Shifting of attentional set is inadequate in severe burnout: Evidence from an event-related potential study

Altered neural processes underlying executive function in occupational burnout-Basis for a novel EEG biomarker

Introduction

As burnout has become a global pandemic, there is a call for improved understanding and detection of alterations in brain functions related to it. We have previously reported challenges in executive functions (EFs) in daily life, especially in metacognition, in subjects with occupational burnout, along with alterations in cardiac physiology. In the current study, we focused on the impact of burnout on brain physiology during a task requiring EF.

Methods

Fifty-four volunteers filled in inventories of burnout, depression, and EF in daily life (BBI-15, BDI, and BRIEF-A). Based on the BBI-15 score, subjects were divided into burnout and non-burnout groups. Subjects performed a Go/NoGo test (Executive RT test) engaging several EFs, while their EEG was recorded. The inventory scores, cognitive performance scores, and event-related potential (N2, P3) amplitudes, latencies, and interpeak latencies (IPLs) were compared between the groups.

Results

There were significant differences in the BDI and BRIEF-A scores between the groups, with more symptoms of depression and challenges in daily life in the burnout group. There were no differences in objective performance measures in the EF task between the groups. However, centroparietal P3 amplitude was larger, and while there were no differences in N2 or P3 latencies, N2-P3 IPL was longer in the Go condition in the burnout than in non-burnout group. Both ERP measures correlated significantly with burnout symptoms. A regression model from centroparietal P3 amplitude and N2-P3 IPL predicted significantly both the BBI-15 score and the BRIEF-A metacognition index.

Discussion

We conclude that burnout is linked with challenges in EF in daily life and alterations in the underlying neural processes. While cognitive performance in the task was equal, electrophysiological measures differed between the groups. Prolonged N2-P3 IPL points toward slowed transition from one cognitive process to another. Increased P3 amplitude, on the other hand, reflects increased allocation of neural processing resources. This may be a compensatory mechanism, allowing for equal performance with controls. These electrophysiological measures, obtained during the EF task, show promise as brain physiology-based biomarkers of burnout, contributing to its improved and objective detection. In addition, these results indicate occupational burnout is linked with objective alterations in brain physiology.

The influence of job burnout on the attention ability of army soldiers and officers: Evidence from ERP

Job burnout is one of the most widespread mental problems in today's society and seriously affects the mental health and combat effectiveness of soldiers and officers. Herein, the effect of burnout on individual attention is studied from the perspective of neuroelectrophysiology. A total of 1,155 army soldiers and officers were included in this investigation and completed the Job Burnout Scale for Military Personnel. A total of 42 soldiers and officers were randomly selected from those with and without burnout to participate in an event-related potential (ERP) study using a visual oddball task. The characteristics of visual P3a and P3b at Fz, FCz, Cz, CPz, and Pz were recorded and analyzed by repeated-measures analysis of variance (ANOVA). P < 0.05 was the criterion for a significant difference. The total average score on the Job Burnout Scale for Military Personnel among the participants was 0.74 ± 0.46, and the detection rate of job burnout was 29.85%. In the Oddball task, the average number of target stimuli counted in the burnout group was lower than that in the control group, but no significant difference was found. For P3a, the Fz, FCz, Cz, CPz, and Pz amplitudes in the burnout group were significantly lower than those in the control group. The average amplitude of P3a evoked in the central parietal area was larger than that in the prefrontal area. For P3b, the amplitudes of the five electrodes in the burnout group were significantly lower than those in the control group. The average amplitude of P3b evoked in the parietal region was larger than those in the prefrontal and central parietal regions. A certain degree of job burnout is evident in army soldiers and officers. The voluntary attention and involuntary attention of individuals with burnout are both affected to some extent, as reflected by the lower amplitudes of P3a and P3b. The results suggest that P3a and P3b can be used as indicators to monitor cognitive neural function in soldiers and officers with burnout and can also be used as references for evaluating the effects of cognitive training and screening methods. In this study, ERP was used to research the attention ability of soldiers and officers with job burnout, and related issues were discussed from the aspects of the burnout results, behavioral results, ERP results, compensation effect of cognitive resources, application in the military field, limitations, and prospects.

