Causes of professional burnout among health workers. Burnout syndrome in medical workers. Burnout syndrome: relevance of the problem

The medical profession is at high risk for the occurrence of burnout syndrome (or, more correctly, professional burnout syndrome). Unfortunately, medical students are not taught how to diagnose burnout syndrome, how to prevent its occurrence and how to get rid of it. Therefore, doctors most often either independently find their own ways of dealing with this painful condition, doing it intuitively, or become victims of it, losing a full and happy life.

This article once again raises questions about what burnout syndrome is in the work of doctors, as well as how and why to fight it and prevent it. We hope this material will be useful for all practicing doctors and will make life more harmonious and happier.

Burnout syndrome: relevance of the problem

Burnout syndrome is one of the most pressing problems of our time. According to WHO statistics, depressive disorders are in first place among psychosomatic diseases. And the WHO considers chronic fatigue syndrome and emotional burnout at work to be the main causes of depression.

Work constitutes a significant part of the lives of most people, not only in the temporary, but also in the emotional (thoughts about work, the emergence of emotions associated with successes (failures), etc.) and financial (work as a source of income) aspect. Therefore, it is not surprising that all sorts of behavioral and emotional disorders in people can be associated with work.

In ICD-10 you can find the following positions, to one degree or another related to work:

• Z73 Problems associated with difficulties in maintaining a normal lifestyle.
• Z73.0 Overwork. A state of exhaustion of vitality.
• Z73.2 Lack of rest and relaxation.
• Z73.4 Inadequate social skills, not elsewhere classified.
• Z73.5 Conflict related to social role, not classified elsewhere.
• Z56 Problems related to work and unemployment.
• Z56.3 Busy work schedule.
• Z56.4 Conflict with boss and co-workers.
• Z56.5 Unsuitable work.
• Z56.6 Other physical and mental stress at work.
• Z56.7 Other and unspecified work-related problems.

Of course, such disorders affect not only the ability to work, but also personal life and physical health.

Burnout syndrome - why is it common among doctors?

Burnout syndrome (as well as other disorders associated with professional activities) primarily affects representatives of professions associated with direct work with people and/or high responsibility for others (especially when it comes to life, health and safety).

Meanwhile, the work of a doctor has the following features:

The work of a doctor, by definition, requires significant emotional investment, as it is associated with communication with people and all the difficulties that arise from this (negative emotions, transference, experiences, conflicts).

The work of a doctor requires intellectual and time investment in study and ongoing postgraduate education, both within the framework of advanced training courses and independently.

The work of a doctor is often associated with stress, night shifts, and irregular working hours.

A doctor needs a circle of professional communication. And problems in relationships with colleagues (isolation, conflicts) are usually difficult for the doctor, even if he does not realize it.

People in such a complex profession as a doctor are very susceptible to changes in mood and motivation to work due to conflicts with colleagues and difficulties in communication with management.

Also, in the work of a doctor there are many difficulties associated with maintaining records, which requires time and can be a source of conflicts with management.

The need to financially provide for oneself and family often conflicts with the professional aspirations of a doctor.

All these factors hang like a sword of Damocles over the head of every doctor, threatening him with the development of chronic fatigue syndrome, which entails a whole range of psychosomatic disorders. That is why burnout syndrome is a common problem for this category of working people.

Professional burnout syndrome: definition, signs, danger

30 years ago, researcher E. Morrow figuratively described burnout syndrome as “the smell of burning psychological wiring.” Objectively, the concept of “professional burnout syndrome” refers to the depletion of a working person’s emotional, energetic and personal resources that develops against the background of chronic stress.

The concept of emotional burnout at work was first introduced in 1974 by psychologist H. Freidenberg, who discovered it among workers in crisis centers and psychiatric clinics and explained it as “the negative impact of professional activity on the individual in the person-to-person sphere.” Later it was revealed that burnout is common in representatives of many professions, and its symptoms are almost the same in all cases. Therefore, gradually emotional burnout at work began to be called professional burnout syndrome. Or just burnout syndrome.

Signs of burnout syndrome:

• Reluctance to go to work.
• Feeling tired.
• Irritability, irritable weakness.
• Conflicts at work.
• Touchiness.
• Decreased initiative.
• Feelings of loneliness and disappointment.
• Possible sleep disturbances, appetite disorders, headaches.

Of course, it is impossible to diagnose burnout syndrome only on the basis of the listed symptoms - special tests have been developed for this, many of which can be found on the Internet and books on psychodiagnostics. In particular, the Russian scientist E. Klimov dealt with issues of labor psychology (and, accordingly, the problem of burnout). There is also the author’s test questionnaire by V. Boyko, which allows you to determine emotional burnout. It is quite cumbersome and requires a certain amount of time to complete, but the ability to promptly identify such a serious problem as burnout syndrome is worth all the effort!

Burnout syndrome is especially dangerous because, against the backdrop of growing problems, a person (even a doctor!), instead of starting to analyze the problem and solve it, withdraws into himself, is inactive, moves away from people, which further aggravates the painful condition.

Burnout syndrome: what to do

Burnout syndrome, as studies have shown, has another unpleasant feature: unlike a runny nose or a “cold,” it does not disappear on its own—to get rid of it, you need to make an effort. Of course, the ideal option would be to visit a psychologist and work closely with him on this issue. However, not all of us can afford this form of help. Therefore, let’s try to follow the famous commandment “To the doctor, heal yourself!”

Burnout syndrome occurs against the background of information and emotional overload due to the lack of processing and transformation of this material. Therefore, there is only one way out - learn to manage emotions and relax, qualitatively analyze arrays of information and correctly set priorities both in daily work and in the future.

1. Introverts are more susceptible to burnout syndrome than extroverts - this is due to the fact that introverts do not tend to “make public” their emotions.

2. Burnout syndrome in many cases arises from the realization that in daily practice the “golden proportion” of the cost/reward ratio is violated (note: reward can be not only material).

Solution: Analyze what your expectations are from your job and how well it meets them, and then honestly answer yourself what is necessary for professional activity to bring true satisfaction.

Each of us has a need for achievement, increased comfort, income, status. If we do not get what we strive for for a long time, we become irritated and dissatisfied, leading to professional burnout syndrome. Therefore, no matter how “our brother” is afraid (or embarrassed) to dream, he still wants what... what he really wants. Therefore, as part of the fight against burnout syndrome, you should not compromise with yourself or ignore your own desires - you need to follow your dream.

Do you think that your calling is not to see patients, but to lecture to future doctors? What is needed for that? Start thinking about a dissertation topic? Looking for a leader and department? Forward!

Has it become crowded within your specialty? Need to learn new skills? Take courses such as ultrasound or laparoscopic surgery.

Don't want or can't work with people anymore? Consider moving to a laboratory, histology department, or research department.

Not enough money? There are many options here: from changing your job in a public clinic to a private one (to begin with, at least in the form of additional consultations) to leaving medicine - for example, in the pharmaceutical business.

Deep down, don't you love your job at all? Then develop a plan for changing your profession. Even a doctor has only one life, and he, as the classic said, “must live it in such a way that there is no excruciating pain for the years spent aimlessly.”

Of course, everything said requires certain emotional and material costs. But in this case, the risk is justified: a good mood, new professional prospects and financial opportunities will result in a positive impact on the life of any individual. And vice versa - if you do nothing, burnout syndrome will turn its “victim” into an unhappy, irritated person suffering from a feeling of loneliness. And for a doctor this is disastrous!

3. Burnout syndrome can also be caused by a certain monotony of the daily routine: the work-home-work pattern, typical for a doctor, does not seem to everyone to be the embodiment of the dream of happiness! In this case, auxiliary ways to compensate for professional burnout syndrome are sports, hobbies, communication with loved ones, and trips to resorts. And also breathing techniques, autogenic training, meditative techniques, limiting alcohol and coffee intake, aromatherapy, etc.

It is also very useful to learn to separate work and everything that is not related to it. Don't allow yourself to deal with professional issues outside of work hours. Take time-outs while working - breaks for 5-10 minutes every 2 hours. During breaks, prohibit yourself from thinking about the “work topic” - it’s better to breathe deeply, take a walk... or just imagine a sheet of white paper in front of you. These measures will help you “stabilize” faster and easier, and, therefore, cope with professional burnout syndrome.

But don’t wait too long to help yourself, because the process of self-destruction can go too far. And then it will be difficult for you to cope without consulting a specialist psychologist. In advanced cases, you may even need drug therapy - sedatives, anxiolytics, tranquilizers, antidepressants.

But, in general, even “acquaintance” with burnout syndrome can be beneficial. Having dealt with burnout syndrome once, you will already know the “enemy by sight”, and you will probably be able to identify it in time in yourself and your loved ones and overcome it with honor.

Olga Karaseva, psychologist

Professional burnout syndrome is a condition that develops due to chronic stress experienced by a person at work. Such processes ultimately lead to the depletion of a person’s personal, emotional and energetic resources. Professional burnout is a consequence of the internal accumulation of negative emotions. When a person does not have the possibility of a kind of “discharge,” then sooner or later he will definitely develop a similar syndrome.

Professional burnout syndrome provokes the development of an apathetic state in a person

The phrase “burnt out at work” has a very serious connotation, because a person who devotes all his free time to his professional activities and does not have psychological release is at risk for developing this syndrome. At the same time, his body will be exhausted not only morally, but also physically. Health is undermined, interest in life is lost.

There is nothing wrong with working at your peak in the beginning. However, if this continues for a long time, the situation will begin to escalate, become stressful, until it turns into chronic stress. Such people experience chronic fatigue, and over time they lose all interest not only in work, but also in hobbies, family and friends. These symptoms are very similar to signs of depression.

Burnout syndrome provokes the following consequences in the patient:

• nervous exhaustion;
• apathetic state;
• loss of any motivation;
• problems with concentration.

Professional burnout syndrome develops gradually. The pace of its development is individual for each individual person, his working conditions, way of thinking, etc.

The opinion that any stressful work will certainly cause the development of professional burnout syndrome is erroneous. If a person knows how to combine work and rest, then even with high workloads he can feel absolutely normal.

Causes

There are general and specific causes of this syndrome. General ones include:

• conducting professional activities in constantly changing conditions, encountering unpredictable circumstances, etc.;
• the need to communicate a lot, including with negatively-minded individuals;
• life and work in megacities, where a person is forced to communicate with a large number of unfamiliar people, the need for unexpected contacts, which often turn into negative experiences.

The last factor has a particularly strong influence on people with complexes and lack of self-confidence, making them even less sociable and depressed.

Specific causes of professional burnout are:

• professional problems related to working conditions or career growth, wages, state of work places, etc.;
• increased likelihood of injury and death due to occupational activity;
• social vulnerability, lack of health insurance, etc.;
• threats from clients (patients) to go to court with certain claims (the main reason for the development of professional burnout syndrome among medical workers);
• the need to communicate with aggressive clients or patients who are trying to solve their psychological problems at the expense of their opponent.

To a lesser extent, professional burnout affects people who have experience successfully coping with stress at work. If a person shows flexibility and is able to adapt to changing conditions and develop a positive attitude, then he is not in danger of developing such a syndrome.

