The study of the severity of emotional burnout
To diagnose the degree of severity of the "burnout effect", a personnel survey technique developed by American psychologists K. Maslach and S. Jackson to measure the degree of burnout in "person-to-person" professions can be used. The questionnaire consists of 22 statements reflecting the thoughts and feelings of a person about his professional activity, and has three rating scales:
- "emotional exhaustion"(manifested in feelings of emotional overstrain and in a feeling of emptiness, exhaustion of one's emotional resources; a person feels that he cannot devote himself to work as before);
- "depersonalization"(associated with the emergence of an indifferent, negative and even cynical attitude towards people with whom it is necessary to contact by the nature of work; contacts with them become impersonal and formal);
- "reduction of personal achievements"(manifested in a decrease in the assessment of one’s competence (in a negative perception of oneself as a professional), dissatisfaction with oneself, a decrease in the value of one’s activity, a negative attitude towards oneself as a person; in indifference to work).
The technique allows assessing the intensity of negative feelings and thoughts experienced by the respondent, which characterizes the degree of severity of the "burnout" effect. Below is a sample of the questionnaire form for the study of the severity of the "burnout syndrome" and the procedure for interpreting the results of the study.
Interpretation of study results
The "burnout effect" is expressed if there is a high degree of emotional exhaustion, the severity of depersonalization and a reduction in personal achievements.
The answers to the questionnaire questions are evaluated as follows: "never" - 1 point, "very rarely" - 2 points, "sometimes" - 3 points, "often" - 4 points, "very often" - 5 points, "every day" - 6 points.
The degree of emotional exhaustion of the employees of the team is characterized by the sum of points for answers to questions N 1, 2, 3, 6, 8, 13, 14, 16, 20 .
The severity of depersonalization characterizes the sum of points for questions N 5, 10, 11, 15, 22 .
The decrease in work productivity as a reduction in personal achievements is characterized by answers to questions N 4, 7, 9, 12, 17, 18, 19, 21 .
The development of "burnout" occurs latently, over a long period, and depends on the personal characteristics of the employee (for example, lack of sociability, shyness, emotional instability, low self-sufficiency, etc.) and the influence of production factors. "Burnout" develops earlier if the employee:
Evaluates his work as insignificant;
Not satisfied professional growth;
Lacks independence, believes that he is overly controlled;
Completely absorbed in their work (workaholic);
Experiencing role uncertainty due to fuzzy requirements for him;
Experiencing overload or, conversely, underloading (the latter gives rise to a feeling of its uselessness).
Questionnaire
Dear respondent!
Stress monitoring is carried out in order to study the stressfulness of the organizational environment and, on this basis, develop effective measures to reduce professional stress and conflicts.
Instruction: Carefully read the description of emotional states presented in the table below, and evaluate how often this description corresponds to your state by putting a "+" sign in the appropriate column.
| How often can you say the following about yourself: | Answer Options (Check only one answer per question): | |||||
| never | very rarely | Sometimes | often | Often | every day | |
| 1. I feel emotionally drained. | ||||||
| 2. After work, I feel like a "squeezed lemon" | ||||||
| 3. I feel tired in the morning and don't feel like going to work. | ||||||
| 4. I am well aware of how my colleagues and subordinates feel and I try to take this into account in the interests of the business | ||||||
| 5. I feel that I communicate with some subordinates and colleagues as with objects (without warmth and affection for them) | ||||||
| 6. After work for a while, I want to retire from everyone and everything | ||||||
| 7. I can find the right solution in conflict situations that arise when communicating with colleagues | ||||||
| 8. I feel depressed and apathetic | ||||||
| 9. I am sure that people need my work | ||||||
| 10.B Lately I have become more callous towards the people I work with | ||||||
| 11. I notice that my work hardens me. | ||||||
| 12. I have many plans for the future, and I believe in their implementation | ||||||
| 13. My job is becoming more and more frustrating. | ||||||
| 14. I feel like I work too hard. | ||||||
| 15. It happens that I really do not care what happens to some of my colleagues and subordinates. | ||||||
| 16. I want to retire and take a break from everyone and everything | ||||||
| 17. I can easily create an atmosphere of goodwill and cooperation in a team. | ||||||
| 18. During work, I feel a pleasant revival | ||||||
| 19. Thanks to my work, I have already done a lot of really valuable things in my life | ||||||
| 20. I feel a loss of interest and indifference to many things that made me happy in my work. | ||||||
| 21. At work, I calmly deal with emotional problems. | ||||||
| 22. Recently, it seems to me that colleagues and subordinates are increasingly shifting the burden of their problems and responsibilities onto me. |
Completion date __________20___
INTRODUCTION
“Burned at work” - until recently, these words were perceived as nothing more than a vivid metaphor. Many studies conducted over the past decades have proven the reality of the existence of this phenomenon. In the literature, it was called the emotional burnout syndrome (SES). The term "emotional burnout" was introduced American psychologist Fredenberg in 1974 to determine the psychological state caused by emotional, mental and physical exhaustion.
