The Development and Feasibility of a Novel Group Intervention to Support Helping Professionals in Metabolizing Suffering and Engaging Strengths: The CHRYSALIS Program.

This feasibility study reports on the development and initial evaluation of a novel online intervention for helping professionals (HPs; i.e. mental health professionals, chaplains, clergy) designed to (a) address occupational hazards, such as burnout and vicarious traumatization, and (b) promote well-being and flourishing at work. In contrast with competency and self-care focused models, the CHRYSALIS (Catalyzing Helping Professionals' Resilience, VitalitY, Spirituality, Authentic Living, and Inner Strength) intervention centers the self of the provider, explores cultural and spiritual contexts, and attends to systemic challenges. As part of a larger randomized controlled trial evaluating two program formats, the group format entails eight online sessions exploring strengths that can promote well-being, including processing, relational, vitalizing, orienting, and agentic capacities. To pilot test this framework and establish proof of concept, this study analyzed data from 41 HPs who had been randomly assigned to the group condition and completed surveys at four time points. Quantitative results indicated significant reductions in vicarious traumatization and burnout as well as increased well-being and meaning in work. Qualitative results suggest the intervention fostered relational support, cultivated new perspectives, and increased engagement with strengths, positively impacting participants' work and navigation of caregiving systems. Feedback about cohesion and group dynamic challenges in an online format informed further program development. This study provides initial support for the feasibility and efficacy of the group format of the CHRYSALIS intervention as a creative means to address HPs' risk for occupational hazards and promote holistic formation in a relational context.

Zentangle® Pilot Study: A Mindfulness Exercise for Oncology Nurses.

BACKGROUND: This study introduced Zentangle®, which involves drawing simple, repetitive lines and shapes to create patterns, as a tool to promote wellness for oncology nurses in a clinical practice setting. OBJECTIVES: The purpose of this study was to determine whether Zentangle used as a meditative activity in an acute time frame decreased stress, fatigue, and burnout while increasing professional quality of life and well-being in oncology nurses. METHODS: Twenty-six oncology nurses participated in a two-hour Zentangle class and received materials to complete art over four weeks. The Perceived Stress Scale, the Warwick-Edinburgh Mental Wellbeing Scale, the Patient-Reported Outcomes Measurement Information System-29, and the Professional Quality of Life measure were administered at selected periods. Twenty-four participants completed the study. FINDINGS: Nurses' well-being, socialization, anxiety, fatigue, secondary traumatic stress levels, and stress levels improved significantly. Most participants noted they would continue using Zentangle after the study. Zentangle is another tool to advance nurses' wellness by encouraging self-care.

A Mindfulness-Based Intervention for Acute Care Nursing Staff: A Pilot Study.

Purpose:The purpose of this study was to determine if a mindfulness-based smartphone application, used for 5 minutes a day for 30 days, could address burnout among acute care nursing staff. Methods: A pretest-posttest design with a midpoint evaluation was utilized. The sample included 31 nursing staff from cardiovascular acute care units. The Copenhagen Burnout Inventory, Cognitive and Affective Mindfulness Scale-Revised, Perceived Stress Scale, and Brief Resilience Scale were used to measure the impact of the intervention on participants. Findings: In a repeated measures analysis, there were no statistically significant changes in scores on the Brief Resilience Scale across the three timeframes (F = 0.64, df = 1.42, p = .49). There were significant reductions over time for perceived stress (F = 10.56, df = 1.74, p = .002) and personal burnout (F = 11.8, df = 1.10, p = .007), and increased scores on mindfulness (F = 4.76, df = 1.57, p = .039). Conclusions: The utilization of a mindfulness-based smartphone application may promote the health and well-being of cardiovascular nurses in acute care units. Mindfulness-based smartphone apps should be considered as a method of self-care, along with other holistic approaches to improve well-being.

"I Can't Think of Anything More Fulfilling": An Interpretative Phenomenological Analysis of Eight Female-Identifying Music Therapists' Career Longevity.

