Maryanna Klatt

Effects of Low-Dose Mindfulness-Based Stress Reduction (MBSR-ld) on Working Adults

Mindfulness-based stress reduction (MBSR) has produced behavioral, psychological, and physiological benefits, but these programs typically require a substantial time commitment from the participants. This study assessed the effects of a shortened (low-dose [ld]) work-site MBSR intervention (MBSR-ld) on indicators of stress in healthy working adults to determine if results similar to those obtained in traditional MBSR could be demonstrated. Participants were randomized into MBSR-ld and wait-list control groups. Self-reported perceived stress, sleep quality, and mindfulness were measured at the beginning and end of the 6-week intervention. Salivary cortisol was assessed weekly. Significant reductions in perceived stress (p = .0025) and increases in mindfulness (p = .0149) were obtained for only the MBSR-ld group (n = 22). Scores on the global measure of sleep improved for the MBSR-ld group (p = .0018) as well as for the control group (p = .0072; n = 20). Implications and future research are discussed.

Workplace based mindfulness practice and inflammation: A randomized trial

We have developed a low dose Mindfulness-Based Intervention (MBI-ld) that reduces the time committed to meetings and formal mindfulness practice, while conducting the sessions during the workday. This reduced the barriers commonly mentioned for non-participation in mindfulness programs. In a controlled randomized trial we studied university faculty and staff (n=186) who were found to have an elevated CRP level,>3.0 mg/ml, and who either had, or were at risk for cardiovascular disease. This study was designed to evaluate if MBI-ld could produce a greater decrease in CRP, IL-6 and cortisol than an active control group receiving a lifestyle education program when measured at the end of the 2 month interventions. We found that MBI-ld significantly enhanced mindfulness by 2-months and it was maintained for up to a year when compared to the education control. No significant changes were noted between interventions in cortisol, IL-6 levels or self-reported measures of perceived stress, depression and sleep quality at 2-months. Although not statistically significant (p=.08), the CRP level at 2-months was one mg/ml lower in the MBI-ld group than in the education control group, a change which may have clinical significance (Ridker et al., 2000; Wassel et al., 2010). A larger MBI-ld effect on CRP (as compared to control) occurred among participants who had a baseline BMI <30 (-2.67 mg/ml) than for those with BMI >30 (-0.18 mg/ml). We conclude that MBI-ld should be more fully investigated as a low-cost self-directed complementary strategy for decreasing inflammation, and it seems most promising for non-obese subjects.

Feasibility and preliminary outcomes for Move-Into-Learning: An arts-based mindfulness classroom intervention

This feasibility study investigated teachers’ assessment of Move-Into-Learning (MIL), an eight-week school-based Mindfulness-based intervention (MBI), designed to reduce stress and improve behavior in at-risk elementary students. MIL was implemented with two classrooms of third-grade students (n = 41) in a low income, urban neighborhood using a pretest to posttest single group design. One of the two classrooms (n = 20) completed a two-month follow-up measure examining sustainability of results. The program included mindfulness meditation, yoga movement with breathing exercises, and Appreciative Inquiry (AI) exercises that invited students to express themselves in the written and visual arts. MIL was evaluated via semi-structured teacher interviews and the Connors’ Behavior Rating Scale. Pre/post intervention showed significant improvement in behaviors, such as hyperactivity (t[1,39 = 3.1; p = 0.002), and highly significant differences in the attention-deficit/hyperactivity disorder index (t[1,39] = 5.42; p < 0.001) and cognitive/inattentiveness (t[1,39] = 5.56; p < 0.001) subscales. Teacher interview data supported these findings suggesting MIL as a feasible and acceptable MBI that can be implemented in a third-grade classroom.

A small randomized pilot study of a workplace mindfulness-based intervention for surgical intensive care unit personnel: effects on salivary α-amylase levels.

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 &agr;-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 &agr;-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.

Mindfulness in Motion (MIM): An Onsite Mindfulness Based Intervention (MBI) for Chronically High Stress Work Environments to Increase Resiliency and Work Engagement.

