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Cited by 147Mindfulness and Compassion InterventionsStress and Burnout ResearchOccupational Health and Burnout

A Small Randomized Pilot Study of a Workplace Mindfulness-Based Intervention for Surgical Intensive Care Unit Personnel: Effects on Salivary α-Amylase Levels

Open access
Duchemin, Anne-Marie, Steinberg, Beth A., Marks, Donald R., Vanover, Kristin, Klatt, Maryanna·2015·Journal of Occupational & Environmental Medicine
DOI 10.1097/jom.0000000000000371PMC PMC4624325
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Abstract

OBJECTIVE: To determine whether a workplace stress-reduction intervention decreases reactivity to stress among personnel exposed to a highly stressful occupational environment. METHODS: Personnel from a surgical intensive care unit were randomized to a stress-reduction intervention or a waitlist control group. The 8-week group mindfulness-based intervention included mindfulness, gentle yoga, and music. Psychological and biological markers of stress were measured 1 week before and 1 week after the intervention. RESULTS: Levels of salivary α-amylase, an index of sympathetic activation, were significantly decreased between the first and second assessments in the intervention group with no changes in the control group. There was a positive correlation between salivary α-amylase levels and burnout scores. CONCLUSIONS: These data suggest that this type of intervention could decrease not only reactivity to stress but also the risk of burnout.

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Crossref · 10.1097/jom.0000000000000371

Cites

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Claims the paper makes

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  • Findingown data

    DASS stress scores were strongly negatively correlated with FFMQ non-reactivity scores (r = −0.49, p < 0.0001).

    “In addition, there was a strong negative correlation between DASS stress scores and FFMQ non-reactivity scores (r = −0.49, p < 0.0001).”
    Quote in the paperNot a substantial claim
  • Findingown data

    No correlation with DASS stress scores was found for the remaining FFMQ facets (describing, awareness, non-judging).

    “The other facets of mindfulness as measured on the FFMQ (describing, acting with awareness, non-judging of inner experience) did not correlate with DASS stress scores.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Maslach burnout scores showed no significant pre-to-post change.

    “The scores did not significantly changes between pre- and post-intervention.”
    Quote in the paperNot a substantial claim
  • Findingown data

    FFMQ non-reactivity scores were negatively correlated with ProQOL burnout scores (r = −0.4998, p < 0.0001).

    “There were significant negative correlations between scores of the FFMQ non-reactivity and emotional exhaustion on the Maslach’s inventory and burnout on the ProQOL scale (r = −0.3105, p = 0.0125 and r = −0.4998, p < 0.0001 respectively) (Fig 3).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Participants' self-rated work stress did not change between the first and second assessments in either group.

    “The levels of work stress did not change between the 1st and 2nd sets of assessments (p=0.2316, t=1.224 and p=0.6905, t=0.4021 for MBI and control groups respectively).”
    Quote in the paperNot a substantial claim
  • May combine two claims. 44
  • Classified as probably not a substantial claim. 39

  • May combine two claims.

    Findingown data

    Maslach depersonalization and personal accomplishment scores did not differ significantly between groups.

    “The scores were 7.78±5.53 for depersonalization and 36.5±7.449 for personal accomplishment with no significant difference between the groups (p = 0.685, t = 0.4909 and p = 0.3508, t = 0.9477 respectively).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    On the DASS stress subscale, 37% of participants had scores above the cut-off of 14, with no significant baseline difference between groups.

    “On the DASS stress subscale, 37% had score > 14, the cut-off value for stress, with no significant difference between the two groups (p = 0.1552, t = 1.458).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    On the PSS, 12% of participants had low stress scores (<10) and 37% had high stress scores (>16).

    “On the PSS, only 12% of participants had a score < 10 (low stress), while 37% had a score > 16 (high stress).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Salivary α-amylase levels decreased significantly from the first to the second assessment in the mindfulness intervention group, while the control group showed no change.

    “Levels of salivary α-amylase, an index of sympathetic activation, were significantly decreased between the 1st and 2nd assessments in the intervention group with no changes in the control group.”
    • Also stated in: § RESULTS · plain
      “Levels of salivary α-amylase were reduced by 40% between baseline and 2-month time-points in the MBI group (p = 0.026, t = 2.562) compared to 4% in the control group (Fig 4).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    At baseline, participants rated their work stress at 7.15 ± 1.89 on a 1-to-10 scale, with no significant difference between groups.

