• Amrinder Babbra, M.S.

ACT and Float REST: A Solution to Burnout Syndrome?

Updated: Aug 25, 2018

Amrinder Babbra, M.S. - Director of Behavioral Research


Photo by Jordan Opel

Throughout my career working as a behavior therapist at in-home and school settings I have experienced teachers, therapists, and others in the human services industry give their all to individual clients and their families. In addition, I have witnessed caregivers, guardians, and/or parents reaching to superhuman lengths to just provide an opportunity for their children to improve the quality of their lives. Lost in the narrow focus of the client is the importance of self-care because “we do not have time”. A pragmatic perspective to the situation is, if we do not take good care of ourselves, we will not be at our best for those for the individuals that need us the most.


Within the field of behavior analysis, mental health can be aptly described as a foreign concept. Burnout is defined as a “prolonged response to chronic emotional and interpersonal stressors on the job” (Maslach, Schaufeli, & Leiter, 2001). Thus, burnout syndrome can be defined as a state of chronic stress that leads to physical and emotional exhaustion, cynicism, and detachment, and feelings of ineffectiveness and lack of accomplishment (Carter, 2013). Human services providers often develop burnout, along with psychological distress, including anxiety and depression (Hulsheger, Alberts, Feinholdt, & Lang, 2013; Killian, 2008). Those experiencing burnout are likely to have a number of somatic complaints, such as shortness of breath, headaches, gastrointestinal symptoms, sleeplessness, aches, and lingering colds (Freudenberger, 1974). In fact, the current literature indicates burnout syndrome, workplace stress, and management practices are directly associated with turnover rates, which can be costly to organizations (Arshadi & Damiri, 2013). The cost of turnover per employee can vary from 15% to more than 200% of an employee’s annual salary (Sundberg, 2016). In monetary terms, the average behavior therapist or registered behavior technician costs approximately $5,000 per person including talent search, recruitment, screening, onboarding, training, time to become proficient, and service gaps from lost staff (Sundberg, 2016). Although the current literature has looked primarily at human service providers, I believe burnout syndrome can be similarly applicable to caregivers, guardians, and parents. Unfortunately, American companies, universities, and the general public, unlike our European counterparts (particularly the Netherlands and Sweden) have been slow to recognize the rise, and by extension, the far-reaching effects of negative phenomenon.


One potential way to address burnout syndrome is through mindfulness. Mindfulness has been used therapeutically to foster effective behavioral and emotional responding to distress (Bishop, Lau, Shapiro, Carlson, Anderson, Carmody, & Devins (2004). In a systematic review of mindfulness training, decreases in job burnout were evident for healthcare professionals and teachers (Luken & Sammons, 2016).


In 1982, the clinical psychologist Steven Hayes, developed Acceptance and Commitment Therapy (ACT), a unique empirically established psychological intervention, based on the theoretical framework of Relational Frame Theory (RFT). ACT utilizes acceptance and mindfulness-based strategies, together with commitment and behavior change strategies, to increase psychological flexibility. ACT has been efficaciously used for chronic pain, anxiety, depression, addiction, and general stress – all issues relevant to burnout syndrome (for a recent meta-analytic review, see A-Tjak, Davis, Morina, Powers, Smits, & Emmelkamp (2015). One finding from previous ACT studies on chronic pain and workplace stress alike is that treatment effects are larger for psychosocial effects than they are for reductions in physiological symptoms (McCracken & Vowles, 2014; Bond & Bruce, 2000). Therefore, for a burnout syndrome intervention to be complete, it may be necessary to include an ancillary treatment to supplement ACT. One approach that directly addresses physiological symptoms is Float REST (Restricted Environmental Stimulation Therapy).


In 1954, the cognitive neuroscientist John Lilly, developed the sensory deprivation tank to access a wide range of healing, higher brain functions, and meditation through an unparalleled deep relaxation state. Float REST, which typically provides sensory isolation and deep relaxation by laying supine in a light-proof, sound-proof, zero-gravity tank with 10-12 inches of water and 1,200 pounds of Epsom salt for approximately an hour. Preliminary, noncontrolled studies on Float REST have shown promising results for ADHD, anxiety, burnout syndrome, depression, fibromyalgia, muscle tension pain, PTSD, and stress (Feinstein, Khalsa, Yeh, Wohlrab, Simmons, Stein, & Paulus, 2018; Kjellgren, Edebol, Nordon, & Norlander, 2013).


Previous research has indicated a combination of Float REST and psychotherapy results in a significant decrease in degree of anxiety and depression stemming from burnout syndrome and increased positive outlook in life. In addition, the research has indicated a significant decrease in extent of painful areas and intensity (Kjellgren, Buhrkall, & Norlander, 2011). However, the authors did not indicate the specific form of therapy that was provided to participants, nor did they parse the effects in a controlled, comparative way, or look to see if one treatment bolstered the other. In 2010, Vowles and McCracken determined that changes on acceptance and mindfulness-based coping measures following ACT better predicted pain related outcomes than did changes on traditional coping measures. Thus, one could reasonably conclude an acceptance and values-based treatment would be the perfect complement to Float REST in order to address both physiological and psychological components of burnout syndrome.