A pragmatic mindfulness intervention to benefit personnel working in chronically high-stress environments, delivered onsite during the workday, is timely and valuable to employee and employer alike. Mindfulness in Motion (MIM) is a Mindfulness Based Intervention (MBI) offered as a modified, less time intensive method (compared to Mindfulness-Based Stress Reduction), delivered onsite, during work, and intends to enable busy working adults to experience the benefits of mindfulness. It teaches mindful awareness principles, rehearses mindfulness as a group, emphasizes the use of gentle yoga stretches, and utilizes relaxing music in the background of both the group sessions and individual mindfulness practice. MIM is delivered in a group format, for 1 hr/week/8 weeks. CDs and a DVD are provided to facilitate individual practice. The yoga movement is emphasized in the protocol to facilitate a quieting of the mind. The music is included for participants to associate the relaxed state experienced in the group session with their individual practice. To determine the intervention feasibility/efficacy we conducted a randomized wait-list control group in Intensive Care Units (ICUs). ICUs represent a high-stress work environment where personnel experience chronic exposure to catastrophic situations as they care for seriously injured/ill patients. Despite high levels of work-related stress, few interventions have been developed and delivered onsite for such environments. The intervention is delivered on site in the ICU, during work hours, with participants receiving time release to attend sessions. The intervention is well received with 97% retention rate. Work engagement and resiliency increase significantly in the intervention group, compared to the wait-list control group, while participant respiration rates decrease significantly pre-post in 6/8 of the weekly sessions. Participants value institutional support, relaxing music, and the instructor as pivotal to program success. This provides evidence that MIM is feasible, well accepted, and can be effectively implemented in a chronically high-stress work environment.

Educational innovations to foster resilience in the health professions

Abstract Stress and burnout of healthcare providers has become a major healthcare issue that has implications for not only workforce projections, but the cost and quality of care and the lives of healthcare providers and their families. Burnout, characterized by loss of enthusiasm for work, feelings of cynicism and a low sense of personal accomplishment is associated with early retirement, alcohol use, and suicidal ideation. Healthcare professional “wellbeing” or “care of the caregiver” is a topic that has not been significantly addressed in the education of healthcare professionals. The culture that has dominated much of education has been one where students have been expected to forego personal needs, endure stressful environments, and emerge from highly competitive and often dysfunctional environments to work in care settings where health and wellbeing is also largely ignored. Three curricular innovations are highlighted that target pre-professional students, students enrolled in health professions education and practicing health care professionals. Strategies are highlighted that both help individuals cultivate resiliency and wellbeing in their personal and professional lives and that address system issues that contribute to unhealthy learning and work environments.

Interprofessional Competencies in Integrative Primary Healthcare

In October 2014, the National Center for Integrative Primary Healthcare (NCIPH) was launched as a collaboration between the University of Arizona Center for Integrative Medicine and the Academic Consortium for Integrative Health and Medicine and supported by a grant from the Health Resources and Services Administration. A primary goal of the NCIPH is to develop a core set of integrative healthcare (IH) competencies and educational programs that will span the interprofessional primary care training and practice spectra and ultimately become a required part of primary care education. This article reports on the first phase of the NCIPH effort, which focused on the development of a shared set of competencies in IH for primary care disciplines. The process of development, refinement, and adoption of 10 “meta-competencies” through a collaborative process involving a diverse interprofessional team is described. Team members represent nursing, the primary care medicine professions, pharmacy, public health, acupuncture, naturopathy, chiropractic, nutrition, and behavioral medicine. Examples of the discipline-specific sub-competencies being developed within each of the participating professions are provided, along with initial results of an assessment of potential barriers and facilitators of adoption within each discipline. The competencies presented here will form the basis of a 45-hour online curriculum produced by the NCIPH for use in primary care training programs that will be piloted in a wide range of programs in early 2016 and then revised for wider use over the following year.

