Self-help for stress and burnout without therapist contact: An online randomised controlled trial

Interventions designed to reduce stress and burnout may be costly and access is limited. This study examined the effectiveness of a self-help book, using Acceptance and commitment therapy (ACT) to target stress and burnout in a randomised controlled online trial without any therapist contact. Participants were recruited through a newsletter of a health insurance company. Participants (N?=?119) who reported at least moderate levels of stress were randomly assigned to an immediate intervention (n?=?61) or a waitlist group (n?=?58). Measures before and after the intervention assessed stress, burnout (primary outcomes), depression, well-being, emotion regulation (secondary outcomes) and ACT-specific constructs. Compared to the waitlist group, participants in the immediate intervention group reported lower stress and burnout and higher psychological flexibility at post-assessment. Effects between groups were large for stress (d?=?0.9), moderate to large for burnout (d?=?0.5–0.8) and large for psychological flexibility (d?=?0.8). All primary and most secondary outcomes and ACT processes continued to improve in the 3-month-follow-up period. Results suggest that an ACT self-help book without any therapist contact is effective in reducing stress and burnout for various occupations. Thus, it may provide a cost-effective public health intervention for reducing stress and burnout.     

Health, well-being and burnout of ICU nurses on 12- and 8-h shifts

It is generally agreed that some features of shift systems can influence the extent of well-being and health problems experienced by the workers involved. Extended working days (9-12 h) have been found to aggravate some problems associated with shiftwork, especially when the work is mentally and emotionally demanding. The aim of the study was to compare measures of health, sleep, psychological and social well-being, job satisfaction and burnout of ICU nurses on 12- and 8-h shifts. The groups of subjects were matced for age, length of shiftwork experience, marital status and number of hours worked. the 12-h shift nurses, when compared to their 8-h shift colleagues, experienced more chronic fatigue, cognitive anxiety, sleep disturbance and emotional exhaustion. Job satisfaction seems to be independent of the shift duration. The nurses on 12-h shifts reported less social and domestic disruption than those on 8-h shifts. The 12-h shift nurses showed worse indices of health, well-being and burnout tan the 8-h shift nurses. It is suggested that this may be associated with their longer daily exposure to the stress of work. The increased number of rest days of 12-h shift nurses seems tobe insufficient to dissipate the adverse health and well-being effects that built up over their longer shifts.     

Job stress,burnout and substance use among urban transit operators: The potential mediating role of coping behaviour

Abstract

Urban transit operators, compared to other occupational groups, have higher rates of mortality and morbidity. A major risk factor is the highly stressful objective environment. This study used structural equation modelling to test a model hypothesizing that transit operators’ coping behaviours in responding to daily job hassles mediate the associations of work stress with burnout and substance use. The study sample consisted of 1231 transit operators who participated in the San Francisco MUNI Health and Safety Study. The results showed a direct and strong association between transit operators’ daily job stress and symptoms of occupational burnout even when a series of controls and coping behaviours were considered. In addition, use of “disengage-deny” and escapist strategies to cope with job stress was positively associated with burnout; the job stress–burnout association was partially mediated through such coping practices. Daily job stress was related to substance use only indirectly and mediated through burnout and use of “disengage-deny” and escapist coping strategies. “Disengage-deny” coping strategies might help reduce substance use whereas escapist coping strategies might increase such use. Overall, our findings suggest that coping behaviour may be an important correlate of transit operators’ ill health. Interventions enabling healthy coping behaviours may help reduce health risks for this occupational group.     

The impact of sense of coherence and high-demand/low-control job environment on self-reported health,burnout and psychophysiological stress indicators

Sense of Coherence (SOC) is a new concept belonging to a salutogenic paradigm, proposing to explain health as contrasted to disease, a pathogenic paradigm. The Job Demand-Control (JDC) model of job stress suggests that the combination of high job demands and low job control, defined as job strain, is strongly associated with adverse health consequences. The aim of this study was to evaluate the relationship between SOC and the JDC model in assessment of negative job effects within three pathogenically defined contexts: self-reported health, burnout and psychophysiological stress indicators, assessing the explanatory value of SOC for such variables. The study was conducted with 103 employees of social-welfare and social-insurance agencies in Sweden. A questionnaire related to job conditions, health and burnout was administered, and blood samples were collected and analysed for serum concentrations of cortisol, prolactin and immunoglobulin G. Multiple-regression models were calculated including variables from all three contexts. In the analyses, a distinction was made between emotional job strain and quantitative job strain. The SOC interacted with emotional job strain, but the interaction also increased the independent effect of emotional job strain. The independent effect of SOC disappeared in most models when interaction was included. It is concluded that studies of job strain-effects according to the JDC model should include the SOC as an interaction factor.     

