Burn-out and stress percipience bene its of a stress management program by autogenic relaxation training for teachers: A pilot study

Stress in the present world is an indivisible piece of life, regardless of social position and status. Burnout is characterized as a negative mental encounter that is responses to work-related pressure. It relates to emotions experienced that require repeated exposure to emotionally charged social situations. In this manner, it is a work-related risk to which all individuals are uncovered, including teachers. The teaching profession is under large occupational pressure and prone to job burnout. The study aims to (i) assess the level of occupational burnout and stress among teachers of private and fully aided schools in the post-test for the experimental and control groups. (ii) to determine the effectiveness of autogenic relaxation on occupational burnout and stress among teachers of private and fully aided schools. A quantitative research approach with a True experimental design with experimental and control group, pre-test post-test control group design was adopted for this study. The study focused on the selected schools in Vellore district. Totally, 28 participants selected by consecutive sampling techniques with the age of 25-60 years. Based on the inclusion criteria and availability of teachers, they were allocated into the control group (n=14) and experimental group (n=14). Demographic variables, occupational burnout, stress were assessed by using (Maslach burnout inventory and teacher stress inventory) it was analyzed by descriptive and inferential statistics. Stress management program by autogenic training once aweek for 6weekswas given. This programwas prepared based on existing research and studies. We found that the median value in the pre-test is signi icantly different from themedian value in the post-test for Maslach Burnout Inventory; the median value is signi icantly different for the emotional exhaustion sub-scale (t=216 and P=0.02).


INTRODUCTION
Stress in the present world is an indivisible piece of life, regardless of social position and status.It is inevitably experienced by all in different magnitude in daily life.(Albertson and Kagen, 1987) Burnout is characterized as a negative mental encounter that is responses to work-related pressure.It relates to emotions experienced that require repeated exposure to emotionally charged social situations.Thus, it is an occupational hazard for a teacher who encounters it.The teaching profession is very prone to job burnout and works related to pressure.(Asimeng-Boahene, 2003) Teacher burnout is a progressing issue in educational systems all through the world.According to the Ministry of statistics , the total number of secondary schools in Tamilnadu is 2,49,026, and the teacher's population comprised of 5,58,089.Accordingly, the negative side effects of employment burnout among teachers are jeopardizing both students and teachers themselves.The consequence of this aspect makes teachers confronting anomalous dif iculties of a professional catastrophe and endurance.(Beck, 1984) According to the Vellore district statistical handbook (2016 -2017) number of higher secondary schools in the Vellore district is 292, and the number of Teachers working in higher schools is 4966.Out of this 1440 Teachers are working in private and fully aided schools.
As indicated by the most recent information from Optum, a high 46% of the workforce in institutions in India agonize from some or other form of stress, this study had a sample size of 200,000 workers (more than 30 large organization) took an online Health Risk Assessment during the irst quarter of 2016.The result found were 43% with inclined BMI (body mass index), of which 30% with a diabetic risk factor, 30% with a hypertension risk factor, and 46% with stress as a risk factor.
National Mental Health Survey of India (2015)(2016) reported in Tamilnadu, 11.8 % population suffers from neurotic and stress-related disorders.According to the Trades Union Congress survey (2016), 70% of people report stress is the biggest threat to workplace health.The nursing intervention based on these three models attempt to change and correct cognitive appraisal and response to stress ;(a) to help the teachers comprehend the segments of stress and how stress works in their lives (b) to give a chance to teachers to learn, practice, and apply the stress management procedures for change in lives, and (c) to advance solid strategies for overseeing pressure.
Relaxation training gives an exceptional strategy to manage stress.Autogenic training is a psychophysiological sort of psychotherapy dependent on autosuggestion, irst created by the German doctor and specialist J.H. Schultz in the mid-twentieth century.(Bond and Bunce, 2000;Brantly and Ames, 2001;Brouwers and Tomic, 1999;Brouwers, 2000) At comprises of six progressive steps.The irst step concentrates on muscle relaxation is enact by recapitulating a technique to promote a sensation of heaviness in limbs, and eventually, con-sideration is centered inactively around detecting warmth, at that point on moderate breathing, stomach warmth, a quiet heartbeat, and a cool temple.It has been prescribed that the AT program be directed more than about two months and that it be made out of one gathering session every week and selfpreparing multiple times day by day.While advancing through these activities, the vast majority experience detached ixation, which enables the person to break out the horrible stress cycle.AT leads a high-excitement thoughtful, anxious reaction to lowexcitement parasympathetic apprehensive reaction by means of relaxation.
A pilot study is a preliminary of the principle study.A pilot study was carried out to understand the feasibility of execution of the various phases of the research procedures, and to overcome the dif iculties during main data collection.The aims of the pilot study was to take small sample size and (i) to compare the pre and post-test level of occupational burnout, stress, among higher secondary school teachers within and between the control and the experimental group (ii) to compare the effectiveness of autogenic relaxation training on occupational burnout, stress, among higher school teachers within and between the control and the experimental group.Brie ly, in the present study, the investigator will make an attempt to assess the effectiveness of autogenic relaxation training on occupational burnout, stress among higher secondary school teachers.This will help the investigator to achieve a holistic understanding of an individual.

