How Effective are Mindfulness‐Based Interventions for Reducing Stress Among Healthcare Professionals? A Systematic Review and Meta‐Analysis
Abstract
Workplace stress is high among healthcare professionals (HCPs) and is associated with reduced psychological health, quality of care and patient satisfaction. This systematic review and meta‐analysis reviews evidence on the effectiveness of mindfulness‐based interventions (MBIs) for reducing stress in HCPs. A systematic literature search was conducted. Papers were screened for suitability using inclusion criteria and nine papers were subjected to review and quality assessment. Seven papers, for which full statistical findings could be obtained, were also subjected to meta‐analysis. Results of the meta‐analysis suggest that MBIs have the potential to significantly improve stress among HCPs; however, there was evidence of a file drawer problem. The quality of the studies was high in relation to the clarity of aims, data collection and analysis, but weaker in terms of sample size and the use of theoretical frameworks. MBIs have the potential to reduce stress among HCPs; however, more high‐quality research is needed before this finding can be confirmed. Future studies would benefit from long‐term follow‐up measures to determine any continuing effects of mindfulness training on stress outcomes. Copyright © 2016 John Wiley & Sons, Ltd.
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TL;DR
This systematic review and meta-analysis found that mindfulness-based interventions (MBIs) have the potential to significantly reduce stress among healthcare professionals, with a medium combined effect size. However, the authors caution that evidence of a file drawer problem and methodological weaknesses mean more high-quality research is needed before the finding can be confirmed.
Key findings
- Across 9 reviewed studies, 8 reported significant positive effects of MBIs on stress among healthcare professionals; 1 did not (Horner et al., 2014).
- Meta-analysis of 7 studies with 188 participants found a combined effect size of r = 0.342 (CI = 0.202–0.468), a medium effect, with combined probability p < .00002; studies were homogeneous (heterogeneity p > 0.05).
- Evidence of a file drawer problem was present: 44 non-significant studies would be needed to render the findings non-significant, while 45 additional non-significant studies are likely to exist.
- Quality assessment showed studies scored highest on clarity of aims, data collection, and method of data collection, but weaker on sample size and use of theoretical frameworks; inter-rater reliability was Krippendorff’s Alpha = 0.8221 (95% CI 0.7436–0.8914).
Methods
- Systematic review and meta-analysis of intervention studies using mindfulness as a key component to reduce stress among practicing healthcare professionals; searches covered MEDLINE, PsycINFO, CINAHL, and BNI, with initial searches in December 2013 and top-up searches in February, June, and August 2015.
- Inclusion required an MBI evaluation, practicing healthcare professionals, and a pre- and post-intervention stress outcome measure; 9 papers were included in the review, and 7 with obtainable statistical data were meta-analyzed.
- Methodological quality was assessed with the QATSDD; effect sizes were converted to r, transformed to Fisher’s Z, and used to calculate weighted mean effect, confidence interval, combined probability, heterogeneity, and publication bias checks.
Limitations
- The paper states that the review focused only on stress as an outcome, so burnout could not be meta-analyzed because it was not consistently reported; meta-analysis was also limited to immediate follow-up data, so long-term impact cannot be concluded.
- The paper states that more high-quality research is needed, including longitudinal studies, cost-effectiveness assessment, and investigation of lower-dose MBIs and intervention fidelity.
- Evident from the text: many included studies had small, self-selected samples, several had no control group, attrition was high in some studies (30%, 40%, 35%, and 44%), and lack of detail on intervention design, content, and delivery limits conclusions about active ingredients.
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Claims the paper makes
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- Findingnone given§ Conclusion · p. 16
High dropout rates were reported in the reviewed studies.
“high dropout rates reported”
Quote in the paperSubstantial claim - Findingown data§ Discussion · p. 14
All four studies that measured state mindfulness reported increases in mindfulness.
“while all reported increases in mindfulness”
Quote in the paperSubstantial claim - Findingcitation§ Discussion · p. 13
Shapiro et al. (2005) reported a 44% attrition rate only in the intervention group when compared to a wait-list control.
