Improve Physician-Patient Interactions with Mindfulness

August 22, 2017 psyjdc Leave a comment

By John M. de Castro, Ph.D.

”For physicians, mindfulness and the exploration of clinical narratives helped them to be aware of how they are feeling, how events in their own lives might be influencing how they react to patients, and how they can better recognize the meaning and satisfaction derived from the practice of medicine.” – Michael Krasner

Stress is epidemic in the western workplace with almost two thirds of workers reporting high levels of stress at work. In high stress occupations, such as healthcare, burnout is all too prevalent. This is the fatigue, cynicism, emotional exhaustion, and professional inefficacy that comes with work-related stress. It is estimated that over 45% of healthcare workers experience burnout. Burnout frequently results from emotional exhaustion. This exhaustion not only affects the healthcare providers personally, but also the patients, as it produces a loss of enthusiasm, empathy, and compassion. This can markedly impair the critical communications between the physician and patient and result in substantially poorer quality of care.

Loss of effective physician-patient communications is a threat to healthcare. Hence, improving communications and preventing burnout has to be a priority. Mindfulness training has been demonstrated to be helpful in treating and preventing burnout and mindfulness training improves interpersonal communications. So, it would be reasonable to expect that mindfulness training would improve the communications between physicians and their patients. In today’s Research News article “Improving Communication between Physicians and Their Patients through Mindfulness and Compassion-Based Strategies: A Narrative Review.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5373002/, Amutio-Kareaga and colleagues review the published research literature on the ability of mindfulness to improve physician-patient communications.

They identified 20 empirical or review studies on the effectiveness of mindfulness training on communications between doctors and their patients. They found that the published studies reported that mindfulness-based interventions reduced burnout, increased compassion, physician empathy, and quality of care, and improved physician-patient communications. Hence, training physicians in mindfulness greatly improves their ability to communicate and work with their patients. This is important suggesting that physicians should be routinely trained in mindfulness for their own benefit but especially for the benefit of their patients. These results suggest that this could result in more effective healthcare and reduced physician burnout.

So, improve physician-patient interactions with mindfulness.

“An emerging body of research points to the benefits of mindfulness for physicians. Practicing mindfulness can reduce physician burnout, and improve physician well being. Now research shows that physician mindfulness is good news for patients too: . . .physicians with mindfulness skills communicate well with patients, and provide better quality care.” – Emily Nauman

CMCS – Center for Mindfulness and Contemplative Studies

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

Study Summary

Amutio-Kareaga, A., García-Campayo, J., Delgado, L. C., Hermosilla, D., & Martínez-Taboada, C. (2017). Improving Communication between Physicians and Their Patients through Mindfulness and Compassion-Based Strategies: A Narrative Review. Journal of Clinical Medicine, 6(3), 33. http://doi.org/10.3390/jcm6030033

Abstract

Communication between physicians and patients is a key pillar of psychosocial support for enhancing the healing process of patients and for increasing their well-being and quality of life. Physicians and other health professionals might benefit from interventions that increase their self-care, awareness, compassion, and other-focused concern, and reduce the chances of distress and burnout. There is substantial evidence for the contribution of different management strategies to achieve these aims. The goal of this article is to review the potential effect of mindfulness and compassion-based strategies for the improvement of physician-patient interactions. The acquisition of the necessary skills by physicians requires continuous education. Future research will be useful for identifying more evidence on the cost-effectiveness of this type of intervention.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5373002/

Improve Emotional Exhaustion and Employee Retention with Mindfulness

August 10, 2017 psyjdc Leave a comment

Improve Emotional Exhaustion and Employee Retention with Mindfulness

By John M. de Castro, Ph.D.

“In ten years of informally and two years of formally teaching agents mindfulness techniques, I can boldly and honestly say there is no downside to introducing it to your employees. I have seen it completely revolutionize things, transforming a call center in amazing ways. I have also seen it integrated on a small level, added as a tool along with many others. Regardless, the results are always positive.” – Debi Mongan

Call centers can be particularly stressful due to a heavy workload, sustained fast work pace, repetitive tasks, lack of control over the job, the blurred relation between feelings and actions, a competitive environment, and being faced with losing a client. These stresses can lead to problems, including visual, auditory, and speech fatigue. Indeed, each year, 60% of employees take sick leave and 39.4% of employees showed psychological distress symptoms and 8.3% found themselves in a severe situation of psychological distress, and 24% were taking psychoactive drugs. This also produces high turnover, with the average employee leaving the job after only a year.

One technique to counteract these problems that is gaining increasing attention is mindfulness training. It has been demonstrated to be helpful in the workplace in reducing stress, improving emotional regulation, and treating and preventing burnout in a number of work environments. In today’s Research News article “The Mediating Role of Emotional Exhaustion in the Relationship of Mindfulness with Turnover Intentions and Job Performance.” (See summary below). Reb and colleagues conducted two studies on the relationship of mindfulness with workplace well-being. They recruited call center workers and had them complete measures of mindfulness, emotional exhaustion, and intention to leave the job.

They found that the higher the level of the employee’s mindfulness the lower the level of emotional exhaustion and interest in changing jobs. They also found that the higher the level of emotional exhaustion the higher the interest in changing jobs. They further found with a mediation analysis that the majority of the relationship of mindfulness with lower interest in changing jobs was due to the negative relationship of mindfulness with emotional exhaustion which in turn was related to lower interest in changing jobs. So, mindfulness was associated with retention of employees directly and indirectly by being associated with lower emotional exhaustion.

