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Original Paper
Mindfulness-Based Resilience Training in the Workplace: Pilot
Study of the Internet-Based Resilience@Work (RAW) Mindfulness
Program
Sadhbh Joyce1, BA (Hons), MClinNeuropsych; Fiona Shand2, PhD; Richard A Bryant3, PhD; Tara J Lal4, BSc (Hons);
Samuel B Harvey1,2, PhD
1School of Psychiatry, Faculty of Medicine, University of New South Wales, Randwick, Australia
2Black Dog Institute, Randwick, Australia
3School of Psychology, Faculty of Science, University of New South Wales, Randwick, Australia
4Fire and Rescue New South Wales, Alexandria, Australia
Corresponding Author:
Sadhbh Joyce, BA (Hons), MClinNeuropsych
School of Psychiatry
Faculty of Medicine
University of New South Wales
The Black Dog Institute
Hospital Road
Randwick, 2031
Australia
Phone: 61 401297711
Email: sadhbh.joyce@unsw.edu.au
Abstract
Background: The impact of mental illness on society is far reaching and has been identified as the leading cause of sickness
absence and work disability in most developed countries. By developing evidence-based solutions that are practical, affordable,
and accessible, there is potential to deliver substantial economic benefits while improving the lives of individual workers. Academic
and industry groups are now responding to this public health issue. A key focus is on developing practical solutions that enhance
the mental health and psychological resilience of workers. A growing body of research suggests resilience training may play a
pivotal role in the realm of public health and prevention, particularly with regards to protecting the long-term well-being of
workers.
Objective: Our aim is to examine whether a mindfulness-based resilience-training program delivered via the internet is feasible
and engaging to a group of high-risk workers. Additionally, we aim to measure the effect of the Resilience@Work Resilience@Work
Mindfulness program on measures of resilience and related skills.
Methods: The current pilot study recruited 29 full-time firefighters. Participants were enrolled in the 6-session internet-based
resilience-training program and were administered questionnaires prior to training and directly after the program ended.
Measurements examined program feasibility, psychological resilience, experiential avoidance, and thought entanglement.
Results: Participants reported greater levels of resilience after Resilience@Work training compared to baseline, with a mean
increase in their overall resilience score of 1.5 (95% CI -0.25 to 3.18, t14=1.84, P=.09). Compared to baseline, participants also
reported lower levels of psychological inflexibility and experiential avoidance following training, with a mean decrease of -1.8
(95% CI -3.78 to 0.20, t13=-1.94, P=.07). With regards to cognitive fusion (thought entanglement), paired-samples ttests revealed
a trend towards reduction in mean scores post training (P=.12).
Conclusions: This pilot study of the Resilience@Work program suggests that a mindfulness-based resilience program delivered
via the Internet is feasible in a high-risk workplace setting. In addition, the firefighters using the program showed a trend toward
increased resilience and psychological flexibility. Despite a number of limitations, the results of this pilot study provide some
valuable insights into what form of resilience training may be viable in occupational settings particularly among those considered
high risk, such as emergency workers. To the best of our knowledge, this is the first time a mindfulness-based resilience-training
program delivered wholly via the internet has been tested in the workplace.
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(J Med Internet Res 2018;20(9):e10326) doi:10.2196/10326
KEYWORDS
resilience training; workplace mental health; occupational health; wellbeing; online intervention; employee resilience; health and
safety; psychological health
Introduction
Improving workplace mental health is an opportunity of
immense scale and profound importance [1-3]. By developing
evidence-based solutions that are practical, affordable, and
accessible, there is potential to deliver substantial economic
benefits, while improving the lives of individual workers [4,5].
The impact of mental illness on society is far reaching and has
been identified as the leading cause of sickness absence and
work disability in most developed countries [6-11]. Poor mental
health also produces large productivity losses due to absenteeism
as well as presenteeism, with affected workers attending work,
yet performing at a diminished capacity [12,13]. As a result,
common mental health conditions such as depression and anxiety
have a significant and direct impact on the overall economic
welfare of a nation [14,15]. However, the impact of mental
illness in the working population goes well beyond
macroeconomics. Once an individual worker develops a mental
health condition, they often suffer personal financial losses,
career disruption, and reduced well-being.
