. 2020 Sep 24;12(1):1–28. doi: 10.1007/s12671-020-01500-9

Table 1.

Summary of MBSR studies reviewed

Author/year	Purpose	Design/method	Sample and n	Interventions	Measures	Salient findings and overall global quality rating
Amutio et al. (2015)	Acceptability and effectiveness of a long-term educational intervention to reduce physicians’ stress-related conditions No incentives noted.	Randomised controlled trial Waitlist control group	Physicians in both public and private practice Participants n = 42 Control n = 21 Intervention n = 21 Final n = 42 Gender: Male, 42.9% Female, 57.1% Mean age, 47.31 Ethnicity information not documented. Self-selected sample as participants were individuals that had enrolled on a course by the Official Medical College of Biscay.	Two-phase MBSR programme 8-week initial treatment (8 weekly sessions of 2.5 h over 2 months plus one 8-h retreat) plus 10-month maintenance phase for the experimental group (one session of 2.5 h per month–25 h) 45 min of formal mindfulness practice Overall participation: Weekly sessions, 88% Monthly sessions, 72% MBSR teacher.	1. Five Facet Mindfulness Scale 2. Maslach Burnout Inventory 3. Qualitative questionnaire 4. Blood pressure and heart rate measures of the intervention group* 5. Record sheet of mindfulness practice	Overall global quality rating: moderate–strong (score = 9). Findings: 1. Intervention group reported significant improvements in mindfulness post-intervention when compared to the control group 2. Intervention group reported significant reductions in burnout emotional exhaustion post intervention when compared to the control group. Limitations: 1. Small sample size 2. Participant characteristics may have affected observed outcomes 3. Two outliers with high levels of burnout (2 control, 1 intervention) were included in the analyses 4. Lack of control group in the second phase of the study
Duchemin et al. (2015)	A small randomised pilot study of a workplace mindfulness-based intervention for surgical intensive care unit personnel: Effects on salivary amylase levels No incentives noted.	Randomised controlled trial Waitlist control group	Personnel from a large academic medical centre. Participants n = 32 Control n = 16 Intervention n = 16 Final n = 32 Gender (both groups): Male, 12.5% Female, 87.5% Mean age, 44.2 Ethnicity information not documented. Random allocation and convenience sample, however, participants were self-selected.	Low-dose 8-week MBSR programme 7 sessions of 1 h and one session of 2 h 20 min of daily mindfulness practice Overall participation: not noted. Trained mindfulness and certified yoga teacher.	1. Perceived Stress Scale (PSS) 2. Depression Anxiety Stress Scale (DASS) 3. Maslach Burnout Inventory 4. Professional Quality of Life Measure 5. Five Facet Mindfulness Questionnaire 6. Salivary amylase levels*	Overall global quality rating: moderate–strong (score = 9). Findings: 1. No significant changes in perceived stress levels pre and post-intervention on the PSS, however, stress levels on the DASS significantly reduced in the intervention group post-intervention and maintained when compared to waitlist controls 2. Scores for emotional exhaustion decreased, however, were not significant pre and post-intervention 3. No significant differences observed for personal accomplishment and depersonalisation 4. The observation facet score significantly increases post intervention and maintained when compared to waitlist controls. Limitations: 1. Small sample size 2. The group intervention as a source of support 3. Did not inquire about life stressors 4. Self-selection of individuals 5. Overrepresentation of nurses and females limiting the generalisability of the findings to other groups.
Martin-Asuero et al. (2014)	Effectiveness of a mindfulness education programme in primary health care professionals: A pragmatic controlled trial Payment of 49 euros for intervention materials (CD and books).	Randomised controlled trial Control group	Primary care professionals from a health institute including physicians, nurses, social workers and clinical psychologists Participants n = 68 Control n = 25 Intervention group n = 43 Final n = 68 Gender: Male, 8% Female, 92% Mean age: Control, 46.9 Intervention, 48.8 Ethnicity information not documented. Stratified randomisation of a self- selected sample.	MBSR 8 sessions 2.5 h per week plus 1-day session of 8 h Overall participation, 92% Certified MBSR teacher.	1. Maslach Burnout Inventory 2. Profile of Mood States 3. Jefferson Scale of Physician Empathy* 4. Five Facets Mindfulness Questionnaire 5. Questionnaire on changes in personal habits and mindfulness practice	Overall global quality rating: moderate–strong (score = 9). Findings: 1. The intervention group reported significant improvements with mood disturbance and burnout post-intervention when compared to the control group 2. The intervention group reported significant improvements in mindfulness post-intervention when compared to the control group with the exception of the facet describing. Limitations: 1. Self-administered questionnaires 2. Small sample size which was not gender representative due to participants being mostly women 3. No follow-up 4. Self-selection of participants 5. Lack of active control group.
Moody et al. (2013)	To investigate the effects of a mindfulness-based course on burnout of paediatric oncology staff No incentives noted.	Randomised controlled trial Control group	Nurses, social workers, physicians, nurse practitioners, psychologists and child-life specialists from two children’s hospitals Participants n = 48 Control n = 24 Intervention n = 24 Final n = 46 Control n = 24 Intervention n = 22 Gender Male, 20% Female, 80% No age or ethnicity information. Stratified randomisation of a self-selected sample.	8-week MBSR programme 1 initial 6 h session; 6 weekly 1 h follow-up sessions and a final 3 h session Daily 10–20-min formal mindfulness practice Overall participation: Not noted. Two licenced clinicians with experience of teaching MBSR.	1. Maslach Burnout Inventory 2. Perceived Stress Scale 3. Beck Depression Inventory 4. Daily logs of mindfulness practice 5. Daily journal of feelings at work	Overall global quality rating: moderate–strong Findings: 1. No significant changes in burnout, stress and depression between group post intervention. Limitations: 1. Small sample size 2. Over-representation of women 3. Lack of intervention in the control group 4. Lack of blinding 5. Previous mindfulness experience not noted.
Pipe et al. (2009)	To investigate the effects of a mindfulness meditation programme for stress management on nurse leaders stress No incentives noted.	Randomised controlled trial Control group: Advanced stress and leadership strategies course	Nurses in supervisor positions from a healthcare system Participants n = 33 Control n = 17 Intervention n = 16 Final n = 32 Control n = 17 Intervention n = 15 Gender: Male, 3% Female, 97% Mean age: Control, 49.4 Experimental, 50.2 Ethnicity information not documented. Randomisation of a self-selected sample.	4-week MBSR programme 4 2 h sessions Daily 30-min practice Overall participation for all sessions: Intervention = 26.7% Control = 52.9% MBSR teacher.	1. Symptom Checklist-90-Revised 2. Caring Efficacy Scale*	Overall global quality rating: moderate–strong (score = 8). Findings: 1. Intervention group reported significant more improvements in stress symptoms that controls 2. Intervention group reported significant more improvements in symptom distress and severity than controls 3. Intervention group reported nearly significant more improvements in symptom frequency than controls. Limitations: 1. Limited monitoring of frequency and duration of meditation practice 2. Recruited motivated nurses 3. Small sample size 4. No follow-up between groups.
Wang et al. (2017)	The effects of mindfulness-based stress reduction on hospital nursing staff Participants received $100 as an incentive for filling out the questionnaire each time.	Controlled clinical trial Quasi-experimental design and 3- and 6-month follow-up Control group (Humanities class) Intervention group Non-intervention group	Hospital nursing staff Participants n = 78 Control n = 35 MBSR group n = 31 Non-intervention group n = 12 Final n = 66 Control n = 29 MBSR group n = 26 Non-intervention group n = 11 Gender: Female, 100% Mean age, 22.7 Ethnicity information not documented. Self-selected sample.	8-weeks MBSR programme, 3 h per week and 1-day retreat Overall participation: not noted. Qualified MBSR teacher and a psychologist.	1. Five Facet Mindfulness Questionnaire 2. Nurse Stress Checklist	Overall global quality rating: moderate–strong (score = 9). Findings: 1. MBSR group reported significant increases in mindfulness post-intervention, however this was not maintained at 3- and 6-month follow-up 2. MBSR group reported significant reductions in stress post-intervention and this subsequently decreased at 3- and 6-month follow-up 3. No salient significant differences between groups were found. Limitations: 1. Not an RCT 2. Small sample size 3. Longer follow-up 4. The effects of mindfulness on the therapist’s personal experiences can produce therapeutic effects.
Verweij et al. (2016)	Mindfulness-based stress reduction for GPs No incentives noted.	Controlled clinical trial Mixed methods design Waitlist control group	GPs affiliated with training hospitals Participants n = 50 Waitlist control group: 20 Intervention group: 30 Final n = 43 Waitlist control group: 20 Intervention group: 23 Gender: Waitlist control group: Male, 60% Female, 40% MBSR group: Male, 70% Female, 30% Mean age: Waitlist control group, 56.0 MBSR group, 54.5 Ethnicity information not documented. Self-selected sample and MBSR programme was offered as part of a regular CPD programme and accredited by the professional bodies.	8 weekly MBSR programme, sessions lasting 2.5 h and 1 day silent retreat 30–45 min daily formal mindfulness practice Overall participation: Not noted. Two MBSR teachers, a GP/psychotherapist and psychologist/psychotherapist.	1. Utrecht Burnout Scale 2. Utrecht Work Engagement Scale* 3. Jefferson Scale of Empathy* 4. Five Facet Mindfulness Questionnaire	Overall global quality rating: moderate (score = 10). Findings: 1. Intervention group reported a greater decrease in depersonalisation than the waitlist control group post-intervention 2. Mindfulness skills increased significantly in the intervention group compared with the waitlist control group post-intervention. Limitations: 1. Lack of randomisation 2. Important baseline differences between the GPs that participated in the MBSR programme during the first period than those in the second period 3. Self-selected sample 4. No follow-up period.