Participants
The Pilot study was conducted among higher secondary school teachers of private and fully aided schools in Vellore district.The higher secondary schools in the Vellore district were selected by random sampling technique using the lottery method.The study was conducted at SDA higher secondary school and Shantiniketan matriculation higher secondary school.The total population of higher secondary school teachers was 21 in SDA higher secondary school and 18 in Shantiniketan matriculation higher secondary school, respectively.A total of twenty-eight participants were selected by consecutive sampling techniques based on the inclusion criteria and availability of teachers, and they were allocated into the control group (n=14) and experimental group (n=14).The participants were briefed on the information for the purposes of the study, written informed consent, and oral consent was obtained from the participants.This study was af irmed by the Institutional Human Ethics Committee of Saveetha Medical College and Hospital, (005/09/2018/IEC/SMCH; Dated on 07 th September 2018).Participants working in private and fully aided higher secondary schools teaching a class from 10 th -12 th std, with the age group of 25-60 years, both male and female teachers were included in the study.

Methodology
Step I-on day one: the purpose of the study was explained to the participants.Informed consent was taken from the participants before starting the study.Demographic variables, occupational burnout (Maslach Burnout Inventory) stress (Teacher stress inventory) were assessed.
Step II-The intervention was administered for a sixweek period with 2-hour sessions per week, and there was typically 10 person limit per session.The techniques fall into two categories, so it included two sessions.
Session I The Nature of Stress: de inition of stress, causes, and implications of stress were presented in PowerPoint to the participants.The teachers instructed on signs and symptoms of stress and potential sources of stress, it will create awareness that they could adapt to stress, and igure out how such reactions can wind up maladaptive.
Session II Relaxation training: The procedure for relaxation training was as follows.The autogenic relaxation technique was demonstrated to the teachers for 20 minutes.The teachers were asked to assemble in the spare classroom, and relaxation technique was demonstrated for the teacher who had mild and moderate stress.Six progressive steps were practiced for 15-20 minutes in a sitting position with an arm supporting the chair during which the teachers concentrated on breathing, relaxation of muscles.(Heaviness Formula, Warmth Formula, Cardiac Formula, Respiratory Formula, Abdominal Formula and Coolness Formula) The last session assessed stress management techniques.The investigator gave an outline of how the various procedures sway the connection reaction modalities and of their impacts on emotional well-being.This action was led utilizing the psycho-instructive system.
Step III-At the end of 6 weeks of intervention, a posttest was done to both the groups (control and experimental) using the same tool with the same procedure.

Statistics
The data were expressed as mean ± SE, and as frequency distribution.The paired and unpaired t-test was used for the comparison of means of control and experimental groups.Chi-square was not done as the sample size was less.A probability of 0.05 or less was taken statistically signi icant.The analysis was carried out using Sigma Plot 13 (Systat Software Inc., USA).