Academic and industry groups are now responding to this public
health issue. A key focus is on developing practical solutions
that enhance the mental health and psychological resilience of
workers [16]. There is no simple universal solution to workplace
mental health. Best practice frameworks highlight the
importance of a multifaceted approach that addresses individual,
team, and organizational level factors. These factors include
work design, organizational culture, good management,
promoting and facilitating early help-seeking and early
intervention, as well as supporting return-to-work programs and
recovery [16,17]. These frameworks also make specific
reference to the importance of employee resilience training.
This type of individual training can form part of broader
programs of workplace health promotion [18].
Indeed, a growing body of research suggests resilience training
may play a pivotal role in the realm of public health and
prevention, particularly with regards to protecting the long-term
well-being of workers [17,19,20]. While definitions of resilience
are diverse and plentiful, there is growing consensus that
resilience is a malleable construct, wherein an individual’s
ability to adapt effectively during challenging circumstances
can be enhanced over time. Leading researchers in the field,
along with the American Psychological Society, describe
resilience as a process of “bouncing back” from difficult
experiences and “adapting well in the face of adversity, trauma,
tragedy, threats or significant sources of stress” [21,22].
In terms of enhancing resilience, numerous studies have
described positive outcomes from various types of resilience
training programs among groups including medical specialists,
youth workers, nurses, factory workers, and public servants
[23-28]. In addition, research among emergency workers (ie,
firefighters, police, paramedics) and military personnel
highlights the benefits of resilience training among individuals
who frequently experience high-stress situations as an inherent
aspect of their work [29-31]. Conversely, a number of larger
trials with US Army Personnel and more recently with London
Ambulance in the United Kingdom reported limited
improvements following resilience training [32,33]. Establishing
what types of resilience training programs are beneficial to
high-risk groups such as emergency workers is particularly
important for several reasons. First, these workers play an
essential role in delivering and maintaining critical services in
our communities. Second, given the nature of their work,
emergency workers are at greater risk of developing common
mental health conditions such as depression, anxiety, and alcohol
misuse as well as posttraumatic stress disorder (PTSD) [34-37].
Finally, resilience programs that are evaluated and found to be
useful among emergency service personnel may provide
valuable insight on how to best support the mental health of
workers in other high-stress occupations (eg, health care,
journalism).
Despite the growing body of research supporting resilience
training, considerable measurement variation exists in terms of
how researchers evaluate the effectiveness of these programs.
For example, some researchers specifically focus on changes
observed on reliable and validated measures of psychological
resilience following times of intense stress and adversity. Windle
et al [38] offer a review of resilience measures. Other researchers
have primarily examined the overall impact of resilience training
on measures of general well-being and mental health
symptomology. While research continues to highlight a positive
relationship between resilience and psychological well-being,
the latter approach may provide limited insight into whether a
resilience intervention can truly facilitate change in an
individual’s overall ability to bounce back from adversity. A
program may improve mental health symptoms, yet not enhance
a person’s overall psychological resilience or vice versa [39,40].
The use of reliable and validated measures of psychological
resilience is central to examining the efficacy of any intervention
aimed at enhancing psychological resilience [38], particularly
in groups where people identify as “mentally healthy.”
Resilience training programs can differ considerably in terms
of content, delivery, and length. In their systematic review of
resilience interventions, Leppin et al unsurprisingly concluded
“no single accepted theoretical framework or consensus
statement exists to guide the development or application of these
programs” [19]. This may explain why resilience researchers
are now drawing on evidence-based therapies such as
Acceptance and Commitment Therapy (ACT), Cognitive
Behavioral Therapy, Mindfulness-Based Cognitive Therapy,
and Mindfulness-Based Stress Reduction (used in the treatment
of common mental health conditions) to inform program
development [23,24,27,41-45]. These resilience programs tend
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to include a combination of cognitive strategies, mindfulness
training, psycho-educational material, and goal setting. They
typically focus on enhancing a person’s capacity to manage
stressful situations and adverse circumstances more effectively
and with greater emotional insight. These skills and strategies
require time to practice and gain proficiency. As such, the
majority of resilience studies to date describe interventions
involving multiple face-to-face training sessions [19,20]. This
is a particular challenge for many employers, where taking
workers away from the workplace to attend training creates
considerable disruption to business and critical services. In
addition, the associated costs for replacement staff during this
time can be significant. The expense inherent in face-to-face
training can pose a hindrance, as can the availability of trainers
and programs in remote areas. Moreover, stigma associated
with mental health remains prevalent and may prevent a subset
of workers from choosing to engage openly in group-training
sessions that focus on psychological topics [46]. A universal
approach where all employees complete the training may go
some way towards reducing this stigma [47].