This phenomenon is most often observed among professionals working in the field of social assistance and who have constant close contact with clients. In other words, among the professionals of the "man-man" system. These include doctors, teachers, clergy, salespeople, managers, lawyers, social workers, psychiatrists, psychotherapists, and psychologists.
A special subgroup includes doctors and consultants who provide assistance to:
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people in the terminal stages of diseases such as AIDS, cancer;
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socially disadvantaged groups of the population (homeless children, people without a fixed place of residence, the poor, the socially unprotected);
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survivors of violence have become victims of terrorist attacks.
Representatives of these professions in the course of their activities are more likely to encounter negative emotional experiences of their clients and therefore more often experience a state of increased emotional stress.
In this work, we will constantly use two concepts: "consultant" and "client". "Consultant" - referring to a specialist providing information (this may be a doctor working with patients, as well as a psychologist or social worker); "client" - referring to people who seek this help from a consultant.
COMBUSTION SYNDROME.
WHAT IS ITS DANGER?
Emotional burnout syndrome (SES) is caused by disorders and difficulties that arise in the human body in the course of his professional activity. This is the body's response to a situation that causes constant, prolonged stress.
SES is characterized as a state of mental fatigue and frustration and most often occurs in people in the so-called helping (helper) professions. This condition is accompanied by emotional exhaustion, depersonalization, decreased performance.
The symptoms accompanying the syndrome of emotional burnout can be conditionally divided into three groups: those associated with the physical state of a person, associated with his social relationships, and intrapersonal experiences of a person.
Symptoms associated with the physical condition indicate that certain processes are taking place in the human body that can cause a deterioration in health. These symptoms include:
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increased fatigue, apathy;
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physical malaise, frequent colds, nausea, headache;
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heart pain, high or low blood pressure;
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pain in the abdomen, impaired appetite and diet;
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asthma attacks, asthmatic symptoms;
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increased sweating;
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tingling behind the sternum, muscle pain;
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sleep disorders, insomnia.
Symptoms associated with social relationships are manifested when a person contacts with others: colleagues, clients, relatives and relatives. These include:
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the appearance of anxiety in those situations where it did not arise before;
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irritability and aggressiveness in communication with others; cynical attitude to clients, to the ideas of a common cause, to one's work;
·
unwillingness to work, shifting responsibility;
·
lack of contact with clients and / or unwillingness to improve the quality of work;
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formalism in work, stereotypical behavior, resistance to change, active rejection of any creative principle;
·
aversion to food or overeating;
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abuse of mind-altering chemicals (alcohol, smoking, pills, etc.);
·
involvement in gambling (casino, slot machines).
Intrapersonal symptoms relate to the processes occurring inside a person and due to a change in his attitude towards himself, his actions, thoughts and feelings. These include:
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increased feeling of self-pity;
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feeling of own lack of demand;
·
guilt;
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anxiety, fear, feeling of being driven out;
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low self-esteem;
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a feeling of one's own oppression and the meaninglessness of everything that happens, pessimism;
·
destructive self-digging, playing in the head of situations related
with strong negative emotions;
·
mental exhaustion;
·
doubt about performance.
Each person has a burnout syndrome with varying degrees of severity of symptoms. The initial assumption that people who have worked in helping professions for many years are the most vulnerable to burnout syndrome is not always true - as it turned out, over time, many of them adapt to the profession and develop their own ways to prevent burnout syndrome. Much more cases of SES occur among young professionals.
Syndrome Models
There are several scientific models of the syndrome. The most common is the three-component model, according to which the syndrome professional burnout includes three components: emotional exhaustion, depersonalization and reduction of personal achievements.
emotional exhaustion
The development of the emotional burnout syndrome is preceded by a period of increased activity, when a person is completely absorbed in work, to the detriment of his needs in other areas of life. This leads to the development of the first sign of the burnout syndrome - emotional exhaustion. Emotional exhaustion is expressed in the appearance of emotional emptiness and a feeling of fatigue caused by work. The feeling of tiredness does not go away after a night's sleep. After a period of rest (weekends, holidays), it becomes smaller, but upon returning to the usual working situation, it resumes with the same force. Emotional overload and the inability to replenish energy lead to an attempt to self-preservation through detachment and alienation. A person is no longer able to do his work with the same energy. The work is done mostly formally. Emotional exhaustion is the main symptom of professional burnout.
