Ingrid Pirker-Binder Editor

Mindful Prevention
of Burnout in
Workplace Health
Management
Workplace Health Management,
Interdisciplinary Concepts, Biofeedback
Mindful Prevention of Burnout in Workplace Health
Management
Ingrid Pirker-Binder
Editor

Mindful Prevention
of Burnout in Workplace
Health Management
Workplace Health Management,
Interdisciplinary Concepts, Biofeedback

123
Editor Translation by
Ingrid Pirker-Binder Andrea Zimpernik
Health-Consulting, Psychotherapy, Linguaserv–Translations
Biofeedback Business English
Vienna Vienna
Austria Austria

ISBN 978-3-319-61336-9 ISBN 978-3-319-61337-6 (eBook)

https://doi.org/10.1007/978-3-319-61337-6

Library of Congress Control Number: 2017958605

Translated from German original “Prävention von Erschöpfung in der Arbeitswelt.

Betriebliches Gesundheitsmanagement, interdisziplinäre Konzepte, Biofeedback.” Springer
Berlin, Heidelberg, 2016

Enriched and updated

© Springer International Publishing AG 2017

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I want to dedicate this book to
all those people who pursue
life and work in flow

To my sons
Foreword I

Do we really need another book that tells us that the modern work environment is
the reason for burnout, is detrimental to people’s health and reduces employees’
productivity? The answer is yes, and Ingrid Pirker-Binder’s book provides a great
rationale for that answer. Global competition and technological advancement,
especially the “freedom to work from anywhere, anytime” seem to have turned
against us. And so, the prospect of ever higher salaries or faster careers is no longer
enough to cover up that employees worldwide experience some degree of disillu-
sionment and even burnout and that we are facing a talent and people crisis in
organizations.
For instance, a recent and widely publicized study by Gallup has shown that
49.5% of employees are “not engaged” and 16.5% are “actively disengaged” in
their work. On the flip side, another study by Dale Carnegie showed that companies
with engaged employees outperform others by 202%. Shouldn’t this alone be
reason enough to address the issue?
Naturally, there are societal trends that are difficult to address by individuals or
by organizations. But there are practices and strategies that we can control,
including how we create meaningful work experiences and how we integrate them
with our personal lives. Ingrid Pirker-Binder addresses these questions from the
angle of occupational and business psychotherapy and provides great insight and
wonderful, practical solutions. But she takes it even further. All too often, the
relevant literature does little more than to suggest alternatives. Based on a profound
understanding of the literature, Ingrid Pirker-Binder actually provides scientific
insights into how our physical selves are impacted by the work environment and
how a focus on our physical health can improve productivity and satisfaction in the
workplace. In this book, she takes us on a journey from psychotherapy to occu-
pational health and from nutrition to strategic management in organizations.

vii
viii Foreword I

I truly hope not only that employees suffering from stress or threatened by
looming burnout will read this book, but that it will also find a wide audience
among top decision-makers who care for their employees and the long-term
viability of their companies.

Gerhard Apfelthaler, Ph.D.

Dean and Professor
School of Management
California Lutheran University
Thousand Oaks, USA
Foreword II

This book ranges from the phenomenon of exhaustion to methods, which revive
and support creativity in people.
In a time, which subjectively feels to be passing ever faster, during which the
social and economic pressures are increasing, it is crucial to understand the
connections.
Our understanding must be directed towards the true nature and culture of
human beings. However, nature and culture can only be understood in dialogue,
and the understanding thereof does not arise by itself.
This book examines the conditions in which there is a risk that people’s life
energy keeps diminishing to a point where it almost completely vanishes.
The editor is a specialist in the diagnostics and therapy of diminished or
dwindling life energy. Her biofeedback procedure, refined in many facets and
up-to-date, helps her to recognize the blockages and release them. This requires an
understanding of the authenticity of each individual. This book provides all the
details and leaves you truly enriched.

Univ.Prof.Dr.Dr.h.c mult Alfred Pritz

SFU Sigmund Freud Private University
Vienna Linz Paris Berlin Milano Ljubljana

ix
Preface

Dear readers,
In my work as an occupational and business psychotherapist and psychothera-
peutic expert on (in) ability to work due to exhaustion, I have become familiar with
the everyday crises, problems, work and time pressure of my clients and patients
and their stress and work-related complaints. This has spurred my inspiration and
motivation for this book.
Technological progress makes it possible—unfortunately or fortunately:
Work anytime and anywhere.
People must not forget about themselves and get lost in the daily time pressure
and ruminating. Work needs to be integrated meaningfully into life; a mindful way
of life may also take place during work time to facilitate life and work in flow. Long
gone are the days of work-life balance; the focus is much rather on work-life
integration and mindful interaction; it is also no longer a question of relaxing but of
preserving active regeneration.
From the perspective of a meaning-oriented occupational and business psy-
chotherapy, I will show in this book ways to sustainably preserve human resources,
performance capability and motivation, for the benefit of the working people and
the economic success of their businesses.
To keep fit at work, a holistic view of humans, their needs, desires, strive for
meaning, personality and work environment is required. The topics discussed in this
book range from the company to the needs of the cell and from the importance of a
meaning-oriented occupational and business psychotherapy and its integration into
company health management as an internal or external Health Assistance Program
to new holistic approaches for early detection of exhaustion. LifeSkript-,
WorkSkript- and LifeEnergyAnalysis, which I developed, should serve as a guide.
The chapters of this book throw a spotlight on businesses and management, on
the working people and their energy and on new measurement and training methods
offered by biofeedback in the workplace; in particular, the importance of heart-rate
variability for the prevention of exhaustion and for specific training to preserve
health will be addressed; additionally, an expanded image of stress and strain will
be presented.

xi
xii Preface

I would like to sincerely thank my clients and patients for their trust and also my
co-authors who have contributed much to the success of this book. Also, I wish to
thank the employees of the publishing house who supported me and always pro-
vided assistance. Last but not least, I am indebted to my friends who have helped
me with proofreading and creating graphics.
My co-authors and I hope you will find this book full of useful ideas and that
you will enjoy reading it!

Vienna, Austria Ingrid Pirker-Binder

Contents

Part I Human Resources in the Work and Economic World

1 Prevention of Exhaustion of Human Resources in Workplace
Health Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Ingrid Pirker-Binder
2 Leadership from the Perspective of a Commercial Executive . . . . . 35
Martin Reich
3 Work Areas, Concepts and Methods or Meaning Oriented
Occupational and Business Psychotherapy . . . . . . . . . . . . . . . . . . . 49
Ingrid Pirker-Binder
4 The Value Balance in Business®—Healthy Corporate Culture,
Healthy Employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Heinrich Anker
5 On Diagnosis and Development of a Health—Promoting
Corporate Culture with the Value Balance in Business® . . . . . . . . . 89
Heinrich Anker

Part II The Working People and Their Resources

6 The Working Human—The Exhausted Human . . . . . . . . . . . . . . . 107
Ingrid Pirker-Binder
7 The Working People and Their Energy . . . . . . . . . . . . . . . . . . . . . 125
Ingrid Pirker-Binder
8 Food Supplements = Supplement to Food . . . . . . . . . . . . . . . . . . . . 143
Ingrid Spona
9 Nutrition for Body, Mind and Soul . . . . . . . . . . . . . . . . . . . . . . . . . 157
Gerhard Moser and Ingrid Pirker-Binder

xiii
xiv Contents

10 People and Their Workplace . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167

Ingrid Pirker-Binder
11 Mental Profile: Stress and Energy—A Diagnostic Method:
The CA Method and Its Use in Practice . . . . . . . . . . . . . . . . . . . . . 179
Bohdana Fialová, Jiří Šimonek, Marie Šťastná
and Ingrid Pirker-Binder

Part III Biofeedback in the Work and Economic World

12 Biofeedback: Measurement and Training Methods . . . . . . . . . . . . . 191
Ingrid Pirker-Binder
13 Health in the 21st Century . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
Ingrid Pirker-Binder
Editor and Contributors

About the Editor

MMag. Dr. Ingrid Pirker-Binder studied international
business and educational sciences in Vienna and subsequently
completed a psychotherapeutic training in Existential Analysis
and Logotherapy by Viktor Frankl. She qualified in
value-oriented imagination by Böschemeyer, EMDR, Bio-/
Neurofeedback (aapb.org) and earned her doctorate at the
Sigmund Freud University in Vienna. She is a sworn and
judicially certified expert for psychotherapy. Her professional
focus is on workplace health management, management training,
and occupational and business psychotherapy. Besides her work
as a psychotherapist in private practice, Dr. Pirker-Binder acts as
a coach and consultant for capacity to work in the case of a
fatigue syndrome, works as a business mediator and offers
supervision. She applies methods such as bio-/neurofeedback,
heart-rate variability measurement and training within stress and
prevention management. Additionally, she is a lecturer and
textbook author and holds lectures, seminars and workshops.

Contact
offi[email protected]
www.pirker-binder.at
++43 (0) 676 70 47 668
RETREAT R4—the adventure week in addition to the book:
Outpatient prevention of exhaustion at selected hotels
Reset * Reflection * Regeneration * Restart
Work and life in flow, preservation of performance capability
and vitality
www.betriebliche-gesundheit.at
offi[email protected]

xv
xvi Editor and Contributors

Contributors

Heinrich Anker Lyss, Switzerland

Bohdana Fialová DAP Services a.S, Ostrava, Czech Republic
Gerhard Moser Vigaun, Austria
Ingrid Pirker-Binder Vienna, Austria
Martin Reich Vienna, Austria
Jiří Šimonek DAP Services a.S, Ostrava, Czech Republic
Ingrid Spona Vitalogic Dr. Spona VertriebsgmbH, Vienna, Austria
Marie Šťastná DAP Services a.S, Ostrava, Czech Republic
 Part I
Human Resources in the Work and
Economic World
Chapter 1
Prevention of Exhaustion of Human
Resources in Workplace Health
Management

Ingrid Pirker-Binder

Humans have two tasks,

Creating the world through action,
and maturing on the inner path.
(K. F. Graf Dürckheim)

Contents

1.1 Initial Situation .................................................................................................................. 4

1.1.1 The Eternal Topic of Burnout and Stress .............................................................. 6
1.1.2 The Beloved Eustress as Savior? ........................................................................... 7
1.2 Successful Prevention in the Work and Economic World............................................... 8
1.2.1 Aspects of Successful Prevention .......................................................................... 9
1.3 Meaning-Oriented Occupational and Business Psychotherapy as Part of the Human
Resources Department ....................................................................................................... 11
1.3.1 Frankl’s Meaning Oriented Concept as a Motivating Factor................................ 12
1.3.2 Exhaustion and the Question of Meaning at the Workplace ................................ 13
1.3.3 The Theory of Meaning in Workplace Health Management ................................ 15
1.3.4 Meaning and Values—From the Concept of Meaning to Modern Management . 16
1.4 Prevention as Workplace Health Management of the Future .......................................... 18
1.4.1 System Thinking as Preventive Factor .................................................................. 20
1.5 Management in Transition ................................................................................................ 24
1.5.1 Management Style in Transition—Transformational Management....................... 25
1.5.2 Management and Its Effect on the Work Environment and the Emotional State
of Employees .......................................................................................................... 27
1.5.3 Leadership, Motivation and Emotional State......................................................... 30
References .................................................................................................................................. 33

I. Pirker-Binder (&)
Vienna, Austria
e-mail: offi[email protected]

© Springer International Publishing AG 2017 3

I. Pirker-Binder (ed.), Mindful Prevention of Burnout in Workplace Health
Management, https://doi.org/10.1007/978-3-319-61337-6_1
4 I. Pirker-Binder

Work-life-integration is replacing work-life-balance.

Global economic crises, the dynamics of our technological development, the loss
of power of money, the reorganization of working environments (decentralized and
flexible workplaces, home office, permanent reachability, etc.) call for a restruc-
turing of economic and educational ways of thinking. The exclusive focus of the
economy on financial success without regard to the environment is passé; a new
way of thinking is arising from the crises. Humans and the preservation of their
resources are being focused on more than ever. New media make it possible: work
has become omnipresent! Humans have to learn to integrate work and their private
life into the day and to distance themselves at the same time—it is an integration
process and has long ceased to be a balancing act.

1.1 Initial Situation

Global economic crises, the dynamics of our technological development, the loss of
power of money, the reorganization of working environments (decentralized and
flexible workplaces, home office, permanent reachability, etc.) call for a restruc-
turing of economic, educational and humanistic ways of thinking. The exclusive
focus of the economy on financial success without regard to the environment is
passé; a new way of thinking is arising from the crises, and the time has come to
seek the preservation of human resources. Only if the individual can keep up his/her
performance capability, can a company be successful and achieve positive
long-term health results. Businesses are social and living systems.
Workplace health management deals with the human resources of the employ-
ees. Before any meaningful steps in health promotion can be taken in a company, a
workplace health management needs to be put in place. Meaning-oriented occu-
pational and business psychotherapy can make a significant contribution both,
through business consulting of strategic management, as well as through consulting
and designing policies and interventions for employees. Its purpose is the preser-
vation of human resources and their performance and readiness potential.
The analysis aims at the individual in the social network at work, the basics of
fatigue and prevention, leadership concepts and Viktor Frankl’s concept of meaning
as a motivating factor.
The word Burnout1 (fatigue syndrome), with its wide terminology reflects
today’s zeitgeist. Numerous studies analyze the burnout status of various profes-
sional groups and describe the hazards associated with a psychological and/or
physical collapse. Not to be neglected are the significant economic costs incurred
by the temporary or permanent loss of capacity to work. According to a publication

1
Here burnout is referred to as a condition of mental and/or physical exhaustion that can upset the
internal and external balance if it is not recognized in time. If the balance cannot be reestablished, a
complete mental and/or physical collapse may result. The term burnout will subsequently be
replaced by exhaustion or fatigue syndrome.
1 Prevention of Exhaustion of Human Resources … 5

of the European Community at least 40 million employees in the EU countries are

affected and cause annual costs of at least 20 million euros, apart from the negative
impact on production and competitiveness (European Commission 2000).
While technological progress has remained a permanent focus of attention and
machines require, and are subject to, constant maintenance, the human resources
have largely been neglected; humans with their needs and necessities have, so to
speak, been subordinated to technical and economic success.
However, machines cannot replace the human factor. The “individual as a
whole” and his/her resources are slowly being put into perspective, which is called
human capital;2 ways to make this human capital measured and displayable are
being looked for.
The rising number of sick days caused by psychological and physical stress, the
high rate of burnout cases shows that it is time to make the people and their needs
the focus of interest so as to secure future economic survival. In this respect Souba
(2014) pointedly quotes Wiener (1988),
We have modified our environment so radically that we must now modify ourselves in
order to exist in this new environment. We can no longer live in an old one. Progress
imposes not only new possibilities for the future but new restrictions.3

Exhaustion at the workplace has to do with people, their performance capability,

their achievement motivation and their ability to work; it concerns their commu-
nication, interactions, their physical and mental abilities and skills and the place
where work takes place that provides the framework for their economic activities.
At the beginning of the technological explosion, it was assumed that the new
technologies would facilitate the existing work and that human labor could sub-
sequently be saved. Meanwhile technological progress has overtaken us. Dascal and
Dror, professors of cognitive psychology in Tel-Aviv and London, write in this
respect:
Viewed from this perspective, we think that technological innovations have not necessarily
reduced the amount of work but rather significantly changed the type of work performed by
humans …These innovations did not replace human labour but introduced deep changes in
its environment, which led to the requirement and development of new cognitive compe-
tences …We will not be able to describe the work environment by blunt physical and
psychosocial factors. We will need a new vocabulary that describes the work by e.g.
declarative, procedural, executive, memory capacities, implicit/explicit, etc. functions with
relation to brain function. (Dascal and Dror 2005)

Now what does the technological progress mean for the working people, the
society? First of all, certainly lifelong learning, followed by the willingness to
change and a lot of flexibility, which concerns both the work and the activity per se.
It almost looks as if the technological development were much faster than humans

2
Human Capital, definition: The performance potential of the employees (work capacity) based on
training and education (Gabler Wirtschaftslexikon 2014).
3
Wiener (1988).
Souba (2014).
6 I. Pirker-Binder

can take it. They lag behind. For the requirements of this time to be met, willingness
to change and personality development are demanded from all people. This applies
not only to dealing with oneself, but in future also the orientation towards the
community and the communal taking of responsibility for ecology and nature will
move more and more in the foreground: from the “I” to “you” to “we.”

1.1.1 The Eternal Topic of Burnout and Stress

It is a fact that the word burnout is an often-used term, which is not yet clearly
defined. It is imprecise and very often used incorrectly. In Austria it is allowed to
stay at a rehabilitation health spa (so-called “Burnout clinics”) because of burnout
(usually diagnosed as exhaustion depression). In the Manual ICD-10 for the clas-
sification of mental disorders (2012) strain is classified with the number Z73.3 and
fatigue syndrome (being burnt out, burnout) with the number Z73.0. Complaints
that fall under these numbers do not entitle to compensation of costs in the case of
psychotherapy. Burnout is thus only an additional diagnosis, not a treatment
diagnosis. The term burnout has become a buzzword. In fact, however, burnout is a
serious diagnosis when a person is suffering from it.
Burnout as a fatigue syndrome is a state of mental and/or physical exhaustion,
which, if not diagnosed and the internal and external balance being restored, results
in a complete mental and/or physical breakdown of the organism. The occurring
complaints are complex, sometimes diffuse. For this reason, the term burnout is
replaced by the terms exhaustion or fatigue syndrome in this section.
Long-lasting mental and/or physical stress and strain cause chronic stress, which
may result in a fatigue syndrome. From the manifold definitions of burnout I would
like to summarize based on Nelting (2010) and Ahola et al. (2005) as shown in the
box below.

Exhaustion at the Workplace

Exhaustion at work is defined as a process-like illness, as a system excitation
from a persistent, gradually-reinforcing or chronically existing
workplace-related, emotional, mental or physical activation. This initiates a
process of dissolution of the psychophysical self-regulation, with the cardinal
symptom of exhaustion.
1 Prevention of Exhaustion of Human Resources … 7

The more severe the exhaustion, the higher is the probability of a depression.

Stress
The word stress is used to characterize a state of activation. The organism
does not know any difference between negative and positive stress, but only
activation or different level of activation.

1.1.2 The Beloved Eustress as Savior?

Eustress (used for positive stress) is usually understood as a challenge, the person
concerned has sufficient coping strategies for in order to take up this challenge and
to cope with the task positively. However, prolonged eustress also results in
exhaustion just as Distress does (e.g. “I love my work”, “It does not bother me to
work twelve hours every day”). Loving one’s work, having a high level of moti-
vation, do not suffice to keep people healthy, only life and work in flow, in
accordance with the individual resources, does.
If one refers to this understanding of eustress as positive stress, all those should
not suffer from exhaustion, who love their work and have sufficient skills and
competences to complete the tasks at hand. Yet, this is not true anymore.
It’s no longer merely a matter of cognitive coping strategies, but rather whether
the organism of the working human has sufficient recovery times and mechanisms.
As is known from the biofeedback research, it is assumed according to a new
approach in active stress management that, for the preservation of health, the res-
onance ability of the organ systems within the body must not be disturbed or
unsettled by prolonged strain (heart rate variability). So, it’s not about relaxation,
which means as much as reduction of tension starting at a given level, but rather the
strengthening of the regeneration system, i.e. the parasympathetic part of the
autonomic nervous system (specifically the vagus nerve) and preservation of the
resonance ability of the heart rate. This is done in a harmonious and
resource-oriented interplay between various degrees of alertness on the one hand
and relaxed letting-go and deep regeneration on the other hand.
Basically it’s about the answer to the question how much the working human is
aware of his/her performance capability, resources and resilience and in how far he/
she can bring life and work into a state of coherence or how he/she integrates
recovery in work time (regenerative micro breaks).
It’s not a matter of balance between work and life (work-life balance), but of
integration of work in life. Integration is demanded even more, the more work-
places change; the home office can serve as one of many examples.
8 I. Pirker-Binder

Work-Life Integration Replaces Work-Life Balance

It is no longer a question of two opposites, which are to be brought into
balance, but of life with meaningful integration of times of activity and times
of recovery and regeneration. The body cannot distinguish whether the person
is working out of duty or for pleasure. Strain remains strain, no matter where
it takes place. Hence, for quite some time it has not been merely about stress
but regenerative capacity.

If people neglect the needs of the body and, in particular, its ability to recover,
exhaustion or illness will not fail to appear. The solution is active energy man-
agement, awareness and a sense of using only as much energy as is necessary for
the work at hand and not more: one can be all tense in front of the PC or work in a
comfortable position. High muscle tension as a result of concentration is not
necessary.

1.2 Successful Prevention in the Work and Economic

World

If timely appropriate prevention, intervention and training measures are taken,

longer-term sickness-induced absences, sick leave and, in the worst case, complete
inability to work can be prevented. This raises the question of appropriate measures.
It is, therefore, not surprising that almost feverish attempts are being made to
influence this process of rising cases of burnout (see Footnote 3)4 in various ways.
In Austria the clearest reaction was the entry into force of the Worker Protection
Law amendment (ASchG-Novelle; Federal Law Gazette BGBl 118/2012) on
1.1.2013, which places more emphasis on the importance of mental health and
prevention of work-related psychological stress, which leads to inappropriate strain,
and incorporates into law measures to assess psychological stress in the workplace.
With the Worker Protection Law amendment the duty to evaluate psychological
stress at work has become required by law. Psychological stress, leading to inap-
propriate strain, and also strain on the musculoskeletal apparatus, are a common
cause of work-related ailments and illnesses (physical requirements/mental
requirements). They cause much human suffering, but also enormous business
and economic costs (Federal Ministry of Labor, Social and Consumer Affairs
2015).

4
Nil et al. (2010) speak of burnout as a labor psychological concept and not a psychiatric diag-
nosis: “As a concept it may easily be linked to existing stress models in the field of work
physiology and psychology and their postulated, predictive health consequences. These extend,
according to empirical findings, not only to psychiatric disorders such as depression, but with
increasing evidence, also to somatic illnesses such as those of the cardiovascular system.”
1 Prevention of Exhaustion of Human Resources … 9

Psychological stress includes psychosocial, psycho-emotional and

psycho-mental stress.

Psychological Stress from the Point of View of Occupational Science

“Psychological stress is the totality of all detectable influences that come to
the people from the outside and influence them mentally” (Federal Ministry
of Labor, Social and Consumer Affairs 2015). Reactions to psychological
strain are understood as psychological stress at work.

Psychological Stress from the Perspective of Occupational and Business

Psychotherapy
Psychological stress is the totality of all detectable influences that act from
outside and inside on the people and have an impact on their emotional
experience, emotions and reactions; because psychological stress at work and
the reactions to it are individual and closely connected with the personality,
the world of experience of the working people and the environmental factors.

1.2.1 Aspects of Successful Prevention

Hence, successful workplace prevention will increasingly need to be oriented

towards the person and his/her world of experience. In the future companies should
regard the term “success” in terms of health success, as market-based success
follows resource-oriented work.
Prevention and intervention are areas of workplace health management, whose
responsibilities include two questions:
A. What role and what objective shall the issue of health and commitment of
employees have within workplace health management and as an integrated part
of corporate thinking?
Answering this question is a strategic management decision. New concepts that
are based on people are required here; the implementation of strategic decisions
takes place within workplace health promotion (education, training, further
training).
B. What meaningful preventive measures can be used to avoid health crises and
what actions should be taken when they have occurred?
To answer this question interventions and concrete measures are necessary
(consulting, coaching, brief therapy, various methods from the portfolio of
10 I. Pirker-Binder

therapeutic methods, emergency and crisis intervention, anonymous point of con-

tact within the company or outside the company for all employees).5
The meaning-oriented occupational and business psychotherapy can make a
significant contribution to answering both questions. Its contribution to question A
lies in the business consulting function of strategic management and in project
management; with regard to question B it provides consulting, designing measures
and interventions for employees of a company. Its task is to maintain the specific
human resources and their performance and readiness potential.

Successful prevention of exhaustion at the workplace refers to two aspects:

1. Individual: prevention based on the individual employee, his/her inner
work experience, his/her attitude and evaluation system, his/her life story.
2. Collective: prevention based on groups, teams, and all employees of a
company. Collective health ensures the company’s success.

Collective prevention includes all employees of a company and is a basic pre-

condition for commercial success. In a macroeconomic perspective, the under-
standing of collective health is extended to all working people of a society and the
respectful use of all available resources.
If the individual employee is thriving, so is the team and the group as well.
Healthy groups and teams have positive interaction patterns among themselves and
in upstream or downstream teams. Even executives are employees, even though
they are in a sandwich position between the top management/the company owner
and its employees.
The basis of any prevention initiative should be the question about the currently
lived corporate culture, because it provides the framework and the breeding ground
for economic activity in an organization. A guideline for such consideration is
provided through the LifeScriptAnalysis for companies.
The reductionist view claiming that health could be guaranteed by means of
good nutrition, exercise and relaxation alone, is giving way to a holistic view of
lifestyle. The human being is more than a functioning machine with inexhaustible
physical and mental resources. The way the pendulum between health and illness
swings, which pole it tends to move to, depends on the individual person. If the
workplace is included, the community of working people in the company and the
framework conditions also determine the swing of the pendulum.
• Prevention should not merely be understood as a package of measures but
as a process, as opening the awareness for the significance of human
resources, for the individual person, a team, a company, for a
resource-oriented economic way of thinking and acting.

Internal or external “health assistance program” (www.betriebliche-gesundheit.at).

5
1 Prevention of Exhaustion of Human Resources … 11

If a company’s success is considered health success, reasonable prevention

viewed from a future perspective can be aligned along three areas:
1. Area of the company, that serves as a common place for a group of
working people at their workplaces and offers a living and working
framework. In the future, the health of a company will be determined by
these factors:
1. in how far it nourishes its roots, provides the employees with the
framework to maintain their performance capability and achievement
motivation,
2. how it keeps the eye on the market and responds to changes quickly
and flexibly. Thereby it should not constantly be hungry for higher
returns, but also consider periods of regeneration.
3. how much it respects nature, i.e. how it deals with its corporate social
responsibility.
2. Area of the workplace as the location where work takes place, where most
of people’s lifetime is spent and culture is lived.
3. Area of the individual working individual: his/her psychological perfor-
mance, his/her work experience, his/her life script, his/her meaning and
value orientation. This is about the responsibility for the body and the
individual’s awareness of its needs for maintaining the mental and
physical performance capacity.

1.3 Meaning-Oriented Occupational and Business

Psychotherapy as Part of the Human Resources
Department

The roots of the meaning-oriented occupational and business psychotherapy are in

the research of Antonovsky (1997) on coherence, Csikszentmihalyi (2000, 2004) on
the flow and Frankl on meaning (1969, 2002, 2004).
Antonovsky abandoned the pathogenic search for why someone falls ill and
researched why people stay healthy. For success prevention this health-oriented
approach is groundbreaking. He realized that stressors are challenges, which must
be addressed. They are lifelong influences.
The confrontation with a stressor … results in a state of tension one has to be able to handle.
Whether the result will be pathological, neutral or healthy, depends on the adequacy of
processing tension. (Antonovsky 1997, p. 16)
12 I. Pirker-Binder

Antonovsky examined whether there may be predictions about tension pro-

cessing and developed the concept of generalized resistance resources.
… My fundamental philosophical assumption is that the river is the stream of life. Nobody
goes safely along the banks. Furthermore, it is clear to me that a large part of the river is
contaminated, both literally and figuratively. There are forks in the river resulting in a light
current or in dangerous rapids and swirls. My work is dedicated to dealing with the
following question: How do you become a good swimmer, regardless of the river’s con-
dition, the nature of which is determined by historical, socio-cultural and physical envi-
ronmental conditions? (Antonovsky 1997, p. 92)

He noted that good swimmers possess three major components or resistance

resources:
– understandability: life’s challenges can be explained and are thus
comprehensible.
– manageability: there is the belief that enough resources are available to master
these challenges.
– significance: the challenges hold significance, a deeper meaning. This is about
recognizing that the challenges have an inherent significance, a deeper meaning.
Depending on the distinctive relationship (coherence) of these three beliefs—
generalized resistance resources—i.e. the higher the SOC (“sense of coherence”),
the better the person concerned is equipped to master dangerous rapids in the river
of life. However, Antonovsky’s concept does not provide an explanation, why also
people with high SOC scores may suffer from exhaustion at the workplace.6 One
explanation could be that obviously those people, who show high psychosomatic
intelligence, do not suffer from exhaustion because of their good feeling for
themselves and practice good energy management with and for themselves.
Antonovsky’s discussion about meaningfulness also led him to Viktor Frankl’s
philosophy and his concept of unconditional meaning in and towards life.

1.3.1 Frankl’s Meaning Oriented Concept

as a Motivating Factor

Viktor Frankl’s fundamental belief system is built on the pursuit of meaning and
values.
He founded the Third Viennese School of Psychotherapy, Existential Analysis
and Logotherapy, after Sigmund Freud’s Psychoanalysis, i.e. the First Viennese
School and Alfred Adler’s Individual Psychology, the Second Viennese School.
The existential analytical approach allows exploring the personal character of
each individual.

6
According to my hypothesis high eustress and high SOC scores are in a close
relationship. Overwhelmingly high SOC scores indicate an overestimation of one’s own resources.
1 Prevention of Exhaustion of Human Resources … 13

The findings of Neuropsychotherapy (Grawe 2004) and the neurosciences offer

theories for understanding the importance of basic human needs and allow
hypotheses about which distortions of thought patterns, actions and attitudes and
thus also strain might result if deficits or micro-traumas appeared during the ful-
fillment of basic needs during childhood, the impact of which extend into the here
and now.
The existential analytical approach provides the rational basis for the indi-
vidual living and work concept and explores the unconscious gaps. When uncon-
scious experience becomes conscious, the individual is able to understand, to
change and to build new coping mechanisms. Logotherapy focuses on the imple-
mentation of these findings and with the opening up of possibilities of meaning.

1.3.2 Exhaustion and the Question of Meaning

at the Workplace

From a logotherapeutic point of view burnout or exhaustion can be seen as a

distortion in one’s meaning of life. The individual does not live what he/she could
be, but what he/she has to live or believes he/she has to live. He/she does not
recognize his/her own space and ignores the needs of his/her body. He/she is not
aware of his/her wholeness and lives only individual aspects. Then the aspect of
meaningfulness moves into the background in favor of gratification of needs. Work
is more and more being reduced to fulfillment of purpose.
This is when the working people live in discord
– with themselves, their intuition, their purpose, their sense of life
– with their mental, physical and emotional resources
– with their working environment
– with the companies they work for
If open and respectful interaction at the workplace no longer exists, the indi-
vidual poses the question, “Why am I still doing this?” Even Nietzsche wrote, “If
one has one’s Why of life, one gets along with almost anyone” (Nietzsche 2014).
However, if there is no “why”, “what for” or “for whom” any more, the individual
starts to question the meaningfulness of his/her activity and dedication.
Questioning their own activities also affects those who have had a brilliant
career, who have achieved something. Sometimes, in their career pursuit, they have
become so distanced to their actual core business that they plunge into a crisis
because the horizon of meaning of their job performance has changed and greatly
departed from the original basis. Sometimes, though, these people face a crisis
because they have simply lost their sense of meaning. They have forgotten to live
the essence of life; they have lost the “what for”. In this case one generally speaks
of “midlife crisis”. Crises of meaning associated with the workplace, are closely
related to the lived culture, mission and vision, leadership, work contents and
timelines.
14 I. Pirker-Binder

Dichotomy Between Mission/Vision and Individual Concepts of Meaning and

Values

Mr. X, a young man just over 30 years old, contacts me in my practice. He is close to tears
and makes a very depressive impression. His wife had sent him because of burnout, he says.
During the diagnostic interview it becomes clear that it is neither a case of burnout nor
depression, but a question of meaning and values and the feeling of not having any freedom
of choice.

Background: The young man was department head in a medium-sized com-

pany. He was known as very efficient and had good opportunities for advancement.
Nevertheless, he himself had an ever-increasing identification problem with the
mission and vision of the company. His work, the mission and future vision of the
company were becoming less and less compatible with his attitude. He plunged into
a crisis when he did not dare to quit. He had two small children, lived in a small
town where he had also taken on various tasks such as working as a volunteer
firefighter. He did not see any way out. After graduation from university he had
already worked in 3 different companies, and he was of the opinion that changing
jobs frequently would be a hindrance during the job search. In the existential
analysis of his crisis it turned out that for a long time Mr. X had already been
carrying a wish within himself, namely to become self-employed in the special area
of the future-oriented field of environmentally friendly construction. He blossomed
visibly as soon as he delved into that matter; his depressed mood had disappeared.
He slowly began to recognize and to feel where his path would take him and that he
had to leave his company if he wanted to recover. He eventually did so, although
the company management tried everything to persuade him to stay.
A business as a living, social system offers people a place of individual growth
by successfully managing challenging tasks. It takes a reflective person to perceive
situations, be able to recognize relationships and act sensibly and purposefully.
A balanced ratio of will to take action and activity requirements results in enthu-
siasm for the work and a sense of coherence (Bauer and Brown 2014, p. 17).
Another phenomenon is the crisis of meaning in the middle years of a person’s
life, which is generally known as “midlife crisis”. It is the time when all the material
and ideological objectives have been achieved, the house is built, the family is
founded, and the children are grown up. At that point, frequently, the question
“Why am I doing all this?” arises. In this case it is an existential crisis, which entails
deep thought “What am I here for, what do I live for?” The finite nature of existence
and the awareness of the terminal nature of earthly life cause an emotional shock.
This is not a burnout, but the realization that there is an end to everything. The crisis
contains the invitation to deal with one’s own meaning of life or reorient oneself.
The meaning must be found anew. Another aspect involves the fear of the loss of
one’s job.
1 Prevention of Exhaustion of Human Resources … 15

1.3.3 The Theory of Meaning in Workplace Health

Management

The logotherapeutic assessment concentrates on the distortion, i.e. what blocks

people’s experience of meaningfulness.
Frankl’s theory of meaning has proven to be the motivation concept par
excellence in today’s management. Human activity is based on a causal strive
towards meaningfulness. This pursuit, or determination, can be divided into two
aspects, namely
– the inner aspect, which exists inside every individual and
– the outer aspect, which includes the offered concepts of meaning and options for
the realization of meaning.
This primal force of wanting to do something truly meaningful, which is located
inside every human, is neither diminished by illness nor by immaturity or senility.
Willingness to perform and capacity to work originate here.
Coherence between internal and external aspects results in willingness to per-
form and psychological capacity to work. Work, as quest for meaning and real-
ization of meaning, has an effect on psychological health or illness.
• Exhaustion as a result of a distortion of realization of meaning
If the realization of meaning becomes distorted, disruptive factors become active
that may result in emotional and/or physical exhaustion.
Once a person no longer feels connected to his/her physical resources, ignores or
denies all somatic indications, his/her resources may fail, any reserves are exploited
—this results in a physical and/or psychological breakdown. Whether first a psy-
chological or physical breakdown happens, depends on individual personality
factors, primarily on where the person affected has hidden his/her blind spots and
deficits. Disruptive factors may be rooted in the people themselves, for example, if
work serves as a substitute for unsatisfied basic needs, or in the environment at
work:
– lack of modes of meaning at the workplace,
– a conflict of values, which arises through a mismatch between the demands of
work and individual attitudes and principles (Maslach and Leitner 2001, p. 17),
– onerous working conditions.
The basic needs are the same for all people; they merely differ in severity. In his
consistency theoretical view of psychological functioning Grawe (2004, p. 190)
states two influencing factors, namely
– the pursuit of congruence (fulfillment of all basic needs) and
– the pursuit of consistency (basic principle of psychological functioning)
16 I. Pirker-Binder

In his opinion:
Psychological processes are continually focused on perceiving in the sense of activated
motivational goals.
Behind the motivational goals are the basic needs … goals and behavior are, in contrast to
basic needs, related to concrete situations or classes of situations. With regard to goals and
behavior people differ due to their life experience, in their basic needs, however, they do
not. (Grawe 2004, p. 190)

Elger (2009, Pos. 1459) describes from the point of view of “neuroleadership”
four vital needs as the cornerstones, which are closely interwoven and ensure
psychological wellbeing in life and working life:
– establishing, shaping and maintaining social relations,
– understanding the world—being curious and learning,
– preserving the existing and avoiding losses,
– developing and growing.
• According to Frankl striving for realization of meaning is the elemental
force per se, which is anchored in every human being.
Looking now at this concept of motivation and Grawe’s consistency theory, the
roots of (in-) ability to work due to exhaustion can already be guessed here. If there
are shortcomings in the basic needs, the quintessential realization of meaning is
primarily directed towards overcoming those shortcomings, and only secondarily
towards the actual finding of meaning in work life. An example would be if work
served as a love substitute or boost of self-appreciation.

1.3.4 Meaning and Values—From the Concept of Meaning

to Modern Management

Based on the human striving for realization of meaning work is meaningful. Here
Frankl’s existential analysis and logotherapy extend to modern management. In this
sense, logotherapeutic expert opinions for the evaluation of psychological capacity
to work can fill a gap between aspects of humanistic psychotherapy and modern
leadership. Renowned business experts (Malik, Anker, Corvey etc.) are dealing
with Frankl’s logotherapy and describe his concept of meaning as the contemporary
concept of motivation per se.
Corvey (1992) bases his model of Pro-activity (Fig. 1.1) on Frankl’s theory of
the inner freedom to decide for or against something and the ability to choose
between stimulus and response.
Thereby Corvey understands the ability of humans to subordinate an impulse to
a value. He distinguishes between reactive people, who are driven by their feelings,
the circumstances or their environment, and pro-active people, who receive moti-
vation from their values. So,
1 Prevention of Exhaustion of Human Resources … 17

Fig. 1.1 Proactive model. Modified according to Corvey (1992)

… Frankl utilized the gift of self-awareness to discover a fundamental principle: the

individual has the freedom to choose between stimulus and response. In the freedom of
choice lie the talents that make us unique as human beings. In addition to self-awareness,
we have the imagination - the ability to mentally create something beyond our present
reality. We have conscience - a deep inner awareness of right and wrong, of the principles
that determine our behavior, and a sense for the degree to which our thoughts and actions
are in accordance with them. And we have the independent will - the ability to act inde-
pendently from all other influences on the basis of our self-awareness. (Corvey 1992, p. 69
ff.)

Anker uses Frankl’s concept of meaning as a model of thinking for his book
Balanced Valuecard; performance instead of egoism:
Meaning-centered self-motivation mobilizes forces and creativity, which are completely
neglected in neoliberal economics: professional circles estimate that employees under a
utilitarian-neoliberal regime (can) only bring 30 to 50% of their potential to their work – an
immense waste of resources, not taking into account the disregard of humans as beings with
a profound need for meaning, for an answer to the “why” and “what for” of their actions
and existence …
Böckmann with recourse to Frankl: With meaning to profit - for the people, businesses and
the economy … Our brain rewards cooperation, and it responds positively to appreciation,
which we receive, - Contemporary research speaks a language very different from the
utilitarianism of the 19th century. (Anker 2010, p. 237)
18 I. Pirker-Binder

1.4 Prevention as Workplace Health Management

of the Future
It is interesting that the English words whole and health have the same roots (the Old
English hal, as in unhurt or whole). Thus, it should not come as a surprise that the hopeless
state of our world is in direct proportion to our inability to perceive it holistically. (Senge
2001, p. 88)

A future workplace health management deals with the questions: How healthy is
the company, and not only from the perspective of economic indicators, but
especially from the perspective of human resources? How can health be maintained
in the company?

A future workplace health management will have to be oriented towards a

holistic view and bear three aspects in mind:
– the health success of a company expressed as economic success
– the health success of its human resources—the performance capability and
commitment of its employees, which is substantially influenced by the
personality and social competence of the managers
– the livability of its mission and vision—corporate culture

In this context health success is understood as the future economic performance

capacity of a company and is synonymous with the corporate success.
It will depend largely on the extent the management is able to shift its attention
towards a holistic understanding of economic activity, towards meaning and value
dimensions and sustainability in the future; it means a rethinking from
ever-increasing growth figures towards the preservation of what already exists, of
existing success and learning from nature. Without a healthy environment, there is
no existence. Corporate Social Responsibility will be a guarantee of future survival;
not only for the company itself, but also as an aspect of meaning and motivation for
the people who work in such companies, because in this way the “What for and
Why” of the effort made becomes clear.
88% of the working population in Switzerland express a strong preference for
employers with social responsibility and ethical behavior. “Companies with social
responsibility and environmental awareness are the most attractive employers”
(Kelly study in Anker 2010).
The stronger staff retention, the less absenteeism and turnover of staff; according
to a Gallup Study conducted in 2009, in Germany a company with 500 employees
can achieve cost savings of nearly 1 million euros a year through staff retention,
companies with 2000 employees, can save almost 4 million euros (Gallup Study in
Anker 2010).
1 Prevention of Exhaustion of Human Resources … 19

This suggests planning changes in terms of a future vision. How food for thought
for changes can be found, is described by Scharmer (2009) in his book Theory U—
leading from the future.
For the preservation of health and prevention of depletion of human resources
both, on a small or big scale, the kind of change is crucial, which can be described
as follows:
1. qualitative long-term or
2. short-term snapshot
• Ad 1: qualitative long term
Qualitative long-term changes are directed towards a future qualitative
improvement—change processes are considered from a future point of view
(Scharmer 2009).
• Ad 2: short-term snapshot
Short-term snapshots denote changes that are meant for the purpose of a cor-
rection of the current state. In case there is a problem, it is attempted to restore the
previous condition in the sense of a homeostasis (Otto et al. 2007, p. 79). On the
corporate level, they are comparable to the legal obligation to evaluate psycho-
logical stress in the workplace in Austria. With regard to its basic idea, this is a
milestone for the appreciation of human resources in the work world. In practice,
however, this is little efficient. Selected external parties interfere in companies for
evaluation purposes. For now this is sufficient in terms of the law. However, change
processes in a company require an impetus from the inside, the core of the system.
On a personal level such a procedure could mean that employees who are
diagnosed with exhaustion are granted a dispensation from work and sent to a
rehabilitation center. Once back in the work world, the old patterns start creeping
into everyday life. Everything starts again. In this case the next sick leave is already
pre-programmed. To illustrate this link, the story of the carpet dealer seems
appropriate.
Story of the Carpet Dealer
Once there was a carpet dealer who discovered a large bump in the middle of his
most beautiful carpet. He tried to smoothen it with his feet—with success. But it
appeared again at a spot close to the first one. Again the carpet dealer jumped on the
bump, and it disappeared—only to reappear immediately afterwards at a new spot.
Angrily the man pursued the cheeky bump crisscrossing all over the carpet. He
jumped and stomped, stomped and jumped, and was ruining the beautiful fabric
until he finally lifted the carpet in a corner, and, behold—an angry snake darted out
(Shah 1982 courtesy of Herder publishing house).
Conclusion: “Often the causes of our problems are a mystery to us, even though
we would only need to look more closely at the solutions we arrived at yesterday.”
(Senge 2001).
20 I. Pirker-Binder

1.4.1 System Thinking as Preventive Factor

Peter Senge is a pioneer in new disciplines of a learning organization. His book The
Fifth Discipline (2001) is considered one of the standard reference works for new
economic thinking, for system thinking.
In today’s discussion of the preservation of human resources, this book together
with the Fieldbook for the Fifth Discipline (Senge et al. 2000) a wealth of
thought-provoking ideas not only for a learning organization, but also for successful
prevention, or for an active workplace health management, for one of the key
factors in a company is the personal qualities of its managers. Their attitudes,
thinking and behavior models considerably determine the corporate culture and
employee satisfaction.
The background is framed by abandoning the fixation on the present and a
turning towards an active way of shaping the economic future; He calls this focus
on a new way of perception system thinking—the fifth discipline.
System thinking focuses
– on a holistic approach
– on the perception of interrelations rather than a simple cause-effect causality
– on the perception of change processes

The discipline of system thinking aims at being able to recognize wholes. This discipline
creates preconditions so that we perceive interrelations instead of immovable things and
change patterns instead of static snapshots … after all, system thinking is also a form of
sensitivity for the subtle interconnectedness, which adds their unique character to living
systems. (Senge 2001, p. 91 ff)

System thinking shows two components:

1. Detail complexity
2. Dynamic complexity

Ad 1 Detail complexity provides a very narrow change frame. The view of the
higher-level whole missing; the employed instruments do not facilitate sustainable,
new, future effective changes. According to its content detail complexity is equal to
short-term snapshots.
Ad 2 According to Senge dynamic complexity exists when the same action has
completely different effects in the short term than in the long term. Also, an action
might have a specific effect in a particular system, but a completely different one in
another system. To achieve long-term change, it is important to consider the
leverage effect of individual instruments and strategies. Doing the obvious does not
lead to the apparently obvious, desired result (Senge 2001, p. 91).
Prevention of exhaustion requires system thinking and raises the question of the
right levers. Including the current situation on the labor market with the increasing
number of psychological and physical exhaustion of working people, a sixth
1 Prevention of Exhaustion of Human Resources … 21

discipline can be added: the psychological and physical health for the health success
of a company.
• Workplace Health Management must be allowed to develop individually in
companies and should be oriented towards the following question: What
position in the company must be the starting point in order to bring about
what long-term change in the future in terms of conservation of human
resources?
As a basis for system thinking Senge outlines the need for a change of learning
and thinking in four core disciplines such as
1. Personal Mastery
2. Mental models
3. A shared vision
4. Team Learning

Ad 1: Personal Mastery The central content of personal mastery is the principle

of creative tension. It arises when vision and current reality diverge. On the one
hand creative tension allows development and growth, on the other hand, it can lead
to emotional stress resulting in feelings like anxiety, tension, discouragement,
hopelessness and helplessness. Personal mastery means committing oneself to the
truth, that is, remaining faithful to one’s visions and tracing one’s negative beliefs
and fears and undergoing a liberating change process (cited in Senge 2001, p. 190 et
seq.).
Ad 2: Mental Models Mental models are understood to be deadlocked beliefs and
ideas, which develop into theories and entail specific actions and behavior.
Undetected mental models block system thinking, learning and change stagnate.
Ad 3: Shared Vision The shared vision, creating something together, is the
greatest shared force and energy of a living, social system (Fig. 1.2).
If the visions of the individuals in a team diverge with respect to the corporate
goal or how to get there (meaning, working conditions, climate, etc.), it does not
only weaken the health success of the organization concerned, but also results in
decreased commitment of the people working in it and may lead to frustration and
illness.
Ad 4: Team-Learning Team-learning could also be understood as relationship
learning. All members of a team have the same goal and thereby increase their
energies and skills. Then they work in coherence with each other. According to
Otto et al. (2007, p. 54) this can also be called swarm intelligence. Schools of fish or
bird migration can serve as models. The movement of each individual member is
carried out in perfect harmony with the other flock members. In nature this coor-
dination happens intuitively, biologically. To achieve this a living social system
needs
22 I. Pirker-Binder

Fig. 1.2 Tree model (Pirker-Binder)

– flexibility in terms of the changing conditions

– robustness when one or more members are absent
– self-organization: the team organizes itself
– self-regulation: specific rules are set up or existing ones are further developed as
needed.
The quality of the coherence of team members requires a high degree of social
competence, empathy and willingness to learn and communicate. Dialog7 provides
an aid to efficient mutual understanding. In a dialogue different viewpoints are
opened up and explored through professional, unbiased asking. In a dialogue, the
parties become observers of their own thinking (Senge 2001, p. 294).
David Bohm, a quantum physicist and philosopher, was the pioneer of dialogue
in the sense of free flowing group conversation. According to Bohm “our thoughts
are incoherent and the resulting counter-productivity is the origin of our biggest
problems … The dialogue aims to uncover the incoherence of our thinking” (Senge
2001, p. 294).
For a successful dialogue three conditions are necessary:
1. Assumptions and hypotheses must be presented and allow reflection.
2. Participants must consider themselves equal partners.
3. A neutral helper moderates the dialogue.

Greek: “dialogos”: “dia” = through; “logos” = the word, the meaning.

7
1 Prevention of Exhaustion of Human Resources … 23

In his “Theory U” Scharmer (Fig. 1.3) addresses holistic thinking and refines it
for learning and change processes, “Whenever a process stagnates on an action
level, it is important to tackle the same problem differently, rather than do more of
the same” (Scharmer 2009, p. 239). He expands Jaworski’s thoughts, who points
out that it is not enough to merely perceive the world superficially. Only those who
succeed in delving more deeply into the nature of relationships, can detect new
options:
… It’s about a shift from seeing a world made up of things to seeing a world that’s open
and primarily made up of relationships, where whatever is manifest, whatever we see,
touch, feel, taste, and hear, whatever seems most real to us, is actually nonsubstantial.
A deeper level of reality exists beyond anything we can articulate. Once we understand this,
we begin to see that the future is not fixed, that we live in a world of possibilities … through
this shift of mind, we begin to realize that the sense of despair we’ve been feeling arises out
of a fundamentally naïve view of the world. In fact, absolutely everything around us is in
continual motion …when we start to accept this fundamental shift of mind, we begin to see
ourselves as part of the unfolding. We also see that’s actually impossible for our lives not to
have meaning (Jaworski 1998, S. 10 ff).

Similar to a psychotherapy process Scharmer describes four steps to capture

social reality, wherein between steps a logical movement, opening and change
process takes place.
“Downloading” denotes a first step in the disclosure of topics, aims, problems
and visions.
Transition 1: Opening of thinking: pausing and opening. “Seeing” (taking a
look) denotes a process of initial perception, of seeing different thinking and
behavior patterns.
Transition 2: Opening of feeling: redirecting and immersion in perception.
“Sensing” (feeling): Scharmer calls it delving into relevant contexts, also intuitively
grasping relationships, which might result in a new perception, redirecting or
refocusing of attention.
Transition 3: Opening of the will: letting go, letting come. “Presencing”
describes a new quality of perception, which emerges from the creative source point
(blind spot); a new perception, which enables new action from the resulting whole
(Scharmer 2009, p. 236.). For the ability to go through this development or change
process, courage is necessary to engage in the blind spot and to overcome the
voices of resistance:
– voice of judgment (VOJ): letting go of fixed opinions and thought patterns
– voice of cynicism (VoC): letting go of negative emotions and language
– voice of fear (VoF): letting go of fear of change, of the future
Both Senge and Scharmer consider businesses living, social systems. To keep
them healthy, a holistic approach and the promotion of personal development of
employees and executives are the most important preventive measures. Thereby
major focal points are dealing with rigid patterns of thinking and acting and
emotions, because they give economic activity action input and an aspect of
meaning. Scharmer describes the experience of Presencing:
24 I. Pirker-Binder

Fig. 1.3 Theory U. Image copyright: Presencing Institute, Otto Scharmer, www.presencing.com/
permissions

The state of the bottom of the U is presencing – seeing from the deepest source and
becoming a vehicle for that source. When we suspend and redirect our attention, perception
starts to arise from within the living process of the whole. ‘When we are presencing, it
moves further, to arise from the highest future possibility that connects self and whole. The
real challenge in understanding presencing lies not in its abstractness but in the subtlety of
experience.’ (Senge et al. 2004, S. 89)

• Meaning oriented occupational and business psychotherapy takes up Senge

and Scharmer’s ideas and promotes prevention management, humane
change management and offers psychotherapeutic knowledge through
consulting, projects and interventions.

