Therapie des Burnout

Zusammenfassung

Der Begriff Burnout beschreibt ein Erschöpfungssyndrom als Folge lange andauernder Belastung, insbesondere am Arbeitsplatz. Zentrale Symptome umfassen eine emotionale Erschöpfung, gepaart mit Zynismus und Demotivation, eine körperliche Erschöpfung mit verschiedenen vegetativen Begleiterscheinungen und das subjektive Gefühl reduzierter Leistungsfähigkeit. Symptomatisch besteht eine gewisse Überlappung mit dem Störungsbild der Neurasthenie und dem Chronic-Fatigue-Syndrome. Starke Verknüpfungen finden sich auch mit depressiven Störungen, vor allem bei zunehmendem Schweregrad des Burnouts. Depression und Burnout sind verwandte, aber nur zum Teil übereinstimmende Konzepte. Als Risikofaktoren für die Entwicklung gelten einerseits Arbeitsbedingungen, wie hoher Arbeitsdruck, Konflikte und Unklarheit bezüglich der beruflichen Rolle und fehlende Autonomie, andererseits persönliche Charakteristika wie Neurotizimus, externale Kontrollüberzeugung und mangelnde Widerstandsfähigkeit. Therapeutische Interventionen zur individuellen Behandlung von Burnout wurden bisher wenig erforscht. Hier wird ein stationäres multimodales Behandlungskonzept vorgestellt, welches auf den Elementen der kognitiv-behavioralen Therapie und Ressourcenaktivierung, auf Entspannungsverfahren und Körpertherapie zur vegetativen Normalisierung und auf Sport aufbaut, ergänzt durch adjuvante Therapien, insbesondere der Traditionellen Chinesischen Medizin.

Summary

Burnout denotes a syndrome of exhaustion as a consequence of chronic work related stress. The key symptoms consist in emotional exhaustion associated with cynicism and demotivation, physical fatigue coupled with various psychosomatic reactions and reduced personal effectiveness. On a symptomatic level there is a significant overlap with the concept of Chronic Fatigue Syndrome and of Neurasthenia as well as with depressive disorders, particularly with increasing severity of burnout. Depression and burnout are related, but not redundant concepts. Major risk factors for the development are high workload, role conflicts, lack of role clarity and low control at work, and individual characteristics, particularly high neuroticism, external locus of control and low hardiness. Therapeutic interventions for the individual treatment of burnout have seldom been investigated. This paper presents a treatment program for inpatients based on the elements of cognitive-behavioral therapy and resource activation, on relaxation techniques and body related therapy as well as physical activation through sports, completed with methods stemming from traditional Chinese medicine.

