MHChat

What is Burnout?

Burnout is a ‘psychological syndrome in response to chronic interpersonal stressors on the job’ (Maslach, Schaufeli, & Leiter, 2001). Therefore, to avoid burnout it is important to establish and maintain an effective work-life balance.

The three dimensions of the “burnout” syndrome include: ‘overwhelming exhaustion’ or feeling depleted of one’s emotional and physical resources (this is the central ‘stress; quality of burnout); cynicism and detachment from the job; and feeling a lack of accomplishment and a sense of ineffectiveness. Other factors associated with burnout that are often primary antecedents to burnout include: work overload, limited support, role conflict and role ambiguity (Maslach, Schaufeli, & Leiter, 2001).

Burnout can occur at any stage of life and career however, research suggests that burnout tends to be more prevalent in younger ‘helping professionals’ (ibid; Maslach, 1982; Farber, 1985) than in professionals aged 30 to 40 years and over. Although these results are confounded by work experience and survival bias, they point to the need for greater support for younger and newly qualified practitioners. Supervision provides an excellent space for unpacking emotional toil and vicarious trauma, while, peer support can be an invaluable resource. In fact, research indicates that social support is a significant mitigating factor, while lack of support is a contributing and predictive factor for burnout (Kruger et al., 1991; 1995).

But, what is stress? Is stress avoidable? and Whose responsibility is it?

Stress is a natural reaction to pressure. However, it is our capacity to manage stress that can prevent distress. Given the inherent stress in caring relationships, it is essential that practitioners use their professional skills to manage ‘self’, stress and emotions effectively.

Organisational factors linked to stress:

Various definitions of stress have offered different theoretical perspectives for understanding organisational stress over the past years. However, there is a growing convergence about definition of organisational stress as a harmful psychological and/or physiological response on the part of the individual, that has both emotional and cognitive components and that is the result of an imbalance between individual’s appraisal of the environmental demands and his/her coping resources (Cox & Mackay 1981; Israel 1996).

Mackay et al. (2004) suggest the following as the main factors contributing to organisational stress:

• Demands – This includes workload and work patterns.
• Control – How much say do you have in the way you do your work?
• Support – This includes management encouragement, supportive leadership and appropriate resources to do/complete one’s work.
• Relationships at work – What are the interpersonal interactions and relationships between you and your colleagues as well as other professionals? and What are the processes for dealing with and resolving conflict?
• Role – Is there clarity of role? Do you understand your role and what is expected of you? Are there any overlaps or conflicts between your role and others?
• Change – How is change communicated and managed in the organisation? How are the uncertainties inherent in the change process mitigated and managed?
• Culture – What is the prevalent organisational culture? Does the organisation demonstrate a commitment to fairness and openness?

Corporate Social Responsibility and stress prevention:

There is abundant evidence of biological, psychological, and psychosocial links between excessive workplace stress and poor physical health (e.g. blood pressure, cardiovascular diseases, neuro-endocrine changes, etc.) and poor mental health outcomes.

Research highlights the link between work stress, lack of role clarity, work overload with negative mental and psychological outcomes such as anxiety, depression, and emotional exhaustion, in addition to negative health behaviour such as smoking, lack of activity, poor diet, alcohol misuse all of which augment the risk of physical illness (LaMontagne et al. 2006).

In spite of the above and the abundant evidence, given the inherent emotional toil associated with relationship-based professions, many organisations lack a systematic approach to workplace stress. Some managers and organisations attribute the main causes of stress to individual factors such as lack of emotional resilience or inability to deal with stress, while employees and unions argue that workplace and environments cause stress (Sanders 2001; LaMontagne et al., 2006; Redfern, Rees & Rowlands 2008). Unfortunately, such divergent views and differences in understanding the underlying causes of stress result in ineffective approaches in tackling organisational and workplace stress.

In general, the budget allocations for reducing and addressing workplace stress do not seem to be commensurate with the level direct and indirect costs associated with stress. (Cooper et al. 2001; Giga et al. 2003b).

To address workplace stress effectively requires that organisations adopt a risk management approach to workplace stress. This means that organisations should approach workplace stress as part of health and safety policy and with the same sense of rigour and responsibility as other operational, physical safety, and business risks.

Stress prevention and categories of interventions:

Stress interventions have been categorised along two main dimensions (Sutherland & Cooper 2000):

1. The degree of prevention:
   1. Primary intervention – aims to prevent the occurrence of stress (e.g. job redesign),
   2. Secondary intervention – is to minimise/improve the effects of stress once they have occurred (e.g. CBT, stress management techniques), and
   3. Tertiary intervention – aims to address long-term and negative health outcomes associated with workplace stress through rehabilitation and return to workplace; and
   4. The level of organisational involvement, namely:
      1. Organisation wide (e.g. process redesign),
      2. Team-based,
      3. Individual, and
      4. a combination of the above.