1.5 Management in Transition

The way interactions between people in companies happen and are performed is
mainly determined by the corporate culture and in particular by executives. At
present a paradigm shift is happening: away from a pure production society to a
1 Prevention of Exhaustion of Human Resources … 25

knowledge and service society. This change in values significantly influences the
understanding of what it means to be human and management behavior in busi-
nesses and thus sets new challenges to social competences.
In the traditional approach executives have the right to control employees by
integrating management tools.
This is contrasted with a new understanding of management, which is under-
stood “as mutual interpersonal influence, interaction and permanent shaping of a
corporate reality for the common achievement of aims.” (Franken 2007).
Work is set in relation to meaningfulness, self-fulfillment, independence,
accountability and participation. The transformation from a production to a
knowledge society together with a change in the human image significantly influ-
ences the topic of management. The quest for realization of meaning and values
changes the image of work, work and life quality. Rational values such as hard
work, productivity and monetary incentives have changed in favor of a holistic
perspective. Aspects of meaningfulness, self-fulfillment, autonomy and
self-organization are new objectives and motives.
• The paradigm and value change and the development of the people not only
requires new business structures, such as new places of work (home office),
working hours, work experience and mindsets (towards greater corporate
social responsibility), but also a new understanding of management.
An essential aspect of the paradigm shift is the appreciation of performance,
respect of the personality of employees, error culture, flat hierarchies, involving
instead of marginalizing and monitoring. Acting together instead of hierarchically
against each other. Only together and with due respect for each other, is there a
successful and healthy future for all.

1.5.1 Management Style in Transition—Transformational

Management

One possible management model is called transformational management; it is a

holistic model, evolved from the delegative management style, which gives the
employees a high degree of personal decision, and adds a value dimension.
Transformational or value-oriented management integrates the aspect of meaning
into entrepreneurial actions. Anker (2010) speaks of three main roads on the way to
the aspect of meaning in a company (Fig. 1.4):
– Individual action shall be orientated towards social values.
– Our objective and our actions should not just be an end in itself, but directed
towards a “what for”, something that goes beyond us.
– Social readiness for other people should exist.
26 I. Pirker-Binder

Fig. 1.4 The three main roads to meaning (Anker 2010)

The questions of “why” and “what for” may be asked. The motivation of
employees happens through the aspect of meaning and intrinsic motives.
Transformational Leadership does not only demand a high social competence from
the executives—also the employees are expected to play an active part, participate,
think proactively and also change and practice lifelong learning.
Transformational leadership requires a high degree of humanity and being
human from executives—despite high economic demands and a success-oriented
way of thinking. It may also be called the 4 i-skills according to Bass (Franken
2007, p. 272):
1. Individual: employees are individually guided and developed.
2. Intellectual: There is mental stimulation; new ways of thinking.
3. Inspiring: objectives and tasks must be significant; the vision and mission
should be appealing.
4. Identifying: the manager must be authentic and exemplary.
“Being human means being aware and being responsible”, that’s how Viktor
Frankl (1986) phrased it.
1 Prevention of Exhaustion of Human Resources … 27

1.5.2 Management and Its Effect on the Work Environment

and the Emotional State of Employees

The results of the INQA 2005 survey (Franken 2007, p. 277) emphasize the
importance of management for the mood of employees. About 50% of respondents
complained about lack of support and 61% lack about lack of appreciation. Bad
working atmosphere leads to physical and psychological reactions of those affected.
Those who do not feel comfortable are not focused or stay at home; sick leave and
underperformance are the results (Fig. 1.5).
Fear of losing one’s job results in underperformance through presenteeism
(presence at work despite illness). The Stanford University California has created a
formula for calculating the downtime costs through underperformance of

Fig. 1.5 Corporate culture, management deficiencies, fear, crisis of meaning, mobbingCorporate
culture and sick leave (Pirker-Binder)
28 I. Pirker-Binder

Fig. 1.6 Best practice models in the EU-27 area; concepts for the reduction of stress at work and
promotion of health and wellbeing. Image source Jimenez et al. (2012), with kind permission

employees and executives, which were caused by problems like worries, stress,
crises, bullying, addiction etc.

Number of employeesðNE Þ  20% ¼ Number of affected employees

Poor managers make employees sick; this is the result of an EU study by

Jimenez, occupational psychologist at the Karl Franzens University (Jimenez et al.
2012; Fig. 1.6). A boss with good management qualities, however, has healthier
employees. The study proves that health promoting measures for stress and burnout
prevention in companies are worthwhile:
In 48.4% of the companies the satisfaction, trust, loyalty and motivation of the
employees increased. 22.6% showed a reduction in sick leave. 17.7% stated posi-
tive effects on staff welfare. 4.5% showed an improvement of the working atmo-
sphere and environment. 14.5% noticed a sensitization of the employees for the
issues of psychological health, stress and burnout and a reduction in staff turnover
rates.
The reduction of the human being and his/her actions to reason, and the sepa-
ration from his/her inner psychological experience has clearly been refuted by
neuroscience.
• What does this mean for the topic of leadership?
The forecast rising numbers of absenteeism and underperformance, which are
caused by stress or psychological factors, the ageing population and the resulting
longer working lives require new motivation and health concepts.
1 Prevention of Exhaustion of Human Resources … 29

A new set of meaning and values arises, which has to be incorporated more and
more into corporate management.
The workplace is considered a place of realization of meaning—those who want
performance, must provide meaning (Böckmann 1989, p. 87). The discussion about
the questions, what should/has to be done to offer people meaning in their work,
and thus preserve long-term willingness to work and performance, and which work
and workplace concepts will exist for an ageing society, has occupied scientists and
economists worldwide.
“Every affect status determines the immune status” (Frankl 1999, p. 74). This
sentence clearly indicates that not only the individual access to thought and action
patterns, learning, work and performance, but also the motivation and culture,
which are decisively determined by managers, have an influence on the psycho-
logical health and performance capability of people and thus also on the survival of
our society. Managers, wherever they might be active (Kindergarten, school,
business, NPOs) bear this responsibility.
Siebert (in Neuberger 2002, p. 53) writes on the topic of emotions, “Emotions
are not only the basis for learning motives and learning resistances, but our reality
constructions themselves are caused and tinted emotionally. Emotions are—con-
sciously or unconsciously—intentional motivations for action and also the gateway
to health or sickness, depending on how they are lived, denied and/or processed.”8
Takeover, Continuation of Business
Mr. Y started with a small company, which he had taken over from his father, and over time
has established a globally highly successful business. Now he is considering passing the
business on to his son. However, his son develops various kinds of psychosomatic com-
plaints. The responsibility of taking over his father’s beloved business crushes him. Several
consulting companies are involved in the takeover, without taking care of the father’s and
the son’s emotions and unvoiced wishes. Obviously, the father would like his son to
continue the family business. The son basically feels pressured into this role; he has never
had the option of a free decision whether he really wants take over the business, and if so, in
which way.
Only after the father has withdrawn and the son realizes his creative and decision-making
possibilities, can the burden, which rests on both of them, be eased.
Conclusion: in any kind of business takeover the emotions and needs of the involved
people have to be considered and addressed respectfully. In addition to support in factual
and legal matters also emotional support should be provided, e.g. by occupational and
business psychotherapists.

Transformational leadership entails a wider debate on the meaning of social

competence of managers. People, who successfully lead other people into the
future, need a high degree of social competence. Competency enhancement within
the meaning of healthy and resource-oriented management expands to management
responsibilities in many areas, not only in the economy. On the contrary, it is

8
Here emotions are defined as emotional states, which entail visible or invisible, noticeable
physiological changes depending on their intensity.
30 I. Pirker-Binder

always appropriate where people are involved in working, learning and training.
Particularly important are healthy and resource-oriented leadership skills of people
who educate children and adolescents.
Salovey and Mayer (1990, pp. 185–211) discussed for the first time the concept
of emotional intelligence, which was popularized by Goleman (1996). People, who
can lead themselves well and handle their emotions, aggression and frustration well,
are successful.
Yet, in the discussion about healthy and resource-oriented leadership these
capabilities alone are not sufficient. A new research approach is successfully pre-
sented by Fazekas (2006, p. 185 et seq.) including “psychosomatic intelligence”; he
correlates thinking and feeling. A high psychosomatic intelligence implies a sen-
sitive perception of one’s own body:
Through the deliberate inclusion of bodily perceptions and emotions in a sym-
bolized way, PI (psychosomatic intelligence) leads to a deliberate relatedness of
thought processes to the whole organism. This relatedness to the whole organism is
brought about by the fact that the thought processes are also based on compre-
hensive information which is relevant and thus comprehensive for the whole
organism. Hence, these thought processes show particular relevance for the whole
organism and its efforts to achieve an adequate individual-environment match.
PI includes five areas:
1. PI promotes sentience.
2. PI encourages thought processes oriented towards the whole organism.
3. PI deepens the understanding of one’s own corporeal being.
4. PI extends the ability to regulate psychosomatic processes.
5. PI facilitates the recognition of inconsistencies and their use as information.

1.5.3 Leadership, Motivation and Emotional State

If we understand leadership as a tool for motivation of commitment and willingness

to work towards a common aim, it is clear that there has to be a close relationship
between emotional states and motivation. Just as students are only able to provide
learning performance in a pleasant, positive environment, the employees are only
motivated to provide their full performance capability to the company if they
perceive the general conditions positively.
Intrinsic motivation (motivation from the inside out) creates a dynamic tension
towards an action. In this respect a link to Eustress can be established, because then
work brings joy, provides self-realization and fulfillment of meaning for a larger
whole.
On the one hand an executive has to fulfill management tasks in the field of
economic thinking and in the implementation of strategic goals, on the other hand,
as the leader of a group of people, he/she has the task of motivating, promoting and
challenging them.
1 Prevention of Exhaustion of Human Resources … 31

If a negative state of stress arises between the executive and the employees, this
results in a negative emotional state and the commitment decreases. Emotions do
not only play a big role in decision and action processes, but also with regard to
commitment. Emotions such as constant inner tension, emotional conflicts, anxiety
or fear accelerate the exploitation of vital energy in the cells.
The reasons for a negative state of stress in the company can be diverse:
– strategic objectives, processes etc.
– incompetent leadership style and/or a personality disorder of the executives (e.g.
narcissistic or histrionic personality disorder)
– work order, work allocation and working hours
– corporate culture
With regard to coherence the cooperation between managers and employees
would be disturbed; the flow at the workplace, synchronous oscillation would be
interrupted. If this occurs, resource-oriented work is no longer possible; exploitation
of human resources occurs resulting in a decline in the company’s health success.
Interaction between management and commitment according to Maslach and
Leitner
Maslach and Leitner (2001, p. 111) describe the following interdependent areas:

1. Input of management. This includes:

1. Mission and objectives
2. Centralized management
3. Control
4. Communication
5. Performance assessment
6. Health and safety. These factors are responsible for the way in which work is
lived in the company.
2. How work is lived, how human resources are used. This includes the factors
1. Scope of work
2. Control
3. Reward
4. Community
5. Fairness
6. Values
32 I. Pirker-Binder

Area 1 and area 2 being in coherence leads to identification conducive with

work, and the employees are motivated to perform.
3. Degree of identification with work, promotes individual use of human
resources:
1. Energy use
2. Dedication
3. Performance capability
Maslach and Leitner see the main challenges in a company in the definition of
target agreements and value structures in the management field so that the greatest
possible coherence of work and company life is reached, or as little misunder-
standing and conflicts as possible arise.
Concerning these objectives there are two challenges according to Maslach and
Leitner (2001):
– Creating harmony between people and their work in a way that
– leads to a change in both the working environment and the people (Maslach and
Leitner 2001, p. 154).
In their view the following tasks for the management can be formulated as a
solution:
– The scope of work must be bearable and feasible.
– The employee needs freedom to make decisions and for self-control.
– Performance must not only be recognized but remunerated accordingly.
– A living community is important.
– Fairness, mutual appreciation and respect, as well as justice must exist.
– The aspect of meaning and value of work must be given.

Mr. Z is a manager in a big company. He is an excellent strategist, and he has had a

storybook career. However, in his department the number of sick leave days and absences
due to “burnout” is increasing. The fact that the sickness rates might be connected to him is
beyond him. Mr. Z is a power seeker, narcissistic and choleric. His employees complain
that they never know what mood he is in at any particular moment. He might scream and
shout at the slightest little thing, and in this case his choice of words also leaves much to be
desired. For his employees his behavior means pure stress. They are afraid of his outbursts
of rage and humiliations.

Quite often managers become executives, even though they are not suitable for
human resources management.
They may be good strategists, but lack of emotion control and social competence
should be a reason for exclusion from leadership positions. Leadership cannot be
studied from a course book but only acquired through reflection and
self-experience; leadership is a value based on experience. Primarily this value
demands a great understanding of one’s own emotions—only those who are able to
understand their own life story, their motives for thinking and acting and impulses
1 Prevention of Exhaustion of Human Resources … 33

for action, have the appropriate basic knowledge in order to grasp their counterpart
in his/her own life. Soube demands in his article “The phenomenology of leader-
ship” a phenomenological approach to leadership. “A phenomenlogical inquiry9
into leadership does not study the attributes of leaders, but rather the fundamental
structures of human beings that make it possible to be a leader in the first place.”
In terms of successful prevention the selection of appropriate executives should
be a priority in a company; executives with a lack of social competence should be
referred to an occupational and business psychotherapist for self-experience pur-
poses. The coaching framework is not sufficient for this.

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Corvey SR (1992) Die sieben Wege zur Effektivität. Campus, Frankfurt am Main
Csikszentmihalyi M (2000) Das Flow-Erlebnis. 8. Aufl. Klett-Cotta, Stuttgart
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menschenrechtsverfahren.files.wordpress.com/2013/10/wc3bcrze-des-lebens-e28094-oder-
gifthauch-des-todes.pdf. Last access on 16 Dec 2015
Fazekas CH (2006) Psychosomatische Intelligenz; Spüren und Denken – ein Doppelleben.
Springer, Wien, New York

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A phenomenon (from Greek phainomenon meaning “that which appears or is seen”) could be
defined as any occurrence entity or situation known through the senses rather than by deduction or
reasoning (Burns 1978 in Souba …Phenomenology is the study of phenomenon and the way in
which they are experienced from the first person point of view. Smith 2013 in Souba (2014).
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Franken S (2007) Verhaltensorientierte Führung: Handeln, Lernen und Ethik in Unternehmen.

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Chapter 2
Leadership from the Perspective
of a Commercial Executive

Martin Reich

Contents

2.1 Leadership.......................................................................................................................... 36
2.2 Commercial Component.................................................................................................... 38
2.3 Vision................................................................................................................................. 40
2.4 Executive ........................................................................................................................... 41
2.4.1 Use of Energy......................................................................................................... 41
2.4.2 Schedule and Task Planning .................................................................................. 42
2.4.3 Dealing with Signals .............................................................................................. 43
2.4.4 The Role of Sports ................................................................................................. 44
2.4.5 Handling Emotions ................................................................................................. 45
2.4.6 Consequence ........................................................................................................... 46
2.4.7 Meaning .................................................................................................................. 47
References .................................................................................................................................. 47

This chapter includes four components that need to be taken care of. The starting
point is the point of view of a controller of a health institution, who is directly
assigned to the management due to his function as a department head. The first
component is leadership. Anglicisms have to be understood, and therefore, the term
is to be defined. The second component is vision, because the roles and respon-
sibilities directly determine the orientation of the point of view. The “vision” has
two dimensions, as it follows commercial management. The commercial aspects
form their own system, with business literature applying to it. Here the view of the
executive is shown. The commercial component is visualized by the controlling
process. The fourth component—and that is the most important—is the executive as
this is the person that has to bring together all parts. The main focus is on the
personal aspect, dealing with changes, strain and the energy balance that has to be
controlled. It starts with the component of leadership.

M. Reich (&)
Lacknergasse 106/1/2, Vienna 1180, Austria
e-mail: [email protected]

© Springer International Publishing AG 2017 35

I. Pirker-Binder (ed.), Mindful Prevention of Burnout in Workplace Health
Management, https://doi.org/10.1007/978-3-319-61337-6_2
36 M. Reich

2.1 Leadership

Leadership no longer essentially consists of the distribution of work and coordi-

nation of daily operations but has as the core task to “create conditions, which
enable average intelligent staff to complete their tasks independently and
efficiently.”
(Doppler and Lauterburg 1994, p. 54). The previous boss or dynamic leader and
top manager does not only have to get used to the role of the trainer, coach or highly
qualified service provider, but also master and fulfill this role.
The traditional concept of leadership (attempt to control the employees, regu-
lations and detailed instructions as to what has to be done by whom and when) is
management under false pretenses. It is about giving freedom and space to act to
teams and individuals (Pflägig 2009, p. 64). In addition to comprehensive expertise
in the respective field (i.e. in-depth business management knowledge, detailed
knowledge of the controlling tools) also not so easily measurable factors are
required, which I would like to describe as “instinct/gut feeling”. Gut feeling and
experience bring security and calm, even in turbulent times when it comes to
change and its management. Being calm and having the courage to listen to your
gut feeling or allow it to exist are an art that must be learned. What is more, the
individual has to want it and allow it. Then, a path evolves, which is marked by
consistency and continuity, which is very significant not only for the respective
person, but also for the employees. However, the employees in this environment
must also meet certain characteristics, which are marked by natural curiosity, a
spirit of independence and the perception regarding the delegated competence and
responsibility. The relatively old Harzburger model (Hoehn and Böhne 1969)
appears again here and is integrated. Employees, who do job-oriented work and
need instructions for individual steps, must be regarded as a chance for further
development on the part of the executive—provided that the potential exists.
According to Malik (2000, p. 171–264) the prevalent tasks are:
Ensure goals:
• organize,
• decide
• control.
Tools used (Malik 2000, S. 277–373), are:
• sessions,
• reports,
• job design,
• budgets
• and performance reviews, but also systematic garbage disposal.
The latter is a difficult discipline. Only systematic releasing permits selective
access. A timely withdrawal creates the opportunity for a new beginning. Simply
adding projects with the target of growth are not conducive to the development.
2 Leadership from the Perspective of a Commercial Executive 37

It is a great skill to master the sequence of letting go, opening options, focusing,
accessing, letting go, etc. (Risak 2003, p. 89).
Special attention has to be given to behaviour patterns that seem to contradict the
change process. In The Robber Hotzenplotz Ottfried Preußler describes Kasperl’s
behavior, who—dressed up as “Seppl”—makes the great magician Petrusilius
Zwackelmann let him off of numerous tasks “due to inanity”. (Preußler 2012,
p. 56). The great magician being glad to have a stupid service messenger, who does
not figure out his spells, at best fits into the ancient definition of management, but
not at all into any modern requirements. However, such statements clearly shape
from childhood on. In organizations it is the executives’ task to recognize these
patterns and change them. This requires calm and a lot of endurance; it is often
faster to complete tasks (seen in the short term) instead of delegating them to others,
which prevents learning. Following key issues are central (Doppler and
Lauterbourg, 1994, p. 54 f.):
• What qualifications do the employees need?
• Who needs to learn what, so that the required performance level is achieved and
can also be kept in the long run?
• What information, resources and personal support do the employees need so that
the pending tasks can be tackled independently and successfully?
• What can/must be changed in terms of optimization of costs and benefits in the
operation?
It needs not be explained here that these are long-term, multi-year processes. It is
about “step for step thinking” and actually taking the steps; just like Nordic
walking. The poles only help when they are properly used with the right technique.
• It is about step-for-step thinking and actually taking the steps.
In the change process the executive is mentally a few steps ahead, but must not
lose the reference to reality and to the employees. The magic words are commu-
nication and targeted consistent information. This is easier said than done. It is an
art to find the right balance between too much and too little. Too much creates
“over-filling”, too little creates uncertainty. In any case, it takes time to prepare
information and time again to give information. Here, the executive is greatly
challenged. Not every single person can be informed.
The art is to bring the team consistently and transparently on the right level of
information and to keep it. The time required for this has to be planned. The basis
for a functioning process is trust, which is formed through feedback loops incor-
porated in decision-making processes. This must be addressed in communication at
eye-level with employees (Henckel von Donnersmarck 2014, p. 63). The controlled
handling of important information is one of the taboos. There must not be a circle of
“better informed”. Information cascades distort messages. Stakeholders and
involved parties should obtain all information directly (Lenz 1998, p. 142).
38 M. Reich

Tips1
• ask yourself and also your manager the key issues.
• delegate skills and responsibility and thus create trust.
• take time for feedback and in turn demand feedback.

2.2 Commercial Component

The classical controlling process that is usually the central process of management
begins with the target agreement/planning. Based on that the degree of target
achievement is measured during the year (quarterly/monthly) by means of a
planned/actual or plan/projection comparison. The first shows a snapshot for
example of the last day of the month; the second shows the expected result
involving measures taken (implemented) and thus evaluated up to the end of the
year. Depending on how projection is defined, the effect on all those involved in the
process is different. If, for example, by the end of June of the current budget year
overruns are determined and the projection assumes reaching the targets in com-
pliance with specifications, massive pressure to implement the measures results.
The time frame for countermeasures is shrinking. The process is completed with the
result of the year (Fig. 2.1).
A fund-financed hospital in Austria (BMG 2014) faces the challenge to run three
controlling processes parallel, because settlement through the provincial fund will
only be completed in October of the following year. One controlling process is in
the planning stages, one in the control phase, and one in the settlement phase. The
executive faces multiple challenges at the same time. In the planning phase, the
plans of the departments have to be integrated into an overall plan taking
the objectives of the owner into account. This requires skills such as scheduling and
adherence to schedules, stress management, reporting, as well as stamina and
especially trustworthiness.
The controller team stands for values (not only budgeted figures in euro) and
reliability. Only in this way, can the responsible profession be exercised. The
management of amounts in euro, the booking of plans on cost centres and cost
categories is the result of agreements that are comprehensibly documented with the
accounting document in the planned cost calculation. Business expertise is
assumed; living through trustworthiness is the style. This, and only this, creates a
positive image towards customers and attracts people who also possess this virtue
(Henckel von Donnersmarck 2014, p. 45).

1
Regarding the tips I give at the end of each section, one should be aware that the implementation
must be matched to the respective person and situation. Also experiences both in dealing with
signals of the body and from the professional environment play a large role.
2 Leadership from the Perspective of a Commercial Executive 39

Fig. 2.1 Controlling process. Modified according to Eisl et al. (2008, p. 779)

The controller section has a difficult task to tackle—representing and commu-

nicating corporate goals to the departments (in the hospital these are the clinical
areas as well as the specialist directorates) as well as the consolidation of the
departmental plans but also a comprehensive coaching function. This is to set out
the planning method, but also to explain the planning premises together with the
corporate management and to ensure that no pure requirement plans are submitted.
Planning has to be in line with the corporate management. Receiving only
requirement plans means substantial additional effort for the controller section.
Each department must be streamlined (=additional effort in times of tight
schedules).
A compensation of the activities of the departments through the central
controller-section must not happen, because otherwise no learning effect is obtained
and the identification with the plans is not given (see Petrusilius Zwackelmann). For
the controller and therefore, the executive, the main task is to keep the process
going.
This requires much endurance, experience and the correct tempo (Sect. 2.4.1
energy usage).
40 M. Reich

Tips
• the accounting homework must be done.
• cost and performance accounting is the basis; forms of cost category and
cost center accounting as actual and planned cost system.

2.3 Vision

The commercial component focuses on the controlling process, the indicators and
measures for achieving the goals. The goals need to be achieved despite interim
deviations. This point is not the subject of these explanations, but rather the per-
spective of the executive who controls the process and who has to make sure that
the tasks are fulfilled. Such task completion has to be carried out by the responsible
people. The executive and the controller section cannot compensate it.
Key issues of workload, scheduling and ensuring the transparency of informa-
tion characterize this view. There are different perspectives depending on the role.
As a controller, the sandwich position between controller section, the departments
within the company (such as hospitals) and the company management is
pre-programmed. The business management literature describes controlling as an
activity at the intersection between management and controller section (Fig. 2.2).
Figure 2.2 clearly represents the intersection. In practice, the situation looks
different. For the controllers as the providers of this service function, the roles in the

Fig. 2.2 Controlling as intersection. Modified according to Dehyle (1996), p. 177

2 Leadership from the Perspective of a Commercial Executive 41

controlling process, the management position in their division, and the coordination
with corporate management converge. The tasks and views are different depending
on the role and not easy to juggle. Regarding coordination with management, there
are again two dimensions—management and the departments (i.e. clinical areas)
that need to be brought together. Taking into account the own management func-
tion, this means first and foremost, to cope with the complexity, to structure and go
a consistent way. The prerequisites are only partly inherited or can only be learnt to
some extent during university education.

Tips
• When at the intersection do not allow being crushed!
• Remain true to yourself!

2.4 Executive

In the sections leadership, commercial component and vision the subject matter and
the complexity that has to be coped with were explained. This section is about the
executive, about dealing with pressure, emotions, peak workloads, different inter-
ests, but also compensation and prevention.

2.4.1 Use of Energy

In the section commercial component the controlling process was represented,

which must be kept running. It is clear that this energy is necessary, but also the
correct gear ratio if one imagines the moving (rotating) process as the rear wheel of
a bicycle.
This ratio must not be too large, because otherwise the energy is not sufficient to
cope with the long haul. It shouldn’t be too small either, as then sprinting may be
possible, but the pace for an endurance track is far too high. The example of the
bicycle has specifically been chosen as the overall ratio determines the pace or the
resistance, which have to be overcome, as well as the expected performance. Grade,
headwind and road conditions are excluded from the model. Also that in practice it
is never just one person who provides the energy, and thereby keeps the process
running, must be clear.
• The executives are in the unique position to be able to integrate the theme of
energy management in their own target agreement, and in those of the
employees. Thus, it is subject to corporate planning.
42 M. Reich

The art to manage this energy management is sophisticated, but it is hardly the
subject of management literature or of controlling curricula. My extensive experi-
ence and intensive dealing with both subjects have shown that energy management
is essential. It is the executive’s responsibility but also that of every individual.

Tips
• Accept that energy is not freely available and therefore the control of the
energy balance is an important task.
• Endurance gets you further than a succession of sprints.

2.4.2 Schedule and Task Planning

Day-to-day operations concern the integration of schedule and task planning in the
processes. If correctly applied, computer programs such as Outlook can help to
create work appointments, and thus scheduled times for activities in the office (such
as cost category and cost centre planning), and thereby to incorporate that as well as
meeting dates in the organization of work.
Meeting deadlines should also carefully be dealt with. It is essential to decide
who attends what appointments, or whether the meetings are necessary at all. The
meeting itself has to be planned and the agenda has to be set up. The literature in
this respect (Malik 2000, p. 280 ff.) is impressive, but practical application often
greatly differs. Here it depends on the self-discipline and the learning performance
of the executives (I include myself here), but also on all stakeholders whether
improvements are achieved.
The main function of executives is to be a role model, and to go all the way.
This way is by no means even. Interim uphill and downhill passages may
happen, but should not discourage you. Exact ideas and goals help here quite a bit.
For the employees, the executive should schedule as much time as for sessions and
work schedules. It does not only include a monthly jour-fixe, but the planned
possibility to talk to each other during the week without having to check if this is
even time even allows it.
• Good scheduling becomes evident when unforeseen tasks come up.
The implementation of this scheduling is the duty of the administration and must
be closely coordinated. The administrative staff must support the schedule and
communicate it in a suitable form. Otherwise conflicts arise quickly, as appoint-
ments arrive at administration first. “No” must be said here; this is where priorities
are communicated. The executive has to coordinate these priorities with the general
management. Saying no supports organized working. It is clear, however, that this
is not always possible in the case of deadlines. Good scheduling becomes evident
2 Leadership from the Perspective of a Commercial Executive 43

only when unplanned tasks come up. Here, also, the step-for-step process and
consistent implementation is coupled with communication for best practice.

Tips
• all appointments have to be put into a calendar.
• defend your appointment and task plans.
• set your priorities and coordinate them with superiors and co-workers.

2.4.3 Dealing with Signals

This topic is discussed in the business literature, but rather in terms of the signals
from the environment of the company, i.e. regarding the signals concerning the
market (Ansoff 1976, p. 129–152). Due to the financial crisis the market signals are
also evident in the Austrian healthcare system. In the health sector, the market does
not collapse; the patient volume rather continues to grow. The revenue side, which
is provided by the public budgets and provincial funds (linked to the VAT tax
revenue), will become lower. Hence, company management is under considerable
pressure to reduce costs.
In this context signals refer to the reactions of the body in relation to the energy
management and how to manage it. “The body has a far better sense of time than
the brain; it does not miscount and knows when to stop” (Tammet 2014, p. 294 ff.).
• The body has a far better sense of time than the brain; it does not miscount and
knows when to stop.
It is a must for every person, not only to be informed, but also have a targeted
personal strategy to see the signals, so as not to succumb to the phenomenon of
rushing permanently. (Seiwert 2005, p. 23–29). It is caused by the mistaken belief
that, if we do everything faster, we can achieve everything. What is missing out in
this case is our personal rhythm, which is derived from our physical, mental and
emotional condition and is crucial for our wellbeing.
If we do not listen to our body and ignore the personal rhythm, we cannot tackle
our tasks in the long term. Here, the “step-for-step method” is expedient. Should
this not suffice, the body shows very clearly what is not good for it. What lessons
are learnt from these experiences and whether there is the opportunity to make and
utilize any changes, remains to be considered in each individual case. The personal
willingness to deal with the issue and to learn how to handle the signals, as well as
their assessment is vital for steps toward energy management and dealing with
stressful situations. There is no general recipe.
I must listen to the signals and practice what I have learned, which assists and helps
in stress situations. These tools (e.g. relaxation techniques, specific regeneration,
44 M. Reich

learned breathing techniques while maintaining the body tension) should be inte-
grated into everyday life.
A measure for me was, for example, selling my moped and replacing the drive to
work with a daily walk to and from work. This allows for plenty of air and helps get
your head free, which should not be underestimated. Also, realizing that there are
many books apart from the business literature can be valuable. People, who like to
read, can integrate their own preferences.
People should not strive for complete relaxation everyday. This goal should not
be set, as otherwise it generates reverse pressure. But the tools help to achieve a
never previously thought of sustainability, which maintains the energy balance. The
art is to integrate downtime even in times of heavy workload. In times of change,
the executive is particularly challenged. Nevertheless, it is rarely discussed that the
executives also undergo the process of change, which means that they have to deal
with their own emotions as well. It is a fine art to direct the change, to think about
the goals and to understand one’s own signals that accompany this process. The
executives must be alert and willing to learn. They must be grounded to be able to
maintain the ground, because stability is essential for survival in uncertain times.

Tips
• Allow yourself to hear signals timely, so that they do not have to scream at
you.
• Take time and space for processing and training.
• Find your own way.

2.4.4 The Role of Sports

Sport is essential in the field of energy management. People who are good with
numbers should not do sports with objectives. There were times I did cycling with
an annual total kilometer goal. That matched my job beautifully, but not the human
body. Now I have a new goal, which is called wellbeing, where conditions are
determined by medical examinations. The optimal training area was set. Only by
doing so could I succeed in bringing together training and recreation.
• Sport in the nature has many advantages. It helps to get the head free and ground
yourself.
Also an important experience for me was that with sport, Nordic walking sticks
can be used and that nature can be experienced. By walking—also on paths without
concrete—it is possible to experience the nature more intensively, to feel the
bumps, to smell, to see. As I can very easily remember images, I can again take the
impressions from nature as relaxing images. Especially in times of intense
2 Leadership from the Perspective of a Commercial Executive 45

preoccupation with numbers and in the course of the change processes, this option
is very helpful—in the sense of clearing one’s head. Nature also greatly helps with
grounding. Ultimately, work benefits from this time and again. Leisure is never
unproductive but reproductive and equally important for success as working time
(Henckel von Donnersmarck 2014, p. 15).

Tips
• Sport is important, but please do not rate it with numbers and targets.
• Step by step has great effect and leads to sustainable success.
• The nature experience is fun. It helps when dealing with emotions.

2.4.5 Handling Emotions

Never forget, “The controller is a person!” The experiences on a daily basis do not
leave you indifferent. They touch; they affect you in various degrees. Here, the
personal value system plays a big role. Whenever this is affected, the energy
balance is involved as well.
• The controller is a person! Work experiences leave no one indifferent.
The personal handling of attacks on the value system also has to be learned. It
does not have to happen every day, but a personal calendar with entries based on
demand helps here. For sport there should be a personal booklet, in which beautiful
tours should be entered. Dealing with emotions is always a matter of personal
concern and dissociation. The numbers person tries to reach a factual level by
communication through and about numbers, where emotions are largely avoided.
Each number, especially in a comparison of planned/actual data, is pure emotion.
Self-image and external image come together, trustworthiness is evident or
dissolves into nothing, and measures are effective or are counteracted by effects.
Here it becomes evident whether values are lived or are mere lip service (Hlinka
2014, p. 2 f.). These phenomena need to be processed and a way, which is com-
prehensible, and also documented, should be found. This way decisions are made
transparent and differences are explained. The controller must be able to realize that
the deviation is the rule, not the exception. Of course, the private environment that
acts as a backbone in all situations and is irreplaceable helps when dealing with
emotions.
46 M. Reich

Tips
• Do not take everything personally.
• Emotions are allowed and should be felt.
• Take time for and space for processing and training.

2.4.6 Consequence

The “step-for-step method” means that a continuous development takes place - such
as when going on a Nordic walking tour. If you proceed like this, the 4-h tour is not
the goal, but each step, and at the end comes the surprise about how far the way
was. Working life is, of course, not so haphazard, but knowing the target should
facilitate proceeding in manageable portions with a sense of achievement built into
the process. With a walking tour planning and also realizing it is one’s own
responsibility—except depending on weather conditions. In the controlling process
step 1 is done, but at the same time three more steps are required. The art is to stop
and briefly review a completed task item (such as planning). Also, the emptiness,
which is formed emotionally, must be felt and processed before proceeding.
Consequence allows such moments and is equally necessary when dealing with
employees. Thereby, it is important to note the following points (Mesnaric 2010,
pp. 72–74):
• Support your employees to feel their inner impulses. This requires relaxation
instead of great pressure, and silence instead of perpetual background noise and
meeting marathons, as well as listening to the inner voice.
• Train their capacity of reason.
• Analyze the skills and abilities of your employees before determining their fields
of activity.
• Give real, serious appreciation and recognition.
• If potential and talents show, which do not match with the corporate goals,
check whether the company can be changed as a living system.
Then there is the chance to associate positive feelings with work and to achieve
job satisfaction on the way to target completion. (Camelli and Rosenstiel 2009,
p. 63) Only then do “whiners, distrust monster, know-it-all villain, leviathan
impatience, abstract rip-off, digital idiot and routine grubber—all the good mood
thieves” not have a chance anymore. (Püttjer and Schnierda 2009, pp. 24 ff.)
• The art is to stop and briefly review a completed task item. Also, the emptiness,
which is formed emotionally, must be felt and processed before proceeding.
2 Leadership from the Perspective of a Commercial Executive 47

Tip
• You should walk step by step, and continue walking.

2.4.7 Meaning

“The job has to be fun”, is a popular saying—in my opinion, it must be

meaningful.
The meaning of the tasks of the controller in a hospital ranges from cost
transparency to support in achieving the company’s goals, but ultimately it is
always for the benefit of the patient. Everyday life is often dry and sometimes the
question of meaning arises. Particularly in this role, this question must be permitted,
even wanted; however it must not permanently become a topic.
The tightrope walk between reflecting one’s doing, making sure to be in the
present moment and being able to look into the future, is the main point of the
controller profession. From this, you can develop an inner drive, which should be
used to continue in a focused manner. The same applies to your own work, whose
place in society and its mission must be clearly defined, to exactly create this
meaning. The self broadcast stand with the talents and interests accordingly. Only
then do you achieve the lightness (Henckel von Donnersmarck, 2014, p. 25 ff.) for
your head to be clear and thinking freely. “Dream your goal before you realize it!”
(Maxwald 2002, p. 70).

Tips
• Dare to ask the question of meaning, and take time to answer.
• As an executive, convey meaning and also demand it.

References

Ansoff HI (1976) Managing surprise and discontinuity—strategic response to weak signals. zfbf
3:129–152
BMG (Bundesministerium für Gesundheit). Modell der leistungsorientierten Krankenanstal-
tenfinanzierung in der geltenden Fassung. URL: http://bmg.gv.at/home/Schwerpunkte/
Krankenanstalten/LKF_Modell_2014/. Last access on 9.11.2014
Camelli G, Rosenstiel LV (2009) Führung durch Motivation. Vahlen, München
Deyhle A (1996) Controller Praxis Band II. 11. Aufl, Verlag Controlling Wissen AG
Doppler K, Lauterburg C (1994) Change Management. Campus, Frankfurt
48 M. Reich

Eisl C, Hangl C, Losbichler H, Mayr A (2008) Grundlagen der finanziellen Unternehmensführung.

Linde, Wien
Henckel von Donnersmarck F (2014) Reich werden auf die gute Art. Edition a, Wien
Hlinka A (2014) Rettung für die Unternehmenswerte. Kurier 19.7.2014, Karrieren
Höhn R, Böhne G (1969) Führungsbrevier der Wirtschaft, Bad Harzburg
Lenz G, Ellabracht H, Osterhold G (1998) Vom Chef zum Coach. Gabler, Wiesbaden
Malik F (2000) Führen, Leisten, Leben, 3rd edn. Deutsche Verlagsanstalt, Stuttgart
Maxwald F (2002) Struwelpeter für Manager. Gerling Akademie Verlag
Mesnaric C (2010) Aristoteles für Manager. Campus, Frankfurt
Pflägig N (2009) Die 12 neuen Gesetze der Führung. Campus, Frankfurt
Preußler O (2012) Der Räuber Hotzenplotz. Thieneman, Stuttgart/Wien
Püttjer C, Schnierda U (2009) Keine Macht den gute Laune Dieben. Campus, Frankfurt
Risak J (2003) Der Impact Manager. Linde, Wien
Seiwert LJ (2005) Wenn du es eilig hast, gehe langsam, 9th edn. Campus, Frankfurt
Tammet T (2014) Die Poesie der Primzahlen. Carl Hanser, München
Chapter 3
Work Areas, Concepts and Methods
or Meaning Oriented Occupational
and Business Psychotherapy

Ingrid Pirker-Binder

Contents

3.1 Freedom of Decision: A Thought Concept Taken from Existential Analysis

and Logotherapy................................................................................................................ 50
3.1.1 Freedom of Decision—The Power of the Noetic Dimension ............................... 50
3.1.2 Two Motivational Incentives from Meaning Oriented Occupational and Business
Psychotherapy......................................................................................................... 54
3.1.3 Meaning Oriented Occupational and Business Psychotherapy as a Key Point
Within the Human Resources Department ............................................................ 56
3.2 Psychotherapeutic Services at a Glance............................................................................ 58
3.2.1 Area of Responsibility of Meaning Oriented Occupational and Business
Psychotherapy......................................................................................................... 58
3.3 Measures and Promotion of the Collective in Terms of the WAVE Process ................. 59
3.4 Answer to Questions on the Ability or Inability to Work in the Case of Exhaustion.... 62
3.4.1 Content of Psychotherapeutic Expert Reports ....................................................... 63
3.4.2 Legal Foundations of Psychotherapeutic Expert Reports...................................... 64
3.4.3 Psychotherapeutic Diagnostics ............................................................................... 64
References .................................................................................................................................. 65

Meaning oriented occupational and business psychotherapy understands businesses

as living, social systems. They provide a framework, a structure and a space in
which people do their work. The founders, whose visions are thereby transformed
from a possibility into reality, sow the seed. A vision and a mission provide the
framework for the structures, processes and the culture.
If preventive measures are to be taken in the field of human resources, it is
necessary to install an appropriate office within the company or externally. Also
a combination there of may be useful. It is crucial that there is a properly defined
framework, which allows answers to questions regarding health and the reinte-
gration after an illness, measures of personality development and individual emo-

I. Pirker-Binder (&)
Saileräckergasse 43/26, 1190 Vienna, Austria
e-mail: offi[email protected]

© Springer International Publishing AG 2017 49

I. Pirker-Binder (ed.), Mindful Prevention of Burnout in Workplace Health
Management, https://doi.org/10.1007/978-3-319-61337-6_3
50 I. Pirker-Binder

tional crisis counseling. Establishing a department for occupational and business

psychotherapy as an “internal assistance health program” (IAHP) or as an “external
assistance health program” (EAHP) is highly recommended.
In the case an employee is indefinitely written off sick with a “stress-induced
depression” or any other disease, there is often great helplessness about the proper
therapeutic procedure and the time frame for convalescence and recovery of per-
formance capability on both sides, i.e. the person himself or herself as well as in the
company. Many unanswered questions arise. The psychotherapeutic expert can
provide help answering questions about (in)ability to work, treatment recommen-
dations and reintegration, and advise and support managers as well as affected
employees. The expert report may be issued by an external psychotherapeutic
expert or within the company, as part of occupational and business psychotherapy.
Other focal points include the description of two motivational concepts from the
meaning oriented psychotherapy by Frankl. These concepts serve as a preventive
measure, tasks, objectives and tool kit of occupational and business psychotherapy in
workplace health management. The tree model of the LifeScriptAnalysis is applied for
psychological health in a company from the perspective of human resources. It is
intended as a guide and facilitates the detection of structures, interactions and lived
culture in a company.

3.1 Freedom of Decision: A Thought Concept Taken

from Existential Analysis and Logotherapy

3.1.1 Freedom of Decision—The Power of the Noetic

Dimension

Frankl (2004) extends the two-dimensional consideration of being human, which

represents the psyche and the soma (physicality), with a third dimension, i.e. the
noetic (spiritual) dimension, named after the Greek word “nous” for “spirit”. All
three dimensions are always active in the human being, but in different forms:
• The somatic dimension comprises assigned corporeality, emotions and instincts
in existential analysis and logotherapy.
• The psychological dimension is made up of assigned thought concepts, cog-
nitions, emotions and skills.
The third dimension is the most significant level of being human. It allows free
opinion through a free decision concerning oneself, physicality, psychological
condition, includes “conscience as a sense organ” according to Frankl and acts as
the highest moral authority, intuition, creative and artistic designing, meaning
orientation, understanding of values and love. Even though all three dimensions are
anchored within a human being, they interact differently (Fig. 3.1).
3 Work Areas, Concepts and Methods or Meaning … 51

Fig. 3.1 Free space for decision (Pirker-Binder)

While soma and psyche constantly interact and mutually influence each other,
the mental-spiritual, or noetic dimension rises above them1 (Fig. 3.1, example a).
Should the person tremble with fear (emotion) (soma), the noetic dimension still
allows an opinion. It provides a free space; the individual can decide how he or she
wants to deal with fear and trembling. Thus, the individual is no longer simply
stuck in his/her fear and trembling.
The individual can emerge from his/her helplessness, act again, develop a new
attitude and/or set an action (Fig. 3.1, example b). Even if the work pressure is very
high, the individual decides how to deal with it, how much energy he/she applies,
when he/she needs a regenerative break and also takes it, or allows it.2
The noetic dimension calls on the individual
• to gain in knowledge (through his/her feelings, thought concepts, cognitions)
and
• to formulate an opinion about it (e.g. how do I deal with this insight, which
actions do I want to take?).

1
Noetic, or mental-noetic dimension is in no way related to spirituality in terms of esoterism, but is
to be understood as an expansion of consciousness which facilitates a distanced perspective, i.e.
response to internal and external conditions.
2
Logotherapy depicts the human being as an active being, contrary to behavioral therapy, which
regards the human being as a reacting being, and psychoanalysis, which presents humans as
venting beings (Lukas 1998, p. 15 ff.).
52 I. Pirker-Binder

Thanks to the noetic dimension humans can defy their fate; they always have a
freedom to something, they always have the option to choose something. So, the
individual can choose whether to remain a victim or whether to take action, whether
to actively take breaks or not, whether to learn to distance him-/herself from what is
going on or not, whether he/she stays an alcoholic or not.
Frankl describes this opportunity as the principle of Noodynamics, dynamics
that originates from the noetic dimension. It is also considered an opponent to the
homeostasis principle, which, according to Frankl, refers to the ego’s wish to
re-establish the state of the old equilibrium as soon as possible. While soma and
psyche are looking to establish homeostasis by mutual dispute, the noetic dimen-
sion opens up a new field of tension, a tension between the is and the should. The
close relationship of logotherapy to the economy has its roots here; the question of
the meaningfulness, the search for the modes of meaning in professional life is
located here (Lukas 1998).
1. Here, the first link can be built between logotherapy and economic thinking,
namely the short-term snapshot and the story of the carpet dealer (Chap. 1).
For workplace health management and prevention measures a decision has to be
made between two goals: look for new, meaning oriented solutions as an overall
concept for a livable future or quickly remove disagreements and return to
homeostasis.
2. The second link is established by the principle of noodynamics, the search for
realization of meaning, value sets and structures in working life. It is about the
contrast between is and should. If the aspect of meaning of work and/or work
life or experience shifts, or an imbalance develops between mission, business
objectives, corporate culture and/or leadership styles and the employees’ atti-
tudes and experience of meaning, this tension affects the commitment and the
health of the employees. In case a person or a group feel restricted in their
freedom to design modes of meaning, the intrinsic motivation changes and thus
the will to common creation (Fig. 3.2).
• Common will is the strongest force within living social systems. It is the will,
which originates in the intention stemming from intrinsic motivation that
leads to realization of meaning, an action, a process or a deed.
The third link can be established as a contribution to the concepts of Senge
(2001, 2004, 2008) and Scharmer (2009). Both deal in their theories with the blind
spot in living, social systems with a simultaneous view to the overall whole. For a
resource- and meaning oriented workplace health and prevention management this
can mean a three-stage program of change:
a. An existential analytical consideration of the company in terms of analyzing
what is. Scharmer transforms this question into a process of downloading, the
unbiased realization of what is. An existential assessment of the current state
explores what should be preserved and looks for what needs to be changed.
3 Work Areas, Concepts and Methods or Meaning … 53

Fig. 3.2 Success through collective realization of meaning (Pirker-Binder)

b. Locating the blind spot and an enquiry into the modes of meaning and
understanding of values. The relevant question could be: how should work be
lived and understood in the future. What for and how do we create a common
“we” in the company. “What are the inner sources from which individuals or
groups become active when they perceive, communicate and act?”
(Scharmer 2009, p. 28). This raises the question: “How can health success be
carried into the future?”
54 I. Pirker-Binder

From the recognition of the blind spot, from the experience of a non-judgmental
inner stillness that Scharmer calls “presencing” for tapping the deepest source, new
models for workplace health management and prevention as well as intervention
measures can be developed.
• To initiate the process, the promotion of personal development of executives
is required. After all it is them who must produce the results that are
generated from processes and decisions.
The success of an intervention depends on the internal condition of the inter-
vening party. It is about the source, which constitutes the basis of acting; it is all
about the bare screen that is to be written on (Scharmer 2009, p. 28). In practice,
this means: if the executives have lost their quality of life or their ability of dis-
tancing themselves or are not aware of their own resources, they do not have any
understanding of their employees.
From a logotherapeutic perspective recognizing the blind spot may be con-
sidered an unbiased stepping back from old attitudes or thought patterns. It means
checking the goals, the mission, the lived culture, etc. One allows taking a step
outside to perceive and recognize from the noetic dimension, the superordinate
context, what is good, what should be preserved and which structures and values
should be changed in terms of prevention and preservation of health success.
c. Preservation and further development of mission and vision in the corporate
culture for a common commitment requires an understanding that
• work time is also life time,
• work must provide options for the realization of meaning and
• long-term survival is only possible under consideration of the great superior
whole.

3.1.2 Two Motivational Incentives from Meaning Oriented

Occupational and Business Psychotherapy

According to logotherapy workplace health management as prevention manage-

ment includes two motivational incentives (Fig. 3.3):
• the willingness to something: motivational incentive for the individual
• the willingness for something: motivational incentive for a group, a team
The willingness to something in a living, social system requires personality
characteristics, which I summarize under the German acronym ASTI:
• A “awareness” = mindfulness, respect, appreciation of others
• S “social competence” = social thinking and feeling
3 Work Areas, Concepts and Methods or Meaning … 55

Meaning oriented workspace health management fort he prevention

of exhaustion of human resources

Willingness to Together for

is directed towards the directeds towards the
do something something
individual collective

requires collective goal

requires personality

WAVE: wanting,
ASTI - awareness and collective wanting
respect social thinking, assignment, common
feeling tolerance, without assignment of tasks
judgement, open intuition vision, for a shared vision
in inner consent engagement, dedication,
commitment

communication, health
individual training modules, measurement
procedures as
Personality training, accompanying
LifeScriptAnalysis, instruments

WorkScriptAnalysis
LifeScriptAnalysis of the
LifeEnergyAnalysis
company, dialogue-circle
Confidential counseling
as think tanks, SuMeCo
center
gteam supervision,
mediation, coaching,
WorkScriptAnalysis
LifeScriptAnalysis,
training and education
programs in the fields of
heath, illness, prevention

Realization of meaning
Success
Flow through self-transcendence

Fig. 3.3 Meaning oriented workplace health management (Pirker-Binder)

56 I. Pirker-Binder

• T “tolerance” = tolerance for errors, flexibility towards one’s own attitudes,

learning ability
• I “intuition” = intuition: the inner consent of thinking, feeling, acting
The willingness for something in a living, social system requires a collective
pursuit of the same goals. Everyone involved therein pulls together and in the same
direction. I would like to sum up this collective pursuit with the acronym WAVE:
• W “want”: collective wanting
• A “assignment”: common assignment of tasks, mission
• V “vision”: for a shared vision—as a specific destination, an image of a desired
future (Senge 2001, p. 182)
• E “engagement”: commitment of the group
The acronym WAVE also represents the economic process, which cannot lead
straight upwards to continuously growing success, but moves in waves like the
tides.