    “Participants scored the stress level of their work at 7.15 ± 1.89 on a scale of 1 to 10 (with 10 being most stressful) at baseline with no significant difference between the two groups (p=0.8833, t= 0.1480).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Average Maslach emotional exhaustion subscale score was 23.12 ± 10.1, with 28% of participants scoring above 26 and no difference between groups.

    “On the Maslach’s burnout inventory, the average emotional exhaustion subscale score was 23.12±10.1 with 28% of participants having scores > 26 and no difference between intervention and control groups (p = 0.3185, t = 1.0124).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    DASS stress scores decreased by 25% in the MBI group from baseline to 2 months, a significant change, while the control group showed a non-significant 13% decline.

    “DASS stress scores decreased 25% in the MBI group (p = 0.040, t = 2.245) compared to a non-significant 13% decline in the control group (p = 0.6675, t = 0.4339) between baseline and 2-month assessments (Fig 2).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The number of participants with emotional exhaustion scores above 26 decreased by 34% in the MBI group and did not change in the control group.

    “However, the number of participants with scores > 26 on emotional exhaustion decreased 34% in the MBI intervention group with no change in the waiting list control group.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Average salivary α-amylase level for all participants at baseline was 93.6 ± 15.9 units/ml, with no difference between groups.

    “The average value for all participants was 93.6 ±15.9 units/ml (mean ± SEM) with no difference between the two groups (p = 0.6812, t = 0.4152).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In the MBI arm, 66% fewer participants scored above 14 on the DASS stress scale, whereas the control arm showed no such shift.

    “The number of participants with DASS stress scores > 14 decreased 66% in the MBI group with no change in the control group.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    sAA showed positive but non-significant associations with DASS stress (p = 0.0586) and Maslach emotional exhaustion (p = 0.0660).

    “There were positive correlations between salivary α-amylase levels and both DASS stress and Maslach emotional exhaustion scores, though neither reached significance (p = 0.0586 and p = 0.0660, respectively).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The percentage of individuals with high emotional exhaustion scores decreased in the intervention group and not in the waiting-list group.

    “although the percentage of individuals with high scores for emotional exhaustion decreased in the intervention group and not in the waiting-list group.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In our sample, mean emotional exhaustion was 23.1±10.1 and depersonalization was 7.8±5.5.

    “In our sample, emotional exhaustion was 23.1±10.1 and depersonalization 7.8±5.5.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In a separate analysis, the four PSS items measuring over-reactivity decreased (non-significant, p = 0.09), while the other PSS items did not change.

    “Separate analysis of the 4 items of the PSS corresponding to over-reactivity showed a decrease in scores (although non-significant, p = 0.09) and no change in the other items.”
    Quote in the paperSubstantial claim

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

    Findingown data

    The average age of participants was 44.2, years of experience 14.5, years working in SICU 11.8.

    “The average age of the participants was 44.2 and the number of years of experience was 14.5 years with 11.8 years working in the SICU.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    Workplace stressors have been linked to shifts in nurses' physical and mental health.

    “Associations have been found between workplace stressors and changes in the physical and mental health of nurses5.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] Chang EM Daly J Hancock KM Bidewell JW Johnson A Lambert VA Lambert CE The relationships among workplace stressors, coping methods, demographic characteristics and health in Australian nurses J Prof Nurs 2006 22 30 38 16459287 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Health care professionals often work in stressful settings, and multiple studies document harmful stress effects in this group.

    “A stressful work environment is common for health care professionals and several studies have shown the deleterious effects of stress among this population2,3,4.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [2] Lambert VA Lambert CE Literature review of role stress/strain on nurses: an international perspective Nurs Health Sci 2001 3 161 172 11882192 source

      Not checked in the free run.

    • cites [3] Lambert VA Lambert CE Itano J Inouye J Kim S Kuniviktikul W Sitthimongkol Y Pongthavomkamol K Gasemgitvattana S Ito M Cross-cultural comparison of workplace stressors, ways of coping and demographic characteristics as predictors of physical and mental health among hospital nurses in Japan, Thailand, South Korea and the USA (Hawaii) Int J Nurs Stud 2004 41 671 84 15240091 source

      Not checked in the free run.

