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Burnout, Fatigue, and Overuse in Performing Artists
Feeling burned out. Too tired to push forward. Can’t shake the exhaustion. Don’t care anymore. These are thoughts and feelings that plague many individuals in the workforce, and performing artists are no exception. The challenge for medical practitioners and performers is differentiating fatigue from overuse or burnout or both.
Burnout is generally considered a syndrome. Although, in some countries it is regarded as a disease. It is a debilitating condition that negatively impacts health and job performance. Features of burnout include fatigue, exhaustion, decrease in performance quality and output, unmotivated responses and behaviors, a sense of being an outside observer to life, detachment from others, and a loss of interest in a career that was once a passionate and desired profession. Burnout typically presents as a gradual decrement over time. What is confusing for many who suffer from burnout is the gradual onset that often morphs into a chronic condition lasting months or years.
According to Christina Maslach, cognitive signs of burnout manifest as poor concentration and loss of curiosity. Psychological symptoms encompass depersonalization, anxiety, depression, and frequently higher risk for substance abuse and suicidal ideation. Physical symptoms include an inability to recover from muscular exertion, poor coordination, excess fatigue, chronic muscle weakness, disrupted sleep, altered menstrual cycles, loss of appetite, compromised immune response (difficulty recovering from infections), headaches, gastrointestinal disturbances, and cardiovascular irregularities. All these symptoms are commonly associated with chronic stress, suggesting that burnout may in fact be a psychosocial-environmental stress disorder.
Like individuals engaged in careers that demand high performance such as medical professionals and athletes, performing artists share similar conditions that increase the likelihood of burnout. They typically practice or rehearse for long hours, they must exert intense concentration during these sessions, and they are continually scrutinized for performance excellence. These conditions can lead to physical and emotional exhaustion. Although these conditions persist throughout a performance career, young performers are particularly vulnerable to burnout, especially when their training infiltrates playtime. Regardless of age, everyone needs time for free play. Without opportunities to recuperate, the chronic emotional and physical demands gradually erode performance efficiency and increase feelings of despair.
A unique characteristic of a performance career is the need to investigate emotional expressivity. Like mental health workers, performers are vulnerable to emotional exhaustion, a factor that is considered a key component leading to burnout. Emotional exhaustion is characterized by increased cynicism, callousness, dehumanizing perceptions, or flatness. If performers continue to work in this emotional exhaustion state compassion markedly diminishes, job dissatisfaction increases, and career termination may result. Even when a sense of autonomy (self-directed opportunities) is present, the intense emotional demands can offset potential experiences of feeling a sense of accomplishment and being valued. Like all professions, performing artists need (1) the support of others, (2) to feel that they can make independent choices, and that (3) these choices enrich feelings of competence. These factors greatly diminish burnout conditions, especially emotional exhaustion.
The likelihood of emotional exhaustion, coupled with increased injury risk, is intensified when obsessional passion, rather than harmonious passion, drives performers. According to Robert Vallerand and his colleagues, motivation and passion can be regarded as bi-polar. Obsessional passion is evident when a performer is rigidly motivated to practice despite feelings of pain or fatigue; whereas, harmonious passion, an equally strong motivator, is maintained via flexible adaptive behaviors during practice sessions. Performers are typically passionate about their work; they generally self-identify as a performer and they embrace opportunities to share their talents. Unfortunately, if they are driven by an obsessional passion they are at a much higher risk for burnout, as well as the negative associated effects of fatigue and overuse syndromes.
Similar to emotional exhaustion, ongoing fatigue is another factor that can lead to burnout. Fatigue can manifest as muscular or cognitive failures. Literally, mental or physical activities diminish or stop all together. Without restorative recovery phases fatigue may lead to serious injuries. For performing artists who must train long hours to acquire and then maintain optimal performance states, fatigue is highly likely. Likewise, when performers work in environments that demand multiple performances a week, the risk for debilitating fatigue rises.
Generally, fatigue is associated with insufficient nutrients and rest to facilitate the metabolic demands of recovery. Transient fatigue occurs when there are momentary decreases in work capacity. Muscle fatigue, also known as peripheral fatigue, is associated with a shortage of metabolic substrates; whereas, central fatigue is considered a failure of central nervous system signaling to the muscle. During central fatigue, the muscles will literally not engage. Performers experience peripheral fatigue on a regular basis; luckily most performers seldom encounter the startling consequences of central fatigue. Regardless of fatigue type, if performers have insufficient rest and recovery time, they are at higher risk for injury and illness. Postural control, fine motor performance, and cognitive processing all diminish.