Although there is literature exploring burnout and music therapists who have left the profession, there is a lack of research exploring the lived experience of music therapists who have remained in the profession for their careers. Therefore, the purpose of this study was to understand the lived experience of music therapy clinicians in the United States who remained in the profession for their careers. We individually interviewed eight female-identifying music therapy clinicians who had been in the profession between 25 and 48 (M = 40.63; SD = 8.53) years. We used interpretive phenomenological analysis to analyze the data. Participants reviewed their transcripts and the results to provide credibility to the themes. We identified nine themes that described career longevity: centering service users; other professional opportunities and responsibilities; building a sustainable and thriving program; humility, professional agency, and growth; professional service to support peers and service users; training and supervising music therapists; connecting with the professional community; coping with work-related stressors; and music as a resource for resiliency. On the basis of these results, we developed a model depicting professional resiliency in music therapy that centered and revolved around the service users. In addition to their clinical expertise, there is considerable knowledge to be gained from music therapists regarding professional resiliency and career longevity. Additional scholarship in music therapy career longevity is necessary to grow the profession and increase access to services. Implications, limitations, and suggestions for future research are provided.

A mindful approach to physician self-care.

There has been an increasing awareness of the importance of physician mental health. Several South African studies show a high prevalence of burnout among doctors. Burnout is characterised by three components: exhaustion, depersonalisation, and a sense of a lack of efficacy. Burnout is a result of both external and internal pressures. While lifestyle modification is essential, mindfulness-informed programmes promote self-regulation and resilience. Mindfulness programmes comprise three components: present moment awareness, perspective-taking and wisdom, and compassion. Physician wellness begins with individuals recognising the need of self-care and giving themselves permission to prioritise this. Ongoing identification of self-care needs and acting compassionately to address these needs is essential.

Physician resilience and perceived quality of care among medical doctors with training in psychosomatic medicine during the COVID-19 pandemic: a quantitative and qualitative analysis.

BACKGROUND: At an individual level, physician resilience protects against burnout and against its known negative effects on individual physicians, patient safety, and quality of care. However, it remains uncertain whether physician resilience also correlates with maintaining a high level of healthcare quality during crises such as a pandemic. This study aimed to investigate whether higher resilience among physicians, who had received training in resilience-related competences in the past, would be associated with higher quality of care delivered during the COVID-19 pandemic. METHODS: This study enrolled physicians working in family medicine, psychiatry, internal medicine, and other medical specialties, who had obtained at least one of three consecutive diplomas in psychosomatic medicine in the past. Participants completed a quantitative and qualitative anonymous online survey. Resilience was measured using the Connor-Davidson Resilience Scale, and healthcare quality was assessed through single-item quality indicators, including perceived quality of care, professional autonomy, adequate time for patient care, and job satisfaction. RESULTS: The study included 229 physicians (70 males/159 females) with additional training in psychosomatic medicine, working in family medicine (42.5%), psychiatry (28.1%), internal medicine (7.0%), or other medical specialties (22.4%). Participants represented four intensity levels of training background (level 1 to level 4: 9.2%, 32.3%, 46.3%, and 12.2% of participants). Training background in psychosomatic medicine was positively associated with resilience (B = 0.08, SE = 0.04, p <.05). Resilience and training background independently predicted perceived quality of care, even after controlling for variables such as own health concerns, involvement in the treatment of COVID-19 patients, financial strain, percentage of working hours spent on patient care, age, and gender (resilience: B = 0.33, SE = 0.12, p <.01; training background: B = 0.17, SE = 0.07, p <.05). Both resilience and training background predicted job satisfaction (resilience: B = 0.42, SE = 0.12, p <.001; training background: B = 0.18, SE = 0.07, p <.05), while resilience alone predicted professional autonomy (B = 0.27, SE = 0.12, p <.05). In response to an open question about their resources, resilient physicians more frequently reported applying conscious resilient skills/emotion regulation (p <.05) and personal coping strategies (p <.01) compared to less resilient medical doctors. CONCLUSION: Physician resilience appears to play a significant role in the perceived quality of patient care, professional autonomy, and job satisfaction during healthcare crises.

