INTRODUCTION
“Burn out at work” - until recently, these words were perceived as nothing more than a vivid metaphor. Many studies conducted over the past decades have proven the reality of this phenomenon. In the literature, it is called emotional burnout syndrome (EFS). The term “emotional burnout” was introduced by the American psychologist Fredenberg in 1974 to define a psychological state caused by emotional, mental and physical exhaustion.
This phenomenon is most often observed among professionals working in the field of social assistance and who have constant close contact with clients. In other words, among professionals of the “person-to-person” system. These include doctors, teachers, clergy, salespeople, managers, lawyers, social workers, psychiatrists, psychotherapists, and psychologists.
A special subgroup includes doctors and consultants who provide assistance:
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people in terminal stages of diseases such as AIDS, cancer;
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socially disadvantaged groups of the population (street children, people without a fixed place of residence, the poor, socially vulnerable);
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people who survived violence and became victims of terrorist attacks.
Representatives of these professions, in the course of their activities, more often encounter negative emotional experiences of their clients and therefore more often experience a state of increased emotional stress.
In this work we will constantly use two concepts: “consultant” and “client”. “Consultant” - referring to a specialist who provides information (this could be a doctor working with patients, as well as a psychologist or social worker); “client” - speaking about people who seek this help from a consultant.
COMBUSTION SYNDROME.
WHAT IS ITS DANGER?
Emotional burnout syndrome (EFS) is caused by disorders and difficulties that arise in the human body during his professional activities. This is the body's response to a situation that causes constant, prolonged stress.
SES is characterized as a state of mental fatigue and disappointment and most often occurs in people of the so-called helping professions. This condition is accompanied by emotional exhaustion, depersonalization, and decreased performance.
The symptoms accompanying emotional burnout syndrome can be divided into three groups: those associated with a person’s physical condition, those associated with his social relationships, and a person’s intrapersonal experiences.
Symptoms associated with a physical condition indicate that certain processes are occurring in the human body that can cause a deterioration in health. These symptoms include:
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increased fatigue, apathy;
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physical malaise, frequent colds, nausea, headache;
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heart pain, high or low blood pressure;
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abdominal pain, loss of appetite and diet;
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asthma attacks, asthmatic symptoms;
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increased sweating;
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tingling behind the sternum, muscle pain;
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sleep disorders, insomnia.
Symptoms associated with social relationships appear when a person has contact with others: colleagues, clients, loved ones and relatives. These include:
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the appearance of anxiety in situations where it did not arise before;
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irritability and aggressiveness in communicating with others; a cynical attitude towards clients, towards the ideas of the common cause, towards one’s work;
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reluctance to work, shifting responsibility;
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lack of contact with clients and/or unwillingness to improve the quality of work;
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formalism in work, stereotypical behavior, resistance to change, active rejection of any creativity;
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food aversion or overeating;
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abuse of mind-altering chemicals (alcohol, smoking, pills, etc.);
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involvement in gambling (casinos, slot machines).
Intrapersonal symptoms relate to processes occurring within a person and caused by changes in his attitude towards himself, his actions, thoughts and feelings. These include:
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increased feeling of self-pity;
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feeling of being unclaimed;
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guilt;
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anxiety, fear, feeling trapped;
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low self-esteem;
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a feeling of one’s own oppression and the meaninglessness of everything that happens, pessimism;
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destructive self-examination, replaying situations in the head related to
with strong negative emotions;
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mental exhaustion;
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doubt about work efficiency.
Each person experiences combustion syndrome with varying degrees of symptom severity. The initial assumption that the most vulnerable to burnout syndrome are people who have worked for many years in helping professions is not always true; as it turned out, over time, many of them adapt to the profession and develop their own ways of preventing burnout syndrome. Much more cases of SES occur among young professionals.
Models of the syndrome
There are several scientific models of the syndrome. The most common is the three-component model, according to which the professional burnout syndrome includes three components: emotional exhaustion, depersonalization and reduction of personal achievements.
Emotional exhaustion
The development of emotional burnout syndrome is preceded by a period of increased activity, when a person is completely absorbed in work, to the detriment of his needs in other areas of life. This leads to the development of the first sign of combustion syndrome - emotional exhaustion. Emotional exhaustion is expressed in the appearance of emotional emptiness and a feeling of fatigue caused by work. The feeling of fatigue does not go away after a night's sleep. After a period of rest (weekends, vacations), it becomes smaller, but upon returning to the usual work situation it resumes with the same force. Emotional overload and the inability to replenish energy lead to an attempt at self-preservation through detachment and alienation. A person is no longer able to do his work with the same energy. The work is carried out mainly formally. Emotional exhaustion is a major symptom of professional burnout.
Depersonalization
In the social sphere, depersonalization involves an insensitive, inhumane and cynical attitude towards a client seeking treatment, consultation, educational and other services. The client is perceived as an impersonal object. The consultant may have the illusion that all the client’s problems and troubles are given to him for his good. A negative attitude is reflected in expecting the worst, unwillingness to communicate, and ignoring the client. Among his colleagues, the “burning out” specialist talks about him with hostility and disdain. At first, he can still partially restrain his feelings, but gradually it becomes more and more difficult for him to do this, and in the end they begin to literally spill out. The victim of a negative attitude is an innocent person who turned to a professional for help and hoped, first of all, for a humane attitude.
Reduction of personal achievements
The reduction or belittlement of personal achievements is accompanied by a decrease in the consultant’s self-esteem. The main manifestations of this symptom are:
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tendency to negatively evaluate oneself, one’s professional achievements and successes;
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negativism towards official responsibilities, decreased professional motivation, shifting responsibility to others.
