Breathe in the VA

Research Type

Clinician/Staff Level Research


  • Angela Rollins, PhD
  • Michelle Salyers, PhD
  • Louanne Davis, PsyD
  • Marina Kukla, PhD
  • Alissa Russ, PhD
  • Linda Collins, Program Manager
  • Amethyst Green, Research Assistant
  • Kathy Snow, Data Manager


The purpose of this research study was to rigorously test the impact of the BREATHE intervention in a randomized design and determine longer-term effects of the training, to examine the organizational contextual factors increasing or reducing burnout, and to design an overarching intervention framework for the implementation of BREATHE that includes organizational factors. 

We recruited 180 mental health staff and randomize participants to either intervention or control group and conducted follow-up online surveys at baseline, 6 weeks post-training day, and 6-months post-training day. We randomly selected 40 participants for individual qualitative interviews to explore their lived experience of burnout and work engagement, as well as organizational factors, job demands, and job resources that might promote or reduce burnout. We also worked with experts on organizational interventions to help us evaluate our qualitative themes related to organizational contexts


We used a stratified randomized design. Participants were randomized within each facility to receive the BREATHE workshop or the control workshop. The control condition allowed us to gather data on an active group, a more rigorous test of our intervention. Data collection procedures included a web-based survey, administered at 3 time periods: Time 1 (baseline prior to any workshop, as people agree to and enroll in the study), Time 2 (6 weeks after the workshops are completed), and Time 3 (6 months post workshop follow-up). Actual turnover data was obtained from site leadership for all participants in the study. For organizational contextual data, we used open-ended questions collected in the web-based survey from all participants, and we also included collections of more in-depth qualitative interviews of a subsample of participants in the intervention and control groups. The subsample of participants recruited for the in-depth qualitative interviews were asked to provide a copy of actual leave time from the Decentralized Hospital Computer Program (DHCP) for the 6 month period following the workshop. Non-VA participants were asked to provide equivalent documentation of leave time. 


The purpose of this project was to improve the technical capabilities of the field by providing an intervention program for mental health providers in the VA and elsewhere. At the same time, we aimed to increase scientific knowledge about effective approaches for reducing mental health provider burnout. Reducing burnout and turnover offers the possibility of improving the quality of care, including the fidelity of evidence-based practices and the continuity of important therapeutic relationships which ultimately impact consumer outcomes. This project represented a unique opportunity for the VA to have a hand in the development of a multi-level burnout intervention strategy that was helpful in reducing burnout and improving other organizational and patient-level outcomes in the national VA healthcare system.