Our current aim is to examine whether participants that receive Acceptance and Commitment Therapy (ACT) with Float REST (Restricted Environmental Stimulation Therapy) will have larger decreases of the burnout phenomenon than those who receive either only ACT or Float REST. Given commercial float centers are becoming more popular and affordable, and that this study would be a pilot study for future research to establish a safe, cost-effective, additive treatment could improve the quality of life by reducing suffering and increasing psychological flexibility for many individuals in the human services industry and thus, by extension, to individual clients and their families.




This material is for general experimental purposes only and does not replace the work of a trained behavioral professional. All information suggested in this blog post should only be done within your own scope of understanding. If you need further assistance, please find a behavioral professional to consult with.




References:


Arshadi, N, & Damiri, H. (2013). The relationship of job stress with turnover intention and job performance: moderating role of OBSE. Procedia – Social and Behavioral Sciences, 84(2003), 706-710. http://doi.org/10.1016/j.sbspro.2013.06.631


A-Tjak, J., Davis, M., Morina, N., Powers, M., Smits, J., & Emmelkamp, P. (2015). Meta-Analysis of the Efficacy of Acceptance and Commitment Therapy for Clinically Relevant Mental and Physical Health Problems. Psychotherapy & Psychosomatics, 84,30-36.


Bishop, S.R., Lau, M., Shapiro, S., Carlson, L., Anderson, N.D., Carmody, J., & Devins, G. (2004) Mindfulness: A proposed operational definition. Clinical Psychology: Science and Practice, 11, 230-241. doi:10.1093/clipsy.bph077


Bond, F.W., & Bunce, D. (2000). Mediators of change in emotion-focused and problem- focused worksite stress management interventions. Journal of Occupational Health Psychology, 5, 156-163.


Carter, S. B. (2013, November 26). The Tell Tale Signs of Burnout...Do You Have Them? Retrieved from https://www.psychologytoday.com/us/blog/high-octane- women/201311/the-tell-tale-signs-burnout-do-you-have-them.


Feinstein, J. S., Khalsa, S. S., Yeh, H. W., Wohlrab, C., Simmons, W. K., Stein, M. B., & Paulus, M. P. (2018). Examining the short-term anxiolytic and antidepressant effect of Floatation REST. PLoS ONE 12(2).


Freudenberger, H. J. (1974). Staff Burn-Out. Journal of Social Issues, 30, 159-165.

doi:10.1111/j.1540-4560.1974.tb00706.x


Hülsheger, U. R., Alberts, H. M., Feinholdt, A., & Lang, J. B. (2013). Benefits of mindfulness at work: The role of mindfulness in emotion regulation, emotional exhaustion, and job satisfaction. Journal of Applied Psychology, 98(2), 310-325. doi:10.1037/a0031313


Killian, K. D. (2008). Helping till it hurts? A multimethod study of compassion fatigue, burnout, and self-care in clinicians working with trauma survivors. Traumatology, 14,32-44. doi:10.1177/15347656083


Kjellgren, A., Buhrkall, H., & Norlander, T. (2011). Preventing Sick-leave for Sufferers of High Stress-load and Burnout Syndrome: A Pilot Study Combining Psychotherapy and the Flotation Tank. International Journal of Psychology and Psychological Therapy, 11(2), 297-306.


Kjellgren, A., Edebol, H., Norden, T., & Norlander, T. (2013). Quality of Life with Flotation Therapy for a Person Diagnosed with Attention Deficit Disorder, Atypical Autism, PTSD, Anxiety, and Depression. Open Journal of Medical Psychology, 2,134-138.


Luken, M., & Sammons, A. (2016). Systematic review of mindfulness practice for reducing job burnout. American Journal of Occupational Therapy, 70, doi:10.5014/ajot.2016.01695


Maslach, C., Schaufeli, W. B., & Leiter, M. P. (2001). Job burnout. Annual Review of Psychology, 52,397-422. doi.org/10.1146/annurev.psych.52.1.397


Sundberg, D. B. (2016). Why People Quit Your Company and How Behavior Analysis Can Slow the Revolving Door At ABA Service Providers. Retrieved from https://bsci21.org/why-people-quit-your-company-and-how-behavior-analysis-can-slow-the-revolving-door-at-aba-service-providers.


Sundberg, D. B. (2016). The High Cost of Stress in the ABA Workplace. Retrieved from https://bsci21.org/the-high-cost-of-stress-in-the-aba-workplace.


Vowles, K. E., & McCracken, L. M. (2010). Comparing the influence of psychological flexibility and traditional pain management coping strategies on chronic pain treatment outcomes. Behaviour Research and Therapy, 48, 141-146. doi:10.1016/j.brat.2009.09.011

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