How to recognize burnout?

Constantly drowsy state is the first sign of professional burnout syndrome

A whole set of symptoms has been established that make it possible to accurately identify professional burnout syndrome. Conventionally, they can be divided into three groups:

• psychophysical;
• behavioral;
• socio-psychological.

Psychophysical signs:

• the patient feels physical and emotional exhaustion;
• constant fatigue occurs, which is observed not only after a working day, but also in the morning (this symptom indicates the development of chronic fatigue);
• headaches that occur frequently and without any reason;
• shortness of breath due to even minor emotional or physical stress;
• drowsiness, lethargy;
• weight change (both decrease and increase are possible);
• insomnia, which can manifest itself either completely or partially;
• asthenia – general weakness, fatigue, decreased hormonal levels;
• disorders of the digestive system;
• decreased hearing, smell, touch and vision, partial loss of bodily sensations.

Social and psychological symptoms manifest themselves as follows:

• general depression and indifference to everything, including the results of one’s own activities;
• constant negative emotions that are completely unjustified;
• increased anxiety - a person is afraid that he has done something wrong;
• irritability for minor reasons;
• lack of faith in professional or personal prospects;
• a constant feeling of fear of making a mistake, manifestation of hyper-responsibility;
• high frequency of nervous breakdowns, when the patient experiences unmotivated anger or refusal to communicate with others.

Behavioral symptoms include:

• refusal to make decisions required by a responsible position;
• irresponsibility;
• feeling of constant complication of work;
• tendency to radically change the working mode;
• a feeling of absolute uselessness, lack of enthusiasm and complete indifference to the results of the work done.

When these symptoms develop, a person needs proper rest. He may also need psychological help to objectively assess the situation at work.

Complications and consequences

With the syndrome, chronic depression and feelings of depression begin to develop

Beginning with banal fatigue, teacher burnout syndrome can lead to disastrous consequences that will negatively affect not only a person’s mental, but also physical health. In the final stages of the pathology, the individual completely loses his ability to work. He no longer wants and is psychologically unable to do his usual work, and even a change in activity does not bring tangible results.

Against the background of such changes, a feeling of dissatisfaction with one’s own life and disappointment in oneself grows. As a result, chronic diseases develop that threaten human life. There is a feeling of complete despair, which often leads to thoughts of suicide.

In modern medicine, there are two types of consequences of professional burnout syndrome:

1. Physiological abnormalities. The functioning of the cardiovascular and digestive systems is disrupted, obesity and spinal problems develop. Immunity decreases, which makes the body susceptible to the development of a number of infectious diseases.
2. Psychological deviations. Chronic depression and feelings of depression develop. Some patients develop sleep problems and irritability. As a result, a number of somatic problems appear.

Diagnostics

Due to the vivid symptoms, any experienced psychologist and psychiatrist will be able to accurately identify burnout syndrome during the first interaction with the patient. By asking leading questions, the specialist will determine the type and degree of mental deviation. To complete the picture of the disease, psychiatric tests can be used.

Treatment

We are talking about a pathological condition that will worsen without adequate treatment. Treatment for this disorder involves the following:

1. Rest and healthy sleep. Taking even potent drugs will be ineffective without quality rest. It is very important that a person begins to allocate a certain amount of time to pursue hobbies and communicate with loved ones. Experts recommend sleeping at least 7 hours a day. It is also advisable to set aside about 15 minutes during the working day for complete relaxation.
2. Taking sedatives. Recommended for advanced disease. Medicines and the course of treatment should be prescribed exclusively by a specialist.
3. Visiting a psychotherapist to develop a positive attitude and learn the basics of self-control.
4. The so-called “threshold principle” is considered very effective. This technique involves separating work from private life. Such exercises are necessary for people suffering from professional burnout syndrome.

Preventing burnout at work

Regular walks in the fresh air are an excellent way to prevent professional burnout syndrome

It is very important for people who work intensively to know how to prevent professional burnout syndrome. To do this you need to follow these tips:

1. You shouldn't make work the center of your life. It is necessary from time to time to switch to other activities: family, hobbies, travel.
2. It is advisable to distribute the work throughout the day, taking breaks.
3. You should develop as calm an attitude towards problems as possible and avoid stress.
4. Exercising will keep your body in good shape.
5. Don't give up your vacation. Once a year you definitely need to take a break from everyday work.
6. Walking in the fresh air is a great way to unwind.
7. It is imperative to make plans for the future, set goals for yourself and achieve them.

The work has been approved for protection at the State Examination Committee

deputy Director of Academic Affairs of DBMK

E.N. Tarasenko

Order No.___ “__” _____________ 20_

Donetsk 20___

Introduction (from 3-4)

Chapter 1. Social and psychological essence of professional burnout syndrome (p.5-12)

1.1 The concept of professional burnout (p.5-7)

1.2 Causes, factors, symptoms of professional burnout (p. 7-11)

Chapter 2. Features of the manifestation of professional burnout syndrome in medical workers (p. 12-17)

2.1 The influence of the specifics of medical activity on the formation of symptoms of professional burnout syndrome (p. 12-17)

Chapter 3. Organization of activities to prevent the syndrome

professional burnout of a medical worker (p.18-24)

3.1 Measures to prevent professional burnout syndrome (p. 18-21)

3.2 Methods of self-regulation (p. 21-24)

Conclusion (p.25-26)

Literature (p.27-28)

Applications

Introduction

Relevance of the research topic:

At the present stage of development of society, in conditions of socio-economic instability, competition in the labor market, and social stress, the demands placed on individual professionalism are growing. However, not everyone can adapt and effectively carry out their professional activities and social role, and therefore the likelihood of developing unfavorable mental states increases.

One of the priority tasks of developmental psychology, medical psychology, and occupational psychology is the study of specific socio-psychological phenomena, which include “professional burnout” among specialists in various fields of work, and the development of programs for their prevention and correction.

Professional burnout occurs as a result of the internal accumulation of negative emotions without a corresponding “discharge” or “liberation” from them, leading to the depletion of a person’s emotional, energetic and personal resources. From the point of view of the concept of stress, first formulated in 1936 by the Canadian physiologist G. Selye, professional burnout is distress, or the third stage of the general adaptation syndrome - the stage of exhaustion. In 1981, E. Moppoy (A. Morrow) proposed a vivid emotional image that, in his opinion, reflects the internal state of an employee experiencing the distress of professional burnout: “The smell of burning psychological wiring.”

Doctors and nursing staff are people highly susceptible to this syndrome. The basis for this conclusion is both the general causes inherent in the occurrence of professional burnout in all categories of workers, and specific features associated with the nature of their activities.

However, the dedication of doctors, their dedication, “burning out” does not at all mean complete devastation, powerlessness, self-forgetfulness, emotional fatigue, leading to professional burnout. Medical workers who fall under the influence of professional burnout syndrome clearly express its symptoms. They lose mental energy and get tired quickly. Psychosomatic problems appear, such as fluctuations in blood pressure, headaches, diseases of the digestive system, insomnia, irritability, etc. As a result, a negative attitude towards patients appears, decreased motivation to work, aggressiveness and increased conflict when communicating with colleagues.

This problem is relevant at the present time and requires a detailed study of the characteristics of the manifestation of burnout, clarification of the symptoms and factors that determine its formation in the professional activities of doctors, timely identification, development of scientifically based health programs aimed at the prevention of professional deformations and diseases, as well as the restoration of psychoenergetic potential workers.

Purpose of the thesis:

A study of the phenomenon of professional burnout, as well as the prevention and correction of this syndrome among medical workers, since the presence of burnout negatively affects not only the psychophysical well-being of individual workers, but also the activities of the medical institution as a whole.

Job Objectives:

Define the concept of professional burnout syndrome;

Explore the causes, factors, symptoms of professional burnout;

To study the features of the manifestation of professional burnout syndrome in medical workers;

To analyze the influence of the specifics of medical activity on the formation of symptoms of professional burnout syndrome;

To characterize measures to prevent medical worker burnout syndrome.

The object of the study is:

Professional burnout syndrome as a special human condition resulting from professional stress. The subject of the study is the prevention and correction of negative phenomena associated with burnout syndrome.

Chapter 1. Social and psychological essence of professional burnout syndrome

1.1 The concept of professional burnout

Professional burnout is a syndrome that develops against the background of chronic stress and leads to the depletion of the emotional, energetic and personal resources of a working person. Professional burnout occurs as a result of the internal accumulation of negative emotions without a corresponding “discharge” or “liberation” from them. The danger of burnout is that it is not a short-term passing episode, but a long-term process of “burning to the ground.” A burnt out person begins to experience a feeling of self-doubt and dissatisfaction with his personal life. Not finding sufficient grounds for self-respect and strengthening positive self-esteem, developing a positive attitude towards his own future and thus losing the meaning of life, he tries to find it through self-realization in the professional sphere. Daily work, sometimes without breaks or days off, with constant physical and psychological stress, complicated by intense emotional contacts, leads to life in a state of constant stress, the accumulation of its consequences, depletion of a person’s supply of vital energy and, as a result, to serious physical illnesses. Therefore, workaholics who are ready to give all their best 24 hours a day, to devote themselves to work without reserve, without breaks, entrances and holidays, are the first candidates for complete psychological burnout, resulting in early mortality.

Since the emergence of the concept of burnout, the study of this phenomenon has been difficult due to its substantive ambiguity and multicomponent nature. On the one hand, the term itself was not carefully defined, so the measurement of burnout could not be reliable, on the other hand, due to the lack of appropriate measurement tools, this phenomenon could not be described in detail empirically.

American specialists drew attention to the problem of mental burnout in connection with the creation of social services. People working in the field of psychological and social assistance, obliged by duty to show compassion and empathy, are in contact with visitors for a long time. The duty of the workers of these services is to provide psychological support: they must listen and support people who seek help. However, despite special training and selection of personnel for social services according to certain criteria necessary in this type of activity, after some time the heads of services were often faced with facts of unsatisfactory work of employees, primarily with complaints from visitors about inattention, indifference, callousness, and sometimes coarseness. The conducted research led to the discovery of a kind of professional “communication stress”, which was called the “mental burnout” syndrome. This syndrome began to be considered as a stress reaction to prolonged stress in interpersonal relationships. Thus, from a “payment for sympathy”, the “burnout” syndrome has turned into a “disease” for workers in “communication” professions, i.e. professions that place high demands on psychological stability in business communication situations.

The term burnout (burnout, combustion) was first introduced by the American psychiatrist H. Fredenberg. Burnout meant a state of exhaustion combined with a feeling of one’s own uselessness and uselessness. However, the term has widely entered the scientific literature and psychotherapeutic practice after numerous publications by K. Maslach (Maslach). In 1982, her book “Burnout - the Cost of Compassion” was published, in which she presented the results of her extensive research on this sad phenomenon. Her new view on the problems of stress was immediately accepted by many scientists and practicing psychologists in all countries.

