Code QD85 Burnout: Is it finally recognized as an occupational disease in post-pandemic era? What is it actually?
Dr. Solveig Beyza Evenstad
Associate Professor Organizations & Management. Multi-disciplinary, multi-cultural systems thinker. Leadership developer & Coach
The World Health Organization (WHO) declared stress as the greatest health risk of the 21st century for some time. COVID-19 pandemics has taken burnout to new heights all over the world. The COVID-19 pandemic resulted not only in the increased morbidity and mortality due to the virus but also in significant health, lifestyle, economic and societal changes. New trends such as “the great resignation” emerged; trust issues connected to remote leadership are resurging with employers calling workers back to office; even a rather misleading term as “quiet quitting” which has nothing to do with quitting but is a desperate attempt to set boundaries and manage work-life balance are all shaking the work life. Managers and HR departments are understanding that post-pandemic era is representing challenges they were not prepared for.
All over the world, stress, anxiety, burnout, and depression are on the rise and mental health and well-being at work agenda is forcing its way into the workplace as never before. The days of blaming the individual worker who “was weak and couldn’t handle the pressure at work” and the common advice such as “people should do yoga and meditation so they can cope with stress” are suddenly over. Most managers and HR people have either themselves experienced the high and prolonged stress during the pandemics while both parents and children were getting exhausted from back-to-back Zoom or Teams meetings, sharing non-optimal physical spaces for work, and suffering from social isolation, or they have heard about people who burned out.
Burnout has been a controversial concept for years, but finally, may be thanks to COVID-19 and the research into stress and burnout during the pandemics, it is making headlines again. I myself having burned out in my ICT line manager positions, finally left ICT all together back in 2007. I changed my course and took a Master of Management in Organization and Leadership with specialization in Coaching, Counselling and Motivation where I could pursue my interest in organizational psychology and work sociology. I did my research on ICT workers' experience of burnout and developed a model for burnout that showed how organizational and personal factors interacted in the burnout process. Later, when I did my PhD, I took a communicational perspective and looked at how these factors arose through various communication processes in organizations and compared French and Norwegian ICT workers to have an intercultural perspective as well. Although I was no longer focused on the experience of burnout itself, my interviews revealed those as well as practices for treatment. Human beings across cultures suffer equally much, the communication processes that are behind stress and burnout factors are influenced by national and organizational cultures and so does treatment methods. How we perceive burnout in different countries are also different, in some countries it is "nonexistent" while in others, it is taken very seriously as an occupational disease.
Is burnout an occupational disease?
After years of battle to make burnout recognized as an occupational disease, burnout is now categorized as a “syndrome” that results from “chronic workplace stress that has not been successfully managed,” according to the World Health Organization’s International Disease Classification (ICD-11) effective from January 1, 2022, and it got code QD85. In 9 countries (Denmark, Estonia, France, Hungary, Latvia, Netherlands, Portugal, Slovakia and Sweden) burnout syndrome can be acknowledged as an occupational disease (OD). Solely in Latvia, burnout syndrome is explicitly listed on the List of ODs. A further 5 countries (Denmark, Estonia, Hungary, Slovakia, and Portugal) accept chronic stress-related occupational diseases as occupational through the “open item” in the List of ODs. In the Netherlands and Sweden, countries not using List of ODs, any disease or injury may be acknowledged as occupational, supposing a sufficient proof of the causality has been given. In France, chronic stress-related occupational disorders (i.e., depression, anxiety disorders and burn-out syndrome) can be recognized and compensated as occupational diseases using an additional occupational disease recognition system: if the disease can be directly attributed to the victim’s usual work activity and has led to his or her death or permanent disability. (See indhealth-56-160.pdf (nih.gov).)?
It has taken France some suicide waves in France Telecom / Orange, Renault, La Poste after major restructuration, and good political work from people like Benoit Hamon during his presidential campaign in 2017 to achieve this. Fortunately, not all burnout cases end up with untreated depression that can give way to suicide. People recover after sick-leave, therapy and medication if needed. Metaphorical descriptions such as “going down to the cellar”, “hitting/meeting the wall” are used in the workplace about the burned-out worker. General Practitioners use subsidiary diagnoses such as stress, feelings of depression, and so on in sick leave reports because burnout is still not?classified as a medical condition.?
What is burnout?
In ICD-11, it is characterized by three dimensions:
Exhaustion?refers to feelings of overstrain, tiredness, and fatigue, which result from long-term involvement in an over-demanding work situation.
