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arbete och hälsa | vetenskaplig skriftserie isbn 91-7045-744-1 issn 0346-7821 nr 2005:4 Performance-based self-esteem A driving force in burnout processes and its assessment Lennart Hallsten, Malin Josephson and Margareta Torgén National Institute for Working Life  ARBETE OCH HÄLSA Editor-in-chief: Staffan Marklund Co-editors: Marita Christmansson, Birgitta Meding, Bo Melin and Ewa Wigaeus Tornqvist © National Institut for Working Life & authors 2005 National Institute for Working Life S-113 91 Stockholm Sweden ISBN 91–7045–744–1 ISSN 0346–7821 http://www.arbetslivsinstitutet.se/ Printed at Elanders Gotab, Stockholm Arbete och Hälsa Arbete och Hälsa (Work and Health) is a scientific report series published by the National Institute for Working Life. The series presents research by the Institute’s own researchers as well as by others, both within and outside of Sweden. The series publishes scientific original works, disser- tations, criteria documents and literature surveys. Arbete och Hälsa has a broad target- group and welcomes articles in different areas. The language is most often English, but also Swedish manuscripts are welcome. Summaries in Swedish and English as well as the complete original text are available at www.arbetslivsinstitutet.se/ as from 1997.  Preface This is the final report from the project “Utbränning, sjukskrivning och arbetsbyte – en prospektiv populationsstudie” (“Burnout, sickness absence and turnover – a prospective population study”), which was begun in the year 2000 funded by AFA, the insurance company (Dnr 2000-0173). The presented empirical material has its point of departure in data from the third phase of the project focusing on performance-based self-esteem (study B in the present manuscript). In addition, the study has been supplemented by data on performance-based self-esteem from the first two phases of the project (study A in the manuscript) as well as from two Swedish surveys from the projects, ”Ett arbetsliv för alla åldrar” (“A working life for all ages”) at National Institute for Working Life and ”Hållbar hälsa i kommuner och landsting” (“Sustainable health in local governments and county councils”) at the Karolinska institute. April 2005 Lennart Hallsten Margareta Torgén National Institute for Working Life, Stockholm Malin Josephson Karolinska Institutet, Stockholm  Contents Preface 1. Introduction 1 2. Theoretical and empirical background 3 2.1. Burnout as a route of self-esteem strivings into psychic strain and distress 3 2.2. Self-esteem, contingent self-esteem and performance-based self-esteem 5 2.3. Related performance and achievement orientations 6 2.4. Contingent self-esteem and symptoms in the burnout process 7 2.5. Origins and determinants of contingent self-esteem 9 2.6 A work model of performance based self-esteem and burnout 10 3. Aim and hypotheses 11 4. Methods and data 13 4.1. Datasets 13 4.2. Variables and indices 14 5. Results 18 5.1. Basic measurement properties of the Pbse-scale 18 5.2. Convergent validity 20 6. Discussion and conclusions 23 6.1. Psychometric properties of the Pbse scale 23 6.2. Validity of the Pbse scale 24 6.3. Performance-based self-esteem: some characteristics 27 6.4. Implications for the conception and assessment of burnout and its prevention 29 7. Sammanfattning 32 8. Summary 32 9. References 33 10. Appendix 39  1 1. Introduction In recent years, the interest in questions pertaining to burnout has been wide- spread both within research and public debate. Ever since the publication of the first scientific papers on the phenomenon in the mid-1970’s (Freudenberger, 1974; Maslach, 1976) around 6,000 publications on burnout have been published (Schaufeli et al., 1998), and each year since the early 1980’s, the database Psych- Info has included around 100 papers and books that have burnout in their titles. It would appear as if mental well-being has declined in Western countries over the last decades, and in Sweden, there has been an increase in the prevalence of psychological problems not just among employees but also among non-employed groups, such as students and unemployed people. This is indicated by cross- sectional and longitudinal data from national population surveys (Hallsten et al., 2004). Between 1986/87 and 2000/01, there was at least a 50 percent increase in the prevalence of fatigue, sleeping problems and anxiety for these mentioned groups. These tendencies have most probably involved burnout processes. While burnout has, in general, been viewed as a stress and crisis concept of major interest to both occupational and social psychologists, burnout has in recent times, at least in Sweden, also become a concern for both clinically oriented professionals and the general public. A large number of people have sought clinical help and cures for stress-related problems and exhaustion. Burnout has been used as a diagnosis in sickness certificates and research reports on sickness absence from the Swedish Social Insurance Board (National Social Insurance Board, 2002) have included burnout as one category of absence. This type of stress-related phenomenon often results in long-term sickness absence, and at