The Effect of Mindfulness-Based Training on Stress, Anxiety, Depression, and Job Satisfaction Among Ward Nurses: A Randomized Control Trial

J Nurs Manag. 2020 May 20. doi: 10.1111/jonm.13049.

Abstract

Aim: To assess the effect of a 4-week Mindfulness-Based Training intervention on improving stress, anxiety, depression, and job satisfaction among ward nurses.

Background: Previous literature showed that mindfulness training is useful for helping nurses cope with stress.

Method: Nurses who have mild to moderate levels of stress, anxiety, and depression identified from a teaching hospital were invited to a randomized control trial. The intervention group had a 2-hour Mindfulness-Based Training workshop, followed by 4 weeks of guided self-practice Mindfulness-Based Training website. Both the intervention group (n=118) and the control group (n=106) were evaluated pre- and post-intervention, and 8 weeks later (follow-up) using the Depression, Anxiety, and Stress Scale-21, Job Satisfaction Scale, and Mindful Attention Awareness Scale.

Results: There was a significant effect over time on stress, anxiety, depression and mindful level (p˂.05). Regarding the difference between the groups and interaction between time and group, there was a significant effect for anxiety (p=.037 p=.008) and job satisfaction (p˂.001, p=0,40) respectively, with moderate effect size for anxiety reduction (0.465) and small for job satisfaction increment (0.221).

Conclusion: Mindfulness-Based Training is effective in improving anxiety and job satisfaction among nurses.

Clinical implications for nursing management: Mindfulness-Based Training can be included as hospital policy to reduce anxiety and increase job satisfaction among nurses.

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Mindfulness Moments for Clinicians in the Midst of a Pandemic

Ir J Psychol Med. 2020 May 21;1-4. doi: 10.1017/ipm.2020.59.

Abstract

Clinicians are routinely subjected to intense and stressful working environments, and the current COVID-19 crisis increases their risk of psychological distress. Mindfulness has been shown to improve life satisfaction, resilience to stress, self-compassion, compassion and general well-being in healthcare workers.

Based on their clinical experience, the authors present mindfulness moments for clinicians (MMFC), a selection of short, simple and accessible mindfulness practices to promote resilience and compassion among clinicians working in this pandemic.

The practices can be used on the job and are accessible to both novice and experienced meditators. Most of these practices are extracted from evidence-based mindfulness programmes.

Further research is indicated to assess the effectiveness of using MMFC to support clinicians in their work and to promote resilience.

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Stress-reducing Effects of a Brief Mindfulness Intervention in Palliative Care: Results From a Randomised, Crossover Study

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Eur J Cancer Care (Engl). 2020 May 21;e13249. doi: 10.1111/ecc.13249.

Abstract

Objective: Mindfulness-based interventions are a widely used and highly accepted adjunct treatment in oncology. Due to a paucity of research in advanced cancer and other terminal illnesses, we aimed to evaluate the stress-reducing effects of a brief, standardised mindfulness intervention for use in palliative care.

Methods: This study was a randomised, crossover trial where patients participated in both a single mindfulness intervention and a resting state control condition. The order of the conditions was randomised. Study outcomes encompassed self-report data on stress and well-being and measures of heart rate variability. All outcome data were measured at four times per day.

Results: Forty-two patients participated in this study. We found significantly stronger reductions in self-rated stress and mean heart rate as well as an increase in heart rate variability after the mindfulness intervention. Psychophysiological effects were strongest in the immediate pre- to post-intervention comparison, while the effect on subjective stress persisted after 20 to 40 min. No significant differences were found for self-rated well-being.

Conclusions: Despite the rather small magnitude of effects, the brief mindfulness intervention showed to be effective and accepted by patients in very advanced stages of a disease and could be offered by trained healthcare professionals in palliative care.

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Effects of Mindfulness-Based Stress Reduction on Anxiety Symptoms in Young People: A Systematic Review and Meta-Analysis

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Psychiatry Res. 2020 May 7;289:113002. doi: 10.1016/j.psychres.2020.113002.