Cynicism?reflects an indifferent and distant attitude towards work, disengagement, and a lack of enthusiasm for work. It is a dysfunctional way of coping with exhausting situations, reducing the possibilities of finding creative solutions at work.
Professional efficacy?consists of feelings of competence, successful achievement, and accomplishment in one's work, which diminishes as burnout develops.
In the most influential article on job burnout, Maslach, Schaufeli and Leiter, (2001), defined burnout as “a prolonged response to chronic emotional and interpersonal stresses on the job”. In order to understand burnout, we should understand stress.
What is stress?
Lazarus (1991) stated that stress is experienced “when a person perceives that the demands exceed the personal and social resources the individual is able to mobilize.” The key word here is perception. Neither the environmental event nor the person’s response defines stress, rather the individual’s perception of the situation is the critical factor. The effects that stress has on a person is based more on that person’s feelings of threat, vulnerability and ability to cope. That is why Lazarus defines “psychological stress” as “a particular relationship between the person and the environment that is appraised by the person as taxing or exceeding his or her resources and endangering his or her well-being”. Epictetus said “It is not events that bother men, so much as their view of them”.
Stress is a normal reaction to everyday pressures but can become unhealthy when it disturbs day-to-day functioning. Stress affects all systems of the body including the musculoskeletal, respiratory, cardiovascular, endocrine, gastrointestinal, nervous, and reproductive systems influencing how people feel and behave. By causing mind–body changes, stress contributes directly to psychological and physiological disorder and disease, reducing quality of life.
Several factors such as work content, workload and work pace, schedule, control, environment and equipment, organizational culture and function, interpersonal relationships at work, role in the organization, career development and family/work interface have been identified as psychosocial work environment factors that can cause stress. Bullying, harassment, and workplace violence are also considered psychosocial risks that can cause psychological strain at the same time as being an indicator/symptom of a destructive or toxic working environment. When stress reaches an all-time high, it’s harder to regulate emotions like sadness, anger, and guilt, which may result in panic attacks, anger outbursts, and substance use. Chronic stress leads to burnout.
Why stress causes burnout?
Several researchers have investigated the connection between stress and burnout and based their theories on conditions that create stress and burnout. Karasek's Job demands – control model has formed the starting point for much of the research on burnout. Why is prolonged stress dangerous? The body mobilizes the same stress response with the secretion of stress hormones as when a zebra flees from a lion (Sapolsky, 1994). The problem is that the zebra relaxes when the danger is over, while we humans can experience work stress over weeks, months, and years.
Why is stress dangerous for physical health?
It has been documented that chronic/lasting stress leads to increased abdominal fat, which increases the risk of cardiovascular disease, type 2 diabetes and depression (Rosmond & Bj?rntorp, 2000; Melamed, Shirom, Toker, Berliner, & Shapira, 2006). Chronic stress continuously activates the so-called HPA axis and stress hormones such as cortisol and glucocorticoids remain high, resulting in the accumulation of body fat. In recent years, the phenomenon called “hypocortisolism” has been reported in 20-25% of patients with stress-related disorders such as chronic fatigue syndrome (CFS), chronic pelvic pain (CPP), fibromyalgia (FMS), post-traumatic stress disorder (PTSD), irritable bowel syndrome (IBS), low back pain (LBP), burnout, and atypical depression (Fries, Hesse, Hellhammer & Hellhammer, 2005). A triad of increased stress sensitivity, pain, and fatigue follows. No wonder that burned-out people lack energy, and their condition can easily be confused with chronic fatigue syndrome.
A brief history of burnout concept
The burnout phenomenon was originally discovered in professionals employed in human service work; particularly among professional care groups, by Herbert Freudenberger in 1974, and since then, several hundred scientific studies on this mental condition have been published. It was later realized that burnout can result from prolonged work stress in a wider range of occupations such as medical staff, teachers, social workers, and people working in the financial sector, ICT sector, hospitality sector, among salespeople, and managers. Freudenberger and Richelson (1980) defined burnout process as “to deplete oneself; to exhaust one's physical and mental resources; to wear oneself out by excessively striving to reach some unrealistic expectation imposed by oneself or by the values of society”. Maslach and Jackson (1981) have developed the three-dimensional construct which is still the most influential: exhaustion, cynicism and reduced professional efficacy which may develop in sequence or in parallel. ?
What are the symptoms of burnout?