Effective interventions to reduce burnout in nurses: A meta-analysis.

BACKGROUND: To examine the effectiveness of interventions to ameliorate burnout, secondary traumatic stress, and emotional exhaustion in nurses and midwives. The systematic review was completed with all available studies that reported data on the effect of interventions that targeted burnout using the outcome measures of the Professional Quality of Life scale (ProQOL), or the Maslach Burnout Inventory (MBI). METHODS: We used a systematic review methodology, which included a meta-analysis. A total of 2103 articles resulted from the systematic search; 688 were removed as duplicates, and 1415 articles were reviewed by the title and abstract, of which 255 were eligible for full-text screening. Only 66 met the inclusion criteria and were included in the analysis. The final meta-analysis consisted of 33 reports divided into 12 studies for ProQOL and 21 studies for the MBI. RESULTS: The results provide an overall effect in studies using the ProQOL measurement was Z = 2.07 (P = 0.04) and a positive improvement mean difference of 9.32. The overall effect in studies using MBI was Z = 3.13 (P = 0.002) and a positive improvement mean difference of 6.58. CONCLUSIONS: Whilst most studies indicated a positive difference, the most effective interventions included clinical supervision or activities that addressed the personal physical and mental well-being of nurses. Less effective interventions were managerial interventions or ones that used a strictly educational approach.

Embedding Mindfulness-Based Resiliency Curricula Into Surgical Training to Combat Resident Burnout and Improve Wellbeing.

Surgery residents are at a higher-than-average risk of burnout syndrome, which is characterized by emotional exhaustion, depersonalization, and a sense of ineffectiveness. This risk of burnout can translate to increased stress and distress in trainees, poor performance, as well as worse patient outcomes. Therefore, developing and implementing burnout reduction strategies that are feasible, acceptable, and effective among surgical residents is paramount. Studies demonstrate that inherent mindfulness is associated with improved resiliency, reduced stress and burnout, as well as improved cognitive and motor skill performance. Fortunately, mindfulness is a skill that can be developed and maintained through targeted mindfulness-based interventions embedded within surgical education curriculum. Here, we present the data supporting the use of mindfulness as an integral part of burnout reduction efforts in surgical trainees as well as highlight evidence-based strategies for implementation in diverse surgical training environments.

Nurse and midwife navigator resilience, well-being, burnout, and turnover intent: A multi-methods study.

PURPOSE: To explore levels of Navigator resilience, well-being, burnout, and turnover intent. DESIGN: A longitudinal, multi-methods study concurrently collected quantitative and qualitative data over three years. METHODS: A survey and Action Learning Groups. FINDINGS: No statistically significant change in resilience, well-being, burnout, or turnover intent. Supports, self-care and leaving the position, were used to maintain well-being. CONCLUSIONS: While quantitative measures did not change, qualitative data demonstrated how adaptive coping mechanisms maintain well-being. Recommendations for nurses working in Navigator, or similar community/public health roles include work-based programs targeting support, good leadership, governance systems including their impact on turnover intent. CLINICAL EVIDENCE: Job turnover intent can be used as a mechanism to monitor resilience and well-being.

Twelve tips for creating a multicultural mindfulness-based intervention in diverse healthcare settings.

High levels of stress and burnout, low help-seeking behaviour and unhealthy coping in healthcare professionals (HCPs), are a critical concern globally. Mindfulness-based interventions (MBIs) reduce stress, are a healthy coping mechanism and have become increasingly popular among HCPs, especially during the Covid-19 pandemic. Nevertheless, HCPs' busy schedules require the intervention to be accessible, pragmatic, and context specific. Key to this goal is approaching mindfulness from a multicultural perspective, especially in diverse settings such as Africa. This paper aims to provide practical tips to ensure that the MBI offered is effective with multicultural HCPs during intense stress. Four tips each discuss the curriculum, implementation, and sustainability, respectively. The tips are elucidated by practical examples of regulating stress in healthcare settings and to offer a guideline to help structure future MBIs to be culturally and context appropriate.

