A Systematic Review and Meta-analysis of the Impact of Mindfulness-Based Interventions on the Well-Being of Healthcare Professionals
Efforts to improve the well-being of healthcare professionals include mindfulness-based interventions (MBIs). To understand the value of such initiatives, we conducted a systematic review and meta-analysis of empirical studies pertaining to the use of MBIs with healthcare professionals. Databases were reviewed from the start of records to January 2016 (PROSPERO registration number: CRD42016032899). Eligibility criteria included empirical analyses of well-being outcomes acquired in relation to MBIs. Forty-one papers met the eligibility criteria, consisting of a total of 2101 participants. Studies were examined for two broad classes of well-being outcomes: (a) “negative” mental health measures such as anxiety, depression, and stress; (b) “positive” indices of well-being, such as life satisfaction, together with outcomes associated with well-being, such as emotional intelligence. MBIs were generally associated with positive outcomes in relation to most measures (albeit with moderate effect sizes), and mindfulness does appear to improve the well-being of healthcare professionals. However, the quality of the studies was inconsistent, so further research is needed, particularly high-quality randomised control trials.
KeywordsMindfulness Meditation Healthcare professionals Meta-analysis
Compliance with Ethical Standards
This article does not contain any studies with human participants or animals performed by any of the authors.
(All meta-analysis papers are indicated by *)
- *Aggs, C., & Bambling, M. (2010). Teaching mindfulness to psychotherapists in clinical practice: The mindful therapy programme. Counselling and Psychotherapy Research, 10(4), 278–286. https://doi.org/10.1080/14733145.2010.485690.
- *Barbosa, P., Raymond, G., Zlotnick, C., Wilk, J., Toomey, I. R., & Mitchell, I. J. (2013). Mindfulness-based stress reduction training is associated with greater empathy and reduced anxiety for graduate healthcare students. Education for Health, 26(1), 9–14. https://doi.org/10.4103/1357-6283.112794.
- *Bazarko, D., Cate, R. A., Azocar, F., & Kreitzer, M. J. (2013). The impact of an innovative mindfulness-based stress reduction program on the health and well-being of nurses employed in a corporate setting. Journal of Workplace Behavioral Health, 28(2), 107–133.Google Scholar
- Boellinghaus, I., Jones, F. W., & Hutton, J. (2014). The role of mindfulness and loving-kindness meditation in cultivating self-compassion and other-focused concern in health care professionals. Mindfulness, 5(2), 129–138.Google Scholar
- *Bond, A. R., Mason, H. F., Lemaster, C. M., Shaw, S. W., Mullin, C. S., Holick, E. A., & Saper, R. B. (2013). Embodied health: the effects of a mind-body course for medical students. Medical Education Online, 18(1). https://doi.org/10.3402/meo.v18i0.20699.
- *Bonifas, R. P., & Napoli, M. (2014). Mindfully increasing quality of life: a promising curriculum for MSW students. Social Work Education, 33(4), 469–484. https://doi.org/10.1080/02615479.2013.838215.
- Borenstein, M., Hedges, L. V., Higgins, J. P. T., & Rothstein, H. R. (2009). Multiple outcomes or time-points within a study. In Introduction to meta-analysis (pp. 225–238). Chichester: John Wiley & Sons, Ltd.Google Scholar
- Bourdieu, P. (1986). The forms of capital. In J. G. Richardson (Ed.), Handbook of theory and research for the sociology of education (pp. 241–258). New York: Greenwood.Google Scholar
- *Brady, S., O’Connor, N., Burgermeister, D., & Hanson, P. (2012). The impact of mindfulness meditation in promoting a culture of safety on an acute psychiatric unit. Perspectives in Psychiatric Care, 48(3), 129–137. https://doi.org/10.1111/j.1744-6163.2011.00315.x.
