Mindfulness-Based Resilience Training in the Workplace: Pilot Study of the Internet-Based Resilience@Work (RAW) Mindfulness Program

Organisational coaching to improve workplace resilience: a scoping review and agenda for future research

In an increasingly demanding and pressured work environment, employee resilience is acknowledged as a critical element to navigate adversity. There has been increased focus and interest in studying the nature of resilience in the workplace, however the mechanisms of developing and sustaining resilience are still under debate. Coaching is a promising method organisations use to improve employee resilience and provides employees with support to deal with the challenging working environment. There has been significant interest in coaching for resilience in recent years, however there is no overarching, consolidated view on the nature and dynamics of resilience coaching. This scoping review seeks to fill this gap by making three contributions. Firstly, we present details on various types of coaching approaches used to improve resilience. Secondly, we review the specific coaching elements and processes that lead to improved resilience and finally, we provide an overview on the efficacy of resilience coaching interventions. We conclude this scoping review with a roadmap for future research to help position and strengthen organisational coaching as a pillar of resilience development. This scoping review followed a five-stage PRISMA-ScR methodology which entails formulating research questions; identifying studies; choosing studies; extracting and charting data; and summarising the findings.

Social media use for work during non-work hours and turnover intention: the mediating role of burnout and the moderating role of resilience

Introduction

This study uses survey data from 504 Chinese teachers to investigate the relationship between social media use for work during non-work hours (SMUNW) and turnover intention, focusing on the mediating role of burnout and the moderating role of resilience in this relationship.

Methods

In November 2023, online survey links were sent to 529 teachers from Shandong Province, China, asking them to report their perceptions of SMUNW, burnout, resilience, and turnover intention. A sample of 504 valid responses was obtained. The analysis was performed using SPSS 26.0 and Hayes' PROCESS MACRO for SPSS for testing the hypotheses.

Results

The results revealed that burnout acts as a mediator in the relationship between SMUNW and turnover intention. In addition, resilience moderated the relationship between SMUNW and burnout such that when resilience was higher, the relationship between SMUNW and burnout was alleviated. Moreover, resilience moderated the indirect relationship between SMUNW and turnover intention through burnout such that when resilience was higher, the indirect relationship was alleviated.

Discussion

The results of this study indicate that SMUNW is related to turnover intention through the mediating role of burnout. Furthermore, resilience moderates the influence of SMUNW on burnout and thus weakens the influence of SMUNW on turnover intention through burnout. This study expands our knowledge of the nuanced influence mechanisms of social media use in the context of increasing technostress among public employees. Practically, it suggests that managers should pay due attention to the impairments brought about by social media use, especially from the perspectives of preventing burnout and fostering resilience.

Efficacy of the my health too online cognitive behavioral therapy program for healthcare workers during the COVID-19 pandemic: A randomized controlled trial

Background

Healthcare workers' mental health has been impacted by the COVID-19 pandemic, emphasizing the need for mental health interventions in this population. Online cognitive behavioral therapy (CBT) is efficient to reduce stress and may reach numerous professionals. We developed "MyHealthToo", an online CBT program to help reduce stress among healthcare workers during the COVID-19 pandemic.

Objective

The aim of our study is to investigate the efficacy of an online CBT program on stress and mental health conditions among healthcare workers during a health crisis.

Methods

We performed a multicentric randomized controlled trial among 155 participants allocated either to the experimental or active control group (bibliotherapy). The primary outcome was the decrease of perceived stress scores (PSS-10) post-treatment. Secondary outcomes included depression, insomnia and PTSD symptoms along with self-reported resilience and ruminations. Assessments were scheduled pretreatment, mid-treatment (4 weeks), post-treatment (8 weeks), and at 1-month and 4-months follow-up.

Results

For both interventions, mean changes on the PSS-10 were significant post-therapy (W8), as at 1-month (W12) and 4-months (W24) follow-ups. The between-group comparison showed no difference at any time point (ps > 0.88). Work-related ruminations significantly decreased in the experimental group with a significant between-group difference at W8 (Δ = -1.83 [-3.57; -0.09], p = 0.04). Posttraumatic stress symptoms significantly decreased in the experimental group with a significant between-group difference at W12 (Δ = -1.41 [-2.68; -0.14], p = 0.03). The decrease in work-related ruminations at W8 mediated the decrease in posttraumatic stress symptoms at W12 (p = 0.048).

Conclusion

The "MyHealthToo" online CBT intervention may help reduce ruminations about work and posttraumatic stress symptoms among healthcare workers during a major health crisis. Work-related ruminations may represent a relevant target of online interventions to improve mental health among healthcare workers.

[Should we take into account the informational stress of the medical oncologist?]

Information overload, informational stress and its deleterious consequences constitute a subject of growing interest in the way of work. This is quite well documented among anesthesiologists. Studies have also been carried out on cancer patients or on the general public in terms of cancer prevention. After having defined the concepts and the consequences, we hypothesize the presence of informational stress among medical oncologists. We illustrate this hypothesis regarding adjuvant treatment of breast cancer. Specific studies (qualitative and quantitative ones) would be particularly interesting in oncology.

