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Teacher Stress Interventions: A Systematic Review

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Title: Teacher Stress Interventions: A Systematic Review
Language: English
Authors: von der Embse, Nathaniel (ORCID 0000-0003-2545-7691), Ryan, Shannon V., Gibbs, Tera, Mankin, Ariel
Source: Psychology in the Schools. Sep 2019 56(8):1328-1343.
Availability: Wiley-Blackwell. 350 Main Street, Malden, MA 02148. Tel: 800-835-6770; Tel: 781-388-8598; Fax: 781-388-8232; e-mail: cs-journals@wiley.com; Web site: http://www.wiley.com/WileyCDA
Peer Reviewed: Y
Page Count: 16
Publication Date: 2019
Document Type: Journal Articles
Reports - Evaluative
Descriptors: Teachers, Teacher Burnout, Anxiety, Stress Management, Stress Variables, Intervention, Negative Attitudes, Perception, Metacognition, Attention Control, Program Effectiveness, Behavior Modification, Cognitive Restructuring
DOI: 10.1002/pits.22279
ISSN: 0033-3085
Abstract: Due to the increased pressure from test-based accountability practices, teachers have reported high levels of stress and burnout. High teacher stress has an impact on school outcomes, including links to absenteeism, burnout, school climate, and teacher behavior management. Teacher stress interventions may be an important first step toward reducing these negative outcomes. Although there have been several recent intervention studies in the domain of teacher stress, there has been no systematic review to compare the type and effectiveness of teacher stress interventions. Included within this review are interventions from a variety of modalities such as knowledge-based, behavioral, cognitive-behavioral, and mindfulness approaches. Results indicated that the most effective interventions were in the mindfulness, behavioral, and cognitive-behavioral domains. Interventions which delivered solely informational content were among the least effective.
Abstractor: As Provided
Entry Date: 2019
Accession Number: EJ1224070
Database: ERIC
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  Value: <anid>AN0137889595;pis01sep.19;2019Aug07.08:54;v2.2.500</anid> <title id="AN0137889595-1">Teacher stress interventions: A systematic review </title> <p>Due to the increased pressure from test‐based accountability practices, teachers have reported high levels of stress and burnout. High teacher stress has an impact on school outcomes, including links to absenteeism, burnout, school climate, and teacher behavior management. Teacher stress interventions may be an important first step toward reducing these negative outcomes. Although there have been several recent intervention studies in the domain of teacher stress, there has been no systematic review to compare the type and effectiveness of teacher stress interventions. Included within this review are interventions from a variety of modalities such as knowledge‐based, behavioral, cognitive‐behavioral, and mindfulness approaches. Results indicated that the most effective interventions were in the mindfulness, behavioral, and cognitive‐behavioral domains. Interventions which delivered solely informational content were among the least effective.</p> <p>Keywords: behavioral; cognitive‐behavioral; mindfulness; stress; student behavior; teachers</p> <p>Teaching is a highly stressful profession (von der Embse, Pendergast, Segool, Saeki, & Ryan, [<reflink idref="bib27" id="ref1">27</reflink>]; Kyriacou, [<reflink idref="bib57" id="ref2">57</reflink>]). Teacher stress has been as a contextual specific type of occupational stress (Kyriacou & Sutcliffe, [<reflink idref="bib58" id="ref3">58</reflink>]). Occupational stress refers to an individual's experience of psychological discomfort and associated disorders that result from general working conditions (Warr & Wall, [<reflink idref="bib80" id="ref4">80</reflink>]), whereas teacher stress is a specific form of stress within the school context. In recent years, policy decisions at the federal and state level have intensified the demands on teachers resulting in higher levels of stress (von der Embse, Sandalos, Pendergast, & Mankin, [<reflink idref="bib28" id="ref5">28</reflink>]). These decisions include the adoption of a common and standardized curriculum in many states (Common Core State Standards Initiative, [<reflink idref="bib20" id="ref6">20</reflink>]), while requiring teachers to adopt a new set of instructional practices aligned with said standards. In addition, in the years since the implementation of No Child Left Behind ([<reflink idref="bib1" id="ref7">1</reflink>]) (Linn, Baker, & Betebenner, [<reflink idref="bib63" id="ref8">63</reflink>]), federal policy has changed how teachers are evaluated by linking teacher performance to student standardized test scores; these evaluations include consequences for performance evaluations such as merit pay and teacher tenure. These decisions have been linked with an increase in teacher stress (von der Embse, Schoemann, Wicoff, Kilgus, & Bowler, [<reflink idref="bib29" id="ref9">29</reflink>]). In a recent study, nearly 30% of teachers reported clinically impaired levels of stress (von der Embse, Kilgus, Bowler, Solomon, & Curtiss, [<reflink idref="bib26" id="ref10">26</reflink>]).</p> <p>Teacher stress represents a significant challenge for schools given links to a myriad of variables important to student success, including impact on climate, attrition, absenteeism, and decision‐making for mental health (Collie, Shapka, & Perry, [<reflink idref="bib18" id="ref11">18</reflink>]; von der Embse et al., [<reflink idref="bib27" id="ref12">27</reflink>]; von der Embse, Sandalos, Pendergast, & Mankin, [<reflink idref="bib28" id="ref13">28</reflink>]; Putwain & Roberts, [<reflink idref="bib70" id="ref14">70</reflink>]). Teachers with higher levels of stress are also more likely to change their instructional practices, such as teaching to the test (rather than the general curriculum; Putwain & Roberts, [<reflink idref="bib70" id="ref15">70</reflink>]). Teacher stress and student behavior are strongly linked; while teachers report that student behavior is a source of stress, teachers also manage student behavior differently under high levels of stress (Clunies‐Ross et al., [<reflink idref="bib15" id="ref16">15</reflink>]; Hastings & Bham, [<reflink idref="bib41" id="ref17">41</reflink>]). Knowing which interventions may be most effective is essential to reducing teacher stress. No contemporary systematic review of teacher interventions has taken place to examine how administrators, school psychologists, or school‐based personnel may intervene to reduce stress for teachers. Such a review may then inform school‐based interventions such as teacher training or professional development around stress reduction.</p> <p>Interventions for teacher stress have traditionally fallen in three main categories including those that are: Knowledge‐based intervention (KBI), such as a psychoeducational or informational training, cognitive‐behavioral intervention (CBI), or behavioral intervention (BI). Over recent years, treatment studies have fourth modality, mindfulness‐based approaches (MBI), or the use of meditation, acceptance, and raised awareness of physiological indicators of stress (e.g., Greenberg & Harris, [<reflink idref="bib38" id="ref18">38</reflink>]). Some criticisms of MBIs are that use of meditation, without underlying emphasis on behavior change, may augment the rumination tendency within stress‐based disorders (Hofmann, Sawyer, Witt, & Oh, [<reflink idref="bib45" id="ref19">45</reflink>]). More recently, initial evidence has emerged that has evaluated mindfulness practices across a number of problem behavior domains (Klingbeil et al., [<reflink idref="bib56" id="ref20">56</reflink>]). However, little is known about its influence on teachers or its application to occupational type stress. To support implementation, a critical review of the relative effectiveness of various teacher stress interventions is needed, including how mindfulness is implemented for teachers in a school setting and whether MBIs are as successful as other types of teacher stress interventions.