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The aim of this study was to examine cross-cultural differences, as operationalized by Schwartz's refined theory of basic values, in burnout levels among psychotherapists from 12 European countries during the coronavirus disease (COVID-19) pandemic. We focused on the multilevel approach to investigate if individual- and country-aggregated level values could explain differences in burnout intensity after controlling for sociodemographic, work-related characteristics and COVID-19-related distress among participants. 2915 psychotherapists from 12 countries (Austria, Bulgaria, Cyprus, Finland, Great Britain, Serbia, Spain, Norway, Poland, Romania, Sweden, and Switzerland) participated in this study. The participants completed the Maslach Burnout Inventory-Human Service Survey, the revised version of the Portrait Values Questionnaire, and a survey questionnaire on sociodemographic, work-related factors and the COVID-19 related distress. In general, the lowest mean level of burnout was noted for Romania, whereas the highest mean burnout intensity was reported for Cyprus. Multilevel analysis revealed that burnout at the individual level was negatively related to self-transcendence and openness-to-change but positively related to self-enhancement and conservation values. However, no significant effects on any values were observed at the country level. Male sex, younger age, being single, and reporting higher COVID-19-related distress were significant burnout correlates. Burnout among psychotherapists may be a transcultural phenomenon, where individual differences among psychotherapists are likely to be more important than differences between the countries of their practice. This finding enriches the discussion on training in psychotherapy in an international context and draws attention to the neglected issue of mental health among psychotherapists in the context of their professional functioning.
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Burnout among psychotherapists:
a cross‑cultural value survey
among 12 European countries
during the coronavirus disease
Angelika Van Hoy1*, Marcin Rzeszutek1, Małgorzata Pięta1, Jose M. Mestre2,
Álvaro Rodríguez‑Mora2, Nick Midgley3, Joanna Omylinska‑Thurston4, Anna Dopierala5,
Fredrik Falkenström6, Jennie Ferlin7, Vera Gergov8, Milica Lazić9, Randi Ulberg10,
Jan Ivar Røssberg10, Camellia Hancheva11, Stanislava Stoyanova12, Stefanie J. Schmidt13,
Ioana Podina14, Nuno Ferreira15, Antonios Kagialis16, Henriette Löer‑Stastka17 &
Ewa Gruszczyńska18
The aim of this study was to examine cross‑cultural dierences, as operationalized by Schwartz’s
rened theory of basic values, in burnout levels among psychotherapists from 12 European countries
during the coronavirus disease (COVID‑19) pandemic. We focused on the multilevel approach to
investigate if individual‑ and country‑aggregated level values could explain dierences in burnout
intensity after controlling for sociodemographic, work‑related characteristics and COVID‑19‑
related distress among participants. 2915 psychotherapists from 12 countries (Austria, Bulgaria,
Cyprus, Finland, Great Britain, Serbia, Spain, Norway, Poland, Romania, Sweden, and Switzerland)
participated in this study. The participants completed the Maslach Burnout Inventory‑Human Service
Survey, the revised version of the Portrait Values Questionnaire, and a survey questionnaire on
sociodemographic, work‑related factors and the COVID‑19 related distress. In general, the lowest
mean level of burnout was noted for Romania, whereas the highest mean burnout intensity was
reported for Cyprus. Multilevel analysis revealed that burnout at the individual level was negatively
related to self‑transcendence and openness‑to‑change but positively related to self‑enhancement
and conservation values. However, no signicant eects on any values were observed at the country
1Faculty of Psychology, University of Warsaw, Stawki 5/7, 00-183, Warsaw, Poland. 2University Institute of
Sustainability and Social Development (INDESS), Jerez de la Frontera, Universidad de Cádiz, Department of
Psychology, Puerto Real (Cádiz), Spain. 3Child Attachment and Psychological Therapies Research Unit (ChAPTRe),
Anna Freud Centre for Children and Families, 4-8 Rodney Street, London N1 9JH, UK. 4School of Health and
Society, University of Salford, Frederick Road Campus, Broad Street, Salford M6 6PU, UK. 5School of Psychology,
University of Lincoln, Brayford Pool, Lincoln LN6 7TS, UK. 6Department of Psychology, Linnaeus University, SE-351
95 Växjö, Sweden. 7Linköping University, 581 83 Linköping, Sweden. 8Department of Psychology and Logopedics,
Faculty of Medicine, University of Helsinki, P.O. Box 63, 00014 Helsinki, Finland. 9Department of Psychology,
Faculty of Philosophy, University of Novi Sad, 2 Dr Zorana Đinđića, 21101 Novi Sad, Serbia. 10Insitute of Clinical
Medicine, University of Oslo, Blindern, P.O Box 1171, 0315 Oslo, Norway. 11Department of Psychology, Head of
Center for Psychological Counselling and Research, Soa University “St. Kliment Ohridski, 15 Tsar Osvoboditel
Blvd., 1504 Soa, Bulgaria. 12Department of Psychology, Faculty of Philosophy, South-West University “Neot
Rilski”, 66 Ivan Mihaylov Street, 2700 Blagoevgrad, Bulgaria. 13Department of Clinical Child and Adolescent
Psychology, Institute of Psychology, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland. 14Faculty of
Psychology and Educational Sciences, University of Bucarest, 90 Panduri Street, sector 5, 050663 Bucharest,
Romania. 15Department of Social Sciences, School of Humanities and Social Sciences, University of Nicosia, 46
Makedonitissas Avenue, 2417 Nicosia, Cyprus. 16Department of Psychiatry, School of Medicine, University of
Crete, 715 00 Heraklion, Greece. 17Department of Psychoanalysis and Psychotherapy, Medical University Vienna,
Währinger Gürtel 18-20, 1090 Vienna, Austria. 18Faculty of Psychology, SWPS University of Social Sciences and
Humanities, Chodakowska 19/31, 03-815 Warsaw, Poland. *email:
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level. Male sex, younger age, being single, and reporting higher COVID‑19‑related distress were
signicant burnout correlates. Burnout among psychotherapists may be a transcultural phenomenon,
where individual dierences among psychotherapists are likely to be more important than
dierences between the countries of their practice. This nding enriches the discussion on training in
psychotherapy in an international context and draws attention to the neglected issue of mental health
among psychotherapists in the context of their professional functioning.
Since Freud’s1 early observation of the danger of analysis for the analyst, subsequent empirical studies have
shown that psychotherapists may be vulnerable to burnout (see reviews and metanalyses2,3. Although this highly
emotionally taxing helping profession should be a textbook example of a job with a high risk of burnout47, stud-
ies on burnout among psychotherapists are much less prevalent than those on burnout in other similar health
professions such as physicians or nurses (see reviews and meta-analyses812). us, the issue of burnout in this
occupation was and is still largely understudied in the elds of clinical psychology and psychotherapy, which
are traditionally focused on the clients of psychotherapy rather than on psychotherapists13,14. However, several
authors have observed that burned-out psychotherapists not only lose their ability to maintain their therapeutic
relationship with clients and manage the whole therapeutic process1518 but also experience a substantial decline
in their well-being, accompanied by various somatic and psychological complaints1921. Until now, the most
commonly studied burnout risk factors among psychotherapists were either work-related (e.g., caseload and
years of experience) or sociodemographic (sex and age)3. Much less attention was paid to the interpersonal and
intrapersonal characteristics of therapists22. In addition, several studies found vast discrepancies in burnout
prevalence among psychotherapists from various countries, ranging from 6%–54%3. To date, however, the cul-
tural context has only been examined from the perspective of client outcomes, not how it potentially relates to a
psychotherapists functioning and well-being23. In our study, we followed the basic cultural values in the rened
Schwartz value theory24,25 to assess burnout dierences among psychotherapists from 12 European countries
during the coronavirus disease (COVID-19) pandemic. To combine both individual and cultural perspectives,
we employed the multilevel approach, which allowed us to evaluate burnout at dierent levels of this hierarchy
simultaneously26,27. is approach may provide new insight into the fundamental question of whether burnout
is a multidimensional phenomenon or unitary, single-factor syndrome consisting of interrelated symptoms27. In
our study, we wanted to verify whether, among psychotherapists from these 12 countries, dierences in profes-
sional burnout were associated with individual and country-aggregated Schwartz’s values, aer controlling for
sociodemographic and work-related characteristics as well as the COVID-19 distress.