The consultant loses vision of the prospects of his professional activity, receives less satisfaction from work, loses faith in his own professional capabilities, and as a result he develops a feeling of incompetence and doomed to failure.
In this case, we can already talk about the complete combustion of the specialist. The man still retains a certain aplomb and outward respectability, but if you look closely, his “empty gaze” and “cold heart” will become obvious: as if the whole world has become indifferent to him.
Paradoxically, burnout syndrome is a protective mechanism
our body, because it forces us to dose and spend energy resources sparingly. At the same time, this statement turns out to be true only in the case when we are talking about the very beginning of the formation of this state. In later stages, “burnout” negatively affects the performance of professional duties and relationships with others. The “burning” person may not be aware of the reasons for the processes occurring in him. To protect himself, he stops perceiving his own feelings related to work. Formalism, harsh intonations and cold looks, to which we are almost accustomed in clinics, schools, and other administrative organizations, in most cases are manifestations of emotional burnout syndrome.
CAUSES OF THE SYNDROME
PROFESSIONAL COMBUSTION
There are two main groups of reasons that play a key role in
formation and development of professional burnout syndrome: causes
internal and external nature.
Internal reasons
- are associated with individual characteristics of a person: age, high expectations, self-criticism, dedication, readiness for hard work, the need to prove one’s worth.
External reasons
- are associated with the characteristics of professional activity: “difficult” contingent, emotionally intense activities, difficult working conditions, increased demands from management, unfavorable psychological atmosphere in the team. Individual characteristics are rather a predisposing factor, and the characteristics of the profession are a determining factor. This statement can be easily verified if the influence of external causes is reduced: all other things being equal, professional burnout syndrome will not develop. There is an additional number of external reasons that can also lead to the development of specialist burnout syndrome or its intensification. Illness, death of loved ones, divorce, wedding, natural disasters, etc. All these factors can also increase a specialist’s stress and lead to burnout syndrome.
Currently, the risk of developing emotional burnout syndrome is recognized as possible for people in various fields of activity. This is explained by the fact that during the working day, almost any person has a number of short-term contacts with unfamiliar/barely familiar people, and there are also other factors that increase the risk of developing SES.
In psychology, when talking about solving a problem, the first step is acceptance of the situation. This moment is very important! A person needs to feel the ground under his feet in order to have something to push off from.
on the path to change.
PREVENTION METHODS
AND WORK WITH SES
The branch of psychology devoted to emotional burnout syndrome has emerged relatively recently. Despite this, SES is a fairly studied phenomenon, and many techniques have already been developed to work with it and achieve positive results. After conducting a short survey and using the experience of SES training, we have collected several particularly interesting techniques that can be used as a basis for further personal growth and prevention of burnout syndrome. F SES
WORKING WITH BELIEFS
AND ILLUSIONS
Burnout is primarily a disappointment. Disappointment occurs when we are faced with a reality that is different from our beliefs and illusions. The presence of illusions is inevitable. As children, we all read books about hard-working, kind and beautiful heroes. Our parents passed on to us age-old folk wisdom in very succinct and clear messages: fairy tales, myths, proverbs. If a person has no illusions at all, he can be called a cynic. And cynicism is one of the signs of SES.
The assimilation of any new information in our minds occurs in the form of beliefs. A belief is a short message that, during its existence, makes life easier, helps to understand reality and recognize oneself in it. Conviction determines our attitude towards ourselves and towards environmental phenomena. With the help of beliefs, we evaluate everything new and relate it to our vision of the world. A feature of beliefs is the combination of reality with an ideal, and with an ideal that is difficult to achieve. Every belief has its own age. When the distance between reality and the “ideality” of a belief becomes obvious, it stops working positively for us and begins to cause harm. The inaccessibility of the ideal image, which is present in the belief, causes negative emotions, expressed in the so-called four “poisonous feelings”: fear, guilt, shame, resentment. If you find these feelings in yourself, know that you are characterized by irrational beliefs that can lead to a dead end.
How to define an irrational belief?
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It contains words such as: Nobody, Everyone, Always, Never, Must, Shouldn't.
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“Poisonous Feelings” is definitely nearby.
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The statement contains a certain ideal image that is difficult to realize in reality.
Here are some of the most common types of irrational beliefs:
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Since I work with people, I shouldn't have my own psychological problems.
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My clients should love me and be grateful for my work.
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If clients are disappointed in our work together, then I mean something
I'm doing it wrong.
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My clients must be just as responsible and motivated
and hard workers like me.
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I must never make mistakes.
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The client's interests are higher than personal interests.
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I won't be able to work anywhere else.
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I must know the answers to all questions.
Let's look at one of the beliefs and analyze its pros and cons to understand how it can influence the work of a specialist. And we reformulate the belief so as to strengthen its positive aspects and remove the negative ones.
As an example:
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I must know the answers to all questions.
The positive side of this belief is the incentive to learn and
growth of professionalism. A consultant or doctor who has this belief may be afraid of difficult questions and unexpected situations that can cause him to lack confidence in his abilities and, as a result, dissatisfaction with himself as a professional. It is impossible to completely abandon a belief. At the same time, the responsibility that accompanies it is an almost unbearable burden for the doctor. A person cannot know everything! Moreover, thanks to his clients, he learns new things. He has the right not to know the answer now, he can prepare it for the next consultation. You can reformulate the belief taking into account its positive side as follows: thanks to my clients, I am always in the process of learning; my work pushes me towards self-development.In this form, belief provides more freedom, retains positive properties, and eliminates the possibility of “toxic feelings” appearing.
