Therapist Burnout Negatively Affects Patient Outcomes During Psychotherapy

Therapist burnout negatively affected the delivery of trauma-focused psychotherapies (TFPs) to patients with posttraumatic stress disorder (PTSD), according to study results published in JAMA Network Open.

Clinicians who experience burnout have previously reported that their symptoms affect the quality of care they deliver, their communication with patients, and the likelihood of making a medical error. Additionally, recent evidence indicates that the effect of burnout on patient outcomes may be worse among clinicians and therapists who conduct interventions that require a high level of empathy and interpersonal engagement, such as psychotherapy.

To this aim, researchers from the Veteran’s Affairs Heath Care System conducted a prospective cohort study to evaluate the effect of therapist burnout on TFPs for PTSD care. Licensed mental health professionals (n=165) who provided TFPs were invited to participate in an online survey about burnout between May and October of 2019. The patients (n=1268) who initiated TFPs in the year after the clinician survey were surveyed about their treatment experience after completing treatment through 2020. Burnout was defined as a score of 3 or higher on the 5-point score from the Physician Worklife Study.

Of the mental health professionals, 53.9% were women, 87.9% were White, 55.8% were psychologists, 35.2% had 6 to 10 years of professional experience, and 39.4% had 6 to 10 years of treating veterans with PTSD. For the patients, 75.8% were men, 67.3% were White, 46.3% were employed, and 7.4% did not have stable housing. Most patients had an index trauma event involving combat (52.7%), had a history of childhood trauma (56.6%), were diagnosed with a psychiatric comorbidity in the previous year (65.7%), and had a multiple trauma history (56.6%).

These findings suggest that interventions to reduce therapist burnout might also result in more patients experiencing clinically meaningful improvement in PTSD symptoms from evidence-based psychotherapies.

Overall, 35.2% of therapists experienced burnout. The reserachers found that therapists residing in the South of the United States were more likely to report burnout (odds ratio [OR], 5.39; P =.005) and patients living in the South were more likely to be treated by a therapist with burnout (OR, 4.95; P <.001), relative to those living in the Northeast.

Patients were less likely to have a clinically meaningful improvement in their PTSD symptoms if their therapist was experiencing burnout (OR, 0.63; P =.002), if they had a past-year diagnosis of depression (OR, 0.68; P =.004), had dropped out of treatment (OR, 0.15; P <.001), and with every 3 additional days between treatment sessions (OR, 0.80; P =.002). Conversely, achieving a meaningful improvement in PTSD symptoms was positively related with PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5) scores at baseline (OR, 1.37; P <.001), retired work status (OR, 1.63; P =.02), and lack of stable housing (OR, 1.64; P =.04).

The association between therapist burnout and the reduced odds of a meaningful improvement remained significant after adjusting for patient dropout (adjusted OR [aOR], 0.56; P =.001) and session timing (aOR, 0.65; P =.003).

Study authors concluded, “These findings suggest that interventions to reduce therapist burnout might also result in more patients experiencing clinically meaningful improvement in PTSD symptoms from evidence-based psychotherapies.”

This study may have been limited by using single-item burnout measures and by not reassessing therapist burnout following the COVID-19 pandemic.

This article originally appeared on Psychiatry Advisor

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