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A clinical perspective on burnout: diagnosis, classification, and treatment of clinical burnout


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In clinical psychology, burnout is regarded as a mental disorder assessed in patients who apply for psychological treatment and no longer work because of their symptoms or experience of serious problems in functioning at work. This definition of burnout is mostly referred to as ‘clinical burnout’. The purpose of this article is to provide insight into how clinicians in The Netherlands establish a diagnosis of clinical burnout and how they fit it in their classification systems. An outline is given on how psychological interventions for burnout are applied in therapies. The different phases in the treatment of clinical burnout – crisis, recovery, prevention, and post burnout growth, as well as their accompanying interventions are described. It may be relevant for work and organizational psychologists to realize that biological processes may play a role in the development of clinical burnout. For the physiology of stress, it does not matter whether the stress is work-related or the result of stress in private life or both. Central to understanding clinical burnout is the lack of recovery of the (physiological) stress system. It is also argued that the relevance of questionnaires, for detecting who is at serious health risk, is limited.
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European Journal of Work and Organizational Psychology
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A clinical perspective on burnout: diagnosis,
classification, and treatment of clinical burnout
Arno van Dam
To cite this article: Arno van Dam (2021): A clinical perspective on burnout: diagnosis,
classification, and treatment of clinical burnout, European Journal of Work and Organizational
Psychology, DOI: 10.1080/1359432X.2021.1948400
To link to this article:
© 2021 The Author(s). Published by Informa
UK Limited, trading as Taylor & Francis
Published online: 14 Jul 2021.
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A clinical perspective on burnout: diagnosis, classication, and treatment of clinical
Arno van Dam
Tranzo Scientific Center for Care and Welfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands;
Department Research and Innovation, GGZ WNB Mental Health Institute, Research and Innovation, Halsteren, The Netherlands
In clinical psychology, burnout is regarded as a mental disorder assessed in patients who apply for
psychological treatment and no longer work because of their symptoms or experience of serious
problems in functioning at work. This denition of burnout is mostly referred to as ‘clinical burnout’.
The purpose of this article is to provide insight into how clinicians in The Netherlands establish a
diagnosis of clinical burnout and how they t it in their classication systems. An outline is given on
how psychological interventions for burnout are applied in therapies. The dierent phases in the
treatment of clinical burnout – crisis, recovery, prevention, and post burnout growth, as well as their
accompanying interventions are described. It may be relevant for work and organizational psychologists
to realize that biological processes may play a role in the development of clinical burnout. For the
physiology of stress, it does not matter whether the stress is work-related or the result of stress in private
life or both. Central to understanding clinical burnout is the lack of recovery of the (physiological) stress
system. It is also argued that the relevance of questionnaires, for detecting who is at serious health risk, is
Received 11 April 2021
Accepted 22 June 2021
burnout; clinical;
classification; diagnosis;
treatment; psychotherapy
Burnout and clinical burnout
In mental health care, psychiatrists and clinical psychologists
approach mental disorders like diseases. The nature and sever-
ity of symptoms determine whether you have the disease or
not. A symptom is an observed or detectable sign of an illness
or disorder, like fatigue, insomnia, fever, or pain. The combina-
tion of a number of specic symptoms is dened as a disease or
disorder. This also applies to mental disorders like clinical burn-
out. You either have it or you don’t. Having a disorder is there-
fore considered as qualitatively dierent from being healthy
and comprises clinically signicant distress or impairments
(Americain Psychiatric Association, 2013). The onset and course
of a mental disorder, like clinical burnout may comprise quali-
tative dierent phases that dier from each other with regard
to symptoms, emotions, behaviours, severity, and coping
(Åsberg et al., 2010; Carpenter et al., 2019). This conceptualiza-
tion of (clinical) burnout diers from the denition that is used
by work- and organizational psychologists who consider burn-
out as a multidimensional construct that is assessed with ques-
tionnaires in relatively healthy working populations (Schaufeli
et al., 2001).
The denition of clinical burnout is usually based on the
criteria of work-related neuroasthenia in the International
Classication of Diseases (ICD-10; World Health Organization,
2010), and comprises the following features (1) persistent and
distressing complaints of increased fatigue after mental eort,
or persistent and distressing complaints of bodily weakness
and exhaustion after minimal eort; (2) at least four of the
following additional symptoms – insomnia, cognitive decits,
pain, palpitations, gastroenteric problems, sound and light
sensitivity. These complaints and symptoms (3) must be pre-
sent nearly every day for at least two weeks; (4) are due to
psychosocial stressors that have been present for at least six
months before diagnosis; and (5) lead to clinically signicant
distress or impairment (Grossi et al., 2015; Persson Asplund,
2021; Schaufeli et al., 2001).
Fundamental to the dierence between conceptualizations
of burnout applied by clinical psychologists versus work- and
organizational psychologists is the role of biology. Clinical psy-
chologists conceptualize mental disorders from the bio-psycho
-social model whereas work- and organizational psychologists
mainly focus on psychosocial factors (Gatchel et al., 2020;
Schaufeli, 2007; Weber & Jaekel-Reinhard, 2000). The addition
of biology leads to a number of notable dierences in the
conceptualization of burnout. First, from a biological point of
view, it does not matter whether the chronic stress is caused by
working conditions or private circumstances or both. It is about
the consequences of (chronic) stress for the functioning of the
biological processes in the organism that also aect psycholo-
gical processes and social behaviour (Sanders, 2014; Sapolsky,
1998). For clinical psychologists, burnout is therefore not neces-
sarily work-related, but rather stress-related (Van Dam et al.,
2015b). A second dierence that arises from the biological
perspective is that the development of clinical burnout is not
regarded as a linear process but like many biological processes
as a process with qualitative dierent phases (Sapolsky, 1998).
Another dierence compared to the organizational
approach, arises from the fact that clinical psychologists study
abnormal emotions, thoughts and behaviour in individual
CONTACT Arno van Dam
© 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
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patients. Therefore, a considerable attention of clinical psychol-
ogists is paid to individual dierences in maladaptive coping
and psychological dysfunction, whereas less attention is paid to
universal factors in human functioning like work- and organiza-
tional psychologists do. An aspect that may play a role in the
development of psychological disorders is that individuals dif-
fer in the extent to which they are aware of their own feelings,
thoughts and physical signals of stress (Eurelings-Bontekoe
et al., 2009; Ginot, 2017). That is why scores on questionnaires
are not always reliable. For clinical psychologists, people with
elevated scores on a burnout questionnaire are not necessarily
at risk for clinical burnout. Also, individuals with short-term
stress (less than 3 months) show elevated levels on burnout
measures, just like individuals with other mental disorders like
major depression and anxiety disorders do (Kleijweg et al.,
2013; Van Dam et al., 2015a).
It is essential to dierentiate between short-term stress and
clinical burnout, because short-term stress has a more favour-
able prognosis than clinical burnout. Research shows that an
average of 80% of all employees with short-term stress recover
within a few months and are partially or fully back at work
within six to twelve weeks (Van der Klink et al., 2003). The
recovery of clinical burnout, however, may take more than
one year (Eskildsen et al., 2016; Van Dam et al., 2012b). Some
studies show that even after 2 to 4 years, a substantial part (25–
50%) of the patients with clinical burnout is not fully recovered
(Dalgaard et al., 2020; Eskildsen et al., 2016; Van Dam et al.,
2012b). Therefore, questionnaires and assessments that focus
solely on symptom levels are not sucient to make
a distinction between clinical burnout and short-term work-
related stress. It is important, however, to make this distinction,
because the prognosis for recovery of clinical burnout is much
less favourable than for the mild short-term stress disorders.
Both approaches, the clinical and work- and organizational,
are useful and generate specic knowledge about stress, work,
and fatigue. It is relevant to be specic about which denition is
used because it is not known whether ndings obtained in
clinical populations are applicable to the general population
and vice versa (Deligkaris et al., 2014).
Yet another reason to be specic about which denition of
burnout is used is that there is discussion among clinicians and
health insurance companies whether burnout is a mental dis-
order and qualies for reimbursement (Grossi et al., 2015;
Schaufeli, 2007; Van der Voort- van Beusekom et al., 2016; Van
Dam et al., 2017). Clinical samples should therefore be homo-
geneous, consisting of persons with severe symptoms and
fulling the work-related neuroasthenia criteria of the ICD-10
(Grossi et al., 2015; Persson Asplund, 2021; Schaufeli et al., 2001;
World Health Organization, 2010). Research shows that this is
not always the case, which is problematic because it may fuel
discussion about the legitimacy of the diagnosis of clinical
burnout (Bianchi et al., 2015; Van Dam, 2016).
