Received: 4 February 2019 | Revised: 10 June 2019 | Accepted: 18 June 2019

DOI: 10.1002/pits.22279

RESEARCH ARTICLE

Teacher stress interventions: A systematic

review

Nathaniel von der Embse1 | Shannon V. Ryan2 | Tera Gibbs2 |

Ariel Mankin2

1
College of Education, University of South
Florida, Tampa, Florida
2
College of Education, Temple University,
Philadelphia, Pennsylvania
Correspondence
Nathaniel von der Embse, PhD, College of
Education, University of South Florida, 4202
E. Fowler Avenue, Tampa, FL 33620.
Email: natev@usf.edu.
Abstract
Due to the increased pressure from test‐based account-
ability 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 ap-
proaches. Results indicated that the most effective inter-
ventions were in the mindfulness, behavioral, and cognitive‐
behavioral domains. Interventions which delivered solely
informational content were among the least effective.

KEYWORDS
behavioral, cognitive‐behavioral, mindfulness, stress, student
behavior, teachers

Teaching is a highly stressful profession (von der Embse, Pendergast, Segool, Saeki, & Ryan, 2016; Kyriacou, 2001).
Teacher stress has been as a contextual specific type of occupational stress (Kyriacou & Sutcliffe, 1977).
Occupational stress refers to an individual's experience of psychological discomfort and associated disorders that
result from general working conditions (Warr & Wall, 1975), 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, 2016).

Psychol Schs. 2019;1–16. wileyonlinelibrary.com/journal/pits © 2019 Wiley Periodicals, Inc. | 1

2 | VON DER EMBSE ET AL.

These decisions include the adoption of a common and standardized curriculum in many states (Common Core
State Standards Initiative, 2010), 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 (2002) (Linn, Baker, &
Betebenner, 2002), 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, 2017). In a recent study, nearly 30% of teachers reported clinically impaired
levels of stress (von der Embse, Kilgus, Bowler, Solomon, & Curtiss, 2015).
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, 2012; von der Embse et al., 2016; von der Embse, Sandalos, Pendergast, & Mankin, 2016; Putwain
& Roberts, 2009). 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, 2009). 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., 2008; Hastings & Bham, 2003).
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.
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, 2012). 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, 2010). More recently, initial evidence has emerged that has evaluated mindfulness
practices across a number of problem behavior domains (Klingbeil et al., 2017). 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.

1 | CO NS E Q UEN CE S O F T E A CH E R S T RE SS

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, 1996). Burnout has been linked to deleterious consequences for teachers across numerous
studies, including absenteeism and even attrition from the profession (Betoret, 2006; Darling‐Hammond, 2000;
Sass, Seal, & Martin, 2011). 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., 2017). Teacher turnover leads
to a loss of financial and occupational resources for school administrators (Darling‐Hammond, 2010). 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, 2001). This leads to poor
student test score performance and impaired student‐teacher relationships over time.
VON DER EMBSE ET AL. | 3

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, 2003; Hastings & Brown, 2002) and to report lower levels of self‐efficacy (Lamude, Scudder, & Furno‐
Lamude, 1992). Teachers with high levels of stress use more reactive and punitive (von der Embse et al., 2017).
Moreover, high levels of stress may lead to seeking less input from others in making decisions for student behavior
(Collie et al., 2012). In addition, teacher stress leads to lower accuracy in ratings of student mental health
(Kokkinos, Panayiotou & Davazoglou, 2005; McLean, Eklund, Kilgus, & Burns, 2019).
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, 2008) 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 (2009) 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., 2011). 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, 2001).

2 | TEAC HER S TRESS I NTE RV ENTION S

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, 1980). 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, 2008). In recent years, interventions which integrate behavioral approaches and cognitive approaches
have become popular (Jeffcoat & Hayes, 2012). These cognitive‐behavioral approaches integrate stress appraisal
with physiological stress reduction (Beck, 1979). 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, 1995), and stress has long
been linked with impaired teacher‐student relationships (Yoon, 2002).
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,
1989). 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.

3 | K NO WL E D G E‐BA SE D I NTERVE NTIONS

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 &
4 | VON DER EMBSE ET AL.

