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Emotional stress of peer counselors in www.youth-life-line.de-project

Authors:

Abstract

Objective: Peer counseling movement begun in the 1970s in U.S.. Other countries followed. Since the 1990s scientific investigation of the effect of peer counseling on the helpers themselves is published. Peer counseling is assumed to have great importance in prevention of psychosocial risks including suicide. Peer helpers seem to have better knowledge of the specific situation of the youth in question. And peer counseling should cause a threshold facilitation to gain professional assistance. On a second level peer helpers seem to help themselves. The changes in peer counselors seem to be greater than those of supported patients. (Schwartz et Sendor 1999) Most of these effects are ascribed to the training of helpers preceding peer counseling. High school peer helpers improved by training positive attitudes toward suicide intervention (Stuart et al. 2003) and demonstrated a higher level of self-appraisal. (Steinbauer 1998) Helping students are significantly more likely to select helping professions and significantly more likely to indicate higher self-esteem. (Moore 1994) None of these studies addresses peer counseling by internet or the impact of counseling on the emotional state of the helper. Most of the studies stressed the effect of peer counseling training on the counselors. Therefore our survey directed its attention on emotional changes during one year of internet peer counseling by youths and young adults. We presumed counseling peers putting counselors under great emotional stress and reduction of stress and anxiety by peer counseling becoming routine.
ADS: low depression high depression
100%80%60%40%20%0%
STAI: anxiety trait low high
100%
80%
60%
40%
20%
0%
after session prior to session
MBDF-vigilance: mean
100%
80%
60%
40%
20%
0%
2021 133140N =
after sessionprior to session
MBDF-mood-percentile range: mean + 95% CI
90%
80%
70%
60%
50%
40%
30%
sex
female
male
191920N =
TEST
15 months2 monthsstart
STAI X1: mean + 95% CI
42
40
38
36
34
32
30
28
Emotional stress of peer counselors in www.youth
Emotional stress of peer counselors in www.youth-
-life
life-
-line.de
line.de-
-project
project
*
G.M. Barth
1
, S. Denoix
2
, F.-J. Kimmig
2
, M. Weinhardt
2
, U. Sünkel
1
, G. Klosinski
1
University of Tübingen, Germany
1Department of Child and Adolescent Psychiatry and Psychotherapy
Osianderstraße 14, D-72076 Tübingen
2Arbeitskreis Leben, Österbergstraße 4, 72070 Tübingen
gottfried.barth@med.uni-tuebingen.de - http://www.medizin.uni-tuebingen.de/ppkj/
16th World Congress of the International Association for Child and Adolescent Psychiatry and Allied Professions (IACAPAP)
Method:
Method:
References
References
:
:
Results:
Results:
Objective:
Objective:
Peer counseling movement begun in the 1970s in U.S.. Other countries followed. Since the 1990s
scientific investigation of the effect of peer counseling on the helpers themselves is published.
Peer counseling is assumed to have great importance in prevention of psychosocial risks including
suicide. Peer helpers seem to have better knowledge of the specific s ituation of the youth in question.
And peer counseling should cause a threshold facilitation to gain professional assistance.
On a second level peer helpers seem to help themselves. The changes in peer counselors seem to be
greater than those of supported patients. (Schwartz et Sendor 1999) Most of these effects are ascribed
to the training of helpers preceding peer counseling. High school peer helpers improved by training
positive at titudes toward suicide intervention (Stuart et al. 2003) and demonstrated a higher level of
self-appraisal. (Steinbauer 1998) Helping students are significantly more likely to select helping
professions and significantly more likely to indicate higher self-esteem. (Moore 1994)
None of these studies addresses peer counseling by internet or the impact of counseling on the
emotional state of the helper. Most of the studies stressed the effect of peer counseling training on the
counselors. Therefore our survey directed its attention on emotional changes during one year of
internet peer counseling by youths and young adults.
We presumed counseling peers putting counselors under great emotional stress and reduction of stress
and anxiety by peer counseling becoming routine.
20 of 21 youth counselors continued
counseling after 15 months, one 17
years old girl finished early. The girl
who finished showed extreme
scores in MBDF (percentile range
1% - 92%).
18 female and 2 male peer
counselors continued. Therefore no
sex differences could be analyzed.