Later K. Kondo [S. Condo, 1991] defines burnout as “a state of maladjustment in the workplace due to excessive workload and inadequate interpersonal relationships.” T. V. Formanyuk (1994) considers emotional burnout syndrome “a specific type of occupational disease of persons working with people.” R. Kociunas (1999) defines burnout syndrome as “a complex psychophysiological phenomenon accompanied by emotional, mental and physical exhaustion due to prolonged emotional stress.” According to V.V. Boyko (1999), emotional burnout is “a psychological defense mechanism developed by an individual in the form of a complete or partial exclusion of emotions (a decrease in their energy) in response to their selected psychotraumatic influences.” L.A. Kitaev-Smyk (2007) points out that “burnout of emotions is only one component of the burnout syndrome, the main result of which is not a deterioration in performance, but a deformation of the professional’s personality” and supplements the terminology with the expressions: “burnout of personality,” “burnout of the soul.”

What is “burnout” of the soul? The judgment of the outstanding thinker of the second half of the 20th century brings us closer to the answer to this question. I. Volodkovich: “Man lives in a world of illusions and cannot live without them. They are the basis of faith, hope, love. Burning out in soul, a person is deprived of the illusions of having faith, hope, and love. First, faith melts, and the person is filled with a feeling of his own unaccountable unhappiness. Then hope flies away. A person develops a devil-may-care attitude towards everything. The last thing to leave a person is love, and with it he loses the meaning of life. Only by moving to a new living area, radically different from the previous one, can a burnt-out person be saved by new illusions.”

1.2 Causes, factors, symptoms of professional burnout

The literature on burnout syndrome indicates a significant expansion of areas of activity susceptible to such danger. These include: teachers, psychologists, pedagogues, educators, doctors, social workers, law enforcement officers and representatives of other professions. All of these are workers in “communicative” professions, the specificity of which lies in a large number of emotionally rich and cognitively complex interpersonal contacts, which requires the specialist to make a significant personal contribution to daily professional affairs. As K. Maslach writes: “The activities of these professionals are very different, but they are all united by close contact with people, which, from an emotional point of view, is often difficult to maintain for a long time.”

In addition, in professions focused on working with people, receiving feedback from them is of great importance (for example, gratitude, recognition, respect, information about changes in well-being or about new plans regarding further business interaction, etc.), there is also high responsibility for the result of communication; a certain dependence on communication partners; the need to understand their individual characteristics, claims and expectations, private claims to informal relationships in solving their problems; conflict or tense communication situations caused by distrust, disagreement and manifested in various forms of refusal to further interaction (communication).

T.I. Ronginskaya rightly notes that research into the psychological phenomenon - professional burnout syndrome - can be based on a metaphor: “Nothing is such a strong burden and such a strong test for a person as another person.”

Thus, professional risk factors for burnout include:

Emotionally rich business communication;

High requirements for constant self-development and increasing professional competence;

High responsibility for the business and for other people;

The need to quickly adapt to new people and rapidly changing professional situations;

High requirements for self-control and interpersonal sensitivity.

Along with these potential risk factors for burnout, there may be existential factors:

Unfulfilled life and professional expectations;

Dissatisfaction with self-actualization;

Dissatisfaction with the results achieved;

Disappointment in other people or in the chosen activity;

Depreciation or loss of meaning of one’s efforts;

Experience of loneliness;

Feeling of the meaninglessness of active work and life.

Regarding the relationship between gender and burnout, there are opposing points of view on who is more susceptible to the process of burnout - men or women. It has been found that men have higher scores on depersonalization, and women are more susceptible to emotional exhaustion, which is due to the fact that men have predominant instrumental values, while women are more emotionally responsive and have less feelings of alienation from their clients.

Scheme 1. Severity of burnout syndrome among the examined doctors depending on gender

Among organizational factors, the main emphasis in the study was placed primarily on the time parameters of activity and volume of work. Almost all studies provide a similar picture, indicating that increased workload and overtime work stimulate the development of burnout.

The content of the work includes quantitative and qualitative aspects of working with clients: the number of clients, the frequency of their service, the degree of depth of contact with them. Thus, direct contact with clients and the severity of their problems usually contribute to burnout. The influence of these factors is most clearly shown in those types of professional activities where the severity of clients' problems is combined with minimizing success in the effectiveness of solving them. This is work with chronically ill people or people suffering from incurable diseases (AIDS, cancer and some others). It is noted that any critical situation with a client, regardless of its specifics, is a heavy burden for the employee, negatively affecting him and ultimately leading to burnout.

Considerable attention is paid to the relationship between burnout and motivation. Thus, researchers have noted a decrease in work motivation characteristic of “burned out” people, which manifests itself in the desire to reduce work to a minimum, manifestations of apathy and chronic negativism in relation to functional responsibilities, although they emphasize the difference between burnout and dissatisfaction with the profession.

Personal endurance is closely related to professional burnout syndrome - a quality that can influence a person’s susceptibility to stress. Foreign psychologists define it as the ability of an individual to be highly active every day, to exercise control over life situations and to respond flexibly to various kinds of changes. People with a high degree of this characteristic have low scores on emotional exhaustion and depersonalization and high scores on the scale of professional achievements.

Psychologists distinguish 3 stages of burnout syndrome.

First stage - at the level of performing functions, voluntary behavior: forgetting some moments, in everyday language, lapses in memory (for example, whether the necessary entry was made or not in the documentation, whether the planned question was asked, what answer was received), failures in performing any motor actions etc. Usually few people pay attention to these initial symptoms, jokingly calling it “girl memory” or “sclerosis”. Depending on the nature of the activity, the magnitude of neuropsychic stress and the personal characteristics of the specialist, the first stage can be formed within three to five years.

On second stage there is a decrease in interest in work, the need for communication (including at home, with friends): “I don’t want to see” those with whom the specialist communicates by line of work (schoolchildren, patients, clients), “on Thursday it feels like it’s already Friday ", "the week lasts forever", increasing apathy towards the end of the week, the appearance of persistent somatic symptoms (no strength, energy, especially towards the end of the week, headaches in the evenings; "dead sleep, no dreams", an increase in the number of colds); increased irritability, a person “gets turned on,” as they say, half a turn, although he had never noticed anything like this before. The formation time of this stage is on average from five to fifteen years.

Third stage - personal burnout itself. Characterized by a complete loss of interest in work and life in general, emotional indifference, dullness, and a feeling of constant lack of strength. A person strives for solitude. At this stage, he is much more pleasant to communicate with animals and nature than with people. The stage can take ten to twenty years to form.

Thus, professional burnout syndrome is one of the phenomena of personal deformation and is a multidimensional constructive set of negative psychological experiences associated with prolonged and intense interpersonal interactions, characterized by high emotional intensity or cognitive complexity; Professional burnout syndrome is a response to prolonged stress in interpersonal communications.

Scheme 2. Prevalence and severity of “emotional burnout” syndrome

Chapter 2. Features of the manifestation of professional burnout syndrome in medical workers

2.1 The influence of the specifics of medical activity on the formation of symptoms of professional burnout syndrome

The profession of a medical worker is a complex type of work that requires the subject to have versatile education, continuity of the process of professionalization, as well as the possession of personal and professional qualities.

A medical worker is invested with the trust of society, therefore the attention and humanism of a medical worker, his respect for the patient should not be determined by the feigned courtesy and sugary sweetness of his words, good but false manners. He must have a sense of duty, responsibility, fierce patience, observation, intuition, determination, optimism, etc.

The work of medical workers is responsible, requires endurance, involves a high and constant psycho-emotional load, as well as the need to make decisions in extreme situations. The professional activity of medical workers itself involves emotional intensity and a high percentage of factors causing stress. Emotions, as a rule, are ambivalent: satisfaction about a successful operation or treatment, a sense of self-worth, belonging to other people, approval and respect from colleagues; but also regret, oppression due to an incorrect diagnosis or treatment error, envy of successful colleagues, disappointment in the profession, etc.

The responsibilities of medical workers include providing medical care to citizens, and often such care must be urgent, provided in a situation of extreme stress experienced by a patient in serious condition. In the course of their activities, medical workers keep records of the patient’s health status, prescribe the necessary medical supplies, thereby taking responsibility for his further condition. A medical worker is entrusted with great responsibility for the life and health of the population in the area entrusted to him, which undoubtedly causes this category of employees to be exposed to daily stress situations and can affect their mental health.

The communicative side of the activities of medical workers is of no small importance, because during this process, an employee of a healthcare institution must provide assistance to the patient, and often such assistance is not so much medical as psychological. A medical worker is obliged to support a person who finds himself in a difficult situation, to show care, attention, and empathy. When faced with negative emotions, a medical worker involuntarily and involuntarily becomes involved in them, due to which he himself begins to experience increased emotional stress.

The work of most medical workers is carried out in such conditions that they are affected by a complex of unfavorable production factors of various natures, neuro-emotional stress, and high responsibility.

The doctor, at the level of emotional experience, constantly deals with death. It can appear for him in three forms:

1) real (futility of resuscitation measures, death on the surgeon’s table);

2) potential (the health, and, possibly, the life of a person depends on the results of the doctor’s activities, on his professionalism);

3) phantom (it can be represented by complaints about the state of health of a suspicious person, fear and anxiety of a chronic patient, relationships with relatives of seriously ill patients, and even the idea of ​​death in the public consciousness).

In each of these cases, there is a problem for the doctor not to include his feelings in the situation. This is not always possible, because with all these formations (real, potential and phantom death) he simply needs to build relationships. Naturally, only an emotionally mature, holistic person is able to solve these problems and cope with such difficulties.

Psychological stress factors that affect medical personnel include::

A large number of contacts with sick people and their relatives, constant contact with other people’s problems and other people’s pain, with negative emotions that carry negative energy;

· increased requirements for the professional competence of a doctor and for service to others, dedication;

· responsibility for the life and health of other people;

· a working environment with new social risk factors, such as crime, drug addiction, homelessness, etc.

As a result of observations, specific studies of mental burnout syndrome show that among the causes of burnout in physicians, general and specific ones can be distinguished.

Common reasons include:

· intensive communication with different people, including negative ones;

· work in changing conditions, encountering unpredictable circumstances;

· features of life in megacities, in conditions of forced communication and interaction with a large number of strangers in public places, lack of time and funds for special actions to improve one’s own health.

Specific reasons include:

· problems of a professional nature (career growth) and working conditions (insufficient level of salary, state of workplaces, lack of necessary equipment for high-quality and successful performance of one’s work);

· inability to provide assistance to the patient in some cases;

· higher mortality rate than in most other departments;

· the impact of patients and their loved ones seeking to solve their psychological problems through communication with a doctor;

· a recent trend is the threat of requests from relatives of patients in the event of death with legal claims, lawsuits, and complaints.

Often, employees exposed to long-term professional stress experience internal cognitive dissonance: the harder a person works, the more actively he avoids thoughts and feelings associated with internal “burnout.” The development of this condition is facilitated by certain personal characteristics in medical workers - a high level of emotional lability (neuroticism), high self-control, especially when expressing negative emotions with the desire to suppress them, rationalization of the motives of their behavior, a tendency to increased anxiety and depressive reactions associated with the unattainability of the “internal” standard” and blocking negative experiences, a rigid personal structure. The paradox is that the ability of health professionals to deny their negative emotions may indicate strength, but it often becomes their weakness.

