Integrated Literature Review on Stress Management Interventions for Teachers

1 Integrated Literature Review on Stress Management Interventions for Teachers Kitara Thompson University of San Francisco NURS-705B-01 Dr Deepika Goyal April 21, 2024 2 Integrated Literature Review on Stress Management Interventions for Teachers Teacher burnout, defined as xxxxxx (cite) is impacts both educators and students. Add a sentence on impact on teachers and another one addressing impact to students. The following review was conducted to identify the best evidence to manage teacher stress in an effort to minimize burnout. strategies that. This review includes 10 articles, 3 reviews (cite here) and x quantitative studies (cite here). The articles included research conducted in several countries: Israel (n = x), Netherlands (n = x), Australia (n = x), etc. The sections below will discuss the articles based on the types of stress reduction techniques that were used: mindfulness; , cognitive therapies, online tools, and promoting self-efficacy. Mindfulness-Based Interventions (MBIs) X articles used mindfulness-based interventions (MBIs) to address stress (cite). What did those articles find? are programs aimed at reducing stress that incorporate mindfulness meditation practices, yoga techniques, and strategies for managing stress (Hagermoser Sanetti et al., 2021). MBIs can be used on teachers as they are practical ways to reduce perceived stress and increase the emotional well-being of educators in at least one study on the topic. One research, however, suggested that intensive mindfulness training programs reduced reported stress levels (Hepburn et al., 2021). Brief MBIs integrating mindfulness and yoga into the school day have also demonstrated benefits, such as bolstering teacher health and wellness. Evidence suggests that relatively short-term MBIs can be impactful. These interventions have been related to improved mindful awareness and decreased burnout symptomology and stress (Agyapong et al., 2023). Most promising is that even very short school-based MBIs have been successful, suggesting that low-cost and quickly instituted options may help overburdened teachers. Most recent research substantiates mindfulness-based practices in mitigating 3 occupational strain among middle school educators, albeit with varying intensities (Ansley et al., 2021). MBIs, therefore, present a promising avenue for supporting teacher wellness. Cognitive Behavioral and Rational Emotive Interventions Cognitive behavioral therapy (CBT) and rational emotive occupational health coaching (REOHC) are interventions to change maladaptive thinking and behaviors identified through assessment. CBT focuses on the cognitive distortion and irrational beliefs an individual may harbor; however, REOHC infuses rational emotive Education. This approach brings many advantages to teachers prone to stress and burnout (Zadok-Gurman et al., 2021). The research found that CBT significantly enhances their perception of job control and workload management and reduces emotional exhaustion and physical symptoms. Separate research on REOHC for special needs teachers found its way to quite similar results, wherein substantial decreases in job burnout and emotional exhaustion were reported following the intervention (Ghannam et al., 2020). The findings demonstrate that cognitive behavioral and rational emotive interventions show promise for helping reduce stress and burnout in teaching professionals through addressing unhealthy thought and behavior patterns. Online Stress Management Programs Studies have explored the benefits of online stress management programs for teachers. One such program discusses the development of a delivered-over-the-internet intervention. The presented findings showed that an online program helped develop teachers’ coping practices and self-efficacy, mainly enhancing their achievements. Participation was related to low emotional exhaustion and depersonalization of the educators. The high retention rate and overwhelmingly positive feedback from the participants further supported the view that, in practice, the remote delivery of therapeutic services through online interventions is feasible and practically 4 unproblematic (Lensen et al., 2021). These limitations in time and accessibility are barriers that can prevent teachers from obtaining necessary access to resources for stress reduction. The research discussed indicates that online platforms represent a tool with promise for managing teacher stress in a convenient, accessible manner. Self-Efficacy and Teacher Stress Self-efficacy and teacher