Another young woman (18 years -
counselor D) searched for
psychiatric advice because of
depressive mood and problems
concerning the f amily continual
since several years. She
communicated no difficulties by
counseling but missing integration in
peer group. She demonstrated the
maximal increase of ADS-score of
all counselors (ADS percentile
range increasing from 44% to 73%
and 64% after 15 months
Counselor D in graph: course of
ADS-scores).
One young man exceeded ADS
deceit test critical limit after 15
months. His test was eliminated.
Conclusions:
Conclusions:
Abstract
Abstract
:
:
In the p eer-counseling-project www.youth-life-line.de trained adolescents
give online s upport for suicidal young people. Question arises whether
these young counselors will be overstrained. 21 adolescent counselors
were tested by questionnaires regarding depression, anxiety and psychic
state in the weeks before first online consulting and during consulting. They
had the possibility to call a psychiatrist if they w ould have psychic
problems.The young counselors demonstrated no extreme emotions in the
questionnaires. There was no s ign for emotional excessive demands. One
of the 21 participants called the psychiatrist. His problems didn’t arise from
counseling. In contrast counseling was able to stabilize preceding problems
and opened the way to an own therapy. Results show no excessive
demand for young counselors. Therefore there is no reason to prevent
them from own counseling. In contrast training and counseling seem to be
supportive for their own psychic maturation.
In March 2003 21 youths in the age of 16–18 years began peer counseling in an new project named
www.youth-life-line.de”. They give answers by internet chat over 2 hours one to three times a
week. At the beginning of their work they were trained over half a year by experienced counselors of
“Arbeitskreis Leben” including a visit in the department of child and adolescent psychiatry. Peer
counseling is supervised by the s ame experienced counselors. The whole project is monitored by
pedagogic and psychiatric accompanying research and by guidance of a child and adolescent
psychiatrist. All the youths were offered consultations by the same psychiatrist if necessary.
The project “www.youth-life-line.de” was intensive accepted by peers and all trained peers were
intensively involved in supervised chat-counseling.
For their own protection they were tested by questionnaire interview accompanying their work. Four
questionnaires were presented 3 to 28 times from March 2003 until July 2004. In June – July 2004
age was 17 – 20 years.
Depression was tested by ADS (Allgemeine Depressions Skala = common depression scale,
Hautzinger et Bailer 1992), the German version of the “Center for Epidemiological Studies
Depression Scale” (CES-D), a standardized 20 items self-assessment questionnaire which was
presented at the beginning of counseling, after 15 months and one week later for confirmation of
effects.
Hautzinger M, Bailer M (1992): ADS –Allgemeine Depressions Skala. Göttingen: Beltz Test.
Moore LB (1994): Peer helpers helping themselves: A study of some of the most significant benefits
of being a peer helper. Dissertation Baylor University. Dissertation Abstracts International Section A:
Humanities and Social Sciences 55(4): 912
Schwartz CE. Sendor M (1999): Helping others helps oneself: response shift effects in peer support.
Social science & medicine 48: 1563-1575.
Spielberger D et al. (1970): State-Trait Anxiety Inventory. Palo Alto: Consulting Psychologists Press.
Steinbauer l et al. (1998): The effects of a high school peer counselor training program on th e self-
appraisal skills and the interpersonal skills of the tr ained peer leader. Dissertation Abstracts
International Section A: Humanities and Social Sciences 59(1): 84
Steyer R et al. (1997): Der Mehrdimensionale Befindlichkeitsfragebogen (MDBF). Göttingen:
Hogrefe.
Stuart C et al. (2003): Many helping hearts: An evaluation of p eer gatekeeper training in suicide risk
assessment. Death Studies 27(4): 321-333.
Anxiety
Anxiety trait score
(STAI X 2) didn’t show
a s ignificant change
from st art to 15
months. There was a
tendency of decrease
and a tendency of
higher scores (more
anxiety) for male
peers. Presumed
reduction of anxiety
couldn’t be found.
Psychic State
The MDBF scores were sampled at the
beginning and at the end of many sessions in
the first two months and before and after two
sessions after 15 months.
No significant change between high and low
spirits (mood) could be found after compared to
before the sessions or after 15 months
compared to starting counseling.
A tendency of lower spirit, lower alertness and
lower peace of mind of male peers could be
seen. Male peers scored mood near 50% range,
vigilance female scored near 50% range,
agitation female peers scored a high level of
peace of mind.
For some counselors extreme changes of
moods during a session could be seen.
