The work was approved for defense at the GEK

deputy director of academic work DBMK

E.N. Tarasenko

Order No. ___ "__" _____________ 20_

Donetsk 20___

Introduction (from 3-4)

Chapter 1. Social and psychological essence of the 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

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 measures for the prevention of 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, social stress, the requirements for the professionalism of the individual are growing. However, not everyone can adapt, effectively carry out their professional activities and social role, and therefore the likelihood of developing adverse mental conditions increases.

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

Professional burnout occurs as a result of the internal accumulation of negative emotions without the appropriate "discharge" or "liberation" from them, leads 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) offered a vivid emotional image, reflecting, in his opinion, internal state an employee experiencing professional burnout distress: "The smell of burning psychological wiring."

Doctors and nurses are highly susceptible to this syndrome. The basis for such a conclusion are both the general causes inherent in the emergence of professional burnout in all categories of workers, and the specific features associated with the nature of their activities.

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

This problem is relevant at the present time and requires a detailed study of the features of the manifestation of burnout, clarification of the symptoms and factors that determine its formation in the professional activities of physicians, timely detection, development of evidence-based health programs focused on the prevention of professional deformities and diseases, as well as the restoration of psychoenergetic potential. workers.

The purpose of the thesis:

The study of the phenomenon of professional burnout, as well as the prevention and correction of this syndrome in 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.

Work tasks:

Give a definition of the concept of professional burnout syndrome;

Investigate the causes, factors, symptoms of professional burnout;

To study the features of the manifestation of the syndrome of professional burnout 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 the syndrome of professional burnout of a medical worker.

The object of the study is:

Occupational burnout syndrome as a special condition of a person resulting from occupational stress. The subject of the study is the prevention and correction of negative phenomena associated with the burnout syndrome.

Chapter 1. Socio-psychological essence of the syndrome of professional burnout

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 lies in the fact that this is not a short-term transient episode, but a long-term process of "burning to the ground." A burnout person begins to experience a feeling of self-doubt and dissatisfaction with his personal life. Not finding sufficient grounds for self-esteem 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 and days off, with constant physical, psychological stress, complicated by intense emotional contacts, leads to a life in a state of constant stress, accumulation of its consequences, depletion of the supply vital energy human and, as a result, to serious physical diseases. Therefore, workaholics who are ready to give all the best for 24 hours a day, give themselves to work without a trace, without breaks, entrances and holidays, are the first candidates for complete psychological burnout, resulting in early death.

Since the appearance of the concept of burnout, the study of this phenomenon has been difficult due to its content 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 measuring tools, this phenomenon could not be described empirically in detail.

American specialists paid 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, who are obliged by duty to show sympathy and empathy, contact 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 have asked for help. However, despite the special training and selection of personnel for social services according to certain criteria necessary for this type of activity, service managers after some time often encountered 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 stresses in interpersonal relationships. Thus, the “burnout” syndrome has turned from a “payment for sympathy” into a “disease” of workers in “communicative” professions, that is, professions that place high demands on psychological stability in situations of business communication.

For the first time, the term burnout (burnout, combustion) was introduced by the American psychiatrist H. Fredenberg. Burnout meant a state of exhaustion combined with a sense of one's own uselessness, uselessness. However, the term has become widely used in scientific literature and psychotherapeutic practice after numerous publications by K. Maslach (Maslakh). In 1982, her book Burnout is the price of sympathy 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 to the workplace due to excessive workload and inadequate interpersonal relationships". T. V. Formanyuk (1994) considers burnout syndrome to be “a specific type of occupational disease 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 a person in the form of a complete or partial exclusion of emotions (lowering their energy) in response to their chosen psychotraumatic effects.” 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 personality of a professional" and supplements the terminology with the expressions: "burnout of the personality", "burnout of the soul".

What is "burnout" of the soul? The answer to this question is brought closer by the judgment of the outstanding thinker of the second half of the 20th century V.V. I. Volodkovich: “A person lives in a world of illusions and cannot live without them. They are at the heart of faith, hope, love. Burning out the soul, a person loses the illusion of having faith, hope, love. First, faith melts, and a person is filled with a sense of his unaccountable unhappiness. Then hope flies away. A person has a disregard for everything. Love is the last thing that leaves a person, and with it he loses the meaning of life. Only by moving to a new life area, radically different from the previous one, can a burned-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 subject to such a danger. These include: teachers, psychologists, educators, educators, doctors, social workers, law enforcement officers and representatives of other professions. All these are employees of "communicative" professions, the specificity of which lies in a large number of emotionally rich and cognitively complex interpersonal contacts, which requires a significant personal contribution from a specialist in daily professional affairs. As K. Maslach writes: “The activities of these professionals are very different, but all of them are 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 people-oriented professions, great importance receives feedback from them (for example, gratitude, recognition, showing respect, information about changes in well-being or about new plans regarding further business interaction, etc.), there is also a 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 relations in solving their problems; conflict or tense situations of communication, caused by distrust, disagreement and manifested in various forms of refusal to further interaction (communication).

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

Thus, occupational risk factors for burnout include:

Emotionally rich business communication;

High requirements for continuous self-development and improvement of professional competence;

High responsibility for business and for other people;

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

High demands on 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 business;

Devaluation or loss of meaning of their efforts;

Experiencing loneliness;

Feeling the meaninglessness of vigorous activity and life.

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

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

Among organizational factors, the main emphasis in the study was placed mainly on the time parameters of activities and the amount of work. Almost all studies give a similar picture, indicating that an increase in the load in activities, 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. So, direct contact with clients, the severity of their problems usually contribute to the occurrence of burnout. The influence of these factors is most clearly shown in those types of professional activity where the acuteness of clients' problems is combined with the minimization of success in the effectiveness of their solution. This is work with chronic patients or people suffering from incurable diseases (AIDS, cancer and some others). At the same time, 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 eventually leading to burnout.

Considerable attention is paid to the relationship between burnout and motivation. Thus, researchers note a decrease in work motivation characteristic of “burnt out”, which manifests itself in the desire to reduce work to a minimum, manifestations of apathy and chronic negativism in relation to functional duties, although the difference between burnout and unsatisfactory profession is emphasized.

The syndrome of professional burnout is closely related to personal endurance - a quality that can affect a person's predisposition to stress. Foreign psychologists define it as the ability of a person 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 values ​​of emotional exhaustion and depersonalization and high values ​​on the scale of professional achievements.

Psychologists distinguish 3 stages of burnout syndrome.

First stage - at the level of performance of functions, arbitrary behavior: forgetting some moments, speaking 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 the performance of any motor actions etc. Usually, few people pay attention to these initial symptoms, jokingly calling it “girl's memory” or “sclerosis”. Depending on the nature of the activity, the magnitude of the neuropsychic stress and the personal characteristics of the specialist, the first stage can be formed within three to five years.

On the 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 occupation (schoolchildren, patients, clients), “on Thursday it feels like it’s already Friday ”,“ the week lasts endlessly ”, an increase in apathy by 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 “turns on”, as they say, from a half turn, although he had not noticed this before. The time of formation of this stage is on average from five to fifteen years.

Third stage - personal burnout. Characterized by a complete loss of interest in work and life in general, emotional indifference, dullness, a feeling of constant lack of strength. Man seeks solitude. At this stage, it is much more pleasant for him to communicate with animals and nature than with people. The stage can be formed from ten to twenty years.

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 saturation or cognitive complexity; professional burnout syndrome is a response to prolonged stresses of interpersonal communications.

Scheme 2. The prevalence and severity of the syndrome of "emotional burnout"

Chapter 2

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 refers to complex types of work that require the subject to have a versatile education, the continuity of the process of professionalization, as well as the possession of personal and professional qualities.

A medical worker is endowed 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 very professional activity of medical workers involves emotional richness and a high percentage of factors that cause stress. Emotions are usually ambivalent: satisfaction with 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 misdiagnosis or mistreatment, envy of successful colleagues, disappointment in the profession, etc.

The duties of medical workers include providing medical assistance to citizens, and often such assistance should be urgent, provided in a situation of severe stress experienced by a patient who is in serious condition. In the course of their activities, medical workers keep records of the patient's health status, prescribe the necessary medical means to him, thereby taking responsibility for his further condition. A medical worker has a 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 stressful situations and can affect their mental health.

The communicative side of the activities of medical workers is of no small importance, because. in the course of it, a healthcare employee 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, empathy. Faced with negative emotions, a medical worker involuntarily and involuntarily becomes involved in them, as a result of 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 adverse production factors of various nature, neuro-emotional overstrain, and high responsibility.

The doctor at the level of emotional experience is constantly dealing with death. She can act for him in three forms:

1) real (uselessness of resuscitation, death on the surgeon's table);

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

3) phantom (in the form of it, 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 mind) can act.

In each of these cases, there is a problem for the doctor of not including his feelings in the situation. This is far from 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.

Among the psychological stress factors that affect the medical staff are:

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;

Work environment with new social risk factors such as crime, drug addiction, homelessness, etc.

As a result of observations of specific studies of the syndrome of mental burnout, it shows that among the causes of burnout in physicians, one can single out general and specific ones.

Common reasons include:

Intensive communication with different people, including negative ones;

· work in changing conditions, collision with unpredictable circumstances;

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

Specific reasons include:

problems of a professional nature (career growth) and working conditions (insufficient salary level, condition of jobs, 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 than in most other departments;

The impact of patients and their relatives seeking to solve their psychological problems through communication with a doctor;

recent trend - the threat of appeals from relatives of patients in case of lethal outcome with legal claims, lawsuits, 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 of 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 one's behavior, a tendency to increased anxiety and depressive reactions associated with the unattainability of "internal standard” and blocking negative experiences in oneself, a rigid personality structure. The paradox is that the ability of medical professionals to deny their negative emotions may indicate strength, but often this becomes their weakness.

Scheme 3. Constituent elements of the professional burnout syndrome

Let us consider in more detail the features of professional activity and the individual characteristics of professionals working in ambulance teams.

“Burned out” ambulance workers indicate the long hours of work, a large number of calls, lack of equipment and medicines, unclear work planning (unstable work schedule). Ambulance workers have increased responsibility for their functions and operations. Doctors and paramedics work "for wear and tear" - after all, responsibility and self-control are very high. As a result, anxiety, depression, emotional rigidity, emotional devastation may appear. Ambulance personnel constantly deal with psychologically difficult contingents (heavy and dying patients). Sometimes there are conflict cases in the “head-subordinate” system, more often in the “colleague-colleague” system, when the doctor and paramedic working in the 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 ambulance professionals leave in the first five years of their employment. They either change the profile of work, or even change their profession. 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 sometimes happens that periods of intense interiorization and psychological defense alternate in work; weak motivation of emotional return in professional activity, moral defects and disorientation of the personality are possible.

The main symptoms of "emotional burnout" of ambulance workers include (according to the conducted clinical and psychological interviews):

Fatigue, fatigue, exhaustion (after vigorous 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 that have taken place);

Negative attitude towards the activity 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, sense of meaninglessness of current events.

One of the first places on the risk of burnout is the profession of a nurse. Her working day is the closest communication with people, mainly with the sick, who require vigilant care and attention.

By the nature of their activities, nurses are required to clearly know and apply the theoretical knowledge they have gained in practice, to carry out sanitary and educational work on the site, including the promotion of medical knowledge, hygiene education and training of the population in a healthy lifestyle, to organize an outpatient doctor's appointment (preparation of the workplace, instruments , tools, preparation of individual outpatient cards, forms, prescriptions, conducting a preliminary history taking, 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 subject to the formation of the syndrome of professional burnout. 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 physicians to report burnout, depression, or other psychiatric disorders. It is noticeable that, first of all, novice specialists are prone to health disorders caused by stress. 76% of junior residents show symptoms of professional 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 work activity is often associated with disappointments for them.

Employees of "heavy" departments, primarily those who care for seriously ill patients with cancer, HIV / AIDS, in burn and resuscitation departments 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 emerging 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 activity of medical workers is a prerequisite for the development of SEB.

