Manual Stress, Erschöpfung, Burn-out (German Edition)

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This quantitative-qualitative mixed-method approach showed that differences in the burnout degree could be explained by looking at the motivational profile, work-home interference, and the ability to meet recovery demands. However, a universal definition of burnout does not exist up to the present Schaffran et al.

Sport-related research especially in coaches has primarily adapted the widely accepted concept proposed by Maslach et al. Following this approach, burnout is characterized by three symptoms: emotional exhaustion, cynism depersonalization , and reduced sense of personal accomplishment Maslach et al. Emotional exhaustion describes the key symptom of burnout and delineates the most obvious manifestation of this complex syndrome Maslach et al. Moreover, it represents the most widely reported and most thoroughly analyzed aspect of burnout Schaffran et al. The development of burnout portrays a process in time that may last several months or even years Leiter and Maslach, ; Lee and Ashforth, ; Taris et al.

Maslach and Leiter as well as the meta-analysis about the correlation of the three burnout symptoms as described by Lee and Ashforth show that emotional exhaustion manifests first in the development of burnout. Depersonalization and a reduced sense of personal accomplishment emerge from this symptom.

The assessment of burnout is usually realized using self-report questionnaires Altfeld and Kellmann, In this context, the Maslach Burnout Inventory Maslach et al. The MBI includes 22 items divided into the three scales emotional exhaustion, depersonalization, and personal accomplishment.

Does job complexity mitigate the negative effect of emotion-rule dissonance on employee burnout?

Apart from the MBI as a general burnout measuring tool, Harris and Ostrow have created the Coach Burnout Questionnaire CBQ to assess burnout as a coach-specific instrument, which also focuses on the three central dimensions of burnout proposed by Maslach et al. According to the MBI and the CBQ, high values in emotional exhaustion and depersonalization and low values in personal accomplishment indicate a high risk of burnout Maslach et al. However, Burisch indicates that these questionnaires may not be applicable in field conditions as they do not offer guidance and recommendations for practical contexts.

Physician Burnout: The Real Reason Doctors Burn Out - NBC Left Field

He criticizes that a coach suffering from burnout is forced into a long break, which potentially includes therapeutic treatment as well. Regardless of the fact that during the last decades an increased number of international studies had focused on correlates of burnout, sensitive and valid measurements for the identification of risk factors of burnout in coaches are still missing Fletcher and Scott, At least three perspectives for the development of burnout emerge from existing concepts.

Self-determination theory SDT; Ryan and Deci, is an approach to human motivation and personality. According to the SDT, the satisfaction of basic psychological needs autonomy, competence, relatedness is associated with a positive development of the individual and with fulfilling and meaningful behavior. This leads to an increased mental well-being and serves as a prevention against burnout Reinboth and Duda, A multidimensional understanding of motivation is the basis for the SDT and can be categorized along a continuum of self-determination.

Amotivation i. Extrinsic motivation, which can be divided into four different types of behavior regulation can differ in their degree of autonomy. This includes two types of controlled and little autonomous behavior: external e. The remaining two types rather describe autonomous and strongly internally regulated behavior: identified i.

The other end of the continuum shows an intrinsic motivation that refers to interesting and enjoyable types of behavior that are engaged in freely and out of choice. Following this model, the development of burnout is all the more probable, the less internalized or intrinsic the reasons and motives for coaches activities are McLean and Mallett, A second approach focuses on different areas of work life, which imply a broad range of psycho-bio-social mechanisms on the development of burnout Leiter and Maslach, According to this approach, the following six areas of job-person mismatch are the critical factors for a development of burnout: workload, control, reward, community, fairness , and values.

Leiter and Maslach postulate that the development of burnout correlates directly with an increasing workload. When the workload of the job exceeds the individual resources, emotional exhaustion is a common result. Control encompasses the perceived ability of a person to influence work-related decisions and accordingly have a personal autonomy Brom et al.

