Netra Raj Paudel
Prakash K. C.1,3
Clas-Håkan Nygård
Subas Neupane- 1Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
- 2Health and Population Department, Central Department of Education, Tribhuvan University, Kathmandu, Nepal
- 3Gerontology Research Center, Tampere University, Tampere, Finland
Background: We aimed to assess the effect of mindfulness-based cognitive behavior therapy (MB-CBT) as an intervention to reduce burnout among secondary school teachers in Nepal.
Methods: The baseline survey of this randomized controlled trial included 218 secondary school teachers from 37 schools in Kathmandu. At a one-month follow-up, 192 teachers completed post-test survey. The Maslach Burnout Inventory for Educators (MBI-ES) tool was used to measure burnout in three dimensions: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). Teachers in the treatment arm (n=102) received MB-CBT, while those in the control arm (n=116) continued their regular activities. Linear regression models with generalized estimating equations were used to calculate the mean, mean change estimates, and their 95% confidence intervals (CIs).
Results: The mean level of EE decreased during the post-test for both treatment (mean change -0.93, 95% CI: -2.56 to 0.70) and control (-1.71, 95% CI: -3.24 to -0.18) arms. The mean level of DP also decreased in the treatment arm (-0.12, 95% CI: -0.98 to -0.75), but a sharper decline was observed in the control arm (-1.97, 95% CI: -2.78 to -1.16). The mean level of PA increased in both the treatment (1.04, 95% CI: -0.21 to 2.30) and control (1.53, 95% CI: 0.35 to 2.70) arms.
Conclusions: The prevalence of high EE and low PA decreased in both arms. However, the prevalence of high DP remained constant in the treatment arm but sharply decreased in the control arm. No significant differences between the arms were found in the post-test mean levels of EE, DP, and PA. The virtual MB-CBT intervention showed no significant impact on reducing burnout. Nonetheless, small reductions in burnout were observed in both groups.
Introduction
Burnout is characterized by the gradual draining of emotional resources required to cope work-related stress (1, 2). Without proper management, burnout can evolve into a chronic condition, leading to physiological changes (3, 4). Over time, it can result in a steady decline in engagement, self-efficacy, and effectiveness, transitioning from enthusiasm to emptiness (5, 6). Moreover, burnout’s impact extends beyond the individual, negatively affecting the entire organization (7). Burnout diminishes employee motivation, reduces productivity, and fosters an unfavorable work environment marked by contagious negativity (8). The consequences are be severe, including higher absenteeism, reduced efficiency, and increased counterproductive behavior (9, 10).
Several factors contribute to burnout. Personality traits, particularly a Type A personality (11–13), and specific sociodemographic factors such as being young, single or unmarried, or a woman, increase susceptibility to burnout (14–16). Organizational factors such as low organizational commitment, job insecurity, excessive workload, role conflicts and ambiguities, limited support from supervisors and peers, and poor working conditions also contribute to burnout (17–19).
Given the demand and dedication required in their profession (20–22), burnout is reportedly more prevalent among educators (5, 6, 23, 24) than among other professionals. With the rapid increase in the prevalence of stress in recent years (25–27), the reported prevalence of perceived extreme stress (burnout) among educators has also risen (25, 28, 29). Nearly one-third of these stress levels may lead to clinical impairment (30). Therefore, to prevent further deterioration, it is necessary to identify early signs of stress and properly manage burnout among teachers (31). Burnout can be averted before it manifests and can also be effectively addressed in its early stages (21).
A recent scoping review (31) based on 40 articles published between 2018 and 2022 revealed that mindfulness interventions were associated reduced stress and burnout among educators. Similarly, our systematic review and meta-analysis (32) of 26 articles found that MB-CBT interventions effectively reduced teacher burnout. Hagermoser et al.’s (33) systematic review studied 18 articles published between 1987 to 2016 which identified meditation and mindfulness-based practices are the most commonly evaluated interventions for reducing teacher stress and burnout. Another study conclusively demonstrated that a brief mindfulness-based intervention effectively alleviated stress and burnout among teachers (34). Von der Embse et al.’s (35) systematic review which examined 24 articles published between 1998 and 2017, aligned with these findings and affirmed the effectiveness of mindfulness and cognitive behavioral interventions. These reviews collectively confirm that mindfulness-based CBT is an effective intervention for mitigating occupational stress and burnout among educators.
We aimed to test whether such interventions could also reduce burnout among community schoolteacher in the culturally and socio-economically different context of Nepal. The present study evaluated the effect of a mindfulness-based cognitive behavior therapy (MB-CBT) intervention on occupational burnout among school teachers in Nepal in a one month follow-up. We hypothesized that MB-CBT intervention would significantly reduce the occupational burnout among school teachers.
