The Effectiveness of Mindfulness-Based Stress Reduction on the Psychological Functioning of Healthcare Professionals: a Systematic Review

Probably not a substantial claim: may not pass S3 (load-bearing).

The review included thirty studies.

“Using PRISMA guidelines thirty studies were included in the review.”

• Also stated in: § Results · plain

  “In total, thirty studies were identified and included in the review using the search method and inclusion and exclusion criteria detailed above.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Four studies had a randomised controlled trial design.

“Four studies employed an RCT design, nine studies employed a clinical controlled trial (CCT), one study employed a quasi-experimental design and the sixteen remaining studies employed a pre-post design with no control or comparison treatment groups.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Thirteen studies gathered follow-up data, with follow-up periods between two months and one year.

“Thirteen studies collected follow-up data, ranging from 2 months to 1 year.”

May combine two claims.

Among the thirty studies, six received a moderate-to-strong rating, five were moderate, and nineteen were weak.

“The ‘global quality rating’ results indicated that six studies were assessed as ‘moderate to strong’, five studies as ‘moderate’ and nineteen studies as ‘weak’.”

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Twenty-six studies provided gender data, and most samples had more female than male participants.

“Twenty-six studies included gender information of participants. With the exception of three studies (Ducar et al. 2019; Pflugeisen et al. 2016; Verweij et al. 2016), there was an overrepresentation of females within all the study samples compared with males.”

• cites Ducar et al. 2019 sourceNot checked yet

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• cites Pflugeisen et al. 2016 sourceNot checked yet

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• cites Verweij et al. 2016 sourceNot checked yet

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The quote only partly states this claim.

Shortened MBSR courses performed as well as the standard eight-week MBSR course.

“Abbreviated MBSR programmes were found to be as effective as the traditional 8-week MBSR programmes.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The number of participants per study ranged from twelve to ninety-three, and the total final sample across the thirty studies was 1053.

“Participant numbers ranged from a minimum of twelve to a maximum of ninety-three and the total number of participants (final n) across all thirty studies included in the review was 1053.”

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Nine studies used a clinical controlled trial design.

“Four studies employed an RCT design, nine studies employed a clinical controlled trial (CCT), one study employed a quasi-experimental design and the sixteen remaining studies employed a pre-post design with no control or comparison treatment groups.”

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Sixteen studies used a pre-post design.

“Four studies employed an RCT design, nine studies employed a clinical controlled trial (CCT), one study employed a quasi-experimental design and the sixteen remaining studies employed a pre-post design with no control or comparison treatment groups.”

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One study had a quasi-experimental design.

“Four studies employed an RCT design, nine studies employed a clinical controlled trial (CCT), one study employed a quasi-experimental design and the sixteen remaining studies employed a pre-post design with no control or comparison treatment groups.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Every participant was self-selected.

“All participants were self-selected, and within four studies (Amutio et al. 2015; Goodman and Schorling 2012; van Wietmarschen et al. 2018; Verweij et al. 2016), participants voluntarily took part in the MBSR courses as part of a group for the purpose of continual professional development (CPD).”

May combine two claims.

Fifteen included studies reported significant improvements in overall mindfulness and in all facets except non-reacting.

“fifteen studies reported significant improvements in overall mindfulness and in all facets of mindfulness (observe, describe, acting with awareness and non-judging) with the exception of non-reacting.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Twenty-three studies reported participant age, with mean ages ranging from 22.7 to 52.2 years.

“Twenty-three studies documented participant age information, and the mean age ranges varied from 22.7 to 52.2 years.”

May combine two claims.

Only two included studies measured resilience, and both reported non-significant findings.

“only two studies measured resilience and both reported non-significant findings (Fortney et al. 2013; Schroeder et al. 2016).”

• cites Fortney et al. 2013 sourceNot checked yet

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• cites Schroeder et al. 2016 sourceNot checked yet

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Significant improvements in psychological distress were maintained at 3-month and 1-year follow-up, with the 1-year result compared to controls.