“This is supported by the pattern of attrition rates in one randomised controlled trial included in this review; for example, Shapiro et al. (2005), reported a 44% attrition rate only in the intervention group when compared to a wait-list control.”
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- Findingown data§ Synthesis of the results: meta-analysis · p. 11
The combined effect size of mindfulness-based interventions on stress among healthcare professionals was r=0.342 (CI = 0.202-0.468), a medium effect size.
“The combined effect size was r=0.342 (CI = 0.202-0.468), which is a medium effect size according to Coh en's (1988) guidelines.”
- Also stated in: § Discussion · p. 12 · plain
“The reviewed MBIs were found to have a moderate effect on HCP stress levels.”
Quote in the paperSubstantial claim - Also stated in: § Discussion · p. 12 · plain
- Findingcitation§ Synthesis of the results: meta-analysis · p. 12
There was evidence of a potential file drawer problem.
“However, there was evidence of a potential file drawer problem (Rosenthal, 1991).”
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- Findingreasoning§ Discussion · p. 14
Studies that did not measure state mindfulness failed to assess participant responsiveness and exposure to the key intervention component.
“those studies which did not include such measures failed to assess participant responsiveness and exposure to the key intervention component.”
Quote in the paperSubstantial claim - Findingcitation§ Key findings · p. 9
Of the four studies that measured state mindfulness, three reported significant improvements post intervention.
“Of the four studies that measured state mindfulness three reported a significant improvements post intervention (Brady et al, 2012; Manotas et al., 2014; Schenstrom et al., 2009)”
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- cites Manotas et al., 2014
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- cites Schenstrom et al., 2009
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- Findingown data§ Discussion · p. 12
The review identified an additional five studies not included in Khoury et al.'s earlier meta-analysis.
“Furthermore our review identified an additional five studies (Brady et al., 2012; Fortney et al., 2013; Horner et al., 2014; Manotas et al., 2014; Schenstrom et al., 2006) not included in this earlier meta-analysis.”
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- cites Fortney et al., 2013
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- cites Horner et al., 2014
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- Findingown data§ Study quality · p. 10
Studies were rated poorly on the use of an explicit theoretical framework, with only two studies clearly referring to a theoretical or conceptual framework.
“Generally studies were rated poorly on the use of a n ' explicit theoretical framework ' , with only two studies clearly referring to a theoretical (theory of humanistic nursing; Brady et al., 2012) or conceptual framework (Foureur et al., 2013).”
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- cites Foureur et al., 2013
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- Findingown data§ Study quality · p. 10
All papers reviewed scored within the range of 20-25 on the QATSDD.
“All papers reviewed scored within the range of 20-25.”
Quote in the paperNot a substantial claim - Findingown data§ Discussion · p. 14
Only four studies measured state mindfulness.
“Only four studies (Brady et al, 2012; Horner et al., 2014; Manotas et al., 2014; Schenstrom et al., 2009) measured state mindfulness”
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- cites Horner et al., 2014
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- cites Manotas et al., 2014
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- Premisecitation§ Introduction · p. 3
Workplace stress is high amongst healthcare professionals.
“a recent UK survey by the Hospital Consultants and Specialist Association reported that, of the 817 doctors and specialists who responded, 81% may retire early because work-related stress and its effects on sleep, relationships and physical health (Hospital Consultants and Specialists Association, 2015).”
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- cites Dall'Ora, Griffiths, Ball, Simon, & Aiken, 2015
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- Premisecitation§ Conclusion · p. 16
Improvements in reducing stress among healthcare professionals can increase patient satisfaction and quality of care.
“improvements in this area can increase patient satisfaction and quality of care (Krasner et al., 2009)”
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- Interpretationown data§ Discussion · p. 12
Quality assessment highlighted several methodological limitations which draw the fidelity of the reported interventions into question.
“Quality assessment conducted as part of this review highlighted several methodological limitations which draw the fidelity of the reported interventions into question.”