WORKING WITH EMOTIONS
Emotions are human reactions to internal and external conditions. Emotions
accompany us every minute of our lives. Emotions determine the significance of phenomena and situations. They signal us about changes in the environment and encourage us to take action. We talk about emotional exhaustion as a main component of burnout syndrome. Let's figure out what's going on. Why do emotions burn out? Almost every language has the phrase “cup of patience.” A person tolerates when he doesn’t like something, when he experiences tension, resentment or anger. But sometimes the cup overflows.
As an illustration, let's imagine a small child who wants to eat, but his mother is not around. He cannot speak and generally knows little about our adult world. How to call your mother? He has feelings for this. In this case, it is a feeling of hunger and/or fear. And they help the child solve the problem. He expresses them: he screams! Here and now, without hesitation, simply because he cannot yet do it differently. As a child grows up, he hears more and more often: “Don’t shout!”, “It’s indecent to behave like that,” “You’re already an adult to be so impatient,” “Why are you crying? Boys/men don't cry." Simply put, the main messages he receives are: “Be patient!”, “When entering the world of adults, learn to restrain your emotions.”
A person gradually learns to deal with his feelings in the way required by the cultural environment around him. He masters the skill of “putting” them into his cup of patience, because it is impossible to completely get rid of experiences. He is still willing to scream if he is hungry or angry. But he doesn’t do this, realizing that if you shout when the cafe doesn’t take your order for a long time, they may refuse to serve you at all. He
capable of howling from loneliness, but only being sure that no one will see or hear him. Because society condemns such behavior, regarding it as “indecent.”
The human body reacts sensitively to the replenishment of the cup of patience and, whenever possible, strives to get rid of accumulated feelings. For example, a situation in which many have been more than once. Morning, a gloomy man is walking, and suddenly someone steps on his foot. If, for clarity, we use the scale for measuring the strength of earthquakes, this situation will reach 3 points. But if a person is in a state that can be defined as “everything in this life is enough!”, then he can “bark” at the unfortunate person in such a way that the situation will already reach 8 points. Where does this reaction come from? Let's take a closer look at it. An event occurred that caused certain negative feelings. How does the body react? He immediately begins to search for similar experiences in the cup, and if he finds them, he adds them to those he has just received. This, of course, greatly spoils the lives of others.
Let's imagine what will happen if a person closes the cup by force of will, stops expressing accumulated feelings, but remains in a society where there are always reasons for irritation. What will a closed cup of patience give to the body?
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The first thing is probably a red face! Because feelings are like a cough:
It is impossible to stop a person from coughing. He will, of course, be able to withstand it for a while, but not for long.
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Headache is one of the first symptoms of strong unexpressed feelings.
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Insomnia - it will come after a headache, because thoughts and unexpressed feelings take away from us a restful, restorative sleep.
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Changes in blood pressure - feelings weigh heavily on a person. Blood pressure drops, unable to bear the load. If the body
will still struggle, blood pressure will increase.
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Stomach pain and ulcers are a proven mechanism for the manifestation of stress from unconscious, unexpressed, negative feelings. Have you seen anyone who suffered from an ulcer from happiness?
And so on. And this is largely due to feelings that cannot find a way out. This is called the fashionable word today “psychosomatics”.
Psychosomatics
(from the Greek “psyche” - soul and “soma” - body) - a branch of medical psychology that studies the influence of psychological factors on the occurrence of a number of somatic diseases. There are a number of diseases in which the role of psychosomatic factors is extremely large: bronchial asthma, hypertension, angina pectoris, duodenal ulcer, ulcerative colitis, neurodermatitis, nonspecific chronic polyarthritis, hypertension, diabetes mellitus, glaucoma.
What can you do to avoid this extensive list of diseases?
The answer is to act.
Healthy ways to manage feelings:
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Express your feelings immediately, do not accumulate them. But feeling angry, not
be sure to scream. You can say about him. And you will immediately feel that it has become easier.
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Your feelings are the most faithful assistants in the decision-making process.
Use them.
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Agree with your feelings. Try to understand what they want to “tell” you.
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Recognize your “scandalous” feelings and use them not to manipulate other people, but to improve the situation in permitted ways.
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Explore your feelings. One of them can “close” the other - the true one.
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Allow yourself to experience your feelings as fully as possible.
RESOLUTION OF CONFLICT SITUATIONS
The “person-to-person” system always presupposes the presence of at least one of two fronts of work that require a large amount of strength and energy: clients, superiors and colleagues. For example, a person working in production does not have the first front of work, but has the second - colleagues and superiors. Sometimes there may be more such fronts. For example, a teacher has three of them: children, bosses and colleagues, parents.
Each of the fronts of activity is based on communication, in which problems often arise. We are all human, and each of us naturally has our own needs, desires and opinions. This means that conflicts cannot be ruled out. When conflict arises, what does it mean? This means that some of our needs (opinions or desires) come into conflict with the needs of another person. Shouting and excessive persistence in defending one’s position on the part of one or both parties to the conflict will only lead to aggravation of the conflict, to the accumulation of resentment and anger towards each other.
There are a great many ways to resolve conflicts; it is hardly possible to describe all of them in one work. We offer one of the methods, the most effective and easy to use.
Usually no one is responsible for the conflict,
but everyone is responsible for resolving it.
Before attacking colleagues with fists, listen with clenched teeth
bosses or, overcoming yourself, to advise a “problem” client, try our form of resolving a conflict situation. SITUATIONS My vision of the situation
The first point of this form helps to clarify the situation, i.e. determining and comparing the positions of participants. To get out of a conflict situation, the first thing you need to do is find out whether the participants correctly understand what the subject of their dispute is. For example, if a conflict is associated with the behavior of one of them, it is possible that for a person it is the norm, and he may sincerely not understand why and why it does not suit/interferes with those around him.
