hector garcia | University of Texas Health Science Center at San Antonio (UTHSCSA) (original) (raw)
Papers by hector garcia
Evolutionary Behavioral Sciences
Administration and policy in mental health, Jan 8, 2018
Psychiatrists in the Veterans Health Administration (VHA) are susceptible to professional burnout... more Psychiatrists in the Veterans Health Administration (VHA) are susceptible to professional burnout due to the unique needs of veterans combined with high organizational demands. The current study examined the mediating role of organizational factors in the direct relationship between providing primarily pharmacological intervention and professional burnout. Data from 125 VHA psychiatrists revealed that fair treatment by superiors and sufficient resources independently mediated the direct relationship that the percent of time devoted to pharmacological intervention had with emotional exhaustion and cynicism. Psychiatrists who feel unfairly treated and lack sufficient resources reported more professional burnout. Implications and future directions are discussed.
The journal of behavioral health services & research, Jan 10, 2018
Implementation of the Veterans Choice Program (VCP) allows Veterans to receive care paid for by t... more Implementation of the Veterans Choice Program (VCP) allows Veterans to receive care paid for by the Department of Veterans Affairs (VA) in community settings. However, the quality of that care is unknown, particularly for complex conditions such as posttraumatic stress disorder (PTSD). A cross-sectional survey was conducted of 668 community primary care and mental health providers in Texas and Vermont to describe use of guideline-recommended treatments (GRTs) for PTSD. Relatively, few providers reported using guideline-recommended psychotherapy or prescribing practices. More than half of psychotherapists reported the use of at least one guideline-recommended psychotherapy for PTSD, but fewer reported the use of core treatment components, prior training in the GRT(s) they use, or adherence to a treatment manual. Suboptimal prescribing for PTSD patients was reported more commonly than optimal prescribing. Findings raise critical questions regarding how to ensure veterans seeking PTSD ...
Psychological services, Jan 16, 2017
Significant changes in national health policy, like the Veterans Choice Act, have created growing... more Significant changes in national health policy, like the Veterans Choice Act, have created growing opportunities for veterans to receive care outside of the Veterans Administration (VA), yet little is known about the attitudes and practices in PTSD care of community providers, particularly their use of evidence-based psychotherapies (EBPs). The authors assessed psychotherapy practices of community providers serving veterans with PTSD in Texas. They surveyed Texas mental health providers regarding their patient population, practice setting, and posttraumatic stress disorder (PTSD)-related screening, assessment, and treatment practices. They identified providers from state licensing board rosters and included a stratified sample of social workers, marriage and family therapists, and professional counselors (500 each), all psychologists with available email addresses (n = 3,986), and 106 providers known to have completed state-sponsored training for 1 of the EBPs for PTSD, cognitive pro...
Psychological Trauma: Theory, Research, Practice, and Policy, 2014
ABSTRACT Mental health providers employed specifically by the Veterans Health Administration to t... more ABSTRACT Mental health providers employed specifically by the Veterans Health Administration to treat posttraumatic stress disorder (PTSD) may be at increased risk for burnout due to both organizational and patient care stressors. Usage of caffeine, alcohol, and tobacco products may increase as a means to cope with burnout and stress. This cross-sectional study measured concurrent changes in burnout levels and caffeine, alcohol, and tobacco use as a means to cope with work stressors among a population of Veterans Health Administration mental health providers working within a PTSD specialty clinic. This study consisted of 138 participants, and the sample was mostly female (67%), Caucasian (non-Hispanic; 81%), and married (70%), with a mean age of 44.3 years (SD = 11.2). Participants completed an electronic survey that assessed demographics, absenteeism, and coping behaviors, as well as burnout as measured through the Maslach Burnout Inventory-General Survey (Maslach, Jackson, & Leiter, 1996). The study results revealed a minor predictive relationship between some dimensions of burnout and the use of some negative health behaviors (drinking and caffeine use) to cope with work stress. Burnout scores (i. e., exhaustion) significantly predicted concurrent missed time from work for both physical and emotional health reasons (sick days/mental health days), but tobacco and caffeine use contributed little, and alcohol was not related to burnout at all. In the future, it would be useful to obtain information regarding in-depth health behaviors that include baseline data as well as prospective systematic fluctuations in these behaviors due to work stressors.
