Specific brain responses to traumatic stress linked to PTSD risk

July 26, 2022

Science Daily/University of North Carolina Health Care

Results from the largest prospective study of its kind indicate that in the initial days and weeks after experiencing trauma, individuals facing potentially threatening situations who had less activity in their hippocampus -- a brain structure critical for forming memories of situations that are dangerous and that are safe -- developed more severe posttraumatic stress disorder (PTSD) symptoms.

This association between reduced hippocampal activity and risk of PTSD was particularly strong in individuals who had greater involuntary defensive reactions to being startled.

This research, published in the JNeurosci, suggests that individuals with greater defensive reactions to potentially threatening events might have a harder time learning whether an event is dangerous or safe. They also are more likely to experience severe forms of PTSD, which include symptoms such as always being on guard for danger, self-destructive behavior like drinking too much or driving too fast, trouble sleeping and concentrating, irritability, angry outbursts, and nightmares.

"These findings are important both to identify specific brain responses associated with vulnerability to develop PTSD, and to identify potential treatments focused on memory processes for these individuals to prevent or treat PTSD," said senior author Vishnu Murty, PhD, assistant professor of psychology and neuroscience at Temple University.

This research is part of the national Advancing Understanding of RecOvery afteR traumA (AURORA) Study, a multi-institution project funded by the National Institutes of Health, non-profit funding organizations such as One Mind, and partnerships with leading tech companies. The organizing principal investigator is Samuel McLean, MD, MPH, professor of psychiatry and emergency medicine at the University of North Carolina School of Medicine and director of the UNC Institute for Trauma Recovery.

AURORA allows researchers to leverage data from patient participants who enter emergency departments at hospitals across the country after experiencing trauma, such as car accidents or other serious incidents. The ultimate goal of AURORA is to spur on the development and testing of preventive and treatment interventions for individuals who have experienced traumatic events.

AURORA scientists have known that only a subset of trauma survivors develop PTSD, and that PTSD is associated with increased sensitivity to threats and decreased ability to engage neural structures retrieving emotional memories. Yet how these two processes interact to increase risk for developing PTSD is not clear. To better understand these processes, Murty and colleagues characterized brain and behavioral responses from individuals two weeks following trauma.

Using brain-imaging techniques coupled with laboratory and survey-based tests for trauma, researchers found that the individuals with less activity in their hippocampus and greatest defensive responses to startling events following trauma had the most severe symptoms.

"In these individuals, greater defensive reactions to threats may bias them against learning information about what is happening so that they can discern what is safe and what is dangerous," said Büşra Tanriverdi, the lead researcher on the study and graduate student at Temple. "These findings highlight an important PTSD biomarker focused on how people form and retrieve memories after trauma."

"These latest findings add to our list of AURORA discoveries that are helping us understand the differences between individuals who go on to develop posttraumatic stress disorder and those who do not," said McLean, an author on the paper. "Studies focusing on the early aftermath of trauma are critical because we need a better understanding of how PTSD develops so we can prevent PTSD and best treat PTSD."

"Since initiating our financial support of the AURORA Study in 2016, we remain steadfast in our commitment to helping AURORA investigators make important discoveries and to bridge the gaps that exist in mental health research funding and patient support," said Brandon Staglin, president of One Mind.

https://www.sciencedaily.com/releases/2022/07/220726194446.htm

Nervous system workings related to PTSD, other mental health disorders

July 5, 2022

Science Daily/University of California - San Diego

A first-of-its-kind study published recently in the journal Brain Stimulation measures changes in the human brain's response to a perceived threat following non-invasive stimulation of the nervous system via the vagus nerve. The results have implications for the development of treatments for post-traumatic stress disorder (PTSD) and other mental health conditions, as well as for increasing alertness and attention during learning.

"While our sample size was small, our results are intriguing," said the study's lead author Dr. Imanuel Lerman of UC San Diego's Qualcomm Institute (QI), School of Medicine, and Jacobs School of Engineering as well as the VA Center of Excellence for Stress and Mental Health. "The stimulation of participants' vagus nerve heightened their reaction to negative images and decreased reaction to positive images. This supports the idea that there's an additive link between vagus nerve stimulation and norepinephrine signaling, which is critical for fight or flight responses, in the brain."

