Motivation and emotion/Book/2023/Burnout

Overview


Amy is a dedicated 35-year-old social worker. She has an innate passion for making a positive impact on her community by helping vulnerable people. To look after her own mental well-being, Amy regularly goes for walks and connects with her friends. For the last 8 years, Amy has been working hard at a local hospital and enjoying being a social worker. However, over the last few months, Amy noticed a significant change in her mental state and attitude towards her workload including several symptoms:
 * Persistent fatigue and ongoing elevated stress levels
 * She found it difficult to be compassionate when engaging with her clients
 * She has observed increasing levels of detachment when listening to her client's stories

The overwhelmingness pervaded her mental and physical states leading Amy to significantly decrease performance at work which led to several complaints from some clients.

Stress is an everyday occurrence that we all certainly experience all the time. We're accustomed to stress being presented negatively, however a moderate amount of stress can serve as motivation. Optimal stress levels can energize people to meet their goals in life as well as helping them complete tasks more effectively.

However, when you experience ongoing and high levels of stress, it feels like you are being weighed down, or trapped, and enveloped by chronic exhaustion that is preventing you from moving forward with your goals and enjoy your life. This feeling permeates your work, study, and social relationships. The time passes by while the overwhelming stillness persists, and you are paralyzed by inaction or reduced cognitive function to make decisions or perform in your daily duties. These "red flags" could be the signs of burnout (see Figure 1).

Focus questions:
 * What is burnout?
 * What factors trigger burnout?
 * What are the consequences of burnout?
 * How to manage burnout?
 * How to prevent burnout?

What is burnout?
Burnout is a psychological phenomenon, defined as the final state of excessive, chronic stress which causes the individuals mentally and physically exhausted (McCormack et al., 2018). Although the burnout concept is defined by numerous research as a "work-related mental-health impairment, ongoing personal and environmental stressors such as major health issue, family hardships, or other persistent adversity are also the reasons to induce burnout (Khammissa et al., 2022).

Occupational burnout is a syndrome that evolves from chronic workplace stress that has not been successfully managed (World Health Organization, 2019). The negative effects of burnout extends beyond an individual's professional and personal life. The World Health Organization (2019) recognized burnout in the 11th Revision of the International Classification of Diseases (ICD-11) as an occupational exposure, and not a medical condition, and one that should not be used to describe stressful experienced in other areas of life.

Dimensions of burnout
Burnout is characterized by three dimensions:


 * Emotional exhaustion: having sense of extreme fatigue or energy draining
 * Depersonalization: increasing emotional detachment from one's job, or sensing negativity and cynicism towards it
 * Reducing personal accomplishment in professional role.

Types of burnout
Burnout syndrome does not occur as a similar pattern to everyone, it can manifest in three variations which are influenced by the level of dedication workers have towards their job:
 * Overload Burnout (Frenetic): typical type of workers who intensely work until energy drained.
 * Under-Challenge Burnout: opposite to the overload type, occurs when the worker is not stimulated by the job, leading to a lack of motivation to keep on the workload
 * Neglect Burnout (Worn-out): the individual is not given enough guidance in workplace, causing them to feel hopeless, uncertain and frustrated (Montero-Marín et al., 2009).


 * Stress: the physiological and emotional reactions to stressor factor (Lloyd et al., 2009). While burnout occurs at the end state of chronic stress, some significant stress can be acute and be beneficial at some point (such as eustress),.
 * Depression: the outcome of traumas and negative life events that is distinct from burnout. It contains the element of poor self-efficacy that share characteristics with burnout concept of diminishing personal accomplishment (Bakker et al., 2000)
 * Anxiety: acts as a protective factor against threatening circumstances, that is correlated strongly with burnout features such as emotional exhaustion and cynicism (Koutsimani et al., 2019).
 * Compassion Fatigue: "the cost of caring", when caring for others caused the feelings of helplessness and frustration, usually in professional role that prioritizing in taking care of clients (eg. nurses) (Gonzalez et al., 2019).

Factors that induce and develop burnout
It is important to identify the factors that causes the individuals to reach the burnout stage, as this syndrome impacts negatively on the individual's work performance and reduces their quality of life. These factors will be demonstrated by the demands-resources model, social cognitive theory and personality characteristics to have a better view on burnout escalation.

