The Effectiveness of a Neurofeedback-Assisted Mindfulness Training Program Using a Mobile App on Stress Reduction in Employees: Randomized Controlled Trial.

BACKGROUND: Mindfulness-based training programs have consistently shown efficacy in stress reduction. However, questions regarding the optimal duration and most effective delivery methods remain. OBJECTIVE: This research explores a 4-week neurofeedback-assisted mindfulness training for employees via a mobile app. The study's core query is whether incorporating neurofeedback can amplify the benefits on stress reduction and related metrics compared with conventional mindfulness training. METHODS: A total of 92 full-time employees were randomized into 3 groups: group 1 received mobile mindfulness training with neurofeedback assistance (n=29, mean age 39.72 years); group 2 received mobile mindfulness training without neurofeedback (n=32, mean age 37.66 years); and group 3 were given self-learning paper materials on stress management during their first visit (n=31, mean age 38.65 years). The primary outcomes were perceived stress and resilience scales. The secondary outcomes were mindfulness awareness, emotional labor, occupational stress, insomnia, and depression. Heart rate variability and electroencephalography were measured for physiological outcomes. These measurements were collected at 3 different times, namely, at baseline, immediately after training, and at a 4-week follow-up. The generalized estimating equation model was used for data analysis. RESULTS: The 4-week program showed significant stress reduction (Wald χ22=107.167, P<.001) and improvements in psychological indices including resilience, emotional labor, insomnia, and depression. A significant interaction was observed in resilience (time × group, Wald χ42=10.846, P=.02). The post hoc analysis showed a statistically significant difference between groups 1 (least squares mean [LSM] 21.62, SE 0.55) and 3 (LSM 19.90, SE 0.61) at the posttraining assessment (P=.008). Group 1 showed a significant improvement (P<.001) at the posttraining assessment, with continued improvements through the 1-month follow-up assessment period (LSM 21.55, SE 0.61). Physiological indices were analyzed only for data of 67 participants (22 in group 1, 22 in group 2, and 23 in group 3) due to the data quality. The relaxation index (ratio of alpha to high beta power) from the right electroencephalography channel showed a significant interaction (time × group, Wald χ22=6.947, P=.03), with group 1 revealing the highest improvement (LSM 0.43, SE 0.15) compared with groups 2 (LSM -0.11, SE 0.10) and 3 (LSM 0.12, SE 0.10) at the 1-month follow-up assessment. CONCLUSIONS: The study demonstrated that the neurofeedback-assisted group achieved superior outcomes in resilience and relaxation during the 4-week mobile mindfulness program. Further research with larger samples and long-term follow-up is warranted. TRIAL REGISTRATION: ClinicalTrials.gov NCT03787407; https://clinicaltrials.gov/ct2/show/NCT03787407.

The Effectiveness of a Four-Week Online Mindfulness Training Course on Individual Mindfulness Skills and Personal Perception of Stress in Company Employees Working from Home.

Working from home comes with many benefits. However, employees are often exposed to various stressors when working outside of the traditional workplace environment. The subjective experience of these stressors is related to one's perception of the situation and the perceived resources available. As working from home has become the new normal for many during the COVID-19 pandemic, it is in the interest of companies to provide employees with tools to cope with these stressors. One such tool is online mindfulness training. This study investigates how a four-week online mindfulness training influences an individual's mindfulness skills, subjective perception, and processing of stressors. Forty participants working from home at the time of the study were examined in a pre-test using a pre-post design in which the experimental group participated in a four-week online training course in mindfulness. Since the results showed a significantly reduced subjective perception of stress in the experimental group after mindfulness training, a long-term study was conducted including 40 additional participants. The study revealed a training success of at least three months. It thus introduces new possibilities for effective stress management in all workplace settings.

The effect of the demonstration-based progressive muscle relaxation technique on stress and anxiety in nurses caring for COVID-19 patients: a randomized clinical trial.