One of the body's major means of communicating with the brain, the vagus nerve plays a critical role in regulating the "fight or flight" response. While previous research had indicated that stimulating this nerve improves attention, reduces reaction time and augments learning, no one had tested how this technique affects the body's response to emotionally charged stimulus.

The research team selected 24 healthy adults to receive either a placebo treatment or non-invasive stimulation of the vagus nerve where it runs parallel to the carotid artery.

These volunteers entered an fMRI machine and completed a simple task that involved pressing a button on a handheld device in response to being shown a blue circle or square. All participants were then either informed that the shape would turn red to signal the imminent appearance of an upsetting image (i.e. an image of warfare), accompanied by a high-pitched tone, or green to signal an incoming pleasant image (i.e. a photo of a quiet lakeside), accompanied by a low, soothing tone.

Researchers recorded the difference in participants' reaction time, brain activity and blood oxygen levels. Volunteers who received vagus nerve stimulation showed significantly quicker reaction times during both the neutral and emotionally charged tasks. However, individuals who received vagus nerve stimulation had stronger brain responses to negative/upsetting imagery, and diminished responses to pleasant imagery when measured with fMRI. The opposite was true for the control group.

"The study's findings represent a first step toward understanding how non-invasive vagus nerve stimulation might be efficiently used as a tool to treat patients with PTSD, generalized anxiety and other disorders that involve a heightened response to perceived threats," Lerman said.

https://www.sciencedaily.com/releases/2022/07/220705162244.htm

Most British COVID-19 mourners suffer PTSD symptoms

July 5, 2022

Science Daily/Curtin University

More than eight out of 10 British people who are seeking support for having lost a loved one to COVID-19 reported alarming Post Traumatic Stress Disorder symptoms, new Curtin University-led research has found.

The study, based on data from people seeking help and guidance from the United Kingdom's National Bereavement Partnership in collaboration with researchers from the Portland Institute for Loss and Transition and Christopher Newport University in the United States of America, also found almost two-thirds of British COVID-19 mourners experienced moderate or severe symptoms of anxiety and depression.

Lead author Professor Lauren Breen, from the Curtin School of Population Health, said the results were alarming given more than six million people had died from COVID-19 across the globe.

"These survey results indicate a concerning 'shadow pandemic' in the wake of a COVID-19 death with the vast majority of British mourners reporting alarming rates of psychological distress including constantly feeling on guard or easily startled," Professor Breen said.

"The mourners who were seeking support from the National Bereavement Partnership also reported concerning symptoms of anxiety and depression, dysfunctional grief including wanting to die in order to be with their loved one, and functional impairment that was affecting their home and family responsibilities."

According to the UK's dedicated PTSD charity, PTSD UK, about 20 per cent of all PTSD cases worldwide are linked to the unexpected death of a loved one.

To date, there have been more than 175,000 COVID-19-related deaths in the United Kingdom.

Professor Breen said the findings had significant implications for counsellors in the UK, particularly in light of modelling that showed an average of nine family members were affected by each COVID-19 death.

"Counsellors in the UK should be alert to a broad band of pandemic-related psychological distress in people who have lost a loved one to COVID-19, and not concentrate solely on symptoms of grief," Professor Breen said.

"In particular, these findings underscore the need to screen for high levels of trauma as well as grief, for potential referral to counsellors with specialised skills in treating the intersection of trauma and bereavement."

Co-author Dr Robert Neimeyer, a leading bereavement researcher and the Director of the Portland Institute for Loss and Transition, said the study suggested a useful focus for support and therapy for COVID-19 loss survivors.

"We found that much of the struggle that mourners reported in terms of intense PTSD symptoms, anguishing grief, and perturbing depression and anxiety was explained by the difficulty they had in making sense of a senseless loss, and preserving their orientation in a bewildering, threatening and disempowering world," Dr Neimeyer said.

