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Open Access 01-12-2018 | Study protocol

Evaluation of mindfulness-based cognitive therapy for life and a cognitive behavioural therapy stress-management workshop to improve healthcare staff stress: study protocol for two randomised controlled trials

Authors: Clara Strauss, Jenny Gu, Nikki Pitman, Cavita Chapman, Willem Kuyken, Adrian Whittington

Published in: Trials | Issue 1/2018

Abstract

Background

Healthcare workers experience higher levels of work-related stress and higher rates of sickness absence than workers in other sectors. Psychological approaches have potential in providing healthcare workers with the knowledge and skills to recognise stress and to manage stress effectively. The strongest evidence for effectiveness in reducing stress in the workplace is for stress-management courses based on cognitive behavioural therapy (CBT) principles and mindfulness-based interventions (MBIs). However, research examining effects of these interventions on sickness absence (an objective indicator of stress) and compassion for others (an indicator of patient care) is limited, as is research on brief CBT stress-management courses (which may be more widely accessible) and on MBIs adapted for workplace settings.

Methods/design

This protocol is for two randomised controlled trials with participant preference between the two trials and 1:1 allocation to intervention or wait-list within the preferred choice. The first trial is examining a one-day CBT stress-management workshop and the second trial an 8-session Mindfulness-Based Cognitive Therapy for Life (MBCT-L) course, with both trials comparing intervention to wait-list. The primary outcome for both trials is stress post-intervention with secondary outcomes being sickness absence, compassion for others, depression symptoms, anxiety symptoms, wellbeing, work-related burnout, self-compassion, presenteeism, and mindfulness (MBCT-L only). Both trials aim to recruit 234 staff working in the National Health Service in the UK.

Discussion

This trial will examine whether a one-day CBT stress-management workshop and an 8-session MBCT-L course are effective at reducing healthcare staff stress and other mental health outcomes compared to wait-list, and, whether these interventions are effective at reducing sickness absence and presenteeism and at enhancing wellbeing, self-compassion, mindfulness and compassion for others. Findings will help inform approaches offered to reduce healthcare staff stress and other key variables. A note of caution is that individual-level approaches should only be part of the solution to reducing healthcare staff stress within a broader focus on organisational-level interventions and support.

Trial registration

ISRCTN Registry, ISRCTN11723441. Registered on 16 June 2017.

Protocol Version 1: 24 April 2017.

Trial Sponsor: Sussex Partnership NHS Foundation Trust (ResearchGovernance@sussexpartnership.nhs.uk).

Available only for authorised users

Advisory Board, 2014. Health care workers may be the nation’s most stressed employees [WWW document]. https://www.advisory.com/daily-briefing/2014/02/13/health-care-workers-may-be-the-nations-most-stressed-employees. Accessed 17 Oct 17.

Antony MM, Bieling PJ, Cox BJ, Enns MW, Swinson RP. Psychometric properties of the 42-item and 21-item versions of the depression anxiety stress scales in clinical groups and a community sample. Psychol Assess. 1998;10:176–81.CrossRef

Baer RA, Smith GT, Hopkins J, Krietemeyer J, Toney L. Using self-report assessment methods to explore facets of mindfulness. Assessment. 2006;13:27–45. https://doi.org/10.1177/1073191105283504.CrossRefPubMed

Baer RA, Carmody J, Hunsinger M. Weekly change in mindfulness and perceived stress in a mindfulness- based stress reduction program. Journal of Clinical Psychology. 2012;68(7):755–765. https://doi.org/10.1002/jclp.21865.

Bernard P, Cullen C, Kuyken W. MBCT for life teacher manual. Oxford: Oxford Mindfulness Centre; 2017.

Bouwmans C, De Jong K, Timman R, Zijlstra-Vlasveld M, Van der Feltz-Cornelis C, Tan SS, Hakkaart-van Roijen L. Feasibility, reliability and validity of a questionnaire on healthcare consumption and productivity loss in patients with a psychiatric disorder (TiC-P). BMC Health Serv Res. 2013;13:217. https://doi.org/10.1186/1472-6963-13-217.CrossRefPubMedPubMedCentral

Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101. https://doi.org/10.1191/1478088706qp063oa.CrossRef

Carmody J, Baer RA. Relationships between mindfulness practice and levels of mindfulness, medical and psychological symptoms and well-being in a mindfulness-based stress reduction program. J Behav Med. 2008;31:23–33. https://doi.org/10.1007/s10865-007-9130-7 CrossRefPubMed

de Vibe M, Solhaug I, Tyssen R, Friborg O, Rosenvinge JH, Sørlie T, Bjørndal A. Mindfulness training for stress management: a randomised controlled study of medical and psychology students. BMC Med Educ. 2013;13(107). https://doi.org/10.1186/1472-6920-13-107.