    • cites [4] Shanafelt TD Balch CM Bechamps G Russell T Dyrbye L Satele D Collicott P Novotny P Sloan J Freischlag J Burnout and Medical Errors Among American Surgeons Ann Surg 2010 251 995 1000 19934755 source

      Not checked in the free run.

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

    Study design and conductcitation

    The trial followed CONSORT reporting standards for randomized studies.

    “The study adhered to the CONSORT guidelines for randomized trials23.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] Boutron I Moher D Altamn DG Schulz KF Ravaud P Methods and processes of the CONSORT group: example of an extension for trials assessing nonpharmacologic treatments Ann Intern Med 2008 148 60 66 18283201 source

      Not checked in the free run.

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

    Premisecitation

    Higher nurse burnout has been linked to more patient infections.

    “nurse burnout associated with increased levels of patient infection13.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13] Cimiotti JP Aiken LH Sloane DM Wu ES Nurse staffing, burnout, and health care-associated infection Am J Infect Control 2012 40 486 90 22854376 PMC3509207 source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    No participants dropped out, and everyone completed both assessment rounds.

    “There was no drop-out and all participants completed the 2 sets of assessments.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    Workers under stress take sick leave more frequently than other employees.

    “Indeed, employees experiencing stress are on sick leave more often than other workers1.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] McCraty R Atkinson M Tomasino D Impact of a workplace stress reduction program on blood pressure and emotional health in hypertensive employees J Altern Complem Med 2003 9 355 369 12816624 source

      Not checked in the free run.

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

    Study design and conductown data

    Eligible participants were randomized 1:1 to intervention or waiting-list control, stratified by gender and type of work.

    “Eligible participants were randomized 1:1 using Graphpad software to intervention group or waiting list control group, with stratification by gender and type of work.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    Stratification by gender assured equal distribution between groups (87.5% females in both), controlling for possible gender differences in response to intervention.

    “There was a limited number of males in our sample, and the stratification by gender assured equal distribution between the two groups (87.5% females for both groups) controlling for possible gender differences in the response to the intervention.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    Biological samples and self-report questionnaires were collected during a 2-hour time-frame in early afternoon, on same day and same time for all participants to control for work-related environmental changes.

    “The collection of biological samples and self-report questionnaires were completed during a 2-hr time-frame during the early afternoon, on the same day and at the same time for all participants to control for work-related environmental changes.”
    Quote in the paperSubstantial claim

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

    Premisecitation

    Increases in salivary amylase correlate with experimental stressors and with the number and severity of critical life events.

    “Increases in salivary amylase correlate not only with experimental stressors, but also with the number and severity of critical life events, suggesting that everyday stress contributes to the regulation of salivary α-amylase levels19.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [19] Nater UM Rohleder N Salivary alpha-amylase as a non-invasive biomarker for the sympathetic nervous system: current state of research Psychoneuroendocrinology 2009 34 486 96 19249160 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The two instruments may capture different stress symptom domains, which could explain their divergent findings.

    “The difference in the types of stress symptoms measured by the two scales may explain the discrepancy.”
    Quote in the paperSubstantial claim

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

    Premisecitation

    Salivary α-amylase levels do not display gender differences at baseline or after acute stress response.

    “Levels of α-amylase do not display gender differences either at baseline or after acute stress response22”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [22] Takai N Yamaguchi M Aragaki T Eto K Uchihashi K Nishikawa Y Gender-specific differences in salivary biomarker responses to acute psychological stress Ann NY Acad Sci 2007 1098 510 515 17435161 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Chronic stress and stress reactivity are associated with increased salivary α-amylase levels.

    “Chronic stress and stress reactivity have been found associated with increased levels of salivary α-amylase18.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [18] Van Stegeren A Rohleder N Everaerd W Wolf OT Salivary alpha amylase as marker for adrenergic activity during stress: effect of beta-blockade Psychoneuroendocrinology 2006 31 137 41 16046076 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Since every assessment occurred one week after the final group session, an immediate intervention effect on DASS, or too-early PSS measurement, is less plausible.