According to Schwartz28, values are “desirable trans-situational goals, varying in importance, that serve as
guiding principles in the life of a person or other social entity.” e recently rened theory of basic values24,25
highlights 19 basic values, which can be grouped into four higher-order values (self-transcendence, self-enhance-
ment, openness to change, and conservation; see Measures section). ese values were recognized in all major
cultures29 and are associated distinctively with human attitudes, behaviors, and demographic variables. e
main important assumption in this theory relates to a circular motivational continuum of values, which shows
motivational conict or compatibility across distinct values30,31. In other words, values can be compatible if
decisions and behaviors that express the goals of one value also correspond to the goals of the other value. By
contrast, values conict if decisions or behaviors that express the goals of some values do so at the cost of other
values. However, one of the still unresolved research questions is to what extent one may observe high within-
country similarity and signicant between-country variability in the culture as a shared meaning system3234.
is problem becomes even more interesting if there is a mismatch between individual values declared by a
citizen of a particular country and a country-aggregated level of these values32. For example, Stephens etal.35
observed that a culturally mismatched environment can be associated with signicant psychological distress,
which can even impact the biological functioning of the person experiencing such mismatch. In the issue of
psychotherapists, existing reviews and meta-analyses have revealed that the link between burnout and work-
related factors may be modied by cultural dierences, which shape not only the organizational characteristics
of this profession but even the types of therapeutic relationships formed with clients2,3,9. Nevertheless, those
cultural factors have never been explicitly measured in previous studies. erefore our study is the rst to apply
a well-established theoretical model to interpersonal and cross-cultural comparisons of values and their potential
impact on burnout among psychotherapists. Finally, we also took into account the most recent and thus, much
understudied potential burnout risk factor among psychotherapists, which is the psychological distress during
the COVID-19 pandemic36,37. In light of the COVID-19 pandemic, psychotherapists were faced with many new
challenges and obstacles regarding their therapeutic practice. Many psychotherapists either stopped working
altogether or changed their practices in some form. One of the main challenges encompassed switching entirely
or partly to providing psychotherapy in an online format. e above-mentioned factors were responsible for
elevated levels of depression, anxiety and loneliness in this particular sample36. However, till now no studies
have been conducted on how the COVID-19 pandemic could be related to burnout among psychotherapists
employing cross-cultural comparisons.
Present Study
e main aim of this study was to examine the cross-cultural dierences in burnout intensity among psy-
chotherapists from 12 countries during the COVID-19 pandemic. We focused on the multilevel approach to
investigate if individual- and country-aggregated level values, as operationalized by Schwartz’s rened theory of
basic values24,25, could explain dierences in burnout aer controlling for sociodemographic and work-related
characteristics and COVID-19-related distress. We formulated the following hypotheses at the individual and
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country-aggregated levels to determine whether burnout in that specic occupation is more an individual syn-
drome or mostly shaped by the between-country dierences in values declared by psychotherapists. To the best
of our knowledge, no studies have been conducted on burnout in this group of participants using such a concrete
model of culture and methodological design. us, our study is mainly explorative.
Hypothesis 1 Burnout among psychotherapists is signicantly related to individual-level values (self-transcend-
ence, self-enhancement, openness to change, and conservation) aer controlling for sociodemographic and
work-related characteristics and COVID-19-related distress.
Hypothesis 2 Burnout among psychotherapists is signicantly related to country-aggregated values (self-tran-
scendence, self-enhancement, openness to change, and conservation) aer including all the variables from
Hypothesis 1.
Hypothesis 3 Burnout among psychotherapists is related to cross-level interactions in a way that a higher level
of burnout is associated with a higher mismatch between the values declared at the individual- and country-
aggregated levels.
Participants. We conducted a cross-cultural survey using standardized questionnaires in online format (see
below) via the specialized survey platform among psychotherapists from 12 European countries: Austria, Bul-
garia, Cyprus, Finland, Great Britain, Serbia, Spain, Norway, Poland, Romania, Sweden, and Switzerland. e
data collection in all the countries was parallelly conducted between June 2020 and June 2021, during the second
and third waves of the COVID-19 pandemic. e online set of the study questionnaires was sent in each country
to the professional psychotherapeutic associations of various therapeutic modalities, which have distributed it
among their members.
Finally, 2915 psychotherapists from the 12 countries representing various psychotherapeutic modalities
participated in this study. e eligibility criteria encompassed certication (or being in the process of certica-
tion) in a particular psychotherapeutic modality and psychotherapeutic practice for at least 1year. e partici-
pants completed the online versions of the questionnaires, which were preceded by detailed sociodemographic
and work-related questions, including items on how the COVID-19 pandemic impacted their practice and on
potential psychological distress associated with the pandemic. In each country, participation was anonymous
and voluntary, and the participants received no remuneration for participating in the survey. Informed consent
was obtained from all participants of this study. e study protocol was accepted by the ethics committee of the
Faculty of Psychology at the University of Warsaw in Poland. e sociodemographic and work-related variables
and COVID-19-related distress among the psychotherapists from each country are presented in the Supplemen-
tary Tables. Finally, it is important to underline that this manuscript contains unique data, which has not been
published in any other journal.
As can be seen in all the tables, age distributions were generally similar among all countries (M = 45.5years,
min. 21years—max. 82years). Regarding the participants’ sexes, female psychotherapists were overrepresented
(83%) in all of the countries. A signicant number of participants were also in some form of stable relation-
ships (75%). In terms of education, most participants held psychology degrees. However, Finnish and Swedish
participants were almost evenly divided between having a psychology degree or a dierent degree such as social
work, counseling, or nursing. In all 12 countries, most psychotherapists worked with adult clients. Nonethe-
less, a signicant number of Polish and Bulgarian psychotherapists also worked with children. Having a private
workplace was almost universal for therapists in all countries. Most psychotherapists in all the countries had
already undergone their own psychotherapy. Supervision was provided once a month to the participants in most
of the countries. However, Austrian psychotherapists used supervision quarterly, and most Spanish therapists
did not use it at all. e results regarding therapeutic modalities varied across countries. Cognitive-behavioral
therapy seemed to be the more common therapeutic approach in Cyprus, Spain, Poland, and Romania. Next,
psychodynamic therapy was the dominant modality in Bulgaria, Norway, and Sweden. Austria and Switzerland
seemed to favor Gestalt therapy. Finally, integrative psychotherapy was the most common approach in the United
Kingdom. On average, psychotherapists in Bulgaria, Cyprus, Finland, Poland, Romania, and Serbia had between
6 and 11years of experience in the profession. On the other hand, psychotherapists who were working in Aus-
tria, Spain, Norway, Switzerland, Sweden, and the United Kingdom had between 12 and 18years of experience.
In eight of the included countries (Austria, Cyprus, Finland, Spain, Norway, Romania, Switzerland, and the
United Kingdom), most psychotherapists reported having a psychology certication (80% or more). e numbers
appeared lower in Bulgaria, Poland, Serbia, and Sweden, with only approximately 35–65% of psychotherapists
obtaining a certicate. Psychotherapists worked anywhere between a couple of hours a week and more than 20h
a week. More specically, the average weekly workload in Bulgaria, Cyprus, Romania, and Serbia was between
1 and 10h. In Sweden and the United Kingdom, the average was between 10 and 20h a week. Psychotherapists
who worked for more than 20h a week were from Finland, Norway, and Poland. Austrian, Spanish, and Swiss
psychotherapists were evenly divided between the last two workload categories. Finally, a general trend in work-
ing partially online during the COVID-19 pandemic was observed, with this being the case for psychotherapists
in 11 countries (Austria, Bulgaria, Cyprus, Finland, Spain, Norway, Poland, Romania, Serbia, Switzerland, and
Sweden). At the time of data collection, UK therapists were still mostly providing their services online only.
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Measures. To assess burnout, we used the Maslach Burnout Inventory-Human Service Survey (MBI-HS)6.
All 12 language adaptations of the MBI-HS were bought from Mind Garden, the ocial distributor of the MBI-
HS. e MBI-HS consists of 22 items and evaluates burnout and its three components: (1) Emotional Exhaustion
(EE), nine items; (2) Personal Accomplishment (PA), eight items; and (3) Depersonalization (DP), ve items. For
each item, the respondent indicated the frequency of symptoms on a Likert-type scale from 0 (never) to 6 (every
day). ). All the summed responses form an overall index, higher values of which indicate higher burnout. We
decided to use the MBI-HS in our study for two reasons: First, it is the most popular and widely used burnout
inventory focused especially on helping professions, which was the case in our research7,38. Second, the MBI-HS
is the only tool available for the assessment of burnout with a wide spectrum of dierent language adaptations;
as such, it is valuable in cross-cultural studies38.
To measure cultural values, the participants completed a revised version of the Portrait Values Question-
naire (PVQ-R) developed by Schwartz etal.24. e PVQ-R consists of 57 short, sex-matched, verbal portraits
of dierent people, each depicting a goal that is important to some person. For each portrait, respondents
highlight how similar the person is to themselves on a 6-point Likert-type scale dened as follows: 1—not like
me at all, 2—not like me, 3—a little like me, 4—moderately like me, 5—like me, and 6—very much like me. e
participants’ values are inferred from the values of the other people they described as similar to themselves. For
example, a respondent who underlines that a person described as "Enjoying life’s pleasures is important to her"
is similar to herself, and probably attributes importance to hedonistic values. e PVQ-R assesses 19 values that
can be combined into higher-order values, which was the case in our study: self-transcendence (universalism-
nature, universalism-concern, universalism-tolerance, benevolence-care, and benevolence-dependability),
self-enhancement (achievement, power dominance, and power resources), openness to change (self-direction
thought, self-direction action, stimulation, and hedonism), conservation (security-personal, security-societal,
tradition, conformity-rules, and conformity-interpersonal). All the language versions of the PVQ-R were pro-
vided by the author of this tool, S. Schwartz.
