UNDERSTANDING BURNOUT

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UNDERSTANDING BURNOUT

• BILL MAULDIN
• BALTIC CHRISTIAN MEDICAL STUDENTS SUMMER CAMP
• PÕLTSAMAA, ESTONIA
• JULY 2008

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I. Personal experience

• Texas
• 1989 and beyond

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II. Related disorders

• Depression
• Post-traumatic stress disorder (PTSD)
• Post abortion stress syndrome (PASS)
• Irritable bowel syndrome
• Burnout
• Chronic fatigue syndrome, and
• Fibromyalgia

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III. What is burnout?

• Symptoms of burnout
• Emotional exhaustion
• Constant fatigue
• Unstable emotions (get angry easily, or
  cry easily)
• Cynicism (constant negative emotions, a
  constant critical feeling)
• Inability to concentrate

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III. What is burnout?

• Symptoms of burnout
• Emotional exhaustion
• Depersonalization
• Loss of personal accomplishment

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IV. Diagnosing burnout

• Psychologically
• Physically

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IV. Diagnosing burnout

• Psychologically
• The Maslach Burnout Inventory

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Dr. Christina Maslach Too long . . .
working too much working in an unjust (unfair)
environment working with little social support
working with little autonomy or control
working in the service of values we strongly
disagree with working for insufficient reward
(whether the currency is money, prestige, or
positive feedback
feedback).
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IV. Diagnosing burnout

• Physically
• Saliva test for cortisol

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V. Susceptibility to burnout

• certain types of people
• depressives
• people with anger problems
• people with anxiety problems
• people with low self-esteem
• certain jobs

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V. Susceptibility to burnout

• certain types of people
• certain jobs
• high work-home interference
• inefficiency
• we dont matter (or our work)
• constant interruptions

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Patterns related to burnout

• Gender
• women more likely to become emotionally
  exhausted
• men more likely to become depersonalized

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Patterns related to burnout

• gender
• Age
• younger adults more likely than older

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Patterns related to burnout

• gender
• age
• time on the job
• most often between 1 and 5 years on the job

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Patterns related to burnout

• gender
• age
• time on the job
• education
• most common with 1 or 2 university degrees

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Patterns related to burnout

• gender
• age
• time on the job
• education
• children
• adults with children are less likely than
  those without children

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Patterns related to burnout

• gender
• age
• time on the job
• education
• children
• children and elderly parents
• in Israel, even with double responsibility, no
  burnout because of family support

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Patterns related to burnout

• . . .
• education
• children
• children and elderly parents
• individualist societies
• higher than in more community oriented
  societies US higher than Mexico

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Patterns related to burnout

• . . .
• education
• children
• children and elderly parents
• individualist societies
• success orientation
• more likely with strong drive for success

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Patterns related to burnout

• . . .
• children
• children and elderly parents
• individualist societies
• success orientation
• perfectionism
• greatly increases likelihood

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The critical issue

• no correlation between burnout and caseload

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The critical issue

• No correlation between burnout and caseload
• The critical factor is frustration at the
  situation (suppressed anger)

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The critical issue

• No correlation between burnout and caseload
• The critical factor is frustration
• Burnout occurs in the gap between expectations
  and results.

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The critical issue

• No correlation between burnout and caseload
• The critical factor is frustration
• Burnout occurs in the gap between expectations
  and results.
• Do the math . . .
• Expectations reality disappointment
• Expectations reality delight

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VI. Connection with self-image

• Field independent vs. field dependent
• (getting our guidance from inside ourselves, or
  from external data)

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VI. Connection with self-image

• Field independent vs. field dependent
• Identity Non Identity
• (Who am I, anyway?)

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VI. Connection with self-image

• Field independent vs. field dependent
• Identity Non Identity
• From inside or outside?
• Where does my identity (self-esteem) come from?

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VI. Connection with self-image

• PERSONAL IDENTITY DEVELOPMENT

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PERSONAL IDENTITY DEVELOPMENT

• APPROXIMATE AGE SELF-IDENTITY
  NON-IDENTITY
• 0 to 1½ years Trust
  Mistrust
• (Infancy) (I can trust
  those (Life is painful
• who care for me)
  and unpredictable)

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PERSONAL IDENTITY DEVELOPMENT

• APPROXIMATE AGE SELF-IDENTITY NON-IDENTITY
• 0 to 1½ years Trust
  Mistrust
• Infancy) (I can trust those (Life
  is painful
• who care for
  me) and unpredictable)
• 18 to 30 years Intimacy
  Isolation
• (I accept myself so (I live as best I
  
• I can accept and can without
• bond with others) asking
  why I
• do what I do)

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PERSONAL IDENTITY DEVELOPMENT

• APPROXIMATE AGE SELF-IDENTITY NON-IDENTITY
• 0 to 1½ years Trust
  Mistrust
• Infancy) (I can trust those (Life
  is painful
• who care for
  me) and unpredictable)
• 18 to 30 years Intimacy
  Isolation
• 30 to 60 years Maturity Self-absorpti
  on
• (Adulthood) (I am a secure, (My focus on
  productive, myself
  leads to
• effective, under or over
• balanced person) achievement)

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VI. Connection with self-image

• Burnout and self-image have a common physical
  component

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VII. Physical process

• The HPA axis
• (Hypothalamic-Pituitary-Adrenal)

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SCN Suprachiasmatic nucleus CRH
Corticotropin-releasing hormone PVN
Paraventricular nucleus ACTH
Adrenocorticotrophic hormone
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VII. Physical process