Hence, control works protectively against the development of burnout. The reward area of work life considers the extent to which the rewards monetary, social, intrinsically agree with the expectations of a person. A smaller agreement means a lower identification with the objectives of the organization, which increases the risk of developing burnout Leiter and Maslach, Community comprises social interactions at work. Support from the family, friends, or coaching colleagues can function as a protection against burnout Hendrix et al.

However, conflicts in these contexts private or work-related can have a negative influence on burnout as well Mazerolle et al. Fairness describes the extent to which a person perceives decisions at work as fair and feels treated with respect. Mutual respect again is a pivotal element in order to receive a sense of community Leiter and Maslach, The area of values is one of the main aspects of a coach's relation to his work.

It comprises the ideals and motivations which initially made the job attractive to the coach and can be described as the motivating connection between a coach and his club, which is more than just an exchange of time for money. This approach does not focus on the consideration of burnout as a person-related problem. The third approach combines chronic stress states with underrecovery Kellmann, In this context, burnout is understood as a person's maximum need for recovery Kallus, b.

Therefore, burnout emerges when recovery means cannot compensate the stress over a longer period of time. Emotional exhaustion would be a good candidate for validation as it is agreed to be the first burnout symptom to appear Lee and Ashforth, Burnout as a clinical syndrome is closely associated with depressive mood.

However, the distinction between burnout and reactive depression is still an unresolved issue in the clinical treatment of burnout Ahola et al. Nonetheless, mood states are closely interlinked to burnout and constitute a basic element of burnout symptoms. Thus, changes in psychological well-being are a sensitive facet in the development of burnout. The aim of this research hence consisted in the synthesis of a questionnaire to measure risk factors of burnout in coaches. In detail, the aim of our studies was to incorporate the different approaches into a new, economic questionnaire.

We did not develop a new instrument from scratch, as the concepts of stress, recovery, areas of worklife, and motivation can be assessed via validated and reliable assessment tools. In effect, we re-evaluated, condensed, and subsequently combined scales of validated psychometric instruments into the Burnout Prevention Questionnaire for Coaches BPQ-C : a new tool for the early detection of risk factors to prevent the development of burnout in coaches. The objective of study 1 was to create and evaluate the psychometric structure of the BPQ-C in two steps.

First, regression analyses with all scales of the selected questionnaires were conducted to determine which scales contributed most to the central aspects of stress, recovery, motivational imbalance, and work-related risk factors for burnout. This step aimed at the identification of relevant scales with regard to risk factors for burnout in coaches.

In a second step, all extracted scales were checked for a possible overlap with an Exploratory Factor Analysis to obtain a factor structure for the BPQ-C. A total of German coaches 64 females with a mean age of The numerical superiority of male coaches within this study corresponds to the distribution of female and male coaches in Germany Bahlke et al.

Active support or coaching of athletes in the indicated sport during the time of assessment served as a selection criterion for the participation in the study. Table 1 provides a detailed overview of the demographic characteristics.


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It can be used within a timeframe of the past seven days and nights Jimenez et al. Individuals rate the items retrospectively on a seven-point frequency scale ranging from never 0 to always 6. The AWS contains 29 items which are further divided into six scales: workload 6 items , control 3 items , reward 4 items , community 5 items , fairness 6 items , and values 5 items. Items are rated on a five-point frequency scale ranging from strongly disagree 1 to strongly agree 5. Leiter and Maslach presented good reliabilities for all scales of the AWS.

The CMQ consists of 22 items divided into six scales: amotivation 4 items , external regulation 4 items , introjected regulation 4 items , identified regulation 3 items , integrated regulation 3 items , and intrinsic motivation 4 items. Coaches rate the items on a seven-point Likert scale ranging from not true at all 1 to very true 7.

The WHO-5 consists of five items which are answered on a six-point frequency scale from at no time 0 to all of the time 5. The five items are added up into a sum score, which mirrors the mental well-being on a scale ranging from 0 to The WHO-5 has been used in German studies with athletes Ohlert and Ott, , but no German coaches have been subject to any studies yet.