Two ways become apparent as preventive measures against the exhaustion of

human resources at the workplace (Fig. 3.3):
• measures for the support of individuals (employees and executives),
• measures for the support of the collective.

3.1.3 Meaning Oriented Occupational and Business

Psychotherapy as a Key Point Within the Human
Resources Department

Meaning oriented occupational and business psychotherapy understands businesses

as living, social systems. They provide a framework, a structure and a place where
people do their jobs. The seed is sown by the founders, whose visions thereby
evolve from a possibility to reality. Vision and mission frame the structures, pro-
cesses and the culture.
Living, social systems are, if they want to survive successfully, dependent on
each other and coordinated; they constantly develop and change. Their survival
ensures the ability of both, keeping an eye on and realizing the changing needs and
necessities within the system and keeping in sight the future whole, the aspired goal
and the influence of external factors.
• Living, social systems are learning systems. They are not rigid, but always
moving, adapting to internal and external factors.
3 Work Areas, Concepts and Methods or Meaning … 57

• Living, social systems are about interactions and fine-tuning between the
individual parts of the system—interactions between people.
Considering organizational structures in companies, a human resources depart-
ment can be found in all of them.
It is usually entrusted with legal, organizational and professional training mea-
sures. The company doctor or occupational health professional deals with health
matters. So far the works council has more or less been available as the contact
point for conflicts and also emotional problems. If prevention of human resources is
to be taken seriously, it is necessary and useful for the future to establish a suitable
office in the company or outside, or both. A confidential health and crisis coun-
seling office for individual psychological problems, reintegration after sickness and
measures for personal development should be offered. The creation of a department
for occupational and business psychotherapy as an “internal assistance health
program” (IAHP) seems to provide a suitable option.
For small and medium-sized enterprises, the cooperation with external occupa-
tional and business psychotherapists providing an “external assistance health pro-
gram” (EAHP) might be more cost effective; they are available externally or only
come to the companies at certain times.

External (EAHP)/Internal Assistance Health Program (IAHP)

Due to the increasing number of cases of psychological illness, it is useful to
allocate this field of activity to professionals, such as occupational and
business psychotherapists, who are not only familiar with the company as a
system with its processes and structures, but also have therapeutic expertise
and diagnostic capabilities (psychological problems, stress due to disease,
personality disorders, psychological emergencies, bullying, stalking, crises
etc.) and skills for personality development and conflict resolution. An
important focal point in this respect is the obligation of confidentiality of
occupational and business psychotherapists.

Active prevention always means a change of attitudes, habits, thought patterns,

rituals and more. People’s life stories, fears and micro traumas can be obstacles for
such processes.
“In seminars, coaching sessions and through questionnaires I have been told
again and again that I should change myself, my attitude and behavior—but no one
has told me so far, how to tackle this,” are remarks I frequently hear in my practice.
Personal change and responsibility management interfere with the individual life
script and require a cautious and trusting approach. Occupational and business
psychotherapists are trained in this respect and deal with issues of people that
concern their work, work culture, work experience, but also the individual in his/her
life story; plus, they have economic knowledge.
58 I. Pirker-Binder

In addition to the departments already installed, i.e. human resources, works

council, occupational medicine, work and organizational psychology (which is
responsible for the work on the system, structures and processes) occupational and
business psychotherapy is responsible for the work with people.
• The scope of activities of occupational and business psychotherapy includes
the preservation of human resources in businesses and addresses both, the
individual and the collective.

3.2 Psychotherapeutic Services at a Glance

Based on the Psychotherapy Act, Austrian Federal Gazette BGBL. No. 361/1990
psychotherapeutic activity comprises the following areas:
• psychotherapeutic treatment including diagnosis and indication
• psychotherapeutic counseling and care
• psychotherapeutic training activity pursuant to §§ 3 et seq. and 6 et seq.
Psychotherapy Act
• measures of personal development:
– self-awareness
– coaching
– training of psychotherapeutic intervention techniques
– supervision3
– further training of psychotherapists
– measures of health promotion, prevention and rehabilitation
– psychotherapeutic findings and expert reports
– psychotherapeutic research.

3.2.1 Area of Responsibility of Meaning Oriented

Occupational and Business Psychotherapy

Occupational and business psychotherapy combines psychotherapeutic knowledge

and economic thinking and builds a bridge between the prevention of depletion of
human resources and corporate goals. Thereby this work may focus on individual
employees, but also on groups. Hence, the field of activity goes beyond ordinary
psychotherapeutic services.

3
Supervision is a form of counseling for people working in psychosocial professions.
3 Work Areas, Concepts and Methods or Meaning … 59

The scope of work of meaning oriented occupational and business psy-

chotherapy comprises
• in workplace health management
– Advising the management,
– Project Management in the field of health
– Action plans for prevention
– Crisis intervention, bullying, addiction, conflicts etc.
– Diagnosis of inability to work due to psychological exhaustion
– Psychotherapeutic expert reports for performance capability
– Short-term therapy
– Support of employees during reintegration after sickness
– Therapeutic interventions and advice of employees
– Work-life supervision or preventive business mediation
– SuMeCo: think tank for a value-oriented team culture and change
processes
– ASTI & WAVE © Personal Mastery Concepts
• in workplace health promotion
– Measures for health awareness
– Education and further training on health issues

The contracting authority of an occupational and business psychotherapist is the

company. The therapists are bound by a duty of confidentiality in the individual
work with the relevant people.

3.3 Measures and Promotion of the Collective in Terms

of the WAVE Process

Before preventive measures can be taken, it is useful to get a general impression of

a company. How intense or detailed this should be done depends on the particular
task, goal setting and target design. A first impression can be gained through a
LifeScriptAnalysis of the company. It serves to understand structures, interactions
and the lived culture of the system. Based on that the first steps and action packages
can be worked out. Figure 3.1 shows the four areas and their impact on the health
success of a company.
In addition to being a counseling center and a contact point for mental problems,
conflicts, bullying, the department of occupational and business psychotherapy
should also design and offer lectures and training measures, which relate to joint
action in terms of a healthy working environment as a living space, work
60 I. Pirker-Binder

experience, culture and interaction. With regard to structural developments dia-

logues, discussion groups or think tanks (idea workshops) according to Scharmer
(development of concepts from a future perspective) seem to be appropriate for
executives.
An overview of possible measures:
• Work-Life supervision or preventive business mediation as an accompanying
service in the company
• SuMeCo in conflicts (Pirker-Binder 2016) includes content from supervision,
mediation,4 coaching5 and psychotherapeutic knowledge. SuMeCo is a pre-
vention and intervention concept of logotherapeutic occupational and business
psychotherapy for personal development and the preservation of psychological
health. The aim is to provide within the company an open framework for per-
sonal development and neutral interaction for a healthy and beneficial working
culture, which is oriented towards a common what for in order to overcome
disharmony as soon as possible. SuMeCo is understood as a think-tank for a
value-oriented team culture and change processes with the aim not to lose sight
of the common vision and aspects of meaning, as well as to promote consistency
in the common work: creates space for change processes.
• ASTI & WAVE Personal Mastery Concepts® include:
– ASTI: promotion of the individual (Fig. 3.3).
– WAVE: Promotion of teams (Fig. 3.3).
– LifeScriptAnalysis. (Table 3.1) of the company as an initial analysis for a
holistic approach to health promotion in workplace health management.
– WorkScriptAnalysis (Chap. 2): explores—similar to the LifeScriptAnalysis for
the working people—the working culture, the work experience of the group,
the team. The goal is the timely detection of conflicts, bullying, loss of moti-
vation, management errors.
• LifeEnergyAnalysis (Chap. 12) describes the possibility to record through
vegetative functional diagnostics both, the individual psychological and physi-
cal stress and the stress within a group or a team early on. The new technology
of biofeedback devices (Pirker-Binder 2008) and evaluation procedures—they
will be explained in detail in Chap. 12—allows reporting back the gathered
information to the employees as a health tool and increasing the responsibility
for their own health. This can result in preventive measures for the individual
employee, but also for a group. Possible measures could be more health
information for shift workers, compliance with rest periods or a survey of the
strain on frequent flyers.

4
Mediation is a form of out-of-court conflict management (http://wirtschaftslexikon.gabler.de/
Definition/mediation.html?referenceKeywordName=Mediator, last access 11 April 2015).
5
Coaching is an interactive person-centered advice and support process in the context of work
(http://www.coachingdachverband.at/index_html?sc=285962687, last access 11 April 2015).
3 Work Areas, Concepts and Methods or Meaning … 61

Table 3.1 The four areas of LifeScriptAnalysis for psychological health of the company
Areas Who/what is What does it Who causes it? “Tree of
involved? influence? success”
Mission, Founder’s vision Type of company, Culture: internal and “the
vision company style external impact seed”
Management Executives Leadership style Work atmosphere “the
Employee Human resources Interaction and Human capital trunk”
communication
Collective Understanding of Commitment Success “the
wanting meaning and values treetop”
Corporate-Social-Responsibility Sustainability Quality
of life
Health success

Case study shiftwork

Mr. X is a shift worker in the construction industry; his workplace is about 800 km
away from his home. This means that every Friday after his shift has ended he
drives home as fast as possible. A 24-hour heart rate variability analysis shows great
tiredness after his shift, between 10 and 11 o’clock. Even though he felt it, he was
not aware of its significance regarding the risk for the journey back home. On the
basis of the measurement Mr. X realizes that it is irresponsible of him to drive home
immediately after the shift. Thereby he puts himself and the colleagues who are
riding with him in danger. He becomes aware of how irresponsible his behavior is.
The risk of micro-sleep is incredibly high. Through the measurement he can
understand the needs of his body, in this case, for urgently required recovery after
working a shift and before driving home. Even during the week he rarely slept after
his shift, but stayed online, his phone was never put to silent mode. He was
basically always alert, suffering from related health issues.
• A perception and sensitization training with biofeedback in order to increase
self-management, self-competence and inner peace and to prevent
hyper-activation as well as enhance the individual stress tolerance and
strengthen the regeneration potential of the organism by means of a training of
the heart rate variability.
• Further training measures for personal development, information from the
field of psychotherapy, psychology, medicine and nutrition
• Health certificate for employees in which health-promoting courses, regener-
ation training, tips on healthy physical activity are documented. Not only the
yearly turnover success should be celebrated, but there should also be a bonus
system for health-conscious employees or managers.
• Creation of a psychotherapeutic expert report on the ability to work.
62 I. Pirker-Binder

The aim of the measures is

1. to develop increasing responsibility for health and, particularly, for the
preservation of psychological and physical performance capability of
both, each employee in a team and the executive, in terms of their duty of
care for their employees, to reflect on themselves and their individual
leadership style and social competence.
2. to improve the team culture and the interaction with each other and with
other teams. The better the working and interaction culture, the higher the
commitment within the company, the greater the health success in the
company.
3. to support the diagnosis and preparation of a set of measures for the
employee and the company with a psychotherapeutic report in the case of
suspected exhaustion and to give suggestions for preventive measures that
arise from the questions for a report.
4. to promote the understanding of the risk of exhaustion and a culture of
open dialogue about it.

3.4 Answer to Questions on the Ability or Inability

to Work in the Case of Exhaustion

A psychotherapeutic expert report in business consulting can answer questions on

ability or inability to work in the case of exhaustion. If an employee is indefinitely
written off sick with a “stress-induced depression” (or any other disease), there is
often great helplessness about the proper procedures and the time frame for con-
valescence and recovery of performance capability on both sides, i.e. the person
himself or herself as well as in the company.
The most frequently asked questions are:
• Who makes the diagnosis of emotional distress and/or strain?
• Who gives a treatment recommendation?
• What should be considered?
• What can I do as an executive?
• How long will the employee be absent?
• Should there be changes in the working time (home-office, part time), if so, what
changes?
• Does the employee have to be taken out of the company (sick leave), or can he/
she continue to work with support?
• Will he/she be completely fit after sick leave again? Or is a convalescence
period needed during rehabilitation?
• Who supports the affected colleague during rehabilitation?
3 Work Areas, Concepts and Methods or Meaning … 63

The psychotherapeutic expert can answer these questions and advise and support
executives and affected employees. The expert report may be issued by an external
psychotherapeutic expert, or as a part of occupational and business psychotherapy
in the company.

A psychotherapeutic expert report about the ability to work includes:

1. Psychotherapeutic diagnostics about the mental condition, ability to work,
work experience (psychotherapeutic conversation for the analysis of the
current situation, LifeScriptAnalysis, WorkScriptAnalysis, question-
naires). It provides information on the current emotional distress, stress
and ability to work.
2. A vegetative functional diagnostics by means of a 24-hour heart rate
variability analysis (Chap. 12). It provides information about the current
strain on the organism and its performance capacity (vegetative functional
diagnostics) and about a possible risk of physical collapse.
3. Recommendation for a set of interventions and measures; sick leave,
home office, short-time work, etc.
4. Psychotherapeutic reports within the scope of meaning oriented occupa-
tional and business psychotherapy deal with issues concerning the topics
work, resilience, rehabilitation after sickness, reduction of working hours,
sick leave, indication of interventions and measures.

3.4.1 Content of Psychotherapeutic Expert Reports

Expert reports can provide clarification in all areas in which psychotherapeutic

questions arise (economy, industry, art, technology, medicine, psychology) (Lankse
and Pritz 2002).

Definition
Psychotherapeutic expert reports examine and assess, on a
psychotherapeutic-scientific basis, psychosocially or psychosomatically
caused behavioral disorders and states of suffering that do not only include
disease treatment but also health care and promotion.
Logotherapeutic expert reports are psychotherapeutic reports, which draw
upon Viktor Frankl’s teaching and image of humanity as well as his exis-
tential analysis and logotherapy in their diagnosis and logical structure.
64 I. Pirker-Binder

It is noted that “also in the healthcare sector either parallel to or completely regardless
of medical or clinical psychological or health-psychological assessment, psychother-
apeutic expert reports have their own place, where the objective of the question induces
the examination of psychotherapy-relevant facts” (Bartuska et al. 2005).
Consequently, the creation of psychotherapeutic expert reports on the subject of
ability to work in the case of exhaustion is to be assigned high importance, not only as
a support for companies and their employees, but also in the healthcare sector for the
duration of sick leave, therapy measures, proposals for spa treatment and much more.

3.4.2 Legal Foundations of Psychotherapeutic Expert

Reports

In 2002 the Federal Ministry of Health in Austria defined criteria for the creation of
expert reports by psychotherapists for the first time. Paragraph 1 Psychotherapy
Act, Austrian Federal Gazette BGBL No. 361/1990 describes the profession of a
psychotherapist as follows:
… comprehensive, conscious and planned treatment, which is preceded by a general and
specific training, of psychosocially or psychosomatically caused behavioral disorders and
states of suffering with scientific and psychotherapeutic methods in an interaction between
one or more treated and one or more psychotherapists with the aim to alleviate or eliminate
existing symptoms, to change dysfunctional behavior and promote personal maturity,
development and the health of those treated (Bartuska 2005, p. 15).

Accordingly, the treatment is preceded by psychotherapeutic diagnostics. This

diagnostics is described as findings in the expert report. The findings contain the
individual information of the affected person and the diagnosis of the expert to
clarify the issue (in this context about the seriousness of exhaustion or on ability or
inability to work).
The diagnostics to be performed by the expert claims to be based on the latest
psychotherapeutic-scientific methods. The findings are followed by the actual
report, which contains the assessment of the expert and a clarification of the issue.

3.4.3 Psychotherapeutic Diagnostics

In the diagnostics guidelines for psychotherapists (Bundesministerium für

Gesundheit 2004)
psychotherapeutic diagnostics is regarded as an inherent part of psychotherapeutic treat-
ment. The diagnosis is a snapshot within a diagnostic process, which can be perceived and
assessed depending on the degree of possible differentiation… The object of psychother-
apeutic diagnostics is the assessment of psychopathological matters in terms of the sub-
jective suffering of one or more persons under the conditions of cultural and social norms as
well as economic conditions.
3 Work Areas, Concepts and Methods or Meaning … 65

There is a differentiation between the initial, development and final diagnosis. In

my view the essential legal information is provided by the Supreme Court judgment
of 18.8.1998, which, in the course of the 50th amendment to the General Social
Insurance Act, ASVG, equates psychotherapeutic treatment with medical aid if,
according to § 135 para. 12 sentence Z 3 ASVG, before or after the first, or in any
event, before the second psychotherapeutic treatment a medical examination has
been carried out. (Bartuska et al. 2005, p. 45). An interesting aspect can also be
found in the Supreme Court judgment definition of psychological illness according
to §§ 120 paragraph 1 and number 1 and 133, paragraph 2:
Psychological illness is an anomalous (pathological) disorder caused by mental or physical
factors, which necessitates medical treatment; through the medical treatment the health,
ability to work and the ability to meet vital personal needs, should be restored as far as
possible, strengthened or improved. Psychological illnesses are no longer or only partially
subject to the volitional control of the patient; they are recognizable in emotional, physical
symptoms or in pathological behavior (disorders of perception, behavior, processing of
experience, social relations and the body functions). Disrupted social relations are only
considered an indication of a psychological illness, if the relationship disorder is linked to
an anomalous (pathological) change in the psychological or physical condition of a human
being and medical treatment is required.

References

Bartuska H, Buchsbaumer M, Mehta G, Pawlowsky G, Wiesnagrotzki S (2005)

Psychotherapeutische diagnostik. Leitlinien für einen neuen Standard, Springer Wien NY
Begriffsklärung und Grundlage eines Gutachtens des Psychotherapiebeirates vom 15.6.2004;
URL: http:// www.bmg.gv.at/cms/home/attachments/6/8/3/CH1002/CMS1144348952885/diag
nostikleitlinie_fuer_psychotherapeutinnen_und_psychotherapeuten_formatiert_fuer_homepage.
pdf last access 24.9.2013)
Bundesministerium für Gesundheit (2004) Diagnostik-Leitlinie für Psychotherapeutinnen und
Psychotherapeuten
Frankl V (2004) Der unbewusste Gott, Psychotherapie und Religion. 7 Aufl dtv, München
Lankse P, Pritz A (Hrsg) (2002) Das psychotherapeutische Gutachten. LexisNexis ARD Orac
Wien, S 18
Lukas E (1998) Lehrbuch der Logotherapie. Profil, München Wien
Pirker-Binder I (2008) Biofeedback in der Praxis, vol II. Erwachsene, Springer, Wien NY
Pirker-Binder I (2016): SuMeCo, in Vorbereitung
Scharmer CO (2009) Theorie U – von der Zukunft her führen. Carl-Auer, Heidelberg
Senge PM (2001) Die fünfte Disziplin: Kunst und Praxis der lernenden Organisation 8. Aufl.
Klett-Cotta Stuttgart
Senge PM, Scharmer O, Jaworski J, Flowers BS (2004) Presence, human purpose and the field of
the future. Crown Business, New York
Senge PM, Kleiner A, Smith B, Roberts C, Ross R (2008) Das Fieldbook zur Fünften Disziplin
(Systemisches Management). 5 Aufl, Schäffer Pöschel, Stuttgart
Chapter 4
The Value Balance in Business®—Healthy
Corporate Culture, Healthy Employees

Heinrich Anker

Contents

4.1 A Company Is Struggling for Its Identity—To the Beginnings of the Value Balance
in Business® .................................................................................................................... 68
4.2 When Employees and Management Are Pulling Together—But in the Opposite
Direction .......................................................................................................................... 69
4.3 Salutogenesis—Link Between Health, Performance and Corporate Culture................. 70
4.4 A New CEO or the Fear of Employees that a New Broom Might Clean Too Well.... 71
4.5 From Being a Swimmer in the Stream to an Oarsman in the Rowing Boat—
Discovering the Independent Force of Cooperation....................................................... 72
4.6 On the Interplay of Individual and Sociocultural Sense of Coherence ......................... 73
4.6.1 The Concept of Meaning ................................................................................... 74
4.6.2 The Concept of Comprehensibility .................................................................... 75
4.7 If You Consider Your Employees to Be Good,You Create a “Healthy” Company ..... 77
4.8 Substitution or Differentiation Strategy? A Weighty Decision ...................................... 78
4.9 Mission, Vision and Values—The Corporate Culture Sources of Meaning
and Appreciation ............................................................................................................. 80
4.9.1 The Mission—The Fixed Star of Companies Serving Customers and Society 82
4.9.2 The Vision—High-Pitched Concrete Objectives Are Inspiring ........................ 82
4.9.3 Values: What Is Important Is Valuable, What Is Valuable, Is Meaningful...... 82
4.10 Excursus: Facets of a Salutogenetic Company Organization......................................... 83
4.11 Value Balance in Business®—Corporate Culture as the Basis for Comprehensive
and Sustainable Health Promotion .................................................................................. 84
References .................................................................................................................................. 86

H. Anker (&)
Heilbachrain 26, 3250 Lyss, Switzerland
e-mail: [email protected]

© Springer International Publishing AG 2017 67

I. Pirker-Binder (ed.), Mindful Prevention of Burnout in Workplace Health
Management, https://doi.org/10.1007/978-3-319-61337-6_4
68 H. Anker

The Value Balance in Business® is on the one hand the reference model of a
meaning- and performance-oriented corporate culture, and on the other hand an
instrument for the analysis and diagnosis of existing cultures and their further
development towards realization of meaning and commitment of the employees.1
The core of the Value Balance in Business® is an ethical one: it is about the
“condition humane” of the employees, about their health and quality of life as well
as its resulting growing power and desire to do their best in their work—for their
own benefit and that of the company, its customers, its shareholders and other
important groups.
Hereinafter the Value Balance in Business® is introduced as a reference model
for a meaning and performance-oriented corporate culture with a particular focus on
its importance for health promotion.

4.1 A Company Is Struggling for Its Identity—To

the Beginnings of the Value Balance in Business®

The beginning of the Value Balance in Business® is determined by the author’s

professional experiences: as a member of the management of a service provider he
lived through the whole range of what a company can demand from and do to its
employees when it loses its soul and breaks its stride: the fears of how to continue
in one’s professional and private life, tensions, arguments, intrigues, times of dis-
orientation, uncertainty and the paralytic feeling of being stuck in the mud—all of
these did not fail to leave their mark physically and psychologically on the
employees: the sickness rate continued to increase.
The company’s inner life was more and more reflected to the outside: its once
excellent reputation suffered; the market shares slipped. The reason why the author
himself did not consider quitting at that time is the conviction, which was formed
through numerous personal discussions with colleagues and teams, that by far the
largest part of the staff did not desire anything more than being able and allowed to
work for a reputable company and “do a good job” for the customers.
In principle, everything required was there: above-average well-trained, com-
mitted and responsible, sincere employees, the necessary equipment and good wage
and working conditions, as well as a still comfortable market position—what was
wrong, completely wrong, was the “software “, the “mental program” or the culture
of the company. In this company less and less was compatible internally. The
symptoms were manifold: misunderstandings, conflicts, mutual recriminations,

1
The Balanced Scorecard® is an instrument for the systematic development of company strategies;
thereby, always the same four perspectives (the finance sector, customers, internal processes and
learning and development perspective) are applied; similarly, the Value Balance in Business® is an
instrument for the systematic development of corporate culture: here also certain perspectives are
applied (a total of nine).
4 The Value Balance in Business® … 69

competence skirmishes, power games, intrigues, bullying, burnout, termination of

work contracts.
Carried by the vision of what this once respected company and its many integral
employees would actually be capable of and what joy and pleasure it would be for
them, their relatives and the customers if only a sustainable corporate culture
existed, the author started to promote the development of a mission statement.
Thanks to various favorable circumstances (more of this below) the new
development of the “software”, i.e. the development of a mission statement gained
momentum. It was carried out cautiously and prudently, step by step: the com-
pany’s internal situation analyzes were confronted with scientific foundations to test
their plausibility and reliability. Then, practical implementation started. With this
permanent exchange between theory and practice and the results of the corre-
sponding implementation steps, the Value Balance in Business® had its beginning.
The positive results of this concrete mission statement development ensured the
energy to further develop this concept and refine it.

4.2 When Employees and Management Are Pulling

Together—But in the Opposite Direction

We are in a company with approx. 1500 employees: the salaries, the holidays and
leisure regulations are among the most generous of the industry, there is no lack of
technical equipment, and the “workload” is in the comparison with the other
companies of this industry sector demonstrably lower—and yet, at every step you
will be confronted with complaints like “We are totally overloaded “, and com-
plaints about bottlenecks regarding labor capacities. There is hardly any discussion
with executives and employees that does not include the catchwords “stress” and
“work life balance” or in the call for more employees.
Behind this, considerable tensions are hidden: the professional ethos, the
knowledge of the importance of the company’s services for the customers and
society is highly developed; it even seems a bit excessive, but, on the other hand
many employees including those in the middle management are haunted by big
worries: if they look beyond their company, they find themselves in an industry
with an extraordinarily intense transformation dynamics and at the same time they
feel that nearly nothing is moving in their company. The fear of missing the boat is
big and widely spread. What is going on inside the company is also found on the
outside: according to studies, which are also picked up by the media, the customers
and the wider public regard the company as “reliable”, but increasingly also as
“backward” and “dull”, and their products are increasingly seen as “not current”,
“distanced”, “not close to the customers” and “emotionally not very appealing”.
This is also reflected in the market shares of the company, which continuously
decrease. Having this mirror held up before them adds to the employees’ pain and
confusion. From their point of view they see the image of a ship whose captain has
70 H. Anker

gone off the course, but he stubbornly keeps going instead of changing the course to
avoid the lurking danger.
The captain is not turning a blind eye to the slipping market shares, yet he does
not have relevant exchange with employees and stifles change and innovation
proposals from their side in the core. Probably not least because of the influence of
a small but influential informal network of beneficiaries of the situation, he is
explicitly not willing to accept the social change, which leads to new needs of
customers, society and, “nota bene”, employees in his industry sector as well. He
refuses to steer the company to a new future oriented course.
As a result, an increasingly and deeper division between the employees (in-
cluding the lower and even middle management) and the company’s top manage-
ment opens up. “You up there—us down here!” becomes the predominant view;
with the participation of the superiors, the departments and teams isolate themselves
from the top management. Communication becomes more and more precarious, and
the top management finds it increasingly difficult to recruit suitable staff for leading
positions. The suspicion on both sides grows, and the climate deteriorates. The
management, in particular the CEO, cannot understand this: “What do you really
want? Our wages and working conditions are among the best!” Hence, business
management control mechanisms are developed, which the employees cannot but
perceived as additional harassment; they reinforce the debilitating feeling of
overload and lost motion even more.
These internal tensions make the company more and more concerned with itself,
and those resources that should be transformed into services for customers and
other stakeholders, are wasted within the organization. This damages the reputation
and the assessment of its services even more, and the market shares continue to
fall—a threatening downward spiral!

4.3 Salutogenesis—Link Between Health, Performance

and Corporate Culture

What does all this mean for the health of the employees? As a first approach to this
question the concept of salutogenesis according to Aaron Antonovsky provides a
helpful concept. At the center of his social psychology model of health is the Sense
of Coherence (SOC) (Schiffer 2011). Depending on the power of their character-
istics, an individual is at a particular place within a health-disease-continuum.
Antonovsky defines the Sense of Coherence as “… a global orientation… which
expresses the extent to which one has a penetrating, persistent and lasting feeling of
confidence that one’s own internal and external environment is predictable and that
it is highly likely that things develop in a way as is reasonably expected. “
(Antonovsky 1997, p. 16) In the sense of (analytical) separation, Antonovsky
distinguishes three Sense of Coherence-components:
4 The Value Balance in Business® … 71

A. Comprehensibility: Do I understand what is happening with my professional

environment and me and what impact does this have on me?
B. Manageability: Do I myself have any influence on these events? Can I help
shape the conditions and in what form?
C. Significance (Antonovsky 1997, pp. 34–38) or meaningfulness (Schwarz u.
Wyssen 2013, p. 38): Can I attribute meaning to my job and to what is hap-
pening around me? Does my acting show a clear “for what” or “why” or “for
whom”?
In the terminology of salutogenesis, the employees of the above mentioned
company show very pronounced components of significance or meaningfulness,
however, the component of manageability is hardly perceptible—a considerable
stress and frustration potential, which keeps building up, with the corresponding
consequences for the well-being and welfare of the employees and (in a figurative
meaning) their company.
Antonovsky sees a close relationship between the Sense of Coherence factors of
significance/meaningfulness and comprehensibility: their interaction not only
includes a cognitive, but also an emotional and a motivational component
(Antonovsky 1997, p. 110). With regard to the latter, in his salutogenetic model
Antonovsky establishes a direct relationship between health as well as motivation,
that is, performance capability and motivation. For the Value Balance in Business®
as a model a meaning and performance oriented corporate culture Antonovsky’s
connection of meaning, motivation and health is crucial.
• It may be concluded that there is a link between “health” on the one hand and
the Value Balance in Business® as a corporate culture model on the other hand,
i.e. a relationship between corporate culture and health.

4.4 A New CEO or the Fear of Employees that a New

Broom Might Clean Too Well

Back to “our” company: After the retirement of the previous general manager a new
CEO was supposed to save the company from this downward swirl. A difficult
legacy! When he starts to implement long overdue reform steps on business
management level and in the product sector, the situation initially aggravated even
more: the employees are gripped by the fear that due to economic reasons the new
manager might turn to the reduction of benefits in the areas of salaries and holiday
arrangements, etc. or even to laying off employees. In general, the fear spreads that
he appreciates the importance of the company’s services less than the employees
and that for him, these services are merely economic products without any deeper
meaning than achieving a higher sales rate as quickly as possible and recapturing
market shares. These fears were supported by the network of the former CEO’s
72 H. Anker

beneficiaries. It was one of the first important steps for the new management to
deprive this “informal clique” of power.
In the Antonovsky terminology this means that among the employees now no
longer only the component of manageability was experienced as critical, but also
that the two core components of the Sense of Coherence, meaningfulness and
comprehensibility, were being questioned more and more; for the employees things
were getting to the “core of the matter”. Where this is the case, soon nothing will
work anymore. The reason for this is that in times of high uncertainty a growing
number of employees are in a panic mood and only thinking about themselves.
They want to salvage their own job and turn more and more into lone wolves. This
also happened in “our” company: the stress, conflict and frustration potential
reached new heights and this had a direct and drastic effect on the health of the
employees. Within two years the amount of colleagues being on sick leave
increased by nearly 30%—an unpleasant situation.
That this company is still alive and that the threatening downhill swirl has turned
into an upward spiral with many enthusiastic employees, a high social reputation,
widely valued services and a growing market share—8% within three years—has
not been achieved with business and organizational measures alone, but it involved
initiatives in the field of corporate culture.

4.5 From Being a Swimmer in the Stream to an Oarsman

in the Rowing Boat—Discovering the Independent
Force of Cooperation

“Culture” is a genuinely social phenomenon with its own strength. Antonovsky

himself speaks on many occasions about a “social SOC” and also explicitly focuses
on the health aspects of the work situation. He mentions historical-cultural char-
acteristics that lead to life experiences, which in turn strengthen or weaken the
individual SOC. They are summarized below (Antonovsky 1997, p. 112):
1. Participation in socially valued decision-making processes; they provide fun and
pride at work and discretionary power
2. Social respect for the company
3. Social respect for the work performed
4. Decision—making powers with regard to the work and the legitimacy of power
distribution among the colleagues
5. Balance with regard to the resources for the individual and within groups; the
extent in which existing potentials can be used in complex work situations
6. Consistency as a degree of clarity regarding the work environment and one’s
own position therein; confidence in the safety of one’s job; communication and
social feedback at work.
4 The Value Balance in Business® … 73

(Almost) all these factors have an impact on the health-promoting corporate

culture; however, they do not provide its foundation: The power of the social and
the culture lies in the people being rooted in a thought, feeling and behavioral
community (Badura 2011). In it the essence of successful cooperation can be found.
This is not adequately expressed in Antonovsky’s analyses, which can possibly be
explained with his paradigmatic concept: “…my fundamental philosophical
assumption is that the river is the stream of life”—and we are the swimmers in this
river. Antonovsky’s view seems to remain centered on the individual (“individual
fighters”).
Consequently, the Value Balance in Business® as a model for corporate culture
has to be based on a different image, i.e. not one of swimmers in the stream, but one
of a rowing boat: if you start by placing yourself in a slim, sleek single-seater and
forcefully start rowing, you might be under the impression of making quite some
headway and are satisfied with yourself. Now, switch to an eight-seater and row in
sync with the others—the force, the speed, and the dynamics that you experience in
comparison to rowing in the skiff are incomparable. It will grasp and inspire you—
you have the feeling you are flying over the water, you may even find real “flow”.
This experience of community or co-operation is the symbol of sociocultural
coherence (Sense of Coherence/SOC) of a group or a community, including a
company.
• The sociocultural SOC will sustainably strengthen your personal SOC, that is,
your trust in what you can accomplish, in what strength you have in you, your
confidence in being able to achieve high goals as well.
David Packard, founder of HP, describes what is at stake here in simple yet
powerful words. For him profit is an important aspect of entrepreneurial activity, yet
he sees the meaning of an enterprise’s existence elsewhere:
We inevitably arrive at the recognition that a group of people get together and exist as an
institution we call a company so they are able to accomplish something collectively that
they could not accomplish separately – they make a contribution to society. (Collins and
Porras 2005)

4.6 On the Interplay of Individual and Sociocultural Sense

of Coherence

Before we can launch the eight-seater rowing boat, we have to make some more
mental effort in advance. It is about working out the social dimension of the two
Sense of Coherence components “meaningfulness” or “significance” on the one
hand, and “comprehensibility” on the other hand, so as to make them fruitful for the
social phenomenon “culture”. It is about conceiving “meaningfulness” and “com-
prehensibility” not only from the perspective of individuals (individual Sense of
Coherence), but also from the point of view of the community (sociocultural or
74 H. Anker

collective, Sense of Coherence). This is important since the individual and com-
munal feeling of coherence are in a synergy relationship with each other, as
mentioned above: in the worst case they may weaken or neutralize each other,
whereas in the positive case they mutually reinforce each other and bring
employees and companies into an upward spiral.

4.6.1 The Concept of Meaning

Viktor Frankl, the founder of the meaning-centered psychology (a branch of

humanistic psychology), works out the interplay between the individual and social
dimension of the concept of meaning based upon the background of the theme
“health”. On the theme “psychological well-being” he writes:
I would say what man really wants, is ultimately not happiness, but a reason to be happy.
As soon as a reason for happiness is given, happiness ensues. (Frankl 1992, p. 15 ff).

Nevertheless, people do not find reasons for happiness in themselves; our per-
sonal wellbeing always has a social dimension. Decisive for our mental well-being
is, according to Frankl, “solely and exclusively… the feeling of being there—for
something or for someone.” (Frankl 1992, p. 57) Frankl further elaborates on this
idea:
Happiness cannot be pursued, it must ensue and it only does so as the unintended side-effect
of one’s personal dedication to a cause greater than oneself or as the by-product of one’s
surrender to a person other than oneself. Happiness must happen …you have to let it
happen by not caring about it. (Frankl 1985, p. 17).

The experience of being happy and having a meaningful and fulfilled life
becomes possible when people do not focus on themselves and their own happi-
ness, but by looking beyond, by serving a thing greater than themselves, or by
intentionally approaching other people.
Applying one’s energies to a bigger cause than we are means defending the
interests of groups of people or letting one be inspired by their ideals and values.2
An example is the doctor, who not only works for his fees, but also in the service of
the ideal of the health and wellbeing—the life quality—of other people. The uni-
verse of ideals, which may provide us with orientation in our actions and give
meaning to our lives is infinite: freedom, (self-) responsibility, democracy, educa-
tion, health, justice, security, mobility, equality before the law, humanity, ecology,
the service of life, free opinion, etc.
The second important source of meaning and happiness is the affection that we
give other people or the affection that we receive from others—also in this case, we
look beyond ourselves, to others, i.e. the “you”.

2
Ideals are considered to be the symbolic representation of the values of groups of people.
4 The Value Balance in Business® … 75

4.6.2 The Concept of Comprehensibility

Meaning orientated actions in a sense of giving attention to the “you”, or to a larger

whole according to Viktor Frankl, requires mutual understanding. In various fields
like philosophy and from anthropology to neurobiology surprisingly great accor-
dance exists that during communication the ability to empathize emotionally and
cognitively (the latter as a human specificity) plays a decisive role. Without them no
successful social relations, no fruitful co-operation, no viable management and
customer relationships can be imagined.3 This means comprehensibility as a
component of the Sense-of-Coherence presupposes empathic communication.
Our empathy is not only the key to comprehensibility, but it leads us back again
to the experience of meaningfulness. Approaching groups of people or ideals helps
us through our ability to empathize to experience being good for something.4 Also
based on our ability to empathize, paying attention to other individuals enables us to
experience being good for someone. They both end in the experience and the
certainty: “It is good that there is me, I have a place in life, I have a place in this
world and I can actively participate in it. Sharing and shaping reality—my existence
has meaning” (Frankl 1995, p. 29 f).
We conclude from this: the individual Sense of Coherence components
“meaningfulness” and “comprehensibility” go back to one and the same existential
need: to the need for insight into the meaning one’s own doing and the associated
appreciation that we grant others and that is given to us.5
Ultimately they can only flourish through social interaction respectively or
cooperation—“meaning” is always connected to culture. From this, the following
can be derived:
• Health and health promotion can never be seen as a merely individual phe-
nomenon; they always have their social and socio-cultural dimension—even and
particularly where people are interacting in highly complex social structures
such as companies.
In our modern era of the economic dogma of maximizing personal advantage
and self-interest (and the associated individual competition) this is probably not “so
easy” to accept for all company managers.

3
See, for example, Marshall B. Rosenberg and his contributions to non-violent communication.
4
Thanks to our ability to empathize, we are subject and object, the active and the suffering parts of
our actions and omissions at the same time. The ability to feel empathy allows us to understand the
consequences our actions have for others—we put ourselves in their shoes and comprehend their
vision of the world. If we do something good, we will also comprehend it ourselves; if we face
others in hatred, we experience this hatred within ourselves as well. Empathy might have more
immediate and drastic, good and bad, consequences on our health than we are aware of.
5
We may receive this appreciation directly as a result of our doing through the others, but we can
also emphatically follow it. For example, if we in the wake of a disaster make a donation, we rarely
receive the thanks of those directly concerned, however, we emphatically understand that their
suffering is alleviated through our contribution (or we hope so, at least).
76 H. Anker

The insight into the meaning of our actions and the empathic experience to be
valued as an individual, that is, being “good for someone” or “good for something”
are for us humans, according to Viktor Frankl, linked inseparably. That is, they are
not further questionable, i.e. constitutive of our human being. They are in a fun-
damental sense our elixir of life and thus the sources of vitality and life quality.
Thus, the forces that we can mobilize for our tasks are correspondingly strong if,
from our point of view, they are connected with the experience of meaning and
appreciation. Their importance for health as well as successful cooperation is
directly evident.
This means: “If you ask for performance, you have to offer the experience of
meaning and appreciation to the people or the employees” (Anker 2012, p. 61).
Nota bene: even above all instrumental health and motivational considerations this
is a fundamental ethical duty: it is about being human itself.
• If you ask for performance, you have to offer the experience of meaning and
appreciation to the people or the employees!
To illustrate the importance of meaning and appreciation, let’s make a small
thought experiment: imagine, you wake up one morning and suddenly the thought
shoots through your head: “I see no sense in what I do, and no one is waiting for
me!” Perhaps you physically feel your strength wane. Do not hang on to these
thoughts too long, rather compare how it feels when you go to work and can say,
“Well, someone is waiting for me there, I am welcome. My services are needed and
I will also be appreciated as a person!” Or imagine how it feels when you are on the
way home from work and you can say: “Great, today I could do a good job for
someone, my efforts have paid off!” Obviously such healthy and motivating
experiences remain hidden from many employees—and this can have serious
consequences for them as well as for their companies:
• In the most important economies according to Gallup in 2008, 70 to around 90%
of all employees only had a weak or no relationship with their work and their
employer (Gallup 2009);—not even a critical relationship, which would still
show interest in their own work and the that of the company.
• Around 50% of all employees worldwide would be happy to accept a lower
salary or occupational status, if they could only do more meaningful work.6
Due to its existential nature the need for meaning and appreciation cannot be
replaced by anything where it is unfulfilled, neither by material incentives nor by
the prospect of pleasure and/or power.7

6
The question was, “Would you take on a lesser role or lower wage if you felt that your work
contributed something more important or meaningful to you or your organization?” (Kelly
Services 2009a, b).
7
According to Elisabeth Lukas, “people are willing to accept sacrifices, if need be, and to leave
needs unsatisfied. The physical and mental wellbeing play a secondary role in the search for
meaning. Compared to this, failure in the search for meaning cannot be balanced by any psy-
chophysical well-being” (Lukas 1998, p. 39).
4 The Value Balance in Business® … 77

Meaning and appreciation are the main pillars of a meaning and

performance-centered and at the same time salutogenetic corporate culture, i.e. they
are at its heart. They are not only effective inside a company, but also against the
outside, in dealing with the customers, the suppliers and many other stakeholders.
Also for them is the experience of meaning and appreciation most important, and at
the same time they are again a source of motivation for employees thanks to the
experience of being able to “do a good job for someone”, “being good for someone
or something”—“Inside, like outside!”

4.7 If You Consider Your Employees to Be Good,

You Create a “Healthy” Company

Until the top management of our company was ready to start tackling the devel-
opment of a mission statement building on this concept of humans and the related
motivation theory, there were hard struggles. Some representatives of the senior
management level still represented a “selfish” concept of humans characterized by
Darwinism and Taylorism: they interpreted the ongoing complaints of the
employees about being overloaded as a tactical measure in the struggle for yet
better salary and compensation conditions. Among other things, pointing to current
findings of neurobiology enabled their colleagues to soften their position:
Joachim Bauer writes on the topic of meaning and appreciation from a neuro-
biological perspective, (Bauer 2007, p. 190/204): “If appreciation, attention and
trust are the neurobiological fuel of the motivation systems: where does this fuel
come from? It comes from only one source: the interpersonal relationship.” Bauer
further states: “Motivation as a basic attitude is greatly influenced by the extent to
which people have the feeling that their work or, what they work for, is basically
meaningful.” An economic company is “meaningful” if it ultimately serves
objectives that are beneficial for society. Where the managerial level keeps an eye
on the question of a superior meaning of the economic activities, potentials can
particularly be activated when crises or temporary difficult phases must be bridged
in a company. If temporary unpleasant decisions are explained in a convincing and
comprehensible manner, this can be a decisive motivation impulse.”
Gerald Hüther, a neurobiologist like Joachim Bauer, describes what develop-
ment and performance potentials are combined with human recognition and
cooperation:
Once we start thinking about what basic attitudes one would have to make his/her own to
use one’s brain more comprehensively, more complex and more networked than before,
(alongside mindfulness and caution) a whole range of terms come to mind… meaning-
fulness, sincerity, modesty, prudence, truthfulness, reliability, commitment… The only
thing, he/she needs is other people, who he/she can share his/her perceptions, feelings,
experiences and knowledge with.” According to Hüther, cooperation makes us intelligent,
whereas self-interest makes us wither away. (Hüther 2006, p. 123 f.)
78 H. Anker

Not least thanks to Edgar Schein the “Darwinists” and “Taylorists” in the
management gradually realized that the alleged selfishness of employees rarely
stands at the beginning of a development, but instead it is the result of a corre-
sponding concept of humans and its resulting leadership “philosophy”:
Executives who believe that people are fundamentally lazy, passive and not interested in the
company, but merely in their own affairs, … train their employees to become lazy and
selfish. Such arising control-oriented organizations might stay alive in stable situations, or
even make progress, as soon as their environment becomes more turbulent; they go under…
(Schein 2004, p. 396).

Against the background of the current state of the company with its continuously
declining market shares, increasing sick leave, its established control-oriented
management and wide-spread mistrust of the new CEO, facts explained by authors
such as Bauer, Hüther and Schein, did not fail to be effective. The decision to start
developing a mission statement according to the requirements of a meaning and
performance centered culture, was ultimately made unanimously thanks to the new
CEO’s prudence.8

4.8 Substitution or Differentiation Strategy? A Weighty

Decision

This basic decision led the company management to a second, also highly chal-
lenging corporate philosophical question: If it is true that who is calling for per-
formance must provide experiences of meaning and appreciation, then for a
company the question arises, how it can create meaning for the employees and give
them appreciation. To anticipate it right here: the most effective way of doing this is
being “good for someone” or “good for something”, that means consistently serving
the needs of the customers and society.
Fortunately, “our” company did not follow the currently prevalent reflex of
short-term shareholder value or short-term profit maximization:
• It renounced entering into (self-) destructive cutthroat competition for the sake
of short-term re-conquering of market shares; the company still had an
impressive market position, and in this case hardly anything is more costly than
a price war.
• Not least bearing in mind the concept of humans the management had previ-
ously decided to adopt, two key strengths of the company were refocused on:
the still above-average high level of education of the employees, and the more or
less latently available high professional ethos.
A price war with the aim of regaining short-term market share and the inevitably
resulting redundancies and service reductions for customers would have massively

8
Otherwise, the development of a mission statement would have caused even more damage.
4 The Value Balance in Business® … 79

compromised the existential need of the employees for meaning and appreciation,
as well as the associated resources and motivation forces. Instead, the management
decided to develop the company in the sense of a differentiation strategy into a
service-oriented personality, which consistently meets the needs of customers and
society with a distinctive face and thereby setting the benchmark for quality stan-
dards in the market. This according to Peter Drucker:
• Business enterprises—and public service institutions as well—are organs of
society. They do not exist for their own sake, but to fulfill a specific social
purpose and to satisfy a specific need of a society, a community, or individuals.
They are not ends in themselves, but means. (Drucker 2007, p. 11)
In the terminology of salutogenesis this decision was about the “reanimation” of
the SOC components of meaningfulness and comprehensibility. And the more
intensely the management had the employees participate in the development of a
mission statement, (a strong signal of the company’s top management with regard
to appreciation and trust in the employees) from their point of view, the more room
was regained by the component of manageability—it became increasingly attractive
to board the eight-seater rowing boat.
The self-image as a “service-oriented personality” led to a high, market-driven
innovative power and to the already mentioned long-term increase in market shares—
it proved to be as sustainable as the rediscovered joy and enthusiasm of many
employees in their work and their appreciation for the company—the eight-seater
rowing boat gradually found its rhythm and steadily took off.
This second philosophical decision took place only after intense discussions and
recourse to a wide range of empiricism and theory. An important contribution were
the following works:
• Peters TJ, Waterman RH (1982) In search of Excellence Lessons from
America’s Best Run Companies, New York
• Kotter JP, Heskett JL (1992) Corporate culture and performance. New York
• Collins JC, Porras JI (2002) Built to last. Successful habits of visionary com-
panies. New York, (1994)
• Joyce W, Nohria N, Roberson B (2003) What (Really) works. The 4 + 2 for-
mula for sustained Business success, New York
These studies are in a chronological sequence. Their research design was
improved from one to the next. They all have one common denominator: In the
long term9 companies are particularly robust and financially sound,
1. if they look beyond themselves and their short-term self-interest, that is, if they
are guided by the primacy of performance in favor of customers and society and
not by the self-interest of short-term profit maximization and shareholder value.

9
The observation periods differ according to the number of years: 10 (Joyce et al.), 11 (Kotter and
Heskett), 20 (Peters Waterman) and 64 years (Collins & Porras). Apparently companies with a
performance-oriented company culture have high life expectancy.
80 H. Anker

2. if they treat the staff appreciatively and value them as individuals, and enable
their active participation in their work as such.
Important insight from a company perspective: the long-term income of com-
panies with a performance primacy and appreciative treatment of the employees
surpasses those with an egoistic primacy of profit or of maximizing shareholder
value, though depending on the study and on the success criterion (total return to
shareholders, growth of stock prices), six- to nine-fold in the long term.10
There are good reasons for this.
1. In companies that are self-consistent in the service of customers and society and
in this sense “good for someone” or “good for something”, the employees’
experience of doing something meaningful and being valued, goes beyond the
limits of the company. Their horizon of meaning seizes worlds beyond and
expands in a decisive way. If a company follows this process, it increases its
offer of meaning to the employees and thereby the performance potential by
several orders of magnitude, whereas otherwise it is greatly reduced. The greater
the contribution of a company to the benefit of customers, society and its greater
environment, the more motivating and salutogenetic is its effect on the
employees.
2. In this way companies acquire a sense of meaningful existence and appreciation,
i.e. a valuable reputation among customers, responsible and dedicated share-
holders and in the wider public—all these are important sources of economic
resources that can contribute to a long life and a lasting high yield of the
companies.

4.9 Mission, Vision and Values—The Corporate Culture

Sources of Meaning and Appreciation

With these considerations, the path was free to develop the core of a mission
statement. It consists of a mission, a vision, and societal values analogous to the (at
least) three ways humans perceive meaning and appreciation. The latter are about
the following three:
1. Space and time transcending dimension of meaning: the orientation towards
an ideal, that is, to a high, very long-term or timeless value. Such an ideal has
the function of a guiding or fixed star, which we can orientate ourselves both in
calm and stormy times; such a star gives us support and orientation in every life
situation.

10
See Kotter and Heskett (1992), p. 11; Collins & Porras (2002), p. 5; Joyce et al. (2003), p. 14 f.
Peters and Waterman (1982) focused on a sample of financially above-average successful com-
panies of the respective industry; in contrast to the following studies this one did not contain a
comparison between successful and less successful companies.
4 The Value Balance in Business® … 81

2. Social Dimension of meaning: the orientation towards values and related ways
of acting and behaving, which ensure mutual appreciation.
3. Time dimension of meaning: the orientation towards a non-unachievable, but
challenging, high-pitched goal. With such a goal in mind every step towards the
goal makes “sense”. The higher and the more desirable the goal, the more
strength and will we invest in order to take the individual steps even if they are
arduous.
The core of guiding images on the basis of a meaning centered and salutogenetic
corporate culture—this is an important aspect of the Value Balance in Business®—
is based on the same, previously discussed three dimensions of meaning. It is
formed by:
1. a mission (in the sense of an ideal, that is, a high societal value transcending
time and space)
2. social or societal values (social dimension)
3. a vision (long-term high-pitched goal as temporal dimension)
In Table 4.1 the individual and collective senses are connected.

