1. The programme at a glance
Indication. The programme is intended for an adult presenting with burnout, that is, a lasting exhaustion attributed to their work, accompanied by a mental distancing from that work and a reduced sense of efficacy, whether they are on sick leave or still at their post. It assumes that the triage in section 3 has been done: a major depressive episode in the foreground, an acute suicide risk or an unexplored physical cause come before it.
Reference model. The programme rests on work-focused cognitive behavioural therapy, that is, a therapy in which every component is related to the work situation and which has return to work as its explicit aim (Slater et al., 2023). It borrows from the job demands-resources model, which explains exhaustion by high and lasting demands and disengagement by a lack of resources (Demerouti et al., 2001), from Maslach and Leiter's (2016) analysis of the six areas of worklife, and from research on recovery, which describes what allows a person to replenish themselves outside work (Sonnentag and Fritz, 2007). Section 6 presents these models.
Format. Ten individual 50-minute sessions, the first lasting 75 minutes, over about four months: the first five are weekly, and the next five take place every two weeks, to accompany a return that happens in stages. Three booster sessions follow, at one, three and six months. This format lies within the range of the interventions that have been evaluated (section 14).
Mechanism targeted. The programme does not seek to make the person more resistant to work that is exhausting them. It aims at four changes: that they genuinely recover, which passive rest does not achieve; that they understand what, in their work and in their way of working, produced the exhaustion; that they return to work, or reorganise it, in stages and with the right people; and that they know how to spot and stop the next drift.
| Session |
Focus |
Session output |
| 1 |
Assess, triage, link with the doctors |
Triage done, risk assessed, baseline measures, logbook handed over |
| 2 |
Understanding one's exhaustion |
Personal circle drawn, everyone's role set out |
| 3 |
Recovering for real |
Written recovery plan, rising time fixed |
| 4 |
Work under the magnifying glass |
Six areas analysed, contact with the occupational health doctor scheduled |
| 5 |
The rules that exhaust |
Two rules rated, one experiment scheduled |
| 6 |
Preparing the return |
Stepped return plan, interim measures |
| 7 |
Saying, asking, refusing |
One conversation prepared, one request made or dated |
| 8 |
The return, step by step |
Plan adjusted on the figures, end-of-day ritual in place |
| 9 |
Stay, change or leave |
A decision or a dated step |
| 10 |
Review and relapse prevention |
Measures repeated, plan for what comes next written |
What the person takes away. Eight printable worksheets, listed in section 35, including a daily logbook, a stepped return plan, a worksheet for those close to the person and a plan for what comes next.
What distinguishes this programme from the other manuals on this site. Three things. It begins with a broader triage than the others, because the word "burnout" is often applied before any assessment and it can conceal a depression that will then not be treated as such. It brings work into the therapy from session 4, with a written return plan and coordination with the GP and the occupational health doctor (a provision of French law; elsewhere, the local equivalent), who is the doctor responsible for employees' health in relation to their job. And it constantly distinguishes what depends on the person from what depends on their organisation, so as to make them carry neither everything nor nothing.
2. Before you begin
The five preliminary decisions
Is it a major depressive episode? This is the most important question in the manual. Exhaustion and depression overlap widely (section 7), and a major depressive episode labelled "burnout" risks receiving neither the treatment nor the monitoring it requires. If one is present and in the foreground, it is treated first with Treating depression in adults: a therapist's manual; the work on the return to work can be linked to it afterwards (section 8).
Is there a suicide risk? The Haute Autorité de santé (the French National Authority for Health) asks that it be specifically assessed in this indication (Haute Autorité de Santé, 2017). It is looked for in session 1, then at every measurement point (section 9).
Has a physical cause been looked for? Lasting fatigue has many medical causes, and the work-up is the doctor's business. If nobody has done it, the person asks for it before session 2 (section 3).
What is the work situation today? On sick leave or at their post, for how long, with what prospect of return, and with what possible danger: harassment, violence or threats that are still going on are not treated like an overload (section 9).