Manotas et al. (2014)	To investigate the effects of brief mindfulness training on stress and distress in Columbian HCPs No incentives noted.	Clinical controlled trial Control group	Healthcare professionals including medical doctors, nurses, support staff, scientists, physical therapists, mental health professionals, dentist, veterinarian and nutritionist Participants n = 131 (65 control, 66 intervention) Final n = 83 (43 Control, 40 Intervention) Gender: Male, 9.6% Female, 90.4% Mean age, 39.05 Ethnicity information not documented. Self-selected sample.	Adapted 4-week MBSR programme 2-h sessions Daily 25-min mindfulness practice Overall participation: Not noted. Primary researcher was the MBSR teacher.	1. Brief Symptom Inventory-18 2. Perceived Stress Scale 3. Five Facet Mindfulness Questionnaire-Long Form	Overall Global Quality Rating: Moderate (Score = 10). Findings: 1. Intervention group reported significant increases in the mindfulness facets of observing, non-judging and overall mindfulness than control group 2. No significant effects for mindfulness facets of describing, acting with awareness and non-reacting 3. Intervention group reported significant reduction in anxiety, depression, psychological distress and stress than control group. Limitations: 1. No follow-up 2. No intention to treat analysis nor placebo group 3. Low scores on the Brief Symptom Inventory-18 resulting in a floor effect and less change over time 4. Did not monitor daily mindfulness practice 5. No measure of previous experience of meditation 6. Group cohesion could be a confounding variable 7. Primary researcher was the MBSR teacher.
Schroeder et al. (2016)	A brief mindfulness-based intervention for primary care physicians: A pilot randomised controlled trial No incentives noted.	Controlled clinical trial and 3-month follow-up Waitlist control group.	Primary care physicians recruited from family medicine and internal medicine departments within a health organisation Participants n = 33 Waitlist control group n = 16 Intervention group n = 17 Final n = 26 Waitlist control group n = 13 Intervention group n = 13 Gender: Male, 27% Female, 73% Mean age, 42.76 Ethnicity information not documented. Randomisation of a self-selected sample.	Mindful Medicine Curriculum based on MBSR 13-h weekend training programme plus 2-h follow-up sessions Overall participation: not noted. Status of teacher not noted.	1. Mindful Awareness Attention Scale 2. Brief Resilience Scale 3. Perceived Stress Scale 4. Santa Clara Brief Compassion Scale* 5. Maslach Burnout Inventory 6. Meditation Practice Questionnaire 7. Patient Self-Reported Satisfaction with Primary Care Physician*	Overall global quality rating: moderate (score = 10). Findings: 1. Intervention group reported significant improvements in stress, mindfulness, emotional exhaustion and depersonalisation post-intervention when compared to the control group 2. Improvements were maintained at 3-month follow-up 3. There was no significant improvement in resilience and personal achievement post-intervention. Limitations: 1. Small sample size 2. Sample size was too small to detect improvements on other outcome measures 3. Self-selected sample 4. Enhanced social support was not controlled for.
Ducar et al. (2019).	Mindfulness for healthcare providers fosters professional quality of life and mindful attention amongst emergency medical technicians No incentives provided.	Pre-post design, follow-up at 3 and 6 months No control group	Volunteer emergency medical service providers including medics, paramedics and medical doctors Participants n = 15 Final n = 11 Gender Male, 13 Female, 2 Mean age, 46.43 Ethnicity information not documented. Self-selected sample and voluntary workers.	8-week adapted MBSR programme, 2.5-h sessions and an additional a 7-h silent retreat Overall participation: not noted. Two experienced MBSR teachers.	1. Perceived Stress Scale 2. Mindful Awareness and Attention Scale 3. Professional Quality of Life Measure 4. Self-care assessment*	Overall global quality rating: moderate (score = 11). Findings: 1. Significant reductions in burnout post-intervention and sustained at 3 and 6 months 2. Significant reductions in perceived stress but not sustained at 3 or 6 months 3. Significant increases in trait mindfulness and sustained at 3 months but not at 6 months. Limitations: 1. No control group 2. Sustained changes in burnout and mindfulness but it is not possible to ascertain how these changes would compare to other interventions 3. Unclear whether changes were sustained at 6 months 4. Low sample size 5. Low number of women included in the sample.
Goodman and Schorling (2012)	To investigate the effects of a meditation course on decreasing burnout and improving mental well-being in different HCPs Participants paid for the intervention. Continuing education credits also provided.	Pre-post design No control-group	Healthcare providers who practiced in community and university settings including physicians, nurses, psychologists and social workers Participants n = 93 Final n = 73 Gender Male, 35% Female, 65% No age or ethnicity information documented. Self-selected sample and participants paid for the intervention.	8-week MBSR programme 2.5-h sessions 7-h retreat 45 min mindfulness practice 6 days per week Overall participation: 97% attended at least 4 sessions Experienced MBSR teachers.	1. Maslach Burnout Inventory 2. SF-12v2 Health Survey Questionnaire	Overall global quality rating: moderate (score = 11). Findings: 1. Significant improvements for emotional exhaustion, depersonalisation and personal accomplishment post-intervention 2. Significant improvements for mental well-being. Limitations: 1. No control group 2. No follow-up data 3. No measure of mindfulness which could provide valuable information regarding the mechanisms by which mindfulness is beneficial.
Crowder and Sears (2017)	Building resilience in social workers: Am exploratory study on the impact of a mindfulness-based intervention No incentives noted.	Clinical controlled trial and follow-up at 13-week follow-up 26-week follow-up for the intervention group Mixed methods design Waitlist control	Social workers Participants n = 14 Waitlist control n = 7 Intervention n = 7 Final n = 14 Gender: Male, 3 Female, 11 Mean age, 46.5 Ethnicity: Caucasian, 10 Canadian, 4 Self-selected sample.	MBSR 2.5-h group session for 8 weeks Overall participation: not noted. MBSR teacher was the primary investigators.	1. Perceived Stress Scale 2. Self-Compassion Scale 3. Experiences Questionnaire* 4. Maslach Burnout Inventory 5. Professional Quality of Life	Overall global quality rating: weak (score = 11). Findings: 1. Intervention group reported significantly reduced stress levels post-intervention compared to the waitlist control group, however, improvements were not sustained at 13-week follow-up 2. No other significant differences between groups were found 3. Intervention group reported significant improvements in self-compassion and stress and these were maintained as 13 weeks and 26 weeks follow-up 4. Burnout was non-significant at 13 weeks but significant reductions in burnout were reported at 26 weeks for the intervention group. Limitations: 1. Small non-representative convenience sample 2. Self-selected volunteers 3. Participants were not blind to the motive of the research 4. Teacher of the intervention was the lead researcher
Duarte and Pinto-Gouveia (2016)	Effectiveness of a mindfulness-based intervention on oncology nurses’ burnout and compassion fatigue symptoms: a non-randomised study No incentives noted.	Clinical controlled trial Waitlist control	Oncology nurses from two oncology hospitals Participants n = 93 (48 waitlist control, 45 intervention) Final n = 48 (19 waitlist control, 29 intervention) Gender: Waitlist control: Male, 3 Female, 16 Intervention: Male, 3 Female, 26 Mean age: Waitlist control, 42.11 Intervention, 38.90 Ethnicity information not documented. Self-selected sample.	Mindfulness group based on MBSR 2-h sessions over 6 weeks 15-min daily formal mindfulness practice Overall participation: not noted. Author was the teacher, whom was also trained in MBSR.	1. Professional Quality of Life Scale 2. Depression, Anxiety, Stress Scale 3. Acceptance and Action Questionnaire* 4. Ruminative Responses Scale-Short* 5. Five Facet Mindfulness Questionnaire 6) Self-Compassion Scale	Overall global quality rating: weak (score = 11). Findings: 1. Intervention group reported a significant reduction in burnout and stress post-intervention compared to waitlist control group 2. Intervention group reported significant increases in mindfulness and self-compassion post-intervention, and improvements regarding observing and non-judging maintained when compared to controls 3. Participants that practiced more mindfulness showed greater reductions in burnout and depression and greater increases in self-compassion compared with those that practised less. Limitations: 1. Small sample size and most participants were women 2. Non-randomised allocation of participants and non-random significant differences between groups 3. Lack of follow-up assessment and large number of questionnaires could have contributed to low response rate at follow-up.