My feelings
Labeling our feelings allows us to define in a socially acceptable manner our attitude towards the situation that caused the conflict. That is, for example, a feeling of irritation or anger indicates that another person is committing some action that violates the integrity of our space. If we take feelings out of this form, we can make it more difficult to get out of the conflict. By naming our feelings, we seem to release them, without thereby destroying either ourselves or the other person. Of course, the question is how to talk about anger, for example. You can say that the conflict will only get worse, or you can say it in another way: as a natural phenomenon for humans. And accordingly, if we have already begun to solve the problem and even resorted to forms of exiting the conflict, it is worth increasing the effectiveness of this work by using a calm tone of conversation. After all, if both participants are restless, the conflict will not be resolved. By naming our feelings, we already half resolve the conflict.
My actions
At this stage, we, having explained our vision of the situation and reacted to it with our feelings, voice our intentions. As adults and reasonable people, we must first understand what does not suit us. In addition, we should remember that no matter how hard we try, changing another person is an unattainable task. Therefore, you will have to agree to certain concessions or actions. We must also be aware that the other party to the conflict may not be willing to find a way out and change their position. In such a situation, the main thing is to do everything possible on your part to resolve the conflict.
My expectations from my opponent
etc.................
The article analyzes the phenomenon of “professional deformations”, which are destructive personality changes that arise after many years of performing the same professional activity. This condition not only negatively affects the productivity of this activity, but also gives rise to undesirable qualities in a person that change his professional behavior. Professional deformations can lead to changes in the mental structure and qualities of a person (behavior, methods of communication, stereotypes of perception, character, value orientations, etc.), they are also one of the reasons that impede a person’s professional development.
Various concepts of the structure of professional deformations are considered. So, E.F. Zeer classifies professional deformations based on four levels of their manifestations, A.K. Markova - according to the main trends, A. Pines, I. Aronson and A. Chirom understand professional deformations as a one-dimensional construct, D.V. Dierendonk, W. Schaufeli, X.J. Sixma - as a two-dimensional structure, B. Pelman, E. Hartman, K. Maslach, S. Jackson, and B.A. Farber identifies three constructs of professional deformations, and G.Kh. Firth, A. Mims, I.F. Ivanichi and R.L. Schwab present professional deformations as a four-factor model, where in addition to emotional exhaustion and reduced professional achievements, depersonalization associated with work and depersonalization associated with recipients are considered.
It is concluded that in domestic and foreign psychology there is no single point of view on the structure of this state.
This section is devoted to psychotherapy for “own use” by doctors of various specialties, because it will talk about the so-called. professional stress among doctors - a special type of stress disorder, the causes and features of the course of which are directly related to medical practice.
The problem of professional stress among doctors of various specialties is one of the leading areas of activity of modern medical and psychological science. This fact is due to a number of reasons, both extra- and intra-scientific.
First of all, the interest in professional stress among doctors is caused by the general trend towards the humanization of modern science, which is reflected in a variety of fields - from the theory of team management to fundamental philosophical epistemology and methodology of science. One of the manifestations of this trend is to attract the attention of researchers to the subject of professional activity, in particular, to the influence of the very nature of this activity on him.
Another reason that led to interest in this problem is the tightening of requirements for professionals of various profiles, imposed by the tempo-rhythmic characteristics of the modern lifestyle. Particularly important in this regard are the requirements for representatives of the so-called. “helping professions”, because the effectiveness of their professional activities, the importance of which in modern society can hardly be overestimated, directly depends on their psychophysiological state. In particular, the importance of studying this issue as applied to medical workers is extremely high, because The “price of a mistake” in their activities is often human life.
The most common form of manifestation of professional stress among specialists in “helping professions”, incl. among doctors, is the so-called “emotional (or mental) burnout syndrome”- a state of physical, emotional and mental exhaustion. Traditionally, three components are considered in the structure of clinical manifestations of occupational stress:
- actual emotional exhaustion b - a state close to the so-called anaesthesia dolorosa psychica (painful/sorrowful mental insensitivity), consisting in a “flattening” of the emotional background with a certain predominance of negative emotions, combined with a painful feeling of difficulty in experiencing vivid emotions (the peculiarity here in comparison with the “traditional” anaesthesia dolorosa is that this condition subjectively directly associated with one’s own work);
- cynicism- a cold, insensitive, inhumane attitude towards the patient, seeing him not as a living person, but only as an “organism”, an object of certain actions (in Western - and domestic literature based on it - this component is often called “depersonalization”, which does not correspond at all to domestic traditions of using this term);
- reduction of professional achievements- devaluation of one’s professional experience, a feeling of one’s own incompetence, professional failure, lack of prospects.
The listed three components form the “core” of the syndrome of emotional burnout among doctors. They can also be accompanied by a wide variety of adventitious symptoms. In addition, there is a whole range of “masked” forms of professional stress, the identification of which requires the intervention of a specialized specialist - a psychotherapist or psychologist.
It can be confidently stated that in the structure of clinical manifestations of professional stress among specialists in “helping” professions (the so-called “emotional burnout”) there are features that bring this phenomenon closer to a number of traditional mental (such as asthenic neurosis) and psychosomatic disorders. This state of affairs allows us to speak about the presence of a psychological link in the etiopathogenetic structure of professional stress, which plays almost the leading role in the emergence and development of this phenomenon.
