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Mindfulness requires cognitive effort and so practice places demands on a meditator’s attention. Many psychological disorders include impairment in attention as a symptom, and patients with attentional impairment may find mindfulness practice too frustrating to sustain. Medications that improve attentional focus may help mindfulness practitioners gain more from their practice.
Modafinil is a medication that improves attention in patients with daytime sleepiness due to problems sleeping. Its psychopharmacologic effects mirror some of the attentional improvements seen in mindfulness training.
Thomas et al. [Journal of Psychopharmacology] tested the effects of modafinil on self-reported state mindfulness, mind wandering, and vigilance among participants practicing mindfulness or relaxation training.
The researchers randomly assigned 80 healthy meditation-naïve participants (average age=25 years; 50% male) to one of four groups: modafinil + mindfulness, modafinil + relaxation, placebo + mindfulness, and placebo + relaxation. Participants were blinded to drug and practice type. On the first day of an eight-day intervention, participants received 200mg of modafinil or a placebo pill and trained in mindfulness or relaxation.
Participants completed assessments immediately before and two hours after medication delivery, and again immediately after initial meditation or relaxation on a variety of measures.
Over the next six days, participants engaged in daily home practice of mindfulness or relaxation techniques, and were then reassessed on the eighth day. Outcome measures included state and trait mindfulness, mood, mind-wandering, heart rate variability, and sustained attention.
Mindfulness and relaxation trainings were delivered as 10-minute audio recordings that contained brief instruction and practice. Mindfulness instructions involved focused attention on the breath.
Relaxation instructions involved abdominal breathing and intentional muscle relaxation. Both sets of instructions emphasized returning to task if one’s mind wandered.
Post-training mind-wandering was assessed by having participants practice either mindfulness or relaxation for 16 minutes, and click on a keyboard mouse whenever their minds wandered. Sustained attention was measured by response times to stimuli randomly presented on a computer screen. This task is known to be sensitive to both mindfulness training and modafinil.
Results from the single day experiment showed modafinil improved state mindfulness before (d=0.34) and after both mindfulness and relaxation training (d=0.45), and to a similar extent by group. Modafinil improved positive mood before (d=0.54) and after the trainings (d=0.60), and to a similar extent by group.
Heart rate variability (a sign of increased parasympathetic activity) increased in the mindfulness group but not the relaxation group (d=0.52). Modafinil significantly improved sustained attention in both groups (partial η2=0.07). There were no drug or group effects on subjective mind-wandering.
After eight days of home meditation or relaxation practice, all groups significantly improved on state mindfulness. Groups who received modafinil on the first day of the intervention showed significantly more weekly home practice (average = 55 mins) than those who received placebo (average = 36 mins).
The study shows that modafinil improves state mindfulness, sustained attention, and positive mood in a single-day experiment. When given at baseline, it increases practice effort over the course of about a week. Mindfulness training increases heart rate variability more than relaxation training, but there were no differences between the trainings on state mindfulness.
The absence of any difference between the groups on state mindfulness may be due to similarities between the trainings, as both involved breathing and instructions to maintain focus. The study is limited by the brevity of its trainings, and lack of emphasis on non-judgmental awareness in the mindfulness group.
Thomas, E. M., Freeman, T. P., Poplutz, P., Howden, K., Hindocha, C., Bloomfield, M., & Kamboj, S. K. (2021). Stimulating meditation: A pre-registered randomised controlled experiment combining a single dose of the cognitive enhancer, modafinil, with brief mindfulness training. Journal of Psychopharmacology.
[Link to study]
People with chronic obstructive pulmonary disease (COPD) suffer from shortness of breath that limits their physical activity. Other symptoms include wheezing, coughing, and an unpleasant awareness of breathing difficulty known as dyspnea. Standard care treatment includes medication and physical rehabilitation focused on breathing exercises.
Lin & Yeh [Clinical Rehabilitation] conducted a randomized controlled trial to test if a mindful walking program improves exercise capacity and reduces perceived difficulty in breathing among older adults with COPD compared to a standard care control.
The researchers randomly assigned 84 older adult Taiwanese clinic patients (average age=72 years; 97% male) with mild-to-severe COPD to mindful walking added to treatment-as-usual or treatment-as-usual only. Participants in the mindful walking group engaged in mindful walking 5 days a week for 8 weeks.