Jobs demands-resources model
The job demands-resources model proposes the cause of the individual's health and well-being depends on two factors: job demands and job resources.


 * Job demands (negative): consist job factors (eg. workload, time pressure, emotional labor etc.) entail individuals sustained physical or mental ability which cause energy reduction, severe long-term mental illness, and lower the individuals' performance (Adil & Baia, 2018). If the individuals fail in efficiently managing their workload within the required timeline together with a lack of work-related resources accessible, they highly suffer from burnout. especially emotional exhaustion (Edú-Valsania et al., 2022).
 * Job resources (positive): in contrast, job resources encompass the physical, social, organizational or psychological facets of work that are either: 1) effective in achieving work goals, 2) lessen job demands and their psychological and physical burdens, 3) foster individual growth, learning, and development (Adil & Baia, 2018). These factors including organizational support (supervisor's feedback, skills development, autonomy, job security. management support, etc.) and personal resources (resilience, comprehensive recovery process, etc.) (McCormack et al., 2018).

This model holds the idea that higher job demands and low work resources potentially cause burnout. Job demands are merely the job requirements and will turn into stressors when the individual has to put more effort into the job progress but are unsuccessful in handling high job demands. while job resources minimize the likelihood of depersonalization as a coping strategy (Edú-Valsania et al., 2022).

Social cognitive theory


Social cognitive theory (SCT) maintains the significant role to individual variables such as self-confidence, self-efficacy and self-concept as key contributors to the development of burnout (Edú-Valsania et al., 2022), thus according to SCT, burnout is escalated when the individuals faces crises related to their professional role, they raise doubts about their own effectiveness or of their group in achieving the final goals.

The individuals highly feel doubt on their efficacy and confidence, including past failures, a lack of role model who successfully overcame similar challenges, limited reinforcement for their work, lack of feedback on completed tasks or excessive negative criticism and work related difficulties. As a result, these inefficacy expectations can diminish the job satisfaction, long-term emotional exhaustion, and as a coping mechanism, cynicism or depersonalization arises (see Figure 2).

Personality traits
Personality plays a vital role in the way individuals perceive their work environment, and, thus, how they cope with job demands and resources. There are 3 dominant personality traits that are strongly related with burnout, which are type A personality, neuroticism in the five factors of personality, and external locus of control.

Type A personality
This personality represents individuals who are "workaholics", highly competitive, aggressive, impatient, impulsive and have high control with their tasks might suffer from burnout, as this pattern is strongly associated with the depersonalization and emotional exhaustion dimensions (Edú-Valsania et al., 2022; Khammissa et al., 2022)

Neuroticism
This trait is characterized by emotions including low self-esteem, anxiety, pessimistic attitude, etc. Individuals with this personality will experience high levels of emotional exhaustion and depersonalization, since they will respond to a change within their work in a way that cause them emotionally drained or feel detached from the job (Maylor, 2018).

External locus of control


The higher the external locus of control (ELoC), the more likely burnout is to develop. People with this characteristics tend to believe that events happening around them are due to external factors such as luck, destiny, or by the decisions of others which indicates that they are not responsible for their actions or behaviors (see Figure 3). The individuals have high level of ELoC might have poor autonomy and control in their workplace, and eventually suffer from burnout (Alfuqaha et al., 2021).

The risk of burnout


Burnout occurs when the symptoms are remained unnoticed for a long period of time, and this can lead to many dangerous consequences that affect the individual's physical health, mental well-being, physiological function, and behavioral responses (Gustafsson et al., 2018). From when the distress started to arise to burnout syndrome is formed, leaving the individual struggling in their personal and professional life (see Figure 4).

Stages of burnout
Table. Three stages of burnout and its consequences (Hozo et al., 2015)

Test yourself

Take a few minute to test yourself with this burnout quiz:

https://psychcentral.com/quizzes/burnout-quiz

Disclaimer: The quiz can help you identify frequent signs of burnout, it is not meant to advise you on how to manage burnout yet is advisable to ask for help from professional healthcare if you are experiencing this syndrome.

How to manage burnout?
According to Kaschka et al. (2011), the treatment for burnout should concentrate on three Rs:
 * Relief from stressors
 * Recovery via relaxation and exercise
 * Reconnecting with the real world by letting go of external ideals of perfection

Psychotherapy
This treatment type concentrates on emotional self-regulation and relaxation to reduce the burnout symptoms. As therapy session is a safe place for individuals to express their thoughts and feelings, psychotherapy including CBT and MBSR is an effective treatment for most severe cases (Edú-Valsania et al., 2022).

