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Resilience@Work Mindfulness Program: Results From a Cluster Randomized Controlled Trial With First Responders

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Background: A growing body of research suggests that resilience training can play a pivotal role in creating mentally healthy workplaces, particularly with regard to protecting the long-term well-being of workers. Emerging research describes positive outcomes from various types of resilience training programs (RTPs) among different occupational groups. One specific group of workers that may benefit from this form of proactive resilience training is first responders. Given the nature of their work, first responders are frequently exposed to stressful circumstances and potentially traumatic events, which may impact their overall resilience and well-being over time. Objective: This study aimed to examine whether a mindfulness-based RTP (the Resilience@Work [RAW] Mindfulness Program) delivered via the internet can effectively enhance resilience among a group of high-risk workers. Methods: We conducted a cluster randomized controlled trial (RCT) comprising 24 Primary Fire and Rescue and Hazmat stations within New South Wales. Overall, 12 stations were assigned to the 6-session RAW Mindfulness Program and 12 stations were assigned to the control condition. A total of 143 active full-time firefighters enrolled in the study. Questionnaires were administered at baseline, immediately post training, and at 6-month follow-up. Measurements examined change in both adaptive and bounce-back resilience as well as several secondary outcomes examining resilience resources and acceptance and mindfulness skills. Results: Mixed-model repeated measures analysis found that the overall test of group-by-time interaction was significant (P=.008), with the intervention group increasing in adaptive resilience over time. However, no significant differences were found between the intervention group and the control group in terms of change in bounce-back resilience (P=.09). At 6-month follow-up, the group receiving the RAW intervention had an average increase in their resilience score of 1.3, equating to a moderate-to-large effect size compared with the control group of 0.73 (95% CI 0.38-1.06). Per-protocol analysis found that compared with the control group, the greatest improvements in adaptive resilience were observed among those who completed most of the RAW program, that is, 5 to 6 sessions (P=.002). Conclusions: The results of this RCT suggest that mindfulness-based resilience training delivered in an internet format can create improvements in adaptive resilience and related resources among high-risk workers, such as first responders. Despite a number of limitations, the results of this study suggest that the RAW Mindfulness Program is an effective, scalable, and practical means of delivering online resilience training in high-risk workplace settings. To the best of our knowledge, this is the first time a mindfulness-based RTP delivered entirely via the internet has been tested in the workplace. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12615000574549; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368296 (Archived by WebCite at http://www.webcitation.org/75w4xtrpw).
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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
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J Med Internet Res 2018 | vol. 20 | iss. 9 | e10326 | p.13http://www.jmir.org/2018/9/e10326/
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Joyce et alJOURNAL OF MEDICAL INTERNET RESEARCH
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... Evidence illustrates that resilience training and interventions, primarily those focused on coping skills and self-efficacy, can work to support a decrease in psychological distress and symptoms of PTSD [13][14][15][16]. Resilience is a broad and often complex concept, which scholars have uniquely interpreted depending on the context and can encompass both the individual and the group [17]. ...
... The eQuoo app was demonstrated to significantly improve the traits of resilience, personal growth, and positive relationships [40]. Similarly, Resilience@Work/Mindarma showed improved adaptive resilience and psychological flexibility [15]. Joyce et al [15] also found that this app significantly increased optimism and mindfulness practice among study participants. ...
... Similarly, Resilience@Work/Mindarma showed improved adaptive resilience and psychological flexibility [15]. Joyce et al [15] also found that this app significantly increased optimism and mindfulness practice among study participants. This study also found that the app increased use of emotional support from others and help-seeking behavior, which addresses the social support pillar of the pillars of mental resilience. ...