As already indicated, the most important psychological aspect of any disorder is its subjective picture, i.e. a complex of sensations, feelings, experiences and knowledge present in a person suffering from a given disorder and arising in connection with the disorder. It is obvious that the role of the subjective picture of the disorder is especially important in the etiopathogenesis of mental and psychosomatic disorders, in the structure of which it occupies a place comparable to the place of the so-called. an acceptor of the results of action within the framework of a normal, “healthy” functional system, not only being a reflection of suffering, but also largely determining its content through the mechanism of reverse afferentation.
Consequently, the emergence and development of professional stress in response to a system of stress factors characteristic of a particular profession does not occur directly, but is mediated by a subjective picture of stress, especially that component of it, which can be designated as a “subjective picture of a system of stress factors.” ", the features of which reflect the specific combination of stress factors characteristic of this profession.
At the same time, often among specialists in helping professions - especially doctors - the subjective picture of professional stress is on the “periphery” of consciousness. That's why first step Both prevention and correction of professional stress is a systematically organized analysis by the doctor of the system of stressors present in his work.
For analysis as myself O Given the combination of stress factors characteristic of a given specialty, and its subjective picture for a given doctor, the following two-dimensional classification seems very convenient:
One dimension Stressors are divided into three groups according to the degree of specificity for a given profession:
- nonspecific stressors;
- general specific stressors characteristic of a group of related professions (in this case, for medical specialties, for example, caused by emotional empathy for a patient);
- specific stressors that are specific to a given specialty (for example, caused by ergonomic miscalculations of designers and manufacturers of surgical equipment).
The second dimension of the classification of stressors goes back to the division of stress factors introduced by G. Selye into social, psychological and biological .
In accordance with this classification, for example, physical discomfort caused by the mentioned ergonomic miscalculations of designers and manufacturers of surgical equipment should be classified as a specific biological stress factor in the professional activity of a surgeon.
Directly for the analysis procedure, in order to increase its clarity, the following table can be used, in the cells of which the doctor should indicate those features of his activity that, in his opinion, fall under the corresponding class of stressors:
The result of this analysis procedure will be a visual three-dimensional model of a system of stressors, characteristic either of a given medical specialty, or directly for the personal professional activity of a given doctor. Two dimensions of this model are specified by the classification described above, and the third is determined by the subjective “weight”, the significance of each class of stressors.
For example, a recent study showed that the system of stressors in the activities of surgeons, compared to doctors of other specialties, is characterized by the following features: high subjective significance of social stressors, i.e. conflict situations in the relationship between a doctor and a surgeon at various levels - from society as a whole (inadequate remuneration for work) to a specific operating team (suboptimal interaction with colleagues and nursing staff); focus on highly professional (privately specific) problems. These results can be visually presented in a diagram.
Subjective significance of various classes of stress factors in the professional activities of surgeons and non-surgical doctors
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S - social, P - psychological, B - biological stressors; NSp - nonspecific, OSp - general specific, ChSp - particular specific stressors.
The second step prevention or correction of professional stress in the work of a doctor should include introspection and self-assessment of the clinical manifestations of it in one’s own behavior and activities. It is important that the assessment of clinical manifestations is not carried out before, A after procedures for analyzing the system of stressors, because the latter gives the doctor preliminary subjective grounds suspect have professional stress and will contribute to a more impartial assessment of their behavior and activities.
It should be taken into account that professional stress can occur not only in the form of its “main clinical form”, described at the beginning of this section (emotional exhaustion, cynicism, reduction of professional achievements), but also in a variety of masked (larded) or “converted” forms. (somatized) forms.
The most typical of the disguised forms of professional stress, especially in individuals of hypersocialized or neurasthenic types, is the so-called. “workaholism” is the replacement of all spheres of life with professional activities. In such cases, the increase in the share of professional activity compared to other areas of life - leisure, family, cultural, etc. - is caused by attempts to compensate for insufficient satisfaction with the results of one’s work, which is subjectively interpreted as a consequence of insufficient labor effort.
In addition to the usual forms (“cynical” and “workaholic”), occupational stress can also take somatized forms, which in many respects are similar in their clinical manifestations to “classical” psychosomatic diseases. In other words, occupational stress can lead to functional - and in especially advanced cases, organic - disorders of the cardiovascular, digestive and respiratory systems, and to neurodermatitis.
Finally, the use of psychoactive substances, in a typical case alcohol, can be an extremely important form of occupational stress. Obviously, in such cases, psychoactive substances are used as a kind of “self-medication”.
Based on the results of the first and second steps, the doctor can conclude that there is a threat of professional stress, or that it already suffers from it.
The third step prevention or correction of professional stress should be the definition of a system of measures that a doctor should take to avoid a threat or to correct his existing professional stress. In this case, measures, as in the case of any other psychotherapy - including autopsychotherapy - can be divided into three classes: causal, pathogenetic and symptomatic, in accordance with those target aspects of the disorder that should be subject to corrective intervention. Obviously, causal measures are aimed at eliminating or reducing the impact professional stressors, characteristic of the activity of a given doctor, and symptomatic ones - for reduction manifestations professional stress in his case.
For example, if one of the significant stressors is broken relationships with patients, measures should be taken to form the so-called. "psychotherapeutic climate" in this area. From the doctor’s side, this looks like a “supportive”, sympathetic attitude towards the patient, manifested in appropriate speech expressions and gestures. At the same time, the “relationship scenario” changes - and the patient, for his part, practically finds himself forced behave differently towards the doctor.
On the other hand, if a given doctor’s professional stress takes the clinical form of “workaholism,” then he should consciously and purposefully restructure the structure of his lifestyle in order to “artificially” expand its non-work components.
