ArticlePDF Available

Leveraging Mindfulness to Build Resilience and Professional Quality of Life in Human Service Professionals

Authors:

Abstract and Figures

Mindfulness-based interventions (MBIs) have shown promise in cultivating resilience and are widely accepted as efficacious in the treatment of a range of psychological disorders. This paper explores the feasibility of a mindful-awareness and resilience skills training (MARST) program to enhance mindfulness and resilience, as a means of increasing psychological well-being and alleviating burnout and compassion fatigue in human service professionals. In this randomised control trial, 46 human service professionals were randomly allocated to either a MARST group or to a no intervention, control group. Multivariate analysis of covariance (MANCOVA), with pre-test scores as the covariates, revealed that the MARST intervention resulted in significant improvements in mindfulness, resilience, compassion satisfaction, and psychological well-being, and significant reductions in burnout and compassion fatigue; at post-intervention. These results were maintained at one month follow-up, with the exception of compassion satisfaction which was non-significant. Mediation analysis using a bootstrap resampling method indicated that mindfulness fully mediated changes in resilience and psychological well-being, as a result of the MARST intervention. Self-reported reductions in burnout following the intervention were mediated by mindfulness and resilience, and decreased compassion fatigue was mediated by resilience. The results of this study suggest that the MARST program may assist in developing resilience and reduce burnout and compassion fatigue in human service professionals. The study also provides evidence for the potential of mindfulness-based approaches to enhance resilience.
© 2018 by the author. This is an open access article distributed under the
conditions of the Creative Commons by Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium or format,
provided the original work is correctly cited.
Open Access
OBM Integrative and
Complementary Medicine
Original Research
Leveraging Mindfulness to Build Resilience and Professional Quality of Life
in Human Service Professionals
Andrew Hanna 1,*, Aileen M. Pidgeon 2
1. School of Health and Human Sciences, Southern Cross University, Coffs Harbour, NSW, Australia
2450; E-Mail: a.hanna.23@student.scu.edu.au
2. Faculty of Society and Design, Bond University, QLD, Australia 4229; Email: apidgeon@bond.edu.au
* Correspondence: Andrew Hanna; E-Mail: a.hanna.23@student.scu.edu.au
Academic Editor: Sok Cheon Pak
Special Issue: Health Benefits of Meditation
OBM Integrative and Complementary Medicine
2018, volume 3, issue 2
doi:10.21926/obm.icm.1802007
Received: April 4, 2018
Accepted: May 7, 2018
Published: May 16, 2018
Abstract
Objective: Mindfulness-based interventions (MBIs) have shown promise in cultivating resilience
and are widely accepted as efficacious in the treatment of a range of psychological disorders.
This paper explores the feasibility of a mindful-awareness and resilience skills training (MARST)
program to enhance mindfulness and resilience, as a means of increasing psychological
well-being and alleviating burnout and compassion fatigue in human service professionals.
Method: In this randomised control trial, 46 human service professionals were randomly
allocated to either a MARST group or to a no intervention, control group.
Results: Multivariate analysis of covariance (MANCOVA), with pre-test scores as the covariates,
revealed that the MARST intervention resulted in significant improvements in mindfulness,
resilience, compassion satisfaction, and psychological well-being, and significant reductions in
burnout and compassion fatigue; at post-intervention. These results were maintained at one
OBM Integrative and Complementary Medicine 2018; 3(2), doi:10.21926/obm.icm.1802007
Page 2/21
month follow-up, with the exception of compassion satisfaction which was non-significant.
Mediation analysis using a bootstrap resampling method indicated that mindfulness fully
mediated changes in resilience and psychological well-being, as a result of the MARST
intervention. Self-reported reductions in burnout following the intervention were mediated by
mindfulness and resilience, and decreased compassion fatigue was mediated by resilience.
Conclusions: The results of this study suggest that the MARST program may assist in developing
resilience and reduce burnout and compassion fatigue in human service professionals. The
study also provides evidence for the potential of mindfulness-based approaches to enhance
resilience.
Keywords:
Resilience; mindfulness; compassion fatigue; burnout; psychological well-being
Key Points:
1. Human service professionals are at risk of compassion fatigue and burnout.
2. Strategies that cultivate resilience may ameliorate the development of these conditions.
3. Mindfulness-based interventions have been shown to build resilience.
4. MARST may assist in developing resilience and reduce burnout and compassion fatigue in
human service professionals.
5. The observed change in resilience was mediated by mindfulness.
6. The change in compassion fatigue was mediated by resilience and mindfulness.
1. Introduction
Over the past two decades, research has demonstrated that prolonged exposure to the pain and
suffering of others may have deleterious effects on psychological well-being and functioning [1, 2].
Evidence also suggests that those who work with individuals with mental illness, addiction, social
deprivation, and trauma may suffer similar and often debilitating consequences [3-5]. As an
occupational group, human service professionals are concerned with the intervention and
empowerment of clinical and otherwise vulnerable social populations. As a result, practitioners are
routinely confronted with the psychological distress, emotional pain and traumatic recollections of
the individuals with whom they work [6]. Indeed, researchers who have examined the occupational
hazards of the human services have stressed that the process of caring itself, may come at significant
personal and psychological costs [4, 7].
The “cost of caring” was first described by Figley [8] who identified compassion fatigue (or
secondary traumatic stress) as the potential consequence of bearing witness to the suffering of
others. Defined as a state of tension and preoccupation with the traumatised client, compassion
fatigue describes a syndrome which often parallels the symptoms of post-traumatic stress disorder
(PTSD[4]). Human service professionals who experience compassion fatigue are also at an increased
OBM Integrative and Complementary Medicine 2018; 3(2), doi:10.21926/obm.icm.1802007
Page 3/21
risk of developing psychological conditions, such as mood and anxiety disorders [9]; substance
dependence [10]; eating disorders [11]; suicide [12]; and clinician burnout [4].
Burnout refers to a multifaceted work-related disorder which occurs when professionals have
insufficient resources to handle excessive occupational demands [13]. Those affected describe
feelings of being over-extended, fatigued, and depleted; attitudes of negativity and cynicism; and a
reduced sense of accomplishment [14]. Burnout among human service professionals is also
considered to contribute to a number of adverse organisational consequences including; increased
staff turnover and absenteeism, unproductive work behaviours, and reduced job-satisfaction [15,
16]. Therefore, practitioner-focused research has recognised the need to understand the factors
which safeguard clinician mental health and explain why some professionals develop these
conditions, while others do not.
This growing interest in resilience represents a shift from the traditional focus on
psychopathology, to an emphasis on the protective factors which promote a healthy response to
stress [17]. Although a universal definition does not exist, resilience is considered an individual’s
capacity to overcome adversities that would otherwise be expected to have negative consequences
[18]. The development of resilience may serve to ameliorate or buffer the impact of occupational
stressors and protect clinicians from instances of burnout, compassion fatigue, and mental illness
[19, 20]. Furthermore, contemporary research suggests that while some individuals may possess an
innate resilience, others have learned to develop and maintain a high degree of resilience through
experience and learning [21]. Therein presents the opportunity for clinicians to identify means to
cultivate and replenish resilience, in order to enhance psychological well-being.
Of the factors thought to contribute to resilience, mindfulness has increasingly gained attention in
recent years [22-24]. Conceptualised as an intentional state of awareness, mindfulness concerns the
process of bringing one’s attention to the present moment, in a non-judgmental and accepting
manner [25]. When contemplating the potential benefits of mindfulness, Richardson [26] argued that
a willingness to attend to unpleasant stimuli and events might encourage growth and adaptive
reintegration; elements considered fundamental to resilience [27, 28]. Contemporary research
appears to support this assertion with positive correlations found between mindfulness and
resilience [29]; distress tolerance [30], emotion regulation skills [31], and psychological flexibility [32].
Accordingly, various psychotherapeutic interventions incorporate a significant mindfulness
component and are widely accepted as effective in the treatment of a range of psychological
conditions [33, 34].
Mindfulness-based interventions (MBIs) have demonstrated some value in increasing resilience
[35, 36], preventing burnout and compassion fatigue [37], and fostering psychological well-being [34,
38]. Shapiro et al. [39] conducted one such study, using a randomised-controlled trial to assess an
eight week mindfulness-based stress reduction program (MBSR; [25]) in human service professionals.
Whilst the results demonstrated preliminary evidence for the potential of mindfulness interventions
to reduce work-related stress and burnout among human service professionals, a small sample size
limited the generalisability of these results. Additionally, this work did not consider resilience or
other factors that might mediate treatment outcomes.