Quote in the paperSubstantial claim - Interpretationreasoning§ Discussion · p. 14
It is difficult to conclude whether changes in stress resulted from increased levels of mindfulness or some other aspect of the intervention.
“It is therefore difficult to conclude whether changes in stress resulted from increased levels of mindfulness or some other aspect of the intervention.”
Quote in the paperSubstantial claim - Interpretationown data§ Discussion · p. 12
There is a file drawer problem suggesting that there may be unpublished studies that contradict the findings.
“However, there is a file drawer problem suggesting that there may be unpublished studies that contradict these findings and therefore further publication of studies evaluating MBIs with HCPs are needed.”
Quote in the paperNot a substantial claim - Interpretationreasoning§ Limitations of this review · p. 15
Conclusions regarding the long term impact of mindfulness-based intervention interventions on stress cannot be drawn.
“Therefore, conclusions regarding the long term impact of MBI interventions on stress cannot be drawn.”
Quote in the paperSubstantial claim - Study design and conductreasoning§ Limitations of this review · p. 15
It was only possible to perform meta-analysis on data collected at immediate follow up, due to inconsistency in follow up data collection across the studies.
“In addition, it was only possible to perform meta-analysis on data collected at immediate follow up, due to inconsistency in follow up data collection across the studies.”
Quote in the paperSubstantial claim - Study design and conductown data§ Study quality · p. 10
Inter-rater reliability for the quality assessment indicated almost perfect agreement (Krippendoff's Alpha = 0.8221, 95% CI 0.7436-0.8914).
“Inter-rater reliability for the quality assessment was calculated and indicated almost perfect agreement (Krippendoff's Alpha = 0. 8221, 95% CI; 0.7436-0.8914) according to Landis and Koch's guidelines (1977).”
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- Interpretationown data§ Discussion · p. 13
A number of studies reported attrition indicating potential issues relating to adherence to intervention protocols, consistency of exposure to intervention content, and participant responsiveness.
“A number of the studies reviewed reported attrition among participants indicating potential issues relating to adherence to intervention protocols, consistency of exposure to intervention content (i.e. whether the same facilitator delivered each intervention), and participant responsiveness (i.e. whether some participants continued to engage throughout the full intervention).”
Quote in the paperNot a substantial claim - Interpretationown data§ Conclusion · p. 16
All forms of mindfulness-based intervention (MBI), not just mindfulness-based stress reduction (MBSR), can be beneficial for reducing stress among healthcare professionals.
“our review has illustrated that all forms of MBI, not just MBSR, can be beneficial for reducing HCP stress.”
Quote in the paperSubstantial claim - Interpretationown data§ Conclusion · p. 16
Mindfulness-based interventions (MBIs) have the potential to be an effective means of reducing stress among healthcare professionals (HCPs).
“This review and meta-analysis indicates that MBIs have the potential to be an effective means of reducing stress among HCPs.”
Quote in the paperSubstantial claim - Premisereasoning§ Introduction · p. 4
It is currently unclear how effective any mindfulness-based intervention might be in reducing stress amongst healthcare professionals.
“It is currently unclear how effective any MBI might be in reducing stress amongst HCPs.”
Quote in the paperSubstantial claim - Premisecitation§ Conclusion · p. 16
Improvements in reducing stress among healthcare professionals can reduce health service costs.
“reduce health service costs (National Health Service Employers Organisation, 2014)”
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- Premisecitation§ Introduction · p. 4
Khoury et al. (2015) restricted their review to studies of MBSR interventions.
“Khoury et al. (2015) restricted their review to studies of MBSR interventions; this is a helpful focus as MBSR remains the most popular mindfulness intervention programme for psychological health in general populations.”
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- Interpretationreasoning§ Discussion · p. 12
Inclusion of non-MBSR interventions indicates that, regardless of variations in intervention delivery including length, dosage and technique, mindfulness informed interventions have a medium effect on stress outcomes for healthcare professionals.
“In addition to standard MBSR interventions, the inclusion of non-MBSR interventions in review indicates that, regardless of variations in intervention delivery; including length, dosage and technique, mindfulness informed interventions have a medium effect on stress outcomes for this population.”