Potential resilience treatments for orangutans (Pongo spp.): Lessons from a scoping review of interventions in humans and other animals

Wild orangutans (Pongo spp.) rescued from human-wildlife conflict must be adequately rehabilitated before being returned to the wild. It is essential that released orangutans are able to cope with stressful challenges such as food scarcity, navigating unfamiliar environments, and regaining independence from human support. Although practical skills are taught to orangutans in rehabilitation centres, post-release survival rates are low. Psychological resilience, or the ability to 'bounce back' from stress, may be a key missing piece of the puzzle. However, there is very little knowledge about species-appropriate interventions which could help captive orangutans increase resilience to stress. This scoping review summarises and critically analyses existing human and non-human animal resilience literature and provides suggestions for the development of interventions for orangutans in rehabilitation. Three scientific databases were searched in 2021 and 2023, resulting in 63 human studies and 266 non-human animal studies. The first section brings together human resilience interventions, identifying common themes and assessing the applicability of human interventions to orangutans in rehabilitation. The second section groups animal interventions into categories of direct stress, separation stress, environmental conditions, social stress, and exercise. In each category, interventions are critically analysed to evaluate their potential for orangutans in rehabilitation. The results show that mild and manageable forms of intervention have the greatest potential benefit with the least amount of risk. The study concludes by emphasising the need for further investigation and experimentation, to develop appropriate interventions and measure their effect on the post-release survival rate of orangutans.

Developing and Evaluating an Online Post-Traumatic Growth Program for Firefighters

We evaluated how an online post-traumatic growth program affected rumination, social support, and post-traumatic growth. We recruited 33 firefighters from two Korean provinces and employed a nonequivalent control group pretest-post-test design. We administered the pretest for the intervention group (n = 16), consisting of eight sessions with an online workbook and messenger group counseling. We conducted post-tests immediately after the program and 4 weeks later. Post-traumatic growth and social support increased significantly. There were no statistically significant differences for intrusive or deliberate rumination. Psychological support programs should be developed to reflect firefighters' work characteristics and needs, including programs designed to induce rumination.

Web-Based Mind-Body Tactical Resilience Training Program for First Responders: Pre-Post Study Assessing Feasibility, Acceptability, and Usability

BACKGROUND

First responders report elevated rates of mental disorders, including posttraumatic stress disorder (PTSD), yet many are reluctant to seek care. Preventative resilience training programs attempt to proactively address this issue, and there is evidence showing promise for programs targeting cognitive processes. However, these programs rarely address the physical health conditions associated with PTSD. There is emerging evidence of mind-body exercise training improving PTSD symptoms as well as its associated physical health symptoms. However, the feasibility and acceptability of delivering a web-based mind-body resilience training among first responders are not yet known.

OBJECTIVE

This study aimed to evaluate the feasibility, usability, and acceptability of a web-based mind-body tactical resilience training program designed for first responders. In addition, we explored the preliminary effectiveness of the training program on mental health outcomes, adaptive cognitive strategies, and work productivity.

METHODS

A total of 42 first responders based in the United States enrolled in the web-based training program. Participants were administered web-based surveys before enrolling in the 6-week web-based program and at the end of the program. The primary outcomes of feasibility were measured using the number of training hours, program adherence rates, and self-reported data on frequency of practice. Acceptability and usability were measured using self-reported data. Secondary outcomes were symptoms of PTSD, psychological distress, emotion regulation, stress mindset, psychological preparedness, and work performance.

RESULTS

Overall, the training program was feasible based on the median number of training hours spent on the web-based program (7.57 hours out of an expected total of 6 to 9 hours), and 55% (23/42) of the enrolled participants completed more than half of the program. Although acceptability, usability, and frequency of practice were rated as high, this was based on only 29% (12/42) of the respondents who provided follow-up data. Secondary outcomes showed a significant improvement in the adaptive cognitive strategy of the stress mindset, with a mean difference of -5.42 (SD 4.81; 95% CI -8.475 to -2.358; t₁₁=-3.898; P=.002). All other secondary outcomes were not significant. However, the secondary outcomes were exploratory only, and this study was neither designed nor powered to adequately assess efficacy.

CONCLUSIONS

These findings suggest that a mind-body tactical resilience training program delivered in a web-based format is feasible and acceptable among first responders; however, further refinements may be required to improve adherence rates. Further research using a larger, more rigorous trial design is warranted to examine the effectiveness of this type of training as a possible prevention or treatment strategy for this population.