Methods
The present study is a single-blind cluster randomized controlled trial, including two arms (treatment and control) to assess the impact of a four-week MB-CBT on burnout among school teachers in government-supported community schools in the Kathmandu district of Nepal.
The study protocol was registered in clinical trials (ClinicalTrials.gov ID: NCT05626543), and the ethical committee of Nepal Health Research Council (225/2022) granted ethical approval to conduct the study. Additional permission was obtained from the concerned schools and the Education Development and Coordination Unit in Kathmandu district.
Study sample and randomization
The study population comprised secondary-level school teachers of community schools in the Kathmandu district of Nepal. We calculated the sample size proportional to the prevalence of occupational stress among school teachers. There was a need for a sample of 90 teachers in each study group and 180 in total and assuming a 10% attrition rate, the participants per study group was estimated at 100 and in total 200 teachers. Using a computer-generated random sampling method, we sampled 40 out of 165 eligible schools in the Kathmandu district. However, teachers from only 37 schools provided the consent. Altogether, 218 teachers replied to the baseline survey (Figure 1) out of the 291 who provided their consent, generating a response rate of 75% (36).
Figure 1. Flow diagram of the study.
The web-based survey was conducted at baseline using a sociodemographic questionnaire to assess socio-demographics, lifestyles, health behaviors, work-related factors, and the Maslach Burnout Inventory for Educators (MBI-ES) tool for assessing occupational burnout. Participants at the school level were randomly divided into treatment (n=102) and control (n=116) arms considering balance by age and gender after the baseline survey. The treatment group received four weeks of virtual MB-CBT, while the control group continued regular activities.
A post-test survey was conducted one month after the intervention, in which 192 teachers (response rate 88%) responded to the questionnaire (102 teachers of the control arm and 90 teachers of the treatment). Teacher burnout was measured in the post-test using the same MBI-ES tool in the treatment and control arms.
Outcome measurement tools
We used the MBI-ES tool, a validated and widely recognized instrument (37), to assess occupational burnout among teachers. The MBI-ES tool was obtained from Mind Garden with a license and translation agreement (MBI-ES Copyright ©1986 by Christina Maslach, Susan E. Jackson & Richard L. Schwab, California, USA). The MBI-ES tool comprised 22 items, which evaluate three distinct dimensions of occupational burnout: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). Respondents were asked to rate their emotional states for each item on a 7-point Likert scale, spanning from “never” (0) to “every day” (6). The high burnout levels in each dimension were determined by the specific point score (38). Cronbach’s alpha coefficient (α) for the EE and DP subscales was 0.82 and 0.62, respectively, and the higher values in the subscale correspond to higher levels of burnout. On the other hand, the PA subscale, with eight items and a Cronbach’s alpha coefficient of 0.79, suggests lower levels of burnout with higher score (36).
Measurement of other variables
The baseline measurement of socio-demographics, lifestyles, health behaviors, and work-related factors are described in detail elsewhere (36). Briefly, we measured demographic information on age, gender, ethnicity, income level, etc., as well as lifestyle factors such as smoking status, tobacco use, alcohol consumption, physical activity, self-rated health, physical fitness, sleep quality, comorbidity, and body mass index (BMI) using validated questionnaire tools. Similarly, work-related information such as ability to work, employment status, teaching hours per day, class size, and teaching students with special needs were measured at baseline.
Intervention
The principal investigator conceived and implemented an MB-CBT intervention for teachers of the treatment arm. The intervention manual was developed with two experts with over 20 years of experience. Drawing from contemporary literature on MB-CBT (39–43), the structured intervention was also facilitated by four expert professionals with over 15 years of experience in CBT. The program occurred between November 9 and December 11, 2022, for about a month and was held every four days with a total of eight sessions (Figure 2). The intervention sessions were conducted (44) via the online platform (Zoom) from 8 pm to 9 pm Nepal Standard Time (NPT), focusing on mindfulness-based cognitive practices (39, 42, 45) and providing in the Nepali language. Participant teachers were asked to practice one minute of loving-kindness meditation, five minutes of slow diaphragmatic breathing, five minutes of half-smile, five minutes of breath awareness, and ten minutes of body scan—twice daily on their own in the morning and evening. Flexibility was incorporated into the program, providing participants with recordings of previous sessions during the next session. The theoretical aspect was presented through PowerPoint slides and handouts, while practical sessions utilized audio-visual clips and pictures. Participants were assigned homework after each session, focusing on the upcoming session and reflecting on the immediate past session. Body scan audio instructions and keynotes were sent to participants via phone messages and social media. Two participants provided reflections after each session, and immediate, personal, and supportive counseling was offered to address any difficulties. The program was closely monitored by a second researcher who took notes, recorded the sessions, and responded to chat messages. On the contrary, the control group continued their regular activities; however, the intervention materials were provided to the teachers in the control arm after the follow-up survey.
