Computational Modeling Analysis of Positive Thinking Training for Improving Mental Toughness and Burnout Prevention in Medical Personnel
Pubblicato online: 23 set 2025
Ricevuto: 12 gen 2025
Accettato: 21 apr 2025
DOI: https://doi.org/10.2478/amns-2025-0966
Parole chiave
© 2025 Yeying Song et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.
With the rapid development of modern medical technology, hospitals, as an important place, are increasingly characterized by fast pace, high intensity and high risk. As an important role in this special environment, medical personnel are facing great psychological pressure and occupational challenges for a long time, which can easily lead to mental health problems and burnout [1–4]. And burnout can cause a series of problems, including reduced job satisfaction, decreased work efficiency, interpersonal tension and conflict, absence from work, and so on [5–6]. Effectively alleviating the psychological pressure of medical staff and enhancing their occupational satisfaction and well-being has become an urgent problem in the field of nursing management [7–8].
In general, methods and strategies for medical staff to cope with burnout include seeking job satisfaction, establishing a good work-life balance, seeking support and communication, developing self-regulation, and career planning and development [9–11]. Positive thinking intervention, on the other hand, as a psychological intervention method, has been widely applied and researched in several fields in recent years. Its core idea is to enhance the psychological resilience and coping ability of individuals by cultivating and enhancing their positive thinking level, i.e., focusing on the present moment, positive coping, and accepting self and others [12–14]. Positive thinking interventions have significant effects in improving mental health, reducing stress, and alleviating burnout. By adopting these strategies, physicians can better face burnout, maintain enthusiasm and motivation for their work, and provide better medical services to patients [15–18].
Literature [19] conducted a qualitative study and semi-structured interviews with healthcare workers using mobile positive thinking apps in the emergency department based on the background of prominent occupational stress and burnout among healthcare workers, and the results showed that mobile positive thinking app practice is an important way to enhance healthcare workers' sense of well-being and better manage stress. However, barriers such as lack of motivation exist. Literature [20] conducted a literature search using databases such as Medline and Scopus to understand the impact of positive thinking courses on the physical and mental health of healthcare workers. The results showed that positive thinking courses effectively reduced negative emotions such as stress, burnout, and anxiety among healthcare workers, and improved well-being, quality of life, and productivity, making it an important tool for promoting quality of care. Literature [21] analyzed articles related to the use of positive thinking elements to intervene with healthcare workers, searched in electronic databases such as PubMed with different combinations of Boolean operators, and used MERSQl as a quality assessment criterion, and the results pointed out that the positive thinking elements positively impacted the sense of well-being and burnout of healthcare workers. Literature [22] aimed to examine the effects of positive thinking training on the stress and burnout aspects of physicians. An experiment conducted on 44 emergency department interns revealed that positive thinking intervention improved stress and burnout management and reduced the occurrence of these symptoms in physicians. Literature [23] explored the relationship between attendance and positive thinking in primary care and the role that self-efficacy plays in this relationship. A cross-sectional survey of 580 primary care workers in several hospitals showed that the effect of positive thoughts on primary care workers' attendance was mediated through self-efficacy, making it important to improve the self-efficacy of healthcare workers.
Literature [24] revealed that mental health professionals in Singapore have high levels of positive thinking and relatively low levels of both stress and burnout through a cross-sectional survey and multiple regression analysis of 224 mental health professionals in Singapore, the results of which emphasized a more significant negative correlation between each of the positive thinking aspects and stress, burnout and disengagement. Literature [25] outlined the literature related to positive thinking interventions to reduce burnout based on PRISMA criteria, screening articles against databases such as PubMed and Psychinfo. The results pointed out that the overall level of current evidence assessing the impact of positive thinking interventions on burnout in healthcare professionals is insufficient. Literature [26] discusses the improvement of medical staff well-being based on positive thinking interventions. A systematic review and meta-analysis of empirical studies on the use of positive thinking interventions for medical staff pointed out that positive thinking has improved the well-being of medical staff, but based on the variable quality of these studies, further high-quality randomized controlled trials are needed. Literature [27] conducted a scoping review to also understand the impact of positive thinking exercises on physician burnout, and the results indicated that positive thinking exercises improve physicians' mood and stress, are an important component of positive psychology, and are intrinsically linked to effective leadership. Literature [28] used systematic review and meta-analysis to screen studies related to positive thinking exercises in databases such as Cochrane Library, and the results revealed that positive thinking exercises were effective in relieving the stress and psychological distress of medical students, and that the sense of health and well-being was improved, and emphasized that in these results should be based on the variability between studies.