Becoming More Resilient during COVID-19: Insights from a Process Evaluation of Digital Resilience Training

Resilience training is gaining attention as a strategy to build students' resistance to adversity and promote their mental well-being. However, owing to inconsistencies and variations in the content and delivery of resilience training, more work is needed to examine students' experiences and preferences to address issues relating to intervention fidelity. This study adopted a qualitative approach in exploring students' experience of synchronous and asynchronous versions of a digital resilience training program. Seventeen students were interviewed using a semi-structured virtual face-to-face interview via Zoom. The thematic analyses unveiled four themes: embarking on a journey toward resilience, discovering strategies to develop resilience, finding a balance to benefit from resilience skill enhancement, and instilling resilience in the everyday. Future resilience training should consider students' workload and interactivity to enhance their engagement. As being resilient is associated with better mental well-being, the findings of this study may support the development of future wellness programs.

Resilience for Undergraduate Students: Development and Evaluation of a Theory-Driven, Evidence-Based and Learner Centered Digital Resilience Skills Enhancement (RISE) Program

Protective factors that build students' resilience are known. A six-week digital resilience training program was developed on the basis of theory, evidence, and contextual information. The feasibility study sought to evaluate the acceptability, appropriateness, demand, implementation, and limited efficacy of a digital resilience skills enhancement program for undergraduate students. A single group, pre-test, post-test, concurrent mixed methods design among 10 undergraduate students was conducted in one university in Singapore. The content analysis concluded that students accepted and perceived the digital resilience skills enhancement program as appropriate. Students also proposed several improvements, such as the initiation of the program and revisions to the content. The Wilcoxon signed-rank test found significant improvements in resilience (p = 0.02) and meta-cognitive self-regulation (p = 0.01) scores with medium (d = 0.79, 95% CI: -0.15 to 1.74) and very large effect sizes (d = 1.31, 95% CI: 0.30-2.33), respectively. Students found the digital resilience program appropriate and were able to apply their newly acquired skills to promote their resilience and learning. Although, several improvements are proposed to enhance the rigor of the digital resilience program, the findings of this study suggests that digital resilience programs are important for students' well-being.

Effectiveness of Digital Interventions for Deficit-Oriented and Asset-Oriented Psychological Outcomes in the Workplace: A Systematic Review and Narrative Synthesis

BACKGROUND

Digital psychological interventions can target deficit-oriented and asset-oriented psychological outcomes in the workplace. This review examined: (a) the effectiveness of digital interventions for psychological well-being at work, (b) associations with workplace outcomes, and (c) associations between interventions' effectiveness and their theory-base.

METHODS

six electronic databases were searched for randomised controlled trials (RCT) and quasi-experimental studies. The methodological quality of studies that used randomisation was conducted with the "Cochrane Collaboration's Risk of Bias" tool, while the "JBI Critical Appraisal Checklist" was used for non-randomised studies. Studies' theory-base was evaluated using an adaptation of the "theory coding scheme" (TSC). Due to heterogeneity, narrative synthesis was performed.

RESULTS

51 studies were included in a synthesis describing four clusters of digital interventions: (a) cognitive behavioural therapy, (b) stress-management interventions and workplace well-being promotion, (c) meditation training and mindfulness-based interventions, and (d) self-help interventions. Studies demonstrated a high risk of contamination effects and high attrition bias. Theory-informed interventions demonstrated greater effectiveness. Cognitive behavioural therapy demonstrated the most robust evidence for reducing depression symptoms among healthy employees. With the exception of the Headspace application, there was weak evidence for meditation training apps, while relaxation training was a key component of effective stress-management interventions.

Use of Mobile Apps and Online Programs of Mindfulness and Self-Compassion Training in Workers: A Scoping Review

Mindfulness and self-compassion interventions are two strategies helpful in preventing and reducing burnout and work stress. However, professionals with overburdened schedules can experience obstacles in learning and practicing these interventions, originally taught with lengthy programs. The use of digital technologies could make these interventions more accessible to workers, as studied in a recent, growing body of evidence. The evidence available is diverse in terms of interventions, designs, outcomes, and populations. This calls for a review that can take into consideration this diversity while still rigorously synthesize it. Scoping reviews are designed to examine emerging evidence and summarize the evidence on a specific topic of interest. The present scoping review aims to assess the current state of the literature on the use of online programs and mobile applications of self-compassion, mindfulness, and meditation (digital mindfulness-based interventions; dMBIs) by workers. More specifically, information on the type of intervention, population, advantages, and disadvantages, measured outcomes, and advice for future research are gathered. MEDLINE (PubMed; Ovid), PsychInfo (Ovid), and Web of Science (Clarivate) were searched to identify all relevant articles. The screening process resulted in 56 articles being included in this scoping review. Inclusion criteria were (1) participants are workers; (2) the intervention is individual, digital, and mindfulness/self-compassion/meditation-based; and (3) articles were available in French or English language at the time of the review. Interventions used were mostly mindfulness-based, equally categorized under web-based and app-based interventions. Most interventions included information on mindfulness, meditation or self-compassion, meditation exercises, other types of exercises, instructions on how to use, and reminders. dMBIs are often studied in the healthcare population and predominantly in female samples. Although dMBIs present advantages (low cost, accessibility, practicality, feasibility), obstacles can arise in their implementation (low engagement and motivation, concerns about confidentiality). Included articles measured outcomes related to work, mindfulness or self-compassion, and other psychological variables (stress/anxiety, depression, resilience, wellbeing). Articles provided important directions to further research on dMBIs regarding methodological aspects, modality and intervention, and individual and organizational questions. dMBIs are becoming more popular and interventions are diverse. Although not without limitations, this scoping provided a synthesis on different aspects of the use of dMBIs within workers and highlighted pertinent future research directions.

