A moment of brightness:the effects of brief morning Bright Light Therapy on burnout related complaints

In the context of education, high stress levels can be experienced by teachers as well as students. An approaching deadline, the pressure to perform, or unsupportive colleagues or supervisors are only some of many examples which could increase daily stress levels. A prolonged experience of daily stress related to work and study might deplete one’s available resources, which over time could develop into a burnout (Bährer-Kohler, 2013; Demerouti, Bakker, Nachreiner, & Schaufeli, 2001). Burnout is a socio-economical problem. It is a social problems since it affects wellbeing. When a burnout becomes more severe it could lead to absenteeism, partial sick leave or even resignation or withdrawn from study. It is an economical problem since burnout directly and indirectly influences healthcare costs and costs in an organisation. People who are on partial sick leave need to be (temporarily) replaced. Burnout is characterised with many complaints, such as severe exhaustion, cynicism, decreased personal efficacy, mood changes, sleeping problems, and psychosomatic complaints, among which neck pain, headaches, muscle pain and dizziness (Bährer-Kohler, 2013). These burnout complaints could become more severe in any specific order, however exhaustion is seen as a key complaint to start and sustain the vicious circle of exhaustion, insomnia an burnout (Bährer-Kohler, 2013; Ekstedt & Fagerberg, 2005; Saleh & Shapiro, 2008). Softening of these symptoms, which could prevent a severe burnout, could therefore be a solution for this socio-economical problem. Most solutions to prevent a burnout include organizational changes. However, research has shown that individual symptoms in non-burnout patients could improve by the use of BLT, among which exhaustion (e.g. Ancoli-Israel et al., 2012; Leppämäki, Partonen, & Lönnqvist, 2002; Partonen & Lönnqvist, 2000; Rüger, Gordijn, Beersma, de Vries, & Daan, 2006), mood (e.g. Aan Het Rot, Moskowitz, & Young, 2008; Avery et al., 1991; Avery, Kizer, Bolte, & Hellekson, 2001; Yamada, MartinIverson, Daimon, Tsujimoto, & Takahashi, 1995) and sleeping problems (e.g. Avery et al., 2001; Hubalek, Brink, & Schierz, 2010; Riemersma-van der Lek et al., 2008). Moreover, research by Meester and Waslander (2010) with burnout patients on sick leave has showed that fatigue, depression ratings and severity of burnout could be improved by the use of BLT. It might be expected BLT could also be helpful to reduce these symptoms in people with mild to moderate burnout related complaints, therefore possibly preventing burnout. The current research therefore focussed on a possible preventive strategy for burnout by the use of BLT. In comparison with BLT being used as a treatment, in this case BLT was used by students and teachers who experienced mild to moderate levels of exhaustion, but were still teaching or studying. Therefore, this research investigated if brief morning Bright Light Therapy (BLT) could help to reduce burnout related complaints among teachers and students with a sub-threshold exhaustion score. In which burnout related complaints were exhaustion, mood changes, sleep disturbances (higher sleep onset, non-refreshing sleep and wakefulness) and psychosomatic complains. A sub-threshold exhaustion score in this case meant having a high score on the exhaustion dimension of a burnout measurement. Unique to other research related to burnout interventions was the usage in a population still focused on their work still actually working, and the use of an experienced sampling method (ESM) – frequent assessment of a questionnaire. This method allowed more detailed information throughout the research period, therefore giving deeper understanding of the complaints. To establish the effectiveness of BLT, a within subject design with two light conditions was used: Bright Light Therapy (BLT) versus a dim red lamp (DRL) placebo condition of 20-30 minutes. Each participant had a baseline week, an intervention week (BLT), and a placebo week (DRL), in which BLT and DRL were controlled for order. Duration of the light intervention was kept as short as possible to lower the burden of the intervention as much as possible. Questions were assessed with two mediums, a website for the screening test and the weekly questionnaires, and an app for the daily questionnaires using ESM. Questionnaires to answer the research questions were focused on the severity of burnout, exhaustion, (depressive) mood, sleep habits, psychosomatic complaints and user experience. Findings of the current research showed that only a partial effect of BLT on the burnout related complaints was found. This partial effect of BLT was merely due to that we