COVID-19 related distress was assessed via short, but reliable operationalization of this variable based on
some other studies published at the time, when we started our research39,40. Namely, we asked participants on
a Likert 1–5 point scale how stressful they found the situation in their role as psychotherapists caused by the
COVID-19 pandemic. e answers varied between 1 (“not at all)” to 5 (“very much”). We also examined the issue
of changes in psychotherapy settings (i.e. online setting) imposed by the pandemic situation.
Data analysis. e data obtained had a two-level structure with persons (2915 units) nested within coun-
tries (12 units); thus, a cross-sectional multilevel model was adopted41. e explained variable was the burnout
level among the psychotherapists, which was operationalized as the global burnout indicator. e explaining
variables at Level 1 were the four higher-order values assessed by each person (see Measures section), centered
on their means (centering on the group mean). e Level 2 variables were aggregates of the individual persons
scores on four higher-order values to form a country mean of each value, which was then centered on the mean
for all countries at a given value (see, centering on the grand mean). e maximum likelihood (ML) estimation
method was used. For random eects (the random intercept model), the covariance structure of the variance
components (VC) was assumed.
Unconditional (i.e., intercept only) modeling was the rst step of the analysis. It was also used to obtain the
interclass correlation coecient (ICC)42, which informs about the proportion of variance in the burnout level
explained by a grouping variable, that is, a country in which a participant is a psychotherapist. ICC values as
low as 0.01 were treated as non-trivial43. Next, sociodemographic and work-related characteristics and COVID-
19-related distress were added to the model. Continuous variables were centered on the group mean (e.g., age,
work experience, and pandemic-related stress), whereas categorical variables were transformed into two dummy-
coded categories (sex: female = 0, male = 1; relationship status: single = 0, in a stable relationship = 1; weekly
workload: 0 = less than 20h, 1 = 20h and more; supervision: 0 = quarterly or less, 1 = once a month or more). In
subsequent steps, only the variables found to be signicantly related to the explained variable were taken into
account44. In the third step, the Level 1 personal values were added, followed by the introduction of the Level 2
aggregates of these values for each country in the fourth step. Finally, the cross-level interactions of all values were
tested45,46. For signicant cross-level interactions, simple slopes, regions of signicance, and condence bands
were established using the computational tools developed by Preacher etal.47. Statistical analysis was performed
using IBM SPSS Statistics version 2748. Only the nal hypothesis-testing models are presented in the article.
For model comparison, deviance statistics, based on χ2 distribution with the degrees of freedom equal to
the dierence in the number of parameters estimated in nested models, and the Akaike Information Criterion
were used41.
Ethical approval. All procedures performed in studies involving human participants were in accordance
with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki
Declaration and its later amendments or comparable ethical standards.
Descriptive statistics. Table1 presents descriptive statistics on burnout levels and the four higher-order
values for each national sample of therapists.
Figure1 illustrates the mean burnout levels at the country level. e lowest mean was noted for Romania,
whereas the highest mean was reported for Cyprus. However, the ICC equals 0.09; thus, only 9% of the variance
of burnout level in the study sample of psychotherapists was related to the country level.
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Country nMean SD Range Kurtosis Skewness
Austria 151 32.21 14.26 9–76 0.89 1.05
Bulgaria 217 38.36 15.26 8–105 0.97 0.79
Cyprus 202 42.50 17.74 10–85 − 0.72 0.47
Finland 254 31.32 12.52 8–82 0.84 0.89
Norway 225 42.12 16.27 11–89 0.13 0.60
Poland 340 37.38 14.28 10–122 4.19 1.22
Romania 202 26.50 13.51 8–74 0.73 1.06
Serbia 237 31.39 14.28 8–79 0.68 0.89
Spain 320 35.61 16.03 8–90 0.41 0.85
Sweden 275 40.53 16.00 9–106 0.61 0.74
Switzerland 205 33.90 12.95 9–74 0.44 0.77
United Kingdom 287 42.14 17.19 10–103 0.46 0.76
Austria 150 4.83 0.77 1–6 1.49 − 1.17
Bulgaria 217 4.48 0.79 1–6 − 0.80 1.19
Cyprus 202 4.91 0.65 2–6 1.32 − 0.93
Finland 254 4.86 0.55 3–6 − 0.66 0.05
Norway 225 4.82 0.63 1–6 3.23 − 1.20
Poland 340 5.01 0.50 3–6 1.03 − 0.64
Romania 202 4.82 0.68 1–6 5.43 − 1.63
Serbia 237 4.38 0.64 2–6 1.91 − 1.13
Spain 320 5.09 0.55 3–6 0.88 − 0.88
Sweden 275 4.83 0.57 3–6 − 0.52 − 0.40
Switzerland 205 5.10 0.54 3–6 0.00 − 0.63
United Kingdom 287 4.90 0.58 2–6 0.67 − 0.73
Austria 151 3.02 0.75 1–6 − 0.47 0.25
Bulgaria 217 3.14 0.81 1–6 − 0.46 0.22
Cyprus 202 3.64 0.85 1–6 − 0.14 − 0.27
Finland 254 2.67 0.89 1–6 0.46 0.84
Norway 225 3.29 0.93 1–6 − 0.44 0.44
Poland 340 2.88 0.83 1–6 0.50 0.62
Romania 202 3.37 0.81 1–6 0.70 0.11
Serbia 237 3.71 0.69 2–6 0.13 0.22
Spain 320 2.88 0.80 1–6 0.42 − 0.22
Sweden 275 2.88 0.85 1–6 0.16 0.78
Switzerland 205 2.94 0.76 1–5 − 0.31 0.39
United Kingdom 287 3.24 0.74 1–6 − 0.30 0.28
Openness to change
Austria 151 4.53 0.73 2–6 0.39 − 0.58
Bulgaria 217 4.31 0.79 1–6 0.64 − 0.47
Cyprus 202 3.64 0.66 2–6 0.74 − 0.54
Finland 254 3.98 0.60 2–6 − 2.94 − 0.22
Norway 225 4.25 0.62 1–6 − 0.82 2.56
Poland 340 4.56 0.57 2–6 0.28 − 0.37
Romania 202 4.63 0.69 1–6 3.43 − 0.99
Serbia 237 4.42 0.70 2–6 0.96 − 0.92
Spain 320 4.76 0.56 2–6 0.07 − 0.35
Sweden 275 4.26 0.59 2–6 − 0.31 0.11
Switzerland 205 4.74 0.58 2–6 0.12 − 0.50
United Kingdom 287 4.41 0.63 2–6 − 0.19 − 0.23
Austria 151 3.66 0.65 2–6 − 0.07 − 0.04
Bulgaria 217 3.79 0.75 1–6 0.78 − 0.21
Cyprus 202 4.31 0.70 1–6 1.10 − 0.61
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Hypothesis testing. e results of the hypothesis testing are presented in Table2.
For Hypothesis 1, the test revealed that the psychotherapist-reported self-transcendence and openness-to-
change values that were higher than the typical values for a national sample were related to the lower overall
burnout levels of the psychotherapists. On the other hand, the higher-than-typical self-enhancement and con-
servation values were related to higher overall burnout levels. Moreover, we observed signicant associations
of burnout with some of the sociodemographic and work-related characteristics as well as COVID-19-related
distress. e burnout correlates were male sex, being single, younger age, and reporting more intense pandemic-
related stress than typical for the national sample.
For Hypothesis 2, aer controlling for all the variables mentioned in Hypothesis 1, the dierences in values
at the country-aggregated level were not signicant for burnout.
Finally, with regard to Hypothesis 3, we observed signicant cross-level interaction between openness-to-
change values reported at individual- and aggregated country-level (B = − 3.81, SE = 1.92, t = 1.98, p < 0.05). e
analysis of simple slopes is presented in Fig.2. As can be observed, the openness-to-change values were more
negatively related to burnout among psychotherapists in the countries with aggregated openness-to-change values
higher than the cross-country average (Β = − 3.47, SE = 0.70, z = − 4.98, p < 0.001) in comparison to the countries
for which these aggregated values were lower (Β = − 1.72, SE = 0.68, z = − 2.55, p < 0.05). us, the protective eect
of being individually highly localized on openness-to-change values in the national sample was further ampli-
ed by originating from a country with aggregated openness-to-change values higher than the average for all
12 studied countries. Referring these results to the condence bands of the aggregated values (− 61.83, 0.29),
inside which the simple slopes were equal to zero, we conclude that there was no relationship between personal
openness-to-change values and burnout only for psychotherapists from Finland (Β = − 0.75, SE = 1.05, z = − 0.73,
ns), which at the country level has the lowest openness to change among the studied countries. However, this
result should be interpreted with caution as a model including interaction is not signicantly better tted to the
data than a model including only main eects.