Schlüsselwörter

Burnout - Depression - arbeitsbedingter Stress - Erschöpfungssyndrom - Therapie

Keywords

Burnout - depression - work related stress - exhaustion syndrome - therapy

• Literatur

• 1 Ahola K, Hokonen T, Isometa E. et al. The relationship between job related burnout and depressive disorders –results form the Finnish Health 2000 Study. J Affec Dis 2005; 88: 55-62.
• 2 American Psychiatric Association, deutsche Übersetzung. Sass H, Wittchen H-U, Zaudig M, Houben I. Diagnostische und Statistisches Manual Psychischer Störungen DSM-IV-TR. Göttingen: Hogrefe; 2003
• 3 Bakker AB, Schaufeli WB, Sixma HJ. et al. Patient demands, lack of reciprocity and burnout: A fiveyear longitudinal study among general practitio- ners. Journal of Organizational Behaviour 2000; 21: 425-441.
• 4 Bates A. Of patients and horses: Equine-facilitated psychotherapy. J Psychosoc Nurs Ment Health Serv 2002; 40 (Suppl. 05) 16-19.
• 5 Becksteed JW. Confirmatory factor analysis of the Maslach burnout inventory among Florida nurses. Int J of Nursing Studies 2002; 39: 785-792.
• 6 Berking M. TEK, Training Emotionaler Kompetenz. Psychologische Praxisstelle der Universität Bern; 2007
• 7 Beschoner P, Braun M. Das Burnout Syndrom bei Ärzten in Deutschland : ein Überblick mit Fokus auf die Psychiatrie. Nervenheilkunde 2007; 26: 125-133.
• 8 Borritz M, Bültmann U, Rugulies R. et al. Psychosocial Work characteristics as predictors for burnout: findings from a 3-year follow-up of the PUMA study. JOEM 2005; 47 (Suppl. 10) 1015-10255.
• 9 Borritz M, Rugulies R, Bjornev JB. et al. Burnout among employees in human service work: design and baseline findings from the PUMA study. Scandinavian J Publ Health 2006; 34: 49-58.
• 10 Burisch M. A longitudinal study of burnout: the relative importance of dispositions and experiences. Work & Stress 2002; 16 (Suppl. 01) 1-17.
• 11 Burisch M. Das Burnout-Syndrom. Heidelberg: Springer; 2006
• 12 Burke RJ, Greenglass ER. A longitudinal examination of the Cherniss model of Burnout. Soc Sci Med 1995; 40 (Suppl. 10) 1357-1363.
• 13 Cameron HA, Gould E. Adult neurogenesis is regulated by adrenal steroids in the dentate gyrus. Neuroscience 1994; 61: 203-209.
• 14 Cherniss C. Professional Burnout in Human Service Organizations. New York: Praege; 1980
• 15 Cherniss C. Jenseits von Burnout und Praxisschock. Deutscher Nachdruck der Originalausgabe Beyond Burnout . Weinheim: Belz Verlag; 1999
• 16 Cleare AJ. The neuroendocrinology of Chronic Fatigue Syndrome. Endocrine Reviews 2003; 24 (Suppl. 02) 236-252.
• 17 Cohen J. Statistical power analysis for the behavioral sciences. New York: Academic Press; 1988
• 18 Collins MA. The relation of work stress, hardiness and burnout among full-time hospital staff nurses. J of Nursing Staff Development 1996; 12 (Suppl. 02) 81-85.
• 19 Derogatis LR, Lipman RS, Covi L. SCL-90: An outpatient rating scale – preliminary report. Psychopharmacological Bulletin 1973; 9: 13-27.
• 20 Ekstedt M, Söderström M, Akerstedt T. et al. Disturbed sleep and fatigue in occupational burnout. Scan J Work Environ Health 2006; 32 (Suppl. 02) 121-131.
• 21 Enzmann D, Kleiber D. Helfer-Leiden. Stress und Burnout in psychosozialen Berufen. Heidelberg: Ansanger; 1989
• 22 Eriksson PS. Neurogenesis in the adult human hippocampus. Nat Med 1998; 4: 1313-1317.
• 23 Eriksson PS, Wallin L. Functional consequences of stress-related suppression of adult hippocampal neurogenesis – a novel hypothesis of the neurobiology of burnout. Acta Neurol Scand 2004; 110: 275-280.
