1
|
Brotto LA, Basson R, Grabovac A, Chivers ML, Zdaniuk B, Bodnar TS, Weinberg J. Impact of mindfulness versus supportive sex education on stress in women with sexual interest/arousal disorder. J Behav Med 2024; 47:721-733. [PMID: 38668816 DOI: 10.1007/s10865-024-00491-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 04/09/2024] [Indexed: 08/02/2024]
Abstract
Low desire in women is the most common sexual difficulty, and stress has been identified as a significant predictor of symptoms. We evaluated a mindfulness-based cognitive therapy (MBCT) group treatment versus a sex education comparison group treatment (STEP) on self-reported stress and on the physiological stress response measured via morning-to-evening cortisol slope in 148 women with a diagnosis of sexual interest/arousal disorder (SIAD). Perceived stress decreased following treatment in both groups, and significantly more after MBCT. The cortisol slope was steeper (indicative of better stress system regulation) from pre-treatment to 6-month follow-up, with no differences between the groups. As an exploratory analysis, we found that the reduction in perceived stress predicted increases in sexual desire and decreases in sex-related distress for participants after MBCT only. These findings suggest that group mindfulness targeting women with low sexual desire leads to improvements in self-reported and physiological stress, with improvements in self-reported stress partially accounting for improvements in sexual desire and distress.
Collapse
Affiliation(s)
- Lori A Brotto
- Department of Obstetrics and Gynaecology, University of British Columbia, 2775 Laurel Street, 6th Floor, Vancouver, BC, V5Z 1M9, Canada.
| | - Rosemary Basson
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Andrea Grabovac
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | | | - Bozena Zdaniuk
- Department of Obstetrics and Gynaecology, University of British Columbia, 2775 Laurel Street, 6th Floor, Vancouver, BC, V5Z 1M9, Canada
| | - Tamara S Bodnar
- Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, Canada
| | - Joanne Weinberg
- Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, Canada
| |
Collapse
|
2
|
Biao D, Umoh K, Qiguang C, Xiaole W, Ting F, Yuqian Y, Jinchao Z, Fushui L. The Role of Mindfulness Therapy in the Treatment of Chronic Pain. Curr Pain Headache Rep 2024:10.1007/s11916-024-01284-w. [PMID: 38951466 DOI: 10.1007/s11916-024-01284-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2024] [Indexed: 07/03/2024]
Abstract
PURPOSE OF REVIEW Mindfulness therapy is a widely used treatment for many diseases and has been shown to improve pain-related functions. There is growing support for the use of psychotherapy in the treatment of chronic pain. While studies have shown a positive effect of mindfulness therapy, it is important to consider psychosocial factors as there are still a small number of studies that question its effectiveness. RECENT FINDINGS Based on current studies, mindfulness therapy involves cognitive factors related to chronic pain, both in terms of cognitive production and its impact on cognitive control. Psychological and neurobasic studies were reviewed to provide a deeper understanding of these components, which include thought inhibition, attention deficit, pain catastrophizing, and self-efficacy. Mindfulness therapy has the potential to normalize psychology and nerves, and increase internal and external connectivity to work networks related to stress perception, cognition, and emotion. However, further research is needed to fully understand its effects. By exploring the relationship between mindfulness therapy and chronic pain. This review provides a new avenue for future research in psychotherapy for patients with chronic pain.
Collapse
Affiliation(s)
- Deng Biao
- School of Clinical Medicine, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - KuyikAbasi Umoh
- School of Clinical Medicine, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Cao Qiguang
- Apartment of Acupotomy and Chiropractic, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Wang Xiaole
- Apartment of Acupotomy and Chiropractic, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China.
| | - Fang Ting
- Apartment of Acupotomy and Chiropractic, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Yang Yuqian
- School of Clinical Medicine, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Zhu Jinchao
- School of Clinical Medicine, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Liu Fushui
- Apartment of Acupotomy and Chiropractic, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China.
| |
Collapse
|
3
|
Tang M, Ann-Yi S, Zhukovsky DS, Fellman B, Bruera E. Distress, demoralization, and fulfillment among palliative care providers during the COVID-19 pandemic. Palliat Support Care 2024; 22:482-486. [PMID: 38037463 DOI: 10.1017/s1478951523001803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
OBJECTIVES Prolonged distress is a risk factor for burnout among health-care providers (HCP) and may contribute to demoralization. We examined sources of distress during the COVID-19 pandemic and associations with demoralization. METHODS This prospective cross-sectional survey of HCP was conducted among palliative care providers of an academic medical center. Participants completed a survey evaluating sources of distress and the Demoralization Scale-II (DS-II) to measure the intensity of demoralization. RESULTS Of 106 eligible participants, 74 (70%) completed the survey. DS-II median (range) score was 2 (0-19). There were no statistically significant associations with demographic characteristics. Participants reported high rates of distress for multiple reasons and high rates of sense of fulfillment (90%) and satisfaction (89%) with their profession. SIGNIFICANCE OF RESULTS Our study identified high levels of distress but low demoralization rates. Further study to evaluate fulfillment and satisfaction as protective factors against demoralization and burnout is indicated.
Collapse
Affiliation(s)
- Michael Tang
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sujin Ann-Yi
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Donna S Zhukovsky
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bryan Fellman
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
4
|
Ong NY, Teo FJJ, Ee JZY, Yau CE, Thumboo J, Tan HK, Ng QX. Effectiveness of mindfulness-based interventions on the well-being of healthcare workers: a systematic review and meta-analysis. Gen Psychiatr 2024; 37:e101115. [PMID: 38737894 PMCID: PMC11086195 DOI: 10.1136/gpsych-2023-101115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 03/07/2024] [Indexed: 05/14/2024] Open
Abstract
Background Growing evidence attests to the efficacy of mindfulness-based interventions (MBIs), but their effectiveness for healthcare workers remains uncertain. Aims To evaluate the evidence for MBIs in improving healthcare workers' psychological well-being. Methods A systematic literature search was conducted on Medline, Embase, Cumulative Index for Nursing and Allied Health Literature, PsycINFO and Cochrane Central Register of Controlled Trials up to 31 August 2022 using the keywords 'healthcare worker', 'doctor', 'nurse', 'allied health', 'mindfulness', 'wellness', 'workshop' and 'program'. Randomised controlled trials with a defined MBI focusing on healthcare workers and quantitative outcome measures related to subjective or psychological well-being were eligible for inclusion. R V.4.0.3 was used for data analysis, with the standardised mean difference as the primary outcome, employing DerSimonian and Laird's random effects model. Grading of Recommendations, Assessment, Development and Evaluation framework was used to evaluate the quality of evidence. Cochrane's Risk of Bias 2 tool was used to assess the risk of bias in the included studies. Results A total of 27 studies with 2506 participants were included, mostly from the USA, involving various healthcare professions. MBIs such as stress reduction programmes, apps, meditation and training showed small to large effects on anxiety, burnout, stress, depression, psychological distress and job strain outcomes of the participants. Positive effects were also seen in self-compassion, empathy, mindfulness and well-being. However, long-term outcomes (1 month or longer postintervention) varied, and the effects were not consistently sustained. Conclusions MBIs offer short-term benefits in reducing stress-related symptoms in healthcare workers. The review also highlights limitations such as intervention heterogeneity, reduced power in specific subgroup analyses and variable study quality. PROSPERO registration number CRD42022353340.