stress emphasize the critical role of self-efficacy in managing stress experienced by teachers. It was found that high levels of self-efficacy and belief in their capability are related to managing challenges more effectively and with sustained motivation on the job. Contrarily, low self-efficacy could result in fatigue of emotions and the tendency to withdraw from working tasks, considering the way by which self-efficacy contributes to the level of stress that a teacher might undergo and the way by which a teacher can cope with occupational demands (Schnaider-Levi et al., 2020). Arguably, it may appear that in this study, the growth of solid self-efficacy could be perceived as the protective factor against strain in this population. Thus, interventions directed at educator self-efficacy to enhance the same may pay off as effective strategies for enhancing resilience and reducing susceptibility to stress-induced burnout. Measuring Burnout The Copenhagen Burnout Inventory (CBI) (cite) is a x-item tool that measures teacher burnout. The CBI has been used widely to assess different dimenstions of burnout t (Rocha et al., 2020). For example, one of the inventories that examine critical areas that reflect the burnout process is the burnout inventory, which concerns an individual’s physical and psychological fatigue from work demands. Such a multidimensional outlook aligns with the conceptualization of burnout as more than only emotional exhaustion. 5 . The CBI focuses primarily on job-related burnout, in contrast to generalized life stress, which adds very much to it being applicable in this review, as it has a valid, efficient, and occupation-specific approach from CBI (Rocha et al., 2020). Significance of Findings The findings from the ten articles included in my review provide valuable insight for addressing occupational burnout among middle school teachers through stress management interventions. Some have researched the effect of mindfulness-based interventions (Hagermoser Sanetti et al., 2021). They indicated that even within a classroom environment, the brief application significantly reduced the students’ perceived stress and improved their emotional well-being, posed that low-cost and feasible programs integrated within the school setting hold the potential to support teacher health. In addition, some results are revealed in a study on cognitive behavior therapies and rational emotive coaching, causing better stress coping and decreased exhaustion (Hidajat et al., 2023). The implication is that targeting maladaptive thoughts and behaviors could alleviate strain. Online programs introducing stress management techniques also demonstrated potential through improving coping skills and self-efficacy while decreasing draining symptoms in one evaluated initiative. Remote delivery of yoga may also provide a broader range of access to help in stress management by more teachers because of its accessibility and convenience. Selfefficacy also appeared integral, as high levels were linked to enhanced challenge management and motivation (Schnaider-Levi et al., 2020). Evidence presented across studies indicates that addressing sources of stress through mindfulness, cognitive approaches, developing coping skills, and efficacy can lower burnout indicators for middle school educators. Using a validated inventory like the CBI, further measures burnout to ensure adequate strategies (Zadok-Gurman et 6 al., 2021). In addressing the PICO question, these integrated findings offer guidance on practical, evidence-based options school systems could employ to support educator wellness. The level of evidence was critically appraised and rated at 3 Level-1 and 5 Level-2 using the JHNEBP Research and Non-Research appraisal tools. The quality rating varied from good to high quality, with several consistent findings in studies. Mindfulness-based interventions delivered in brief and more extended formats effectively reduced teacher burnout, stress, and related symptoms immediately and in the long term. MBIs demonstrate high internal consistency, or reliability, in assessing educator burnout and validity (Lensen et al., 2021). The strengths of the study design varied, and most were limited by small sample sizes and self-report measures. Overall, this study’s findings seem valid when applied to a group of middle school teachers, as this would have answered the PICO(T) question since CBI did indicate that a stress management program can effectively reduce burnout. The body of evidence very strongly supports offering evidence-based mindfulness-based and multimodal stress management programs (Schnaider-Levi et al., 2020). It is recommended against teacher burnout, with many high- and good-quality studies providing consistent results. Therefore, recommendations to continue these studies would still be warranted in larger sample sizes and longer-term trials. 