When it comes to symptoms, it is important to distinguish between being tired and burnt out. If we are very tired, a good, long holiday helps. If we come back from holiday just as tired, then something is not right. Burnout has several symptom categories (Schaufeli & Enzmann, 1998):
(i)?emotional symptoms such as emotional exhaustion, anxiety, decreased emotional control;
(ii)?mental symptoms such as feelings of helplessness, poor self-image, guilt;
(iii)?physical symptoms such as headache, back and neck pain, chest pain, nausea, restlessness and gastrointestinal illness;
(iv)?behavioral symptoms such as hyperactivity, impulsivity, increased intake of coffee, alcohol, smoke, drugs, over- or undereating and
(v)?motivational symptoms such as disappointment, boredom, loss of idealism, listlessness, indifference.
Many of these symptoms can easily be confused with depression or chronic fatigue syndrome (CSF). Depression can be a result of burnout (Schaufeli, Bakker & Hoogduin, 2001, Hallsten, 1993). But according to research, there are different biomarkers for depression and burnout that can be determined through a blood test (Toker, Shirom , Shapira & Berliner, 2005). Furthermore, depression is a condition that is present at all times and aspects of life, while a burned-out person may have desire and energy for activities outside of work.
How does burnout develop?
According to researchers (Maslach & Jackson, 1981), burnout develops along three dimensions as a result of poor coping strategies: Either one increases efforts too much to achieve everything that is demanded or feel one must achieve and enter into a vicious cycle and become exhausted physically, emotionally and mentally; there comes the famous “Bang!”. Or, one reduces efforts too much in an attempt to reduce the workload, becomes rigid and develops negative thoughts and feelings towards colleagues and customers, so one becomes cynical.
In both cases, one will have reduced professional efficacy either because when one is exhausted, it is easy to make professional mistakes or because when one doesn’t care anymore, one does sloppy work. Another aspect is about cognitive distortions kicking in because of stress which impairs judgement and decision-making ability which will eventually lead to poor relations, poor decisions and poor work results which further will reduce self-efficacy beliefs and motivation. ?
Researchers disagree about what develops first, whether they develop in sequence or in parallel, but here there are many variations depending on profession, personality, and the context one finds oneself in. In any case, one ends up with a loss of self-esteem and it takes time to rebuild. In case of a long sick leave, one is ashamed “having hit the wall” and “one couldn't stand the pressure”. What one imagines others, especially managers, saying behind one’s back becomes a harmful self-talk.
How do we measure burnout?
There are tests that measure burnout along these three dimensions. Those who are burnt out do not see the warning signs themselves and it is important that there is knowledge of these symptoms so that this can be discovered by colleagues and managers before it goes too far.
The most widely used instrument to measure burnout is the Maslach Burnout Inventory (MBI), which is targeted for human service professionals. The MBI consists of 22 items. Its general version, the Maslach Burnout Inventory – General Survey, comprises of 16 items and can be used in a variety of workplaces. Other burnout measures include, for example, the Oldenburg Burnout Inventory,?the Copenhagen Burnout Inventory, and the Bergen Burnout Inventory (BBI).
Why do people burn out?
There are many models, and the curious reader can check the resources on internet. When I did my research back in 2010-2011, I developed a model, and it was said that I contributed to the burnout theory. When the demands exceed the resources (resource gap, Evenstad, 2011) and the reward is far below what the effort and results indicate (reward gap, Evenstad 2011), one experiences a psychological contract breach which causes one to lose work engagement. “Burnout is a loss of work engagement, i.e. reduced energy, dedication, self-efficacy beliefs and motivation when a person invests too much of him/herself in a relationship (the job) and experiences too little personal returns” (Evenstad, 2011, NTNU Master's thesis).
Which organizational factors contribute to burnout?
Burnout comes from chronic, i.e., long-term, stress. The researchers Maslach and Leiter (1997) have found a number of work and organizational factors that create stress: high workload, lack of control, lack of social support, lack of reward, lack of fairness, and value conflict as the most important psychosocial risk factors that lead to burnout.
The first factor, high workload where challenges/demands exceed resources, can be both quantitative and qualitative. Quantitative workload means that you simply have too much to do. Qualitative means that one is either over- or under-qualified for the job, which respectively leads to boredom or anxiety and stress due to a lack of competence to perform one's tasks. This imbalance will mainly be related to exhaustion but will indirectly affect cynicism and reduced professional efficacy through exhaustion.
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The second factor is lack of control over one's own work, which is particularly related to role conflicts and role ambiguity when there are unclear and conflicting demands from others. If you have several tasks that come into conflict with each other, for example different clients, projects and/or you experience uncertainty about what is expected of you, you can feel constant stress around the right prioritization. If responsibility is greater than authority, i.e. one has responsibility for the results, but no control over the resources and/or time to exercise one's responsibility, one feels disempowered and that one is trying hard but achieving little. This will lead to reduced professional efficacy.
