The ICD-11 of the World Health Organization (WHO) describes occupational burnout as a work-related phenomenon resulting from chronic workplace stress that has not been successfully managed. According to the WHO, symptoms include "feelings of energy depletion or exhaustion; increased mental distance from one's job, or feelings of negativism or cynicism related to one's job; and reduced professional efficacy."[4] It is classified as an occupational phenomenon, but is not recognized by the WHO as a medical or psychiatric condition.[5] Maslach and colleagues made clear that burnout does not constitute "a single, one-dimensional phenomenon".[6]
National health bodies in some European countries do recognise it as such however,[7] and it is also independently recognised by some health practitioners.[8] Nevertheless, a body of evidence suggests that what is termed burnout is a depressive condition.[9]
History
Kaschka, Korczak, and Broich (2011)[10] advanced the view that burnout is described in the Book of Exodus (18:17–18).[10] In the New International Version of the Bible, Moses’ father-in-law said to Moses, “What you are doing is not good. You and these people who come to you will only wear yourselves out. The work is too heavy for you; you cannot handle it alone."[11]Gordon Parker suggested that the ancient European concept of acedia refers to burnout and not depression as many others believe.[12][13]
By 1834, the German concept of Berufskrankheiten (occupational diseases) had become established. The concept reflected adverse work-related effects on mental and physical health.[14] In 1869, New York neurologist George Beard used the term "neurasthenia" to describe a very broad condition caused by the exhaustion of the nervous system, which he argued was to be found in "civilized, intellectual communities".[15] The concept soon became popular, and many in the United States believed themselves to suffer from it. Some came to call it "Americanitis".[16] Beard further broadened the potential symptoms of neurasthenia such that the disorder could be the source of almost any symptom or behaviour.[17] Don R Lipsitt would later wonder if the term "burnout" was similarly too broadly defined to be useful.[18] In 2017 the Dutch psychologist Wilmar Schaufeli pointed out similarities between Beard's concept of neurasthenia and that of contemporary concept of occupational burnout.[19] The rest cure was a commonly prescribed treatment for neurasthenia in the United States, particularly for women. The American doctor Silas Weir Mitchell often prescribed this treatment. Other treatments included hypnosis, Paul Charles Dubois's cognitive behavioural therapy (this is distinct from and devised much earlier than Aaron Beck's cognitive behavioral therapy), and Otto Binswanger's life normalisation therapy.[20]
In 1888, the English neurologist William Gowers coined the term occupation neurosis to describe nerve damage caused by repetitive strain injury, translating the German concept of Beschäftigungsneurosen (occupational diseases affecting the nerves).[21] The related term occupational neurosis came to include a wide range of work-caused anxieties and other mental problems. By the late 1930s, American health professionals had become widely acquainted with the condition.[22] It became known as berufsneurose in German.[23] From 1915, the Japanese psychiatrist Shoma Morita developed Morita therapy to treat neurasthenia.[24] He had come to have a different understanding of the condition than Beard,[25] preferring to call it shinkeishitsui; he published two books about the condition.
In 1957, Swiss psychiatrist Paul Kielholz coined the term Erschöpfungsdepression - 'exhaustion-depression'.[26][27][28] The concept was one of a number of new depression-subtypes that gained traction in France and Germany during the 1960s.[29] In 1961, British author Graham Greene published the novel A Burnt-Out Case, the story of an architect who became disenchanted with the fame his achievements garnered for him and volunteered to work at leper colony in the Congo.[30] In 1965, Kielholz publicised the idea of anti-depressant therapy Erschöpfungsdepression in the German-speaking world through his book Diagnose und Therapie der Depressionen für den Praktiker [Diagnosis and Treatment of Depression for the Practitioner].[31] His work inspired further writing on the topic by Volker Faust.[32] In 1968, the WHO's DSM-II replaced "psychophysiologic nervous system reaction" with the condition neurasthenic neurosis (neurasthenia).[33] This condition was "characterized by complaints of chronic weakness, easy fatigability, and sometimes exhaustion." Another condition added to this edition was the similar asthenic personality, which was "characterized by easy fatigability, low energy level, lack of enthusiasm, marked incapacity for enjoyment, and oversensitivity to physical and emotional stress."