the present time there are no generally accepted remedies for these illnesses. The current study addresses conceptions and measurements of burnout, and especially one component of burnout linked to self-esteem strivings that so far has been ignored. Nowadays, the Maslach Burnout Inventory (MBI) and its different versions (Maslach et al., 1981, 1996) has evolved as a form of standard instrument to assess burnout, which is operationally defined as a psychological state or syndrome of emotional exhaustion, cynicism, and reduced professional efficacy. A more dubious aspect is that depressive feelings or distress are not included in the syndrome, and an even more problematic feature is that this instrument is built on the presumption that burnout only can emerge among employees and self- employed persons in work settings. This job-restricted view of burnout cannot be confirmed or rejected by using the MBI, since its scales presuppose that the subjects are occupationally active. More generic and existential perspectives on burnout have, however, been formulated (Hallsten, 1989, 1993; Pines, 1996; Pines et al., 1981) and context-free instruments have been developed, e.g. the Burnout Measure (BM) (Pines et al., 1981), Melamed’s burnout syndrome scale (Melamed et al., 1992, 1999), and the Copenhagen Burnout Inventory (Borritz et al., 2000). All these instruments assess various negative reactions, such as exhaustion, critical attitudes, reduced engagement and efficacy, depressed mood, strain, etc,  2 that in the present paper are primarily regarded as indications of strain and distress, not of burnout which is to be explained below. A shortcoming in all these burnout instruments, whether job-restricted or not, is that they involve a risk of over-inclusion (Hallsten, 1993), and that they capture subgroups that preferably should be differentiated from each other. All these instruments ignore a general theme in nearly every individual and interpersonal conception of burnout (Schaufeli & Enzmann, 1998), specifically that burnout affects persons with an initially high motivation and engagement (Cherniss, 1980; Edelwich, 1980; Freudenberger, 1974, 1983; Hallsten, 1993; Pines, 1993). Ex- haustion, cynicism and demoralisation may, however, also affect persons with low initial engagement and it has never been asked whether individuals with high burnout scores previously exhibited higher engagement and involvement, for example when they began work. An issue is then whether persons with low initial engagement and high MBI scores should be classified as burnout or not. The standpoint taken here is that they should not, and an attendant question is how to differentiate burnout individuals from other exhausted, cynical and demoralised individuals. One possible approach is to proceed from a process model of burnout (Hallsten, 1993) and to complement ordinary burnout assessments with data from a scale for “performance-based self-esteem”, the Pbse-scale (Hallsten, 2005). Performance-based self-esteem is assumed to contribute to high but vulnerable engagement and involvement in jobs and tasks, and individuals with high scores on ordinary burnout scales and high performance-based self esteem are regarded as “burnout”, while those with high ordinary burnout scores and low performance- based self esteem are labelled “wornout”. This distinction has revealed some interesting outcomes. Wornout and burnout were noticeably negatively correlated (r = -0,58) over occupations in a nationally representative sample of Swedes (Hallsten, 2005) and wornout and burnout seem to be differently related to edu- cation, age, job demands, organisational events and coping behaviours. The Pbse-scale has been used in several studies with a large aggregated number of individuals, over 17,000, and the major aim of this report is to present psychometric properties of the scale, such as means, standard deviations, internal consistency, stability and convergent validity. As a background, the concept of performance-based self-esteem is introduced and elaborated in some detail and its role in burnout is suggested. It is argued that performance-based self-esteem is a form of contingent self-esteem and a vulnerable achievement orientation that makes the process of burning out comprehensible. A working model for perfor- mance-based self-esteem and burnout is outlined together with presumed associ- ations with various variables. This framework provides the basis for empirical testing of the convergent validity of the Pbse scale.  