Psychology and Psychotherapy: Theory, Research and Practice, 2015
Prolonged exposure (PE) and cognitive processing therapy (CPT) - post-traumatic stress disorder (... more Prolonged exposure (PE) and cognitive processing therapy (CPT) - post-traumatic stress disorder (PTSD) treatments now available at the Veterans Health Administration (VHA) - expose the provider to graphic traumatic material. Little is known about the impact of traumatic material on VHA providers. The purpose of this study was to examine the relationship between trauma content, patient characteristics, and burnout among VHA PTSD Clinical Team (PCT) providers. It was hypothesized that trauma content and patient characteristics would significantly predict burnout in this population. This cross-sectional study consisted of 137 participants. The sample was mostly female (67%), Caucasian (non-Hispanic; 81%), and married (70%) with a mean age of 44.3 years (SD = 11.3). Participants completed an electronic survey that assessed demographics, patient characteristics (i.e., anger, personality disorder, malingering), trauma content characteristics (e.g., killing of women and children) as well as burnout as measured by the Maslach Burnout Inventory-General Survey (MBI-GS; Maslach et al., 1996, Burnout inventory manual. Palo Alto: Consulting Psychologist Press). Over half of the study population reported being bothered by trauma content; however, trauma content did not predict burnout. Treating patients with personality disorders and suspected malingering predicted burnout in PCT providers. High numbers (77%) reported perceiving that emotional exhaustion impacted the quality of care they provided. These findings suggest an important role of burnout assessment, prevention, and treatment strategies at the VHA. This paper addresses the impact of provider burnout on perceived quality of care. This paper also addresses potential predictors of burnout in PCT settings. This paper outlines potential remedies to provider burnout in the VHA.
Psychological services, Jan 24, 2014
In response to the growing numbers of veterans with posttraumatic stress disorder (PTSD), the Dep... more In response to the growing numbers of veterans with posttraumatic stress disorder (PTSD), the Department of Veterans Affairs (VA) has sought to make evidence-based psychotherapies for PTSD available at every VA facility. We conducted a national survey of providers within VA PTSD clinical teams (PCTs) to describe utilization of prolonged exposure (PE) and cognitive processing therapy (CPT) and to identify individual and organizational factors associated with treatment uptake and adherence. Participants (N = 128) completed an electronic survey assessing reported utilization of PE and CPT treatments, adherence to treatment manuals, and characteristics of the provider and workplace environment. Participants reported conducting a weekly mean of 4.5 hours of PE, 3.9 hours of CPT (individual format), 1.3 hours of CPT (group format), and 13.4 hours of supportive care. Perceived effectiveness of PE and CPT were significantly associated with utilization of and adherence to those treatments. R...
Psychological Services, 2014
Psychology of Men & Masculinity, 2014
Psychology of Men & Masculinity, 2011
In response to the growing numbers of veterans with posttraumatic stress disorder (PTSD), the Dep... more In response to the growing numbers of veterans with posttraumatic stress disorder (PTSD), the Department
of Veterans Affairs (VA) has sought to make evidence-based psychotherapies for PTSD available
at every VA facility. We conducted a national survey of providers within VA PTSD clinical teams
(PCTs) to describe utilization of prolonged exposure (PE) and cognitive processing therapy (CPT) and
to identify individual and organizational factors associated with treatment uptake and adherence.
Participants (N 128) completed an electronic survey assessing reported utilization of PE and CPT
treatments, adherence to treatment manuals, and characteristics of the provider and workplace environment.
Participants reported conducting a weekly mean of 4.5 hours of PE, 3.9 hours of CPT (individual
format), 1.3 hours of CPT (group format), and 13.4 hours of supportive care. Perceived effectiveness of
PE and CPT were significantly associated with utilization of and adherence to those treatments. Reported
number of hours conducting supportive care was positively associated with feeling the clinic was not
sufficiently staffed (p .05). Adherence to the PE treatment manual was positively associated with
receiving emotional support from coworkers (p .01). Provider attitudes and organizational factors such
as staffing and work relationships may have an important impact on treatment selection and the quality
of PTSD care provided in VA PCTs.