In this paper, the Positive Thinking Training Scale, the Mental Toughness Scale and the Burnout Scale were selected as the data measurement tools, and the data were collected after a seven-week positive thinking training program for six medical staff members in a hospital in M city. At the end of the experiment, two paired and two independent samples tests were used to process the collected data. Based on the results of the questionnaire, it was clarified whether positive thinking training improves the mental toughness of medical staff while reducing their burnout.
Through consultation with a hospital in Province M, the leadership of the hospital center in Province M selected, at their discretion, six medical staff members for the training of positive thinking in this experiment according to the current arrangement of the hospital's operation. The basic information of these six medical staff (nurses) is as follows:
female, 26 years old, 174 cm, 57 kg; female, 27 years old, 168cm, 51kg; female, 23 years old, 167cm, 53kg; female, 25 years old, 176cm, 49kg; female, 28 years old, 171cm, 52kg; female, 27 years old, 168cm, 50kg.
The present study hypothesized that after positive thinking training the subjects' own level of positive thinking and acceptance would increase, and at the same time the medical staff's corresponding mediating psychological variables, such as level of attention, level of positive mindfulness, and level of mental toughness, and their corresponding outcome variables, such as the quality of training and the level of athletic performance, would also increase.
Chinese Burnout Scale CMBI: The Burnout Questionnaire (CMBI) was used, which consists of three dimensions, namely, emotional exhaustion, depersonalization, and reduced sense of accomplishment, with 15 question items, each dimension containing 5 question items, and a 7-point scale, with some items reverse scored. The homogeneous reliability of the questionnaire was 0.9133, the split-half reliability was 0.8974, and the retest reliability was 0.9852. The critical values on the three dimensions were depletion score ≥ 25, depersonalization score ≥ 11, and reduced sense of accomplishment score ≥ 16, respectively. Exceeding the critical value on one dimension was mild burnout, exceeding the respective critical value on two dimensions was moderate burnout, and exceeding the respective critical value on all three dimensions was high burnout. The actual discriminant validity was good.
Chinese version of the CD-RISC scale: a total of 25 items with a 5-point scale divided into five dimensions: initiative, self-regulation, attachment, overall protective factors and behavioral problems.
This experiment utilized a 2*3 mixed experimental design. The experimental condition (positive mindfulness group/control group) was the between-subjects variable, and the testing time (pre-test/post-test) was the within-subjects variable, with an 8-week interval between the pre-test and the post-test, and the follow-up test was conducted 2 weeks after the post-test in order to detect the long-term effects of positive mindfulness training. Based on the results of the pre-test, the subjects were divided into two groups: the positive thinking group (n=3) and the control group (n=3). There were no significant differences in the levels of positive thinking, mental toughness, and burnout between the two groups on the pre-test. Starting from the second week of the experiment, subjects in the positive thinking group began to receive a 7-week course on positive thinking training, while subjects in the control group received a 7-week course on the history of sport psychology. The course schedule was basically maintained at a frequency of 1 session per week, and each session lasted approximately 90 minutes, with the first 60 minutes being a basic theory session and the second 30 minutes being daily duty training.
The program of the positive thinking training method [29] used in this study is divided into seven weeks in total. A series of studies have proved the feasibility and effectiveness of MAC in Western countries, but due to the influence of cultural differences between the East and the West, there may be a certain degree of cultural exclusion when the mental training method based on the Western cultural background is tried out in China, therefore, the curriculum of the Positive Thought Training Program is as follows:
The first week was devoted to the intervention theme of psychological preparation for positive thinking training, and the main intervention contents included: 1) introduction of the curriculum of positive thinking training, 2) the basic concept of positive thinking training, 3) the main points of positive thinking training, 4) the current status of the development and application of positive thinking training, 5) the role of positive thinking training, and 6) the completion of the fixation exercise.
The second week took positive thinking as the intervention theme, and the main intervention contents were as follows: 1), presenting the concept of positive thinking, 2), analyzing the relationship between positive thinking and behavioral performance, 3), introducing the positive breathing exercise and the positive walking exercise, and 4), completing the positive fruit eating exercise.
The third week had de-centering as the intervention theme, and the main interventions were as follows: 1) Introducing the concept of de-centering, 2) Presenting the shift from self-focus to task-focus, 3) Presenting the second aspect of de-centering, 4) Presenting the concept of forgetfulness, 5) Introducing the positive thought dishwashing exercise, and 6) Completing the number exercise.