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Background: Military members (MMs) and public safety personnel (PSP) are vulnerable to occupational stress injuries because of their job demands. When MMs and PSP transition out of these professions, they may continue to experience mental health challenges. The development and implementation of resilience-building mobile health (mHealth) apps as an emergent mental health intervention platform has allowed for targeted, cost-effective, and easily accessible treatment when in-person therapy may be limited or unavailable. However, current mHealth app development is not regulated, and often lacks both clear evidence-based research and the input of health care professionals. Objective: This study aims to evaluate the evidence-based quality, efficacy, and effectiveness of resilience-building mobile apps targeted toward the MMs, PSP, and veteran populations via a scoping literature review of the current evidence base regarding resilience apps for these populations and an evaluation of free resilience apps designed for use among these populations. Methods: The studies were selected using a comprehensive search of MEDLINE, CINAHL Plus, PsycINFO, SocINDEX, Academic Search Complete, Embase, and Google and were guided by PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). A narrative synthesis of the resulting papers was performed. The Alberta Rating Index for Apps was used to conduct a review of each of the identified apps. The inclusion criteria consisted of apps that were free to download in either the Google Play Store or the Apple App Store; updated within the last 3 years; available in English and in Canada; and intended for use by MMs, veterans, and PSP. Results: In total, 22 apps met the inclusion criteria for evaluation. The resilience strategies offered by most apps included psychoeducation, mindfulness, cognitive behavioral therapy, and acceptance and commitment therapy. Overall, 50% (11/22) of apps had been tested in randomized controlled trials, 7 (32%) apps had been evaluated using other research methods, and 5 (23%) apps had not been studied. Using the Alberta Rating Index for Apps, the app scores ranged from 37 to 56 out of 72, with higher rated apps demonstrating increased usability and security features. Conclusions: The mHealth apps reviewed are well-suited to providing resilience strategies for MMs, PSP, and veterans. They offer easy accessibility to evidence-based tools while working to encourage the use of emotional and professional support with safety in mind. Although not intended to function as a substitute for professional services, research has demonstrated that mHealth apps have the potential to foster a significant reduction in symptom severity for posttraumatic stress disorder, depression, anxiety, and other mental health conditions. In clinical practice, apps can be used to supplement treatment and provide clients with population-specific confidential tools to increase engagement in the treatment process.
... Two studies reported on the Resilience@Work Mindfulness Program (RAW; Joyce et al., 2018Joyce et al., , 2019. The aim of this training program (and in both studies) was to enhance psychological resilience in high-risk workers (Joyce et al., 2018(Joyce et al., , 2019. ...
... Two studies reported on the Resilience@Work Mindfulness Program (RAW; Joyce et al., 2018Joyce et al., , 2019. The aim of this training program (and in both studies) was to enhance psychological resilience in high-risk workers (Joyce et al., 2018(Joyce et al., , 2019. The training program involves "mindfulness training, psychoeducation, and a range of skills and strategies drawn from evidence-based therapies" (Joyce et al., 2018;p. ...
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The importance of resilience for employees' well-being and performance at work has grown steadily in recent years. This development has become even more pronounced through the recent COVID-19 pandemic and its consequences, including major changes in occupational settings. Although there is increasing interest in resilience in general and a growing number of publications focusing on the development of resilience in particular, many questions remain about resilience training, especially in organizational contexts. The purpose of this scoping review is to uncover what is known about resilience training in organizational contexts. A systematic search of four databases for articles published through 2021 was conducted. A total of 48 studies focusing on resilience training programs in organizational contexts were included in this review. The review provides relevant insights into resilience training programs by focusing on program characteristics, target group, study design, and outcomes. Based on the results, the main aspects that concern the development of resilience training programs for organizational settings and requirements for the study design for empirical investigation were summarized. The results of the review highlight possible directions for future research and offer useful insights for resilience-enhancing training programs in organizations.
... A study reviewing suicidal risk among emergency service workers emphasized that despite interventions to reduce suicidal risk being considered important [68], few studies on interventions to prevent suicide have been conducted. Furthermore, to conduct assessments for suicidal risk, interventions using mindfulness-based resilience training may increase the resilience of emergency service workers [70]. Previous literature has revealed that higher resilience is negatively associated with three subdomains of PTSD [16]: depression, burnout, and suicidal ideation [71]. ...
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Background Emergency service workers are often exposed to fatalities during accidents or disasters. Therefore, they may be more prone to experiencing posttraumatic stress disorder (PTSD) and depression. It has been shown that these comorbid disorders are related to personality traits and quality of life (QOL). Methods We hypothesized that mental disorders, such as symptoms of PTSD and depression, mediate the relationship between personality traits, as measured on the 10-Item Personality Inventory (TIPI), and QOL, as measured on the MOS 36-item Short-Form Health Survey (SF-36). Results Participants were aged 23–61 years. Questionnaires were sent to 373 participants, 220 of whom returned responses. A direct effect was found between two subscales of the TIPI (Extraversion and Emotional stability) and mental component summary scores of the SF-36 (Extraversion: β = 0.154, p < .001; Emotional stability: β = 0.179, p < .001), which indicated partial mediation. A significant indirect effect was revealed between two personality traits and mental health summary scores (Extraversion: β = 0.058, p < .001; Emotional stability: β = 0.087, p < .001). We also found a direct effect of extraversion scores of the TIPI on role/social component summary scores of the SF-36 (β = 0.084, p < .05). However, none of the 95% confidential intervals was significant, which indicated full mediation, and the indirect effect was significant (β = 0.023, p < .01). Sensitivity analysis indicated that a direct effect between extraversion scores of the TIPI and role/social component summary scores of the SF-36 was significant, which indicated partial mediation. Conclusions The findings of direct and indirect effects highlight the importance of identifying effective methods for protecting individuals from developing symptoms of PTSD and depression; moreover, they may help improve QOL. The capacity of dealing with incidents among emergency service workers may vary depending on their personality traits. Therefore, the screening of mental health states that includes a personality trait inventory may be valuable.
