{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T03:20:20Z","timestamp":1793762420302,"version":"4.6.1"},"reference-count":58,"publisher":"BMJ","issue":"3","funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2019,2,5]]},"published-print":{"date-parts":[[2019,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>High rates of healthcare worker (HCW) burn-out have led many to label it an \u2018epidemic\u2019 urgently requiring interventions. This prospective pilot study examined the efficacy, feasibility and evaluation of the \u2018Three Good Things\u2019 (3GT) intervention for HCWs, and added burn-out and work\u2013life balance to the set of well-being metrics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>228 HCWs participated in a prospective, repeated measures study of a web-based 15-day long 3GT intervention. Assessments were collected at baseline and 1, 6 and 12-month post-intervention. The primary measure of efficacy was a derivative of the emotional exhaustion subscale of the Maslach Burnout Inventory. The secondary measures were validated instruments assessing depression symptoms, subjective happiness, and work\u2013life balance. Paired samples t-tests and Cohen\u2019s d effect sizes for correlated samples were used to examine the efficacy of the intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>3GT participants exhibited significant improvements from baseline in emotional exhaustion, depression symptoms and happiness at 1 month, 6 months and 12\u2009months, and in work\u2013life balance at 1 month and 6 months (effect sizes 0.16\u20130.52). Exploratory subgroup analyses of participants meeting \u2018concerning\u2019 criteria at baseline revealed even larger effects at all assessment points (0.55\u20131.57). Attrition rates were similar to prior 3GT interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>3GT appears a promising low-cost and brief intervention for improving HCW well-being.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>This study is approved by the Institutional Review Board of Duke University Health System (Pro00063703). All participants are required to give their informed consent prior to any study procedure.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2018-022695","type":"journal-article","created":{"date-parts":[[2019,3,21]],"date-time":"2019-03-21T05:34:21Z","timestamp":1553146461000},"page":"e022695","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":121,"title":["Forty-five good things: a prospective pilot study of the Three Good Things well-being intervention in the USA for healthcare worker emotional exhaustion, depression, work\u2013life balance and happiness"],"prefix":"10.1136","volume":"9","author":[{"given":"J Bryan","family":"Sexton","sequence":"first","affiliation":[{"name":"Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, North Carolina, USA"},{"name":"Psychiatry, Duke University School of Medicine, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn C","family":"Adair","sequence":"additional","affiliation":[{"name":"Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,3,20]]},"reference":[{"key":"2025101810344715000_9.3.e022695.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2015.08.023"},{"key":"2025101810344715000_9.3.e022695.2","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.e1717","article-title":"Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States","volume":"344","author":"Aiken","year":"2012","journal-title":"BMJ"},{"key":"2025101810344715000_9.3.e022695.3","doi-asserted-by":"publisher","DOI":"10.1108\/02683940710733115"},{"key":"2025101810344715000_9.3.e022695.4","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1037\/ocp0000056","article-title":"Job demands-resources theory: taking stock and looking forward","volume":"22","author":"Bakker","year":"2017","journal-title":"J Occup Health Psychol"},{"key":"2025101810344715000_9.3.e022695.5","unstructured":"Maslach C . Burnout: The Cost of Caring. New York: Prentice-Hall, 1982."},{"key":"2025101810344715000_9.3.e022695.6","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0149913","article-title":"Depression-Burnout Overlap in Physicians","volume":"11","author":"Wurm","year":"2016","journal-title":"PLoS One"},{"key":"2025101810344715000_9.3.e022695.7","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.drugalcdep.2015.12.038","article-title":"Risky alcohol use in Danish physicians: associated with alexithymia and burnout?","volume":"160","author":"Pedersen","year":"2016","journal-title":"Drug Alcohol Depend"},{"key":"2025101810344715000_9.3.e022695.8","doi-asserted-by":"publisher","DOI":"10.1080\/13811110802325349"},{"key":"2025101810344715000_9.3.e022695.9","doi-asserted-by":"publisher","DOI":"10.1097\/01.psy.0000239247.47581.0c"},{"key":"2025101810344715000_9.3.e022695.10","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0b013e3180556825"},{"key":"2025101810344715000_9.3.e022695.