In a second study Reb and colleagues recruited worker – supervisor pairs from a variety of industries. They again collected measures of mindfulness, emotional exhaustion, and intention to leave the job but also collected supervisor ratings of the employees’ job performances. They again found that the higher the level of the employee’s mindfulness the lower the level of emotional exhaustion and interest in changing jobs and the higher level of job performance. They also found that the higher the level of emotional exhaustion the higher the interest in changing jobs and the lower the job performance. They further found, as in study 1, with a mediation analysis that the majority of the relationship of mindfulness with lower interest in changing jobs was due to the negative relationship of mindfulness with emotional exhaustion which in turn was related to lower interest in changing jobs. But, they also found that the positive relationship of mindfulness with higher job performance was due to the negative relationship of mindfulness with emotional exhaustion which in turn was related to higher job performance.

These are interesting findings but are correlational, so causation cannot be concluded. But, the findings suggest that mindfulness is highly related to job performance and employee retention and better job performance. The results further suggest that these associations of mindfulness are due to a large extent to mindfulness’ relationship with lower emotional exhaustion. In other words, mindfulness appears to be related to less likelihood of leaving the job and better performance on the job both as a direct result of their relationship with mindfulness and indirectly due to mindfulness’ relationship with lower emotional exhaustion.

So, improve emotional exhaustion and employee retention with mindfulness.

“My advice to companies looking to introduce mindfulness techniques in their contact center culture is simple: start small but cultivate it and tend to it so it grows. One small step for your contact center, one giant leap for your entire company!” – Debi Mongan

CMCS – Center for Mindfulness and Contemplative Studies

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

Study Summary

Reb, J., Narayanan, J., Chaturvedi, S., Ekkirala, S. The Mediating Role of Emotional Exhaustion in the Relationship of Mindfulness with Turnover Intentions and Job Performance. Mindfulness (2017) 8: 707. doi:10.1007/s12671-016-0648-z

Abstract

Mindfulness in the workplace has emerged as a legitimate and growing area of organizational scholarship. The present research examined the role of employee emotional exhaustion in mediating the relationship of mindfulness with turnover intentions and task performance. Drawing on theory and empirical research on both organizational behavior and mindfulness, we predicted that more mindful employees would show lower turnover intentions and higher task performance and that these relationships would be mediated by emotional exhaustion. We tested these hypotheses in two field studies in an Indian context. Study 1 was a field study of call center employees of a multinational organization, an industry in which turnover rates are very high. This study found that mindfulness was associated with lower turnover intentions and less emotional exhaustion, and that emotional exhaustion mediated the relationship between mindfulness and turnover intentions. Study 2 replicated these results in a sample of employees based in major Indian cities and drawn from different industries. In addition, it showed that mindfulness was positively related to supervisor-rated task performance, with emotional exhaustion again playing a mediating role. We discuss theoretical and practical implications of our findings, as well as future research directions.

Reduce General Practitioner Burnout with On-Line Mindfulness

July 27, 2017 psyjdc Leave a comment

Reduce General Practitioner Burnout with On-Line Mindfulness

By John M. de Castro, Ph.D.

“Mindfulness practice — the cultivation of a focused awareness on the present moment — can improve physicians’ performance by not only preventing burnout, but also by helping them better connect with their patients.” – Carolyn Gregoire

“General Practitioners confront stress on a daily basis. Even moderate levels of stress when prolonged, all too frequently results in a professional burnout. This is the fatigue, cynicism, emotional exhaustion, and professional inefficacy that comes with work-related stress. Healthcare is a high stress occupation. It is estimated that over 45% of healthcare workers experience burnout. Regardless of the reasons for burnout or its immediate presenting consequences, it is a threat to the healthcare providers and their patients. In fact, it is a threat to the entire healthcare system as it contributes to the shortage of doctors and nurses. Hence, preventing existing healthcare workers from burning out has to be a priority.

Mindfulness has been demonstrated to be helpful in coping with stress and in treating and preventing burnout. But, General Practitioners (GPs) are pressed for time and it is difficult for them to commit the time to mindfulness training on a schedule at a therapist’s location. Mindfulness training over the internet is an alternative training for people who find face-to-face training difficult and inconvenient. Online mindfulness training has shown great promise with effectiveness equivalent to face-to-face training.

In today’s Research News article “Impact of a Blended Web-Based Mindfulness Programme for General Practitioners: a Pilot Study.” (See summary below). Montero-Marin and colleagues recruited General Practitioners and provided them with on-line mindfulness training with both audio and video instruction in 45-minute sessions occurring twice a week for 4 weeks. Before and after training the GPs were measured for mindfulness, positive and negative emotions, resilience, and burnout.

They separated the GPs according to their participation rates into completers who completed two or more practices per week and non-completers who completed on average less than one practice per week. They found that the completers in contrast to the non-completers had significant increases in mindfulness and positive emotions. They also found that the amount of practice had a direct effect on positive emotions and also and indirect effect by increasing mindfulness which in turn increases positive emotions.

Hence, on-line mindfulness training appeared to enhance mindfulness and positive feelings in those GPs who completed the provided practices. To some extent the results were disappointing as there were a large proportion of the GPs who did not complete the program’s practice requirements (approximately 80% of those recruited). This could be due to the busy schedules of the GPs or that the program was not sufficiently engaging to motivate participation. In addition, there were no significant effects of the practice on negative emotions, resilience, or burnout. This may be due to the relatively small amount of practice. Perhaps a longer duration program might have more positive effects. Indeed, previous research has shown significant reductions in GP burnout with 8 weeks of in-person mindfulness training. Hence, it is possible that the program in the present study needs to be longer. It is also possible that on-line presentation is not effective for GP burnout.

The program, when completed, did produce greater mindfulness and positive emotions. So, there is reason to believe that it may be effective. This suggests that a modified more engaging and longer program should be developed and tested in a randomized controlled trial as an effective treatment for GPO burnout is sorely needed.