“Significant improvements in psychological distress were maintained at 3-month (Martin-Asuero and Garcia-Banda 2010) and 1-year follow-up (Geary and Rosenthal 2011; compared to controls)”

• cites Martin-Asuero and Garcia-Banda 2010 sourceNot checked yet

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• cites Geary and Rosenthal 2011 sourceNot checked yet

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Classified as probably not a substantial claim.

The review excluded studies published before 2008 because the search found no pre-2008 studies that had not already appeared in other reviews.

“For the purpose of the review, studies published before 2008 were not included, as no other studies were identified from the search pre-2008 that had not already been included in other reviews.”

May combine two claims.

Eighteen included studies found significant stress reductions, while four found non-significant stress results.

“Eighteen studies reported significant reductions in stress and four studies reported non-significant findings”

May combine two claims.

One included study found a significant stress reduction on the Depression Anxiety Stress Scale but a non-significant result on the Perceived Stress Scale.

“one study reported a reduction in stress on the Depression Anxiety Stress Scale (Lovibond and Lovibond 1995), but a non-significant finding on the Perceived Stress Scale (Cohen et al. 1983; Duchemin et al. 2015).”

• cites Lovibond and Lovibond 1995Not checked yet

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• cites Cohen et al. 1983 sourceNot checked yet

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• cites Duchemin et al. 2015 sourceNot checked yet

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In four studies, participants joined MBSR voluntarily as part of continuing professional development.

“All participants were self-selected, and within four studies (Amutio et al. 2015; Goodman and Schorling 2012; van Wietmarschen et al. 2018; Verweij et al. 2016), participants voluntarily took part in the MBSR courses as part of a group for the purpose of continual professional development (CPD).”

• cites Amutio et al. 2015 sourceNot checked yet

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• cites Goodman and Schorling 2012 sourceNot checked yet

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• cites van Wietmarschen et al. 2018 sourceNot checked yet

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Non-significant findings were reported for the mindfulness facets observe, describe, acting with awareness, and non-reactiveness.

“non-significant findings were also reported for the facet observe (Dobie et al. 2016), describe (Manotas et al. 2014; Martin-Asuero et al. 2014), acting with awareness and non-reactiveness (Manotas et al. 2014).”

• cites Dobie et al. 2016 sourceNot checked yet

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• cites Manotas et al. 2014 sourceNot checked yet

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• cites Martin-Asuero et al. 2014 sourceNot checked yet

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Four studies reported ethnicity; three had mostly Caucasian participants and one had mostly Chinese participants.

“Four studies detailed ethnicity information of participants, and there was an overrepresentation of Caucasian participants in three studies (Crowder and Sears 2017; Fortney et al. 2013; Geary and Rosenthal 2011) and an overrepresentation of Chinese participants in another study (Suyi et al. 2017).”

• cites Crowder and Sears 2017 sourceNot checked yet

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• cites Fortney et al. 2013 sourceNot checked yet

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• cites Geary and Rosenthal 2011 sourceNot checked yet

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In one included study, burnout was non-significant at 13-week follow-up but significant at 26-week follow-up.

“Crowder and Sears (2017) reported a non-significant finding for burnout at 13-week follow-up; however, a significant reduction in burnout was later reported at 26-week follow-up.”

• cites Crowder and Sears 2017 sourceNot checked yet

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Significant reductions in anxiety, depression, and stress were maintained at 9-month follow-up.

“Significant reductions in anxiety, depression and stress were maintained at 9-month follow-up (Fortney et al. 2013).”

• cites Fortney et al. 2013 sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Across the included MBSR studies, programme duration ranged from 2 days to 11 weeks, and one programme included a 10-month maintenance phase.

“With regard to programme duration, programmes varied from 2 days to 11 weeks and one programme had a 10-month maintenance phase.”

May combine two claims.

Three included MBSR programmes were less than 3 weeks long and produced significant reductions in anxiety, depression, stress, and burnout and significant improvements in mindfulness.

