1

Perceptions of burnout in medical dosimetry within a post-pandemic work environment

Todd J Baumgartner, BS, RT(T); Keegan Sanborn, BS, RT(T); Milen Reta, BS, RT(T);
Nishele Lenards, PhD, CMD, RT(R)(T), FAAMD; Ashley Hunzeker, MS, CMD;
Sabrina Zeiler, MS, CMD, RT(T)
Medical Dosimetry Program at University of Wisconsin, La Crosse, WI, USA
Abstract
According to the World Health Organization, burnout is described as having a negative
attitude regarding one’s work and being exhausted. Previous studies have shown that
occupational burnout exists amongst medical dosimetrists, however, the incidence of medical
dosimetrist burnout before and after a pandemic warrant continued research. Medical
dosimetrists could be experiencing increased burnout in the workplace post-pandemic due to
staffing shortages and increased remote planning, which may reduce work performance. The
researchers utilized a survey to answer research questions regarding whether staffing shortages
or remote planning influenced perceived occupational burnout among medical dosimetrists in a
post COVID-19 pandemic environment. The survey was intended to assess levels of emotional
exhaustion (EE), depersonalization (DP) and personal accomplishment (PA). It was distributed
electronically to 2591 certified medical dosimetrists in the United States through the American
Association of Medical Dosimetrists (AAMD) membership database. A total of 160 responses
were recorded, resulting in a response rate of 6% (160/2591). The results of this study indicated
that increased staffing shortages have a direct relationship with increased burnout incidence.
Increased remote work appears to be inversely related to the incidence of burnout among medical
dosimetrists.
Keywords: Workplace burnout, medical dosimetrists, COVID-19 pandemic, remote work
Introduction
Workplace burnout is closely related to other stress and anxiety disorders and can affect a
person’s mental and physical state.1 According to the World Health Organization, burnout is
described as having a negative attitude regarding one’s work and being exhausted.2 There is
concern for medical dosimetrists succumbing to workplace burnout due to the demands of the
job, such as working on radiation treatment plans for terminally ill patients in a timely fashion.
Howard1 performed a study in 2012 that focused on the incidence rates of burnout and
compassion fatigue (CF) among medical dosimetrists. The methodology of the study was a
 2

survey developed from the Maslach Burnout Inventory (MBI) which assessed participants in
areas of emotional exhaustion (EE), depersonalization (DP), and decreased levels of personal
accomplishment (PA).1 Emotional exhaustion can be exhibited by someone who is drained of
emotional resources with insufficient time to recuperate. Depersonalization occurs when an
individual exhibits general cynicism, and decreased PA exists among those who believe their
efforts have become ineffective. Howard1 revealed that over 25% of subjects surveyed exhibited
EE, DP, or low PA.
The COVID-19 pandemic drastically changed the work environment by increasing
remote work capabilities. This change may have affected the mental health of employees through
the addition of various stressors that exist in the remote environment, such as family care or
technical challenges, which have been found to contribute to a negative work-from-home
experience.2 Aczel et al4 surveyed individuals regarding the benefits and challenges of remote
work during the pandemic and revealed that participants felt they could read and analyze data
more easily while working remote but had increased difficulty with collaborative tasks with
colleagues in this setting. Hayes et al3 assessed the incidence of burnout among individuals with
remote work access during the pandemic and discovered that there was a higher rate of burnout
among those who had remote access to work prior to the pandemic. Hoffman et al2 surveyed all
members of the radiation oncology team (n=572) to determine if there was a link between
working from home and occupational burnout amidst the COVID-19 pandemic. Of the
participants in the study, 42 were medical dosimetrists. While 100% of these participants
admitted to having at least some remote capabilities, 31% of medical dosimetry participants’
responses indicated burnout to some degree.2 The survey used by Hoffman et al2 facilitated the
discovery of correlations between burnout and factors such as the COVID-19 pandemic, control
over workload, job security, and experience with working from home. Although fewer burnout
symptoms were reported by those who worked from home, it could not be concluded that remote
work alone elicits a burnout-free work environment.2
There is a predicted imbalance in the number of medical dosimetrists per available job in
the near future. According to the American Association of Medical Dosimetrists (AAMD), the
supply of medical dosimetrists met the demand in 2020, but a staffing shortage is expected to
increase until 2035 due in part to large scale retirement of baby boomers from 2028-2030 and
growing cancer incidence.5 Furthermore, a new stipulation set forth in 2017 requires graduation
 3