Depersonalization
In the social sphere, depersonalization implies an insensitive, inhumane and cynical attitude towards a client who seeks treatment, consultations, educational and other services. The client is perceived as a kind of impersonal object. The consultant may have the illusion that all the problems and troubles of the client are given to him for the good. Negative attitude affects the expectation of the worst, unwillingness to communicate, ignoring the client. In the circle of his colleagues, the “burning out” specialist talks about him with hostility and disdain. At first, he can still partially restrain his feelings, but gradually it becomes more and more difficult for him to do this, and in the end they begin to literally spill out. The victim of a negative attitude is an innocent person who turned to a professional for help and hoped, first of all, for a humane attitude.
Reduction of personal achievements
The reduction or belittling of personal achievements is accompanied by a decrease in the consultant's self-esteem. The main manifestations of this symptom are:
·
a tendency to negatively evaluate oneself, one's professional achievements and successes;
·
negativity towards official duties, decrease in professional motivation, shifting responsibility to others.
The consultant loses the vision of the prospects of his professional activity, receives less job satisfaction, loses faith in his own professional capabilities, and as a result he has a feeling of incompetence and doomed to failure.
In this case, we can already talk about the complete combustion of a specialist. The person still retains a certain aplomb and external respectability, but if you look closely, his “empty look” and “cold heart” will become obvious: as if the whole world has become indifferent to him.
Paradoxically, burnout syndrome is a defense mechanism
our body, because it forces us to dose and economically spend energy resources. At the same time, this statement turns out to be true only when it comes to the very beginning of the formation of this state. In the later stages, "burnout" adversely affects the performance of professional duties and relationships with others. "Burning" may not be aware of the causes of the processes occurring in it. To protect himself, he ceases to perceive his own feelings associated with work. Formalism, harsh intonations and cold looks, to which we are almost accustomed in clinics, schools, and other administrative organizations, in most cases are manifestations of the emotional burnout syndrome.
CAUSES OF THE SYNDROME
PROFESSIONAL COMBUSTION
There are two main groups of causes that play a key role in
formation and development of the syndrome of professional combustion: causes
internal and external character.
Causes of an internal nature
- associated with the individual characteristics of a person: age, high expectations, self-criticism, selflessness, readiness for hard work, the need to prove one's worth.
Causes of an external nature
- associated with the peculiarities of professional activity: "difficult" contingent, emotionally intense activity, difficult working conditions, increased exactingness of management, unfavorable psychological atmosphere in the team. Individual characteristics are rather a predisposing factor, and the characteristics of the profession are the determining factor. This statement is easy to verify if we reduce the influence of external causes: all other things being equal, the burnout syndrome will not develop. There is an additional number of causes of an external nature, which can also lead to the development of specialist burnout syndrome or its intensification. Illness, death of loved ones, divorce, marriage, natural disasters, etc. All of these factors can also increase specialist stress and lead to burnout syndrome.
Currently, the risk of developing emotional burnout syndrome is recognized as possible for people in various fields of activity. This is explained by the fact that during the working day, almost any person has a number of short contacts with strangers / unfamiliar people, and there are other factors that increase the risk of developing SES.
In psychology, when talking about solving a problem, the first step is to accept the situation. This moment is very important! A person needs to feel the ground under their feet in order to have something to push off from.
on the way to change.
PREVENTION METHODS
AND WORK WITH SES
The section of psychology devoted to the syndrome of emotional burnout arose relatively recently. Despite this, SES is a fairly well-studied phenomenon, and many techniques have already been developed to work with it and achieve positive results. After conducting a short survey and using the experience of training in SES, we have collected some particularly interesting techniques that can be used as a basis for further personal growth and the prevention of burnout syndrome. F SES
WORKING WITH BELIEF
AND ILLUSIONS
Combustion is first and foremost a disappointment. Frustration sets in when we face a reality that is different from our beliefs and illusions. The presence of illusions is inevitable. We were all read in childhood books about hard-working, kind and beautiful heroes. Parents passed on to us age-old folk wisdom in very capacious and clear messages: fairy tales, myths, proverbs. If a person has no illusions at all, he can be called a cynic. And cynicism is one of the signs of SES.
The assimilation of any new information in our minds occurs in the form of beliefs. Persuasion is a short message that, during its existence, makes life easier, helps to understand reality and realize oneself in it. Belief determines our attitude to ourselves and to the phenomena of the environment. With the help of beliefs, we evaluate everything new and relate it to our vision of the world. A feature of beliefs is the combination of reality with an ideal, and with an ideal that is difficult to achieve. Every belief has its age. When the distance between reality and the "ideal" belief becomes obvious, it ceases to work positively for us and begins to be harmful. The inaccessibility of the ideal image, which is present in the belief, causes negative emotions, expressed in the so-called four "poisonous feelings": fear, guilt, shame, resentment. If you find these feelings in yourself, know that you have irrational beliefs that can lead to a dead end.
How to define an irrational belief?
