Abstract
Background
Professions such as nurses, doctors, social workers, teachers, and service employees bear significant responsibility for the health and well-being of patients, clients, and pupils, increasing the risk of burnout and sick leave. However, the factors that protect against these outcomes are not well understood. This study aims to identify specific strategies to manage emotional demands across various occupations, assess their impact on burnout levels. It also explore how these strategies are applied in practice, and explore the organizational conditions necessary for their implementation.
Methods
A three-step sequentially mixed-method design, combining qualitative and quantitative methods was used. Step one involved an expert focus group interview to identify practical strategies used in workplaces. Step two consisted of a survey of 1,336 employees to evaluate the associations and effects of these strategies on burnout. In step three, 32 qualitative focus group interviews were conducted at 14 workplaces to understand the application of these strategies. The 14 workplaces were selected based on the quantitative survey data only including those workplaces with high emotional demands and low burnout levels.
Results
Six practical strategies were identified: providing opportunities for supervision, discussing emotionally demanding cases, offering prompt feedback, allowing employees to "vent" with colleagues or management, performing task rotation, and discussing strategies to manage high emotional demands. The quantitative survey results indicated that these strategies were associated with lower burnout levels. The qualitative findings supported these results, highlighting the importance of these support measures in reducing emotional burdens. The study revealed that trust among staff and management and a strong sense of psychological safety were crucial.
Conclusion
This study recommends that workplaces implement these six specific strategies as effective tools to prevent burnout.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12889-025-25085-x.
Keywords: Emotional demands, Protective factors, Mixed methods study
Introduction
Professions such as nurses, doctors, social workers, teachers, and service employees must take on significant responsibilities regarding the health and well-being of patients, clients, pupils, and customers to address traumatic and stressful life events that impact their lives [1]. A unique aspect of such professions is social interactions with these individuals, where employees must professionally engage with them and manage the emotions they express [2]. This leads to the presence of emotional demands in the workplace. Thus, emotional demands refer to emotionally demanding situations such as having contact with clients who are in difficult situations (such as individuals affected by serious illness, accidents, grief, crisis, or social problems) [1]. Furthermore, managing one’s own emotions is a job requirement for many employees in these sectors, and this type of management is referred to as emotional labor [3]. Hochschild (1983) defined emotional labor as "the management of feeling to create a publicly observable facial and bodily display; emotional labor is sold for a wage and therefore has exchange value" [4]. This necessity stems from the demanding nature of these professions, where individuals must maintain professionalism and empathy to ensure optimal outcomes and high-quality service delivery. Hochschild's theory of emotional labor encompasses two fundamental concepts: "feeling rules" and "display rules." Feeling rules pertain to the norms and expectations that dictate the emotions employees are expected to experience in specific contexts. In contrast, display rules prescribe the way emotions should be outwardly expressed, irrespective of the individual's genuine emotional state. Emotional labor involves the utilization of two distinct emotional regulation strategies: surface acting and deep acting [5]. Surface acting involves feigning or pretending to experience a specific emotion, whereas deep acting entails genuinely experiencing the desired emotion [6]. Research on emotional labor has consistently shown that surface acting negatively impacts job-related outcomes such as burnout, job satisfaction, and job performance, whereas deep acting has a positive effect. However, it is important to consider that surface and deep acting are enacted in response to organizational display rules—formal or informal norms that guide emotional expression in the workplace—which can influence the extent to which emotional labor is experienced as stressful or fulfilling [7].
Several studies of emotional demands in particular occupations have shown that emotional demands can be exhausting and increase the risk of mental health issues such as burnout [8], depression [9, 10], and long-term sickness absence [2, 11–13]. The negative impact of emotional demands on employee well-being [14] may also adversely affect work engagement, including vitality at work [15].
Organizational strategies to manage emotional demands at work
Improving employees' resilience, defined as their personal capacity to adjust to and manage challenges and pressures at work [16], has been recognized as a general strategy for mitigating the risk of burnout [17]. Resilience in individuals has been linked to various factors, such as self-efficacy, self-awareness, self-care, and emotional intelligence [17]. While research has focused on the individual factors that reduce the deleterious effects of emotional demands [18], less work has been conducted to examine how organizations assist individual employees in managing emotional demands at work. Therefore, this study focuses on fostering organizational resilience. While organizational resilience is often understood as an organization’s ability to sustain operations and adapt to disruptions, this study adopts a complementary perspective by examining how organizational resources can foster employees’ capacity to manage emotional demands. By focusing on this micro-level resilience—how individuals manage emotional demands—this approach highlights that strengthening employees’ ability to manage such demands also contributes to the organization’s overall (macro-level) resilience [19].
To manage emotional demands, supervisors may be important. Chen et al. reported that supervisor support plays a moderating role in the relationship between surface acting/deep acting and job satisfaction among Chinese hotel employees [20]. When subordinates receive substantial support and encouragement from their supervisors, they are more likely to internalize the emotions desired by the organization in a positive way. However, the quality of leadership does not significantly moderate the negative impact of high emotional demands at work on the likelihood of antidepressant treatment. Employees exposed to high emotional demands are at increased risk of initiating antidepressant treatment, irrespective of the quality of leadership [21]. The findings indicate that although good leadership might offer some protection, its buffering effect is limited.
Several studies have examined the protective effect of organizational social support. Perceived organizational support refers to employees' beliefs about how much their organization values their contributions and cares about their well-being [22]. One study revealed that an interactive effect between emotional labor and perceived organizational support significantly predicts both job satisfaction and job performance [23]. Furthermore, perceived organizational support has been found to enhance the positive relationship between deep acting and job performance while reducing the negative correlation between surface acting and job satisfaction. These findings provide evidence supporting the claim that employees' perception of organizational support acts as an enhancing mechanism, amplifying the positive effects of deep acting [24]. A study revealed that perceived organizational support emerged as a significant moderator of the relationships between emotional labor strategies and employee strain. Employees who felt supported by their organization reported higher levels of professional efficacy and mental well-being, as well as lower levels of emotional exhaustion, than did employees who reported lower perceived organizational support [25]. These findings provide evidence supporting the claim that employees' perception of organizational support functions as a protective mechanism.
The results of these studies show that organizational strategies that provide support and autonomy can reduce the risk of burnout resulting from high emotional demands. However, in these studies, organizational support is defined at a more general level, but effective management of emotions involves more than perceived social support. Managing emotion at work may involve expressing and identifying one's emotions, regulating them, and subsequently expressing them in an appropriate manner [26].
Emotion regulation
Engaging in discussions with a colleague or supervisor, or reflecting on emotionally demanding situations, appears to be crucial for processing one's feelings about such challenges [26]. When employees discuss their experiences with others, it provides an opportunity to gain new perspectives and support, which can aid in processing and understanding the emotional reactions that arise in such situations [27]. Furthermore, sharing experiences and reflecting with others, such as colleagues or supervisors, can offer a sense of community and support, which can further enhance an individual's ability to handle challenges. The capacity to articulate emotional experiences and genuine feelings within a supportive context may facilitate the development of more effective coping mechanisms among employees, thereby safeguarding them against potential health risks [5, 28]. This social support can play a crucial role in validating feelings, building coping strategies, and fostering emotional resilience. This form of social interaction may serve as a buffer against burnout and facilitate more rational and structured processing of emotional burdens [5, 28, 29].
For this reason, it is important to identify specific strategies beyond perceived organizational support and autonomy that are necessary for employees to manage emotional demands and enhance their resilience.
