What Makes Us Burnout and What Protects Us?

A few stats(1)

negative work environment
  • 21-67% of mental health workers report high levels of burnout(depending on the study)
  • Those who say they experience burnout also report increased depression, anxiety, sleep problems, impaired memory, pain, and alcohol consumption

A few definitions

  • Burnout: "a prolonged response to chronic emotional and interpersonal stressors on the job, and is defined by the three dimensions of exhaustion, cynicism, and inefficacy."(2)
  • Compassion Fatigue: asserts that, distinct and different than burnout or therapists' negative feelings toward difficult work, there are costs of caring, being empathic, and investing emotionally to help reduce others' suffering.(3)  See this really nice 2017 critical review if this construct interests you.(4)

A few caveats

  1. It's not clear that burnout as a construct holds up to rigorous scrutiny. "Burnout" may be just another way of saying "depression."(5)
  2. Most of the research is cross-sectional (researchers measure people at one point in time and correlate variables). We know little about causality. Some prospective studies and experimental interventions studies exist, but strong data are limited.

A few preliminary answers

All that said, prolonged exposure to negative work environments in transaction with 3 personal factors seems to drive reports of experiencing burnout.(6)

Work Environment: Aspects of the work environment seem to toggle either a good or bad impact. A work environment has a more negative impact when it:

  • places high demands that exceed resources (e.g., long hours, work overload)
  • offers less control over work (e.g., less latitude in decision-making)
  • has less social support in the workplace
  • and when job insecurity and physical exertion are high.
  • Whereas positive work environments better align demands with resources, offer more autonomy, job security, team cohesiveness, social support, and so on.

3 Personal Factors:

  • Work-Family Conflict: the stress associated with incompatible pressures between work and family roles
  • Emotional Exhaustion: the feeling of being overextended and depleted of one's emotional and physical resources
  • Performance-based Self-esteem: self-valuation based on how well one does one's work

It's very early in well-designed interventions research, but preliminary evidence suggests that while targeting mindfulness and self-care may be protective(7), changing the negative work environment may be most impactful.(8)

The Bottom Line
Given that for many of us changing our work environments or personal factors is difficult, treating professional burnout is likely to require sustained problem solving and acceptance-oriented skill. This is why I'm so excited Charlie Swenson is teaching on this topic! (see below)

--Kelly Koerner, PhD

References:
(1) Burnout in Mental Health Services: A Review of the Problem and Its Remediation. Morse, Salyers, Rollins, Monroe-DeVita, & Pfahler (2012)

(2) Maslach, C., Schaufeli, W. B., & Leiter, M. P. (2001). Job burnout. Annual review of psychology, 52(1), 397-422.

(3) Figley, C. R. (1995). Compassion fatigue: Toward a new understanding of the costs of caring. & Figley, C. (2002) Compassion fatigue: Psychotherapists' chronic lack of self care

(4) Sinclair, S., Raffin-Bouchal, S., Venturato, L., Mijovic-Kondejewski, J., & Smith-MacDonald, L. (2017). Compassion fatigue: A meta-narrative review of the healthcare literature. International Journal of Nursing Studies.

(5) Bianchi, R., Schonfeld, I. S., & Laurent, E. (2015). Burnout-depression overlap: A review. Clinical psychology review, 36, 28-41.

(6) Richter, A., Schraml, K., & Leineweber, C. (2015). Work-family conflict, emotional exhaustion and performance-based self-esteem: reciprocal relationships. International archives of occupational and environmental health, 88(1), 103-112.

(7) Luken, M., & Sammons, A. (2016). Systematic Review of Mindfulness Practice for Reducing Job Burnout. American Journal of Occupational Therapy, 70(2), 7002250020p1-7002250020p10.

(8)  Westermann, C., Kozak, A., Harling, M., & Nienhaus, A. (2014). Burnout intervention studies for inpatient elderly care nursing staff: Systematic literature review. International journal of nursing studies, 51(1), 63-71.

 


Development, Prevention, and Treatment of Therapist Burnout

Thursday, March 9, 2017 from 8-9:30am pacific/11-12:30pm Eastern/4-5:30pm GMT
1 CE Credit Course

Therapist burnout is common, is even to be expected, among psychotherapists who work with individuals with severe and chronic emotion dysregulation.  Just as one must anticipate that a firefighter is likely to get burned during his or her career, so one should anticipate that a psychotherapist with these individuals will become emotionally dysregulated. In a sense, the therapist may develop a "circumscribed case of emotion dysregulation" with respect to a given patient.  If burnout is not detected and/or not understood, it can proceed to severe levels, even irreversible levels, before being detected or treated as such. The theory and treatment strategies from Dialectical Behavior Therapy (DBT) target emotional dysregulation, and help to understand, prevent, and treat syndromes of burnout.
 
In this presentation, Charlie Swenson will use case examples, exercises, and discussion, based on DBT's theory and practice, to identify causal and maintaining factors of burnout, and to propose a DBT-informed way to prevent and treat it.

Get all the details and register now!