Help for impaired physicians.

A physician is considered to be impaired when personal problems (e.g., chemical dependence, emotional disorders, physical disability) or professional difficulties (e.g., malpractice litigation stress, incompetence) begin to interfere with the ability to function in the profession and in personal life. In this article, the nature of the impairment problem is briefly described and the issues of prevention, early recognition, effective and humane treatment, and the recovery process are addressed.     

Leadership and stress: A meta-analytic review

Stress has been implicated as an important determinant of leadership functioning. Conversely, the behavior of leaders has long been argued to be a major factor in determining the stress levels of followers. Yet despite the widespread acknowledgement that stress and leadership are linked, there has been no systematic attempt to organize and summarize these literatures. In the present, we meta-analytically review the relationship between three leadership constructs (transformational leadership, leader-member exchange, and abusive supervision) and stress and burnout. Our analyses confirm that leader stress influences leader behavior and that leadership behaviors and leader-follower relationships are significant determinants of stress and burnout in subordinates. We build on these results to suggest new avenues for research in this domain as well as discussing how these results can inform practice with regards to leader development.     

The role of work-related personal projects during two burnout interventions: a longitudinal study

Burnout is nowadays a common problem among employees, and a new approach to reduce its extent is needed. This study looked at burnout interventions in terms of personal goals and/or projects. These represent what individuals are striving to achieve, and include work-related goals. Our aim was to examine the extent to which two kinds of burnout intervention, in the form of different types of psychotherapy, influence employees’ personal projects. The two types of therapy were psychoanalytic and experiential, both in the form of group therapy. To determine the extent, 62 employees who had contacted the Helsinki Occupational Health Services suffering from severe burnout participated, in the course of a single year, in 16 sessions of either analytic or experiential group psychotherapy. In addition, 28 employees suffering from severe burnout served as controls. All the participants filled in Little's Personal Project Analysis and the Bergen Burnout Indicator one month before the intervention, in the middle of the intervention and one month after the intervention. The results showed that among participants in the intervention groups the level of burnout decreased. Further, the number of work-related personal projects, project-related negative emotions, and tendencies towards negative action, decreased among those in the intervention groups compared to the control group. Moreover, project-related progress, social support and managing project-related emotions increased during the intervention. Finally, the results showed that when the negative emotions related to personal projects decreased during intervention, the level of burnout also decreased.     

The impact of sense of coherence and high-demand/low-control job environment on self-reported health, burnout and psychophysiological stress indicators

Sense of Coherence (SOC) is a new concept belonging to a salutogenic paradigm, proposing to explain health as contrasted to disease, a pathogenic paradigm. The Job Demand-Control (JDC) model of job stress suggests that the combination of high job demands and low job control, defined as job strain, is strongly associated with adverse health consequences. The aim of this study was to evaluate the relationship between SOC and the JDC model in assessment of negative job effects within three pathogenically defined contexts: self-reported health, burnout and psychophysiological stress indicators, assessing the explanatory value of SOC for such variables. The study was conducted with 103 employees of social-welfare and social-insurance agencies in Sweden. A questionnaire related to job conditions, health and burnout was administered, and blood samples were collected and analysed for serum concentrations of cortisol, prolactin and immunoglobulin G. Multiple-regression models were calculated including variables from all three contexts. In the analyses, a distinction was made between emotional job strain and quantitative job strain. The SOC interacted with emotional job strain, but the interaction also increased the independent effect of emotional job strain. The independent effect of SOC disappeared in most models when interaction was included. It is concluded that studies of job strain-effects according to the JDC model should include the SOC as an interaction factor.     

