Petri Näätänen

The role of work-related personal projects during two burnout interventions: a longitudinal study

Burnout is nowadays a common problem among employees, and a new approach to reduce its extent is needed. This study looked at burnout interventions in terms of personal goals and/or projects. These represent what individuals are striving to achieve, and include work-related goals. Our aim was to examine the extent to which two kinds of burnout intervention, in the form of different types of psychotherapy, influence employees’ personal projects. The two types of therapy were psychoanalytic and experiential, both in the form of group therapy. To determine the extent, 62 employees who had contacted the Helsinki Occupational Health Services suffering from severe burnout participated, in the course of a single year, in 16 sessions of either analytic or experiential group psychotherapy. In addition, 28 employees suffering from severe burnout served as controls. All the participants filled in Littles Personal Project Analysis and the Bergen Burnout Indicator one month before the intervention, in the middle of the intervention and one month after the intervention. The results showed that among participants in the intervention groups the level of burnout decreased. Further, the number of work-related personal projects, project-related negative emotions, and tendencies towards negative action, decreased among those in the intervention groups compared to the control group. Moreover, project-related progress, social support and managing project-related emotions increased during the intervention. Finally, the results showed that when the negative emotions related to personal projects decreased during intervention, the level of burnout also decreased.

The relationship of respiratory sinus arrhythmia to the co-activation of autonomic and facial responses during the Rorschach test

We studied the relationship of respiratory sinus arrhythmia (RSA) to the co-activation of autonomic and facial expressive responses in 37 adult men during Rorschach testing. Interbeat interval (IBI), electrodermal activity, and facial electromyography were recorded continuously during the experiment. Prevailing mood and variability in the experience of valence and arousal were also measured. Bivariate intraindividual time series analysis was used to quantify spontaneously coupled phasic physiological responses. The results suggested that (a) spontaneous autonomic and expressive responses tend to parallel in time; (b) baseline, task-level, and task-induced change of RSA were positively related to coupled autonomic-expressive responses, a change in mood toward a more energetic state, and a tendency to have more variability in the emotional experience during the task; and (c) especially cardiac-expressive response coupling was related to mood change. It is concluded that the vagal system is related to the control of facial muscle activity and may mediate both tonic and phasic emotion-related changes in IBI. The role of phasic intraindividual response patterns in emotional and social behavior is highlighted.

The Influence of Alexithymic Characteristics on the Self-Perception and Facial Expression of a Physiological Stress State

Background: In spite of the connection of alexithymic characteristics to many stress-related disorders, little is known about the effects of these characteristics on the self-perception of stress, which may have functional value in the regulation of daily behavior. The present study assessed the influence of alexithymic characteristics on the self-perception of stress in relation to the corresponding physiological/expressive responses during and while recovering from a phasic stressor. Methods: A median split of the scores on the Toronto Alexithymia Scale was used to divide 32 healthy middle-aged men into two groups, a high alexithymia (HA) and a low alexithymia (LA) group. Both groups participated in a 3-min hand-grip task, followed by a 3-min recovery period. During these periods, subjects’ heart rate (HR) and facial electromyographical (EMG) activity on the corrugator supercilii and frontalis lateralis areas were measured and perceptions of exertion, unpleasantness and tension were self-rated. The perceptual style was assessed with the discrepancy scores: standardized scores of the physiological measures were subtracted from the corresponding standardized scores of the perceptions. Thus, positive scores indicated that self-reported perceptions exceeded the corresponding physiological or expressive activity (overestimation) and negative scores indicated the opposite (underestimation). Results: The HA group decreasingly underestimated exertion in relation to HR during the task and increasingly overestimated it during the recovery period. The HA group also overestimated unpleasantness in relation to the corrugator EMG response during the recovery period. Conclusions: High alexithymic characteristics seem to predispose to the delayed self-perception of physiological stress state so that the beginning of this state may remain subjectively unnoticed and the subjective recovery from it prolonged relative to the physical recovery. During this prolonged subjective recovery the feelings of unpleasantness are not facially expressed. The consequences of this style for health-related behavior are discussed.