In 1969, American prison official Harold B Bradley used the term burnout in a criminology paper to describe the fatigued staff at a centre for treating young adult offenders.[34] Bradley's article has been cited as the first known academic paper to use the term.[35]
In 1974, Herbert Freudenberger, a German-born American clinical psychologist, used the term "burn-out" in his academic paper "Staff Burn-Out."[36] The paper was based on his qualitative observations of the volunteer staff (including himself) at a free clinic for drug addicts.[36] He characterized burnout by a set of symptoms that includes exhaustion resulting from work's excessive demands. Other symptoms he identified were headaches, sleeplessness, "quickness to anger," and closed thinking. He observed that the burned-out worker "looks, acts, and seems depressed." After the publication of Freudenberger's paper, interest in the concept grew.
The American social psychologist Christina Maslach described in a 1976 magazine article[37] the impact of interpersonal stress on human service workers (e.g., social workers, psychiatrists, poverty lawyers, etc.). The impact manifested itself in symptoms such as fatigue, quickness to anger, and cynical attitudes toward the people the service workers were supposed to help. Also in 1976, Israeli-American psychologist Ayala Pines[38] and American psychologist Elliot Aronson, using group workshops, began to treat people having symptoms of burnout.[39] Pines collaborated with Maslach[40][41] in writing essentially data-free papers[42] about burnout in individuals who worked in day care centers and mental health facilities.
In 1980, the DSM-III was released. It abolished the concepts of neurasthenia and asthenic personality, both with the explanation "This DSM-II category was rarely used." Neither was directly replaced.
Also in 1980, American psychologist Cary Cherniss published the book Staff Burnout: Job Stress in the Human Services.[43] In 1981, Maslach and fellow American psychologist Susan E. Jackson published an instrument for assessing occupational burnout, the Maslach Burnout Inventory (MBI).[2] It was the first such instrument of its kind, and soon became the most widely used occupational burnout instrument.[44] The two researchers described occupational burnout in terms of emotional exhaustion, depersonalization (feeling low-empathy towards other people in an occupational setting), and reduced feelings of work-related accomplishment.[1][45] In 1988, Pines and Aronson wrote the popular book Career Burnout: Causes and Cures,[39] an updated version of a book they had published in April 1981 with fellow American psychologist Ditsa Kafry. They found that "marriage burnout" was just as prevalent as "job burnout".
The WHO's ICD-10 (1994) removed the diagnosis of asthenic personality; the WHO, however, continued to include neurasthenia (F48.0).[46] In 1998, Swedish psychiatrists Marie Åsberg and Åke Nygren[47] investigated a surge of depression-related health insurance claims in their country. They found that the symptoms of many cases did not match the typical presentation of depression. Complaints like fatigue and decreased cognitive ability dominated, and many believed their working conditions to be the cause.[48]:16 In 2005, the Swedish Board of Health and Welfare adopted a category described as "exhaustion disorder".[49] Treatment programs followed. In December 2007, the Swiss Expert Network on Burnout (SEB) was established.[50] It has since held a number of symposia, and published recommendations for treating burnout.[51]
In 2003, the American psychiatrists Philip M. Liu and David A. Van Liew advanced the view that the concept of burnout is largely bereft of meaning and has often come to refer to "stress-induced unhappiness" with one's job.[52] They, however, also wrote that burnout can mean "everything from fatigue to a major depression and now seems to have become an alternative word for depression but with less serious significance" (p. 434). In 2015, French psychologist Renzo Bianchi and his colleagues provided a literature review on the burnout–depression overlap (based on 92 studies) and concluded that the studies fail to prove consistently the nosological distinctiveness of the burnout phenomenon.[53] Bianchi et al.'s (2021)[54] later research suggests that burnout is a depressive condition.