7 References Agyapong, B., Brett-MacLean, P., Burback, L., Agyapong, V. I. O., & Wei, Y. (2023). Interventions to reduce stress and burnout among teachers: A scoping review. International journal of environmental research and public health, 20(9), 5625. https://www.mdpi.com/1660-4601/20/9/5625 Ansley, B. M., Houchins, D. E., Varjas, K., Roach, A., Patterson, D., & Hendrick, R. (2021). The impact of an online stress intervention on burnout and teacher efficacy. Teaching and Teacher Education, 98, 103251. https://www.sciencedirect.com/science/article/pii/S0742051X20314426 Ghannam, J., Afana, A., Ho, E. Y., Al-Khal, A., & Bylund, C. L. (2020). The impact of a stressmanagement intervention on medical residents’ stress and burnout. International Journal of Stress Management, 27(1), 65. https://psycnet.apa.org/record/2019-11842-001 Hagermoser Sanetti, L. M., Boyle, A. M., Magrath, E., Cascio, A., & Moore, E. (2021). Intervening to decrease teacher stress: A review of current research and new directions. Contemporary School Psychology, 1-10. https://link.springer.com/article/10.1007/s40688-020-00285-x Hepburn, S. J., Carroll, A., & McCuaig, L. (2021, November). Promoting stress management and well-being for teachers, A pilot study. In Frontiers in Education (Vol. 6, p. 744227). Frontiers Media SA. https://www.frontiersin.org/articles/10.3389/feduc.2021.744227/full Hidajat, T. J., Edwards, E. J., Wood, R., & Campbell, M. (2023). Mindfulness-based interventions for stress and burnout in teachers: A systematic review. Teaching and Teacher Education, 134, 104303. https://www.sciencedirect.com/science/article/pii/S0742051X23002913 8 Lensen, J. H., Stoltz, S. E. M. J., Kleinjan, M., Speckens, A. E. M., Kraiss, J. T., & Scholte, R. H. J. (2021). Mindfulness-based stress reduction intervention for elementary school teachers: a mixed method study. Trials, 22, 1-10. https://link.springer.com/article/10.1186/s13063-021-05804-6 Rocha, F. L. R., Jesus, L. C. D., Marziale, M. H. P., Henriques, S. H., Marôco, J., & Campos, J. A. D. B. (2020). Burnout syndrome in university professors and academic staff members: psychometric properties of the Copenhagen Burnout Inventory-Brazilian version. Psicologia: Reflexão e Crítica, 33, 11. https://www.scielo.br/j/prc/a/x5kgFJKvKB67rt3Ytprby9v/?lang=en Schnaider-Levi, L., Ganz, A. B., Zafrani, K., Goldman, Z., Mitnik, I., Rolnik, B., & Lev-Ari, S. (2020). The effect of inquiry-based stress reduction on teacher burnout: A controlled trial. Brain Sciences, 10(7), 468. https://www.mdpi.com/2076-3425/10/7/468 Zadok-Gurman, T., Jakobovich, R., Dvash, E., Zafrani, K., Rolnik, B., Ganz, A. B., & Lev-Ari, S. (2021). Effect of inquiry-based stress reduction (IBSR) intervention on teachers’ wellbeing, resilience, and burnout during the COVID-19 pandemic. International journal of environmental research and public health, 18(7), 3689. https://www.mdpi.com/16604601/18/7/3689 9 Appendix A. Table of Included Studies (organize alphabetically) Purpose Design or aim Sample Conceptu Main Variable Data Main Conclusions, Level of Evidence Strengths, , al Outcome Measureme Analysis Finding recommendation (Critical Limitations setting Framewo Variable nt s s, feasibility Appraisal Score) rk or (s) Worth to Practice Theory Sanetti, L. M. H., Boyle, A. M., Magrath, E., Cascio, A., & Moore, E. (2020). Intervening to Decrease Teacher Stress: a Review of Current Research and New Directions. Contemporary School Psychology, 25(4), 416–425. https://doi.org/10.1007/s40688-02000285-x Review System stressatic reductio review n interven tions for teachers, Include Lazarus Mental Employs descripti Meditati Advocates for Practical insight sx and health, self-report ve stats, on, school for educators and studies Folkman’s burnout, measures, effect improve psychologists’ psychologists, with K- transactio physiologica sizes ed role, suggesting 12 nal theory l indicators, teacher collaboration for actionable teacher of stress; standardized wellintervention interventions for s, most scales. being development, and teacher stress. (x%) in and practical the US, reduced implementation. in list burnout. them settings . Hidajat, T., Edwards, E. J., Wood, R., & Campbell, M. (2023). Mindfulness-based interventions for stress and burnout in teachers: A systematic review. Teaching and Teacher Education, 134, 