“When I talk or listen to peers and colleagues, I am amazed at how many healthcare professionals are already integrating mindfulness, meditation or relaxation techniques into their lives on a regular basis in order to ground themselves and find headspace and calm.” – Jon Kabat-Zin

CMCS – Center for Mindfulness and Contemplative Studies

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

Study Summary

Montero-Marin, J., Gaete, J., Araya, R. et al. Impact of a Blended Web-Based Mindfulness Programme for General Practitioners: a Pilot Study. Mindfulness (2017). doi:10.1007/s12671-017-0752-8

Abstract

General practitioners (GPs) report high levels of distress. This study examined whether a brief blended web-based mindfulness intervention could be effective at enhancing well-being for GPs and assessed the possible mediating role of awareness. An open uncontrolled trial, with pre-post measurements, was conducted. The programme comprised one face-to-face meeting (4 h) and eight online practice sessions with no support (two weekly sessions over 4 weeks). The primary outcome was positive affect (PANAS-positive). The secondary outcomes were as follows: negative affect (PANAS-negative), awareness (MAAS), resilience (CDRISC), and the burnout subtypes (BCSQ-12). Mixed-effects analysis for repeated measures and mediation analysis by regression models were performed. Two hundred ninety Spanish GPs took part in the study, attending the face-to-face meeting. Nearly one out 10 participants (n = 28) completed ‘one weekly practice’, and 10.4% (n = 30) accomplished ‘two or more weekly practices’. There were benefits for those with ‘two or more weekly practices’ in PANAS-positive (B = 2.97; p = 0.007), and MAAS (B = 4.65; p = 0.023). We found no benefits for those with ‘one weekly practice’ in any of the outcomes. There were mediating effects of MAAS in PANAS-positive (explaining a 60.8% of total effects). A brief blended mindfulness intervention, with minimum face-to-face contact and web-based practice sessions, seems to confer improvements in the well-being of Spanish GPs. The benefits may be mediated by awareness. The implementation of this kind of programme might enhance the well-being among GPs, but there is a need to improve adherence to practice. Further research using randomized controlled designs will be needed to support the evidence found in our study.

Alleviate General Practitioner Burnout with Mindfulness

March 18, 2017 psyjdc 1 Comment

Alleviate General Practitioner Burnout with Mindfulness

By John M. de Castro, Ph.D.

“Enhancing the already inherent capacity of the physician to experience fully the clinical encounter—not only its pleasant but also its most unpleasant aspects—without judgment but with a sense of curiosity and adventure seems to have had a profound effect on the experience of stress and burnout. It also seems to enhance the physician’s ability to connect with the patient as a unique human being and to center care around that uniqueness.” – Michael Krasner

General Practitioners confront stress on a daily basis. Even moderate levels of stress when prolonged, all too frequently results in a professional burnout. This is the fatigue, cynicism, emotional exhaustion, and professional inefficacy that comes with work-related stress. Healthcare is a high stress occupation. It is estimated that over 45% of healthcare workers experience burnout. Currently, over a third of healthcare workers report that they are looking for a new job. Nearly half plan to look for a new job over the next two years and 80% expressed interest in a new position if they came across the right opportunity.

Regardless of the reasons for burnout or its immediate presenting consequences, it is a threat to the healthcare providers and their patients. In fact, it is a threat to the entire healthcare system as it contributes to the shortage of doctors and nurses. Hence, preventing existing healthcare workers from burning out has to be a priority. Mindfulness has been demonstrated to be helpful in treating and preventing burnout. One of the premiere techniques for developing mindfulness and dealing effectively with stress is Mindfulness Based Stress Reduction (MBSR) pioneered by Jon Kabat-Zinn. It is a diverse mindfulness training containing practice in meditation, body scan, and yoga. As a result, there have been a number of trials investigating the application of MBSR to the treatment and prevention of health care worker burnout.

In today’s Research News article “Mindfulness-based stress reduction for GPs: results of a controlled mixed methods pilot study in Dutch primary care.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4723221/

Verweij and colleagues investigated the effectiveness of Mindfulness Based Stress Reduction (MBSR) in preventing burnout in General Practitioners. They recruited General Practitioners who were required to participate in continuing professional education courses and offered as an option participation in an 8-week MBSR program. They compared GPs who selected the MBSR program during one 8-week period to those who selected a waitlist condition and received the usual continuing professional education course. They completed measures both before and after the treatment of burnout, work engagement, and mindfulness.

They found, not surprisingly, that compared to the waitlist controls, the MBSR program resulted in higher levels of mindfulness. But, importantly, it also significantly decreased levels of burnout depersonalization and increased levels of work dedication. During interviews after completion of the program The GPs reported that the MBSR program helped them to become more aware of their bodily sensations, thoughts, and emotions, of their beliefs and values, and a recognition of the autopilot mode they usually engaged in. They also reported that the MBSR program increased their wellbeing and compassion towards themselves and others, including their patients.

The findings from this pilot study are very encouraging. They demonstrate that mindfulness training reduces self-reported burnout, and improves professional dedication, recognition of bodily reactions and how activities have become routinized, and general wellbeing. By improving their awareness of the sensations, thoughts, and actions in the present moment mindfulness training appears to be somewhat an antidote to burnout. This suggests that mindfulness practices should be included in the continuing education of healthcare professionals.

So, alleviate general practitioner burnout with mindfulness.

“Mindfulness gives doctors permission to attend to their own health and well-being. But is also allows doctors to help patients by listening more, talking less and seeing what the patient needs.” – Mary Breach

CMCS – Center for Mindfulness and Contemplative Studies

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

Study Summary

Verweij, H., Waumans, R. C., Smeijers, D., Lucassen, P. L., Donders, A. R. T., van der Horst, H. E., & Speckens, A. E. (2016). Mindfulness-based stress reduction for GPs: results of a controlled mixed methods pilot study in Dutch primary care. The British Journal of General Practice, 66(643), e99–e105. http://doi.org/10.3399/bjgp16X683497

Abstract

Background

Burnout is highly prevalent in GPs and can have a negative influence on their wellbeing, performance, and patient care. Mindfulness-based stress reduction (MBSR) may be an effective intervention to decrease burnout symptoms and increase wellbeing.