Scheme 3. Components of professional burnout syndrome

Let us take a closer look at the features of professional activity and the individual characteristics of professionals working in ambulance teams.

“Burnt out” ambulance workers indicate long hours of work, a large number of calls, lack of equipment and medicines, unclear planning of work activities (unstable work schedule). Emergency medical workers have increased responsibility for the functions and operations they perform. Doctors and paramedics work “extremely” - after all, the responsibility and self-control are very great. As a result, anxiety, depression, emotional rigidity, and emotional devastation may occur. Ambulance personnel constantly deal with psychologically difficult populations (seriously and dying patients). Sometimes conflict cases arise in the “manager-subordinate” system, more often in the “colleague-colleague” system, when the doctor and paramedic working in a team are people with completely different views and positions on certain things.

All of the above refers to external factors (features of professional activity) that cause the syndrome of “emotional burnout.”

Internal factors (individual characteristics of the professionals themselves) include: a tendency to emotional rigidity; intensive internalization of the circumstances of professional activity.

About 20% of young emergency medical technicians leave within the first five years of their work experience. They either change their job profile or change their profession altogether. After 5-7 years, doctors and paramedics acquire energy-saving strategies for performing professional activities. The reason is the depletion of emotional and energy resources and, in connection with this, the search for ways to restore and save them. Indeed, it happens that work alternates between periods of intense internalization and psychological defense; Poor motivation for emotional return in professional activities, moral defects and personal disorientation are possible.

The main symptoms of “emotional burnout” among emergency medical workers include (according to clinical and psychological interviews):

· fatigue, exhaustion, exhaustion (after active professional activity);

· psychosomatic problems (fluctuations in blood pressure, headaches, diseases of the digestive and cardiovascular systems, neurological disorders);

· insomnia;

· negative attitude towards patients (after positive relationships have taken place);

· negative attitude towards the activity being performed (instead of the previously present “this is a matter for life”);

· stereotyping of personal attitudes, standardization of communication, activities, acceptance of ready-made forms of knowledge, narrowing of the repertoire of work actions,

· rigidity of mental operations;

· aggressive tendencies (anger and irritability towards colleagues and patients);

· functional, negative attitude towards oneself;

· anxiety states;

· pessimistic mood, depression, feeling of the meaninglessness of current events.

One of the first places in terms of risk of burnout is the nursing profession. Her working day involves close contact with people, mainly the sick, who require constant care and attention.

By the nature of their work, nurses are required to clearly know and apply the theoretical knowledge they have acquired in practice, carry out sanitary and educational work at the site, including the promotion of medical knowledge, hygienic education and training the population in a healthy lifestyle, organize outpatient doctor’s appointments (preparation of the workplace, equipment , instruments, preparation of individual outpatient records, forms, prescriptions, preliminary collection of anamnesis, preliminary examination of the patient), perform preventive, therapeutic, diagnostic measures prescribed by the doctor in the clinic and in the hospital, assist the doctor during outpatient operations and complex manipulations, etc. d.

Various categories of medical workers are susceptible to the formation of professional burnout syndrome. The risk of the disease is high among professionals working in the field of psychiatry and psychotherapy. For example, psychiatrists are more likely than other doctors to report having job burnout, depression, or other mental disorders. It is noticeable that, first of all, novice specialists are susceptible to health problems caused by stress. 76% of junior residents show symptoms of burnout, such as emotional exhaustion or demotivation. The fact is that they often have idealized ideas about their profession and therefore the beginning of their working career is often associated with disappointments for them.

Employees of “severe” departments, primarily those who care for seriously ill patients with cancer, HIV/AIDS, in burns and intensive care units, constantly experience a state of chronic stress due to negative mental experiences, intense interpersonal interactions, tension and complexity of work and etc. As a result of the gradually developing burnout syndrome, mental and physical fatigue, indifference to work arise, the quality of medical care decreases, and a negative and even cynical attitude towards patients is generated.

Thus, the specificity of the professional activities of medical workers is a prerequisite for the development of CMEA.

The rudeness and inattention of doctors is a problem that hospital visitors constantly face. often suffer from emotional burnout, which results in their professional deformation. Let's look at what professional burnout is for medical workers and what ways to prevent it exist.

General information

Representatives of professions related to communication are most prone to professional burnout. As a result of the influence of external and internal factors, a person becomes indifferent to others, no longer feels the value of life, nothing makes him happy. The doctor not only performs his job worse, he also develops problems with mental and physical health.

According to statistical studies, 64% of doctors in Russia suffer from neurotic disorders or are in a borderline state. 68% of medical workers were found to have emotional burnout syndrome. 90% of doctors are dissatisfied with their salaries. 38% of doctors were diagnosed with depression. Most often, emergency doctors, surgeons, oncologists, and therapists suffer from neurotic disorders.

The term “burnout” was first coined by G. Freudenberger in 1974 to describe the emotional state of some workers in psychiatric institutions. It was later discovered that this term is suitable for many professions related to communicating with people. Burnout occurs as a result of prolonged exposure to professional psychotraumatic factors on a person. A healthcare worker is constantly under pressure. Large volumes of work, improper organization of work, pressure from patients and their relatives, pressure from superiors lead to professional burnout syndrome among medical workers.

Components of professional burnout syndrome and risk zones

Burnout syndrome manifests itself in three components:

1. Absolute emotional exhaustion and exhaustion. A person is no longer able to devote himself to work; he feels dissatisfied with his own activities.
2. Lack of empathy for patients, cynicism.
3. Dislike for your job and yourself.

There are three types of behavioral characteristics of nurses that are most susceptible to professional burnout:

1. Pedantic nurses who strive for perfection. They are always careful and attentive to patients. They do their job well. The result is important to them.
2. A demonstrative type of behavior in which a person cares about the recognition of other people and primacy in everything. Such nurses spend a lot of energy in the process of their activities, as they try to achieve greater heights than others.
3. behavior is characterized by increased empathy towards the experiences of others. Such people perceive someone else's tragedy as their own, which causes a rapid waste of personal emotional resources.

Among medical workers, the most susceptible to professional burnout are:

• young inexperienced specialists;
• doctors with insufficient qualifications;
• doctors experiencing problems in their personal lives.

Causes

Symptoms and treatment of nervous system exhaustion directly depend on the causes that caused it. They can be divided into two groups:

1. Objective reasons related to the characteristics of the activity performed (for example, daily routine, volume of work, number of days off).
2. Subjective reasons related to the employee’s attitude towards his own activities (for example, the relationship between a doctor and his patient, attitude towards failures, relationships with colleagues).

In general, the following reasons for professional burnout among medical workers can be identified:

• Psychological unpreparedness to provide emergency assistance.
• Huge physical and psychological stress.
• Incurable diseases and death of patients.
• Pressure from patients and their relatives.
• Lack of necessary knowledge.
• Personal attitude towards death.
• Low wages.
• Unsatisfactory working conditions.
• Ambiguous job requirements.
• Risk of reprimands and fines.
• No vacation or full days off.
• Physical overload.
• Social insecurity.

Factors influencing the formation of professional burnout syndrome

Professional burnout syndrome most often affects people in “helping professions.” Their activities involve close communication with people, as well as providing them with comprehensive assistance. The following factors can be identified that can cause professional burnout syndrome in medical workers:

• Insufficient employee motivation, lack of encouragement, prohibition of innovation and creative freedom.
• Strict rationing of work schedules, impossibility of completing work on time.
• Low qualification category of medical worker.
• Monotony of work.
• A lot of effort put into work but not properly rewarded.
• Working with patients who do not follow all recommendations and resist treatment. This leads to the ineffectiveness of the physician’s efforts.
• Tensions in the work team, quarrels with colleagues.
• Lack of opportunity for further professional growth.
• Awareness of an erroneous choice of profession, inconsistency of personal characteristics with the specifics of the chosen profession.

Health workers and patient deaths

Doctors who work with hopelessly ill and dying people are most susceptible to professional burnout. Death for them can come in three forms:

1. Real death of patients, futility of treatment, futile efforts to save lives.
2. Potential death of the patient due to incorrect diagnosis or erroneous actions of the doctor.
3. Phantom death is when the doctor constantly faces the fear of death in the patient and his relatives.

With all this, the doctor has to emotionally distance himself from the patient’s death. Not every doctor is able to cope with this, because he experiences someone else’s misfortune as his own, which accelerates the process of professional burnout. Due to the impact of traumatic circumstances, a person feels physical and emotional fatigue, he takes it out on his other patients, colleagues and relatives. A good doctor must have qualities that will allow him not to take the death of his patients to heart.

Formation process

The process of formation of professional burnout syndrome goes through three stages:

1. The employee begins to feel bored, his emotions are muffled. So far it seems that everything is in order, but work no longer brings the same pleasure. There are fewer positive emotions, and a detached attitude towards the family appears. It gets to the point that when a person returns home, he wants to be left alone.
2. Misunderstandings with patients and disdainful attitude towards colleagues appear. A person feels flashes of irritation, even when he is alone. This is due to an overabundance of communication.
3. A person becomes indifferent to others and to himself. The worker no longer realizes the value of life, he becomes cynical. Outwardly, it may seem that everything is in order with such a person, but in fact, everything is indifferent to him.

When the syndrome just begins to develop, a person tries to fight traumatic factors with a positive attitude to work, but he only spends more energy. Soon the person feels tired and frustrated, and loses interest in work. In such cases, they say that the person “burned out at work.”

According to the degree of reversibility, the following stages of development of professional burnout syndrome can be distinguished:

1. Neurotic reaction. Traits of neurasthenia are visible. Fatigue and irritability increase. Performance decreases. Conflict increases, a person lashes out at others. Mental and physical activity decreases. There is emotional exhaustion.
2. Neurotic development. A person feels disgusted with work, does it carelessly, builds a wall around himself, and does not want to communicate with anyone.
3. Final personality change. Professional personality deformation occurs. The person becomes indifferent, cynical or even aggressive. He is no longer able to enjoy life. Depression appears, which can last for years.

There is a direct relationship between the lack of professional motivation of a medical worker and the quality of the duties he performs. Their financial independence and security depend on how much doctors receive for their work. A low salary devalues ​​a person’s efforts in the process of his professional activity. Demanding bosses and constant conflicts lead a person to a feeling of futility of all efforts put into work. The doctor begins to shirk work, perform it only within the framework of regulations, and emotionally distance himself from patients.

Signs and symptoms

Signs of professional deformation include the following phenomena:

• The doctor is more focused on the disease rather than on the patient's recovery.
• Lack of an individual approach to patients; patients end up on the conveyor belt.
• Lack of moral support for the patient.
• Treating the patient as a biological mechanism in which a breakdown has occurred.
• Shifting responsibility for the results of treatment from yourself to pills and equipment.
• Unfriendliness.
• Reluctance to work.
• Refusal to come to help in emergency situations.
• Rudeness and rudeness of medical staff.
• Corrupt practices.
• Irresponsibility and cynicism.
• Bureaucracy.
• Issuance of false medical documents.
• Medical errors and crimes.
• Refusal to inform the patient about the diagnosis and treatment plan.
• Violation of medical confidentiality.
• Ridiculing patients.
• Experiments on people.
• Lack of mercy.