Collapse
Affiliation(s)
- Natasha Yixuan Ong
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Finn Jing Jie Teo
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jane Zi Ying Ee
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chun En Yau
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Julian Thumboo
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Health Services Research Unit, Singapore General Hospital, Singapore
- SingHealth Duke-NUS Medicine Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - Hiang Khoon Tan
- Singhealth Duke-NUS Global Health Institute, Singapore
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore
| | - Qin Xiang Ng
- Health Services Research Unit, Singapore General Hospital, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| |
Collapse
|
5
|
Zhang L, Wu Y, Jing S, Liu X, Ren T, Liu X, Dai Z, Fu J, Chen X, Xiao W, Huang Y, Wang H, Wang W, Gu X, Ma L, Zhang S, Yu Y, Li L, Su X, Qiao Y. The second dose of COVID-19 vaccine booster hesitancy among health care workers in China: A multicenter cross-sectional study. Am J Infect Control 2024; 52:525-532. [PMID: 38007100 DOI: 10.1016/j.ajic.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND The COVID-19 outbreak in China exposed health care workers (HCWs) to an increased risk of infection. The acquired immunity rapidly diminishes after the previous COVID-19 vaccination and the second booster vaccination has been recommended in several countries. HCWs are a priority group for vaccination because they are at increased risk of being infected, however, a certain amount of HCWs were hesitant. METHODS The survey was conducted among 5805 HCWs in China from January 5 to February 9, 2023. Questionnaire included sociodemographic information, COVID-19-related variables, psychological factors, and the COVID-19 vaccine hesitancy scale. Multiple logistic regression analysis was used to assess the influencing factors of the second dose of COVID-19 vaccine booster hesitancy. RESULTS 42.2% of HCWs self-reported having the second dose of COVID-19 vaccine booster hesitancy. Occupations, years of working, COVID-19 infection status were associated with less vaccine hesitancy. HCWs who had received 3 doses of COVID-19 vaccine were less likely to be hesitant compared to those had not received. HCWs with PTSD symptoms and anxiety symptoms were more likely to be hesitant. No relation was observed between COVID-19 vaccine booster hesitancy and age, marriage, salary, and perceived an increased risk of COVID-19 infection due to work (all P > 0.05). CONCLUSIONS A considerable proportion of HCWs were hesitant to accept the second dose of the COVID-19 booster vaccine. Incorporating vaccine knowledge and new evidence into routine health educations and procedures to raise confidence and reduce complacency may be effective and feasible in promoting the vaccination and implementing future vaccination programs.
Collapse
Affiliation(s)
- Ling Zhang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yijin Wu
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shu Jing
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xin Liu
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Tianrui Ren
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaoyang Liu
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhenwei Dai
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jiaqi Fu
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xu Chen
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Weijun Xiao
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yiman Huang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Hao Wang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Wenjun Wang
- School of Nursing, Jining Medical University, Jining, Shandong, China
| | - Xiaofen Gu
- Affiliated Tumor Hospital, Xinjiang Medical University, Urumqi, China
| | - Li Ma
- Public Health School, Dalian Medical University, Dalian, China
| | - Shaokai Zhang
- Henan Cancer Hospital, Affiliate Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanqin Yu
- The First Affiliated Hospital of Baotou Medical College, Inner Mongolia, China
| | - Li Li
- Department of Clinical Research, the First Affiliated Hospital of Jinan University, Guangdong, China
| | - Xiaoyou Su
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
| | - Youlin Qiao
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; Department of Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| |
Collapse
|
6
|
Bhat SG, Nagaraj M, Balentine C, Hogan T, Meier J, Prince H, Abdelfattah K, Zeh H, Levi B. Assessing a Structured Mental Fitness Program for Academic Acute Care Surgeons: A Pilot Study. J Surg Res 2024; 295:9-18. [PMID: 37956507 DOI: 10.1016/j.jss.2023.09.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 08/22/2023] [Accepted: 09/18/2023] [Indexed: 11/15/2023]
Abstract
INTRODUCTION There is a well-established positive correlation between improved physician wellness and patient care outcomes. Mental fitness is a component of wellness that is understudied in academic medicine. We piloted a structured mental fitness Positive Intelligence (PQ) training program for academic surgeons, hypothesizing this would be associated with improvements in PQ scores, wellness, sleep, and trainee evaluations. METHODS This is a single-institution, prospective, mixed-methods pilot study. All active Burn/Trauma/Acute & Critical Care Surgical faculty and fellows in our division were offered the PQ program and the option to participate in this research study. The 6-wk program consists of daily exercises on a smartphone application, weekly readings, and small-group meetings with a trained mindfulness coach. Study outcomes included changes in pretraining versus post-training PQ scores, sleep hygiene, wellness, and teaching scores. A Net Promoter Score was calculated to measure user overall experience (range -100 to 100; positive scores being supportive). For secondary analysis, participants were stratified into high versus low user groups by "muscle" scores, which were calculated by program use over time. A postintervention focus group was also held to evaluate perceptions of wellness and experience with the PQ program. RESULTS Data were analyzed for 15 participants who provided consent. The participants were primarily White (73.3%), Assistant Professors (66.7%) with Surgical Critical Care fellowship training (86.7%), and a slight female predominance (53.3%). Comparison of scores pretraining versus post-training demonstrated statistically significant increases in PQ (59 versus 65, P = 0.004), but no significant differences for sleep (24.0 versus 29.0, P = 0.33) or well-being (89.0 versus 94.0, P = 0.10). Additionally, there was no significant difference in teaching evaluations for both residents (9.1 versus 9.3, P = 0.33) and medical students (8.3 versus 8.5, P = 0.77). High versus low user groups were defined by the median muscle score (166 [Interquartile range 95.5-298.5]). High users demonstrated a statistically higher proportion of ongoing usage (75% versus 14%, P < 0.05). The final Net Promoter Score score was 25, which demonstrates program support within this group. Focus group content analysis established eight major categories: current approaches to wellness, preknowledge, reasons for participation, expected gains, program strengths, suggestions for improvement, recommendations for approaches, and sustainability. CONCLUSIONS Our pilot study highlighted certain benefits of a structured mental fitness program for academic acute care surgeons. Our mixed-methods data demonstrate significant improvement in PQ scores, ongoing usage in high user participants, as well as interpersonal benefits such as improved connectedness and creation of a shared language within participants. Future work should evaluate this program on a higher-powered scale, with a focus on intentionality in wellness efforts, increased exposure to mental fitness, and recruitment of trainees and other health-care providers, as well as identifying the potential implications for patient outcomes.
Collapse
Affiliation(s)
- Sneha G Bhat
- Burns/Trauma/Acute & Critical Care Division, University Of Texas Southwestern Medical Center, Dallas, Texas.
