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Under what conditions can mindfulness courses help health care workers manage stress and burnout?

stressed_nurseMed­ical pro­fes­sion­als are bur­dened dai­ly with the pain and suf­fer­ing of patients. Many work long hours, and reg­u­lar­ly face stress­ful sit­u­a­tions. This bur­den does not come with­out con­se­quence: 60 per­cent of physi­cians report hav­ing expe­ri­enced burnout at some point in their careers.

Mind­ful­ness cours­es designed to help health care work­ers cope have been effec­tive in reduc­ing job-relat­ed stress and burnout, but require a 30-to-60 hour time com­mit­ment of learn­ing skills like stay­ing in the moment and non-judg­men­tal aware­ness of thoughts and feel­ings.

What hap­pens when we add this pro­gram to a health care work­ers’ intense work­load? Coun­ter­pro­duc­tive­ly, stress increas­es, and many decide to drop the course; a mind­ful­ness course that aims to reduce stress becomes an addi­tion­al time bur­den.

To tack­le this prob­lem, two recent stud­ies have inves­ti­gat­ed the effec­tive­ness of abbre­vi­at­ed mind­ful­ness-based cours­es for health care work­ers. The results say that mind­ful­ness brings many ben­e­fits to doc­tors, nurs­es, and oth­er med­ical professionals—but only up to a point.

The lim­its of mind­ful­ness

In a study pub­lished in the Jour­nal of Pedi­atric Oncol­o­gy Nurs­ing, Karen Moody and her col­leagues stud­ied nurs­es, social work­ers, physi­cians, and psy­chol­o­gists car­ing for chil­dren with can­cer in both the Unit­ed States and at a hos­pi­tal in Israel. They spent eight weeks learn­ing about and prac­tic­ing mind­ful­ness, for a total of 12 hours.

Accord­ing to ques­tion­naires that the researchers admin­is­tered before the start of the course and fol­low­ing its com­ple­tion, the inter­ven­tion did not sig­nif­i­cant­ly reduce the staff mem­bers’ lev­el of burnout, stress, and depres­sion.

How­ev­er, analy­sis of jour­nals that the care­givers kept through­out the course sug­gest­ed that the inter­ven­tion did have pos­i­tive effects.

In the jour­nals, staff mem­bers wrote about how the mind­ful­ness course lead to increased inner peace, and decreased stress and anx­i­ety; because of the tools staff mem­bers learned in the mind­ful­ness course, they were bet­ter abil­i­ty to relax their mind, and let go of neg­a­tive thoughts. They also felt bet­ter able to han­dle stress­ful sit­u­a­tions, such as giv­ing diag­noses to patients and their fam­i­lies.

The staff also wrote about hav­ing an increased aware­ness of their thoughts and actions, which enabled them to be more effi­cient in their work, focus and make goals. This aware­ness also helped them to feel good about their work, as they were able to review their behav­ior at the end of the day, and appre­ci­ate the effect of their work.

What’s more, the staff wrote of being more accept­ing and under­stand­ing of their patients, which made it eas­i­er to con­nect with them in a mean­ing­ful way. Final­ly, jour­nal entries sug­gest­ed that the mind­ful­ness course fos­tered sup­port from col­leagues at work, as col­leagues would dis­cuss the mate­r­i­al and some­times prac­tice mind­ful­ness exer­cis­es togeth­er.

So if the jour­nals point­ed to so many ben­e­fits of the mind­ful­ness train­ing, why didn’t the researchers see changes in scores on burnout, stress, and depres­sion?

The researchers think that this may be because the pedi­atric oncol­o­gy staff was expe­ri­enc­ing such a high lev­el of stress and burnout. While the mind­ful­ness train­ing seemed to have ben­e­fi­cial effects, it sim­ply wasn’t enough to sig­nif­i­cant­ly reduce the stress and burnout the staff was expe­ri­enc­ing.

Also, though this eight-week course required a small­er time com­mit­ment than pre­vi­ous forms of the inter­ven­tion, some staff mem­bers wrote in their jour­nals that the time com­mit­ment of the class was still a bur­den, which may have hin­dered them from reap­ing the full ben­e­fits of the course.

