Mind-body skills groups for medical students: reducing stress, enhancing commitment, and promoting patient-centered care

James S Gordon, James S Gordon

Abstract

Background: For several decades, psychological stress has been observed to be a significant challenge for medical students. The techniques and approach of mind-body medicine and group support have repeatedly demonstrated their effectiveness at reducing stress and improving the quality of the education experience.

Discussion: Mind-Body Skills Groups provide medical students with practical instruction in and scientific evidence for a variety of techniques that reduce stress, promote self-awareness and self-expression, facilitate imaginative solutions to personal and professional problems, foster mutual understanding among students, and enhance confidence in and optimism about future medical practice. The Center for Mind-Body Medicine, which developed this model 20 years ago, has trained medical school faculty who offer these supportive small groups to students at more than 15 US medical schools. This paper describes the model, surveys its use in medical schools, summarizes published research on it, and discusses obstacles to successful implementation as well as its benefits.

Summary: Mind-Body Skills groups have demonstrated their effectiveness on reducing stress in medical students; in enhancing the students' experience of medical education; and in helping them look forward more confidently and hopefully to becoming physicians. The experience of these 15 institutions may encourage other medical schools to include mind-body skills groups in their curricula.

References

    1. Compton MT, Carrera J, Frank E. Stress and depressive symptoms/dysphoria among US medical students: results from a large, nationally representative survey. J Nerv Ment Dis. 2008;196(12):891–897. doi: 10.1097/NMD.0b013e3181924d03.
    1. Goebert D, Thompson D, Takeshita J, Beach C, Bryson P, Ephgrave K, Kent A, Kunkel M, Schechter J, Tate J. Depressive symptoms in medical students and residents: a multischool study. Acad Med. 2009;84(2):236–241. doi: 10.1097/ACM.0b013e31819391bb.
    1. Dyrbye LN, Thomas MR, Huschka MM, Lawson KL, Novotny PJ, Sloan JA, Shanafelt TD. A multicenter study of burnout, depression, and quality of life in minority and nonminority US medical students. Mayo Clin Proc. 2006;81(11):1435–1442. doi: 10.4065/81.11.1435.
    1. Dyrbye LN, Thomas MR, Huntington JL, Lawson KL, Novotny PJ, Sloan JA, Shanafelt TD. Personal life events and medical student burnout: a multicenter study. Acad Med. 2006;81(4):374–384. doi: 10.1097/00001888-200604000-00010.
    1. Dyrbye LN, Thomas MR, Massie FS, Power DV, Eacker A, Harper W, Durning S, Moutier C, Szydlo DW, Novotny PJ, Sloan JA, Shanafelt TD. Burnout and suicidal ideation among U.S. medical students. Ann Intern Med. 2008;149(5):334–341. doi: 10.7326/0003-4819-149-5-200809020-00008.
    1. Thomas NK. Resident burnout. JAMA. 2004;292(23):2880–2889. doi: 10.1001/jama.292.23.2880.
    1. Dahlin M, Joneborg N, Runeson B. Performance-based self-esteem and burnout in a cross-sectional study of medical students. Med Teac. 2007;29(1):43–48. doi: 10.1080/01421590601175309.
    1. Shanafelt T, Habermann T. Medical residents' emotional well-being. J Am Med Assoc. 2002;288(15):1846–1847. doi: 10.1001/jama.288.15.1846.
    1. Biaggi P, Peter S, Ulich E. Stressors, emotional exhaustion and aversion to patients in residents and chief residents - what can be done? Swiss Med Wkly. 2003;133(23–24):339–346.
    1. Dashef SS, Espey WM, Lazarus JA. Time-limited sensitivity groups for medical students. Am J Psychiatr. 1974;131(3):287–292.