Let us highlight the symptoms of professional burnout among medical workers:

1. Insomnia.
2. Constant fatigue.
3. Depression.
4. Alcoholism.
5. Irritability.
6. Reluctance to work.
7. Aggression towards patients, colleagues and superiors.

Professional deformation is irreversible personality changes that occur as a result of a person fulfilling his professional obligations. As a result, personal values, character, and manner of communication with patients and loved ones change. Deformation appears due to professional burnout. The body's defense mechanisms weaken, and personality destruction begins. Personality changes due to the influence of professional factors on it.

A person transfers his habits and habits associated with his profession into his personal life. He is no longer able to separate work and everyday life. However, professional deformation does not always have only a negative imprint. In the process of work, a person gains useful experience and skills that can be very useful in his free time.

It is professional adaptation that stands at the core of emotional burnout. A person adapts under the influence of external and internal factors. Problems begin when internal resources are not enough to cope with stress. When an adaptive function fails, psychological and physiological changes occur in the body. It seems that the person is “burned out at work.”

Occupational deformation is often observed among medical workers. They have a certain power, because the health and lives of patients depend on them. At the beginning of their professional career, doctors react violently and emotionally to people’s suffering. Due to the influence of the self-defense mechanism, they gradually distance themselves from the suffering of others. A professionally deformed doctor may seem indifferent and uninterested in his recovery to the patient, even if the doctor himself does not realize this. Not all future physicians realize the challenges ahead before becoming doctors.

There is another extreme of professional deformation, when an employee tries to compensate for dissatisfaction with his own work by excessive workaholism. A person does not feel satisfied with his work, so he puts more and more effort into it in order to achieve results that suit him. He is sure that failures happen only because he is not a very good doctor. The personal life of a doctor often suffers from this, because he cannot forget about work for a minute.

Prevention

Prevention of professional burnout should begin while studying at a medical school. How do you become a doctor? Students need to be prepared for the specifics of their future work. They must be aware of all possible risks. Upon graduating from an educational institution, an employee should know about methods for preventing professional burnout. It is necessary to conduct a preventive conversation with new employees, where it is worth describing the possible difficulties that they may encounter and ways to overcome them.

It is important to train staff in the rules of communication with patients, the correct actions in a critical situation, and methods aimed at combating occupational stress. Self-help groups can be created where health workers can communicate and share their experiences of overcoming professional burnout. In case of emotional burnout and depression, any employee should receive qualified help from a psychologist.

Don't forget about the material side of life. Their emotional state directly depends on how much doctors receive. Remuneration must correspond to the complexity of the work performed.

Prevention of emotional burnout is as follows:

• proper nutrition and healthy lifestyle;
• the presence of other interests that are far from professional activities;
• the presence of close people with whom you are on good terms;
• the ability to adequately evaluate one’s own work, lack of dependence on the opinions of others;
• development of new approaches and techniques, creative approach to work;
• adequate acceptance of failures;
• awareness that a doctor is a necessary profession;
• desire to achieve goals;
• acceptance of new experiences, the ability to learn from mistakes;
• not focusing only on things related to the profession;
• improving your own qualifications, communicating with other specialists, attending seminars;
• having a hobby;
• collaboration with colleagues.

Fighting methods

The following methods can be identified to combat professional burnout of medical workers on the part of the administration:

1. Increasing wages for employees.
2. Reconsidering the optimal load.
3. Providing vacations and days off.
4. Selection of competent and understanding management.
5. Helping young employees adapt to the specifics of their profession.
6. Conducting professional trainings and seminars.
7. Professional motivation of employees.

Not all medical workers are able to recognize the symptoms of exhaustion of the nervous system in time, and its treatment may be delayed until irreversible changes occur in the person’s psyche. In this case, the employee must provide assistance from a qualified specialist.

To cope with burnout, you need to try to look into your future and identify the goals you strive for. If you feel that you have reached the peak in your field, engage in activities that are close to your work. This way you can use your accumulated experience and learn new things at the same time. In the process of professional activity, you should not use only well-studied and familiar techniques. It is necessary to look for new ways and means of treatment. You shouldn’t try to always be the best in everything. It is necessary to take a simpler approach to conflicts with colleagues and superiors.

Thus, professional and emotional burnout is a problem that almost all medical workers face. Constant stress, incurable diseases and death of patients, high workload trigger protective mechanisms in the body, under the influence of which a person becomes indifferent and lack of initiative. Gradually, professional deformation occurs, during which the character and habits of a person in everyday life change. We have listed ways to prevent professional burnout among medical workers, which are aimed at helping in the fight against work stress and difficulties.

P.I. SIDOROV, Doctor of Medical Sciences, Professor, Academician of the Russian Academy of Medical Sciences, Moscow

Burnout syndrome (EBS) is a long-term stress reaction, or syndrome, that occurs as a result of prolonged professional stress. In the "International Neurological Journal" No. 1(5), 2006, an article was published on neuronal apoptosis resulting from psycho-emotional stress. The work now published underscores the importance of the problem raised. Emotional burnout syndrome most often occurs as a result of accumulating, difficult-to-control conflict between a boss and a subordinate. The syndrome is based on a discrepancy between the requirements for an employee and his real capabilities. Specifically for our medical department, this is an insufficiently correct relationship between the chief physician and the manager. department, head department and resident, head. department and assistant, associate professor... Although the topic is not new, we watch the series “Medical Confidentiality” on TV, and the topic exists, and it exists urgently!

My dear fellow leaders! You have under your command people of the most humane profession on Earth and with the most sensitive and fragile souls - doctors. It doesn’t matter who organized the team or who got it. These are your employees. And not only a “whip” is required, but also a warm attitude. Less irritability, short temper, hysteria. Praise your colleague in a timely manner - it’s so nice. Let us remember that the intelligentsia is the layer that protects us from rudeness.

Burnout syndrome is a process of gradual loss of emotional, cognitive and physical energy, manifested in symptoms of emotional and mental exhaustion, physical fatigue, personal detachment and decreased job satisfaction.

In the literature, the term “mental burnout syndrome” is used as a synonym for the term “emotional burnout syndrome.”

Emotional burnout syndrome is a psychological defense mechanism developed by an individual in the form of complete or partial exclusion of emotions in response to selected psychotraumatic influences. It represents an acquired stereotype of emotional, most often professional behavior. Burnout is partly a functional stereotype, since it allows you to dose and use energy resources sparingly. At the same time, its dysfunctional consequences may arise when burnout negatively affects the performance of professional activities and relationships with partners.

A number of authors of CMEA (in foreign literature known under the term “burnout”) are designated by the concept of “professional burnout,” which allows us to consider this phenomenon in the aspect of personal deformation of a professional under the influence of professional stress.

The first works on burnout appeared in the 70s in the USA. One of the founders of the idea of ​​burnout is H. Frendenberger, an American psychiatrist who worked in alternative health care services. In 1974, he described the phenomenon and gave it the name “burnout” to characterize the psychological state of healthy people who are in intense and close communication with clients (patients) in an emotionally charged atmosphere while providing professional assistance. Another founder of the idea of ​​burnout, K. Maslac (1976), a social psychologist, defined this concept as a syndrome of physical and emotional exhaustion, including the development of negative self-esteem, a negative attitude towards work, loss of understanding and empathy towards clients or patients. Initially, SEW meant a state of exhaustion with a feeling of one’s own uselessness. Later, the symptoms of this syndrome expanded significantly due to the psychosomatic component. Researchers have increasingly begun to associate the syndrome with psychosomatic well-being, classifying it as a pre-illness state. Currently, CMEA is included in the heading of the International Classification of Diseases (ICD-10: Z73 - “Stress associated with difficulties in maintaining a normal lifestyle”).

Prevalence of burnout syndrome

Among the professions in which SEV occurs most often (from 30 to 90% of workers), we can note doctors, psychologists, social workers, teachers, law enforcement officers, and rescuers. Almost 80% of psychiatrists, psychiatrists, narcologists, and psychotherapists have signs of SEV of varying degrees of severity, 7.8% have a pronounced syndrome leading to psychosomatic and psychovegetative disorders. According to another study, among psychologists-consultants and psychotherapists, signs of SEV of varying severity are detected in 73%. 5% have a pronounced phase of exhaustion, which is manifested by emotional exhaustion, psychosomatic and psychovegetative disorders.

Among nurses in psychiatric departments, signs of SEV were found in 62.9% of respondents. The resistance phase dominates the picture of the syndrome in 55.9%; 8.8% of respondents aged 51-60 years with more than 10 years of experience in psychiatry have a pronounced phase of exhaustion. 61.8% of dentists show signs of SEV, and 8.1% have the syndrome in the exhaustion phase.

85% of social workers have some symptoms of burnout. The existing syndrome is observed in 19% of respondents, in the formation phase - in 66% of respondents.

According to English researchers, among general practitioners a high level of anxiety is found in 41% of cases, clinically significant depression in 26% of cases. A third of doctors take medications to correct emotional stress, and the amount of alcohol consumed exceeds the average level. In a study conducted in our country among general practitioners, 26% had a high level of anxiety and 37% had subclinical depression.

SEV is found in one third of employees of the penitentiary system who directly communicate with convicts, and one third of law enforcement officers.

Data on the prevalence of SEV emphasize its medical and social significance, since SEV reduces the quality of professional activity of workers.

Etiological aspects of CMEA

The main cause of SEV is considered to be psychological, mental fatigue. When demands (internal and external) prevail over resources (internal and external) for a long time, a person’s state of balance is disturbed, which inevitably leads to SEW.

A connection has been established between the observed changes and the nature of professional activity associated with responsibility for the fate, health, and lives of people. These changes are regarded as a result of exposure to prolonged occupational stress. Among the professional stressors that contribute to the development of SEW, the need to work in a strictly established mode and the great emotional intensity of the very act of interaction are noted. For a number of specialists, the stressfulness of interaction is due to the fact that communication with patients occurs hour after hour, day after day for many years, and the recipients are sick people with a difficult fate, disadvantaged children and adolescents, criminals and victims of disasters, talking about their innermost, suffering , fears, hatred.

When considering SEW as a one-dimensional construct, this phenomenon is viewed as a state of physical and psychological exhaustion caused by prolonged exposure to emotionally overloaded situations.

Stress in the workplace is a key component of SEW: a mismatch between the individual and the demands placed on him. Organizational factors that contribute to burnout include: high workload; absence or lack of social support from colleagues and superiors; insufficient remuneration for work, both moral and material; high degree of uncertainty in assessing the work performed; inability to influence important decisions; ambiguous, ambiguous job requirements; constant risk of penalties (reprimand, dismissal, prosecution); monotonous, monotonous and unpromising activity; the need to outwardly show emotions that do not correspond to real ones, for example the need to be empathetic; lack of days off, vacations and interests outside of work.