Do values reflect what is important? Exploring the nexus between work values, work engagement and job burnout

Purpose

Work values are a representation of people’s priorities as they reflect what is pertinent for them and what they want to accomplish. In light of this, the purpose of this study is to understand the priorities given to work values (extrinsic and intrinsic) by employees and also to explore whether these work values vary with the levels of work engagement and job burnout.

Design/methodology/approach

The study was based on the survey responses of 386 officers working in Indian manufacturing organisations engaged in different areas.

Findings

The findings reveal that security officers give much priority to extrinsic work values than intrinsic work values (IWVs). Moreover, IWVs vary with different levels of work engagement along with job burnout. The security officers belonging to the engaged group differ significantly with those belonging to the job burnout group in terms of IWVs. Moreover, work values also have a negative correlation with job burnout and a positive correlation with work engagement.

Originality/value

This study explores the variation in work values of security officers working in Indian manufacturing organisations with changes in levels of job burnout and work engagement, which is a novel contribution in the field. The findings also advocate that it is crucial for human resource managers, supervisors and key people in organisations to find out employees showing early signs of job burnout (exhaustion or disengagement) or early stages of strain and frustration as the priorities of work values of the employees are affected by these parameters. Such identified employees should be provided with required managerial support and necessary work resources immediately.

Impaired cognitive functioning in stress-induced exhaustion disorder: a new tablet-based assessment

BACKGROUND

The adverse health effects of stress induced exhaustion disorder (SED) cause increasing concern in Western societies. This disorder is characterized by severe fatigue, decreased tolerance to further stress, and attention and memory lapses. Despite subjective complaints, individual cognitive deficits are not always detected in a clinical setting, which calls for the validation of more sensitive instruments.

AIM

The objective of this study was to investigate if a short, tablet-based serial naming task, MapCog Spectra (MCS) could be used as a marker for cognitive problems in SED.

PARTICIPANTS

The study comprised of 39 subjects (35 females, four males) with SED. Their mean age was 46,8 years (SD 10.1; range 30-60 yrs.). All participants were healthcare professionals, with a college or university degree, doctors, registered nurses, and psychologists.

METHODS

The MCS was used to assess the number of aberrant pauses during serial naming of coloured geometrical shapes. The Coding, Matrix Reasoning, Digit Span, Symbol Search of the WAIS-IV, and RUFF 2&7 tests, were administered together with a short interview.

RESULTS

Mean values were within normal reference limits for all tests, except for the MCS, which showed a significantly higher number of aberrant pauses (p < 0,001) in the SED group, compared to normal reference values. Although subjects performed within normal limits on the RUFF 2&7, a significant difference between individuals was found in the performance strategy of the participants.

CONCLUSION

Here we report that subjects with SED have performance deficits on the MCS, in terms of aberrant pause times, despite average performance on WAIS-IV tests measuring inductive reasoning, processing speed, working memory, and attention. We also demonstrate that subjects use different strategies to overcome their problems. These findings add to the growing evidence of cognitive deficits in SED and that the MCS might aid neuropsychologists in disentangling cognitive markers, important to substantiate the subjective complaints of affected individuals.

Auditory deviance detection and involuntary attention allocation in occupational burnout-A follow-up study

Here, we investigated the central auditory processing and attentional control associated with both recovery and prolongation of occupational burnout. We recorded the event-related brain potentials N1, P2, mismatch negativity (MMN) and P3a to nine changes in speech sounds and to three rarely presented emotional (happy, angry and sad) utterances from individuals with burnout (N = 16) and their matched controls (N = 12). After the 5 years follow-up, one control had acquired burnout, half (N = 8) of the burnout group had recovered, and the other half (prolonged burnout) still had burnout. The processing of acoustical changes in speech sounds was mainly intact. Prolongation of the burnout was associated with a decrease in MMN amplitude and an increase in P3a amplitude for the happy stimulus. The results suggest that, in the absence of interventions, burnout is a persistent condition, associated with alterations of attentional control, that may be amplified with the prolongation of the condition.

