Exploring key job demands and resources in Norwegian child mental health services: a cross-sectional study of associations with and relationship between compassion satisfaction, burnout, secondary traumatic stress and turnover intention.

Background: Burnout, secondary traumatic stress, and high turnover rates among child mental health clinicians are a challenge, not only for the individual therapist and the organization but also for the successful implementation of evidence-based practices. However, little is known about which and how job-and implementation-related factors are associated with burnout, secondary traumatic stress, and turnover intention as well as compassion satisfaction among child therapists. In the present study, we aimed to explore these factors and related mechanisms by integrating the "professional quality of life" and the "job demands-resources" models of occupational health. Methods: We measured the perceived professional quality of life and turnover intention among a national sample of 256 therapists working in Norwegian Child and Adolescence Mental Health Clinics (n = 44) that implemented Trauma-Focused Cognitive Behavior Therapy (TF-CBT). Seventeen Job-and implementation-related resources and demands were also measured using the General Nordic Questionnaire for Psychological and Social Factors at Work and the Implementation Component Questionnaire. Path analysis was used to test whether burnout and compassion satisfaction mediate the relationship between job demands and resources on one hand, and secondary traumatic stress and turnover intention on the other hand. Results and discussion: Results revealed that two job resources, i.e., positive challenges at work and mastery of work, were significant predictors of all professional outcomes. The proposed model was only partly supported. That is, while burnout did mediate the relationship between some job demands (i.e., work-family interference and role conflict) and job resources (i.e., human resource primacy, positive challenges, and mastery of work) with secondary traumatic stress and turnover intention, compassion satisfaction did not mediate the relationship between job resources and turnover intention. Moreover, in addition to their indirect effects via burnout, role conflict and organizational climate (human resource primacy) also directly affected turnover intention. These findings propose that interventions that reduce burnout should be prioritized to improve the professional quality of life and turnover intention among child therapists. Theoretically, it seems that compassion satisfaction and work engagement act differently.

Professional wellbeing and turnover intention among child therapists: a comparison between therapists trained and untrained in Trauma-Focused Cognitive Behavioral Therapy.

BACKGROUND: Poor professional wellbeing and job turnover is challenging for child mental health clinics and despite an increasing interest in implementing evidence-based practices (EBPs) in mental health services, little is known about if and how using EBPs may influence therapists' professional wellbeing and turnover intention. To investigate this, we compare the average level of compassion satisfaction, burnout, secondary traumatic stress, and turnover intention between therapists trained in an EBP (Trauma-Focused Cognitive Behavioral Therapy - TF-CBT) and untrained therapists. We also explore the prevalence of and the associations between these personal and organizational outcomes. METHOD: In this cross-sectional study, the data is collected from a national sample of 373 therapists 5 years after an implementation program began (i.e., in the sustainment phase). The variables were measured by the Professional Quality of Life and the Turnover Intention Scales. The Evidence-Based Practice Attitude Scale was also used to measure therapists' attitudes toward EBPs. RESULTS: Over 70% of the respondents reported medium to high levels of burnout, secondary traumatic stress symptoms, and compassion satisfaction, whereas one-third of the respondents reported a high level of intention to leave their job in the current or near future. Higher ratings on burnout and secondary traumatic stress were significantly associated with lower compassion satisfaction and higher turnover intention. Finally, we found significantly lower degree of burnout and turnover intention along with higher compassion satisfaction among TF-CBT therapists (n = 96), compared to other therapists who were not trained in TF-CBT (n = 231). These differences could not be explained by between-group differences in age, job tenure, educational background, or therapists' attitudes towards EBPs. However, mean differences in ratings on secondary traumatic stress symptoms were not statistically significant. CONCLUSION: Although the prevalence findings are in general alarming, the present study provides the first empirical evidence for a potential positive effect of being trained in TF-CBT on therapists' wellbeing and turnover intention. We discuss these findings in the light of self-efficacy theory and the job demands-resources model.

The effects of cognitive abilities and task demands on tonic and phasic pupil sizes.

Previous studies on individual differences in pupil size of healthy individuals and their relation to performance have been inconclusive. Using a novel approach, we tested the effect of general cognitive abilities and level of task performance on pretrial baseline and task-evoked pupil (TEP) sizes (N = 116) while we manipulated the level of task demands using a multiple object tracking task. Results did not reveal an effect of general cognitive abilities, estimated by working memory capacity and gF scores, on either baseline or TEP sizes. In contrast, we found an interaction in TEP sizes between level of overall MOT performance and task demands. We propose that individual differences in TEP sizes are related to state-specific level of task performance and task demands, probably in combination with other factors like age, personality traits, and state-specific level of motivation and arousal. We also suggest methodological confounds that may cause the previous inconclusive findings.

Pupillary and behavioral markers of alerting and orienting: An individual difference approach.