K
The purpose of this study was to conduct the first assessment of burnout among Veterans Health Ad... more The purpose of this study was to conduct the first assessment of burnout among Veterans Health Administration (VHA) mental health clinicians providing evidence-based posttraumatic stress disorder (PTSD) care. This study consisted of 138 participants and the sample was mostly female (67%), Caucasian (non-Hispanic; 81%), and married (70%) with a mean age of 44.3 years (SD 11.2). Recruitment was directed through VHA PTSD Clinical Teams (PCT) throughout the United States based
on a nationwide mailing list of PCT Clinic Directors. Participants completed an electronic survey that assessed demographics, organizational work factors, absenteeism, and burnout (assessed through the Maslach Burnout Inventory-General Survey, MBI-GS). Twelve percent of the sample reported low
Professional Efficacy, 50% reported high levels of Exhaustion, and 47% reported high levels of Cynicism as determined by the MBI-GS cut-off scores. Only workplace characteristics were significantly associated with provider scores on all 3 scales. Exhaustion and Cynicism were most impacted by perceptions
of organizational politics/bureaucracy, increased clinical workload, and control over how work is done. Organizational factors were also significantly associated with provider absenteeism and intent to leave his or her job. Findings suggest that providers in VHA specialty PTSD-care settings may benefit from programs or supports aimed at preventing and/or ameliorating burnout.
Objective. Prolonged exposure (PE) and cognitive processing therapy (CPT) – post-traumatic stress... more Objective. Prolonged exposure (PE) and cognitive processing therapy (CPT) –
post-traumatic stress disorder (PTSD) treatments now available at the Veterans Health
Administration (VHA) – expose the provider to graphic traumatic material. Little is known
about the impact of traumatic material on VHA providers. The purpose of this study was
to examine the relationship between trauma content, patient characteristics, and burnout
among VHA PTSD Clinical Team (PCT) providers. It was hypothesized that trauma
content and patient characteristics would significantly predict burnout in this population.
Design. This cross-sectional study consisted of 137 participants. The sample was mostly
female (67%), Caucasian (non-Hispanic; 81%), and married (70%) with a mean age of
44.3 years (SD = 11.3).
Methods. Participants completed an electronic survey that assessed demographics,
patient characteristics (i.e., anger, personality disorder, malingering), trauma content
characteristics (e.g., killing of women and children) as well as burnout as measured by the
Maslach Burnout Inventory-General Survey (MBI-GS; Maslach et al., 1996, Burnout
inventory manual. Palo Alto: Consulting Psychologist Press).
Results. Over half of the study population reported being bothered by trauma content;
however, trauma content did not predict burnout. Treating patients with personality
disorders and suspected malingering predicted burnout in PCT providers. High numbers
(77%) reported perceiving that emotional exhaustion impacted the quality of care they
provided.
Conclusion. These findings suggest an important role of burnout assessment,
prevention, and treatment strategies at the VHA.
This preliminary study examined the relationship between burnout and the use of evidence-based ps... more This preliminary study examined the relationship between burnout and the use of evidence-based psychotherapies
(EBPs) for posttraumatic stress disorder (PTSD) among Veterans Health Administration (VHA)
mental health clinicians. Recruitment was directed through VHA PTSD Clinical Teams (PCTs) across the
United States based on a nationwide mailing list of PCT clinic directors. Participants completed an electronic
survey assessing provider demographics, EBP usage, perceptions of EBPs’ effectiveness, manual adherence,
and burnout (assessed through the Maslach Burnout Inventory-General Survey [MBI-GS]). No significant
relationship was found between treatments used and burnout. Older clinicians and those with better adherence
to the Prolonged Exposure (PE) manual reported higher Professional Efficacy. Older clinician age was
associated with lower Cynicism scores on the MBI-GS. The findings of this study raise a number of important
questions regarding the relationship between evidence-based treatments and provider burnout and underscore
the need for additional research to better understand these associations.
