Mindfulness-Based Interventions to Reduce Burnout and Stress in Physicians: A Systematic Review and Meta-Analysis

Mindfulness- and acceptance-based programmes for obsessive-compulsive disorder: A systematic review and meta-analysis

Mindfulness- and acceptance-based programmes (MABPs) in the treatment of obsessive-compulsive disorder (OCD) are increasingly gaining research interest, yet a comprehensive systematic review and meta-analysis is missing. To fill this gap, we analysed 46 trials involving 2221 patients. Two independent reviewers screened records, extracted data, assessed risk of bias, and rated overall quality of evidence. MABPs were associated with large reductions in OCD-severity in between-group analysis in randomised controlled trials (k = 33; g = -.87; CI = -1.13,-.60) and within-group pre-post analysis in all MABPs (k = 49; g = -1.72; CI = -2.00,-1.44). Depressive symptoms decreased between- and within-group with a small to moderate effect, with maintained reductions at follow-up for both OCD and depression. Moderate to large pre-post improvements were also observed in anxiety, obsessive beliefs, and quality of life. MABPs did not differ from cognitive behavioural therapy and exposure and response prevention (k = 9; g=.02; CI = -.23,.26) but were superior to medication (k = 5; g = -.77; CI = -1.44,-.11) and waitlist (k = 16; g = -1.66; CI = -2.1,-1.24). Symptom reductions were observed across world regions, but to varying degrees. When combined, increases in mindfulness and psychological flexibility predicted reductions in OCD symptoms. Outcomes were not moderated by treatment duration, samples', and therapists' characteristics. MABPs can reduce OCD-severity, but further high-quality trials with long-term follow-ups are needed to confirm results.

Yoga, mindfulness and acupuncture impact on burnout: a preliminary meta-analysis

Mindfulness, yoga, and acupuncture are three practices that have received little attention in stress management literature, with scholars suggesting that they can improve physical and mental health, reduce stress and burnout, and boost productivity and job satisfaction. However, while there is growing interest in these practices, many employers remain sceptical about their potential benefits and are hesitant to invest resources in implementing them. This meta-analysis aimed to examine the impact of these practices on burnout and explore potential moderators. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to ensure comprehensive and transparent reporting in the identification of eligible studies. Overall, 21 studies were included (8 on mindfulness, 7 on yoga, and 6 on acupuncture), all involving independent samples, with a total of 1,364 participants. The meta-analytic results showed that all three therapeutic practices have consistent and beneficial effects on reducing burnout. Furthermore, moderation analyses indicated that mindfulness interventions conducted within the work schedule have a significant reduction in burnout, while acupuncture interventions with between 4 or 8 weeks (the more weeks, the better) also reduced burnout. However, no significant moderation effect was observed for yoga interventions. Overall, the findings provide insights into the effectiveness of these complementary practices in reducing burnout and highlight the need for further research in this area.

C. P, Nygård CH, Neupane S. Effect of a mindfulness-based cognitive behavior therapy intervention on occupational burnout among school teachers

Background

We aimed to assess the effect of mindfulness-based cognitive behavior therapy (MB-CBT) as an intervention to reduce burnout among secondary school teachers in Nepal.

Methods

The baseline survey of this randomized controlled trial included 218 secondary school teachers from 37 schools in Kathmandu. At a one-month follow-up, 192 teachers completed post-test survey. The Maslach Burnout Inventory for Educators (MBI-ES) tool was used to measure burnout in three dimensions: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). Teachers in the treatment arm (n=102) received MB-CBT, while those in the control arm (n=116) continued their regular activities. Linear regression models with generalized estimating equations were used to calculate the mean, mean change estimates, and their 95% confidence intervals (CIs).

Results

The mean level of EE decreased during the post-test for both treatment (mean change -0.93, 95% CI: -2.56 to 0.70) and control (-1.71, 95% CI: -3.24 to -0.18) arms. The mean level of DP also decreased in the treatment arm (-0.12, 95% CI: -0.98 to -0.75), but a sharper decline was observed in the control arm (-1.97, 95% CI: -2.78 to -1.16). The mean level of PA increased in both the treatment (1.04, 95% CI: -0.21 to 2.30) and control (1.53, 95% CI: 0.35 to 2.70) arms.

Conclusions

The prevalence of high EE and low PA decreased in both arms. However, the prevalence of high DP remained constant in the treatment arm but sharply decreased in the control arm. No significant differences between the arms were found in the post-test mean levels of EE, DP, and PA. The virtual MB-CBT intervention showed no significant impact on reducing burnout. Nonetheless, small reductions in burnout were observed in both groups.

A Meta-Regression of psychosocial factors associated with sleep outcomes in mindfulness-based intervention trials

OBJECTIVES

In this meta-regression, we aimed to explore associations between changes in psychosocial factors and changes in sleep disturbance during mindfulness-based interventions (MBIs). We also investigated participant-specific and methodological factors associated with sleep disturbance during MBIs.

METHOD

We utilized data from a published meta-analysis of 40 randomized controlled trials of MBIs (published from inception to 2020) with a sleep disturbance outcome measure in healthy and clinical adult populations. We conducted meta-regressions to test associations between sleep improvements following MBIs and psychosocial factors, as well as demographic and methodological factors.

RESULTS

MBIs were associated with significant reductions in sleep disturbance (SMD = -0.523; 95% CI = -0.678 to -0.368) and psychosocial factors (SMD = -0.213 - -0.894). Reductions in sleep disturbance were associated with reductions in stress (r = 0.74, p = .02) and depression (r = 0.90, p < .001).

CONCLUSIONS

MBIs improve sleep disturbance across a wide range of healthy and clinical populations. Stress and depression may be important psychosocial factors associated with sleep disturbance. Future RCTs should include measures of additional factors and should investigate longitudinal associations between psychosocial, demographic, and methodological factors with changes in sleep disturbance to test mechanisms and to identify "active ingredients" of MBIs.

