Article

The impact of mindfulness on wellbeing and performance in the workplace: An inclusive systematic review of the empirical literature

Abstract and Figures

Work can be demanding, imposing challenges that can be detrimental to the physical and mental health of workers. Efforts are therefore underway to develop practices and initiatives that may improve occupational wellbeing. These include interventions based on mindfulness meditation. This paper offers a systematic review of empirical studies featuring analyses of mindfulness in occupational contexts. Databases were reviewed from the start of records to January 2016. Eligibility criteria included experimental and correlative studies of mindfulness conducted in work settings, with a variety of wellbeing and performance measures. 153 papers met the eligibility criteria and were included in the systematic review, comprising 12,571 participants. Mindfulness was generally associated with positive outcomes in relation to most measures. However, the quality of the studies was inconsistent, so further research is needed, particularly involving high-quality randomised control trials.
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The impact of mindfulness on wellbeing and performance in the workplace: An
inclusive systematic review of the empirical literature.
Authors
Tim Lomas1†, Juan Carlos Medina2, Itai Ivtzan1, Silke Rupprecht3, Rona Hart1, Francisco
Eiroa-Orosa1
1 School of Psychology, University of East London, Arthur Edwards Building, Water Lane,
London, E15 4LZ, United Kingdom
2 Faculty of Psychology, University of Barcelona, Passeig de la Vall d'Hebron, 08035
Barcelona, Spain
3 Leuphana University, Scharnhorststraße 1, 21335 Lüneburg, Germany
Author responsible for correspondence:
Email: t.lomas@uel.ac.uk
Note: This article may not exactly replicate the final published version. It is not the copy of
record.
Page 2 of 52
Abstract
Work can be demanding, imposing challenges that can be detrimental to the physical and
mental health of workers. Efforts are therefore underway to develop practices and initiatives
that may improve occupational wellbeing. These include interventions based on mindfulness
meditation. This paper offers a systematic review of empirical studies featuring analyses of
mindfulness in occupational contexts. Databases were reviewed from the start of records to
January 2016. Eligibility criteria included experimental and correlative studies of mindfulness
conducted in work settings, with a variety of wellbeing and performance measures. 153 papers
met the eligibility criteria and were included in the systematic review, comprising 12,571
participants. Mindfulness was generally associated with positive outcomes in relation to most
measures. However, the quality of the studies was inconsistent, so further research is needed,
particularly involving high-quality randomised control trials.
Keywords: mindfulness; meditation; occupation; wellbeing; systematic review.
Practitioner points:
- Understand the value of mindfulness in the workplace
- Appreciate the strengths and weaknesses of the underlying evidence base
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Introduction
Work appears to be increasingly stressful in the UK, posing a risk to employees’ mental
health. This claim is based upon the observation that although the prevalence of mental illness
in the general UK population has not significantly increased in the last twenty years (Office for
National Statistics, 2014), since 2009 the number of sick days lost to stress, depression and
anxiety has increased by 24%, while the number lost to serious mental illness has doubled
(Davies, 2014). The annual report by Davies, the UK’s Chief Medical Officer, suggests mental
ill health is the leading cause of sickness absence in the UK, accounting for 70 million sick
days (more than half of the 130 million sick days taken every year). Given this context, there
are ongoing efforts to develop initiatives to help people deal with the stresses of work, and to
protect against or ameliorate work-related mental health issues. In recent years, among the most
prominent are programmes based on mindfulness meditation mindfulness-based
interventions (MBIs) which is the focus of this review.
Mindfulness
Recent decades have seen a burgeoning interest in mindfulness in the West, spanning
clinical practice, academia, and society more broadly. Mindfulness is generally regarded as
originating in the context of Buddhism around 500 B.C.E, though its roots stretch back even
further as part of the Brahmanic traditions in the Indian subcontinent (Cousins, 1996). It came
to prominence in the West through Kabat-Zinn (1982), who harnessed it for an innovative
Mindfulness-Based Stress Reduction (MBSR) programme (discussed further below) for
chronic pain. The term ‘mindfulness’ is polysemous, frequently used to refer to both: (1) a state
or quality of mind; and (2) a form of meditation that enables one to cultivate this. Both uses
will be deployed in this review (with the context making clear which is being used). The most
prominent operationalisation of mindfulness as a state/quality is Kabat-Zinn’s (2003, p.145)
definition: ‘the awareness that arises through paying attention on purpose, in the present
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moment, and nonjudgmentally to the unfolding of experience moment by moment.’ Shapiro,
Carlson, Astin, and Freedman (2006) formulated a theoretical elucidation of this definition,
deconstructing it into three components: intention (motivation for paying attention in this way);
attention (cognitive processes through which said attention is enacted); and attitude (the
emotional qualities and/or mental stance one adopts with respect to the object of attention, such
as compassion or non-judging).
The second main usage of the term mindfulness is for the forms of meditation practice
which can facilitate this mindful state. Mindfulness meditation, and meditation more broadly,
refers to mental activities which share a common focus on training the self-regulation of
attention and awareness (Lomas, Ivtzan, & Fu, 2015), with the goal of enhancing voluntary
control of mental processes, thereby increasing wellbeing (Walsh & Shapiro, 2006). Lutz,
Slagter, Dunne, and Davidson (2008) suggest most common forms feature either focused
attention’ or ‘open-monitoring’ processes. Focused attention can be operationalised in terms of
the co-ordination of various attention networks (Posner & Petersen, 1990), including sustained
attention (towards a target, like the breath), executive attention (preventing one’s focus from
wandering), attention switching (disengaging from distractions), and selective attention and
attention re-orienting (redirecting focus back to the target). In contrast, open-monitoring refers
to a broader receptive capacity to detect events within an unrestricted ‘field’ of awareness
(Raffone & Srinivasan, 2010). Mindfulness both as a practice, and as a state/quality is
commonly presented as an example of open-monitoring (Kabat-Zinn, 2003). However, in
practice, mindfulness meditation usually involves a combination of both forms, beginning with
a period of focused attention on a target, like the breath, in order to focus awareness, followed
by more receptive open-monitoring (Chiesa, Calati, & Serretti, 2011).
According to Shapiro et al. (2006), the main significance of mindfulness as a
quality/state, and as a practice is that it involves a meta-mechanism known as reperceiving.
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The three components of mindfulness (intention, attention and attitude) combine to generate a
‘fundamental shift in perspective,’ in which ‘rather than being immersed in the personal drama
or narrative of our life story, we are able to stand back and witness it (p.377). Thus, in
practising mindfulness, people are seen as learning how to enter a different relationship with
their subjectivity: being able to ‘stand back’ and dispassionately view qualia i.e., the contents
of their subjectivity (e.g., thoughts, feelings) as phenomena passing though their internal
world, rather than identifying with and attaching to or becoming averse to such qualia (Bishop
et al., 2004). This ‘standing back’ referred to by Shapiro et al. as ‘reperceiving’ is also
known as ‘decentring,’ i.e., ‘the ability to observe one’s thoughts and feelings as temporary,
objective events in the mind, as opposed to reflections of the self that are necessarily true’
(Fresco et al., 2007, p.234).
Crucially, Shapiro et al. (2006) theorise reperceiving/decentring as having a positive
impact upon wellbeing. In MBIs, the aim is not to change participants’ thoughts/feelings per
se, as cognitive therapy might seek to, but to help people ‘become more aware of, and relate
differently to’ this content (Shapiro, Astin, Bishop, & Cordova, 2005, p.165). Thus, MBIs
involve ‘retraining awareness’ so that people have greater choice in how they relate and
respond to their subjective experience, rather than habitually responding in maladaptive ways
(Chambers, Gullone, & Allen, 2009, p.659). The positive impact of retraining awareness is
thought to impact positive on mental health, potentially in the following way: (a) mindfulness
involves introspective practices that facilitate the development of attention and awareness
skills; (b) development of these skills leads to enhanced emotional regulation (including
abilities such as reperceiving); and (c) emotional regulation is a meta-skill that subserves
manifold wellbeing outcomes (while, conversely, poor regulation is a transdiagnostic factor
underlying diverse psychopathologies) (Aldao, Nolen-Hoeksema, & Schweizer, 2010).
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Mindfulness interventions were initially limited to clinical settings. The first was
Kabat-Zinn’s (1982) MBSR program, which was used to treat chronic pain, before being
applied in the treatment of other conditions, such as stress and anxiety (Ledesma & Kumano,
2009). MBSR is a group-based programme, typically involving 8-10 weekly meetings
delivered by a trained mindfulness teacher, in which participants are offered mindfulness
meditation teaching and an opportunity to practice a variety of mindfulness meditative
techniques. This is often accompanied by group work, and individual support (e.g.,
opportunities for participants to discuss their experiences with the programme facilitator, and
ideally to receive appropriate guidance, encouragement, and emotional support). Importantly,
participants are expected to practice mindfulness daily and to continue this after the completion
of the training. Subsequently, other clinical interventions adapted the MBSR protocol for the
treatment of specific mental health problems, such as Mindfulness-Based Cognitive Therapy
for recurrent depression (MBCT) (Segal, Williams, & Teasdale, 2002).
However, since the late 1990s, there has been increasing interest in the use of MBIs in
occupational contexts, not only for staff who may be suffering with stress and mental health
issues, but for workers more generally, as a means to improve wellbeing and performance, as
well as a protective measure for building resilience against stress and burnout (Shapiro,
Schwartz, & Bonner, 1998). As such, the current paper aims to assess the current literature on
mindfulness in the workplace. While a number of such reviews have already been conducted,
these tend to have fairly narrow remits, focusing exclusively on specific populations, such as
school staff (Weare, 2014) or healthcare providers (Lamothe et al., 2016), or on specific
outcomes, such as burnout (Luken & Sammons, 2016), or on specific interventions like MBSR
(Chiesa & Serretti, 2009; Lamothe et al., 2016). By contrast, this paper aims for inclusivity,
reporting the results of a far broader systematic review, focusing on the impact of mindfulness
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generally (not limited to any one intervention), on a wide range of wellbeing and performance
outcomes, in workers across all occupational contexts.
Methods
The literature search was conducted by the first author using the MEDLINE and Scopus
electronic databases. The criteria were: mindfulness (AND) work OR occupation OR
profession OR staff (in all fields in MEDLINE and limited to article title, abstract, and
keywords in Scopus). The dates selected were from the start of the database records to 28th
January 2016. In terms of PICOS (participants, interventions, comparisons, outcomes and
study design), the key criteria were: participants current employees of a company or
organisation; interventions for the purposes of this review, an MBI was defined as an
intervention in which mindfulness meditation was the central component (as indicated by
mindfulness either featuring in the title of the intervention or being given prominence in the
abstract); outcomes mindfulness, wellbeing, and job performance (with wellbeing used here
as an all-encompassing term, spanning physical and mental health); and study design any
empirical study featuring data collection. Although we were principally interested in studies
which tested the efficacy of MBIs, as a secondary concern we were also interested in non-
intervention studies of mindfulness in the workplace (e.g., regression analyses of the
association between trait mindfulness and health and wellbeing outcomes). Studies were
required to be published (or in press) in a peer-reviewed academic journal, and to be in English.
The review was conducted according to the Preferred Reporting Items for Systematic Reviews
and Meta-Analyses (PRISMA) guidelines (Moher, Liberati, Tetzlaff, & Altman, 2009). The
review protocol was registered with the International Prospective Register of Systematic
Reviews (PROSPERO) database on 5th January 2016. Registration number:
CRD42016032899 (www.crd.york.ac.uk/PROSPERO). The details of the inclusions and
rejections at each stage of the winnowing process are shown as a PRISMA flow diagram in
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supplementary figure 1. The papers selected for inclusion by the first author were separately
checked by the second and last authors, who confirmed in all cases that their inclusion was
warranted.
