Burnout – not just a problem for our patients

Norbert Lindner Naturopath, Zeuthen, Germany

Dear Colleagues,

I am pleased to present to you today a topic that has now become the subject of much discussion.

Burnout.

Why is burnout such an important topic? Let’s take a closer look at a couple of facts.

A survey conducted by Pronova BKK in 2018 revealed the following picture: one in two Germans feel threatened by burnout. 90 % of Germans feel stressed by their work.

61 % of people in Germany complain of typical burnout symptoms such as:

  • Chronic exhaustion
  • Back pain
  • 23 percent of them even frequently

59 % sometimes feel an inner tension.

54 % of respondents worry about their work.

53 % report sleeping poorly.

More than 50 % of working people suffer at least occasionally from:

  • Back pain
  • Chronic fatigue
  • Inner tension
  • Apathy
  • Insomnia

Health insurer AOK reported per 1,000 members 13.9 sick days in 2005

120.5 sick days in 2018 due to burnout syndrome.

If this figure is extrapolated to all employees covered by statutory health insu­rance, the number of persons suffering burnout in 2018 was around 176,000 with (rounded up) 3.9 million sick days.

At particular risk are:

Teachers, nursing staff, social workers, doctors and police officers

In Germany, one in five of the population is already affected by burnout syndrome. According to WHO forecasts, “stress-related mental illness” will be the world’s leading cause of all illnesses in 2020, in particular “exhaustion depression”.

But how do we recognise burnout, how do we make a reliable diagnosis? Let us first look at the definition.

1. Definition

According to the World Health Organization, burnout is not a disease in its own right, but a problem “related to difficulties in living”.

Brockhaus Psychology (Brockhaus, 2009) describes burnout as “a syndrome with the main symptoms of emotional exhaustion, depersonalisation and reduced perfor­mance”.

The Wärterbuch der Psychologie (Great Dictionary of Psychology); Compact, 2007 defi­nes the Burnout Syndrome as: “Emotional, mental and physical state of exhaustion af­ter a previous process of high workload, stress and/or overwork”.

And the Lexikon der Psychologie (Encyclopedia of Psychology – wissenschaft-online.de) says that burnout “is a phenomenon that often occurs in people who are very commit­ted at the start of their careers, but who in the course of their work increasingly suffer from states of exhaustion and develop an increasingly distanced attitude towards their clientele”.

Summary:

The burnout syndrome describes a condition in which the affected person feels physically, emotionally and mentally completely exhausted, the ability to perform is significantly reduced and the feeling is described as “burnt out”. Only those who are on fire for something can also burn out!

2. Causes

The causes of burnout syndrome can vary greatly. A person’s own conditioning as well as external pressures or extreme stress situations can quickly lead to excessive de­mands and ultimately to burnout.

We can divide the causes into two areas:

  • Personal causes
  • Situation-related causes

Burnout

Our personal inner motivation has many names, the most important are wealth, suc­cess, recognition, power, love and self-worth. Many people rush into burnout as a re­sult. However, most of the time there is more than one driver.

2.1 Personal causes

People who set themselves unrealistically high standards through a deep sense of per­fectionism or ambition often experience extreme stress.

Even people with a strong sense of responsibility are in danger of burning out, as they sacrifice themselves to a great extent for their fellow human beings. This is particularly pronounced in “social occupations” and is referred to in extreme cases as the “helper syndrome”.

Our beliefs play a decisive role in personal causes. It makes no difference whether they were inherited (by birth) or instilled into us.

  • Over-commitment and perfectionism:

High commitment at work

Perfect fulfillment of tasks

Overload and exhaustion

An inability to maintain distance: Problems are taken home

  • Excessive expectations:

Expected results fail to materialise

Frustration and stress

  • High pressure to perform in the family

Pressure from parents

Too much emphasis on achievement

Withdrawal of affection

  • Inadequate stress management mechanisms

2.2 Situation-related causes

Since, with the exception of sleep, humans spend most of their time working, this is of­ten the biggest trigger for burnout.

This includes a high workload, lack of recognition, difficulties in the workplace such as bullying, but also the absence of a commensurate salary.

  • Time pressures

Performing ever more tasks in ever less time

  • Multitasking

When the flow of work is interrupted too often

  • Absence of goals and success criteria

Missing moments of success

No sense of accomplishment

  • Poor working environment

No recognition from the boss

Hostile working atmosphere

  • Too many different expectations

Caught between two fronts

Expectations of the boss/customers differ

  • Limited opportunities for development and scope for action Underchallenged at work
  • Night and shift work

3. The 12 burnout phases

According to Freudenberger, a person suffering from burnout passes through 12 sta­ges. Herbert J. Freudenberger was a German-American clinical psychologist and psy­choanalyst. He published the first scientific article on burnout in 1974.