104303. https://doi.org/10.1016/j.tate.2023.104303 Comprehensiv e review with practical recommendatio ns; limited scope and potential bias in included studies are acknowledged. Investig ate social media impact Longitudinal design, robust analysis, theoretical framework Wellstructur ed longitu dinal Adequa te diverse sample, reflecti Grounded in establishe d psycholog Clearly defined relevant variables, social Reliable valid measurement , standardized Robust statistical methods, regressio n Signific ant correlati on found, Supported findings, offer insights, recommendations for action, High level evidence, strong critical appraisal score, 10 Purpose Design or aim on adolesce nts’ mental health. Main Outcome Variable (s) Variable Measureme nt Data Analysis design, aids causalit y underst anding. Sample Conceptu , al setting Framewo rk or Theory ve real- ical world theories, adolesc solid ent theoretical conditi foundation ons. . media usage, mental health. scales, accepted techniques. analysis controls confound ing variables. Crosssection al, nonprobabi listic samplin g, adequat ely sized, conveni ence samplin g. 676 univers ity staff, Brazil, public univers ities, good represe ntation, low dropout rate. Burnout levels (PB, WB, CB), reliable, valid measures, CBI-Br. Self-report CBI-Br, 19 items, Likert scale, psychometri cally sound. CFA, converge nt, discrimin ant validity, reliability tests, appropria te statistical methods. Main Finding s Conclusions, Level of Evidence Strengths, recommendation (Critical Limitations s, feasibility Appraisal Score) Worth to Practice increase discuss methodological strengths, selfd social feasibility. rigor. report media Highly relevant to limitations. usage, clinical practice, poorer Education, mental policymaking, health. actionable insights. Rocha, F. L. R., De Jesus, L. C., Marziale, M. H. P., Camelo, S. H. H., Marôco, J., & Campos, J. Á. D. B. (2020). Burnout syndrome in university professors and academic staff members: psychometric properties of the Copenhagen Burnout Inventory–Brazilian version. Psicologia: Reflexão E Crítica, 33(1). https://doi.org/10.1186/s41155-020-00151-y Assess CBI-Br psycho metric properti es for Brazilia n universit y staff, explore burnout levels, determi nants. Grounded in burnout theory, consistent with job stressors, Maslach’s burnout model. CBI-Br psycho metricall y sound, threefactor model, acceptab le fit, strong reliabilit y, validity. Valid, reliable CBI-Br for Brazilian university staff, useful for burnout diagnosis, intervention. High level evidence, robust psychometric analysis, methodologically rigorous. Valuable for clinical practice, policy-making, occupational health interventions. Solid theoretical grounding, robust psychometric properties, cross-sectional design, convenience sampling. 11 Purpose Design or aim Sample Conceptu Main Variable Data Main Conclusions, Level of Evidence , al Outcome Measureme Analysis Finding recommendation (Critical setting Framewo Variable nt s s, feasibility Appraisal Score) rk or (s) Worth to Practice Theory Hepburn, S., Carroll, A., & McCuaig, L. (2021). Promoting stress management and well-being for teachers, a pilot study. Frontiers in Education, 6. https://doi.org/10.3389/feduc.2021.744227 Investig Mixed- How Draws on Perceived Surveys to PairedElevated Yoga-based CI CI feasibility ate method many? research stress, measure sample stress; supports stress demonstrated; change s PSTs on teacher mindfulne what? at two and CI management; larger-scale studies in stress, design. from stress, ss, welltime points, independ decrease integrate into needed. mindful multipl mindfulne being, and pre-/postent td stress, teacher training. ness, e ss, and coping. program tests. increase and univers coping. measures. d wellities in mindful being in Queens ness. PSTs. land, Austral ia. Agyapong, B., Brett-MacLean, P., Burback, L., Agyapong, V. I. O., & Wei, Y. (2023). Interventions to reduce stress and burnout among teachers: A scoping review. International journal of environmental research and public health, 20(9), 5625. https://www.mdpi.com/1660-4601/20/9/5625 Strengths, Limitations Determi ne psychol ogical interven tions to address stress and burnout Strengths: Broad scope and identifies gaps. Limitations: Does not perform quality assessment of Scopin g review 40 Not articles, specified 4344 teacher particip ants Asia, North Americ a, Stress and burnout Perceived Stress Scale, Teacher Stress Inventory. Maslach Burnout Inventory. Qualitati ve thematic analysis Of the 16 identifie d intervent ions most popular were mindful Implementing suitable schoolbased interventions is necessary to improve teacher well-being. Governments and schools should prioritize As a scoping review it does not perform quality assessment but provides an overview of available evidence. Strengths: Mixedmethods, clear presentation, practical implications. Limitations: Small sample, potential bias, limited generalizability . 