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Effects of Low-Dose Mindfulness-Based Stress Reduction (MBSR-ld) on Working Adults

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Mindfulness-based stress reduction (MBSR) has produced behavioral, psychological, and physiological benefits, but these programs typically require a substantial time commitment from the participants. This study assessed the effects of a shortened (low-dose [ld]) work-site MBSR intervention (MBSR-ld) on indicators of stress in healthy working adults to determine if results similar to those obtained in traditional MBSR could be demonstrated. Participants were randomized into MBSR-ld and wait-list control groups. Self-reported perceived stress, sleep quality, and mindfulness were measured at the beginning and end of the 6-week intervention. Salivary cortisol was assessed weekly. Significant reductions in perceived stress (p = .0025) and increases in mindfulness (p = .0149) were obtained for only the MBSR-ld group (n = 22). Scores on the global measure of sleep improved for the MBSR-ld group (p = .0018) as well as for the control group (p = .0072; n = 20). Implications and future research are discussed.
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Effects of Low-Dose Mindfulness-Based Stress
Reduction (MBSR-ld) on Working Adults
Maryanna D. Klatt, PhD
Janet Buckworth, PhD
William B. Malarkey, MD
Mindfulness-based stress reduction (MBSR) has produced behavioral, psychological, and physiological
benefits, but these programs typically require a substantial time commitment from the participants. This study
assessed the effects of a shortened (low-dose [ld]) work-site MBSR intervention (MBSR-ld) on indicators of
stress in healthy working adults to determine if results similar to those obtained in traditional MBSR could
be demonstrated. Participants were randomized into MBSR-ld and wait-list control groups. Self-reported per-
ceived stress, sleep quality, and mindfulness were measured at the beginning and end of the 6-week interven-
tion. Salivary cortisol was assessed weekly. Significant reductions in perceived stress (p = .0025) and
increases in mindfulness (p = .0149) were obtained for only the MBSR-ld group (n = 22). Scores on the global
measure of sleep improved for the MBSR-ld group (p = .0018) as well as for the control group (p = .0072;
n = 20). Implications and future research are discussed.
Keywords: work-site stress reduction; mindfulness meditation; working adults
Stress-related illness generates large health care expenditures for both employer and
employee. Employees who experience chronic stress can have impaired job perfor-
mance and increased risk of stress-related illness such as hypertension, risk factors of
coronary heart disease, depression (Tennant, 2001), and sleep disorders (A. Williams,
Franche, Ibrahim, Mustard, & Layton, 2006). These rising health care costs are power-
ful incentives for companies to offer work-site wellness programming that includes
stress management classes. Such classes have become an increasingly popular vehicle
for delivering the tools to help people manage stress and are a cost-effective way to
reduce the risk of stress-related chronic illness (van der Klink, Blonk, Schene, & van
Dijk, 2001). Sustained stress, even at low levels, can increase the risk of disease, affect
1
Maryanna D. Klatt, College of Medicine, The Ohio State University, Columbus. Janet Buckworth, College
of Education and Human Ecology, The Ohio State University, Columbus. William B. Malarkey, College of
Medicine, The Ohio State University, Columbus.
Address correspondence to Maryanna D. Klatt, Ohio State University, School of Allied Medical Professions,
306 G Atwell Hall, Columbus, OH 43210; phone: (614) 292-0065; e-mail: klatt.8@osu.edu.
This study was supported by the General Clinical Research Center at The Ohio State University, Grant
M01-RR00034 from the National Center of Research Resources of the NIH. Statistical analyses were com-
pleted by Dr. H. N. Nagaraja, GCRC biostatistician.
Health Education & Behavior, Vol. XX (X): xx-xx (Month XXXX)
DOI: 10.1177/1090198108317627
© 2008 by SOPHE
Health Educ Behav OnlineFirst, published on May 9, 2008 as doi:10.1177/1090198108317627
Copyright 2008 by Society for Public Health Education.
immune response (Glaser, Sheridan, Malarkey, MacCallum, & Kiecolt-Glaser, 2000),
and provoke sleep disturbances (A. Williams et al., 2006).
There is good evidence that work-site programs that focus on managing stress and
anxiety and on developing coping skills can significantly reduce illness and health care
utilization (Rahe et al., 2002). One program that has been utilized in this manner is
mindfulness-based stress reduction (MBSR), developed in 1979 by Jon Kabat-Zinn at
the University of Massachusetts Medical Center’s outpatient stress reduction clinic.
This program has been used as a model for other medical centers and settings as a stress
reduction intervention (Kabat-Zinn, 2003). Mindfulness meditation teaches nonjudg-
mental awareness of sensation, emotion, cognition, and perception and provides a
method to observe the mind’s filtering of both internal and external experience.
Mindfulness encourages a state of mind in which one distances from one’s own mental
noise. It allows for a new awareness of mind that permits focused attention on releas-
ing stressful constructions and a more relaxed moment-to-moment awareness and
movement. MBSR is a participatory educational approach, exposing the power of inter-
nal resources in framing what a person experiences as stressful. Lifestyle change in
MBSR refers to a change in one’s interior disposition toward awareness. Awareness of
one’s affective response to external events is presented as the key to changing one’s
internal experience of stress. Events may be perceived positively or negatively and may
be within or beyond our control, but to become aware of our affective responses to inter-
nal and external events is the core activity of MBSR. The only goal in MBSR is to
habitually participate in meditation, without evaluating one’s meditation performance.
