Skills training in the long-term management of stress and occupational burnout

The current managed healthcare environment stresses brief and effective short-term therapy. However, often this short-term treatment does not lead to long-term behavioral changes and clients return to therapy many times for help with the same dysfunctional behavioral patterns. The main problem with these traditional forms of treatment is the assumption that clients have the basic skills to change their ineffective behaviors. Yet, many people lack the basic skills to manage our highly stressful society, and may take years to master new behavioral management skills. Examining the relationship between stress and coping, this study explored both short-and long-term approaches to behavioral change relative to occupational burnout, and focused upon the teaching of skills to manage stress. Subjects who participated in a 6-week stressmanagement program reported only temporary decreases in burnout, while those subjects who received 1-hour coping “refresher” sessions at 5 months, 11 months, and 17 months showed consistent decreases in burnout throughout a 2 1/2 year period. These results suggest that psychologists can be much more effective behavioral change agents through long-term approaches that emphasize teaching new skills to manage chronic behavioral problems. Given the changes in the health insurance industry and the way therapeutic services are provided, the field may need to rethink approaches that are grounded in personality theory and abnormal psychology to approaches that emphasize principles of learning theory.     

Association of Burnout with Emotional Coping Strategies,Friendship, and Institutional Support Among Internal Medicine Physicians

Physician burnout influences physician mental health, staff stress, safety events, and patient outcomes. The association of burnout with compassion satisfaction, secondary stress, emotional coping strategies and many psychosocial variables, such as institutional support, friendship, and spirituality, have not been well studied. A convenience sample of internal medicine physicians was emailed a survey using validated instruments to explore these associations. The response rate was 337/1021 (33%), with a burnout prevalence of 175/337 (52%). Grit, acceptance, active coping, positive reframing, and strategy planning were associated with lower burnout domains and greater compassion satisfaction. Certain emotional coping strategies such as denial, disengagement, self-blame, substance abuse, and venting were associated with greater burnout and lower compassion satisfaction. Greater institutional support was associated with lower burnout (r?=????.35, p?<?.001), secondary stress (r?=????.14, p?<?.05), and compassion satisfaction (r?=?.28, p?<?.0001). Friendship was associated with lower burnout (r?=????.25, p?<?.0001) and greater compassion satisfaction (r?=?.28, p?<?.0001). This study suggests that amelioration of burnout requires both intrinsic strategies that emphasize physician coping skills as well as extrinsic strategies that address institutional support.

     

Cognitive and behavioral self-control strategies: Applications for the clinical management of adult stutterers

A model of therapy for adult stutterers which emphasizes the role of cognition in mediating the conditions for behavioral change is described. The philosophy of the program along with the specific forms and effects of several self-control strategies are discussed in relation to: (1) expectancy formation and the attainment of goals; (2) speech modification procedures; (3) transference of clinical gains; and (4) assessment of results. The use of cognitive restructuring procedures, self-instructional strategies, imagery and other coping skills for the management of speech-related stress is outlined. The importance of developing self-management and self-monitoring programs that clients may use in ongoing confrontations with real-life problems is emphasized in defining responsible behavior and the responsibility for change.     

Effectiveness of Cognitive/Behavioral Small Group Intervention for Reduction of Depression and Stress in Non-Hispanic White and Hispanic/Latino Women Dementia Family Caregivers: Outcomes and Mediators of Change

This study enrolled 184 middle-aged and older women (95 Non-Hispanic White and 89 Hispanic/Latino) who provided in-home hands-on care to an elderly relative with Alzheimer’s disease or another form of dementia. Within ethnic group they were randomly assigned to either a CBT-based small group intervention program called “Coping with Caregiving” (CWC) that taught a variety of cognitive and behavioral skills to reduce stress and depression, or to a minimal telephone based control condition (TSC). Intervention lasted about 4 months; one post-treatment assessment was completed 6 months after baseline by interviewers blind to the intervention condition. Interviews and interventions were conducted in English or Spanish by trained staff. Results indicated that those in the CWC (regardless of ethnicity) showed greater improvement from pre to post intervention than those in the TSC on measures of depressive symptoms, overall life stress, and caregiving-specific stress. In order to investigate if these changes may have been related to one proposed mechanism of change in CBT (skill utilization), a new measure was constructed. Change in frequency of use and perceived helpfulness of adaptive coping skills were assessed in all caregivers. Results indicated that caregivers in CWC reported greater frequency of use, and greater perceived helpfulness, of these skills at post intervention compared to caregivers in the TSC. Improvement measured by dependent measures was correlated with an increase in these indices for those in the CWC. Tests for mediation suggest that effective skill utilization may mediate the effect of treatment on outcome. Implications of these findings are discussed and recommendations provided for future research.     