Country nMean SD Range Kurtosis Skewness
Finland 254 3.77 0.72 2–6 − 0.57 0.00
Norway 225 3.89 0.72 1–6 0.35 − 0.42
Poland 340 3.69 0.70 1–6 − 0.50 0.31
Romania 202 3.91 0.66 1–6 1.81 − 0.84
Serbia 237 4.28 0.66 2–6 0.55 − 0.60
Spain 320 3.98 0.80 1–6 − 0.13 − 0.20
Sweden 275 3.57 0.71 1–6 − 0.21 0.21
Switzerland 205 3.69 0.67 1–6 − 0.39 − 0.02
United Kingdom 287 3.70 0.73 1–6 − 0.51 0.05
Table 1. Descriptive statistics for overall burnout level and personal values in the study sample of
psychotherapists (N = 2915) according to country of origin.
Figure1. Burnout mean levels values per country. A black line indicates a grand mean.
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e results of our study were in accordance with our hypotheses at the individual level rather than at the coun-
try-aggregated level of analysis. At the individual level, burnout was negatively related to the self-transcend-
ence and openness-to-change values but positively related to the self-enhancement and conservation values.
Although Schwartz’s30 theory of basic human values has been used in hundreds of studies and various theoretical
contexts24,25,49, it has not been applied to the issue of psychological disorders. Owing to the fact that this is the rst
study to link cross-cultural values to burnout syndrome among psychotherapists, this result is dicult to discuss
other than exploratorily. Nevertheless, it is intriguing that motivational goals expressed in higher-order values
Table 2. Results for the hypothesis testing for the overall burnout indicator in the study sample of
psychotherapists (N = 2915). ***p < 0.001, **p < 0.05.
Hypothesis 1 model Hypothesis 2 model Hypothesis 3 model
Estimate (SE) Estimate (SE) Estimate (SE)
Fixed eects
Intercept 37.11 (1.50)*** 37.10 (1.31) *** 37.14 (1.35) ***
Sex 1.70 (0.69)** 1.68 (0.69) ** 1.68 (0.69) ***
Relationship status − 1.54 (0.61)** − 1.54 (0.61) ** − 1.58 (0.61) **
Age − 0.33 (0.03)*** − 0.33 (0.03) *** − 0.33 (0.03) ***
COVID-19-related stress 4.33 (0.26)*** 4.33 (0.26) *** 4.33 (0.26) ***
Level 1 values
Self-transcendence_w -4.01 (0.56)*** − 4.01 (0.56)*** − 4.10 (0.56)***
Self-enhancement_w 1.65 (0.39)*** 1.65 (0.39)*** 1.61 (0.39)***
Openness to change_w − 2.52 (0.52)*** − 2.52 (0.52)*** − 2.57 (0.52)***
Conservation_w 0.94 (0.45)** 0.94 (0.45)** 0.92 (0.45)**
Level 2 values
Self-transcendence_b 15.88 (9.71) 15.89 (9.71)
Self-enhancement_b 12.84 (7.82) 12.84 (7.82)
Openness to change_b − 10.66 (7.81) − 10.66 (7.81)
Conservation_b − 6.42 (8.69) − 6.43 (8.69)
Cross-level interactions
Self-transcendence_w*b − 0.97 (2.08)
Self-enhancement_w*b 1.80 (1.14)
Openness to change_w*b − 3.81 (1.92)**
Conservation_w*b − 0.06 (1.82)
Random eects
Residual variance 185.20 (4.95)*** 185.21 (4.94)*** 184.71 (4.93)***
Between-country variance (intercept) 22.32 (9.49)** 17.04 (7.35)** 17.04 (7.35)**
Model parameters
Akaike Information Criterion 22,765.39 22,770.33 22,770.85
− 2LL 22,743.39 22,740.33 22,732.85
2 LL Δ (df ) 3.06 (4) 7.48 (4)
-1 -0.5 00.
Figure2. Simple slopes for cross-level interaction for openness-to-change values on burnout. For Level-2
openness-to-change values slopes are probed at a mean and one standard deviation above and below a mean.
Level-1 openness-to-change values were centered around within-country means.
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of self-enhancement (e.g. power-dominance) and conservation (tradition, conformity-rules) were found to be
burnout predictors, while motivational goals of self-transcendence (e.g. universalism-tolerance) and openness-
to-change (e.g. self-direction thought) acted as buers against burnout in this particular sample. us, our study
may be an interesting adjunct to the literature on the psychological functioning of psychotherapists, including
the neglected cross-cultural context2,3. As part of the psychotherapy training process, it is also important to
consider this latter context.
However, the most intriguing nding was somehow a null result at the country-aggregated level. At this level,
dierences in values were irrelevant to the burnout levels of the participants. is was also conrmed by the
comparisons of the eects at the individual and country levels. For example, we observed dierences in burnout
among the 12 countries, with the highest levels in Cyprus, Sweden, Norway, and the United Kingdom and the
lowest levels in Romania, Serbia, and Finland. Nevertheless, these dierences were explained almost entirely by
interpersonal dierences, as only 9% of the burnout variance was related to the country level. From a dierent
perspective, burnout among psychotherapists tends to be a transcultural phenomenon rather than a country-
specic problem. Although values do matter, their idiosyncratic aspect is more important for burnout than the
collectivist aspect, i.e. shared by a group of representatives of this profession in a given country. is may be an
important conclusion for reection on the organizational structure and training in psychotherapy in Europe13,50.
e country-level aggregated values were found to be signicant in the only observed cross-level interaction
concerning openness to change. is supports the hypothesis on the role of t between individual and collec-
tive values24,25. Namely, the protective eect of individual values was enhanced when being a psychotherapist
in a country where other psychotherapists also declared high openness-to-change values. However, this result
requires further research. Observing it only for this category of values may in fact be due to the specic circum-
stances of the study. e COVID-19 pandemic universally enforced adaptation to the "new normal". Burnout
may therefore actually aect to a lesser extent those who consider openness to change as an important value
in their lives since they have an intrinsic motivation for novelty and mastery, but this adaptation may also be
facilitated or hindered by what happens in the social environment of such a person. e attitudes represented
by ones occupational group, especially when the external demands include major changes in the conditions
of work, are likely to become an inuential reference point to modify an individual’s appraisals and behaviors.
We found that higher burnout levels among psychotherapists were associated with sociodemographic data
(younger age, being single, and male sex) and higher levels of COVID-19-related distress. Previous studies on
burnout among psychotherapists have shown that younger psychotherapists are at greater risk of burnout than
older psychotherapists and usually more experienced colleagues15,5153. is nding is oen explained by the fact
that young psychotherapists may have high and unrealistic expectations about their roles in this occupation, and
a subsequent reality crash may be a burnout catalyst52. Our study also showed that male psychotherapists can be
at a higher risk of burnout than female psychotherapists, but the results reported in the literature on this topic
are discrepant54,55. Our meta-analysis revealed that men and women may experience burnout in dierent ways;
for example, women score higher on emotional exhaustion, whereas men score higher on depersonalization56.
Consistent with our ndings, the psychotherapy profession may also be associated with burnout among men
due to sex-related dierences in self-ecacy, which is usually higher among females in helping professions57.
As expected, COVID-19-related distress was a signicant burnout correlate in all the countries included in the
study, which is consistent with the most recent research36,37. However, this subject is still understudied in general,
particularly in this sample. In light of the COVID-19 pandemic, psychotherapists were faced with many new
challenges and obstacles regarding their practices, clients, and their well-being.
In a more general discussion, our ndings contradict one of the main assumptions at the root of cross-cultural
psychology, which is high within-country similarity and signicant between-country variability in shared cultural
meaning systems33,34,58. is notion suggests conducting cross-country comparisons by “unpacking” cultural
dierences within the studied psychological constructs and discussing them in light of a culture-comparative
perspective33. Nevertheless, for at least two decades, attempts have been made to calculate the eect sizes of the
aforementioned within-culture consensus and cross-cultural variability in several theoretical constructs59,60.
Fisher and Schwartz32 examined values in 67 countries and observed negligible variances in value ratings that
may be associated with country dierences. Specically, they found that the cross-country dierences and within-
country consensus in values were very low in all examined countries. us, we can infer that this is not because
values are part of some shared meaning system dened as culture but because people, in general, dier in values
regardless of where they come from. We obtained a similar pattern of results in this study. However, the afore-
mentioned problem needs further examination, as we did not observe a consistent pattern of the eects of a
mismatch between individual and country-aggregate values on burnout outcomes at the cross-level interactions
(Fig.2). e clinical context in cross-cultural psychology, that is, the role of values in psychological disorders,
is, therefore, an important research gap to address in the future.