    1. Hilberman E, Konanc J, Perez-Reyes M, Hunter R, Scagnelli J, Sanders S. Support groups for women in medical school: a first-year program. J Med Educ. 1975;50(9):867–875.
    1. Klamen DL, Williams RG. The effect of medical education on students' patient-satisfaction ratings. Acad Med. 1997;72(1):57–61.
    1. Webster TG, Robinowitz CB. Becoming a physician: long-term student group. Gen Hosp Psychiatry. 1979;1(1):53–61. doi: 10.1016/0163-8343(79)90078-1.
    1. Cadden JJ, Flach FF, Blakeslee S, Charlton R., Jr Growth in medical students through group process. Am J Psychiatr. 1969;126(6):862–868.
    1. Johnson W, Snibbe J, Hoffman K, Evans L. Focused psychiatric curriculum selection: student, psychiatrist, and nonpsychiatrist physician expectations. Am J Psychiatr. 1977;134(10):1126–1130.
    1. Kinsler DD. Relaxation: key to stress reduction. Occup Health Nurs. 1977;25(7):7–8.
    1. Borysenko M, Borysenko J. Stress, behavior, and immunity: animal models and mediating mechanisms. Gen Hosp Psychiatry. 1982;4(1):59–67. doi: 10.1016/0163-8343(82)90028-7.
    1. Nathan RG, Nixon FE, Robinson LA, Bairnsfather L, Allen JH, Hack M. Effects of a stress management course on grades and health of first-year medical students. J Med Educ. 1987;62(6):514–517.
    1. Franco KS, Tamburrino MB, Carroll BT, Somani A, Wagner SM. Reducing the stress of a medical education: two approaches. Ohio Med. 1987;83(10):691–692.
    1. Kelly JA, Bradlyn AS, Dubbert PM. St Lawrence JS. Stress management training in medical school. J Med Educ. 1982;57(2):91–99.
    1. Holtzworth-Munroe A, Munroe MS, Smith RE. Effects of a stress-management training program on first- and second-year medical students. J Med Educ. 1985;60(5):417–419.
    1. Brokaw JJ, Tunnicliff G, Raess BU, Saxon DW. The teaching of complementary and alternative medicine in U.S. medical schools: a survey of course directors. Acad Med. 2002;77(9):876–881. doi: 10.1097/00001888-200209000-00013.
    1. Benson H, Beary JF, Carol MP. The relaxation response. Psychiatry. 1974;37(1):37–46.
    1. Kabat-Zinn J. An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results. Gen Hosp Psychiatry. 1982;4(1):33–47. doi: 10.1016/0163-8343(82)90026-3.
    1. Kutz I, Borysenko JZ, Benson H. Meditation and psychotherapy: a rationale for the integration of dynamic psychotherapy, the relaxation response, and mindfulness meditation. Am J Psychiatr. 1985;142(1):1–8.
    1. Wallace RK. Physiological effects of transcendental meditation. Science. 1970;167(3926):1751–1754. doi: 10.1126/science.167.3926.1751.
    1. Kamiya J. Biofeedback training in voluntary control of EEG alpha rhythms. Calif Med. 1971;115(3):44.
    1. Shapiro D, Schwartz GE. Biofeedback and visceral learning: clinical applications. Semin Psychiatr. 1972;4(2):171–184.
    1. Schwartz GE. Biofeedback as therapy. Some theoretical and practical issues. Am Psychol. 1973;28(8):666–673. doi: 10.1037/h0035759.
    1. Leuner H. Guided affective imagery (GAI): A method of intensive psychotherapy. Am J Psychother. 1969;23(1):4–21.
    1. Kosbab FP. Imagery techniques in psychiatry. Arch Gen Psychiatry. 1974;31(3):283–290. doi: 10.1001/archpsyc.1974.01760150005001.
    1. Shapiro SL, Schwartz GE, Bonner G. Effects of mindfulness-based stress reduction on medical and premedical students. J Behav Med. 1998;21(6):581–599. doi: 10.1023/A:1018700829825.
    1. Shapiro SL, Schwartz GE. Intentional systemic mindfulness: an integrative model for self-regulation and health. Adv Mind Body Med. 2000;16(2):128–134.
    1. Palan BM, Chandwani S. Coping with examination stress through hypnosis: an experimental study. Am J Clin Hypn. 1989;31(3):173–180. doi: 10.1080/00029157.1989.10402886.