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

Burnout Syndrome (BS) is a long-term stress reaction, or a syndrome that occurs as a result of prolonged occupational 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 emphasizes the importance of the problem raised. The syndrome of emotional burnout most often occurs as a result of an accumulating, hard-to-hold conflict between a boss and a subordinate. At the heart of the syndrome is a discrepancy between the requirements for the employee and his real capabilities. Specifically, to our medical shop - this is not enough correct relationship between the head doctor and the head. department, chief department and resident, head. department and assistant, associate professor ... Although the topic is not new, but here we are watching the series "Medical Secret" on TV, but the topic exists, and acutely exists!

Dear fellow leaders! You have under your command people of the most humane profession on Earth and with the most sensitive and fragile soul - doctors. Who organized the team himself or who got it - it doesn't matter. These are your employees. And not only a "lash", but also a warm attitude is required. Less irritability, temper, hysteria. Praise a colleague in time - it's so nice. Let us remember that the intelligentsia is a layer that protects us from rudeness.

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

In the literature, the term "burnout syndrome" is used as a synonym for the term "burnout syndrome".

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

A number of authors of CMEA (known in foreign literature 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 the alternative health care service. 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 loaded atmosphere when 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, CMEA meant a state of exhaustion with a sense of one's own uselessness. Later, the symptoms of this syndrome expanded significantly due to the psychosomatic component. Researchers increasingly began to associate the syndrome with psychosomatic well-being, referring it to pre-illness states. At present, CMEA is included in the rubric International classification diseases (ICD-10: Z73 - "Stress associated with difficulties in maintaining a normal lifestyle").

The prevalence of burnout syndrome

Among the professions in which SEB occurs most often (from 30 to 90% of employees), doctors, psychologists, social workers, teachers, law enforcement officers, and rescue workers can be noted. Almost 80% of psychiatrists, psychiatrists, narcologists, psychotherapists have signs of EBS of varying severity, 7.8% have a pronounced syndrome leading to psychosomatic and psychovegetative disorders. According to another study, among psychologists-consultants and psychotherapists, signs of EBS 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 the nurses of psychiatric departments, signs of EBS are found in 62.9% of the respondents. The phase of resistance dominates in the picture of the syndrome in 55.9%; 8.8% of respondents aged 51-60 years old with more than 10 years of experience in psychiatry have a pronounced phase of exhaustion. In 61.8% of dentists, signs of EBS are detected, and in 8.1% - the syndrome is in the exhaustion phase.

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

According to British researchers, among general practitioners, a high level of anxiety is found in 41% of cases, clinically pronounced depression - in 26% of cases. A third of doctors take medications to correct emotional stress, 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 the employees of the penitentiary system who directly communicate with convicts, and one third of employees of law enforcement agencies.

Data on the prevalence of EBS emphasize its medical and social significance, since EBS reduces the quality of workers' professional activities.

Etiological aspects of CMEA

The main cause of EBS is considered to be psychological, mental overwork. When demands (internal and external) prevail over resources (internal and external) for a long time, a state of equilibrium is disturbed in a person, which inevitably leads to SEV.

The connection between the observed changes and the nature of professional activity associated with responsibility for the fate, health, and life of people has been established. These changes are regarded as the result of prolonged occupational stress. Among the professional stressors that contribute to the development of CMEA, there is a need to work in a strictly established mode, a great emotional saturation of the very act of interaction. 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, hate.

When considering the CMEA as a one-dimensional structure, this phenomenon is viewed as a state of physical and psychological exhaustion caused by a long stay in emotionally overloaded situations.

Workplace stress is a key component of SEB: a mismatch between the individual and the demands placed on them. Organizational factors contributing to burnout include: high workload; lack or lack of social support from colleagues and superiors; insufficient remuneration for work, both moral and material; a high degree of uncertainty in the assessment of the work performed; inability to influence the adoption of 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 empathic; lack of days off, vacations and interests outside of work.

Occupational risk factors include: "helping", altruistic professions, where the work itself obliges to help people (doctors, nurses, social workers, psychologists, teachers, and even clergymen). Work with "heavy" clients also predisposes to burnout. In medicine, these are gerontological, oncological patients, aggressive and suicidal patients, patients with addictions. Recently, the concept of CMEA has expanded to specialties for which contact with people is not typical at all (programmers).

The development of SEV is facilitated by personality traits - 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 in oneself , rigid personality structure.

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

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

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

From the foregoing, we can conclude that the main etiological factors in the occurrence of BS 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 multicomponent nature in the descriptive characteristics of the CMEA, and there was no measuring toolkit. Currently, researchers identify about 100 symptoms, one way or another associated with SES.

Occupational conditions can often also be the cause of chronic fatigue syndrome. Currently, the concept of chronic fatigue syndrome and SES are distinguished, however, they occur quite often together.

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

Until recently, the viral hypothesis of chronic fatigue syndrome has been popular. However, most researchers tend 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 disturbance, malnutrition, sedentary lifestyle, lack of fresh air. Against the background of the formed immunodeficiency and develops viral infection. There is a hypothesis that people suffering from chronic fatigue syndrome have a vulnerable nervous system and innate immune weakness. Women suffer from chronic fatigue syndrome 2-3 times more often than men. A number of researchers refer to the risk group of people who make too high demands on themselves and are stressed at work.

The most intensive "burnout" syndrome began to be studied after the publication of the works of K. Maslach (1976). In 1986, the Maslach Burnout Inventory (MBI) was developed to standardize research.

The MBI sees the CMEA as a three-dimensional construct that includes emotional exhaustion, depersonalization, and the reduction of personal achievement.

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

Depersonalization is manifested in the deformation (depersonalization) of relations 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 negative self-assessment, a decrease in the significance of one's own achievements, in limiting one's capabilities, negativism regarding official duties, in a decrease in self-esteem and professional motivation, in the reduction of one's own dignity, in abdication of responsibility or removal ("withdrawal") from duties towards others.

In the model of the German researchers Enzmann and Kleiber (1989), three types of exhaustion are distinguished: demoralization, exhaustion, and loss of motivation.

Japanese researchers believe that in order to determine SEB, a fourth factor should be added to the three-factor model of K. Maslach - Involvement (addiction, involvement), which is characterized by headaches, sleep disturbance, irritability, and the presence of chemical addictions (alcoholism, smoking).

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

There are three key features of CMEA. The development of CMEA 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 comes - exhaustion. Exhaustion is defined as a feeling of overstrain and depletion of emotional and physical resources, a feeling of fatigue that does not go away after a night's sleep. After a period of rest (weekends, holidays), these manifestations decrease, but upon returning to the previous working situation, they resume.

The second sign of CMEA 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, emotionally withdraw. In extreme manifestations, a person practically does not care about professional activity, neither positive nor negative circumstances cause an emotional response. Lost interest in the client, he is perceived as inanimate object, the very presence of which is sometimes unpleasant.

The third sign is the feeling of loss. own efficiency, or a drop in self-esteem as part of a burnout. A person does not see prospects in his professional activity, satisfaction from work decreases, 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, which differ in the relationship of indicators for three factors (the values ​​of the indicators mean the scores scored on the subscales of the MBI questionnaire relative to the average values). The proposed model allows us to identify the average degree of burnout, at which high rates of emotional exhaustion are observed. Until this stage of burnout, the emotional-energetic "reserve" counteracts the growing depersonalization and reduction of achievements.

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

emotional exhaustion - the "affective" factor refers to the area of ​​complaints of poor physical health, nervous tension;

depersonalization - the "setting" factor manifests itself in a change in attitude towards patients and towards oneself.

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

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

People with BS usually have a combination of psychopathological, psychosomatic, somatic symptoms and signs of social dysfunction. Observed chronic fatigue, cognitive dysfunction (impaired memory and attention), sleep disturbances with difficulty falling asleep and early awakenings, personality changes. Possible development of anxiety, depressive disorders, addictions to psychoactive substances, suicide. 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 SES.

Physical symptoms:

• fatigue, physical fatigue, exhaustion;

  reduced or increased weight;

  insufficient sleep, insomnia;

  poor general health (including sensation);

  shortness of breath, shortness of breath;

  nausea, dizziness, excessive sweating, trembling;

  increased blood pressure;

  ulcers and inflammatory diseases skin;

  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 restlessness, inability to concentrate;

  depression, guilt;

  tantrums, mental suffering;

  loss of ideals, hopes or professional prospects;

  an increase in depersonalization, one's own or others (people become faceless, like mannequins);

  loneliness prevails.

Behavioral symptoms:

• working hours more than 45 hours a week;

  during the working day, fatigue and a desire to interrupt, relax;

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

justifying the use of tobacco, alcohol, drugs;

accidents (eg falls, injuries, accidents, etc.);

impulsive emotional behavior.

Intelligent state:

• a decrease in interest in new theories and ideas in the work;

  a decrease in interest in alternative approaches to solving problems (for example, in work);

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

  an increase in preference for standard patterns, routine, rather than a creative approach;

  cynicism or indifference to innovations, innovations;

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

  formal work.

Social symptoms:

• no time or energy for social activities;

  decrease in activity and interest in leisure, hobbies;

  social contacts are limited to work;

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

  feeling isolated, misunderstood by others and by others;

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

In our country, the method of diagnosing the level of emotional burnout by V.V. Boyko, which is an analogue of MBI (application).

Thus, BS 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 work, personal relationships of employees, and their interpersonal interactions. Work stress affects employee productivity, financial efficiency, stability and competitiveness of the entire organization as a whole.

Work-related stress is a possible reaction of the body when work makes demands on people that do not correspond to their level of knowledge and skills. Stress factors may relate to the content of the job, the workload and place of work, the organization of working time, the degree of participation in the decision-making process and the possibility of influencing this process. Most of the causes of stress relate to the nature of the organization of work and the management of production processes. Other sources of stress may relate to career opportunities, status and pay, the role of employees within the organization, interpersonal relationships, organizational culture, and inadequate work-life balance.

In a survey conducted in 2000 in 15 member states of the European Union, 56% of workers reported very high work rates, 60% tight deadlines for at least one quarter of their working hours, 40% monotony of their work . Over one-third of the workers do not have the opportunity to exert any influence on the order in which work is performed.

Work-related stressors contribute to the development of health problems. Thus, 15% of employees complain about headache, 23% for neck and shoulder pain, 23% for fatigue, 28% for stress, and 33% for back pain. Nearly one in 10 workers report being subjected to intimidation tactics in the workplace.

Another phenomenon that is common in many workplaces is mental abuse, which is caused by deterioration in interpersonal relationships and organizational dysfunctions. One of the most common forms of mental violence at work is "mobbing" (or "bullying"), which poses a health risk. Mobbing, as a rule, means the abuse of power in relation to people who are not able to protect themselves. Almost 90% of respondents consider stress and mobbing to be the result of poor work organization.

Data from individual states is alarming. In Austria, 1.2 million workers suffer from work-related stress due to too 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 have to work intensively on a daily basis, and 40% of them work without a lunch break.

In the 15 member states of the European Union, until 2004, the cost of work stress and related mental health problems averaged around €265 billion annually. Studies show that work-related stress alone costs the private and public sectors in these countries about €20 billion in absenteeism and related health care costs, not to mention lost productivity costs. , higher employee turnover and reduced ability of workers to innovate.

Nowadays, the problems of managing industrial stresses are becoming the most relevant due to rapidly changing socio-economic and political situations, an increase in neuropsychic and information loads, diversification of production, and a constant increase in competitiveness.

The attitude towards work is changing in society. Confidence in the stability of the social and financial situation, in the guarantee of the workplace is lost. The competition for prestigious and well-paid jobs is intensifying. The rating of a number of socially significant professions is falling: medical workers, teachers, doctors; mental and emotional stress is growing, which is associated with stress in the workplace.

Workplace stressors include:

physical (vibration, noise, polluted atmosphere);

physiological (shift schedule, lack of diet);

socio-psychological (conflict of roles and role uncertainty, overload or underload of employees, unsettled 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 disorders 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 they begin to predominate. chronic diseases: coronary heart disease, depression, kidney disease, immunological diseases, etc. The number of stress reactions increases due to the action of the "acceleration principle", when an already developed stress reaction leads to changes in life and new stresses, and the "contagiousness principle", especially pronounced in production teams.