</p> <hd id="AN0137889595-2">1 CONSEQUENCES OF TEACHER STRESS</hd> <p>The adverse consequences of stress can be monumental for teachers, schools, and students. Extreme forms of stress may lead to burnout, lower personal accomplishment, depersonalization, and emotional exhaustion (Maslach, Jackson, & Leiter, [<reflink idref="bib65" id="ref21">65</reflink>]). Burnout has been linked to deleterious consequences for teachers across numerous studies, including absenteeism and even attrition from the profession (Betoret, [<reflink idref="bib8" id="ref22">8</reflink>]; Darling‐Hammond, [<reflink idref="bib22" id="ref23">22</reflink>]; Sass, Seal, & Martin, [<reflink idref="bib76" id="ref24">76</reflink>]). Schools with a high amount of absenteeism or burnout may experience chronic understaffing, and thereby, a loss of high‐quality instruction for students (Ryan et al., [<reflink idref="bib75" id="ref25">75</reflink>]). Teacher turnover leads to a loss of financial and occupational resources for school administrators (Darling‐Hammond, [<reflink idref="bib23" id="ref26">23</reflink>]). The National Commission on Teaching and America's Future estimates the cost of teacher turnover to be as high as $17,862 per teacher. In addition to fiscal costs, turnover further impairs school climate by reducing the number of experienced teachers in schools and disrupting the consistency of classroom instruction (Ingersoll, [<reflink idref="bib46" id="ref27">46</reflink>]). This leads to poor student test score performance and impaired student‐teacher relationships over time.</p> <p>Moreover, teacher stress may alter teacher perception of student externalizing and internalizing disorders. Teachers with high levels of stress are also more likely to have students with behavioral referrals (Hastings, & Bham, [<reflink idref="bib41" id="ref28">41</reflink>]; Hastings & Brown, [<reflink idref="bib42" id="ref29">42</reflink>]) and to report lower levels of self‐efficacy (Lamude, Scudder, & Furno‐Lamude, [<reflink idref="bib59" id="ref30">59</reflink>]). Teachers with high levels of stress use more reactive and punitive (von der Embse et al., [<reflink idref="bib29" id="ref31">29</reflink>]). Moreover, high levels of stress may lead to seeking less input from others in making decisions for student behavior (Collie et al., [<reflink idref="bib18" id="ref32">18</reflink>]). In addition, teacher stress leads to lower accuracy in ratings of student mental health (Kokkinos, Panayiotou & Davazoglou, [<reflink idref="bib55" id="ref33">55</reflink>]; McLean, Eklund, Kilgus, & Burns, [<reflink idref="bib66" id="ref34">66</reflink>]).</p> <p>While the link between student mental health and teacher stress is still being developed, teacher stress has been shown to influence school climate (Grayson & Alvarez, [<reflink idref="bib37" id="ref35">37</reflink>]) and overall perception of student misbehavior. Therefore, to intervene for school mental health, it may be important to consider teacher wellness too. Jennings and Greenberg ([<reflink idref="bib49" id="ref36">49</reflink>]) have posited that to ensure child well‐being, mental health interventions in schools must begin with mentally well teachers. The model of the prosocial classroom, wherein teacher social competence ensures child learning access, requires that teachers are mentally well and able to handle the rigor of the teaching profession. Given the ubiquitous and widespread nature of teacher stress, it is increasingly important to understand how to intervene to alleviate teacher stress (Sass et al., [<reflink idref="bib76" id="ref37">76</reflink>]). There has been a recent increase in the development of teacher stress interventions but an overall lack of empirical evidence summarizing efficacy and usability (e.g., treatment duration or dosage). Moreover, while there have been important clinical advancements in treating stress and anxiety disorders, these treatments are often suited for a clinical setting and are not adapted for teacher stress, which has unique dimensions and context‐specific manifestations (Ingersoll, [<reflink idref="bib46" id="ref38">46</reflink>]).</p> <hd id="AN0137889595-3">2 TEACHER STRESS INTERVENTIONS</hd> <p>Teacher stress interventions have varied widely over the past few decades. Since teacher stress was defined and conceptualized in the 1970s, there has been a growing demand to implement effective interventions to reduce stress for teachers (Phillips & Matthew, [<reflink idref="bib68" id="ref39">68</reflink>]). However, interventions for stress in schools have largely been targeted for students, rather than teachers. When interventions have been implemented for teachers, they have had little consistency in approach or type of treatment, often falling across diverse and eclectic areas (Richardson & Rothstein, [<reflink idref="bib72" id="ref40">72</reflink>]). In recent years, interventions which integrate behavioral approaches and cognitive approaches have become popular (Jeffcoat & Hayes, [<reflink idref="bib47" id="ref41">47</reflink>]). These cognitive‐behavioral approaches integrate stress appraisal with physiological stress reduction (Beck, [<reflink idref="bib5" id="ref42">5</reflink>]). In schools, this approach may be particularly effective due to the multifaceted nature of teacher stress. A significant amount of teacher stress arises from teacher cognitive perception of student behavior and difficulty with classroom management (Friedman, [<reflink idref="bib35" id="ref43">35</reflink>]), and stress has long been linked with impaired teacher‐student relationships (Yoon, [<reflink idref="bib82" id="ref44">82</reflink>]).</p> <p>The highly varied approach to teacher stress interventions, as well as the multidimensional nature of teacher stress, suggested that searching for a single univariate solution may be futile (Bertoch, Nielsen, Curley, & Borg, [<reflink idref="bib6" id="ref45">6</reflink>]). However, categorizing and examining whether one type of teacher stress intervention is more effective than others may be particularly important when considering multiple treatment options and thus assisting school psychologists and administrators to allocate resources more effectively. Four major categories of teacher stress interventions have emerged and include knowledge‐based, behavioral, cognitive‐behavioral, and mindfulness methods.</p> <hd id="AN0137889595-4">3 KNOWLEDGE‐BASED INTERVENTIONS</hd> <p>KBIs for teacher stress include informational or psychosocial training for teachers. Such informational interventions include teacher education on problem behaviors (e.g., attention deficit hyperactivity disorder (ADHD); Barbaresi & Olsen, [<reflink idref="bib4" id="ref46">4</reflink>]), and psychosocial education on stress risk (Cicotto, De Simone, Giustiniano, & Pinna, [<reflink idref="bib14" id="ref47">14</reflink>]; Wu, Li, Wang, Wang, & Li, [<reflink idref="bib81" id="ref48">81</reflink>]). These types of interventions typically do not include a physiological or wellness component to reduce stress. KBI may be efficient, cost‐effective and easy to administer within a traditional preservice training paradigm in a school setting. Using KBIs alone to reduce teacher stress may eventually cause frustration without rehearsal or attempts to generalize, especially if peers or administrators are reluctant to support teachers' attempts at implementing new strategies (Dede, Ketelhut, Whitehouse, Breit, & McCloskey, [<reflink idref="bib24" id="ref49">24</reflink>]). Moreover, teachers frequently cite time as a barrier to strategy acquisition and may not prioritize a primarily information‐based approach without cognitive or behavioral rehearsal to ensure maintenance (Erchul & Martens, [<reflink idref="bib30" id="ref50">30</reflink>]).</p> <hd id="AN0137889595-5">4 BEHAVIORAL INTERVENTIONS</hd> <p>While KBIs focus on training and education, BIs incorporate the practice of a defined skill or strategy to reduce teacher stress. Behavioral‐based teacher stress interventions include meditation and relaxation practice (Anderson, Levinson, Barker, & Kiewra, [<reflink idref="bib3" id="ref51">3</reflink>]; Kaspereen, [<reflink idref="bib54" id="ref52">54</reflink>]), the practice of journaling exercises to record gratitude (Chan, [<reflink idref="bib12" id="ref53">12</reflink>]), and participation in dyadic consultation on student behavioral problems (Ray, [<reflink idref="bib71" id="ref54">71</reflink>]). While each BI included in the present review focused on a different technique, each involved regular practice to reduce stress. Behavioral strategies give opportunities for practice and supportive feedback, a necessary component to any strategic educational change (Dede et al., [<reflink idref="bib24" id="ref55">24</reflink>]; Joyce & Showers, [<reflink idref="bib51" id="ref56">51</reflink>]).