Feasibility and effectiveness of the mindfulness-based stress reduction programs on relieving burnout of healthcare providers during the COVID-19 pandemic: a pilot randomized controlled trial in China

BACKGROUND

The 2019 coronavirus disease (COVID-19) pandemic brings critical health problems to workers in many occupations, particularly healthcare providers. The aim of the study was to examine the feasibility and effectiveness of the mindfulness-based stress reduction (MBSR) program on relieving burnout of healthcare providers during the pandemic. The roles of positive and negative emotion as well as emotion regulation strategy in the intervention effects were also investigated.

METHODS

A sample of 112 healthcare providers in China were recruited and randomly assigned to the MBSR (n = 56) or the control condition (n = 56). Measures were collected at pre-intervention, mid-intervention, and post-intervention, assessing mindfulness level, emotion regulation strategy, positive and negative emotion, and burnout.

RESULTS

The MBSR program showed acceptable feasibility. Compared to the control group, healthcare providers in the MBSR group showed significant increase in personal accomplishment and decrease in emotional exhaustion after the intervention. No significant difference was detected on the dimension of depersonalization. Results of mediation analyses implied that cognitive reappraisal and positive affect partially mediated the intervention effects on personal accomplishment.

CONCLUSIONS

The study provided preliminary evidence that the MBSR programs might be effective in reducing healthcare providers' burnout, even during the pandemic. Cognitive reappraisal and positive emotion might be important mechanisms of how the training took effect.

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.

Prevalence of burnout among German radiologists: a call to action

OBJECTIVES

In the presence of escalating global concerns regarding physician burnout, this study aims to analyze the prevalence and associated factors of burnout among radiologists in Germany.

METHODS

A comprehensive online survey, inclusive of 73 targeted questions including a German-modified version of the Maslach Burnout Inventory, was distributed among all members of the German Radiological Society and the German Interventional Radiological Society between May and August 2023. The survey encompassed aspects of employment, workload, well-being, and coping mechanisms. Data from 172 completed surveys were analyzed, with correlations explored via crosstabs and the Pearson-chi-square test.

RESULTS

In total, 76.7% of participating radiologists were identified to be burnt out. The prevalence was significantly associated with increased workload, reduced sleep quality, suboptimal working conditions, reduced job satisfaction, and the negative interplay between work, family life, and health. Median work satisfaction was described as "satisfied" while median workload was assessed as "frequently overwhelming of work." A total of 41.9% of respondents noted facing daily time pressure. Radiologists' concerns about work interfering with private family life were voiced by approximately 70%, and 73.3% highlighted the perceived negative effects on their health.

CONCLUSION

The pronounced prevalence of burnout among German radiologists demonstrates an urgent, unmet need for comprehensive interventions and systemic changes. Our findings act as a catalyst for initiating targeted, multifaceted strategies and dialogs, essential for fostering a resilient and effective healthcare ecosystem. Further large-scale systematic studies should follow to analyze the findings in broad.

CLINICAL RELEVANCE STATEMENT

Consistent with other countries, there is a high prevalence of burnout among radiologists in Germany. A call for further investigation is recommended to help mitigate adverse outcomes associated with physician burnout.

KEY POINTS

• The prevalence of burnout has yet not been evaluated for German radiologists. • German radiologists have a high prevalence of burnout. • Steps must be implemented to engage this problem to prevent worsening.

History and Current Status of Well-being Among Organizations (Impact of Wellness on a Section, Division, Institution and Profession, ACGME Requirements, Policies)

The authors provide an overview of cultural adjustments and policy changes to support wellness in medicine. Subsequently, the data around wellness in cardiothoracic surgery, as well as policies and interventions that have been put into place to address wellness concerns in cardiothoracic surgery is discussed. The authors focus on both trainees and attendings and provide both a list of actions to address deficits in wellness management in the field, as well as resources available to promote well-being among cardiothoracic surgeons.

The Social Ecology of Burnout: A framework for research on nurse practitioner burnout

BACKGROUND

The U.S. health system is burdened by rising costs, workforce shortages, and unremitting burnout. Well-being interventions have emerged in response, yet data suggest that the work environment is the problem. Nurse practitioner (NP) burnout is associated with structural and relational factors in the work environment, practice autonomy, and hierarchical leadership.

PURPOSE

We explore the unique social, cultural, and political environment in which NPs work through the lens of social ecology and present the Social Ecology of Burnout (SEB) framework.

METHODS

We review current burnout frameworks in the context of the NP practice environment and discuss the SEB, specifically exploring psychological safety and its influence on burnout.

FINDINGS

Psychological safety, work environment, and policy are presented within the SEB and solutions which empower NPs are considered.

DISCUSSION

Our framework can serve as a guide for future nursing research, practice, and policy.

Just-in-Time Strategies to Reduce the Effect of Interviewer Bias During Trainee Recruitment

Bias impacts all aspects of medical trainee applications, from grades to narrative reviews. Interviews provide an avenue to become acquainted with applicants beyond their written application, but even the most egalitarian interviewers are subject to implicit biases, including those who hold marginalized identities themselves. Simply building awareness around implicit bias is inadequate to reduce the effect. Here, 5 evidence-informed strategies are presented that can be implemented by faculty on-the-spot to mitigate the impact of implicit bias during the short interview interaction: individuation, mindfulness, perspective taking, stereotype replacement, and counter-stereotypic imaging. These strategies can be used by individual interviewers as one component of a comprehensive plan including institutional changes to promote more equitable recruitment processes.

Development of an Artificial Intelligence-Based Tailored Mobile Intervention for Nurse Burnout: Single-Arm Trial

BACKGROUND

Nurse burnout leads to an increase in turnover, which is a serious problem in the health care system. Although there is ample evidence of nurse burnout, interventions developed in previous studies were general and did not consider specific burnout dimensions and individual characteristics.