Inclusion criteria were: (1) research undertaken in an occupational setting; (2) empirical
assessment of mindfulness, wellbeing, and/or performance outcomes; (3) quantitative or
qualitative analysis; (4) published (or in press) in a peer-reviewed academic journal; and (5)
written in English. Regarding point (4), it was deemed necessary to restrict the review in this
way, e.g., instead of also exploring the far broader terrain of registered trials and grey literature,
to keep the review to a manageable size, as well as to ensure a certain level of quality (i.e., as
provided by the peer-review process, which would not necessarily be present with grey
literature). Exclusion criteria were: (1) theoretical articles or commentaries without statistical
or qualitative analyses; and (2) interventions in which mindfulness practice is not the central
component (even if they incorporate elements of mindfulness practice or theory), such as
Acceptance and Commitment Therapy (ACT) (Hayes, Strosahl, & Wilson, 1999). Regarding
this latter point (2), interventions like ACT are sometimes described as ‘incorporating’ or being
‘based on’ mindfulness. Thus, ascertaining whether mindfulness is ‘the central component’ of
these is a judgement call. However, to keep the review to a manageable scale, the focus here is
on interventions that ‘self-identify’ as having mindfulness as their central component
(indicated, as noted above, by mindfulness either featuring in the title of the intervention or
being given prominence in the abstract).
Papers were divided into experimental intervention studies and non-intervention (e.g.,
correlational) studies. For intervention studies, the following variables were extracted from
each paper: type of design (RCT versus non-randomised samples); occupation of participants;
number of experimental and control participants (if applicable); type of MBI; length of MBI;
control condition; principle wellbeing and performance outcomes; and the effect sizes of
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principle outcomes (and in cases where this information was not available, it was calculated).
For non-intervention studies, the following variables were extracted from each paper: type of
analysis (quantitative or qualitative); occupation of participants; number of participants;
wellbeing and performance outcomes; and the regression or correlation coefficients of
outcomes. The primary measures of interest were mindfulness, mental health (anger, anxiety,
burnout, depression, distress, stress, satisfaction, wellbeing), and physical health (illness, diet,
exercise, and sleep). Secondary measures of interest were outcomes that pertain to wellbeing
(compassion, empathy, emotional intelligence and regulation, resilience, and spirituality).
Tertiary summary measures of interest were outcomes relating to job performance (often
specific to particular occupations). Finally, we sought to classify studies in terms of whether
they observed a significant improvement in each outcome in relation to an MBI (or a significant
association with mindfulness in the case of non-intervention studies). This classification e.g.,
per table 3 in the results section was made, where possible, based on effect size (in the case
of intervention studies). In that respect, we applied the usual criterion of Cohen’s d, where d
.20 indicates a change, and small, medium, and large values of d are considered to be 0.2, 0.5,
and 0.8 respectively (Cohen, 1988). In terms of data extraction, the second and last author
independently checked all the 153 included papers, and agreed on the relevant outcomes (as
reported in tables 1 and 2).
The Quality Assessment Tool for Quantitative Studies (QATQS; National
Collaborating Centre for Methods and Tools, 2008) was used to assess the quality of the
studies. QATQS assesses methodological rigor in six areas: (a) selection bias; (b) design; (c)
confounders; (d) blinding; (e) data collection method; and (f) withdrawals and drop-outs. Each
area is assessed on a score of 1 to 3 (1 = strong; 2 = moderate; 3 = weak). If there are no weak
ratings, the study is given a global score of 1 (judged as strong); one weak rating leads to a
score of 2 (moderate); and two or more weak ratings generates a score of 3 (weak). The QATQS
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scoring results can be found in supplementary table 1, while supplementary table 2 provides a
summary of the QATQS scoring outcomes for interventions specifically. (All supplementary
tables are available online, accessible at the first authors page on www.researchgate.net.)
Scoring was conducted by the fourth author, and checked by the first author. Any discrepancies
were resolved by discussion with agreement reached in all cases.
Results
Following removal of duplicate citations, 721 potentially relevant papers were
identified. From the abstract review, 479 papers were excluded. From the full text reviews of
242 papers, 89 further papers were excluded. Thus, a total of 153 papers were included in the
systematic analysis (112 intervention studies, and 41 non-intervention studies). Eleven of these
papers were identified as reporting on five samples of participants: (1) Baltzell and Akhtar
(2014) and Baltzell, Caraballo, Chipman, and Hayden (2014); (2) Cohen-Katz, Wiley,
Capuano, Baker, Deitrick, et al. (2005) and Cohen-Katz, Wiley, Capuano, Baker, Kimmel, et
al. (2005); (3) Grégoire and Lachance (2015) and Grégoire, Lachance, and Taylor (2015); (4)
Shonin and Van Gordon (2015) and Shonin, Van Gordon, Dunn, Singh, and Griffiths (2014);
and (5) van Berkel, Boot, Proper, Bongers, and van der Beek (2013, 2014a, and 2014b). As
such, the 153 papers in the analysis represented results from 147 independent participant
samples. These comprised a total of 12,571 participants (discounting participants who were not
including in the analyses due to attrition).
There were 5,755 participants in the intervention studies, as detailed below in tables 1
(RCT studies) and 2 (non-RCT studies), including 3,728 participants undertaking MBIs, and
2,027 separate control participants (excluding n = 3 studies in which participants acted as their
own controls). These tables report statistical significance and effect sizes (where available): in
studies featuring a control group, post-intervention between-group differences are reported,
whereas with single group studies, pre-post changes are reported. In addition, there were 6,816
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participants in non-intervention studies, as detailed in supplementary tables 3
(regression/correlation analyses) and 4 (qualitative studies). Overall, the studies covered a
range of occupations, including physicians (n = 10), nurses (16), disability professionals (4),
therapists, psychologists and counsellors (24), mixed (non-specific) mental health
professionals (8), mixed (non-specific) healthcare professionals (20), social workers (9),
teachers (16), sportspeople (2), technicians (3), service personnel (4), legal profession (1),
firefighters (1), and police (1), as well as people employed by a university (3), business (7),
factory (1), government (1), administrative occupation (1), call centre (n = 1), and mixed (non-
specific) contexts (18). Of the 112 intervention studies, 48 were randomised controlled trials,
64 were non-randomised samples. Overall, data on effect sizes was not available for 22 studies.
The reasons for this lack of information were non-reporting of means and standard deviations,
and/or not replying to our request for such data (20 articles), and not using standardised
assessment measures (2 articles). An overview of the findings is shown in table 3 below. This
shows whether outcomes were either: (a) improved in relation to an MBI; (b) did not change
in relation to an MBI; (c) in exceptional cases, changed in a ‘negative’ direction; and (d)
associated with mindfulness (in non-intervention studies).
Cite as: Lomas, T., Medina, J. C., Ivtzan, I., Rupprecht, S., Hart, R., & Eiroa-Orosa, F. J. (2017). The impact of mindfulness on well-being and performance in the workplace:
an inclusive systematic review of the empirical literature. European Journal of Work and Organizational Psychology, 26(4), 492513.
https://doi.org/10.1080/1359432X.2017.1308924
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Table 1. Overview of Intervention Studies (RCT)
Authors
Occupation
Expt.
group
Intervention
Length
Control
Primary outcome(s)
(Aikens et al., 2014)
Dow Chemical
employees
34 (44)
Mindfulness
program (specific
to study)
7 weeks
Wait-list
PI < (decreases in) mindfulness & awareness (observe, d = -.20); and stress & strain
(perceived stress, d = -.25). PI > (increases in) mindfulness & awareness (describe, d =
.27; and act aware, d = .22). PI >< (no changes in) burnout (physical energy, d = .04;
cognitive liveliness, d = -.05; and emotional energy, d = -.14); mindfulness &
awareness (non-judging, d = -.12; and non-reacting, d = .07); and resilience
(resilience, d = -.04).
(Baccarani,
Mascherpa, &
Minozzo, 2013)
University
administrators
10
Mindfulness
program (specific
to study)
4 weeks
NR
Effect size data not available. PI > mindfulness & awareness; and wellbeing,
satisfaction and flourishing.
(Burnett &
Pettijohn, 2015)
Healthcare
employees
20
active
MBST
5 weeks
Passive
intervention:
abstention from
work activity.
Control: nothing.
Passive intervention group: PI >< stress & strain (perceived stress, d = -.09).
No intervention group: PI < stress & strain (perceived stress, d = -.70).
(Cohen-Katz, Wiley,
Capuano, Baker, &
Shapiro, 2005)
Nurses
12 (14)
MBSR
8 weeks
Wait-list
Effect size data not available. PI < burnout. PI > mindfulness & awareness. PI ><
distress & anger.
(de Vibe et al.,
2013)
Trainee doctors
144
MBSR
adaptation
6 weeks
Nothing
PI < burnout (burnout, d = -1.5), distress & anger (distress, d = -.77), mindfulness &
awareness (non-judging, d = -.23), stress & strain (stress, d = -.27). PI > mindfulness
& awareness (non-reacting, d = .31), and wellbeing, satisfaction & flourishing
(subjective wellbeing, d = .43). PI >< mindfulness & awareness (act aware, d = -.04;
describe, d = -.06; and observe, d = .18).
(Duchemin,
Steinberg, Marks,
Vanover, & Klatt,
2015)
Intensive care
professionals
16
Mindfulness
program (specific
to study)
8 weeks
Wait-list
Effect size data not available. PI < stress & strain. PI > wellbeing, satisfaction &
flourishing. PI >< anxiety; burnout; depression; mindfulness & awareness; and stress
& strain.
(Erogul, Singer,
McIntyre, &
Stefanov, 2014)
Trainee doctors
28
MBCT
8 weeks
Nothing
PI < stress & strain (perceived stress, d = -.60). PI > compassion & empathy (self-
compassion, d = .88), and resilience (d = .27).
(Flaxman & Bond,
2010)
Government
employees
104
(177)
Stress
management
training
3 x 0.5
days
Wait-list
PI < distress & anger (d = -.28).
Page 13 of 52
(Flook, Goldberg,
Pinger, Bonus, &
Davidson, 2013)
Teachers
10
MBSR
adaptation
8 weeks
Wait-list
PI < burnout (emotional exhaustion, d = -.24; and personal accomplishment, d = .94),
and distress & anger (psychological distress, d = -.51). PI > compassion & empathy
(self-compassion, d = .24), job performance (emotional support, d = .26; and
classroom organization, d = .27), mindfulness & awareness (observe, d = .32;
describe, d = .23; act aware, d = .34; non-reacting, d = .47; and affective attentional
bias, d = -.32), and stress & strain (morning cortisol, d = .67). PI>< burnout
(depersonalization, d = -.03), job performance (instructional support, d = -.18), and
mindfulness & awareness (non-judging, d = .12; and sustained attention, d = .00).
(Franco, Mañas,
Cangas, Moreno, &
Gallego, 2010)
Teachers
34
Mindfulness
program (specific
to study)
10
weeks
Music listening
PI < distress & anger (psychological distress, d = -1.71).
(Frank, Reibel,
Broderick, Cantrell,
& Metz, 2015)
Teachers
18
MBSR
8 weeks
Wait-list
PI < mindfulness & awareness (act aware, d = -.34). PI > burnout (depersonalisation,
d = .26; and personal accomplishment, d = -.27), emotional intelligence & regulation
(acceptance, d = .23; acknowledgement, d = .55; and calmness, d = .85), health (sleep
impairment, d = -1.22), and mindfulness & awareness (observe, d = .71; describe, d =
.69; and non-reacting, d = .56). PI >< burnout (emotional exhaustion, d = -.16),
compassion & empathy (self-compassion, d = .10), distress & anger (psychological
distress, d = .02), emotional intelligence & regulation (present moment, d = .10), and
mindfulness & awareness (non-judging, d = -.18).
