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BREATHE: A Pilot Study of a One-Day Retreat to Reduce Burnout Among Mental Health Professionals

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Michelle Salyers at Indiana University-Purdue University Indianapolis
Michelle Salyers
Candice Hudson
Candice Hudson
Candice Hudson
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Gary Morse
Gary Morse
Angela L Rollins
Angela L Rollins
Angela L Rollins
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Abstract

Staff burnout is a frequent problem for mental health providers and may be associated with negative outcomes for providers, consumers, and organizations. This study tested an intervention to reduce staff burnout. Community mental health providers were invited to participate in a day-long training session to learn methods to reduce burnout. A Web-based survey was given at time of registration, before the intervention, and again six weeks later. Eighty-four providers participated in the training, and follow-up data were available for 74. Six weeks after the day-long training, staff reported significant decreases in emotional exhaustion and depersonalization and significant increases in positive views toward consumers. There were no significant changes in providers' sense of personal accomplishment, job satisfaction, or intention to leave their position. Ninety-one percent of the staff reported the training to be helpful. This brief intervention is feasible, is acceptable to staff, and may improve burnout and staff attitudes.
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BREATHE: A Pilot Study of a One-Day Retreat to Reduce
Burnout Among Mental Health Professionals
Michelle P. Salyers, Ph.D., Candice Hudson, B.S., Gary Morse, Ph.D., Angela L. Rollins,
Ph.D., Maria Monroe-DeVita, Ph.D., Cynthia Wilson, M.S.N., P.M.H.C.N.S., and Leah
Freeland, M.A., L.M.H.C.
Dr. Salyers and Dr. Rollins are affiliated with the Department of Psychology, Indiana University–
Purdue University Indianapolis, 402 N. Blackford St., LD124, Indianapolis, IN 46202. Dr. Salyers
and Dr. Rollins are also with the Center of Excellence, Health Services Research and
Development Service, Roudebush Department of Veterans Affairs Medical Center, Indianapolis,
with which Ms. Hudson is affiliated. Dr. Morse is with Community Alternatives, St. Louis, Missouri.
Dr. Monroe-DeVita is with the Department of Psychiatry and Behavioral Sciences, University of
Washington, Seattle. Ms. Wilson and Ms. Freeland are with the Midtown Mental Health Center,
Indianapolis
Abstract
Objective—Staff burnout is a frequent problem for mental health providers and may be
associated with negative outcomes for providers, consumers, and organizations. This study tested
an intervention to reduce staff burn-out.
Methods—Community mental health providers were invited to participate in a day-long training
session to learn methods to reduce burnout. A Web-based survey was given at time of registration,
before the intervention, and again six weeks later.
Results—Eighty-four providers participated in the training, and follow-up data were available
for 74. Six weeks after the day-long training, staff reported significant decreases in emotional
exhaustion and depersonalization and significant increases in positive views toward consumers.
There were no significant changes in providers' sense of personal accomplishment, job
satisfaction, or intention to leave their position. Ninety-one percent of the staff reported the
training to be helpful.
Conclusions—This brief intervention is feasible, is acceptable to staff, and may improve
burnout and staff attitudes.
Mental health service providers may be at increased risk of experiencing staff burnout, a
syndrome consisting of emotional exhaustion, depersonalization, and decreased personal
accomplishment (1). Burnout is frequently discussed as a problem, with studies reporting
that 21%–67% of mental health workers experience high levels of burnout (2,3). Moreover,
burnout may be on the rise because government budget cuts and revenue shortfalls have led
some mental health agencies to increase staff productivity standards for billable services
within a given workday.
Burnout has been associated with a range of negative work consequences, including
increased absenteeism and reduced satisfaction, commitment, and performance (4). Burnout
effects can also spill over to life outside of work, with burned out mental health workers
mpsalyer@iupui.edu .
Disclosures The authors report no competing interests.
NIH Public Access
Author Manuscript
Psychiatr Serv. Author manuscript; available in PMC 2011 May 4.
Published in final edited form as:
Psychiatr Serv
. 2011 February ; 62(2): 214–217. doi:10.1176/appi.ps.62.2.214.
NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript
reporting more strain on personal relationships (5), poorer health and somatic complaints
(6), and mental health concerns, such as depression, anxiety, and substance abuse (3).
Burnout can also have a negative impact on employers—and ultimately consumers—with
increased employee sick days and turnover and decreased empathy, continuity of care,
productivity, and effectiveness. Burn-out in mental health agencies has been shown to lead
to economic inefficiencies and waste (7).
Surprisingly little research has studied interventions for reducing burnout among mental
health workers. For example, a systematic review of interventions designed to improve
outcomes for mental health staff in inpatient or community-based residential psychiatric
units found only four studies that directly measured burnout, and two found significant
between-group differences in favor of the intervention (7). Because of the small number of
studies, additional research and development are clearly needed.
We tested the feasibility and preliminary outcomes of a day-long training retreat to reduce
burnout (Burn-out Reduction: Enhanced Awareness, Tools, Handouts, and Education—or
BREATHE). Building on a conceptual framework of burnout (Morse GM, Salyers MP,
Monroe-DeVita M, et al., unpublished manuscript), we included training on mindfulness and
contemplative practices as well as breathing and visualization exercises, and we
incorporated materials on setting priorities and boundaries. We hypothesized that the
training would result in decreased burnout, increased job satisfaction, and more positive
views toward consumers.
Methods
Initially, we planned a randomized trial with a wait-list control group, but staff scheduling
conflicts made randomization difficult. We then shifted to a pre-post design, whereby staff
selected one of several dates of training. We also added an additional baseline assessment to
examine change over time before any intervention (sequenced as an AAB within-subjects
design).
Participants were employed at a public agency providing comprehensive mental health and
substance abuse services in a large Midwestern city. At the time of the study, the agency had
530 employees, of which 60% were white and 79% were female. All employees, including
direct-care staff, administrators, and support staff, were eligible to participate and were
recruited through e-mails and flyers advertising a test of a burnout reduction program.
Potential participants were directed to a Web site to learn more about the study, provide
informed consent, and register for training. Once participants registered, a research assistant
contacted them via e-mail to confirm participation and sent reminder e-mails before the
training and the follow-up surveys.
Participants were asked to complete a baseline survey at registration and a second baseline
survey on the morning of the training session (participants from the first training session
completed only one baseline survey at registration). The same measures were readministered
six weeks after training. Participants received a $15 gift card for each survey completed. All
procedures were approved by the authors' institutional review board. Burnout was assessed
with the Maslach Burnout Inventory (8), a widely used measure of emotional exhaustion,
depersonalization, and personal accomplishment. The subscales have shown good internal
consistency, stability over time, and convergent validity with related constructs (8). Job
satisfaction was assessed with five items from the Job Diagnostic Survey, which has shown
good internal consistency (9) and evidence of convergent and divergent validity (10).
Intentions to leave their position were assessed by two items: “How often have you seriously
considered leaving your job in the past six months?” (rated from 1, never, to 6, several times
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a week) and “How likely are you to leave your job in the next six months?” (rated from 1,
not likely at all, to 4, very likely). Staff views of consumers were measured with the
Consumer Optimism scale. Staff were asked to think about consumers with whom they
currently work and estimate how many of them they expect will have specific outcomes (for
example, housed or employed) on a 5-point scale ranging from 1, almost all, to 5, none, with
items recoded such that higher scores indicate more optimism. This 16-item scale has good
internal consistency and correlates with related constructs (11).
The training was provided as a oneday workshop (six hours long) at a local hotel. Training
included a brief introduction, burnout prevention principles, and experiential exercises and
skill building in six major areas: contemplative practices (for example, mindfulness and
meditation), social (for example, developing support and setting limits), physical (for
example, body scan), cognitive-philosophical (for example, cognitive restructuring and
values clarification), imagery, and other self-care activities. Information was presented in a
lecture format, interspersed with individual, dyadic, and group activities. A conceptual
framework for understanding burn-out was presented and consisted of a functional analysis
and steps for relapse prevention. Participants were provided with a toolkit with which they
were encouraged to identify personal burnout warning signs and triggers and to outline a
follow-up personalized burnout prevention plan. Each participant attended only one
workshop. Attendance at the five workshops ranged from ten to 28 participants. At the end
of the training day, 91% (N=76) of the participants rated the overall training as moderately
helpful or very helpful.