BACKGROUND: Caring for patients with coronavirus disease 2019 (COVID-19) challenges nurses and causes them to experience stress and anxiety. From this perspective, it is of utmost importance to develop quick and effective intervention strategies to prevent numerous complications. This study aimed to investigate the effect of the progressive muscle relaxation technique, using the demonstration method on the stress and anxiety of nurses who care for COVID-19 patients. METHODS: This randomized clinical trial was conducted in 2021. Forty-six nurses working in two referral hospitals with wards for COVID-19 patients in Tehran, Iran recruited by convenience sampling method and then randomly assigned to experimental or control groups. The nurses in the experimental group educated the progressive muscle relaxation by the demonstration method, and they were encouraged to practice it. The Depression Anxiety Stress Scale-21 was utilized to measure the stress and anxiety levels in the nurses. RESULTS: Before the intervention, the levels of stress in the experimental and control groups were 13.91 ± 2.41 vs. 14.34 ± 2.74 (p = 0.571), and their anxiety was 13.34 ± 3.41 vs. 12.78 ± 2.21 (p = 0.510), respectively. After the intervention, the levels of stress in the experimental and control groups were 10.95 ± 2.01 vs. 14.17 ± 2.34 (p < 0.001), and their anxiety was 9.47 ± 2.37 vs. 12.91 ± 1.85 (p < 0.001), respectively. Moreover, the levels of stress and anxiety in the experimental group significantly diminished after intervention (p < 0.001), but no significant changes were observed in the control group (p > 0.05). CONCLUSION: Concerning the effectiveness of the progressive muscle relaxation technique in relieving the stress and anxiety of the nurses caring for COVID-19 patients, it is suggested to include this relaxation technique in nursing courses.

Changes in Salivary Immunoglobulin A, Stress, and Burnout in a Workplace Mindfulness Intervention: A Pilot Study.

The purpose of this pilot study was to examine the effectiveness of a 6-week workplace mindfulness- and self-compassion-based intervention (MSCBI) on perceived stress, burnout, immune functioning (assessed with the biomarker Immunoglobulin A), self-compassion, and experiential avoidance compared to a Workplace Stress Management Intervention. Both interventions were contextual, i.e., they were carried out in the workplace setting and during working hours. We followed a randomised controlled trial study design. The total sample was composed of 24 employees of an automotive company. One-way analyses of covariance between groups revealed significant differences in post-intervention levels of perceived stress, salivary Immunoglobulin A (sIgA), emotional exhaustion, self-compassion, and experiential avoidance, after adjusting for pre-test scores. The results of this study have several implications. Firstly, it confirms that MSCBIs might be more effective than regular psychoeducational interventions for work-related stress and burnout treatment. Secondly, sIgA can be used to assess immune function state changes when MSCBIs are carried out. Furthermore, these results indicate that it is feasible to carry out MSCBIs within companies and during working hours, and that these interventions can help effectively manage stress and burnout associated with the work environment.

The Effect of Mindfulness-Based Breathing and Music Therapy Practice on Nurses' Stress, Work-Related Strain, and Psychological Well-being During the COVID-19 Pandemic: A Randomized Controlled Trial.

Infectious diseases cause psychological problems for health care workers and especially nurses. Nurses who provided coronavirus disease-2019 (COVID-19) patients with care experience negative feelings such as stress, work-related strain, discomfort, and helplessness related to their high-intensity work. The aims of this study are to investigate the effect of the mindfulness-based breathing and music therapy practice on stress, work-related strain, and psychological well-being levels of nurses who provided COVID-19 patients with care. This randomized controlled trial was conducted in a COVID-19 department at a university hospital in Turkey. Nurses who care for patients infected with COVID-19 were randomly divided into an intervention group (n = 52) and a no-treatment control group (n = 52). The intervention group received mindfulness-based breathing and music therapy. In data collection, the Personal Information Form, State Anxiety Inventory, Work-Related Strain Scale, and Psychological Well-Being Scale were used. The data from the study showed that mindfulness-based breathing and music therapy decreased stress and work-related strain (P < .05) and increased psychological well-being (P < .05). The control group showed no statistically significant changes on these measures (P > .05). The mindfulness-based breathing and music therapy practice reduced nurses' stress and work-related strain and increased psychological well-being during the COVID-19 pandemic.