| | - Madhuri Nagaraj
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Courtney Balentine
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Timothy Hogan
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jennie Meier
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Hillary Prince
- Burns/Trauma/Acute & Critical Care Division, University Of Texas Southwestern Medical Center, Dallas, Texas
| | - Kareem Abdelfattah
- Burns/Trauma/Acute & Critical Care Division, University Of Texas Southwestern Medical Center, Dallas, Texas
| | - Herbert Zeh
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Benjamin Levi
- Burns/Trauma/Acute & Critical Care Division, University Of Texas Southwestern Medical Center, Dallas, Texas
| |
Collapse
|
7
|
Brintz CE, Polser G, Coronado RA, French B, Faurot KR, Gaylord SA. Are Formal and Informal Home Mindfulness Practice Quantities Associated With Outcomes? Results From a Pilot Study of a Four-Week Mindfulness Intervention for Chronic Pain Management. GLOBAL ADVANCES IN INTEGRATIVE MEDICINE AND HEALTH 2024; 13:27536130241236775. [PMID: 38434590 PMCID: PMC10906052 DOI: 10.1177/27536130241236775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 01/19/2024] [Accepted: 02/13/2024] [Indexed: 03/05/2024]
Abstract
Background The association between home mindfulness practice quantity in standard length mindfulness-based interventions (MBIs) and chronic pain outcomes is variable. Few studies focus on abbreviated MBIs (< 8 weeks) and distinguish between formal guided practices and informal practices in daily life. Objectives To characterize home mindfulness practice and explore associations between home practice quantity and pre-to-post-outcome changes after an MBI for chronic pain. Methods In this single-arm study, 21 adults with chronic pain (mean age = 54 years, 81% White, mean pain duration = 7 years) completed an MBI with four weekly group sessions. Pre and post self-report measures of pain intensity/interference, physical function, depression, anxiety, positive affect, sleep disturbance (all PROMIS measures), and pain acceptance, catastrophizing, perceived stress and mindfulness were completed, along with daily surveys of formal (mindfulness of breath, body scan) and informal (breathing space, mindfulness of daily activities) practice. Bivariate correlations and multivariable regression models were used to assess the association between days and minutes of practice and change in outcomes. Results On average, formal practice was completed on 4.3 days per week and 13.5 minutes per day. Informal practice was completed on 3.5 days per week and 8.6 minutes per day. Formal practice was not significantly correlated with outcomes (Spearman's ρ = |.01|-|.32|), whereas informal practice was correlated with multiple outcomes (ρ = |.04|-|.66|). Number of days practiced informally was associated with improved pain interference, physical function, sleep disturbance, and catastrophizing (p's ≤ .05). Number of minutes practiced informally was associated with improved pain interference, anxiety, positive affect, and catastrophizing (p's ≤ .05). Conclusion Informal home practice quantity, but not formal practice quantity, is associated with improved outcomes during an abbreviated MBI for chronic pain. For these MBIs, it is important to evaluate the distinct roles of formal and informal practice. ClinicalTrialsgov Registration NCT03495856.
Collapse
Affiliation(s)
- Carrie E. Brintz
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Geneva Polser
- Department of Counseling Psychology, University of Denver, Denver, CO, USA
| | - Rogelio A. Coronado
- Vanderbilt Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Benjamin French
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Keturah R. Faurot
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Susan A. Gaylord
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| |
Collapse
|
8
|
Christensen AJ, Virnig JP, Case NL, Hayes SS, Heyne R, Taylor LA, Allen MP. Addressing Burnout in the Primary Care Setting: The Impact of an Evidence-Based Mindfulness Toolkit. Mil Med 2023; 189:64-70. [PMID: 37956332 DOI: 10.1093/milmed/usad277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/19/2023] [Accepted: 07/07/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Burnout is insidious and manifests over prolonged, repeated exposure to occupational stressors. There is a growing crisis among health care workers (HCWs) due to high levels of burnout and associated adverse outcomes. Identifying and addressing burnout can be problematic due to extensive variances of perceived occupational stressors across HCWs. PURPOSE Mindfulness-based training can enhance individual HCWs' abilities to perceive and constructively respond to stresses endemic in the health care environment. It can reduce the prevalence of burnout in the primary care setting. An evidence-based multimodal Mindfulness-Based Stress Reduction toolkit (MBSR TK) was designed, implemented, and evaluated for its impact on HCWs' self-reported stress levels (SRSL). IMPLEMENTATION STRATEGIES A pre-post-program evaluation explored the impact of a multimodal toolkit program on HCW SRSL with the Mini-Z burnout survey (MZBS). The MBSR TK program, consisting of a 45 minute introduction and 4 biweekly 15 minute mindfulness sessions offering acupressure, meditation, journaling for gratitude, and self-compassion was designed, delivered, and evaluated with HCWs across 2 military primary care clinics in South Texas. RESULTS All HCWs across 2 Air Force family practice clinics were invited to participate in all toolkit components. Seventy percent of all HCWs (N = 90) attended the introduction session. Thirty-seven (41%) HCWs completed pre and post MZBSs, and these responses are included in the data analysis section. The most represented HCWs were registered nurses, physician assistants, and technicians, respectively, at 24%, 21%, and 18%. The Wilcoxon Signed-Rank test examined changes in HCWs' SRSL after participation in the MBSR TK program. HCWs who attended the introduction plus one biweekly session showed statistically significant decreases in self-reported stress (P = 0.018) and burnout (P = 0.045) and a significant increase in electronic health record proficiency (P = 0.033). CONCLUSIONS Multimodal mindfulness toolkits to address SRSL burnout are practical, accessible, easily implemented, adaptive to any environment, and can decrease burnout with participation with just one 15 minute session. This MBSR TK implementation effectively lowered self-reported stress in HCWs who are repeatedly challenged to adapt to various settings around the world during peacetime, wars, natural disasters, humanitarian crises, and now, pandemics.
Collapse
Affiliation(s)
- Andrew J Christensen
- The Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of Health Sciences, Bethesda, MD 20841, USA
| | - Jonathan P Virnig
- The Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of Health Sciences, Bethesda, MD 20841, USA
| | - Nicole L Case
- The Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of Health Sciences, Bethesda, MD 20841, USA
| | - Stephanie S Hayes
- The Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of Health Sciences, Bethesda, MD 20841, USA
| | - Rebecca Heyne
- Joint Base San Antonio, Lackland, JBSA-Lackland, TX 78236, USA
| | - Laura A Taylor
- The Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of Health Sciences, Bethesda, MD 20841, USA
| | - Micheal P Allen
- The Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of Health Sciences, Bethesda, MD 20841, USA
- Joint Base San Antonio, Lackland, JBSA-Lackland, TX 78236, USA
| |
Collapse
|
9
|
Looper EM, Gleason P, Newnam K, Talbott E, Rouch TM. Feasibility of a Mindfulness Education Module for Nurses: An Evidence-Based Practice Project. J Contin Educ Nurs 2023; 54:516-523. [PMID: 37747143 DOI: 10.3928/00220124-20230918-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Nurse burnout is a well-defined problem that has been exacerbated by the coronavirus disease 2019 (COVID-19) pandemic and negatively affects nurses' mental health, nursing shortages, patient safety, and quality of care. Evidence shows that mindfulness is an effective strategy for managing stress and decreasing burnout among nurses. This article describes an evidence-based practice project that translated this evidence into practice via a vetted mindfulness educational intervention for nurses on a pulmonary medicine unit and a medical intensive care unit. The goal of this project was to assess the feasibility of this educational intervention, processes, and outcomes with the goal to extend the project hospital-wide. Preintervention levels of nurse burnout were assessed using the validated Copenhagen Burnout Inventory. For both units, personal and work-related burnout were in the moderate range and patient-related burnout was in the mild range. Postintervention surveys completed by participant nurses and the nurse managers of both units supported the feasibility of this education module. Future implementation of annual mindfulness education was supported through both participant and administrative feedback. [J Contin Educ Nurs. 2023;54(11):516-523.].