Cognitive behavioral therapy
Cognitive behavioral therapy (CBT) helps the individual tackling on their intrusive, negative thoughts and emotional processes that related to their working, studying stressors, as how the physical and mental maladaptive replies to these thinking patterns (Khammissa et al., 2022). CBT aims to help individuals restructure and reevaluate their perspective and appreciation on problematic and stressful circumstances, hence they can manage these situation more appropriately (Edú-Valsania et al., 2022). Moreover, CBT is believed to be effective as its strategies identify and modify the individuals' misconception in their reality perception, which can impact how they provoke emotions and behaviors (Edú-Valsania et al., 2022).

Mindfulness-based stress reduction
Mindfulness-based stress reduction (MBSR) is a mental practice to cultivate a state of conscious awareness by observing the individuals' emotions, thinking patterns, and actions without judgement (Khammissa et al., 2022). MBSR is found to be helpful in reducing stress, enhance one's life quality and self-compassion through cognitive restructuring, focused attention, meditation and adaptive learning strategies (Kriakous et al., 2021). The standard programme lasts for 8 weeks as group intervention, where individuals meet once for 2-3 hours weekly and undertaking 6-h silent retreat (Kriakous et al., 2021). Mindful walking, body scan, hatha yoga and sitting meditation are formal practices to regulate the individuals with mindfulness, as well as informal practices including washing dishes, brushing teeth, etc. are instructed to mindfully participate in them (Kriakous et al., 2021).

Beside the psychotherapeutic treatment which might be costly, individuals suffering from burnout can manage their symptoms independently with these solutions:

Therapeutic journaling
By writing out the feelings, thoughts and experiences for the self-reflection and self-recovery, this technique is believed to positively influence the individual's stress, promote self-worth and let individuals understand themselves better (Gall, 2021). For instance, the teachers are under enormous work amounts that interfere with a work-life balance, they found journaling effective in helping them analyze how they spent time, reflect on the pros and cons of their teaching technique so that they could spend quality time in improving their teaching ability, as well as for self-care (Gall, 2021).

Yoga and meditation
Individuals can register for yoga classes at their local suburb and they are free to decide the length for the class periods. Meditation is also a helpful method to reduce stress that is applied widely in the mindfulness practice. However, It is also not hard to search for videos teaching yoga from the beginner level to advanced one, as well as videos for meditation on Youtube, or other online platforms if they are keen on practicing at home, with the length for the yoga session, meditation period, as well as the yoga methods will depend on the individual's habit and capacity.

Sleep management
Although sleep is an ordinary activity, it plays a significant role in facilitating our emotions and mood. Sleep hours are different for certain age range, for instance young adults from 18-25 years old should ensure their sleep varies from 7-9 hours (Chaput et al., 2018). Lack of sleep associates with many consequences throughout a day involving depressed mood, poor functioning, fatigue as well as many other health and safety problems (Chaput et al., 2018)

Engage in leisure indoor and outdoor activities
According to Weng and Chiang (2014), leisure activities are beneficial for one's mental and physical state by helping reduce depression, anxiety and promote positive emotions. For instance, horticultural therapy was found to significantly mediate the individual's cognitive, physical, emotional state, improve sensory motor function, develop life satisfaction and social participation (Wei & Chiang, 2014). Common indoor activities such as listening to music, reading, chatting, etc. as well as outdoor activities including going to the cinema, visiting friends or relatives, walking, etc. are simple to do yet participate a huge benefit in lowering anxiety and improving self-esteem (Wei & Chiang, 2014).

Prevention for burnout
Although the employee is expected to complete their workload within the given timeline and still able to manage their health and well-being, it is crucial to understand how easily distress and burnout can still be occurred. Therefore, here are some interventions can be applied within work and personal context to prevent the occurrence of burnout

Prevention strategies recommended for organizations and employees

 * What can workplaces do?

