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Christopher M, Bowen S, Witkiewitz K, Grupe D, Goerling R, Hunsinger M, Oken B, Korecki T, Rosenbaum N. A multisite feasibility randomized clinical trial of mindfulness-based resilience training for aggression, stress, and health in law enforcement officers. BMC Complement Med Ther 2024; 24:142. [PMID: 38575888 PMCID: PMC10993469 DOI: 10.1186/s12906-024-04452-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 03/22/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Law enforcement officers (LEOs) are exposed to significant stressors that can impact their mental health, increasing risk of posttraumatic stress disorder, burnout, at-risk alcohol use, depression, and suicidality. Compromised LEO health can subsequently lead to aggression and excessive use of force. Mindfulness training is a promising approach for high-stress populations and has been shown to be effective in increasing resilience and improving mental health issues common among LEOs. METHODS This multi-site, randomized, single-blind clinical feasibility trial was intended to establish optimal protocols and procedures for a future full-scale, multi-site trial assessing effects of mindfulness-based resilience training (MBRT) versus an attention control (stress management education [SME]) and a no-intervention control, on physiological, attentional, and psychological indices of stress and mental health. The current study was designed to enhance efficiency of recruitment, engagement and retention; optimize assessment, intervention training and outcome measures; and ensure fidelity to intervention protocols. Responsiveness to change over time was examined to identify the most responsive potential proximate and longer-term assessments of targeted outcomes. RESULTS We observed high feasibility of recruitment and retention, acceptability of MBRT, fidelity to assessment and intervention protocols, and responsiveness to change for a variety of putative physiological and self-report mechanism and outcome measures. CONCLUSIONS Results of this multi-site feasibility trial set the stage for a full-scale, multi-site trial testing the efficacy of MBRT on increasing LEO health and resilience, and on decreasing more distal outcomes of aggression and excessive use of force that would have significant downstream benefits for communities they serve. TRIAL REGISTRATION ClinicalTrials.gov, NCT03784846 . Registered on December 24th, 2018.
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Affiliation(s)
- Michael Christopher
- School of Graduate Psychology, Pacific University, 190 SE 8thAve, Suite 260, Hillsboro, OR, 97123, USA.
| | - Sarah Bowen
- School of Graduate Psychology, Pacific University, 190 SE 8thAve, Suite 260, Hillsboro, OR, 97123, USA
| | - Katie Witkiewitz
- Department of Psychology, University of New Mexico, 2001 Redondo S Dr, Albuquerque, NM, 87106, USA
| | - Daniel Grupe
- Center for Healthy Minds, University of Wisconsin Madison, 625 West Washington Ave, Madison, WI, 53703, USA
| | - Richard Goerling
- School of Graduate Psychology, Pacific University, 190 SE 8thAve, Suite 260, Hillsboro, OR, 97123, USA
| | - Matthew Hunsinger
- School of Graduate Psychology, Pacific University, 190 SE 8thAve, Suite 260, Hillsboro, OR, 97123, USA
| | - Barry Oken
- Department of Neurology, Oregon Center for Complementary and Alternative Medicine in Neurological Disorders, Oregon Health & Science University, 3181 Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Tyrus Korecki
- Department of Psychology, University of California Los Angeles, 1285 Franz Hall, Los Angeles, CA, 90095, USA
| | - Nils Rosenbaum
- Behavioral Sciences Department, Albuquerque Police Department, 400 Rome, NW, Albuquerque, NM, 87102, USA
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Hinrichs LA, Seidler KJ, Morrison K, Coats H. "We're not broken. We're human." A qualitative meta-synthesis of health-care providers' experiences participating in well-being programs. Physiother Theory Pract 2024; 40:65-90. [PMID: 35876152 DOI: 10.1080/09593985.2022.2103052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 07/13/2022] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Protecting health-care provider (HCP) well-being is imperative to preserve health-care workforce capital, performance, and patient care quality. Limited evidence exists for the long-term effectiveness of HCP well-being programs, with less known about physiotherapists specifically. PURPOSE To review and synthesize qualitative research describing experiences of HCP, generate lessons learned from the greater population of HCP participating in workplace well-being programs, and then to inform programs and policies for optimizing psychological well-being in an understudied population of physiotherapists. METHODS This qualitative meta-synthesis included a systematic literature search conducted in September 2020; critical appraisal of results; and data reduction, re-categorizing, and thematic extraction (reciprocal translation) with interpretive triangulation. RESULTS Twenty-five papers met the inclusion criteria. Participants included physicians, nurses, and allied health providers. All programs targeted the individual provider and included psychoeducational offerings, supervision groups, coaching, and complementary therapies. Four themes were constructed: 1) beneficial outcomes across a range of programs; 2) facilitators of program success; 3) barriers to program success; and 4) unmet needs driving recommendations. CONCLUSIONS The findings enhance our understanding of diverse individual-level programs to address HCP well-being. Beneficial outcomes were achieved across program types with system-level support proving critical; however, HCP described barriers to program success (HCP characteristics, off-site programs, institutional culture) and remaining needs (resources, ethical dissonance) left unaddressed. Organizations should offer individual-level programs to support physiotherapists in the short term while pursuing long-term, system-level change to address drivers of well-being.
