Centre for Stress Related Illnesses

Ever increasing numbers of people suffer from a stress-related illness. The Swiss State Secretariat for Economic Affairs (Seco) estimates the economic losses caused by stress at over 4 billion Swiss Francs annually.* Besides somatic stress and its sequelae , burnout is increasingly common in our society. And in its advanced stages it is a medical condition requiring therapy.

Burnout – what is it?
Burnout is a process of increasing exhaustion accompanied by reduced physical and mental capabilities which is triggered by chronic stress factors. Those affected feel that they can no longer manage. The stress factors are usually found in the workplace environment, but could also be related to excessive demands in social or family contexts.

Symptoms
The symptoms of a burnout syndrome can be described using the following five categories:

• 1) Motivational symptoms
   Exhaustion, loss of motivation, lack of drive, reduction in self-initiative which could extend to feelings of resignation.
• 2) Performance-related symptoms
  Impaired concentration and memory, reduced decision-making ability connected to self doubt, a decline in productivity, creativity and flexibility, reduced ability to carry out complex tasks, increased inaccuracy and disorganisation.
• 3) Emotional symptoms
  Depressed state or mood swings, feeling empty inside, anxiety, nervousness, irritability which may lead to cynicism, increased aggression.
• 4) Behavioural level symptoms
  Reduced or increased activity, impulsiveness or increased procrastination, engaging in more risky behaviour, increased intake of addictive substances, withdrawal from social life, neglecting leisure activities.
• 5) Physical symptoms and their side effects
  Chronically overloaded responses like fatigue and difficulty sleeping as well as headaches and back pain, dizziness and gastrointestinal complaints, cardiovascular diseases, dyslipidemia and stomach ulcers.
  
   

Development of a burnout syndrome
Burnout is a gradual process, which is generally preceded by a strong commitment to work.

The I-S-A-R model shows a typical four-step process and covers the most commonly described symptoms found in the research literature. Atypical processes are also possible, for example with people who also feel overburdened in situations in which they are not under any particular pressure to perform.
 

The preventative and therapeutic strategies for dealing with stress induced illnesses are, depending upon their form, comprised of:

• 1) Early diagnosis of increased vulnerability to stress
• 2) Coaching and psychotherapeutic interventions
  For both of these steps it is recommended to have outpatient consultations with a specialised psychotherapist or professional support from a coach. Those affected can turn to the Centre for Stress Related Illnesses at any time for a consultation with a member of the therapy team.
• 3) For advanced cases of burnout, an inpatient therapy is recommended - one which uses regenerative offerings in combination with an intensive individualised programme of psychotherapy. Depending upon the form of the illness, the treatment can be supplemented through the use of medication and biological therapies.

Burnout is caused by a long-term imbalance between personal resources and external performance demands. Treatment requires an exact as possible clarification of the source of the imbalance and makes use of tailor-made therapeutic interventions based on this.

An experienced team of doctors and psychologists at Sanatorium Kilchberg developed the SymBalance therapy concept which is especially aimed at the treatment of burnout. In comparison to traditional approaches, SymBalance distinguishes between three fundamental dimensions of burnout:

• Objective dimension
• Subjective dimension
• Existential dimension

 
Depending on the individual case, one of the three dimensions is more prominent, which is taken into account in the therapy planning

In the case of the objective dimension, the focus is on the imbalance between existing resources and actual needs.

On the subjective level however, the personal perception of the imbalance is crucial and this can differ significantly from the objective circumstances. Burnout very often does not result from a person's actual competency deficiency, but rather stems from a lack of belief in their own abilities and an overestimation of performance expectations.   

The existential dimension describes the extent to which the imbalance is viewed as relevant to an individual's identity. Particularly in the more advanced stages of burnout, the perceived difference between resources and requirements becomes a central aspect of a person's own self-image. Non-performance related parts of life fade into the background and in this way lose their regenerative effects of balance and recuperation.

 
Combining these three dimensions leads to a 3-D model of burnout, a model on which the newly developed SymBalance therapy concept is based.

 
1) Objective dimension

2) Subjective dimension

3) Existential dimension

Physician-supervised psychological therapies
The therapy programme takes into account the patient's individual symptoms. A patient’s personal circumstances are discussed in psychologically theraupeutic individual sessions. In this way elements of cognitive behavioural therapy – Mindfulness Based Stress Reduction as well as procedures focused on emotion and an extension of Klaus Grawe's therapy concept – are applied. Training programmes on the workplace, communication and emotional intelligence are offered in a group setting. The philosophy group is able, through the use of ancient and contempory texts, to reflect on individual styles of living.

Together with the patient we draw from the selection on offer to create a customised therapy programme which will best meet the patient’s needs.

The clinic’s own internal medicine service is responsible for physical care and medical examinations. Bodily regeneration is complemented through a balanced diet including nutritional counselling.

If necessary, we offer a prudent and individualised drug therapy. As a certified clinic for drug safety (AMSP), we strive to offer treatments with minimum side effects. Furthermore, we employ chronotherapeutic techniques such as light and sleep restriction therapies in order to stabilise a patient's biological clock.  

Specialist therapies
The specialist therapies available focus on activating physical and psychological resources. On offer are:

• Physiotherapy and exercise therapy
• Jacobson method of progressive muscle relaxation
• Exercises to increase body awareness
• Ear acupuncture (NADA method)
• Back exercises and therapeutic massages
• Yoga, Shiatsu and Qigong
• Self-awareness recreational therapy
• HRV biofeedback
• Physio- und Bewegungstherapie
• Nordic walking and physical exercise
• Art studio, art therapy and music therapy

In addition to all of these activities in the clinic, patients can also use the Kilchberg swimming pool and the Holmes Place fitness studio in nearby Oberrieden.

