This document discusses identifying and tackling burnout. It begins by looking at trends in entertainment that reflect social problems and issues like burnout. It then lists several news reports on burnout affecting different professions. Risk factors for burnout are identified as negative job characteristics, occupational factors, organizational factors, demographic variables, and personality traits. Emotional labor jobs in helping professions like medical, social work, and mental health are outlined as particularly risky for burnout. Signs and symptoms of burnout for both employees and management are provided. Popular assessment tools for measuring burnout like the Maslach Burnout Inventory are also mentioned. The document concludes with tips for preventing and coping with burnout at both the individual and organizational level

1. Identifying and Tackling
Burnout
Kim Fitzgerald
PhD Psychology (Health, Rehab, and Occupational)
M.Ed. Vocational Rehabilitation Counselling
Consulting Psychologist: Coaching, Return to Work, Job Analysis, Disability
Management Consultancy, Counselling
Reg. Psychol., Ps.S.I., CPsychol, CBDMA, DMS, BFA

2. The Working Dead?
Trends in entertainment industry reflect
social problems: “Zombie films typically
critique humanity in times of crisis. Half
an hour of the Walking Dead shows
enough angst and inter-group frustrations
you’ll start to consider going solo during an
apocalypse...”
https://cccspeaks.wordpress.com/2013/07/05/lets-talk-zombies/

3. In the news...
Half of Irish Staff on Verge of Burnout (Business World, 2015)
Physician Burnout: It Just Keeps Getting Worse (Medscape Family Medicine, 2015)
Majority on brink of stress: Office tensions rising but flexible working provides a solution (Regus
Global, 2015)
Social workers are resigning from their jobs at a rate of one a week (RTE, 2015)
EU study blames long shifts for nurse burnout (Irish Examiner, 2015)
According to the American Institute of Stress, "workplace stress
costs more than $300 billion each year in health care, missed work
and stress-reduction."

4. Identifying

5. Risk Factors for Burnout Syndrome
Negative Job Characteristics
• Workload: Overwork and heavy
workload, boredom
• Work conflicts
• Diminished resources
• Lack of input or feedback
• Job insecurity
• Effort-reward imbalance
• Length of training and delayed
gratification
Occupational factors
• Step hierarchy
• Understaffing
• High demands for employees
• Number of years in current profession
and total number of years
Organisational Factors
• Continuing rapid organisational
changes
Demographic variables
• Younger adults
• Unmarried people/women caring for
children
Personality traits
• Low hardiness
• Poor self-esteem
Job attitudes
• Unrealistically high expectations
• Financial issues (salary)
Source: Burnout for Experts: Prevention
in the Context of Living and Working
(2013)

6. Risky Roles: Emotional Labour
The Helping Professions
“Cost of caring" for others in emotional and physical pain (Figley,1982).

7. Medical Profession:
• Oncologists
• Surgeons
• Anaesthesiologists
• Intensive care unit staff
• Neonatal intensive care
• Academic medicine chairs
• Rehabilitation practitioners
• Medicine residents and
medicine students
• Emergency service
personnel
• Dentists
• Nurses
• Social workers
• Mental health workers
• Psychologists
• Occupational therapists
• Speech and language
therapists
Risky Roles: Emotional Labour
Source: Burnout for Experts: Prevention in the
Context of Living and Working (2013)

8. Pressures to:
Perform
Show results
Be seen as a good
leader/role model
Be strong
High Level Peak Performers and/or Senior Staff:
“It’s Lonely at the Top....”
Who can you trust?
Who can you talk to?