Work- and organizational psychologists who take the
burnout perspective of clinical psychologists may learn
that particularly the combination of work-related stressors
and stress in private life plays a role in the development of
mild burnout symptoms into clinical burnout. In addition,
work and organizational psychologists should be careful
regarding the dominant role of questionnaires that is
prevalent in their work. In this article, I will show that the
relevance of questionnaires is limited when it comes to
detecting who is at serious health risk.
The purpose of this article is to provide insight into how
clinicians establish a diagnosis of clinical burnout and how
they t it in their classication systems, despite the contro-
versies about the phenomenon. Furthermore, an outline is
given on how psychological interventions for burnout are
applied in burnout therapies. In this way, I hope to show
that tailor-made care is needed, not only in the eld of clinical
psychology but also in the eld of work and organizational
psychology. A crucial point is that people with the same score
on a questionnaire may require dierent approaches to pre-
vent mental illness. This is also relevant for work- and organi-
zational psychologists who develop interventions for people
at risk for burnout in the work-environment but also for
researchers interested in dierent pathways to clinical
Diagnosis and classication of clinical burnout
A complication for clinicians to establish clinical burnout and
dierentiate it from mild stress disorders is that burnout is not
included as an ocial disorder in the Diagnostic and Statistical
Manual of Mental Disorders (DSM; American Psychiatric
Association, 2013). In the International Classication of
Diseases (ICD-10; World Health Organization, 2010), burnout is
classied as a “State of vital exhaustion” (Z73.0) under
“Problems related to life-management diculty” (Z73), but it
is also not considered a disorder. In their review, Grossi et al.
(2015) showed that there is no consensus among clinicians
which classication matches clinical burnout. The classications
used by clinicians are “work-related” neuroasthenia (ICD code
F48.0), undierentiated somatoform disorder (DSM IV code:
300.82; ICD code F45.1), severe stress and adjustment disorder
(DSM IV code: 309.9; ICD code: F43.20), “other reaction to severe
stress” (F.43.8), and major depression (DSM IV code: 296.xx.; ICD
code F32.xx). In some studies, clinically burned-out participants
were diagnosed with a range of axis I disorders – mainly anxiety
and mood disorders – when assessed according to DSM criteria
(Grossi et al., 2015). In order to solve the diagnostic controver-
sies, the Swedish Board of Health and Welfare, introduced
“exhaustion disorder” (ED; F43.8A) into the Swedish version of
the 10th revision of the International Classication of Diseases
(ICD-10-SE; Socialstyrelsen, 2010), which resembles “clinical
burnout” and is also based on the criteria of work-related
neuroasthenia in ICD-10 (Grossi et al., 2015; Socialstyrelsen,
2010: World Health Organization, 2010). However, the addition
of exhaustion disorder to the ICD-10 is limited to Sweden and
therefore also not a universally used denition of clinical
This variety in classications for clinical burnout must be
seen in the light of a broader discussion about the tenabil-
ity of classication systems for psychological disorders. The
reliability and validity of traditional taxonomies are limited
by arbitrary boundaries between psychopathology and nor-
mality, often unclear boundaries between disorders, fre-
quent disorder co-occurrence (overlap), heterogeneity
within disorders (subgroups), and diagnostic instability
(symptom change). These taxonomies went beyond evi-
dence available on the structure of psychopathology and
were shaped by a variety of other considerations, which
may explain the aforementioned shortcomings (Kotov
et al., 2017). New dimensional models are developed that
are empirically driven and are based on neuroscience and
advances in quantitative research on the organization of
psychopathology (Clark et al., 2017; Kotov et al., 2017;
Panksepp & Yovell, 2014). These models thus show simila-
rities with the dimensional approach of the organizational
psychologists, although the dimensions seem to be dier-
ent. Some studies suggest that the dimensions associated
with clinical burnout are distress and dysphoria which are
also related to depression, but there is no consensus yet
(Schonfeld et al., 2019; Van Dam, 2016).
Because individuals with short-term stress show elevated
levels on burnout measures, just like individuals with other
mental disorders like major depression and anxiety disorders
a clinician cannot solely rely on questionnaires in order to
make a qualitative distinction between the mild stress disorders
and clinical burnout (Kleijweg et al., 2013; Van Dam et al., 2015
Instead, clinicians need to reconstruct the pathogenesis, which is
the history and sequence of life-events, symptoms, and mechan-
isms that lead to the syndrome (Beekman & Hengeveld, 2014;
Schiavone et al., 2015; Weber & Jaekel-Reinhard, 2000).
Pathogenesis of clinical burnout
In this section, I will explain the dierence between the devel-
opment of clinical burnout compared to individuals who seek
help when having relative short-term stress symptoms (less
than 3 months). Individuals with short-term work-related stress
report a clear relation between a stressor and the mental
problems within a period of not more than 3 months after
the stressor emerged. Stressors that are often mentioned are
conicts with colleagues or the supervisor, a merger, and an
increase in workload (Weber & Jaekel-Reinhard, 2000). The fact
that these persons seek help after a relative short period of
experiencing stress symptoms may be regarded as a healthy
coping mechanism (Bakker & de Vries, 2021; Roohafza et al.,
2016). Patients with clinical burnout, however, report that they
ignored stress symptoms for several years (Maslach & Goldberg,
1998; Weber & Jaekel-Reinhard, 2000). Living a stressful life was
a normal condition for them. Some were not even aware of the
stressfulness of their lives, until they collapsed. The ultimate
reason for collapsing may be a relative minor stressor. The
clinician needs to understand that it is not only that minor
stressor that led to the total breakdown, but that the minor
stressor is the nal straw that broke the camel’s back after years
of chronic stress. Final stressors that are often mentioned by
patients with clinical burnout are conicts, being unable to
relax during holidays, and not recovering from u.
The coping style of clinical burnout patients seems to be
quite dierent from that of patients with short-term stress-
related disorders. Those with clinical burnout are not inclined
to seek help when there is stress but persist without complain-
ing. This observation is in line with research showing that the
coping style of burnout patients is characterized by persever-
ance (continued eort to do or achieve something despite
diculties) and reluctance to asking social support (Martínez
et al., 2020; Van Dam et al., 2013, 2015b; Wallace, 2017).
Research in relative healthy populations suggests that perse-
verance is a protective factor for burnout. Perseverance may
indeed be benecial when someone is actually having control
over one’s situation (Fabelico & Afalla, 2020). However, in case
of lack of control, perseverance is not adaptive anymore and
individuals should shift to other coping strategies like asking
for social support and reecting on one’s situation and feelings
(Bakker & de Vries, 2021; DeLongis & Holtzman, 2005; Sapolsky,
1998; Van Dam et al., 2013). Perseverance may in that case
contribute to the maintenance of chronic stress.
In the literature on fatigue in healthy individuals, it has been
shown that fatigued individuals adapt their performance strat-
egy in order to regulate the mobilization of mental eort
(Hockey, 1997/2011). Strategic adjustments can be achieved,
for instance, by allowing failures for secondary goals. For
instance, an individual may selectively neglect low-priority
task components (e.g., the speed or accuracy of responses) or
they may neglect subsidiary activities or shift to simpler
response strategies with fewer demands on working memory.
Because fatigue is a central characteristic of the burnout syn-
drome, one may expect that burnout patients will also start to
routinely select less demanding performance strategies.
Several studies have suggested that the opposite is true: in
contrast to healthy fatigued individuals, burnout patients do
not appear to be particularly reluctant to expend high levels of
eort (Bakker & de Vries, 2021; Demerouti et al., 2014; Van Dam
et al., 2013). These ndings point out a tendency to cope with
stress with perseverance and trying to maintain high standards
of task performance.
In the reconstruction of the years prior to the establishment
of clinical burnout, a number of phases in the development of
clinical burnout can be distinguished that describe the process
of burning out (Hamming, 2020; Weber & Jaekel-Reinhard,
2000). These phases broadly outline how individuals develop
burnout. Individual variations are, of course, possible and
phases may overlap in time. The phases with their main fea-
tures, processes, and symptoms are described in Table 1.