Strengths and Limitations. is study has several strengths, including its large sample of psychothera-
pists from 12 dierent countries observed during the critical period of the COVID-19 pandemic and the use
of a theoretical model for cross-cultural comparisons and a multilevel design, which make it a pioneer study
in the relevant literature. However, several limitations should be mentioned. First, for organizational reasons,
our samples of psychotherapists were heterogeneous concerning psychotherapeutic modalities and other work-
related characteristics. In addition, they cannot be considered representative of the countries in which they
were sampled. is represents a common shortcoming in the literature on the psychological functioning of this
professional group3 but is hard to avoid, particularly in international comparisons and associated dierences in
regulations for this job between countries. Second, our research shares other common limitations in burnout
studies among psychotherapists, including its cross-sectional design and precluding causal inferences2. e role
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Scientic Reports | (2022) 12:13527 |
of values in the prospective study design would be interesting to investigate to determine the stability of its eect
at the individual and country levels. Two typical shortcomings must be borne in mind in cross-cultural research,
namely the reference group eect61 and the response style eect62. e former deals with the problem of using a
self-report measure to assess cross-cultural dierences when participants compare themselves to familiar oth-
ers (e.g., Poles compared themselves to other known Poles). e latter illustrates culture-related dierences in
response styles. ese eects may also be the reason for the small eects of the country-aggregated level of analy-
sis. However, another reason may be that there are not enough units of analysis at this level. A general rule of
thumb is to have as many units at a higher level as possible63. In cross-cultural research, because of practical con-
siderations, this rule is rarely fullled64. Finally, our study was not limited in terms of the number of countries,
but also in terms of their location. e participants represented only European countries, which was due both
to organizational issues, including the course of the pandemic, but also to the sharing of the basic foundations
of psychotherapy as a profession. Future research should therefore focus on comparisons that cover a broader
spectrum of countries.
In light of the recent inclusion of burnout in the 11th Revision of the International Classication of Diseases65,
one should bear in mind that burnout is a global occupational phenomenon that can be observed in any
profession10, including psychotherapists3. Our data suggest that burnout among psychotherapists may be, in
some sense, a transcultural phenomenon, in which there is room for interplay between what is individual and
what is shared with one’s occupational group. However, the most important factors are the individual dierences
between psychotherapists, regardless of their cultures, at least across the studied European countries. Although
this nding should be treated with caution because of the explorative characteristics and limitations of our study,
it may be an enriching adjunct to the discussion on preventing psychotherapists’ burnout. Specically, the results
of our study call for the need to place more focus on psychotherapists’ personal values regarding their professional
and private lives, especially during the psychotherapy training process. It has been found that these are crucial
factors that promote the personal and professional quality of life in this profession66.
Data availability
All data generated or analysed during this study are included in this published article and its supplementary
information les.
Received: 3 March 2022; Accepted: 28 July 2022
1. Freud, S. e Standard Edition of the Complete Psychological Works of Sigmund Freud (Macmillan, 1964).
2 . Lee, M. K., Kim, E., Paik, I. S., Chung, J. & Lee, S. M. Relationship between environmental factors and burnout of psychotherapists:
Meta-analytic approach. Couns. Psychother. Res. 20(1), 164–72. https:// doi. org/ 10. 1002/ capr. 12245 (2020).
3. Simionato, G. K. & Simpson, S. Personal risk factors associated with burnout among psychotherapists: A systematic review of the
literature. J. Clin. Psychol. 74(9), 1431–56. https:// doi. org/ 10. 1002/ jclp. 22615 (2018).
4. Demerouti, E., Bakker, A. B., Nachreiner, F. & Schaufeli, W. B. e job demands-resources model of burnout. J. Appl. Psychol.
86(3), 499–512. https:// doi. org/ 10. 1037/ 0021- 9010. 86.3. 499 (2001).
5 . Maslach, C. Understanding burnout: Denitional issues in analyzing a complex phenomenon. In Job Stress and Burnout (ed. Paine,
W. S.) 29–41 (SAGE, 1982).
6. Maslach, C., Jackson, S. & Leiter, M. Maslach Burnout Inventory Manual (Consulting Psychologists Press, 1996).
7. Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Psychol. 2001;52(1):397–422. Doi: https:// doi. org/ 10. 1146/ annur ev.
psych. 52.1. 397
8. Aronsson, G. et al. A systematic review including meta-analysis of work environment and burnout symptoms. BMC Public Health
https:// doi. org/ 10. 1186/ s12889- 017- 4153-7 (2017).
9. Cieslak, R. et al. A meta-analysis of the relationship between job burnout and secondary traumatic stress among workers with
indirect exposure to trauma. Psychol. Serv. 11(1), 75–86. https:// doi. org/ 10. 1037/ a0033 798 (2014).
10. Guthier, C., Dormann, C. & Voelkle, M. C. Reciprocal eects between job stressors and burnout: A continuous time meta-analysis
of longitudinal studies. Psychol. Bull. 146(12), 1146–73. https:// doi. org/ 10. 1037/ bul00 00304 (2020).
11. Koutsimani, P., Montgomery, A. & Georganta, K. e relationship between burnout, depression, and anxiety: A systematic review
and meta-analysis. Front. Psychol. 10, 284. https:// doi. org/ 10. 3389/ fpsyg. 2019. 00284 (2019).
12. Schaufeli, W. B., Leiter, M. P. & Maslach, C. Burnout: 35 years of research and practice. Career Dev. Int. 14(3), 204–20. https:// doi.
org/ 10. 1108/ 13620 43091 09664 06 (2009).
13. Laverdière, O., Kealy, D., Ogrodniczuk, J. S. & Morin, A. J. S. Psychological health proles of Canadian psychotherapists: A wake
up call on psychotherapists’ mental health. Can. Psychol. 59(4), 315–22. https:// doi. org/ 10. 1037/ cap00 00159 (2018).
14. Laverdière, O., Ogrodniczuk, J. S. & Kealy, D. Clinicians’ empathy and professional quality of life. J. Nerv. Ment. Dis. 207(2), 49–52.
https:// doi. org/ 10. 1097/ NMD. 00000 00000 000927 (2019).
15. Ackerley, G. D., Burnell, J., Holder, D. C. & Kurdek, L. A. Burnout among licensed psychologists. Prof. Psychol. 19(6), 624–31.
https:// doi. org/ 10. 1037/ 0735- 7028. 19.6. 624 (1988).
16. Berjot, S., Altintas, E., Lesage, F.-X. & Grebot, E. e impact of work stressors on identity threats and perceived stress: An explo-
ration of sources of diculty at work among French psychologists. SAGE Open 3(3), 215824401350529. https:// doi. org/ 10. 1177/
21582 44013 505292 (2013).
17. Farber, B. A. & Heifetz, L. J. e process and dimensions of burnout in psychotherapists. Prof. Psychol. 13(2), 293–301. https:// doi.
org/ 10. 1037/ 0735- 7028. 13.2. 293 (1982).
18. Rupert, P. A. & Morgan, D. J. Work setting and burnout among professional psychologists. Prof. Psychol. 36(5), 544–50. https://
doi. org/ 10. 1037/ 0735- 7028. 36.5. 544 (2005).
19. Raquepaw, J. M. & Miller, R. S. Psychotherapist burnout: A componential analysis. Prof. Psychol. 20(1), 32–6. https:// doi. org/ 10.
1037/ 0735- 7028. 20.1. 32 (1989).
20. Rosenberg, T. & Pace, M. Burnout among mental health professionals: special considerations for the marriage and family therapist.
J. Marital Fam. er. 32(1), 87–99. https:// doi. org/ 10. 1111/j. 1752- 0606. 2006. tb015 90.x (2006).
Content courtesy of Springer Nature, terms of use apply. Rights reserved
Scientic Reports | (2022) 12:13527 |
21. Rupert, P. A., Stevanovic, P. & Hunley, H. A. Work-family conict and burnout among practicing psychologists. Prof. Psychol.
40(1), 54–61. https:// doi. org/ 10. 1037/ a0012 538 (2009).
22. Rzeszutek, M. & Schier, K. Temperament traits, social support, and burnout symptoms in a sample of therapists. Psychotherapy
51(4), 574–9. https:// doi. org/ 10. 1037/ a0036 020 (2014).
23. Lee, E., Greenblatt, A. & Hu, R. A knowledge synthesis of cross-cultural psychotherapy research: A critical review. J. Cross-Cult.
Psychol. 52(6), 511–532. https:// doi. org/ 10. 1177/ 00220 22121 10289 11 (2021).
24. Schwartz, S. H. et al. Rening the theory of basic individual values. J. Pers. Soc. Psychol. 103(4), 663–88. https:// doi. org/ 10. 1037/
a0029 393 (2012).
25. Schwartz, S. H. et al. Value tradeos propel and inhibit behavior: Validating the 19 rened values in four countries: Value tradeos
and behavior. Eur. J. Soc. Psychol. 47(3), 241–58. https:// doi. org/ 10. 1002/ ejsp. 2228 (2017).
26. Bakker, A. B. & de Vries, J. D. Job Demands-Resources theory and self-regulation: New explanations and remedies for job burnout.
Anxiety Stress Coping 34(1), 1–21. https:// doi. org/ 10. 1080/ 10615 806. 2020. 17976 95 (2021).
27. Gruszczynska, E., Basinska, B. A. & Schaufeli, W. B. Within- and between-person factor structure of the Oldenburg Burnout
Inventory: Analysis of a diary study using multilevel conrmatory factor analysis. PLoS ONE 16(5), e0251257. https:// doi. org/ 10.