“Three MBSR programmes were less than 3 weeks in duration and yielded significant reductions in anxiety, depression, stress and burnout and significant improvements in mindfulness (Ando et al. 2011; Fortney et al. 2013, Hallman et al. 2017).”

• cites Ando et al. 2011 sourceNot checked yet

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• cites Fortney et al. 2013 sourceNot checked yet

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• cites Hallman et al. 2017 sourceNot checked yet

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In one less-than-3-week programme, resilience findings were non-significant.

“Findings were non-significant for resilience (Fortney et al. 2013).”

• cites Fortney et al. 2013 sourceNot checked yet

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In four included studies, participants completed MBSR voluntarily as part of CPD, and in two studies participants paid for the intervention.

“This was particularly relevant to four research studies whereby participants completed MBSR courses on a voluntary basis as part of their CPD and within two studies participants paid for the intervention (Goodman and Schorling 2012; van Wietmarschen et al. 2018).”

• cites Goodman and Schorling 2012 sourceNot checked yet

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• cites van Wietmarschen et al. 2018 sourceNot checked yet

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In Duarte and Pinto-Gouveia (2016), oncology nurses who practiced more mindfulness showed greater reductions in burnout and depression and greater increases in self-compassion than those who practiced less.

“Duarte and Pinto-Gouveia (2016) reported that oncology nurses that practiced more mindfulness showed greater reductions in burnout and depression, and greater increases in self-compassion compared to those that practiced less.”

• cites Duarte and Pinto-Gouveia 2016 sourceNot checked yet

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Eighteen included MBSR programmes were 8 weeks in duration.

“eighteen programmes were 8 weeks in duration.”

The quote only partly states this claim.

In one 6-week programme, improvements in mindfulness and self-compassion were maintained at 3-month follow-up.

“in one study improvements in mindfulness and self-compassion were maintained at 3-month follow-up.”

May combine two claims.

In Moody et al. (2013), MBSR did not produce consistent or significant improvements in burnout, stress, or depression.

“MBSR did not result in any consistent or significant improvements in burnout, stress or depression.”

• cites Moody et al. 2013 sourceNot checked yet

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Two included MBSR programmes were 6 weeks long and produced significant improvements in stress, burnout, mindfulness, and self-compassion.

“Two MBSR programmes were 6 weeks in duration and yielded significant improvements in stress, burnout, mindfulness and self-compassion (Duarte and Pinto-Gouveia 2016; Suyi et al. 2017)”

• cites Duarte and Pinto-Gouveia 2016 sourceNot checked yet

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• cites Suyi et al. 2017 sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Two MBSR programmes were part of a regular CPD programme accredited by professional bodies, and in another study participants were paid a portion of their work time.

“Two MBSR programmes were part of a regular CPD programme accredited by professional bodies and in another study, participants were paid a portion of their work time.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Fourteen included studies encouraged daily formal mindfulness practice ranging from 15 to 45 minutes throughout the MBSR programme.

“Fourteen studies encouraged participants to engage in daily formal mindfulness, which ranged from 15 to 45 min, throughout the duration of the MBSR programmes.”

May combine two claims.

Three included MBSR programmes were 4 weeks long and produced significant improvements in psychological distress, anxiety, depression, stress, and mindfulness.

“Three MBSR programmes were 4 weeks in duration and yielded significant improvements in psychological distress, anxiety, depression, stress and mindfulness (Brady et al. 2012; Pipe et al. 2009; Verweij et al. 2016)”

• cites Brady et al. 2012 sourceNot checked yet

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• cites Pipe et al. 2009 sourceNot checked yet

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• cites Verweij et al. 2016 sourceNot checked yet

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Two included MBSR programmes were 2 days long and produced significant improvements in stress, mindfulness, emotional exhaustion, and depersonalisation.

“Two MBSR programmes were 2 days in duration and yielded significant improvements for stress, mindfulness, emotional exhaustion and depersonalisation (Schroeder et al. 2016; Trowbridge et al. 2017)”

• cites Schroeder et al. 2016 sourceNot checked yet

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• cites Trowbridge et al. 2017 sourceNot checked yet

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One traditional MBSR programme had a 10-month maintenance phase with one 2.5-hour session per month.

