Cognition training during or after burnout

Research interest in burnout has persisted over the past 50 years but is
currently more relevant than ever. Using the 2015 data of the European Working
Conditions Survey, Schaufeli (2018) found that the prevalence of burnout was
10% for the European workforce, and 17% for workers in non-European countries.
Another large study conducted around the same time in the United States showed
that 28% of the millennials felt frequently or constantly burned-out, compared
to 21% of all workers that belonged to older generations (Pendell, 2018). The
Covid-19 pandemic has led to an even larger rise of individuals suffering from
burnout (da Silvera-Pereira & Silva Ribeiro, 2022). Although burnout is broadly
researched, it has only recently been recognized as an occupational phenomenon
by the World Health Organization in the International Categorization of
Diseases (ICD-11; WHO, 2019). It is not classified as a medical condition.

Research has by now consistently linked burnout to various types of cognitive
impairment (Deligkaris et al., 2014). Some researchers even regard cognitive
weariness (having slow thinking processes and reduced mental agility) as a main
dimension of burnout (Shirom et al., 2006). On top of that, several studies
have shown that burnout patients continue to suffer from some form of cognitive
decline for a long time (e.g., Oosterholt et al., 2016; Van Dam et al., 2012).
The most consistent cognitive deficits detected in burnout patients have been
found in three main cognitive functions: executive functions, attention, and
memory (Deligkaris et al., 2014). Because these cognitive functions are key to
performance, not treating these symptoms may be a hindering factor in returning
to work (for burnout patients) or in returning to pre-burnout performance
levels (for employees who have been officially recovered from their burnout).

A central problem in the burnout literature is that interventions to
effectively prevent and reduce burnout are often advocated, but rarely designed
and studied. Most interventions published today focus on stress reduction among
individuals who suffer from burnout, through relaxation, mindfulness, and
cognitive behavioural therapy (Maslach et al., 1996). The core aim of these
interventions is symptom control and stress relief. None of those focus on the
cognitive challenges that burnout patients face and continue to face for a long
time. Therefore, even those who officially recovered from their burnout, have
difficulties going back to their former jobs.

Research shows that the executive functions, attention, and memory - the areas
that are affected in burnout patients - are trainable cognitive functions. This
has been demonstrated so far mostly in older adults (Karbach & Kray, 2009;
Mozolic et al., 2011) but also in specific age groups (Bürki et al., 2014;
Zinke et al., 2012) and with video games (Strobach & Schubert, 2020). We
therefore designed a cognition enhancement training specifically aimed at
improving these cognitive functions in burnout patients and employees who have
officially recovered from burnout.

At this point, we have some preliminary evidence for the effectiveness of our
training. In a group of healthy employees, we measured the extent to which they
experienced burnout symptoms. We found that those with higher burnout
complaints improved their performance on the memory and executive functioning
tasks, significantly more so than those with higher burnout complaints in the
control group.

Primary objective: To study the effectiveness of a cognition enhancement
training for improving the performance on working memory, inhibition and task
switching among employees who are either burned-out or have been burned-out in
the past.

Research question: What is the effect of a cognitive enhancement training on
performance on working memory, inhibition (i.e., executive function) and task
switching (i.e., attention) among workers who are burnout or have recovered
from burnout?

Intervention study with a waiting list control group. Mixed design:

Within factors
• Pre-versus post-assessment of measures on inhibition, working memory, task
switching.
Between factor
• Training versus a waiting control group.

Both groups will have two online meetings with one of the researchers, at the
start of the study (pre-assessment) and after 6 weeks (post-assessment), in
which they perform several cognitive tasks to test their working memory,
inhibition and task switching. Both groups will also go through six 30-minute
online training sessions (one each week) in their own time. The intervention
group will do this in between the pre- and post-assessment, the waiting control
group after the post-assessment. Participants will be randomly assigned to
either one of these two groups (making sure that age and education level is
equally distributed across groups). This way, both groups have the possibility
to benefit from the training. Moreover, we can determine the effectiveness of
the training by comparing the improvement in cognition from pre- to
post-assessment between the two groups.

Participants will follow a six-week online cognitive enhancement training. They
will receive one 30-minute training each week, every training session having a
different theme but similar challenging tasks. They go through the training on
their own, in their own time, using their own laptop or computer and the
internet.

The training, as well as the pre-and post-assessment, was designed and
administered using open-access platform Qualtrics.

Each training session consists of tasks alternated by relevant background
information in the form of text and videos. Each training session has a theme
through which background information is being provided. The themes are
vitality, memory processes, cognitive flexibility, mindfulness, prospective
memory, and embodied cognition. This background information and related videos
(from youtube) function as a link to the tasks and as a moment of rest between
the strenuous tasks. All tasks were designed to improve relevant cognitive
skills and each training includes tasks to train working memory, task switching
ability and inhibition ability.

To improve working memory, participants learn a different memory strategy
during each training session, and over the six sessions, learn to combine them.
For example, training 1 starts with the memory strategy of using imagination to
learn and organize new information. In training 2, this strategy is expanded
was continued by adding the loci memory strategy, and so on. To improve
task-switching abilities, participants are asked to perform a series of
assignments, during which they are interrupted several times. For instance,
participants are instructed to compose an email then get interrupted by another
task, to look something up on the internet. After completion of this task, they
have to continue composing the email, during which they are interrupted again,
to check their personal agenda for available dates for a board meeting. To
improve inhibition ability, participants learn to ignore annoying visual and
auditory distractors when performing an assignment.

Each training session concludes with ratings of how enjoyable and informative
the training session had been, and a rating of the workload of the training
session.

Participants are either burnout or recovered from a burnout. The reason these
groups are the focus of our research is that these groups often experience
cognitive impairments that are not treated with regular therapy by for example
a GP or psychologist. The risk is that the training is too cognitively
challenging for them (but see above how we will deal with that risk). Yet, in
order to improve their cognitive functions, it is important that the training
is at least somewhat challenging. The benefit of the training is that it may
improve their cognitive functions in the domains of working memory, inhibition,
and task switching, and with that, help them to deal with cognitive tasks both
at work and in their daily life. To reduce the risk of overburdening
participants, we decided to extend the training from 2 to 6 weeks (after
evaluating a pilot with a healthy population), in order for participants to
complete 1 training session each week. In addition, we inform participants that
they may quit the training at any time without having to give a reason and
without consequences and encourage them to consult their GP and/or therapist
before and during the training