Figure 2. Timeline of participation in the study.
Statistical analysis
The study group first presented baseline characteristics of the studied population as frequencies and percentages. Linear regression models with generalized estimating equations (GEE) were used to assess changes in burnout (EE, DP, and PA) within and between the study groups from baseline to the post-test. The study groups were used as the between-subject factor, and time (baseline and post-test) as the within-subject factor. We calculated the mean, mean change, and 95% confidence intervals of all three dimensions of occupational burnout at baseline and post-test, and the difference between the study groups was tested. We conducted all the analyses considering intention-to-treat. Prevalence of occupational burnout in all three dimensions (high EE, high DP, and low PA) of burnout at baseline and post-test are also presented with their 95% CIs. We also calculated the interaction effect between the study group and time; as a sensitivity analysis, we presented the within and between-group difference in the mean level of burnout as mean change estimates and their 95% CI among those who replied at baseline and post-test.
All analyses were conducted using Stata statistical software (Release17. College Station, TX: StataCorp LLC).
Results
Table 1 shows the baseline characteristics of the study participants by study group. Of the 218 participants who replied to the baseline questionnaire, 116 were in the control, and the remaining 102 were in the treatment group. There was no statistically significant difference between the study groups in the baseline characteristics. Most of the participants were aged ≥40, male, married, had master’s degree qualifications, and had a monthly income exceeding 50,000 Nepali rupees. Most of the participants reported good self-rated health, no comorbidities, and had moderate to very good work ability. Among behavioral and lifestyle factors, most of the respondents had good sleep quality, were physically active, non-smokers, and non-alcohol drinkers. Most were teaching at least five hours/day and in classrooms with a higher number of students.
Table 1. Baseline characteristics of the studied population by study group.
Figure 3 presents the mean with their 95% CIs of all three dimensions of occupational burnout of school teachers at baseline and post-test by the study groups. At baseline, the mean EE and PA in the treatment group were higher than the controls. At the post-test, the mean EE and DP decreased in the treatment group and controls. However, a sharper decrease was found in DP in the controls. The PA was increased within the treatment and the controls at the post-test. The mean scores for within-group change (Table 2) show a significant decrease in EE (-1.71, -3.24 to -0.18), DP (-1.97, -2.78 to -1.16), and an increase in PA (1.53, 0.35 to 2.70) in the control group. In the treatment group, decreased mean levels in EE (-0.93, 95% CI -2.56 to 0.70), and increased PA (1.04, -0.21 to 2.30) were found, which were not statistically significant while, decrease in DP (-0.12, -0.98 to -0.75) was statistically significant. Similarly, the changes between the study groups show an increased mean difference in EE and DP and decreased difference in PA from the baseline to the post-test. The interaction between the study group and time (baseline and post-test) was found to be significant for DP only.
Figure 3. Mean (95% CI) emotional exhaustion, depersonalization and personal accomplishment during baseline and post-test.
Table 2. Mean difference in emotional exhaustion, depersonalization, and personal accomplishment during baseline and post-test.
Figure 4 shows the change in the distribution of prevalence of occupational burnout (high EE, high DP, and low PA) with their 95% CIs among school teachers at baseline and post-test by study groups. The prevalence of high EE and low PA was decreased in both arms. However, the prevalence of high DP was constant in the treatment arm and sharply decreased in the control arm.
Figure 4. Prevalence (95% CI) of high emotional exhaustion, high depersonalization and low personal accomplishment during baseline and post-test.
Sensitivity analysis
We did additional analysis excluding the participants who were lost to follow-up at post-test. The results show a similar trend, except that DP for the treatment group had almost no change in the mean levels from baseline to the post-test (Supplementary Table S1). A similar trend was also found in the prevalence of high EE, high DP, and low PA (Supplementary Table S2).
Discussion
This single-blinded cluster randomized controlled trial showed a modest positive impact of virtual MB-CBT on reducing occupational burnout among school teachers in Nepal; however, the reduction in occupational burnout was also observed among controls.