“One of these MBSR programmes also had a 10-month maintenance phase that involved one session of 2.5 h per month.”

May combine two claims.

In one 4-week programme, improvements in stress and mindfulness were sustained at 3-month follow-up, while burnout results were non-significant.

“in one study the improvements in stress and mindfulness were sustained at 3-month follow-up (Brady et al. 2012) although the results for burnout proved non-significant.”

• cites Brady et al. 2012 sourceNot checked yet

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Eight of the 8-week programmes followed the traditional MBSR model of eight 2.5-hour weekly sessions plus a day retreat.

“Eight of which followed the traditional MBSR model, namely eight 2.5-h weekly sessions along with a day retreat.”

Probably not a substantial claim: may not pass S3 (load-bearing).

One included MBSR programme was 11 weeks in duration.

“Another programme was 11 weeks in duration.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In Brady et al. (2012), HCPs were paid for attending MBSR classes, and in Dobie et al. (2016), mindfulness sessions were facilitated in the morning at the beginning of shifts.

“In Brady et al.’s (2012) study, HCPs were paid for attending MBSR classes, and in Dobie et al.’s (2016) research, mindfulness sessions were facilitated in the morning at the beginning of shifts.”

• cites Brady et al. 2012 sourceNot checked yet

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• cites Dobie et al. 2016 sourceNot checked yet

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In one included study, HCPs were allocated 15 minutes of meditation time within their working day.

“HCPs were allocated 15-min meditation time within their working day (Hallman et al. 2017).”

• cites Hallman et al. 2017 sourceNot checked yet

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Hallman et al. (2017) found that only a few HCPs used the allocated meditation time, and Brady et al. (2012) reported a 30% attrition rate due to varying work schedule demands.

“Hallman et al. (2017) found that only a few HCPs used the allocated meditation time and Brady et al. (2012) reported a 30% attrition rate due to the varying work schedule demands of the unit.”

• cites Hallman et al. 2017 sourceNot checked yet

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• cites Brady et al. 2012 sourceNot checked yet

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After discussion, the authors found no differences in how they interpreted the QATQS.

“Deviations in how aspects of QATQS were interpreted were noted; however, following further discussion, no deviations in interpretation were noted.”

May combine two claims.

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.”

• cites Irving et al. 2009 sourceNot checked yet

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• cites Burton et al. 2017 sourceNot checked yet

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• cites Lomas et al. 2019 sourceNot checked yet

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Occupational stress and burnout are common among healthcare professionals.

“Occupational stress and burnout are common amongst different HCPs, including nurses, physicians and psychologists (Rupert and Morgan 2005; Shanafelt et al. 2003; Vahey et al. 2004).”

• cites Rupert and Morgan 2005 sourceNot checked yet

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• cites Shanafelt et al. 2003 sourceNot checked yet

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• cites Vahey et al. 2004 sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The QATQS has demonstrated good content validity and test-retest reliability.

“The QATQS was developed by the Effective Public Health Practice Project (EPHPP 1998) and has been found to have good content validity and test-retest reliability (Thomas et al. 2004).”

• cites Thomas et al. 2004 sourceNot checked yet

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Mindfulness-based interventions can lower stress and burnout in healthcare professionals.

“There is a growing body of research evidence which has suggested that mindfulness-based interventions (MBIs) can help decrease stress and burnout experienced amongst HCPs, increase job satisfaction levels and improve patient outcomes (Escuriex and Labbe 2011; Irving et al. 2009; Shanafelt et al. 2009).”

• cites Escuriex and Labbe 2011 sourceNot checked yet

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• cites Irving et al. 2009 sourceNot checked yet

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• cites Shanafelt et al. 2009 sourceNot checked yet

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The first and third authors checked inter-rater reliability for the quality assessment.