• 24 Fischer L. Neuraltherapie nach Huneke: Grundlagen– Technik. Praktische Anwendungen. Stuttgart: Hippokrates Verlag; 2001
• 25 Freudenberger HJ. Staff Burn-Out. J of Soc Issues 1974; 30: 159-165.
• 26 Fukuda K, Straus SE, Hickie I. et al. The chronic fatigue syndrome: a comprehensive approach to its definition and study. Ann Intern Med 1994; 121: 953-959.
• 27 Gaab J, Ehlert U. Chronische Erschöpfung und Chronisches Erschöpfungssyndrom. Fortschritte der Psychotherapie. Göttingen: Hogrefe Verlag; 2005
• 28 Glass David C, Daniel McKnight, Valdimarsdottir H. Depression, burnout, and perceptions of control in hospital nurses. Journal of Consulting and Clinical Psychology 1993; 61 (Suppl. 01) 147-155.
• 29 Glass DC, McKnight JD. Perceived control, depressive symptomatology and professional burnout: A review of the evidence. Psychology and Health 1996; 11: 23-48.
• 30 Goehring C, Gallacchi MB, Künzi B. et al. Psychosocial and professional characteristics of burnout in swiss primary care practitioners: a cross-sectional survey. Swiss Med Wkly 2005; 135: 101-108.
• 31 Golembiewski RT, Munzenreider RF. Phases of Burnout: developments in concepts and actualisations. New York: Praeger; 1988
• 32 Grassi L, Magnani K. Psychiatric morbidity and burnout in the medical profession: an Italian study of general practitioners and hospital physicians. Psychother Psychosom 2000; 69 (Suppl. 06) 39-334.
• 33 Grawe K. (Hrsg.). Verhaltenstherapie in Gruppen. Fortschritte der Klinischen Psychologie Bd. 22. München: Urban und Schwarzenberg; 1980
• 34 Grawe K, Donati R, Bernauer F. Psychotherapie im Wandel – Von der Konfession zur Profession. Göttingen: Hogrefe; 1994
• 35 Grawe K. Neuropsychotherapie. Göttingen: Hogrefe; 2004
• 36 Gross CG. Neurogenesis in the adult brain: death of a dogma. Nat Rev Neurosci 2000; 1: 67-73.
• 37 Hallsten L, Bellaag K, Gustafsson K. Burnout in Sweden – a population study. Arbete och Hälsa; 2002: 6.
• 38 Hallsten L. Burnout and wornout: concepts and data from a national survey. Research compagnion to organizational health psychology 2005; 516-537.
• 39 Hautzinger M. Depression. Fortschritte der Psychotherapie. Göttingen: Hogrefe; 1988
• 40 Hautzinger M. Kognitive Verhaltenstherapie bei Depression. Weinheim: Beltz; 2003
• 41 Hinsch R, Pfingsten U. GSK, Gruppentraining sozialer Kompetenzen; 4. Auflage. Weinheim: Psychologie Verlags Union; 2002
• 42 Hobfoll SE, Shirom A. Conservation of resources theory: Applications to stress and management in the workplace. In Golembiewski RT. (eds.). Handbook of organization behaviour; 2000: 57-81.
• 43 Jacobs D. Die menschliche Bewegung. Seelze Velber: Kallmeyer’sche Verlagsbuchhandlung GmbH; 1980
• 44 Jacobson E. You must relax. Blocklick, Ohio: McGraw-Hill; 1978
• 45 Kalimo R. The challenge of changing work and stress for human ressources: the case of Finland. J Tokyo Med Univ 2000; 58: 349-356.
• 46 Kalimo R, Pahkin K, Mutanen P. et al. Staying well or burning out at work: work characeristics and personal resources as long term predictors. Work Stress 2003; 17: 109-122.
• 47 Kaluza G. Stressbewältigung. Trainingsmanual zur psychologischen Gesundheitsförderung. Heidelberg: Springer; 2004
• 48 Kandolin I. Burnout of female and male nurses in shiftwork. Ergonomics 1993; 36 1–3 141-147.
• 49 Kaptchuck TJ. Acupuncture: theory, efficacy and practice. Ann Intern Med 2002; 136: 374-388.