</p> <hd id="AN0137889595-6">5 COGNITIVE‐BEHAVIORAL INTERVENTIONS</hd> <p>CBIs teacher stress interventions merge cognitive training and strategic behavioral practice to give teachers both the knowledge and the skills they need to manage work‐related stress. Traditional cognitive‐behavioral approaches focus on specific, manual‐based treatment protocols (e.g., acceptance and commitment therapy [ACT] Hayes, [<reflink idref="bib43" id="ref57">43</reflink>]; Vujanovic et al., [<reflink idref="bib79" id="ref58">79</reflink>]). Interventions of this type include ACT (Jeffcoat & Hayes, [<reflink idref="bib47" id="ref59">47</reflink>]), and the use of a cognitive‐behavioral stress management curriculum (Shimazu, Okada, Sakamoto, & Miura, [<reflink idref="bib77" id="ref60">77</reflink>]; Zolnierczyk‐Zreda, [<reflink idref="bib83" id="ref61">83</reflink>]; Leung, Chiang, Mak, & Wong, [<reflink idref="bib64" id="ref62">64</reflink>]). Cognitive‐behavioral stress interventions are feasible for workplace wellness programs, and they promote general health and well‐being for employees (Riley et al., [<reflink idref="bib73" id="ref63">73</reflink>]). Acceptance‐based interventions, including ACT, focus on new ways of relating to stressors and have been classified as "third‐wave" cognitive‐behavioral approaches (Riley et al., [<reflink idref="bib73" id="ref64">73</reflink>]). Combining training and practice feasibly generates more comprehensive opportunities for teacher stress management and serves as a foundation for innovative strategies to manage workplace stress.</p> <hd id="AN0137889595-7">6 MINDFULNESS‐BASED INTERVENTIONS</hd> <p>Another "third‐wave" therapeutic approach to stress intervention is mindfulness (Riley et al., [<reflink idref="bib73" id="ref65">73</reflink>]). Mindfulness takes cognitive and behavioral strategies and focuses on the process of feeling and thinking rather than on thought content (Riley et al., [<reflink idref="bib73" id="ref66">73</reflink>]). Awareness and acceptance without judgment are key components of mindfulness strategies (Kabat‐Zinn et al., [<reflink idref="bib53" id="ref67">53</reflink>]). Recent results suggest that while mindfulness may have efficacy as an approach for student‐based behavior, there has been a lack of evidence for teachers (Klingbeil et al., [<reflink idref="bib56" id="ref68">56</reflink>]). Mindfulness interventions have seen an uptick in the literature in the past dozen years (e.g., Ancona & Mendelson, [<reflink idref="bib2" id="ref69">2</reflink>]; Beshai, McAlpine, Weare, & Kuyken, [<reflink idref="bib7" id="ref70">7</reflink>]; Jennings, Frank, Snowberg, Coccia, & Greenberg, [<reflink idref="bib48" id="ref71">48</reflink>]; Roeser et al., [<reflink idref="bib74" id="ref72">74</reflink>]) and have been deemed practicable and effective long term (Bowen et al., [<reflink idref="bib11" id="ref73">11</reflink>]). Because mindfulness targets symptoms associated with stress but may not have the stigma associated with help‐seeking for mental health, mindfulness may represent a positive approach in stress treatment (Flook, Goldberg, Pinger, Bonus, & Davidson, [<reflink idref="bib32" id="ref74">32</reflink>]).</p> <hd id="AN0137889595-8">7 BEHAVIOR INTERVENTIONS FOR STUDENTS</hd> <p>A predominant source of teacher stress arises from student behavior and impaired student relationships (Friedman, [<reflink idref="bib35" id="ref75">35</reflink>]; Yoon, [<reflink idref="bib82" id="ref76">82</reflink>]). While this review focuses primarily on interventions targeting teacher manifestation of stress, a reduction of teacher stress may be a secondary outcome of interventions that target classroom management or student behavioral correction. Therefore, if an intervention study for classroom management or student problem behavior also evaluates teacher stress as a secondary outcome, that study will be included within one of the four categories of teacher stress interventions.</p> <hd id="AN0137889595-9">8 THE PRESENT STUDY</hd> <p>There is a wide variety in the approaches used to alleviate stress and promote wellness in teachers. Teacher stress has been linked to a variety of negative outcomes for both teachers (e.g., increased likelihood of burnout; Ryan et al., [<reflink idref="bib75" id="ref77">75</reflink>]) as well as students (e.g., lowered teacher accuracy in detecting student behavioral health problems, lower school climate; Collie et al., [<reflink idref="bib18" id="ref78">18</reflink>]; Grayson & Alvarez, [<reflink idref="bib37" id="ref79">37</reflink>]). While an eclectic approach to stress interventions can promote diversity of options for school administrators researching interventions, there lacks a synthesis of intervention effectiveness in the domain of teacher stress. Therefore, this study attempts to (a) synthesize the disparate literature on teacher stress interventions into four categories, and (b) summarize the effectiveness of studies within each domain. Because of the myriad adverse consequences for teachers and students related to burnout in teachers, it is important to understand which treatments have been demonstrated to be successful to reduce stress and ultimately improve social‐emotional and academic outcomes for students. Given the various approaches to teacher stress present in the literature and the emerging trend of mindfulness, there is a need to systematically review intervention effectiveness and emerging trends in the field of teacher stress interventions. The present study examines the types and trend in the development of teacher stress interventions and the effectiveness in reducing stress and burnout. The research questions of this investigation are threefold:</p> <p></p> <ulist> <item> 1) What types of stress interventions for teachers have been published within the research literature?</item> <p></p> <item> 2) What types of assessments are used to evaluate intervention outcomes?</item> <p></p> <item> 3) Which interventions have been effective in reducing teacher stress?</item> </ulist> <hd id="AN0137889595-10">9 METHOD</hd> <p>The authors conducted a preliminary review of evidence‐based treatments for teacher stress interventions to provide a foundation for a more systematic literature review. Treatment for stress in teachers has been characterized in several different treatment domains, including behavioral techniques, cognitive‐behavioral‐based treatments, and mindfulness therapy. To identify the relevant domains of teacher stress intervention or treatment studies, the authors conducted an initial search on PsycINFO, ERIC, EBSCOhost, and Google Scholar using search terms related to teachers (e.g., "teacher," "educator," "instructor,"), stress (e.g., "anxiety," "depression," "burnout," "fatigue"), and interventions ("treatment," "therapy," or "intervention"). The search was limited to studies from 1995 to 2018, published in English, and in peer‐reviewed journals. The search terms were entered both independently and in combination. In the initial search, 64 studies were identified as meeting the criteria for teacher stress interventions. These studies were experimental and quasi‐experimental studies for groups. No single‐case studies were identified or included in the review.