Geary and Rosenthal (2011)	To investigate the effect of MBSR on academic healthcare employees stress, well-being and spiritual experiences No incentives noted.	Controlled clinical trial and 1 year follow-up Control group	Nurses and respiratory therapists in a university medical branch and neonatal services Participants n = 108 (49 control, 59 intervention) Final n = 91 (37 control, 54 intervention) Gender Control: Male, 4% Female, 96% Intervention: Male, 15% Female, 85% Mean age: Control, 42 Intervention, 48 Ethnicity: Control: 55% White, 14% Hispanic, 11% African American, 17% Asian. Intervention: 75% White, 18% Hispanic, 2% African American, 5% Asian. Self-selected sample.	8-week MBSR programme 3 h per week 8-h retreat Overall participation: Cumulative completion = 89% Certified MBSR teacher.	1. Symptom Checklist Revised-90-Revised 2. Perceived Stress Scale 3. SF-36 Health Survey Questionnaire 4. Daily Spiritual Experiences Scale*	Overall global quality rating: weak (score = 11). Findings: 1. Significant improvements in stress, psychological distress and mental well-being post-intervention compared to controls 2. Improvements maintained at 1-year follow-up. Limitations: 1. Not randomised 2. No blinding 3. Significant difference between groups regarding percentage of patient care 4. Possible selection bias.
Norouzinia et al. (2017)	The effect of mindfulness-based stress reduction training on stress and burnout of nurses No incentives noted.	Controlled clinical trial Control group	Nurses working in two hospitals Participants n = 60 Control group n = 30 Intervention group n = 30 No attrition data. Age: < 30 years, 33.3% 31–40 years, 53.3% 41–50 years, 13.3% No gender or ethnicity information documented. Self-selected sample.	MBSR programme - No further details documented. Overall participation: Not noted. Teacher status not noted.	1. Nurse Stress Scale 2. Maslach Burnout Inventory	Overall global quality rating: weak (score = 11). Findings: 1. Significant reduction in job stress and three aspects of burnout post-intervention. Limitations: 1. Lack of follow-up 2. Lack of randomisation.
Bazarko et al. (2013)	To investigate the effects of an innovative MBSR programme on health and well-being of nurses Gift of low monetary value and continuing education credits (one contact hour) for each survey completion as compensation for their time.	Pre-post design and 4-month follow-up No control group	Nurses within a large healthcare organisation Participants n = 41 Final n = 36 Gender Male, 0% Female, 100% Mean age, 52.2 Ethnicity information not documented. Self-selected sample.	Group telephonic MBSR (tMBSR) sessions Two 8-h person retreats 6 weekly 1.5-h group tele-conference calls, email contact between sessions Daily 25–30-min mindfulness practice Overall participation: Person retreat, 86.9% Teleconference hours, 87.8% MBSR instructor.	1. The Perceived Stress Scale 2. Copenhagen Burnout Inventory 3. SF-12v2 Health Survey Questionnaire 4. Brief Serenity Scale* 5. Jefferson Scale of Physician Empathy* 6. The Self-Compassion Scale 7. Log of amount and type of participation	Overall global quality rating: weak (score = 12). Findings: 1. Significant reduction in stress and burnout post-intervention and maintained at 4-month follow-up 2. Significant improvements in mental health and self-compassion post-intervention and maintained at 4 months follow-up 3. Participants who maintained mindfulness practice had lower stress and burnout and higher self-compassion. Limitations: 1. No control group 2. Small and self-selected sample 3. Unaware of previous MBSR a d meditation experience 4. Homogenous sample as all female nurses 5. Incentives for participation could positively bias results.
Ceravolo and Raines (2019)	The impact of a mindfulness intervention on nurse managers No incentives noted.	Pre-post design and 3 months follow-up No control group	Nurse managers at an acute care hospital, including a perinatal centre and adult beds Participants n = 13 Final n = 12 No information regarding gender, age and ethnicity was recorded. Self-selected sample.	Weekly 60-min sessions for 8 weeks based on MBSR principles and exercises Overall participation: Not noted. Mindfulness expert was the teacher.	1. Quality of Life Inventory* 2. Copenhagen Burnout Inventory 3. Perceived Wellness Scale	Overall global quality rating: weak (score = 12). Findings: 1. Significant improvements in burnout (personal and work-related) scores post intervention, however improvements were not maintained at 3-month follow-up 2. There were negligible changes in perceived wellness post-intervention. Limitations: 1. Small sample size and all participants employed by the same organisation 2. Self-selected sample 3. Lack of control group
Dobie et al. (2016)	Preliminary evaluation of a brief mindfulness-based stress reduction intervention for mental health professionals No incentives noted.	Pre-post design No control group	Mental health professionals working in a non-acute inpatient mental health unit (nursing, social work, occupational therapy and psychology) Participants n = 9 Final n = 9 Gender, age and ethnicity not documented. Self-selected sample.	8 weeks of daily 15-min MBSR training with three 30-min education sessions during weeks 2, 4 and 6 Overall participation, 100% Status of teachers not noted.	1. Depression Anxiety Stress Scale 2. Kentucky Inventory of Mindfulness Skills	Overall global quality rating: weak (score = 12). Findings: 1. Significant reductions in anxiety and stress post-intervention 2. Observed reductions in depression post-intervention but were not significant 3. Reported increases in the mindfulness observe skill post-intervention but were not significant. Limitations: 1. Only observations from a treatment group 2. No control group 3. Data was not collected on caseload acuity and complexity or workplace environment 4. No follow-up data.
Gaspar et al. (2018)	Exploring the benefits of a mindfulness programme for Portuguese public healthcare workers No incentives noted.	Pre-post design No control group	Public health workers at a blood and transfusion centre Participants n = 51 Final n = 26 Gender (Final): Male, 34.6% Female, 65.4% Mean age, 44.58 Ethnicity information not documented. Self-selected sample.	Mindfulness intervention following the structure of MBCT 45-min daily mindfulness sessions for 11 weeks Mean participation: 35.42 h Status of teacher not noted.	1. Five Facet Mindfulness Questionnaire 2. Depression, Anxiety and Stress Scale 3. Positive and Negative Affect Schedule 4. Self-Compassion Scale 5. Compassion Scale* 6. Interpersonal Reactivity Index*	Overall global quality rating: weak (score = 12). Findings: 1. Significantly higher scores in acting with awareness and self-compassion scores post-intervention 2. Marginal significant results with regard to an increase in positive affect and describing and decrease in negative affect, stress. Limitations: 1. Small sample size 2. Self-selected and non-randomised 3. Self-report questionnaires 4. Average time practising mindfulness was too short 5. A large variation of attendance between participants thus differences in the specific content or exercises learnt may have occurred.
Martin-Asuero and Garcia-Banda (2010)	To investigate the effects of MBSR on HCPs psychological distress Financial compensation with regard to a coupon after each evaluation.	Pre-post design and 3-month follow-up Two intervention groups No control group	HCPs in hospitals and primary care centres Doctors, nurses, psychologists, educational professionals and service industry employees Participants n = 29 Final n = 27 Gender: Male, 17% Female, 83% Mean age, 41.1 No ethnicity information documented. Self-selected sample.	8-week MBSR Programme 2.5-h per session plus one 8-h session Daily 45-min mindfulness practice Overall participation: Average attendance = 92% MBSR teacher was the first author of this study.	1. Symptom Checklist-90-Revised 2. Survey of Recent Life Experience* 3. Perceived Stress Scale 4. Positive and Negative Affect Scale 5. Emotional Control Questionnaire*	Overall global quality rating: weak (score = 12). Findings: 1. A significant reduction in psychological distress post-intervention 2. A significant reduction in negative affect post-intervention 3. All improvements maintained at 3-month follow-up 4. Reduction in stress but not significant. Limitations: 1. Self-selected sample 2. No control group 3. Intervention effects on the group were not isolated.
Pflugeisen et al. (2016)	Brief video-module administered mindfulness programme for physicians: a pilot study No incentives noted.	Pre-post design and 2-month follow-up No control group	Physicians in a community hospital setting Participants n = 23 Final n = 19 Gender: Male, 60.9% Female, 39.1% Mean age, 46 Ethnicity information not documented. Self-selected sample.	8-week MBSR training 3 90-min in person trainings Weekly online 5–7-min video module trainings Weekly 1-h teleconference coaching calls Overall participation: not noted. Programme delivery was one of the authors, and family medicine physician and certified professional coach.	1. Perceived Stress Scale 2. Maslach Burnout Inventory 3. Kentucky Inventory of Mindfulness Skills 4. Participant use of mindfulness	Overall global quality rating: weak (score = 12). Findings: 1. Significant reductions in stress, personal accomplishment and emotional exhaustion was observed post-intervention and at 8-weeks follow up 2. Significant increases in mindfulness skills post-intervention, with increases in describing, acting with awareness and accepting without judgement maintaining 8-week follow up. Limitations: 1. Small sample size 2. Self-selected sample 3. Without a control population 4. Limited self-reported data.
Raab et al. (2015)	Mindfulness-based stress reduction and self-compassion amongst mental healthcare professionals: a pilot study No incentives noted.	Pre-post design No control group	Mental healthcare professionals working in a large mental healthcare centre Participants n = 22 Final n = 22 Gender: Female, 100% Age, 24–69 years Ethnicity information not documented. Self-selected sample and participants completed a voluntary MBSR course.	MBSR programme 8 weekly 2.5-h long classes with 1 day of silence Overall participation: Not noted. Certified MBSR teachers.	1. Self-compassion scale 2. Maslach Burnout Inventory 3. Quality of Life Inventory*	Overall global quality rating: weak (score = 12). Findings: 1. Self-compassion significantly improved post intervention 2. No statistically significant changes for burnout post-intervention. Limitations: 1. Open trial design 2. Self-selected sample 3. Not randomised 4. Lack of control group 5. Included an additional Loving Kindness meditation to the standard MBSR techniques thus this could have biased the findings.