Baseline characteristics were comparable between the control and treatment groups, ensuring that observed post-test burnout differences could be attributed to the intervention rather than baseline disparities (46). The mean EE, DP and PA were comparable at baseline, with mean EE and PA were little higher in the control group. Post-test results showed a decrease in EE and DP in both groups, with a sharper decline in DP in the control group. PA increased in both groups, but not significantly. Overall, although not statistically significant we found positive changes in mean EE and PA, but this was also observed in the control group. A recent systematic review study shows that the effectiveness of mindfulness-based interventions may reduce certain dimensions of burnout, such as PA (47).
Overall, our findings indicate a positive effect of the MB-CBT intervention in reducing burnout among school teachers; however, the findings were not significant. We found a decrease in mean levels of burnout within the treatment arm. Many of the previous studies show the beneficial impact of MB-CBT in reducing burnout among teachers (31, 34, 48–55) and in other occupational groups (56–60). We used a virtual approach to deliver MB-CBT intervention for a month; a previous study reported this technique as effective (61). Our findings regarding the modest impact align with the findings of a meta-analysis of intervention studies, which suggested that mindfulness interventions lasting less than one month could have modest effects (62). We utilized a four-week MB-CBT for school teachers, targeting to reduce EE and DP and increase PA—all three dimensions of burnout (63).
Our findings contradict the generally expected outcome where the treatment group was anticipated to show a more significant improvement than the controls. Several reasons could explain this unexpected finding. First, the external factors or passage of time may lead to a natural reduction in burnout—even if it is not expected in a short time—across both groups. Second, the study participants may have been influenced by the awareness of being part of a study, leading to improved outcomes—the so-called Hawthorne effect (64, 65). Third, those in the control group may have realized that they were not part of the intervention group by the time the second survey was conducted, which was not explicitly communicated to them. However, it is possible that their awareness of not being part of the intervention could have influenced their response in the second survey. This may also explain the observed reduction in burnout within the control group, potentially due to compensatory rivalry or other related factors.
The major strength of this study is its design (two arms, single-blinded, cluster randomized), which establishes a strong internal validity framework (66), promoting confident causal inferences about the effects of the MB-CBT intervention. Digital surveys and virtual interventions were utilized to represent a cost-efficient and time-conserving approach (67, 68). The intervention was developed based on contemporary literature and the findings of a recent systematic review on the effectiveness of interventions in reducing stress and burnout among school teachers (32), strengthening its reliability and reproducibility. We used the Maslach Burnout Inventory (MBI-ES) tool, which is widely recognized for its robustness and accuracy in measuring occupational burnout (37), and the survey questionnaire was sent to both groups simultaneously avoiding chance of possible bias due to measurement instrument and timing of assessment. The study participants were balanced at baseline, and the sensitivity analysis contributed to the overall robustness of the findings.
However, the diverse backgrounds of participants and self-reported data pose challenges to eliminating bias compared to controlled laboratory clinical trials. Online delivery of MB-CBT may also raise concerns about participant engagement and consistency of intervention fidelity. The intervention was delivered quite late in the evening (8-9 pm) when most teachers are tired already which might also affect their willingness to accept and utilize the intervention properly. However, this was the only suitable time for most teachers especially the female teachers who also have lots of household responsibilities to be completed before they can join the intervention session. Generalizability may be limited to low-resource settings. The non-significant differences in the intervention in burnout dimensions suggest avenues for further exploration. More research is required to compare the effectiveness of MB-CBT interventions in virtual and physical formats. For future research, incorporating objective measurements, such as cortisol assessments besides self-reported data, is advisable. This dual approach can provide a more comprehensive understanding by combining subjective self-assessments with objective physiological measurements. The study’s focus on a specific group of teachers in Nepal may limit the generalizability of the findings to other similar populations or cultural contexts. The time constraints teachers face, and the challenges of adapting these programs to different contexts require careful consideration.
Conclusions
In conclusion, the study indicates a moderate impact of virtual MB-CBT on reducing occupational burnout among school teachers in a one-month follow-up. The intervention had statistically no significant impact on occupational burnout. However, a reduction in burnout was found in both groups, with a sharper reduction in the control group, warranting further studies and explanation.
Data availability statement
Data from this study can be requested at bmV0cmEucGF1ZGVsQHR1bmkuZmk=.
Ethics statement
The study protocol was registered in clinical trials (ClinicalTrials.gov ID: NCT05626543), and the ethical committee of Nepal Health Research Council (225/2022) granted ethical approval to conduct the study. Additional permission was obtained from the concerned schools and the Education Development and Coordination Unit in Kathmandu district. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.