"Not only did they lose their loved ones, but they also lost a sense of predictability, justice and control over the circumstances of the loss -- all of which could be crucial themes to address in bereavement support and therapy."

The study was based on surveys completed by 183 people seeking support from the National Bereavement Partnership in the United Kingdom.

Of those surveyed, 83 per cent reported clinically elevated PTSD symptoms, 64 per cent experienced psychiatric distress, 57 per cent suffered functional impairment and 39 per cent reported clinically significant symptoms of dysfunctional grief.

https://www.sciencedaily.com/releases/2022/07/220705162239.htm

Complex post-traumatic stress disorder

July 1, 2022

Science Daily/University of Zurich

The World Health Organization (WHO) recently listed a new sibling diagnosis for post-traumatic stress disorder (PTSD), termed complex post-traumatic stress disorder (CPTSD). An international team with the involvement of the University of Zurich has now summarized the symptoms of the long-awaited new diagnosis and issued guidelines for clinical assessment and treatment.

One of the most widely known responses to trauma is post-traumatic stress disorder, or PTSD. People affected by this mental disorder typically suffer intrusive memories or flashbacks that may overwhelm them. But international experts have been aware for decades that some trauma victims or survivors exhibit a broader pattern of psychological changes, most commonly after prolonged or repetitive events -- such as exposure to war, sexual abuse, domestic violence or torture -- now termed CPTSD.

Expanded criteria

Many experts have thus been calling for the diagnostic requirements for PTSD to be adapted. Earlier this year, the WHO issued a new version of its International Classification of Diseases (ICD-11). The updated ICD now includes a new diagnosis for complex post-traumatic stress disorder (complex PTSD). New symptoms -- such as self-organization disturbances -- were added to the previous symptoms of PTSD, which include flashbacks, nightmares, avoidance, social withdrawal and hypervigilance. Key features of self-organization disturbances include excessive or heightened emotional responses, feelings of worthlessness and persistent difficulties in sustaining relationships and in feeling close to others.

An international team with the involvement of UZH has now published a study in The Lancet describing in detail how to diagnose complex PTSD based on a patient's symptoms. The study describes the difficulties that may occur, the distinct features of the disease in children and adolescents, and the diagnostic differences that need to be made to closely related mental health disorders such as severe depression, bipolar disorders, psychoses or personality disorders.

Precise description of diagnosis and therapy

"We elaborate how the CPTSD diagnosis can be made in routine situations in emergency medical facilities and in regions with underdeveloped health care systems, for example," says first author Andreas Maercker, professor of psychopathology and clinical intervention at the University of Zurich. The study covers the latest findings on biopsychosocial correlations based on systematic selection criteria. The researchers also analyzed the evidence base for all available therapeutic studies and developed guidelines for treating CPTSD.

"This is particularly important, since not all countries use the WHO's disease classification. Some have adopted the DSM-5 classification published by the American Psychiatric Association, which currently doesn't list a diagnosis for complex PTSD," explains Maercker, emphasizing the significance of their study.

New classification developed globally

The University of Zurich was also involved in updating the WHO's new International Classification of Diseases. Based on their own research and clinical experience, Andreas Maercker from the UZH Department of Psychology and Marylene Cloitre from Stanford University came out in favor of a new diagnosis for complex post-traumatic stress disorder. In addition, global surveys among psychiatrists and psychologists also showed that there was a need for a more detailed assessment of this mental disorder. A systematic review of previous research as well as new findings then led to the creation of the new diagnosis for complex post-traumatic stress disorder.

https://www.sciencedaily.com/releases/2022/07/220701113149.htm

Study reveals the job problems contributing to physician suicide

June 29, 2022

Science Daily/University of California - San Diego

Physician burnout and suicide are a growing public health concern, with 1 in 15 physicians experiencing suicidal ideation. Studies consistently show that physicians are more likely than non-physicians to experience work-related stressors prior to suicide. Still, the exact nature of these stressors was unknown.

