Pilot study of the effectiveness of a Mindful Self-Care and Resiliency program for rural doctors in Australia.

OBJECTIVE: Rural doctors are difficult to recruit and retain. Burnout and stress in the medical workforce fluctuates according to location. Overall, doctors have an elevated risk of depression and suicide compared to the general population and other professionals. Higher levels of occupational stress also effect patient care, levels of work satisfaction and relationships with others. This study evaluated the effectiveness, acceptability, feasibility and sustainability of the Mindful Self-Care and Resiliency Program. DESIGN: This was a sequential mixed-method study involving the collection of both quantitative and qualitative data. SETTING: The study was conducted in Emerald, Queensland. PARTICIPANTS: Thirteen doctors took part in the program with seven providing pre and post survey responses. Qualitative data were collected via semi-structured telephone interviews with an additional four rural doctors. Intervention The Mindful Self-Care and Resiliency program consisted of a 4-hour face-to-face session and three 1-hour video-conference follow up sessions. Main outcome measures Burnout, negative affect, well-being and psychological strain were assessed using self-report measures before and after taking part in the program. Results The majority (six out of seven) of the doctors showed reductions in burnout, psychological strain and negative affect following participation in the program. The qualitative data indicated that all doctors gained new skills: self-awareness, reflection and self-care. They also reported improved interaction with colleagues and patients, to whom they passed on their new learning. Conclusion This preliminary investigation of the effectiveness and feasibility of Mindful Self-Care and Resiliency for rural doctors indicates that the program has promise in improving the emotional well-being of this occupational group. Although this study captured approximately one-third of the Emerald workforce, further research with a larger sample is required to confirm these findings.

A nonrandomized effectiveness comparison of broad-spectrum group CBT to individual CBT for depressed outpatients in a community mental health setting.

Controlled trials have established the efficacy of cognitive-behavior therapy (CBT) for depression. However, the relative effectiveness of individual versus group treatment formats in real-world settings is less well established. The current study evaluated the effectiveness of group CBT (n=157) compared to individual CBT (n=77) for depressed outpatients in a naturalistic setting. Symptom improvements for depression, anxiety, and quality of life were compared between treatment formats in intent-to-treat and completer analyses. Effect sizes and rates of recovery were examined. Results showed that both individual and group CBT were effective, even in the presence of high levels of comorbidity. Whereas individual CBT was associated with larger effect sizes and significantly higher rates of recovery, group CBT compared favorably to outcomes established by past research. A broad-spectrum group CBT program may be a viable treatment option when depression symptoms are less severe and when this format of treatment delivery is desirable.

MCMI-III personality complexity and depression treatment outcome following group-based cognitive-behavioral therapy.

This study investigated the association of personality disorder complexity to treatment outcome for depression following time-limited group-based cognitive-behavioral therapy. One hundred fifteen outpatients with a primary diagnosis of depression participated in the study. In this study, personality disorder complexity was determined by the degree of personality disorder comorbidity identified by the Millon Clinical Multiaxial Inventory-III (T. Millon, 1994). As predicted, analyses revealed that increasing personality disorder complexity was related to increasing baseline symptom severity and slightly poorer end-state functioning at posttreatment. However, results regarding clinically significant improvement and mean improvement in depression symptoms were less supportive of an association between personality disorder complexity and poorer treatment outcome. The implications of these findings for treatment planning are discussed.