Dossier: Stress and relaxation

Recognising and preventing burn-out

Nothing describes the state of total exhaustion better than the term “burn-out”. Your body and mind pull the emergency brake. If you react too late, you risk slipping into depression. What are the first signs and what treatments are available?

Text: Helwi Braunmiller, Julie Freudiger: Photo: iStock

Total exhaustion – physical, emotional and mental. Those who have burn-out feel empty, lacking in energy and, as the name suggests, burnt out. It can happen to anyone. Studies estimate that 7 out of 100 people in employment suffer from burnout. Other figures are significantly higher or lower. The problem is that although the term “burn-out” has existed since the 1970s, it wasn’t until May 2019 that burn-out found its way into the International Disease Catalogue. Burn-out is defined as a “syndrome that results from chronic workplace stress that has not been successfully managed” (ICD-11). 

In other words: burn-out is a gradually developing stress disorder that poses a great risk of severe physical, emotional and psychological exhaustion – and which can culminate in depression. There is also a connection between burn-out and various physical symptoms, such as increased blood pressure or lung disease. This is shown in a study by the University Hospital of Zurich. Therefore, the first signs of burn-out should not be ignored, but counteracted at an early stage. The sooner the risk of burn-out is recognised, the sooner the negative spiral can be stopped.

Causes: what triggers burn-out

Burn-out is triggered by a high workload, which also includes unpaid activities such as caring for relatives or family work. But the number of hours worked per week is not the only decisive factor. A bad working atmosphere, bullying, excessive stress, fear of losing one’s job as well as personal strain also play a role. Above all, however, individual characteristics play a key role. It is often idealistic and committed people who are pushed to their limits while striving to deliver perfection, achieve their ambitions and fulfil their sense of responsibility.

Work-related risks

  • External pressure to perform/high workload
  • Time pressure
  • Monotonous activity/lack of self-determination
  • Lack of recognition, appreciation and support
  • Interpersonal conflicts in the workplace
  • Combined burden of family and work

Personality-related risks

  • High demands on oneself and high willingness to perform
  • Tendency towards perfectionism
  • Always wanting to please others/not being able to say no
  • Few or no relaxing activities, lack of recreation 

Symptoms: What are the signs of burn-out?

Burn-out does not develop overnight. It starts off with the enthusiastic idealist who is on fire for a project, work or family care – and who refuses to admit that they are constantly overexerting themselves. They develop a mentality of “I’ll handle it” and over-exertion becomes the norm. Often, the need to get things done also dominate their thoughts during their leisure time and they neglect to relax and take part in recreation. The first signs of exhaustion and overwork are ignored or the workload is even increased in order to cope with the stress. The payback comes in the form of physical symptoms such as sleep and digestive disorders, headaches, muscle tension and back pain. Distance from the social environment and a sense of resignation at work are also warning signs. Those affected usually do not pay attention to these until a state of total exhaustion – physical, psychological and emotional – and even severe depression sets in.

The numerous symptoms – far more than 100, depending on the source – are difficult to grasp objectively, so there is no clear clinical picture. Symptoms include the following, for example:

  • Increasing listlessness both professionally and privately, decreasing interest in everything
  • Reduced mental sharpness, concentration problems
  • Cynicism and distancing from work
  • Increased irritability
  • Problems switching off in free time
  • Difficulty sleeping, constantly tired
  • Loss of appetite
  • Headaches and back pain
  • Dizziness and palpitations
  • Nervousness and anxiety, inner void
  • Stomach and intestinal problems
  • Susceptible to infections
  • Tinnitus
  • Exhaustion depression

Stages: How burn-out can develop over time

Burnout occurs in stages. However, these stages cannot be clearly categorised, because every person affected experiences burnout differently. Individual stages might be skipped or experienced in a different order. Depending on the source, reference is made to a 3-, 5-, 7- or 12-stage model, although most of them do not fundamentally contradict each other. Even if the stage models have not been scientifically proven, they still give important indications of how a burnout can develop. Last but not least, they encourage self-reflection. One model that is often cited is that developed by the pioneer of burnout research, Herbert Freudenberg. Together with Gail North, he developed the 12-stage model:

1. Need to prove oneself

Great commitment, euphoria, placing high demands on yourself that go beyond your limit.