To better understand and characterize the job stressors that contribute to physician suicide, researchers at UC San Diego Health reviewed the death investigation narratives from 200 physician suicides collected by a national database between 2003 and 2018. Using natural language processing and thematic analysis -- tools for extracting and interpreting data from the reports -- the team was able to identify the main issues contributing to physician job stress and suicide.

The study, published June 29, 2022 in Suicide and Life-Threatening Behavior, found six overarching themes in the reports. These included an incapacity to work due to deterioration of physical health, substance use that was jeopardizing employment, the interaction between mental health and work-related issues, relationship conflicts affecting work, legal problems and increased financial stress.

"We often overlook the physical health of our health care workers, but poor health can lead to difficulty performing tasks at work, which then leads to job stress and mental health issues," said corresponding author Kristen Kim, MD, a resident physician in psychiatry at UC San Diego Health.

The authors outlined several short- and long-term solutions for health care systems to consider.

In the short-term, they stressed the need to improve physicians' access to primary care services, minimize their scheduling challenges, and address their concerns about confidentiality. Kim encouraged health care workers to utilize resources like the UC San Diego Healer Education Assessment and Referral (HEAR) program, which provides access to confidential mental health counseling and was recently endorsed by the U.S. Surgeon General's Advisory on Health Worker Burnout.

In the long-term, the authors called for broader structural and cultural changes to address workplace stress and poor physician self-care.

"The unspoken culture of medicine encourages self-sacrifice, deferred needs and delayed rewards," said Kim. "We always want to put our patients first, but healers cannot optimally heal unless they themselves are first whole."

The authors highlighted the importance of cultivating a sense of safety and community among physicians. They also suggested that health care systems and medical schools provide additional personal finance education and legal support.

"There is a lot of work to be done," said Kim, "but identifying and acknowledging the problem is always the first step towards a solution, and that's exactly what we're doing."

https://www.sciencedaily.com/releases/2022/06/220629150307.htm

Why the memory of fear is seared into our brains

June 1, 2022
Science Daily/Tulane University
Experiencing a frightening event is likely something you'll never forget. But why does it stay with you when other kinds of occurrences become increasingly difficult to recall with the passage of time?

A team of neuroscientists from the Tulane University School of Science and Engineering and Tufts University School of Medicine have been studying the formation of fear memories in the emotional hub of the brain -- the amygdala -- and think they have a mechanism.

In a nutshell, the researchers found that the stress neurotransmitter norepinephrine, also known as noradrenaline, facilitates fear processing in the brain by stimulating a certain population of inhibitory neurons in the amygdala to generate a repetitive bursting pattern of electrical discharges. This bursting pattern of electrical activity changes the frequency of brain wave oscillation in the amygdala from a resting state to an aroused state that promotes the formation of fear memories.

Published recently in Nature Communications, the research was led by Tulane cell and molecular biology professor Jeffrey Tasker, the Catherine and Hunter Pierson Chair in Neuroscience, and his PhD student Xin Fu.

Tasker used the example of an armed robbery. "If you are held up at gunpoint, your brain secretes a bunch of the stress neurotransmitter norepinephrine, akin to an adrenaline rush," he said.

"This changes the electrical discharge pattern in specific circuits in your emotional brain, centered in the amygdala, which in turn transitions the brain to a state of heightened arousal that facilitates memory formation, fear memory, since it's scary. This is the same process, we think, that goes awry in PTSD and makes it so you cannot forget traumatic experiences."

https://www.sciencedaily.com/releases/2022/06/220601133030.htm

Concussion symptoms in children may have multiple underlying causes

May 17, 2022

Science Daily/McGill University

Different types of brain damage caused by a concussion may lead to similar symptoms in children, according to research led by McGill University. A new way of studying concussions could help develop future treatments.

While most children fully recover after a concussion, some will have lasting symptoms. The findings published in eLife help explain the complex relationships that exist between symptoms and the damage caused by the injury.