MBSR currently has substantial research-based evidence for its efficacy in a variety of
medical, social, educational, intercultural, and work-site settings (Kabat-Zinn, 2003) and
has been found useful for a variety of symptoms and illnesses including anxiety, binge eat-
ing disorders, depression, cancer, coronary artery disease, chronic pain, and psychiatric
disorders. Both controlled and uncontrolled studies of MBSR (Grossman, Niemann,
Schmidt, & Walach, 2004) show effect sizes of approximately .5 (p < .0001) with a homo-
geneity of distribution. Improvements have been noted in standardized mental health mea-
sures including quality of life scales, depression, anxiety, coping style, social functioning
(Reibel, Greeson, Brainard, & Rosenzweig, 2001), and other affective dimensions of dis-
ability, all of which affect workers’ ability to function in the workplace. Although physical
and biologic measures were less frequently assessed in these studies, improvements were
noted in pain control, functional quality of life, psoriatic skin disease (Grossman et al.,
2004), and in a previous MBSR work-site study (Davidson et al., 2003), immune function.
The MBSR program typically requires participants to commit to a 2.5- to 3-hour
instructor-led group session each week and 45 to 60 minutes of mindfulness practice
each day for 8 weeks. Much of the research conducted on the benefits of MBSR has uti-
lized participants who are highly motivated medical patients willing to make the time
commitment necessary to satisfy these program requirements. With these participants,
program adherence is approximately 85%, whereas in another university community
MBSR program, the adherence rate was only 70% to 75% (K. A. Williams, Kolar,
Reger, & Pearson, 2001).
MBSR programs can provide a low-cost, high-yield benefit for workers dealing with
chronic stress, but the MBSR program has to be in a sustainable, realistic form for
the population being served. There are two aspects of the typical MBSR program that
may be barriers to effective implementation in a work-site setting. First, participants
must make a considerable time commitment on a weekly and a daily basis. One study
using MBSR (Chang et al., 2004) indicated that high attrition rates were caused by
the required time commitment. Second, yoga is often utilized in MBSR, but limited
2 Health Education & Behavior (Month XXXX)
work-site space may make the inclusion of yoga difficult. Yoga, a method for manag-
ing stress that has a long history as a health care treatment in non-Western cultures, has
grown in popularity as a complementary treatment for several physical and mental dis-
eases (Raub, 2002). There is evidence that the regular practice of yoga is also effective
as a low-cost stress management technique (Baldwin, 1999), and yoga in the workplace
has been shown to be a practical strategy for relieving tension and job stress (Gura,
2002). However, inconvenience, such as the need to change clothes and to find appro-
priate space, makes it difficult to practice yoga regularly at the work site, thus dimin-
ishing its usefulness as a stress management tool in the workplace.
We have addressed these barriers through the development of an abbreviated MBSR
program, MBSR-ld (low dose), that could realistically be done at work by employees in
their professional attire, with the least amount of time spent away from the home and fam-
ily. MBSR-ld was specifically designed as a pragmatic adaptation of MBSR to the work
site by the first author, who participated in a 7-day MBSR professional training under the
direction of Jon Kabat-Zinn, PhD, and Saki Santorelli, EdD, and has been using MBSR in
her personal meditation practice and university classes since 1995. To minimize the time
commitment, the duration of weekly meetings was reduced from 2.5 to 3 hours to 1 hour,
the daily 45 to 60 minutes of meditation were reduced to 20 minutes of meditation/yoga,
and the full-day retreat within traditional MBSR was omitted. MBSR-ld participants
attended abbreviated weekly meetings during their lunch hour, with an abbreviated daily
meditation given to them via a two-CD set. The CD and premeditative workspace yoga
stretches were included to decrease the time committed and to minimize inconvenience.
In 2002 researchers produced an operational definition of mindfulness for research
investigations concerning the mediating role and mechanism of the action of mindfulness
(Bishop, 2002). The two critical components were determined to be (1) self-regulation of
attention and (2) the adoption of an orientation toward one’s experiences in the present
moment. MBSR-ld was developed to retain the construct of mindfulness, as originally
conceived and taught by Kabat-Zinn, while adapting it for working adults. MBSR-ld is
comparable to traditional MBSR programs concerning the operational definition, differ-
ing only in the amount of time both per day and week committed to the intervention.
Therefore, the purpose of this study was to determine whether the MBSR-ld program
would produce a statistically significant decrease in symptoms of stress and yield adher-
ence rates that mimicked those of traditional MBSR interventions (85%). Specifically,
we hypothesized that participants in the MBSR-ld group would demonstrate significant
reductions in perceived stress and improvements in sleep. We also hypothesized that
there would be reductions in salivary cortisol, a biological marker of stress, given the
suggested link between reductions in perceived stress and cortisol secretory activity
(Kamei et al., 2000). Mindfulness was measured using an established self-report instru-
ment (Brown & Ryan, 2003); tracking the actualization of moment-to-moment aware-
ness was predicted to increase for the intervention group and not for the control group.