Studies have shown that professional feedback and clinical supervision enhance employees' job satisfaction and increase employee retention [30–32]. A review highlighted the need to implement professional supervision to help staff cope with the diverse emotional demands of their work [1]. Practice-based evidence and research have shown that structured, supportive, and reflective supervision help improve employee retention and performance, prevent burnout, and increase the quality of services [33]. However, formalized supervision alone may be insufficient to address all aspects of staff well-being in workplaces with high emotional demands. A qualitative study among crisis resolution home treatment teams revealed that the expression of emotions serves important functions for social worker team members, as it fulfills a need that cannot easily be met by someone outside the team. The authors emphasize that informal exchanges of emotions are a necessary aspect of work [28]. However, a qualitative case study at two social services departments revealed that a coping strategy among social workers was to shut off emotions both during and after meetings, and on other occasions, to defer emotions and process them at a later time [34]. Furthermore, a study among prison guards revealed that emotions could not be freely expressed in prisons. Prison officers must express some emotions and suppress others as a part of their job [35]. This finding suggests that both the organizational culture and the display rules associated with specific roles can shape the emotions that are deemed appropriate to express and influence the manner in which those emotions are displayed. Such display rules, often embedded in job expectations, reflect broader organizational norms and are central to the performance of emotional labor [4].
Additionally, fostering a positive organizational culture where staff care about each other and supervisors are open to giving feedback to their employees can improve the well-being of employees by providing emotional and professional support [36]. Facilitating the expression of vulnerable emotions while simultaneously restricting criticism, anger, and confrontational behavior is essential for fostering a sense of psychological and emotional safety within the team [28].
However, these promising studies have several limitations. One limitation of these studies is that each study typically focuses on data from a single profession, whereas the present study draws on data from a wide range of professions. Burnout is shaped by the specific demands, stressors, resources, and cultural dynamics of each organization. Likewise, the implementation of intervention strategies may vary significantly owing to organizational structures and the availability of resources. Therefore, it is crucial to examine whether the six practical strategies for managing emotional demands are consistently effective across diverse sectors, despite variations in contextual factors and implementation methods, Thus, it is not given that strategies applicable in one sector are necessarily applicable in another sector. Furthermore, even though the studies prove detailed descriptions of how emotions can be expressed and regulated, the studies cannot empirically answer whether such management of emotions has a statistically significant effect in relation on burnout due to their qualitative designs.
Therefore, it is crucial to examine whether the six practical strategies for managing emotional demands are consistently effective across diverse occupational sectors. Even though variation in contextual factors such as emotional display rules, work tasks, and organizational norms, should to some degree be accounted for, identifying patterns of effectiveness that hold across sectors are a valuable contribution to the field and can inform broader organizational practices.
On the basis of existing knowledge, this study will first identify specific strategies for managing high emotional demands across various professions. Next, we will quantitatively study whether these strategies influence the level of burnout. Finally, in a qualitative study, we will analyze how employees across different professions apply the identified strategies to manage high emotional demands.
The purpose of this study is therefore as follows:
To identify specific strategies to manage emotional demands across various occupations
To utilize longitudinal survey data to evaluate whether these strategies influence burnout levels among a large sample of employees across various occupations.
To gain a deeper understanding of how employees apply the identified strategies to manage high emotional demands and how these strategies influence employee burnout across various professions, as well as the organizational conditions required for their effective implementation.
Methods
Study design and procedures
The study was conducted as a mixed-method study based on both qualitative and quantitative data, with both sequential and concurrent study processes (see Fig. 1). Sub-study one was a qualitative study based on focus group interviews with an expert panel, aimed at identifying the existing strategies of support in relation to high emotional demands. Sub-study one examines aim one. Following sub-study one, a longitudinal survey study, sub-study two, was conducted with a baseline (T1) and two follow-up waves (T2 and T3) over 6 months. Sub-study two examines aim two Finally, on the basis of sampling from the baseline data of sub-study two, a third sub-study was conducted. Sub-study three was based on qualitative interviews at workplaces where high levels of emotional demands but low levels of burnout were reported. The third sub-study was conducted concurrently with sub-study two. Sub-study three examines aim three. The results from sub-study two and sub-study three were synthesized. The inclusion of both qualitative and quantitative data was decided to secure an overall assessment of the relevant associations of factors within the sample (survey study), as well as an understanding of possible causal mechanisms involved in the associations between these factors (qualitative study).
Fig. 1.
Figure 1 illustrates the design of the study
A three-step concurrent mixed-method design, combining qualitative and quantitative methods, was used. To integrate both datasets, the qualitative findings were compared with the quantitative results to offer a deeper understanding of the statistical trends observed. Specifically, the qualitative data served to contextualize the numerical patterns by providing insights into underlying motivations, processes, or experiences that may not be fully captured through statistical analysis alone. In instances where the quantitative data revealed significant results, the qualitative findings clarified these results by offering rich, narrative explanations that explored the underlying processes. This integration, reflecting a form of data triangulation, facilitated a more nuanced interpretation of the data [37].
Initially, two focus group interviews with experts were conducted to identify practical strategies utilized in workplace, thereby addressing the first of the three study aims.
In step two, a baseline follow-up survey study was conducted on 1,336 employees. The sub-study evaluated the association and effect modification of the practical strategies, identified in step one, in relation to burnout. This study aimed to address the second study aim.
In the third step, 32 focus group interviews involving employees from 14 workplaces were conducted to understand how practical strategies were used in those workplaces. The workplaces were selected on the basis of data from the survey conducted in step two. This sub-study aimed to address the third study aim.
Substudy one—focus group interviews with professions with emotional demands
Two focus group interviews were conducted with representatives from sectors with high emotional demands including representatives from major Danish unions and employers, to identify practical strategies for reducing the risk of burnout in highly emotionally demanding workplaces. The expert group included representatives from the unions of teachers, union of public employees, social workers, nurses, nursing auxiliaries, and social educators, along with representatives from the Danish Labour Inspection Authority, The Local Government Denmark, and the Prison and Probation Service. The representatives were occupational health and safety consultants affiliated with trade unions or employers' organizations. They are regarded as experts in their field, possessing extensive practical experience and maintaining sustained, systematic engagement with a wide range of workplaces through their ongoing interactions with members across Denmark.
The two focus group interviews were conducted online due to COVID-19 restrictions during the first phase of the study. The focus group interviews were conducted with the objective of identifying specific strategies utilized across various professions to effectively manage emotional demands. This objective was achieved by examining representatives’ experiences in managing high emotional demands, which they had been informed about by their members in the respective sections,.drawing on their extensive engagement and contact with members across numerous workplaces in Denmark.,. This inquiry encompassed both formal and informal approaches, individual and team-level practices, and organizational strategies. The focus group interviews were facilitated by the research group and lasted 1.5 h. The focus group interview was conducted as an unstructured interview to allow for diverse inputs from various occupational areas Data in the form of interview notes were collected from the researchers during the interviews. The notes from the first focus group interview were analyzed using a qualitative content analysis approach, following the inductive category development method [38]. The data were systematically reviewed and coded to identify recurring themes and patterns related to practical strategies for managing emotional demands. These codes were then grouped into broader categories, resulting in a comprehensive map of practical strategies. No strategies were discarded during this process, as all were considered valuable for managing emotional demands. Following this, the identified strategies were further refined and reformulated into a set of clear, concise survey questions designed to assess their perceived appropriateness and applicability in various professional settings. This process ensured that the strategies were represented accurately and could be easily understood by survey participants, allowing for meaningful responses. The second focus group interview was held with the same group of experts. The invited experts received the survey questions in advance to evaluate them before the meeting. During the focus group interview, the discussion focused on two aspects: 1) whether any central or commonly used practical strategies were missing, and 2) whether the survey items were clear and accurately represented the practical strategies they intended to measure. The researchers ensured consensus on the formulation of survey questions before concluding the interview.
After the second interviews, the research team revised the survey items based on feedback from experts.
Substudy two – survey study
Data collection
An electronic survey study was conducted to evaluate the effectiveness of practical strategies. Data were collected at baseline as well as the 3- and 6-month follow-ups. The study used convenience sampling to recruit participants from 129 different workplaces characterized by high levels of emotional demands. These workplaces included healthcare professionals, including nurses, doctors, health assistants, physiotherapists, ergonomic therapists, and psychologists. Also recruited were professionals such as social workers, municipal unemployment counselors, and social benefit authority workers as well as employees working in the education sector, including school teachers, kindergarten teachers, special educators, special teachers, teacher assistants, and substitutes. Finally, employees working in the same organizations but in various supporting roles, including administrative personnel, front desk staff, unskilled assistants, and consultants, were also invited.