OBJECTIVE

The objectives of this study were to develop and optimize the first tailored mobile intervention for nurse burnout, which recommends programs based on artificial intelligence (AI) algorithms, and to test its usability, effectiveness, and satisfaction.

METHODS

In this study, an AI-based mobile intervention, Nurse Healing Space, was developed to provide tailored programs for nurse burnout. The 4-week program included mindfulness meditation, laughter therapy, storytelling, reflective writing, and acceptance and commitment therapy. The AI algorithm recommended one of these programs to participants by calculating similarity through a pretest consisting of participants' demographics, research variables, and burnout dimension scores measured with the Copenhagen Burnout Inventory. After completing a 4-week program, burnout, job stress, stress response using the Stress Response Inventory Modified Form, the usability of the app, coping strategy by the coping strategy indicator, and program satisfaction (1: very dissatisfied; 5: very satisfied) were measured. The AI recognized the recommended program as effective if the user's burnout score reduced after the 2-week program and updated the algorithm accordingly. After a pilot test (n=10), AI optimization was performed (n=300). A paired 2-tailed t test, ANOVA, and the Spearman correlation were used to test the effect of the intervention and algorithm optimization.

RESULTS

Nurse Healing Space was implemented as a mobile app equipped with a system that recommended 1 program out of 4 based on similarity between users through AI. The AI algorithm worked well in matching the program recommended to participants who were most similar using valid data. Users were satisfied with the convenience and visual quality but were dissatisfied with the absence of notifications and inability to customize the program. The overall usability score of the app was 3.4 out of 5 points. Nurses' burnout scores decreased significantly after the completion of the first 2-week program (t=7.012; P<.001) and reduced further after the second 2-week program (t=2.811; P=.01). After completing the Nurse Healing Space program, job stress (t=6.765; P<.001) and stress responses (t=5.864; P<.001) decreased significantly. During the second 2-week program, the burnout level reduced in the order of participation (r=-0.138; P=.04). User satisfaction increased for both the first (F=3.493; P=.03) and second programs (F=3.911; P=.02).

CONCLUSIONS

This program effectively reduced burnout, job stress, and stress responses. Nurse managers were able to prevent nurses from resigning and maintain the quality of medical services using this AI-based program to provide tailored interventions for nurse burnout. Thus, this app could improve qualitative health care, increase employee satisfaction, reduce costs, and ultimately improve the efficiency of the health care system.

The effects of mindfulness-based interventions on alleviating academic burnout in medical students: a systematic review and meta-analysis

BACKGROUND

Mindfulness-based interventions have been tested to be the effective approach for preventing/reducing burnout in medical students. Therefore, this systematic review and meta-analysis aimed to synthesize the scientific evidence and quantify the pooled effect of MBIs on the burnout syndrome in medical students.

METHODS

A comprehensive literature search was conducted in the databases, including PubMed, Embase, ERIC, PsycINFO, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), China National knowledge Information Database (CNKI) and WanFang Database from database inception to February 2023 using the terms of "mindfulness", "burnout" and "medical students". Two reviewers independently reviewed the studies, and extracted the data of the eligible studies, as well as assessed the risk of bias. A random-effects model was employed to calculate the standardized mean differences (SMD) with 95% confidence intervals (CI) of overall burnout and its sub-domains of burnout (i.e., emotional exhaustion, cynicism, and academic efficacy).

RESULTS

Of 316 records in total, nine studies (with 810 medical students) were ultimately included. The four RCT studies demonstrated an overall judgment of some concerns risk of bias, and the overall risk of biases of the five qRCT studies were judged as serious. In term of the SORT, the RCT and qRCT studies were evaluated as level 2 evidence, and the overall strength of recommendation was classified as B (limited-quality patient-oriented evidence). The pooled analysis showed that MBIs were associated with significant small to moderate improvements for medical students' overall burnout (SMD=-0.64; 95% CI [-1.12, -0.16]; P = 0.009) in the included four RCTs, emotional exhaustion (SMD=-0.27; 95% CI [-0.50, -0.03]; P = 0.03) and academic efficacy (SMD = 0.43; 95% CI [0.20, 0.66]; P<0.001) in the four qRCTs.

CONCLUSIONS

MBIs can serve as an effective approach for reducing burnout symptoms in medical students. Future high-quality studies with a larger sample size and robust randomized controlled trial methodologies should be obtained to reinforce the effectiveness of MBIs for reducing academic burnout in medical students.

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.

Global health workforce strategies to address the COVID-19 pandemic: Learning lessons for the future

COVID-19 put unprecedented strain on the health and care workforce (HCWF). Yet, it also brought the HCWF to the forefront of the policy agenda and revealed many innovative solutions that can be built upon to overcome persistent workforce challenges. In this perspective, which draws on a Policy Brief prepared for the WHO Fifth Global Forum on Human Resources for Health, we present findings from a scoping review of global emergency workforce strategies implemented during the pandemic and consider what we can learn from them for the long-term sustainability of the HCWF. Our review shows that strategies to strengthen HCWF capacity during COVID-19 fell into three categories: (1) surging supply of health and care workers (HCWs); (2) optimizing the use of the workforce in terms of setting, skills and roles; and (3) providing HCWs with support and protection. While some initiatives were only short-term strategies, others have potential to be continued. COVID-19 demonstrated that changes to scope-of-practice and the introduction of team-based roles are possible and central to an effective, sustainable workforce. Additionally, the use of technology and digital tools increased rapidly during COVID-19 and can be built on to enhance access and efficiency. The pandemic also highlighted the importance of prioritizing the security, safety, and physical and mental health of workers, implementing measures that are gender and equity-focused, and ensuring the centrality of the worker perspective in efforts to improve HCWF retention. Flexibility of regulatory, financial, technical measures and quality assurance was critical in facilitating the implementation of HCWF strategies and needs to be continued. The lessons learned from COVID-19 can help countries strengthen the HCWF, health systems, and the health and well-being of all, now and in the future.