Olsen, 1998), and psychosocial education on stress risk (Cicotto, De Simone, Giustiniano, & Pinna, 2014; Wu, Li,
Wang, Wang, & Li, 2006). 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,
2009). 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, 2010).

4 | BEHAVIORAL INTERVENTIONS

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, 1999; Kaspereen, 2012), the practice of journaling exercises to record gratitude (Chan,
2011), and participation in dyadic consultation on student behavioral problems (Ray, 2007). 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., 2009; Joyce & Showers, 2002).

5 | COGNITIVE‐B E H A V I O R A L I N T E R V E N T I O N S

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, 2004;
Vujanovic et al., 2017). Interventions of this type include ACT (Jeffcoat & Hayes, 2012), and the use of a cognitive‐
behavioral stress management curriculum (Shimazu, Okada, Sakamoto, & Miura, 2003; Zolnierczyk‐Zreda, 2005;
Leung, Chiang, Mak, & Wong, 2011). Cognitive‐behavioral stress interventions are feasible for workplace wellness
programs, and they promote general health and well‐being for employees (Riley et al., 2017). 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., 2017). 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.

6 | M IN D F UL NE S S ‐BA SE D I NTERVE NTIONS

Another “third‐wave” therapeutic approach to stress intervention is mindfulness (Riley et al., 2017). Mindfulness
takes cognitive and behavioral strategies and focuses on the process of feeling and thinking rather than on thought
content (Riley et al., 2017). Awareness and acceptance without judgment are key components of mindfulness
strategies (Kabat‐Zinn et al., 1992). 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., 2017). Mindfulness
interventions have seen an uptick in the literature in the past dozen years (e.g., Ancona & Mendelson, 2014; Beshai,
McAlpine, Weare, & Kuyken, 2015; Jennings, Frank, Snowberg, Coccia, & Greenberg, 2013; Roeser et al., 2013) and
have been deemed practicable and effective long term (Bowen et al., 2014). Because mindfulness targets symptoms
VON DER EMBSE ET AL. | 5

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, 2013).

7 | B E H AVI O R I N TE RV E N TI O N S F O R S T U D EN T S

A predominant source of teacher stress arises from student behavior and impaired student relationships (Friedman,
1995; Yoon, 2002). 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.

8 | THE PRESENT STUDY

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., 2017) as well as students (e.g., lowered teacher accuracy in detecting student behavioral health problems,
lower school climate; Collie et al., 2012; Grayson & Alvarez, 2008). 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:

1) What types of stress interventions for teachers have been published within the research literature?
2) What types of assessments are used to evaluate intervention outcomes?
3) Which interventions have been effective in reducing teacher stress?

9 | METHOD

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
6 | VON DER EMBSE ET AL.

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.
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, 1998). One study was eliminated for failing to include an intervention
(Guthrie, Ciccarelli, & Babic, 2010) 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, 2013), 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.
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., 2004).
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.
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, 1988). 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 (d < 0.20),
medium (d = 0.5), and large (d > 0.8).
The between‐group effect size was calculated using the following formula:

X¯T 2 − X¯T1 (NT 2 − 1) SDT22 + (NT1 − 1) SDT21

dtreatment − control = sp = .
Sp (NT 2 − 1) + NT1 − 1
VON DER EMBSE ET AL. | 7

When regression was used, the effect size was calculated using the following formula:

Bunstandardized
dtreatment − control =
Sp

The pretest to posttreatment ES was calculated using the following formula:

X¯T 2 − X¯T1 2 2
(S T 1 + S T 2 ) .
dpre − post = Sp =
Sp 2

When analysis of variance was used, the between‐group effect size was calculated using the following formula:

F
dtreatment − control = 2
N

10 | RES U LTS

10.1 | Treatment techniques

See Table 1 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. (2006), 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.
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, 1996), the Perceived Stress Scale (Cohen, Kamarck, & Mermelstein, 1983), the Index of Teacher Stress (ITS;
Greene, Abidin, & Kmetz, 1997), Teacher Stress Inventory (TSI; Fimian, 1988), the Depression Anxiety Stress Scales
(DASS; Henry & Crawford, 2005), the Occupational Stress Inventory‐Revised (OSI‐R; Osipow, 1998), the Warwick‐
Edinburgh Mental Wellbeing Scale (Stewart‐Brown et al., 2011). 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.