Author contributions
NR: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Software, Writing – original draft, Writing – review & editing. PK: Formal analysis, Methodology, Writing – review & editing. C-HN: Supervision, Writing – review & editing. SN: Formal analysis, Methodology, Writing – review & editing, Supervision.
Funding
The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher’s note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
Supplementary material
The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpsyt.2024.1496205/full#supplementary-material
References
1. De Clercq M, Watt HM, Richardson PW. Profiles of teachers’ striving and wellbeing: Evolution and relations with context factors, retention, and professional engagement. J Educ Psychol. (2022) 114:637. doi: 10.1037/edu0000702
2. Nwoko JC, Emeto TI, Malau-Aduli AE, Malau-Aduli BS. A systematic review of the factors that influence teachers’ Occupational wellbeing. Int J Environ Res Public Health. (2023) 20:6070. doi: 10.3390/ijerph20126070
3. Salim EM, Touhami AAO, Oudda H. Job stress and general health among university teachers in the Moroccan context. Acta Neuropsychologica. (2023) 21:65–77. doi: 10.5604/01.3001.0028.3546
4. Sánchez-Narváez F, Velasco-Orozco JJ, Pérez-Archundia E. Burnout syndrome and sleep quality in basic education teachers in Mexico. Int J Environ Res Public Health. (2023) 20, 6276. doi: 10.3390/ijerph20136276
5. Bellingrath S, Weigl T, Kudielka BM. Chronic work stress and exhaustion is associated with higher allostastic load in female school teachers: Original research report. Stress. (2009) 12:37–48. doi: 10.1080/10253890802042041
6. Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Psychol. (2001) 52:397–422. doi: 10.1146/annurev.psych.52.1.397
7. Borritz M, Christensen KB, Bültmann U, Rugulies R, Lund T, Andersen I, et al. Impact of burnout and psychosocial work characteristics on future long-term sickness absence. Prospective results of the Danish PUMA study among human service workers. J Occup Environ Med. (2010) 52:964–70. doi: 10.1097/JOM.0b013e3181f12f95
8. Giorgi G, Arcangeli G, Perminiene M, Lorini C, Ariza-Montes A, Fiz-Perez J, et al. Work-related stress in the banking sector: a review of incidence, correlated factors, and major consequences. Front Psychol. (2017) 8:308542. doi: 10.3389/fpsyg.2017.02166
9. Edú-Valsania S, Laguía A, Moriano JA. Burnout: A review of theory and measurement. Int J Environ Res Public Health. (2022) 19, 1780. doi: 10.3390/ijerph19031780
10. Salvagioni DAJ, Mesas AE, Melanda FN, Dos Santos HG, González AD, Girotto E, et al. Prospective association between burnout and road traffic accidents in teachers. Stress Health. (2020) 36:629–38. doi: 10.1002/smi.v36.5
11. Akbari H, Kashani MM, Bidgoli SD, Nasrabadi MK, Karamali F. An analysis of association of personality traits with job burnout among nurses working in hospital. J Integr Nurs. (2023) 5:43–9. doi: 10.4103/jin.jin_53_22
12. Angelini G. Big five model personality traits and job burnout: a systematic literature review. BMC Psychol. (2023) 11:49. doi: 10.1186/s40359-023-01056-y
13. Oksa R, Mäkikangas A, Savela N, Latikka R, Oksanen A. Longitudinal development of well-being among Finnish employees during 2019–2021: Relationships with personality trait profiles. Scandinavian J Psychol. (2023) 64:179–93. doi: 10.1111/sjop.12868
14. Maslach C, Leiter MP. Understanding burnout: New models. In Cooper C. L., Quick J. C. (Eds.), The handbook of stress and health: A guide to research and practice. Wiley Blackwell. (2017), 36–56. doi: 10.1002/9781118993811.ch3
15. O’Connor M, Munnelly A, Whelan R, McHugh L. The efficacy and acceptability of third-wave behavioral and cognitive eHealth treatments: A systematic review and meta-analysis of randomized controlled trials. Behav Ther. (2018) 49:459–75. doi: 10.1016/j.beth.2017.07.007
16. Schneider-Matyka D, Świątoniowska-Lonc N, Polański J, Szkup M, Grochans E, Jankowska-Polańska B. Assessment of the effect of stress, sociodemographic variables and work-related factors on rationing of nursing care. Int J Environ Res Public Health. (2023) 20:2414. doi: 10.3390/ijerph20032414
17. Bakker AB, Demerouti E. Job demands–resources theory: Taking stock and looking forward. J Occup Health Psychol. (2017) 22:273. doi: 10.1037/ocp0000056
18. Guo W, Hancock J, Cooper D, Caldas M. Job autonomy and employee burnout: the moderating role of power distance orientation. Eur J Work Organizational Psychol. (2023) 32:79–94. doi: 10.1080/1359432X.2022.2101451
19. Petitta L, Jiang L. How emotional contagion relates to burnout: A moderated mediation model of job insecurity and group member prototypicality. Int J Stress Manage. (2020) 27:12. doi: 10.1037/str0000134
20. Belay AA, Gasheya KA, Engdaw GT, Kabito GG, Tesfaye AH. Work-related burnout among public secondary school teachers is significantly influenced by the psychosocial work factors: a cross-sectional study from Ethiopia. Front Psychol. (2023) 14. doi: 10.3389/fpsyg.2023.1215421
21. Shanafelt TD, Noseworthy JH. Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout. Mayo Clinic Proceedings. (2017) 92(1):129–46.
