Burnout Group for work stress

The article below on the development and evaluation of the Burnout Group was originally published in CBT Today magazine (December 2024 edition), the official magazine for all BABCP members.

A pilot of a stress management group for Health and Social Care staff 
Ciara James and Dr Chloe Schneider

Frontline workers are at increased risk of higher rates of depression, anxiety and PTSD symptoms due to repeated ongoing exposure to stressful and traumatic work situations (Wild et. al, 2021; Gilleen et. al, 2021). As a CBT Therapist working in an NHS staff mental health hub, my team and I have encountered many colleagues describing the negative emotional impact of organisational pressures on their psychological wellbeing. With nearly 42% of staff having felt unwell as a result of work-related stress in the past 12 months (NHS Staff Survey, 2023), the long-term consequences of ongoing systemic pressures to healthcare staff’s psychological wellbeing are significant. With many employees facing low staffing levels, excessive workloads, high targets, reduced access to resources and increased patient complexity, the knock-on effects can range to low team morale, longer waiting lists, lower staff retention rates and increased sickness. Difficulties relating to mental health are the most frequent reason for sickness absence amongst NHS employees (NHS Digital, 2024).

We know that health and social care workers will be impacted by unpleasant, traumatic and stressful scenarios in the workplace. It has been interesting to observe how many staff referring to our hub are unfamiliar with the concepts of moral distress, moral injury, compassion fatigue or vicarious trauma. This is corroborated by a British Medical Association study that reported how over 40% of doctors were not aware of the term moral distress, despite 80% resonating with this feeling in light of their work experiences (BMA, 2021). If we as clinicians fail to recognise these narratives experienced by frontline staff, we risk potentially invalidating their response to the emotionally distressing situations they find themselves in as general low mood or anxiety symptoms. Failure to acknowledge, educate and empathise with such reactions in ourselves, our colleagues and patients may indirectly reinforce feelings of isolation, guilt and distorted beliefs of not being resilient enough.

As individuals who have previously undertaken CBT trainings in Talking Therapies services, we are very much acquainted with CBT stress management protocols and the famous stress bucket analogy! From listening to staff accessing our hub, we wondered whether CBT stress management interventions might have limitations with the health and social care sector population. For example, how can we utilise cognitive restructuring effectively with a paramedic whose reality over the past decade of employment includes attending to frequent violent calls on a weekly basis? How can a nurse successfully employ assertiveness techniques and decline attending to extra patients on a significantly short-staffed ward, when saying “no” could literally result in a life-or-death situation for the patient? How can we expect a hospital doctor to meaningfully stick to principles of behaviour activation, when they are unexpectedly and repeatedly called in on days off to cover extra shifts with little notice?

This is of course not a criticism of utilising CBT protocols for stress management interventions - we know that many CBT protocols are extremely effective in reducing stress and have a clear evidence-base. However, the frequent calls from staff members struggling with work stress did pose a question in our hub of whether we could do more to support our colleagues.

Developing the Burnout Group

The lightbulb moment came in 2022 when an attendee from a previous group intervention suggested we could set up a “burnout” group for staff members to come together in a shared space to acknowledge the realities of work stress and learn about coping skills. Reflecting on this suggestion in consideration of the distinctive stress presentations we encountered in our service, the answer lay in us adopting an integrated, flexible group model for work stress. Keen to trial an adapted psychological intervention for this cohort to account for occupational challenges, we also wanted to uphold and maintain empirically-validated practices. With evidence emerging that some components of Acceptance and Commitment Therapy (ACT) are helpful for preventing stress and burnout among healthcare professionals (e.g. Towey-Swift et. al, 2023; Stafford-Brown & Pakenham, 2012), we created a group intervention modelled on ACT protocols with CBT elements.

In February 2023, we ran our first six-week “Burnout Group” pilot for health and social care staff referring to the service for work stress. The response to the Trust communications was encouraging, referrals flooded our inbox, and we set about assessing and discussing with staff whether this might be a useful intervention for them. The 1.5-hour sessions were conducted via video-call with a CBT Therapist and Assistant Psychologist with a closed group of 12 attendees to promote consistency and psychological safety within the sessions. As we had envisioned an interactive group to encourage the sharing of experiences, we incorporated group discussions, Menti forums, mindfulness meditations, powerpoint presentations and breakout rooms.