3 2. Theoretical and empirical background 2.1. Burnout as a route of self-esteem strivings into psychic strain and distress In the aforementioned process model, burnout is conceived as a phase in a process of burning out. This process may take place in any context, in work, family, edu- cation, job search, as long as the context is important for a person’s self-esteem or self-worth. The initial phase of the process is called “Anxious engagement” (earlier called “Absorbing commitment”) characterised by high involvement and engagement but also by signs of concern and anxiety. This phase may turn over into “Frustrated strivings” and eventually into “Burnout” in case of exposure to unmanageable recurring or chronic stressors. The coping efforts and preoccupa- tions during “Frustrated strivings” may be quite demanding and “Burnout” is assumed to occur after additional experiences of defeat or reduced functional capacity. Thus, burnout does not refer to a syndrome of psychic strain-distress and crisis, but to a route or a mediating process of self-esteem strivings into this syndrome (see Figure 1), occurring when the enactment of a self-definitional role is threatened or obstructed by an incongruent environment with enduring or recurrent stressors. Other routes to psychic strain, distress and crises, as indicated by the dotted line in Figure 1, are called wornout. Burnout is supposed to occur only in activities with a potential for self-expression or self-definition, not in activities performed just for extrinsic, instrumental reasons. Traditional burnout instruments capture a rather heterogeneous group and a multitude of processes are presumed to result in stress or crises expressed by emotional exhaustion, cynicism and low efficiency. Consequently, it seems reasonable to try to distinguish the process of burning out from similar yet different processes. The idea has been to assess cognitions, motives and drives underlying “Anxious engagement” that may be relatively unaffected by the process. Questions about previous coping attempts and strivings were seen as an option, but retrospective reports can be unreliable and were to be avoided. Earlier Figure 1. A crude model of burnout. Burnout as a mediating process of self-esteem strivings into psychic strain-distress, activated and influenced by an enduring incongruent environment. An elaborated model is found in section 2.6. Enduring or recurrent environmental stressors Psychic strain- distress Self-esteem strivings  4 embrace the script “I am my achievements”, i.e., that their self-esteem was con- tingent on how well they performed in roles that were of vital significance for their self-realisation. I have called this contingent self-worth or self-esteem (Crocker et al., 2001) “performance-based self-esteem”. Stressors within such roles and domains are appraised as being challenges or threats to self-worth, self- esteem and personal image, which bring about a pattern of strenuous self-esteem strivings. From this point of view, states of exhaustion, strain, distress and negative attitudes are not regarded as indications of burnout unless signs or traces of high performance-based self-esteem are observed. High BM-scores as well as high emotional exhaustion are assumed to primarily express psychic strain and distress. High scores on the BM together with low performance based self-esteem are regarded as indications of wornout rather than burnout. Wornout is used as an umbrella term for strain-distress states not influenced by exhausting attempts to create or validate self-esteem or to perform well in a certain role. While burnout corresponds to a self-worth crisis, wornout is more related to general situational concerns and apprehensions or to feelings of being fed up with a job or activity. Most persons probably do not have attitudes such as anxious engagement towards their jobs, studies or activities. Some have low expectations and engagement, others have more balanced attitudes and utilise less demanding coping patterns, but may still get exhausted, cynical and depressed in some circumstances. A key difference between burnout and wornout individuals is that the former ones are more inclined to feel responsible for negative outcomes and to attribute causes to their own personal characteristics. In this process perspective, burnout denotes a certain strain-distress and con- tingent self-esteem profile. By combining1 strain-distress data from Pines’ BM- scale and contingent self-esteem data from the Pbse-scale, four patterns are Table 1. Four strain-distress/contingent self-esteem patterns. Low scores on a scale for per- formance-based self-esteem High scores on a scale for per- formance-based self-esteem Low scores on traditional burnout scales such as the BM (“low strain-distress”) “Relaxed” “Challenged” High scores on traditional burn- out scales such as the BM (“high strain-distress”) “Wornout” “Burnout” 1 How to combine these data is a somewhat thorny issue. There are two principal approaches, the person-oriented categorical approach and the variable-oriented continuous approach, both with certain weaknesses and strengths. In the categorical approach, the scales are divided in low-high (or mediate) levels, and individuals are categorised into just one of these categories, e.g. people high on both scales are classified as “burnout”, etc (see Hallsten, 2005). In the continuous app- roach, strain-distress and Pbse-scores are added to create a burnout dimension, while the Pbse- scores are subtracted from strain-distress scores to produce a wornout dimension. Each individual is then given both a burnout and a wornout score (see Hallsten, 2004).  5 obtained, see Table 1. Burnout refers to a combination of high strain-distress and high performance-based self-esteem, while wornout corresponds to high strain- distress and low performance-based self-esteem. Two low strain-distress profiles are also distinguished, a “Relaxed” and a “Challenged” group. 