- Bright, R. P., & Krahn, L. (2011). Depression and suicide among physicians. Current Psychiatry, 10(4), 16.Google Scholar
- Bühlmayer, L., Birrer, D., Röthlin, P., Faude, O., & Donath, L. (2017). Effects of mindfulness practice on performance-relevant parameters and performance outcomes in sports: a meta-analytical review. Sports Medicine, 47(11), 2309–2321.Google Scholar
- *Burnett, M., & Pettijohn, C. (2015). Investigating the efficacy of mind-body therapies and emotional intelligence on worker stress in an organizational setting: an experimental approach. Journal of Organizational Culture, Communications and Conflict, 19(1), 146–158.Google Scholar
- Burton, A., Burgess, C., Dean, S., Koutsopoulou, G. Z., & Hugh-Jones, S. (2017). How effective are mindfulness-based interventions for reducing stress among healthcare professionals? A systematic review and meta-analysis. Stress and Health, 33(1), 3–13. https://doi.org/10.1002/smi.2673.Google Scholar
- Coetzee, S. K., & Klopper, H. C. (2010). Compassion fatigue within nursing practice: a concept analysis. Nursing & Health Sciences, 12(2), 235–243.Google Scholar
- *Cohen, J. S., & Miller, L. J. (2009). Interpersonal mindfulness training for well-being: a pilot study with psychology graduate students. Teachers College Record, 111(12), 2760–2774.Google Scholar
- Cosley, B. J., McCoy, S. K., Saslow, L. R., & Epel, E. S. (2010). Is compassion for others stress buffering? Consequences of compassion and social support for physiological reactivity to stress. Journal of Experimental Social Psychology, 46(5), 816–823. https://doi.org/10.1016/j.jesp.2010.04.008.Google Scholar
- Daya, Z., & Hearn, J. H. (2017). Mindfulness interventions in medical education: a systematic review of their impact on medical student stress, depression, fatigue and burnout. Medical Teacher, 1–8. https://doi.org/10.1080/0142159X.2017.1394999.
- *De Vibe, M., Solhaug, I., Tyssen, R., Friborg, O., Rosenvinge, J. H., Sørlie, T., & Bjørndal, A. (2013). Mindfulness training for stress management: a randomised controlled study of medical and psychology students. BMC Medical Education, 13(1), 107. https://doi.org/10.1186/1472-6920-13-107.
- *Dobie, A., Tucker, A., Ferrari, M., & Rogers, J. M. (2016). Preliminary evaluation of a brief mindfulness-based stress reduction intervention for mental health professionals. Australasian Psychiatry, 24(1), 42–45. https://doi.org/10.1177/1039856215618524.
- Dudman, J., Isaac, A., & Johnson, S. (2015, 10 June 2015). Revealed: how the stress of working in public services is taking its toll on staff, The Guardian. Retrieved from http://www.theguardian.com/society/2015/jun/10/stress-working-public-services-survey.
- Eby, L. T., Allen, T. D., Conley, K. M., Williamson, R. L., Henderson, T. G., & Mancini, V. S. (2017). Mindfulness-based training interventions for employees: a qualitative review of the literature. Human Resource Management Review. https://doi.org/10.1016/j.hrmr.2017.03.004.
- Edwards, R. T., Bryning, L., & Crane, R. (2015). Design of economic evaluations of mindfulness-based interventions: ten methodological questions of which to be mindful. Mindfulness, 6(3), 490–500.Google Scholar
- *Erogul, M., Singer, G., McIntyre, T., & Stefanov, D. G. (2014). Abridged mindfulness intervention to support wellness in first-year medical students. Teaching and Learning in Medicine, 26(4), 350–356. https://doi.org/10.1080/10401334.2014.945025.
- Firth-Cozens, J. (1998). Individual and organizational predictors of depression in general practitioners. British Journal of General Practice, 48(435), 1647–1651.Google Scholar
- Firth-Cozens, J. (2003). Doctors, their wellbeing, and their stress: it’s time to be proactive about stress—and prevent it. BMJ: British Medical Journal, 326(7391), 670–671.Google Scholar
- *Fortney, L., Luchterhand, C., Zakletskaia, L., Zgierska, A., & Rakel, D. (2013). Abbreviated mindfulness intervention for job satisfaction, quality of life, and compassion in primary care clinicians: a pilot study. Annals of Family Medicine, 11(5), 412–420. https://doi.org/10.1370/afm.1511.
