The "Burnout Clinical Subtype Questionnaire" (BCSQ-36/BCSQ-12): A new definition of burnout through a differential characterization of the syndrome

El exceso de estrés en el trabajo crea un caldo de cultivo para el síndrome de burnout, un estado de agotamiento a largo plazo y disminución del interés. Al estar sobrecargados con el trabajo, la monotonía y la percepción de falta de reconocimiento pueden ser catalizadores de burnout. Jesús Montero-Marín, autor de este trabajo, ha analizado los factores que influyen en el desarrollo de los tres perfiles de esta condición: frenético, sin motivación y desgastado, en función de las características del síndrome mostrado. El empleado "frenético" suele estar muy involucrado en su papel, es muy ambicioso y tiene una sobrecarga de trabajo de gran tamaño. El falto de motivación (Sub-challanged) es un trabajador que realiza tareas monótonas, con tendencia al aburrimiento y la falta de oportunidades de desarrollo personal. El perfil desgastado tiende a aparecer entre la gente que termina haciendo caso omiso de sus responsabilidades debido a la falta de control y la falta de reconocimiento que perciben en su entorno. El Cuestionario Subtipo Clínico Burnout (BCSQ-36 o BCSQ-12) se ha visto muy útil para evaluar las causas subyacentes del síndrome de burnout, que son de vital importancia para conocer el diseño de intervenciones específicas y estrategias de tratamiento

Towards a brief definition of burnout syndrome by subtypes: Development of the "Burnout Clinical Subtypes Questionnaire" (BCSQ-12)

<p>Abstract</p> <p>Background</p> <p>Burnout has traditionally been described by means of the dimensions of exhaustion, cynicism and lack of eficacy from the "Maslach Burnout Inventory-General Survey" (MBI-GS). The "Burnout Clinical Subtype Questionnaire" (BCSQ-12), comprising the dimensions of overload, lack of development and neglect, is proposed as a brief means of identifying the different ways this disorder is manifested. The aim of the study is to test the construct and criterial validity of the BCSQ-12.</p> <p>Method</p> <p>A cross-sectional design was used on a multi-occupational sample of randomly selected university employees (n = 826). An exploratory factor analysis (EFA) was performed on half of the sample using the maximum likelihood (ML) method with varimax orthogonal rotation, while confirmatory factor analysis (CFA) was performed on the other half by means of the ML method. ROC curve analysis was preformed in order to assess the discriminatory capacity of BCSQ-12 when compared to MBI-GS. Cut-off points were proposed for the BCSQ-12 that optimized sensitivity and specificity. Multivariate binary logistic regression models were used to estimate effect size as an odds ratio (OR) adjusted for sociodemographic and occupational variables. Contrasts for sex and occupation were made using Mann-Whitney U and Kruskall-Wallis tests on the dimensions of both models.</p> <p>Results</p> <p>EFA offered a solution containing 3 factors with eigenvalues > 1, explaining 73.22% of variance. CFA presented the following indices: χ²= 112.04 (p < 0.001), χ²/gl = 2.44, GFI = 0.958, AGFI = 0.929, RMSEA = 0.059, SRMR = 0.057, NFI = 0.958, NNFI = 0.963, IFI = 0.975, CFI = 0.974. The area under the ROC curve for 'overload' with respect to the 'exhaustion' was = 0.75 (95% CI = 0.71-0.79); it was = 0.80 (95% CI = 0.76-0.86) for 'lack of development' with respect to 'cynicism' and = 0.74 (95% CI = 0.70-0.78) for 'neglect' with respect to 'inefficacy'. The presence of 'overload' increased the likelihood of suffering from 'exhaustion' (OR = 5.25; 95% IC = 3.62-7.60); 'lack of development' increased the likelihood from 'cynicism' (OR = 6.77; 95% CI = 4.79-9.57); 'neglect' increased the likelihood from 'inefficacy' (OR = 5.21; 95% CI = 3.57-7.60). No differences were found with regard to sex, but there were differences depending on occupation.</p> <p>Conclusions</p> <p>Our results support the validity of the definition of burnout proposed in the BSCQ-12 through the brief differentiation of clinical subtypes.</p