Learning to take frequent small breaks can alleviate some of the many complications associated with fatigue, along with creating a training regime that strengthens muscular and cardiovascular endurance. For many performers, acquiring skills such as visualization can promote prolonged mental practice without the added physical repetitive strain effects. Also cultivating stress management skills can alleviate fatigue as well. For example, positive self-talk (challenging negative thoughts and re-directing thoughts and behaviors towards optimal task performance) combined with a daily internal practice of “body mapping” to determine muscular and cognitive fatigue levels can greatly reduce cumulative fatigue states.
Overuse syndromes occur as a result of working in fatigued states for prolonged periods of time. Some of the many injuries that result from overuse include repetitive strain injuries, stress fractures, dystonia (small muscle cramping and weakness), wear and tear musculoskeletal damage, hearing loss, vocal disorders, skin infections, and urinary incontinence. These overuse injuries typically occur near the end of rehearsals; however, they can present as a sudden onset injury, although the injury/disorder may have kindled unnoticed for a long period of time. Maladaptive perfectionism, commonly defined as extreme preoccupation with external standards established in the socio-cultural climate of the performer, along with rigid, excessive self-oriented perfectionistic demands, may increase vulnerability for overuse, as well as chronic fatigue and burnout.
The metaphor of fire is deeply woven into the concept of burnout. For most performing artists, they begin with intense desires to pursue their career. Their vigor, enthusiasm and passion fuel the fire within. They invest great financial and personal resources in order to reach professional status. Gradually the resources, both metabolic energy that fuels their bodies and their psychosocial support systems begin to diminish or are inadequate to sustain the work demands. With continued decrement, the fuel needed to sustain the fire is depleted. Chronic peripheral and central fatigue patterns emerge along with associated overuse injuries. These conditions are the precursor for burnout. What is troubling in the performing arts is that at any given time approximately 70% of orchestra musicians are performing in this pre-burnout state of fatigue and overuse. A high percentage of dancers, singers, and actors are equally at risk for chronic fatigue (physical, emotional, and / or cognitive) and overuse injuries and disorders. If insufficient rest and recovery persists, burnout is likely.
In order to restore the resources needed to sustain a burning fire, performers need a healthy wellness program. They need to engage in outside activities unrelated to their profession and they must address perfectionistic unrealistic standards so that they can work with less obsessional rigidity, If burnout is extreme, they may need to seek support from medical and mental health practitioners. Similar to sports medicine, performing arts medicine should include health care practitioners who are well versed in the biopsychosocial environment of the performing arts. They must be able to recognize and evaluate all factors that contribute to fatigue, overuse and burnout syndromes.
The cost of burnout, including chronic fatigue and overuse injuries, is high. Losing the skills of highly trained and talented professionals is too great a cost. Pursuing high-demand careers must include wellness programs to reduce the possibility of burnout. Simple strategies such as maintaining a well-balanced diet, engaging in regular exercise, and getting adequate sleep greatly diminish burnout. Identifying and participating in meaningful avocations offer opportunities to creatively explore and engage in the restorative benefits of “play”. Recognizing the early signs of burnout and treating them can greatly reduce the devastating effects of career termination, coupled with the chronic illnesses that are associated with burnout. Individuals who enter professions associated with high burnout rates such as the medical field, athletics and the performing arts need to understand the risks of burnout. It is a debilitating condition that can be avoided.
The author of this article is Paula Thomson, Professor, Co-Director of the Performance Psychophysiology Laboratory at California State University Nortrhidge, Clinical Psychologist, and a freelance choreographer. Together with co-author and co-director S. Victoria Jaque, their book, Creativity and the Performing Artist: Behind the Mask, examines the performing artist as both the creative person and the creative product. The book focuses particularly on the nature of creativity and the psychological, physical, and social challenges that performers face.
We are pleased to offer you a look at the book by providing you with a chapter, “Chapter 20. Health Concerns and Burnout.” In this chapter, the complications of a performing arts career are examined. Topics include; (1) introductory comments and definitions, (2) injury and the effects on creativity, (3) injury safety policies and workers compensation, (4) injury prevalence and severity, (5) pain appraisal and coping strategies to manage pain, (6) hypermobility conditions and injury vulnerability, (7) overuse, overtraining, and fatigue, (8) unique injury profiles in performing artists, (9) injury patterns in specific performing arts domains (actors, singers, musicians, dancers), (10) rehabilitation
If you would like to view additional chapters, you can do so online via ScienceDirect. If you would like to purchase a print or e-copy of the book, visit the Elsevier Store. Apply discount code PSYCH317 at checkout and save up to 30% off the list price and free shipping!
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