Emotional Labor and Burnout: A Review of the Literature.

This literature review was conducted to investigate the association between emotional labor and burnout and to explore the role of personality in this relationship. The results of this review indicate that emotional labor is a job stressor that leads to burnout. Further examination of personality traits, such as self-efficacy and type A behavior pattern, is needed to understand the relationships between emotional labor and health outcomes, such as burnout, psychological distress, and depression. The results also emphasized the importance of stress management programs to reduce the adverse outcomes of emotional labor, as well as coping repertories to strengthen the personal potential suitable to organizational goals. Moreover, enhancing employees' capacities and competence and encouraging a positive personality through behavior modification are also necessary. © Copyright: Yonsei University College of Medicine 2018.

INTRODUCTION

Job stress is now a much-discussed topic and has drawn the focus of popular media. It can lead to negative physiological, psychological, and behavioral responses among employees.123 With the expansion of service industries, emotional labor has emerged as a new job stressor. When employees regulate or suppress their emotions in exchange for wages, they are considered to be performing emotional labor.

The service industry plays a crucial role in today's world economies. Indeed, service activities now exceed approximately 70% of the gross domestic product (GDP) in the United States, as well as in European countries.4 Thus, emotional labor is likely to be common among most employees across several vocational fields, not just those that entail services to the public. Morris and Feldman5 indicated that the significance of emotional labor has been acknowledged in a variety of occupations. Today, most organizations manage or regulate employees' emotions in order to accomplish their organizational goals. These regulations and requirements have been found to be more prevalent in jobs that demand constant interactions with customers or clients.

This literature review was performed to demonstrate the association between emotional labor and burnout and to investigate the role of personality traits, such as self-efficacy and type A behavior pattern (TABP), in this relationship.

DEFINITIONS OF EMOTIONAL LABOR

Beginning with the work by Hochschild,6 literature on emotional labor has grown immensely in the last three decades.78 The term “emotional labor” is appropriate only when emotional work is exchanged for something, such as wages or some other type of valued compensation. Wharton9 remarked that such work is not only performed for wages, but also under the control of others. However, despite remarkable progress in academic research on emotional labor, some important questions remain unsolved.

Previous research has demonstrated that emotional labor contributes to negative attitudes, behaviors, and poor health of the employee.56 To highlight its constituting components, comprehensive definition and a theoretical model have been performed, which are expected to explain negative outcomes, such as individual stress and adverse health outcomes. There are various conceptualizations of emotional labor as a strategic model,6 a job characteristics model,5 and a mixed model proposed by Grandey.10

Hochschild6 defined emotional labor as “the management of feelings to create a publicly observable facial and bodily display (p. 7).” According to this perspective, managing emotions is recognized as one way for employees to achieve organizational norms or goals. Ashforth and Humphrey11 defined emotional labor as “the act of displaying appropriate emotions, with the goal to engage in a form of impression management for the organization (p. 90).” They proposed that emotional labor should be positively associated with task effectiveness, provided that the clients perceive the expression as sincere. They also suggested that if employees are not expressing genuine emotions, emotional labor may not become detrimental for them by creating a need to distinguish from their own emotions.

Morris and Feldman5 defined emotional labor as the “effort, planning, and control needed to express organizationally desired emotion during interpersonal transactions (p. 987).” This definition includes the organizational expectations for employees concerning their interactions with the clients, as well as the internal state of tension or conflict that occurs when employees have to display fake emotions, which is known as emotional dissonance. Grandey10 defined emotional labor as the process of managing emotions such that they are suitable to organizational or professional display rules. This conceptualization assumes that some organizations or professions have their own limited or typical set of emotions that are to be displayed while interacting with clients.

HEALTH CONSEQUENCES OF EMOTIONAL LABOR

These approaches indicate that emotions are being managed and regulated in the workplace to meet an organization's display rules, and suggest either individual or organizational outcomes of emotional labor. For example, Schaubroeck and Jones12 found that emotional labor was more likely to elicit symptoms of ill-health among employees who identified less, or were less involved, with their jobs. Several studies of emotional labor in particular occupations have documented that it can be exhausting, be considered as stressful, and increase the risk of psychological distress and symptoms of depression.91314 Hochschild6 and other researchers have proposed that emotional labor is stressful and may lead to burnout.