Mental Disorder Symptoms and the Relationship with Resilience among Paramedics in a Single Canadian Site

There is growing recognition in research and policy of a mental health crisis among Canada’s paramedics; however, despite this, epidemiological surveillance of the problem is in its infancy. Just weeks before the emergence of the COVID-19 pandemic, we surveyed paramedics from a single, large, urban paramedic service in Ontario, Canada to assess for symptom clusters consistent with post-traumatic stress disorder (PTSD), major depressive disorder, and generalized anxiety disorder and to identify potential risk factors for each. In total, we received 589 completed surveys (97% completion rate) and found that 11% screened positive for PTSD, 15% screened positive for major depressive disorder, and 15% screened positive for generalized anxiety disorder, with one in four active-duty paramedics screening positive for any of the three as recently as February 2020. In adjusted analyses, the risk of a positive screen varied as a function of employment classification, gender, self-reported resilience, and previous experience as a member of the service’s peer support team. Our findings support the position that paramedics screen positive for mental disorders at high rates—a problem likely to have worsened since the onset of the COVID-19 pandemic. We echo the calls of researchers and policymakers for urgent action to support paramedic mental health in Canada.

My Health Too: Investigating the Feasibility and the Acceptability of an Internet-Based Cognitive-Behavioral Therapy Program Developed for Healthcare Workers

Background: The COVID-19 crisis has had a considerable mental health impact on healthcare workers. High levels of psychological distress are expected to have a significant impact on healthcare systems, warranting the need for evidence-based psychological interventions targeting stress and fostering resilience in this population. Online cognitive behavioral therapy (CBT) has proved to be effective in targeting stress and promoting resilience. However, online CBT programs targeting stress in healthcare workers are lacking. Objective: The aim of our study is to evaluate the feasibility and acceptability of an internet-based CBT intervention, the My Health Too program we developed during the first COVID-19 epidemic peak in France. Methods: We recruited 10 participants among Alsace region hospital staff during the first peak of the pandemic in France. They were given 1 week to test the website and were then asked to answer an internet survey and a semi-structured phone interview. Results: We conducted a thematic analysis of the content from the phone interviews. Major themes were identified, discussed and coded: the technical aspects, the content of the website and its impact on participants' emotions and everyday life. Overall, the participants reported finding the website easy to use and interactive. They described the resources as easy to understand, readily usable, and useful in inducing calm and in helping them practice self-compassion. Conclusion: Our results suggest that the My Health Too online CBT program is highly feasible and acceptable to healthcare workers during the highly stressful times of the pandemic peak. The feedback provided helped to improve the program whose efficacy is to be tested.

Feasibility, Acceptability, and Preliminary Efficacy of an App-Based Meditation Intervention to Decrease Firefighter Psychological Distress and Burnout: A One-Group Pilot Study (Preprint)

Background

Firefighters are often exposed to occupational stressors that can result in psychological distress (ie, anxiety and depression) and burnout. These occupational stressors have only intensified with the onset of the COVID-19 pandemic and will likely persist in the postpandemic world.

Objective

To address occupational stressors confronting firefighters, we pilot tested a novel, cost-effective, smartphone app–based meditation intervention created by Healthy Minds Innovations that focused on mindfulness (awareness) training along with practices designed to cultivate positive relationships (connection), insight into the nature of the self (insight), and a sense of purpose in the context of challenge (purpose) with a sample of professional firefighters from a large metropolitan area in southwestern United States.

Methods

A total of 35 participants were recruited from a closed online group listserv and completed the self-guided 10-unit meditation app over the course of 10 days, at 1 unit per day. We assessed anxiety symptoms, depression symptoms, burnout, and negative affect as well as saliva diurnal cortisol rhythm, an objective indicator of stress-related biology, before and after use of the meditation app.

Results

This study demonstrated the meditation app was both feasible and acceptable for use by the majority of firefighters. We also found significant reductions in firefighters’ anxiety (P=.01), burnout (P=.05), and negative affect (P=.04), as well as changes in cortisol diurnal rhythm, such as waking cortisol (P=.02), from before to after use of the meditation app.

Conclusions

Our study findings call for future research to demonstrate the efficacy of this meditation app to reduce psychological distress and burnout in firefighters.

