Do you know the story about the frog in a pot?
As the story goes, if a frog is placed in a pot of water, it won’t notice the slow increase in temperature; by the time the water has begun to boil, it is too late for the frog to jump out to freedom.
Admittedly, the story is grim, but it’s a useful metaphor for how we remain unaware of the insidious effects of stress until it is too late. In the workplace, this can cause burnout.
In this post, we will explore the signs and symptoms of burnout and provide you with useful tools and tips that act as a thermometer to gauge your clients.
Before you continue, we thought you might like to download our three Stress & Burnout Prevention Exercises (PDF) for free. These science-based exercises will equip you and those you work with, with tools to manage stress better and find a healthier balance in your life.
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Does Your Client Have Burnout? 14 Warning Signs
Burnout refers to a state of emotional and physical exhaustion that results from poorly managed workplace stress (Maslach, 2003; Maslach & Jackson, 1981).
The term ‘burnout’ was first used in literature to describe healthcare professions (Freudenberger, 1974); however, ‘burnout’ is now recognized as a form of occupation stress that is not industry specific.
Considering this, the first condition for ‘burnout’ is that it is work related. Although unemployed clients may also experience high levels of stress, their experience is not classified as ‘burnout.’
Occupational burnout is experienced in three dimensions (World Health Organization, 2019; Maslach & Jackson, 1981):
- Cynicism about work
- Feelings of inefficacy
Of these three dimensions, the most important is fatigue. Without fatigue, the diagnosis of burnout is not possible; however, fatigue on its own is insufficient for a diagnosis of burnout.
The other two dimensions – cynicism and a sense of inefficacy – reflect our complex relationships with our work, the people with whom we work, and the way our work affects our self-worth.
Here are some warning signs that your client is experiencing burnout:
The primary diagnostic symptom of burnout is an experience of overwhelming and insatiable emotional fatigue (Maslach & Jackson, 1981).
For example, does your client:
- Report feeling tired even though they get enough sleep?
- Mention that they tire easily or feel overcome by feelings of exhaustion?
- Feel like they can’t sleep or rest enough?
- Feel like they are overstretched or overwhelmed by the amount of work?
Fatigue and exhaustion can also manifest in other ways, so look for signs such as:
- Lack of energy for tasks that require emotional or physical input
- Lack of motivation for work-related and everyday tasks
- Huge amount of effort needed to complete tasks
2. Feelings of cynicism or negativity toward work
This second symptom is a two-part process. Maslach and Jackson (1981) report that employees who are experiencing burnout initially try to distance themselves from their work. They take longer to respond to work requests, go into the office less frequently, and are less concerned with work.
If left unchecked, the second step of burnout is activated, where employees develop feelings of negativity and cynicism toward their work.
In the first step, your clients may report:
- Scaling back on responsibilities
- Taking some me-time
- Cutting down on their workload
Taking these actions is not indicative of burnout yet; in fact, taking those actions suggests your client is aware of their feelings and acting appropriately to their occupational stress. At this point, their actions are self-protective.
However, the symptoms of the second step are more concerning and show that the changes made in the first step were insufficient. Clients who develop cynicism toward their workplace may report:
- Feeling disheartened, discontent, or disillusioned with work
- Not being invested in the work
- Feeling unhappy with their accomplishments
- Dehumanizing their colleagues (e.g., “X deserves it”)
3. Feelings of inefficacy
Burnout is often accompanied by feelings of reduced work efficacy or performance.
Your client might report that they take longer to complete work-related tasks, produce poor-quality work, or are poorly suited to their job. Your client might report that they feel incompetent or question whether they are in the right job.
6 Validated Questionnaires for Your Clients
Determining whether the source of your client’s behavior and thoughts is a result of burnout can be difficult.
To aid you, we’ve compiled a list of six validated questionnaires that have been used extensively in peer-reviewed journals.
The questionnaires differ from each other in the following ways:
- They measure different key dimensions of burnout.
- They are worded differently depending on the industry where the client works.
Maslach Burnout Inventory
The Maslach Burnout Inventory (MBI; Maslach & Jackson, 1981) is the most extensively used tool in peer-reviewed manuscripts.
