The Effect of The Effect of Burnout on Burnout on

Cortisol Reactivity Cortisol Reactivity to a Laboratory to a Laboratory Stressor TaskStressor TaskEddie ErazoEddie Erazo

University of California, University of California, IrvineIrvine

BurnoutBurnout

Defined as chronic exhaustion of Defined as chronic exhaustion of a person’s energetic resources a person’s energetic resources as the result of an extended as the result of an extended period of stress period of stress

Involves negative outcomes such Involves negative outcomes such as emotional fatigue, physical as emotional fatigue, physical exhaustion, and mental exhaustion, and mental wearinessweariness Sleep disturbance, impaired Sleep disturbance, impaired

immunity, and cortisol alterationsimmunity, and cortisol alterations

CortisolCortisol

Stress hormone that is released in Stress hormone that is released in response to stressresponse to stress

Associated with negative physiological Associated with negative physiological outcomesoutcomes Affects metabolism, mental, immune and Affects metabolism, mental, immune and

endocrine system functionsendocrine system functions However, it IS a normal and necessary However, it IS a normal and necessary

part of healthy functioning, but not in part of healthy functioning, but not in chronically excessive or blunted levelschronically excessive or blunted levels

HPA AxisHPA Axis

Sympathetic Nervous SystemSympathetic Nervous System Fight/Flight Response (i.e. Heart Rate)Fight/Flight Response (i.e. Heart Rate)

Hypothalamic Pituitary Adrenal AxisHypothalamic Pituitary Adrenal Axis

Hypothalamus (CRH)

Pituitary Gland (ACTH)

Adrenal Gland Cortisol

Stressor

Cortisol and DiseaseCortisol and Disease

““So what?”So what?” Often, stress is Often, stress is chronicchronic in the form of in the form of

pressure from boss or work without the pressure from boss or work without the definite end of an definite end of an acuteacute stressor, such stressor, such as a speechas a speech

Repeated excessive cortisol reactivity Repeated excessive cortisol reactivity or a blunted response takes a toll on the or a blunted response takes a toll on the body and may lead to disease (i.e. CVD)body and may lead to disease (i.e. CVD)

Does burnout have an Does burnout have an effect on cortisol levels?effect on cortisol levels?

Lack of agreement as to whether Lack of agreement as to whether burnout increases, decreases, or has burnout increases, decreases, or has no effectno effect

Different findings depending on CAR Different findings depending on CAR or day-curve focusor day-curve focus

Important to determine whether Important to determine whether there is an effect to further research there is an effect to further research cortisol’s role in diseasecortisol’s role in disease

Burnout’s effect on Burnout’s effect on cortisolcortisol

For the most part, there is no effect in For the most part, there is no effect in CAR when the MBI is used to measure CAR when the MBI is used to measure burnoutburnout

Difficult to conclude an effect given the Difficult to conclude an effect given the small number of studies having used the small number of studies having used the constructs of burnout and cortisol levelsconstructs of burnout and cortisol levels

Further research is needed to help solidify Further research is needed to help solidify current findingscurrent findings

HypothesisHypothesis

The literature shows that burnout may not The literature shows that burnout may not have a definitive effect on cortisol levels have a definitive effect on cortisol levels in the absence of a stressor…in the absence of a stressor… hypothesize that subjects high on burnout will hypothesize that subjects high on burnout will

have greater have greater cortisol reactivity to a stressorcortisol reactivity to a stressor than subjects low on burnout.than subjects low on burnout.

High

Low

1 2 3 4 5

Cortisol

Hypothesis

Research MethodsResearch Methods

69 undergraduate students from the 69 undergraduate students from the human subjects pool at the human subjects pool at the University of California, Irvine (after University of California, Irvine (after exclusions)exclusions)

Burnout measured using the Burnout measured using the Maslach Burnout Inventory (MBI )Maslach Burnout Inventory (MBI )

Saliva samples, or salivettes, used to Saliva samples, or salivettes, used to measure cortisol levelsmeasure cortisol levels

Maslach Burnout Inventory Maslach Burnout Inventory (MBI)(MBI)

16 items broken into 3 subscales 16 items broken into 3 subscales Exhaustion (EX)Exhaustion (EX) Cynicism (CY)Cynicism (CY) Professional Efficacy (PE-Reverse Coded)Professional Efficacy (PE-Reverse Coded)

