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Family Practice Vol. 21, No. 5 © Oxford University Press 2004, all rights reserved. Doi: 10.1093/fampra/cmh511, available online at www.fampra.oupjournals.org

Printed in Great Britain

Physician you can heal yourself! Cognitive behavioural training reduces stress in GPs
Maria Gardinera, Greg Lovellb and Paul Williamsona
Gardiner M, Lovell G and Williamson P. Physician you can healyourself! Cognitive behavioural training reduces stress in GPs. Family Practice 2004; 21: 545–551. Background. High stress and low morale is a well accepted and studied phenomenon in general practice. Objective. This study aimed to determine the benefits and mechanisms of stress management training in improving the psychological well-being and morale of GPs. Methods. There were 85 GPs in the treatmentgroup and 25 GPs in the control group, all from the Adelaide metropolitan region. The treatment group GPs were surveyed by questionnaire before and after a 15 h cognitive behavioural stress management training programme. Results and Conclusion. The study found that following this training programme, GPs’ quality of work life and morale improved while their work-related distress and generalpsychological distress decreased. These gains were maintained or further improved at 12 week follow-up. Furthermore, results suggested that the most robust long-term benefits came from developing a problem-focused style to cope with life and work events. Keywords. Cognitive behavioural training, physicians, quality of life, stress, work.

Introduction
The nature and severity of stress in general practicehave been well studied and are now an accepted, albeit highly undesirable, part of practising medicine.1–4 As a result, GPs report stress-related illnesses such as depression, anxiety2,3,5 and burnout.6 It is also often reported, both anecdotally and empirically, that GPs have low workrelated morale and are dissatisfied with their jobs (e.g. Schattner and Coman3 and Bailie et al.7). In Australia,a recent government-funded report notes that low morale among GPs is a “major barrier to the practice of high quality general practice”.8 Since it seems likely that GP stress also has implications for patient care, it is essential that evidence-based interventions become available. Although there are many stress management programmes on offer, there has been little evaluation of any kind of theireffectiveness, particularly for GPs (however, see Reynolds et al.,9 Sims10 and Winefield et al.11). Also, no study to date has attempted to uncover

the mechanism by which stress management programmes may improve the psychological well-being of GPs. To address this gap in the literature and to help guide future interventions, we tested the effect of cognitive behavioural training on copingstyles, and in turn the effect this had on GP stress outcomes: work-related distress, work-related morale, quality of work life and, ultimately, general psychological distress. Findings suggest that when individuals attempt to manage stressful work experiences using their emotional responses (emotion-focused coping), work-related distress increases. However, when individuals attempt to managestressors by dealing with the problem (problemfocused coping), work-related morale improves.12–14 In summary, the current study is the first to adopt a quasi-experimental methodology to determine the benefits and mechanisms of stress management training in improving the psychological well-being and morale of GPs.

Methods
Received 20 June 2003; Revised 16 February 2004; Accepted 17 May 2004. aSchool ofPsychology, Flinders University of South Australia, Bedford Park, South Australia 5042 and bAdelaide Central & Eastern Division of General Practice, 226 Fullarton Road, Eastwood South Australia 5063, Australia; E-mail: maria. gardiner@flinders.edu.au

Participants Participants in the treatment group were GPs from the Adelaide (South Australia) metropolitan area who elected to attend a 5 week...