The fourth week had acceptance as the intervention theme, and the main interventions were as follows: 1), strengthening the subjects' understanding of experience acceptance and experience avoidance, 2), connecting acceptance with positive thinking and de-centering, 3), introducing coexisting competence 1 and coexisting competence 2, and 4), completing the Positive Thinking Yoga Exercise.
The fifth week was devoted to the intervention theme of values and awareness, and the main interventions were as follows: 1) Introducing the concept of values, 2) Introducing the concept of awareness, 3) Understanding the relationship between values and awareness, and 4) Completing the positive mindfulness behavioral exercise, the positive mindfulness duty exercise.
The sixth week took input as the intervention theme, and the main intervention contents were as follows: 1) Introducing the concept of input, 2) Understanding the input of adversity, 3) Understanding the concept of poise, 4) Relationship between input, poise and positive thinking, 5) Completing the poise exercise.
The seventh week was based on the integrated practice as the intervention theme, and the main interventions were as follows: 1), sorting out the positive thinking skills section, 2), sorting out the behavioral orientation section, 3) completing the integrated practice-storytelling exercise, and 4) homework (the subjects were expected to continue to adhere to the positive thinking training).
Two paired samples t-test [30] is used to infer whether the means of two aggregates are significantly different.
Formulation of null hypothesis The paired samples t-test entails testing whether there is a significant difference between two overall means. Its null hypothesis is Selecting the test statistic Let ( Under the condition that the null hypothesis holds, the mean of the difference from the overall When Calculate the observed value of the test statistic and the probability of its occurrence Given the null hypothesis, substitute the test value Given the level of significance, statistically infer results When the probability
The t-test for two independent samples [31] is to test whether the means of two independent normal totals are equal.
Formulation of null hypothesis The two independent samples t-test entails testing whether the means of two totals are significantly different. Its null hypothesis is Selecting the test statistic The two independent samples mean test presupposes that the two independent overall distributions obey the normal distribution Under the condition that the null hypothesis is valid, the test of means of two independent samples uses the When the variances of the two aggregates are unknown but equal, i.e., When the two overall variances are unknown and do not want to be equal, i.e., This statistic obeys a In statistical analysis, if the variances of two totals are equal, the LeveneF chi-square test can be utilized to test whether the variances of the two totals are significantly different. To conduct the LeveneF chi-square test, the null hypothesis The formula for calculating the value of the F statistic in the F test is:
Calculate the observed price of the test statistic and the probability of its occurrence Given the null hypothesis, the test value 0 is brought into the Given the level of significance, the statistical inference result When the probability
In order to explore the effectiveness of the positive thinking training activities implemented in this study on improving the mental toughness level of medical personnel, the method of educational experiment was used to conduct pre and post-tests on medical personnel in the experimental group and the control group. The researcher first conducted a pre-test of the mental toughness level of the two groups of medical personnel to understand the basic situation of the development of the mental toughness level of the medical personnel, and accordingly designed and implemented the program of positive thinking training activities. After that, the post-test data were collected, and the differences between the groups were analyzed by independent samples t-test.
Before the start of the Positive Thinking training program, a uniform questionnaire was administered to the experimental and control groups, so that there was no significant difference in demographic indicators between the experimental and control groups before the intervention of the Positive Thinking training program, and there was considerable homogeneity between the two groups. In this paper, we investigated the mental toughness of the two groups before the beginning of the experiment by using independent samples t-test in five aspects, namely, “initiative, self-regulation, attachment, overall protective factors and behavioral problems”. The results of the pre-test of mental toughness of the two groups are shown in Table 1. The results show that the P-values of these two groups of samples in the experiment in the five aspects of initiative, self-regulation, attachment, overall protective factors and behavioral problems are 0.3624, 0.6317, 0.2744, 0.6925 and 0.1913, respectively, and all of them show that there is no significant difference (P > 0.05). It is inferred that there is homogeneity in the level of mental toughness between the experimental group and the control group of medical personnel in large classes, which lays the foundation for subsequent educational experimental interventions.