... The reviewer agreement on the selection of eligible studies was good (k = 0.74). Two studies (Joyce et al., 2019;Smyth et al., 2018) did not provide sufficient information in their publication and were excluded from the meta-analysis. (Bekki et al., 2013) to 2022 (Brog et al., 2022). ...
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Resilience is learnable and broadly described as an individual’s adaptive coping ability, its potential value for stress reduction must be explored. With a global coronavirus pandemic, innovative ways to deliver resilience training amidst heightened mental health concerns must be urgently examined. This systematic review aimed to (1) evaluate the effectiveness of digital training for building resilience and reducing anxiety, depressive and stress symptoms and (2) to identify essential features for designing future digital training. A three‐step search was conducted in eight electronic databases, trial registries and grey literatures to locate eligible studies. Randomised controlled trials examining the effects of digital training aimed at enhancing resilience were included. Data analysis was conducted using the Stata version 17. Twenty‐two randomised controlled trials involving 2,876 participants were included. Meta‐analysis revealed that digital training significantly enhanced the participants’ resilience with moderate to large effect (g = 0.54 – 1.09) at post‐intervention and follow‐up. Subgroup analyses suggested that training delivered via the Internet with a flexible program schedule was more effective than its counterparts. This review supports the use of digital training in improving resilience. Further high‐quality randomised controlled trials with large sample size are needed. This article is protected by copyright. All rights reserved.
... Meta-analysis has shown that spirituality is correlated with resilience (Schwalm et al., 2021). Previous research has also found that mindfulness (Harker et al., 2016;Joyce et al., 2018;Joyce et al., 2019;Liu et al., 2020;) and selfefficacy (Benight & Cieslak, 2011;Keye & Pidgeon, 2013;Lee et al., 2013) were associated with resilience. Hence, the empirical evidence from our study suggests that spiritual well-being, mindfulness and self-efficacy are important components to overall resilience through the proactive pathway of PBA. ...
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Two previous studies by Burnett and colleagues found preliminary support for several innate well-being and behavioral variables that contribute to one's Psychological Body Armor's TM (PBA), which is comprised of two unique interacting pathways (proactive and reactive resilience) among trained disaster mental health responders and the general population. This study sought to improve, expand, and replicate the findings of these two studies. Data was collected from 509 Amazon Mechanical Turk workers and 343 trained novice and experienced disaster mental health crisis intervention responders, who were general members of the International Critical Incident Stress Foundation or the Michigan Crisis Response Association, eight months into the COVID-19 global pandemic. Participants completed eight of the original measures used in the original studies, three revised measures, five new measures and an open-ended question about one's spiritual wellness routines. Controlling for the level of social disruption due to COVID-19, several significant correlations for both pathways were found similar to the two previous studies. Among both samples, hierarchical regression analyses revealed that mindfulness and self-efficacy were significant predictors of resilience capacity for the proactive pathway, while personal relationships with others was a significant predictor for the reactive pathway. Similar to the two previous studies, qualitative comparative analysis (QCA) revealed having professional crisis intervention training contributed more to strong resilience for both pathways. Transcendental phenomenological qualitative data analysis identified 14 spiritual wellness routines among crisis responders with prayer, reading religious literature, meditation and attending religious services being the most frequent.
... The second-most frequently used module was mindfulness. This is in line with recent efforts and success of implementing mindfulness interventions for mental health and other health workers [53,54]. Previous studies have reported significant effects of mindfulness programs in scalable, practical ways, including successful delivery of web-based mindfulness training in high-risk workplace settings and first responders in an entirely web-based version, as in our study [50]. ...
