The Impact of Psychological Interventions with Elements of Mindfulness on Burnout and Well-Being in Healthcare Professionals: A Systematic Review

Figures & data

Figure 1 Presentation of detailed search strategy.

Table 1 Main Characteristics of the Reviewed Studies

Author/Year/Ref No./Location	Study Design	Sample Size	Intervention (See Table 2 for Details)	Main Findings	QA
1. Kemper (2017);^Citation22 USA	Prospective non-randomized pre-post intervention study	178	Three 1h online mindfulness modules	Small but significant increase in mindfulness scores	11
2. Dobkin (2016);^Citation23 France	Prospective non-randomized pre-post intervention study	27	8-week MBSR	Significant reductions in stress and burnout; increase in mindfulness and meaningfulness	11
3. Kemper et al (2015);^Citation24 USA	Prospective non-randomized pre-post intervention study	513	12 1h online modules; mind-body skills training programme	Acute improvements in stress levels, mindfulness, empathy and resilience	11
4. Goodman et al (2012);^Citation25 USA	Prospective non-randomized pre-post intervention study	93	8-week MBSR + 1-day retreat	Significant reduction in burnout scores and improvements in mental well-being	10
5. Asuero et al (2014);^Citation26 Spain	Randomized controlled trial	68	8-week mindfulness training and group discussions + 1-day retreat	Improvement in all measured scales – total mood disturbance, mindfulness, burnout and empathy	12.5
6. Sallon et al (2015);^Citation27 Israel	Prospective non-randomized pre-post controlled intervention study	215	Caring for caregivers – 8 months of weekly workshops	Significant improvements in quality of work, decrease in symptoms of perceived stress and emotional exhaustion associated with burnout	10.5
7. Moody et al (2013);^Citation28 USA, Israel	Randomized controlled pilot study	48	8-week mindfulness training	No significant improvement in scores of burnout, perceived stress or depression	12.5
8. Abeni et al (2014);^Citation29 Italy	Prospective non-randomized pre-post intervention study	34	Modified “Balint Group” method according to a mindfulness technique	Development of more adaptive ways of using defence mechanisms	10
9. Lamothe et al (2018);^Citation30 Canada	Prospective non-randomized pre-post intervention study	37	8-week MBSR	Significant improvements in perspective taking, identification of one’s own emotions, and emotional acceptance	11.5
10. Gracia Gozalo et al (2019);^Citation31 Spain	Prospective non-randomized pre-post intervention study	32	8-week mindfulness training	A decrease in emotional exhaustion and an increase in self-compassion	11
11. Suyi et al (2017);^Citation32 Singapore	Prospective non-randomized pre-post intervention study	37	Modified MBSR	Significant improvements in four of the five mindfulness facets and compassion levels; gains maintained at 3 months follow-up	11
12. Steinberg et al (2017);^Citation33 USA	Randomized controlled pilot study	32	8-week mindfulness training	Significant increase in work satisfaction which negatively correlated with burnout	12.5
13. Kemper et al (2015);^Citation34 USA	Prospective non-randomized pre-post intervention study	103	Online MBS training – 12 1h modules	Significant improvements in stress, mindfulness, and confidence in providing calm, compassionate care	11.5
14. Barattucci et al (2019);^Citation35 Italy	Prospective non-randomized pre-post intervention study	602	IARA training programme	Improvement in emotional regulation, anxiety and stress 6 months after intervention	11.5
15. Janssen et al (2020);^Citation36 Netherlands	Prospective non-randomized pre-post intervention study	30	MBSR	Significant improvements in mindfulness, burnout dimension PA, quality of sleep, positive emotions and self-efficacy	10.5

Abbreviations: QA, quality assessment; USA, United States of America; MBSR, Mindfulness Based Stress Reduction; MBS, Mind Body Skills; IARA, an Italian acronym translatable into meeting, compliance, responsibility, autonomy.