Suyi et al. (2017)	Effectiveness of mindfulness intervention in reducing stress and burnout in mental health professionals in Singapore Small monetary imbursement after each study visit.	Pre-post design and follow up at 3 months Three cohorts No control group	Mental health professionals including nurses, occupational therapists, social workers, case managers, pharmacist, psychologist/counsellors and researchers Participants n = 44 Final n = 37 Follow-up n = 37 Gender: Male, 18.9% Female, 81.1% Age: < 25, 5.4% 25–30, 27% 30–35, 24.3% 35–40, 13.5% 40–45, 16.2% > 45, 13.5% Ethnicity: Chinese, 78.4% Malay, 5.4% Indian, 10.8% Self-selected sample.	Mindfulness programme based on MBSR, 6 2-h sessions once per week for 6 weeks 30 min of formal meditation practice Overall participation: Attended all 6 sessions, 45% Certified MBSR teacher with 2 MBCT certified teachers as co-facilitators.	1. Five Facet Mindfulness Scale 2. Self-Compassion Short Scale Short Form 3. Compassion Scale* 4. Perceived Stress Scale 5. Oldenburg Burnout Inventory	Overall global quality rating: weak (score = 12). Findings: 1. Significant improvements in all facets of mindfulness post-intervention and sustained at 3 months follow-up with the exception of act with awareness 2. Significant improvements in self-compassion post-intervention and sustained at 3 months follow-up 3. Significant reductions in stress post-intervention, however not sustained at 3 months follow-up 4. No significant changes in burnout. Limitations: 1. Lack of control group 2. Self-selected sample 3. One of the investigators of the study was the main instructor for the mindfulness programme 4. Sample cannot be generalised to other healthcare professionals 5. Small sample size
Ando et al. (2011)	To investigate the effect of mindfulness-based meditation therapy on nurses’ sense of coherence and mental health No incentives noted.	Controlled clinical trial Control group No incentives noted.	Nurses working on a ward with elderly patients Participants n = 28 Control n = 13 Intervention n = 15 No attrition data. No gender, age or ethnicity information. Self-selected sample.	Adapted MBSR programme Two sessions within a 2 week period Mindfulness home practice Overall participation: Not noted. Instructors were nurses who received training on the programme for 3 h.	1. General Health Questionnaire	Overall global quality rating: weak (score = 13). Findings: 1. Significant deduction in anxiety and depression post-intervention. Limitations: 1. Small sample size 2. No randomisation 3. No balancing or matching between groups 4. No follow-up 5. Self-selected sample
Brady et al. (2012)	To investigate the effect of mindfulness meditation on managing work stress and improving patient outcomes Participants were paid for classes as a portion of work time.	Pre-post design and 3-month follow-up No control group	Acute psychiatric inpatient unit psychiatric nurses, social workers, mental health technologists, recreational therapist and health unit co-ordinator Participants n = 23 Final n = 16 Gender: Male, 19% Female, 81% No age or ethnicity information documented. Self-selected sample.	4-week MBSR group 1 h per session Daily 30-min mindfulness practice Overall participation: 16 out of 23 participants attended all sessions Status of instructor not reported.	1. Mental Health Professionals Stress Scale 2. The Toronto Mindfulness Scale 3. Maslach Burnout Inventory	Overall global quality rating: weak (score = 13). Findings: 1. Significant reduction in stress post-intervention and at 3-month follow-up 2. Significant increase in mindfulness post-intervention and at 3-month follow-up 3. No significant reduction in emotional exhaustion and depersonalisation, there was an improvement in personal accomplishment but it was not significant. Limitations: 1. Small sample size 2. Not controlled nor randomised 3. Sampling bias 4. Did not take into account personality traits or cultural background 5. Response bias on measures 6. No comparison group
Hallman et al. (2018)	To investigate the effects of MBSR on staff stress in a high-acuity psychiatric inpatient unit No incentives noted.	Pre-post design and 2-month follow-up No control group	Nurses, teachers social worker, activity therapist and physician from a high-acuity inpatient child/adolescent psychiatric unit Participants n = 15 Final n = 12 Gender Male, 17% Female, 83% Mean age, 39 Ethnicity information not documented. Self-selected sample.	MBSR 4 45-min classes offered over 8 days Daily 15-min meditation practice as part of their shift Overall participation: 12 of the 15 participants attended all sessions Principal investigator was the MBSR teacher.	1. Toronto Mindfulness Scale 2. Perceived Stress Scale	Overall global quality rating: weak (score = 13). Findings: 1. Significant reductions in stress post-intervention and maintained at 2 months follow-up 2. Significant increase in mindfulness post-intervention and maintained at 2-month follow-up. Limitations: 1. Small sample size 2. Self-selected participants 3. Response bias due to self-report measures 4. Homogeneity of sample could limit generalisability 5. Daily mindfulness practice was limited.
Fortney et al. (2013)	To investigate the effects of an abbreviated mindfulness intervention on health and well-being of primary care clinicians No incentives noted.	Pre-post design and 9-month follow-up Two intervention groups No control-group	Doctors, nurse practitioners and physician assistants in departments of family medicine, internal medicine and paediatrics Participants n = 30 Final n = 23 Gender Male, 40% Female, 60% Mean age, 40.5 Ethnicity: 97% White 3% Hispanic Self-selected sample.	Abbreviated version of the 8-week MBSR programme 14 h over a weekend 2 2-h follow up sessions Daily 10–20 min of mindfulness practice Overall participation: not noted. Mindfulness teachers.	1. Maslach Burnout Inventory 2. Depression, Anxiety and Stress Scale 3. Perceived Stress Scale 4. Resilience Scale 5. Santa Clara Compassion Scale*	Overall global quality rating: weak (score = 13). Findings: 1. Significant improvements in emotional exhaustion, depersonalisation and personal accomplishment post-intervention and at 9 months 2. Significant reductions in anxiety, depression and stress post-intervention and at 9 months 3. No significant improvements in resilience. Limitations: 1. Uncontrolled pilot study 2. Lack of control group 3. Small sample size and self-selected participants 4. Group effects versus actual practice of mindfulness
Cucarella and Gianinni (2016)	Effectiveness of a pilot mindfulness programme in volunteers of a breast cancer association Incentives not noted.	Pre-post design No control group	Volunteers of a foundation that supports women with breast cancer Participants n = 7 No attrition data. Gender: Female, 100% Mean age, 46.7 Ethnicity information not documented. Self-selected sample and voluntary workers.	8-week MBSR programme 2.5 hourly sessions Overall participation: not noted. Status of teacher not noted.	1. Positive and Negative Affect Scale 2. Hospital Anxiety and Depression Scale 3. Professional Quality of Life Measure	Overall global quality rating: weak (Score = 14). Findings: 1. Significant reductions in anxiety and depression post-intervention 2. No significant differences found in burnout nor positive and negative affect pre- and post-intervention. Limitations: 1. Small sample size 2. No control group 3. No follow-up.
Trowbridge et al. (2017)	Preliminary investigation of workplace-provided mindfulness-based stress reduction with paediatric medical social workers No incentives documented.	Pre-post design No control group	Social workers employed by a regional children’s healthcare system Participants n = 43 Final n = 21 No information documented regarding gender, age and ethnicity. Self-selected sample.	Compressed MBSR (cMBSR) programme Two days 20 min formal mindfulness practice Overall participation: not noted. University of Massachusetts trained instructor.	1. Professional Quality of Life 2. Perceived Stress Scale-10 Item 3. Mindful Attention and Awareness Scale 4. Caring Efficacy Scale*	Overall global quality rating: weak (score = 14). Findings: 1. Significant increase in mindfulness post-intervention 2. No significant differences for stress and burnout between pre and post-test intervention. Limitations: 1. Small sample size 2. Self-selected sample 3. Attrition rate between recruitment and intervention.
van Wietmarschen et al. (2018)	Effects of mindfulness training in perceived stress, self-compassion and self-reflection of primary care physicians: A mixed-methods approach No incentive noted.	Pre- and post-design and 6 months follow-up Mixed methods design No control group	Primary care physicians Participants n = 54 Post-intervention = 51 Follow-up n = 23 Gender: Male, 22% Female, 78% Mean age, 40 Ethnicity information not documented. Self-selected sample and participants paid $750 dollars for the programme and the training was accredited by the Royal Dutch Medical Association.	Adapted MBSR programme 8 weekly group sessions totalling 26 h Overall participation: Not noted. Two qualified MBSR teachers.	1. Perceived Stress Scale 2. Self-Compassion Scale 3. Groningen Reflection Ability Scale*	Overall global quality rating: weak (score = 14). Findings: 1. Significant reductions in stress post-intervention 2. Significant increases in self-compassion post-intervention 3. Improvements were maintained at 6-month follow-up. Limitations: 1. Not a randomised design 2. Lacked an appropriate control group 3. Self-selected sample 4. Reduced response rates at 6-months follow-up

