Noémi Balázs & Anna Leszovszki
Burnout is a psychological reaction to chronic work stress that may result in serious consequences both for the individual, and for the work organisation. Consequences for the individual involve far-reaching impacts on mental and physical health, such as coronary heart disease, type 2 diabetes, common infections, musculoskeletal pain, depressive symptoms, increased risk of severe injuries, and even premature death. Consequences for the organization may involve increased risk of absence from work, more work days lost due to illness, inability to work, low work satisfaction, and giving up work completely (Westermann, Kozak, Harling, & Nienhaus, 2014; Aloha, Toppinen-Tanner & Seppänen, 2017). Therefore, burnout has been investigated by many researchers during the past few decades, and although various theoretical models, research studies and measures have been developed to contribute to a better understanding of its causes and consequences, there is still no consensus on the concept of burnout (Maslach et al., 2001; Maslach & Leiter, 2016). Nevertheless, the conceptualization of Christina Maslach (Schaufeli, Leiter, Maslach, & Jackson, 1996) can be considered as the most widely used one, according to which burnout manifests itself through symptoms of exhaustion, cynicism, and diminished professional efficacy (Aloha et al., 2017). These are known as the three dimensions of burnout.
Exhaustion is the most widely reported and most thoroughly analysed dimension. It represents the basic individual stress dimension of burnout, referring to feelings of being overextended and depleted of one’s emotional and physical resources. Depersonalisation or cynicism represents the interpersonal context dimension of burnout, referring to a negative, callous, or excessively detached response to various aspects of the job, especially a detached approach to people under one’s care. Diminished professional efficacy represents the self-evaluation dimension of burnout, referring to feelings of incompetence and a lack of achievement and productivity at work, and low self-efficacy and negative feelings towards one’s self. (Maslach et al. 2001; Awa, Plaumann, & Walter, 2010).
One main group of contributing factors that increase vulnerability to burnout is work characteristics. This includes, for example, high workload, role conflict and ambiguity, low predictability, lack of participation and social support, and experienced unfairness. Another group of predisposing factors that are related to higher odds of suffering from burnout are Individual traits, such as low sense of coherence, alexithymia, neuroticism, low extraversion, agreeableness, and conscientiousness (Aloha et al., 2017).
Despite abundant research on burnout and the disagreements about the concept, there is also no consensus on how to treat it (Aloha et al., 2017). However, a consensus of the published studies is that most intervention programs for preventing burnout aim to empower individuals and reduce their experience of stressors. Interventions can be categorised as persondirected (individual/groups), organization-directed or a combination of both person- and organization directed aspects. Person-directed intervention programs are usually cognitive behavioural measures aimed at enhancing job competence and personal coping skills, containing social support elements or different kinds of relaxation exercises. Organizationdirected interventions on the other hand are usually changes in work procedures, containing task restructuring, work evaluation and supervision aimed at decreasing job demand, increasing job control or the level of participation in decision making (Awa et al., 2010).
If one intends to learn about the effectiveness of scientifically established interventions for a psychologically significant phenomena like burnout, IS HYPNOSIS AN EFFECTIVE INTERVENTION FOR BURNOUT? – 19 – 2018, Volume 42, No. 4 meta-analyses or systematic reviews are usually the first sources to examine. These are acknowledged as reliable resources for evidence based intervention strategies. However, these reviews usually include only a few relevant research articles, due to their restrictive study-selecting procedures and inclusion criteria in regard of the quality of research design and reporting statistic indices.
As an unfortunate result, recent meta-analyses and systematic reviews that investigate the effectiveness of interventions aiming to prevent occupational stress or burnout include none (e.g Awa et al., 2010; Ruotsalainen, Verbeek, Mariné, & Serra, 2015; Maricutoiu, Sava, & Butta, 2016; Aloha et al., 2017) or only a few (e.g Fisch, Brinkhaus, & Teut, 2017) interventions that use hypnotherapy or medical suggestions, despite including interventions that use relaxation or meditation techniques. Nicole Ruysschaert in her essay on the topic (Ruysschaert, 2009) also emphasises that her search on Pubmed and the National Library of Medicine of the terms ‘hypnosis and burnout’, ‘hypnosis and vicarious traumatization’, ‘hypnosis and compassion fatigue’ yielded no results.
There are, however, some published studies on promising interventions that exemplify how hypnosis can be effectively used in stress reduction and burnout. Fisch, Brinkhaus & Teut (2017) collected evidence in their systematic review for how hypnosis influences perceived stress.
One such example is that of Norman R. Barling and Susan J. Raine (2005) who examined the effect of hypnosis on stress-related diseases like depression, burnout and anxiety. They used three types of treatment processes, which were designed to differentiate the deepness of hypnosis. Level one, light trance induction was progressive muscle relaxation (PMR), level two was guided imagery, and level three was deep trance, using specific mindbody healing language, which targeted the boosting of the immune system response. The participants were randomly allocated to a treatment group, and hypnotised according to the standardised script for that particular group and the intervention for each session was also recorded on audiotape. Participants were asked to continue listening to the recorded intervention for three to four weeks, and to record their frequency of use. In order to assess the level of burnout, stress, anxiety and depression, selfreported Depression Anxiety Stress Scale and Burnout Assessment Test were administrated before and after the treatment session. They also took a sample of Saliva Immunoglobulin A as an indicator of prolonged stress and humoral immune system response.
