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Objective: Among efforts to improve the well-being of healthcare professionals are initiatives based around mindfulness meditation. To understand the value of such initiatives, we conducted a systematic review of empirical studies pertaining to mindfulness in healthcare professionals. Method: Databases were reviewed from the start of records to January 2016. Eligibility criteria included empirical analyses of mindfulness and well-being outcomes acquired in relation to practice. 81 papers met the eligibility criteria, comprising a total of 3,805 participants. Studies were principally examined for outcomes such as burnout, distress, anxiety, depression, and stress. Results: Mindfulness was generally associated with positive outcomes in relation to most measures (although results were more equivocal with respect to some outcomes, most notably burnout). Conclusion: Overall, mindfulness does appear to improve the well-being of healthcare professionals. However, the quality of the studies was inconsistent, so further research is needed, particularly high-quality randomized controlled trials.
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Cite as: Lomas, T., Medina, J. C., Ivtzan, I., Rupprecht, S., Hart, R., & Eiroa-Orosa, F. J. (2017). A systematic
review of the impact of mindfulness on the wellbeing of healthcare professionals. Journal of Clinical
Psychology. https://doi.org/10.1002/jclp.22515
Page 1 of 54
A systematic review of the impact of mindfulness on the wellbeing of healthcare
professionals.
Tim Lomas1†, Juan Carlos Medina2, Itai Ivtzan1, Silke Rupprecht3, Francisco José 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
Page 2 of 54
Abstract
Objectives: Among efforts to improve the wellbeing of healthcare professionals are initiatives
based around mindfulness meditation. To understand the value of such initiatives, we
conducted a systematic review of empirical studies pertaining to mindfulness in healthcare
professionals.
Design: Databases were reviewed from the start of records to January 2016. Eligibility criteria
included empirical analyses of mindfulness and wellbeing outcomes acquired in relation to
practice. 81 papers met the eligibility criteria, consisting of a total 3,805 participants. Studies
were principally examined for outcomes such as burnout, distress, anxiety, depression and
stress.
Results: Mindfulness was generally associated with positive outcomes in relation to most
measures (although results were more equivocal with respect to some outcomes, most notably
burnout).
Conclusion: Overall, mindfulness does appear to improve the wellbeing of healthcare
professionals. However, the quality of the studies was inconsistent, so further research is
needed, particularly high-quality randomised control trials.
Keywords: mindfulness; meditation; healthcare professionals; wellbeing; systematic review.
Page 3 of 54
A systematic review of the impact of mindfulness on the wellbeing of healthcare
professionals.
Healthcare professionals (HCPs) can face particular challenges that can be detrimental
to their physical and mental health. A wealth of research has accumulated indicating that HCPs
are liable to experience a range of mental health issues, including anxiety (Gao et al., 2012),
burnout (Khamisa, Oldenburg, Peltzer, & Ilic, 2015), depression (Givens & Tjia, 2002), and
stress (Bidwal, Ip, Shah, & Serino, 2015). Moreover, these problems may be particularly acute
among HCPs relative to people in other professions (Brooks, Gerada, & Chalder, 2011). A
recent survey of over 3,700 public sector workers in the UK found that staff working for the
National Health Service were the most stressed, with 61% reporting feeling stress all or most
of the time, and 59% stating that stress is worse this year than last year (Dudman, Isaac, &
Johnson, 2015).
Analyses of these problems include attempts to understand why HCPs are especially
vulnerable to mental health issues. Some scholars explain outcomes like burnout according to
the model of effort-reward imbalance, finding that HCPs face a particularly disadvantageous
imbalance due to the considerable effort required by their work, emotionally and physically
(Rasmussen et al., 2015). Such efforts include factors such as emotional demands (Tyssen,
Vaglum, Grønvold, & Ekeberg, 2000), exacerbated by often limited resources, such as time
allocation per patient (Mossialos, Wenzl, Osborn, & Anderson, 2015). Another factor is
adverse events in healthcare settings, which can mean that HCPs may be ‘second victims’
(Draper, Kõlves, De Leo, & Snowdon, 2014). Particular HCP populations can be especially
vulnerable, such as younger and/or less experienced workers; Bidwal et al. (2015) found that
levels of stress among trainees in the healthcare professions were roughly twice as high as in
the general adult population. Professionals may also fare worse than others owing to their
specific occupational context, such as work demands in their particular national healthcare
Page 4 of 54
system. For instance, a survey of general practitioners in 11 developed countries found that
workers in the UK reported the highest levels of stress, with 29% saying they intended to quit
general practice within five years.
These issues represent a significant problem: obviously for the wellbeing of the HCPs
themselves, but also for patients (e.g., the ability of HCPs to treat them skilfully), and for the
healthcare system (e.g., the economic cost of staff burnout) (Toppinen-Tanner, Ojajärvi,
Väänaänen, Kalimo, & Jäppinen, 2005). As such, efforts are underway to protect against or
ameliorate work-related mental health issues in HCPs. Among the most prominent of these
types of initiatives are programmes based around mindfulness meditation mindfulness-based
interventions (MBIs) which is the focus of this review.
Mindfulness
The past few decades have seen a burgeoning interest in mindfulness in the West,
spanning clinical practice, academia, and society more broadly. Originating in the context of
Buddhism around the 5th century B.C.E, mindfulness came to prominence in the West through
Kabat-Zinn (1982), who created a pioneering ‘mindfulness-based stress reduction(MBSR)
programme for chronic pain. ‘Mindfulness’ can refer to: (1) a state/quality of mind; and (2) a
meditation practice that enables one to cultivate this. The most prominent operationalisation of
mindfulness as a mental state/quality is Kabat-Zinn’s (2003, p.145) definition of it as ‘the
awareness that arises through paying attention on purpose, in the present moment, and
nonjudgmentally to the unfolding of experience moment by moment.’ Expanding on this,
Shapiro, Carlson, Astin, and Freedman (2006) deconstruct it into three components: intention
(motivation for paying attention thus); attention (cognitive processes through which attention
is enacted); and attitude (emotional qualities with which one imbues one’s attention).
’Mindfulness is also deployed for meditation practices which facilitate this state.
Meditation broadly refers to mental activities which share a common focus on training the self-
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regulation of attention and awareness, thereby enhancing control of mental processes, and
consequently increasing wellbeing (Walsh & Shapiro, 2006). According to Lutz, Slagter,
Dunne, and Davidson (2008), most practices feature either ‘focused attention’ or ‘open-
monitoring’ processes. Focused attention can be operationalised in terms of the co-ordination
of various attention modalities (Posner & Petersen, 1990), including sustained, executive, and
selective attention. By contrast, open-monitoring delineates a broader receptive capacity to
detect events within an open ‘field’ of awareness (Raffone & Srinivasan, 2010). Mindfulness
as a practice, and a state of mind is commonly presented as a case of open-monitoring
(Kabat-Zinn, 2003). However, in practice, mindfulness meditation usually involves both
focused attention and open-monitoring, e.g., beginning with a period of focused attention on
the breath, in order to stabilise one’s awareness, followed by the more receptive state of open-
monitoring (Chiesa, Calati, & Serretti, 2011).
According to Shapiro et al. (2006), the main significance of mindfulness as a
quality/state, and a practice is that it involves a meta-mechanism known as reperceiving. 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). This process,
also known as ‘decentring,’ is defined as ‘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). This ability is theorised 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). For example, in Mindfulness-Based
Cognitive Therapy (MBCT), designed to prevent depressive relapse, people are taught to
decentre from their cognitions, thus helping prevent a ‘downward spiral’ of negative thoughts
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and worsening negative affect which could otherwise trigger relapse (Segal, Williams, &
Teasdale, 2002). Thus MBCT, and MBIs generally, 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).
For instance, the development of decentring can help people tolerate distressing qualia, which
is important given that inability to tolerate such qualia is a transdiagnostic factor underlying
diverse psychopathologies (Aldao, Nolen-Hoeksema, & Schweizer, 2010).
Mindfulness interventions were initially limited to clinical settings, such as Kabat-
Zinn’s (1982) MBSR program and subsequent adaptations like MBCT (Segal et al., 2002).
However, since the late 1990s, there has been increasing use of mindfulness in occupational
contexts, not only for staff who may be suffering with stress and mental health issues, but for
workers ‘in general’ (e.g., as a protective measure against future issues). To assess the state of
this literature with regard to HCPs, we conducted a systematic review of relevant research.
Although a number of reviews have already been conducted in this area, these have tended to
have fairly narrow remits in terms of population and/or outcome. These include reviews
focused only on certain healthcare professions, such as General Practitioners (Murray, Murray,
& Donnelly, 2016), social workers (Trowbridge &Lawson, 2016), and nurses (Botha, Gwin, &
Purpora, 2015), all of which featured small numbers of studies (e.g., Murray et al. selected just
four papers, not all of which were even exclusively concerned with mindfulness per se). Or,
such reviews have concentrated on HCPs more generally, but have only been concerned with
specific outcomes, such as stress in the case of Burton, Burgess, Dean, Koutsopoulou, and
HughJones (2017), who only included nine studies, or empathy and emotional competencies
in the case of Lamothe, Rondeau, Malboeuf-Hurtubise, Duval, and Sultan (2016), which
focused just on MBSR, and identified 14 such studies. By contrast, the current paper aims for
greater inclusivity, reporting the results of a far broader systematic review, encompassing: (a)
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workers across all HCP contexts; (b) a wide range of wellbeing outcomes; and (c) the impact
of mindfulness generally (not limited to any one intervention).
Methods
The literature search was conducted using the MEDLINE and Scopus electronic
databases. The search was conducted as part of a broader systematic review on mindfulness in
all occupations (which is still ongoing). The criteria for the broader review 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 10th January 2016. For this current review into HCPs, in terms of PICOS
(participants, interventions, comparisons, outcomes and study design) the key inclusion criteria
were: participants currently employed in a healthcare context; outcomes any pertaining to
mindfulness, wellbeing, and job performance; and study design any empirical study featuring
data collection. Exclusion criteria were theoretical articles or commentaries without statistical
or qualitative analyses. Although we were principally interested in studies of MBIs in
healthcare workplaces, as a secondary concern we were also interested in non-intervention
studies (e.g., regression analyses of the association between trait mindfulness and wellbeing
outcomes). Studies were required to be published (or in press) in English in a peer-reviewed
academic journal. 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 for the broader systematic review was registered with the
International Prospective Register of Systematic Reviews (PROSPERO) database on 5th
January 2016 (registration number: CRD42016032899).
Papers were divided into intervention studies and non-intervention studies. For
intervention studies, the following variables were extracted from each paper: type of design
(e.g., RCT versus convenience sample); occupation of participants; number of experimental
Page 8 of 54
participants; number of control participants (if applicable); type of MBI; length of MBI; nature
of control; principle wellbeing and performance outcomes; and the significance level and effect
size of principle outcomes. For non-intervention studies, the following variables were
extracted: type of analysis (e.g., regression versus qualitative); occupation of participants;
number of experimental participants; principle wellbeing and performance outcomes; and the
significance level of principle outcomes.