Collapse
|
10
|
Bagereka P, Ameli R, Sinaii N, Vocci MC, Berger A. Psychosocial-spiritual well-being is related to resilience and mindfulness in patients with severe and/or life-limiting medical illness. BMC Palliat Care 2023; 22:133. [PMID: 37697251 PMCID: PMC10494355 DOI: 10.1186/s12904-023-01258-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/06/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Improvement of psychosocial-spiritual well-being in patients with life-threatening or life-limiting illness is desirable. Resilience and mindfulness are considered to be helpful for enhancing psychosocial-spiritual well-being. Mindfulness-based interventions have been shown to promote resilience to stress and enhance well-being. However, in medical patients, evidence for the associations between mindfulness and resilience is lacking. We hypothesize patients with higher levels of psychosocial-spiritual well-being demonstrate greater resilience and mindfulness. METHODS 200 patients (mean age = 50.2, SD = 15.5) with serious and or life-limiting illnesses were recruited from the NIH Clinical Center. Patients completed a demographic questionnaire, the NIH-HEALS measure of psychosocial-spiritual well-being, the Connor-Davidson Resilience Scale (CD-RISC-10), and the Mindful Attention Awareness Scale (MAAS). The demographic questionnaire also included a question on current stress level. RESULTS The NIH-HEALS was positively correlated to CD-RISC-10 (rs=0.44, p < 0.001) and MAAS (rs=0.32, p < 0.001). These findings were consistent across all three NIH-HEALS factors. Additionally, CD-RISC-10 and MAAS demonstrated a meaningful relationship to each other (rs=0.46, p < 0.001). All three constructs were inversely related to current stress level. CONCLUSIONS Findings suggest that there is a meaningful relationship between psychosocial-spiritual well-being, mindfulness, and resilience. Mindfulness and resilience are positively correlated in a medical population. Clinical interventions aimed at enhancing psychosocial-spiritual well-being through mindfulness and resilience can be highly promising for patients with severe and or life limiting illness.
Collapse
Affiliation(s)
- Polycarpe Bagereka
- Pain and Palliative Care Service, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Rezvan Ameli
- Pain and Palliative Care Service, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Ninet Sinaii
- Biostatistics and Clinical Epidemiology Service, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Marcelli Cristine Vocci
- Pain and Palliative Care Service, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Ann Berger
- Pain and Palliative Care Service, Clinical Center, National Institutes of Health, Bethesda, MD, USA.
| |
Collapse
|
11
|
Shiri R, Nikunlaakso R, Laitinen J. Effectiveness of Workplace Interventions to Improve Health and Well-Being of Health and Social Service Workers: A Narrative Review of Randomised Controlled Trials. Healthcare (Basel) 2023; 11:1792. [PMID: 37372909 DOI: 10.3390/healthcare11121792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/30/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
Health and social service workers face high levels of workload and job stressors, which can affect their health and well-being. Therefore, it is important to evaluate the effectiveness of workplace interventions that aim to improve their mental and physical health outcomes. This review summarizes the findings of randomized controlled trials (RCTs) that examined the impact of different types of workplace interventions on various health indicators among health and social service workers. The review searched the PubMed database from its inception to December 2022 and included RCTs that reported on the effectiveness of organizational-level interventions and qualitative studies that explored barriers and facilitators to participation in such interventions. A total of 108 RCTs were included in the review, covering job burnout (N = 56 RCTs), happiness or job satisfaction (N = 35), sickness absence (N = 18), psychosocial work stressors (N = 14), well-being (N = 13), work ability (N = 12), job performance or work engagement (N = 12), perceived general health (N = 9), and occupational injuries (N = 3). The review found that several workplace interventions were effective in improving work ability, well-being, perceived general health, work performance, and job satisfaction and in reducing psychosocial stressors, burnout, and sickness absence among healthcare workers. However, the effects were generally modest and short-lived. Some of the common barriers to participation in workplace interventions among healthcare workers were inadequate staff, high workload, time pressures, work constraints, lack of manager support, scheduling health programs outside work hours, and lack of motivation. This review suggests that workplace interventions have small short-term positive effects on health and well-being of healthcare workers. Workplace interventions should be implemented as routine programs with free work hours to encourage participation or integrate intervention activities into daily work routines.
Collapse
Affiliation(s)
- Rahman Shiri
- Finnish Institute of Occupational Health, P.O. Box 18, 00032 Helsinki, Finland
| | - Risto Nikunlaakso
- Finnish Institute of Occupational Health, P.O. Box 18, 00032 Helsinki, Finland
| | - Jaana Laitinen
- Finnish Institute of Occupational Health, P.O. Box 18, 00032 Helsinki, Finland
| |
Collapse
|
12
|
Tamminga SJ, Emal LM, Boschman JS, Levasseur A, Thota A, Ruotsalainen JH, Schelvis RM, Nieuwenhuijsen K, van der Molen HF. Individual-level interventions for reducing occupational stress in healthcare workers. Cochrane Database Syst Rev 2023; 5:CD002892. [PMID: 37169364 PMCID: PMC10175042 DOI: 10.1002/14651858.cd002892.pub6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND Healthcare workers can suffer from work-related stress as a result of an imbalance of demands, skills and social support at work. This may lead to stress, burnout and psychosomatic problems, and deterioration of service provision. This is an update of a Cochrane Review that was last updated in 2015, which has been split into this review and a review on organisational-level interventions. OBJECTIVES: To evaluate the effectiveness of stress-reduction interventions targeting individual healthcare workers compared to no intervention, wait list, placebo, no stress-reduction intervention or another type of stress-reduction intervention in reducing stress symptoms. SEARCH METHODS: We used the previous version of the review as one source of studies (search date: November 2013). We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PsycINFO, CINAHL, Web of Science and a trials register from 2013 up to February 2022. SELECTION CRITERIA We included randomised controlled trials (RCT) evaluating the effectiveness of stress interventions directed at healthcare workers. We included only interventions targeted at individual healthcare workers aimed at reducing stress symptoms. DATA COLLECTION AND ANALYSIS: Review authors independently selected trials for inclusion, assessed risk of bias and extracted data. We used standard methodological procedures expected by Cochrane. We categorised interventions into ones that: 1. focus one's attention on the (modification of the) experience of stress (thoughts, feelings, behaviour); 2. focus one's attention away from the experience of stress by various means of psychological disengagement (e.g. relaxing, exercise); 3. alter work-related risk factors on an individual level; and ones that 4. combine two or more of the above. The crucial outcome measure was stress symptoms measured with various self-reported questionnaires such as the Maslach Burnout Inventory (MBI), measured at short term (up to and including three months after the intervention ended), medium term (> 3 to 12 months after the intervention ended), and long term follow-up (> 12 months after the intervention ended). MAIN RESULTS: This is the second update of the original Cochrane Review published in 2006, Issue 4. This review update includes 89 new studies, bringing the total number of studies in the current review to 117 with a total of 11,119 participants randomised. The number of participants per study arm was ≥ 50 in 32 studies. The most important risk of bias was the lack of blinding of participants. Focus on the experience of stress versus no intervention/wait list/placebo/no stress-reduction intervention Fifty-two studies studied an intervention in which one's focus is on the experience of stress. Overall, such interventions may result in a reduction in stress symptoms in the short term (standardised mean difference (SMD) -0.37, 95% confidence interval (CI) -0.52 to -0.23; 41 RCTs; 3645 participants; low-certainty evidence) and medium term (SMD -0.43, 95% CI -0.71 to -0.14; 19 RCTs; 1851 participants; low-certainty evidence). The SMD of the short-term result translates back to 4.6 points fewer on the MBI-emotional exhaustion scale (MBI-EE, a scale from 0 to 54). The evidence is very uncertain (one RCT; 68 participants, very low-certainty evidence) about the long-term effect on stress symptoms of focusing one's attention on the experience of stress. Focus away from the experience of stress versus no intervention/wait list/placebo/no stress-reduction intervention Forty-two studies studied an intervention in which one's focus is away from the experience of stress. Overall, such interventions may result in a reduction in stress symptoms in the short term (SMD -0.55, 95 CI -0.70 to -0.40; 35 RCTs; 2366 participants; low-certainty evidence) and medium term (SMD -0.41 95% CI -0.79 to -0.03; 6 RCTs; 427 participants; low-certainty evidence). The SMD on the short term translates back to 6.8 fewer points on the MBI-EE. No studies reported the long-term effect. Focus on work-related, individual-level factors versus no intervention/no stress-reduction intervention Seven studies studied an intervention in which the focus is on altering work-related factors. The evidence is very uncertain about the short-term effects (no pooled effect estimate; three RCTs; 87 participants; very low-certainty evidence) and medium-term effects and long-term effects (no pooled effect estimate; two RCTs; 152 participants, and one RCT; 161 participants, very low-certainty evidence) of this type of stress management intervention. A combination of individual-level interventions versus no intervention/wait list/no stress-reduction intervention Seventeen studies studied a combination of interventions. In the short-term, this type of intervention may result in a reduction in stress symptoms (SMD -0.67 95%, CI -0.95 to -0.39; 15 RCTs; 1003 participants; low-certainty evidence). The SMD translates back to 8.2 fewer points on the MBI-EE. On the medium term, a combination of individual-level interventions may result in a reduction in stress symptoms, but the evidence does not exclude no effect (SMD -0.48, 95% CI -0.95 to 0.00; 6 RCTs; 574 participants; low-certainty evidence). The evidence is very uncertain about the long term effects of a combination of interventions on stress symptoms (one RCT, 88 participants; very low-certainty evidence). Focus on stress versus other intervention type Three studies compared focusing on stress versus focusing away from stress and one study a combination of interventions versus focusing on stress. The evidence is very uncertain about which type of intervention is better or if their effect is similar. AUTHORS' CONCLUSIONS Our review shows that there may be an effect on stress reduction in healthcare workers from individual-level stress interventions, whether they focus one's attention on or away from the experience of stress. This effect may last up to a year after the end of the intervention. A combination of interventions may be beneficial as well, at least in the short term. Long-term effects of individual-level stress management interventions remain unknown. The same applies for interventions on (individual-level) work-related risk factors. The bias assessment of the studies in this review showed the need for methodologically better-designed and executed studies, as nearly all studies suffered from poor reporting of the randomisation procedures, lack of blinding of participants and lack of trial registration. Better-designed trials with larger sample sizes are required to increase the certainty of the evidence. Last, there is a need for more studies on interventions which focus on work-related risk factors.