found no support for a beneficial effect of BLT over DRL on burnout related complaints, even when controlled for order of the lamps. Findings of the current research showed inconsistencies on the effectiveness of BLT, which in general fitted in either one of the three following situations. In the first situation, neither BLT nor DRL had an effect. This situation occurred for exhaustion, psychosomatic complaints, tension, and stress experience . The key component of burnout, exhaustion, did not improve with either BLT or DRL. This could mean that a vicious circle of exhaustion, sleep complaint and burnout had not been broken or that exhaustion levels were not that severe as intended, meaning no vicious circle was present to be broken. In the second situation, BLT as well as DRL had a significant effect, but the effectiveness of BLT was not significantly greater when compared to DRL. This situation occurred for improving the severity of burnout, depression, positive affect, alertness, sleep onset, and the easiness to fall asleep. In this situation either a placebo effect – the expectation an intervention has a certain effect while in reality it does not have an effect – might had occurred, or something else BLT and DRL have in common might had influenced results. It is less likely that a placebo effect occurred, since results from the user experience indicated that only a few people experienced effects from DRL. Results might be explained by people taking a moment for themselves in the morning, before the start of their workday, when using either BLT or DRL. Previous research showed that interventions based on relaxation or mindfulness are effective in lowering stress, thus relaxation might had improved resources in these studies (for an overview: Awa, Plaumann, & Walter, 2010; Bährer-Kohler, 2013, pp. 230–237). Participants who normally do not take a moment for themselves before a demanding working day, could already benefit from taking a brief moment for themselves in the morning, which in a certain manner is a form of relaxation. In the third situation only DRL compared to BLT had an effect. Compared to BLT, DRL had worse sleep quality, but improved refreshment after awakening and the easiness of awakenings. Results found in the current research are inconsistent with previous research, and might have been caused by several limitation in the design used. At first, exhaustion levels might not have been as severe as expected, which could have been due to a non-validated threshold for students. It is therefore suggested to increase the threshold for exhaustion if student will be used. Secondly, BLT was used in a field experiment, meaning that daylight light levels could have influenced results. In future research it will be suggested to additionally use a light sensors to test whether bright light levels beside BLT usage might influence results. Besides the limitation it is important to note that the experienced burden of BLT and DRL was found to be high. Decreasing the burden nature of the intervention would be less demanding and therefore also less depleting. The burden nature of the intervention can be lowered by changing the moment of using BLT or by presenting bright light in a more automatic manner, which can be referred to as ambient lighting – lighting that is part of the environment. Possibilities for ambient lighting might be the use of increased brightness in ceiling illumination, since this will not require one to wake up earlier, and would therefore less obstruct people in their daily life. To conclude, we only found partial effects of BLT on burnout complaints. On the complaints where BLT did had an effect, also DRL had an effect. The effectiveness of BLT was however not significantly greater than DRL. On the contrary, DRL worsened sleep quality, but improved refreshment after awakening and the easiness of awakenings. The key component of burnout, exhaustion, however did not improve with either BLT or DRL. This could mean that a vicious circle of exhaustion, sleep complaint and burnout has not been broken or that exhaustion levels were not that severe as intended, meaning no vicious circle was present to be broken. We therefore cannot conclude whether a moment of brightness by the use of BLT is suggested when burnout complaints are present. Limitations of the current research should first be overcome in order to draw more reliable conclusions for the use of BLT. Relaxation and a reduction in fatigue and exhaustion may already be achieved by reflection on personal wellbeing due to the frequent questionnaires, or by taking a moment for oneself in the morning. Burnout related complaints may therefore be improved by a moment of brightness; whether it be by light, consciousness or taking a moment for oneself.