The 35-minute daily mindful walking program included 5 minutes of meditation with focused diaphragmatic breathing, 5 minutes of stretching, 20 minutes of walking with controlled breathing, and a 5-minute cool down with gradually decelerating walking.
Controlled breathing while walking involved 3-second inhalations using diaphragmatic breathing and 6-second exhalations through pursed lips. Participants were trained on mindful walking on the first day of the program, then did their daily walking independently at home.
Treatment-as-usual included standard care medical education focused on medication, diet, and smoking cessation as well as a monthly telephone medical consultation.
Participants were evaluated at baseline, week 4 and 8 of treatment, and at 12-week follow-up after study end on walking distance within 10 minutes, perceived difficulty in breathing, heart rate variability, and interoceptive awareness.
Perceived difficulty in breathing was measured on a 10-point scale, with low scores indicating the absence of symptoms and the highest score indicating severe shortness of breath accompanied by panic. The interoceptive awareness measure included subscales on emotional awareness, attentional regulation, body listening, and noticing.
The results showed that the mindful walking group significantly increased distance walked in 10 minutes, whereas the control group decreased distance walked. The mindful walking group increased distance walked by an average of 29 meters, a clinically meaningful increase, while the control group decreased distance walked by an average of 8 meters.
This between-group difference was significant at 4, 8, and 12 weeks. Mindful walkers reported significantly less difficulty in breathing than controls.
This study shows that a mindful walking program can increase walking distance and decrease perceived breathing difficulties in COPD patients compared to a clinical treatment-as-usual.
The study is limited by the absence of an active control group, especially one that includes walking without mindfulness training. It is unclear how much benefit was gained from the mindfulness component relative to the physical demands of daily walking.
Lin, F.-L., & Yeh, M.-L. (2021). Walking and mindfulness improve the exercise capacity of patients with chronic obstructive pulmonary disease: A randomised controlled trial. Clinical Rehabilitation.
Link to study
People often look forward to leisure vacations as relief from work and life routines, and to improve their well-being. Little is known about what types of vacations yield the most enduring benefits. For example, would a person benefit more from a leisure vacation, a meditation retreat, or a mixture of both?
It is commonly reported that the benefits of leisure-only vacations are short-lived upon return to mundane routines, and so it is possible that adding meditation to leisure vacations might support a more enduring sense of well-being.
Blasche et al. [PLOS One] conducting a naturalistic study to observe the relative psychological benefits of intensive meditation retreats, leisure vacations with meditation, and leisure vacations without meditation in a sample of people with previous meditation experience.
The researchers assessed 120 experienced meditators (average age=52 years, 59% female, average weekly meditation practice=5 hours) before and after an intensive meditation retreat, a leisure vacation with some mediation practice, or a leisure vacation without meditation. All participants were members or affiliates of a Buddhist organization who were planning a retreat or vacation.
The average length of retreats and vacations was 14-15 days. Intensive retreats included an average of 34 hours of meditation practice per week. Vacations with meditation included an average of 3 hours of meditation per week. Leisure-only vacations did not include meditation. Primary forms of meditation used were focused-attention and/or open monitoring meditation.
Participants were assessed 10 days before, 10 days after, and 10 weeks after their retreat or vacation on measures of fatigue, emotional well-being, and acting with mindful awareness. The study period was similar for all participants and spanned August to October of the same year.
The results show that all three retreats/vacations led to significant decreases in fatigue and increases in well-being and acting with awareness at immediate post assessment and 10-week follow-up. The intensive retreat and the vacation-with-meditation groups, however, had significantly higher levels of acting with awareness (d=0.50) than the leisure-only group at immediate post assessment and 10-week follow-up.
At 10-week follow-up, the intensive retreat and the vacation-with-meditation groups had significantly higher well-being (d=0.81; d=0.70) and significantly lower fatigue scores (d=0.60; d=0.62) than the leisure-only group.
This study finds that intensive retreats and vacations infused with some meditation practice enhance acting with mindful awareness better than leisure-only vacations out to 10 weeks after the vacation ends. The well-being and fatigue benefits of a vacation lacking meditation fade more quickly over time than similar benefits derived from intensive retreats or vacations that include some meditation practice.