Collapse
Affiliation(s)
- Sietske J Tamminga
- Public and Occupational Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Societal Participation & Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Lima M Emal
- Public and Occupational Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Societal Participation & Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Julitta S Boschman
- Public and Occupational Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Societal Participation & Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Alice Levasseur
- Faculté des sciences de l'éducation, Université Laval, Québec, Canada
| | | | - Jani H Ruotsalainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Roosmarijn Mc Schelvis
- Public and Occupational Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Societal Participation & Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Body@Work, Research Center on Work, Health and Technology, TNO/VUmc, Amsterdam, Netherlands
| | - Karen Nieuwenhuijsen
- Public and Occupational Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Societal Participation & Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Henk F van der Molen
- Public and Occupational Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Societal Participation & Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| |
Collapse
|
13
|
Argyriadis A, Ioannidou L, Dimitrakopoulos I, Gourni M, Ntimeri G, Vlachou C, Argyriadi A. Experimental Mindfulness Intervention in an Emergency Department for Stress Management and Development of Positive Working Environment. Healthcare (Basel) 2023; 11:healthcare11060879. [PMID: 36981535 PMCID: PMC10048260 DOI: 10.3390/healthcare11060879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/01/2023] [Accepted: 03/15/2023] [Indexed: 03/19/2023] Open
Abstract
Mindfulness-based interventions have increasingly gained the interest of health professionals in the last decade, especially practices that are short, economical, easily accessible, and physically, cognitively, and psychologically compelling. Nurses of Emergency Departments are a special, dynamic, but at the same time vulnerable group of health professionals who work in shifts and face multiple challenges. Considering the recent literature and the fact that stress and a hostile work environment are the top ranked health professionals’ challenges, there is a need for a further study of the use of mindfulness. This study aimed to investigate the effect of the application of mindfulness on nurses in the Emergency Department on several factors related to daily nursing practice and that directly affect these specific health professionals. This experimental study was performed on 14 participating nurses in the Emergency Department of a Public General Hospital in Athens, randomized into two groups: a control and an intervention group. The data collection tools were two digital smart devices, participatory observation, and semi-structured interviews. By practicing mindfulness meditation, the participating nurses in the intervention group showed improvement in their cognitive functions (attention, thinking, memory, concentration), professional interpersonal relationships, personal satisfaction and communication with patients and caregivers, sleep rate, negative emotions, and behaviors. The findings suggest that the application of mindfulness practices should be considered an easy, affordable, economical, accessible, and effective method that nurses can use to strengthen and empower themselves, enjoying its multiple benefits. The effectiveness of the application of mindfulness remains an important issue for future research in other health professionals as well.
Collapse
Affiliation(s)
- Alexandros Argyriadis
- School of Health Sciences, Frederick University, Nicosia 1036, Cyprus
- Correspondence: (A.A.); (A.A.)
| | - Louiza Ioannidou
- School of Education and Social Sciences, Frederick University, Nicosia 1036, Cyprus
| | | | - Maritsa Gourni
- School of Health Sciences, Frederick University, Nicosia 1036, Cyprus
| | - Georgia Ntimeri
- Hellenic Ministry of Health, Aristotelous 17, 10187 Athens, Greece
| | - Chrisi Vlachou
- School of Health Sciences, Frederick University, Nicosia 1036, Cyprus
| | - Agathi Argyriadi
- School of Education and Social Sciences, Frederick University, Nicosia 1036, Cyprus
- Correspondence: (A.A.); (A.A.)
| |
Collapse
|
14
|
Prado K, Robinson A, Chao YY. The Impact of Mindful Meditation on Health Care Workers During the COVID-19 Pandemic. J Nurse Pract 2023; 19:104513. [PMID: 36748057 PMCID: PMC9894608 DOI: 10.1016/j.nurpra.2022.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background The COVID-19 pandemic placed a spotlight on health care workers as the world struggled with mental health crises. As the number of COVID-19 cases rose exponentially, this also paralleled health care workers' perceived stress burden and increased risk for mental health trauma. This research project assessed the impact of a mobile mindful meditation application on health care workers' perceived stress levels during a pandemic. Methodology Through quasi-experimental design, researchers assessed the effect of using a mobile mindful meditation (Synctuition) app on health care workers' stress levels. Participants listened for 20 to 30 minutes daily for 30 days. Participants perceived stress levels were measured with Cohen's Perceived Stress Scale. Results Of the 100 participants, there was a statistically significant decrease in perceived stress reduction between the groups across various categories. The pretest perceived stress scores were reduced from moderate to low stress postintervention after using the mindful meditation application. Implications for Practice Reducing stress in health care workers can potentially increase the quality of life for health care workers. and lowering stress levels can potentially improve the quality of care provided.
Collapse
|
15
|
Liu H, Cai K, Wang J, Zhang H. The effects of mindfulness-based interventions on anxiety, depression, stress, and mindfulness in menopausal women: A systematic review and meta-analysis. Front Public Health 2023; 10:1045642. [PMID: 36699873 PMCID: PMC9869042 DOI: 10.3389/fpubh.2022.1045642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023] Open
Abstract
Background Mindfulness-based interventions (MBIs) are psychological interventions widely used in menopausal women. Currently, there is no evidence summary on the effectiveness of MBIs on anxiety, depression, stress, and mindfulness in menopausal women. This meta-analysis examines the effectiveness of MBIs in improving anxiety, depression, stress, and mindfulness scores in menopausal women. Methods A systematic search was conducted in PubMed, Embase, Web of Science, the Cochrane Library, CNKI (China National Knowledge Infrastructure), and Wanfang, using relevant terms such as MBIs as keywords and covering all studies published before March 13, 2022. The outcomes were anxiety, depression, stress, and mindfulness. The screening and extraction of data were conducted by two independent reviewers. Results A total of 1,138 menopausal women participated in 13 studies. Meta-analysis results showed that MBIs significantly reduced stress in menopausal women (SMD = -0.84, 95% CI: -1.64 to -0.05, p = 0.04), but no statistical differences were found in reducing anxiety (SMD = -0.40, 95% CI: -0.81 to 0.01, p = 0.06) and depression (SMD = -0.19, 95% CI: -0.45 to 0.07, p = 0.16) and in raising the scores of mindfulness (SMD = 0.37, 95% CI: -0.06 to 0.81, p = 0.09) in menopausal women. Conclusion MBIs may reduce stress in menopausal women, but their effect on improving anxiety, depression, and mindfulness needs further validation. Systematic review registration https://www.crd.york.ac.uk/prospero/#recordDetails.