The primary summary measures were mindfulness and wellbeing outcomes. These
were principally psychometric scales pertaining to mindfulness, mental health (e.g., anger,
anxiety, burnout, depression, distress, stress, satisfaction, wellbeing), and physical health (e.g.,
illness, diet, exercise, and sleep). Secondary summary measures of interest were outcomes that
pertain to wellbeing (e.g., compassion, empathy, emotional intelligence and regulation,
relationships, resilience, and spirituality). Tertiary summary measures of interest were
outcomes relating to job performance. The Quality Assessment Tool for Quantitative Studies
(QATQS; National Collaborating Centre for Methods and Tools, (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 quality score of 1 to 3 (1 = strong; 2 =
moderate; 3 = weak). Scores for each area were collated, and a global score assigned to each
study. If there are no weak ratings, the study is scored 1 (strong); one weak rating leads to a 2
(moderate); and two or more weak ratings generates a 3 (weak). QATQS scoring was
conducted by the fourth author, and checked independently by the first author. Any
discrepancies were resolved by discussion with agreement reached in all cases.
Results
For the broader systematic review (i.e., mindfulness across all occupations), following
removal of duplicate citations, 721 potentially relevant papers were identified. In the current
Page 9 of 54
specific systematic review (focusing specifically on HCPs), from reviewing the abstract, 543
papers were excluded. From the full text reviews of 178 papers, 97 further papers were
excluded. Thus, a total of 81 papers were included in the systematic analysis (66 intervention
studies, and 15 non-intervention studies). Two of these papers pertained to the same trial
(Cohen-Katz, Wiley, Capuano, Baker, Kimmel, et al., 2005; Cohen-Katz, Wiley, Capuano,
Baker, Deitrick, et al., 2005), and so the 81 papers included in the analysis represented results
from 80 independent participant samples. The studies comprised a total of 3,805 participants
(discounting participants not including in analyses due to attrition). There were 2,645
participants in the intervention studies, as below in table 1, including 1,869 undertaking MBIs,
663 separate control participants (excluding Singh et al., 2006, in which participants acted their
own controls), plus one study (Grepmair, Mitterlehner, Loew, & Nickel, 2007) in which
participants were not HCPs per se, but rather patients being treated by them. There were 1,160
participants in non-intervention studies, as detailed in table 2. The studies covered a range of
occupations, including physicians (n = 9), nurses (n = 16), disability professionals (n = 4),
therapists, psychologists and counsellors (n = 24, mixed (non-specific) mental health
professionals (n = 8), and mixed (non-specific) healthcare professionals (n = 20).
Page 10 of 54
Table 1. Overview of studies
Authors
Occupation
Design
Expt.
group
Intervention
Length
Control
Primary outcome(s)
(Aggs & Bambling,
2010)
Psychotherapists
Convenience
sample
47
Mindful therapy
8 weeks
N/A
PI < stress & strain (p < .01). PI > mindfulness & awareness (p <
.01).
(Barbosa et al.,
2013)
Healthcare
graduates
Convenience
sample
13
MBSR
8 weeks
Nothing
PI < anxiety (d = -.09, p < .001), burnout (emotional exhaustion, d
= -.41; depersonalisation, d = -.26; and personal accomplishment, d
= .29; p < .001). PI > compassion & empathy (physician empathy,
d = .77, p < .01).
(Bazarko, Cate,
Azocar, & Kreitzer,
2013)
Nurses (corporate)
Convenience
sample
36
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; p < .001), and stress &
strain (perceived stress, d = -1.21, p < .001). PI > compassion &
empathy (physician empathy, d = .76; and self-compassion, d =
1.25; p < .001), health (physical health, d = -.38, p < .001; and
mental health, d = 1.40 p < .05), and wellbeing, satisfaction &
flourishing (serenity, d = 1.48 p < .001).
(Beckman et al.,
2012)
Primary care
physicians
Convenience
sample
20
Program in mindful
communication (Krasner et
al., 2009).
52 hours
N/A
Qualitative interviews (n = 20): PI > mindfulness & awareness,
and relationships.
(Beddoe & Murphy,
2004)
Trainee nurses
Convenience
sample
16 (23)*
MBSR
8 weeks
N/A
PI < stress & strain (p < .05). PI >< compassion & empathy.
(Bond et al., 2013)
Trainee doctors
Convenience
sample
27
Mind-body course**
11 weeks
N/A
PI > compassion & empathy (self-compassion, d = .17, p=.04),
emotional intelligence & regulation (self-regulation, d = .01,
p=.003). PI >< compassion & empathy (physician empathy, d =
.09), and stress & strain (perceived stress, d = -.03).
(Bonifas & Napoli,
2014)
Trainee social
workers
Convenience
sample
77
Mindfulness curriculum
(specific to study)
16 weeks
N/A
PI > wellbeing, satisfaction & flourishing (quality of life, d = .88, p
< .001). PI >< stress & strain (perceived stress, d = .06).
(Brady et al., 2012)
Psychiatric ward
professionals
Convenience
sample
16 (23)
MBSR adaptation
4 weeks
N/A
PI < stress & strain (stress, d = -.70, p < .01), burnout (emotional
exhaustion, d = -.50; depersonalisation, d = -.23; and personal
accomplishment, d = .29). PI > mindfulness & awareness
(mindfulness, d = .64, p <.01; and intrapersonal presence, d = .54,
p =.02).
(Brooker et al.,
2013)
Disability
professionals
Convenience
sample
34 (36)
Occupational mindfulness
training program
8 weeks
N/A
PI < wellbeing, satisfaction, & flourishing (extrinsic job
satisfaction, p < .05). PI > mindfulness & awareness (p < .05),
stress & strain (p < .05), and wellbeing, satisfaction & flourishing
(positive affect, p < .05; and negative affect. p < .05). PI ><
burnout, compassion & empathy, depression, wellbeing,
satisfaction & flourishing.
(Brooker et al.,
2014)
Disability
professionals
Convenience
sample
12
Occupational mindfulness
training program
8 weeks
N/A
PI > job performance (restraint of patients, and seclusion of
patients; p < .05).
(Burnett &
Pettijohn, 2015)
Healthcare
employees
Random
allocation
20 active
& 17
passive
MBST
5 weeks
Passive
intervention
: abstention
from work
activity.
Passive intervention group: PI >< emotional intelligence &
regulation, stress & strain (perceived stress, d = -.09).
Control group: PI >< emotional intelligence & regulation, and
stress & strain (perceived stress, d = -.70).
Page 11 of 54
Control:
nothing.
(Christopher,
Christopher,
Dunnagan, &
Schure, 2006)
Trainee
counsellors
Convenience
sample
11
Mindfulness curriculum
(specific to study)
1 term
N/A
Qualitative interviews: PI < burnout, and stress & strain.
(Cohen & Miller,
2009)
Trainee clinical
psychologists
Convenience
sample
21 (28)
Interpersonal mindfulness
training
6 weeks
N/A
PI < anxiety (d = -.46, p = .027), and stress & strain (perceived
stress, d = -.53, p <.001). PI > emotional intelligence & regulation
(emotional intelligence, d = .39, p = .020), and relationships (social
connectedness, d = 57, p = .002). PI >< depression (d = -.11),
mindfulness & awareness (mindful attention awareness, d = .48),
and wellbeing, satisfaction & flourishing (life satisfaction, d = .43,
p=.051; searching of meaning in life, d = -.35; and presence of
meaning in life, d = .12).
(Cohen-Katz,
Wiley, Capuano,
Baker, Kimmel, et
al., 2005)
Nurses
RCT
12 (14)
MBSR
8 weeks
Wait-list
PI < burnout (p = .050). PI > mindfulness & awareness (p = .001).
PI >< distress & anger.
(Cohen-Katz,
Wiley, Capuano,
Baker, Deitrick, et
al., 2005)
Nurses
RCT
12 (14)
MBSR
8 weeks
Wait-list
Qualitative data analysis (n = 12): PI > emotional intelligence &
regulation (self-acceptance), mindfulness & awareness (self-care,
and self-awareness), relationships, and wellbeing, satisfaction &
flourishing (relaxation).
(Dobie, Tucker,
Ferrari, & Rogers,
2015)
Mental health
professionals
Convenience
sample
9
MBSR adaptation
8 weeks
N/A
PI < anxiety (d = -.86, p = .02), distress (p = .002), and stress &
strain (stress, d = -.96, p <.05). PI > mindfulness & awareness
(mindfulness, d = .41). PI >< depression (d = -.44, p = .06).
(De Vibe et al.,
2013)
Trainee doctors
RCT
144
MBSR adaptation
6 weeks
Nothing
PI < distress & anger (distress, d = -.77, p < .001), and stress &
strain (stress, d = -.27, p = .021). PI > wellbeing, satisfaction &
flourishing (subjective wellbeing, d = .43, p < .001). PI >< burnout
(burnout, d = -.13), and mindfulness & awareness (act aware, d = -
.04; describe, d = -.06; observe, d = .18; non-judging, d = -.23; and
non-reacting, d = .31).
(de Zoysa, Ruths,
Walsh, & Hutton,
2014)
Mental health
professionals
Convenience
sample
7
MBCT (in (Ruths et al.,
2013)
8 weeks
N/A
Qualitative interviews: PI > emotional intelligence & regulation
(self-regulation).
(Dorian &
Killebrew, 2014)
Trainee
psychotherapists
Convenience
sample
21
Mindfulness curriculum
(specific to study)
10 weeks
N/A
Qualitative interviews: PI < distress & anger. PI > compassion &
empathy (compassion), emotional intelligence & regulation
(acceptance), and mindfulness & awareness (awareness, and
coping).
(Duchemin, B. A.
Steinberg, D. R.
Marks, K. Vanover,
& M. Klatt, 2015)
Intensive care
professionals
RCT
16
Mindfulness program
(specific to study)
8 weeks
Wait-list
PI < stress & strain (p = .040). PI > wellbeing, satisfaction &
flourishing (quality of life, p = .031). PI >< anxiety, burnout,
depression, and mindfulness & awareness.
(Erogul, Singer,
McIntyre, &
Stefanov, 2014)
Trainee doctors
RCT
29
MBCT
8 weeks
Nothing
PI < stress & strain (perceived stress, d = -.60, p = .03). PI >
compassion & empathy (self-compassion, d = .88, p <.001). PI ><
resilience (d = .27, p=.05).
Page 12 of 54
(Felton, Coates, &
Christopher, 2015)
Trainee
counsellors
Convenience
sample
Mindfulness curriculum
(specific to study)
15 weeks
N/A
Qualitative interviews: PI < stress & strain. PI > compassion &
empathy (compassion), emotional intelligence & regulation
(acceptance), and mindfulness & awareness (awareness).
(Fisher & Hemanth,
2015)
Clinical
psychologists
Convenience
sample
8
Mindfulness program
(specific to study)
10 weeks
N/A
Qualitative interviews: PI > emotional intelligence & regulation
(acceptance), and wellbeing, satisfaction & flourishing
(relaxation).
(Fortney,
Luchterhand,
Zakletskaia,
Zgierska, & Rakel,
2013)
Primary care
clinicians
Convenience
sample
28 (32)
MBSR adaptation
18 hours
(over 5
sessions)
N/A
PI < anxiety (d = -.47, p = .006), burnout (emotional exhaustion, d
= -.31, p=.009; depersonalisation, d = -22, p=.005; and personal
accomplishment, d = .50, p <.001), depression (depression, d = -
.54, p <.001), and stress & strain (perceived stress, d = -.54, p =
.002; and stress, d = -.31, p = .002). PI >< compassion & empathy
(compassion, d = -.04), resilience (resilience, d = .17).
(Foureur, Besley,
Burton, Yu, &
Crisp, 2013)
Nurses &
midwives
Convenience
sample
28 (40)
MBSR adaptation
1 day (&
8 weeks
practice)
PI < distress & anger (distress, d = -.59, p = .031), and stress &
strain (stress, d = -.65, p = .004). PI > wellbeing, satisfaction &
flourishing (sense of coherence, d = .73, p = .009). PI >< anxiety
(d = -.28, p = .079), and depression (d = -.33).