The employees were invited through their workplace email, which contained an anonymous link. This link directed them to an email page that provided information about the project and the utilization of data. Upon providing written consent, the participants were enrolled in the project and directed to an internet-based survey. During the baseline survey, participants provided their email addresses for the purpose of receiving the follow-up surveys. Survey data were collected at baseline to assess participants' age, gender, type of job function, experience of quantitative demands at work, experience of emotional demands at work, and self-reported level of burnout. At the 3-month follow-up T2, the utilization of practical strategies was assessed. A follow-up survey was administered 6 months later T3, encompassing the same factors that were assessed at baseline. A total of 2,181 individuals opted to participate at T1, with 1,336 individuals responding to both the baseline and follow-up questionnaires, leading to an attrition rate of 39%.
Measures
Burnout was the main outcome. Burnout was measured with the validated personal burnout subscale from the Copenhagen Burnout Inventory [39]. The subscale measures mental and physical exhaustion. The burnout syndrome consists of three dimensions, i.e., exhaustion, disengagement, and reduced work efficacy [40, 41]. Exhaustion is considered the core factor of burnout and is the first group of symptoms that develops in this syndrome. The exhaustion subscale was used in this study to reduce the risk of response fatigue in a three-wave survey design and because burnout is a syndrome that has long development stages, which means that exhaustion symptoms are most likely to change during a relatively short follow-up period of 6 months. The scale consists of six items. For example, “How often do you feel tired?”/“How often do you feel worn out?” The scale consists of six items, measured on a Likert scale ranging from 0 (not at all) to 4 (all of the time). The items were summed into a 0–30-point sum scale, which demonstrated excellent internal consistency, Cronbach's alpha = 0.892.
The main explanatory variable was the six specified practical strategies used in workplaces to reduce the risk of burnout caused by emotionally demanding work tasks. In total, six types of practices were identified and formulated into single survey items (see Results section, Phase 1 below).
Each category was formulated into a single question. For example, "To what degree does the workplace provide you with the opportunity for supervision when dealing with emotionally demanding or difficult patients, citizens, or students?" Each item was answered on a Likert scale ranging from 0 = to a very low degree to 4 = to a very high degree. For the main analysis, responses were dichotomized into 1 = high, including answers to a high degree and to a very high degree; 0 = low, including answers from to some degree, to a low degree, and to a very low degree. The categorization was performed to compare respondents who used the practice as an everyday coping strategy with those who did not use the strategy continuously.
We also included several adjustment variables known to possibly affect the level of burnout, such as age [40], measured in five age groups: 18–30 years, 31–40 years, 41–50 years, 51–60 years, and > 60 years. Gender was also included [40] measured as female, male, or other gender identities; quantitative demands (ibid.) were measured via the validated scale of quantitative demands from the Copenhagen Psychosocial Questionnaire version two (COPSOQ II) [42]. The quantitative demand scale consists of four items and was measured on a Likert scale ranging from 1 = never/almost never to 5 = always, creating a sum scale ranging from 4 to 20. The scale showed excellent internal consistency, Cronbach's alpha = 0.870. Emotional demands were included even though emotional demands were a core condition of all the selected workplaces. However, differences could exist at the level of emotional demands among employees and organizations. We focused on content emotional demands, i.e., work tasks that are known to be emotionally taxing. We used the validated scale of emotional demands from the Danish Psychosocial Questionnaire [43]. The scale consists of five items asking about emotionally demanding work tasks, such as interacting with clients/patients/citizens who are in challenging situations (e.g., individuals with a serious illness, those experiencing a life crisis or being socially marginalized, etc.). All the items were answered on a Likert scale ranging from 1 = never/almost never to 5 = always, resulting in a total score ranging from 5 to 25. The scale showed acceptable internal consistency, Cronbach's alpha = 0.740.
Finally, we included a variable on work area because each work area may involve context-specific characteristics of the overall type of emotional demand. Additionally, each work area could entail psychosocial work environment factors related to burnout that were not captured in the survey in a manner relevant to all respondents. The 23 professional groups in the sample were recoded into four overall work areas: health professionals (nurses, doctors, health assistants, physiotherapists, ergonomic therapists, psychologists); social workers (social workers, municipality unemployment consultants, social benefit authority workers); teaching/pedagogy (including school teachers, kindergarten teachers, special educators, special teachers, teacher assistants, and teacher substitutes); and other professions (administrative and front desk workers, unskilled helpers, consultants).
Analysis
Data assessment
Missing data and attrition were assessed via the missing data analysis function in SPSS version 28. This was done to assess possible patterns of missingness and evaluate the appropriateness of using maximum likelihood estimation models. Attrition was assessed using logistic regression analysis. Here, all baseline variables were set as predictor variables for the outcome of dropout = 1, with no dropout = 0 set as the reference, to assess whether any of our factors predicted dropout. Additionally, t tests and chi-square tests were performed on all baseline factors to assess differences between the two groups: dropout vs. nondropout.
The data were further assessed for critical outliers via standardized residual analysis. Multicollinearity was assessed through basic bivariate correlation analysis and assessment of the variance inflation factors derived from a basic multiple regression model that incorporated all baseline measures [44]. An assessment of the basic assumptions for generalized mixed models was conducted. The distribution of residuals was assessed via residual plots, and the overall trends of burnout from T1 to T3 were assessed via spaghetti plots, with subject ID used as the group identifier [45, 46]. Descriptive analysis was conducted to assess all variables at baseline in terms of the distribution of means and the number of participants.
Main analysis
We utilized generalized mixed models to assess the impact of each practical strategy at T2 on the development of burnout from T1 to T3. We assessed the fixed effects of the six strategies in six different models, one for each strategy. In addition to measuring the fixed effect of each practical strategy, we also entered an interaction term (practice*time) to assess the impact of the strategy on the change in burnout from T1 to T3. In all six models, we entered all adjustment variables to account for aggregate confounding, including them as fixed effects. Because display rules consist of both formal (e.g., organizational policies) and informal (e.g., cultural norms) expectations, they are inherently difficult to measure directly in large-scale survey data. Therefore, we use code occupations into area of work as a proxy measure for occupational type. We further included job titles as a random effect clustered on individual ID, including an intercept, to account for possible correlations of data within these levels and to accommodate the repeated data design.
All the models were conducted with the individual ID as the identifier and time as the repeated effect, and the identity link function and the scaled identity covariance structure were used to ensure model convergence. All the models were carried out with the Satterthwaite approximation and the robust estimation function in IBM, SPSS ver. 28 (Armonk, NY, USA).
Substudy three: interview study with employees
Data collection
To understand how a variety of daily practical strategies help employees and ensure their resilience against burnout, workplaces were sampled on the basis of results from the baseline data of the survey study. We used a median split on both the level of burnout and the level of emotional demands. Workplaces were selected if the mean level of reporting of emotional demands was above the median and if the mean level of burnout was below the median. This sampling strategy was chosen to select workplaces where employees experienced high emotional demands and still reported low levels of burnout, indicating that they had successful preventive strategies. In total, 14 workplaces were sampled. In total, 32 focus group interviews were conducted. Three to four employees usually participating in each focus interview. The participants held various job titles, including 11 teachers, 4 preschool teachers, 6 early childhood educators, 23 social workers, 8 nurses, 9 healthcare assistants, 3 occupational therapists, 1 Master of Science (MSc) in Health and Sports Science, 1 Master of Science (MSc) in Criminology, and 1 Master of Social Work (MSW). The length of employment at their current workplace ranged from 6 months to 29 years. The average length of employment at the current workplace was 6 years.