A facet analysis by Borg (1992), in accordance with the description of the symptoms as found in Freudenberger and North (1992) as well as in Rauscher (2009) and Gabriel (2010), initially generated ten items per phase, but these were ultimately reduced to three items per phase. (ASU issue: 12-2014)

Stage 1: The compulsion to prove oneself

~          I am often under tension at work.

~          It is very important to me to do my work particularly well.

~          I feel strange when I go home early.

Stage 2: Working harder

~          I always do my work very quickly.

~          I feel guilty when work is left undone.

~          I often work very long hours and do a lot of overtime.

Stage 3: Neglecting needs

~          I often have the feeling that my life comes too short.

~          I am often so tired after work or at the weekend that I cannot bring myself to do anything.

~          I have had to be very careful lately not to forget or overlook anything.

Stage 4: Displacement of conflicts

~          I fall ill more often than before.

~          I find it difficult to fall asleep or I frequently lie awake at night.

~          I often find it difficult not to talk about work.

Stage 5: Revision of values

~          My situation at work is much more stressful than it used to be.

~          I have more conflicts with colleagues than before.

~          Disagreements within the family are more frequent.

Stage 6: Denial of emerging problems

~          I can handle more stress than other people.

~          I often feel misunderstood by other people.

~          I have little time for sports or hobbies.

Stage 7: Withdrawal

~          I meet less often with friends and acquaintances.

~          I can’t really feel happy about anything anymore.

~          I resort to alcohol and/or medication to relieve stress.

Stage 8: Odd behavioural changes

~          I often have to force myself to take an interest in my friends.

~          When I am at home, I would prefer not to be addressed by anyone.

~          I watch too much television or surf the Internet to switch off.

Stage 9: Depersonalisation

~          My family or friends are worried about me.

~           I often overstep my health limits.

~           I only function like a machine now.

Stage 10: Inner emptiness

~          A real panic sometimes overcomes me.

~          New challenges at work are increasingly turning into torment.

~          I already have a queasy feeling at the weekend when I think about work.

Stage 11: Depression

~           I am sometimes filled with a feeling of emptiness.

~          There are days when l really despair.

~           I often just want to lie in bed and sleep.

Stage 12: Complete exhaustion

~          I often can’t bring myself to get up in the morning.

~           I don’t want to go on like this.

~          I can’t go on any longer.

The important thing is that the earlier support is given, the easier it is to break out of the cycle.

4. Symptoms

The following symptoms and conditions may indicate a burnout syndrome: Psychological symptoms

  • Psychosomatic disorders
  • Depression
  • Aggressiveness
  • Need for distance
  • Blame
  • Increased risk of addiction – alcohol, tobacco consumption, drugs

Lack of drive

  • Lack of motivation
  • Poor concentration
  • Indifference
  • Loneliness
  • Disinterest
  • Cynicism
  • Existential despair

Physical (bodily) smptoms

  • Insomnia
  • Chronic fatigue
  • Exhaustion

Lack of energy

  • Night sweats (nocturnal sweating)
  • Headache
  • Stomach cramps
  • Susceptibility to infection

5. The issue of stress

There is more to life than increasing its speed. – Mahatma Gandhi (1869-1948)

90 % of Germans feel stressed by their work.

The greatest change that people have experienced over the millennia is that they no longer live in the rhythm of nature.

Nature used to set the pace, today it is economic growth.

At one time we worked to survive, today we work for prosperity.

Many people permanently have the feeling that they have no time to spare. Is stress, however, just a phenomenon of modern times?

No, because the lives of our ancestors were also shaped by stress. They were threate­ned by predators, the weather or hostile fellow humans and survival was always at stake.

Nevertheless, the cavemen of the Stone Age were better able to cope with stress be­cause they could react physically to the stress situation. Thus, early humans had the choice to either fight or flee. Anyone facing their angry boss these days can do neither one thing nor the other.

The stress hormones that are released are “not consumed” and damage the organism over the long term.

You can determine whether your patients have increased stress levels by completing a simple questionnaire on their symptoms.

Since stress occurs in many areas nowadays, a detailed stress anamnesis is the first step towards gaining an understanding of our patients. This is necessary in order to start the therapy in the right area.