9. What does it look like?
Employee might experience:
● Difficulty coming to work and
getting started once at work
● More irritable and less patient
with co-workers, clients,
customers
● Lack of energy to be
consistently productive at
work
● Self harm: Tendency to self-
medicate with alcohol or
drugs, behavioural (risky
behaviours)
● Becoming cynical, sarcastic,
critical at work
Management might observe:
● Aggressiveness and Irritability
● Poor Memory / Mental
Confusion
● Lower Quality of Work
● Change in Working Hours
● Fatigue
● Bad Time Management
● Mood Swings
● Fearful
● Loss of Self-Confidence
● Loss of Motivation
● Increased Absenteeism
(Calling in Sick)

10. Risk Factors
• Personality factors: The people most likely to burn out
quickly are over-achievers, perfectionists, and
pessimists
• An imbalance between work and home life: If one or
the other is taking over an employee’s life, work will
suffer and burnout will ensue
• Work-related stress: An overwhelming workload,
increased job demands without commensurate benefits,
a lack of recognition or feedback, and a loss of faith in
leadership can all contribute to burnout
• Lack of involvement with decision making

11. Assessing
What was it before?

12. International Classification of Disease (ICD-10)
“Burnout: State of
vital exhaustion.”
Category Z73,
under: “Problems
related to life
management and
difficulty”

13. Overlapping Symptoms: What’s really going
on? It isn’t ‘burnout’ but it could be...
Depression
• Trouble concentrating
• Trouble remembering
• Trouble making decisions
• Impairment of performance at
work
• Sleep problems
• Loss of interest in work
• Withdrawal from family,
friends, co-workers
• Feeling pessimistic, hopeless
• Feeling slowed down
• Fatigue
Anxiety
• Feeling apprehensive and
tense
• Difficulty managing daily tasks
• Difficulty concentrating

14. Other Problems Related to the
Social Environment
Not mental disorders but circumstances
that may impact diagnosis, course,
prognosis and treatment:
• Phase of Life
• Problem Related to Living Alone
• Acculturation Difficulty
• Social Exclusion or Rejection
• Target of (Perceived) Adverse
Discrimination or Persecution
Reference: Other Conditions that May be a Focus of Clinical Attention, DSM-V Codes, p. 724

15. Problems Related to Other Psychosocial,
Personal, and Environmental Circumstances
• Religious or Spiritual Problems
• Problems Related to Unwanted Pregnancy
• Problems Related to Multiparity
• Discord with Social Service Provider,
Including Probation Officer, Case Manager,
or Social Services Worker
• Victim of Terrorism or Torture
• Exposure to Disaster, War, or Other
Hostilities
• Other Problem Related to Psychosocial
Circumstances
• Unspecified Problem Related to Unspecified
Psychosocial Circumstances
Reference: Other Conditions that May be a Focus of Clinical Attention, DSM-V Codes, p. 725

16. Popular Assessment Tools
Maslach Burnout Inventory (MBI): 22-25 items, 3 scales:
• Emotional Exhaustion (9 items)
• Depersonalisation (5 items)
• Personal Accomplishment (8 items)
Tedium Measure (the Burnout Measure)
• Physical, emotional and mental exhaustion

17. Symptoms Disease
Abdominal Pain Addisonian crisis; diabetic ketoacidosis; hyperparathyroidism
Amenorrhea or
Oligomenorrhea
Adrenal insufficiency, adrenogenital syndrome, anorexia nervosa, Cushing’s
syndrome, hyperprolactinemic states, hypopituitarism, hypothyroidism, menopause,
ovarian failure, polycystic ovaries, pseudohermaphroditic syndromes
Anemia Adrenal insufficiency, gonadal insufficiency, hypothyroidism, hyperparathyroidism,
panhypopituitarism
Anorexia Addison’s disease, diabetic ketoacidosis, hypercalcemia (e.g. hyperparathyroidism),
hypothyroidism
Constipation Diabetic neuropathy, hypercalcemia, hypothyroidism, pheochromocytoma
Depression Adrenal insufficiency, Cushing’s Syndrome, hypercalcemic states, hypoglycemia,
hypothyroidism
Diarrhea Hyperthyroidism, metastatic carcinoid tumors, metastatic medullary thyroid
carcinoma
Fever Adrenal insufficiency, hyperthyroidism (severe: thyroid storm), hypothalamic disease
Hair changes Decreased body hair (hypothyroidism, hypopituitarism,thyrotoxicosis); hirsuitism
(androgen excess states, Cushing’s Syndrome, acromegaly)
Headache Hypertensive episodes with pheochromocytoma, hypoglycemia, pituitary tumors
Underlying Health Problems/Endocrine Disease?
Referring to GP
Adapted from Basic & Clinical Endocrinology, (Gardner & Shoback, 2007).