12 Purpose Design or aim among teachers. Sample Conceptu , al setting Framewo rk or Theory Oceani a, Europe, Africa Main Outcome Variable (s) 104 K12 Burnout and Variable Measureme nt Data Analysis Main Finding s Conclusions, Level of Evidence Strengths, recommendation (Critical Limitations s, feasibility Appraisal Score) Worth to Practice nessawareness and individual based intervention studies. intervent programs. ions alone or with yoga/CB T. These led to decrease d stress and burnout scores. REBT and other intervent ions also reported positive outcome s. Ansley, B. M., Houchins, D. E., Varjas, K., Roach, A., Patterson, D., & Hendrick, R. (2021). The impact of an online stress intervention on burnout and teacher efficacy. Teaching and Teacher Education, 98, 103251. https://www.sciencedirect.com/science/article/pii/S0742051X20314426 Impact of an RCT Not specified. Maslach Burnout ANCOV A to Teacher The online s who intervention was Moderate. As an RCT it allows for Strengths: RCT design. 13 Purpose Design or aim online stress intervent ion program on burnout and teacher selfefficacy. Sample Conceptu , al setting Framewo rk or Theory teacher s from 14 schools in southea stern US. Main Outcome Variable (s) Variable Measureme nt Data Analysis Main Finding s Conclusions, Level of Evidence Strengths, recommendation (Critical Limitations s, feasibility Appraisal Score) Worth to Practice teacher selfefficacy. InventoryEducators Survey and Ohio State Teacher Efficacy Scale. compare scores postinterventi on while controllin g for preinterventi on scores. receive d the interve ntion reporte d signific antly lower levels of emotio nal exhaust ion and higher persona l accomp lishmen t compar ed to the control group. effective in reducing burnout and improving self-efficacy. Such programs should be implemented by schools. causal inferences but generalizability may be limited due to sample. Limitations: Small and localized sample. 14 Purpose Design or aim Sample Conceptu Main Variable Data Main Conclusions, Level of Evidence Strengths, , al Outcome Measureme Analysis Finding recommendation (Critical Limitations setting Framewo Variable nt s s, feasibility Appraisal Score) rk or (s) Worth to Practice Theory Zadok-Gurman, T., Jakobovich, R., Dvash, E., Zafrani, K., Rolnik, B., Ganz, A. B., & Lev-Ari, S. (2021). Effect of inquiry-based stress reduction (IBSR) intervention on well-being, resilience, and burnout of teachers during the COVID-19 pandemic. International journal of environmental research and public health, 18(7), 3689. https://www.mdpi.com/1660-4601/18/7/3689 Assess the effects of an IBSR blended intervent ion on psychol ogical and subjecti ve wellbeing, resilienc e, burnout, mindful ness, and teachers’ stress during the Prospec tive controll ed trial with interve ntion and compar ison groups. 67 teacher s from large cities in Israel, interve ntion group (N=35), control group (N=32). Based on principles and skills of observatio n, selfexploratio n, change of interpretat ion (cognitive reframing) , and empower ment from Inquiry Based Stress Reduction technique. Wellbeing, resilience, burnout, mindfulne ss, stress. Validated Intention- IBSR questionnaire to-treat enhanc s (PERMA analysis. ed Profiler, resilien Satisfaction ce and with Life improv Scale, ed Positive and wellNegative being. Affect Scale, Control Brief group Resilience suffere Scale, d Mindfulness increas in Teaching ed Scale, burnout Maslach and Burnout decline Inventory, d wellPerceived being. Stress Scale). IBSR during stressful events like COVID-19 can benefit teachers’ wellbeing and ability to flourish. Level 2 evidence from a controlled trial with findings suggesting that IBSR is worth practicing to promote teacher wellness. Strengths: Prospective design and validated measures. Limitations: Non-random assignment, relatively small sample. 