I have taken a part of the anamnesis sheets in this script from the book by Ms Ingrid Strobel, whose book “Stressbewältigung und Burnoutprävention” (“Stress manage­ment and burnout prevention”), Thieme Verlag, ISBN 978-3-13-240226-3, is both a good guide and valuable diagnostic questionnaires (for use in practice).

Stress arises through perception and through evaluation. And that is exactly how it can be reduced.

6. Diagnosis

At the beginning of a burnout diagnosis there should be an extensive physical and la­boratory chemical examination to exclude physical causes. Many diseases show the symptoms of burnout syndrome such as fatigue or exhaustion. These include vitamin and electrolyte deficiency, hormonal and metabolic disorders, autoimmune diseases, sleep disorders as well as liver or kidney diseases.

The two most common diagnostic tools for detecting burnout are the Maslach Burnout Inventory test (MBI) and the Tedium Measure test (TM).

Maslach Burnout Inventory test (MBI)

The Maslach Burnout Inventory was developed by Maslach & Jackson in 1981. Alt­hough there are now more detailed and specific tests (for example for certain professi­onal groups such as teachers), the MBI still has its justification.

The test covers three dimensions of burnout syndrome:

  • Emotional exhaustion
  • Depersonalisation
  • Reduced personal efficiency

Indicate how often the following statements apply to you by ticking the appropriate number:

0 = Never

1 = At least a few times a year

2 = At least once a month

3 = Several times a month

4 = Once a week

5 = Several times a week

6 = Every day

Add the results for each of the three dimensions at the end of the questionnaire. Check whether the total score is “low”, “medium” or “high”.

Diagnosis 1

Total points for work-related exhaustion (TWE)

Add the results of questions 01, 02, 03, 06, 08, 13, 14, 16, 20

Diagnosis 2

Burnout level

Beware if the sum of your TWE and TD answers are both in the red, especially if your own performance assessment is also in the red!

Diagnosis 3

Medium Measure

(After Pines, Aronson and Kafry, dt. 1993)

The Tedium Measure (TM) comprises 21 questions, which can be used to determine your own “tedium scale”, or degree of burnout. The self-test covers the three areas of exhaustion: physical, mental and emotional.

Please rate each of the following statements on a scale of 1 to 7 to see to what extent they apply to you for the last 4 to 6 weeks.

Diagnosis 4

Diagnosis 5

Assessment:

2-3 points:       Currently no burnout danger apparent

3-4 points:       No burnout syndrome yet, but critical stress load

over 5 points:  Clear signs of burnout.

7. Diagnosis and treatment with the BICOM® bioresonance device

In this chapter I would like to show you the BICOM programs that you can use for diag­nosing and, of course, treating your patients. In my practice, the BICOM treatment au­tomatically runs in every discussion therapy session. So two valuable instruments at the same time.

We have a “burn-out” substance complex in the second channel of the BICOM optima. You can use it to test and, if it resonates with the patient, you can place it on a BICOM chip or on BICOM minerals.

Channel 2

Burnout

Stress

Cardiovascular stress

Energy boost

Energy boost nerves

Neurohormone deficiency/female

Neurohormone deficiency/male

Deep relaxation, vegetative dysregulation

Fatigue, exhaustion

TCM insomnia

Basic programs

All basic programs after conductivity measurement or testing 10327 – Stabilisation A

3452 – Stabilisation A lowest frequency

693 – Stabilisation A normal frequency

694 – Stabilisation A without bandpass

Blocking programs

3017 – Release (deep) blockages

3433 – Release nerve blocks

Stress programs

3084 – Regulation, gen. (physical stress reduction)

3137 – Stress reduction

Vegetative regulation

960.4 – Vegetative malfunction

3463 – Psychosomatic disorders (1st progr.)

3464 – Psychosomatic disorders (2nd progr.)

3465 – Neurological and neurovegetative symptoms

Energetic balance

127.1 – Overtreatment 1st p. (and harmonising)

507 – Yin-yang balance

580.1 – Energy balance with very diff. quadr.

583.2 – Energy balance with very diff. quadr.

900.1 – Activate vitality

Powerlessness

3035 – Lack of energy, weakness

580.2 – Lack of energy 1st program

583.1 – Lack of energy 2nd program

900.1 – Activate vitality

Neurotransmitters

841      – Improve serotonin effect 1st p.

980.5 – Improve serotonin effect 2nd p.

Program sepuences

10169 – Vegetative dystonia

915.2 – Release (energy) blockages 1st p.

