Psychology
2012. Vol.3, No.8, 583-589
Published Online August 2012 in SciRes (http://www.SciRP.org/journal/psych) http://dx.doi.org/10.4236/psych.2012.38087
Burnout Patients Primed with Success Did Not Perform Better on
a Cognitive Task than Burnout Patients Primed with Failure
Arno Van Dam1*, Ger P. J. Keijsers2, Marc J. P. M. Verbraak2,3,
Paul A. T. M. Eling4, Eni S. Becker2
1GGZ-Westelijk Noord Brabant, Institute for Mental Health, Bergen op Zoom, Netherlands
2Radboud University Nijmegen, Behavioural Science Institute, Nijmegen, Netherlands
3HSK-Group, Arnhem, Netherlands
4Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, Netherlands
Received May 1st, 2012; revised June 5th, 2012; accepted July 7th, 2012
Burnout patients perform poorer on cognitive tasks than healthy controls. A possible explanation for this
decreased performance is a relatively permanent reduced motivation to expend effort. In a previous study,
we failed to enhance the performance of burnout patients using a monetary incentive and positive feed-
back. In an attempt to bypass cognitions about fatigue and performance, we tried to motivate healthy con-
trols and burnout patients implicitly by priming participants with either success or failure prior to task
performance. As expected, healthy controls primed with success outperformed healthy controls primed
with failure. However, no differential priming effect was observed in burnout patients. This suggests that
success priming fails to enhance performance in subjects with burnout.
Keywords: Burnout; Cognition; Motivation; Performance; Prime; Success
Introduction
Burnout is a stress-related syndrome characterized by ex-
haustion, occupational detachment, and reduced personal ac-
complishment. Burnout results from prolonged periods of stress
and from an inability to achieve personal goals. Burnout pa-
tients frequently report reduced job satisfaction, physical com-
plaints, especially fatigue, and impaired cognitive performance
(Maslach, Schaufeli, & Leiter 2001; Schaufeli & Enzmann,
1998; Schmidt, Neubach, & Heuer, 2007; Taris, 2006).
Several studies have shown that burnout patients perform
poorer on cognitive tasks than healthy controls (Sandström,
Rhodin, Lundberg, Olsson, & Nyberg, 2005; Van Dam, Kei-
jsers, Eling, & Becker, 2011; Van der Linden, Keijsers, Eling,
& Van Schaijk, 2005). Many authors regard a reduction in mo-
tivation to expend effort as the underlying mechanism for de-
creased performance in burnout (Boksem & Tops, 2008;
Schaufeli & Taris, 2005; Van Dam et al., 2011). An important
question is whether this decreased motivation can be reversed
by a motivational intervention. Some authors suggest that mo-
tivational interventions may increase performance to normal
levels (Halbesleben & Bowler, 2007; Rubino, Luksyte, Jansen
Perry, & Volpone, 2009). Other authors, however, suggest that
reduced motivation cannot readily be reversed by motivational
interventions, because burnout patients suffer from biochemical
changes due to prolonged periods of stress that affect perform-
ance over longer periods (months, years) of time (Boksem &
Tops, 2008; Frankenhaeuser, 1986; Mommersteeg, Keijsers,
Heijnen, Verbraak, & Van Doornen, 2006; Sandström et al.,
2005; Van der Linden et al., 2005). Boksem and Tops (2008)
argue that physiological changes in the dopaminergic/motivational
system, (due to systematic neglect of signs of fatigue for pro-
longed periods of time), may be fundamental to long-term fa-
tigue syndromes such as burnout. This theory is supported by a
study by Van Dam et al. (2011): in which they failed to moti-
vate burnout patients by providing fake positive feedback about
their performance and by announcing a financial reward for the
best performing participants.
The findings of Van Dam et al. (2011), however, fail to ex-
plain why burnout patients could not be motivated to increase
their performance. One possibility is that performance was
already as high as possible. Another possibility is that positive
feedback and financial rewards did not successfully counteract
the patient’s belief that their performance cannot be improved.