• 50 Karasek RA, Theorell T. Healthy work: Stress, productivity and the reconstruction of working life. New York: Basic Books; 1990
• 51 Kempermann G, Kronenberg G. Depressed new neurons – adult hippocampal neurogenesis and a cellular plasticity hypothesis of major depression. Biol Psychiatry 2003; 54: 499-503.
• 52 Klerman GL, Weissman MM, Rounsaville BJ. et al. Interpersonal Psychotherapy of Depression. New York: Basic Books; 1984
• 53 Kobosa SC. Stressful life events, personality and health. An inquiry into hardiness. J of Personality and Social Psychology 1979; 37 (Suppl. 01) 1-11.
• 54 Kobosa SC, Maddis SR, Kahn S. Hardiness and health: A prospective study. J of Personality and Social Psychology 1982; 45 (Suppl. 04) 839-850.
• 55 Korkeila JA, Töyry S, Kumpulainen K. et al. Burnout and selfperceived health among Finnish psychiatrists and child psychiatrists: a national survey. Sand J Public Health 2003; 31: 85-91.
• 56 Lazarus RS. Stress, appraisal, and coping. New York: Springer; 1974
• 57 Lee TE, Ashfort BE. A meta-analytic examination of the correlates of the three dimensions of job burnout. JApplied Psychol 1996; 81 (Suppl. 02) 123-133.
• 58 Leiter MP, Maslach C. Six areas of worklife: A model of the organizational context of burnout. JHHSA Spring 1999; 472-489.
• 59 Leiter MP, Maslach C. Burnout and health. In Baum A, Revenson TA, Singer J. Handbook of health psychology; 2001 415-426.
• 60 Linehan MM. Cognitive behavioral treatment of borderline personality disorder. New York: Guilford Press; 1993
• 61 Malberg JE, Schechter LE. Increasing hippocampal neurogenesis: A novel mechanism for antidepressant drugs. Curr Pharmac Design 2005; 11: 145-155.
• 62 Maslach C, Jackson SE. The measurement of experienced burnout. Journal of Occupational Behaviour 1981; 2: 99-113.
• 63 Maslach C, Jackson SE. Maslach Burnout Inventory, second edition. Palo Alto, CA: Consulting Psychologist Press; 1986
• 64 Maslach C, Schaufeli WB. Historical and conceptual development of burnout,. in. Schaufeli WB, Maslach C, Marek T. (eds). Professional burnout: Recent Developments in theory and resarch.; Washington, DC: Taylor and Francis 1993 1-16.
• 65 Maslach C, Jackson SE, Leiter MP. Maslach Burnout Inventory Manual. Palo Alto, CA: Consulting Psychologist Press; 1996
• 66 Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Psychol 2001; 52: 397-422.
• 67 McKnight JD, Glass DC. Perceptions of control, burnout and depressive symptomatology: A replication and extension. Journal of Consulting and Clinical Psychology 1995; 63 (Suppl. 03) 490-494.
• 68 Meichenbaum D. Interventionen bei Stress. Anwendungen und Wirkungen des Stressimpfungstrainings, 2. Aufl. Bern Hans Huber 1991/2003.
• 69 Melamed S, Shirom A, Toker S. et al. Burnout and risk of cardiovascular disease: evidence, possible causal paths and promising research directions. Psychological Bulletin 2006; 132 (Suppl. 03) 327-353.
• 70 Meregillano G. Hippotherapy. Phys Med Rehabil Clin N Am 2004; 15: 843-854.
• 71 Mommersteeg PMC, Heijnen CJ, Verbraak MJPM. et al. Clinical burnout is not reflected in the cortisol awakening response, the day-curve or the response to a low-dose dexamethasone suppression test. PNEC 2006; 31: 216-225.
• 72 Mommersteeg PMC, Heijnen CJ, Verbraak MJPM. et al. A longitudinal study on cortisol and complaint reduction in burnout. PNEC 2006; 31: 793-804.
• 73 Nilsson M. Enriched environment increases neurogenesis in the adult rat dentate gyrus and improves spatial memory. J Neurobiol 1999; 39: 566-569.