</p> <p>Next, two reviewers (authors) independently coded the articles in two phases: Initial sort for inclusion, then rating based on treatment type. The reviewers obtained an interrater reliability of 96%. The coding was based on three categories, (a) the study met criteria for a treatment or intervention (as opposed to a nonexperimental or literature review type study), (b) the study measured teacher stress or burnout at pre and posttest to allow for calculation of effect sizes, and (c) the sample included teachers who taught in grades K‐12. Upon a second review of the collected abstract and titles for the pool of studies, 27 studies were excluded for failing to meet the initial criteria, including the population of the sample (e.g., educators who taught in preschool or early childhood settings), measures (did not assess stress and/or burnout) or subject (not classified as a treatment study). In addition, studies that included defined measures of teacher stress but the primary treatment target was student behavior problems were included (e.g., Barbaresi & Olsen, [<reflink idref="bib4" id="ref80">4</reflink>]). One study was eliminated for failing to include an intervention (Guthrie, Ciccarelli, & Babic, [<reflink idref="bib40" id="ref81">40</reflink>]) and another was not included as the outcomes measures were qualitative in nature (e.g., stress narratives; Sneyers, Jacobs, & Struyf, 2016). Several other studies were not experimental or quasi‐experimental in nature and were thus not included in this review. The raters' inclusion votes disagreed for one study (Biglan, Layton, Jones, Hankins, & Rusby, [<reflink idref="bib9" id="ref82">9</reflink>]), and the study was ultimately excluded for enrolling preschool teachers and family consultants, rather than educators in elementary, middle or high school. There were 24 studies from the initial yield in the first phase of data collection. These studies used an experimental or quasi‐experimental design to measure the effectiveness of stress interventions for teachers in comparison to a control group or pre‐test measure. Results indicate the studies enrolled teachers across elementary, middle and high school settings. These studies were administered across numerous countries, including the United States, China, Italy, and Japan.</p> <p>The studies were coded in a second phase for intervention type (KBI, MI, CBI, BI). MBI was created as its own inclusion category because, although mindfulness involves both cognitive and behavioral components, studies on mindfulness represented a large percent of the studies included and represent a more recent approach to stress intervention. In addition, since the creation of mindfulness‐based stress reduction (MBSR) in the 1970s, mindfulness has existed as its own rigorous approach which is distinct from other cognitive‐behavioral techniques (Bishop et al., [<reflink idref="bib10" id="ref83">10</reflink>]).</p> <p>For the purpose of the review, MBI studies were defined as any study which refers to mindfulness in the abstract or title. In the review, KBI studies were defined as studies rooted in informational or information delivery to teachers, such as workplace training on stress management. BI studies were defined as studies with a practical component focused on repetition or physical calming, such as relaxation, exercise, yoga or journaling, but which lacked cognitive correction. CBI studies were defined as studies with both a cognitive component, which focused on teacher cognitions and thoughts around stress and behavioral practice, such as relaxation, exercise or breathing.</p> <p>Effect sizes were calculated for studies with a pre‐ and postdesign and for studies with a between‐group design. Effect sizes are a standard metric used to quantify a study's level of effectiveness (Cohen, [<reflink idref="bib16" id="ref84">16</reflink>]). The effect size indicates the level of difference in the result within a single group from pre‐ to posttest or between control and treatment group. Following the convention established by Cohen, effect sizes are classified as small (<emph>d</emph> < 0.20), medium (<emph>d</emph> = 0.5), and large (<emph>d</emph> > 0.8).</p> <p>The between‐group effect size was calculated using the following formula:</p> <p> <ephtml> <math display="block" altimg="urn:x-wiley:00333085:media:pits22279:pits22279-math-0001" xmlns="http://www.w3.org/1998/Math/MathML"><mrow><msub><mi>d</mi><mrow><mrow><mi mathvariant="normal">t</mi><mi mathvariant="normal">r</mi><mi mathvariant="normal">e</mi><mi mathvariant="normal">a</mi><mi mathvariant="normal">t</mi><mi mathvariant="normal">m</mi><mi mathvariant="normal">e</mi><mi mathvariant="normal">n</mi><mi mathvariant="normal">t</mi></mrow><mo>−</mo><mrow><mi mathvariant="normal">c</mi><mi mathvariant="normal">o</mi><mi mathvariant="normal">n</mi><mi mathvariant="normal">t</mi><mi mathvariant="normal">r</mi><mi mathvariant="normal">o</mi><mi mathvariant="normal">l</mi></mrow></mrow></msub><mo linebreak="goodbreak" form="infix">=</mo><mfrac><mrow><msub><mover accent="true"><mi>X</mi><mo>¯</mo></mover><mrow><mi>T</mi><mn>2</mn></mrow></msub><mo>−</mo><msub><mover accent="true"><mi>X</mi><mo>¯</mo></mover><mrow><mi>T</mi><mn>1</mn></mrow></msub></mrow><msub><mi>S</mi><mi>p</mi></msub></mfrac><msub><mi>s</mi><mi>p</mi></msub><mo linebreak="goodbreak" form="infix">=</mo><msqrt><mrow><mfrac><mrow><mrow><mo>(</mo><mrow><msub><mi>N</mi><mrow><mi>T</mi><mn>2</mn></mrow></msub><mo>−</mo><mn>1</mn></mrow><mo>)</mo></mrow><mi>S</mi><msubsup><mi>D</mi><mrow><mi>T</mi><mn>2</mn></mrow><mn>2</mn></msubsup><mo>+</mo><mrow><mo>(</mo><mrow><msub><mi>N</mi><mrow><mi>T</mi><mn>1</mn></mrow></msub><mo>−</mo><mn>1</mn></mrow><mo>)</mo></mrow><mi>S</mi><msubsup><mi>D</mi><mrow><mi>T</mi><mn>1</mn></mrow><mn>2</mn></msubsup></mrow><mrow><mrow><mo>(</mo><mrow><msub><mi>N</mi><mrow><mi>T</mi><mn>2</mn></mrow></msub><mo>−</mo><mn>1</mn></mrow><mo>)</mo></mrow><mo>+</mo><msub><mi>N</mi><mrow><mi>T</mi><mn>1</mn></mrow></msub><mo>−</mo><mn>1</mn></mrow></mfrac><mn>.</mn></mrow></msqrt></mrow></math> </ephtml> </p> <p>When regression was used, the effect size was calculated using the following formula:</p> <p> <ephtml> <math display="block" altimg="urn:x-wiley:00333085:media:pits22279:pits22279-math-0002" xmlns="http://www.w3.org/1998/Math/MathML"><mrow><msub><mi>d</mi><mrow><mi mathvariant="normal">t</mi><mi mathvariant="normal">r</mi><mi mathvariant="normal">e</mi><mi mathvariant="normal">a</mi><mi mathvariant="normal">t</mi><mi mathvariant="normal">m</mi><mi mathvariant="normal">e</mi><mi mathvariant="normal">n</mi><mi mathvariant="normal">t</mi><mo mathvariant="normal">−</mo><mi mathvariant="normal">c</mi><mi mathvariant="normal">o</mi><mi mathvariant="normal">n</mi><mi mathvariant="normal">t</mi><mi mathvariant="normal">r</mi><mi mathvariant="normal">o</mi><mi mathvariant="normal">l</mi></mrow></msub><mo linebreak="goodbreak" form="infix">=</mo><mfrac><msub><mi>B</mi><mrow><mi mathvariant="normal">u</mi><mi mathvariant="normal">n</mi><mi mathvariant="normal">s</mi><mi mathvariant="normal">tan</mi><mi mathvariant="normal">d</mi><mi mathvariant="normal">a</mi><mi mathvariant="normal">r</mi><mi mathvariant="normal">d</mi><mi mathvariant="normal">i</mi><mi mathvariant="normal">z</mi><mi mathvariant="normal">e</mi><mi mathvariant="normal">d</mi></mrow></msub><msub><mi>S</mi><mi>p</mi></msub></mfrac></mrow></math> </ephtml> </p> <p>The pretest to posttreatment ES was calculated using the following formula:</p> <p> <ephtml> <math display="block" altimg="urn:x-wiley:00333085:media:pits22279:pits22279-math-0003" xmlns="http://www.w3.org/1998/Math/MathML"><mrow><msub><mi>d</mi><mrow><mi mathvariant="normal">p</mi><mi mathvariant="normal">r</mi><mi mathvariant="normal">e</mi><mo mathvariant="normal">−</mo><mi mathvariant="normal">p</mi><mi mathvariant="normal">o</mi><mi mathvariant="normal">s</mi><mi mathvariant="normal">t</mi></mrow></msub><mo linebreak="goodbreak" form="infix">=</mo><mfrac><mrow><msub><mover accent="true"><mi>X</mi><mo>¯</mo></mover><mrow><mi>T</mi><mn>2</mn></mrow></msub><mo>−</mo><msub><mover accent="true"><mi>X</mi><mo>¯</mo></mover><mrow><mi>T</mi><mn>1</mn></mrow></msub></mrow><msub><mi>S</mi><mi>p</mi></msub></mfrac><msub><mi>S</mi><mi>p</mi></msub><mo linebreak="goodbreak" form="infix">=</mo><msqrt><mfrac><mrow><mo>(</mo><mrow><msubsup><mi>S</mi><mrow><mi>T</mi><mn>1</mn></mrow><mn>2</mn></msubsup><mo>+</mo><msubsup><mi>S</mi><mrow><mi>T</mi><mn>2</mn></mrow><mn>2</mn></msubsup></mrow><mo>)</mo></mrow><mn>2</mn></mfrac></msqrt><mn>.