2.2. Self-esteem, contingent self-esteem and performance-based self-esteem Self-esteem is a phenomenon with a seemingly pervasive influence on human cognition and affect (Baumeister, 1993; Crocker, 2002). Self-esteem is a strong predictor of life satisfaction (Diener, 1984; Rosenberg et al., 1995) and it func- tions as a potent resource in coping with stressful events. The MBI-dimensions have also been clearly negatively correlated to self-esteem in a number of studies (Pfenning & Husch, 1994 in Schaufeli & Enzmann, 1998), with somewhat stronger relations to emotional exhaustion than to depersonalisation (≈ cynicism) and reduced personal accomplishment (≈ professional efficacy). Whether self- esteem primarily functions as an antecedent, a concomitant or a consequence of the MBI-dimensions has not been possible to determine (Rosse et al., 1991). The type of self-esteem correlated with MBI in these studies is global self- esteem, which refers to individuals' assessment of their general, personal worth. Global self-esteem as measured, for example, by Rosenberg’s self-esteem scale (Rosenberg, 1965) contrasts with more specific or domain-related self-esteems, such as self-esteem related to physical appearance, achievements, skills, power or memberships. Performance-based self-esteem does not describe a certain level of self-esteem but indicates how self-esteem is shaped and maintained. Performance-based self- esteem refers to one type of contingent self-esteem or self-worth (Crocker et al., 2004; Kernis et al., 1995), i.e., a self-esteem that depends on fulfilments of certain contingencies, such as having a characteristic, being a member or accomplishing a certain task. Self-esteem primarily built on accomplishments and “doing” rather than on “being” or “having” are called performance-based self-esteem, and this concept is introduced in the burnout modelling to give a plausible explanation for the alleged transition and shift in the burnout process from high involvement into strain, distress and disinterest (Schaufeli & Enzmann, 1998). High levels of moti- vation and involvement per se do not constitute vulnerability factors for strain and disinterest (Schmitz et al., 1999). High initial motivation can, however, be an expression of a need to maintain or boost global or specific self-esteem. A central assumption is that burnout processes can be understood as unsuccessful strivings to avoid or raise a fragile self-esteem by trying to match certain self-worth con- tingencies. Thus, a seemingly active coping process is assumed to aggravate the psychological effects of an incongruent environment and contribute to burnout. Performance-based self-esteem is a label for a psychological construct of interrelated cognitions, emotions and motives arising as a response to chronic or recurring stressors, appraised as challenges or threats to self-worth and self- esteem. Societal influences and individual history have contributed to this pattern,  6 which presumably has been advantageous in many situations. However, this pattern can under some circumstances become maladaptive and conducive to burnout. Pressures in self-definitional domains, roles and tasks trigger performance- based self-esteem. The activated cognitions entail contingency and imperative beliefs (Clark et al., 1999) regarding conditions and requirements for esteem. Examples of such beliefs are “If I do not manage project X in time, then I’d feel ashamed and lose my self-esteem” and “I must manage project X in time, or else ...”. Evidently, cognitions like these involve personal and ego-oriented motives and goals as well as self-evaluative concerns and worries. Since self-esteem often acts as a potent need, people with high contingency-based self-esteem will strenuously act and strive to set aside self-esteem doubts by matching the con- tingencies. In addition, the importance attached to the goals often obstructs psychological withdrawal from the self-definitional task. If these strivings aid in reaching the goals, self-esteem may be raised or maintained, otherwise not. Thus, performance-based self-esteem refers to a pattern of intimately linked cognitions, emotions and motives that generate behaviours and strivings with the aim of maintaining or raising self-esteem. The Pbse-scale measures the cognitions involved in this pattern, i.e., contingency and imperative beliefs, as well as evaluative concerns that regulate the endeavours to attain self-esteem, e.g. by items such as “I think that I sometimes try to prove my self-worth by being competent”. 