Subtypes in clinical burnout patients enrolled in an employee rehabilitation program: differences in burnout profiles, depression, and recovery/resources-stress balance.

BACKGROUND: Burnout is generally perceived a unified disorder with homogeneous symptomatology across people (exhaustion, cynicism, and reduced professional efficacy). However, increasing evidence points to intra-individual patterns of burnout symptoms in non-clinical samples such as students, athletes, healthy, and burned-out employees. Different burnout subtypes might therefore exist. Yet, burnout subtypes based on burnout profiles have hardly been explored in clinical patients, and the samples investigated in previous studies were rather heterogeneous including patients with various physical, psychological, and social limitations, symptoms, and disabilities. Therefore, the aim of this study is to explore burnout subtypes based on burnout profiles in clinically diagnosed burnout patients enrolled in an employee rehabilitation program, and to investigate whether the subtypes differ in depression, recovery/resources-stress balance, and sociodemographic characteristics. METHODS: One hundred three patients (66 women, 37 men) with a clinical burnout diagnosis, who were enrolled in a 5 week employee rehabilitation program in two specialized psychosomatic clinics in Austria, completed a series of questionnaires including the Maslach Burnout Inventory - General Survey (MBI-GS), the Beck Depression Inventory, and the Recovery-Stress-Questionnaire for Work. Cluster analyses with the three MBI-GS subscales as clustering variables were used to identify the burnout subtypes. Subsequent multivariate/univariate analysis of variance and Pearson chi-square tests were performed to investigate differences in depression, recovery/resources-stress balance, and sociodemographic characteristics. RESULTS: Three different burnout subtypes were discovered: the exhausted subtype, the exhausted/cynical subtype, and the burned-out subtype. The burned-out subtype and the exhausted/cynical subtype showed both more severe depression symptoms and a worse recovery/resources-stress balance than the exhausted subtype. Furthermore, the burned-out subtype was more depressed than the exhausted/cynical subtype, but no difference was observed between these two subtypes with regard to perceived stress, recovery, and resources. Sociodemographic characteristics were not associated with the subtypes. CONCLUSIONS: The present study indicates that there are different subtypes in clinical burnout patients (exhausted, exhausted/cynical, and burned-out), which might represent patients at different developmental stages in the burnout cycle. Future studies need to replicate the current findings, investigate the stability of the symptom patterns, and examine the efficacy of rehabilitation interventions in different subtypes.

Psychophysiological Effects of a Single, Short, and Moderately Bright Room Light Exposure on Mildly Depressed Geriatric Inpatients: A Pilot Study.

BACKGROUND: Light interventions typically exert their mood-related effects during morning bright light exposures over several weeks. Evidence about immediate ambient room light effects on depressed individuals is still sparse. OBJECTIVE: The present study aimed at examining the acute effects of a single moderately bright room light exposure on mood, and behavioural and cardiac stress reactions of mildly depressed geriatric inpatients during a short cognitive stimulation and while resting. METHODS: Twenty-one inpatients were tested in a balanced cross-over design on 2 consecutive days under either conventional room light (standard light) or artificial sunlight conditions for 30 min. Room illumination was implemented with an artificial skylight, which perfectly imitated solar indoor illumination (e.g., cloudless sky and bright artificial sun). Light-induced changes of mood, heart rate, and heart rate variability were recorded while performing a perseveration test (acted as cognitive stimulation) twice. Additionally, light-related behaviour was observed during a resting period between the cognitive tests and various subjective ratings were obtained. RESULTS: Compared to standard light, exposure to artificial sunlight had a subjective calming effect over time (p = 0.029) as well as decreased heart rate and increased vagal tone (root mean squared of successive inter-beat intervals), both under cognitive workload and in resting conditions. Effect sizes of reported cardiac reactions were large. Cognitive variables were not influenced by light. Additionally, under the higher corneal illuminance of the artificial sunlight, patients perceived stronger glare (p = 0.030) and kept their eyes closed for longer times (p = 0.033) during the resting period. However, patients did not avoid bright light exposure while resting but voluntarily stayed within the area directly lit by the artificial sun nearly all the time (97%). CONCLUSION: To our knowledge, this study for the first time demonstrated immediate psychophysiological effects of a single, short room light exposure in mildly depressed geriatric inpatients during a short cognitive stimulation and while resting. The findings complement reported evidence on immediate alerting and mood-related effects of bright light exposures.

