burnout

Burnout: Short overview

• symptoms: deep exhaustion, no possibility to “switch off”, psychosomatic complaints, feeling of lack of recognition, “service by regulation”, detachment, cynicism, performance losses, and finally depression
• Causes: Self-exaggeration or stress due to external circumstances, perfectionism, self-esteem that is fueled by achievement, saying “no” to problems, a strong desire for recognition
• Prevent: perceive one’s own needs, reduce stress management, reduce perfectionism, define and pursue clear personal goals, build good self-acceptance, social contacts, healthy lifestyle
• Diagnosis: by means of special questionnaires, differentiation to fatigue and depression
• Therapy: Crisis intervention, cognitive behavioral therapy, depth psychology-based psychotherapy, group therapy, possibly antidepressants
• Forecast: good chances of healing with early treatment, untreated threatens permanent disability

Burnout: symptoms

Burnout symptoms are very diverse. They express themselves emotionally, mentally and in mental capacity, but can also occur in the form of psychosomatic complaints. Each affected person shows an individual pattern of symptoms and complaints. These change depending on the stage of the disease. However, the main symptom of burnout is a feeling of deep fatigue.

Burnout symptoms in the initial stages

In the early phase of a burnout the affected person usually puts a lot of energy into his tasks. This can happen voluntarily out of idealism or ambition, but also be born out of necessity – for example, because of multiple burdens, relatives to care for or fear of losing a job.

A characteristic early sign of burnout is when people can no longer turn off. You can not recover properly, are less efficient, and then have to use more power to accomplish your tasks. This starts a vicious circle. Other burnout symptoms in the initial stages include:

• Feeling of being indispensable
• Feeling never to have enough time
• Denial of own needs
• Repression of failures and disappointments
• Restriction of social contacts to clients, patients, clients etc.

Soon, the first burnout signs of fatigue are noticeable. This includes:

• restlessness
• lack of energy
• lack of sleep
• increased risk of accidents
• increased susceptibility to infections

2nd phase: reduced commitment

The typical for the initial phase over-commitment tilts at some point increasingly in a claim attitude. The victims expect that they will be given something back for their great commitment. If they are disappointed, they slip into a strong frustration. The following symptoms help you to recognize an impending burnout:

Internal termination: Those affected take longer breaks than usual, come to work late and return early. They are increasingly entering a state of “internal termination”. The strong reluctance to work causes them to do only the bare minimum, if at all.

Depersonalization and cynicism: Especially in helping professions a “depersonalization” of relationships is a typical burnout symptom. Compassion and compassion for others (empathy) decreases. In dealing emotional coldness and cynicism are spreading. For example, caregivers rate their patients severely.

Effects on the family: Such signs of burnout often affect family life as well. Those affected place ever greater demands on their partner without giving anything back. They no longer have the strength and patience to spend time with their children.

Typical burnout symptoms at this stage are:

• dwindling idealism
• Shutting down the engagement
• Feeling of lack of appreciation
• Feeling of being exploited
• Flourishing at leisure
• increasing detachment towards clients, patients, business partners
• decreasing ability to empathize with others
• emotional coldness and cynicism
• Negative feelings towards colleagues, clients or supervisors

3. Emotional reactions – depression, aggression, blame

Burnout symptoms also manifest in emotional reactions. When the excessive commitment slowly turns into frustration, disillusionment often sets in. The people realize that the reality does not correspond to their own wishes. They blame either the environment or themselves. The former leads to aggression. The latter contributes to a depressed mood (“I am a failure!”).

Depressive symptoms of burnout are:

• Feeling of powerlessness and helplessness
• Feeling of inner emptiness
• crumbling self esteem
• pessimism
• anxiety
• Depression
• listlessness

Aggressive symptoms of burnout are:

• Blaming to the outside, to colleagues, supervisors or “the system”
• Moodiness, irritability, impatience
• frequent conflicts with others, intolerance
• anger

4. Removal, dwindling efficiency

The sinking motivation and the strong emotional burden are reflected after some time in a worse performance. The people are more likely to make careless mistakes or forget appointments. Further signs of cognitive decline are:

• dwindling creativity
• Inability to handle complex tasks
• Problems making decisions
• “Call of duty”
• undifferentiated black and white thinking
• Rejecting changes

The last two burnout symptoms are also based on a closer look at a decline in performance. For differentiated thinking and change require strength that burnout candidates can no longer muster.

