Introduction

Burnout is increasingly recognised as a significant occupational phenomenon that affects individuals’ psychological and physical well-being, leading to decreased productivity, higher absenteeism, depression and other health issues (Poulus et al., 2024). In 2019, the World Health Organization classified burnout as a work-related psychological state characterised by physical fatigue, emotional exhaustion and loss of motivation, which significantly impacts an individual’s quality of life and organisational effectiveness (WHO, 2019). While existing literature extensively examines burnout across various industries (e.g. manufacturing, high-tech industries) and regional cultures (e.g. Japanese, and Korean zaibatsu firms, Western liberal firms, and Chinese private companies versus state-owned enterprises (SOEs)), providing comprehensive insights into its nature (Norton, 2022; Schaufeli, 1996; You et al., 2015). However, less attention has been paid to burnout in SOEs in China, where these organisations have distinct characteristics that may shape the experience of burnout in unique ways. Unlike private enterprises, Chinese SOEs are characterised by hierarchical structures, bureaucratic processes and strong ties to state policies, creating a unique work environment that impacts employee attitudes and stress responses (Song, 2018). SOEs working positions are viewed as desirable due to their stability and social security benefits.

SOEs are often perceived as extensions of governmental functions, characterised by hierarchical organisational structures (Xin et al., 2019)., in their study on burnout among public servants in northern China, found that factors such as job duties, salary and income satisfaction, job security, work pressure and interpersonal skills significantly influence employees’ burnout risks. However, compared to public servants, grassroots employees in SOEs face structural challenges, including limited promotion opportunities, heavy workloads, weak support systems and inadequate resource allocation (Xu et al., 2021). These issues not only constrain career advancement but also perpetuate high-pressure work environments, leading to job dissatisfaction and increased risk of burnout (Lin et al., 2020). Despite SOEs typically offering higher job security and benefits, their distinctive hierarchical organisational structure and work environment impose substantial emotional and cognitive burdens on grassroots employees. However, research on occupational burnout and psychological health among SOE employees remains relatively insufficient (Yu et al., 2022). Current interventions in Chinese SOEs, such as psychological counselling and motivational lectures, may face effectiveness limitations due to high costs, inadequate cultural adaptation and insufficient strategies tailored to the high-pressure, hierarchical environments within SOEs (Long and Cooke, 2023).

Burnout interventions in the workplace are often multimodal. Individual-based cognitive behavioural therapy (CBT) has been shown to effectively reduce stress and burnout (Anclair et al., 2018; Korczak et al., 2012; von der Embse et al., 2019). However, traditional CBT, which primarily relies on verbal communication and behaviour modification, may not be suitable for all cultural backgrounds or individual preferences (Hofmann et al., 2012). For individuals who are less inclined to verbalise emotions, Art Therapy integrated with CBT offers a valuable non-verbal alternative. This approach facilitates emotional expression through creative activities such as doodling and colouring, which have been proven to alleviate anxiety and enhance emotional well-being (Chilton and Leavy, 2014; Curry and Kasser, 2005; Rajendran et al., 2020). Chilton and Leavy (2014) highlight that including art, music and theatre can be used as creative activities in art therapy to provide an opportunity for participants to express their emotions non-verbally. Such scenarios are where individuals are more likely to express feelings that they may struggle to put into words. Similarly, Rajendran et al. (2020) conducted a meta-analysis of the effectiveness of art therapy in improving the emotional well-being of employees and found significant reductions in stress and emotional distress through arts-based interventions. This study aims to fill this gap by exploring a novel, culturally sensitive intervention for burnout among SOEs employees, using a combination of CBT and non-verbal expressive techniques such as doodling.

The purpose of this study was to develop a CBT-based intervention combined with doodling as a tool, and to explore the impact of this non-verbal tool on reducing burnout among grassroots employees in Chinese SOEs. To examine our intervention, we conducted a field experiment to evaluate the impact of a Happy Doodle Toolkit (HDT) intervention on burnout among grassroots employees of a Chinese SOE. This is a tool developed based on CBT and art therapy. A total of 225 employees were randomly selected from a SOE with 634 staff to complete the pre-intervention questionnaire. Among them, 38 participants voluntarily joined the four-week intervention programme using the HDT and completed the post-intervention burnout questionnaire. Qualitative data were gathered through semi-structured interviews, which focused on participants’ emotional well-being and work attitudes. We believe this study makes three knowledge contributions: (1) this study introduces a novel non-verbal intervention approach by combining CBT and art therapy, expanding theoretical perspectives on burnout intervention; (2) this intervention provides insights into the applicability of burnout in the context of Chinese SOEs, filling a relatively under-researched area; (3) it highlights the potential of low-cost, self-administered interventions to contribute to the mental health and job satisfaction of frontline employees in a bureaucratic organisational setting.

Literature review

Burnout and the challenges of Chinese SOEs

Burnout is characterised by fatigue, cynicism about work and a sense of meaninglessness at work, not only reducing creativity and innovation, but also affecting the performance of individuals, teams and organisations (Eckleberry-Hunt et al., 2018). However, in studies on burnout, employees in SOEs are often overlooked. This oversight stems from the public’s stereotypical perception of SOE employment as embodying the concept of the ‘iron rice bowl’—a historical guarantee of lifetime employment and benefits in Chinese SOEs (Tian et al., 2022). However, with recent market reforms, the organisational mechanisms and welfare systems of SOEs have evolved. The traditional stability and high benefits associated with the ‘iron rice bowl’ have gradually diminished, leading to a more dynamic and challenging work environment within SOEs, thereby exacerbating employee burnout (Xin et al., 2017; Lin et al., 2020). Simultaneously, transitioning out of SOEs to pursue other career opportunities imposes high costs on employees (Lin et al., 2020). They often need to forgo certain implicit benefits such as housing subsidies, medical insurance and social security. Consequently, many employees, despite facing high-pressure environments, tend to remain within SOEs throughout their careers, contributing to a phenomenon known as ‘lock-in effect’ (Chen et al., 2018). This career path’s closed nature and limited opportunities further amplify employees’ feelings of powerlessness and emotional exhaustion, increasing the risk of burnout.