Several authors have called for the appropriate analysis of the mechanisms of change within such
OBM Integrative and Complementary Medicine 2018; 3(2), doi:10.21926/obm.icm.1802007
Page 4/21
programs, rather than simply reporting variations in symptomology [40, 41]. This issue is particularly
salient in studies of MBIs as mindfulness practices are seldom used as a stand-alone intervention. As
a result, it is often not possible to infer whether the beneficial outcomes of MBIs are in fact due to
increased levels of mindfulness or other simultaneous therapeutic elements [42]. Investigating the
mediators of interventions that target burnout and compassion fatigue may also allow an assessment
of how such interventions are effective, and how they may be improved.
1.1 Aims and Hypotheses
The primary aim of this study was to examine the efficacy of a mindful-awareness and resilience
skills training (MARST) program to enhance mindfulness and resilience, as a means of increasing
psychological well-being and compassion satisfaction, and alleviating burnout and compassion
fatigue in human service professionals. Furthermore, in response to calls for research of this nature
to address the factors which mediate experimental outcomes, the current research investigates the
indirect effect of the MARST intervention on burnout and compassion fatigue, through changes in
mindfulness and resilience.
On the basis of the presented research, the following hypotheses were formulated. Hypothesis
one, pertaining to short-term intervention effects, predicts that at post intervention the MARST
group will report significantly higher levels of mindfulness, resilience, compassion satisfaction and
psychological well-being, and significantly lower levels of burnout and compassion fatigue, compared
to the control group. Hypothesis two predicted that the intervention outcomes outlined in the first
hypothesis will be maintained at one month post-intervention. Hypothesis three, predicted that
increased levels of resilience and psychological well-being, as a result of participation in the MARST
group, will be mediated by increased mindfulness. Hypothesis four predicted that reductions in
compassion fatigue, as a result of participation in the MARST group, will be mediated by increased
mindfulness and resilience. Hypothesis five predicted that reductions in burnout, as a result of
participation in the MARST group, will be mediated by increased mindfulness and resilience. That is,
mindfulness and resilience will emerge as significant unique mediators, and together as a group of
mediators, of the impact of the MARST intervention on compassion fatigue and burnout.
2. Method
2.1 Participants
A sample of 50 human service professionals was recruited from a not-for-profit community and
family services organisation. The professionals provide a range of services for children, young people
and families including: counselling, family intervention and support, live-in home services for
mothers and babies, and community engagement and development programs. Of the initial sample,
46 participants returned baseline data and met inclusion criteria (i.e., >18 years of age, working with
clients directly and not engaged in professional psychological intervention at the time of
recruitment). Table 1 presents the participant demographics.
The majority of participants reported that they did not practice mindfulness meditation at the
OBM Integrative and Complementary Medicine 2018; 3(2), doi:10.21926/obm.icm.1802007
Page 5/21
time of recruitment (n = 25; 54.3%) and had not previously attended training in mindfulness
meditation (n = 26; 56.5%). Based on random assignment, a total of 25 participants in the MARST
group and 21 participants in the control group completed baseline and post-intervention data. A
total of 41 human service professionals completed one month follow-up measurement, comprised of
23 and 18 participants from the MARST and control groups, respectively.
Table 1 Participant demographics.
Variables
%
Age
Gender
Education
Employment status
24 - 64
(M = 42, SD = 10.58)
Male
Female
Bachelor
Postgraduate
Other
Full-Time
Part-Time
100
19.6
80.4
47.8
30.4
21.7
78.3
21.7
2.2 Materials
Demographic Questions. Participants were asked to supply demographic information for the
purpose of describing the sample. Participants indicated their age, gender, education, employment
status, involvement in current meditative practices, and participation in past mindfulness-based
training programs or retreats.
Mindfulness. Self-reported mindfulness was assessed with the Five Facet Mindfulness
Questionnaire (FFMQ; [43]). The FFMQ is a 39-item measure of five distinct skill areas cultivated by
the practice of mindfulness: observing, describing, acting with awareness, non-reactivity, and
non-judging. Items are measured on 5-point Likert scales (1 = never or very rarely true to 5 = very
often or always true). The FFMQ identifies five subscale scores and a total FFMQ; with higher scores
reflecting greater mindfulness [43]. Research has shown the FFMQ to be a valid and reliable measure
of the skills cultivated by the practice of mindfulness, both in long-term meditators and in novices
[44]. The measure has shown adequate internal consistency, with Cronbach’s alpha coefficients
ranging from .73 for non-reactivity to .91 for describing [45]. In the present study, the Cronbach
alpha value for total FFMQ was .87.
Resilience. The Resilience Quotient Scale (RQS; [46]) is a 60-item measure of an individual’s level
of resilience, based on seven factors of resilience: emotion regulation, impulse control, causal
analysis, self-efficacy, realistic optimism, empathy, and reaching out. Participants respond on 6-point
OBM Integrative and Complementary Medicine 2018; 3(2), doi:10.21926/obm.icm.1802007
Page 6/21
scales (1 = not at all true to 5 = very true or often true, and 6 = don’t know) yielding total scores across
each of the seven factors and an overall resilience quotient (RQ). Higher scores on each of the scales
indicate a higher endorsement of that factor of resilience and a higher RQ indicated a higher level of
resilience. The RQS is a valid and psychometrically sound instrument with established evidence of
criterion and predictive validity [46]. Adequate internal consistency of the RQS was demonstrated in
the present study with a Cronbach’s alpha of .83.
Compassion Fatigue, Burnout and Compassion Satisfaction. The Professional Quality of Life Scale
- Fifth Edition (ProQOL-V; [47]) is a 30-item measure of compassion fatigue, burn-out and compassion
satisfaction in those who work with traumatised populations. Compassion fatigue has been defined
as a psychological syndrome resulting from work-related secondary exposure to extremely stressful
events [48]. Items are measured on a 5-point scale (1 = never, 2 = rarely, 3 = sometimes, 4 = often and
5 = very often) with the three distinct constructs yielding independent totals. Validity evidence for
the ProQOL is based on several studies indicating that practitioners with higher levels of compassion
fatigue or burnout perform in a manner consistent with the construct [16, 49]. The Cronbach’s alpha
values reported by Stamm [47] for the three scales were .82 for compassion satisfaction, .71 for
burnout, and .78 for compassion fatigue. The current study identified adequate internal consistency
with mean values for Cronbach’s alpha as .88 for compassion satisfaction, .83 for compassion fatigue,
and .89 for burnout.
Psychological Well-Being. The General Well-Being Schedule (GWS; [50]) is an 18-item
self-reported measure of psychological well-being and distress. The instrument addresses six
dimensions of subjective well-being including: depression, anxiety, positive well-being, self-control,
vitality and general health. As several items are reverse scored (i.e., items 1, 3, 6, 7, 9, 11, 15, and 16),
14 is subtracted from the total score, yielding a total range of scores from 0 to 110; lower scores
represent distress and higher scores representing greater well-being [50]. The GWB is a valid and
psychometrically sound instrument with evidence of test-rest reliability and high internal consistency
[47, 51]. The total GWB mean value of Cronbach’s alpha in the current study was .73.
2.3 Procedure
This research was approved by the affiliated university ethics committee and gatekeeper approval
was obtained from the relevant not-for-profit organisation. The recruitment process commenced
with an invitation to attend an information seminar delivered by the principal investigator. Following
the presentation, participants expressing interest in the study were provided with an explanatory
statement and requested to complete the battery of questionnaires.
Participants were assigned to the MARST or control groups on the basis of an unpredictable,
chance (random) process, using simple (unrestricted) randomisation. This process involved the
generation of a table of random numbers and the authors assigned participants to the trial groups.
The table of random numbers was generated using the random number generator from
http://stattrek.com/statistics/random-number-generator.aspx. Prior to disbursement, 50
pre-intervention questionnaire packages were assigned a number based on the table of random
numbers to allocate prospective participants to either the MARST group or the control group. Of the
OBM Integrative and Complementary Medicine 2018; 3(2), doi:10.21926/obm.icm.1802007
Page 7/21
50 participants who volunteered for the study, a total of 25 MARST group, and 21 control group
participants returned completed pre-intervention questionnaires. Repeat data were obtained from
the intervention and control groups at post-intervention and at one month follow-up. Minimal
attrition was realised at one month follow-up in both groups, due to absences as a result of sick and
annual leave, time pressures and conflicting organisational commitments. As a result, 41 human
service professionals completed one month follow-up measurement, comprised of 23 MARST group
and 18 control group participants. The schedule of the research design and measurement of the
MARST and control groups is depicted in Figure 1.
Figure 1 Schedule of research design and measurement for the mindful-awareness and
resilience skills training group and the control group.
OBM Integrative and Complementary Medicine 2018; 3(2), doi:10.21926/obm.icm.1802007
Page 8/21
Mindful-Awareness and Resilience Skills Training (MARST). The MARST intervention involved
three days (approximately eight hours) of training over three consecutive weeks. The program was
facilitated by a clinical psychologist with some 20 years of experience utilising mindfulness-based
approaches and training in mindfulness. The two co-facilitators had received training in
mindfulness-based interventions as part of a Master’s Degree in Clinical Psychology and also regularly
practiced formal meditation.
