Maintenance of Effects and Correlates of Changes Following Mindfulness for Interdisciplinary Health Care Professional Students

Sarah Ellen Braun, Samantha N Mladen, Christina M Luberto, Patricia Anne Kinser, Sarah Ellen Braun, Samantha N Mladen, Christina M Luberto, Patricia Anne Kinser

Abstract

Objectives: To evaluate long-term outcomes after an 8-week mindfulness intervention, Mindfulness for Interdisciplinary Health Care Professionals (MIHP), and investigate relationships between outcomes overtime.

Design/methods: In this single-arm study, 35 participants received MIHP and completed measures of burnout, perceived stress, activity impairment, and dispositional mindfulness at baseline, post-MIHP, and a 3-month follow-up. Changes over time were evaluated using repeated-measures analysis of variance (ANOVA) and reliable change indices (RCIs). Then, correlations between dispositional mindfulness and distress/impairment outcomes were evaluated.

Results: At follow-up, aspects of burnout and several mindfulness skills demonstrated maintained improvements. RCIs showed that a higher percentage of participants improved on all outcomes at each time period than declined-all outcomes showed little to no deterioration. However, most participants did not reliably change, and this was more pronounced at the follow-up. Changes in two mindfulness skills (acting with awareness and nonjudging of inner experience) were consistently negatively correlated with distress and impairment outcomes.

Conclusions: Acquired mindfulness skills during MIHP were maintained at the follow-up. RCI analyses demonstrated that MIHP may protect against worsening stress and burnout during training. Two mindfulness skills, acting with awareness and nonjudging of inner experience, showed potential mechanistic effects on work-relevant outcomes. Booster sessions to encourage maintained mindfulness practices and skills should be investigated in future trials. This study was registered on clinicaltrials.gov (#NCT03403335) on January 11, 2018.

Keywords: RCI; activity impairment; burnout; health care professional students; mindfulness; stress.

Conflict of interest statement

No competing financial interests exist.

© Sarah Ellen Braun et al., 2022; Published by Mary Ann Liebert, Inc.

Figures

FIG. 1.
FIG. 1.
CONSORT flow diagram. LTFU, lost to follow-up; MIHP, Mindfulness for Interdisciplinary Health Care Professionals.