Rate how often they feel this way (0-6):Rate how often they feel this way (0-6): ““I feel emotionally drained from my work” I feel emotionally drained from my work”

(EX)(EX) ““I doubt the significance of my work” (CY)I doubt the significance of my work” (CY) ““In my opinion, I am good at my job” (PE)In my opinion, I am good at my job” (PE)

MBIMBI

Altered from “work” to “work/school Altered from “work” to “work/school (work)”(work)”

Divided subjects into 3 equal groups based Divided subjects into 3 equal groups based on scores for each subscaleon scores for each subscale

CY

High Average Low

EX

High Average Low

PE

High Average Low

Research DesignResearch Design Subject’s baseline cortisol and burnout Subject’s baseline cortisol and burnout

is found, followed by the stressor and is found, followed by the stressor and the rest periodthe rest period

Stressor involves a 5 minute interview-Stressor involves a 5 minute interview-like speech to an evaluative panellike speech to an evaluative panel

Baseline RecoverySpeechSamples:(Practice), 1 2, 3, 4, 5

Results: DemographicsResults: Demographics

Ethnicity:Ethnicity: Mostly Asian- 61% (especially Chinese- Mostly Asian- 61% (especially Chinese-

28%)28%) White- 16%White- 16% Latino- 9%Latino- 9% Other- 14%Other- 14%

Gender:Gender: Fairly even split- 52% female, 48% maleFairly even split- 52% female, 48% male

ResultsResults

Gender Differences in cortisol reactivity Gender Differences in cortisol reactivity (Males higher)(Males higher)

Repeated Measures ANOVA showed that Repeated Measures ANOVA showed that there was no effect between EX/CY/PE and there was no effect between EX/CY/PE and cortisolcortisol

However, PE graph showed differences in However, PE graph showed differences in reactivity to the speechreactivity to the speech

PE: Univariate ANOVA controlling for PE: Univariate ANOVA controlling for baseline and genderbaseline and gender All time points were tested for group differencesAll time points were tested for group differences Only the 3Only the 3rdrd time point (reactivity peak) was time point (reactivity peak) was

significantsignificant

Graph adjusted: High PE = High Graph adjusted: High PE = High burnoutburnout

Graph adjusted: High PE = High Graph adjusted: High PE = High burnoutburnout

SummarySummary

Burnout’s 3 subscales had different Burnout’s 3 subscales had different effects on cortisol reactivityeffects on cortisol reactivity

EX/CY had no significant effectEX/CY had no significant effect PE groups showed differences in PE groups showed differences in

cortisol cortisol Contrary to hypothesis, those high on Contrary to hypothesis, those high on

burnout (low PE) had blunted cortisol burnout (low PE) had blunted cortisol responses to the speechresponses to the speech

Possible ExplanationsPossible Explanations

Ironically, a lack of confidence (low PE) Ironically, a lack of confidence (low PE) may lead to apathy and prevent may lead to apathy and prevent psychological stress, which could psychological stress, which could reduce the release of cortisolreduce the release of cortisol

*High burnout level, with regard to PE, *High burnout level, with regard to PE, caused the blunted cortisol response to caused the blunted cortisol response to the speechthe speech This group may lack normal cortisol This group may lack normal cortisol

responses to stressful situations in generalresponses to stressful situations in general

ImplicationsImplications

Given the association, treatment Given the association, treatment may help:may help: Decrease burnout Decrease burnout

Cognitive TherapyCognitive Therapy

……in order to restore normal health, in order to restore normal health, including cortisol levels, and including cortisol levels, and decrease the risk of disease, such as decrease the risk of disease, such as CVD, diabetes, depression, etc.CVD, diabetes, depression, etc.

LimitationLimitation

College students are, in general, College students are, in general, more burnt out than the national more burnt out than the national averageaverage

Future research could use samples Future research could use samples more representative of the United more representative of the United StatesStates Effect sizes could be bigger and may Effect sizes could be bigger and may

reveal effects for EX and CYreveal effects for EX and CY

AcknowledgmentsAcknowledgments

Prof. Sally DickersonProf. Sally Dickerson Frank ZaldivarFrank Zaldivar Valerie JennessValerie Jenness Peggy MycekPeggy Mycek Health Responses Lab TeamHealth Responses Lab Team Social Ecology Honors StudentsSocial Ecology Honors Students