Aim

To gain insight into the feasibility and effectiveness of MBSR on burnout, empathy, and (work-related) wellbeing in GPs.

Design and setting

A mixed methods pilot study, including a waiting list-controlled pre-/post-study and a qualitative study of the experiences of participating GPs in the Netherlands.

Method

Participants were sent questionnaires assessing burnout, work engagement, empathy, and mindfulness skills, before and at the end of the MBSR training/waiting period. Qualitative data on how GPs experienced the training were collected during a plenary session and with evaluation forms at the end of the course.

Results

Fifty Dutch GPs participated in this study. The MBSR group reported a greater decrease in depersonalisation than the control group (adjusted difference −1.42, 95% confidence interval [CI] = −2.72 to −0.21, P = 0.03). Dedication increased more significantly in the MBSR group than in the control group (adjusted difference 2.17, 95% CI = 0.51 to 3.83, P = 0.01). Mindfulness skills increased significantly in the MBSR group compared with the control group (adjusted difference 6.90, 95% CI = 1.42 to 12.37, P = 0.01). There was no significant change in empathy. The qualitative data indicated that the MBSR course increased their wellbeing and compassion towards themselves and others, including their patients.

Conclusion

The study shows that MBSR for GPs is feasible and might result in fewer burnout symptoms and increased work engagement and wellbeing. However, an adequately powered randomised controlled trial is needed to confirm the study’s findings.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4723221/

Improve Attitudes and Mental Health at Work with Mindfulness

March 8, 2017 psyjdc 1 Comment

Improve Attitudes and Mental Health at Work with Mindfulness

By John M. de Castro, Ph.D.

“Mindfulness is, above all, about being aware and awake rather than operating unconsciously. When you’re consciously present at work, you’re aware of two aspects of your moment-to-moment experience—what’s going on around you and what’s going on within you. To be mindful at work means to be consciously present in what you’re doing, while you’re doing it, as well as managing your mental and emotional state.” – Shamash Alidina

Stress is epidemic in the western workplace with almost two thirds of workers reporting high levels of stress at work. In high stress occupations burnout is all too prevalent. It frequently results from emotional exhaustion. Burnout is the fatigue, cynicism, emotional exhaustion, sleep disruption, and professional inefficacy that comes with work-related stress. Sleep disruption is an important consequence of the stress. This exhaustion produces a loss of enthusiasm, empathy, and compassion. Regardless of the reasons for burnout or its immediate presenting consequences, it is a threat to the workplace. From a business standpoint, it reduces employee efficiency and productivity and increases costs. From the worker perspective, it makes the workplace a stressful, unhappy place, promoting physical and psychological problems. Hence, preventing burnout in the workplace is important. One technique that is gaining increasing attention is mindfulness training. It has been demonstrated to be helpful in treating and preventing burnout in a number of work environments.

In today’s Research News article “Mindful2Work: Effects of Combined Physical Exercise, Yoga, and Mindfulness Meditations for Stress Relieve in Employees. A Proof of Concept Study.” See summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241323/

de Bruin and colleagues performed a pilot study of the effectiveness of a program of exercise, meditation, and yoga for the relief of work related stress symptoms. They recruited

workers who were referred by physicians who diagnosed them with work related stress issues. The workers received training in six weekly 2-hour sessions and a follow-up session, consisting of 20 minutes of aerobic exercise, 20 minutes of Hatha restorative yoga, and 80 minutes of mindfulness meditation including psycho-education. The participants were encouraged to practice at home. They were measured before and after the intervention, 6 weeks and 6 months after the completion of the program for workability, perceived stress, anxiety, depression, emotions, and sleep.

They found that the participants liked the program rating it at 8.1 on a 10-point scale. Following the intervention work-related fatigue and exhaustion (burnout) was markedly and significantly reduced while motivation, activation, focus and concentration, and energy were significantly increased. The employees became significantly less likely to leave their job, worked a significantly greater proportion of their contract hours, and found the work environment to be significantly better. Hence, the employees showed markedly improved attitudes and behavior toward their jobs. The employees’ psychological health was also greatly improved, with significant reductions in anxiety, depression, perceived stress, and increases in sleep quality and positive emotions. These effects all had very large effect sizes and were still strong and present 6 months after the conclusion of training. Hence, work-related psychological issues were improved in a lasting way with the intervention.

These results of this pilot study were impressive. But, the lack of a control group or condition markedly limits the conclusions that can be reached. Also, since the intervention contained meditation, yoga, and aerobic exercise, it cannot be determined which, or which combination of components are necessary for the benefits. But, the results certainly suggest that a large randomized controlled clinical trial should be conducted. With the intense stresses of the modern work environment, a program that reduced stress and improved attitudes and emotions, would be extremely valuable both to the employer and the employees.

So, improve attitudes and mental health at work with mindfulness.

“Many corporations and employees are realizing that the benefits of mindfulness practices can be dramatic. In addition to supporting overall health and well-being, mindfulness has been linked to improved cognitive functioning and lower stress levels.” – Carolyn Gregoire

CMCS – Center for Mindfulness and Contemplative Studies

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

Study Summary

De Bruin, E. I., Formsma, A. R., Frijstein, G., & Bögels, S. M. (2017). Mindful2Work: Effects of Combined Physical Exercise, Yoga, and Mindfulness Meditations for Stress Relieve in Employees. A Proof of Concept Study. Mindfulness, 8(1), 204–217. http://doi.org/10.1007/s12671-016-0593-x