Table 4.1 Individual and collective meaning dimensions

Ways to meaning for individuals Ways to meaning for enterprises
What are the life maxims and ideals I want to Mission, fixed star or ideal: which is the real
hold on to in good and bad times? What ideals meaning of the enterprise’s existence? (David
do I want to be guided by? Which are the Packard). What or who is it good for? How do
highest values that give me support? we want to put it in the service of customers
(Time-transcending dimension of meaning, and a larger group of people/society?
our lasting fixed star) (Peter Drucker)
It is not about the range of products, but about
their function: health, mobility, education,
communication, beauty, security, belonging,
pioneer spirit etc
High-pitched goal, at which an individual can Vision: a concrete, high-pitched goal that
grow and perhaps even outgrow him-/herself. challenges the human mind, which it makes
(Temporal dimension of meaning) sense to give one’s best for, together with the
others
Specifically experienced appreciation or External values:
attention to the “YOU”, to other people: Benefit values: How can we and how do we
How do I want to be good for someone or want to solve the problems of our customers?
something in my life? How do I want to enrich What purpose should our products have for
people through my existence and my work? them?
(Social dimension of meaning) Relationship values: How do we want to
fashion our relationship with the customers
(and, if necessary, also with the suppliers)?
How can we appreciate them?
Internal values: What values do we want to
keep in the company in order to deal with each
other in an appreciative way?
What does it take to make our company
successful?
82 H. Anker

These three dimensions of meaning develop their biggest strength when they are
consistent among themselves. In the following, the mission, the vision and values
will be illustrated through some concrete examples.

4.9.1 The Mission—The Fixed Star of Companies Serving

Customers and Society
We are driving the future of our country! (a school bus company)
For Ricola, business success must not be an end in itself, but it should rather facilitate
taking responsibility towards the employees, society and the environment… As Ricola is a
nature-loving company, it places the greatest value on excellent quality of the raw mate-
rials. And so, the processed herbs strictly stem from controlled environmentally friendly
cultivation. Such herbs are not only more aromatic but also possess an inner force: the
strengthening power of nature. (Ricola 2015)

4.9.2 The Vision—High-Pitched Concrete Objectives Are

Inspiring
• We are the BBC of Switzerland! (Swiss Radio DRS)
In every household a PC! (Bill Gates)
Authentic fidelity—sound experience like a live concert (Dynaudio
loudspeakers)

4.9.3 Values: What Is Important Is Valuable, What Is

Valuable, Is Meaningful

Example of internal values:

“Like the cylinder for the crane, the work basket for the stage, the lifting fork for
the forklift, such are the employees for Palfinger.11 (Palfinger 2015)
Examples of (external) benefit and relationship values:
• We Trisans are grateful to be able to produce, honest and meaningful products”
(relationship value), which communicate health, joy and wellbeing (benefit
values) to our fellow human beings. (Trisa 2015)
• The endeavor to serve our fellow human beings all over the world (relationship
value) with practical, functional, efficient and inexpensive quality products
(utility value) gives our lives a deeper meaning as well as joy and gratification at
work.”(Victorinox 2015)

11
A probably somewhat “palpable” formulation, however, it has the advantage of great clarity: in
the language of the industry each one immediately understands, what this entails.
4 The Value Balance in Business® … 83

In “our” company the company management developed the mission statement in

an intensive dialogue with the employees. This process alone already created the
foundations of a climate of mutual appreciation and confidence between top
management and employees, but also among the employees: hardly anything is
more thrilling, reassuring and motivating (and binding) than to see that the col-
leagues also do their best in the eight-seater rowing boat. The mission, a brilliant
vision and clear-cut and consistently lived internal and external values worked like
a catalyst or fountain of youth with regard to the employees’ commitment and
willingness to perform. In the sense of differentiation the company achieved
strategically decisive innovation and the sickness rates were reduced again by a
good 30% to the level before the outbreak of the crisis. At the same time also the
claims of the employees for compensation of irregular or extraordinary work
decreased.
Consequently, the company succeeded not only in consolidating its position in
the market, but in strengthening it permanently (the market share increased by 8%).
At the same time, also the perception by the customers and the general public
turned positive—the company actually developed more and more into a successful,
robust service personality with a distinctive and likeable face.

4.10 Excursus: Facets of a Salutogenetic Company

Organization

Cultures, including corporate cultures, are closely connected with concepts of

humans, that is, with ideas of the human being, of what moves people, what they
strive after, whether and how they are embedded in a larger whole. Today’s
standard theory of economics still sees humans as intelligent animals, beings that
utilize all their abilities merely to maximize their personal benefit. The fundamental
question of the company organization is in this case: How can the actions of all
employees be coordinated so that they facilitate the maximization of the company’s
benefits? This approach leads to a command and control structure—the company as
a purely rational machine and the employees as replaceable at any time—as little
cogwheels.
If we consider humans as beings with an existential need for meaning and
appreciation, a completely different organization principle arises: a living organism.
The two alternatives are compared ideal-typically in the following Table 4.2 (Anker
2012, p. 116 f).
The organization built on meaning and appreciation has a salutogenetic effect. It
corresponds in various ways to the Sense of Coherence concept of salutogenesis
and the associated health factors like manageability, the comprehensibility and
meaningfulness.
84 H. Anker

Table 4.2 Facets of a salutogenetic company organization

The human as a selfish being—the company as Man in search of meaning and appreciation
a rational machine —a salutogenetic company organization
Self-interest creates mutual distrust Striving for meaning and appreciation:
climate of trust
(Meaningfulness, comprehensibility,
manageability)
Disciplining, coercion (command and control Scope of responsibility for employees
structure), no space concerning responsibility (Meaningfulness, comprehensibility,
manageability)
Stiffness, “interfaces” (“machine”) Flexibility, “seams” (“living organism”)
(Manageability)
Fear, paralysis due to negative sanctions Motivation, self-initiative, creativity
(Meaningfulness)
High burden of control Low burden of control
(Manageability)
The company looks inside The company looks outward, at customers,
society, the environment
(Meaningfulness)
Company not adaptable in turbulent times: The 6-f company: fit, fast, flexible, focused,
danger friendly
(for customers), fulfilling (for employees):
high adaptability
(Comprehensibility, manageability,
meaningfulness)

4.11 Value Balance in Business®—Corporate Culture

as the Basis for Comprehensive and Sustainable
Health Promotion

Returning to our initial question regarding the link between corporate culture and
occupational health promotion we would like to state:
Workplace health promotion is gaining in effectiveness and sustainability and
goes hand in hand with a growing willingness to perform in the company if it is
borne by the knowledge of the existential importance of meaning and appreciation
for the employees (of all levels!): health promotion becomes a sustainable com-
parative competitive advantage for a company from a cultural perspective, when it
places itself in the service of customers and society through a responsible mission,
corresponding values and a corresponding vision. In this way, horizons of meaning
arise for the employees as well as sources of empathic appreciation, which are
clearly beyond their actual work in the company: through their work they play an
active part in the (co-) shaping of their reality and that of all others. Thereby it is all
about a fundamental experience of participation, effectiveness, coherence, “value of
life” and health.
4 The Value Balance in Business® … 85

If 80–90% of all workers in Europe, North America and Asia voiced preferences
for employers who would be ethically and socially responsible and environmentally
friendly (Kelly Services 2009a, b), this cannot be a temporary phenomenon but the
existential need of people for meaning and appreciation.
A second essential contribution of a meaning and performance oriented corpo-
rate culture to the health promotion and enhancement of the company’s perfor-
mance potential is that it helps the employees grow closer together through a shared
mission, shared values and a commonly pursued vision towards a community of
thinking, feeling and behavior, i.e. a cooperative community.
Its performance potential is high because it is borne by a shared sense and
mutual appreciation. That is, in the face of the synergetic link between individual
and sociocultural SOC, health care has to regard people within their social rela-
tionships and from including them in its efforts. This concerns the social rela-
tionships in the company itself as well as those of the employees to the customers
and other stakeholders of the company.
In the long term it is important for companies to understand which concept of
humans, which motivation theory,—it is at the same time always a “health theory”—
they want to be guided by in dealing with the employees, but also in dealing with the
customers, suppliers and other stakeholders. Businesses are only efficient in the long
term if human beings receive their space, if economic value and societal values are in
a balance—hence the concept of the Value Balance in Business® and its credo:
• The increase in economic value of the company starts with the appreciation of
the employee as whole, unique and irreplaceable person, as a being in search of
meaning and appreciation.
Lack of meaning and appreciation cannot be compensated for—neither with
regard to the health of the people or the employees, nor their motivation and their
ability to perform.
With regard to occupational health promotion, we are confronted with an
interesting finding: Antonovsky’s concept of health, with its three components of
comprehensibility, manageability, and meaningfulness, or the related existential
categories of meaning and human appreciation easily applies to the corporate world,
on two levels: that of the employees as individuals as well as that of the company as
an organization or institution. These two levels are inextricably linked. Specifically,
this means:
• Measures for health promotion can only have sustainable positive effect if they
are not exclusively directed towards the employees as individuals, but also
include their firm’s culture and its organization.
The recourse to Antonovsky’s salutogenesis is all the more important as his
understanding of health is inextricably linked to the concept of resilience; the
epitome of the will to live and the vitality of people and organizations, even in
challenging times; never have they been more challenging than in today’s global
world.
86 H. Anker

The approach developed here does not stand alone: in the form of the so-called
Meikirch-Modell (Bircher and Kuruvilla 2014) recently published a new,
future-oriented health definition that is fully compatible with the concept developed
here, i.e. a concept in accordance with Antonovsky’s the Sense of Coherence:
• “Health is a dynamic state of well-being emergent from conducive interactions
between an individual’s potentials, life’s demands, and social and environmental
determinants. Health results throughout the life course when an individual’s
potentials—and social and environmental determinants—suffice to respond
satisfactorily to the demands of life. Life’s demands can be physiological,
psychosocial, or environmental, and vary across individuals and contexts, but in
every case unsatisfactory responses lead to disease.”12

References

Anker H (2012) Ko-Evolution versus Eigennützigkeit. Creating Shared Value mit der Balanced
Valuecard, Berlin
Antonovsky A (1997) Salutogenese. Zur Entmystifizierung der Gesundheit, DGVT, Tübingen
Badura B (2011) Entwicklung einer Kultur der Achtsamkeit für Gesundheit an Schulen. Vortrag,
gehalten in Pforzheim, 4. Oktober 2011
Bauer J (2007) Prinzip Menschlichkeit. Warum wir von Natur aus kooperieren. 5. Aufl. Hoffmann
und Campe, Hamburg
Bircher J, Kuruvilla S (2014) Defining health by addressing individual, social, and environmental
determinants: new opportunities for health care and public health. J Pub Health Policy,
Macmillan Publishers Ltd. www.palgrave-journals.com/jphp/
Collins J, Porras JI (2002) Built to last. Successful Habits of Visionary Companies, New York
(1994)
Collins J, Porras JI (2005) Immer erfolgreich. Die Strategien der Topunternehmen, Dtv, München
Drucker PF (2007) The essential drucker. Selections from the Management Works of Peter F.
Drucker, The Classic Drucker Collection, edn 2007
Frankl VE (1985) Man’s Search for Meaning. Washington Square Press, New York
Frankl VE (1992) Psychotherapie für den Alltag. 4. Aufl, Freiburg
Frankl VE (1995) Die Psychotherapie in der Praxis. 5. Aufl, München
Gallup (2009) Engagement index Deutschland 2008. Pressegespräch Marco Nink, Potsdam, 14.
Januar 2009
Hüther G (2006) Bedienungsanleitung für ein menschliches Gehirn. 6. Aufl, Vandenhoek und
Rupprecht, Göttingen
Joyce W, Nohria N, Roberson B (2003) What (really) works. The 4 + 2 formula for sustained
business success, New York
Kelly Services, Media release (2009a) Social responsibility key to attracting top talent. Troy,
Mich. October 28
Kelly Services, Media release (2009b) Around the globe the desire for meaningful work triumphs
over pay, promotion, and job choices. Troy, Mich., February 25

12
Detailed information on the Meikirch model of health available at: http://f1000researchdata.s3.
amazonaws.com/manuscripts/8450/9e8b9c61-f654-43b6-964d-771adaf9064f_7849_-_johannes_
bircher.pdf.
4 The Value Balance in Business® … 87

Kotter JP, Heskett JL (1992) Corporate culture and performance. New York
Lukas E (1998) Lehrbuch der Logotherapie. München/Wien
Palfinger (2015) Media release. URL: www.palfinger.ag/de/karriere/arbeiten-bei-palfinger/
palfinger-werte. Download 23.11.2015
Peters TJ, Waterman RH (1982) In search of excellence. Lessons from America’s Best Run
Companies, New York. Last access on 23.11.2015
Ricola (2015) Media release. URL: http://www.swiss-press.com/newsflashartikel.cfm?key=
1057194. Last access on 23.11.2015
Schein EH (2004) Organizational culture and leadership. 3rd ed, San Francisco
Schiffer E (2011) Synergieeffekte durch salutogenetisches Denken und Handeln in der ärztlichen
Praxis. Talk, held on 10 November 2011 at “Ärztekammer Hannover”
Schwarz S, Wyssen R (2013) Sinnorientierte Führung. Entwicklung der Wertekultur im
Unternehmen. HRM-Dossier Nr. 62, Zürich, S 38
Trisa (2015) Media release. URL: http://archive-ch.com/ch/t/trisa.ch/2012-10-05_371773_2/
Philosophie_Kultur_und_Mission/. Last access on 23.11.2015
Victorinox (2015) Media release. URL: http://www.victorinox.com/ch/de/Homepage/cms/home?
lang=de, http://www.vic-torinox.com/ch/app/content/%3bjsessionid=0C5C2E4FA0EBF1766CE
A54116. Last access on 23.11.2015
Chapter 5
On Diagnosis and Development of a
Health—Promoting Corporate Culture
with the Value Balance in Business®

Heinrich Anker

Contents

5.1 Introduction........................................................................................................................ 89
5.2 The Value Balance in Business® in Practice—
A Concrete Case Study ..................................................................................................... 93
5.2.1 On the Profile of the Audit .................................................................................... 93
5.2.2 A Cause-and-Effect Model—References to Starting Points of the Development
of a Company Culture............................................................................................ 93
5.2.3 The Distribution of Commitment in the Company ............................................... 96
5.2.4 The Value Balance in Business® Reveals a “Clash of Cultures”......................... 98
5.2.5 Facets of a Cluster Analysis Based on Personality Traits of the Employees....... 100
References .................................................................................................................................. 103

5.1 Introduction

Management and management instruments are never neutral and objective: they are
based among other things on the more or less reflected basic assumptions of their
authors. With the choice of instruments, their users determine to a certain extent
also their procedure and the results of their interventions. This also applies to the
Value Balance in Business® (VBB) as an instrument for the analysis and devel-
opment of corporate cultures.
In theory, the VBB is based on the findings of meaning-centered psychology
(Viktor Frankl), neurobiology, anthropology and medicine (salutogenesis). They all
concede: humans are not primarily self-serving beings, as utilitarian economics still
teaches, but they rather derive their vitality and their will for life and performance

H. Anker (&)
Heilbachrain 26, 3250 Lyss, Switzerland
e-mail: [email protected]

© Springer International Publishing AG 2017 89

I. Pirker-Binder (ed.), Mindful Prevention of Burnout in Workplace Health
Management, https://doi.org/10.1007/978-3-319-61337-6_5
90 H. Anker

from the experience that their actions are meaningful and that they are valued as
human beings—not least as a result of their realization of meaning.
Meaning and appreciation have a (socio-) cultural dimension: they occur in
mutual understanding and cooperation on the basis of empathy. At the same time,
these are elementary factors of our health according to salutogenesis. The motto is
therefore, “if you want to strengthen the health and performance capability as well
as the motivation of the employees, you must offer them the experience of meaning
and appreciation.”
• This motto is only sustainable if meaning and appreciation are alive in the
culture of a company and not merely understood and implemented as an eco-
nomic instrument—the VBB is opposed to any instrumentalization of
employees.
Against this background the guiding questions of the VBB in its function as
corporate culture audit are the following:
1. How far do the employees see and experience meaning in their work?
2. How far do they experience human appreciation in the company?
3. What is the resulting level of commitment of the employees?
To systematically record the perception and experience of meaning and appre-
ciation by the employees in the company, the Value Balance in Business® audit
uses a fixed grid with nine perspectives. They are the basis, with the help of which
reliable information about the extent of the perception of meaning and appreciation
by the employees (always of all management levels) and the associated perfor-
mance potentials are collected.
From its basic conception the Value Balance in Business® (as a method of
development and maintenance of company cultures) is similar to the design of the
Balanced Scorecard (as a tool for the development of company strategies). The
Balanced Scorecard (BSC) works on the basis of the four perspectives: customer
perspective, internal process perspective, and learning and development perspec-
tive. They all contribute directly or indirectly to the financial perspective. The Value
Balance in Business®, on the other hand, is based on nine perspectives, all of which
can contribute to performance commitment. Every company has to adapt it to its
situation.
The nine perspectives of the Value Balance in Business® result from the
observation where sources of meaning and appreciation can be found in the com-
pany—always from the point of view of the employees. Each of these perspectives
is operationalized through 8–12 interview questions to the employees. The scope of
the survey and the wording stem from qualitative preliminary studies in the
respective company (mostly semi-structured individual interviews with selected
employees). Subsequently, the staff survey is mostly based on closed questions.
Below the content of the nine perspectives is briefly outlined.
1. Mission, vision and internal as well as external values These are the central
sources of meaning and appreciation in a company and form the core or the
5 On Diagnosis and Development … 91

uppermost reference point of a meaning and performance oriented, salutoge-

netic corporate culture. The most important questions in the assessment are
whether they exist in a company, and in how far they are known to the
employees, and how consistently they are lived according to their experience.
2. Top Management/Leadership Do the top company managers live the mis-
sion, the vision and the values in an exemplary way and can they demand it
from the other employees as well? Have they earned the employees’ confidence
to facilitate a secure future for the company? Do they have an open ear for the
concerns of the employees; is their “know how” and “know what” appreciated?
Do the employees understand what important business matters specifically
mean for them, what they have to be prepared for? How well do the processes
in the company work, how well do the units/subunits cooperate with each other
(processes)?
3. Customers Do the employees consider themselves capable of being able to
solve the problems of the customers effectively and efficiently and to treat the
customers as appreciatively as they themselves would like to be treated as
customers? If this can be affirmed, the employees in turn emphatically antici-
pate the appreciation of their customers. The same can also happen when
dealing with the company’s suppliers and other groups involved.
4. Products (services) Are these a fair offer for the customers according to the
point of view of the employees? Can they look the customers in the eye when
selling or giving advice? Is the company fair? As with the question of the
customer relationships, the question or experience here is mainly, “Am I good
for someone or something?” “Can I do a good job for the customers?”
5. Competitiveness of the company Does the company provide the right prod-
ucts for the market? Is it forward-looking and innovative? Can it set standards?
Does it have a good reputation in the industry, i.e. do the competitors respect
the employees and the company? The clearer these questions can be affirmed,
the more confident the employees are regarding their future and the more
meaning they see in their commitment for the company.
6. Reputation Does the company have a good standing in the public? Do the
customers and the society believe that, according to its mission statement
(mission, vision, values), the company is good for someone or something? Is it
considered a “good citizen”, employees can commit to with conviction?
7. Shareholders Are the shareholders—always according to the employees’
perception—entrepreneurially minded, that is, do they have the ambition to
advance the company, or are they speculators whose sole interest is to suck out
its substance as quickly as possible? Much of this creates distinctly different
future and meaning perspectives of the employees and determines their com-
mitment and loyalty to the company.
8. Communication The primary task of internal communication is not the mass of
communicated content but ensuring the organization’s information channels
and information flow: it has to guarantee open and mutual exchange “top
down–bottom up”, as well as between the business units and functional areas.
92 H. Anker

Once this is the case, the communication partners will provide the relevant
information content themselves. This means that the communication execu-
tives’ duty is not gathering and disseminating information, but managing the
communication channels. Good communication fulfills two functions: through
the transmission of knowledge, it generates meaning, comprehensibility and
manageability. At the same time, it creates mutual appreciation between
employees and management and also between members of the various business
and functional units (meta level communication). Internal communication plays
a crucial role for the health and well being of the employees.
9. The employees and their immediate environment In this perspective, various
topics come up such as the management relationship with the direct supervisors
(communication of meaningfulness and appreciation), social integration (teams,
working groups), work organization, personnel management (compensation
and benefits, career planning, further training, work equipment), but the per-
sonal dispositions of the employees as well: in how far are they willing to take
responsibility for the larger whole? How do they rate their own initiative and
team spirit? How great is their personal work ethos, that is, to what extent are
they prepared from their inner impulse to go “the last mile”, so that they are
satisfied with their own work? How well are they able to deal with challenges
like failure and uncertainties? (Coping skills).
10. Commitment as the target value It is based on the self-assessment of the
employees with regard to three questions. One of them captures the degree of
emotional attachment to the company, another one asks directly for the com-
mitment to the company (pragmatic dimension), a third one focuses on the
employees’ attitude towards the subject of “professional work” in general
(work ethos, i.e. work as a social value). In the subsequent questionnaire, an
index of “commitment” was formed from the answers to these three questions
(the three variables were all of the same weight in the index).
In contrast to many other employee surveys, the Value Balance in Business®
also systematically includes the aspects of the mission, the vision, as well as the
internal and external values, the quality of the products, the quality of the customer
contacts, the intentions of the shareholders as well as the internal communication.
They are not only important with regard to the experience of meaning and appre-
ciation but also from the perspective of the health and wellbeing of the employees.
Like many other audit tools, the Value Balance in Business® also works with a
more or less predefined questionnaire (the nine perspectives). The evaluation,
however, is different for each company, which is another special feature of the
VBB. External benchmarking is therefore not possible; this would be a contra-
diction in terms of corporate culture: the culture of a company is what makes a
company incomparable, lends it a distinctive face, its own “personality”. External
benchmarking, on the other hand, leads to standardization (and to substitution
strategies) rather than to differentiation and self-determined development of the
company due to its own special potential. (On the other hand, the VBB permits
unlimited internal benchmarking between business units and subunits.)
5 On Diagnosis and Development … 93

5.2 The Value Balance in Business® in Practice—

A Concrete Case Study

5.2.1 On the Profile of the Audit

What the Value Balance in Business® does as an audit tool, is illustrated below with
reference to a case study. It is a company located in Switzerland’s economic capital
with almost 700 employees. It is the Swiss subsidiary of a globally operating IT
company. The audit took place in a very exciting phase: one year before, a company
unit was acquired from another company, and at the time of the audit itself the
integration of another company was imminent. Therefore, we will be dealing with
three business units (BU): BU 1 is the parent company, BU 2 is the unit that was
acquired in the previous year, and BU 3 denotes the business unit whose takeover
and integration was imminent at the time of the investigation.
The survey was aimed at all employees of BU 1, BU 2 and BU 3. It ran online
and was fully completed by 425 employees. The return rate was almost 65%—a
considerable figure for an average processing duration of 45 min.

5.2.2 A Cause-and-Effect Model—References to Starting

Points of the Development of a Company Culture

In a first step, the data were reduced by a factor analysis and condensed into factors.
A model with 10 factors proved to be the best solution in this case (see Table 5.1).
These 10 factors are based on 27 variables or interview questions; for them a
“grading” by the employees (on a scale from 1 to10) (see “Average value” in
Table 5.1) was available.
In the next step, these 10 factors were related to the dependent variable
“commitment/motivation” (see Fig. 5.1). Seven of the 10 factors have a directly
quantifiable effect on the commitment. With a declared variance of 63% their
influence is remarkable; this is an indication of the consistency and validity of the
VBB model for this special company. Factor 1 “appreciation as a person” has the
greatest effect on commitment followed by factor 2 “values” and factor 3 “cus-
tomers”. The strength of the impact of these factors is equally significant with their
leverage when defining and implementing measures to strengthen the commitment.
In this company satisfaction does not precede but follow commitment, and even
more: with every point that commitment increases, satisfaction even experiences an
increase of 1.13 points. From the perspective of a company culture based on
meaning and performance, this situation can be interpreted in such a way that the
employees are satisfied when they learn that they are “doing a good job”, i.e.
providing meaningful performance.
Consequently, satisfaction is not a prerequisite for the employees to do perform
well. In accordance with Viktor Frankl, feelings of happiness or satisfaction can
94 H. Anker

Table 5.1 Factors and their underlying variables Source Anker (2012)
Factor designation Mean Interview questions or key performance indicators (KPI)
value
factor
1. Appreciation as a 7.3 Respect of employees as real people
person Quality of the working environment
2. Values 8.7 Striving for trustworthiness among colleagues
Concern for the wellbeing of the colleagues
Environmental protection
3. Customers 7.9 Degree of the presence of customers and their needs with
the employees, even if they do not have direct customer
contact (self-assessment)
Assessment of the competitiveness of the company in the
industry
Value attitude with regard to customers
4. Market position 7.2 Company affiliation with the top companies regarding
the state of development of its products
Importance of belonging to a top company from the
employees’ perspective
Assessment of the reputation of the products in the home
market
5. Coping skills 7.9 Ability to bear insecurities
Coping with failures
6. Teamwork 8.2 I am a motivator
Teamwork above personal success
Attitude to teamwork
7. Company 7.5 Future prospects for the company
The mission thrillsa
Company perceived as leader in the industry
Proud of their company
8. Compensation 6.9 Satisfaction with company services
9. Team leadership 8.0 Employees’ opinions are asked by their superiors
Support for employees, especially in difficult situations
Loyalty to employees
Employees feel perceived as people
10. Innovative 8.5 Openness to innovation
inclination Willingness to take risks
a
A provisional mission statement was queried for test purposes; a real mission did not exist at the
time of the survey

result from meaningful action. For this reason, the VBB, in contrast to other
assessment instruments, does not focus on the satisfaction of employees, but on
their commitment.
There are two descriptions for these 10 factors: the degree of their effect on
commitment (Table 5.1) as well as the employees’ assessment of how well these
factors are met in the company. Thanks to these two dimensions, a conventional
four-field matrix can be formed (Fig. 5.2). On the ordinate axis, the degree of the
5 On Diagnosis and Development … 95

Specific example of a factor model of commitment

Commitment factors Magnitude of the impact of
commitment

1. Appreciation as people 0.27

2. Values 0.20
Explained variance = Explained variance =
63% 67%
3. Customers 0.12

4. Market position 0.06 Commitment Satisfaction

5. Coping skills 0.10

(r 2 = 63%) (r 2 = 67%)
6. Teamwork 0.08

7. Company (reputation) 0.07

8. Compensation
No direct, demonstrable
9. Team leadership
impact on commitment
10. Innovation

Fig. 5.1 Factor model of the survey in an IT company (n = 425). Legend: if the assessment of
factor 1 (“Appreciation as people”) rises by one point, the commitment increases by 0.27 points.
Source Anker (2012), by courtesy of Erich Schmidt publisher, Berlin

Commitment factors their impact and scoring by employees

Handling cultivating
Impact on commitment

Factor score
Low score High score

Fig. 5.2 Fourfold table: impact of the factors on commitment and their scoring. Source Anker
(2012), by courtesy of Erich Schmidt publisher, Berlin
96 H. Anker

effect of the factors on commitment is represented, whereas the x-axis shows the
assessment by the employees.
In a certain sense Fig. 5.2 reflects the “cultural landscape” of the company as
perceived and experienced by the employees. What holds people together in this
company are factor 2 “values”, factor 3 “customers” and factor 5 “coping skills” as
well as factor 6 “teamwork”. They form the core of the current corporate culture. It
can build on it.
The most critical factor is factor 1 “appreciation as a person”. This acts more
efficiently than all other factors on commitment, but at the same time it is more
critically assessed than the average of all factors—evidence of a clear deficit. It seems
sensible to continue to cultivate and optimize the performance factors 2, 3, 5 and 6.
However, an important key to greater commitment (and to more satisfaction) is also
provided by factor 1: it has the strongest leverage effect in terms of commitment.

5.2.3 The Distribution of Commitment in the Company

How commitment is spread in the company is shown in Fig. 5.3. On a scale from 1
to 10 the average performance in this company is at 8.3, the internal benchmark,
formed by the five units with the highest commitment, is 9.1. It is below average in
the central services (human resources, finance and controlling as well as legal
department). These are those units of the company, which were particularly chal-
lenged by the merger in the year preceding the survey and also by the imminent
merger.

Distribution of commitment by business unit and their subunits

10.0
internal
benchmark 9.0
Mean value
8.0

7.0

6.0
Degree of
5.0
commitment
4.0

3.0

2.0

1.0
l

al

B 1 / bu i t 1
/S u 2
un 3

B 2 / u bu i t 1
B 2 / u bu i t 2
B 2 / ub u i t 3

/S u 5
un 6
7

B / bu t 1
B 3 / u bu i t 2
B 3 / ub u i t 3

B 3 / u bu i t 5
B 3 / u bu i t 6

3 S u uni 7
/S b t8
u n it 9
10
it (BU )
(B 2)
3)
ve

B 2 / u bu i t 4

B 3 / u bu i t 4
al

un 2 U 1
eg

1 u b it
ub n i t

2 u b it
u b ni t
it

B 3 u b ni t
it
er

Fi

i
U

it
U S n
U S n

U S n
U S n
U S n

U S n

U S n
U S n
U S n

U S n
U S n

ub u n
U S n

U S n
B
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ov

B / bu

B 2 / u bu

B / bu
p

es n (
ce
To

in s u it 1

u
u

u
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ny

U S

U S

U S

U S
an

s t i
pa

us s n

B /

B 2/

B /

U /
in

B ine u

1
1

3
3
3
om

/F

U
us s
R

B
B ine
C

us
B

Fig. 5.3 Distribution of commitment in the company (n = 425). Source Anker (2012), by
courtesy of Erich Schmidt publisher
5 On Diagnosis and Development … 97

Differences in the scoring of factors by business units

Negative deviation from mean value Positive deviation from mean value
-0.60 -0.40 -0.20 0.00 0.20 0.40 0.60

Motivation
Satisfaction
1. Recognition as an individual (0.27)
2. Societal values (0.20)
3. Customers (0.12)
5. Coping skills (0.10)
6. Teamwork (0.08)
7. Company (reputation) (0.07)
4. Market position (0.06)
8. Compensation (0.00)
9. Team leadership (0.00)
10. Innovation (0.00)

Business unit 1 Business unit 2 Business unit 3

Fig. 5.4 Differences between the business units with regard to the scoring of the individual
factors of commitment, expressed in deviation from the mean value of the company (n = 425).
Bars to the right show positive deviation from the mean value, bars to the left refer to negative
deviation from the mean value of the company. Source Anker (2012), by courtesy of Erich
Schmidt publisher

Further, it is shown: In the parent company (BU 1) the commitment is above

average, in UE 2—the business unit, which was integrated a year before—statis-
tically significantly lower. This also applies to most of the subunits of BU 2. This
suggests that the integration of BU 2 staff has not yet been successful. At BU 3, the
situation is somewhat different: the parent company—the new employer—has an
excellent reputation in the industry, among others due to its leadership culture, and
the new employees are looking forward to the change.
In the following diagram (Fig. 5.4), the 10 factors for the three business units are
broken down separately. This will show us, among other things, where the problem
lies in the integration of BU 2. At the zero point (0.00), the average value of all the
factors determined for the entire company is shown. From the zero point (0.00) to
the right pointing bars indicate that the corresponding factor in the concerned
business unit is above average in comparison to the overall company. For example,
in BU 1 (in the parent company), the commitment is significantly higher than
the average commitment in the company as a whole. Bars which are offset from the
zero point (0.00) to the left indicate that the corresponding business unit has a value
with respect to the factor concerned, which is below the company average. For
example, the commitment in BU 2 significantly points in the negative direction: it is
clearly below that of BU 1.
98 H. Anker

Why this is so can be seen immediately: parallel to the commitment of BU 2,

there are clear deviations to the left for factor 1 “appreciation as people” as well as
for factor 7 “company”, which means the reputation of the company. Obviously the
employees of BU 2 have not yet arrived properly in their “new home”—factor 1
shows clearly the fact that they feel little valued as humans and that they hardly
appreciate their new employer or his reputation (factor 7). At the same time,
however, factor 8 (“compensation”) implies that the integration, which has not been
successful so far, is not a question of remuneration. In this respect, the employees
assess their new employer even more positively than the employees of BU 1 and
BU 3.
An in-depth analysis led to the following: as the employees of BU 2 see it, the
poor reputation of the company (factor 7) is a direct consequence of the lack of
appreciation according to factor 1. For the same reason, the employees of BU 2 also
critically evaluate the customer orientation of their new employer (factor 3 “cus-
tomers”). The problem was aggravated by a lack of team spirit according to factor 6
(which was not considered important by the former employer) and comparatively
weak coping skills according to factor 5 (dealing with uncertainties and failures).
A weak team structure obviously makes it difficult to deal constructively with
uncertainties and failures. Conversely, this means: “Shared suffering is half the
pain.” It seems to be easier to deal with uncertainties and failure when one feels
supported by a team than when one is a lone fighter. This clearly illustrates the
importance of the sociocultural Sense of Coherence (SOC) for the individual SOC
(and the damage that can be caused by individual incentive systems).
The deficit of personal appreciation of the staff of BU 2 can be explained with
the experience, that the new employer did not consider them for promotion.
Another reason was that no one from their ranks was in the upper management of
the parent company. They also felt left out in this respect and believed not to have a
voice in the company management. Consequently, the company management
entered into an intensive dialogue with those concerned, the human resources
department revised their training and promotion system, and very soon BU 2 was
also involved in management through a committee member.

5.2.4 The Value Balance in Business® Reveals

a “Clash of Cultures”

Behind the unsatisfying integration of BU 2 an even deeper and more profound

problem was hidden.
The employees of BU 2 came from a company with an extremely shareholder-
and short-term profit-oriented culture with rigid structures. They were managed
authoritatively; self-initiative and teamwork were not popular. Their scope of action
in the sense of manageability was very limited, as was the component of com-
prehensibility. These circumstances are also of little help to the component of
meaningfulness. In the new headquarters, on the other hand, a culture of
5 On Diagnosis and Development … 99

self-initiative, non-bureaucratic, self-responsible cooperation and team spirit had

already been established for a very long time. The motto was “help yourself!” This
led to disastrous misunderstandings. As the new staff of BU 2 was accustomed to an
authoritative culture, they were waiting for instructions from “above” and from their
new team colleagues from the headquarters. However, there nobody understood
what the new colleagues were waiting for. The BU 2 employees were increasingly
marginalized, and consequently, hardly anybody from their ranks was promoted.
Ultimately, the frustration of the BU 2 staff and their associated lack of com-
mitment have to be understood against the background of the clash between these
two opposing cultures. A mentoring and coaching system was set up following
these findings. This allowed the employees of BU 2 to freely communicate with
colleagues from UE 1 and, if necessary, get advice from them. Thanks to these
contacts, the understanding of BU 1 employees for their new colleagues also grew,
and the situation relaxed.
This study allows all 10 factors to be analyzed down to the team level (see
Fig. 5.5). It turned out that even in BU 2 there were clear differences in
team-to-team commitment—not all units of BU 2 were in a real crisis. This allowed
the forces to be deployed in the first place where something had to be done
urgently, that is to bundle the energies and to use them in a focused manner—and
thus also economically.

Business unit 2: Differences in the scoring of the 10 factors by

business subunits (length of bars: degree of deviation from the
company average)

Fig. 5.5 The subunits of BU 2 and their respective degree of commitment (n = 107). Source
Anker (2012), by courtesy of Erich Schmidt publisher
100 H. Anker

In this study, for example, the situation of subunit 5 of BU 2 stands out: com-
mitment was the lowest of all business units and subunits. It is immediately
apparent: the main problem was the appreciation as people (factor 1). This resulted
in the well-known negative attitude to the company (factor 7) and to its benefit for
the customers (factor 3). This was a general phenomenon in business unit 2. The
special thing about this team, however, was that it took together with its team leader
a hedgehog position against the rest of the company. The company management
and the HR department were very careful around this team. The team leader ulti-
mately decided to leave the company; the other members slowly built up confidence
in the company following the personal attention they had experienced.
Another example: the resolution of the survey down to team level revealed an
acute bullying problem in subunit 3: the anonymous survey allowed the team
members to express themselves freely, that is, without control by the team leader.
The survey resulted in a very rapid intervention and a change of the head of this
team.

5.2.5 Facets of a Cluster Analysis Based on Personality

Traits of the Employees

The VBB survey also includes questions about the personal attitudes of the
employees, their attitude towards work itself, the degree of self-responsibility, their
general performance orientation, their team orientation and willingness to cooper-
ate, etc. On the basis of the answers given by employees on such questions, they
were put in groups with the same or similar characteristics (clusters).
In this case (Fig. 5.6), five groups were defined. Almost a quarter of all
employees have a very close relationship with the company and a much
above-average level of commitment. Another eighth of the employees show a
similarly high level of commitment, but these employees are worried about the
company’s future. They are skeptical to pessimistic. They are people who need
special attention and appreciation; this is how they feel grounded; if left alone, they
are particularly prone to burnout.
Another good quarter of the workforce also consider other things important in
life. The company is not their center of life, and therefore, they do not have any
career plans, but they are grateful to the company for the freedoms it provides in
shaping their lives—they feel themselves to be taken seriously, valued and con-
nected with the company.
An interesting case is the 14% of employees with frustrated career expectations.
An above-average amount of employees of this group is characterized by a high
level of self-initiative and sense of responsibility—their merely average commit-
ment is a strange contrast. Investigations showed interesting results: many members
of this group were once team leaders and thus formed the company’s bottom
management. In order to reduce costs, this lowest (and widest) hierarchical level
5 On Diagnosis and Development … 101

Grouping of employees by level of commitment and attitude toward

the company (cluster analysis)

Below average
degree of
commitment
22% Above
average
degree of
commitment
37%

Average degree of commitment 41%

Fig. 5.6 Grouping of employees according to their psychological disposition (n = 425). Source
Anker (2012), by courtesy of Erich Schmidt publisher

was cancelled two years before the Value Balance in Business® assessment, and the
corresponding employees were downgraded. From the point of view of human
appreciation, this was a hard blow for those affected. Evidently, many had not yet
overcome this after two years—see commitment.
A fifth of all employees are completely alienated from the company: they neither
feel appreciated as human beings, nor do they know why they are in this company,
that is, what meaning their work has. Here, on the basis of the cluster analysis, we
encounter the same phenomenon, which the factor analysis has already shown with
regard to the employees of BU 2. This estrangement is accentuated by the fact that a
good two-thirds of these employees state that professional work is of great
importance in their lives. For them, today’s situation is highly stressful from the
viewpoint of meaning and appreciation or from the point of view of the SOC
components of meaningfulness, comprehensibility and manageability, and, with
regard to salutogenesis, their health is therefore particularly threatened.
These five groups of employees can again be represented according to functional
areas and business units (Fig. 5.7).
The line “total” contains the grouping already described in Fig. 5.6. If we take a
look at the three business units, the picture of the previous analysis is confirmed: the
highest proportion of alienated employees (34%) is found in BU 2. Another result:
every eighth manager (17%) feels alienated from the company—from the point of
view of the multiplier effect of the superiors, this is a fact that cannot be overlooked.
102 H. Anker

Composition of business units, function groups, and managers/

employees by five clusters

Fig. 5.7 The five groups of employees, divided according to business units and functional groups
(n = 425). Source Anker (2012), by courtesy of Erich Schmidt publisher

Similarly, the fact that in the marketing and sales units—the company’s face to the
customers—more than 40% of the employees are critical or very critical of the
company: 20% belong to the group of alienated employees, 22% are those who
have been degraded from team leaders to non-executive employees.
Above information provides some insight into what the Value Balance in
Business® does as an audit and assessment, or diagnostic and development tool.
Based on the results of this study, an action plan was developed with the HR
managers of the company. In its development and implementation, the company
management as well as experts from the areas of HR, management training,
company, personnel and organizational development were included. We have
pointed out a few measures.
The example of a merger, briefly presented here, shows, among other things,
how closely the commitment of the employees and thus the performance capacity of
the company are connected with the culture of the company, and how important it is
to keep this issue in mind—in the interest of the people and companies, their
well-being, health and success.
Good, respectful and responsible entrepreneurship towards customers, employ-
ees, shareholders, society and the natural environment is a basic but specific health
factor that constitutes a reliable way to long-lasting high profit.
• Success and ethics do not exclude each other; on the contrary, in the long run
they are mutually dependent factors. Only healthy people i.e. employees
experiencing meaning and personal appreciation make flourishing enterprises.
5 On Diagnosis and Development … 103

Reference

Anker H (2012) Ko-Evolution versus Eigennützigkeit. Creating Shared Value mit der Balanced
Valuecard®. Erich Schmidt, Berlin
 Part II
The Working People and Their Resources
Chapter 6
The Working Human—The Exhausted
Human

Ingrid Pirker-Binder

Contents

6.1 Life-Script-Analysis—An Existential Reminiscence on Life ........................................... 109

6.2 The Process Model of Life-Script-Analysis...................................................................... 111
6.2.1 Step 1: Question of “What Is” and the Desire for Change and Information ....... 113
6.2.2 Step 2: Contemplation Process .............................................................................. 114
6.2.3 Step 3: Recognize the Individual Basic Pattern of Thinking, Feeling and Acting 115
6.2.4 Step 4: Opening-Up Personal Freedom and Recognizing the Possibilities
for Shaping One’s Life........................................................................................... 116
6.2.5 Step 5: Personal Development (ASTI) .................................................................. 116
6.3 Suitable Work: Work and Life in Flow............................................................................ 117
References .................................................................................................................................. 123

People do not resist change; they resist being changed (Peter Senge).
The real voyage of discovery consists not in seeking new lands but seeing with
new eyes (Marcel Proust).
Nowadays working life and life itself are often seen as two different terms. The
term “Work-Life Balance” is considered a keyword suggesting that it is only about
the right balance between work and life. However, completely disregarded is the
fact that life takes place twenty-four hours every day with a mere change in the
distribution of tasks. This means that individual thought patterns and attitudes not
only characterize the private everyday life, but also the lifetime spent at work and
with work.
In the popular imagination, there is the world of work and on the other hand the
private world, the personal life where the “I” can be lived, where people are there
for themselves, pursue their hobbies, maintain relationships.
But as attitudes, intrapersonal conflicts, thought and behavior patterns are con-
stant companions of a person, any active preventive measure of a fatigue syndrome

I. Pirker-Binder (&)
Saileräckergasse 43/26, 1190 Vienna, Austria
e-mail: offi[email protected]

© Springer International Publishing AG 2017 107

I. Pirker-Binder (ed.), Mindful Prevention of Burnout in Workplace Health
Management, https://doi.org/10.1007/978-3-319-61337-6_6
108 I. Pirker-Binder

at the workplace, and also its therapeutic treatment, has to incorporate the life story
of the person concerned, his/her desires and needs, striving for meaning and his/her
values.
Work takes place at the workplace in a mutual relationship pattern between
board members and executives, executives and employees and between employees.
If the workplace is not in the company, but in other places, such as a Home Office
space, the interaction pattern is extended to the respective structure of the work-
place at the respective location.
Often there are disparities or misunderstandings that lead to problems in work
life. Misunderstandings that cause depletion and drain of human resources (physical
and mental exhaustion), may be manifold, such as:
• misunderstandings between corporate culture and aspect of meaning or visions
of the employees
• disparities in interaction (management styles, organizational processes and
structures)
• disparities and misunderstandings in work allocation, work management and in
conception of work
• disparities and misunderstandings at the workplace (e.g. as non-compliance with
rest periods of shift workers who do not work in the company itself, but at other
places; workplaces abroad)
• emotional misunderstanding at the workplace (conflicts, bullying, crises)
• disparities in the design of workplace and location (open-plan offices, noise, lack
of separation in the home office, etc.)
The working people, no matter whether they are employees or executives, are
involved in the work world with their needs, attitudes and visions, whereby
exhaustion may result depending on intrapersonal characteristics, thought patterns,
attitudes, personality patterns and disorders, fears, prejudices, etc. An example for
this is exaggerated sense of duty or striving for perfection. In this case the pre-
vailing thought would be, “First comes my duty, and only if everything is done and/
or perfect, may I take time for myself, is my work finished or can I relax.”
Unfortunately, the desk never becomes empty, and even the housework is a per-
petuum mobile. Anyone who operates a home office is particularly at risk in this
respect.
This suggests that fatigue may result both from
• misunderstandings and disparities that are directly related to the company and/or
the executives, but also from
• the life history and characteristics of the individuals themselves
• or from both aforementioned areas.
While in Chap. 5 the entrepreneurial aspect was examined in terms of exhaus-
tion and prevention options, the focus is now on the question of what mechanisms
act within and on people and can, if they are not changed, lead to a deterioration of
psychological, physiological and mental vitality. To capture the individual
6 The Working Human—The Exhausted Human 109

mechanisms and areas that can lead to exhaustion, it is useful to consider various
aspects, which are listed here as follows:
1. Dimension psyche: the model of Life-Script-Analysis
2. Dimension work: the model of Work-Life-Analysis
3. Dimension physicality (energy, physical performance): the model of
Life-Energy-Analysis
4. Spiritual dimension: knowledge and change potential

Ad 1: Dimension Psyche So as to understand one’s own life landscape, I have

developed the Life-Script-Analysis model as an existential analysis of life. In a
structured process a close look can be taken at the gateway to understanding causes
and effects, the unconscious and subconscious life script, and in a further step the
scope for personal reaction and change options can be opened.
Ad 2: Dimension Work In the working environment the psychological connection
between life and work has to be scrutinized. As a guide to research this aspect I
have created the Work-Life-Analysis.
Ad 3: Physicality As a connection and bridge between psyche, body and mind,
Life-Energy-Analysis is a great tool. It promotes understanding between uncon-
scious and conscious experience. Biofeedback methods are used as development
tools in this context.
Ad 4: Spiritual Dimension Existential analysis and logotherapy according to
Frankl sees humans as acting beings that, due to their spiritual (noetic) dimension,
are able to reflect upon themselves and change attitudes and behavior, if necessary
and useful. However, long-term changes can only happen if recognition of the need
or opportunity and the will to do so exist.

6.1 Life-Script-Analysis—An Existential Reminiscence

on Life

In the model of the Life-Script-Analysis (LSA) anything inherited, acquired,

learned, experienced and lived is brought into consciousness, observed and ana-
lyzed, and insights are generated. From these findings, experiences and thought
patterns, attitudes, desires, visions, needs, positive and negative dispositions of
humans can be learned and discussed. It is essential to recognize that all experiences
a person gathers in the course of his/her life are stored mentally, physically,
emotionally and on a cellular level, and represent a “script” for the present life.
If a human does not live what he/she is, but rather what he/she believes should or
has to be done in his/her life script, an inner negative tension is built up. This
tension produces constant internal activation, which drains power and energy.
110 I. Pirker-Binder

Fig. 6.1 Four formative

worlds of experiences
(Life-Script-Analysis)

Activation that persists too long, exploits the resources, and results in an exhaustion
process.
The life experiences and dispositions are situated in the life script. The indi-
vidual stages of the disposition can be summarized as IALEL
• Inherited
• Acquired
• Learned and Experienced
• Lived
The Life-Script-Analysis (LSA) helps to uncover content from the four areas and
to look out for change options (Fig. 6.1).
Prevention is not only about imparting coping mechanisms, but also primarily
about creating an understanding of why nothing is done about psychological stress
and strain at an early stage or why humans do not confront smoldering problems
sooner.
The explanation is that the affected individual does not even recognize his/her
possibilities for action. He/she is more or less caught up and squeezed into his/her
life story and unaware of the shaping influence of the world of experiences. Only
once the individual life landscape has been unraveled and is clearly visible, is it
possible to learn new, adapted action mechanisms. In this case they are formed from
the inner understanding of the respective person, otherwise they would merely be
imposed.
This suggests that before any preventive measure, clarification and under-
standing processes have to happen inasmuch as the beliefs, mental obstacles, ways
of thinking, emotions, tensions and relationship patterns which influence life, and
particularly work life, negatively, have to be made visible, tangible and perceptible.
The story of the frog and hot the water by Charles Hardy, which is retold below,
illustrates how calls for action are often not noticed.
The Frog and the Hot Water
It came to pass that an old man was sitting in front of his house on the lakeshore,
thinking about life. A frog on the shore drew his attention. He caught it and brought
it into his hut. Once there, he threw it into a pot of boiling water. The startled frog
leaped out of the pot in a shock and disappeared. After a while the old man was
6 The Working Human—The Exhausted Human 111

sitting in front of his house again musing about life. Suddenly he remembered the
frog that spontaneously saved itself from the hot water in the pot to enjoy life again.
Once more a small frog caught the man’s attention, and again he took it back into
his hut. As he did not have any boiling water on the stove, he put the frog into a pot
of cold water and set it on the hotplate. Then he made a fire. The frog did not move
to get out of it and kept sitting quietly. The frog did not even make a move to escape
this threatening situation when the water was getting hotter. The old man was very
pleased and enjoyed his frog soup, while he continued thinking about life.
The story of the frog and the hot water can lead people to the conclusion that it
makes sense to sensitize one’s individual perception in thinking, feeling and acting
to be able to counteract negative influences as soon as possible and to become
aware of the free space for an array of choices.
As an example I would like to mention the computer workstation. Stress-related
distorted postures are not only connected with non-ergonomic office chairs or
tables, but much rather with how the employees use them. A tense posture sooner
or later leads to pain with or without an appropriate chair. If the person concerned
knows about the relationship (posture and pain) and he/she can get in touch with
himself/herself well, he/she is able to notice physical strain early on and respond
adequately to it; that is, he/she has a decision space, i.e. “do I keep sitting on my
chair this way and accept pain or do I change my position.”
The Computer Screen
In many offices, the computer screen is adjusted incorrectly. Mostly it is vertical and
the user virtually has to bend unnaturally, especially in the neck, in order to see
properly. The problem: nobody notices it even though the solution is quite simple:
as soon as pain occurs, one has either been sitting in a cramped and concentrated
position in front of the screen for too long and/or the screen is too vertical.
Do a test: bring a book in the same position as your computer screen—would
you read like this?
The Life-Script-Analysis, which I have developed from my logotherapeutic
work, should lead to an increased awareness, and aims at opening up free space for
knowledge and decisions to facilitate development and possibilities for change. It
serves as a tool for personal development and as an intervention measure for
psychological exhaustion.