The third factor is lack of reward. Internal reward in the form of pride in one's own work and satisfaction is important for intrinsic motivation. Getting social or non-financial rewards in the form of recognition and praise is a motivational factor that is just as important as financial rewards. Hygiene factors such as the right salary level and other benefits must be in place, but if motivational factors such as feedback, recognition, reward for one's efforts are not present, this will erode one's self-esteem. Lack of reward is associated with reduced professional efficacy.
The fourth factor is a lack of social support. If you have support in your surroundings, you can persevere in an otherwise demanding job. If there are long-term conflicts, mistrust in the workplace, low psychological safety, the employees will be more concerned with protecting themselves than supporting each other. If you do not get social belonging, you are given the cold-shoulder, excluded from the main group, this is experienced as very burdensome.
The fifth factor is lack of fairness. Fairness signals respect and helps confirm one's self-worth. If you do not receive the reward you deserve, are given too much workload in relation to others, are not included in an important decision-making process, are not heard in a conflict, or are made unreasonable demands without opportunities for control, you experience injustice which will be emotionally taxing and exhausting. It will gradually lead to cynicism in relation to the job.
The sixth and final factor is value conflict that can arise if there is an imbalance between the individual's values and the organization’s values, for example when one experiences a large distance between the values the company claims to have (espoused values) and their daily practices (enacted values). This will be very disappointing and prevent you from identifying with the company. Within the organization there may be organizational values that are in conflict with each other.
In my PhD research (A communicational approach to burnout by interpretative phenomenological analysis: Understanding the role of stress-inducing communications in burnout, 2016), I have looked behind these six factors. How do they arise? In the burnout research literature, there was very little focus on communication around these factors.?For instance, through which communication processes an employee ends up with an unmanageable workload??What kind of messages are exchanged, how the employee is presented with and the given the excessive workload? Which attempts have been done to negotiate to lower the workload, increase the resources? I took a communicational approach to burnout and asked what happens in the new world of work with acceleration and efficiency discourses that influence organizational culture which in its turn influence the managerial discourses (interpersonal communication), and what employees tell themselves (intrapersonal communication). I found a range of stress-inducing communication patterns which are either pathological (paradoxes, double-binds, social undermining, bullying and so on) or ineffective (information and communication overload and so on). There will be an article about it here soon.
How to avoid burnout?
Let’s go back to stress, because burnout is the result of chronic stress.
Cooper and Marshall (1976) made a classification of work stressors. Cartwright and Cooper (1997) refined it and divided the work-related stressors into six categories which was further summarized by Dewe et al. (2010) into the following classification:
Factors intrinsic to the job itself, encompassing work environment, workloads, work hours, use of technologies, risks or hazards.
Roles in the organization, including role ambiguity, role conflict, role responsibilities, and role overload.
Social relationships at work, such as relationships with colleagues, supervisors, and customers.
Career development, such as job insecurity, perceived under- or over- promotion, and lack of a sense of career achievements.
Organizational factors, including organizational structure, political climate within the organization, organizational policies, lack of effective participation in decision-making processes, overly bureaucratic structure, inappropriate and ineffective communication strategies.
The work-home interface, such as conflict or interference between work and family life.
According to WHO, burnout syndrome results from chronic workplace stress that has not been successfully managed. “Not been successfully managed” by who? All of the factors above involve leadership practices as well as employeeship practices, while the last one will also involve a third party, the family. ?To avoid burnout, we must try to reduce stress at source and each of the above areas need active strategies from both the organization and the employee. In other words, I am taking the psychosocial stance here, that sees burnout as a function of organization and employee. In comparison, psychological stance will focus on the individual and sociological stance will focus on the work environment. I believe it is an interaction.
For a long time, stress and burnout were seen as the worker’s problem—something they needed to fix with self-care, yoga and sleep if they would become resilient and cope with work stress effectively. According to an article in the American Medical Association (AMA) (See WHO adds burnout to ICD-11. What it means for physicians. | American Medical Association (ama-assn.org) . ), the best response to burnout “is to focus on fixing the workplace rather than focusing on fixing the worker,” according to Dr. Sinsky who also says, “The ICD-11 definition of burnout is consistent with our research and our approach, which is that burnout is related to stressors within the environment rather than related to weakness on the part of susceptible individuals.”