Self-reported cognitive difficulties and cognitive functioning in relation to emotional exhaustion: Evidence from two studies

Individuals with burnout often report having difficulties with concentration and memory in everyday life. However, empirical evidence on cognitive decline using performance-based measures is limited and often obtained on small clinical samples. The aim of the present two studies was to investigate cognitive correlates of emotional exhaustion on otherwise healthy populations at different life stages with varying degrees of burnout. A total of 201 graduate and undergraduate students participated in Study 1, and a heterogeneous sample (N = 203) of working individuals took part in Study 2. Cognitive performance was assessed by self-reported cognitive difficulties and three performance-based cognitive tests of sustained attention, inhibition of irrelevant information, and inhibition of prepotent responses. Controlling for gender, age, and depression symptoms, multiple regression analyses in Study 1 indicated a positive relationship between emotional exhaustion and self-reported cognitive difficulties but no correlation with the performance-based cognitive measures. A similar pattern of results emerged in Study 2. However, we found tentative evidence for cognitive impairment on the sustained attention measure. The results of these two studies partially support previous findings and extend the literature on cognitive aspects of burnout.

Cognitive functioning, sleep quality, and work performance in non-clinical burnout: The role of working memory

We investigated the relationship between cognitive functioning, work performance, and sleep in non-clinical burnout. In a working population, an online survey was conducted with additional online neuropsychological tests of varying complexity, measuring attention and different components of working memory, of which the coordinating subcomponent the ‘Central Executive’ is thought to be the most vulnerable to stress. Results indicate that non-clinical burnout is associated with more—though not severe—sleep problems, more depressive complaints, impaired work performance, and with both subjective and objective cognitive impairments. Compared with healthy respondents (N = 107), people with non-clinical burnout (N = 17) had a significantly poorer performance on the tests of the visuospatial sketchpad and the Central Executive of the working memory. Our study also indicates that more complex tests may be more sensitive in detecting cognitive dysfunction in non-clinical burnout. Furthermore, a relationship was found between dual-task performance and work performance. Regarding to sleep quality, in our sample of people with non-clinical burnout, there were no severe sleep problems. In the entire sample, however, insomnia was significantly related to subjective, but not objective, cognitive functioning, and also not to work performance.

Psychophysiological Characteristics of Burnout Syndrome: Resting-State EEG Analysis

INTRODUCTION

The consequences of chronic work-related stress are related to various emotional, cognitive, and behavioral symptoms. Occupational burnout as a complex syndrome is characterized by exhaustion, cynicism, and lower professional efficacy. Moreover, the growing amount of research on the neural correlates of burnout broadens the existing knowledge on the mechanisms underlying this syndrome.

AIM OF THE STUDY

The aim of the study is to explore possible differences in brain activity between burnout and nonburnout employees. Frequency-specific EEG power analyses in a resting-state condition in burnout subjects and controls are presented.

MATERIALS AND METHODS

Burnout employees (N=46; 19 men) were matched with the control group (N=49; 19 men; mean age: 36.14 years, SD=7.89). The Maslach Burnout Inventory-General Survey (MBI-GS) and the Areas of Worklife Survey (AWS) scale were used to measure burnout symptoms and work conditions, respectively. A 256-channel EEG (EGI System 300) was used to collect psychophysiological data. A repeated measures ANOVA was performed with condition (eyes-open vs. eyes-closed) and region (6 levels: extracted scalp regions) factors; burnout (2 levels: burnout vs. no burnout) was the grouping factor.

RESULTS

A significant difference was observed only in the alpha frequency band: the burnout group revealed significantly lower alpha power in the eyes-open condition compared to the controls (p<0.05). The correlation analysis revealed that gender may significantly change the pattern of relations between EEG spectral characteristics and burnout symptoms.

CONCLUSIONS

Reduced alpha power in burnout individuals suggests cortical hyperactivity and may be related to greater mental effort and the possible development of compensatory mechanisms by burnout subjects.