    “The fact that all the assessments were performed one week after the last group session makes it less likely that the change in the DASS was due to the immediate effect of the intervention or that PSS scores were measured too early to detect an effect.”
    Quote in the paperSubstantial claim

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

    Premisecitation

    A recent survey of over 3,000 ICU staff found 37% with high stress and 29% with severe burnout.

    “In a recent study of more than 3,000 ICU staff, 37% felt highly stressed and 29% had severe burnout9.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9] Merlani P Verdon M Businger A Domenighetti G Pargger H Ricou B STRESI+ Group Burnout in ICU caregivers: a multicenter study of factors associated to centers Am J Resp Crit Care 2011 184 1140 6 21852543 source

      Not checked in the free run.

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

    Premisecitation

    Chronic stress at work can lead to burnout characterized by emotional exhaustion with emotional numbness and/or negative attitude towards self and others.

    “Chronic stress at work can also lead to burnout that is characterized by a feeling of emotional exhaustion associated with emotional numbness and/or negative attitude towards self and others6.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] Maslach C Schaufeli WB Leiter MP Job burnout Annual Rev Psychol 2001 52 397 422 11148311 source

      Not checked in the free run.

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

    Premisecitation

    Nurses in intensive care, emergency, and operating room settings report higher burnout than outpatient clinic nurses.

    “Burnout scores are higher for nurses working in intensive care/emergency services and operating rooms than for nurses working in outpatient clinics8.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [8] Ilahn MN Durukan E Taner E Maral I Bumin MA Burnout and its correlates among nursing staff: questionnaire survey J Adv Nurs 2007 61 100 106 18034813 source

      Not checked in the free run.

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

    Interpretationcitation

    The sample's stress prevalence (37%) matched the 37% reported among over 3,000 ICU staff in a prior study.

    “Participants displayed levels of stress (37%) identical to those reported in a large study of 3,000 ICU personnel (37%)8.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [8] Ilahn MN Durukan E Taner E Maral I Bumin MA Burnout and its correlates among nursing staff: questionnaire survey J Adv Nurs 2007 61 100 106 18034813 source

      Not checked in the free run.

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

    Premisecitation

    The PSS reliability has been demonstrated.

    “It measures the degree to which situations in the individual’s life are perceived as stressful, and its reliability has been demonstrated25.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [25] Mitchell AM Crane PA Kim Y Perceived stress in survivors of suicide: psychometric properties of the Perceived Stress Scale Res Nurs Health 2008 31 576 85 18449942 source

      Not checked in the free run.

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

    Study design and conductown data

    University ethics review approved the study, and every participant gave written informed consent.

    “The study was approved by the university ethical review board, and all participants provided signed informed consent.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Salivary amylase negatively correlates with changes in salivary oxytocin, which suppresses sympathetic activation.

    “and it negatively correlates with changes in salivary oxytocin, which suppresses sympathetic activation39.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [39] Holt-Lunstad J Birmingham WA Light KC Influence of a “warm touch” support enhancement intervention among married couples on ambulatory blood pressure, oxytocin, alpha amylase, and cortisol Psychosomatic Med 2008 70 976 985 18842740 source

      Not checked in the free run.

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

    Study design and conductown data

    For the DASS stress scale, Cronbach's α was 0.90.

    “Cronbach’s α, was 0.90 for the DASS stress scale.”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    In both arms, 69% of participants were nurses.

    “Nurses represented 69% of participants in each group.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    Measurements were done between 1 and 3 pm to avoid changes immediately after waking.

    “To avoid the changes that occur immediately after waking, measurements were done between 1 and 3 pm.”
    Quote in the paperSubstantial claim

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

    Premisecitation

    Skin conductance, a measure of stress reactivity, decreased during MBSR sessions and after stress stimuli following MBSR.

    “For example, increase in skin conductance, another measure of stress reactivity, has been found to decrease during MBSR sessions43 or after stress stimuli following MBSR44.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [43] Lush E Salmon P Floyd A Studts JL Weissbecker I Sephton SE Mindfulness meditation for symptom reduction in fibromyalgia: psychophysiological correlates J Clin Psychol Med Settings 2009 16 200 7 19277851 source

      Not checked in the free run.