The researchers found that certain combinations of brain damage were associated with specific symptoms such as attention difficulties. Other symptoms, such as sleep problems, occurred in children with multiple types of injuries. For example, damage to areas of the brain that are essential for controlling sleep and wakefulness could cause challenges with sleeping, as could damage to brain regions that control mood.

The brain's white matter holds clues

To do this, they examined how damage to the brain resulting from concussion affected its structural connection network, known as white matter. They then used statistical modelling techniques to see how these changes related to 19 different symptoms reported by the children or their caregivers.

Analysing symptoms may advance treatment

"Despite decades of research, no new treatment targets and therapies for concussions have been identified in recent years," says lead author Guido Guberman, a Vanier Scholar and MDCM Candidate at McGill University. "This is likely because damage to the brain caused by concussions, and the symptoms that result from it, can vary widely across individuals. In our study, we wanted to explore the relationships that exist between the symptoms of concussion and the nature of the injury in more detail."

Guberman and his colleagues analysed data collected from 306 children, aged nine to 10 years old, who had previously had a concussion. The children were all participants in the Adolescent Brain Cognitive Development (ABCD) Study.

"The methods used in our study provide a novel way of conceptualising and studying concussions," says senior author Maxime Descoteaux, a Professor of Computer Science at Université de Sherbrooke. "Once our results are validated and better understood, they could be used to explore potential new treatment targets for individual patients. More broadly, it would be interesting to see if our methods could also be used to gather new insights on neurological diseases that likewise cause varied symptoms among patients."

https://www.sciencedaily.com/releases/2022/05/220517151823.htm

Study finds increased risk of dementia after hospitalization for major TBI

Minor traumatic brain injury did not increase dementia risk

May 12, 2022

Science Daily/American Academy of Neurology

People who have been hospitalized for a major traumatic brain injury (TBI) may have a higher risk of developing dementia when compared to people who do not have a TBI, according to a new study published in the May 11, 2022, online issue of Neurology®, the medical journal of the American Academy of Neurology. Major TBI was defined as having bleeding in the brain and a hospital stay of three or more days. Researchers did not find an increased risk for people who had minor TBI, which was defined as a concussion with no more than a one-day hospital stay.

"Traumatic brain injury has been identified as a possible risk factor for dementia, and due to increasing numbers of people living with dementia, it is imperative to identify risk factors that might be modifiable to decrease the number of people who develop dementia in the future," said study author Rahul Raj, MD, PhD, of the University of Helsinki in Finland. "The goal of our study was to assess the association between TBI and dementia while adjusting for other relevant dementia risk factors like high blood pressure, smoking, alcohol consumption and physical activity."

For the study, researchers used a Finnish national database that includes health surveys collected every five years. Focusing on a 20-year period, they identified 31,909 people who completed one or more surveys that included details on lifestyle factors such as physical activity, smoking and alcohol use.

Researchers then looked at national health registries. Of the study group, they identified 288 people hospitalized due to a major TBI and 406 hospitalized due to a minor TBI who did not have dementia within one year of their injury. A total of 976 people developed dementia over an average 16-year follow-up period.

Of those with a major TBI, 27 people, or 9%, developed dementia. Of those with a minor TBI, nine people, or 2%, developed dementia. And of those with no TBI, 940 people, or 3% developed dementia.

After adjusting for age and sex, researchers found that people who were hospitalized due to a major TBI had a 1.5 times greater risk of dementia than those without a TBI.

But after further adjustment for other relevant dementia risk factors such as education, smoking, alcohol consumption, physical activity and high blood pressure, the association weakened. Raj explained that alcohol use and physical activity appeared to play the biggest role in weakening the association.

Researchers found no increased risk of dementia for people hospitalized for minor TBI.

"Approximately one in 10 people in our study who had major TBI did develop dementia," said Raj. "Considering that there is no cure for dementia or TBI, the results of our study suggest that prevention of other dementia risk factors such as excess alcohol consumption and physical inactivity could possibly reduce the risk of dementia in people with major TBI. More research is needed in larger groups of people."