The MARST intervention teaches a set of core skills and strategies derived from the principles
theoretically underpinning mindfulness-based cognitive therapy (MBCT; [52]) , mindfulness-based
stress reduction (MBSR; [25]) and mindful self-compassion (MSC; [53]), and integrates some of the
basic principles of cognitive behavioural therapy (CBT).
The mindfulness component of the program included training in formal (i.e., mindfulness of the
breathe meditation, body-scan meditation and compassion meditation) and informal mindfulness
practice (i.e., mindful walking, eating and posture exercises) with periods of extended silence.
Approximately one hour of the program was devoted to teaching the basic cognitive behavioural ABC
model however MARST aims to assist individuals to make changes in a different way to CBT. While
CBT attempts to change unhelpful behaviour by modifying people's non-resilient thinking, MARST
aims to assist individuals to learn to develop control over the processes that maintain the
non-resilient thoughts through mindfulness training. Essentially, MARST aims to change the process
of thinking, not just the content of the thoughts. Table 2 presents an overview of the structure and
content of the MARST program.
Table 2 Overview of content of mindful-awareness and resilience skills training program.
Training Day
Content
Week 1 - Day One
The MARST course objectives, content and structure.
Psychoeducation on resilience and the cognitive-behavioural
model.
Introduction to the ABC model, strategies to develop resilient
thinking.
Introduction and practice of mindfulness and
mindful-awareness skills.
Home activities
Week 2 - Day Two
Review of home activities
Introduction to mindfulness compassion meditation and
mindful-awareness integration tool.
Practice of formal and informal mindfulness meditation and
exercises.
Practice applying the mindful-awareness integration tool.
Home activities
OBM Integrative and Complementary Medicine 2018; 3(2), doi:10.21926/obm.icm.1802007
Page 9/21
Week 3 - Day Three
Review of home activities
Introduction to situational awareness and the map of
mindful-awareness.
Experiential exercises to develop resilient thinking.
Practice of formal and informal mindfulness meditation and
exercises.
Practice applying the mindful-awareness integration tool.
2.4 Design
A randomisation process was employed with one independent variable of two levels; the
mindful-awareness and resilience skills training group (MARST) and no intervention (Control). The
dependent variables for the study were resilience, mindfulness, compassion fatigue, burn-out and
compassion satisfaction, and psychological well-being.
To determine group differences, multivariate analysis of covariance (MANCOVAs) were used to
compare short-term (i.e., baseline to post intervention) and follow-up (i.e., baseline to one month
follow-up) differences on each of the dependent variables; in combination with subsequent
univariate analysis of variance (ANOVAs). In accordance with relevant research, baseline data and age
were incorporated as covariates [54, 55]. Next, the study incorporated a bootstrapping resampling
procedure to explore the role of mindfulness in mediating the impact of participation in the MARST
program on resilience and psychological well-being. Finally, multiple mediation analysis was
conducted to consider the role of mindfulness and resilience, in mediating changes in compassion
fatigue and burnout as a function of the MARST intervention.
3. Results
3.1 Multivariate Analysis of Covariance
Short Term Treatment Effects. A one-way between-groups MANCOVA was performed to
investigate group differences for the six aforementioned dependent variables, immediately following
the MARST intervention (i.e., post-intervention). The analysis included one independent variable of
two levels; the MARST group and control (no intervention) group. Baseline scores on the dependent
variables and participant age were used as covariates, to control for individual differences and reduce
unexplained variance.
Preliminary checks were conducted to test assumptions of multivariate normality, linearity,
univariate and multivariate outliers, and multicollinearity, with no violations noted. Covariates were
judged to be adequately reliable for covariance analysis. A non-significant Box’s M indicated that the
homogeneity of variance-covariance matrix assumption had not been violated. After adjusting for
baseline scores and age, a significant multivariate main effect was found for group, F (6, 32) = 2.94, p
<.05, Pillai’s Trace = .36;
2 = .36, power = .83.
Given the significant multivariate main effect, univariate analysis of variance (ANOVAs) for each
dependent variable was assessed. Levene’s test of homogeneity was non-significant across all
OBM Integrative and Complementary Medicine 2018; 3(2), doi:10.21926/obm.icm.1802007
Page 10/21
dependent variables, indicating the data set had equal variance across the sample. The results
revealed significant univariate effects for group across the dependent variables; mindfulness, F(1, 44)
= 5.92, p <.05,
2 =.14 ; resilience, F(1, 44) = 7.66, p <.01,
2 =.17; psychological well-being, F(1, 44) =
7.88, p <.01,
2 =.18; compassion satisfaction, F(1, 44) = 6.86, p <.05,
2 =.16; burnout, F(1, 44) =
12.19, p = .001,
2 =.25; and compassion fatigue, F(1, 44) = 12.46, p =.001,
2 = .25.
Table 3 displays the means and standard deviations for the dependent variables between groups,
at baseline, post-intervention and one month follow-up. As noted in Table 3, the MARST group
reported significantly higher levels of mindfulness, resilience, psychological well-being, and
compassion satisfaction post-intervention, compared to the control group. Furthermore, the MARST
group reported significantly lower levels of burnout and compassion fatigue, when compared with
the control group immediately following the intervention. Thus, the results suggest that hypothesis
one was supported.
Follow-up Treatment Effects. A one-way between-groups MANCOVA was performed to
investigate group differences for the dependent variables, one month following the MARST
intervention (i.e., follow up effects). The analysis included group allocation as the independent
variable and the six dependent variables. Baseline scores on the dependent variables and participant
age were used as covariates as per previous research [54, 55].
Results of evaluation of assumptions of normality, linearity, univariate and multivariate outliers,
reliability of covariates, and multicollinearity were considered satisfactory. Results showed a
significant multivariate main effect was found for group, F (6, 27) = 2.92, p <.05, Pillai’s Trace = .39;
2
= .39, power = .81.
Given the significant multivariate main effect, univariate analyses of variance (ANOVAs) for each
dependent variable were examined. Levene’s test was non-significant across all dependent variables,
indicating homogeneity of variance. The results revealed significant univariate effects for group
across the following dependent variables; mindfulness, F(1, 39) = 6.84, p <.05,
2 =.18; resilience, F(1,
39) = 16.75, p <.001,
2 =.34; psychological well-being, F(1, 39) = 5.19, p <.05,
2 =.14; burnout, F(1,
39) = 8.55, p <.01,
2 =.21; and compassion fatigue, F(1, 39) = 5.87, p <.05,
2 = .16. No significant
difference was found between groups on measures of compassion satisfaction at one month
follow-up, F(1, 39) = 18.73, p >.05,
2 =.02.
As shown in Table 3, the MARST group reported significantly higher levels of mindfulness,
resilience and psychological well-being and significantly lower levels of burnout and compassion
fatigue at one month follow-up compared to the control group. As differences in compassion
satisfaction between groups were not statistically significant, hypothesis two was partially supported.
Table 3 Means and Standard Deviations of the Dependent Variables between Groups at
Pre, Post and Follow-up.
MARST (n = 23)
Control (n = 18)
Variable
Pre
Post
Follow-Up
Pre
Post
Follow-Up
M (SD)
M (SD)
M (SD)
M (SD)
M (SD)
M (SD)
OBM Integrative and Complementary Medicine 2018; 3(2), doi:10.21926/obm.icm.1802007
Page 11/21
Mindfulness
138.60
(28.44)
149.44
(20.12)
154.04*
(21.82)
135.14
(20.69)
136.19
(22.53)
139.28
(21.25)
Resilience
67.15
(9.32)
70.17
(6.87)
74.30***
(7.01)
66.11
(9.76)
64.37
(12.21)
64.72
(11.19)
Psychological
Well-being
70.96
(16.69)
80.92
(11.20)
80.22*
(12.66)
76.14
(14.84)
73.62
(13.72)
73.83
(15.39)
Compassion
Satisfaction
41.04
(6.24)
42.12
(4.72)
42.35
(5.60)
40.38
(5.94)
38.52
(7.25)
39.61
(7.78)
Burnout
20.20
(5.45)
18.20
(3.42)
18.09**
(4.34)
20.00
(6.12)
21.62
(6.38)
21.67
(6.49)
Compassion
Fatigue
18.56
(4.45)
17.68
(3.59)
17.17*
(3.71)
18.90
(5.21)
21.76
(6.36)
20.00
(7.57)
Note. * p<.05, ** p<.01, ***p<.001. MARST = mindful-awareness and resilience skills training
(treatment group).
3.2 Simple Mediation Analysis: Bootstrap Resampling
Mediation analysis was conducted using a bootstrap resampling method which provides a formal
significance test of the indirect effect (ab product; [56]).This procedure is a non-parametric
multivariate extension of the Sobel test, recommended with studies of smaller sample sizes (i.e., n <
80) as it is considered to have higher power with reasonably controlled Type I error rate [57].