(Galantino, Baime,
Maguire, Szapary,
& Farrar, 2005)
Healthcare
professionals
Convenience
sample
84
Mindfulness program
(specific to study)
8 weeks
N/A
PI < anxiety (p = .001), burnout (p = .002), depression (p = .001),
and distress & anger (p = .001). PI >< compassion & empathy, and
stress & strain.
(Gauthier et al.,
2015)
Paediatric ICU
nurses
Convenience
sample
38 (45)
Mindfulness program
(specific to study)
30 days
N/A
PI < stress & strain (stress, d = -.40, p = .006). PI >< burnout
(emotional exhaustion, d = -.18; depersonalisation, d = -.13; and
personal accomplishment, d = .12), compassion & empathy (self-
compassion, d = .23), and mindfulness & awareness (mindful
attention awareness, d = .07).
(Gockel et al.,
2013)
Trainee social
workers
Convenience
sample
38
MBSR adaptation
10 weeks
N/A
PI > job performance (counselling self-efficacy, d = .53, p = .005),
mindfulness & awareness (mindfulness, d = .72, p = .034).
(Goodman &
Schorling, 2012)
Healthcare
professionals
Convenience
sample
93
Mindfulness for healthcare
providers
8 weeks
N/A
PI >< burnout (emotional exhaustion, d = -.29; depersonalisation, d
= -.44; and personal accomplishment, d = .44), and health (mental
health, d = .78; physical health, d = -.02).
(Grepmair,
Mitterlehner, Loew,
& Nickel, 2007)
Trainee
psychotherapists
Convenience
sample
58
Mindfulness program
(specific to study)
9 weeks
Pre-training
PI > job performance (patients’ distress, d = -.93, p < .01).
(Hallman,
O'Connor, Hasenau,
& Brady, 2014)
Psychiatric
service
professionals
Convenience
sample
12 (13)
MBSR
8 weeks
N/A
PI < stress & strain (perceived stress, d = -.20, p < .05). PI >
mindfulness & awareness (mindfulness, d = .68, p < .05).
(Hemanth & Fisher,
2015)
Clinical
psychology
trainees
Convenience
sample
10
Mindfulness program
(specific to study)
10 weeks
N/A
Qualitative interviews: PI > compassion & empathy, job
performance, relationships, and emotional intelligence &
regulation.
(Hopkins & Proeve,
2013)
Trainee
psychologists
Convenience
sample
11
MBCT
8 weeks
N/A
PI > compassion & empathy (emotional concern, d = -.40;
perspective taking, d = -.37; personal distress, d = -.23; and
fantasy, d = -.30; p <.01), and mindfulness & awareness (act
aware, d = .11; observe, d = .43; describe, d = .18; non-reacting, d
= .77;and non-judging, d = 1.27; p <.05). PI >< stress & strain,
(perceived stress, d = -.67).
Page 13 of 54
(Horner, Piercy,
Eure, & Woodard,
2014)
Nurses
Convenience
sample
31 (46)
Mindfulness program
(specific to study)
10 weeks
Nothing
PI >< burnout, compassion & empathy, mindfulness & awareness,
stress & strain, and wellbeing, satisfaction & flourishing
(professional quality of life).
(Johnson et al.,
2015)
Healthcare
professionals
RCT
20
Resilience training
8 weeks
Wait-list
PI < anxiety (trait, d = -1.41, p=.008), depression (depression with
the CESD-10, d = -1.50, p=.002; and depression with the PHQ-9, d
= -1.56, p<.001), and stress & strain (perceived stress, d = -1.30,
p<.01). 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; p<.05). PI >< anxiety (state,
d = -1.02).
(Kemper &
Khirallah, 2015)
Health
professionals
Convenience
sample
112
Mindfulness in daily life
1 hour
N/A
PI > mindfulness & awareness (cognitive and affective
mindfulness, d = .24, p = .004; and mindful attention awareness, d
= .20, p < .001), and resilience (resilience, d = .21, p < .001).
(Klatt et al., 2015)
Intensive care IC
staff
RCT
34
Mindfulness in motion
8 weeks
N/A
PI > resilience (engagement, p = .012; resilience, p = .023; and
vigour, p = .033).
(Krasner et al.,
2009)
Primary care
physicians
Convenience
sample
70
Mindfulness program
(specific to study)
8 weeks
N/A
PI < burnout (emotional exhaustion, d = -.37, depersonalisation, d
= -.19; and personal accomplishment, d = .15; p < .001), and
distress & anger (distress, d = -.47, p < .001). PI > compassion &
empathy (physician empathy, d = .36, p < .001), and mindfulness
& awareness (mindfulness, d = .86, p < .001).
(Mackenzie et al.,
2006)
Nurses
RCT
16
MBSR adaptation
4 weeks
Wait-list
PI < burnout (emotional exhaustion, d = .32, p < .01;
depersonalisation, d = -.04, p < .05; and personal accomplishment,
d = 1.55, p < .05). PI > wellbeing, satisfaction & flourishing
(relaxation dispositions, d = .24, p < .01). PI >< wellbeing,
satisfaction & flourishing (intrinsic job satisfaction, d = .17;
satisfaction with life, d = -.13; and sense of coherence, d = .16).
(Manotas, Segura,
Eraso, Oggins, &
McGovern, 2014)
Healthcare
professionals
RCT
40 (66)
MBSR adaptation
4 weeks
NR
PI < distress & anger (distress, d = -.61, p = .006), and stress &
strain (perceived stress, d = -.68, p < .001). PI > mindfulness &
awareness (act aware, d = -.29; observe, d = .23; describe, d = -.28;
non judging, d =.32; non reacting, d = .03; and total mindfulness, d
= .07; p < .001).
(Martín-Asuero &
García-Banda,
2010)
Healthcare
professionals
Selected
sample
29
MBSR adaptation
8 weeks
N/A
PI < depression (rumination, d = -.19, p = .010), and distress &
anger (psychological distress, d = -.59, p = .016). PI > wellbeing,
satisfaction & flourishing, (negative affect, d = -.26, p = .002). P
>< stress & strain (daily stress, d = -.39).
(Martín-Asuero et
al., 2014)
Healthcare
professionals
RCT
43
MBSR adaptation
8 weeks
Wait-list
PI < anxiety (p < .001), burnout (emotional exhaustion, d = -.59;
depersonalisation, d = -.32; and personal accomplishment, d = .27;
p < .01), depression (p < .05), and distress & anger (distress, d = -
.83, p < .001). PI > compassion & empathy (physician empathy, d
= .40, p < .05), and mindfulness & awareness (act aware, d = .84;
describe, d = .44; observe, d = 1.27; non-reacting, d = 1.21; and
non-judging, d = .49; p < .05).
Page 14 of 54
(McConachie,
McKenzie, Morris,
& Walley, 2014)
Support staff
RCT
66
Acceptance and
mindfulness workshop
1.5 days
Wait-list
PI < distress & anger (distress, d = -.35, p < .001). PI ><
wellbeing, satisfaction & flourishing (mental wellbeing, d = .17).
(Mealer et al.,
2014)
Intensive care
nurses
RCT
13
Resilience training
program*
12 weeks
Nothing
PI < depression (p = .03), and stress & strain (PTSD, p = .01). PI >
resilience (p = .01). PI >< anxiety & burnout.
(Moody et al.,
2013)
Paediatric
oncology staff
RCT
24
Mindfulness program
(specific to study)
8 weeks
Nothing
PI >< burnout, depression, and stress & strain.
(Moore, 2008)
Trainee clinical
psychologists
Convenience
sample
16 (23)
Mindfulness program
(specific to study)
4 weeks
N/A
PI > mindfulness & awareness (p = .04) PI >< compassion &
empathy, and stress & strain.
(Newsome,
Christopher,
Dahlen, &
Christopher, 2006)
Counsellors
Convenience
sample
33
Mindfulness curriculum
(specific to study)
15 weeks
N/A
Qualitative interviews: PI >< emotional intelligence & regulation
(acceptance), mindfulness & awareness (awareness), health,
relationships, and wellbeing, satisfaction & flourishing
(spirituality).
(Newsome, Waldo,
& Gruszka, 2012)
Trainee helping
professionals
Convenience
sample
31
Mindfulness program
(specific to study)
6 weeks
N/A
PI < stress & strain (perceived stress, d = -1.01, p < .0001). PI >
compassion & empathy (self-compassion, d = 1.13, p < .0001), and
mindfulness & awareness (mindful attention awareness, d = .91, p
< .001),
(Noone & Hastings,
2010)
Disability support
workers
Convenience
sample
34
Promotion of acceptance in
carers and teachers
1.5 days
N/A
PI < distress & anger (distress, d = -.54, p = .020). PI >< stress &
strain (stress, d = -.13).
(Pflugeisen,
Drummond,
Ebersole, Mundell,
& Chen, 2015)
Physicians
Convenience
sample
19 (23)
MBSR adaptation
8 weeks
N/A
PI < burnout (emotional exhaustion, d = -.46; depersonalisation, d
= -.32; and personal accomplishment, d = .56; p = <.03), and stress
& strain (perceived stress, d = -.87, p = .005). PI > mindfulness &
awareness (mindfulness skills, d = .84, p = .01).
(Pipe et al., 2009)
Nurses
RCT
15
MBSR adaptation
4 weeks
Wait-list
PI < distress & anger (psychological distress, d = -.39, p = .009).
PI >< depression (d = -.54), job performance (caring efficacy, d =
.48), and relationships (interpersonal sensitivity, d = .38, p = .29).
(Poulin et al., 2008)
[study 1]
Nurses
RCT
16
MBSR adaptation
4 weeks
Imagery &
progressive
muscle
relaxation
PI > wellbeing, satisfaction & flourishing (relaxation, d = -.63, p <
.05). PI >< burnout (emotional exhaustion, d = -.07;
depersonalisation, d = -.16; and personal accomplishment, d = .73).
(Raab et al., 2015)
Mental health
professionals
Convenience
sample
22
MBSR
8 weeks
N/A
PI > compassion & empathy (self-compassion, d = .48, p = .003).
PI >< burnout (depersonalisation, d = -.11; emotional exhaustion, d
= -.20; and personal accomplishment, d = .20), and wellbeing,
satisfaction & flourishing (quality of life, d = .02).
(Rimes &
Wingrove, 2011)
Trainee clinical
psychologists
Convenience
sample
20
MBCT
8 weeks
N/A
PI < depression (rumination, d = -.57, p < .0005). PI > anxiety (d
= .26, p = <.05), compassion & empathy (fantasy, d = .52; self-
compassion, d = .48, empathic concern, d = .00; personal distress,
d = -.06; and perspective taking, d = -.03; p = <.05), and
mindfulness & awareness (act aware, d = .10; non non-reacting, d
= .59; non judging, d = .52; describe, d = .31; and observe, d = .38;
p < .001). PI >< stress & strain (perceived stress, d = -.23).
(Rocco, Dempsey,
& Hartman, 2012)
Mental health
professionals
Convenience
sample
16
Calm abiding meditation
8 weeks
N/A
Qualitative interviews: PI > emotional intelligence & regulation
(acceptance, and emotion regulation), mindfulness & awareness
(awareness), and health (health behaviours).
(Ruths et al., 2013)
Mental health
professionals
Convenience
sample
27
MBCT
8 weeks
N/A
PI < distress & anger (p = .003). PI > mindfulness & awareness (p
= .008). PI >< anxiety, and wellbeing, satisfaction & flourishing
(satisfaction with life).