1371/ journ al. pone. 02512 57 (2021).
28. Schwartz, S. H. Are there universal aspects in the structure and contents of human values?. J. Soc. Issues 50(4), 19–45. https:// doi.
org/ 10. 1111/j. 1540- 4560. 1994. tb011 96.x (1994).
29. Schwartz, S. H. et al. Extending the cross-cultural validity of the theory of basic human values with a dierent method of measure-
ment. J. Cross Cult. Psychol. 32(5), 519–42. https:// doi. org/ 10. 1177/ 00220 22101 03200 5001 (2001).
30. Schwartz, S. H. Universals in the content and structure of values: eoretical advances and empirical tests in 20 countries. In
Advances in Experimental Social Psychology 1–65 (Elsevier, 1992).
31. S chwartz, S. A eory Of Cultural Value Orientations: Explication and applications. Comp Sociol. 5(2–3), 137–82. https:// doi. org/
10. 1163/ 15691 33067 78667 357 (2006).
32. Fischer, R. & Schwartz, S. Whence dierences in value priorities?: Individual, cultural, or artifactual sources. J. Cross Cult. Psychol.
42(7), 1127–44. https:// doi. org/ 10. 1177/ 00220 22110 381429 (2011).
33. Hofstede, G. Culture’s Consequences: Comparing Values, Behaviors, Institutions and Organizations Across Nations (SAGE, 2001).
34. Leung, K. & van de Vijver, F. J. R. Strategies for strengthening causal inferences in cross cultural research: e consilience approach.
Int. J. Cross Cult. Manag. 8(2), 145–69. https:// doi. org/ 10. 1177/ 14705 95808 091788 (2008).
35. Stephens, N., Townsend, S., Markus, H. & Phillips, L. A cultural mismatch: Independent cultural norms produce greater increases
in cortisol and more negative emotions among rst-generation college students. J. Exp. Soc. Psychol. 48(6), 1389–1393. https:// doi.
org/ 10. 1016/j. jesp. 2012. 07. 008 (2012).
36. Brillon, P. et al. Psychological distress of mental health workers during the COVID-19 pandemic: A comparison with the general
population in high- and low-incidence regions. J. Clin. Psychol. 78, 602–621. https:// doi. org/ 10. 1002/ jclp. 23238 (2021).
37. Summers, E. M. A., Morris, R. C., Bhutani, G. E., Rao, A. S. & Clarke, J. C. A survey of psychological practitioner workplace well-
being. Clin. Psychol. Psychother. 28(2), 438–51. https:// doi. org/ 10. 1002/ cpp. 2509 (2021).
38. Leiter, M. P. & Maslach, C. Latent burnout proles: A new approach to understanding the burnout experience. Burnout Res. 3(4),
89–100. https:// doi. org/ 10. 1016/j. burn. 2016. 09. 001 (2016).
39. Dragan, M., Grajewski, P. & Shevlin, M. Adjustment disorder, traumatic stress, depression and anxiety in Poland during an early
phase of the COVID-19 pandemic. Eur. J. Psychotraumatol. 12(1), 1860356. https:// doi . o r g/ 10. 1080/ 20008 198. 2020. 18603 56 (2021).
40. Gambin, M. et al. Generalized anxiety and depressive symptoms in various age groups during the COVID-19 lockdown in Poland.
Specic predictors and dierences in symptoms severity. Compr. Psychiatry. 105, 152222. https:// doi. org/ 10. 1016/j. compp sych.
2020. 152222 (2021).
41. Snijders, T. A. B. & Bosker, R. J. Multilevel Analysis: An Introduction to Basic and Advanced Multilevel Modeling 2nd edn. (SAGE,
42. Kre, I. & de Leeuw, J. Introducing Multilevel Modeling (SAGE Publications, Ltd, 1998).
43. Bliese, P. D. Group size, ICC values, and group-level correlations: A simulation. Organ. Res. Methods 1(4), 355–73. https:// doi. o rg/
10. 1177/ 10944 28198 14001 (1998).
44. B ecker, T. E. Potential problems in the statistical control of variables in organizational research: A qualitative analysis with recom-
mendations. Organ. Res. Methods 8(3), 274–89. https:// doi. org/ 10. 1177/ 10944 28105 278021 (2005).
45. Aguinis, H., Gottfredson, R. & Culpepper, S. Best-practice recommendations for estimating cross-level interaction eects using
multilevel modeling. J. Manag. 39(6), 1490–1528. https:// doi. org/ 10. 1177/ 01492 06313 478188 (2013).
46. Hayes, A. A primer on multilevel modeling. Hum. Commun. Res. 32(4), 385–410. https:// do i . org/ 10. 1111/j. 1468- 2958. 2006. 00281
47. Preacher, K. J., Curran, P. J. & Bauer, D. J. Computational tools for probing interactions in multiple linear regression, multilevel
modeling, and latent curve analysis. J. Educ. Behav. Stat. 31(4), 437–48. https:// doi. org/ 10. 3102/ 10769 98603 10044 37 (2006).
48. IBM. SPSS Statistics for Windows, Version 270 2020 (IBM, 2020).
49. Cieciuch, J., Davidov, E., Vecchione, M. & Schwartz, S. H. A hierarchical structure of basic human values in a third-order conrma-
tory factor analysis. Swiss J. Psychol. 73(3), 177–82. https:// doi. org/ 10. 1024/ 1421- 0185/ a0001 34 (2014).
50. McCormack, H. M., MacIntyre, T. E., O’Shea, D., Herring, M. P. & Campbell, M. J. e prevalence and cause(s) of burnout among
applied psychologists: A systematic review. Front. Psychol. 9, 1897. https:// doi. org/ 10. 3389/ fpsyg. 2018. 01897 (2018).
51. Berjot, S., Altintas, E., Grebot, E. & Lesage, F.-X. Burnout risk proles among French psychologists. Burn. Res. 7, 10–20. https://
doi. org/ 10. 1016/j. burn. 2017. 10. 001 (2017).
52. Rupert, P. A. & Kent, J. S. Gender and work setting dierences in career-sustaining behaviors and burnout among professional
psychologists. Prof. Psychol. Res. P. 38(1), 88–96. https:// doi. org/ 10. 1037/ 0735- 7028. 38.1. 88 (2007).
53. van der Ploeg, H. M., van Leeuwen, J. J. & Kwee, M. G. Burnout among Dutch psychotherapists. Psychol. Rep. 67(1), 107–12. https://
doi. org/ 10. 2466/ pr0. 1990. 67.1. 107 (1990).
54. Allwood, C. M., Geisler, M. & Buratti, S. e relationship between personality, work, and personal factors to burnout among clinical
psychologists: Exploring gender dierences in Sweden. Couns. Psychol. Q. 35, 324–343. https:// doi. org/ 10. 1080/ 09515 070. 2020.
17680 50 (2020).
55. Emery, S., Wade, T. D. & McLean, S. Associations among therapist beliefs, personal resources and burnout in clinical psychologists.
Behav. Change 26(2), 83–96. https:// doi. org/ 10. 1375/ bech. 26.2. 83 (2009).
56. Pur vanova, R. K. & Muros, J. P. Gender dierences in burnout: A meta-analysis. J. Vocat. Behav. 77(2), 168–85. https:// doi. org/ 10.
1016/j. jvb. 2010. 04. 006 (2010).
57. Roohani, A. & Iravani, M. e relationship between burnout and self-ecacy among Iranian male and female EFL teachers. J.
Lang. Educ. 6(1), 173–88. https:// doi. org/ 10. 17323/ jle. 2020. 9793 (2020).
58. Poortinga, Y. H. & Van De Vijver, F. J. R. Explaining cross-cultural dierences: Bias analysis and beyond. J. Cross Cult. Psychol.
18(3), 259–82. https:// doi. org/ 10. 1177/ 00220 02187 01800 3001 (1987).
59. Matsumoto, D., Grissom, R. J. & Dinnel, D. L. Do between-culture dierences really mean that people are dierent?: A look at
some measures of cultural eect size. J. Cross Cult. Psychol. 32(4), 478–90. https:// doi. org/ 10. 1177/ 00220 22101 03200 4007 (2001).
60. Schwartz, S. H. & Bardi, A. Value hierarchies across cultures: Taking a similarities perspective. J. Cross Cult. Psychol. 32(3), 268–90.
https:// doi. org/ 10. 1177/ 00220 22101 03200 3002 (2001).
Content courtesy of Springer Nature, terms of use apply. Rights reserved
Scientic Reports | (2022) 12:13527 |
61. Heine, S. J., Lehman, D. R., Peng, K. & Greenholtz, J. Whats wrong with cross-cultural comparisons of subjective Likert scales?:
e reference-group eect. J. Pers. Soc. Psychol. 82(6), 903–18. https:// doi. org/ 10. 1037/ 0022- 3514. 82.6. 903 (2002).
62. van de Vijver, F. J. R. & Leung, K. Methods and data analysis of comparative research. In Handbook of Cross-cultural Psychology
2nd edn (eds Berry, J. W. et al.) 257–300 (Allyn & Bacon, 1997).
