Nearly 50% of the adult workforce experience adverse psychological symptoms (e.g., stress, depression, burnout, etc.) stemming from workplace stressors, with healthcare workers experiencing rates as high as 80%. Some common complaints and downstream consequences of working in high-stress healthcare occupations are elevated levels of perceived stress, depression, and burnout. These conditions have been associated with unfavorable occupational (e.g., increased medical errors), patient (e.g., increased mortality rates), and provider-related outcomes (e.g., increased rates of cardiovascular disease), imposing a heavy burden on an already stretched system. Given the impact of perceived stress, depression, and burnout on employee and patient health, a clear need exists to develop effective interventions to reduce distress and promote well-being among healthcare professionals. In particular, interventions that target processes particularly vulnerable to provider stress (e.g., compassion) are needed.
The present study will evaluate the feasibility and efficacy of a mindfulness-based intervention inspired by the Buddhist Four Immeasurables practice on reducing perceived stress (primary outcome), depressive symptoms, burnout, and biological markers of inflammation, and enhancing psychological well-being and sleep quality (secondary outcomes) in 80 healthcare workers. Additionally, we will investigate several mediators (compassion, positive emotions, equanimity, and mindfulness) of intervention effects. Participants will be healthcare employees of UCLA Health. They will be enrolled in a six-week, two-arm randomized controlled trial. Participants will complete self-report questionnaires at baseline, mid-course, and post-intervention to assess study outcomes and mediators. We aim to advance the study of interventions that reduce distress and promote well-being using practices that cultivate kind feelings toward oneself and others.
None
None
Parallel
Building Emotional Strength Training
BehavioralThe BEST intervention was designed as a secularized version of the traditional Four Immeasurables practice to promote the distinct emotional states of loving-kindness, compassion, sympathetic joy, and equanimity. Each session provides structured training and exercises in mindfulness, including formal meditation practices and strategies for the daily informal use of mindfulness, as well as opportunity for questions and group discussion. Home practice is a key component of BEST and is particularly important for addressing stress in daily life. Participants will be instructed to practice mindfulness techniques on a daily basis, beginning with five minutes and increasing to 20 minutes, with practice prior to work or other stress-inducing situations.
Mean Change from Baseline in Perceived Stress as Assessed by the Perceived Stress Scale
Stress will be assessed using the ten-item Perceived Stress Scale (PSS). The PSS evaluates how often individuals appraised situations in their lives as stressful during the past month (e.g., "In the last month, how often have you been angered because of things that were outside of your control?"). Respondents respond on a five-point Likert scale from 0 (never) to 4 (very often). All scores are summed to provide a total stress score. Scores range from 0 to 40, with higher scores indicating a higher level of perceived stress. The PSS has been widely used with healthcare professional populations and has been shown to be responsive to mindfulness-based interventions.
Mean Change from Baseline in Depressive Symptoms as Assessed with the Center for Epidemiological Studies Depression Scale
Depressive symptoms will be based on scores on the 20-item Center for Epidemiologic Studies-Depression Scale (CES-D), a commonly used depression measure. The CES-D is a reliable, validated, and widely used measure that includes central components of depressive symptomatology, including depressed mood, worthlessness, hopelessness, loss of appetite, and psychomotor retardation. Respondents respond to twenty statements that assess how often the individual felt or behaved during the past week (e.g., "I felt that I could not shake off the blues even with help from my family and friends") on a four-point Likert scale from 0 (rarely or none of the time \[less than 1 day\]) to 3 (most or all of the time \[5-7 days\]). All 20 items will be summed to provide a total score. The possible range of scores is 0-60, with higher scores indicating a greater frequency of depressive symptoms. The CES-D has frequently been used to assess depressive symptoms in healthcare workers.
Mean Change from Baseline in Burnout as Assessed with the Maslach Burnout Inventory for Medical Personnel
Burnout will be measured via the 22-item Maslach Burnout Inventory for Medical Personnel (MBI-M). The MBI-M measures three components of burnout: emotional exhaustion, depersonalization, and reduced personal accomplishment. Emotional exhaustion refers to feeling emotionally overextended and exhausted by one's work. Depersonalization refers to an impersonal response toward the recipients of one's services. Personal accomplishment refers to feelings of competence and achievement in work-related pursuits. Items are scored on a 7-point Likert scale from 0 (never) to 6 (every day). Higher scores on the emotional exhaustion and depersonalization subscales correspond to a greater experience of burnout. The personal accomplishment subscale is positively worded; therefore, a one-item increase corresponds to a greater experience of work-related efficacy. Each subscale will be summed, providing a total score for emotional exhaustion, depersonalization, and personal accomplishment.
