Mindfulness training for healthcare professionals and trainees: A meta-analysis of randomized controlled trials

Mindfulness-Based Interventions for Mental Health Outcomes in Frontline Healthcare Workers During the COVID-19 Pandemic: A Randomized Controlled Trial

BACKGROUND

The COVID-19 pandemic significantly impacted the mental health of frontline healthcare workers (HCWs), but solid evidence on psychological interventions for HCWs remains limited.

OBJECTIVE

Whether an adjusted therapist-assisted Mindfulness-based Stress Reduction group intervention (adjusted MBSR) is superior to a minimal self-guided mindfulness-based intervention (self-guided MBI) in improving mental health of HCWs during the COVID-19 pandemic.

DESIGN

Randomized controlled trial.

PARTICIPANTS

201 frontline HCWs (47 physicians, 120 nurses, 34 supporting staff); enrollment between June 2020 and September 2021.

INTERVENTIONS

A 4-week adjusted MBSR with eight biweekly 1.5-h sessions; or a 4-week self-guided MBI with 24 mindfulness/compassion exercises.

MEASURES

Primary outcome was the Patient Health Questionnaire - Somatic, Anxiety and Depressive Symptom Scales (PHQ-SADS) at 6-month follow-up. Secondary outcomes included posttraumatic symptoms, insomnia, alcohol use, repetitive negative thinking, mental well-being, posttraumatic growth, mindfulness, and self-compassion at post-intervention and 3- and 6-month follow-up.

KEY RESULTS

At 6-month follow-up, the adjusted MBSR was not superior to the self-guided MBI (mean difference (SE) PHQ-SADS, 0.23 (1.03), P=0.82). Both interventions showed similar within-group improvement in PHQ-SADS (Cohen's d between baseline and 6-month follow-up: adjusted MBSR -0.78 (95% CI -1.07; -0.48), self-guided MBI -0.72 (95% CI -1.01; -0.43)). Secondary outcomes showed that symptom trajectories differed between groups for PHQ-SADS (intervention*time F(3, 420)=3.99, P=0.008), with greater reduction at post-intervention for adjusted MBSR, and posttraumatic growth (intervention*time F(3, 350)=5.32, P=0.001), with exclusive increase post-intervention in adjusted MBSR. Both interventions showed comparable significant within-group improvements on posttraumatic symptoms, insomnia, repetitive negative thinking, mental well-being, mindfulness, and self-compassion.

CONCLUSIONS

The adjusted MSBR was not superior to the self-guided MBI; both were accompanied by significant reductions of depressive, anxiety, and somatic symptoms after 4 weeks of treatment which was sustained at 6-month follow-up. Further research is needed to investigate the possible role of MBIs to support HCWs involved in future healthcare crises.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04720404; onderzoekmetmensen.nl/en NL73793.091.20.

Impact of burnout on turnover, medical errors, medical leave and a cross-sectional study of contributing factors among Chilean physicians

BACKGROUND

During the COVID-19 pandemic, many physicians experienced burnout, underscoring the need to identify factors associated with this condition to develop effective prevention and treatment strategies.

OBJECTIVE

To examine the relationship between physician burnout and individual factors, medical errors, medical leave and the work environment.

DESIGN

A cross-sectional online survey conducted from November 2020 to December 2020.

PARTICIPANTS

Physicians registered with the Medical College of Chile.

SETTING

Registered physicians working in Chile across primary, secondary and tertiary levels of healthcare.

PRIMARY OUTCOMES

Burnout was assessed using the Maslach Burnout Inventory for Human Services.

SECONDARY OUTCOMES

Self-reported medical errors, medical leave and turnover.

INDEPENDENT VARIABLES

Sociodemographic characteristics, personality factors, psychological well-being, mindfulness factors, self-compassion and work environment factors. Descriptive statistics, linear and logistic regressions and regression analyses with cross-validation using least absolute shrinkage and selection operator (LASSO) tests were applied.

RESULTS

Of the 23 481 registered physicians, 795 (3.4%) completed the survey. The sample included 64.1% women, with a mean age of 37.7 years (SD=11.3). The prevalence of burnout syndrome was 20.4% based on strict criteria and 68.9% based on lax criteria. Burnout scores predicted days of medical leave (ß=0.086, p<0.01), turnover (ß=0.012, p<0.05) and perceived medical errors (ß=0.009, p<0.001). In contrast, burnout was inversely correlated with age (ß=-0.125, p<0.001), agreeableness as a personality trait (ß=-0.107, p<0.001), psychological well-being (ß=-0.248, p<0.001) and the mindfulness factor awareness (ß=-0.145, p<0.001). In the work environment, time pressure (ß=0.167, p<0.001) was positively associated with burnout among others.

CONCLUSION

Younger physicians may be prioritised for individual-level interventions, while addressing time pressure at the organisational level could help prevent burnout. However, longitudinal studies are needed to clarify the directionality of relationships with psychological factors.

TRIAL REGISTRATION NUMBER

NCT05013489; Results.

Holistic Healing Through Mindfulness: An Experimental Study Addressing Psychological Challenges Among Nurses Caring for Patients With COVID-19

Purpose: This study aimed to evaluate the effect of mHealth-based mindfulness intervention on trait mindfulness, stress, anxiety, and depression among Registered Nurses caring for patients with COVID-19 in Jordan. Method: Using a pretest-posttest parallel controlled design, 102 nurses from the King Abdullah University Hospital were randomly assigned into experimental (n = 51) and control (n = 51) groups. The experimental group received 5 weeks of individual 30-min mindfulness intervention sessions via WhatsApp. The collected data included demographic information as well as baseline and postintervention scores from the Mindfulness Attention Awareness Scale and the Depression, Anxiety, and Stress Scale. Findings: Paired t-tests revealed that the experimental group demonstrated significantly lower levels of stress, anxiety, and depression, as well as higher trait mindfulness scores following the intervention. Independent t-tests indicated that, compared to the control group, the experimental group had significantly reduced depression and stress levels and increased trait mindfulness scores at the end of the intervention. Although anxiety scores were lower in the experimental group following the intervention, the difference between the groups was not statistically significant. Conclusion: This finding aligns with existing literature, which has reported similar outcomes in studies on mindfulness interventions. These studies highlight the potential of mHealth-based mindfulness intervention as a holistic approach to enhancing psychological well-being among nurses who care for patients with COVID-19. Trial Registration: Clinicaltrials.gov; ID: NCT06401252.

Does mindfulness-based stress reduction training have an impact on the occupational burnout and stress experienced by nurses? A randomized controlled trial

BACKGROUND

In an effort to combat burnout, a study investigates Mindfulness-Based Stress Reduction (MBSR) training for nurses. The goal is to reduce stress and improve job satisfaction, ultimately enhancing patient care. These findings may inspire the development of mindfulness-based support systems for healthcare professionals to promote overall well-being in the workplace.

MATERIALS AND METHODS

A single-blinded, randomized controlled trial with 60 emergency medical center nurses was conducted to assess the effectiveness of an eight-session MBSR program in reducing stress and burnout. The randomization process, utilizing sealed envelopes, ensured unbiased allocation to intervention or control groups. The training program included group sessions focused on meditation, yoga, and discussions, with participants receiving educational materials and CDs for home practice. Collected data included demographics, Maslach Burnout Inventory, and Occupational Stress Questionnaire results. Statistical analysis, utilizing SPSS version 21, featured Kolmogorov-Smirnov, Mann-Whitney U, and Wilcoxon tests to evaluate outcomes.

RESULTS

Following MBSR Training, the intervention group displayed statistically significant differences in all occupational stress subscales compared to the control group (P < 0.05). Post-intervention, the intervention group also exhibited significant differences in burnout subscale scores (P < 0.001) compared to the control group.