The scores of burnout and anxiety decreased after the light-trance hypnosis, but there was no significant change for depression, stress, and immunity. According to the authors this means that PMR is an indicator of light trance, as it physically relaxes the person and may reduce anxiety symptoms and in turn may reduce burnout pressure to a significant degree. But their results also suggest that PMR as a hypnotic intervention is not powerful enough to modify depression and stress measured by Depression Anxiety Stress Scale and Saliva Immunoglobulin A.
The guided imagery group also showed significant changes in all the negative effect variables (burnout, stress, anxiety, depression) but there were no significant changes in Immunity measures (in saliva). In the authors’ opinion this supports the suggestion that hypnotic induced guided imagery, releasing negative feelings and memories, taking a subject into a deeper level of trance after relaxation, lays the groundwork for powerful change, but an extra component is required to affect immunity. There were also significant differences in changes in burnout, depression and anxiety between the control group and the deep-trance group. In this case, significant difference was recorded between the pre-and post-saliva Immunoglobulin A, as well. The authors say, this shows that deep trance significantly reduces negative emotional affect and improves immunocompetence.
Based on their results they concluded that hypnosis can be an effective way to prevent or cope with stress-influenced diseases (Barling & Raine, 2005). Fisch, Brinkhaus & Teut (2017) in their systematic review, however, highlight a methodological concern that Barling & Raine (2005) did not report in detail what kind of hypnotherapeutic techniques were used in their study, which makes it difficult to understand exactly how to use effectively hypnosis in such diseases.
When trying to pursue more ways of using hypnosis in burnout, we can also follow a practical approach. Nicole Ruysschaert (2009) in her essay describes possibly effective hypnosis techniques in burnout, based on theoretical considerations. She raises the question, whether prevention is the responsibility of organizations or the individual. Her answer is that working and offering help on both sides increases the chances of the effect of the intervention. She describes in detail different methods and levels of possible intervention, based on the thought that recovery from burnout can take months so prevention is the best cure. She presents a variety of techniques for self-care, stress control, debriefing, self-awareness and affect management, setting boundaries, increasing resilience, getting access to resources, reconnecting with engagement and reliving or celebrating job satisfaction. She describes a technique, an example of a strategy for selfprotection, where in order to experience safety and protection the individual can imagine a protective shield or a bubble around themselves. After this, and after each described technique, she also gives the text of induction. In her essay she concludes that hypnosis can be integrated into different aspects of prevention: possible relationships between empathy and hypnotisability can be seen as an additional motivation to give hypnosis more attention in the approach.
This leads us back to the field of research studies, in which reside the necessary tools for examining the effectiveness of such techniques. Such studies with accurate research methods are needed especially because burnout interventions focusing on individuals seem to reduce burnout in the short term (6 months or less), and although a combination of both person and organization-directed interventions seem to have longer lasting positive effects (12 months and over), eventually in both cases, positive intervention effects tend to diminish over time (Awa et al, 2010). Could the effectiveness of burnout interventions be enhanced by involving hypnosis techniques? Meta-analyses of research studies on burnout interventions also highlight that cognitive-behavioural interventions and interventions based on relaxation techniques seem to be effective only for reducing emotional exhaustion symptoms of burnout, thus new types of interventions would be needed, to address depersonalization and personal accomplishment as well (Maricutoiu et al., 2016). Could interventions using hypnosis techniques address these two dimensions of burnout effectively?
Overall the effectiveness of hypnosis or hypnotherapy in stress reduction and burnout prevention remains unclear, as current reviews studying the question conclude that the role of hypnosis in stress reduction has to be investigated more thoroughly by using precise research methods (Fisch, et al., 2017). Until then, with some promising research results and theoretically based practical approaches we may move in small steps towards answering the title’s question – Is Hypnosis an Effective Intervention in Burnout?
Noémi Balázs
Health psychologist Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary Noémi Balázs is a health psychologist working at a Hungarian Foundation called Mental Health for Wellbeing, and a PhD student at the Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary. Her research is connected to stress and burnout, and interventions for preventing them. Prof. Róbert Urbán is her supervisor of the PhD studies, at the Department of Personality and Health Psychology, ELTE.
Anna Leszovszki
BA Student in Psychology ELTE Eötvös Loránd University, Budapest, Hungary Anna Leszkovszki is a psychology BA student at Eötvös Loránd University in Budapest. Her areas of interests are sport psychology, and work and organisational psychology. She is looking forward to start her master psychology studies next year.
REFERENCES
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- Awa, W. L., Plaumann, M., & Walter, U. (2010). Burnout prevention: A review of intervention programs. Patient Education and Counseling, 78, 184–190. – 21 – 2018, Volume 42, No. 4
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