Elsevier

Teaching and Teacher Education

Volume 54, February 2016, Pages 98-106
Teaching and Teacher Education

Associations between the awakening responses of salivary α-amylase and cortisol with self-report indicators of health and wellbeing among educators

https://doi.org/10.1016/j.tate.2015.11.012Get rights and content

Highlights

  • Reports of depersonalization and ambition were associated with less steep awakening responses in cortisol.

  • Ambition and perceived stress were associated with a less steep sAA awakening response.

  • Increased emotional suppression as associated with more total cortisol output.

Abstract

Chronic job stress makes teachers susceptible to burnout and negative health outcomes. Identifying factors that contribute to burnout is critical for teachers' health and their students' learning. This cross-sectional study examined the daily cycle of stress-related biomarkers (alpha amylase and cortisol) and self-reports of stress, burnout and psychological wellbeing in 64 middle school teachers. Reports of depersonalization and ambition were associated with less steep awakening responses in cortisol whereas ambition and perceived stress were associated with a less steep alpha amylase awakening response. Findings indicate that examining multiple dimensions of burnout is useful in understanding teacher wellbeing.

Introduction

Teachers report some of the highest levels of occupational stress among the helping professions (Johnson, Cooper, Cartwright, Donald, & et al., 2005). In the first 5 years of teaching, nearly 50% of teachers leave the profession (Ingersoll, 2001, National Commission on Teaching and America’s Future, 1996). Work-related stress and heavy workloads are the most commonly reported reasons for leaving teaching (MetLife, 2013, Smithers and Robinson, 2003). Teachers' occupational stress results from a variety of job demands including maintaining discipline, teaching students who lack motivation (Hargreaves, 2000, Sutton and Wheatley, 2003), and the pressure of evaluations based on standardized testing (Darling-Hammond & Sykes, 2003). Teachers who report high levels of chronic stress have higher rates of absenteeism (Darr & Johns, 2008) and report more depressive symptoms, and reductions in self-esteem, job satisfaction and motivation to teach (Schonfeld, 2001).

Jennings and Greenberg (2009) describe the deleterious effects of stress on teachers, which they refer to as the “burnout cascade” (p. 492). When teachers are unable to effectively manage the social and emotional challenges within the classroom context, students are more likely to demonstrate lower levels of on-task behavior and performance (Marzano, Marzano, & Pickering, 2003).

Burnout is a psychological construct characterized by exhaustion and diminished interest in one's career resulting from excessive occupational stress (Maslach, Schaufeli, & Leiter, 2001). Maslach and colleagues' identified three dimensions of burnout; emotional exhaustion, depersonalization, and low personal achievement. Of the three dimensions, exhaustion is the most widely reported (Maslach et al., 2001). However, Maslach et al. (2001) argue that simply focusing on exhaustion loses sight of the full phenomenon of burnout. While emotional exhaustion reflects the stress dimension of burnout, it does not assess the nature of relationships at work including those with students and colleagues, which are particularly important to consider for those in helping professions like teaching. Thus, the depersonalization subscale of the Maslach Burnout Inventory (MBI) is important to examine when assessing the impacts of chronic occupational stress in teachers because of the impact of student-teacher relationships on student learning (Pianta, La Paro, Payne, Cox, & Bradley, 2002). When one shows high depersonalization, one attempts to put distance between oneself and those they serve by actively ignoring them (Maslach et al., 2001), behavior that if a teacher fell into could be detrimental to students' experience in school.

In attempting to manage disruptive student behavior, teachers may become emotionally exhausted and resort to reactive and excessively punitive responses that do not support the development of students' self-regulation and may promote a self-sustaining cycle of classroom disruption (Osher et al., 2007). Exhausted teachers may begin to depersonalize the students, which could manifest as displaying indifferent and cynical attitudes towards their students, which may negatively impact learning, classroom climate and student-teacher relationships. When teachers no longer believe they can make a valuable contribution to their students, they may begin to feel a lack of personal accomplishment.