Peer support groups are a good example of a multi-modal approach that operates on both individual as well as organisational levels. Other techniques such as CBT based training and relaxation are aimed at altering individuals’ perception of work environment while learning and enhancing resilience and coping skills (Richardson & Rothstein 2008).

Individual strategies for coping with stress

Individual approaches to stress management aim to alter the individual’s perceptual, information processing, and cognitive and behavioural responses in order to enhance their capacity for stress management and therefore, reduce the probability of negative outcomes associated with stress. One such approach is to enhance individuals’ emotional intelligence and resilience.

Emotional resilience and stress:

There is a strong positive correlation between emotional intelligence and our emotional resilience and ability to manage stress. In fact, emotional resilience is closely related to emotional intelligence and emotional literacy, defined as the ability to recognise, understand, and appropriately express emotions.

Our coping abilities depend mostly on our habits and the attitudes that we have learnt/developed early in life. These habits and attitudes are set in place and reinforced by our everyday experiences. As we establish our daily routine and acquire habitual thoughts, feelings, and behaviour, these form patterns of information processing in our brains that become the dominant pathways for our interpretations and reactions to various stimuli/impulses.

Therefore, here are a few suggestions on how to enhance emotional literacy and resilience:

1. Understand emotional states and their consequences – Learning to recognise your emotions and their psychological and behavioural consequences is important in enabling us to manage our response and emotional states. For instance, clenching your fist, shouting, crying or withdrawal are behavioural consequences of different emotions.

2. Self-regulation and change – Most cognitive functions are located in the outer parts of the brain (the cerebral cortex) while emotional processing takes place in the deeper part of the brain. Therefore, developing emotional intelligence and resilience are experiential processes that require overcoming entrenched habits and involve new emotional learning. However, since emotional learning involves deeper parts of the brain, cognitive knowledge often does not suffice to modify our habits. For instance, knowing cigarettes damage one’s health is usually not enough to stop the person from smoking. Therefore, when you recognise a dysphoric emotion or a disruptive impulse, you can apply cognitive behavioural techniques to exert self-restraint and to monitor/control its behavioural consequences in order to respond through more appropriate and constructive alternatives (e.g. when you feel angry, instead of pounding your fist on the table, go for a walk).

3. Recognise emotional toil and express your emotions – Self-regulation helps us identify and adopt more appropriate response to our emotional triggers; it also enhances our emotional resilience. However, repressing our emotions or ignoring emotional toil inherent in relationship-based professions (e.g. clinical work or mental health practice) or disregarding the effects of vicarious trauma (secondary traumatic stress), can lead to long-term problems ranging from emotional bias, to irritability and lack of sensitivity as well as psychological disorders. Therefore, it is important to allocate time and place, and find appropriate avenue to express our emotions and let go of any negative feelings.

4. Allocate time and place for healing – You are not immune from emotional toil and even healthy work environments can be stressful. So, Allocate regular time and place to your “self” for emotional processing and healing. It is most helpful if you can do this at the same time and place regularly. You will begin to associate that time and specific place/setting with unwinding, and this positive association will help facilitate the process of unpacking your emotions and healing the “self” during your “self” time.

5. Positive regard and self-affirmation – Positive self-affirmations enhance positive thinking and self-esteem. Spend a few minutes a day writing positive self-affirmations. This will not only affect your thinking positively, but also, through repetition it will raise your awareness, and will make you identify with that trait, quality, or characteristic which will in turn enhance that trait.

6. Journalise your thoughts, emotions and experiences –  Create a daily journal where you can record anything salient about your day. Journalising your feelings, thinking, relationships, experiences, and events will help processing associated emotions and will increase awareness of your preferences, emotions, needs, and growth.

7. Motivation and positive thinking – Aspire for excellence in all that you do and maintain internal congruence by aligning what you say and do with what you feel and value. Align your goals with your possibilities, capacities, and resources, and maintain work-life balance.

8. Maintain a positive attitude and a proactive stance – Positive attitude produces positive influences, so adopt a positive approach. Use supervision to unpack emotional toil. Join a group/committee that deals with your practice. You will gain a better perspective about practice while contributing to decision making in your profession. Join discussions and debates and get involved in knowledge communities of practice and interest.

9. Reflect on your day – At the end of each day, reflect on what went right or wrong, how you felt, and how you can improve. This serves as a debriefing opportunity that helps put your work experiences into perspective before you bring undue stress home. Follow this with a few minutes of journaling salient issues, feelings, and follow up points.

Remember life is a dynamic experiential process/journey with no mistakes, just greater self-discovery and learning opportunities.