Abstract

In this study, we evaluated the efficacy of mindfulness-based stress reduction (MBSR) for young people with anxiety symptoms . We used many databases, including PubMed, PsycINFO, Web of Science, EMBASE, CINAHL and Cochrane Library (from inception to May 2019). We included randomized controlled trials (RCTs) comparing MBSR with various control conditions, including didactic lecture course, health education, treatment as usual, didactic seminar and cognitive behavioral program in young people with anxiety symptoms . Finally, we selected fourteen studies comprising 1489 participants comparing with control conditions.

The meta-analysis suggested that MBSR significantly reduced anxiety symptoms compared to control conditions at post-treatment (Standardized Mean Difference, SMD = -0.14, 95% CI -0.24 to -0.04). However, the effect of MBSR on anxiety symptoms in young people may be affected by different intervention duration, especially the significance in a short-term intervention (less than 8 weeks). In addition, the meta-analysis indicated publication bias for anxiety symptoms . Using the trim-and-fill method, we found the adjusted standardized mean difference, which indicated that MBSR was still significantly superior to the other control conditions. The sensitivity analysis showed that the result was reliable.

Current evidence indicates MBSR has superior efficacy compared with control conditions in treating young people with anxiety symptoms . Based on this, we suggest there is a significant effect of MBSR on young people with anxiety symptoms, especially the effects of long-term intervention for future studies.

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Holistic Nursing in Practice: Mindfulness-Based Yoga as an Intervention to Manage Stress and Burnout

 

J Holist Nurs. 2020 May 27;898010120921587. doi: 10.1177/0898010120921587.

Abstract

Purpose: Effects of a mindfulness-based (MB) yoga practice on stress, burnout, and indicators of well-being among nurses and health care professionals (HCPs).

Design: A randomized controlled trial, 80 HCPs assigned to either MB yoga intervention or control group.

Method: The MB yoga intervention group (n = 41) attended weekly yoga classes and practiced yoga independently. The control group (n = 39) did not receive the yoga intervention. Study participants completed pre- and postintervention questionnaires, instruments included (a) Perceived Stress Scale; (b) Maslach Burnout Inventory; (c) Vitality subscale of the Medical Outcomes Study Short Form-36; (d) Global Sleep Quality item, (e) Mindfulness Awareness Survey, and (f) subscale of the Brief Serenity Scale. Diurnal salivary cortisol and blood pressure were assessed pre and postintervention.

Results: Significant improvements (p < .01) noted in MB yoga compared with control for self-reported factors, including stress (Perceived Stress Scale), burnout (Maslach Burnout Inventory), vitality (Medical Outcomes Study Short Form-36), sleep (GSQ), serenity/inner haven (IH), and mindfulness (Mindfulness Awareness Survey). Diurnal cortisol slopes and blood pressure were not significantly improved.

Conclusion: The MB yoga intervention had a statistically significant effect on the health and well-being of nurses and HCPs, most specifically for measures of stress; perceived stress, burnout, vitality, sleep quality, serenity, and mindfulness.

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Influence of a Multidisciplinary Program of Diet, Exercise, and Mindfulness on the Quality of Life of Stage IIA-IIB Breast Cancer Survivors

Integr Cancer Ther. Jan-Dec 2020;19:1534735420924757. doi: 10.1177/1534735420924757.

Abstract

Background: Integrative oncology has proven to be a useful approach to control cancer symptoms and improve the quality of life (QoL) and overall health of patients, delivering integrated patient care at both physical and emotional levels. The objective of this randomized trial was to evaluate the effects of a triple intervention program on the QoL and lifestyle of women with breast cancer.

Methods: Seventy-five survivors of stage IIA-IIB breast cancer were randomized into 2 groups. The intervention group (IG) received a 6-month dietary, exercise, and mindfulness program that was not offered to the control group (CG). Data were gathered at baseline and at 6 months postintervention on QoL and adherence to Mediterranean diet using clinical markers and validated questionnaires. Between-group differences at baseline and 3 months postintervention were analyzed using Student’s t test for related samples and the Wilcoxon and Mann-Whitney U tests.

Results: At 6 months postintervention, the IG showed significant improvements versus CG in physical functioning (p = .027), role functioning (p = .028), and Mediterranean diet adherence (p = .02) and a significant reduction in body mass index (p = .04) and weight (p = .05), with a mean weight loss of 0.7 kg versus a gain of 0.55 kg by the CG (p = .05). Dyspnea symptoms were also increased in the CG versus IG (p = .066).