Mental health providers employed specifically by the Veterans Health Administration to treat post... more Mental health providers employed specifically by the Veterans Health Administration to treat posttraumatic
stress disorder (PTSD) may be at increased risk for burnout due to both organizational and patient
care stressors. Usage of caffeine, alcohol, and tobacco products may increase as a means to cope with
burnout and stress. This cross-sectional study measured concurrent changes in burnout levels and
caffeine, alcohol, and tobacco use as a means to cope with work stressors among a population of Veterans
Health Administration mental health providers working within a PTSD specialty clinic. This study
consisted of 138 participants, and the sample was mostly female (67%), Caucasian (non-Hispanic; 81%),
and married (70%), with a mean age of 44.3 years (SD 11.2). Participants completed an electronic
survey that assessed demographics, absenteeism, and coping behaviors, as well as burnout as measured
through the Maslach Burnout Inventory-General Survey (Maslach, Jackson, & Leiter, 1996). The study
results revealed a minor predictive relationship between some dimensions of burnout and the use of some
negative health behaviors (drinking and caffeine use) to cope with work stress. Burnout scores (i.e.,
exhaustion) significantly predicted concurrent missed time from work for both physical and emotional
health reasons (sick days/mental health days), but tobacco and caffeine use contributed little, and alcohol
was not related to burnout at all. In the future, it would be useful to obtain information regarding in-depth
health behaviors that include baseline data as well as prospective systematic fluctuations in these
behaviors due to work stressors.
Cognitive– behavioral therapies (CBTs) can be effective treatments for posttraumatic stress disor... more Cognitive– behavioral therapies (CBTs) can be effective treatments for posttraumatic stress disorder (PTSD) but their effectiveness is limited by high rates of premature dropout. Few studies have compared pretreatment characteristics of treatment completers and dropouts, and only one has examined these factors in Operations Iraqi Freedom and Enduring Freedom (OIF/OEF) Veterans. This study analyzed archival clinical data from 117 OEF/OIF Veterans evaluated and treated through a Veterans Affairs PTSD clinic. High numbers dropped out of treatment (68%). Treatment dropouts
(n 79) and completers (n 38) differed significantly on Minnesota Multiphasic Personality Inventory-2 (MMPI-2) scales, PTSD symptom severity, and age. Regression analyses identified one MMPI-2 scale, TRT (negative treatment indicators), and
age as unique but modest predictors of dropout.
Evolutionary Behavioral Sciences
Administration and policy in mental health, Jan 8, 2018
Psychiatrists in the Veterans Health Administration (VHA) are susceptible to professional burnout... more Psychiatrists in the Veterans Health Administration (VHA) are susceptible to professional burnout due to the unique needs of veterans combined with high organizational demands. The current study examined the mediating role of organizational factors in the direct relationship between providing primarily pharmacological intervention and professional burnout. Data from 125 VHA psychiatrists revealed that fair treatment by superiors and sufficient resources independently mediated the direct relationship that the percent of time devoted to pharmacological intervention had with emotional exhaustion and cynicism. Psychiatrists who feel unfairly treated and lack sufficient resources reported more professional burnout. Implications and future directions are discussed.
The journal of behavioral health services & research, Jan 10, 2018
Implementation of the Veterans Choice Program (VCP) allows Veterans to receive care paid for by t... more Implementation of the Veterans Choice Program (VCP) allows Veterans to receive care paid for by the Department of Veterans Affairs (VA) in community settings. However, the quality of that care is unknown, particularly for complex conditions such as posttraumatic stress disorder (PTSD). A cross-sectional survey was conducted of 668 community primary care and mental health providers in Texas and Vermont to describe use of guideline-recommended treatments (GRTs) for PTSD. Relatively, few providers reported using guideline-recommended psychotherapy or prescribing practices. More than half of psychotherapists reported the use of at least one guideline-recommended psychotherapy for PTSD, but fewer reported the use of core treatment components, prior training in the GRT(s) they use, or adherence to a treatment manual. Suboptimal prescribing for PTSD patients was reported more commonly than optimal prescribing. Findings raise critical questions regarding how to ensure veterans seeking PTSD ...