- *Foureur, M., Besley, K., Burton, G., Yu, N., & Crisp, J. (2013). Enhancing the resilience of nurses and midwives: pilot of a mindfulness-based program for increased health, sense of coherence and decreased depression, anxiety and stress. Contemporary Nurse, 45(1), 114–125.Google Scholar
- Fresco, D. M., Moore, M. T., van Dulmen, M. H. M., Segal, Z. V., Ma, S. H., Teasdale, J. D., & Williams, J. M. G. (2007). Initial psychometric properties of the experiences questionnaire: validation of a self-report measure of decentering. Behavior Therapy, 38(3), 234–246. https://doi.org/10.1016/j.beth.2006.08.003.Google Scholar
- Gao, Y.-Q., Pan, B.-C., Sun, W., Wu, H., Wang, J.-N., & Wang, L. (2012). Anxiety symptoms among Chinese nurses and the associated factors: a cross sectional study. BMC Psychiatry, 12(1), 141.Google Scholar
- *Gauthier, T., Meyer, R. M. L., Grefe, D., & Gold, J. I. (2015). An on-the-job mindfulness-based intervention for pediatric ICU nurses: a pilot. Journal of Pediatric Nursing, 30(2), 402–409. https://doi.org/10.1016/j.pedn.2014.10.005.
- George, B. (2012). Mindfulness helps you become a better leader. Harvard Business Review, 26, 21–32.Google Scholar
- Givens, J. L., & Tjia, J. (2002). Depressed medical students’ use of mental health services and barriers to use. Academic Medicine, 77(9), 918–921.Google Scholar
- *Gockel, A., Burton, D., James, S., & Bryer, E. (2013). Introducing Mindfulness as a Self-Care and Clinical Training Strategy for Beginning Social Work Students. Mindfulness, 4(4), 343–353. https://doi.org/10.1007/s12671-012-0134-1.
- *Goodman, M. J., & Schorling, J. B. (2012). A mindfulness course decreases burnout and improves well-being among healthcare providers. International Journal of Psychiatry in Medicine, 43(2), 119–128. https://doi.org/10.2190/PM.43.2.b.
- *Grepmair, L., Mitterlehner, F., Loew, T., & Nickel, M. (2007). Promotion of mindfulness in psychotherapists in training: preliminary study. European Psychiatry, 22(8), 485–489. https://doi.org/10.1016/j.eurpsy.2007.02.004.
- *Hallman, I. S., O’Connor, N., Hasenau, S., & Brady, S. (2014). Improving the culture of safety on a high-acuity inpatient child/adolescent psychiatric unit by mindfulness-based stress reduction training of staff. Journal of Child and Adolescent Psychiatric Nursing, 27(4), 183–189. https://doi.org/10.1111/jcap.12091.
- Higgins, J. P., & Green, S. (Eds.). (2011). Cochrane handbook for systematic reviews of interventions (Vol. 5). Chichester: Wiley-Blackwell.Google Scholar
- *Hopkins, A., & Proeve, M. (2013). Teaching mindfulness-based cognitive therapy to trainee psychologists: qualitative and quantitative effects. Counselling Psychology Quarterly, 26(2), 115–130. https://doi.org/10.1080/09515070.2013.792998.
- Hwang, Y.-S., Bartlett, B., Greben, M., & Hand, K. (2017). A systematic review of mindfulness interventions for in-service teachers: a tool to enhance teacher wellbeing and performance. Teaching and Teacher Education, 64(Supplement C), 26–42. https://doi.org/10.1016/j.tate.2017.01.015.Google Scholar
- *Johnson, J. R., Emmons, H. C., Rivard, R. L., Griffin, K. H., & Dusek, J. A. (2015). Resilience training: A pilot study of a mindfulness-based program with depressed healthcare professionals. EXPLORE: The Journal of Science and Healing, 11(6), 433–444. https://doi.org/10.1016/j.explore.2015.08.002.