</mn></mrow></math> </ephtml> </p> <p>When analysis of variance was used, the between‐group effect size was calculated using the following formula:</p> <p> <ephtml> <math display="block" altimg="urn:x-wiley:00333085:media:pits22279:pits22279-math-0004" xmlns="http://www.w3.org/1998/Math/MathML"><mrow><msub><mi>d</mi><mrow><mi mathvariant="normal">t</mi><mi mathvariant="normal">r</mi><mi mathvariant="normal">e</mi><mi mathvariant="normal">a</mi><mi mathvariant="normal">t</mi><mi mathvariant="normal">m</mi><mi mathvariant="normal">e</mi><mi mathvariant="normal">n</mi><mi mathvariant="normal">t</mi><mo mathvariant="normal">−</mo><mi mathvariant="normal">c</mi><mi mathvariant="normal">o</mi><mi mathvariant="normal">n</mi><mi mathvariant="normal">t</mi><mi mathvariant="normal">r</mi><mi mathvariant="normal">o</mi><mi mathvariant="normal">l</mi></mrow></msub><mo linebreak="goodbreak" form="infix">=</mo><mn>2</mn><msqrt><mfrac><mi>F</mi><mi>N</mi></mfrac></msqrt></mrow></math> </ephtml> </p> <hd id="AN0137889595-11">10 RESULTS</hd> <p></p> <hd id="AN0137889595-12">10.1 Treatment techniques</hd> <p>See Table for a summary of key study characteristics including sample size, treatment type, treatment duration, study design, outcome measure, and effect size. All studies reviewed in the study were grounded in MBI, KBI, BI, or CBI techniques. Recent trends indicate that MBI interventions are the most commonly administered intervention type and also have been administered most frequently since 2010. Most of the studies (approximately 75%) had been published since 2010 indicating a more recent increase of teacher stress intervention studies. In addition to MBIs, eight studies were rooted in CBI theoretical framework, three in KBI, and five studies were BI in focus. Of the 24 studies reviewed, most studies had a sample size larger than 20 participants. Only two studies had a sample size between 10 and 20 participants. The largest study was by Wu et al. ([<reflink idref="bib81" id="ref85">81</reflink>]), which had a sample of 961 participants. No studies used a single‐case design. This review only included studies that utilized experimental or quasi‐experimental designs, with a control group and experimental group or a pretest and posttreatment measure.</p> <p>1 Summary of included teacher stress intervention studies with effect sizes</p> <p> <ephtml> <table><thead valign="bottom"><tr valign="bottom"><th>Author (year)</th><th>Sample size</th><th>Design</th><th>Intervention type</th><th>Duration</th><th>Treatment measure</th><th>Effect size</th></tr></thead><tbody valign="top"><tr><td>Anacona and Mendelson (<xref ref-type="bibr" rid="bibr2">2</xref>)</td><td char="." align="char">43</td><td>Experimental</td><td>MBI</td><td>Two sessions per week for 3 weeks</td><td>TSI, MBI‐ES</td><td>0.42–0.54</td></tr><tr><td>Anderson et al. (<xref ref-type="bibr" rid="bibr3">3</xref>)</td><td align="char" char=".">91</td><td>Experimental</td><td>Behavioral</td><td>One session per week for 5 weeks</td><td>TSI, STAIA, MBI</td><td>0.90</td></tr><tr><td>Beshai et al. (<xref ref-type="bibr" rid="bibr7">7</xref>)</td><td align="char" char=".">89</td><td>Quasi‐Experimental</td><td>MBI</td><td>Nine 75‐min sessions</td><td>PSS, FFMQ, SCS</td><td>1.21</td></tr><tr><td>Barbaresi and Olsen (<xref ref-type="bibr" rid="bibr4">4</xref>)</td><td align="char" char=".">44</td><td>Experimental</td><td>KBI</td><td>2.5 hr program</td><td>ITS</td><td>0.84</td></tr><tr><td>Chan (<xref ref-type="bibr" rid="bibr12">12</xref>)</td><td align="char" char=".">63</td><td>Quasi‐experimental</td><td>Behavioral</td><td>Daily log, 8 weeks</td><td>GQ‐6, OHS</td><td>0.66</td></tr><tr><td>Cheek, Bradley, and Parr (<xref ref-type="bibr" rid="bibr13">13</xref>)</td><td align="char" char=".">51</td><td>Experimental</td><td>CBI</td><td>One session per week for 6 weeks</td><td>MBI‐ES</td><td>0.63</td></tr><tr><td>Cicotto et al. (<xref ref-type="bibr" rid="bibr14">14</xref>)</td><td align="char" char=".">92</td><td>Quasi‐experimental</td><td>KBI</td><td>Four 3‐hr training modules</td><td>MBI</td><td>0.50</td></tr><tr><td>Flook et al. (<xref ref-type="bibr" rid="bibr32">32</xref>)</td><td align="char" char=".">18</td><td>Experimental</td><td>MBI</td><td>7 weeks</td><td>FFMQ, MBI</td><td>0.25</td></tr><tr><td>Franco , Mañas, Cangas, Moreno, and Gallego (<xref ref-type="bibr" rid="bibr33">33</xref>)</td><td align="char" char=".">68</td><td>Quasi‐experimental</td><td>MBI</td><td>One session per week for 10 weeks</td><td>SCL90‐R</td><td>0.88–1.73</td></tr><tr><td>Frank et al. (<xref ref-type="bibr" rid="bibr34">34</xref>)</td><td align="char" char=".">36</td><td>Quasi‐experimental</td><td>MBI</td><td>One session per week for 8 weeks</td><td>BSI, SCS, FFMQ, MBI‐ES</td><td>0.18–0.33</td></tr><tr><td>Gold et al. (<xref ref-type="bibr" rid="bibr36">36</xref>)</td><td align="char" char=".">11</td><td>Quasi‐experimental</td><td>MBI</td><td>One session per week for 8 weeks</td><td>FG, KIMS, DASS</td><td>1.18</td></tr><tr><td /><td align="char" char=".">64</td><td>Experimental</td><td>MBI, CBI</td><td>Four sessions per week, 16 weeks</td><td>FFMQ, MBI, DTS, PANAS</td><td>0.52–0.80</td></tr><tr><td>Jeffcoat and Hayes (<xref ref-type="bibr" rid="bibr47">47</xref>)</td><td align="char" char=".">236</td><td>Experimental</td><td>CBI</td><td>8 weeks</td><td>GHQ, KIMS</td><td>0.56–0.98</td></tr><tr><td>Jennings et al. (<xref ref-type="bibr" rid="bibr48">48</xref>)</td><td align="char" char=".">50</td><td>Experimental</td><td>MBI</td><td>One session per week for 4 weeks</td><td>PANAS, ERQ, MBI</td><td>0.004</td></tr><tr><td>Johnson & Naidoo (<xref ref-type="bibr" rid="bibr50">50</xref>)</td><td align="char" char=".">43</td><td>Quasi‐experimental</td><td>CBI</td><td>One session per week for 15 weeks</td><td>PSS, CBI</td><td>0.54–0.66</td></tr><tr><td>Kaspereen (<xref ref-type="bibr" rid="bibr54">54</xref>)</td><td align="char" char=".">54</td><td>Experimental</td><td>Behavioral</td><td>One session per week for 4 weeks</td><td>PSS, SWLS</td><td>1.06</td></tr><tr><td>Lhospital and Gregory (<xref ref-type="bibr" rid="bibr62">62</xref>)</td><td align="char" char=".">33</td><td>Quasi‐experimental</td><td>Behavioral</td><td>Not specified</td><td>ITS</td><td>0.28</td></tr><tr><td>Lueng, Chiang, Chui, Mak, and Wong (<xref ref-type="bibr" rid="bibr64">64</xref>)</td><td align="char" char=".">124</td><td>Quasi‐experimental</td><td>CBI</td><td>3 Weeks</td><td>OSI‐R, DASS</td><td>0.03–0.63</td></tr><tr><td>Pülschen & Pülschen (<xref ref-type="bibr" rid="bibr69">69</xref>)</td><td align="char" char=".">68</td><td>Quasi‐experimental</td><td>CBI</td><td>One session per day for 12 days</td><td>Subjective tension</td><td>0.63</td></tr><tr><td>Ray (<xref ref-type="bibr" rid="bibr71">71</xref>)</td><td align="char" char=".">59</td><td>Experimental</td><td>Behavioral</td><td>10 Weeks</td><td>ITS</td><td>0.70–0.94</td></tr><tr><td>Roeser et al. (<xref ref-type="bibr" rid="bibr74">74</xref>)</td><td align="char" char=".">113</td><td>Experimental</td><td>MBI</td><td>11 Sessions over 8 weeks</td><td>FFMQ</td><td>0.62–0.79</td></tr><tr><td>Shimazu et al. (<xref ref-type="bibr" rid="bibr77">77</xref>)</td><td align="char" char=".">24</td><td>Experimental</td><td>CBI</td><td>Five sessions over 8 weeks</td><td>BJSQ, JSS</td><td>0.06</td></tr><tr><td>Wu et al. (<xref ref-type="bibr" rid="bibr81">81</xref>)</td><td align="char" char=".">961</td><td>Experimental</td><td>KBI</td><td>24 Sessions over 1 year</td><td>OSI‐R, WAI</td><td>0.04–0.13</td></tr><tr><td>Zolnierczyk‐Zreda (<xref ref-type="bibr" rid="bibr83">83</xref>)</td><td char="." align="char">58</td><td>Quasi‐experimental</td><td>CBI</td><td>Two 6‐hr sessions</td><td>MBI</td><td>2.66</td></tr></tbody></table> </ephtml> </p> <p>1 <emph>Note:</emph> Treatment measures per study are not all inclusive.</p> <p>2 Abbreviations: BJSQ, Brief Job Stress Questionnaire; BSI, Brief Symptom Inventory; CBI, cognitive‐behavioral intervention; DASS, Depression Anxiety Stress Scales; ERQ, Emotion Regulation Questionnaire; FFMQ, Five Facet Mindfulness Questionnaire; GQ‐6, Gratitude Questionnaire; ITS, Index of Teacher Stress; JSS, Job Stress Scale; KBI, knowledge‐based intervention; KIMS, Kentucky Inventory of Mindfulness Skills; MBI, mindfulness‐based intervention; MBI‐ES, Maslach Burnout Inventory; OHS, Orientations to Happiness Scale; OSI‐R, Occupational Stress Inventory‐Revised Edition; PANAS, Positive + Negative Affect Schedule‐Short Form; PSS, Perceived Stress Scale; SCS, Self Compassion Scale; SWLS, Satisfaction with Life Survey; STAIA, State‐Trait Anxiety Inventory for Adults; TSI, teacher stress inventory.