from a Joint Review Committee for Education of Radiologic Technology (JRCERT) accredited
program to meet Medical Dosimetry Certification Board (MDCB) examination eligibility;
therefore, removing on the job training options for prospective students. This new restriction
coupled with limitations at clinical training sites during the pandemic could potentially decrease
the pool of medical dosimetry candidates entering the profession.5 Bhandari et al6 collected
Current Population Survey (CPS) data in 2019-2020, which suggested a drastic increase in
unemployment among technologists and medical dosimetrists. A multitude of layoffs and
furloughs occurred during the pandemic; specifically, CPS findings revealed a 10.5% increase in
unemployment for medical dosimetry in 2019-2020.6 Additional reports indicate the average
medical dosimetrist worked 6.4 hours less per week during the COVID-19 pandemic.5 This
statistic may be linked to the decline in non-COVID critical illness care during this period.6
Riegel et al7 reported a 25% decrease in external beam patients at their institution during the
COVID-19 crisis and suggest a possible connection to the clinic’s increased treatment planning
and plan checking efficiency they observed since physicists had greater availability to take on
these tasks. Moreover, healthcare providers were delaying non-urgent cancer care procedures,
and patients were less likely to contact their oncologist during this period.8,9
Burnout is more prevalent among oncology workers than in other medical careers, and it
has been linked to psychological distress and a desire to abandon the career. Elevated workload
and time-related pressure have been shown to induce burnout.10 This makes the field of medical
dosimetry a potentially high stress environment. Medical dosimetrists are expected to complete
many treatment plans, sometimes simultaneously, in a short timeframe, with little to no mental
decompression time. Furthermore, technology in the field is rapidly advancing, which can make
it difficult to maintain proficiency. For those reasons, the members of this profession make
exceptional candidates for an occupational burnout study. Hoffman et al2 and Hayes et al3
provided evidence of how occupational burnout exists among radiation oncology team members.
However, a lack of focus in medical dosimetry as well as changes during and after a pandemic
warrant continued research about medical dosimetrists. The problem is that medical dosimetrists
could be experiencing increased burnout in the workplace post-pandemic due to staffing
shortages and increased remote planning which may have a negative impact on work
performance. The purpose of the study was to evaluate perceptions of medical dosimetrists
specific to workplace burnout in a post-pandemic environment. Researchers intended to answer
 4

research questions: (Q1) what effect do staffing shortages have on perceived burnout among
medical dosimetrists and (Q2) what effect does remote planning appear to have on perceived
burnout among medical dosimetrists?
Methods and Materials
Population
The population that was selected for this study consisted of a sample of certified medical
dosimetrists (CMDs) within the United States that have full active membership with AAMD.
Medical dosimetrists that hold full membership have been board certified by the MDCB and
were selected through the AAMD membership database to receive the survey. Upon beginning
the survey, participants were asked their level of dosimetry work experience, and a minimum of
3 years of experience was required to proceed with the survey. This requirement was
implemented to ensure that participants would be able to answer questions pertaining to working
as a medical dosimetrist in a pre-COVID-19 pandemic work environment and a post-pandemic
work environment.
Instrumentation
To evaluate workplace burnout amongst medical dosimetrists in a post-pandemic
environment, a 14-question survey was created using Qualtrics XM. This survey was based on
the Maslach Burnout Inventory (MBI) and utilized the 3 areas of assessment outlined in the MBI
to determine the risk of burnout.11 These questions were categorized into 2 sections. The first set
of questions (Section 1) consisted of questions pertaining to staffing shortages and perceived
burnout in the workplace. The second set of questions (Section 2) pertained to the effects of
remote planning and perceived burnout.
The first question of the survey pertained to demographic information related to work
experience and was used to filter participants based on the selected population described. The
second question of Section 1 helped identify medical dosimetrists that had experienced staffing
shortages since the pandemic versus those who did not. Those that did not experience staffing
shortages were asked no further questions for that section. The remaining questions in Section 1
focused on the impact that staffing shortages may have had on workload, mood, and emotional
well-being, to assess levels of EE, DP, and PA of the medical dosimetrist. Section 2 questions
were based on remote work in the medical dosimetry profession. The first question in this section
was used to identify medical dosimetrists that had access to remote planning versus those that
 5

