Prevention of burnout: New perspectives

Job burnout has long been recognized as a problem that leaves once-enthusiastic professionals feeling drained, cynical, and ineffective. This article proposes two new approaches to the prevention of burnout that focus on the interaction between personal and situational factors. The first approach, based on the Maslach multidimensional model, focuses on the exact opposite of burnout: increasing engagement with work by creating a better “fit” between the individual and the job. The second approach draws from the decision-making literature and reframes burnout in terms of how perceptions of the risk of burnout may lead to suboptimal choices that actually increase the likelihood of burning out. These new approaches provide a more direct strategy for preventing burnout than typical unidimensional “stress” models because these new approaches (1) specify criteria for evaluating outcomes and (2) focus attention on the relationship between the person and the situation rather than one or the other in isolation.     

Cognitive-Behavioral and Systematic Desensitization Procedures in Reducing Stress and Anger in Caregivers for the Disabled

Twenty-six highly stressed family and community caregivers for people with a disability completed scales designed to assess perceived stress, state anger, and trait anger. They were randomly divided into three groups. Subjects in one group underwent stress-reduction training in a self-instructional procedure, subjects in the second group underwent stress-reduction training in systematic desensitization, and subjects in the third group were placed in a wait-list condition. Results showed that state anger and trait anger were correlated with perceived stress at pretreatment, and state anger was correlated with perceived stress at posttreatment and follow-up. Subjects in both the self-instructional and systematic desensitization groups showed a reduction in perceived stress. Subjects in the self-instructional training group also showed a decrease in trait anger. The wait-list group showed no significant change in perceived stress and anger.     

MK-801-Induced Disruptions of One-Trial Inhibitory Avoidance Are Potentiated by Stress and Reversed by Naltrexone

Five experiments were carried out to investigate opioid and NMDA receptor-mediated responses to one-trial inhibitory avoidance training in CD1 mice. In the first experiment immediate posttraining intraperitoneal administration of the noncompetitive N-methyl-d-aspartate (NMDA) receptor antagonist MK-801 impaired the performance of mice. The effects of MK-801 were time-dependent (they were absent in mice injected with the drug starting 120 min after training). No effect was evident in no-foot-shock groups, showing lack of proactive influence of the treatment on performance. In the second experiment preexposure of the mice to the testing apparatus decreased the effects of MK-801. In the the third experiment naltrexone antagonized the effects of MK-801, suggesting an involvement of opioid neurons. In the fourth experiment immediate posttraining immobilization stress exerted a potentiating effect on the performance of MK-801-injected animals. In the fifth experiment the potentiation of the impairing effect of MK-801 induced by immobilization stress was antagonized by naltrexone.     

高中学生心理应激及其中介变量的研究

学生的心理应激与心理健康问题日益受到人们的关注。本研究对浙江省范围内的４３７名高中学生进行应激源、中介变量和应激反应方面的调查研究,并在此基础上,对高中学生的心理应激过程作了较详细的探讨。研究表明：（１）高中学生的主要应激源是学习压力及与家庭亲友的人际关系问题,（２）对高中学生的应激反应有影响的中介变量主要是社会支持和“问题解决”、“逃避”等应对策略。本研究结论认为,在高中学生的心理卫生工作中要注意减轻他们的学习压力,加强社会支持系统的建立及积极应对方式的教育。     

Gender differences in acute and chronic stress in Wistar Kyoto (WKY) rats

While females are considered more susceptible to depressive behavior, this assertion is not strongly supported by the experimental literature. Since stress contributes to depressive behavior, male and female Wistar Kyoto (WKY) rats were exposed to either one session (acute stress) or 5 sessions (chronic stress) of restraint plus cold in order to study depressive behavior in male and female rats. After their respective treatment exposure, rats were tested in the open field test (OFT) and for retention of a passive-avoidance (P-A) task. One stress session resulted in significant immobility in the OFT for males, whereas 5 sessions were required to produce similar immobility in female rats. Acute stress interfered with the retention of the P-A response for males, while both acute and chronic stress produced poor P-A responses in female rats. Food consumption decresed, progressively, as a function of stress sessions, in female rats, whereas feeding in males returned to control levels after five stress days. Both acute and chronic stress exacerbated the stress ulcer response in male rats, but not in female rats. Chronic, but not acute, stress resulted in an increase in serotonin transporter mRNA levels in the dorsal raphe nucleus of both male and, female rats. The general consensus from these data suggested that female rats were more vulnerable to chronic stress and consequently supported the notion that females may be more susceptible to stress induced behavioral depression.     

