## 3 Results of the Literature Review
### MRI and fMRI Studies
In addition, the volume of their caudate nucleus and shell cortex was reduced, correlating inversely with the degree of stress experienced. The results indicate a morphological involvement of the frontal striatal circuits in individuals exposed to stress. The finding of morphological changes, particularly GM atrophy in these areas, supports the previous conclusion that patients reporting classic symptoms of occupational stress have a medical condition that requires careful and precise diagnosis and treatment [23]. [PERSON] et al. examined the relationship between self-reported burnout severity and psychological measures of empathic dissonance, emotional dissonance, and alexithymia in physicians to test two conflicting hypotheses to explain burnout:  
* compassion fatigue--that is, individuals become overly emotionally involved;
* emotional dissonance--that is, a discrepancy between felt and expressed emotions along with decreased emotional regulation. They then investigated whether increased or decreased brain activity related to empathy as measured by fMRI was associated with burnout severity scores and psychological measures. Twenty-five active nurses (twenty women and five men) with work experience ranging from 1 to 10 years participated in the study. During the fMRI study, participants were presented with video clips showing the hand with and without pain. After the fMRI study, participants completed self-report measures:  
* severity of burnout was assessed using the MBI;
* empathic disposition was assessed using the Interpersonal Reactivity Index (IRI) [24,30]. The study by [PERSON] et al. was limited to a very specific population: nurses recruited via advertising from hospitals in Kyoto (Japan). The results showed higher activation in the anterior cerebral hemisphere/inferior frontal gyrus (AI/IFG) and temporoparietal junction (TPJ) under pain conditions compared to the no-pain situation. Hence, the severity of burnout in medical professionals is explained by reduced brain activity related to empathy, and this reduced brain activity is correlated with stronger emotional dissonance and alexithymiaia and greater empathy. The results support the findings of previous studies that burnout is associated with emotional dysregulation. Predicting future burnout among doctors using neuroimaging may be an important addition to psychological research. A more complete understanding of burnout is possible by identifying specific aspects of trait and empathy status and neural processes that may be associated with burnout severity. A study by [PERSON] et al. in a group of patients exposed to chronic occupational stress found reduced thickness of the right prefrontal cortex (PFC) and left superior temporal gyrus (STG), enlarged amygdala volume, and reduced caudate volume, with these abnormalities more prominent in women, except for changes in caudate nucleus volume. These were all related to perceived stress, which was similar for both sexes. PFC thickness correlated with impaired ability to modulate negative emotions downwards. After 1-2 years, amygdala enlargement and left STG thinning persisted. In the control group, the above changes did not occur. Chronic occupational stress was associated with partially reversible structural abnormalities in key stress processing regions, correlated with the degree of stress experienced. The above changes weremore pronounced in women as a possible cause of increased brain vulnerability to stress-induced psychiatric disorders [25]. In [PERSON] et al. 's study, burnout levels were positively correlated with neuronal activation in the rostral prefrontal cortex, posterior parietal cortex, and striatum, as observed by fMRI, and striatal activity decreased after therapy as a result of improved burnout levels [26]. The Shirom-Melamed Burnout Questionnaire (SMBQ) [31] containing 22 items in four subscales was used to evaluate burnout level.Cognitive training may bring improvements, but this requires further research on larger patient samples [32; 33; 34].