Emotional labor has been linked to various job-related negative behaviors and adverse health outcomes, such as job dissatisfaction, loss of memory, depersonalization, job stress, hypertension, heart disease, emotional exhaustion, and burnout,8 and has even been shown to exacerbate cancer.15 For example, Zapf8 revealed that emotional labor in combination with organizational problems, was related to burnout.

In addition to the negative effects of emotional labor, it is well known that emotional labor itself is closely related to workplace violence. Employees working in service sectors are more likely to be exposed to occupational violence from their clients while performing their duties, compared to those of other industries, such as manufacturing, and those who engage in white-collar jobs. Client violence is very common in today's modern industrialized society and includes client-, patient-, customer-, and prisoner-initiated violence.16 In Western countries, high risk jobs of client violence were found to be “caring jobs,” such as police; firefighters; teachers; and welfare, health care, and social security workers.16 Approximately 10% of health care workers in the United Kingdom had reported a minor injury, while 16% of them had been verbally abused.17 In the United States, 46–100% of health care providers are estimated to have been assaulted while performing their duties.18 Accordingly, when researchers try to examine the relationship between emotional labor and its negative consequences, such as health problems and work disabilities, it is recommended that the combined effects of emotional labor and workplace violence including verbal abuse from the clients be considered.

BURNOUT

Burnout research has its roots in service industry sectors, such as caregiving, in which the core aspect of the job is the relationship between provider and recipient.19 Burnout is a state of emotional, mental, and physical exhaustion caused by excessive and prolonged stress.20 Maslach and Jackson21 defined it as “a syndrome of emotional exhaustion and cynicism that occur frequently among individuals who do ‘people-work’ of some kind (p. 99).” In contrast to the approach proposed by Maslach, et al.,19 other researchers have argued that job burnout might be reduced to a single common experience, namely exhaustion.22 Studies of psychological burnout have been conducted in several countries, including Norway,23 Israel,242526 Canada,27 the United States,28 and Korea,29 and have produced remarkably similar findings.

BURNOUT AND HEALTH OUTCOMES

Burnout from work-related demands or tension is of utmost concern for organizations because they incur high costs in the form of negative outcomes.30 Burnout is a negative emotional reaction to one's job that results from prolonged exposure to a stressful work environment.1931 It is a state of exhaustion and emotional depletion that is dysfunctional for the employee and leads to absenteeism, turnover, and reduced job performance.323334 Moreover, these effects are particularly problematic for health care professionals, whose lower job performance can also have an adverse effect on their patients' health.35

The importance of burnout is suggested by its relationship with such outcomes as decreased job performance and physical/mental health problems.36 According to the conservation of resources (COR) theory, burnout occurs over prolonged periods of having few resources, which causes other resources to become compromised as well.37 Unfortunately, the extent to which employees engage in the regulation of their emotions is related to stress-induced physiological arousal,383940 as well as with job strain, which are manifested in the form of poor work attitudes and burnout.124142434445 However, the specific mechanisms to understand the relationship between emotional labor and stress outcomes have not yet been clarified.

Several studies on the relationships between emotional labor and burnout have been based on “the dissonance theory of emotional labor.” According to this theory, emotional dissonance is considered a cornerstone of emotional labor.46 It is conceptualized as a conflict between felt and displayed emotions, encompassing both potential and actually manifested emotions.47 Morris and Feldman5 found that employees gradually begin to experience burnout when their capacity for emotional dissonance is exhausted as a result of emotional labor. Zapf8 also suggested that emotional dissonance is found to be positively associated with burnout.

In particular, employees are depleted of energy and become fatigued if they are continuously exposed to situations requiring emotional regulation (e.g., adherence to excessive display rules). As a coping strategy with this emotional exhaustion, they may demonstrate negative and cynical attitudes toward others and express dehumanizing and indifferent responses, which, in turn, can result in poor productivity and, finally, in a negative evaluation of themselves.48 Burnout manifests differently depending on the job, although it appears to be much more common among workers involved in customer service than among those in the manufacturing industry.49 Taken together, these findings suggest that greater attention should be paid to burnout among caregivers, given their high degree of emotional labor.50 Indeed, it is especially important, given that the effects of burnout span beyond individual members and can affect entire organizations. In other words, burnout is inimical to the productivity and efficiency of the organization, thereby increasing turnover, facilitating negative job attitudes, and decreasing performance.285152 While there is a growing body of evidence that emotional labor can be stressful and lead to burnout symptoms, research has not sufficiently addressed the differing factors of emotional labor as predictors of burnout.

