The Effect of Burnout on Cortisol Reactivity to a Laboratory Stressor Task Eddie Erazo University of California, Irvine

Burnout Defined as chronic exhaustion of a person’s energetic resources as the result of an extended period of stress Defined as chronic exhaustion of a person’s energetic resources as the result of an extended period of stress Involves negative outcomes such as emotional fatigue, physical exhaustion, and mental weariness Involves negative outcomes such as emotional fatigue, physical exhaustion, and mental weariness Sleep disturbance, impaired immunity, and cortisol alterations Sleep disturbance, impaired immunity, and cortisol alterations

Cortisol Stress hormone that is released in response to stress Stress hormone that is released in response to stress Associated with negative physiological outcomes Associated with negative physiological outcomes Affects metabolism, mental, immune and endocrine system functions Affects metabolism, mental, immune and endocrine system functions However, it IS a normal and necessary part of healthy functioning, but not in chronically excessive or blunted levels However, it IS a normal and necessary part of healthy functioning, but not in chronically excessive or blunted levels

HPA Axis Sympathetic Nervous System Sympathetic Nervous System Fight/Flight Response (i.e. Heart Rate) Fight/Flight Response (i.e. Heart Rate) Hypothalamic Pituitary Adrenal Axis Hypothalamic Pituitary Adrenal Axis Hypothalamus (CRH) Pituitary Gland (ACTH) Adrenal GlandCortisol Stressor

Cortisol and Disease “So what?” “So what?” Often, stress is chronic in the form of pressure from boss or work without the definite end of an acute stressor, such as a speech Often, stress is chronic in the form of pressure from boss or work without the definite end of an acute stressor, such as a speech Repeated excessive cortisol reactivity or a blunted response takes a toll on the body and may lead to disease (i.e. CVD) Repeated excessive cortisol reactivity or a blunted response takes a toll on the body and may lead to disease (i.e. CVD)

Does burnout have an effect on cortisol levels? Lack of agreement as to whether burnout increases, decreases, or has no effect Lack of agreement as to whether burnout increases, decreases, or has no effect Different findings depending on CAR or day- curve focus Different findings depending on CAR or day- curve focus Important to determine whether there is an effect to further research cortisol’s role in disease Important to determine whether there is an effect to further research cortisol’s role in disease

Burnout’s effect on cortisol For the most part, there is no effect in CAR when the MBI is used to measure burnout For the most part, there is no effect in CAR when the MBI is used to measure burnout Difficult to conclude an effect given the small number of studies having used the constructs of burnout and cortisol levels Difficult to conclude an effect given the small number of studies having used the constructs of burnout and cortisol levels Further research is needed to help solidify current findings Further research is needed to help solidify current findings

Hypothesis The literature shows that burnout may not have a definitive effect on cortisol levels in the absence of a stressor… The literature shows that burnout may not have a definitive effect on cortisol levels in the absence of a stressor… hypothesize that subjects high on burnout will have greater cortisol reactivity to a stressor than subjects low on burnout. hypothesize that subjects high on burnout will have greater cortisol reactivity to a stressor than subjects low on burnout. High Low Cortisol Hypothesis

Research Methods 69 undergraduate students from the human subjects pool at the University of California, Irvine (after exclusions) 69 undergraduate students from the human subjects pool at the University of California, Irvine (after exclusions) Burnout measured using the Maslach Burnout Inventory (MBI ) Burnout measured using the Maslach Burnout Inventory (MBI ) Saliva samples, or salivettes, used to measure cortisol levels Saliva samples, or salivettes, used to measure cortisol levels

Maslach Burnout Inventory (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” (EX) “I feel emotionally drained from my work” (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)

MBI Altered from “work” to “work/school (work)” Altered from “work” to “work/school (work)” Divided subjects into 3 equal groups based on scores for each subscale Divided subjects into 3 equal groups based on scores for each subscale CY HighAverageLow EX HighAverageLow PE HighAverageLow

Research Design Subject’s baseline cortisol and burnout is found, followed by the stressor and the rest period Subject’s baseline cortisol and burnout is found, followed by the stressor and the rest period Stressor involves a 5 minute interview-like speech to an evaluative panel Stressor involves a 5 minute interview-like speech to an evaluative panel BaselineRecovery Speech Samples: (Practice), 12, 3, 4, 5

Results: Demographics Ethnicity: Ethnicity: Mostly Asian- 61% (especially Chinese- 28%) Mostly Asian- 61% (especially Chinese- 28%) White- 16% White- 16% Latino- 9% Latino- 9% Other- 14% Other- 14% Gender: Gender: Fairly even split- 52% female, 48% male Fairly even split- 52% female, 48% male

Results Gender Differences in cortisol reactivity (Males higher) Gender Differences in cortisol reactivity (Males higher) Repeated Measures ANOVA showed that there was no effect between EX/CY/PE and cortisol Repeated Measures ANOVA showed that there was no effect between EX/CY/PE and cortisol However, PE graph showed differences in reactivity to the speech However, PE graph showed differences in reactivity to the speech PE: Univariate ANOVA controlling for baseline and gender PE: Univariate ANOVA controlling for baseline and gender All time points were tested for group differences All time points were tested for group differences Only the 3 rd time point (reactivity peak) was significant Only the 3 rd time point (reactivity peak) was significant

Graph adjusted: High PE = High burnout

Summary Burnout’s 3 subscales had different effects on cortisol reactivity Burnout’s 3 subscales had different effects on cortisol reactivity EX/CY had no significant effect EX/CY had no significant effect PE groups showed differences in cortisol PE groups showed differences in cortisol Contrary to hypothesis, those high on burnout (low PE) had blunted cortisol responses to the speech Contrary to hypothesis, those high on burnout (low PE) had blunted cortisol responses to the speech

Possible Explanations Ironically, a lack of confidence (low PE) may lead to apathy and prevent psychological stress, which could reduce the release of cortisol Ironically, a lack of confidence (low PE) may lead to apathy and prevent psychological stress, which could reduce the release of cortisol *High burnout level, with regard to PE, caused the blunted cortisol response to the speech *High burnout level, with regard to PE, caused the blunted cortisol response to the speech This group may lack normal cortisol responses to stressful situations in general This group may lack normal cortisol responses to stressful situations in general

Implications Given the association, treatment may help: Given the association, treatment may help: Decrease burnout Decrease burnout Cognitive Therapy Cognitive Therapy …in order to restore normal health, including cortisol levels, and decrease the risk of disease, such as CVD, diabetes, depression, etc.

Limitation College students are, in general, more burnt out than the national average College students are, in general, more burnt out than the national average Future research could use samples more representative of the United States Future research could use samples more representative of the United States Effect sizes could be bigger and may reveal effects for EX and CY Effect sizes could be bigger and may reveal effects for EX and CY

Acknowledgments Prof. Sally Dickerson Prof. Sally Dickerson Frank Zaldivar Frank Zaldivar Valerie Jenness Valerie Jenness Peggy Mycek Peggy Mycek Health Responses Lab Team Health Responses Lab Team Social Ecology Honors Students Social Ecology Honors Students