Changes in hair cortisol and self-reported stress measures following mindfulness-based stress reduction (MBSR): A proof-of-concept study in pediatric hematology-oncology professionals.

BACKGROUND AND PURPOSE: Little data is available on the effect of mindfulness amongst pediatric hematology-oncology professionals. The purpose was to further document change in biological and psychological stress following a mindfulness-based stress reduction (MBSR) program. MATERIALS AND METHODS: We led two pre-post interventional studies (n = 12 and n = 25) and measured changes on hair cortisol concentrations, perceived stress, psychological distress and burnout. RESULTS: Professionals did not change on biological stress (d = 0.04), but improved on self-reported measures (median d = 0.58). Effects were maintained over 3 months for psychological distress, anxiety, depression, and burnout (median d = 0.66). Effects were larger if trainees participated to the retreat and if they reported higher baseline perceived stress. CONCLUSION: In pediatric hematology-oncology professionals, an MBSR program was related with improvements in self-reported stress over 3 months. Components of the program and characteristics of trainees may influence the impact of MBSR.

Developing professional caregivers' empathy and emotional competencies through mindfulness-based stress reduction (MBSR): results of two proof-of-concept studies.

OBJECTIVES: To assess the feasibility and acceptability of a mindfulness-based stress reduction (MBSR)-based intervention and determine if the intervention is associated with a significant signal on empathy and emotional competencies. DESIGN: Two pre-post proof-of-concept studies. SETTING: Participants were recruited at the University of Montreal's Psychology Department (Study 1) and the CHU Sainte-Justine Department of Hematology-Oncology (Study 2). PARTICIPANTS: Study 1: 12 students completed the 8-week programme (mean age 24, range 18-34). Study 2: 25 professionals completed the 8-week programme (mean age 48, range 27-63). INTERVENTION: Standard MBSR programme including 8-week mindfulness programme consisting of 8 consecutive weekly 2-hour sessions and a full-day silent retreat. OUTCOMES MEASURES: Mindfulness as measured by the Mindful Attention Awareness Scale; empathy as measured by the Interpersonal Reactivity Index (IRI)'s Perspective Taking and Empathic Concern subscales; identification of one's own emotions and those of others as measured by the Profile of Emotional Competence (PEC)'s Identify my Emotions and Identify Others' Emotions subscales; emotional acceptance as measured by the Acceptance and Action Questionnaire-II (AAQ-II) and the Emotion Regulation Scale (ERQ)'s Expressive Suppression subscale; and recognition of emotions in others as measured by the Geneva Emotion Recognition Test (GERT). RESULTS: In both studies, retention rates (80%-81%) were acceptable. Participants who completed the programme improved on all measures except the PEC's Identify Others' Emotions and the IRI's Empathic Concern (Cohen's d median=0.92, range 45-1.72). In Study 2, favourable effects associated with the programme were maintained over 3 months on the PEC's Identify my Emotions, the AAQ-II, the ERQ's Expressive Suppression and the GERT. CONCLUSIONS: The programme was feasible and acceptable. It was associated with a significant signal on the following outcomes: perspective taking, the identification of one's own emotions and emotional acceptance, thus, justifying moving towards efficacy trials using these outcomes.

Outcomes of MBSR or MBSR-based interventions in health care providers: A systematic review with a focus on empathy and emotional competencies.

BACKGROUND: Emotional competencies are extremely important for healthcare providers exposed to patients' suffering. The effect of mindfulness-based stress reduction (MBSR) has been studied in this population. However, it is unclear whether capacities identified as core for care are modified favourably by this intervention. OBJECTIVES: (1) To identify outcomes in studies on the effect of MBSR in healthcare providers. (2) To evaluate the impact of MBSR on these outcomes. (3) To assess current knowledge on whether capacities central to care are positively impacted by MBSR: empathy, identification of one's own emotions, identification of other's emotions and emotional acceptance. METHODS: We performed a systematic review on interventional studies published up to 2015 evaluating the effect of MBSR in healthcare professionals. A subset of studies including empathy and emotional competencies was assessed for bias following current methodological standards. RESULTS: Thirty nine studies were identified. 14/39 studies measured empathy or some form of emotional competence in healthcare providers. Evidence regarding the effects of MBSR in professionals suggests this intervention is associated with improvements in burnout, stress, anxiety and depression. Improvements in empathy are also suggested but no clear evidence is currently available on emotional competencies. CONCLUSIONS: High quality evidence is available on the effect of MBSR on professionals' mental health. However, while some emotional competencies have been identified as being of major importance for high quality care, they are still scarcely studied. Studying these outcomes is important, as it may help explain how mindfulness contributes to professionals' mental health and thus help develop targeted interventions.

To be or not to be empathic: the combined role of empathic concern and perspective taking in understanding burnout in general practice.

BACKGROUND: General practice is stressful and burnout is common among family physicians. A growing body of evidence suggests that the way physicians relate to their patients could be linked to burnout. The goal of this study was to examine how patterns of empathy explained physicians' burnout. METHODS: We surveyed 294 French general practitioners (response rate 39%), measured burnout, empathic concern (EC) and perspective taking (PT) using self-reported questionnaires, and modeled burnout levels and frequencies with EC, PT and their interaction in linear and logistic regression analyses. RESULTS: Multivariate linear models for burnout prediction were associated with lower PT (ß = -0.21, p < 0.001) and lower EC (ß = -0.17, p < 0.05). Interestingly, the interaction (EC x PT) also predicted burnout levels (ß = 0.11, p < 0.05). The investigation of interactions revealed that high scores on PT predicted lower levels of burnout independent from EC (odd ratios (OR) 0.37; 95% confidence interval (95% CI) 0.21-0.65 p < 0.001), and high scores on both EC and PT were protective against burnout: OR 0.31; 95% CI 0.15-0.63, p < 0.001). CONCLUSIONS: Deficits in PT alone might be a risk factor for burnout, whereas higher PT and EC might be protective. Educators should take into account how the various components of empathy are potentially associated with emotional outcomes in physicians.