A new definition of burnout syndrome based on Farber's proposal

<p>Abstract</p> <p>Background</p> <p>Although diverse definitions have been construed for burnout syndrome, most authors consider it to be a single phenomenon, the result of chronic work-related stress. However, in order to enable specific intervention strategies to be adopted, it is first necessary to establish different profiles for the syndrome. In this respect, have been proposed three burnout types ("frenetic", "underchallenged" and "worn-out"), each of which requires different means of dealing with frustration in the workplace. This study is an attempt to define and systematize the properties that characterize this typology proposal.</p> <p>Methods</p> <p>For this purpose, the documents considering preliminary typology were examined by means of qualitative content analysis supported by grounded theory. Semiotic analysis was then performed on the core category resulting from the previous analysis.</p> <p>Results</p> <p>A classification criterion, made up of three different burnout subtypes ("frenetic", "underchallenged", and "worn-out") capable of integrating the entire proposal was formulated.</p> <p>Discussion</p> <p>Understanding the development of burnout syndrome, as a succession of stages characterized by the progressive diminishing of dedication to work, could serve for the establishment of specific therapies and for the prevention of the syndrome.</p

Influence of liquid-to-biogas ratio and alkalinity on the biogas upgrading performance in a demo scale algal-bacterial photobioreactor

The influence of the liquid-to-biogas ratio (L/G) and alkalinity on methane quality was evaluated in a 11.7 m3 outdoors horizontal semi-closed tubular photobioreactor interconnected to a 45-L absorption column (AC). CO2 concentrations in the upgraded methane ranged from <0.1 to 9.6% at L/G of 2.0 and 0.5, respectively, with maximum CH4 concentrations of 89.7% at a L/G of 1.0. Moreover, an enhanced CO2 removal (mediating a decrease in CO2 concentration from 9.6 to 1.2%) and therefore higher CH4 contents (increasing from 88.0 to 93.2%) were observed when increasing the alkalinity of the AC cultivation broth from 42 ± 1 mg L−1 to 996 ± 42 mg L−1. H2S was completely removed regardless of the L/G or the alkalinity in AC. The continuous operation of the photobioreactor with optimized operating parameters resulted in contents of CO2 (<0.1%–1.4%), H2S (<0.7 mg m−3) and CH4 (94.1%–98.8%) complying with international regulations for methane injection into natural gas grids.Peer ReviewedPostprint (published version

Examining the psychometric properties of the burnout clinical subtype questionnaire (BCSQ-12) in secondary school teachers

Based on Farber’s burnout proposal, the first aim of this study was to examine the psychometric properties of the short version of the Burnout Clinical Subtype Questionnaire (BCSQ-12) in secondary school teachers. The second aim of the study was to examine possible differences in the burnout subtypes in terms of gender, type of school, and teaching experience. Two different samples of 584 (M¿=¿45.04; 43% males) and 106 (M¿=¿45.50; 40% males) secondary school teachers participated in the study. Results obtained from both the exploratory structural equation modeling (ESEM) and the confirmatory factor analysis (CFA) supported the three-factor structure of the BCSQ-12, comprised of overload, lack of development, and neglect. Further, the BCSQ-12 showed adequate composite reliability. The negative relationships between the three-factor structure of burnout, teachers’ basic psychological need satisfaction, and teachers’ job satisfaction provide evidence of the nomological validity of BCSQ-12. Finally, female teachers, state school teachers, and experienced teachers reported a greater risk of suffering one or more of these three burnout subtypes. Theoretical, methodological, and practical contributions of the BCSQ-12 are discussed, highlighting the importance of assessing the three burnout subtypes separately

Validación del Cuestionario de Subtipos Clínicos de Burnout BCSQ-36 en personal de Atención Primaria