With the amount of workload and various other difficulties, burnout monitoring and customized design for plans is an ideal resource in reducing burnout in workers, which can be measured by surveys to check the organization's burnout level of workers in every unit, position, location, etc., with the aim to recognize the onset of the symptoms and then avoid the syndrome from becoming chronic (Edú-Valsania et al., 2022). Beside that, the workplaces can consider reorganizing work schedules to enhance flexibility, enabling employees to balance their professional and personal role (Edú-Valsania et al., 2022).

Provide efficient job training is vital as burnout is produced by both inadequate training and extreme environmental demands (Taormina, 2001). Providing suitable training can help employee acquire technical knowledge and new skills to improve their self-efficacy expectations and coping strategies (Edú-Valsania et al., 2022).

To maintain the employees' health and well-being is the supervisor support and leadership. According to Lloyd et al. (2009), emotional support from the supervisors to their social worker employees is associated with lower work stress, burnout and mental health issues. In order to increase the efficiency in supporting the co-workers, the leadership style of supervisors should be authentic, servant, and transformational to help improve the workers' psychological resources and decrease burnout (Edú-Valsania et al., 2022).

To improve the social resources, proactive skill should be put in practice, when the employees are encouraged to seek for help if needed and for feedback from supervisors (Edú-Valsania et al., 2022). Proactivity can be the participation in appropriate projects to one's ability to enhance the skills, the relationships with co-workers, and the responsibility in completing the tasks (Edú-Valsania et al., 2022).
 * What can employees do?

Time management is another important skill to practice, since people who are at risk of burnout usually feel pressure by the lack of time to fulfill their tasks on time, or they do not have time for personal use since they have worked long hours (Edú-Valsania et al., 2022). The proper way to acquire this skill is to set goals, build a plan, and estimate the outcome (Thomack, 2012). Some tips to effectively improve time managements are:


 * Create checklist (eg. to-do list), set priorities for each task
 * Estimate proper deadlines for tasks, make changes as soon as possible if sudden events interfere
 * Schedule breaks between tasks to maintain well-being

For personal context, enhancing interpersonal skills allows people to improve their interactions with other. People can learn to facilitate relaxed interactions while creating their own boundaries by refusing requests that are too burdensome (Taormina, 2001). Applying time management in personal context to facilitate daily tasks is an effective way to prevent individuals from being overwhelmed by the planned tasks, such as house chores, medical appointment, etc. Lastly, performing healthy lifestyle such as having enough sleep, balanced diet and physical exercise (aerobic, yoga, etc.) is the popular coping strategy to avoid psychological burnout symptoms as well as preventing potential physical diseases caused by burnout such as cardiovascular (Ochentel et al., 2018)

Quiz
{'''Let's take a look back to the case study of Amy from the Overview part. What do you think Amy should do to manage her symptoms? + Talk to her supervisor and ask for advice - Set higher and bigger expectations to prove her dedication + Take short breaks throughout the day to recharge - Use alcohol and drug to cope with stress as they make her forget the stress at work
 * type="[]"}

Conclusion
Burnout is an individual response to chronic, excessive stress that common in workplace (occupational stress). In addition, burnout can also induce by many other prolonged environmental and personal factors such as health impairments, family issues, etc. that is characterized by three dimension 1) emotional exhaustion, 2) depersonalization, and 3) reduced personal accomplishment. This syndrome develops differently that depends on the workers' dedication to their work activity.

Burnout escalation in this context is demonstrated by the demands-resources theory, social cognitive theory and three personality traits, the factors underlying these explanation came from internal and external reasons, which means this syndrome is induced from both organizational and personal reasons. The syndrome negatively impacts on the individual's physiological, psychological, physical and behavioral reactions with many symptoms from mild, moderate to severe level which can bring a lot of dangerous impairment if the symptoms are unnoticed and untreated.

Burnout management can vary from professional therapeutic strategies such as mindfulness or CBT, as well as individual strategies that people can apply at home, or anywhere they feel like practicing, The organization plays a vital role in helping their employees prevent and manage their burnout by providing support, training new coping and working skills, and regularly checking up the employee's mental status. The individual, eventually, should be aware on their symptoms and practice different skills to cope with distress, involving time management either professional or personal tasks, practice healthy lifestyle habits and always prioritize their mental well-being.


 * Take-home messages:
 * "Resting is not laziness, it's medicine" - Glennon Doyle
 * Burnout is not a failure. It is a reminder, and an opportunity to re-prioritize yourself, and know your worth.