The first version of the MBI was developed from a series of interviews with health services professionals; these interviews were adapted into a set of statements that form the MBI items.
The MBI reliably measures three dimensions:
- Emotional exhaustion
- Personal accomplishment
Factor analysis indicates a fourth, less stable dimension: Involvement.
Each dimension is measured on two variables: the frequency and the degree that is experienced.
Overall, the results suggest that job satisfaction is negatively correlated with emotional exhaustion and depersonalization, but positively correlated with personal accomplishment.
Since then, the MBI has been adapted for other domains; for example:
- The MBI-Human Services Survey for Medical Personnel is appropriate for clients who work in healthcare.
- The MBI-Human Services Survey is appropriate for clients who work with people, but not only in the healthcare industry.
- The MBI-Educators Survey is appropriate for clients who are educators.
- The MBI-General Survey is appropriate for clients who work in other industries.
- The MBI-General Survey for Students is appropriate for clients who are still students or scholars.
The MBI is proprietary and must be purchased to use. The MBI and its different validated versions are available for purchase from Mind Garden, the official publishers of the MBI.
Oldenburg Burnout Inventory
The Oldenburg Burnout Inventory (OBI) was developed to measure burnout across various occupational groups (Demerouti & Bakker, 2008; Demerouti, Bakker, Vardakou, & Kantas, 2003).
This inventory measures two dimensions of burnout:
- Exhaustion (which is the primary symptom of burnout)
- Disengagement from work
Unlike the MBI, the OBI does not measure a personal sense of inefficacy.
The authors of the OBI argue that compared to the MBI, the strengths of this inventory include the following:
- Employees who work in any industry can use it, not just healthcare workers.
- Exhaustion is not limited to affective characteristics, but also includes cognitive and physical characteristics.
- Cynicism is measured more broadly by exploring various ways that employees disengage from their work, which is not limited to dehumanization.
Validity studies using employees from various occupations and countries confirm that this inventory:
- Measures two underlying factors (exhaustion and work disengagement)
- Is strongly correlated with the MBI
- Has good test–retest reliability using a four-month interval
To access the Oldenburg Burnout Inventory, please contact Professor Evangelia Demerouti directly.
3 Helpful Tests & Quizzes
If you do not need to use a validated test, the following list of tests and questions may be useful.
Although these tests have been reported in peer-reviewed manuscripts, they have not been validated using large samples. Despite this, the results of these tests serve as useful indicators of the presence of burnout and act as a good starting point.
Professional Fulfillment Index (PFI)
Trockel et al. (2018) argued that the MBI and OBI yield an incomplete picture of physicians’ job satisfaction. As a solution, they developed the Professional Fulfillment Index (PFI), also referred to as the Stanford Professional Fulfillment Index.
Unlike the MBI and OBI, the PFI asks about fulfillment over the past two weeks, indicating recent job fulfillment but allowing fulfillment to be tracked over time.
The PFI comprises 16 items that measure three dimensions:
- Work exhaustion, as related to burnout
- Interpersonal disengagement, as related to burnout
- Professional fulfillment
The PFI is freely available and published in the key paper authored by Trockel et al. (2018). To access the survey, please contact the Stanford WellMD Center.
Quick burnout assessment tool
Maslach and Leiter (2005a) provide an abridged version of an assessment tool that could be used to assess burnout. In this tool, clients are asked the degree to which various work-related conditions match up to their expectations.
For example, when asked to consider ‘the amount of work to complete in a day,’ clients must respond whether it is ‘just right,’ a ‘mismatch,’ or a ‘major mismatch’ based on their personal preferences, work patterns, and aspirations.
The items listed in the quick burnout assessment tool cover various domains including workload, control, reward, community, fairness, and values. Although some mismatches are expected, many mismatches concentrated in one domain are worrying and require further investigation.
The full assessment is available in Maslach and Leiter’s (2005b) book Banishing Burnout: Six Strategies for Improving Your Relationship With Work.
The quick assessment is available from the Stanford Social Innovation Review.