Page 15 of 54
(Shapiro et al.,
1998b)
Trainee doctors
RCT
37
Stress reduction and
relaxation
7 weeks
Wait-list
PI < anxiety (state, d = -.46; and trait, d = -.59; p < .05), depression
(depression, d = -.46, p < .006), and distress & anger
(psychological distress, d = -.69, p < .02). PI > compassion &
empathy (empathy, d = .47, p < .05), and wellbeing, satisfaction &
flourishing (spirituality, d = .32, p < .02).
(Shapiro et al.,
2005)
Healthcare
professionals
RCT
18
MBSR
8 weeks
Wait-list
PI < stress & strain (perceived stress, d = -.15, p = .04). PI >
compassion & empathy (self-compassion, d = .02, p = .004). PI ><
burnout (emotional exhaustion, d = -.18; depersonalisation, d = -
.74; and personal accomplishment, d = .64), distress & anger
(distress, d = -.07), and wellbeing, satisfaction & flourishing
(satisfaction with life, d = .15).
(Shapiro et al.,
2007)
Trainee
psychotherapists
Convenience
sample
22
MBSR
8 weeks
Psychology
course
PI < anxiety (state, d = -.55, p = .0005; and trait, d = -.91, p =
.0002), depression (rumination, d = -.41, p = .0006), and stress &
strain (perceived stress, d = -.67, p <.0001). PI > compassion &
empathy (self-compassion, d = .42, p <.0001), mindfulness &
awareness (mindful attention awareness, d = .36, p = .006), and
wellbeing, satisfaction & flourishing (positive affect, d = .57, p =
.0002; and negative affect, d = -.46, p = .04).
(Singh et al., 2015)
Disability
professionals
Convenience
sample
9
Mindfulness-based positive
behavioural support
7 days
N/A
PI < stress & strain (perceived stress, d = -3.89 p < .001), PI > job
performance (restraining patients, p < .001; staff injury, p < .001; ,
disciplining patients, p < .001).
(Singh et al., 2006)
Psychiatric staff
Convenience
sample
18 (3
teams)
Mindfulness-based
mentoring
11, 8 or 6
sessions
Control
within &
between
teams
PI > job performance (team functioning, p < .001).
(Song & Lindquist,
2015)
Trainee nurses
RCT
21 (25)
MBSR
8 weeks
Wait-list
PI < anxiety (d = -.50, p = .023), depression (d = -.70, p = .002),
and stress & strain (stress, d = -.85, p < .001). PI > mindfulness &
awareness (mindful attention awareness, d = .13, p = .010).
(Stew, 2011)
Trainee occ
therapists
Convenience
sample
12
MBSR adaptation
4 weeks
N/A
Qualitative interviews (n = 10): PI > emotional intelligence &
regulation (acceptance), and mindfulness & awareness.
(Tarrasch, 2014)
Trainee
counsellors and
support staff
Convenience
sample
19
Mindfulness curriculum
(specific to study)
2 terms
N/A
Qualitative interviews (n = 19) PI > emotional intelligence &
regulation (acceptance), mindfulness & awareness (awareness,
calmness, coping).
(Van der Riet,
Rossiter, Kirby,
Dluzewska, &
Harmon, 2015)
Trainee nurses
Convenience
sample
14
Mindfulness program
(specific to study)
7 weeks
N/A
Qualitative analysis: PI < stress & strain. PI > mindfulness &
awareness (awareness), emotional intelligence & regulation, and
relationships.
(West et al., 2014)
Physicians
RCT
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).
All statistically significant results are reported. Effect sizes were calculated when means and standard deviations were available, otherwise, just statistically significant differences are offered. Note. < = decreases in; >
= increases in; >< = no change in; 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. 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.
Page 16 of 54
Table 2. Overview of non-intervention studies.
Authors
Workplace
Meditators
Non-meditators
Analysis
Primary result
(Choi & Koh, 2015)
Nurses
-
330
Correlations
Mindfulness correlation: < stress & strain (job stress, r = -.279, p < .001). > job satisfaction (r =
.171, p = .002).
(Christopher et al.,
2011)
Counsellors &
psychotherapists
13
3
Qualitative
Mindfulness > emotional intelligence & regulation (acceptance, and self-regulation), mindfulness
& awareness (awareness), job performance, and relationships.
(Cigolla & Brown,
2011)
Psychotherapists
6
-
Qualitative
Mindfulness > emotional intelligence & regulation (acceptance), mindfulness & awareness
(awareness), job performance, relationships, and wellbeing, satisfaction & flourishing
(spirituality).
(Di Benedetto &
Swadling, 2014)
Psychologists
-
167
Correlation
Mindfulness correlation: < burnout (r = -.42, p < .0003).
(Dauenhauer, 2006)
Professional caregivers
-
20
Qualitative
Mindfulness > emotional intelligence & regulation (acceptance, and sensitivity), mindfulness &
awareness (awareness), and relationships.
(Gill, Waltz, Suhrbier,
& Robert, 2015)
Psychotherapists
7
-
Qualitative
Mindfulness > emotional intelligence & regulation (acceptance), mindfulness & awareness
(awareness), job performance, relationships, and wellbeing, satisfaction & flourishing
(wellbeing).
(Keane, 2014)
Psychotherapists
-
40
Correlations
Mindfulness (FFMQ, all facets) correlation: > compassion & empathy (IRI Perspective taking; r
range .44-.60, p < .001), mindfulness & awareness (FFMQ Observe, Non-judging, Non-
reactivity) correlation: > compassion & empathy (IRI Global empathy; r range .44-.60, p < .001).
(Kemper et al., 2015)
Health professionals
-
213
Correlations
Mindfulness correlation: stress & strain (perceived stress, r = -.58, p < 0.001). > health (health, r
= .37, p < .01; sleep quality, r = - .32, p < .01; and global mental health, r = .56, p <.001),
resilience (r = .5, p <.01), and compassion & empathy (self-compassion, r = .63, p <.001).
(McCollum & Gehart,
2010)
Psychotherapists
13
-
Qualitative
Mindfulness > emotional intelligence & regulation (acceptance), and job performance.
(McCracken & Yang,
2008)
Rehabilitation workers
-
98
Correlations
Mindfulness correlation: < burnout (exhaustion; r = -.43, p < .05), and stress & strain (r =.23, p <
.001). > health (r = .30, p < .01; vitality, r = .43, p < .01; social
Functioning, r = .44, p < .001; emotion Functioning, r = .40, p < .001; and emotion role, r = .33,
p < .001). >< wellbeing, satisfaction & flourishing (job satisfaction).
(Razzaque, Okoro, &
Wood, 2015)
Clinical psychologists
-
76
Correlations
Mindfulness correlation: > relationships (therapeutic alliance, r = .356, p < .01).
(Ryan, Safran, Doran, &
Muran, 2012)
Psychotherapists
-
52 (26 dyads)
Correlations
Mindfulness correlation: > relationships (interpersonal functioning, p < .05; and therapeutic
alliance, p < .05). PI >< job performance (patient distress).
(Simon, Ramsenthaler,
Bausewein, Krischke, &
Geiss, 2009)
Palliative care
professionals
-
10
Qualitative
Mindfulness > emotional intelligence & regulation (acceptance), and job performance.
(Talisman, Harazduk,
Rush, Graves, &
Haramati, 2015)
Medical training
facilitators
62
-
Correlations &
qualitative
Mindfulness correlation: < emotional intelligence & regulation (self-affiliation, r = .413, p < .05).
Qualitative interviews: > mindfulness & awareness, compassion & empathy, job performance,
and relationships.
(Westphal et al., 2015)
Intensive care nurses
-
50
Correlations
Mindfulness correlation: < anxiety (r = -.55, p < .001), burnout (depersonalization; r = -.37, p <
.001; emotional exhaustion; r = -.52, p < .001), and depression (r = .49, p < .001).
Note. < = negative correlation with; > = positive correlation with; >< = no correlation.
Page 17 of 54
An overview of the findings is shown in table 3 below. This shows whether outcomes
were either: (a) increased in relation to an MBI; (b) did not change in relation to an MBI (or in
exceptional cases, changed in a ‘negative’ direction); or (c) were found in non-intervention
studies to be associated with mindfulness (i.e., through regression analyses). A more detailed
breakdown of the results is included below in the discussion, featuring tables detailing all the
studies that assessed a given outcome.
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
Association (benign)
with mindfulness
Anxiety
16
9
7, + *1
1
Burnout
25
11
11
3
Compassion & empathy
28
16
9
3
Depression
18
10
7
1
Distress & anger
16
14
2
0
Emotional intelligence &
regulation
21
12
2
7
Health
7
3
2
2
Job performance
13
6
1
6
Mindfulness & awareness
39
27
6
6
Relationships
13
5
2
6
Resilience
6
3
2
1
Stress & strain
40
25
12, + *1
3
Wellbeing, satisfaction &
flourishing
24
12
11, + *1
2, + *1
Note: * = studies showing worsening outcomes in relation to mindfulness. In instances where the total number of studies does not appear to
be an accurate product of the other three columns (e.g., in the case of anxiety), this is because some studies used multiple measures with
respect to a given outcome, and observed both a significant impact and no significant change.
Discussion
MBIs generally had a positive impact upon all outcome measures. However, there were
some areas in which findings were more equivocal (including burnout, health, resilience, and
generic wellbeing). This discussion will run through the main outcomes in turn, beginning
with mindfulness and awareness itself.
Page 18 of 54
Figure 1. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Flow
Diagram
Records identified through
database search
(n = 1,158)
Records identified through
additional sources
(n = 9)
Records after duplicates removed
(n = 721)
Records screened
(n = 721)
Records excluded
(n = 543)
Reasons:
- Not about mindfulness (n = 98)
- Not empirical (n = 207)
- Not pertaining to work (172)
- Not pertaining to healthcare (n = 64)
- Not in English (n = 2)
Full-text articles
assessed for eligibility
(n = 178)
Full-text articles excluded
(n = 97)
Reasons:
- Not about mindfulness (n = 7)
- Not empirical (n = 48)
- Not pertaining to healthcare (n = 40)
- Not in English (n = 2)
Papers included
(n = 81)
Page 19 of 54
Mindfulness & Awareness
MBIs certainly appear effective at engendering mindfulness, with a small to medium
effect size (d=.36) as assessed by 33 intervention studies, as shown in table 4 below. The vast
majority of these (n = 27) showed an increase in mindfulness in relation to an MBI, while six
found no significant improvement. However, as positive as these headline figures are, further
nuance is provided by digging a little deeper into the results, since a range of scales were used
across the studies scales which construct mindfulness in diverse ways with some interesting
variation. This diversity of scales is both a weakness and a strength. It is a weakness inasmuch
as it difficult to draw comparisons across studies. Indeed, inconsistency in the use of scales
across studies was a common theme in this review. That said, the diversity of measures does
allow us to discern nuances in the development of mindfulness. The most popular tool was
Brown and Ryan’s unidimensional (2003) Mindful Attention and Awareness Scale (MAAS),
which assesses dispositional mindfulness according to a single core characteristic of
mindfulness (open and receptive awareness), which essentially aligns with Kabat-Zinn’s
(2003) definition cited above.