The primary purpose of the pilot study was to examine the feasibility and preliminary
effectiveness of the training program. First, we identified participants and compared them
with those who registered for the training but did not attend. Next, we examined changes
over time in scores related to burnout, job satisfaction, intentions to leave the position, and
staff views of consumers. For the total sample, we used paired t tests to compare the results
of the first baseline survey with those of the six-week follow-up. For the subsample that had
two completed baseline measures (N=58), we used repeated-measures analyses of variance
to examine changes over time, with post hoc comparisons between time periods.
Results
A total of 103 people registered for the training, and 84 attended a session. The 79 attendees
with demographic information included whites (N=62, 79%), blacks (N=15, 19%), and
persons of “other” race or ethnicity (N=2, 3%). In addition three persons (4%) were
Hispanic. Most participants were female (N=69, 87%). Nonparticipants were more likely
than participants to be from a racial or ethnic minority group (N=12, or 63%, versus N=17,
or 22%) (p<.01) and to have a greater percentage of adults in their caseload (mean of 94%
±15% versus 77%±39%) (p<.05). For participants who completed the six-week follow-up
(N=74), we found significant reductions in two of the three components of burnout (Table
1). As we hypothesized, emotional exhaustion was significantly lower at follow-up than at
baseline, with a large effect size (d=.65). Depersonalization was also significantly lower at
follow-up than at baseline (moderate effect size, d=.43). Personal accomplishment did not
differ significantly from baseline to follow-up. Participants also reported a significant but
small effect for increased consumer optimism at follow-up. Other secondary outcomes of
job satisfaction and turnover intentions did not change over time. For participants who
completed both baseline surveys and the follow-up (N=58), we also found significant
decreases in emotional exhaustion and depersonalization and significant increases in
consumer optimism. Post hoc comparisons showed follow-up scores to be significantly
different from both baseline scores, but the two baseline scores did not differ from each
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other. [An appendix showing detailed dropout analyses and post hoc comparisons is
available as an online supplement to this report at ps.psychiatryonline.org.]
Discussion
This preliminary, quasi-experimental examination of a new burnout intervention showed
promising results. We found that a one-day workshop to reduce staff burnout was well
received. Of the 103 persons who initially registered, 82% attended—a positive finding in
itself, given the hectic pace of community mental health work. Participants reported
significant reductions in emotional exhaustion and depersonalization and significant
increases in consumer optimism six weeks after the training. In a stronger test of our
hypotheses, the subsample who completed two baseline assessments showed the same
posttraining changes, with no difference between the two baseline assessments. This
increases confidence that improvements may be related to the intervention rather than being
a function of the assessment or maturation.
We found large effect sizes for reductions in emotional exhaustion, moderate effects for
depersonalization, and no changes in personal accomplishment. In prior research, emotional
exhaustion was the most robust dimension and diminished personal accomplishment the
least robust, leading some to argue that burnout is better conceptualized as a two-
dimensional phenomenon or even a single dimension of emotional exhaustion (Morse GM,
Salyers MP, Monroe-DeVita M, et al., unpublished manuscript). Others, including Maslach
(12), have argued for a temporal relationship between the components, suggesting that
emotional exhaustion may lead to depersonalization and later to reduced personal
accomplishment. If that is the case, six weeks may not have been enough time to see
changes in that dimension. Also, the training may need an enhanced focus to improve a
sense of personal accomplishment.
We found little or no change in job satisfaction or intentions to leave the position—
outcomes that we viewed as secondary to and distal from our intervention. Both job
satisfaction and intention to leave are complex constructs, with multiple determinants (for
example, pay) that were not the target of our intervention. In addition, prior studies have
found mixed results in terms of burnout predicting job satisfaction or turnover (3,4).
The finding of increased consumer optimism is encouraging and may reflect broader
benefits of the burnout intervention beyond staff morale. Other studies have shown that staff
expectations of consumers are related to consumer outcomes (13). If staff members are
taking better care of themselves and feeling better, they may be able to respond more
compassionately and positively toward those with whom they work. It is interesting to note
that we did not explicitly include training concerning consumer expectations. However,
mindfulness techniques directly targeted at reducing stigmatizing attitudes have resulted in
reductions in burnout as well (14).