10.2 | Treatment types and outcomes

Four main categories of stress interventions were identified in the literature: KBI, CBI, BI, and MBI studies.

10.2.1 | Knowledge‐based studies

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,
 8
|
T A B L E 1 Summary of included teacher stress intervention studies with effect sizes

Author (year) Sample size Design Intervention type Duration Treatment measure Effect size
Anacona and Mendelson 43 Experimental MBI Two sessions per week for 3 TSI, MBI‐ES 0.42–0.54
(2014) weeks
Anderson et al. (1999) 91 Experimental Behavioral One session per week for 5 TSI, STAIA, MBI 0.90
weeks
Beshai et al. (2015) 89 Quasi‐Experimental MBI Nine 75‐min sessions PSS, FFMQ, SCS 1.21
Barbaresi and Olsen 44 Experimental KBI 2.5 hr program ITS 0.84
(1998)
Chan (2011) 63 Quasi‐experimental Behavioral Daily log, 8 weeks GQ‐6, OHS 0.66
Cheek, Bradley, and Parr 51 Experimental CBI One session per week MBI‐ES 0.63
(2003) for 6 weeks
Cicotto et al. (2014) 92 Quasi‐experimental KBI Four 3‐hr training modules MBI 0.50
Flook et al. (2013) 18 Experimental MBI 7 weeks FFMQ, MBI 0.25
Franco , Mañas, Cangas, 68 Quasi‐experimental MBI One session per week for 10 SCL90‐R 0.88–1.73
Moreno, weeks
and Gallego (2010)
Frank et al. (2013) 36 Quasi‐experimental MBI One session per week for 8 BSI, SCS, FFMQ, 0.18–0.33
weeks MBI‐ES
Gold et al. (2010) 11 Quasi‐experimental MBI One session per week for 8 FG, KIMS, DASS 1.18
weeks
64 Experimental MBI, CBI Four sessions per week, 16 FFMQ, MBI, DTS, 0.52–0.80
weeks PANAS
Jeffcoat and Hayes (2012) 236 Experimental CBI 8 weeks GHQ, KIMS 0.56–0.98
Jennings et al. (2013) 50 Experimental MBI One session per week for 4 PANAS, ERQ, 0.004
weeks MBI
Johnson & Naidoo (2017) 43 Quasi‐experimental CBI One session per week PSS, CBI 0.54–0.66
for 15 weeks
Kaspereen (2012) 54 Experimental Behavioral One session per week for 4 PSS, SWLS 1.06
weeks
VON DER EMBSE

(Continues)
ET AL.
TABLE 1 (Continued)

Author (year) Sample size Design Intervention type Duration Treatment measure Effect size
Lhospital and Gregory 33 Quasi‐experimental Behavioral Not specified ITS 0.28
VON DER EMBSE

(2009)
Lueng, Chiang, Chui, Mak, 124 Quasi‐experimental CBI 3 Weeks OSI‐R, DASS 0.03–0.63
ET AL.

and Wong (2011)

Pülschen & Pülschen 68 Quasi‐experimental CBI One session per day for 12 days Subjective tension 0.63
(2015)
Ray (2007) 59 Experimental Behavioral 10 Weeks ITS 0.70–0.94
Roeser et al. (2013) 113 Experimental MBI 11 Sessions over 8 weeks FFMQ 0.62–0.79
Shimazu et al. (2003) 24 Experimental CBI Five sessions over 8 weeks BJSQ, JSS 0.06
Wu et al. (2006) 961 Experimental KBI 24 Sessions over 1 year OSI‐R, WAI 0.04–0.13
Zolnierczyk‐Zreda (2005) 58 Quasi‐experimental CBI Two 6‐hr sessions MBI 2.66
Note: Treatment measures per study are not all inclusive.
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.
|
9
10 | VON DER EMBSE ET AL.

exercise, and relaxation but did not involve a component of behavioral practice. In one study, Wu et al. (2006)
offered lectures on stress management biweekly or once monthly. The effect size on the Occupational Stress
Inventory was small (d = 0.11) or psychological strain (d = 0.04). However, in a similar study from Cicotto et al.
(2014), 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 (d = 0.50) from pretest. While the program was informational in type, participants also received
information on behavioral skills (e.g., effective communication skills).
Finally, in a study by Barbaresi and Olsen (1998), 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 (d = 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.