</p> <p>Across studies, there was little consistency in measurement of teacher stress or use of specific subscales, indicating that the field has little agreement upon a singular scale that adequately measures stress. Across studies, eight self‐report scales were consistently used, including the Maslach Burnout Inventory (MBI; Maslach, Jackson, & Leiter, [<reflink idref="bib65" id="ref86">65</reflink>]), the Perceived Stress Scale (Cohen, Kamarck, & Mermelstein, [<reflink idref="bib17" id="ref87">17</reflink>]), the Index of Teacher Stress (ITS; Greene, Abidin, & Kmetz, [<reflink idref="bib39" id="ref88">39</reflink>]), Teacher Stress Inventory (TSI; Fimian, [<reflink idref="bib31" id="ref89">31</reflink>]), the Depression Anxiety Stress Scales (DASS; Henry & Crawford, [<reflink idref="bib44" id="ref90">44</reflink>]), the Occupational Stress Inventory‐Revised (OSI‐R; Osipow, [<reflink idref="bib67" id="ref91">67</reflink>]), the Warwick‐Edinburgh Mental Wellbeing Scale (Stewart‐Brown et al., [<reflink idref="bib78" id="ref92">78</reflink>]). Overall, an initial review of study type and outcome measures indicates an eclectic nature to the field of stress treatment for teachers. Treatment length, outcome measures, and treatment types vary systematically over the last 20 years. More recently, mindfulness‐based approaches have emerged as an important positive advancement in the field of teacher stress reduction.</p> <hd id="AN0137889595-13">10.2 Treatment types and outcomes</hd> <p>Four main categories of stress interventions were identified in the literature: KBI, CBI, BI, and MBI studies.</p> <hd id="AN0137889595-14">10.2.1 Knowledge‐based studies</hd> <p>Three studies were categorized as knowledge‐based or informational studies or interventions rooted in the dissemination of knowledge around stress and stress reduction. These training often included content on nutrition, exercise, and relaxation but did not involve a component of behavioral practice. In one study, Wu et al. ([<reflink idref="bib81" id="ref93">81</reflink>]) offered lectures on stress management biweekly or once monthly. The effect size on the Occupational Stress Inventory was small (<emph>d</emph> = 0.11) or psychological strain (<emph>d</emph> = 0.04). However, in a similar study from Cicotto et al. ([<reflink idref="bib14" id="ref94">14</reflink>]), participants received a psychosocial training on stress management offered in the school setting in four three‐hour time blocks. This content consisted of training module workplace‐related stress for teachers, organized in four 3‐hr time blocks on stress management, communication, ability to work in a team and problem‐solving. On the posttest measure of occupational burnout, the participants demonstrated a medium effect size in stress reduction (<emph>d</emph> = 0.50) from pretest. While the program was informational in type, participants also received information on behavioral skills (e.g., effective communication skills).</p> <p>Finally, in a study by Barbaresi and Olsen ([<reflink idref="bib4" id="ref95">4</reflink>]), participants in experimental and control groups received an informational training on ADHD and management of ADHD, then were measured on stress pre‐ and posttest. The effect size for this intervention was large (<emph>d</emph> = 0.85), which may be due to highly specific information targeted to the source of teacher stress, rather than knowledge about the dimensions of stress itself. This was by far the most effective study published in the KBI domain, but as was common across study areas, each study examined stress on different outcome measures.</p> <hd id="AN0137889595-15">10.2.2 Behavioral studies</hd> <p>Overall, five studies in the review were classified as behavioral in nature or involving components of behavioral regulation, such as relaxation. However, 20 of the 24 studies involved some component of behavioral regulation in stress reduction. This is consistent with Couser ([<reflink idref="bib21" id="ref96">21</reflink>]) in that the majority of studies in stress reduction are behavioral in nature. Overall, behavioral stress reduction appears to be a promising component of stress treatment. In this category, purely behavioral approaches ranged from involvement in pre‐referral teams in a school (Lhospital & Gregory, [<reflink idref="bib62" id="ref97">62</reflink>]) to involvement in teacher consultation dyads (Kaspereen, [<reflink idref="bib54" id="ref98">54</reflink>]) to involvement in relaxation training (Kaspereen, [<reflink idref="bib54" id="ref99">54</reflink>]) or journaling (Chan, [<reflink idref="bib12" id="ref100">12</reflink>]). Two studies evaluated BIs that were rooted in practices already present in a school setting. Both studies suggest that involvement in school‐based approaches reduces stress. Lhospital and Gregory ([<reflink idref="bib62" id="ref101">62</reflink>]) examined 33 teachers' involvement in prereferral intervention teams. From the first time‐point until the third, student‐teacher stress reduced steadily, with an effect size of <emph>d</emph> = 0.66 from time one until time three. The authors theorized that involvement in a supportive team, as well as student progress on referral concerns, resulted in the stress reduction.</p> <p>Ray ([<reflink idref="bib71" id="ref102">71</reflink>]) examined how teacher participation in consultation or child participation in play therapy reduced teacher stress on the ITS (Greene et al., [<reflink idref="bib39" id="ref103">39</reflink>]) scale. Notably, there was a significant reduction in teacher stress for all groups in the study, although there was no difference between stress reduction for play therapy (child participation), consultation (teacher participation), and a combined group. The effect size was large for teachers <emph>(d</emph> = 0.94) from the beginning to the end of the 10‐week program. Therefore, participation in a program which managed student behavioral issues was found to reduce teacher stress significantly, despite whether students or teachers participated in the intervention. It is important to note that one other study (Barbaresi & Olsen, [<reflink idref="bib4" id="ref104">4</reflink>]) evaluated how information on student behavior would decrease teacher stress through an informative workshop on ADHD. This study also reported a large effect size in teacher stress reduction at posttest. Finally, three studies examined behavioral practices such as relaxation and meditation. One such study was by Kaspereen ([<reflink idref="bib54" id="ref105">54</reflink>]), examined whether participation in a behavioral relaxation program for teachers, which focused on relaxation and meditation over a period of 4 weeks, would reduce stress on the Perceived Stress Scale. The study found a large effect size (<emph>d</emph> = 1.06) for stress reduction from pre‐ to posttest. Similarly, Anderson et al. ([<reflink idref="bib3" id="ref106">3</reflink>]) examined whether participation in a meditation program from the American Meditation Society reduced stress on the TSI over 5 weeks. The effect size was large (<emph>d</emph> = 0.90) between experimental and treatment groups at posttest. This appears to support the principle of meditation and behavioral practice for stress reduction.</p> <hd id="AN0137889595-16">10.2.3 Cognitive‐behavioral studies</hd> <p>A total of eight studies used a cognitive‐behavioral treatment approach to intervene for stress in teachers, which included cognitive restructuring and behavioral regulation. As with the other treatment types, effect sizes varied from small to large based on a number of participants, type of stress scale, and duration of treatment. The curriculum varied widely in etiology, including five studies grounded in cognitive‐behavioral therapy (CBT), two studies grounded in Stress Inoculation Training and one study grounded in the ACT. Treatment lengths varied from 2 days (Zolnierczyk‐Zreda, [<reflink idref="bib83" id="ref107">83</reflink>]) to 15 weeks (Johnson & Naidoo, [<reflink idref="bib50" id="ref108">50</reflink>]). Outcome measures included assessments such as the Brief Job Stress Questionnaire, the Job Stress Scale, the DASS, the MBI, and the OSI‐R at posttest. As with other treatment types, there was little consistency on scales used to measure stress. Cognitive‐behavioral techniques used phases of skill development, typically involving challenging cognitions, acquiring new skills, and practice. Behavioral practice included elements of yoga, meditation, and exercise. Effect sizes for the CBI studies ranged from very small (0.03) to very large (2.66).