Collapse
|
16
|
Sucich JT, Lehrer J, Breitbart V, Julliard KN. Mindfulness training for community-based psychotherapists: a feasibility study. Pilot Feasibility Stud 2022; 8:250. [PMID: 36494854 PMCID: PMC9733050 DOI: 10.1186/s40814-022-01205-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 11/09/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND While mindfulness training's feasibility has been assessed in many health care settings, the feasibility of teaching mindfulness to psychotherapists of various orientations for both self- and patient-care has not been explored. The objectives of this feasibility assessment were to determine the degree to which clinic psychotherapists were willing to complete a skills-based mindfulness training program; evaluate the acceptability of integrating mindfulness interventions into an urban community mental health clinic; examine the training's influence on both personal mindfulness practice and integration into patient care; and explore the impact of a support group following the training. METHODS Data on six aspects of feasibility were gathered through quantitative surveys, semi-structured qualitative interviews, and group observation and feedback, analyzed using grounded theory. RESULTS Sixteen therapists and one administrator attended at least one session of this voluntary program and responded to the associated surveys. At 1-year post-training, 7 participants had attended one or more group support sessions, and 4 more than 50% of sessions. The following factors were identified as contributing to the training's success: significant interest on the part of clinic staff to receive the training; diversity of the teaching staff, buy-in from clinic administration, provision of meditation scripts, role-play exercises, the variety of practices taught, and case presentations. Therapists indicated that the training helped them create a personal mindfulness practice, and several proceeded to integrate mindfulness into client sessions. A bi-weekly support group organized after the training encompassed group practice, discussion, case presentations, and information about trauma-sensitive mindfulness. Clinicians identified the following challenges to integrating mindfulness into sessions: lack of scripts in client languages other than English, the unacceptability of mindfulness to some clients' religious beliefs, the lack of appropriateness for clients facing ongoing psychosocial crises, the lack of interest on the part of some clients, and the time constraints posed by brief therapy sessions. CONCLUSIONS These findings indicate that such training may be feasible in community mental health settings given support from leadership and the presence of qualified facilitators within the organization. Adaptations to the training based on participant feedback can inform a larger scale trial that compares our protocol with another intervention in the treatment of a psychological disorder or condition identified by the participants as having responded favorably to the program.
Collapse
Affiliation(s)
- James T. Sucich
- grid.137628.90000 0004 1936 8753Family Health Centers at NYU Langone, 514 49th Street, Brooklyn, NY 11220 USA
| | - Jeremy Lehrer
- grid.21729.3f0000000419368729Columbia University, New York City, USA
| | - Vicki Breitbart
- grid.137628.90000 0004 1936 8753Silver School of Social Work, New York University, New York City, USA
| | - Kell N. Julliard
- grid.137628.90000 0004 1936 8753Family Health Centers at NYU Langone, 514 49th Street, Brooklyn, NY 11220 USA
| |
Collapse
|
17
|
Kulchar RJ, Haddad MB. Preventing burnout and substance use disorder among healthcare professionals through breathing exercises, emotion identification, and writing activities. JOURNAL OF INTERPROFESSIONAL EDUCATION & PRACTICE 2022; 29:100570. [PMID: 36349226 PMCID: PMC9633656 DOI: 10.1016/j.xjep.2022.100570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/17/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
Abstract
The introduction of the COVID-19 pandemic has placed additional strain on healthcare workers, inducing immense levels of stress and workplace burnout. Health care professionals are acutely susceptible to COVID-19 exposure, ultimately leading to elevated levels of anxiety and mental illness. For example, dental professionals are at high risk due to their close work with the oral cavity. To provide temporary relief to the stress, some may turn toward substance use, especially if that individual has some form of mental illness. To curb the onset of burnout and its byproduct of substance use disorder, it is crucial to be equipped with proper tools and healthy habits that can counteract extreme levels of stress. In this article, a time-effective, 3-step method is introduced, with each activity proven to lessen the symptoms of burnout. When followed, an individual can navigate burnout's symptoms through a healthy mind and body approach. Additionally, resources to find resilience-building and mentorship programs are provided. Common substance use support groups and information regarding group meetings and contact information are listed.
Collapse
|
18
|
Mindfulness–based positive transformative leadership development for health organisations. Leadersh Health Serv (Bradf Engl) 2022. [DOI: 10.1108/lhs-04-2022-0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Positive transformative leadership development practices in health care are perhaps the most important pathway that, collectively, can be pursued while heading towards a post-corona virus disease 2019 world, and race towards 2030. As a practitioner paper, based on front line and leadership experience, this study aims to argue that we need transformational leaders who will go beyond knowing to practice and implementation. While the findings from research is presented from different organisations and companies, they all have something in common – people. Hence, important lessons can be extrapolated to health-related organisations in the future.
Design/methodology/approach
The approach is based on practical research findings based on the literature. The approach uses real practical examples from companies and organisations to demonstrate the need for a new, radical way forward.
Findings
The findings from the literature clearly indicate that mindfulness-based transformative leadership development program is a worthwhile investment for decision-makers and organisations. A new transformative leader for the future of health care needs to be developed with care with investment in that development.
Research limitations/implications
Implications of this paper show that health-care organisations need to begin this journey. There is a paucity in the literature to demonstrate the implementation of mindfulness-based transformative leadership development programs.
Practical implications
Organisations of the future face even greater challenges brought about by intelligent technology, new pandemics and even tighter government regulation. The time to prepare for such eventualities is now. This is not a choice but an imperative for organisations to know what to do rather than react with regret.
Originality/value
There is a paucity in the health-care literature that tracks, measures, and reports on the long-term results of a mindfulness-based transformative leadership development program. This needs to be addressed, and health care should be a leader in the field of mindfulness and transformative leadership of the future.
Collapse
|
19
|
Malik H, Annabi CA. The impact of mindfulness practice on physician burnout: A scoping review. Front Psychol 2022; 13:956651. [PMID: 36204751 PMCID: PMC9530040 DOI: 10.3389/fpsyg.2022.956651] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/31/2022] [Indexed: 11/21/2022] Open
Abstract
Background Physician burnout is a growing phenomenon in current health systems worldwide. With the emergence of COVID-19, burnout in healthcare is progressively becoming a serious concern. Increasing emotional exhaustion, depersonalization, and reduced personal accomplishment threaten the effective delivery of healthcare. Compassion fatigue and moral injury are a considerable risk to the doctor-patient relationship. These issues can potentially be mitigated by mindfulness practice, which has shown promising results in reducing burnout, restoring compassion, and preventing moral injury in physicians. Methodology A scoping review was conducted to investigate the effects of mindfulness practice on physician burnout. High-ranking journals were targeted to analyze high-quality studies and synthesize common themes in the literature. Studies conducted on current practicing physicians were included. Mindfulness practice of varying forms was the main intervention studied. Gray literature and studies conducted only on allied health personnel were excluded from this review. Results 31 studies were included in this scoping review. Mindfulness practice decreased emotional exhaustion and depersonalization while improving mood, responses to stress, and vigor. Self-awareness, compassion, and empathy were also increased in study participants. From this review, four themes emerged: innovations in mindfulness practice, mindfulness and positive psychology, the impact of mindfulness on work and patient care, and barriers and facilitators to physician mindfulness practice. Conclusion Mindfulness was widely reported to benefit mental health and well-being, but the studies reviewed seemed to adopt a mono focus and omitted key considerations to healthcare leadership, systems-level culture, and practices. Mindfulness practice is a quintessential component of positive psychology and is inherently linked to effective leadership. A mindful and compassionate physician leader will play a crucial role in addressing current practice gaps, prioritizing staff mental health, and providing a supportive platform for innovation.