6.2 The Process Model of Life-Script-Analysis

An analysis of individual life characteristics, a person’s life script, the pattern a

person thinks, feels and acts in, permits an understanding of the relationships and
enables self-knowledge. Only understanding and feeling how internal tension or a
negative belief are formed and what they do, can build a link to freedom and opens
the door for possibilities to change (Fig. 6.2).
112 I. Pirker-Binder

Fig. 6.2 Opening-up of future possibilities to shape life and work (Pirker-Binder)

The spotlight of analysis includes the past and reaches into the present. The four
worlds of experience are considered and checked for exhaustion promoting content.
Through the freedom in the spiritual dimension (Chap. 3) a vision of the new, the
healthy, the things worth living for, grows and can be designed from the present
moment and projected into the future. The Life-Script-, Work-Script-, and the
Life-Energy-Analysis provide clues and methods for that.
The fundamental principle for this opening of one’s free space is looking at the
links and mutual influence of psychological experiences and concepts on the
physicality. From the dimension of the mind (noetic dimension) the spotlight is
directed towards it, which enables knowledge. Out of the neutral, value-free dis-
tance can the recognition of one’s personal freedom for decisions to strengthen
one’s desire for change develop (Fig. 6.3).
The process is divided into five steps:
1. question of “what is”
2. contemplation of the process
3. recognizing the individual basic pattern
4. opening-up of personal freedom and recognizing the possibilities for shaping
one’s life
5. personal development
6 The Working Human—The Exhausted Human 113

Fig. 6.3 Dissociation

potential due to dimension of
the mind (Pirker-Binder)

6.2.1 Step 1: Question of “What Is” and the Desire

for Change and Information

Humans come into my private practice with a desire for change. The first question
may be, “Why are you here today?” It is about the “actual state analysis” of the
current mental state. The second question will be: “What do you want to achieve,
what is your aim?”
After analyzing the condition, the client receives information about biological
and psychological interrelations of an exhaustion process. They form the starting
point of the Life-Script-Analysis with the explanatory model on the three factors of
influence on a successful life (body, psyche, spiritual dimension) from the per-
spective of existential analysis and logotherapy. They provide an explanation for
the subsequent reminiscence of life.
In a first step, the correlations and interactions between soma and psyche are
explained, as well as the possibility of free decision in the spiritual (noetic) dimension,
114 I. Pirker-Binder

Table 6.1 Explanatory model: factors of influence on life and work in flow (Pirker-Binder)
Body Autonomous nervous system I sense: Energy
(regulation, regeneration): Nervous management
Cell muscles/physical condition system
cardiovascular system Hormonal
system
Immune
system
Psyche Emotions/emotional life I feel: Emotion
thinking Affect management
situation
Mental processes I think: Thought
Mental management
concepts
Mind Personal freedom for decisions I design: Attitude
My management
philosophy of Living and
life working in flow
My spirituality
My mindfulness
My connectedness

which empowers humans to be acting beings. The person must realize what he/she has
let others do to himself/herself or what he/she has done to himself/herself.
Most of what we see is shaped by our impressions, our history, our baggage, our pre-
conceptions. We can’t see people as they really are because we’re too busy reacting to our
own internal experiences of what they evoke in us, so we rarely actually relate to reality.
We mostly relate to internal remembrances of our own history, stimulated and evoked by
whatever is externally before us (Jaworski 1998)

From the explanatory model the following three aspects can be used for sub-
sequent personality development: knowledge acquisition and opening of creative
space takes place under the spotlight of the interactions in these three fields
• attitude management—spiritual dimension
• emotion, thought management—psyche, thinking
• energy management—body
The recovered information opens up a new room for available options
(Table 6.1).

6.2.2 Step 2: Contemplation Process

Through the steps of the Life-Script-Analysis the unconscious and subconscious

interactions between the three aspects are brought into consciousness in the spot-
light of the spiritual dimension, the distancing and the freedom of decision. The aim
6 The Working Human—The Exhausted Human 115

of the contemplation process is to record, recognize, process, let go or fit into the

life story obstacles, resistances, traumas or freely accepted loads and sorrows. For
illustration, I would like to present the story of the hiker by Nossrat Peseschkian.
The Hiker
In Persian mysticism there is a story of a hiker who was walking painfully along a
seemingly endless road. He was hung all over with different loads. Groaning and
moaning he was moving forward step by step, complaining about his hard fate and
agonizing fatigue. Trudging along he met a farmer in the glowing midday heat, who
asked him, “Tired hiker, why do you load yourself with these rocks?”—“Too bad,”
answered the hiker, “but I have not noticed them yet.” At that he threw the chunks
of rock away and felt much lighter. After a long distance, another farmer approa-
ched him, who inquired, “Say, tired hiker, why are you lugging around a half-rotten
pumpkin on your head and are dragging such heavy iron weights on chains?” The
hiker replied, “I am glad that you’ve made me aware of it; I had no idea, what I was
doing to myself”. He shed the chains and smashed the pumpkin in the ditch. Again
he felt lighter. But the farther he went, the more he began to suffer again. A farmer,
who was coming from the field, looked at the hiker, amazed, “Good man, you are
carrying sand in your backpack, but what you see in the distance, is more sand than
you could ever carry. And how big your water container is—as if you wanted to
cross the Kawir desert. Beside you a clear river flows, which will accompany your
way for a long distance!”—“Thanks to you, dear farmer, now I see what I have
been lugging around with me.” With these words, the hiker tore open the water
container, its brackish water trickling away on the path, and filled a pothole with the
sand from the backpack. He looked down at him, saw the heavy millstone on his
hand and suddenly realized that it was the stone that still let him walk with a
stoop. He untied it and threw it as far as he could down into the river. Free from all
his loads he wandered through the cool evening to look for lodging (Peseschkian
2003, p. 56. By courtesy of Herder Publishing House).

6.2.3 Step 3: Recognize the Individual Basic Pattern

of Thinking, Feeling and Acting

By recognizing the basic patterns of the past, present actions can be understood
better. In the Now, it is possible to create a new future of thinking, feeling and
acting (Table 6.2).
116 I. Pirker-Binder

Table 6.2 The four Life-Script-Analysis steps (Pirker-Binder)

Inherited Disposition in DNA Cell Prenatal, “What I inherited
structure antepartum, from my ancestors”
peripartum,
postpartum
Acquired Conditioning from Parents Until about “What was
the environment 7 years, role demonstrated to me”
models, sensed
life
Learned Conditioning through Parents, 7 years until now “What my
and social interactions school, peer Learning new environment taught
experienced groups ways of behavior me”
and thinking
Lived Feeling, thinking and Everyday Everyday life “How I design and
acting according to work and live my private and
points 1–3 private life work life”
Intuition (conscience) “What life means for me”
Meta-life plan and master plan
Life in harmony with the individual purpose
Quality of life

6.2.4 Step 4: Opening-Up Personal Freedom

and Recognizing the Possibilities for Shaping
One’s Life

Through existential reminiscence on life a recognition and understanding of the

individual life landscape is created.
Thinking, feeling and acting become visible. The distance of the noetic
dimension facilitates grasping the freedom of one’s possibilities for shaping life.
Thereby stepping towards future transformation and reorganization is facilitated.
All freedom has a “What from” and “What for”:
“what” humans can be free “from” is being driven.
The I is free from the It; but “what” humans are free “for”, is being responsible.
So, the freedom of the human will is freedom “from” being driven “to” being
responsible, to having a conscience (Frankl 2004, p. 39).

6.2.5 Step 5: Personal Development (ASTI)

By recognizing the individual freedom strategies and alternatives one’s actions can
be initiated and directed towards the change objective. This results in two work
approaches:
6 The Working Human—The Exhausted Human 117

• individual visions and goals: originate in the life script ASTI

• individual goals in terms of the relationship to others, embedded in the work
context
Individual goals in terms of the relationship to others refer to the ASTI process
(Chap. 3). This does not only involve the individual, but also the respective group,
the team, the individual is embedded in. Development steps are:
• awareness and respect towards oneself and others
• social thinking: working on the “you”—and “us” feeling
• tolerance: dropping (pre-) conceptions and judgment of others
• intuition: trusting one’s feelings, perceiving and noticing somatic markers.

6.3 Suitable Work: Work and Life in Flow

Basic patterns of thinking, feeling and acting accompany humans in their private
and professional environment. Based on the experience of work the affected person
explores his/her understanding of work, work experience, interactions and emotions
at work with the aim of experiencing working time as lifetime, as realization of
meaning, away from “being driven”. This can best be considered living and
working in flow.
• understanding that working time means lifetime. Work is part of life, it should
not be seen as removed from life, in the sense of “let’s work fast so that there is
time for life afterwards.” One may also live during work!

Ms. Y is a teacher; she loves her job. She comes to my practice because she feels
“exhausted”, and also in the summer months, the feeling of being under stress seems to
persist – it’s the stress of having to recover quickly. So far she has lived to the motto: school
time is working time and during the summer holidays I recover. Unfortunately, this way of
thinking does not work indefinitely, i.e. only until the resources are running in reserve
power. Then one can feel that recovery no longer works. Ms. Y did not know what exactly
recovery might be for her; she says that for her quietly sitting in a deckchair in the garden
does not work, as she is permanently under pressure of having to recover.
Through analyzing her life script and in particular her relationship to her very difficult and
demanding mother, she gets to know herself and her inner drives and her needs. She begins
to understand and comprehend that during the school year she constantly puts herself under
pressure by subordinating her needs to the wishes of others. Both, colleagues and the family
exploit her helpfulness. As a result, she learns to distance and re-orientate herself.
The result: at the end of the next school year she is neither exhausted nor frustrated. She
has learned, that even during working time she may live; she has learned to distance herself
and has thereby gained a new quality of life. She has de-cluttered her judgments and
attitudes, has added new perspectives and ways of thinking and learned to listen to and trust
her inner voice.

• suitable work: work that corresponds to the skills and competencies of people
• a suitable workplace: design options and control of and at one’s workplace
118 I. Pirker-Binder

• working in flow presupposes the meaning aspect of work (see below quote:
Frankl 2004, p. 84)
• working in flow demands being mindful and present in the now: in harmony
with oneself and with one’s goals and visions = the individual perspective of
life
• working in flow in relation to the work context means: being attentive, present
with concentrated composure in the now: at a suitable work place with adequate
conditions and culture, a pleasant environment etc. = the individual perspective
of working
• working in flow in terms of social context means: being embedded in the
interactions at work, in a collective “Us” = corresponds to the WAVE process
(Chap. 3).
… humans are not interested in any inner states, be it lust, inner balance, but they are
oriented towards the world, the outside world, and within the world they seek meaning that
they strive to find, or another human whom they could love. And due to a pre-reflective
ontological self-image, they also know somehow that they fulfill themselves to the extent in
which they forget themselves, and they forget themselves again exactly to the extent that
they surrender, surrender to a cause they serve, or a person they love (Frankl 2004, p. 84).

Living and working in flow means meaningful living and working. Frankl
coined the concept of self-transcendence (Frankl 1990) as a way of meaningful
fulfillment. This means directing one’s doing and acting towards something that is
not the individual himself/herself; e.g. not regarding work as a means to more
money or success, but as a process that creates meaning through action. Success or
more money may be the resulting reward, but is not an end in itself.
Only tasks, one is willing and able to devote oneself to, have the motivational, meaningful
character that stabilizes and keeps under self-control an individual’s life as well as living
together… we, too, need to learn; everyone for himself or herself; learning “to stand above
it all” – things and judgments of others, and doing things for their own sake. The
decision-making body determining what is correct and “the real thing” for us, what we can
justify can only lie within ourselves and not at the discretion of the environment
(Böckmann 1981, pp. 62, 58).

In the experience of work it is important what the person does in life, with
others, or what he/she experiences. Böckmann regards as life success “the sum of
all meaningful situations in life.” Accordingly, professional activity leads to pro-
fessional success through one’s inner calling (Böckmann 1981, p. 142, 1984).
Böckmann speaks of “performance drive as an expression of mental health, while
eagerness to succeed represents an expression of distrust against oneself: its trauma
is the fear of failure” (Böckmann 1981, p. 94).
According to Frankl success cannot be forced, it rather has to arise from
self-determination and personal responsibility. People should not predicate their
success on particular situations, it rather arises from realization of meaning and
values. Success stems from meaningful actions, expressed by performance
(Böckmann 1981, pp. 85, 114).
6 The Working Human—The Exhausted Human 119

If the realization of meaning is the realization of values, what categories can

values be divided into in terms of work?
Frankl assigns three areas to values as motivation for living:
• creative values: contain active, productive activity and creation
• experience levels: the experience of life
• attitudinal values: opinion on something, on life, on oneself (Riedel et al.
2002)
The value system of work according to Böckmann (1981, p. 65):
• creative values: develop, organize, improve, plan, design, and produce
• experience values are divided into
– socially bound experience values; they refer to the relationship, role, status
within a group
– socially unbound experience values; artistic values
• attitudinal values: attitude to life, to work itself, human image, dedication to
something.
If realization of meaning exists in the three value areas, they relate to each other.
Then, basically, the person experiences himself/herself as being in the right
workplace. He/she is at the right place and the work corresponds to his/her abilities
and skills, i.e. the conditions for work in flow are given.
If the individual loses himself/herself in ambitious pursuit for more (more
money, more power) and all happiness depends on it, he/she loses himself/herself
and also his/her life. Tolstoy’s story of Pachom, the farmer, should be a warning for
us in this respect.
How Much Land Does a Person Need?
Pachom, the farmer, buys a piece of land and becomes a landowner. He is “proud
and happy”. But his sense of ownership is now awakened. He becomes hostile to
his neighbors because of minor damage to crops they cause along the field
boundaries. Also, things are stolen from him. He cannot catch the thief; his charge
is dismissed. Now Pachom is quarrelling with the judges and the neighbors. The
farmers threatened him with the red rooster. So, even though Pachom has enough
space on his land, he feels crowded in the community. Eastward, further inland,
good land is supposed to be on sale cheaply. After verifying this rumor, he sells his
property and settles four hundred versts located east of the Volga. Now Pachom
lives ten times better than before. But there are richer farmers than him. In the urge
to grow, he also falls out with his neighbors here. Then he hears from a passing
120 I. Pirker-Binder

merchant that one could cheaply buy good steppe country from the Bashkirs, even
further to the east. With his servant Pachom travels five hundred versts to the steppe
dwellers. He is given a friendly welcome in their camp and is allowed to buy as
much land as he can circle on foot from sunrise to sunset. However, when assessing
his future property, Pachom overestimates his powers. He collapses and dies from
exhaustion, after having circled a tremendous piece of land, because towards the
end, during sunset, he was running desperately. “The servant took the hoe and dug a
grave for Pachom, just as long as the piece of earth, which he covered with his
body, from top to toe, - six cubits - and buried him” (Tolstoy, retold on Wikipedia
2015).
Csikszentmihalyi (2000, p. 72 ff.) describes flow as flowing, as recognizing that
humans are continuously flowing. The purpose of this flow is to stay flowing and
not seek highlights or utopian goals, but to stay in the flow.
The flow contains consistent action requirements, a sense of control and the
feeling of selflessness. The flow experience has autotelic character, that is, it needs
no goals or rewards that lie outside it. This also explains why financial incentives as
a motivation factor only have an effect to a certain degree.
What flow offers is an opportunity to increase the quality of existence
(Csikszentmihalyi 2004, p. 87). A flow experience is a condition that arises through
self-transcendence, dedication to something, a situation, or people. Tolstoy’s
description in Anna Karenina, of how the rich landowner Levin learns to scythe,
gives an impression of what may be a flow experience.
The Wealthy Landowner Lewin
“I’ll reach back less with the arm and press more with the whole body,” he thought
when he compared Tit’s uniform, perfectly straight strip with his uneven and messy
one next to it … He thought of nothing, wished nothing more than not staying
behind the farmers and doing his task as well as possible. He heard nothing but the
clatter of scythes, and saw in front of him only Tit’s receding shape … Lewin lost
any awareness of time and no longer knew whether it was late or early. Now a
change happened in his work, which gave him the greatest enjoyment. In the midst
of his work he had moments when he forgot what he was doing; he felt lighthearted,
and in these moments his strip was just as smooth and beautiful as Tit’s. But as
soon he focused his mind on what he was doing and wanted to make an effort to do
a better job, he immediately felt the difficulty of the work and his strip turned out
badly… And more and more often those moments of semi-unconsciousness arose,
during which one did not have to think about what one was doing. The scythe was
mowing by itself. Those were happy moments (Tolstoy 1959).
6 The Working Human—The Exhausted Human 121

Fig. 6.4 Flow experience (modified according to Csikszentmihalyi 2004). X = start of an

activity; the activity is new, challenge and curiosity are present. Y = after some time boredom sets
in, the activity becomes routine. Y to Z = new challenges are needed so as not to get lost in
boredom (this is where the so-called “Bore-out-Syndrome” arises; an exhaustion syndrome may
develop due to insufficient life tasks). Z to M = the process starts anew

Self-transcendence leads to a flow experience. What is needed in professional

life is the right mix of skills, competencies and challenge, a happy medium between
fear and boredom (Fig. 6.4).
Hence, living and working in flow requires
• bringing one’s own life into a state of flow: in inner harmony with oneself, one’s
needs and visions,
• being embedded in a social and work culture,
• a suitable job: consistent with the individual skills and competences,
• an adequate workplace: design options and control over and at the workplace/
place where work takes place.
In Fig. 6.5 the way to flow or burnout can be traced. Starting from the given
conditions, such as individual habits, past conditioning, and given structure and
culture in the workplace, like leadership style, work culture, job content, location
and its connected cognitions, emotions, physical and mental state, an inner tension
arises, which develops either as a positive, motivating and challenging tension or as
a negative, stressful, anxious tension.
Through happiness at work, concentrated composure and mindfulness when
dealing with oneself, positive, motivating tension leads to flow without burning out.
If composure and mindfulness are missing, a fatigue syndrome may develop despite
motivating work, because the individual energy reserves are being depleted.
122 I. Pirker-Binder

Fig. 6.5 Flow or exhaustion (Pirker-Binder)

Negative tension chronically uses up too much energy to be able to sustain

attention and concentration. Nightly rumination and tensed-up working unavoid-
ably lead to psychosomatic and/or stress-induced complaints if not interrupted.
6 The Working Human—The Exhausted Human 123

References

Böckmann W (1981) Das Sinn-system. Psychotherapie des Erfolgsstrebens und der

Misserfolgsangst. Econ, Düsseldorf Wien
Böckmann W (1984) Wer Leistung fordert, muss Sinn bieten; moderne Menschenführung in
Wirtschaft und Gesellschaft. Econ
Csikszentmihalyi M (2000) Das Flow-Erlebnis. 8. Aufl. Klett-Cotta, Stuttgart
Csikszentmihalyi M (2004) Flow im Beruf. Das Geheimnis des Glücks am Arbeitsplatz. Klett
Cotta, Stuttgart
Frankl V (1990) Der leidende Mensch. Anthropologische Grundlagen der Psychotherapie. Piper,
München
Frankl V (2004) Der unbewusste Gott. Psychotherapie und Religion. 7. Aufl, DTV München
Jaworski J (1998) Synchronicity: the inner path of leadership. Berrett-Koehler, San Francisco
Peseschkian N (2003) Klug ist jeder. Der eine vorher, der andere nachher. Geschichten und
Lebensweisheiten. Herder Freiburg im Breisgau
Riedel C, Deckart R, Noyon A (2002) Existenzanalyse und Logotherapie. Ein Handbuch für
Studium und Praxis. Primus Darmstadt
Tolstoj L (1959) Anna Karenina. Walter-Verlag, Olten
Wikipedia (2015) Nacherzählung von Leo Tolstoj (1885). Stichwort “Wieviel Erde braucht der
Mensch?” URL: https://de.wikipedia.org/wiki/Wieviel_Erde_braucht_der_Mensch%3F. Last
access on 10 July 2015
Chapter 7
The Working People and Their Energy

Ingrid Pirker-Binder

Contents

7.1 Energy Production—The Mitochondria ............................................................................ 125

7.2 Stress and the Intestine: The Leaky-Gut Syndrome......................................................... 127
7.3 Food Intolerance and Allergy ........................................................................................... 129
7.4 The Busy Manager and the Desire to Have Children...................................................... 130
7.5 Stress, Nutrition and Sleep................................................................................................ 130
7.5.1 Electrosmog and Interference Fields...................................................................... 131
7.6 Control of Energy Production: Brain and Autonomic Nervous System.......................... 132
7.7 Polyvagal Theory According to Porges ............................................................................ 134
7.7.1 Polyvagal Theory and Stress.................................................................................. 136
7.8 The Heart: Power Source for Life .................................................................................... 138
References .................................................................................................................................. 140

When the heartbeat becomes as regular as the tapping of the woodpecker or the
rhythm of the rain droplet on the roof, the patient will die within four days (Wang
Shuhe, 3rd century. Chr.).
For a better understanding of what processes lead to people feeling exhausted
and/or being exhausted, a glimpse into energy production and control is required.
Below a brief overview of the key stakeholders, the mitochondria, the brain and the
autonomic nervous system is provided.

7.1 Energy Production—The Mitochondria

Prevention cannot be practiced without including the needs of the body, i.e. par-
ticularly its requirement of nutrients. The Nobel Prize laureate Linus Pauling coined
the term orthomolecular psychiatry for the first time.

I. Pirker-Binder (&)
Saileräckergasse 43/26, 1190 Vienna, Austria
e-mail: offi[email protected]

© Springer International Publishing AG 2017 125

I. Pirker-Binder (ed.), Mindful Prevention of Burnout in Workplace Health
Management, https://doi.org/10.1007/978-3-319-61337-6_7
126 I. Pirker-Binder

Orthomolecular Medicine According to Pauling

Pauling defined orthomolecular medicine as “prevention of good health and
treatment of illnesses through changes to the concentration of substances in
the human body, which are usually present in the body and are necessary for
staying healthy” (Pauling 2015).

The Österreichische Akademie der Ärzte (2015) writes in its Preamble to the
Diploma Directive Orthomolecular Medicine:
The method of orthomolecular medicine for the prevention, recovery or cure of diseases
comprises selective variations in the molecular concentrations of the substances that are
normally present in the body. These biochemical stimuli are processed and answered by the
body. This leads to an activation and reactivation of cell metabolism, stabilization of the
physiological balance, timely intervention in the energy metabolism, optimization of repair
mechanisms, fight of free radicals etc. (Austrian Academy of Physicians 2015)

The production of energy takes place in the mitochondria. They are the power
plants of the cells. They produce energy not only from oxygen, but also from
glucose (sugar) without oxygen. Besides, they are also responsible for the degra-
dation of fatty acids. The production of energy takes place in two different ways:
• in normal mode
• in economy mode
The energy saving mode normally takes place during the time period when cells
divide in order to resume full production afterwards. In the event of unnatural stress
caused by free radicals, mitochondria also switch to economy mode as a protective
measure against destruction (Kuklinski and Schemionek 2012, p. 72 ff.). During the
energy production free radicals, i.e. waste, accrue, which can destroy cells if they
appear in too large a quantity. The body’s antioxidant systems prevent the cell from
that and protect it against free radicals.
Such protection systems are
• essential micronutrients: necessary micronutrients that the body cannot produce
itself
• secondary phytochemicals
• glutathione, a protein compound from amino acids
Free radicals also arise from
• chronic physical and psychological strain
• chronic intestinal disorders or inflammation
• nicotine, alcohol, light stress
• environmental toxins
Too high a proportion of free radicals (oxidative stress) in the blood, can
overburden the body’s own protective mechanisms. The result is the mitochondria
switching into economy mode: too little energy.
7 The Working People and Their Energy 127

Counteractive measures and support of the antioxidants are:

• Regeneration
– micro-breaks during everyday life
– regeneration during sleep (Chap. 11)
• diet containing sufficient quantities of macro and micronutrients
We receive macronutrients from our diet; these include carbohydrates, proteins
and fats. The body requires micronutrients in smaller amounts, but they are
essential for metabolism.
A particular form of oxidative stress is an overload by nitro stress (NO gas).
It is an overproduction of nitrogen monoxide gas. A result might be adrenal
dysfunction (adrenal fatigue), which affects the production of cortisol, adrenalin and
noradrenalin. Its result is a lack of energy production and the feeling of exhaustion
(Eichinger and Hoffmann-Nachum 2012, p. 24 ff).
Besides oxidative stress, neuro stress is also a main focus point in the case of
exhaustion. It is a dysfunction in the stress axis hypothalamus-pituitary
gland-adrenal gland, the so-called neuroendocrine stress axis. Affected are corti-
sol, DHEA, adrenalin, noradrenalin, serotonin, dopamine, GABA and glutamate
(Rau 2015).
A micronutrient deficiency can be recognized by laboratory diagnostics and
corrected through orthomolecular medicine. For prevention to be successful not
only educating people about macro- and micronutrients is important, but also
making canteen staff consider this information. Suspected exhaustion should in any
case include laboratory diagnostics to review the impact of oxidative, neuro and
nitro stress in addition to a medical check. Laboratory diagnostics is a comple-
mentary element of the Life-Energy-Analysis.

7.2 Stress and the Intestine: The Leaky-Gut Syndrome

Science is now putting a stronger focus on the intestine and its significance for a
functioning immune system. About 33% of all autoimmune diseases are associated
with a leaky intestine, the leaky gut syndrome. Stark (2014, p. 96 ff) provides a first
overview of diseases and ailments connected with a leaky gut syndrome.
In addition to many harmful effects on the intestine, the importance of acute and
chronic stress is in the foreground in this context. If the intestinal mucosa is
damaged and permeable, toxins can get into the blood. Often also chronic fatigue
and lack of concentration can be traced back to this, as toxins hinder the immune
system and thought processes of the brain.
In her study Van Hemert (2014) points out the influence of a leaky gut on
migraine and brain dysfunction. In the case of chronic stress cortisol is produced in
the adrenal medulla to protect the organism. It inhibits inflammation and pain,
128 I. Pirker-Binder

increases in emergency situations and stress and decreases with relaxation and
regeneration (Rauland 2001, p. 84 ff).

Consequences of Permanent Stress

If stress lasts too long, cortisol keeps being produced. It cannot maintain its
anti-inflammatory effect any longer, which results in a weakened immune
system. In the case of chronic stress the level of adrenalin may be up to ten
times higher than normal. Not only anxiety and inner pressure lead to an
activation of the sympathetic system but also anger and joy.

Mr. Z is busy employee in a large company. Taking breaks is unfamiliar to him; his weekly
working time is about 60 h. He starts his holidays right from the office. He rushes to catch
his flight; his wife has previously packed his suitcase and is waiting for him at the airport.
Once arrived, Mr. Z already feels bad. He gets sick and can only begin to enjoy his vacation
in the third week. This symptom is known as “manager disease”. Once the stress subsides,
the weakened immune system collapses.

Metabolic disorders are also closely related to stress and poor nutrition
(Fig. 7.1).

Fig. 7.1 Stress and metabolic syndrome (adapted from Stark 2014)
7 The Working People and Their Energy 129

7.3 Food Intolerance and Allergy

Clinical psycho-neuro-immunology deals with the relationships between the psy-

che, neurological processes and the immune system, primarily on cellular level. Its
focus is the study of new insights into nutrition.
As a new approach in this regard, a kind of diet following the Stone Age people,
called “Stone Age” or “paleo-diet”, is frequently mentioned. It is a diet made up of
fresh, GMO-free biological food, high in protein and healthy fats, and little, and if
so, gluten-free cereal. In case of physical ailments or just to treat one’s body to a
recovery, it makes sense to have oneself tested as to which foods are conducive to
one’s organism and which are not, or which foods one should leave out for a certain
time.
At least once a year detoxifying the body under professional guidance should be
considered. Stress makes the body acidic; basic diets combined with a gentle detox
cleanse and refresh the whole person.
Rising food intolerances and allergies are a cause for concern. Too much stress
promotes allergies, because the body no longer has sufficient strength for com-
pensation. Nonetheless, the scientific question arises why allergies occur in the first
place. There are interesting theories in specialist journals, which I would like to
refer readers to at this point.
Complaints caused by food intolerances have been rising sharply in recent years.
Particularly noteworthy in this respect are wheat and products from cow’s milk. While
many adults do not tolerate cow’s milk any longer and ought to switch to other dairy
products, the highly cultivated wheat varieties pose a huge risk for many diseases. In
particular the wheat protein gliadin should be pointed out here, an appetizing sub-
stance that is added to many foods. In this respect the Wheat Belly books by Williams
Davis, need to be mentioned, which are devoted to this topic in detail.
Ms. Y had been suffering from bad asthma since childhood. At the age of 45 her general
practitioner, who focuses on holistic medicine, tells her that she is suffering from wheat
intolerance. In the following months she completely left out any wheat products—with an
astonishing result: firstly, her asthma disappeared and secondly she lost eight kilos without
ever going hungry.
Ms. M was suffering from incredible fatigue; nobody could find the reason for it. She did
know that she had histamine intolerance and was already leaving out foods high in his-
tamine. But only a special food intolerance test and cutting out different foods and the
treatment of her leaky gut syndrome could provide help.

A gluten allergy is, if undetected, a long ordeal for those affected. Fatigue,
shortness of breath, abdominal pain, intestinal damage, diarrhea and also depression
may be associated concomitantly. Gluten is protein that occurs in very many foods.
If the gluten allergy is not treated, it can lead to an inflammation of the mucous
membrane of the small intestine, which results in deficiency symptoms. Since
vitamins cannot be absorbed sufficiently, further complaints might appear. For the
purpose of successful prevention and intervention it is useful to provide training and
further education for executives and employees about
130 I. Pirker-Binder

• the effect of stress hormones in the body

• intestinal health
• the consequences of malnutrition (too many carbohydrates, too little healthy fat)
• new diagnostic methods offered by holistic medicine in the event of complaints
of unclear origin or for stress diagnostics
New ideas for a healthy cuisine at work, which meets all requirements, are
important for preventive measures. Sports facilities and the daily green apple are
not enough.

7.4 The Busy Manager and the Desire to Have Children

More and more often couples that would like to have children come to my practice.
Taking a look at the above-mentioned regarding stress and nutrition, the influence
of a healthy and mindful lifestyle on the preconditions for a woman to become
pregnant and the quality of a man’s sperm cannot be denied. Too much stress not
only makes the body acidic, but also infertile. An adequate supply of micronutrients
has to be taken into account. If medical reasons can be excluded, a program for
inner balance and learning how to gain inner peace and regeneration is recom-
mended (Chap. 11).

7.5 Stress, Nutrition and Sleep

Poor sleep, disorders of initiating and maintaining sleep can have various causes.
Stress-related causes such as lack of distancing oneself from work, worries and fears
can be reasons, but also certain dietary habits (e.g. only eating in the evenings,
eating too much and too heavily for dinner) or the sleeping place (Sect. 7.5.1) and
sleeping habits. Frequent travel and irregular bedtimes can cause problems as well.
Therapeutic interventions, regeneration and relaxation training can help.
A Somewhat Paradoxical Situation

Mr. O comes to see me in my practice because of his state of exhaustion. When asked
whether he sleeps well, he says “like a rock”. However he does not feel like having
recovered at all in the morning. This situation occurs often when the body is already so
exhausted, that it falls into a deep rest; therefore we call it coma sleep, during which
regeneration cannot take place anymore. This means that the organism cannot recover
during sleep. By means of a vegetative functional diagnostics, a 24-h heart rate variability
analysis, this state can be proven. Then, a comprehensive therapeutic program to relearn
inner peace, relaxation and regenerative ability is strongly advised (Chap. 11).
7 The Working People and Their Energy 131

7.5.1 Electrosmog and Interference Fields

Recently electrosmog has been discussed more frequently and heatedly, and jus-
tifiably so, as for many sensitive people it has become a scourge of the new
technologies. A man without a mobile phone in a trouser or breast pocket is an
exception nowadays. Whether being concerned is justified or not, is discussed in
different studies on this issue. In any case, sensitive people should remember: strain
and interference fields can be verified with the modern heart rate variability
measurement.
Interference fields are
• water veins. They produce a weak electric field
• faults, geological fracture
• magnetic lines and intersections of the earth’s magnetic field. Hartmann dis-
covered the “Global Grid”. The intersection points are disruptive, but not the
lines.
• the Curry diagonal grid. It was discovered by Curry and runs along the 45th
grade to the Global Grid and may promote nightmares, depression, anxiety
states.
• the Benker system, a grid system discovered by Benker, that overlaps every
fourth Hartmann-line. It involves high-energy ionizing radiation (Dahlke 2013).

Migraine and Sleeping Place

A mother and her son come to my practice for biofeedback therapy. Both suffer from
headaches. Testing for stress induced by interference fields before starting pain therapy is
one of my standard procedures. The testing was positive, and I pointed out that she might
want to consult a building biologist so as to refurbish the sleeping place or at least to get the
head out of this area. The mother confirmed that there were interference issues in the house;
she had already had it tested. Her bed was located a floor up, but it was in the same location
as her son’s. She was aware of the interference but would not make any changes. In this
case, biofeedback therapy to reduce the headaches cannot be successful.

Interference Field Sleeping Place and Workplace

Mr. Z, a young, athletic man in his mid-twenties, came to my practice with a suspected
diagnosis of severe fatigue/burnout. He was incredibly pale and was so tired that he was
trudging along slowly. According to conventional medicine he was completely healthy.
A geopathic testing revealed both, a negative charge of his sleeping place and his work-
place. Small changes showed a major effect. After a short period of time Mr. Z could train
in his soccer club again; his power of concentration and performance capability were
re-established.

In case of ailments of unclear cause it is advisable to consult a building biologist

for clarification whether interference fields or electrosmog at the sleeping or
workplace are contributing factors.
132 I. Pirker-Binder

Consequences of Chronic Stress and Anxiety

The human being is a physical, psychological and energetic work of art.
Negative emotions, problems and stress can cause blockages in the energy
system of the body and vice versa. In particular, blockages in the meridian
system and complaints caused by blocked vertebrae (spine) need to be
pointed out here. From traditional Chinese medicine it is known that teeth are
in connection with meridians and organs, which can influence each other.
This shows why a holistic view of humans, whether medically and/or ther-
apeutically, is useful and necessary. Chronic stress and anxiety can lead to
blockages!

7.6 Control of Energy Production: Brain and Autonomic

Nervous System

The brain communicates over twelve pairs of nerves directly with the organism,
each from the right and left hemisphere. The analysis of stimuli and their evaluation
are assumed by the limbic system, the amygdala and associated parts. These
include:
– amygdala: it assigns an emotion to an incoming stimulus, selects a mode of
reaction and passes on the respective command for an action to the
hypothalamus.
– thalamus: it is also called the gateway to consciousness. All incoming stimuli
are received here and forwarded to the cerebral cortex for analysis and review.
In life-threatening situations stimuli are directly transferred to the amygdala; in
that case analysis and review only happen after the situation has eased.
– hypothalamus: it controls all vegetative and hormonal processes as well as the
release of adrenaline and noradrenaline via the adrenal medulla and the release
of cortisol via the adrenal cortex. These effect the activity of the autonomic
nervous system, the sympathetic and parasympathetic nerves. The pituitary
gland works together with the hypothalamus and is involved in the release of the
hormone (ACTH), which in turn supports the release of cortisol.
– hippocampus: it works together with the amygdala. It stores the facts, whereas
the amygdala adds the emotional evaluation (Rauland 2001; Morschitzky 2004)
The control of energy use is up to the brain in collaboration with the autonomous
nervous system. In the brain, the analysis of incoming stimuli happens, which is
followed by passing on an impulse to the central nervous system. The central
nervous system is divided into the
• peripheral nervous system: for arbitrary reactions
• autonomous nervous system: responsible for the functioning of the organism
7 The Working People and Their Energy 133

Fig. 7.2 Sympathetic and parasympathetic nerve and their connection to the viscera. Sympathetic
nerves organize and mobilize energy resources, parasympathetic nerves help build up energy
reserves (modified from Pinel 1997, p. 54)

• enteric nervous system: also called gut brain.

The autonomic nervous system consists of two protagonists that are responsible
for activating and deactivating energy production (Fig. 7.2):
• sympathetic nerve: responsible for providing energy required for activity and
performance
• parasympathetic nerve: recreation, regeneration, and energy build-up.
• The most important player in the parasympathetic system is the vagus
nerve, the 10th cranial nerve. It also regulates the parasympathetic control
of the heart and is responsible for regeneration.
Its strength or weakness shows in the respiratory sinus arrhythmia (Chap. 11).
Activation of the sympathetic nerve takes place on two levels (Morschitzky 2004,
pp. 224–225):
– hypothalamus-adrenal medulla system
(neural activation): short-term energy mobilization, release of 80% of adrenaline
and 20% of noradrenaline and recourse to stored energy reserves.
134 I. Pirker-Binder

– hypothalamus-pituitary gland-adrenal cortex system (hormonal activation):

release of adrenocortical hormones to replenish emptied storage. In cooperation
with thyroid hormones the organism tries to build new reserves and to make the
body more efficient and resistant. Approximately 4 h after an alarm response the
hormones reach their highest blood sugar levels (Morschitzky 2004, p. 225).
In the biological reactivity of humans there are different ways of reacting to fear,
excitement and stress, i.e. there are sympathetic tone types (fight and flight types)
and vagotonic types (shock types).
Sympathetic tone types show a tendency towards sympathetic over-excitation,
increases in blood pressure, overstrain in the muscles, heating up, they are easily
irritated or quickly become aggressive and have problems with relaxation. In case
of illness they tend to suffer from cardiac, circulatory problems, heart palpitations,
coronary artery disease. In fearful situations they show palpitations, pressure in the
chest, muscle tension and breathing problems (hyperventilation).
Vagotonic types tend to show parasympathetic overreaction, such as a drop in
blood pressure, dizziness, drowsiness, fainting tendency, sweating, sensitivity to
cold, weak knees, blushing, crying, urinary and rectal urgency. The vagotonic
condition is expressed either by a strong helplessness or incapacity due to a strong
shock disposition or shock reaction or by exhaustion after excessive tension.
Vagotonic types remain in shock-induced paralysis/“fright rigidity” as if paralyzed
and are unable to reach resistance and active engagement with the stressor. The
psychological feeling of powerlessness appears physically through constant
drowsiness, dizziness and fainting tendency (Morschitzky 2004, p. 229). In case of
illness those affected complain about dizziness, nausea, diarrhea and bladder
pressure and have the feeling of collapsing or fainting.
• In diagnostics it makes sense to consider various ways of reacting to strain and
stress. Even if they are individually predefined they can be changed to a certain
degree.

7.7 Polyvagal Theory According to Porges

With his theory Porges moves the brain-heart axis to the center of consideration.
The Polyvagal Theory provides a bidirectional brain-body model, which under-
stands the regulation of the peripheral physiology through the brain (neuronal
regulation of the cardiovascular and endocrine functions) as a neural platform for
developing adaptive social and defensive behavior (Porges 2010, p. 21). The aim of
the Poyvagal Theory is to develop methods that strengthen the social vagus. In this
context the heart rate variability training offers a very effective solution; however,
the training is to be embedded in a therapeutic concept.
Porges builds on the researches of Darwin and James and extends the general
understanding of the antagonists sympathetic and parasympathetic nerves to the
7 The Working People and Their Energy 135

model of the social, myelinated and the non-myelinated vagus. He attributes to

them two different affect-regulation functions in threat situations:
1. Mobilization: combat and flight behavior when danger looms, initiated by the
sympatho-adrenal activation system (sympathetic nervous system) and the
inhibiting influence of the vagus (social vagus). Additionally, facial expression,
voice, rhythm and information from the viscera (the inner organs) are deter-
mining factors. Information from the internal organs is so important, because
early-childhood stress (trauma, attachment disorders, etc.) is “encoded in the
body” (stored) (Van der Kolk 1994).
– System of social commitment: the social vagus (originates in the nucleus
ambiguus) regulates the assessment of signals (such as threat or security) of
other people and from the environment; it facilitates the recognition of
positive signals and the proper assessment of and reaction to dangers.
2. Immobilization: if the risk is too great, the mobilization system might fail and
the non-myelinated vagus (dorsal motor vagus center) with its reaction pattern
of freezing and/or fainting occurs. Immobilization goes along with a slowdown
of the heart rate and a decrease of blood pressure.
Porges summarizes the function of the social vagus under the term “system of
social commitment” (SSC). When working with people under high levels of stress,
it is important to bear these two reaction patterns to stress in mind. In coaching
processes the increasing importance of somatic markers is becoming more and more
evident, for example by advising, “Pay attention to your physical sensation when
making decisions; listen to your inner voice”.
With reference to Porges’ theory, feeling and listening to the messages of the
body can work very well (psychosomatic intelligence), but only in people whose
system of social commitment is not affected by early trauma.
During the Life-Skript-Analysis (Chap. 2) dysfunctional patterns are collected
and registered and discussed in an interactive process. The heart rate
variability (HRV) training research provides hope that in combination with psy-
chotherapy changes in the neural network of the affected people can happen.
Subsequently, a tailor-made concept for victims of traumatic experiences is
necessary.
Trauma researchers such as Van der Kolk point out that the body does not forget,
and numerous methods deal with releasing body blockages (Dennison 1990; Levine
2013; Klinghardt 2006; Gallo and Vincenzi 2005, Van der Kolk 2000). Exciting in
this context is that in the preface to Porges’ book, Van der Kolk mentions his good
friend Packer, who works on the soothing effect of hexameters. In his own practice
it has been found out in a 24-h HRV measurement that chanting (a particular
meditation form with pre-defined singing) can lead to a change of heart rate vari-
ability towards the desired optimum of 0.1 Hz in the low frequency range. States of
excitement act from the brain to the heart and back again (Chap. 3).
136 I. Pirker-Binder

Porges tries to obtain a neurobiological answer to the question of why certain

behaviors of people and environmental stimuli evoke a sense of security in some
people and a feeling of threat in others. The reason for this lies in neurobiologically
congenital or acquired defense mechanisms, whose roots are in the vagus complex,
i.e. in a healthy or dysfunctional neuroception.
For the ability to establish positive human relationships, control over the indi-
vidual neurobiological defense mechanisms is necessary. Adaptive systems for
prosocial and defensive behavior are required that are able to assess information
from the environment properly (as threatening or safe). Impaired assessment is
considered dysfunctional neuroception.
The human nervous system allows expressing emotions, communication and
influencing physical and behavioral states. Polyvagal Theory combines the devel-
opment of the ability of neuronal control of heart activity with affective experience,
emotional expression, the expressive powers of the face, vocal communication and
the part of social behavior that reacts to the behavior of other people.
• Polyvagal Theory points out that the neuronal control of the heart is
neuro-anatomically connected with the neuronal control of the muscles of
the face and head.

7.7.1 Polyvagal Theory and Stress

Based on Gellhorn (1967, in Porges 2010, Gellhorn 1979), who describes the
parasympathetic nervous system as a trophotropic system and the sympathetic
nervous system as an ergotropic one, Porges regards the parasympathetic nervous
system as the homeostasis regulating system. According to his view, homeostasis is
an autonomous state, which supports the fulfillment of visceral needs in the absence
of external requirements (Porges 2010, p. 101).
In this sense stress could be seen as a disturbance of the homeostasis, which is
represented by a decrease in the tone of the parasympathetic nervous system. If so
required due to external influences, the sympathetic nervous system becomes
involved as well. Homoeostatic processes regulate themselves through feedback
loops, which result in a rhythmic pattern. They express a phasic rise and decrease of
neuronally efferent signals to the organs (e.g. the heart). The results are: the higher
the amplitude of this organized rhythmic, physiological variability, the greater the
flexibility of the reaction modulation (Porges 2010, p. 101).
It is also interesting in this context that a rising vagal tone not only results in an
increased energy production in the organism but is also important for the digestive
organs (also swallowing, esophagus, etc.), the gastric motility (Porges 2010, p. 107)
and breathing (bronchial tubes). This facilitates making a potential connection
between the complaint of reflux and a weakened vagus.
7 The Working People and Their Energy 137

Physiological Link Between Stress and Muscles

Green and Green (1999) describe a physiological link between stress and
unneeded muscles (during stress only those particular muscles are well
supplied with blood that are required for fight or flight). As in a dangerous
situation no food is taken in, the lower esophageal muscles become somewhat
slacker. This can lead to reflux. Stomach and intestinal ailments and vagus are
also closely linked.

A long list of complaints caused by a weakened vagus could be cited here. In

prevention management an understanding should be promoted of how the
parasympathetic system of humans can be trained in a regenerative break, for
example through breathing technique.
Porges postulated that the one-sided focus in the definition of stress on the
sympathetic nervous system has reached its end. The quantification of the cardiac
vagal tone is novel; it can be calculated from the heart rate and thus provides
feedback on the power of the parasympathetic system.1 The vagal tonus is
expressed as the power of the respiratory sinus arrhythmia (RSA, Chap. 11).
A reduction in the tone of the parasympathetic system before confronting a difficult
task may be a reference to physiological vulnerability or susceptibility to stress
(Porges 2010, p. 100).
Note: In the Biofeedback section in Chap. 11 various stress response tests are
discussed as well as the associated validity of the psychophysiological, measurable
changes using biofeedback. In the passive reaction test the respective people are
signaled a stimulus without showing stimuli on the computer screen.
The client is completely alone with his/her expectations. This test method could
be used in accordance with Porges to measure the vulnerability of the physiological
system. Due to the physiological changes of the measured values during the
expectation phase a link can be established between psychosomatic or stress-related
complaints. For example, a narrowing of the pulse amplitude might indicate sen-
sitivity in the vascular system, etc. For the evaluation of 24-h heart rate variability
measurement the change of the RSA before and during stress provides helpful
information in the coaching or psychotherapeutic process.

1
The term “cardiac vagal tone” is a construct that describes the functional relationship between the
brain stem and the heart (Porges 2010, p. 109, 1995).
138 I. Pirker-Binder

7.8 The Heart: Power Source for Life

The heart is a high performance machine and the center of life. It is developed even
before the brain and is an electromagnetic power source of 2.4 W. Its vibrations and
signals are measurable down to the smallest cell.
But not only the heart, also every other organ swings in its very own life melody.
When all these rhythms (brain, heart, breathing) are in consistency and coherence,
we feel the body is healthy, i.e. in flow.
In this state, humans feel creative, dynamic, buoyant and vital. This vitality is
dependent on the adaptability of the body to emotional, psychological and physical
challenges of life. The organism is in constant interaction with the outside world. It
reacts “unconsciously” to incoming stimuli and automatically adapts the required
energy demand to the respective situation. This is done through the heart frequency
in combination with different other organ systems, such as breathing, nervous
system, hormonal system and vascular system (Pirker-Binder 2008, p. 32 ff.).
Consequently, the heart rate is not a fixed value but individually adapts to external
and internal conditions. This adaptation is achieved by changing the time intervals
between the individual heartbeats (heart rate variability, Fig. 7.3).

Heart Rate Variability as a Global Indicator

Mück-Weymann describes heart rate variability as a global indicator of the
ability and adaptivity of vibration (resonance) of bio-psycho-social function
in exchange between organism and environment. It works like a buffer or

Fig. 7.3 Change of heart rate variability in different stress conditions. Picture used with the
courtesy of Hottenrott (2006)
7 The Working People and Their Energy 139

interface that helps the body to communicate with the inner and outer envi-
ronment (Mück-Weymann 2010).

The better the body can adapt to the daily challenges, strain and stress, the
greater the harmony of the vibrations generated in the body. This harmony of
rhythms (brain, heart, breathing) is called coherence.
As shown in Fig. 7.3, it can be seen that with increasing strain the variability is
decreasing and the heart rate is getting more and more regular.

If a spotlight is placed on the physiological processes with respect to suc-

cessful prevention, it becomes obvious that intervention measures, which do
not involve a general understanding of connections and wholeness, cannot
bring about any longer lasting change towards increased health. It is neces-
sary to observe energy production and control in the organism as well when
exhaustion occurs. Activation that lasts too long can exhaust the energy
reserves, but also make energy production impossible and even prevent the
release of necessary hormones through weakened associated organs. Here, the
question often arises where the cycle begins; perhaps in the thought and
experience patterns of each person. The Life-Script- and the
Work-Script-Analysis build on this in combination with the
Life-Energy-Analysis.

In Chap. 11 the method, measurement and training and, in particular, the heart
rate variability of the biofeedback method are explained in detail. Biofeedback
serves the opening of the consciousness for the above described.
Objectives of a biofeedback measurement and training are:
• gaining insight on unconscious feelings and thought patterns and experience
models that have an influence on energy consumption,
• recognizing the interplay between activation, deactivation and regeneration
and
• achieving increased functionality of the vagus nerve in heart rate variability
training.

An essential aspect for prevention and intervention is generating a basic

understanding about how stimuli are processed and how evaluation is
anchored in the brain. This explains why changing a thought process or a
negative attitude is not so easy to manage. The Life-Script- and the
140 I. Pirker-Binder

Work-Script-Analysis are guides for the content in the exchange with people,
their assessments, thought patterns and feelings. In a further step, the
respective people can take a stance on their thought patterns and feelings if
the contexts are understandable. Now they can think about changes, make
revaluations and take the first steps.

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Dennison PE (1990) Befreite Bahnen. Angewandte Kinesiologie. VAK, Kirchzarten
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Vitalstoffmangel – Burnout fängt in der Körperzelle an; das Präventionsprogramm mit
Praxistipps und Fallbeispielen. Systemed, Lünen
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Einfuehrung.htm. Last accessed on 21 Dec 2015
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at/fileadmin/template/main/OeAeKDiplomePDFs/Diplom-Richtlinien/RL07_
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Medizin. Last accessed on 2 Feb 2015
Pinel JP (1997) Biopsychologie, eine Einführung. Spektrum, Heidelberg, Berlin
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fneur.2014.00241
Chapter 8
Food Supplements = Supplement to Food

Ingrid Spona

Contents

8.1 Do We Need Food Supplements at All? .......................................................................... 144

8.2 Why Is Long-Term Stress So Harmful? ........................................................................... 145
8.3 As a Reminder: A Brief Clarification of the Terms from a Medical Point of View ...... 145
8.3.1 Stress—Briefly Summarized with Regard to Food Supplements........................ 145
8.3.2 Silent Inflammation .............................................................................................. 146
8.3.3 Insulin Resistance ................................................................................................. 146
8.4 What Do Food Supplements Definitely Not Stand For?.................................................. 147
8.5 Which Substances Are Particularly Important with Regard to High Stress Levels?....... 147
8.5.1 Magnesium ........................................................................................................... 147
8.5.2 Potassium .............................................................................................................. 148
8.5.3 Vitamin C ............................................................................................................. 148
8.5.4 Vitamin A ............................................................................................................. 149
8.5.5 B—Vitamins ......................................................................................................... 149
8.5.6 Vitamin D—Calcium—Vitamin K2 .................................................................... 149
8.5.7 Omega 3 Fatty Acids ........................................................................................... 150
8.5.8 Q 10 ...................................................................................................................... 150
8.5.9 Plant Nutrients ...................................................................................................... 150
8.5.10 Amino Acids......................................................................................................... 151
8.5.11 Tryptophan............................................................................................................ 151
8.5.12 Phenylalanine/Tyrosine......................................................................................... 152
8.5.13 Glutamic Acid (Glutamate)/GABA/Glutamine .................................................... 152
8.6 Last But Not Least—The Intestine ................................................................................... 154
Further Reading ......................................................................................................................... 155

Chronic high stress can lead to a multitude of complaints ranging from intestinal
problems, insulin resistance and silent inflammation to related secondary diseases.
Relevant dietary supplements can support the organism in this context; yet, the
supply is huge, but what substance is useful and when?