At each workplace, the selection of participants for the interviews was performed in collaboration with the local supervisor in a meeting where the background of the study and preferences for informants were discussed. We requested three interviews at each workplace: two interviews with employees with daily contact with clients (32 interviews) and one interview with supervisors (13 interviews). The interviews were all planned as group interviews. The supervisor suggested which employees should participate in the group interviews. In this study, we only use interviews with employees with daily contact with clients.
The first and second authors conducted the focus group interviews. The interviews lasted between 45 and 60 min. At the beginning of the interview, the participants provided informed and written consent. All names were altered.
Focus group interviews were chosen because they allow different people with various experiences and strategies to manage emotional demands to come forward and enable the participants to discuss each other's experiences and strategies [47]. The focus group interviews were conducted at the workplaces, as they are presumed to enhance the ecological validity of the interviews [48]. The workplace environment may prime the interviewees to recall work-related issues and express work-related experiences more precisely.
The interview guide (see appendix 1) and the questions were developed to allow respondents to convey their experience and strategies in their own terms and to be unobtrusive and non-directive [49]. The development of the semi-structured interview guide was informed by existing literature on emotional demands, The guide was designed to be open-ended and exploratory, allowing for both structure and flexibility in capturing respondents' lived experiences. The interview guide was semi-structured and centered on a framework of themes: situations with high emotional demands; how high emotional demands are handled informally/formally, individually, within the team and at the organizational level; and conditions for managing high emotional demands. The first thing we asked the participants was if they themselves had experienced a situation with high emotional demands, and then we asked them to provide some examples.
The interview guide ensured that relevant questions were raised, the scope and direction of questioning followed the purpose of the study, and probes were provided when further information was necessary. The first thing we asked the participants was if they themselves had experienced a situation with high emotional demands, and then we asked them to provide some examples. Each theme was introduced by an open-ended question (for instance, “How are high emotional demands handled in your team?”). Each theme had follow-up questions to avoid simple “yes” or “no” answers (for example, “Please explain more; what does that mean?” and “Do you have an example?”).
It is important to clarify that the six strategies included in the questionnaire from Study 2 were not directly applied or imposed upon the qualitative responses in Study 3. While the questionnaire in Study 2 required participants to self-report specific strategies for managing emotional demands, the interviews conducted in Study 3 were open-ended and aimed at exploring broader, more nuanced approaches to managing emotional challenges in the workplace. The interview format did not prompt participants to recall the predefined strategies; rather, it allowed for a more expansive exploration of the participants' experiences.
Data analysis
All interviews were audio-recorded and transcribed verbatim. The transcriptions were analyzed using thematic analysis following the approach outlined by Braun and Clarke [50].
Initial coding was conducted inductively, allowing themes to emerge directly from the data without imposing preconceived categories. During this phase, segments of text were assigned codes representing meaningful features related to managing emotional demands in the workplace.
Following this open coding, codes were grouped and abstracted into broader categories and potential themes through a process of comparison and refinement. Once preliminary themes were developed, a deductive step was introduced to compare these emergent themes with the six practical strategies identified in Study One.
A key focus throughout the analysis was to identify not only confirmatory data but also divergent perspectives. This deliberate attention to potential contradictory data helped to mitigate confirmation bias and provided a more nuanced and balanced interpretation of the findings.
NVivo 15 software (QSR International Pty Ltd.) supported the organization and management of data during coding and theme development. The initial coding and thematic development were conducted independently by the first and second authors, followed by discussions to resolve discrepancies and refine the coding framework. This process enhanced the credibility and reliability of the analysis.
To analyze the qualitative data, we employed thematic analysis, which revealed numerous examples of strategies that appeared to align with the predefined categories identified in Study 2. However, these themes emerged inductively from the participants' narratives, without being constrained by the six predefined strategies. In this sense, the qualitative analysis did not follow a deductive framework, but instead allowed the themes to emerge organically from the data.
Results
Substudy 1: focus group interviews with experts
The focus group interviews with experts from various occupational areas resulted in the identification of six major categories describing everyday practical strategies to manage high emotional demands at work. These categories include the following:
The workplace provides employees with the:
The opportunity for supervision when dealing with emotionally demanding or difficult patients, citizens, or pupils.
The opportunity to discuss emotionally demanding or difficult patients, citizens, or pupils
The opportunity to provide prompt feedback when dealing with emotionally demanding or difficult patients, citizens, or pupils.
The opportunity to "vent" with colleagues or management when dealing with emotionally demanding or difficult patients, citizens, or pupils.
The opportunity to rotate tasks when dealing with emotionally demanding or difficult patients, citizens, or pupils.
The opportunity to discuss strategies for managing high emotional demands.
In this context, supervision refers to a structured and often formalized process, typically led by a trained supervisor, in which employees reflect on emotionally challenging experiences, receive guidance, and develop coping strategies. It may occur individually or in groups and is commonly used in professions such as healthcare, education, and social work. Discussion, by contrast, denotes informal or ad hoc conversations with colleagues or team members about emotionally demanding situations, without the structured format of supervision. Venting involves the spontaneous and emotionally charged expression of frustration or stress, usually without the intention of reflection or problem-solving. Lastly, discussing strategies for managing high emotional demands specifically refers to solution-oriented conversations focused on exchanging practical ideas, tools, or approaches for handling emotionally taxing work situations.
The strategies are presented as conceptually distinct, however in practice they may overlap. The categorization was used analytically to differentiate the primary function of each form of strategi.
At the follow-up interview, a consensus was reached on the descriptions of the overall strategies without there being any major discrepancies across the occupational areas. Furthermore, the formulation of the survey items was deemed appropriate and easy to understand while still reflecting the practices employed. Some discussions were held regarding the wording of the strategy for expressing emotions, where terms such as "venting" or "letting off steam" were considered. The aim was to strike a balance in the wording to explain the importance of expressing emotions and frustrations that may arise when dealing with emotionally demanding work tasks, without framing it as simply complaining about work-related factors in general. A term was selected in Danish that best translates the phenomenon following a contextualization of emotionally demanding work tasks. The formulation of the survey items on the six practical strategies was considered suitable in terms of face validity for use in step two of the survey.
Substudytwo: survey study
The assessment of the survey data indicated that the data was missing at random (MAR); thus, the use of models based on maximum likelihood estimation was found to be appropriate. Dropout analysis did not raise concerns about strong bias in the analysis. Compared with the completers, the non-completers had a small but significantly higher level of quantitative demands (11.4 vs 11.7) and emotional demands (13.7 vs 14.0). For a full description of the data assessment, please refer to Appendix 1.
Descriptive statistics revealed that the sample consisted mainly of women, most of whom were between the ages of 31 and 60. The reporting of high usage of the practices ranged between 30 and 60%, indicating a widespread use of the selected practices. The overall level of burnout remained relatively stable from T1 to T3 (see Table 1).
Table 1.
Descriptive statistics of the survey sample, presented as percentages (%) and number of respondents (n) or as the mean and standard deviation (SD)
| Factor | Total sample 100% (n = 1336) |
Mean (SD) | |
|---|---|---|---|
| Gender | Men | 21.7% (n = 290) | |
| Women | 78.3% (n = 1046) | ||
| Age | 18–30 years | 11% (n = 147) | |
| 31–40 years | 23.6% (n = 315) | ||
| 41–50 years | 30.4% (n = 405) | ||
| 51–60 years | 25.9% (n = 346) | ||
| > 60 years | 9.2% (n = 123) | ||
| Job categories | Health | 27% (n = 361) | |
| Social work | 18.7% (n = 249) | ||
| Teaching/pedagogy | 47% (n = 627) | ||
| Other | 7.4% (n = 99) | ||
| Quantitative demands | 12.5 (3.1) | ||
| Emotional demands | 16.3 (3.5) | ||
| Type of practices | Supervision “high/low/missing” |
44.6%/38%/17.4% (n = 591/503/231) |
|
| Discussion of client “high/low/missing” |
59.3%/23.3%/17.4% (n = 786/309/230) |
||
| Promt feedback”high/low/missing” |
47.2%/35.2%/17.5% (n = 626/467/232) |
||
| Ventilation”high/low/missing” |
60.3%/22.0%/17.7% (n = 799/292/234) |
||
| Task rotation”high/low/missing” |
29.6%/52.8%/17.7% (n = 392/699/234) |
||
| Discussion on strategies of handling emotional demands”high/low/missing” |
44.5%/37.7%/17.8% (n = 590/499/236) |
||
| T1 Burnout | 16.5 (4.5) | ||
| T3 Burnout | 16.4 (4.6) |
An analysis of the linear outcome of practical strategies revealed that all six types of practical strategies measured at T2 were statistically significantly and inversely associated with the level of burnout at T3: access to supervision B = 0.2, W(1) = 4.4, p = 036; access to discuss emotionally demanding clients B = 0.3, W(1) = 10.2, p = 0.001; access to prompt feedback B = 0.4, W(1) = 14.2, p < 0.001; Access to the possibility of venting B = 0.4, W(1) = 16.0, p < 0.001; Access to task rotation B = − 0.4, W(1) = 15.6, p < 0.001; access to discussion of strategies B = 0.5, W(1) = 22.9, p < 0.001.