In May 2015, the WHO adopted a new conceptualisation of "occupational burnout." The conceptualization was consistent with Maslach's.[55] However, occupational burnout was "not itself classified by the WHO as a medical or psychiatric condition or mental disorder."[56] As of 2017, nine European countries (Denmark, Estonia, France, Hungary, Latvia, Netherlands, Portugal, Slovakia and Sweden) legally recognized burnout syndrome as an occupational disorder, for example, by awarding workers' compensation payments to affected people.[7] The WHO's ICD-11 began official use in 2022. Within this categorisation, the concept of neurasthenia became part of the new condition of bodily distress disorder (6C20).[57][58] The WHO also modified their definition of burnout that year.[59]
In 2020, the Occupational Depression Inventory was published[60] and considered to be a potential replacement for burnout scales such as the MBI.[61]
Rotentstein et al. (2018)[67] in a review of research on physician burnout identified 142 different definitions of burnout, underlining the great heterogeneity in diagnostic criteria for burnout. Marked differences among researchers' conceptualizations of what constitutes burnout have underlined the need for a consensus definition.[68]
As of 2017, nine European countries may legally recognise burnout in some way, such as by providing workers' compensation payments.[7] (Legal recognition for financial purposes is not the same as medical recognition as a discrete disease.) If, after treatment, a person with burnout continues to have persistent physical symptoms triggered by the condition, in Iceland they may be considered to have "somatic symptom disorder" (DSM-5) and "bodily distress disorder" (ICD-11).[69]
The ICD-10 (current 1994–2021) classified "burn-out" as a type of non-medical life-management difficulty under code Z73.0.[70] It was considered to be one of the "factors influencing health status and contact with health services" and "should not be used" for "primary mortality coding".[71] It was also considered one of the "problems related to life-management difficulty".[72] The condition is further defined as being a "state of vital exhaustion", which historically had been called neurasthenia.[73] The ICD-10 also contained a medical condition category of "F43.8 Other reactions to severe stress".[74]
In 2005, the Swedish Board of Health and Welfare added "exhaustion disorder" (ED; F43.8A) to the Swedish version of the ICD-10, the ICD-10-SE, representing what is typically called "burnout" in English.[75][76] Swedish sufferers of severe burnout had earlier been treated as having neurasthenia.[77] According to Lindsäter et al., "The diagnosis has become almost as prevalent as major depression in Swedish health care settings, and currently accounts for more instances of long-term sick-leave reimbursement than any other single diagnosis in the country."[78]
The Royal Dutch Medical Association defined "burnout" as a subtype of adjustment disorder[79] as part of the ICD-10 system. In the Netherlands, overspannenheid (overstrain) is a condition that leads to burn-out.[80] In that country, burnout is included in handbooks and medical staff are trained in its diagnosis and treatment.[77] A reform of Dutch health insurance resulted in adjustment disorder treatment being removed from the compulsory basic package in 2012. Practitioners were told that more serious cases of the condition may qualify for classification as depression or anxiety disorder.[81]
A new version of the ICD, ICD-11, was released in June 2018, for first use in January 2022.[82] The new version has an entry coded and titled "QD85 Burn-out". The ICD-11 describes the condition as follows:
Burn-out is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions: 1) feelings of energy depletion or exhaustion; 2) increased mental distance from one's job, or feelings of negativism or cynicism related to one's job; and 3) reduced professional efficacy. Burn-out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.[83]
This condition is classified under "Problems associated with employment or unemployment" in the section on "Factors influencing health status or contact with health services." The section is devoted to reasons other than recognized diseases or health conditions for which people contact health services.[56][84] In a statement made in May 2019, the WHO said "Burn-out is included in the 11th Revision of the International Classification of Diseases (ICD-11) as an occupational phenomenon. It is not classified as a medical condition."[85] The ICD-11 also has the medical condition "6B4Y Other specified disorders specifically associated with stress",[86] which is the equivalent of the ICD-10's F43.8.