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Findingown data§ Synthesis of the results: meta-analysis · p. 11The meta-analysis included a total of 188 participants.
“The remaining seven studies were included in the meta-analysis with a total of 188 participants.”
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Findingown data§ Participants and Settings · p. 8Seven studies provided attrition data.
“Seven studies provided attrition data.”
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Findingcitation§ Participants and Settings · p. 8Attrition rates in four studies were 30%, 40%, 35%, and 44% respectively.
“Attrition in the Brady et al. (2012) study was 30% (baseline n=16), in the Horner et al. (2014) study was 40% (17 of the 43 participants did not attend 5 or more of the 30 minute classes), in the Manotas et al. (2014) study was 35% (23 of 66 participants did not complete the intervention), and in the Shapiro et al. (2005) study was 44% (baseline n=38).”
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- cites Horner et al. (2014)
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- cites Manotas et al. (2014)
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Findingown data§ Study quality · p. 10Highest quality scores were for clarity of aims, description of data collection, and method of data collection.
“Highest scores were for: clarity of aims, description of data collection, and method of data collection.”
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Findingreasoning§ Search Strategy · p. 6Nine papers were included in the review.
“Following all searches, 9 papers were included in the review.”
Quote in the paperSubstantial claimMay combine two claims.
Findingcitation§ Key findings · p. 9Eight studies reported significant positive effects of mindfulness-based interventions on stress among healthcare professionals, and one study did not.
“Eight studies reported significant positive effects of MBIs on stress among healthcare professionals, one study did not (Horner et al., 2014).”
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Findingown data§ Limitations of this review · p. 15Burnout was examined in several studies but not consistently reported, so meta-analysis could not be performed.
“Whilst burnout was examined in several studies it was not consistently reported and therefore meta-analysis could not be performed.”
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Findingreasoning§ Synthesis of the results: meta-analysis · p. 12Forty-four non-significant studies would be needed to render the findings non-significant and 45 additional non-significant studies are likely to exist.
“For this metaanalysis, 44 non-significant studies would be needed to render the findings non-significant and 45 additional non-significant studies are likely to exist.”
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Findingcitation§ Study quality · p. 11Reasons for attrition were reported in three studies: work pressures, shift patterns, and a combination of health, family and work pressures.
“Reasons for attrition were reported in three studies; these included work pressures (Brady et al., 2012), shift patterns (Horner et al., 2014), and a combination of health, family and work pressures (Shapiro et al., 2005).”
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Findingnone given§ Conclusion · p. 16Mindfulness-based interventions require time commitments.
“Given the time commitments needed”
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Findingown data§ Synthesis of the results: meta-analysis · p. 11Seven papers were included in the meta-analysis.
“The remaining seven studies were included in the meta-analysis with a total of 188 participants.”
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Premisecitation§ Introduction · p. 4One meta-analytic review reported that MBSR interventions appear to benefit healthcare professionals in particular compared to other healthy stressed populations.
“One meta-analytic review reported that interventions employing Mindfulness Based Stress Reduction (MBSR), which was originally developed by Kabat-Zinn (1982, 1990) and combines mindfulness meditation with Yoga, appear to benefit HCPs in particular, at least when compared to other healthy stressed populations exposed to the intervention (e.g. students, academics, teachers and community groups) (Kh”
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Premisecitation§ Introduction · p. 3Previous meta-analysis indicates a small effect of mindfulness-based interventions in people with vascular disease.
“and a small effect in people with vascular disease (Abbott et al., 2014).”
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Premisecitation§ Introduction · p. 3Mindfulness-based interventions are recommended by the NHS and the National Institute for Health and Care Excellence for the prevention and management of stress.
“Mindfulness-based-interventions (MBIs) are recommended by the NHS and the National Institute for Health and Care Excellence (NICE) for the prevention and management of stress (National Institute for Health and Care Excellence, 2009).”
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Premisecitation§ References · p. 23In Fortney et al. (2013), there was a significant decrease in emotional exhaustion.