Table 2 shows the main effects of each practical strategy in the stratified analysis in regard to the high and low levels of access to each strategy. As expected, a pattern emerged where the low access groups had statistically significantly stronger associations with levels of burnout as a repeated measure for T1 and T3 than did the high access groups. However, only the practical strategies of prompt feedback, venting, and discussion of strategies showed a significant interaction with time, resulting in a significant change in burnout over time from T1 to T3.
Table 2.
Fixed and interaction effects of six practical strategies for handling emotional demands and their associations with burnout, measured repeatedly at T1 and T3. The results are based on a sample of 1336 employees from 129 workplaces characterized by high emotional demands. The results are presented as uncorrelated coefficients (Coeffs), standard errors (SEs), t statistics (t) and Bonferroni adjusted level of significance (p)
| Type of practice | Coeff | SE | t | P | |
|---|---|---|---|---|---|
| Supervision High vs. Low | High (ref) | - | |||
| Low | 0.46 | 0.20 | 2.5 | 0.015 | |
| Supervision*time | − 0.24 | 0.20 | − 1.1 | 0.234 | |
| Discuss client | High (ref) | - | - | - | - |
| Low | 0.57 | 0.21 | 2.8 | 0.005 | |
| Discuss client *time | − 0.22 | 0.22 | − 1.0 | 0.321 | |
| Prompt Feedback r | High (ref) | - | - | - | - |
| Low | 0.57 | 0.19 | 3.0 | 0.003 | |
| Prompt Feedback *time | − 0.48 | 0.20 | − 2.4 | 0.017 | |
| “Venting” | High (ref) | - | - | - | - |
| Low | 1.1 | 0.22 | 5.0 | < 0.001 | |
| Venting*time | − 0.51 | 0.23 | − 2.2 | 0.026 | |
| Task rotation | High (ref) | - | - | - | - |
| Low | 0.48 | 0.20 | 2.4 | 0.016 | |
| Task rotation*time | − 0.36 | 0.20 | − 1.7 | 0.088 | |
| Discuss strategies | High (ref) | - | - | - | - |
| Low | 0.91 | 0.20 | 4.8 | < 0.001 | |
| Discuss strategies*time | − 0.62 | 0.20 | − 3.1 | 0.002 |
Adjusted for age, gender, job type, level of quantitative demands, and level of emotional demands
The test statistic is significant at p ≤.005
An analysis of the estimated means of burnout between the low- and high-access groups at T1 and T3 is shown in Table 3, where at T1, the difference in levels of burnout between the high- and low-access groups was not significantly different for any of the practical strategies except for venting. At T3, the level of burnout was significantly different between the high-access and low-access groups regarding all the practical strategies. Furthermore, the high-access groups had lower levels of burnout than did the low-access groups with regard to all the strategies (see Table 3). The overall pattern across all six groups was that the low-access groups experienced an increase in burnout, whereas the high-access groups experienced a decrease in burnout from T1 to T3, as depicted in table 2. However, the change in burnout over time was statistically significant only for access to prompt feedback F(1, 881) = 5.7, p = 0.017; access to venting F(1, 881) = 5.0, p = 0.026; and access to discussion of strategies F(1, 917) = 9.8, p = 0.002.
Table 3.
Contrast estimates of estimated means of burnout at time 1 (baseline) and time 3 (6-month follow-up) for each of the existing practices of coping with high emotional demands. The data are presented as contrast estimates at time 1 (T1cont.est.) and time 3 (T3 cont. est.), 95 percent confidence intervals (95% CIs) and Bonferroni adjusted level of significance (p)
| Type of Practice | T1 cont. est |
95% CI | p | T3 cont. Est |
95% CI | p |
|---|---|---|---|---|---|---|
| Supervision High vs. Low | − 0.21 | [− 0.58–0.16] | 0.237 | − 0.46 | [− 0.83–0.09] | 0.014 |
| Discussion client High vs. Low | − 0.22 | [− 0.58–0.14] | 0.236 | − 0.45 | [− 0.82–0.09] | 0.015 |
| Prompt feedback High vs. Low | − 0.09 | [− 0.46–0.28] | 0.621 | − 0.57 | [− 0.93 to − 0.20] | 0.003 |
| Venting High vs. Low | − 0.57 | [− 1.0 to − 0.14] | 0.009 | − 1.10 | [− 1.50 to − 0.66] | < 0.001 |
| Task rotation High vs. Low | − 0.12 | [− 0.50–0.26] | 0.544 | − 0.48 | [− 0.87 to − 0.90] | 0.016 |
| Discus strategies High vs. Low | − 0.29 | [− 0.08–0.67] | 0.127 | − 0.91 | [− 1.29 to − 0.54] | < 0.001 |
Adjusted for age, gender, job type, level of quantitative demands and level of emotional demands
The results are significant at p ≤.005
Step three: focus group interviews with employees
After a short introduction, we asked the participants if they experienced situations with high emotional demands at work and encouraged them to express in their own words descriptions of such situations. We then asked them to explain how they managed these situations so that they were not overly affected by these emotionally demanding situations.
The expert group has previously evaluated the strategies that employees typically use to manage emotional demands in their work (see step one). Through the thematic analysis of the qualitative data, we identified several examples of strategies that appeared to align with those previously identified in Study 2. While Study 2 relied on a structured questionnaire that required participants to self-report specific strategies, Study 3 employed open-ended interviews to elicit broader and more nuanced accounts of managing emotional challenges at work. These themes were not merely a confirmation of the predefined strategies; they emerged organically from the participants' experiences. However, in spite of methodological differences, the qualitative analysis demonstrated that employees across the 14 workplaces articulated a range of approaches that could be synthesized into six practical strategies. However, rather than identifying entirely new strategies, the interviews provided a deeper understanding of how participants managed emotional demands in practice and highlighted the personal significance of these strategies, shedding light on their impact on participants' ability to manage emotional demands.
The following sections draw on focus group data to illustrate how employees experience these strategies in practice and to explicate the mechanisms through which they manage high emotional demands.
As one employee explained, “The colleagues come in, completely worn out, sit down and just: blah blah blah, talking, a bit of humor, and all those things that weren't said in the meeting, but you need to say” (employee workplace 10).
Strategies in use
When dealing with emotionally demanding patients, clients, citizens, or pupils, we found that the most commonly used strategies were expressing emotions to the workgroup (venting) and providing quick feedback. In the following we illustrate how employees in various professions apply the identified strategies to manage high emotional demands and the organizational conditions necessary for their implementation.