Abstract

Work-related stress and associated illness and burnout is rising in western society, with now as much as almost a quarter of European and half of USA’s employees estimated to be at the point of burnout. Mindfulness meditation, yoga, and physical exercise have all shown beneficial effects for work-related stress and illness. This proof of concept study assessed the feasibility, acceptability, and preliminary effects of the newly developed Mindful2Work training, a combination of physical exercise, restorative yoga, and mindfulness meditations, delivered in six weekly group sessions plus a follow-up session. Participants (n = 26, four males), referred by company doctors with (work-related) stress and burnout complaints, completed measurements pre and post the intervention, as well as at 6-week (FU1) and 6-month (FU2) follow-up. Results showed very high feasibility and acceptability of the Mindful2Work training. The training and trainers were rated with an 8.1 and 8.4 on a 1–10 scale, respectively, and training dropout rate was zero. Significant improvements with (very) large effect sizes were demonstrated for the primary outcome measures of physical and mental workability, and for anxiety, depression, stress, sleep quality, positive and negative affect, which remained (very) large and mostly increased further over time. Risk for long-term dropout from work (checklist individual strength [CIS]) was 92 % at pre-test, reduced to 67 % at post-test, to 44 % at FU1, and 35 % at FU2, whereas employees worked (RTWI) 65 % of their contract hours per week at pre-test, which increased to 73 % at post-test, 81 % at FU1 and 93 % at FU2. Intensity of home practice or number of attended sessions were not related to training effects. To conclude, the newly developed Mindful2Work training seems very feasible, and acceptable, and although no control group was included, the large effects of Mindful2Work are highly promising.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241323/

Improve Sleep and Resilience with Mindfulness and Self-Compassion

September 27, 2016 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“Medical professionals are burdened daily with the pain and suffering of patients. Many work long hours, and regularly face stressful situations. This burden does not come without consequence: 60 percent of physicians report having experienced burnout at some point in their careers.” – Emily Nauman

Stress is epidemic in the western workplace with almost two thirds of workers reporting high levels of stress at work. In high stress occupations, like healthcare, burnout is all too prevalent. It is estimated that over 45% of healthcare workers experience burnout. Currently, over a third of healthcare workers report that they are looking for a new job. Nearly half plan to look for a new job over the next two years and 80% expressed interest in a new position if they came across the right opportunity.

Burnout is the fatigue, cynicism, emotional exhaustion, sleep disruption, and professional inefficacy that comes with work-related stress. It not only affects the healthcare providers personally, but also the patients, as it produces a loss of empathy and compassion. Sleep disruption is an important consequence of the stress. “Poor or inadequate sleep can contribute to poor personal health and burnout and adversely affect the quality of care” (Kemper et al. 2016).

Regardless of the reasons for burnout or its immediate presenting consequences, it is a threat to the healthcare providers and their patients. In fact, it is a threat to the entire healthcare system as it contributes to the shortage of doctors and nurses. Hence, preventing existing healthcare workers from burning out has to be a priority. Mindfulness has been demonstrated to be helpful in treating and preventing burnout, increasing resilience, and improving sleep. Another factor that could affect healthcare workers’ responses to stress is self-compassion. By treating oneself with kindness and understanding the effects of stress can be mitigated. So, it makes sense to investigate the relationship of mindfulness and self-compassion to stress symptoms in healthcare workers.

In today’s Research News article “Are Mindfulness and Self-Compassion Associated with Sleep and Resilience in Health Professionals?” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1334256059931650/?type=3&theater

or see summary below or view the full text of the study at:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4523072/

Kemper and colleagues do just that. They solicited participation of adult healthcare workers (n = 213) via email which provided a link to a survey that measured demographic characteristics, mindfulness, self-compassion, sleep, resilience, global mental and physical health, and perceived stress. Simple correlation analysis and multiple linear regression analysis were performed upon the survey responses.

They found that the higher the level of mindfulness, self-compassion, resilience, and physical and mental health the lower the level of sleep disturbance and the greater the level of resilience. The greater the level of perceived stress the greater the sleep disturbance and the lower the resilience. Mindfulness and self-compassion were highly related and the higher their levels the greater the levels of physical and mental health and the lower the levels of sleep disturbances and perceived stress.

These findings underscore the significant positive relationships between mindfulness and self-compassion with resilience and with mental and physical health and significant negative relationships with sleep problems and stress. Hence, being more mindful improves the chance that the healthcare worker will be more resilient, healthier, less stressed, and sleep better. Similarly, having greater self-compassion, being kind and understanding toward the self, also improves the chance that the individual will be more resilient, healthier, less stressed, and sleep better. So, mindfulness and self-compassion appear to improve the health and well-being of healthcare workers. But, it should be noted that the study was correlational and did not manipulate mindfulness and self-compassion. So, causal connections cannot be conclusively demonstrated.

So, improve sleep and resilience with mindfulness and self-compassion.

“Mindfulness gives doctors permission to attend to their own health and well-being. But it also allows doctor to help patients by listening more, talking less, and seeing what the patients need.” – Catherine Beach

CMCS – Center for Mindfulness and Contemplative Studies

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts

Study Summary

Kemper, K. J., Mo, X., & Khayat, R. (2015). Are Mindfulness and Self-Compassion Associated with Sleep and Resilience in Health Professionals? Journal of Alternative and Complementary Medicine, 21(8), 496–503. http://doi.org/10.1089/acm.2014.0281

Abstract

Objectives: To describe the relationship between trainable qualities (mindfulness and self-compassion), with factors conceptually related to burnout and quality of care (sleep and resilience) in young health professionals and trainees.

Design: Cross-sectional survey.

Setting: Large Midwestern academic health center.

Participants: 213 clinicians and trainees.

Outcome measures: Sleep and resilience were assessed by using the 8-item PROMIS Sleep scale and the 6-item Brief Resilience Scale. Mindfulness and self-compassion were assessed using the 10-item Cognitive and Affective Mindfulness Scale, Revised and the 12-item Self-Compassion Scale. Health was assessed with Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health measures, and stress was assessed with the 10-item Perceived Stress Scale. After examination of descriptive statistics and Pearson correlations, multiple regression analyses were done to determine whether mindfulness and self-compassion were associated with better sleep and resilience.