Effects of flower essences on nursing students' stress symptoms: a randomized clinical trial.

OBJECTIVE: To analyze the effects of flower essence bouquets on the signs and symptoms of stress in nursing students. METHOD: Randomized clinical trial, triple blind, with two groups, flower essence group and placebo group, carried out with 101 nursing students. The groups used the formula for 60 days at a dosage of 4 drops 4 times a day. The outcome was evaluated using the Baccaro Test and the Perceived Stress Scale applied at the beginning and at the end of the intervention. The outcome analysis was performed using the mixed effects model, with 〈 = 5% and the effect size verified by the Cohen's d test. RESULTS: There was no significant difference between the groups in stress reduction (p > 0.05). Both groups showed a reduction in scale scores (p < 0.001) with large effect size. There was an influence of the COVID-19 pandemic in the reduction of Baccaro Test scores. CONCLUSION: The intervention with flower essence therapy was not more effective than placebo in reducing stress signs and symptoms. Brazilian Registry of Clinical Trials: UTN U1111-1257-5715.

Effectiveness of auriculotherapy on stress reduction in health workers: a controlled randomized clinical trial / Efetividade da auriculoterapia na redução de estresse em trabalhadores de saúde: ensaio clínico controlado randomizado / Efectividad de la auriculoterapia para la reducción del estrés de trabajadores de la salud: ensayo clínico controlado aleatorizado

Abstract Objective: to assess the effectiveness of auriculotherapy in reducing occupational stress among Family Health Strategy workers during the COVID-19 pandemic. Method: a controlled randomized clinical trial divided into two groups, namely: auriculotherapy for stress group and placebo group. The Shapiro-Wilk test was used to assess data normality. The ANOVA test for repeated measures and the Tukey post-hoc test were applied to the group with normal samples. In turn, the Friedman and Durbin-Conover tests were employed in the group with non-normal distribution. Cohen's d index was calculated for the therapy effect size. A 95% significance level and p<0.05 were considered. Results: the auriculotherapy group presented 16.3% and 23.7% reductions in occupational stress after the third and sixth auriculotherapy sessions, with Cohen's d indices of 1.12 (large effect) and 1.82 (very large effect), respectively. Conclusion: auriculotherapy proved to be effective in reducing occupational stress among Family Health Strategy workers during the COVID-19 pandemic. It is suggested that new studies are developed both during and after the pandemic in order to improve health workers' Quality of Life. ReBEC registration: RBR - 38hjyt3.

Resumo Objetivo: avaliar a efetividade da auriculoterapia na redução do estresse ocupacional em trabalhadores de saúde da Estratégia de Saúde da Família durante a pandemia da COVID-19. Método: ensaio clínico controlado randomizado em dois grupos: grupo auriculoterapia para o estresse e grupo placebo. Foi utilizado o teste de Shapiro-Wilk para avaliar a normalidade dos dados. O teste ANOVA de medidas repetidas e o teste post-hoc Tukey foram aplicados para o grupo com amostras normais. Já o teste de Friedman e de Durbin-Conover foram utilizados no grupo com distribuição não normal. Para o tamanho do efeito da terapia, foi calculado o índice d de Cohen. Considerou-se o nível de significância de 95% e valor p<0,05. Resultados: o grupo auriculoterapia apresentou redução do estresse ocupacional de 16,3 e 23,7% após a terceira e sexta sessões de auriculoterapia, com índices d de Cohen de 1,12 (grande efeito) e 1,82 (efeito muito grande), respectivamente. Conclusão: a auriculoterapia mostrou-se efetiva na redução do estresse ocupacional em trabalhadores de saúde da Estratégia Saúde da Família durante a pandemia da COVID-19. Sugere-se que novos estudos sejam desenvolvidos durante e após a pandemia de maneira a melhorar a qualidade de vida dos trabalhadores de saúde. Registro ReBEC: RBR - 38hjyt3.