The application of virtual reality meditation and mind-body exercises among older adults

Virtual reality (VR)-based mindfulness is a promising method to improve the health of older adults. Therefore, many attempts have been made to explore the application of VR-based mindfulness, such as VR meditation and mind-body exercises, in older adults. Generally, current studies indicate the heavy reliance on apparatus for implementing VR-based mindfulness interventions. In VR meditation, the crucial apparatus is VR headsets. In VR mind-body exercises, three essential components are required: motion capture sensors, main consoles, and display screens. In the aspect of health promotion, VR meditation is an effective method for improving mental health, pain, and quality of life in older adults. VR mind-body exercises contribute to increasing the mental health and physical function of older adults. Furthermore, VR mind-body exercises may be combined with other forms of exercise as a mixed method to promote the health of older adults. VR-based mindfulness interventions enhance the meditation and mind-body exercises experience for older adults while improving accessibility. However, their implementation still encounters a series of challenges, such as cost, technical anxiety, and apparatus-related issues. Additionally, we recommend future research to examine the optimal exercise dose for VR mind-body exercises to maximize their health benefits.

Paying attention to attention: a program evaluation of faculty-delivered mindfulness-based attention training to optimize wellness and professionalism in medical students

BACKGROUND

As physician distress rises, medical schools must provide programs to counter such distress at the earliest stages of training. Mindfulness training (MT) is one intervention that can alleviate stress during medical school. However, framing MT around wellness alone misses the opportunity to connect core cognitive and psychological capacities strengthened by MT to professional goals and skill acquisition inherent to successful medical training. Here, we highlight how the attentional components of MT align with students' goals of becoming attending physicians while promoting academic, psychological, and interpersonal flourishing. MT courses that focus on strengthening attentional capacities can intuitively link academic and professional development with wellness, appealing to a wide array of students.

METHODS

We iteratively recontextualized an existing short-form mindfulness training program for high-stress pre-professionals, known as Mindfulness Based Attention Training (MBAT), to the medical school context (MBAT-Rx). MBAT-Rx was offered by physician trainers to first-year medical students at Warren Alpert Medical School of Brown University as a tool for improving study habits and focus in addition to the development of both self-care and patient care strategies. MBAT-Rx consists of weekly, two-hour sessions over four weeks, with 10-15 min of daily mindfulness practice between sessions. At the end of the four weeks, students submitted voluntary program evaluation responses detailing their experience of the program.

RESULTS

Optional program evaluation responses (n = 67) highlight that students found the program to be useful for their academic success and ability to pay attention, their interpersonal relationships, and their psychological health. By framing MT as an opportunity to boost core attentional capacities and connecting this to professional and academic goals in addition to wellness, MBAT-Rx appealed to a wide variety of students.

CONCLUSIONS

Our ongoing work suggests that framing MT as both a professional development and wellness promotion tool, taught by physicians themselves, and structured around students' time demands, may be a successful model for medical schools looking to increase the impact of their mindfulness offerings. Such programs are needed to equip medical students to navigate the demands of a challenging healthcare training landscape.

Radiologist and Radiology Practice Wellbeing: A Report of the 2023 ARRS Wellness Summit

In April 2023, the first American Roentgen Ray Society (ARRS) Wellness Summit was held in Honolulu, Hawaii. The Summit was a communal call to action bringing together professionals from the field of radiology to critically review our current state of wellness and reimagine the role of radiology and radiologists to further wellbeing. The in-person and virtual Summit was available free-of-cost to all meeting registrants and included 12 sessions with 44 invited moderators and panelists. The Summit aimed to move beyond simply rehashing the repeated issues and offering theoretical solutions, and instead focus on intentional practice evolution, identifying implementable strategies so that we as a field can start to walk our wellness talk. Here, we first summarize the thematic discussions from the 2023 ARRS Wellness Summit, and second, share several strategic action items that emerged.

Mindful, mindless, or misunderstood? A critical perspective of the mindfulness concept

Mindfulness is everywhere, but the term is often used mindlessly. This article discusses the growth of mindfulness-based interventions in many countries over the past fifty years and, more recently, the emergence of the idea of 'McMindfulness', with particular emphasis on the concept of 'spiritual bypassing'. Critical discourse is a valuable resource in any discipline. Proportionate, mindful incorporation of reasoned critiques strengthens mindfulness, rather than undermining it. Misunderstandings and misinterpretations of mindfulness highlight a need to counter the notions that mindfulness involves avoiding difficult issues in our lives or simply accepting social problems that need to be addressed. The opposite is true: mindfulness of reality inevitably generates insights about change. Before we change the world, we need to see it. Mindfulness practice is opting in, not opting out.

Mindfulness Applications: Can They Serve as a Stress, Anxiety, and Burnout Reduction Tool in Orthopaedic Surgery Training? A Randomized Control Trial

Stress and burnout are prevalent within the orthopaedic surgery community. Mindfulness techniques have been shown to improve wellness, yet traditional courses are generally time-intensive with low surgeon utilization. We sought to determine whether the introduction of a simple mindfulness-based phone application would help decrease stress, anxiety, and burnout in orthopaedic surgery residents.

Methods

Twenty-four residents participated in this prospective, randomized controlled trial. After simple 1:1 randomization, the treatment group received access to a mindfulness-based phone application for 2 months while the control group did not receive access. All participants completed the Perceived Stress Scale, Generalized Anxiety Disorder-7, and Maslach Burnout Inventory with emotional exhaustion (EE), depersonalization (DP), and personal accomplishment subscores to measure stress, anxiety, and burnout at baseline and after 2 months. Paired t tests were used to compare baseline scores and conclusion scores for both groups.

Results

There was no difference in baseline burnout scores between groups, but the treatment group had higher stress and anxiety scores at baseline. On average, the treatment group spent approximately 8 minutes per day, 2 days per week using the mindfulness application. After 2 months, the treatment group had significantly decreased stress (mean = -7.42, p = 0.002), anxiety (mean = -6.16, p = 0.01), EE (mean = -10.83 ± 10.72, p = 0.005), and DP (mean = -5.17 ± 5.51, p = 0.01). The control group did not have any significant differences in stress, anxiety, or burnout subscores.