CONCLUSION

MBSR can boost resilience and job satisfaction, enhancing patient care. Healthcare organizations should integrate MBSR programs for nursing staff well-being and combat stress and burnout. Research should probe long-term impacts and effective delivery methods for sustained stress relief in nursing.

TRIAL REGISTRATION

This study has registered in Iranian Registry of Clinical Trials by the number of IRCT20131112015390N5 on Jun 2022.

Development of the process of determining essential hazardous psychosocial factors of employee stress risk

The purpose of the study is to determine the impact of hazardous psychosocial factors on stress among employees when performing production tasks to develop recommendations for reducing their impact. Based on the recommendations of the ISO 45003:2021 standard, a special questionnaire was developed to determine hazardous psychosocial factors that lead to the appearance of worker's stress, the answers to which were evaluated on a Likert scale with points from 0 to 4. 68 workers (23 men and 45 women) aged 20 to 45 took part in the survey conducted at industrial enterprises of the Dnipro region in May-June 2023. A questionnaire was developed to identify significant psychosocial hazardous factors in personnel at an industrial enterprise, which includes three groups of psychosocial hazardous factors and consists of thirty questions. A ten-step process for managing significant hazardous psychosocial risks is proposed. It was established that women pay more attention to challenges (psychosocial hazardous factors) that are associated with the organization of work (uncertainty at work, lack of breaks due to workload) and social problems (disrespect, disrespect and inattention to employees, unreasonable behavior towards you by leadership); for men, a significant group of hazardous psychosocial factors is-equipment, working environment, hazardous tasks (fear of performing hazardous work; work is associated with a significant risk to life). The novelty consists in the justification of the process of identifying essential psychosocial factors, which will allow managers to systematically monitor the state of mental health of employees, the psychological climate in the organization and respond in a timely manner to expected problems and develop corrective actions to normalize the situation. The process of managing significant hazardous psychosocial risks has been developed, which consists of ten steps and differs from the known procedure of identifying significant hazardous psychosocial factors on a Likert scale, considering the answers of women and men.

Online Mindfulness-Based Interventions for Healthcare Professionals: A Scoping Review

BACKGROUND

Healthcare professionals work in challenging environments with extended working hours and excessive workloads to provide high-quality care. However, they hardly get the time to care for themselves. Online mindfulness-based interventions-which are not restricted by time or location-can be a powerful strategy to help healthcare professionals.

OBJECTIVES

This scoping review aims to explore the current evidence about online mindfulness-based interventions for healthcare professionals.

DESIGN

A scoping review was conducted.

METHODS

A literature search was conducted to retrieve articles published between October 2016 and March 2023 in seven databases, including backward and forward citation tracking from the included articles. Among 1,278 articles retrieved, 33 met the criteria for review.

RESULTS

Two-thirds of the studies utilized commercialized mindfulness programs (n = 22). Duration of the mindfulness interventions varied from 1 week to 4 months, and half of the studies used audio-guided programs. Online mindfulness-based intervention studies were targeted to reduce burnout (n = 26), and the majority reported reduction in burnout (n = 18).

CONCLUSION

Most studies used individual audio-guided programs that warrant the use of diverse delivery methods such as video media, simulation, and virtual reality for interactions in the future. Although the literature has accumulated evidence for commercialized online mindfulness-based interventions, further studies are needed to develop and test tailored interventions for healthcare professionals.

Professional competencies in geriatric nursing for geriatric nurses: a latent profile analysis

BACKGROUND

As the global population continues to age, social realities such as advanced age, disability and living alone are coming to the fore, and the demand for medical care and health services for the elderly is increasing dramatically, especially in geriatrics. Given the important role geriatric nurses play in the diagnosis and treatment of diseases and rehabilitation of elderly patients, and due to the uniqueness and complexity of geriatric work, this requires geriatric nurses not only to have the competencies that are available in general nursing, but also to ensure that they have sufficient geriatric core competencies in order to effectively meet the needs of the patients and accelerate their recovery. Although previous studies have investigated the core competencies of nursing staff, there has been little research on geriatric nurses' core geriatric nursing competencies and their predictors. The aim of this study was to investigate the current status of the geriatric nursing competency inventory (GNCI) among geriatric nurses using latent profiling, to identify potential subgroups and their population characteristics, and to explore the factors that influence the potential subgroups.

METHODS

From January to March 2024, 1,313 geriatric nurses in Hefei City were selected by stratified cluster sampling method and surveyed with general information questionnaire, geriatric nursing competency inventory, and occupational coping self-efficacy scale for nurses(OCSE-N). Potential subgroups of GNCI differences among geriatric nurses were identified by latent profile analysis (LPA). Multiple logistic regression analyses were used to explore the factors influencing the GNCI of geriatric nurses with different latent profiles.

RESULTS

Geriatric nurses' OCSE-N was positively correlated with GNCI, and the GNCI score was 123.06(41.60), which indicated that geriatric nurses' GNCI was at an intermediate level. The OCSE-N score was 35.44(7.34), which was at a relatively high level. There was heterogeneity in the GNCI of geriatric nurses, which was classified into three subgroups i.e., Low-competency group, Medium-competency group, High-competency group. The results of multiple logistic regression analyses showed that OCSE-N, title, whether or not they attended geriatric nurse specialist training, and specialist nurse status were predictors of GNCI among geriatric nurses (P < 0.05).

CONCLUSION

The GNCI categorical characteristics of geriatric nurses are obvious, and nursing managers should adopt targeted interventions according to the characteristics of nurses in different profiles to improve the overall quality of care.

The impact of mindfulness-based stress reduction training on the occupational stress and burnout experienced by nurses in geriatric wards? A randomized controlled trial

In this clinical trial, 60 nurses from three geriatric centers were enlisted and randomly split into two groups: control (n = 30) and intervention (n = 30). Statistical analysis using SPSS version 21 employed Kolmogorov-Smirnov, Chi square, and t-test to assess results. The intervention group received eight training sessions. After the MBSR Training in the intervention groups, results showed there was a statistically significant difference between the two groups concerning the scores of the subscales of death and dying (t = 6.161, P < 0.001), conflicts with physicians (t = 7.962, P < 0.001), inadequate preparation (t = t = 6.524, P < 0.001), lack of support resources (t = 5.532, P < 0.001), conflicts with nurses (t = -6.632, P < 0.001), workload (t = 6.587, P < 0.001), uncertainty of treatment (t = 5.587, P < 0.001) as well as the scores of the subscales of burnout.

Mindfulness-based interventions for improving mental health of frontline healthcare professionals during the COVID-19 pandemic: a systematic review

BACKGROUND

Mindfulness-based interventions (MBIs) appear to be effective for improving the mental health of healthcare professionals (HCPs). However, the effectiveness of MBIs on extreme psychological trauma caused by the coronavirus disease 2019 (COVID-19) pandemic is largely unknown. The aim of this paper was to systematically review empirical studies of MBIs for HCPs carried out during the COVID-19 pandemic, to evaluate them and their effectiveness in different areas of mental health.

METHODS

The electronic databases searched were Web of Science, Scopus, PubMed, and PsycINFO. The date when each database was last searched was September 15, 2023. Randomized controlled trials (RCTs), non-randomized controlled trials (NRCTs), and non-randomized non-controlled trials (NRNCTs) focused on MBIs for health care staff who were working in healthcare centers during the COVID-19 pandemic were included. All of them employed standardized measures of mental health. The review followed the best practices and reported using PRISMA guidelines. A data collection form, adapted from the Cochrane handbook for systematic reviews of interventions, was used to extract and synthesize the results. The methods used to assess the risk of bias in the included studies were the Cochrane Risk of Bias Tool and the ROBINS-I Tool.