(Gockel, Burton,
James, & Bryer,
2013)
Trainee social
workers
38
MBSR
adaptation
10
weeks
Effect size data not available. PI > job performance, and mindfulness & awareness. PI
>< mindfulness & awareness.
(Grégoire &
Lachance, 2015)
Call-centre
employees
18(24)
Mindfulness
program (specific
to study)
5 weeks
Wait-list
(counter-
balanced)
PI < distress & anger (psychological distress, d = -.80); and stress & strain
(psychological stress, d = -.92). PI > health (fatigue, d = -.66); mindfulness &
awareness (mindfulness, d = .20); and wellbeing, satisfaction & flourishing (negative
affect, d = -1.09).
(Grégoire,
Lachance, & Taylor,
2015)
Call-centre
employees
26(39)
Mindfulness
program (specific
to study)
5 weeks
Wait-list
(counter-
balanced)
PI < burnout (burnout, d = -1.48), distress & anger (psychological distress, d = -1.22),
& stress & strain (psychological stress, d = -1.43). PI > emotional intelligence &
regulation (lack of emotional awareness, d = -.39; and impulse control difficulties, d =
-.46); mindfulness & awareness (mindfulness, d = .78); and wellbeing, satisfaction &
flourishing (psychological wellbeing, d = 1.33).
(Harris, Jennings,
Katz, Abenavoli, &
Greenberg, 2016)
Teachers
34
CALM
16
weeks
Wait-list
PI < burnout (emotional exhaustion, d = -.27; depersonalisaton, d = -.37; and personal
accomplishment, d = .37), distress & anger (distress tolerance, d = .42), and stress &
strain (perceived stress, d = -.21; diastolic blood pressure, d = -.54; and systolic blood
pressure, d = -.47). PI > emotional intelligence & regulation (expressive suppression,
d = -.24), health (physical symptoms, d = -.23; and sleep-related impairment, d = -.37),
job performance (classroom management, d =.38; and instructional practices, d =.20),
mindfulness & awareness (observe, d = .41; act aware, d = .23; and non-reacting, d =
.20), relationships (teacher-teacher relational trust, d = .40), stress & strain (morning
cortisol, d = .61), and wellbeing, satisfaction & flourishing (positive affect, d = .62).
PI >< emotional intelligence & regulation (cognitive reappraisal, d = .09), job
performance (student engagement, d = -.10), mindfulness & awareness (describe, d =
.10; and non-judging, d = .13), stress & strain (time urgency, d = -.16), and wellbeing,
satisfaction & flourishing (negative affect, d = -.06).
Page 14 of 52
(Huang, Li, Huang,
& Tang, 2015)
Factory
employees
58 (72)
MBSR
adaptation
8 weeks
Wait-list
PI < distress & anger (psychological distress, d = -.75), and stress & strain (perceived
stress, d = -.47). PI > health (fatigue, d = -.38), and job performance (job control, d =
.55; and job demands, d = -.55).
(Hülsheger, Alberts,
Feinholdt, & Lang,
2013)
Mixed
employees
22
(102)
Mindfulness
program (specific
to study)
2 weeks
Wait-list
PI > mindfulness & awareness (mindfulness, d = .39), and wellbeing, satisfaction &
flourishing (job satisfaction, d = .69). PI >< burnout (emotional exhaustion, d = -.18).
(Hülsheger,
Feinholdt, &
Nübold, 2015)
Company
employees
67(75)
Mindfulness
program (specific
to study)
10 days
Wait-list
PI > health (sleep quality, d = .88). PI >< burnout (psychological detachment, d = .03),
and mindfulness & awareness (mindfulness, d = -.14).
(Jay et al., 2015)
Laboratory
technicians
53 (56)
Mindfulness
program (specific
to study)
10
weeks
Company health
initiative
Effect size data not available. PI > health. PI >< stress & strain.
(Jennings, Frank,
Snowberg, Coccia,
& Greenberg, 2013)
Teachers
25 (27)
Cultivating
awareness &
resilience in
education
1 month
(2
w’end)
Wait-list
PI < burnout (personal accomplishment, d = .33), depression (depression, d = -.68),
and stress & strain (general hurry, d = -.40). PI > emotional intelligence & regulation
(cognitive reappraisal, d = .99; and expressive suppression, d = -.27), health (physical
symptoms, d = -.87), job performance (students’ engagement, d = .46; and
instructional practices, d = .31), mindfulness & awareness (observe, d = .61; act
aware, d = .26; non-judging, d = .35; and non-reacting, d = .65), and wellbeing,
satisfaction & flourishing (positive affect, d = .32; and negative affect, d = -.51). PI ><
burnout (emotional exhaustion, d = -.05; and depersonalisation, d = -.16), job
performance (classroom management, d = .13), mindfulness & awareness (describe, d
= -.03); and stress & strain (task-related hurry, d = -.18).
(John, Kumar, &
Lal, 2012)
Professional
shooters
55
Mindfulness
program (specific
to study)
4 weeks
Wait-list
Mindfulness vs no intervention: PI > job performance (performance score, d = .86).
Mindfulness vs music therapy: PI >< job performance (performance score, d = -.11).
(Klatt, Buckworth,
& Malarkey, 2009)
University
employees
22 (24)
MBSR
adaptation
6 weeks
Wait-list
PI < mindfulness (mindful attention awareness, d = -1.20), and stress & strain
(perceived stress, d = -.44). PI > health (sleep impairment, d = -.85).
(Klatt, Steinberg, &
Duchemin, 2015)
Intensive care
IC staff
34
Mindfulness in
motion
8 weeks
N/A
Effect size data not available. PI < burnout. PI > and resilience.
(Leroy, Anseel,
Dimitrova, & Sels,
2013)
Mixed
employees
76
MBSR
8 weeks
Wait-list
Effect size data not available. PI < burnout. PI > mindfulness & awareness, and
wellbeing, satisfaction & flourishing.
(Mackenzie, Poulin,
& Seidman-Carlson,
2006)
Nurses
16
MBSR
adaptation
4 weeks
Wait-list
PI < burnout (depersonalisation, d = -.20; and personal accomplishment, d = 8.27). PI
> burnout (emotional exhaustion, d = 3.44), and wellbeing, satisfaction & flourishing
(relaxation dispositions, d = .24. PI >< wellbeing, satisfaction & flourishing (intrinsic
job satisfaction, d = .17; satisfaction with life, d = -.13; and sense of coherence, d =
.16).
Page 15 of 52
(Malarkey, Jarjoura,
& Klatt, 2013)
University
employees
84 (93)
Mindfulness
program (specific
to study)
8 weeks
Lifestyle
education
programme
PI < stress & strain (C-reactive protein, d = -.26). PI >< stress & strain (cortisol day’s
slope, d = -.08; interleukin-6, d = .14).
(Manotas, Segura,
Eraso, Oggins, &
McGovern, 2014)
Healthcare
professionals
40 (66)
MBSR
adaptation
4 weeks
NR
PI < distress & anger (distress, d = -.61), mindfulness & awareness (act aware, d = -
.29; and describe, d = -.28), and stress & strain (perceived stress, d = -.68). PI >
mindfulness & awareness (non-judging, d =.32; and observe, d = .23). P ><
mindfulness & awareness (non-reacting, d = .03), and total mindfulness, d = .07).
(Martín-Asuero et
al., 2014)
Healthcare
professionals
43
MBSR
adaptation
8 weeks
Wait-list
PI < burnout (emotional exhaustion, d = -7.20; depersonalisation, d = -1.80; and
personal accomplishment, d = 1.40), and distress & anger (distress, d = -.83). PI >
compassion & empathy (physician empathy, d = .40), and mindfulness & awareness
(non-reacting, d = 1.21; non-judging, d = .49; act aware, d = .84; describe, d = .44; and
observe, d = 1.27).
(McConachie,
McKenzie, Morris,
& Walley, 2014)
Support staff
66
Acceptance and
mindfulness
workshop
1.5 days
Wait-list
PI < distress & anger (distress, d = -.35). PI >< wellbeing, satisfaction & flourishing
(mental wellbeing, d = .17).
(Mealer et al., 2014)
Intensive care
nurses
13
Resilience
training
program*
12
weeks
Nothing
Effect size data not available. PI < anxiety; depression; and stress & strain. PI >
resilience. PI >< anxiety; and burnout.
(Moody et al., 2013)
Paediatric
oncology staff
24
Mindfulness
program (specific
to study)
8 weeks
Nothing
Effect size data not available. PI >< burnout; depression; and stress & strain.
(Pidgeon, Ford, &
Klaassen, 2014)
Human service
professionals
14 (22)
Mindfulness
retreat (specific
to study)
2.5 days
Nothing
Effect size data not available. PI > compassion & empathy, mindfulness & awareness,
and resilience.
(Pipe et al., 2009)
Nurses
15
MBSR
adaptation
4 weeks
Wait-list
PI < anxiety (d = -.21), depression (d = -.54), distress & anger (psychological distress,
d = -.39). PI > job performance (caring efficacy, d = .48), and relationships
(interpersonal sensitivity, d = -.38).
(Ramsey & Jones,
2015)
Teachers
13 (22)
Mindfulness
workshop
(specific to
study)
1 day
NR
Effect size data not available. PI > relationships.
(Roeser et al., 2013)
Teachers
54
Mindfulness
Training
8 weeks
Wait-list
PI < anxiety (anxiety state, d = -.69), burnout (burnout, d = -.80), depression
(depression, d = -1.03), and stress & strain (occupational stress, d = -.56; and morning
cortisol, d = -.20). PI > compassion & awareness (self-compassion, d = .84), job
performance (absences from work, d = -.34), and mindfulness & awareness (working
memory capacity stringent, d = .27; errors on math distractor problems, d = .32;
observe, d = .81; act aware, d = .54; and non-reacting, d = .75). PI >< mindfulness &
awareness (working memory capacity total, d = .15; describe, d = .01; and non-
judging, d = .13), and stress & strain (systolic blood pressure, d = .05; and diastolic
blood pressure, d = .15).
(Shapiro, Schwartz,
& Bonner, 1998)
Trainee doctors
37
Stress reduction
and relaxation
7 weeks
Wait-list
PI < anxiety (state, d = -.46; and trait, d = -.59), depression (depression, d = -.46), and
distress & anger (psychological distress, d = -.69). PI > compassion & empathy
(empathy, d = .47), and wellbeing, satisfaction & flourishing (spirituality, d = .32).
Page 16 of 52
(Shapiro, Astin,
Bishop, & Cordova,
2005)
Healthcare
professionals
10 (18)
MBSR
8 weeks
Wait-list
PI < burnout (emotional exhaustion, d = -2.10; depersonalisation, d = -3.38; and
personal accomplishment, d = 3.38). PI >< compassion & empathy (self-compassion,
d = .02), distress & anger (distress, d = -.07), stress & strain (perceived stress, d = -
.15), and wellbeing, satisfaction & flourishing (satisfaction with life, d = .15).
(Shonin, Van
Gordon, Dunn,
Singh, & Griffiths,
2014)
Office middle
managers
68 (76)
Meditation
awareness
training
8 weeks
CBT education
class
PI < distress & anger (psychological distress, d = -2.14), and stress & strain (work-
related stress, d = -1.75). PI > job performance (work performance, d = 1.39) and
wellbeing, satisfaction & flourishing (job satisfaction, d = 1.63).
(Shonin & Van
Gordon, 2015)
Office middle
managers
68
Meditation
awareness
training
8 weeks
CBT education
class
Qualitative interviews: PI > job performance; and wellbeing, satisfaction &
flourishing.
(Song & Lindquist,
2015)
Trainee nurses
21 (25)
MBSR
8 weeks
Wait-list
PI < anxiety (d = -.50) depression (d = -.70), and stress & strain (stress, d = -.85). PI
>< mindfulness & awareness (mindful attention awareness, d = .13).