Experimental results of the experimental results of the two groups of samples
| Test content | Preexperimental test | Pretest of control group | t | P |
|---|---|---|---|---|
| Initiative | 1.82±0.12 | 1.86±0.12 | -0.86 | 0.3624 |
| Self-regulation | 2.23±0.19 | 2.30±0.09 | 0.47 | 0.6317 |
| Attachment, | 2.22±0.16 | 2.07±0.09 | 1.03 | 0.2744 |
| Overall protective factor | 6.24±0.46 | 6.29±0.46 | 0.36 | 0.6925 |
| Behavioral problem | 2.37±0.19 | 2.38±0.17 | 1.21 | 0.1913 |
The samples of these two groups were analyzed for the pre- and post-tests of mental toughness by means of paired samples t-tests. The results of the difference test of the pre- and post-test of psychological toughness in the experimental group are shown in Table 2. The results show that the t-means of the experimental group's medical staff in the five dimensions of mental toughness and initiative, self-regulation, and attachment were -13.74, -12.11, -15.79, -16.86, and 30.84, respectively; and the p-values corresponding to each of the five dimensions were 0.0000, which all showed highly significant differences (p < 0.01). It can be inferred that the positive thinking training intervention led to a significant change in the level of mental toughness of the medical staff.
Test results of the different experimental group's psychological toughness
| Test content | Pre-experimental results | The results of the experimental group | t | P |
|---|---|---|---|---|
| Initiative | 1.82±0.12 | 2.31±0.39 | -13.74 | 0.0000 |
| Self-regulation | 2.23±0.19 | 3.21±0.16 | -12.11 | 0.0000 |
| Attachment, | 2.22±0.16 | 3.31±0.22 | -15.79 | 0.0000 |
| Overall protective factor | 6.24±0.46 | 9.38±0.65 | -16.86 | 0.0000 |
| Behavioral problem | 2.37±0.19 | 0.85±0.17 | 30.84 | 0.0000 |
The results of the test of differences between the pre-test and post-test scores of the control group are shown in Table 3. The results of the paired samples t-test on the measured data showed that the post-test scores of the control group medical staff in the five dimensions of “initiative, self-regulation, attachment, overall protective factors and behavioral problems” were 1.98±0.13, 2.34±0.11, 2.04±0.14, 6.48±0.40 and 2.26±0.16, respectively. Which showed no significant difference (p>0.05) compared to the pretest scores in the 5 dimensions corresponding to p-values of 0.2639, 0.0508, 0.0872, 0.0502, and 0.3267, respectively. In other words, the level of mental toughness of the medical staff in the control group did not show any significant difference in all aspects of the natural situation and remained basically unchanged.
The difference between the control group and the post-test score was tested
| Test content | The pre-test results of the control group | The posterior test of the control group | t | P |
|---|---|---|---|---|
| Initiative | 1.86±0.12 | 1.98±0.13 | -1.07 | 0.2639 |
| Self-regulation | 2.30±0.09 | 2.34±0.11 | -2.13 | 0.0508 |
| Attachment, | 2.07±0.09 | 2.04±0.14 | -1.82 | 0.0872 |
| Overall protective factor | 6.29±0.46 | 6.48±0.40 | -2.39 | 0.0502 |
| Behavioral problem | 2.38±0.17 | 2.26±0.16 | 0.81 | 0.3267 |
At the end of the experiment, the posttest scores of the experimental and control groups were analyzed by independent samples t-test comparison. The results of the test of difference between the posttest scores of the experimental and control groups are shown in Table 4. The results clearly reflect the posttest scores of the two groups in the five dimensions of initiative, self-regulation, attachment, overall protective factors and behavioral problems, and the p-value of significance is 0.0000, which shows that there is a significant difference between the two groups (p < 0.01). It can be inferred that the mental toughness level of the medical staff in the experimental group changed significantly as a result of the positive thinking training intervention. In summary, the posttest results of the experimental group were higher than those of the control group in terms of overall protective factors and scores on each dimension; and lower than those of the control group in terms of scores on the dimension of behavioral problems. In conclusion, a comparative analysis of the data on various aspects of mental toughness shows that the overall development of mental toughness of the medical staff who received positive thinking training activities was significantly better than that of the medical staff in the control group. This is especially true for the dimensions of “initiative” and “attachment”. At the same time, the mental toughness scores of the control group also changed slightly, but the change was not significant. This suggests that the development of mental toughness of medical staff can also be promoted through daily routine teaching activities, but the effect is far less than that of positive thinking training activities.
