Subtipos de burnout e implicaciones clínicas: Una propuesta teórica basada en abordajes terapéuticos específicos

Abstract

Abstract:Burnout is associated with a poor perception of health status, psychosomatic disorders and physical illness. The aim of this study is to construct a comprehensive theoretical proposal for a therapeutic intervention that is sensitive to the different clinical manifestations of this state. In order to do this, the frenetic, underchallenged and wornout subtypes of burnout are presented in a systematic manner, together with the interventions that may provide suitable management for each subtype. Said clinical profiles may represent different stages in the progression of burnout, and have specific dysfunctional mechanisms that require a choice of adjusted intervention strategies according to the characteristics of each particular case. Finally, the degree of dedication to work and its clinical repercussions are put forward as a hypothesis to explain the progressive impairment caused by burnout, and as a target on which primary, secondary and tertiary prevention strategies could be founded.Keywords: Stress; burnout subtypes; BCSQ; psychological treatment. Subtipos de burnout e implicaciones clínicas: Una propuesta teórica basada en abordajes terapéuticos específicosResumen: El burnout se asocia con un peor estatus de salud percibida, trastornos psicosomáticos y enfermedades físicas. El objetivo del presente trabajo es articular una propuesta teórica comprehensiva de intervención terapéutica sensible a las diferen tes manifestaciones clínicas de dicho estado. Para ello, se presentan de forma sistemática los subtipos de burnout frenético, sindesafíos y desgastado, así como las intervenciones que pueden proporcionar un adecuado manejo de cada subtipo. Dichos perfiles clínicos parecen representar momentos diferentes en la progresión del burnout, con mecanismos disfuncionales especí ficos, que obligan a optar por estrategias de intervención ajustadas a las características de cada caso en particular. Finalmente, se propone el grado de dedicación en el trabajo, y sus repercusiones clínicas, como hipótesis para explicar la progresiva erosión que supone el burnout, y como eje sobre el que fundamentar las estrategias de prevención primaria, secundaria y terciaria.Palabras clave: Estrés; subtipos de burnout; BCSQ; tratamiento psicológico.

Frenetic, under-Challenged, and Worn-out Burnout Subtypes among Brazilian Primary Care Personnel: Validation of the Brazilian “Burnout Clinical Subtype Questionnaire” (BCSQ-36/BCSQ-12)

“…The worn-out subtype, in addition to cynicism, also presented significant levels of exhaustion and (lack of) efficacy as well as the absence of positive affect and presence of negative affect. The worn-out subtype appears to be also a very affected profile in terms of symptoms, as observed in the raw analyses referred to above and obtained in previous research [21,25,31,32,39]. This subtype has demonstrated a passive coping tendency [39] that has usually been observed when high levels of job strain are present [81].…”

“…The pattern of correlations between the subscales showed that overload was conceptually far away from lack of development and neglect, which were conceptually closer to each other-this result was also observed when analysing the relationships among the BCSQ-36 general factors. Previous studies including Spanish university workers [32] and healthcare students [56] have obtained this same result, suggesting that the under-challenged and worn-out subtypes might present some aspects in common as opposed to the frenetic subtype, such as a lower interest in tasks [20,21].…”

“…So far, it has not been possible to measure the different burnout subtypes using the Portuguese language in general and in Brazilian contexts in particular. This was a need of clinicians and those in charge of the implementation of programmes because not all subjects suffering from the burnout syndrome present the same risk factors, characterization, and prognosis [20,21,25,28,31,32,39]. In our study, we have seen that the Brazilian versions of the BCSQ, both in its long (BCSQ-36) and short (BCSQ-12) formats, were suitable for use with Brazilian PC professionals.…”

“…The development of the burnout condition has been explained longitudinally by the degree of dedication at work, progressing from more to less (from enthusiasm to apathy), in an attempt to adopt a certain distance to alleviate the excess of activity but at the cost of entering into the spiral of erosion of illusion and a pattern of perceived stress due to frustration [21,83,84]. If we apply this theoretical framework-which understands burnout as a progressive impairment in levels of commitment-to the subtype conceptualization, one might interpret the burnout profiles as different stages in the development of the syndrome [21,25,31]. Nevertheless, as we have seen, our results only partially fit with this assumption because, although this gradation seemed to be observed in the degree of affection in the psychological health-related variables and the frenetic was the more engaged and less affected subtype in terms of burnout, the other two profiles were rather similarly affected by burnout symptoms and even the under-challenged might suffer from greater lack of engagement.…”

“…It has been said that this variable could play a major role in the development and chronification of the syndrome by means of a positive feedback mechanism [64]. Thus, clarifying the specific role feelings of guilt may play in the burnout development in Brazilian PC professionals could bring greater understanding of the clinical evolution of the syndrome in this population, adding new psychotherapeutic elements for consideration when designing clinical interventions [21].…”