RESULTS

Twenty-eight studies were included in the systematic review. Overall, the methodological quality of the studies was moderate. The results showed the effectiveness of MBIs in improving levels of stress, mindfulness, and mental well-being. However, no conclusive results were found regarding the effectiveness of MBIs in improving the levels of burnout, anxiety, depression, sleep quality, and resilience of HCPs.

CONCLUSIONS

The MBIs for HCPs carried out during the COVID-19 pandemic have mainly contributed to improving stress, mindfulness, and mental well-being at a time of serious health emergency. However, more robust studies at a methodological level would have been desirable.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42021267621.

Effects of standardized mindfulness programs on burnout: a systematic review and original analysis from randomized controlled trials

According to the World Health Organization (WHO), burnout is a syndrome conceptualized as resulting from chronic occupational stress that has not been successfully managed. It is characterized by emotional exhaustion, cynicism toward work, and a lack of personal accomplishment at work. Recent WHO guidelines on mental health suggest that mindfulness could have beneficial effects in a professional environment, but to the best of our knowledge, there is currently no study that has made a large inventory of research focused specifically on the effects of standardized programs on burnout. Which professional populations have already been studied? What are the characteristics of the programs? Have studies shown a significant effect and on what indicator?

Objective

To assess the effects of standardized programs of mindfulness on burnout, we carried out a systematic review using an exhaustive inventory of the international literature based on randomized controlled trials (RCTs).

Methods

The articles were selected according to PRISMA recommendations. The Embase, PubMed/MEDLINE, EBSCOhost, HAL databases were searched with the keywords "mindfulness," "burnout," and "randomized" in the title and abstract of each article. The data were all collected in an Excel spreadsheet and analyzed in pivot tables, which were then presented in graphs and maps.

Results

A total of 49 RCTs were thus selected, the majority of which were of good methodological quality, of American origin (43% of studies), concerned professionals in the health sector (64% of participants included), and mostly women (76%). The RCTs assessed the effects of 31 different mindfulness programs, mostly with the Maslach Burnout Inventory (78% of RCTs). More than two-thirds of RCTs (67%) showed a significant beneficial effect on burnout measurement indicators, with emotional exhaustion being the most impacted component.

Conclusion

This systematic review shows that mindfulness-based interventions could be approaches of choice to prevent emotional distress of burnout. Further studies are still needed to determine which type of program is best suited to impact the two other components of burnout.

The effect of mindfulness-based interventions on reducing stress in future health professionals: A systematic review and meta-analysis of randomized controlled trials

Students in health professions often face high levels of stress due to demanding academic schedules, heavy workloads, disrupted work-life balance, and sleep deprivation. Addressing stress during their education can prevent negative consequences for their mental health and the well-being of their future patients. Previous reviews on the effectiveness of mindfulness-based interventions (MBIs) focused on working health professionals or included a wide range of intervention types and durations. This study aims to investigate the effect of 6- to 12-week MBIs with 1- to 2-h weekly sessions on stress in future health professionals. We conducted a systematic review and meta-analysis of randomized controlled trials published in English by searching Embase, Medline, Web of Science, Cochrane Central Register of Controlled Trials, and PsycINFO. We used post-intervention stress levels and standard deviations to assess the ability of MBIs to reduce stress, summarized by the standardized mean difference (SMD). This review is reported according to the PRISMA checklist (2020). We identified 2932 studies, of which 11 were included in the systematic review and 10 had sufficient data for inclusion in the meta-analysis. The overall effect of MBIs on reducing stress was a SMD of 0.60 (95% CI [0.27, 0.94]). Our study provides evidence that MBIs have a moderate reducing effect on stress in students in health professions; however, given the high risk of bias, these findings should be interpreted with caution, and further high-quality studies are needed.

The use of mHealth apps to improve hospital nurses' mental health and well-being: A systematic review

BACKGROUND

Nursing well-being has become a heightened focus since the COVID-19 pandemic. Nurses are leaving the profession early in their careers or retiring sooner than expected. Those who remain in the workforce report higher levels of burnout, anxiety, depression, and exhaustion. There is concern that there may be a shortage of at least half a million nurses by 2030.

AIMS

This systematic review aimed to investigate the evidence of using a mental health promotion mHealth app to improve the mental health of hospital nurses.

METHODS

A systematic search was conducted in CINAHL Plus with Full Text, MEDLINE with Full Text, Professional Development Collection, Psychology and Behavioral Sciences Collection, Sociological Collection, PsycInfo, Embase, and PubMed with search dates of January 2012-November 15, 2022. The mHealth intervention needed to be asynchronously delivered through a smartphone with hospital nurse participants to be included in this review.

RESULTS

Of the 157 articles screened for this review, six were included. Primary outcome variables were anxiety, burnout, coping, depression, self-efficacy, stress, well-being, and work engagement. Intervention types included mindfulness-based interventions (MBIs), cognitive behavioral therapy (CBT), stress inoculation therapy (SIT), psychoeducation, and stress management. Anxiety, depression, well-being, and burnout improved with MBIs; depression improved with CBT; and anxiety and active coping improved with SIT.

LINKING EVIDENCE TO ACTION

This review demonstrated promising findings in using mHealth apps to improve the mental health of hospital nurses. However, more randomized controlled trials with larger sample sizes may reveal which type of mHealth app and how much exposure to the intervention is more effective in improving specific mental health symptoms. Longitudinal follow-up is also recommended to study sustainability of the mental health improvements.

Exploring the lived experiences of participants and facilitators of an online mindfulness program during COVID-19: a phenomenological study

The coronavirus pandemic (COVID-19) has placed incredible demands on healthcare workers (HCWs) and adversely impacted their well-being. Throughout the pandemic, organizations have sought to implement brief and flexible mental health interventions to better support employees. Few studies have explored HCWs' lived experiences of participating in brief, online mindfulness programming during the pandemic using qualitative methodologies. To address this gap, we conducted semi-structured interviews with HCWs and program facilitators (n = 13) who participated in an online, four-week, mindfulness-based intervention program. The goals of this study were to: (1) understand how participants experienced work during the pandemic; (2) understand how the rapid switch to online life impacted program delivery and how participants experienced the mindfulness program; and (3) describe the role of the mindfulness program in supporting participants' mental health and well-being. We utilized interpretive phenomenological analysis (IPA) to elucidate participants' and facilitators' rich and meaningful lived experiences and identified patterns of experiences through a cross-case analysis. This resulted in four main themes: (1) changing environments; (2) snowball of emotions; (3) connection and disconnection; and (4) striving for resilience. Findings from this study highlight strategies for organizations to create and support wellness programs for HCWs in times of public health crises. These include improving social connection in virtual care settings, providing professional development and technology training for HCWs to adapt to rapid environmental changes, and recognizing the difference between emotions and emotional states in HCWs involved in mindfulness-based programs.