Realizar un análisis factorial confirmatorio (AFC) y un análisis de fiabilidad del cuestionario de subtipos clínicos de burnout (BCSQ-36) tomando como muestra a personal sanitario de Atención Primaria de la provincia de Zaragoza. El cuestionario BCSQ-36, está diseñado para evaluar los subtipos de butnout: frenético, sin desafíos y desgastado. Hemos analizado, además, que patrones de asociación tienen los tres subtipos de burnout con los constructos: afecto positivo y negativo, autoestima basada en el rendimiento, injusticia percibida, mindfulness y resiliencia

Facilitadores y obstáculos de una intervención psicoterapéutica asistida por ordenador para la depresión en atención primaria: un estudio cualitativo

El objetivo principal de esta tesis doctoral es analizar en profundidad el impacto que puede tener la implementación de una intervención psicoterapéutica asistida por ordenador para la depresión leve y moderada en atención primaria. Para ello se realizan dos estudios cualitativos y se construyen sendas taxonomías de facilitadores y obstáculos de la implementación exitosa de la intervención. En el primer estudio se encuentran diferentes posiciones discursivas, en aparente conflicto, en los tres agentes implicados en el proceso psicoterapéutico: pacientes, médicos de atención primaria y gestores del sistema de salud. Los tres agentes implicados muestran su aceptación de la medida, la consideran innovadora y valoran sus eventuales efectos positivos en el tratamiento de la depresión. Pero al tiempo, los médicos señalan la importancia de que la medida lejos de incrementar su carga de trabajo debería reducirla, los gestores apuntan a la importancia de que permita el acceso a tratamiento a los usuarios del sistema de forma coste-efectiva y los pacientes esperan poder mantener una atención individualizada y especializada. El segundo estudio, sobre la base del modelo resultante en el primer estudio, profundiza en la experiencia de los pacientes tras participar en un ensayo clínico controlado y aleatorizado con la psicoterapia asistida por ordenador. El modelo emergente subraya la importancia de los aspectos relacionales, como la alianza terapéutica, y el rol fundamental que juega la supervisión de un especialista en la adherencia con el tratamiento en la fase intermedia y de mantenimiento del proceso psicoterapéutico. En conjunto, los resultados de esta tesis doctoral apuntan a que la psicoterapia asistida por ordenador puede implementarse satisfactoriamente en atención primaria. Los participantes muestran una aceptación positiva siempre y cuando se cubran ciertas necesidades particulares y el proceso esté supervisado por salud mental. Se discuten las posibilidades existentes dentro del funcionamiento específico del sistema nacional de salud español y la relevancia al respecto de los modelos de interfaz entre atención primaria y salud mental. Referencias: Andersson G, Cuijpers P. Internet-based and other computerized psychological treatments for adult depression: a meta-analysis. Cogn Behav Ther. 2009; 38:196-205. Andersson G, Cuijpers P, Carlbring P, Riper H, Hedman E. Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: a systematic review and meta-analyses. World Psychiatry. 2014; 13:288-95. Barley EA, Murray J, Walters P, Tylee A. Managing depression in primary care: a meta-synthesis of qualitative and quantitative research from the UK to identify barriers and facilitators. BMC Fam Pract. 2011; 12:47. Bennett-Levy J, Richards DA, Farrand P, Christensen H, Griffiths KM, Kavanagh DJ et al. Oxford guide to Low Intensity CBT Interventions. Oxford: Oxford University Press; 2010. Bower P, Gilbody S. Stepped care in psychological therapies: access, effectiveness and efficiency. Narrative literature review. Br J Psychiatry. 2005; 186:11-7. Chisholm D, Sweeny K, Sheehan P, Rasmussen B, Smit F, Cuijpers P et al. Scaling-up treatment of depression and anxiety: a global return on investment analysis. Lancet Psychiatry. 2016; 3:415-24. Clark DM, Layard R, Smithies R, Richards DA, Suckling R, Wright B. Improving access to psychological therapy: initial evaluation of two UK demonstration sites. Behav Res Ther. 2009; 47(11):910-20. Cuijpers P, Andersson G, Donker T, van Straten A. Psychological treatment of depression: results of a series of meta-analyses. Nord J Psychiatry. 2011; 65(6):354-64. Elkin I, Gibbons RD, Shea MT, Sotsky SM, Watkins JT, Pilkonis PA et al. Initial severity and differential treatment outcome in the national institute of mental health treatment of depression collaborative research program. J Consult Clin Psychol. 1995; 63(5):841-7. Ferrari AJ, Charlson FJ, Norman RE, Patten SB, Freedman G, Murray CJL et al. Burden of depressive disorders by country, sex, age and year: findings from the Global Burden of Disease Study 2010. PLoS Med. 2013; 10(11):e1001547. doi:10.1371/journal.pmed.1001547. Hardeveld F, Spijker J, De Graaf R, Nolen WA, Beekman AT. Prevalence and predictors of recurrence of major depressive disorder in the adult population. Acta Psychiatr Scand. 2010; 122:184-91. Kazdin AE, Blase SL. Rebooting psychotherapy research and practice to reduce the burden mental illness. Perspect Psychol Sci. 2011; 6(1):21-37. Layard R, Clark DM. Thrive: How better mental health care transforms lives and saves money. London: Penguin Press; 2015. Montero-Marín J, Araya R, Pérez-Yus MC, Mayoral F, Gili M, Botella C et al. An internet-based intervention program for depression in primary care in Spain: a randomized controlled trial. J Med Internet Res. 2016; 18(8):e231. Montero-Marín J, Prado-Abril J, Botella C, Mayoral-Cleries F, Baños R, Herrera-Mercadal P et al. Expectations among patients and health professionals regarding web-based interventions for depression in primary care: a qualitative study. J Med Internet Res. 2015; 17(3):e67. NICE. Computerized Cognitive Behavior Therapy for Depression and Anxiety. Technology Appraisal 97. London: NICE; 2006. Titov N, Dear BF, Johnston L, Lorian C, Zou J, Wootton B. Improving adherence and clinical outcomes in self-guided internet treatment for anxiety and depression: a randomized controlled trial. PLoS ONE. 2013; 8:e62873. World Health Organization (WHO). 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Burnout subtypes and their clinical implications: A theoretical proposal for specific therapeutic approaches