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It contains words such as: Nobody, Everyone, Always, Never, Must, Shouldn't.
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Definitely next to "Poisonous Feelings".
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The statement contains a certain ideal image, which is difficult to implement in reality.
Here are some of the most common variations of irrational belief:
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Since I work with people, I shouldn't have any psychological problems of my own.
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My clients should love me and be grateful for my work.
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If clients are disappointed in our joint work, it means that I
I'm doing it wrong.
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My clients should be just as responsible, motivated
and hardworking like me.
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I must never be wrong.
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The interests of the client are higher than personal interests.
·
I can't work anywhere else.
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I must know the answers to all questions.
Let's look at one of the beliefs and analyze its pros and cons to understand how it can affect the work of a specialist. And let's reformulate the belief in such a way as to strengthen its positive aspects and remove the negative ones.
As an example:
·
I must know the answers to all questions.
The positive side of this belief is the incentive to learn and
the growth of professionalism. A consultant or doctor who has such a conviction may be afraid of difficult questions and unexpected situations that can cause him to be insecure about his abilities and, as a result, dissatisfaction with himself as a professional. It is impossible to completely abandon belief. At the same time, the responsibility that accompanies it is an almost unbearable burden for the doctor. One cannot know everything! Moreover, thanks to clients, he learns new things. He has the right not to know the answer now, he can prepare it for the next consultation. Reformulate the belief with its positive side in the following way: thanks to my clients, I am always in the process of learning; my work pushes me to self-development.In this form, persuasion provides more freedom, retains positive properties, and eliminates the possibility of the appearance of "poisonous feelings."
WORKING WITH EMOTIONS
Emotions are human reactions to internal and external conditions. Emotions
accompany us every minute of our lives. Emotions determine the significance of phenomena and situations. They signal us about changes in the environment and encourage us to act. We are talking about emotional exhaustion as the main component of the emotional burnout syndrome. Let's see what's going on. Why do emotions burn out? Almost every language has the phrase "Cup of patience." A person tolerates when he does not like something, when he experiences tension, resentment or anger. But sometimes the cup overflows.
As an illustration, let's imagine a small child who wants to eat, but his mother is not around. He does not know how to speak and generally knows little about our adult world. How to call mom? He has feelings for this. In this case, it is a feeling of hunger and / or fear. And they help the child solve the problem. He expresses them: he screams! Here and now, without hesitation, simply because he cannot do it differently yet. As the child grows older, he hears more and more often: “Don’t scream!”, “It’s indecent to behave like that”, “You are already an adult to be so impatient”, “Why are you crying? Boys/men don't cry." Simply put, the main messages he receives are: “Be patient!”, “Entering the world of adults, learn to restrain your emotions.”
A person gradually learns to handle his feelings in the way that the cultural environment around him requires. He masters the skill of "putting" them into his bowl of patience, because it is impossible to completely get rid of experiences. He is still ready to scream if he is hungry or when he is angry. But he does not do this, realizing that if you shout when the order is not carried in the cafe for a long time, they may refuse to serve at all. He
is able to howl from loneliness, but only being sure that no one will see or hear him. Because society condemns such behavior, regarding it as "indecent".
The human body is sensitive to the replenishment of the cup of patience and, at every opportunity, seeks to get rid of the accumulated feelings. For example, a situation in which many have been there more than once. Morning, a gloomy man walks, and suddenly someone steps on his foot. If, for clarity, we use a scale for measuring the strength of earthquakes, this situation will pull by 3 points. But if a person is in a state that can be defined as “everything in this life is enough!”, Then he can “bark” at the unfortunate person in such a way that the situation will pull all 8 points. Where does such a reaction come from? Let's look at it in more detail. Something happened that caused certain negative feelings. How does the body react? He immediately starts looking for similar experiences in the cup, and if he finds them, he adds them to the ones he has just received. This, of course, greatly spoils the life of others.
Let's imagine what will happen if a person closes the cup by willpower, stops expressing accumulated feelings, but at the same time remains in a society where there are always reasons for irritation. What will give the body a closed cup of patience?
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First of all, probably a red face! Because feelings are like a cough:
it is impossible to stop a person from coughing. For a while, of course, he will be able to withstand, but not for long.
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Headache is one of the first symptoms of strong unexpressed feelings.
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Insomnia - it will come after a headache, because thoughts and unexpressed feelings take away from us a restful, restorative sleep.
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Change in blood pressure - feelings weigh heavily on a person. Blood pressure drops, unable to carry the load. If the body
still will fight, blood pressure will rise.
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Pain in the stomach, ulcers - a proven mechanism for the manifestation of stress from unconscious, unexpressed, negative feelings. Have you seen anyone suffering from an ulcer from happiness?
And so on. And the blame for everything is largely feelings that do not find a way out. This is called the fashionable word today "psychosomatics".