did not. Participants that identified as having access were then asked additional questions
pertaining to remote planning. The rationale behind these questions was to evaluate possible
correlations between remote planning and perceived burnout. This section identified whether
remote planning contributed to either an increase or decrease in levels of EE, DP, and PA of the
medical dosimetrist.
Study validation
A pilot study was conducted to verify the accuracy of the survey questions and study
format. A 13-question pilot survey was distributed to a total of 7 medical dosimetrists, and 7
responses were received. Based on the results of the pilot study, a demographics section with an
additional question was added to the survey to identify years of experience. Question 2 was
clarified to only include medical dosimetrists, and an additional question was added to assess
accessibility to remote planning following the pandemic. The final survey consisted of 14
questions and was prepared for distribution to the full study population.
Data Collection
The survey was distributed electronically to certified medical dosimetrists in the United
States in collaboration with the AAMD via the membership database. Participants were emailed
a description of the study with an attached link to complete the survey, which was created
through the Qualtrics XM website. Those who participated were able to access the survey while
remaining anonymous, and all participant information remained confidential. A statement of
implied consent was included in the introduction of the survey, explaining that participation in
the survey was completely voluntary and that consent was implied once the survey began. The
survey was distributed on September 26, 2022, and closed on October 10, 2022. Qualtrics
software recorded the results of the survey and provided information for data analysis. Questions
were recorded as showing either positive or negative signs of experiencing burnout. A response
of “agree” or “strongly agree” represented high risk for burnout for questions 3-7 and 14.
Alternatively, answers of “disagree” or “strongly disagree” represented high risk for burnout in
questions 10, 12, and 16. A response that indicated an increased level of job-related stress in
question 11 was recorded as being high risk for burnout.
Statistical Analysis
Quantitative analysis was used to evaluate data to measure EE, DP, and PA. The
Qualtrics survey tool was used to record answers and organize data. Survey results were
 6

analyzed separately in two sections; section 1 measured burnout due to staffing shortages, and
section 2 measured burnout due to remote planning. Burnout was then further categorized in
subscales DP, EE, and PA. Descriptive statistics were utilized to indicate the number and
percentage of respondents that exhibited burnout by each subscale. Researchers categorized
information based on risk level for burnout into either high-risk or low-risk categories. Likert
scaling was used for most of the survey questions, and answers ranged from strongly agree to
strongly disagree. For each section and subscale, a chi-square test was conducted to compare the
current survey results to those from the Howard1 study. This would indicate whether the
incidence of burnout increased or decreased since the study was performed in 2012. Researchers
also investigated whether the subscale responses differed based on the degree of remote
planning.
Institutional Review Board
Prior to performing this study, researchers completed the Institutional Review Board for
the Protection of Human Subjects (IRB) approval process which is essential to protect the rights
and welfare of study participants. An IRB protocol review form was completed by researchers
that detailed the purpose of the proposed research and provided the specifics of procedures and
activities that subjects would undergo. In this document, researchers described how informed
consent would be obtained by providing a statement in the introduction of the survey which
explained that participation was voluntary, and that participation implied voluntary informed
consent. Researchers also provided a description of procedures to ensure confidentiality.
Responses to the survey would remain anonymous, no identifiable information would be
required to participate, and data would be stored through the Qualtrics XM website. The IRB
review form and the survey were submitted for review. Researchers communicated with the IRB
as necessary to obtain approval. It was determined that the proposed research was exempt from
IRB full review, and approval was granted. Once approval was obtained, the survey was
distributed.
Results
A total of 2591 medical dosimetrists were emailed a survey which resulted in a response
rate of 6% (160/2591). Ten participants indicated they had < 3 years of experience as a medical
dosimetrist; therefore, were excluded from completing the remainder of the survey. Thus, 150
responses were used for data analysis.
 7