Some scholars point out that although SOEs are government-controlled at central or local levels, in practice, they serve dual economic and policy objectives (Lin et al., 2020; Jefferson, 1998). This dual mandate requires SOEs to pursue economic profitability while fulfilling national stability and social security policies. Consequently, SOEs often retain redundant staff to achieve political and social stability, which lowers work utilisation rates and task monotony. This not only diminishes work efficiency but also intensifies workplace psychological stress (Luo et al., 2023). Moreover, the compensation systems within SOEs typically respond sluggishly to company performance, undermining employee motivation mechanisms. Disparities in income between grassroots employees and senior executives further breed doubts about salary fairness among some employees, reducing workplace morale (Kato and Long, 2006). Furthermore, the corporate culture of Chinese SOEs is deeply influenced by traditional Confucian thought and collectivism, emphasising collective harmony and interests over individual aspirations and well-being. Over time, this exacerbates employee dissatisfaction and burnout (Clugston et al., 2000; Ouyang et al., 2022). Due to heavy policy burdens, redundant employment practices and state intervention, SOEs often underperform economically (Beladi et al., 2020; Lin, 2021). In this context, severe employee burnout coexists with limited financial and available resources, further hindering the implementation of systematic mental health interventions. Therefore, developing low-cost burnout relief strategies tailored to the specific challenges of SOEs under resource constraints has become an urgent priority.

Cognitive behavioural therapy (CBT) as an intervention to reduce burnout

CBT is recognised as an effective intervention for burnout, aiming to address the cognitive and behavioural factors that contribute to emotional distress and burnout (Farber, 2000; Kuribayashi et al., 2022). According to the CBT theory, thought distortions and maladaptive behaviours can lead to psychological disorders. By teaching individuals new coping mechanisms and methods for processing information, CBT helps address overcome these distortions and behaviours (Beck, 2020). Current prominent CBT interventions include behavioural modification, cognitive restructuring, thought journaling, emotion logs, goal-setting and self-recovery strategies (Dike et al., 2021a; Grant, 2017). Ghasemi (2023) developed a CBT-based group therapy programme that significantly reduced teachers’ emotional exhaustion and burnout through cognitive restructuring and relaxation training.

However, traditional CBT methods, relying heavily on verbal communication, may face resistance in hierarchical and collectivist cultures, such as those prevalent in SOEs. In SOEs, individuals tend to avoid exposing personal weaknesses or emotional problems due to the Chinese cultural values of ‘Mianzi(face)’, which refers to maintaining one’s social reputation and dignity, and collectivism (Hsu, 1980; Zhang, 2023). In the workplace, employees may be reluctant to engage in open verbal communication about personal psychological conditions and work-related stress. This cultural context requires psychological interventions to be more indirect, non-verbal and culturally adapted, to avoid feelings of shame and rejection when individuals confront their problems (Xiong and Du, 2023). The rigid bureaucratic system in SOEs, with its top-down management style, also leads to employees preferring to follow orders rather than actively engaging in self-reflection or expressing personal emotions when it comes to mental health interventions (Yu et al., 2022). This cultural context may limit interventions such as CBT that require a high degree of self-revelation and open communication. Given these cultural and structural factors, some scholars have suggested that non-verbal, creative interventions such as art therapy or emotional release activities may be more acceptable to participants than traditional CBT (Pan et al., 2023).

In recent years, the effectiveness of CBT, both independently and in combination with other interventions, has been explored. For instance, Zielhorst et al. (2015) integrated CBT with therapeutic digital gaming, finding that incorporating digital games into burnout treatment programmes alongside CBT enhanced its effectiveness. Similarly, Khalsa et al. (2015) proposed a CBT-yoga approach, which proved effective in treating generalised anxiety disorder and significantly improved various psychological symptoms associated with anxiety and depression. These studies highlight the potential of a comprehensive treatment strategy that incorporates CBT with other intervention modalities in burnout research.

Doodling as creative self-expression and interventions

Doodling, as a form of creative self-expression, has various clinical applications. Kalmanowitz and Ho (2016) utilised doodling as a preparatory technique in art therapy to help individuals connect with their underlying emotions and encourage openness about their experiences. This art-based projection allows individuals to express internal states of mind, particularly when verbal or visual expression is challenging (Isis et al., 2024). Unlike traditional text diaries, doodle diaries can effectively encode autobiographical memories, enhancing recall accuracy and quality (Tran et al., 2023). Therefore, doodling offers a non-confrontational outlet for SOEs employees to articulate suppressed emotions, addressing a key gap in traditional verbal interventions. In addition, compared to other forms of art therapy, such as music and dance, which may require team participation, physical engagement, or special equipment (Uttley et al., 2015), doodling is a low-cost, low-barrier intervention that can be implemented individually without time or space constraints (Burton and Baxter, 2019). As a visual, self-paced and user-driven activity, doodling is highly suitable as a long-term tool for recording and self-monitoring burnout among employees in SOEs.

Doodling facilitates association, provides a non-verbal means of expression, but also enhances self-efficacy and serves as self-care, supporting mental, physical and emotional well-being (Coward, 2022a). Salzano et al. (2013) examined whether a collaborative group approach to drawing could reduce burnout among hospice carers. Participants in the art intervention reported reduced stress levels and experienced relaxation and pleasure in the creative process, suggesting therapeutic benefits. Similarly, Glime (2023) combined doodling with positive thinking techniques, enabling healthcare workers to address burnout while experiencing a sense of accomplishment, leading to decreased burnout and increased well-being. Researchers have shown that doodling or freehand colouring allows staff to record their emotions, alleviate stress and foster positive actions (Isis et al., 2024; Coward, 2022b; Karagiorgakis and Palmer, 2024). Although burnout intervention methods have been widely studied in the West, there are still significant research gaps in their application to grassroots employees of Chinese SOEs in a specific cultural and organisational environment.