Within the current study, bootstrapping was accomplished by taking 5000 samples of the original
sample size at post-intervention (n = 46) and computing the ab product for the mediator in each
sample [56]. The point estimate of the indirect effect is the mean of the ab product over 5000
samples and the procedure yields a 95% confidence interval [56, 57]. If the upper and lower limits of
the confidence interval do not contain zero, the null hypothesis may be rejected and the indirect
effect is significant [56].
The Indirect Effect of the MARST Intervention on Resilience, through Mindfulness. Mediation
analysis was conducted to assess mindfulness as a potential mediator of improvements in resilience
as a result of participation in the MARST intervention. The analysis included a dichotomous
independent (predictor) variable; participation in the MARST group and no intervention (control)
group, post-intervention mindfulness as the mediator, and post-intervention resilience as the
dependent variable. As per previous research, baseline covariates where included in the analysis to
increase the efficacy of estimating the direct and indirect effects [54, 58]. Furthermore, due to the
dichotomous nature of the independent variable, regression coefficients were reported in
unstandardised form [59]. The analysis was conducted using SPSS macros for mediation analysis
provided online at http://www.afhayes.com/spss-sas-and-mplus-macros-and-code.html#indirect.
Results indicated that participation in the MARST group (as opposed to the control group) was
OBM Integrative and Complementary Medicine 2018; 3(2), doi:10.21926/obm.icm.1802007
Page 12/21
positively related to resilience (B = 5.00, SEB = 1.66, t(44) = 3.00, p <.01). It was also found that
participation in the MARST group was positively related to increased mindfulness (B = 11.16, SEB =
4.35, t(44) = 2.56, p <.05). Lastly, results indicated that the mediator, mindfulness, was positively
associated with resilience (B = .24, SEB = .05, t (44) = 5.11, p <.001). Figure 2 displays the mediation
results and unstandardised regression coefficients.
Figure 2 Indirect effect of MARST intervention on resilience, through mindfulness. Note. *
p<.05, ** p<.01, ***p<.001. a = independent variable to mediator, b = mediator to
dependent variable, c = total effect, c’ = direct (partial) effect.
As both the a-path and b-path were significant, mediation analysis based on 5000 bootstrapped
samples using bias-corrected 95% confidence estimates was conducted [56, 57]. Results confirmed
the significant mediating role of mindfulness in the relationship between participation in the MARST
group and resilience (B = 2.70, CI = .69 to 5.91). In addition, the results indicated that the direct effect
of the MARST program on resilience became non-significant when controlling for the effects of
mindfulness (B = 2.34, SEB = 1.41, t(44) = 6.39, p >.05), thus suggesting full mediation and support of
hypothesis three.
The Indirect Effect of the MARST Intervention on Psychological Well-Being, through Mindfulness.
Mediation analysis was conducted to assess whether improvements in psychological well-being as a
result of participation in the MARST group, were mediated by increased mindfulness. Thus, the
analysis included the independent variable of two levels; participation in the MARST group and no
intervention (control) group, post-intervention mindfulness as the mediator, post-intervention
psychological well-being as the dependent variable, and baseline scores as the covariates. First it was
found that participation in the MARST group (as opposed to the control group) was positively related
to psychological well-being (B = 8.76, SEB = 3.56, t(44) = 2.46, p <.05). It was then found that
participation in the MARST group was positively related to increased mindfulness (B = 10.75, SEB =
4.61, t(44) = 2.33, p <.05). Next, results indicated that the mediator, mindfulness, was positively
associated with psychological well-being (B = .38, SEB = .10, t(44) = 3.64, p <.001).
Mediation analysis using the bootstrapping method with bias-corrected confidence estimates was
conducted and a 95% confidence interval of the indirect effect was obtained (5000 samples; [56, 57]).
OBM Integrative and Complementary Medicine 2018; 3(2), doi:10.21926/obm.icm.1802007
Page 13/21
Results of the mediation analysis confirmed the significant mediating role of mindfulness in the
relationship between participation in the MARST group and psychological well-being (B = 4.07, CI =
.61 to 8.43). The results also found that the direct effect of the MARST program on psychological
well-being became non-significant when controlling for the effects of mindfulness (B = 4.66, SEB =
3.33, t(44) = 1.40, p >.05); indicating full mediation and support of hypothesis three. Figure 3 displays
the results of the mediation analysis and unstandardised regression coefficients.
Figure 3 Indirect effect of MARST intervention on psychological well-being, through
mindfulness. Note. * p<.05, ** p<.01, ***p<.001. a = independent variable to mediator, b
= mediator to dependent variable, c = total effect, c’ = direct (partial) effect.
3.3 Multiple Mediation Analysis: Bootstrap Resampling
The Indirect Effect of the MARST Intervention on Compassion Fatigue, through Mindfulness and
Resilience. To explore hypothesis four, that changes in mindfulness and resilience will mediate the
impact of the MARST intervention on compassion fatigue, a bootstrapping resampling procedure that
allows the simultaneous examination of multiple mediators was conducted [41]. In the current
analysis, changes in mindfulness and resilience were entered as candidate mediators of the effects of
participation in the MARST group (as opposed to the control group) on changes in compassion
fatigue.
The results indicated that participation in the MARST group was negatively related to compassion
fatigue, (B = -3.97, SEB = 1.50, t(44) = -2.65, p <.05). It was also found that participation in the MARST
group was positively related to increased mindfulness (B = 11.16, SEB = 4.35, t(44) = 2.56, p <.05) and
resilience (B = 5.00, SEB = 1.66, t(44) = 3.00, p <.01). Lastly, it was found that resilience was negatively
associated with compassion fatigue (B = -.46, SEB = .15, t(44) = -3.13, p <.01), however changes in
mindfulness were non-significant (B = -.04, SEB = .06, t(44) = -.63, p >.05). Figure 4 displays the results
and unstandardised regression coefficients.
As the a-path and b-path were significant for the mediator, resilience, bootstrapping with
bias-corrected confidence estimates was subsequently conducted with a 95% confidence interval of
the indirect effect (5000 samples; [41]). Results of the mediation analysis confirmed the role of
OBM Integrative and Complementary Medicine 2018; 3(2), doi:10.21926/obm.icm.1802007
Page 14/21
resilience in mediating the relationship between participation in the MARST group and reductions in
compassion fatigue (B = -2.26, CI = -4.65 to -.83). Furthermore, the results indicated that the direct
effect of the MARST group on compassion fatigue became non-significant when controlling for the
effects of the mediators (B = -1.26, SEB = 1.38, t(44) = -.91, p = .37). However, as only resilience
emerged as a unique individual mediator (specific indirect effect), hypothesis four was partially
supported.
Figure 4 Mediation analysis of mindfulness and resilience as candidate mediators of the
MARST intervention’s effects on changes in compassion fatigue. Note. * p<.05, ** p<.01,
***p<.001.
The Indirect Effect of the MARST Intervention on Burnout, through Mindfulness and Resilience.
Changes in mindfulness and resilience were entered as candidate mediators of the effects of group
participation (MARST intervention vs. control) on changes in burnout. The results indicated that
participation in the MARST group was negatively related to burnout, (B = -3.16, SEB = 1.35, t(44) =
-2.35, p <.05). It was also found that participation in the MARST group was positively related to
increased mindfulness (B = 11.16, SEB = 4.35, t(44) = 2.56, p <.05) and resilience (B = 5.00, SEB = 1.66,
t(44) = 3.00, p <.01). Next, it was found that the mediators, mindfulness (B = -.14, SEB = .05, t(44) =
-3.05, p <.01) and resilience (B = -.26, SEB = .12, t(44) = -2.24, p <.05), were negatively associated with
burnout.
Bootstrapping with bias-corrected confidence estimates was therefore conducted with a 95%
confidence interval of the indirect effect (with 5000 samples; [41]). Results of the mediation analysis
confirmed the independent mediating roles (specific indirect effects) of mindfulness (B = -1.48, CI =
-3.82 to -.21) and resilience (B = -1.32, CI = -2.80 to -.25) in the relationship between MARST
participation and reductions in burnout. Additionally, the results indicated that the direct effect of
the MARST program on burnout became non-significant when controlling for the effects of the
mediators as a group (B = -.31, SEB = 1.10, t(44) = -.28, p >.05), subsequently demonstrating full
mediation and support of hypothesis five. Figure 5 displays the results of the mediation analysis and
unstandardised regression coefficients.
OBM Integrative and Complementary Medicine 2018; 3(2), doi:10.21926/obm.icm.1802007
Page 15/21
Figure 5 Mediation analysis of mindfulness and resilience as candidate mediators of the
MARST intervention’s effects on changes in burnout. Note. * p<.05, ** p<.01, ***p<.001.
