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Implementation context and burnout among Department of Veterans Affairs psychotherapists prior to and during the COVID-19 pandemic.

Rosen CS, Kaplan AN, Nelson DB, La Bash H, Chard KM, Eftekhari A, Kehle-Forbes S, Wiltsey Stirman S, Sayer NA. Implementation context and burnout among Department of Veterans Affairs psychotherapists prior to and during the COVID-19 pandemic. Journal of affective disorders. 2023 Jan 1; 320:517-524.

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BACKGROUND: The first goal of this study was to assess longitudinal changes in burnout among psychotherapists prior to (T1) and during the COVID-19 pandemic (T2). The second objective was to assess the effects of job demands, job resources (including organizational support for evidence-based psychotherapies, or EBPs) and pandemic-related stress (T2 only) on burnout. METHOD: Psychotherapists providing EBPs for posttraumatic stress disorder in U.S. Department of Veterans Affairs (VA) facilities completed surveys assessing burnout, job resources, and job demands prior to (T1; n  =  346) and during (T2; n  =  193) the COVID-19 pandemic. RESULTS: Burnout prevalence increased from 40 % at T1 to 56 % at T2 (p  <  .001). At T1, stronger implementation climate and implementation leadership (p  <  .001) and provision of only cognitive processing therapy (rather than use of prolonged exposure therapy or both treatments; p  <  .05) reduced burnout risk. Risk factors for burnout at T2 included T1 burnout, pandemic-related stress, less control over when and how to deliver EBPs, being female, and being a psychologist rather than social worker (p  <  .02). Implementation leadership did not reduce risk of burnout at T2. LIMITATIONS: This study involved staff not directly involved in treating COVID-19, in a healthcare system poised to transition to telehealth delivery. CONCLUSION: Organizational support for using EBPs reduced burnout risk prior to but not during the pandemic. Pandemic related stress rather than increased work demands contributed to elevated burnout during the pandemic. A comprehensive approach to reducing burnout must address the effects of both work demands and personal stressors.

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