evaluation of a bibliotherapy-based stress management (PDF)

EVALUATION OF A BIBLIOTHERAPY-BASED STRESS MANAGEMENT TRAINING FOR TEACHERS __________________________________________________________________ A Dissertation Presented to the Faculty of the Graduate School University of Missouri-Columbia __________________________________________________________________ In Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy __________________________________________________________________ by COLLEEN L. EDDY Dr. Keith C. Herman, Dissertation Supervisor MAY 2021  The undersigned, appointed by the dean of the Graduate School, have examined the dissertation entitled EVALUATION OF A BIBLIOTHERAPY-BASED STRESS MANAGEMENT TRAINING FOR TEACHERS presented by Colleen L. Eddy, a candidate for the degree of doctor of philosophy, and hereby certify that, in their opinion, it is worthy of acceptance. ____________________________________ Professor Keith Herman ____________________________ Professor Wendy Reinke ____________________________________ Professor Francis Huang ____________________________________ Professor Chris Slaten ____________________________________ Professor T. Chris Riley Tillman ____________________________________ Professor James Sebastian  To all the teachers who have given so much to me throughout my life. You are amazing. Thank you!  ii ACKNOWLEDGEMENTS I would like to thank Dr. Herman and Dr. Reinke for creating the Stress Management Training for Teachers book and doing so much to make this project possible. I would also like to thank Dr,’s Huang, Sebastian, Slaten, and Riley-Tillman for all of the feedback to improve the study. This research was funded by an internal research grant from the University of Missouri and supported by the wonderful team at the Missouri Prevention Science Institute.  iii TABLE OF CONTENTS ACKNOWLEDGMENTS................................................................................................ ii LIST OF TABLES AND FIGURES............................................................................... vi ABSTRACT..................................................................................................................... vii CHAPTER I: INTRODUCTION.....................................................................................1 Background ....................................................................................................................1 Statement of the Problem..............................................................................................3 Purpose of the Current Study.......................................................................................6 Research Questions........................................................................................................6 CHAPTER II: LITERATURE REVIEW .......................................................................8 Teacher Stress and Transactional Theory...................................................................8 Overview and Prevalence of Teacher Stress ...............................................................8 Transactional Theory of Stress..................................................................................10 Teacher Coping............................................................................................................11 Negative Results of Teacher Stress.............................................................................15 Impact of Teacher Stress on Students........................................................................15 Impact of Stress on Teachers.....................................................................................19 Impact of Teacher Stress on the Educational System................................................20 Existing Teacher Stress Reduction Programs...........................................................21 Mindfulness Based Programs ....................................................................................22 Cognitive-Behavioral Programs................................................................................26 Gaps in Existing Literature.........................................................................................30 Present Study................................................................................................................32  iv CHAPTER III: METHODS ...........................................................................................34 Participants...................................................................................................................34 Measures .......................................................................................................................36 Self-Report Measures.................................................................................................36 Observation Measures ...............................................................................................41 Procedures ....................................................................................................................42 Recruitment................................................................................................................42 Intervention...................................................................................................................45 Analyses ........................................................................................................................48 CHAPTER IV: RESULTS..............................................................................................52 