Description of higher secondary school teachers according to their demographic variables
Table 1 shows the description of higher secondary school teachers according to their demographic variables in the control and experimental group.The majority of the participants were in the age group of 46-60 (44% in the control group), 36-45 (58% in the experimental group).With regard to gender, the majority of the participants were female (58% in the control group, 79% in the experimental group).Regarding the marital status, 64% of the participants were married in the control group, 86% of the participants were married in the experimental group and.With regard to the monthly income in Rupees, 64% were earning more than 30,000/per month in the control group, and 86% in the experimental group.With regard to the educational quali ication, the majority of the participants have completed PG/B.Ed.& M.Ed (50% in the control group, 72% in the experimental group).Regarding the Location of the school (42% in the control group, 71% in the experimental group) were located in an urban area.Regarding Teaching experience, 42% had over 10-15 years of teaching in the control group, and 43% had over 15 years of teaching experience in the experimental group.Most of the participants in both the groups (42% in the control group, 86% in the experimental group) were permanent Teachers.Regarding the Nature of subjects teaching, 29% in control were teaching languages and commerce, and 36% in the experimental group were teaching science subjects.With regard to the role of seniority, 43% were < 3 years in the control group, and 43% were 3-10 years in the experimental group.Most of the participants in both groups (50% in the control group, 43% in the experimental group) were residing in rural and urban areas.
With regard to the number of members in the family, 57% in the control group were had above 5 members in the family, and 57% in the experimental group were had 3-5 members in the family.
Most of the participants in both groups (36% in control, 43% in the experimental group have had a family as an emotional support network.Regard to the classes taught, 36% in the control group were teaching 10 th , 11th, and 12 th standard, and 57% in the experimental group was teaching 10 th standard.

Effectiveness of autogenic relaxation on occupational burnout and stress
The summary of occupational burnout and stress according to the domain.The score of control and experimental group before and after the administration of intervention were depicted in Tables 2 and 3 and it shows median, mean, 25 percentile, 75 percentile, minimum value, maximum value, and the outliers.The main objective was to study the effectiveness of autogenic relaxation on occupational burnout and stress among teachers of private and fully aided schools.The results in this study showed that the phenomenon of teacher burnout and stress is a signi icant issue that should be underscored before the impacts lead the teachers to dif iculties.(Byrne, 1991) study demonstrates a noteworthy correlation between work-related stress, teachers burnout and emotional wellness.In this study, teachers by and large endure a high level of burnout.(Bhuin, 2016;Bellingrath et al., 2008;Burke and Greenglass, 1989) School organizations should focus on teacher's burnout, on the grounds that teachers experiencing burnout will, in general, be irritable at home and in class, experiencing nervousness and sentiments of frailty, joined by physical inconvenience, for example, constant weariness, cerebral pains, sleeping disorder, shingles and heart palpitations.(Capel, 1991) Sceptical, frigid, away, depersonalized perspective towards the job and the students, having a tendency to limit the contribution at work and desert the goals, losing the determination to make a difference professionally will occur.(Capel, 2006;Cherniss, 1980) They are inclined to lose their objectives, will and vitality, to have less eagerness for the work and to display a decreased level of teaching performance.(Crump et al., 1980)