10.2.2 | Behavioral studies

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 (2008) 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, 2009) to involvement in teacher consultation dyads (Kaspereen, 2012) to involvement in relaxation
training (Kaspereen, 2012) or journaling (Chan, 2011). 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 (2009) 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 d = 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.
Ray (2007) examined how teacher participation in consultation or child participation in play therapy reduced
teacher stress on the ITS (Greene et al., 1997) 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
(d = 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, 1998)
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 (2012),
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 (d = 1.06) for stress reduction from pre‐ to posttest. Similarly, Anderson et al. (1999) 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 (d = 0.90) between experimental and treatment groups at posttest. This appears to
support the principle of meditation and behavioral practice for stress reduction.
VON DER EMBSE ET AL. | 11

10.2.3 | Cognitive‐behavioral studies

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, 2005) to 15 weeks (Johnson & Naidoo, 2017). 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).
Cognitive‐behavioral approaches identified within this review were also combined with related treatment
modalities. For example, Cheek et al. (2003) 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 (2012) 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 (d = 0.48–0.98) between conditions and time‐points.
Traditional CBT workshops held over a short‐term basis, such as 3 days of sessions, were less effective in stress
reduction. Leung et al. (2011) 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 (d = 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 (d = 0.63).

10.2.4 | Mindfulness‐based studies

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., 2013),
Mindfulness Training (Roeser et al., 2013), Holistic Life Foundation Yoga (Ancona & Mendelson, 2014), MBSR
(Frank, Reibel, Broderick, Cantrell, & Metz, 2013; Gold et al., 2010), Flow Meditation (Franco et al., 2010), and the
“Foundations Course” adapted for Mindfulness in Schools (Beshai et al., 2015). MBSR (Kabat‐Zinn, 1990) is used to
target attention and emotional processing at symptoms of stress. Three studies were grounded in an MBSR‐based
approach (Flook et al., 2013; Frank et al., 2013; Gold et al., 2010). On the MBI Emotional Exhaustion scale, Frank
et al. (2013) reported a small to moderate effect size from pretreatment to posttreatment. The treatment included
mindfulness‐based meditation for 8 weeks. Gold et al. (2010) 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.
Several other mindfulness‐based approaches, including the Holistic Life Yoga program (Ancona & Mendelson,
2014), Flow Meditation (Franco et al., 2010), and the CARE program (Jennings et al., 2013), 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. (2010) 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 (d < .01) and there
were no substantial differences reported between intervention and control groups.
12 | VON DER EMBSE ET AL.

11 | DI S C U S S IO N

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.
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 (2009), 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.
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., 2006). Duration of treatment may
influence the magnitude of the treatment gains, apart from the type of treatment administered.
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., 2013). 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., 2017). 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.

11.1 | Implications and future research

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, 2017). 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.
VON DER EMBSE ET AL. | 13

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., 2017). 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, 2015). 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 and maintain the
intervention when considering which type of treatment to select.
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, 2015) or
a sequential, multiple assignment, randomized trial (Lei, Nahum‐Shani, Lynch, Oslin, & Murphy, 2012) 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, 2015), these results may more clearly present the
most effective teacher stress treatment with the least amount of required resources. For schools seeking to
support student academic and emotional outcomes, providing effective and evidence‐based treatments for teacher
stress reduction may be an important component of a comprehensive strategy.

OR CID

Nathaniel von der Embse http://orcid.org/0000-0003-2545-7691

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How to cite this article: von der Embse N, Ryan SV, Gibbs T, Mankin A. Teacher stress interventions: A
systematic review. Psychol. Schs. 2019;1–16. https://doi.org/10.1002/pits.22279