The most complex class of measures for the prevention and correction of professional stress are pathogenetic measures aimed at changing the mechanisms that ensure the relationship between the system of stressors and the clinical picture of stress. Typically, this quality is represented by the typological features of the doctor’s personality and the features of his biography. For example, the mechanism for the emergence of a clinical picture of professional stress of the “workaholism” type in individuals of a hypersocialized or neurasthenic type has already been mentioned above. In general, the variety of such mechanisms, which represent a subclass of a more general class of personality defense mechanisms (this concept was introduced and developed mainly within the framework of the psychoanalytic “family” of psychotherapeutic directions), is extremely large.
Determining the system of pathogenetic mechanisms in a particular case is a difficult task, usually requiring the intervention of a specialized specialist, psychotherapist or psychologist. However, in most cases, for the successful correction of professional stress, a well-thought-out system of causal and symptomatic measures, determined by the doctor independently, is quite sufficient - and only in the case when they do not give the desired result, is it really necessary to contact a specialized specialist.
Thus, the “algorithm” for the prevention or correction of professional stress can be briefly summarized as follows:
- First step: self-analysis of the system of stressors, determining the significance of each class of stressors;
- Second step: self-analysis of clinical manifestations of possible professional stress, making a decision about its presence/absence/threat.
- Third step: formation of a complex of corrective and preventive measures;
- Fourth step: implementation of a program of corrective and preventive measures;
- Fifth step: control of results - repeated analysis of the system of stressors and the clinical picture, assessment of the changes that have occurred, making a decision on continuing/changing the implementation of the program of corrective and preventive measures, or on the need to contact a specialized specialist.
Previously, your business activity could be envied, but now many people say that you look tired and irritated. Yes, you yourself are concerned about your condition, but you don’t know what the reason is and what can be done. Let's try to figure it out...
Today we will talk about a phenomenon that pretty much ruins the lives of many of us - professional burnout syndrome. It is hardly possible to develop a plan of five to ten points, the implementation of which would lead to complete recovery. However, we hope that by reading our article you will expand your understanding of this phenomenon and be able to find ways to overcome it.
Psychologists' opinion
Professional activity is full of stressogens. Among the main ones, psychologists name the following:
The need to communicate a lot and intensively with different people, familiar and unfamiliar. Every day you have to deal with different problems of many people, and such contact from an emotional point of view is very difficult to maintain for a long time. If you are characterized by modesty, shyness, isolation and concentration on the problems of “everyday work,” then you tend to accumulate emotional discomfort.
Frequently work in situations requiring high efficiency(you should always be nice, charming, polite, organized, collected, etc.). Such publicity and strict external control on the part of both the manager and colleagues can, over time, cause internal irritation and emotional instability.
Emotionally tense atmosphere(flow of calls, things to do “for yesterday”, receptions, visits, dependence on the mood of the manager), constant control over the correctness of your actions. In conditions where demands exceed your internal and external resources, stress arises as a natural reaction.
Unfortunately, managers are more often inclined to shift all responsibility for professional burnout onto you, citing poor training and personal characteristics. In fact, this syndrome occurs as a result of many factors: the environment in which one has to work; education received; working conditions and personal issues.
In psychology, professional burnout syndrome is defined as one of the manifestations of long-term work stress, as well as some types of professional crisis. It arises as a result of the accumulation of negative emotions without a corresponding “discharge,” which leads to the depletion of a person’s emotional, energetic and personal resources.
The concept of “professional burnout” appeared in the psychological literature relatively recently. It was first introduced in 1974 by the American psychiatrist Herbert Freudenberger to characterize the psychological state of healthy people who work in the “person-to-person” system, intensively and closely communicate with clients (patients) in an emotionally “loaded” atmosphere while providing professional assistance. University of California psychology professor Christina Maslach and her colleagues have developed a scientific approach to studying the problem of professional burnout, viewing it as a three-component system that includes:
Emotional exhaustion (decreased emotional background, indifference or emotional satiety).
Depersonalization (deformation of relationships with other people or increased dependence on others, the emergence of a negative, even cynical attitude towards others).
Reduction of personal achievements (tendency to negatively evaluate oneself, one’s professional achievements and successes, limiting one’s capabilities, obligations towards others).
So, although science has long proven that without stress a living creature dies, too often being in stressful situations is toxic to the human psyche. When there is a heavy load at work, it is important to set a voltage level that is safe for the nervous system. Then professional burnout will be brought under control or avoided altogether.
Let's put everything on the shelves
In order to assess your emotional state and the possible presence of symptoms of professional burnout, you need to get a clear picture of them. In psychology, it is customary to divide the symptoms of professional burnout into three groups:
psychophysical;
socio-psychological;
behavioral.
Carefully read the characteristics of each of them and try (but without fanaticism) to analyze your internal state.
So to psychophysical symptoms professional burnout include:
feeling of constant, persistent fatigue (a symptom of chronic fatigue);
feeling of emotional and physical exhaustion;
decreased sensitivity and reactivity to changes in the external environment (absence of a curiosity reaction to the factor of novelty or a fear reaction to a dangerous situation);
general asthenia (weakness, decreased activity and energy, deterioration of blood biochemistry and hormonal parameters);
frequent causeless headaches;
persistent gastrointestinal disorders;
sudden weight loss or weight gain;
complete or partial insomnia (quick falling asleep and lack of sleep in the early morning, starting at 4 a.m., or, conversely, inability to fall asleep in the evening until 2–3 a.m. and “difficult” awakening in the morning when you need to get up for work);
constant lethargy, drowsiness and desire to sleep throughout the day;
shortness of breath or difficulty breathing during physical or emotional stress;
a noticeable decrease in external and internal sensory sensitivity: deterioration of vision, hearing, smell and touch, loss of internal, bodily sensations.