Design of the Happy Doodle Toolkit (HDT)

Inspired by the probe toolkit design guidelines (Sanders and Stappers, 2014), this study developed a toolkit named the ‘Happy Doodle Toolkit’ (HDT) by combining CBT and doodle-based theory. The specific intervention goals and corresponding measures are shown in Table 1. This toolkit comprises a paper ‘doodle weekly diary’ and a box of 12 coloured pencils, designed to encourage grassroots staff to engage in self-intervention and documentation (Fig. 1A).

Table 1 HDT design based on CBT theory and doodle theory.
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Fig. 1: Contents of HDT.
figure 1

A Items in the toolkit, B the three modules included in the doodle weekly diary and C burnout intervention corresponding to six scenarios.

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According to Kaimal et al. (2017), activities such as colouring, doodling and freehand drawing activate the brain, enhancing an individual’s self-perception of creativity and stimulating reward pathways that support emotion regulation. This study categorised the HDT into three modules (see Fig. 1B).

In designing the structured doodle module (Part 1), the AHP was employed to develop the doodle paradigm by selecting the six most suitable burnout intervention strategies for grassroots employees. This study adhered to Saaty’s methodological recommendations, with the following specific research steps:

  1. a.

    Define the decision problem and construct a hierarchical model.

Construct the judgement matrix, compare the items using the relative scale table, then assign values to each element in the hierarchical structure, and build the judgement matrix.

$$A=\left[{\alpha }_{{ij}}\right]=\left[\begin{array}{cccc}{a}_{11} & {a}_{12} & \cdots & {a}_{1n}\\ {\alpha }_{21} & {\alpha }_{22} & \cdots & {\alpha }_{2n}\\ \vdots & \vdots & \ddots & \vdots \\ {\alpha }_{m1} & {\alpha }_{m2} & \cdots & {\alpha }_{{mn}}\end{array}\right]$$
(1)
  1. b.

    Perform hierarchical ordering and consistency testing.

    Derive the maximum eigenvalue and eigenvector of the judgement matrix and normalise them.

    $$A\overline{W^{\prime} }={\lambda }_{\max }\bar{W^{\prime}}$$
    (2)
    $$\begin{array}{l}\delta =\left[\frac{{W}_{1}^{\prime} }{{\sum }_{i-1}^{m}{{W}^{{\prime} }}_{i}},\frac{{W}_{2}^{\prime} }{{\sum }_{i-1}^{m}{{W}^{{\prime} }}_{i}},\ldots ,\frac{{W}_{m}^{\prime} }{{{\sum }_{i-1}^{m}{W}^{\prime} }_{i}}\right]\\\quad=\left({\delta }_{1},{\delta }_{2},\ldots ,{\delta }_{m}\right)\end{array}$$
    (3)

    Conduct a consistency test. If CR < 0.1, the judgement matrix is deemed acceptable.

    $${C}_{o}{R}_{o}=\frac{{C}_{o}{I}_{o}}{{R}_{o}{I}_{o}},{C}_{o}{I}_{o}=\frac{{\lambda }_{\max }-n}{n-1}$$
    (4)
  2. c.

    Conduct hierarchical total ranking.

Calculate the average of all the relative weights obtained to calculate the composite weights.

$${W}_{j}=\frac{1}{n}\mathop{\sum }\limits_{i-1}^{n}{B}_{{ij}}$$
(5)

This study utilised the Proactive Burnout Prevention Inventory for Employees proposed by Otto et al. (2020), which covers work, family and personal behaviours and has good validity. The inventory was coded to construct the factor layer. Through the application of the evaluation indicator model within the AHP framework, four criteria for the indicator layer were systematically established to screen burnout interventions. This process was carried out through co-design workshops involving collaboration among psychologists, company executives and grassroots employees. The identified criteria include learning burden (B1), time cost (B2), financial burden (B3) and accessibility (B4), ensuring a comprehensive and multidisciplinary approach to the development of intervention strategies. This categorisation was then used to develop a screening indicator system aimed at burnout interventions for grassroots employees in SOEs (see Fig. 2).

Fig. 2
figure 2

Hierarchical structure of burnout interventions evaluation.

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This study employed the 1–9 scale calibration method (Saaty, 2008). Weights for the indicator levels and factor levels were assigned by three psychologists, two company executives and two grassroots employees of the study subjects. Incorporating the perspectives of both company executives and grassroots employees into the evaluation and selection of burnout interventions serves a critical purpose. Company executives provide a macro-level perspective, leveraging their understanding of organisational resource availability and employee characteristics to assess the feasibility of intervention implementation. Meanwhile, grassroots employees, as the direct users of the toolkit, offer essential insights that ensure the toolkit is user-cantered and tailored to their needs, enhancing its practical effectiveness and usability. The indicators and scores were encoded into the Yaahp software to derive the judgement matrix and the weights for the criterion and factor layers (see Supplementary Tables S1 and S2). These weights were then tested for consistency. Finally, the aggregate weights corresponding to the burnout interventions were calculated (see Supplementary Table S2) and ranked by weight magnitude to identify the top six interventions for inclusion in the colouring frames: 1. Seek/Perform energising tasks; 2. Seek feedback; 3. Improve /Maintain physical health; 4. Participate in relaxation activities; 5. Improve/Maintain mental health; 6. Seek career development. These six selected burnout intervention strategies were integrated into a single scenario and presented as the colouring frames (see Fig. 1C).

Method

Research scope

This study focuses on a state-owned water company located in a city in southern China. The company employs 634 regular employees and has annual sales exceeding RMB 600 million. Water supply plays a central role in urban infrastructure and local governance, which closely reflects the broader socio-political context of Chinese SOEs, where social responsibility and state involvement are integral. As a typical public utility monopoly, the company operates under government supervision while providing essential services to the public. It embodies core structural characteristics commonly found in Chinese SOEs, including a hierarchical management system, bureaucratic decision-making processes and a large grassroots workforce (Song, 2018). As such, this case company not only fulfils the typical functions of a Chinese SOE, but also provides a relevant setting for studying burnout interventions that are applicable to other resource-constrained, bureaucratic organisations throughout China.