Understanding teachers' stress and the dimensions of burnout they experience may inform ways to protect their long-term physical and psychological health, reduce attrition, and promote student learning. Classroom environments are primarily shaped by teachers, and their warmth and sensitivity contribute to a positive classroom climate and healthy relationships and that promote learning and academic performance (Eccles and Roeser, 1999, Pianta et al., 2002). However, ambitious educators who show more commitment to their work also report higher levels of burnout (Klusmann et al., 2008, Maslach et al., 2001).

Teaching is an emotional profession and, therefore, teachers need to be equipped with strategies to cope with its demands (Jennings & Greenberg, 2009). Emotion regulation consists of cognitive and affective processes involved in monitoring, evaluating and modifying emotional reactions to experiences (Eisenberg & Spinrad, 2004). Emotion regulation is a form of coping and strategies can be response-focused and antecedent-focused (Gross & John, 2003). Cognitive reappraisal (or cognitive restructuring) is an adaptive antecedent-focused behavior that involves decreasing the emotional impact of a situation by changing how one thinks about it. Expressive suppression, inhibiting emotion-expressive behavior, is an example of a maladaptive, response-focused, regulatory behavior because it does not reduce the experience of a negative emotion and, thus, it will linger and accumulate unresolved. It also requires ongoing effortful management of these negative emotions, which can tax cognitive resources (Gross & John, 2003). Understanding more about emotion regulation behaviors that teachers use to manage the demands of their job could give us more insight into how to support their wellbeing.

Although self-report measures are most commonly used to assess perceived stress, burnout, and wellbeing, biomarkers of stress may contribute to our understanding of this process. Physiological measurement of teacher's wellbeing in addition to their self-reports may provide insight into their responsiveness to interventions designed to reduce stress and promote wellbeing. Biomarkers are indicators of underlying normative or disease-causing physiological processes (Baum & Grunberg, 1997). Measuring biomarkers has the potential to provide additional insight into the underlying biological mechanisms associated with self-reported stress and burnout as well as the positive behavioral change resulting from interventions designed to reduce stress and promote wellbeing (Greenberg, Katz, & Klein, 2015).

The assessment of stress biomarkers has gained popularity in research on burnout and wellbeing, in part, because they can be measured non-invasively and they provide information about how our bodies respond to stress. Self-report measures and biomarkers of health/stress are often not highly correlated (e.g. Brant et al., 2010, Karlson et al., 2011, Leininger and Skeel, 2012). In fact, this lack of concordance is noteworthy, given that previous studies of teacher stress and burnout have relied primarily on self-report. Understanding where these measures diverge or overlap could help researchers determine how physiological measures should be incorporated into studies that aim to reduce stress and promote wellbeing.

Stress triggers a cascade of coordinated biobehavioral responses beginning in the central nervous system (Cannon, 1932). When stress is perceived, the autonomic nervous system (ANS), a division of the peripheral nervous system, stimulates the sympathetic adrenal medullary (SAM) axis and the hypothalamic pituitary adrenal (HPA) axis in response to stress. Salivary alpha-amylase (sAA) is a purported biomarker of the SAM and exhibits diurnal patterns with low levels at waking, a sharp decrease after waking and high levels at the end of the day (Nater & Rohleder, 2009). HPA activation results in the release of cortisol from the adrenal cortex. Salivary cortisol is a primary biomarker for psychological stress and a reliable indicator of emotional wellbeing (Chida and Steptoe, 2009, Gunnar and Adam, 2012, Hellhammer et al., 2009). It has a diurnal pattern, with lowest levels occurring during the first hours of sleep, followed by an increase in the early morning hours and a rapid increase after waking, peaking about 30 min later and a slow decline over the day. This sharp increase after waking is the cortisol awaking response (CAR) and is considered an intermediary link between psychological and physiological wellbeing (Clow, Thorn, Evans, & Hucklebridge, 2004). SAA's diurnal pattern is reciprocal to that of cortisol(Nater, Rohleder, Schlotz, Ehlert, & Kirschbaum, 2007). Chronic stress may impair the functioning of one system or the interplay between the two (Bauer, Quas, & Boyce, 2002).