Our ability to draw firm conclusions is limited by the lack of a controlled comparison group.
Although a subsample completed two baseline measures, changes may not necessarily be
related to enhanced skills from the training. Future studies will need to include a randomized
control group and assess the effects of burnout prevention over a longer follow-up period.
Positive outcomes from a one-day workshop are encouraging, but more lasting changes may
require more frequent or intensive training, spaced over a period of time. We were also
limited in our ability to engage and retain participants from racial and ethnic minority
groups. Although minority status was not directly related to outcomes, we found an
interaction such that persons from racial-ethnic minority groups had lower depersonalization
scores at baseline and no significant decrease in the depersonalization score at follow-up.
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Emotional exhaustion decreased regardless of minority status. However, interventions may
need to be adapted to encourage greater participation of racial and ethnic minority groups.
Conclusions
With a one-day workshop, we found large reductions in emotional exhaustion, moderate
reductions in depersonalization, and small but significant improvements in consumer
optimism six weeks later. Future work is needed to ensure acceptability and feasibility with
certain populations (racial and ethnic minority groups) and to assess the durability of
positive effects over a longer follow-up, but our initial work shows that the training was
helpful and that participants reported using the techniques in practice. Given the demands of
mental health work and the potential negative effect of burnout, successful burnout
interventions are critical, and this is a promising intervention.
Acknowledgments
This study was funded by Interventions and Practice Research Infrastructure Program grant R24 MH074670
(Recovery-Oriented Assertive Community Treatment) from the National Institute of Mental Health.
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Salyers et al. Page 6
Table 1
Survey results of 74 mental health professionals who participated in a day-long retreat to reduce burnout
Baseline 6-week follow-up
Outcome M SD M SD t df Effect size (Cohen's d)
Burnout (M ± SD score)a
Emotional exhaustion 33.7 7.6 28.9 7.1 6.06** 73 .65
Depersonalization 15.4 5.4 13.2 5.1 4.15** 73 .43
Personal accomplishment 24.7 4.9 24.1 5.1 1.04 73 .12
Secondary outcomes (M±SD score)
Job satisfactionb,c4.6 1.2 4.7 1.4 −1.07 72 −.09
Considered leaving position in the past 6 monthsb,d2.3 1.5 2.5 1.6 1.30 72 .11
Likely to leave position in the next 6 monthse1.6 .8 1.7 .9 1.69 73 .14
Consumer optimismb,f3.2 .5 3.3 .5 −2.45
*
72 −.21
aAs measured by the Maslach Burnout Inventory. Possible scores on the emotional exhaustion subscale range from 0 to 56, on the depersonalization subscale range from 0 to 30, and on the personal
accomplishment subscale range from 0 to 48, with higher scores indicating higher burnout for all sub-scales except for personal accomplishment, where higher numbers indicate a higher sense of
accomplishment.
bData were missing for one participant.
cAs measured by items on the Job Diagnostic Survey. Possible scores range from 1 to 7, with higher scores indicating higher satisfaction.
dPossible scores range from 1 to 6, with higher scores indicating a greater likelihood of turnover.
ePossible scores range from 1 to 4, with higher scores indicating a greater likelihood of turnover.
fAs measured by the Consumer Optimism scale. Possible scores range from 1 to 5, with higher scores indicating higher anticipation of consumer success.
*p<.05
**p<.01
Psychiatr Serv. Author manuscript; available in PMC 2011 May 4.
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... A 3-day intervention study by Woo-Jeong., et al. (2010) involving pregnant women, highlighted that practicing breathing techniques 3 times a day lessened anxiety symptoms [8]. Michelle., et al. (2011) found that practicing breathing exercises for a day helped relieve exhaustion from emotional stress and depersonalization from "burnout" at the workplace [9]. Patients with chronic back pain reported considerable exercise improvement in anxiety and depression in a 7-day intensive residential yoga program, including pranayama, a type of breathing exercise [10]. ...