Conclusions

Use of a mindfulness-based phone app for 2 months led to significant reductions in stress, anxiety, and burnout scores in orthopaedic surgery residents. Our results support the use of a mindfulness-based app to help decrease orthopaedic resident stress, anxiety, and burnout. Benefits were seen with only modest use, suggesting that intensive mindfulness training programs may not be necessary to effect a change in well-being. The higher baseline stress and anxiety in the treatment group may suggest that mindfulness techniques are particularly effective in those who perceive residency to be more stressful.

Level of Evidence

I.

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.

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.

Universal, selective and indicated interventions for supporting mental health at the workplace: an umbrella review of meta-analyses

The current umbrella review aimed to assess and summarise evidence on universal, selective and indicated interventions for mental health at the workplace. This umbrella review forms one of the evidence reviews which were commissioned by the WHO to develop global guidelines on mental health at work. We conducted systematic searches in five bibliographic databases (PubMed, Embase, PsycINFO, Cochrane and Global Medicus Index) and included meta-analyses of randomised trials examining psychosocial, physical activity and lifestyle interventions delivered to all general workers (universal interventions), at-risk workers (selective interventions) and workers already experiencing symptoms of mental disorders (indicated interventions). We included outcomes from seven domains: symptoms of mental health conditions, positive mental health, quality of life, work-related outcomes, substance use, suicide-related outcomes and potential adverse effects. We identified 16 meta-analyses producing 66 pooled effect sizes of the examined interventions, mostly on symptoms of mental health conditions (n=43 pooled effect sizes) (eg, burnout, insomnia, stress) and positive mental health (n=15) (eg, well-being). Most of the evidence on universal, selective and indicated interventions was focused on psychosocial interventions, showing small to moderate effects across the various outcomes. Certainty levels according to GRADE (Grading of Recommendations Assessment, Development and Evaluation) were low to very low in almost all of the examined outcomes. The results of existing meta-analyses are promising for the use of preventative and early treatment interventions in the workplace. However, the quality and certainty of the evidence were very modest, and further research on the effectiveness of these interventions is warranted.

The art of seeing: The impact of a visual arts course on medical student wellbeing

PURPOSE

Medical student burnout is becoming increasingly common. The Art of Seeing is a visual arts elective at one US medical school. The purpose of this study was to determine the effect of this course on attributes that are foundational to wellbeing: mindfulness, self-awareness, and stress.

METHODS

A total of 40 students participated in this study from 2019 through 2021. Fifteen students participated in the pre-pandemic, in-person course, and 25 students participated in the post-pandemic, virtual course. Pre and post-tests included open-ended responses to works of art, which were coded for themes, and standardized scales: mindful attention awareness scale (MAAS), situational self-awareness scale (SSAS), and perceived stress questionnaire (PSQ).

RESULTS

The students had statistically significant improvements on the MAAS (p < .01), the SSAS (p < .01), and the PSQ (p = 0.046). Improvements in the MAAS and the SSAS did not depend on class format. Students also demonstrated increased focus on the present moment, emotional awareness, and creative expression in the post test free responses.

CONCLUSIONS

This course significantly improved mindfulness, self-awareness, and stress levels in medical students, and can be used to help enhance wellbeing and mitigate burnout in this population, both in-person and virtually.

Sources of stress and coping mechanisms: Experiences of maternal health care providers in Western Kenya

The dynamic and complex nature of care provision predisposes healthcare workers to stress, including physical, emotional, or psychological fatigue due to individual, interpersonal, or organizational factors. We conducted a convergent mixed-methods study with maternity providers to understand their sources of stress and coping mechanisms they adopt. Data were collected in Migori County in western Kenya utilizing quantitative surveys with n = 101 maternity providers and in-depth interviews with a subset of n = 31 providers. We conducted descriptive analyses for the quantitative data. For qualitative data, we conducted thematic analysis, where codes were deductively developed from interview guides, iteratively refined based on emergent data, and applied by a team of five researchers using Dedoose software. Code queries were then analysed to identify themes and organized using the socioecological (SE) framework to present findings at the individual, interpersonal, and organizational levels. Providers reported stress due to high workloads (61%); lack of supplies (37%), poor salary (32%), attitudes of colleagues and superiors (25%), attitudes of patients (21%), and adverse outcomes (16%). Themes from the qualitative analysis mirrored the quantitative analysis with more detailed information on the factors contributing to each and how these sources of stress affect providers and patient outcomes. Coping mechanisms adopted by providers are captured under three themes: addressing stress by oneself, reaching out to others, and seeking help from a higher power. Findings underscore the need to address organizational, interpersonal, and individual level stressors. Strategies are needed to support staff retention, provide adequate resources and incentives for providers, and ultimately improve patient outcomes. Interventions should support and leverage the positive coping mechanisms identified.

Incidence of Burnout Syndrome among Anesthesiologists and Intensivists in France: The REPAR Study

BACKGROUND

Burnout syndrome (BOS) impacts health workers and has become a real public health issue. The primary objective of this observational study was to re-evaluate the incidence of BOS among anesthesiologists and intensivists (AI) in France, ten years after the SESMAT study, a French Physician Health Survey carried out among burnout salaried AI. The secondary objective was to investigate risks factors.

METHODS

The REPAR survey is an observational study carried in France among AI, residents, and seniors, whatever their main mode of practice, in the framework of a self-questionnaire distributed on the Internet from 11 April 2018 to 1 July 2018. BOS was assessed using the Copenhagen Burnout Inventory (CBI). A score above 50% on two of the dimensions (personal burnout and work-related burnout) indicated BOS, as a main criterion. In order to investigate risks factors, questions were about sociodemographic characteristics, professional and extraprofessional environments, personality and mood using the Major Depression Inventory (MDI). A significance threshold of p < 0.05 was retained.