Many authors (Afari & Buchwald, 2003; Knoop, Prins, Moss-
Morris, & Bleijenberg, 2010) argue that cognitions play a major
role in the perpetuation of symptoms in fatigue-related syn-
dromes. Many individuals suffering from long-term fatigue
believe that they have no control over their fatigue symptoms
(Findley, Kerns, Weinberg, & Rosenberg, 1998; Knoop et al.,
2010) and may perceive a good performance as unattainable,
and therefore do not try to improve their performance despite
an announced financial reward. It is theoretically and clinically
important to find out whether reduced performance of burnout
patients can be improved by the proper means. Therefore, we
decided to examine the possibility of motivating patients im-
plicitly using subliminal priming (Bargh, 2005; Dijksterhuis,
Aarts, & Smith, 2005), thus bypassing cognitions about fatigue
and performance. Several studies (Aarts, Custers, & Veldkamp,
2008; Chartrand & Bargh, 2002) have shown that motivation
can be primed and that individuals primed with achieve-
ment-related stimuli perform at a higher level on subsequent
tasks compared to non-primed individuals. A procedure for
successfully priming subsequent behaviour is the “scrambled
sentence task” developed by Srull and Wyer (1979; for a review,
*Corresponding author.

A. VAN DAM ET AL.
see Bargh & Chartrand, 2000). The task is presented as a verbal
ability task and is based upon sets of four words in random
order. Participants are asked to construe grammatically correct
sentences using three of the four words. For each set, only a
single grammatically correct solution is possible. Without in-
forming the participants, a proportion of these correct sentences
refer to a specific behaviour, mood, or attitude which (un-
knowingly to the participant) becomes activated or “primed”. In
our study, we used sentences that primed for success, for in-
stance: “John is winning” or for failure, for instance “John gives
up”.
We hypothesized that, if we primed healthy controls with ei-
ther failure or success, and if we subsequently presented them
with a complex cognitive task, those primed with success
would outperform those primed with failure. With regard to
burnout patients, we also expected that those, primed with suc-
cess, would perform better than those primed with failure if
cognitions about the fatigue-performance relationship played a
role in reduced cognitive performance.
Methods
Participants
Burnout patients (N = 63) were recruited from institutions for
mental health where they were being treated for their symptoms.
The diagnosis of burnout was established by the mental health
institutions using the following criteria. Patients had to meet: 1)
the validated cut-off points (Brenninkmeijer & van Yperen,
2003) for severe burnout on the Dutch version of the Maslach
Burnout Inventory General Survey (see Measurements section
for a description of the instruments): exhaustion ≥ 2.20 and
either cynicism ≥ 2.00 or personal accomplishment ≤ 3.67; 2)
the cut-off point for prolonged fatigue (Bültman et al., 2000) on
the checklist individual strength (≥76); 3) the criteria for the
proposed psychiatric equivalents of clinical burnout, namely the
ICD-10 (World Health Organisation, 1994) criteria for work
related neurasthenia (Schaufeli, Bakker, Hoogduin, Schaap, &
Kladler, 2001; Schaufeli & Enzmann, 1998); and 4) the DSM-
IV (American Psychiatric Association, 2000) criteria for un-
specified somatoform disorder with prolonged fatigue as the
main symptom (Hoogduin, Schaap, & Methorst, 2001). Both
diagnoses were established by using the Dutch adaptation
(Overbeek, Schruers, & Griez, 1999) of the Mini International
Neuropsychiatric Interview (Sheehan et al., 1998) and a semi-
structured interview checking ICD-10 criteria for work-related
neurasthenia. Of the 61 patients meeting these criteria, 12 pa-
tients also met the criteria of simple phobia as a secondary di-
agnosis. They were equally divided over the prime-conditions.
Patients diagnosed with burnout were sent a brochure about the
research project and were offered additional information by
telephone, whenever they wanted to. When patients decided to
participate, they signed an informed consent form and returned
it to the experimenter.
Healthy controls (N = 40) were volunteers and did not meet
the criteria for any of the DSM-IV disorders or currently re-
ceive psychotherapeutic or psychopharmacologic treatment.
They were employees (secretaries, cooks, cleaners and nurses)
of a mental health institute or members of a sport club. Both
groups were equally divided over the prime conditions. The
healthy controls received 5 euros for participation and the
burnout patients received a book on occupational stress.
Measurements
Severity of burnout symptoms was assessed with the Dutch
adaptation of the Maslach Burnout Inventory General Survey
(Maslach, Jackson, & Leiter, 1996), referred to as the Utrecht
BurnOut Scale-A (UBOS-A; Schaufeli & Dierendonck, 2000).
The UBOS-A comprises the following scales: emotional ex-
haustion, depersonalization, and perceived job competence with
high scores on emotional exhaustion and depersonalization and
low scores on perceived job competence indicating burnout.