Nonproprietary single item
If your client is a healthcare practitioner, you can use the following single item to assess burnout (Dolan et al., 2015):
- Overall, based on your definition of burnout, how would you rate your level of burnout?
Responses are made on a five-point scale, with lower scores showing the absence of burnout, and higher scores indicating the presence of burnout.
The responses on the scale are as follows:
1 = I enjoy my work. I have no symptoms of burnout.
2 = Occasionally, I am under stress, and I don’t always have as much energy as I once did, but I don’t feel burned out.
3 = I am definitely burning out and have one or more symptoms of burnout, such as physical and emotional exhaustion.
4 = The symptoms of burnout that I’m experiencing won’t go away. I think about frustration at work a lot.
5 = I feel completely burned out and often wonder if I can go on. I am at the point where I may need some changes or may need to seek some sort of help.
Although the question does not specifically ask about healthcare work and could presumably be used for clients who do not work in healthcare, the studies that have used this single-item questionnaire have only used it with healthcare practitioners. It is unknown whether non-healthcare practitioners will respond to it in the same way (Hansen & Pit, 2016; Knox, Willard-Grace, Huang, & Grumbach, 2018).
Top 2 Burnout Inventories & Checklists
Another useful way to measure burnout without using a validated test is to use an inventory of questions.
We’ve compiled a list of useful inventories, some of which directly measure burnout and others that measure life or job satisfaction, which are typically negatively affected by burnout.
Copenhagen Burnout Inventory
Another nonproprietary burnout inventory is the Copenhagen Burnout Inventory (Kristensen, Borritz, Villadsen, & Christensen, 2005). This inventory was developed in response to several criticisms of the MBI, for example:
- The definition of burnout is rooted in the MBI, which is also the primary tool used to measure burnout. As a result, the two items – burnout and the MBI – cannot be separated.
- The MBI is limited to healthcare services and is not appropriate for other professions.
- Poorly worded questions evoked severe negative reactions in participants.
The Copenhagen Burnout Inventory measures burnout across the following three dimensions:
- Personal burnout; the questions for this dimension are appropriate for people in any profession and not only limited to people who are employed.
- Work-related burnout; the questions for this dimension ask about paid work and are not limited to healthcare employment.
- Client-related burnout; the questions in this section are tailored to ask about clients (rather than patients).
Each of these dimensions can be measured on its own; therefore, if your client is employed but doesn’t work with clients of their own, you can still administer the questions for the first two dimensions.
The Copenhagen Burnout Inventory can be downloaded from the Danish National Research Center for the Working Environment.
Other relevant inventories
Since the theoretical definition of burnout is linked to three domains, any checklist or questionnaire that measures job satisfaction, perceived level of stress, or emotional exhaustion can be helpful to measure burnout in your client.
Although this inventory does not measure burnout directly, The Basic Needs Satisfaction in General Scale from PositivePsychology.com could be a starting point to tentatively infer whether your client might be experiencing burnout.
This tool can be administered in a session with your client and will highlight whether your client is dissatisfied with their life.
Remember, this scale does not measure burnout; low results do not necessarily indicate that your client has burnout. A low score does indicate that your client is dissatisfied, and it is worth investigating whether the source of this unhappiness can be traced to workplace stress.
How to identify signs of burnout – Medmastery
7 Best PositivePsychology.com Burnout Prevention Tools
Burnout is the final stage of consistent and poorly managed stress in the workplace. The following PositivePsychology.com tools can help your client better cope with stress.
- Reactions to Stress
This exercise provides your client with a table to capture stressful events and their reactions. By recording feelings, behaviors, and thoughts, repeating patterns can be recognized.
- Stress as a Stimulus for Change
This worksheet can be used to capture stressful situations that your client wishes to change and begin the transformation process.
- Identifying Your Stress Resources
Clients can begin recognizing helpful stress resources in their lives and identify how they can support their strengths with these questions.
- Self-Care Check-In
Here are some useful check-in questions that give your client a quick way to see where more attention is needed and better meet their self-care needs.
- Assertive Message Role-Play
If you are working with a group of clients, this role-play exercise helps participants develop assertive communication skills that can be used in setting healthier workplace boundaries.