CMEA is considered by many authors as a consequence of industrial stress, as a process of maladjustment to the workplace or professional duties. At the same time, the main predisposing factor for burnout is the duration and excessive workload in situations of intense interpersonal relationships. In this regard, SEV is typical for representatives of the communicative professions of the "man - man" system: doctors, medical personnel, and teachers. Psychologists, psychiatrists, psychotherapists, representatives of various service professions, as well as all categories of executive 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 anxiety, anxiety, irritability, vegetative disorders appear, self-esteem decreases, awareness of the meaning of one's own professional activity is lost.

There is a close relationship between professional burnout and activity motivation. Burnout can lead to a decrease in professional motivation: hard work gradually turns into an empty occupation, apathy and even negativism appear in relation to work duties, which are reduced to a minimum. Mental burnout is more prone to "workaholics" - those who work with high dedication, responsibility, installation on a permanent work process and have found their calling in work. This list can be supplemented by "authoritarianism", a low level of empathy. The interrelation of burnout with non-constructive models of behavior in problematic production situations and a certain personal symptom complex (personal "risk factors") has been established.

The development of CMEA is characteristic primarily for professions where the provision of assistance to people dominates (medical workers, teachers, psychologists, social workers, rescuers, law enforcement officers, firefighters). EBS is seen as the result of an unfavorable resolution of stress in the workplace.

There is a link between occupational stressors and burnout symptoms:

between the general (total) indicator of burnout and the characteristics of the work (the significance of the task, 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 to professional duties, the significance of work, etc.

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

The facts are given that make it possible to attribute the contingent of dentists to the risk group. In this activity, a wide range of factors contributing to the development of the CMEA can be singled out. Dentists in the United States have a high suicide rate - 2.5 times higher than the average for the population. A large number of divorces, depressions, alcoholism, drug addictions, psychosomatic disorders are revealed in the contingent of dentists. Among the causes of stress, overload as a result of professional activities, financial failures, unsatisfactory interactions in the work team, problems of professional growth and career, complicated personal life conditions, low prestige of the profession and lack of a proper public image are noted.

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

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

One of the first places in terms of the risk of EBS is also occupied by the profession of a nurse. The working conditions of nurses often become the cause of the occurrence of SEB. Their working day is the closest communication with people, besides the sick, requiring vigilant care and attention. Faced mainly with negative emotions, the nurse involuntarily and involuntarily becomes involved in them, which is why she herself begins to experience increased emotional stress. Most of all, those who make unreasonably high demands on themselves are at risk of developing BS. In their view, a real doctor is an example of professional invulnerability and perfection. Individuals belonging to this category associate their work with a purpose, a mission, so the line between work and private life is blurred for them.

There are three types of nurses who are threatened with CMEA: Type 1 - "pedantic"; the main characteristics of this type: conscientiousness raised to the absolute; excessive, painful accuracy, the desire to achieve exemplary order in any business (albeit to the detriment of oneself); type 2 - "demonstrative"; people of this type strive to excel in everything, always be in sight; they are characterized by a high degree of exhaustion when performing inconspicuous, routine work; 3rd type - "emotive"; impressionable and sensitive people; their responsiveness, their tendency to perceive someone else's pain as their own, borders on pathology, on self-destruction.

In a study conducted with psychiatric nurses, it was revealed that SEB is manifested by inadequate response to patients and their colleagues, lack of emotional involvement, loss of the ability to empathize with patients, fatigue leading to a reduction in professional duties and the negative impact of work on personal life.

The professional activity of mental health workers poses a potential threat to the development of CMEA. Personal traits of emotional instability, conformity, timidity, suspicion, a tendency to feel guilty, conservatism, impulsiveness, tension, introversion are important in the formation of CMEA. In the picture of the syndrome in mental health workers, the symptoms of the “resistance” phase predominate. This is manifested by inadequate emotional response to patients, lack of emotional involvement in contact with clients, loss of the ability to empathize with patients, fatigue leading to a reduction in professional duties and the negative impact of work on personal life. The experience of psycho-traumatic circumstances is also quite pronounced (phase "tension"), which is manifested by a feeling of physical and psychological overload, stress at work, 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 main population of the population in mental imbalance and deviant behavior in one form or another.

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

Usually in everyday practice, the attitude of the patient to the psychotherapist is unwittingly emphasized respectful, similar to what can take place in relations with older and experienced ones. But often, patients with personality disorders are able to cause in others, including the therapist, an involuntary feeling of hostility and indignation at their behavior. But the therapist must provide medical care 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 think about 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 possess includes patience, high mental tolerance. In this case, we are talking about mental defensiveness, the ability to endure the unusual behavior of the interlocutor without expressed excitement, the ability to reach a level of distress and mental stress. Such skills refer to the skills of donation or, in other words, the skills to do good.

In a treatment situation, the doctor uses an intrapunitive type of response, in which the response to external influences is limited to the search for internal causes and responses 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. This skill is offered to learn by patients. Reflection and introspection are the main mechanisms used in psychotherapy. The therapist tries to arouse the patient's sympathy. Be "their guy" for them. He behaves in this way for the sake of achieving 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, a tendency to empathize with 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. Prolonged communication with the patient creates the impression that sick people who seek help constitute, in general, the only environment of the therapist. It seems that ordinary, healthy people generally do not fall into the field of vision and social circle of a psychotherapist.

Due to the delay in time of the 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, they begin to consider themselves almost charlatans. This situation, at first subconsciously, and then consciously suppresses the therapist. Mood, working capacity decrease, mental discomfort appears. On the other hand, professional deformation is accompanied by indifference to someone else's grief, a cold dispassionate assessment of the patient's psychological state and social position. At some stage of professional activity, the therapist has thoughts of leaving work and changing specialty. First, in a situation of professional failure, and then more and more persistently and out of touch with the results of work. From the daily practice of communication between a psychotherapist and patients, a pattern of behavior towards others is formed.

Other categories of medical workers, especially those caring for severe patients with oncological diseases, HIV / AIDS, working in intensive care and burn departments, are also susceptible to the formation of SES.

Employees of professionally "difficult" departments constantly experience a state of chronic stress associated with negative mental experiences, intense interpersonal interactions, tension, labor complexity, etc. Gradually formed as a result of CMEA reduces the quality of the organization of medical care, gives rise to 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 the 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 insight 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 a social worker. Social work is classified as a profession that requires a lot of emotional stress, responsibility and has very vague criteria for success. Social workers, who by the nature of their activities are involved in long-term intense communication with other people, are characterized by SEB.

The formation of SEV in the professional activities of a social worker may be associated with factors such as situations of change or loss social status; risk situations; situations with extreme conditions, uncertain situations. Characteristic for these situations are overloads - too many customers, many requirements, an excess of information. With an increase in overload, social workers begin to unconsciously strive to reduce contact - they are less personally involved in interaction, more often resort to formal rules and rituals, and use more impersonal forms of work. The risk of SEB among social workers may increase in the following situations: investing large personal resources in the work with a lack of 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 her choice.

In social work, young professionals have a higher risk of developing BS. 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 defined, professional interests have been formed, and mechanisms for professional self-preservation have been developed.

The teaching profession is one of those that are heavily influenced by the CMEA. This is due to the fact that the professional work of the teacher in general and the teacher high school in particular, it is distinguished by a very high emotional load. There are a large number of emotional factors, both objective and subjective, that have a negative impact on the work of a teacher, causing severe emotional stress and stress. Also, the profession of a teacher is one of the professions of an altruistic type, which increases the likelihood of mental burnout.

Emotional factors cause a growing sense of dissatisfaction, the 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, there are psychological and behavioral symptoms - a feeling of boredom, decreased enthusiasm, resentment, insecurity, irritability, inability to make decisions. The consequence of this is a decrease in the effectiveness of the teacher's professional activity. The growing feeling of dissatisfaction with the profession leads to a decrease in the level of qualification and causes the development of the process of mental burnout of the teacher. All these phenomena often occur 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 singled out. 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 the CMEA.

Employees of the penitentiary system also belong to the category of workers at risk of developing professional deformation. This is facilitated by many physiological, psychological, economic and social factors. Thus, the solution of professional tasks requires from employees of penitentiary institutions intensive communication and the ability to build their relationships with convicts and colleagues. Intensive communication within the framework of work activity increases the likelihood of BS. There are indications of the existence of manifestations of this syndrome in the professional environment of employees of the penitentiary system who directly communicate with convicts. The factors contributing to the development of CMEA, 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 needs for self-actualization, a decrease in meaningful life ideas, low status in a professional group, etc.

Law enforcement officers, especially those who are constantly on the front lines of the fight against crime, are also susceptible to SEV. These are sentry, district, operational workers, employees of security departments. 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 frequent phenomena. Similar psychological problems are observed among Western police officers, which, however, are compensated by relatively high salaries and much higher social security.

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

Principles of treatment and prevention of burnout syndrome

Preventive and remedial measures with burnout syndrome, they are in many ways similar: what protects against the development of this syndrome can also be used in the treatment of an already developed one.

Preventive, therapeutic and rehabilitative measures should be aimed at relieving the stressor - relieving work stress, increasing professional motivation, balancing the balance between the effort expended and the reward received. With the appearance and development of signs of CMEA 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 major role in the fight against CMEA belongs primarily to the worker himself. By following the recommendations listed below, the employee will not only be able to prevent the occurrence of EBS, but also achieve a decrease in its severity.

Definition of 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 stresses, are very important. Sometimes you need to "run away" from life's problems and have fun, you need to find an activity that would be exciting and enjoyable.

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

Professional development and self-improvement. One of the ways to protect against CMEA is the exchange of professional information with representatives of other services. Collaboration gives a sense of a wider world than that which exists within a single team. To do this, there are various advanced training courses, all kinds of professional, informal associations, conferences where people with experience who work 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 striving for success in business creates anxiety, makes a person too aggressive, which, in turn, contributes to the emergence of CMEA.

Emotional communication. When a person analyzes their feelings and shares them with others, the likelihood of burnout is significantly reduced or this process is not so pronounced. Therefore, it is 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 for him a reasonable solution to his problem.

Maintaining good physical shape. There is a close relationship between body and mind. Chronic stress affects a person, so it is very important to maintain good physical shape through exercise and a rational diet. Improper nutrition, abuse of alcohol, tobacco, reduction or excessive increase in body weight exacerbate the manifestation of SES.

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

try to calculate and deliberately distribute their loads;

learn to switch from one activity to another;

easier to deal with conflicts at work;

Don't try to always be the best in everything.

Psychological work to eliminate CMEA should include three main areas.

The first direction should be aimed at relieving employees of stressful conditions that arise in connection with strenuous activity, developing self-regulation skills, teaching relaxation techniques and controlling their own physical and mental state, and increasing stress resistance.

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

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

One of the ways to prevent SEB is to include in the duties of a psychologist in an institution work with personnel on the prevention, detection and correction of symptoms of the syndrome (questionnaires, trainings, conversations). Heads of institutions can neutralize the CMEA threat by diversifying activities (within the framework of the employee's professional duties).

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

Prevention of CMEA is the correct organization of professional activity. When hiring an employee, the manager should consider him as a valuable resource for the implementation of the organization's goals. Features of the profession, emotional involvement and CMEA require certain conditions for the organization. This is the presence of mentoring, debriefing, advanced training. Individual counseling on issues of professional activity (for example, career guidance). Professionals who are engaged in psychotherapy, counseling should have other working conditions that would take into account the characteristics of the profession.

V preventive purposes Adequate informing representatives of communicative professions about the early signs of burnout and risk factors can be used. The main methods of self-influence, the formation of mental tolerance can be used, allowing you to create a psychological image that is distinguished by defensiveness. Many of the techniques can be used in the prevention of burnout syndrome and for representatives of other professions.

Ways to build an effective relationship with the 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, deeds, situations, activities, including the use of psychological tests. The therapist is supposed to compile a register of his own typical reactions.

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

This type of technique is based on modeling a specific situation in order to build 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 the appearance and behavior, is well recognized and read by others. Therefore, it is quite enough just to think about something, how it finds an external embodiment in the appearance and behavior of a person. Conversely, a person who tries to hide something from those around him is first forced to internally convince himself and imagine a situation other than the one he is hiding.