Resilience Training Programs in Organizational Contexts: A Scoping Review

The importance of resilience for employees' well-being and performance at work has grown steadily in recent years. This development has become even more pronounced through the recent COVID-19 pandemic and its consequences, including major changes in occupational settings. Although there is increasing interest in resilience in general and a growing number of publications focusing on the development of resilience in particular, many questions remain about resilience training, especially in organizational contexts. The purpose of this scoping review is to uncover what is known about resilience training in organizational contexts. A systematic search of four databases for articles published through 2021 was conducted. A total of 48 studies focusing on resilience training programs in organizational contexts were included in this review. The review provides relevant insights into resilience training programs by focusing on program characteristics, target group, study design, and outcomes. Based on the results, the main aspects that concern the development of resilience training programs for organizational settings and requirements for the study design for empirical investigation were summarized. The results of the review highlight possible directions for future research and offer useful insights for resilience-enhancing training programs in organizations.

Loneliness and frailty among nursing home older adults: the multiple mediating role of social support and resilience

BACKGROUND

Loneliness has been considered as a risk factor for frailty. Social support (as an external protective resource) and resilience (as an inner protective resource) might play protective roles on the association between loneliness and frailty. In this study, the mediating roles of social support and resilience between loneliness and frailty were explored among older adults living in nursing homes.

METHODS

Older adults (N = 210) from three nursing homes in China were recruited in this cross-sectional study. Information for sociodemographic variables, frailty, loneliness, social support and resilience were collected. The bootstrap analyses by PROCESS macro were conducted to test the multiple mediating role of social support and resilience between loneliness and frailty.

RESULTS

The prevalence of frailty was 34.8% among older adults in nursing homes. Also, social support and resilience mediated the association between loneliness and frailty, respectively. Furthermore, the multiple mediating testing results showed that social support and resilience played sequential mediating roles in the link of loneliness to frailty.

CONCLUSIONS

The findings underscore the protective role of social support and resilience of loneliness and frailty among nursing home older adults.

A review of workplace mental health interventions and their implementation in public safety organizations

OBJECTIVE

Workplace mental health is relevant to public safety organizations due to the exposure that many public safety personnel (PSP) have to psychological trauma in the course of their daily work. While the importance of attending to PSP mental health has been established, the implementation of workplace mental health interventions is not as well understood. This scoping review describes workplace mental health interventions and their implementation in public safety organizations.

METHODS

English published primary studies with any publication date up to July 3, 2020 were considered. JBI methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews was followed.

RESULTS

89 citations met inclusion criteria out of the 62,299 found. Articles and reports found were largely published within the last decade, most frequently from Western nations, and most often applied to police, followed by firefighters. The focus of interventions was commonly stress management and resilience, and a frequent implementation strategy was multi-session group training. Comprehensive quality improvement initiatives, a focus on supervisors and managers, and interventions across primary, secondary, and tertiary prevention, were infrequent.

CONCLUSION

Public safety organizations are frequently reporting on stress management and resilience interventions for police and firefighters, implemented through multi-session group training. A focus across a range of PSP, including paramedics, corrections officers, and emergency dispatchers, using implementation strategies beyond group training, is suggested. This area of research is currently expanding, with many studies published within the past decade; ongoing evaluation of the quality of interventions and implementation strategies is recommended.

Coping among public safety personnel: A systematic review and meta–analysis

Public safety personnel (PSP) are routinely exposed to potentially psychologically traumatic events (PPTEs) that, in turn, can result in posttraumatic stress injuries (PTSI), including burnout and increased symptoms of depression and anxiety. However, the longitudinal impact of PPTEs on PSP coping remains unclear. Coping can be operationalized as various strategies (i.e., behaviours, skills, thought and emotion regulation) for dealing with stressors, which are broadly categorized as either approach (adaptive, positive, social support) or avoidant coping strategies (maladaptive withdrawal, avoidance, substance use). This systematic review and meta-analysis aims to evaluate longitudinal coping outcomes among PSP. Thirteen eligible repeated-measures studies explicitly evaluated coping in 1854 police officers, firefighters, and rescue and recovery workers. Study designs included randomized-control trials, within-subject interventions and observational studies. Effect sizes (Cohen's d) at follow-up were described in 11 studies. Separate meta-analyses reveal small (d < 0.2) but non-significant improvements in approach and avoidant coping. Studies were of moderate quality and low risk of publication bias. Heterogeneity in outcome measures, follow-up durations, and study types precluded subgroup analyses. The current findings can inform the development and evaluation of organizational training programs that effectively promote sustained adaptive coping for PSP and mitigate PTSIs.

Team Belonging: Integrating Teamwork and Diversity Training Through Emotions

With the worldwide focus shifting toward important questions of what diversity means to society, organizations are attempting to keep up with employees’ needs to feel recognized and belong. Given that traditionally team and diversity trainings are provided separately, with different theoretical backgrounds and goals, they are often misaligned and ineffective. We review 339 empirical articles depicting a team, diversity, or emotional management training to extract themes and determine which methods are most effective. Although research has demonstrated the importance of belonging for providing positive workplace outcomes, we found that the traditional design of these trainings and lack of emotional management prevent a balance between team and diversity goals, preventing belonging. We propose an integrative training with emotional management to help teams foster optimal belonging, where members can unite together through their differences. Accordingly, our themes inform this training model that can inspire future research into more effective training.