Author/year

Purpose

Design/method

Sample and n

Interventions

Measures

Salient findings and overall global quality rating

Amutio et al. (2015)

Acceptability and effectiveness of a long-term educational intervention to reduce physicians’ stress-related conditions

No incentives noted.

Randomised controlled trial Waitlist control group

Physicians in both public and private practice

Participants n = 42

Control n = 21

Intervention n = 21

Final n = 42

Gender:

Male, 42.9%

Female, 57.1%

Mean age, 47.31

Ethnicity information not documented.

Self-selected sample as participants were individuals that had enrolled on a course by the Official Medical College of Biscay.

Two-phase MBSR programme

8-week initial treatment (8 weekly sessions of 2.5 h over 2 months plus one 8-h retreat) plus 10-month maintenance phase for the experimental group (one session of 2.5 h per month–25 h)

45 min of formal mindfulness practice

Overall participation:

Weekly sessions, 88%

Monthly sessions, 72%

MBSR teacher.

1. Five Facet Mindfulness Scale

2. Maslach Burnout Inventory

3. Qualitative questionnaire

4. Blood pressure and heart rate measures of the intervention group*

5. Record sheet of mindfulness practice

Overall global quality rating: moderate–strong (score = 9).

Findings:

1. Intervention group reported significant improvements in mindfulness post-intervention when compared to the control group

2. Intervention group reported significant reductions in burnout emotional exhaustion post intervention when compared to the control group.

Limitations:

1. Small sample size

2. Participant characteristics may have affected observed outcomes

3. Two outliers with high levels of burnout (2 control, 1 intervention) were included in the analyses

4. Lack of control group in the second phase of the study

Duchemin et al. (2015)

A small randomised pilot study of a workplace mindfulness-based intervention for surgical intensive care unit personnel: Effects on salivary amylase levels

No incentives noted.

Randomised controlled trial

Waitlist control group

Personnel from a large academic medical centre.

Participants n = 32

Control n = 16

Intervention n = 16

Final n = 32

Gender (both groups):

Male, 12.5%

Female, 87.5%

Mean age, 44.2

Ethnicity information not documented.

Random allocation and convenience sample, however, participants were self-selected.

Low-dose 8-week MBSR programme

7 sessions of 1 h and one session of 2 h

20 min of daily mindfulness practice

Overall participation: not noted.

Trained mindfulness and certified yoga teacher.

1. Perceived Stress Scale (PSS)

2. Depression Anxiety Stress Scale (DASS)

3. Maslach Burnout Inventory

4. Professional Quality of Life Measure

5. Five Facet Mindfulness Questionnaire

6. Salivary amylase levels*

Overall global quality rating: moderate–strong (score = 9).

Findings:

1. No significant changes in perceived stress levels pre and post-intervention on the PSS, however, stress levels on the DASS significantly reduced in the intervention group post-intervention and maintained when compared to waitlist controls

2. Scores for emotional exhaustion decreased, however, were not significant pre and post-intervention

3. No significant differences observed for personal accomplishment and depersonalisation

4. The observation facet score significantly increases post intervention and maintained when compared to waitlist controls.

Limitations:

1. Small sample size

2. The group intervention as a source of support

3. Did not inquire about life stressors

4. Self-selection of individuals

5. Overrepresentation of nurses and females limiting the generalisability of the findings to other groups.

Martin-Asuero et al. (2014)

Effectiveness of a mindfulness education programme in primary health care professionals: A pragmatic controlled trial

Payment of 49 euros for intervention materials (CD and books).

Randomised controlled trial

Control group

Primary care professionals from a health institute including physicians, nurses, social workers and clinical psychologists

Participants n = 68

Control n = 25

Intervention group n = 43

Final n = 68

Gender:

Male, 8%

Female, 92%

Mean age:

Control, 46.9

Intervention, 48.8

Ethnicity information not documented.

Stratified randomisation of a self- selected sample.

MBSR 8 sessions 2.5 h per week plus 1-day session of 8 h

Overall participation, 92%

Certified MBSR teacher.

1. Maslach Burnout Inventory

2. Profile of Mood States

3. Jefferson Scale of Physician Empathy*

4. Five Facets Mindfulness Questionnaire

5. Questionnaire on changes in personal habits and mindfulness practice

Overall global quality rating: moderate–strong (score = 9).

Findings:

1. The intervention group reported significant improvements with mood disturbance and burnout post-intervention when compared to the control group

2. The intervention group reported significant improvements in mindfulness post-intervention when compared to the control group with the exception of the facet describing.

Limitations:

1. Self-administered questionnaires

2. Small sample size which was not gender representative due to participants being mostly women

3. No follow-up

4. Self-selection of participants

5. Lack of active control group.

Moody et al. (2013)

To investigate the effects of a mindfulness-based course on burnout of paediatric oncology staff

No incentives noted.

Randomised controlled

trial

Control group

Nurses, social workers, physicians, nurse practitioners,

psychologists and child-life specialists from two children’s hospitals

Participants n = 48

Control n = 24

Intervention n = 24

Final n = 46

Control n = 24

Intervention n = 22

Gender

Male, 20%

Female, 80%

No age or ethnicity information.

Stratified randomisation of a self-selected sample.

8-week MBSR programme

1 initial

6 h session; 6 weekly 1 h follow-up sessions

and a final 3 h session

Daily 10–20-min formal mindfulness practice

Overall participation: Not noted.

Two licenced clinicians with experience of teaching MBSR.

1. Maslach Burnout Inventory

2. Perceived Stress Scale

3. Beck Depression Inventory

4. Daily logs of mindfulness practice

5. Daily journal of feelings at work

Overall global quality rating: moderate–strong

Findings:

1. No significant changes in burnout, stress and depression between group post intervention.

Limitations:

1. Small sample size

2. Over-representation of women

3. Lack of intervention in the control group

4. Lack of blinding

5. Previous mindfulness experience not noted.

Pipe et al. (2009)

To investigate the effects of a mindfulness meditation programme for stress management on nurse leaders stress

No incentives noted.

Randomised controlled trial

Control group: Advanced stress and leadership strategies course

Nurses in supervisor positions from a healthcare system

Participants n = 33

Control n = 17

Intervention n = 16

Final n = 32

Control n = 17

Intervention n = 15

Gender:

Male, 3%

Female, 97%

Mean age:

Control, 49.4

Experimental, 50.2

Ethnicity information not documented.

Randomisation of a self-selected sample.

4-week MBSR programme

4 2 h sessions

Daily 30-min practice

Overall participation for all sessions:

Intervention = 26.7%

Control = 52.9%

MBSR teacher.

1. Symptom Checklist-90-Revised

2. Caring Efficacy Scale*

Overall global quality rating: moderate–strong (score = 8).

Findings:

1. Intervention group reported significant more improvements in stress symptoms that controls

2. Intervention group reported significant more improvements in symptom distress and severity than controls

3. Intervention group reported nearly significant more improvements in symptom frequency than controls.

Limitations:

1. Limited monitoring of frequency and duration of meditation practice

2. Recruited motivated nurses

3. Small sample size

4. No follow-up between groups.

Wang et al. (2017)

The effects of mindfulness-based stress reduction on hospital nursing staff

Participants received $100 as an incentive for filling out the questionnaire each time.

Controlled clinical trial

Quasi-experimental design and 3- and 6-month follow-up

Control group (Humanities class)

Intervention group

Non-intervention group

Hospital nursing staff

Participants n = 78

Control n = 35

MBSR group n = 31

Non-intervention group n = 12

Final n = 66

Control n = 29

MBSR group n = 26

Non-intervention group n = 11

Gender:

Female, 100%

Mean age, 22.7

Ethnicity information not documented.

Self-selected sample.

8-weeks MBSR programme, 3 h per week and 1-day retreat

Overall participation: not noted.

Qualified MBSR teacher and a psychologist.

1. Five Facet Mindfulness Questionnaire

2. Nurse Stress Checklist

Overall global quality rating: moderate–strong (score = 9).

Findings:

1. MBSR group reported significant increases in mindfulness post-intervention, however this was not maintained at 3- and 6-month follow-up

2. MBSR group reported significant reductions in stress post-intervention and this subsequently decreased at 3- and 6-month follow-up

3. No salient significant differences between groups were found.

Limitations:

1. Not an RCT

2. Small sample size

3. Longer follow-up

4. The effects of mindfulness on the therapist’s personal experiences can produce therapeutic effects.

Verweij et al. (2016)

Mindfulness-based stress reduction for GPs

No incentives noted.

Controlled clinical trial

Mixed methods design

Waitlist control group

GPs affiliated with training hospitals

Participants n = 50

Waitlist control group: 20

Intervention group: 30

Final n = 43

Waitlist control group: 20

Intervention group: 23

Gender:

Waitlist control group:

Male, 60%

Female, 40%

MBSR group:

Male, 70%

Female, 30%

Mean age:

Waitlist control group, 56.0

MBSR group, 54.5

Ethnicity information not documented.

Self-selected sample and MBSR programme was offered as part of a regular CPD programme and accredited by the professional bodies.

8 weekly MBSR programme, sessions lasting 2.5 h and 1 day silent retreat

30–45 min daily formal mindfulness practice

Overall participation: Not noted.

Two MBSR teachers, a GP/psychotherapist and psychologist/psychotherapist.

1. Utrecht Burnout Scale

2. Utrecht Work Engagement Scale*

3. Jefferson Scale of Empathy*

4. Five Facet Mindfulness Questionnaire

Overall global quality rating: moderate (score = 10).

Findings:

1. Intervention group reported a greater decrease in depersonalisation than the waitlist control group post-intervention

2. Mindfulness skills increased significantly in the intervention group compared with the waitlist control group post-intervention.