METHOD
Participants
Full-time faculty and staff employed at a large midwestern university were recruited
through e-mail announcements, health fair presentations, and faculty and staff newslet-
ters advertising a stress reduction research study. For inclusion, participants had to be
between the ages of 18 and 60, have a BMI 30, exercise less than 30 minutes on most
Klatt et al. / Stress Reduction for Working Adults 3
days of the week as determined by responses to the Godin Leisure-Time Exercise
Questionnaire (Godin & Shephard, 1985), and consume no more than two alcoholic
beverages per day and no more than six beverages with caffeine per day. They also
could not be pregnant or nursing, currently engaged in regular yoga practice or a weekly
yoga class, and have a recent or chronic illness that required medication, as these poten-
tially could confound quality of sleep.
Interested faculty and staff attended one of three possible familiarization meetings.
At these meetings, the risks and benefits of participating in the study were outlined and
questions about the study were addressed. More than 60 full-time faculty and staff vol-
unteered to participate in the study without any financial incentive. Forty-eight volun-
teers met the inclusion/exclusion requirements and were enrolled in the study. A BMI
of more than 30 was the most frequent exclusion criteria, followed by chronic illnesses
requiring multiple medications. Additional volunteers were excluded because of
exceeding the minimal exercise criteria.
Procedure
Upon completion of informed consent, participants were randomized to the MBSR-
ld intervention (n = 24) or a wait-list control group (n = 24). Participants in the inter-
vention group were enrolled in the 6-week MBSR-ld program. The wait-list control
group was offered MBSR-ld following the completion of the intervention group. Both
the intervention and wait-list control participants completed the self-report question-
naires before beginning the intervention (pretest) and after completion of the interven-
tion (posttest). Salivary cortisol samples were given by all participants according to the
study protocol (see the Measures section). The only procedural difference between
groups was the collection of the questionnaires and salivary cortisol samples. Two grad-
uate research assistants collected questionnaires and cortisol from the wait-list control
participants at their campus offices, whereas the intervention participants brought their
salivary cortisol samples to the MBSR-ld meetings.
Intervention
The MBSR-ld intervention consisted of group instruction for 60 minutes, once per
week, at noon in a centrally located campus classroom. Similar to the Kabat-Zinn proto-
col, MBSR-ld incorporated breathing, relaxation, body scans, and gentle yoga movement
as facilitation toward a meditative state. The primary aim of all techniques utilized in the
intervention was to enhance the participants’ ability to pay attention to their moment-to-
moment, internal and external experience. This program was geared toward the local
stresses commonly experienced by healthy working adults. Work environment stresses
were discussed in the formal education segment of the weekly meetings, alongside presen-
tations of the physiology of stress and its symptoms, causes, and so forth. The premedita-
tion yoga stretching was important for individuals who spend the majority of their working
day seated, bringing the focus to the breath and body and enabling meditative awareness.
The design utilized physical movement to facilitate mental quieting, yet the yoga stretches
in MBSR-ld could all be done seated or standing within the physical confines of a typical
workspace. These stretches were appropriate for a work environment and did not require
the participant to remove shoes, change clothes, or use a yoga mat. The workspace yoga
postures were introduced with the intention of facilitating formal mindfulness meditation.
4 Health Education & Behavior (Month XXXX)
MBSR-ld participants were instructed to wear loose-fitting professional attire that
allowed movement. Handouts were used to illustrate concepts, and homework reflec-
tions were listed in the adherence workbook. Each meeting began with verbal instruc-
tions that served as the prompt for contemplation during the next hour. For example,
participants were asked to think back over their past week and identify what elicited a
stress response, and each week they were asked to focus on a particular dynamic such
as “When were other times in your life that you felt like you were going from one
unbalanced state to another, shifting back and forth, and never feeling ‘sure-footed’?”
There were no right or wrong responses to any prompt. Each participant considered his
or her personal response to the prompt when the prompt was later called up as the focus
of that week’s meditation. Each participant’s response to the prompt was personal and
silent, but some participants chose to share their responses to the prompt at the begin-
ning of the hour. There was no pressure, nor encouragement, to volunteer thoughts.
It was emphasized to all participants that they should bring an attitude of respect and
mutual discovery to the process and a nonjudgmental attitude to the 6-week program. It
was necessary for each individual to engage in the intervention without evaluation of
progress toward his or her stress reduction goals because mindfulness is defined as a non-
judgmental, moment-to-moment awareness. Until the study was completed, the partici-
pants were asked to reserve judgment and focus on becoming aware of momentary
experience. Only after completion of the study were they asked to evaluate if their
increased awareness of their affective responses facilitated a reduction in stress reactivity.