Coaches are instructed to answer on a seven-point frequency scale ranging from never 0 to every day 6. To create a standardized item structure as basis for further analyses, the response formats of the AWS and CMQ were adapted to the frequency-based item format of the RESTQ, resulting in seven-point frequency scales [ never 0 to always 6 ] for these three questionnaires. However, reliabilities were rechecked after this change in item format. The study was approved by the university ethic committee of the home university and was conducted according to the Declaration of Helsinki.

Informed consent was given by clicking a button on the first page of the online survey. Information about the study was distributed to the coaches with the support of their respective national sport federation. Sport federations were requested to only contact coaches with the third highest national level of coaching license or lower to save the top coaches for the second study.

In total, twenty national and regional sport federations were contacted. For the purpose of weighing the different predictors of burnout multiple linear regression analyses were conducted, using the scale Emotional Exhaustion MBI-Coach , and the sum score of the WHO-5 as dependent variables. Emotional Exhaustion as a dependent variable mirrors the core symptom of burnout which initiates the development of depersonalization and reduced personal accomplishment Lee and Ashforth, These scales were adapted from the Maslach Burnout Inventory and depict symptom-like constructs which are inappropriate as predictors.

All other scales of the applied questionnaires were set as independent variables, respectively. As a next step, an Exploratory Factor Analysis Principal Axis Factoring with Oblimin Rotation was performed with the remaining scales to obtain a factor structure. In contrast to Principal Component Analysis as the most widely used method , the aim of Principal Axis Factoring is not only the reduction of data, but also to reveal any latent variables that cause the manifest variables to covary Costello and Osborne, Oblimin Rotation, as an oblique rotation method, has been used due to the fact that from theory the factors are not uncorrelated.

In oblique rotation methods, the Oblimin Rotation is the most common choice Costello and Osborne, Moreover, Fabrigar et al. Parallel Analysis, suggested by Horn as a method to determine the number of factors, was employed to determine the factor structure. In Parallel Analysis, eigenvalues of the determined factors in randomly simulated data sets are compared to those of the factors in the actual data set.

In this process, the focus lies on how many of the factors obtained from the actual data have an Eigenvalue greater than that of the simulative data and accordingly the number of factors is decided.


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The results of the performed Parallel Analysis suggest only one global factor from these nine scales, as the first factor is the only one that shows a greater Eigenvalue for the actual data compared to the simulative data Table 4. The Eigenvalue of the simulative data surpasses that of the actual data in the second factor already. Due to this, factor analyses with more than one factor will be suggested as possible solutions. In the solution with two factors Table 5 , there are stress and recovery scales within the same factor factor 2.

Further it shows that the scales Sleep Quality and Social Stress have strong cross loadings and can therefore not clearly be matched with one of the two factors. Oblimin rotation was applied. Main factor loadings are printed in bold type. Comparable to the two factor solution, even in the three factor solution, high side-loads can be identified for the scales Sleep Quality, General Well-being , and Being in Shape Table 6. However, in contrast to the two factor solution, the analyses show that these three recovery scales have been isolated within one factor Table 6.

Only Undisturbed Leisure Time could also be assigned to the recovery scales, but as an inverted scale it has a close proximity to Disturbed Breaks. The aim of study 2 was the validation of the BPQ-C. This was done by examining the exploratory structure of the instrument with an independent sample of sport coaches. For this purpose, a Confirmatory Factor Analysis CFA was performed and the construct validity as well as the criterion validity were verified by means of intercorrelations and content-related questionnaires, respectively.

The sample of study 2 consisted of German coaches 90 females with a mean age of Compared to study 1, coaches in the current sample displayed higher performance levels and possessed coaching licenses with a higher level than those surveyed in study 1 Table 1. The BPQ-C consists of 36 items divided into 9 scales 8 scales with 4 items, the scale Amotivation with 3 items, 1 warm-up item. Coaches rate the items retrospectively on a seven-point frequency scale ranging from never 0 to always 6. In line with study 1, the 20 regional and national sport federations were contacted.