Limitations:

1. Lack of randomisation

2. Important baseline differences between the GPs that participated in the MBSR programme during the first period than those in the second period

3. Self-selected sample

4. No follow-up period.

Manotas et al. (2014)

To investigate the effects of brief mindfulness training on stress and distress in Columbian HCPs

No incentives noted.

Clinical controlled trial

Control group

Healthcare professionals including

medical doctors, nurses, support staff, scientists, physical therapists, mental health professionals, dentist, veterinarian and nutritionist

Participants n = 131

(65 control, 66 intervention)

Final n = 83

(43 Control, 40 Intervention)

Gender:

Male, 9.6%

Female, 90.4%

Mean age, 39.05

Ethnicity information not documented.

Self-selected sample.

Adapted 4-week MBSR programme

2-h sessions

Daily 25-min mindfulness practice

Overall participation: Not noted.

Primary researcher was the MBSR teacher.

1. Brief Symptom Inventory-18

2. Perceived Stress Scale

3. Five Facet Mindfulness Questionnaire-Long Form

Overall Global Quality Rating: Moderate (Score = 10).

Findings:

1. Intervention group reported significant increases in the mindfulness facets of observing, non-judging and overall mindfulness than control group

2. No significant effects for mindfulness facets of describing, acting with awareness and non-reacting

3. Intervention group reported significant reduction in anxiety, depression, psychological distress and stress than control group.

Limitations:

1. No follow-up

2. No intention to treat analysis nor placebo group

3. Low scores on the Brief Symptom Inventory-18 resulting in a floor effect and less change over time

4. Did not monitor daily mindfulness practice

5. No measure of previous experience of meditation

6. Group cohesion could be a confounding variable

7. Primary researcher was the MBSR teacher.

Schroeder et al. (2016)

A brief mindfulness-based intervention for primary care physicians: A pilot randomised controlled trial

No incentives noted.

Controlled clinical trial and 3-month follow-up

Waitlist control group.

Primary care physicians recruited from family medicine and internal medicine departments within a health organisation

Participants n = 33

Waitlist control group n = 16

Intervention group n = 17

Final n = 26

Waitlist control group n = 13

Intervention group n = 13

Gender:

Male, 27%

Female, 73%

Mean age, 42.76

Ethnicity information not documented.

Randomisation of a self-selected sample.

Mindful Medicine Curriculum based on MBSR

13-h weekend training programme plus 2-h follow-up sessions

Overall participation: not noted.

Status of teacher not noted.

1. Mindful Awareness Attention Scale

2. Brief Resilience Scale

3. Perceived Stress Scale

4. Santa Clara Brief Compassion Scale*

5. Maslach Burnout Inventory

6. Meditation Practice Questionnaire

7. Patient Self-Reported Satisfaction with Primary Care Physician*

Overall global quality rating: moderate (score = 10).

Findings:

1. Intervention group reported significant improvements in stress, mindfulness, emotional exhaustion and depersonalisation post-intervention when compared to the control group

2. Improvements were maintained at 3-month follow-up

3. There was no significant improvement in resilience and personal achievement post-intervention.

Limitations:

1. Small sample size

2. Sample size was too small to detect improvements on other outcome measures

3. Self-selected sample

4. Enhanced social support was not controlled for.

Ducar et al. (2019).

Mindfulness for healthcare providers fosters professional quality of life and mindful attention amongst emergency medical technicians

No incentives provided.

Pre-post design, follow-up at 3 and 6 months

No control group

Volunteer emergency medical service providers including medics, paramedics and medical doctors

Participants

n = 15

Final n = 11

Gender

Male, 13

Female, 2

Mean age, 46.43

Ethnicity information not documented.

Self-selected sample and voluntary workers.

8-week adapted MBSR programme, 2.5-h sessions and an additional a 7-h silent retreat

Overall participation: not noted.

Two experienced MBSR teachers.

1. Perceived Stress Scale

2. Mindful Awareness and Attention Scale

3. Professional Quality of Life Measure

4. Self-care assessment*

Overall global quality rating: moderate (score = 11).

Findings:

1. Significant reductions in burnout post-intervention and sustained at 3 and 6 months

2. Significant reductions in perceived stress but not sustained at 3 or 6 months

3. Significant increases in trait mindfulness and sustained at 3 months but not at 6 months.

Limitations:

1. No control group

2. Sustained changes in burnout and mindfulness but it is not possible to ascertain how these changes would compare to other interventions

3. Unclear whether changes were sustained at 6 months

4. Low sample size

5. Low number of women included in the sample.

Goodman and Schorling (2012)

To investigate the effects of a meditation course on decreasing burnout and improving mental well-being in different HCPs

Participants paid for the intervention. Continuing education credits also provided.

Pre-post design

No control-group

Healthcare providers who practiced in community and university settings

including physicians, nurses, psychologists and social workers

Participants

n = 93

Final n = 73

Gender

Male, 35%

Female, 65%

No age or ethnicity information documented.

Self-selected sample and participants paid for the intervention.

8-week MBSR

programme

2.5-h sessions

7-h retreat

45 min mindfulness practice 6 days per week

Overall participation: 97% attended at least 4 sessions

Experienced MBSR teachers.

1. Maslach Burnout Inventory

2. SF-12v2 Health Survey Questionnaire

Overall global quality rating: moderate (score = 11).

Findings:

1. Significant improvements for emotional exhaustion, depersonalisation and personal accomplishment post-intervention

2. Significant improvements for mental well-being.

Limitations:

1. No control group

2. No follow-up data

3. No measure of mindfulness which could provide valuable information regarding the mechanisms by which mindfulness is beneficial.

Crowder and Sears (2017)

Building resilience in social workers: Am exploratory study on the impact of a mindfulness-based intervention

No incentives noted.

Clinical controlled trial and follow-up at 13-week follow-up

26-week follow-up for the intervention group

Mixed methods design

Waitlist control

Social workers

Participants

n = 14

Waitlist control n = 7

Intervention n = 7

Final n = 14

Gender:

Male, 3

Female, 11

Mean age, 46.5

Ethnicity:

Caucasian, 10

Canadian, 4

Self-selected sample.

MBSR 2.5-h group session for 8 weeks

Overall participation: not noted.

MBSR teacher was the primary investigators.

1. Perceived Stress Scale

2. Self-Compassion Scale

3. Experiences Questionnaire*

4. Maslach Burnout Inventory

5. Professional Quality of Life

Overall global quality rating: weak (score = 11).

Findings:

1. Intervention group reported significantly reduced stress levels post-intervention compared to the waitlist control group, however, improvements were not sustained at 13-week follow-up

2. No other significant differences between groups were found

3. Intervention group reported significant improvements in self-compassion and stress and these were maintained as 13 weeks and 26 weeks follow-up

4. Burnout was non-significant at 13 weeks but significant reductions in burnout were reported at 26 weeks for the intervention group.

Limitations:

1. Small non-representative convenience sample

2. Self-selected volunteers

3. Participants were not blind to the motive of the research

4. Teacher of the intervention was the lead researcher

Duarte and Pinto-Gouveia (2016)

Effectiveness of a mindfulness-based intervention on oncology nurses’ burnout and compassion fatigue symptoms: a non-randomised study

No incentives noted.

Clinical controlled trial

Waitlist control

Oncology nurses from two oncology hospitals

Participants

n = 93

(48 waitlist control, 45 intervention)

Final n = 48

(19 waitlist control, 29 intervention)

Gender:

Waitlist control:

Male, 3

Female, 16

Intervention:

Male, 3

Female, 26

Mean age:

Waitlist control, 42.11

Intervention, 38.90

Ethnicity information not documented.

Self-selected sample.

Mindfulness group based on MBSR

2-h sessions over 6 weeks

15-min daily formal mindfulness practice

Overall participation: not noted.

Author was the teacher, whom was also trained in MBSR.

1. Professional Quality of Life Scale

2. Depression, Anxiety, Stress Scale

3. Acceptance and Action Questionnaire*

4. Ruminative Responses Scale-Short*

5. Five Facet Mindfulness Questionnaire

6) Self-Compassion Scale

Overall global quality rating: weak (score = 11).

Findings:

1. Intervention group reported a significant reduction in burnout and stress post-intervention compared to waitlist control group

2. Intervention group reported significant increases in mindfulness and self-compassion post-intervention, and improvements regarding observing and non-judging maintained when compared to controls

3. Participants that practiced more mindfulness showed greater reductions in burnout and depression and greater increases in self-compassion compared with those that practised less.

Limitations:

1. Small sample size and most participants were women

2. Non-randomised allocation of participants and non-random significant differences between groups

3. Lack of follow-up assessment and large number of questionnaires could have contributed to low response rate at follow-up.

Geary and Rosenthal (2011)

To investigate the effect of MBSR on academic healthcare employees stress, well-being and spiritual experiences

No incentives noted.

Controlled clinical trial and 1 year follow-up

Control group

Nurses and respiratory therapists in a university medical branch and neonatal services

Participants n = 108

(49 control, 59 intervention)

Final n = 91

(37 control, 54 intervention)

Gender

Control:

Male, 4%

Female, 96%

Intervention:

Male, 15%

Female, 85%

Mean age:

Control, 42

Intervention, 48

Ethnicity:

Control:

55% White, 14% Hispanic, 11% African American, 17% Asian.

Intervention:

75% White, 18% Hispanic, 2% African American, 5% Asian.

Self-selected sample.

