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

Figures & data

Table 1. Phases in the development of clinical burnout

Phase	Main features and process	Symptoms
1	Lack of recovery: Stressful events combined with limited possibilities to recuperate	Need for recovery Aversion to spending effort
2	Changes in stress physiology: Higher homoeostatic stress values	Hyperactivity Sleep difficulties Inability to relax Restlessness
3	Chronic stress symptoms: Physical symptoms: Mental symptoms: Emotional problems: Behavioural problems:	headaches intestinal problems muscle tension or pain chest pain fatigue reduced sex drive stomach upset vulnerability to diseases concentration deficits being forgetful and absent-minded trouble staying focused indecisiveness impaired learning capability impaired planning and control feeling frustrated and angry irritability overreacting feeling upset or sad without knowing why feeling unable to control one’s emotions anxiety and panic conflicts social withdrawal drinking alcohol, taking medicine, eating too much quitting hobbies and sports
4	Pseudopsychopathology: 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
5	clinical burnout: Reduced motivation and passivity	Emotional breakdown Severe fatigue Passivity 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.

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.	Psychoeducation Sick leave Dropping domestic tasks and social obligations Inform social network
Phase 2: Recovery	Recovery of the (physiological) stress system to normal allostatic stress levels.	Registration of stress and activities. Relaxation exercises Mindfulness Healthy lifestyle advices Graded exercise Gradually resume activities Psychoeducation social network and employer Gradual return to work
Phase 3: Prevention, learning from the past	Acquiring insight and skills to prevent relapse in clinical burnout.	Analysing stressful situations Analysing dysfunctional thought patterns Learning new coping skills Learning social skills Job crafting Time management Making choices regarding career and personal life
Phase 4: Post burnout growth	Improving sustainable quality of life.	Setting priorities regarding quality of life and interpersonal relationships.

Based on: Hamming, 2020; Keijsers et al., 2004; Van Dam et al., 2017; Van Zweden, 2015; Weber & Jaekel-Reinhard, 2000.

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