To address these barriers, we developed an interactive e-learning
program called The Resilience@Work (RAW) Mindfulness
Program. This self-paced intervention aims to enhance
psychological resilience among workers. It consists of 6
internet-based training sessions, each taking about 20-25 minutes
to complete on a tablet or computer (see Figure 1).
The RAW program involves mindfulness training,
psycho-education, and a range of skills and strategies drawn
from evidence-based therapies including ACT,
Mindfulness-Based Stress Reduction, and Compassion-Focused
Therapy. A large body of literature highlights the positive
benefits of mindfulness practice on mental health outcomes
[48-53] while a growing number of studies also describe the
positive impact of mindfulness training on psychological
resilience [23,24,41,54].
The RAW program also teaches a number of core cognitive
strategies, which may further enhance a learner’s ability to
manage stress and cope with adverse circumstances more
effectively. These core strategies, drawn from ACT, aim to
enhance psychological flexibility by applying mindfulness,
acceptance-based emotion regulation strategies, and cognitive
skills, while also emphasizing behavioral change that reflects
personal values. Psychological flexibility is “the ability to be
in the present moment with full awareness and openness to our
experience, and to take action guided by our values” [55].
Psychological flexibility is associated with lower levels of
depression, anxiety, and distress in clinical and nonclinical
populations [56-58]. More recently, it has been found to protect
against depression and PTSD among returned service personnel
[59].
Figure 1. Resilience@Work Mindfulness Program homepage.
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Table 1. Overview of skills and topics covered in the Resilience@Work Mindfulness Program.
Mindfulness tracksResilience topic and skills focusSession
Introduction to mindfulness, resilience and psychological well-being1 1. Drop Anchor
2. Take 10
3. Leaves on a Stream
Mindfulness skills, Understanding your reactive mind versus wise mind, Rec-
ognizing unhelpful mind chatter and managing uncomfortable and unhelpful
thoughts (cognitive defusion); Recognizing your values exercise
2 1. Mindful Breathing
2. Defusion Technique; Notice it, Name it, Let it Go
(I’m having the thought that…)
3. Defusion Technique 2: Thank you Mind
Revision of cognitive defusion, Introduction to mindfulness with emotions,
The reactive mind and avoidance, Understanding how values are linked to
emotions; Valued action check
3 1. Creating Space (mindfulness with emotions)
2. Mindful Body Scan
3. The Golden Room
The problem with avoidance, Recognizing avoidance strategies versus adaptive
strategies
4 1. Creating Space
2. A Mindful Break (mindfulness with words)
3. Surfing Waves
Self-care and support, The compassion myth, barriers to accessing compassion,
compassion fatigue, self-compassion actions & resilience; Identifying mindful
support (compassionate, nonjudgmental and mindful); Valued action check
5 1. A Kind and Gentle Hand (loving-kindness practice)
2. A Safe Place (compassion-focused mindfulness)
3. A Bird’s Eye View
Compassion-focused mindfulness; Gratitude practice, optimism and resilience,
identify and celebrate the milestones; Creating a personalized action plan to
practice skills
6 1. Breathing in the Present Moment
2. A Golden Moment exercise
3. Being Kind to your old wounds
Table 1 provides an overview of the resilience topics, core
strategies, and mindfulness skills covered in each session.