5. Flattening, disinterest

The lack of energy also leads to an emotional retreat. Affected persons are increasingly indifferent. They often feel bored, give up hobbies, retire from friends and family. Burnout makes you lonely.

6. Psychosomatic reactions

The enormous psychological burden is also reflected in physical complaints. Such psychosomatic signs appear in the early stages of burnout. Physical symptoms include:

• Sleep disorders and nightmares
• Muscle tension, back pain, headache
• increased blood pressure, palpitations and tightness of the chest
• Nausea and indigestion (vomiting or diarrhea)
• sexual problems
• heavy weight gain or weight loss due to changing eating habits
• Increased consumption of nicotine, alcohol or caffeine
• increased susceptibility to infection

7. Last Level: Desperation

In the last burnout stage, the feeling of helplessness intensifies into a general hopelessness. Life seems pointless in this phase and suicidal thoughts emerge. Nothing prepares more joy and everything becomes indifferent. The victims sink into a severe burnout depression.

Burnout causes and risk factors

The burnout causes are manifold. The onset of the burnout syndrome always involves internal (personality) and external (environmental) factors.

Who is the subject of a burnout?

The term burnout comes from the English language and stands for “burned out, total exhaustion”. Such a condition can affect anyone. Especially the wide distribution is typical for burnout. Teachers suffer as much as managers, nurses or single parents. But even with retirees, people who do not work, and housewives can empty the energy batteries.

The disease was first described by volunteers and people working in the health and care professions. Often, these professions involve people who bring with them a high degree of idealism, over and above the limits of physical and emotional stress, without receiving much recognition.

A question of resilience

Everybody reacts differently to burdens. Some are barely grown under moderate pressure. With them, little is enough to set the fatal burnout spiral in motion.

Others manage well even in very difficult situations. But there are also situations that are objectively so burdening and hopeless that few people survive them without burning out. Experts also refer to the latter as “goods out”, “attrition” or “passive burnout”.

Even very resistant persons are therefore not protected against burnout. One is particularly vulnerable when a series of frustrating episodes occur and the resources to deal with them are exhausted.

Causes of burnout

The burnout causes are individually as different as the affected person. The needs and goals of each person are unique in their particular constellation. Equally different is the environment in which they live.

Risk factors for burnout

Basically, there seem to be two types of people who have an increased burnout risk:

1. People with a weak self-esteem who are consequently over-sensitive, more adaptive and passive and in particular need of love.
2. Likewise among the Burnout candidates are often dynamic, very purposeful people who want to achieve a high goal with much ambition, idealism and commitment.

These two guys are very opposite and have something in common. Both types have difficulty expressing their feelings and a strong desire for recognition by their environment.

Internal risk factors for burnout are also:

• Dependence of self-image on the successful exercise of a single role (for example, the self-sacrificing nurse, the successful manager)
• Doubts about the meaning of one’s own actions
• unrealistically ambitious goals that can not be achieved or can only be achieved with disproportionate use of energy
• Goals that do not meet your own needs but the expectations of others.
• high expectations of the reward that follows the achievement of a specific goal
• Difficulties to admit personal weakness and helplessness
• Difficulties saying “no” – either to others or to your own “inner impulse” that spurs ambitious people to perfection and excellence

External causes that increase the risk of burnout

Many burnout processes start when the life situation changes fundamentally. This can be the beginning of the studies, career entry, job change or a new manager. In such burnout phases, one’s own self-image is sometimes severely shaken, expectations are disappointed or even life goals are destroyed.

On the other hand, the lack of a desired change can also contribute to frustration and burnout, for example if the desired job is awarded to another applicant or if the promotion is not given.

External factors that increase the risk of burnout are:

• overwork
• Lack of control
• Lack of autonomy
• lack of recognition
• lack of justice
• insufficient rewards
• bureaucratic obstacles
• Conflict between one’s own values ​​and beliefs and the demands
• lack of social support in private life
• unresolved conflicts with superiors or employees

Burnout: Prevention

Even people who normally cope well with problems can develop a burnout in times of high stress. The good news is that this process is not helpless and can contribute to burnout prevention. The following strategies can help you:

To perceive own needs: Try to fulfill your wishes and needs. What is really important to you? Social recognition, advancement opportunities, freedom in the design of work processes or influence? Admit that your needs are as important as those of your fellow human beings.

Discover basic needs: Burnout arises out of a frustration. Find tasks that meet your individual basic needs. For example, creativity, reputation, diverse social contact or movement. Therefore, it is important for you to choose a job that you know exactly the everyday life in the desired occupation.