“Significant decrease in emotional exhaustion and depersonalization. Significant improvement in personal accomplishment, anxiety, depression. Effect was maintained over 9 months.”
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Premisecitation§ References · p. 23In Fortney et al. (2013), there was a significant improvement in depression.
“Significant decrease in emotional exhaustion and depersonalization. Significant improvement in personal accomplishment, anxiety, depression. Effect was maintained over 9 months.”
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Interpretationcitation§ Discussion · p. 15By reducing staff stress, mindfulness-based interventions could reduce sickness absence and improve job satisfaction, with the potential to benefit the employer, the employee, and consequently patients and service users within the healthcare system.
“Furthermore, by reducing staff stress, MBIs could reduce sickness absence and improve job satisfaction, with the potential to benefit the employer, the employee, and consequently patients and service users within the healthcare system (Fortney et al., 2013).”
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Interpretationreasoning§ Discussion · p. 13The investment required for mindfulness-based interventions is considerable and may be impractical for many healthcare professionals.
“Consequently, the investment required is considerable and may be impractical for many healthcare professionals.”
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Premisecitation§ References · p. 23In Fortney et al. (2013), there was a significant improvement in anxiety.
“Significant decrease in emotional exhaustion and depersonalization. Significant improvement in personal accomplishment, anxiety, depression. Effect was maintained over 9 months.”
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Interpretationreasoning§ Discussion · p. 15The promising findings from these small scale studies could have real, practical benefits.
“Despite this, the promising findings from these small scale studies could have real, practical benefits.”
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Premisecitation§ References · p. 23In Brady et al. (2012), there was a significant improvement in overall sense of self.
“Significant improvement in mindfulness, stress, and overall sense of self.”
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Premisecitation§ Discussion · p. 15Lack of detail on intervention design, content and delivery is a problem prevalent in publications of behaviour change interventions more generally.
“An additional challenge is the lack of detail on intervention design, content and delivery; a problem prevalent in publications of behaviour change interventions more generally (Michie et al., 2011).”
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Interpretationcitation§ Discussion · p. 14Reductions in stress may have been supported by the group effect.
“Alternatively, reductions in stress may have been supported by the group effect.”
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Premisecitation§ References · p. 23In Fortney et al. (2013), there was a significant improvement in personal accomplishment.
“Significant decrease in emotional exhaustion and depersonalization. Significant improvement in personal accomplishment, anxiety, depression. Effect was maintained over 9 months.”
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Interpretationown data§ Discussion · p. 12The finding of a moderate effect of mindfulness-based interventions on healthcare professional stress lends support to Khoury et al. (2015), who reported that MBSR is a moderately effective intervention for reducing stress in healthcare professionals.
“This finding lends support to Khoury et al. (2015) who reported that MBSR is a moderately effective intervention for reducing stress in HCPs.”
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Premisecitation§ References · p. 23In Fortney et al. (2013), there was a significant decrease in depersonalization.
“Significant decrease in emotional exhaustion and depersonalization. Significant improvement in personal accomplishment, anxiety, depression. Effect was maintained over 9 months.”
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Premisecitation§ References · p. 23In Brady et al. (2012), there was a significant improvement in mindfulness.
“Significant improvement in mindfulness, stress, and overall sense of self.”
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Interpretationcitation§ Discussion · p. 15This lack of detail makes it difficult to differentiate between programmes and prohibits analysis of which components are most strongly predictive of positive outcomes.
“This lack of detail makes it difficult to differentiate between programmes and prohibits analysis of which components are most strongly predictive of positive outcomes (Carroll et al., 2007).”
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Study design and conductnone given§ Limitations of this review · p. 15This review has only focussed on stress as an outcome measure.
“This review has only focussed on stress as an outcome measure.”
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Interpretationcitation§ Discussion · p. 14The effectiveness of mindfulness-based interventions for healthcare professionals is likely to be influenced by usually unmeasured variables such as readiness to change, motivation to change, education, and psychoeducation.
“The effectiveness of MBIs for HCPs is also likely to be influenced by a number of, usually unmeasured, variables.”
