Pauline Anderson

October 24, 2017

SAN DIEGO —  Practicing mindfulness, which can include activities such as yoga, meditation and breathing exercises, reduces anxiety levels among medical students, new research shows.

"This project exemplified what we can do for medical students, which is a really high-stress population," study author Jennifer Golden, a fourth-year student at the West Virginia School of Osteopathic Medicine, Lewisburg, told Medscape Medical News.

"If there's a practice that enables you to find peace and clarity, stay focused, and not get so overwhelmed (by medical school), that's going to be, hands down, the best thing for you," said Golden. "Everybody needs outlets. This is a useful tool for students, and it's something that we found actually has results."

The study was presented here at the Academy of Integrative Pain Management (AIPM) 28th Annual Meeting. The poster won the AIPM's Blue Ribbon award for distinguished research in the student-resident-fellow section.

Reduced Stress, Anxiety

Golden noted that mindfulness-based stress reduction programs have positive effects on stress and anxiety levels in other populations.

For the current study, eight students completed an 8-week online course on mindfulness-based stress reduction. The program covers "a wide umbrella" of activities, said Golden. In addition to meditation, yoga, and breathing, students practiced guided imagery, tai chi, and other movements.

Each week, the students met for an hour in a group setting with a certified coach, who was also the lead author on the poster. In addition, they practiced daily mindfulness activities on their own. 

"They would have to do something related to that week's topic. For example, one week it might be guided meditation and then during the group meetings, we would reflect on how that went for everybody," said Golden.

Every 2 weeks for 3 months, the mindfulness group, as well as a control group of 15 volunteers, completed an electronic survey. Participants were asked how many minutes they practiced mindfulness techniques from a provided list.

They completed the seven-item Generalized Anxiety Disorder (GAD-7) assessment.

A score of 0 to 5 on the GAD-7 represents mild anxiety; 6 to 10, moderate anxiety; and 11 to 15, high anxiety. At the study's conclusion, the mean GAD-7 score was 6716 in the control group compared with 5.19 in the mindfulness group — a difference of 1.53.

During the study, the mindfulness group reported reduced nervousness, worry, and irritability.

The researchers also wanted to determine whether taking the course helped medical students maintain mindfulness practices. For each survey period, the mindfulness-trained students spent significantly more time participating in related practices (166 minutes) compared with controls (73 minutes).

The control group "did a decent amount of mindfulness on their own, but we found that the mindfulness group practiced mindfulness for a significantly greater number of minutes per week over a 2-week period than the controls," said Golden.

The researchers were keen to learn whether the program improved school grades, but they were "not able to find a correlation," said Golden.

However, she noted that determining the impact on grades "is tough" because of barriers to accessing academic scores. "As students, we couldn't get into that because of logistical limitations."

The mindfulness course is available online free of charge.

Timely Reminder

Commenting on the findings for Medscape Medical News, AIPM President W. Clay Jackson, MD, clinical assistant professor of family medicine and psychiatry, University of Tennessee College of Medicine, Memphis, said it's "a timely reminder that we must model and teach self-care to our developing clinicians."

Dr W. Clay Jackson

The stigma of mental illness often leads clinicians to avoid reporting symptoms and seeking help, said Dr Jackson.

"In an environment where we lose 400 physicians per year to suicide, we need more studies like this one that highlight interventions to improve the mental health of all clinicians."

In a separate presentation on preventing physician suicide during the AIPM meeting, Dr Jackson talked about the "secrecy and shame" surrounding the issue.

Depression plays a major role in driving physicians to consider taking their own life, he said. One recent Canadian study found that a quarter of 3213 practicing physicians reported a recent depressed mood and that depression was more common among female physicians and general practitioners.

Doctors are reluctant to seek treatment for depression because of the stigma, concerns over licensure issues, and the belief that they should somehow be able to avoid depression, said Dr Jackson.

Burnout, which Dr Jackson defined as loss of enthusiasm for work, feelings of cynicism, and low sense of personal accomplishment, also plays a role in suicides in the profession.

"Burnout must be openly and actively addressed as it plays a role in the high rates of physician suicide" Dr Jackson told delegates.

He suggested methods of preventing burnout, including connecting more with colleagues and friends, practicing self-care, and cultivating meaning and purpose in life.

Ms Golden and Dr Jackson have disclosed no relevant financial relationships.

Academy of Integrative Pain Management (AIPM) 28th Annual Meeting. Abstract 26.Presented October 20, 2017. 

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