8-week MBSR programme

3 h per week

8-h retreat

Overall participation:

Cumulative completion = 89%

Certified MBSR teacher.

1. Symptom Checklist Revised-90-Revised

2. Perceived Stress Scale

3. SF-36 Health Survey Questionnaire

4. Daily Spiritual Experiences Scale*

Overall global quality rating: weak (score = 11).

Findings:

1. Significant improvements in stress, psychological distress and mental well-being post-intervention compared to controls

2. Improvements maintained at 1-year follow-up.

Limitations:

1. Not randomised

2. No blinding

3. Significant difference between groups regarding percentage of patient care

4. Possible selection bias.

Norouzinia et al. (2017)

The effect of mindfulness-based stress reduction training on stress and burnout of nurses

No incentives noted.

Controlled clinical trial

Control group

Nurses working in two hospitals

Participants n = 60

Control group n = 30

Intervention group n = 30

No attrition data.

Age:

< 30 years, 33.3%

31–40 years, 53.3%

41–50 years, 13.3%

No gender or ethnicity information documented.

Self-selected sample.

MBSR programme

- No further details documented.

Overall participation: Not noted.

Teacher status not noted.

1. Nurse Stress Scale

2. Maslach Burnout Inventory

Overall global quality rating: weak (score = 11).

Findings:

1. Significant reduction in job stress and three aspects of burnout post-intervention.

Limitations:

1. Lack of follow-up

2. Lack of randomisation.

Bazarko et al. (2013)

To investigate the effects of an innovative MBSR programme on health and well-being of nurses

Gift of low monetary value and continuing education credits (one contact hour) for each survey completion as compensation for their time.

Pre-post design and 4-month follow-up

No control group

Nurses within a large healthcare organisation

Participants

n = 41

Final n = 36

Gender

Male, 0%

Female, 100%

Mean age, 52.2

Ethnicity information not documented.

Self-selected sample.

Group telephonic MBSR (tMBSR) sessions

Two 8-h person retreats

6 weekly 1.5-h group tele-conference calls, email contact between sessions

Daily 25–30-min mindfulness practice

Overall participation:

Person retreat, 86.9%

Teleconference hours, 87.8%

MBSR instructor.

1. The Perceived Stress Scale

2. Copenhagen Burnout Inventory

3. SF-12v2 Health Survey Questionnaire

4. Brief Serenity Scale*

5. Jefferson Scale of Physician Empathy*

6. The Self-Compassion Scale

7. Log of amount and type of participation

Overall global quality rating: weak (score = 12).

Findings:

1. Significant reduction in stress and burnout post-intervention and maintained at 4-month follow-up

2. Significant improvements in mental health and self-compassion post-intervention and maintained at 4 months follow-up

3. Participants who maintained mindfulness practice had lower stress and burnout and higher self-compassion.

Limitations:

1. No control group

2. Small and self-selected sample

3. Unaware of previous MBSR a d meditation experience

4. Homogenous sample as all female nurses

5. Incentives for participation could positively bias results.

Ceravolo and Raines (2019)

The impact of a mindfulness intervention on nurse managers

No incentives noted.

Pre-post design and 3 months follow-up

No control group

Nurse managers at an acute care hospital, including a perinatal centre and adult beds

Participants

n = 13

Final n = 12

No information regarding gender, age and ethnicity was recorded.

Self-selected sample.

Weekly 60-min sessions for 8 weeks based on MBSR principles and exercises

Overall participation: Not noted.

Mindfulness expert was the teacher.

1. Quality of Life Inventory*

2. Copenhagen Burnout Inventory

3. Perceived Wellness Scale

Overall global quality rating: weak (score = 12).

Findings:

1. Significant improvements in burnout (personal and work-related) scores post intervention, however improvements were not maintained at 3-month follow-up

2. There were negligible changes in perceived wellness post-intervention.

Limitations:

1. Small sample size and all participants employed by the same organisation

2. Self-selected sample

3. Lack of control group

Dobie et al. (2016)

Preliminary evaluation of a brief mindfulness-based stress reduction intervention for mental health professionals

No incentives noted.

Pre-post design

No control group

Mental health professionals working in a non-acute inpatient mental health unit (nursing, social work, occupational therapy and psychology)

Participants

n = 9

Final n = 9

Gender, age and ethnicity not documented.

Self-selected sample.

8 weeks of daily 15-min MBSR training with three 30-min education sessions during weeks 2, 4 and 6

Overall participation, 100%

Status of teachers not noted.

1. Depression Anxiety Stress Scale

2. Kentucky Inventory of Mindfulness Skills

Overall global quality rating: weak (score = 12).

Findings:

1. Significant reductions in anxiety and stress post-intervention

2. Observed reductions in depression post-intervention but were not significant

3. Reported increases in the mindfulness observe skill post-intervention but were not significant.

Limitations:

1. Only observations from a treatment group

2. No control group

3. Data was not collected on caseload acuity and complexity or workplace environment

4. No follow-up data.

Gaspar et al. (2018)

Exploring the benefits of a mindfulness programme for Portuguese public healthcare workers

No incentives noted.

Pre-post design

No control group

Public health workers at a blood and transfusion centre

Participants

n = 51

Final n = 26

Gender (Final):

Male, 34.6%

Female, 65.4%

Mean age, 44.58

Ethnicity information not documented.

Self-selected sample.

Mindfulness intervention following the structure of MBCT 45-min daily mindfulness sessions for 11 weeks

Mean participation: 35.42 h

Status of teacher not noted.

1. Five Facet Mindfulness Questionnaire

2. Depression, Anxiety and Stress Scale

3. Positive and Negative Affect Schedule

4. Self-Compassion Scale

5. Compassion Scale*

6. Interpersonal Reactivity Index*

Overall global quality rating: weak (score = 12).

Findings:

1. Significantly higher scores in acting with awareness and self-compassion scores post-intervention

2. Marginal significant results with regard to an increase in positive affect and describing and decrease in negative affect, stress.

Limitations:

1. Small sample size

2. Self-selected and non-randomised

3. Self-report questionnaires

4. Average time practising mindfulness was too short

5. A large variation of attendance between participants thus differences in the specific content or exercises learnt may have occurred.

Martin-Asuero and Garcia-Banda (2010)

To investigate the effects of MBSR on HCPs psychological distress

Financial compensation with regard to a coupon after each evaluation.

Pre-post design and 3-month follow-up

Two intervention groups

No control group

HCPs in hospitals and primary care centres

Doctors, nurses, psychologists, educational professionals and service industry employees

Participants

n = 29

Final n = 27

Gender:

Male, 17%

Female, 83%

Mean age, 41.1

No ethnicity information documented.

Self-selected sample.

8-week MBSR

Programme

2.5-h per session plus one 8-h session

Daily 45-min mindfulness practice

Overall participation:

Average attendance = 92%

MBSR teacher was the first author of this study.

1. Symptom Checklist-90-Revised

2. Survey of Recent Life Experience*

3. Perceived Stress Scale

4. Positive and Negative Affect Scale

5. Emotional Control Questionnaire*

Overall global quality rating: weak (score = 12).

Findings:

1. A significant reduction in psychological distress post-intervention

2. A significant reduction in negative affect post-intervention

3. All improvements maintained at 3-month follow-up

4. Reduction in stress but not significant.

Limitations:

1. Self-selected sample

2. No control group

3. Intervention effects on the group were not isolated.

Pflugeisen et al. (2016)

Brief video-module administered mindfulness programme for physicians: a pilot study

No incentives noted.

Pre-post design and 2-month follow-up

No control group

Physicians in a community hospital setting

Participants n = 23

Final n = 19

Gender:

Male, 60.9%

Female, 39.1%

Mean age, 46

Ethnicity information not documented.

Self-selected sample.

8-week MBSR training

3 90-min in person trainings

Weekly online 5–7-min video module trainings

Weekly 1-h teleconference coaching calls

Overall participation: not noted.

Programme delivery was one of the authors, and family medicine physician and certified professional coach.

1. Perceived Stress Scale

2. Maslach Burnout Inventory

3. Kentucky Inventory of Mindfulness Skills

4. Participant use of mindfulness

Overall global quality rating: weak (score = 12).

Findings:

1. Significant reductions in stress, personal accomplishment and emotional exhaustion was observed post-intervention and at 8-weeks follow up

2. Significant increases in mindfulness skills post-intervention, with increases in describing, acting with awareness and accepting without judgement maintaining 8-week follow up.

Limitations:

1. Small sample size

2. Self-selected sample

3. Without a control population

4. Limited self-reported data.

Raab et al. (2015)

Mindfulness-based stress reduction and self-compassion amongst mental healthcare professionals: a pilot study

No incentives noted.

Pre-post design

No control group

Mental healthcare professionals working in a large mental healthcare centre

Participants n = 22

Final n = 22

Gender:

Female, 100%

Age, 24–69 years

Ethnicity information not documented.

Self-selected sample and participants completed a voluntary MBSR course.

MBSR programme 8 weekly 2.5-h long classes with 1 day of silence

Overall participation: Not noted.

Certified MBSR teachers.

1. Self-compassion scale

2. Maslach Burnout Inventory

3. Quality of Life Inventory*

Overall global quality rating: weak (score = 12).

Findings:

1. Self-compassion significantly improved post intervention

2. No statistically significant changes for burnout post-intervention.

Limitations:

1. Open trial design

2. Self-selected sample

3. Not randomised

4. Lack of control group

5. Included an additional Loving Kindness meditation to the standard MBSR techniques thus this could have biased the findings.