Working in this direction, the psychotherapist does not just remember these feelings and attitudes, but tries to vividly imagine how they are reflected in behavior, appearance and mutual relations. Difficulties in the implementation of eidetic representations or obtaining an appropriate emotional mood with the perfection of eidetic skills are compensated by the use of NLP techniques. The technical means of entering the image include: eidetic, non-verbal self-hypnosis; using NLP techniques to successfully enter the role; verbal, mental pronunciation of the necessary mood to oneself.

Affirmations for Inner Mood:

not be afraid to make a mistake at work;

• set achievable psychotherapeutic goals;

  
  

Introduction

1. Theoretical aspects of the study of personal characteristics and burnout syndrome in medical workers

1.1 Characteristics of the personal characteristics of medical workers

1.2 Socio-psychological essence of the burnout syndrome

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

2. Empirical study of the relationship between emotional burnout and personal characteristics of doctors and nurses

2.1 Organization and research methods

Conclusion

scale From - internality in relation to illness and health.

In this work, we used only one scale, namely the Scale of General Internality. High rate on this scale corresponds to a high level of subjective control over any significant situations, and a low score on the Io scale corresponds to a low level of subjective control. Other scales were not used because they are, firstly, all included in the "Scale of General Internality", and, secondly, this study does not require their separate interpretations.

Methodology "Study of the level of empathic tendencies" (I.M. Yusupov)

The technique was developed by the Kazan psychologist I.M. Yusupov to study empathy (empathy), i.e. the ability to put oneself in the place of another person and the ability for arbitrary emotional responsiveness to the experiences of other people. Empathy is accepting the feelings that another person is experiencing as if they were our own.

To identify the level of empathic tendencies, the subject must, answering each of the 36 statements, assign the following numbers to the answers: for the answer "I don't know" - 0, "no, never" - 1, "sometimes" - 2, "often" - 3, " almost always" - 4, and the answer "yes, always" - 5.

The technique allows assessing the degree of frankness of the answers of the subjects and identifying 5 levels of empathy: very high, high, medium, low, very low (Appendix 2)

Scales for assessing the level of reactive and personal anxiety (C.D. Spielberg, Yu.L. Khanin)

The Spielberger-Khanin test is one of the methods that investigate the psychological phenomenon of anxiety. This questionnaire consists of 20 statements related to anxiety as a state (a state of anxiety, reactive or situational anxiety) and 20 statements to define anxiety as a disposition, a personality trait (a property of anxiety). What Spielberger understands by both measures of anxiety can be seen from the following quote: "The state of anxiety is characterized by subjective, consciously perceived sensations of threat and tension, accompanied by or associated with activation or excitation of the autonomic nervous system." Anxiety as a personality trait, apparently, means a motive or an acquired behavioral disposition that obliges the individual to perceive a wide range of objectively safe circumstances as containing a threat, prompting them to respond with anxiety states, the intensity of which does not correspond to the magnitude of the real danger. Spielberger's Reactive and Personal Anxiety Scale is the only method that allows differentially measuring anxiety both as a personal property and as a state. In our country, it is used in the modification of Yu.L. Khanin (1976), which he himself adapted to the Russian language.

Significant deviations of anxiety indicators from the "psychological comfort zone" (31-45 points) require special attention.

High anxiety causes the appearance of an unpleasant and hampering human condition, in this case it is necessary to change the emphasis from fear of failure and disapproval of others to the content of the activity, its meaning, the process of implementation.

Low anxiety, on the contrary, requires the awakening of personality activity, interest and a sense of responsibility (Appendix 3).

"Methodology for diagnosing the level of emotional burnout" V.V. Boyko.

Emotional burnout is a stereotype of emotional, most often professional conduct. "Burnout" is partly a functional stereotype, since it allows a person to dose and economically spend energy resources. At the same time, dysfunctional consequences can also occur, when "burnout" adversely affects the performance of professional activities and relationships with partners. The term "partner" means the subject of professional activity. V pedagogical activity these are students.

The technique allows diagnosing the leading symptoms of "emotional burnout" and determining which phase of stress development they belong to: "tension", "resistance", "exhaustion". Using the semantic content and quantitative indicators calculated for different phases of the formation of the "burnout" syndrome, it is possible to give a fairly voluminous characteristic of the personality, assess the adequacy of the emotional response in a conflict situation, outline individual measures

The methodology consists of 84 judgments that allow diagnosing three phases of "emotional burnout": tension, resistance and exhaustion. Each phase of stress is diagnosed on the basis of four symptoms characteristic of it.

In accordance with the "key" the following calculations are carried out:

The sum of points is determined separately for each of the 12 symptoms of burnout.

The sum of symptom scores is calculated for each of the 3 phases of symptom severity formation.

The final indicator of the burnout syndrome is found - the sum of all twelve symptoms.

Stress phase	№	SYMPTOM
VOLTAGE	1
	2	Self dissatisfaction
	3	"Caged"
	4	Anxiety and depression
RESISTANCE	1
	2
	3
	4
EXHAUSTATION	1	Emotional deficit
	2	Emotional detachment
	3	Personal detachment (depersonalization)
	4

The proposed method gives a detailed picture of the "emotional burnout" syndrome. The severity of each symptom ranges from 0 to 30 points.

In each stage of stress, a score from 0 to 100 points is possible. However, comparison of the obtained scores by phases is not legitimate, since it does not indicate their relative role or contribution to the syndrome. The fact is that the phenomena measured in them are significantly different - the reaction to external and internal factors, methods of psychological protection, the state of the nervous system (Appendix 4)

2.2 Description of study results

The results of the diagnosis of the locus of control are presented in Appendix 5. The distribution of doctors and nurses by the level of the locus of control is presented in Table 1

Table 1

The results of the study of the locus of control in medical workers according to the method of J. Rotter

Table 1 shows that the majority of medical workers have a low level of both general internality and internality in their professional activities: it is expressed in 64% of doctors and 80% of nurses. This indicates the manifestation of their externality. They are characterized by outwardly directed protective behavior. Any situation is desirable to the external as externally stimulated, and in cases of success, one's abilities and capabilities are demonstrated. They are convinced that their failure is the result of bad luck, accidents, the negative influence of other people. Approval and support for such people is very necessary. However, one should not expect special gratitude for sympathy from them.

36% of doctors and 18% of nurses have a high level, which indicates the manifestation of internality. These medical workers are most often convinced that their successes or failures are not accidental, depending on their competence, purposefulness, level of abilities and being a natural result of purposeful activity and amateur activity. They have a broader time perspective, covering a significant number of events, facts, both future and past.

At the same time, their behavior is aimed at consistently achieving success through the development of skills and deeper processing of information, setting tasks that are ever increasing in complexity.

The need for achievement, therefore, tends to increase, associated with an increase in the values ​​of personal and reactive anxiety, which is a prerequisite for possibly greater frustration and less stress resistance in cases of serious failures.

However, in general, in real, externally observed behavior, internals give the impression of quite self-confident people, especially since in life they often occupy a higher social position than externals. These people believe that everything they have achieved in life is the result of their work and merit.

The severity of the locus of control in medical workers is shown in Figure 1.

Fig.1. Indicators of the severity of internality in medical workers according to the USK method.

The results of diagnosing empathic tendencies are presented in the table in Appendix 6

The distribution of doctors and nurses by the level of empathic tendencies is presented in Table 2

table 2

Empathic tendencies in medical workers according to the method of I. M. Yusupov

The distribution of doctors and nurses by levels of empathy showed that medical workers with an average level of empathy predominate (81.5% among doctors and 89% among nurses), which indicates that they have normal level empathy inherent in the vast majority of people. The level of sensitivity of such medical workers is at an average level, in interpersonal relationships they tend to judge others by their actions, rather than trust their personal impressions. They are not alien to emotional manifestations, but for the most part they are under self-control. In communication, such medical workers are attentive, they try to understand more than what is said in words, but if the interlocutor’s feelings are excessively influenced, they lose patience, however, medical workers with an average level of empathy find it difficult to predict the development of relationships between people, therefore, it happens that their actions turn out to be unexpected for them . They are not characterized by looseness of feelings, and this interferes with the full perception of people.

10.5% of medical workers have a high level of empathy. They are characterized by sensitivity to the needs and problems of others, generosity, a tendency to forgive them a lot. They treat people with genuine interest, are emotionally responsive, sociable, quickly establish contacts with others and find a common language with them, try to avoid conflicts and find compromise solutions. In evaluating events, they trust their feelings and intuition more than analytical conclusions. At the same time, they prefer to work with people rather than alone, they constantly need social approval of their actions.

A low level of empathy is expressed in 3% of doctors. It is typical for them to experience difficulties in establishing contacts with people, they prefer solitary pursuits in a specific business, rather than working with people. They prefer precise formulations and rational solutions. They are valued more for business qualities and a clear mind than for sensitivity and responsiveness.

Fig.2. Indicators of the severity of empathic tendencies in medical workers

The results of anxiety diagnostics are presented in Appendix 7.

The distribution of doctors and nurses according to the level of anxiety is presented in Table 3

The distribution of doctors and nurses according to the level of anxiety showed that most doctors and nurses have a moderate level of both reactive and personal anxiety, which indicates an adequate response to stressful situations.

Table 3

Reactive and Personal Anxiety in Medical Workers

Type of anxiety	Level	Doctors		nurses
		Number of people	%	Number of people	%
ST	high	10	36	9	32
	average	16	57	18	64
	short	2	7	1	4
LT	high	9	32	10	36
	average	19	68	17	61
	short	0	0	1	11

36% of doctors and nurses have a high level of situational and personal anxiety, which indicates an inadequate response to the situation in the form of high anxiety, which may be accompanied by low self-esteem.

11% of nurses have a low level of anxiety, which indicates calmness, self-confidence.

The results of diagnosing the severity of emotional burnout in medical workers are presented in Appendix 8

The results of the distribution of doctors and nurses according to the formation of the CMEA phases are presented in Figures 3-4.

From Figure 3, we see that the majority of doctors (46%) have a resistance phase. This indicates that these specialists have developed psychological defenses, resistance mechanisms.

The phase of tension in the majority (50%) is not formed, as well as the phase of exhaustion (43%).

Every third doctor has all three phases in the formation stage: tension (32%), resistance (32%), exhaustion (36%), this suggests that most specialists experience psycho-emotional tension and stress in the course of their work, which provoke development of symptoms of emotional burnout

Figure 3. Formation of the phases of CMEA in doctors.

From Figure 4, we see that the majority of nurses (72%), as well as doctors, have developed a phase of resistance, while the phases of tension and exhaustion have not been formed in the majority (57% and 50%, respectively). 29% of the subjects, the resistance phase in 14%, and the exhaustion phase in 39%.

This also indicates that nurses, as well as doctors, experience psycho-emotional stress, which causes burnout syndrome.

Fig. 4. Formation of the phases of SES in nurses

Let us consider the formation of individual symptoms of the CMEA phases in doctors and nurses.

Table 4

Formation of symptoms of the tension phase of CMEA in medical workers (in %)

An analysis of the symptoms of the tension phase showed that the symptom of emotional burnout "experiencing psychotraumatic circumstances" was formed in 57% of doctors and nurses. In the stress phase, this symptom is most pronounced in medical workers and is manifested by an increasing awareness of psycho-traumatic factors of professional activity that are difficult or completely unremovable, irritation with them gradually grows, despair and indignation accumulate. The insolvability of the situation leads to the development of other phenomena of "burnout". In 25% of doctors and 18% of nurses, this symptom is in the formation phase.

Syndrome "dissatisfaction with oneself" formed in 3%. These medical workers are dissatisfied with themselves, with their chosen profession, position, and specific responsibilities. There is a mechanism of "emotional transfer" - the energy is directed not only and not so much outside, but towards oneself. Impressions from external factors of activity constantly injure a person and encourage her to experience psychotraumatic elements of professional activity again and again. In this scheme, the well-known internal factors that contribute to the emergence of emotional burnout are of particular importance: intensive internalization of duties, roles, circumstances of activity, increased conscientiousness and a sense of responsibility. In the initial stages of "burnout" they escalate tension, and in the subsequent ones they provoke psychological defense. Most healthcare workers do not develop these symptoms,

The symptom of "being driven into a cage" was formed in 16% of medical workers. This symptom is a logical continuation of developing stress. That is, psychotraumatic circumstances affect health workers, and despite the fact that it is impossible to eliminate them, they experience a sense of hopelessness. This is a state of intellectual-emotional impasse.