It is surprising that the results did not show a superiority of intensive retreats over vacations that included meditation in terms of acting with awareness. These were all experienced meditators, however, and so there may be a ceiling on their ability to improve on a mindfulness measure. Findings are limited by the use of a naturalistic study design that lacked randomization to groups.
Blasche, G., deBloom, J., Chang, A., & Pichlhoefer, O. (2021). Is a meditation retreat the better vacation? Effect of retreats and vacations on fatigue, emotional well-being, and acting with awareness. PLOS ONE, 16(2), e0246038.
Brain imaging studies find that mindfulness training can change the human brain’s functional connectivity. That is, the degree to which various brain regions jointly covary in their activity. However, the causal direction of brain connectivity remains unknown due to the limitations of functional connectivity analyses that only indicate if synchrony occurs, but cannot clarify the brain regions that initiate these changes.
Effective connectivity analyses is a newer method that may be able to uncover the temporal sequence of brain functional activity
Santarnecchi et al. [Journal of Neuroscience Research] tested the effects of MBSR on brain activity compared to an inactive control group of healthy participants using fMRI functional and effective connectivity analyses of brain regions in a randomized controlled trial.
The researchers randomly assigned 46 meditation-naïve Italian adults (average age=30 years; 52% female) to either MBSR program or a wait-list control. MBSR was delivered in the standard 8-week group-based format that included 45 minutes of daily homework and a 7-hour retreat.
All participants underwent neuroimaging before and after the intervention period, both during a resting state and while engaging in mindfulness of the breath and body. Pre-treatment conditions and the post-treatment control condition were told to attend to sensations of breathing and bodily sensations, while the post-treatment MBSR condition was instructed to meditate as they had been taught in MBSR.
Imaging results showed that MBSR resulted in significant decreases in local regional homogeneity in the right anterior putamen and the right insula during the resting state compared to controls.
MBSR also resulted in a significant decrease in right cerebellum regional homogeneity during mindfulness practice compared to controls. Regional homogeneity is a measure of the degree to which adjacent fMRI voxels within a brain region show synchronous activity.
The effective connectivity analysis using the above regions as seeds revealed a number of functional changes as a result of mindfulness training:
During the resting state, the anterior cingulate cortex decreased its excitatory influence on the right anterior putamen.
During mindfulness practice, the right cerebellum decreased its inhibitory effect on the right posterior putamen and right orbitofrontal cortex; the left posterior putamen decreased its excitatory influence on the right cerebellum; and the left somatosensory cortex increased its inhibitory effect on the right cerebellum.
The role of the putamen is prominent in several of these findings. This makes sense as the anterior putamen is involved in executive functioning and attention, while the posterior putamen is involved in somatosensory processing. These processes play key roles in the attentional control and awareness of bodily sensations that are central to mindfulness.
This study uses a novel brain imaging methodology and shows that MBSR alters the influences of the anterior cingulate and orbitofrontal cortexes on the putamen, and the putamen on the cerebellum. Findings highlight the temporal patterns that play a key role in brain activity correlated with mindfulness training.
The study interpretation is limited by not including respiration and cardiac rates as covariates, as these might affect changes in the blood oxygenation levels that generate fMRI images.
Santarnecchi, E., Egiziano, E., D’Arista, S., Gardi, C., Romanella, S. M., Mencarelli, L., Rossi, S., Reda, M., & Rossi, A. (2021). Mindfulness-based stress reduction training modulates striatal and cerebellar connectivity. Journal of Neuroscience Research.
Link to article
Mild Cognitive Impairment (MCI) is a decline in cognitive performance that is more severe than that of normal aging, yet less severe than that of dementia. Patients with MCI are at risk for developing dementia, and researchers are interested in treatments that can forestall or prevent the progression to dementia onset.
Since mindfulness-based interventions are associated with improvements in attention and increases in brain gray matter cortical thickness, they may be able to help slow or prevent the progression to dementia.
Yu et al. [Journal of Psychiatric Research] compared changes in cognitive functioning and brain cortical thickness in older adults with MCI who participated in either a nine-month mindfulness-based intervention or a control group.
The researchers randomly assigned 54 Singaporean adults (average age=71; 74% female) diagnosed with MCI to either a mindfulness training or health education program. MCI diagnosis was based on subjective reports of cognitive difficulty and a battery of objective neuropsychological tests with final diagnosis made by expert panel consensus. Both interventions met in 45-minute group sessions on a weekly basis for the first 3 months, and then on a monthly basis for the final 6 months of the study.