Descriptive Statistics..................................................................................................52 Self-report surveys.....................................................................................................52 Feedback on the Intervention.....................................................................................56 CHAPTER V: DISCUSSION .........................................................................................59 Initial Program Efficacy...............................................................................................59 Comparison to other Teacher Stress Programs.........................................................65 Limitations....................................................................................................................67 Future Directions .........................................................................................................69 Conclusion and Summary...........................................................................................72 References.........................................................................................................................74 Appendices........................................................................................................................90 Appendix A...................................................................................................................91 Project Timeline.........................................................................................................91  v Appendix B. ..................................................................................................................92 Weekly Self-Monitoring Form ..................................................................................92 Appendix C...................................................................................................................93 Theory of Change for Stress Management Intervention............................................93 Appendix D.......................................................................................................................94 Intervention Components...........................................................................................94 Appendix E. ..................................................................................................................95 Tables and Figures .....................................................................................................95 Appendix F. ................................................................................................................106 Feedback on the Program.........................................................................................106 VITA................................................................................................................................109  vi LIST OF TABLES AND FIGURES Table 1 Participant Demographic Information…..……………………………………… 93 Table 2 Study Measures……………………………………………………………….…94 Table 3 Treatment Effects for Stress and Burnout……….…...………………………….95 Table 4 Treatment Effects for Coping Strategies……………………………………….. 95 Table 5 Treatment Effects for Efficacy, Organizational Health, and Job Satisfaction ….96 Table 6 Treatment Effects for Mental Health Screening………………………………...96 Table 7 Treatment Effects for Observed Teacher Behaviors…………………………….96 Table 8 Growth Modelling of Stress and Coping over Time ……………………………97 Table 9 Pre and Post Comparisons of Study Measures ……………………………….... 98 Figure 1 Average Self-Reported Stress over Time ……………………………………...99 Figure 2 Average Self-Reported Coping over Time……………………………………..99 Figure 3 Average Self-Reported Confidence in Coping over Time……………………100 Figure 4 Average Self-Reported Awareness of Coping Strategies over Time ………...100 Figure 5 Average Self-Reported Understanding of Coping Strategies over Time……..101 Figure 6 Average Self-Reported Use of Coping Strategies over Time……………...…101 Figure 7 Participants’ Change in Anxiety Severity Levels……………………………..102 Figure 8 Participants’ Change in Depression Severity Levels………………………….102 Table 10 Control Group Only Pre-Post Comparisons………………………………….103  vii ABSTRACT The study was a randomized control trial of a cognitive-behavioral bibliotherapy-based stress management training for teachers. The intervention consisted of the Stress Management for Teachers book, an in-person meeting, and three brief follow-up webinars with weekly practice over the course of 4 weeks. There were 53 participants in the study and teachers were randomly assigned to the intervention or waitlist control conditions. Multilevel regression was used to examine the intervention effects accounting for teachers nested in schools and controlling for school district, years of teaching experience, and the baseline measure. The intervention reduced stress on the Perceived Stress Scale (β = -0.53). Teachers also increased in specific coping strategies of planning (β = 0.62), positive reframing (β = 0.66), and decreased in self-reported substance use (β = -0.44). The intervention did not have statistically significant effects on contextual factors or on observed classroom behaviors. The intervention demonstrated treatment effects on anxiety symptoms on the GAD-7 (β = -0.51). Further, in comparison to participants in the control group, teachers in intervention condition had statistically significant changes in symptom severity level in anxiety on the GAD-7 (Cramer’s V = .45) and in depression on the PHQ-8 (Cramer’s V = .42). From progress monitoring data, teachers in the intervention condition had greater rates of improvement in increased coping, confidence and use of coping strategies (p’s < .05). Additional supports may be needed to enhance coping with stressors related to classroom management and organizational health and to optimize the intervention delivery.  