We found that venting serves important functions for employees and that both informal and formal exchanges of emotions are necessary parts of work. Furthermore, the expressions modify emotions and make them less overwhelming, thus making it easier to manage emotional demands. This is exemplified in the following:
Yes, exactly. I can also express my feelings by discussing them with colleagues and saying, "Okay, you may also experience that feeling at times. "It's easier for me to handle when I know that it's not just me who can be in these situations. It's normal; we are all human. It's just nice to hear it said out loud, "Yes, it also affects me sometimes, "because then I know that I have handled the situation properly (employee workplace 9).
Therefore, it's extremely important to be able to unload sometimes and say, "Paul did this" or "he did that," and have colleagues who understand your frustration and can say, "I know how you feel" or "I understand, you just need to take a break or something." (employee workplace 1.
Yes, and we're also good at creating room for each other sometimes, because we also get filled up, and then creating room to say: 'Would you mind spending five minutes with me, I just need to let all this air out,' and then it's out, and then we can return to that room where we say: 'Okay, what do I do now, what do I do in this situation'? (employee workplace 7).
As it can be seen from the quotes, venting serves important functions by allowing employees to express and share emotional experiences with colleagues, both informally and formally. This process helps to modify overwhelming emotions, normalize difficult feelings, and foster mutual understanding, which facilitates emotional regulation.
Practical strategies, such as venting and providing quick feedback, helped employees manage high emotional demands. We found that the expression of emotions among team members involved recognition and a validation of their emotions by acknowledging that, "your feelings are acceptable." The observed validation of feelings was characterized by mutual respect, alongside acknowledgment and acceptance of encountering challenging work situations, rather than attributing any shortcomings to individual skills in coping with the client. This can be seen in the following:
It's respected. I mean, the feelings I have are respected. And there's not much… It's not something that needs to be debated. It was received very understandably and openly. Yes. (employee workplace 9).
So that I can say it out loud to some colleagues, it just helps to get all that crazy, weird stuff that only we experience out of my system…get it out in the way it exactly feels inside me, it just helps. (employee workplace 7).
Quick feedback, discussion, or venting when dealing with difficult patients, clients, citizens, or pupils also seems to foster a sense of shared responsibility in handling emotionally demanding work tasks with clients. The responsibility was no longer solely for the individual employee; instead, it became a collective problem. This was presented as a comforting factor, reassuring the employee that they were not alone with their feelings and responsibilities, but that others understood and supported them. This is illustrated in the following:
I feel that at this school, they take it seriously if you are uncomfortable. Things are talked about, and when you are sad, the leader comes and says, "Come, let's talk about it." You never stand alone with a task, and it is never said that it is solely your problem. (employee workplace 4).
Quick feedback and discussion of emotional demanding patients, pupils or clients also serves function be creating of sense of safety. This can be illustrated in the following:
And at first, I felt very, very insecure, but here at this school, I feel that the supervisor takes it seriously. In my department, he immediately sits down and say, "Okay, why do you feel insecure? What can we do about it? Is there anything else we can do?" And this happens all the time. If something comes up every day, it gets discussed. And when you're upset, the supervisor comes and says, "Come, let's talk about it." You never stand alone with a task, and it's never said, "This is your problem" or "You acted wrongly." (employee workplace 5)
The quote shows that the experience of feedback and discussion of emotional demanding patients, clients and pupils, plays central role in creating psychological safety. When the supervisor actively engages in understanding and addressing employees’ feelings of insecurity, as described in the quote, a sense arises that their concerns are being taken seriously. The open communication, where employees are never left to handle their problems alone and where there is always support from both colleagues and supervisor, fosters a strong sense of community and trust. This feedback and discussion, which combines emotional recognition with practical problem-solving, not only creates a sense of safety but also a sense of meaning in the work, as employees feel seen, heard, and supported.
Thus, sharing responsibility can create positive synergy, making the solutions better than if the individual had faced the problem alone. The shared responsibility is also clearly seen in the following quote in that this person constantly refers to "we" instead of "I".
Therefore, we are, we are good at like "okay, what do we have here." Well, then we try to handle it. And we always have each other's support. We can always count on each other, actually. I mean, we might not completely agree, but if that's what we're going with, then we go with it. And I think that's why we… Because we have really been… I mean, we have had many challenges…but you know… But we are just good together. (employee workplace 13).
Additionally, formalized initiatives such as professional supervision involve validating team members' understanding of the situation. In all the workplaces, there are fixed times for supervision. The supervisor was often a licensed psychologist who came from outside. While venting and quick discussions often take place very informally, supervision is a formal forum at a specific time. Supervision often involves validating team members' understanding of the situation. Many employees expressed that supervision was very useful. This can be illustrated in the following:
And then our supervision—I think it's really good because we can have things brought up in our team meeting and discuss them, but when we have supervision on a case, it just adds an extra dimension, you know…to look at it from a different angle, and you leave with: "Oh, okay, that's why I got angry, that's what made me so upset", or something like that, right? And I think that gives me something completely different than the collegial sparring does (employee workplace 7).
Finally, one of the six practical strategies was to have the opportunity to rotate tasks when dealing with emotionally demanding or difficult patients, citizens, or pupils. This can be illustrated in the following:
Well, we just had a little venting session in the office: “Oh, for heaven’s sake, that was so annoying.” You know, the kind of thing you just need to get out, so we were really good at that, or just looking at each other and saying, “I’ll step back for a bit, and you can take over” (employee workplace 8).
Taken together, the findings suggest that the implementation of practical strategies create a foundation for psychological safety, shared responsibility, and professional meaning. The opportunity to articulate emotions—through venting, feedback, supervision, or discussion—affirms that such emotions are legitimate and expected. This validation reduces feelings of isolation and insecurity, reinforcing the sense that employees are supported rather than left to manage emotional demands individually.
Moreover, these practical strategies shift responsibility from the individual to the team which create trust and community within the workplace. Importantly, when supervisors and colleagues engage actively in recognizing and addressing emotional challenges, employees experience their work as meaningful, as their concerns are acknowledged and their contributions respected.
Taken together, the findings suggest that the implementation of practical strategies creates a foundation for psychological safety, shared responsibility, and professional meaning, as employees feel supported, recognized, and they see that their work has a tangible, positive impact on clients, or colleagues.
The organizational conditions necessary for implementation of the strategies
The expression of emotions, discussions of thoughts, and validation of team members' understanding of the situation were characterized by mutual respect, along with recognition and acceptance of facing difficult work situations, rather than blaming individual employees for lacking professional skills in dealing with the client. An important prerequisite to be able to utilize practical support measures is that the workplace is characterized by trust among staff and toward management, as well as a high level of psychological safety. This can be seen in the following quotes:
And this sense of safety that I feel like I can talk to every colleague in the office, there really aren't any colleagues that I feel I wouldn't go to. It's an immense comfort for me, and if I ever feel unsure or doubtful about how I've handled certain situations, knowing that I can bring it up and that no one will judge me, but rather, we can brainstorm together. (employee workplace 10).
And there is a good division of work, and then there is trust, a mutual trust, if Jens comes and taps me on the shoulder and says, 'you know what, I think we should switch roles here.' Then we do it, and there is no losing face. Am I losing face in front of the child? Or am I losing face in front of my colleague? No—we don't have that here. (employee workplace 4).
The results indicate that workplaces with high emotional demands can enhance the well-being of their employees by fostering a positive organizational culture where employees care about each other, and supervisors and colleagues are open to providing feedback to their employees.
Discussion
In collaboration with representatives from major Danish unions and employer organizations, we identified six practical strategies to manage emotional demands. These categories include whether the workplace provides employees with the opportunity for supervision when dealing with emotionally demanding or difficult patients, citizens, or pupils; the opportunity to discuss emotionally demanding or difficult patients, citizens, or pupils; the opportunity to provide prompt feedback when dealing with emotionally demanding or difficult patients, citizens, or pupils; the opportunity to vent with colleagues or management when dealing with emotionally demanding or difficult patients, citizens, or pupils; the opportunity to rotate tasks when dealing with emotionally demanding or difficult patients, citizens, or pupils; and finally, the opportunity to discuss strategies for managing high emotional demands.