Lack of recovery
The process to burnout starts with lack of recovery from phy-
siological stress reactions (Geurts & Sonnentag, 2006;
Hamming, 2020; Weber & Jaekel-Reinhard, 2000). A human
being is capable of enduring considerable amounts of stress,
if stressful periods are alternated by periods of rest and one is
able to recover (Ganzel et al., 2010: Geurts & Sonnentag, 2006).
There are fewer opportunities to recover from stress when
there are problems both at home and at work. For example,
there is work stress due to a reorganization and conicts and
there is stress in private life due to caring for ill family members,
long-term problematic renovation of the house, and/or nan-
cial problems. In this phase, individuals may experience need
for recovery and an aversion to spend eort (Hunter & Wu,
2016; Meijman & Mulder, 1998)
Changes in stress physiology
When stress levels continue to be high over prolonged periods of
time, the stress system adapts itself. New homoeostatic stress
values are established, which means that the organism sets
a higher stress level as the default level (McEwen, 2017; Sterling,
2004). Due to chronically elevated stress levels, sleep problems
emerge. People experience diculties to fall asleep because the
stress system is still active at the time they want to sleep. This is
a major problem because sleep quality appears to be predictive of
recovery of burnout (Grossi et al., 2015; Sonnenschein et al., 2008).
Another problem that arises is that people cannot relax anymore
even when there is no pressure. The stress system is activated
whether there is a stressor or not. As a result, individuals become
hyperactive and cannot relax anymore. This often leads to rest-
lessness in spare time and the inability to relax during holidays
(Eden, 2001; Fritz & Sonnentag, 2006).
Chronic stress symptoms
long-term physiological stress leads to physical, mental, beha-
vioural and emotional problems (Geurts & Sonnentag, 2006;
Sapolsky, 1998; Weber & Jaekel-Reinhard, 2000)
Physical symptoms: Stress has a major impact on our
immune system, cardiovascular system, digestive system,
endocrine system, and reproductive system (Sapolsky,
1998). Therefore, chronic stress may lead to a variety of
physical symptoms in burnout patients, like headaches,
intestinal problems, muscle tension or pain, chest pain,
fatigue, change in sex drive, stomach upset, and vulner-
ability to diseases.
Table 1. Phases in the development of clinical burnout.
Phase Main features and process Symptoms
1Lack of recovery:
Stressful events combined with limited
possibilities to recuperate
Need for recovery
Aversion to spending effort
2Changes in stress physiology:
Higher homoeostatic stress values
Sleep difficulties
Inability to relax
3Chronic stress symptoms:
Physical symptoms:
Mental symptoms:
Emotional problems:
Behavioural problems:
intestinal problems
muscle tension or pain
chest pain
reduced sex drive
stomach upset
vulnerability to diseases
concentration deficits
being forgetful and absent-minded
trouble staying focused
impaired learning capability
impaired planning and control
feeling frustrated and angry
feeling upset or sad without knowing why
feeling unable to control one’s emotions
anxiety and panic
social withdrawal
drinking alcohol, taking medicine, eating too
quitting hobbies and sports
Reduction of the complexity of reality
by applying more rigid ways of problem
solving and cognitive simplification
Stigma and blaming the victim
compulsive and rigid behaviour
dependency on others
being suspicious
reduced creativity
reduced empathy
reduced self-reflection
5clinical burnout:
Reduced motivation and passivity
Emotional breakdown
Severe fatigue
Inability to motivate oneself
learned helplessness
mood problems
Based on: Boksem & Tops, 2008; Hamming, 2020; Van Dam et al., 2017; Van Zweden, 2015; Weber & Jaekel-Reinhard, 2000.
Mental problems: Chronic stress also aects cognitive
performance. Several studies have shown that cognitive
functions such as attention, concentration and working
memory are impaired in clinical burnout (Deligkaris et al.,
2014). The cognitive impairments observed in burnout
patients seem to especially aect the more complex,
higher cognitive processes, such as executive functioning
rather than the more simple cognitive processes
(Deligkaris et al., 2014; Van Dam et al., 2011; Van der
Linden et al., 2005). Specic symptoms include diculties
to think clearly and learn new things at work, being for-
getful and absent-minded, indecisiveness, poor memory,
attention and concentration decits, and trouble staying
focused at work. Since executive control is essential for
performance on tasks that require planning, control, eva-
luation, adaptation and problem solving, these impair-
ments may well result in an overall impaired job-
performance (Bakker et al., 2008; W. Schaufeli et al.,
2020; Taris, 2006).
Emotional problems: Stress reduces the capability to con-
trol emotions (Raio et al., 2013). Chronic stress therefore
leads to emotional instability which is manifested by
intense emotional reactions and feeling overwhelmed
by one’s emotions. Specic symptoms include feeling
frustrated and angry at work, irritability, anxiety and
panic, overreacting, feeling upset or sad without knowing
why, and feeling unable to control one’s emotions at work
(W. Schaufeli et al., 2020; Van Dam et al., 2015
Behavioural problems: Due to the cognitive impairments
and increased emotional lability, burnout patients will
have more conicts with other people. The conicts
usually rst arise in private life, because people try to
maintain adequate social functioning at work as long as
possible. In private social situations, burnout patients
tend to withdraw themselves and are more easily agitated
which evokes negative reactions of family members and
friends. Eventually, these conicts also emerge at work.
Another type of behavioural problem that emerges has to
do with the desire of the overstressed person to comfort
him or herself by drinking alcohol, taking medicine, eating
too much, and quitting hobbies and sports. This
unhealthy lifestyle usually makes things worse as it has
a negative eect on sleep quality and health in general
(Monk et al., 2003).
Stress aects the way in which information is processed and
how we deal with the world. In order to reduce stress, indivi-
duals reduce the complexity of reality by applying more rigid
ways of problem solving and cognitive simplication (Hockey,
2011; Michailidis & Banks, 2016). These mechanisms are cata-
strophic in regard to creativity, empathy, and the ability to
reect on complex problems as well on one’s own functioning.
Bakker and de Vries (2021) showed that coping is also aected
by stress. They argue that when stress increases, individuals are
less likely to use adaptive coping strategies (e.g., job crafting
and recovery), which means that they do not build the job and
personal resources needed to cope with ongoing job demands.
As a result of this, it may seem that the person has maladaptive
personality traits. This syndrome, which develops on the basis
of chronic stress, can best be qualied as pseudopsychopathol-
ogy (Van Zweden, 2015).
Importantly, this often leads to the false interpretation of
employers, but also clinicians, that burnout symptoms are
a result of adaptation problems due to maladaptive personality
traits. This may lead to blaming the victim and trying to x the
individual instead of the suboptimal and stressful environment
(Bakker et al., 2014). Pseudo maladaptive personality traits that
are often observed in clinical burnout are obsessive compul-
sive, dependent and paranoid personality traits, which manifest
itself by being very compulsive and rigid, not daring to make
decisions without consulting others or being suspicious.
It is crucial to nd out whether this rigid maladaptive inter-
personal style is a cause or a result of chronic stress. A good
possibility to check this is to ask a relative whether the person
has always been like that or whether personality changed
during the burnout process. Personality disorders are persistent
inexible or impaired patterns of thought and behaviour that
usually cause diculties in forming and maintaining interper-
sonal relationships and in meeting the daily demands of one’s
personal and work life (APA, 2013). These disorders typically
become apparent during adolescence or early adulthood.
Pseudo personality psychopathology develops as a result of
chronic stress and not in a specic stage of life. Moreover, the
newly acquired clinical prole disappears with the recovery
from burnout.
Reduced motivation and passivity (clinical burnout)
This nal stage is the condition in which people meet the
diagnosis of clinical burnout. The hyperactivity that charac-
terizes the initial phase of chronic stress may change to passiv-
ity and a relatively permanent impaired motivation (Boksem &
Tops, 2008; Schaufeli et al., 2020; Van Dam et al., 2015b).
Instead of trying to maintain performance of work tasks at
high levels, burnout patients seem not to be able to motivate
themselves anymore. Research shows that whereas some burn-
out patients are active showing high task engagement, others
are passive showing low task engagement (Tops et al., 2007).