Participants were instructed to complete individual sessions of daily meditation for 20
minutes during the remaining work days for the 6-week intervention (i.e., 23 total indi-
vidual sessions). At the first group meeting, each MBSR-ld participant was given an
adherence workbook to track his or her daily meditations, saliva collection, and a record
of any confidential reflections or thoughts. Participants also received two CDs each with
six different 20-minute daily meditations. Each participant agreed to listen to the daily
mindfulness meditations on the CD four times per week for the duration of the interven-
tion. This meant that each participant was expected to engage in mindfulness meditation
each workday for the 6 weeks of the intervention and to record adherence to the proto-
col daily. There was a written explanation of each track provided so that each participant
could choose which track best fit his or her circumstances for the particular day.
Each 20-minute track was an abbreviated version of the weekly 60-minute experience in
mindfulness meditation and corresponded to the theme of the weekly meeting, reinforcing
techniques used in class. The audio program built on the hourly instruction and included
options for daily meditations such as guidance in movement for relaxation and focus, breath-
ing exercises, awareness training, balance in life, awareness of body through centering on
body sensations, feeling secure, clarity and release, and commitment to daily practice.
Measures
At pretest, all participants completed a demographic questionnaire that included age,
gender, height, weight, race, job classification, and marital status. Within 5 days after
the study was completed, MBSR-ld participants completed a program evaluation that
included items related to specific components of the MBSR-ld. At the pretest and
posttest, investigators administered the following self-report questionnaires:
Perceived Stress Scale. Participants rated their responses to 10 statements about their
feelings and thoughts during the past month (pretest) and 6 weeks (posttest) on a 5-point
Klatt et al. / Stress Reduction for Working Adults 5
Likert-type scale ranging from never to very often. The Perceived Stress Scale (Cohen,
Kamarck, & Mermelstein, 1983) measures the degree to which situations in life are
appraised as stressful. Items are designed to evaluate how overloaded, unpredictable, and
uncontrollable one finds one’s life. It also queries current levels of experienced stress.
Cohen et al. (1983) reported internal consistency scores of .84, .85, and .86. In our sam-
ple, Cronbach’s α was .87.
Pittsburgh Sleep Quality Index. Participants responded to 24 items of the Pittsburgh
Sleep Quality Index (Buysse, Reynolds, Monk, Berman, & Kupfer, 1989) that measure
sleep quality and disturbances during a 1-month period (pretest) and the previous
6 weeks (posttest). This is a self-rated instrument that assesses sleep quality and sleep
dysfunction. It has good diagnostic sensitivity and specificity (a score of 6 or above
yields a diagnostic sensitivity of 89.6% and a specificity of 86.5%) in distinguishing
good and poor sleep. The scale yields a total score as well as seven subscale scores:
Participant Sleep Quality, Sleep Latency, Sleep Duration, Habitual Sleep Efficiency,
Sleep Disturbances, Use of Sleep Medications, and Daytime Dysfunction.
Mindful Attention Awareness Scale (MAAS). Participants rated 15 statements from
the MAAS (Brown & Ryan, 2003) on a 6-point Likert scale to determine the frequency
of mindful states over time, specifically the presence or absence of attention to and
awareness of what is occurring in the present. The items in the scale are distributed
across cognitive, emotional, physical, interpersonal, and general domains, and higher
scores reflect more mindfulness. Brown and Ryan (2003) reported good test-retest reli-
ability over 2 weeks (r = .81) and convergent, discriminate, and criterion validity. In our
sample, Cronbach’s α was .91.
Assessment of Salivary Cortisol. Saliva samples were collected using a Salivette
(Sarstedt, Inc., Newton, NC). Salivary cortisol measurement allows frequent self-sampling,
approximates mean 24-hour cortisol secretion, and measures free biologically active corti-
sol because in its passage from serum to saliva it is removed from its binding protein. It is
highly correlated with serum cortisol levels. Baseline levels of salivary cortisol were estab-
lished from 2 consecutive days of sampling conducted 20 minutes after waking but prior
to brushing teeth (approximately 7:00 a.m.), at 1:00 p.m., and at 10:00 p.m. Salivary cor-
tisol was sampled again 20 minutes after waking but prior to brushing teeth (approximately
7:00 a.m.), at 1:00 p.m., and at 10:00 p.m. once per week on the same day of the week dur-
ing each week of the intervention, and again for 2 days at 1 week after completion of the
intervention. After collection, the procedure was to remove the suspended inner tube and
pour the saliva into 12 × 75 polypropylene storage tubes, which were frozen until assayed.
Cortisol determinations were made using the Cortisol Coat-A-Count RIA (Diagnostic
Products Corporation, Los Angeles, CA). Intra-assay variation is 4.3%, and interassay vari-
ation is 5.2%. Sensitivity is adequate for this population at .025 μg/dL.
Analysis
In anticipation that the biometric change would be the most sensitive change to
detect, power calculations were conducted to determine an adequate sample size to
detect significant changes in salivary cortisol. Twenty participants were needed in each
group (total sample size = 40) for adequate power (i.e., .80) to determine a significant
difference. A sample size of 48 participants was set to control for a potential dropout of
6 Health Education & Behavior (Month XXXX)
15% to 20%. Summary statistics for demographic variables were computed. Changes
in the response variables from their baseline values (pre/post) were examined using
paired t tests. All p values under .05 were statistically significant.