Resumen Objetivo: evaluar la efectividad de la auriculoterapia para la reducción del estrés laboral en trabajadores de salud de la Estrategia Salud de la Familia durante la pandemia de COVID-19. Método: ensayo clínico controlado aleatorizado en dos grupos: grupo auriculoterapia para el estrés y grupo placebo. Se utilizó la prueba de Shapiro-Wilk para evaluar la normalidad de los datos. Al grupo con muestras normales se les aplicó la prueba ANOVA de medidas repetidas y la prueba post-hoc de Tukey. Se utilizaron las pruebas de Friedman y Durbin-Conover en el grupo con distribución no normal. Para el tamaño del efecto de la terapia se calculó el índice d de Cohen. Se consideró un nivel de significación del 95% y un valor de p <0,05. Resultados: el grupo auriculoterapia mostró una reducción del estrés laboral de 16,3 y 23,7% después de la tercera y sexta sesión de auriculoterapia, con índices d de Cohen de 1,12 (efecto grande) y 1,82 (efecto muy grande), respectivamente. Conclusión: la auriculoterapia demostró ser eficaz para la reducción del estrés laboral en trabajadores de la salud de la Estrategia Salud de la Familia durante la pandemia de COVID-19. Se sugiere desarrollar nuevos estudios durante y después de la pandemia con el fin de mejorar la calidad de vida de los trabajadores de la salud. Registro ReBEC: RBR - 38hjyt3.

Managing job stress among teachers of children with autism spectrum disorders: A randomized controlled trial of cognitive behavioral therapy with yoga.

BACKGROUND: Job-related stress undermines occupational, personal, and organizational outcomes. Stress symptoms are common among teachers of children with autism spectrum disorders and affect the academic progress of the children. This study investigated the effectiveness of yoga-based cognitive behavioral therapy in reducing occupational stress among teachers of children with autism in Lagos states, Nigeria. METHODS: The current study adopted a group-randomized waitlist control (WLC) trial design with pre-test, posttest, and follow-up assessments. Participants included 58 teachers of children with autism in public and private special schools in Lagos state. Participants were randomly assigned to combined cognitive behavioral therapy and yoga (Y-CBT) (N = 29) and WLC (N = 29) groups. The Y-CBT group participated in a 2 hours Y-CBT program weekly for 12 weeks. Three instruments - Demographic Questionnaire, Single-Item Stress Questionnaire, and Teachers' Stress Inventory (TSI) were used to collect data. Data were collected at baseline; posttest and follow-up evaluations. Data were analyzed using means, standard deviations, t test statistics, repeated measures analysis of variance, and bar charts. RESULTS: Results revealed that all dimensions of job stress (perception of stress sources, stress manifestation, and total TSI scores) reduced significantly at posttest and follow up assessments among the Y-CBT group, compared to the WLC. CONCLUSION: It was concluded that Y-CBT modalities could help to minimize the perception of stress sources and stress manifestation as well as total TSI scores among teachers of children with autism spectrum disorders.

Yoga complemented cognitive behavioral therapy on job burnout among teachers of children with autism spectrum disorders.

BACKGROUND/OBJECTIVE: Job burnout is a syndrome of reaction to chronic job-related stress which affects overall health, limits occupational efficacy, and personal accomplishments of employees thereby thwarting organizational outcomes. Burnout symptoms are common among teachers of children with autism spectrum disorders (ASD) and affect the academic progress of the children. This study investigated the effectiveness of Yoga-based cognitive behavioral therapy (Y-CBT) in reducing occupational burnout among teachers of children with autism in Lagos States, Nigeria. METHODS: A group-randomized control-trial with immediate intervention and waitlist control groups was design was adopted. Participants included 58 teachers of children with autism in public and private special schools in the area. Participants were randomly assigned to Y-CBT (N = 29) and waitlist control (N = 29) groups. The Y-CBT group participated in a 2 hours Y-CBT program weekly for 12 weeks. Three instruments Demographic variable, Single Item Stress Questionnaire (SISQ), and Maslach Burnout Inventory-Educators' Survey (MBI-ES) were used to collect data. Data were collected at baseline; post-test and follow-up evaluations. Data were analyzed using means, standard deviations, t test statistics, repeated measures analysis of variance, and bar charts. RESULTS: Results revealed that job-burnout reduced significantly at post-test assessment among the Y-CBT group compared to the waitlisted group. The reduction in the participant was sustained across 3months follow-up evaluation. CONCLUSION: It was concluded that Y-CBT modalities could help to reduce the burnout symptoms among teachers of children with ASD.