The groups probably reect the dierent phases in the burnout
process. The nal phase in the burnout process that is charac-
terized by chronic demotivation and high levels of stress may
be related to the phenomenon of “learned helplessness”
(Seligman, 1975). Learned helplessness refers to a state in
which a person believes they have no control over the situation
and, therefore, does not try to cope with the situation any
longer and experiences high levels of stress (Sapolsky, 1998).
Several studies showed that burnout patients exhibit implicit
(unconscious) associations with failure, which is also indicative
for learned helplessness (Brenninkmeijer et al., 2001; Van Dam
et al., 2012b).
Treatment of clinical burnout
The variations in the conceptualization of burnout also have an
impact on the literature on the treatment of (clinical) burnout.
Meta-analyses usually fail to make any distinction between
research on interventions for employees with relatively mild
short-term work stress complaints and interventions for
patients with clinical burnout complaints (Ahola et al., 2017;
Awa et al., 2010). Moreover, some interventions are more
focused on the prevention of burnout whereas others are
aimed at the treatment of clinical burnout. Therefore, it is not
possible to draw rm conclusions about the eectiveness of
treatment programmes. However, there are indications that the
majority of patients with clinical burnout improves signicantly
after treatment (Oosterholt et al., 2012; Van Dam et al., 2012b).
In this paper, I will describe the therapeutic interventions that
are commonly used in the treatment of severe clinical burnout.
Various burnout treatment protocols have been described in
the literature (Hamming, 2020; Keijsers et al., 2004; Van Dam
et al., 2017; Van Zweden, 2015). These protocols have in com-
mon that they are aimed at restoring a healthy balance
between eort and rest, recovery from chronic stress, and
improving coping skills. Dierent phases can be distinguished
in the treatment of clinical burnout: (1) crisis, (2) recovery, and
(3) prevention (Hamming, 2020; Van Dam et al., 2017; Van
Zweden, 2015; Weber & Jaekel-Reinhard, 2000). In this para-
graph, interventions will be described for each specic phase
and also which interventions are contraindicated in that speci-
c phase (see also Table 2).
Phase 1 Crisis
The rst phase of the treatment is characterized by crisis (Van
Dam et al., 2017; Van Zweden, 2015). Despite severe fatigue
and distress, the patient tries to fulll all obligations at work
and in private life and notices that (s)he makes many mistakes,
is unable to concentrate, is emotionally unstable and prone to
conicts. It may also be that the patient feels so severely
fatigued that he feels unable to do anything and nds himself
staring and doing nothing most of the time. The patient feels
despair and hopes the therapist can do something that makes
him/her able to again fulll all obligations at work and in
private life.
In this rst phase, it is necessary that the therapist is
empathic to the feelings of the patient but also honest and
straightforward regarding the possibilities of quick recovery
(Van Dam et al., 2017; Van Zweden, 2015). The therapist
makes it clear to the patient that clinical burnout is the
result of prolonged periods of stress and that there are no
quick tricks or solutions. The balance between stress and
restoration has to change and the body needs to recover
and nd a healthy balance again. And this takes time. The
rst thing to do now is to make recovery possible and to
create time and opportunities to take a good look at the
situation (Van Dam et al., 2017). This can be done by drop-
ping almost all responsibilities for the next few weeks. For
many patients, this is very dicult to accomplish because of
strong feelings of responsibility and feeling uneasy about
bothering others. Indecisiveness may also be fuelled by
cognitive impairments (Deligkaris et al., 2014; Van Dam
et al., 2011; Van der Linden et al., 2005). Because higher
cognitive processes such as executive functioning are
impaired, patients may experience diculty getting an over-
view of their situation and diminished problem-solving cap-
abilities. It is recommendable, in this phase of the treatment
that the therapist takes the lead and actively helps the
patient to nd solutions and if necessary, communicates
with the social network about the measures being taken.
Phase 2: Recovery of the stress system
The main purpose of the second phase is recovery of the stress
system. Homoeostatic stress values need to return to normal
levels (McEwen, 2017; Sterling, 2004). Therefore, it is important
that stress is reduced. In the rst phase of the treatment,
sources of stress are drastically reduced by skipping social
obligations and avoiding work and household chores. In
the second phase, patients will resume activities gradually.
The relative distress an activity causes is registered, and the
therapist advises the client to start with nonwork activities that
cause little stress for limited duration alternated with rest or
relaxing activities. It is essential that the individual will be able
again to switch from arousal to rest.
Therefore, the therapist and patient make schemes in which
activity and rest are alternated (Keijsers et al., 2004; Van Dam
et al., 2017). Only if the patient feels recovered after two hours
rest, the number and duration of activities can be extended. In
the course of phase 2, reintegration to work should start gra-
dually. The pace at which reintegration can take place must be
geared to the degree of recovery. It is wise to involve the
employer in this process and explain how the recovery will
proceed and what can be expected regarding task perfor-
mance. This also depends on the extent to which the employer
is willing to take into account the limitations of the patient
during the recovery process (Brouwers et al., 2020).
Table 2. Phases in the treatment of clinical burnout.
Phase Treatment goal Therapeutic interventions
Phase 1: Crisis Recognition of the patient
that the problems are
serious, and that serious
action is required.
Sick leave
Dropping domestic tasks
and social obligations
Inform social network
Phase 2:
Recovery of the
(physiological) stress
system to normal allostatic
stress levels.
Registration of stress and
Relaxation exercises
Healthy lifestyle advices
Graded exercise
Gradually resume
Psychoeducation social
network and employer
Gradual return to work
Phase 3:
learning from
the past
Acquiring insight and skills to
prevent relapse in clinical
Analysing stressful
Analysing dysfunctional
thought patterns
Learning new coping
Learning social skills
Job crafting
Time management
Making choices
regarding career and
personal life
Phase 4: Post
Improving sustainable quality
of life.
Setting priorities regarding
quality of life and
Based on: Hamming, 2020; Keijsers et al., 2004; Van Dam et al., 2017; Van Zweden,
2015; Weber & Jaekel-Reinhard, 2000.
A healthy lifestyle needs to be promoted because it is ben-
ecial for recovery. Healthy food, alcohol in moderation, mod-
erate exercise and especially a healthy sleep pattern are
essential for recovery (Sonnenschein et al., 2008). Another pro-
blem that needs attention in this phase is that ignoring signals
of the body like fatigue and stress has become a habit or
lifestyle for many burnout patients. The strong ability to perse-
vere and postpone need gratication makes that they are les
tuned to signals of their body and tend to choose their actions
on basis on what they think that they should do and not on
what they feel. Relaxation exercises, meditation and mindful-
ness exercises can be helpful to become more receptive to
signals of the body again (Bednar et al., 2020).
During this phase, which lasts several months, the patient
will become less fatigued and will be motivated and able again
to perform tasks. For a part of the patients, the cognitive
impairments seem to decrease in a slower pace than the
other symptoms (Dalgaard et al., 2020; Van Dam et al.,
2012b). This should be taken into account when someone
reintegrates into the work. The duration with which someone
can perform complex cognitive tasks is limited and should
therefore be alternated with other tasks.
In the second phase, it is also important not to do a number
of things because it will hinder recovery. First, it is inadvisable
to start psychotherapy. Psychotherapy may be emotionally
demanding and stressful and therefore hinders recovery from
chronic stress (Linden, 2013). In addition, due to the chronic
stress, there may be pseudopsychopathology (Van Zweden,
2015). This will disappear by itself when someone recovers.
For the same reasons, no assessment or psychological testing
should take place at this stage. As a result of the chronic stress,
people will score less intelligent and more disturbed on the
tests than they actually are.
Many burnout patients experience relational problems
because family members experience that the burnout patient
is often irritable and reluctant to engage in social activities
(Carnes, 2017; Davis et al., 2011). It is helpful to involve partners
or family members in the treatment to provide explanations
and advice on how to deal with the symptoms. However,
focusing on the relational problems would only increase the
stress and be unnecessary because the relational problems will
probably disappear once the patient has recovered (Cuijpers,
2007; Hener et al., 2004).
