Several young men dressed in prison clothes their legs chained to each other shuffled down the corridor. This was not a scene from a real prison but a famous psychological experiment done at Stanford University, a quarter century ago. Psychologist Phillip Zimbardo was testing the effects of perceived power when ordinary persons are cast into [...]


Burnout – when your job stresses you out

“The pouches under his eyes were like purses that contained the smuggled memories of a disappointing life.” Graham Greene, A Burnt-Out Case

Several young men dressed in prison clothes their legs chained to each other shuffled down the corridor. This was not a scene from a real prison but a famous psychological experiment done at Stanford University, a quarter century ago. Psychologist Phillip Zimbardo was testing the effects of perceived power when ordinary persons are cast into roles of prisoner and jail guard.

The findings were disturbing and the effects on the participants devastating. Zimbardo, the chief investigator, did not realize this initially. But a young psychology graduate Christina Maslach who was watching, was greatly disturbed and persuaded Zimbardo to bring the experiment to a halt prematurely. Christina Maslach later married Zimbardo and became famous in the field of ‘job burnout,’ the subject of my article today.

The main character in Graham Greene’s 1961 novel ‘A Burnt Out Case’ is Querry, a famous architect who tired of his celebrity status travels to the Congo to work in a leper colony. There he meets Dr Colin, the resident physician, who diagnoses him as a ‘burnt out case.’ In 1971 Herbert Freudenberger, an American psychologist first used the term burnout in academic literature. He defined it as a state of mental and physical exhaustion caused by one’s professional life. Professions, where there is intense involvement with people, such as doctors, nurses, policemen, are particularly at risk.

The Maslach Burnout Inventory (MBI) is the standard tool used for measuring burnout in research. It measures problems in three areas; emotional exhaustion, depersonalization and a diminished sense of personal efficacy. In emotional exhaustion, the person feels emotionally drained, tired and down without sufficient energy to cope with the day’s work. There may be physical symptoms such as pain, stomach and bowel problems. In depersonalization, there is cynicism about one’s work and colleagues. Persons affected feel distant emotionally and numb about their work. Burnout leads to reduced work performance, lack of creativity and listlessness and a reduced sense of self-efficacy.

Some symptoms considered typical of burnout are also seen in depression. They include extreme exhaustion, feeling down and reduced performance. Because of this similarity, some people with depression may be mistakenly diagnosed as having burnout. This might lead to inappropriate treatment. For example, a person with depression may be asked to take time off from work to recover. In persons with burnout who are exhausted from work, this may help but depression needs different remedies such as antidepressants or psychotherapy. In burnout, the problems are work-related but in depression, negative thoughts and feelings are not restricted to work but more universal. Other typical symptoms of depression such as low self-esteem, hopelessness and ideas of suicide are not seen in burnout.

What can be done about burnout? At the American Conference on Physician Health held in San Francisco recently, Dr Bryan Sexton, a psychologist from the Duke University presented a simple tool that could be used to reduce the effects of burnout. Though the three features of burnout were emotional exhaustion, depersonalisation and reduced personal efficacy, researchers have found that the main intervention to reduce burnout is to improve a person’s ability to focus on positive emotions. Our perceptions are coloured by how we feel. When we are burnt out it changes what we notice or do not notice of the world around us.

In experiments when people who are stressed are shown negative, positive or neutral images they recall in great detail the negative images but not the positive or neutral images. According to Dr Sexton, “Our brains are hardwired to identify and react to threats. We notice and remember the negative over the positive because there’s an evolutionary advantage in doing so.” Though it makes evolutionary sense to run away from danger rather than wait to admire the beauty of the scenery, in our present world it is detrimental to our wellbeing and happiness.

Dr Sexton and his team tested a simple programme called ‘Three Good Things’ to reduce burnout. For the study, volunteers, just before going to bed, wrote down three good things that happened to them that day. They also labelled each item with one of 10 emotions that have been most closely linked to burnout; joy, gratitude, serenity, interest, hope, pride, amusement, inspiration, awe and love. These positive events need not be major but even minor ones such as watching a movie or spending time with friends count. It is important to take time to write out the events in detail rather than simply remembering the events. Just doing the exercise in our heads does not have the same lasting benefits. The programme retrains our brains to focus on the positive and our role in bringing about positive things.

There are other ways to incorporate the three good things programme into our lives. You can share the three good things with your family, friends or team members in your work place. The sharing appears to extend the benefit. Using this simple programme, 148 internal medicine residents at Duke Medicine, decreased burnout by 15% in just two weeks. A year after the intervention ended, 48% remained resilient, suggesting a lasting effect. There was also significantly less depression, less conflict and better work-life balance.

Another method suggested by Dr Sexton to reduce burnout and increase resilience is to write a letter of appreciation to someone who has had a lasting and positive impact on your life. After writing it is best to read it to the person concerned or if the person is deceased to someone who knew that person well. Even if you do not share the letter, the act of writing will have a positive impact on your mental wellbeing.
The third method advised by Dr Sexton is what he calls “awe intervention.” Finding awe is not difficult, look at a photograph of a beautiful place, take time to admire it. If you have time to travel find something new in nature. “There is such profound beauty and grace in the world,” says Sexton, “When we reconnect with the emotion of awe, it helps us feel inspired and time slows down.”

Three simple things you can do to make your job more fulfilling and your life happier. Just try it.

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