The Breath of Life: Breathing Techniques as Effective “Medicine”
Article
Full-text available
  • Feb 2022
Breathing is a fundamental activity of all living organisms and is necessary for life. Although breathing is a priority, greater than 90% of living organisms use less than 50% of their breathing capacity efficiently. How a person breathes affects the functions of their entire body. Breathing exercises are regularly recommended to maintain mental peace, alleviate stress, improve psychophysiological function, and organ performance. Yoga relieves stress, depression, anxiety, and various acute or chronic mood disorders. Physical postures (asanas), breathing techniques (pranayamas) and meditation practices (dhyana) are the components of yoga that unite the mind, body, and spirit. Yogic breathing involves following a recommended breathing pattern and movements to positively affect immune function, regulate any imbalance in the autonomic nervous system, manage psychological and stress-related disorders and alleviate physiological functions, which help improve quality of life (QoL). If an individual is purposeful, these exercises are easy to learn, positively impacting life and behavior. Several experimental and computational studies support the benefits of controlled breathing methods on overall well-being. Each type of yoga provides unique physiological and psychological advantages attributed to posture, the use of mouth and nostrils, frequency and duration of breathing, laryngeal muscle contraction, glottis position, and tidal capacity. Practicing yoga is generally considered safe, although special populations-such as older individuals and those with high-risk diseases-require appropriate consultation before undergoing such practices. This review provides an overview of breathing related practices, such as breathing as a non-pharmacological intervention to manage and overcome stress and other breathing disorders.
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... In another study, it was reported that a breathing exercise of five minutes and 30 sessions per day could significantly reduce the anxiety in pregnant women who experienced preterm labor. 30 Salyers et al. 31 emphasized that a one-day breathing exercise relieved an emotional exhaustion, and depersonalization caused by occupational burnout. In a study conducted to determine the effects of the diaphragmatic respiration on exercise-induced oxidative stress and the potential role of the cortisol hormone in this stress condition, it was found that diaphragm breathing applied after an intensive training increased the antioxidant defense status, and this situation resulted from the decrease in the cortisol level. ...
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... Los resultados obtenidos indican que los cuidadores redujeron sus puntuaciones principalmente en la variable sdl y su dimensión de desgaste físico y psíquico que se ha reportado es la manifestación primaria del síndrome y la más reportada por los trabajadores (Maslach y Jackson, 1997;Leiter, Schaufeli y Maslach, 1993). En estudios previos se había comprobado el efecto de una icc en la mejoría de la calidad de vida laboral de los profesionistas (Isaksson et al., 2010;Brattberg, 2006;Salyers et al., 2011;Van der Klink et al., 2001;Boekhorst et al., 2008), pero los resultados presentados reflejan la mejoría en la calidad de vida general, así como cuadro 3. Continuación sus dimensiones salud física, salud psicológica y relaciones sociales, lo cual confirma que la disminución del sdl mejora la calidad de vida no solo en el trabajo, sino en todos los ámbitos. ...
Calidad de vida en la vejez
Book
Full-text available
  • Jan 2018
Durante el proceso de envejecimiento las personas experimentan una separación gradual de su entorno, porque se ven forzadas a desprenderse de su patrón cotidiano de vida, disminuyendo con ello su interacción social. Algunos investigadores han denominado a este proceso, desvinculación social. Al envejecer los individuos, van perdiendo cierto carácter social, ya sea en el trabajo, la familia, los amigos y la sociedad. Este proceso, es el conjunto de cambios morfológicos y fisiológicos que aparecen con el transcurso del tiempo y se acentúan en la vejez. En este período se va presentando una disminución de la capacidad de adaptación en cada uno de los órganos, aparatos y sistemas, así como de la capacidad física. Los cambios mencionado aparecen de manera ineludibles a medida que avanza la edad. Uno de los aspectos que se deben considerar en el estudio de estos procesos, son las condiciones de trabajo en las que se desenvolvieron las personas, donde no pocas veces requirió de esfuerzos físicos y mentales de considerable magnitud, los cuales en la vejez pueden incidir de manera directas y negativa en sus procesos de salud-enfermedad. En este trabajo además de estudiar los procesos mencionados, se explora la socialización del adulto mayor en su familia, ya que el núcleo familiar puede ser el apoyo más importante que se le puede otorgar en la vejez. Para esto último se busca contestar dos preguntas: una, ¿hasta qué punto la persona se siente ligada a la familia una vez que deja el trabajo y regresa a su vida?; y otra, ¿cuál es el apoyo que recibe de la esposa, los hijos y posiblemente los nietos?