The Effects of Mindfulness Meditation on Stress and Burnout in Nurses.

Background: Occupational burnout related to stress in the workplace is experienced by nurses who are regularly confronted with trauma, suffering, and high workloads. Burnout can negatively impact patient care and have detrimental effects on nurses' physical and mental health. Mindfulness-based stress reduction programs have been researched as a potential holistic intervention for reducing stress and burnout in nurses through cultivating present awareness, emotional regulation, and positive thinking. Purpose: This critical review of the literature explores current knowledge on the effectiveness of mindfulness meditation on stress and burnout in nurses, examines gaps in the current literature, and provides recommendations for future research on this topic. Methods: Search terms included mindfulness, meditation, mindfulness-based stress reduction , occupational stress, stress, burnout, and nurs*. Peer-reviewed research directly related to the impact of mindfulness-based stress reduction on nurses experiencing stress and/or burnout was reviewed. Findings: Findings reveal evidence that mindfulness meditation is effective in decreasing stress and burnout in nurses. Mindfulness-based interventions have been shown to significantly decrease stress, improve all aspects of burnout, and increase self-compassion and compassion satisfaction in practicing nurses. Conclusions: Mindfulness meditation has the potential to decrease stress and burnout in nurses by decreasing self-judgment and overidentification with experience, and by increasing resiliency, compassion, and emotional regulation.

Nurse spiritual self-care: A scoping review.

BACKGROUND: The health care research on spirituality has focused on patients. Less is known about the spiritual self-care of nurses who work with these patients in all types of challenging environments. Nurse spiritual self-care may be helpful in reducing workplace stress and burnout. PURPOSE: The purpose of this review was to provide a comprehensive understanding of the conceptual definitions, theory and measurement of nurse spiritual self-care as reflected in the current literature. METHODS: The review framework was aligned with the recommendations consistent with the Joanna Briggs Institute guidance for scoping reviews. FINDINGS: Ten studies were included. Three included explicit definitions and five explicitly stated theories. Five quantitative, four qualitative, and one mixed measurement of concept were found. DISCUSSION: This scoping review identified conceptualizations, theoretical frameworks, and measurements that can be foundational to future research in this area. Our paper highlights the need for further research on nurse spiritual self-care.

Mindfulness Workshops Effects on Nurses' Burnout, Stress, and Mindfulness Skills.

Burnout decreases work performance and quality of care and can result in medical errors, lower patient satisfaction, and higher rates of turnover. A study of 68 000 registered nurses showed that 35% of hospital nurses were experiencing symptoms of burnout. A systematic review identified that mindfulness-based interventions for health care professionals reduced stress and burnout and increased self-compassion and general health. However, the authors determined that more high-quality research is needed. This study examined the impact of a 4-hour workshop on burnout syndrome, perceived stress, and mindfulness skills. The objective of this study was to determine whether a 4-hour mindfulness workshop was effective in reducing burnout and perceived levels of stress and increasing mindfulness. Nurses at a Midwest academic medical center were recruited through e-mail to attend a 4-hour mindfulness workshop. Participants completed the Maslach Burnout Inventory-Human Service Survey, Perceived Stress Scale, and Cognitive and Affective Mindfulness Scale-Revised prior to the start of the workshop and 1 and 6 months after the workshop. The study design allowed for comparisons preintervention and postintervention. Of the 52 nurses who completed the baseline questionnaires, 94% were female with an average age of 38 years. Thirty-one percent completed the questionnaires at 1 month and 20 nurses at 6 months. At 1 month, nurses reported statistically significant decreased perceptions of stress (-2.31, P = .01) and emotional exhaustion (-4.78, P = .03). Mindfulness skills, personal accomplishment, and depersonalization improved but were not statistically significant. At 6 months, statistically significant findings included increased perceptions of mindfulness (2.50, P = .04), personal accomplishment (4.43, P = .04), and decreased emotional exhaustion (-6.21, P = .05). Perceptions of stress and depersonalization improved but were not statistically significant. In this study, nurses reported decreases in burnout and perceived stress and increases in mindfulness after attending a 4-hour mindfulness workshop. Further research is needed to determine the long-term impact of mindfulness-based training on nurses' burnout, stress, and mindfulness skills. The results of this study add to the body of literature that supports the benefits of mindfulness-based interventions.