2. Intense effort

Perfectionism takes over and you want to do everything alone and as quickly as possible.

3. Neglecting one’s own needs

Work takes priority, your own needs take a back seat.

4. Repressing conflicts and needs

First mistakes start to appear, but these are ignored, just like the first physical symptoms. Conflicts may arise, for example, in your relationship. 

5. Change in personal values

Work comes first, social contacts and previous priorities are seen as a burden.

6. Denial of problems

You become cynical and react increasingly aggressively. You constantly deny the excessive workload.

7. Withdrawal

You withdraw and lose hope. You notice your performance drop and seek comfort or distraction in addictive substances.

8. Change in behaviour

Distinct changes in behaviour. Concerned friends are appeased and criticism dismissed.

9. Depersonalisation

You feel detached from your body, mind and emotions. You no longer value your own life.

10. Inner void

You feel useless, empty and exhausted. You may suffer panic attacks.

11. Depression

Total lack of drive and desire, sufferers feel exhausted and desperate.

12. Total exhaustion

Besides a mental breakdown, burn-out can also cause physical illness. Suicidal thoughts may occur.

Note: Burn-out is not a disease in itself, but a risk condition for mental and physical illnesses such as depression. There is therefore a debate among experts about whether “depression” should appear as the last stage of the model or be omitted altogether.

Treatment is as individual as the burn-out itself

Treating burn-out depends on the causes and above all on the person affected. In very severe cases, an inpatient stay in a clinic is necessary, for example if someone is suicidal. Otherwise, outpatient therapy is usually sufficient. In such cases, the family doctor or a psychologist are good first points of contact.

In addition to psychological treatment, it’s important to restore your balance and replenish your energy reserves. Here, too, there is no one-size-fits-all approach: what soothes one person, bores another. Generally, relaxation methods, physical therapy, sports and mindfulness exercises have proven successful. It’s important to learn long-term strategies for dealing with stress, developing the ability to say no, and giving up perfectionism. Depending on the severity of the burnout, it may also be useful or even essential to get away from the workplace. 

Long-term effects: burn-out lingers

A superficial scratch on a tabletop can be mended much faster than a deep gouge. The same applies to your mental health: the longer you do nothing about exhaustion, the deeper you slip and the longer it takes to heal. A person under constant stress no longer manages to relax. This must first be learned again.

In fact, many burn-out sufferers report long-term effects. This was also shown in a study at the University of Gothenburg , which examined people with stress-related exhaustion.

The result: only 16 percent of the sufferers who participated in the study considered themselves to be completely recovered seven years after the first treatment. Four percent said their health had not changed or had even worsened. Eighty percent felt much better or better, but some symptoms remained: Almost half of the participants suffered from extreme fatigue, 73 percent reported low stress tolerance, and 43 percent reported memory difficulties.

How to prevent burn-out

For most people, avoiding stress altogether is not an option. Nor is it necessary, because a healthy dose of stress is not harmful – as long as it’s followed by recovery and the over-exertion doesn’t become constant. In the case of work stress, a good discussion with your superior may help to defuse the situation, but it’s also down to your own handling of stress: you cannot just take mental health for granted - it has to be looked after like physical health.

What you can do to prevent it

  • Recognise your own needs and take them into account: How much sleep do I need? Do I have a regular, balanced diet? What are my limits? Which jobs can I realistically get done? What makes me feel good?
  • Recognising stress triggers: In which situations do I feel overwhelmed?
  • Analyse and change behavioural patterns: Why am I stressed? Are the demands I’m placing on myself too high? Where could I react differently and take a different course of action?
  • Changing habits: Leave your laptop in the office, don’t check work emails in your free time, don’t try to be perfect, plan time for exercise, eat in peace, say no sometimes.
  • Seek support from superiors, colleagues, family and friends.
  • Give yourself breaks and pay attention to balance, cultivate friendships and get enough exercise.

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