• The HPA axis cortisol imbalance
• Circadian rhythm

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VII. Physical process

• The HPA axis
• Circadian rhythm
• The hippocampus

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VII. Physical process

• The HPA axis
• Circadian rhythm
• The hippocampus
• Connection with the immune system

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VII. Physical process

• The HPA axis
• Circadian rhythm
• The hippocampus
• Connection with the immune system
• Long term affect

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VII. Physical process

• The HPA axis
• Circadian rhythm
• The hippocampus
• Connection with the immune system
• Long term affect
• Difference in depression burnout
• depression has high flat levels of cortisol
  is related to a passive response to frustration
  (the under achiever with low personal identity)
• burnout has low flat levels of cortisol is
  related to an aggressive response to frustration
  (the over achiever with low personal identity)

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VIII. Avoiding burnout

• Most important action to avoid
• Recognize the risk

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VIII. Avoiding burnout

• Recognize the risk
• Learn and practice self-awareness
• the ability to step outside ourselves and
  analyse our responses (I can feel myself getting
  angry . . .

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VIII. Avoiding burnout

• Recognize the risk
• Learn and practice self-awareness
• Learn and practice renewal techniques

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VIII. Avoiding burnout

• . . .
• Learn and practice renewal techniques
• Eating habits
• Exercise
• Time away
• Social issues
• Spiritual issues
• Issues of self-worth

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VIII. Avoiding burnout

• . . .
• Learn and practice renewal techniques
• Issues of self-worth
• Who I Am in Christ

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Who I Am in Christ

• I am accepted
• John 112 I am Gods child (also Rom 814-16).
• John 1515 I am Christs friend.
• Col 114 I am redeemed and all my sins are
  forgiven
• I am secure
• Rom 835-39 Nothing can separate me from the
  love of God.
• Phil 320 I am a citizen of heaven.
• I am significant
• Matt 513-14 I am the light of the world and
  the salt of the earth.
• John 1516 I have been chosen to bear fruit.

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VIII. Avoiding burnout

• Recognize the risk

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IX. Treating burnout

• Learned helplessness.
• Even when past efforts have not worked, dont
  quit trying. It does not mean that there are not
  good solutions. Keep seeking fresh ways to cope.

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IX. Treating burnout

• Learned helplessness.
• Figure out why it happened

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IX. Treating burnout

• Learned helplessness.
• Figure out why it happened
• Make lifestyle changes

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IX. Treating burnout

• . . .
• Make lifestyle changes
• Change careers or jobs (Matt 188-9)
• Eating habits
• Exercise
• Time away
• Social issues
• Spiritual issues
• Issues of self-worth

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X. Spiritual connections

• Isaiah 40

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Isaiah 40

• 1 Comfort, comfort my people, says your God.
• 10 See, the Sovereign LORD comes with power, and
  his arm rules for him. See, his reward is with
  him, and his recompense accompanies him.
• 11 He tends his flock like a shepherd He
  gathers the lambs in his arms and carries them
  close to his heart he gently leads those that
  have young.

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Isaiah 40

• 13 Who has understood the mind of the LORD, or
  instructed him as his counselor?
• 14 Whom did the LORD consult to enlighten him,
  and who taught him the right way? Who was it that
  taught him knowledge or showed him the path of
  understanding?
• 15 Surely the nations are like a drop in a
  bucket they are regarded as dust on the scales
  he weighs the islands as though they were fine
  dust.
• 17 Before him all the nations are as nothing
  they are regarded by him as worthless and less
  than nothing.

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Isaiah 40

• 21 Do you not know? Have you not heard? Has it
  not been told you from the beginning? Have you
  not understood since the earth was founded?
• 22 God sits on his throne above the circle of
  the earth, and its people are like insects. He
  stretches out the heavens like a tent to live in.
• 23 He brings princes to nothing and reduces the
  rulers of this world to nothing.
• 24 As soon as they are planted, as soon as they
  take root in the ground, he blows on them and the
  wind sweeps them away.

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Isaiah 40

• 25 The Holy One says, "To whom will you compare
  me? Or who is my equal?"
• 26 Lift your eyes and look to the heavens Who
  created all these? He who brings out all the
  stars one by one, and calls them each by name.
  Because of his great power and mighty strength,
  not one of them is missing.
• 27 O Jacob, O Israel, why do you complain and
  say, "My way is hidden from the LORD my cause is
  forgotten by my God"?

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Isaiah 40

• 28 Do you not know? Have you not heard? The LORD
  is the everlasting God, the Creator of the ends
  of the earth. He will not grow tired or weary,
  and his understanding no one can discover.
• 29 He gives strength to the weary and increases
  the power of the weak.

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Isaiah 40

• 30 Even youths grow tired and weary, and young
  men stumble and fall
• 31 but those who hope in the LORD will renew
  their strength. They will soar on wings like
  eagles they will run and not grow weary, they
  will walk and not be faint.

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Isaiah 4031

• . . . those who hope in the LORD will renew
  their strength.
• They will soar on wings like eagles
• they will run and not grow weary,
• they will walk and not be faint.

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Isaiah 4031

• . they will run and not grow weary,
• burnout
• they will walk and not be faint.
• depression

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X. Spiritual connections

• Isaiah 40
• our view of God has a lot to do with our view
  of our situation
• The image of God
• we have the ability to use our conscious minds
  to out think our natural, emotional responses to
  stress

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Isaiah 4031

• . . . those who hope in the LORD will renew
  their strength.
• They will soar on wings like eagles
• they will run and not grow weary,
• they will walk and not be faint.
• ? ? ?