If we can assume that the organization is doing what the organization can and there is still psychological stress, what can we do?
How to cope with stress?
When we feel stressed, we go through two important phases that are (i)?cognitive appraisals?and (ii)?coping.
?Cognitive appraisal?is the “process of categorizing an encounter, and its various facets, with respect to its significance for well-being” (Lazarus and Folkman, 1984). The cognitive appraisal is in two steps which are primary and secondary appraisals. Primary appraisal is an assessment of what is at stake: “Am I in trouble or am I going to experience something good? Is it now or in the future, and in what ways?” If the answer to this question is yes, then people perceive a threat and/or a challenge. While threat suggests potential danger to one's well-being or self-esteem, challenge suggests that one focuses on the success, the social rewards, and the personal growth that the situation could bring and these two are not mutually exclusive. For instance, waiting for presenting to Board of Directors can be appraised as particularly threatening and challenging at the same time.
Secondary appraisal is an assessment of coping resources and answers to the question: “Can I cope with this situation? Do I have the resources to cope with it?” Resources can be physical (e.g., health, energy), social (e.g., social support one can get from family, friends and social network), psychological (e.g., beliefs, self-esteem, perceived control, morale), or material (e.g., financial, tools).
Coping refers to “cognitive and behavioral efforts to master, reduce, or tolerate the internal and/or external demands that are created by the stressful transaction” (Folkman,?1984). Coping serves two major functions. One is emotion-focused coping which can?include wishful thinking, distancing, avoidance, and positive reappraisal. The other is problem-focused coping which is directed at problem solving or taking action to change the source of the stress.
Although both forms of coping are used in most stressful encounters, they are nevertheless dependent of the way one appraises the situation (i.e., as a threat and/or a challenge). Problem-focused strategies are typically invoked when constructive action can be taken, whereas emotion-focused coping is used when people feel that the situation cannot change and must be endured.
Our coping styles differ. There are two major styles: Approach and Avoidance Coping Style. Dispositional coping style refers to a person’s preferred behavioral and cognitive responses to stressful situations (Carver, Scheier, & Weintraub, 1989). A person with an approach coping style prefers strategies that are aimed at problem solving or active attempts to resolve the stressor through seeking information, negotiating for increased control, resources, rewards and reduced demands. A person with an avoidance coping style prefers strategies that are aimed at avoiding active confrontation of the stressor or reducing emotional tension associated with the stressor (e.g., denial, withdrawal, i.e., not thinking about the stressor, distraction, i.e., engage in other activities to avoid thinking about the problem).
Which personal factors contribute to burnout?
How people appraise and cope with a stressful situation depends on characteristics of the individual and characteristics of the situation. Commitments (which defines what is important for the person and so what is at skate in that situation), beliefs (such as beliefs about personal control, self-efficacy and so on) and personal traits (such as self-esteem, negative affect and so on), also coping and communication styles (such as having an approach coping style and being assertive or having avoidance coping style and being passive and so on) have a lot to say.?
It is said that “to burn out you have to burn for something”. According to Pines (1993), people with high goals and expectations are prone to burnout and that only highly motivated people can experience burnout. So sometimes, it is not only the environment that puts demands that exceed available resources, but one can “get caught in the honey trap” because one gets too engaged. When the work is so interesting that the work itself becomes the reward, people will be working more and more. This has nothing to do with being a workaholic since the latter will work compulsively although they don’t even enjoy it. We are talking here about the employee’s own demands to self that can be too high. We then talk about burnout as “highflyers syndrome”, i.e., there is something about performing a lot and getting recognition, and the employee having performance-based self-esteem (Hallsten, 2005), believing that “if I don't perform, I'm worthless”. Among those, we find perfectionists and we find people with imposter syndrome. Cognitive behavioral therapy is used to challenge them who have this quest for recognition, scared of failure and work disproportionately hard.
Like other personal factors, age, marital status, education etc. come into play. It is often the young and ambitious who get burnt out, the idealistic ones straight out of school and then face reality - and get reality shock, as the researchers have found out. Young people tend to burn out because they lack life experience (Pouline & Walter, 1993). Women seem to develop emotional exhaustion while men develop cynicism/depersonalization. Surveys show that unmarried people burn out more often than those who are married, and it seems that having a family and the responsibility to support a family protects against burnout. Studies have shown that the higher a person's education, the greater the likelihood of burnout (Mor & Laliberte, 1984).
?How to prevent burnout?