By contrast, a number of studies deployed multidimensional scales, most notably Baer,
Smith, Hopkins, Krietemeyer, and Toney’s (2006) Five Facets of Mindfulness Questionnaire
(FFMQ), which focuses more on mindfulness skills (as opposed to the dispositional
mindfulness of the MAAS). Here it was difficult to discern a coherent pattern among the studies
with respect to the five dimensions/skills. For instance, consider Hopkins and Proeve (2013),
Manotas et al. (2014), Martin-Asuero et al. (2014), and Rimes and Wingrove (2011). Their
respective effect sizes for the five dimensions varied considerably, as follows: observing (.43,
.23, 1.27, .38); describing (.18, -.28, .44, .31); non-judging of inner experience (1.27, .32, .49,
.52); non-reactivity to inner experience (.77, .03, 1.21, .59); and acting with awareness (.11, -
.29, .84, .10). Thus, there was considerable variation between studies with respect to the
Page 20 of 54
different dimensions; for instance, ‘non-reactivity’ ranged from .03 (Manotas et al., 2014) to
1.21 (Martin-Asuero et al., 2014). Moreover, there was also strong variation within individual
studies across the dimensions. For instance, whereas Manotas et al. found small effect sizes for
observing (.23) and non-judging (.32), they observed no change with respect to non-reactivity
(.03), and actually saw worsening skills in describing (-.28) and acting with awareness (-.29).
Such variation shows the value of drilling down into the fine-grained details of studies.
Furthermore, it highlights the notion that so far as multidimensional scales are concerned
mindfulness is not a monolithic construct, but rather comprises nuances, upon which there may
be differential rates of change and development.
Table 4. Mindfulness & Awareness Outcomes across all Studies
Measure
Improvement (positive change) related to
mindfulness intervention
No change in relation
to mindfulness
intervention
Association (benign) with
mindfulness
Five facets of
mindfulness
questionnaire
(Brooker et al., 2013) (Hopkins & Proeve, 2013)
(Manotas et al., 2014) (Martín-Asuero et al.,
2014) (Rimes & Wingrove, 2011)
(De Vibe et al., 2013)
(Duchemin et al.,
2015)
(Keane, 2014)
Freiberg
mindfulness
inventory
(Gockel et al., 2013)
Kentucky
inventory of
mindfulness skills
(Dobie et al., 2015) (Moore, 2008) (Pflugeisen et
al., 2015)
Mindful attention
awareness scale
(Cohen-Katz, Wiley, Capuano, Baker, Kimmel,
et al., 2005) (Kemper & Khirallah, 2015)
(Newsome et al., 2012) (Ruths et al., 2013)
(Shapiro et al., 2007) (Song & Lindquist, 2015)
(J. S. Cohen & Miller,
2009) (Gauthier et al.,
2015) (Horner et al.,
2014)
Mindful therapy
scale
(Aggs & Bambling, 2010)
Qualitative
interviews
(Beckman et al., 2012) (Cohen-Katz, Wiley,
Capuano, Baker, Deitrick, et al., 2005) (Dorian &
Killebrew, 2014) (Felton et al., 2015) (Rocco et al.,
2012) (Stew, 2011) (Tarrasch, 2014) (Van der Riet
et al., 2015)
(Newsome et al., 2006)
(Christopher et al., 2011)
(Cigolla & Brown, 2011)
(Dauenhauer, 2006) (Gill et al.,
2015) (Talisman et al., 2015)
Toronto
mindfulness scale
(Brady et al., 2012) (Hallman et al., 2014)
Two factor
mindfulness scale
(Krasner et al., 2009)
Note. Authors in bold denote RCT studies.
Anxiety
Turning now to the various wellbeing outcomes, firstly, On balance, mindfulness
appears to have a beneficial impact upon anxiety, as shown in table 5 below, with a medium
Page 21 of 54
effect size (d=-.51). While nine studies reported an improvement in relation to an MBI, six
observed no change (although one further study (Rimes & Wingrove, 2011) actually reported
worsening levels of anxiety). In addition, of the non-intervention studies, Westphal et al. (2015)
reported an inverse correlation between anxiety and mindfulness. Given the high prevalence
and burden of anxiety among healthcare professionals e.g., a survey of Chinese nurses found
the prevalence of clinically-significant anxiety symptoms to be as high as 43.4% the
improvements in anxiety linked to MBIs are noteworthy, modest though they are. As with
mindfulness, a range of scales were deployed. The most prominent were Spielberger, Gorsuch,
and Lushene’s (1970) State-Trait Anxiety Inventory, and Lovibond and Lovibond’s (1995)
Depression Anxiety Stress Scale (DASS). The multidimensional DASS is particularly useful,
since it also covers depression and stress, therefore it enables more ground to be covered with
the one scale (thus reducing the empirical demands placed on participants).
Table 5. Anxiety Outcomes across all Studies
Measure
Improvement (positive change) related to
mindfulness intervention
No change in relation to
mindfulness intervention
Association (benign)
with mindfulness
Beck anxiety inventory
(J. S. Cohen & Miller, 2009)
Burns anxiety inventory
(Barbosa et al., 2013)
Depression anxiety stress
scale [anxiety]
(Dobie et al., 2015) (Fortney et al., 2013)
(Song & Lindquist, 2015)
(Duchemin et al., 2015)
(Foureur et al., 2013)
Hospital anxiety &
depression scale [anxiety]
(Mealer et al., 2014)
(Rimes & Wingrove, 2011)!
(Westphal et al., 2015)
Penn state worry
questionnaire
(Ruths et al., 2013)
Profile of mood states
[anxiety]
(Galantino et al., 2005)
(Martín-Asuero et al.,
2014)
State trait anxiety
inventory
(Johnson et al., 2015) (Shapiro, G.
Schwartz, & G. Bonner, 1998a) (Shapiro et
al., 2007)
(Johnson et al., 2015)
(Ruths et al., 2013)
Note. Authors in bold denote RCT studies; ! in third column = poorer outcome in relation to mindfulness.
Burnout
Regarding burnout, the results were more equivocal, as shown in table 6 below. Of the
22 intervention studies examining this, only 11 registered a significant improvement, while
equally 11 reported no significant change. Nevertheless, the overall effect size in this outcome
was small to medium (d=-.33). In addition, three non-intervention studies observed an inverse
correlation between burnout and mindfulness.
Page 22 of 54
One possible explanation for the relatively equivocal results with respect to the MBIs may lie
in the relatively small sample sizes of many studies. Some intervention studies that did not find
a significant improvement in burnout certainly observed trends in the predicted direction (e.g.,
Mealer et al., 2014; Poulin et al., 2008; Raab et al., 2015; Shapiro et al., 2005), although De
Vibe et al. (2013) found trends in the other direction. Larger sample sizes may allow any impact
of MBIs on burnout to be clearer. Another possible explanation is the multifaceted nature of
the construct. The dominant measure used was the Maslach Burnout Inventory (Maslach,
Jackson, & Leiter, 1986), which has three dimensions: emotional exhaustion, cynicism (also
known as depersonalisation), and professional efficacy (or accomplishment). When
considering the components separately, a number of studies found that MBIs tended to have a
stronger positive effect (albeit still non-significant) on emotional exhaustion compared to the
other two components (e.g., Barbosa et al., 2013; Duchemin, Steinberg, Marks, Vanover, &
Klatt, 2015; Moody et al., 2013; Poulin et al., 2008).
Table 6. Burnout outcomes across all Studies
Measure
Improvement (positive change) related to
mindfulness intervention
No change in relation to mindfulness
intervention
Association
(benign) with
mindfulness
Copenhagen
burnout
inventory
(Bazarko et al., 2013)
(Brooker et al., 2013)
(Di Benedetto
& Swadling,
2014)
Maslach burnout
inventory
(Barbosa et al., 2013) (Brady et al., 2012)
(Cohen-Katz, Wiley, Capuano, Baker, Kimmel,
et al., 2005) (Fortney et al., 2013) (Galantino et
al., 2005) (Krasner et al., 2009) (Mackenzie et al.,
2006) (Martín-Asuero et al., 2014) (Pflugeisen et
al., 2015)
(De Vibe et al., 2013) (Duchemin et al.,
2015) (Gauthier et al., 2015) (Goodman &
Schorling, 2012) (Mealer et al., 2014)
(Moody et al., 2013) (Poulin et al., 2008)
(Raab et al., 2015) (Shapiro et al., 2005)
(Westphal et al.,
2015)
Professional
quality of life
scale [burnout]
(Horner et al., 2014)
Profile of mood
states [fatigue]
(Martín-Asuero et al., 2014)
Profile of mood
states [vigour]
(Galantino et al., 2005) (Krasner et al., 2009)
Qualitative
interviews
(Christopher et al., 2006)
SF-12-v2 health
survey [vitality]
(McCracken &
Yang, 2008)
Note: Authors in bold denote RCT studies
Depression
Page 23 of 54
The results were generally favourable with respect to depression, as shown in table 7
below, with an overall medium effect size (d=-.53). Of the 16 intervention studies examining
this, while 10 registered a significant improvement, seven reported no significant change.
Meanwhile, in terms of non-intervention studies, Westphal et al. (2015) reported an inverse
correlation between depression and mindfulness. The relatively favourable results for this
outcome are welcome, given the relatively high incidence of depression in HCPs. For instance,
a study by Caplan (1994) in the UK found high levels of depression, particularly among GPs,
27% of whom scored as borderline or likely to be depressed. These figures contrast with
estimates that around 2.3% of the general UK adult population experience a depressive episode
at any one time (i.e., in the past week), with 9% experiencing mixed anxiety and depressive
disorder (The Health and Social Care Information Centre, 2009). There are many hypothesised
reasons for greater liability to depression among HCPs, including personality traits like
perfectionism, burdens of clinical responsibility, and reluctance to seek-treatment (Bright &
Krahn, 2011). Whatever the reasons, it is encouraging that, on balance, MBIs appear to help in
this regard although it bears repeating that over one third of intervention studies reported no
significant change reflecting the more established efficacy of MBIs such as MBCT with
respect to depression (Segal et al., 2002).
Table 7. Depression Outcomes across all Studies
Measure
Improvement (positive change)
related to mindfulness
intervention
No change in relation to mindfulness
intervention
Association (benign)
with mindfulness
Beck depression inventory
(Moody et al., 2013)
Centre for epidemiological
studies depression
(Johnson et al., 2015)
(J. S. Cohen & Miller, 2009)
Depression anxiety stress
scale [depression]
(Fortney et al., 2013) (Song &
Lindquist, 2015)
(Brooker et al., 2013) (Dobie et al., 2015)
(Duchemin et al., 2015) (Foureur et al.,
2013)
Emotional
Control Questionnaire
(Martín-Asuero & García-Banda,
2010)
Hospital anxiety &
depression scale
[depression]
(Mealer et al., 2014)
(Westphal et al.,
2015)
Patient health questionnaire
(Johnson et al., 2015)
Profile of mood states
[depression]
(Galantino et al., 2005) (Martín-
Asuero et al., 2014)
Reflection-rumination
questionnaire
(Rimes & Wingrove, 2011)
(Shapiro et al., 2007)
Page 24 of 54
Symptom checklist-90-R
[depression]
(Shapiro et al., 1998a)
(Pipe et al., 2009)
Note. Authors in bold denote RCT studies.
Stress & Strain
More consistent results were found for stress, by far the outcome receiving the most
attention, as shown in table 8 below. Of the 37 intervention studies examining this, 25
registered a significant improvement in relation to an MBI, while 12 reported no significant
change (although, in addition, Brooker et al. (2013) observed worsening levels). The global
effect size for this outcome was small to medium (d=-.42). Three non-intervention studies also
observed an inverse correlation between stress and mindfulness. These generally positive
results are again welcome: as with the other outcomes, stress is generally higher among HCPs
than in the general population: Firth-Cozens (2003) reported that the proportion of HCPs being
above threshold levels of stress is around 28% in surveys, compared with about 18% in the
general working population. As with depression, a similar range of factors have been
implicated in elevated stress levels among HCPs, from long working hours, to the burden of
clinical responsibility (Sochos, Bowers, & Kinman, 2012). Unfortunately, as highlighted
above, these burdens have only increased over recent years, due to factors such as curbs on
healthcare spending meaning that overwork has become even more acute. As noted above, a
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 et al., 2015). Thus, while it is
encouraging that MBIs may help alleviate or prevent stress, it is of course vital that these
underlying structural causes are also addressed.