Conclusions: These results demonstrate that an integrative dietary, physical activity, and mindfulness program enhances the QoL and healthy lifestyle of stage IIA-IIB breast cancer survivors. Cancer symptoms may be better managed by the implementation of multimodal rather than isolated interventions.

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Mindfulness-based Cognitive Therapy for Bipolar Disorder: A Systematic Review and Meta-Analysis

Psychiatry Res. 2020 May 25;290:113116. doi: 10.1016/j.psychres.2020.113116.

Abstract

Background: Mindfulness-based cognitive therapy (MBCT) is an increasingly popular treatment for major depression and anxiety disorder, but has shown inconsistent efficacy for bipolar disorder (BD). Therefore, we conducted a meta-analysis to assess the general efficacy of MBCT for BD.

Methods: Ten studies were identified that fulfilled the current inclusion criteria, including three controlled and seven uncontrolled studies. The effects of MBCT on depression, anxiety, mania, stress, mindfulness ability, and emotional regulation were assessed by comparing psychometric scale scores within groups (pre- vs. post-intervention) across trials as well as between groups (control vs. MBCT) across controlled trials.

Results: Within-group comparison revealed a reduction in symptoms of depression (g = 0.37, 95%CI = 0.09-0.64, P = 0.009) and anxiety (g = 0.45, 95%CI =0.16-0.75, P = 0.002) following treatment compared to baseline. Stress symptoms were also significantly reduced (g = 0.39, 95%CI = 0.09-0.69, P = 0.01), mindfulness ability (g = 0.63, 95%CI = 0.39-0.87, P<0.00001) and emotion regulation (g = 0.62, 95%CI=0.14-1.10, P = 0.01) were significantly improved compared to baseline. However, symptoms of mania were not alleviated (g=-0.26, 95%CI=-1.43-0.91, P = 0.66). Subgroup analysis indicated that symptoms of depression and anxiety were still significantly improved at 3 months post-intervention (g = 0.46, 95%CI = 0.13-0.80, P = 0.006 and g = 0.57, 95%CI = 0.21-0.94, P = 0.002, respectively) but not at 12 months (g = 0.04, 95%CI = -0.29-0.37, P = 0.82 and g = 0.17, 95%CI =-0.16-0.50, P = 0.31). In between-groups analysis of controlled studies, MBCT significantly reduced depressive symptoms (g = 0.3, 95%CI =-0.05-0.65, P = 0.09) but not anxiety symptoms (g = 0.51, 95%CI = -0.20-1.22, P = 0.16).

Conclusion: Mindfulness-based cognitive therapy appears effective for alleviation of depression and anxiety among BD patients, possibly by improving emotional regulation and mindfulness abilities. However, efficacy appears time-limited and inconsistent, necessitating additional larger-scale studies and the development of post-intervention programs for sustained efficacy.

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Promoting Resilience in Medicine: The Effects of a Mind-Body Medicine Elective to Improve Medical Student Well-being

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Glob Adv Health Med. 2020 May 21;9:2164956120927367. doi: 10.1177/2164956120927367. eCollection 2020.

Abstract

Background: Poor mental health is common among medical students. In response, some medical schools have implemented wellness interventions. The University of Florida College of Medicine recently introduced a mind-body medicine elective, Promoting Resilience in Medicine (PRIMe), based on the Georgetown University School of Medicine course. PRIMe teaches meditation techniques including mindfulness, biofeedback, art, and journaling in a faculty-facilitated small group setting.

Methods: First- and second-year medical students (N = 24) who participated in the 11-week elective (3 cohorts over 2 years) completed anonymous surveys regarding their experiences. Measures included the Freiberg Mindfulness Inventory (FMI), Perceived Stress Scale-10 item (PSS-10), and a series of multiple-choice and free-response questions developed for this study. The study was approved by the University of Florida Institutional Review Board.

Results: Among students with available pre- and posttest scores, the average PSS-10 score at pretest was 14.4 (SD = 6.17, range = 3-26) and at posttest was 14.2 (SD = 4.17, range = 8-22), suggesting no change in perceived stress. However, average scores on the FMI improved from 34.4 (SD = 6.10, range = 24-47) at pretest to 41.8 (SD = 4.81, range = 33-49) at posttest. The overwhelming majority of participants (95.8%) described the course as “definitely” worth it. The greatest improvements were noted in mindfulness, relationships with peers, and having a safe place in medical school to receive support. Learning mindfulness/meditation skills and increasing social support were noted as the primary factors impacting student well-being.

