Sood 2011.

Study characteristics
Methods	Study design: RCT Study grouping: parallel group Unit of randomisation: individuals Power (power sample size calculation, level of power achieved): A sample size of 40 was selected for this pilot study after weighing statistical considerations along with logistical and resource constraints. In general, for a continuous outcome variable, a sample size of 40 provides statistical power (2‐tailed, α = 0.05) of > 85% to detect a difference of 1 SD between groups. Imputation of missing data: no imputation of missing data; per‐protocol analysis with participants who complied with allocated intervention and for whom outcomes were obtained
Participants	Country: USA Setting: Department of Medicine Faculty, clinic Age: IG mean = 46.8 (SD = 8.3) years, CG mean = 50.2 (SD = 5.7) years (unclear for total sample as number of participants considered for baseline characteristics not specified) Sample size (randomised): 40 Sex: comparable gender distribution across 2 study arms (IG = 55% men; CG = 50% men) Comorbidity (mean (SD) of respective measures in indicated, if available) at baseline: anxiety (SAS): IG = 55.2 (13.6), CG = 50.5 (23.0) Population description: physicians of Department of Medicine Faculty, all academic clinicians Inclusion criteria: 1) being a faculty member of the Department of Medicine; 2) being able and willing to participate Exclusion criteria: 1) a recent (within the past 6 months) psychotic episode; 2) clinically significant, acute, unstable neurological, psychiatric, hepatic, renal, cardiovascular, or respiratory disease that prevented participation in the study Attrition (withdrawals and exclusions): of the 40 enrolled, 32 (80%) physicians completed the study; 8/20 (40%) participants in the CG declined to participate after randomisation and prior to filling out any assessments Reasons for missing data: scheduling issues in CG
Interventions	Intervention: SMART (n = 20) delivery: face‐to‐face; individual setting providers: not specified duration of treatment period and timing: single 90‐minute session, optional 30 – 60‐minute follow‐up session depending on individual needs description: attention training is instruction to help participants direct their interpretations away from fixed prejudices toward a more flexible disposition while cultivating skills such as gratitude, compassion, acceptance, forgiveness, and higher meaning; brief structured relaxation intervention (paced breathing meditation) compliance: All 20 participants completed the 90‐minute training; 4 participants participated in an additional 30‐minute session. integrity of delivery: not specified economic information: not specified theoretical basis: adapted from Attention and Interpretation Therapy (AIT); AIT is a structured therapy developed at the Mayo Clinic to decrease stress and enhance resilience; addresses 2 aspects of human experience, attention and interpretation; AIT guides learners to delay judgement and pay greater attention to the novelty of the world Control: wait‐list control (n = 20) compliance: 8 participants declined to participate after randomisation; did not receive the intervention
Outcomes	Outcomes collected and reported: Primary outcome resilience ‐ CD‐RISC perceived stress ‐ PSS anxiety ‐ SAS quality of life ‐ Linear Analog Self Assessment Scale fatigue ‐ Visual Analog Scale Fatigue Time points measured and reported: 1) pre‐intervention; 2) 2‐month follow‐up (8 weeks after single session intervention) Adverse events: not specified
Notes	Contact with authors: no correspondence required Study start/end date: not specified Funding source: Department of Medicine, Mayo Clinic, Rochester, MN Declaration of interest: none disclosed Ethical approval needed/obtained for study: study protocol reviewed and approved by Mayo Foundation IRB Comments by authors: not specified Miscellaneous outcomes by the review authors: not relevant Correspondence: Amit Sood, MD, Complementary and Integrative Medicine Program, Division of General Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; sood.amit@mayo.edu
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote: "After obtaining the informed consent, physicians were randomly assigned to one of two groups an active arm or a wait‐list control arm." Judgement comment: insufficient information about random‐sequence generation to permit judgement of ‘Low risk’ or ‘High risk’; RCT and no apparent baseline differences between randomised groups for mean age, gender, baseline stress and resilience measures; verified baseline comparability of groups for some sociodemographic variables (age, gender) and outcome measures (stress, resilience); but statistical (non)significance not reported and baseline comparability for other variables also unclear
Allocation concealment (selection bias)	Unclear risk	Judgement comment: insufficient information about allocation concealment to permit judgement of ‘Low risk’ or ‘High risk’
Blinding of participants and personnel (performance bias) Subjective outcomes	High risk	Judgement comment: blinding of participants and personnel probably not done (face‐to‐face intervention) and the outcome is likely to be influenced by lack of blinding
Blinding of outcome assessment (detection bias) Subjective outcomes	High risk	Judgement comment: insufficient information about blinding of outcome assessment; however, due to potential performance bias (no blinding of participants), the review authors judge that the participants' responses to questionnaires may be affected by the lack of blinding (i.e. knowledge and beliefs about intervention they received)
Incomplete outcome data (attrition bias) All outcomes	High risk	Quote: "Figure 1. Flow diagram of the progress in a randomized clinical trial to assess the effect of resiliency training among physicians." Quote: "Of the 40 enrolled (all academic clinicians), 32 (80%) physicians completed the study. Eight participants (all in the control arm) declined to participate after randomization and prior to filling out any assessments because of scheduling issues (Fig. 1)." Judgement comment: reasons for missing outcome data likely to be related to true outcome with imbalance in numbers for missing data (only missing data in CG, n = 8); per‐protocol analysis with participants who complied with allocated intervention and for whom outcomes were obtained
Selective reporting (reporting bias)	Low risk	Judgement comment: no study protocol available, but it is clear that the published report includes all expected outcomes, including those that were prespecified