Abstract: Burnout is associated with a poor perception of health status, psychosomatic disorders and physical illness. The aim of this study is to construct a comprehensive theoretical proposal for a therapeutic intervention that is sensitive to the different clinical manifestations of this state. In order to do this, the frenetic, under-challenged and worn-out subtypes of burnout are presented in a systematic manner, together with the interventions that may provide suitable management for each subtype. Said clinical profiles may represent different stages in the progression of burnout, and have specific dysfunctional mechanisms that require a choice of adjusted intervention strategies according to the characteristics of each particular case. Finally, the degree of dedication to work and its clinical repercussions are put forward as a hypothesis to explain the progressive impairment caused by burnout, and as a target on which primary, secondary and tertiary prevention strategies could be founded.Resumen: Subtipos de burnout e implicaciones clínicas: Una propuesta teórica basada en abordajes terapéuticos específicos. El burnout se asocia con un peor estatus de salud percibida, trastornos psicosomáticos y enfermedades físicas. El objetivo del presente trabajo es articular una propuesta teórica comprehensiva de intervención terapéutica sensible a las diferen­tes manifestaciones clínicas de dicho estado. Para ello, se presentan de forma sistemática los subtipos de burnout frenético, sin-desafíos y desgastado, así como las intervenciones que pueden proporcionar un adecuado manejo de cada subtipo. Dichos perfiles clínicos parecen representar momentos diferentes en la progresión del burnout, con mecanismos disfuncionales especí­ficos, que obligan a optar por estrategias de intervención ajustadas a las características de cada caso en particular. Finalmente, se propone el grado de dedicación en el trabajo, y sus repercusiones clínicas, como hipótesis para explicar la progresiva erosión que supone el burnout, y como eje sobre el que fundamentar las estrategias de prevención primaria, secundaria y terciaria.Abstract: Burnout is associated with a poor perception of health status, psychosomatic disorders and physical illness. The aim of this study is to construct a comprehensive theoretical proposal for a therapeutic intervention that is sensitive to the different clinical manifestations of this state. In order to do this, the frenetic, under-challenged and worn-out subtypes of burnout are presented in a systematic manner, together with the interventions that may provide suitable management for each subtype. Said clinical profiles may represent different stages in the progression of burnout, and have specific dysfunctional mechanisms that require a choice of adjusted intervention strategies according to the characteristics of each particular case. Finally, the degree of dedication to work and its clinical repercussions are put forward as a hypothesis to explain the progressive impairment caused by burnout, and as a target on which primary, secondary and tertiary prevention strategies could be founded.Resumen: Subtipos de burnout e implicaciones clínicas: Una propuesta teórica basada en abordajes terapéuticos específicos. El burnout se asocia con un peor estatus de salud percibida, trastornos psicosomáticos y enfermedades físicas. El objetivo del presente trabajo es articular una propuesta teórica comprehensiva de intervención terapéutica sensible a las diferen­tes manifestaciones clínicas de dicho estado. Para ello, se presentan de forma sistemática los subtipos de burnout frenético, sin-desafíos y desgastado, así como las intervenciones que pueden proporcionar un adecuado manejo de cada subtipo. Dichos perfiles clínicos parecen representar momentos diferentes en la progresión del burnout, con mecanismos disfuncionales especí­ficos, que obligan a optar por estrategias de intervención ajustadas a las características de cada caso en particular. Finalmente, se propone el grado de dedicación en el trabajo, y sus repercusiones clínicas, como hipótesis para explicar la progresiva erosión que supone el burnout, y como eje sobre el que fundamentar las estrategias de prevención primaria, secundaria y terciaria