2.3. Related performance and achievement orientations Other concepts have been applied to capture conditional self-esteem and endea- vours to attain self-confirmation in a similar way as for performance-based self- esteem, and the distinction between non-contingent and contingent self-esteem has been given prominence among some researchers. In their studies of both level and type of self-esteem, Kernis and his colleagues have developed a scale for contingent self-esteem (Kernis et al.; Paradise et al., 2002) that assesses the extent to which individuals’ self-worth depends upon meeting expectations, matching standards or achieving specific outcomes. Johnson and Forsman (Johnson, 1997) have presented a similar scale called “earning self-esteem” comprising three subscales, self-esteem contingency, hard work and need for power. Crocker and Wolfe (Crocker & Wolfe, 2001) have also scrutinised self-esteem contingency and maintain that all self-esteem is contingent, but on different sources of con- tingency. The latter mentioned authors assume that persons with an high, overall level of contingent self-esteem should have their self-esteem primarily based on externally controlled domains, such as competence, appearance and social app- roval, while those with low contingent self-esteem base their self-esteem in domains with rather high internal control such as virtue and morality. Contingent self-esteem has also been linked to a number of phenomena, e.g. performance goals (Dweck et al., 1988; Elliot et al., 1997a, 1997b, 1988), moti-  7 vation types (Deci et al., 1995, 2002; Ryan et al., 2000) and self-validation pursuits (Blatt et al., 1992; Dance et al., 1987; Dykman, 1998; Kuiper et al., 1986). For instance, in their self-determination theory, Deci and Ryan (Deci & Ryan, 1995, 2002; Ryan & Deci, 2000) distinguish between intrinsically and extrinsically motivated behaviours. Introjected and integrated behaviours are two extrinsically motivated types of actions, the difference being that the introjected behaviours are less internalised with a person’s self, and are regulated by contin- gent self-esteem (Ryan & Deci, 2000). They claim that introjected behaviours are performed under pressure and ego-involvement, with self-esteem and self-worth continuously at stake. A similar line of thinking about performance and achieve- ment orientations as vulnerability factors for mental ill-health is found in Dyk- man’s self-validation model for depression (Dykman, 1998; Dykman et al., 1998). He has proposed a framework for goal striving and depression suggesting that depression-prone individuals primarily seek self-validation rather than growth and self-improvement. This self-validation attitude is quite similar to the one implied by performance-based self-esteem. Contingent self-esteem and self-confirmation strivings have also been related to personality orientations. It has been suggested that contingent self-esteem, to- gether with sensitivity to mistakes and need for admiration, constitute important aspects of perfectionism (Rice et al., 2002). Type-A behaviour, characterised by competitiveness, time urgency and hostility, implies a focus on self-standards and harsh achievement evaluations, and Price (1982) has assumed that one impetus for type-A behaviour is the concern for self-worth. Kuiper and colleagues (Kuiper et al., 1986; Martin et al., 1989; Yuen et al., 1992) have suggested that the type-A behaviour pattern is used to minimise negative self-evaluations and to avoid nega- tive self-esteem. A similar motivational structure is at work for the “overcom- mitted” persons in the effort-reward imbalance model (Kudielka et al., 2004; Siegrist et al., 2004). 2.4. Contingent self-esteem and symptoms in the burnout process According to the process model of burnout, people should often show strong involvement and, later on, signs of tension, frustration, anxiety, and eventually exhaustion and depressed moods. There are a number of observations indicating that contingent and labile or low self-esteem are related to these and similar symptoms. Persons in the phase of “Anxious engagement” should indicate involvement, ambitions and worry, and it is generally assumed that persons that are active in domains on which self-esteem is contingent should show high motivation (Crocker & Wolfe, 2001). Performance-based self-esteem has also constituted one dimension of high work involvement (Jans, 1982). Thus, there seems to be some connection between contingent self-esteem and high involvement. Connections between contingent self-esteem and anxiety come from studies showing that  8 contingent self-esteem correlates positively with anxiety and neuroticism (Judge et al., 2002; Kernis et al., 1993; Roberts et al., 1997; Watson et al., 2002). Sensitivity to negative events and stress, irritation and anger and demanding strivings to overcome problems and incongruent environmental conditions should be typical of the second burnout phase, “Frustration”. A large number of studies have shown that persons with low self-esteem are highly upset after negative events and failures (Di Paula et al., 2002; Greenier et al., 1999; Southall et al., 2002; Stake et al., 1995) and that labile self-esteem in combination with life stress is related to increased affective responses (Roberts & Kassel, 1997). In the initial part of the frustration phase, there should be demanding strivings, that later may result in more resigned attitudes. Studies done on the relationship between self-esteem levels and strivings, in general, show that persons with low self-esteem are less inclined to cope actively after failures and set-backs as com- pared to those with high self-esteem (Schuetz, 1998). However, some low-esteem individuals may exhibit strong efforts and persistence during