Further detail about the varied ways clinicians and others used the then-current ICD and DSM classifications with burnout was published by Dutch psychologist Arno Van Dam in 2021.[8] The US government's National Institutes of Health includes the condition as "psychological burnout" in its index of the National Library of Medicine,[87] and provides a number of synonyms. It defines the condition as "An excessive reaction to stress caused by one's environment that may be characterized by feelings of emotional and physical exhaustion, coupled with a sense of frustration and failure."[87]SNOMED CT includes the term "burnout" as a synonym for its defined condition of "Physical AND emotional exhaustion state", which is a subtype of anxiety disorder.[88] The Diseases Database defines the condition as "professional burnout".[89]
Instruments used to assess burnout symptoms
In 1981, Maslach and Jackson developed the first widely used instrument for assessing burnout, the Maslach Burnout Inventory (MBI).[2] It remains by far the most commonly used instrument to assess the condition. Consistent with Maslach's conceptualization, the MBI operationalizes burnout as a three-dimensional syndrome consisting of emotional exhaustion, depersonalization (an unfeeling and impersonal response toward recipients of one's service, care, treatment, or instruction),[a] and reduced personal accomplishment.[1][2] The MBI originally focused on human service professionals (e.g., teachers, social workers).[2] Since that time, the MBI has been used for a wider variety of workers (e.g., healthcare workers). The instrument or its variants are now employed with job incumbents working in many other occupations.[1]
There are other conceptualizations of burnout that differ from that suggested by Maslach and adopted by the WHO. In 1999, Demerouti and Bakker, with their Oldenburg Burnout Inventory (OLBI), conceptualized burnout in terms of exhaustion and disengagement,[90] linking it to the job demands-resources model. This instrument is used mainly in the United States. Also that year, Wilmar Schaufeli and Arnold Bakker released the Utrecht Work Engagement Scale (UWES). It uses a similar conceptualisation to the MBI. However the UWES measures vigour, dedication and absorption; positive counterparts to the values measured by the MBI.[91] It is used mainly in Germany. In 2005, TS Kristensen et al. released the public domain Copenhagen Burnout Inventory (CBI).[3] They argued that the definition of burnout should be limited to fatigue and exhaustion.[3] The CBI has had some use in Germany.
In 2006, Shirom and Melamed with their Shirom-Melamed Burnout Measure (SMBM) conceptualized burnout in terms of physical exhaustion, cognitive weariness, and emotional exhaustion.[92][93] An examination of the SMBM's emotional exhaustion subscale, however, indicates that the subscale more clearly embodies Maslach's[94] concept of depersonalization than her concept of emotional exhaustion.[44] This measure has seen some use in Sweden. In 2010, researchers from Mayo Clinic used portions of the MBI, along with other comprehensive assessments, to develop the Well-Being Index, a nine-item self-assessment tool designed to measure burnout and other dimensions of distress in healthcare workers specifically.[95] It has been mainly used in the United States.
In 2014, Aniella Besèr et al. developed the Karolinska Exhaustion Disorder Scale (KEDS),[49][96] which is used mainly in Sweden. It was designed to measure the symptoms defined by the ICD-10-SE's category for exhaustion disorder. The authors believed that those with the disorder were often initially depressed, but that this soon passed. The core symptoms of the disorder were deemed to be "exhaustion, cognitive problems, sleep disturbance". The authors also believed that the condition was clearly differentiated from both depression and anxiety. In 2021, the Sydney Burnout Measure (SBM) was released by Gordon Parker et al., which "captures domains of exhaustion, cognitive impairment, loss of empathy, withdrawal and insularity, and impaired work performance, as well as several anxiety, depression and irritability symptoms."[97] There are still other conceptualizations as well that are embodied in other instruments, including the Hamburg Burnout Inventory,[98] and Malach-Pines's Burnout Measure.[99]