* “www.youth-life-line.de” is kindly financed by the “Erwin Ringel Stiftung”, Tübingen (Germany) and the “Landesstiftung Baden-Württemberg”, Stuttgart (Germany).
Correlations between Scores
Between alls scores of ADS, STAI and MBDF
were high correlations with the exception of
ADS-depression vs. MBDF-agitation (r=0,22,
p<0,5).
Within MBDF-scale the highest bivariate
correlation exists between MBDF-mood and
MBDF-agitation (r=0,65, p<0,001), lower
correlation between MBDF-mood and MBDF-
vigilance (r=0,48, p<0,001) and MBDF-agitation
and MBDF-vigilance (r=0,47, p<0,001).
STAI state anxiety shows a correlation to trait
anxiety (r=0,54, p<0,001) and higher bivariate
correlation to MBDF-agitation (r=0,82, p<0,001)
and MBDF-mood (r=0,78, p<0,001). Correlation
between STAI-state and ADS-depression is
lower (r=0,47, p<0,001).
ADS: low depression high depression
MBDF-sleepy MBDF-alert
181918N =
15,1 month15 monthStart
ADS percentile scale: mean + 95% CI
70%
60%
50%
40%
30%
20%
10%
Anxiety was tested by STAI (State-Trait Anxiety Inventory, Spielberger et al. 1970, German version
by Laux et al.), a partly standardized self-assessment questionnaire. Standardized Trait-score of
anxiety (STA I X2) was sampled like ADS. State-score of anxiety (STAI X1) was presented each
counselor 3 to 14 times, average 7 times at the beginning of a session. Like ADS and STAI X2
anxiety-state was tested at the beginning of counseling and after 15 months.
The MDBF (Der Mehrdimensionale Befindlichkeitsfragebogen = multidimensional psychic state
questionnaire, Steyer et al. 1997) was used to test changes of psychic state during a session of peer
counseling chat and in the c ourse of peer counseling over more t han a year. MDBF can be used as
a 12 or 24 item self-assessment questionnaire and can be scored into 3 standardized dimensions:
mood (high spirits versus low spirits), vigilance (alert vs. sleepy) and agitation (peace of mind vs.
restlessness). The questionnaire was presented at the beginning and at the end of a session each
counselor 4 to 14 times, average 7 times at the beginning and in the first month of counseling and
two times after 15 months.
Statistical Analysis was made as explorative data analysis of changing scores an correlations
between scores. In ADS and S TAI X2 mean value of both tests after 15 months and one week later
were compared with tests at the beginning. One patient exceeded in one ADS-test the critical limit of
the deceit test. This test was eliminated. Comparison of start and 15 months test was only conducted
when both tests were available.
Depression
At the beginning of c ounseling, peer helpers showed a quite
normal range of depression in ADS (mean 50,5% in
percentile range). No significant sex-difference (only a
tendency of a higher range for male youths). None of t he
youths had a high score in deceit test.
After 15 months of peer counseling a significant reduction of
depression (31,1% in percentile range, p < 0,001) which was
confirmed one week later (29,6%). Also no significant sex-
difference (only tendency of a higher range for male youths).
Score in ADS deceit test without significant change. This
points to the decrease of depression not as a process of
increased conformity.
Course of ADS-score for each counselor shows decreasing
score for 14 counselors and increasing score for 3 peers.
Peer counselors showed a quite normal profile of depression (ADS
Peer counselors showed a quite normal profile of depression (ADS = 50%) and anxiety (STAI X2 = 52%) and normal ranges in psychic
= 50%) and anxiety (STAI X2 = 52%) and normal ranges in psychic state at the beginning of their work. After one
state at the beginning of their work. After one
year of peer counseling depression decreased (ADS = 31%). Peer c
year of peer counseling depression decreased (ADS = 31%). Peer counselors showed a significant (p=0,001) reduced level of depres
ounselors showed a significant (p=0,001) reduced level of depression in ADS
sion in ADS-
-scale during one year of counseling.
scale during one year of counseling.
Score in ADS deceit test also decreased. This points to the decr
Score in ADS deceit test also decreased. This points to the decrease of depression not only as a better social adjustment. Psych
ease of depression not only as a better social adjustment. Psychic state showed a sight progression in vigilance (more
ic state showed a sight progression in vigilance (more
alertness) and agitation (more peace of mind) during 15 months o
alertness) and agitation (more peace of mind) during 15 months of counseling but no consistent changes were found in mood or dur
f counseling but no consistent changes were found in mood or during the sessions.
ing the sessions.