Compassion satisfaction,compassion fatigue,and burnout in a national sample of trauma treatment therapists

Abstract

For behavioral health professionals working with traumatized clients, continuous and prolonged exposure to the stress of working with the myriad of trauma-related stressors experienced by their clients can lead to various responses including burnout, compassion fatigue, and compassion satisfaction. The present study investigates the impact of using evidence-based practices on compassion fatigue, burnout, and compassion satisfaction in a random, national sample of self-identified trauma specialists (N=532). The 30-item Professional Quality of Life Scale (Stamm, 2005) and the 19-item Trauma Practices Questionnaire (Craig & Sprang, 2009) were included in a survey to licensed social workers and psychologists from professional membership rosters. Age and years of experience proved to be powerful predictors of only two of the three criterion variables, with younger professionals reporting higher levels of burnout and more experienced providers endorsing higher levels of compassion satisfaction. The utilization of evidence-based practices predicted statistically significant decreases in compassion fatigue and burnout, and increases in compassion satisfaction. The utility of these findings in understanding the process of trauma transmission between therapist and client as well as directions for future research are discussed.     

Coaching Clients to Manage Depression

The author presents a system of behavioral techniques that permits clients to manage their own depression. By coaching clients through the sequence of self-management procedures identified by Kahn (1976) and using the strategies offered by Lewinsohn (1975), counselors have an effective set of techniques to lead clients to successful coping with depression. The sequence of self-observation, self-mediation, and self-reinforcement activities is based on Lewinsohn's (1975) work and is effective with moderately depressed clients. This comprehensive treatment program requires a minimum amount of counselor intervention for a maximum amount of client gain.     

Coping tendencies and changes in athlete burnout over time

Burnout can lead to numerous negative outcomes for athletes. While we know a reasonable amount about how athlete burnout develops over time, we know comparably less about the role of coping in this process. The present study aimed to help address this issue by examining the role of coping tendencies in predicting changes in athlete burnout over a six-month period. A sample of 141 junior athletes (mean age = 17.3 years) completed measures of coping tendencies (problem-focused and avoidance coping) and burnout. Participants also completed the measure of burnout on two further occasions, three months and six months after the initial assessment. Conditional latent growth curve modelling revealed that coping tendencies predicted changes in athlete burnout over time. In this regard, avoidance coping predicted increases in athlete burnout, whereas problem-focused coping was unrelated to changes in athlete burnout. These findings provide evidence that an athlete’s tendency to use avoidance coping strategies is linked to burnout development over time.     

Training behavioral technicians to implement naturalistic behavioral interventions using behavioral skills training

Training behavioral technicians mainly focuses on teaching accurate implementation of structured behavioral intervention programs. Often behavioral technicians are unable to adequately promote their clients' learning in less structured environments, which can limit opportunities for generalization of the clients' skills to the natural environment. The aim of the present study was to evaluate the effectiveness of using behavioral skills training to coach behavioral technicians on the implementation of naturalistic behavioral interventions. Naturalistic behavioral interventions take advantage of naturally occurring situations to teach new skills and practice mastered skills in natural settings, thus promoting generalization across environments and in the presence of natural contingencies. Five behavioral technicians were trained to implement a novel protocol based on play therapy. Specifically, they were coached to engage in well‐defined positive behaviors during their interactions with clients (e.g., labeled praise). All participants reached mastery criteria, maintained skills at follow‐up, and demonstrated generalization of skills with novel clients.     

Treatment of Excessive Interpersonal Dependency: A Cognitive-Behavioral Model

Clients with excessive dependency often seek treatment for an Axis I anxiety or mood disorder. Simply providing treatment for the Axis I disorder may fail to address the long-standing personality factors that may underlie the acute anxiety and depression. A four-stage model has been proposed for the treatment of excessive interpersonal dependency. This model describes strategic ways therapy content and style should change over the course of treatment. Despite the apparent utility of the four-stage treatment model, it may be difficult to apply in many sites that now emphasize short-term approaches to treatment. In many cases, therapy can be designed to address themes that are relevant to both dependency and the Axis I syndrome. Therapy can be focused around helping clients make improvements in stabilizing emotional reactions, enhancing views of the self, and improving social functioning. Treatment focused on stabilizing emotional reactions can help clients confront and develop tolerance for feelings of depression and anxiety. Treatment focused on enhancing views of the self can help clients improve their self-esteem, self-reinforcement and reduce self-criticism. Treatment focused on improving social functioning can enhance social skills, reduce social anxiety and challenge feelings of loneliness. In addition, treatment can focus on reducing specific aspects of interpersonal dependency and confronting developmental antecedents that may underlie the dependency.     