Such a symptom of emotional burnout as "anxiety and depression" is formed in 21% of doctors and 14% of nurses, in the majority of medical workers (in 50% of doctors and 72% of nurses), this symptom is not formed. This syndrome is found in connection with professional activity in especially complicated circumstances, prompting emotional burnout as a means of psychological protection. The feeling of dissatisfaction with work and oneself is generated by powerful energy tensions in the form of situational or personal anxiety experienced by doctors, disappointment in oneself, in the chosen profession, in a specific position.

The results of diagnosing the formation of symptoms of the CMEA tension phase are shown in Figure 5.

Symbols: 1 - Experience of psychotraumatic circumstances; 2 - Dissatisfaction with oneself; 3 - "Caged in a cage"; 4 - Anxiety and depression

Fig.5. Formation of symptoms of the stress phase of CMEA in health workers

The phase of resistance is formed in the majority of health workers, let's consider the formation of its individual symptoms. The results of diagnosing the symptoms of the resistance phase are presented in Table 5

Table 5

Distribution of medical workers according to the formation of symptoms of the resistance phase of CMEA (in %)

№	Symptoms	Not formed		Formed		Formed
		doctors	nurses	doctors	nurses	doctors	nurses
1	Inappropriate emotional response	14	14	29	14	57	72
2	Emotional and moral disorientation	32	36	39	43	29	21
3	Expansion of the sphere of economy of emotions	46	36	21	21	33	43
4	Reduction of professional duties	25	18	28	25	46	57
phase of resistance		22	14	32	14	46	72

The symptom of "inadequate emotional response" is the most pronounced in this phase, it is formed in 57% of doctors and 72% of nurses, in 29% of doctors and 14% of nurses it is in the process of formation. The severity of this syndrome is an undoubted "sign of burnout", it shows that medical workers cease to grasp the difference between two fundamentally different phenomena: the economic manifestation of emotions and inadequate selective emotional response, demonstrating the latter.

The symptom of "emotional and moral disorientation" is expressed in 29% of doctors and 21% of nurses, while in most medical workers it is in the formative stage. This symptom, as it were, deepens the inadequate reaction in relations with patients and colleagues. Consequently, most doctors feel the need for self-justification. Without showing the proper emotional attitude to the subject, they defend their strategy. At the same time, judgments are made: “this is not the case to worry about”, “such people do not deserve a good attitude”, “you cannot sympathize with such people”, “why should I worry about everyone”, this is less typical for nurses

The symptom of "expansion of the sphere of economy of emotions" was formed in 33% of doctors and in 46% it was not formed, while among nurses this symptom was formed in 43% and in 36% it was not formed. The formation of this symptom indicates that health workers get tired at work from contacts, conversations, answers to questions, and they no longer want to communicate even with their loved ones. And often it is the family who become the first "victim" of emotional burnout. In the service, specialists still communicate according to standards and duties, and houses are closed.

The symptom of "reduction of professional duties" was formed in 46% of doctors and 57% of nurses in this sample; in 28% of doctors and 25% of nurses, this symptom is in the process of formation. Reduction is manifested in attempts to lighten or reduce responsibilities that require emotional costs - patients are deprived of attention. The doctor does not find it necessary to talk with the patient longer, to encourage a detailed presentation of complaints. The anamnesis turns out to be mean and insufficiently informative.

The results of the study of the formation of symptoms of the resistance phase of CMBS are shown in Figure 6.

Legend: 1 - Inadequate emotional response; 2 - Emotional and moral disorientation; 3 - Expansion of the sphere of economy of emotions; 4 - Reduction of professional duties

Fig.6. Formation of symptoms of the phase of resistance of CMEA in health workers

The distribution of doctors and nurses according to the level of symptom formation of this phase of exhaustion in table 5

Table 5

Formation of symptoms of the phase of exhaustion of CMEA in medical workers (in %)

№	Symptoms	Not formed		Formed		Formed
		doctors	nurses	doctors	nurses	doctors	nurses
1	Emotional deficit	43	46	28	32	29	21
2	Emotional detachment	50	61	21	36	29	3
3	Personal detachment	46	61	25	32	29	7
4	Psychosomatic and psychovegetative disorders	61	43	18	36	21	21
Exhaustion phase		43	50	36	39	21	11

For most medical workers, the "exhaustion" phase is in the formative stage. This phase is characterized by a more or less pronounced drop in the overall energy tone and a weakening of the nervous system. Emotional protection in the form of "burnout" becomes an integral attribute of the personality.

From Table 5, we see that the symptom of "emotional deficit" is formed in 29% of doctors and 21% of nurses, in most nurses (46%) and doctors (43%) this symptom is not formed. This symptom is manifested in the belief that emotionally a person can no longer help the subjects of his activity. Unable to enter into their position, to participate and empathize, to respond to situations that should touch, induce, enhance intellectual, volitional and moral impact. The fact that this is nothing more than emotional burnout is evidenced by his recent experience: some time ago there were no such sensations, and the person is experiencing their appearance. Gradually, the symptom intensifies and acquires a more complicated form: positive emotions appear less and less often and more often negative ones. Sharpness, rudeness, irritability, resentment, whims - complement the symptom of "emotional deficit".

The symptom of "emotional detachment" was formed in 29% of doctors and only in 3% of nurses, in 21% of doctors and 36% of nurses, the symptom was not formed, while this symptom was not formed in most medical workers. In the case of the formation of this symptom, doctors completely exclude emotions from the sphere of professional activity. They care about almost nothing, almost nothing causes an emotional response - neither positive nor negative circumstances. Moreover, this is not an initial defect in the emotional sphere, not a sign of rigidity, but emotional protection acquired over the years of serving people. Man gradually learns to work like a robot, like a soulless automaton. In other spheres he lives full-blooded emotions.

Reacting without feelings and emotions is the most striking symptom of "burnout". It testifies to the professional deformation of the personality and damages the subject of communication. Patients of such medical professionals usually experience the indifference shown to them and can be deeply traumatized.

The symptom of "personal detachment, or depersonalization" was formed in 29% of doctors and 7% of nurses, in most health workers it, like the previous symptom, was not formed.

This symptom manifests itself in a wide range of mentality and actions of a professional in the process of communication. First of all, there is a complete or partial loss of interest in a person - the subject of professional action. It is perceived as an inanimate object, as an object for manipulation - something has to be done with it. The object burdens with its problems, needs, its presence, the very fact of its existence is unpleasant. There is a depersonalized protective emotional-volitional anti-humanistic attitude. The personality claims that working with people is not interesting, does not give satisfaction, and does not represent social value.

The symptom of "psychosomatic and psychovegetative disorders" was formed in 21% of doctors and nurses. For most medical workers, it is also not formed.

This symptom manifests itself at the level of physical and mental well-being. Usually it is formed by a conditioned reflex connection of a negative nature: much of what concerns the subjects of professional activity provokes deviations in somatic or mental states. Sometimes even the thought of such subjects or contact with them causes a bad mood, bad associations, insomnia, a feeling of fear, discomfort in the heart, vascular reactions, exacerbation of chronic diseases.

The results of the study of the formation of symptoms of the phase of exhaustion of CMBS are shown in Figure 7.

Legend: 1 - Emotional deficit; 2 - Emotional detachment; 3 - Personal detachment; 4 - Psychosomatic and psychovegetative disorders

Fig.7. Formation of symptoms of the exhaustion phase of CMEA in health workers

Thus, in the course of diagnosing emotional burnout, we found that, among medical workers, the most pronounced symptoms of emotional burnout among doctors are such symptoms of emotional burnout as experiencing psychotraumatic circumstances (in 57% - a formed symptom), inadequate emotional response (in 57% - a formed symptom), reduction of professional responsibilities (an existing symptom in 46%),

The least pronounced symptoms of emotional burnout among doctors are dissatisfaction with oneself (an existing symptom - in 3%), "driven into a cage" (an existing symptom - in 18%)

For nurses, the most pronounced symptoms of emotional burnout are the experience of psychotraumatic circumstances (in 57% - a symptom that has formed), inadequate emotional response (in 72% - a symptom that has formed), the reduction of professional duties (a symptom that has developed in 57%), and the expansion of the sphere of saving emotions. (an established symptom in 43%), reduction of professional duties (an established symptom in 53%)

The least pronounced symptoms of emotional burnout in nurses are dissatisfaction with oneself (an existing symptom in 3%), emotional detachment (an existing symptom in 3%) and personal detachment (an existing symptom in 7%).

Let us analyze the formation of phases. The results are presented in Figure 8.

An analysis of the formation of phases in doctors showed that among them doctors prevail, in whom none of the phases is completely formed (50%), in 25% of doctors two phases are formed (33%), in 11% all phases are formed, in 14% 2 phases are formed. (Fig. 8).

Fig.8. The results of the analysis of the totality of the formation of phases for each medical worker

Among the nurses, those who have one phase completely formed (61%) also prevail, 21% have not a single phase completely formed, 14% have 2 formed at the same time, and only 3% have 3 phases formed at once.

At the same time, the analysis showed that in 18% of doctors and 11% of nurses, all phases are not formed (Appendix 8, sheet 3-4).

To determine the significance of differences in the severity of burnout syndrome among doctors and nurses, we used the Fisher slope φ. The results are presented in table 6

Table 6

The results of statistical analysis of differences in the formation of SES among doctors and nurses using the Fisher angular coefficient φ

Phases	№	Symptoms	Doctors		nurses		φ emp
			%	φ	%	φ
Voltage	1	Experience of traumatic circumstances	57	1,711	57	1,711	0
	2	Self dissatisfaction	3	0,348	3	0,348	0
	3	"Caged"	18	0,875	14	0,757	0,44
	4	Anxiety and depression	21	0,952	14	0,757	0,72
	Total		18	0,875	14	0,757	0,44
resistance	1	Inappropriate emotional response	57	1,711	72	2,026	1,178
	2	Emotional and moral disorientation	29	1,137	21	0,952	0,69
	3	Expansion of the sphere of economy of emotions	33	1,222	43	1,43	0,77
	4	Reduction of professional duties	46	1,481	57	1,711	1,09
	Total		46	1,481	72	2,026	2,27*
exhaustion	1	Emotional deficit	29	1,137	21	0,952	0,69
	2	Emotional detachment	29	1,137	3	0,348	2,95**
	3	Personal detachment	29	1,137	7	0,536	2,24*
	4	Psychosomatic and psychovegetative disorders	21	0,952	21	0,952	0
	Total		21	0,952	11	0,676	1,03

*at р≤ 0.05φ cr =1.66; ** at р≤0.01 φ Кр =2.28

From Table 6, we see that there were no significant differences between doctors and nurses in terms of the severity of the phases of tension and its symptoms, as well as the phase of exhaustion and symptoms of the resistance phase.

Significant differences between doctors and nurses exist only in terms of the severity of the resistance phase in general and the syndromes of the exhaustion phase, emotional and personal detachment.

Based on this, we can say that there are differences in the severity of EBS between doctors and nurses: nurses have more EBS.

Thus, the majority of medical workers have a formed phase of resistance to the syndrome of emotional burnout, as well as formed symptoms such as experiencing psychotraumatic circumstances, inadequate emotional response, reduction of professional duties.

The results of a study of the personal characteristics of medical workers showed that most of them have an external locus of control, an average level of empathy and moderate anxiety.

2.3 Analysis of the study results

A summary table of the results of the study of personal characteristics and the formation of SES among doctors and nurses is presented in Appendix 9.

Let us compare the results of the study of the severity of BS and the level of internality among medical workers. The results of the analysis are presented in table 8.

An analysis of the results of the study of the severity of SES and internality showed that the majority of doctors and nurses with a high degree of internality did not form any phase of SES.

With low internality, in most doctors and nurses, the stress phase is also not formed, the resistance phase is formed, and the exhaustion phase is formed.

Table 8

The degree of severity of the phases of EBS in medical workers with different levels of internality (in %)

The degree of phase formation	The level of internality with varying degrees of formation of the SEV phases
	voltage		resistance		exhaustion
	high	short	high	short	high	short
doctors	formed	20	17	30	55	20	22
	formed	20	39	20	39	20	45
	not formed	60	44	50	6	60	33
nurses	formed	20	13	40	78	20	9
	formed	20	20	20	13	0	48
	not formed	60	57	40	9	60

Thus, we can note that the lower the level of internality, the more pronounced the resistance phase.