It is important to note that biomarkers of stress are not objective measures of stress. The physiological response to stress involves many systems of the body, varies greatly by individual and, therefore, cannot be simplified into one quantitative value. That being said, the associations between cortisol and chronic stress are well documented. Stressors that are uncontrollable elicit a high, flat diurnal profile of cortisol secretion over the course of a day (Gunnar and Quevedo, 2007, Miller et al., 2007). Consistent exposure to stress can negatively impact long-term health including immune, cardiovascular, metabolic and neurological functions (McEwen, 1998). A blunted cortisol awakening response (CAR) is commonly associated with chronic stress (Fries, Dettenborn, & Kirschbaum, 2009) and has been shown to be positively associated with work stress (Kunz-Ebrecht, Kirschbaum, & Steptoe, 2004).

The specific relationship between measures of occupational burnout and cortisol is unclear. Some studies report a relationship between self-reported burnout and salivary cortisol levels. For example, the cortisol awakening response is found to be positively associated with job stress and negatively associated with burnout, whereas total cortisol output (area under the curve) is positively associated with general life stress (Chida & Steptoe, 2009). In a study of nurses, those who reported high levels of burnout (as measured by the MBI) also had elevated diurnal salivary cortisol output (Wingenfeld, Schulz, Damkroeger, Rose, & Driessen, 2009). Grossi et al., (2005) found that in their sample of 64 working adults, those reporting high burnout (as measured by the Shirom-Melamed Burnout Questionnaire, Melamed et al., 1999) had higher cortisol concentrations at waking and 30 min later as well as greater area under the curve for salivary cortisol. However in a meta-analysis examining possible biomarkers of burnout in 31 studies, no differences were found in the cortisol awakening response between patients reporting differing levels of burnout (Danhof-Pont, Van Veen, & Zitman, 2011). Additionally, there is no consensus on which biomarkers are most consistently associated with the subscales of MBI (Danhof-Pont et al., 2011, Maslach et al., 1997).

The field has only begun to explore to what extent the sAA diurnal profile may be influenced by stress, mood, stable characteristics and contextual factors (Granger, Kivlighan, El-Sheikh, Gordis, & Stroud, 2007; Out, Granger, Sephton, & Segerstrom, 2013). However, a growing number of studies report change in diurnal profiles or alteration in the awakening response of adults (Rohleder, Marin, Ma, & Miller, 2009; Thoma, Joksimovic, Kirschbaum, Wolf, & Rohleder, 2012). Studies have shown that the daily secretion pattern of sAA is altered in individuals reporting chronic stress (Nater et al., 2007), in young women experiencing chronic shame (Rohleder, Chen, Wolf, & Miller, 2008), in children with asthma experience chronic home life stress (Wolf, Nicholls, & Chen, 2008), Bosnian War refugees with PTSD (Thoma et al., 2012) and in caregivers for cancer patients (Rohleder et al., 2009). SAM activation increases as stressors become chronic and prolonged activation can result in tissue damage (Nater et al., 2007, Piazza et al., 2010). However, not all studies reporting sAA are consistent and it is still a relatively new biomarker in psychological research (Nater et al., 2005). For instance, a study of nurses found no association between sAA with work-related stress or burnout (Wingenfeld et al., 2010).

