It’s that time of year when we all reflect on the previous year and think ahead to the coming year focusing on what we might want to change in our lives to make them more satisfying or fulfilled. New Year resolutions abound with declarations about getting fitter, healthier or improving the work-life balance. At the start of 2013 I’ve been reflecting and thinking about burnout, my own susceptibility to burnout, work-life balance and building resilience. With colleagues I have studied burnout in the cancer workforce and this year I am working with a team of researchers to look at ways of building resilience in students and professionals working in the cancer field, so it makes sense for me to start this process with a little reflection on my own burnout susceptibilities and strategies for resilience.
What is Burnout?
Burnout is a phenomenon that occurs in a linear order across 3 dimensions: emotional exhaustion, depersonalisation and personal accomplishment (1). It is reported to exist where individuals have contact with the general public within roles such as nursing, the medical profession or teaching. However, it has also been studied within the sporting field. Gould and Whitley describe athlete burnout as a physical and emotional withdrawal from a sport that was previously enjoyable and characterised by:
“emotional and physical exhaustion, reduced sense of accomplishment, and sport devaluation, often occurring as a result of chronic stress and motivational changes in the athlete.” 
In our research we identified negative correlations between levels of work satisfaction and levels of emotional exhaustion (i.e. those that scored high for emotional exhaustion scored low for satisfaction). Emotional exhaustion was also negatively correlated with aspects of individual control. For example, those involved in role extension where there is greater opportunity for autonomy and control over the tasks and pace of work, reported lower levels of emotional exhaustion. Similarly, where participants indicated their manager’s leadership style allowed worker empowerment, staff reported lower levels of emotional exhaustion. The importance of control is supported in other research (2;3) and even considered fundamental to the prevention of burnout in athletes (4). 
There is much that can be done at an organisational level to reduce the risk of burnout. For example, how an organisation’s management structure influences individual workload, personal control, levels of reward, a sense of community, fairness and organisational values all of which may influence individual engagement with work (3). At an individual level what can we do?  Can we build resilience to prevent burnout? and what is the best way to achieve this? Well I wish I had the perfect answer here, but I don’t (hence our current research in this area to gain better insight). One useful conceptual model is that proposed by Dunn, Iglewicz and Moutier (5)where it is postulated that individuals have a coping reservoir. Within the internal structure of the reservoir are the individual’s personal traits, temperament, and coping style. For example, some experts talk about burnout being a greater risk to conscientious , diligent individuals or super-achievers (6). Personal traits act to top up or deplete the reservoir with some individuals naturally more able to defend against stressors. External factors act upon the reservoir including stress, time and energy demands. Positive factors influencing the reservoir include support from family and friends, social activities (which may include time out from work, study or training), mentorship, stimulation (or enthusiasm for the activities the individual is involved in). Where the individual is able to keep the reservoir replenished resilience will develop; where this doesn’t occur the consequences maybe burnout.
 Life is a great balancing act
Regaining Control or Establishing Balance
If we all indeed have a reservoir that needs to be replenished the amount that is needed to be actioned to balance the reservoir will differ from person to person based on our individual personality, traits and workloads. For some it maybe necessary to take time out to replenish energy and coping levels (5). In our qualitative work on job satisfaction with radiation therapists I interviewed a worker who narrated her experience of reaching a point of depersonalisation, she recognised this and chose to leave the profession. After a period of working elsewhere and some time out from emotional labour she realised how much she loved her job as a therapist and feeling replenished she returned to the profession; more aware of her sucsptibilities to burnout in the future. Maslach and Leiter emphasise the importance of being aware of the opportunity for burnout (3) and maybe this is the first step in gaining control, being aware, and scheduling time out  or regular breaks to prevent burnout occurring.