“Inter-rater reliability of the quality assessment of all the studies was examined between the first and third authors.”

Classified as probably not a substantial claim.

Shapiro et al. and Bishop et al. proposed that improvements in self-regulation and nonreactive awareness can lead to changes in perspective.

“Shapiro et al. (2006) and Bishop et al. (2004) postulated that improvements in self-regulation and nonreactive awareness could lead to changes in perspective.”

• cites Shapiro et al. 2006 sourceNot checked yet

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• cites Bishop et al. 2004 sourceNot checked yet

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May combine two claims.

Decentering or reperceiving leads individuals to use a mindfulness-mediated stress response and be less affected by the stress response.

“This process of decentering (Baer 2003; Brown et al. 2007) or reperceiving (Shapiro et al. 2006) leads individuals to employ a ‘mindfulness-mediated stress response’ (Kabat-Zinn 2013) and thus be less affected by the power of the stress response.”

• cites Baer 2003 sourceNot checked yet

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• cites Brown et al. 2007 sourceNot checked yet

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• cites Shapiro et al. 2006 sourceNot checked yet

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The review found MBSR programmes effective in improving particular aspects of psychological functioning in different types of HCPs, including reducing anxiety, depression, and stress and increasing self-compassion.

“The systematic review findings provided further evidence that MBSR programmes were effective in improving particular aspects of psychological functioning in different types of HCPs, including reducing anxiety, depression, and stress and increasing self-compassion.”

Classified as probably not a substantial claim.

The QATQS evaluates methodological rigour through six domains: selection bias, study design, confounders, blinding, data collection methods, and withdrawal/dropouts.

“The QATQS measures the methodological rigour of studies with regard to six components: (1) selection bias, (2) study design, (3) confounders, (4) blinding, (5) data collection methods and (6) withdrawal and drop outs.”

• cites National Collaborating Centre for Methods and Tools 2008Not checked yet

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All included studies received a weak rating for selection bias because all samples were self-selected.

“All studies obtained a weak rating for selection bias, as all samples were self-selected.”

May combine two claims.

Some included studies did not assess previous experience of mindfulness practice, which may have influenced outcomes.

“some studies did not assess for previous experience of mindfulness practice which may have influenced the outcome of the research findings.”

Classified as probably not a substantial claim. May combine two claims.

With such skills, HCPs would be expected to show improved stress management and reduced stress and burnout.

“With the development of such skills, HCPs would be expected to display improved stress management and reduced levels of stress and burnout.”

May combine two claims.

Resilience is a trait that develops over time and may be less amenable to change following MBSR than emotional states such as anxiety, depression, and stress.

“Arguably, resilience is a trait that develops over time and may be less amenable to change following an MBSR intervention compared to other emotional states such as anxiety, depression and stress.”

Probably not a substantial claim: may not pass S3 (load-bearing).

All included studies reported attrition data except three.

“all studies in the systematic review included attrition data with the exception of three studies (Ando et al. 2011; Cucarella and Gianinni 2016; Norouzinia et al. 2017).”

• cites Ando et al. 2011 sourceNot checked yet

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• cites Cucarella and Gianinni 2016 sourceNot checked yet

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• cites Norouzinia et al. 2017Not checked yet

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Ruiz-Fernandez et al. (2019) proposed that when daily mindfulness practice was encouraged, stress levels reduced and mindfulness increased.

“Ruiz-Fernandez et al. (2019) postulated that when daily mindfulness practice was encouraged, stress levels reduced and mindfulness increased.”

• cites Ruiz-Fernandez et al. 2019 sourceNot checked yet

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Included studies with a control or waitlist control generally explored preexisting differences between groups on demographic characteristics and pre-intervention scores, and generally used statistical analyses to control significant differences.

“the studies that had a control group or waitlist control generally did explore preexisting differences between groups regarding demographic characteristics and pre-intervention measure scores. If significant differences were found between groups, statistical analyses were generally used to control such differences.”

May combine two claims.