In order to be able to properly estimate whether complaints
are the cause or consequence of the chronic stress, it is best to
ask family and acquaintances how the patient’s functioning
was before the chronic stress episode. Another point of atten-
tion is that in an attempt to solve the problematic situation,
people may take drastic decisions like changing jobs, divorce or
emigration. This is seldomly a good idea in this phase because
of the eorts it requires to adapt oneself to a new (work)
environment while being already exhausted and experiencing
diculties in cognitive control (García-León et al., 2019;
McCarthy & Lambert, 1999).
Phase 3 Prevention, learning from the past
In the third and nal phase, the patient is almost fully recov-
ered, and the time has come to explore the reasons why some-
one ended up with burnout. Knowledge about factors that
contributed to the burnout may help to prevent that a person
will go through years of chronic stress again. Research shows
that fty percent of the individuals who returned to work after
burnout had a relapse in burnout within two and a half year.
Six percent of the individuals who received a structured work-
place-oriented intervention had more than two relapses com-
pared to fourteen percent of the individuals who did not
receive the intervention (Karlson et al., 2014).
Factors that may inuence vulnerability to burnout are cir-
cumstances, coping, and dysfunctional thought patterns.
-Circumstances: Circumstances may lead to chronic stress
reactions when there are not enough possibilities for recovery.
In some cases, people have very limited inuence on conditions
that cause stress (Bakker & de Vries, 2021; DeLongis &
Holtzman, 2005; Sapolsky, 1998). You can think of
a combination of a bad atmosphere at work in combination
with caring for a sick family member. The therapist and the
burnout patient can take a look at whether it had been possible
to deal with the situation dierently by asking for more social
support or setting limits.
-Coping: An eective way of dealing with problems is to
make far-reaching but necessary decisions. This is something
that many people nd dicult to do (Maslach & Goldberg,
1998). It may be the case, for example, that due to changes at
work, someone no longer really likes his work that much, but
does not want to admit it to himself or is not fully aware of it
(Follmer et al., 2018). The same process may also play a role in
private life. Some people appear not to be our best friends
when we take a closer look (Lee et al., 2010). Another dilemma
may occur when someone has made a career change and
would experience it as a failure to recognize that this job
does not suit him and go back in social status and salary
(Verheyen & Guerry, 2018). It is essential that a therapist con-
fronts clients with a mismatch between desires and possibilities
and also helps them make painful but necessary decisions.
Improving coping skills may also comprise learning new ways
to solve problems, social skill training, time management and
job crafting (Keijsers et al., 2004; Van Dam et al., 2017).
- Dysfunctional thought patterns: As a result of education
and experiences in life, people develop thoughts and expecta-
tions about themselves, others, and the world (Sauerland et al.,
2015). These thoughts can be functional if they contribute to
happiness and the ability to adapt to changing life circum-
stances. Thoughts are dysfunctional when they allow people
to enter patterns that are rigid and non-adaptive and contri-
bute to stress, emotional problems and destructive behaviour
patterns (Keijsers et al., 2004; Sauerland et al., 2015; Van Dam
et al., 2017). In burnout patients, this may express itself in
perfectionism, conict avoidance, sub-assertiveness, the idea
of always having to prove oneself or an excessive sense of duty.
Cognitive behavioural therapy may then be eective in break-
ing through these dysfunctional patterns by changing dysfunc-
tional thought patterns and learning new social skills (Keijsers
et al., 2004; Van Dam et al., 2017).
A successful treatment of burnout may move into
a fourth phase. There is a body of literature suggesting
that people exposed to even the most traumatic events
may perceive at least some good emerging from their
struggle with tragedies. This is called posttraumatic growth
(Tedeschi et al., 2018). At least three broad categories of
perceived benets have been identied: changes in self-
perception, changes in interpersonal relationships, and
a changed philosophy of life. In recovered burnout
patients the same phenomenon can be observed
(Glouberman, 2007; Semeijn et al., 2019; Van Dam & de
Leeuw, 2004). Many former burnout patients report that
they have learned from their burnout and that their life is
better now than before their burnout. They know better
who they are and what is important to them in life; they
spend more time with their friends and families; and they
changed their priorities. Many former burnout patients
allow themselves to enjoy life more and to be happy.
This may be called post-burnout growth. These observa-
tions are in line with empirical ndings (Semeijn et al.,
2019) and may hopefully contribute to a dierent (more
positive) perspective on burnout.
In this article I have explained the dierence between syndromes
resulting from short-term stress and those resulting from chronic
stress. Because individuals with short-term stress show elevated
levels on burnout measures, just like individuals with other mental
disorders like major depression and anxiety disorders a clinician
cannot solely rely on questionnaires in order to make a qualitative
distinction between the mild stress disorders and clinical burnout
The dierence between these syndromes, in terms of people who
are predisposed for them and the prognosis, is qualitative rather
than dimensional. It is relevant for work- and organizational psy-
chologists to know that biological processes play an important
role in the development of clinical burnout. It does not matter for
physiological processes whether the stress is work-related or the
result of stress in private life or both. Central to understanding
clinical burnout is the lack of recovery of the (physiological) stress
system. Work- and organizational psychologists could pay more
attention to coping instead of symptom level to determine who is
at risk for clinical burnout. Furthermore they could adjust their
interventions to the various risk proles; for example, stress man-
agement programmes for employees with mild stress symptoms
and healthy lifestyle programmes for individuals with excessive
I hope that this contribution will inspire work- and orga-
nization psychologists in designing interventions and con-
ducting research.
Disclosure statement
No potential conict of interest was reported by the author(s).
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... Whereas depression is a clearly defined clinical disorder (for criteria see International Classification of Diseases ICD-10), which is not necessarily work-related, burnout has no uniform definition (Demerouti et al., 2021). Usually, work-and organizational psychologists define burnout as a state of emotional exhaustion, depersonalization, and reduced personal accomplishments that develops as a consequence of a prolonged stress situation at work (Maslach et al., 2001; for a clinical perspective on burnout see van Dam, 2021). Although there is still an ongoing scholarly debate on differences between both concepts, depression and burnout have considerable similarities and overlapping symptoms (e.g. ...
... exhaustion, bad mood). Accordingly, clinicians even often use depression as a diagnosis for burnout (van Dam, 2021). Regardless of conceptual distinctiveness, both are associated with serious negative consequences such as long-lasting sickness absence, losses in productivity, and early retirement (Badura et al., 2020;Kessler, 2012;Salvagioni et al., 2017). ...
... Thus, they set new priorities to save time and accomplish their tasks. For example, they may strengthen their effort to overcome obstacles, and solve current problems to reach their goals (van Dam, 2021). In this case, they may pay less attention to their employees' health status. ...
Due to growing demands, there is an increase in depression and burnout causing sickness absence and early retirement. Detecting depression and burnout at an early stage is a crucial task for leaders to allow for early support and prevent more severe illnesses. Within the health-oriented leadership concept, awareness is the ability to recognize followers’ warning signals as a potential health risk. Although it is widely accepted that awareness is a precondition to taking appropriate action, it is yet unclear to what extent leaders recognize the warning signals of followers and which factors facilitate or impede awareness. In an experimental study (N = 54) and a survey study (N = 215) we examined antecedents of awareness in followers and leaders: (a) clarity of displayed warning signals in followers, (b) leaders’ stressors, (c) leaders’ autonomy. Even under favorable conditions, only about half of the leaders recognized warning signals as a health risk. Leaders showed lower awareness during times of high stress and low autonomy and when followers displayed less clear warning signals. Autonomy moderated the effect of stress (workload) on awareness, but there was no buffering effect as expected. The findings deepen the theoretical understanding of awareness and suggest that leaders need to know how their awareness may be impeded. We provide practical recommendations for human resource management on how leaders’ awareness can be fostered.
... In particular, systematic reviews have yet to focus explicitly on the effects and working mechanisms of rehabilitation interventions that address both employees and their working contexts. In the Netherlands, the prevailing rehabilitation guidelines van Dam, 2021) deem such combined (both person-and organization-directed) interventions crucial to burnout recovery and the RTW process. In the first phase of the research, I thus focus on the following research questions: ...
... In the Netherlands, burnout is the most significant predictor of high sick leave and replacement costs, estimated to be 3.1 billion euros annually (TNO, 2020). The so-called Dutch "rehabilitation guidelines" emphasize facilitating the return to work (RTW) process through reducing burnout complaints, using cognitive-behavioral therapies (CBT) and psycho-education, combined, if possible, with intervening in the working context Van Dam, 2021). However, evaluations of the effectiveness of such burnout-rehabilitation interventions reveal suboptimal results in terms of both reducing burnout complaints and facilitating the RTW process (Ahola et al., 2017;Awa et al., 2010;Pijpker et al., 2020); for example, showed that combining both CBT and a reduced workload only facilitated a partial RTW but did not fully alleviate burnout complaints. ...
