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Borderline and Burnout
Transcript of Borderline and Burnout
N = number of people in population
P = estimated variance in population, as a decimal
A = precision desired, expressed as a decimal
Z = based on confidence level
R = estimated response rate, as a decimal n = 620
with response rate of 60%, 50% variance, +/- 5% precision, 95% confidence (1.96), 10,000 people in population
n = 1610
with response rate of 60%, 50% variance, +/- 3% precision, 95% confidence (1.96), 10,000 people in population Characterized by:
Fear of Abandonment
Over-dependence on Others
Impulsivity Borderline Personality Disorder STEPPS Training Program 20 week treatment program for clients
Will be condensed into a 1 day, 6 hour training
6 Sessions will be used for training:
Review of Borderline Personality Disorder and description and education of schemas in BPD
Emotional Intensity Continuum
How to challenge maladaptive filters
Positive affirmations to reduce emotional intensity
Balancing problematic behaviors
Interpersonal boundaries MBI-HSS 22 Likert-scale questions
"never" to "everyday"
"I feel depressed at work"
"I have accomplished many worthwhile things in this job"
"I don't really care what happens to some recipients" Burnout Emotional Exhaustion
Low Personal Accomplishment Scoring Descriptive Statistics Internal Consistency
Emotional Exhaustion - .90
Depersonalization - .79
Personal Accomplishment - .71
Emotional Exhaustion - .82, .75, .60
Depersonalization - .60, .64, .54
Personal Accomplishment - .80, .62, .57 (Maslach, Jackson, Leiter, & Schaufeli, 1996) Low
Emotional Exhaustion </= 19
Depersonalization </= 5
Low Personal Accomplishment >/= 40
Emotional Exhaustion = 19-26
Depersonalization = 6-9
Low Personal Accomplishment = 34-39
Emotional Exhaustion >/= 27
Depersonalization >/= 10
Low Personal Accomplishment </=33 Overall Scoring Low
All 3 low
1 over low
1 over high
2 over high (Pena, Palomino, & Vallejos, 2012) (Maslach, Jackson, Leiter, & Schaufeli, 1996) (Blum, et al., 2008) (Pena, Palomino, & Vallejos, 2012) (Maslach, Jackson, Leiter, & Schaufeli, 1996) (American Psychiatric Association, 2000) Appropriate Sample Size Research Question Does STEPPS training for Borderline Personality Disorder effect burnout rates among clinicians? Hypotheses
There is no change in burnout rates after clinicians participate in a STEPPS training and education program.
There is a decrease in burnout rates after clinicians participate in a STEPPS training and education program. Conclusion
A paired-samples t-test was conducted to compare levels of burnout before and after the STEPPS treatment program. There was a significant difference in the pre-overall scores (M=3.52, SD=.577) and post-overall (M=1.68, SD=.709) scores for burnout; t(99)=20.287, p = 0.000.
A Durbin-Watson was run on the data to determine if the data was being influenced by another variable. All values were between 2.011 and 2.215, suggesting that there was no autocorrelation.
These results suggest that the STEPPS treatment does have an effect on burnout. Specifically, the results suggest that after participating in the STEPPS treatment program, counselor burnout decreases. Problem Statement
The problem is little systematic research has been done focusing on counselor burnout in relation to working with clients with BPD.
The purpose of this pre-test/post-test study with control examines the use of a training program, STEPPS, to reduce burnout rates among clinicians who treat individuals with BPD. Limitations
Factors of Burnout - personal accomplishment
Burnout "unethical" - skew results
More varied sample
Inpatient and Outpatient
MBI and CBI
DSM-V The high t-statistic suggests that the variables are serially correlated with one another, or that there is another influence on the variable.
This suggests the need for a test such as Durbin-Watson, which tests to see if the values are autocorrelated. References American Psychiatric Association. (2000). Borderline Personality Disorder. Diagnostic and statistical manual of mental disorders: DSM-IV-TR (4th ed., pp. 706-710). Arlington: Author.
Blum, N., St. John, D., Pfohl, B., Stuart, S., McCormick, B., Allen, J…Black, D.W. (2008) Systems Training for Emotional Predictability and Problem Solving (STEPPS) for outpatients with Borderline Personality Disorder: A randomized controlled trial and 1-year follow-up. Journal of Psychiatry, 165, 468-478.