Because samples were self-selected, only motivated participants would have completed the MBIs and would be more likely to report positive treatment outcomes.

“Due to the samples being self-selected, only motivated participants would have arguably completed the MBIs and thus would be more likely to report positive treatment outcomes (Klein et al. 2019).”

• cites Klein et al. 2019Not checked yet

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Selection bias may have influenced results of non-randomised studies, because random assignment is critical to reducing selection bias.

“Selection bias may have influenced the results of non-randomised studies, as randomly assigning participants to either control or experimental group is critical in reducing selection bias.”

May combine two claims.

Six included studies had no dropouts or withdrawals, and in the remaining twenty-one studies attrition rates ranged from 3% to 57%.

“Six studies had no dropouts or withdrawals, and in the remaining twenty-one studies, the attrition rates varied from 3 to 57%.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The varied facet findings could be due to HCPs developing some mindfulness skills associated with anxiety and stress during the MBSR programme.

“The varied findings could be attributed to the HCPs developing some aspects of mindfulness skills associated with anxiety and stress during the completion of the MBSR programme.”

May combine two claims.

Fourteen included studies did not measure mindfulness pre- and post-intervention, making it difficult to determine whether treatment outcomes resulted from increased mindfulness skills or other factors such as social support or group cohesion.

“fourteen studies in the review did not measure mindfulness as an outcome measure pre- and post-intervention, thus making it difficult to ascertain whether effective treatment outcomes were a consequence of increased mindfulness skills (Spinelli et al. 2019) or other factors such as social support of group cohesion.”

• cites Spinelli et al. 2019 sourceNot checked yet

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The overall quality of the included research was weak to moderate, with common methodological limitations such as variability in methodology, outcome measures, small sample sizes, self-selected samples, and over-representation of Caucasian women.

“The robustness of the available research included in the systematic review indicated that the overall quality proved weak to moderate and that methodological limitations were common (e.g. variability in methodology, outcome measures, small sample sizes, self-selected samples and over-representation of Caucasian women).”

May combine two claims.

The participant samples over-represented women compared to men, reducing generalisability of study findings.

“the participant samples were noted to be over-representative of women compared to men in the studies, thus reducing the generalising of study findings.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Twenty-one included studies noted no incentives, three paid participants directly, and six gave monetary incentives, education credits, or coupons.

“no incentives were noted in twenty-one of the studies, three studies paid participants directly for their involvement and the remaining six studies gave participants a monetary incentive, education credits and/or a coupon following each completion of questionnaires or study visit.”

May combine two claims.

Among four included studies that reported ethnicity, Caucasian and Chinese participants were overrepresented, limiting generalisability.

“Within four studies that detailed ethnicity information, there was an overrepresentation of Caucasian and Chinese participants, again limiting the generalisability of findings.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Some mindfulness facets, such as acting with awareness and non-reactiveness, may take longer to develop, similar to resilience.

“Alternatively, like resilience some facets of mindfulness may take longer to develop, such as acting with awareness and non-reactiveness.”

May combine two claims.

Sixteen included studies did not include information about formal daily mindfulness practice, and six monitored participants' mindfulness practice.

“Sixteen studies did not include information about formal daily mindfulness practice and six studies monitored participants mindfulness practice.”

May combine two claims.

Burnout is a distinct construct connected to mental health difficulties such as anxiety, depression, and stress but not the same as them.

“research that has previously suggested that burnout is a distinct construct, which is connected to mental health difficulties such as anxiety, depression and stress (Awa et al. 2010; Maslach et al. 2001), but is not the same.”

• cites Awa et al. 2010 sourceNot checked yet

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• cites Maslach et al. 2001 sourceNot checked yet

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Even MBSR programmes shortened to within 3 weeks produced effective outcomes for stress and mindfulness maintained at 2-month follow-up and for anxiety, depression, stress, and burnout maintained at 9-month follow-up.

“Even MBSR programmes that were shortened and delivered within a 3-week period, produced effective treatment outcomes for (1) stress and mindfulness maintained at 2-month follow-up (Hallman et al. 2017) and (2) anxiety, depression, stress and burnout maintained at 9-month follow-up (Fortney et al. 2013).”