(Sood, Sharma,
Schroeder, &
Gorman, 2014)
Radiologists
11 (13)
Stress
management and
resiliency
training
1 day
Wait-list
PI < anxiety (anxiety, d = -.54), stress & strain (perceived stress, d = -.45). PI >
mindfulness & awareness (mindfulness, d = .90). PI >< resilience (resilience, d = -
.17), and wellbeing, satisfaction & flourishing (quality of life, d = .00).
(Taylor et al., 2016)
Teachers
26
SMART
8 weeks
Wait-list
PI < stress & strain (occupational stress, d = -.89). PI > compassion & empathy
(dispositional compassion, d = .21; and tendency to forgive, d = .66).
(van Berkel, Boot,
Proper, Bongers, &
van der Beek, 2013)
Mixed
employees
121
(129)
Mindful vitality
in practice
8 weeks
NR
NA.
(van Berkel, Boot,
Proper, Bongers, &
van der Beek,
2014a)
Mixed
employees
121
(129)
Mindful vitality
in practice
8 weeks
NR
PI < health (physical activity, d = -.34). PI > health (health enhancing physical
activity, d = .25).
(Van Berkel, Boot,
Proper, Bongers, &
Van Der Beek,
2014b)
Mixed
employees
121
(129)
Mindful vitality
in practice
8 weeks
NR
PI >< burnout (need for recovery, d = -.04), health (mental health, d = .02), job
performance (work engagement, d = .00), and mindfulness & awareness, d = .00.
(West et al., 2014)
Physicians
35 (37)
Small group
curriculum*
10
weeks
Nothing
PI >< compassion & empathy (physician empathy, d = -.05), stress & strain (perceived
stress, d = .13); and wellbeing, satisfaction & flourishing (job satisfaction, d = -.14).
(Walach et al., 2007)
High-stress
professionals
12
MBSR
8 weeks
Wait-list
PI < stress & strain (positive coping strategies, d = .87). PI >< stress & strain
(negative coping strategies, d = -.03).
(Wolever et al.,
2012)
Insurance
employees
82 (96)
Mindfulness at
work
12
weeks
Wait-list, &
Viniyoga stress
reduction
program
Mindfulness vs wait-list: PI < stress & strain (perceived stress, d = -4.76; systolic
blood pressure, d = -1.71; diastolic blood pressure, d = -.87; breathing rate, d = -2.72;
heart rate coherence, d = -.99; and time between heart beats, d = -.84). PI > depression
(depression, d = .43), health (sleep quality, d = -.80), job performance (work
limitations, d = -1.43), and mindfulness & awareness (mindfulness, d = 2.42).
Mindfulness vs yoga: PI < health (sleep quality, d = 1.49), and stress & strain
(perceived stress, d = -1.35). PI > job performance (work limitations, d = -.73),
mindfulness & awareness (mindfulness, d = 0.42), and stress & strain (systolic blood
pressure, d = 1.11; diastolic blood pressure, d = 1.25; heart rate coherence, d = .45;
Page 17 of 52
and time between heart beats, d = 1.01). PI >< depression (depression, d = -.07), and
stress & strain (breathing rate, d = -.06)
Note: All reported results significant to p<.05 (or lower). < = decreases in; > = increases in; >< = no change in; ! = mindfulness associated with worsened outcome; expt = experimental group; cnt = control group;
PI = post-intervention; NR = not-reported; MBCT = mindfulness-based cognitive therapy; MBSR = mindfulness-based stress reduction; MBST = mindfulness-based stress reduction therapy. CALM = community
approach to learning mindfully. CARE = cultivating awareness and resilience in education. SMART = stress management and relaxation training. MM = mindfulness meditation; NCC = neural correlates of
consciousness; NR = not recorded; N/A = not applicable; NA = not available; RCT = randomized controlled trial;.* = number in parenthesis is the initial sample size (if different from sample size featured in
analysis).
Table 2. Overview of intervention studies (non-randomised samples samples)
Authors
Occupation
Expt. group
Control
group
Intervention
Length
Control
Primary outcome(s)
(Aggs & Bambling,
2010)
Psychotherapists
47
-
Mindful therapy
8 weeks
N/A
Effect size data not available. PI < stress & strain. PI > mindfulness &
awareness.
(Barbosa et al.,
2013)
Healthcare
graduates
13 (16)
15
MBSR
8 weeks
Nothing
PI < burnout (emotional exhaustion, d = -.41; personal accomplishment, d =
.29; and depersonalisation, d = -.26), and compassion & empathy (physician
empathy, d = -.77).. PI >< anxiety (d = -.09).
(Baltzell & Akhtar,
2014)
Football players
19
23
Mindfulness
meditation training
for sports
12 sessions
Nothing
PI < wellbeing, satisfaction, and flourishing (positive affect, d = -.20; and
satisfaction with life, d = -.43). PI > mindfulness & awareness (mindfulness,
d = .41), wellbeing, satisfaction, and flourishing (negative affect, d = -.86;
and wellbeing, d = .60).
(Baltzell, Caraballo,
Chipman, &
Hayden, 2014)
Football players
7
-
Mindfulness
meditation training
for sports
12 sessions
Nothing
Qualitative interview: PI > emotional intelligence & regulation; health; and
mindfulness & awareness.
(Bazarko, Cate,
Azocar, & Kreitzer,
2013)
Nurses (corporate)
36 (41)
-
MBSR adaptation
(6 sessions by
telephone)
8 weeks
N/A
PI < burnout (personal burnout, d = -.97; work-related burnout, d = -.67; and
client-related burnout, d = -.30), health (physical health, d = -.38), and stress
& strain (perceived stress, d = -1.21). PI > compassion & empathy (physician
empathy, d = .76; and self-compassion, d = 1.25), health (mental health, d =
1.40), and wellbeing, satisfaction & flourishing (serenity, d = 1.48).
(Beckman et al.,
2012)
Primary care
physicians
20
-
Program in
mindful
communication
52 hours
N/A
Qualitative interviews: PI > mindfulness & awareness; and relationships.
(Beddoe & Murphy,
2004)
Trainee nurses
16 (23)*
-
MBSR
8 weeks
N/A
Effect size data not available. PI < stress & strain. PI >< compassion &
empathy.
(Beshai, McAlpine,
Weare, & Kuyken,
2016)
Teachers
49
40
.b Foundations
course
9 session
Wait-list
PI < stress & strain (perceived stress, d = -.48). PI > compassion & empathy
(self-compassion, d = .74), mindfulness & awareness (observe, d = .97;
describe, d = .51; non-judging, d = .27; and non-reacting, d = .32), and
wellbeing, satisfaction & flourishing (mental wellbeing, d = .70). PI ><
mindfulness & awareness (act aware, d = -.10).
Page 18 of 52
(Birnbaum, 2008)
Trainee social
workers
7
-
Mindfulness
program (specific
to study)
8 weeks
N/A
Qualitative interviews: PI > emotional intelligence & regulation; and
mindfulness & awareness.
(Bond et al., 2013)
Trainee doctors
24 (27)
-
Mind-body course
11 weeks
N/A
PI >< Compassion & empathy (self-compassion, d = .17; and physician
empathy, d = .09), emotional intelligence & regulation (self-regulation, d =
.01), and stress & strain (perceived stress, d = -.03).
(Bonifas & Napoli,
2014)
Trainee social
workers
77
-
Mindfulness
curriculum
(specific to study)
16 weeks
N/A
PI > wellbeing, satisfaction & flourishing (quality of life, d = .88). PI ><
stress & strain (perceived stress, d = .06).
(Brady, O’Connor,
Burgermeister, &
Hanson, 2012)
Psychiatric ward
professionals
16 (23)
-
MBSR adaptation
4 weeks
N/A
PI < burnout (emotional exhaustion, d = -.50; depersonalisation, d = -.23; and
personal accomplishment, d = .29), and stress & strain (stress, d = -.70). PI >
mindfulness & awareness (mindfulness, d = .64; and intrapersonal presence,
d = .54).
(Brooker et al.,
2013)
Disability
professionals
34 (36)
-
Occupational
mindfulness
training program
8 weeks
N/A
Effect size data not available. PI > mindfulness & awareness; and wellbeing,
satisfaction & flourishing. PI >< anxiety; burnout; compassion & empathy;
depression; stress & strain, and wellbeing, satisfaction & flourishing.
(Brooker et al.,
2014)
Disability
professionals
12
-
Occupational
mindfulness
training program
8 weeks
N/A
Effect size data not available. PI > job performance.
(Christopher,
Christopher,
Dunnagan, &
Schure, 2006)
Trainee
counsellors
11
-
Mindfulness
curriculum
(specific to study)
1 term
N/A
Qualitative interviews: PI < burnout; and stress & strain.
(Cohen & Miller,
2009)
Trainee clinical
psychologists
21 (28)
-
Interpersonal
mindfulness
training
6 weeks
N/A
PI < anxiety (d = -.46), stress & strain (perceived stress, d = -.53), and
wellbeing, satisfaction & flourishing (searching of meaning in life, d = -.35).
PI > emotional intelligence & regulation (emotional intelligence, d = .39),
mindfulness & awareness (mindful attention awareness, d = .48),
relationships (social connectedness, d = 57), and wellbeing, satisfaction &
flourishing (life satisfaction, d = .43). PI >< depression (d = -.11), and
wellbeing, satisfaction & flourishing (presence of meaning in life, d = .12).
(Cohen-Katz,
Wiley, Capuano,
Baker, Deitrick, et
al., 2005)
Nurses
25
-
MBSR
8 weeks
N/A
Qualitative interviews: PI > compassion & empathy; emotional intelligence
& regulation; health; mindfulness & awareness; and relationships.
(Dobie, Tucker,
Ferrari, & Rogers,
2016)
Mental health
professionals
9
-
MBSR adaptation
8 weeks
N/A
PI < anxiety (d = -.86), depression (d = -.44), and stress & strain (stress, d = -
.96). PI > mindfulness & awareness (mindfulness, d = .41).
(de Zoysa, Ruths,
Walsh, & Hutton,
2014)
Mental health
professionals
7
-
MBCT
8 weeks
N/A
Qualitative interviews: PI > emotional intelligence & regulation.
(Dorian &
Killebrew, 2014)
Trainee
psychotherapists
21
-
Mindfulness
curriculum
(specific to study)
10 weeks
N/A
Qualitative interviews: PI < distress & anger. PI > compassion & empathy,
emotional intelligence & regulation, and mindfulness & awareness.
Page 19 of 52
(Felton, Coates, &
Christopher, 2015)
Trainee
counsellors
Mindfulness
curriculum
(specific to study)
15 weeks
N/A
Qualitative interviews: PI < stress & strain. PI > compassion & empathy,
emotional intelligence & regulation, and mindfulness & awareness.
(Fisher & Hemanth,
2015)
Clinical
psychologists
8
-
Mindfulness
program (specific
to study)
10 weeks
N/A
Qualitative interviews: PI > emotional intelligence & regulation, mindfulness
& awareness.
(Fortney,
Luchterhand,
Zakletskaia,
Zgierska, & Rakel,
2013)
Primary care
clinicians
28 (30)
-
MBSR adaptation
18 hours
(over 5
sessions)
N/A
PI < anxiety (d = -.47), burnout (emotional exhaustion, d = -.31;
depersonalisation, d = -22; and personal accomplishment, d = .50),
depression (depression, d = -.54), and stress & strain (perceived stress, d = -
.54; and stress, d = -.31). PI >< compassion & empathy (compassion, d = -
.04), resilience (resilience, d = .17).
(Foureur, Besley,
Burton, Yu, &
Crisp, 2013)
Nurses &
midwives
28 (40)
MBSR adaptation
1 day (& 8
weeks
practice)
PI < anxiety (d = -.28), depression (d = -.33), distress & anger (distress, d = -
.59), and stress & strain (stress, d = -.65). PI > wellbeing, satisfaction &
flourishing (sense of coherence, d = .73).