Results: Respondents had an average age of 28 years; 73% were female. Professions included dieticians (11%), nurses (14%), physicians (38%), social workers (24%), and other (12%). Univariate analyses showed normative values for all variables. Sleep disturbances were significantly and most strongly correlated with perceived stress and poorer health, but also with less mindfulness and self-compassion. Resilience was strongly and significantly correlated with less stress and better mental health, more mindfulness, and more self-compassion.

Conclusions: In these young health professionals and trainees, sleep and resilience are correlated with both mindfulness and self-compassion. Prospective studies are needed to determine whether training to increase mindfulness and self-compassion can improve clinicians’ sleep and resilience or whether decreasing sleep disturbances and building resilience improves mindfulness and compassion.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4523072/

Improve Physician Care of Patients and Themselves with Religious Practice

September 4, 2016 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“Patients need to believe in their doctor. An empathetic touch can make all the difference and also be the key to medical success. . . The tragedy of burnout is that it effaces genuine empathy, spirituality, and commitment. Nietzsche put it best: “Physician, heal thyself: Then wilt thou also heal thy patient.” – Tom Murphy

Stress is epidemic in the western workplace with almost two thirds of workers reporting high levels of stress at work. In high stress occupations burnout is all too prevalent. This is the fatigue, cynicism, emotional exhaustion, and professional inefficacy that comes with work-related stress. Healthcare and teaching are high stress occupations. It is estimated that over 45% of healthcare workers experience burnout with emergency medicine at the top of the list, over half experiencing burnout. Currently, over a third of healthcare workers report that they are looking for a new job. Nearly half plan to look for a new job over the next two years and 80% expressed interest in a new position if they came across the right opportunity.

Burnout frequently results from emotional exhaustion. This exhaustion not only affects the healthcare providers personally, but also the patients, as it produces a loss of enthusiasm, empathy, and compassion. Regardless of the reasons for burnout or its immediate presenting consequences, it is a threat to the healthcare providers and their patients. In fact, it is a threat to the entire healthcare system as it contributes to the shortage of doctors and nurses. Hence, preventing burnout has to be a priority. Mindfulness has been demonstrated to be helpful in treating and preventing burnout. Religiosity and spirituality are also known to help improve mental health and well-being.

In today’s Research News article “An exploration of the role of religion/spirituality in the promotion of physicians’ wellbeing in Emergency Medicine.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1313533765337213/?type=3&theater

or see summary below or view the full text of the study at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4929145/, Salmoirago-Blotcher and colleagues surveyed emergency room physicians measuring burnout, maladaptive behaviors, malpractice, religiosity, religious affiliation, spirituality, private religious/spiritual practice, and religious commitment. They found that high levels of burnout were associated with being single or divorced, and not surprisingly with high numbers of patients seen, hours on call, and shifts each month. There were no significant relationships between religiosity/spirituality and burnout. They did find, however, that the greater the observance of a religious day of rest, the lower the levels of malpractice and maladaptive behaviors. In addition, the greater the attendance at religious services the lower the level of maladaptive behaviors.

These results are interesting and suggest that although not directly associated with burnout, religious practice was associated with higher quality of medical services provided to the patients, as evidenced by fewer malpractice suits, and the better care the physicians took of themselves, as evidenced by low maladaptive behaviors. The maladaptive behaviors included smoking, drug use and addiction, and alcohol use. It is interesting that the results were not due to the levels of spirituality or religiosity themselves but rather to participation in religious services and taking a religious day of rest. This suggests that the effects may be the result taking time off to go to church and rest may be important for physicians well-being. Since, this was a correlational study, however, it’s possible that the causation was in the opposite direction with the kinds of physicians who participated in religious practices also being the type of physicians who take better care of themselves and others.

So, improve physician care of patients and themselves with religious practice.

“We can’t afford to ignore the potential effect of spirituality and religion on health.” – Alexandra Shields

CMCS – Center for Mindfulness and Contemplative Studies

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts

Study Summary

Salmoirago-Blotcher, E., Fitchett, G., Leung, K., Volturo, G., Boudreaux, E., Crawford, S., … Curlin, F. (2016). An exploration of the role of religion/spirituality in the promotion of physicians’ wellbeing in Emergency Medicine. Preventive Medicine Reports, 3, 189–195. http://doi.org/10.1016/j.pmedr.2016.01.009

Abstract

Background: Burnout is highly prevalent among Emergency Medicine (EM) physicians and has significant impact on quality of care and workforce retention. The objective of this study was to determine whether higher religion/spirituality (R/S) is associated with a lower prevalence of burnout among EM physicians (primary outcome). A history of malpractice lawsuits and maladaptive behaviors were the secondary outcomes. Methods: This was a cross-sectional, survey-based study conducted among a random sample of physicians from the Massachusetts College of Emergency Physicians mailing list. Burnout was measured using a validated 2-item version of the Maslach Burnout Inventory. Maladaptive behaviors (smoking, drinking, and substance use) and medical malpractice were self-reported. R/S measures included organized religiosity, religious affiliation, private R/S practice, self-rated spirituality, religious rest, and religious commitment. Logistic regression was used to model study outcomes as a function of R/S predictors. Results: Of 422 EM physicians who received the invitation to participate, 138 completed the survey (32.7%). The prevalence of burnout was 27%. No significant associations were observed between burnout and R/S indicators. Maladaptive behaviors (adjusted OR = 0.42, CI: 0.19 to 0.96; p = 0.039) and history of medical malpractice (adjusted OR = 0.32; CI: 0.11 to 0.93; p = 0.037) were less likely among physicians reporting to be more involved in organized religious activity and to observe a day of rest for religious reasons, respectively. Conclusion: This study provides preliminary evidence for a possible protective association of certain dimensions of R/S on maladaptive behaviors and medical malpractice among EM physicians.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4929145/