• cites Hallman et al. 2017 sourceNot checked yet

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• cites Fortney et al. 2013 sourceNot checked yet

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May combine two claims.

Burnout levels may take longer to decrease than mental health difficulties, and may reduce only after healthier coping strategies such as decentering and reperceiving are implemented.

“Levels of burnout may take longer to decrease compared with mental health difficulties, and it is only following the implementation of healthier coping strategies, such as decentering and reperceiving, that levels of burnout may reduce.”

May combine two claims.

Many included studies lacked randomisation, blinding procedures, and control groups, and none of the four RCTs included an alternative treatment comparison.

“Many of the studies lacked randomisation, blinding procedures and control groups, and none of the four RCTs included an alternative treatment comparison.”

Classified as probably not a substantial claim.

Uncertainty remains about the optimal amount of MBSR needed to alleviate stress and other emotional constructs.

“uncertainty remains regarding the optimal amount of MBSR needed to alleviate stress and other emotional constructs (Smith 2014).”

• cites Smith 2014 sourceNot checked yet

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May combine two claims.

The review found MBSR effective in reducing HCPs' experiences of anxiety, depression, and stress.

“The systematic review highlighted that MBSR was effective in reducing HCPs experiences of anxiety, depression and stress.”

May combine two claims.

The review found MBSR effective in increasing HCP levels of mindfulness and self-compassion.

“MBSR was also found to be effective in increasing HCP levels of mindfulness and self-compassion.”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

Burnout and resilience may be traits rather than states, potentially taking longer to improve and requiring longer-term implementation of healthier coping strategies.

“Burnout and resilience may be viewed as traits rather than states, thus potentially taking longer to improve, requiring the longer-term implementation of healthier coping strategies which then facilitate improvements in burnout and resilience.”

May combine two claims.

Great variability was found between included studies investigating different aspects of psychological functioning, which could lead to ambiguity and difficulty comparing findings between studies on the same construct.

“great variability was found between studies that investigated different aspects of psychological functioning (e.g. anxiety, depression, stress, burnout and mindfulness). Such variability could lead to ambiguity and difficulty comparing findings between studies that investigate the same psychological construct.”

Probably not a substantial claim: may not pass S2 (checkable).

Burnout and resilience may be conceptualised as different constructs from depression, anxiety, and stress.

“Arguably burnout and resilience may be conceptualised as different constructs to depression, anxiety and stress.”

May combine two claims.

Of thirty included studies, twenty-four employed certified MBSR instructors and mindfulness teachers, while six provided no information about MBSR facilitators.

“Of the thirty studies included in the systematic review, twenty-four studies employed certified MBSR instructors and mindfulness teachers and six studies failed to include any information about the MBSR facilitators.”

May combine two claims.

The review findings suggest that shorter, well-organised MBSR programmes embedded into HCP working schedules could reduce attrition rates and increase engagement in MBIs.

“Overall, the findings suggested that shorter, well-organised MBSR programmes embedded into the working schedules of HCPs could reduce attrition rates and increase engagement in MBIs.”

May combine two claims.

Existing included studies were generally of poor quality, with shortcomings related to self-selected samples, lack of controlled studies and randomisation, lack of blinding, and overrepresentation of Caucasian women.

“Existing studies were generally found to be of poor quality with shortcomings related to self-selected samples, lack of controlled studies and randomisation, lack of blinding and overrepresentation of Caucasian women within samples.”

May combine two claims.

In four included studies, MBSR facilitators were part of the research team, potentially reinforcing selection bias through social desirability effects.

“Of note, four of the studies MBSR facilitators were also part of the research team, thus potentially reinforcing selection bias due to social desirability effects.”

May combine two claims.

MBSR did not appear as effective in reducing burnout or improving resilience among HCPs.

“However, MBSR did not appear as effective in reducing burnout or improving resilience amongst HCPs.”