(Galantino, Baime,
Maguire, Szapary,
& Farrar, 2005)
Healthcare
professionals
84
-
Mindfulness
program (specific
to study)
8 weeks
N/A
Effect size data not available. PI < anxiety; burnout; depression; and distress
& anger. PI >< compassion & empathy; and stress & strain.
(Gauthier, Meyer,
Grefe, & Gold,
2015)
Paediatric ICU
nurses
42 (45)
-
Mindfulness
program (specific
to study)
30 days
N/A
PI < stress & strain (stress, d = -.40). PI > compassion & empathy (self-
compassion, d = .23). PI >< burnout (emotional exhaustion, d = -.18;
depersonalisation, d = -.13; and personal accomplishment, d = .12), and
mindfulness & awareness (mindful attention awareness, d = .07).
(Gold et al., 2010)
Teachers and
assistants
11
MBSR
8 weeks
N/A
PI < anxiety (anxiety, d = -.58), depression (depression, d = -1.53), and stress
& strain (stress, d = -1.15). PI > mindfulness & awareness (mindfulness, d =
.55).
(Goodman &
Schorling, 2012)
Healthcare
professionals
73 (93)
-
Mindfulness for
healthcare
providers
8 weeks
N/A
Physicians sample: PI < burnout (emotional exhaustion, d = -.72;
depersonalisation, d = -.44; and personal accomplishment, d = .60. PI >
health (mental health, d = 1.00). PI >< health (physical health, d = -.16).
Other healthcare providers sample: PI < burnout (emotional exhaustion, d = -
.29; depersonalisation, d = -.27; and personal accomplishment, d = .44). PI >
health (mental health, d = .78). PI >< health (physical health, d = -.02).
(Gregory, 2015)
Social workers
5
6
Mindfulness
program (specific
to study)
3 weeks
Nothing
Effect size data not available. PI > compassion & empathy. PI >< burnout,
and stress & strain.
(Grepmair,
Mitterlehner, Loew,
& Nickel, 2007)
Trainee
psychotherapists
58
55 (same
as expt)
Mindfulness
program (specific
to study)
9 weeks
Pre-training
PI > job performance (patients’ distress, d = -.93).
(Hallman,
O’Connor, Hasenau,
& Brady, 2014)
Psychiatric service
professionals
12 (13)
-
MBSR
8 weeks
N/A
PI < stress & strain (perceived stress, d = -.20). PI > mindfulness &
awareness (mindfulness, d = .68).
(Hemanth & Fisher,
2015)
Clinical
psychology
trainees
10
-
Mindfulness
program (specific
to study)
10 weeks
N/A
Qualitative interviews: PI > compassion & empathy; emotional intelligence
& regulation; job performance; and relationships.
(Hopkins & Proeve,
2013)
Trainee
psychologists
11 (12)
-
MBCT
8 weeks
N/A
PI <Compassion & empathy (emotional concern, d = -.40; perspective
taking, d = -.37; personal distress, d = -.23; and fantasy, d = -.30), and stress
& strain, (perceived stress, d = -.67).. PI > mindfulness & awareness (non-
Page 20 of 52
reacting, d = .77; observe, d = .43; non-judging, d = 1.27. PI >< mindfulness
& awareness (act aware, d = .11; and describe, d = .18).
(Horner, Piercy,
Eure, & Woodard,
2014)
Nurses
31 (46)
12 (28)
Mindfulness
program (specific
to study)
10 weeks
Nothing
Effect size data not available. PI >< burnout; compassion & empathy;
mindfulness & awareness; stress & strain; and wellbeing, satisfaction &
flourishing.
(Hue & Lau, 2015)
Trainee teachers
35 (78)
35
Mindfulness
program (specific
to study)
6 weeks
Nothing
PI < anxiety (anxiety, d = -.25), and depression (depression, d = -.33). PI >
mindfulness & awareness (mindfulness, d = .22), stress & strain (perceived
stress, d = .34; and stress, d = .31), and wellbeing, satisfaction & flourishing
(wellbeing, d = .43). PI >< mindfulness & awareness (mindful attention
awareness, d = .07).
(Jennings,
Snowberg, Coccia,
& Greenberg, 2011)
Study 1: Teachers
29 (31)
-
Cultivating
awareness &
resilience in
education
1 month (2
w’end)
N/A
PI < depression (depression, d = -.22), and stress & strain (task-related hurry,
d = -.23; and general hurry, d = -.25). P > job performance (instructional
practices, d = .43; and classroom management, d = .34), mindfulness &
awareness (observe, d = 1.02; describe, d = .34; act aware, d = .21; non-
judging, d = .44; non-reacting, d = .88; and interpersonal mindfulness in
teaching, d = .56), and wellbeing, satisfaction & flourishing (negative affect,
d = -.22). P >< health (physical symptoms, d = -.10), job performance
(promoting intrinsic motivation, d = .01; and students’ engagement, d = .16),
and wellbeing, satisfaction & flourishing (positive affect, d = .00).
Study 2: Teachers
17(21)
22
Cultivating
awareness &
resilience in
education
1 month (2
w’end)
Wait-list
PI < stress & strain (general hurry, d = -.37). PI > job performance
(motivation, d = .63; and instructional practices, d = .26), mindfulness &
awareness (act aware, d = .21), and wellbeing, satisfaction & flourishing
(negative affect, d = -.43). PI >< depression (despression, d = -.09), health
(physical symptoms, d = .05), job performance (student engagement, d = .07;
classroom management, d = .19); mindfulness & awareness (observe, d =
.19; describe, d = .11; non-judging, d = .09; and non-reacting, d = .08); stress
& strain (task-related hurry, d = .02), wellbeing, satisfaction & flourishing
(positive affect, d = .11).
(Johnson, Emmons,
Rivard, Griffin, &
Dusek, 2015)
Healthcare
professionals
18 (20)
19 (20)
Resilience training
8 weeks
Wait-list
PI < anxiety (state, d = -1.02; and trait, d = -1.41), depression (depression
with the CESD-10, d = -1.50; and depression with the PHQ-9, d = -1.56), and
stress & strain (perceived stress, d = -1.30). PI > health (health responsibility,
d = .96; interpersonal relations, d = 1.40; nutrition, d = .34; physical activity,
d = .81; spiritual growth, d = .99; stress management, d = 1.17; abseentism, d
= -.50; activity impairment, d = -1.23; presenteeism, d = -1.28; and work
productivity loss, d = -1.38).
(Jouper &
Johansson, 2013)
Administrative
employee
1
-
Mindfulness
program (specific
to study)
12 weeks
N/A
Qualitative interviews: PI < stress & strain. PI > mindfulness & awareness,
and wellbeing, satisfaction & flourishing.
(K. Kemper &
Khirallah, 2015)
Health
professionals
112 one
module and
102 the
other
-
Mindfulness in
daily life
1 hour
N/A
PI > mindfulness & awareness (cognitive and affective mindfulness, d = .24;
and mindful attention awareness, d = .20), and resilience (resilience, d = .21).
(Krasner et al.,
2009)
Primary care
physicians
59 (70)
-
Mindfulness
program (specific
to study)
8 weeks
N/A
PI < burnout (emotional exhaustion, d = -.37), and distress & anger (distress,
d = -.47). PI > compassion & empathy (physician empathy, d = .36), and
Page 21 of 52
mindfulness & awareness (mindfulness, d = .86). PI >< burnout
(depersonalisation, d = -.19; and personal accomplishment, d = .15).
(Martín-Asuero &
García-Banda,
2010)
Healthcare
professionals
29
-
MBSR adaptation
8 weeks
N/A
PI < distress & anger (psychological distress, d = -.59), and stress & strain
(daily stress, d = -.39). PI > wellbeing, satisfaction & flourishing, (negative
affect, d = -.26). P >< emotional intelligence & regulation (rumination, d = -
.19).
(McGarrigle &
Walsh, 2011)
Human service
workers
12
-
Mindfulness
program (specific
to study)
8 weeks
N/A
PI < stress & strain (perceived stress, d = -.83). PI > mindfulness &
awareness (mindfulness, d = 1.05).
(Moore, 2008)
Trainee clinical
psychologists
16 (23)
-
Mindfulness
program (specific
to study)
4 weeks
N/A
Effect size data not available. PI > mindfulness & awareness. PI ><
compassion & empathy; and stress & strain.
(Napoli & Bonifas,
2011)
Trainee social
workers
31 (46)
-
Mindfulness
program (specific
to study)
16 weeks
N/A
PI > mindfulness & awareness (mindfulness, d = .64).
(Newsome,
Christopher,
Dahlen, &
Christopher, 2006)
Counsellors
33
-
Mindfulness
curriculum
(specific to study)
15 weeks
N/A
Qualitative interviews: PI > emotional intelligence & regulation; health;
mindfulness & awareness; relationships; and wellbeing, satisfaction &
flourishing.
(Newsome, Waldo,
& Gruszka, 2012)
Trainee helping
professionals
31
-
Mindfulness
program (specific
to study)
6 weeks
N/A
PI < stress & strain (perceived stress, d = -1.01). PI > compassion & empathy
(self-compassion, d = 1.13), mindfulness & awareness (mindful attention
awareness, d = .91),
(Noone & Hastings,
2010)
Disability support
workers
34
-
Promotion of
acceptance in
carers and teachers
1.5 days
N/A
PI < distress & anger (distress, d = -.54). PI >< stress & strain (stress, d = -
.13).
(Pflugeisen,
Drummond,
Ebersole, Mundell,
& Chen, 2016)
Physicians
19 (23)
-
MBSR adaptation
8 weeks
N/A
PI < burnout (emotional exhaustion, d = -.46; depersonalisation, d = -.32; and
personal accomplishment, d = .56), and stress & strain (perceived stress, d =
-.87). PI > mindfulness & awareness (mindfulness skills, d = .84).
(Poulin, Makenzie,
Soloway, &
Karayolas, 2008)
Study 1: Nurses
16
10 & 14
MBSR adaptation
4 weeks
Imagery &
progressive
muscle
relaxation, &
wait-list.
Mindfulness vs. Imagery & progressive muscle relaxation: PI < burnout
(personal accomplishment, d = .73), and wellbeing, satisfaction & flourishing
(relaxation, d = -.63). PI >< burnout (emotional exhaustion, d = -.07; and
depersonalisation, d = -.16), and wellbeing, satisfaction & flourishing
(satisfaction with life, d = .15).
Mindfulness vs. wait-list: PI < burnout (personal accomplishment, d = 1.32).
PI > burnout (emotional exhaustion, d = .22), and wellbeing, satisfaction &
flourishing (relaxation, d = .24). PI >< burnout (depersonalisation, d = .00),
and wellbeing, satisfaction & flourishing (satisfaction with life, d = -.07).
Study 2: Teachers
28
16
Mindfulness-based
wellbeing
education
8 weeks
Nothing
PI > job performance (students’ engagement, d = .46; and classroom
management, d = .20). PI >< distress & anger (distress, d = .04), job
performance (instructional practices, d = .12), mindfulness & awareness
(mindfulness, d = .15), and wellbeing, satisfaction & flourishing (satisfaction
with life, d = .09).
(Phang, Chiang, Ng,
Keng, & Oei, 2016)
Trainee doctors
123(135)
-
MBCT adaptation
4 weeks
N/A
PI < distress & anger (distress, d = -.76), and stress & strain (perceived
stress, d = -.57). PI > mindfulness & awareness (mindfulness, d = .57).
Page 22 of 52
(Raab, Sogge,
Parker, & Flament,
2015)
Mental health
professionals
22
-
MBSR
8 weeks
N/A
PI < burnout (emotional exhaustion, d = -.20; and personal accomplishment,
d = .20). PI > compassion & empathy (self-compassion, d = .48). PI ><
burnout (depersonalisation, d = -.11), and wellbeing, satisfaction &
flourishing (quality of life, d = .02).