Burnout,job stress and violent behaviour among Dutch police officers

Much has been published on burnout in the human services. However, despite the extensive literature on job stress in policing, burnout in police officers has rarely been studied. The present study examined stressors in police work, focusing specifically on the lack of reciprocity that officers experience in relations with civilians, colleagues and the police service. It also investigated the relationship between burnout and the attitudes of officers towards violence, as well as to their own use of violence. Dutch police officers (N = 358) completed a self-report questionnaire. The results showed that: (1) organizational stressors were more prevalent than task-related stressors; (2) compared to other service jobs, police officers report a particular profile on the three scales of the Maslach Burnout Inventory (MBI)?a relatively low level of emotional exhaustion,an average level of depersonalization, and a high level of personal accomplishment; (3) burnout is associated with a lack of reciprocity between investments and outcomes in the relations that officers have with citizens, colleagues and their organization; and (4) burnout is positively related to attitudes towards use of violence and the use of violence during the officers' duty.     

Burnout, job stress and violent behaviour among Dutch police officers

Much has been published on burnout in the human services. However, despite the extensive literature on job stress in policing, burnout in police officers has rarely been studied. The present study examined stressors in police work, focusing specifically on the lack of reciprocity that officers experience in relations with civilians, colleagues and the police service. It also investigated the relationship between burnout and the attitudes of officers towards violence, as well as to their own use of violence. Dutch police officers (N = 358) completed a self-report questionnaire. The results showed that: (1) organizational stressors were more prevalent than task-related stressors; (2) compared to other service jobs, police officers report a particular profile on the three scales of the Maslach Burnout Inventory (MBI)?a relatively low level of emotional exhaustion,an average level of depersonalization, and a high level of personal accomplishment; (3) burnout is associated with a lack of reciprocity between investments and outcomes in the relations that officers have with citizens, colleagues and their organization; and (4) burnout is positively related to attitudes towards use of violence and the use of violence during the officers' duty.     

The disruptive physician. A quality of professional life factor.

Medical leaders need to understand that attending to quality of professional life issues includes dealing with the insidious costs and stress associated with disruptive physician behavior. The disruptive physician or professional undermines practice morale, heightens turnover in the organization, steals from productive activities, increases the risks for ineffective or substandard practice, and causes distress among colleagues. Physician executives need to help reduce or prevent this behavior and develop accepted systems in which to manage, confront, and rehabilitate the person labeled "disruptive." Suggested strategies to consider in developing a system include: (1) Defining reasonable and competent interpersonal behavior; (2) educating in interpersonal skills; (3) evaluating interpersonal skills; (4) developing disruptive policy; and (5) assessing, confronting, and rehabilitating.     

The role of work-related personal projects during two burnout interventions: a longitudinal study

Burnout is nowadays a common problem among employees, and a new approach to reduce its extent is needed. This study looked at burnout interventions in terms of personal goals and/or projects. These represent what individuals are striving to achieve, and include work-related goals. Our aim was to examine the extent to which two kinds of burnout intervention, in the form of different types of psychotherapy, influence employees' personal projects. The two types of therapy were psychoanalytic and experiential, both in the form of group therapy. To determine the extent, 62 employees who had contacted the Helsinki Occupational Health Services suffering from severe burnout participated, in the course of a single year, in 16 sessions of either analytic or experiential group psychotherapy. In addition, 28 employees suffering from severe burnout served as controls. All the participants filled in Little's Personal Project Analysis and the Bergen Burnout Indicator one month before the intervention, in the middle of the intervention and one month after the intervention. The results showed that among participants in the intervention groups the level of burnout decreased. Further, the number of work-related personal projects, project-related negative emotions, and tendencies towards negative action, decreased among those in the intervention groups compared to the control group. Moreover, project-related progress, social support and managing project-related emotions increased during the intervention. Finally, the results showed that when the negative emotions related to personal projects decreased during intervention, the level of burnout also decreased.     

Stress and Burnout in Bicultural Teams in Hi‐tech Industry

This study examined burnout, stress and work importance among 120 Israelis working in binational teams, using quantitative (questionnaire) and qualitative (semi‐structured interview) methodologies. Based on the existential perspective, the study documented low levels of burnout despite high levels of stress, which were explained by the high perceived importance of the work. Hierarchical regression showed that importance moderated the effect of stress on burnout. Findings also revealed that the unexpected social stressors associated with cultural differences between team members were more stressful than the stressors associated with high‐tech work.     