• 74 North TC, McCullagh P, Tran ZV. The effect of exercise on depression. Exerc Sport Sci Rev 1990; 18: 323-329.
• 75 Nyklicek I, Pop VJ. Past and familial depression predict current symptoms of professional burnout. Journal of Affective Disorders 2005; 88: 63-68.
• 76 Paine WS. The burnout syndrome in context. In: The burnout syndrome: Current research, theory and interventions. Park Ridge, Illinois: London House Press; 1982
• 77 Paluska SA, Schwenk TL. Physical activity and mental health : current concepts. Sports Med 2000; 36 (Suppl. 07) 167-180.
• 78 Peluso MAM, Silveira Guerra de Andrade H. Physical activity and mental health: The association between exercise and mood. Clinics 2005; 60 (Suppl. 01) 61-70.
• 79 Petruzzello SJ, Landers DM, Hartfield BD. et al. A meta-analysis of anxiety-reducing effects of acute and chronic exercise . Outcomes and mechanisms. Sports Med 1991; 11 (Suppl. 03) 142-182.
• 80 Pines A, Aronoson E. Career Burnout: Causes and Cures. New York: Free Press; 1988
• 81 Prüssner M. Self-reported depressive symptoms and stress levels in healthy young men: associations with the cortisol response to awakening. Psychosoma Med 2003; 65: 92-99.
• 82 Sachse R. Persönlichkeitsstörungen. Leitfaden für die psychologische Psychotherapie. Göttingen: Hogrefe; 2004
• 83 Sachse R. Klärungsorientierte Psychotherapie. Göttingen: Hogrefe; 2003
• 84 Schaarschmidt U, Fischer A. Arbeitsbezogenes Verhaltens- und Erlebensmuster (AVEM). Frankfurt: Swets Test Service; 1996
• 85 Schaufeli WB, Van Dierendonck D. A cautionary note of the cross-sectional and clinical validity of cut-off points for the Maslach Burnout Inventory. Psychological Reports 1995; 76: 1083-1090.
• 86 Schaufeli WB, Leiter MP, Maslach C. et al. Maslach Burnout Inventory-General survey manual. in Maslach C, Jackson SE, Leiter MP. (eds) Maslach Burnout Inventory manual (3rd ed) Palo Alto, CA: 1996
• 87 Schaufeli W, Enzmann D. The burnout companion to study and practice. London: Taylor and Francis; 1998
• 88 Schaufeli WB, Bakker AB, Hoogduin K. et al. On the clinical validity of the Maslach Burnout Inventory and the Burnout Measure. Psychology and Health 2001; 16: 565-582.
• 89 Santavirta N, Solovieva S, Theorell T. The association between job strain and emotional exhaustion in a finnish cohort of teachers. British J of Educational Psychology 2007; 77: 213-228.
• 90 Seiwert LJ. Das neue 1 x 1 des Zeitmanagements. München: Gräfe und Unzer; 2003
• 91 Sexton H, Soggard AJ, Olstad R. How are mood and exercise related?. Soc Psychiatry Epidemiol 2001; 36: 348-352.
• 92 Sharpe MC, Archad LC, Banatvala JE. et al. A report – chronic fatigue: guidelines for research. J of the Royal Society of Medicine 1991; 84: 118-121.
• 93 Snider L, Korner-Bitensky N, Kammann C. et al. Physical and occupational therapy in pediatircs. 2007; 27 (Suppl. 02) 5-23.
• 94 Thomas NK. Resident burnout. JAMA 2004; 292: 2880-2889.
• 95 Van der Klink JJL, Blonk RWB, Schene AH. et al. The benefits of interventions for work-related stress. Am J Public Health 2001; 91: 270-276.
• 96 Weltgesundheitsorganisation. Dilling H, Mombur W, Schmitt MH. (Hrsg.). Internationale Klassifikation psychischer Störungen, Kapitel V, (F). Klinisch- diagnostische Leitlinien. Bern: Hans Huber Verlag; 1993
• 97 van Praag HG. Kempermann. Neural consequences of environmental enrichment. Nat Rev Neurosci 2000; 1: 191-198.
• 98 Wust S. Genetic factors, perceived chronic stress, and the free cortisol response to awakening. PNEC 2000; 25: 707-720.