BURNOUT AS A NEGATIVE CONSEQUENCE OF EMOTIONAL LABOR

Due to global competition and the spread of the service sector, today's world of work is rapidly changing.53 This transformation leads to increasing mental workloads and demands.54 Although previous literature has revealed that burnout can occur both within and outside human service sectors,55 caregiving service professionals are more likely to face a relatively higher risk of burnout.56 The occupational perspective regards occupational grouping as being relevant in and of itself, meaning that workers employed in “high emotional labor” jobs6 and “high burnout” jobs48 report higher levels of stress than those in other jobs.

It has been generally assumed that there is something unique about “caregiving” professions that make their jobs more likely to feel burnout.28575859 Interactions with clients that are frequent and long-lasting have been regarded as antecedents to burnout.48 Researchers have documented differences in the dimensions of burnout for various service and caregiving professions,60 and have developed taxonomies of “high-burnout” jobs based on the frequency of interactions48 and the emotional control needed while interacting with clients.

The literature on emotional labor is focused on customer service, where interactions are less spontaneously “emotional” despite the necessity of high levels of emotional management or regulation to maintain positive relationships to customers.661 Hochschild6 proposed a list of “emotional labor jobs” that involve frequent customer contact and control over the emotional displays of the employees by their organization. However, comparing the occupations on Hochschild's list to non-emotional labor jobs has not been very useful in determining stress and burnout.121462 Employees in the “high emotional labor” grouping do not feel higher levels of emotional exhaustion than those in the “low emotional labor” grouping. This finding could be attributed to the fact that emotional labor is not a dichotomous variable; there may be a wide range of emotional labor demands with many jobs having some level of these demands.545

High levels of job demand may contribute to numerous stress reactions, such as burnout and depression, which may finally result in absenteeism, work disability, and turnover.63 For, example, Jeung, et al.64 reported that sub factors of emotional labor are positively related to burnout. These results indicate that conflicts and tensions occurring in the process of interactions with clients, and experiencing emotional dissonance are more likely to increase the risk of burnout. In addition, a shortage of supportive and protective systems in the organization also contributes to job burnout.

Emotional demand and regulation are more common in the human and public service occupations wherein customers constantly demand attention.65 People who are frequently faced with other people are more likely to feel burnout.66

REASONINGS FOR THE EFFECTS OF EMOTIONAL LABOR ON BURNOUT

Some mechanisms provide theoretical explanations about whether emotional labor contributes to burnout.42 According to the COR theory,67 when individual resources are threatened or lost, these losses cause anxiety and distress, thereby increasing physiological arousal and health problems.68 Experiencing interpersonal stressors is recognized as one of the most threatening sources of stress, posing a threat to self-image and resulting in increased cortisol response and perceived distress than other stressors.69 Previous research has reported that employees are likely to respond to angry or rude customers by suppressing genuine emotion.70 Such frequent self-regulatory efforts may lead to a loss of resources. First, the inauthenticity of faking expressions, or surface acting,42 reduces one's self-worth and self-efficacy. Such acts of strategic modification of one's emotions, thoughts, and behaviors require cognitive effort.8 This reduction of resources may play a crucial role in enhancing the stressful situation. Moreover, the loss of resources due to cognitive effort is more likely to contribute to strained or impaired well-being.71 Second, suppressing emotions requires energy resources, as exhibited by increased physiological arousal, higher levels of glucose, and decreased motivation.72 Consequently, continuous exposure to stress due to excessive emotional demands might activate the stress system, including the hypothalamic pituitary adrenal axis and the sympathetic nervous system. Furthermore, excessive and long-lasting emotional demands could contribute to depression or anxiety and behavioral problems, such as alcohol abuse or physical inactivity.73 Third, suppressing genuine emotions results not in actually showing or directly changing those feelings, but in fewer social connections with others,38 which consequently reduces social resources.

A second explanation for the mechanisms of the causal relationship between emotional labor and burnout has focused on emotional acting: surface acting. Surface acting is more likely to cause emotional exhaustion due to the effort required to fake or suppress negative emotions.41 Surface acting consistently produces emotional exhaustion that results in diminished well-being.74 Research suggests that surface acting is likely to deplete energy, as it involves long-lasting internal tension between one's displayed (suppressed) and true feelings, which in turn causes emotional dissonance. According to the person-centered concept of authenticity, conforming to external expectations leads to self-alienation and compromised feelings of authentic living.75 Empirical research has revealed that accepting external influences and acting against one's internal emotions has a significant association with anxiety, stress, and diminished subjective and psychological wellness.75 The continuous experience of emotional dissonance is more likely to increase the risk of high levels of psychological effort, thereby leading to loss of resources.7677 and finally resulting in burnout. Surface acting involves displaying inauthentic emotions that can produce negative responses from others. Scott and Barnes78 examined the relationship of emotional labor with work withdrawal, and they found that surface acting is significantly associated with negative effects and work withdrawal.