The first section of survey questions was used to answer research question (Q1) what
effect do staffing shortages have on perceived burnout among medical dosimetrists? Of the 150
participants, 57% (86/150) reported experiencing a medical dosimetrist staffing shortage since
the start of the COVID-19 pandemic. For those experiencing a staffing shortage, 72% (60/83)
indicated that they were forced to take on more work than they could handle for given deadlines.
Only 11% (9/83) disagreed with the notion that they were forced to take on more work than they
could handle. Nearly 87% (72/83) of respondents felt that a staffing shortage caused them to feel
mentally and emotionally exhausted at the end of the day. Additionally, 61% (51/83) felt that
they dreaded the idea of going back to work the following morning or after a weekend. Almost
89% (74/83) of participants believed that their mood and well-being would be positively
impacted with an increase in staffing at their center. Results demonstrated that 88% (76/86) were
experiencing DP, 84% (72/86) were experiencing EE and 85% (73/86) were experiencing
decreased PA (Figure 1). Overall, 93% (80/86) of medical dosimetrists were experiencing at
least 1 type of burnout due to a staffing shortage at their cancer center.
The second section of survey questions was used to answer research question (Q2) what
effect does remote planning appear to have on perceived burnout? Respondents were asked about
their clinic’s stance on allowing staff to plan remotely; 73% (106/145) answered that they were
permitted to plan remotely to some extent. Almost 54% (57/106) of participants who were
permitted to plan remotely indicated that the frequency was > 1 time per week and 21% (22/106)
answering only 1 time per week. Ninety percent (93/103) of respondents felt that the
opportunities to plan remotely increased since the start of the COVID-19 pandemic. In a non-
remote working environment, 82% (117/142) of respondents experienced constant interruptions
in their work setting and 75% (87/116) of medical dosimetrists felt frustrated at work due to the
constant interruptions. Specific to whether working remotely decreased their level of job-related
stress, 67% (69/103) of participants responded positively, with 83% (86/103) agreeing that
working remotely positively impacted their mood and well-being. When planning remotely, 67%
(69/103) of medical dosimetrists agreed that they were more confident in their ability to
complete their work. Additionally, 91% (79/87) of participants believed that the number of
interruptions decreased when working remotely versus at the clinic; and 65% (75/116) of
respondents thought remote planning allowed or could allow them to personally contribute to
patient care more effectively. Based on statistical analysis, it was found that 67% (71/106) were
 8

experiencing DP, 6% (6/106) were experiencing EE and 8% (8/106) were experiencing

decreased PA (Figure 2). Overall, 68% (72/106) of medical dosimetrists in this survey were
experiencing at least 1 type of burnout due to remote planning.
Discussion
Medical dosimetrists experiencing staffing shortages in their clinic were found to be at an
increased risk of experiencing at least 1 type of burnout. Seventy-two percent of participants that
experienced a medical dosimetrist staffing shortage in their clinic felt that they were forced to
take on more work than they could handle for given deadlines. According to McCormack et al,12
an increase in workload can contribute to EE by placing excessive demands on staff, depleting
their energies. This is supported by the results from the current study, where 87% of medical
dosimetrists felt that a staffing shortage caused them to feel mentally and emotionally exhausted
at the end of the day. Ballenger-Browning et al13 found that psychologists who had a greater
number of patients per week had decreased feelings of personal accomplishment. The results of
the Ballenger-Browning et al13 study could suggest a similar trend for medical dosimetrists in
that an increase in number of patients plans may lead to decreased plan quality or feelings of PA.
Many medical dosimetrists from the current study answered that an increase in staff at their
clinic would positively impact their mood and well-being, which may also allow them to
personally contribute to patient care more effectively. Furthermore, the AAMD expects an
increased staffing shortage of medical dosimetrists over the next decade.5 Preemptive action may
need to be taken by employers to provide clinics with adequate medical dosimetrist staffing
levels to avoid increased burnout among employees.
Medical dosimetrists that were permitted to periodically plan remotely were found to be
at a decreased risk of experiencing at least 1 type of burnout. The strongest indicator of burnout
among this population was feeling frustrated at work due to constant interruptions when onsite.
Many medical dosimetrists in this current study felt that the frequency of interruptions
throughout the workday is decreased when working remotely versus in-person. Furthermore,
67% of respondents felt that working remotely has decreased their job-related stress. Sanghera
et al14 found that healthcare employees that worked in person during the COVID-19 pandemic
were anxious and afraid of being exposed to the infection themselves. The results from the
Sanghera et al14 study suggested that medical dosimetrists that planned remotely during the
COVID-19 pandemic felt they were at a decreased risk of developing symptoms, leading to a
 9