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Affiliation(s)
- Lauren A Hinrichs
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Colorado, Aurora
| | - Katie J Seidler
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Colorado, Aurora
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center Rocky Mountain Regional VA Medical Center, Aurora, USA
| | - Katherine Morrison
- Palliative Medicine Inpatient Service, Department of Medicine, University of Colorado, Colorado, Aurora
| | - Heather Coats
- Office of Research and Scholarship, College of Nursing, University of Colorado, Colorado, Aurora
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Van de Velde J, Levecque K, Weijters B, Laureys S. Doing what matters in times of stress: No-nonsense meditation and occupational well-being in COVID-19. PLoS One 2023; 18:e0292406. [PMID: 37910465 PMCID: PMC10619828 DOI: 10.1371/journal.pone.0292406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/19/2023] [Indexed: 11/03/2023] Open
Abstract
While the COVID-19 pandemic challenged the general public's health and well-being, it exacerbated the pre-existing well-being issues in the educational sector in many countries. Mindfulness-based interventions are often applied to protect and promote occupational well-being. To investigate how the well-being benefits of these interventions arise, we selected one accessible technique that is used in most of them: focused attention meditation. In the middle of the COVID-19 pandemic, 199 teachers voluntarily practiced five to ten minutes of meditation together with their pupils, every morning for six months. We employed a three-wave longitudinal design to follow any changes in the meditating teachers' well-being and compared these changes to a waitlist control condition of 42 teachers. Three dimensions of well-being were measured at baseline, half-time, and post-intervention: emotional, cognitive, and physical well-being. Latent growth curve models revealed that the meditation technique not only improves well-being but also prevents the development of well-being problems. The practice of focused attention meditation resulted in improvements in emotional and physical well-being and prevented the development of cognitive well-being problems that were observed within the control condition. The effects were strongest for emotional and cognitive well-being and followed a linear trend. This paper shows that the well-being effects of mindfulness-based interventions are at least in part due to the focused attention meditation that is practiced in them. Occupational groups that experience emotional, cognitive, or physical well-being issues can benefit from a few minutes of focused attention meditation per day. Trial registration: ISRCTN ISRCTN61170784 (https://doi.org/10.1186/ISRCTN61170784).