- Coping – Stressors and Resources
This worksheet invites your client to think about past, current, and anticipated future stressors while linking them with existing coping resources to better manage stress in the workplace.
- My Self-Care Promise
Signing a self-contract like this can encourage clients to commit to engaging in more nurturing activities as a healthy way of coping with stress.
A Take-Home Message
Burnout is an insidious condition; it develops slowly but can have devastating effects on your client’s health, relationships, and life.
Since it develops so slowly, your client may not realize that they are experiencing burnout until it is too late.
With these useful questionnaires and inventories, you can recognize the early signs of burnout and help your client realize that they’re in a ‘hot pot’ flavored with fatigue, cynicism, and a sense of inefficacy. With your help, your client can jump out before it’s too late.
One caveat with burnout is that it is currently linked to employment; if your client is unemployed, they cannot experience ‘burnout.’
This seems strange, though, because your client can still experience feelings of stress, anxiety, and overwhelm in other areas of their lives.
This confusing distinction between stress and burnout is due to the etiology of burnout:
- Is it a ‘different’ psychological syndrome that exists on its own?
- Or is it stress and depression that result from the workplace?
When consulting with your client, pay attention to how they describe their feelings, thought processes, behaviors, and motivations.
Burnout is ultimately a psychological and physical response to stress; use your training, experience, and the information in this post to help you identify it in your clients.
We hope you enjoyed reading this article. Don’t forget to download our three Stress & Burnout Prevention Exercises (PDF) for free.
- Demerouti, E., & Bakker, A. B. (2008). The Oldenburg Burnout Inventory: A good alternative to measure burnout and engagement. In J. R. B. Halbesleben (Ed.), Handbook of stress and burnout in health care (pp. 65–78). Nova Science.
- Demerouti, E., Bakker, A. B., Vardakou, I., & Kantas, A. (2003). The convergent validity of two burnout instruments: A multitrait-multimethod analysis. European Journal of Psychological Assessment, 19(1), 12–23.
- Dolan, E. D., Mohr, D., Lempa, M., Joos, S., Fihn, S. D., Nelson, K. M., & Helfrich, C. D. (2015). Using a single item to measure burnout in primary care staff: A psychometric evaluation. Journal of General Internal Medicine, 30(5), 582–587.
- Freudenberger, H. J. (1974). Staff burn-out. Journal of Social Issues, 30(1), 159–165.
- Hansen, V., & Pit, S. W. (2016). The single item burnout measure is a psychometrically sound screening tool for occupational burnout. Health Scope, 5(2).
- Kristensen, T. S., Borritz, M., Villadsen, E., & Christensen, K. B. (2005). The Copenhagen Burnout Inventory: A new tool for the assessment of burnout. Work & Stress, 19(3), 192–207.
- Knox, M., Willard-Grace, R., Huang, B., & Grumbach, K. (2018). Maslach burnout inventory and a self-defined, single-item burnout measure produce different clinician and staff burnout estimates. Journal of General Internal Medicine, 33(8), 1344–1351.
- Maslach, C. (2003). Job burnout: New directions in research and intervention. Current Directions in Psychological Science, 12(5), 189–192.
- Maslach, C., & Jackson, S. E. (1981). The measurement of experienced burnout. Journal of Organizational Behavior, 2(2), 99–113.
- Maslach, C., & Leiter, M. P. (2005a). Reversing burnout: How to rekindle your passion for your work. Stanford Social Innovation Review, 43–49.
- Maslach, C., & Leiter, M. P. (2005b). Banishing burnout: Six strategies for improving your relationship with work. John Wiley & Sons.
- Trockel, M., Bohman, B., Lesure, E., Hamidi, M. S., Welle, D., Roberts, L., & Shanafelt, T. (2018). A brief instrument to assess both burnout and professional fulfillment in physicians: Reliability and validity, including correlation with self-reported medical errors, in a sample of resident and practicing physicians. Academic Psychiatry, 42(1), 11–24.
- World Health Organization. (2019, May 28). Burn-out an “occupational phenomenon”: International classification of diseases. Retrieved March 24, 2021, from https://www.who.int/mental_health/evidence/burn-out/en/