The difference test results of the two groups of samples were tested
| Test content | The results of the experimental group | Results of the control group | t | P |
|---|---|---|---|---|
| Initiative | 2.31±0.39 | 1.98±0.13 | -13.46 | 0.0000 |
| Self-regulation | 3.21±0.16 | 2.34±0.11 | -11.75 | 0.0000 |
| Attachment, | 3.31±0.22 | 2.04±0.14 | -15.74 | 0.0000 |
| Overall protective factor | 9.38±0.65 | 6.48±0.40 | -18.14 | 0.0000 |
| Behavioral problem | 0.85±0.17 | 2.26±0.16 | 28.15 | 0.0000 |
After seven weeks of positive thinking training, participants were tested on the Burnout Scale in the three dimensions of Emotional Failure (EF), Depersonalization (PD), and Low Sense of Accomplishment (LSA). The results of the pre-test of burnout levels are shown in Figure 1. The results show that the six samples scored between 33-37, 19-23, and 42-45 points for emotional exhaustion, depersonalization, and low achievement, respectively, with small differences in scores.
The pre-test results of the level of burnout
The results of the post-test of burnout level are shown in Figure 2. The results of the experiment showed that the scores of the six testers in the three aspects of “Emotional Failure (EF), Depersonalization (PD) and Low Sense of Accomplishment (LSA)” changed. Firstly, the total score was reduced to between 71-81; secondly, the scores of emotional exhaustion (EF), depersonalization (PD) and low achievement (LSA) were reduced to between 23-27, 20-23 and 26-32, respectively. .
The post-test results of the level of burnout
The results of the paired samples t-test for the pre and post-tests of burnout levels are shown in Table 5. Based on the results of the comparison between the pre-test and the post-test, we can clearly see that there is a significant improvement in the burnout level of the six medical professionals. Comparison of the mean values of the pre and post-tests reveals that there is a decrease from the total score to the dimension scores. After SPSS paired samples t-test results, the t-value corresponding to the mean values of total score, emotional exhaustion and low achievement are 8.494, 6.732 and 5.831 respectively, and the corresponding p-values are equal to 0.000 presenting a significant difference. It indicates that the overall level of fatigue, emotional exhaustion and low achievement of the medical staff was significantly alleviated after the positive thinking training.
Test of matching samples of the job burnout level
| Survey content | Premeasurement | Posttest | t | P | ||
|---|---|---|---|---|---|---|
| Average score | Standard deviation | Average score | Standard deviation | |||
| Burnout score | 100 | 0.00 | 75.67 | 2.48 | 8.494 | 0.000 |
| Affective failure | 35.67 | 2.47 | 25.50 | 1.32 | 6.732 | 0.000 |
| Personality disintegration | 21.00 | 1.09 | 21.33 | 1.05 | 1.286 | 0.0705 |
| Low sense of accomplishment | 43.33 | 2.18 | 28.83 | 2.13 | 5.831 | 0.000 |
In this paper, we conducted a 7-week positive thinking training for medical personnel by using the contents of the Chinese Burnout Scale CMBI and the Chinese version of the CD-RISC scale. Afterwards, according to the experimental results, two paired and two independent samples tests were conducted on their questionnaire data.
The t-means of the experimental group were -13.74, -12.11, -15.79, -16.86, and 30.84 for the dimensions of “initiative, self-regulation, attachment, overall protective factors, and behavioral problems,” with p-values of 0.0000, which were highly significant (p<0.01); while the p-values of the control group were 0.2639, 0.0508, 0.0872, 0.0502, and 0.3267, which were not significant (p<0.01). While the control group had p-values of 0.2639, 0.0508, 0.0872, 0.0502 and 0.3267 corresponding to the 5 dimensions, all of which demonstrated non-significant differences (p>0.05). Comparison of the post-test scores of mental toughness of medical personnel in the two groups revealed that their t's corresponding to the five dimensions were -13.46, -11.75, -15.74, -18.14 and 28.15, respectively, which were all characterized by significant differences (p < 0.01). This shows that receiving positive thinking training activities significantly increases the mental toughness of medical personnel. The results of the burnout survey of medical personnel in the experimental group and the control group showed that the t-values of the burnout scores of medical personnel in the three aspects of “total score, emotional exhaustion and low sense of accomplishment” in the pre- and post-tests of the experimental group were 8.494, 6.732 and 5.831, respectively, and that the differences between the pre- and post-test scores were significant (P<0.01). 0.01). This indicates that the overall level of fatigue, emotional exhaustion and low sense of accomplishment of medical personnel was significantly alleviated after the positive thinking training.