Inhibited and disinhibited temperament and autonomic stress reactivity

We examined the relationship of temperament dimensions serving as markers for Grays behavioral activation system (BAS) and behavioral inhibition system (BIS) with autonomic stress reactivity in 35 middle-aged men. Temperament was measured using the Strelau Temperament Inventory--Revised. Skin conductance responses and inter-beat interval were measured during administration of the Rorschach test. The results showed that temperamental activation was positively related to the task-level of and task-induced change in respiratory sinus arrhythmia (RSA) amplitude, but unrelated to heart rate (HR) reactivity. Temperamental inhibition was negatively associated with the task-level of electrodermal activity and task-induced change in RSA amplitude, and positively associated with HR reactivity. The findings are in part contrary to the hypotheses presented in the literature. They also suggest that the temperamental inhibition-HR reactivity relationship is mediated by the parasympathetic nervous system.

The synchronization of electrodermal activity and heart rate and its relationship to energetic arousal: a time series approach

We examined the synchronization between indices of autonomic nervous system (ANS) function and its relation to multiple measures of arousal in 37 middle-aged men. Electrodermal activity (EDA), heart rate (HR), and subjective and behavioral arousal were measured during administration of the Rorschach test. Prevailing mood and depression were also measured. The relationship between phasic EDA and HR activity was assessed by constructing within-subjects time series models. The results showed that phasic EDA and HR accelerations were synchronized, while there was no association between tonic EDA and HR in between-subjects analysis. In addition, EDA-HR synchronization was positively associated with verbal activity, variability of arousal experience, and activation mood, and negatively associated with depression. It is suggested that within-subjects analysis of physiological time series data can further our understanding of the individual differences in ANS function and on the correlates of effector organ synchronization.

Development of sense of coherence during two group interventions

Burnout is a serious occupational hazard. This study investigated the possibility to develop an effective salutogenic group intervention among employees suffering from severe burnout symptoms. Participants consisted of employees aged 31 to 59 years working in different public service occupations, such as police officers, tax officers, (and other public service officers), and assigned to three different groups: analytic (N = 25), psychodramatic (N = 24) and controls (N = 28). The intervention comprised 16 separate days over a nine-month period. Changes in sense of coherence (SOC) were measured four times with the 13-item Orientation to Life Questionnaire during the intervention and at six-month follow-up, and analyzed by general linear model (GLM) and using Cohens d to estimate effect sizes. Change in SOC between the three groups was statistically significant (F(4,148) = 2.65, p = 0.036). The psychodrama group showed a higher increase in SOC than the analytic group during the intervention, while the improvement in the analytic group was significant during the six-month follow-up. Total effect size from baseline to follow-up was in the analytic group 0.71, in the psychodrama group 0.47, and in the control group from baseline to end of intervention 0.09. The results show that it is possible to improve SOC by group intervention in the occupational healthcare context. The dialogue-based analytic method and action-based psychodramatic method differ in their specific effects.

Differences and similarities of risk factors for suicidal ideation and attempts among patients with depressive or bipolar disorders

BACKGROUND Substantial literature exists on risk factors for suicidal behaviour. However, their comparative strength, independence and specificity for either suicidal ideation or suicide attempt(s) remain unclear. METHODS The Helsinki University Psychiatric Consortium (HUPC) Study surveyed 287 psychiatric care patients with ICD-10-DCR depressive or bipolar disorders about lifetime suicidal behaviour, developmental history and attachment style, personality and psychological traits, current and lifetime symptom profiles, and life events. Psychiatric records were used to confirm diagnosis and complement information on suicide attempts. Multinomial regression models predicting lifetime suicidal ideation and single or repeated suicide attempts were generated. RESULTS Overall, 21.6% patients had no lifetime suicidal behaviour, 33.8% had lifetime suicide ideation without attempts, and 17.1% had a single and 27.5% repeated suicide attempts. In univariate analyses, lifetime suicidal behaviour was associated with numerous factors. In multivariate models, suicidal ideation was independently predicted by younger age, severe depressive disorder, bipolar disorder type II/nos, hopelessness, and childhood physical abuse. Repeated suicide attempts were independently predicted by younger age, female sex, severe depressive disorder with or without psychotic symptoms, bipolar disorder type II/nos, alcohol use disorder, borderline personality disorder traits, and childhood physical abuse. LIMITATIONS Cross-sectional and retrospective study design, utilization of clinical diagnoses, and relatively low response rate. CONCLUSIONS Risk factors for suicidal ideation and attempts may diverge both qualitatively and in terms of dose response. When effects of risk factors from multiple domains are concurrently examined, proximal clinical characteristics remain the most robust. All risk factors cluster into the group of repeated attempters.