In an effort to establish balance and keep the coping reservoir at a healthy level is there something about the internal structure of my reservoir that I need to look at? I am a try hard perfectionist with a desire to do well, and like many I take the experience of journal article rejections and failed research funding bids as a personal failure. My karate instructor wrote an article about fear of failure in karate competitors the section I particularly like is the notion of athletes being given the freedom to fail because with that the athlete fights in a more confident, more relaxed manner; thus reducing some of the external negative pressure on the coping reservoir. For the concientious, perfectionist, super-achievers the notion of failure may be a hard pill to swallow, and maybe it starts with giving yourself permission to fail.
So with permission to fail how else can i regain balance? Balance is something I should be good at. I was a competitive gymnast for over eleven years in my youth, beam was my best apparatus so balance should be a doddle for me; yet I don’t appear to have got the work-life balance perfectly right so far. So maybe I need to go back to basics. Learning to balance requires practice it’s not something you achieve straight off and re-gaining your balance after some tasks is harder than others. Let’s take the example of a gymnast on a beam. Landing a back somersault on a 4 inch wide plank of wood is easier (believe it or not) than landing a forward somersault and for many gymnasts that is easier than a one foot 360 degree spin. The reason is that in a back somersault the gymnast will spot the beam well before her feet land allowing focus on landing. During a front (forward) somersault the gymnast must start to open out from the tuck position before the beam is spotted so focus on landing is delayed. For a full spin on one foot the gymnast is made vulnerable by any slight deviation from the central spinning position (i.e from a change in arm position perhaps) and focus on exit of the spin is vital if the gymnast is to avoid an early dismount from the beam. So is balancing work and the rest of one’s life actually about focus?
When I was taught to balance as a gymnast before I perfected the skill, the coaching tip was to spot something ahead of you to focus your eyes on. The process of focussing on one thing that wasn’t moving was to allow concentration on tensing the relevant muscles required to undertake the movement and retain balance.  
I am all too aware that sometimes my to do list is not completed because I’m distracted  sometimes by the amount of tasks I have to do, sometimes by the frustration of work processes that are beyond my control, and sometimes because I’m thinking about food (usually cake). Focussing on what the priority is for that moment as a way of balancing the demands of work and normal life seems rather obvious. However, it’s easy to forget such simple things in the complexity and speed of modern life.
So in order for me to retain balance in my life (and avoid burnout) I have taken control over the things that are in my power to action. I have scheduled my holidays for this year, booked at regular intervals to ensure sufficient time out. My next task for this year is to re-visit an article rejection from a high impact journal by corresponding with the journal editor on the validity of the original comments and requesting a review of an updated version; this is facing fear of second failure full on, but this time with an attitude that I have nothing to loose.
Finally, my New Year mantra will be focus, focus, focus. Like learning to balance it comes with practice. My five year old couldn’t do this balance two days ago, but when she learned to focus she mastered it. 
Just to disprove the saying “people that can do, people that can’t teach” this is me balancing on one leg, just need to transfer that skill to the rest of my life-then job done!
Reference List
(1) Maslach C, Jackson SE. Burnout in health professions: A social psychological analysis. Social psychology of health and illness .Hillsdale NJ: Erlbuam; 1982. p. 227-51.
(2) Keeton K, Fenner DE, Johnson TR, Hayward RA. Predictors of physician career satisfaction, work-life balance, and burnout. Obstet Gynecol 2007 Apr;109(4):949-55.
(3) Maslach C, Leiter MP. The Truth about Burnout. San Fransisco: Jossey-Bass; 1997.
(4) Coakley J. Burnout among adolescent athletes: a personal failure or social problem? 
  Sociology of Sport Journal 1992;9(3):271-85.
(5) Dunn LB, Iglewicz A, Moutier C. A conceptual model of medical student well-being: promoting resilience and preventing burnout. Acad Psychiatry 2008 Jan;32(1):44-53.
(6) Schaufeli W, Enzmann D. The burnout companion to study and practice: a critical analysis. Taylor and Francis LTD; 1998.











One thought on “Burnout….Resilience….Balance…..Focus

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