    • cites [44] Ortner CNM Kilner SJ Zelazo PD Mindfulness meditation and reduced emotional interference on a cognitive task Motivation and Emotion 2007 31 271 83

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationown data

    Participants' PSS scores likely accurately reflected their evaluation of work stress, which did not decrease between the two assessments.

    “The participants’ scores on the PSS may accurately reflect their evaluation of their work stress, which did not decrease between the two assessments.”
    Quote in the paperSubstantial claim

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

    Interpretationreasoning

    It is reasonable to hypothesize that mindfulness training reduced negative affect and sympathetic reactivity linked to perceived stress, even though the SICU environment and cognitive appraisal of stress did not change.

    “It is reasonable to hypothesize that, although the SICU environment remained the same and the participants’ cognitive appraisal of its stressful character did not change, mindfulness training decreased the negative affect and sympathetic reactivity associated with the participants’ perception of stress in their environment.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The SICU environment did not change between the two assessments.

  • May combine two claims.

    Premisecitation

    After waking, salivary α-amylase starts low, rises sharply in the first hour, and then levels off for the remainder of the day.

    “Salivary α-amylase levels are low upon awakening, increase rapidly during the first hour after waking, and then plateau for the rest of the day34.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [34] Nater UM Rohleder N Schlotz W Ehlert U Kirschbaum C Determinants of the diurnal course of salivary alpha-amylase Psychoneuroendocrinology 2007 32 392 401 17418498 source

      Not checked in the free run.

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

    Study design and conductown data

    All randomized subjects were included in intention-to-treat analyses.

    ““Intention to treat “analyses which included all subjects randomized were performed.”
    Quote in the paperNot a substantial claim

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

    Study design and conductreasoning

    A wait-list control and simultaneous assessments were used to address possible shifts in workplace stress.

    “To control for potential changes in the levels of stress in the work environment, the study was designed with a waiting list control group and the assessments were done at the same time for all the participants.”
    Quote in the paperSubstantial claim

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

    Study design and conductcitation

    The FFMQ's internal consistency was acceptable, with α values of 0.75 (non-reactivity), 0.83 (observing), 0.87 (acting with awareness), 0.91 (describing), and 0.87 (non-judging).

    “The scale presents good internal consistency with Cronbach’s α of 0.75 for non-reactivity, 0.83 for observing, 0.87 for acting with awareness, 0.91 for describing, and 0.87 for non-judging32.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [32] Baer RA Smith GT Hopkins J Krietemeyer J Toney L Using self-report assessment methods to explore facets of mindfulness Assessment 2006 13 27 45 16443717 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Salivary amylase is a good marker of SAM pathway activation and a sensitive marker of autonomic reactions to stress, especially sympathetic nervous system function.

    “Salivary amylase is a good marker of SAM pathway activation, and a sensitive marker of autonomic reactions to stress, especially sympathetic nervous system function.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [38] Inagaki T Miyaoka T Okazaki S Yasuda H Kawamukai T Utani E Wake R Hayashida M Horiguchi J Tsuji S High salivary alpha-amylase levels in patients with schizophrenia: A pilot study Prog Neuropsychopharmacol Biol Psychiatry 2010 34 688 91 20347911 source

      Not checked in the free run.

    • cites [39] Holt-Lunstad J Birmingham WA Light KC Influence of a “warm touch” support enhancement intervention among married couples on ambulatory blood pressure, oxytocin, alpha amylase, and cortisol Psychosomatic Med 2008 70 976 985 18842740 source

      Not checked in the free run.

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

    Study design and conductcitation

    Cronbach's α values for Maslach subscales were 0.90 emotional exhaustion, 0.79 depersonalization, 0.71 personal accomplishment.

    “Cronbach’s α was 0.90 for emotional exhaustion, 0.79 for depersonalization and 0.71 for personal accomplishment29.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [29] Maslach C Jackson SE Leiter MP Maslach burnout inventory 3 Palo Alto Consulting Psychologist Press 1996

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

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

    Premisecitation

    Relaxation response programs using mind-body strategies have been developed for patients to cope with chronic stress.