Occupational risk factors include: “helping”, altruistic professions, where the work itself obliges to provide assistance to people (doctors, nurses, social workers, psychologists, teachers and even clergy). Working with “difficult” clients also predisposes you to burnout. In medicine, these are gerontological and oncological patients, aggressive and suicidal patients, and patients with addictions. Recently, the CMEA concept has expanded to include specialties for which contact with people is not typical (programmers).

The development of SEV is facilitated by personal characteristics - a high level of emotional lability, high self-control, especially when expressing negative emotions with the desire to suppress them, rationalization of the motives of one’s behavior, a tendency to increased anxiety and depressive reactions associated with the unattainability of the “internal standard” and blocking negative experiences. , rigid personality structure.

Since a person’s personality is a fairly holistic and stable structure, it seeks unique ways to protect itself from deformation. One of the methods of such psychological defense is SEV. The main reason for SEW is a mismatch between the personality and the job performed. In the practice of consulting firms and organizations, there are several variants of inconsistency that lead to the emergence of SEV. First of all, this is a discrepancy between the requirements for an employee and his real capabilities, when managers place increased demands on the individual. If for an employee it is a matter of honor to carry out the orders of his boss, but he is objectively unable to do this, then stress arises, the quality of work deteriorates, and relationships with colleagues may break down.

SEW is often caused by a discrepancy between the desire of workers to have a greater degree of independence in their work, to determine ways and means of achieving the results for which they are responsible, and the rigid irrational policy of the administration in organizing and monitoring work activity. The result of such total control is the emergence of a feeling of futility of one’s activities and a lack of responsibility.

The lack of appropriate remuneration for work is experienced by the employee as lack of recognition of his work, which can also lead to emotional apathy, decreased emotional involvement in the affairs of the team, a sense of injustice and, accordingly, burnout.

From the above, we can conclude that the main etiological factors for the occurrence of SEW are occupational stress, as well as the presence of certain bio- and psychosocial personality traits in workers.

Principles for diagnosing burnout syndrome

Until the 1980s, there was some uncertainty and multicomponentity in the descriptive characteristics of CMEA, and there were no measuring instruments. Currently, researchers have identified about 100 symptoms that are in one way or another related to SEV.

Working conditions can often also be a cause of chronic fatigue syndrome. Currently, the concept of chronic fatigue syndrome and SEF is differentiated, but they occur quite often together.

Chronic fatigue syndrome is an unreasonable, severe, general fatigue that exhausts the body, does not go away after rest, and prevents a person from living in his usual rhythm. It is necessary to distinguish chronic fatigue syndrome from simple fatigue, which is the body’s natural reaction to overwork, a signal of the need for rest. Typical complaints of patients: progressive fatigue, decreased performance; poor tolerance to previously habitual loads; muscle weakness; muscle pain; sleep disorders (insomnia or drowsiness); headache; forgetfulness; irritability; decreased mental activity and ability to concentrate. People suffering from chronic fatigue syndrome may experience prolonged low-grade fever and sore throat. It should be noted that there must be no other causes or diseases that caused the appearance of such symptoms.

Until recently, the viral hypothesis of the occurrence of chronic fatigue syndrome was popular. However, most researchers are inclined to believe that the addition of a viral infection occurs later. Factors contributing to the development of mental fatigue syndrome can be various stressful situations, including professional ones, depression, sleep disturbances, poor diet, sedentary lifestyle, and lack of fresh air. Against the background of formed immunodeficiency, a viral infection develops. There is a hypothesis that people suffering from chronic fatigue syndrome have a vulnerable nervous system and congenital immune weakness. Women suffer from chronic fatigue syndrome 2-3 times more often than men. A number of researchers classify individuals who place too high demands on themselves and are exposed to stress at work as a risk group.

The “burnout” syndrome began to be studied most intensively after the publication of the works of K. Maslach (1976). In 1986, the Maslach Burnout Inventory (MBI) questionnaire was developed to standardize the studies.

In the MBI, SEW is viewed as a three-dimensional construct that includes emotional exhaustion, depersonalization, and reduction of personal achievement.

Emotional exhaustion is the main component of professional burnout, manifested in experiences of decreased emotional tone, loss of interest in the environment or emotional oversaturation; in aggressive reactions, outbursts of anger, and the appearance of symptoms of depression.

Depersonalization manifests itself in the deformation (depersonalization) of relationships with other people: increased dependence on others or, on the contrary, negativism, cynicism of attitudes and feelings towards recipients (patients, subordinates, students).

The reduction of personal achievements is manifested in a tendency to a negative assessment of oneself, a decrease in the significance of one’s own achievements, in limiting one’s capabilities, negativism regarding one’s official duties, in a decrease in self-esteem and professional motivation, in a reduction in one’s own dignity, in abdicating responsibility or disengaging (“withdrawal”). from responsibilities towards others.

The model of German researchers Enzmann and Kleiber (1989) identifies three types of exhaustion: demoralization, exhaustion and loss of motivation.

Japanese researchers believe that to determine SEW, a fourth factor should be added to K. Maslach’s three-factor model - Involvement (dependence, involvement), which is characterized by headaches, sleep disturbances, irritability, as well as the presence of chemical dependencies (alcoholism, smoking).

Most experts recognize the need to take into account exactly three components to determine the presence and degree of burnout. At the same time, the contribution of factors is different.

There are three key features of SEV. The development of SEW is preceded by a period of increased activity, when a person is completely absorbed in work, refuses needs that are not related to it, forgets about his own needs, then the first sign sets in - exhaustion. Exhaustion is defined as a feeling of overexertion and exhaustion of emotional and physical resources, a feeling of tiredness that does not go away after a night's sleep. After a period of rest (weekends, vacation), these manifestations decrease, but upon returning to the previous work situation they resume.

The second sign of SEV is personal detachment. Professionals experiencing burnout use detachment as an attempt to cope with emotional stressors at work: they cease to feel compassion for the client, and become emotionally distant. In extreme manifestations, a person practically does not care about professional activity; neither positive nor negative circumstances evoke an emotional response. Interest in the client is lost; he is perceived as an inanimate object, whose very presence is sometimes unpleasant.

The third sign is a feeling of loss of self-efficacy, or a drop in self-esteem as part of burnout. A person does not see prospects in his professional activity, job satisfaction decreases, and faith in his professional capabilities is lost.

The mutual influence of factors determines the dynamics of the development of the burnout process. The authors of the dynamic phase model “burnout” identify three degrees and eight phases of burnout, differing in the relationship of indicators for three factors (indicator values ​​mean the assessment of points scored on the subscales of the MBI questionnaire relative to the average statistical values). The proposed model allows us to identify an average degree of burnout, at which high rates of emotional exhaustion are observed. Until this stage of burnout, the emotional and energetic “reserve” counteracts the increasing depersonalization and reduction of achievements.

There is a two-factor approach, according to which CMEA includes:

emotional exhaustion - the “affective” factor refers to complaints about poor physical well-being, nervous tension;

depersonalization - the “attitude” factor manifests itself in a change in attitude towards patients and towards oneself.

SEW is a combination of physical, emotional and cognitive exhaustion or fatigue, with emotional exhaustion being the main factor. Additional components of “burnout” are a consequence of behavior (stress relief) leading to depersonalization or cognitive-emotional burnout itself, which is expressed in a reduction in personal achievements.

At present, there is no single view on the structure of CMEA, but despite this, we can say that it represents a personal deformation due to emotionally difficult and tense relationships in the “person-person” system. The consequences of burnout can manifest themselves both in psychosomatic disorders and in purely psychological (cognitive, emotional, motivational and attitudinal) changes in personality. Both have direct significance for the social and psychosomatic health of the individual.

People with SES typically have a combination of psychopathological, psychosomatic, somatic symptoms and signs of social dysfunction. Chronic fatigue, cognitive dysfunction (impaired memory and attention), sleep disturbances with difficulty falling asleep and early awakenings, and personality changes are observed. The development of anxiety, depressive disorders, addiction to psychoactive substances, and suicide are possible. Common somatic symptoms are headache, gastrointestinal (diarrhea, irritable stomach syndrome) and cardiovascular (tachycardia, arrhythmia, hypertension) disorders.

There are 5 key groups of symptoms characteristic of SEV.

Physical symptoms:

• fatigue, physical fatigue, exhaustion;

  decreased or increased weight;

  insufficient sleep, insomnia;

  poor general health (including sensations);

  difficulty breathing, shortness of breath;

  nausea, dizziness, excessive sweating, trembling;

  increased blood pressure;

  ulcers and inflammatory skin diseases;

  diseases of the cardiovascular system.

Emotional symptoms:

• lack of emotions;

  pessimism, cynicism and callousness in work and personal life;

  indifference, fatigue;

  feeling of frustration, helplessness, hopelessness;

  irritability, aggressiveness;

  anxiety, increased irrational worry, inability to concentrate;

  depression, guilt;

  hysterics, mental suffering;

  loss of ideals, hopes or professional prospects;

  increased depersonalization, one’s own or others’ (people become faceless, like mannequins);

  a feeling of loneliness prevails.

Behavioral symptoms:

• working hours more than 45 hours per week;

  During the working day, fatigue and a desire to take a break and rest appear;

  indifference to food; the table is meager, without any frills;

justification for the use of tobacco, alcohol, drugs;

accidents (for example, falls, injuries, accidents, etc.);

impulsive emotional behavior.

Intellectual state:

• decreased interest in new theories and ideas at work;

  decreased interest in alternative approaches to solving problems (for example, at work);

  increased boredom, melancholy, apathy or lack of courage, taste and interest in life;

  increased preference for standard templates, routine, rather than a creative approach;

  cynicism or indifference to innovations, innovations;

  reluctant participation or refusal to participate in developmental experiments (trainings, education);

  formal performance of work.

Social symptoms:

• no time or energy for social activities;

  decrease in activity and interest in leisure and hobbies;

  social contacts are limited to work;

  poor relationships with other people both at home and at work;

  feeling of isolation, misunderstanding by others and by others;

  feeling of lack of support from family, friends, colleagues.

In our country, V.V.’s method of diagnosing the level of emotional burnout has become widespread. Boyko, which is an analogue of MBI (application).

Thus, SEV is a natural combination of symptoms of disorders in the mental, somatic and social spheres of life.

Features of CMEA among representatives of certain professions

Industrial (professional) stress is a multidimensional phenomenon, expressed in physiological and psychological reactions to a difficult work situation. The development of stress reactions is possible even in progressive and well-managed organizations, as it is determined not only by structural and organizational features, but also by the nature of the work, personal relationships of employees, and their interpersonal interactions. Occupational stress affects employee productivity, financial performance, stability and competitiveness of the entire organization.

Work-related stress is a possible reaction of the body when work places demands on people that are not commensurate with their level of knowledge and skills. Stress factors may relate to the content of the job, the workload and location of the job, the organization of working hours, the degree of participation in the decision-making process and the ability to influence this process. Most causes of stress relate to the nature of work organization and management of production processes. Other sources of stress may relate to career opportunities, status and pay, employees' roles within the organization, interpersonal relationships, organizational culture, and poor work-life balance.

In a 2000 survey of 15 European Union member states, 56% of workers reported very fast work pressures, 60% reported tight deadlines for at least one quarter of their working time, and 40% reported monotony of work. . More than one third of workers do not have the opportunity to exert any influence on how work is performed.