RESULTS

Among 1519 questionnaires received, 1500 completed questionnaires were analyzed. There were 775 men (52%) and 721 women (48%), aged 23 to 74 years. Among those, 24% suffered from BOS, 9% showed depressive symptoms (MDI > 25) and 35% were considering changing jobs or stopping their studies. There was no significant difference with the SESMAT study for the general BOS score. After multivariate analysis, 12 variables were significantly associated with the main criterion.

CONCLUSIONS

Ten years after the SESMAT study, the incidence of BOS in AI has not decreased in the largest cohort of AI studied to date in France.

Mindfulness Using a Wearable Brain Sensing Device for Health Care Professionals During a Pandemic: A Pilot Program

OBJECTIVE

The purpose of this feasibility pilot study was to evaluate safety and adherence of a wearable brain sensing wellness device designed to reduce stress among healthcare professionals (HCP).

METHODS

A total of 40 HCP were invited to participate in an open-label pilot study. Participants were asked to use a brain sensing wearable device (MUSE-S™) on a daily basis to reduce their stress, for a total of 90 days. Total study participation duration was 180 days. Study enrollment began in August 2021 and ended December 2021. The exploratory outcomes included stress, depression, sleep, burn-out, resilience, quality of life, and cognition.

RESULTS

Among the 40 HCP in study, the majority were female (85%), white (87.5%) and with an average age of 41.3 ± 11.0 years (SD). Participants used the wearable device an average of 23.8 times over a 30-day period with a mean duration of 5.8 min with each use. Study results demonstrate the positive impact of guided mindfulness using the wearable device MUSE-S™ and its accompanying application (APP). A statistically significant improvement was found for a reduction in stress (P < .001) and improvement in resilience (P = .02), quality of life (P = .003), and cognition (P < .001). The majority (91.9%) of the participants indicated they felt more relaxed after using the device, and 73% indicated they would continue to use this device at end-of-study. No adverse effects were reported.

CONCLUSION

Study results show that 3 to 10 min of guided meditation during work hours through the use of a brain sensing wearable device is safe and acceptable, with associated health benefits for HCP.

A Narrative Review of Key Studies in Medical Education in 2021: Applying Current Literature to Educational Practice and Scholarship

To remain at the forefront of clinical practice and pedagogy, pediatric medical educators must stay informed of the latest research. Yet familiarization with the growing body of literature in both pediatrics and medical education is a near-impossible task for the busy medical educator. The purpose of this annotated bibliography is to summarize key manuscripts in medical education published in 2021 that have the potential to significantly influence a pediatric medical educator's practice. Using a 2-staged iterative process, discrete author pairs reviewed 1599 abstracts from 16 medical education and specialty journals. In summary, 16 manuscripts were selected and grouped into the following 6 domains: assessment and feedback, USMLE Step 1 changes, communication, wellness, diversity and inclusion, and professional development. The authors provide abridged summaries and high-yield take-aways from these manuscripts that may impact educational practices in pediatrics. This year, we also provide a 6-year retrospective review of the journals that have had selected articles for this annotated bibliography since inception.

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.

Feasibility of a brief mindfulness-based program for burnout in pain healthcare professionals

Introduction

Stress inherent to health care, which is characterized by work overload and shortage of specialized staff, is associated with decreased quality of life and suboptimal patient care. Mindfulness-based programs have proved to be effective in reducing stress in healthcare providers. This study aims to assess the feasibility of an 8-week mindfulness program to reduce the burnout levels of the staff of a pain clinic in a tertiary public hospital.

Materials and methods

A longitudinal study with a within subject pre/post-intervention design, consisting of daily face-to-face 10-min sessions and the creation of a virtual group using a social media platform. Variables measured: burnout, mindfulness, empathy, self-compassion, and demographic characteristics.

Results

Program feasibility (i.e., reach, adherence, acceptability, and preliminary effectiveness) was evaluated in 10 participants (6 physicians, 2 nurse practitioners, 1 nursing assistant, and 1 administrative). The results revealed a high reach (i.e., participation rate of 90%), excellent adherence to the program (daily practice 95% of times), and very good acceptability of the group format and satisfaction with most treatment components. Regarding potential effectiveness, we report the results of the Wilcoxon signed-rank tests and its associated effect size (r). We observed improvements in mindfulness and all its subscales (−2.077 ≤ Z ≤ −2.703, 0.69 ≤ r ≤ 0.90, all p &lt; 0.05) except for non-reactivity and all subcomponents of self-compassion (−2.501 ≤ Z ≤ −2.611, 0.83 ≤ r ≤ 0.87, all p &lt; 0.05) but not on its global self-compassion score. Empathy and burnout did not change. In an exploratory manner, however, we found significant reductions in the burnout component of emotional exhaustion, but only in physicians (Z = −2.201, p = 0.028, r = 0.73).

Discussion

We believe that the 8-week mindfulness-based program described in the present investigation might be a feasible and potentially effective method that can be easily implemented to reduce burnout and promote mindfulness in specialized pain clinics.

Evaluation of the Processes and Outcomes of a Physician Leadership Program: The Continuous Feedback Loop Design

INTRODUCTION

Physicians assume leadership roles in their health care organizations and practices often without support or training. The Physicians Leadership Academy provides integrated leadership seminars, mindfulness training, and executive coaching in a 10-month curriculum to physicians across area organizations.

METHODS

Program evaluators responded to stakeholders' need for continuous program improvement by developing a continuous feedback loop evaluation design incorporating a program monitoring system and a theory-driven program evaluation. Given the size of the 2019 to 20 cohort ( n = 19), a one-group pretest/posttest design was used to assess the mechanisms of the program (mindfulness and wellbeing) along with knowledge development, emotional intelligence, and personal and professional growth. The assessments used a combination of published and administrator-developed assessments to address the unique aspects of the program. Doing such ensured continuous improvement and sustainability for the program.