1 CHAPTER I: INTRODUCTION Background Teachers contribute greatly to youth development, as schools are typically the main systems children first interact with outside of their homes (Bronfenbrenner & Morris, 2006; Rimm-Kaufman & Pianta, 2000). The task of educating youth is essential to the health and growth of society and is the key responsibility of teachers. Beyond providing academic instruction, educators are also responsible for teaching youth how to interact with others in social settings (Davis, 2003; Pianta, Hamre, & Stuhlman, 2003). One teacher has the potential to impact each student in the classroom, and across the course of a teacher’s career, this influence on youth development compounds with each year in the profession. Positive teaching practices and student-teacher relationships are protective and beneficial for students (Hamre & Pianta, 2001; Roorda, Koomen, Spilt, & Oort, 2011). The reverse is also true, such that negative interactions with teachers together with existing risk factors can lead to cascading negative outcomes (Masten et al., 2005), such as lower academic engagement and achievement (Roorda et al., 2011), as well as poorer social and emotional outcomes (Jennings & Greenberg, 2009). Positive relationships with teachers can be protective for students and buffer against existing risk (Gregory & Ripski, 2008; Rudasill, Reio, Stipanovic, & Taylor, 2010). In addition to playing such an important role in youth development, teachers make up a large percentage of the workforce in the United States. In 2017, there were 3.2 million full-time public school teachers in the United States (National Center for Education Statistics Institute of Education Sciences, 2018). The high populations of  2 teachers makes it one of the top five largest occupations in the country, following retail salespersons, which included 4.4 million workers in 2017 and greater than 2.9 million registered nurses (U. S. Bureau of Labor Statistics, 2018). Given the sheer number of teachers in the profession, the needs of teachers are critical to consider from an occupational perspective. Despite the importance and the large percentage of workers who are teachers, there are many challenges facing the profession today, and this contributes to high levels of stress. The problem of teacher stress has been consistently reported since the 1970s across many countries (Kyriacou, 2001, 2011; Kyriacou & Sutcliffe, 1978). Teacher stress is a societal concern because it is associated with a wide range of negative outcomes for students, schools, and the broader educational system. Stress and negative emotional factors impact teachers’ abilities to provide effective instruction, manage students’ behaviors, and model social emotional competencies for students (Arens & Morin, 2016; Herman, Hickmon-Rosa, & Reinke, 2018; Jennings & Greenberg, 2009; McLean & Connor, 2015). Teacher stress and burnout are associated with negative mental health outcomes including depression, anxiety, and leaving the profession (Shin, Noh, Jang, Park, & Lee, 2013; Skaalvik & Skaalvik, 2011). In considering the broader educational system, teacher attrition costs millions of dollars with the need to recruit, rehire, and train new teachers each year (Barnes, Crowe, & Schaefer, 2007; Ingersoll, 2001; Watlington, Shockley, Guglielmino, & Felsher, 2010). Though the estimates vary, it is commonly reported that one in five teachers leave the field within the first five years of entering the profession (Ingersoll, 2001), and most often high stress is reported at the reason for leaving the field (Ingersoll & Smith, 2003). Given the widespread problem of  3 teacher stress and associated negative outcomes, evidence-based programs are needed to support teachers to cope with their occupational stress. Statement of the Problem There are a few promising interventions to support teachers to cope with the stress of their jobs, yet these programs have not completed the research and development process necessary to be considered evidence-based interventions (Gottfredson et al., 2015). There have been two main categories of stress management programs for teachers based in psychological theories of cognitive behavioral therapy and mindfulness (Cullen & Wallace, 2010; Forman, 1982; Jennings et al., 2017). Both types of programs have demonstrated positive effects through initial randomized control efficacy trials, but additional refinement of these programs is needed prior to scale-up and dissemination (Gottfredson et al., 2015). The cognitive behavioral programs were initially developed in the 1980s and were based in stress inoculation theory (Forman, 1982). Initial studies showed that the stress management program for teachers had positive effects on reducing teacher symptoms of stress and mental health symptoms in comparison to control groups as well as in comparison to classroom management training and teacher support groups (Cecil & Forman, 1990; Forman, 1982; Sharp & Forman, 1985). Despite these promising results of these early efficacy studies, there has not been additional development of these programs informed by the findings of the studies until recently. Dicke, Elling, Schmeck, and Leutner (2015) found similar effects on stress reduction in comparing a cognitive- behavioral