Psychosomatics
(from the Greek "psyche" - soul and "soma" - body) - a direction of medical psychology that studies the influence of psychological factors on the occurrence of a number of somatic diseases. There are a number of diseases in which the role of psychosomatic factors is extremely important: bronchial asthma, hypertension, angina pectoris, duodenal ulcer, ulcerative colitis, neurodermatitis, nonspecific chronic polyarthritis, hypertension, diabetes mellitus, glaucoma.
What to do to avoid this extensive list of diseases?
The answer is to act.
Healthy Ways to Manage Feelings:
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Express your feelings right away, don't accumulate them. But when angry,
be sure to scream. You can say about him. And you will immediately feel that it has become easier.
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Your feelings are the most faithful assistants in the decision-making process.
Use them.
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Come to terms with your feelings. Try to understand what they want to "tell" you.
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Recognize your "scandalous" feelings and use them not to manipulate other people, but to improve the situation in legal ways.
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Explore your feelings. One of them can "close" the other - the true one.
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Allow yourself to experience your feelings as fully as possible.
SOLUTION OF CONFLICT SITUATIONS
The "man-to-man" system always assumes the presence of at least one of two fronts of work that require a large amount of effort and energy: clients, superiors and colleagues. For example, a person working in production does not have the first front of work, but there is a second one - colleagues and superiors. Sometimes there can be more such fronts. For example, a teacher has three of them: children, superiors and colleagues, parents.
Each of the fronts of activity is based on communication, in which problems often arise. We are all human beings and each of us naturally has our own needs, desires and opinions. This means that conflicts are not excluded. When conflict occurs, what does it mean? This means that some of our needs (opinions or desires) come into conflict with the needs of another person. Shouting, excessive perseverance in defending one's position on the part of one or both participants in the conflict will only lead to an aggravation of the conflict, to the accumulation of resentment and anger at each other.
There are a great many ways to resolve conflicts, it is hardly possible to describe all of them in one work. We offer one of the ways, the most effective and easy to use.
Usually no one is responsible for the conflict,
but everyone is responsible for its resolution.
Before attacking colleagues with fists, gritting your teeth to listen
superiors or, overcoming yourself, to advise a "problem" client, try our form of conflict resolution. SITUATIONS My vision of the situation
The first paragraph of this form contributes to the clarification of the situation, i.e. determination and comparison of participants' positions. To get out of a conflict situation, the first step is to find out whether the participants correctly understand what the subject of their dispute is. For example, if the conflict is related to the behavior of one of them, it is possible that for a person it is the norm, and he may sincerely not understand what and why it does not suit / interfere with others.
My feelings
Labeling our feelings allows us to socially accept how we feel about the situation that caused the conflict. That is, for example, a feeling of irritation or anger indicates that another person is performing some action that violates the integrity of our space. If we discard feelings from this form, we can complicate the way out of the conflict. By naming our feelings, we kind of release them, thus not destroying either ourselves or the other person. Of course, the question is how to say, for example, anger. It can be said that the conflict will only get worse, but it can be said in another way: as a natural phenomenon for a person. And accordingly, if we have already taken up the solution of the problem and even resorted to forms of way out of the conflict, it is worth increasing the efficiency of this work using a calm tone of conversation. After all, if both participants are restless, the conflict will not be resolved. By naming our feelings, we are already halfway through the conflict.
My actions
At this stage, having explained our vision of the situation and reacting to it with our feelings, we voice our intentions. As adults and reasonable people, we must first understand what does not suit us. In addition, we should remember that no matter how hard we try, changing another person is an unattainable task. Therefore, you will have to agree to certain concessions or actions. We must also be aware that the other party to the conflict may not seek to find a way out and change their position. In such a situation, the main thing is to do everything possible for your part to resolve the conflict.
My expectations from the opponent
etc.................
The problem of burnout came into the world of research and discussion in the second half of the 20th century. Sometimes the term "professional burnout" is used, emphasizing that this syndrome manifests itself in the professional sphere and is associated with a person's attitude to work. And if there are no changes in the professional sphere, the person will transfer the consequences of the syndrome to other areas of his life.
In our time of mad rush and constant change this topic is becoming more and more relevant to modern man.
Causes of burnout
Let's understand why this syndrome occurs. According to Lengle, for example, this is due to the lack of a true existential meaning in the activities performed by a person. There are a number of other theories that name the following causes of emotional burnout - constant stress at work, monotonous work, misunderstanding of the company's goals, increased sense of responsibility, and others.
Previously, it was believed that representatives of the “man-to-man” professions, those who communicate with people every day: salespeople, teachers, HR specialists, are subject to emotional burnout. We conducted a study among employees of a manufacturing company, which showed that the level of burnout is even higher among employees of the “human-technical” direction, those who work in production and communicate minimally with people during their work shift. What does it say? What's on this moment Employees of various activities are subject to this symptom.
