September 2016

Burnout – preventing, recognising and treating

It all starts with performance drive and a quest for perfection, accompanied by chronic stress. It ends with total exhaustion, maybe even depression and thoughts of suicide. Burnout is a symptom of our times. But it can be prevented and treated. Dr. Edith Holsboer-Trachsler explains how.

In earlier times it was called “executive burnout”, but it can happen to anybody: men and women, athletes, teachers, people in nursing professions, mechanics. But what is burnout? Edith Holsboer-Trachsler, physician-in-chief at the Psychiatric Hospital of the University of Basel and head of the Centre for Affective, Stress and Sleep Disorders, defines it as follows: “Burnout is a term used in occupational psychology. It describes the final stage of a process triggered by chronic stress.” The first warning signs come when someone starts working much harder, often clocking up a lot of overtime. This is followed by a general feeling of tiredness, reduced productive capacity and motivation, and then by psychosomatic complaints such as sleep disorders, diffuse pain, changed eating and sexual habits. And it finally ends with despair, even depression and thoughts of suicide.

Burnout Rad

The Freudenberg model describes the progress of burnout in twelve phases, but in practice these phases cannot always be clearly identified.

Burnout has a positive connotation

External factors play a central role in burnout: bad atmosphere at work, lack of recognition, too long working hours, permanent availability. Andreas Krause, professor at the School of Applied Psychology at the University of Applied Sciences and Arts Northwestern Switzerland, also blames new concepts to increase productivity: “Many companies manage their employees by objectives, figures and benchmarks; employees are given objectives, but no help in reaching these objectives.” Is burnout the same as depression? “Fatigue is a central symptom of burnout and also a relevant symptom of depression,” says psychiatrist Edith Holsboer. But there are differences: “Some of the basic symptoms of depression such as sadness, desperation and feelings of guilt are not necessarily present with burnout.” And while burnout is linked to “the demands of the workplace and the quality of the social environment”, there is no such specific link for depression. Burnout also has a positive connotation: “It points to an intensive commitment to the work.” In Dr. Holsboer's experience, many patients therefore diagnose themselves with “burnout”.

Every fifth person suffers from chronic stress

According to the “Job Stress Index 2015” of Health Promotion Switzerland, more than a million workers in Switzerland or 22.5 percent suffer from permanent stress at work. Just as many (22.6 percent) are fatigued. This causes damage to Quote the individual as well as the national economy: the report states that with suitable measures, Swiss companies can save five billion francs a year. “In total, stress, burnout and depression trigger estimated costs of 19 billion francs per year,” says Thomas Mattig, Director of Health Promotion Switzerland. How can burnout be prevented? “Employers have to assume more responsibility,” says Mattig. “Their occupational health management policies should also take account of mental health.” Dr. Holsboer is in favour of “improving work structures, promoting a culture of recognition, and ensuring a better balance between the use of resources and the result.” But every individual has to shoulder some of the responsibility. Employees should ask themselves: What is more important, work and material riches? Or satisfaction, self-fulfilment, family, friends? Can I recover well enough? Must I really be available 24 hours per day? Dr. Holsboer also recommends physical activity to improve sleeping patterns. Other good strategies include the analysis of problems, removal of sources of stress, and humour. And, of course, the misuse of alcohol, nicotine and other substances should be avoided.

How can burnout be treated?

If someone visits her practice with “burnout”, Dr. Holsboer first establishes the psychiatric and general medical condition. If a complaint is less serious, some measures of organisation and occupational psychology to improve the work situation are usually enough. Psychotherapy can help those who react negatively to stress, for example with extreme anxiety, fear or self-doubt. Someone who is depressed or mentions thoughts of suicide needs psychiatric treatment and possibly also anti-depressants. “Patients are treated on an outpatient basis whenever possible,” explains Edith Holsboer. “In serious cases, however, they have to be hospitalised.”

Text: Artur K. Vogel