    “Programs to elicit the relaxation response using mind-body strategies have been developed for patients to cope with chronic stress41.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [41] Park ER Traeger L Vranceanu AM Scult M Lerner JA Benson H Denninger J Friecchione GL The development of a patient-centered program based on the relaxation response: the relaxation response resilience program (3RP) Psychosomatics 2013 54 165 174 23352048 source

      Not checked in the free run.

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

    Study design and conductown data

    The assay's within-run variability was 3.1%, and between-run variability was 13.3%.

    “Intra-assay coefficient of variation was 3.1% and inter-assay coefficient of variation 13.3%.”
    Quote in the paperNot a substantial claim

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

    Study design and conductnone given

    Participant sampling may have been biased by self-selection of individuals open to a group mindfulness and yoga intervention.

    “There may have also been a bias in the participant sampling by self-selection of individuals open to the idea of a group intervention with mindfulness and yoga components.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    A randomized study of a biweekly 9-month small-group mindfulness discussion for physicians found no change in stress but decreased emotional exhaustion and depersonalization at 9 and 12 months.

    “A randomized study of a biweekly 9-month small group discussion incorporating elements of mindfulness for physicians found no change in stress but a decrease in emotional exhaustion and depersonalization in the intervention group at 9 and 12 months51.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [51] West CP Dyrbye LN Rabatin JT Call TG Davidson JH Multari A Romanski SA Henriksen Hellyer JM Sloan JA Shanafelt TD Intervention to Promote Physician Well-being, Job Satisfaction, and Professionalism; A Randomized Clinical Trial JAMA Intern Med 2014 174 527 33 24515493

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationnone given

    Awareness of stress and burnout among health care professionals creates an opportunity to develop evidence-based interventions that can mitigate these effects and benefit providers, patients, and institutions.

    “The awareness of the negative effects of stress and burnout among health care professional provides an opportunity for developing evidence-based interventions that can help mitigate these effects and benefit, not only the health providers themselves, but also patients and institutions.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    Mindfulness down-regulates left amygdala activation during emotional processing in novice practitioners.

    “Mindfulness has also been shown to induce a down-regulation of the left amygdala activation during emotional processing in novice practitioners47.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [47] Taylor VA Grant J Daneault V Scavone G Breton E Roffe-Vidal S Courtemanche J Lavarenne AS Beauregard M Impact of mindfulness on the neural responses to emotional pictures in experienced and beginner meditators Neuroimage 2011 57 1524 33 21679770 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Interventions designed to reduce stress reactivity in high-stress workplaces could prevent harmful effects of stress on personnel health and behavior.

    “Interventions intended to decrease reactivity to stress and specifically designed for high-stress workplace environments could prevent the deleterious effects of stress on the personnel’s health and behavior.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Long-term relaxation response practitioners using mind-body techniques report lower stress and reduced biological stress markers (e.g., norepinephrine during elicitation) than novices.

    “Long-term practitioners of the relaxation response, through use of various mind-body techniques, have been shown to report lower levels of stress than novices, as well as a reduction in biological markers of stress, such as norepinephrine levels during a relaxation response elicitation42.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [42] Chang BH Dusek JA Benson H Psychobiological changes from relaxation response elicitation: long-term practitioners vs. novices Psychosomatics 2011 52 550 559 22054625 source

      Not checked in the free run.

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

    Premisecitation

    An 8-week MBSR intervention is associated with reduced gray matter density in the amygdala.

    “an 8-week MBSR intervention has been associated with reduced gray matter density of this structure46.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [46] Hölzel BK Carmody J Evans KC Hoge EA Dusek JA Morgan L Pitman RK Lazar SW Stress reduction correlates with structural changes in the amygdala Soc Cogn Affect Neur 2010 5 11 17 PMC2840837 19776221 source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    There were no significant differences between groups for age, years of experience, or years working in SICU.

    “There were no significant differences between the two groups for age (p = 0.9496, t= 0.0638), years of experience (p = 0.9485, t = 0.06512), or years working in the SICU (p = 0.8702, t = 0.1648).”
    Quote in the paperNot a substantial claim

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

    Interpretationreasoning

    Generalization of this intervention may be hindered by the specific constraints of the SICU environment and the need for institutional support.