Reflective Skills, Empathy, Wellbeing, and Resilience in Cognitive-Behavior Therapy Trainees Participating in Mindfulness-Based Self-Practice/Self-Reflection

Self-Practice/Self-Reflection (SP/SR) is an aspect of therapist training and professional development aimed at enhancing therapy skills, empathy, wellbeing, and resilience in the ultimate furtherance of client outcomes. For many decades, intensive SP/SR has been a required part of therapist training in many countries but relatively little is known about the effect of SP/SR. Studies have found cognitive-behavior therapy (CBT) therapists trained under a Beckian CBT paradigm benefitted from more time limited Beckian SP/SR. Mindfulness-based CBT is a more recent third-wave CBT paradigm with psychological process aims similar to those of SP/SR. While training in mindfulness-based CBT often has prominent SP/SR aspects, and mindfulness practice has been shown to benefit health care providers personally and professionally, to date no evaluations have been reported specifically of effects of participation of CBT trainees in stand-alone mindfulness-based SP/SR that meets regulatory requirements for more intensive SP/SR. A study on SP/SR training meeting German requirements is reported here. Post-graduate CBT trainees (N = 95) were assigned to delayed or immediate SP/SR with those in the delayed SP/SR condition crossing-over into SP/SR training after two baseline evaluations on a variety of reflective skill, wellbeing, and resilience measures spaced six to 9 months apart before participating in 120-150 hours of stand-alone mindfulness-based SP/SR followed by a third reevaluation on all study measures. Participants assigned to the immediate SP/SR condition underwent identical SP/SR training with pre/post assessments. Results indicate participation in intensive stand-alone mindfulness-based SP/SR resulted in favorable changes in measures operationalizing all variables. Findings are discussed in terms of their implications for training and professional development of CBT therapists.

Improving physician wellness through the Applied Mindfulness Program for Medical Personnel: findings from a prospective qualitative study

BACKGROUND

Physicians play a critical role across health care delivery systems, yet their own well-being is often overlooked; mindfulness has been widely recommended as a promising modality to support physician wellness. We sought to explore how physicians experience and engage with a 5-week applied mindfulness program and how they perceive its impact on their personal well-being in the context of their daily lives.

METHOD

We delivered the Applied Mindfulness Program for Medical Personnel (AMP-MP) at a tertiary care hospital in downtown Toronto, Canada. This prospective qualitative study consists of a thematic analysis of post-program interviews with physicians, from across different specialties, who participated in the AMP-MP. The program includes 2-hour sessions, delivered once a week over 5 weeks, and is based on the teachings of Thích Nhất Hạnh.

RESULTS

We interviewed 28 physicians after they completed the AMP-MP. Our data show that a 5-week training was sufficient for physicians to develop a foundational level of mindfulness that integrated into their daily life. Two themes were identified: mindfulness encourages behavioural and cognitive changes that facilitate well-being, and mindfulness improves communication with patients and colleagues.

INTERPRETATION

Our results show applied mindfulness to be well received by physicians as an effective modality to increase their perceived sense of wellness and enhance communication with their patients and colleagues. Further research is necessary to better understand the individual and systemic implications of mindfulness training, and how this modality can complement other efforts being made to address and maintain physician wellness.

FIRECARE: An Evidence-Based Prevention Program to Reduce Burnout among Prehospital Caregivers: Benefits of a Combined Mindfulness, Heart Coherence Training, and Positive Psychology Intervention

BACKGROUND

Burnout among emergency health care professionals is well-described, especially during the COVID-19 pandemic. Prevention interventions, such as mindfulness, focus on the management of stress.

OBJECTIVE

To evaluate the effects of the FIRECARE program (a mindfulness intervention, supplemented by heart coherence training and positive psychology workshops) on burnout, secondary stress, compassion fatigue, and mindfulness among advanced life support ambulance staff of the Paris Fire Brigade.

MATERIALS AND METHODS

We used a non-randomized, two-group quasi-experimental study design with a waitlist control and before-and-after measurements in each group. The intervention consisted of six, once-weekly, 2.5-h sessions that included individual daily meditation and cardiac coherence practice. The study compared intervention and waitlist control groups, and investigated baseline, post-program, and 3-month follow-up change on burnout (measuring using the ProQOL-5 scale) and mindfulness (measuring using the FMI scores). Baseline burnout (measured using the ProQOL-5) was evaluated and used in the analysis.

RESULTS

Seventy-four 74 participants volunteered to participate; 66 were included in the final analysis. Of these, 60% were classified as suffering from moderate burnout, the 'burnout cluster'. A comparison of intervention and waitlist control groups found a decrease in the burnout score in the burnout cluster (p = 0.0003; partial eta squared = 0.18). However, while secondary stress fell among the burnout cluster, it was only for participants in the intervention group; scores increased for those in the waitlist group (p = 0.003; partial eta squared = 0.12). The pre-post-intervention analysis of both groups also showed that burnout fell in the burnout cluster (p = 0.006; partial eta squared = 0.11). At 3-month follow-up, the burnout score was significantly reduced in the intervention group (p = 0.02; partial eta squared = 0.07), and both the acceptance (p = 0.007) and mindfulness scores (p = 0.05; partial eta squared = 0.05) were increased in the baseline burnout cluster.

CONCLUSION

FIRECARE may be a useful approach to preventing and reducing burnout among prehospital caregivers.

The Profound Implications of the Meaning of Health for Health Care and Health Equity

Policy Points The meaning of health in health care remains poorly defined, defaulting to a narrow, biomedical disease model. A national dialogue could create a consensus regarding a holistic and humanized definition of health that promotes health care transformation and health equity. Key steps for operationalizing a holistic meaning of health in health care include national leadership by federal agencies, intersectoral collaborations that include diverse communities, organizational and cultural change in medical education, and implementation of high-quality primary care. The 2023 report by the National Academies of Sciences, Engineering, and Medicine on achieving whole health offers recommendations for action.

Effectiveness of Workplace Interventions to Improve Health and Well-Being of Health and Social Service Workers: A Narrative Review of Randomised Controlled Trials

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.

Hybrid Delivery of Mindfulness Meditation and Perceived Stress in Pediatric Resident Physicians: A Randomized Clinical Trial of In-Person and Digital Mindfulness Meditation

Physicians are experiencing epidemic levels of work-related stress and burnout. Determine efficacy of mindfulness meditation delivered as a hybrid (in-person and digital) format to reduce perceived stress in pediatric residents. Pediatric residents (n = 66) were block randomized to a hybrid Mindful Awareness Practices (MAPs) intervention, comprised of one in-person 60-min session and 6-week access to a digitally delivered MAPs curriculum (n = 27) or wait-list control (n = 39). Perceived Stress Scale (PSS) was administered at baseline and post-intervention as the primary outcome measure. A priori secondary outcomes were measured using the Abbreviated Maslach Burnout Inventory-9, Beck Depression Inventory, Beck Anxiety Inventory, UCLA Loneliness Scale, and Pittsburgh Sleep Quality Index. After the first session, 58% participated at least one digital session (M = 2.0; SD = 1.3). MAPs participants showed significant decrease in PSS compared to controls, with between-group mean difference of 2.20 (95% CI 0.47-3.93) at post-intervention (effect size 0.91; 0.19-1.62). No secondary outcome group differences were detected. Exposure to a hybrid mindfulness intervention was associated with improvement in perceived stress among pediatric residents.Trial Registration: NCT03613441.

Individual-level interventions for reducing occupational stress in healthcare workers

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.

Comparison of two brief mindfulness interventions for anxiety, stress and burnout in mental health professionals: a randomised crossover trial

Background

Anxiety, stress and burnout are a growing reality among mental health professionals, impacting negatively on them and their clients. Mindfulness-based interventions (MBIs) have demonstrated effectiveness in mitigating these sufferings. Nevertheless, there is a lack of knowledge on the impact of MBIs in Cuba.

Objectives

To compare the effectiveness of two brief mindfulness-based interventions for reducing anxiety, work stress and burnout.

Methods

A total of 104 mental health professionals from Havana (Cuba) participated in a randomised crossover trial. Group A received first an intervention involving body-centred practices (body scan and Hatha yoga) and a second intervention involving mind-centred practices (focused attention and open monitoring meditation). Group B received the same interventions but in reverse order. Four measures (anxiety, stress, burnout syndrome, and antecedents of burnout) were measured at baseline, posttest1, posttest2, and 6-months follow-up.