4. Discussion
To the authors’ knowledge, this was the first study to implement and evaluate a brief intensive
mindfulness based program to cultivate resilience and mindfulness, as a means of increasing
psychological well-being and reducing burnout and compassion fatigue, in human service
professionals. To achieve this, the study examined the efficacy of a mindful-awareness and resilience
skills training (MARST) program and sought to determine if treatment outcomes were mediated by
increased levels of mindfulness and/or resilience.
The first and second hypotheses predicted that compared to the control group, MARST
participants would report significantly higher levels of mindfulness, resilience, compassion
satisfaction and psychological well-being, and significantly lower levels of burnout and compassion
fatigue; immediately after and one month following the intervention. These effects were found
across each of the variables, at both time intervals, with the exception of compassion satisfaction
which failed to sustain self-reported improvements.
In agreement with authors that describe resilience as a dynamic and modifiable construct [20] this
finding suggests that clinician resilience is indeed amenable to change and responsive to educational
and cognitive transformational processes. The results also corroborate findings which suggest that
mindfulness-based interventions (MBIs) may effectively replenish resilience [36, 60] reduce states of
burnout and traumatic stress [37, 39], and improve psychological well-being [34, 38].
Notwithstanding the non-significant finding of compassion satisfaction at follow up, the MARST
program was effective in producing sustainable outcomes over time.
Although practitioners may require additional or supplementary intervention to ensure
compassion satisfaction is maintained, improvements in mindfulness and resilience seemed to
accumulate and develop with time. This result was indicated by larger proportions of variance
OBM Integrative and Complementary Medicine 2018; 3(2), doi:10.21926/obm.icm.1802007
Page 16/21
attributable to the MARST group at one-month follow up; resilience (post = 17%; one month follow
up = 34%) and mindfulness (post = 14%; one month follow up = 18%). In a similar observation,
Pidgeon et al. [60] predicted that the development of mindfulness and resilience may mature with
time, following an opportunity to practice the skills learnt. Should this assertion be justified, one
might conceptualise growth in these areas as following a ‘snowball effect’, based on the maintenance
of skills triggered by this brief intensive intervention.
Hypothesis three was supported and indicated that self-reported gains in resilience and
psychological well-being, following participation in MARST, were fully mediated by increased
mindfulness. This finding exemplifies the ability of human service professionals to build resilience and
enhance their psychological well-being through interventions and practices which increase
mindfulness. The mediating effect of mindfulness in influencing change in resiliency and
psychological well-being is also consistent with previous studies which suggest that mindfulness is
related to the development of skills that form the fundamental elements of resilience [27, 28].
Hypothesis four and five predicted that reductions in compassion fatigue and burnout, as a result
of MARST participation, would be mediated by increased mindfulness and resilience. Although
resilience was found to mediate the relation between MARST and compassion fatigue, mindfulness
was not a significant mediator of this effect. Both mindfulness and resilience were however found to
mediate the relationship between MARST and self-reported burnout.
Interestingly, this result may add to the assumed path by which MARST influenced its outcomes.
While mindfulness did not directly mediate MARST’s impact on compassion fatigue, increased
mindfulness was found to mediate the relationship between the intervention and resilience, which in
turn mediated change in compassion fatigue. This may suggest that participation in MARST led to
increased levels of mindfulness, which resulted in increased resilience, which subsequently impacted
upon reductions in compassion fatigue. Conversely, when considering clinical interventions for
burnout among professionals, both mindfulness and resilience appear to be important unique
therapeutic targets.
The noted mediation effect supports research which highlights the importance of personal
qualities and characteristics in safeguarding against compassion fatigue and burnout [48]. According
to third wave resilience research, increased mindfulness may provide the positive growth and
cognitive transformational processes required to replenish resiliency factors [26]. The development
of resilience would in turn safeguard professionals against the repeated exposure to traumatic
material inherent to the human service professions [19]. Further to this, developing skills to cultivate
mindfulness and replenish resilience may serve to protect clinicians from mental exhaustion and
workplace disengagement, by providing additional resources and restoring the balance with
occupational demands [13].
Nevertheless, a number of limitations must be considered when examining these results. First,
attrition contributed to the small sample size which limits the generalisability of the findings. The
sample was predominantly female, well-educated and recruited from the same not-for-profit
organisation. A large percentage of participants also reported prior experience with mindfulness.
Whilst exposure to mindfulness training among human service professionals is to be expected, the
research may have appealed more so to those individuals that are open to this intervention. Future
OBM Integrative and Complementary Medicine 2018; 3(2), doi:10.21926/obm.icm.1802007
Page 17/21
studies should include a larger sample recruited from more diverse educational and socioeconomic
backgrounds, and multiple human service employers. The current study also involved a no
intervention control and future studies would benefit from the use of an alternative intervention or
waitlist control. In light of findings that mindfulness and resiliency skills may develop with time,
additional longitudinal measurement may also assist researchers to examine this phenomenon
further.
There are several implications of this work for future research. The findings contribute to an
understanding of the factors which influence the development and maintenance of resilience, in
addition to means of alleviating burnout and compassion fatigue among human service professionals.
The study provides preliminary evidence for MARST as a brief, intensive intervention that may bolster
psychological resources and safeguard against known job-related risk factors, prevalent among this
occupational group. Results suggest that interventions which effectively increase mindfulness among
human service professionals may result in the added benefits of increased resilience and subsequent
reductions in instances of burnout and compassion fatigue. Although the findings are to be
interpreted with some caution given the limitations of the study, they highlight the value of
simultaneously examining multiple variables as mediators of the effects of mindfulness-based
interventions.
Acknowledgments
The authors gratefully acknowledge the participation and support of Francis Klaassen and the staff
at Mercy Family Services, without which the present study could not have been completed. The
authors would also like to thank Breeana Souter for her assistance in co-facilitating the MARST
program.
Author Contributions
Both authors contributed to the design and implementation of the research, to the analysis of the
results and to the writing of the manuscript.
Funding
This research was financially supported by Mercy Family Services.
Competing Interests
The authors have declared that no competing interests exist.
References
1. Angerer JM. Job burnout. J Employ Couns. 2003; 40: 98-107.
2. Stebnicki MA. Empathy fatigue: healing the mind, body, and spirit of professional counselors. Am
J Psychiat Rehabil. 2007; 10: 317-338.
OBM Integrative and Complementary Medicine 2018; 3(2), doi:10.21926/obm.icm.1802007
Page 18/21
3. Brian E. Bride PhD L, MSW EW. Secondary traumatic stress in substance abuse treatment. J Teach
Addict. 2006; 5: 5-20.
4. Figley CR. Treating compassion fatigue. Hoboken: Taylor and Francis; 2002.
5. Rossi A, Cetrano G, Pertile R, Rabbi L, Donisi V, Grigoletti L, et al. Burnout, compassion fatigue,
and compassion satisfaction among staff in community-based mental health services. Psychiatry
Res. 2012; 200: 933-938.
6. Elwood LS, Mott J, Lohr JM, Galovski TE. Secondary trauma symptoms in clinicians: A critical
review of the construct, specificity, and implications for trauma-focused treatment. Clin Psychol
Rev. 2011; 31: 25-36.
7. Harr C. Promoting Workplace Health by Diminishing the Negative Impact of Compassion Fatigue
and Increasing Compassion Satisfaction. Soc Work Christian. 2013; 40: 71-88.
8. Figley CR. Compassion fatigue as secondary traumatic stress disorder: an overview. compassion
Fatigue. New York: Brunner/Maze; 1995.
9. Hegney DG, Craigie M, Hemsworth D, Osseiran-Moisson R, Aoun S, Francis K, et al. Compassion
satisfaction, compassion fatigue, anxiety, depression and stress in registered nurses in Australia:
study 1 results. J Nurs Manag. 2014; 22: 506-518.
10. Cunningham M. Impact of trauma work on social work clinicians: empirical findings. Soc Work.
2003; 48: 451-459.
11. Vanderlinden J, Vandereycken W. Trauma, dissociation, and impulse dyscontrol in eating
disorders. New York: Brunner/Maze; 1999.
12. Austin W, Goble E, Leier B, Byrne P. Compassion fatigue: the experience of nurses. Ethics Soc
Welfare. 2009; 3: 195-214.
13. Demerouti E, Nachreiner F, Bakker AB, Schaufeli WB. The job demands-resources model of
burnout. J Appl Psychol. 2001; 86: 499-512.
14. Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Psychol. 2001; 52: 397-422.
15. Angerer JM. Job burnout. J Employ Couns. 2003; 40: 98-107.
16. Potter P, Deshields T, Divanbeigi J, Berger J, Cipriano D, Norris L, et al. Compassion fatigue and
burnout: prevalence among oncology nurses. Clin J Oncol Nurs. 2010; 14: E56-62.