10.

Elliott R, Rodgers B. Client change interview schedule (v5) [WWW document]. 2008. https://drive.google.com/file/d/0B4QhybeF75vseWRYMjlFQVFRWlU/edit. Accessed 6 Feb 2018.

11.

Elliott R, Slatick E, Urman M. Qualitative change process research on psychotherapy: alternative strategies. In: Frommer J, Rennie DL, editors. Qualitative psychotherapy research: methods and methodology. Lengerich: Pabst Science; 2001. p. 69–111.

12.

Erogul M, Singer G, McIntyre T, Stefanov DG. Abridged mindfulness intervention to support wellness in first-year medical students. Teach Learn Med. 2014;26:350–6. https://doi.org/10.1080/10401334.2014.945025.CrossRefPubMed

13.

Faul F, Erdfelder E, Lang A-G, Buchner A. G*power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39:175–91.CrossRefPubMed

14.

Geary C, Rosenthal SL. Sustained impact of MBSR on stress, well-being, and daily spiritual experiences for 1 year in academic health care employees. J Altern Complement Med. 2011;17:939–44. https://doi.org/10.1089/acm.2010.0335.CrossRefPubMed

15.

Good DJ, Lyddy CJ, Glomb TM, Bono JE, Brown KW, Duffy MK, Baer RA, Brewer JA, Lazar SW. Contemplating mindfulness at work. J Manag. 2016;42:114–42. https://doi.org/10.1177/0149206315617003.

16.

Gu J, Cavanagh K, Baer R, Strauss C. An empirical examination of the factor structure of compassion. PLoS One. 2017;12:e0172471. https://doi.org/10.1371/journal.pone.0172471.CrossRefPubMedPubMedCentral

17.

Gu J, Strauss C, Crane C, Barnhofer T, Karl A, Cavanagh K, Kuyken W. Examining the factor structure of the 39-item and 15-item versions of the five-facet mindfulness questionnaire before and after mindfulness-based cognitive therapy for people with recurrent depression. Psychol Assess. 2016;28(7):791–802. https://doi.org/10.1037/pas0000263.

18.

Hall LH, Johnson J, Watt I, Tsipa A, O’Connor DB. Healthcare staff wellbeing, burnout, and patient safety: a systematic review. PLoS One. 2016;11:e0159015. https://doi.org/10.1371/journal.pone.0159015.CrossRefPubMedPubMedCentral

19.

Henry JD, Crawford JR. The short-form version of the depression anxiety stress scales (DASS-21): construct validity and normative data in a large non-clinical sample. Br J Clin Psychol. 2005;44:227–39. https://doi.org/10.1348/014466505X29657.CrossRefPubMed

20.

Johnson S. NHS staff most stressed public sector workers, survey finds. Guardian; 2015. https://www.theguardian.com/healthcare-network/2015/jun/12/nhs-staff-most-stressed-public-sector-workers-survey-finds.

21.

Joyce S, Modini M, Christensen H, Mykletun A, Bryant R, Mitchell PB, Harvey SB. Workplace interventions for common mental disorders: a systematic meta-review. Psychol Med. 2016;46:683–97. https://doi.org/10.1017/S0033291715002408.CrossRefPubMed

22.

Koopmanschap MA. PRODISQ: a modular questionnaire on productivity and disease for economic evaluation studies. Expert Rev Pharmacoecon Outcomes Res. 2005;5:23–8. https://doi.org/10.1586/14737167.5.1.23.CrossRefPubMed

23.

Kuyken W, Warren FC, Taylor RS, Whalley B, Crane C, Bondolfi G, Hayes R, Huijbers M, Ma H, Schweizer S, Segal Z, Speckens A, Teasdale JD, Van Heeringen K, Williams M, Byford S, Byng R, Dalgleish T. Efficacy of mindfulness-based cognitive therapy in prevention of depressive relapse. JAMA Psychiatry. 2016;73:565. https://doi.org/10.1001/jamapsychiatry.2016.0076.CrossRefPubMed

24.

Lazarus RS. Psychological stress in the workplace, occupational stress: a handbook. London: Taylor & Francis; 1995.

25.

Lazarus RS, Folkman S. Transactional theory and research on emotions and coping. Eur J Personal. 1987;1:141–69. https://doi.org/10.1002/per.2410010304.CrossRef

26.

Lazarus RS, Folkman S. Stress, appraisal, and coping. 1984

27.

Lovibond S, Lovibond P. Manual for the depression anxiety stress scale. Sydney: Psychology Foundation; 1995.