Results

After the first intervention, there was a between-group difference for burnout syndrome, but the ES was similar for both groups. After the second intervention (implementing both practises), groups showed the largest effect sizes, and there was a between-group difference for antecedents of burnout. Results were partially maintained at 6-month follow-up.

Conclusion

These results suggest that mind-centred practises can be as effective as body-centred practises for stress, anxiety and burnout reduction. The combination of both types of practises could be the most effective way of teaching mindfulness. About the sequence of implementation, teaching mind-centred practises first and then body-centred practises could be most effective for reducing antecedents of burnout.Clinical Trial Registration: www.clinicaltrials.gov NCT03296254.

Work Ability and Well-Being Management and Its Barriers and Facilitators in Multinational Organizations: A Scoping Review

The aim of this scoping review was to identify effective workplace programs for work ability and well-being management and its barriers and facilitators in multinational organizations. The PubMed, Embase, and Web of Science databases were searched from 1974 through February 2023 to identify quantitative and qualitative studies on the management of work ability and well-being, and related outcomes including presenteeism, absenteeism, productivity loss, and healthy practices, conducted in a multinational organization or company. The titles and abstracts of over 11,000 publications were screened, and 10 studies fulfilling the inclusion criteria were included in the review. The management of work ability and well-being in multinational companies requires leadership support and commitment, effective communication, employee health awareness and engagement, comprehensive personalized health risk and condition assessments, and the management of risk factors and occupational and non-occupational health conditions. Financial constraints, high workloads, competing priorities, a lack of effective communication, a lack of worksite managers' motivation, employees' language barriers, high worksite managers' turnover, and a decline in the support of senior managers are considered as barriers, and the presence of existing participatory practices is considered as a facilitator of participation in workplace health and well-being interventions in multinational companies. This review suggests that the management of work ability and well-being in multinational companies should go beyond health promotion and include comprehensive personalized health risk and health condition assessments and management.

Rapid and sustainable self-questionnaire for large-scale psychological screening in pandemic conditions for healthcare workers

Background

The pandemic caused by a coronavirus (COVID-19) has shocked healthcare systems worldwide. However, the psychological stressors remain unclear. The objective of this study was to assess the impact of a major pandemic on healthcare workers. We hypothesized that exposure to the virus would be the primary cause of psychological stress perceived by healthcare workers.

Methods

A national cross-sectional study conducted via an online questionnaire was distributed between April 9 and April 19, 2020 with a non-probabilistic sample technique. A structural equation model (SEM) was built with the variable "exposure to the virus" and the Psychological Stress and Adaptation at work Score (PSAS). "Exposure to the virus" was defined as the combined factors of 'personal-sphere', "work-related stress" and "hospital characteristics." A generalized linear model (GLM) was also tested.

Results

A total of 2,197 participants filled in the questionnaire and were analyzed. The exploratory factor analysis showed statistically significant variables related to the personal-sphere, work-related stress and the hospital's characteristics, although the confirmatory factor analysis showed only the work-related stress factors to be significant. The GLM showed that personal-sphere-related variables (P < .001), stress at work (P < 0.001) and age (P < 0.001) were statistically significant.

Conclusion

Physical exposure to the virus is an essential factor that contributes to the psychological impact perceived during the pandemic by healthcare professionals. A combination of personal-sphere variables, work-related stress and hospital characteristics is a significant factor correlating with the degree of stress measured by PSAS, a new and fast instrument to assess stress in healthcare workers.

Shared Meditation Involving Cancer Patients, Health Professionals and Third Persons: Perceptions of Participants Through a Focus Group Study

People with cancer often experience psychological distress and in addition, the practice of oncology is one of the most stressful areas of medicine for health professionals. Mindfulness meditation has been used to alleviate stress-related symptoms. We therefore ran a pilot study to assess the feasibility of a mindfulness intervention involving cancer patients, health professionals, and third persons together, as part of a comprehensive project aiming to evaluate the added value of 'meditating together'. Following on from our quantitative analyses of the project, we investigated its qualitative aspects through focus groups to explore the perceptions of participants regarding their experience. Focus groups conducted in 7 patients, 7 health professionals, and 8 third persons after the intervention showed that 'meditating together' was generally appreciated, particularly by patients, who found it motivating and a way to relieve their feelings of loneliness in the face of illness. All participants reported better stress management. They also shared benefits and difficulties concerning the practice of meditation and the programme's modalities. In addition, they all stated that the programme should be lasting. The opinion of the patients (our target population) will be decisive in building an optimized programme that will suit them the best. In conclusion, the protocol and the qualitative findings of the present study validate the rationale for conducting a fully powered randomized trial to demonstrate the potential added value of shared meditation and how it improves well-being by promoting bridge-building between cancer patients, health professionals and others.Trial Registration: ClinicalTrials.gov. NCT04410185. Registered on June 1, 2020.

Mindfulness Initiatives for Students, Teachers, and Parents: a Review of Literature and Implications for Practice During COVID-19 and Beyond

The use of mindfulness in schools has greatly expanded over the past 10 years. Research has demonstrated positive psychological effects of mindfulness for students as well as teachers (Emerson et al., Mindfulness 8:1136-1149, 2017; Semple et al., Psychology in the Schools 54:29-52, 2017). Similarly, studies focusing on mindfulness interventions for parents of children with disabilities and/or psychosocial difficulties have also yielded a variety of positive outcomes, including reduced parenting stress, increases in quality of life, and improved parent-child interactions (Bögels et al., 2016; Rayan and Ahmad, Research in Developmental Disabilities 55:185-196, 2016). Although there has been a proliferation of mindfulness research, and mindfulness has become a buzzword in popular culture, it has not been systematically examined or applied as an approach to improving psychosocial functioning in children, school personnel, and families during COVID-19 and in online settings. This article provides a preliminary framework for this examination by reviewing relevant research and providing practical strategies and resources for school psychologists.

Efficacy and Feasibility of the Minimal Therapist-Guided Four-Week Online Audio-Based Mindfulness Program 'Mindful Senses' for Burnout and Stress Reduction in Medical Personnel: A Randomized Controlled Trial

Previous online mindfulness-based interventions for burnout and stress reduction in medical personnel had limited effect size and high dropout rate, so we developed a new online mindfulness program 'Mindful Senses (MS)' with aims to increase effect size and lower dropout rate. To test its efficacy and feasibility, ninety medical personnel with moderate or high levels of burnout and stress from across Thailand were recruited and randomly allocated into Group A and Group B equally. Group A read psychological self-help articles (PSA) and attended MS program through smartphone application during weeks 1-4. Group B read PSA during weeks 1-4 and attended MS program during weeks 9-12. Burnout, stress, anxiety, depression, mindfulness, and quality of life were measured at baseline, week 4, and week 8 for both groups, and at weeks 12 and 16 for Group B. Group x time interaction was analyzed by repeated-measures ANOVA. The results showed that, compared to PSA only, MS + PSA had statistically significant improvement of burnout, stress, anxiety, depression, mindfulness, and quality of life with moderate-to-very large effect sizes at week 4 (d = 1.33, 1.42, 1.04, 1.14, 0.70, and 1.03, respectively) and moderate-to-large effect sizes at week 8 (d = 0.84, 0.98, 0.73, 0.73, 0.66, and 0.94, respectively). The dropout rate was 4.4%. In conclusion, the MS program has potential to be an alternative intervention for medical personnel suffering from burnout and stress.

Mindfulness training for community-based psychotherapists: a feasibility study

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.