    1. Whitehouse WG, Dinges DF, Orne EC, Keller SE, Bates BL, Bauer NK, Morahan P, Haupt BA, Carlin MM, Bloom PB, Zaugg L, Orne MT. Psychosocial and immune effects of self-hypnosis training for stress management throughout the first semester of medical school. Psychosom Med. 1996;58(3):249–263. doi: 10.1097/00006842-199605000-00009.
    1. Maclaughlin BW, Wang D, Noone AM, Liu N, Harazduk N, Lumpkin M, Haramati A, Saunders P, Dutton M, Amri H. Stress biomarkers in medical students participating in a mind body medicine skills program. Evid Based Complement Alternat Med. 2011;2011:950461. doi: 10.1093/ecam/neq039.
    1. Rosenzweig S, Reibel DK, Greeson JM, Brainard GC, Hojat M. Mindfulness-based stress reduction lowers psychological distress in medical students. Teach Learn Med. 2003;15(2):88–92. doi: 10.1207/S15328015TLM1502_03.
    1. Kiecolt-Glaser JK, Glaser R, Strain EC, Stout JC, Tarr KL, Holliday JE, Speicher CE. Modulation of cellular immunity in medical students. J Behav Med. 1986;9(1):5–21. doi: 10.1007/BF00844640.
    1. Rakel DP, Hedgecock J. Healing the healer: a tool to encourage student reflection towards health. Med Teach. 2008;30(6):633–635. doi: 10.1080/01421590802206754.
    1. Gordon JS, Staples JK, Blyta A, Bytyqi M. Treatment of posttraumatic stress disorder in postwar Kosovo high school students using mind-body skills groups: a pilot study. J Trauma Stress. 2004;17:143–147. doi: 10.1023/B:JOTS.0000022620.13209.a0.
    1. Gordon JS, Staples JK, Blyta A, Bytyqi M, Wilson AT. Treatment of posttraumatic stress disorder in postwar kosovar adolescents using mind-body skills groups: a randomized controlled trial. J Clin Psychiatry. 2008;69(9):1469–1476. doi: 10.4088/JCP.v69n0915.
    1. Staples JK, Abdel Attai JA, Gordon JS. Mind-body skills groups for posttraumatic stress disorder and depression symptoms in Palestinian children and adolescents in Gaza. Int J Stress Manag. 2011;18(3):246–262. doi: 10.1037/a0024015.
    1. Jacobs TL, Epel ES, Lin J, Blackburn EH, Wolkowitz OM, Bridwell DA, Zanesco AP, Aichele SR, Sahdra BK, MacLean KA, King BG, Shaver PR, Rosenberg EL, Ferrer E, Wallace BA, Saron CD. Intensive meditation training, immune cell telomerase activity, and psychological mediators. Psychoneuroendocrinology. 2011;36(5):664–681. doi: 10.1016/j.psyneuen.2010.09.010.
    1. Nidich SI, Rainforth MV, Haaga DA, Hagelin J, Salerno JW, Travis F, Tanner M, Gaylord-King C, Grosswald S, Schneider RH. A randomized controlled trial on effects of the Transcendental Meditation program on blood pressure, psychological distress, and coping in young adults. Am J Hypertens. 2009;22(12):1326–1331. doi: 10.1038/ajh.2009.184.
    1. Lazar SW, Kerr CE, Wasserman RH, Gray JR, Greve DN, Treadway MT, McGarvey M, Quinn BT, Dusek JA, Benson H, Rauch SL, Moore CI, Fischl B. Meditation experience is associated with increased cortical thickness. Neuroreport. 2005;16(17):1893–1897. doi: 10.1097/01.wnr.0000186598.66243.19.
    1. Kerr CE, Sacchet MD, Lazar SW, Moore CI, Jones SR. Mindfulness starts with the body: somatosensory attention and top-down modulation of cortical alpha rhythms in mindfulness meditation. Front Hum Neurosci. 2013;7:12.
    1. Saunders PA, Tractenberg RE, Chaterji R, Amri H, Harazduk N, Gordon JS, Lumpkin M, Haramati A. Promoting self-awareness and reflection through an experiential mind-body skills course for first year medical students. Med Teac. 2007;29(8):778–784. doi: 10.1080/01421590701509647.
    1. Finkelstein C, Brownstein A, Scott C, Lan YL. Anxiety and stress reduction in medical education: an intervention. Med Educ. 2007;41(3):258–264. doi: 10.1111/j.1365-2929.2007.02685.x.
Pre-publication history
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