FIRECARE: An Evidence-Based Prevention Program to Reduce Burnout among Prehospital Caregivers: Benefits of a Combined Mindfulness, Heart Coherence Training, and Positive Psychology Intervention.

BACKGROUND: Burnout among emergency health care professionals is well-described, especially during the COVID-19 pandemic. Prevention interventions, such as mindfulness, focus on the management of stress. OBJECTIVE: To evaluate the effects of the FIRECARE program (a mindfulness intervention, supplemented by heart coherence training and positive psychology workshops) on burnout, secondary stress, compassion fatigue, and mindfulness among advanced life support ambulance staff of the Paris Fire Brigade. MATERIALS AND METHODS: We used a non-randomized, two-group quasi-experimental study design with a waitlist control and before-and-after measurements in each group. The intervention consisted of six, once-weekly, 2.5-h sessions that included individual daily meditation and cardiac coherence practice. The study compared intervention and waitlist control groups, and investigated baseline, post-program, and 3-month follow-up change on burnout (measuring using the ProQOL-5 scale) and mindfulness (measuring using the FMI scores). Baseline burnout (measured using the ProQOL-5) was evaluated and used in the analysis. RESULTS: Seventy-four 74 participants volunteered to participate; 66 were included in the final analysis. Of these, 60% were classified as suffering from moderate burnout, the 'burnout cluster'. A comparison of intervention and waitlist control groups found a decrease in the burnout score in the burnout cluster (p = 0.0003; partial eta squared = 0.18). However, while secondary stress fell among the burnout cluster, it was only for participants in the intervention group; scores increased for those in the waitlist group (p = 0.003; partial eta squared = 0.12). The pre-post-intervention analysis of both groups also showed that burnout fell in the burnout cluster (p = 0.006; partial eta squared = 0.11). At 3-month follow-up, the burnout score was significantly reduced in the intervention group (p = 0.02; partial eta squared = 0.07), and both the acceptance (p = 0.007) and mindfulness scores (p = 0.05; partial eta squared = 0.05) were increased in the baseline burnout cluster. CONCLUSION: FIRECARE may be a useful approach to preventing and reducing burnout among prehospital caregivers.

A metasynthesis of nurses and midwives' experiences of clinical supervision.

PROBLEM: Given the current rate of burnout and attrition among nurses and midwives globally, there is a need to understand the effectiveness of supportive strategies to help retain this workforce. BACKGROUND: Clinical supervision can help to ensure that nurses and midwives are supported and have the capacity to cope with their job demands. Yet there are no metasyntheses that provide a collective understanding of their experiences with clinical supervision. AIM: To synthesise the experiences of nurses and midwives who have accessed clinical supervision. METHODS: A metasynthesis was conducted by systematically searching academic databases for relevant publications; assessing their quality using an established checklist; extracting and analysing qualitative content; and synthesising key findings about the experiences of nurses and midwives regarding clinical supervision. FINDINGS: Themes and subthemes were identified from 12 papers, including: optimal logistics; support; safety and confidentiality; improving practice through reflection; and trust in the group. DISCUSSION: For clinicians to feel comfortable discussing their practice and workplace with the facilitator and colleagues, nurses and midwives needed to feel safe during clinical supervision and trust the process and their peers. Despite common difficulties of finding time for the sessions, clinical supervision can enhance collaboration and communication in the workplace. CONCLUSION: Clinical supervision that adheres to group rules can provide professional support within a safe, confidential space. Having trust in peers and facilitators at the sessions can help staff develop confidence, provide personal development and professional sustenance.

Addressing Pandemic Burnout Among Health Care Professionals: Beyond Intrapersonal Wellness Programming.