- *Kemper, K. J., & Khirallah, M. (2015). Acute effects of online mind–body skills training on resilience, mindfulness, and empathy. Journal of Evidence-Based Complementary and Alternative Medicine, 20(4), 247–253. https://doi.org/10.1177/2156587215575816.
- Khoury, B., Lecomte, T., Fortin, G., Masse, M., Therien, P., Bouchard, V., … Hofmann, S. G. (2013). Mindfulness-based therapy: a comprehensive meta-analysis. Clinical Psychology Review, 33(6), 763–771. https://doi.org/10.1016/j.cpr.2013.05.005.
- *Krasner, M. S., Epstein, R. M., Beckman, H., Suchman, A. L., Chapman, B., Mooney, C. J., & Quill, T. E. (2009). Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA - Journal of the American Medical Association, 302(12), 1284–1293. https://doi.org/10.1001/jama.2009.1384.
- Kudesia, R. S. (2015). Mindfulness and creativity in the workplace. In J. Reb & P. W. B. Atkins (Eds.), Mindfulness in organizations: foundations, research, and applications (pp. 190–212). Cambridge: Cambridge University Press.Google Scholar
- Lamothe, M., Rondeau, É., Malboeuf-Hurtubise, C., Duval, M., & Sultan, S. (2016). Outcomes of MBSR or MBSR-based interventions in health care providers: a systematic review with a focus on empathy and emotional competencies. Complementary Therapies in Medicine, 24, 19–28.Google Scholar
- Linley, P. A., & Joseph, S. (2004). Applied positive psychology: a new perspective for professional practice. In P. A. Linley & S. Joseph (Eds.), Positive psychology in practice (pp. 3–12). Hoboken: John Wiley and Sons.Google Scholar
- Lomas, T., Medina, J. C., Ivtzan, I., Rupprecht, S., & Eiroa-Orosa, F. J. (2017a). The impact of mindfulness on the wellbeing and performance of educators: a systematic review of the empirical literature. Teaching and Teacher Education, 61, 132–141. https://doi.org/10.1016/j.tate.2016.10.008.Google Scholar
- Lomas, T., Medina, J. C., Ivtzan, I., Rupprecht, S., Hart, R., & Eiroa-Orosa, F. J. (2017b). The impact of mindfulness on wellbeing and performance in the workplace: an inclusive systematic review of the empirical literature. European Journal of Work and Organizational Psychology, 26(4), 492–513. https://doi.org/10.1080/1359432X.2017.1308924.Google Scholar
- Luken, M., & Sammons, A. (2016). Systematic review of mindfulness practice for reducing job burnout. American Journal of Occupational Therapy, 70(2). https://doi.org/10.5014/ajot.2016.016956.
- *Mackenzie, C. S., Poulin, P. A., & Seidman-Carlson, R. (2006). A brief mindfulness-based stress reduction intervention for nurses and nurse aides. Applied Nursing Research, 19(2), 105–109. https://doi.org/10.1016/j.apnr.2005.08.002.
- *Manotas, M., Segura, C., Eraso, M., Oggins, J., & McGovern, K. (2014). Association of brief mindfulness training with reductions in perceived stress and distress in Colombian health care professionals. International Journal of Stress Management, 21(2), 207–225. https://doi.org/10.1037/a0035150.
- *Martín-Asuero, A., & García-Banda, G. (2010). The mindfulness-based stress reduction program (MBSR) reduces stress-related psychological distress in healthcare professionals. Spanish Journal of Psychology, 13(2), 897–905.Google Scholar
- *Martín-Asuero, A., Queraltó, J. M., Pujol-Ribera, E., Berenguera, A., Rodriguez-Blanco, T., & Epstein, R. M. (2014). Effectiveness of a mindfulness education program in primary health care professionals: a pragmatic controlled trial. Journal of Continuing Education in the Health Professions, 34(1), 4–12. https://doi.org/10.1002/chp.21211.
- *McConachie, D. A. J., McKenzie, K., Morris, P. G., & Walley, R. M. (2014). Acceptance and mindfulness-based stress management for support staff caring for individuals with intellectual disabilities. Research in Developmental Disabilities, 35(6), 1216–1227. https://doi.org/10.1016/j.ridd.2014.03.005.