I. Spona (&)
Vitalogic Dr. Spona VertriebsgmbH, Praterstrasse 45/12, 1020 Vienna, Austria
e-mail: [email protected]

© Springer International Publishing AG 2017 143

I. Pirker-Binder (ed.), Mindful Prevention of Burnout in Workplace Health
Management, https://doi.org/10.1007/978-3-319-61337-6_8
144 I. Spona

The physical basis for a successful adaptation to changing living conditions will
always be a good diet.
Food supplements cannot and are not intended to replace that. However, they
can undoubtedly support the organism with regard to adaptation to high and specific
requirements.
The physician Dr. Ingrid Spona and the biochemist Prof. Dr. Jürgen Spona have
been working intensively in this field for more than 20 years.
This chapter discusses the effects of stress on the organism and briefly examines
the relationship between stress, insulin resistance and silent inflammations, together
with the corresponding consequences.
In the context of stress, the main focus is on supporting the adrenal glands and
the mental power. The gut-brain axis is also addressed.
On the one hand, it is explained which substances are increasingly consumed in
this context and thus also required in an increased manner, while they can subse-
quently also prevent or at least mitigate the harmful effects on the organism. This
advice is intended as a suggestion and should under no circumstances replace the
instructions of a doctor or therapist.

8.1 Do We Need Food Supplements at All?

The answer is no. The organism can compensate for a great deal, and today it is
unlikely that anyone suffers from scurvy or beriberi, the wide-spread deficiency
diseases of the past.
The other question, however, is whether one wants to do this to one’s organism
and whether it does not make sense after all to provide best possible support;
particularly in times of high stress. In this case it definitely makes sense to
specifically use food supplements.
A solid basis for controlled digestion, for smooth metabolism and thus for
optimal energy supply, is provided by good nutrition adapted to the individual
requirements. This topic fills entire libraries and has almost assumed the character
of ideologies rather than hard scientific facts. Therefore, it cannot be the topic of
this short article.
However, one thing is clear: it is about optimally providing the organism with
energy in order to cope with the respective requirements.
The “energy currency” of the body is ATP, which is generated in the energy
power plants of the body, the mitochondria. Ideally, 38 “units” of ATP are created,
whereas in the event of an emergency only 2 ATPs are generated. Without going into
specific biochemistry right now, this dimension alone makes it clear that the energy
resources also play a big role in how you feel and, of course, how productive you are.
The approach with regard to using dietary supplements in chronic stress situa-
tions or chronic stress exposure can only be to take into account the increased need
in stress situations. It is obvious and also scientifically proven that the demand for
nutrients in stress situations is considerably higher.
8 Food Supplements = Supplement to Food 145

It is clear that the main focus must be on mental measures to relieve the
organism in the long term. The fact that the basis for a certain level of mental power
has to be created first, is also obvious.
This applies, on the one hand, to the consumption of substances that affect the
stress response itself and, on the other hand, the substances that are required to a
greater degree due to the stress response.
The organ, which is at the forefront of stress responses, is the adrenal gland.
There, among other things, the hormones are produced that enable the organism to
cope with stress.

8.2 Why Is Long-Term Stress So Harmful?

Because chronic stress activates disastrous chain reactions. Stress causes inflam-
mations, silent inflammations, inflammations lead to insulin resistance, insulin
resistance causes inflammations and inflammations cause diabetes, cardiovascular
disease, cancer and dementia.
• Chronic stress leads to a series of metabolic disorders, which means that stress
leads to diabetes, and diabetes increasingly triggers stress reactions. This is only
one of the “vicious circles” that have to be broken.
In addition, stress has a negative effect on the intestinal flora, which can ulti-
mately lead to digestive problems, food intolerances, migraine and depression.
The occurrence of these secondary diseases is certainly partly lifestyle-
dependent. This has now been scientifically investigated and proven. In this con-
text, numerous scientific studies provide evidence of the value of a sensible, tar-
geted use of high-quality food supplements.

8.3 As a Reminder: A Brief Clarification of the Terms

from a Medical Point of View

8.3.1 Stress—Briefly Summarized with Regard to Food

Supplements

Stress mobilizes the so-called HPA axis to cope with a threat. This means that the
brain is told that there is a threat, whereupon the pituitary gland instructs the adrenal
glands to release stress hormones. These mobilize the reserves of the organism. The
threat, however, has an enormously high subjective component. Is it really a
saber-tooth tiger, or unfinished files or a difficult situation with (supposedly) dif-
ficult fellow human beings? The response is always the same: release of stress
hormones. This makes a lot of sense for acute short-time stress, but it is very
146 I. Spona

stressful for the organism if it becomes chronic, for the organism does not stop
reacting as long as this situation persists.
In essence, this means that all precautions are taken to make the best possible use
of the muscles. Ultimately, it is about fight or flight, i.e. either face a fight or run
away from danger. Overall, therefore, it is about the greatest possible mobilization
of the physical forces, which has precarious consequences for us nowadays: for
finishing undone tasks or getting along with difficult people we do not need any
special muscular force. The provision of these resources ultimately results in excess
energy that is not needed and ends up in any stores of the body, usually in the fat
stores.

8.3.2 Silent Inflammation

Silent inflammation—the stage the immune system already enters the scene. This is
not the case in the acute stress reaction. When it comes to fight or flight, the
organism is not concerned with the defense of any germs, as, pragmatically seen,
the formation of antibodies or the mobilization of special cells for defense against
penetrating toxicants would take much too long, and therefore no power and energy
are used for that. From the point of view of nature, this topic is not the top priority
in an acute stress situation, for it might well be that one does not need defense
against germs, because one has already fallen victim to the acute threat.
The situation is quite different when all of this takes longer.
The long-term release of stress hormones has precarious consequences:
The vessels are damaged, the adrenal glands are exhausted and the memory is
damaged, because after all, long-term reflection is not of primary importance in
acute stress situations. So, no resources are used for this either.

8.3.3 Insulin Resistance

… is also a mechanism that is particularly useful in the defense against acute

threats. It enables the organism to provide the cells with as many resources as
possible.
Insulin is needed to make energy carriers such as glucose usable for the cell.
Insulin is a hormone and hormones can affect the cells only via receptors. If a lot of
glucose is available, these receptors become increasingly exhausted. The organism
compensates this with an increased release of insulin to ensure the supply.
However, the receptors become more and more insensitive. This circulus vitiosus
ultimately ends in a complete exhaustion of the receptors and, as a result, in an
exhaustion of the insulin-producing organs, namely the pancreas, or more precisely,
8 Food Supplements = Supplement to Food 147

the part of the pancreas, which is responsible for the production of insulin and for
the carbohydrate metabolism. Ultimately, this leads to diabetes with all the known
resulting sicknesses such as heart attack, stroke and increased risk of dementia and
tumors.

8.4 What Do Food Supplements Definitely Not Stand For?

The use of dietary supplements must clearly be separated from the idea of doping.
This means that they are by no means meant to squeeze out even more per-
formance and resources. They should support the organism gently in accordance
with the natural conditions and, in the best case, perhaps even prevent permanent
damage by chronic stress.

8.5 Which Substances Are Particularly Important

with Regard to High Stress Levels?

Let us now go on a journey through the jungle of infinite selection of substances:

which are crucially important, which are “nice to have” and which can provide
support in certain situations?
Please note that the following substances represent average empirical values.
This also means, of course, that you should clarify and discuss any possible intake
of food supplements with your physician or curative practitioner.

8.5.1 Magnesium

Currently it is known that magnesium is involved in more than 300 metabolic

pathways and reactions. However, this is probably not the end of the story, as
certainly not all metabolic pathways have been explored yet, and new discoveries
are constantly being made.
Many metabolic processes are even dependent on magnesium.
Numerous scientific studies have shown that a good supply of magnesium
improves insulin resistance as well as inflammations. As stress is also an inde-
pendent risk factor for insulin resistance, the circle closes here. Magnesium is
significantly involved in the efficiency of insulin. This in turn means that all people
with insulin resistance have a magnesium deficiency.
An increased sympathetic tone, that is, an imbalance of the vegetative nervous
system towards the sympathetic, leads to magnesium deficits. If this is not properly
treated, all the doors are thrown wide open to the mentioned resulting sicknesses.
148 I. Spona

The fact that the increased sympathetic activity hinders a restful sleep, and thus
the urgently needed regeneration, starts the vicious circle.
The production of ATP, and hence the energy production of the organism, is also
dependent on magnesium.
This means that magnesium is certainly a fixed starter within the context of
supplementation at high stress levels.
Especially with minerals and trace elements, it is very important to consider
whether the respective substance really arrives where it is needed in the body. They
can usually be absorbed more easily than chemical compounds. In principle,
therefore, the question is whether a substance is bioavailable.
With regard to magnesium it has been proven that, for example, magnesium
citrate or magnesium gluconate can be absorbed better by the organism than the
cheaper magnesium carbonate.
A good dose for magnesium citrate is for example 300 mg/day. Magnesium is
present both in the cell and outside. By the way, it takes a few weeks for the
important intracellular reserves to be filled as well.

8.5.2 Potassium

… is another fixed starter with regard to a high stress level, as its consumption is
increased in this situation.
As a citrate potassium is also readily bioavailable; again, a dose of 300 mg
makes sense.

8.5.3 Vitamin C

…is the 3rd essential nutrient at high stress levels, since the demand increases in the
same way as the release of stress hormones.
Interestingly, all mammals, except for apes, guinea pigs and humans, can pro-
duce large amounts of vitamin C themselves. Humans are, therefore, dependent on
a supply from outside.
Vitamin C can also inhibit some of the contra-productive effects of the stress
response, especially in the immune system.
Very recent scientific studies have shown that vitamin C has positive effects on
the heart/circulatory system by protecting the vessel walls.
The recommended dose is 75 mg/day, but orthomolecular physicians recom-
mend at least 500 mg/day.
For specific indications, even several grams/day are administered.
Cats, who belong to the species that make vitamin C themselves, produce
between 3 and 10 g daily.
8 Food Supplements = Supplement to Food 149

8.5.4 Vitamin A

…is predominantly involved in the formation of new mitochondria, i.e. those

responsible for the energy of the cells.
It also plays a major role in the immune system as it stimulates certain cells to
produce anti-inflammatory enzymes.
The individual dose differs and should always be agreed with a doctor or an
alternative practitioner, since there is a risk of overdosing as with all fat-soluble
vitamins.

8.5.5 B—Vitamins

…are essential for the energy production in the mitochondria and many other
metabolic functions; they are very often deficient. Particularly in the case of high
stress levels and insulin resistance, measurements reveal pronounced deficiency
states.
For example, the adrenal glands cannot fulfill their central role in stress pro-
cessing if there is a deficiency of B5. This state may lead to the collapse of the
adrenal glands.
This means that measurements and individual supplementation are recom-
mended in cases of high stress. If this is not possible, a common low-dose com-
bination of B vitamins consisting of the vitamins B1, 2, 3, 5, 6, 12 and folic acid is
extremely useful, since this is the basic prerequisite for smooth energy production.

8.5.6 Vitamin D—Calcium—Vitamin K2

A vitamin D deficiency is very common. This may also be due to the fact that the
basic demand is increased with a high stress load. Apart from this, the long-standing
view that 10 min of daylight exposure is sufficient to ensure the vitamin D pro-
duction has been disproved. This is at best sufficient to prevent rickets, but not to
benefit from all other positive vitamin D effects. While it was previously thought
that vitamin D is important only for healthy, strong bones, it is now known that the
effects of vitamin D go far beyond this.
In connection with stress load it is especially important to point out that vitamin
D is essential for a well-functioning immune system, and that the risk for cardio-
vascular diseases rises sharply in the case of vitamin D deficiency. Since such risk
is already increased under stress, adequate supply is crucial.
Important: vitamin D should always be given together with calcium, as it can
only be effective when calcium levels are sufficient.
150 I. Spona

What is more, vitamin K2 is also essential for the optimal interplay of forces. Its
effect on healthy vessels has been demonstrated in large scientific studies.

8.5.7 Omega 3 Fatty Acids

Scientific studies show that omega-3 fatty acids are anti-inflammatory, thus
reducing the risk of secondary diseases such as cardiovascular diseases, cancer and
dementia. The positive effect with regard to cardiovascular diseases is further
enhanced by an improvement in the flow properties of the blood.
In addition, Omega 3 fatty acids improve the cognitive abilities demonstrably.
In this respect, DHA is particularly important, whereas EPA has a positive effect
on the cardiovascular system.
The main source of this is traditionally fish oil, with krill and algae oil becoming
increasingly significant.
Linseed oil is a good Omega 3 source, however, it has to be metabolized first,
since in this case the two components DHA and EPA are not yet accessible.

8.5.8 Q 10

A coenzyme that plays a prominent role in the energy production of cells.

It is also important for good muscle function, especially the heart muscle should
be mentioned here.
Q 10 should be taken in any case when cholesterol-lowering medication (statins)
is taken, as this medication causes a drastic drop of the Q 10 level.

8.5.9 Plant Nutrients

There is a large number of plant nutrients that have adaptogen properties. These are
substances, which facilitate the adaptation of the organism to the external
conditions.
Representative of many others are Rhodiola (rose root), Passiflora (passion
flower) and Ashwaganda (from Ayurveda medicine).
8 Food Supplements = Supplement to Food 151

8.5.10 Amino Acids

Amino acids are the building blocks of proteins. While carbohydrates serve almost
completely, and fats for the most part, as energy generators for coping with
everyday life, it is the main task of proteins to build up body structures.
This means that bones, skin, mucous membranes, connective tissue, hair, nails,
muscles and most organs are made up of amino acids. But also a large proportion of
the hormones, transport carriers in the blood, immunoglobulin and neurotransmit-
ters in the brain are continuously formed from amino acids.
The current state of science stipulates that 20 amino acids can build up about
1 million different proteins; these construction and conversion processes happen at
incredible speed and intensity. Thus, it is assumed that about 2.5 million new red
blood cells are formed every second, that the intestinal mucosa is renewed every
7 days and the skin every 28 days.
To make a projection, it means that we are “renewed” every 7 years.
In emergency times, however, amino acids can also act as energy producers. In
this case, they are mainly removed from the muscles, which in the long run is, of
course, not a desirable effect.
In the particular context of this book, it is above all the neurotransmitters in the
brain that are of primary interest, but also the amino acids, which are important for
the immune system or as building blocks for hormones.
Of the 20 amino acids, depending on the author, 8–10 are considered essential,
which means that they must be supplied to the organism, while the remaining ones
can be formed from these essentials. In particular stress situations even the
non-essential ones become essential, because the need is much higher.
Amino Acids and the Brain
It is scientifically proven that the presence of certain amino acids is crucial for a
smooth transmission between the nerve cells, the mood, the mental faculties and
ultimately for a restful sleep.
Amino acids also activate genes that are responsible for stress resistance. In this
respect new knowledge is continually being gained, as new metabolic pathways are
constantly being discovered.

8.5.11 Tryptophan

One of the most studied substances in this context is the essential amino acid
tryptophan. If tryptophan is kept artificially high or particularly low in the course of
experiments, characteristic differences in brain function and behavior are observed.
In case of deficiency, mainly depressive moods and increased aggressive
behavior occur. It could also be shown that tryptophan administration leads to better
sleep and reduced pain perception. These changes correlate with the serotonin level
152 I. Spona

in the brain. Tryptophan is the precursor for this messenger substance, which is
ultimately responsible for our mood.
It was also shown that the decision-ability is impaired at a low tryptophan level.
In the presence of stress hormones, tryptophan is increasingly degraded, so the
need is greater in this situation.
Tryptophan is the precursor of melatonin, whose importance goes far beyond the
regulation of the day/night rhythm according to recent studies. It also plays a major
role with regard to mood, immune system, and anti-aging and is now considered
one of the most important antioxidants.

8.5.12 Phenylalanine/Tyrosine

Tyrosine is a non-essential amino acid that can be formed from the essential amino
acid phenylalanine.
It is the starting point for stress hormones adrenaline and noradrenaline, for
dopamine and also for thyroid hormones.
Dopamine, next to serotonin, is another crucial messenger substance in the brain,
which is commonly referred to as happiness hormone, because it controls the
reward system in the brain and thus stimulates pleasant feelings. It also controls
attention, learning ability, motivation, and motor skills.
It has been proven that tyrosine has positive effects on stress resistance.

8.5.13 Glutamic Acid (Glutamate)/GABA/Glutamine

These 3 messenger substances are closely related to each other, because, if required,
they can be converted very quickly into one another by relatively simple chemical
reactions.
Glutamic Acid
is a non-essential amino acid and is particularly interesting in our context with
regard to 2 functions:
On the one hand, glutamic acid (also referred to as glutamate in medical liter-
ature) is a stimulating neurotransmitter. It is very important for learning and
memory performance and plays a crucial role in the transmission of sensory
perceptions.
On the other hand, it is one of the 3 amino acids that form glutathione.
Glutathione is enormously important because it is the most important radical
catcher of the organism. This means that the so-called free radicals, which occur in
the metabolism, are neutralized by glutathione. If these free radicals accumulate, as
is often the case in stress situations, oxidative stress can occur which can damage
the cells and organs. In such situations, glutathione is inherently important.
8 Food Supplements = Supplement to Food 153

GABA
Through a special enzyme, glutamate can be traced back to its direct counterpart,
GABA. It is an inhibitory messenger substance that acts as a natural sedative. It
works to relieve anxiety and promote a restful sleep in a natural way.
Glycin
Is another inhibiting messenger substance. Scientifically studied and proven is its
sleep-inducing effect. Very often, the intake of a small amount of glycine is ben-
eficial right before sleeping.
Lysine
Lysine is essential and it is the amino acid that first leads to visible signs of
deficiency if the diet mainly consists of cereals.
It could be shown that anxiety states were significantly more frequent due to
stress load with lysine deficiency. These could be improved significantly by lysine
administration.
Lysine also has a significant effect concerning herpes, the “cold sores”, which
occur more frequently in stressful situations.
If lysine is taken at the first signs, such as itching and burning skin, a full
outbreak can often be prevented.
Glutamine
represents the largest proportion of the amino acid pool in the human organism.
Nevertheless, it is not essential. The quantity of glutamine is usually sufficient, but
in particularly stressful situations an additional intake may be very helpful. This can
be inferred from its numerous functions.
An important function is the detoxification of ammonia, which occurs within the
protein metabolism. In excess, ammonia impedes the energy production in the cells.
It is particularly involved in the formation of glutathione via glutamic acid, into
which it can be converted very easily.
Glutamine plays an important role in the immune system because it is the main
energy source of leukocytes. These different white blood cells are the basis of any
immune reaction. There are studies that show that glutamine prevents the detri-
mental effects of high stress due to physical stress with regard to a weakening of the
immune system.
Glutamine is a key player with regard to intestinal health, because it facilitates
the cohesion of intestinal mucosa cells and thereby prevents the entry of bacteria or
toxins into the blood circulation, i.e. it prevents the negative effects of “leaky gut”.
Glutamine deficiency can thus lead to disorders of the important intestinal
barrier.
Arginine
Is the precursor of NO, nitrogen monoxide.
For this discovery, the Nobel Prize in Medicine was awarded in 2008.
NO is a gas which acts as a vasodilator, that is, in this way, it can promote blood
circulation and act against high blood pressure. This effect has also led to the
attribution of the name “natural Viagra”.
154 I. Spona

In addition, it is the first barrier to penetrating germs, thus playing an important

role in the immune system.
It improves wound healing, has anti-inflammatory properties and improves
resistance to insulin, which are all effects that are of great importance during high
stress loads.
Arginine is also essential for the degradation of ammonia.
However, particularly in the case of arginine, the right quantity determines the
positive or negative effect, as too much NO is counterproductive.
Methionine/Cysteine
Is an essential amino acid and supplies the organism with sulfur. It is the original
substance of cysteine, which in turn is part of glutathione.
Methionine is also the substance that starts any protein synthesis, that is, any
structure buildup. The proteins are formed in such a way that the amino acids are
lined up in accordance with the genetic code.
Methionine is always the first amino acid in “threading the bead chain”.
Methionine is anti-inflammatory as well.
Histidine
Should be mentioned at this point, since it plays an important role in detoxification,
especially of metals. Exposure to mercury (amalgam), aluminum or lead from old
water pipes is frequent and poses a major burden for the organism.

8.6 Last But Not Least—The Intestine

This topic is now filling libraries and rightly so, because it is an organ that is very
sensitive to stress.
The intestine ultimately has two main tasks:
It is responsible for ensuring that the nutrients are duly processed for the
organism and transferred into the blood circulation, where they are available for the
countless metabolic processes.
However, it represents a barrier, which does not allow inappropriate agents, such
as, for example, penetrating germs.
The intestinal mucosa fulfills this task. It is strongly folded and has innumerable
protuberances, the so-called intestinal villi. If the intestinal mucosa were spread, it
would cover the unimaginable area of more than 300 m2. The intestine is the largest
immune organ and is populated by more than 400 bacterial strains weighing a total
of almost 2 kg.
In stressful times it can happen that bad germs populate the intestine. This leads
to severe flatulence, food intolerance, defecation problems or stomach pain.
Additionally, an increasing number of inflammatory substances are built, which
have a negative effect on the immune system in the long run.
8 Food Supplements = Supplement to Food 155

Intestinal Repair
Is therefore extremely important in the context of stress and consists of three
components:
1. Probiotics:
These are intestinal germs that correct the negative effects of miscolo-
nization. Good products usually contain several bacterial strains.
2. Prebiotics:
are indigestible fibers that serve as a food substrate for the intestinal
bacteria. They are fermented in the intestine and in this way the beneficial
intestinal bacteria are promoted.
3. Amino acids:
are useful for the intestinal mucosa—on the one hand as building mate-
rials for the mucous membrane and on the other as nutrients for the
bacteria.

This small collection of useful substances can, of course, only be incomplete in

this limited space and can merely be regarded a suggestion. Especially in
demanding times the application of supposedly harmless remedies should be carried
out in consultation with the treating physician or therapist, also with regard to the
quantity. Not always is a more of good things beneficial.
In principle, it is, of course, best if deficits are detected by measurements so that
they can then be supplemented precisely.

Further Reading

Dibaba DT et al (2014) Dietary magnesium intake is inversely associated with serum C-reactive
protein levels: meta-analysis and systematic review. Eur J Clin Nutr 68(4):510–516. doi:10.
1038/ejcn.2014.7 Epub Feb 12
Harding HP et al (2003) An integrated stress response regulates amino acid metabolism and
resistance to oxidative stress. Mol Cell 11(3):619–633
Ishrat T et al (2006) Coenzyme Q10 modulates cognitive impairment against intracerebroven-
tricular injection of streptozotocin in rats. Behav Brain Res 171(1):9–16
Jenkins TA et al (2016) Influence of tryptophan and serotonin on mood and cognition with a
possible role of the gut-brain axis. Nutrients 8(1). pii: E56. doi:10.3390/nu8010056
Kelly JR et al (2015) Breaking down the barriers: the gut microbiome, intestinal permeability and
stress-related psychiatric disorders. Front Cell Neurosci 9:392
Kuebler U et al (2013) Plasma homocysteine levels increase following stress in older but not
younger men. Psychoneuroendocrinology 38(8):1381–1387
Lim SY et al (2016) Nutritional factors affecting mental health. Clin Nutr Res 5(3):143–152
Stough C et al (2014) Reducing occupational stress with a B-vitamin focussed intervention: a
randomized clinical trial: study protocol. Nutr J 13:122
Swanson D et al (2012) Omega-3 fatty acids EPA and DHA: health benefits throughout life. Adv
Nutr 3:1–7. doi:10.3945/an.111.000893
156 I. Spona

Walker AF et al (2003) Mg citrate found more bioavailable than other Mg preparations in a

randomised, double-blind study. Magnes Res 16(3):183–191
Yan YX et al (2016) Investigation of the relationship between chronic stress and insulin resistance
in a Chinese population. J Epidemiol 26(7):355–360
Z Jin et al (2013) GABA is an effective immunomodulatory molecule. Amino Acids 45(1):87–94
Żychowska M et al (2015) Vitamin C, A and E supplementation decreases the expression of
HSPA1A and HSPB1 genes in the leukocytes of young polish figure skaters during a 10-day
training camp. J Int Soc Sports Nutr 12
Chapter 9
Nutrition for Body, Mind and Soul

Gerhard Moser and Ingrid Pirker-Binder

Contents

9.1 cPNI—Food as a Health Factor........................................................................................ 158

9.2 cPNI and Frankl’s Logotherapy and Existential Analysis ............................................... 160
9.3 Gut-Brain Axis: Interactions and Mood Parameter .......................................................... 161
9.4 Leaky Gut Syndrome ........................................................................................................ 163
References .................................................................................................................................. 165

The food you eat can be either the safest and most powerful form of medicine or the slowest
form of poison (Ann Wigmore).1

“Death is located in the intestine”—traditional Chinese medicine has already

attributed crucial importance to the intestine. Its significance is by far higher than
generally known: the intestinal surface of the digestive tract of an adult corresponds
approximately 500 m2 (skin surface about 2 m2), the length of the intestine is about
8 m. The intestine is home to about 80% of the immune system cells, 90% of the
“happiness hormone” serotonin, and is therefore primarily responsible for the
body’s defenses. (Priumboom et al. 2014)
Listlessness, fatigue, skin problems, allergies and asthma—these are but a few,
widespread examples of symptoms and syndromes that can be attributed to a lack of
intestinal health, even if the cause of health problems is often suspected elsewhere.

1
http://www.goodreads.com/quotes/563016-the-food-you-eat-can-be-either-the-safest-and, last
access on 2.1.2017.

G. Moser
I. Pirker-Binder (&)

Aigenpeterweg 345/4, 5424 Vigaun, Austria
e-mail: offi[email protected]
G. Moser
e-mail: [email protected]

© Springer International Publishing AG 2017 157

I. Pirker-Binder (ed.), Mindful Prevention of Burnout in Workplace Health
Management, https://doi.org/10.1007/978-3-319-61337-6_9
158 G. Moser and I. Pirker-Binder

The modern, western diet is characterized by sugar, milk and wheat products, which
results in a leaky gut. The key to a healthier life is a specific and health-conscious
diet. The new science of cPNI—clinical psycho-neuroimmunology shows us in an
understandable way how nutrition can promote health, energy and balance.
With her quote, “The food you eat can be either the safest and most powerful
form of medicine or the slowest form of poison”, Ann Wigmore gets to the heart of
the matter. The importance of a proper diet does not only apply to our beloved pets,
but especially to us humans, if we want to have a healthy, vital, satisfying life and
use all the life potential available to us. Eating is more than just food intake—it
connects us with Mother Nature, with community experiences and emotions: fun,
pleasure, taste. What is more, it has an effect: either positive or negative, depending
on the importance given to nutrition as a fuel for the power plant called human
being—and it affects everyone; child, adult, the sick, athletes, managers.
Nutrition is equally necessary for our survival, performance capability and health
as oxygen is for breathing. In addition to caring for our attitude to life and main-
taining the functional capacity of the autonomic nervous system, a suitable diet is
another fundamental pillar of prevention.

9.1 cPNI—Food as a Health Factor

cPNI-clinical psycho-neuroimmunology is a young science that has its origins in

classical psycho-neuro-immunology (PNI). The father of PNI is the psychologist
Robert Ader (Ader and Cohen 1975).2 He was able to prove for the first time that
the immune system works together with the central nervous system and that it is
capable of learning. PNI is also considered a field of modern psychosomatic and
psychotherapeutic research; it deals with the communication, cooperation and
interaction of the psyche, nerves, hormone and immune systems in the human body.
cPNI transfers the resulting findings into the therapeutic everyday life. Its tool is a
suitable diet, herbs, and/or other active substances to support the body’s regener-
ative and regulatory measures. It is not about symptom control, but about restoring
the healthy functioning of the body or supporting it in its operation.

2
Ader and Cohen (1975), pp. 333–340.
9 Nutrition for Body, Mind and Soul 159

cPNI pioneers were Bram van Dam, Leo Pruimboom (Priumboom et al. 2014)
and Kharrazian (2013). In cPNI, the focus of attention is, on the one hand, epi-
genetics and, on the other hand, on influencing physiological inflammatory pro-
cesses. In epigenetics it is considered that even though the DNA of humans is
created at birth, it is greatly influenced by the environment, attitude towards life (see
LifeSkriptAnalysis, Chap. 6) and lifestyle. That is, while an inherited disposition
for certain diseases and ailments, such as cardiac diseases, may exist, but the
individual does not necessarily have to suffer from it. “However, whether a gene is
switched on or switched off is largely dependent on the respective environmental
conditions in most genes” (Bauer 2002).3
Chronic inflammatory reactions, caused by an unhealthy lifestyle, malnutrition
due to a poor diet, lack of movement and stress are the most frequent companions of
the 21st century. cPNI states resolemics (from: to resolve) as the most important
other task. Inflammatory reactions for the self-healing of the organism are vital
processes. However, unhealthy lifestyle, psychological strain and permanent stress,
can cause chronic inflammations, which are then the starting point for a variety of
diseases and ailments. Resolemics is based on healthy nutrition and an individual
diet supported by necessary food supplements.

3
Bauer (2002), p. 26.
The gene of the immune messenger substance Interleukin 6 can be activated by inflammatory
factors as well as by psychological stress. The activation of genes by psychological stress has not
only been proven for Interleukin 6 but also for numerous other genes (such as the stress gene
CRH) J. Bauer, p. 36.
160 G. Moser and I. Pirker-Binder

9.2 cPNI and Frankl’s Logotherapy and Existential

Analysis

Psychological strain, caused by a transgenerational trauma,4 birth experience, life

and environmental experiences, and/or chronic workloads, lack of exercise and
a poor diet, affect the functional capacity of the organism. They disturb the body’s
balance. The result is a weakened immune system, chronic inflammatory processes,
rising infections, allergies, and food intolerances. Both, the soul and the body
suffer. This requires careful reflection on life, a re-evaluation of the individual life
story. If you know yourself better and understand the signals of your body, a
conscious reorientation is easy. In order for this to succeed, a sense of meaning and
determination are necessary. This is the task of psychotherapy. In Frankl’s
logotherapy and existential analysis there is the concept of NOO-psycho-somatics.
It means the influence of the mind on the psyche and the soma (body). NOO refers
to the word NOUS from ancient Greek philosophy and means spirit; translated into
the therapeutic language of logotherapy, it is the spiritual dimension from which
humans can take a position on themselves and their being (see Chap. 3).

cPNI represents a useful supplement to logotherapeutic interventions in the field

of prevention. In particular, it requires the client’s active, self-determined collab-
oration. Psychotherapy, with its tools aiming at a change in attitude, lifestyle change
and healing of mental conflicts, has a great influence on the immune system of the
organism. Every affect status determines the immune status (Lukas 1998). In
contrast, cPNI takes a different scientific approach and supports the immune system
with natural food and active ingredients from nature (herbs, etc.).

4
Transgenerational traumas are severe psychological strain (e.g. wartime experiences) whose
psychological experience (e.g. inexplicable anxiety, etc.) is passed on to later generations. Traumas
can be detected in male semen.
9 Nutrition for Body, Mind and Soul 161

9.3 Gut-Brain Axis: Interactions and Mood Parameter

Physical and mental health are inextricably linked, as are eating and digesting. In
traditional Chinese medicine and Ayurveda, the intestine is the center of health.
Actually, this is logical, because everything we eat must also be digested and
available for the energy production and maintenance of our life energy and health.
If the intestine does not get what it needs, the effect on the soul is negative. The
saying that people are what they eat is becoming increasingly important. Kirsten
Tillisch (ULCA Newsroom 3013) was able to demonstrate the effects of intestinal
bacteria on the brain and the emotional condition. In his book “Why isn’t my brain
working?” Kharrazian describes very convincingly the connections of a
non-functional brain with intestinal problems and the related malfunctions and
disharmonies in the organism.
The intestine is a highly complex system with its own nervous system, the
enteric nervous system. It absorbs information from the inside of the body and food,
processes it, and passes it on. For this reason, the digestive system is also called the
intestinal brain. How does this connection work? The information carrier is the
vagus nerve, which emanates from the brain stem and goes through all internal
organs. This 10th cranial nerve is decisively involved in the regeneration and
regulation capacity of the organism. (More about regeneration and vagus nerve in
Chap. 12).
The institute “Initiative Gehirnforschung Steiermark” (Initiative Brain Research
Styria) deals with the communication system stomach-intestine-brain (see Fig. 9.1)
thereby cooperating with reputable institutions. Together they have been able to
locate four information channels between the brain and the gastrointestinal tract:
• Signals of the intestinal microbiome
• Gut hormones
• Messenger substances of the immune system
• Sensory neurons
Through these pathways they exert influence on the psychological condition or
susceptibility to stress and the emotions, and with them on the cognitive processes
and the amount of food that humans take in.
The latest research is concerned with the influence of the intestinal bacteria on
the metabolic processes and thus on the effects on the weight. At the University of
Leuven, Belgium, under the supervision of Professor Patrice Cani, examinations
have shown that the intestinal flora not only changed due to heavy fat consumption,
but also made it permeable, giving toxic molecules unimpeded access to various
organs thereby causing inflammatory reactions.
The so-called intestinal flora, or microbiota as it is called today, has an influence
on feelings, motivation, immune defense and the early warning system in the case
of diseases. They thus influence the behavior more than previously assumed. In
order to feel healthy and active, it will be important to avoid or reduce stress stimuli
162 G. Moser and I. Pirker-Binder

Microbiome-intestine- Appetite and energy balance

Emotion and mood
brain-axis Stress resilience
Brain Learning and memory
pain

Microbial factors
Intestinal hormones
Zytokins Autonomous neurons
Sensitive neurons hormones

Intestine-nervous system

Intestine-immune system

Intestine-mucosa M E L M E

Intestinal-microbiome
800-1000 kinds of bacteria
100 trillion cells
3 million genes

Fig. 9.1 The microbiome-intestine-brain-axis. Image source Institute for experimental and
clinical pharmacology of the University of Graz; cited according to Prof. Dr. Peter Holzer

and, on the other hand, to take care of the food we give the intestinal bacteria so that
they can easily perform their most important task in the human body
(Rieser-Lembang 2016, p. 119).
Physical and psychological/mental health are directly linked. The brain plays an
essential role in the digestion/metabolism5: the “transport” of the food through the
body, the release of digestive enzymes, which break down the foodstuffs, as well as
the regulation of the blood circulation, which promotes intestinal health and repair,
are controlled by the brain.
Through the five sensory organs (eyes, ears, nose, mouth, skin), the brain per-
manently receives information about the environment. Based on this information, it
responds. These responses can be actively controlled to a certain extent; this is the
motor system accounting for about 10% of the total brainpower. The majority of the
brainpower, namely the remaining 90%, is used for passively controlled processes.

5
Kharrazian: Why isn’t my brain working? p. 164 ff.
9 Nutrition for Body, Mind and Soul 163

In addition to digestion, this includes heartbeat and breathing. Consequently, brain

performance is concentrated to a large extent on involuntarily controlled, vital
processes!
Decreased brain performance affects the functioning of the intestine. The
impairment is noticeable, for example, by reduced memory, articulation or learning
difficulties. As a result, digestive disorders (for example, bloating, diarrhea) can
occur.
When the brain activity decreased, observations showed that the digestion
function was the first to be impaired. If the performance of the brain continues to
diminish, further intestinal problems as well as loss of control over the bladder
result.

9.4 Leaky Gut Syndrome

Intestinal health has a major influence on the general wellbeing of humans.

Unfortunately, the intestine is generally given relatively little attention, although its
importance is increasingly emphasized.
Many symptoms emanate from limited intestinal function such as allergies,
asthma, celiac disease, Crohn’s disease, depression, diabetes mellitus type 1,
Hashimoto’s disease, migraine, multiple sclerosis, psoriasis, rheumatism, acne, low
blood pressure, arthritis and osteoporosis.
Intestinal wall cells are located on the intestinal surfaces. These intestinal wall
cells are connected with cell connections “tight junctions” and thus form a barrier
for the protection of the intestinal wall. Through the release of stress hormones
(noradrenaline and cortisol) or due to a poor diet and malnutrition (lectins, gliadins,
saponins6), these cell connections are weakened or even destroyed, resulting in an
opening in the intestinal wall. Food components (especially gluten), bacteria and
viruses enter the intestinal tract, where they are absorbed by macrophages
(phagocytes) and identified as intruders. The body’s immune system fights these
intruders by means of cell-destroying substances and inflammatory reactions. This
process also damages other cells. A part of the inflammatory substances enter the
organism via the blood channels and lymph and lead to innumerable secondary
diseases.
Many people of Western civilization are doubly vulnerable by the release of
stress hormones and malnutrition.
Especially long-lasting, so-called permanent stress weakens the organism gen-
erally, in particular the intestinal connections and thus the intestinal health.

6
Gliadins occur primarily in cereals and can destroy the connections between the intestinal wall
cells; lectins are defenses, which occur mainly in cereals and legumes. They can bind to intestinal
wall cells and thereby damage them. Saponins are soap-like substances which can bind to the
cholesterol of intestinal wall cells and thus damage them. When potatoes or legumes are boiled,
they can be recognized by their foaming property (beer).
164 G. Moser and I. Pirker-Binder

The most common dietary habits leave much to be desired. Despite an over-
supply and overprovision of food, a serious under-supply of nutrients can be
observed. In particular, inflammation-inducing and acid-forming substances in the
food lead to permanent defensive reactions of the body. The immune system is
permanently active and cannot respond to emergency situations due to a lack of
other resources. Diseases occur because of the weakened immune system.
Everybody can actively counteract the destruction of cell compounds and
intestinal cells. This is done with simple means, especially a basic diet change
focusing on base-producing meals and sufficient liquid intake.
In addition, a multi-phase intestinal rehabilitation, which can easily be integrated
in everyday life, is recommended. At the beginning, the intestine is healed, then
thoroughly cleansed, and finally, the intestinal flora is restored.
Case Study 1
Ms. C, mid-40, entrepreneur, coach and mother suffers from a lipoedema stage 3.
For years, she tried various diets; recently she tried to control her weight and her
insulin resistance with an HCG diet (500 kcal, and pregnancy hormones).
Before the weight reduction could be started, the removal of venous weakness
was tackled as a first step. By means of adapted nutrient supply, optimal intestinal
function was restored. At the same time, the nutrient concept supported and posi-
tively influenced the blood flow, fibrosis and low-grade inflammation in the white
adipose tissue. The next step was to develop an enhanced nutrient concept for the
thyroid function.
After 8 months, the attending physician told Ms. C that the lipoedema had
stopped growing. Her condition had improved dramatically, she had normal bowel
movement again (she had not had it since she was 14), no inner pain, and the kilos
tumbled.
Conclusion: it is always about a restoration of the internal regulatory mecha-
nisms and a change in lifestyle. For this, cPNI provides valuable information.
Case Study 2
Ms. M, 34, owner of a group fitness franchise chain, had gone through a seemingly
endless process of unsuccessful therapies.
Her complaints were:
• Allergies (apple, milk, tomato, wool, citrus fruits, grasses, glutamate, aggravated
allergy symptoms at night)
• Diabetes II
• Emotional stress, adrenal fatigue,—skin impurities/reactions
• “Toilet paper” allergy
• Concentration weakness
• An emotional collapse
• Massive abdominal pain during the female cycle with suspected endometriosis,
chlamydia
9 Nutrition for Body, Mind and Soul 165

The therapy program included:

A change to a nutrient-rich, alkaline-forming and anti-inflammatory diet, free of
gluten, lactose and industrial sugar. No food alone is a potent trigger for neuro-
logical problems and autoimmunity. It is often the interplay of many minor or major
problems, which leads to massive health problems, which inhibit the organism in its
functional processes. Routine standard test methods often do not provide the nec-
essary information. Often extensive gluten sensitivity and autoimmunity tests are
required.
Special attention should be paid to the intestine to influence the leaky gut
positively through special food products. A healthy intestine is a guarantee for the
maintenance of life energy and mental health.
Once the nutrient deficiency was cured and the intestine healed, the organism
was able to carry out its regeneration and regulation processes, the stress boosts
became less and less, the energy increased. After over a year of consistent imple-
mentation of all concepts all complaints had disappeared.
• A poor diet and stress lead to lack of energy and premature aging. Thanks
to cPNI numerous ailments can be eased and health can be restored. We
have but one health—it absolutely makes sense to preserve it. Health starts
with one’s individual life style and the fuel we supply for our body.

References

Ader R, Cohen N (1975) Behaviorally conditioned immunosuppression. Psychosom Med 37(4)

Bauer J (2002) Das Gedächtnis des Körpers; wie Beziehungen und Lebensstile unsere Gene
steuern. Eichborn AG, Frankfurt am Main
Kharrazian D (2013) Why isn’t my brain working? Elephant Press LP, CA, USA
Lukas E (1998) Lehrbuch der Logotherapie. Profil Verlag München, Wien
Priumboom L, Reheis D, Rinderer M (2014) Wirk-Kochbuch, 2nd edn. Hohenems-Wien,Vaduz
Rieser-Lembang B (2016) Der Darm und seine Gefühle. In: Prävention von Erschöpfung in der
Arbeitswelt, German edn. Springer, Berlin-Heidelberg
Wigmore A http://www.goodreads.com/quotes/563016-the-food-you-eat-can-be-either-the-safest-
and. Last access on 2 Jan 2017
Chapter 10
People and Their Workplace

Ingrid Pirker-Binder

Contents

10.1 Office Environment.......................................................................................................... 168

10.1.1 Rising Popularity of Open-Plan Offices............................................................. 168
10.1.2 The Closed Door or the Right to Undisturbed Work........................................ 169
10.1.3 Home Office........................................................................................................ 171
10.2 The Workplace at Distant Places: Risks and Possibilities ............................................. 172
10.3 Process Model: Work-Script Analysis ............................................................................ 176
References .................................................................................................................................. 178

Not only the work content and requirements have changed considerably in recent
years, but also the workplace, workplace design and working hours. Currently there
is a trend away from the individual office towards flexible workplaces, working
units, open-plan offices and home office. Despite all the dynamics people and their
needs must not be forgotten. The workplace should be conducive to the people’s
needs. Not all new models are suitable for all people. There must be a development
and research, which place the people at the center and do not fit people into the
models in retrospect.
Flexibility of workplaces, working hours and work content mean more
responsibility and self-management for individuals. Frequently the people lag
behind these conditions. Learning steps and responsibility management are nec-
essary. In times of technological progress and permanent availability work-life
balance is giving way to a new concept of work-life integration and interaction. It is
about the integration of work and leisure in the daily life.
For prevention as well as intervention measures in the case of exhaustion at the
workplace, it is necessary to analyze the work area to identify stress fields. While
Life-Script-Analysis records the individual or business meaning and experience

I. Pirker-Binder (&)
Saileräckergasse 43/26, 1190 Vienna, Austria
e-mail: offi[email protected]

© Springer International Publishing AG 2017 167

I. Pirker-Binder (ed.), Mindful Prevention of Burnout in Workplace Health
Management, https://doi.org/10.1007/978-3-319-61337-6_10
168 I. Pirker-Binder

framework, Work-Script-Analysis refers to the meaning and experience framework

of work, the working environment, the physical and psychological effect and
experience of work.

10.1 Office Environment

10.1.1 Rising Popularity of Open-Plan Offices

In Austria the space and air requirements per employee are regulated in the
Workplace Ordinance (Arbeiterkammer Wien 2015a, b). Amongst others it deals
with the control of the room height (3 m, at a size of 100–500 m2 also 2.8 m, up to
100 m2—without physical strain—also 2.5 m), the floor area which is allocated to
each worker (minimum 8 m2, for each additional employee 5 m2) and the air (with
low physical stress at least 12 m3). The objective of the Workplace Ordinance is to
adapt the workplace to the needs of the people working in it and not vice versa.
Looking for greater flexibility in the work organization, workflows and means of
saving costs, new models of workplace design were developed, such as the
open-plan office. This is a large open area, which is divided into smaller working
units without walls and doors.
The initial ideas for this model were formed by the following considerations
(Oommen 2008, p. 37 ff.):
• lower construction costs due to less space requirement: compared to individual
offices, more people can be accommodated on the same area.
• lower maintenance costs (heating, ventilation, air conditioning etc.).
• every employee has the same available space.
• easier communication between employees; this is supposed to increase pro-
ductivity and creativity.
• greater work flexibility due to the possibility to work in different areas without
regard for time and space.
• everything is centrally available.
• technical resources can be used more efficiently (e.g. copiers, printers, etc.).
What was disregarded in the planning of such offices is the uniqueness of every
person and the relationship between the physical environment, the need for quiet and
performance capability of each individual employee during work. The workplace
should be helpful and stimulating to the user; it should not be an obstacle or restrict
the employee in his/her capacity to work. Hence, it must support the working people
in their needs. Specifically, this can have an impact on the following factors:
• right to privacy: design possibility (pictures, plants, etc.).
• possibility to control one’s work environment: one’s own workplace that does
not have to be shared.
• feeling of security: many people feel observed when others are present.
10 People and Their Workplace 169

• right to quiet: conversations, people walking to and fro, subliminal noise caused by
conversation and phone calls can impede the attention and focus on difficult tasks.
• right to undisturbed working: in open-plan offices there is no barrier in the form
of a closed door.
• status and identity. Work in an open-plan office may entail status loss and/or
identity loss within the organization. In the open-plan office the individual is one
amongst many others.
If the workplace is used by different people through job rotation (several
employees share a workplace), not only the feeling of control is lost, but also
privacy (everyone has his/her filing habits, or would like to find the workplace in
the same condition as he/she left it).

10.1.2 The Closed Door or the Right to Undisturbed Work

Many employees complain about continuous interruptions through telephone calls

or disturbance through colleagues. Many have problems closing their office door or
not answering a phone call or e-mail immediately. “My door is always open for
everybody,” I hear very often. It is a matter of organization to create quiet periods
for undisturbed work for oneself, be it closing office doors for certain times or not
responding to enquiries immediately. It has also been proven useful to put time for
concentrated working into the calendar system just like appointments.
If employees share a room with colleagues, mutual consideration is necessary. It
has paid off to work with headphones at times of special concentration.
A young man whose job it is to develop game software, tells me that in his
company it works perfectly with headphones, “When I develop something, I put on
my headphones not only to be able to fully concentrate but also to enjoy the support
of quiet music. It is agreed with the colleagues that no one is to be disturbed as long
as the headphones are up.”
There is no door in open-plan offices that can be closed to signal the desire for
privacy. It is necessary to implement a regulation for undisturbed working. Even if
“quiet working islands” are provided, it is not always possible to use them, be it
because they are occupied, or documents cannot always be carried around.
Depending on the personality and the area of responsibility some employees are
also advocates of open-plan offices. However, in terms of efficiency it is beneficial
not to go over people’s heads when deciding on their workplaces. The increased
noise level in open-plan offices may lead to a stimulus overflow and hyperstimu-
lation among individual employees. Not everyone is the same, particularly when it
comes to scheduling, compliance with deadlines, concentration or a high level of
responsibility and decision-making for the tasks at hand.
Recent developments make it possible to reduce noise by means of structural
measures. Adequate office equipment and resources for the employees (e.g. head-
sets that reduce the noise of telephone calls or head-phones that provide quiet and
concentration for the working people) are conducive to a working atmosphere.
170 I. Pirker-Binder

If a company is planning to move from conventional offices into an open-plan

office, not only good and thoughtful planning is required but also preparing
the employees, who will be working in it, for the new way of working.
Open-plan offices demand a different kind of living together. In open-plan
offices a new culture of consideration is necessary.

Mr. M, an aspiring employee of a large company, reports on the open-plan office. It has
existed for a long time and does not meet the current state-of-the-art anymore. Mr. M is
suffering from the constant disturbances, on the one hand by impromptu meetings close to
his workspace or, on the other hand, by the smell of a doner kebab, a colleague likes to eat
during work. The smell then spreads in the whole office. Mr. M also attributes the source of
the disturbances to weak management.

• Sensitive and highly sensitive people particularly suffer in an open-plan office.

Oommen (2008, p. 42) compares the following positive and negative aspects of
open-plan offices:
Positive aspects:
• lower construction costs
• lower costs for heating, ventilation, air-conditioning
• more people per area
• equal workspace for all employees
• greater communication possibilities
• improved cooperation
• greater flexibility to work in different areas
Negative aspects:
• high noise level
• loss of concentration
• lower productivity
• reduced privacy
• status problems
• feeling of insecurity
• dissatisfaction with work
• more conflicts at the workplace
• more stress, risk of infection, physical and psychological exhaustion, muscle
aches, tiredness and elevated blood pressure
• higher fluctuation
The Stress Research Institute and the Institute for Psychology at the University
of Stockholm have pursued the question whether office design has an influence on
sickness rates (Bodin Danielsson et al. 2014, p. 139 ff.). Thereby seven different
kinds of offices were compared (Table 10.1).
10 People and Their Workplace 171

Table 10.1 Different kinds of offices, classification according to Bodin Danielsson et al. (2014)
Cell office Traditional single room, high level of concentration, all necessary office
equipment available in the room
Shared room 2–3 people
office
Traditional 4–9 people/ 10–24 people/room: More than 24 people/room:
open-plan room: “medium-sized open-plan “large open-plan office”
office “small office”
open-plan
office”
Flex office There are no individual workplaces but workstations, i.e. rooms for
concentrated work, for making telephone calls, meeting rooms. Workplaces
can be chosen freely
Combi office More than 20% does not take place at the individual workplace; there is
teamwork. The focus is on rooms for group activities

1852 people participated in the Swedish study, which could establish a signif-
icant link between sickness rates and office design. Traditional open-plan offices
showed an increased rate of short sickness rates.
A higher risk of longer sickness absences was documented for women in
open-plan offices, for men in flex offices.
1230 people participated in the SBiB study (Amstutz 2010), a Swiss survey on
the evaluation of the working conditions. It is notable that the type of office was not
rated as decisive in the first place, but rather whether the workplace meets the needs
for working qualitatively. Below essential characteristics of a workplace were
named:
• possibility of 2–3 hours undisturbed work
• quiet in order to concentrate
• possibility to make phone calls undisturbed
The requirements were met best in the one-person office and were decreasingly
met the bigger the office size was.