22. Travers C. Current Knowledge on the Nature, Prevalence, Sources and Potential Impact of Teacher Stress. In: McIntyre T., McIntyre S., Francis D. (eds) Educator Stress. Aligning Perspectives on Health, Safety and Well-Being. Springer, Cham. (2017). doi: 10.1007/978-3-319-53053-6_2
23. Maslach C, Jackson SE, Schwab RL. Maslach burnout inventory-educators survey (MBI-ES). MBI manual. (1996) 3:27–32.
24. Wettstein A, Jenni G, Schneider I, Kühne F, Grosse Holtforth M, La Marca R. Predictors of psychological strain and allostatic load in teachers: examining the long-term effects of biopsychosocial risk and protective factors using a LASSO regression approach. Int J Environ Res Public Health. (2023) 20:5760. doi: 10.3390/ijerph20105760
25. Cohen S, Gianaros PJ, Manuck SB. A stage model of stress and disease. Perspect psychol Sci. (2016) 11:456–63. doi: 10.1177/1745691616646305
26. Greenberg MT, Brown JL, Abenavoli RM. Teacher stress and health effects on teachers, students, and schools [Issue Brief]. Pennsylvnia, USA: Edna Bennett Pierce Prevention Research Center, Pennsylvania State University (2016).
27. Richards J. Teacher stress and coping strategies: A national snapshot. In: The educational forum. London: Taylor & Francis Group (2012) 76, 299–316.
28. Collie RJ, Shapka JD, Perry NE. School climate and social–emotional learning: Predicting teacher stress, job satisfaction, and teaching efficacy. J Educ Psychol. (2012) 104:1189. doi: 10.1037/a0029356
29. Geving AM. Identifying the types of student and teacher behaviours associated with teacher stress. Teach Teacher Educ. (2007) 23:624–40. doi: 10.1016/j.tate.2007.02.006
30. Von der Embse NP, Kilgus SP, Solomon HJ, Bowler M, Curtiss C. Initial development and factor structure of the Educator Test Stress Inventory. J Psychoeducational Assess. (2015) 33:223–37. doi: 10.1177/0734282914548329
31. Agyapong B, Brett-MacLean P, Burback L, Agyapong VIO, Wei Y. Interventions to reduce stress and burnout among teachers: A scoping review. Int J Environ Res Public Health. (2023) 20, 5625. doi: 10.3390/ijerph20095625
32. Paudel NR, Adhikari BA, Prakash KC, Kyrönlahti S, Nygård CH, Neupane S. Effectiveness of interventions on the stress management of school teachers: a systematic review and meta-analysis. Occup Environ Med. (2022) 79(7):477–85. doi: 10.1136/oemed-2021-108019
33. Hagermoser Sanetti LM, Boyle AM, Magrath E, Cascio A, Moore E. Intervening to decrease teacher stress: A review of current research and new directions. Contemp School Psychol. (2021) 25:416–25. doi: 10.1007/s40688-020-00285-x
34. Taylor SG, Roberts AM, Zarrett N. A brief mindfulness-based intervention (bMBI) to reduce teacher stress and burnout. Teach Teacher Educ. (2021) 100:103284. doi: 10.1016/j.tate.2021.103284
35. Von der Embse N, Ryan SV, Gibbs T, Mankin A. Teacher stress interventions: A systematic review. Psychol Schools. (2019) 56:1328–43. doi: 10.1002/pits.2019.56.issue-8
36. Paudel NR, KC P, Ghimire R, Nygård CH, Neupane S. Occupational burnout and their determinants among schoolteachers in Nepal: a cross-sectional study. BMC Psychiatry. (2024) 24(1):472.