Stress management and relaxation: Stress is a burnout driver. Actively fight against! Helpful for burnout prophylaxis are stress management and relaxation techniques such as autogenic training or progressive muscle relaxation.

Self-awareness: Burnout usually goes unnoticed. Regularly ask yourself how much stress you have and how satisfied you are with your life.

Stress Diary: A stress diary helps to uncover the situations and contexts in which stress is occurring and whether it is constantly increasing. If you do not want to rely solely on your self-perception, you can also ask friends and family for help. They may directly reflect you if you appear more irritable or less motivated than usual.

Social contacts: The social network is an important factor in burnout prevention. Take time for your friends and family. The contact with people close to you offers you the necessary balance to the working life.

Inner impellers disempower: People who are prone to burnout have inner impulses that whip them into overwork. These can be maxims like “Be perfect!” Or “Make it all right!”. Only those who know their personal inner impellers can deprive them. Be aware that no one can always be perfect and mistakes are part of life.

Defining clear life goals: Find out which goals really matter to you in life. This allows you to use your energy in a targeted manner. Also try to say goodbye to ideas that others have inspired you with. Only in this way do you not get bogged down in energy-consuming projects that ultimately do not satisfy you.

Strengthening self-acceptance: Burnout is especially prone to people who prefer their self-confidence mainly from a role in work or private life: the perfect mother or successful manger. People with a strong self-acceptance also have a self-confidence that is independent of success. This reduces the risk of over-commitment and the feeling of being exploited.

Healthy lifestyle: Even a healthy lifestyle can prevent burnout. This includes a balanced diet, but above all regular exercise and a lot of exercise – this helps to reduce stress. Limit consumption of stimulants (e.g., nicotine, caffeine) or stimulants (e.g., alcohol, sugar). As a result, you will not only feel fitter, but without the chemical impulses, you may also go less than your personal limits.

Searching for help: It is often not easy to put good intentions into practice. If you experience an elevated level of stress or typical symptoms of burnout with you over a long period of time, you should always consult a doctor, psychotherapist or psychiatrist. The sooner a burnout is detected, the better the chances of recovery.

Prevent burnout – what you can do in the job

Since the burnout syndrome often arises with dissatisfaction in the work, it is important to apply the above strategies also at the workplace. The following points can help you with burnout prevention and improve your working environment:

Go for autonomy: Those who can flexibly divide up their tasks and working hours are much less at risk for burnout. Try to negotiate a flexible working time model with your employer.

Time Management: Anyone who does not want to get bogged down in a challenging job should acquire strategies for the right time management.

Say no: The ability to turn down a job once it is offered is an important burnout prophylaxis. Otherwise, you jerk yourself up too fast. This applies to tasks that are brought to you from the outside, but also to those that you have imposed on yourself.

Reduce unrealistic expectations: Anyone who hopes unrealistically much recognition and personal satisfaction through his duties, will be disappointed. This applies to the nurse, who expects gratitude from his patients, as well as to the secretary, who takes over unpopular errands and hopes for praise and recognition.

Living and working in balance: The term “work-life balance” – the balance between work and leisure – includes an essential basic human need. Those who can not afford to have adequate space and time off will most likely fall into the burnout trap.

Career Planning: Even the nicest job can lead to monotonous boredom after years. If you have a career goal in mind, you are less likely to get stuck in everyday life. Continuing education is also a good way to prevent burnout and to find inspiration for everyday work.

To prevent burnout, you can also contact coaches specializing in burnout to help you implement strategies at work.

When the first symptoms such as persistent fatigue, exhaustion or sleep disturbances occur, affected people usually first visit the family doctor. In an anamnesis interview, the patient will ask the patient about his complaints and special burdens. The following questions could ask the family doctor in case of suspected burnout:

• Do you feel that you never come to rest?
• Do you feel that there are many tasks that only you can do?
• Have you worked more lately than usual?
• Can you sleep well at night?
• Do you often experience a feeling of tiredness during the day?
• Do you feel valued at your job?
• Do you feel like being exploited?
• Do you feel impulsive?
• Do you have other physical complaints?

Further investigation may exclude a physical cause of the condition. Inexplicable tiredness and fatigue can also indicate, for example, a malfunction of the thyroid gland or another serious physical illness. This can be detected among other things in the context of a blood test.

However, if the suspicion of burnout becomes apparent, the family doctor will refer you to a specialist. This is in this case a psychological or medical psychotherapist.

Burnout tests

The psychotherapist will clarify in a clinical interview by asking if your symptoms actually indicate a burnout syndrome.

