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Mindfulness-Based Resilience Training in the Workplace: Pilot Study of the Internet-Based Resilience@Work (RAW) Mindfulness Program


Abstract and Figures

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 Mindfulness program on measures of resilience and related skills.
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Original Paper
Mindfulness-Based Resilience Training in the Workplace: Pilot
Study of the Internet-Based Resilience@Work (RAW) Mindfulness
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
Phone: 61 401297711
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
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
resilience training; workplace mental health; occupational health; wellbeing; online intervention; employee resilience; health and
safety; psychological health
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,
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
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
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
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.
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 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.
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).
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.
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.
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).
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.
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).
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.
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.
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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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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
J Med Internet Res 2018 | vol. 20 | iss. 9 | e10326 | p.12
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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
J Med Internet Res 2018;20(9):e10326
©Sadhbh Joyce, Fiona Shand, Richard A Bryant, Tara J Lal, Samuel B Harvey. Originally published in the Journal of Medical
Internet Research (, 11.09.2018. This is an open-access article distributed under the terms of the Creative
Commons Attribution License (, 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
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and license information must be included.
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Full-text available
Introdução: Os novos desafios e exigências do trabalho evidenciam o interesse de investir na promoção da saúde, bem-estar e produtividade dos funcionários. O Enfermeiro do Trabalho, possui um conjunto de competências para avaliar os Riscos profissionais, em especial os psicossociais, bem como consciencializar, aumentar a segurança e operar mudanças promotoras de ambientes saudáveis. A implementação de um programa de saúde mental e bem-estar no trabalho, tem impacto na prevenção de problemas de saúde e também na aquisição de hábitos de vida saudáveis, com impacto positivo no trabalhador e na organização. Objetivos: Analisar a evidência científica sobre o bem-estar e a saúde mental do trabalhador, na área da Saúde Ocupacional. Metodologia: Trata-se de uma revisão integrativa da literatura. Realizou-se a pesquisa nas bases de dados Pubmed® e CINAHL®Complete, MedicLatina, MEDLINE Complete, Nursing & Allied Health: Comprehensive Edition e Cochrane Database of Systematic Reviews. Selecionaram-se 25 artigos, que respeitaram os critérios de inclusão definidos (publicação entre 2016 e 2022, idiomas inglês, espanhol e português, na área da saúde e bem-estar no trabalho). Resultados: Os problemas mais relatados no contexto de trabalho foram a depressão, ansiedade, sobrecarga de trabalho e desvalorização profissional. Intervenções baseadas em terapia cognitivo-comportamental demonstraram eficácia na redução dos sintomas nos trabalhadores. O envolvimento dos gestores num programa de saúde, de preferência assente em formato digital, contribui para ambientes laborais saudáveis. Conclusões: A implementação de programas de saúde mental e bem-estar simples e acessíveis, incluindo o incentivo a práticas como o mindfulness e o ioga, podem criar mudanças significativas, com ganhos em saúde e para a organização, pelo impacto positivo para a pessoa e para a sua produtividade. Atualmente é fundamental promover a articulação entre o Enfermeiro do Trabalho e os gestores das organizações, pois ao zelar pelo interesse dos trabalhadores e a melhoria dos indicadores ao nível da saúde mental, favorece-se o vínculo, o desempenho, o capital humano e a produtividade.
Full-text available
Objectives: The purpose of this study was to address military leader perceptions of their resilience, transformational leadership behaviors, and leadership effectiveness before and after experiencing Mindfulness-Based Attention Training (MBAT). Methods: Participants were formal and informal leaders in the Kansas Air National Guard. The study used a mixed-methods sequential exploratory design. Phase I involved analyzing pretest and posttest results obtained from a Jha Lab study for three self-report assessments in an intervention group (n = 36) vs a control group (n = 37). The qualitative data in phase II was obtained from individual interviews of participants (n = 12) following the Jha Lab study. Results: The phase I quantitative results confirmed the null hypotheses-no significant differences found-for all research questions. Phase II resulted in eight thematic codes, six of which were central to the experiences described by participants (Halting, Sensing, Being, Shielding, Considering, and Engaging) and two that were not (Obstructing, and Escaping). Conclusions: The key finding was that the descriptions of mindful thoughts and behaviors were consistent across participants indicating that MBAT accurately presents mindfulness during the course and the training had positive effects on participant mindfulness, primarily in the areas of being present to self, shielding the self through reperceiving, and then consciously altering behavior based on the new perspective. Results should direct future resiliency course development, leadership course curricula, and aid understanding of how leaders mentally conceptualize stress, incorporate resilient behaviors and then apply that knowledge to their own leadership behaviors.