The core of all of these conceptualizations, including that of Freudenberger, is exhaustion.[94][100]
In 2020, the Occupational Depression Inventory (ODI),[60] was published. The measure quantifies the severity of work-attributed depressive symptoms and generates provisional diagnoses of job-ascribed depression.[61][9] The ODI covers nine symptoms, including exhaustion (burnout's putative core). The instrument exhibits robust psychometric properties. The ODI is the only instrument that assesses work-related suicidal thoughts, a particularly important symptom calling for immediate attention. Available evidence indicates that burnout scales have very high correlations with the ODI, correlations that cannot be explained by item overlap,[61] suggesting that the ODI is a suitable replacement for burnout scales like the MBI.[9]
Maslach[94] advanced the idea that burnout should not be viewed as a depressive condition. Recent evidence, based on factor-analytic and meta-analytic findings, calls into question this supposition.[54][101][44] Burnout is also now often seen as involving the full array of depressive symptoms (e.g., low mood, cognitive alterations, sleep disturbance).[102][103]
Burnout affects caregivers; in the ICD-11 classification, in the description for code QF27 "Difficulty or need for assistance at home and no other household member able to render care" the term "caregiver burnout" is given as a synonym.[86]
Spouse burnout
Kristensen et al.[3] and Malach-Pines (who also published as Pines)[104] advanced the view that burnout can also occur in connection to life outside of work. For example, Malach-Pines developed a burnout measure keyed the role of spouse.[105][106]
A type of occupational burnout which burdens athletes young and old. Relatively little research has been conducted on this phenomenon, but it affects the mental health and overall well-being of countless athletes across the world. It may lead to athletes feeling immensely stressed out and in extreme cases terminating their participation in an activity they once enjoyed.[108] Further impacts are unknown, but various other detriments to mental health are possible as well.
A growing body of evidence suggests that burnout is etiologically, clinically, and nosologically similar to depression.[115][116][117][118][119][120] In a study that directly compared depressive symptoms in burned out workers and clinically depressed patients, no diagnostically significant differences were found between the two groups; burned out workers reported as many depressive symptoms as clinically depressed patients.[121] Moreover, a study by Bianchi, Schonfeld, and Laurent (2014) showed that about 90% of workers with very high scores on the MBI meet diagnostic criteria for depression.[117] The view that burnout is a form of depression has found support in several recent studies.[100][116][122][118][119][120][98] Some authors have recommended that the nosological concept of burnout be revised or even abandoned entirely given that it is not a distinct disorder and that there is little agreement on burnout's diagnostic criteria.[123] A newer generation of studies indicates that burnout, particularly its exhaustion dimension, problematically overlaps with depression; these studies have relied on more sophisticated statistical techniques, for example, exploratory structural equation modeling (ESEM) bifactor analysis, than earlier studies of the topic.[124][100] The advantage of ESEM bifactor analysis, which combines the best features of exploratory and confirmatory factor analysis, is that it provides a granular look at item-construct relationships, without falling into traps earlier burnout researchers fell into.[125]
Liu and van Liew[52] wrote that "the term burnout is used so frequently that it has lost much of its original meaning. As originally used, burnout meant a mild degree of stress-induced unhappiness. The solutions ranged from a vacation to a sabbatical. Ultimately, it was used to describe everything from fatigue to a major depression and now seems to have become an alternative word for depression, but with a less serious significance" (p.434). The authors equate burnout with adjustment disorder with depressed mood.