certain conditions of failure, e.g. when the task is perceived to be nearly impossible (Di Paula & Campbell, 2002), when feed-back is experienced as humiliating (Baumeister et al., 1985), when alternative self-esteem domains are few (Barnett et al., 1988; Blatt & Zuroff, 1992) or when there has been a lot of investment in a certain domain (Brunstein et al., 1996; Jenkins, 1996; Pyszcynsky et al., 1987). The coping patterns among persons high in perfectionism and in the type-A behaviour pattern indicate that evaluative concerns and self-esteem contingency beliefs may generate enduring strivings and preoccupations with the tasks and problems at hand. People with both contingent and low self-esteem may have problems deacti- vating goal intentions although their efforts have been non-productive, and they will typically ruminate more and have difficulties relaxing and calming down. Inability to withdraw psychologically from problems is also typical of “over- committed” individuals in the effort-reward imbalance model (Kudielka et al., 2004). This brings us to the third phase of the burnout process: crisis and burnout marked by resignation, exhaustion, demoralisation and disengagement. Data on less persistence in, and disengagement from tasks have been seen in a number of studies for low self-esteem persons (Sommer et al., 2002) but this has not been studied to the same degree for those with contingent self-esteem. One study has however shown that contingent self-esteem is related to lowered affect and depressive mood after failure (Crocker et al., 2003). Perfectionist strivings also seem to create a great deal of exhaustion and fatigue (Magnusson et al., 1996; Saboonchi et al., 2003). Thus, it seems that performance-based self-esteem as an instance of con- tingent self-esteem and self-worth strivings can be linked to many of the behavio- ural manifestations and changes in the burnout process.  9 2.5. Origins and determinants of contingent self-esteem An implicit assumption in the paragraph above is that contingent self-esteem acts as an antecedent to, or moderating factor of the symptoms of burnout, but the question should also be posed regarding the origins and sources of performance- based and contingent self-esteem. Hitherto, no longitudinal studies in natural contexts have been carried out with contingent self-esteem as an outcome variable, and most investigations have been cross-sectional studies in experimental and clinical settings. A common supposi- tion has been that contingent self-esteem is a rather stable phenomenon founded early in life by socialisation experiences or by genetic factors. A certain support for primary socialisation effects comes from a role-playing experiment where children received three forms of criticism and praise: person, outcome and process feedback (Kamins et al., 1999). In a subsequent task involving a setback, the children who received person feedback with a focus on both positive and negative attributes of the children, displayed clear signs of contingent self-worth, even if they had just been praised for their earlier successes. Indirect evidence of sociali- sation influences comes from studies of extrinsic motivation and introjected goals (Deci & Ryan, 1995, 2002) that are assumed to result in contingent self-esteem. The authors do not discuss the specific sources of these introjections but it is reasonable to believe that some of these influences occurred early in life. A similar line of reasoning is also found within cognitive theories of depression (Clark et al., 1999; Dykman, 1998; Ingram, 2003) and anxiety (Beck et al., 1997; Eysenck, 1992; Scher et al., 2003). Within these frameworks early experiences are assumed to create vulnerable cognitive schemas and modes that later on increase the risk of depressive or anxious reactions. Effects of individual history are, how- ever, not just restricted to prior socialisation experiences. Twin-studies from a behavioural genetic perspective have shown genetic influences not just on the levels of global and domain specific self-esteem, but also on their stabilities (Neiss et al., 2002), which are closely related to contingent self-esteem. Situational influences on contingent self-esteem or performance-based self- esteem can be inferred from studies where performance goals and performance orientations have been manipulated in experimental settings (Baldwin et al., 1996; Elliott & Dweck, 1988; McFarlin, 1985; Rawsthorne et al., 1999). This implies that contingencies for self-esteem can be activated by instructions, tasks or feed- back. Explicit effects of stress or negative mental states on contingent self-esteem have not been reported. However, there are studies showing that cognitive vulne- rabilities such as maladaptive autonomy and sociotropy often vary with changes in mental state and are increased during stress (Clark et al., 1999). All in all, these data suggest that contingent and performance-based self- esteem are influenced both by factors related to prior individual history and by situational features in the environment or the person.  