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Background Many organisations promote eHealth applications as a feasible, low-cost method of addressing mental ill-health and stress amongst their employees. However, there are good reasons why the efficacy identified in clinical or other samples may not generalize to employees, and many Apps are being developed specifically for this group. The aim of this paper is to conduct the first comprehensive systematic review and meta-analysis evaluating the evidence for the effectiveness and examine the relative efficacy of different types of eHealth interventions for employees. Methods Systematic searches were conducted for relevant articles published from 1975 until November 17, 2016, of trials of eHealth mental health interventions (App or web-based) focused on the mental health of employees. The quality and bias of all identified studies was assessed. We extracted means and standard deviations from published reports, comparing the difference in effect sizes (Hedge’s g) in standardized mental health outcomes. We meta-analysed these using a random effects model, stratified by length of follow up, intervention type, and whether the intervention was universal (unselected) or targeted to selected groups e.g. “stressed”. Results 23 controlled trials of eHealth interventions were identified which overall suggested a small positive effect at both post intervention (g = 0.24, 95% CI 0.13 to 0.35) and follow up (g = 0.23, 95% CI 0.03 to 0.42). There were differential short term effects seen between the intervention types whereby Mindfulness based interventions (g = 0.60, 95% CI 0.34 to 0.85, n = 6) showed larger effects than the Cognitive Behaviour Therapy (CBT) based (g = 0.15, 95% CI 0.02 to 0.29, n = 11) and Stress Management based (g = 0.17, 95%CI -0.01 to 0.34, n = 6) interventions. The Stress Management interventions however differed by whether delivered to universal or targeted groups with a moderately large effect size at both post-intervention (g = 0.64, 95% CI 0.54 to 0.85) and follow-up (g = 0.69, 95% CI 0.06 to 1.33) in targeted groups, but no effect in unselected groups. Interpretation There is reasonable evidence that eHealth interventions delivered to employees may reduce mental health and stress symptoms post intervention and still have a benefit, although reduced at follow-up. Despite the enthusiasm in the corporate world for such approaches, employers and other organisations should be aware not all such interventions are equal, many lack evidence, and achieving the best outcomes depends upon providing the right type of intervention to the correct population.
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Background Stress, depression, and anxiety among working populations can result in reduced work performance and increased absenteeism. Although there is evidence that these common mental health problems are preventable and treatable in the workplace, uptake of psychological treatments among the working population is low. One way to address this may be the delivery of occupational digital mental health interventions. While there is convincing evidence for delivering digital psychological interventions within a health and community context, there is no systematic review or meta-analysis of these interventions in an occupational setting. Objective The aim of this study was to identify the effectiveness of occupational digital mental health interventions in enhancing employee psychological well-being and increasing work effectiveness and to identify intervention features associated with the highest rates of engagement and adherence. Methods A systematic review of the literature was conducted using Cochrane guidelines. Papers published from January 2000 to May 2016 were searched in the PsychINFO, MEDLINE, PubMed, Science Direct, and the Cochrane databases, as well as the databases of the researchers and relevant websites. Unpublished data was sought using the Conference Proceedings Citation Index and the Clinical Trials and International Standard Randomized Controlled Trial Number (ISRCTN) research registers. A meta-analysis was conducted by applying a random-effects model to assess the pooled effect size for psychological well-being and the work effectiveness outcomes. A positive deviance approach was used to identify those intervention features associated with the highest rates of engagement and adherence. Results In total, 21 randomized controlled trials (RCTs) met the search criteria. Occupational digital mental health interventions had a statistically significant effect post intervention on both psychological well-being (g=0.37, 95% CI 0.23-0.50) and work effectiveness (g=0.25, 95% CI 0.09-0.41) compared with the control condition. No statistically significant differences were found on either outcome between studies using cognitive behavioral therapy (CBT) approaches (as defined by the authors) compared with other psychological approaches, offering guidance compared with self-guidance, or recruiting from a targeted workplace population compared with a universal workplace population. In-depth analysis of the interventions identified by the positive deviance approach suggests that interventions that offer guidance are delivered over a shorter time frame (6 to 7 weeks), utilize secondary modalities for delivering the interventions and engaging users (ie, emails and text messages [short message service, SMS]), and use elements of persuasive technology (ie, self-monitoring and tailoring), which may achieve greater engagement and adherence. Conclusions This review provides evidence that occupational digital mental health interventions can improve workers’ psychological well-being and increase work effectiveness. It identifies intervention characteristics that may increase engagement. Recommendations are made for future research, practice, and intervention development.