Several reviews and meta-analyses have found medium to large
effect sizes for ACT-based interventions across a range of
clinical and nonclinical settings including anxiety, depression,
substance abuse, worksite stress, and burnout [60-64]. Moreover,
a number of studies have found that ACT can improve mental
health in the workplace [64,65], highlighting its potential as an
intervention that may promote psychological resilience in
occupational settings.
A recent review and meta-analysis found that digital mental
health interventions in the workplace can improve psychological
well-being and work effectiveness among employees [66].
Despite the apparent advantages of online resilience training,
there has been very limited research examining the acceptability
and efficacy of this approach. A few trials have examined either
a blended approach (ie, programs that combine internet-based
and face-to-face resilience training) [24,41] or an online
approach with an emphasis on stress reduction and/or enhancing
resilience-related factors [67,68]. As with the main resilience
literature to date, these studies vary greatly in their approach to
measuring program efficacy and thus limited conclusions can
be drawn. In addition, while the research evidence for online
mindfulness interventions continues to grow [48,69], to date
there have been no published trials examining the efficacy of a
mindfulness-based resilience training program delivered solely
online.
The primary aim of our pilot study is to examine whether a
mindfulness-based resilience-training program delivered via
the internet is feasible and engaging to a high-risk group of
workers, that is, firefighters. A secondary aim is to capture
changes in measures of resilience and psychological skills
among firefighters undertaking the training program. To the
best of our knowledge, this is the first pilot study of a self-paced
mindfulness-based resilience training program delivered
completely in an online format.
Methods
Resilience@Work Mindfulness Program
The RAW program is a mindfulness-based intervention, which
also draws on ACT and has significant emphasis on
self-compassion and acceptance skills. The intervention involves
completing 6 internet-based training sessions. Each session
takes about 20-25 minutes to complete on a tablet or computer.
It was anticipated that an engaging and interactive program
would help address the issue of adherence; a challenge that
employers frequently encounter when offering resilience training
and support to their workers. Rather than having to read through
lengthy paragraphs on a website, the RAW program engages
workers in the process of learning by utilizing a combination
of interactive exercises, audio, and animation (see Figure 2).
Participants were able to download mindfulness tracks to their
own device for continued practice. Participants also had the
opportunity to sign up for text-message reminders and/or
reminder emails. A podcast accompanied each RAW session
with additional mindfulness tracks to encourage skills
development. Podcasts were not a mandatory part of the training
but were available via a website for those participants who chose
to use them.
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Figure 2. Screenshots of training material from the Resilience@Work Mindfulness Program
To ensure program engagement, workers from target industries
were invited to provide detailed insight into the specific
work-related challenges they encountered on a regular basis.
Examples were provided by workers to the research team via
email, phone, and in person during a workplace well-being
seminar. This information was collated and incorporated
throughout the RAW program as “real-world” examples when
introducing new resilience strategies and techniques.
Each session teaches a new strategy to cultivate psychological
resilience and involves a combination of psycho-education and
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mindfulness training. The program also interweaves simple
quotes and messages from the eastern philosophies of Buddhism
and Yogic teaching traditions from which mindfulness has its
origins [70-74].
Participants
Participants for this pilot study were drawn from Fire and Rescue
New South Wales (FRNSW) in Australia. FRNSW is the seventh
largest urban fire service in the world and responds to
firefighting, rescue, and hazardous material emergencies in
Sydney, Australia, and surrounding regional areas. Given the
nature of their work, employees are known to have elevated
risk of depression, anxiety, and PTSD [36].
Potential participants were informed about the study during a
standard well-being talk facilitated by members of the FRNSW
Peer Support Team. Firefighters were provided with a participant
information sheet and consent form to read and review along
with the study questionnaire. Participation was voluntary.
Firefighters who opted to participate in the study signed the
consent form and provided a valid email address in order to
register into the training program. Prepaid envelopes were
provided to mail consent forms and completed questionnaires
to the research team. Overall, 29 firefighters were recruited (see
Table 2). Any potential participants who were currently engaged
in any regular individual psychological therapy sessions with
a psychologist and/or psychiatrist were excluded from this study.
Ethics approval was obtained via the Human Research Ethics
Committee at the University of New South Wales, Australia.