63. Snijders, T. Power and Sample Size in Multilevel Linear Models. Wiley StatsRef: Statistics Reference Online. https:// doi. org/ 10. 1002/
97811 18445 112. stat0 6584 (2014).
64. Nezlek, J. B. Multilevel modeling and cross-cultural research. In Cross-Cultural Research Methods in Psychology (eds Matsumoto,
D. & van de Vijver, F. J. R.) 299–345 (Cambridge University Press, 2010).
65. International Classication of Diseases (ICD). World Health Organization https:// www. who. in t/ s ta n d a rds/ class ica tions/ class ica
tion- of- disea ses. (Accessed: 6 Jan 2022)
66. Norcross, J. & VandenBos, G. Leaving it at the oce: A Guide to Psychotherapist Self-care 2nd edn, 276 (e Guilford Press, 2018).
is project has received funding from the New Ideas of POB V project implemented within the scope of the
"Excellence Initiative—Research University" Program, by the Ministry of Science and Higher Education in Poland
(number PSP: 501-D125-20-5004310).
Author contributions
All authors reviewed the manuscript. All authors took part in the data collection. A.V. and M.R. prepared the
original version of the manuscript. A.V. and M.R., E.G. prepared results analysis. A.V. and M.R. prepared research
plan. A.V., M.R., M.P., and E.G. prepared all visualisation of data and its interpretations.
Competing interests
e authors declare no competing interests.
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... Beyond this general burden, the COVID-19 pandemic has challenged psychotherapists in an unprecedented way (e.g., Aafjes-van Doorn et al., 2020, 2021a. This ongoing public health challenge has negatively impacted mental health in both general and clinical populations (Robinson et al., 2022;Clemente-Suárez et al., 2021), and a rise in burnout prevalence has been observed in psychotherapists (van Hoy et al., 2022). Particularly when therapists and patients are simultaneously experiencing a disaster, e.g., during Hurricane Katrina (Culver et al., 2011) or following the terrorist attacks on 9/11 (Boscarino et al., 2004), the experience of secondary traumatic stress seems to increase the disaster's deleterious impact on mental health practitioners (Aafjes-van Doorn et al., 2020). ...
BACKGROUND Although the SARS-Cov-2 pandemic has severely affected wellbeing of at-risk groups, most research on resilience employed convenience samples. OBJECTIVE We investigated psychosocial resilience and risk factors (RFs) for the wellbeing of psychotherapists and other mental health practitioners, an under-researched population that provides essential support for other at-risk groups and was uniquely burdened by the pandemic. METHODS We examined 18 psychosocial factors for their association with resilience, of which four were chosen due to their likely relevance specifically for therapists, in a cross-sectional multi-national sample (N=569) surveyed between June and September 2020. Resilience was operationalized dimensionally and outcome-based as lower stressor reactivity (SR), meaning fewer mental health problems than predicted given a participant’s levels of stressor exposure. General SR (SRG) scores expressed reactivity in terms of general internalizing problems, while profession-specific SR (SRS) scores expressed reactivity in terms of burnout and secondary trauma, typical problems of mental health practitioners. RESULTS Factors previously identified as RFs in other populations, including perceived social support, optimism and self-compassion, were almost all significant in the study population (SRG: 18/18 RFs, absolute βs=.16-.40; SRS: 15/18 RFs, absolute βs=.19-.39 all Ps <.001). Compassion satisfaction emerged as uniquely relevant for mental health practitioners in regularized regression. CONCLUSIONS Our work identifies psychosocial RFs for mental health practitioners’ wellbeing during crisis. Most identified factors are general, in that they are associated with resilience to a wider range of mental health problems, and global, in that they have also been observed in other populations and stressor constellations.
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Background The need for scalable delivery of mental health care services that are efficient and effective is now a major public health priority. Artificial intelligence (AI) tools have the potential to improve behavioral health care services by helping clinicians collect objective data on patients’ progress, streamline their workflow, and automate administrative tasks. Objective The aim of this study was to determine the feasibility, acceptability, and preliminary efficacy of an AI platform for behavioral health in facilitating better clinical outcomes for patients receiving outpatient therapy. Methods The study was conducted at a community-based clinic in the United States. Participants were 47 adults referred for outpatient, individual cognitive behavioral therapy for a main diagnosis of a depressive or anxiety disorder. The platform provided by Eleos Health was compared to treatment-as-usual (TAU) approach during the first 2 months of therapy. This AI platform summarizes and transcribes the therapy session, provides feedback to therapists on the use of evidence-based practices, and integrates these data with routine standardized questionnaires completed by patients. The information is also used to draft the session’s progress note. Patients were randomized to receive either therapy provided with the support of an AI platform developed by Eleos Health or TAU at the same clinic. Data analysis was carried out based on intention-to-treat approach from December 2022 to January 2023. The primary outcomes included the feasibility and acceptability of the AI platform. Secondary outcomes included changes in depression (Patient Health Questionnaire-9) and anxiety (Generalized Anxiety Disorder-7) scores as well as treatment attendance, satisfaction, and perceived helpfulness. Results A total of 72 patients were approached, of whom 47 (67%) agreed to participate. Participants were adults (34/47, 72% women and 13/47, 28% men; mean age 30.64, SD 11.02 years), 23 randomized to the AI platform group, and 24 to TAU. Participants in the AI group attended, on average, 67% (mean 5.24, SD 2.31) more sessions compared to those in TAU (mean 3.14, SD 1.99). Depression and anxiety symptoms were reduced by 34% and 29% in the AI platform group versus 20% and 8% for TAU, respectively, with large effect sizes for the therapy delivered with the support of the AI platform. No group difference was found in 2-month treatment satisfaction and perceived helpfulness. Further, therapists using the AI platform submitted their progress notes, on average, 55 hours earlier than therapists in the TAU group (t=–0.73; P<.001). Conclusions In this randomized controlled trial, therapy provided with the support of Eleos Health demonstrated superior depression and anxiety outcomes as well as patient retention, compared with TAU. These findings suggest that complementing the mental health services provided in community-based clinics with an AI platform specializing in behavioral treatment was more effective in reducing key symptoms than standard therapy. Trial Registration NCT05745103;
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The Burnout Syndrome (BOS) is a psycho-emotional disorder generating sustained stress over time, and inability to cope with the demands in an adaptive manner. The aims of the study were (1) to describe the prevalence of BOS during the third COVID-19 pandemic wave (May-June 2021); (2) to explore the relation of BOS with physical symptoms, and (3) to determine the profile favoring the development of BOS. This cross-sectional descriptive study was conducted amongst a sample of 759 healthcare professionals (HCPs). Data on sociodemographic variables, physical symptoms, the Maslach Burnout Inventory, Cervical Disability Index, and Numeric Pain Rating Scale were collected. The prevalence of BOS was 58.9% (447 subjects); 382 subjects (50.3%) showed high levels of Emotional Exhaustion (EE), whereas 219 participants (28.9%) had high Depersonalization (DP) levels, whilst 135 individuals (17.8%) showed low levels of Personal Fulfillment (PF). Women showed higher levels of EE (Z=-3.46; p = 0.001), whilst men showed higher levels of DP (Z=-2.69; p = 0.007). A total of 579 participants (76.3%) experienced muscle pain. A young nurse working in a hospital, or an emergency department emerges as a specific vulnerable profile. The current study confirms the need to overcome BOS in HCPs, implementing multidimensional tailored intervention to decrease the symptoms.
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Objective Despite their essential role during this health crisis, little is known about the psychological distress of mental health workers (MHW). Method A total of 616 MHW and 658 workers from the general population (GP) completed an online survey including depressive, anxiety, irritability, loneliness, and resilience measures. Results Overall, MHW had fewer cases with above cut-off clinically significant depression (19% MHW vs. 27%) or anxiety (16% MHW vs. 29%) than the GP. MHW in high-incidence regions of COVID-19 cases displayed the same levels of depressive and anxiety symptoms than the GP and higher levels compared to MHW from low-incidence regions. MHW in high-incidence regions presented higher levels of irritability and lower levels of resilience than the MHW in low-incidence regions. Moreover, MHW in high-incidence regions reported more feelings of loneliness than all other groups. Conclusion Implications for social and organizational preventive strategies to minimize the distress of MHW in times of crisis are discussed.
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This article presents a current knowledge synthesis of empirical studies on cross-cultural psychotherapy since 1980. Guided by a critical review framework, our search in seven relevant databases generated 80 studies published in English. Main themes are organized into (1) therapists’ cultural competence ( n = 46); (2) therapy process in cross-cultural dyads ( n = 22); and (3) cross-cultural differences in gender, sexual orientation, or social class ( n = 12). Compared to previous reviews on cross-cultural psychotherapy, the findings of this review highlight a broad range of methodological rigor in both quantitative and qualitative studies. Most studies examined actual therapy participants rather than participants in analog studies, thus emulating more therapy-near experiences in cross-cultural psychotherapy research. Also, several studies explored cross-cultural compositions beyond racial and ethnic majority therapist-minority client dyads, and included therapists of color as the participants, exploring reverse power dynamics in therapy and giving voices to foreign-born therapists. The therapy process research provides rich and full descriptions around the dynamic and interactional therapy process in cross-cultural dyads, which can be used to foster cultural sensitivities among therapists in their practice and training. We discuss the limitations of the studies included in the review and its implications for psychotherapy practice, training, and future research.