The COVID-19 pandemic has been distressing to health care professionals, causing significant burnout. Burnout has resulted in notable rates of mental health symptoms and job turnover. Hospitals have incorporated programming to meet the needs of health care professionals. A previously reported intervention at the study institution was a cognitive behavioral narrative writing program to target job-related stress. On the basis of participant feedback, psychoeducational seminars, psychotherapy drop-in sessions, and complementary interventions (mindfulness, yoga, and acupuncture) were also implemented to alleviate stress. This article is an update based on these year 2 augmentations. Participation in brief psychoeducational seminars and acupuncture was high, but engagement in other programming (individual psychotherapy and mindfulness) was poor. Hospitals should consider multimodal approaches to address pandemic-related stress and burnout. In addition to educational seminars, programs that address lasting distress should be offered to health care professionals. Targeting job-related burnout at organizational and systemic levels may ameliorate distress. This article discusses methods of integrating organizational programs into clinics.

Impact of an online training tool on individual and organizational resilience and mindfulness among radiological personnel in Norway.

BACKGROUND: Heavy workloads and increasing demands for productivity have contributed to rising rates of stress and burnout among radiological staff. Different forms of mindfulness and resilience-training might assist with stress management and protect these employees against burnout. AIM: The objective of this study is to evaluate the impact of an online training tool on individual and organizational resilience, mindfulness and quality of care. METHODS: An online questionnaire was used, consisting of the Connor-Davidson Resilience Scale, the Mindful Attention Awareness Scale, the Benchmark Resilience Tool, and questions pertaining to quality, safety, and burnout (baseline = 68 participants between July 2022 - October 2022, follow-up = 13 participants between November 2022 - February 2023). Descriptive statistics and a paired-sampled t-test were used for statistical analysis. RESULTS AND CONCLUSIONS: Few participants reported completing any of the exercises. The baseline group had significantly higher mean resilience (p = 0.018) and mindfulness scores (p = < 0.001), mean decrease in scores was 7.46 for resilience and 1.7 for mindfulness. In conclusion, both individual and organizational resilience are perceived as low among radiological personnel in Norway. However, it does not seem to affect quality and safety.

Addressing Burnout in the Primary Care Setting: The Impact of an Evidence-Based Mindfulness Toolkit.

BACKGROUND: Burnout is insidious and manifests over prolonged, repeated exposure to occupational stressors. There is a growing crisis among health care workers (HCWs) due to high levels of burnout and associated adverse outcomes. Identifying and addressing burnout can be problematic due to extensive variances of perceived occupational stressors across HCWs. PURPOSE: Mindfulness-based training can enhance individual HCWs' abilities to perceive and constructively respond to stresses endemic in the health care environment. It can reduce the prevalence of burnout in the primary care setting. An evidence-based multimodal Mindfulness-Based Stress Reduction toolkit (MBSR TK) was designed, implemented, and evaluated for its impact on HCWs' self-reported stress levels (SRSL). IMPLEMENTATION STRATEGIES: A pre-post-program evaluation explored the impact of a multimodal toolkit program on HCW SRSL with the Mini-Z burnout survey (MZBS). The MBSR TK program, consisting of a 45 minute introduction and 4 biweekly 15 minute mindfulness sessions offering acupressure, meditation, journaling for gratitude, and self-compassion was designed, delivered, and evaluated with HCWs across 2 military primary care clinics in South Texas. RESULTS: All HCWs across 2 Air Force family practice clinics were invited to participate in all toolkit components. Seventy percent of all HCWs (N = 90) attended the introduction session. Thirty-seven (41%) HCWs completed pre and post MZBSs, and these responses are included in the data analysis section. The most represented HCWs were registered nurses, physician assistants, and technicians, respectively, at 24%, 21%, and 18%. The Wilcoxon Signed-Rank test examined changes in HCWs' SRSL after participation in the MBSR TK program. HCWs who attended the introduction plus one biweekly session showed statistically significant decreases in self-reported stress (P = 0.018) and burnout (P = 0.045) and a significant increase in electronic health record proficiency (P = 0.033). CONCLUSIONS: Multimodal mindfulness toolkits to address SRSL burnout are practical, accessible, easily implemented, adaptive to any environment, and can decrease burnout with participation with just one 15 minute session. This MBSR TK implementation effectively lowered self-reported stress in HCWs who are repeatedly challenged to adapt to various settings around the world during peacetime, wars, natural disasters, humanitarian crises, and now, pandemics.