10 2.6 A work model of performance based self-esteem and burnout Based in parts on the reasoning and data above, a working model for perfor- mance-based self-esteem and burnout is presented in Figure 2 to give a structure for the analysis of convergent validity. The model is an elaborated version of the one seen in Figure 1 and should describe the most important influences on, and consequences of performance-based self-esteem. Effects of individual history, conditions in core domains for self-esteem, and of psychic stress and self-esteem are outlined. Besides possible genetic influences, individual history includes socialisation experiences emphasizing the value and expectations of effort and responsibility from family, educational, organisational and professional settings. The assumption is that these beliefs are introjected and used as personal standards and goals to gain or maintain self-esteem. Certain roles or domains, first and fore- most the work and family domains, become crucial self- definitional arenas for self-esteem. Incongruent or uncertain conditions within these domains as well as psychic strain-distress and reduced self-esteem may activate performance-based self-esteem and self-esteem strivings, as can evaluative procedures and climates. Individual history: - Socialisation experiences: family, professional, and organisational values and standards emphasizing achievement and effort - high education - genetic influences Psychic strain- distress - Anxiety, exhaustion, ambivalent or negative attitudes, depressed mood Performance-based self-esteem: Emotions: - Self-evaluative concerns Cognitions: - Beliefs of criteria for self-esteem (contingency and imperative beliefs) Motivation: - Introjected, contingency standards - ego-involvement Strivings and coping behaviours: - Exertion, effort, hesitance to say no, neglect personal needs, approach and avoidance strivings Stability and level of self-esteem - Labile and/or low self- esteem Appraisal: - Adequate solutions? Feed- back? Support? Rewards? Behavioural and somatic symptoms: - Sleep distur- bance, reduced recuperation, - somatic and cognitive symptoms, preoccupations, ruminations - reduced role/ functional capacity Conditions in self- definitional domains (work, family, other) - Enduring negative or uncertain job/family conditions - Evaluative climate and procedures Figure 2. A work model for performance-based self-esteem and burnout. See text.  11 The interrelations and influences between early socialisation experiences, perfor- mance-based self-esteem and strivings are assumed to be especially strong since they would form a tight associative network of feelings, ideas and action readiness similar to a schema (Clark et al., 1999). In contrast, the influences from work on performance-based self-esteem may be moderate since work does not constitute a self-definitional domain for all people. According to the model, the outcome of these endeavours in terms of problem solving, feedback, support and rewards has consequences for self-esteem, symp- toms, and psychic strain and distress. These factors are also interrelated in an intricate manner. Increased psychic strain-distress as well as lowered self-esteem may reinforce and intensify cognitions and thoughts about personal self-esteem contingencies, followed by further endeavours and coping attempts. If this vicious circle continues it may eventually lead to increased psychic strain and distress that may be labelled burnout (no generally accepted criterion for burnout has been given). Positive solutions to getting out of this circle are finding new self-esteem arenas and domains, changing the domain conditions or changing the contingency beliefs. Some reasonable influences, not touched upon here, are indicated in Figure 2 by dashed arrows. 3. Aim and hypotheses After this explication of performance-based self-esteem and its presumed role in burnout, the aim is now to describe psychometric properties of the Pbse-scale that have been utilized in four large studies. Data on central tendencies (medians and arithmetic means), standard deviations and skewness will be described together with reliability indices such as internal consistency (α) and stability over one year. Correlations with a number of variables indicating the convergent validity of the Pbse-scale are also reported. These variables are classified according to the working model in Figure 2, although a strict testing of the model cannot be carried out here. Related self-evaluative concepts such as perfectionism and type-A behaviour pattern have been extensively studied but primarily on convenience samples of students or on clinical groups. In contrast, the present data sets have been derived from studies based on large or national population samples. The Pbse-scale will be related to a number of variables referring to demographic and socio-economic aspects, job and family conditions, global self-esteem, mental health, sickness absence, coping behaviours and personality variables. Some assumptions of the relations for the Pbse-scale to these variables will be succinctly presented, and if these assumptions prove to be valid, it should indicate a convergent validity of the scale. The predictions proceed from a general assumption that the Pbse-scale mea- sures a certain set of cognitions that have