Measuring task-evoked pupillary (TEP) responses as an index of phasic activity in the locus coeruleus (LC), we examined two competing hypotheses regarding the alerting and orienting mechanisms of attention. According to a dual mechanism account (Fernandez-Duque & Posner, 1997), two separate noradrenergic and cholinergic mechanisms modulate, respectively, the alerting and orienting effects. However, Corbetta and colleagues (2008) proposed that LC phasic activity may also be involved in orienting effect through its functional relationship with the ventral attentional network. We recruited seventy-five healthy Norwegian participants to perform a Posner cueing task. Both behavioral and pupillary responses revealed the alerting effect. Also, both behavioral and pupillary responses indicated that cued attention is affected by age. Behavioral responses also revealed orienting effect However, we found no TEP differences between valid, invalid, and neutral conditions, suggesting that TEP effects were driven by the alerting effect of cue presentation. Moreover, both behavioral and pupillary estimates of alertness and orienting were uncorrelated. Finally, individual differences in general cognitive abilities did not appear to affect the orienting and alerting mechanisms. This pattern of results is consistent with the dual mechanism account of attention. However, the LC involvement in the (re)orienting attention may be driven by state-specific factors.

Measurement invariance of the moral vitalism scale across 28 cultural groups.

Moral vitalism refers to a tendency to view good and evil as actual forces that can influence people and events. The Moral Vitalism Scale had been designed to assess moral vitalism in a brief survey form. Previous studies established the reliability and validity of the scale in US-American and Australian samples. In this study, the cross-cultural comparability of the scale was tested across 28 different cultural groups worldwide through measurement invariance tests. A series of exact invariance tests marginally supported partial metric invariance, however, an approximate invariance approach provided evidence of partial scalar invariance for a 5-item measure. The established level of measurement invariance allows for comparisons of latent means across cultures. We conclude that the brief measure of moral vitalism is invariant across 28 cultures and can be used to estimate levels of moral vitalism with the same precision across very different cultural settings.

Individual differences in resting-state pupil size: Evidence for association between working memory capacity and pupil size variability.

Dynamic non-luminance-mediated changes in pupil diameter have frequently been shown to be a reliable index for the level of arousal, mental effort, and activity in the locus coeruleus, the brainstem's noradrenergic arousal center. While pupillometry has most commonly been used to assess the level of arousal in particular psychological states or the level of engagement in cognitive tasks, some recent studies have found a relationship between average resting-state (i.e. baseline) pupil sizes and individuals' working memory capacity (WMC), indicating that individuals with higher WMC on average have larger pupils than individuals with relatively lower WMC. In the present study, we measured pupil size continuously in 212 participants during rest (i.e. while fixating) and estimated WMC in all participants by administering the Letter-Number Sequencing (LNS) task from WAIS-III. We were unable to replicate the relation between average pupil size and WMC. However, the novel finding was that higher WMC was associated with higher variability in resting-state pupil size. The present results are relevant for the current debate on the role of noradrenergic activity on working memory capacity.

Ocular signatures of proactive versus reactive cognitive control in young adults.

During the execution of a cognitive task, the brain maintains contextual information to guide behavior and achieve desired goals. The AX-Continuous Performance Task is used to study proactive versus reactive cognitive control. Young adults tend to behave proactively in standard testing conditions. However, it remains unclear how interindividual variability (e.g., in cognitive and motivational factors) may drive people into more reactive or proactive control under the same task demands. We investigated the use of control strategies in a large population of healthy young adults. We computed the proactive behavioral index and consequently divided participants into proactive, reactive, and intermediate groups. We found that reactive participants were generally slower, presented lower context sensitivity, and larger response variability. Pupillary changes and blink rate index cognitive effort allocation. We measured, concomitantly to the task, the pupil size and frequency of blinks associated with the cue maintenance and response intervals. During the cue period, nonfrequent, nontarget cues led to increased pupil dilation and number of blinks in all participants. During the response interval, we found more errors and increased pupil dilation to the probe when all participants had to overcome a response bias generated by the frequent cue. Only reactive participants showed larger response-related pupil when they had to overcome a response bias related to the frequent probe. Contrary to expectations, groups did not differ in ocular measures in the cue period. In conclusion, interindividual differences in cognitive control between healthy adults can be mapped onto different patterns of effort allocation indexed by the pupil.

Another look at category effects on colour perception and their left hemispheric lateralisation: no evidence from a colour identification task.

The present study aimed to replicate category effects on colour perception and their lateralisation to the left cerebral hemisphere (LH). Previous evidence for lateralisation of colour category effects has been obtained with tasks where a differently coloured target was searched within a display and participants reported the lateral location of the target. However, a left/right spatial judgment may yield LH-laterality effects per se. Thus, we employed an identification task that does not require a spatial judgment and used the same colour set that previously revealed LH-lateralised category effects. The identification task was better performed with between-category colours than with within-category task both in terms of accuracy and latency, but such category effects were bilateral or RH-lateralised, and no evidence was found for LH-laterality effects. The accuracy scores, moreover, indicated that the category effects derived from low sensitivities for within-blue colours and did not reflect the effects of categorical structures on colour perception. Furthermore, the classic "category effects" were observed in participants' response biases, instead of sensitivities. The present results argue against both the LH-lateralised category effects on colour perception and the existence of colour category effects per se.