(Reingold, 2015)
Radiologic
technicians
42
-
MBSR adaptation
6 weeks
N/A
Effect size data not available. PI < stress & strain.
(Rimes &
Wingrove, 2011)
Trainee clinical
psychologists
20
-
MBCT
8 weeks
N/A
PI < depression (rumination, d = -.57), and stress & strain (perceived stress, d
= -.23). PI > anxiety (d = .26), compassion & empathy (fantasy, d = .52; and
self-compassion, d = .48), and mindfulness & awareness (non-reacting, d =
.59; non-judging, d = .52; describe, d = .31; and observe, d = .38). PI ><
compassion & empathy (empathic concern, d = .00; personal distress, d = -
.06; and perspective taking, d = -.03), depression (d = .00), and mindfulness
& awareness (act aware, d = .10).
(Rocco, Dempsey,
& Hartman, 2012)
Mental health
professionals
16
-
Calm abiding
meditation
8 weeks
N/A
Qualitative interviews: PI > emotional intelligence & regulation; health; and
mindfulness & awareness.
(Ruths et al., 2013)
Mental health
professionals
27
-
MBCT
8 weeks
N/A
Effect size data not available. PI < distress & anger. PI > mindfulness &
awareness. PI >< anxiety; distress & anger, and wellbeing, satisfaction &
flourishing.
(Schussler,
Jennings, Sharp, &
Frank, 2016)
Teachers
50
-
CARE
8 weeks
N/A
Qualitative focus groups. PI > emotional intelligence & regulation.
(Shapiro, Brown, &
Biegel, 2007)
Trainee
psychotherapists
22
32 (42)
MBSR
8 weeks
Psychology
course
PI < anxiety (state, d = -.55; and trait, d = -.91), depression (rumination, d = -
.41), and stress & strain (perceived stress, d = -.67). PI > compassion &
empathy (self-compassion, d = .42), mindfulness & awareness (mindful
attention awareness, d = .36), and wellbeing, satisfaction & flourishing
(positive affect, d = .57; and negative affect, d = -.46).
(Shonin, Van
Gordon, & Griffiths,
2014)
Technology
employee
1
-
Meditation
awareness training
8 weeks
N/A
Case report: PI < distress & anger. PI > health.
(Singh et al., 2015)
Disability
professionals
9
-
Mindfulness-based
positive
behavioural
support
7 days
N/A
PI < stress & strain (perceived stress, d = -3.89).
(Singh, Singh,
Sabaawi, Myers, &
Wahler, 2006)
Psychiatric staff
18 (3
teams)
18 (same
as expt
group)
Mindfulness-based
mentoring
11, 8 or 6
sessions
Control within
& between
teams
Effect size data not available. PI > job performance; and wellbeing,
satisfaction & flourishing.
(Stew, 2011)
Trainee occ
therapists
12
-
MBSR adaptation
4 weeks
N/A
Qualitative interviews: PI > emotional intelligence & regulation, and
mindfulness & awareness.
(Tarrasch, 2014)
Trainee
counsellors and
support staff
19
-
Mindfulness
curriculum
(specific to study)
2 terms
N/A
Qualitative interview: PI > emotional intelligence & regulation, and
mindfulness & awareness.
(Thomley, Ray,
Cha, & Bauer,
2011)
Mixed employees
37(50)
-
Yoga-based
wellness program
6 weeks
N/A
PI < stress & strain (diastolic blood pressure, d = -.24). PI > wellbeing,
satisfaction & flourishing (wellbeing, d = .39). PI >< stress & strain (systolic
blood pressure, d = -.14).
Page 23 of 52
(van der Riet,
Rossiter, Kirby,
Dluzewska, &
Harmon, 2015)
Trainee nurses
14
-
Mindfulness
program (specific
to study)
7 weeks
N/A
Qualitative analysis: PI < stress & strain. PI > emotional intelligence &
regulation; mindfulness & awareness; and relationships.
Note: All reported results significant to p<.05 (or lower). < = decreases in; > = increases in; >< = no change in; ! = mindfulness associated with worsened outcome; expt = experimental group; cnt = control group;
PI = post-intervention; NR = not-reported; MBCT = mindfulness-based cognitive therapy; MBSR = mindfulness-based stress reduction; MBST = mindfulness-based stress reduction therapy. CALM = community
approach to learning mindfully. CARE = cultivating awareness and resilience in education. SMART = stress management and relaxation training. MM = mindfulness meditation; NCC = neural correlates of
consciousness; NR = not recorded; N/A = not applicable; NA = not available; RCT = randomized controlled trial;.* = number in parenthesis is the initial sample size (if different from sample size featured in
analysis); ** = mindfulness just one component of broader intervention.
Table 3. Summary of common outcomes across all studies
Outcome
Number of studies
assessing
Improvement related to
mindfulness intervention
No change in relation to
mindfulness intervention
Worsening related to
mindfulness intervention
Association (benign) with mindfulness
in non-intervention studies
Anxiety
25
17
5
1
2
Burnout
57
33
11
3
10
Compassion & empathy
40
24
10
2
4
Depression
30
13
5
1
4
Distress & anger
35
28
4
0
4
Emotional intelligence &
regulation
40
23
3
0
10
Health
29
19
3
3
4
Job performance
60
37
6
0
17
Mindfulness & awareness
76
60
6
4
6
Relationships
23
16
0
0
7
Resilience
9
6
3
0
0
Stress & strain
83
55
15
5
8
Wellbeing, satisfaction &
flourishing
66
40
10
2
14
Page 24 of 52
Discussion
Overall, MBIs had a generally positive impact upon all outcome measures. However, before
discussing the main findings, it is worth first highlighting some issues afflicting the research
base, which will be important to bear in mind when appraising the results.
Research Issues
First, the quality of the studies is relatively poor overall (as detailed in supplementary table 1,
and summarised with respect to intervention studies in supplementary table 2). Only 22.1 % of
intervention studies scored the highest rating, with many studies providing a poor level of detail
regarding their design (e.g., the precise nature of the MBI). Moreover, only 44% of intervention
studies featured an RCT design (with the percentage of RCTs rated as 1 being 39.5%). The
relatively poor quality of many studies limits the conclusions that can be drawn. We shall return
to this issue of quality at the end of the discussion, where we offer recommendations for future
research. That said, there are some exemplary studies (e.g. Aikens et al., 2014), which provide
a high standard for future research to emulate. Moreover, there are sufficient numbers of high
quality studies with 21 intervention studies scoring 1 on QATQS to permit the drawing of
tentative conclusions. As such these 21 studies will be prioritized in the discussion below,
where they are referred to as HQTs (high-quality trials).
A second key issue is the considerable heterogeneity in the design of the studies,
particularly in terms of the type of intervention, and the outcome measures assessed. Regarding
the intervention, there were a great range deployed across the studies (as detailed in
supplementary table 5). Only 14.4% of interventions used what could be regarded as the two
most established MBIs, namely MBSR (9.9%) and MBCT (5.4%), with a further 18% using a
bespoke MBSR adaptation (e.g., varying the number of weeks, or mode of delivery, or content
of the sessions). Added to these, 27.9% used a less well-established MBI (of which there were
25 different types), while the largest percentage of studies (39.6 %) used an idiosyncratic
Page 25 of 52
intervention or curriculum that appears specific to that study. Added to this variability, there
was considerable heterogeneity in the outcome measures, not only in terms of outcomes (e.g.,
anxiety, depression, satisfaction), but also the scales used to assess these. For instance, 10
different scales were used to gauge mindfulness alone. While a diversity of outcomes is
welcome, the diversity of tools is less so, as it makes comparative assessment (e.g., meta-
analyses) difficult. This difficulty is then compounded by the heterogeneity in interventions
noted above, which means that the studies lack parity in their design. We shall return to these
issues below, in our recommendations for future research. With those issues in mind, we can
turn to the outcomes themselves.
Mindfulness and Mental Health Outcomes
We can begin by observing that the MBIs appeared effective at facilitating the development of
mindfulness, which was assessed by 64 intervention studies, of which the majority found
increased mindfulness in relation to the MBI (as detailed in supplementary table 6). There was
a decent showing of HQTs: of these 21, mindfulness outcomes were reported by nine, with
eight finding significant improvement in at least some aspects of mindfulness, and one
reporting no change. However, as alluded to in the previous sentence, most of these HQTs did
not find a uniformly positive improvement in mindfulness, but only in facets of it, which shows
the importance of analysing its various components separately (which many studies did, e.g.,
deploying Baer et al.’s (2006) Five Facets of Mindfulness Scale). Thus, for instance, although
De Vibe et al. (2013) observed a small to moderate effect size in the non-reacting component
(d = .31), no improvements were found with the others, namely, ‘non-judging’ (d = .0), ‘act
aware’ (d = .04), ‘describe (d = .06), and ‘observe’ (d = .18). Conversely, Manotas et al. (2014)
found no improvement on non-reacting (d = .03), but did in relation to non-judging (d = .32)
and observing (d = .23). However, they unexpectedly observed a decrease in the final two
components, act aware (d = -.29) and describe (d = -.28). Such findings show the need to avoid
Page 26 of 52
simplistic statements about MBIs improving mindfulness, without at least clarifying which
aspect or type of mindfulness one is referring to.
Turning to the specific outcomes, first, mindfulness appears to have an overall
beneficial impact upon mental health, although the pattern of results can by no means be
regarded as conclusive. The results were fairly favourable for anxiety, stress, and
distress/anger. With anxiety (supplementary table 7), of the 21 HQTs, four found an
improvement in relation to an MBI mostly with moderate effect sizes compared to two
which found no effect. Given the high prevalence and burden of occupational anxiety,
particularly in some especially challenging professions, such as healthcare (Firth-Cozens,
2003), these improvements in anxiety linked to mindfulness are noteworthy. The results for
stress (supplementary table 8) were similarly favourable: eight HQTs observed a positive
impact of the intervention, whereas only two found no impact, although one found worsening
in relation to the MBI (Flook et al., 2013). Again, such findings are welcome, given that Firth-
Cozens (2003) reported that the proportion of healthcare professionals experiencing clinically-
significant levels of stress is consistently around 28% in most empirical studies, compared with
about 18% in the general working population. Indeed, a recent survey of NHS staff found that
61% reporting feeling stress all or most of the time, and 59% stating that the stress is worse
this year than last year (Dudman, Isaac, & Johnson, 2015). Likewise, the results were
favourable with respect to distress and anger (supplementary table 9), where all HQTs
assessing this (n = 4) found a significant improvement.
The results for depression and burnout were somewhat more equivocal. With
depression (supplementary table 10), although the large majority of studies overall found an
improvement in relation to an MBI, while four of the HQTs did, three found no such
improvement. However, such results are perhaps understandable, given that MBIs such as
MBCT are primarily targeted at people who are at risk of relapse to depression, rather than
Page 27 of 52
people who are actually currently depressed (and indeed, MBIs are generally contraindicated
in such instance; Dobkin, Irving, & Amar, 2012). The results for burnout (supplementary table
11) were even poorer: while a slight majority of studies found that MBIs had a positive effect,
only one HQT did, while six found no significant impact, and one (Hülsheger et al., 2013)
found a worsening effect. One possible explanation for these results may lie in the relatively
small sample sizes of many studies. Some of the MBIs that failed to observe a significant
improvement in burnout certainly observed trends in the predicted direction (e.g., Mealer et al.,
2014 among the HQTs). The use of larger sample sizes may allow any impact of MBIs on
burnout to be clearer. Another possible explanation is the multifaceted nature of the burnout
construct. The dominant psychometric measure used was the Maslach Burnout Inventory
(Maslach, Jackson, & Leiter, 1986), which has three dimensions: emotional exhaustion,
cynicism (or depersonalisation), and professional efficacy (or accomplishment). Numerous
studies found that MBIs tended to have a stronger positive effect (albeit still non-significant)
on emotional exhaustion than the other components (e.g., Duchemin et al., 2015, among the
HQTs ). On that note, it is interesting that some scholars (e.g., Demerouti & Bakker, 2008)
argue that personal efficacy/accomplishment should not be regarded as a core component of
burnout (but rather as one of its outcomes). It is therefore possible that this presence of this
factor in the Maslach Burnout Inventory may be diluting the impact of the MBIs (if burnout is
analysed globally), and that other measures of burnout which exclude the factor, such as the
Oldenburg Burnout Inventory (Demerouti & Bakker, 2008), might prove to be more precisely-
targeted in this respect.