Page 25 of 54
Table 8.
Stress & Strain Outcomes across all Studies
Measure
Improvement (positive change) related to
mindfulness intervention
No change in relation to mindfulness
intervention
Association
(benign) with
mindfulness
Depression
anxiety stress
scale [stress]
(Dobie et al., 2015) (Duchemin et al., 2015)
(Fortney et al., 2013) (Foureur et al., 2013)
(Brooker et al., 2013)!
Derogatis stress
profile
(Beddoe & Murphy, 2004) (Song & Lindquist,
2015)
Job stress
questionnaire
(Choi & Koh,
2015)
Perceived
medical school
stress
(De Vibe et al., 2013)
Perceived stress
questionnaire
(Martín-Asuero & García-Banda, 2010)
Posttraumatic
diagnostic scale
(Mealer et al., 2014)
Perceived stress
scale
(Bazarko et al., 2013) (J. S. Cohen & Miller, 2009)
(Erogul et al., 2014) (Fortney et al., 2013)
(Hallman et al., 2014) (Johnson et al., 2015)
(Manotas et al., 2014) (Newsome et al., 2012)
(Pflugeisen et al., 2015) (Shapiro et al., 2005)
(Shapiro et al., 2007) (Singh et al., 2015)
(Bond et al., 2013) (Bonifas & Napoli,
2014) (Brooker et al., 2013)! (Burnett &
Pettijohn, 2015) (Hopkins & Proeve,
2013) (Moody et al., 2013) (Moore,
2008) (Rimes & Wingrove, 2011) (West
et al., 2014)
(Kemper et al.,
2015)
Mental health
professionals
stress scale
(Brady et al., 2012)
Professional
quality of life
scale [stress]
(Horner et al., 2014)
Nursing stress
scale
(Gauthier et al., 2015)
Qualitative
interviews
(Felton et al., 2015) (Van der Riet et al., 2015)
(Christopher et al., 2006)
(Bond et al., 2013) (Moody et al., 2013)
Salivary α-
Amylase
(Duchemin et al., 2015)
Salivary cortisol
(Galantino et al., 2005)
Staff stressor
questionnaire
(Noone & Hastings, 2010)
Stress (survey
question)
(McCracken &
Yang, 2008)
Stress & tension
ratings
(Aggs & Bambling, 2010)
Note. Authors in bold denote RCT studies; ! in third column = poorer outcome in relation to mindfulness.
Other Wellbeing Outcomes
Page 26 of 54
This general pattern of mindfulness being associated with wellbeing was followed
across the other outcomes. For example, 15 studies examined the relationship between
mindfulness and distress or anger, and generally found it to have a positive impact as shown in
table 9 below, with a total effect size between medium and large (d=.60): 13 registered an
improvement, whereas only two reported no change. Mindfulness was also associated with
various more ‘positive’ wellbeing outcomes, although the results overall were equivocal as
shown in table 10, with an overall small to medium effect size (d=.36). Of the 21 intervention
studies examining outcomes in this area, while 12 registered an improvement, 11 reported no
change. (The non-additive nature of the numbers in that last sentence reflects the fact that two
studies used multiple wellbeing measures, and reported both significant and non-significant
outcomes in relation to these.) In addition, two non-intervention studies observed a correlation
with mindfulness (while McCracken and Yang (2008, actually observed an inverse
correlation). Mindfulness also appeared conductive to health with a medium to large effect size
(d=.62), although there were fewer studies focusing on such outcomes, as seen in table 11
below. Of the 5 intervention studies examining this, three registered an improvement, while
two reported no change; additionally, two non-intervention studies observed a correlation with
mindfulness
Table 9. Distress & Anger Outcomes across all Studies
Measure
Improvement (positive change) related to
mindfulness intervention
No change in relation to mindfulness
intervention
Association (benign)
with mindfulness
Brief symptom
inventory
(Manotas et al., 2014)
(Cohen-Katz, Wiley, Capuano,
Baker, Kimmel, et al., 2005)
(Shapiro et al., 2005)
Depression anxiety
stress scale
(Foureur et al., 2013)
General health
questionnaire
(De Vibe et al., 2013) (Foureur et al., 2013)
(McConachie et al., 2014) (Noone & Hastings,
2010) (Ruths et al., 2013)
Profile of mood
states [anger]
(Galantino et al., 2005) (Krasner et al., 2009)
(Martín-Asuero et al., 2014)
Qualitative
interviews
(Dorian & Killebrew, 2014)
Symptom
checklist-90-R
(Martín-Asuero & García-Banda, 2010) (Pipe et
al., 2009) (Shapiro et al., 1998a)
Note. Authors in bold denote RCT studies.
Page 27 of 54
Table 10.
Wellbeing, Satisfaction & Flourishing Outcomes across all Studies
Measure
Improvement (positive change)
related to mindfulness
intervention
No change in relation to
mindfulness intervention
Association (benign) with mindfulness
Brief serenity index
(Bazarko, Cate, Azocar, &
Kreitzer, 2013)
Index of core spiritual
experiences
(Shapiro et al., 1998a)
Job satisfaction scale
(Mackenzie et al., 2006)
Job satisfaction (survey
question)
(McCracken & Yang, 2008)!
Meaning in life
questionnaire
(J. S. Cohen & Miller,
2009)
Minnesota satisfaction
questionnaire
(Brooker et al., 2013)!
Physician job satisfaction
scale
(West et al., 2014)
Positive & negative affect
scale
(Brooker et al., 2013) (Martín-
Asuero & García-Banda, 2010)
(Shapiro et al., 2007)
Professional quality of life
scale
(Duchemin et al., 2015)
(Brooker et al., 2013)
(Horner et al., 2014)
Quality of life index
(Bonifas & Napoli, 2014)
Quality of life inventory
(Raab et al., 2015)
Qualitative interviews
(Fisher & Hemanth, 2015)
(Cohen-Katz, Wiley,
Capuano, Baker, Deitrick,
et al., 2005)
(Gill et al., 2015)
Qualitative interviews
(spirituality)
(Newsome et al., 2006)
(Cigolla & Brown, 2011)
Satisfaction with life scale
(Mackenzie et al., 2006) (Poulin
et al., 2008)
(Brooker et al., 2013) (J.
S. Cohen & Miller, 2009)
(Ruths et al., 2013)
(Shapiro et al., 2005)
Sense of coherence
(Foureur et al., 2013)
(Mackenzie et al., 2006)
Smith relaxation
disposition inventory
(Mackenzie et al., 2006) (Poulin
et al., 2008)
Subjective wellbeing
scale
(De Vibe et al., 2013)
Warwick-Edinburgh
mental wellbeing scale
(McConachie et al.,
2014)
Note. Authors in bold denote RCT studies; ! in third column = poorer outcome in relation to mindfulness; ! in fourth column = inverse
correlation with mindfulness.
Page 28 of 54
Table 11. Health Outcomes across all Studies
Measure
Improvement (positive change)
related to mindfulness
intervention
No change in relation to
mindfulness intervention
Association (benign) with mindfulness
Health promoting lifestyle
profile
(Johnson et al., 2015)
Patient reported outcomes
measurement information
system
(Kemper et al., 2015)
Qualitative interviews
(Rocco et al., 2012)
(Newsome et al., 2006)
SF-12-v2 health survey
[physical health]
(Bazarko et al., 2013)
(Goodman & Schorling,
2012)
(McCracken & Yang, 2008)
Workplace productivity
and impairment general
health questionnaire
(Johnson et al., 2015)
Note. Authors in bold denote RCT studies.
In addition to these primary wellbeing outcomes, mindfulness was also linked to
various factors and qualities associated with wellbeing including relationships, resilience,
and emotional intelligence which may provide an explanation for the generally positive
outcomes adumbrated above. Regarding relationships, mindfulness practice seems to have a
positive impact as seen in Table 12, with an effect size between small and medium (d=.46).
Most of the 13 studies analysing this outcome found either improvement or benign association
with regard to mindfulness, while only two failed to provide significant results. Similarly,
mindfulness was also linked to resilience, although the results were somewhat equivocal: as
shown in Table 13, of the five intervention studies examining this, three observed an
improvement while two reported no significant change. The overall effect size for this outcome
was small (d=.21). Meanwhile, Kemper et al. (2015) observed a correlation with mindfulness.
Page 29 of 54
Mindfulness appeared to impact also upon emotional intelligence and regulation, as shown in
table 14 below. Of the 14 intervention studies examining this, 12 observed an improvement
and only two reported no significant change. Nevertheless, this time no effect size was found
(d=.18). In addition, seven non-intervention studies observed a correlation with mindfulness.
The significance of this particular outcomes is that, as outlined above, a key mechanism
through which mindfulness is thought to exert its positive effects is reperceiving (Shapiro et
al., 2006), also known as decentring (Fresco et al., 2007). This ability which means that
people are better able to detach themselves from distressing qualia that might otherwise
precipitate feelings of stress etc. could be regarded as an aspect of a more general capacity of
emotion regulation (Walsh & Shapiro, 2006). The suggestion is that mindfulness might
positively impact on wellbeing 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 multiple wellbeing outcomes (while,
conversely, poor regulation skills are a transdiagnostic factor underlying diverse
psychopathologies; Aldao et al., 2010). Future work may help to elucidate these hypothesised
causal chains further, e.g., through longitudinal studies deploying regression analyses.
Table 12. Resilience Outcomes across all Studies
Measure
Improvement (positive change)
related to mindfulness
intervention
No change in relation to
mindfulness intervention
Association (benign) with mindfulness
Brief resilience scale
(Kemper & Khirallah, 2015)
(Kemper et al., 2015)
Connor David resiliency
scale
(Klatt et al., 2015) (Mealer et al.,
2014)
Resilience scale
(Erogul et al., 2014)
(Fortney et al., 2013)
Utrecht work engagement
scale [vigour]
(Klatt et al., 2015)
Note: Authors in bold denote RCT studies.
Table 13. Relationships Outcomes across all Studies
Page 30 of 54
Measure
Improvement (positive change)
related to mindfulness
intervention
No change in relation to
mindfulness intervention
Association (benign) with mindfulness
Inventory of interpersonal
problems-32
(Ryan et al., 2012)
Symptom checklist-90-R
[interpersonal sensitivity]
(Pipe et al., 2009)
Qualitative interviews
(Beckman et al., 2012) (Cohen-
Katz, Wiley, Capuano, Baker,
Deitrick, et al., 2005) (Hemanth
& Fisher, 2015) (Van der Riet et
al., 2015)
(Newsome et al., 2006)
(Christopher et al., 2011) (Cigolla &
Brown, 2011) (Dauenhauer, 2006)
(Gill et al., 2015) (Talisman et al.,
2015)
Social-connectedness
scale
(J. S. Cohen & Miller, 2009)
Note: Authors in bold denote RCT studies.