Mindfulness-Based Intervention for the Reduction of Compassion Fatigue and Burnout in Nurse Caregivers of Institutionalized Older Persons with Dementia: A Randomized Controlled Trial

The recent COVID-19 pandemic has severely impacted the mental health of nurses caring for institutionalized older people. Caring in this environment can be complex, with higher levels of burnout and compassion fatigue in staff. It is therefore important to find interventions to increase the well-being of staff. Mindfulness training is known to be effective in treating a variety of physical and mental health conditions. This study sought to conduct a direct evaluation of the effectiveness of a combined online training in two types of mindfulness-based therapies for the reduction of compassion fatigue and burnout in geriatric nurses caring for institutionalized elderly people with dementia. In a randomized controlled trial (n = 39 experimental group, n = 35 control group), we explored whether individuals with high levels of burnout and compassion fatigue would benefit more from an online mindfulness training program. The outcome variable was the ProQoL professional quality of life scale, which was collected at baseline, at six weeks, and at three months after completion of the intervention. Significant differences were found between both groups for the subscales Compassion Fatigue and Burnout (p < 0.05), with a significant improvement in the experimental group (significant effect size). These findings were maintained at three months after the end of the intervention for both compassion fatigue (F1,28 = 18.14, p = 0.003) and burnout (F1,28 = 7.25, p = 0.040). However, there were no differences between groups for the satisfaction subscale. The effect of time and the effects of comparing the two groups after controlling for time were statistically significant for all three subscales of the questionnaire (all p values < 0.001), with effect sizes ranging from small to large (R² change 0.10-0.47). These data indicate that the experimental condition was more effective, explaining between 10 and 18% more of the variance. A short, online intervention based on mindfulness training appears to be effective for reducing compassion fatigue and burnout in geriatric nurses, with sustained effects over time.

Health Care Workers' Need for Headspace: Findings From a Multisite Definitive Randomized Controlled Trial of an Unguided Digital Mindfulness-Based Self-help App to Reduce Healthcare Worker Stress

BACKGROUND

Health care workers experience high stress. Accessible, affordable, and effective approaches to reducing stress are lacking. In-person mindfulness-based interventions can reduce health care worker stress but are not widely available or accessible to busy health care workers. Unguided, digital, mindfulness-based self-help (MBSH) interventions show promise and can be flexibly engaged with. However, their effectiveness in reducing health care worker stress has not yet been explored in a definitive trial.

OBJECTIVE

This study aimed to investigate the effectiveness of an unguided digital MBSH app (Headspace) in reducing health care worker stress.

METHODS

This was a definitive superiority randomized controlled trial with 2182 National Health Service staff in England recruited on the web and allocated in a 1:1 ratio to fully automated Headspace (n=1095, 50.18%) or active control (Moodzone; n=1087, 49.82%) for 4.5 months. Outcomes were subscales of the Depression, Anxiety, and Stress (primary outcome) Scale short form; Short Warwick Edinburgh Mental Well-being Scale; Maslach Burnout Inventory; 15-item Five-Facet Mindfulness Questionnaire minus Observe items; Self-Compassion Scale-Short Form; Compassionate Love Scale; Penn State Worry Questionnaire; Brooding subscale of the Ruminative Response Scale; and sickness absence.

RESULTS

Intention-to-treat analyses found that Headspace led to greater reductions in stress over time than Moodzone (b=-0.31, 95% CI -0.47 to -0.14; P<.001), with small effects. Small effects of Headspace versus Moodzone were found for depression (b=-0.24, 95% CI -0.40 to -0.08; P=.003), anxiety (b=-0.19, 95% CI -0.32 to -0.06; P=.004), well-being (b=0.14, 95% CI 0.05-0.23; P=.002), mindfulness (b=0.22, 95% CI 0.09-0.34; P=.001), self-compassion (b=0.48, 95% CI 0.33-0.64; P<.001), compassion for others (b=0.02, 95% CI 0.00-0.04; P=.04), and worry (b=-0.30, 95% CI -0.51 to -0.09; P=.005) but not for burnout (b=-0.19, -0.04, and 0.13, all 95% CIs >0; P=.65, .67, and .35), ruminative brooding (b=-0.06, 95% CI -0.12 to 0.00; P=.06), or sickness absence (γ=0.09, 95% CI -0.18 to 0.34). Per-protocol effects of Headspace (454/1095, 41.46%) versus Moodzone (283/1087, 26.03%) over time were found for stress, self-compassion, and compassion for others but not for the other outcomes. Engagement (practice days per week) and improvements in self-compassion during the initial 1.5-month intervention period mediated pre- to postintervention improvements in stress. Improvements in mindfulness, rumination, and worry did not mediate pre- to postintervention improvements in stress. No serious adverse events were reported.

CONCLUSIONS

An unguided digital MBSH intervention (Headspace) can reduce health care workers' stress. Effect sizes were small but could have population-level benefits. Unguided digital MBSH interventions can be part of the solution to reducing health care worker stress alongside potentially costlier but potentially more effective in-person mindfulness-based interventions, nonmindfulness courses, and organizational-level interventions.

TRIAL REGISTRATION

International Standard Randomised Controlled Trial Number ISRCTN15424185; https://tinyurl.com/rv9en5kc.

Effect of Mindfulness-Based Stress Reduction on the Well-Being, Burnout and Stress of Italian Healthcare Professionals during the COVID-19 Pandemic

COVID-19 has overwhelmed healthcare systems and increased workload and distress in healthcare professionals (HCPs). The objective of this study was to evaluate baseline distress before and after the pandemic, and the effect of Mindfulness-Based Stress Reduction (MBSR) training on well-being (PGWBI), stress (PSS) and burnout (MBI) in Italian HCPs. Moreover, the “fear of COVID-19” (FCV-19S) questionnaire was administered to HCPs participating in the post-emergency MBSR program. Baseline distress results were moderate in all groups. No differences between baseline distress were observed between the groups of HCPs beginning the MBSR courses in the pre or post pandemic period. Total PGWBI lowered with aging. Additionally, FCV-19S positively correlated with age. MBSR was able to lower distress levels, except for depersonalization, which increased, while emotional exhaustion decreased in the group enrolled in the last post-pandemic MBSR course. Levels of fear of COVID-19 in HCPs significantly decreased after MBSR training. The lack of change in baseline distress over time indicates that it is more influenced by work-related distress than by the pandemic in our HCPs. In view of its beneficial effects on psycho-emotional status, MBSR training may represent an effective strategy to reduce distress in emergency periods as well as an essential part of HCPs’ general training.

Shared meditation involving cancer patients, health professionals and third persons is relevant and improves well-being: IMPLIC pilot study

BACKGROUND

Alleviating suffering and improving quality of life are universally shared goals. In this context, we implemented a pilot study to assess the feasibility and acceptability of a mindfulness intervention in the form of meditation involving together cancer patients, health professionals, and third persons.

METHODS

Two groups of 15 participants equally composed of patients, health professionals and third persons were constituted. A dedicated programme on mindfulness and compassion was constructed, including 12 weekly sessions of 1.5 h and a half-day retreat. Adherence and satisfaction with the programme were evaluated. All participants completed questionnaires on perceived stress, quality of life, mindfulness, empathy, and self-efficacy. Burnout was assessed in health professionals.

RESULTS

Shared meditation was feasible as 70% of participants attended ≥ 80% of the 13 meditation sessions. Satisfaction with the programme was high (median satisfaction score: 9.1 out of 10) and all participants expressed positive attitudes towards shared meditation and a benefit on their global quality of life. Participants reported significant improvement in stress (p < 0.001), global quality of life (p = 0.004), self-efficacy (p < 0.001), and mindfulness skills (p < 0.001) from baseline to post-programme.