Less time, less stress

In a sim­i­lar mod­i­fi­ca­tion of Jon Kabat-Zinn’s Mind­ful­ness-Based Stress Reduc­tion course, Luke Fort­ney and his col­leagues in Madi­son, Wis­con­sin designed an 18-hour inter­ven­tion that took one week­end and two short fol­lowup ses­sions to complete—but would (they hoped) have the same pos­i­tive effect as an eight-week inter­ven­tion.

Thir­ty pri­ma­ry care clin­i­cians at the Uni­ver­si­ty of Madi­son Wis­con­sin joined the pro­gram. Dur­ing the immer­sive week­end and fol­lowup ses­sions, the clin­i­cians learned mind­ful­ness prac­tices and how they could be applied to prac­tic­ing med­i­cine and every­day life. They also com­plet­ed sur­veys that mea­sured their lev­el of burnout, depres­sion, anx­i­ety, and stress right before and right after they com­plet­ed the course, and then two more times: eight weeks and, again, nine months lat­er.

The results, pub­lished in the Annals of Fam­i­ly Med­i­cine, show that the clin­i­cians were sig­nif­i­cant­ly less burned out, depressed, anx­ious and stressed after they par­tic­i­pat­ed in the mind­ful­ness train­ing than the day before they start­ed it. This result was the same eight weeks and nine months lat­er. In short, this time, the short­er ver­sion of the mind­ful­ness train­ing worked—and the pos­i­tive effects last­ed.

What can we learn?

Why might account for the dis­crep­an­cy between the two stud­ies?

The dif­fer­ence may lie in the rel­a­tive inten­si­ty and con­di­tions of the med­ical work under­tak­en by the two groups stud­ied. Peo­ple who work with dying chil­dren, as do the pedi­atric oncol­o­gists in the first study, may need some­thing more than a reduced time com­mit­ment. For instance, in addi­tion to address­ing per­son­al cop­ing skills, Karen Moody and her col­leagues think inter­ven­tions should address envi­ron­men­tal fac­tors that con­tribute to stress, such as under­staffing. They also think that a work­place envi­ron­ment could be improved by incor­po­rat­ing a “relax­ation sta­tion” at work, where staff mem­bers could take a moment to lounge in a mas­sage chair or lis­ten to a guid­ed med­i­ta­tion.

Both stud­ies also men­tioned that the peer inter­ac­tion inher­ent to the group for­mat of the mind­ful­ness course sig­nif­i­cant­ly con­tributed to the reduc­tion in stress in burnout. In oth­er words, it might not be enough to just learn the mind­ful­ness skills on one’s own; social sup­port mat­ters.

From these stud­ies, we learn that an abbre­vi­at­ed mind­ful­ness course to reduce stress and burnout in health care work­ers.

While these ini­tial stud­ies inves­ti­gat­ing time effi­cient mind­ful­ness inter­ven­tions for health care work­ers are promis­ing, addi­tion­al stud­ies are need­ed to con­firm the results—and also inves­ti­gate the impact of fac­tors like work­load and the dif­fer­ent lev­els of suf­fer­ing they encounter.

emily-nauman–Emi­ly Nau­man is a GGSC research assis­tant. She com­plet­ed her under­grad­u­ate stud­ies at Ober­lin Col­lege with a dou­ble major in Psy­chol­o­gy and French, and has pre­vi­ous­ly worked as a research assis­tant in Oberlin’s Psy­cholin­guis­tics lab and Boston University’s Eat­ing Dis­or­ders Pro­gram. Pub­lished here by cour­tesy of Greater Good, an online mag­a­zine based at UC-Berke­ley that high­lights ground break­ing sci­en­tific research into the roots of com­pas­sion and altru­ism.

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Categories: Cognitive Neuroscience, Education & Lifelong Learning, Health & Wellness, Peak Performance

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As seen in The New York Times, The Wall Street Journal, BBC News, CNN, Reuters,  SharpBrains is an independent market research firm tracking how brain science can improve our health and our lives.

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