17. Seligman ME. Building resilience. Harv Bus Rev. 2011; 89: 100-106, 138.
18. Edward KL. The phenomenon of resilience in crisis care mental health clinicians. Int J Mental
Health Nurs. 2005; 14: 142148.
19. Grafton E, Gillespie B, Henderson S. Resilience: the power within. Oncol Nurs Forum. 2010; 37:
698-705.
20. Jackson D, Firtko A, Edenborough M. Personal resilience as a strategy for surviving and thriving in
the face of workplace adversity: a literature review. J Adv Nurs. 2007; 60: 1-9.
21. Phillips G. Resilience in practice interventions. Child Care Pract. 2008; 14: 45-54.
22. Breckman B. Mindfulness as a key resource for development and resilience. Nurs Stand. 2012; 26:
32.
23. Owen R. Facing the storm: using CBT, mindfulness and acceptance to build resilience when your
world 1st ed. New York: Taylor and Francis; 2012.
OBM Integrative and Complementary Medicine 2018; 3(2), doi:10.21926/obm.icm.1802007
Page 19/21
24. Rogers HB. Mindfulness meditation for increasing resilience in college students. Psychiat Ann.
2013; 43: 545-548.
25. Kabatzinn J. Mindfulness-based interventions in context: past, present, and future. Clin Psychol
Sci Pract. 2003; 10: 144-156.
26. Richardson GE. The metatheory of resilience and resiliency. J Clin Psychol. 2002; 58: 307-321.
27. Feder A, Nestler EJ, Charney DS. Psychobiology and molecular genetics of resilience. Nat Rev
Neurosci. 2009; 10: 446-457.
28. Haglund ME, Nestadt PS, Cooper NS, Southwick SM, Charney DS. Psychobiological mechanisms of
resilience: relevance to prevention and treatment of stress-related psychopathology. Dev
Psychopathol. 2007; 19: 889-920.
29. Mirkova AM. Investigation of the Relationship between Resilience, Mindfulness, and Academic
Self-Efficacy. Open J Soc Sci. 2013; 1: 1-4.
30. Feldman G, Dunn E, Stemke C, Bell K, Greeson J. Mindfulness and rumination as predictors of
persistence with a distress tolerance task. Pers Individ Dif. 2014; 56: 154-158.
31. Lutz J, Herwig U, Opialla S, Hittmeyer A, Jancke L, Rufer M, et al. Mindfulness and emotion
regulation--an fMRI study. Soc Cogn Affect Neurosci. 2014; 9: 776-785.
32. Masuda, Akihiko, Tully, Erin C. The role of mindfulness and psychological flexibility in somatization,
depression, anxiety, and general psychological distress in a nonclinical college sample. J
Evid-Based Complement Altern Med. 2012; 17: 66-71.
33. Eberth J. The effects of mindfulness meditation: a meta-analysis. Mindfulness. 2012; 3: 174-189.
34. Keng SL, Smoski MJ, Robins CJ. Effects of mindfulness on psychological health: a review of
empirical studies. Clin Psychol Rev. 2011; 31: 1041-1056.
35. Pidgeon AM, Ford L, Klaassen F. Evaluating the effectiveness of enhancing resilience in human
service professionals using a retreat-based Mindfulness with Metta Training Program: a
randomised control trial. Psychol Health Med. 2014; 19: 355-364.
36. Stanley EA, Schaldach JM, Kiyonaga A, Jha AP. Mindfulness-based mind fitness training: a case
study of a high-stress predeployment military cohort. Cogn Behav Pract. 2011; 18: 566-576.
37. Geller R, Krasner M, Korones D. Clinician self-care: the applications of mindfulness-based
approaches in preventing professional burnout and compassion fatigue (336). J Pain Symptom
Manag. 2010; 39: 366-366.
38. Brown KW, Ryan RM. The benefits of being present: mindfulness and its role in psychological
well-being. J Pers Soc Psychol. 2003; 84: 822-848.
39. Shapiro SL, Astin JA, Bishop SR, Cordova M. Mindfulness-based stress reduction for health care
professionals: results from a randomized trial. Int J Stress Manag. 2005; 12: 164-176.
40. Kraemer HC. Toward non-parametric and clinically meaningful moderators and mediators. Stat
Med. 2008; 27: 1679-1692.
41. Preacher KJ, Rucker DD, Hayes AF. Addressing moderated mediation hypotheses: theory,
methods, and prescriptions. Multivariate Behav Res. 2007; 42: 185-227.
42. Thompson RW, Arnkoff DB, Glass CR. Conceptualizing mindfulness and acceptance as
components of psychological resilience to trauma. Trauma Violence Abuse. 2011; 12: 220-235.
OBM Integrative and Complementary Medicine 2018; 3(2), doi:10.21926/obm.icm.1802007
Page 20/21
43. Baer RA, Smith GT, Hopkins J, Krietemeyer J, Toney L. Using self-report assessment methods to
explore facets of mindfulness. Assessment. 2006; 13: 27-45.
44. Baer RA. Measuring mindfulness. Contemp Buddhism. 2011; 12: 241-261.
45. de Bruin EI, Topper M, Muskens JG, Bogels SM, Kamphuis JH. Psychometric properties of the Five
Facets Mindfulness Questionnaire (FFMQ) in a meditating and a non-meditating sample.
Assessment. 2012; 19: 187-197.
46. Reivich K, Shatte A. The resilience factor: Seven essential skills for overcoming life’s inevitable
obstacles. New York: Broadway Books; 2002.
47. StammBH. The concise ProQOL manual [Internet]. 2013.
48. Stamm BH. The ProQOL Manual: The professional quality of life scale: compassion satisfaction,
burnout & compassion fatigue/secondary trauma scales. Baltimore: Sidran Press; 2005.
49. Lauvrud C, Nonstad K, Palmstierna T. Occurrence of post traumatic stress symptoms and their
relationship to professional quality of life (ProQoL) in nursing staff at a forensic psychiatric
security unit: a cross-sectional study. Health Qual Life Out. 2009; 7: 31.
50. Mcdowell I. Measuring health: a guide to rating scales and questionnaires. Oxford University
Press; 2006.
51. Taylor JE, Poston WS, Haddock CK, Blackburn GL, Heber D, Heymsfield SB, et al. Psychometric
characteristics of the General Well-Being Schedule (GWB) with African-American women. Qual
Life Res. 2003; 12: 31-39.
52. Segal ZV, Williams JMG, Teasdale JD. Mindfulness-based cognitive therapy for depression: A new
approach to preventing relapse. New York: Guilford Press; 2002. (p. 351).
53. Germer CK, Neff K. The mindful self-compassion training program. 2013: 365-396.
54. Mayers A. Introduction to statistics and SPSS in psychology. Chemical Communications. 1966;
13: 416-417.
55. Van Breukelen GJ, Van Dijk KR. Use of covariates in randomized controlled trials. J Int
Neuropsych Soc. 2007; 13: 903-904.
56. Preacher KJ, Hayes AF. SPSS and SAS procedures for estimating indirect effects in simple
mediation models. Behav Res Methods Instrum Comput. 2004; 36: 717-731.
57. Mackinnon DP, Lockwood CM, Williams J. Confidence limits for the indirect effect: distribution of
the product and resampling methods. Multivariate Behav Res. 2004; 39: 99.
58. Ten Have TR, Joffe MM. A review of causal estimation of effects in mediation analyses. Stat
Methods Med Res. 2012; 21: 77-107.
59. Hayes AF. Introduction to mediation, moderation, and conditional process analysis: a
regression-based approach. New York: Guilford Publications; 2013. (p. 335-337).
60. Pidgeon A, Keye M. Relationship between resilience, mindfulness, and psychological well-being
in university students. Int J Liber Arts Soc Sci, 2014; 2: 27-32.
OBM Integrative and Complementary Medicine 2018; 3(2), doi:10.21926/obm.icm.1802007
Page 21/21
OBM Integrative and Complementary Medicine
Enjoy OBM Integrative and Complementary
Medicine by:
1. Submitting a manuscript
2. Joining in volunteer reviewer bank
3. Joining Editorial Board
4. Guest editing a special issue
For more details, please visit:
http://www.lidsen.com/journals/icm
OBM Integrative and Complementary Medicine
... Studies that analyze the effects of mindfulness on social workers are still scarce (Trowbridge and Lawson, 2016), although they are currently on the rise. These investigations have found a significant relationship between the practice of mindfulness and the reduction of burnout (and its individual dimensions) in social workers in general (Crowder and Sears, 2017;Thomas, 2012;Thomas and Otis, 2010), in geriatric social workers (Pandya, 2019), and in human service professionals in general (Hanna and Pidgeon, 2018). Among these professionals, mindfulness practice has additionally been associated with lower levels of compassion fatigue (Thomas, 2012;Thomas and Otis, 2010), greater resilience (Hanna and Pidgeon, 2018), greater compassion satisfaction (Pandya, 2019), and a greater degree of mental well-being (Goodman and Shorling, 2012). ...