RESULTS
Forty-eight participants were randomized to the intervention and control group. Two
participants dropped out, one from the control group who was unwilling to comply with the
randomization and one from the intervention group because of a family emergency. One
MBSR-ld participant did not complete at least 80% of the intervention and was not included
in the analysis. Adherence to the study protocol was emphasized and recorded each day
during the study. The analyses were conducted on 22 participants in the intervention group
and 20 participants in the control group. Three control participants did not have complete
data and were not included in the analysis. Adherence to the MBSR-ld protocol was 85%,
with no differences in outcome measures detected based on gender, age, or job classifica-
tion. Most of the participants were classified as research assistants (31%), midlevel man-
agement (29%), or faculty (13%). Please see Table 1 for demographic information.
Mindfulness, Perceived Stress, and Quality of Sleep
There was a significant increase in MAAS scores for the intervention (p = .0149,
d = .56) but not the control group. Scores on the Perceived Stress Scale decreased signifi-
cantly for the MBSR-ld (p = .0025, d = .73) but not the control group. The global measure
of sleep from the Pittsburgh Sleep Quality Index improved significantly for both the
MBSR-ld group (p = .0018, d = .76) and the control group (p = .0072, d = .68). However,
three of the seven components of sleep quality showed significant improvement for the
intervention group. Reports on subjective sleep quality (p = .0162, d = .54), sleep latency
(p = .0355, d = .48), sleep disturbances (p = .0157, d = .56), and daytime dysfunction
(p = .0162, d = .56) were significantly better at the end of the intervention compared to the
pretest (see Table 2).
Klatt et al. / Stress Reduction for Working Adults 7
Table 1. Demographics
a
Variables MBSR-ld (n = 22) Control (n = 23)
Age (M ± SE) 43.41 ± 2.17 46.50 ± 1.89
BMI (kg · m
2
) 22.91 ± 0.49 23.58 ± 0.64
Gender (% female) 77 73
Ethnicity (%)
Caucasian 72 86
African American 9 0
Latino 5 0
Asian 0 9
Other 14 5
Marital status (%)
Single 14 14
Married/partnered 73 77
Divorced 13 9
a. There were no significant differences between groups.
8
Table 2. Mindfulness, Perceived Stress, and Sleep Scores (M ± SE)
MBSR-ld (n = 22) Control (n = 20)
Measure Pre Post Diff p value
a
Pre Post Diff p value
a
MAAS 55.14 + 2.90 60.50 + 2.65 –5.36 + 2.02 .0149 63.15 + 3.08 63.70 + 2.57 –0.55 + 1.57 .7294
Perceived Stress Scale 28.09 + 1.19 25.00 + 0.96 3.09 + 0.90 .0025 26.20 + 1.30 25.55 + 1.46 0.65 + 0.86 .4586
PSQI component scores
Global PSQI 6.73 + 0.69 5.00 + 0.46 1.73 + 0.48 .0018 6.68 + 0.67 5.50 + 0.68 1.18 + 0.39 .0072
Subjective Sleep Quality 1.23 + 0.13 0.91 + 0.15 0.41 + 0.16 .0162 1.22 + 0.14 0.89 + 0.15 0.35 + 0.18 .0692
Sleep Latency 1.09 + 0.20 0.68 + 0.19 0.41 + 0.18 .0355 0.75 + 0.20 0.65 + 0.18 0.10 + 0.14 .4936
Sleep Duration 0.91 + 0.11 0.82 + 0.13 0.09 + 0.09 .3287 1.00 + 0.18 1.00 + 0.19 0.00 + 0.10 1.000
Habitual Sleep Efficiency 0.14 + 0.07 0.18 + 0.11 –0.05 + 0.08 .5758 0.35 + 0.15 0.25 + 0.12 0.10 + 0.07 .1625
Sleep Disturbances 1.41 + 0.11 1.09 + 0.11 0.32 + 0.12 .0157 1.65 + 0.13 1.35
+ 0.11 0.30 + 0.15 .0553
Use of Sleeping Medications 0.50 + 0.17 0.27 + 0.10 0.23 + 0.17 .2037 0.50 + 0.22 0.55 + 0.25 –0.05 + 0.18 .7894
Daytime Dysfunction 1.45 + 0.17 1.05 + 0.15 0.41 + 0.16 .0162 1.20 + 0.19 0.85 + 0.15 0.35 + 0.18 .0692
NOTE: MAAS = Mindful Attention Awareness Scale; PSQI = Pittsburgh Sleep Quality Index.
a. Based on paired t tests for the null hypothesis that there is no difference.
Cortisol Levels
Despite randomization, baseline salivary cortisol was higher in the control compared
to the MBSR-ld group. Regardless, there were no changes in average daily salivary cor-
tisol levels over time for participants in both groups and no differences from the pretest
to the posttest.
MBSR-ld Program Evaluation
Participants in the MBSR-ld (n = 18) also rated components of the program based
on individual usefulness using a 10-point Likert-type scale, with 10 indicating most use-
ful (see Table 3). The two most highly rated components of the program were related to
the time commitment of the intervention: the 1-hour weekly meetings and the 20-minute
daily meditations.