The mindfulness program included exercises in focused sensory attention, the body scan, walking meditation, and gentle movement meditation. The health education control included didactic instruction on chronic illness, medication compliance, diet, exercise, and relaxation.
Participants were assessed at baseline, 3 months, and 9 months. Assessments included CT scans of the brain and neuropsychological measures of working memory (digit span), divided attention (a trail making task with interference), verbal memory, verbal fluency and, visuospatial processing. CT scans of the brain were evaluated for region of interest changes in gray matter cortical thickness. Regions of interest, including the anterior cingulate cortex, orbitofrontal cortex, frontal pole, and insula, were based on findings from previous mindfulness studies.
Neuropsychological test results at 9 months showed the mindfulness group improved significantly more on cognitive performance than controls (partial η2= 0.44). Subsequent post-hoc analyses showed this superiority was mostly due to improvements in working memory (partial η2= 0.18) and divided attention (partial η2= 0.13). The significance of the post-hoc analyses did not survive correction for multiple tests of significance.
CT scan results at 9 months showed that the mindfulness group showed significantly greater CT scan region of interest increases in cortical thickness (partial η2= 0.67) than controls. Subsequent post-hoc analyses showed this was primarily due to significantly greater increases in right frontal pole (partial η2= 0.21) cortical thickness, and significantly greater decreases in left anterior cingulate cortex cortical thickness (partial η2= 0.21).
The gains in right frontal cortical thickness are consonant with gains in executive cognitive function. The decrease in cingulate cortex cortical thickness was unexpected, but not necessarily a bad outcome as it could reflect reductions in negative emotional reactivity. The significance of these post-hoc analyses did not survive correction for multiple tests of significance.
Yu, J., Rawtaer, I., Feng, L., Fam, J., Kumar, A. P., Kee-Mun Cheah, I., Honer, W. G., Su, W., Lee, Y. K., Tan, E. C., Kua, E. H., & Mahendran, R. (2021). Mindfulness intervention for mild cognitive impairment led to attention-related improvements and neuroplastic changes: Results from a 9-month randomized control trial. Journal of Psychiatric Research, 135, 203–211.
A majority of Americans report sleep problems, and over 50 million Americans meet diagnostic criteria for a sleep disorder. Sleep disorders are associated with many impairments in daytime functioning such as work performance, fatigue, and sleepiness. Sleep aid medications can help in the short-term but are not recommended for long-term use.
Cognitive-behavioral therapies show promise yet can be costly and difficult to access in some regions. Since stress and worry are known to contribute to sleep difficulties, mindfulness training may also aid in resolving problems sleeping.
Huberty et al. [PLOS One] tested the effects of a brief daily use of a mindfulness meditation smartphone app compared to waitlist controls on sleep disturbance symptoms among people reporting elevated insomnia symptoms.
The researchers randomly assigned 263 participants (average age=45 years; 75% female; 57% Caucasian) reporting elevated insomnia symptoms (an Insomnia Severity Index Score >10) to an app-based mindfulness training or a waitlist control. Many of the participants reported having received prior diagnoses such as insomnia (25%), restless leg syndrome (22%), sleep apnea (16%), night terrors (12%) and narcolepsy (5%).
The mindfulness group was assigned to meditate at least 10 minutes daily using the smartphone Calm app over an 8-week period. The Calm app is a commercially available app containing guided meditations derived from Mindfulness-Based Stress Reduction (MBSR) and Vipassana meditation.
Self-report ratings of daytime fatigue, daytime sleepiness, and cognitive and somatic pre-sleep arousal were assessed at baseline, mid-treatment (4 weeks) and post-treatment (8 weeks). Participants in the mindfulness group also kept a daily sleep quality diary for the 8-week period.
The results showed that the mindfulness group spent an average of 15 minutes per day using the Calm app. At post-treatment, the mindfulness group reported significantly greater decreases in fatigue (d=0.23), daytime sleepiness (d=0.30), and cognitive (d=0.33), and somatic pre-sleep arousal (d=0.46) than controls. Mindfulness participants also reported significant improvements in sleep quality (d=0.13) over time, reporting that they fell asleep faster (d=-0.03) and slept longer (d=0.90).