18. Symptoms Disease
Hypothermia Hypoglycemia, hypothyroidism
Libido changes Adrenal insufficiency, Cushing’s syndrome, hypercalcemia, hyperprolactinema,
hyperthyroidism, hypokalemia, hypopituitarism, hypothyroidism, poorly controlled
diabetes mellitus
Nervousness Cushing’s syndrome, hyperthyroidism
Polyuria Diabetes insipidus, diabetes mellitus, hypercalcemia, hypokalemia
Skin changes Acanthosis nigricans (obesity, polycystic ovaries, severe insulin resistance), Cushing’s
syndrome, acromegaly), acne (androgen excess), hyperpigmentation (adrenal
insufficiency, Nelson’s syndrome), hypothyroidism, hypopigmentation
(panhypopituitarism), striae, plethora, bruising, ecchymoses (Cushing’s syndrome),
vitiligo (autoimmune thyroid disease, Addison’s disease)
Weakness and
fatigue
Addison’s disease, Cushing’s syndrome, diabetes mellitus, hypokalemia (e.g. primary
aldosteronism, Bartter’s syndrome), hypothyroidism, hyperthyroidism, hypercalcemia
(e.g. hyperparathyroidism, panhypopituitarism, pheochromocytoma)
Weight gain Central nervous system disease, Cushing’s syndrome, hypothyroidism, insulinoma,
pituitary tumors
Weight loss Adrenal insufficiency, anorexia nervosa, cancer of endocrine glands, hyperthyroidism,
type 1 diabetes mellitus, panhypopituitarism, pheochromocytoma
Underlying Health Problems/Endocrine Disease?
Referring to GP
Adapted from Basic & Clinical Endocrinology, (Gardner & Shoback, 2007).

19. 12 Phases of
Burnout
Freudenberger & North
Twelve-phase model of Herbert Freudenberger and Gail North (1992). The 12 phases are depicted in the abbreviated
form; see text for more details (Source: Coaching, Empirical Social Research and Gender Research, 2013).

20. Burnout is a Multi-
Dimensional
Syndrome
How to Cope?
Prevention: Awareness, Balance, Connection

21. Tips for Companies
• Instead of “burnout prevention” training, consider “work
engagement” angle
• If using employee surveys, assess for employee
engagement instead of burnout
• Consider professional supports of younger staff/new to
the career (Mentoring)?
• Induction: Health Promotion: Red Flags
• Manager Training: Emotional Intelligence focus
(Coaching needed?)
• Respect & support recovery time of individuals
• Return to Work: Immediate contact + ongoing!

22. Tips for Companies
Demands ● Work Loads
● Work Patterns
● Work Environment
Control How much say a person has in the way they do
their work
Support Encouragement, sponsorship and resources
provided by the organisation, line management and
colleagues
Role ● Understanding role in the organisation
● Conflicting roles
Change How it is managed and communicated?
Relationships
(Dignity at Work)
Promote positive working to avoid conflict and
dealing with unacceptable behaviour
Source: “How to tackle work-related stress: A guide for employers on making the
management standards work” Health and Safety Executive UK

23. Psychological Supports
Guilt and Shame: It’s most likely not about YOU
• Assess for perfectionism/personality traits
• Current life situation (Life Span)
• Personal resources: Coping skills, family, friends, skills
set
• Digital Detox
• Let Go and Let Grieve: Bereavement, confronting as
PTSD

24. Tips for Individuals
Rebuilding self-esteem is a key element of
the rehabilitation of burned-out employees.
Psychological Resilience/Mental Fitness
Physical Fitness
Increase in job burnout and depression strongest among employees
who did not engage in physical activity and weakest to the point of
non-significance among those engaging in high physical activity
(Toker & Biron, 2012).