10.1.3 Home Office

Due to new technologies and multi media applications the paperless office is not a
distant reality anymore. Flexible work hours and flexible ways of working con-
tribute to a change of the work world. In the future work will become less and less
connected to a workplace. The home office will become prevalent.
“New World of Work means more than merely flexible work. New World of
Work in companies appears more like a holistic concept of work innovation in the
dimensions people, place and technology (Bartz and Schmutzer 2015).
172 I. Pirker-Binder

Within the currently predominant dynamics people and their needs must not
be forgotten. The workplace should serve the people. Not all new models fit
all people. There must be a development and research that puts the human
beings at the center and does not place them into the new system afterwards.

Taking the example of the home office, it can be shown that establishing distance
to work is often more difficult than in the office. Statements by people working in
their home office like “I don’t even dare to have a break because if I’m not online
and available anytime, the colleagues in the company think I do not work! “Or”
When I work at home, I constantly have a bad conscience about not doing enough;
you might think I work too slowly or too little”, are very common in therapeutic
practice. Distancing oneself from work is difficult. A high level of commitment and
strive for perfection, missing tolerance for failure or mistakes directly lead to
exhaustion.
However, the home office also offers a great scope of work design and more
flexibility in time management. For all those who are able to organize themselves
very well, this model will be expanded in the future; new technologies facilitate
this. The disadvantage is that one is almost constantly in communication with the
company. Constant accessibility or the belief that they must be constantly available,
may put a strain on life quality and life energy.

Work-Life-Balance is changing into Work-Life-Integration and Interaction.

The working people have to learn that work is an integrated part of life and
vice versa. The thoughts, “Business before pleasure”, or “I am going to relax
when I have finished all the tasks” are outdated, as they do not work anymore
nowadays. The new media have made work omnipresent.

10.2 The Workplace at Distant Places:

Risks and Possibilities

Global economics makes traveling a necessity. On Monday morning the planes are
fully booked by people flying to work, sometimes returning daily or at the end of
the week. Without active stress and regeneration management these people run the
risk of being exhausted. Whether and what risks the traveler takes when his/her
workplace is in a distant place, depends on the following:
• time, frequency, duration of air travel
• shift work locally or abroad
10 People and Their Workplace 173

• intensity of work and working time

• ability to eat healthy and regularly
Many travelers take the early morning flight on Monday to get to their workplace
abroad. This usually means that they are already dealing with topics on Sunday that
are due on Monday, to be well prepared. The suitcase must be packed and the
night’s sleep is significantly shortened for a timely arrival at the airport. The work
then mostly starts on the plane and continues all day, often until late into the night.
Everything should be done quickly. Consequently, the daily working time is very
long, sometimes interrupted with breaks, but often they are ignored due to time
pressure. The return in the middle or at the end of the week is then filled with
follow-up work or preparations for next week, informing and delegating.
Case history frequent flyer a manager, who has spent his working hours in
Germany from Monday to Wednesday evening, complains that there is no time left
for him. Apart from the short night on Sunday, the evening after his return is busy
with working on accumulated tasks, so as not to forget anything and to get
important issues out of the head. He finds it useful to pack all the information in
emails, so that his employees are informed on the next day. With astonishment he
notes several times that he receives replies to his emails in the middle of the night.
But as soon as he gets an answer, he somehow feels compelled to write back again.
So it often happens that the time to sleep is much too short. Due to his frequent
travels, he also feels never to have time for himself; somehow he is either arriving
or departing. Especially the time missing on Sunday evening has become notice-
able. Vegetative functional diagnostics (24-h heart rate variability measurement)
clearly points out the strain.
Time pressure, completion dates and deadlines are energy killers. In particular,
however, striving for perfection and the inability to relax, but also an exaggerated
sense of responsibility towards work, lead to health risks at the workplace.
• Anyone who travels a lot should learn to integrate micro-breaks and regenera-
tion times.
There are chances for a longer or shorter break now and then, e.g. during a
meeting, when you are not actively involved, waiting times or just the necessary
times you spend on the toilet. In principle, recovery is quite simple, it requires
• letting go of the thoughts for a couple of minutes,
• relaxing the muscles (there are many tense, concentrated faces),
• the right breathing and
• mindfulness to the needs of the body.
– Those who forget about themselves and the needs of their body, fall by the
wayside sooner or later. Life goes by without having been lived. However, work
does not have to be fatal. It can be integrated into life because working time is
also lifetime.
174 I. Pirker-Binder

Case history heart attack

Mr. X is 40 years old and loves his profession. He is working on an important
project. He has problems with his health, his internist advises him to slow down.
Mr. X’s attitude, “I know, that I am running out of strength, but I need to finish this
task, then I will recover.” He made this statement in January. In March, he suffered
a heart attack. Those who do not stop the inner pressure and are in tension too long,
should not be surprised if the body reacts accordingly.
The assumption of great responsibility without distancing from work combined
with anxious expectation or foresight is bad. Foresight is good; expecting some-
thing negative may severely impede one’s health if it is a life and/or work pattern.
Those who have distancing problems or problems shutting off at the workplace, or
who constantly worry, should not hesitate to work through these issues with a
trained therapist.
Case history health
Mr. O, an executive on a drilling rig, comes into my practice. He is going through a
health check, because it has to be clarified whether Mr. O is capable to work again
after his last bypass operation (he has already had several). Mr. O is in a very poor
health condition. His cardiovascular system is severely damaged, which is visible in
both the biofeedback as well as in the 24-hour-heart rate analysis. From a thera-
peutic perspective Mr. O is no longer able to work - he is psychologically and
physically running on empty. His story is shocking. He tells me that he always has
four weeks off and then spends a fortnight on the drilling rig. As soon as he is
picked up by the helicopter after his vacation and flown to his workplace, he is in a
state of emergency. He is constantly worried, “What if fire breaks out?” He con-
stantly goes through the rescue measures in his head. Since he is a senior engineer,
a large part of the responsibility is on his shoulders. He has not learnt to switch off,
to build up a certain trust or to tense up in case of an emergency only and not
constantly. He has been working in this job for over twenty years; nothing has ever
happened—but his health, in particular his heart, has been seriously damaged by the
chronic tension, worrying and anxiety.

Fear and constant distress facilitate chronic tension and lead to narrowing of
the vessels. Being in a constant state of alert about a potential danger deprives
the body of sufficient rest and recovery during sleep. This results in the
regeneration mechanisms not functioning any more, i.e. the downward spiral
begins.

Through therapeutic measures, learning how to achieve inner silence and

regeneration, Mr. O would have been able to preserve his health and joy of life. An
executive has the function of a role model. It is not without reason to say, “If the
10 People and Their Workplace 175

executive is well, so are the employees!” A manager is responsible for the human
resources. Executives who constantly call their employees after work hours are not
an example.
Case history leadership and role model Mr. P is a controller in a company. He
puts himself under a lot of pressure, suffering from ruminating and not being able to
switch off. He feels burned out. He tells of his boss, who is a role model. She works
until late at night every day, because of work she decided not to have children or a
husband; work is her sole purpose in life. Therefore Mr. P feels obliged to work
equally hard or has a guilty conscience when he goes home early.
• Managers, who cannot distance themselves, disregard their resources and ded-
icate their lives to work, are no role models.

Shift work, diet at the workplace

People working in exposed positions at home or abroad carry a high responsibility
for their health and energy. Often, diet is a special issue, as there are either no
shopping opportunities or different eating habits at remote workplaces. It is on the
one hand the company’s task to prepare its employees for this, but also to encourage
them to take up responsibility for their wellbeing. This also applies to sleeping and
recreation times in the case of shift work.
Case history shift work Mr. M is a shift worker and works about 800 km from
his company location. After his shift he does not switch off his mobile phone, he is
virtually on “Standby” while he should actually observe rest periods. He complains
that his colleagues in the head office would not show consideration for this. “They
must know that now, in the morning, I am ending my shift,” he says. It does not
occur to him that the colleagues at the head office might not even have considered
this. He has not realized yet that he alone is responsible for his rest periods - and
that his mobile phone and computer should be switched off during these times. For
a successful communication with the parent company fixed times should be
arranged.

Flexibility of workplaces, working hours and work content means more

responsibility and self-management for the individual. Very often people lag
behind with regard to these requirements. Learning steps and responsibility
management are necessary. In times of technological progress and permanent
availability work-life balance is superseded by a new term: work-life inte-
gration. It’s about the integration of work and leisure into the daily life.
Mindful treatment of oneself is one of the learning objectives of integrating
work and leisure into the daily life.
176 I. Pirker-Binder

10.3 Process Model: Work-Script Analysis

For preventive measures and for intervention in the case of exhaustion at the
workplace it is necessary to analyze the work area to identify stress fields. While the
Life-Script Analysis records the individual meaning and experience framework, the
Work-Script Analysis focuses on the meaning and experience framework of work.
The Work-Script Analysis refers both to the work environment, as well as the
physical and psychological influence and experience, which might lead to a rough
classification into “hard facts” and “soft facts”.
The “hard facts” include:
• working contexts and work contracts, such as all-in contracts, work content,
areas of responsibility
• working hours: fixed or variable office hours, home office, workshop, shift work,
external office hours (in branch offices abroad, in the client’s office)
• working place: stable, changing, flexible
The “soft facts” include:
• corporate culture: mission, vision, values, meaning
• leadership: leadership culture, personality of the manager
• team: interaction, roles, work distribution, responsibility, conflicts, bullying
• break culture: regenerative break, nutrition (company kitchen), humor
• health awareness: information, workshops, healthy diet
• complaints: physical/psychological; stress-related, workplace-specific
(open-plan office, computer, assembly line, construction, travel activity)
Conflicts in the workplace or discomfort due to an inappropriate working
environment result in physical and psychological stress. According to the SBiB
study (Amstutz 2010) the need to be able to do concentrated work stands at 90%. If
the necessary peace and quiet is not given, the person concerned has to invest more
energy into keeping up the level of concentration. That means more effort
accompanied by an internal negative feeling (e.g. anger, impatience) of being
refused the necessary environment for work. Hence, the working time as well as the
quality of work suffers. The increased effort consumes more energy; fatigue and the
physical and psychological tension rise with the desire to complete the respective
task in the specified time.
The equipment of the workplace has a significant impact on the experience of
work. However, the best office chair does not help if the user sitting on it is tense.
Ergonomically designed and equipped workplaces are a prerequisite, yet training
the individual body perception regarding tension and unhealthy working postures
should be an integral part of all preventive measures. Perception exercises sup-
ported by biofeedback (Chap. 11) can reduce work-related physical tensions.
The Work-Script Analysis aims to receive an overview of necessary prevention
and intervention measures in the different work areas. These can be addressed to the
whole company, the leadership culture, one or more teams, but also only to
10 People and Their Workplace 177

Table 10.2 Work-script analysis

Area Content Perception Questions/solutions
Hard facts
Work All-in contract Balanced work Responsibility?
context/ expenditure area content
work workload
contract
Working Fixed office hours Physical Are there resulting
hours Variable office hours perception of the stress fields?
Home office strain?
Shift work Time for
External office hours regeneration?
Air travel?
Workplace Stable Physical/ Determining
changing psychological psychological/
flexible stress? physical stress
Office type Single office, open-plan office Fields of Determining fields
disruption? of disruption
Soft facts
Leadership Mission/vision Corresponding
values and quest for
meaning?
Team Interaction, roles, role patterns Work distribution, Appreciation,
responsibility respect, interaction?
SuMeCo
Information Email, telephone, open office Disruption Distancing oneself
culture door etc. Constant Rules for
availability communication
Break Regenerative break Physical Short regeneration
culture
Health Company kitchen Nutrition = energy Information
awareness Health promotion measures Wellbeing Responsibility
Complaints Stress-related Physical Determining stress,
Workplace specific (computer complaints sickness rates
workplace, air travel, shift
work etc.)

individual employees. The Life-Script Analysis and the Work-Script Analysis form
the basis for prevention and intervention measures against exhaustion at the
workplace (see Table 10.2).
178 I. Pirker-Binder

References

Amstutz S (2010) SBiB Studie: Schweizerische Befragung in Büros. URL www.seco.admin.ch

oder www.hslu.ch/cctp. www.news.admin.ch/NSBSubscriber/message/attachments/18922.pdf.
Last access on 23 March 2015
Arbeiterkammer Wien (2015a) ArbeitnehmerInnenschutz. URL: http://media.Arbeiterkammer.at/
wien/PDF/Publikationen/ArbeitnehmerInnenschutz/Arbeitsttaetten.pdf
Arbeiterkammer Wien (2015b) Arbeitsstätten; Gestaltung und Ausstattung von Arbeitsstätten.
URL: http://media.Arbeiterkammer.at/wien/PDF/Publikationen/ArbeitnehmerInnenschutz/
Arbeitsttaetten.pdf. Last access on 2 Aug 2015
Bartz M, Schmutzer T (2015) New world of work transformation - Herausforderungen auf dem
Weg zum Unternehmen der nächsten Generation. In Vorbereitung
Bodin-Danielsson C, Chungkham HS, Wulff C, Westerlund H (2014) Office design’s impact on
sick leave rates. Ergonomics 57:139–147
Oommen VG et al (2008) Should health service managers embrace open plan work environments?
A review. ASIA Pac J Health Manag 3:37 ff
Chapter 11
Mental Profile: Stress and Energy—A
Diagnostic Method: The CA Method
and Its Use in Practice

Bohdana Fialová, Jiří Šimonek, Marie Šťastná

and Ingrid Pirker-Binder

Contents

11.1 The CA Method .............................................................................................................. 180

11.1.1 Sensor and Data Collection Method .................................................................. 181
11.2 Sample Results of Diagnostics for Mental Stress and Energy Profile........................... 182
11.2.1 Verbal Schematic................................................................................................ 182
11.2.2 Constructive Types of Behavior ........................................................................ 183
11.2.3 Degree of Stress ................................................................................................. 185
11.2.4 The Balance of Body and Psyche...................................................................... 186
11.3 Advantages of Use in Practice ........................................................................................ 186
References .................................................................................................................................. 187

The article describes the CA method (Color association method) and its possible
applications in practice. The CA method is a combined projective technique using
calibrated sets of words and Lűscher Color Test. It measures the dynamics of
functional processes of consciousness, attitudes, i.e. comprehensive units within the
consciousness. The test is carried out via a computer program; the whole admin-
istration process takes 20–40 min with regard to personal pace and the extent of the
calibrated set of words. The results are computer processed and are available
immediately upon completion of the test. In current practice, the CA method is used
in HR, sport, education, market surveys and health.

B. Fialová
J. Šimonek
M. Šťastná

DAP Services a.S, Smetanovo Náměstí 328/1, 702 00 Ostrava, Czech Republic
e-mail: fi[email protected]
I. Pirker-Binder (&)
Saileräckergasse 43/26, 1190 Vienna, Austria
e-mail: offi[email protected]

© Springer International Publishing AG 2017 179

I. Pirker-Binder (ed.), Mindful Prevention of Burnout in Workplace Health
Management, https://doi.org/10.1007/978-3-319-61337-6_11
180 B. Fialová et al.

Furthermore, the utilization in prevention of burnout is described here, where the

diagnostic tool Mental stress and energy profile is used. This tool focuses on the
level of experienced and managed stress. With the help of value word schemes it
attempts to identify its sources. Another measured item is body-mind balance,
which makes it possible to see whether these parts are in balance and whether they
support and complement each other or whether one or the other part is more or less
accentuated. With the assistance of constructive types of behavior we are able to
observe how we can approach and work with a client and what solutions will be
functional and effective.
An advantage of the CA method is its speed, the non-demanding nature of the
test and a quick access to results.

11.1 The CA Method

The CA method (Color association method) is a combined projective technique

using calibrated sets of words (“verbal modules”—48–130 words) and a test of eight
colors by Lűscher (1971). Lűscher’s diagnostics is based on evaluating the impor-
tance of preference and rejection of certain colors. The basic hypothesis is the
reasoning that color preference is in a way dependent on certain personality vari-
ables, situational states in the organism as well as objectively active agents (Svoboda
1999). The theory of the test is based on the relationship between physiological
mechanisms and color structures, i.e. a specific color relates to specific forms and
stereotypes of behaviors or individual experience. There are 8 different colors, which
are different in their measurable wavelengths range and form the basis of “Little
Lüscher’s color test” (LCT). The numerical designation of each color (according to
LCT) is maintained, which allows easier recording of specific responses (answers) of
analyzed people to the stimulative word. The recording is implemented with the use
of a computer. Apart from assessing the two preferential selections and one statistical
preferential choice, the client also matches each stimulative word with 3 colors. It is
a forced choice with regard to its order (it is not possible to select the same color
more than once with one word). 56 possible variations are thus formed (color triads)
of reactions to one specific word. The generated tool might then be used to determine
the responses of people. Its basis is the documented existence of “cortical association
areas”. Innovation in the form of putting together Lűscher’s color test with
color-word associations allows us to focus on various areas of human behavior and
perception. The CA method combines advantages of both these methods.
The CA method measures the social-psychological spectrum of attitudes,
including their implementation potency—not only what people think but also what
they prefer (hierarchy of values) and if they would in fact implement their attitudes
11 Mental Profile: Stress and Energy … 181

in their behavior, if so, how successfully and in what time frame. It measures the
dynamics of functional processes of consciousness, attitudes, i.e. comprehensive
units within the consciousness (of individuals or groups). Data scanning is carried
out using a computer program called Sensor (Šimonek 2007–2009).
In current practice, the CA method is used in HR, sport, education, market
surveys and health.

11.1.1 Sensor and Data Collection Method

In practice, we use Internet sensor (Fig. 11.1). The perception field during submitting and
choosing combined color word associations has been adapted so that the form of testing
• eliminates perceptual defenses as much as possible
• if possible, does not evoke spatially-perceptual stereotypes
Practical application has been standardized. It has 3 phases and the client follows
the given procedure. Instructions are included in the diagnosis and are described at
the start of the test in the on-line form. This procedure may be explained by the
administrator as well.
(1) initial color selection
• look at the colors and let them work on you for a while
• then select all the eight colors in the order from most pleasant to the least
enjoyable one
• once you have entered the complete selection, continue with selecting colors for
individual words

Fig. 11.1 Internet sensor and

perception field; color
selection
182 B. Fialová et al.

(2) select three colors to match the individual verbal stimulants

• look at the colors and let them work on you for a while
• read the word out loud and then repeat it again in your mind
• take a look at the colors, and select three of them as quickly as possible
• as soon as you have entered all three colors, immediately go to the next word
(3) final color selection
• look at the colors and let them work on you for a while
• then select all the eight colors in the order of how they work on you at the
moment (it is not a hidden memory test, the selection may be quite different,
similar or the same)
• as soon as you are finished, end the program.
Data scanning can be implemented individually or in a group. The whole
application process takes 20–40 min with regard to personal pace and the extent of
the calibrated set of words. The results are computer processed and are available
immediately upon completion of the test.

11.2 Sample Results of Diagnostics for Mental Stress

and Energy Profile

11.2.1 Verbal Schematic

The diagram of consciousness shows the structural map of consciousness composed

of verbal objects (words), which have been used for testing.
Objects are divided into 5-value groups—Ideals (idols, i.e. existentially
anchoring, long-term positive effects), Satisfactors and Motivators (strong, posi-
tively experienced energy resources and rewarding tools of regeneration), Operators
(predominantly effective and situationally used tools), Stressors (mostly inefficient
situational tools, accompanied by pressure), Destructors (existentially threatening
and developmentally devastating long-term influences)—depending on how they
are usually preferred in the relevant age category (Fialová and Šimonek 2009).
This creates the typical significance structure of values in consciousness, which
has its quantitative and qualitative fulfillment. For each value (verbal object) there
are some characteristic general functional and dysfunctional implementation pat-
terns (methods and forms of behavior typical in a certain developmental stage and
environment).
The verbal diagram (Fig. 11.2) provides an insight into the current state of the
hierarchy of values of the person and it can be used as a guide showing how to work
with the person. Working with the verbal diagram allows identifying how to
11 Mental Profile: Stress and Energy … 183

Company words

Work words

Fig. 11.2 Verbal schematic—structure of values in consciousness. Company words and work
words

motivate the individuals or reward them. You will also find out which tasks and
activities they perform routinely, flexibly and without any problems and recognize
what is a potential source of tension or a possible destructive factor.

11.2.2 Constructive Types of Behavior

Everyday life and work bring a large and diverse palette of situations and problems,
which need to be addressed and, if possible, sorted out successfully. There are a lot
of response and behavior types. However, only some enable and facilitate real
solutions. By virtue of the CA method, six basic types (Šimonek 2007–2009) are
defined and measured which include a constructive approach, i.e. support for
reaching solutions.
Individual constructive types—individual abilities and strengths are involved
in reaching the solution. They include vitality, ambition and logic. Group
184 B. Fialová et al.

Fig. 11.3 Two different results of constructive type of behaviors

constructive types—group skills and strengths play a role in obtaining a solution.

They include cooperation and participation. Mixed constructive types—indi-
vidual strengths and skills with functioning and effect in the group are required for
reaching the solution. This includes dominance.
From this chart (Fig. 11.3) you can see what type of behavior the measured
person uses most frequently, what the relationship between the types of behavior is,
whether an individual or group type of solution prevails or which way of addressing
problems is the least preferred and used. This information can then be used when
hiring the best possible candidates or when new work teams are formed.
The images show how different the measured results may be with individuals.
11 Mental Profile: Stress and Energy … 185

Fig. 11.4 Internally experienced stress; 0 = no stress; 100 = intensive stress

He/she does not reveal anything

He/she tries not to reveal anything
He/she shows stress regularly
He/she shows stress more intensively
He/she always expresses stress

Fig. 11.5 Stress management; 0 = doesn´t reveal anything, 100 always expresses stress

Fig. 11.6 Stress in the

company; 0 = no stress,
100 = intensive stress

Fig. 11.7 Amount of mental

power; 0 = no power;
100 = high power

11.2.3 Degree of Stress

It is commonly assumed that it is not possible to avoid stress. It is a normal and

integral part of personal and work life.
Stress reaction takes place automatically and it includes both positive (ener-
gizing, activation, etc.) and negative factors (excessive load).
Using the CA method, the level of internally experienced stress can be mea-
sured as well as stress management in relation to the outside environment.
Degree of stress (Fig. 11.4).
Degree of stress (Fig. 11.5).
Due to the fact that the CA method works with words, it is possible to measure
the degree of stress in different environments, e.g. stress in the company.
Degree of stress (Fig. 11.6).
186 B. Fialová et al.

Fig. 11.8 The balance of

body and psyche

Body Psyche

Stressors can be highly individual, but using verbal diagrams (Sect. 11.2) the
stress activator for the individually analyzed person within the company can
specifically be identified.
This item can measure the amount of mental power of the clients and how they
handle it.
Mental energy (Fig. 11.7).
At the moment, the client has a normal amount of stamina, which he uses in a
sensible and balanced way. The resulting scale of energy gained and lost is well
balanced.

11.2.4 The Balance of Body and Psyche

The item shows whether the client’s body controls their psyche or vice versa
(Fig. 11.8).
Such a high measured value means that the client overcomes sensations in the
body (pain or fatigue) using their psyche and will. The balance is severely affected.
Physical congestion is excessive and the respective client is unaware of the possible
consequences. In other words, the psyche and/or will are controlling the body. This
state indicates that it might not take long until serious health problems emerge.

11.3 Advantages of Use in Practice

Compared to conventional questionnaires, the CA method diagnostics has several

advantages. The progress of the diagnosis feels more like a “game” than testing;
thus it is a great advantage that clients’ defenses are largely removed.
Administration usually takes no longer than 20 min, it is simple, quick and
understandable and the results are available in a few minutes from the end of testing
owing to computer software. The principles of the CA method and subsequent
evaluation allow us to see inner attitudes and experiences, which are not rationally
controlled and influenced. Considering this aspect, we obtain results that far more
11 Mental Profile: Stress and Energy … 187

accurately describe the real state of the client’s consciousness. This enables us to
select the intervention or prevention methods much faster and in a more targeted
way. What is more, we cannot only measure both experiential and attitudinal parts
of the consciousness, but also their implementation potency in a vast majority of
items.

References

Fialová B, Šimonek J (2009) Profil jednotlivce, VOA a VOŠ Masarykova 10, Valašské Meziřící
Lüscher M (1971) Der Lűscher Test. Rowohlt Verlag GmbH, Persönlichkeitsbeurteilung durch
Farbwahl. Reinbek bei Hamburg
Šimonek J (2007–2009) Soubor studijních materiálů pro výcvik Profil jednotlivce, DAP Services,
Ostrava
Svoboda M (1999) Psychologická diagnostika dospělých. Prague, Portál
 Part III
Biofeedback in the Work and Economic
World
Chapter 12
Biofeedback: Measurement and Training
Methods

Ingrid Pirker-Binder

Contents

12.1 Why Biofeedback in the Work and Economic World? ................................................. 192
12.2 Biofeedback—Awareness Bridge to Freedom................................................................ 194
12.3 Biofeedback—On the Way to Inner Resources.............................................................. 199
12.3.1 Biofeedback as a Measuring Instrument............................................................ 199
12.3.2 Biofeedback as a Prevention Variable ............................................................... 203
12.3.3 Learning by Observation .................................................................................... 204
12.4 Learning Through Appropriate Test Methods ................................................................ 206
12.4.1 Passive Test Methods ......................................................................................... 206
12.4.2 Performance-Dependent Test Methods .............................................................. 208
12.4.3 Combined Test Methods .................................................................................... 209
12.4.4 Heart Rate Variability Measurement: 24-h Long-Term Measurement ............. 210
12.5 Biofeedback as a Training Method for Prevention of Exhaustion................................. 214
12.5.1 Respiratory Sinus Arrhythmia (RSA) ................................................................ 216
12.5.2 Heart Rate Variability-Biofeedback Training .................................................... 217
12.6 Awareness and Consciousness Training ......................................................................... 221
12.7 Biofeedback and Ergonomics at the Workplace............................................................. 223
12.8 The Process Model of the Life Energy Analysis (LEA)................................................ 229
References .................................................................................................................................. 231

The biofeedback measurement and training technology opens up promising oppor-

tunities in the combat of fatigue. The process triggered thereby is simple and leads to
an understanding of inner psychological and physiological interactions in our body
during work. This knowledge provides a new basis for individual personal devel-
opment, self-management and self-control of one’s body’s energy efficiency, for the
processing of emotions and a new basic understanding of regeneration and prevention.

I. Pirker-Binder (&)
Saileräckergasse 43/26, 1190 Vienna, Austria
e-mail: offi[email protected]

© Springer International Publishing AG 2017 191

I. Pirker-Binder (ed.), Mindful Prevention of Burnout in Workplace Health
Management, https://doi.org/10.1007/978-3-319-61337-6_12
192 I. Pirker-Binder

In ergonomics, the use of biofeedback is indispensable for the facilitation of

awareness of posture, unconscious tension and tenseness, unrhythmical breathing and
related (psycho) somatic, stress and workplace-related complaints. New diagnostic and
training methods such as the heart rate variability analysis make it possible to measure
activation and stress during work and regeneration capacities during breaks and
sleep. With this method, those interested are provided with direct feedback (Life Energy
Analysis). Biofeedback training sensitizes the individual for the way to enhanced
perception of the needs of the body and to more mindfulness in working life, more
relaxed, mindful concentration and flow without unnecessary tension or tenseness.
The biofeedback measurement and training methods provide a solid framework
for successful prevention and preservation of human resources in the world of
work, for personal development, “high performance” and for the diagnostics of
exhaustion. In high-risk professions accompanying strain measurement is a useful
tool for the safety of those working in this profession, for the prevention of
stress-related accidents or the processing of traumas after distressing events.
• The company management should provide measures for personal devel-
opment and an understanding of health care. What is more, the partici-
pation in such measures should be appreciated, i.e. with a reward system.
• Everyone is responsible for the health of his/her body and its energy.

12.1 Why Biofeedback in the Work and Economic World?

Biofeedback is one of the most important achievements for the area of personal
development, self and resource management. It is a tool that brings about a better
understanding of the body and how it functions. By measuring changes in
breathing, pulse rate, pulse amplitude or ECG, heart rate variability, skin conduc-
tance, muscle tension and finger temperature, the connection between psyche
(thought patterns, emotions) and soma (body processes) become visible on the
computer screen, understandable, controllable and thereby changeable.
The changes are measured during activation, stress, strain, in breaks and recovery
times and during the regeneration phase of sleep. The knowledge about the inter-
actions in one’s own body should be the basis of any regeneration management.
• Everyone knows what stress is and how it feels. But only a few know what
regeneration is, how it feels and what you have to do for it.
The human organism is a miracle of nature. It provides us with energy every day
and is endowed with a high self-healing and regeneration potential—provided that
it is not disturbed in its inner harmony. Here lies the root of the scourge of our
modern age: the exhaustion of human resources due to carelessness regarding the
needs of the body and the psyche.
The internal pressure (perfection pressure, pressure to perform, success pressure,
etc.) of the working people, which seems to push them forward using a whip
12 Biofeedback: Measurement and Training Methods 193

making them behave as if they were on the run, and the external pressure (e.g. time
pressure), which is voluntarily accepted, are the protagonists in this scenario. It has
not been about work-life balance for a long time. Work has generally crept into life
and due to the modern media it can take place almost anywhere, regardless of time
and place. The main advantage is a high flexibility as to when and where work is
done. Still, why do people become exhausted?
The main reason is that we have not learned to regard life energy as a temporary
gift. The importance of the preservation or the regenerative capacity of the
organism on the one hand and a proper diet (sufficient macro- and micronutrients)
only becomes evident, when the body and the psyche no longer cooperate and
people become sick. Once the regenerative capacity starts decreasing, the energy
production is disturbed. The organism reduces its performance capability to a low
flame and if nothing changes, the system collapses at some point. The processes,
which lead the working people to stay in chronic activation, are manifold; they are
described in the first part of the book.
• Biofeedback expands awareness, sensitizes perception and supports change
processes. Heart rate variability measurement and training protect against
burnout and are indispensable for high-risk professions.

The application areas of biofeedback in modern enterprises are diverse and

efficient. Examples include:
• Personal development:
– emotions management (e.g. anger management)
– attitude management
– self-control, stress management, “high performance”
– change processes
– charisma
• Regeneration management:
• letting go (mental processes, quieting the mind through neurofeedback)
• relaxation (physical process of releasing muscular tension)
• regeneration (mindfulness, inner silence, active regeneration, coherence
between breathing and heart beat)
• Opening room for creativity, inspiration, “becoming aware from the
heart” (Scharmer 2009, p. 189 ff.)
• Feedback on stress at the workplace and the ability to recover during
breaks and sleep.
– Heart rate variability measurement (HRV)
– Long-term measurement (24 h or longer) as protection from excessive
strain and burnout: especially important in high-risk professions, for
“high potentials”, shift workers and travelers
194 I. Pirker-Binder

• Heart rate variability training as a learning method for preserving

human resources
– as a training method for restoring recovery ability (coherence training
between breathing and heart activity)
– to increase perceptual capacity and mindfulness
– A must in case of exhaustion to strengthen the parasympathetic system
(braking and recovery system of the body)
• Pain reduction/stress reduction
Muscular tension due to non-resource-oriented working and inappropriate
physical strain (e.g. shoulder or neck discomfort, headache, back pain, carpal
tunnel syndrome etc.)

The gateway to efficient energy management is opened by the following three

factors:
• thought processes
• perception and change of tension and inner pressure
• breathing as a time base and corrective
Biofeedback technology is a tool that is very often wrongly degraded to relax-
ation training or simple breathing training. But it is much more. Biofeedback serves
people as a gateway to insight and, under expert guidance, it supports change
processes leading to more self-awareness, self-control, self-management and
responsibility for health.
Biofeedback technology is always embedded in an individual development
concept and/or a training program such as in the processes of the Life Script
Analysis, Work Script Analysis and Life Energy Analysis. It is a useful prevention
tool in companies.

12.2 Biofeedback—Awareness Bridge to Freedom

The American Association for Psychophysiology and Biofeedback (aapb) places

biofeedback in the fields of learning and improving individual health, performance
capability and quality of life. Biofeedback is a scientifically recognized method that
uses computers and sensors to make visible, and thus experienceable, recognizable
and changeable, unconscious psychophysiological processes. Biofeedback provides
the trainees with information, which enables them to learn (Pirker-Binder 2015).
Biofeedback is a process that enables an individual to learn how to change physiological
activity for the purposes of improving health and performance. Precise instruments measure
physiological activity such as brainwaves, heart function, breathing, muscle activity, and
12 Biofeedback: Measurement and Training Methods 195

skin temperature. These instruments rapidly and accurately “feed back” information to the
user. The presentation of this information – often in conjunction with changes in thinking,
emotions, and behavior – supports desired physiological changes. Over time, these changes
can endure without continued use of an instrument … Biofeedback has evolved from a
fascination in the 1960s and 70s to a mainstream methodology today for treating certain
medical conditions and improving human performance. This evolution has been driven by
years of scientific research demonstrating that the mind and body are connected, and that
people can be taught to harness the power of this connection to change physical activity and
improve health and function. (Aapb 2011)

Elmar and Alyce Green write the following about the significance of biofeed-
back for awareness training:
… learning how to move the homeostatic balance points arbitrarily into a certain direction,
physically, emotionally and mentally. One can imagine the spreading waves, which will
finally influence our society, just like inner law and order spreads from the individual to the
family and society. (Green 1999, p. 201)

They refer to the option of choosing one’s thoughts, feelings and actions. And it
is exactly what is possible in existential analysis and logotherapy by recognizing
one’s freedom: the freedom of deciding for or against something, for this path or a
different one.
Biofeedback meets Frankl’s requirements (Chap. 1) of the existential act. The
people concerned receive information, which they can adopt a position on. They
have the choice to recognize this information as an enrichment of their con-
sciousness, to take a position and consider expanding the ways they deal with
themselves, or not. During a biofeedback supported measurement or training pro-
cedure the responsibility always remains in the hands of the client. The therapist is a
companion, explainer and supporter. Biofeedback is a method, which should
always be embedded in a process and may never stand as a method on its own.
Biofeedback supports the learners in their change process and thereby provides the
necessary information for their learning progress.
Biofeedback is a measurement and training method for awareness raising and
activating self-regulation and self-healing mechanisms.
It has been shown that a certain degree of willful control over psychophysiological pro-
cesses, which are normally not noticed, is possible once they are made conscious. One can
also say that with the help of biofeedback training awareness can be expanded to normally
unconscious processes in the body. (Green 1999, p. 66)

Green and Green are convinced that biofeedback technology can clarify a
physiological principle.
Any change in the physiological state is combined with a corresponding, consciously or
unconsciously initiated change of the mental-emotional state, and reversely, any con-
sciously or unconsciously created change of the mental-emotional state is followed by a
corresponding change of the physiological state. In other words: mind and body build a
uniform system. (Simonton 2005, p. 44)
If nowadays medical experts in research can train the heart - or the feelings of the heart – to
reverse a pathological condition, then also the practicing physicians need to learn that
interrelationship between body and mind is more powerful than has been assumed so far.
196 I. Pirker-Binder

The explanatory models of psychosomatics, which refer to the mental-spiritual origin of

pathological phenomena, have long been accepted; the biofeedback research provides the
first medically verifiable evidence that mental forces are able to do both, heal diseases and
cause them. (Barbara Brown in Simonton 2005, p. 44)

In their psychophysiological diagram (Fig. 12.1) Green and Green establish a

relationship between the psychological areas of the conscious and unconscious and
the different sectors of the arbitrary and involuntary physiological areas.
The peripheral nervous system is divided into the arbitrary and the autonomous,
involuntary nervous system. The protagonists of the autonomous nervous system
are the sympathetic and parasympathetic nerves; they control all the vital systems.
Whereas the activity of the sympathetic nerve increases the activity or the tension in
the body, the parasympathetic nerve reduces tension and initiates regeneration. The
impulse of the sympathetic nerve is in the brain, i.e. in the hypothalamus. To reduce
excessive energy or a high activation level in the body, the activity of the sym-
pathetic nerve has to be reduced and the parasympathetic nerve, in particular the
nervus vagus (10th cranial nerve) has to be strengthened. In biofeedback training,
the smallest physiological changes are made accessible to conscious perception and
thereby they are under self-control. Green and Green (1999) put the steps of
learning self-control into a schematic diagram, which is shown in Fig. 12.2.
Green and Green differentiate in their model between conscious (whether per-
ception takes place is at the will of the person concerned) and unconscious per-
ception and between external influences (OUTS influences/events) and internal
influences (INS influences/events). The two fields (emotional and mental reaction)
are exactly on this line as they may occur both consciously and unconsciously. The

Conscious area
Arbitrary processes
Reac ons to “ac ve will”

craniospinal Separates conscious

and unconscious part

cor cal

PNS
CNS

subcor cal

autonomous
Unconscious area
Involuntary processes
Reac ons to “passive will”

Fig. 12.1 Psychophysiological diagram. PNS: peripheral nervous system, CNS: central nervous
system. Modified according to Green and Green (1999, p. 70)
12 Biofeedback: Measurement and Training Methods 197

Sensual percep on Sensual percep on

of external events of internal events
8
(OUTS) (INS) via biofeedback

6 Direct percep on of 5
internal events
1 Line separates
(INS) conscious
and unconscious
10
Emo onal and mental Emo onal and mental
reac on to OUTS events reac on to INS events
2 9
7
3 Reac on of 4
Limbic Physiological
hypothalamus and
reac on Reac on
pituitary gland

Fig. 12.2 learning of self-control (modified according to Green and Green 1999, p. 71)

limbic system is situated in the unconscious part. It is considered the behavioral

assessment system of the brain and is also involved in affective and emotional
behavioral control (Roth 1996, p. 197 and 2009, p. 15 ff.).
The unconscious understood in terms of Freud’s conceptions includes those psychological
basic structures from a neurobiological and psychological view, which determine our
character and personality, i.e. the way we react towards ourselves and our natural, and
particularly, social environment, how we make commitments, learn impulse control and
develop self-confidence and confidence in others. This is mainly related to the limbic
system. (Roth 1996, p. 154)

The assessment system is inseparably linked with the memory system of

humans, for memory is not possible without assessment, and any assessment
necessitates memory. Earlier experiences and evaluations are saved in the memory
and serve as a template for assessment of and behavior in new situations (Roth
1996, p. 198).
The hypothalamus is a part of the limbic system. It is responsible for the reward
system and controls the production of endorphins. In another part of the limbic
system, the Amygdala, vegetative and affective responses are controlled in com-
bination with the reticular formation and the hypothalamus: an important function
for the response to stress and stress management. Figure 12.2 shows the function
using arrows.
Arrow 1: External stimuli are involved with both, more conscious as well as
unconscious emotional and mental responses.
198 I. Pirker-Binder

Arrow 2: The incoming stimuli are processed in the limbic system and lead to a
reaction in the hypothalamus and pituitary gland (arrow 3). A physiological reaction
(arrow 4) results.
Arrow 5: If the physiological reaction is reported to the respective person through
biofeedback, there is a possibility (arrows 6 and 7) to learn new limbic responses.
These change the reaction paths 3 and 4 and also the original physiological reaction.
This leads to a learning process that places the homoeostatic balance under
willful control. In the process of learning the feedback via biofeedback devices is no
longer necessary, as the respective person acquires the ability to practice
self-regulation independently through increased sensitization for the incoming
“IN-events”.
The new emotional reaction is connected with a new limbic response (arrow 7). It modifies
the original limbic response (arrow 2). This new limbic response in turn affects the
hypothalamus and pituitary gland secretion, which results in a new physiological state. This
creates a closed cybernetic circle, which seems to close the normal gap between conscious
and unconscious, arbitrary and involuntary processes. (Green and Green 1999, p. 75)

Biofeedback trains the sensitivity to internal conditions (arrow 8). Learning with
biofeedback makes it possible to dispense with the paths 5, 6 and 8. The circle
closes between arrows 9–10–7–3–4–9. In their model Green and Green also place a
link to the will. Unconscious parts of the nervous system respond to the active will,
while the normally unconscious parts respond to the passive will (Green and Green
1999, p. 77). The passive will can be developed by biofeedback. The authors
distinguish between autogenic training which uses passive concentration as a means
of change, and biofeedback training, which activates the passive will, that is, a
change is facilitated, and the body works by itself.
According to Green and Green psychosomatic self-regulation follows this
principle:
Our will enables self-regulation in our body. The principle states that the body affects the
mind and the mind influences the body and thereupon the new physical state in turn
influences the mind, and so on. If the psychophysiological operations are connected to the
will, psychosomatic self-regulation happens. (Green and Green 1999, p. 82)

In terms of existential analysis and logotherapy the biofeedback method works

like a bridge. It makes connections between psyche and body visible and brings the
unconscious and subconscious into consciousness. Knowledge gained thereby
expands the freedom to decide between various options (Fig. 12.3).
12 Biofeedback: Measurement and Training Methods 199

Freedom to
decide

Biofeedback

Body Psyche

Fig. 12.3 Biofeedback and freedom to decide (Pirker-Binder)

12.3 Biofeedback—On the Way to Inner Resources

12.3.1 Biofeedback as a Measuring Instrument

The measuring possibilities of psychophysiological parameters are diverse. A first

classification can be made according to the location of its usage. Everything
measured on the head is covered by the term “neurofeedback”, while everything
measured on the body can be summarized with the term “multimodal biofeedback”
(Figs. 12.4 and 12.5).

Fig. 12.4 Classification according to neurofeedback and biofeedback (Pirker-Binder)

200 I. Pirker-Binder

Fig. 12.5 Representation of biofeedback parameters on a computer screen. From top to bottom:
breathing, skin conductance, skin temperature, blood volume pulse, blood volume pulse
amplitude, pulse frequency. Source of image: Schuhfried GmbH. www.schuhfried.at

Neurofeedback includes:
• EEG feedback = neurofeedback: measurement of brainwaves, which are split up
according to frequency components and fed back to the computer screen. The
individual frequency components are allocated to different states of attention or
consciousness, measured and submitted to training.
• HEG Feedback: hemoecephalography: with the help of red and/or infrared light
the degree of redness is locally determined in a specific area, which allows
conclusions on the intensity of the blood circulation and thus also displays the
oxygen supply for this area (Pirker-Binder 2014). HEG biofeedback is used as
attention training, for the increase of attention and concentration, but also for
learning to let go of thoughts and rumination. Currently it is being researched to
what extent HEG feedback is suitable for impulse control. Thereby two pro-
cedures are differentiated
– NIR-HEG: “near infrared spectroscopy”: infrared light is used for mea-
surement of blood circulation
– PIR-HEG: “passive infrared photography”: the change of warmth at the
measuring point is recorded
• SCP feedback: “slow cortical potentials” are reactions of the brain to external and
internal stimuli (Schwartz and Andrasik 2003, p. 464 ff.). They basically mirror
the processing of the stimuli in certain areas of the brain (Haus et al. 2013).
12 Biofeedback: Measurement and Training Methods 201

Multimodal biofeedback includes the following parameters:

• pulse frequency and pulse amplitude (ECG)
• breathing rate and breathing depth
• muscle tension
• skin conductance
• temperature
• oxygen saturation
• motility: the movement of the test person is recorded during the measurement

Heart rate variability biofeedback includes the following parameters:

• pulse
• ECG
• breathing
The time intervals between two heartbeats are measured as a peak-to-peak
interval (RR interval) or an interbeat-to-interbeat (IBI) from the pulse. Subsequently
the RR intervals are converted into frequency spectra using statistical processes and
allocated to various areas.
In colloquial use, the visual representation of the heart rate variability
measurement data (Fig. 12.7) is also called AutoChrone image (www.heart-
balance.org).
Time-related representations, such as a histogram or Poincaré plot as non-linear
methods (represents RR intervals in a coordinate system) and minimum and
maximum heartbeat difference are a useful and necessary supplement for diagnostic
analysis (Fig. 12.6a–d).
The individual frequencies can be read in Table 12.1.
The respective power of the frequency ranges is decisive for measurement and
training.
“High frequency” (HF) refers to the activity of the paramagnetic nerve and
expresses the adjustment of the heart rate to the respiratory rhythm. It is an
expression of tonic vagal activity.
“Low frequency” (LF) corresponds to the so-called Mayer waves (represent the
blood pressure regulating system), and they are associated with the activity of the
sympathetic as well as the parasympathetic nervous system. In healthy people
(at rest) the parasympathetic nervous system dominates the heart activity through
the vagus nerve, i.e. 10th cerebral nerve.
Mental stress loads are mostly controlled … by withdrawal of the vagus. Reductions of the
HRV are an indicator for mental stress. In the case of acute stress, in situations of particular
tension, the sympathetic nerve dominates. Everyday life is controlled by variations of the
vagus. Accordingly, chronic stress leads to a chronic reduction of vagal activity without
sympathetic activity increases. (Sroka 2002, p. 38)

Everyday strain in the lower and medium performance ranges (up to about a
heart rate of 100/min) is primarily regulated by taking back the strong rest vagal
tone. Only in the upper performance range (approximately in the upper third) is the
202 I. Pirker-Binder

(a) (b)

Heart frequency (1/min)

Class width 5/min

(c) (d)

Heart frequency (1/min)

Class width 5/min

Fig. 12.6 a–d Histogram and Poincaré-diagram (Yang 2006) provide information on the heart
rate variability. a Histogram showing the measurement of a bad HRV. b Poincaré-diagram
showing the measurement of a bad HRV. c Histogram showing the measurement of a good HRV.
d Poincaré-diagram showing the measurement of a good HRV. Source of image Company
Biosign, by courtesy of Dr. Reinhard Beise

Table 12.1 Frequency ULF Ultra low frequency <0.003 Hz

ranges
VLF Very low frequency 0.003–0.04 Hz
LF Low frequency 0.04–0.15 Hz
HF High frequency 0.15–0.40 Hz

sympathetic activity connected as well. In acute stress, in situations of particular

tension, the sympathetic nerve dominates. Everyday life is controlled by variations
of the vagal tone. Accordingly, it can be assumed that chronic stress leads to a
12 Biofeedback: Measurement and Training Methods 203

chronic reduction of vagal activity without sympathetic activity increases (Sroka

2002, p. 133; Pirker-Binder 2008, p. 33).
The “very low frequency” (VLF) is associated with the vascular tone, tem-
perature regulation and also inner psychic activities. A correspondence to the skin
conductance value has also been established. (Pirker-Binder 2008, p. 33 ff)
The “ultra low frequency” (ULF) reflects the rhythm of the heart activity
throughout the day. It is influenced by different factors such as light, food, hor-
mones, etc.) The “ultra low frequency” can only be used in long-term measurement.
Circadian impulse generators control the daytime rhythms of the heart rate and
other physiological values. The central circadian impulse generator is the
suprachiasmatic nucleus of the ventral hypothalamus. A control element is the
light-dark change, which is regulated by the eyes and/or by the melatonin released
by the pineal gland (Weippert 2009, p. 8).

12.3.2 Biofeedback as a Prevention Variable

For an effective prevention process, it is necessary to correlate the information from

the Life Script Analysis and the Work Script Analysis to the individual energy
consumption or activation pattern. As shown in Chap. 2, the organism strives to
always supply the energy needed for our thinking, feeling and acting. Prevention
means in this context realizing and becoming aware
• of how much energy is consumed for what, whether the use is resource-oriented,
or not,
• about the stress, which is individually put on the organism,
• of an opening to a more sensitive perception about the needs of the body,
• of how regeneration works,
• of strengths and weaknesses of the organism.
Everyone has a predisposition, a higher sensitivity, in one or the other functional
system,
• for example, if heart function disorders occur frequently in a family, there might
be an increased responsiveness in this organ system compared to other organ
systems. Specifically, this means that in the case of system overuse this system
sends a first alarm signal, such as increased blood pressure, extra systoles
(beats). Additionally, tensions, migraine, irritable bowel syndrome, hypersen-
sitivity in the vascular system, etc. can occur.
Biofeedback can, through observation or appropriate test procedures, provide
information on how the body responds to stimuli and/or which system of the body
is the fastest or the slowest to recover. This realization is integrated into awareness
training. Thoughts, attitudes, assessments and expectations control the life energy
204 I. Pirker-Binder

use. Biofeedback uncovers these relationships, makes them visible on the computer
screen and thus controllable.
Controllable impulse generators for energy input are
• cognitive processes,
• muscle tension,
• breathing.
From this follows that with the consideration of inner psychic patterns and
mechanisms of regeneration a change process with regard to a resource-oriented use
starts (that is, producing only as much energy as is really needed for the corre-
sponding situation and practicing active regeneration), in which unconscious is
brought into awareness.
• Regeneration is more than relaxation; it virtually follows from the pro-
cesses of letting go and relaxation.
The learning process results from the understanding that life and daily routine
follow a particular rhythm: a change between activation, deactivation and regen-
eration. If activation is kept up too long, depletion will occur. The inner resources
are used up and eventually the human being falls ill. Thereby depletion can surface
in different areas:
• problems with thinking, concentration and memory
• exhaustion of the energy production of the cell
• excessive activity of the sympathetic nerve, loss of the activity of the
parasympathetic nerve
• physical discomfort and disease
A learning or cognitive process using biofeedback can be initiated in different
ways:
• by observation,
• by suitable test methods,
• through a 24-h heart rate variability measurement.