Reduce Job Burnout with Mindfulness

August 2, 2016February 6, 2017 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“Mindfulness’s deliberate presence allows for improvement in care of peers and patients even when not directly caring for them in a medical manner. And it is this deliberate presence that can provide individuals with tools to be mentally and emotionally centered in a professional field that demands continuously increasing forms of self-sacrifice.” – Ayoosh Pareek

Burnout frequently results from emotional exhaustion. This exhaustion not only affects the healthcare providers and teachers personally, but also the patients and students, as it produces a loss of enthusiasm, empathy, and compassion. Regardless of the reasons for burnout or its immediate presenting consequences, it is a threat to the healthcare providers and their patients and to schools and their students. In fact, it is a threat to the entire healthcare and educational systems as it contributes to the shortage of doctors, nurses, and teachers. Hence, preventing burnout has to be a priority. Mindfulness has been demonstrated to be helpful in treating and preventing burnout.

In today’s Research News article “Systematic Review of Mindfulness Practice for Reducing Job Burnout.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1284829924874264/?type=3&theater

or below or view the full text of the study at:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4776732/

Luken and Sammons reviewed the published research literature on the effectiveness of mindfulness training in treating professional burnout. They found that all of the published studies used between-groups designs with waitlist control groups. The studies also employed either modified forms of the Mindfulness-Based Stress Reduction (MBSR) program or other mindfulness training programs. They found that the majority of the published research literature provided clear evidence of efficacy. Mindfulness training was found to significantly reduce burnout in both healthcare professionals and teachers.

The hallmark of Mindfulness-Based Stress Reduction (MBSR) and mindfulness training in general is the reduction in stress; not actual stress but the individual’s physical and psychological responses to stress. Stress is still felt but the individual reacts less and responds more adaptively to it. This is very helpful in dealing with the high levels of stress that teachers and healthcare workers experience on a daily basis. It is this stress that drains the individual and eventually produces exhaustion. Hence, stress reduction is a major contributor to the observed reduction in burnout.

Mindfulness training also makes the individual more aware of their own immediate physical and emotional state. Since this occurs in real time, it provides the individual the opportunity to recognize what is happening and respond to it effectively before it contributes to an overall state of burnout. Indeed, mindfulness training has been shown to significantly improve emotion regulation. This produces clear experiencing of the emotion in combination with the ability to respond to the emotion adaptively and effectively. So, teachers and healthcare worker can recognize their state, realize its origins, not let it affect their performance, and respond to it appropriately, perhaps by the recognition that rest is needed. This too contributes to mindfulness training’s ability to reduce burnout.

So, reduce job burnout with mindfulness.

CMCS – Center for Mindfulness and Contemplative Studies

“While the practice of mindfulness is never a “cure-all”, research suggests that it is a powerful foundation upon which teachers can start to build their social-emotional skills—and, in turn, improve their teaching. So while we may never be able to stop that student from making an offensive remark, we can control our reaction—which, in the end, may make the student think twice about doing it again.” – Vicki Zakrzewski

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts

Study Summary

Luken, M., & Sammons, A. (2016). Systematic Review of Mindfulness Practice for Reducing Job Burnout. The American Journal of Occupational Therapy, 70(2), 7002250020p1–7002250020p10. http://doi.org/10.5014/ajot.2016.016956

Abstract

OBJECTIVE. A systematic search and critical appraisal of interdisciplinary literature was conducted to evaluate the evidence for practicing mindfulness to treat job burnout and to explore implications for occupational therapy practitioners.

METHOD. Eight articles met inclusion criteria. Each study was assessed for quality using the Physiotherapy Evidence Database scale. We used the U.S. Agency for Health Care Policy and Research guidelines to determine strength of evidence.

RESULTS. Of the studies reviewed, participants included health care professionals and teachers; no studies included occupational therapy practitioners. Six of the 8 studies demonstrated statistically significant decreases in job burnout after mindfulness training. Seven of the studies were of fair to good quality.

CONCLUSION. There is strong evidence for the use of mindfulness practice to reduce job burnout among health care professionals and teachers. Research is needed to fill the gap on whether mindfulness is effective for treating burnout in occupational therapy practitioners.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4776732/

Keep Health Care Professionals from Burning Out with Mindfulness

March 29, 2016September 25, 2020 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“Through practicing mindfulness we become more aware of subtle changes in our mood and physical health, and can start to notice more quickly when we are struggling. Rather than waiting for a full meltdown before we take action, we can read the signals of our minds and bodies and start to take better care of ourselves.” – The Mindfulness Project

Stress is epidemic in the western workplace with almost two thirds of workers reporting high levels of stress at work. In high stress occupations burnout is all too prevalent. This is the fatigue, cynicism, emotional exhaustion, and professional inefficacy that comes with work-related stress. Healthcare is a high stress occupation. It is estimated that over 45% of healthcare workers experience burnout with emergency medicine at the top of the list, over half experiencing burnout. Currently, over a third of healthcare workers report that they are looking for a new job. Nearly half plan to look for a new job over the next two years and 80% expressed interest in a new position if they came across the right opportunity.

Burnout is not a unitary phenomenon. In fact, there appear to be a number of subtypes of burnout. The overload subtype is characterized by the perception of jeopardizing one’s health to pursue worthwhile results, and is highly associated with exhaustion. The lack of development subtype is characterized by the perception of a lack of personal growth, together with the desire for a more rewarding occupation that better corresponds to one’s abilities. The neglect subtype is characterized by an inattentive and careless response to responsibilities, and is closely associated with inefficacy. All of these types result from an emotional exhaustion. This exhaustion not only affects the healthcare providers personally, but also the patients, as it produces a loss of empathy and compassion.