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Affiliation(s)
| | - Katia Levecque
- Department of Work, Organization, and Society, Ghent University, Ghent, Belgium
| | - Bert Weijters
- Department of Work, Organization, and Society, Ghent University, Ghent, Belgium
| | - Steven Laureys
- Coma Science Group, GIGA Consciousness Research Unit, University and University Hospital of Liège, Liège, Belgium
- CERVO Brain Research Center, Laval University, Québec, Canada
- Consciousness Science Institute, Hangzhou Normal University, Hangzhou, Zhejiang, China
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Monfries N, Sandhu N, Millar K. A Smartphone App to Reduce Burnout in the Emergency Department: A Pilot Randomized Controlled Trial. Workplace Health Saf 2022; 71:181-187. [PMID: 36373628 PMCID: PMC10080362 DOI: 10.1177/21650799221123261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Burnout is a significant concern among health care professionals, particularly those working in the emergency department (ED). Given the negative personal and professional consequences that burnout can have on all health care professionals, multidisciplinary solutions are needed to address burnout. Our objective was to evaluate the feasibility and potential impact of resilience training delivered through a smartphone application on burnout among health care professionals working at a tertiary-care pediatric ED. Methods: We conducted a single-center pilot randomized controlled study enrolling multidisciplinary health care professionals working in our ED. Participants assigned to the intervention group received self-driven access to a smartphone application that provided a structured resilience curriculum for a period of 3 months. The participants completed psychometric assessments both prior to and following the invention period. Changes in psychometric measures of the intervention group were then compared with a waitlist-control group. Results: Following the intervention period, a total of 20 participants were included in the final analysis. The change in participant scores on psychometric measures prior to and following the intervention period was calculated. A statistically significant mean decrease in burnout measure (emotional exhaustion subscale of Maslach-Burnout Inventory mean score −5.88, p < .001) and increase in mindfulness measure (Mindful Attention Awareness Scale mean score 0.51, p < .001) was observed among the intervention group participants. Conclusions/Application to Practice: Our study suggests that a resilience training program delivered using a smartphone application can be an effective intervention in reducing burnout and increasing mindfulness skills. Our study also demonstrated the potential feasibility of a randomized controlled study of burnout within a multidisciplinary group of health care professionals.
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Epstein RM, Marshall F, Sanders M, Krasner MS. Effect of an Intensive Mindful Practice Workshop on Patient-Centered Compassionate Care, Clinician Well-Being, Work Engagement, and Teamwork. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2022; 42:19-27. [PMID: 34459443 DOI: 10.1097/ceh.0000000000000379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Mindfulness-based interventions for health professionals have been linked to improvements in burnout, well-being, empathy, communication, patient-centered care, and patient safety, but the optimal formats and intensity of training have been difficult to determine because of the paucity of studies and the heterogeneity of programs. A 4-days residential "Mindful Practice" workshop for physicians and medical educators featuring contemplative practices, personal narratives, and appreciative dialogs about challenging experiences may hold promise in improving participants' well-being while also improving compassionate care, job satisfaction, work engagement, and teamwork. METHODS We collected baseline and 2-month follow-up data during four workshops conducted in 2018 to 2019 at conference centers in the United States and Europe. Primary outcomes were burnout, work-related distress, job satisfaction, work engagement, patient-centered compassionate care, and teamwork. RESULTS Eighty-five of 120 participants (71%) completed both surveys (mean age was 49.3 and 68.2% female). There were improvements (P < .01) in two of three burnout components (emotional exhaustion and depersonalization), work-related distress, job satisfaction, patient-centered compassionate care, work engagement and meaning, teamwork, well-being, positive emotion, mindfulness, somatic symptoms, and spirituality. Effect sizes (standardized mean difference of change) ranged from 0.25 to 0.61. With Bonferroni adjustments (P < .0031), teamwork, general well-being, and mindfulness became nonsignificant. DISCUSSION An intensive, multiday, mindfulness-based workshop for physicians had clinically significant positive effects on clinician well-being, quality of interpersonal care and work satisfaction, and meaning and engagement, all important indicators of improved health and sustainability of the health care workforce. Future iterations of the program should increase the focus on teamwork.
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Affiliation(s)
- Ronald M Epstein
- Mr. Epstein: Professor of Family Medicine, Oncology and Medicine (Palliative Care), and American Cancer Society's Clinical Research Professor, Codirector, Center for Communication and Disparities Research, Departments of Family Medicine and Medicine and the Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY. Mr. Marshall: Professor, Department of Neurology, Division of Geriatric Neurology, University of Rochester School of Medicine and Dentistry, Rochester, NY. Mr. Sanders: Senior Instructor, Department of Family Medicine, Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, NY. Mr. Krasner: Professor of Clinical Medicine and Clinical Family Medicine, Departments Medicine and Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY
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Villarreal M, Hanson P, Clarke A, Khan M, Dale J. Feasibility, acceptability and effect of the Mindful Practice curriculum in postgraduate training of general practitioners. BMC MEDICAL EDUCATION 2021; 21:327. [PMID: 34098921 PMCID: PMC8186227 DOI: 10.1186/s12909-021-02747-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 04/19/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Early career general practitioners are known to be at high risk of burnout. There is a need for widely applicable, cost-effective evidence-based interventions to develop trainees' protective skills and strategies. RESULTS Of 120 eligible trainees, 23 (19.2%) expressed interest in participating, 17 subsequently started the course, and 15 completed at least 5 out of its 6 sessions. All psychological measures were stable for the six-week period prior to commencing the course. Following the course, there were statistically significant (p < 0.05) improvements in wellbeing, resilience, mindfulness, emotional exhaustion, disengagement, and stress scores. Participants described numerous benefits, and most stated that they would recommend it to colleagues. CONCLUSION Including mindful practice within general practice vocational training is feasible, and in this study it benefited the psychological wellbeing of participants. Further research is needed to explore ways of increasing uptake and course completion, the sustainability of its effects, and the wider applicability of this approach.
