Beyond Tired: Burnout Predictors, Prevention, and Programs
Everyone has felt tired from work, school, their personal life, or all three, and need ways to manage stress and anxiety. However, there comes a point where that tired feeling becomes more detrimental to everyday functioning. That breaking point is called burnout.
Burnout is more than just being tired, it involves high cynicism, exhaustion, and feelings of inadequacy. Due to the intense nature of burnout there are serious costs. One may think of the only possible costs as poor performance at work or school and tense personal relationships.
There is also a financial cost of burnout. A 2019 study found “that approximately $4.6 billion in costs related to physician turnover and reduced clinical hours is attributable to burnout each year in the United States” (Han, Shanafelt, Sinsky, Awad, Dyrbye, Fiscus, Trockel, & Goh 2019).
This study demonstrates the monetary loss that is experienced in the medical field due to burnout. When people experience burnout, they may have to reduce their work hours or be fully replaced. This poses a cost for the employer as well as the employee. There are clear costs to burnout. But how can we tell when burnout is going to occur?
Hatice Yildiz Duraka of Bartin University and Mustafa Saritepeci of Necemettin Erbakan University conducted a study that was aimed at finding factors that can predict burnout in teachers. Researchers looked at demographics, occupational variables, information and communication technology usage, and personality traits of 194 teachers in Turkey.
There was a significant relationship between social media usage and burnout (Yildiz Durak & Saritepeci 2019). Burnout was measured with the Maslach Burnout Inventory (MBI) which contains 9 items about emotional burnout, 8 items about personal success, and 5 items about desensitization. Social media usage is quite often a culprit of negative cognitive outcomes, and in the case of burnout that is no different. One way to reduce your risk of burnout is to cut down on screen time, especially social media.
Here are some questions from the MBI:
Rate each statement using the scale 0-Never 1-Rarely 2-Sometimes 3-Often 4-Always
The same study also found a significant relationship between the personality trait openness and burnout (Yildiz Durak & Saritepeci 2019). Openness was measured using the Big Five Personality Traits Scale. Openness is related to creativity, curiosity, and flexibility. People who are considered to have a high level of openness may have a growth mindset and see challenges at work as opportunities for improvement. This is usually a very good thing, but always striving for more without proper rest could leave a person vulnerable to burnout.
Here is an example of a question that measures openness. How would you rate yourself on a scale of "don't agree" to "strongly agree"?
"I see myself as someone who has an active imagination."
Burnout is also common in situations where there is a perceived imbalance between the effort that someone puts in and the rewards that they receive. An Australian study found that “an imbalance of effort and reward was associated with poorer physical health, increased burnout, and reduced productivity” in university students (Hodge, Wright, & Bennett 2020).
Rewards can be income, security, or any benefit from completing work. Effort exerted to do the work comes from the demands or obligations placed on one in order to receive those rewards. Maintaining a balance between required effort and rewards given is a way that employers and supervisors can limit the potential for burnout for their employees.
Perceived effort and reward were measured using the Effort Reward Imbalance at University (ERI-U) scale. Here are examples of the three types of questions. How would you rate yourself on a scale of "don't agree" to "strongly agree"?
Effort: "I have to learn too much every day"
Reward: "I am always satisfied with the teachers’ appraisal of my contributions"
Overcommitment: "As soon as I get up in the morning I start thinking about my study problems"
Due to the global pandemic there has been an increase in burnout within the medical community. As hostiplas reach full capacity, those working to save lives have also hit their capacity. The perceived threat of COVID-19 is a prevalent factor in the burnout of nurses in northern Spain as of April 2020 ( Manzano García & Ayala Calvo 2020). It can be expected that burnout for those on the frontlines will continue to increase as cases rise and months pass.
The medical field is not the only place that symptoms of burnout are on the rise due to the pandemic. Social distancing protocols have more people working from home. The perfect balance between work and home can be even harder to find now. An article from the National Institute for Occupational Safety and Health blog on the CDC website addresses this concern.“
While technology use may help workers meet their job demands, it can also extend working hours and further blur work-home boundaries, which can be consequential for workers and their families. Specifically, workers’ ability to psychologically detach, or “switch off mentally” at the end of the workday can be compromised, which has been associated with many indicators of poor well-being, including anxiety, depression, negative affect, emotional exhaustion, and fatigue” (Nigam, Streit, Ray, & Swanson 2020).