Proactive psychological programs designed to mitigate posttraumatic stress injuries among at-risk workers: a systematic review and meta-analysis

BACKGROUND

Public safety personnel and frontline healthcare professionals are at increased risk of exposure to potentially psychologically traumatic events (PPTE) and developing posttraumatic stress injuries (PTSI, e.g., depression, anxiety) by the nature of their work. PTSI are also linked to increased absenteeism, suicidality, and performance decrements, which compromise occupational and public health and safety in trauma-exposed workers. Evidence is lacking regarding the effectiveness of "prevention" programs designed to mitigate PTSI proactively. The purpose of this review is to measure the effectiveness of proactive PTSI mitigation programs among occupational groups exposed to PPTE on measures of PTSI symptoms, absenteeism, and psychological wellness.

METHODS

Five electronic databases were searched per PRISMA guidelines for English or French peer-reviewed studies from 2008 to 2019 evaluating PTSI and psychological wellness in adults exposed to occupational PPTE. The risk of bias was assessed using the Newcastle-Ottawa Scale.

RESULTS

We identified 42 studies evaluating 3182 public safety and frontline healthcare professionals, PPTE-exposed educational staff, and miners. Significant overlap was found across program themes that included mindfulness, psychoeducation, resilience promotion, and stress management strategies. Post-program effect sizes were small (SMD < 0.5) to moderate (SMD < 0.8) for reductions in PTSI symptoms and for promoting measures of well-being as indicated by a meta-analysis on 36 studies. There was no evidence for significant reductions in substance use, absenteeism, or biomarkers of distress except for heart rate. Subgroup analyses indicated that multimodal programs effectively improved general psychological health, while resilience programs improved measures of depression, burnout, coping, and resilience. Effect sizes for resilience, depression, and general psychological health improvements were greatest immediately or 1-month post-training, while improvements in PTSD symptoms and coping were larger at longer follow-up. Studies were of moderate quality and risk of bias.

CONCLUSIONS

The current results showcase modest evidence for time-limited reductions in PTSI following participation in holistic programs that promote resilience, stress, and emotion regulation among at-risk workers. Implications for organizational implementation of proactive PTSI mitigation programs and areas of future research are discussed.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO (CRD42019133534).

A mindful path to the COVID-19 pandemic: an approach to promote physical distancing behavior

Purpose

The present situation is marked by the threat of COVID-19 pandemic on entire humankind and researchers across the globe are looking forward to vaccines or medicines to tackle COVID-19. However, according to the scholars and health-care agencies, vaccines alone would not be of much help and in the longer run adhering to the physical distancing policy along with sanitation could be the only solution. Moreover, extant studies across different areas have noted a positive association between various human psychological factors and prosocial behaviours. Additionally, an empirical study undertaken in the western context has tried exploring the association between human psychological factors and physical distancing behaviour (a kind of prosocial behaviour) in the COVID-19 context. The results of the extant study seem intriguing and encouraging enough to undertake a more robust exploratory study in this developing area. Against this background, this study aims to explore the relationship between individuals’ mindfulness and physical distancing behaviour, along with the mediating role of empathy during the COVID-19 pandemic.

Design/methodology/approach

To achieve the study objectives, this study has used an online survey method and has collected responses from the general adult population in India spread across all six regions. The survey was conducted during May 2020 when India was under a nationwide lockdown to mitigate the risk of COVID-19 pandemic. The respondents were identified based on convenience and snowball sampling techniques. Using social media platforms, the prospective respondents were contacted through WhatsApp, LinkedIn and Facebook or e-mails. Post data cleaning, a total of 315 responses were found to be suitable for analysis. For analysis, confirmatory factor analysis was conducted to establish the validity and reliability of the conceptual model, whereas Pearson correlation was undertaken to study the relationship between variables and mediation was examined using the PROCESS macro of Hayes.

Findings

The findings were encouraging and could become the foundation stone for further research and a practical guide for policymakers, agencies working in the health-care areas and even corporate leaders. As expected, an individual’s mindfulness was noted to be positively-related and influencing physical distancing behaviour. The mediation analysis indicated the intervening role of empathy in the association between an individual’s mindfulness and physical distancing behaviour.

Practical implications

The findings of the present could be a game-changer in restricting the spread of the COVID-19 pandemic. As espoused by various scholars, as well as health-care organizations about the use of physical distancing in mitigating the risk of COVID-19, policymakers, health-care authorities and even corporate leaders could look forward to strategizing and execute the dissemination of various mindfulness-based programs among the individuals. These mindfulness-based programs, which could be disseminated offline and online through smartphones, could, in turn, help in positively influence physical distancing behaviour among the individuals leading to the success of physical distancing policy.