Measures
The current pilot study sought to (1) examine the initial
feasibility of the RAW Mindfulness Program in a workplace
setting and (2) determine whether it would lead to measurable
changes in resilience and key process variables, specifically
cognitive fusion and experiential avoidance.
Measure of Feasibility
Engagement and feasibility of the RAW Mindfulness Program
were recorded by storing the total number of sessions completed
by each participant and the number of training hours completed.
Measure of Resilience
Psychological resilience was measured using the validated short
form 10-item version of the Connor-Davidson Resilience Scale
(CD-RISC 10) [75]. Participants respond to each item on a
5-point scale, ranging from 0 (not true at all) to 4 (true nearly
all of the time). The total score ranges from 0-40 with a higher
score indicative of higher psychological resilience. Previous
studies have found the CD-RISC 10 to be a reliable and valid
measure with Cronbach alpha ranging from .81-.88 [76,77] and
test-retest reliability of 0.9 at 6 weeks [77,78].
Measure of Process
The RAW Mindfulness Program was designed to utilize a
variety of mindfulness and ACT techniques, the most prominent
of which were cognitive defusion and psychological flexibility.
In order to measure the impact of the intervention program on
these processes, the Cognitive Fusion Questionnaire (CFQ) and
the Acceptance and Action Questionnaire version 2 (AAQ-II)
were administered to participants.
Cognitive Fusion Questionnaire
The CFQ is a measure of cognitive fusion and defusion, a core
component of the ACT model [79]. The CFQ contains 7 items
rated on a 7-point scale from 1 (never true) to 7 (always true)
with a total score range of 7-49. A higher score reflects greater
cognitive fusion and thought entanglement. A sample item is
“I get so caught up in my thoughts that I am unable to do the
things that I most want to do.” Previous studies have found the
CFQ to be a reliable and valid measure with Cronbach alpha
ranging from .89-.93 [79,80].
Table 2. Demographics of participants in Resilience@Work pilot study (N=29).
ValueCharacteristics
43.7 (8.7) 24-59Age, mean (SD); range
Sex, n (%)
28 (97)Male
1 (3)Female
Highest education, n (%)
8 (27.6)High school
15 (51.7)Technical and Further Education (TAFE)
5 (17.2)Graduate degree
1 (3.4)Postgraduate degree
Years with Fire and Rescue New South Wales , n (%)
3 (10.7)1-5
4 (14.3)6-10
5 (17.9)11-15
3 (10.7)16-20
13 (46.4)20+
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Acceptance and Action Questionnaire-II
The AAQ-II is a 7-item self-reported measure of experiential
avoidance and psychological inflexibility. Participants rate each
question on a 7-point Likert scale from 1 (never true) to 7
(always true) with a total score range of 7-49. A higher score
reflects greater avoidance behavior and less psychological
flexibility. Previous research has found the AAQ-II to be a
reliable and valid measure with a Cronbach alpha of .84 and
test-retest reliability of 0.81 at 3-month follow-up [56].
Data Analysis Plan
Analyses were conducted using SPSS statistical analysis
program. Prior to analysis, frequency distributions and plots for
each of the outcome and process variables were examined for
unusual data points and to ensure the assumption of normality
was not violated, using the Shapiro-Wilk’s test. Paired-samples
ttests were used to determine any differences between each
measure at baseline and immediately after the intervention. The
main measure of the efficacy of the intervention was the level
of psychological resilience as measured by the CD-RISC 10.
We proposed that an effect size of 0.5 would be considered a
meaningful and clinically important effect. Based on such
figures, we aimed to recruit at least 26 participants to this pilot
study, which would achieve 0.8 power of detecting an effect
size of 0.5 in terms of the CD-RISC 10 with an alpha of 0.1
(two-sided). This approach is similar to other pilot studies of
this kind [81]. The total number of modules completed by each
participant was also recorded to examine program engagement.
In addition, univariate analysis using chi-square tests and
Student ttests were used to examine which baseline measures
predicted completion of at least 50% of the RAW program.
Baseline factors considered were age, gender, level of education,
years working as a firefighter, and baseline resilience.