In 2022, the company identified widespread employee burnout. The research team distributed 191 valid questionnaires, which revealed that 84% of the employees desired increasing focus on mental health in the workplace. Based on these findings, the research team recommended implementing targeted burnout interventions.

Between 2022 and 2023, the company employed traditional burnout interventions, including expert lectures and psychological counselling. However, these methods proved costly and generated only limited positive responses from employees. Consequently, the company’s human resource management sought further assistance from the research team to conduct targeted burnout research and develop a low-cost, bottom-up, individually orientated intervention toolkit that employees could use independently to enhance engagement and effectiveness.

A day in the life: uncovering burnout triggers in SOEs

In 2022, a questionnaire confirmed the presence of burnout within the company. To further explore the causes, the research team interviewed 40 employees and analysed the data, identifying high-frequency and life stressors. The storyboard method, a typical ‘day in the life of an employee’s workday’ was illustrated (see Fig. 3). Common issues at the grassroots level included trivial work and repetitive tasks, lack of innovation in work content and difficulty balancing family and work. Employees sometimes spontaneously sought ways to relieve stress, but lacked scientific and systematic psychological interventions. The bureaucratic nature of SOEs exacerbates these stressors, particularly for grassroots employees who often experience limited control over their work environment.

Fig. 3
figure 3

A day in the life of grassroots employees in state-owned enterprises.

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Research process

This self-intervention toolkit (HDT) was developed and implemented from November 2023 to June 2024 (see Fig. 4). This study employed qualitative and quantitative methods to develop the tool and evaluate its effectiveness and adaptability for employees of different ages.

Fig. 4
figure 4

Research process.

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November–December 2023: burnout research phase

The research team conducted extensive research on burnout within the company. The research team distributed 225 questionnaires through the internal workgroups and received 222 valid responses (grassroots staff N = 169, managerial staff N = 53). The findings indicated that burnout was more prevalent among grassroots employees than those in managerial staff (see the section ‘Questionnaire and Burnout Scale’ for details on the questionnaires and burnout measurements). Consequently, the research focused on grassroots staff.

January–March 2024: HDT development phase

  1. a.

    Development: The research team developed HDT based on the CBT theory, Doodle Theory and the Proactive Burnout Prevention Inventory, utilising the AHP (see the section ‘Design of the Happy Doodle Toolkit (HDT)’ for details).

  2. b.

    Recruitment of participants: In collaboration with the Human Resources Department, the research team issued a recruitment request, inviting employees who were experiencing mental health challenges or seeking to improve their workplace psychological well-being to participate. Purposive sampling and the maximum variation method were used to ensure diversity, resulting in 31 volunteers (16 females and 15 males, aged 24–54 years, with employment durations ranging from 1 to 28 years). Seven additional staff under 35 were later recruited to explore age-related effects on tool use. Supplementary Table S3 presents the socio-demographic data of the 38 participants. Participants’ specific names and positions were anonymised using generic descriptions.

  3. c.

    Workshops (see Supplementary Fig. S1): These workshops aimed to introduce the HDT to participants and validate its effectiveness. All participants completed demographic and burnout questionnaires before the workshops. The first round included 31 participants. After data analysis, seven more young participants were recruited for a second round to explore age-related engagement. Both workshops followed the same process, including HDT instructions, a doodle test and a group reflection session. It is important to note that we placed special emphasis on introducing participants to the six scenarios in the Structured Doodle Module and the corresponding interventions they represent, ensuring the effectiveness of this visualisation approach.

April–May 2024: HDT field experimentation phase

Participants completed a burnout questionnaire before the experiment (see the section ‘Questionnaire and Burnout Scale’ for the questionnaire design). Over four weeks, they used the HDT to summarise their work–life situation on the last working day of each week and maintained a reflective diary.

May–June 2024: data collection and analysis phase

At the end of the experiment, participants completed the burnout questionnaire again. Data from both baseline and final questionnaires were analysed using statistical methods. Additionally, one-on-one and group semi-structured interviews were conducted and the completed HDT was analysed.

Questionnaire and Burnout Scale

The questionnaire was administered online. To determine the reliability and validity of the Chinese version, this study utilised the Chinese version of the Maslach Burnout Inventory–General Survey (MBI-GS), developed by Maslach et al. and revised by Li (2003). The scale is a standardised questionnaire that has been widely validated in Chinese samples, demonstrating good structural validity and reliability (Gao et al., 2023; Zheng et al., 2022). This 15-item scale is divided into three subscales: ‘Emotional Exhaustion’ (five items), ‘Cynicism’ (four items) and ‘Professional Efficacy’ (six items). The internal consistency coefficients were 0.88, 0.83 and 0.82, respectively. The questionnaire employed a seven-point Likert scale (Likert, 1932) ranging from ‘never’ to ‘very frequently’ with scores ranging from 0 to 6. The score for each subscale was the average of all item scores in that subscale. Burnout is conceptualised as a continuous variable, ranging from low to high levels, rather than a dichotomy of presence or absence (Maslach, 1996). Higher scores on ‘Emotional Exhaustion’ and ‘Cynicism’ indicate more severe burnout, while lower scores on ‘Professional Efficacy’ indicate more severe burnout (Schaufeli, 1996).

Ethical considerations

This study received ethical approval from the Institutional Review Board of City University of Macau (approval no. FIAD-20240218-003), in accordance with the Declaration of Helsinki and relevant institutional and national regulations. The approved protocol covered all procedures involving human participants, including recruitment, consent and implementation. All participants provided written informed consent after being fully briefed on the study’s purpose, confidentiality safeguards and voluntary nature. They were assured that participation would involve neither rewards nor penalties.

Data analysis methods

This study uses a mixed-methods approach, combining qualitative and quantitative techniques to minimise biases and weaknesses in data collection (Creswell and Poth, 2016). The analytical methods and research questions are illustrated in Fig. 5.

Fig. 5
figure 5

Brief overview of this study.