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The teaching profession is under major occupational pressure and prone to job burnout.Teacher burnout is a progressing issue in educational systems all through the world.One underpinning behind the high number of existing psychological maladjustments and tress disorders is inadequate articulation and teaching, or rather learning, of techniques for managing the everyday pressure unalienable in the teaching profession.(Dworkin, 1985;Bond and Dryden, 2002) Teachers with dynamic adapting procedures essentially manage these troubles all the more effectively.Then again, work propensities change over the burnout risk behavior.
They should practice intervention strategies to counter these negative factors.The present study examines the effectiveness of Autogenic relaxation on all the domains of burnout and reveals that the experimental group learned to reduce burnout, and there was a signi icant difference in occupational burnout between the experimental and control group.This was also supported by the study indings concluded that Burnout and stress-related mental disorders (depression, anxiety) occurs in teachers with an altogether higher predominance than in the all-inclusive community.Simultaneously, the learning of ways of dealing with stress against pressure is as yet not a necessary part of them.(Guglielmi and Tatrow, 1998) In this pilot study, we built up an elective course for learning relaxation procedures and inspected the state of the teachers before and after the course.42 teachers took an interest in the semester courses in 2012 and 2013, just as in an overview toward the beginning and end of each course.
The teachers were told in autogenic preparing (AT) and dynamic muscle unwinding, as indicated by Jacobsen (PMR), with the objective of free and ordinary working out.Toward the start and the inish of the semester/course, the teachers were interviewed with utilizing institutionalized, approved surveys on burnout (BOSS-II) and uneasiness (STAI-G), despondency (BDI), personal satisfaction (SF-12) and feeling of intelligence (SOC-L9).The course acquainting AT and PMR drove with a critical decrease of burnout and nervousness inside the taking part gathering of teachers.Indeed, even the course participation for only one semester brought about noteworthy improvement in the assessed parameters as opposed to those instructors who didn't go to the course.
Work-life stability is a deprecatory aspect to improve teacher ef icacy and ful illment with regard to student learning.(Wiley, 1998) It has been demonstrated over and over that a good quality of work-life equalization results in the wellbeing of the workforce and furthermore improved student behavior.The present study examined the effectiveness of relaxation training on all domains of quality of life and revealed that the experimental group felt the overall good quality of life, and there was a signi icant difference in the quality of life between the experimental and control group.This was also supported by the indings of the study concluded that relaxation therapy (RT) could be effective in helping high school teachers and staff members to reduce stress.Speci ically, the investigator examined the effectiveness of RT on overall perceived stress, perceived work stress, and life satisfaction.
This quantitative, experimental study randomly selected 54 teachers and staff members from a selected higher secondary school to an intervention relaxation group and control group.RT was piloted once a week for 30-45 min for each session for 4 weeks time period for the intervention group, and both the groups were estimated before and after the interventional blended ANOVA demonstrated that the intervention was compelling.Generally, stress and perceived work stress diminished, and life fulillment scores expanded for the mediation gathering.No movements occurred on these three measures in the control gathering.Relaxation training programs could be one procedure to improve worker satisfaction.

CONCLUSIONS
The pilot study showed that there was an improvement in reducing burnout and stress at the end of the intervention.The experimental group showed more effectiveness compared to the control group.In the present study, statistical analysis was carried out by using Mann Whitney Rank Sum Test and Wilcoxon Signed Rank Test.No adverse effect was found in the study.However, there was no statistically signi icant in a few parameters of occupation burnout and stress.It might probably due to a small sample size.This pilot study was found feasible for te main study.Participants were very co-operative throughout the study.Hence, modi ication was done in the sample size, physiological parameters such as blood pressure and BMI, blood investigation such as serum cholesterol, serum albumin, and fasting blood sugar in main study data collection were included after discussing with the experts.

Table 2
comparison of pre-test and post-test scores of occupational burnout domain in both control and experimental group.The median values of control group pre-test, control group post-test, experimental group pre-test, and experimental group posttest were 15, 17, 24 and 33 respectively.The medians of control group pre-test and experimental pre-test were not statistically signi icant by the Mann Whitney rank sum test (unpaired test).After the intervention, the control post-test and experimental post-test median values showed a statistically signi icant change in emotional exhaustion (p=0.02) by the Mann Whitney rank-sum test and did not show signi icant changes in depersonalization and personal achievement.The median control pre-test and post-test were compared by Wilcoxon Signed Rank Test (paired test), which showed statistically signi icant changes in personal achievement (p=0.004) and did not show a signi icant change in emotional exhaustion and depersonalization.The median values of experimental group pre-test and post-test were also compared by Wilcoxon Signed Rank Test, and it showed a statistically signi icant change in depersonalization (p=0.002) and no signi icant change in emotional exhaustion and personal achievement.It reveals that the intervention is effective in all domains of occupational burnout except in few parameters among the experimental group.

Table 1 : Frequency and percentage distribution of demographic variables among higher secondary school teachers in the experimental group and control group (n= 14)
-Chi-square was not carried out as the sample size was less