RESULTS

The cohort of physicians demonstrated significant engagement and learning across the curriculum, improved mindfulness, and improved capacity of the providers to affect their health care system and communities.

CONCLUSIONS

The utility of the program was demonstrated through quantitative and qualitative analyses. Implications of the methodology for future evaluations of program developments are discussed.

A mindfulness-based cognitive therapy informed virtual psychiatry trainee wellbeing programme: Development and preliminary feedback

OBJECTIVE

To report the development and feedback on a newly created mindfulness-based cognitive therapy (MBCT) informed virtual wellbeing programme for psychiatry trainees.

METHODS

Thirteen of the 14 trainees participated in the programme provided feedback via an online questionnaire. Qualitative data was analysed using thematic analysis.

RESULTS

Thematic analysis revealed three main themes: timing of the intervention in relation to the COVID-19 pandemic; trainees were connected to the facilitator, their peers and within oneself; and trainees were going through a transformative experience.

DISCUSSION

Our findings support including an optional MBCT informed wellbeing programme in psychiatry training programmes. Future research could measure efficacy of this online programme by utilising pre- and post-outcome measures of dispositional mindfulness and stress.

Mindfulness for internet use disorder: a study protocol of a systematic review and meta-analysis

INTRODUCTION

Internet use disorder (IUD) is on the rise and is associated with detrimental health consequences. Growing evidence suggests that mindfulness-either as a trait or cultivated in mindfulness-based programmes (MBPs)-is promising in preventing and treating IUD. With this systematic review and meta-analysis, we will examine (1) the association between trait mindfulness (TM) and IUD and (2) the effectiveness of MBPs in reducing IUD.

METHODS AND ANALYSIS

In October 2022, we will screen Medline, PsycINFO, PSYINDEX, CINAHL, Web of Science, and the Cochrane Register of Controlled Trials without language or publication date restrictions. We will conduct backward and forward citation searches of included studies and relevant reviews. We will include studies that evaluate either (1) the association between TM and IUD or (2) the effectiveness of MBPs in reducing IUD. Two reviewers will independently screen records, select and extract data, and rate the risk of bias. In total, we will conduct three meta-analyses: a first meta-analysis will be on the correlation between TM and IUD, a second meta-analysis will be on between-group data examining the effectiveness of MBPs in reducing IUD in randomised controlled trials (RCTs), and a third meta-analysis will be on within-group pre-postdata examining the effectiveness of MBPs in reducing IUD in all kinds of intervention studies. For the second and third meta-analyses, the primary outcome will be changes in IUD. We will explore moderators and sources of between-study heterogeneity and pursue a narrative synthesis of results. We will use the Grading of Recommendations Assessment, Development and Evaluation system to assess the overall quality of evidence across intervention studies.

ETHICS AND DISSEMINATION

Ethics approval is not required. Results will be published in a peer-reviewed journal and presented at (inter)national conferences.

PROSPERO REGISTRATION NUMBER

CRD42022350071.

'Dear Doctor': a randomised controlled trial of a text message intervention to reduce burnout in trainee anaesthetists

One in four doctors in training in the UK reports feeling 'burnt out' due to their work and similar figures are reported in other countries. This two-group non-blinded randomised controlled trial aimed to determine if a novel text message intervention could reduce burnout and increase well-being in UK trainee anaesthetists. A total of 279 trainee anaesthetists (Core Training Year 2, Specialty Training Years 3 or 4) were included. All participants received one initial message sharing support resources. The intervention group (139 trainees) received 22 fortnightly text messages over approximately 10 months. Messages drew on 11 evidence-based themes including: gratitude; social support; self-efficacy; and self-compassion. Primary outcomes were burnout (Copenhagen Burnout Inventory) and well-being (Short Warwick-Edinburgh Mental Well-being Scale). Secondary outcomes were as follows: meaning in work; professional value; sickness absence; and consideration of career break. Outcomes were measured via online surveys. Measures of factors that may have affected well-being were included post-hoc, including the impact of COVID-19 (the first UK wave of which coincided with the second half of the trial). The final survey was completed by 153 trainees (74 in the intervention and 79 in the control groups). There were no significant group differences in: burnout (β = -1.82, 95%CI -6.54-2.91, p = 0.45); well-being (-0.52, -1.73-0.69, p = 0.40); meaning (-0.09, -0.67-0.50, p = 0.77); value (-0.01, -0.67-0.66, p = 0.99); sick days (0.88, -2.08-3.83, p = 0.56); or consideration of career break (OR = 0.44, -0.30-1.18, p = 0.24). Exploratory post-hoc analysis found the intervention was associated with reduced burnout in participants reporting personal or work-related difficulties during the trial period (-9.56, -17.35 to -1.77, p = 0.02) and in participants reporting that the COVID-19 pandemic had a big negative impact on their well-being (-10.38, -20.57 to -0.19, p = 0.05). Overall, this trial found the intervention had no impact. However, given this intervention is low cost and requires minimal time commitment from recipients, it may warrant adaptation and further evaluation.