... These investigations have found a significant relationship between the practice of mindfulness and the reduction of burnout (and its individual dimensions) in social workers in general (Crowder and Sears, 2017;Thomas, 2012;Thomas and Otis, 2010), in geriatric social workers (Pandya, 2019), and in human service professionals in general (Hanna and Pidgeon, 2018). Among these professionals, mindfulness practice has additionally been associated with lower levels of compassion fatigue (Thomas, 2012;Thomas and Otis, 2010), greater resilience (Hanna and Pidgeon, 2018), greater compassion satisfaction (Pandya, 2019), and a greater degree of mental well-being (Goodman and Shorling, 2012). ...
... Moreover, a statistically significant relationship can be observed between the burnout construct along with two of its dimensions (exhaustion and depersonalization), on one hand, and the performance of meditative practices on the other, so that those who have carried out this type of practice present more exhaustion and depersonalization. These results are at odds with research that indicates the positive effects of different practices based on mindfulness in reducing burnout (Goodman and Shorling, 2012;Hanna and Pidgeon, 2018;Pandya, 2019;Thomas, 2012;Thomas and Otis, 2010). A similar situation occurs in the analysis of the mindfulness construct (MAAS), which again presents a statistically significant relationship with the fact of not having practiced meditative techniques at any time in life. ...
Article
Although the number of studies on burnout in social work has increased in recent years, research is still scarce. A similar situation occurs in the area of studies on the effects of mindfulness in this profession, although the research topic has increased exponentially. Based on a quantitative analysis, our study proposes a structural equation model that relates the constructs of burnout, areas of worklife, and dispositional mindfulness among social workers. Results suggest that high levels of mindfulness as well as consistency in the areas of worklife have predictive and preventive effects on the incidence of burnout in social work.
... Eastern [142,143,146,149,150,[152][153][154]156,159,181,182,187,189,191,193,233,239,250] 19 ( 59,60,63,67,69,70,79,80,84,94,101,108,110,117,124,[130][131][132]135,137,166,168,171,198,200,202,[213][214][215]225,244] 32 (14.5%) ...
... Western [42,[44][45][46]48,51,52,64,69,70,77,89,93,97,107,114,118,120,121,125,126, Western [41,63,66,68,74,75,78,81,[85][86][87][88]95,96,104,105,108,110,112,127,129,131, Western [39,40,43,[47][48][49][53][54][55][56][57][58][59][60]62,64,66,67,[71][72][73][74]76,79,[81][82][83][84][85]90,92,94,95,[98][99][100][101][102][103][104]106,109,111,[113][114][115][116][117][118][119]122,123,126,128,[130][131][132][133][135][136][137][138][139][140]162,[164][165][166] ...
Article
Full-text available
Previous research has demonstrated the efficacy of psychological interventions to foster resilience. However, little is known about whether the cultural context in which resilience interventions are implemented affects their efficacy on mental health. Studies performed in Western (k = 175) and Eastern countries (k = 46) regarding different aspects of interventions (setting, mode of delivery, target population, underlying theoretical approach, duration, control group design) and their efficacy on resilience, anxiety, depressive symptoms, quality of life, perceived stress, and social support were compared. Interventions in Eastern countries were longer in duration and tended to be more often conducted in group settings with a focus on family caregivers. We found evidence for larger effect sizes of resilience interventions in Eastern countries for improving resilience (standardized mean difference [SMD] = 0.48, 95% confidence interval [CI] 0.28 to 0.67; p < 0.0001; 43 studies; 6248 participants; I2 = 97.4%). Intercultural differences should receive more attention in resilience intervention research. Future studies could directly compare interventions in different cultural contexts to explain possible underlying causes for differences in their efficacy on mental health outcomes.
... Nila et al. (2016) revealed in their research that mindfulness-based stress reduction intervention improves individuals' resilience and distress tolerance. Moreover, Hanna and Pidgeon (2018) found in their study that mindfulness-centered interventions increase individuals' levels of resilience and decrease their burnout. When all these study findings are considered together, it seems possible to say that an increased level of mindfulness can serve as a protective factor in building resilience for women who perceived abuse in a romantic relationship. ...
Article
Full-text available
Purpose This study aimed to examine the mediating role of awareness, cognitive flexibility, positive attitude towards the future, and social support in the relationship between perceived abuse and resilience in women. Method The researchers used structural equation modelling to test whether internal protective factors such as mindfulness, cognitive flexibility, positive attitudes towards the future, and external protective factors such as perceived social support from family and friends play a role as protective factors in the effect of abuse women perceive in their romantic relationships on their resilience. Within the scope of this research, data were collected by purposive sampling method from 818 women aged 18 and over who are currently in a romantic relationship. Results The findings of this study revealed that the hypothetical model established based on the literature was not rejected [χ² / df = 4,400; RMSEA = 0.065; SRMR: 057; CFI = 0.951; NFI =, 938; TLI / NNFI = 0.925; GFI = 0.964; AGFI = 0.935]. Besides, it has been found that internal and external protective factors together explain 52% of the change in resilience. Conclusions The mediating role of the internal and external protective factors in the model revealed that they play a crucial role in the process of developing resilience among women. The findings obtained from the research were discussed within the scope of the related literature and suggestions were presented to researchers and those working in the practice field for further studies.
... Various studies reported that the practice of mindfulness-based intervention resulted in a statistically significant increase in resilience among the practitioners (Philippe et al., 2021;Champion et al., 2018;Galante et al., 2018;Hanna and Pidgeon, 2018;Noble et al., 2019;Ramasubramanian, 2017). The practice of transcendental meditation resulted in notable growth of resilience among the teachers and support staff of a school with small-to-medium effect sizes (Valosek et al., 2021). ...
Article
A BSTRACT Context Rising stress levels among students in the current era of cutthroat competition are a cause of concern, and one of the major reasons for this rising stress is to excel in academics. Academic stress negatively impacts the lives of students, which raises an utmost need to control this stress among students. With a decrease in stress, there is also a necessity to make them able to bear stress up to some extent, i.e. to make them resilient. Meditative practices are considered effective in reducing stress among students, and these also led to improvements in resilience among practitioners. These studies served as a base for executing meditative practices as an intervention for the current study. Aims The aim of this study was to investigate the effects of meditative practices on the academic stress and resilience of ninth-graders. Settings and Design A nonequivalent pretest–posttest control group design was used. The school was chosen using purposive sampling, and the experiment was conducted on ninth-class students; the intact sections of the class were randomly assigned as the experimental and control groups for the purpose. Materials and Methods The Academic Stress Scale by Chavhan and the Resilience Scale by Kaur were administered for the assessment of academic stress and resilience. Statistical Analysis Used The Mann–Whitney U test was used to compare the gain scores of the experimental and control groups for academic stress and resilience. The rank biserial correlation was done to calculate the effect sizes. Results Academic stress was significantly decreased in the intervention group compared to the control group at the time of the posttest; however, no significant improvements were observed on the scale of resilience among the students of the intervention group compared to the control group at the time of the posttest. Conclusions Meditative practices can be appraised as a valuable tool for the reduction of academic stress among students and that does not cost a penny. More intensive and long practices may be needed for the improvement of resilience among ninth-class students.
... Mindfulness meditation has been shown to have a positive impact on female teachers' mental health and wellbeing in the SARS-COV-2 outbreak in Italy [80]. Hanna and Pidgeon [81]and Behan [76] argue that of the many different forms of meditation and mindfulness, what have been evidenced in showing improvements in depression, panic, anxiety and pain is mindfulness-based stress reduction (MBSR). Having MBSR as a low-cost method to complement medical treatment in COVID-19 and post the pandemic is being of particular interest to healthcare professionals and in alternative medicine [57,76]. ...
Article
Full-text available
The SARS-COV-2 virus has changed people’s lives and caused significant public health issues. The lockdown implemented by several governments across the globe has raised serious concerns on mental and physical wellbeing. Doctors, nurses and other COVID-19 frontline workers being put under extreme pressure to attend to patients’ health are being impacted by high stress levels which can result in burn-out and the inability to cope with the situation. This paper draws on multi-disciplinary research including complementary, traditional and integrative medicine, behavioral medicine, and social and environmental psychology to develop and propose a single integrative model of wellbeing encompassing dimensions of mental, physical and spiritual wellbeing in a pandemic context. The article discusses COVID-19 place confinement as a context to deliver body-mind medicine interventions in this challenging time. The aim is to provide the required support to promote behavior change for better public health outcomes. A range of cognitive behavioral therapies including psycho-social, psycho-educational, relaxation, meditation and nature therapies are discussed. Promoting alternative forms of traditional, complementary and integrative medicine in the local, global communities are discussed as preventive and sustainable measures to improve public health and wellbeing aligning with Global Health and the United Nations Sustainable Development Goals. This has important implications for people’s wellbeing and quality of life during and post the COVID-19 pandemic.