Maslach Burnout Inventory (MBI)

The most commonly used burnout test by experts is the Maslach Burnout Inventory (MBI). It measures burnout based on 22 questions the three scales:

• emotional exhaustion
• Depersonalization / cynicism (impersonal / cynical attitude towards clients, colleagues and supervisors)
• personal fulfillment / achievement satisfaction

For example, typical statements are: “I feel emotionally exhausted through my work,” “I have become more blunted towards people since I did this work”; “I feel I am at the end of my wisdom”.

However, some burnout symptoms are not included in this burnout test. For example, the initially extremely high level of commitment that gradually flattened to complete disinterest.

Tedium Measure (Burnout Measure)

The Tedium Measure, also called Burnout Measure, consists of 21 questions. On a scale of one to seven, those affected can indicate how far the particular question applies to them (1 = never applies, 7 = always applies).

In this questionnaire, the physical (“Are you physically exhausted?”), Emotional (“Are you emotionally exhausted?”) And mental exhaustion (“Are you working out?”) Queried. Depersonalization and performance satisfaction play no role in this burnout test, unlike the MBI.

Burnout tests on the Internet

On the internet you can find numerous free burnout test. However, such a burnout self-test can never replace medical or psychological diagnostics. However, the online check can help you to become aware of your own level of stress and your personal work frustration. If there is evidence of burnout, consult a doctor or psychologist.

Differential diagnosis burnout

Although the term “burnout” appears frequently in media and everyday language, there is still no universal clinical burnout definition.

Therefore, burnout is not listed as a standalone disorder in the mental disorder classification systems (ICD-10; DSM-V). Burnout in the ICD 10 is only listed under the diagnosis item “Problems with difficulty coping with life” as an additional diagnosis in the sense of burnout.

The symptoms of burnout overlap with those of other disorders, such as chronic fatigue syndrome. Above all, there are overlaps with the depression. This complicates the diagnosis.

Burnout or depression?

Some experts even doubt that burnout is a disease in its own right. They assume that people with the disease are basically suffering from depression.

In fact, it is conceivable that many can better accept the diagnosis of burnout than depression. Because a burnout is commonly attributed to people who have done a lot before. Depression, however, is still falsely associated with weakness.

Many of the symptoms of burnout, especially the deep emotional exhaustion, are actually also indicative of depression. Signs of loss of interest and motivation are also signs of depression.

However, some major symptoms of burnout and depression do not match. Thus, depersonalization and dissatisfaction are atypical for depression. The general sense of self-esteem that plagues many depressives is again not typical for people with burnout.

Some experts also view burnout as a risk factor for mental health problems rather than as a standalone disease. Others describe the disease as a process that, if not stopped, leads to an exhaustion depression. The border between burnout and depression thus remains blurred. The therapist needs to check very carefully whether there is actually – or in addition – depression that needs to be treated appropriately.

Burnout: treatment

Burnout is a serious condition that should be treated professionally as soon as possible. If a burnout discovered too late and treated, the chances of recovery worsen. That’s why you seek timely professional help with burnout.

A burnout therapy is composed of many different building blocks. They are individually tailored to the problems and personality of the patient. In addition to psychotherapeutic support, medications can also help with burnout – especially if more severe depressive symptoms occur.

At the beginning there is the disease insight

The prerequisite for any therapy is the insight that there is even a burnout problem. For this purpose, those with therapeutic support should clarify the following four questions:

• To what extent am I personally contributing to the difficult situation?
• Where do I go beyond my limits?
• Which environmental factors are involved?
• Which can be changed, which not?

People with burnout, who do not admit their own contribution to the situation, can not even tackle the root of the problem themselves. The confrontation with other burnout victims, for example in self-help groups or on testimonials, can help to find ways out of the burnout.

Fast crisis intervention

If the burnout process is still in its infancy, a crisis intervention or short-term therapy of a few hours is often enough to be the first burnout aid. The goal is to develop improved skills for conflict and problem solving and to get a finer feeling for the limits of their own resilience.

Relaxation techniques like autogenic training or progressive muscle relaxation according to Jacobson can also be helpful in supporting burnout treatment.

psychotherapy

If the burnout is already advanced, a psychotherapy for burnout treatment is usually necessary. Since the reasons that lead to burnout are quite different, the therapy focus and the method are individually different. The following therapeutic procedures may help.

behavior therapy

Cognitive-behavioral therapy helps to dissolve misconceptions and patterns of behavior that burnout patients have often internalized. An example: “I have to do everything perfectly, otherwise I’m worthless.” The questioning of such patterns and worldviews (paradigms) makes it possible to rid oneself of the pathogenic “inner drivers”. One goal of burnout therapy is therefore to recognize the problematic patterns and to gradually change them.