DISCUSSION
The purpose of this study was to assess the feasibility and effectiveness of MBSR-ld
as a stress reduction intervention in a group of healthy working adults when offered at
the work site. A comprehensive review and meta-analysis of studies conducted on
MBSR and health benefits (Grossman et al., 2004) showed that MBSR may help a
broad range of individuals cope with clinical and nonclinical problems, from individuals
struggling with chronic illness to healthy individuals dealing with the stresses of daily
life. Our intent was to adapt MBSR to a “dose” that was feasible but produced similar
adherence rates and outcome measures as traditional MBSR interventions. Both objec-
tives were obtained in this study. Effect sizes equal to and greater than traditional MBSR
studies were obtained. The connections between stress and various health outcomes are
being investigated as the cost of health care continues to rise. A low-cost, on-site stress
reduction program that shifts an individual’s perspective on stress by increasing a mind-
ful approach to life could be beneficial for both employee and employer. Work-site loca-
tion and yoga adapted for the work site were components of this intervention that were
considered essential for the positive outcomes and good adherence.
Klatt et al. / Stress Reduction for Working Adults 9
Table 3. MBSR-ld Participant Ratings of Program Components (n = 18)
Program Component MSD
Weekly session 9.1 0.93
Body scan 8.6 1.55
Yoga stretches 8.7 1.34
Breathing awareness 9.0 1.14
Meditation 8.7 1.44
Handouts 7.2 1.60
Teacher personality 8.8 1.23
20-minute CD 9.3 0.83
Reflection questions 5.5 2.06
NOTE: Likert-type scale: 1 = useless; 10 = extremely useful.
Work-Site Location
MBSR-ld was structured so that employees would be drawn to participate in the
program, as the lunch-time weekly meeting did not infringe on work or family time. MBSR-
ld also accommodated the time and space confines of most working adults. High ratings
were given to the value and location of the weekly meetings, as employees participated in a
program at work that addressed awareness of perceived stress without distinction between
work and home stresses. The focus was on becoming aware of moment-to-moment, inter-
nal and external experiences, especially those that produced stress reactivity.
The MBSR-ld component that received the highest rating by participants was the 20-
minute mindfulness meditation provided to them via the two-CD set, as participants
were able to practice the MBSR-ld meditation at work, during a 20-minute break.
Yogic Movement Appropriate for the Work Site
The yoga movement designed with workspace limitation in mind allowed movement
for individuals within their workspaces, introducing participants to possible movements
within those parameters. Most participants were not aware of the possible range of yoga
movement suggested in MBSR-ld.
The MBSR-ld intervention (both the weekly group meeting and the daily meditations)
included substantial yoga stretches and breathing exercises to facilitate mindfulness in a
population that spends the majority of their working hours seated at a desk. Yoga has
gained acceptance and popularity in American culture as a stress reduction technique and
a complementary and alternative medical (CAM) approach to wellness, such that it is 1
of the 10 most common CAM therapies used today (Barnes, Powell-Griner, McFann, &
Nahin, 2004). Yoga movement is no longer considered “fringe” activity but is commonly
identified in popular culture as a stress reduction technique. Thus, yogic movement was
emphasized, not de-emphasized, in the MBSR-ld protocol. There is also research evi-
dence that a physiological change occurs with the practice of yoga that enhances the abil-
ity to deal with stress (Schell, Allolio, & Schonecke, 1994). However, yoga classes can be
inconvenient and time consuming, which can make attendance difficult, thereby dimin-
ishing their usefulness as a stress management method. MBSR-ld offered a procedure for
practicing yoga at the work site that removed such barriers to regular yoga practice.
MBSR-ld Outcome Measures
Perceived Stress. Significant reductions in perceived stress obtained by the MBSR-
ld group were of the same magnitude as traditional MBSR interventions (Grossman
et al., 2004). This illustrates the pragmatic value of a lower dosed program for popula-
tions with time and space limitations.
Quality of Sleep. The National Institutes of Health (NIH) State-of-the-Science
Conference Statement on Manifestations and Management of Chronic Insomnia in
Adults in 2005 emphasized that insomnia seems to be associated with high health care
utilization, with the direct and indirect costs of chronic insomnia costing billions annu-
ally. MBSR-ld significantly improved participants’ subsets of subjective sleep quality—
sleep disturbances, sleep latency, and daytime dysfunction—as compared to controls.
Clearly, a restful night’s sleep is an important aspect of daytime functionality. The
improvements in restorative sleep may be the most important results achieved in this
10 Health Education & Behavior (Month XXXX)
study. When insomniac patients are asked about their sleep patterns, they consider day-
time improvements in fatigue, irritability, and performance to be the benchmarks of treat-
ment response (Carey, Moul, Pilkonis, Germain, & Buysse, 2005). The other two subsets
that significantly changed were reductions in both sleep latency and sleep disturbances.