37. Schaufeli W, Enzmann D. The burnout companion to study and practice: A critical analysis. Philadelphia, USA: CRC press (1998).
38. Matejić B, Milenović M, Kisić Tepavčević D, Simić D, Pekmezović T, Worley JA. Psychometric Properties of the Serbian Version of the Maslach Burnout Inventory-Human Services Survey: A Validation Study among Anesthesiologists from Belgrade Teaching Hospitals. The Scientific World Journal. (2015) e903597. doi: 10.1155/2015/903597
39. McKeown P. Atomic focus: Harness the true power of your brain, develop resilience against stress, and get focused with simple breathing exercises to change your mental and physical state. UK: OsyATPublishing (2021).
40. Moore S. Practical yoga nidra: A 10-step method to reduce stress, improve sleep, and restore your spirit. USA: Rockridge Press (2020).
41. Kennedy F, Pearson D. Integrating CBT and Third Wave Therapies: Distinctive Features. London: Routledge (2020).
42. Kabat-zinn J. Mindfulness for all: The wisdom to transform the world. USA: Hachette Books (2019).
43. Gach G. Pause breathe smile awakening mindfulness when meditation is not enough. USA: Sounds True (2018).
44. Ritvo P, Knyahnytska Y, Pirbaglou M, Wang W, Tomlinson G, Zhao H, et al. Online mindfulness-based cognitive behavioral therapy intervention for youth with major depressive disorders: randomized controlled trial. J Med Internet Res. (2021) 23:e24380. doi: 10.2196/24380
46. De Boer MR, Waterlander WE, Kuijper LD, Steenhuis IH, Twisk JW. Testing for baseline differences in randomized controlled trials: an unhealthy research behavior that is hard to eradicate. Int J Behav Nutr Phys Activity. (2015) 12:1–8. doi: 10.1186/s12966-015-0162-z
47. Ramachandran HJ, Bin Mahmud MS, Rajendran P, Jiang Y, Cheng L, Wang W. Effectiveness of mindfulness-based interventions on psychological well-being, burnout and post-traumatic stress disorder among nurses: A systematic review and meta-analysis. J Clin Nurs. (2023) 32:2323–38. doi: 10.1111/jocn.16265
48. Anama-Green C. Intrapersonal mindfulness is associated with reduced risk of burnout among Central Appalachian educators. Explore. (2022) 18:64–9. doi: 10.1016/j.explore.2020.10.003
49. de Carvalho JS, Oliveira S, Roberto MS, Gonçalves C, Bárbara JM, de Castro AF, et al. Effects of a mindfulness-based intervention for teachers: a study on teacher and student outcomes. Mindfulness. (2021) 12:1719–32. doi: 10.1007/s12671-021-01635-3
50. Fabbro A, Fabbro F, Capurso V, D’Antoni F, Crescentini C. Effects of mindfulness training on school teachers’ Self-reported personality traits as well as stress and burnout levels. PERCEPTUAL AND MOTOR SKILLS. (2020) 127:515–32. doi: 10.1177/0031512520908708
51. Guidetti G, Viotti S, Badagliacca R, Colombo L, Converso D. Can mindfulness mitigate the energy-depleting process and increase job resources to prevent burnout? A study on the mindfulness trait in the school context. PloS One. (2019) 14:e0214935. doi: 10.1371/journal.pone.0214935
52. Hidajat TJ, Edwards EJ, Wood R, Campbell M. Mindfulness-based interventions for stress and burnout in teachers: A systematic review. Teach Teacher Educ. (2023) 134:104303. doi: 10.1016/j.tate.2023.104303
53. Li J, Xue E, He Y. Investigating the effect of cognitive–behavioral, mindful-based, emotional-based intervention and professional training on teachers’ Job burnout: A meta-analysis. Behav Sci. (2023) 13:803. doi: 10.3390/bs13100803
54. Luken M, Sammons A. Systematic review of mindfulness practice for reducing job burnout. Am J Occup Ther. (2016) 70:7002250020p1–7002250020p10. doi: 10.5014/ajot.2016.016956
55. Russell A, Smyth S. Using a 10-day mindfulness-based app intervention to reduce burnout in special educators. J Res Special Educ Needs. (2023) 23(4):278–89. doi: 10.1111/1471-3802.12599
56. Fendel JC, Bürkle JJ, Göritz AS. Mindfulness-based interventions to reduce burnout and stress in physicians: a systematic review and meta-analysis. Acad Med. (2021) 96:751–64. doi: 10.1097/ACM.0000000000003936