Depth Psychological Procedures

Many burnout sufferers focus on building a more stable self-esteem. As self-esteem increases, its dependence on external recognition diminishes. It is often the secret engine behind the depletion of its own forces.

In such cases, profound mental restructuring is necessary, which can be better achieved by depth psychology such as psychoanalysis. Such processes can be tedious and sometimes painful at first, but in some cases are essential for effective burnout therapy.

group therapy

Group therapy can also provide important support in burnout. For many patients, it is initially unusual to share their own problems with a group of strangers. However, it usually has a relieving effect of interacting with other people who are also affected.

Body therapy and sports

Many patients with burnout have forgotten how to realize their own needs. In such cases, so-called body therapies can help in addition to psychotherapy. The patient learns to perceive the physical tension caused by anxiety and stress. If the physical tension is deliberately dissolved, the psyche also relaxes.

Also physical activity supports the recovery process, show various investigations. It has a positive effect on body awareness and self-esteem.

Therapy offer in burnout clinics

In case of severe burnout, a stay in a special clinic may be useful. Burnout clinics offer patients a wide range of therapies. In addition to depth psychological approaches, cognitive behavioral therapy, systemic therapy and group therapy, these often include body therapy, art therapy or occupational therapy.

The exact treatment plan is tailored to the individual patient. Due to the inpatient setting, patients can deal intensively and without distraction with their problems, discover causes and practice new patterns of behavior and thinking. Such a “burnout cure” helps them to better manage their resources in the long term.

Drugs during burnout

Special burnout drugs do not exist. However, if a patient suffers from pronounced depressive symptoms such as listlessness, inner emptiness and loss of interest, antidepressants may be a good option in addition to psychotherapy. Serotonin reuptake inhibitors (SSRIs), for example, raise serotonin levels in the brain and thus increase their motivation.

Burnout: disease course and prognosis

Burnout statistics from the Robert Koch Institute indicate that 4.2 percent of Germans in Germany suffer from burnout. Most of all, there is still the idea that burnout syndrome is always preceded by a phase of idealistic over-commitment and the so-called “burning”. That’s not the case.

However, those affected invest more energy in their tasks than they can cope with in the long term. This may have its origin in idealism, but also emerge from an emergency.

A frequent warning signal is that those affected can not switch off after work and can not recover. In this phase, however, a threat of burnout is rarely recognized.

Only when the hoped-for reward, for example in the form of career advancement or recognition, remains behind expectations, or the strength is no longer sufficient, does the burn-out phase begin – the burnout syndrome.

Fatigue, irritation and frustration then follow the (self) overburden. The tremendous emotional stress does not leave its mark on the body. Therefore, psychosomatic complaints, such as headaches, stomach aches or sleep disturbances can be signs of a burnout syndrome.

The same applies to burnout as to many other diseases and disorders: the sooner the problem is identified and addressed, the better it can be remedied.

Threatening disability

If a severe burnout syndrome is not recognized and treated for a long period of time, it usually leaves a permanent mark. Schon der normale berufliche und soziale Stress ist für viele Betroffene noch Monate und Jahre nach der Therapie eine Überforderung. Teilinvalidität oder auch vollständige Invalidität infolge eines Burnouts sind nicht selten. Daher sollte ein drohendes Burnout ernst genommen und rasch behandelt werden.

Weiterführende Informationen

Books

• Thomas Bergner Burnout-Prävention: Erschöpfung verhindern – Energie aufbauen – Selbsthilfe in 12 Stufen Taschenbuch – 14. Oktober 2015
• Sabine Gapp-Bauß: Depression und Burn-out überwinden: Ihr roter Faden aus der Krise: Die wirksamsten Selbsthilfestrategien VAk – 15. Februar 2016
• Mirriam Prieß: Finde zu dir selbst zurück!: Wirksame Wege aus dem Burnout Südwest, 29. April 2014

Leitlinie

• HTA-Bericht “Therapie des Burnout-Syndroms” des Deutschen Instituts für Medizinische Dokumentation und Information (2012)

Selbsthilfe

• Burnout Selbsthilfe
• Nationale Kontakt- und Informationsstelle zur Anregung und Unterstützung von Selbsthilfegruppen (NAKOS)