Psychological services, Jan 16, 2017
Significant changes in national health policy, like the Veterans Choice Act, have created growing... more Significant changes in national health policy, like the Veterans Choice Act, have created growing opportunities for veterans to receive care outside of the Veterans Administration (VA), yet little is known about the attitudes and practices in PTSD care of community providers, particularly their use of evidence-based psychotherapies (EBPs). The authors assessed psychotherapy practices of community providers serving veterans with PTSD in Texas. They surveyed Texas mental health providers regarding their patient population, practice setting, and posttraumatic stress disorder (PTSD)-related screening, assessment, and treatment practices. They identified providers from state licensing board rosters and included a stratified sample of social workers, marriage and family therapists, and professional counselors (500 each), all psychologists with available email addresses (n = 3,986), and 106 providers known to have completed state-sponsored training for 1 of the EBPs for PTSD, cognitive pro...
Psychological Trauma: Theory, Research, Practice, and Policy, 2014
ABSTRACT Mental health providers employed specifically by the Veterans Health Administration to t... more ABSTRACT Mental health providers employed specifically by the Veterans Health Administration to treat posttraumatic stress disorder (PTSD) may be at increased risk for burnout due to both organizational and patient care stressors. Usage of caffeine, alcohol, and tobacco products may increase as a means to cope with burnout and stress. This cross-sectional study measured concurrent changes in burnout levels and caffeine, alcohol, and tobacco use as a means to cope with work stressors among a population of Veterans Health Administration mental health providers working within a PTSD specialty clinic. This study consisted of 138 participants, and the sample was mostly female (67%), Caucasian (non-Hispanic; 81%), and married (70%), with a mean age of 44.3 years (SD = 11.2). Participants completed an electronic survey that assessed demographics, absenteeism, and coping behaviors, as well as burnout as measured through the Maslach Burnout Inventory-General Survey (Maslach, Jackson, & Leiter, 1996). The study results revealed a minor predictive relationship between some dimensions of burnout and the use of some negative health behaviors (drinking and caffeine use) to cope with work stress. Burnout scores (i. e., exhaustion) significantly predicted concurrent missed time from work for both physical and emotional health reasons (sick days/mental health days), but tobacco and caffeine use contributed little, and alcohol was not related to burnout at all. In the future, it would be useful to obtain information regarding in-depth health behaviors that include baseline data as well as prospective systematic fluctuations in these behaviors due to work stressors.
Psychology and Psychotherapy: Theory, Research and Practice, 2015
Prolonged exposure (PE) and cognitive processing therapy (CPT) - post-traumatic stress disorder (... more Prolonged exposure (PE) and cognitive processing therapy (CPT) - post-traumatic stress disorder (PTSD) treatments now available at the Veterans Health Administration (VHA) - expose the provider to graphic traumatic material. Little is known about the impact of traumatic material on VHA providers. The purpose of this study was to examine the relationship between trauma content, patient characteristics, and burnout among VHA PTSD Clinical Team (PCT) providers. It was hypothesized that trauma content and patient characteristics would significantly predict burnout in this population. This cross-sectional study consisted of 137 participants. The sample was mostly female (67%), Caucasian (non-Hispanic; 81%), and married (70%) with a mean age of 44.3 years (SD = 11.3). Participants completed an electronic survey that assessed demographics, patient characteristics (i.e., anger, personality disorder, malingering), trauma content characteristics (e.g., killing of women and children) as well as burnout as measured by the Maslach Burnout Inventory-General Survey (MBI-GS; Maslach et al., 1996, Burnout inventory manual. Palo Alto: Consulting Psychologist Press). Over half of the study population reported being bothered by trauma content; however, trauma content did not predict burnout. Treating patients with personality disorders and suspected malingering predicted burnout in PCT providers. High numbers (77%) reported perceiving that emotional exhaustion impacted the quality of care they provided. These findings suggest an important role of burnout assessment, prevention, and treatment strategies at the VHA. This paper addresses the impact of provider burnout on perceived quality of care. This paper also addresses potential predictors of burnout in PCT settings. This paper outlines potential remedies to provider burnout in the VHA.