Borschmann, R., & Moran, P. (2010). Crisis management in Borderline Personality Disorder. International Journal of Social Psychiatry, 57(1), 18-20. doi: 10.1177/0020764010106599
Borderline Personality Disorder: Treatment and management. (2009). National Institute for Health and Clinical Excellence, Clinical Guideline 78.
Bos, E. H., Bas van Wel, E., Appelo, M.T., Verbraak, M.J. (2011). Effectiveness of Systems Training for Emotional Predictability and Problem Solving (STEPPS) for Borderline Personality problems in a ‘real world’ sample: Moderation by diagnosis or severity? Psychotherapy and Psychosomatics, 80, 173-181. doi: 10.1159/000321793
Cambanis, E.V. (2012). Treating Borderline Personality Disorder as a trainee psychologist: Issues of resistance, inexperience, and countertransference. Journal of Child & Adolescent Mental Health, 24(1), 99-109. doi: 10.2989/17280583.2011.639075
Commons Treloar, A.J. (2009). Effectiveness of education programs in changing clinicians’ attitudes toward treating Borderline Personality Disorder. Psychiatric Services, 60(8), 1128-1131. Retrieved from http://ps.psychiatryonline.org/issue.aspx?journalid=18&issueid=3886 Commons Treloar, A.J., & Lewis, A.J. (2008). Professional attitudes towards deliberate self-harm in patients with borderline personality disorder. Austrailian and New Zealand Journal of Psychiatry, 42, 578-584. doi: 10.1080/00048670802119796
Krawitz, R. (2004). Borderline personality disorder: Attitudinal change following training. Austrailian and New Zealand Journal of Psychiatry, 38,554-559. doi: 10.1080/000486700675
Miller, G.D., Iverson, K.M., Kemmelmeier, M., MacLane, C., Pistorello, J., Fruzzetti, A.E...Crenshaw, K.Y. (2011). A preliminary examination of burnout among counselor trainees treating clients recent suicidal ideation and borderline traits. Counselor Education and Supervision, 50, 344-359
Pena, S.B., Palomino, S.L., Vallejos, J.R. (2012). Professional burnout among basic life support caregivers in the Basque Country. Emergencias, 24, 13-18.
Perseius, K.I., Kaver, A., Ekdahl, S., Asberg, M., & Samuelsson, M. (2007). Stress and burnout in psychiatric professionals when starting to use dialectical behavioural therapy in the work with young self-harming women showing borderline personality symptoms. Journal of Psychiatric and Mental Health Nursing, 14, 635-643. doi: 10.1111/j.1365-2850.2007.01146.x
Shanks, C., Pfohl, B., Blum, N., & Black, D.W.(2011). Can negative attitudes towards patients with Borderline Personality Disorder be changed? The effect of attending a STEPPS workshop. Journal of Personality Disorders, 25(6), 806-812. doi: 10.1521/pedi.2011.25.6.806
Vanheule, S., Rosseel, Y., & Vlerick, P. (2007). The factorial validity and measurement invariance of the Maslach Burnout Inventory for human services. Stress and Health, 23, 87-91. doi: 10.1002/smi.1124
Warner, R.M. (2008). Applied statistics: From bivariate through multivariate techniques. California: Sage Publications, Inc. References (cont'd) Clinician Interactions
negative view of individuals with BPD
heavy burden to work with
over-dependence and utilization of services
STEPPS training has been used to educate clinicians and improve their attitudes towards Borderline Personality Disorder The National Institute for Health and Clinical Excellence (2009), in their clinical guideline for diagnosis and management of Borderline Personality Disorder, stated the need for more training on diagnosis and management of Borderline Personality Disorder.
Perseius, Kaver, Ekdahl, Asberg, and Samuelson (2009) found that burnout played a large role in therapy and clinician interactions with clients with Borderline Personality Disorder.
They believe a burnout should be assessed, and studies should try and find a way to improve burnout in relation to Borderline Personality Disorder. Methods
Stratified Random Sampling of clinicians across the United States
Administer the MBI-HSS before and 6 months after attending a STEPPS training workshop at a national conference.
At least 5 years in the field
30 or more clients
At least 1 client with Borderline Personality Disorder A Pretest/Posttest Study (Cambanis, 2012; Commons Treloar, 2009; Commons Treloar & Lewis, 2008; Krawitz, 2004; Shanks, Pfohl, Blum, & Black, 2011)