... To develop the intervention and evaluation model of outdoor therapy, we build on the generic context, process, and outcome (CPO) evaluation model and the generic burnout recovery model (BRM) (Pijpker et al., 2021;Van Dam, 2021) as an overarching frame. Based on this deductively derived generic frame, we then inductively specified the intervention and evaluation model of our exemplary outdoor therapy case in the Netherlands, using both primary and secondary data. ...
... As a major public health concern, exhaustion increases behavioral health risk factors [6,7] and in turn the morbidity risk [8]. Malakh-Pines [9] defined three types of exhaustion: emotional, mental, and physical exhaustion. ...
... By the first definition of burnout, Freudenberger [3] listed frequent headaches, gastrointestinal problems, sleep trouble, and shortness of breath as its physical signs. In recent research, assessing burnout and differentiating it from exhaustion turned out to be problematic [8]. Van Dam [8] stated that clinical burnout could not be measured using the common questionnaires, as they overestimated the burnout prevalence due to the participants′ short-term stress, neglecting the duration of the symptoms. ...
... In recent research, assessing burnout and differentiating it from exhaustion turned out to be problematic [8]. Van Dam [8] stated that clinical burnout could not be measured using the common questionnaires, as they overestimated the burnout prevalence due to the participants′ short-term stress, neglecting the duration of the symptoms. ...
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Chronic exhaustion is a consequence of detrimental working conditions and demands, as well as inadequate coping techniques, potentially resulting in burnout. Previous research has studied occupational environment and individual factors as predictors of exhaustion. Although these differ between former East and West German states, the regional distinction regarding exhaustion has been neglected. To fill this gap, we used the Copenhagen Burnout Inventory in a representative German sample from 2014 to assess the burnout symptom exhaustion. Estimating ordinary least squares regressions, important burnout predictors were compared between the former East and West German states. Regional differences concerning occupational environments were related to the associations between individual factors, situational aspects of technostress and exhaustion. Associations between individual factors (e.g., female sex, lower working hours, age, partnership status, and household income) and exhaustion were stronger in East Germany, whereas technostress (strain of internet use, number of e-mails during leisure time, and social pressure to be constantly available) was more strongly associated with exhaustion in West Germany. Despite lower financial gratification and a higher social pressure to be constantly available in the East, West Germans were more afflicted by exhaustion. Individual factors and technostress should thus be considered when focusing on job-related mental health issues.
... The so-called Dutch "rehabilitation guidelines" emphasize facilitating the return-to-work (RTW) process through reducing burnout complaints, using cognitive behavioral therapies (CBT) and psychoeducation, combined, if possible, with intervening in the working context (van Dam et al., 2017;Van Dam, 2021). However, evaluations of the effectiveness of such burnout rehabilitation interventions reveal suboptimal results in terms of both reducing burnout complaints and facilitating the RTW process (Awa et al., 2010;Ahola et al., 2017;Perski et al., 2017;Pijpker et al., 2020); for example, Blonk et al. (2006) showed that combining both CBT and a reduced workload only facilitated a partial RTW but did not fully alleviate burnout complaints. ...
... This means that Dutch healthcare insurers can financially cover outdoor therapy for their clients. 1 To develop the intervention and evaluation model of outdoor therapy, we build on the generic context, process, and outcome (CPO) evaluation model (Fridrich et al., 2015) and the generic burnout recovery model (BRM; Pijpker et al., 2021;Van Dam, 2021) as an overarching frame. Based on this deductively derived generic frame, we then inductively specified the intervention and evaluation model of our exemplary outdoor therapy case in Netherlands, using both primary and secondary data. ...
... With regard to outdoor therapy in the Netherlands, the omnibus context refers to the location of the therapy or the season in which it takes place. The discrete context refers to aspects directly relevant to the implementation process of key outdoor intervention elements; for example, clients can be in different phases of the rehabilitation process (Pijpker et al., 2021;Van Dam, 2021), which may require that outdoor elements are adapted to achieve therapeutic goals in a certain rehabilitation phase. ...
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Background Burnout is a major societal issue adversely affecting employees’ health and performance, which over time results in high sick leave costs for organizations. Traditional rehabilitation therapies show suboptimal effects on reducing burnout and the return-to-work process. Based on the health-promoting effects of nature, taking clients outdoors into nature is increasingly being used as a complementary approach to traditional therapies, and evidence of their effectiveness is growing. Theories explaining how the combination of general psychological support and outdoor-specific elements can trigger the rehabilitation process in outdoor therapy are often lacking, however, impeding its systematic research. Aim The study aims to develop an intervention and evaluation model for outdoor therapy to understand and empirically evaluate whether and how such an outdoor intervention may work for rehabilitation after burnout. Methodological Approach We build on the exemplary case of an outdoor intervention for rehabilitation after burnout, developed by outdoor clinical psychologists in Netherlands. We combined the generic context, process, and outcome evaluation model and the burnout recovery model as an overarching deductive frame. We then inductively specified the intervention and evaluation model of outdoor therapy, building on the following qualitative data: semi-structured interviews with outdoor clinical psychologists and former clients; a content analysis of the intervention protocol; and reflective meetings with the intervention developers and health promotion experts. Results We identified six key outdoor intervention elements: (1) physical activity; (2) reconnecting body and mind; (3) nature metaphors; (4) creating relationships; (5) observing natural interactions; and (6) experiential learning. The results further showed that the implementation of these elements may facilitate the rehabilitation process after burnout in which proximal, intermediate, and distal outcomes emerge. Finally, the results suggested that this implementation process depends on the context of the therapist (e.g., number of clients per day), therapy (e.g., privacy issues), and of the clients (e.g., affinity to nature). Conclusion The intervention and evaluation model for outdoor therapy shows how key outdoor intervention elements may contribute to the rehabilitation process after burnout. However, our model needs to be further tested among a larger group of clients to empirically evaluate whether and how outdoor therapy can support rehabilitation.
... Approached from a biological perspective, the characterization of burnout is even more problematic. van Dam [51] observed: "… from a biological point of view, it does not matter whether the chronic stress is caused by working conditions or private circumstances or both. It is about the consequences of (chronic) stress for the functioning of the biological processes in the organism that also affect psychological processes and social behaviour" (p. 1). ...
Objective: There is mounting evidence that burnout problematically overlaps with depression. However, the generalizability of this finding remains debated. This study examined the burnout-depression distinction based on a recently developed measure of work-attributed depressive symptoms-the Occupational Depression Inventory (ODI). Methods: We relied on a sample of 891 Australian teachers. The ODI was employed to assess work-attributed depressive symptoms. The Shirom-Melamed Burnout Measure (SMBM) and the Oldenburg Burnout Inventory (OLBI) were employed to assess burnout symptoms. The SMBM assesses burnout as a syndrome combining physical fatigue, cognitive weariness, and emotional exhaustion. The OLBI assesses burnout as a syndrome of exhaustion and disengagement. Results: Confirmatory factor analysis indicated that the factors underlying burnout's components correlated more highly with the Occupational Depression factor than with each other, calling into question the syndromal unity of burnout. Moreover, the factors underlying burnout's components and the Occupational Depression factor were reflective of a common higher-order factor. Conclusions: Our findings are consistent with the view that burnout symptoms are part of a depressive syndrome and do not reflect a unique or distinct entity. Conducted in the Australian context, this study strengthens the generalizability of the finding that burnout problematically overlaps with depression. Given the profound problems affecting the burnout construct, we recommend a paradigm shift from burnout to occupational depression. Such a shift raises the prospects of more reliably and validly assessing severity and prevalence of job-related distress and, consequently, of reaching more psychologically meaningful and productive conclusions regarding treatment, prevention, and public health decision-making.