Who are the doctors? You note the name of the GP and of the occupational health doctor, or of the occupational health service, and you agree with the person on what you will be able to pass on to them. Sick leave, its length and its end are medical decisions, and the programme is carried out in liaison with those who take them (section 14).
What this programme does not treat
It does not, on its own, treat a major depressive episode, which goes through its own protocol first, as the first decision says.
It does not treat the organisation of work. The French guidelines exclude action on the organisation from their scope, while describing it as indispensable to prevention (Haute Autorité de Santé, 2017). This programme helps the person to use the levers that exist; it replaces neither the occupational health doctor, nor the staff representatives, nor a prevention approach within the company.
It does not treat post-traumatic stress disorder following a serious event at work, an assault or an accident for example. That falls under Post-traumatic stress disorder in adults: a therapist's manual.
It does not treat exhaustion that does not come from work. The World Health Organization's definition reserves the term for the occupational context (section 7), even though many of the tools in this manual apply elsewhere. A parent's exhaustion falls under the public programme Parental burnout: when being a parent wears you out; autistic burnout is described in Autism in adults: a therapist's manual (section 8).
It does not settle a dispute. A conflict with the employer, a dismissal procedure or a claim for recognition as an occupational disease (a provision of French law; elsewhere, the local equivalent) are handled with legal and trade-union advisers; you support the person, but you are neither their lawyer nor their expert witness (section 30).
How to use it
Read the whole manual before the first session, in particular sections 3, 7, 9 and 26: the triage, the debate with depression, safety and the gradual return. These are the four places where a mistake costs the most.
Each session is described with the same framework: the aim, the steps, what you say, the frequent mistakes, and the criterion for moving on.
Three warnings specific to this indication.
The word "burnout" often arrives before you do. The person has read it, a colleague has said it, sometimes a doctor has written it. It brings relief, because it says that work has something to do with it, and it traps, because it can make you miss a depression. You do not challenge it straight away; you do the triage, then you say what you have found.
The first trap is to make the person carry what belongs to the work. Many of these people have carried for months a load that nobody could have carried. Teaching them to manage their stress better without ever looking at the load amounts to telling them that the problem comes from them. Session 4 is designed to avoid that.
The symmetrical trap is to attribute everything to work. Part of the exhaustion often comes from personal rules — doing everything perfectly, never refusing, never disappointing — that met a job which exploited them. Ignoring that part leaves the person with no hold over the next time. Session 5 deals with it.
3. Five presentations not to be confused
Five situations present with the same complaint, "I can't take my work any more", and they do not call for the same course of action.
1. The fatigue of a busy period
What you observe. Marked fatigue, shortened sleep and irritability, during a period of intense work whose end is known: a deadline, a season, covering for someone.
What points the way. The fatigue is repaired by a weekend or a few days off, interest in the work is intact, and there is neither cynicism nor a feeling of incompetence.
What this implies. No programme is needed: information about recovery is enough, with a reassessment if the period goes on or if the fatigue no longer yields to rest.
2. Burnout
What you observe. An exhaustion that ordinary rest no longer repairs, a mental distancing from work, often in the form of cynicism or irritability towards colleagues, service users or clients, and a feeling of no longer being effective, all present for months (section 4).
What points the way. The complaint remains centred on work. Pleasure is preserved, at least at times, in activities that have nothing to do with it, self-esteem outside work holds up more or less, and mood picks up when the person is genuinely away from their post, even if the physical exhaustion takes weeks to yield.
What this implies. This is the programme described here.
3. The major depressive episode
What you observe. A depressed mood or a loss of interest that affects the whole of life and not only work, with other manifestations: sleep, appetite, guilt, self-deprecation, thoughts of death.
What points the way. The anhedonia is global: the person finds no pleasure on holiday, with those close to them, or in what they used to enjoy. The self-deprecation concerns their whole self, not just their competence at work. And the hopelessness extends to the future in general. This is the difference retained by those who separate the two presentations: burnout is linked to work and to a situation, whereas depression spills over every context (Maslach and Leiter, 2016).