State and trait neural correlates of the balance between work and nonwork roles

Difficulty managing the demands of work and nonwork roles (often referred to in terms of managing balance) can be detrimental to psychological wellbeing and contribute to occupational burnout. The current study investigated the neural correlates of perceived satisfaction with this balance using both trait and state EEG alpha measures. EEG was recorded from 14 participants in full time employment (12 females, aged 35.1 ± 10.1 years) during a resting state and performance of an auditory oddball task; e-mail and messaging alert sounds were used as target stimuli. It was predicted that dissatisfaction with the balance between work and nonwork roles would be associated with increased resting alpha power, consistent with studies of burnout, and diminished alpha response to oddball distractors, consistent with difficulty suppressing automatic responses to work-related stimuli. Significant correlations between self-reported measures of work/nonwork balance and both resting, and task-related alpha responses, supported our predictions. Furthermore, an exploratory partial correlation between work and nonwork balance and resting EEG, controlling for task-related alpha response, suggested that the three variables were interrelated. We propose that dissatisfaction with work/nonwork balance is associated with a state hypervigilance to work-related cues, and a trait neural marker of fatigue, both symptomatic of lowered cognitive capacity.

Work Values of Police Officers and Their Relationship With Job Burnout and Work Engagement

Values represent people's highest priorities and are cognitive representations of basic motivations. Work values determine what is important for employees in their work and what they want to achieve in their work. Past research shows that levels of both aspects of job-related well-being, job burnout and work engagement, are related to work values. The policing profession is associated with high engagement and a risk of burnout. There is a gap in the literature regarding the hierarchy of work values in police officers, how work values are associated with job burnout and work engagement in this group, and whether work values in police officers are sensitive to different levels of job burnout and work engagement. Therefore, the aim of our study was to examine the relationships between work values and job burnout and work engagement, in a group of experienced police officers. We investigated: (a) the hierarchy of work values based on Super's theory of career development, (b) relationships between work values and burnout and work engagement, and (c) differences between the work values in four groups (burned-out, strained, engaged, and relaxed). A group of 234 Polish police officers completed the Work Values Inventory (WVI) modeled upon Super's theory, the Oldenburg Burnout Inventory and the Utrecht Work Engagement Scale. The results show that police officers gave the highest priority to extrinsic work values. Job burnout was negatively correlated with the cognitive intrinsic work values (Creativity, Challenge, and Variety), while work engagement was positively correlated with the largest group of intrinsic work values (Creativity, Challenge, Variety, Altruism, and Achievement), as well as with the extrinsic work values (Prestige and Co-workers). The police officers showed significant differences, between levels of job burnout and work engagement, for intrinsic work values such as Variety, Challenge, and Creativity (large effects), and for Altruism and Prestige (moderate effects). The findings are discussed within the context of the Conservation of Resources theory, which explains how people invest and protect their personal resources, and how this is connected with preferred work values. We conclude that intrinsic work values are sensitive to different levels of burnout and engagement.

Neurophysiological Markers of Emotion Processing in Burnout Syndrome

The substantial body of research employing subjective measures indicates that burnout syndrome is associated with cognitive and emotional dysfunctions. The growing amount of neurophysiological and neuroimaging research helps in broadening existing knowledge of the neural mechanisms underlying core burnout components (emotional exhaustion and depersonalization/cynicism) that are inextricably associated with emotional processing. In the presented EEG study, a group of 93 participants (55 women; mean age = 35.8) were selected for the burnout group or the demographically matched control group on the basis of the results of the Maslach Burnout Inventory – General Survey (MBI-GS) and the Areas of Worklife Survey (AWS). Subjects then participated in an EEG experiment using two experimental procedures: a facial recognition task and viewing of passive pictures. The study focuses on analyzing event-related potentials (ERPs): N170, VPP, EPN, and LPP, as indicators of emotional information processing. Our results show that burnout subjects, as compared to the control group, demonstrate significantly weaker response to affect-evoking stimuli, indexed by a decline in VPP amplitude to emotional faces and decreased EPN amplitude in processing emotional scenes. The analysis of N170 and LPP showed no significant between-group difference. The correlation analyses revealed that VPP and EPN, which are ERP components related to emotional processing, are associated with two core burnout symptoms: emotional exhaustion and cynicism. To our knowledge, we are one of the first research groups to use ERPs to demonstrate such a relationship between neurophysiological activity and burnout syndrome in the context of emotional processing. Thus, in conclusion we emphasized that the decreased amplitude of VPP and EPN components in the burnout group may be a neurophysiological manifestation of emotional blunting and may be considered as neurophysiological markers of emotional exhaustion and cynicism. Additionally, we did not observe a decrease in LPP, which may be considered as a marker that significantly differentiates burnout from depression.