Collapse
Affiliation(s)
- Hani Malik
- Department of Family Medicine, Royal College of Surgeons in Ireland, Medical University of Bahrain, Manama, Bahrain
- *Correspondence: Hani Malik,
| | - Carrie Amani Annabi
- Graduate School of Healthcare Management, Royal College of Surgeons in Ireland-Dubai, Dubai, United Arab Emirates
| |
Collapse
|
20
|
Comparison of Mindfulness Interventions for Healthcare Professionals: A Mixed-Methods Study. Complement Ther Med 2022; 70:102864. [DOI: 10.1016/j.ctim.2022.102864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 11/22/2022] Open
|
21
|
Kakoschke N, Hassed C, Chambers R, Lee K. The importance of formal versus informal mindfulness practice for enhancing psychological wellbeing and study engagement in a medical student cohort with a 5-week mindfulness-based lifestyle program. PLoS One 2021; 16:e0258999. [PMID: 34673830 PMCID: PMC8530308 DOI: 10.1371/journal.pone.0258999] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 10/10/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Medical students commonly experience elevated psychological stress and poor mental health. To improve psychological wellbeing, a 5-week mindfulness-based lifestyle course was delivered to a first-year undergraduate medical student cohort as part of the core curriculum. This study investigated the effects of the program on mental health, perceived stress, study engagement, dispositional mindfulness, and whether any improvements were related to amount of formal and/or informal mindfulness practice. Methods Participants were first year undergraduate medical students (N = 310, 60% female, M = 18.60 years) with N = 205 individuals completing pre and post course questionnaires in a 5-week mindfulness-based lifestyle intervention. At pre- and post-intervention, participants completed the Mental Health Continuum-Short Form, the Perceived Stress Scale, the Utrecht Work Engagement Scale for Students, the Freiburg Mindfulness Inventory, and the Mindfulness Adherence Questionnaire. Results Mental health, perceived stress, study engagement, and mindfulness all improved from pre- to post-intervention (all p values < .001). Improvements on these outcome measures were inter-related such that PSS change scores were negatively correlated with all other change scores, FMI change scores were positively correlated with MHC-SF and UWES-S change scores, the latter of which was positively correlated with MHC-SF change scores (all p values < .01). Finally, observed improvements in all of these outcomes were positively related to informal practice quality while improved FMI scores were related to formal practice (all p values < .05). Conclusions A 5-week mindfulness-based program correlates with improving psychological wellbeing and study engagement in medical students. These improvements particularly occur when students engage in informal mindfulness practice compared to formal practice.
Collapse
Affiliation(s)
- Naomi Kakoschke
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- Health & Biosecurity, CSIRO, Adelaide, South Australia, Australia
- * E-mail:
| | - Craig Hassed
- Department of General Practice, Monash University, Melbourne, Australia
- Centre for Consciousness and Contemplative Studies, Monash University, Melbourne, Australia
| | - Richard Chambers
- Campus Community Division, Monash University, Melbourne, Australia
| | - Kevin Lee
- Department of Medicine, Monash University, Melbourne, Australia
- Department of Physiology, Monash University, Melbourne, Australia
| |
Collapse
|
22
|
Effectiveness of a Mindfulness and Self-Compassion Standard Training Program versus an Abbreviated Training Program on Stress in Tutors and Resident Intern Specialists of Family and Community Medicine and Nursing in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910230. [PMID: 34639532 PMCID: PMC8507764 DOI: 10.3390/ijerph181910230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/14/2021] [Accepted: 09/21/2021] [Indexed: 12/18/2022]
Abstract
Stress is one of the most common problems among healthcare professionals, as they are exposed to potentially stressful and emotionally challenging situations in the workplace. Mindfulness-based stress reduction (MBSR) training programs have been shown to decrease stress. The objective of this study was to compare the effectiveness of an abbreviated 4-weeks MBSR training program in relation to a standard 8-weeks one on the stress levels. A controlled and randomized clinical trial was designed, in which 112 tutors and resident intern specialists in Family and Community Medicine and Nursing of six Spanish National Health System teaching units (TUs) participated. Participants included in the experimental groups (EGs) received a MBRS training program (standard or abbreviated), while control group (CG) participants did not receive any intervention. The stress levels were assessed by the Perceived Stress Questionnaire (PSQ) in three different moments during the study: before, immediately after, and 3 months after the intervention. Adjusted covariance analysis (ANCOVA), using pretest scores as the covariate, showed a significant reduction in stress (F(2,91) = 5.165; p = 0.008; η2 = 0.102) in the post-test visit, attributable to the implementation of the standard training program, but without the maintenance of its effects over time. No significant impact of the abbreviated training program on stress levels was observed in the intergroup comparison. A standard 8-weeks MBSR training program aimed at tutors and resident intern specialists in Family and Community Medicine and Nursing produces significant improvements in stress levels compared with the abbreviated intervention and no intervention. New studies about abbreviated training programs are needed to provide effective treatments which improve well-being of these professionals.
Collapse
|
23
|
Schechter-Finkelstein T, Plenert E, La Rosa J, McLean J, Chiang KY, Krueger J, Hearne E, Sung L. Pediatric hematology/oncology healthcare professional emotional health during COVID-19. Cancer Med 2021; 10:7144-7151. [PMID: 34467652 PMCID: PMC8525130 DOI: 10.1002/cam4.4253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/06/2021] [Accepted: 08/17/2021] [Indexed: 01/26/2023] Open
Abstract
Objectives Little is known about the impact of coronavirus disease 2019 (COVID‐19) on healthcare professional emotional health in pediatric hematology/oncology. Primary objective was to describe anxiety, depression, positive affect, and perceived stress among pediatric hematology/oncology healthcare professionals following a COVID‐19 outbreak. Secondary objectives were to compare these outcomes based on contact with a positive person, and to identify risk factors for worse outcomes. Materials and methods We included 272 healthcare professionals working with pediatric hematology/oncology patients. We determined whether respondents had direct or indirect contact with a COVID‐19‐positive individual and then measured outcomes using the Patient‐Reported Outcomes Measurement Information System (PROMIS) depression, anxiety, and positive affect measures, and the Perceived Stress Scale. Results Among eligible respondents, 205 agreed to participate (response rate 75%). Sixty‐nine (33.7%) had contact with a COVID‐19‐positive person. PROMIS anxiety, depression, and positive affect scores were similar to the general United States population. Those who had contact with a COVID‐19‐positive individual did not have significantly different outcomes. In multiple regression, non‐physicians had significantly increased anxiety (nurses: p = 0.013), depression (nurses: p = 0.002, pharmacists: p = 0.038, and other profession: p = 0.021), and perceived stress (nurses: p = 0.002 and other profession: p = 0.011) when compared to physicians. Conclusions Pediatric hematology/oncology healthcare professionals had similar levels of anxiety, depression, and positive affect as the general population. Contact with a COVID‐19‐positive individual was not significantly associated with outcomes. Non‐physician healthcare professionals had more anxiety, depression, and perceived stress when compared to physicians. These findings may help to develop programs to support healthcare professional resilience.