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The Effect of Psychological Hotwash on Resilience of Emergency Medical Services Personnel
Article
Full-text available
  • Aug 2021
Introduction: Emergency medical services (EMS) personnel are exposed to stress. Job stress in EMS personnel can reduce their resilience and have adverse effects on their clinical performance and mental health, thus reducing the quality of their work. The present research was performed to determine the effect of psychological hotwash on resilience of emergency medical services personnel. Methods: This study was a quasiexperimental. Sixty-four EMS personnel were randomly divided into two groups of hotwash and control. The psychological hotwash program was performed in the intervention group for a month based on the protocol; however, the control group continued their usual work and received no intervention. A day and six weeks after the psychological hotwash in the intervention group, the resilience of the EMS personnel was remeasured in both groups. Results: Before the intervention, the participants' mean resilience score was 138.37 ± 7.04 in the intervention group and 137.34 ± 8.48 in the control group. There was a statistically significant difference between the mean scores of resilience in the intervention and control groups a day after the intervention (P=0.003). There was no statistically significant difference between the mean scores of resilience in the intervention and control groups 6 weeks after the intervention (P=0.102). Conclusion: The EMS personnel's attendance at psychological hotwash sessions could increase their resilience. Nevertheless, the sessions should not be interrupted because the 6-week interruption of the sessions caused the nonsignificant scores of resilience in the hotwash and control groups. Hence, it is recommended to continue the investigation of the effects of hotwash on resilience, stress reduction, and job burnout reduction in EMS personnel by other researchers in different settings.
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Burnout: A Multidimensional Perspective
Chapter
Full-text available
  • Jan 1993
It has been almost twenty years since the term "burnout" first appeared in the psychological literature. The phenomenon that was portrayed in those early articles had not been entirely unknown, but had been rarely acknowledged or even openly discussed. In some occupations, it was almost a taboo topic, because it was considered tantamount to admitting that at times professionals can (and do) act "unprofessionally." The reaction of many people was to deny that such a phenomenon existed, or, if it did exist, to attribute it to a very small (but clearly mentally disturbed) minority. This response made it difficult, at first, for any work on burnout to be taken seriously. However, after the initial articles were published, there was a major shift in opinion. Professionals in the human services gave substantial support to both the validity of the phenomenon and its significance as an occupational hazard. Once burnout was acknowledged as a legitimate issue, it began to attract the attention of various researchers. Our knowledge and understanding of burnout have grown dramatically since that shaky beginning. Burnout is now recognized as an important social problem. There has been much discussion and debate about the phenomenon, its causes and consequences. As these ideas about burnout have proliferated, so have the number of empirical research studies to test these ideas. We can now begin to speak of a "body of work" about burnout, much of which is reviewed and cited within the current volume. This work is now viewed as a legitimate and worthy enterprise that has the potential to yield both scholarly gains and practical solutions. What I would like to do in this chapter is give a personal perspective on the concept of burnout. Having been one of the early "pioneers" in this field, I have the advantage of a long-term viewpoint that covers the twenty years from the birth of burnout to its present proliferation. Furthermore, because my research was among the earliest, it has had an impact on the development of the field. In particular, my definition of burnout, and my measure to assess it (Maslach Burnout Inventory; MBI) have been adopted by many researchers and have thus influenced subsequent theorizing and research. My work has also been the point of departure for various critiques. Thus, for better or for worse, my perspective on burnout has played a part in framing the field, and so it seemed appropriate to articulate that viewpoint within this volume. In presenting this perspective, however, I do not intend to simply give a summary statement of ideas that I have discussed elsewhere. Rather, I want to provide a retrospective review and analysis of why those ideas developed in the ways that they did. Looking back on my work, with the hindsight of twenty years, I can see more clearly how my research path was shaped by both choice and chance. The shape of that path has had some impact on what questions have been asked about burnout (and what have not), as well as on the manner in which 2 answers have been sought. A better understanding of the characteristics of that path will, I think, provide some insights into our current state of knowledge and debate about burnout. In some sense, this retrospective review marks a return to my research roots. The reexamination of my initial thinking about burnout, and an analysis of how that has developed and changed over the years, has led me to renew my focus on the core concept of social relationships. I find it appropriately symbolic that this return to my research roots occurred within the context of a return to my ancestral roots. The 1990 burnout conference that inspired this rethinking took place in southern Poland, from which each of my paternal grandparents, Michael Maslach and Anna Pszczolkowska, emigrated to the United States in the early 1900s. Thus, my travel to Krakow had great significance for me, at both personal and professional levels.