The influence of mindfulness-based stress reduction on the work life of healthcare professionals - A qualitative study.

BACKGROUND: and purpose: Quantitative studies show that mindfulness-based interventions can reduce stress and burnout in healthcare professionals. Few qualitative studies have explored healthcare professionals' experiences with mindfulness training. The aim of the study was to explore healthcare professionals' experiences of how attending a course in Mindfulness-Based Stress Reduction influenced their work life, including their relationship with patients and colleagues. METHODS: Fifty-six healthcare professionals attended a Mindfulness-Based Stress Reduction course between January and June 2022. Participant observation followed by six semi-structured focus group interviews and 15 individual interviews were conducted. Data were collected in a cardiology department and in an obstetrics and gynaecology department. Thematic data analysis was performed. Reporting followed COREQ guidelines. RESULTS: Six themes were identified: 1) Allowing a pause and focusing on one thing at a time, 2) Awareness of the freedom to choose, 3) The need for self-compassion, as a prerequisite for taking care of others, 4) The value of presence and calmness in patient encounters, 5) Awareness of how stressful behavior affects oneself and others, 6) The value of practicing mindfulness with colleagues. CONCLUSION: This study suggests that offering Mindfulness-Based Stress Reduction to healthcare professionals can start a positive process of change from a tendency to neglect personal needs to becoming more compassionate towards oneself and others. Mindfulness training may thus prevent burnout and lead to a more compassionate workplace culture that also manifests in better patient care. However, a collective understanding and knowledge of mindfulness in the work setting may be necessary to sustain these changes.

Implementation of a pharmacy residency wellness program: Impact on burnout and mindfulness and lessons learned.

BACKGROUND AND PURPOSE: Attention to wellness in the pharmacy workplace is occurring. To maintain accreditation, pharmacy residency programs must incorporate wellness and resilience initiatives. EDUCATIONAL ACTIVITY AND SETTING: Orlando Health created a pharmacy residency wellness program for post-graduate year one (PGY-1) and post-graduate year two (PGY-2) pharmacy residents to address wellness and burnout. The wellness program included assignment of a mentor, development of a personal wellness plan, completion of monthly reflections, and wellness and resiliency training. FINDINGS: Pharmacy residents anonymously completed the Oldenburg Burnout Inventory (OLBI) and Mindful Attention Awareness Scale (MAAS) at the beginning and end of the residency year. A total of nine pharmacy residents were eligible to participate in the wellness program. Eight residents completed the pre-survey, and seven residents completed the post-survey. No change was observed in the overall median OLBI score (pre-program = 35 [IQR 31.5-37.3] and post-program = 36 [IQR 31-37.5]; P = .683). Similar results were found on the OLBI for disengagement and exhaustion, correlating with low burnout risk. There was no change in the overall median MAAS score (pre-program = 3.7 [IQR 3.6-4.1] and post-program = 3.8 [IQR 3.5-3.9]; P = 1.000). Overall, feedback from the pharmacy residents after program completion was positive. SUMMARY: Pharmacy residents participating in the wellness program at our institution had low risk for burnout and a high level of mindfulness pre- and post-program completion. Pharmacy residents enjoyed participating in the wellness program and found the program to be valuable, supporting its continued implementation.

Healer's High.