Conclusion: A mind-body medicine elective course may be a practical method to improve medical student well-being and improve ability to care for patients. Future studies should include follow-up testing to determine if benefits are sustained over time. In addition, more work is needed to understand the cost-benefit of providing instruction in mind-body medicine techniques to all medical students.

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Online Yoga to Reduce Post Traumatic Stress in Women Who Have Experienced Stillbirth: A Randomized Control Feasibility Trial

BMC Complement Med Ther. 2020 Jun 5;20(1):173. doi: 10.1186/s12906-020-02926-3.

Abstract

Background: About 1 in every 150 pregnancies end in stillbirth. Consequences include symptoms of post traumatic stress disorder (PTSD), depression, and anxiety. Yoga has been used to treat PTSD in other populations and may improve health outcomes for stillbirth mothers. The purpose of this study was to determine: (a) feasibility of a 12-week home-based, online yoga intervention with varying doses; (b) acceptability of a “stretch and tone” control group; and (c) preliminary efficacy of the intervention on reducing symptoms of PTSD, anxiety, depression, perinatal grief, self-compassion, emotional regulation, mindfulness, sleep quality, and subjective health.

Methods: Participants (N = 90) were recruited nationally and randomized into one of three groups for yoga or exercise (low dose (LD), 60 min per week; moderate dose (MD), 150 min per week; and stretch-and-tone control group (STC)). Baseline and post-intervention surveys measured main outcomes (listed above). Frequency analyses were used to determine feasibility. Repeated measures ANCOVA were used to determine preliminary efficacy. Multiple regression analyses were used to determine a dose-response relationship between minutes of yoga and each outcome variable.

Results: Over half of participants completed the intervention (n = 48/90). Benchmarks (≥70% reported > 75% satisfaction) were met in each group for satisfaction and enjoyment. Participants meeting benchmarks (completing > 90% of prescribed minutes 9/12 weeks) for LD and MD groups were 44% (n = 8/18) and 6% (n = 1/16), respectively. LD and MD groups averaged 44.0 and 77.3 min per week of yoga, respectively. The MD group reported that 150 prescribed minutes per week of yoga was too much. There were significant decreases in PTSD and depression, and improvements in self-rated health at post-intervention for both intervention groups. There was a significant difference in depression scores (p = .036) and grief intensity (p = .009) between the MD and STC groups. PTSD showed non-significant decreases of 43% and 56% at post-intervention in LD and MD groups, respectively (22% decrease in control).

Conclusions: This was the first study to determine the feasibility and preliminary efficacy of an online yoga intervention for women after stillbirth. Future research warrants a randomized controlled trial.

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The Effects of Mindfulness-Based Cognitive Therapy on Risk and Protective Factors of Depressive Relapse – A Randomized Wait-List Controlled Trial

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BMC Psychol. 2020 Jun 5;8(1):57. doi: 10.1186/s40359-020-00417-1.

Abstract

Background: The aim of this randomized wait-list controlled trial was to explore the effects of Mindfulness-Based Cognitive Therapy (MBCT) on risk and protective factors for depressive relapse within the domains of cognition, emotion and self-relatedness.

Methods: Sixty-eight individuals with recurrent depressive disorder were randomized to MBCT or a wait-list control condition (WLC).

Results: Completers of MBCT (N = 26) improved significantly on measures assessing risk and protective factors of recurrent depression compared to WLC (N = 30) on measures of rumination (d = 0.59, p = .015), emotion regulation (d = 0.50, p = .028), emotional reactivity to stress (d = 0.32, p = .048), self-compassion (d = 1.02, p < .001), mindfulness (d = 0.59, p = .010), and depression (d = 0.40, p = .018). In the Intention To Treat sample, findings were attenuated, but there were still significant results on measures of rumination, self-compassion and depression.

Conclusions: Findings from the present trial contribute to evidence that MBCT can lead to reduction in risk factors of depressive relapse, and strengthening of factors known to be protective of depressive relapse. The largest changes were found in the domain of self-relatedness, in the form of large effects on the participants’ ability to be less self-judgmental and more self-compassionate.

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