Our mixed-methods approach provided complementary insights into how participants manage high emotional demands. The qualitative findings from Study 3 provide valuable insights that both confirm and extend the strategies identified in Study 2. While several of the strategies identified in the quantitative questionnaire were also found in the qualitative interviews, the open-ended nature of the interviews allowed for a more nuanced exploration of how participants managed emotional demands in practice.
The qualitative analysis provided deeper understanding of how these strategies were enacted in real-world contexts. Participants described a range of formal and informal approaches to managing emotional challenges in their work, highlighting both the practical and emotional significance of these strategies. These findings offer a richer understanding of how emotional demands are managed and shed light on the personal meaning participants attach to these strategies.
However, variations emerged in the extent to which formalizing these strategies and providing supervision was feasible, often due to financial constraints. Despite structural differences, the workplaces were highly comparable, likely due to their selection on the basis of shared characteristics of high emotional demands and low burnout rates. Although emotional display rules—defined as the socially and professionally sanctioned norms governing emotional expression—likely varied across the participating workplaces, the present analysis focused on the perceived effectiveness of six practical strategies for managing emotional demands across diverse organizational contexts. As Hochschild (1983) [4] emphasizes, such display rules are embedded within occupational cultures and play a central role in shaping how emotional labor is enacted. However, the aim of this study was not to examine the display rules themselves, but to explore whether the identified strategies were perceived as effective regardless of differences in emotional demands and context-specific expectations for emotional expression. Thus, they represented best-practice examples across diverse workplace settings.
In summary, the results of the survey study highlight the critical role of practical strategies in managing burnout among participants. The inverse associations between access to various strategies and burnout levels indicate that those who had greater access to supervision, discussion of emotionally demanding clients, prompt feedback, opportunities for venting, task rotation, and discussions of strategies to handle high emotional demands experienced lower levels of burnout.
The stratified analysis further emphasized the protective effects of these strategies, particularly for participants with low access, who reported significantly higher burnout levels. The significant interaction effects observed for prompt feedback, venting, and discussion of strategies suggest that these specific strategies may be particularly effective in reducing burnout over time. In the qualitative study, we found that practical support strategies are widely used, and that employees feel that they help them, making it easier to handle emotional demands. While many of the strategies identified involve emotional or interpersonal elements, they are considered practical in the sense that they represent concrete, implementable forms of support that are accessible in everyday workplace settings.
During venting, prompt feedback, discussions of strategies, and supervision, it is possible to express emotions verbally, which reduces the intensity of the feelings and makes emotions less overwhelmed. The formulation of the feelings experienced by coworkers or supervisors also helps provide clarity and understanding about what one was feeling and why. This, in turn, could help employees find solutions or coping strategies that make it possible or easier to manage emotional demands and thus reduce the risk of burnout. Finally, the interviews revealed that implementing the six practical strategies required trust among staff and management, as well as a strong sense of psychological safety.
The results from the quantitative study suggest that these six practical strategies could be effective preventive measures against burnout in professions with high emotional demands., However, few studies have focused on identifying strategies to prevent burnout in workplaces with high emotional demands [10, 51, 52].
Overall, the results suggest that the six practical strategies may serve as preventive measures against burnout in occupations with high emotional demands, although the quantitative results indicate minor effects. The findings from the qualitative study revealed that these practical strategies were perceived to serve important functions for employees. Employees reported using various strategies to manage emotionally demanding situations, including validating their emotions, sharing responsibility for client interactions, modulating emotional responses to reduce their intensity, and verbalizing emotions to better understand their underlying causes. These processes contributed to reducing the intensity of overwhelming emotions and fostering a supportive work environment in which challenges were addressed collectively rather than in isolation. Such strategies align with emotion-focused coping [53], as they assist individuals in managing the emotional consequences of workplace demands. They also reflect mechanisms of emotional regulation [54], by promoting emotional expression, shared reflection, and cognitive reappraisal within a socially supportive context.
The findings suggest that these six practical strategies may play crucial preventive roles against burnout in emotionally demanding occupations. However, although the effects of the six practical strategies on burnout are modest, the results can still hold practical significance. For example, the implementation of these strategies may lead to significant long-term gains, making their implementation valuable. Furthermore, the relationship may become more pronounced in future longitudinal studies with extended follow-up periods, which should be the focus of subsequent research. Thus, these findings represent an important first step toward understanding the association between the six practical strategies and the reduced risk of burnout, even if the effect was not large in the current study.
The responses to questions regarding the six practical strategies do not directly indicate whether an employee actively employs them but rather reflect the extent to which employees perceive opportunities for using these strategies in the workplace. This seems to apply especially for access to prompt feedback, venting, and discussion of strategies for handling emotional demands. The observed reduction in the risk of burnout suggests that when employees perceive access to these strategies, they are more likely to adopt and apply them in managing emotional demands. This implies that even without directly measuring individual adoption, the availability of these strategies may foster a culture where these strategies become implicitly integrated into daily practices as demonstrated in the qualitative data. This finding underscores the importance of creating an environment that encourages and normalizes the use of these strategies to manage emotional demands.
We identified as many as six practical strategies, which may seem to be many. Much of the research on managing emotional demands often focuses on single strategies such as supervision, deep acting, and surface acting. Therefore, having six practical strategies to manage emotional demands might seem daunting to implement. However, both the results from the interviews and the questionnaire survey demonstrated that all six strategies were frequently utilized and perceived to be effective in managing emotional demands. However, the quantitative results indicate that access to prompt feedback, venting, and discussion of strategies for handling emotional demands may be more effective than the other three strategies i.e. supervision, job rotation, and the opportunity to discuss emotional and difficult clients.
Owing to their challenging interactions with clients, it is necessary for employees in such workplaces to manage their own emotions [4]. The challenging interactions must be interpreted in light of Hochschild's theory of emotional labor, which describes two central concepts: "feeling rules" and "display rules." Feeling rules refer to the norms and expectations that govern which emotions employees should feel in certain situations, whereas display rules dictate how emotions should be expressed publicly, regardless of an employee's actual feelings. Hochschild's work emphasizes how emotional labor can result in emotional dissonance, creating a conflict between an employee's true feelings and what they are required to express. This can have consequences for employee's well-being and burnout. The use of the six practical strategies can reduce the risk for emotional dissonance and thus the risk for burnout because when employees express and discuss their experiences with others, it may be possible to identify one's emotions, regulate them, and subsequently express them in an appropriate manner, which can result in greater alignment with display rules and feeling rules. This assumption is supported by the result of the quantitative survey.
The discussion of emotional expressions among employees may also serve as a validation of their understanding of the situation. This means that when employees share their emotions with each other, it not only serves as a means of expressing emotions but also helps reinforce their understanding and acknowledgment of the circumstances they are facing. By openly discussing their feelings, employees can mutually confirm and affirm their understanding of the situation, fostering a deeper sense of shared understanding. The expression of emotions was characterized by mutual respect, as well as recognition and acceptance of being in difficult work situations, rather than pointing to insufficient individual social skills to handle the situation. It is acceptable to doubt and share one's difficulties without fearing criticism. Thus, the expression of emotions was based on a foundation of trust and high levels of psychological safety in the workplace [55].
Although we did not measure resilience, our findings align with studies on the topic, which consistently show that social support and feedback from colleagues in the workplace are positively associated with resilience [56]. Additionally, elements such as a learning culture, inquiry and dialogue, knowledge-sharing structures [57], and the collaborative sharing of responsibilities and tasks among employees may also contribute to organizational resilience [58]. These factors foster a supportive environment that strengthens workplaces’ capacity, routines, and processes for managing emotional demands, which are critical components of organizational resilience.
Practical strategies played crucial roles for employees in managing their own emotions, particularly in expressing and validating emotions. This may assist employees to introspectively examine their own feelings, potentially fostering a “reflective stance” toward their emotions in a given moment [26]. This stance can contribute to interactions not being perceived as burdensome. This aligns well with the findings from the quantitative study, where it was discovered that the chance to promptly discuss emotionally demanding clients with colleagues and/or supervisors, the opportunity for venting, and the opportunity to discuss how to manage high emotional demands were all associated with significantly lower levels of burnout.
