BREATHE-OUT Burnout Reduction: Enhanced Awareness, Tools, Handouts, and Education-Organizational Understanding and Training

Research Type

Clinician/Staff Level Research


  • Michelle P. Salyers, PhD
  • Angela L. Rollins, PhD
  • Mike Sliter, PhD
  • Gary Morse, PhD
  • Sadaaki Fukui, PhD
  • Kimberly Dreher, MS
  • Jennifer Garabrant, BSW
  • Nancy Henry, BA
  • Alex Miller, BS


Health care providers, particularly those who work in the mental health field, are at high risk for experiencing burnout – high levels of emotional exhaustion, cynical attitudes towards consumers of services, and a reduced sense of personal accomplishment. Theory and research suggest that as care providers conserve psychological resources to deal with emotional stress, they withdraw and become less engaged in their work, which can have a negative impact on the quality of care provided. Yet, few studies have intervened to reduce mental health worker burnout. We have developed an intervention entitled Burnout Reduction: Enhanced Awareness, Tools, Handouts, and Education (BREATHE) that has shown promising outcomes regarding burnout for mental health providers. This intervention targets the individual provider, focusing on building the individual’s resilience and skills. However, research suggests that organizational factors can be powerful predictors of burnout and engagement. Thus, the purpose of this R34 project is to examine the feasibility and preliminary outcomes of integrating an organizational approach to reducing burnout with the BREATHE program. We will use Appreciative Inquiry as both a participatory action research strategy and an organizational change approach to identify what is working well within a community mental health center and to partner with stakeholders in the organization to develop and implement strategies to build on those strengths to enhance worker engagement and reduce burnout. We will combine Appreciative Inquiry with BREATHE in an open trial in six mental health teams using a multiple baseline design with staggered start times. This project is the first important step in addressing a critical need in workforce development that could ultimately address strategic aims of the National Institute of Mental Health in ensuring access to the highest quality and most cost-effective services for consumers with mental illness.


  • Aim 1. Use Appreciative Inquiry to develop an organizational approach to reduce burnout and enhance BREATHE training. We will use Appreciative Inquiry as a qualitative data collection technique and quality improvement intervention. Building on a recent pilot study of Appreciative Inquiry we completed in a community mental health center, we will work with staff on six treatment teams to learn what is most effective in engaging workers and reducing burnout. Using the identified themes, agency work groups comprised of diverse stakeholders will design and implement strategies based on those themes. We have added Organizational Understanding and Training to reflect this addition - resulting in the BREATHE-OUT intervention.
  • Aim 2. Test feasibility and preliminary outcomes of organizationally-supported burnout reduction (BREATHE-OUT). We will conduct an open trial, with a staggered, pre-post evaluation of BREATHEOUT. For feasibility, we will assess participation in and satisfaction with individual BREATHE training and Appreciative Inquiry activities. For preliminary outcomes, we will assess changes in provider burnout, job satisfaction, turnover intention, and perceived quality of care. We will also assess changes in aspects of organizational climate over time.


This developmental project addresses workforce development and retention in behavioral health care. Staff burnout is a highly prevalent condition, posing challenges for healthcare providers, organizations, and the consumers of the healthcare services. This study will develop an organizational approach to reducing staff burnout to complement an existing individual-level intervention. We will evaluate the feasibility and preliminary outcomes of this combined approach to reducing staff burnout and maintaining an effective behavioral health care workforce.

This research is supported by the National Institute of Mental Health of the National Institutes of Health under Award number R34MH104201-01 (Burnout Reduction for MH Providers to Improve QOC and Reduce Staff
Turnover). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.