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Affiliation(s)
- Manuel Villarreal
- The Unit of Academic Primary Care, University of Warwick, Coventry, CV4 7AL, UK.
| | - Petra Hanson
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Amy Clarke
- School of Pharmacy, Centre for Behavioural Medicine, University College London, London, UK
| | - Majid Khan
- The Unit of Academic Primary Care, University of Warwick, Coventry, CV4 7AL, UK
| | - Jeremy Dale
- The Unit of Academic Primary Care, University of Warwick, Coventry, CV4 7AL, UK
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Montero-Marin J, Kuyken W, Gasión V, Barceló-Soler A, Rojas L, Manrique A, Esteban R, García Campayo J. Feasibility and Effectiveness of a Workplace-Adapted Mindfulness-Based Programme to Reduce Stress in Workers at a Private Sector Logistics Company: An Exploratory Mixed Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1643. [PMID: 32138362 PMCID: PMC7084587 DOI: 10.3390/ijerph17051643] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/28/2020] [Accepted: 02/28/2020] [Indexed: 12/24/2022]
Abstract
There is a high prevalence of stress in the logistics sector owing to very demanding, fast-paced and unpredictable tasks. Mindfulness-based programmes may reduce stress but require considerable practice. Our aim was to evaluate the feasibility and effectiveness of a shortened, workplace-adapted mindfulness-based programme for the logistics sector (WA-MBP-LS) for the purpose of reducing stress. A nonblinded, nonrandomised, two-arm controlled trial was conducted. The WA-MBP-LS (n = 32) consisted of six weekly 90-min mindfulness sessions. The control group (n = 36) attended a psycho-educational seminar. The Perceived Stress Scale (PSS) and Five Facets of Mindfulness Questionnaire (FFMQ) were measured at pretest, posttest and 6-month follow-up. Differences between groups were evaluated using mixed-effects models. Qualitative methods were used to analyse implementation issues. A 64.2% reduction was observed between initial volunteers and actual participants. Attrition at six-month follow-up was 45.6%. Participants attended a median of five sessions. Decreases in PSS favoured the WA-MBP-LS group at posttest and follow-up. FFMQ played a mediating role in PSS reductions. Barriers were disinterest, lack of programming, work overload and absences from work. Facilitators were curiosity, timing, company facilities and audio recordings. The WA-MBP-LS was feasible and effective in reducing stress, but more efforts to improve the practicalities of implementation are desirable.
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Affiliation(s)
- Jesus Montero-Marin
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK; (J.M.-M.); (W.K.)
| | - Willem Kuyken
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK; (J.M.-M.); (W.K.)
| | - Virginia Gasión
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), 50009 Zaragoza, Spain;
| | - Alberto Barceló-Soler
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), 50009 Zaragoza, Spain;
- Institute for Health Research (IIS Aragón), 50009 Zaragoza, Spain
| | - Lynda Rojas
- Mindfulness Consultant, Parenthesis Consultants, 050031 Medellin, Colombia;
| | - Ana Manrique
- Human Resources Department, Sese Group, 50014 Zaragoza, Spain; (A.M.); (R.E.)
| | - Rosa Esteban
- Human Resources Department, Sese Group, 50014 Zaragoza, Spain; (A.M.); (R.E.)
| | - Javier García Campayo
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), 50009 Zaragoza, Spain;
- Institute for Health Research (IIS Aragón), 50009 Zaragoza, Spain
- Miguel Servet University Hospital, University of Zaragoza, 50009 Zaragoza, Spain
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