25. Assess for Addictions
• Gambling
• Risky Sexual Behaviours
• Over-Reliance on
Prescription Meds?
(Benzos)
• Alcohol/Drugs
• Disordered Eating
• How much is too much?
Impact on functioning?

26. Our individual life situations and
perspectives are unique....and
complex
Not just one particular cause...
Consider scope of additional stressors,
treatment should be person-centred.

27. Find your Groove
• Slow down
• Interests and aptitudes
• Time Management/Priorities
• Assertiveness
• Confidence building
• Redefining the self
• Body Awareness
• Mindfulness/Relaxation
• Don’t be a martyr: Look into Assertiveness Skills
• Learn how to identify, avoid and cope with Emotional
Vampires in your personal

28. Important
Tips
Especially
when in
Recovery
from Burnout
What is really within your
control or how can you
change how you perceive
it or deal with it?

29. Return to Work Coordination, Counselling, Coaching,
Workshops & Training, Job Analysis
Web: www.southdublincoaching.com
Email: southdublincoaching@gmail.com

30. Suggested Reading
The Joy of Burnout: How Burning Out Unlocks the Way to a Better, Brighter
Future (2007)
Dr Dina Glouberman
Burnout for Experts (
Burnout for Experts: Prevention in the Context of Living and Working (2013)
Bahrer-Kohler (Ed).
Mindful Path to Self Compassion (2009)
Christopher Germer
High Octane Women: How Superachievers Can Avoid Burnout (2010)
Sherrie Bourg Carter, PsyD
Primal Leadership: Learning to Lead with Emotional Intelligence(2004)
Daniel Goleman, Richard E. Boyatzis, and Annie McKee.

31. Research
Causes of burnout are multidimensional and can be categorized into three groups:
organisational, job-related and individual factors (Shirom, 2003).
“Feeling types” more prone to burnout than “thinking types,” especially in relation to cynicism
(Maslach, Shaufeli, & Leiter, 2001).
Performance based self-esteem is a predictor and a consequence of burnout (Dahlin, Joneborg,
& Runeson, 2007; Rosse, Boss, Johnson, & Crown, 1991).
Associated with poor health including hypertension, alcoholism, myocardial infarction
(Shanafelt et al. 2006; Väänäenet al. 2008, Alves et al. 2009), cardiovascular,
musculoskeletal, skin, and allergic diseases including somatic co-morbidtiy (which increases
with burnout).
Work overload linked to high cholesterol (Melamed, Shirom, Toker, & Shapira,2006).
Burnout is associated with musculoskeletal diseases among women and with cardiovascular
diseases among men (Honkonen, et al; 2006).
Emotional exhaustion is considered to be the most important dimension of burnout
syndrome (Roelofs et al. 2005).

32. Burnout and Depression
Burnout often associated with depression (Ahola & Hakanen, 2007; Bianchi, Schonfeld, &
Laurent, E., 2015; Hintsa et al., 2014)
Job strain predisposes to depression through burnout. In comparison, job strain causes a
predisposition towards burnout directly and via depression (Ahola & Hakanen, 2007).
A predisposition for depression, as reflected by a personal and familial history of depression,
may enhance the risk for burnout (Nyklicek & Pop, 2005).
Raised inflammatory markers in depression (Glassman & Miller, 2007)
Association between job strain and depression is stronger for women (Mausner-Dorsch
and Eaton 2000).
Association between burnout and depression particularly based on emotional exhaustion
component of the MBI (Ahola et al., 2005; Nyklicek & Pop, 2005; Peterson et al., 2008).
Risk of having a depressive disorder greater when burnout severe compared to mild or no
burnout (Ahola, et al., 2005).