To consider ways to overcome and prevent the syndrome, it is worth remembering the theory of K. Maslach, according to which the burnout syndrome manifests itself in three symptoms, and the ways to deal with each will be different.
First symptom: emotional exhaustion
Manifested by constant fatigue, physical malaise and reduced emotional background. In simple words- a person feels constant fatigue and he just needs to remember the first step of Maslow's pyramid and satisfy his physiological needs - sleep well, eat and relax, preferably in the fresh air. If you are a leader and you notice such symptoms in your subordinate, you should not talk about “high” with him, but simply let him go for a day or two from work.
Second symptom: depersonalization
It manifests itself in indifference and even negativism towards other people, relations with colleagues are deformed, attitudes become cynical towards others. The first thing to do is to remember that all people are normal and in each person we already find what we like and what we don’t like. But, after doing the recommendations for the first symptom, people will already seem more pleasant.
Third Symptom: Reducing Personal Achievement
The most difficult to fight. A person underestimates his successes and achievements, negatively evaluates himself and underestimates his own dignity. In the most aggravated cases, it may seem to a person that he has always done the wrong thing, has chosen the wrong profession, has not achieved anything in this life, and sees no way out. The first thing to do is to remember that "there are no failures, only the lessons we learn from them." A wonderful quote by Robin Sharma, whose books are recommended reading, especially in a state of emotional burnout. When we treat past experiences as good teacher, then we understand that it is never too late to start something new, set ourselves new goals, write an implementation plan and achieve them. If you are a leader and have begun to notice signs of this symptom, this is a signal that the subordinate needs additional support and motivation. Tell him how much you appreciate him, believe in him, emphasize his virtues and his contribution.
Remember that work with burnout syndrome begins with unloading and a physically healthy body, and then work with thinking and attitudes follows.
This section is devoted to psychotherapy for "own use" by doctors of various specialties, since it will focus on the so-called. occupational stress in doctors - a special kind of stress disorder, the causes and course of which are directly related to medical practice.
The problem of occupational stress in doctors of various specialties is one of the leading areas of modern medical and psychological science. This fact is due to a number of reasons, both extra- and intra-scientific.
First of all, interest in occupational stress among doctors is caused by a general trend towards humanization. modern science which is reflected in a wide variety of fields - from the theory of team management to fundamental philosophical epistemology and the methodology of science. One of the manifestations of this trend is to attract the attention of researchers to the subject of professional activity, in particular, to the influence of the very nature of this activity on him.
Another reason for the interest in this problem is the tightening of requirements for professionals of various profiles, imposed by tempo-rhythmic characteristics. modern look life. Particularly important in this regard are the requirements for representatives of the so-called. "helping professions", because the effectiveness of their professional activity directly depends on their psychophysiological state, the significance of which in modern society hard to overestimate. In particular, the importance of studying this problem in the application to medical workers, because The “price of error” in their activities is often human life.
The most common form of manifestation of professional stress among specialists in "helping professions", incl. among doctors, is the so-called. "syndrome of emotional (or mental) burnout"- a state of physical, emotional and mental exhaustion. Traditionally, three components are considered in the structure of clinical manifestations of occupational stress:
- actually emotional exhaustion b - a state close to the so-called. anaesthesia dolorosa psychica (painful / mournful mental insensitivity), which consists in the "flattening" of the emotional background with some predominance negative emotions, combined with a painful feeling of difficulty in experiencing vivid emotions (a feature here compared to the "traditional" anaesthesia dolorosa is that such a state is subjectively directly related to one's own work);
- cynicism- a cold, insensitive, inhumane attitude towards the patient, seeing in him not a living person, but only an "organism", an object of certain actions (in Western - and based on it domestic - literature, this component is often called "depersonalization", which is completely inconsistent with domestic tradition of using this term);
- reduction professional achievements - depreciation of one's professional experience, a sense of one's own incompetence, professional failure, lack of prospects.
The listed three components make up the “core” of burnout syndrome among doctors. They can also be joined by very diverse incidental symptoms. In addition, there is a whole range of "masked" forms of professional stress, the identification of which requires the intervention of a specialized specialist - a psychotherapist or psychologist.
It is safe to say that in the structure of clinical manifestations of occupational stress in specialists of "helping" professions (the so-called "emotional burnout") there are features that bring this phenomenon closer to a number of traditional mental (such as asthenic neurosis) and psychosomatic disorders. This state of affairs allows us to speak about the presence in the etiopathogenetic structure of occupational stress of a psychological link that plays almost the leading role in the emergence and development of this phenomenon.