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The Cognitive Fusion Questionnaire (CFQ) is a recently published measure of cognitive fusion – a key construct in the model of psychopathology of acceptance and commitment therapy (ACT). This study presents the psychometric properties and factor structure data of a Spanish translation of the CFQ in Colombia. Three samples with a total of 1,763 participants were analyzed. The Spanish CFQ showed psychometric properties very similar to the ones obtained in the original version. Internal consistency across the different samples was good (Cronbach's alpha between .89 and .93). The one-factor model found in the original scale showed a good fit to the data. Measurement invariance was also found across sample and gender. The mean score of the clinical sample on the CFQ was significantly higher than the scores of the nonclinical samples. CFQ scores were significantly related to experiential avoidance, emotional symptoms, mindfulness, and life satisfaction. The CFQ was sensitive to the effects of a 1-session ACT intervention. This Spanish version of the CFQ shows good psychometric properties in Colombia.
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Background: Veterans with history of deployment in the Global War on Terror face significant and ongoing challenges with high prevalences of adverse psychological, physical, spiritual, and family impacts. Together, these challenges contribute to an emerging public health crisis likely to extend well into the future. Innovative approaches are needed that reach veterans and their family members with strategies they can employ over time in their daily lives to promote improved adjustment and well-being. Objective: The objective of this study was to evaluate effects of use of a Web-based, self-directed program of instruction in mind- and body-based wellness skills to be employed by Global War on Terror veterans and their significant relationship partners on mental health and wellness outcomes associated with postdeployment readjustment. Methods: We recruited 160 veteran-partner dyads in 4 regions of the United States (San Diego, CA; Dallas, TX; Fayetteville, NC; and New York, NY) through publicity by the Iraq and Afghanistan Veterans of America to its membership. Dyads were randomly allocated to 1 of 4 study arms: Mission Reconnect (MR) program alone, MR plus the Prevention and Relationship Enhancement Program (PREP) for Strong Bonds weekend program for military couples, PREP alone, and waitlist control. We administered a battery of standardized and investigator-generated instruments assessing mental health outcomes at baseline, 8 weeks, and 16 weeks. Dyads in the MR arms were provided Web-based and mobile app video and audio instruction in a set of mindfulness-related stress reduction and contemplative practices, as well as partner massage for reciprocal use. All participants provided weekly reports on frequency and duration of self-care practices for the first 8 weeks, and at 16 weeks. Results: During the first 8-week reporting period, veterans and partners assigned to MR arms used some aspect of the program a mean of 20 times per week, totaling nearly 2.5 hours per week, with only modest declines in use at 16 weeks. Significant improvements were seen at 8 and 16 weeks in measures of posttraumatic stress disorder, depression, sleep quality, perceived stress, resilience, self-compassion, and pain for participants assigned to MR arms. In addition, significant reductions in self-reported levels of pain, tension, irritability, anxiety, and depression were associated with use of partner massage. Conclusions: Both veterans and partners were able to learn and make sustained use of a range of wellness practices taught in the MR program. Home-based, self-directed interventions may be of particular service to veterans who are distant from, averse to, or prohibited by schedule from using professional services. Leveraging the partner relationship may enhance sustained use of self-directed interventions for this population. Use of the MR program appears to be an accessible, low-cost approach that supports well-being and reduces multiple symptoms among post-9/11 veterans and their partners. Trial registration: NCT01680419; (Archived by WebCite at
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Background: The 10-item Connor-Davidson Resilience Scale (CD-RISC) has demonstrated satisfactory psychometric properties as a measure of resilience in all the previous studies conducted in developed countries. Objective: The objective of this study was to explore the psychometric characteristics of the 10-item CD-RISC among students nurses in southwestern Nigeria. Design: This descriptive cross-sectional study involved a total of 449 student nurses who completed the 10-item CD-RISC in addition to measures of self-esteem, depression, religiosity, and psychological distress. Results: The scale demonstrated adequate reliability (Cronbach's α = .81) and satisfactory validity with significant correlations with the measures of self-esteem, depression, religiosity, and psychological distress. Factor analyses revealed that resilience was best explained by a two-factor construct. Conclusions: The scale is a valid measure of resilience among Nigerian student nurses.