What this implies. The depression is treated first, with Treating depression in adults: a therapist's manual. The work on the return is added afterwards, or in parallel when the person's condition allows it (section 8).
4. Adjustment disorder
What you observe. Distress and difficulty functioning that appeared in the weeks following an identifiable change at work — a reorganisation, a new manager, a conflict, the announcement that a post is being cut —, with an all-consuming preoccupation with that event.
What points the way. The starting point is a dated event rather than wear and tear over several months, and preoccupation with that stressor dominates the picture. The boundary with burnout is blurred, and several trials on return to work include both without distinction (section 11).
What this implies. A brief programme centred on problem solving is suitable; the present manual is also suitable when work is at the heart of the picture. The international classification in fact excludes burnout when the picture meets the criteria for an adjustment disorder (section 7).
5. Anxiety disorder or trauma
What you observe. Either an all-consuming worry that spills beyond work, or panic attacks, or re-experiencing of a specific event that happened at work.
What points the way. The anxiety concerns many areas other than work, or the picture is organised around a fear of sensations, or around a memory that keeps coming back.
What this implies. The corresponding protocol applies: Treating generalised anxiety disorder in adults: a therapist's manual, Panic disorder and agoraphobia: a therapist's manual, or Post-traumatic stress disorder in adults: a therapist's manual.
The physical causes that should have been ruled out
Lasting fatigue, concentration problems and disturbed sleep can come from a medical condition: anaemia, a thyroid disorder, diabetes, sleep apnoea syndrome, a prolonged infection, an inflammatory disease, a side effect of medication. The Haute Autorité de santé asks for a physical work-up as part of the diagnostic process (Haute Autorité de Santé, 2017). You do not do it; you check that it has been done, and you ask for it if it has not.
The four triage questions
These four questions are interview pointers specific to this manual. None has been validated as a test: they guide the interview, and a depressive episode is confirmed by the full interview and the depression questionnaire (section 10).
"When you have been away from work for several days, do you find pleasure in anything again?" It turns into a question the distinction described above for the depressive episode, which Parker and Tavella (2021) also take up. A positive answer is reassuring without ruling out depression, since the two often coexist (section 7).
"What you think of yourself — does it concern your work, or your whole person?" It separates the feeling of professional incompetence from global self-deprecation.
"Do you ever think that you would rather not be here any more, or think about dying?" It opens the assessment of suicide risk, which is carried out with everyone (section 9).
"What happened at work, and since when?" It separates slow wear and tear from a dated event, and it brings to light any harassment or violence.
4. The dimensions of burnout
Exhaustion
What you observe. A physical and mental fatigue that is already there on waking, that the weekend no longer repairs, and that gets worse at the mere thought of work. Many people describe a feeling of being drained, of having no reserves left, and of having to draw on an effort of will for the simplest tasks.
What needs clarifying. Ask how long it has lasted, how it changes during holidays, and what relieves it. This is the central dimension: many authors make it the core of burnout, and it is also the one closest to depression (Bianchi et al., 2021; section 7).
Mental distance
What you observe. Detachment, cynicism, irritability towards colleagues, service users, patients, pupils or clients, a feeling that the work no longer has any meaning, and often shame about this detachment in people who had chosen their profession in order to look after others.
What you need to know. This distance is both a symptom and an attempt at protection: one withdraws from what costs too much. It is worked on without reproach, by looking for what it protects.
Reduced efficacy
What you observe. The feeling of no longer being competent, of no longer achieving anything, and often a real drop in performance, which feeds the feeling.
What needs clarifying. Distinguish the part played by the real drop from the part played by interpretation. "I can't do anything any more" may be a global conclusion drawn from three overdue files.
Cognitive and emotional impairment
What you observe. Problems with concentration and memory, difficulty making decisions, unusual forgetfulness, and reduced emotional regulation: unexpected tears or outbursts of anger, hypersensitivity to noise and to demands.