Article
BACKGROUND Since the emergence of COVID-19, health care workers and first responders have been at a high risk for mental health symptoms owing to their exposure to the virus and increased work stress during the pandemic. Although interventions exist to address mental health issues following exposure to disasters, emergencies, and humanitarian crises, considerably less is known about web-based unguided interventions to help mitigate the negative impacts of such events. Additionally, in contexts in which emergencies reduce access to in-person care, remote forms of support are critical, yet there are limited studies on the use of such interventions. Evidence-based, easy-to-use, scalable interventions are direly needed for this population. OBJECTIVE This study aimed to develop and test the feasibility of an unguided electronic mental health program, COVID-19 Anxiety and Stress Resilience Training (COAST), tailored to first responders and health care personnel, based on scientific evidence and empirically based techniques. METHODS We developed COVID-19-specific training modules focusing on several domains that are previously reported as key to resilience and stress recovery: self-efficacy, mindfulness, sleep quality, and positive thinking. The program was made available to 702 first responders between May and August 2020, during the COVID-19 pandemic. Sociodemographic, work-, and COVID-19-related information was collected, and psychometric questionnaires were completed. We examined user acceptance and user activity, including module choice and participant feedback. RESULTS In total, 52 of 702 (7%) first responders to whom we reached out used the program at least once. COAST use was independent of age, sex, or baseline levels of self-efficacy, mindful awareness, sleep quality, and positive thinking (for all, P>.39). First responders who had tested positive and those who had been quarantined were more likely to engage in the program. A click count analysis per module showed that participants used the self-efficacy and mindfulness modules most often, with 382 and 122 clicks, respectively, over 15 weeks. Overall, first responders expressed satisfaction with the program. CONCLUSIONS Engagement of first responders in the multimodule web-based COAST program was feasible and the first responder cohort expressed overall satisfaction with the program. Those in more difficult circumstances, including those in quarantine and those who tested positive, may be more likely to engage in such programs. Further controlled studies could pave the way for efficacy studies and the development of additional modules, including just-in-time interventions or blended interventions combining individual use of an unguided self-help intervention, such as COAST, with subsequent individual psychotherapy for those who continue to experience stress and psychological symptoms.
... Furthermore, leaders should also explore avenues to cultivate resilience among employees that account for cultural differences. Several evidence-based intervention programs are available that aim at fostering resilience and helping employees across cultures cope positively with stressful circumstances (e.g., Joyce, Shand, Lal, Mott, Bryant, & Harvey, 2019;Raghavan & Sandanapitchai, 2019;Robertson, Cooper, Sarkar, & Curran, 2015). Nevertheless, this resilience/well-being program may not always be feasible. ...
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Drawing on social cognitive theory (SCT), this study examined the effects of employee resilience, through well-being, on job productivity and relational satisfaction among extraverted versus introverted workers in Croatia, Thailand, and the United States during the early period of the COVID-19 pandemic. Participants included 832 working adults from various industries. Moderated mediation analyses revealed employee resilience positively predicted psychological well-being which, in turn, positively predicted both productivity and relational satisfaction. Regardless of culture, extraverted workers reported less productivity but greater satisfaction with coworkers than introverted workers. Also, resilience dampened the negative effects of introversion on relational satisfaction. The findings support the multilevel perspective of resilience and SCT assertion that behavioral outcomes are determined by an interaction between personal and environmental factors and highlight the need to promote employee resilience and well-being during times of crisis. Recommendations on how managers can support employees during this unprecedented global health crisis are provided.
Background—Public safety personnel (PSP) are at heightened risk of developing mental health challenges due to exposures to diverse stressors including potentially psychologically traumatic experiences. An increased focus on protecting PSP mental health has prompted demand for interventions designed to enhance resilience. While hundreds of available interventions are aimed to improve resilience and protect PSPs’ mental health, research evidence regarding intervention effectiveness remains sparse. Methods—Focus groups with PSP elicited a discussion of psychoeducational program content, preferred modes of program delivery, when such training should occur, and to whom it ought to be targeted. Results—The results of thematic analyses suggest that PSP participants feel that contemporary approaches to improving mental health and resilience are lacking. While welcomed, the provision of sporadic one-off mental health and resilience programs by organizations was seen as insufficient, and the available organizational mental health supports were perceived as being questionable. The available programs also left participants feeling insufficiently prepared to deal with personal mental health problems and in discussing mental health concerns with co-workers. Conclusions—Participants reported needing more engaging methods for delivering information, career-long mental health knowledge acquisition, and a systems approach to improve the workplace culture, particularly regarding mental health.