Psychological services, Jan 24, 2014
In response to the growing numbers of veterans with posttraumatic stress disorder (PTSD), the Dep... more In response to the growing numbers of veterans with posttraumatic stress disorder (PTSD), the Department of Veterans Affairs (VA) has sought to make evidence-based psychotherapies for PTSD available at every VA facility. We conducted a national survey of providers within VA PTSD clinical teams (PCTs) to describe utilization of prolonged exposure (PE) and cognitive processing therapy (CPT) and to identify individual and organizational factors associated with treatment uptake and adherence. Participants (N = 128) completed an electronic survey assessing reported utilization of PE and CPT treatments, adherence to treatment manuals, and characteristics of the provider and workplace environment. Participants reported conducting a weekly mean of 4.5 hours of PE, 3.9 hours of CPT (individual format), 1.3 hours of CPT (group format), and 13.4 hours of supportive care. Perceived effectiveness of PE and CPT were significantly associated with utilization of and adherence to those treatments. R...
Psychological Services, 2014
Psychology of Men & Masculinity, 2014
Psychology of Men & Masculinity, 2011
In response to the growing numbers of veterans with posttraumatic stress disorder (PTSD), the Dep... more In response to the growing numbers of veterans with posttraumatic stress disorder (PTSD), the Department
of Veterans Affairs (VA) has sought to make evidence-based psychotherapies for PTSD available
at every VA facility. We conducted a national survey of providers within VA PTSD clinical teams
(PCTs) to describe utilization of prolonged exposure (PE) and cognitive processing therapy (CPT) and
to identify individual and organizational factors associated with treatment uptake and adherence.
Participants (N 128) completed an electronic survey assessing reported utilization of PE and CPT
treatments, adherence to treatment manuals, and characteristics of the provider and workplace environment.
Participants reported conducting a weekly mean of 4.5 hours of PE, 3.9 hours of CPT (individual
format), 1.3 hours of CPT (group format), and 13.4 hours of supportive care. Perceived effectiveness of
PE and CPT were significantly associated with utilization of and adherence to those treatments. Reported
number of hours conducting supportive care was positively associated with feeling the clinic was not
sufficiently staffed (p .05). Adherence to the PE treatment manual was positively associated with
receiving emotional support from coworkers (p .01). Provider attitudes and organizational factors such
as staffing and work relationships may have an important impact on treatment selection and the quality
of PTSD care provided in VA PCTs.
K
The purpose of this study was to conduct the first assessment of burnout among Veterans Health Ad... more The purpose of this study was to conduct the first assessment of burnout among Veterans Health Administration (VHA) mental health clinicians providing evidence-based posttraumatic stress disorder (PTSD) care. This study consisted of 138 participants and the sample was mostly female (67%), Caucasian (non-Hispanic; 81%), and married (70%) with a mean age of 44.3 years (SD 11.2). Recruitment was directed through VHA PTSD Clinical Teams (PCT) throughout the United States based
on a nationwide mailing list of PCT Clinic Directors. Participants completed an electronic survey that assessed demographics, organizational work factors, absenteeism, and burnout (assessed through the Maslach Burnout Inventory-General Survey, MBI-GS). Twelve percent of the sample reported low
Professional Efficacy, 50% reported high levels of Exhaustion, and 47% reported high levels of Cynicism as determined by the MBI-GS cut-off scores. Only workplace characteristics were significantly associated with provider scores on all 3 scales. Exhaustion and Cynicism were most impacted by perceptions
of organizational politics/bureaucracy, increased clinical workload, and control over how work is done. Organizational factors were also significantly associated with provider absenteeism and intent to leave his or her job. Findings suggest that providers in VHA specialty PTSD-care settings may benefit from programs or supports aimed at preventing and/or ameliorating burnout.
Objective. Prolonged exposure (PE) and cognitive processing therapy (CPT) – post-traumatic stress... more Objective. Prolonged exposure (PE) and cognitive processing therapy (CPT) –
post-traumatic stress disorder (PTSD) treatments now available at the Veterans Health
Administration (VHA) – expose the provider to graphic traumatic material. Little is known
about the impact of traumatic material on VHA providers. The purpose of this study was
to examine the relationship between trauma content, patient characteristics, and burnout
among VHA PTSD Clinical Team (PCT) providers. It was hypothesized that trauma
content and patient characteristics would significantly predict burnout in this population.
Design. This cross-sectional study consisted of 137 participants. The sample was mostly
female (67%), Caucasian (non-Hispanic; 81%), and married (70%) with a mean age of
44.3 years (SD = 11.3).