Outcomes and Reflections

Pre-and post-intervention outcomes were assessed by the PHQ-9, GAD-7 and Personal Burnout and Work-Related subscales of the Copenhagen Burnout Inventory. We were pleased to see positive outcome results along with affirmative group feedback, which provided further rationale to continue offering the group. Since the initial pilot, we have delivered five more groups with health and social care staff across all bandings, roles and teams. Outcome findings from our groups have shown:

• 79% and 67% of staff members clinically recovered on PHQ-9 and GAD-7 measures, respectively

• 56% of staff members reliably recovered and reliably improved on both measures, and 9% reliably improved

• Scores for symptoms of Personal Burnout dropped by 7.56 points, and scores for symptoms of Work-Related Burnout dropped by 9.48 points across all groups

• 42% of attendees reported improvements in their ability to cope with work, deliver a quality service to their patients and their ability to attend work

• 23% of attendees reported a reduction in likelihood in leaving their current role

We have just completed our sixth group, and with this article hope to present the preliminary findings into the public domain. Facilitating the Burnout Group has been a valuable learning experience for us in empowering, supporting and looking after colleagues, teams and ourselves. Consistent positive feedback from the attendees highlighting the importance of having a validating dedicated space has made us more determined than ever to continue offering the group sessions.

Despite the evidence that for every £1 spent on staff wellbeing initiatives there is at least a £5 return on investment currently (Deloitte, 2022), ring-fenced funding for staff and mental health wellbeing programmes has been significantly reduced (NHS England, 2024). Investment in effective bespoke psychological support initiatives for health and social care staff is needed more than ever.

We could all benefit from pausing from our busy working days and recognising our achievements during these trying times. We hope that this article provides a little inspiration in reminding us that it is perfectly ok to put our wellbeing first and be accepting of that compassion for ourselves and our peers.

References

Wild, J., McKinnon, A., Wilkins, A., & Browne, H. (2021). Post-traumatic stress disorder and major depression among frontline healthcare staff working during the COVID-19 pandemic. British Journal of Clinical Psychology, 61 (3), 859-866.

Gilleen, J., Santaolalla, A., Valdearenas, L., Salica, C., & Fuste, M. (2021). Impact of the Covid-19 pandemic on the mental health and well-being of UK healthcare workers. BJPsych Open, 7 (88), 1-12.

NHS Staff Survey Results 2023: National-Results-Briefing-2023- V3.pdf

NHS Digital: NHS Sickness Absence Rates 2024: NHS Sickness Absence Rates, February 2024 - NHS England Digital

BMA Moral Distress Survey 2021: Moral distress in the NHS and other organisations (bma.org.uk)

Towey-Swift, K.D., Lauvrud, C. & Whittington, R. (2023). Acceptance and commitment therapy (ACT) for professional staff burnout: a systematic review and narrative synthesis of controlled trials. Journal of Mental Health, 32 (2), 452-464.

Stafford-Brown, J., & Pakenham, K. I. (2012). The effectiveness of an ACT informed intervention for managing stress and improving therapist qualities in clinical psychology trainees. Journal of Clinical Psychology, 68 (6), 592–513.

Deloitte, (2022). Mental health and employers: The case for investment – pandemic and beyond: deloitte-uk-mental-health-report-2022.pdf

NHS England Staff Mental Health and Wellbeing Hubs Update: NHS England » Staff mental health and wellbeing hubs

While burnout includes many of the same symptoms as stress, there are three specific feelings that differentiate burnout:

• Feeling tired or exhausted
• A lack of enthusiasm and increased negativity towards your job
• Decreased ability to perform your job

Often, burnout results in depressive symptoms, such as sadness or a lack of hope. But it can also contribute to a wide range of negative emotions and even physical symptoms, such as:

• Frustration or anger
• Irritability or annoyance
• Anxiety, agitation, or restlessness
• Physical feelings of stress, such as headaches, stomach issues, body pains, or fatigue

Source: www.stress.org