As already mentioned, the most important psychological aspect any disorder is its subjective picture, i.e. a complex of sensations, feelings, experiences and knowledge that is present in a person suffering from this disorder and arising in connection with the disorder. Obviously, the role of the subjective picture of the disorder is especially important in the etiopathogenesis of mental and psychosomatic disorders, in the structure of which it occupies a place comparable to that of the so-called. acceptor of the results of action within the framework of a normal, “healthy” functional system, not only being a reflection of suffering, but also largely determining its content through the mechanism of reverse afferentation.
Consequently, the emergence and development of professional stress in response to a system of stress factors characteristic of a particular profession does not occur directly, but is mediated by the subjective picture of stress, in particular, that component of it, which can be designated as “a subjective picture of the system of stress factors ”, the features of which reflect the specifics of the combination of stress factors characteristic of this profession.
At the same time, specialists in helping professions - especially doctors - often have a subjective picture of professional stress on the "periphery" of consciousness. That's why first step both prevention and correction of occupational stress is a systematically organized analysis by the doctor of the system of stressors present in his activity.
To analyze as myself O th characteristic combination of stress factors for this specialty, as well as its subjective picture in a given doctor, the following two-dimensional classification seems to be very convenient:
One dimension stressors are divided into three groups according to the degree of specificity for this profession:
- non-specific stressors;
- general specific stressors characteristic of a group of related professions (in this case, for medical specialties, for example - caused by emotional empathy for the patient);
- private-specific stressors, characteristic directly for this specialty (for example, caused by ergonomic miscalculations of designers and manufacturers of surgical equipment).
The second dimension of the classification of stressors goes back to the division of stress factors into social, psychological and biological .
In accordance with such a classification, for example, physical discomfort caused by the mentioned ergonomic miscalculations of designers and manufacturers of surgical equipment should be qualified as a particular biological stress factor in the professional activity of a surgeon.
Directly for the analysis procedure, in order to increase its clarity, a table of the following type can be used, in the cells of which the doctor should indicate those features of his activity that, in his opinion, fall under the corresponding class of stressors:
The result of such an analysis procedure will be a visual three-dimensional model of the system of stressors, which is characteristic either for a given medical specialty, or directly for the personal professional activity of a given doctor. Two dimensions of this model are given by the classification described above, and the third one is given by the subjective "weight", the significance of each class of stressors.
For example, a recent study showed that the system of stressors in the activities of surgeons, compared with doctors of other specialties, is characterized by the following features: high subjective significance of social stressors, i.e. conflict situations in the relationship of a surgeon at various levels - from society as a whole (inadequate remuneration for work), to a specific operating team (non-optimal interaction with colleagues and paramedical staff); focus on narrowly professional (private-specific) problems. These results can be visualized in a diagram.
Subjective significance of various classes of stress factors in the professional activities of surgeons and non-surgical doctors
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C - social, P - psychological, B - biological stressors; NSp - non-specific, OSp - general specific, NSP - particular specific stressors.
second step prevention or correction of occupational stress in the activities of a doctor should be self-analysis and self-assessment of the clinical manifestations of this in one's own behavior and activities. It is important that the assessment of clinical manifestations is carried out not before, A after procedures for analyzing the system of stressors, tk. the latter gives the doctor preliminary subjective grounds suspect the presence of professional stress and will contribute to a more impartial assessment of their behavior and activities.
At the same time, it should be taken into account that professional stress can occur not only in the form of its “main clinical form” described at the beginning of this section (emotional exhaustion, cynicism, reduction of professional achievements), but also in various masked (larved) or “converted” forms. (somatized) forms.
The most typical of the masked forms of occupational stress, especially in individuals of hypersocialized or neurasthenic types, is the so-called. “Workaholism” is the substitution of professional activity for all spheres of life. In such cases, the increase in the share of professional activity in comparison with other spheres of life - leisure, family, cultural, etc. - is caused by attempts to compensate for insufficient satisfaction with the results of one's work, subjectively interpreted as a consequence of insufficient labor efforts.
In addition to the usual forms of flow ("cynical" and "workaholic"), occupational stress can also take somatized forms, in many respects converging in their clinical manifestations with "classic" ones. psychosomatic illnesses. In other words, occupational stress can lead to functional - and in especially neglected cases, to organic - disorders of the cardiovascular, digestive and respiratory systems, to neurodermatitis.
Finally, the use of psychoactive substances, in a typical case, alcohol, can also be an extremely important form of occupational stress. Obviously, in such cases, psychoactive substances are used as a kind of "self-medication".
Based on the results of the first and second steps, the doctor can conclude that there is a threat of occupational stress, or that he already suffers from it.
third step Prevention or correction of professional stress should be the definition of a system of measures that the doctor should take to avoid the threat or to correct the professional stress he has. At the same time, measures, as in the case of any other psychotherapy - including autopsychotherapy - can be divided into three classes: causal, pathogenetic and symptomatic, in accordance with those target aspects of the disorder that should be subjected to corrective intervention. Obviously, causal measures are aimed at eliminating or reducing the impact occupational stressors, characteristic for the activity of this doctor, and symptomatic - for reduction manifestations occupational stress in his case.