</p> <p>Cognitive‐behavioral approaches identified within this review were also combined with related treatment modalities. For example, Cheek et al. ([<reflink idref="bib13" id="ref109">13</reflink>]) used a CBT aligned curriculum, which focused on stress inoculation, for the treatment group, and music therapy and CBT combined curriculum for the control group. The group used a journal to record daily thoughts and feelings as behavioral practice. Jeffcoat and Hayes ([<reflink idref="bib47" id="ref110">47</reflink>]) implemented an ACT self‐help bibliotherapy intervention for 236 teachers over 8 weeks. ACT is rooted in acceptance, self‐awareness, coping with stressful feelings, and behaving in congruence with personal values. The effect size from pre‐test to posttest was medium to large (<emph>d</emph> = 0.48–0.98) between conditions and time‐points.</p> <p>Traditional CBT workshops held over a short‐term basis, such as 3 days of sessions, were less effective in stress reduction. Leung et al. ([<reflink idref="bib64" id="ref111">64</reflink>]) used a brief, three session CBT workshop based on discussion, quizzes, worksheets, and practice to combat stress. The workshop was rooted theoretically in Beck's cognitive triad. The effect size indicated the workshop had a small effect (<emph>d</emph> = 0.03) across participants on the OSI‐R. The researchers reported that if results were broken out by gender, the effect size was more substantial (<emph>d</emph> = 0.63).</p> <hd id="AN0137889595-17">10.2.4 Mindfulness‐based studies</hd> <p>Finally, eight studies were grounded in a mindfulness treatment approach. These approaches included six different mindfulness approaches: Cultivating Awareness and Resilience in Education program (CARE; Jennings et al., [<reflink idref="bib48" id="ref112">48</reflink>]), Mindfulness Training (Roeser et al., [<reflink idref="bib74" id="ref113">74</reflink>]), Holistic Life Foundation Yoga (Ancona & Mendelson, [<reflink idref="bib2" id="ref114">2</reflink>]), MBSR (Frank, Reibel, Broderick, Cantrell, & Metz, [<reflink idref="bib34" id="ref115">34</reflink>]; Gold et al., [<reflink idref="bib36" id="ref116">36</reflink>]), Flow Meditation (Franco et al., [<reflink idref="bib33" id="ref117">33</reflink>]), and the "Foundations Course" adapted for Mindfulness in Schools (Beshai et al., [<reflink idref="bib7" id="ref118">7</reflink>]). MBSR (Kabat‐Zinn, [<reflink idref="bib52" id="ref119">52</reflink>]) is used to target attention and emotional processing at symptoms of stress. Three studies were grounded in an MBSR‐based approach (Flook et al., [<reflink idref="bib32" id="ref120">32</reflink>]; Frank et al., [<reflink idref="bib34" id="ref121">34</reflink>]; Gold et al., [<reflink idref="bib36" id="ref122">36</reflink>]). On the MBI Emotional Exhaustion scale, Frank et al. ([<reflink idref="bib34" id="ref123">34</reflink>]) reported a small to moderate effect size from pretreatment to posttreatment. The treatment included mindfulness‐based meditation for 8 weeks. Gold et al. ([<reflink idref="bib36" id="ref124">36</reflink>]) implemented an 8‐week MBSR trial in a school setting, including a 5‐hr "Silent Day" for colleagues and staff. As indicated on the DASS, a large effect size from pretreatment to posttreatment was reported.</p> <p>Several other mindfulness‐based approaches, including the Holistic Life Yoga program (Ancona & Mendelson, [<reflink idref="bib2" id="ref125">2</reflink>]), Flow Meditation (Franco et al., [<reflink idref="bib33" id="ref126">33</reflink>]), and the CARE program (Jennings et al., [<reflink idref="bib48" id="ref127">48</reflink>]), were implemented to reduce teacher stress and burnout. Despite modifications in the curriculum, type of behavioral practice and duration, effect sizes ranged from small to large. Franco et al. ([<reflink idref="bib33" id="ref128">33</reflink>]) reported a large effect size for the use of Flow Meditation at posttreatment across 10 weeks. Jennings et al. used the CARE curriculum, which improves teachers' social‐emotional competence as part of professional development training. The CARE program is an intensive 30‐hr training program delivered over 4 days. The reported effect size was small for the CARE program (<emph>d < </emph>.01) and there were no substantial differences reported between intervention and control groups.</p> <hd id="AN0137889595-18">11 DISCUSSION</hd> <p>This review synthesized the effectiveness of teacher stress interventions. Wide variability in treatment approaches was noted, which may be reflective of the traditional eclectic nature to approach to treatment. Rather than one unified type of stress intervention, there were four primary treatment domains identified in the literature: Those oriented in cognitive‐behavioral, behavioral, mindfulness, and psychoeducational or knowledge‐based approaches.</p> <p>Three studies in this review involved student behavior, or training teachers on addressing student behavioral issues, to reduce teacher stress. Overall, these effect sizes fell in the medium‐large range. This suggests that when schools intervene to reduce student behavioral issues, the results of successful interventions may have positive results for teachers as well. This fits within the model described by Jennings and Greenberg ([<reflink idref="bib49" id="ref129">49</reflink>]), which suggests that teacher and student relationships are explicitly connected and may have reciprocal (positive or negative) effects. Resource allocation toward classroom management training or student behavior management may be effective alone in reducing stress, although additional research will be necessary to systematically evaluate these relationships.</p> <p>Notably, across categories, most treatment types appeared to report effect sizes in the small to medium range regardless of intervention type. Administration of consistent, regular and applied interventions with 8–10 weeks in duration and regular weekly meetings from 60 to 90 min seem necessary to obtain significant, positive outcomes. Studies varied widely in the treatment length, with some intervention protocols as short as three to four sessions while others were delivered weekly over the course of a year (Wu et al., [<reflink idref="bib81" id="ref130">81</reflink>]). Duration of treatment may influence the magnitude of the treatment gains, apart from the type of treatment administered.</p> <p>Since 2010, eight studies have been published on mindfulness, or the mindful awareness of physical symptoms, stress, and acceptance of noted symptoms (i.e., Jennings et al., [<reflink idref="bib48" id="ref131">48</reflink>]). On the basis of these findings, mindfulness‐based approaches represent a more recent trend in incorporating acknowledgment of physiological and cognitive reactions to a stressful context or event. Effect sizes varied across studies for mindfulness treatments which are somewhat consistent with prior meta‐analyses in this domain (Klingbeil et al., [<reflink idref="bib56" id="ref132">56</reflink>]). The variability in treatment effectiveness may be, in part, due to different outcome variables used for mindfulness‐based approaches, which were often rooted in the acquisition of mindfulness skills, like awareness, and less oriented toward stress‐specific outcomes. There were no data within this review to indicate that mindfulness‐based treatments are more effective than other treatment types in reducing teacher stress. It is important to note that across all study types, 20 of the 24 studies reviewed involve a component of behavioral practice or including strategies that physically calm or relax the body. The studies vary in whether or not they used meditation, yoga, exercise or a combination of approaches, but the overwhelming consistency of physical regulation inclusion in stress intervention trials suggests behavioral regulation should be an important part of stress treatments in the future.