In contrast to study 1, sport federations were requested to contact coaches with the second highest national level of coaching license or higher. As it was already the case in study 1, this study was approved by the university ethic committee of the home university, conducted according to the Declaration of Helsinki, and informed consent of the coaches was given by clicking a button on the first page of the online survey.

In order to do so, all three models of the Exploratory Factor Analysis from study 1 were checked. In the selection of the fit indices used, the present study followed the recommendations of Beauducel and Wittmann , who refer to the consideration of two criteria. On the one hand, fit indices should be utilized that have been used regularly in psychological research to ensure the comparability of the values with other studies as well as the traceability of the results. On the other hand, Tanaka postulated that the fit indices should cover the widest possible range of different dimensions absolute vs.

Absolute fit indices evaluate how well an a priori model reproduces the sample data. Incremental fit indices evaluate model fit by comparing a target model with a more restricted, nested baseline model. Another important aspect of fit indices is whether they adjust for model complexity the number of free parameters of a model. Indices adjusting for complexity favor the more simple models Tanaka, A third characteristic that was represented in the selected fit indices was whether they are population-based or not. The benefit of population-based fit indices is that they are relatively independent from sampling error Schermelleh-Engel et al.

Intercorrelations of scales as well as the stability of intercorrelations across the two samples have been administered to support construct validity. Initially, the results of the CFA revealed an unsatisfactory fit to all of the three models Table 7. However, the best fit was found for the three factor solution and therefore, further modifications were made on the basis of the three factor model.

In a modified model, five specific correlations between the factors must be allowed to obtain a good structural model for the three factor model Figure 1. This procedure was justified by assuming a high degree of similarity in the scale content. On the one hand, one reason for that could be the high proximity between scales of different factors, which already led to the assumption of a one-factorial structure in study 1.

On the other hand, Kenny et al. The interscale correlations were examined as an indicator of construct validity. All scales within each factor correlated positively with the scales of the related factor Table 8. Moreover, factor correlations were stable across the two samples. About this book Introduction This interdisciplinary book explores the connections and tensions between sociological, psychological, and biological theories of exhaustion. It examines how the prevalence of exhaustion — both as an individual experience and as a broader socio-cultural phenomenon — is manifest in the epidemic rise of burnout, depression, and chronic fatigue.

It provides innovative analyses of the complex interplay between the processes involved in the production of mental health diagnoses, socio-cultural transformations, and subjective illness experiences. Using many of the existing ideologically charged exhaustion theories as case studies, the authors investigate how individual discomfort and wider social dynamics are interrelated.

Chronic Fatigue Syndrome M. Editors and affiliations. So, exhaustion could be seen as the absence of Efforts. Therefore, it seems natural to analyze at least the LMA Effort System in connection with burnout patients, since in the main burnout concepts exhaustion is the major symptom of burnout Cox et al. The Effort elements Space, Time, Weight and Flow range between two types of Effort qualities: from indulging to fighting against the external motion factors. The indulging elements do not resist although they are active qualities , while the fighting elements move against the motion factors.

The indulging and fighting qualities within one Effort element cannot be shown simultaneously because one either indulges in an external motion factor or one is fighting against it. However, the indulging and fighting qualities of different Effort elements can be shown simultaneously. It can be also show more Effort elements simultaneously or an absence of all Effort elements throughout a movement. There have been several scientific investigations in which the LMA was used to analyze the movements of patients with psychiatric diseases such as anorexia nervosa Burn, ; Shenton, ; Lausberg et al.

In comparison to a heterogenic group of psychosomatic disorders Lausberg et al. Patients with anorexia nervosa, bulimia and inflammatory bowel disease showed significantly fewer Strong movements within the Effort Weight as well as fewer Free movements within the Effort Flow in comparison to a healthy control group. However, there were no significant differences between the diseases whatsoever Lausberg, Patients with depression showed on average a smaller repertoire relative to the Effort System. The movement of burnout patients has, to the knowledge of the authors, not been investigated yet, neither with the LMA nor with any other movement analysis system.

