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The Burn-out

Understand what burnout is, so as not to confuse it with simple work-addiction or depression.

What is a burnout? Definition and symptoms

Definition of burnout

Originally, burnout was a term used by caregivers or volunteers to talk about overworked colleagues who have become cynical of the people they care for.
One of the first definitions was given by Freudenberger in 1974 in these terms: “the internal resources come to be consumed as under the action of the flames, leaving only an immense vacuum inside, even if the outer shell seems more or less intact”.
Then Maslach added, in 1976: “an incapacity of the intervener’s adaptation to a level of continuous emotional stress caused by the work environment”.
Freudenberger, in 1981, again defined burn out as: “An exhaustion of the internal resources of the individual and the reduction of his energy, his vitality and his capacity to function, which result from a sustained effort deployed by this individual to achieve an unachievable goal, and this, in the context of work, more particularly in the helping professions”.
In summary, it is a “state of physical, emotional and mental exhaustion, caused by long-term involvement in situations that are emotionally demanding” (Pines and Aronson).

Burn-out or depression?

Depression and burnout are often confused, not only because of their close symptoms, but also because of misconceptions that tend to spread easily in common conception.
Depression is a disease while burnout is not a pathology per se; it is not listed in the American Manual of Mental Disorders (DSM). Depression and burnout must be well differentiated: a person suffering from burnout is not necessarily depressed, and what affects him or her rests mainly on professional causes.
In a depressed patient, the origin is more diffuse and negative thoughts concern different spheres: professional, family, personal …
The consequences of burnout and depression are quite similar, however: loss of pleasure and of the desire to do things, fatigue, reduced concentration and memory, somatic disorders (eating, sleeping, libido, hypertension…).

What are the symptoms of burnout?

Burn out is characterized by three main key phases:

  • Psychological, physical and emotional exhaustion and an inability to regain energy. The simple idea of ​​going to work then becomes unbearable;

  • Depersonalization: the person will set up a protection mechanism which consists of detaching him or herself emotionally from the people he or she meets. He or she will become indifferent and cynical towards his or her colleagues, clients or patients;

A loss of the sense of personal accomplishment: the job has lost all meaning, and the person doubts both its efficiency and its skills.
During these three stages, a multitude of symptoms generally appears,s which affect the person suffering from burnout.
Discreet signs:

  • Cognitive impairment (attention, concentration, memory, etc.)

  • Decrease in profitability

  • Fatigability and denial of overwork

Then, the visible symptoms:

  • Sleep disturbance, irritability

  • Emotional freedom and loss of pleasure

  • Digestive disorders and recurrent viral infections

  • Addictive remedy (alcohol, cocaine, etc.)

  • Finally, the state phase characterized by:

  • Affective drying and cynicism

  • A feeling of helplessness and a lived experience of failure

  • An experience of wear and tear

Burn-out, work addiction and drug addiction

It is not easy to determine if a person is addicted to work (“workaholic”) or just has a profile of “hard worker”. However, occupational health specialists agree on three characteristic signs leading to this diagnosis:

  • The “workaholic” patient works a lot and devotes most of his time and energy to his professional activity

  • He does not do it by the obligation of one of his superiors or because he needs money, but rather because of internal motivation, a conviction or a vocation

  • He does not enjoy working; the enthusiasm has given way to a real addiction which he is trapped at the expense of any other activity

On the evolutionary level, three successive stages can be described (Limosin, 2004):
The first stage corresponds to a progressive lengthening of the time devoted to work, associated with an increasing reluctance to take advantage of holidays.
The second stage corresponds to an overinvestment in work and the appearance of the first signs of negative repercussions on a personal level (stress, sleep disorders, fatigue) or family, with an increasingly marked avoidance of moments of leisure.
The third stage leads to an overall impact with repercussions:

  • Physical (headache, severe fatigue, cardiovascular disorders, …)

  • Psychological (dulling of affects, feeling of worthlessness, depressive symptoms …)

  • And ultimately, the risk of developing burnout

However, addiction to work can quickly be associated with other behaviours or disorders harmful to the individual. A study from January 2015, published in the medical journal The British Medical Journal and involving 40,000 people in fourteen different countries, showed that beyond 48 hours of weekly work, the risk of having a problematic alcohol consumption is increased by 12%.
The essential difficulty is then to differentiate, in these situations, the causes from the consequences. Addictive behaviour, for example, is it the result of a state of burnout? Or conversely, is exhaustion and various dysfunctions at the workplace correlated with this individual compensation strategy based on the consumption of products?
Burnout can then be thought of as co-morbid addictive behaviour. Thus, the complexity and prevalence of addictive behaviour in the workplace require studying the possible correlation between the duration of working time, as an indicator of arduousness, and addictive behaviour as such.

The causes of burnout

Each professional and personal context is unique. However, we generally designate three factors leading to burning out and whose combination is particularly harmful:

  • Poorly assessed workload, including overload. 

  • The absence of “decisional latitude”, that is to say a lack of autonomy, of room for manoeuvre to achieve its objectives, the impossibility of choosing the means and the organization deployed to carry out its task.

  • Lack of support, both from colleagues and from the hierarchy.

Other factors, internal or external, can also lead to burnout: lack of communication, a dangerous professional context that requires constant vigilance, a situation of moral harassment, lack of recognition and chronic inability to say no.

Burnout is not lastingly improved by rest. Temporarily suspended by the distance from the professional context, exhaustion returns as soon as you resume work under the same conditions.

What treatments and treatment for burnout?

The treatment is mostly based on a cognitive-behavioural approach. The first step is for the patient is to become aware of their behavioural disorder and agree to be taken care of. However, this compulsory passage is not always obvious, especially when the compulsive behaviour is underpinned by relational and/or family difficulties, and therefore corresponds to avoidance behaviour, a source of secondary benefits.

The different approaches proposed in the management of addiction to work are:

  • Stress management:

  • assertiveness techniques (knowing how to say no …), relaxation and cognitive restructuring;

  • meditative mindfulness technique;

  • cognitive and behavioural psychotherapy;

  • family therapies;

  • self-help groups

Thus, after an evaluation of behaviour at work and an identification of the various favourable factors, the therapy aims to learn to resist the compulsion by adopting behavioural strategies favouring the resumption of a normal life.

Once the person is cured of his work addiction, it has been shown that he or she recovers better productivity, while devoting much less time to his professional activity (Burke, 2000).

The treatment of burn-out within the group emphasizes the need, in such a situation, to break away from the usual environment and stressful stimulation. The setting of our facilities lends itself perfectly to this thanks to the tranquillity that surrounds our patients, and thanks to the care necessary for rest, taking a distance and think.

Psychiatric care is adjusted individually and according to any associated disorders (depression, sleep disorders, addictions, anxiety disorders).

Hospitalization has four objectives:

  • rest and away from stimulation;

  • management of symptoms (such as depressed mood, insomnia, anxiety, etc.);

  • understanding the circumstances of occurrence of burn-out, reflection on work;

  • development of strategies for resuming work and preventing a new burn-out syndrome.

This psychological work is carried out during daily interviews and information meetings.