Profiles of middle school teacher stress and coping: Concurrent and prospective correlates

This study examined the stress and coping patterns of middle school teachers. A final teacher sample of 102 and student sample of 1450 agreed to participate in the study. We conducted a latent profile analysis of the teachers' self-reported levels of stress and coping at the beginning of the school year and used the resulting profiles to predict teacher practices and student outcomes over time. Nearly all teachers were characterized by high stress and high coping (66%) or high stress and low coping (28%). Based on concurrent ratings and observations, the High Stress/Low Coping profile had higher burnout and lower self-efficacy, higher rates of observed reprimands, and higher student-reported depression in comparison to the other classes. The most adaptive profile, Low Stress/High Coping (6% of sample), had lower burnout, greater parent involvement and higher student prosocial skills in comparison to the other groups. Profiles also predicted the maintenance of most of these effects and the increase of some effects over the school year. Examining stress and coping in combination can inform efforts to improve teacher well-being and have a positive influence on student learning environments.     

Grief and trauma intervention for children after disaster: exploring coping skills versus trauma narration

This study evaluated the differential effects of the Grief and Trauma Intervention (GTI) with coping skills and trauma narrative processing (CN) and coping skills only (C). Seventy African American children (6-12 years old) were randomly assigned to GTI-CN or GTI-C. Both treatments consisted of a manualized 11-session intervention and a parent meeting. Measures of trauma exposure, posttraumatic stress symptoms, depression, traumatic grief, global distress, social support, and parent reported behavioral problems were administered at pre, post, 3 and 12 months post intervention. In general, children in both treatment groups demonstrated significant improvements in distress related symptoms and social support, which, with the exception of externalizing symptoms for GTI-C, were maintained up to 12 months post intervention. Results suggest that building coping skills without the structured trauma narrative may be a viable intervention to achieve symptom relief in children experiencing trauma-related distress. However, it may be that highly distressed children experience more symptom relief with coping skills plus narrative processing than with coping skills alone. More research on the differential effects of coping skills and trauma narration on child distress and adaptive functioning outcomes is needed.     

Perfectionism in school teachers: relations with stress appraisals, coping styles, and burnout

Many school teachers suffer from stress and burnout, and perfectionism is a personality characteristic that has been associated with increased stress, maladaptive coping, and burnout. Recent findings, however, show that perfectionism has both positive and negative facets. To investigate how these facets are related to stress, coping, and burnout in teachers, a sample of 118 secondary school teachers completed multidimensional measures of perfectionism, stress appraisals, coping styles, and burnout. Multiple regression analyses showed that striving for perfection was positively related to challenge appraisals and active coping and inversely to threat/loss appraisals, avoidant coping, and burnout whereas negative reactions to imperfection were positively related to threat/loss appraisals, avoidant coping, and burnout and inversely to challenge appraisals and active coping. Perceived pressure to be perfect showed differential relationships depending on the source of pressure: Whereas pressure from students was positively related to loss appraisals and pressure from students' parents was positively related to burnout, pressure from colleagues was inversely related to threat appraisals and burnout. The findings suggest that striving for perfection and perceived pressure from colleagues do not contribute to stress and burnout in teachers, whereas negative reactions to imperfection and perceived pressure from students and students' parents may be contributing factors.     

A Second Look at the Revolution in Counseling

In 1965 the revolutionary counseling development was tailoring specific behavioral goals with clients and testing innovative procedures to help clients learn how to achieve their goals. Since then an experimental self-correcting approach has produced a variety of techniques known to help clients overcome many problems, and has led substantial numbers of counselor educators to teach behavioral approaches to counselors. Future counseling will emphasize prevention more than remediation, internal more than external control, and a better balance among cognition, emotion, and action. Anyone can join the continuing search for better procedures to help clients learn.     