A limitation of the study was that it included only people hospitalized for TBI, so people who did not seek care for a mild TBI were not included.

https://www.sciencedaily.com/releases/2022/05/220512092701.htm

Clues about concussions from the gut

Research showed microbiome may be used to track impact of injuries and recovery timeline

May 10, 2022

Science Daily/Houston Methodist

Scientists suggest telltale signs of concussions might be found in the gut. By taking blood, stool and saliva samples from 33 football players, the researchers were able to examine the diagnostic potential of the gut's microbiome. They say their findings demonstrate that a simple, objective diagnostic test could be developed to track the impact of concussions and signal when it's safe to return to action.

A recently published study by Houston Methodist scientists suggests telltale signs of concussions might be found in the gut. By taking blood, stool and saliva samples from 33 Rice University football players, the researchers were able to examine the diagnostic potential of the gut's microbiome. They say their findings demonstrate that a simple, objective diagnostic test could be developed to track the impact of concussions and signal when it's safe to return to action.

The findings of this study are described in a paper titled "Alterations to the gut microbiome after sport-related concussion in a collegiate football players cohort: A pilot study" appearing in the May issue of Brain, Behavior, & Immunity -- Health, a peer-reviewed journal of the Psychoneuroimmunology Research Society with an emphasis on research that has translational impact and clinical implications. Sonia Villapol, Ph.D., an assistant professor of neurosurgery at the Center for Neuroregeneration in the Houston Methodist Research Institute, is the corresponding author on the study.

While brain movement within the skull may cause injury to nerve cells, such microscopic cellular injuries are not visible on imaging tests like X-rays, CT scans and MRIs, which are more capable of finding injuries on the scale of skull fractures, brain bleeding or swelling. So, the most commonly used test for diagnoses of concussions relies exclusively on self-reported symptoms like blurry vision, dizziness, nausea and headaches, which can be very vague, subjective and often underreported by athletes who want to continue playing. This can make them notoriously difficult to diagnose.

The study, conducted over the course of one season, found a post-concussion drop-off of two bacterial species normally found in abundance in stool samples of healthy individuals. It also found a correlation between traumatic brain injury linked proteins in the blood and one brain injury linked bacterial species in the stool.

While there have been dozens of brain injury biomarkers identified, there has been limited success in developing commercial blood tests sensitive enough to detect tiny increases in biomarker concentrations. However, the central nervous system is also intimately linked to the enteric nervous system, occurring in the intestines, and head trauma invariably leads to changes in the gut microbiota, Villapol said.

After a concussion, the injuries cause inflammation, sending small proteins and molecules circulating through the blood that breach the intestinal barrier and cause changes in the gut, affecting metabolism.

She said these changes in the microbiota could offer an opportunity to acquire a readout of the ongoing injury to the central nervous system.

"Until your gut microbiome has returned to normal, you haven't recovered," Villapol said. "This is why studying the gut is so useful. It doesn't lie. And that is why there is so much interest in using it for diagnostic purposes."

While only four of the players in the study were diagnosed with major concussions, the researchers say the results will need to be confirmed in a larger sample size. They also plan to conduct a similar study soon using women's soccer athletes, who similarly have frequent head trauma.

"Women and men don't have the same immunities or gut microbiomes, and as a woman and a mother of daughters, I would hate to be that researcher who only looks at men's issues while overlooking women," Villapol said. "Women soccer players have very high rates of concussions, as well, and all the same problems when it comes to existing diagnostic methods."

https://www.sciencedaily.com/releases/2022/05/220510151514.htm

Coaching program reduces burnout among resident physicians

May 6, 2022

Science Daily/University of Colorado Anschutz Medical Campus

A coaching program aimed at decreasing burnout among female resident physicians significantly reduced emotional exhaustion and imposter syndrome while increasing self-compassion over a six month period, according to researchers at the University of Colorado Anschutz Medical Campus.

"Physician burnout is linked to increased errors, higher patient mortality rates, depression, suicidal ideation and high job turnover," the study said. "The culture leading to burnout begins in medical school and worsens throughout training."