- McConville, J., McAleer, R., & Hahne, A. (2017). Mindfulness training for health profession students—the effect of mindfulness training on psychological well-being, learning and clinical performance of health professional students: a systematic review of randomized and non-randomized controlled trials. EXPLORE: The Journal of Science and Healing, 13(1), 26–45. https://doi.org/10.1016/j.explore.2016.10.002.Google Scholar
- National Collaborating Centre for Methods and Tools. (2008). Quality Assessment Tool For Quantiative Studies (QATQS). Hamilton: McMaster University.Google Scholar
- *Newsome, S., Waldo, M., & Gruszka, C. (2012). Mindfulness group work: preventing stress and increasing self-compassion among helping professionals in training. Journal for Specialists in Group Work, 37(4), 297–311. https://doi.org/10.1080/01933922.2012.690832.
- Noetel, M., Ciarrochi, J., Van Zanden, B., & Lonsdale, C. (2017). Mindfulness and acceptance approaches to sporting performance enhancement: a systematic review. International Review of Sport and Exercise Psychology, 1–37.Google Scholar
- *Noone, S. J., & Hastings, R. P. (2010). Using acceptance and mindfulness-based workshops with support staff caring for adults with intellectual disabilities. Mindfulness, 1(2), 67–73. https://doi.org/10.1007/s12671-010-0007-4.
- *Pflugeisen, B. M., Drummond, D., Ebersole, D., Mundell, K., & Chen, D. (2016). Brief video-module administered mindfulness program for physicians: a plot study. EXPLORE: The Journal of Science and Healing, 12(1), 50–54. https://doi.org/10.1016/j.explore.2015.10.005.
- *Pipe, T. B., Bortz, J. J., Dueck, A., Pendergast, D., Buchda, V., & Summers, J. (2009). Nurse leader mindfulness meditation program for stress management: a randomized controlled trial. Journal of Nursing Administration, 39(3), 130–137.Google Scholar
- Pollard, E. L., & Davidson, L. (2001). Foundations of child wellbeing. Paris: UNESCO.Google Scholar
- *Poulin, P. A., Mackenzie, C. S., Soloway, G., & Karayolas, E. (2008). Mindfulness training as an evidenced-based approach to reducing stress and promoting well-being among human services professionals. International Journal of Health Promotion and Education, 46(2), 72–80. https://doi.org/10.1080/14635240.2008.10708132.
- *Raab, K., Sogge, K., Parker, N., & Flament, M. F. (2015). Mindfulness-based stress reduction and self-compassion among mental healthcare professionals: a pilot study. Mental Health, Religion and Culture, 18(6), 503–512. https://doi.org/10.1080/13674676.2015.1081588.
- R Core Team (2017). R: a language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing. Retrieved from https://www.R-project.org/.
- *Rimes, K. A., & Wingrove, J. (2011). Pilot study of mindfulness-based cognitive therapy for trainee clinical psychologists. Behavioural and Cognitive Psychotherapy, 39(2), 235–241. https://doi.org/10.1017/S1352465810000731.
- Rudaz, M., Twohig, M. P., Ong, C. W., & Levin, M. E. (2017). Mindfulness and acceptance-based trainings for fostering self-care and reducing stress in mental health professionals: a systematic review. Journal of Contextual Behavioral Science, 6(4), 380–390. https://doi.org/10.1016/j.jcbs.2017.10.001.Google Scholar
- Salovey, P., & Mayer, J. D. (1990). Emotional intelligence. Imagination, Cognition, and Personality, 9(3), 185–211.Google Scholar
- Schwarzer, G. (2007). Meta: an R package for meta-analysis. R News, 7(3), 40–45.Google Scholar
- Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness-based cognitive therapy for depression: a new approach to preventing relapse. New York: Guilford Press.Google Scholar
- Seligman, M. E. P., & Csikszentmihalyi, M. (2000). Positive psychology: an introduction. American Psychologist, 55, 5–14.Google Scholar
- *Shapiro, S. L., Astin, J. A., Bishop, S. R., & Cordova, M. (2005). Mindfulness-based stress reduction for health care professionals: results from a randomized trial. International Journal of Stress Management, 12(2), 164–176. https://doi.org/10.1037/1072-5245.12.2.164.