References

    1. Dyrbye L, Shanafelt T. A narrative review on burnout experienced by medical students and residents. Med Educ 2016;50:132–149.
    1. Bullock G, Kraft L, Amsden K, et al. . The prevalence and effect of burnout on graduate healthcare students. Can Med Educ J 2017;8:e90–e108.
    1. McEwen BS, Stellar E. Stress and the individual: mechanisms leading to disease. Arch Intern Med 1993;153:2093–2101.
    1. Maslach C, Leiter MP, Schaufeli W. Measuring burnout. In: Cartwright S, Cooper C, eds. The Oxford Handbook of Organizational Well Being. New York: Oxford University Press; 2009.
    1. Shanafelt TD, Hasan O, Dyrbye LN, et al. . Changes in burnout and satisfaction with work-life balance in physicians and the general US Working Population between 2011 and 2014. Mayo Clin Proc 2017;90:1600–1613.
    1. Pospos S, Young IT, Downs N, et al. . Web-based tools and mobile applications to mitigate burnout, depression, and suicidality among healthcare students and professionals: a systematic review. Acad Psychiatry 2018;42:109–120.
    1. Paro HBMS, Silveira PSP, Perotta B, et al. . Empathy among medical students: is there a relation with quality of life and burnout? Hermes-Lima M, editor. PLoS One 2014;9:e94133.
    1. Oreskovich MR, Shanafelt T, Dyrbye LN, et al. . The prevalence of substance use disorders in American physicians. Am J Addict 2015;24:30–38.
    1. Dyrbye LN, Massie FSJ, Eacker A, et al. . Relationship between burnout and professional conduct and attitudes among US medical students. JAMA 2010;304:1173–1180.
    1. McEwen BS. Physiology and neurobiology of stress and adaptation: central role of the brain. Physiol Rev 2007;87:873–904.
    1. Braun SE, Auerbach SM, Rybarczyk B, et al. . Mindfulness, burnout, and effects on performance evaluations in internal medicine residents. Adv Med Educ Pract 2017;8:591–597.
    1. Hall LH, Johnson J, Watt I, et al. . Healthcare staff wellbeing, burnout, and patient safety: a systematic review. PLoS ONE 2016;11:e0159015.
    1. Deligkaris P, Panagopoulou E, Montgomery AJ, Masoura E. Job burnout and cognitive functioning: a systematic review. Work Stress 2014;28:107–123.
    1. Sokka L, Leinikka M, Korpela J, et al. . Job burnout is associated with dysfunctions in brain mechanisms of voluntary and involuntary attention. Biol Psychol 2016;117:56–66.
    1. Halbesleben JRB, Rathert C. Linking physician burnout and patient outcomes: exploring the dyadic relationship between physicians and patients. Health Care Manage Rev 2008;33:29–39.
    1. Shanafelt T, Goh J, Sinsky C. The business case for investing in physician well-being. JAMA Intern Med 2017;177:1826.
    1. Burton A, Burgess C, Dean S, et al. . How effective are mindfulness-based interventions for reducing stress among healthcare professionals? A systematic review and meta-analysis. Stress Health 2016;33:3–13.
    1. Lamothe M, Rondeau É, Malboeuf-Hurtubise C, et al. . Outcomes of MBSR or MBSR-based interventions in health care providers: a systematic review with a focus on empathy and emotional competencies. Complement Ther Med 2016;24:19–28.
    1. Baer R a, Smith GT, Lykins E, et al. . Construct validity of the five facet mindfulness questionnaire in meditating and nonmeditating samples. Assessment 2008;15:329–342.
    1. Quaglia JT, Braun SE, Freeman SP, et al. . Meta-analytic evidence for effects of mindfulness training on dimensions of self-reported dispositional mindfulness. Psychol Assess 2016;28:803–818.
    1. Baer R, Gu J, Cavanagh K, et al. . Differential sensitivity of mindfulness questionnaires to change with treatment: a systematic review and meta- analysis. Psychol Assess 2019;31:1247.
    1. Kinser P, Braun S, Deeb G, et al. . Awareness is the first step: an interprofessional course on mindfulness & mindful-movement for healthcare professionals and students. Complement Ther Clin Pract 2016;25:18–25.
    1. Braun SE, Dow A, Loughan A, et al. . Mindfulness training for healthcare professional students: a waitlist controlled pilot study on psychological and work-relevant outcomes. Complement Ther Med 2020;51:102405.
    1. Braun SE, Kinser P, Carrico CK, Dow A. Being mindful: a long-term investigation of an interdisciplinary course in mindfulness. Glob Adv Heal Med 2019;8:216495611882006.
    1. Rees CS, Craigie MA, Slatyer S, et al. . Pilot study of the effectiveness of a Mindful Self-Care and Resiliency program for rural doctors in Australia. Aust J Rural Health 2020;28:22–31.
    1. Marx R, Strauss C, Williamson C, et al. . The eye of the storm: a feasibility study of an adapted Mindfulness-based Cognitive Therapy (MBCT) group intervention to manage NHS staff stress. Cogn Behav Ther 2014;7:E18.
