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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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