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2012.07.021"},{"key":"2025101810344715000_9.3.e022695.12","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(96)90077-X"},{"key":"2025101810344715000_9.3.e022695.13","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-14-254"},{"key":"2025101810344715000_9.3.e022695.14","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-14-325"},{"key":"2025101810344715000_9.3.e022695.15","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e3181bfdab3"},{"key":"2025101810344715000_9.3.e022695.16","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39469.763218.BE"},{"key":"2025101810344715000_9.3.e022695.17","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2013.07.016"},{"key":"2025101810344715000_9.3.e022695.18","article-title":"Emotional exhaustion and workload predict clinician-rated and objective patient safety","volume":"5","author":"Welp","year":"2014","journal-title":"Front Psychol"},{"key":"2025101810344715000_9.3.e022695.19","doi-asserted-by":"publisher","DOI":"10.1001\/jama.288.16.1987"},{"key":"2025101810344715000_9.3.e022695.20","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2009.1384"},{"key":"2025101810344715000_9.3.e022695.21","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1080\/13548506.2014.986143","article-title":"Enhancing relaxation states and positive emotions in physicians through a mindfulness training program: a one-year study","volume":"20","author":"Amutio","year":"2015","journal-title":"Psychol Health Med"},{"key":"2025101810344715000_9.3.e022695.22","doi-asserted-by":"publisher","DOI":"10.1002\/chp.21211"},{"key":"2025101810344715000_9.3.e022695.23","doi-asserted-by":"crossref","DOI":"10.1001\/jamainternmed.2013.14387","article-title":"Intervention to promote physician well-being, job satisfaction, and professionalism: a randomized clinical trial","volume":"174","author":"West","year":"2014","journal-title":"JAMA Intern Med"},{"key":"2025101810344715000_9.3.e022695.24","unstructured":"West CP , Dyrbye LN , Satele D , et al . A randomized controlled trial evaluating the effect of COMPASS (COlleagues Meeting to Promote and Sustain Satisfaction) small group sessions on physician well-being, meaning, and job satisfaction. J Gen Intern Med 2015;30."},{"key":"2025101810344715000_9.3.e022695.25","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1001\/jamainternmed.2016.7674","article-title":"Controlled interventions to reduce burnout in physicians: a systematic review and meta-analysis","volume":"177","author":"Panagioti","year":"2017","journal-title":"JAMA Intern Med"},{"key":"2025101810344715000_9.3.e022695.26","doi-asserted-by":"publisher","DOI":"10.1037\/0003-066X.60.5.410"},{"key":"2025101810344715000_9.3.e022695.27","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1007\/s10902-012-9380-0","article-title":"Strength-based positive interventions: further evidence for their potential in enhancing well-being and alleviating depression","volume":"14","author":"Gander","year":"2013","journal-title":"J Happiness Stud"},{"key":"2025101810344715000_9.3.e022695.28","doi-asserted-by":"publisher","DOI":"10.1002\/jclp.20593"},{"key":"2025101810344715000_9.3.e022695.29","doi-asserted-by":"publisher","DOI":"10.1007\/s00406-014-0549-x"},{"key":"2025101810344715000_9.3.e022695.30","doi-asserted-by":"crossref","unstructured":"Bianchi R , Schonfeld IS , Laurent E . Is it time to consider the \"burnout syndrome\" a distinct illness? Front Public Health 2015;3.doi:10.3389\/fpubh.2015.00158","DOI":"10.3389\/fpubh.2015.00158"},{"key":"2025101810344715000_9.3.e022695.31","doi-asserted-by":"publisher","DOI":"10.1177\/0013164410391579"},{"key":"2025101810344715000_9.3.e022695.32","doi-asserted-by":"publisher","DOI":"10.1080\/08870440108405527"},{"key":"2025101810344715000_9.3.e022695.33","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1136\/bmjqs-2016-006399","article-title":"Providing feedback following Leadership WalkRounds is associated with better patient safety culture, higher employee engagement and lower burnout","volume":"27","author":"Sexton","year":"2018","journal-title":"BMJ Qual Saf"},{"key":"2025101810344715000_9.3.e022695.34","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2014-002831"},{"key":"2025101810344715000_9.3.e022695.35","doi-asserted-by":"publisher","DOI":"10.1016\/S0749-3797(18)30622-6"},{"key":"2025101810344715000_9.3.e022695.36","doi-asserted-by":"publisher","DOI":"10.1177\/1073191113481998"},{"key":"2025101810344715000_9.3.e022695.37","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1016\/j.ridd.2010.03.009","article-title":"Wellbeing perception of institutional caregivers working for people with disabilities: use of subjective happiness scale and