... 12 There are various psychological interventions to treat anxiety but CBT is found to be the preferred choice and scientifically more effective. 13 However, research findings suggest that CBT in this particular age group is less effective than in late adolescence. Psychological intervention based on mindfulness (PIBM) cognitive therapy is preferred in this study over pure CBT. ...
Article
Full-text available
Background The increasing mental health problems of Indian adolescents are of great concern but child-health mental service is in a nascent stage. Anxiety is the most common psychological problem found in school-going children. The psychological intervention for this high-risk population at an early stage of adolescence can prevent mental health problems. Aim The study aimed to assess the applicability and effectiveness of mindfulness-based cognitive therapy (MBCT) on resilience and anxiety of early school-going adolescents with anxiety. Method This study used pre, post, and follow-up with a randomized control group design. Out of 200 samples screened by Preliminary Identification Performa and Clinical Interview Schedule (PI&CI), General Health Questionnaire-12 (GHQ-12), Spence Children’s Anxiety Scale (SCAS), and Brief Psychiatry Rating Scale (BPRS-C), 72 samples aged between 10 to 14 were included in the final study and grouped into two equal groups through a simple randomized method. Psychological intervention based on mindfulness (PIBM) group with N = 36 received 12 sessions of mindfulness-based intervention (MBCT-C) but only 33 completed up to follow-up. Only N = 32 in Treatment Waiting List (TWL) group completed three assessments who received parental counseling about anxiety. The outcome measures were Child and Adolescent Mindfulness Measure (CAMM), SCAS, Bharathiar University Resilience Scale (BURS). Result The findings suggested that the PIBM group significantly improved in mindfulness and resilience, and anxiety symptoms were reduced. The effect size observed is strong and the post hoc t-test showed significant change in variables in every assessment duration. The TWL group did not have significant change. Thus MBCT-C is an applicable and effective intervention for a early school-going adolescent with anxiety.
... Lindsay and Creswell (2017) argued that mindfulness is related to lower psychological distress during stressful life events. Hanna and Pidgeon (2018) introduced a mindfulness program which may assist in developing resilience and reduce burnout and compassion fatigue in human service professionals. Joyce et al. (2018) suggested that there is a greater level of resilience among employees after practicing a mindfulness-based resilience program. ...
Article
Full-text available
During the COVID-19 pandemic, school closures have brought significant disruptions to education throughout the world. This pandemic has affected the mental state of teachers from having to adapt to provide online classes. Teacher resilience refers to the capacity of teachers to survive and thrive in extremely adverse circumstances and sustain their educational purposes. This study attempts to empirically examine the effect of mindfulness on teacher resilience through integrating characteristics of Eastern and Western mindfulness. A concurrent triangulation mixed methodology was applied in this study. In the quantitative part, the cross-sectional questionnaires were completed by 330 teachers who were working in five universities in Thailand and had faced the crisis of COVID-19. The Mindfulness Awareness Attention Scale (MAAS) was employed to quantify mindfulness in Eastern perspective, and the Langer Mindfulness Scale (LMS14) was employed to quantify mindfulness in Western perspective. The Employee Resilience (EmpRes) was used to measure teacher resilience. The estimated structural equation model (SEM) provides strong and convincing support that Western mindfulness positively affects teacher resilience. Novelty seeking and novelty producing which are core factors of Western mindfulness mediate the relationship between mindfulness in Eastern perspective and teacher resilience. Where the survey data were collected, we conducted focus group interviews with five university teachers and executives who had experienced the crisis to understand this relationship in qualitative methodology simultaneously. The findings give additional support to the argument of how mindfulness plays an important role in enhancing teacher resilience. Discussion and practical implications are also included.
... It would be particularly useful to develop resilience during helpers' initial training and measure it in order to identify helpers who may need more support to develop resilience and other mental health protection factors such as self-compassion, optimism, or hope. Resilience may be developed, for example, through mindfulnessbased practices [47,48], positive psychology interventions [49], or compassion-focused therapy. Furthermore, by increasing professional skills to help the client overcome such a situation, it may help to reduce empathic distress fatigue by increasing the orientation of the professional towards helping relieve other's suffering. ...
Article
Full-text available
This study validated the French version of the Brief Resilience Scale (BRS-F) and tested the protective role of resilience in the context of vicarious trauma (22 March 2016 terrorist attacks in Brussels) regarding anxiety and depression symptoms. Confirmatory factor analyses indicated a single-factor structure of the BRS-F. Investigation of convergent validity showed that the BRS-F was positively correlated with usual outcomes such as subjective happiness, acceptance, and sense of coherence, and negatively correlated with anxiety and depression symptoms. Lastly, the results of the study showed that resilience protected against the effect of vicarious trauma in two ways. First, at the time of exposure, the more resilient individuals reported lower levels of anxiety and depression symptoms. Second, after three months, the more resilient individuals recovered from these symptoms, whereas no significant effect was found for less resilient individuals. Theoretical and clinical implications of the findings are discussed.
Article
Full-text available
Mindfulness has emerged as one of the major strategies for the well-being of employees in the current corporate world. As the workspace continues to evolve due to technological and structural advancement, employees face difficulty coping and lack the desired agility. The present study is a systematic review of around a hundred scientific papers and various books and business research articles from the period of 2000–2021 focusing on mindfulness and employee wellness research from various journals such as Jama Psychiatry, Applied Psychology: Health and Well-being, journals from Frontier Psychology and Emerald Publications, and others. The study aims to explore mindfulness and its applications across various vocational sectors, with particular emphasis on its potential relevance to the Indian population. The study also discusses the evolution of mindfulness, its implications for improving work culture and leadership, and its application in various workplaces. As there are very few mindfulness-based studies conducted on the Indian working population, the present study helps to bridge the gap and recommends future studies to be conducted on the Indian population to establish concrete scientific evidence on the possible impact of mindfulness on employees' vocational lives. The paper makes a unique contribution by analyzing the potential for enhancement through mindfulness in various vocational sectors and also identifies a strong scope for research in the emerging areas of corporate agility and robot-assisted interventions.
Article
Full-text available
The most commonly used method to test an indirect effect is to divide the estimate of the indirect effect by its standard error and compare the resulting z statistic with a critical value from the standard normal distribution. Confidence limits for the indirect effect are also typically based on critical values from the standard normal distribution. This article uses a simulation study to demonstrate that confidence limits are imbalanced because the distribution of the indirect effect is normal only in special cases. Two alternatives for improving the performance of confidence limits for the indirect effect are evaluated: (a) a method based on the distribution of the product of two normal random variables, and (b) resampling methods. In Study 1, confidence limits based on the distribution of the product are more accurate than methods based on an assumed normal distribution but confidence limits are still imbalanced. Study 2 demonstrates that more accurate confidence limits are obtained using resampling methods, with the bias-corrected bootstrap the best method overall.
Article
One effect of rising health care costs has been to raise the profile of studies that evaluate care and create a systematic evidence base for therapies and, by extension, for health policies. All clinical trials and evaluative studies require instruments to monitor the outcomes of care in terms of quality of life, disability, pain, mental health, or general well-being. Many measurement tools have been developed, and choosing among them is difficult. This book provides comparative reviews of the quality of leading health measurement instruments and a technical and historical introduction to the field of health measurement, and discusses future directions in the field. This edition reviews over 100 scales, presented in chapters covering physical disability, psychological well-being, anxiety, depression, mental status testing, social health, pain measurement, and quality of life. An introductory chapter describes the theoretical and methodological development of health measures, while a final chapter reviews the current status of the field, indicating areas in which further development is required. Each chapter includes a tabular comparison of the quality of the instruments reviewed, followed by a detailed description of each instrument, covering its purpose and conceptual basis, its reliability and validity, alternative versions and, where possible, a copy of the scale itself. To ensure accuracy, each review has been approved by the original author of each instrument or by an acknowledged expert.
Article
CME Educational Objectives 1. Discuss the interplay between stress and resilience. 2. Describe the unique characteristics of emerging adulthood. 3. Describe the beneficial effect of mindfulness training on resilience. Resilience, the ability to recover psychologically from stressful or traumatic events, is often discussed in the psychiatric literature in terms of an individual’s ability to recover from significant trauma. Much of the information about what builds or inhibits an individual’s resilience is based on research on people who have survived severe traumas or on animal models of severe trauma. However, in the world of college counseling, the emphasis is slightly different. Although there are certainly a number of college students presenting to student counseling centers who have survived horrific challenges, a much more common presentation is the student who is having trouble adapting to more-routine life events, such as failing in academic endeavors or being rejected by a love interest. Helping emerging adults (EAs) build the resilience they need to manage their day-to-day stresses is one of the core challenges for clinicians working with college students.