CONCLUSIONS

This study demonstrated the feasibility of a shared dedicated meditation programme in terms of participation and acceptability of participants. The measured benefits observed among participants furthermore justify the interest of a subsequent randomized study aiming to demonstrate the potential added value of shared meditation by promoting bridge-building between cancer patients, health professionals and others.

TRIAL REGISTRATION

ClinicalTrials.gov. NCT04410185 . Registered on June 1, 2020.

Emergency Department Nurses' Experiences of a Mindfulness Training Intervention: A Phenomenological Exploration

Purpose: The purpose of this study was to explore emergency care nurses' experiences of an intervention to increase compassion and empathy and reduce stress through individual mindfulness training delivered via workshops and a smartphone application. We also explored how the nurses felt about the practical and technical aspects of the intervention. Design: Qualitative interview study. Method: Individual interviews were conducted with eight of the 56 participants in the intervention study and used phenomenological analysis to illuminate how they made sense of their lived experiences of mindfulness training. Findings: Three themes illuminated the nurses' experiences: becoming aware, changing through mindfulness, and gaining the tools for mindfulness through workshops and the mobile application. The first two themes expressed personal experiences, whereas the third expressed experiences of the practical and technical aspects of the intervention. Most nurses found the mobile application easy to use and effective. Conclusions: Emergency care nurses can feel that the awareness and changes that come with mindfulness training benefit them, their colleagues, and the patients for whom they care. The findings also provide insights into the challenges of practicing mindfulness in a busy emergency care setting and into the practical aspects of using a smartphone application to train mindfulness.

Meditative practices, stress and sleep among students studying complementary and integrative health: a cross-sectional analysis

Background

The International Cohort on Lifestyle Determinants of Health (INCLD Health) is an ongoing, prospective cohort study assessing the health behaviours and lifestyles of higher education students, including their use of specialty diets and complementary and integrative health (CIH) practices. Purpose: This cross-sectional analysis of the INCLD Health cohort aims to (1) evaluate the associations between perceived stress, sleep disturbance, and meditative practices with diurnal salivary free cortisol and (2) evaluate the associations of meditative practices as well as mind-body practices with perceived stress and sleep disturbance.

Methods

Serial multivariable linear regression models, adjusting for sociodemographic and lifestyle behaviours, were used to assess associations of (1) perceived stress, sleep disturbance, and meditative practices with salivary cortisol, and (2) meditative practices as well as mind-body practices with perceived stress and sleep disturbance. Meditative and mind-body practices were evaluated using a stress-management and self-care survey; perceived stress and sleep disturbance were evaluated using the 10-item Perceived Stress Scale (PSS), and the patient reported outcome measures information system-29 (PROMIS-29) sleep sub-score respectively. Salivary cortisol was collected at 4 time points over a 24-hour period and area under the curve (AUC) calculations conducted.

Results

82.5% (n = 80) of participants utilized at least monthly meditative practices. Greater disturbed sleep, but not perceived-stress, meditative, nor mind-body practices was independently associated with increased AUC cortisol (b = 0.02, 95% CI: 0.002–0.05, p = 0.03) after adjusting for age, sex, race, ethnicity, and BMI. Neither meditative nor mind-body practices were associated with perceived stress or disturbed sleep.

Conclusions

Among INCLD Health participants, greater sleep disturbance, but not perceived stress or meditative practices were associated with daytime cortisol.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12906-022-03582-5.

Psychedelic Experiences and Mindfulness are Associated with Improved Wellbeing

Both psychedelics and mindfulness are recently emerging topics of interest in academia and popular culture. The Prevalence of personal meditation practices and recreational psychedelic use has consistently increased in the past decade. While clinical work has shown both to improve long-term wellbeing, data on naturalistic applications of psychedelics and mindfulness are lacking. The current study examined the relationship between psychedelic use, mindfulness, and multi-faceted wellbeing as an outcome. Hierarchical regression was used to quantify these associations on a sample of people (N = 1,219) who engage in both meditation practices and psychedelic use. Results show that both mindfulness and mystical experiences are associated with substantial increases in wellbeing. Psychedelics were found to be a moderator of the relationship between mystical experience wellbeing. These data are among the first to establish a strong relationship between personal mindfulness practice, recreational psychedelic use, and overall psychological wellbeing in a naturalistic framework.

Mindfulness as a Protective Factor Against Increased Tobacco and Alcohol Use in Hospital Workers Following the First COVID-19-Related Lockdown: a Study in Southern France

COVID-19-related national lockdowns worldwide have had repercussions on people's well-being and have led to increased substance use. Mindfulness has previously been associated with reduced psychological distress and benefits in terms of addictive behaviors. We aimed to assess whether dispositional mindfulness protected against increased tobacco and alcohol use in hospital workers after France's first lockdown started. All workers in two French hospitals were contacted by email to participate in an online survey. Three hundred eighty-five workers answered. We ran two separate logistic regression models to test for associations between the level of dispositional mindfulness and both increased tobacco and alcohol use, after adjusting for affect deterioration. Dispositional mindfulness was associated with a lower likelihood of increased tobacco (adjusted odds ratio (AOR) [95% CI] 0.71 [0.51; 0.99], p = 0.046) and alcohol (0.66 [0.50; 0.87], p = 0.004) use. The effect of mindfulness on tobacco use was partially mediated by affect deterioration. Dispositional mindfulness appeared to be a protective factor against lockdown-related tobacco and alcohol use increases in French hospital workers.

The Effect of a Mindfulness-Based Intervention on Nurses in Kelantan, Malaysia

Background

Among healthcare workers, nurses have a particularly high risk of stress. Stressful conditions in the workplace increase the possibility of burnout and psychological distress. Short mindfulness-based interventions can help to decrease stress, anxiety and depression. This study aimed to explore the effectiveness of a mindfulness-based intervention in reducing perceived stress, anxiety and depression among public teaching hospital staff nurses.

Methods

Thirty-five nurses from various specialities were recruited from Hospital Universiti Sains Malaysia (HUSM). The intervention comprised a 1-day brief mindfulness-based intervention workshop and 1 h group practice session each month for 3 months together with daily follow-up via WhatsApp group. All the participants completed a self-administered sociodemographic questionnaire validated for use in a Malay population. The Depression, Anxiety and Stress Scale 21 (DASS 21) and Perceived Stress Scale 10 (PSS 10) were used to measure perceived stress, anxiety and depression before the intervention, and 3 months later upon completion of the intervention.

Results

There was a statistically significant reduction in the scores for stress perception (95% confidence interval [CI]: 0.06, 2.92; P = 0.04) and anxiety (95% CI: 0.06, 2.34; P = 0.04) post-intervention.

Conclusion

A brief mindfulness-based intervention was effective in reducing perceived stress and anxiety among nurses.

Mindfulness as a tool for reducing stress in healthcare professionals: An umbrella review

BACKGROUND

Health care providers (HCPs) and health care students experience a huge amount of stress due to high workloads and pressure to perform and are likely to develop anxiety, depression and burnout.

OBJECTIVE

The objective was to carry out an umbrella review of systematic and narrative reviews on the effectiveness of mindfulness-based interventions in reducing stress and improving well-being in HCPs and health care students.

METHODS

Systematic and narrative reviews that examined the impact of mindfulness-based interventions on HCPs and healthcare students' perceived stress were identified through a systematic search of three electronic databases: PubMed, Scopus and Web of Science.

RESULTS

Fifteen articles were included in the analysis: eleven systematic and four narrative reviews. Studies' quality varied from critically low to high. The different interventions showed positive results in reducing stress in both HCPs and students, with mindfulness-based stress reduction (MBSR) course having the major impact.