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Quantitative data analysis

Burnout survey data were analysed using the SPSS software (SPSS, IBM Version 29). Paired-sample t-tests assessed changes in burnout from baseline to post-intervention, measuring intervention effectiveness. This study used G*Power 3.1 to calculate the minimum required sample size. Based on an assumed medium effect size (Cohen’s d = 0.5), significance level (α = 0.05) and power (0.8), the minimum required sample size was calculated to be 34 participants, thus confirming that the sample size (38) meets the minimum requirements. To examine the effect of age on the effectiveness of the HDT intervention, participants were divided into two groups: Group 1 (employees aged 35 years or younger) and Group 2 (employees older than 35 years). Data from these groups were analysed using a two-way repeated-measures ANOVA. Choosing 35 years old as the age division point considers that in the Chinese workplace, it is commonly regarded as a key milestone in one’s career development (Zhou, 2007; Xiayan et al., 2025).

Qualitative data analysis

The qualitative data collected for this study were analysed using Braun and Clarke’s (2006) thematic analysis. The qualitative data consisted of (1) doodle journals completed by 38 participants during the four-week intervention; (2) observation notes and discussion transcripts from three workshops; (3) transcripts of one-to-one semi-structured interviews conducted with 38 participants; (4) transcripts of in-depth one-on-one interviews with 12 of the employees who showed the most significant improvement in burnout; and (5) interviews with four company executives. The research team began by reading through all the materials several times to gain a general understanding for future coding. The two authors used an open coding approach, going through the text line by line and labelling content that was relevant to the research question or appeared frequently. The two authors compared the results of independent coding and improved the coding system through discussion. The three authors then collaborated to categorise and synthesise the coding, eventually refining the three main themes. In the later stages of thematic analysis, the research team selected representative quotes from each subtheme to represent the participants’ real-life experiences and to back up the findings. The complete coding results are shown in Table 4.

Results

Quantitative findings

Using data from 38 baseline and 38 post-test questionnaires, the quantitative study determined that (1) the HDT as a burnout intervention positively impacts grassroots staff in SOEs, and (2) age influences the effectiveness of the HDT as a burnout intervention.

Baseline characteristics and engagement patterns of participants

Supplementary Table S4 presents the descriptive statistics of the sample. In terms of gender, 47.4% of the participants are male, and 52.6% are female. More than 52.6% of participants are 35 or younger, and 84.2% hold a bachelor’s degree or higher. In terms of work experience, 31.6% have less than five years, 42.1% have 5–15 years and 26.3% have over 15 years. Additionally, 68.4% of the participants began their careers at this enterprise.

The mean scores of the Emotional Exhaustion and Cynicism subscales at baseline were above 3, indicating that some degree of burnout was present before the intervention. Furthermore, 31.6% of the participants had higher scores on all three subscales (with the Professional Efficacy subscale scored in reverse), reflecting more severe burnout.

The HDT implementation demonstrated a high overall completion rate, with notable engagement and varied usage patterns among participants. The completion rate was 97.4%, with 37 participants completing all four weeks of diaries, and one participant completing three weeks due to personal health reasons. Among the participants, 28 exclusively chose structured doodling, while one opted solely for freehand drawing. Of the remaining nine participants who adopted a hybrid approach (combining structured doodle and freehand doodle), three selected freehand doodles for the first two weeks and structured doodle for the last two weeks; one opted for freehand drawing in the final week; two used freehand drawing in the first week; and three switched to freehand drawing during one or two intermediate weeks.

For the Reflection Module, the completion rate was 73.5%, with 17 participants providing written reflections on their doodles across all four weeks. One participant did not use the textual reflection section, citing it as overly time-consuming. Regarding the six structured doodling scenarios, no participant repeated the same activity throughout all four weeks. Furthermore, 63.2% of participants documented more burnout intervention activities in the fourth week compared to the baseline, with 10 participants noting more than three activities in the last week.

Positive effects as a burnout intervention

This study conducted paired-sample t-tests to compare changes in outcome variables from baseline to post-intervention. Table 2 and Fig. 6A display the scores on the three subscales of the MBI-GS at baseline and after four weeks of applying the HDT. The data indicate significant positive changes across all three subscales of the MBI-GS. Scores for ‘Emotional Exhaustion’ significantly decreased (N = 38, Cohen’s d = 0.32, 95% CI: −0.49 to −0.28, p < 0.001). Similarly, ‘Cynicism’ scores also showed a significant reduction (N = 38, Cohen’s d = 0.32, 95% CI: −0.36 to −0.14, p < 0.001), while ‘Professional Efficacy’ scores significantly increased (N = 38, Cohen’s d = 0.35, 95% CI: 0.15–0.38, p < 0.001). These results demonstrate the positive effects of the HDT as a burnout intervention.

Table 2 Outcomes scores of MBI subscales with comparison to baseline (N = 38).
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Fig. 6: Outcomes scores.
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A MBI subscales with comparison to baseline (N = 38), B Means for the ‘Cynicism’ subscale by times and groups. EE emotional exhaustion, CY cynicism, PE professional efficacy, T1 baseline, T2 end of programme.

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Impacts on different age groups

During the HDT development phase, workshop and interview data indicated that younger employees were more willing to engage with the toolkit than older employees. To determine if the users’ age influenced the effectiveness of the HDT’s burnout intervention, this study performed two-factor repeated-measures ANOVA on each of the three subscales of MBI-GS (see Table 3). The respondents (N = 38) were categorised into two groups: Group 1, employees 35 years old and younger (N = 20), and Group 2, employees older than 35 years (N = 18). The findings confirmed that each group followed a normal distribution, and that the variance chi-square test was satisfied between the two groups at each time point.

Table 3 Results of two-factor repeated ANOVA on the MBI subscales.
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First, the effect of age on the ‘Emotional Exhaustion’ subscale was examined. The analysis revealed no interaction between group and time (Ftime × group = 0.013, p = 0.909), indicating that age did not influence the intervention effect on ‘Emotional Exhaustion’. Similarly, the interaction between time and group in the ‘Professional Efficacy’ subscale was not statistically significant (Ftime × group = 0.019, p = 0.892).