Reliability and validity of the UBOS are good, Cronbach’s
alpha’s are usually well above .70 (Schaufeli et al., 2001).
General fatigue was assessed with the Dutch adaptation
(Vercoulen, Alberts, & Bleijenberg, 1999) of the Checklist
Individual Strength (CIS; Vercoulen et al., 1994). Its 20 items
assess subjective feelings of fatigue and physical fitness, activ-
ity level, motivation, and concentration during the previous 14
days. Reliability and validity of the CIS are good, Cronbach’s
alpha for the CIS is .90 (Vercoulen et al., 1994).
Participants were asked to rate their mood by placing a mark
on a Visual Analogue Scale of 10 cm, with on the lefts side the
word “sad” and on the right side the word “cheerful”. The dis-
tance between the left endpoint and the mark was used as a
measure of mood.
Subjective assessment of acute fatigue was measured with
the mental-fatigue scale (mf) of the short version of the Rating
Scale Mental Effort (RSME; Zijlstra, 1993), which specifically
measures how fatigued a participant is feeling as a result of
performing the task at hand. The level of fatigue is indicated on
a continuous line with 0 signifying “not fatigued at all” and 150
denoting “extremely fatigued”.
The Rating Scale Expectancy of Performance (RSEP) was
specifically developed for this study to assess the participants’
expectations about their performance level for the Scrambled
Sentence Task (SST) and the cognitive switch task (see Task
section below). Participants were asked to place a mark on a
line of 10 cm, with on the lefts side “poor” and on the right side
“good”. The distance between the left endpoint and the mark
was used as a measure of performance expectancy.
The Subjective Effort Scale (SES) was specifically devel-
oped for this study to measure to what extent participants had
tried to perform well at the SST and the switch task (see Task
section below). Participants were asked to rate on a five-point
Likert scale to what extent they had tried to perform well at the
SST and the switch task (see Task section below).
Tasks
The Scrambled Sentence Task (SST) is an adaptation of the
SST developed by Srull and Wyer (1979). The task was pre-
sented to participants as a verbal ability task and comprised 25
lines of 4 words placed in random order (for example: “John,
winning, chair, is”). Participants were asked to construe gram-
matically correct sentences of three words out of 4 words. Only
one grammatically correct solution was possible. For 16 lines
the correct solution was related to either success (for example:
“John is winning”) or failure (for example: “John gives up”),
the other nine lines comprised neutral words only to disguise
the purpose of the task.
Because mental fatigue seems to affect performance on com-
plex tasks more than on simple tasks (Holding, 1983; Matthews,
Davies, Westerman, & Stammers, 2000), we presented partici-
pants with a complex task. The task, based on the switch task of
584

A. VAN DAM ET AL.
Rogers and Monsell (1995), involves the use of higher control
processes necessary for the planning and preparation of future
actions. This switch task paradigm has been used frequently in
studies on cognitive performance in healthy controls as well as
in burnout patients (Matthews et al., 2000; Oosterholt, Van der
Linden, Maes, Verbraak, & Kompier, 2011; Van Dam et al.,
2011).
Using the current version of the switch-task, 300 letters ap-
peared successively in a clockwise fashion in each corner of a
screen, starting in the upper left square. The letters were ran-
domly chosen from the set: A, B, E, G, O, and S. The colour of
the letters was randomly chosen from the set green or red. If a
green letter appeared in the upper half of the screen, participants
had to push the left button on a button box as fast as possible;
in case of a red letter, they had to push the right button. If the
letter was in the lower half of the screen, participants had to
push the left button as fast as possible when the letter was a
vowel, and the right button if it was a consonant. Thus, subjects
were asked to switch tasks every second trial.
The task started with an Inter-Stimulus-Interval (ISI) of 1500
ms, which is ample time for healthy controls to respond ade-
quately without much effort (Lorist et al., 2000; Nieuwenhuis &
Monsell, 2002; Rogers & Monsell, 1995). Four correct re-
sponses in succession resulted in a reduction of the ISI by 50
ms, leading to an acceleration of the letters appearing on the
screen. When participants made two or more errors in a set of
four responses, the ISI was increased by 20 ms. Accordingly,
the speed of the task was adapted to the level of performance.
The speed (ISI) of the letters appearing on the screen at the end
of the task (Mean of last 30 ISIs) was used as a measure for
performance.