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Interpretationreasoning§ Discussion · p. 14The majority of studies included a pre-post design and decreases in stress may have resulted from testing effects.
“For example, the majority of studies included a pre-post design and decreases in stress may have resulted from testing effects.”
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Premisecitation§ References · p. 23In Brady et al. (2012), there was a significant improvement in stress.
“Significant improvement in mindfulness, stress, and overall sense of self.”
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Premisecitation§ References · p. 25In Shapiro et al. (2005), there was a significant reduction in stress in the intervention group.
“Significant reduction in stress and self-compassion in intervention group. Self-compassion”
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Premisecitation§ References · p. 24In Martin-Asuero and Garcia-Banda (2010), there was a significant difference in the combined means between pre-, post- and follow up measures.
“Significant reduction in psychological distress, daily stress, rumination and negative affect. Significant difference in the combined means between pre-, post- and follow up measures.”
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Premisecitation§ References · p. 24In Horner et al. (2014), there were improvements in patient satisfaction among the intervention group, but not statistically significant.
“Improvements in mindfulness, burnout, stress and patient satisfaction among intervention group, but not statistically significant”
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Premisecitation§ References · p. 24In Horner et al. (2014), there were improvements in stress among the intervention group, but not statistically significant.
“Improvements in mindfulness, burnout, stress and patient satisfaction among intervention group, but not statistically significant”
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Premisecitation§ References · p. 24In Martin-Asuero and Garcia-Banda (2010), there was a significant reduction in daily stress.
“Significant reduction in psychological distress, daily stress, rumination and negative affect. Significant difference in the combined means between pre-, post- and follow up measures.”
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Premisecitation§ References · p. 24In Foureur et al. (2013), participants reported the intervention as enjoyable.
“Significant improvements in health, SOC-Orientation to life and stress. Participants reported the intervention as enjoyable.”
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Premisecitation§ References · p. 24In Manotas et al. (2014), there were significant improvements in anxiety post-intervention.
“Significant improvements in mindfulness, stress, depression and anxiety post-intervention.”
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Premisecitation§ References · p. 25In Shapiro et al. (2005), there was a significant reduction in self-compassion in the intervention group.
“Significant reduction in stress and self-compassion in intervention group. Self-compassion”
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Premisecitation§ References · p. 24In Foureur et al. (2013), there were significant improvements in SOC-Orientation to life.
“Significant improvements in health, SOC-Orientation to life and stress. Participants reported the intervention as enjoyable.”
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Premisecitation§ References · p. 24In Foureur et al. (2013), there were significant improvements in stress.
“Significant improvements in health, SOC-Orientation to life and stress. Participants reported the intervention as enjoyable.”
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Premisecitation§ References · p. 23In Fortney et al. (2013), the effect was maintained over 9 months.
“Significant decrease in emotional exhaustion and depersonalization. Significant improvement in personal accomplishment, anxiety, depression. Effect was maintained over 9 months.”
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Probably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation§ References · p. 24In Martin-Asuero and Garcia-Banda (2010), there was a significant reduction in psychological distress.
“Significant reduction in psychological distress, daily stress, rumination and negative affect. Significant difference in the combined means between pre-, post- and follow up measures.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Martin-Asuero and Garcia- Banda (2010)
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation§ References · p. 24In Manotas et al. (2014), there were significant improvements in depression post-intervention.
“Significant improvements in mindfulness, stress, depression and anxiety post-intervention.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Manotas et al. (2014)
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation§ References · p. 24In Foureur et al. (2013), there were significant improvements in health.
“Significant improvements in health, SOC-Orientation to life and stress. Participants reported the intervention as enjoyable.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Foureur et al. (2013)
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation§ References · p. 24In Martin-Asuero and Garcia-Banda (2010), there was a significant reduction in negative affect.
“Significant reduction in psychological distress, daily stress, rumination and negative affect. Significant difference in the combined means between pre-, post- and follow up measures.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Martin-Asuero and Garcia- Banda (2010)
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Premisecitation§ References · p. 24In Horner et al. (2014), there were improvements in mindfulness among the intervention group, but not statistically significant.