Disorder-specific internet-based cognitive-behavioral therapy in treating panic disorder, comorbid symptoms and improving quality of life: A meta-analytic evaluation of randomized controlled trials.

Compared to conventional face-to-face psychological treatments, internet-based cognitive-behavioral therapy (iCBT) presents an innovative alternative that has been found to be effective in the treatment of anxiety disorders. The current study provides a meta-analysis investigating the efficacy of disorder-specific guided self-help (Gsh) iCBT compared to various active and inactive control conditions, with focus on adult panic disorder sufferers with or without agoraphobia (PD/A). Systematic literature search yielded 13 randomized controlled trials (RCTs) (N = 1214) that met the eligibility criteria for this study. We found no statistically significant differences between Gsh iCBT and various active CBT interventions in reducing PD/A symptoms at both post-test (g = 0.015, k = 10) and follow-up (g = 0.113, k = 6) levels. Also, comorbid anxiety and depression were reduced equivalently at post-test (g = 0.004, k = 6) and follow-up (g = 0.004, k = 6). Quality of life was equally improved at post-test (g = -0.100, k = 5) and follow-up (g = 0.074, k = 2). When compared to inactive controls, we found large effect sizes in PD/A (g = -0.892, k = 9) and comorbid anxiety and depression (g = -0.723, k = 9) symptoms, and moderate change in quality of life (g = -0.484, k = 3) at post-test. There was no difference between Guided self-help iCBT and Self-help iCBT in PD/A (g = -0.025, k = 3) and comorbid anxiety and depression (g = -0.025, k = 3) at post-test. Baseline severity, country of original research and adherence to the treatment in form of initial uptake were identified as statistically significant moderators of the iCBT treatment.

[Problematic internet use (PIN)--a review of assessment questionnaires and risk factors]. / Problematisches Internetnutzungsverhalten (PIN)--eine Übersicht zu Messinstrumenten und Risikofaktoren.

Internet is nowadays an integral part of our lives. However, excessive internet use, which is in many ways comparable to substance addictions and behavioral addictions, has become of growing interest in popular media, health policy and scientific research. Nevertheless, there is still considerable controversy with respect to diagnostic criteria and assessment questionnaires, and the diagnosis does not yet appear in any official diagnostic system such as the DSM-5 or ICD-10. Due to the lack of consistent diagnostic criteria for problematic internet use and both the use of different assessment questionnaires and classification systems, the reported prevalence rates vary significantly across studies. Thus, the comparison of study results is limited.In this review article a brief overview of the various diagnostic criteria and assessment questionnaires as well as the prevalence of problematic internet use (PIN) will be given. Furthermore, several usage-related and person-related risk factors of PIN will be discussed. With regards to the latter, the focus will be on both sociodemographic and psychiatric risk factors and on personality traits.

[Biological basis of problematic internet use (PIN) and therapeutic implications]. / Biologische Grundlagen des Problematischen Internetnutzungsverhaltens (PIN) und therapeutische Implikationen.

The repetitive excessive use of internet has led to an increasing number of reports about the negative consequences of overuse and is now viewed as an important public health issue, although the diagnosis of internet addiction remains problematic. Increasing knowledge about the neurobiological mechanism of behavioral addictions will promote future research and is essential for the development of specific and effective treatment. Growing evidence suggests that the neurobiological substrates and pathways of internet addiction resemble those of substance dependency and other forms of behavioral addictions. This paper reviews the current neuroimaging findings and genetic influencing factors for problematic internet use (PIN)/internet addiction. Recent evidence from neuro-scientific studies has pointed out that certain dysfunctions in the prefrontal cortex possibly driven by impaired dopamine neurotransmission are related to symptoms of internet addiction. Finally the literature on psychological and pharmacological interventions for internet addiction will be discussed. However, due to a lack of methodological sound treatment studies in this field it is currently impossible to recommend any evidence-based treatment of internet addiction.