Leading beyond the bottom line

Do physician executives approach managing and leading health care organizations like a CEO of a Fortune 100 company? Or does their training as physicians first give them a unique perspective, leading them to view organizational issues differently? The authors suggest that to be a physician executive is to be the practitioner, teacher, coach, and mentor for a new philosophy of leadership and management called Leading Beyond the Bottom Line. While the financial health of an organization is critical to its survival and its ability to fulfill its purpose, the trap is to focus on maximizing the bottom line. This new philosophy leads an organization to attend in equal measure to the (1) welfare of its patients, (2) its financial health, (3) the well-being of its employees, and (4) the building of its community. "The Optimal Organization" is one in which these four objectives are seen not only as related, but interconnected, and the goal is to maximize all of them. The legitimate role of the physician executive is to manage in search of Pareto Optimum, or the maximum benefit for all four organizational objectives. Clearly, this is a tougher job than maximizing profits or just optimizing profits and patient care.     

Work stress and attentional difficulties: An initial study on burnout and cognitive failures

Professional burnout is a stress-related disorder, having mental exhaustion due to work stress as its most important characteristic. Burned out individuals also often complain about attentional problems. However, it is currently not clear whether such complaints are based on true cognitive deficits or whether they merely reflect the way burned out individuals rate their own cognitive performance. To confirm the cognitive complaints we used a cognitive failure questionnaire (CFQ) to assess the level of self-reported attentional difficulties in daily life. We also measured performance on tasks of sustained attention and response inhibition (the SART and the Bourdon-Wiersma Test). We compared three groups: (1) a group of 'burned out' individuals (n=13) who stopped working due to their symptoms and sought professional treatment; (2) teachers at a vocational training institute (n=16) who reported high levels of burnout symptoms but continued to work; and (3) teachers from the same institute (n=14) who reported no burnout symptoms. The level of burnout symptoms was found to be significantly related to the number of cognitive failures in daily life, and to inhibition errors and performance variability in the attentional tasks. To our knowledge, explicit tests of objective cognitive deficits in burned out individuals have not been conducted before. Consequently, this is the first study to indicate that burnout is associated with difficulties in voluntary control over attention and that the level of such difficulties varies with the severity of burnout symptoms.     

Why does organizational identification relate to reduced employee burnout? The mediating influence of social support and collective efficacy

Although prior studies have consistently shown that organizational identification can reduce employees' stress and burnout, little is known about the mediating processes that underlie this relationship. Against this backdrop and building on recent theoretical work on the social identity model of stress, the present research tests a two-step mediation model for the organizational identification–burnout link. Specifically, it is hypothesized that employees who strongly identify with their organization are particularly likely to receive social support from their colleagues. This, in turn, should promote a sense of collective efficacy and, as a consequence, negatively relate to burnout. Data from a study with 192 Italian high schoolteachers supported the hypotheses.     

Adult attachment styles and their relationship to burnout: a preliminary,cross-cultural investigation

While many studies have addressed the relationship between adult attachment styles and stress, so far no studies have addressed the relationship between attachment styles and burnout, which is thought often to characterize highly motivated individuals. Based on a psychodynamic existential perspective it was predicted that adult attachment styles would correlate with burnout: that there would be a negative correlation between secure attachment style and burnout and a positive correlation between insecure attachment styles (avoidant or anxious/ambivalent) and burnout. A pilot study was conducted in a sample of Israeli MBA students (N=41), nearly all of whom were in full-time employment. A further four studies were then conducted on Hungarian social studies students (N=751), Israeli dialysis nurses (N=216) and national samples of Israeli Jews (N=511) and Arabs (N=505). These studies supported this hypothesis. Finally, a follow-up study involving Israeli students (N=160), who described the importance of various work features and their strategies for coping with burnout-causing situations, helps to explain the findings. These results have a theoretical and a practical implication: burnout research and intervention should include greater emphasis on personal factors in addition to contextual factors.     

Role stress among physician executives

On the one hand, physician executives are clinicians who place value on professional autonomy. As clinicians, the best interests of the patient drive their decision making and their value system. On the other hand, as managers, physician executives serve as agents of an organization. Because of the differences in the two cultures, some physicians have called the physician executive position a "no man's land" To address these issues and answer the questions that surround them, the authors developed a survey that was mailed to a random sample of the membership of the American College of Physician Executives. Parts of the survey served in other studies of role conflict and role ambiguity. Parts of the survey are new, developed specifically to analyze the physician executive role. The findings are reported in this article.