EMDR in Telemental Health Counseling for Healthcare Workers Caring for COVID-19 Patients: A Pilot Study.

BACKGROUND: The COVID-19 pandemic is putting a strain on health systems around the world. Healthcare workers, on the front lines of the epidemic, are facing major and potentially traumatic stressful events, overwhelming their ability to cope and their resources. OBJECTIVE: The objective of this article will be to show how the use of the URG-EMDR protocol in a telemental health setting has proven to be feasible and effective in the treatment of a group of healthcare professionals working in nursing homes or hospital services that were highly mobilized during the acute phase of COVID-19. METHOD: 17 participants, registered nurses (N = 7) and licensed practical nurses (N = 10), were remotely treated using the URG-EMDR protocol in a single session. The assessment focused on anxiety and depressive symptoms (HAD scale) and the level of perceived disturbance (SUD). An additional evaluation of the satisfaction with the remote psychotherapy intervention was conducted. RESULTS: As the URG-EMDR protocol has already proven itself during emergency interventions, it is interesting to note that its remote use in the treatment of healthcare providers caring for COVID-19 patients allows for an improvement in the emotional state and a decrease in perceived disturbance, in a single session. This result is maintained 1 week after the intervention, despite the continued professional activities of the participants and the continuity of the event. Moreover, the remote therapy setting was judged satisfactory by the patients, even if it required adjustments and certain recommendations for practice. DISCUSSION: The remote use of the URG-EMDR protocol opens up innovative perspectives for early interventions and the prevention of the development of psychological disorders in the long term following a situation of acute stress.

Mobilizing an institutional supportive response for healthcare workers and other staff in the context of COVID-19: The Yale experience.

The burden of the COVID-19 pandemic upon healthcare workers necessitates a systematic effort to support their resilience. This article describes the Yale University and Yale New Haven Health System effort to unite several independent initiatives into a coherent integrated model for institutional support for healthcare workers. Here, we highlight both opportunities and challenges faced in attempting to support healthcare workers during this pandemic.

El Quigong en la intervención de la depresión, la ansiedad, y el estrés psicológico laboral / The Quigong in the intervention of depression, anxiety, and psychological stress at work

El impacto de los dramáticos cambios multidimensionales ocasionado por la globalización genera un proceso histórico crítico que impacta al tejido social, sometiendo a muchas poblaciones, a un deterioro de su calidad de vida y de sus posibilidades de acceso a la atención sanitaria. Asimismo están expuestos a tensiones crónicas que pueden desbordar las capacidades y mecanismos de adaptación de las personas. La Medicina Tradicional China tiene más de 5.000 años de práctica empírica y abarca cinco componentes: fitoterapia, dietética, masajes, acupuntura y el Quigong. Su rol terapéutico ha sido reconocido por la OMS, quien ha diseñado estrategias para promover su integración al sistema sanitario de todos los países. Se eligió el componente Quigong para revisar trabajos científicos donde se implementaron sus prácticas en el tratamiento de la Depresión, la Ansiedad y el Estrés psicológico laboral. Los resultados de los estudios revisados concluyeron que existen evidencias significativas de que el Quigong puede mejorar la clínica de pacientes con diagnóstico de Depresión, Ansiedad y estrés laboral. Asimismo, los autores de los trabajos realizados coinciden en la necesidad de proseguir la línea de investigación relativa a las aplicaciones del Quigong como terapia preventiva y curativa en estrés psicológico, ansiedad y depresión.

