Counseling people suffering from burnout first means understanding the process that they are going through. Burnout is a complex disease that develops over years. A treatment decision must therefore consider the stage of the process which the patient is in.
The boundary between health and illness is vague. Nobody is “absolutely ill” or “completely healthy”. Especially in processual conditions that develop over longer periods, the point at which symptoms indicating that a person is “still healthy” or “already ill” is a subtle quality.
This “healthy–ill continuum” plays a special role when one tries to interpret burnout as a process that begins in health and – after a transition phase – ends in illness. For recognition of the individual phases is not only of theoretical interest, it is also important for the treatment: What treatment is applied at which point of the process, is critical to success.
In the literature on this topic, various approaches describe the phases of a burnout. They vary from three to twelve stages, with the models also differing with regard to whether they consider the order of the stages as fixed or as variable. The classification presented here is based on the transition from healthy to diseased burnout phenomena.
The main characteristics of the three stages
Burnout stage 1: Problem stage (“I can do anything…”)
- Overloading / overtaxing (however, this happens unbeknownst to the affected persons )
- Compensatory mechanisms
- Lack of leisure (activities)
- Neglect of own needs
- Neglect of relationships
- Increased irritability / stress conditions
- Insomnia (difficulty falling asleep)
- Appetency disorders (food, sexuality, etc.)
Burnout stage 2: Transitional stage (“I can still do it…”)
- Overloading / overtaxing (now consciously perceived by the affected person)
- ”Sympathetic tone”, i.e. the autonomic nervous system is in a constant state of arousal. This alertness leads to an increase in performance.
- Lack of leisure (activities)
- Complete concentration on work
- Increasing social isolation
- Stress states / anxiety (especially without work) / fears
- Sleep-onset and sleep-maintenance insomnia
- Increased irritability / depressed mood
- Non-specific psychosomatic complaints
Burnout stage 3: Illness stage (“I cannot do it anymore…”)
- Complete exhaustion (“parasympathetic tone” as a counter-reaction to the alertness in stage 2)
- Inability to work (subjective / objective)
- Social withdrawal / Social phobia
- Chronic pain
- Shortened / prolonged sleep (problems waking up)
- Manifest physical illnesses
- Generalized “lackadaisicality syndrome” (bleak, listless, lethargic, with reduced or no appetite, indifferent, hopeless)
- Weariness of life
The burnout treatment must be geared to the respective stage of the disease. In stage 1, comprehensive inpatient rehabilitation, as it is appropriate in stage 3, does not make sense. For burnout patients in stage 1, analysis in terms of occupational psychology and counseling is important. This is about information and assistance for the individual circumstances of life and resource activation or finding power sources, respectively.
Stage 2 requires psychiatric and psychotherapeutic measures, which go beyond mere counseling. Stage 3 requires complex treatment and rehabilitation addressing physical, psychological, and social problems, but also the individual’s resources.
The goal of the therapy must not be the quickest possible reintegration into the labor market, which would be quite unrealistic and often counterproductive. Rather, the goal is to enable affected persons to return to a joyful and autonomous life.
Musalek Michael, Zeidler Raphaela (2013): Burn-out als Prozess [Burnout as a process] In: Spectrum Psychiatrie 4/2013
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