This result of this study is significant, as it demonstrates that the six practical strategies for managing emotional demands are effective in reducing the risk of burnout across diverse sectors, despite variations in organizational structures and the availability of resources. This underscores their broad applicability and potential for widespread adoption, offering a viable solution to mitigate the risk of burnout and enhance employee well-being. By illustrating the effectiveness of these strategies across different contexts, this result emphasizes their generalizability and highlights their crucial role in fostering healthier work environments.
However, the effectiveness of these strategies may vary significantly depending on the quality and fidelity of their implementation [59]. Understanding challenges such as resource constraints, and organizational resistance will be vital to overcoming obstacles and ensuring that emotional demand management strategies are widely adopted. Future research is needed that tests the practical strategies in a study with a randomized intervention design as well as in studies on the implementation of these strategies. Involving employees throughout this process is crucial. A participatory approach is advised, as it encourages practical suggestions for improvement and facilitates necessary adjustments by leveraging employees' expertise and knowledge. Furthermore, this approach fosters a sense of ownership, which is essential for securing employees' commitment and ensuring the successful adoption of these strategies [60, 61]. Further research could also evaluate the effectiveness of these strategies when implemented in various organizational contexts. Longitudinal studies could assess the long-term outcomes of such strategies, measuring their impact on employee well-being and burn-out.
Strengths and limitations
The study’s results must be evaluated considering its strengths and limitations.
A limitation of the qualitative study may be that the supervisor at the workplace selected the participating employees. Although we sought representation from various professional groups and seniority levels, the selection process may have favored employees with more positive views of how the workplace manages emotional demands. This could induce possible bias in the study, as the supervisor may have selectively chosen employees whom he/she knew held the most favorable views on the subject in general, and specifically toward the supervisor. However, since the current study concentrates on perspectives related to managing emotional demands and fostering resilience in the workplace, as well as how these are implemented through daily practical strategies, we do not consider this to pose a challenge to the validity of the findings. Another limitation may be that we use group interviews, which also have some disadvantages. Some participants may be less willing to voice their opinions in the presence of their coworkers; thus, there may be a tendency toward conformity harmony. The influence of social norms and group dynamics may lead to conformity or individuals withholding information [62], making it difficult for researchers to address this issue during interviews. Finally, while our results may be generalized to many occupations, they should be interpreted with caution in sectors involving customer service.
However, the qualitative part of the study has several important strengths. Conducting interviews across 14 different workplaces and multiple industries ensures a diverse and comprehensive sample. This diversity increases the generalizability of the findings, as it captures a wide range of experiences and perspectives related to managing emotional demands. The fact that the sampling was based on the baseline survey allowed the study to focus on organizations that succeeded in coping with high emotional demands, thus allowing the study to pursue information on the mechanisms that are important to success. Furthermore, conducting 31 interviews provides a substantial amount of qualitative data. This allows for a deeper understanding of the phenomena under study and enhances the credibility of the findings through data saturation, where similar themes and patterns emerge across multiple interviews. Additionally, the fact that no workplaces or individuals refused to participate suggests a high level of engagement and willingness to contribute to the study. This can indicate the relevance and importance of the research topic to the participants and may result in richer and more detailed responses. Furthermore, by including multiple industries, the study can identify common themes and differences in managing emotional demands across different contexts. Display rules in professions such as prison work, security, hospitality, or customer service may differ from those in our sample, the strategies identified were not tied to any single occupational display norm. Rather, they represent broader forms of structural and social support that may be adaptable across varying emotional and organizational contexts. This suggests that, despite contextual differences, such strategies could offer cross-sectoral relevance in supporting employees' emotional well-being at work.. Finally, the voluntary nature of participation can enhance the reliability of the data because participants are more likely to share their true feelings and experiences when they are not coerced or obligated to take part. Additionally, it may be a limitation that the items measuring strategy to manage emotional demands use are not validated. However, each strategy was assessed using a single-item measure and analyzed independently. These items were not intended to form a unified scale or reflect an underlying latent construct. Rather, they represent distinct, self-reported approaches to managing emotional demands. As such, traditional measures of reliability and validity (e.g., internal consistency or factor analyzes) are not applicable. The items were used to explore associations between specific strategies and burnout risk.
The quantitative study should be considered in light of several limitations as well. Even though we sent reminders twice, 39% of the participants in the baseline assessment did not participate in the follow-up assessments. We contacted all workplaces during the study and encouraged them to motivate employees to fill out the questionnaire. However, if only employees with an interest in the topic responded, the results would be affected by selection bias, decreasing the level of generalizability. Common method bias is another limitation of survey studies. The use of survey data only increases the risk of inflation of the association between measures [63]. However, little is known about how this type of bias affects the statistical results, and whether it favors the null hypothesis [64]. Importantly, burnout and the experience of emotionally demanding work tasks are partly intrapsychic phenomena. One may argue that it is important to use self-reported measures to investigate these phenomena. However, future studies could benefit from including objective data on exposure to emotionally demanding work tasks, i.e., by including registration of patient/client/student load, reports on difficult citizens, etc., from the organizations. Such formal registration would improve present knowledge within this area.
The quantitative study also has several important strengths. The use of a longitudinal design allowed the study to capture changes over time and including a wide variety of workplaces enhances the generalizability of the findings. The combination of longitudinal data and sampling based on diverse workplace settings contributes to the overall validity and applicability of the study and to a wide range of organizational contexts.
Finally, the multimethod approach results in rich and diverse data. Expert interviews provide in-depth knowledge, surveys capture a wide range of responses and allow for statistical analysis, and qualitative interviews provide detailed context and personal experiences. The strong alignment of results gained from multiple methods allows for the triangulation of data and enhances the credibility and validity of the overall findings.
Conclusion
Being based on both the quantitative and qualitative data, this study highlights the effectiveness of six practical strategies for managing emotional demands and reducing burnout risk across diverse sectors, despite variations in organizational structures and resources. The study results indicate the potential of implementing one or more of these strategies because they support mechanisms of heightened resilience such as expressing and understanding of one’s own emotional reactions as well as fostering a supportive work environment where challenges with emotionally demanding work tasks are addressed collectively rather than in isolation.
Future intervention studies that focus on one or more of the six strategies are recommended.
Supplementary Information
Authors’ contributions
L.P.A, D. A. and J. P–T did substantial contributions to the application, conception and design and acquisition of data. J.P–T. made the analysis and interpretation of data. L.P.A. drafted the article. D. A and J. P–T. revised the article critically for important intellectual content. L.P.A, D. A. and J. P–T read the final manuscript and approved the version to be published.
Funding
Study supported by: The Danish Working Environment Research Fund. Grant number 52–2020-03 20205100159.
Data availability
To protect the privacy of participants and ensure the confidentiality of the data, the datasets used and analyzed during the study are not publicly available but can be obtained from the corresponding author upon reasonable request.
Declarations
Ethics approval and consent to participate
All methods were carried out in accordance with relevant guidelines and regulations (declaration of Helsinki). The use of the data was carried out under the same conditions and with the same purpose as collected data. Participation in the study was voluntary, and the collected data were treated confidentially. The study was approved by the Danish Data Protection Agency prior to data collection. According to Danish Law (Act on Research Ethics Review of Health Research Projects), which is available at: www.nvk.dk/english/act-on-research, questionnaire- and register-based studies require neither approval by ethical nor scientific committees.
The collected information was only used if the participant had given informed consent by ticking off a box with the following text at the beginning of the questionnaire: “I have been informed that I can receive a copy of my own answers and can have them deleted if I wish, and hereby agree to participate in the survey.”
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
To protect the privacy of participants and ensure the confidentiality of the data, the datasets used and analyzed during the study are not publicly available but can be obtained from the corresponding author upon reasonable request.