Self-Criticism: A Measure of Uncompassionate Behaviors Toward the Self, Based on the Negative Components of the Self-Compassion Scale

BACKGROUND: The use of the Self-Compassion Scale (SCS) as a single measure has been pointed out as problematic by many authors and its originally proposed structure has repeatedly been called into question. The negative facets of this construct are more strongly related to psychopathology than the positive indicators. The aim of this study was to evaluate and compare the different structures proposed for the SCS, including a new measure based only on the negative factors, and to assess the psychometric features of the more plausible solution. METHOD: The study employed a cross-sectional and cross-cultural design. A sample of Brazilian (n = 406) and Spanish (n = 416) primary care professionals completed the SCS, and other questionnaires to measure psychological health-related variables. The SCS factor structure was estimated using confirmatory factor analysis by the maximum likelihood method. Internal consistency was assessed by squaring the correlation between the latent true variable and the observed variables. The relationships between the SCS and other constructs were analyzed using Spearman's r s . RESULTS: The structure with the best fit was comprised of the three negative first-order factors of "self-judgment", "isolation" and "over-identification", and one negative second-order factor, which has been named "self-criticism" [CFI = 0.92; RMSEA = 0.06 (90% CI = 0.05-0.07); SRMR = 0.05]. This solution was supported by both samples, presented partial metric invariance [CFI = 0.91; RMSEA = 0.06 (90% CI = 0.05-0.06); SRMR = 0.06], and showed significant correlations with other health-related psychological constructs. Reliability was adequate for all the dimensions (R ≥ 0.70). CONCLUSIONS: The original structure proposed for the SCS was not supported by the data. Self-criticism, comprising only the negative SCS factors, might be a measure of uncompassionate behaviors toward the self, with good psychometric properties and practical implications from a clinical point of view, reaching a stable structure and overcoming possible methodological artifacts