'Mindfulness at Work' Program Cuts HCP
Stress Levels

Batya Swift Yasgur MA, LSW

September 03, 2020

A brief mindfulness-based self-care (MBSC) intervention that can be done while on the job is an effective and feasible stress reduction tool for healthcare professionals (HCPs), results from a randomized clinical trial show.

Investigators found HCPs randomly assigned to receive the active intervention had significantly reduced levels of stress and anxiety as well as improved positive affect compared with controls. Furthermore, these effects were sustained at 13-week follow-up.

"I think clinicians and health systems need to take responsibility for improving self-care and well-being since stress levels in healthcare environments are high, and mindfulness practices are effective in reducing stress and anxiety and enhancing self-care and well-being," lead author Rezvan Ameli, PhD, a clinical psychologist at the National Institute of Mental Health, Bethesda, Maryland, told Medscape Medical News.

The study from Ameli and colleagues was published online August 25 in JAMA Network Open.

High-Stress Population

Stress among healthcare workers is well documented and the use of mindfulness based interventions to reduce stress has shown promising results, the investigators note. However, the time commitment required by typical programs can be a barrier for busy and stressed HCPs.

Ameli said she was motivated to conduct the study after observing the stress levels of HCPs and wanted to find a way to help them relieve stress during work hours.

Implementing such programs in a healthcare setting is challenging because they require time for training and practice. Ameli and colleagues wanted to explore whether an abbreviated MBSC was feasible and effective.

The randomized trial included 78 HCPs who completed the 5-week study. Participants included administrators (16.3%), nurses (4.7%), social workers (4.7%), PhD scientists (14%), physicians (16.3%), and training fellows (44.2%).

Participants were randomly assigned to a life-as-usual control condition (n = 35) or a brief MBSC program (n = 43), consisting of five, once-weekly sessions 60 to 70 minutes each delivered during work hours.

MBSC classes consisted of didactic material, group discussions, and mindfulness practice, with a "buddy system" established within the group to enhance sense of community.  

The primary outcome was stress level, using the Perceived Stress Scale 10-item (PSS-10). Secondary outcomes included anxiety; burnout; positive and negative affect; mindfulness (trait and state); and global and general self-care, which included mindfulness and meditation practice.

Feasibility was collectively assessed based on response rate, attendance rate, postprogram evaluations, and reports of adverse events.

Participants were evaluated at baseline and at the end of the study. In addition, participants in the intervention group were reassessed at 13-week follow-up.

Efficacious and Feasible

At the end of the intervention, the MBSC group demonstrated:

  • Reduced stress levels (P =  .02)

  • Reduced anxiety (P  <  .001)

  • Improved positive affect (P <  .001)

  • Improved state mindfulness (mean [SD] score, 3.74 [1.18] vs 2.78 [1.16]; P < .001)

  • Improved mindful self-care (P < .001).

Burnout, negative affect, and trait mindfulness did not differ between groups following the intervention.

At week 13, sustained changes within the MBSC group included reduction in stress (change, –6.14; P < .001), reduction in anxiety (change, –1.46; P < .001), and improved state mindfulness (change, 1.89; P < .001). Participants in the MBSC group also showed improved trait mindfulness (change, 0.63; P < .001).

The program showed high feasibility. Classes filled rapidly, "indicating a high response rate and interest in mindfulness in the workplace," the authors write.

Of the 43 participants, 81.4% completed the program, indicating a high adherence rate.

Most participants in the MBSC group completed postprogram evaluations, with the overall program quality rated "very good" to "excellent" by 97.1%, and with 91.4% describing the course as "very helpful."

The authors note several limitations, including the use of a life-as-usual control group, since the inclusion of an active control group could have highlighted the "unique contributions of mindfulness."

Timely, Relevant

Commenting on the study for Medscape Medical News, Heather Gilmartin, PhD, NP, clinical assistant professor, Management and Policy, Colorado School of Public Health, called the study "an important contribution to the mindfulness literature for HCPs."

"The main take-home message is that HCPs should be offered brief mindfulness-based stress reduction training in their work setting and during work hours. This can help individuals who are stressed or anxious [and] may also create a community of practitioners who could normalize mindfulness as a resource for HCPs," suggested Gilmartin, who was not involved with the study.

Also commenting on the study for Medscape Medical News, Sanjay Saint, MD, MPH, chief of medicine, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, noted that there were several components to the mindfulness intervention, "so it remains unclear which is the key 'active’ ingredient, or if all are needed."

Saint, a professor of Internal Medicine at University of Michigan medical school, cited a recent pilot study conducted by his group that also included Gilmartin.

"Even 7.5 hours may be too much to ask from a busy clinician, [which is] why [in our study] we linked mindfulness to hand hygiene and introduced it to physicians using a 60-minute intervention," said Saint, who was not involved in the current research.

Claire Adams Spears, PhD, associate professor, Georgia State University School of Public Health, Atlanta, told Medscape Medical News that this "important work could not be more timely" and, "although the study was conducted in 2017-2018, mindfulness-based self-care could be even more relevant for highly stressed healthcare providers during the COVID-19 pandemic."

Spears, who was not involved with the study, suggested that, "in the COVID-19 context, future directions might include adapting this model for virtual or hybrid of virtual/in-person delivery."

The study had no specific funding. The authors, Gilmartin, Saint, and Spears have disclosed no relevant financial relationships. Spears reports having attended mindfulness workshops led by Ameli.

JAMA Network Open. Published online August 25, 2020. Full text

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