Confidence in work-related goals and feelings of exhaustion during a therapeutic intervention for burnout: A time-series approach

This study investigated recursive relations between confidence in achieving work-related goals and work exhaustion among employees who participated in an intervention to reduce their burnout. Thirty-six employees of age 33-59 years suffering from severe burnout (28 females and 8 males) filled in burnout and well-being measures before and after a 10-month therapeutic intervention. They also filled in weekly measures of confidence in work-related goals (progress and capability) and work exhaustion throughout the intervention, as well as 4 weeks before and 4 weeks afterwards. Intra-individual variation was modelled using dynamic factor analyses. The results showed that, for most participants, confidence in work-related goals and work exhaustion during a given week could be predicted from those of the preceding week. Moreover, high self-esteem predicted low weekly stability in goal confidence, whereas high burnout contributed to high weekly stability in work exhaustion. The intra-individual stabilities in goal confidence and exhaustion also predicted which of the participants benefited from the intervention in terms of increasing well-being and decreasing work-related stress.

Anxiety symptoms in a major mood and schizophrenia spectrum disorders

BACKGROUND Comorbid anxiety symptoms and disorders are present in many psychiatric disorders, but methodological variations render comparisons of their frequency and intensity difficult. Furthermore, whether risk factors for comorbid anxiety symptoms are similar in patients with mood disorders and schizophrenia spectrum disorders remains unclear. METHODS The Overall Anxiety Severity and Impairment Scale (OASIS) was used to measure anxiety symptoms in psychiatric care patients with schizophrenia or schizoaffective disorder (SSA, n=113), bipolar disorder (BD, n=99), or depressive disorder (DD, n=188) in the Helsinki University Psychiatric Consortium Study. Bivariate correlations and multivariate linear regression models were used to examine associations of depressive symptoms, neuroticism, early psychological trauma and distress, self-efficacy, symptoms of borderline personality disorder, and attachment style with anxiety symptoms in the three diagnostic groups. RESULTS Frequent or constant anxiety was reported by 40.2% of SSA, 51.5% of BD, and 55.6% of DD patients; it was described as severe or extreme by 43.8%, 41.4%, and 41.2% of these patients, respectively. SSA patients were significantly less anxious (P=0.010) and less often avoided anxiety-provoking situations (P=0.009) than the other patients. In regression analyses, OASIS was associated with high neuroticism, symptoms of depression and borderline personality disorder and low self-efficacy in all patients, and with early trauma in patients with mood disorders. CONCLUSIONS Comorbid anxiety symptoms are ubiquitous among psychiatric patients with mood or schizophrenia spectrum disorders, and in almost half of them, reportedly severe. Anxiety symptoms appear to be strongly related to both concurrent depressive symptoms and personality characteristics, regardless of principal diagnosis.

Self-reported symptoms of schizotypal and borderline personality disorder in patients with mood disorders

BACKGROUND Distinguishing between symptoms of schizotypal (SPD) and borderline personality disorders (BPD) is often difficult due to their partial overlap and frequent co-occurrence. We investigated correlations in self-reported symptoms of SPD and BPD in questionnaires at the levels of both total scores and individual items, examining overlapping dimensions. METHODS Two questionnaires, the McLean Screening Instrument (MSI) for BPD and the Schizotypal Personality Questionnaire Brief (SPQ-B) for SPD, were filled in by patients with mood disorders (n=282) from specialized psychiatric care in a study of the Helsinki University Psychiatric Consortium. Correlation coefficients between total scores and individual items of the MSI and SPQ-B were estimated. Multivariate regression analysis (MRA) was conducted to examine the relationships between SPQ-B and MSI. RESULTS The Spearmans correlation between total scores of the MSI and SPQ-B was strong (rho=0.616, P<0.005). Items of MSI reflecting disrupted relatedness and affective dysregulation correlated moderately (rφ varied between 0.2 and 0.4, P<0.005) with items of SPQ. Items of MSI reflecting behavioural dysregulation correlated only weakly with items of SPQ. In MRA, depressive symptoms, sex and MSI were significant predictors of SPQ-B score, whereas symptoms of anxiety, age and SPQ-B were significant predictors of MSI score. CONCLUSIONS Items reflecting cognitive-perceptual distortions and affective symptoms of BPD appear to overlap with disorganized and cognitive-perceptual symptoms of SPD. Symptoms of depression may aggravate self-reported features of SPQ-B, and symptoms of anxiety features of MSI. Symptoms of behavioural dysregulation of BPD and interpersonal deficits of SPQ appear to be non-overlapping.