12.3.3 Learning by Observation

During learning by observation, realization and understanding are facilitated by

watching the change of the measured parameters. Therefore, the selection of the
appropriate sensors is crucial. “Appropriate” means that the biofeedback therapist
chooses the correct sensors for creating awareness of the desired situation. If
anything is unclear, it has been proven most successful to choose as comprehen-
sively as possible (i.e. using more than one sensor).
12 Biofeedback: Measurement and Training Methods 205

Change of
Medita on posi on Relaxed si ng
posture posture

pulse

breathing

heart rate

Fig. 12.7 Observation of breathing, pulse and heart rate during meditation posture and in relaxed
sitting posture. Screenshot Nexus 10. Left: Meditation posture, middle: change of position, right:
relaxed sitting posture (Pirker-Binder)

Figure 12.7 shows the measurement of a client who would like to ease his
migraine by means of relaxation meditation. He is asked to practice his way of
meditation while his breathing, pulse and heart rate are measured. In the screenshot
(copy of the screen) it can clearly be recognized that there is no coherence between
breathing and heart rate, a so-called RSA vibration (respiratory sinus arrhythmia,
Chap. 5). Once the client starts to relax, focusing on letting go and breathing, the
image changes; it indicates that the measured values oscillate with each other and
that letting go, a coherence of breathing and heart rate, occurs in the body.
Through observation the client learns to understand the different reactions of his
body and the meaning of letting go for a specific topic.
In sports, the strain of various functional systems of the body in different
positions is measured and reported back so as to set a basis for “high performance”
in the competition. Biofeedback is known in sports as a contribution to
high-performance training but it could also be called ergonomics in sports.
• The aim is to achieve best possible performance with the lowest possible
energy input and correct muscle activity and corresponding mental effort.
The same applies to people working on the PC, driving, working on the
assembly line, during and after the shift work, during lectures, meetings, in train-
ings as a teacher, during leisure time sports, gardening, etc.—the list could be
continued as desired. With Biofeedback it is the same as with competitive sports,
i.e. it is always about the right energy input, perception, performance and regen-
eration (Fig. 12.8a, b).
206 I. Pirker-Binder

Fig. 12.8 a, b Example of a training session for competitive sports with biofeedback. Abhinav
Bindra, the first Indian winner of the Olympic gold medal for single competition in air gun
shooting is training with the sports psychologist Timothy Harkness. b screen with bio and
neurofeedback for optimal competition preparation during the training of speed skaters. Source of
image Courtesy of Thought Technology Ltd. (www.thoughttechnology.com)

12.4 Learning Through Appropriate Test Methods

For the acquisition of knowledge and the development of training steps biofeedback
reaction tests can make a valuable contribution when used as an initial test. Various
methods are used:
• passive tests
• performance-dependent tests
• combined tests
• 24-h heart rate variability measurement
• short-term measurement of heart rate variability
Depending on the initial situation and information interest a choice between
different test procedures is available. In practical work it has proven useful to apply
a test method which allows focusing on the individual expectation and the inner
experience. This includes passive tests and a 24-h long-term measurement of heart
rate variability.

12.4.1 Passive Test Methods

In the passive test method as few inputs as possible are directed towards the person
to be tested, i.e. except for a little animation on the screen or few external verbal
instructions. The goal is to recognize the change of the measured parameters
through internal processing. Passive test methods are particularly suitable for
12 Biofeedback: Measurement and Training Methods 207

detecting activation through anticipation (lat. “anticipo”: to pre-empt), so-called

expectation. An example is when the person concerned already gets nervous on
Sunday afternoon when he thinks about the upcoming work on Monday.
In such a case a learning goal could be making a difference between creative
thinking and visualization and putting oneself into alertness by activation. In this
respect learning steps are learning to distance oneself and dealing with the topics of
responsibility and inner peace.
The test situation procedure is divided into several steps. The person to be tested
is asked to sit down as comfortably as possible into an easy chair. The sensors are
chosen by the biofeedback therapist/trainer. The test sequence can be standardized,
so that no intervention of the therapist is necessary during the test phase. The
procedure is divided into five sections:
1. Relaxation phase. Screen displays the request, “Please relax, keep your eyes
open and keep quiet as much as possible” (Movements influence the mean-
ingfulness of the measured values).
2. Announcement phase. Information appears on the screen that the stress is
coming soon. Afterwards, the screen returns to the image of the input phase. The
client does not know when what kind of stimulus will come to him/her. At this
moment the attitude of expectation of the test person begins.
An analysis of the data including the baseline can also show that the client
already starts building up expectation before the actual start of the test
(Pirker-Binder 2008)
3. Expectation phase.
4. Stimulus. An acoustic and visual stimulus is set as an orientation reaction that
lasts a few seconds.
5. Recovery phase. A text field on the screen informs that the stress situation is
over and advises to recover again.
In the evaluation it can be seen that after the announcement phase the skin
conductance value (also considered an indicator of mental activity, ruminating)
recovers very quickly and returns to the starting position, even after the stimulus. In
the cardiovascular system an increase (heart rate increase, pulse and blood volume
pulse constriction) like anticipation of a future stimulus can be seen during the
expectation phase. In the following recovery phase the values return to the original
level.
Different biofeedback suppliers offer different stress response tests in their
program. If test methods are used, there should always be a clear definition of the
goal, what knowledge should be acquired and what motion artifacts will be inherent
(Fig. 12.9).
If the test person talks or moves, the validity changes. Having somebody do
calculations or solve tasks, tests the performance or the knowledge or concentration
of the relevant person. The inner experience is difficult to capture.
208 I. Pirker-Binder

Fig. 12.9 Passive stress reaction test. Screenshot of Nexus 10 (Pirker-Binder)

• It is very important to select carefully, what test in what form should

provide what statement. The therapist should have a clear target definition.
In training courses and supervision I have repeatedly experienced that partici-
pants conduct biofeedback test procedures without knowing or previously defining
what statements should be made in the evaluation. For example, if the picture on the
screen is changed in the expectation phase or even a second counter is displayed
(counting until the appearance of the stimulus), the attention of the test person
changes. He/she leaves the inner attention, to turn towards what is happening on the
screen. In this case, no longer the innerpsychic processing is measured, but the
processing of the information of the image or the processing of a particular task or
concentrated attention to something specific in the picture.
• For the orientation stimulus, objects or sounds that might cause negative or
frightening associations should not be selected, such as spiders or sounds of war.

12.4.2 Performance-Dependent Test Methods

With regard to performance-dependent procedures, a certain performance is

demanded, such as calculating, solving brain challenges thinking about a negative
event or a conflict, doing a preset test, giving a talk and many more. When such a
procedure is used, the target of information acquisition has to be very clear. It is
12 Biofeedback: Measurement and Training Methods 209

important to remember that the test persons move when solving the various tasks or
prefer doing certain tasks to others. I would like to say, on a rather critical note, that
the interpretation is difficult because it is the activation during solving a task that is
queried, and not inner processes and motion artifacts, which additionally influence
the result. It is often easy to confuse activation with stress. Different tasks demand a
different level of energy.
This situation is quite different when a trained performance or self-control shall
be examined. In such a case the task could be applying something learned previ-
ously, e.g. remaining calm when lecturing, not panicking with aircraft noise, not
getting annoyed in a traffic jam and use it as a recovery pause instead etc. For
impulse control in the case of addictive behavior biofeedback training and control
are essential factors. Here pictures of beverages or, with regard to gambling
addiction, videos of games, machines and casinos are displayed on the screen with
the respective person being supposed to learn to control his/her addictive behavior.
In sports, biofeedback measurements are examined for performance check
during visualizations as well. For example, a swimmer gets the task to imagine his/
her 100 m distance. He/she keeps the eyes closed and imagines swimming the
distance. On the computer screen it can accurately be identified when the athlete
makes the turn in the pool.
Performance-related tests make sense to check the application of training con-
tent, or to clarify certain questions.
• It could be said that performance-related tests answer the question how a
person deals with a specific situation, whereas passive tests focus on eval-
uating the innerpsychic processes of a person during the test phases.
Every test situation has to be considered with its overall connection to the
question, and is only a part of information and knowledge acquisition. Activation
must not be equated with stress.
In ergonomics performance-related tests can say a lot about stress at the
workplace. In this case, it makes sense to measure and make visible the muscle
tension during work. A reduction of stress can often be made clear by slight
behavioral changes.
In the discussion, findings from the change of the parameters can be related to
findings from the Life Script Analysis and Work Script Analysis.

12.4.3 Combined Test Methods

For information acquisition and training supervision combined test methods seem
to be useful. Depending on which information is needed to bring unconscious
processes to consciousness, different test variations can be combined or applied
alternately. A central condition is, however, that the biofeedback therapist has
adequate knowledge of psychosomatic relationships, biofeedback application,
210 I. Pirker-Binder

design of training units and interpretation of the data obtained and a clear idea of
which information should be acquired from the evaluation of the measured results.

12.4.4 Heart Rate Variability Measurement: 24-h

Long-Term Measurement

In recent years multimodal biofeedback has been at the forefront as a learning

method for controlling psychophysical activity. The goal has always been the
change of a certain level; e.g. the reduction of muscle tension or the increase of
finger temperature.
Heart rate variability measurement and training pursue a different goal. The
focus of research, training and therapy are the measurement and positive manipu-
lation of the resonance variability of the heart rate. The aim is to strengthen the
endogenous physiological control mechanisms (Lehrer et al. 2007, p. 228 ff.).
A major advance in heart rate variability-biofeedback was initiated by the space
industry. Vaschillo et al. (1983, pp. 257–265) conducted the first studies in the
Soviet Union when the heart rate variability of cosmonauts was used as a measure
of the functional capacity of the autonomous system. Influenced by Vaschillo,
Lehrer and his colleagues began to research this method in America (Lehrer et al.
2000, p. 171, 2003, pp. 796–805; Gevirtz and Teacher 2003, pp. 212–244).
When a biological variable rises, a regulatory reflex is triggered that makes it fall again;
and, as it falls, a complementary reflex makes it rise. This sequence causes a pattern of
continuing oscillation and also gives us a window to the body’s processes for
self-regulation and homeostasis. Any one physiological function is usually controlled by
multiple reflexes. One could think of them as multiple backup systems for homeostatic
control; hence the complexity of the oscillatory patterns, as well as the amplitude, reflects
healthy adaptiveness … When the body is well regulated, these oscillations have a complex
pattern and are of relatively high amplitude. Reductions in either amplitude or complexity
are a sign of vulnerability, indicating that the body’s self-regulatory mechanisms are
damaged or inefficient and unable to withstand the vicissitudes of stress, disease, in jury,
and so forth. (Lehrer 2007, S. 227)

While in America the heart rate variability biofeedback training has been
paramount, the research development in Austria focuses more on recording the
heart rate variability over 24 h. A great effort is being made to implement this
measurement procedure in the prevention and evaluation of therapeutic advances.
To my knowledge biofeedback research and training and heart rate variability
research and training are regarded as two separate areas, with an increasing ten-
dency towards measurement.
Unfortunately, heart rate variability training has not been integrated into the var-
ious therapeutic training directions of psychotherapy or psychosomatic psychother-
apy (currently, this term is still not generally used) in Austria. Also, the 24-h
long-term measurement is primarily used by business consultants, coaches and
psychologists in order to obtain information on the strain on employees. It has to be
12 Biofeedback: Measurement and Training Methods 211

critically noted that there are no compulsory trainings on the applicability and eval-
uation of biofeedback measurement data and biofeedback training (heart rate vari-
ability measurement and training is a part of biofeedback) for the application and
interpretation of heart rate variability measurements. In Austria only certain profes-
sions such as psychotherapists, doctors, health psychologists and a limited group of
body therapists are entitled to apply these methods in the therapeutic process.
The development of biofeedback measuring devices for the detection of heart
rate variability has experienced a huge boom in recent years. The fact that the
evaluation and interpretation of the obtained data is not easy, poses a problem.
Another weak point is that there are no generally valid statements on the parameters
collected, as there is no data pool, which can be resorted to. Each device/software
producer more or less draws on their own data. The “Task Force of the European
Society of Cardiology and the North American Society of Pacing and
Electrophysiology” already set standards for statistical data collection (European
Heart Journal 1996) in 1996.
• Heart rate variability measurement, especially over 24 h, is an excellent tool
to gain insight into the performance capacity of the autonomic nervous
system, the psychological strain on the body and into sleep quality as an
important regeneration factor: as vegetative functional diagnostics or as
chronobiological regulation diagnostics, depending on which side one starts.
Heart rate variability measurements, which more and more companies are
offering to their employees, allow statements about the regulation of activation,
deactivation and quality of sleep. However, it must be stated that a human being
cannot be reduced to a key figure. There is currently a tendency in economic circles
to recognize this measuring method for health benchmarking. This could mean that
the health of the employees is reduced to a reference number. Here, ethical issues
come to the foreground, i.e. how to deal with data obtained with this technology.
On the one hand, it is a matter of protection, and on the other hand the psy-
chophysiological data should be interpreted. It must not be forgotten that behind the
measured data and the reference numbers there is a human being. This technology
provides information that only becomes valuable, meaningful and important
through individual anamnesis discussions with experienced therapists. In business
consultancy it makes sense to use heart rate variability measurements in prevention,
personality formation, ergonomics and in the detection of fatigue symptoms.
Nevertheless, I would like to note here that exhaustion might also occur even
though the heart rate variability measurement showed excellent values. Such a
phenomenon can be explained in so far as exhaustion of resources can take place at
different levels, which more or less intensively also affect the vegetative nervous
system, for example disbalance of the energy supply of the cells etc.
It is also worth noting that the health of humans cannot be reduced to a reference
number. On a critical note, it should be considered that there are different causes of
excessive activation of the sympathetic nerve or disturbed sleep. For example, old
212 I. Pirker-Binder

traumas or other psychological strain latent in the subconscious, play a role as well
(Fig. 12.10).
• Measurement and interpretation must be treated carefully and fully
appreciate the measured person. Premature conclusions must be avoided.
Depending on the biofeedback measuring device and the stored software, dif-
ferent data are collected and evaluated. The pictorial representation gives a first
impression. The example analysis shows the measurement of a 42-year-old
man (Fig. 12.10), father of a family, with a fatigue syndrome. The evaluation is
carried out according to statistical specifications in frequency domains and,
depending on the software provider, also in time domains. For representation all
measured heartbeats are submitted to a frequency analysis and subsequently eval-
uated and proportionally allocated to sympathetic and parasympathetic activity:

Sympathe c ac vity

Parasympathe c ac vity

Sympathe c ac vity

SDNN index

RSA

Heart rate

Pulse / breathing rate

Ac vity record

sleep

Fig. 12.10 Example of a 24-h heart rate variability measurement by Pirker-Binder with HeartMan
(by company HeartBalance Innovations GmbH)
12 Biofeedback: Measurement and Training Methods 213

• In (totRR/m2): total power divided into In (LFRR/m2) and In (HFRR/m2)

• LF/HF: shows the relationship between sympathetic and parasympathetic ner-
vous system. In the American literature it is somewhat controversial to use this
value as a core statement:

… use the LF:HF ratio as a measure of autonomic balance, there is some doubt about validity
of this use, particularly in the supine position … because there is evidence that sympathetic
system contributes only minimally to supine HRV (Myers et al. 2001, S. 62–75).

• Not all providers offer the evaluation of a further subdivision, a separate eval-
uation of the VLF, “very low frequency” and the LF, “low frequency”; however,
in terms of information this would be very important, since this area is pre-
dominantly allocated to the sympathetic nerve, while in the LF range sympa-
thetic and parasympathetic are represented.
• SDNN index: SDNN index is the mean value of the standard deviation of all RR
intervals for all 5-min sections of a 24-h measurement (Eller-Berndl 2010,
p. 104)
• Heart rate: is calculated from the R-R intervals
• log RSARR/m2: statistical calculation of RSA
• QPA: pulse-breath ratio represents the ratio (coherence) between heart rate and
breathing; a ratio of 4:1 in sleep is desired
• Vegetative quotient: relationship sympathetic to parasympathetic
All the collected key figures are compared with a database, allocated according
to age and gender and evaluated. A weak point of the evaluation is that there are
different databases that are partly not created along uniform criteria. This means that
evaluations of different providers cannot and should not be compared with each
other. However, if several measurements are made with the same person at different
times, a trend can be realized, i.e. the current status can be assessed much better.
With the newly launched HeartSensor by HeartBalance it is possible to record a
medical ECG, but also a separate evaluation of the individual frequencies. Another
advantage is the simplicity of the measurement.
Electrodes to not have to be attached any more; also movement, position,
temperature and air pressure can be measured.
A good overview is obtained if in addition to the HRV evaluation also
time-related parameters (in the form of a histogram, etc.) are displayed.
For the planning of preventive measures and/or intervention measures, it is
necessary to take further diagnostic measures in addition to vegetative functional
diagnostics by means of heart rate variability measurement over 24 h:
• the therapeutic conversation,
• questionnaires on work experience and life satisfaction, etc.,
• information from the Work Script Analysis,
• information from the Life Script Analysis,
• medical clarification.
214 I. Pirker-Binder

12.5 Biofeedback as a Training Method for Prevention

of Exhaustion

In the prevention of exhaustion biofeedback training has an important and heart

rate-biofeedback training a special position. It can be divided into three different
training areas:
• preservation or restoration of the balance of the autonomous nervous system by
internal coherence of the individual oscillation pattern in the organism. This
includes the respiratory sinus arrhythmia (RSA) and heart rate variability
biofeedback training (HRV-BF).
• perception or awareness training: multimodal biofeedback or perception and
control of the energy consumption, the inner peace as well as learning
regeneration.
• biofeedback in ergonomics: here, the focus is especially on the perception of
muscle tension and learning a situation-adjusted posture and muscle tension.
Also, the issue of dysponesis (tension as a protection mechanism) can be
mentioned here.
In a training program, these three different training contents are properly inte-
grated into each other, so as to achieve an overall effect.
• Inner peace and control over the autonomous nervous system can only be
achieved when the whole organism is in resonance.
The idea behind the 24-h heart rate variability measurement is the attempt to
detect strain of the vegetative functional capacity early on and to inform the affected
people, or to initiate training programs. It is always about measuring the oscillation
capacity of the autonomous nervous system, which is an essential part of the
regulatory reflexes of the organism.
These oscillations represent the body‘s self regulatory reflexes. When the body is well
regulated, these oscillations have a complex pattern, and are of relatively high amplitude
(Lehrer 2007, p. 227).

Another important rhythm is the 90–120-min rhythm, which appears very clearly
in the structure of the night sleep. A rhythm of parasympathetic (green) and
sympathetic (red) system expresses deep sleep and REM phases. This rhythm is
influenced chronobiologically and controlled via the autonomic nervous system.
It is called BRAC (Basic Rest and Activity Cycle), i.e. a basic relaxation and
activation rhythm. This important rhythm represents the balance between activation
and recreation in people and provides for the long-term health and sustainable
performance capability of the organism.
This rhythm, i.e. the ability of people for activation and performance, deacti-
vation, regeneration and relaxation, depends on the regulatory capacity of the
autonomic nervous system.
12 Biofeedback: Measurement and Training Methods 215

• The regulatory capacity of the autonomic nervous system becomes one of the
most important parameters for the assessment of longer-term stable health.
Figure 12.11 shows a comparison between good and poor regulation capability.
Poor regulatory ability can be caused by chronic activation, stress, over-training of
athletes or traumatic experiences, allergies or physical disorders.
The process of reducing the vital potential can lead to psychological and
physical deficits and disorders. Figure 12.12 shows in an ideal-type manner the
course of good vitality (stage 1) up to burnout (stage 12). The reduction in the
course of each stadium becomes clearly visible.
• The goal of a training program with heart rate biofeedback in prevention
can be defined as the preservation and/or restoration of the regulatory
capacity of the autonomic nervous system, the reduction of stress-induced
and psychosomatic complaints and an increased perception of health.
Due to the results of the research on heart rate variability two training steps have
been established in biofeedback training:
• Respiratory Sinus Arrhythmia (RSA)—biofeedback training
• Heart rate variability biofeedback training

Fig. 12.11 Image source Courtesy of HeartBalance Innovations GmbH (www.heartbalance.org)

216 I. Pirker-Binder

HeartBalance®Analysis

Good regula on

Poor regula on

Fig. 12.12 Good and poor regulatory capacity compared. Image source By courtesy of
HeartBalance Innovations GmbH, www.heartbalance.org

12.5.1 Respiratory Sinus Arrhythmia (RSA)

Respiratory sinus arrhythmia means the change of the heart rate by the breathing;
that is, the heart rate increases during the inhalation phase and decreases during the
exhalation phase (Porges 1995, pp. 225–233, 2010). The RSA, which is influenced
by the breathing, appears at a breathing rate from 6 to 24 breaths per minute in
healthy people, which corresponds to the range of “high frequency” (HF) 0.15–
0.4 Hz on the frequency band.
The power of the RSA is considered the strength of the parasympathetic system
(“vagal tone”). The RSA is influenced by the vagus nerve (10th cranial nerve),
which, in the exhalation phase, is responsible for the release of acetylcholine, the
transmitter substance of the parasympathetic nervous system (Fig. 12.13).
However, merely determining the strength of the vagal tone through RSA is not
always easy:
It is important to consider respiration rate while evaluating HRV as a measure of autonomic
function. If increases in RSA occur independently of respiration rate and are coupled with
decreases in HR, then one can confidently interpret these effects as reflecting increased
vagal tone. (Lehrer 2007, S. 229)
12 Biofeedback: Measurement and Training Methods 217

Stad.1 Stad.7

Stad.2 Stad.8

Stad.3 Stad.10

Stad.4 Stad.11

Stad.5 Stad.12

Fig. 12.13 Simulation of burnout. Image source By courtesy of HeartBalance Innovations

GmbH, www.heartbalance.org

12.5.2 Heart Rate Variability-Biofeedback Training

In addition to respiratory sinus arrhythmia, the heart rate variability is affected by

the baroreceptors. They control the blood pressure and are located in the aortic arch
(influenced by the vagus nerve) and in the carotid sinus (influenced by the glos-
sopharyngeal nerve).
The baroreflex can be represented in the “low frequency” area 0.04–0.15 Hz,
with a peak at 0.1 Hz. The power of the baroreflex is an indicator for the adapt-
ability of the cardiovascular system to life’s challenges. The peak at 0.1 Hz means
that at this frequency coherent oscillation occurs between heart rate and blood
pressure (Vaschillo et al. 2002, pp. 1–27 and 2004, pp. 1385–1386).
We have found that the phase relationship between HR and blood pressure oscillations at
the resonant frequency (and only at this frequency) is exactly 180°, that the phase rela-
tionship between HR oscillations and respiration is exactly 0° with inhalation coinciding
with HR accelerations, and that the highest amplitudes of Biofeedback-produced HRV are
achievable when people breathe at this frequency. Thus is associated with increases in HR
(presumably driven by respiration-RSA) and decreases in blood pressure. The decrease in
blood pressure then stimulates the BRs (Baroreflexes- added by author), so that they also
produce increases in HR at this time, thus enhancing the respiratory-induced increases in
HR. (Lehrer 2007, S. 231).

Such coherence, also known as cardiac coherence, happens at a breathing rate of

around 6 breaths per minute. This breathing rate, or “resonant frequency”, is
218 I. Pirker-Binder

Fig. 12.14 RSA training and power spectra/frequency analysis, screenshot. Image source By
courtesy of Mind Media www.mindmedia.nl

individual and differs between 4.5 and 7 breaths per minute (Johnson and
Piscataway 2000; Harvard Business Review 2015; Fig. 12.14).

Heart rate variability training in the area of “resonant frequency”, i.e. the
breathing rate, which enables the highest amplitude in the RSA, leads to
• strengthening of the vagus nerve,
• high amplitudes in the heart rate,
• higher heart rate variability,
• strengthening of the pulmonary function,
• strengthening the baroreflex,
• a “mindful mental state” (Gevirtz, Lehrer in Schwartz and Andrasik
2003),
• an increase in health,
• a reduction of stress-induced and psychosomatic complaints,
• and blood pressure regulation.

New research approaches by Vaschillo (2002 in Schwartz and Andrasik 2003,

p. 248) deal with influences of the baroreflex system and blood pressure oscillations
of around 0.05 Hz. The research results might prove that special heart rate vari-
ability training in this frequency range also greatly affects the strength of the
baroreflex and the control of the autonomic nervous system.
12 Biofeedback: Measurement and Training Methods 219

• It is to be noted that for efficient training not only well-equipped biofeed-

back devices are necessary, but therapists who can operate them and are
able to design useful training concepts.
Efficient heart rate variability biofeedback training requires consciousness and
perception training. Without proper breathing, mental, psychological and physical
letting go, the desired success is very difficult to achieve. The goal should be life
and wellbeing without the support of devices. Inner mindfulness and concentrated
serenity should be our daily companions without having to practice continuously.
This requires professional support during change processes with biofeedback.
Learning and discovering with biofeedback should be an integrated component of
prevention programs. Advisors and coaches should undergo self-awareness training
before practical application of measuring or training methods.
Patient Report September 2015
In November 2004 I suffered a hypertension crisis and was admitted to hospital.
After my condition had stabilized, the treating physicians prescribed blood pressure
medicines. These should keep my blood pressure stable during the next few years.
With continuously rising stress at work the dose kept being increased over the years
until it reached a level in the spring of 2015 that I no longer wanted to increase.
A further increase of the dose had only resulted in short-term improvement. The use
of psychotherapeutic drugs did indeed have a positive effect, but seemed to me no
viable alternative.
At the advice of my general practitioner, I decided to try biofeedback. The
training should, on the one hand, provide me with an instrument for extreme stress
situations and, on the other hand, it should help to freeze the drug dose, which had
been increasing in recent years, or, ideally, even reduce it.
After an initial talk with Ms. Mag. Dr. Pirker-Binder, we decided on a training
series of ten sessions. These were divided into an analysis of the causes of stress
and corresponding respiratory training (heart rate variability biofeedback training,
therapist’s note). Both parts were necessary for me to recognize where my problems
were in the daily workflow or in stress management. The sessions took place at
intervals of two to three weeks.
The training quickly showed that I could positively influence my body’s regen-
eration system. I started with daily breathing exercises before and during work,
measured my blood pressure and my finger temperature (part of the hand warm-up
training) at the same time every day and followed the instructions during the daily
endurance training. The records rapidly showed significant improvements in blood
pressure, so that I started the next step, which was measuring my blood pressure at
different times of the day and indicating particularly stressful days in my notes.
Spiritual anchors like “The anger over the mistakes of others makes sure my
mood is indirectly controlled by these people”, or “Keep working slowly; not
everything has to be finished immediately” helped me with upcoming anger or
stress, or avoided such a crisis situation all together. Scheduled breaks and a relaxed
sitting posture at the PC have become important for me to facilitate mental
letting-go and relaxation in between.
220 I. Pirker-Binder

The analysis of the blood pressure values after a recording phase of three months
showed that my values had not only normalized, but also sunk. My physical
wellbeing has risen significantly. The training has helped me to better manage my
stressful everyday life and to use my energy more efficiently and purposefully. In
consultation with the general practitioner we therefore began to reduce the medi-
cation on individual days and on weekends. The lower dose has so far had no effect
on the blood pressure values.
Development of blood pressure values:
Apr.15: 150/100 (before the training)
Jul.15: 128/81 (after 5 weeks of training)
Dec.15: 119/71 (after 5 months of training)
Different biofeedback units are available for individual heart rate variability
training at home. These small appliances (www.vital-monitor.com or www.heart-
math.org) are used for the reduction of stress-induced and psychosomatic com-
plaints (according to a predefined plan of the treating therapist) and/or for health
control and sports training control. These small appliances are easy to use via
mobile phone or tablet. Based on the progressive graphs the daily stress and
regeneration factor can be read. It is particularly exciting to see the course of the
biological age (“bioage”), which results from daily measurement and analysis of the
statistical evaluation of peers. Stress after an intensive working day or too intensive
sports activities can be recognized quickly, but also the efficiency of active
regeneration units (Fig. 12.15a, b).

Fig. 12.15 a, b Graph a shows changes during heart rate variability training or coherence
training, namely changes in breathing (respiration), heart rate variability and in the blood pressure
rhythm. Specific training helps to quickly get from a strained to a harmonious, coherent state. All
three rhythms are synchronized. To the left of the marker all rhythms are unsynchronized as they
occur in stress situations. To the right of the marking line one can see how coherently and
synchronously the rhythms appear in a balanced state. The aim of heart rate variability training is
to achieve this coherence as often as possible during the day to relieve the body. b shows the
difference between “relaxation” and “appreciation” in the frequency spectrum. The expression of
the vagal tone (expressed by the RSA, is usually in the high frequency range (HF) (between 0.15
and 0.4 Hz) slips into the “low frequency” range during this breathing training in conjunction with
heart rate variability training. Image source By courtesy of HeartMath Institute (www.heartmath.
com)
12 Biofeedback: Measurement and Training Methods 221

12.6 Awareness and Consciousness Training

Awareness and consciousness training is done using multimodal biofeedback

training. Thereby the change of the individual parameters is observed and practiced
in small steps. The Life Script Analysis and Work Script Analysis provide pre-
liminary data, also combined with 24-h heart rate variability measurement and a
consultation. It is of fundamental importance to clarify with the trainee before the
start of the training the contents and connections between physical, psychological
and mental condition and to define the goal for change, whether it be anger or
emotion management, learning concentrated serenity, mindfulness, distancing from
what is going on or the reduction of muscle tension. Every training step has a
relationship as its goal, especially for letting go of inner pressure:
• Respiratory training: general oscillation ability, inner peace, and precursor to
HRV training
• EMG training = perception of tension and reduction of muscle tension
• Hand warming = general relaxation and uncramping
• RSA training: harmonization, strengthening the parasympathetic system
• Skin conductance: reduction of mental tension, reduction of a sympathetic over
excitation
• Combination with HEG-training and neurofeedback for special issues
Helpful strategies for self-control are supported by biofeedback training
(Pirker-Binder 2008) (Fig. 12.16a, b ).
In awareness and consciousness training the learning content is intensified
self-awareness, a balance between brain and heart and body-mind balance (psy-
chosomatic competence), the return to one’s own needs, support in the processing
of old conflicts and, above all, letting go of inner pressure in the workplace.
• Heightened self-awareness in the sense of psychosomatic competence increases
responsibility for one’s own health. Biofeedback shows the way to self-help.
Control of one’s individual life energy can be named as the paramount goal, i.e.
realizing how much energy is necessary for what task and life situation as well as
avoiding long-term tension and stress.
• Dysponesis—protective function of the body
Whatmore and Kohli (1974, 1979) coined the term dysponesis in 1974, which
still is not represented in the health literature and German-language research.
Dysponesis (“dys”: bad, faulty, false, “ponos”: effort, work, energy) is a reversible
pathological condition due to errors in energy consumption, which is disadvanta-
geous on the nervous system and the control of the organ functions.
As unhealthy strain, the effort to give even more or to grit the teeth, triggers functional
disorders in the organism. It is often unclear whether we are dealing with inherited, con-
stitutional characteristics or effort patterns acquired in the course of life. Dysponesis is
related to physical, emotional and mental reactions. Unhealthy, i.e. wrong, efforts then exist
222 I. Pirker-Binder

Fig. 12.16 a, b Based on the progressive graph the daily stress and regeneration factor can be
read. Calculating the biological age is particularly exciting. Source of image By courtesy of Pulse7
GmbH

mainly from errors in nerve impulses (action potentials) in nerve tracts, which include
motor and premotor cortex neurons, pyramidal and extrapyramidal strands up to the
peripheral musculature. These nerve pathways are involved in all conscious motor activi-
ties. (Whatmore and Kohli 1974).

Whatmore could prove that on the one hand dysponesis represents a safety
mechanism, namely at the beginning of the so-called fight/flight mechanism, but
also develops from itself by means of hereditary disposition as a reaction against
stress, through illness and/or pain or it accompanies these. Muscular dysfunction
has many different sources, be it pathology of the muscle tissue, dreams or injury,
accompanied by a wrong muscle strain or poor posture. All this leads to physical
symptoms that are often mistakenly regarded as anatomically or biochemically
pathological and become evident through trembling, sweating, respiratory
12 Biofeedback: Measurement and Training Methods 223

problems, palpitations, stomach problems and more. Dysponesis affects the entire
organism and affects the respiratory function, gastrointestinal activity,
cardio-vascular activity and the movement pattern. It produces states of exhaustion,
insomnia, headaches, back pain, hyperventilation, anxiety, depression and indi-
gestion. Dysponesis can stand alone or be embedded into a disease or the course of
a disease.
The importance of dysponesis in health prevention is obvious. Chronic muscular
tension causes pain, which in turn entails a poor posture and/or further tension. Just
think of a dental appointment: once the drill is in action, approximately 95% of
patients tense up in order to better endure the coming pain. Often this tension also
causes the sensation of pain even though none is present yet—tension increases the
pain (Pirker-Binder 2008)
• Dysponesis builds a bridge to corporate culture and shows the relationship
between an unsuitable reaction on stress and anxiety and high muscle
tension. Biofeedback measurement and training can give an answer to that.

12.7 Biofeedback and Ergonomics at the Workplace

In the field of ergonomics, the focus is not on the attitude to work or work expe-
rience, but the body posture, which is adopted during work, such as tense, pulled-up
shoulders, neck, forehead, cramped breathing, twisted sitting position, incorrectly
adjusted office furniture or screens, which can cause eye problems or headaches. It
is about resource-oriented work with the right body posture and micro-breaks for
the prevention of chronic tension, but also about restoring healthy awareness of the
needs of the body and preventing pain through disuse. To measure the influence of
psychological and physical stress on the body, HRV measurement during working
hours, shift work etc. seems to be useful.
The analysis gives an insight into how the organism copes with strain, or
whether it still has a good regeneration capacity. By recording the daily routine in
the activity record, the different stress peaks can be seen. Information about the
muscular tension is provided by biofeedback measurement at the workplace, during
lectures or a meeting, which can also be combined with video recording.
With the increasing number of computers and workstations with screens the
related stress problem was understood in the 1990s and regulated in the EU
directive 90/70/EEC Council Directive regarding the minimum safety and health
requirements for work with display screen equipment.
In Austria the implementation was carried out in §§ 67.68 ASchG (Employee Protection
Act), Federal Gazette no. 450/94 and in the BS-V (Ordinance for Work with Visual Display
Units). § 67 (2) ASchG states that employers are obliged to design ergonomic screen
workstations. (Wichtl 2007)
224 I. Pirker-Binder

Compliance with the regulations is a prerequisite for complaint-free work. The

complaints through screen workstations include:
• Shoulder-neck complaints 49.2%
• Back and low back pain 37.3%
• Headaches 35.4%
• Eyestrain 29.8%
• Despite good workplace equipment, stress and tense muscles may occur—
namely because of sitting in the wring position or for too long and/or
unhealthy tension during work.
Apart from a bad posture, high internal pressure, deadlines, tight time windows
and high work requirements are frequently to blame for physical tension despite
good workplace equipment. High muscle tension is often accompanied uncon-
sciously and unnecessarily by high concentration.
Biofeedback measurements of muscle tension at the workplace can provide
initial insight into self-inflicted complaints. Figures 12.17, 12.18, 12.19, 12.20 and
12.21, show how muscle tension and breathing change while working on the PC,
depending on how much tension work causes or in how far concentration can be
represented through muscle tension.
Concentration often entails muscle tension in the forehead and neck. If one is
not aware of this, it is often the pain that makes the concentrated, working people
take a short break or change the posture.
Biofeedback measurement makes this unconscious tension during concentration
or work under pressure visible. During the training, relaxed concentration is
practiced, as well as working without too much muscle tension. The goal is to use
only as much muscle tension as necessary.
When writing on a computer short micro-breaks should be taken, i.e. a short
release of tension to allow the muscle(s) brief relief (Fig. 12.18). In Fig. 12.17 the
short relief of the muscle while writing can be seen very well. With regard to
working on a PC, it is about the flow, the alternating play between adequate tension
and short phases of letting go, when not writing but thinking or when the computer
is processing information and one has to wait anyway. Figures 12.18, 12.19 and
12.20 show relaxed concentrated working on a PC with micro-breaks.
Biofeedback supported awareness training increases the sensitivity to the body,
one begins to feel like oneself again and listens to the needs of the body. Pain is like
a bomb: there is a long fuse, a long time of not realizing or suppressing, until the
bomb bursts and the pain hits. Also, it is not just about working on the PC. Being
aware of muscle tension is useful wherever people are at work, especially in
professions that typically involve bad posture, such as musicians or dentists.
Without a more sensitive awareness and feeling there will not be any change; those
who are not aware of themselves, quickly fall back into old patterns of tension after
a relaxing massage or physiotherapeutic treatment (Fig. 12.21).
The aim of biofeedback measurement or biofeedback training in ergonomics is
perception training of the physical and psychological strain during working,
making people aware of unconscious tension and tenseness and learning a
12 Biofeedback: Measurement and Training Methods 225

Forearm
right hand

Right
shoulder

Breathing

Fig. 12.17 Muscle tension measurement of the forearm of the right hand, right shoulder and
breathing during writing on the computer. When typing starts, muscle tension increases and
breathing becomes unrhythmical. Upper line: forearm, medium line: shoulder, lower line:
breathing. Image source By courtesy of Schuhfried GmbH

Neck

Forehead

Breathing

Beginning of
typing

Fig. 12.18 Muscle tension in neck and forehead during concentrated typing on the PC. Breathing
is unrhythmical. Upper line: neck, middle line: forehead, lower line: breathing. Image source by
courtesy of Schuhfried GmbH
226 I. Pirker-Binder

Micro pause

Fig. 12.19 Writing on the PC with micro-breaks; muscle tension is measured. At the low points
of the graph small breaks were taken. Image source By courtesy of Schuhfried GmbH

Fig. 12.20 A comparison: left—working on the PC with a lot of tension; right—working on the
PC with micro-breaks. Image source By courtesy of Schuhfried GmbH
12 Biofeedback: Measurement and Training Methods 227

Fig. 12.21 Working on a pic with micro-breaks and regular breathing. Image source By courtesy
of Schuhfried GmbH

resource-oriented attitude. Even the best office chair can cause discomfort if one is
either sitting too long on it or with too much tension.

Aims of Working with Biofeedback in Ergonomics

• Making conscious and creating awareness of the transformation of per-
formance pressure and/or concentration into muscle tension.
• Recognizing how inner pressure leads to tense muscles and changes in
breathing, which consequently may cause stress- and workplace-related
pain, respectively chronic tension.
• Learning a mindful attitude towards work with micro-breaks.
• Resource-oriented work means tension adapted to the situation with
integrated micro-breaks, during which the tension is loosened rather than
rigid persistence in a specific work posture.
• People at work have to learn to feel themselves again in order to establish
contact to their resources.

However, not only screen workstations require special attention. Work on the
assembly line, at changing workplaces (the traveling manager) or shift work need good
energy management of the affected people, so that they do not become exhausted. This
necessitates a high degree of sensitivity to the needs of the body and its performance
capacity. Biofeedback measurements reveal tension and strain on the screen and thus
provide information about different kinds of physical and psychological strain and relief.
228 I. Pirker-Binder

Fig. 12.22 Training screen, right and left Trapezius Image source By courtesy of Schuhfried
GmbH

• Relaxation is not synonymous with regeneration, but only a preliminary stage .

One of the most important learning steps is learning regeneration. Relaxation is
not regeneration, but only a preliminary stage. The term regeneration includes “to
generate”, i.e. one would like to generate energy again, to refuel, so to speak.
Regeneration and recreation are both active processes of the passive will, that is,
allowing the regeneration mechanisms of the body to happen. Small children are
not yet aware of this. When they are tired, they sleep as long as they need to.
Unfortunately, we unlearn these mechanisms, this feeling for what the body needs,
with everyday life.
People who travel a lot and those doing shift work must comply with active and
passive regeneration times. Active regeneration time may be a break; passive
regeneration time is restful sleep.
• The quality of the regeneration is determined by the ability of the respective
person to go into inner stillness, to make body, mind and soul coherent.
Biofeedback in ergonomics deals with
• Raising awareness of the body, breathing, muscle tension, regeneration
mechanisms,
• Reduction of unnecessary tension, use of adequate energy,
• Healthy breathing also during work,
• adequate energy use, i.e. suitable for given task,
• Learning of micro-breaks for regeneration,
• Sleep quality.
12 Biofeedback: Measurement and Training Methods 229

12.8 The Process Model of the Life Energy Analysis

(LEA)

The goal of a Life-Energy Analysis is to provide awareness about the use of life
energy, the individual activation level, the process of activation and deactivation,
and to learn self-awareness and self-control of energy use—so as to facilitate work
without energy loss and the adequate use of individual resources in the work
process. The Life-Energy-Analysis builds on information gained through Life
Script Analysis and Work Script Analysis and supplements this subjective infor-
mation with biofeedback measurement data and additional holistic measurement
methods for the analysis of the stress level.
The Life Energy Analysis prepares the ground for targeted biofeedback and
neurofeedback training as well as a holistic process of change. Relationships
between activation and work situations or stress and psychosomatic complaints in
professional and private life can be recognized and understood. If mental relaxation
is very difficult, complementary neurofeedback training is recommended. It works
like biofeedback training—the client learns to influence his/her brainwaves, i.e. to
make them rest. Neurofeedback alone without previous biofeedback or heart rate
variability training is not advisable, since only conscious awareness of the body and
learning regeneration mechanisms can lead to the desired success in the long run,
that is, work and life in flow.
A 24-h heart rate variability measurement as vegetative functional diagnostics
represents the current use of energy. It indicates whether a specific state of acti-
vation is already exaggerated and poses a risk to health. It is also possible to
determine whether sleep is restful and whether sufficient regeneration is available.
This measurement provides information on the autonomous vegetative balance.
The Life Energy Analysis (Table 12.2) is considered to be a template for
biofeedback consciousness and awareness training. Information from the Life Script
Analysis and Work Script Analysis (Sect. 12.1) run together here. By means of
biofeedback the individual can recognize the impact of negative thoughts and
feelings on the activation in the body. With training supported by biofeedback new
behavior, inner peace and self-control can be learned. In particular, it is learned to
use activation carefully and in relation to the tasks and situations at hand, and to
return to a phase of rest and regeneration in due time.
Changes in the workplace and permanent availability psychologically and
physically demand a lot from people. Unfortunately, more and more people are
unlearning the feeling for the needs of their body and for their physical resources.
They do not get in touch with themselves any more.
Body awareness, mindfulness and consciousness exercises are an integral part of
effective prevention. The so-called relaxation, which people want to turn into
regeneration in the evening or on holiday, is not enough. What sport is beneficial
for what people at what time is dependent on the energetic condition of their
organism. It is the task of the occupational and business psychotherapist to
230 I. Pirker-Binder

Table 12.2 Life Energy Analysis® (Pirker-Binder)

Test type Content Why?
Biofeedback test procedure
Biofeedback HRV 24 h vegetative function – Strain/relief during 24-h period
diagnostics – Regeneration capacity during sleep,
sleep diagnostics
– Breaks
Multimodal biofeedback Base line measurable Insight into psychophysiological
parameter connections, initial information
Biofeedback test procedures Passive/active/ – Understanding connections
combined tests – Expectations
– System most sensitive to stress
– Stress, workplace induced and
psychosomatic complaints
Biofeedback—consciousness and awareness process
Multimodal BF Sensitizing awareness Self-control of activation and deactivation
RSA-biofeedback training Coherence between Strengthening parasympathetic nerve in
breathing and heart rate the HF range
HRV-biofeedback training Increasing coherence – Increasing HRV = preservation of health
between – Learning regeneration
– Breathing – Serenity and mindfulness
– Heart rate – Easing complaints
– Baroreflex system
Neurofeedback
EEG neurofeedback Improving brain – Self-regulation
function – Improving performance
– Diverse applications (ADS, ADHS,
peace of mind and focusing, tics etc.)
HEG-neurofeedback Blood circulation in the – Direction of attention
frontalis – Peace of mind
SCP-neurofeedback Training slow potentials Learning activation/deactivation
Complementary measurement methods
Cortisol Saliva test Measurement of cortisol to determine
stress level, adrenal gland fatigue
FRAS-test or others – Analysis of free Analysis of the body’s capacity to deal
(Free Radical Analytical System radicals with oxidative stress
Test) – Antioxidative capacity
Complementary questionnaires/ e.g. Blood count Micronutrient requirement, allergies, other
conversations /findings strain
Collecting data on mental states, Questionnaires Determining internal triggers
pain symptoms, sleep quality Life-script analysis Inner balance
Work-script analysis
Mental stress and
energy profile (MSEP)
12 Biofeedback: Measurement and Training Methods 231

holistically treat the people and to show them ways to concentrated serenity and
resource-oriented work.
The biofeedback technology and the possibilities of heart rate variability analysis
are adequate tools for the prevention of exhaustion in the workplace and comple-
ment the Life Script Analysis and Work Script Analysis. The Life-Energy Analysis
provides an overview of the application of biofeedback in the work and economic
world, and is complemented by alternative methods of stress measurement in the
organism.

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Chapter 13
Health in the 21st Century

Ingrid Pirker-Binder

Contents

13.1 Back to Nature................................................................................................................. 234

13.2 E-health: Digitialization and Cloud Communication...................................................... 235
13.3 Outlook ............................................................................................................................ 235

This is a time of reflection, rethinking and a new beginning. The human beings and
their resources are at the center of attention, as the speed of time and the dynamism
of technological development take their toll. The amount of psychological illnesses
explodes and the health costs are no longer financially viable. The living conditions
of the people have changed drastically. This development is creating a new
awareness of human resources. The responsibility for one’s health can no longer
exclusively be delegated to the health system, but rather lies in the individual’s own
hands. Thereby people are supported by new digital technology.
Performance pressure and pressure to succeed, existential fears, multiple burdens
of work and raising children, multiple jobs and performance demands in the leisure
area, divorce (patchwork families), poor nutrition, environmental pollution such as
contaminated water, air pollution and electrosmog, and many more affect the body,
mind and soul of the people. It is not only high time, but already 10 past 12, to
reflect on our values, needs and resources, if we do not want to perish despite
technological top performances and significant research results.
For a long time, western health care has only concentrated on combating symptoms
and diseases. The question “how does the individual human being stay healthy?” has
not been asked. Performance mentality and the pursuit of ever more success, power
and development has long been the prevailing goal in private life and the economic
environment. The education system can be taken as an indicator of this zeitgeist.

I. Pirker-Binder (&)
Saileräckergasse 43/26, 1190 Vienna, Austria
e-mail: offi[email protected]

© Springer International Publishing AG 2017 233

I. Pirker-Binder (ed.), Mindful Prevention of Burnout in Workplace Health
Management, https://doi.org/10.1007/978-3-319-61337-6_13
234 I. Pirker-Binder

Here, the foundations for the future should be laid with the children. What catches our
eyes in this respect? Healthy nutrition is considered a project and not daily learning, the
issue of a daily gym class at school is merely a political discussion, and much more.
In the age of resource scarcity, more mindfulness of nature, life and people is
called for. Our body is a marvel of nature, a finely tuned chemical plant; the only
thing it needs is air, water, food and MINDFULNESS. This means that one must
not interfere in its processes and workflow; it must be given rest and regeneration,
necessary nutrients and understanding. An active mind and a happy soul can
only live in a healthy, balanced body. This, however, is the prerequisite for moti-
vation, performance and work capability.
Responsibility for one’s own health is first and foremost in the hands of every
human being. The future goal must therefore be mindfully dealing with one’s life
and physical resources, so that the human being does not have to become ill to learn
to appreciate health and its preservation.
Salutogenesis—preservation of health—replaces pathogenesis (healing of
disease).
This leads to questions such as:
• What do people need to stay healthy?
• How can they better recognize the needs of their body?
• How do they keep body-psyche-brain healthy, active and powerful into old age?
Two pathways result from this:
1. Back to nature, to Mother Earth, to reflection, to more mindfulness and care of
resources: one’s own and those of the environment.
2. Taking advantage of the growing digitalization of the world and cloud
communication.

13.1 Back to Nature

Great progress has been made in understanding health and the relationship between
body-psyche-brain through psychosomatics, psychoneurology, neuropsychology,
neurosciences, psychotherapies, etc. These scientific fields explain how psy-
chosocial and psychological factors affect the nervous, hormonal and immune
system. In psychotherapy, especially in occupational and business psychotherapy,
the psychiatrist and pioneer of logotherapy and existential analysis Dr. Viktor
Frankl made a great contribution. The orientation towards meaning and values has
entered the economy (see Chap. 1, Sects. 1.1, 1.2, 1.4 and 1.5).
In the field of psychoneuroimmunology, cPNI, i.e. clinical psychoneuroim-
munology has emerged. The significance of this still young science is the support of
self-healing powers by means of active substances that the body desperately needs,
such as certain herbs, supplements, etc. (see Chaps. 7, 9). They must be
13 Health in the 21st Century 235

supplemented when a person is exhausted, or does not absorb them due to poor
nutrition; abandoning the path of exclusively combating symptoms in favor of
healing the causes of illnesses.1
Psychotherapeutic diagnosis, counseling and treatment will increasingly come to
the fore, because every affect status determines the immune status (Lukas, Elisabeth
1998, Lehrbuch der Logotherapie, Profil Verlag München, Wien). Occupational
and business psychotherapy particularly deals with psychological problems at the
workplace. Management consulting, training, preventive measures, acute counsel-
ing, quick preventive intervention and short-term therapy are its main focus.

13.2 E-health: Digitialization and Cloud Communication

“My health is my responsibility, it lies in my hands” is the new slogan. Health

cannot be handed over to doctors in general. “The doctor will put it right” is no
longer universally valid. Digitization and technology are not only making working
life easier, they also help interested people in staying healthy. This trend has long
been visible in sports. Fitness bracelets, heart rate monitors, step counters, breathing
trainers, computers attached to the fitness machines, etc. shape sports in everyday
life.
What is new now is that one can keep records on one’s health via PC or
smartphone and APP (Fig. 13.1). If you are interested, you can enter your sleeping
habits, your diet, blood values, blood pressure, heart rate variability and your
training intensity into your smartphone or PC, or directly transfer them from
measuring instruments. Not only that, also the transfer of the data directly to the
doctor, therapist, fitness trainer or coach is now possible without sitting in the
waiting room for hours. Webinars, online and Skype coaching are new ways of
communication, counseling and therapy.

13.3 Outlook

New measurement and training methods are an integral part of good diagnostics and
are indispensable in occupational and business psychotherapy. It somewhat relieves
the strict schedule of time and space of practice-based consultation by facilitating
measurement and interdisciplinary intervention at any place and at any time. Health
is becoming visible and is thus increasingly moving into people’s awareness and
responsibility. Also, the concept of psychological health is becoming more and
more understandable and is gradually losing its often negative connotation.
Psychological health includes the whole human being, i.e. the harmonious interplay

1
For more information about seminars, workshops, retreat-week mail to offi[email protected].
236 I. Pirker-Binder

Fig. 13.1 Intervention cycle via PC, smartphone, App; provided by www.heartbalance.org

of body, brain and psyche, because “every affect status influences the immune
status” (Viktor Frankl). Psychological health includes MINDFULNESS;
meaning-centered occupational and business psychotherapy integrates it into
the working life. It combines economic knowledge with psychotherapeutic
knowledge about psychological health. Occupational and business psy-
chotherapy is dedicated to prevention, personality training, short-term ther-
apy and counseling. It is concerned with interventions in the economic context. As
a new special psychotherapeutic area, it will increasingly be recognized and become
a link between workplace and people with their resources.