Analysis of the results of the study of the formation of BS and the severity of empathy is presented in table 9

Table 9

Severity of SEB phases in medical workers with different levels of empathy (in %)

phase	Phase formation level	The level of empathy among doctors			The level of empathy in nurses
		high	average	short	high	average
voltage	formed	0	13	100	0	16
	formed	67	30	0	0	32
	not formed	33	57	0	100	52
resistance	formed	67	39	100	67	72
	formed	0	39	0	0	16
	not formed	33	22	0	33	12
exhaustion	formed	33	17	50	0	12
	formed	33	39	0	0	44
	not formed	33	43	50	100	44

As we can see from the table, most doctors and nurses with a high level of empathy have formed only the resistance phase.

With a low level of empathy in physicians, the phases of SES are formed, the phase of exhaustion is not formed in 50%, and in the same number it is formed.

With an average level of empathy in most medical workers, the tension phase is not formed, as well as the exhaustion phase, while the resistance phase is formed.

Thus, the lower the empathy, the more pronounced the SEB.

The results of the analysis of the level of anxiety and the severity of SES are presented in Table 10.

Table 10

Severity of SES phases in medical workers with different levels of anxiety (in %)

Phase	Phase formation level	The level of anxiety of doctors					Nurse Anxiety Level
		high		average		short	high		average		short
		ST	LT	ST	LT	ST	ST	LT	ST	LT	ST	LT
voltage	formed	40	45	6	5	0	45	30	0	6	0	0
	formed	10	33	50	31	0	22	50	33	18	0	0
	not formed	50	22	44	63	100	33	20	67	76	100	100
resistance	formed	50	67	50	37	0	89	90	61	65	100	0
	formed	20	22	38	37	50	11	10	17	12	0	100
	not formed	30	11	12	26	50	0	0	22	18	0	0
exhaustion	formed	50	45	6	10	0	22	2	6	6	0	0
	formed	30	22	44	42	0	67	60	28	29	0	0
	not formed	20	33	50	47	100	11	20	67	65	100	100

The study showed that in most doctors and nurses with a high level of situational anxiety, both the resistance phase and the exhaustion phase are formed, the stress phase is not formed in half of the doctors, in the other 40% it is formed, and in 10% of doctors it is in the formation stage.

With low situational anxiety in doctors and nurses, the phases of SES are not formed, or are being formed.

With high personal anxiety, the stress phase is formed in most doctors, while in most nurses it is not formed. A low level of personal anxiety was not revealed by more than one doctor. In nurses with low personal anxiety, the stress and exhaustion phases are not formed, and the resistance phase is in the process of formation.

Thus, the higher the level of anxiety among doctors and nurses, the more pronounced the SEB.

And so, on the basis of the analysis carried out, we can note the existence of a connection between personal characteristics and the severity of SEV.

To test the statistical significance of the identified relationships, we used the Spearman rank correlation coefficient.

The results of the correlation analysis are presented in Table 11.

Table 11

The results of the correlation analysis of the relationship between the severity of SES and personal characteristics in doctors and nurses using the Spearman correlation coefficient (N=28)

Phase	Locus of control	Empathic tendencies	situational anxiety	Personal anxiety
Doctors	voltage	-0,127	-0,467*	0,39*	0,48**
	resistance	-0,39*	-0,12	0,39**	0,52**
	exhaustion	-0,46*	-0,15	0,52**	0,50**
	CMEA	-0,47*	-0,245	0,51**	0,56**
nurses	voltage	-0, 26	-0,39*	0,42*	0,49**
	resistance	-0,47*	-0,18	0,44**	0,59**
	exhaustion	-0,46*	-0,25	0,54**	0,53**
	CMEA	-0,42*	-0,32	0,53**	0,66*

*at p≤ 0.05 r cr =0.38; ** at р≤0.01 r Кр =0.48

Correlation analysis showed that there are significant direct relationships among doctors and nurses, both between the phases of SES, and the general indicator of SES and situational and personal anxiety, as well as significant feedbacks between the level of the locus of control and the phases of resistance, exhaustion, and in general SES and the level empathy and tension phase

Thus, the higher the level of anxiety and the lower the level of internality and empathy, the more pronounced emotional burnout.

And so, in the course of this study, we confirmed that the severity of the burnout syndrome is interconnected with the personal characteristics of doctors and nurses.

High anxiety causes nervous tension, doctors and nurses react to a greater number of situations with a state of anxiety, therefore, more stressors and less ability of the nervous system to resist them.

With an external locus of control, doctors and nurses are focused on external assessment and are more willing to comply with it, all this in turn causes high anxiety and burnout.

Empathy as the ability of an individual to penetrate the state of another person with the help of imagination and intuition contributes to the balance of interpersonal relationships. Developed empathy is the key to success in all activities that require empathy into the world of a communication partner and understanding of his experiences. In our study, we confirmed the data obtained by other researchers that high empathy prevents the occurrence of EBS, however, we identified this pattern only in the stress phase, but this trend was noted at a qualitative level.

Thus, based on the study, we can do the following: conclusions:

1. The locus of control, both general and in the field of professional activity, is external in 64% of doctors and 82% of nurses, that is, most medical workers are characterized by outwardly directed protective behavior. Any situation is desirable for them as externally stimulated, and in cases of success, a demonstration of their abilities and capabilities occurs. They are convinced that their failure is the result of bad luck, accidents, the negative influence of other people.

2. Most medical professionals (80.5% of doctors and 89% of nurses) have an average level of empathy. The level of sensitivity of such medical workers is at an average level, in interpersonal relationships they tend to judge others by their actions, rather than trust their personal impressions. They are not characterized by looseness of feelings, and this interferes with the full perception of people.

3. Most medical workers have a moderate level of both reactive (57% of doctors and 64% of nurses) and personal anxiety (68% of doctors and 61% of nurses), which indicates an adequate response to stressful situations.

4. The majority of medical workers (46% of doctors and 72% of nurses) have a phase of resistance, which indicates that these specialists have developed psychological defenses and resistance mechanisms. The phases of stress and exhaustion are not formed in the majority. The most pronounced among medical workers are such symptoms of emotional burnout as experiencing psychotraumatic circumstances, inadequate emotional response, reduction of professional duties;

5. Significant differences between doctors and nurses exist only in the severity of exhaustion phase syndromes, emotional and personal detachment. Based on this, we can say that the hypothesis about the presence of differences in the severity of SES among doctors and nurses was confirmed;

6. With low internality, in most medical staff, the stress phase is not formed, the resistance phase is formed, and the exhaustion phase is formed. With a low level of empathy, most medical workers have all phases of SEB, with a high level of empathy, the SEB phases are either not formed or are in the process of formation, and most medical workers with a high level of anxiety have both a stress phase and phases of resistance and exhaustion. while with low anxiety among employees, the phases of CMEA are not formed, or are being formed.

7. Correlation analysis showed that there are significant relationships between the severity of SES and the personal characteristics of doctors and nurses, which confirms the hypothesis that there is a relationship between the severity of SES and such personal characteristics of medical workers as locus of control (p≤0.01), empathy (p≤ 0.05), personal (p≤0.01) and situational anxiety (p≤0.01)

Conclusion

In this thesis work, we studied the formation of BS in medical workers with different personal characteristics.

Theoretical analysis of the literature on the research problem showed that medical workers are most often subject to SEV, which is due to the peculiarities of their professional activity, which consists in helping other people, high responsibility for their health and life.

By the nature of their activities, medical workers are exposed to various adverse factors of the working environment and the labor process itself, which include: harmful chemicals and biological agents, ionizing radiation, noise, vibration, carcinogens, high neuropsychic stress, forced position of the body during work, overvoltage of analyzer systems, etc.

There is a general concern that the medical specialty itself contributes to the development of disease states. This manifests itself as disillusionment with the profession and demoralization, an increasing tendency to contemplate leaving the profession, as well as a deterioration in the mental health of medical practitioners, a decrease in the stability of marriages among medical professionals, and the development of a tendency to use psychoactive substances and alcohol.

Western researchers see the reasons for the burnout of physicians in the social sphere and culture. Fragmentation and stratification of society, reduced access to public and family resources are placing increasingly higher demands on the work of specialists, dictating at the same time the need for assistance and change.

It is known that making direct decisions about the methods of medical influence and responsibility for them to a greater extent belongs to the doctor, while the nursing staff fulfills the doctor's prescriptions. However, nurses daily deal with pain, suffering, fear of their sick relatives and, like doctors, experience emotional stress.

Based on the fact that the specificity of professional activity has an impact on the formation of EBS in health workers of different categories, we studied the formation of phases and syndromes of EBS in doctors and nurses. The study showed that most doctors and nurses have a resistance phase, the symptoms of which reflect the formation of protective mechanisms, mechanisms of resistance to psycho-traumatic influences, while the formation of these symptoms deforms the personality of a professional. Typical are "emotional dullness", inadequacy of emotional reactions, a formal attitude to their duties, the health worker, as it were, takes the position of "nothing personal".

The study did not reveal the predominance of workers with a formed phase of exhaustion among the medical staff, which indicates a high resistance to stress.

In the course of statistical analysis, we revealed significant differences in the formation of the resistance phase and such symptoms of the exhaustion phase as emotional and personal detachment among doctors and nurses. Thus, the hypothesis about the presence of differences between doctors and nurses in the severity of SES was confirmed.

An analysis of the personal characteristics of medical workers showed that among them, people with an external locus of control, an average level of empathy and moderate anxiety predominate. Comparison of the data of the SEB study and personal characteristics and correlation analysis made it possible to establish that the higher the level of anxiety and the lower the level of internality and empathy, the more pronounced emotional burnout among doctors and nurses. This allows us to say that the hypothesis about the relationship between the severity of CMEA and personal characteristics has been confirmed.

Thus, the results obtained in the course of the study can be used in the development of methods for preventing and overcoming emotional burnout in particular and professional deformation of the personality in general of medical workers and are of interest to psychologists, personnel specialists, and managers.

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Progressive feelings of one's own professional inferiority, hostility towards colleagues and clients, lack of desire to go to work, which arose in a person who previously had a good attitude towards his work - this is not a characteristic of a bad employee. Most often this happens when a person develops a syndrome of emotional burnout.

What it is

The syndrome of emotional burnout is a condition when emotional, and then mental, and physical exhaustion develop and progress first. With such a reaction, the body responds to chronic stress, which is mainly associated with the professional activity of a person. The initial manifestations of emotional burnout are unwillingness to go to work, which previously not only did not cause negative emotions, but also brought satisfaction, a feeling of weakness, and a decrease in interest in what was happening. If no measures are taken, the loss of emotional, cognitive and even physical energy progresses.

Work experience, marital status do not play a special role in the development of the syndrome. It develops when several causes appear, which can be divided into: personal factors and situational problems.

The first group includes such personality traits:

• humanism;
• pessimism;
• orientation to the surrounding people;
• prolonged internal experience of negative situations at work;
• introversion;
• loyalty to some idea;
• the desire to take control of everything;
• tendency to emotional enslavement;
• propensity to self-sacrifice;
• inability to refuse;
• high expectations from the results of their professional activities;
• propensity to daydream;
• idealized outlook on work and life.

Situational causes include:

• activities that are subject to increased control;
• high responsibility;
• competition in the workplace;
• no integration of actions with other people;
• conflicts with colleagues or superiors;
• work is monotonous or primitive;
• poor organization of work;
• many hours of work;
• lack of sufficient moral or financial remuneration for work;
• lack of a clear job description;
• psychologically difficult contingent with whom you need to communicate at work;
• lack of time for rest;
• lack of support from friends or family.

Especially often the syndrome develops in young people whose activities are connected with people who put their soul into work, worry about it, bearing the burden of responsibility on their own.

Operating under shared responsibility reduces the risk of developing the syndrome.

Symptoms

The syndrome develops gradually: first appear early signs, then, if the person ignores them, the following develop.

The first stage of burnout is emotional burnout, which is considered by psychologists as a defensive reaction to the conflict of a predisposed personality with the work environment and type of activity. It manifests itself:

• emotional overstrain, turning into exhaustion;
• feeling drained and weakened for the rest of the day;
• a feeling of indifference to surrounding events.