Work-related stress factors contribute to the development of health problems. Thus, 15% of workers complain of headaches, 23% of pain in the neck and shoulders, 23% of fatigue, 28% of stress and 33% of back pain. Almost one in ten workers report being subjected to intimidation tactics in the workplace.

Another phenomenon common to many workplaces is mental abuse, which is caused by deteriorating interpersonal relationships and organizational dysfunction. One of the most common forms of mental violence at work is “mobbing” (or “bullying”), which poses a health risk. Mobbing generally means the abuse of power against people who are unable to defend themselves. Almost 90% of respondents believe that stress and mobbing are the result of poor work organization.

The data received from individual states is alarming. In Austria, 1.2 million workers suffer from work-related stress due to extremely tight deadlines. In Denmark, 8% of employees often feel emotionally drained. In Spain, 32% of workers identified their work as stressful. In Sweden, 9 out of 10 employees constantly have to work intensively to carry out their daily duties, and 40% of them work without a lunch break.

In the 15 member states of the European Union, the cost of work stress and related mental health problems averaged around €265 billion annually until 2004. Research shows that as a result of work-related stress alone, the private and public sectors in these countries lose around €20 billion in absenteeism and stress-related health care costs, not to mention the costs associated with lost productivity , higher staff turnover and a reduced ability of employees to innovate.

Nowadays, the problems of managing industrial stress are becoming more pressing due to rapidly changing socio-economic and political situations, increasing neuropsychic and information loads, diversification of production, and constant growth of competitiveness.

Society's attitude towards work is changing. Confidence in the stability of social and financial situation and job security is lost. Competition for prestigious and highly paid jobs is intensifying. The ratings of a number of socially significant professions are falling: medical workers, teachers, doctors; mental and emotional stress is growing, which is associated with stress in the workplace.

Among the production stress factors are:

physical (vibration, noise, polluted atmosphere);

physiological (shift schedule, lack of diet);

socio-psychological (role conflict and role uncertainty, overload or underworking of workers, poor information flows, interpersonal conflicts, high responsibility, lack of time);

structural and organizational (organizational stress).

According to the concept of G. Selye, work in a stressful environment always leads to the mobilization of internal resources and can both cause acute disturbances and manifest itself in the form of delayed consequences. During the first three years of exposure to a stress factor, the number of acute conditions and reactions (psychosis, heart attacks) increases, and then chronic diseases begin to predominate: coronary heart disease, depression, kidney disease, immunological diseases, etc. The number of stress reactions increases due to the action of " the principle of acceleration,” when an already developed stress reaction leads to changes in life and new stress, and the “principle of contagion,” especially expressed in production teams.

SEW is considered by many authors as a consequence of work stress, as a process of maladaptation to the workplace or professional responsibilities. At the same time, the main predisposing factor of burnout is the duration and excessive workload in situations of tense interpersonal relationships. In this regard, SEV is typical for representatives of communicative professions of the “person-to-person” system: doctors, medical personnel, teachers. Psychologists, psychiatrists, psychotherapists, representatives of various service professions, as well as all categories of executives and managers. In the context of professional activity, the negative consequences of interpersonal work communications are designated by the concept of “professional burnout.” Burnout is directly related to the preservation of health, mental stability, reliability and professional longevity of specialists who have long-term interpersonal communications.

As a result of burnout, a person loses mental energy, he develops psychosomatic fatigue (exhaustion), emotional exhaustion ("exhaustion of resources"), unmotivated restlessness, anxiety, irritability, vegetative disorders appear, self-esteem decreases, and awareness of the meaning of one's own professional activity is lost.

There is a close relationship between professional burnout and motivation. Burnout can lead to a decrease in professional motivation: hard work gradually turns into a meaningless activity, apathy and even negativism appear in relation to work responsibilities, which are reduced to a minimum. “Workaholics” are more susceptible to mental burnout - those who work with high dedication, responsibility, an attitude towards a constant work process and have found their calling in work. This list can be supplemented by “authoritarianism” and a low level of empathy. The relationship between burnout and unconstructive behavior patterns in problematic production situations and a certain personal symptom complex (personal “risk factors”) has been established.

The development of CMEA is typical primarily for professions where helping people dominates (medical workers, teachers, psychologists, social workers, rescuers, law enforcement officers, firefighters). SEW is seen as a result of unfavorable resolution of stress in the workplace.

There is a connection between work stress factors and symptoms of burnout:

between the general (total) burnout indicator and job characteristics (task significance, productivity, intentions to change jobs);

between depersonalization and indiscipline, poor relationships with family and friends;

between emotional exhaustion and psychosomatic illnesses, between personal achievements and attitude towards professional responsibilities, the significance of work, etc.

There is unity in understanding the risk factors for CMEA for representatives of various professions. Professional specificity affects only a certain degree of stressogenicity of individual factors.

Facts are presented that allow us to classify the contingent of dentists as a risk group. In this activity, a wide range of factors can be identified that contribute to the development of CMEA. Dentists in the United States have a high suicide rate - 2.5 times higher than the average for the population. Among dentists, a large number of divorces, depression, alcoholism, drug addiction, and psychosomatic disorders are detected. Among the causes of stress are overload as a result of professional activity, financial failures, unsatisfactory interactions in the work team, problems of professional growth and career, complicated personal life conditions, low authority of the profession and lack of proper public image.

Particular importance is attached to the peculiarities of interaction between a doctor and a patient. A dentist, sitting face to face with a patient all day long, empathizes with him in his pain and fear of pain, and almost every patient perceives a dental procedure with fear and sometimes with disgust, against which the doctor is defenseless, although he strives to carry out everything stages of treatment are painless. About 15% of dentists experience severe or very severe stress from contact with patients.

Stress is an absolute problem for 13% of dentists. Many note emotional and personal detachment; they stated that they had lost interest in people, in everything that happened at work, that they began to perceive patients only as an object for manipulation. Most of them complain of poor health, sleep disturbances, fatigue, irritability, poor digestion, occasional dizziness and palpitations, and inability to relax after a hard day. Many doctors, and especially men, complain of high anxiety and a feeling of despondency associated with failures at work. Among the factors causing emotional stress, doctors noted: unsatisfactory financial situation, peculiarities of interaction with patients, conflicts and disagreements with colleagues and immediate supervisor, work overload.

The profession of a nurse also occupies one of the first places in terms of risk of developing SEV. The working conditions of nurses often become the cause of SEV. Their working day involves close contact with people, including sick people who require constant care and attention. Faced mainly with negative emotions, the nurse involuntarily and involuntarily becomes involved in them, due to which she herself begins to experience increased emotional stress. People who place unreasonably high demands on themselves are most at risk of developing SEV. In their minds, a real doctor is an example of professional invulnerability and perfection. Individuals included in this category associate their work with a purpose, a mission, so for them the line between work and private life is blurred.

Three types of nurses who are at risk of CMEA have been identified: type 1 - “pedantic”; the main characteristics of this type: conscientiousness, elevated to absolute; excessive, painful neatness, the desire to achieve exemplary order in any matter (even to the detriment of oneself); Type 2 - “demonstrative”; people of this type strive to excel in everything, to always be in sight; they are characterized by a high degree of exhaustion when performing inconspicuous, routine work; Type 3 - “emotive”; impressionable and sensitive people; their responsiveness and tendency to perceive other people's pain as their own borders on pathology, on self-destruction.

A study conducted among psychiatric nurses revealed that EMS is manifested by an inadequate response to patients and colleagues, lack of emotional involvement, loss of the ability to empathize with patients, fatigue leading to a reduction in professional responsibilities and the negative impact of work on personal life.

The professional activities of mental health workers pose a potential threat to the development of CMEA. Personality traits of emotional instability, conformity, timidity, suspicion, tendency to feel guilty, conservatism, impulsiveness, tension, introversion are important in the formation of SEW. The picture of the syndrome among mental health workers is dominated by symptoms of the “resistance” phase. This is manifested by an inadequate emotional response to patients, lack of emotional involvement when contacting clients, loss of the ability to empathize with patients, fatigue leading to a reduction in professional responsibilities and the negative impact of work on personal life. The experience of psychotraumatic circumstances is also quite pronounced (the “stress” phase), which is manifested by a feeling of physical and psychological overload, stress at work, and the presence of conflicts with superiors, colleagues, and patients.

The activity of a psychotherapist is public, implies the need to work with a large number of people and involves the provision of services to clients. Moreover, the latter differ from the general population of the population in mental imbalance and deviant behavior in one form or another.

Among psychotherapists and psychologists-consultants, people with a low level of professional security are susceptible to SEV, for example, lack of professional education and systematic advanced training, inability to participate or irregular participation in Balint and supervisory groups, young age, lack of life experience and practical work experience. SEV can be provoked by illness, weakness after illness, experiencing severe stress, psychological trauma (divorce, death of a loved one or patient).

Typically, in everyday practice, the patient’s attitude towards the psychotherapist is involuntarily emphasized as respectful, similar to what can occur in relations with elders and experienced people. But often patients with personality disorders are able to evoke in others, including the therapist, an involuntary feeling of hostility and indignation at their behavior. But the therapist is obliged to provide medical assistance to patients regardless of the moral qualities of the latter. The doctor is forced to treat all applicants, even if they are criminals or have committed reprehensible acts, and has no right to reflect on the right of these persons to medical and psychotherapeutic assistance.

Dealing with such people is difficult and requires mental strength as well as special skills. The concept of mental strength that a psychotherapist must have includes patience and high mental tolerance. In this case, we are talking about mental defensiveness, the ability to tolerate unusual behavior of an interlocutor without expressed excitement, the ability to reach a level of distress and mental tension. Such skills refer to the skills of donation or, in other words, the skills of doing good.

In a therapeutic situation, the doctor uses an intrapunitive type of response, in which the reaction to external influence is limited to the search for internal causes and answers to what is happening. The doctor seeks to empathically penetrate the patient’s experiences and understand what feelings and thoughts arise in him under certain conditions. Patients are encouraged to learn this skill. Reflection and self-analysis are the main mechanisms used in psychotherapy. The psychotherapist tries to arouse the patient's sympathy. Be "their guy" for them. He behaves this way to achieve therapeutic contact. Such “dissolution” of the therapist in the interests of the patient leads to self-denial, dulling of self-esteem, self-respect and forgiveness. Constant focus on one’s own experiences and a tendency to empathically feel into the experiences of the interlocutor make the therapist’s state look like an altered, narrowed consciousness. The psychotherapist is forced to be in a state of deprivation all the time. Long-term communication with a patient creates the impression that sick people seeking help constitute the therapist’s only environment. It seems that ordinary, healthy people do not come into the psychotherapist’s field of vision and social circle at all.