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The study examined the factor structure of burnout, as measured with the Oldenburg Burnout Inventory. The participants were 235 employees of a public administration agency who assessed their burnout online for 10 consecutive working days. Two models were tested with multilevel confirmatory factor analysis, assuming the same one or two-factor structure at the within- and between-person levels. Both models showed a reasonable fit to the data, but due to a strong correlation between exhaustion and disengagement and low within-person reliability for disengagement, a unidimensional model seems more valid. A cross-level invariance was not confirmed for either of the structures, showing that factor loadings for the same items differ significantly between the levels. This suggests that burnout is not the same latent variable at each level; rather, there are factors other than daily burnout that influence person-level scores and ignoring these across-level discrepancies may lead to biased conclusions.
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Background: The current COVID-19 pandemic is associated with a variety of stressors. Preliminary research has demonstrated that general public are experiencing a range of psychological problems, including stress-related disturbances. However, to date, there is not much research on the prevalence of adjustment disorder during the current pandemic. Objectives: This study aimed to assess the prevalence and severity of symptoms of adjustment disorder compared to posttraumatic symptoms, depression and generalized anxiety in a large sample of adult Poles, in the first phase of the current pandemic. Method: Self-report data from a web-based sample (N = 1,742) was collected between March 25 and April 27, just after the introduction of nationwide quarantine measures in Poland. Results: The current COVID-19 pandemic was a highly stressful event for 75% of participants and the strongest predictor of adjustment disorder. Increased symptoms of adjustment disorder were reported by 49%, and they were associated with female gender and not having a full-time job. However, after exclusion of co-occurring symptomatology, 14% of the sample were finally qualified as meeting diagnostic criteria of adjustment disorder. A substantial proportion of the sample screened also positive for generalized anxiety (44%) and depression (26%); the rate for presumptive PTSD diagnosis was 2.4%. Conclusions: High rates of negative mental health outcomes were found in the Polish population in the first weeks into the COVID-19 pandemic and lockdown measures. They indicate the intense current stress-related symptoms in the early phase of the pandemic and warrant further monitoring on population’s mental health.
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Background Previous studies carried out in different countries have indicated that young adults experienced higher levels of emotional distress, in the form of depressive and anxiety symptoms, than older age groups during the COVID-19 pandemic. However, little is known about which pandemic-related difficulties and factors may contribute to these forms of emotional distress in various age groups. Purpose The aim of the current study was to investigate: (i) differences in levels of depressive and generalized anxiety symptoms in four age groups in the Polish population during the COVID-19 lockdown; (ii) differences in perceived difficulties related to the pandemic in these groups; and (iii) which factors and difficulties related to the pandemic are the best predictors of generalized anxiety and depressive symptoms in various age groups during the COVID-19 lockdown. Method A total of 1115 participants (aged 18–85) took part in the study. The sample was representative of the Polish population in terms of sex, age, and place of residence. Participants completed the following online: the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, a Scale of Perceived Health and Life Risk of COVID-19, a Social Support Scale, and a Scale of Pandemic-Related Difficulties. Results Younger age groups (18–29 and 30–44) experienced higher levels of depressive and generalized anxiety symptoms than older adults (45–59 and 60–85 years). Household relationship difficulties were among the most significant predictors of depressive and generalized anxiety symptoms in all age groups. Fear and uncertainty related to the spread of the virus was one of the most important predictors of emotional distress in all the groups apart from the adults between 18 and 29 years, whereas difficulties related to external restrictions were one of the most significant predictors of depressive and anxiety symptoms exclusively in the youngest group. Conclusions The youngest adults and those experiencing difficulties in relationships among household members are the most vulnerable to depressive and generalized anxiety symptoms during the COVID-19 lockdown. It is important to plan preventive and therapeutic interventions to support these at-risk individuals in dealing with the various challenges related to the COVID-19 pandemic.
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Results from longitudinal studies are ambiguous regarding the direction of effects between job stressors and burnout over time. We meta-analyzed possible reciprocal relations between job stressors and burnout in k = 48 longitudinal studies (N = 26,319), accounting for variation of time intervals in primary studies by using continuous time meta-analysis. Additionally, we analyzed whether country-level job resources (job control & job support; k = 31 European studies, N = 17,747) moderated the effect of job stressors on burnout (stressor-effect) and the effect of burnout on job stressors (strain-effect). Further, we analyzed the replicability of the primary studies by assessing between-study heterogeneity, publication bias, and statistical power. Reciprocal effects between job stressors and burnout exist. The stressor-effect is small, whereas the strain-effect is larger and moderated by job control and job support. Analyses of the different burnout symptoms (emotional) exhaustion and depersonalization/cynicism demonstrated that reciprocal relations between emotional exhaustion and job stressors exist, but depersonalization/cynicism is not directly related to job stressors. Between-study heterogeneity was comparable to other psychological studies, whereas statistical power of primary studies was comparatively large. Conclusions are limited because few primary studies used time intervals of less than 12 months, more than two measurement occasions, and objective measures of stressors. Overall, results imply the need for extended job stress models and new job stress interventions that help employees cope with burnout symptoms.
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Background: High job demands and low job resources may cause job strain and eventually result in burnout. However, previous research has generally ignored the roles of time and self-regulation. Objectives: This theoretical article synthesizes the literature to propose a multilevel model that delineates how acute job strain translates into enduring and severe job burnout. Methods: We integrate self-regulation perspectives in job demands-resources (JD-R) theory to propose that short-term job strain and eventually enduring burnout is the result of consistently high job demands and low job resources – combined with failed self-regulation. Results: The model shows that when employees are confronted with increased job strain, they are more likely to use maladaptive self-regulation strategies, such as coping inflexibility and self-undermining. In addition, when job strain increases, employees are less likely to use adaptive self-regulation strategies, such as job stress recovery and job crafting. It follows that when the job becomes more stressful, stable resources become more important. Organizational resources such as human resource practices and healthy leadership may help employees to regulate their short-term fatigue and avoid enduring burnout. Furthermore, key personal resources like emotional intelligence and proactive personality may help employees to recognize and regulate their fatigue in an effective way. Conclusion: The proposed model of burnout expands JD-R theory and offers important practical implications for the prevention and reduction of burnout.
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This study investigated the effects of gender, personality (prosocialness, relational-interdependent self-construal, and brooding), job demands, affective work rumination, and personal-to-work conflict on burnout (exhaustion and disengagement), among clinical public-health psychologists in Sweden. The participants answered a self-report questionnaire (n = 828). Hierarchical multiple regression analyses showed that affective work-rumination, brooding and personal-to-work conflict were most strongly associated with exhaustion, whereas affective work-rumination, brooding, role conflict, and prosocialness most strongly predicted disengagement. Furthermore, in the full models, quantitative job demands and relational-interdependent self-construal related to exhaustion, whereas emotional demands related to disengagement. Interestingly, role conflict had a positive relation and emotional demands a negative relation to disengagement. Women reported higher exhaustion, but not higher disengagement, than men. Women also reported higher levels on most of the independent variables. In sum, the results show that a broad range of factors influence burnout among clinical psychologists.
The wellbeing of the psychological workforce is an area of concern. However, it has been sparsely studied in an holistic manner encompassing workplace wellbeing as well as burnout. This study reports a survey of 1,678 psychological practitioners accessed through professional networks. The short Warwick Edinburgh Mental Wellbeing Scale (SWEMWBS) and the Psychological Practitioner Workplace Wellbeing Measure (PPWWM) were administered with a demographic questionnaire. The mean for the SWEMWBS was below that of a national population survey. The inter-correlation of these tests was.61. Subgroup analyses showed significant differences: assistant psychologists, counsellors and psychological wellbeing practitioners demonstrated better than average workplace wellbeing. But for general wellbeing (SWEMWBS) trainee clinical psychologists and assistant psychologists showed lower than average wellbeing while psychological wellbeing practitioners were higher than average. Other factors associated with wellbeing were: contract type -both measures (higher workplace wellbeing in those with temporary contracts and the self-employed); employment sector -for PPWWM only (private organisation/independent workers and third sector/charitable organisation workers scored above the PPWWM mean); ethnicity - for both measures (Asian groups except Chinese had higher wellbeing than average for the PPWWM and SWEMWBS); disability was strongly associated with lower wellbeing on both measures. Harassment, feeling depressed or a failure and wanting to leave the NHS were associated with lower wellbeing. Greater age, pay and years of service were negatively correlated with wellbeing. A five-factor structure was obtained with this sample. The results confirmed psychological practitioners as an at-risk group and identified a number of factors associated with workplace wellbeing.