CONCLUSIONS

MBSR techniques and other mindfulness based interventions resulted to be potentially effective in reducing stress. However, despite the vast amount of data collected by the studies and the promising results, several limitations affected the validity of the studies. Therefore, more research that considers the critical aspects of this field is required, in order to provide more reliable results.

Mindfulness-Based Program for Anxiety and Depression Treatment in Healthcare Professionals: A Pilot Randomized Controlled Trial

In primary health care, the work environment can cause high levels of anxiety and depression, triggering relevant expert and individual change. Mindfulness-Based Stress Reduction (MBSR) programs reduce signs of anxiety and depression. The purpose of this sub-analysis of the total project, was to equate the effectiveness of the standard MBSR curriculum with the abbreviated version in minimizing anxiety and depression. This randomized controlled clinical trial enrolled 112 mentors and resident specialists from Family and Community Medicine and Nurses (FCMN), distributed across six teaching units (TU) of the Spanish National Health System (SNHS). Experimental group participants received a MBRS training (abbreviated/standard). Depression and anxiety levels were measured with the Goldberg Anxiety and Depression Scale (GADS) at three different time periods during the analysis: before (pre-test) and after (post-test) participation, as well as 3 months after the completion of intervention. Taking into account the pre-test scores as the covariate, an adjusted analysis of covariance (ANCOVA) showed significant depletion in anxiety and depression in general (F (2.91) = 4.488; p = 0.014; η² = 0.090) and depression in particular (F (2, 91) = 6.653; p = 0.002; η² = 0.128 at the post-test visit, maintaining their effects for 3 months (F (2.79) = 3.031; p = 0.050; η² = 0.071-F (2.79) = 2.874; p = 0.049; η² = 0.068, respectively), which is associated with the use of a standard training program. The abbreviated training program did not have a significant effect on the level of anxiety and depression. The standard MBSR training program had a positive effect on anxiety and depression and promotes long-lasting effects in tutors and resident practitioners. New research is needed to demonstrate the effectiveness of abbreviated versions of training programs.

An Integrative Review on the Research Progress of Mindfulness and Its Implications at the Workplace

Mindfulness has rapidly become a significant subject area in many disciplines. Most of the work on mindfulness has focused on the perspective of health and healthcare professionals, but relatively less research is focused on the organizational outcomes at the workplace. This review presents a theoretical and practical trajectory of mindfulness by sequential integration of recent fragmented scholarly work on mindfulness at the workplace. The review showcases that most contemporary practical challenges in organizations, such as anxiety, stress, depression, creativity, motivation, leadership, relationships, teamwork, burnout, engagement, performance, well-being, and physical and psychological health, could be addressed successfully with the budding concept of mindfulness. The causative processes due to higher mindfulness that generate positive cognitive, emotional, physiological, and behavioral outcomes include focused attention, present moment awareness, non-judgmental acceptance, self-regulatory functions, lower mind wandering, lower habit automaticity, and self-determination. Employee mindfulness could be developed through various mindfulness interventions in order to improve different organizational requirements, such as psychological capital, emotional intelligence, prosocial behavior, in-role and extra-role performance, financial and economic performance, green performance, and well-being. Accordingly, this review would be beneficial to inspire academia and practitioners on the transformative potential of mindfulness in organizations for higher performance, well-being, and sustainability. Future research opportunities and directions to be addressed are also discussed.

Meditation involving people with cancer, medical staff and witnesses: a pilot study exploring improvement in wellness and connectedness

INTRODUCTION

Mindfulness meditation is likely to promote better management of stress, pain and negative emotions. We propose to address the benefit of meditation in an open setting associating people with cancer (target population), medical staff and witnesses (neither patient nor medical staff). This study aims (1) to evaluate the effects of meditation on wellness improvement and (2) to identify criteria and modalities for a subsequent randomised study.

METHODS AND ANALYSIS

We propose a longitudinal pilot study consisting of a non-randomised experimental preintervention/postintervention survey. The intervention consists in delivering a meditation programme (12 weekly meditation sessions of 1.5 hours each), specifically adapted to our target population and addressing our research hypothesis in an open setting involving people with cancer, medical staff and witnesses (equally distributed in two groups of 15 participants). The main objective is to evaluate participants' adherence to the programme. The effects of meditation will be evaluated on stress, quality of life, feeling of personal effectiveness, on the development of mindfulness and empathy, and on satisfaction and perception of a change in quality of life. We will also measure the putative added value of 'meditating together'. This study is expected to allow validating the evaluation tools and refining the modalities of the workshops. We expect to demonstrate the evolution that this meditation-based intervention induces in the participants. We aim to promote bridge-building, between patients, medical staff but also others. In this way, one's own suffering may be understood in the light of others' suffering, thereby promoting the sense of otherness and giving insights into 'living better with'. This exploratory study will investigate the relevance of this hypothesis, which could then be explored by a randomised study.

ETHICS AND DISSEMINATION

The protocol was approved by the local ethics committee (Comité de Protection des Personnes Est II). Trial findings will be published in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

NCT04410185.

The effects of mindfulness on health profession students' simulation training outcomes: An integrative review

Health profession students (HPSs) continuously experience psychological issues which can exacerbate cognitive errors and harm emotional well-being. The Healthcare simulation environment is stressful and overwhelming in nature and may impair learning outcomes. Therefore, integrating psychological interventions into simulation-based learning (SBL) instructional design may alleviate students' psychological distress and improve their learning outcomes.

OBJECTIVES

to examine the effects of mindfulness on health professions students' SBL outcomes.

DESIGN

a literature review, based on Whittemore and Knafl's (2005) updated methodology was used in this study.

DATA SOURCES

We investigated PubMed, ERIC, ScienceDirect, and Google Scholar to find papers addressing the effects of mindfulness on health professions students' SBL outcomes. We targeted Results: This integrative review suggests that although mindfulness improves SBL outcomes, HPSs still struggle to transfer mindfulness benefits to real clinical practice.

CONCLUSION

research on mindfulness in healthcare SBL is in its infancy, thus, further research is needed to prove mindfulness effects on HPSs' SBL outcomes.

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

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.

Mindfulness-Based Interventions to Reduce Burnout in Primary Healthcare Professionals: A Systematic Review and Meta-Analysis

Mindfulness-based interventions (MBIs) are reported by experimental studies as practical approaches to reduce burnout in primary healthcare professionals (PHCP). However, to date, no research has synthesized the evidence to determine the overall effects of MBIs for reducing burnout in PHCP. We conducted a systematic review and meta-analysis to analyze the effects of MBIs to reduce burnout in PHCP. We searched articles in the PubMed/MEDLINE, Web of Science, Cochrane, and Scopus databases from inception to September 2021 using MeSH terms: "mindfulness", "burnout", and "primary healthcare". Two reviewers extracted the data and assessed the risk of bias. We used a random-effects meta-analysis to calculate the standardized mean differences (SMD) and mean differences (MD) with 95% confidence intervals (CI) of emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA) domains of burnout. Of 61 records, ten were included (n = 417). Overall, the studies were rated as having a high risk of bias and limited quality evidence. MBIs significantly reduced EE (SMD = -0.54, 95%CI: -0.72 to -0.36; MD = -5.89, 95%CI: -7.72 to -4.05), DP (SMD = -0.34, 95%CI: -0.52 to -0.17; MD = -1.96, 95%CI: -2.96 to -0.95), and significantly increased PA (SMD = 0.34, 95%CI: 0.17 to 0.52; MD = 2.05, 95%CI: 1.04 to 3.06). Although further high-quality research is needed, our findings support the implementation of MBIs for reducing burnout in PHCP.