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Background Face-to-face cognitive behavioral therapy (CBT) is the most promising treatment to reduce stress, but access to CBT is limited. Internet-delivered CBT (ICBT) enables large-scale dissemination at low costs. Evidence suggests that ICBT can reduce stress in subclinical and mixed diagnostic samples, but less is known about the effect of ICBT in targeted samples suffering from elevated perceived stress or stress-related disorders. Objective To investigate the efficacy of ICBT specifically aimed at reducing stress in adults with elevated perceived stress or stress-related disorders. Methods We searched for randomized controlled trials comparing ICBT with a control group in PubMed, Web of Science, and PsycInfo between 2010 and 2021. A meta-analysis of 14 comparisons (total N = 1831) was performed, and Cohen's d was calculated to assess the difference between intervention and control groups at posttest for the primary outcome self-rated stress. Effects on secondary outcomes of anxiety and depression were also investigated. Results The pooled mean effect size for self-rated stress at posttest was d = 0.78 [CI 95 % 0.66–0.90]. For anxiety and depression, the effects were d = 0.69 [95 % CI 0.52–0.86] and d = 0.65 [95 % CI 0.56–0.75] respectively. The heterogeneity of results between studies was overall low to moderate. Subgroup analyses were not conducted due to the limited number of studies eligible for inclusion. Conclusions Results provide evidence of the efficacy of ICBT to reduce stress, anxiety, and depressive symptoms in adults suffering from elevated stress or stress-related disorders. Findings have important implications for the development of safe and evidence-based treatment guidelines in the face of a rapid digital expansion. This study was preregistered at Open Science Framework ( with DOI 10.17605/OSF.IO/BQAZ3.
Amongst the approximately 3.1 million graduate students currently enrolled in advanced degree programs in the United States, nearly 66% reported above-average stress since the beginning of the pandemic, most notably due to poor relationships with advisors and difficulty finding a work-life balance. This has led to considerable feelings of burnout. Burnout is not a new phenomenon in the United States, as it was first defined by psychoanalyst H.J. Fruedenberger in 1974. While burnout is often used to describe the working population throughout the United States, it has become increasingly noticed that graduate students are particularly vulnerable to feelings of burnout, which is evident by three symptoms particular to students: cynicism, exhaustion, and lack of professional efficacy. This essay explored published literature on burnout in graduate students, analyzed the literature for recurring themes, and proposed a future study to address the gaps in knowledge in current literature. Current literature suggests that certain comorbid mental health conditions are present among graduate students and a few documented methods that mitigate the effects of burnout in this demographic. However, a few problems exist evident in current literature regarding burnout in graduate students. First of all, current literature lacks qualitative data to help understand why graduate students experience burnout. Furthermore, the reviewed articles do not measure burnout consistently, making it difficult to generalize findings. As a result, is it recommended that focus groups be conducted to account for the gap in existing literature and to guide the development of future interventions targeted at this population. Future exploration of this topic will help ease the burden of graduate school and guide creation of conducive learning environments for many generations of future graduate students to come. Easing the burden of graduate school for students will also help to eliminate other public health problems in this population, including substance abuse, suicide, anxiety, and depression.
Op grond van aanwijzingen dat zorginterventies in de natuur positieve effecten kunnen hebben op het herstel na burn-outklachten, gaan steeds meer GZ-psychologen in de behandeling daarvan de natuur inzetten. Door gebrek aan onderzoek weten we nog maar weinig over hoe dit werkt. Deze bijdrage reflecteert op de werking aan de hand van een eerste evaluatiemodel van mogelijke werkzame elementen, gebaseerd op de casus De Buitenpsychologen. Achtergrond Volgens TNO (2020) hadden in 2019 bijna 1,3 miljoen (17%) Nederlandse werknemers burn-outklachten en zijn de daaraan gerelateerde verzuimkosten opgelopen tot 3,1 miljard euro per jaar. De gemiddelde verzuimduur van een burn-out varieert ussen zes maanden en een jaar, maar er zijn ook studies die laten zien dat zelfs na twee tot vier jaar bijna de helft van de werknemers met een burn-out nog niet volledig hersteld is (Dalgaard et al., 2021; Van Dam et al., 2021). Hoewel de oorzaken van een burn-out goed onderzocht zijn (Alarcon, 2011; Lee & Ashfort, 1996), waarbij het niet meer kunnen herstellen van (fysiologische) stress de belangrijkste is (Van Dam, 2021), weten we nog maar weinig over effectieve manieren om burnoutklachten te verminderen (Pijpker et al., 2020).
El presente documento recoge algunas ideas en relación con el progreso y visibilización que hoy más que nunca se le viene haciendo al concepto del agotamiento (burnout) en la vida de las personas, organizaciones y sociedades. Este artículo no está diseñado para explorar todos los aspectos. Este artículo no es una guía clínica, ni pretende develar formas absolutas de manejo en relación con la condición, más bien recoge ideas de autores, publicaciones y estudios que han planteado escenarios de como visualizar, gestionar y atender este desafío silencioso.
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Purpose: The aim of this study was to investigate the effect of possible late effects of cancer treatment (physical complaints, fatigue, and cognitive complaints) and of two job resources (autonomy and supportive leadership style) on future burnout complaints, among employees living 2–10 years beyond breast cancer diagnosis. Methods: Data at T1 (baseline questionnaire) and at T2 (9 months later) were collected in 2018 and 2019 (N = 287). These data were part of a longitudinal study among Dutch speaking workers with a cancer diagnosis 2–10 years ago. All complaints and job resources were self-reported. Longitudinal multivariate regression analyses were executed, controlling for years since diagnosis, living with cancer (recurrence or metastasis), and other chronic or severe diseases. Mediation by baseline burnout complaints was considered. Results: A higher level of fatigue and cognitive complaints at baseline (T1) resulted in higher future burnout complaints (at T2), with partial mediation by baseline burnout complaints. No effect of physical complaints at T1 was observed. Higher levels of autonomy or a supportive leadership style resulted in lower burnout complaints, with full mediation by baseline burnout complaints. Buffering was observed by autonomy in the relationship of cognitive complaints with future burnout complaints. No moderation was observed by supportive leadership. Conclusion: The level of burnout complaints among employees 2–10 years beyond breast cancer diagnosis may be an effect of fatigue or cognitive complaints, and awareness of this effect is necessary. Interventions to stimulate supportive leadership and autonomy are advisable, the latter especially in the case of cognitive complaints.
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Objectives This study investigated whether common factors underlie the established mindfulness facets, as assessed by the Five Facet Mindfulness Questionnaire (FFMQ) and some of the mechanisms, which have been previously proposed to explain the beneficial effects of mindfulness on mental health.Methods Multigroup exploratory structural equation models (ESEM) were fitted to samples of non-meditators and meditators (total N = 3265) to (1) identify the number of factors that underlie the facets and mechanisms of mindfulness, (2) establish measurement invariance, and (3) conduct path analyses to determine the associations of extracted factors with psychological symptoms.ResultsFive measurement-invariant common factors were found to underlie the mechanisms and facets of mindfulness. The FFMQ facets loaded distinctly, but none of them highest, on these common factors. The common factors represented different ways of focusing, dealing with distress, and relating towards one’s own thoughts, feelings, emotions, and body sensations. Three of the common factors appeared to specifically reflect meditation experience. The FFMQ facets accounted for less variance of depression, anxiety, somatization, and stress scores than marker scales of the five common factors, all of which derived from the proposed mechanisms.Conclusions The common factors appear to be elements of the supporting mechanisms and psychological faculties of mindfulness. Their existence may explain the mutual interrelations between mechanisms and self-reported mindfulness but also suggests that self-reported mindfulness may not be factorially distinct from its assumed mechanisms. Longitudinal studies as well as behavioral data are needed to probe the generalizability and causality of these psychometric results.
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Background: High job demands and low job resources may cause job strain and eventually result in burnout. However, previous research has generally ignored the roles of time and self-regulation. Objectives: This theoretical article synthesizes the literature to propose a multilevel model that delineates how acute job strain translates into enduring and severe job burnout. Methods: We integrate self-regulation perspectives in job demands-resources (JD-R) theory to propose that short-term job strain and eventually enduring burnout is the result of consistently high job demands and low job resources – combined with failed self-regulation. Results: The model shows that when employees are confronted with increased job strain, they are more likely to use maladaptive self-regulation strategies, such as coping inflexibility and self-undermining. In addition, when job strain increases, employees are less likely to use adaptive self-regulation strategies, such as job stress recovery and job crafting. It follows that when the job becomes more stressful, stable resources become more important. Organizational resources such as human resource practices and healthy leadership may help employees to regulate their short-term fatigue and avoid enduring burnout. Furthermore, key personal resources like emotional intelligence and proactive personality may help employees to recognize and regulate their fatigue in an effective way. Conclusion: The proposed model of burnout expands JD-R theory and offers important practical implications for the prevention and reduction of burnout.
