Mindfulness-Based Stress Reduction for Residents: A Randomized Controlled Trial

Journal of General Internal Medicine, Dec 2017

Background Burnout is highly prevalent in residents. No randomized controlled trials have been conducted measuring the effects of Mindfulness-Based Stress Reduction (MBSR) on burnout in residents. Objective To determine the effectiveness of MBSR in reducing burnout in residents. Design A randomized controlled trial comparing MBSR with a waitlist control group. Participants Residents from all medical, surgical and primary care disciplines were eligible to participate. Participants were self-referred. Intervention The MBSR consisted of eight weekly 2.5-h sessions and one 6-h silent day. Main Measures The primary outcome was the emotional exhaustion subscale of the Dutch version of the Maslach Burnout Inventory–Human Service Survey. Secondary outcomes included the depersonalization and reduced personal accomplishment subscales of burnout, worry, work–home interference, mindfulness skills, self-compassion, positive mental health, empathy and medical errors. Assessment took place at baseline and post-intervention approximately 3 months later. Key Results Of the 148 residents participating, 138 (93%) completed the post-intervention assessment. No significant difference in emotional exhaustion was found between the two groups. However, the MBSR group reported significantly greater improvements than the control group in personal accomplishment (p = 0.028, d = 0.24), worry (p = 0.036, d = 0.23), mindfulness skills (p = 0.010, d = 0.33), self-compassion (p = 0.010, d = 0.35) and perspective-taking (empathy) (p = 0.025, d = 0.33). No effects were found for the other measures. Exploratory moderation analysis showed that the intervention outcome was moderated by baseline severity of emotional exhaustion; those with greater emotional exhaustion did seem to benefit. Conclusions The results of our primary outcome analysis did not support the effectiveness of MBSR for reducing emotional exhaustion in residents. However, residents with high baseline levels of emotional exhaustion did appear to benefit from MBSR. Furthermore, they demonstrated modest improvements in personal accomplishment, worry, mindfulness skills, self-compassion and perspective-taking. More research is needed to confirm these results.

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Mindfulness-Based Stress Reduction for Residents: A Randomized Controlled Trial

Mindfulness-Based Stress Reduction for Residents: A Randomized Controlled Trial Hanne Verweij 2 3 Hiske van Ravesteijn 2 3 Madelon L. M. van Hooff 1 2 Antoine L. M. Lagro-Janssen 0 2 Anne E. M. Speckens 2 3 0 Department of Primary and Community Care, Unit Gender and Womens' Health, Radboud University Medical Center , Nijmegen , The Netherlands 1 Behavioural Science Institute, Radboud University , Nijmegen , The Netherlands 2 Trial Registration: 3 Department of Psychiatry, Radboud University Medical Center , Nijmegen , The Netherlands BACKGROUND: Burnout is highly prevalent in residents. No randomized controlled trials have been conducted measuring the effects of Mindfulness-Based Stress Reduction (MBSR) on burnout in residents. OBJECTIVE: To determine the effectiveness of MBSR in reducing burnout in residents. DESIGN: A randomized controlled trial comparing MBSR with a waitlist control group. PARTICIPANTS: Residents from all medical, surgical and primary care disciplines were eligible to participate. Participants were self-referred. INTERVENTION: The MBSR consisted of eight weekly 2.5-h sessions and one 6-h silent day. MAIN MEASURES: The primary outcome was the emotional exhaustion subscale of the Dutch version of the Maslach Burnout Inventory-Human Service Survey. Secondary outcomes included the depersonalization and reduced personal accomplishment subscales of burnout, worry, work-home interference, mindfulness skills, selfcompassion, positive mental health, empathy and medical errors. Assessment took place at baseline and postintervention approximately 3 months later. KEY RESULTS: Of the 148 residents participating, 138 (93%) completed the post-intervention assessment. No significant difference in emotional exhaustion was found between the two groups. However, the MBSR group reported significantly greater improvements than the control group in personal accomplishment (p = 0.028, d = 0.24), worry (p = 0.036, d = 0.23), mindfulness skills (p = 0.010, d = 0.33), self-compassion (p = 0.010, d = 0.35) and perspective-taking (empathy) (p = 0.025, d = 0.33). No effects were found for the other measures. Exploratory moderation analysis showed that the intervention outcome was moderated by baseline severity of emotional exhaustion; those with greater emotional exhaustion did seem to benefit. CONCLUSIONS: The results of our primary outcome analysis did not support the effectiveness of MBSR for reducing emotional exhaustion in residents. However, residents with high baseline levels of emotional exhaustion did appear to benefit from MBSR. Furthermore, they demonstrated modest improvements in personal accomplishment, worry, mindfulness skills, self-compassion and perspective-taking. More research is needed to confirm these results. emotional exhaustion; burnout; residents; mindfulness; randomized controlled trial INTRODUCTION Residency is a particularly demanding and challenging period, and a peak time for distress.1,2 Residents are confronted with a high workload and stressful situations. There is a great deal of responsibility for patients, but often a lack of control and autonomy.3This can lead to burnout, especially when combined with personal characteristics such as perfectionism, self-judgment and poor emotional regulation.4 Burnout is defined as a work-related syndrome characterized by three principal components: emotional exhaustion, depersonalization and reduced personal accomplishment.4 In the Netherlands, approximately one fifth of residents have moderate to severe burnout symptoms.5 In other countries, these numbers are even higher, ranging from 27% to 82%.1,6,7 Burnout can lead to depression, suicidal thoughts, suboptimal patient care and medical errors.8–11 Given its considerable impact on both their own well-being and the quality of patient care, it is worrying that physicians often do not seek professional help for themselves.12 Research on interventions to prevent or reduce resident burnout is scarce.2 A review and meta-analysis indicated that cognitive, behavioral and mindfulness-based approaches may contribute to lower levels of burnout among physicians.13 In fact, mindfulness has been reported to be helpful not only in reducing burnout but also in promoting well-being and quality of patient care among healthcare professionals.13–15 Mindfulness is defined as intentionally paying attention to the present moment in a non-judgmental way.16 Its application as an intervention within healthcare emerged in the 1970s with the 8-week group-based Mindfulness-Based Stress Reduction (MBSR) program. MBSR was initially developed for patients with chronic somatic conditions but is currently offered more broadly, including both patients and healthy individuals.16 Although mindfulness has been taught for centuries as part of Buddhist tradition, the meditation practices taught in MBSR are psycho-educational and secular.16,17 MBSR has been found to reduce symptoms of depression and anxiety and to improve quali (...truncated)


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Hanne Verweij PhD, Hiske van Ravesteijn MD, PhD, Madelon L. M. van Hooff PhD, Antoine L. M. Lagro-Janssen MD, PhD, Anne E. M. Speckens MD, PhD. Mindfulness-Based Stress Reduction for Residents: A Randomized Controlled Trial, Journal of General Internal Medicine, 2017, pp. 1-8, DOI: 10.1007/s11606-017-4249-x