Endocrine findings
Kakiashvili et al.,[126] argued that although burnout and depression have overlapping symptoms, endocrine evidence suggests that the disorders' biological bases are different. They argued that antidepressants should not be used by people with burnout because the medications can make the underlying hypothalamic–pituitary–adrenal axis dysfunction worse. Others have found Kakiashvili et al.'s argument specious.[117]
Despite its name, depression with atypical features, which is seen in the above table, is not a rare form of depression.[133] The cortisol profile in atypical depression, in contrast to that of melancholic depression, is similar to the cortisol profile found in burnout.[117] Commentators advanced the view that burnout differs from depression because the cortisol profile of burnout differs from that of melancholic depression; however, as the above table indicates, burnout's cortisol profile is similar to that of atypical depression.[117]
Risk factors
Evidence suggests that the etiology of burnout is multifactorial, with personality factors playing an important, long-overlooked role.[134][135][136] The researchers identified the prominent personality factor neuroticism in the development of burnout. Cognitive dispositional factors implicated in depression have also been found to be implicated in burnout.[137]
Burnout is thought to occur when there is a mismatch between the job and the worker. A common type of mismatch is work overload. For example, work overload can occur when a worker survives a round of layoffs, but after the layoffs the worker is doing too much with too few resources. Overload may occur in the context of downsizing, which often does not narrow an organization's goals, but requires fewer employees to meet those goals.[138] The research on downsizing, however, indicates that downsizing has more destructive effects on the health of the workers who survive the layoffs than burnout; these health effects include increased levels of sickness and greater risk of mortality.[139]
The job demands-resources model has implications for burnout, as measured by the Oldenburg Burnout Inventory (OLBI). Physical and psychological job demands were concurrently associated with the exhaustion, as measured by the OLBI.[140] Lack of job resources was associated with the disengagement component of the OLBI. Maslach, Schaufeli and Leiter identified six risk factors for burnout in 2001: mismatch in workload, mismatch in control, lack of appropriate awards, loss of a sense of positive connection with others in the workplace, perceived lack of fairness, and conflict between values.[94]
Although job stress has long been viewed as the main determinant of burnout, recent meta-analytic findings indicate that job stress is a weak predictor of burnout.[141] These findings question one of the most central assumptions of burnout research.
People who experience a work situation with little opportunity to influence, in combination with too high demands, develop more depressive symptoms.
People who experience a lack of compassionate support in the work environment develop more symptoms of depression and exhaustion disorder than others. Those who experience bullying or conflict in their work develop more depressive symptoms than others, but it is not possible to determine whether there is a corresponding connection for symptoms of exhaustion disorder.
People who feel that they have urgent work or a work situation where the reward is perceived as small in relation to the effort develops more symptoms of depression and exhaustion disorder than others. This also applies to those who experience insecurity in the employment, for example concerns that the workplace will be closed down.
In some work environments, people have less trouble. People who experience good opportunities for control in their own work and those who feel that they are treated fairly develop less symptoms of depression and exhaustion disorder than others.
Women and men with similar working conditions develop symptoms of depression as much as exhaustion disorder.[142]
Symptoms sufferers, past sufferers and health professionals associate with exhaustion disorder.
A 2023 study by Elin Lindsäter et al. found a wide range of symptoms had by people formally diagnosed with exhaustion disorder. The most common symptoms reported by people currently suffering with the condition were tiredness (48%), lack of energy (41%), difficulty recovering from exertion (33%), poor general cognitive functioning (33%), memory issues (32%) and difficulty coping with perceived stressors and demands (31%).[144] Some research indicates that burnout is associated with reduced job performance,[145] coronary heart disease,[93] and mental health problems.[146] Examples of emotional symptoms of occupational burnout include a lack of interest in the work being done, a decrease in work performance levels, feelings of helplessness, and trouble sleeping.[147]
The Swedish health department has defined the effects of exhaustion disorder as being:
Concentration difficulties or impaired memory
Markedly reduced capacity to tolerate demands or to work under time pressure
Emotional instability or irritability
Sleep disturbance
Marked fatigability or physical weakness
Physical symptoms such as aches and pains, palpitations, gastrointestinal problems, vertigo or increased sensitivity to sound.[148]