Table 2 Detailed Information About the Interventions

Author (Year); Ref No.	Intervention/Duration	Description
1. Kemper (2017);^Citation22	Three 1h online mindfulness modules	Introduction to mindfulness Mindfulness in daily life Mindful breathing and walking
2. Dobkin (2016);^Citation23	8-week MBSR + 1-day retreat 2.5h per class on a weekly basis for 8 consecutive weeks	MBSR is a systematic approach to group mindfulness training. Classes opened with meditation practice, and included mindful movement, sitting and body scan meditations; specific exercises were extended as homework. Two classes focused on stress management and three included exercises to enhance communication skills. Group discussions were encouraged.
3. Kemper et al (2015);^Citation24	Mind-body skills (MBS) training 12 1h online modules	3 modules for each of 4 types of mind-body skills: (1) Focused attention meditation (relaxation response); (2) Mindfulness; (3) Guided imagery and hypnosis (including autogenic training); and (4) Positive affect-generating meditation (such as gratitude and loving-kindness). The participants were allowed to complete the modules in any number, any order, and in any combination.
4. Goodman et al (2012);^Citation25	8-week MBSR + 1-day retreat	4 types of formal mindfulness practices were taught (body scan, mindful movement, walking meditation, sitting meditation). Each class had a topic: (1) Overview of mindfulness; (2) Applying mindfulness in everyday life; (3) Mindful movement; (4) Applying mindfulness to challenging situations; (5) Mindful communication; (6) Practising appreciation; (7) Compassion meditation; (8) Review.
5. Asuero et al (2015);^Citation26	8-week mindfulness training + 1-day retreat	Each weekly session included four types of activities: (1) Educational presentation of different topics; (2) Formal mindfulness meditation; (3) Narrative and appreciative inquiry exercises; (4) Discussion.
6. Sallon et al (2015);^Citation27	Caring for caregivers (CCG) 8 months of workshops (30 weekly sessions – 2.25 hours/week + a final full-day workshop)	Five components of CCG intervention: (1) Cognitive (mindfulness training); (2) Somatic (body awareness-relaxation; mindful movement and postural alignment); (3) Emotive-expressive (drawing/journalling/listening circle); (4) Dynamic-interactive (movement/interactive dance); and (5) Hands-on (acupressure/shiatsu).
7. Moody et al (2013);^Citation28	8-week mindfulness-based course (initial 6h session;6 weekly 1h follow-up sessions; final 3h wrap-up session)	Primary focus on the experiential practices (body scan, sitting meditation, mindful movement, STOP technique (Stop, Take a breath, Observe, Proceed), “loving-kindness” meditation) and discussion about them, and 20% didactic information (cultivating awareness of body sensations, thoughts, and emotions during pleasant and unpleasant events; identifying perceptual biases and filters; exploring individual reactivity to stress; reflecting on meaningful experiences and practice; training in skilful listening and communication, exploring self-care).
8. Abeni et al (2014);^Citation29	“Balint group” modified according to a mindfulness technique 30 1h sessions	This method promotes a group process of exploration and training based on reflection on the relational experience with patients, focusing on the development of attentive awareness of sensations, thoughts, and perceptions of reality at the time of the session.
9. Lamothe et al (2018);^Citation30	8-week MBSR	MBSR as already described. Participants received a workbook and audio recordings of guided meditations to help them with home practice.
10. Gracia Gozalo et al (2019);^Citation31	8-week mindfulness training Short practices (5–8 min) in the course of 8 weeks	On Monday of each week, the participants received a text file via WhatsApp explaining the exercise, and an audio file that could be used for guided meditation. Each day the participants received a practice reminder message in the form of a motivating phrase, image or video. Session objectives: (1) introduction to mindfulness; (2) knowing attention and internal anchoring in breathing; (3) attention to the body; (4) attention to thoughts; (5) informal practice; (6) knowing techniques in movement; (7) knowing the potential in emotional regulation; (8) introduction to compassion.
11. Suyi et al (2017);^Citation32	Modified MBSR 6 weekly 2h sessions	Topics: (1) introduction to practice; (2) perception and engaging with practice; (3) awareness of being stuck in one’s life and how to get unstuck; (4) reacting and responding to stress, exploring perceptions and thoughts; (5) mindful communication in stressful situations; (6) cultivating kindness towards oneself and others. During the training, meditation practices were taught. Participants were asked to practise 30 min of formal meditation daily.
12. Steinberg et al (2017);^Citation33	8-week mindfulness-based intervention (weekly 1h group session at the workplace during work hours)	Participants were asked to do 20-minute daily individual practices.
13. Kemper et al (2015);^Citation34	Online MBS (mind-body skills) training 12 1h modules	4 general topics: (1) focused attention meditation (relaxation response); (2) mindfulness meditation; (3) positive affect meditation (positive or sacred word, gratitude, and loving-kindness/compassion meditation); (4) guided imagery/hypnosis (autogenic training; guided imagery to prepare for surgery, procedures, or childbirth; and guided imagery for sleep and changing habits).
14. Barattucci et al (2019);^Citation35	IARA training programme 4 meetings for 8 hours Group training (18–22 participants per group)	1st meeting: IARA principles, creation of a working group, developing awareness of here and now 2nd meeting: techniques of counselling, improving emotional awareness and patient-centred care 3rd meeting: SWOT analysis, creative imagination, IARA techniques 4th meeting: seven psychological types, planning changes, improving awareness of people’s qualities
15. Janssen et al (2020);^Citation36	8-week MBSR + 1 day silence during working hours	Guided instruction in mindfulness meditation practices (body scan, sitting meditation) Simple movement exercises (stretching and yoga) Short group discussion Informal meditation exercises: paying full attention to daily activities (eg brushing one’s teeth, taking a shower, eating)

