Burn out syndrome
*Psychiatrist-Psychotherapist, Clinical Research Associate, University of Athens Medical School, 1st Psychiatry Dept., Eginition Hospital, 11528 Athens, Greece and Greek University Mental Health Research Institute, Psychosocial and Vocational Rehabilitation Unit, Papayou 15601, Athens, Greece

Burn out syndrome was described for the first time by Freudenberger (1974) while observing the staff of a detoxification clinic in the mid 1960s being affected by this disorder. It was in the 1980s that Maslach proposed evaluation criteria for the syndrome through the design of a standard measurement instrument, the Maslach Burnout Inventory or MBI (Maslach and Jackson 1986). Burnout syndrome involves feelings of emotional exhaustion, depersonalization and diminished personal accomplishment at work. Workers perceive they are no longer able to participate on an emotional level (emotional exhaustion), they develop negative attitudes and feelings towards persons for whom work is done (depersonalization), they negatively value their own capacity to carry out tasks and feel unhappy or dissatisfied with the results obtained. Its etiology is generally thought to be chronic stress at work or elsewhere (Maslach et al. 2001).

Stress could be defined as an automatic physical response to any stimulus that requires from a person to adjust to change (Benson and Casey, 2008), or as Professor Chrousos proposes stress occurs when homeostasis is threatened or perceived to be so (2009). Walter Cannon, a Harvard physiologist was the first who isolated the hormone epinephrine from the adrenal glands of frightened cats (Cannon and Paz, 1911). When he injected epinephrine to calm cats, he produced a physical reaction of fear; the cat's heartbeat and blood pressure increased and this reaction became known as the "fight or flight response" or as the "stress response". Later, two more stress hormones were discovered: nor-epinephrine again from Cannon and then cortisol. These hormones prepare our body to fight of flee. Hans Selye (1936) was the first to introduce the notion that physical and psychosocial stressors trigger the same response. He was able to make the distinction between "good" stress which everybody uses to overcome obstacles and the "bad" stress to which a person is unable to adopt and cope with. This "bad" stress is associated with numerous health problems like anxiety, depression, allergic skin reactions, nervousness, insomnia, etc.

According to Lazarus and Folkman (1984), coping is "cognitive and behavioural efforts to manage specific internal and/or external demands that are appraised as exceeding the resources of the person. A person will be psychologically vulnerable to a determined situation (for example his work) if he/she does not possess sufficient coping resources to handle it adequately, and if at the same time, he/ she places considerable importance on the threat of the consequences of this failure to handle things. Social support from friends and family can alleviate excessive work stress while physical exercise can mitigate mood and anxiety disorders. Furthermore, a mediterranean dietary pattern has been associated with lower incidence of depressive episodes. Last but not least cognitive-behavioral treatment (CBT), relaxation techniques and spirituality seem to protect from excessive stress. Consequently, the combination of CBT, relaxation techniques, spirituality, social support as well as the implementation of a healthier lifestyle (physical exercise and mediterranean dietary pattern) might help considerably in the prevention of excessive work stress. Encephalos 2010, 47(4):193-198

Key words: Burnout syndrome, stress, cognitive-behavioral therapy, physical exercise, mediterranean diet, social support, spirituality.