Social and psychological symptoms Professional burnout is such unpleasant sensations and reactions as:
indifference, boredom, passivity and depression (low emotional tone, feeling depressed);
increased irritability to minor events;
frequent nervous breakdowns (“withdrawal”, outbursts of unmotivated anger or refusal to communicate);
constant experience of negative emotions for which there is no reason in the external situation (feelings of guilt, resentment, suspicion, shame, constraint);
a feeling of unconscious anxiety and increased anxiety (the feeling that “something is not right”);
a feeling of hyper-responsibility and a constant feeling of fear (“I won’t be able to do this”, “I can’t handle it”);
a general negative attitude toward life and professional prospects (“no matter how hard you try, nothing will work out”).
TO behavioral symptoms Professional burnout includes the following actions and behaviors:
the feeling that the work is becoming harder and harder, and doing it is becoming more and more difficult;
a noticeable change in the working day;
regardless of objective necessity, you constantly take work home, but do not do it at home;
feeling of uselessness, decreased enthusiasm for work, indifference to results;
failure to complete important, priority tasks and getting stuck on small details; spending the majority of working time on performing automatic and elementary actions (little conscious or unconscious) that does not meet job requirements;
distance from employees and clients, increased inappropriate criticality;
a sharp increase in the number of cigarettes smoked per day, alcohol abuse, and drug use.
Among the symptoms that appear first are a feeling of fatigue and increased irritability, turning into unmotivated aggression towards colleagues. The reasons for this behavior lie in internal tension caused by dissatisfaction with oneself or other internal conflicts, which you, as a rule, are not aware of. Tension gradually accumulates, resulting in the need to “reset” it. When this need makes itself felt, then, unfortunately, the “last straw” is any difficulties that previously did not cause a strong emotional reaction in you.
How to determine your emotional state
Professional burnout syndrome usually begins so quietly that it is not always possible to notice its occurrence. At first, emotions are simply muted, dissatisfaction with oneself is felt, or, conversely, insensitivity to things that usually cause a sharp reaction appears. At the same time, a person begins to be haunted by inexplicable headaches and back pain, endless colds and insomnia.
At the second stage of this syndrome, the psychological state manifests itself at the level of emotions. Like a mirror reflecting your inner world, your emotional sphere begins to produce negative energy. It is during this period that an unfriendly attitude towards people with whom you have to communicate every day arises: they irritate, make you angry. To avoid these negative experiences, you may unconsciously withdraw from colleagues and visitors, doing only the minimum amount of work.
But this can't last forever. The third stage begins - exhaustion. There are no more emotions, strength, will... The work is done on autopilot. Sharpness, anger, rudeness, detachment, isolation, and revaluation of professional values appear. You are offended by the whole world and yourself. Fortunately, this phase is rarely reached.
In the first two stages of professional burnout syndrome, it is possible to recover, but to return to normal life, you must either learn to live with what you have, or change the situation.
To manage the situation, it must be studied. Therefore, we invite you to check your emotional state using the Burnout Syndrome technique. It will allow us to determine the severity of the main components of this syndrome and thus establish a general indicator of professional burnout. Regardless of the results, even if it seemed to you that this problem does not concern you, we believe that preventive measures would not be superfluous.
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Methodology “Burnout Syndrome” Here are 22 statements about feelings and experiences related to work. Please read each statement carefully and decide if you feel this way. If the described sensation is not typical for you, mark position 0 on the answer form - “never.” If this is typical for you, indicate how often. To do this, put a point next to the question that corresponds to the frequency of occurrence of a particular feeling. Answer form
Processing and interpretation of results Please determine the amount of points for three main indicators: Emotional exhaustion- the results are calculated for the following questions: 1, 2, 3, 6, 8, 13, 14, 16, 20. The maximum possible sum is 54. Depersonalization- the results are calculated for the following questions: 5, 10, 11, 15, 22. The maximum possible sum is 30. Reduction of personal achievements- the results are calculated for the following questions: 4, 7, 9, 12, 17, 18, 19, 21. The maximum possible score is 48. |
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We create protective mechanisms
People with the following characteristics experience a lower health risk of professional burnout:
good health;
conscious, targeted care of one’s physical condition (constant exercise and maintaining a healthy lifestyle);
high self-esteem and confidence in yourself, your abilities and capabilities.
In addition, professional burnout is less likely to occur for those who have experience successfully overcoming professional stress and are able to make constructive changes in stressful conditions. They are sociable, open, independent and strive to rely on their own strength, constantly improving their professional and personal level. Finally, an important feature of individuals who are resistant to professional burnout is the ability to form and maintain optimistic attitudes both towards themselves and other people and life in general.
So, it is necessary to remember that low performance during a crisis does not deprive you of your professional qualities and you continue to remain a valuable employee.
There are several methods of psychological recovery from a difficult situation that will help neutralize professional burnout. The latter in the early stages is almost completely correctable without the help of psychologists and special medical devices.
- this is a panacea for almost all ills and a cure for all mental trauma. For some, auto-training or meditation is more suitable, for others, daily exercises or dousing with cold water, and for others, running or modern dancing.Complete rest. Without it, effective work is impossible. What is a vacation for you - decide for yourself. There is only one condition - you need to spend some time on rest, and not just “take a nap in the subway.” A change of scenery, new impressions, an emotional shake-up will renew you and, when you return, you will be able to continue working productively.
The Art of Rationalization. Remember that your job is not your whole life. Treat it like a small fragment of your life film.