Kemper KJ. Brief online mindfulness training: immediate impact. J Evid Based Complementary Altern Med. 2017;22(1):75–80. doi:10.1177/2156587216639199

 PubMedGoogle Scholar

Dobkin PL, Bernardi NF, Bagnis CI. Enhancing clinicians’ well-being and patient-centered care through mindfulness. J Contin Educ Health Prof. 2016;36(1):11–16. doi:10.1097/CEH.0000000000000021

 PubMed Web of Science ®Google Scholar

Kemper KJ, Khirallah M. Acute effects of online mind-body skills training on resilience, mindfulness, and empathy. J Evid Based Complementary Altern Med. 2015;20(4):247–253. doi:10.1177/2156587215575816

 PubMedGoogle Scholar

Goodman MJ, Schorling JB. A mindfulness course decreases burnout and improves well-being among healthcare providers. Int J Psychiatry Med. 2012;43(2):119–128. doi:10.2190/PM.43.2.b

 PubMed Web of Science ®Google Scholar

Asuero AM, Queraltó JM, Pujol-Ribera E, Berenguera A, Rodriguez-Blanco T, Epstein RM. Effectiveness of a mindfulness education program in primary health care professionals: a pragmatic controlled trial. J Contin Educ Health Prof. 2014;34(1):4–12. doi:10.1002/chp.21211

 PubMed Web of Science ®Google Scholar

Sallon S, Katz-Eisner D, Yaffe H, Bdolah-Abram T. Caring for the caregivers: results of an extended, five-component stress-reduction intervention for hospital staff. Behav Med. 2017;43(1):47–60. doi:10.1080/08964289.2015.1053426

 PubMed Web of Science ®Google Scholar

Moody K, Kramer D, Santizo RO, et al. Helping the helpers: mindfulness training for burnout in pediatric oncology – a pilot program. J Pediatr Oncol Nurs. 2013;30(5):275–284. doi:10.1177/1043454213504497

 PubMed Web of Science ®Google Scholar

Abeni MS, Magni M, Conte ML, et al. Psychological care of caregivers, nurses and physicians: a study of a new approach. Cancer Med. 2014;3(1):101–110. doi:10.1002/cam4.163

 PubMed Web of Science ®Google Scholar

Lamothe M, McDuff P, Pastore YD, Duval M, Sultan S. Developing professional caregivers’ empathy and emotional competencies through mindfulness-based stress reduction (MBSR): results of two proof-of-concept studies. BMJ Open. 2018;8(1):e018421. doi:10.1136/bmjopen-2017-018421

 PubMed Web of Science ®Google Scholar

Gracia Gozalo RM, Ferrer Tarrés JM, Ayora Ayora A, Alonso Herrero M, Amutio Kareaga A, Ferrer Roca R. Application of a mindfulness program among healthcare professionals in an intensive care unit: effect on burnout, empathy and self-compassion. Med Intensiva. 2019;43(4):207–216. doi:10.1016/j.medin.2018.02.005

 PubMed Web of Science ®Google Scholar

Suyi Y, Meredith P, Khan A. Effectiveness of mindfulness intervention in reducing stress and burnout for mental health professionals in Singapore. Explore. 2017;13(5):319–326. doi:10.1016/j.explore.2017.06.001

 Google Scholar

Steinberg BA, Klatt M, Duchemin AM. Feasibility of a mindfulness-based intervention for surgical intensive care unit personnel. Am J Crit Care. 2016;26(1):10–18. doi:10.4037/ajcc2017444

 PubMed Web of Science ®Google Scholar

Kemper KJ, Lynn J, Mahan JD. What is the impact of online training in mind-body skills? J Evid Based Complementary Altern Med. 2015;20(4):275–282. doi:10.1177/2156587215580882

 PubMedGoogle Scholar

Barattucci M, Padovan AM, Vitale E, Rapisarda V, Ramaci T, De Giorgio A. Mindfulness-based IARA model® proves effective to reduce stress and anxiety in health care professionals. A six-month follow-up study. Int J Environ Res Public Health. 2019;16(22):4421. doi:10.3390/ijerph16224421

 PubMed Web of Science ®Google Scholar

Janssen M, Van der Heijden B, Engels J, Korzilius H, Peters P, Heerkens Y. Effects of mindfulness-based stress reduction training on healthcare professionals’ mental health: results from a pilot study testing its predictive validity in a specialized hospital setting. Int J Environ Res Public Health. 2020;17(24):9420. doi:10.3390/ijerph17249420

 PubMed Web of Science ®Google Scholar