Pijpker Roald, Veen Esther J, Vaandrager Lenneke, Koelen Maria, Bauer Georg F
Health and Society, Social Sciences Group, Wageningen University, Wageningen, Netherlands.
Urban Food Issues, Aeres University of Applied Sciences, Almere, Netherlands.
Front Psychol. 2022 Mar 3;13:785697. doi: 10.3389/fpsyg.2022.785697. eCollection 2022.
Burnout is a major societal issue adversely affecting employees' health and performance, which over time results in high sick leave costs for organizations. Traditional rehabilitation therapies show suboptimal effects on reducing burnout and the return-to-work process. Based on the health-promoting effects of nature, taking clients outdoors into nature is increasingly being used as a complementary approach to traditional therapies, and evidence of their effectiveness is growing. Theories explaining how the combination of general psychological support and outdoor-specific elements can trigger the rehabilitation process in outdoor therapy are often lacking, however, impeding its systematic research.
The study aims to develop an intervention and evaluation model for outdoor therapy to understand and empirically evaluate whether and how such an outdoor intervention may work for rehabilitation after burnout.
We build on the exemplary case of an outdoor intervention for rehabilitation after burnout, developed by outdoor clinical psychologists in Netherlands. We combined the generic context, process, and outcome evaluation model and the burnout recovery model as an overarching deductive frame. We then inductively specified the intervention and evaluation model of outdoor therapy, building on the following qualitative data: semi-structured interviews with outdoor clinical psychologists and former clients; a content analysis of the intervention protocol; and reflective meetings with the intervention developers and health promotion experts.
We identified six key outdoor intervention elements: (1) physical activity; (2) reconnecting body and mind; (3) nature metaphors; (4) creating relationships; (5) observing natural interactions; and (6) experiential learning. The results further showed that the implementation of these elements may facilitate the rehabilitation process after burnout in which proximal, intermediate, and distal outcomes emerge. Finally, the results suggested that this implementation process depends on the context of the therapist (e.g., number of clients per day), therapy (e.g., privacy issues), and of the clients (e.g., affinity to nature).
The intervention and evaluation model for outdoor therapy shows how key outdoor intervention elements may contribute to the rehabilitation process after burnout. However, our model needs to be further tested among a larger group of clients to empirically evaluate whether and how outdoor therapy can support rehabilitation.
职业倦怠是一个重大的社会问题，对员工的健康和工作表现产生不利影响，长期来看会给组织带来高昂的病假成本。传统的康复疗法在减轻职业倦怠和恢复工作过程方面效果欠佳。基于自然对健康的促进作用，带客户到户外接触自然越来越多地被用作传统疗法的补充方法，且其有效性的证据也在不断增加。然而，解释一般心理支持与户外特定元素的结合如何在户外治疗中触发康复过程的理论往往缺失，这阻碍了对其进行系统研究。
本研究旨在开发一种户外治疗的干预和评估模型，以理解并实证评估这种户外干预对职业倦怠后的康复是否有效以及如何起作用。
我们以荷兰户外临床心理学家开发的职业倦怠后户外康复干预的典型案例为基础。我们将通用的背景、过程和结果评估模型与职业倦怠恢复模型相结合，作为一个总体的演绎框架。然后，我们基于以下定性数据归纳确定户外治疗的干预和评估模型：对户外临床心理学家和 former clients 的半结构化访谈；干预方案的内容分析；以及与干预开发者和健康促进专家的反思会议。
我们确定了六个关键的户外干预元素：（1）体育活动；（2）身心重新连接；（3）自然隐喻；（4）建立关系；（5）观察自然互动；（6）体验式学习。结果进一步表明，这些元素的实施可能有助于职业倦怠后的康复过程，在此过程中会出现近端、中间和远端结果。最后，结果表明这种实施过程取决于治疗师的背景（例如，每天的客户数量）、治疗（例如，隐私问题）以及客户的背景（例如，对自然的亲近感）。
户外治疗的干预和评估模型展示了关键的户外干预元素如何有助于职业倦怠后的康复过程。然而，我们的模型需要在更大规模的客户群体中进一步测试，以实证评估户外治疗是否以及如何能够支持康复。