Chapter
Based on theory and research in positive organizational development and positive psychology, this chapter proposes a framework for positive capacity building. Positive capacity building is a strengths‐based approach to organizational development that social impact organizations can use to improve their effectiveness and sustainability and build the social and psychological resources of their people in order to maximize social impact. Positive capacity building is a comprehensive framework designed to be easy to follow and adapt to an organization’s specific context and capacity building needs, which can range from a focus on the entire organization to a specific aspect of the organization. Based on the appreciative inquiry and action research models for organizational development, positive capacity building consists of eight phases that build on the “4‐D” appreciative inquiry model and are tailored to focus on capacity building for social impact organizations: Develop, Desire, Discover, Dream, Design, Deliver, Determine, and Decide.
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Military personnel and frontline emergency workers may be exposed to events that have the potential to precipitate negative mental health outcomes such as depression, symptoms of post‐traumatic stress and even post‐traumatic stress disorder (PTSD). Programmes have been designed to build psychological resilience before staff are deployed into the field. This review presents a synthesis of the literature on these “pre‐deployment resilience‐building programmes”. shorturl.at/pDHUX
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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 t tests 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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Objectives To synthesise the available evidence on interventions designed to improve individual resilience. Design A systematic review and meta-analysis Methods The following electronic databases were searched: Ovid Medline, Ovid EMBASE, PsycINFO, Ovid Cochrane and WHO Clinical Trials Registry in order to identify any controlled trials or randomised controlled trials (RCTs) examining the efficacy of interventions aimed at improving psychological resilience. Pooled effects sizes were calculated using the random-effects model of meta-analysis. Outcome measures Valid and reliable measures of psychological resilience. Results Overall, 437 citations were retrieved and 111 peer-reviewed articles were examined in full. Seventeen studies met the inclusion criteria and were subject to a quality assessment, with 11 RCTs being included in the final meta-analysis. Programmes were stratified into one of three categories (1) cognitive behavioural therapy (CBT)-based interventions, (2) mindfulness-based interventions or (3) mixed Interventions, those combining CBT and Mindfulness training. A meta-analysis found a moderate positive effect of resilience interventions (0.44 (95% CI 0.23 to 0.64) with subgroup analysis suggesting CBT-based, mindfulness and mixed interventions were effective. Conclusions Resilience interventions based on a combination of CBT and mindfulness techniques appear to have a positive impact on individual resilience.
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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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The present research analyzed the elements of thalassemia which affect the patient’s perceived quality of life. Three hundred patients with Thalassemia Major (males = 165, 55%; females = 135, 45%; Mage = 36.13, standard deviation = 8.54) were the sample. Analysis of multiple mediations revealed a direct effect of self-efficacy on the Satisfaction with Life Scale that is mediated only by social support.The findings suggest a need to accentuate help and support to patients with Thalassemia Major.
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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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First responders are exposed to critical incidents and chronic stressors that contribute to a higher prevalence of negative health outcomes compared to other occupations. Psychological resilience, a learnable process of positive adaptation to stress, has been identified as a protective factor against the negative impact of burnout. Mindfulness-Based Resilience Training (MBRT) is a preventive intervention tailored for first responders to reduce negative health outcomes, such as burnout. This study is a secondary analysis of law enforcement and firefighter samples to examine the mechanistic role of psychological resilience on burnout. Results indicated that changes in resilience partially mediated the relationship between mindfulness and burnout and that increased mindfulness was related to increased resilience (b = 0.41, SE = 0.11, p < .01), which in turn was related to decreased burnout (b = −0.25, SE = 0.12, p = .03). The bootstrapped confidence interval of the indirect effect did not contain zero [95% CI; −0.27, −0.01], providing evidence for mediation. Limitations and implications are discussed.
Article
Objectives: To examine whether baseline measures of resilience among active first responders predicts future mental health symptomology following trauma exposure. Methods: Multivariate linear regression examined the associations between baseline resilience and future mental health symptomatology following repeated trauma exposure. Symptomatology at six-month follow-up was the dependent variable. Results: The associations between baseline resilience and future PTSD (p=0.02) and depression (p=0.03) symptoms were statistically significant. Those reporting higher resilience levels had lower symptomology at six-month follow-up. Eighty percent of first-responders who screened positive for low resilience went on to develop more PTSD symptoms. Conclusions: Examining resilience may serve as a more effective means of screening, given resilience is a malleable construct which can be enhanced via targeted interventions. Higher levels of resilience may protect the long-term mental health of first-responders, particularly in regard to future PTSD.
Article
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.
Article
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.