Guided Discovery

Guided discovery involves a therapeutic dialogue that is designed to assist clients in finding their own solutions to their problems. An integration of problem-solving therapy and the Socratic method can help clients to develop their own coping skills. Problem-solving therapy provides a useful framework for helping clients to manage many of the problems they typically encounter. The Socratic method provides a useful therapeutic style to promote self-guided discovery and self-regulation. Strategies from the Socratic method can be used to guide the process of the therapeutic dialogue, while the stages of problem-solving serve as the structure for the content of therapy sessions. Therapy can be structured according to five main stages: (1) Help clients establish a realistic and adaptive attitude toward common life problems; (2) Define problems in terms of specific and realistic goals; (3) Help clients to generate a wide variety of coping options; (4) Guide clients through a process of rational decision-making in order to select the best coping options, and (5) Implement the plan and evaluate its effectiveness. A systematic series of questions can be used to facilitate the client’s self-evaluation of different problems, goals, and coping efforts. The process helps to promote client autonomy and self-guided action. When problem-solving therapy is integrated within the Socratic method, clients can learn to approach most problems in a logical, thoughtful, and self-directed manner.     

Relationships between Teachers' Occupational Stress and Their Burnout and Distress: Roles of Coping and Negative Mood Regulation Expectancies

Teaching school is a highly stressful occupation. Consequences of this stress are burnout, physical and emotional distress, and choosing to leave the profession. Research on teacher stress and burnout has largely focused on environmental and contextual factors while ignoring personality characteristics of teachers that may have an impact on relationships between job stress and its consequences. The current study has a cross-sectional self-report design, focusing on teachers' negative mood regulation (NMR) expectancies as predictors of their coping, burnout and distress, in response to occupational stress. NMR expectancies are people's beliefs that they can control the negative moods they experience. Participants were 86 primary and secondary school teachers, who filled out questionnaire measures of teacher stress, NMR expectancies, coping, burnout, and distress. Simultaneous regression analyses showed that higher stress on the job did indeed predict greater burnout and distress. Additionally, stronger NMR expectancies predicted more active coping. NMR expectancies also predicted less burnout and distress, independent of stress level and coping. Believing one could control one's negative moods was associated with more adaptive outcomes for teachers. Results argue for the value of examining individual difference variables in research on occupational stress, in particular negative mood regulation expectancies.     

Maternal Coping Skills as a Moderator Between Depression and Stressful Life Events: Effects on Children's Behavioral Problems in an Intervention Program

In this study, I report secondary analyses using data from the Infant Health and Development Program (IHDP). The IHDP included parent-targeted as well as child-targeted components as an integral part of early intervention programs. I examined three questions: (1) Do the IHDP early intervention services enhance adaptive maternal coping skills? (2) Do maternal coping skills moderate the relationship between stressful life events and maternal depression? (3) Are maternal coping skills associated with children's behavioral scores? Mothers in the treatment group have more adaptive coping skills than follow-up only mothers, and these effects are moderated by maternal characteristics. Adaptive coping skills moderate the effects of negative life events on maternal depression. Adaptive maternal coping skills are significantly associated with fewer behavioral problems for children at age three. These effects are moderated by the intervention. Implications for early intervention programs are discussed.     

Cognitive-Behavioral Treatment of Social Phobia

Social phobia can be a chronic disorder, capable of restricting a client's social and occupational functioning. Cognitive-behavioral therapy can help many clients learn to overcome their social inhibitions, and make lasting changes in their interpersonal style. Cognitive-behavioral therapy for social phobia includes four general components for helping clients learn to manage their social anxiety. First, therapy begins with the establishment of a sound therapeutic alliance, a focus on assessment, diagnostic interviewing, and education regarding anxiety symptoms and their treatment. Second, the therapist helps clients to develop competence in social skills, relaxation training, and cognitive restructuring. Third, therapy uses exposure to social situations in order to help clients confront their fears and refine their coping skills. Fourth, relapse prevention strategies are used to help clients learn to tolerate feelings of discomfort and confront challenging social interactions. This treatment framework can be adapted to the specific needs of different clients.     

job stress,coping strategies,and burnout among abuse‐specific counselors

The purpose of this study is to investigate whether effective coping strategies play an important role to reduce burnout levels among sexual or substance abuse counselors. The authors examined whether coping strategies mediated or moderated relations between job stress and burnout in a sample of 232 abuse‐specific counselors. Results indicated that self‐distraction and behavior disengagement coping strategies mediated the relationships between 3 job stress variables (workload, role conflict, and job ambiguity) and burnout. Although venting and humor coping strategies positively moderated the relationship between role ambiguity and burnout, active coping strategies negatively moderated the relationship between workload and burnout.