Executive control, ERP and pro-inflammatory activity in emotionally exhausted middle-aged employees. Comparison between subclinical burnout and mild to moderate depression

Burnout is a syndrome occurring mainly in individuals with long-term stressful work. The main complaints are emotional exhaustion and reduced performance. Burnout also largely overlaps with depression. Both are characterized by increased incidence of infections due to dysregulation of the immune system, overexpression of pro-inflammatory cytokines and cognitive deficits, particularly related to executive functions. To distinguish between burnout and depression already at the pre-clinical stage, the present double-blinded study compared immunological and cognitive parameters in seventy-six employees from emotionally demanding occupations who were post-hoc subdivided into two groups scoring low (EE-) and high (EE+) in emotional exhaustion and low (DE-) and high (DE+) in depression. Immunological parameters were measured from blood samples. Executive functions were studied by analyzing event-related brain potentials (ERPs) and performance during a task switching paradigm. Psychosocial job parameters were measured with standardized questionnaires. Burnout and mild to moderate depression largely overlapped. However, several subjects showed burnout without depressive symptoms. Higher levels of the pro-inflammatory cytokines IL-6 and IL-12 were correlated with burnout severity and depressive symptoms in male individuals. In the switch task a trend for lower performance in the EE+ vs. EE- group and no difference between DE+ and DE- groups were found. In the ERPs, however, differences were observed which distinguished between subclinical burnout and depression: the terminal contingent negative variation (CNV), indicating preparatory activity and the P3b, related to allocation of cognitive resources were generally reduced in EE+ vs. EE-, whereas no differences were found in the DE+ vs. DE- groups. The frontal P3a was selectively reduced in switch trials in the EE+ vs. EE- group and showed only a trend in DE+ vs. DE-, indicating impairment of executive control in subclinical burnout. Taken together, the results unveil specific immunological changes and declines in brain functions in employees with subclinical burnout that are not apparent in persons with moderate depression. Hence, the combination of immunological, behavioral and ERP methods renders a promising method for distinguishing both syndromes and for improving an early diagnosis of burnout before a clinical stage is reached.

Cognitive Impairments in Occupational Burnout - Error Processing and Its Indices of Reactive and Proactive Control

The presented study refers to cognitive aspects of burnout as the effects of long-term work-related stress. The purpose of the study was to investigate electrophysiological correlates of burnout to explain the mechanisms of the core burnout symptoms: exhaustion and depersonalization/cynicism. The analyzed error-related electrophysiological markers shed light on impaired cognitive mechanisms and the specific changes in information-processing in burnout. In the EEG study design (N = 80), two components of error-related potential (ERP), error-related negativity (ERN), and error positivity (Pe), were analyzed. In the non-clinical burnout group (N = 40), a significant increase in ERN amplitude and a decrease in Pe amplitude were observed compared to controls (N = 40). Enhanced error detection, indexed by increased ERN amplitude, and diminished response monitoring, indexed by decreased Pe amplitude, reveal emerging cognitive problems in the non-clinical burnout group. Cognitive impairments in burnout subjects relate to both reactive and unconscious (ERN) and proactive and conscious (Pe) aspects of error processing. The results indicate a stronger ‘reactive control mode’ that can deplete resources for proactive control and the ability to actively maintain goals. The analysis refers to error processing and specific task demands, thus should not be extended to cognitive processes in general. The characteristics of ERP patterns in burnout resemble psychophysiological indexes of anxiety (increased ERN) and depressive symptoms (decreased Pe), showing to some extent an overlapping effect of burnout and related symptoms and disorders. The results support the scarce existing data on the psychobiological nature of burnout, while extending and specifying its cognitive characteristics.