    “The generalization of this type of intervention may also be hindered by the specific constraints of this environment and the required support of the institution for it to be feasible.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    The DASS has been tested in large groups and found to have good discriminant validity.

    “It has been tested in large groups of subjects and found to have good discriminant validity28.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] Henry JD Crawford JR The short-form version of the Depression Anxiety Stress Scales (DASS-21): construct validity and normative data in a large non-clinical sample Br J Clin Psychol 2005 44 227 39 16004657 source

      Not checked in the free run.

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

    Premisecitation

    Non-reactivity is inversely correlated with insula activation during stress.

    “Also, non-reactivity was shown to be inversely correlated with insula activation during stress45.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [45] Paul NA Stanton SJ Greeson JM Smoski MJ Wang L Psychological and neural mechanisms of trait mindfulness in reducing depression vulnerability Soc Cogn Affect Neurosci 2013 8 56 64 22717383 PMC3541493 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Non-reactivity is a mindfulness skill learned in MBI and changed most rapidly during traditional MBSR.

    “Non-reactivity is one of the skills, or facets of mindfulness, learned in MBI, and the one that changed the most rapidly during traditional MBSR35.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [35] Baer RA Carmody J Hunsinger M Weekly change in mindfulness and perceived stress in a mindfulness-based stress reduction intervention J Clin Psychol 2012 68 755 765 22623334 source

      Not checked in the free run.

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

    Premisecitation

    In a study of overweight/obese women, a mindfulness intervention reduced anxiety but did not change PSS scores or chronic stress levels.

    “A study among overweight/obese women found that anxiety levels decreased in the intervention group but PSS scores and levels of chronic stress did not change after a mindfulness intervention36.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [36] Daubenmier J Lin J Blackburn E Hecht FM Kristeller J Maninger N Kuwata M Bacchetti P Havel PJ Epel E Changes in stress, eating, and metabolic factors are related to changes in telomerase activity in a randomized mindfulness intervention pilot study Psychoneuroendocrinology 2012 37 917 28 22169588 PMC3384690 source

      Not checked in the free run.

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

    Premisecitation

    An 8-month stress reduction intervention in an industrial plant decreased stress reactivity and salivary α-amylase.

    “An 8-month stress reduction intervention in an industrial plant decreased stress reactivity and salivary α-amylase50.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [50] Limm H Gündel H Heinmüller M Marten-Mittag B Nater UM Siegrist J Angerer P Stress management interventions in the workplace improve stress reactivity: a randomized controlled trial Occup Environ Med 2011 68 126 33 20833759

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    Samples were collected at the workplace on a working day to capture work-related stress effects on the enzyme.

    “Measurements were done in the work setting during a work day to reflect the effects of the stress associated with the work environment on the levels of the enzyme.”
    Quote in the paperSubstantial claim

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

    Interpretationreasoning

    Although acute sympathetic activation can be beneficial in the SICU, stress reactivity symptoms (e.g., over-reacting, agitation, nervous energy, irritability) may impair functioning, with potential implications for SICU personnel and patients.

    “Although the activation of the sympathetic system in response to an acute situation requiring quick decision and action can be beneficial in the SICU environment, symptoms of stress reactivity, such as over-reacting, getting agitated, using a lot of nervous energy, being irritable, may impair functioning, with potential implications both for SICU personnel and the patients for whom they care.”
    Quote in the paperSubstantial claim

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

    Premisecitation

    In students, an MBSR intervention did not change PSS scores at 2-month follow-up.

    “Similarly, among students, an MBSR intervention did not change PSS scores at 2 months follow-up37.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [37] Shapiro SL Brown KW Thoresen C Plante TG The moderation of mindfulness-based stress reduction effects by trait mindfulness: results from a randomized controlled trial J Clin Psychol 2011 67 267 77 21254055 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Eliciting the relaxation response lowers sympathetic nervous system activity, a mechanism for reducing stress reactivity.

    “Elicitation of the relaxation response reduces sympathetic nervous system activity40, a mechanism for decreasing reactivity to stress41.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [40] Hoffman JW Benson H Arns PA Stainbrook GI Landsberg GL Young JB Gill A Reduced sympathetic nervous system responsivity associated with the relaxation response Science 1982 215 190 192 7031901 source

      Not checked in the free run.