Overall, research has documented that faking or suppressing one's genuine emotions is linked to stress, resource depletion,72 and burnout.79

RELATIONSHIP BETWEEN PERSONALITY TRAITS AND BURNOUT

Experiencing frequent and chronic job stress, combined with a low sense of efficacy for managing job demands and lack of social support when faced with difficult situations and environments, is more likely to increase risk of burnout.8081 Indeed, over the last two decades, several studies have demonstrated that individual differences may play an important role in developing burnout. Several systematic reviews and meta-analytical studies examining the predictors of burnout emphasized the role of some individual characteristics.828384 Jeung, et al.64 revealed positive associations between the three sub-factors of emotional labor and TABP to burnout, and a negative association between self-efficacy and burnout among Korean dental hygienists. A growing body of research is proposing that self-efficacy and TABP operate as personal modifiers against job burnout caused by emotion regulation.

Although much research on burnout has concentrated on working environments, personality traits were also found to play a pivotal role in the development of job burnout.19 Recently, several investigations have documented that job autonomy, organizational climate, and some personality traits play significant roles as modifiers or mediators in the relationship between emotional labor and job burnout.85 Numerous works have emphasized the importance of personality traits; they have stressed the personal experience of emotional labor over time and identified personality traits as moderators.

Unfortunately, research on job stress has ignored the role of individual differences in the stress process. One personal characteristic that is likely to play an crucial role in the relationships among work stress, work control, and employee adaptation is self-efficacy.86 Beyond the environmental factors influencing burnout, it is also important to consider individual and self-regulatory factors that result in useful resources.

Self-efficacy refers to an individual's belief in his or her capability to organize and execute a course of action needed to meet the demands of a situation,87 and it refers to judgments that employees make concerning their ability to do what is needed to successfully conduct their jobs.88 As expected, work control and autonomy decreased the adverse effects of job stress on outcome measures only for employees who recognized themselves as having high levels of self-efficacy in the work place.

Workers who have high levels of self-efficacy believe they have the potential for mastering stressors more effectively than those with lower self-efficacy. A range of self-efficacy levels is likely to be associated with variance in employees' reactions because self-efficacy affects the choice of coping behaviors and the level of persistence in overcoming job-related barriers and stressors.89 Most research studies have emphasized the individual perceptions of one's social capital, such as self-efficacy and job autonomy, which can reduce or buffer against the tension of emotional labor.7790

Behavior patterns as a protective factor have long been implicated as a health risk factor. People with TABP as conceptualized by Friedman and Rosenman91 are described as “impulsive, competitive, aggressive, impatient, and more susceptible to developing the symptoms of coronary heart disease.” Consequently, these individuals are less likely to have a possibility of coping with job stress. Numerous studies have reported a significant relationship between job strain and a linear combination of TABP and job characteristics. Froggatt and Cotton92 revealed that type A individuals experience more stress when their work load increases, and Choo93 found a positive relationship between job stress and TABP. Fisher,94 however, did not find a moderating effect of TABP on the relationship of role stress to job satisfaction and performance.

Nevertheless, little is known as to why people with TABP are more susceptible to adverse health outcomes. Abush and Burkhead95 analyzed the relationship between TABP, perceived job characteristics, and feelings of job tension, and they found a significant relationship between job tension and a linear combination of TABP and job characteristics. Thus, research shows that the tendency to experience burnout cannot be separated from personality or behavior pattern.96

CONCLUSION

The results of this review suggest that emotional labor, as a new job stressor in modern society, leads to burnout and that an examination of some personality traits, such as self-efficacy and TABP, is needed to understand the relationship between emotional labor and its consequences, such as burnout. These results also emphasize the importance of stress management programs to reduce the adverse outcomes caused by emotional labor and of coping repertories to promote the personal potential suitable to organizational goals and norms. Moreover, enhancing individual capacities and encouraging a healthy personality through behavior modifications are required. Furthermore, legislation at the state level is needed for the protection of negative impacts caused by emotional labor.