Therefore, the aim of the study is to close this knowledge gap in order to obtain a new perspective on burnout. The focus is not on bodily symptoms, such as vegetative dysregulations, but to investigate these equivalents in terms of body expression and movement in relation to burnout. So, the aim of the study is to analyze the movement of burnout patients, and to closely analyze the movement expression of burnout patients in comparison to healthy people with the LMA Effort System to detect possible deficits.

It is our opinion that the link between movement expression and burnout might be important for several reasons. Firstly, an understanding of movement expression of burnout patients could lead both to an additional perspective for investigating the syndrome, and to an extension of diagnostic advice in the future.

Secondly, potential deficits within the movement expression of burnout patients can give new indications for movement interventions in the treatment of burnout. Thirdly, the potential deficits within the movement expression of burnout patients may give new starting points for preventive movement programs in health promotion. The findings in the studies of LMA with psychiatric patients, as well as a pilot study, suggest that burnout patients have deficits in their movements regarding the LMA Effort System.

Indications were already given by the literature about burnout definition which considers exhaustion to be the relevant symptom Maslach et al. The research question of this study is: Do burnout patients have deficits within their movement in comparison to a healthy control group, analyzed with the LMA Effort System? It was hypothesized that burnout patients show deficits in their movements regarding the LMA Effort System. Moreover, it was hypothesized that the deficits affect all four Efforts of the Effort System.

Twenty-three burnout patients 14 male and 9 female , hospitalized in a rehabilitation clinic for psychiatric illnesses, were tested. The control group consisted of 21 participants 10 male and 11 female. Two participants were dropped after the test because of the diagnosis of burnout by means of a burnout questionnaire. So, 22 burnout patients 14 male and 8 female, age A comparable age-distribution across the two groups was sought to avoid influences due to age related changes in movements.

Additionally, data regarding educational level, dance affinity, dance and dance therapy experience, as was well intake of medication with a five-tier Likert scale was gathered because these variables were quite likely to influence the movement. In the control group 4 participants have a low, 6 a middle and 10 a high education level.

All burnout patients took psychotropic drugs, and none were taken by the control group. Burnout patients took sedating as well as stimulating psychotropic drugs, often together. Between their 1st and 2nd week of hospitalization the burnout patients were asked by the attendant psychiatrists in the clinic to participate in a scientific study. The control group was recruited through social media and mailing lists. If they agreed to participate they were informed about the study and they signed a consent form. The participants received only basic information about the procedure of the study in which they were involved.

Regarding the movement session, they only received information that it would be a session with very easy, not exhausting movement tasks to avoid dance or movement affinity with the participants. Inclusion criteria for the burnout patients was the diagnosis of burnout. Exclusion criteria for the subjects of the control group was the diagnosis of burnout. Exclusion criteria for all participants were other psychiatric conditions besides burnout and somatic illnesses or intellectual impairment, as this could influence movement behavior.

All participants were blind to the aim, the hypothesis and the different participant groups. Aspects of the body, emotion and cognition are investigated along with it.

„Burnout“ – Krankheit oder Folge von Stress?

With the friends scale, tendencies toward social withdrawal and inner isolation as well as tensions with friends are considered. The physical problems scale is addresses several physical paresthesias and pain, especially regarding the cardiovascular, respiratory, digestive and immune systems as well as general parameters such as sleep quality. With the cognitive problems scale discomforts in terms of concentration, control of attention, perfectionism, decisiveness, rumination, etc. With the emotional problems scale, data about specific emotions like anxiety, shame and mistrust are collected.

The BOS-Scales III are concerned with satisfaction and resources in these areas: job 5 items , self 5 items , family 5 items , and friends 5 items. The self scale considers self-evaluation, self-esteem and homeostasis. Validity of the BOSS: Besides correlations with other questionnaires, the questionnaire shows good criterion-related validity as the statistical values coincide with the clinical diagnosis of psychiatrists Geuenich and Hagemann, Thus the burnout diagnosis by the psychiatrists in the clinic was further confirmed by the questionnaire Burnout Screening Scales BOSS I—III Geuenich and Hagemann, , which was the inclusion criteria for the hospitalized burnout patients.