An Evaluation of Speech-Based Recognition of Emotional and Physiological Markers of Stress

Life in modern societies is fast-paced and full of stress-inducing demands. The development of stress monitoring methods is a growing area of research due to the personal and economic advantages that timely detection provides. Studies have shown that speech-based features can be utilised to robustly predict several physiological markers of stress, including emotional state, continuous heart rate, and the stress hormone, cortisol. In this contribution, we extend previous works by the authors, utilising three German language corpora including more than 100 subjects undergoing a Trier Social Stress Test protocol. We present cross-corpus and transfer learning results which explore the efficacy of the speech signal to predict three physiological markers of stress—sequentially measured saliva-based cortisol, continuous heart rate as beats per minute (BPM), and continuous respiration. For this, we extract several features from audio as well as video and apply various machine learning architectures, including a temporal context-based Long Short-Term Memory Recurrent Neural Network (LSTM-RNN). For the task of predicting cortisol levels from speech, deep learning improves on results obtained by conventional support vector regression—yielding a Spearman correlation coefficient (ρ) of 0.770 and 0.698 for cortisol measurements taken 10 and 20 min after the stress period for the two corpora applicable—showing that audio features alone are sufficient for predicting cortisol, with audiovisual fusion to an extent improving such results. We also obtain a Root Mean Square Error (RMSE) of 38 and 22 BPM for continuous heart rate prediction on the two corpora where this information is available, and a normalised RMSE (NRMSE) of 0.120 for respiration prediction (−10: 10). Both of these continuous physiological signals show to be highly effective markers of stress (based on cortisol grouping analysis), both when available as ground truth and when predicted using speech. This contribution opens up new avenues for future exploration of these signals as proxies for stress in naturalistic settings.

The impact of a tailored mindfulness-based program for resident physicians on distress and the quality of care: A randomised controlled trial

BACKGROUND

Many resident physicians suffer from distress, which endangers their individual health and the quality of care.

OBJECTIVE

To examine the impact of a tailored mindfulness-based program (MBP) for resident physicians on distress and the quality of care.

METHODS

A single-centre, two-armed, longitudinal randomised controlled trial. The intervention group took part in an 8-week, tailored MBP that included a coursebook. The MBP was followed by a 4-month maintenance phase. The active control group received the coursebook for self-study. Assessments were at baseline (t0, 0 months), after the intervention (t1, 2 months), after the maintenance phase (t2, 6 months), and at follow-up (t3, 12 months). The primary outcome was a change in burnout at t2. Secondary outcomes included perceived stress, mental distress, perceived job strain, depression, anxiety, hair cortisol secretion, self-reported medical errors and third-party ratings by patients, supervisors and colleagues.

RESULTS

Seventy-six participants were randomised to the intervention and 71 to the control group. The intervention group showed greater improvements in the primary outcome (burnout at t2, d = 0.32, p = 0.046), in perceived stress (d = 0.31, p = 0.046) and perceived job strain (d = 0.33, p = 0.026) at t1, and in supervisor rated empathy (d = 0.71, p = 0.037) and colleague rated attentiveness (d = 0.85, p = .006) at t2. There was no difference between groups in the other outcomes.

CONCLUSION

A tailored MBP for resident physicians improved burnout and might have improved other aspects of distress and the quality of care.

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.

Effectiveness of a Mindfulness and Self-Compassion Standard Training Program versus an Abbreviated Training Program on Stress in Tutors and Resident Intern Specialists of Family and Community Medicine and Nursing in Spain

Stress is one of the most common problems among healthcare professionals, as they are exposed to potentially stressful and emotionally challenging situations in the workplace. Mindfulness-based stress reduction (MBSR) training programs have been shown to decrease stress. The objective of this study was to compare the effectiveness of an abbreviated 4-weeks MBSR training program in relation to a standard 8-weeks one on the stress levels. A controlled and randomized clinical trial was designed, in which 112 tutors and resident intern specialists in Family and Community Medicine and Nursing of six Spanish National Health System teaching units (TUs) participated. Participants included in the experimental groups (EGs) received a MBRS training program (standard or abbreviated), while control group (CG) participants did not receive any intervention. The stress levels were assessed by the Perceived Stress Questionnaire (PSQ) in three different moments during the study: before, immediately after, and 3 months after the intervention. Adjusted covariance analysis (ANCOVA), using pretest scores as the covariate, showed a significant reduction in stress (F_(2,91) = 5.165; p = 0.008; η² = 0.102) in the post-test visit, attributable to the implementation of the standard training program, but without the maintenance of its effects over time. No significant impact of the abbreviated training program on stress levels was observed in the intergroup comparison. A standard 8-weeks MBSR training program aimed at tutors and resident intern specialists in Family and Community Medicine and Nursing produces significant improvements in stress levels compared with the abbreviated intervention and no intervention. New studies about abbreviated training programs are needed to provide effective treatments which improve well-being of these professionals.

Mindfulness-based and acceptance-based programmes in the treatment of obsessive-compulsive disorder: a study protocol for a systematic review and meta-analysis

INTRODUCTION

Cognitive-behavioural therapy (CBT) with exposure and response prevention is the recommended standard for the treatment of obsessive-compulsive disorder (OCD). However, a high proportion of patients refuse this treatment, do not respond or relapse shortly after treatment. Growing evidence suggests that mindfulness-based and acceptance-based programmes (MABPs) are an effective option for the treatment of OCD. This systematic review and meta-analysis will examine the effectiveness of MABPs in treating OCD. We also aimed to explore potential moderators of the programmes' effectiveness.

METHODS AND ANALYSIS

We will systematically search MEDLINE, Embase, PsycINFO, PSYINDEX, Web of Science, CINAHL and Cochrane Register of Controlled Trials (no language restrictions) for studies that evaluate the effect of MABPs on patients with OCD. We will conduct backward and forward citation searches of included studies and relevant reviews and contact corresponding authors. The primary outcome will be pre-post intervention change in symptom severity. A secondary outcome will be change in depressive symptoms. Two reviewers will independently screen the records, extract the data and rate the methodological quality of the studies. We will include both controlled and uncontrolled trials. Randomised controlled trials will be meta-analysed, separately assessing between-group effects. A second meta-analysis will assess the within-group effect of all eligible studies. We will explore moderators and sources of heterogeneity such as the specific programme, study design, changes in depressive symptoms, hours of guided treatment, control condition and prior therapy (eg, CBT) using metaregression and subgroup analyses. We will perform sensitivity analyses using follow-up data. A narrative synthesis will also be pursued. We will use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to assess the quality of the evidence.

ETHICS AND DISSEMINATION

Ethical approval is not required. Results will be published in peer-reviewed journals and presented at international conferences.