33. References
Ahola, K., & Hakanen, J. (2007). Job strain, burnout, and depressive symptoms: a prospective study among dentists. Journal of Affective
Disorders, 104 (1-3): 103-110.
Alves, M.G., Chor, D., Faerstein, E., Werneck, G.L., & Lopes, C.S. (2009). Job strain and hypertension in women: Estudo Pro-Saúde
(Pro-Health Study). Revista de Saúde Pública, 43, 893-896.
Bianchi, R., Schonfeld, I.S., & Laurent, E. (2015). Is burnout separable from depression in cluster analysis? A longitudinal study. Social
Psychiatry and Psychiatric Epidemiology, 50(6), 1005-11.
Dahlin., M., Joneborg, N., & Runeson, B. (2007). Performance-based self-esteem and burnout in a cross-sectional study of medical
students. Medical Teacher, 29(1), 43-48.
Figley, C.R. (Ed). (1995) Compassion fatigue: Coping with secondary trauma disorder in those who treat the traumatized. New York:
Brunner/Mazel
Glassman, A.H., & Miller, G.E. (2007). Where there is depression, there is inflammation....sometimes! Biological Psychiatry, 62 (4), 280-
81.
Hintsa, T., Elovainio, M., Jokela, M., Ahola, K., Virtanen, M., & Pirkola, S. (2014). Is there an independent association between burnout
and increased allostatic load? Testing the contribution of psychological distress and depression. Journal of Health Psychology, pii:
1359105314559619. [Epub ahead of print]
Honkonen, T. Ahola, K., Pertovaara, M., Isometsa, E., Kalimo, R., Nykyri, E., Aromaa, A., & Lonnqvist, J. (2006). The association
between burnout and physical illness in the general population- results from the Finnish Health 2000 Study. Journal of Psychosomatic
Research; 61(1): 59-66.

34. References
Maslach, C., Schaufeli, W.B. and Leiter, M.P. (2001), Job burnout. Annual Review of Psychology, Vol. 52 No. 1, pp. 397-422.
Mausner-Dorsch, H., & Eaton, W. (2000). Psychosocial work environment and depression: Epidemiologic assessment of the demand-control
model. American Journal of Public Health, 90, 1765-1770.
Nyklicek, I., & Pop, V.J. (2005). Past and familial depression predict current symptoms of professional burnout. Journal of Affective Disorders,
8(1), 63-8.
Roelofs, J., Verbraak, M., Keijsers, G.P.J., de Bruin, M.B.N., & Schmidt, A.J.M. (2005). Psychometric Properties of a Dutch version of the
Maslach Burnout Inventory General Survey (MBI-DV) in individuals with and without clinical burnout. Stress and Health, 21, 17-25.
Rosse, J.G., Boss, R.W., Johnson, A.E., & Crown, D.F. (1991). Conceptualizing the role of self-esteem in the burnout process. Group &
Organization Management, 16(4), 428-451.
Shanafelt, T., Chung, H., White, H., & Lyckholm, L.J. (2006). Shaping your career to maximize personal satisfaction in the practice of oncology.
Journal of Clinical Oncology, 24, 4020-4026.
Melamed, S., Shirom, A, Toker, S., & Shapira, I. (2006). Burnout and risk of type 2 diabetus: a prospective study of apparently healthy
employed persons. Psychosomatic Medicine, 68 (6): 863-9.
Shirom, A. (2003). Job-related burnout. In J.C. Quick& L.E. Tetrick (Eds.) Handbook of occupational health psychology, (pp. 245-265).
Washington, DC: American Psychological Association.
Väänäen, A., Koskinen, A., Joensuu, M., Kivimaäki, M., Vahtera, J., Kouvonen, A., et al. (2008). Lack of predictability at work and risk of acute
myocardial infarction: An 18 year prospective study of industrial employees. American Journal of Public Health 98, 2264-2271.

35. According to the American Psychological
Association (2014), the signs of burnout
include:
• Loss of pleasure in work
• Depression (sleep or appetite
disturbance, lethargy, negative mood)
• Inability to focus or concentrate;
forgetfulness
• Anxiety
• Substance use/abuse or other
compulsive behaviours to manage stress
• More frequent clinical errors
• Less contact with colleagues
• Workaholism
• Persistent thoughts about clients and
their clinical material
• Intrusive imagery from clients’
traumatic material
• Increased cynicism, overgeneralised
negative beliefs
• Increased isolation from or conflict with
intimates
• Chronic irritability, impatience
• Increased reactivity and loss of
objectivity and perspective in work
• Suicidal thoughts