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Teachers are the prime movers in changing the state of any nation towards globalization and industrialization. However, perseverance and passion in the teaching profession influences teachers' performance. This research was conducted to examine the interrelationships between and between variables such as teacher characteristics, motivation , self-efficacy, burnout, and performance to create a model that explains teacher success.This descriptive correlation study utilized the Short Grit Scale, Norwegian Teacher Self- Efficacy Scale, Maslach Burnout Inventory for Teachers, and the NBC 461 QCE instruments to gather data. The respondents were the faculty members of a state university in Cagayan Valley Region, Philippines. This study found that teachers have high rates of selfefficiency, moderate levels of burnout, and very satisfactory teaching results, regardless of age , gender, marital status, number of dependents, educational attainment, length of service, teaching status, and academic rank. The level of teachers' grit, self-efficacy, and performance are comparable across teachers' characteristics while the level of teachers' burnout varies with the number of dependents. Grit is positively related to educational attainment while burnout is negatively related to the number of dependents. Grit and self-efficacy showed significant positive relationship with each other. While teacher performance is independent of grit, self-efficacy and burnout, teacher performance is best predicted by knowledge of the subject matter and management of learning. Future research should validate the proposed model on a wider scale to include other variables.
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Burnout syndrome is has been associated with mental health problems such as depression, anxiety, and stress. Given this fact, some teachers implement various coping strategies for emotional control that are not always functional to mitigate such difficulties. Accordingly, this study aimed to identify different burnout profiles that vary in the levels of the three underlying dimensions: depersonalization (DE), emotional exhaustion (EE), and personal accomplishment (PA). Further, this study aimed to examine whether there are significant differences in depressive symptomatology, coping strategies, and the quality of interpersonal relationships at school between teachers with varying burnout profiles. The Maslach Burnout Inventory (MBI), Zung Self-Rating Depression Scale (SDS), Coping with Stress Questionnaire, and a questionnaire that measured sociodemographic characteristics were administered to 215 teachers (men: 42.8%) who were recruited from various secondary schools. Cluster analysis identified three different burnout profiles: groups of teachers with a predominance of (a) low levels of EE and high levels of PA, (b) high levels of EE and DE, and (c) low levels of DE and PA. The results revealed that there were significant differences in coping strategies, depressive symptomatology, and the quality of interpersonal relationships at school between teachers with different burnout profiles. These results have important implications for educational professionals. Specifically, the findings underscore the need for prevention and intervention programs that enhance teachers’ emotional skills, especially their ability to cope with exhaustion. These skills will alleviate their depression and consequently offer both teachers and students a conducive learning environment.
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Purpose Adequate recovery from burnout is important to understand. The purpose of this paper is to investigate whether post-traumatic growth (PTG) contributes to higher engagement and reduced symptoms of burnout and whether this process is mediated by personal resources. Design/methodology/approach In a cross-sectional survey, 166 Dutch workers who had fully recovered from burnout were questioned on their level of PTG, their personal resources (optimism, resilience and self-efficacy), and their levels of engagement and burnout. Findings Fully recovered workers scored somewhat higher on current burnout level, but did not differ from norm group workers in their engagement level. Moreover, PTG appeared to positively affect both higher engagement and lower burnout levels, which is fully mediated by personal resources. Research limitations/implications Post-traumatic growth (PTG) impacts on engagement and burnout levels amongst workers who have recovered from burnout by enhancing personal resources. The role of personal resources and the impact of PTG on engagement and burnout complaints following (recovery from) burnout deserve further investigation. Practical implications Management can support workers who have (recovered from a) burnout, by being aware of their (higher) engagement, and facilitate the enhancement of PTG and personal resources. Originality/value This study is one of the first to study the role of PTG after (recovery from) burnout and reveals valuable findings for both research and practice.
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Purpose Whether or not to disclose mental illness or mental health issues in the work environment is a highly sensitive dilemma. It can facilitate keeping or finding paid employment, but can also lead to losing employment or to not being hired, because of discrimination and stigma. Research questions were: (1) what do stakeholders see as advantages and disadvantages of disclosing mental illness or mental health issues in the work environment?; (2) what factors are of influence on a positive outcome of disclosure? Methods A focus group study was conducted with five different stakeholder groups: people with mental illness, Human Resources professionals, employers, work reintegration professionals, and mental health advocates. Sessions were audio-taped and transcribed verbatim. Thematic content analysis was performed by two researchers using AtlasTi-7.5. Results were visually represented in a diagram to form a theoretical model. Results Concerning (dis-)advantages of disclosure, six themes emerged as advantages (improved relationships, authenticity, work environment support, friendly culture) and two as disadvantages (discrimination and stigma). Of influence on the disclosure outcome were: Aspects of the disclosure process, workplace factors, financial factors, and employee factors. Stakeholders generally agreed, although distinct differences were also found and discussed in the paper. Conclusion As shown from the theoretical model, the (non-)disclosure process is complex, and the outcome is influenced by many factors, most of which cannot be influenced by the individual with mental illness. However, the theme ‘Aspects of the disclosure process’, including subthemes: who to disclose to, timing, preparation, message content and communication style is promising for improving work participation of people with mental illness or mental health issues, because disclosers can positively influence these aspects themselves.
At the outset, it should be noted that the term biopsychosocial model was originally introduced by George Engel, G. L. (1977. The need for a new medical model: A challenge for biomedicine. Science, 196(4286), 129–136; Engel, G. L. (1980). The clinical application of the biopsychosocial model. The American Journal of Psychiatry, 137(5), 535–544) because he felt that the traditionally embraced biomedical reductionist model in medicine was outdated in light of the newer advances in medicine. He emphasized that modern medicine needed to encompass a more dynamic system approach, which included different levels of organization that included not only factors related to the patient and physician but also other important sociocultural and lifestyle variables in a “systems theory” manner initially introduced in biology by scientists such as Weiss, P. (1969. The living system: Terminism stratified. In J. Smythies & A. Koestler (Ed.), Beyond reductionism. New York, NY: Macmillan Publishing Co; Weiss, P. (1977). The system of nature and the nature of systems: empirical holism and practical reductionism harmonized. In K. E. Schaefer, H. Hensel, & R. Brody (Eds.), Toward a man‐centered medical science. Mt. Kisco, NY: Futura Publishing Co) and von Bertalanffy, L. V. (1968. General systems theories: Foundations, development and applications. New York, NY: G. Braziller; von Bertalanffy, L. (1969). Chance or law. In J. Smythies & A. Koestler (Eds.), Beyond reductionism. New York, NY: Macmillan Publishing Co).
Patients on sick leave due to work-related stress often present with cognitive complaints. The primary aim of this prospective cohort study was to examine potential long-term consequences of previous ongoing work-related stress in terms of cognitive functioning four years after initial professional care seeking. We tested a group of patients with work-related stress complaints with a comprehensive neuropsychological test battery. Patients were examined at a department of occupational medicine and tested at baseline, one-year follow-up and four-year follow-up. At each time point, we compared the performance of patients with healthy controls matched pairwise on sex, age and length of education. This paper presents the results from the four-year follow-up. Patients improved on their neuropsychological test performance during the four years but the main improvements took place during the first year. At baseline, the main impairments in the patient group concerned executive function and mental speed. At four-year follow-up, patients displayed slightly lower scores on the neuropsychological tests relative to controls but only the difference on immediate memory was significant corresponding to a small effect size (Cohen’s d). More than half of the patients who participated in the four-year follow-up reported that they felt only slightly or partially recovered. The level of work participation among the former patients improved considerably during the four-year follow-up period. • Lay Summary • This study examines the long-term consequences of work-related stress in terms of cognitive functioning and recovery four years after initial professional care seeking. After four years, patients continued to display significantly lower memory scores than controls but no other significant differences between the groups were found on neuropsychological tests. Levels of work participation among patients improved considerably over time, yet, more than half of the former patients who participated in the four-year follow-up did not feel completely recovered.