Night-rest urinary catecholamine excretion in relation to aspects of free time, work and background data in a teacher group

Free time, work and background data were related to night-rest catecholamine excretion rates in a teacher group (n = 137) during an autumn term. The explained interindividual variance increased slightly towards the end of the term. Adrenaline excretion was predicted better than noradrenaline, notedly by coffee consumption, amount of physical activity, and subjective stress feelings which explained 16% of the variance in adrenaline excretion during night rest. However, the results indicated that the differences in catecholamine excretion during night rest remained mostly unpredictable.     

Minnesota Multiphasic Personality Inventory (MMPI)-derived psychopathology subtypes among former prisoners of war (POWs): Replication and extension

Psychopathology and symptom patterns identified among former prisoners of war (POWs) by Sutker, Winstead, Goist, Malow, and Allain (1986) were replicated in an independent sample of 51 former POWs with similar personal backgrounds and military experiences. Data collection instruments included the Minnesota Multiphasic Personality Inventory (MMPI), self-report measures of anxiety and depression, and a structured clinical interview including a POW Trauma Index. Two prototypic MMPI profile patterns were identified using modal profile analysis (Skinner & Lei, 1980). Both were highly similar in shape and elevation to those reported in the previous investigation. Multiprofile-multisample analysis produced prototypic profile patterns which were accurate representations of profiles identified in separate analyses of the derivation and replication samples (r's .96). Representing unique constellations of clinical features, profile subtypes were associated differentially with confinement stress severity, postservice adjustment, and nature and extent of stress-induced symptomatology.     

The Daily Stress Inventory: Validity and effect of repeated administration

The Daily Stress Inventory (DSI) is a self-report measure of minor stressors which is administered daily. One test of the validity of a measure of daily stress is its sensitivity to the difference between the stressors of workdays and those of weekends. A second concern in establishing the validity of a test administered repeatedly is that self-monitoring may influence the obtained scores. The present study investigated these two issues using a sample of 70 community adults who reported full-time employment. These subjects provided a week of self-monitoring with the DSI. The results indicated that the DSI was sensitive to the difference between weekends and weekdays. The analyses of the effect of repeated administration suggested that the first day of self-monitoring may differ from the other days of self-monitoring. When the first day was eliminated, there was no significant difference among the days of self-monitoring, and the difference between the weekdays and the weekends remained. The data suggest that the DSI is a valid measure of the construct of daily stress and that any influence of repeated self-monitoring with the scale may be easily resolved.     

Hypnotherapy and cognitive behaviour therapy of acute stress disorder: a 3-year follow-up

The long-term benefits of cognitive behaviour therapy (CBT) for trauma survivors with acute stress disorder were investigated by assessing patients 3 years after treatment. Civilian trauma survivors (n=87) were randomly allocated to six sessions of CBT, CBT combined with hypnosis, or supportive counselling (SC), 69 completed treatment, and 53 were assessed 2 years post-treatment for post-traumatic stress disorder (PTSD) with the Clinician-Administered PTSD Scale. In terms of treatment completers, 2 CBT patients (10%), 4 CBT/hypnosis patients (22%), and 10 SC patients (63%) met PTSD criteria at 2-years follow-up. Intent-to-treat analyses indicated that 12 CBT patients (36%), 14 CBT/hypnosis patients (46%), and 16 SC patients (67%) met PTSD criteria at 2-year follow-up. Patients who received CBT and CBT/hypnosis reported less re-experiencing and less avoidance symptoms than patients who received SC. These findings point to the long-term benefits of early provision of CBT in the initial month after trauma.     

Cognitive therapy for post-traumatic stress disorder: development and evaluation

The paper describes the development of a cognitive therapy (CT) program for post-traumatic stress disorder (PTSD) that is based on a recent cognitive model (Behav. Res. Therapy 38 (2000) 319). In a consecutive case series, 20 PTSD patients treated with CT showed highly significant improvement in symptoms of PTSD, depression and anxiety. A subsequent randomized controlled trial compared CT (N = 14) and a 3-month waitlist condition (WL, N = 14). CT led to large reductions in PTSD symptoms, disability, depression and anxiety, whereas the waitlist group did not improve. In both studies, treatment gains were well maintained at 6-month follow-up. CT was highly acceptable, with an overall dropout rate of only 3%. The intent-to-treat effect sizes for the degree of change in PTSD symptoms from pre to post-treatment were 2.70-2.82 (self-report), and 2.07 (assessor-rated). The controlled effect sizes for CT versus WL post-treatment scores were 2.25 (self-report) and 2.18 (assessor-rated). As predicted by the cognitive model, good treatment outcome was related to greater changes in dysfunctional post-traumatic cognitions. Patient characteristics such as comorbidity, type of trauma, history of previous trauma, or time since the traumatic event did not predict treatment response, however, low educational attainment and low socioeconomic status were related to better outcome.