There is research on dentists[116] and physicians[98] that suggests that burnout is a depressive syndrome. Thus reduced job performance and cardiovascular risk could be related to burnout because of burnout's tie to depression. Behavioral signs of occupational burnout are demonstrated through cynicism within workplace relationships with coworkers, clients, and the organization itself. Forced overtime, heavy workloads, and frenetic work paces give rise to debilitating repetitive stress injuries, on-the-job accidents, over-exposure to toxic substances, and other dangerous work conditions.[149] Williams and Strasser suggested that healthcare workers have focused much attention on the workplace risk factors for heart disease and other illnesses, but have underemphasized work-related depression risk.[150]
Other effects of burnout can manifest as lower energy and productivity levels, with workers observed to be consistently late for work and feeling a sense of dread upon arriving. They can suffer concentration problems, forgetfulness, increased frustration, and/or feelings of being overwhelmed. They may complain and feel negative, or feel apathetic and believe they have little impact on their coworkers and environment.[147] Occupational burnout is also associated with absenteeism, other time missed from work, and thoughts of quitting.[151]
As in depression, chronic burnout is also associated with cognitive impairments in memory and attention.[152] Research suggests that burnout can manifest differently between genders, with higher levels of depersonalisation among men and increased emotional exhaustion among women.[153][154] Other research suggests that people revealing a history of occupational burnout face future hiring discrimination.[155]
Treatment and prevention
Health condition treatment and prevention methods are often classified as "primary prevention" (stopping the condition occurring), "secondary prevention" (removing the condition that has occurred) and "tertiary prevention" (helping people live with the condition).[156]
Maslach suggested that preventing burnout requires a combination of organizational change and worker education.[138] She and Leiter argued that burnout can occur in connection to six areas of work life: workload, control, reward, community, fairness, and values.[94] For example, with regard to workload, an organization should take steps to assure that a worker has adequate resources to meet job demands.[94] With regard to values, clearly stated ethical organizational values are important for ensuring employee commitment.[94] Supportive leadership and relationships with colleagues are also helpful.[94] Hätinen et al. suggest "improving job-person fit by focusing attention on the relationship between the person and the job situation, rather than either of these in isolation, seems to be the most promising way of dealing with burnout."[157] They also note that "at the individual level, cognitive-behavioural strategies have the best potential for success."[157] One approach for addressing these discrepancies focuses specifically on the fairness area. In one study employees met weekly to discuss and attempt to resolve perceived inequities in their job.[158] The intervention was associated with decreases in exhaustion over time but not cynicism or inefficacy, suggesting that a broader approach is required.[94]
Barry A. Farber suggests strategies like setting more achievable goals, focusing on the value of the work, and finding better ways of doing the job, can all be helpful ways of helping the stressed. People who do not mind the stress but want more reward can benefit from reassessing their work–life balance and implementing stress reduction techniques like meditation and exercise. Others with low stress, but are underwhelmed and bored with work, can benefit from seeking greater challenge.[159]
Michel Libert's 2021 book "Éviter le crash du burn-out: vade-mecum de prévention"[160] (Avoiding the burnout crash: prevention guide) details the burnout-avoidance approach of the co-founder of a Brussels burnout clinic.[161]
In addition to interventions that can address and improve conditions on the work side of work-life balance, the ways in which people spend their non-work time can help to prevent burnout and improve health and well-being.[162]
Corporate Social Responsibility (CSR) initiatives are considered a resource which counteracts the stress effects of job demands, lowering employee burnout by boosting happiness, resilience and capitalizing altruism.[163] Establishing a sense of psychological safety (the belief that it is safe to speak up) in an organisation helps prevent burnout.[164][165][166][167] Similarly, feeling heard may also help.[164] Training employees in ways to manage stress in the workplace is effective in preventing burnout.[168] One study suggests that social-cognitive processes such as commitment to work, self-efficacy, learned resourcefulness, and hope may insulate individuals from experiencing occupational burnout.[151] Increasing a worker's control over his or her job is another intervention has been shown to help counteract exhaustion and cynicism in the workplace.[157]
Despite all the above recommendations, high-quality research on burnout prevention with random allocation of experimental units (either individual workers or organizational units) to intervention and control conditions has been relatively rare.[169][170] For example, Richardson and Rothstein's (2008)[169] meta-analysis of workplace interventions included only two high-quality studies that addressed burnout. In their meta-analysis, Estevez Corres et al. (2021)[170] identified only eight high-quality studies devoted to preventing emotional exhaustion in "high-stress jobs"; fewer interventions were devoted to depersonalization and reduced accomplishment.