Mindfulness. Much of the MBSR literature uses outcome measures of psychological
health such as the Profile of Mood States, but few studies have utilized the Brown and
Ryan scale as a quantitative measure of actually changing one’s ability to attend to the
present moment. This study examined whether an MBSR intervention actually affected
an individual’s ability to acquire “present-centered attention awareness.” The answer was
affirmative and was correlated with reductions in perceived stress and improvements in
quality of sleep. Thus, the Brown and Ryan scale may be an appropriate measure of
actual changes in mindfulness as operationally defined (Bishop, 2002).
Salivary Cortisol. Because MBSR-ld focused heavily on yoga stretches to facilitate the
meditation practice in both the weekly and daily practice, and hatha yoga practice had been
associated with a decrease in salivary cortisol for college students (West, Otte, Geher,
Johnson, & Mohr, 2004), a hypothesis of this research was that there would be a decrease
in daily salivary cortisol averages for the intervention group during the 6 weeks of the inter-
vention. Although there had been preexisting conflicting data elsewhere concerning the
effects of yoga on cortisol levels (Kamei et al., 2000; Schell et al., 1994), the hope was to
establish a correlation between decreases in self-reported stress and physiological decreases
in salivary cortisol from pre- to posttest. Posttest cortisol levels were not significantly
reduced for the MBSR-ld participants whereas the perceived stress scores were significantly
reduced. There was no significant correlation between self-reported baseline stress and sali-
vary cortisol. This finding was consistent with a recent study exploring the correlation
between psychological measures and biological measures in breast cancer patients in which
no correlation was found (Carlson, Campbell, Garland, & Grossman, 2007).
This may highlight the complex nature of using salivary cortisol as a solitary marker
of physiological manifestation of stress. Salivary cortisol levels can be affected by diet
and physical activity, which were not controlled in this study. Directions were given to
the participants concerning dietary intake, the necessity of refraining from brushing
teeth, and so forth within 20 minutes of obtaining the salivary cortisol sample, but in a
community study, this was difficult to control, and several intervention participants
would walk from their offices to the weekly meeting. Salivary cortisol is an accessible
biomarker of stress but may be confounded by too many other variables to be used as a
sole physiological measure of stress to supply meaningful research data.
Limitations and Future Directions
In this study, self-reported measures of perceived stress were measured only pre- and
postintervention while salivary cortisol levels were assessed weekly. It would have
strengthened the study to have participants fill out the perceived stress test weekly to
establish a correlation between perceived stress and salivary cortisol levels. Various
other physiological variables, such as resting blood pressure, could also have been mea-
sured weekly to establish correlations between perceived stress and physiological mea-
sures of stress. The question of the correlation between self-report instruments and
physiological evidence was not clearly established. Future research using MBSR and
yoga needs to examine the correlation between self-report measures and physiological
Klatt et al. / Stress Reduction for Working Adults 11
markers of stress. Participants clearly report improvements in sleep quality and percep-
tions of stress, but further research is needed to identify the physiological evidence that
stress is indeed reduced due to the intervention. Also, there was no follow-up assess-
ment included, so it is uncertain if positive results were sustained over time.
Conducting a relatively small study on the campus of a large university may have
affected the generalizability of the results, as participants were faculty and staff volun-
teers, met a substantial list of exclusion criteria, and thus were a select group of moti-
vated participants.
One feature of the MBSR-ld intervention that we did not measure was the impact of
a shared sense of lifestyle change with colleagues at work. None of the research partic-
ipants had offices in the building where the intervention was conducted. An MBSR-ld
work-site intervention in which employees could attend the weekly meeting within the
building in which they work, with coworkers, might affect the results obtained. Most par-
ticipants in this study did not know each other or work together. A recent study (Oginska-
Bulik, 2005) has confirmed the critical role of personal and social resources and
perceived social support in reducing job stress and preventing negative health outcomes
for workers of uniformed professions. Additionally, positive psychosocial work features,
such as social support, have been associated with fewer sleep disruptions (A. Williams
et al., 2006). A social support measure in a study where participants work together on a
daily basis could add valuable information in future studies utilizing MBSR-ld.
IMPLICATIONS FOR PRACTITIONERS
MBSR-ld abbreviated the weekly and daily time commitment of traditional MBSR and
still obtained significant decreases in perceived stress and improvements in quality of sleep
while increasing daily mindfulness for healthy working adults. From an applied perspec-
tive, this study indicates that MBSR-ld is an effective adaptation of the MBSR approach
for healthy working individuals limited by time. Adapting a well-researched stress reduc-
tion intervention (MBSR) for the workplace may be a starting place for further research
using MBSR-ld as a low-cost stress reduction intervention with a relatively high rate of
adherence. Even though there is an abundance of information on the impact of stress on
one’s well-being, MBSR-ld is a tool that participants can experience firsthand and use to
explore the personal impact of a stress reduction program on their stress levels.
Offering the intervention on site, with often-cited limitations eliminated, may indi-
cate that MBSR-ld is a viable, innovative approach for employers looking to reduce
stress-related health care costs. Although MBSR-ld was developed to address the real-
time limitations experienced by working adults, future research could investigate if
MBSR-ld affects health expenditures associated with stress-induced illness. MBSR-ld
may be an appropriate low-cost clinical intervention capable of achieving desired stress
reduction for healthy working adults.