Social implications

This study relates and extends the mechanism of mindfulness in influencing individuals’ physical distancing behaviour in the pandemic situation, notably the COVID-19 pandemic. Moreover, based on the “empathy-altruism hypothesis”, as well as Schwartz’s theory of fundamental values, the intervening role of empathy has been explored and the findings further helped in extended these two theories in the domain of pandemic.

Originality/value

This study could be the first to conceptualize and examine the human psychological factors, particularly the relationship and role of an individual’s mindfulness with physical distancing behaviour among the general public during the COVID-19 pandemic. Additionally, this could also be the first study to conceptualize and explore the intervening role of empathy in the relationship between an individual’s mindfulness and physical distancing behaviour. Moreover, in conceptualizing and exploring the relationship between an individual’s mindfulness and physical distancing behaviour, this study explored and extended the “reperceiving” mechanism of mindfulness and the “empathy-altruism hypothesis” along with Schwartz’s theory of fundamental values in the domain of pandemic.

Efficacy of an online cognitive behavioral therapy program developed for healthcare workers during the COVID-19 pandemic: the REduction of STress (REST) study protocol for a randomized controlled trial

BACKGROUND

The acknowledgment of the mental health toll of the COVID-19 epidemic in healthcare workers has increased considerably as the disease evolved into a pandemic status. Indeed, high prevalence rates of depression, sleep disorders, and post-traumatic stress disorder (PTSD) have been reported in Chinese healthcare workers during the epidemic peak. Symptoms of psychological distress are expected to be long-lasting and have a systemic impact on healthcare systems, warranting the need for evidence-based psychological treatments aiming at relieving immediate stress and preventing the onset of psychological disorders in this population. In the current COVID-19 context, internet-based interventions have the potential to circumvent the pitfalls of face-to-face formats and provide the flexibility required to facilitate accessibility to healthcare workers. Online cognitive behavioral therapy (CBT) in particular has proved to be effective in treating and preventing a number of stress-related disorders in populations other than healthcare workers. The aim of our randomized controlled trial study protocol is to evaluate the efficacy of the 'My Health too' CBT program-a program we have developed for healthcare workers facing the pandemic-on immediate perceived stress and on the emergence of psychiatric disorders at 3- and 6-month follow-up compared to an active control group (i.e., bibliotherapy).

METHODS

Powered for superiority testing, this six-site open trial involves the random assignment of 120 healthcare workers with stress levels > 16 on the Perceived Stress Scale (PSS-10) to either the 7-session online CBT program or bibliotherapy. The primary outcome is the decrease of PSS-10 scores at 8 weeks. Secondary outcomes include depression, insomnia, and PTSD symptoms; self-reported resilience and rumination; and credibility and satisfaction. Assessments are scheduled at pretreatment, mid-treatment (at 4 weeks), end of active treatment (at 8 weeks), and at 3-month and 6-month follow-up.

DISCUSSION

This is the first study assessing the efficacy and the acceptability of a brief online CBT program specifically developed for healthcare workers. Given the potential short- and long-term consequences of the COVID-19 pandemic on healthcare workers' mental health, but also on healthcare systems, our findings can significantly impact clinical practice and management of the ongoing, and probably long-lasting, health crisis.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04362358 , registered on April 24, 2020.

Warr;or21: A 21-Day Program to Enhance First Responder Resilience and Mental Health

First responders face multiple stressors on a daily basis. They have experienced higher rates of anxiety disorders, depression, burnout, post-traumatic stress disorder (PTSD), suicide (Asmundson and Stapleton, 2008), alcohol and substance abuse (Ballenger et al., 2010), and deficient sleep hygiene (Pearsall, 2012) compared to the general population. Existing resilience research can be utilized and adapted to help first responders cope in a positive manner as a form of prevention and also as part of their recovery. New resiliency programs continue to emerge and this paper details one – warr;or21. The warr;or21 program is explained and based on an evaluation of the program’s preliminary data, the results are promising with how the program can assist first responders (and the general public) increase their resiliency and mental health.

Information Overload in Emergency Medicine Physicians: A Multisite Case Study Exploring the Causes, Impact, and Solutions in Four North England National Health Service Trusts

Background

Information overload is affecting modern society now more than ever because of the wide and increasing distribution of digital technologies. Social media, emails, and online communications among others infuse a sense of urgency as information must be read, produced, and exchanged almost instantaneously. Emergency medicine is a medical specialty that is particularly affected by information overload with consequences on patient care that are difficult to quantify and address. Understanding the current causes of medical information overload, their impact on patient care, and strategies to handle the inflow of constant information is crucial to alleviating stress and anxiety that is already crippling the profession.

Objective

This study aims to identify and evaluate the main causes and sources of medical information overload, as experienced by emergency medicine physicians in selected National Health Service (NHS) trusts in the United Kingdom.