Results
Overview
A total of 29 firefighters were recruited for the pilot study. Of
the participants, 72% (21/29) had completed some form of
post-high school education and the majority (16/29, 55%) had
been employed by FRNSW for more than 15 years. In line with
most first responder agencies, the vast majority of participants
were male. Baseline resilience scores on the CD-RISC 10 were
similar to normative data from first responders [69].
Program Engagement
Table 3 outlines the number of RAW program sessions
completed by participants. The majority of participants (16/29,
55%) completed more than half the program (mean number of
sessions completed was 3.6 out of a possible 6, SD 2.2) equating
to 60-75 minutes of training. Eleven participants (11/29, 38%)
completed all 6 sessions (a total of at least 2 hours training).
Analysis examining for baseline predictors of completion found
no evidence that age, gender, level of education, years working
as a firefighter, or baseline resilience were able to predict which
participants were more likely to complete at least half of the
RAW program (P>.05 for all).
Resilience, Cognitive Fusion, and Psychological
Inflexibility/Experiential Avoidance
Participants reported greater levels of resilience after RAW
training compared to baseline, with a mean increase in their
CD-RISC 10 score of 1.5 (95% CI -0.25 to 3.18, t14=1.84,
P=.09), equating to a moderate effect size of 0.5. Table 4
displays the baseline and post-training measurements of
resilience and measures of process.
Table 3. The number of Resilience@Work sessions completed by pilot study participants.
n (%)Minimum number of sessions completed
29 (100)1
21 (72)2+
16 (55)3+
14 (48)4+
14 (48)5+
11 (38)6
Table 4. Baseline and post-training scores for measures of resilience and process variables.
Pvalue
Post Resilience@Work training, mean (SD)Baseline, mean (SD)Measure
.0927.5 (4.9)26.0 (5.5)Resilience, CD-RISC 10a(n=15)
.1218.4 (7.5)20.7 (8.9)Cognitive fusion, CFQb(n=13)
.0716.7 (5.7)18.5 (6.7)Psychological inflexibility, AAQ-IIc(n=14)
aCD-RISC 10: 10-item version of the Connor-Davidson Resilience Scale.
bCFQ: Cognitive Fusion Questionnaire.
cAAQ-II: Acceptance and Action Questionnaire version 2.
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Compared to baseline, participants reported lower levels of
psychological inflexibility and experiential avoidance following
training, with a mean decrease of -1.8 (95% CI -3.78 to 0.20,
t13=-1.94, P=.07). With regards to cognitive fusion (thought
entanglement), paired-samples ttest revealed a trend towards
reduction in mean scores post training (P=.12).
Discussion
Principal Findings
This pilot study of the RAW Mindfulness Program suggests
that an internet-based resilience-training program is feasible in
a workplace setting. In addition, those using the RAW program
showed a trend toward increased resilience and psychological
flexibility. To the best of our knowledge, this is the first time a
wholly online mindfulness-based resilience-training program
and its feasibility have been tested in the workplace.
While it is difficult to directly compare effect sizes from pre-post
studies compared to control trials, it is worth noting that the
moderate effect sizes demonstrated in this pilot study are similar
to those described in a recent meta-analysis examining the
effectiveness of online mindfulness interventions aimed at
reducing stress [48]. In addition, the observed trends in both of
the predicted process factors, cognitive fusion (thought
entanglement), and psychological inflexibility/experiential
avoidance, suggest the desired skills and techniques can be
taught via an internet-based format.
Limitations
There were some important limitations to this pilot study, most
notably the lack of a control group, the small sample size, and
the absence of longer-term follow-up. The use of self-reported
measures of resilience and process measures is also a limitation,
although all scales used were well validated and the resilience
measure chosen is known to be associated with a range of mental
health outcomes among working populations [82]. Recruitment
was facilitated by peer supporters and occurred while a
proportion of firefighters were either responding to emergency
calls or off duty. It is therefore unknown what proportion of
firefighters were informed of the program and subsequently
signed up for resilience training. Thus, limited insight was
gained into overall acceptability of the program. It is important
to note that our sample of emergency workers was a uniformed,
male-dominated, high-risk group. Therefore, it remains unclear
as to whether this form of resilience training is feasible among
gender-balanced, low-risk workforces.