Mean Change from Baseline in Psychological Well-being as Assessed with the Mental Health Continuum Short Form
Well-being will be measured using the 14-item Mental Health Continuum Short Form (MHC-SF). The MHC-SF is a 14-item scale that measures three dimensions of psychological well-being: hedonic, eudaimonic-social, and eudaimonic-psychological. Hedonic well-being refers to pleasurable states characterized by the presence of positive and absence of negative affect. Eudaimonic social well-being refers to flourishing within a social context characterized by social coherence and actualization. Eudaimonic psychological well-being refers to a sense of living a life of purpose, characterized by feelings of personal growth and self-actualization. Respondents respond to the fourteen items to assess how often they felt concerning the statements during the past month, using a six-point Likert scale ranging from 0 (never) to 5 (every day). All scores are summed to provide a total well-being score. The possible range of scores is 0-70, with higher scores indicating greater subjective well-being.
Mean Change from Baseline in Sleep Quality as Assessed with the Insomnia Severity Index
Sleep quality will be assessed using the seven-item Insomnia Severity Index (ISI). The ISI is a reliable and valid self-report measure that evaluates the severity and impact of insomnia over the past two weeks. Respondents are asked to respond to the seven items to assess how they relate to each statement over the past two weeks, using a five-point Likert scale ranging from 0 (not at all) to 4 (very much). Scores are summed to obtain a total score. The possible range of scores on the ISI is 0-28, with higher scores indicating more severe insomnia. Additionally, scores of 15 or higher are indicative of clinically significant insomnia. The ISI has been validated for use with healthcare professionals and shown to be responsive to mindfulness interventions.
Mean Change from Baseline in Self-compassion as Assessed with the Self-Compassion Scale
Self-compassion will be assessed using the 12-item Self-Compassion Scale-Short Form (SCS-SF). The SCS-SF assesses an individual's global tendency to show kindness, concern, and sympathy for one's own suffering. The scale has six subscales with two items each: self-kindness (compassion for oneself during difficult moments), self-judgment (disapproval or intolerance of oneself), common humanity (appreciation of the universal nature of having flaws and inadequacies), isolation (experiencing failures alone), mindfulness (balance and poise during difficult moments), and over-identification (obsessing over negative feelings). Individuals answer how often they generally behave in a stated manner on a five-point Likert scale from 1 (almost never) to 5 (almost always) in response to the 12 items. Scores range from 1 - 5, with higher scores indicating greater feelings of self-compassion. The SCS-SF has been used in the context of an intervention for healthcare workers.
Mean Change from Baseline in Compassion for Others as Assessed with the Compassion Scale
Compassion for others will be assessed using the 16-item Compassion Scale (CS) (129). The CS comprises four subscales, each with four items, that determine how one generally reacts toward others. The four subscales include kindness (compassion and caring towards others during times of difficulty), common humanity (appreciation for the universal experience of pain), mindfulness (awareness of others and their experiences), and indifference (an unsympathetic demeanor towards the suffering of others). Individuals answer how often they generally behave in a stated manner on a five-point Likert scale from 1 (almost never) to 5 (almost always) in response to the 16 items. The mean of each subscale is then calculated to compute a total mean (the average of the six subscale means). Scores range from 1 - 5, with higher scores indicating greater feelings of compassion for others. The CS has been used in healthcare worker populations .
Mean Change from Baseline in Positive and Negative Emotions as Assessed with the modified Differential Emotions Scale
Positive emotions will be assessed using the 20-item modified Differential Emotions Scale (mDES) (133). The mDES is based on Fredrickson's Broaden-and-Build theory of positive emotions and assesses the degree to which individuals experience a spectrum of discrete positive and negative emotions within a given timeframe. The questionnaire includes ten items assessing positive emotions, such as contentment, amusement, and awe, and ten items assessing negative emotions, such as sadness, shame, anger, and hatred. The mDES attempts to capture the experience of both high and low arousal positive and negative emotions. For each item, respondents indicate the extent to which they felt a specific emotion in the past 24 hours on a five-point Likert scale, ranging from 0 (not at all) to 4 (extremely). Each subscale (positive and negative) is independent of the other, so the mDES will yield a total score for both positive and negative emotions. Scores on each subscale range from 0 to 40.
Mean Change from Baseline in Equanimity as Assessed with the Equanimity Scale
Equanimity will be assessed using the 16-item Equanimity Scale (ES-16). The ES-16 assesses the tendency of an individual to act in a balanced, calm, and even-tempered manner toward all experiences (positive or negative). The scale comprises two subscales, each consisting of eight items: experiential acceptance (neutrality toward all internal experiences) and non-reactivity (an evenness of response toward all experiences). Example items include, "When I experience distressing thoughts and images, I can accept the experience," and "I can pay attention to what is happening in my body without disliking or wanting more of the feeling or sensation." Individuals respond on a five-point Likert scale from 1 (strongly disagree) to 5 (strongly agree) to indicate how they view themselves. The eight items from the non-reactivity subscale are reverse-scored. All 16 items are summed to provide a total score. Scores range from 16 - 80, with higher scores indicating greater levels of equanimity.
Click on the lead sponsor to view all of their trials.