Wellbeing and Performance Outcomes
An important aspect of the current review was an effort towards inclusivity, especially with
respect to outcomes. Most studies and reviews of MBIs tend to focus mainly on the kind of
mental health outcomes reviewed above, which is perhaps understandable given the origins of
Page 28 of 52
the MBI paradigm in treating physical and mental illness (Kabat-Zinn, 1982). However, it is
increasingly common to find studies not only reporting on these ‘negative’ indicators of
wellbeing (i.e., outcomes whose absence is indicative of adaptive function), but also on more
positive measures of wellbeing and functioning (e.g., job performance). Compared to the
outcomes reviewed above, there was far greater heterogeneity with respect to such measures,
which renders the process of making meaningful comparisons and assessment more difficult.
Nevertheless, it is still instructive to consider the scope of the emerging work in this area. To
begin with, mindfulness was associated with 31 different measures of ‘positive’ wellbeing
(supplementary table 12), with a majority observing positive outcomes in relation to an MBI,
including four HQTs, which reported on outcomes including spiritual experiences (Shapiro et
al., 1998), job satisfaction (Hülsheger et al., 2013), professional quality of life (Duchemin et
al., 2015), and subjective wellbeing (de Vibe et al., 2013). That said, three HQTs reported no
significant improvement in relation to wellbeing (van Berkel et al., 2014b), self-regard (Sood
et al., 2014), and meaning in life (West et al., 2014). The data was slightly stronger regarding
physical health (supplementary table 13); here, the four HQTs assessing such outcomes
observed a positive impact, with measures including individual strength (Huang et al., 2015),
sleep quality (Wolever et al., 2012), pain (Jay et al., 2015), and health-enhancing physical
activity (van Berkel et al., 2014a), although the latter study also found worsening outcomes in
relation to physical activity.
Studies also analysed outcomes that could be regarded as aspects or facets of wellbeing,
including resilience (supplementary table 14), relationships (supplementary table 15), and
emotional intelligence (supplementary table 16). Although there were relatively few studies
assessing these outcomes, the pattern of findings was generally favourable in terms of the
effectiveness of MBIs, although obviously the small number of relevant studies means that any
conclusions drawn are tentative, and further work is required to substantiate these points.
Page 29 of 52
Resilience was only analysed by nine studies, although these included four HQTs, three of
which reported a positive improvement (while one found no improvement). A larger number
of studies (n = 23) examined relationships, with these unanimously finding either a significant
improvement related to an MBI (including one HQT). A still larger number of articles (n = 40)
considered emotional intelligence or regulation (albeit no HQTs), with most studies finding an
improvement relating to an MBI (although a handful found no significant impact). This latter
outcome is particularly interesting, as from a theoretical perspective it provides one of the
strongest potential mechanisms by which the positive outcomes adumbrated above may be
mediated. As outlined in the introduction, according to Shapiro et al. (2006), the key
mechanism through which mindfulness exerts its positive effects is ‘reperceiving,’ whereby
people are better able to detach themselves from distressing qualia that might otherwise
precipitate stress etc. Reperceiving could be regarded as an aspect of a more general capacity
of emotion regulation. For instance, Walsh and Shapiro (2006) define meditation as “a family
of self-regulation practices that focus on training attention and awareness in order to bring
mental processes under greater voluntary control and thereby foster general mental well-being”
(pp.228-229).
Finally, mindfulness was associated with various aspects of job performance. Again,
there was great heterogeneity in this regard, which makes the drawing of comparisons and
conclusions difficult. Nevertheless, one imagines that organisations themselves would be keen
to note any improvement in occupational functioning related to an intervention such as
mindfulness. Numerous studies analysed compassion and empathy (supplementary table 17).
Although these qualities can also be considered facets of wellbeing (Gilbert, 2009), their
analysis in studies here was mainly in relation to healthcare professions, where these are
deemed indicative of professional competence and efficacy. In this respect the data was fairly
encouraging, with four HQTs finding a significant improvement, and only one reporting no
Page 30 of 52
impact. Lastly, there were a disparate range of 26 different measures of job performace
(supplementary table 18), which were mostly specific to particular occupational domains,
ranging from competition performance among professional athletes (John, Kumar, & Lal,
2012) to restraint of patients within psychiatric settings (Brooker et al., 2014). Again the
findings were generally positive, including four HQTs finding a significant improvement,
against two which observed no impact.
Future Directions
Overall, MBIs had a generally positive impact upon most outcome measures, (although some
outcome measures returned rather equivocal results, particularly burnout and depression).
Moreover, a fairly large evidence-base on mindfulness in workplace settings is gradually
accumulating, with 153 papers included in this review, comprising 12,571 participants.
Together, these studies suggest mindfulness can potentially reduce mental health issues (e.g.,
stress), enhance wellbeing-related outcomes (e.g., job satisfaction), and improve aspects of job
performance. However, as argued at the start of this section, there are numerous issues with the
research base which limits the conclusions that can be drawn. Thus, as promising as the
findings are, there is still much work to be done in terms of substantiating the positive results
reported above. In that regard, based on the critiques and research gaps identified above, the
following recommendations can be made vis-à-vis future work in this area. Points one and two
pertain to all types of research (interventions and non-interventions), while the remainder focus
specifically on intervention studies.
First, there will ideally be a diversification of the occupations and workplaces that are
investigated. There is a preponderance of research into healthcare-related occupations, and
while this research is valuable, it will be instructive to expand the diversity of occupations
examined, with a particular need to look at corporate settings (in which many people work, and
which seem particularly under-represented here). Second, it would likewise be good to see a
Page 31 of 52
diversification of outcome measures, with studies not only addressing mental health outcomes,
but also more ‘positive’ non-clinical outcomes, such as work engagement and life satisfaction
(which, although analysed by some studies, certainly constitute a minority here), and also
outcomes which are similarly desirable in many occupational settings, but which did not feature
in any studies here (such as creativity). Third, where possible, intervention studies should
implement an RCT design, with large sample sizes (ideally determined by a priori power
calculations drawing on estimated effect size). Fourth, in addition to the standard passive
control group deployed in most intervention studies (e.g., wait-list), it would be useful for trials
to also include an active control group (a good example of which is Wolever et al. (2012),
which included yoga as an active control). This will better enable any positive effects to be
ascribed to mindfulness per se (i.e., rather than simply being involved in an absorbing group
activity). Fifth, where possible, trials should involve established MBIs (rather than bespoke
adaptations), to better enable comparison and aggregation across studies. At the same time
though, there is also value in moving beyond MBIs that were developed for clinical contexts
(e.g., MBSR), and exploring MBIs created specifically for the workplace. Sixth, MBIs should
always be delivered by an accredited mindfulness practitioner as was the case in many studies
here (although such details were not unanimously reported) since it requires training to teach
mindfulness skilfully and safely. That said, although efforts are being made towards developing
standardised systems of training and accreditation, such efforts are in their infancy (Adams et
al., 2016), and so organisations looking to implement good practice are advised to check the
latest guidance by leading bodies such as the Oxford Mindfulness Centre.
Finally, the case for mindfulness will be strengthened certainly from the perspective
of organisations themselves through cost-benefit analyses. Ultimately, corporations are
generally driven by (and indeed are legally mandated to focus on) their profitability; while this
fact may feel somewhat dispiriting from certain standpoints, it means that if MBIs are shown
Page 32 of 52
to produce an overall net gain (where rewards outweigh the costs), this then provides
organisations with a strong incentive to implement such MBIs. Unfortunately, Edwards,
Bryning, and Crane (2015) suggest there are currently few such cost-benefit analyses, not only
in occupational settings, but in all contexts. There are some exceptions. For instance, Aikens
et al. (2014) conducted a cost-benefit analysis based on rates of self-reported burnout,
concluding that the findings were suggestive of a 20% increase in worker productivity,
potentially representing employer savings of up to $22,580 per employee year. Equally striking
was an analysis of intensive care units across three large hospitals by Vogus, Cooil, Sitterding,
and Everett (2014), who calculated that the impact of engaging in ‘mindful organising’ was a
13.6% decrease in turnover, representing an average hospital saving of between $169,000 and
$1,014,560. Such analyses will be useful going forward in terms of generating managerial and
organisational ‘buy in’ to the potential value of mindfulness, thus helping facilitate the further
research that is needed to fully substantiate the promise of the research reviewed here.
Nevertheless, even as it stands, the research base supports the contention that mindfulness
certainly has a positive role to play in occupational contexts.
Page 33 of 52
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(2016). Building the Case for Mindfulness in the Workplace. London: The Mindfulness
Initiative.
Aggs, C., & Bambling, M. (2010). Teaching mindfulness to psychotherapists in clinical
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... This effect has been mediated by the five mindfulness facets of the FFMQ (observing, non-reacting, acting with awareness, non-judging and describing while the mediation effect was the strongest for non-reacting. Moreover, mindfulness was related to well-being and performance in the workplace (Lomas et al., 2017). Several mediators in the relation between mindfulness and well-being have been found, such as emotional intelligence (Schutte & Malouf, 2011), resilience (Bajaji & Pande, 2016), and hope and optimism (Malinowski & Lim, 2015). ...
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... The first and most salient research theme (57 documents) delves further into the effects of mindfulness interventions on well-being. Literature reviews within this theme focus on mindfulness-based interventions (MBIs) in the workplace (Eby et al., 2019;Lomas et al., 2017) and indicate that more than 80% tend to focus on stress reduction (Eby et al., 2019). Empirical studies within this cluster emerge from behavioral science, where mindfulness is studied as a key component of cognitive-behavioral therapies. ...
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Verhaltens- und verhältnispräventive Maßnahmen sind wesentliche Bestandteile des Betrieblichen Gesundheitsmanagements (BGM). Eine erfolgreiche Prävention umfasst die Reduktion von Belastungen sowie die Stärkung von Ressourcen (Schaufeli und Taris 2014). Mit dem Ziel die Gesundheit und das Wohlbefinden von Beschäftigten in ihrer Arbeitsumwelt zu erhalten und zu fördern, werden organisationale Prozesse über das betriebliche Gesundheitsmanagement bewusst gesteuert und integriert. Das Thema Gesundheit bei der Arbeit rückt stark in den Fokus der Öffentlichkeit und wird zum „Leitmotiv moderner Gesellschaftspolitik“ (Badura 2017). Nach einleitender Darstellung der Relevanz des Themas zur Reduzierung von Arbeitsanforderungen wird auf die theoretische Fundierung anhand des Belastungs- und Beanspruchungs-Konzepts (Rohmert 1984) sowie des Job-Demand-Resources-Models (Bakker und Demerouti 2007) eingegangen. Verhaltens- und Verhältnisprävention als zwei Komponenten der Prävention am Arbeitsplatz werden inhaltlich vorgestellt und Möglichkeiten der Analyse und Umsetzung aufgezeigt. Der Status Quo von möglichen verhaltens- und verhältnispräventiven Maßnahmen in Organisationen umfasst ein breit gefächertes Angebot personen- und. Angebote, welche in Unternehmen zum aktuellen Zeitpunkt existieren, werden dargestellt und auf verschiedene Möglichkeiten der arbeitsintegrierten oder digitalen Angebotsnutzung eingegangen. Zusätzlich werden Herausforderungen differierend nach Unternehmensgröße beleuchtet sowie Lösungsansätze beschrieben und diskutiert.