Table 14. Emotional Intelligence & Regulation Outcomes across all Studies
Measure
Improvement (positive change)
related to mindfulness
intervention
No change in relation to
mindfulness intervention
Association (benign) with mindfulness
Self-report of emotional
intelligence
(J. S. Cohen & Miller, 2009)
Qualitative interviews
(Cohen-Katz, Wiley, Capuano,
Baker, Deitrick, et al., 2005) (de
Zoysa et al., 2014) (Hemanth &
Fisher, 2015) (Rocco et al., 2012)
(Van der Riet et al., 2015)
(Christopher et al., 2011) (Talisman et
al., 2015)
Qualitative interviews
(acceptance)
(Cohen-Katz, Wiley, Capuano,
Baker, Deitrick, et al., 2005)
(Dorian & Killebrew, 2014)
(Felton et al., 2015) (Fisher &
Hemanth, 2015) (Rocco et al.,
2012) (Stew, 2011) (Tarrasch,
2014)
(Newsome et al., 2006)
(Christopher et al., 2011) (Cigolla &
Brown, 2011) (Dauenhauer, 2006)
(Gill et al., 2015) (McCollum &
Gehart, 2010) (Simon et al., 2009)
Schutte Self Report
Emotional Intelligence
Test
(Burnett & Pettijohn,
2015)
Self-regulation
questionnaire
(Bond et al., 2013)
Note. Authors in bold denote RCT studies
Finally, the impact of mindfulness was not limited to the wellbeing of HCPs, but also
was associated with enhanced job performance. The dominant outcome in this respect was
compassion and/or empathy, as shown in table 15. Of the 28 intervention studies examining
this, 16 observed an improvement while nine reported no significant change, showing an
overall effect size between small and medium (d=-31); meanwhile, three non-intervention
Page 31 of 54
studies observed a correlation with mindfulness. Mindfulness was also associated with a broad
range of other aspects of job performance, as shown in table 16. Of the seven intervention
studies examining outcomes in this area, six observed an improvement and only one found no
change, with a large global effect size (d=.82). Six non-intervention studies also observed a
correlation with mindfulness.
Table 15.
Compassion & Empathy Outcomes across all Studies
Measure
Improvement (positive change)
related to mindfulness
intervention
No change in relation to
mindfulness intervention
Association (benign) with mindfulness
Empathy construct rating
scale
(Shapiro et al., 1998a)
Interpersonal reactivity
index
(Hopkins & Proeve, 2013)
(Beddoe & Murphy, 2004)
(Galantino et al., 2005)
(Keane, 2014)
Jefferson scale of
physician empathy
(Barbosa et al., 2013) (Bazarko et
al., 2013) (Krasner et al., 2009)
(Bond et al., 2013) (West
et al., 2014)
Jefferson scale of
physician empathy
[compassion]
(Martín-Asuero et al., 2014)
Neff compassion scale
(Moore, 2008)
Professional quality of life
scale [compassion]
(Horner et al., 2014)
Qualitative interviews
(Dorian & Killebrew, 2014)
(Felton et al., 2015) (Hemanth &
Fisher, 2015)
(Talisman et al., 2015)
Santa Clara brief
compassion scale
(Brooker et al., 2013)
(Fortney et al., 2013)
Self-compassion scale
(Bazarko et al., 2013) (Bond et al.,
2013) (Erogul et al., 2014)
(Newsome et al., 2012) (Raab et
al., 2015) (Rimes & Wingrove,
2011) (Shapiro et al., 2005)
(Shapiro et al., 2007)
(Brooker et al., 2013)
(Gauthier et al., 2015)
(Kemper et al., 2015)
Note. Authors in bold denote RCT studies
Table 16.
Job Performance Outcomes across all Studies
Measure
Improvement (positive change)
related to mindfulness
intervention
No change in relation to
mindfulness intervention
Association (benign) with mindfulness
Caring efficiency scale
(Pipe et al., 2009)
Counsellor activity self-
efficacy scale
(Gockel et al., 2013)
Patient distress [SC-90-R]
(Grepmair et al., 2007)
Qualitative interviews
(Hemanth & Fisher, 2015)
(Christopher et al., 2011) (Cigolla &
Brown, 2011) (Gill et al., 2015)
(McCollum & Gehart, 2010) (Simon
et al., 2009) (Talisman et al., 2015)
Page 32 of 54
Restraint of patients
(Brooker et al., 2014) (Singh et
al., 2015)
Seclusion of patients
(Brooker et al., 2014)
Treatment team
functioning checklist
(Singh et al., 2006)
Verbal redirection
[disciplining patients]
(Singh et al., 2015)
Note. Authors in bold denote RCT studies
Summary and Recommendations
Overall, MBIs had a positive impact upon most outcome measures (although some
outcomes were rather equivocal, such as burnout). Moreover, a fairly large evidence-base
regarding the use of mindfulness in healthcare settings is gradually accumulating, with 81
papers included in the current review, comprising a total of 3,805 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. These outcomes appear to be fairly evenly distributed across different
healthcare professions. For instance, one might speculate that occupations which potentially
have greater familiarity with psychological interventions like mindfulness, such as those in
the mental health arena, might be more amenable to its effects. However, that appears to not
be the case. Of the 81 papers analysed here, 32 (39%) specifically involved people working
in mental health. These percentages were roughly reflected in the patterns of findings with
respect to the various outcomes. For instance, in terms of anxiety, mental health professionals
were involved in three of the nine interventions that reported a significant improvement, and
two of the seven that found no such improvement (including one that found a worsening
impact). Thus, it appears that mindfulness might be helpful to HCPs generally, regardless of
their particular occupational role.
However, there are a number of issues with the research which limits the conclusions
that can be drawn. In terms of the QATQS quality assessment, few studies scored highly in
all respects (as shown in supplementary table 1). For instance, of the 66 intervention studies,
only 26 (39%) involved a control group, while just 20 (30%) conducted an RCT. Without a
Page 33 of 54
control group, it is harder to ascribe any positive changes observed to mindfulness per se.
Then, even when controls are included, unless participants are randomised into groups, it is
possible that differences in baseline characteristics between the groups generated interaction
effects, thereby compromising the results. For example, in Barbosa et al. (2016), the 16
participants who entered the experimental group (reduced to 13 on attrition) did so after an
invitation email was sent to the entire student population (of around 1300); by contrast, the
control group consisted of individuals who were subsequently selected as matching the
composition of the experimental group, and were paid to take part. Thus, it is conceivable
and indeed likely that the experimental participants already had an interest in mindfulness,
although whether they did so was not reported by the study. Furthermore, there were baseline
differences in anxiety, with moderate levels among the experimental group (which also
perhaps accounts for their interest in participating), compared to mild levels in the control
group. Such factors complicate the assessment of the efficacy of MBIs, which is why RCT
designs are generally preferable (although one acknowledges that not all researchers may be
in a position to implement such a design). Further issues include heterogeneity with respect to
both the type of MBI and the outcome measures looked at (which makes it difficult to
conduct comparative or meta-analytic assessments, and hence to draw robust conclusions
about the research as a whole), and the fact that the research is currently biased towards
psychiatric outcome measures (e.g., anxiety, stress, depression), with little attention exploring
other outcomes relevant to the work arena, such as work engagement or creativity.
Based on these critiques, the following recommendations can be made vis-à-vis future
work in this area. First, where possible, studies should implement an RCT design, ideally
with large numbers of participants (determined by a priori power calculations drawing on
estimated effect size). Second, in addition to a wait-list control protocol, it would be useful if
trials included an ‘active’ control group (e.g., an exercise programme). This will better enable
Page 34 of 54
any positive effects to be ascribed to mindfulness per se (i.e., rather than people simply being
involved in an absorbing group activity). Third, it would be good to see a diversification of
outcome measures, with studies looking beyond ‘negative’ psychiatric issues (e.g., depression
and anxiety), and also focusing on more ‘positive’ (i.e., non-clinical) outcomes such as work
engagement, social capital, and creativity. Finally, where possible, trials should involve
established MBIs (rather than bespoke adaptations), to better enable comparison across
studies. However, these is also a need to move beyond MBIs developed for clinical contexts
(e.g., MBSR), and to explore MBIs created specifically for the workplace. Nevertheless,
despite the issues with the current research base, the evidence of the value of mindfulness for
HCPs is strong, and one might speculate that this will only strengthen over the years ahead.
References
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practice: The mindful therapy programme. Counselling and Psychotherapy Research,
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Supplementary table 1.
QATQS Scoring Assessment of Intervention Studies
Authors
Selection bias
Design
Cofounders
blinding
Data collection
Attrition
Global
(Aggs & Bambling,
2010)
3
3
3
3
3
2
3
(Barbosa et al., 2013)
3
3
2
3
2
2
3
(Bazarko et al., 2013)
2
3
3
3
2
1
3
(Beckman et al., 2012)
Q
Q
Q
Q
Q
Q
Q
(Beddoe & Murphy,
2004)
3
3
3
3
2
2
3
(Bond et al., 2013)
3
3
3
3
2
2
3
(Bonifas & Napoli,
2014)
3
3
3
3
1
1
3
(Brady et al., 2012)
3
3
3
3
2
2
3
(Brooker et al., 2013)
3
3
3
3
1
2
3
(Brooker et al., 2014)
3
3
3
3
2
2
3
(Burnett & Pettijohn,
2015)
3
2
2
3
1
2
3
(Christopher et al.,
2006)
Q
Q
Q
Q
Q
Q
Q
(J. S. Cohen & Miller,
2009)
3
3
3
3
1
2
3
(Cohen-Katz, Wiley,
Capuano, Baker,
Kimmel, et al., 2005)
2
2
2
3
1
1
2
(Cohen-Katz, Wiley,
Capuano, Baker,
Deitrick, et al., 2005)
Q
Q
Q
Q
Q
Q
Q
(Dobie et al., 2015)
3
3
3
3
1
1
3
(De Vibe et al., 2013)
2
1
1
1
1
1
1
(de Zoysa et al., 2014)
Q
Q
Q
Q
Q
Q
Q
(Dorian & Killebrew,
2014)
Q
Q
Q
Q
Q
Q
Q
(Duchemin et al., 2015)
1
1
1
1
1
1
1
(Erogul et al., 2014)
1
1
1
1
1
2
1
(Felton et al., 2015)
Q
Q
Q
Q
Q
Q
Q
(Fisher & Hemanth,
2015)
Q
Q
Q
Q
Q
Q
Q
(Fortney et al., 2013)
3
3
3
3
1
1
3
Page 53 of 54
(Foureur et al., 2013)
3
3
3
3
1
2
3
(Galantino et al., 2005)
3
3
2
3
1
3
3
(Gauthier et al., 2015)
3
3
3
3
1
2
3
(Goodman &
Schorling, 2012)
2
3
3
3
1
3
3
Grepmair et al., 2007)
2
2
1
2
1
1
2
(Hallman et al., 2014)
2
3
3
2
1
1
3
(Hemanth & Fisher,
2015)
Q
Q
Q
Q
Q
Q
Q
(Hopkins & Proeve,
2013)
3
3
3
3
1
2
3
(Horner et al., 2014)
3
3
3
3
1
3
3
(Johnson et al., 2015)
3
3
1
3
1
2
3
(Klatt et al., 2015)
3
3
3
3
1
2
3
(Kemper & Khirallah,
2015)
3
3
3
3
1
2
3
(Krasner et al., 2009)
2
3
3
3
1
2
3
(Kuoppala & Kekoni,
2013)
1
2
2
2
1
1
2
(Mackenzie et al.,
2006)
3
2
2
3
1
2
3
(Manotas et al., 2014)
2
2
1
3
1
2
2
(Martín-Asuero &
García-Banda, 2010)
2
3
3
3
1
1
3
(Martín-Asuero et al.,
2014)
2
2
2
3
1
1
2
(McConachie et al.,
2014)
2
1
1
3
1
2
2
(Mealer et al., 2014)
1
1
1
2
1
1
1
(Moody et al., 2013)
1
1
1
2
1
2
1
(Moore, 2008)
1
3
3
2
1
2
3
(Newsome et al., 2006)
1
3
3
3
3
3
3
(Newsome et al., 2012)
1
3
3
2
1
2
3
(Noone & Hastings,
2010)
1
3
3
1
1
3
3
(Pflugeisen et al., 2015)
1
3
3
2
2
1
3
(Pipe et al., 2009)
2
1
2
1
1
1
1
(Poulin et al., 2008)
1
2
1
1
1
3
2
(Raab et al., 2015)
1
3
3
2
1
2
3
(Rimes & Wingrove,
2011)
1
3
3
1
1
3
3
(Rocco et al., 2012)
Q
Q
Q
Q
Q
Q
Q
Page 54 of 54
(Ruths et al., 2013)
2
3
3
1
1
1
3
(Shapiro et al., 1998b)
1
1
2
1
1
1
1
(Shapiro et al., 2005)
1
1
2
2
1
3
2
(Shapiro et al., 2007)
1
2
1
2
1
1
1
(Singh et al., 2015)
1
3
3
1
1
3
2
(Singh et al., 2006)
1
3
3
1
2
2
3
(Song & Lindquist,
2015)
1
1
2
1
1
1
1
(Stew, 2011)
Q
Q
Q
Q
Q
Q
Q
(Tarrasch, 2014)
Q
Q
Q
Q
Q
Q
Q
(Van der Riet et al.,
2015)
Q
Q
Q
Q
Q
Q
Q
(West et al., 2014)
1
1
1
1
1
2
1
Note. Q = qualitative study.