This study assessed the eff ects of a psychological group intervention based on positive psychology in women with breast cancer. 175 women were randomly assigned either to an experimental group, receiving the 14-session intervention (n = 87), or to a waitlist group (n = 88) that did not receive any type of intervention. For treatment, a group intervention was applied, based on improving psychological strengths and enhancing positive psychology-based styles of coping. Strength-related outcomes, self-esteem, well-being, and happiness were assessed before and after the intervention. The experimental group showed higher scores on all of the study variables after the intervention. Participants reported improved self-esteem, emotional intelligence-related abilities, resilience, and optimism, as well as positive aff ectivity, well-being, and happiness. The results show a benefi cial eff ect of this psychological intervention based on positive psychology on female breast cancer patients' psychological health.
Mental illness is now the leading cause of long-term sickness absence among Australian workers, with significant costs to the individual, their employers and society more broadly. However, to date, there has been little evidence-informed guidance as to what workplaces should be doing to enhance their employees’ mental health and wellbeing. In this article, we present a framework outlining the key strategies employers can implement to create more mentally healthy workplaces. The five key strategies outlined are as follows: (1) designing work to minimise harm, (2) building organisational resilience through good management, (3) enhancing personal resilience, (4) promoting early help-seeking and (5) supporting recovery and return to work. A narrative review is utilised to outline the theoretical evidence for this framework and to describe the available research evidence for a number of key example interventions for each of the five strategies. While each workplace needs to develop tailored solutions, the five strategy framework proposed in this review will hopefully provide a simple framework for employers and those advising them to use when judging the adequacy of existing services and considering opportunities for further enhancements.
Objective: The aim of this study was to quantify the economic benefits of eliminating job strain as a risk factor for depression, using published population-attributable risk estimates of depression attributable to job strain (13.2% for men, 17.2% for women). Methods: Cohort simulation using state-transition Markov modeling estimated costs and health outcomes for employed persons who met criteria for lifetime DSM-IV major depression. A societal perspective over 1-year and lifetime time horizons was used. Results: Among employed Australians, $890 million (5.8%) of the annual societal cost of depression was attributable to job strain. Employers bore the brunt of these costs, as they arose from lost productive time and increased risk of job turnover among employees experiencing depression. Conclusions: Proven, practicable means exist to reduce job strain. The findings demonstrate likely financial benefits to employers for expanding psychosocial risk management, providing a financial incentive to complement and reinforce legal and ethical directives.
Mindfulness-based interventions (MBIs) are increasingly being delivered through the Internet. Whereas numerous meta-analyses have investigated the effectiveness of face-to-face MBIs in the context of mental health and well-being, thus far a quantitative synthesis of the effectiveness of online MBIs is lacking. The aim of this meta-analysis was to estimate the overall effects of online MBIs on mental health. Fifteen randomised controlled trials were included in this study. A random effects model was used to compute pre-post between-group effect sizes, and the study quality of each of the included trials was rated. Results showed that online MBIs have a small but significant beneficial impact on depression (g = 0.29), anxiety (g = 0.22), well-being (g = 0.23) and mindfulness (g = 0.32). The largest effect was found for stress, with a moderate effect size (g = 0.51). For stress and mindfulness, exploratory subgroup analyses demonstrated significantly higher effect sizes for guided online MBIs than for unguided online MBIs. In addition, meta-regression analysis showed that effect sizes for stress were significantly moderated by the number of intervention sessions. Effect sizes, however, were not significantly related to study quality. The findings indicate that online MBIs have potential to contribute to improving mental health outcomes, particularly stress. Limitations, directions for future research and practical implications are discussed.