This experimental study shows a mindfulness training app reduces pre-sleep arousal and daytime fatigue and sleepiness in persons reporting sleep difficulties. App users also reported improved sleep quality. These results are important because they show the promise of an easily-accessed, inexpensive, non-intensive mindfulness training people can perform on their own at home.
The study is limited by reliance only on self-report measures and a control group that received no intervention nor completed sleep diaries. It is possible that any app supporting daily wellness and motivating new behavior could lead to similar improvements in sleep.
Huberty, J. L., Green, J., Puzia, M. E., Larkey, L., Laird, B., Vranceanu, A.-M., Vlisides-Henry, R., & Irwin, M. R. (2021). Testing a mindfulness meditation mobile app for the treatment of sleep-related symptoms in adults with sleep disturbance: A randomized controlled trial. PLOS ONE, 16(1), e0244717.
The human heart beats about 100,000 times per day. The time interval between each heartbeat changes from moment to moment. Heart rate variability (HRV) is a measure of these time fluctuations between heartbeats over time. When relaxed, our hearts show greater momentary beat-to-beat variation, and so greater HRV. This is due to the predominance of parasympathetic over sympathetic nervous system activity when we are not under stress. Researchers consider increases in HRV to be an objective measure of stress reduction.
Preliminary studies show mindfulness meditation increases HRV. However, these studies often rely on one-time measurements, leaving little known about the persistence of HRV changes over time. Kirk et al. [PLOS One] studied short- and longer-term changes in HRV before, during, and after an app-based mindfulness training compared to two control groups. The study is unique in obtaining HRV measures in participants’ home environments rather than in a laboratory setting.
The researchers randomly assigned 90 Danish participants (average age = 37 years; 70% female) to a 10-day mindfulness training using the Headspace app, a 10-day app-based music listening control condition, or a no-intervention control. The Headspace guided meditation sessions were 20-minutes in length on days 1-5, and 30-minutes in length on days 6-10. Mindfulness training included focused-attention on the breath and body, awareness of mind-wandering, and developing a non-judgmental attitude.
The music listening app consisted of a playlist of 20 two- to four-minute music tracks offered in 20- and 30-minute installments. The inactive control group conducted their lives as usual during the 10-day intervention period.
All participants had their HRVs continuously monitored using a wearable device while going about their normal daily activities for 48 hours prior to and 48 hours following the intervention period. In addition, participants in the mindfulness and music groups had their HRVs monitored whenever they were using the assigned intervention app, allowing researchers to monitor HRV over the 10 intervention days. They also completed self-report measures of perceived stress and mindfulness (the Mindful Attention Awareness Scale).
Results showed significantly larger increases in mindfulness (η2p=.14) and larger decreases in perceived stress (η2p=.08) after intervention for the mindfulness group over each control groups. The mindfulness group showed significantly greater increases in average daytime (η2p=.12) and nighttime (η2p=.30) HRV after intervention than each control group.
Increases in post-intervention daytime HRV (r=.47) and nighttime HRV (r=.44) were significantly correlated with total minutes of meditation practice during intervention. Music group nighttime increases in HRV were also correlated with time spent listening to music (r=.36).
There were also acute HRV effects that occurred while meditating or listening to music. The mindfulness group showed a significant 13 millisecond average increase in HRV over baseline while meditating. The music group showed a significant 9 millisecond increase over baseline while listening to music.
The mindfulness group showed a respiration rate that significantly decreased by four breaths a minute compared to baseline while meditating, while the music group did not slow respiration while listening to music.
The study shows that an app-delivered 10-day mindfulness intervention increases HRV while meditating, and that increases in HRV persist for 48 hours after the 10-day training period. Total minutes of meditation correlated with increased HRV. The study demonstrates the feasibility of assessing HRV as an objective biomarker in naturalistic environments outside the laboratory. The analysis in the study is limited by not adjusting for respiration rate and tidal volume which can directly impact HRV.
Kirk, U., & Axelsen, J. L. (2020). Heart rate variability is enhanced during mindfulness practice: A randomized controlled trial involving a 10-day online-based mindfulness intervention. PLOS ONE, 15(12), e0243488.