In order to check whether the prime was effective during the
cognitive task, we used an adaptation of a task employed by
Kruglanski and colleagues (Richter & Kruglanski, 1998) to
measure the implicit activation of success and failure. After
performing the cognitive task, participants were presented with
an employment advertisement (Employment Advertisement
Task; EAT) describing a commercial job. Subsequently, they
were presented with a photograph of a young man and were
asked to rate the likelihood that the man will be admitted to the
job by placing a mark on a Visual Analogue Scale of 10 cm,
with printed on the lefts side “very unlikely” and on the right
side “highly likely”. We hypothesized that if the prime was still
active, healthy controls primed with success would rate the
chances of success as higher than healthy controls primed with
failure.
Procedures
Prior to participation, diagnoses were established as de-
scribed in the participant section. Participants were tested in a
quiet room during the day. They completed a short biographical
questionnaire and rated their scores on the mood rating scale
and the RSME-mf, which took about 2 minutes. Subsequently,
the experimenter asked them to complete the SST presented to
them as a verbal ability task. This took approximately 7 minutes
to complete. Participants were randomly assigned to the success
or failure condition in advance. Next they received instructions
for the switch task and completed the RSEP (the mood rating
scale) and the RSME-mf for the second time, which took less
than a minute. Subsequently they performed the switch task
which took about 10 minutes. Afterwards, participants again
rated the mood rating scale and the RSME-mf.
Participants were presented with the EAT. After rating the
job candidate’s chances for success, they were asked to rate the
extent that they had tried to perform well on the SST and the
switch task and they were asked to describe what they thought
the purpose of the experiment was in order to check if they
discovered the particular content of the SST.
Next, participants completed the CIS and the UBOS. We
asked them to complete these questionnaires at the end of the
experiment so that they could not serve as a prime for the tasks.
Finally participants were debriefed about the purpose of the
tasks and procedures. It is well-known that priming-effects are
short lived (Bargh, 2005) and we did not expect effects after the
experiment. But in case of potential negative effects, participants
were given the phone number and e-mail address of the re-
searcher if they had any questions about the experiment. None
of the participants contacted us after the experiment. Approval
for the study was obtained from the Ethical Committee (ECG)
of the Faculty of Social Sciences of Radboud University Ni-
jmegen in the Netherlands.
Results
Characteristics of the burnout patients and healthy controls in
the different conditions are presented in Table 1. With regard
Table 1.
Characteristics of the burnout patients and healthy controls primed with failure or with success.
Burnout patients Healthy controls
Success prime (N = 31) Failure prime (N = 30) Success prime (N = 35) Failure prime (N = 32)
Gender: Men 19 (61.3%) 18 (60.0%) 19 (54.35%) 12 (37.5%)
Age (Mean SD)** 44.9 (8.6) 44.4 (8.7) 36.4 (11.0) 36.0 (12.2)
Educational level
Low 3 (9.7%) 3 (10%) 5 (14.3%) 1 (3.1%)
Middle 9 (29%) 12 (40%) 9 (25.7%) 12 (37.5%)
High 19 (61.2%) 15 (50%) 21 (60%) 19 (59.4%)
Symptom Measures (Mean SD)
Utrecht Burn Out Scale
Emotional Exhaustion* 3.3 (1.5) 3.6 (1.3) 1.9 (1.3) 1.8 (1.3)
Depersonalization** 2.7 (1.3) 2.7 (1.3) 1.5 (1.2) 1.3 (1.0)
Perceived Job Competence* 3.9 (1.0) 3.9 (.9) 4.3 (.8) 4.3 (.6)
Checklist Individual Strength** 82.0 (22.4) 89.3 (25.2) 63.7 (17.9) 67.6 (12.9)
*Significant for group (burnout patient/healthy control) at p < .05; **Significant for group (burnout patient/healthy control) at p < .001

A. VAN DAM ET AL.
to gender and education, there were no significant differences
between burnout patients and healthy controls or between the
conditions, but there was a significant difference in age be-
tween burnout patients healthy controls, F(1, 124) = 21.5, p
< .001. Inspection of the means showed that burnout patients
were older (M = 44.6, SD = 8.6) than healthy controls (M =
36.2, SD = 11.5). We correlated Age with Performance; the
correlation was not significant in HCs (p > .1) but was signifi-
cant in BPs (r = .30, p < .05). In order to correct for potential
age effects, Age was used as a covariate in subsequent analyses.