940.2 – CNS disorders

960.4 – Vegetative malfunction

900.1 – Activate vitality

10170 – Vegetative malfunction

3021 – Improve blood count

960.4 – Vegetative malfunction

10007 – Activating the left side of the brain

3086 – Oxygen regulation

572 – Activate the left side of the brain

0008 – Activating the right side of the brain

3084 – Regulation, gen. (physical stress reduction)

571 – Activate the right side of the brain

Pure relaxation program sequences

The combination of the following programs has proven to be very effective in practice to build up and stabilise the patients.

You can save the individual programs as a sequence in the BICOM optima

127.1 –   Overtreatment 1st p. (and harmonising)

580.1 –   Energy balance with very diff. quadr.

900.1 –   Activate vitality

125.2 –   Activate right side of the brain 2nd progr.

432.2 –   Shock reatment 1st progr.

911.1 –    Nerve calming

The last 3 programs also work for depression. You can test this sequence for its effec­tiveness or treat it untested if the patient reports the corresponding symptoms such as tiredness, listlessness, weakness or stress.

Test kits

ORTHOMOLECULAR SUBSTANCES

Orthomolecular substances

I would like to recommend a procedure for this test kit that has proven itself in prac­tice.

Test the missing vitamins, minerals, trace elements, amino acids and enzymes before treatment.

The positively tested ampoules are placed in the second channel when the patient is treated.

After treatment, retest the ampoules that were positive before the test. Each ampoule that still tests positive should be substituted by a preparation for the patient.

PSYCHOSOMATICS/NEUROLOGY

Substances

Ai ampoules:

grey with black and blue lettering green

A or Ai ampoules:

yellow with black lettering dark blue with black lettering does not apply to the stress ampoule

A ampoules:

light blue with black lettering dark blue with yellow lettering red

Stress ampoule:

black with white lettering

With this test kit I use the right column for testing and for treatment. If e.g. the “anti­virus” ampoule tests positive, then I test the grey virus ampoules for Ai.

Of course you can also use the complete test kit for diagnosis.

Test with program 191 Ai or 192 A and therapy with 197 Ai or 198 A. Please test the whole time during the therapy. Time testing applies only to 191/192.

8. Diagnosis and therapy with the BICOM® BodyCheck

The BBC2 standard allows you to define your own scan profiles. I have selected the following six sectional images for the burnout diagnosis.

Bicom body check

Adrenal glands

Vegetative nervous system

Vegetative nervous system, left and right abdomen

Vegetative nervous system, left and right thorax

I save this selection under “Vegetative” and can then call up and scan the sectional images selected for burnout diagnosis with a single click.

Bicom body check 2

Let us first take a look at the vegetative nervous system, which for me is the most im­portant level in the investigation.

The vegetative nervous system

The vegetative nervous system, also known as the vegetativum, visceral nervous sys­tem or the autonomous nervous system.

According to the classical anatomical division, it forms the peripheral nervous system (PNS) of the human body together with the somatic nervous system.

This is divided into three components:

The sympathetic nervous system (sympathicus)

The parasympathetic nervous system (parasympathicus)

The enteric nervous system – the nervous system of the gastrointestinal tract

In comparison with the sympathicus and parasympathicus, it is not sub­ject to as much regulation by the central nervous system.

The enteric nervous system is defined as its own, independent system by some authors.

The boundary between the autonomous and somatic nervous system is not very dis­tinct, as parts of the somatic nervous system are not subject to the control of the brain, e.g. motor reflexes. In addition to this, there are also numerous vegetative con­trol centres, e.g. the respiratory centre in the brain, so the vegetative nervous system is not only a part of the PNS.

pns

The sympathetic nervous system

It increases:

  • Heart activity
  • Blood pressure
  • Circulation and the tones of the heart and skeletal muscles
  • Metabolism

It inhibits:

  • Intestinal activity

It also has an influence on:

  • Lung function
  • Bladder function
  • Sexual organs
  • Inner eye muscles
  • Glandular function

The parasympathetic nervous system

It increases:

  • Gastrointestinal tract
  • Liver function
  • Salivary glands
  • Urinary bladder

It inhibits:

  • Heart activity
  • Blood pressure
  • Circulation and tone of the heart and skeletal muscles

The sympathetic and parasympathetic nervous systems have antagonistic effects on their effector organs. Simply put, the sympathetic nervous system is responsible for the quick reaction to environmental stimuli and the mobilisation of the body (”fight or flight”) and the parasympathetic nervous system is responsible for the moderation of outwardly oriented activity (”rest and digest”).

The term “antagonism” only partially applies. For many functional processes in the body, e.g. sexual function, the simultane­ous interplay of both systems is necessary.