Psychological withdrawal. In a situation where you are being insulted by visitors or a supervisor, create a mental barrier in the form of glass in a car through which you can see the other but not hear him.
Creating physical distance. You can stand or sit a little further from visitors than usual, look them in the eyes less often, and use signals that implicitly indicate the transience of the conversation. Talk to visitors about superficial, general topics. This will require much less personal resources from you.
Article provided to our portal
editorial staff of the magazine
Introduction.
Due to the intensification of work and the large contribution of medical personnel to the volume and quality of clinical work in medicine, the problem of “professional burnout” of nursing staff has become acute. Professional maladaptation in general has complex connections with personal, socio-demographic factors, economic characteristics, and specific working conditions. At the same time, nursing staff are under the strong influence of the administration of the medical institution and the team of doctors. (See courses, seminars and trainings on personnel management, for personnel officers, HR, HR directors)
To assess the level of professional burnout, a screening of parameters of professional maladjustment was carried out among nursing staff of the 8th department. In the present study, terms were used to describe states of extreme fatigue and depression that were observed among workers in psychiatric institutions involved in working with patients, introduced by X. Freudenberger (1974). Professional burnout syndrome was considered as a reaction to long-term professional stress, which includes three components:
- depersonalization (manifests itself in the deformation of relationships with other people: this may be increased dependence on others or increased negativism, cynicism of attitudes and feelings towards patients, colleagues, subordinates, etc.),
- reduction of professional achievements (manifested either in a tendency to negatively evaluate oneself, one’s professional achievements and capabilities, or in a reduction in one’s own dignity, limitations of one’s capabilities, responsibilities towards others, a feeling of incompetence in one’s professional field or dissatisfaction with the results of one’s work).
emotional exhaustion (feeling of emptiness and fatigue caused by work, decreased emotional background, indifference or emotional satiety),
The employee’s level of loyalty to the organization was also assessed (the assessment method was developed based on the scale of equal-apparent intervals by L. Thurstone (1927)). A loyal attitude to the organization presupposes the employee’s loyalty to its goals, interests, and direction of activity. A loyal attitude can be interpreted as a person’s motivation, for one reason or another, to work in a given organization. (Cm. courses, seminars and trainings on personnel assessment, certification, competencies )
To solve these problems, part of the staff working in the department was surveyed, and at the time of the survey, the focus group was mainly composed of female employees with extensive experience in this field. The main characteristics of this group are shown in Table No. 1.
Table No. 1.
The study used: a professional burnout questionnaire, a scale for assessing an employee’s loyal attitude to the organization, and a sociogram.
Results.
At the time of the examination, nursing staff found the following data (Table No. 2). Indicators of emotional exhaustion varied within the average for all department employees. Two employees showed high levels of depersonalization. Indicators of reduction in personal achievements turned out to be high for the majority of department employees, with the exception of 3 people. 5 employees showed a low level of loyalty to the organization, and the most loyal employees in relation to PB No. 3 were the 2nd.
Table No. 2.
When conducting a correlation analysis of all the studied characteristics, it turned out that all parameters of professional burnout did not depend on the overall work experience, on the length of work in psychiatry, and on the length of service in this department.
At the same time, a correlation analysis of the results revealed a positive relationship between the level of depersonalization and the parameter of employee loyalty to the organization (correlation coefficient = 0.67). We can interpret the presence of such a connection as follows. The more dependent an employee is on the organization, the more loyal he is to it. The more loyalty an employee demonstrates, the more we observe an increase in negativism, cynicism of attitudes and superficial attitude towards patients. Presumably, in an organization where the vast majority of employees have a high level of loyalty, there is no development of the organization, but either stagnation of the process of the organization’s activities or a reduction in activity, because Such people are most often unable to generate new ideas and new ways of working. The real engine of an organization's development are people who are quite critical of what they do, as well as management methods in the institution. It should be understood that people with a high level of loyalty are not the locomotive of development. Also, if we assume that the staff gave socially desirable answers due to various kinds of fears and concerns, then this fact also indicates the employee’s loyalty to the organization, lack of criticality, desire for some reason to belong to the system in which he works . Also in the group of nursing staff, a correlation was noted between depersonalization and emotional exhaustion (correlation coefficient = 0.60). Thus, the greater the emotional exhaustion and fatigue, the higher the tendency of medical personnel to show negativism and indifference towards patients and colleagues, while employees prefer to only formally perform their duties, they become uninterested in their own achievements, and they stop striving for them .
Conclusion.
The study revealed the presence of “professional burnout” syndrome in this department. The main component of the manifestation of the “professional burnout” syndrome is the severity of the reduction in personal achievements (which manifested itself in 73% of department employees). The data presented above indicate that professional activity in a psychiatric department caused professional decompensation among nursing staff due to the development of a higher level of reduction in personal achievements.
The second identified trend was an increase in 50% of employees' loyalty to the institution in which they work, although working conditions are characterized by a high level of stress (50% of employees have a medium and high level of loyalty to the organization, the remaining 50% have a low level).
The data on the connection between the severity of depersonalization and loyalty to the institution in which they work are also interesting: the nurses of the department showed a connection between the increase in signs of depersonalization and increased loyalty to the institution. This can be explained by a violation of the mechanisms of psychological defense against social aggression (dissatisfaction with the actions of the management: the administration and the team of doctors) and the impossibility of directly responding to this aggression.
All this data is applicable to the functioning of departments and the management of medical teams. This study can be considered one of the steps towards determining the characteristics and criteria for the effectiveness of the department and the hospital as a whole. It must be understood that each department has its own set of optimal characteristics, indicating the department’s ability to work productively within the framework of the goals and objectives of this department.