Due to the delayed effect of psychotherapy, one gets the impression that it is generally ineffective and the therapist’s efforts are useless. Some therapists develop low self-esteem and begin to consider themselves almost charlatans. This situation first subconsciously and then consciously suppresses the therapist. Mood and performance decrease, and mental discomfort appears. On the other hand, professional deformation is accompanied by indifference to the grief of others, a cold, dispassionate assessment of the psychological state and social status of the patient. At some stage of professional activity, the therapist begins to think about leaving his job and changing his specialty. First in a situation of professional failure, and then more and more persistently and out of connection with the results of work. From the daily practice of communication between a psychotherapist and patients, a pattern of behavior towards others develops.

Other categories of medical workers, especially those caring for seriously ill patients with cancer, HIV/AIDS, and working in intensive care and burn departments, are also susceptible to the formation of SEV.

Employees of professionally “difficult” departments constantly experience a state of chronic stress associated with negative mental experiences, intense interpersonal interactions, tension, complexity of work, etc. Gradually emerging as a result of CMEA, it reduces the quality of medical care, generates a negative and even cynical attitude towards patients, mental and physical fatigue and indifference to work.

The profession of a social worker, regardless of the type of work performed, belongs to a group of professions with increased moral responsibility for the health and life of individuals, population groups and society as a whole. Constant stressful situations in which a social worker finds himself in the process of complex social interaction with a client, constant penetration into the essence of the client’s social problems, personal insecurity and other moral and psychological factors have a negative impact on the health of the social worker. Social work is classified as a profession that requires great emotional stress, responsibility and has very vague criteria for success. Social workers, whose occupation is involved in long-term intense communication with other people, are characterized by SEV.

The formation of CMEA in the professional activity of a social worker may be associated with such factors as situations of change or loss of social status; risk situations; situations with extreme conditions, uncertain situations. Characteristic of these situations are overloads - too many clients, too many demands, too much information. As overload increases, social workers begin to unconsciously strive to reduce contact - they become less personally involved in interaction, more often resort to formal rules and rituals, and use more impersonal forms of work. The risk of developing SEW among social work specialists may increase in the following situations: investing large personal resources into work with insufficient recognition, working with “unmotivated” clients who constantly resist efforts to help them; lack of conditions for self-expression at work; tension and conflict in the professional environment; dissatisfaction with the profession, which is based on the awareness of the incorrectness of its choice.

In social work, young professionals have a higher risk of developing SEV. This fact is explained by the fact that a specialist in adulthood has already passed the stage of professional development and adaptation to the profession, specific professional goals have been identified, professional interests have been formed, and mechanisms of professional self-preservation have been developed.

The teaching profession is one of those that is highly susceptible to the influence of CMEA. This is due to the fact that the professional work of a teacher in general and a higher education teacher in particular is characterized by a very high emotional load. There are a large number of emotiogenic factors, both objective and subjective, that have a negative impact on the work of a teacher, causing strong emotional tension and stress. Also, the teaching profession is one of the altruistic professions, which increases the likelihood of mental burnout.

Emotional factors cause a growing feeling of dissatisfaction and accumulation of fatigue, which leads to pedagogical crises, exhaustion and burnout. The result of these processes are physical symptoms - asthenia, frequent headaches and insomnia. In addition, psychological and behavioral symptoms arise - a feeling of boredom, decreased enthusiasm, resentment, uncertainty, irritability, and inability to make decisions. The consequence of this is a decrease in the effectiveness of the teacher’s professional activity. A growing feeling of dissatisfaction with the profession leads to a decrease in the level of qualifications and determines the development of the process of mental burnout of the teacher. All these phenomena often arise under the same conditions - with superoptimal motivation in a frustrating situation - and lead to deterioration or complete disorganization of activity.

Among the many features and difficulties of teaching and pedagogical work, its high mental tension is often highlighted. Moreover, the ability to experience and empathize is recognized as one of the professionally important qualities of a teacher and educator. All these features can contribute to the formation of SEV.

The category of workers at risk of developing professional deformation also includes employees of the penal system. This is facilitated by many physiological, psychological, economic and social factors. Thus, solving professional problems requires employees of penitentiary institutions to intensively communicate and be able to build their relationships with convicts and colleagues. Intense communication within the framework of work activity increases the likelihood of the occurrence of SEV. There are indications of the existence of manifestations of this syndrome in the professional environment of employees of the penal system who directly communicate with convicts. Factors contributing to the development of SEW, in addition to the three main ones (personal, role and organizational), include additional factors characteristic of the penitentiary service, such as dissatisfaction with material needs and self-actualization needs, a decrease in life’s meaning, low status in a professional group, etc.

Law enforcement officers are also susceptible to CMEA, especially those who are constantly on the front line of the fight against crime. These are guards, district police officers, operational workers, and security department employees. In this group, constant psychological and physiological stress and even overstrain naturally and naturally lead to neuroticism. Headaches and the desire to “relieve stress with alcohol” are common occurrences. Similar psychological problems are observed among Western police officers, which, however, are compensated by relatively high salaries and much higher social protection.

Thus, CMEA among representatives of various professions has some features related to the specifics of professional activity.

Principles of treatment and prevention of burnout syndrome

Preventive and therapeutic measures for burnout syndrome are largely similar: what protects against the development of this syndrome can also be used in the treatment of an already developed one.

Preventive, therapeutic and rehabilitation measures should be aimed at relieving the stressor - relieving work tension, increasing professional motivation, equalizing the balance between the effort expended and the reward received. When signs of SEW appear and develop in any of the specialists, it seems necessary to pay attention to the improvement of working conditions (organizational level), the nature of the emerging relationships in the team (interpersonal level), personal reactions and morbidity (individual level).

A big role in the fight against CMEA belongs, first of all, to the worker himself. By following the recommendations listed below, an employee will not only be able to prevent the occurrence of SEV, but also achieve a reduction in its severity.

Defining short-term and long-term goals. This not only provides feedback that the person is on the right track, but also increases long-term motivation. Achieving short-term goals is a success that increases the degree of self-education.

Using timeouts. To ensure mental and physical well-being, time-outs, that is, rest from work and other stress, are very important. Sometimes you need to “escape” from life’s problems and have fun, you need to find an activity that would be exciting and enjoyable.

Mastering skills and abilities of self-regulation. Mastering psychological skills such as relaxation, ideomotor acts, goal setting and positive inner speech helps reduce stress levels that lead to burnout. For example, setting realistic goals helps you balance your professional life and personal life.

Professional development and self-improvement. One of the ways to protect against SEV is to exchange professional information with representatives of other services. Collaboration provides a sense of a wider world than the one that exists within a single team. For this purpose, there are various advanced training courses, all kinds of professional, informal associations, conferences where people with experience, working in other systems, meet, where you can talk, including on abstract topics.

Avoiding unnecessary competition. There are many situations in life when we cannot avoid competition. But too much desire for success in business creates anxiety and makes a person overly aggressive, which, in turn, contributes to the emergence of CMEA.

Emotional communication. When a person analyzes his feelings and shares them with others, the likelihood of burnout is significantly reduced or this process is not so pronounced. It is therefore recommended that employees in difficult work situations exchange views with colleagues and seek professional support from them. If an employee shares his negative emotions with colleagues, they can find a reasonable solution for his problem.

Maintaining good physical shape. There is a close connection between the body and mind. Chronic stress affects a person, so it is very important to maintain good physical shape through exercise and a healthy diet. Poor nutrition, abuse of alcoholic beverages, tobacco, decrease or excessive increase in body weight aggravate the manifestation of SEV.

To avoid burnout syndrome, you must follow the following rules:

try to calculate and deliberately distribute your loads;

learn to switch from one type of activity to another;

easier to deal with conflicts at work;

don’t try to always be the best in everything.

Psychological work to eliminate SEW should include three main areas.

The first direction should be aimed at relieving employees of stressful conditions that arise in connection with intense activities, developing self-regulation skills, teaching techniques for relaxation and control of one’s own physical and mental state, and increasing stress resistance.

The second area is the development of verbal and non-verbal communication skills, which are necessary to establish favorable relationships with colleagues and management. This can be facilitated by holding group training sessions with employees to develop communication skills.

The third direction is leveling the negative influence of a number of professional and personal factors that contribute to CMEA. Work is needed to develop employees’ skills to resolve conflict situations and find constructive solutions; the ability to achieve set goals and revise the system of values ​​and motives that impede professional and personal self-improvement, etc. For this, various types of trainings can be used, for example, trainings on gaining self-confidence, self-discovery, personal growth, decision-making ability, etc.

One of the ways to prevent SEV is to include in the duties of a psychologist in an institution work with staff on the prevention, identification and correction of symptoms of the syndrome (questionnaires, trainings, conversations). Heads of institutions can neutralize the threat of CMEA through a variety of activities (within the professional responsibilities of the employee).

In SEW, group forms of work are most often used, among which debriefing can be noted. During the classes, an analysis of personality ego states (Caring Parent, Critical Parent, Adult, Natural Child, Adaptive Child), driver behavior and early childhood decisions is carried out. After summarizing the information, each participant is asked to decide on his contract and return to the original one. Meditations and trainings are also conducted to develop confident behavior and assertiveness. Debriefing is carried out immediately after an event that was a strong stressor.

Prevention of SEV is the correct organization of professional activities. When hiring an employee, the manager must consider him as a valuable resource for achieving the organization's goals. Features of the profession, emotional involvement and SEW require certain organizational conditions. This includes mentoring, debriefings, and advanced training. Individual counseling on professional issues (for example, career guidance). Professionals who engage in psychotherapy and counseling must have other working conditions that take into account the specifics of the profession.

For preventive purposes, adequate informing of representatives of communication professions about early signs of burnout and risk factors can be used. Basic techniques of self-influence and the formation of mental tolerance can be used, allowing one to create a psychological image characterized by defensiveness. Many of the techniques can be used in the prevention of burnout syndrome for representatives of other professions.

Ways to build an effective relationship with a patient and improve defensiveness skills can be divided into groups:

self-knowledge and psychophysical training;

means of internal mood;

interpersonal means.

Self-knowledge consists of studying one’s own typical reactions to words, actions, situations, and type of activity, including the use of psychological tests. The therapist is expected to compile a register of his own typical reactions.

The psychotherapeutic atmosphere should be supported not only by the therapist’s words, but also by his inner attitude. Means of internal attitude are used to increase defensiveness.

This type of technique is based on modeling a specific situation in order to structure one’s behavior in the right direction and form the desired reaction in the interlocutor, namely the one that is necessary in such a situation. As you know, the inner mood is usually reflected in appearance and behavior, and is well recognized and read by others. Therefore, it is quite enough just to think about something, as it finds external embodiment in the appearance and behavior of a person. And vice versa, a person trying to hide something from others is forced to first internally convince himself and imagine a different situation than the one he is hiding.

Working in this direction, the psychotherapist not only remembers the indicated feelings and mood, but tries to vividly imagine how they are reflected in behavior, appearance and mutual relationships. Difficulties in implementing eidetic ideas or obtaining an appropriate emotional mood while perfecting eidetic skills are compensated for by the use of NLP techniques. Technical means of entering into an image include: eidetic, non-verbal self-hypnosis; using NLP techniques to successfully enter a role; verbal, mental pronunciation to oneself of the necessary mood.

Affirmations for inner attitude:

do not be afraid to make mistakes in your work;

• set achievable psychotherapeutic goals;