In contrast, a significant interaction was observed for the ‘Cynicism’ subscale between group and time (Ftime × group = 5.759, p = 0.022), necessitating a closer examination of individual effects. At baseline, Group 1 had a mean score of 1.214 points higher than Group 2 (F = 4.801, η2p = 0.118). Post-intervention, as illustrated in Fig. 6B, the difference between the mean scores between Group 1 and Group 2 decreased, with Group 1 having a mean score 0.976 points higher than Group 2 (F = 3.330, η2p = 0.090). The effect size was greater for Group 1, suggesting that Group 1 experienced a more substantial benefit from the intervention compared to Group 2.

Qualitative findings

Based on observations and dialogue in three workshops, one-to-many interviews with 38 participants, one-to-one semi-structured interviews with 12 participants, and data from interviews with four company executives, the HDT was effective. We present the findings in three themes based on the thematic analysis. Table 4 contains detailed subthemes and quotes. The intervention encouraged the participants to engage in CBT through doodling, fostered social interactions and enhanced business management.

Table 4 Theme analysis and data coding.
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Cognitive behavioural changes induced by the HDT

General feedback from participants indicated that the four weeks of doodling activities significantly helped them recognise their negative emotions and focus on positive moments in their lives. Engaging in doodling generated positive emotions both during the recording and reviewing of their doodles. These emotions were explicitly reflected in changes such as improved work status, clarified work goals, heightened sense of career fulfilment, a more active lifestyle and greater affirmation of their work efforts. Participant L08 mentioned that HDT served as a trigger, motivating him to engage more actively in the intervention:

‘As soon as Friday comes around, I start thinking about what I should doodle in my weekly diary. This makes me pay more attention to the little things in my life and focus on happy moments, like having dinner with my family… Sometimes, after doodling on Fridays, I look at pictures of potluck dinners and chats, which reminds me to meet up with my friends more often on the weekends. These little things are fun and divert my attention, significantly improving my work ethic’.

[(L08)]

Another participant reflected on how doodling evoked positive memories:

‘This week I doodled a puppy who gets up early every morning, then peeks at the end of my bed, waiting for me to get up. He shows his teeth and sneezes at me’.

[(L21)]

Thematic analysis on the effects of doodling on burnout revealed that high-frequency words like ‘enjoyable’, ‘fun’, ‘meaningful’ and ‘satisfying’ frequently appeared in participants’ feedback. These high-frequency words emerged from systematically coded of textual data from semi-structured interviews and doodle diaries. Initial open-ended coding indicated generally positive affective responses, suggesting that doodling has the potential to enhance positive emotions. These emotions were evident during the doodling process and when participants reviewed their four-week doodle diaries. The positive feedback corresponded with quantitative data improvements in ‘Emotional Exhaustion’ and ‘Cynicism’, highlighting the importance of examining the positive emotions generated during doodling to boost motivation and satisfaction at work. For example, some participants shared their experiences:

‘I didn’t realise how rich this month has turned out to be for me, I was expecting it to be pretty one-dimensional’.

[(L15)]

‘Hey everyone, I learned to cook this week! I’m not trying to become a chef; cooking is more like a life lesson for me. It helps reduce stress, and I highly recommend you all give it a try too’.

[(L18)]

Effects of doodle application

The research findings highlighted the positive effects of the three main modules—structured doodling, free-handed doodling and reflection—on participants’ mood and cognition. The structured doodling module was particularly well-received for its simplicity and instructional design. This is evidenced by the widespread use of the colouring activity, with all 38 retrieved diaries containing colouring traces (Fig. 7a). Participants appreciated that the colouring activity was straightforward and did not require advanced drawing skills, noting that it helped them generate positive thoughts, helping them to de-stress and relax. For instance, some participants mentioned in the interviews:

‘This kind of doodling can reduce stress, just like reading, it’s a process of quietening the mind’.

[(L17)]

Fig. 7: Partial data of HDT.
figure 7

a Structured doodle module data, b freehand doodle module data and c L01 freehand doodle module data.

Full size image

The freehand doodling module, which offered more creative freedom, showed mixed results. A total of 28 diaries had blank sections for freehand doodling, indicating some participants lacked confidence in their drawing abilities (e.g. L06). However, younger participants engaged more actively and creatively in this module, suggesting that they are more receptive to and motivated by novel interventions. One participant shared:

‘The one I drew for my children’s homework; they criticized my drawing for a long time. I drew it ugly, so I didn’t want to draw it’.

[(L06)]

Among the ten participants who engaged in the freehand doodle (Fig. 7b), eight were under the age of 35 (L01, L10, L14, L26, L27, L31, L35 and L36). These younger participants displayed greater motivation and enthusiasm, with their structured doodle modules being more colourful and thoughtfully designed. For instance, a participant with a design background used freehand doodling extensively (Fig. 7c), commenting:

‘Doodling allows me to calm down and immerse myself in the drawing. As a drawer, doodling is a form of relaxation for me’.

‘I think doodling is just a great way to forget about work worries because you can concentrate very well while doodling. It’s also a great way to record memorable moments in the week. Just like tweeting, doodling is also a way to record my life’.

[(L01)]

These qualitative findings support the quantitative results, suggesting that age influences the effectiveness of the HDT intervention. Specifically, the intervention seems to be more beneficial for younger employees. Additionally, the textual reflection area was valued for its role in memory supplementation, helping participants record and reflect on key events, thereby enhancing their perceptions of and satisfaction with their personal achievements.

The dual role in facilitating social interaction and enterprise management

During interviews, it was found that HDT served as a personal psychological intervention and unexpectedly facilitated social interactions among team members. The act of sharing their doodles facilitated mutual curiosity and communication between participants, which enhanced team cohesion despite participants being from different departments and having typically limited interaction. This informal exchange allowed employees to discuss personal hobbies and lives, contributing to a more congenial working relationship. However, some participants expressed concerns that such informal communication might be seen as unprofessional. One participant noted:

‘A good working atmosphere can alleviate burnout, and the doodle activity provides an opportunity for relaxed communication’.