57. Janssen M, Heerkens Y, Kuijer W, van der Heijden B, Engels J. Effects of Mindfulness-Based Stress Reduction on employees’ mental health: A systematic review. PloS One. (2018) 13:e0191332. doi: 10.1371/journal.pone.0191332
58. Kriakous SA, Elliott KA, Lamers C, Owen R. The effectiveness of mindfulness-based stress reduction on the psychological functioning of healthcare professionals: A systematic review. Mindfulness. (2021) 12:1–28. doi: 10.1007/s12671-020-01500-9
59. Pérula-de Torres LA, Atalaya JCVM, García-Campayo J, Roldán-Villalobos A, Magallón-Botaya R, Bartolomé-Moreno C. Controlled clinical trial comparing the effectiveness of a mindfulness and self-compassion 4-session programme versus an 8-session programme to reduce work stress and burnout in family and community medicine physicians and nurses: MINDUUDD study protocol. BMC Family Pract. (2019) 20:1–10. doi: 10.1186/s12875-019-0913-z
60. Wang Q, Wang F, Zhang S, Liu C, Feng Y, Chen J. Effects of a mindfulness-based intervention on stress, burnout in nurses: a systematic review and meta-analysis. Front Psychiatry. (2023) 14. doi: 10.3389/fpsyt.2023.1218340
61. Pérez V, Menéndez-Crispín EJ, Sarabia-Cobo C, de Lorena P, Fernández-Rodríguez A, González-Vaca J. Mindfulness-based intervention for the reduction of compassion fatigue and burnout in nurse caregivers of institutionalized older persons with dementia: a randomized controlled trial. Int J Environ Res Public Health. (2022) 19:11441. doi: 10.3390/ijerph191811441
62. Aloe AM, Amo LC, Shanahan ME. Classroom management self-efficacy and burnout: A multivariate meta-analysis. Educ Psychol Rev. (2014) 26:101–26. doi: 10.1007/s10648-013-9244-0
63. Maslach C, Jackson SE, Leiter MP. Maslach burnout inventory. In: Za- laquett CP, Wood RJ, editors. Evaluating stress: A book of resources. The Scarecrow Press, Lan- han, MD (1997). p. 191–218.
64. Berkhout C, Berbra O, Favre J, Collins C, Calafiore M, Peremans L, et al. Defining and evaluating the Hawthorne effect in primary care, a systematic review and meta-analysis. Front Med. (2022) 9:1033486. doi: 10.3389/fmed.2022.1033486
65. Wickström G, Bendix T. The “Hawthorne effect”—what did the original Hawthorne studies actually show? Scandinavian J Work Environ Health. (2000) 26(4):363–7.
66. Rippe RCA, Merkelbach I. Planned missing data in early literacy interventions: A replication study with an additional gold standard. PloS One. (2021) 16:e0249175. doi: 10.1371/journal.pone.0249175
67. Hollinghurst S, Peters TJ, Kaur S, Wiles N, Lewisand G, Kessler D. Cost-effectiveness of therapist-delivered online cognitive–behavioural therapy for depression: randomised controlled trial. Br J Psychiatry. (2010) 197:297–304. doi: 10.1192/bjp.bp.109.073080
68. Romero-Sanchiz P, Nogueira-Arjona R, García-Ruiz A, Luciano JV, Campayo JG, Gili M, et al. Economic evaluation of a guided and unguided internet-based CBT intervention for major depression: results from a multicenter, three-armed randomized controlled trial conducted in primary care. PLoS ONE. (2017) 12:e017274. doi: 10.1371/journal.pone.0172741
Keywords: burnout, intervention, mindfulness, CBT, educators, low-income countries
Citation: Paudel NR, K. C. P, Nygård C-H and Neupane S (2025) Effect of a mindfulness-based cognitive behavior therapy intervention on occupational burnout among school teachers. Front. Psychiatry 15:1496205. doi: 10.3389/fpsyt.2024.1496205
Received: 13 September 2024; Accepted: 26 December 2024;
Published: 24 January 2025.
Edited by:
Yaakov Shmuel Gershon Hoffman, Bar-Ilan University, IsraelReviewed by:
Badii Amamou, University of Monastir, TunisiaMeenakshi Shukla, Allahabad University, India
Copyright © 2025 Paudel, K. C., Nygård and Neupane. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Netra Raj Paudel, bmV0cmEucGF1ZGVsQHR1bmkuZmk=; bmV0cmEucGF1ZGVsQGNkZWQudHUuZWR1Lm5w