The vegetative nervous system in the BICOM Body Check

The BICOM BodyCheck provides us with five sectional images for the vegetative ner­vous system.

Lungs

With the following images, I would like to illustrate to you how the vegetative nervous system appears using the entropy points and what conclusions we can draw from it.

Lungs 2

Parasympathicus Entropy 2 – Sympathicus Entropy 2

This image shows a well-balanced vegetative nervous system.

Lungs 3

Parasympathicus Entropy 1 – Sympathicus Entropy 2 Parasympathicus blockage

  • The patient cannot relax due to the blockage
  • or they are stuck in relaxation and cannot kick into gear.

Lungs 4

Parasympathicus Entropy 1 – Sympathicus Entropy 5

Parasympathicus blockage with a large amount of sympathicus

  • constant thoughts or unrest in the body
  • Heart agitation – High blood pressure
  • a large amount of stress in the activity area
  • shutting off is not possible due to the blockage

Lungs 5

Parasympathicus Entropy 4 – Sympathicus Entropy 2 Increased parasympathicus activity

  • increased digestive and intestinal activity
  • Irritable bowel syndrome

Lungs 6

Parasympathicus Entropy 2 – Sympathicus Entropy 1 Sympathicus blocked

  • Asthenia and lack of drive
  • Normal digestive function

Lungs 7

Parasympathicus Entropy 4 – Sympathicus Entropy 4
Increased parasympathicus and sympathicus activity

  • Complete tension in the body
  • Digestive complaints
  • Constant stress

Lungs 8

Parasympathicus Entropy 4 – Sympathicus Entropy 5

Increased parasympathicus activity and enormous load on the sympathicus

  • a large amount tension in the body
  • Sympathicus overload
  • Digestive complaints

Lungs 9

Parasympathicus Entropy 1 – Sympathicus Entropy 1

Parasympathicus and sympathicus blocked.

  • Burnout

Automatic evaluation in the BBC2 Standard

Thanks to automatic evaluation, we have an excellent overview of the imbalances within a few minutes, but also of the additional direction in which the loads on the vegetative nervous system are going.

An example of this.

You see the load on the adrenal glands and pancreas in the evaluation and in the case of energetic imbalances, the vegetative imbalance and immunological imbalances.

BBC2

Neurasthenia can be seen in the detailed view of the vegetative imbalance.

 

BBC2 I

and gastritis in the case of immunological imbalances.

BBC2 II

This means that the vegetative stress in the patient leads to exhaustion, fatigue and low resilience, but also to inflammation of the stomach lining, adrenal gland and pan­creas.

A unique feature of the BBC is the ability to show the effects of a sectional image of my patient’s body on pathologies and tissue structures.

It is therefore always worth taking a look at the vegetative nervous system.

9. Treatment of burnout

Treatment of burnout

So how do we clear up this chaos? The anamnesis

We have seen that burnout has many facets. There are often both physical and psy­chological deficits.

You treat the physical diseases as usual.

You work out behaviour patterns, drivers and the beliefs for psychological stress toge­ther with your patients.

An important step is to work with your patient on their inner disposition. This is done, for example, through:

Relaxation exercises and mechanisms for coping with stress

It does not matter whether your patient does yoga or Tai Chi, meditates, jogs, knits or goes swimming. It is only important that this balance is not determined by his/her be­haviour patterns. When the patient again tries to be the best, cannot make any mista­kes or everything has to be perfect, this does not give him or her peace and relaxation.

Work with your patient to find the place where they can relax the most. This can be a real place that they know in life, but it can also be a fantasy place that they imagine or that they find in a meditation exercise.

Important:

The energy that a machine consumes must also be fed back in again, as otherwise the motor stops. We have to compensate for the stress we have by relaxing, otherwise we burn out.

Eight tips against burnout

  1. Remember that every human being has only limited energy. Think about where you use your energy.
  2. Deliberately build breaks into your everyday life in order to regenerate.
  3. Learn to say NO – friendly but firm.
  4. If things get too hectic, set priorities. What happens if you leave something be­hind?
  5. Set boundaries: do not take professional problems into your private life. No person is irreplaceable.
  6. Take your time – for hobbies, relaxation, sports, music or a funny film.
  7. Sometimes top performance is necessary. But then create the appropriate balance.
  8. Do you have the impression that your job or partnership is destroying you? Then be consistent and consider whether it makes sense to change job or profession.

I would like to thank you for your attention and say goodbye with a quote from the Dalai Lama:

“There are only two days a year that nothing can be done. One is called yesterday, the other is called tomorrow. Today is the right day to love, believe, do and mostly live.”