[Attachment Representation and Emotion Regulation in Patients with Burnout Syndrome]. / Repräsentationen früher Bindungsbeziehungen und Emotionsregulation bei Patienten mit Burnout-Syndrom.

OBJECTIVE: Burnout describes a syndrome of exhaustion resulting from insufficient coping with work-related distress. We investigated if patients that are being clinically treated for burnout show insecure and unresolved attachment representation more often compared with healthy controls. METHODS: 50 out of 60 consecutive burnout patients participated in the study. Mental representation of attachment was measured by using the Adult Attachment Interview. Additionally, we administered the Self Report Questionnaire to Assess Emotional Experience and Emotion Regulation and several burnout specific questionnaires. A population sample was used as control group. RESULTS: Burnout patients were classified as insecurely attached significantly more often than controls. Unresolved attachment status concerning loss or trauma was found significantly more often within the burnout sample. Patients with insecure attachment representation reported a lower subjective significance of work. Patients with avoidant insecure attachment showed more depersonalisation. Patients with unresolved loss/trauma reported less social support. They showed more passive-negative emotion experience and emotion regulation characterized by externalization. CONCLUSION: The results of the study suggest that an insecure or unresolved attachment representation might constitute an intrapersonal risk factor for the development of burnout syndrome.

Inpatient and Day Hospital Treatment of Patients with Depression and Job-related Burnout.

OBJECTIVE: Burnout is a process of physical and emotional exhaustion that often results in clinical depression. Detailed descriptions and evaluations of specialized psychosomatic treatment are rare. This pilot study investigates the feasibility of inpatient and day hospital treatment of patients with burnout syndrome. Additionally, we present results of an initial, noncontrolled, pre-post-evaluation of changes in symptoms and individual work-related risk factors for burnout. METHODS: Sixty-four consecutive patients with burnout syndrome were assessed before and after specialized multimodal treatment using a clinical symptom checklist (ICD-10 Symptom Rating) and burnout-specific instruments (Maslach Burnout Inventory, Occupational Stress & Coping Inventory). RESULTS: Patients' average age was 45 (range 23 to 61), 70% were currently employed, 24% in managerial positions or self-employed, and 89% diagnosed with an affective disorder. The average length of time off work due to illness in the past year was 13 weeks. Treatment lasted five weeks on average. After treatment, depression (p < 0.001; effect size d = 0.79), emotional exhaustion (p = 0.001; d = 0.41), and the subjective significance of work (p = 0.001; d = 0.36) decreased, while emotional distancing (p < 0.001; d = 0.56), balance and mental stability (p < 0.001; d = 0.38) and life satisfaction (p < 0.001; d = 0.37) increased. Clinical significance was determined using the Reliable Change Index. CONCLUSIONS: The treatment program described here is well accepted by patients with severe burnout. It contributes to positive changes in symptoms and work-related risk factors. Controlled studies are necessary to establish treatment efficacy.

Maternal Attachment Representation and Neurophysiological Processing during the Perception of Infants' Emotional Expressions.

The perception of infant emotions is an integral part of sensitive caregiving within the mother-child relationship, a maternal ability which develops in mothers during their own attachment history. In this study we address the association between maternal attachment representation and brain activity underlying the perception of infant emotions. Event related potentials (ERPs) of 32 primiparous mothers were assessed during a three stimulus oddball task presenting negative, positive and neutral emotion expressions of infants as target, deviant or standard stimuli. Attachment representation was assessed with the Adult Attachment Interview during pregnancy. Securely attached mothers recognized emotions of infants more accurately than insecurely attached mothers. ERPs yielded amplified N170 amplitudes for insecure mothers when focusing on negative infant emotions. Secure mothers showed enlarged P3 amplitudes to target emotion expressions of infants compared to insecure mothers, especially within conditions with frequent negative infant emotions. In these conditions, P3 latencies were prolonged in insecure mothers. In summary, maternal attachment representation was found associated with brain activity during the perception of infant emotions. This further clarifies psychological mechanisms contributing to maternal sensitivity.

Maternal representations of past and current attachment relationships, and emotional experience across the transition to motherhood: a longitudinal study.

Sad and anxious feelings are known to increase in the immediate postpartum period, whereas studies on new mothers' other emotional qualities such as anger are scarce. In laboratory studies, attachment security was found to be associated with effective emotion regulation in challenging situations. This study investigated attachment representations of experiences with parents and of current experiences with the partner as predictors of sad, anxious, and angry feelings across the transition to motherhood. Seventy-seven pregnant women in their third trimester were administered the Adult Attachment Interview and the Current Relationship Interview. The Differential Emotions Scale was given in pregnancy and at the infant's ages of 2 weeks, 2, 4, and 6 months, asking both mothers and fathers about maternal emotional experience. Sadness and anxiety increased 2 weeks postpartum and returned to below baseline over the following months, while anger did not change. Contrary to mothers with an insecure representation of their couple relationship, those with a secure representation reported and displayed increased sadness and anxiety 2 weeks after giving birth, from which they quickly recovered. For mothers secure in their representation of past attachment relationships with parents, an increase of low-level anger emerged 4 months postpartum, which did not occur in insecure participants and receded quickly. It can be concluded that secure representations of current and past attachment relationships help new mothers express and recover from negative emotions. These findings further elucidate the associations between attachment status and emotion regulation while adding a couple perspective.