While most participants completed half of the program, there
was a notable drop in completion after the second session. This
may be due to a new cognitive skill being taught in this session
that focused on how to manage difficult and uncomfortable
thoughts. This may have been particularly confronting or
challenging for some learners. Dropout analysis found that level
of baseline resilience, age, gender, education level, and years
on the job did not predict who would go on to complete more
than 50% of the program. It is worth noting that this analysis is
hindered by an overall lack of power and that other factors such
as intrinsic motivation may have influenced completion rates.
That said, most participants completed at least half of the RAW
program and of these most went on to complete the entire
program (ie, all 6 sessions).
Conclusion
Despite these limitations, the results of this pilot study provide
some valuable insights into what form of resilience training
may be viable in occupational settings. More specifically, it
suggests that internet-based resilience training is a feasible
approach in workplaces, particularly among those considered
high risk, such as first responders, and those with specific
inherent challenges for training, such as shift work, frequent
travel on the road, and limited access to face-to-face training.
In spite of these promising results, the effectiveness of the RAW
Mindfulness Program needs to be tested via a larger randomized
controlled trial, ideally with both short-term and longer-term
follow up. Additional secondary outcome measures, such as
levels of psychological symptoms, perceived stress, and
well-being are also needed to establish whether programs such
as the RAW program can create meaningful changes beyond
short-term gains in self-reported resilience.
Acknowledgments
This publication was made possible by an Australian Government Research Training Program (RTP) Scholarship and the University
New South Wales Brain Sciences PhD Grant in aid awarded to SJ for her doctoral studies and funding for SH from NSW Health
(grant number: RM09708). Neither RTP nor NSW Health had a role in the study design, collection, analysis, or interpretation of
the data; writing the manuscript; or the decision to submit the paper for publication.
The researchers would like to express their gratitude to the NSW firefighters who participated in this study as well as the peer
support firefighters and FRNSW staff who helped roll out the program, in particular TJL, Brendan Mott, and Mark Dobson.
Authors' Contributions
SJ and SBH devised the study. SJ developed the RAW Mindfulness Program, the internet-based format, and collected, scored,
and entered the data. TJL assisted with data collection. SJ and SBH analyzed and interpreted the data, and SJ wrote the first draft
of the manuscript. All authors read and contributed to subsequent versions and approved the final manuscript.
J Med Internet Res 2018 | vol. 20 | iss. 9 | e10326 | p.8http://www.jmir.org/2018/9/e10326/
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Conflicts of Interest
SJ and SBH are associated with a company that offers resilience training (RAW Mind Coach). SBH and FS work for the Black
Dog Institute, a not-for-profit organization that provides mental health and resilience training to various other organizations.
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Abbreviations
AAQ-II: Acceptance and Action Questionnaire version 2
ACT:acceptance and commitment therapy
CD-RISC 10: 10-item version of the Connor-Davidson Resilience Scale
CFQ: Cognitive Fusion Questionnaire
FRNSW:Fire and Rescue New South Wales
NSW:New South Wales
PTSD: posttraumatic stress disorder
RAW: Resilience@Work
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Edited by G Eysenbach; submitted 08.03.18; peer-reviewed by P Jimenez, F Moir; comments to author 19.04.18; revised version
received 22.05.18; accepted 28.06.18; published 11.09.18
Please cite as:
Joyce S, Shand F, Bryant RA, Lal TJ, Harvey SB
Mindfulness-Based Resilience Training in the Workplace: Pilot Study of the Internet-Based Resilience@Work (RAW) Mindfulness
Program
J Med Internet Res 2018;20(9):e10326
URL: http://www.jmir.org/2018/9/e10326/
doi:10.2196/10326
PMID:
©Sadhbh Joyce, Fiona Shand, Richard A Bryant, Tara J Lal, Samuel B Harvey. Originally published in the Journal of Medical
Internet Research (http://www.jmir.org), 11.09.2018. This is an open-access article distributed under the terms of the Creative
Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly
cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright
and license information must be included.
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