Research shows that mindfulness practice can reduce pro-inflammatory biomarkers related to illness onset and disease progression. Little is known, however, about how meditation-induced changes in inflammation are connected to brain activity. Mindfulness training can reduce fear in response to threat by reducing activity in the amygdala. It can also increase or decrease response to various rewards by modifying activity in the ventral striatum. Fear reduction and reward enhancement are important aspects of how mindfulness facilitates well-being.
Dutcher et al. [Psychoneuroimmunology] studied whether meditation-induced changes in brain activity were correlated with changes in pro-inflammatory biomarkers among breast cancer survivors.
The researchers assigned 22 female breast cancer survivors who had completed primary treatment (average age = 47 years; 60% white) to a Mindfulness Awareness Practices program developed by the UCLA Mindful Awareness Research Center. Participants met in weekly 2-hour groups over 6 weeks.
Class sessions included didactic material on mindfulness, relaxation, and mind-body relationships, and experiential practice with a variety of meditation techniques to cultivate positive emotions.
Participant blood was collected by venipuncture before and after intervention to quantify levels of two pro-inflammatory biomarkers, the cytokine Interleukin-6 (IL-6) and C-reactive protein (CRP). Participants also underwent fMRI brain scans before and after intervention.
Participants engaged in two tasks while being scanned. The first task, intended to stimulate amygdala activity, was a threat reactivity task involving viewing images of threatening facial expressions interspersed with an emotionally neutral task. The second, intended to stimulate ventral striatum activity, was a reward reactivity task involving viewing positively emotionally-toned images of landscapes, sunsets, smiling faces interspersed with neutrally emotionally-toned images of common household objects.
Results showed the women reported significantly decreased depression (d=-0.57) and increased subjective well-being (d=0.57) after intervention. Right amygdala activity in response to threatening images significantly decreased after intervention (d=-0.49). Left ventral striatal activity in response to the landscapes and sunsets significantly increased after intervention (d=0.54).
There were no significant changes in IL-6 or CRP levels after intervention; however, there was a significant association between increases in left ventral striatal activity and changes in IL-6 and CRP. That is, the greater the increase in left ventral striatal activity to landscapes and sunsets, the lower the IL-6 (β=-1.64) and CRP levels (β=-3.07).
The study shows that a mindfulness training program delivered to breast cancer survivors in a group format is associated with changes in brain activity in the amygdala and ventral striatum immediately after intervention. Increased ventral striatal reactivity to positively emotionally-toned nature images inversely correlated with pro-inflammatory markers.
The study lacked a control group, had a small sample size, and included group social support, thus limiting any interpretation of causa
Dutcher, J. M., Boyle, C. C., Eisenberger, N. I., Cole, S. W., & Bower, J. E. (2021). Neural responses to threat and reward and changes in inflammation following a mindfulness intervention. Psychoneuroendocrinology, 125, 105114.
Delivering bad news to patients is one of the many challenges physicians face. The exchange can be emotionally taxing for both the physician and patient, and if communicated poorly, can lead to misunderstanding, emotional devastation, and low treatment compliance. Cultivating a mindful state before delivering bad news may potentially help physicians communicate bad news more skillfully.
Mengin et al. [Journal of Surgical Education] conducted a pilot study to test if a brief guided mindfulness meditation could improve bad news communication skills in medical residents.
The researchers randomized 53 French ear, nose, and throat (ENT) residents to a brief mindfulness meditation and a control condition. Participants in both conditions attended a 45-minute lecture on how to communicate bad news to patients. After the lecture they completed self-report measures of anxiety, fear of evaluation, and mindfulness (Mindful Attention Awareness Scale, MAAS).
The residents completed a bad news consultation training session that consisted of preparation, simulation, and post-simulation phases. The preparation phase included having residents self-rate their stress and self-confidence and then listen to either a 5-minute guided mindfulness meditation audio track or an information-only control audio track on the definition of atoms.
After listening to the audio tracks, residents again rated their stress and self-confidence. In the simulation phase, residents engaged in an 8-minute simulated consultation in which they disclosed a diagnosis of laryngeal cancer to a person acting as a patient.
A psychiatrist and ENT specialist blind to the resident’s study group rated each resident on skill performance. Ratings were made for respect, efficacy, knowledge, communication, and overall impression.