reduction in work-related stress. Researchers in the current study also found that medical
dosimetrists felt more confident in their ability to complete their work when doing so remotely
versus in-person. This increase in confidence may lead medical dosimetrists to believe they are
performing their work more effectively and their effort is beneficial to the patient which could
lead to an improvement in mood and well-being as well as a greater feeling of PA.1 Medical
dosimetrists from the current study reported that the opportunities to plan remotely increased
after the start of the COVID-19 pandemic, as many employers permitted more remote planning
opportunities.
Howard1 focused on the incidence rates of burnout and CF among medical dosimetrists.
Researchers in the current study sought to continue research to evaluate how the work
environment changes caused by the COVID-19 pandemic may have changed the incidence of
burnout among medical dosimetrists. Although this study was on a much smaller scale, the
incidence of burnout in the medical dosimetry field was drastically higher than previously
reported. Work overload was considered a prominent cause for burnout and CF development in
the study by Howard1 which is similar to the current study. No comparisons specific to remote
planning could be made between the Howard1 study and the current research.
Conclusion
Medical dosimetrists are at risk of developing workplace burnout due to the demands of
the role and work-related stressors. These stressors can include creating treatment plans for
terminally ill patients and pressure to meet deadlines in a short timeframe. Limited research has
focused on the incidence of burnout in the medical dosimetry profession. The problem is that
medical dosimetrists could be experiencing increased burnout in the workplace post-pandemic
due to staff shortages and increased remote planning which may have a negative impact on work
performance. The purpose of this study was to evaluate perceptions of medical dosimetrists
specific to workplace burnout in a post-pandemic environment. Howard1 performed a study in
2012 that introduced the idea that medical dosimetrists may suffer from workplace burnout just
as much as any other radiation oncology profession. Researchers in this study continued to
investigate perceptions of medical dosimetrists specific to workplace burnout in a post-pandemic
environment.
There were several limitations to this study. Due to the voluntary participation of this
study, the response rate was 6% (160/2591). As a result of the low response rate, researchers
 10

were unable to conclude that the field of medical dosimetry was well represented as a whole. A
longer survey period and reminder emails to complete the survey could have increased
participation. Another limitation of the study was that not enough data was collected to find an
association between frequency of remote planning and burnout. Additional research into this
topic may identify a relationship between these variables and help validate the findings from this
study. The final limitation of this study was the potential for additional risk factors to impact the
results of the study. Researchers in this study found a strong correlation between the effects of
COVID-19 pandemic and incidence rates of burnout among medical dosimetrists, yet various
risk factors may have also contributed to the results found. Further research may help explain if
additional risk factors experienced by medical dosimetrists that were not addressed in this study
could have an impact on burnout rates and help to validate the current research.
Acknowledgements
The authors would like to thank Dr. Douglas Baumann and John Lininger from the
Statistical Consulting Center at University of Wisconsin-La Crosse for assistance with data
analysis; however, any errors of fact or interpretation remain the sole responsibility of the
authors.
 11

References
1. Howard, M. The incidence of burnout or compassion fatigue in medical dosimetrists as a
function of various stress and psychologic factors. Med Dosim. 2013;38(1):88-94.
https://doi.org/10.1016/j.meddos.2012.07.006
2. Hoffman KE, Garner D, Koong AC, Woodward WA. Understanding the intersection of
working from home and burnout to optimize post-covid19 work arrangements in radiation
oncology. Int J Radiat Oncol Biol Phys. 2020;108(2):370-373. https://doi.org
1016/j.ijrobp.2020.06.062
3. Hayes SW, Priestley JL, Moore BA, Ray HE. Perceived stress, work-related burnout, and
working from home before and during covid-19: an examination of workers in the United
States. SAGE Open. 2021;11(4): https://doi.org/10.1177/21582440211058193
4. Aczel B, Kovacs M, van der Lippe T, Szaszi B. Researchers working from home: benefits
and challenges. PLOS One. 2021;16(3):e0249127.
https://doi.org/10.1371/journal.pone.0249127
5. American Association of Medical Dosimetrists: Medical dosimetry workforce study:
https://pubs.medicaldosimetry.org/pub/6C754B84-E1AA-DDA9-1C85-2F6282AEA009.
Updated June 21, 2021. Accessed April 12, 2022.
6. Bhandari N, Batra K, Upadhyay S, Cochran C. Impact of COVID-19 on healthcare labor
market in the United States: lower paid workers experienced higher vulnerability and slower
recovery. Int J Environ Res Public Health. 2021;18(8):3894.
https://doi.org/10.3390/ijerph18083894
7. Riegel A, Chou H, Baker J, Antone J, Potters L, Cao Y. Development and execution of a
pandemic preparedness plan: therapeutic medical physics and radiation dosimetry during the
COVID-19 crisis. J Appl Clin Med Phys. 2020;21(9):259-265. https://doi.org/
10.1002/acm2.12971
8. Patt D, Gordan L, Diaz M, et al. Impact of COVID-19 on cancer care: how the pandemic is
delaying cancer diagnosis and treatment for American seniors. JCO Clin Cancer Inform.
2020;4:1059-1071. https://doi.org/10.1200/cci.20.00134
9. Bargon C, Batenburg M, van Stam L, et al. Impact of the COVID-19 pandemic on patient-
reported outcomes of breast cancer patients and survivors. JNCI Cancer Spectr.
2021;5(1):pkaa104. https://doi.org/10.1093/jncics/pkaa104
 12

