First published on JAMA Network on Sep. 19, 2022.
Mindpath Health’s Sandeep Vaishnavi, MD, PhD, co-authored a clinical trial that explored transcendental meditation’s impact on chronic stress and burnout. See highlights below or read the full article in JAMA Network here.
Efficacy of transcendental meditation to reduce stress among health care workers
Health care workers (HCWs) are experiencing substantial stress and burnout, with recently reported burnout rates of 60% to 70%. The World Health Organization defines burnout as an occupational phenomenon resulting from chronic workplace stress that has not been successfully managed.
Burnout is characterized by 3 dimensions: feelings of exhaustion, increased mental distance from the job or negativism, and reduced professional efficacy. The serious consequences of burnout, such as rapid turnover, limited patient access and care, and increased health expenditure, can adversely affect HCWs, health care organizations, and patients.
As a result, the Joint Commission and the Department of Health and Human Services have called for prioritization of health care workforce resilience. However, organizational burnout mitigation strategies have a limited evidence base with regard to approaches and strategies.
Several randomized clinical trials have evaluated strategies to reduce stress and burnout, such as the use of psychological or sensory-emotional techniques, group discussions, mindfulness- or compassion-based programs, auricular acupressure, and cannabidiol treatment. These studies reported some short-term improvements; however, small cohorts, high attrition rates, lack of sample diversity, or the need for pharmacological therapy has limited their utility, highlighting the need for rigorously tested interventions for burnout.
Transcendental Meditation (TM) is a meditation practice in which individuals silently recite a single mantra (a sound that lacks meaning) without concentration or contemplation. Studies of TM practitioners have revealed patterns of increased parasympathetic response leading to attenuation of the stress response. Proposed mechanisms underlying the restful alertness achieved with TM include increased α coherence on electroencephalography and increased blood flow to the prefrontal cortex on functional magnetic resonance imaging.
Clinical trials have demonstrated the efficacy of TM for the reduction of stress and burnout among teachers and emergency department clinicians. The practice of TM has been found to reduce posttraumatic stress disorder symptoms in veterans which might be particularly relevant because recent reports of HCW burnout suggest a similarity to the experiences of combat veterans.
We hypothesized that HCWs who practiced TM would demonstrate significantly reduced symptoms of acute psychological distress within 3 months, as measured by the Global Severity Index (GSI) score of the 18-item Brief Symptom Inventory (BSI-18). Secondary outcomes included changes in burnout, resilience, insomnia, depression, and anxiety levels.
In it, 80 HCWs showed that TM practice over 3 months reduced psychological distress scores (primary outcome) on the Global Severity Index by 5.6 points, but this decrease was not significantly different from the reduction of 3.8 points observed in the control group. The practice of TM reduced burnout scores (a secondary outcome) by 5.4 points, representing a statistically significant reduction compared with usual treatment.
Conclusions: This randomized clinical trial found that TM practice may not significantly reduce acute psychological distress among HCWs compared with usual treatment. However, TM may significantly alleviate burnout, anxiety, and insomnia among HCWs.
The findings also revealed high stress levels among HCWs, especially women, who compose more than 50% of the health care workforce. It is important that investigators and organizations use interdisciplinary multidimensional approaches that incorporate personal and organizationally led strategies.
The practice of TM, which is both feasible and safe, could be considered as 1 strategy to prevent or mitigate chronic stress and burnout.