We explore the concept of healer's high, a phenomenon similar to runner's high. We define healer's high as a psycho-endocrine response of intense happiness and bliss, accompanied by a feeling of enhanced energy, experienced by health care professionals when they heal or help someone. We describe the endocrinology that underlies healer's high, and posit that this phenomenon may be used to enhance professional satisfaction, and mitigate compassion fatigue and burnout.

The effect of mindfulness interventions on stress in medical students: A systematic review and meta-analysis.

BACKGROUND: Medical students have high levels of stress, which is associated with higher incidents of burnout, depression, and suicide compared to age-matched peers. Mindfulness practices have been shown to reduce stress among medical students. PURPOSE: The purpose of this systematic review and meta-analysis was to examine if mindfulness interventions have an overall effect on stress outcomes in the high-stress population of medical students globally, particularly given the wide variety of interventions. Any intervention designed to promote mindfulness was included. METHODS: A comprehensive literature search was completed to include multiple databases, ancestry, and hand-searching and 35 studies were included. Standardized mean difference effect sizes (ES) were synthesized across studies using a random-effects model for changes in stress levels in medical students ≥ 18. Moderator analyses were performed to explore variations in effects by participant and intervention characteristics. RESULTS: Mindfulness interventions significantly improved stress among medical students in both the two-arm studies (d = 0.370, k = 19, n = 2,199, 95% CI 0.239-0.501, p < .001) and one-arm pre-post studies (d = 0.291, k = 30, n = 18 (two cohorts from Dyrbye et al), 95% CI 0.127-0.455, p = 0.001). Moderator analyses found trends in less hours and less required practice resulted in better improvement in stress. CONCLUSIONS: This study further confirms that despite a wide variety of mindfulness interventions for medical students around the world, they produce an overall small-to-moderate effect on stress reduction. Future research looking at the most effective protocols for high-stress medical students would be beneficial.

Art therapy-based interventions to address burnout and psychosocial distress in healthcare workers-a systematic review.

BACKGROUND: Burnout and psychosocial distress are serious and growing issues for healthcare workers (HCWs) and healthcare systems across the globe. Exacerbated by changes in healthcare delivery during and following the Covid-19 pandemic, these issues negatively affect HCW wellbeing, clinical outcomes and patient safety. Art Therapy has demonstrated promise as a suitable but under researched intervention, warranting further investigation. This systematic review aims to ascertain what art therapy-based interventions used to address burnout and / or psychosocial distress in HCWs have been reported in the health and social care literature and how these have been evaluated. METHODS: Six databases (PubMed, PsycINFO, MEDLINE, EMBASE, CINAHL, ProQuest Central), Google Scholar and three clinical trial registries (CENTRAL, ICTRP and ClinicalTrials.gov) were searched for studies using art therapy-based methods to engage with burnout risk or psychosocial distress in HCWs. Following screening for eligibility study characteristics and outcomes were extracted by two reviewers independently. Studies were evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal Tools. Outcomes were grouped for analysis. Quantitative and qualitative results were synthesised and integrated using narrative synthesis. RESULTS: Twenty-seven studies, drawn from thirteen countries, spanning five continents were selected for inclusion. Fifty percent were published in the last five years, indicating growing global research in the field. Fourteen studies used quantitative research methods and thirteen used qualitative methods. A total of 1580 participants took part in the studies, with nurses most broadly represented (59%). Interventions were mostly delivered in groups (95%) and by an art therapist (70%). Heterogeneity and insufficient randomised controlled trials precluded the possibility of meta-analysis. However, a review of available data showed evidence of medium to large effects for emotional exhaustion (burnout), work-related stress and common mental health issues. A content analysis of qualitative data of perceived effect complemented quantitative findings. CONCLUSION: Global research into the use of art therapy-based methods to address burnout and psychosocial distress in HCWs is growing. Whilst further high-quality evidence such as randomised controlled trials would be beneficial, findings suggest that art therapy-based methods should be strongly considered as an acceptable and effective treatment for symptoms of emotional exhaustion (burnout) and psychosocial distress in HCWs.