These are some of the possible instances when burnout is likely to occur, but what can be done about it? There are some burnout prevention programs that have been implemented.
A study from the University of Adelaide in Australia demonstrates the effectiveness, feasibility, and acceptability of a Dialectical Behavior Therapy (DBT) skills training group for reducing burnout in psychology trainees. DBT is traditionally used to treat those with Borderline Personality Disorder and other emotional regulation difficulties. (The National Institute of Mental Health characterizes Borderline Personality Disorder as “an illness marked by an ongoing pattern of varying moods, self-image, and behavior” with symptoms such as “impulsive actions and problems in relationships”). But, DBT has also been used in the treatment of populations with substance abuse, eating disorders, and depression.
Sessions included training on mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness. Those who participated in the training had significantly lower levels of reported exhaustion and cynicism (Ginoux 2019).
In a 2020 study, researchers focused on the effectiveness and feasibility of a “Mindful Leadership” course for medical specialists. This course included ten sessions that were 5 hours long and occurred twice weekly. The groups in which the course was administered contained 11 to 19 people. The course taught meditation practices, which participants were encouraged to practice at home, and theories on leadership, such as effective habits and self-awareness. The intervention resulted in reduced burnout through reductions in depersonalization and emotional exhaustion as well as an increase in personal accomplishment (Kersemaekers 2020).
Both of these studies were pilot studies with small sample sizes but the results show promise for these types of burnout prevention programs.
Another study used activity-based burnout prevention and a vigor-promoting program. This program was proposed to involve Nordic walking in a group of twenty people (Ginoux 2019). Nordic walking is a total-body version of walking which involves walking sticks and does not require athleticism. The study protocol has been published but the data has not been collected and therefore results have yet to be published. However, if this study was to support the research hypothesis, it would provide evidence that exercise, especially vigorous and group-based exercise, can reduce burnout.
These burnout interventions all have one thing in common: they were initiated by employers in order to relieve employee burnout. What does employee initiated burnout prevention look like?
There are four main steps to personal burnout prevention: Envisioning, Planning, Encating, and Reflecting (Otto 2019). An interesting difference between the previous programs mentioned and this model is that this model takes personal life and home demands into account, instead of the sole focus on work. Studies on this kind of holistic approach for self, career, and relationships show that burnout is not limited to the workplace, and rather infiltrates every aspect of our lives. For many, burnout prevention may be a form of self-care.
The study found that 1/3 of participants were not concerned with the prevention of possible burnout in the future. These participants were aware of signs of burnout and the negative outcomes associated with it, but they weren't focused on preventative action (Otto 2019).
Why? We often know that certain things are good for us, and other things are bad for us, but fail to correct bad habits or make small adjustments that could dramatically improve our well-being. While it's unclear exactly why this phenomenon exists, it makes logical sense: would we volunteer for flu shots if companies and the government didn't create large-scale public service announcements? Probably not. Similarly, companies play an important role in communicating the importance of burnout prevention and providing the necessary tools to relieve burnout.
The employer-initiated programs above show promise in regards to combating burnout in the workplace. They could be even more effective if employers took the initiative to prevent employee burnout in the first place, and avoid the costs associated with it.
A number of factors determine whether an intervention will be successful. Those factors include the culture surrounding the intervention, infrastructure supporting the intervention, and adaptability of the intervention (Lebares 2020). A burnout prevention program will have more success with the proper support.
A suggested method of how to evaluate burnout prevention programs includes a pre-intervention questionnaire and two post-intervention questionnaires (one at the time of completion and one 3 months after completion). The questionnaires consists of the Five Facet Mindfulness Questionnaire, the Self-Compassion Scale, the Perceived Stress Questionnaire, the Maslach Burnout Inventory-General Survey, the Jefferson Scale of Physician Empathy, and the Goldberg Anxiety and Depression Scale (Pérula-de Torres 2019).