stress management training and classroom management training. These researchers suggest that classroom management training should be included in stress management training for teachers, because it may reduce stress related to student  4 behaviors, which is a commonly cited source of teacher stress (Boyle, Borg, Falzon, & Baglioni, 1995; Dicke et al., 2015). Despite the efficacy of cognitive-behavioral and classroom management training, most recent development of stress management programs for teachers has shifted to mindfulness based stress management, and have not incorporated classroom management into the development of these programs for teachers (Jennings & DeMauro, 2017). Initial efficacy studies on two different mindfulness programs for teachers have demonstrated reductions in teacher reported stress and mental health symptoms (Jennings, Frank, Snowberg, Coccia, & Greenberg, 2013; Roeser et al., 2013). In the largest evaluation study of a mindfulness program, the results showed positive results for teachers who participated in the program as well as improvements in positive observed teacher-student interactions, but with more modest effect sizes in comparison to prior studies (Jennings et al., 2017). These findings suggest possible limitations in existing mindfulness based stress management for teachers. First, the low enrollment could indicate that mindfulness is a specific type of stress management that may work well for some teachers, but may not be desirable for all teachers. Second, the low to moderate effect sizes of the program could also be due to lower effects of relaxation-based stress management programs in comparison to those based in cognitive-behavioral theory (Richardson & Rothstein, 2008). Overall, mindfulness based stress management is a promising technique for some teachers, but programs using only mindfulness, without additional skills to address sources of stress, may not be sufficient to support all teachers to address varied sources of stress.  5 Building on prior research and stress management interventions, Herman and Reinke (2015) created the Stress Management Training for Teachers as a comprehensive model that integrates promising components from existing programs to support teachers to cope with stress. The intervention is delivered through a bibliotherapy, along with one 90 minute in-person training and three online webinars all based on the book content to encourage access and interaction with book resources and activities. Cognitive behavioral theory and social learning theory are the foundational theories for the coping framework for teachers to develop specific skills. The mechanisms for change in the intervention are by increasing the awareness, understanding and use of cognitive and behavioral coping strategies to reduce stress (Herman & Reinke, 2015). First, teachers develop a better understanding of the function of stress and tools for self-monitoring to develop greater awareness of stress and coping (Harmon, Nelson, & Hayes, 1980). Then teachers learn strategies to increase adaptive thinking, such as creating coping thoughts, and decreasing negative thoughts, as well as the ABCDE method (Ellis, 1991). The adaptive behavior section includes recommendations related to prior research in stress management training, such as mindfulness strategies (Jennings & DeMauro, 2017) and increasing competency in classroom management, in order to directly address sources of stress of disruptive student behaviors (Dicke et al., 2015; Sharp & Forman, 1985). By increasing teachers’ with knowledge and awareness of stress, and specific skills to change thoughts and behaviors, this program equips teachers with a wide range of stress management strategies that can be adapted to fit with teachers’ personal preferences and unique experiences of stress.  6 Purpose of the Current Study The purpose of the study is to examine the initial efficacy of the Stress Management Training for Teachers through a randomized control trial. The design of the study will follow the standards for efficacy by the Society of Prevention Research (Gottfredson et al., 2015). The sample included 52 teachers in a Midwestern metropolitan area and surrounding rural areas. The intervention consisted of a bibliotherapy, a therapeutic intervention delivered by reading book, an in-person training, and additional complementary online webinars delivered over a four week period. Teachers were randomly assigned to the treatment or waitlist control condition. The study took place during the academic school year with baseline data collection prior to the intervention and follow-up four to six weeks after the intervention. In order to examine changes over time in response to the intervention, teachers completed weekly ratings of their stress and coping behaviors. The main purpose of the study was to examine the effects of the stress management program on teacher reported stress and coping, long-term outcomes of emotional health and occupational burnout, and contextual factors of teaching efficacy and job satisfaction. In addition to self-report data, classroom-level behavioral observations were completed by trained observers. Overall the purpose of the proposed study is to examine the effects of the Stress Management Training for Teachers under optimal and controlled conditions as an initial efficacy trial, and better understand how changes occur as a result of the intervention. Research Questions 1. Does the Stress Management Training for Teachers reduce teacher reported stress and negative mental health outcomes and improve teacher coping and wellbeing?