    1. Czajkowski SM, Powell LH, Adler N, et al. . From ideas to efficacy: the ORBIT model for developing behavioral treatments for chronic diseases. Heal Psychol 2015;34:971–982.
    1. Beutler LE, Moleiro C. Clinical versus reliable and significant change. Clin Psychol Sci Pract 2006;8:441–445.
    1. Krasner MS, Epstein RM, Beckman H, et al. . Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA 2009;302:1284–1293.
    1. Carpenter JK, Conroy K, Gomez AF, et al. . The relationship between trait mindfulness and affective symptoms: a meta-analysis of the Five Facet Mindfulness Questionnaire (FFMQ). Clin Psychol Rev 2019;74:101785.
    1. Braun SE, Kinser PA, Rybarczyk B. Can mindfulness in health care professionals improve patient care? An integrative review and proposed model. Transl Behav Med 2019;9:187–201.
    1. Spurgeon A. Evaluating stress: a book of resources. Psychol Med 1998;28:S0033291798257163.
    1. Ilic M, Todorovic Z, Jovanovic M, Ilic I. Burnout syndrome among medical students at One University in Serbia: validity and reliability of the Maslach Burnout Inventory—Student Survey. Behav Med 2017;43:323–328.
    1. Tsubakita T, Shimazaki K. Constructing the Japanese version of the Maslach Burnout Inventory-Student Survey: confirmatory factor analysis. Jpn J Nurs Sci 2016;13:183–188.
    1. Yavuz G, Dogan N. Maslach Burnout Inventory-Student Survey (MBI-SS): a validity study. Proc Soc Behav Sci 2014;116:2453–2457.
    1. Rostami Z, Abedi MR, Schaufeli WB, et al. . The psychometric characteristics of Maslach Burnout Inventory Student Survey: a study students of Isfahan University. Zahedan J Res Med Sci 2014;16:55–58.
    1. Faye-Dumanget C, Carré J, Le Borgne M, et al. French validation of the Maslach Burnout Inventory-Student Survey (MBI-SS). J Eval Clin Pract 2017;23:1247–1251.
    1. Simancas-Pallares MA, Fortich Mesa N, González Martínez FD. Validity and internal consistency of the Maslach Burnout Inventory in dental students from Cartagena, Colombia. Rev Colomb Psiquiatr (English Ed) 2017;46:103–109.
    1. Gumz A, Erices R, Brähler E, Zenger M. Factorial Structure and Psychometric Criteria of the German Translation of the Maslach Burnout Inventory-Student Version by Schaufeli et al. (MBI-SS) [in German]. Psychother Psychosom Med Psychol 2013;63:77–84.
    1. Pérez-Mármol JM, Brown T. An examination of the structural validity of the Maslach Burnout Inventory-Student Survey (MBI-SS) using the Rasch Measurement Model. Heal Prof Educ 2018;5:259–274.
    1. Cohen S, Williamson GM. Perceived stress in a probability sample of the United States. Soc Psychol Health 1988;13:31–67.
    1. Roberti JW, Harrington LN, Storch EA. Further psychometric support for the 10-item version of the Perceived Stress Scale. J Coll Couns 2006;9:135–147.
    1. Reilly MC, Zbrozek AS, Dukes EM. The validity and reproducibility of a work productivity and activity impairment instrument. Pharmacoeconomics 1993;4:353–365.
    1. Johnson JR, Emmons HC, Rivard RL, et al. . Resilience training: a pilot study of a mindfulness-based program with Depressed Healthcare Professionals. Explore (NY) 2015;11:433–444.
    1. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav 1983;24:385–396.
    1. Shi Y, Gugiu PC, Crowe RP, Way DP. A Rasch Analysis Validation of the Maslach Burnout Inventory–Student Survey with preclinical medical students. Teach Learn Med 2019;31:154–169.
    1. Jacobson NS, Truax P. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol 1991;59:12–19.
    1. Gu J, Cavanagh K, Strauss C. Investigating the specific effects of an online mindfulness-based self-help intervention on stress and underlying mechanisms. Mindfulness (N Y) 2018;9:1245–1257.
    1. Gu J, Strauss C, Bond R, Cavanagh K. How do mindfulness-based cognitive therapy and mindfulness-based stress reduction improve mental health and wellbeing? A systematic review and meta-analysis of mediation studies. Clin Psychol Rev 2015;37:1–12.
    1. Lilja JL, Lundh LG, Josefsson T, Falkenström F. Observing as an essential facet of mindfulness: a comparison of FFMQ patterns in meditating and non-meditating individuals. Mindfulness (N Y) 2013;4:1–10.
    1. Baer RA, Smith GT, Hopkins J, et al. . Using self-report assessment methods to explore facets of mindfulness. Assessment 2006;13:27–45.
    1. Josefsson T, Larsman P, Broberg AG, Lundh LG. Self-reported mindfulness mediates the relation between meditation experience and psychological well-being. Mindfulness (N Y) 2011;2:49–58.
    1. Gu J, Strauss C, Crane C, Barnhofer T, et al. . Examining the factor structure of the 39-Item and 15-Item Versions of the Five Facet Mindfulness Questionnaire before and after mindfulness-based vCognitive Therapy for People With Recurrent Depression. Psychol Assess 2016;28:791–802.

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