28.

Marx R, Strauss C, Williamson C, Karunavira T. The eye of the storm: a feasibility study of an adapted mindfulness-based cognitive therapy (MBCT) group intervention to manage NHS staff stress. Cogn Behav Ther. 2014;7:e18. https://doi.org/10.1017/S1754470X14000300.

29.

Maslach C, Jackson SE, Leiter MP. Maslach burnout inventory. Palo Alto: Consulting Psychologists Press; 1981.

30.

NHS Survey Coordination Centre. Briefing note: issues highlighted by the 2016 NHS staff survey in England. Oxford; 2017. http://www.nhsstaffsurveys.com/Caches/Files/20170306_ST16_National%20Briefing_v6.0.pdf.

31.

Office for National Statistics. Sickness absence in the labour market: 2016. Newport; 2017. https://www.ons.gov.uk/employmentandlabourmarket/peopleinwork/labourproductivity/articles/sicknessabsenceinthelabourmarket/2016.

32.

Panagioti M, Panagopoulou E, Bower P, Lewith G, Kontopantelis E, Chew-Graham C, Dawson S, van Marwijk H, Geraghty K, Esmail A. Controlled interventions to reduce burnout in physicians. JAMA Intern Med. 2017;177:195. https://doi.org/10.1001/jamainternmed.2016.7674.CrossRefPubMed

33.

Quality Watch. NHS staff sickness absence. London: Nuffield Trust & the Health Foundation; 2016. http://www.qualitywatch.org.uk/indicator/nhs-staff-sickness-absence%23.

34.

Richardson KM, Rothstein HR. Effects of occupational stress management intervention programs: a meta-analysis. J Occup Health Psychol. 2008;13:69–93. https://doi.org/10.1037/1076-8998.13.1.69.CrossRefPubMed

35.

Segal ZV, Williams JMG, Teasdale JD. Mindfulness-based cognitive therapy for depression. 2nd ed. New York: Guilford Press; 2013.

36.

Segal ZV, Williams JMG, Teasdale JD. Mindfulness-based cognitive therapy for depression. New York: Guildford Press; 2002.

37.

Song Y, Lindquist R. Effects of mindfulness-based stress reduction on depression, anxiety, stress and mindfulness in Korean nursing students. Nurse Educ Today. 2015;35:86–90. https://doi.org/10.1016/j.nedt.2014.06.010.CrossRefPubMed

38.

Stewart-Brown S, Tennant A, Tennant R, Platt S, Parkinson J, Weich S. Internal construct validity of the Warwick-Edinburgh mental well-being scale (WEMWBS): a Rasch analysis using data from the Scottish health education population survey. Health Qual Life Outcomes. 2009;7:15. https://doi.org/10.1186/1477-7525-7-15.CrossRefPubMedPubMedCentral

39.

Strauss C, Taylor BL, Gu J, Kuyken W, Baer R, Jones F, Cavanagh K. What is compassion and how can we measure it? A review of definitions and measures. Clin Psychol Rev. 2016;47:15–27. https://doi.org/10.1016/J.CPR.2016.05.004.CrossRefPubMed

40.

van Roijen L, Essink-Bot ML, Koopmanschap MA, Bonsel G, Rutten FF. Labor and health status in economic evaluation of health care. The health and labor questionnaire. Int J Technol Assess Health Care. 1996;12:405–15.CrossRefPubMed

41.

Virgili M. Mindfulness-based interventions reduce psychological distress in working adults: a meta-analysis of intervention studies. Mindfulness (NY). 2013:1–12. https://doi.org/10.1007/s12671-013-0264-0.

42.

Williams MJ, Dalgleish T, Karl A, Kuyken W. Examining the factor structures of the five facet mindfulness questionnaire and the self-compassion scale. Psychol Assess. 2014;26:407–18. https://doi.org/10.1037/a0035566.CrossRefPubMed

Title: Evaluation of mindfulness-based cognitive therapy for life and a cognitive behavioural therapy stress-management workshop to improve healthcare staff stress: study protocol for two randomised controlled trials
Authors: Clara Strauss
Jenny Gu
Nikki Pitman
Cavita Chapman
Willem Kuyken
Adrian Whittington
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: Trials / Issue 1/2018
Electronic ISSN: 1745-6215
DOI: https://doi.org/10.1186/s13063-018-2547-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Evaluation of mindfulness-based cognitive therapy for life and a cognitive behavioural therapy stress-management workshop to improve healthcare staff stress: study protocol for two randomised controlled trials

Abstract

Background

Methods/design

Discussion

Trial registration

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods/design

Discussion

Trial registration

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