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Helping Till It Hurts? A Multimethod Study of Compassion Fatigue, Burnout, and Self-Care in Clinicians Working With Trauma Survivors
Article
Full-text available
  • Jun 2008
There is burgeoning interest in secondary traumatic stress, compassion fatigue, and self-care in the helping professions. This multimethod study focused on therapists' stress and coping in their work with trauma survivors, identifying factors related to resilience and burnout. Semistructured interviews were conducted with 20 clinicians subscribing to a systems perspective, and 104 clinicians were administered a questionnaire inquiring about their caseloads, trauma history, coping styles, emotional self-awareness, work stress, compassion satisfaction, compassion fatigue, and burnout. Interview data demonstrated that therapists detect job stress through bodily symptoms, mood changes, sleep disturbances, becoming easily distracted, and increased difficulty concentrating. Self-care strategies included processing with peers/supervisor, spirituality, exercise, and spending time with family. In the quantitative study, social support, work hours, and internal locus of control accounted for 41% of the variance in compassion satisfaction. Multiple regression procedures accounted for 54% of the variance in compassion fatigue and 74% of the variance in burnout. Implications for clinical training and organizational policy are discussed.
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Burnout as a developmental process: Consideration of models.
Article
Full-text available
  • Jan 1993
focuses on the process of burnout / places burnout in a time perspective and regards it as a developmental process starts with the contention that burnout is a three-dimensional construct, including emotional exhaustion, depersonalization, and reduced personal accomplishment / criticizes the "phase model" of Golembiewski and his colleagues for relying too much on the first dimension and for ignoring the temporal development of burnout / in Leiter's own process model of burnout, emotional exhaustion results from a demanding (work) environment, which in turn contributes to increased depersonalization / depersonalization is considered to be a coping response, which occurs after the emotional resources have been depleted to a large extent (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Meta-Analytic Comparison of the Job Diagnostic Survey and Job Characteristics Inventory as Correlates of Work Satisfaction and Performance
Article
Full-text available
  • Oct 1991
The meta-analytic procedure (J. E. Hunter et al, 1982) was used to compare the relationships of the corresponding scales of the Job Diagnostic Survey and the Job Characteristics Inventory with work satisfaction and performance. Results from 79 studies suggest convergence in the estimated population correlations of the alternative identity and feedback scales with both satisfaction and performance. Results further indicate similarity in the estimated relationships of the alternative autonomy scales with performance and the alternative variety scales with satisfaction. In contrast, dissimilarity was found in the estimated relationships of the alternative variety scales with performance and the alternative autonomy scales with satisfaction. The latter dissimilarity was particularly substantial. Implications of the present findings are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Development of Job Diagnostic Survey
Article
Full-text available
  • Apr 1975
Describes the Job Diagnostic Survey (JDS) which is intended to (a) diagnose existing jobs to determine whether (and how) they might be redesigned to improve employee motivation and productivity and (b) evaluate the effects of job changes on employees. The instrument is based on a specific theory of how job design affects work motivation, and provides measures of (a) objective job dimensions, (b) individual psychological states resulting from these dimensions, (c) affective reactions of employees to the job and work setting, and (d) individual growth need strength (interpreted as the readiness of individuals to respond to "enriched" jobs). Reliability and validity data are summarized for 658 employees on 62 different jobs in 7 organizations who responded to a revised version of the instrument. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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What makes the difference? Practitioner views of success and failure in two effective psychiatric rehabilitation approaches
Article
  • Jan 2008
The current study examined success in two vocational programs by interviewing practitioners in two philosophically different employment programs at a psychosocial rehabilitation agency. Practitioners' views of what constitutes success and factors facilitating success were analyzed using both qualitative and quantitative means. In general, practitioners viewed success as more than just obtaining a job, but maintaining employment over time and making life changes. Success was most often attributed to consumer motivation, and lack of success was attributed to mental health symptoms. Furthermore, practitioners from each program tended to view success in a manner consistent with their program's philosophy.