Now we come back to the question of avoiding burnout. Every country has some form of occupational health and safety act which requires employers to provide and maintain a working environment that is safe and without risks to health, so far as is reasonably practicable. This responsibility includes providing and maintaining safe systems of work and prevent hazards and risks associated with work-related stress. Employees also have duties under this act to take reasonable care for their own health and safety, the health and safety of people in the workplace and to co-operate with their employer.
According to European Agency for Safety and Health at Work, psychosocial risks arise from poor work design, organization and management, as well as a poor social context of work, and they may result in negative psychological, physical and social outcomes such as work-related stress, burnout or depression. Some examples of working conditions leading to psychosocial risks are:
Several of these factors were already mentioned above as stress and burnout factors. There are some more factors here: poorly managed organizational change, job insecurity. At the time of rapid changes in the world of work, pandemics and remote work, restructuration, downsizing, M&A, effective change communication is key to prevent stress and burnout.
With the right approach, psychosocial risks and work-related stress can be prevented and successfully managed, regardless of business size or type. Managing stress is not just a moral obligation and a good investment for employers, it is a legal imperative set out in?Framework Directive 89/391/EEC, supported by the social partners’ framework agreements on work-related stress and harassment and violence at work. Furthermore, the?European Pact for Mental Health and Well-being?recognizes the changing demands and increasing pressures in the workplace and encourages employers to implement additional, voluntary measures to promote mental well-being.
How to build resilience?
Stress arising from psychosocial risks in the workplace can have many different effects on health and wellbeing, both physical and mental. One way in which employers can help to avoid such effects becoming serious is to help workers become healthier. In this way, they are better able to withstand the otherwise harmful effects that stress can have. Providing people with guidance on a healthy lifestyle is not compulsory, but many employers have found that it can be beneficial to their business. Those who eat healthily, exercise regularly, don’t smoke, and avoid drinking to excess are more likely to remain healthy and not be off sick.
As well as these more physical approaches to health and wellbeing, it is also important to build resilience. Resilience is the personal capacity to cope with adverse events and return to normal life, and the determination to see something through to its conclusion, even in the face of significant pressures to do something else or give up. Resilience is part of psychological capital which consists of hope, optimism, resilience and self-efficacy (Luthans, 2007). Those with high levels of personal resilience are often described as having a number of attributes including: self-belief, personal vision, flexibility, good time management, good problem solving, good emotional control, good relationships, positive approach to change. Coping strategies are best put into use also through better communication skills, including negotiation and conflict resolution, boundary setting, and assertiveness. For instance, negotiating to reduce demands and/or increase resources, perhaps increase rewards if demands can’t be reduced need assertiveness. Adjusting personal efforts in relation to the demands and rewards need effective boundary setting and pragmatic attitude and so on; all to maintain the balance between efforts and rewards and the sense of fairness since it is known that effort-reward imbalance creates stress (Siegrist, 1996).
How to treat burnout?
After an initial diagnosis by the General Practitioner, people are put on sick leave and it may vary from 3 months to 3 years to recover from a burnout, depending on the severity. Different countries have different national cultures and approaches to treating burnout. In my research, I discovered that in France, people are put into psychiatric treatment with medication and therapy, i.e., a rapid and effective intervention and shorter sick leave while for instance in Norway it is recommended to relax, take walks in nature etc. and a long sick leave will follow.
?It is important to note that if one stays home without follow-up and treatment, the burnout can easily slip into depression. It is important to have someone to vent to. It is possible to recover from burnout, and there are many things that help: (i) taking a complete break from work, (ii) increasing physical activity, (iii) professional help to change attitudes to work and self and learn to set limits towards self and others, (iv) mastery experiences in non-work related areas to regain self-confidence and (v) support from family, friends and colleagues.
?Returning to work after burnout
How the burned-out employee is met when returning to work after a long sickness absence has a lot to say for safe journey back. One is vulnerable, one is afraid of what people will say, and here the employer must make a plan for carefully increasing the workload so that one does not relapse. The General Practitioner will start with 20 % work and then gradually this percentage will increase over weeks such as 40%, then 60%, then 80% and finally 100%. The most common mistake people do themselves is to start working more than prescribed by the GP because one will prove that one “is back in business” and fully recovered, can be counted on etc. There are plenty of horror examples where one comes back with partial sick leave and gets a hugely challenging project and relapse for this time being on a much longer sick leave. People may think “you're not sick” because burnout is not visible like a broken leg and you yourself must be prepared for experiencing ups and downs before it all stabilizes. The good news is that you can fully recover from burnout with patience and good self-care and good help from your employer.