Only one peer finished premature (unknown reason). One peer took
Only one peer finished premature (unknown reason). One peer took psychiatric help because of familial and peer problems since a
psychiatric help because of familial and peer problems since a long time. She continued counseling.
long time. She continued counseling.
This points to more positive effects than risks in peer counseli
This points to more positive effects than risks in peer counseling for the counselors. Peer counseling brings no disturbing stre
ng for the counselors. Peer counseling brings no disturbing stress for the counselors but develops their emotional state.
ss for the counselors but develops their emotional state.
High correlations were found between Depression and vigilance an
High correlations were found between Depression and vigilance and between state anxiety and mood and agitation. This points to t
d between state anxiety and mood and agitation. This points to the character of by ADS recorded depression and by STAI recorded
he character of by ADS recorded depression and by STAI recorded state anxiety. It
state anxiety. It
correlates to psychoanalytic theories of sleepiness as a (defens
correlates to psychoanalytic theories of sleepiness as a (defense
e-
-) manifestation of depression and anxiety as a stressing form of
) manifestation of depression and anxiety as a stressing form of inner disturbance.
inner disturbance. Remarkable is a high correlation between depression and trait an
Remarkable is a high correlation between depression and trait anxiety,
xiety,
perhaps not clear differentiated constructs. Limitations of the
perhaps not clear differentiated constructs. Limitations of the study are the self
study are the self-
-rating character of the scores. In a second group verification o
rating character of the scores. In a second group verification of results will be done.
f results will be done.
181918N =
15,1 month15 monthStart
ADS deceit test mean + 95% CI
0
-2
-4
-6
-8
-10
-12
Graph: ADS-score and ADS deceit test
score at start and after 15 month (all peers)
Graph: Course of ADS-score for each peer
counselor
TEST
15 monthsstart
ADS percentile scale
100%
80%
60%
40%
20%
0%
192017N =
TEST
15,1 months15 monthsstart
STAI-X2 - percentile range: mean + 95% CI
70%
60%
50%
40%
30%
20%
Anxiety state was
tested over many tests
during the first month.
No significant
reduction of anxiety
prior to the sessions
appeared. Only a
tendency of decreased
scores after 15 months
(not after 2 months)
and a tendency of
increased scores for
male peers appeared.
Only a correlation of
higher alertness and
lower sleepiness
(vigilance) (p < ,005) and
more peace of mind and
less restlessness
(agitation) (p < 0,01) in
the c ourse of counseling
could be found without
consistent change during
a session.
202019 202020N =
15 months2 monthsstart
MBDF-mood-percentile range: mean + 95% CI
100%
90%
80%
70%
60%
50%
40%
TIME
prior to session
after session
Graph: Anxiety trait in course of counseling
(all peer counselors)
Graph: Anxiety state in course of counseling
(all peer counselors)
Graph: psychic state (moo d) during the
sessions and in course of counseling (all
peer counselors)
Graph: psychic state (vigilance) in cou rse of co unseling (all peer counselor s)
a) all scores b) scores d ivided prior and after session
15 months2 monthsstart
MBDF-vigilance-percentile range: mean + 95% CI
60%
50%
40%
30%
15 months2 monthss tart
MBDF-vigilance-percentile range: mean + 95% CI
70%
60%
50%
40%
30%
20%
TIME
prior to session
after session
Graph: psychic state (vigilan ce) during the
second session for each peer counselor
MBDF-score
50403020100
MBDF-score
50
40
30
20
10
0
MBDF-vigilance
MBDF-mood
MBDF-agitation
MBDF-vigilance
MBDF-mood
MBDF-agitation
STAI X1: low high anxiety state
70605040302010
MBDF high spirit / peace of mind
50
40
30
20
10
0
MBDF-agitation
STAI-anxiety state
MBDF-mood
STAI-anxiety state
Graph: distribution within MBDF-scale
ADS depression
score showed high
bivariate c orrelation
to STAI trait anxiety
(r=0,72, p<0,001) and
to MBDF-vigilance
(r=0,63, p<0,001).
Depression correlates
with high trait anxiety
and low alertness.
Graph: distribution between depression
and trait anxiety
Graph: distribution between depression
and MBDF vigilance
Graph: distribution between state anxiety
and MBDF agitation and mood
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