</p> <hd id="AN0137889595-19">11.1 Implications and future research</hd> <p>This review identified empirical support for promising practices rooted in CBT, such as ACT. In addition, promising practices within behavioral regulation were noted, such as meditation and yoga. One more recent domain that has emerged since 2010 is mindfulness‐based stress interventions in schools. It appears that with a consistent duration and length of treatment, mindfulness approaches may be useful in reducing teacher stress and burnout. A link between student mental and behavioral health and teacher stress was noted in several studies within this review. In addition, the overall school environment (i.e., school climate) may be a particularly important domain to support in concert with a teacher‐focused stress reduction efforts given links between environmental pressures and teacher well‐being (von der Embse, [<reflink idref="bib25" id="ref133">25</reflink>]). As school psychologists seek to support student mental health, providing supports for teacher well‐being while also addressing the broader school environment may be an important first step.</p> <p>The included interventions within this review are not without limitations. For example, there may be additional teacher stress interventions that were efficacious but not included within this review if outside the specified search parameters (e.g., outside of the specified date range, not experimental, was not in English). Nearly all of the teacher stress interventions in this investigation did not include two essential elements: an evaluation of treatment maintenance across time, and cost‐effectiveness analysis. For example, mindfulness‐based treatments have been demonstrated to be effective in short durations on pre‐post evaluations yet decrease significantly in effectiveness over time (Klingbeil et al., [<reflink idref="bib56" id="ref134">56</reflink>]). This is an especially relevant concern for school‐based practitioners given the many demands on educators and the need for ongoing coaching and supports to maintain treatment effectiveness. Relatedly, many of the interventions did not utilize the same assessments nor include methodological detail (e.g., cost of protocols, time to treat) that would be necessary for calculating a cost‐effectiveness analysis (Levin & Belfield, [<reflink idref="bib61" id="ref135">61</reflink>]). For example, treatment with a moderate effect size requiring relatively limited implementation "costs" (e.g., professional development, protocols, and materials) may be more suitable than treatment with a larger effect size that necessitates higher costs (e.g., multiple days of professional development and ongoing coaching). Thus, school psychologists and educators should attend to the resources necessary to implement <emph>and</emph> maintain the intervention when considering which type of treatment to select.</p> <p>Future research within the teacher stress intervention domain will be critical to address the weakness noted above, including a systematic comparison of the various treatment types utilizing the same outcome measures. For example, researchers may consider utilizing a multiphase optimization strategy (Collins, Kugler, & Gwadz, [<reflink idref="bib19" id="ref136">19</reflink>]) or a sequential, multiple assignment, randomized trial (Lei, Nahum‐Shani, Lynch, Oslin, & Murphy, [<reflink idref="bib60" id="ref137">60</reflink>]) that would allow for the evaluation of different types and dosages of intervention necessary to achieve the desired treatment outcomes. Combined with a cost evaluation (Levin & Belfield, [<reflink idref="bib61" id="ref138">61</reflink>]), these results may more clearly present the most effective teacher stress treatment with the least amount of required resources. 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Items – Name: Title
  Label: Title
  Group: Ti
  Data: Teacher Stress Interventions: A Systematic Review
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22von+der+Embse%2C+Nathaniel%22">von der Embse, Nathaniel</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0003-2545-7691">0000-0003-2545-7691</externalLink>)<br /><searchLink fieldCode="AR" term="%22Ryan%2C+Shannon+V%2E%22">Ryan, Shannon V.</searchLink><br /><searchLink fieldCode="AR" term="%22Gibbs%2C+Tera%22">Gibbs, Tera</searchLink><br /><searchLink fieldCode="AR" term="%22Mankin%2C+Ariel%22">Mankin, Ariel</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Psychology+in+the+Schools%22"><i>Psychology in the Schools</i></searchLink>. Sep 2019 56(8):1328-1343.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Wiley-Blackwell. 350 Main Street, Malden, MA 02148. Tel: 800-835-6770; Tel: 781-388-8598; Fax: 781-388-8232; e-mail: cs-journals@wiley.com; Web site: http://www.wiley.com/WileyCDA
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 16
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2019
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Evaluative
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Teachers%22">Teachers</searchLink><br /><searchLink fieldCode="DE" term="%22Teacher+Burnout%22">Teacher Burnout</searchLink><br /><searchLink fieldCode="DE" term="%22Anxiety%22">Anxiety</searchLink><br /><searchLink fieldCode="DE" term="%22Stress+Management%22">Stress Management</searchLink><br /><searchLink fieldCode="DE" term="%22Stress+Variables%22">Stress Variables</searchLink><br /><searchLink fieldCode="DE" term="%22Intervention%22">Intervention</searchLink><br /><searchLink fieldCode="DE" term="%22Negative+Attitudes%22">Negative Attitudes</searchLink><br /><searchLink fieldCode="DE" term="%22Perception%22">Perception</searchLink><br /><searchLink fieldCode="DE" term="%22Metacognition%22">Metacognition</searchLink><br /><searchLink fieldCode="DE" term="%22Attention+Control%22">Attention Control</searchLink><br /><searchLink fieldCode="DE" term="%22Program+Effectiveness%22">Program Effectiveness</searchLink><br /><searchLink fieldCode="DE" term="%22Behavior+Modification%22">Behavior Modification</searchLink><br /><searchLink fieldCode="DE" term="%22Cognitive+Restructuring%22">Cognitive Restructuring</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1002/pits.22279
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0033-3085
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Due to the increased pressure from test-based accountability practices, teachers have reported high levels of stress and burnout. High teacher stress has an impact on school outcomes, including links to absenteeism, burnout, school climate, and teacher behavior management. Teacher stress interventions may be an important first step toward reducing these negative outcomes. Although there have been several recent intervention studies in the domain of teacher stress, there has been no systematic review to compare the type and effectiveness of teacher stress interventions. Included within this review are interventions from a variety of modalities such as knowledge-based, behavioral, cognitive-behavioral, and mindfulness approaches. Results indicated that the most effective interventions were in the mindfulness, behavioral, and cognitive-behavioral domains. Interventions which delivered solely informational content were among the least effective.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2019
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1224070
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1224070
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      – Type: doi
        Value: 10.1002/pits.22279
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 16
        StartPage: 1328
    Subjects:
      – SubjectFull: Teachers
        Type: general
      – SubjectFull: Teacher Burnout
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      – SubjectFull: Anxiety
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      – SubjectFull: Metacognition
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      – SubjectFull: Attention Control
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      – SubjectFull: Program Effectiveness
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      – SubjectFull: Behavior Modification
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      – SubjectFull: Cognitive Restructuring
        Type: general
    Titles:
      – TitleFull: Teacher Stress Interventions: A Systematic Review
        Type: main
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            NameFull: Ryan, Shannon V.
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            NameFull: Mankin, Ariel
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            – D: 01
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              Value: 8
          Titles:
            – TitleFull: Psychology in the Schools
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