The impact of the dramatic multidimensional changes caused by globalization generates a critical historical process that impacts the social fabric, subjecting many populations to a deterioration in their quality of life and their possibilities of access to health care. They are also exposed to chronic tensions that can overwhelm people's capacities and adaptation mechanisms. Traditional Chinese Medicine has more than 5.000 years of empirical practice and includes five components: phytotherapy, dietetics, massage, acupuncture and Quigong. Its therapeutic role has been recognized by the WHO, which has designed strategies to promote its integration into the health system of all countries. The Quigong component was chosen to review scientific works where its practices were implemented in the treatment of Depression, Anxiety and Occupational Psychological Stress. The results of the studies reviewed concluded that there is significant evidence that Quigong can improve the clinic of patients diagnosed with Depression, Anxiety, and occupational stress. Likewise, the authors of the works carried out agree on the need to continue the line of research regarding the applications of Quigong as preventive and curative therapy in psychological stress, anxiety and depression.

Effect of a Brief Mindfulness-Based Program on Stress in Health Care Professionals at a US Biomedical Research Hospital: A Randomized Clinical Trial.

Importance: Stress among health care professionals is well documented. The use of mindfulness-based interventions to reduce stress has shown promising results; however, the time commitment of typical programs can be a barrier to successful implementation in health care settings. Objective: To determine the efficacy and feasibility of a brief mindfulness-based program to reduce stress during work hours among health care professionals. Design, Setting, and Participants: This intent-to-treat randomized clinical trial was conducted among full-time health care professionals at the Clinical Center at the National Institutes of Health in Bethesda, Maryland, between September 2017 and May 2018. Participants were randomized to receive mindfulness-based self-care (MBSC) training or life-as-usual control. Data were analyzed from June 2018 to January 2020. Interventions: The MBSC intervention included 5 weekly, 1.5-hour in-class mindfulness practice sessions. Main Outcomes and Measures: Stress level was the primary outcome, assessed with the Perceived Stress Scale 10-Item version. Secondary outcomes included anxiety, burnout, positive and negative affect, mindfulness (trait and state), and self-care. Assessments were taken at baseline and at the end of the intervention (week 5) in the intervention and control groups, and at follow-up (week 13) in the intervention group to test for a maintenance effect. A postprogram evaluation was also obtained. Results: Of 82 randomized participants, 78 who completed the study at week 5 were included in the modified intent-to-treat analysis (median [interquartile range] age, 32 [23-48] years; 65 [83%] women), including 43 participants in the MBSC group and 35 participants in the control group. At the end of the intervention, compared with the control group, the MBSC group had reduced levels of stress (mean [SD] score, 17.29 [5.84] vs 18.54 [6.30]; P = .02) and anxiety (mean [SD] score, 2.58 [1.52] vs 4.23 [1.73]; P < .001), and improved positive affect (mean [SD] score, 35.69 [7.12] vs 31.42 [7.27]; P < .001), state mindfulness (mean [SD] score, 3.74 [1.18] vs 2.78 [1.16]; P < .001), and mindful self-care (mean [SD] score, 7.29 [2.44] vs 5.54 [2.77]; P < .001). Burnout, negative affect, and trait mindfulness levels did not differ between groups. Changes within the MBSC group through follow-up included sustained reductions in stress (change, -6.14; 95% CI, -7.84 to -4.44; P < .001), anxiety (change, -1.46; 95% CI, -1.97 to -0.94; P < .001), trait mindfulness (change, 0.63; 95% CI, 0.36 to 0.90; P < .001), and state mindfulness (change, 1.89; 95% CI, 1.39 to 2.39; P < .001). Conclusions and Relevance: This randomized clinical trial found that this brief mindfulness-based intervention was an effective and feasible means to reduce stress in health care professionals. Larger studies are needed to assess the effects on clinical care and patient outcomes. Trial Registration: ClinicalTrials.gov Identifier: NCT03781336.