satisfaction with life scale analyses","volume":"31","author":"Lin","year":"2010","journal-title":"Res Dev Disabil"},{"key":"2025101810344715000_9.3.e022695.38","doi-asserted-by":"publisher","DOI":"10.1023\/A:1006824100041"},{"key":"2025101810344715000_9.3.e022695.39","doi-asserted-by":"crossref","unstructured":"Sexton JB , Schwartz SP , Chadwick WA , et al . The associations between work\u2013life balance behaviours, teamwork climate and safety climate: cross-sectional survey introducing the work\u2013life climate scale, psychometric properties, benchmarking data and future directions. BMJ Qual Saf 2016:bmjqs-2016-006032.","DOI":"10.1136\/bmjqs-2016-006032"},{"key":"2025101810344715000_9.3.e022695.40","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.paid.2016.02.056","article-title":"How do positive psychology interventions work? A short-term placebo-controlled humor-based study on the role of the time focus","volume":"96","author":"Wellenzohn","year":"2016","journal-title":"Pers Individ Dif"},{"key":"2025101810344715000_9.3.e022695.41","doi-asserted-by":"publisher","DOI":"10.1086\/209405"},{"key":"2025101810344715000_9.3.e022695.42","doi-asserted-by":"crossref","unstructured":"Sawilowsky S . New effect size rules of thumb. Theor Behav Found Educ Fac Publ 2009.","DOI":"10.22237\/jmasm\/1257035100"},{"key":"2025101810344715000_9.3.e022695.43","doi-asserted-by":"publisher","DOI":"10.1136\/ebmh.11.3.66"},{"key":"2025101810344715000_9.3.e022695.44","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1080\/17439760902992464","article-title":"Who benefits the most from a gratitude intervention in children and adolescents? Examining positive affect as a moderator","volume":"4","author":"Froh","year":"2009","journal-title":"J Posit Psychol"},{"key":"2025101810344715000_9.3.e022695.45","doi-asserted-by":"publisher","DOI":"10.1037\/0021-9010.86.3.499"},{"key":"2025101810344715000_9.3.e022695.46","doi-asserted-by":"publisher","DOI":"10.1037\/0022-3514.86.2.320"},{"key":"2025101810344715000_9.3.e022695.47","doi-asserted-by":"publisher","DOI":"10.1023\/A:1010796329158"},{"key":"2025101810344715000_9.3.e022695.48","doi-asserted-by":"publisher","DOI":"10.1016\/j.jesp.2006.05.007"},{"key":"2025101810344715000_9.3.e022695.49","doi-asserted-by":"publisher","DOI":"10.1037\/0003-066X.56.3.218"},{"key":"2025101810344715000_9.3.e022695.50","doi-asserted-by":"crossref","unstructured":"Rippstein-Leuenberger K , Mauthner O , Sexton JB , et al . Three good themes: a qualitative analysis of the three good things intervention in health care workers. Rev 2017.","DOI":"10.1136\/bmjopen-2017-015826"},{"key":"2025101810344715000_9.3.e022695.51","unstructured":"United States Department of Labor. Employed persons by detailed occupation, sex, race, and hispanic or latino ethnicity: United States Department of Labor."},{"key":"2025101810344715000_9.3.e022695.52","doi-asserted-by":"crossref","first-page":"89","DOI":"10.7790\/ejap.v5i1.145","article-title":"The impact of online resilience training for sales managers on wellbeing and performance","volume":"5","author":"Abbott","year":"2009","journal-title":"E-Journal of Applied Psychology"},{"key":"2025101810344715000_9.3.e022695.53","doi-asserted-by":"publisher","DOI":"10.1002\/jclp.21839"},{"key":"2025101810344715000_9.3.e022695.54","doi-asserted-by":"crossref","DOI":"10.1186\/1475-2891-13-13","article-title":"Is drop-out from obesity treatment a predictable and preventable event?","volume":"13","author":"Colombo","year":"2014","journal-title":"Nutr J"},{"key":"2025101810344715000_9.3.e022695.55","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1159\/000441366","article-title":"Weight loss expectations and attrition in treatment-seeking obese women","volume":"8","author":"Dalle Grave","year":"2015","journal-title":"Obes Facts"},{"key":"2025101810344715000_9.3.e022695.56","doi-asserted-by":"publisher","DOI":"10.1177\/1479972316629953"},{"key":"2025101810344715000_9.3.e022695.57","doi-asserted-by":"publisher","DOI":"10.1093\/heapro\/das029"},{"key":"2025101810344715000_9.3.e022695.58","doi-asserted-by":"crossref","DOI":"10.2196\/jmir.7.1.e11","article-title":"The law of attrition","volume":"7","author":"Eysenbach","year":"2005","journal-title":"J Med Internet Res"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2018-022695","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T17:34:54Z","timestamp":1760808894000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2018-022695"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,3]]},"references-count":58,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2019,3,20]]},"published-print":{"date-parts":[[2019,3]]}},"alternative-id":["10.1136\/bmjopen-2018-022695"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2018-022695","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,3]]}}}