The allostatic load (AL) model suggests that greater cumulative stress burden can influence stress-responsive physiology and lead to a variety of health issues (McEwen, 1998). The AL index is a summary measure of ten biomarkers (including cortisol) that attempts to capture the cumulative physiological demands put on the body through attempts to adapt to environmental challenge (Seeman, McEwen, Rowe, & Singer, 2001). AL measures are considered to reflect the wear-and-tear on the body and brain resulting from chronic stress. Increased AL has been linked to tertiary outcomes such as cardiovascular disease, depression, and cognitive impairments in adulthood (Juster et al., 2011, McEwen, 1998). High blood pressure and cardiovascular disease are common symptoms associated with chronic stress (Dimsdale, 2008; McEwen, 2008; Melamed, Shirom, Toker, Berliner, & Shapira, 2006). The AL model may be a biological pathway explaining how chronic work stress can lead to negative long term health outcomes (McEwen & Stellar, 1993). Chronic work stress and burnout has been associated with AL in female teachers (Bellingrath, Weigl, & Kudielka, 2009).

Although research has demonstrated that teachers experience high levels of occupational stress and burnout, few studies have assessed both psychological and physiological measures. Those that have found mixed results. Pruessner, Hellhammer, and Kirschbaum (1999) found that in Germany high levels of teacher burnout were associated with blunted cortisol levels after waking but perceived stress scores were not related to cortisol responses. However, two other studies of teachers in Germany and Spain, found no association between CAR and burnout (Bellingrath et al., 2008, Moya-Albiol and Serrano, 2010). No studies have investigated the relationship between SAM (sAA) and burnout and perceived stress among teachers. These inconsistent conclusions from previous studies as well as the paucity of data on psychophysiological correlates of burnout in teachers in the U.S., provide the rationale for this study.

The goal of the present study is to examine whether educators' perceived stress, emotion regulation strategies and burnout are related to biomarkers commonly associated with physiological experience of stress (i.e., the awakening responses of cortisol and sAA). Our first hypothesis is that teachers show typical diurnal curves for sAA and cortisol, and that higher levels of perceived stress and burnout will predict dysregulated awakening responses for both sAA and cortisol. Our second hypothesis is that teacher's use of reappraisal as an emotion regulation strategy will be associated with lower cortisol output whereas higher levels of suppression will be associated with higher cortisol output over the course of a day.

Section snippets

Participants

Sixty-four teachers from two middle schools in central Pennsylvania, U.SA., volunteered for a longitudinal study of teacher health and wellbeing. In this study, teachers are inclusive of all adults who interact directly with students during the school day, including learning support teachers and school counselors, who provide one-on-one support to students in need. The schools are relatively advantaged, characterized by mostly middle class families, high levels of achievement, and relatively

Results

One of the 64 participants did not collect their saliva. Of the 63 participants who returned saliva samples, 1 was missing the appropriate data to calculate a cortisol awakening response and 2 were missing data needed to determine area under the curve. Four participants did not have sufficient data to calculate the sAA awakening response nor the sAA AUC because of insufficient saliva at waking. All of the missing biomarker data were from female participants. The resulting sample size for

Discussion

The present study examined the daily profiles of cortisol and sAA as well as their relation to self-reported measures of perceived stress and burnout in a sample of educators. Our first hypothesis was partially supported by the data. The mean diurnal rhythm of cortisol and sAA for this sample of teachers followed a typical curve, asymmetric to one another and both with clear awakening responses. Also, higher levels of perceived stress were associated with decreased sAA AR as predicted but there

Conclusion

Overall, this study demonstrates that physiological measures provide information beyond self-report about teacher health and wellbeing. A unique aspect of this study was the measurement of both diurnal sAA and cortisol as well as self-reports of stress and burnout. Our results encourage a multisystem approach to studying teacher stress and burnout to provide a more comprehensive understanding of these complex constructs. This study highlights the need for more research directed towards

Author disclosure

The authors have no competing financial interests to disclose.

Acknowledgments

This work was supported by grants from the 1440 Foundation and the Penn State Children, Youth, and Families Consortium. Deirdre A. Katz was supported by grant R305B090007 from the Institute of Education Sciences. We appreciate the assistance of Sarah Gildea with data collection, salivary assays and data cleaning; Dr. Courtney Whetzel for assaying advice and Alexis Harris and Rachel Abenavoli for their dedication to the project.

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