A study protocol for a cluster randomised controlled trial on mindfulness-based stress reduction: studying effects of mindfulness-based stress reduction and an additional organisational health intervention on mental health and work-related perceptions of teachers in Dutch secondary vocational schools.

BACKGROUND: Dutch teachers in secondary vocational schools suffer from stress and burnout complaints that can cause considerable problems at work. This paper presents a study design that can be used to evaluate the short-term and long-term effectiveness of mindfulness-based stress reduction (MBSR), a person-focused intervention, both within and outside of the context of an additional organisational health intervention. METHODS: The proposed study comprises a cluster randomised controlled trial that will be conducted in at least three secondary vocational schools, to which teachers will be recruited from three types of courses: Care, Technology, and Economy. The allocation of the intervention programme to the participating schools will be randomised. The teachers from each school will be assigned to intervention group 1 (IG 1), intervention group 2 (IG 2), or the waiting list group (WG). IG 1 will receive MBSR training and IG 2 will receive MBSR training combined with an additional organisational health intervention. WG, that is the control group, will receive MBSR training one year later. The primary outcome variable of the proposed study is mindfulness, which will be measured using the Dutch version of the Five Facet Mindfulness Questionnaire (FFMQ-NL). In the conceptual model, the effects of teachers' mindfulness resulting from the intervention programmes (MBSR training and MBSR training combined with an additional organisational health intervention) will be related to salient (secondary outcome) variables: mental health outcomes (e.g., burnout, work engagement), work performance, work-related perceptions (job demands and job resources), and personal competencies (e.g., occupational self-efficacy). Data will be collected before (T0) and immediately after the MBSR training (T1), and 3 (T2) and 9 months (T3) after the training. The power analysis revealed a required sample size of 66 teachers (22 in each group). DISCUSSION: The proposed study aims to provide insight into (1) the short-term and long-term effects of MBSR on teachers' mental health, (2) the possible enhancing effects of the additional organisational health intervention, and (3) the teachers' experiences with the interventions (working mechanisms, steps in the mindfulness change process). Strengths of this study design are the use of both positive and negative outcomes, the wide range of outcomes, both outcome and process measures, longitudinal data, mixed methods, and an integral approach. Although the proposed study protocol may not address all weaknesses of current studies (e.g., self-selection bias, self-reporting of data, the Hawthorne effect), it is innovative in many ways and can be expected to make important contributions to both the scientific and practical debate on how to beat work-related stress and occupational burnout, and on how to enhance work engagement and work performance. TRIAL REGISTRATION: Dutch Trial Register (www.trialregister.nl): NL5581. Registered on 6 July 2016.

Determining the feasibility and effectiveness of brief online mindfulness training for rural medical students: a pilot study.

BACKGROUND: We sought to determine the feasibility and effectiveness of a mindfulness training program, delivered online to medical students at a Rural Clinical School. METHODS: An 8-week online training program was delivered to penultimate-year medical students at an Australian Rural Clinical School during 2016. Using a mixed methods approach, we measured the frequency and duration of participants' mindfulness meditation practice, and assessed changes in their perceived stress, self-compassion and compassion levels, as well as personal and professional attitudes and behaviours. RESULTS: Forty-seven participants were recruited to the study. 50% of participants were practising mindfulness meditation at least weekly by the end of the 8-week program, and 32% reported practising at least weekly 4 months following completion of the intervention. There was a statistically significant reduction in participants' perceived stress levels and a significant increase in self-compassion at 4-month follow-up. Participants reported insights about the personal and professional impact of mindfulness meditation training as well as barriers to practice. CONCLUSIONS: The results provide preliminary evidence that online training in mindfulness meditation can be associated with reduced stress and increased self-compassion in rural medical students. More rigorous research is required to establish concrete measures of feasibility of a mindfulness meditation program.