Patients suffered from clinical burnout , which means that they were hospitalized, diagnosed by a clinician with burnout, unable to work and receiving psychological treatment Schaufeli et al. Differential diagnostics depression, anxiety or fatigue disorders etc. So, a possible comorbidity between burnout and depression — as it is discussed in literature — was not clarified through additional psychological tests. Inclusion criteria for the control group were normal i. One participant from the patient group and one participant from the control group were dropped because one of the burnout patients had normal i.

The distribution of the burnout patients and the healthy participants in their groups was random. Burnout patients and healthy participants were not mixed together to avoid influencing their movement behavior. The participants were asked to move according to verbal movement instructions. These movement sequences took place in the gym at the rehabilitation clinic Privatklinik St. Radegund between 2 and 3 pm. Five cameras filmed the movements from five different angles. A dance therapist, trained in LMA, gave the verbal movement instructions. She was blind to the hypothesis and excluded from the later test evaluation in order not to influence the participants or the analysis.

In addition, the researchers were present as silent observers. The standardized movement instructions consisted of three parts: A warm up 10 min to become familiar with the room, the situation and the cameras, and to ensure that normal movement behavior was achieved. In order to test the hypothesis, the Flow, Space, Time, and Weight Efforts of the hospitalized burnout patients and of the healthy control group were analyzed using the LMA method by two independent movement analysts experts in LMA and these were compared. They analyzed each participant via video independently from each other as well as independently from the dance therapist who gave the verbal instructions, and from the researchers.

They were blind to the distribution of the participants in the groups, the aim and the hypothesis. The Flow Effort is about the continuity and the progress of the movement. The indulging quality of the Flow Effort is Free Flow: the movement is free of tension so that the antagonist muscles resist as little as possible during a movement, and therefore the movement cannot be stopped at any time.

To shake out or swing the arms has the quality of Free Flow. The fighting quality of the Flow Effort is Bound Flow: the movement is controlled with increased tension so that not only are the agonists or active muscles contracted, but also the antagonists during a movement therefore can be stopped at any time. The Space Effort is about the attention given regarding the space and the objects within it. It describes the how, but not the wherefore. The Space Effort describes — with the indulging quality being Indirect and the fighting quality being Direct — whether the movements are oriented directly or indirectly with regard to the surroundings or objects.

All team games need a lot of Indirect: the players need to overview the court and recognize their own team members without facing them with an encompassing focus. If there is no interest in the space whatsoever — neither a direct nor an indirect one, the person is simply moving — the Effort element Space is not present Bartenieff and Lewis, ; Bender, ; Kennedy, The Time Effort is about the time, but not the duration of a movement or the objective measure of the time.

It is about how one approaches whatever the duration of time is. One can either have the feeling of fighting against the motion factor time or indulging it. The indulging quality of the Time Effort is Sustained. It is not only about the higher tempo of the movement but also about fighting against the time, such as an old man with mobility problems crossing the street who tries to fight against the time that the light will remain green. For example, if a fit jogger moves faster and outdistances the old man, the jogger does not fight against the time the light is green with accelerated movements but has all the time in the world to cross the street and moves therefore within the Sustained Time Effort.

So, the opposite of light is not a passive heaviness but strength. For example, picking up a delicate, small object is Light, smashing an object with a fist is Strong. Jumping in ballet is Light but stamping your feet in African dance or sumo style is Strong Bartenieff and Lewis, ; Foroud and Whishaw, ; Bender, ; Kennedy, In previous studies, the reliability of the non-kinematic measures in LMA, which includes the Effort System, has already been validated Fagen et al. The inter-rater reliability was interpreted in accordance with Landis and Koch Following the hypothesis, that there were deficits within all Effort Elements, they were tested one-tailed.