The second stage - depersonalization - is manifested by a decrease in interest in communicating with colleagues, loss of motivation, a more cynical life position, and irritability. Sometimes, on the contrary, a person becomes extremely dependent on the opinions of colleagues.

At the third stage, there is a reduction of one's own achievements, which manifests itself:

• lack of confidence in their competence;
• a decrease in job satisfaction;
• negative attitude to their official duties;
• a decrease in the severity of self-esteem;
• indifference to others;
• communication discomfort.

In addition to emotional, other symptoms appear - physical, behavioral and psychological.

Physical features include:

1. Fatigue;
2. Decreased appetite;
3. Frequent headaches;
4. Symptoms of diseases of the heart and blood vessels.

Behavioral symptoms are a decrease in labor productivity, unreasonable mood changes, "explosions" of emotions. The same group of signs includes the loss of a sense of humor, a decrease in self-criticism, and progressive lack of initiative.

Psychological symptoms include:

1. Disappointment in work and personal life;
2. Decreased interest in work;
3. Frequent mood swings;
4. Feelings of hopelessness and others.

Risk professions

Are at risk of emotional burnout:

• health workers: they serve as either a “vest” or a “target”;
• teachers. The syndrome develops as a result of constant psycho-emotional stress, poor organization of work, pressure from superiors, colleagues, parents of students, and so on;
• psychologists who constantly experience psycho-emotional stress, listening to the negative;
• employees of law enforcement agencies and the Ministry of Emergency Situations;
• social workers;
• operators who are "intermediaries" between man and machine.

Diagnostics

The diagnosis is made by a psychiatrist or psychotherapist based on a combination of a person's complaints of fatigue, weakness, irritability or drowsiness, deterioration in the tolerance of emotional and physical stress, a change in attitude towards clients/colleagues. It is important that these symptoms appeared after a period when a person was 100% absorbed in work, ignoring his own needs. Fatigue and emotional exhaustion do not disappear after a full night's sleep, if after that a person goes to work. A person's self-esteem decreases. During the examination, the therapist did not reveal any signs of somatic diseases.

Burnout syndrome is treated by a psychologist or psychotherapist. For this you need:

1. Take a vacation, change your surroundings.
2. Spend more time with nice people.
3. Find what makes you happy and do it.
4. More time to devote to what you love: reading, drawing, embroidery.
5. Do sports more often.
6. Receive regular training to improve your skills.
7. Revisit priorities.
8. Refine your job description.
9. Actively solve your problems.

Prevention

Methods of prevention are similar to those of treatment:

• rest regularly;
• do not forget about holidays;
• go in for sports, yoga, dancing - what will bring pleasure;
• constantly engage in self-education;
• do not engage in self-discipline, but correct your mistakes;
• sleep enough time;
• take breaks at work
• learn to refuse
• reduce the use of brain stimulants (coffee, guarana, cola, chocolate);
• master relaxation techniques;
• eat healthy food;
• find time every day when you need to turn off your phone and computer, relax.

Below is a video lecture by a psychologist about the problem:

BURNOUT SYNDROME IN MEDICAL WORKERS

Meged E.V.

KUZ VO "VOKPND"

Ulyanova O.V.

FGBOU VO VGMU im. N.N. Burdenko of the Ministry of Health of Russia,

Department of Psychiatry and Neurology IDPO

Russia, G . Voronezh

Annotation.The professional activity of medical workers involved in the treatment and rehabilitation of patients involves emotional richness and a high percentage of stress-causing factors. The article deals withdevelopment problemburnout syndrome (BS)with doctors and others medical workers in the course of their professional activities.

Keywords: doctors, distress,exhaustion, medical workers,occupational stress, psychologists,recovery strategies, uh emotional burnout.

Relevance. According to the WHO, “Burnout Syndrome” is a physical, emotional or motivational exhaustion characterized by impaired work productivity and fatigue, insomnia, increased susceptibility to physical illness, and the use of alcohol or other psychoactive drugs (PSA) in order to obtain temporary relief, which tends to to the development of physical dependence and (in many cases) suicidal behavior [ 10 ] . This syndrome is usually regarded as a stress response in response to relentless work and emotional demands resulting from an individual's excessive devotion to his work and the concomitant neglect of family life and recreation.Scope of activity of medical workersis a profession with the greatest tendency to “burn out”, since the whole working day is constant communication with people, moreover sick and their relativesrequiring care, attention and restraint[ 1 ‒ 4 , 6 , 7 , 9 , 10 , 12 , 14 ] .

According to the classification of professions« criterion of difficulty and harmfulness» (according to A.S. Shafranova), medicine belongs to the profession of the highest type on the basis of the need for constant extracurricular work on the subject and oneself. At 60‒ 1990s in the USA for the first timeterm was introducedprofessional deformation» in the professions «man-man» in which the social environment significantly affects the efficiency of work. Conclusions were drawn about the existence of professional deformation and the need for special professional selection in the professions of the "human‒ Human».

SEB was first described in 1974 by an American psychologist. Freidenberger to describe the demoralization, disillusionment, and extreme weariness that he observed in psychiatric workers. The model he developed turned out to be convenient for estimating given health workers' conditions‒ occupations with the greatest aptitude for"burnout" . After all, their working day‒ this is constant close communication with people, moreover, patients who require vigilant care and attention, restraint[ 1 , 4 , 5 , 6 , 10 , 11 , 13 , 14 ] .

The main symptoms of SES are:fatigue, exhaustion, exhaustion after vigorous professional activity;psychosomatic problems (fluctuations in blood pressure(HELL) , headaches, diseases of the digestive and cardiac ‒ vascular systems(CCS) , neurological disorders, insomnia);the emergence of a negative attitude towards patients (instead of previously existing positive relationships); negative attitude to the activities performed;aggressive tendencies (anger and irritability towards colleagues and patients);functional, negative attitude towards oneself;anxiety, pessimism, depression, sense of meaninglessness of ongoing events, guilt[ 1 , 4 , 5 , 6 , 8 , 9 , 10 , 11 ] .

Mental burnout is understood as a professional crisis associated with work in general, and not only with interpersonal relationships in the workplace.process her. Burnout can beequate to distress: anxiety, depression, hostility, anger in its extreme manifestation and to the third stage of the general adaptation syndrome‒ stages of exhaustion. burnout‒ not just a result of stress, but a consequence of unmanaged stress[ 3 , 4 , 6 , 7 , 13 , 14 ] .

The the syndrome includes three main components: emotional exhaustion, depersonalization (cynicism) and reduction of professional (decrease in personal) achievements:emotional exhaustion‒ feelings of emotional emptiness and fatigue caused by their own work;depersonalization‒ cynical, indifferent attitude to work and objects of one's work;reduction of professional achievements‒ the emergence of a feeling of incompetence in their professional field, the realization of failure in it[ 1 , 4 , 5 , 8 , 9 , 11 , 12 , 14 ] .

Most of all, those who make unreasonably high demands on themselves are at risk of developing BS. Individuals in this category associate their work with a purpose, a mission, so the line between work and personal life is blurred for them. There are three categories people at risk of CMEA:"pedantic" type - characterized by conscientiousness elevated to the absolute; excessive, painful accuracy, the desire in any business to achieve exemplaryorder (albeit to the detriment of itself);« demonstrative" a type , characterized by the desire to excel in everything, always be in sight. At the same time, they are characterized by a high degree of exhaustion when performing inconspicuous, routine work, and overwork is manifested by excessive irritability and anger.

The third type is "emotive" , characterized by unnatural sensitivity and impressionability. Their responsiveness, the tendency to perceive someone else's pain as their own, borders on pathology, self-destruction, and all this with a clear lack of strength to resist any adverse circumstances.[ 3 , 4 , 7 , 8 , 10 , 12 , 14 ] .

SEV includes 3 stages, each of which consists of 4‒ x symptoms.

First stage – Voltagecharacterizedthe following symptoms:dissatisfaction with oneself;"driven" into a cage"; survived nie psychotraumatic situations;anxiety and depression.

Second stage ‒ resistance : inadequate, voternew emotional response; emotionally - moral disorientation; expansion of the sphere ry economy of emotions;reduction of professional duties.

Third stage ‒ exhaustion: emotional deficit; emotional detachment;personal detachment; psychosomatic and psychovegetative violations[ 1 , 2 , 5 , 6 , 7 , 10 , 11 , 13 , 14 ] .

Many factors influence the appearance and severity of EBS. The closest relationship with burnout is age and work experience in the profession. Revealed that the nursing staff of psychiatric clinics"burn out" 1.5 years after starting work, and social workers begin to experience this symptom after 2‒ 4 years. The propensity of younger workers to burnout is explained by the emotional shock they experience when confronted with a reality that often does not meet their expectations. It was found that men have higher scores for depersonalization, and women are more prone to emotional exhaustion. This primarily due to the fact that men are dominated by instrumental values, while women are more emotionally responsive and have less sense of alienation from their clients. A working woman experiences higher work overloads (compared to men) from‒ peradditional household and family responsibilities, but women are more productive than men in using stress avoidance strategies[ 1 , 3 , 4 , 5 , 10 , 13 , 14 ] .

Carried out research showing an association between marital status and burnout. They note a higher degree of predisposition to burnout of persons (especially males) who are not married. Moreover, bachelors are more prone to burnout, even in comparison.relationship with divorced men.

According to British researchers, disability in medical workers in almost half of cases is associated with stress. A third of doctors took medications to correct emotional stress, the amount of alcohol consumed exceeded the average level. It has been established that one of the factors of the "burnout" syndrome is the duration of the stressful situation, its chronic nature.

The development of chronic stress among representatives of communicative professions is influenced by: restriction of freedom of action and usethe existing potential;monotony of work;a high degree of uncertainty in the assessment of the work performed; dissatisfaction with social status[ 1 , 3 , 5 , 7 , 9 , 11 , 13 ] .

Many doctors have no one other than their spouse to talk to about anything.‒ somedaypersonal. In doing so, they risk damaging personal relationships by bringing professional matters into the home and failing to fulfill other responsibilities. By data Western periodicals, the number of divorces in the families of doctors per 10‒ 20% higher than in the general population. Marriages in which husband and wife‒ healthcare workers are more likely to be unhappy[ 3 , 4 , 5 , 9 , 10 , 11 , 14 ] .

Conducted a large number of research in which documentary evidence ena wide th prevalencedissatisfaction Yu profession and a sense of regret in connection with the choice of a medical career. Increased workloads, working hours, overtime stimulate the development of burnout. Breaks from work have a positive effect and reduce burnout, but this effect is temporary: the burnout level partially increases three days after returning to work and fully recovers after three weeks.

Physicians and nurses experience higher burnout than hospital attendants, with higher levels seen in oncology medical staff.branches. Comparative analysis of staff working outside hospitals (for example: doctors in private practice) with mentally ill people and in hospitals shows that the first group of workers is most prone to burnout. Pines and Maslach (1978) found that the longer staff worked in psychiatric institutions, the less they enjoyed working with the sick, the less successful they felt, and the less humane their treatment of the mentally ill.[ 4 , 5 , 8 , 14 ] .

In studying emotional distress in physicians, psychologist King (1992) made a startling conclusion: “Doctors working in a medical institution are subject to significant personal distress, it is difficult for them to open up to anyone‒ anything outside of your immediate family and circle of friends» . Predominant feature of the medical profession‒ deny problems related to personal health. burnout‒ not just a result of stress, but a consequence of unmanaged stress. According to Grainger (1994):« Physicians receive a lot of training in the theory and practice of medicine, but very little in how to take care of themselves and deal with the inevitable stresses. » .

CMEA ‒ Why is it common in doctors?

CMEA (as well as other disorders associated with professional activity), representatives of professions associated with direct work with people and / or high responsibility for others are primarily affected (especially when it comes to life, health and safety)[ 1 , 2 , 5 , 9 , 10 , 12 , 14 ] .

The work of a doctor, by definition, requires significant emotional investment, as it is associated with communication with people and with all the difficulties that result from this (negative emotions, etc.).erenos, feelings, conflicts)[ 1 , 4 , 5 , 6 , 9 , 10 , 13 , 14 ].