Suyi et al. (2017)

Effectiveness of mindfulness intervention in reducing stress and burnout in mental health professionals in Singapore

Small monetary imbursement after each study visit.

Pre-post design and follow up at 3 months

Three cohorts

No control group

Mental health professionals including nurses, occupational therapists, social workers, case managers, pharmacist, psychologist/counsellors and researchers

Participants

n = 44

Final n = 37

Follow-up n = 37

Gender:

Male, 18.9%

Female, 81.1%

Age:

< 25, 5.4%

25–30, 27%

30–35, 24.3%

35–40, 13.5%

40–45, 16.2%

> 45, 13.5%

Ethnicity:

Chinese, 78.4%

Malay, 5.4%

Indian, 10.8%

Self-selected sample.

Mindfulness programme based on MBSR, 6 2-h sessions once per week for 6 weeks

30 min of formal meditation practice

Overall participation:

Attended all 6 sessions, 45%

Certified MBSR teacher with 2 MBCT certified teachers as co-facilitators.

1. Five Facet Mindfulness Scale

2. Self-Compassion Short Scale Short Form

3. Compassion Scale*

4. Perceived Stress Scale

5. Oldenburg Burnout Inventory

Overall global quality rating: weak (score = 12).

Findings:

1. Significant improvements in all facets of mindfulness post-intervention and sustained at 3 months follow-up with the exception of act with awareness

2. Significant improvements in self-compassion post-intervention and sustained at 3 months follow-up

3. Significant reductions in stress post-intervention, however not sustained at 3 months follow-up

4. No significant changes in burnout.

Limitations:

1. Lack of control group

2. Self-selected sample

3. One of the investigators of the study was the main instructor for the mindfulness programme

4. Sample cannot be generalised to other healthcare professionals

5. Small sample size

Ando et al. (2011)

To investigate the effect of mindfulness-based meditation therapy on nurses’ sense of coherence and mental health

No incentives noted.

Controlled clinical trial

Control group

No incentives noted.

Nurses working on a ward with elderly patients

Participants n = 28

Control n = 13

Intervention n = 15

No attrition data.

No gender, age or ethnicity information.

Self-selected sample.

Adapted MBSR programme

Two sessions within a 2 week period

Mindfulness home practice

Overall participation: Not noted.

Instructors were nurses who received training on the programme for 3 h.

1. General Health Questionnaire

Overall global quality rating: weak (score = 13).

Findings:

1. Significant deduction in anxiety and depression post-intervention.

Limitations:

1. Small sample size

2. No randomisation

3. No balancing or matching between groups

4. No follow-up

5. Self-selected sample

Brady et al. (2012)

To investigate the effect of mindfulness meditation on managing work stress and improving patient outcomes

Participants were paid for classes as a portion of work time.

Pre-post design and 3-month follow-up

No control group

Acute psychiatric inpatient unit

psychiatric nurses, social workers, mental health technologists, recreational therapist and health unit co-ordinator

Participants

n = 23

Final n = 16

Gender:

Male, 19%

Female, 81%

No age or ethnicity information documented.

Self-selected sample.

4-week MBSR group

1 h per session

Daily 30-min mindfulness practice

Overall participation:

16 out of 23 participants attended all sessions

Status of instructor not reported.

1. Mental Health Professionals Stress Scale

2. The Toronto Mindfulness Scale

3. Maslach Burnout Inventory

Overall global quality rating: weak (score = 13).

Findings:

1. Significant reduction in stress post-intervention and at 3-month follow-up

2. Significant increase in mindfulness post-intervention and at 3-month follow-up

3. No significant reduction in emotional exhaustion and depersonalisation, there was an improvement in personal accomplishment but it was not significant.

Limitations:

1. Small sample size

2. Not controlled nor randomised

3. Sampling bias

4. Did not take into account personality traits or cultural background

5. Response bias on measures

6. No comparison group

Hallman et al. (2018)

To investigate the effects of MBSR on staff stress in a high-acuity psychiatric inpatient unit

No incentives noted.

Pre-post design and 2-month follow-up

No control group

Nurses, teachers

social worker, activity therapist and physician from a high-acuity inpatient child/adolescent psychiatric unit

Participants

n = 15

Final n = 12

Gender

Male, 17%

Female, 83%

Mean age, 39

Ethnicity information not documented.

Self-selected sample.

MBSR

4 45-min classes offered

over 8 days

Daily 15-min meditation practice as part of their shift

Overall participation: 12 of the 15 participants attended all sessions

Principal investigator was the MBSR teacher.

1. Toronto

Mindfulness Scale

2. Perceived Stress Scale

Overall global quality rating: weak (score = 13).

Findings:

1. Significant reductions in stress post-intervention and maintained at 2 months follow-up

2. Significant increase in mindfulness post-intervention and maintained at 2-month follow-up.

Limitations:

1. Small sample size

2. Self-selected participants

3. Response bias due to self-report measures

4. Homogeneity of sample could limit generalisability

5. Daily mindfulness practice was limited.

Fortney et al. (2013)

To investigate the effects of an abbreviated mindfulness intervention on health and well-being of primary care clinicians

No incentives noted.

Pre-post design and 9-month follow-up

Two intervention groups

No control-group

Doctors, nurse practitioners and physician assistants in departments of family medicine, internal medicine and paediatrics

Participants

n = 30

Final n = 23

Gender

Male, 40%

Female, 60%

Mean age, 40.5

Ethnicity:

97% White

3% Hispanic

Self-selected sample.

Abbreviated version of the 8-week MBSR programme

14 h over a weekend

2 2-h follow up sessions

Daily 10–20 min of mindfulness practice

Overall participation: not noted.

Mindfulness teachers.

1. Maslach Burnout Inventory

2. Depression, Anxiety and Stress Scale

3. Perceived Stress Scale

4. Resilience Scale

5. Santa Clara Compassion Scale*

Overall global quality rating: weak (score = 13).

Findings:

1. Significant improvements in emotional exhaustion, depersonalisation and personal accomplishment post-intervention and at 9 months

2. Significant reductions in anxiety, depression and stress post-intervention and at 9 months

3. No significant improvements in resilience.

Limitations:

1. Uncontrolled pilot study

2. Lack of control group

3. Small sample size and self-selected participants

4. Group effects versus actual practice of mindfulness

Cucarella and Gianinni (2016)

Effectiveness of a pilot mindfulness programme in volunteers of a breast cancer association

Incentives not noted.

Pre-post design

No control group

Volunteers of a foundation that supports women with breast cancer

Participants

n = 7

No attrition data.

Gender:

Female, 100%

Mean age, 46.7

Ethnicity information not documented.

Self-selected sample and voluntary workers.

8-week MBSR programme

2.5 hourly sessions

Overall participation: not noted.

Status of teacher not noted.

1. Positive and Negative Affect Scale

2. Hospital Anxiety and Depression Scale

3. Professional Quality of Life Measure

Overall global quality rating: weak (Score = 14).

Findings:

1. Significant reductions in anxiety and depression post-intervention

2. No significant differences found in burnout nor positive and negative affect pre- and post-intervention.

Limitations:

1. Small sample size

2. No control group

3. No follow-up.

Trowbridge et al. (2017)

Preliminary investigation of workplace-provided mindfulness-based stress reduction with paediatric medical social workers

No incentives documented.

Pre-post design

No control group

Social workers employed by a regional children’s healthcare system

Participants

n = 43

Final n = 21

No information documented regarding gender, age and ethnicity.

Self-selected sample.

Compressed MBSR (cMBSR) programme

Two days

20 min formal mindfulness practice

Overall participation: not noted.

University of Massachusetts trained instructor.

1. Professional Quality of Life

2. Perceived Stress Scale-10 Item

3. Mindful Attention and Awareness Scale

4. Caring Efficacy Scale*

Overall global quality rating: weak (score = 14).

Findings:

1. Significant increase in mindfulness post-intervention

2. No significant differences for stress and burnout between pre and post-test intervention.

Limitations:

1. Small sample size

2. Self-selected sample

3. Attrition rate between recruitment and intervention.

van Wietmarschen et al. (2018)

Effects of mindfulness training in perceived stress, self-compassion and self-reflection of primary care physicians: A mixed-methods approach

No incentive noted.

Pre- and post-design and 6 months follow-up

Mixed methods design

No control group

Primary care physicians

Participants n = 54

Post-intervention = 51

Follow-up n = 23

Gender:

Male, 22%

Female, 78%

Mean age, 40

Ethnicity information not documented.

Self-selected sample and participants paid $750 dollars for the programme and the training was accredited by the Royal Dutch Medical Association.

Adapted MBSR programme

8 weekly group sessions totalling 26 h

Overall participation: Not noted.

Two qualified MBSR teachers.

1. Perceived Stress Scale

2. Self-Compassion Scale

3. Groningen Reflection Ability Scale*

Overall global quality rating: weak (score = 14).

Findings:

1. Significant reductions in stress post-intervention

2. Significant increases in self-compassion post-intervention

3. Improvements were maintained at 6-month follow-up.

Limitations:

1. Not a randomised design

2. Lacked an appropriate control group

3. Self-selected sample

4. Reduced response rates at 6-months follow-up

*All measures in italics refer to measures that have not be included in the systemic review