To control the influence of the following variables, they were gathered and analyzed in ordinal regression models: age and gender, educational level as well as dance affinity, dance and dance therapy experience. The effect size was interpreted in accordance with Cohen The Kappa coefficients ranged from 0. Landis and Koch suggested that 0. TABLE 1. Inter-rater reliability, confidence interval of the dependent variables LMA. Supplementary Table S1 shows descriptive statistics for all variables, i.

As the variables of the LMA Effort System were ordinally scaled only their median and range were calculated. As seen in Supplementary Table S1, almost all variables of the LMA inter-correlated except for a few combinations two combinations with the variable Direct. The results showed that only within the Flow Effort did burnout patients have deficits regarding the fighting element. Within the other three Efforts — Space, Time, and Weight — burnout patients had deficits regarding the indulging element.

TABLE 2. Based on literature concerning the definition of burnout which considers exhaustion as the relevant symptom Maslach et al. It was expected that every Effort would be affected. The results confirmed that indeed every Effort was affected within burnout: burnout patients showed significant deficits in relation to Flow, Space, Time, and Weight in comparison to the healthy control group.

Regarding the Flow Effort Free — Bound , outcomes from this study showed that burnout patients demonstrated a significant deficit concerning Bound movements, but not in terms Free movements. Following Bender or Kennedy Bound movements refer to controlled movements that can be stopped at any time. Therefore, Bound Flow leads to a control of the movement that helps to resist external stimuli, protecting against these.

As a result, with Bound Flow the influence of external stimuli can be regulated.


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The results of our study showed that Bound Flow is significantly less frequent amongst burnout patients when compared to healthy subjects. This reminds us of the non-regulation in their flow of work: they work until they burn out, without stopping or decelerating early enough Burisch, Regarding the Space Effort Indirect — Direct , burnout patients had a significant deficit of Indirect movements, i. Like Bender and Kennedy stated, indirect relatedness to the space does not concentrate on details but is able to perceive more things in parallel with wider attention and it is able to pursue various objectives.

With this flexible orientation, obstacles can be avoided easily Bender, ; Kennedy, However, this study showed that burnout patients have a deficit concerning Indirect movements and they show Direct movements by focusing solely on one object. This reminds us again of the work attitude of burnout patients: they become absorbed in one objective and get lost because of their lack of orientation toward the whole situation. If the focus of interest is removed, nothing remains — as the phase models of burnout Edelwich and Brodsky, ; Freudenberger and North, shows.

Following Bender Sustained is not to fight against time, not to be trapped in time, but rather it is about the sensation of reveling in the run of time. However, the outcomes from this study showed that burnout patients with their deficit of Sustained movements are not able to revel in time. This reminds us of the problem of burnout patients running out of time, so they cannot revel in time in general Burisch, Here burnout patients had a high significant deficit, like this study showed.

They showed significantly fewer airy and delicate movements. This reminds us of the problem that burnout patients cannot generally take things lightly Burisch, Consequently, following the outcomes from this study, it seems, that burnout impairs Bound, Indirect, Sustained and Light movements although it cannot be known if this is caused by burnout. To answer this question, the body movements of burnout patients following recovery should be analyzed. To the knowledge of the authors the movement of burnout patients has not been investigated yet — neither with the LMA nor with any other movement analysis system.

Thus, the present study is the first in this area.

Introduction

Therefore, the results can only be compared with results from other psychiatric disorders not with burnout studies. In particular, the comparison with depression, anxiety and chronic fatigue syndrome seems to be interesting since the differentiation between burnout and these diseases is not clear Korczak et al. To date, there has been no investigation, to the knowledge of the authors, which has analyzed the movements of patients with anxiety or chronic fatigue syndrome, but there is one which analyzed the movements of patients with depression: Welsche found that patients with depression showed overall a smaller repertoire relative to the Effort System.

The outcomes from this study showed that burnout patients with their deficits within all Efforts of the Effort System have a smaller repertoire relative to the Effort System, similar to patients with depression in the study of Welsche Nevertheless, in contrast to patients with depression, burnout patients do not have a preference for Bound movements but display significantly fewer frequent Bound movements — i.