“Improvements in mindfulness, burnout, stress and patient satisfaction among intervention group, but not statistically significant”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Horner et al. (2014)
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation§ References · p. 24In Manotas et al. (2014), there were significant improvements in mindfulness post-intervention.
“Significant improvements in mindfulness, stress, depression and anxiety post-intervention.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Manotas et al. (2014)
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Premisecitation§ References · p. 24In Horner et al. (2014), there were improvements in burnout among the intervention group, but not statistically significant.
“Improvements in mindfulness, burnout, stress and patient satisfaction among intervention group, but not statistically significant”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Horner et al. (2014)
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation§ References · p. 24In Martin-Asuero and Garcia-Banda (2010), there was a significant reduction in rumination.
“Significant reduction in psychological distress, daily stress, rumination and negative affect. Significant difference in the combined means between pre-, post- and follow up measures.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Martin-Asuero and Garcia- Banda (2010)
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation§ References · p. 24In Manotas et al. (2014), there were significant improvements in stress post-intervention.
“Significant improvements in mindfulness, stress, depression and anxiety post-intervention.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Manotas et al. (2014)
Not checked in the free run.
The paper relies on this without support.
Self-selected participants are standard and preferred practice for mindfulness-based interventions, and these interventions are most effective when individuals choose to engage.
“All studies used self-selected participants; this is standard and preferred practice for MBIs as this type of intervention is believed to be most effective when individuals choose to engage.”
The paper relies on this without support.
Mindfulness is an activity requiring a high level of engagement and commitment, with participants often asked to complete intervention homework.
“Mindfulness is an activity requiring a high level of engagement and commitment, with participants often asked not only to take part in the intervention sessions, but to also complete intervention 'homework' (namely personal mindfulness practices).”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Previous meta-analyses indicate a moderate to large within-group and between-group effect of MBIs on stress in the general population and healthcare professionals, but these interventions did not appear as effective in reducing burnout or improving resilience for healthcare professionals.
“Previous meta-analyses of MBIs indicate a moderate to large within-group and between-group effect on stress in the general population11 and healthcare professionals,14 15 but these interventions did not appear as effective in reducing burnout or improving resilience for healthcare professionals.15”
From Effectiveness of mindfulness-based interventions on the well-being of healthcare workers: a systematic review and meta-analysis (2024) · cites this paper as [14]
Split into 2 atoms — 0 confirmed, 1 partially supported, 1 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredNumerous clinical trials have demonstrated that mindfulness can assist with a wide range of mental health symptoms in adult populations.
“numerous clinical trials have demonstrated that mindfulness can assist with a wide range of mental health symptoms in adult populations [18–28].”
From Acceptance and commitment therapy universal prevention program for adolescents: a feasibility study. (2017) · cites this paper as [19]
The Key findings (p. 9) report improvements in stress, depression, anxiety, burnout and other outcomes among healthcare professionals. But the Study characteristics (p. 7) identify only two randomized controlled trials among nine studies; most used pre-post designs. The review therefore supports benefits across several symptoms in this occupational group, but not the broader assertion that numerous clinical trials demonstrated them across adult populations. (LLM, conf=0.87)
Experimental — accuracy not yet measuredMindfulness-based interventions may be well-suited to address burnout in HCPs.
“Mindfulness-based interventions may be well-suited to address burnout in HCPs.”
From Being Mindful: A Long-term Investigation of an Interdisciplinary Course in Mindfulness (2019) · cites this paper as [11]
Earlier systematic reviews and meta-analyses of MBSR for healthcare professionals concentrated on stress reduction and only covered studies published before December 2019.
“To date, systematic reviews and meta-analyses have primarily focused upon empirical investigations into the reduction of stress amongst HCPs using MBSR and are limited to empirical studies published before December 2019.”
