Resilience@Work Mindfulness Program: Results From a Cluster Randomized Controlled Trial With First Responders

Sadhbh Joyce, Fiona Shand, Tara J Lal, Brendan Mott, Richard A Bryant, Samuel B Harvey, Sadhbh Joyce, Fiona Shand, Tara J Lal, Brendan Mott, Richard A Bryant, Samuel B Harvey

Abstract

Background: A growing body of research suggests that resilience training can play a pivotal role in creating mentally healthy workplaces, particularly with regard to protecting the long-term well-being of workers. Emerging research describes positive outcomes from various types of resilience training programs (RTPs) among different occupational groups. One specific group of workers that may benefit from this form of proactive resilience training is first responders. Given the nature of their work, first responders are frequently exposed to stressful circumstances and potentially traumatic events, which may impact their overall resilience and well-being over time.

Objective: This study aimed to examine whether a mindfulness-based RTP (the Resilience@Work [RAW] Mindfulness Program) delivered via the internet can effectively enhance resilience among a group of high-risk workers.

Methods: We conducted a cluster randomized controlled trial (RCT) comprising 24 Primary Fire and Rescue and Hazmat stations within New South Wales. Overall, 12 stations were assigned to the 6-session RAW Mindfulness Program and 12 stations were assigned to the control condition. A total of 143 active full-time firefighters enrolled in the study. Questionnaires were administered at baseline, immediately post training, and at 6-month follow-up. Measurements examined change in both adaptive and bounce-back resilience as well as several secondary outcomes examining resilience resources and acceptance and mindfulness skills.

Results: Mixed-model repeated measures analysis found that the overall test of group-by-time interaction was significant (P=.008), with the intervention group increasing in adaptive resilience over time. However, no significant differences were found between the intervention group and the control group in terms of change in bounce-back resilience (P=.09). At 6-month follow-up, the group receiving the RAW intervention had an average increase in their resilience score of 1.3, equating to a moderate-to-large effect size compared with the control group of 0.73 (95% CI 0.38-1.06). Per-protocol analysis found that compared with the control group, the greatest improvements in adaptive resilience were observed among those who completed most of the RAW program, that is, 5 to 6 sessions (P=.002).

Conclusions: The results of this RCT suggest that mindfulness-based resilience training delivered in an internet format can create improvements in adaptive resilience and related resources among high-risk workers, such as first responders. Despite a number of limitations, the results of this study suggest that the RAW Mindfulness Program is an effective, scalable, and practical means of delivering online resilience training in high-risk workplace settings. To the best of our knowledge, this is the first time a mindfulness-based RTP delivered entirely via the internet has been tested in the workplace.

Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12615000574549; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368296 (Archived by WebCite at http://www.webcitation.org/75w4xtrpw).

Keywords: employee resilience; first responders; health and safety; occupational health; online intervention; psychological health; resilience training; well-being; workplace mental health.

Conflict of interest statement

Conflicts of Interest: SJ and SBH are associated with a company that offers resilience training (RAW Mind Coach). SBH and FS work for the Black Dog Institute, a not-for-profit organization that provides mental health and resilience training to various other organizations.

©Sadhbh Joyce, Fiona Shand, Tara J Lal, Brendan Mott, Richard A Bryant, Samuel B Harvey. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 19.02.2019.

Figures

Figure 1
Figure 1
Consolidated Standards of Reporting Trials flow diagram. RAW: Resilience@Work.
Figure 2
Figure 2
Test of group-by-time interaction (P=.01) change on the 10-item version of the Connor-Davidson Resilience Scale. RAW: Resilience@Work.
Figure 3
Figure 3
Analysis of primary outcome (change on the 10-item version of the Connor-Davidson Resilience Scale) by number of Resilience@Work sessions. Statistical difference test of significance compared with control group obtained from mixed-methods repeated measures models. RAW: Resilience@Work; CDRISC_10: 10-item version of the Connor-Davidson Resilience Scale.
Figure 4
Figure 4
Analysis of change in mindfulness and cognitive fusion scores over time for partial and full program completers. RAW: Resilience@Work; FMI: Freiburg Mindfulness Inventory; CFQ: cognitive fusion questionnaire.

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