- *Shapiro, S. L., Brown, K. W., & Biegel, G. M. (2007). Teaching self-care to caregivers: effects of mindfulness-based stress reduction on the mental health of therapists in training. Training and Education in Professional Psychology, 1(2), 105–115. https://doi.org/10.1037/1931-3922.214.171.124.
- *Shapiro, S. L., Schwartz, G. E., & Bonner, G. (1998). Effects of mindfulness-based stress reduction on medical and premedical students. Journal of Behavioral Medicine, 21(6), 581–599. https://doi.org/10.1023/A:1018700829825.
- *Singh, N. N., Lancioni, G. E., Karazsia, B. T., Myers, R. E., Winton, A. S. W., Latham, L. L., & Nugent, K. (2015). Effects of training staff in MBPBS on the use of physical restraints, staff stress and turnover, staff and peer injuries, and cost effectiveness in developmental disabilities. Mindfulness, 6(4), 926–937. https://doi.org/10.1007/s12671-014-0369-0.Google Scholar
- *Song, Y., & Lindquist, R. (2015). Effects of mindfulness-based stress reduction on depression, anxiety, stress and mindfulness in Korean nursing students. Nurse Education Today, 35(1), 86–90. https://doi.org/10.1016/j.nedt.2014.06.010.
- Spielmans, G. I., & Flückiger, C. (2018). Moderators in psychotherapy meta-analysis. Psychotherapy Research, 28(3), 333–346. https://doi.org/10.1080/10503307.2017.1422214.
- Tang, Y.-Y., Ma, Y., Wang, J., Fan, Y., Feng, S., Lu, Q., … Posner, M. I. (2007). Short-term meditation training improves attention and self-regulation. Proceedings of the National Academy of Sciences, 104(43), 17152–17156. https://doi.org/10.1073/pnas.0707678104.
- The Health & Social Care Information Centre. (2009). Adult psychiatric morbidity in England: results of a household survey. London: The Health & Social Care Information Centre.Google Scholar
- Vettese, L. C., Toneatto, T., Stea, J. N., Nguyen, L., & Wang, J. J. (2009). Do mindfulness meditation participants do their homework? And does it make a difference? A review of the empirical evidence. Journal of Cognitive Psychotherapy, 23(3), 198–225. https://doi.org/10.1891/0889-83126.96.36.199.Google Scholar
- Vogus, T. J., Cooil, B., Sitterding, M., & Everett, L. Q. (2014). Safety organizing, emotional exhaustion, and turnover in hospital nursing units. Medical Care Research and Review, 52(10), 870–876.Google Scholar
- Weng, H.-C., Hung, C.-M., Liu, Y.-T., Cheng, Y.-J., Yen, C.-Y., Chang, C.-C., & Huang, C.-K. (2011). Associations between emotional intelligence and doctor burnout, job satisfaction and patient satisfaction. Medical Education, 45(8), 835–842. https://doi.org/10.1111/j.1365-2923.2011.03985.x.Google Scholar
- *West, C. P., Dyrbye, L. N., Rabatin, J. T., Call, T. G., Davidson, J. H., Multari, A., … Shanafelt, T. D. (2014). Intervention to promote physician well-being, job satisfaction, and professionalism a randomized clinical trial. JAMA Internal Medicine, 174(4), 527–533. https://doi.org/10.1001/jamainternmed.2013.14387.
- Wolever, R. Q., Bobinet, K. J., McCabe, K., Mackenzie, E. R., Fekete, E., Kusnick, C. A., & Baime, M. (2012). Effective and viable mind-body stress reduction in the workplace: a randomized controlled trial. Journal of Occupational Health Psychology, 17(2), 246–258. https://doi.org/10.1037/a0027278.Google Scholar