Here are some questions from the Five Facet Mindfulness Questionnaire:
"I’m good at finding words to describe my feelings."
"I watch My feelings without getting lost in them."
"I am easily distracted."
Similar to the Dialectical Behavior Therapy (DBT) skills training mentioned earlier, DIY therapy apps such as LIFE Intelligence can help with emotional regulation. DBT is used to treat those with difficulties controlling their emotions and building relationships. LIFE is a two-part tool for complete proactive prevention and reactive problem-solving care.
The preventive learning portion educates employees on every aspect of their self, career, and relationship management skills. This includes topics such as cognitive behavioral therapy, self awareness, emotional intelligence, goal setting, decision making, social influence, holistic health, communication, conflict resolution, dating, marriage, and leadership and teamwork.
The reactive problem-solving portion is a complete toolkit for managing moods and difficult situations as they arise. The app provides coping, communication, and self-therapy or coaching exercises to address stress, anxiety, and everything from frustration to envy.
References
Ginoux, I. (2019). “Workplace Physical Activity Program'' (WOPAP) study protocol: a four-arm randomized controlled trial on preventing burnout and promoting vigor. BMC Public Health, 19(1), 289–289. https://doi.org/10.1186/s12889-019-6598-3
Han, S., Shanafelt, T. D., Sinsky, C. A., Awad, K. M., Dyrbye, L. N., Fiscus, L. C., Trockel, M., & Goh, J. (2019). Estimating the Attributable Cost of Physician Burnout in the United States. Annals of internal medicine, 170(11), 784–790. https://doi.org/10.7326/M18-1422
Hodge, W. (2019). Balancing Effort and Rewards at University: Implications for Physical Health, Mental Health, and Academic Outcomes. Psychological Reports, 123(4), 003329411984184–1259. https://doi.org/10.1177/0033294119841845
Kersemaekers, V. (2020). Effectiveness and feasibility of a mindful leadership course for medical specialists: a pilot study. BMC Medical Education, 20(1), 34–34. https://doi.org/10.1186/s12909-020-1948-5
Lebares, G. (2020). Key factors for implementing mindfulness-based burnout interventions in surgery. The American Journal of Surgery, 219(2), 328–334. https://doi.org/10.1016/j.amjsurg.2019.10.025
Manzano García, G, & Ayala Calvo, JC. (2020). The threat of COVID‐19 and its influence on nursing staff burnout. J Adv Nurs. 00: 1– 13.
Nigam, J. A., Streit, J. M., Ray, T. K., & Swanson, N. (2020, June 12). COVID-19 Stress Among Your Workers? Healthy Work Design and Well-Being Solutions Are Critical. Retrieved January 06, 2021, from https://blogs.cdc.gov/niosh-science-blog/2020/06/12/covid-19-stress/
NIMH. (2017, December). Borderline Personality Disorder. Retrieved January 08, 2021, from https://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml
Otto, H. (2019). Exploring Proactive Behaviors of Employees in the Prevention of Burnout. International Journal of Environmental Research and Public Health, 16(20), 3849–. https://doi.org/10.3390/ijerph16203849
Pérula-de Torres, A. (2019). Controlled clinical trial comparing the effectiveness of a mindfulness and self-compassion 4-session programme versus an 8-session programme to reduce work stress and burnout in family and community medicine physicians and nurses: MINDUUDD study protocol. BMC Family Practice, 20(1), 24–24. https://doi.org/10.1186/s12875-019-0913-z
Robins, R. (2019). The effectiveness, feasibility, and acceptability of a dialectical behaviour therapy skills training group in reducing burnout and psychological distress in psychology trainees: A pilot study. Australian Psychologist, 54(4), 292–301. https://doi.org/10.1111/ap.12389
Yildiz Durak, S., & Saritepeci, M. (2019). Occupational burnout and cyberloafing among teachers: Analysis of personality traits, individual and occupational status variables as predictors. The Social Science Journal (Fort Collins), 56(1), 69–87. https://doi.org/10.1016/j.soscij.2018.10.011