With regard to symptoms, we conducted a two-way be-
tween-groups multivariate ANCOVA with emotional exhaustion,
depersonalization, perceived job competence (UBOS-A), and
general level of fatigue (CIS) as dependent variables. Group
[BPs, HCs] and Condition [Success, Failure] were the inde-
pendent variables. There was a significant effect for Group, F(4,
102) = 13.7, p < .001 and the results for the separate dependent
variables also reached statistical significance: exhaustion, F(1,
105) = 31.1, p < .001, depersonalization F(1, 105) = 23.2, p
< .001, perceived job competence, F(1, 105) = 6.6, p < .05,
general level of fatigue, F(1, 105) = 24.0, p < .001. Burnout
patients reported significantly more burnout symptoms and
fatigue than healthy controls. There were no differences be-
tween the conditions and there were no interaction effects be-
tween Group and Condition.
All participants performed faultlessly on the SST. When
asked at the end of the experiment what the participants thought
that the purpose of the experiment was, only one participant
(healthy control primed with success) correctly noted the pur-
pose of the experiment.
The scores on the Mood Rating Scale, RSME-mf, RSEP,
SES and EAT and level of performance on the switch task for
the two groups and the two conditions are presented in Table 2.
The course of the ISI for burnout patients and healthy controls
primed with success or failure is presented in Figure 1. With
regard to performance, we conducted a two-way between-groups
univariate ANCOVA with Group [BPs, HCs] and Condition
[Success, Failure] as the independent variables, ISI as dependent
variable and Age as covariate.
There was a significant effect for Group, F(1, 123) = 4.1,
Table 2.
Scores on rating scales during the experiment and performance of the burnout patients and healthy controls primed with failure or with success.
Burnout patients Healthy controls
Success prime (N = 31)Failure prime (N = 30)Success prime (N = 35) Failure prime (N = 32)
Mood Rating Scale T1 62.8 (19.2) 62.7 (17.4) 67.7 (19.6) 71.0 (15.0)
Mood Rating Scale T2 62.4 (17.9) 62.7 (17.8) 63.8 (17.6) 70.1 (14.8)
Mood Rating Scale T3 56.9 (23.5) 57.2 (20.1) 59.6 (20.2) 62.7 (15.9)
RSME-mf T1** 54.7 (32.3) 55.6 (28.4) 39.3 (29.0) 33.9 (26.1)
RSME-mf T2** 54.9 (34.7) 56.4 (30.2) 41.7 (28.8) 32.4 (23.4)
RSME-mf T3** 59.2 (37.9) 65.9 (33.7) 45.4 (27.6) 40.2 (25.0)
Performance (Mean ISI (ms) on last 30 trials)*# 1983 (1011) 1653 (951) 1090 (267) 1612 (836)
Rating Scale Expectancy of Performance (RSEP) 54.0 (19.4) 55.8 (20.1) 48.9 (14.3) 54.9 (15.9)
Employment Advertisement Task (EAT)# 50.9 (24.8) 61.0 (18.9) 70.8 (14.0) 59.0 (19.2)
Subjective Effort Scale (SES) on SST 4.2 (1.1) 4.4 (.9) 4.3 (.7) 4.3 (.9)
Subjectibe Effort Scale (SES) on Switch task 4.2 (.9) 4.3 (.8) 4.1 (.6) 4.1 (.8)
*Significant for Group (burnout patient/healthy controls) at p < .05. **Significant for Group (burnout patient/healthy control) at p < .001. #Significant interaction effect for
Group (burnout patient/healthy control) and Condition (Success, Failure) at p < .05.
Figure 1.
ISI (Inter-Stimulus-Interval) over 300 trials for the burnout patients and healthy controls primed with
success or with failure.
586

A. VAN DAM ET AL.
p < .05, 2 = .03. The performance of healthy controls was bet-
ter (M = 1339, SD = 659) than the performance of burnout
patients (M = 1821, SD = 988). We also found a significant
Group x Condition interaction, F(1, 123) = 9.3, p < .01, 2
= .07, which indicates that burnout patients and healthy controls
reacted differently to the prime-condition. There was also a
significant effect of Age, F(1, 123) = 7.8, p < .01, 2 = .06.