Methods. Participants completed an electronic survey that assessed demographics,
patient characteristics (i.e., anger, personality disorder, malingering), trauma content
characteristics (e.g., killing of women and children) as well as burnout as measured by the
Maslach Burnout Inventory-General Survey (MBI-GS; Maslach et al., 1996, Burnout
inventory manual. Palo Alto: Consulting Psychologist Press).
Results. Over half of the study population reported being bothered by trauma content;
however, trauma content did not predict burnout. Treating patients with personality
disorders and suspected malingering predicted burnout in PCT providers. High numbers
(77%) reported perceiving that emotional exhaustion impacted the quality of care they
provided.
Conclusion. These findings suggest an important role of burnout assessment,
prevention, and treatment strategies at the VHA.
This preliminary study examined the relationship between burnout and the use of evidence-based ps... more This preliminary study examined the relationship between burnout and the use of evidence-based psychotherapies
(EBPs) for posttraumatic stress disorder (PTSD) among Veterans Health Administration (VHA)
mental health clinicians. Recruitment was directed through VHA PTSD Clinical Teams (PCTs) across the
United States based on a nationwide mailing list of PCT clinic directors. Participants completed an electronic
survey assessing provider demographics, EBP usage, perceptions of EBPs’ effectiveness, manual adherence,
and burnout (assessed through the Maslach Burnout Inventory-General Survey [MBI-GS]). No significant
relationship was found between treatments used and burnout. Older clinicians and those with better adherence
to the Prolonged Exposure (PE) manual reported higher Professional Efficacy. Older clinician age was
associated with lower Cynicism scores on the MBI-GS. The findings of this study raise a number of important
questions regarding the relationship between evidence-based treatments and provider burnout and underscore
the need for additional research to better understand these associations.
Mental health providers employed specifically by the Veterans Health Administration to treat post... more Mental health providers employed specifically by the Veterans Health Administration to treat posttraumatic
stress disorder (PTSD) may be at increased risk for burnout due to both organizational and patient
care stressors. Usage of caffeine, alcohol, and tobacco products may increase as a means to cope with
burnout and stress. This cross-sectional study measured concurrent changes in burnout levels and
caffeine, alcohol, and tobacco use as a means to cope with work stressors among a population of Veterans
Health Administration mental health providers working within a PTSD specialty clinic. This study
consisted of 138 participants, and the sample was mostly female (67%), Caucasian (non-Hispanic; 81%),
and married (70%), with a mean age of 44.3 years (SD 11.2). Participants completed an electronic
survey that assessed demographics, absenteeism, and coping behaviors, as well as burnout as measured
through the Maslach Burnout Inventory-General Survey (Maslach, Jackson, & Leiter, 1996). The study
results revealed a minor predictive relationship between some dimensions of burnout and the use of some
negative health behaviors (drinking and caffeine use) to cope with work stress. Burnout scores (i.e.,
exhaustion) significantly predicted concurrent missed time from work for both physical and emotional
health reasons (sick days/mental health days), but tobacco and caffeine use contributed little, and alcohol
was not related to burnout at all. In the future, it would be useful to obtain information regarding in-depth
health behaviors that include baseline data as well as prospective systematic fluctuations in these
behaviors due to work stressors.
Cognitive– behavioral therapies (CBTs) can be effective treatments for posttraumatic stress disor... more Cognitive– behavioral therapies (CBTs) can be effective treatments for posttraumatic stress disorder (PTSD) but their effectiveness is limited by high rates of premature dropout. Few studies have compared pretreatment characteristics of treatment completers and dropouts, and only one has examined these factors in Operations Iraqi Freedom and Enduring Freedom (OIF/OEF) Veterans. This study analyzed archival clinical data from 117 OEF/OIF Veterans evaluated and treated through a Veterans Affairs PTSD clinic. High numbers dropped out of treatment (68%). Treatment dropouts
(n 79) and completers (n 38) differed significantly on Minnesota Multiphasic Personality Inventory-2 (MMPI-2) scales, PTSD symptom severity, and age. Regression analyses identified one MMPI-2 scale, TRT (negative treatment indicators), and
age as unique but modest predictors of dropout.