    • cites [41] Park ER Traeger L Vranceanu AM Scult M Lerner JA Benson H Denninger J Friecchione GL The development of a patient-centered program based on the relaxation response: the relaxation response resilience program (3RP) Psychosomatics 2013 54 165 174 23352048 source

      Not checked in the free run.

68 of 68

  • The paper relies on this without support.

    The SICU work environment is a real-life stressor that recurs constantly and is difficult to change.

    “The SICU work environment represents a real-life stressor recurring on a constant basis and is difficult to amend given the nature of the work.”

  • The paper relies on this without support.

    Work-related stress often cannot be eliminated.

    “While work-related stress often cannot be eliminated, effective coping strategies may help decrease its deleterious effects.”

  • The paper relies on this without support.

    Mindfulness increases interoceptive awareness and promotes non-reactivity to internal experience.

    “Mindfulness allows the recognition of one’s own internal bodily reactions by increasing interoceptive awareness and, at the same time, promotes experiencing without judgment and the development of non-reactivity to internal experience.”

  • The paper relies on this without support.

    Decreasing reactivity to stress moderates its impact on behavior.

    “In particular, decreasing reactivity to stress may moderate its impact on behavior.”

  • The paper relies on this without support.

    Salivary α-amylase is usually measured in response to acute stress.

    “Salivary α-amylase is usually measured in response to acute stress.”

  • The paper relies on this without support.

    The insula controls emotions and autonomic functions.

    “Given that the insula controls emotions and autonomic functions”

  • The paper relies on this without support.

    Stress increases amygdala volume, which is implicated in threat detection and physiological stress responses.

    “While stress increases the volume of the amygdala, which is implicated in threat detection and physiological responses to stress”

  • The paper relies on this without support.

    Chronic activation of the sympathetic system has deleterious health consequences.

    “Chronic activation of the sympathetic system carries deleterious consequences on heath.”

  • The paper relies on this without support.

    The PSS items measuring overload, inability to act, and loss of control reflect inherently stressful aspects of the SICU workplace that are not likely to change between assessments.

    “These items may reflect inherently stressful aspects of the SICU workplace that are not likely to change between two assessments.”

  • The paper relies on this without support.

    The SICU environment did not change between the two assessments.

    “although the SICU environment remained the same”
10 of 10

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?

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.

  • The same ICU survey is cited with two different reference numbers

    Minor

    The introduction attributes the survey of more than 3,000 ICU staff and its 37% stress figure to reference 9, while the discussion attributes that same survey and figure to reference 8.

1 of 1

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Authors
Duchemin, A.-M., Steinberg, B. A., Marks, D. R., Vanover, K., & Klatt, M.
Affiliations
The Ohio State University Wexner Medical Center (US)
Corresponding author
Duchemin, Anne-Marie
ORCID
Venue
Journal of Occupational & Environmental Medicine
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2015-04
Volume
57
Issue
4
Pages
393-399
ISSN
1076-2752 (ISSN-L)
DOI
10.1097/jom.0000000000000371
PMC
PMC4624325
OpenAlex
W2328924972
Cited by
146
References
48
Citations by year
2026: 11 · 2025: 10 · 2024: 8 · 2023: 14 · 2022: 19 · 2021: 19 · 2020: 13 · 2019: 16 · 2018: 11 · 2017: 10 · 2016: 11 · 2015: 3
FWCI
14.88
Type
journal article
Language
en
Open access
Locations
  • Journal of Occupational and Environmental Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (UL1TR001070)
  • National Center for Advancing Translational Sciences
Topics
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
  • Social Sciences › Psychology › Social Psychology › Stress and Burnout Research
  • Health Sciences › Health Professions › Occupational Therapy › Occupational Health and Burnout
Keywords
workplace mindfulness, stress reduction intervention, occupational stress, salivary amylase, sympathetic activation, burnout, yoga, stress reactivity
MeSH terms
Adolescent, Adult, Burnout, Professional, Critical Care, Female, Humans, Male, Middle Aged, Personnel, Hospital, Pilot Projects, Biomarkers, Occupational Health, Salivary alpha-Amylases, Young Adult, Self Report, Mindfulness

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Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-04.

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