15 Purpose Design or aim Sample Conceptu , al setting Framewo rk or Theory Main Outcome Variable (s) Variable Measureme nt Data Analysis Main Finding s Conclusions, Level of Evidence Strengths, recommendation (Critical Limitations s, feasibility Appraisal Score) Worth to Practice COVID19 pandemi c lockdow n. Ghannam, J., Afana, A., Ho, E. Y., Al-Khal, A., & Bylund, C. L. (2020). The impact of a stress management intervention on medical residents’ stress and burnout. International Journal of Stress Management, 27(1), 65. https://psycnet.apa.org/record/2019-11842-001 Evaluate the effective ness of a stress manage ment intervent ion on reducing stress and burnout among medical residents . Quasiexperi mental prepost interve ntion design 123 resident s from an academ ic medical center in Palestin e Based on Perceived cognitive stress, behavioral burnout therapy techniques for stress manageme nt Perceived Stress Scale, Maslach Burnout Inventory Paired ttests to compare pre-post scores Signific ant reducti ons in perceiv ed stress and emotio nal exhaust ion, and increas e in persona l accomp lishmen t post- A brief stress management intervention can effectively reduce stress and burnout among medical residents. Such interventions should be incorporated into residency training. Level 3 evidence from a quasiexperimental study as findings suggest that stress management training is worth implementing. Strengths: Addressed an important issue. Limitations: No control group, potential reporting bias, short follow up period. 16 Purpose Design or aim Sample Conceptu , al setting Framewo rk or Theory Main Outcome Variable (s) Variable Measureme nt Data Analysis Main Finding s Conclusions, Level of Evidence Strengths, recommendation (Critical Limitations s, feasibility Appraisal Score) Worth to Practice interve ntion. Schnaider-Levi, L., Ganz, A. B., Zafrani, K., Goldman, Z., Mitnik, I., Rolnik, B., & Lev-Ari, S. (2020). The effect of inquiry-based stress reduction on teacher burnout: A controlled trial. Brain Sciences, 10(7), 468. https://www.mdpi.com/2076-3425/10/7/468 Evaluate the effective ness of InquiryBased Stress Reducti on (IBSR) in reducing burnout levels among teachers. Quasiexperi mental study with prospec tive interve ntion and passive control group. 53 high school teacher s in Israel, with 25 in IBSR interve ntion group and 28 in control group. IBSR reframing cognition to identify and reduce stress, based on Cognitive Behaviora l Therapy but using awareness rather than reasoning. Burnout, measured by Maslach Burnout Inventory. Standardized questionnaire s before and after, including Maslach Burnout Inventory, Positive and Negative Affect Scale, Perceived Stress Scale, Depression Anxiety Stress Scales. Repeated measures ANOVA to examine grouptime interactio ns. Correlati ons between changes in variables. Interve IBSR shows Fair quality Strenghts: ntion potential to QuasiEasily group reduce teacher experimental implemented, had burnout. design limits low cost greater Randomized internal validity. intervention. reducti studies needed to Limitations on in establish include quasiemotio causality. IBSR is experimental nal low cost and design, small exhaust feasible. sample, selfion and reported increas measures. e in persona l accomp lishmen t than controls . Lensen, J. H., Stoltz, S. E. M. J., Kleinjan, M., Speckens, A. E. M., Kraiss, J. T., & Scholte, R. H. J. (2021). Mindfulness-based stress reduction intervention for elementary school teachers: a mixed method study. Trials, 22, 1-10. https://link.springer.com/article/10.1186/s13063-021-058046 17 Purpose Design or aim Sample Conceptu , al setting Framewo rk or Theory Evaluate Mixed- 155 Transactio the method Dutch nal Model effective random primary of Stress ness of ized school and an 8controll teacher Coping. week ed trial s from MBSR with a large intervent quantita urban ion tive area compare questio teachin d to a nnaires g waitlist and grades control qualitat 1-6. conditio ive n for intervie reducing ws. perceive d stress in primary school teachers. Main Outcome Variable (s) Variable Measureme nt Data Analysis Main Finding s Conclusions, Level of Evidence Strengths, recommendation (Critical Limitations s, feasibility Appraisal Score) Worth to Practice Perceived stress measured by Perceived Stress Scale. Validated self-report scales for stress, mental health, teacher skills, classroom climate, potential mediators like mindfulness and selfcompassion. Linear mixed models for quantitati ve data, qualitativ e coding and thematic analysis. MBSR effectiv ely reduced perceiv ed stress compar ed to control. Second ary outcom es also improv ed. MBSR shows promise for reducing teacher stress and could be implemented in primary schools. Further research in broader populations is needed. Level 2 evidence from an RCT providing preliminary support for MBSR with teachers. Strengths include design, measures. Limitations include single trainer and urban sample limiting generalizability . 18

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