Social counselling
Because burnout usually develops in connection with a work overload or difficulties in the workplace it is important, even during the leave period from work, to tackle work-related problems.

The head of our social counselling service, Marina Jung (a qualified business economist (FH) and with a masters degree (MAS) in psychosocial management), is available for work-related questions and workplace interventions. The general conditions of different workplaces can be systematically recorded through the use of an assessment tool.
As a result of this stocktaking exercise, goals are agreed upon and actions are planned. In doing so, people and environmental resources are both identified and mobilised. If so desired, specific network partners can be included in the coaching process. Using all available work-related methods and instruments advances the successful continuation of a professional career.

Outpatients
The Centre for Stress Related Illnesses, in addition to inpatient treatment, can also offer outpatient therapy. This includes a diagnostic work-up of the symptoms, as well as a tailormade medical and psychotherapeutic treatment which is compatible with the SymBalance therapy concept.
  
References
Ballweg T, Seeher Chr, Tschitsaz A, Bridler R, Cattapan K. SymBalance: a theory based, integrated therapy concept for burnout treatment.

Swiss Archives of Neurology and Psychiatry 2013; 164(5):170-7

Belvedere: The view of the Lake of Zurich as seen from the Belvedere unit.

The new private Belvedere unit was created for the inpatient treatment of burnout. Our patients can expect tastefully decorated single rooms with a shower, spacious wardrobes, a writing desk, safe and a mini bar. In addition to the pleasant atmosphere in the luxury hotel style unit and a panorama terrace with a fantastic view over the Lake of Zurich, Belvedere can also boast its own spa with a sauna and steam bath as well as a fitness studio.

Important elements for a recuperative retreat from the daily hecticness of life are the idyllic setting, the spacious park and the quiet surroundings of Sanatorium Kilchberg high above the Lake of Zurich with a view of the Glarus Alps. Urban culture and leisure activities can still be enjoyed as the centre of Zurich is easily reachable in only a short 15 minute trip by bus, train or car.      

Our individually designed culinary dishes combine a balance of enjoyment and nutritional principles. It is possible to dine à la carte or enjoy a refreshing snack accompanied by a drink chosen from our large selection of alcohol free beverages.

Prof. Katja Cattapan
Associate Specialist in Psychiatry and Psychotherapy
Deputy Medical Director
Senior Consultant Private Units
Telephone +41 44 716 42 55
k.cattapan@sanatorium-kilchberg.ch

Katja Cattapan's clinical focus is on the treatment of depressive illnesses. She is working to have burnout recognised as a stress related disorder. She considers it necessary that available therapies for burnout which utilise aspects of psychotherapy, neurobiology and organisational psychology have a scientific basis and are continuously evaluated. Meetings with the Senior Consultant regularly take place in the unit.

Christian Seeher
Associate Specialist in Psychiatry and Psychotherapy
Associate Specialist in Neurology
Head Physician at the Centre for Stress Related Illnesses
Telephone +41 44 716 42 82
c.seeher@sanatorium-kilchberg.ch

Christian Seeher has extensive knowledge of psychiatry, psychotherapy and neurology and is specialised in stress related and affective illnesses. He is responsible for individual therapy planning with patients and the implementation thereof in the unit. Patients in the Belvedere unit are personally taken care of by him.

Tobias Ballweg
Certified Psychologist, M.A. in Philosophy
Therapist and Deputy Head of the Centre for Stress Related Illnesses
Telephone +41 44 716 41 31
t.ballweg@sanatorium-kilchberg.ch

Tobias Ballweg made a substantial contribution to the development of the SymBalance therapeutic concept. His main interest is in the relationship between existential questions and personal circumstances. As part of the psychotherapy programme, he offers a specialised group therapy which has a philosophical emphasis.

Dr. Ariane Orosz
Neuroscientist at the Centre for Stress Related Illnesses
IBP Coach / Advisor in training
Telephone +41 44 716 42 47
ariane.orosz@sanatorium-kilchberg.ch

Ariane Orosz is specialised in the neurobiology of stress. In this role in the Belvedere unit, she is therefore involved in scientific studies, psychoeducation and therapy methods.

Together with Katja Cattapan, she works as part of a research network with the Department for Psychiatric Neurophysiology at the University of Berne on the topic of the neurobiological correlation between stress and burnout.

Sanatorium Kilchberg
Centre for Stress Related Illnesses
Alte Landstrasse 70
8802 Kilchberg
Telephone 044 716 40 46
belvedere@sanatorium-kilchberg.ch

Admissions
An application for admission to the Belvedere private unit in Sanatorium Kilchberg can be made by patients themselves, family members or through the physician they are currently attending.

After registering over the telephone or in writing, we will organise an appointment with you to plan the course of action and if needed, take the necessary steps for an inpatient admission.

Admissions Office
Monday to Friday, 8 am to 5 pm
Telephone 044 716 42 75

Administration Office
Patients with supplementary insurance should contact the administration office at the Centre for Stress Related Illnesses directly.

Monday to Friday, 8 am to 5 pm
Telephone 044 716 40 46

Doctor on duty
In an emergency, you may contact the doctor on duty outside of normal office hours. Patients with supplementary insurance should contact the administration office at the Centre for Stress Related Illnesses directly. 
Telephone 044 716 42 42 (via the reception)

Insurace cost coverage
Patient administration.
Telephone 044 716 42 42 (via the reception)