What you need to know. Clinical studies find impairments of memory and executive functions in people with severe exhaustion (Grossi et al., 2015). These complaints worry the person a great deal, as they fear a neurological illness; naming them as a known consequence of exhaustion brings relief, and they matter when gauging the return (section 26). The Burnout Assessment Tool has made them two dimensions in their own right (Schaufeli et al., 2020).
Associated manifestations
What you observe. Sleep problems, which are very frequent, muscle pain, headaches, digestive problems, anxiety, sadness, and sometimes increased use of alcohol, tobacco or medication to keep going or to sleep. The Haute Autorité de santé describes them as emotional, cognitive, behavioural, motivational and physical, often with an insidious onset (Haute Autorité de Santé, 2017).
What matters in practice. Sleep comes first, because it is both a consequence of exhaustion and a factor that maintains it (section 5).
5. What maintains burnout
Burnout does not come from a single factor, and it is not maintained solely by the fault of the work nor solely by the fault of the person. Six mechanisms reinforce one another, and the treatment targets them all.
Demands that lastingly exceed resources
This is the starting point. In the job demands-resources model, the demands of the job — workload, time pressure, emotional demands — are mainly linked to exhaustion, and the lack of resources — autonomy, support, recognition — mainly to disengagement (Demerouti et al., 2001). Maslach and Leiter (2016) describe six areas in which a lasting mismatch between the person and their job makes burnout more likely: workload, control, reward, community, fairness and values.
What this implies. Part of the solution lies in the work itself. That is the reason for session 4.
Recovery that no longer happens
Effort does not cause lasting fatigue if it is followed by recovery. Sonnentag and Fritz (2007) describe four mainsprings of it: mentally detaching from work, relaxing, doing something that involves learning or a challenge, and deciding for oneself how to use one's time. In the exhausted person, all four have died out: they think about work in the evening, they no longer relax, they have given up what stimulated them, and their free time is taken up by what has not been done.
Impossible detachment and rumination
Being unable to stop thinking about work is a well-documented mechanism: in a meta-analysis of 86 publications, psychological detachment was associated with less exhaustion and with better sleep (Wendsche and Lohmann-Haislah, 2017). These data are correlational, but they are consistent with what people describe: the evening emails, the to-do list going round and round at night, Sunday evening already spoiled by Monday.
Sleep
Shortened and fragmented sleep reduces recovery, worsens fatigue and concentration problems, and makes the following day more costly. The review by Grossi et al. (2015) concludes that sleep disturbances are both a cause of severe exhaustion and a factor that maintains it.
Personal rules that leave no limit
"I must do everything perfectly." "If I say no, they'll think I'm incompetent." "I can't let the team down." These rules do not cause exhaustion on their own, but they prevent limits from being set when the load increases. In a meta-analysis of 43 studies, perfectionistic concerns — fear of making mistakes, the feeling that other people's expectations are impossible to meet — were clearly associated with burnout, whereas the mere pursuit of excellence was not, or was negatively associated with it (Hill and Curran, 2016). The nuance matters: the person is not asked to stop working well; what is worked on is the fear that prevents them from stopping.
Withdrawal, then avoidance
As the exhaustion goes on, the person withdraws: they see their friends less, give up sport, do nothing but work and recover badly. Then, once on sick leave, work itself becomes something to avoid: no longer opening their inbox, no longer walking past the building, dreading a call from a colleague. The relief is immediate, and the apprehension grows accordingly. Prolonged sick leave without a return plan can entrench this avoidance over time (section 26).
The complete circle
Put end to end, these mechanisms form a circle. High demands and low resources tire the person out; personal rules prevent them from setting limits, and the load increases further. Recovery no longer happens, fatigue turns into exhaustion, and efficacy falls, which demands more effort for the same result. Then come withdrawal and, once sick leave has been prescribed, avoidance of work.
This is the diagram you draw with the person in session 2, on worksheet 2.