Methods

This study used a quantitative, survey-based data collection approach including close- and open-ended questions. A web-based survey was distributed to emergency physicians to assess the impact of medical information overload on their jobs. In total, 101 valid responses were collected from 4 NHS trusts in north England. Descriptive statistics, principal component analysis, independent sample two-tailed t tests, and one-way between-group analysis of variance with post hoc tests were performed on the data. Open-ended questions were analyzed using thematic analysis to identify key topics.

Results

The vast majority of respondents agreed that information overload is a serious issue in emergency medicine, and it increases with time. The always available culture (mean 5.40, SD 1.56), email handling (mean 4.86, SD 1.80), and multidisciplinary communications (mean 4.51, SD 1.61) are the 3 main reasons leading to information overload. Due to this, emergency physicians experience guideline fatigue, stress and tension, longer working hours, and impaired decision making, among other issues. Aspects of information overload are also reported to have different impacts on physicians depending on demographic factors such as age, years spent in emergency medicine, and level of employment.

Conclusions

There is a serious concern regarding information overload in emergency medicine. Participants identified a considerable number of daily causes affecting their job, particularly the traditional culture of emergency departments being always available on the ward, exacerbated by email and other forms of communication necessary to maintain optimal, evidence-based practice standards. However, not all information is unwelcome, as physicians also need to stay updated with the latest guidelines on conditions and treatment, and communicate with larger medical teams to provide quality care.

Is resilience trainable? An initial study comparing mindfulness and relaxation training in firefighters

Motivated by the growing interest in promoting resilience in first responders and other professionals who face threatening professional circumstances, the current study investigated the effectiveness of offering a short-form mindfulness training (MT) program to firefighters. The overarching question was to determine if psychological and cognitive markers of resilience are bolstered via MT. Firefighters (n = 121) were assigned to an MT program (n = 42), an active-comparison relaxation training program (RT, n = 31), or served as no-training controls (NTC, n = 48). Both the MT and RT programs were contextualized for firefighters and consisted of 4, 2-h training sessions delivered over 4 weeks by the same expert trainer, as well as 10-15 min of daily out-of-class practice. Intent-to-treat analyses revealed a significantly greater increase in psychological resilience from baseline (T1) to post-training (T2) in firefighters who received MT vs. RT or no training. In addition, positive affect and objective attentional task performance demonstrated a greater increase over time (from T1 to T2) with more days per week of out-of-class practice for the MT group but not for the RT group. These results suggest that MT moreso than RT bolsters markers of resilience in firefighters.

Resilience@Work Mindfulness Program: Results From a Cluster Randomized Controlled Trial With First Responders

Background

A growing body of research suggests that resilience training can play a pivotal role in creating mentally healthy workplaces, particularly with regard to protecting the long-term well-being of workers. Emerging research describes positive outcomes from various types of resilience training programs (RTPs) among different occupational groups. One specific group of workers that may benefit from this form of proactive resilience training is first responders. Given the nature of their work, first responders are frequently exposed to stressful circumstances and potentially traumatic events, which may impact their overall resilience and well-being over time.

Objective

This study aimed to examine whether a mindfulness-based RTP (the Resilience@Work [RAW] Mindfulness Program) delivered via the internet can effectively enhance resilience among a group of high-risk workers.

Methods

We conducted a cluster randomized controlled trial (RCT) comprising 24 Primary Fire and Rescue and Hazmat stations within New South Wales. Overall, 12 stations were assigned to the 6-session RAW Mindfulness Program and 12 stations were assigned to the control condition. A total of 143 active full-time firefighters enrolled in the study. Questionnaires were administered at baseline, immediately post training, and at 6-month follow-up. Measurements examined change in both adaptive and bounce-back resilience as well as several secondary outcomes examining resilience resources and acceptance and mindfulness skills.

Results

Mixed-model repeated measures analysis found that the overall test of group-by-time interaction was significant (P=.008), with the intervention group increasing in adaptive resilience over time. However, no significant differences were found between the intervention group and the control group in terms of change in bounce-back resilience (P=.09). At 6-month follow-up, the group receiving the RAW intervention had an average increase in their resilience score of 1.3, equating to a moderate-to-large effect size compared with the control group of 0.73 (95% CI 0.38-1.06). Per-protocol analysis found that compared with the control group, the greatest improvements in adaptive resilience were observed among those who completed most of the RAW program, that is, 5 to 6 sessions (P=.002).

Conclusions

The results of this RCT suggest that mindfulness-based resilience training delivered in an internet format can create improvements in adaptive resilience and related resources among high-risk workers, such as first responders. Despite a number of limitations, the results of this study suggest that the RAW Mindfulness Program is an effective, scalable, and practical means of delivering online resilience training in high-risk workplace settings. To the best of our knowledge, this is the first time a mindfulness-based RTP delivered entirely via the internet has been tested in the workplace.

Trial Registration

Australian New Zealand Clinical Trials Registry ACTRN12615000574549; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368296 (Archived by WebCite at http://www.webcitation.org/75w4xtrpw).