Secondary and tertiary prevention (aka treatment and management)
Hätinen et al. list a number of common treatments, including treatment of any outstanding medical conditions, stress management, time management, depression treatment, psychotherapies, ergonomic improvement and other physiological and occupational therapy, physical exercise and relaxation. They have found that is more effective to have a greater focus on "group discussions on work related issues", and discussion about "work and private life interface" and other personal needs with psychologists and workplace representatives.[157]Mindfulness therapy has been shown to be an effective preventative for occupational burnout in medical practitioners.[171] Additional prevention methods include: starting the day with a relaxing ritual; yoga; adopting healthy eating, exercising, and sleeping habits; setting boundaries; taking breaks from technology; nourishing one's creative side, and learning how to manage stress.[172][173][174]
Kakiashvili et al. said that "medical treatment of burnout is mostly symptomatic: it involves measures to prevent and treat the symptoms." They say the use of anxiolytics and sedatives to treat burnout related stress is effective, but does nothing to change the sources of stress. They say the poor sleep often caused by burnout (and the subsequent fatigue) is best treated with hypnotics and CBT (within which they include "sleep hygiene, education, relaxation training, stimulus control, and cognitive therapy"). They advise against the use of antidepressants as they worsen the hypothalamic–pituitary–adrenal axis dysfunction at the core of burnout. They also believe "vitamins and minerals are crucial in addressing adrenal and HPA axis dysfunction," noting the importance of specific nutrients. Omega-3 fatty acids may be helpful. DHA supplementation may also be useful for moderating norepinephrine. 11 beta-hydroxysteroid dehydrogenase (and potentially other metabolites of liquorice root extract) may help with lowered cortisol response.[126]
Salomonsson et al. found that for workers with exhaustion disorder, CBT was better than a Return to Work Intervention (RTW-I) for reducing stress; and that people whose symptoms were primarily depression, anxiety or insomnia had reduced total time away from work after a RTW-I than for CBT.[175] van Dam et al. had also earlier found that CBT was an effective treatment.[176]
The Swedish national health information service 1177 notes that "It is common for treatment and rehabilitation [of exhaustion disorder] to include several of the following parts:
Information and education about how stress affects the body.
Counseling and education on lifestyle and on methods to reduce daily stress. It can be done individually or in a group.
Treatment with CBT.
Conversation with a counsellor, psychologist or occupational therapist.
Physiotherapy to work with the body in different ways.
Medicines for sleep difficulties or depression."[177]
The Royal Dutch College of General Practiconers recommends a three-stage treatment process, made up of a crisis phase, a problem and solution stage, and an application stage.[178]
The Gothenburg regional government's Institute for Stress Medicine believes that "Recovery [from exhaustion disorder] is found in what is undemanding and joyful, and what that is varies greatly between individuals. Sleep and physical exercise are the basis of recovery and should be prioritized initially."[179] According to a survey of their patients in 2018, the two most important drivers of recovery were "the sick leave itself" and "advice on physical activity."[180] The institute's Kristina Glise (with others) has also twice detailed the institute's treatment practices in papers.[181][182][183] Glise also wrote a series of diagnostic and treatment recommendations for doctors in February 2023.[184]
Despite the above recommendations, high-quality research (e.g., random allocation to experimental and control groups) has been relatively rare in secondary and tertiary interventions aimed at reducing burnout symptoms.[170][187] One study suggests that cognitive behavioral therapy (CBT), which was developed to treat depression, can help some workers with symptoms of burnout although the application of CBT in high-quality studies to burnout has been sparse.[188] A shortcoming of CBT and other tertiary interventions is that they help to restructure the thinking of the worker/patient but do not change the adverse working conditions that give rise to the symptoms.[187]
Communication perspective
In a qualitative study, Meluch,[189] found that disclosing feelings of job burnout tends to make employees feel vulnerable. She also found that the perceived judgment of coworkers towards burnout is worrisome. van der Klink and van Dijk suggested stress inoculation training, cognitive restructuring, and graded activity to help workers with burnout symptoms, although insufficient high-quality research has been carried out on their efficacy.[79] Kim and Lee[190] recommended that organizations provide timely accurate information on activities and policies in order to minimize emotional exhaustion.
↑ The term "depersonalization" as used by Maslach and Jackson should not be confused with the same term used in psychiatry and clinical psychology as a hallmark of dissociative disorder.
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