The study was published today in JAMA Network Open.

Currently, between 40-80% of residents and physicians experience burnout with surveys showing females feel it most acutely.

"When it comes to physician burnout people tend to either blame the system or the individual and miss the physician culture," said study co-author Tyra Fainstad, MD, visiting associate professor at the University of Colorado School of Medicine. "Right now, the physician culture is toxic."

Fainstad and fellow co-author Adrienne Mann, MD, assistant professor at the CU School of Medicine, are both certified life coaches who were alarmed at burnout rates among female residents.

Both had experienced it -- overwork, anxiety and creeping despair. Both found life coaching to be immensely helpful for their experience as doctors, so they each pursued professional certification to help other physicians. They created a coaching program for women resident physicians called Better Together Physician Coaching that targeted often self-destructive attitudes. They expected perhaps 20 people to sign up. They got 101 instead. So they designed a study to test its effectiveness.

Half of the group was offered the 6-month, web-based coaching program facilitated by Mann and Fainstad during their residency program. The other half served as a control group and received training without the coaching program. They were offered coaching at the end of the study.

During the coaching program, participants could take part in two group video-conferencing coaching calls per week where up to five could be coached live on any topic in front of the group.

They could also access unlimited, anonymous written coaching in a forum where participants could submit a narrative reflection and receive a coach's response published to a secure website. The website also housed weekly, self-study sessions using videos and worksheets on topics like goal setting, growth mindset, receiving critical feedback, imposter syndrome and perfectionism.

Participants often cited similar issues: Career decisions. A lack of feedback or poor feedback from supervisors. Struggling to balance medical training and a family. Being expected to embrace unrealistic attitudes toward work. Incidents of sexism. Being unnecessarily hard on themselves.

Imposter syndrome was especially prevalent. Mann and Fainstad created an entire curriculum to address it.

"You feel like a fraud even though you have the evidence that you belong where you are," Mann said. "A lot of people believe if you are hard on yourself you will achieve more, that it will motivate you to succeed. But the exact opposite happens. You stop taking on new challenges for fear of failure all the while your brain is telling you that you don't deserve to succeed."

Other participants feared appearing `arrogant' if they felt pride in their expertise and accomplishments.

"Overworking is often idolized in this culture," Fainstad said. "Many of us land at martyrdom. We sacrifice our home lives for our work."

But coaching is not therapy, she said.

Coaching uses inquiry around perceptions, beliefs and habits to define, reframe and align work with personal values.

Unlike teaching, advising and mentoring, the researchers said, coaching uses extensive questioning to identify patterns of thought and behavior. This helps people manage their thoughts, feelings and actions.

"Unlike therapy, coaching does not diagnose or clinically treat the coachee," the study said. "When supported institutionally, coaching is highly accessible and does not require insurance approval or co-pay."

The researchers used the Maslach Burnout Inventory (MBI) to measure their work. The MBI has three subscales: Emotional exhaustion (EE) or feeling emotionally exhausted from work; Depersonalization (DP), detached and impersonal treatment of patients; Professional accomplishment (PA), beliefs around competence and success at work.

The EE score is a key construct in health care related burnout. A one point increase in the EE scale has been associated with a 7% increase in suicidal ideation and a 5-6% increase in major medical errors.

The study showed a reduced mean EE score among those that took part in the training and an increased EE score in those that did not. It also showed significantly reduced symptoms of imposter syndrome from baseline compared to those who didn't undergo coaching.

"Better Together participants had a meaningful and statistically significant reduction in emotional exhaustion, imposter syndrome and improvement in self-compassion scores," Fainstad said. "The magnitudes of EE reduction were substantial and higher than in previously described wellness interventions."

The success of the coaching program has led to its adoption by 20 other health care training sites around the nation. The researchers plan to study all of them together in the fall of 2022 to investigate generalizability, or how useful the results are for a broader group, and the feasibility of the scaled up coaching program.

https://www.sciencedaily.com/releases/2022/05/220506141142.htm