... Mindfulness-based stress reduction (MBSR), originally proposed to face chronic diseases by reducing distress and improving quality of life in such patients, has become an increasingly prevalent psychological strategy worldwide. Also applied in HCPs, a series of systematic reviews and meta-analyses has documented the effectiveness of MBSR in reducing HCP anxiety, depression and stress, and increasing mindfulness, mood, resilience, self-compassion, self-efficacy, and empathy [8][9][10][11][12]. Therefore, mindfulness-based interventions are strongly recommended by health and educational organizations to implement stress management and enhance the psychosocial well-being of HCPs [12]. ...
... The Psychological General Well-Being Index (PGWBI) is a 22-item self-reported questionnaire to measure the level of subjective psychological well-being or discomfort in the previous 4 weeks [22]. The items are rated on a 6-point scale (Likert scale from 0 to 5), and explore six different dimensions: anxiety (5,8,17,19,22 items), depressed mood (3,7,11), positive well-being (1,9,15,20), self-control (4,14,18), general health (2, 10, 13) and vitality (6,12,16,21), where a high score is indicative of elevated levels of psychological wellbeing. The total scores can reach a maximum value of 110 points. ...
... The Maslach Burnout Inventory (MBI) measures burnout by using a 7-point Likert scale response format (0 = never, 6 = always), including 22 items that rate the three components of burnout: feelings of overwhelming emotional exhaustion (EE; sum of items 1, 2, 3, 6,8,14,16,20), depersonalization and detachment from the job (DP; sum of items 5, 10,11,15,22), and lack of personal or professional accomplishment (PA; sum of items 4,7,9,12,17,18,19,21) [25]. Burnout is indicated by high scores for EE and DP, and a low score for PA. ...
Article
Full-text available
COVID-19 has overwhelmed healthcare systems and increased workload and distress in healthcare professionals (HCPs). The objective of this study was to evaluate baseline distress before and after the pandemic, and the effect of Mindfulness-Based Stress Reduction (MBSR) training on well-being (PGWBI), stress (PSS) and burnout (MBI) in Italian HCPs. Moreover, the "fear of COVID-19" (FCV-19S) questionnaire was administered to HCPs participating in the post-emergency MBSR program. Baseline distress results were moderate in all groups. No differences between baseline distress were observed between the groups of HCPs beginning the MBSR courses in the pre or post pandemic period. Total PGWBI lowered with aging. Additionally, FCV-19S positively correlated with age. MBSR was able to lower distress levels, except for depersonalization, which increased, while emotional exhaustion decreased in the group enrolled in the last post-pandemic MBSR course. Levels of fear of COVID-19 in HCPs significantly decreased after MBSR training. The lack of change in baseline distress over time indicates that it is more influenced by work-related distress than by the pandemic in our HCPs. In view of its beneficial effects on psycho-emotional status, MBSR training may represent an effective strategy to reduce distress in emergency periods as well as an essential part of HCPs' general training.
... Organisations need to support employees' health and well-being through provision of coping strategies and opportunities to decrease and/or prevent BS (Isikhan et al., 2004). Lomas et al. (2017) state that AHPs are very prone to anxiety, mental health problems and burnout because of the efforts required by their job. This can escalate to being a problem for the service user and even for the whole health system in relation to the cost of employees being burned out. ...
... This can escalate to being a problem for the service user and even for the whole health system in relation to the cost of employees being burned out. Lomas et al. (2017) carried out mindfulness-based interventions, with employees who were experiencing burnout symptoms and with other staff as a preventative strategy to reduce stress and anxiety. The authors advise management within organisations to note that even if they are offering some form of mindfulness interventions, they should also aim to work on the issues which initially trigger stress and anxiety. ...
Thesis
A dissertation submitted in partial fulfilment of the Master of Health Systems Management and Leadership
... The usefulness of MM has been studied across various populations, including cancer patients (Ho et al., 2017), cardiac patients (Zieff, 2017), healthcare professionals (T. Lomas, Medina, Ivtzan, Rupprecht, & Eiroa-Orosa, 2018) and lawyers (Minda, Cho, Nielsen, & Zhang, 2019). Most studies use MM to reduce stress as an alternative therapy for Western healthcare (Hilton et al., 2017), whereas some research is focused on the kind of processes MM alters in the brain (Cahn & Polich, 2006;Chiesa & Serretti, 2010). ...
Article
Full-text available
Objective: In this study, we evaluated brain electroencephalographic (EEG) activity in healthy participants during the performance of paired and individual mindfulness meditation (MM). We hypothesized that EEG activity is differentially affected by meditation in pairs compared to individual meditation. Methods: A total of 20 healthy female university students (mean age 19.54 years, SD =1.53) with no prior experience in MM participated in this study. All participants had to perform a 5-minute MM task together and individually while the other participant was in rest or performing a concentration task (control condition). To exclude social interaction as main factor, participants were separated from their research partner by an opaque screen while instructions were given through headphones. Brain electroencephalographic (EEG) activity from each individual student was measured during all conditions. Results: The main findings indicate that left-frontal alpha and theta spectral EEG power was significantly higher during the paired MM condition compared to individual MM and control condition. Conclusions: This controlled MM study demonstrates differences in brain activity between practicing mindfulness in pairs compared to practicing it individually. We conclude that the increased alpha and theta EEG power during paired MM may be associated with social facilitation or the activation of "theory of mind." The results invite further reflection on interpersonal communication and mindfulness.
... Awareness about the benefits of meditation and inculcation of meditation in day-to-day life are on a rising trend. The positive benefits of meditation are being recognized as methods to reduce anxiety and stress among the general public and healthcare workers [30]. In our study, participants who reported high generalized anxiety (n=40, only 17.8%) and those who had depression levels on WHO-QOL (n=169, 70.7%) reported they required meditation for stress. ...
... Health care professionals report higher levels of mental distress and lower levels of life satisfaction than general population, and they are likely to continue reporting high levels of stress, burnout and suicide in situations of crisis (de Vibe et al., 2018). Mindfulness can have an important impact on healthcare professionals, improving their performance (Scheepers et al., 2020), wellbeing and mental health (Lomas et al., 2018), and promoting coping strategies that reduce stress (Burton et al., 2017). Qualitative findings related positive effects to specific mindfulness elements: self-awareness of stress and selfregulation of behaviors facilitated self-care of wellbeing (Verweij et al., 2016). ...
Article
Full-text available
COVID-19 pandemic imposed psychosocial stress increasing in frontline healthcare workers, who managed by responding with different coping strategies. General practitioners were targeted by an extraordinary increase in the demand for reception, diagnosis and treatment from all patients even if working in solo. In Italy, the emergency changed risk assumption and roles in between primary care, unraveling the emotional distress of general practitioners, who suffered not only for isolation, but also emotional threatens. In this correlational study we wanted to evaluate trait anxiety and stress as perceived by general practitioners working in individual ambulatory practice room, and by hospital ward nurses working in group, during a chronic phase (February–May 2021) of COVID-19 pandemic. Our hypothesis is that a different work social organization in clinic contest as for general practitioners compared with nurses could induce adaptive or non-adaptive coping to stress under emergency and mindful attitude could be crucial. A number of 37 general practitioners, and 36 nurses were taken from the sanitary district of ASL1 Avezzano-Sulmona-L’Aquila in Italy. For our analyses we used the Health Professions Stress and Coping Scale to assess the risk of burn-out, and detect the coping strategies. We also used the Cognitive and Affective Mindfulness Scale-Revised, investigating whether clinicians used an eventual mindful attitude to prevent anxiety and responding with adaptive coping strategies. General practitioners reported high levels of anxiety, associated to an increased use of emotional distress. Mindful attitude was protective for anxiety in both general practitioners and nurses. As anxiety increased, it was coped by increasing the demand for social support. This coping strategy correlated with emotional distress and when enhanced, it corresponded to avoidance of the problem. Mindful attitude addressed general practitioners to adaptive coping strategies as the solution of the problem. On the other side, nurses accepted the problem but addressed it to others, by avoiding solving it themselves as beyond their role and organizational responsibility. In conclusion, mindful attitude can prevent dysfunctional reactive behaviors among clinicians at the forefront of emergency and reduce emotional distress for isolation as suffered by general practitioners.
... In den letzten Jahren sind verhaltenspräventive Interventionskonzepte entstanden, die auch digital angeboten werden. Dabei konnte in verschiedenen Studien gezeigt werden, dass internetbasierte Programme psychisches Wohlbefinden und Arbeitseffizienz steigern (Carolan et al. 2017) und die psychische Gesundheit verbessern können (Guillaumie et al. 2017;Lomas et al. 2018 ...
Chapter
Psychische Belastungen sind inzwischen einer der zwei Top-Gründe für Arbeitsausfälle. Um diesem Trend entgegenzuwirken, müssen die Belastungsfaktoren von Arbeitnehmenden möglichst minimiert werden. Dabei stehen ihnen zum einen zahlreiche (digitale) Verfahren zur Gefährdungsbeurteilung psychischer Belastungen zur Verfügung, zum anderen existiert eine zunehmende Anzahl von digitalen Interventionsangeboten zur Prävention. Im Sinne einer Zusammenführung wird eine strukturierte Auswahl verschiedener Verfahren, die für eine Gefährdungsbeurteilung psychischer Belastung eingesetzt werden können, in diesem Kapitel vorgestellt. Darüber hinaus wird eine Übersicht über eine Auswahl digitaler Gesundheitsangebote dargestellt, welche als geeignete Präventionsmaßnahmen fungieren können. Die Forschung zeigt, dass der Einsatz verhältnis- und verhaltenspräventiver Maßnahmen in Kombination die bedeutendsten Effekte zeigt. Ein Beispiel aus der Praxis veranschaulicht die Umsetzung dessen.