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Assessing burn-out and occupational stressors in a medium secure service
Article
  • Jul 2007
The study aimed to identify occupational stressors and measure experiences of clinical burn-out among a group of mental health nurses and occupational therapists in a medium secure service. All the nursing staff (n=115) and occupational therapists (n=9) on three wards in a medium secure hospital were asked to partake in the study, and to complete a modified version of the Psychiatric Nurse Occupational Stress Scale (PNOSS), the Maslach Burnout Inventory (MBI) and a demographic questionnaire designed for the study.Results from the PNOSS revealed that organisational issues elicited the greatest stress and were most strongly related to high burn-out scores, identified by the MBI. Limited resource and staff conflict were also associated with stress and burn-out. Patient care had a relatively small impact. MBI findings were that a substantial proportion (54%) were experiencing high burn-out in relation to emotional exhaustion.
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Burnout: A multidimensional perspective (chapter)
Article
  • Oct 1993
advocates a complex multifaceted model of burnout / describes the emergence of the three-dimensional burnout concept, which is derived empirically rather than theoretically / the first component—emotional exhaustion—closely resembles an orthodox stress variable / both other components add the crucial social dimension to burnout / depersonalization refers to the person's negative perception of his or her recipients, whereas reduced personal accomplishment includes a person's negative self-evaluation in relation to his or her job performance / argues that burnout is an individual stress experience that originates from emotionally demanding interpersonal relationships with recipients / this experience is embedded in a complex social context and also involves the person's attitude toward both others and self (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Can We Improve the Morale of Staff Working in Psychiatric Units?
Article
  • Jul 2009
Background: Those working in psychiatric units care for some of the most vulnerable and needy patients within health services, and suffer some of the highest levels of job dissatisfaction and burnout within healthcare workforce. Poor staff morale is bad for patient care and is economically wasteful. The same level of evidence of effectiveness and efficiency should be considered in workforce planning as is required in patient care. This has hitherto not occurred. Aim: To examine the impact and cost effectiveness of strategies to improve staff morale and reduce “burnout” amongst staff working in psychiatric units. Methods: We conducted a systematic review of robust evaluations of strategies designed to improve psychological wellbeing or the working experience of staff working in psychiatric units. We searched the following databases: EMBASE; MEDLINE; PsycINFO; CINAHL; Sociological Abstracts; HMIC; Management and Marketing Abstracts; Management Contents and Inside Conferences (all to 2004), and sought the following outcomes: Psychological wellbeing; Job satisfaction; staff burnout and stress; staff sickness and turnover; Direct and indirect costs. The following designs were included: Randomised Controlled Trails (RCTs); Controlled Clinical Trials (CCTs); Controlled Before and after studies (CBAs); and interrupted time series (ITSs). We conducted a narrative overview of key design features, endpoints and results. Results: We identified eight evaluations of strategies to improve staff morale (3 RCTs; 3 CCTs and 2 CBAs). Educational interventions designed to enhance the skill and competency of staff were the most commonly evaluated, and showed positive impact on at least one outcome of interest. Psycho-social interventions that sought out members of staff who were experiencing emotional problems and offered work-based support and enhanced social support networks were positive in US healthcare settings, but had been incompletely implemented and evaluated in UK settings. Organisational interventions, such as a shift to continuous care and primary nursing also showed a potential to be effective in reducing sickness rates and improving job satisfaction. Conclusions: There is substantial opportunity to design and implement interventions to improve the working experience of staff in psychiatric units. There is an onus to evaluate the longer term impact and cost effectiveness of these strategies. Unfortunately strategies are currently being implemented in the absence of any prospective evaluation. Declaration of interest: The authors have no conflict of interest.
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