10. Jasperse M, Herst P, Dungey G. Evaluating stress, burnout and job satisfaction in New
Zealand radiation oncology departments. Eur J Cancer Care. 2014;23(1):82-
88. https://doi.org/10.1111/ecc.12098
11. Maslach C, Jackson S. The measurement of experienced burnout. J Occup Behav.
1981;2(2):99-113
12. McCormack HM, MacIntyre TE, O'Shea D, Herring MP, Campbell MJ. The prevalence and
cause(s) of burnout among Applied Psychologists: A systematic review. Frontiers in
Psychology. 2018;9. https://doi.org/10.3389/fpsyg.2018.01897
13. Ballenger-Browning K. K., Schmitz K. J., Rothacker J. A., Hammer P. S., Webb-Murphy J.
A., Johnson D. C. (2011). Predictors of burnout among military mental health providers. Mil
Med. 176, 253–260. https://doi.org/10.7205/MILMED-D-10-00269
14. Sanghera J, Pattani N, Hashmi Y, et al. The impact of sars‐cov‐2 on the mental health of
healthcare workers in a hospital setting—a systematic review. J Occup Health. 2020;62(1).
doi:10.1002/1348-9585.12175
 13

Figures

DP EE Decreased PA
100
88.4
83.7 84.9
Percentage of Respondents

80

60

40

20

0
Burnout Subscale

Figure 1. Percentage of respondents that experienced burnout related to staffing

shortages.

DP EE Decreased PA
80

67.0
Percentage of Respondents

60

40

20

7.6
5.7

0
Burnout Subscale
Figure 2. Percentage of respondents that experienced burnout related to remote planning.
 14

Tables
Table 1. These questions were used to determine if burnout is associated with staffing shortages,
categorized by emotional exhaustion (EE), level of personal accomplishment (PA), and
depersonalization (DP).
Burnout Survey Question
Indicator
EE 6) Choose your level of agreement: Due to a medical dosimetrist staffing
shortage, at the end of the day, I feel mentally and emotionally exhausted.
PA 4) Choose your level of agreement: I believe that increased staffing of medical
dosimetrists at my clinic would allow me to personally contribute to patient care
more effectively.
PA 5) Choose your level of agreement: A medical dosimetrist staffing shortage has
forced me to take on more work than I can handle for given deadlines.
DP 3) Choose your level of agreement: I believe that increased staffing of medical
dosimetrists at my clinic would positively impact my mood and well-being.
DP 7) Choose your level of agreement: Due to a medical dosimetrist staffing
shortage, I dread the idea of going back to work the following morning, after a
weekend, etc.

Table 2. These questions were used to determine if burnout is associated with remote planning,
categorized by emotional exhaustion (EE), level of personal accomplishment (PA), and
depersonalization (DP).
Burnout Survey Question
Indicator
EE 11) I believe that working remotely has ___.
PA 10) Specific to remote planning, I feel more confident in the ability to complete
my work.
PA 16) Choose your level of agreement: Specific to interruptions, I believe remote
planning has allowed/could allow me to personally contribute to patient care
more effectively.
DP 12) Choose your level of agreement: I believe that remote planning has positively
impacted my mood and well-being.
DP 14) Choose your level of agreement: The constant interruptions from other people
or things leaves me feeling frustrated at work.