[(L08)]

The company executives viewed the HDT as a cost-effective and easy-to-implement strategy for enhancing workplace environments and gaining insights into employees’ psychological state, especially within SOEs with limited budgets. While executives acknowledge that the HDT aids in reflecting employee sentiment, they noted that it does not address the root causes of burnout. They stressed the need for more comprehensive, broader structural reforms to substantially improve employees’ mental health and workplace satisfaction. Additionally, the HDT has been formally adopted by the company’s Human Resources Department, with templates made available in the office for free. This initiative supports employees in maintaining their mental health and encourages creative expression daily.

Discussion

This study assessed the effectiveness of the HDT, an intervention combining Doodle Theory and CBT Theory, in mitigating employee burnout within a Chinese SOE. Using a mixed-method approach with pre- and post-tests over four weeks, this study goes beyond previous studies that relied solely on quantitative data, thoroughly exploring the psychological and behavioural effects of doodling (Tran et al., 2023). The findings indicate that merging doodling with CBT provides a unique emotional outlet for participants and broadens the scope of psychological intervention, enriching the theoretical understanding of intervention dynamics in organisational settings.

Theoretical implications

This study advances the use of CBT in burnout interventions by demonstrating the effectiveness of combining CBT with doodling. Traditionally, CBT focuses on verbal communication to address cognitive and behavioural issues, but this study reveals the value of incorporating non-verbal interventions, such as doodling. This integration supports existing psychotherapy theories and underscores the role of visual arts in mental health interventions (Haeyen and Staal, 2021).

The HDT, which merges doodling and CBT, facilitated three significant cognitive-behavioural changes, improving burnout outcomes. First, doodling served as both a relaxation technique and a behavioural cue, encouraging participants to integrate burnout-reducing behaviours in their daily lives. This self-directed behaviour fostered the engagement, as participants linked their colouring activities to personal effort (Van der Klink et al., 2001). Second, the activities shifted participants’ focus from negative to positive aspects of their work and personal lives, enhancing their well-being. This positive shift, supported by reflective colouring, improved their perceptions of professional life, with the findings by Pan et al. (2023). Finally, the study found that CBT enhanced job satisfaction and career fulfilment by boosting participants’ self-efficacy.

The findings of this study support the theoretical framework established by existing research on complementary therapies aimed at cultivating a healthy workplace mindset and alleviating burnout (Dike et al., 2021a; O’Donohue and Fisher, 2009). Prior research has validated the effectiveness of cognitive behavioural art therapy (CBAT), which integrates art therapy with CBT (Gray, 2019; Rubin, 2012). Monson (2022) highlighted CBAT’s benefit for adults with mood disorders, noting art therapy’s ability to facilitate verbal and non-verbal expression of thoughts and emotions, while enhancing coping skills. Furthermore, a combined intervention of doodling and CBT has been shown to improve resilience and promote positive attitudes among at-risk adolescents (Sitzer and Stockwell, 2015). This study builds on these findings by integrating doodling and CBT, thus expanding the scope of CBT-based combination therapies and confirming their effectiveness in addressing burnout within SOEs.

Beyond reinforcing psychotherapy research, these results also resonate with broader positive psychology frameworks, particularly Psychological Capital Theory. Psychological Capital Theory emphasises cultivating an individual’s positive psychological resources—self-efficacy, hope, optimism and resilience—to improve work performance and well-being (Dóci et al., 2023). The HDT intervention’s success in boosting participants’ self-efficacy and coping skills can be interpreted as an enhancement of their psychological capital. Prior studies have found that higher Psychological Capital is associated with lower workplace cynicism (Shrestha and Jena, 2021), supporting our finding that the HDT significantly reduced the cynicism subscale of burnout. By strengthening employees’ confidence and resilience, the intervention created a psychological buffer against stress, thereby fostering greater work engagement and emotional well-being. In this way, our study situates itself within positive psychology’s emphasis on building personal strengths to combat adverse outcomes, demonstrating that a creative CBT-based toolkit can develop employees’ internal resources and reduce negative work attitudes.

Moreover, the findings align with Job Crafting Theory, which posits that employees can proactively reshape their job tasks, relationships, or perceptions to improve person-job fit and find greater meaning in their work (Wrzesniewski and Dutton, 2001). Participants in this study were not passive recipients of a top-down intervention—they actively engaged with the HDT, co-creating their own coping toolkit and reframing daily work experiences through doodling diaries. This active involvement is akin to a job crafting process: by integrating an enjoyable reflective practice into their routine and altering how they interpreted work challenges, employees effectively ‘crafted’ a more positive work experience for themselves. Such self-initiated changes are known to help balance job demands and resources, thereby alleviating burnout (Slowiak and DeLongchamp, 2022). Consistent with job crafting research, our intervention led to increased personal engagement and a reduction in burnout, as employees gained a renewed sense of purpose and control over their work life. This convergence of evidence underscores the study’s theoretical contribution at the nexus of positive psychology and organisational behaviour. It illustrates how enhancing psychological capital and encouraging a form of job crafting through a low-cost, creative intervention can mitigate burnout and promote a healthier, more resilient workforce. In sum, the HDT’s efficacy is not only a testament to the power of combining CBT with art-based techniques, but it also exemplifies how developing positive mindsets and proactive behaviours in employees can advance theory and practice in occupational positive psychology.

Practical implications

From a practical perspective, the HDT provides a cost-effective and straightforward burnout management solution, making it particularly valuable in resource-constrained settings and offering a model that other businesses or organisations can replicate. Unlike previous organisational burnout interventions that have been criticised for lacking personal focus (Van der Klink et al., 2001), the doodling intervention in this study is designed as a personalised self-intervention tool. Its successful implementation demonstrates that it can significantly enhance employee mental health and job satisfaction, offering an effective mental health management strategy, especially in environments with limited resources.

This affordable doodling toolkit addresses burnout on three levels. First, as an art form, doodling has inherent stress-relieving and calming effects. Participants reported positive emotional feedback from the colouring activities, consistent with art therapy research showing that creative expression can reduce stress and foster emotional openness (Isis et al., 2024; Kalmanowitz and Ho, 2016). Secondly, the HDT facilitates CBT by enabling participants to document their daily experiences and work achievements, enhancing their sense of accomplishment and promoting reflective practices that decrease negative emotions and boost positivity and self-efficacy (Coward, 2022a; Tran et al., 2023). Lastly, doodling enhances social interactions in the workplace by providing a comfortable communication platform and environment, thereby strengthening team cohesion and demonstrating how the artistic interventions can enhance team dynamics (Glime, 2023; Salzano et al., 2013).

