Effects of Mindfulness-Based Stress Reduction on employees’ mental health: A systematic review

RESEARCH ARTICLE Effects of Mindfulness-Based Stress Reduction on employees’ mental health: A systematic review Math Janssen1*, Yvonne Heerkens1, Wietske Kuijer1, Beatrice van der Heijden2,3,4, Josephine Engels1 1 Occupation & Health Research Group, HAN University of Applied Sciences, Nijmegen, the Netherlands, 2 Institute for Management Research, Radboud University, Nijmegen, the Netherlands, 3 Open University of the Netherlands, Heerlen, the Netherlands, 4 Kingston University, London, United Kingdom a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 * Abstract Objectives OPEN ACCESS Citation: Janssen M, Heerkens Y, Kuijer W, van der Heijden B, Engels J (2018) Effects of MindfulnessBased Stress Reduction on employees’ mental health: A systematic review. PLoS ONE 13(1): e0191332. https://doi.org/10.1371/journal. pone.0191332 Editor: Klaus Ebmeier, University of Oxford, UNITED KINGDOM The purpose of this exploratory study was to obtain greater insight into the effects of Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT) on the mental health of employees. Methods Using PsycINFO, PubMed, and CINAHL, we performed a systematic review in October 2015 of studies investigating the effects of MBSR and MBCT on various aspects of employees’ mental health. Studies with a pre-post design (i.e. without a control group) were excluded. Received: March 10, 2017 Results Accepted: January 3, 2018 24 articles were identified, describing 23 studies: 22 on the effects of MBSR and 1 on the effects of MBSR in combination with some aspects of MBCT. Since no study focused exclusively on MBCT, its effects are not described in this systematic review. Of the 23 studies, 2 were of high methodological quality, 15 were of medium quality and 6 were of low quality. A meta-analysis was not performed due to the emergent and relatively uncharted nature of the topic of investigation, the exploratory character of this study, and the diversity of outcomes in the studies reviewed. Based on our analysis, the strongest outcomes were reduced levels of emotional exhaustion (a dimension of burnout), stress, psychological distress, depression, anxiety, and occupational stress. Improvements were found in terms of mindfulness, personal accomplishment (a dimension of burnout), (occupational) self-compassion, quality of sleep, and relaxation. Published: January 24, 2018 Copyright: © 2018 Janssen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper and its supporting information files. Funding: The research was funded by a grant of NWO, Dutch Organization for Scientific Research (Den Haag, The Netherlands), File number: 023.007.051, www.nwo.nl. MJ received the funding. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Conclusion The results of this systematic review suggest that MBSR may help to improve psychological functioning in employees. PLOS ONE | https://doi.org/10.1371/journal.pone.0191332 January 24, 2018 1 / 37 MBSR and employees’ mental health: A systematic review Competing interests: The authors have declared that no competing interests exist. Introduction Given their potential benefits for physical and mental health as well as social relations [1, 2], interest is increasing internationally in mindfulness interventions in the workplace [3]. This is also true for the Netherlands, where many work environments are characterized by high productivity targets, overtime, high work pressure, customer aggression, temporary employment contracts, continuous organizational changes, job uncertainty, employee shortages, and little autonomy [4]. Mindfulness is related to meditation, but the terms are not synonymous. Moreover Mindfulness consists of formal meditation exercises (e.g., paying attention to the body, lying on the ground, or walking slowly with a sense of awareness of one’s surroundings) as well as informal exercises (e.g., paying full attention to what one is doing or experiencing at a certain moment) [5]. Mindfulness interventions vary in delivery mode (face-to-face, online) and target population (clinical populations with major depression, anxiety disorders, borderline personality disorders, chronic pain, or eating disorders [6] and non-clinical populations such as students and employees seeking to enhance their subjective well-being). They can range in duration from long term (e.g., eight weekly 2.5-hour sessions, eight-hour daylong retreats, one 2.5-hour session per month for 10 months [7]) to short term (e.g., four weekly 30-minute sessions [8]). The intensity of interventions can vary too, from high dose (e.g., eight weekly 3-hour sessions and 45 minutes of daily mindfulness practice [9]) to low dose (e.g., 30-minute sessions and 15–20 minutes of daily mindfulness practice [8]). Mindfulness interventions in the workplace target workplace functioning: reducing stress and improving decision-making, productivity, resilience, interpersonal communication, organizational relationships, perspective-taking, and self-care [10]. This great diversity in mindfulness interventions makes it difficult to compare the efficacy of such interventions. There are many hypotheses about the mechanisms underlying mindfulness practice that lead to different mental health outcomes. One hypothesis is that exposure to or willingness to experience difficult emotions (e.g., anxiety, distress, anger), awareness of these emotions, and observation of these emotions allow people to dis-identify with and better regulate difficult emotions [5, 11]. Another is that awareness of thoughts, awareness of bodily sensations, and self-compassion help people to deal with stress [5]. This systematic review will evaluate the effects of two types of group-based mindfulness interventions—Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT)–on employees’ mental health. Definition of mindfulness The concept of mindfulness has existed in Buddhist traditions for 2,500 years. Mindfulness meditation is an attitude and a method for reducing personal suffering and developing insight, compassion, and wisdom [12]. In contemporary psychology, mindfulness is seen as a means of increasing awareness and responding optimally to mental processes that contribute to emotional distress and maladaptive behavior [6]. Many definitions of mindfulness have been posited in the psychological literature [6, 13– 15]. Marlatt and Kristeller [13] described mindfulness as “bringing one’s complete attention to the present experience on a moment-to-moment basis.” According to Brown and Ryan [14], “mindfulness can be considered an enhanced attention to and (...truncated)