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This paper offers a novel, easy to execute, mindfulness‐based solution to the waiting time problem at healthcare facilities in particular, with the potential to enhance consumers’ experience within a waiting time scenario. Findings of four studies—one in‐class experiment with undergraduates, one field study among adults in a doctor's office, one online experiment in the U.S., and one online experiment in Brazil—revealed that variations on a 5‐minute mindfulness‐based intervention led to more positive perceptions and greater loyalty intentions towards the service. The findings confirm that offering mindfulness interventions to consumers while they are waiting may help reduce dissatisfaction and other negative outcomes that longer than expected waiting times might evoke. This article is protected by copyright. All rights reserved.
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Mindfulness has grown from an obscure subject to an immensely popular topic that is associated with numerous performance, health, and well-being benefits in organizations. However, this growth in popularity has generated a number of criticisms of mindfulness and a rather piecemeal approach to organizational research and practice on the subject. To advance both investigation and application, the present paper applies The Balance Framework to serve as an integrative scaffolding for considering mindfulness in organizations, helping to address some of the criticisms leveled against it. The Balance Framework specifies five forms of balance: 1) balance as tempered view, 2) balance as mid-range, 3) balance as complementarity, 4) balance as contextual sensitivity, and 5) balance among different levels of consciousness. Each form is applied to mindfulness at work with a discussion of relevant conceptual issues in addition to implications for research and practice. Plain Language Summary In order to appreciate the value of mindfulness at work researchers and practitioners might want to consider both the benefits and potential drawbacks of mindfulness. This paper presents a discussion of both the advantages and possible disadvantages of mindfulness at work organized in terms of the five dimensions of an organizing structure called The Balance Framework.
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Few studies have been conducted to examine the relationship between mindfulness training and emotion regulation at work. This study reports results from a semi-randomized controlled trial of a brief Mindfulness-Based Intervention (MBI) (Gregoire & Lachance, 2015) delivered in audio format. A pretest-posttest switching-replication design was used to assess changes in mindfulness, mental health (psychological wellbeing, psychological distress, stress and burnout) and emotion regulation (emotion awareness and impulse control) among forty-one ( N = 41) employees working in a call center. Data was collected using self-report questionnaires at baseline (t1), week 6 (t2), week 11 (t3) and week 25 (t4) in order to have a follow-up measure. Both the analysis of variance and the prediction analysis showed that the intervention helped increased mindfulness and psychological wellbeing, but also reduced psychological distress, stress and burnout among employees. Overall, the intervention helped employees refrain from impulsive or reactive behavior when experiencing negative emotions but had no significant effect on their emotional awareness. Finally, there was a trend toward emotion regulation mediating the effects of the intervention on psychological distress.
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Objectives: Mental health professionals are particularly susceptible to occupational stress; however, there are limited formal programmes to address the problem. This paper discusses the preliminary results of a brief mindfulness-based stress reduction (MBSR) programme for practising professionals in a public hospital mental health unit. Method: A mixed-group of nine mental health professionals participated in eight weeks of daily 15-minute MBSR training interspersed with three 30-minute education sessions developed by the authors (AD and AT). Levels of psychological distress and mindfulness skill were measured before and immediately after participation. Results: Following the brief MBSR programme, quantitative and qualitative participant feedback revealed a perceived reduction in psychological distress. Conclusions: A brief MBSR programme can be incorporated into the full-time workloads of practicing mental health professionals, potentially addressing a significant unmet workplace need.
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The heavy demands of teaching result in many teachers becoming alienated or burning out. Therefore, it is imperative to identify ways to support teachers’ internal capacities for managing stress and promoting well-being. Mindfulness is an approach with a growing foundation of empirical support in clinical as well as education settings. Cultivating Awareness and Resilience in Education (CARE) is a mindfulness-based professional development program developed to improve teachers’ awareness and well-being and to enhance classroom learning environments. Using an explanatory design, we analyzed data from four focus groups each with three to eight teachers who participated in CARE to explore the mechanisms underlying the intervention effects. Specifically, we examined if/how the CARE intervention affected teachers’ awareness and analyzed why CARE affected particular aspects of teachers’ physical and emotional health and why some aspects were not affected. Results suggest that participants developed greater self-awareness, including somatic awareness and the need to practice self-care. Participants also improved their ability to become less emotionally reactive. However, participants were less likely to explicitly articulate an improvement in their teaching efficacy. Implications for professional development are discussed.
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Background: Emotional competencies are extremely important for healthcare providers exposed to patients' suffering. The effect of mindfulness-based stress reduction (MBSR) has been studied in this population. However, it is unclear whether capacities identified as core for care are modified favourably by this intervention. Objectives: (1) To identify outcomes in studies on the effect of MBSR in healthcare providers. (2) To evaluate the impact of MBSR on these outcomes. (3) To assess current knowledge on whether capacities central to care are positively impacted by MBSR: empathy, identification of one's own emotions, identification of other's emotions and emotional acceptance. Methods: We performed a systematic review on interventional studies published up to 2015 evaluating the effect of MBSR in healthcare professionals. A subset of studies including empathy and emotional competencies was assessed for bias following current methodological standards. Results: Thirty nine studies were identified. 14/39 studies measured empathy or some form of emotional competence in healthcare providers. Evidence regarding the effects of MBSR in professionals suggests this intervention is associated with improvements in burnout, stress, anxiety and depression. Improvements in empathy are also suggested but no clear evidence is currently available on emotional competencies. Conclusions: High quality evidence is available on the effect of MBSR on professionals' mental health. However, while some emotional competencies have been identified as being of major importance for high quality care, they are still scarcely studied. Studying these outcomes is important, as it may help explain how mindfulness contributes to professionals' mental health and thus help develop targeted interventions.
Article
BACKGROUND Chronic musculoskeletal pain is prevalent among laboratory technicians and work-related stress may aggravate the problem. OBJECTIVES This study investigated the effect of a multifaceted worksite intervention on pain and stress among laboratory technicians with chronic musculoskeletal pain using individually tailored physical and cognitive elements. STUDY DESIGN This trial uses a single-blind randomized controlled design with allocation concealment in a 2-armed parallel group format among laboratory technicians. The trial "Implementation of physical exercise at the Workplace (IRMA09)--Laboratory technicians" was registered at ClinicalTrials.gov prior to participant enrolment. SETTING The study was conducted at the head division of a large private pharmaceutical company's research and development department in Denmark. The study duration was March 2014 (baseline) to July 2014 (follow-up). METHODS Participants (n = 112) were allocated to receive either physical, cognitive, and mindfulness group-based training (PCMT group) or a reference group (REF) for 10 weeks at the worksite. PCMT consisted of 4 major elements: 1) resistance training individually tailored to the pain affected area, 2) motor control training, 3) mindfulness, and 4) cognitive and behavioral therapy/education. Participants of the REF group were encouraged to follow ongoing company health initiatives. The predefined primary outcome measure was pain intensity (VAS scale 0-10) in average of the regions: neck, shoulder, lower and upper back, elbow, and hand at 10 week follow-up. The secondary outcome measure was stress assessed by Cohen´s perceived stress questionnaire. In addition, an explorative dose-response analysis was performed on the adherence to PCMT with pain and stress, respectively, as outcome measures. RESULTS A significant (P {\textless} 0.0001) treatment by time interaction in pain intensity was observed with a between-group difference at follow-up of -1.0 (95{\%}CI: -1.4 to -0.6). No significant effect on stress was observed (treatment by time P = 0.16). Exploratory analyses for each body region separately showed significant pain reductions of the neck, shoulders, upper back and lower back, as well as a tendency for hand pain. Within the PCMT group, general linear models adjusted for age, baseline pain, and stress levels showed significant associations for the change in pain with the number of physical-cognitive training sessions per week (-0.60 [95{\%}CI -0.95 to -0.25]) and the number of mindfulness sessions (0.15 [95{\%}CI 0.02 to 0.18]). No such associations were found with the change in stress as outcome. LIMITATIONS Limitations of behavioral interventions include the inability to blind participants to which intervention they receive. Self-reported outcomes are a limitation as they may be influenced by placebo effects and outcome expectations. CONCLUSIONS We observed significant reductions in chronic musculoskeletal pain following a 10-week individually adjusted multifaceted intervention with physical training emphasizing dynamic joint mobility and mindfulness coupled with fear-avoidance and de-catastrophizing behavioral therapy compared to a reference group encouraged to follow on-going company health initiatives. A higher dose of physical-cognitive training appears to facilitate pain reduction, whereas a higher dose of mindfulness appears to increase pain. Hence, combining physical training with mindfulness may not be an optimal strategy for pain reduction. TRIAL REGISTRATION NCT02047669.
Article
Objective: The aim of this study was to rigorously evaluate a brief stress management intervention for nurse leaders. Background: Despite the nursing shortage, evidence-based workplace approaches addressing nurse stress have not been well studied. Methods: Nurse leaders (n = 33) were randomly assigned to brief mindfulness meditation course (MMC) or leadership course (control). Self-report measures of stress were administered at baseline and within 1 week of course completion. Results: Among MMC participants, change scores (from baseline to postintervention) on several sub-scales of the Symptom Checklist 90-Revised showed significantly more improvement in self-reported stress symptoms relative to controls. Mindfulness meditation course participants had significantly more improvement in Positive Symptom Distress Index (P = 0.010; confidence interval [CI] = -0.483 to -0.073) and Global Severity Index (P = 0.019; Cl = -0.475 to -0.046) and nearly significantly more improvement in Positive Symptom Total (P = 0.066; CI = -16.66 to 0.581) compared with controls. Conclusion: Results support preliminary effectiveness of a 4-week MMC in reducing self-reported stress symptoms among nursing leaders.
Article
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.
Article
Purpose To investigate stress levels and causes of stress among radiologic technologists and determine whether an intervention could reduce stress in a selected radiologic technologist population. Methods Demographic characteristics and data on preintervention stress sources and levels were collected through Internet-based questionnaires. A 6-week, self-administered, mindfulness-based stress-reduction program was conducted as a pilot intervention with 42 radiologic technologists from the Veterans Administration Medical Center. Data also were collected postintervention. Identified sources of stress were compared with findings from previous studies. Results Some radiologic technologists experienced improvement in their perceptions of stress after the intervention. Sources of stress for radiologic technologists were similar to those shown in earlier research, including inconsistent management, poor management communication, conflicting demands, long work hours, excessive workloads, lack of work breaks, and time pressures. Conclusion The mindfulness-based stress-reduction program is an example of an inexpensive method that could improve personal well-being, reduce work errors, improve relationships in the workplace, and increase job satisfaction. More research is needed to determine the best type of intervention for stress reduction in a larger radiologic technologist population.
Article
Few studies have been conducted to examine the relationship between mindfulness training and emotion regulation at work. This study reports results from a semi-randomized controlled trial of a brief Mindfulness-Based Intervention (MBI) (Grégoire & Lachance, 2015) delivered in audio format. A pretest-posttest switching-replication design was used to assess changes in mindfulness, mental health (psychological wellbeing, psychological distress, stress and burnout) and emotion regulation (emotion awareness and impulse control) among forty-one (N = 41) employees working in a call center. Data was collected using self-report questionnaires at baseline (t1), week 6 (t2), week 11 (t3) and week 25 (t4) in order to have a follow-up measure. Both the analysis of variance and the prediction analysis showed that the intervention helped increased mindfulness and psychological wellbeing, but also reduced psychological distress, stress and burnout among employees. Overall, the intervention helped employees refrain from impulsive or reactive behavior when experiencing negative emotions but had no significant effect on their emotional awareness. Finally, there was a trend toward emotion regulation mediating the effects of the intervention on psychological distress.