Collapse
Affiliation(s)
| | - Erin Plenert
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jennifer La Rosa
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jennifer McLean
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - K Y Chiang
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Joerg Krueger
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Erin Hearne
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Lillian Sung
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| |
Collapse
|
24
|
Grabbe L, Higgins MK, Baird M, Pfeiffer KM. Impact of a Resiliency Training to Support the Mental Well-being of Front-line Workers: Brief Report of a Quasi-experimental Study of the Community Resiliency Model. Med Care 2021; 59:616-621. [PMID: 33827106 PMCID: PMC8191373 DOI: 10.1097/mlr.0000000000001535] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Front-line workers (FLW) are at risk for secondary traumatic stress, burnout, and related psychiatric sequelae: depression, anxiety, suicidality, posttraumatic stress disorder, and sleep and substance use disorders. FLW are in need of self-care programs to support their mental health. METHODS Quasi-experimental study to assess the impact of a simple mental well-being and emotional regulation training, the Community Resiliency Model (CRM), using a convenience sample of FLW. Baseline scores of mental well-being and stress measures were compared with follow-up scores at 3 time points. Outcomes were psychological wellness (World Health Organization-5 Well-being Index); resilience (Connor-Davidson Resilience Scale-10); traumatic stress (Secondary Traumatic Stress Scale); physical symptoms (Somatic Symptom Scale-8). RESULTS Of the 104 participants who enrolled and attended the CRM training, 73 (70.2%) completed at least 1 posttest. Well-being scores increased at 1 year with a small-moderate effect size (Cohen d=0.32). Resilience scores increased with a small-moderate effect size by 1 year (Cohen d=0.36). Secondary traumatic stress scores declined, with the largest effect at 1 week (Cohen d=0.49). Somatic symptoms decreased at each posttest, with the largest change occurring from baseline to 1 week (d=0.39). Participants reported an awareness of body sensations helped them when overwhelmed as a means of calming themselves. CONCLUSIONS After a 3-hour CRM training, participants reported improved mental well-being and decreased secondary traumatic stress and somatic symptoms. This simple body awareness intervention may be a good resource during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Linda Grabbe
- Nell Hodgson Woodruff School of Nursing, Emory University
| | | | | | | |
Collapse
|
25
|
Global Perspectives on Palliative Care for Cancer Patients: Not All Countries Are the Same. Curr Oncol Rep 2021; 23:60. [PMID: 33829323 PMCID: PMC8026388 DOI: 10.1007/s11912-021-01044-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2021] [Indexed: 12/14/2022]
Abstract
Abstract Purpose of the Review The integration of cancer-related palliative care is essential to holistic, quality cancer care. While some similarities exist between countries, this manuscript will focus on five differences that impact palliative care for cancer patients including the epidemiology of cancer and related symptoms, cancer-specific integration into care, palliative care education, economic development of the country, and cultural and religious differences. Recent Findings The epidemiology of cancer varies around the world resulting in variable symptoms and the need for individualized approaches to palliative care. While palliative care is integrated in some countries, it is lacking in over half of the world, and specific integration into cancer care is virtually absent. Education and training are the key to expansion, and yet oncology-focused palliative care education is lacking or is not well-reported in the literature. To complicate this global lens even further are the economic disparities that exist. Low-to-middle-income countries (LMICs) are resource poor and have the fewest resources and least amount of integration, and yet patients with advanced cancer are over-represented in these countries. Essential to cancer-related palliative care is a tailored approach that addresses cultural and religious differences around the globe. Summary Palliative care is developing around the globe and yet palliative care specific for cancer patients is in its infancy. Cancer care professionals should (1) understand the epidemiologic differences that exist globally and the impact this has on palliative care, (2) integrate palliative care into the cancer care arena, (3) provide cancer-specific palliative education focused on the cancer trajectory from diagnosis through survivorship and end of life, (4) advocate for LMICs, which suffer from a lack of resources and services, and (5) understand cultural and religious differences that exist to provide holistic and sensitive cancer-related palliative care.
Collapse
|
26
|
Ameli R, Skeath P, Abraham PA, Panahi S, Kazman JB, Foote F, Deuster PA, Ahmad N, Berger A. A nature-based health intervention at a military healthcare center: a randomized, controlled, cross-over study. PeerJ 2021; 9:e10519. [PMID: 33505785 PMCID: PMC7789867 DOI: 10.7717/peerj.10519] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 11/17/2020] [Indexed: 12/04/2022] Open
Abstract
We describe a mixed qualitative and quantitative research study in a military facility regarding the role of nature in well-being. Study intervention included two 20-minute walks. One walk was in an intentionally designed woodland environment (Green Road) and the other was on a busy campus road in a medical treatment facility (Urban Road). Twelve volunteers from a military facility participated in both walks in a cross-over experimental design. The two walking sessions were randomly ordered and preceded by pre-walk instructions appropriate to each road’s characteristics and incorporated focused attention and present moment orientation. A semi-structured post-walk interview, the primary outcome, was conducted after the conclusion of each walk. Qualitative data analyses consisted of sentiments and themes by using NVivo 12 software. The Green Road was unanimously rated as positive (100%). Responses to Urban Road were evenly distributed among positive (33.3%), negative (33.3%), and neutral/mixed (33.3%) sentiments. The Green Road yielded predominantly positive themes such as enjoyment of nature, relaxation, and feelings of privacy and safety. Urban Road produced significantly more negative themes such as concerns for safety, dislike of noise and other noxious experiences. Quantitative assessment of distress and mindfulness with Distress Thermometer (DT) and Mindful Attention Awareness Scale-state version (MAAS) demonstrated that a walk on the Green Road significantly decreased distress and increased mindfulness compared to a walk on the Urban Road. We also observed that pre-walk instructions could direct attention to both obvious and subtle elements of experience and enhance awareness. Results support the notion that an intentional nature-based environment may produce significantly more positive experiences and result in health-promoting benefits in a military health-care setting compared to an urban environment. Future studies with clinical populations could advance our understanding of the healing value of nature-based interventions. The impact of intentional green environments may be enhanced by well-designed instructions for both recreational and therapeutic use.
Collapse
Affiliation(s)
- Rezvan Ameli
- NIMH representative to the Clinical Center, National Institutes of Health, Bethesda, MD, United States of America.,Pain and Palliative Care Service, National Institutions of Health, Bethesda, MD, United States of America
| | - Perry Skeath
- Human Performance Partners Corp, Alexandria, VA, United States of America
| | - Preetha A Abraham
- Consortium for Health and Military Performance, Department of Military & Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services Universty of the Health Sciences, Bethesda, MD, United States of America.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
| | - Samin Panahi
- Pain and Palliative Care Service, National Institutions of Health, Bethesda, MD, United States of America
| | - Josh B Kazman
- Consortium for Health and Military Performance, Department of Military & Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services Universty of the Health Sciences, Bethesda, MD, United States of America.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
| | - Frederick Foote
- Institute for Integrative Health, Baltimore, MD, United States of America
| | - Patricia A Deuster
- Consortium for Health and Military Performance, Department of Military & Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services Universty of the Health Sciences, Bethesda, MD, United States of America
| | - Niha Ahmad
- Pain and Palliative Care Service, National Institutions of Health, Bethesda, MD, United States of America
| | - Ann Berger
- Pain and Palliative Care Service, National Institutions of Health, Bethesda, MD, United States of America
| |
Collapse
|