For example, if one of the most significant stressors is disrupted relationships with patients, measures should be taken to form the so-called. "psychotherapeutic climate" in this area. On the part of the doctor, this looks like a "supportive", sympathetic attitude towards the patient, manifested in appropriate speech expressions and gestures. At the same time, the “relationship scenario” changes - and the patient, for his part, practically turns out to be forced behave differently towards the doctor.
On the other hand, if occupational stress in a given doctor takes the clinical form of "workaholism", then he should consciously and purposefully restructure his lifestyle in order to "artificially" expand its non-labor components.
The most complex class of measures for the prevention and correction of occupational stress are pathogenetic measures aimed at changing the mechanisms that ensure the relationship between the system of stressors and the clinical picture of stress. Usually, typological features of the doctor's personality and features of his biography act as such. For example, the mechanism of occurrence of the clinical picture of occupational stress of the type of "workaholism" in individuals of a hypersocialized or neurasthenic type has already been mentioned above. In general, the variety of such mechanisms, which are a subclass of a more general class of personality defense mechanisms (this concept was introduced and developed mainly within the framework of the psychoanalytic “family” of psychotherapeutic areas), is extremely large.
Determination of the system of pathogenetic mechanisms in a particular case - difficult task, usually requiring the intervention of a specialized specialist, psychotherapist or psychologist. However, in most cases, for the successful correction of occupational stress, it is quite a well-thought-out system of causal and symptomatic measures, determined by the doctor himself - and only in the case when they do not give the proper result, it turns out that it is really necessary to contact a specialized specialist.
Thus, the “algorithm” for the prevention or correction of occupational stress can be summarized as follows:
- First step: introspection of the system of stressors, determination of the significance of each class of stressors;
- Second step: introspection of clinical manifestations of possible occupational stress, making a decision about its presence/absence/threat.
- Third step: formation of a complex of corrective and preventive measures;
- Fourth step: implementation of the program of corrective and preventive measures;
- Fifth step: control of the results - re-analysis of the system of stressors and the clinical picture, assessment of the changes that have occurred, making a decision to continue / change the implementation of the program of corrective and preventive measures, or the need to contact a specialized specialist.
In which the requirements, both external and internal, prevail over human resources. As a result, the balance is disturbed and the syndrome of emotional burnout develops. At the same time, a person gradually loses emotional, cognitive, physical energy, personal detachment and a decrease in job satisfaction are observed.
Symptoms of emotional exhaustion
This condition can be diagnosed by:
Loss of appetite.
Constant feeling of tiredness.
Sleep disturbance.
Rapid heartbeat.
Headaches.
Loss of libido.
Loss of coordination, etc.
Those who are interested in what to do with emotional exhaustion should answer that the main preventive, therapeutic and rehabilitative measures in this case are to relieve work stress, increase professional motivation and equalize the balance between the effort expended and the reward received. You need to increase your physical activity, find yourself some kind of hobby or passion. Communicate more with people, do not close yourself off from the world and often visit the fresh air. You need to change your attitude towards the world, others and yourself.
Do not demand too much from yourself or others and do not allow others to claim anything beyond what is possible. You need to raise your self-esteem set goals for yourself and work towards them. Caring for more than just your own physical health but also emotional long years stay alert and full of energy.
Depersonalization - this is a disorder in which a person perceives his own "I" distortedly, is alienated from his personality, body. The individual perceives himself as an observer of own body, and perceives his voice, thoughts and actions as the actions of another person. At the same time, a person retains a sense of reality and can give an objective assessment of the environment. Depersonalization is not considered a mental disorder. An attack of this syndrome occurred at least once in 70% of the population. Depersonalization disorder is most commonly seen in childhood during the formation of self-consciousness. This is expressed in the perception of ongoing events as unreal, a feeling of not belonging to oneself. Episodic seizures are not pathological. The diagnosis is made when the seizures are persistent and last for a long time.
- "emotional exhaustion" (manifested in feelings of emotional overstrain and in a feeling of emptiness, exhaustion of one's emotional resources; a person feels that he cannot devote himself to work as before);
- "depersonalization" (associated with the emergence of an indifferent, negative and even cynical attitude towards people with whom it is necessary to contact by the nature of work; contacts with them become impersonal and formal);
- "reduction of personal achievements" (manifested in a decrease in the assessment of one’s competence (in a negative perception of oneself as a professional), dissatisfaction with oneself, a decrease in the value of one’s activity, a negative attitude towards oneself as a person; in indifference to work).