Feasibility of a Mindfulness-Based Intervention for Surgical Intensive Care Unit Personnel

Background Surgical intensive care unit personnel are exposed to catastrophic situations as they care for seriously injured or ill patients. Few interventions have been developed to reduce the negative effects of work stress in this environment. Objective This pilot study evaluated the feasibility of a workplace intervention for increasing resilience to stress. The intervention was implemented within the unique constraints characteristic of surgical intensive care units. Methods Participants were randomly assigned to an intervention or control group. The mindfulness‐based intervention included meditation, mild yoga movement, and music and was conducted in a group format 1 hour a week for 8 weeks in a surgical intensive care unit during work hours. Assessments were performed 1 week before and 1 week after the intervention. Results The intervention was well received, with a 97% overall retention rate and 100% retention in the intervention group. Work satisfaction, measured with the Utrecht Work Engagement Scale, increased significantly in the intervention group with no change in the control group. Negative correlations were found between the vigor subscale scores of the Utrecht Work Engagement Scale and scores for emotional exhaustion on the Maslach Burnout Inventory and scores for burnout on the Professional Quality of Life scale. Participants rated recognizing their stress response as a main benefit of the intervention. Conclusion Workplace group interventions aimed at decreasing the negative effects of stress can be applied within hospital intensive care units. Despite many constraints, attendance at weekly sessions was high. Institutional support was critical for implementation of this program.

A healthcare utilization cost comparison between employees receiving a worksite mindfulness or a diet/exercise lifestyle intervention to matched controls 5 years post intervention

OBJECTIVE To compare healthcare costs and utilization among participants in a study of two active lifestyle interventions implemented in the workplace and designed to foster awareness of and attention to health with a propensity score matched control group. DESIGN AND SETTING We retrospectively compared changes in healthcare (HC) utilization among participants in the mindfulness intervention (n=84) and the diet/exercise intervention (n=86) to a retrospectively matched control group (n=258) drawn for this study. The control group was matched from the non-participant population on age, gender, relative risk score, and HC expenditures in the 9 month preceding the study. MAIN OUTCOME MEASURES Measures included number of primary care visits, number and cost of pharmacy prescriptions, number of hospital admissions, and overall healthcare costs tracked for 5 years after the intervention. RESULTS Significantly fewer primary care visits (p<.001) for both intervention groups as compared to controls, with a non-significant trend towards lower overall HC utilization (4,300.00 actual dollar differences) and hospital admissions for the intervention groups after five years. Pharmacy costs and number of prescriptions were significantly higher for the two intervention groups compared to controls over the five years (p<0.05), yet still resulted in less HC utilization costs, potentially indicating greater self-management of care. CONCLUSION This study provides valuable information as to the cost savings and value of providing workplace lifestyle interventions that focus on awareness of ones body and health. Health economic studies validate the scale of personal and organization health cost savings that such programs can generate.

A Mixed-Method Approach to Evaluating the Association Between Myofascial Trigger Points and Ankle/Foot Pain Using Handheld Sonography Equipment A Pilot Study

This mixed-method blinded research study used high-frequency diagnostic medical sonography (DMS) to document myofascial trigger points (MTrPs) associated with ankle/foot pain. A total of 17 symptomatic and 8 asymptomatic participants provided 500 MTrP areas for palpation. Forty-nine of these MTrP areas (including 16 tender points, 15 palpable MTrPs, and 18 palpated and imaged MTrPs) were compared with the patient’s ankle/foot pain, collected with the SF-12 Health Survey, Victorian Institute of Sports Assessment–Achilles questionnaire, and a visual analog scale. Qualitative analyses of the participants’ histories were used to understand the context of the data collected. The mean area of the 18 imaged MTrPs was 0.09 cm2, and they appeared inhomogeneous and hypoechoic. Those with right-sided MTrPs were statistically significant for those with reported pain. Participants with left-sided MTrPs did not demonstrate a significant correlation to reported pain. The results demonstrated a promising possible diagnostic approach using sonography to evaluate MTrPs in the ankle/foot for documenting myofascial pain. In addition, elastography and transducer frequencies >12 MHz are proposed as a DMS technique to increase overall diagnostic yield.