The evaluators also passed or failed each resident based on their belief that the resident was now ready to perform bad news consultations independently. In the post-simulation phase residents again rated their stress, self-confidence, and empathy. The patient actors also rated resident empathy.
The results showed that the mindfulness group performed significantly better overall in the simulated bad news consultation (Cohen’s d=0.67) compared to controls, and this effect was driven, in part, by significantly higher scores on knowledge and communication skills.
Only 4% of residents in the mindfulness group failed their simulated consultation, while 30% of the controls failed. There were no between-group differences in either self-rated empathy or empathy as perceived by the patient actor. In addition, there were no differences in perceived stress before and after the mindfulness meditation.
The study shows that a brief mindfulness meditation immediately prior to a simulated bad news consultation significantly improves resident bad news communication. Based on medical specialist evaluator reports, residents who briefly meditate communicate better, appear more knowledgeable, and are less likely to fail a communication task.
The meditation proved effective even though it did not affect residents’ perceived stress or empathy. The fact that the meditation enhanced performance in the absence of prior extensive training suggests that physicians could use mindfulness as a stand-alone technique prior to engaging in bad news delivery to patients. The study is limited by use of a simulation performance rating scale not previously validated.
Mengin, A. C., Kayser, C., Tuzin, N., Perruisseau-Carrier, J., Charpiot, A., Berna, F., Lilot, M., & Vidailhet, P. (2020). Mindfulness Improves Otolaryngology Residents’ Performance in a Simulated Bad-News Consultation: A Pilot Study. Journal of Surgical Education.
Work-related stress is a major cause of employee dissatisfaction, absenteeism, turnover, and ill-health. Hospital healthcare workers face a number of significant work-related stresses including the physical, cognitive, and emotional demands of caring for seriously ill people. Hospitals can benefit from interventions designed to reduce occupational stress, retain personnel, and prevent burnout.
Errazuriz et al. [Journal of Psychiatric Research] tested the efficacy of a mindfulness intervention on hospital healthcare worker distress when compared to a stress management course or waitlist control.
The researchers randomly assigned 105 Chilean non-physician hospital healthcare workers (average age = 40 years; 98% female) to Mindfulness Based Stress Reduction (MBSR), a stress management course, or a waitlist control. Twenty-three percent of participants met the pretest cut-off criteria for being psychologically distressed.
MBSR and stress management groups met in 2-hour weekly group sessions for 8 weeks. The MBSR intervention followed the usual MBSR protocol minus the all-day retreat. The stress management course was a pre-existing hospital program comprised of lectures, interpersonal support and experiential activities on topics such as visualizing strengths, relaxation, self-care, resilience, and seeking social support.
Participants were assessed at baseline, after intervention, and at 4-month follow-up on self-report measures of general and occupational psychological distress, job satisfaction, perceived stress, and mindfulness (Five Facet Mindfulness Questionnaire, FFMQ). Cortisol in saliva, a stress hormone, was collected three times over the course of a single day at baseline and post- intervention.
Participant attrition was high, with 73% completing at least one measure at post-intervention, and 50% completing at least one measure at follow-up.
Immediate post-intervention results showed the MBSR group had significantly less distress and reported higher job satisfaction than the stress management and waitlist groups. The MBSR group also scored significantly higher on FFMQ “describing” and “acting with awareness” facets than stress management group.
For the physiological marker, the MBSR group had a significantly smaller increase in cortisol during the first 45 minutes after morning awakening relative to the comparison groups.
There were no significant differences between stress management and waitlist controls on any measure. At 4-month follow-up, the MBSR group showed significantly less social role dysfunction and significantly higher FFMQ “observing” compared to the stress management group.
The study shows MBSR is more effective than a hospital-delivered stress management course in reducing short-term distress and increasing short-term work satisfaction in Chilean hospital healthcare workers. Most of these effects did not persist on 4-month follow-up, suggesting the need for continued practice to maintain gains. The study is limited by its small sample size and high rate of attrition.
Errazuriz, A., Schmidt, K., Undurraga, E. A., Medeiros, S., Baudrand, R., Cussen, D., Henriquez, M., Celhay, P., & Figueroa, R. A. (2020). Effects of mindfulness-based stress reduction on psychological distress in health workers: A three-arm parallel randomized controlled trial. Journal of Psychiatric Research.
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