Physician Anxiety and Burnout: Symptom Correlates and a Prospective Pilot Study of App-Delivered Mindfulness Training

Alexandra Roy, Susan Druker, Elizabeth A Hoge, Judson A Brewer, Alexandra Roy, Susan Druker, Elizabeth A Hoge, Judson A Brewer

Abstract

Background: Physician burnout is on the rise, yet little is known about its relationship to anxiety. Mindfulness-based stress reduction has demonstrated decreases in anxiety, yet physicians have reported reluctance to engage in it due to significant time commitments.

Objective: The aims of this study are to assess whether app-based mindfulness training can reduce anxiety in physicians and to explore if anxiety and burnout are correlated, thus leading to a reduction in both anxiety and burnout.

Methods: This was a nonrandomized pilot study comprised of 34 physicians who worked in a large US health care network and reported having anxiety. The intervention was an app-based mindfulness program. The main outcome measure was anxiety, measured by the Generalized Anxiety Disorder-7 (GAD-7). The secondary outcome measures assessed burnout: cynicism and emotional exhaustion items from the Maslach Burnout Inventory.

Results: GAD-7 scores decreased significantly at posttreatment (1 month after treatment initiation, 48% reduction, P<.001) and at the 3-month follow-up (57% reduction, P<.001). There was a significant correlation between anxiety and burnout (cynicism: r=.43; P=.01; emotional exhaustion: r=.71; P<.001). There was also a significant decrease in cynicism (50% reduction, P=.003 at posttreatment; 50% reduction, P=.009 at follow-up) and emotional exhaustion at both time points (20% reduction, P<.001 at posttreatment; 20% reduction, P=.003 at follow-up).

Conclusions: This pilot study is the first to test an app-based mindfulness training program targeted at reducing anxiety with physicians and to demonstrate that in physicians, anxiety is correlated with burnout. These findings suggest that this may be an effective tool to reduce anxiety and burnout in physicians.

Trial registration: ClinicalTrials.gov NCT04137081; https://www.clinicaltrials.gov/ct2/show/NCT04137081.

Keywords: anxiety; app; burnout; digital therapeutics; mHealth; mindfulness; physician; smartphone.

Conflict of interest statement

Conflicts of Interest: JAB owns stock in MindSciences, the company that developed the mindfulness app used in this study. This financial interest has been disclosed to and is being managed by Brown University, in accordance with its Conflict of Interest and Conflict of Commitment policies. All other authors report no biomedical financial interests or potential conflicts of interest.

©Alexandra Roy, Susan Druker, Elizabeth A Hoge, Judson A Brewer. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 01.04.2020.

Figures

Figure 1
Figure 1
Development of a "habit loop" via positive and negative reinforcement [15,18,19].
Figure 2
Figure 2
Consolidated Standards of Reporting Trials diagram. MT: mindfulness training.
Figure 3
Figure 3
Box and whisker plots at baseline, one month, and three months for: (a) Generalized Anxiety Disorder-7 scores; (b) cynicism scores from Maslach Burnout Inventory; and (c) emotional exhaustion scores from Maslach Burnout Inventory. Significance level is denoted by asterisks: *=.05; **=.01; ***=.001. GAD-7: Generalized Anxiety Disorder-7.

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