When age was not used as a covariate, we found the same re-
sults with somewhat larger effect sizes (Group, F(1, 123) = 10.6,
p < .001, 2 = .08, Group × Condition interaction, F(1, 123) =
8.9, p < .01, 2 = .07). Separate ANCOVAs for burnout patients
and healthy controls with Condition [Success, Failure] as the
independent variable, and ISI as dependent variable revealed
that healthy controls primed with success performed better than
healthy controls primed with failure, F(1, 64) = 12.8, p < .001,
2 = .17 on the cognitive switch task and that there was no dif-
ference between the burnout patients in the two conditions.
Separate ANCOVAs for the success condition and the failure
condition with Group [BPs, HCs] as the independent variable
and ISI as dependent variable revealed that success primes
resulted in a better performance in healthy controls in compari-
son to burnout patients, F(1, 63) = 14.7, p < .001, 2 = .19.
There was no difference between the groups in the failure con-
dition.
We conducted two-way repeated measures ANCOVAs with
Group [BPs, HCs] and Condition [Success, Failure] as the be-
tween subjects variable and Time (T1, T2, T3) as within vari-
able for the mood rating scales and the RSME-mf separately.
No significant effects were found for the various scores on the
mood rating scale. For the RSME-mf there was a significant
effect for Group, F(1, 123) = 20.8, p < .001, 2 = .14. As ex-
pected, burnout patients reported more mental fatigue than
healthy controls.
With regard to RSEP, SES and EAT, we conducted two-way
between-groups univariate ANCOVAs, with RSEP, TPWS and
EAT scores as dependent variables. Group [BPs, HCs] and
Condition [Success, Failure] were the independent variables.
With regard to the EAT there was a significant effect for
Group, F(1, 123) = 5.7, p < .05, 2 = .04, and a significant
Group x Condition effect, F(1, 123) = 9.9, p < .01, 2 = .08.
Inspections of the means showed that healthy controls (M =
65.2, SD = 17.6) estimated the chances of success larger for the
job candidate than the burnout patients (M = 55.9, SD = 22.5).
Separate ANCOVAs for burnout patients and healthy controls
with Condition [Success, Failure] as the independent variable,
and EAT as dependent variable revealed that healthy controls
primed with success estimated the chances of success larger for
the job candidate than the than healthy controls primed with
failure, F(1, 64) = 8.1, p < .01, 2 = .11. There was a trend be-
tween the burnout patients in the two conditions, F(1, 64) = 3.1,
p = .08, 2 = .05.
We found no significant effects for RSEP and SES.
Discussion
Motivational interventions do not appear to be effective in
improving performance in burnout patients (van Dam et al.,
2011). It is not clear, however, whether the performance in
burnout patients already tends to be as high as possible or
whether burnout patients do not believe that their performance
can be improved despite positive feedback and financial re-
wards. In order to bypass cognitions about fatigue, we investi-
gated the possibility that motivation can be enhanced in an
implicit way, using subliminal priming. We primed burnout
patients and healthy control with success or failure. After
priming, the participants were presented with a complex cogni-
tive task that has been used in previous studies to measure cog-
nitive performance in fatigued individuals (Lorist et al., 2000;
Van Dam et al., 2011).
As expected, burnout patients reported more burnout symp-
toms and fatigue than healthy controls. With regard to task
performance, burnout patients reported that they tried to per-
form well at the cognitive task just like the healthy controls
(SES), but they showed poorer performance than the healthy
controls, and experienced more fatigue during the task. These
findings are in line with studies that show that cognitive per-
formance in burnout is reduced and that mental effort leads to
enhanced fatigue increase (Sandström et al., 2005; Van Dam et
al., 2011; Van der Linden et al., 2005).
Healthy controls primed with success outperformed healthy
controls primed with failure on the cognitive task. Apparently
the prime was effective in increasing motivation in healthy
controls. EAT findings suggest that prime effects were still
present in healthy controls at the end of the experiment. However,
burnout patients primed with success did not perform better
than burnout patients primed with failure or healthy controls
primed with failure. Burnout patients were not positively af-
fected by the success primes to perform well. This finding is in
line with the theory of Boksem and Tops (2008) that burnout
patients are not responsive to motivational interventions any-
more.
However, an alternative explanation is possible as well. The
primes we used in the SST may have also invited the partici-
pants to compare themselves with others. Brenninckmeijer et al.
(2000) found that comparison with successful others leads to a
negative affect in burnout. The effect of the primes might have
been different if we had used words like “I” or “You” in com-
bination with success or failure-related words. We found no
differences in reported mood between groups and conditions
however, which suggests that the formulation of the SST did
not affect our results.