Doodling activities exhibit a ‘mirror’ effect, reflecting one’s past work state and serving as a snapshot of one’s work and life. Previous research on burnout interventions has concentrated on modifying employees’ psychological states through various methods, aimed at uplifting spirits or garnering positive feedback (Demerouti, 2015; Van der Klink et al., 2001). However, in this study, participants were not merely passive recipients of doodling-based burnout interventions. Instead, they actively engaged in a process of self-construction, co-creating their own toolkit and developing positive beliefs. This active engagement fosters a long-term, psychologically healthy workplace.

Moreover, both doodling exercises and CBT are effective in addressing negative and distorted beliefs. CBT instructs individuals to recognise, challenge and replace dysfunctional thoughts with more constructive beliefs, while doodling enhances positive emotions by stimulating the brain’s prefrontal lobe, linked to the reward system and diverting attention from negative thoughts (Curry and Kasser, 2005; Turturro and Drake, 2022). Thus, the combination of CBT and doodling reduces burnout by reducingthe tendency to generate negative thoughts (via doodling) while also replacing maladaptive thoughts (via CBT). This study demonstrates how doodling can transform the typically unappealing task of CBT into an intrinsically motivating activity, making the process of reshaping their perceptions both enjoyable and effective.

This study also found that HDT holds greater potential among younger users. Younger employees benefit significantly from HDT, particularly in terms of reducing Cynicism. This finding supports the views of Marchand et al. (2018) and Perrone et al. (2019), suggesting that younger individuals are more susceptible to occupational burnout. This susceptibility may arise from their early career stage, characterised by greater career uncertainty and challenges, leading to increased emotional fatigue and job burnout (Packirisamy et al., 2017). HDT significantly mitigates their Cynicism levels, thereby effectively alleviating burnout. Furthermore, findings from the qualitative research phase indicate that younger employees demonstrate higher willingness and interest in participating in HDT activities, including doodling, highlighting their inclination towards accepting and trying new intervention methods in the face of work stress and burnout. Organisational researchers suggest that implementing strategies tailored to combating Cynicism can enhance both work performance and prosocial behaviours (Bang and Reio, 2017). Therefore, it can be inferred that HDT, through CBT, not only reduces individual employee burnout levels but also fosters behaviours beneficial to both the organisation and others.

It is worth noting that the hierarchical structure and mianzi(face) culture of Chinese SOEs may affect the acceptability and effectiveness of interventions such as HDT (Xin et al., 2019). Without explicit support from management, employees may perceive HDT as alien or misaligned, limiting participation. Furthermore, an emphasis on mianzi often prevents employees from expressing stress or vulnerability, delaying recognition of burnout and reducing help-seeking (Lin and Zhao, 2016). Positioning tools such as professional development and securing leadership support can help legitimise participation and reduce stigma. Once top-level buy-in is achieved, the collectivist ethos can reinforce adoption, particularly if leaders see these practices as beneficial to team harmony. Accordingly, interventions need to be aligned with the cultural and structural dynamics of SOEs to promote effectiveness and sustainability.

Limitations

Although the HDT significantly reduces burnout among grassroots employees in SOEs, its implementation faces several challenges. A major limitation is the relatively small sample size and the focus on a single company, which may restrict the generalisability of the findings. Moreover, the absence of a control group limits the ability to draw firm causal conclusions, as the observed improvements may be influenced by external factors such as employees’ self-regulation or workplace dynamics. While purposive sampling and the maximum variation method were used to mitigate such confounders, future studies are encouraged to incorporate randomised controlled designs to enhance internal validity. Future research should explore the HDT in a broader range of industries and cultural contexts to verify its broader generalisability and the stability of its effects. Additionally, follow-up studies are necessary to evaluate the intervention’s long-term impact and determine its sustained effectiveness. While the HDT effectively mitigates burnout, the current toolkit only provides a structured colouring template, lacks the capability to track long-term behavioural changes in employees. To address this, it is recommended that the colouring template be updated regularly to increase the appeal of the Doodle activity and adapt to the evolving needs of employees. Moreover, collaboration with business managers and policymakers should progress from individual self-interventions to integrated organisational-level interventions. Finally, given that creative activities generate substantial image data, future research could use semiotic analysis (Chandler, 2022) to examine the themes and symbols within these images. This qualitative approach could provide a deeper insight into the emotional and cultural meanings embedded in the images, providing a richer understanding of employees’ emotional states and the effectiveness of burnout interventions.

Conclusion

This study introduces a doodle-based employee career intervention toolkit to alleviate burnout among grassroots employees in Chinese SOEs. Empirical validation has shown that this toolkit demonstrates significant positive effects in reducing emotional exhaustion and cynicism, as well as enhancing career efficacy. By combining the principles of CBT with the innovative form of doodling, the HDT effectively aids employees in managing their mental health. As a low-cost and personalised self-intervention method, the HDT meets employees’ needs for emotional expression and stress reduction, and it fosters interpersonal interactions within the workplace, contributing to a more cohesive and supportive work environment. These findings highlight the potential for implementing personalised and cost-effective organisational burnout interventions. However, the research has limitations, including a small sample size and a lack of long-term follow-up testing. Future studies should expand the trials and evaluate the long-term effects of the intervention to confirm its sustainability and broader applicability. The research team also plans to collaborate further with business managers and policymakers to expand from individual self-intervention to comprehensive organisational-level interventions. Overall, this study offers new perspectives on workplace well-being, particularly within the constrained framework of Chinese SOEs. It demonstrates a scalable approach to alleviating burnout, a critical issue in today’s workplace. By providing evidence of the effectiveness of the HDT, this study contributed to the ongoing efforts to improve employee mental health and organisational efficiency.