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14 Health Education & Behavior (Month XXXX)
... Perhaps the most common focus of these research on mindfulness and well-being has been stress reduction. Much of mindfulness research is geared toward stress reduction in a variety of populations, including reducing stress and improving quality of life and selfcompassion in healthcare professionals (Shapiro et al., 2005); reducing stress and burnout in educators (Gold et al., 2010); reducing anxiety and depression and increasing empathy in medical and premedical students (Shapiro, Schwartz, & Bonner, 1998); decreasing psychological distress and increasing well-being in rheumatoid arthritis patients (Pradhan et al., 2007); and reducing stress and improving sleep outcomes in working adults (Klatt, Buckworth, & Malarkey, 2009). This list is not exhaustive, but it provides a brief overview of the variety of populations in which mindfulness interventions have decreased stress and improved overall quality of life. ...
Chapter
Mindfulness has been a growing topic of interest in the field of psychology for several decades and has yielded successful interdisciplinary research and interventions to improve mental and physical health. In this article, we briefly review the history of mindfulness in both Buddhist traditions and modern medicine and psychology. We then outline the methods by which mindfulness is induced and measured and review the role of mindfulness in mental and physical health. We close with recommendations for future studies on mindfulness in psychology.
... Dans leur étude, ils concluent sur plusieurs points : il y a un intérêt croissant pour l'application des protocoles de médiation de pleine conscience en entreprise, la majorité des protocoles des études ont un groupe témoin et le programme MBSR de Kabat-Zinn est celui qui reste le plus utilisé mais avec une variabilité importante dans son contenu et dans sa durée. Enfin, des associations ont pu être établies entre les programmes MBI et l'amélioration de la santé psychologique et du bien-être des employés en milieu de travail(Klatt & al., 2009;Pipe & al., 2009;Stanley & al., 2011;Wolever & al., 2012). ...
Thesis
Full-text available
Au cours des vingt dernières années, le concept de mindfulness a été largement investigué dans les recherches scientifiques. De multiples définitions de la mindfulness émanent des études publiées. L’une d’entre elles a particulièrement retenue notre attention, il s’agit de celle de Brown & Ryan (2003). Ces auteurs définissent la mindfulness comme une disposition à être attentif et conscient de ce qui se déroule dans le moment présent. Pour ces auteurs, la mindfulness est une capacité innée ou une ressource psychologique qu’il est possible de développer (Brown & Ryan, 2003; Brown, & Ryan, 2004; Weinstein & al., 2009). Même si quelques études ont établi un lien entre mindfulness et différentes variables liées au travail comme la performance, l’équilibre de vie professionnelle et personnelle ou encore le burnout, trop peu d’études sont menées pour étudier ces effets dans le milieu professionnel (Hülsheger & al., 2013). Cette thèse a pour ambition de répondre à ce constat en étudiant la mindfulness en lien avec la santé au travail. Nous avons souhaité mettre en évidence le rôle de la mindfulness comme une ressource psychologique potentielle pour les individus au travail pouvant leur permettre d’accroître leur bien-être professionnel et les protéger du burnout. Pour cela, nous avons mis en oeuvre quatre études (par questionnaire) permettant de répondre à cet objectif. En conclusion de ces études, les résultats permettent d’enrichir les connaissances, la compréhension du concept et de proposer des pistes d’actions pour élargir son utilisation.
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Despite the prevalence of sleep complaints among psychiatric patients, few questionnaires have been specifically designed to measure sleep quality in clinical populations. The Pittsburgh Sleep Quality Index (PSQI) is a self-rated questionnaire which assesses sleep quality and disturbances over a 1-month time interval. Nineteen individual items generate seven "component" scores: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. The sum of scores for these seven components yields one global score. Clinical and clinimetric properties of the PSQI were assessed over an 18-month period with "good" sleepers (healthy subjects, n = 52) and "poor" sleepers (depressed patients, n = 54; sleep-disorder patients, n = 62). Acceptable measures of internal homogeneity, consistency (test-retest reliability), and validity were obtained. A global PSQI score greater than 5 yielded a diagnostic sensitivity of 89.6% and specificity of 86.5% (kappa = 0.75, p less than 0.001) in distinguishing good and poor sleepers. The clinimetric and clinical properties of the PSQI suggest its utility both in psychiatric clinical practice and research activities.
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This paper presents evidence from three samples, two of college students and one of participants in a community smoking-cessation program, for the reliability and validity of a 14-item instrument, the Perceived Stress Scale (PSS), designed to measure the degree to which situations in one's life are appraised as stressful. The PSS showed adequate reliability and, as predicted, was correlated with life-event scores, depressive and physical symptomatology, utilization of health services, social anxiety, and smoking-reduction maintenance. In all comparisons, the PSS was a better predictor of the outcome in question than were life-event scores. When compared to a depressive symptomatology scale, the PSS was found to measure a different and independently predictive construct. Additional data indicate adequate reliability and validity of a four-item version of the PSS for telephone interviews. The PSS is suggested for examining the role of nonspecific appraised stress in the etiology of disease and behavioral disorders and as an outcome measure of experienced levels of stress.