The mean performance of burnout patients primed with suc-
cess was inferior (although not significantly), compared to that
of burnout patients primed with failure. The large variance
suggests that success primes may even lead to reduced perform-
ance in some of the burnout patients. The finding that primes
can elicit behaviour in the opposite direction than would have
been expected has been observed before and seems to occur
when primed behaviour is by participants perceived as out of
reach (Dijksterhuis et al., 1998; Hart & Albarracin, 2009). This
may also have been the case in our study because several stud-
ies suggest that burnout patients may react differently to suc-
cess than healthy controls because they perceive success as
unattainable (Brenninckmeijer, Van Yperen, & Buunk, 2001;
Brenninckmeijer, 2002).
Although burnout patients primed with success did not im-
prove performance, they reported similar levels of expected
success on the task (RSEP) and similar levels of subjective
effort spent at the task (SES) as the control participants. Ap-
parently the prime did not influence the subjective expectations
for successful performance, nor the perceived amounts of effort
spent on the task or mood during the task. This finding is in line
with many studies on priming that show that priming influences
behaviour, but does not necessarily lead to a change in feelings

A. VAN DAM ET AL.
or cognitions (Bargh, 2005), although some studies demon-
strated that achievement priming can trigger higher expecta-
tions of task outcomes (Custers, Aarts, Oikawa, & Elliot, 2009).
Nevertheless, we conclude that differences in performance
between the two groups cannot be explained by differences in
success expectation and perceived effort.
A limitation of our study is that we did not use a neutral
priming condition. Therefore, we cannot determine to what
extent priming effects can be attributed to priming for success,
failure or both. Several studies have determined that success-
related priming can increase motivation for task performance
(Ciani & Sheldon, 2010; Custers et al., 2009; Custers & Aarts,
2005; Lowery, Eisenberger, Hardin, & Sinclair, 2007), and that
failure-related priming can decrease motivation for task per-
formance (Bry, Follenfant, & Meyer, 2008; Ciani & Sheldon,
2010; Legal & Meyer, 2007). A comparison with the perform-
ance (ISI) of unprimed burnout patients (M = 1716, SD = 888)
and healthy controls (M = 1089, SD = 351) from an earlier
study (Van Dam et al., 2011) in which the same cognitive task
was used, suggests that the strongest prime effect in healthy
controls in this study was the failure prime and the strongest
effect in burnout patients, although in the opposite direction,
was the success prime. As many studies (Johnson, Benas, &
Gibb, 2011; Stieger & Burger, 2010) have demonstrated, psy-
chological disorders are associated with specific implicit cogni-
tions. An explanation for this finding may be that burnout pa-
tients exhibit implicit associations with failure as suggested by
Brenninckmeijer et al. (2000) and healthy controls exhibit im-
plicit associations with success. This is in line with many stud-
ies that show a positive self-judgment bias in healthy individu-
als (Dunn, Stefanovitch, Buchan, Lawrence, & Dalgleish, 2009;
Schmidt & Mast, 2010). It is possible that the implicit cogni-
tions that are already active cannot be activated to a much lar-
ger extent in contrast to cognitions that are not activated yet.
A second limitation that cannot be ruled out is that the score
on the EAT is also influenced by the level of performance on
the switch task. Success on the switch task may have served as
a prime for the EAT. We assume that this effect is small, how-
ever, because participants did not receive feedback about their
performance on the switch task and therefore unable to deter-
mine how well they performed.
A third limitation is that participants performed the switch
task only once. Therefore we cannot establish differential,
within-subjects-effects of the priming procedure, we can only
determine whether there was a difference between the experi-
mental groups.
A fourth limitation may be that the burnout patients in our
study were somewhat older than the healthy controls. Although
statistically significant, the difference was relatively small.
Moreover, the burnout patients performed less well than
healthy controls, and this effect is still significant if age is taken
into account. We therefore assume that the age difference be-
tween the groups did not substantially affect our results.
A fifth limitation may be that healthy controls and burnout
patients received a different kind of reward for participating in
the experiment. Because the reward was related to participation
and not to performance, we assume that this difference did not
affect our results.
In conclusion, this study showed that success primes did not
increase performance in burnout, which supports theories that
state that burnout patients are not responsive to motivational
interventions. Moreover this study indicates that the non-re-
sponsiveness of burnout patients to motivational interventions
is not a mere consequence of cognitions about fatigue and per-
formance but seems to stem from a more structural condition.
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