Regardless of the reasons for burnout or its immediate presenting consequences, it is a threat to the healthcare providers and their patients. In fact, it is a threat to the entire healthcare system as it contributes to the shortage of doctors and nurses. Hence, preventing existing healthcare workers from burning has to be a priority. Mindfulness has been demonstrated to be helpful in treating and preventing burnout. One of the premiere techniques for developing mindfulness and dealing effectively with stress is Mindfulness Based Stress Reduction (MBSR) pioneered by Jon Kabat-Zinn. It is a diverse mindfulness training containing practice in meditation, body scan, and yoga. As a result, there have been a number of trials investigating the application of MBSR to the treatment and prevention of health care worker burnout.

In today’s Research News article “Outcomes of MBSR or MBSR-based interventions in health care providers: A systematic review with a focus on empathy and emotional competencies”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1197241983633059/?type=3&theater

http://www.complementarytherapiesinmedicine.com/article/S0965-2299(15)30014-5/fulltext

Lamothe and colleagues summarize the published literature on the effectiveness of Mindfulness Based Stress Reduction (MBSR) for healthcare worker burnout. They found that the preponderance of evidence from a variety of different trials indicated that MBSR treatment is effective for burnout. In particular, the research generally reports that MBSR treatment significantly improves mindfulness, empathy, and the mental health of healthcare workers. It was found to significantly relieve burnout, and reduce anxiety, depression, and perceived stress.

Hence, the published literature is highly supportive of the application of MBSR for the prevention and treatment of healthcare worker burnout. It appears to not only help the worker, but the improvement in the empathy of the worker projects positive consequences for the patients. In addition, the reduction in burnout suggests that MBSR treatment may help to reduce healthcare workers leaving the field, helping to relieve the systemic lack of providers. These are remarkable and potentially very important results.

Mindfulness training makes the individual more aware of their own immediate physical and emotional state. Since this occurs in real time, it provides the individual the opportunity to recognize what is happening and respond to it effectively before it contributes to an overall state of burnout. Indeed, mindfulness training has been shown to significantly improve emotion regulation. This produces clear experiencing of the emotion in combination with the ability to respond to the emotion adaptively and effectively. So, the healthcare worker can recognize their state, realize its origins, not let it affect their performance, and respond to it appropriately, perhaps by the recognition that rest is needed.

So, keep health care professionals from burning out with mindfulness.

“It helps people to undo some of the sense of the time pressure and urgency that makes it so hard to feel present for your patient, and it helps your patients feel like you’re really there, really listening and that you really care. What you learn is to undo the distractedness that comes with worrying about what happens next, and the concern with what’s already over and done with. It doesn’t take more time; it takes an intention and practice to do it successfully.” – Dr. Michael Baime

CMCS – Center for Mindfulness and Contemplative Studies

Burnout Doctor Burnout with Mindfulness

February 15, 2016 psyjdc Leave a comment

“Something very alarming is going on in the American healthcare system nowadays. Doctors aren’t happy, and neither are patients. The proverbial admonition, “Happy doctors make for happy patients” comes to mind with the caveat that the reverse is also true.” Thomas Murphy

With the advent of managed care and the Affordable Healthcare Act in the U.S., primary healthcare providers have become a critical component of the healthcare system. Unfortunately, there is a marked shortage of these providers. It is estimated that in the U.S. there are over 9,000 fewer primary care physicians than needed. The shortages are not just due to training insufficient numbers of healthcare providers but also due to high turnover rates. In part because of the shortage and high patient loads, primary healthcare providers experience high stress and burnout. They experience a loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment.

In a recent survey 46% of all physicians responded that they had burnout. Currently, over a third of healthcare workers report that they are looking for a new job. Nearly half plan to look for a new job over the next two years and 80% expressed interest in a new position if they came across the right opportunity. Since there is such a great need to retain primary healthcare providers, it is imperative that strategies be identified to decrease stress and burnout.

Doctors appear to vary in resilience, in their ability to withstand the stress of practice and not burnout. They also vary in mindfulness which has been shown to be effective in preventing and treating healthcare professional burnout (see http://contemplative-studies.org/wp/index.php/category/research-news/burnout/). In today’s Research News article “Mindfulness, Resilience, and Burnout Subtypes in Primary Care Physicians: The Possible Mediating Role of Positive and Negative Affect”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1166142213409703/?type=3&theater

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4681844/

Montero-Marin and colleagues investigate the relationship of resilience, mindfulness, and emotions to burnout in 622 Spanish primary care physicians. Using sophisticated statistical techniques, they found that the three types of burnout were highly positively associated, with high levels of each associated with high levels of all the other types. They also found that mindfulness and resilience were highly related, with higher levels of mindfulness associated with higher levels of resilience.

The overload type of burnout was directly associated with both negative emotions and mindfulness. In addition, both mindfulness and resilience appeared to affect overload indirectly by reducing negative emotions and thereby reducing overload burnout. The lack of development type of burnout was negatively associated with positive emotions and resilience was positively associated with positive emotions. So, resilience appeared to affect lack of development burnout by increasing positive emotions which in turn decrease lack of development burnout. Thereby, high levels of resilience were associated with low levels of lack of development. Finally, they found that resilience was negatively related to neglect burnout such that the higher the levels of resilience, the lower the neglect burnout.

These are complex interrelationships. But in general they suggest that the mindfulness and the resilience of the physicians were highly related and worked in consort to reduce all types of primary care physician burnout and they do so, at least in part, by affecting the positive and negative emotions of the physicians. They may do so by different mechanisms, mindfulness by reducing the psychological and physical responses to stress and resilience by increasing the ability to withstand the stress.

Regardless, burnout doctor burnout with mindfulness.

“The benefits of mindful practice extend beyond the practitioner to his or her patients. It is not only that mindful practitioners can listen attentively, but that their patients are empowered to make their voice heard in areas that matter to them.” – Mary Catherine Beach
CMCS – Center for Mindfulness and Contemplative Studies