From The Effectiveness of Mindfulness-Based Stress Reduction on the Psychological Functioning of Healthcare Professionals: a Systematic Review (2021) · cites this paper as Burton et al. 2017
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
File-drawer risk is described as small despite the stated threshold being exceeded
MajorThe paper says 44 non-significant studies would make the result non-significant and that 45 are likely to exist. Its description of this as a very small risk conflicts with those stated figures.
“44 non-significant studies would be needed to render the findings non-significant and 45 additional non-significant studies are likely to exist.”
“This represents a very small risk; however, in light of this results should be interpreted with caution.”
Reported maximum sample size is below a stated study baseline
MinorThe stated maximum sample size is 52, but the attrition account gives the Manotas study 66 participants.
“Sample sizes varied from 16 to 52 participants.”
“in the Manotas et al. (2014) study was 35% (23 of 66 participants did not complete the intervention)”
Reported quality-score range excludes a score in Table 1
MinorThe text says every paper scored between 20 and 25, but Table 1 gives the Manotas study a quality score of 35.
“All papers reviewed scored within the range of 20-25.”
“| Columbia | 35 |”
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Mindfulness-based interventions: an overall review
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“, 2017), for treating burnout in occupational therapy professionals (Luken and Sammons, 2016) and at reducing stress among HCPs (Burton et al., 2017).”
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Mindfulness-based interventions for teachers: a meta-analysis of the emerging evidence base.
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A systematic review of the use of acceptance and commitment therapy in supporting parents.
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“…Previous meta-analyses of MBIs indicate a moderate to large within-group and between-group effect on stress in the general population 11 and healthcare professionals, 14 15 but these interventions did not appear as effective in reducing burnout or improving resilience for healthcare professionals.”
BackgroundLong-term mental health effects of mindfulness training: A 4-year follow-up study
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Comparison of rest‐break interventions during a mentally demanding task
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Mindfulness therapies on health professionals
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Please put on your own oxygen mask before assisting others: a call to arms to battle burnout
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Being Mindful: A Long-term Investigation of an Interdisciplinary Course in Mindfulness
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“Mindfulness-based interventions may be well-suited to address burnout in HCPs. Objective: The purpose of this study was (1) to quantitatively evaluate the effect of a mindfulness-based intervention for interdisciplinary HCPs over time and at a long-term follow-up and (2) to explore perceived benefits, facilitators, an…”
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Mindfulness-Based Interventions for Psychiatry
Ivkovic, A., Evans, S., Mirsky, P., Ashar, Y. K., & Muskin, P. R. (2024) · Tasman’s Psychiatry · doi:10.1007/978-3-030-51366-5_159 · Cited by 1 · see citing works
- Authors
- Burton, A., Burgess, C., Dean, S., Koutsopoulou, G. Z., & Hugh‐Jones, S.
- Affiliations
- University of Staffordshire (GB)
- University of Leeds (GB)
- Corresponding author
- Burton, Amy
- Venue
- Stress and Health
- Publisher
- Wiley
- Published
- 2016-02-25
- Volume
- 33
- Issue
- 1
- Pages
- 3-13
- ISSN
- 1532-2998 (ISSN-L)
- 1532-3005
- OpenAlex
- W2280111206
- Semantic Scholar
- c846fbb26194ce5114a0229d9c04fca741b7f2fe
- Cited by
- 412
- References
- 69
- Citations by year
- 2026: 25 · 2025: 49 · 2024: 47 · 2023: 54 · 2022: 55 · 2021: 58 · 2020: 50 · 2019: 36 · 2018: 18 · 2017: 14 · 2016: 5
- FWCI
- 3.60
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Stress and Health (publishedVersion)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- Staffordshire Online Repository (Staffordshire University) (acceptedVersion)
- Funders
- Economic and Social Research Council (ES/K000632/1)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
- Social Sciences › Psychology › Social Psychology › Stress and Burnout Research
- Keywords
- mindfulness-based interventions, occupational stress, healthcare workers, stress reduction, psychological well-being, quality of care, patient satisfaction
- MeSH terms
- Health Personnel, Humans, Stress, Psychological, Outcome Assessment, Health Care, Mindfulness
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