The work of a doctor requires intellectual and temporary investments in studies and permanent postgraduate education both within the framework of advanced training courses and independently.

The work of a doctor is often associated with stress, night shifts, irregular working hours[ 4 , 5 , 10 , 13 , 14 ] .

The doctor needs a circle of professional communication. And the problems in relations with colleagues (isolation, conflicts) the doctor, as a rule, is going through hard, 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 in case of conflicts with colleagues and difficulties in communicating with management.

Also in the work of a doctor there are many difficulties associated with the managementmedical recordswhich is time consuming and can be a source of conflict with management.The need to financially provide for oneself and the family often comes into conflict with the professional aspirations of a doctor.[ 1 , 4 , 5 , 8 , 9 , 12 , 13 , 14 ] .

All of the above factors hang like a sword of Damocles over the head of every doctor, threatening him with the development of chronic fatigue syndrome(CFS) , entailing a whole range of psychosomatic disorders. That is why SEB is a serious problem in the oh category of working people.

CMEA develops gradually over a long period of time. It does not come suddenly, overnight. If you do not pay attention to the warning signs of burnout in time, then it will certainly come. These signs are subtle at first, but over time are getting worse. Need to remember that early signs CMEA - sort of red flags telling you that something you are not in order and you need to make a decision to prevent a breakdown. If you ignore them, you will eventually SEV [ 1 , 2 , 4 , 6 , 8 , 9 , 14 ] .

physical signs CMEA : feeling tired, exhausted, dizzy, weight change;decreased immunity, feeling unwell, excessive sweating, trembling;problems with appetite and sleep, diseases CCC; frequent headaches, dizziness, back and muscle pain.

Emotional Signs CMEA : feeling of failure and self-doubt, indifference, exhaustion and fatigue;feeling of helplessness and hopelessness, emotional exhaustion, loss of ideals and hopes, hysteria;more and more often a cynical and negative forecast is made, other people become faceless and indifferent (dehumanization);detachment, feelings of loneliness, depression and guilt;decreased satisfaction and sense of accomplishment, mental anguish;loss of motivation and professional prospects, negative perception of their professional training.

behavioral signs CMEA : avoidance of responsibility, impulsive emotional behavior;social isolation;transferring their troubles to others;individual jobs require more time than before;work more than 45 hours a week, insufficient physical activity;using food, drugs, or alcohol to cope with problems[ 1 , 4 , 5 , 8 , 9 , 10 , 14 ] .

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

CMEA it is especially dangerous because, against the background of growing problems, a person (even a doctor!), instead of starting to analyze the problem and solve it, closes in on himself, is inactive, moves away from people, which further exacerbates the painful condition[ 1 , 2 , 5 , 6 , 7 , 8 , 11 , 12 ] .

CMEA , as studies have shown, has another unpleasant feature: unlike a runny nose or "cold", it does not disappear on its own‒ it takes effort to get rid of it. Of course, the ideal option would be to visit a psychologist and work with him on this issue. However, not all of us can afford this form of assistance. Therefore, let's try to follow the famous commandment "Physician, heal yourself!"[ 1 , 4 , 5 , 6 , 7 , 10 , 13 , 14 ] .

CMEA occurs against the background of informational and emotional overload from‒ perlack of processing and transformation of this material. So there is only one way out‒ learn to manage emotions and relax, analyze arrays of information qualitatively and correctly prioritize both in daily work and in the future.

CMEA introverts are more vulnerable than extroverts‒ this is due to the fact that introverts do not tend to "publish" emotions.

CMEA in many cases arises from the realization that in daily practice the “golden ratio” of the cost / reward ratio has been violated (take into account: rewards can be not only material).

The way out: analyze what your expectations from the job are and how it justifies them, and then answer honestly to yourself what is needed in order for professional activity to bring true satisfaction.

Each of us has a need for achievements, increased comfort, income, status. If we do not get what we are striving for for a long time, we experience irritation and dissatisfaction, leading to CMEA ! Therefore, in the fight against CMEA do not compromise with yourself or ignore your own desires‒ you have to follow your dream.Do you think your calling‒ not to accept patients, but to lecture 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? Go to courses like ultrasound or laparoscopic surgery.Don't want or can't work with people anymore? Consider moving to the laboratory, histology department, research department.

Not enough money? There are many options here: from changing a job in a public clinic to a private one (for starters, at least in the form of additional consultations) to leaving medicine‒ e.g. in the pharmaceutical business[ 4 , 5 , 8 , 9 , 10 , 12 , 13 , 14 ] .

Don't you love your job deep down at all? Then develop a career change plan. Even a doctor has only one life, and he, as the classic said, "should live it in such a way that it would not be excruciatingly painful for the aimlessly lived years."VAll of the above requires certain emotional and material costs. But in this case, the risk is justified: good mood, new professional prospects and financial opportunities will positively affect the life of any individual. And vice versa‒ if you don't do anything,CMEAwill turn his "victim" into an unhappy, irritated person suffering from feelings of loneliness. And for the doctor it is disastrous!

CMEAa certain monotony of the daily routine can also cause: work scheme‒ House‒ the work typical of a doctor does not seem to everyone the embodiment of a dream of happiness! In this case, sports, hobbies, communication with loved ones, trips to resorts are auxiliary ways to compensate for SEB. And also‒ breathing techniques, autogenic training, meditative techniques, limiting alcohol and coffee intake, aromatherapy.

OIt is very useful to learn to separate work and everything that is not connected with it. Do not allow yourself to deal with professional problems outside of the working day. Do time‒ out during work‒ breaks for 5‒ 10 minutes every 2 hours. During breaks, forbid yourself to think about the “work topic”‒ better take a deep breath, take a walk... or just imagine a sheet of white paper in front of you. These measures will help to “stabilize” faster and easier, and, therefore, to cope withCMEA[ 3 , 4 , 7 , 8 , 9 , 13 , 14 ] .

HDon't delay helping yourself because the process of self-destruction may go too far. And then it will be difficult to do without consulting a psychologist. Vveryadvanced cases may even require drug therapy‒ sedatives, anxiolytics, tranquilizers, antidepressants[ 1 , 4 , 5 , 8 , 9 , 10 , 13 , 14 ] .

Psychologist's advice on the prevention of emotional burnout

Develop a relaxing ritual for yourself . For example, as soon as you wake up, immediately get out of bed. Meditate for at least fifteen minutes. Read what‒ that which inspires you. Listen to your favorite music.

Eat healthy food, do exercise . When you eat right, get regular physical activity, and get plenty of rest, you will have higher energy and resilience to life's annoyances and demands.

No need to play along . If you don't agree with what‒ then, then firmly answer "no", agree‒ "Yes". Believe me, it's not difficult. Don't overexert yourself.

Take a daily technology break for yourself . Set a time when you can switch off completely. Leave alone your laptop, phone, social networks, email. Analyze the past day, pay more attention to the positive aspects.

Support your creativity . It is that powerful antidote that will help you in the fight againstCMEA. Create which‒ some new interesting project, come up with a new hobby.

Use stress prevention techniques . If you are still on the road to burnout, try to prevent stress by using meditation techniques, take breaks from work, write down your thoughts in a journal, take up your favorite hobby and other activities that have nothing to do with your work.[ 1 , 2 , 5 , 10 , 13 , 14 ] .

recovery strategy #1: Slow down .

If the final stage has comeCMEA, try to look at everything that brought you into such a state with different eyes. Think and take care of your health. You need to rethink your attitude towards your work and personal life, force yourself to consider taking a break from work and healing.

recovery strategy #2: Get Support .

When you're burned out, the natural urge is to isolate yourself in order to protect the energy that's left in you. This is a step in the wrong direction. In these hard times your friends and family are more important to you than ever‒ or. Contact them for support. Just share your feelings with them, it can alleviate your condition a little.

recovery strategy #3: Revisit your goals and priorities . If you have reached the burnout stage, it is likely that what‒ that's not how it works in your life. Analyze everything, do a reassessment of values. You must properly respond to warning signs as an opportunity to re-evaluate your current life. Take the time to consider what makes you happy and what is important to you. If you find yourself neglecting significant activities or people in your life, change your attitude accordingly.[ 1 , 4 , 5 , 6 , 9 , 12 , 13 , 14 ] .

Some more helpful tips . The most effective way is to stop doing what you have been doing up to now. It could be a job change, a career change, a change of residence. But if that's not an option for you, then there are other possibilities to improve your situation or state of mind.

Proactively solve your problems . Manifest active position rather than being passive to solve problems in your workplace, try to eliminate stressful situations at work. You will feel less helpless if you make yourself known and express your needs. Ifyou don't have the capacity to solve the problem, talk to your boss.

Refine your job description . Ask your manager to clarify your job responsibilities. Remind him of the types of work that you had to do recently outside of your functional duties.

Ask for new responsibilities . If you've been doing your job for long enough, ask to try something new: different level of work, different sales territory, different working conditions.

Carve out time . If burnout seems inevitable, take a complete break from work. Ask for regular or unpaid leave, use sick leave. It is important to get out of this situation. Use the time to "recharge your batteries" and embrace a new perspective[ 1 , 4 , 5 , 8 , 9 , 10 , 13 , 14 ] .

If there is no relief after following these tips, be sure to consult a specialist. ‒ psychologist .

Medical psychologists of the KUZ VO "VKPND" have been giving lectures on the topic: "Burnout Syndrome" for several years in medical institutions G. Voronezh.Recently, interest in this problem has grown, medical workers ask a lot of questions, express a wish about personal work with them.

Based on the experience gained in conducting these lectures, it can be concluded that the levelCMEAquite highamonghealthcare workers, and this problemstillrelevant at present[ 7 , 10 ] .

conclusions . studyeCMEAu honeyandQing workers should pursue not only the goal of identifyingproblems, but it is also necessary to find ways to resolvedataquestions. These include:Penlightening work on essence and consequencesyakh professional deformation; Withcreation of "psychological relief" rooms in medicalx institutions for medical staff; Oorganizationwork of a clinical psychologist; Withbuilding a favorable psychologicalabout the climate in the team; organization of mentoring; Testiroanalysis for the identification of CMEA; Ppsychological counseling as an opportunity to work through professional and personal problems.

Literature:

1. AgibalovaT.V. Syndrome of "emotional burnout" / Agibalova T.V., Kozin V.A. // Independence of the individual. –2012. -T.4, No. 2(9). - WITH -. 33-41. 1996 / A.A. Emelyanova, V.A. Kutashov, T.Yu. Khabarova //Central Scientific Bulletin . ‒ 2017. ‒ V. 2, No. 2 (19). ‒ P. 23 ‒ 26.

5. Zakharov O.P., KutashovV.A., Ulyanova O.V. Predicting the prevalence and quality of life of patients with mental disorders based on mathematical modeling /O.P. Zakharov, V.A. Kutashov, O.V. Ulyanova //Central Scientific Bulletin. ‒ 2016. ‒ Vol. 1, No. 17. ‒ P. 10‒12.

6. cannabis YU. What is mental illness // Yu. cannabis. - M., 1928. - 102 p.

7. KutashovV.A. Analytical study of burnout syndrome / Kutashov V.A. // System analysis and management of biomedical systems. - 2015. - V.14, No. 2. - S. 295 - 299.

8. Assessment of the functional state of the cardiovascular system in healthy volunteers in a 520-day experiment / Sudakov O.V. [et al.] // Cardiovascular therapy and prevention - 2015. - V.14, No. S 1. P. 48.

9. Ulyanova O.V. Study of personality accentuation in patients with coronary heart disease comorbidwith affective disorders / O.V. Ulyanova, V.A. Kutashov Kutashov

14. YudchitsYu.A. The problem of prevention of deformation. / Yu.A. Yudchits// Journal of Practical Psychology. ‒ 1998 No. 7 - pp. 28 ‒ 36

Information about the authorOh:

Meged Elena Viktorovna , medical psychologist KUZ IN"Regional Clinical Psychoneurological Dispensary", st. twenty‒ Anniversary of October, 73,

Ulyanova Olga Vladimirovna ‒ Candidate of Medical Sciences, Associate Professor of the Department of Psychiatry and Neurology, IDPO FGBOU VO VSMU named after N.N. Burdenko. [email protected]