Context
Primary care physicians report high levels of distress, which is linked to burnout, attrition, and poorer quality of care. Programs to reduce burnout before it results in impairment are rare; data on these programs are scarce.Objective
To determine whether an intensive educational program in mindfulness, communication, and self-awareness is associated with improvement in primary care physicians' well-being, psychological distress, burnout, and capacity for relating to patients.Design, Setting, and Participants
Before-and-after study of 70 primary care physicians in Rochester, New York, in a continuing medical education (CME) course in 2007-2008. The course included mindfulness meditation, self-awareness exercises, narratives about meaningful clinical experiences, appreciative interviews, didactic material, and discussion. An 8-week intensive phase (2.5 h/wk, 7-hour retreat) was followed by a 10-month maintenance phase (2.5 h/mo).Main Outcome Measures
Mindfulness (2 subscales), burnout (3 subscales), empathy (3 subscales), psychosocial orientation, personality (5 factors), and mood (6 subscales) measured at baseline and at 2, 12, and 15 months.Results
Over the course of the program and follow-up, participants demonstrated improvements in mindfulness (raw score, 45.2 to 54.1; raw score change [Δ], 8.9; 95% confidence interval [CI], 7.0 to 10.8); burnout (emotional exhaustion, 26.8 to 20.0; Δ = −6.8; 95% CI, −4.8 to −8.8; depersonalization, 8.4 to 5.9; Δ = −2.5; 95% CI, −1.4 to −3.6; and personal accomplishment, 40.2 to 42.6; Δ = 2.4; 95% CI, 1.2 to 3.6); empathy (116.6 to 121.2; Δ = 4.6; 95% CI, 2.2 to 7.0); physician belief scale (76.7 to 72.6; Δ = −4.1; 95% CI, −1.8 to −6.4); total mood disturbance (33.2 to 16.1; Δ = −17.1; 95% CI, −11 to −23.2), and personality (conscientiousness, 6.5 to 6.8; Δ = 0.3; 95% CI, 0.1 to 5 and emotional stability, 6.1 to 6.6; Δ = 0.5; 95% CI, 0.3 to 0.7). Improvements in mindfulness were correlated with improvements in total mood disturbance (r = −0.39, P < .001), perspective taking subscale of physician empathy (r = 0.31, P < .001), burnout (emotional exhaustion and personal accomplishment subscales, r = −0.32 and 0.33, respectively; P < .001), and personality factors (conscientiousness and emotional stability, r = 0.29 and 0.25, respectively; P < .001).Conclusions
Participation in a mindful communication program was associated with short-term and sustained improvements in well-being and attitudes associated with patient-centered care. Because before-and-after designs limit inferences about intervention effects, these findings warrant randomized trials involving a variety of practicing physicians.
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<p>Mindfulness is an attribute of consciousness long believed to promote well-being. This research provides a theoretical and empirical examination of the role of mindfulness in psychological well-being. The development and psychometric properties of the dispositional Mindful Attention Awareness Scale (MAAS) are described. Correlational, quasi-experimental, and laboratory studies then show that the MAAS measures a unique quality of consciousness that is related to a variety of well-being constructs, that differentiates mindfulness practitioners from others, and that is associated with enhanced self-awareness. An experience-sampling study shows that both dispositional and state mindfulness predict self-regulated behavior and positive emotional states. Finally, a clinical intervention study with cancer patients demonstrates that increases in mindfulness over time relate to declines in mood disturbance and stress.</p>
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In keeping with cognitive appraisal models of emotion, it was hypothesized that sadness and anger would exert different influences on causal judgments. Two experiments provided initial support for this hypothesis. Sad Ss perceived situationally caused events as more likely (Experiment 1) and situational forces more responsible for an ambiguous event (Experiment 2) than angry Ss, who, in contrast, perceived events caused by humans as more likely and other people as more responsible. Experiments 3, 4, and 5 showed that the experience of these emotions, rather than their cognitive constituents, mediates these effects. The nonemotional exposure to situational or human agency information did not influence causal judgments (Experiment 3), whereas the induction of sadness and anger without explicit agency information did (Experiments 4 and 5). Discussion is focused on the influence of emotion on social judgment.
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Background and objectives. Cancer-related cognitive impairment has been acknowledged as a substantial limiting factor in quality of life among cancer patients and survivors. In addition to deficits on behavioral measures, abnormalities in neurologic structure and function have been reported. In this paper, we review findings from the literature on cognitive impairment and cancer, potential interventions, meditation and cognitive function, and meditation and cancer. In addition, we offer our hypotheses on how meditation practice may help to alleviate objective and subjective cognitive function, as well as the advantages of incorporating a meditation program into the treatment of cancer patients and survivors for cancer-related cognitive deficits. Findings. Various factors have been hypothesized to play a role in cancer-related cognitive impairment including chemotherapy, reduced hormone levels, proinflammatory immune response, fatigue, and distress. Pharmacotherapies such as methylphenidate or modafinil have been suggested to alleviate cognitive deficits. While initial reports suggest they are effective, some pharmacotherapies have side effects and may not relieve other symptoms associated with multimodal cancer treatment including sleep disturbance, nausea and pain. Several recent studies investigating the effects of meditation programs have reported behavioral and corresponding neurophysiological modulations that may be particularly effective in alleviating cancer-related cognitive impairment. Such programs also have been shown to reduce stress, fatigue, nausea and pain, and improve mood and sleep quality. Conclusions. With the increasing success of cancer treatment and the ability to return to previous family, social, and work activities, symptom management and quality of life are an essential part of survivorship. We propose that meditation may help to improve cancer-related cognitive dysfunction, alleviate other cancer-related sequelae, and should be fully investigated as an adjuvant to cancer treatment.
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Despite the call for multilevel observation of negative affect, including multiple physiological systems, too little empirical research has been conducted in infants and young children, and physiology-affect associations are not consistently reported. We examined changes in heart rate, respiratory sinus arrhythmia, and preejection period in 24-month-olds across four increasingly challenging, emotion-eliciting tasks. We predicted that changes in cardiac reactivity would be systematically related to changes in negative affect. Results largely support the predictions with one important exception. With increasing distress across the tasks, HR increased and RSA decreased. However, no significant changes in PEP were observed. HR was associated with negative affect during all tasks, and changes in HR were related to changes in negative affect. PEP and negative affect were associated, but only marginally so. Within-subject analyses confirmed the predicted associations. Finally, the associations between physiology and negative affect were different for boys and girls. We discuss these results in the context of implications for future research on cardiac-affect associations in young children.
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Previous research indicates that lower-class individuals experience elevated negative emotions as compared with their upper-class counterparts. We examine how the environments of lower-class individuals can also promote greater compassionate responding-that is, concern for the suffering or well-being of others. In the present research, we investigate class-based differences in dispositional compassion and its activation in situations wherein others are suffering. Across studies, relative to their upper-class counterparts, lower-class individuals reported elevated dispositional compassion (Study 1), as well as greater self-reported compassion during a compassion-inducing video (Study 2) and for another person during a social interaction (Study 3). Lower-class individuals also exhibited heart rate deceleration-a physiological response associated with orienting to the social environment and engaging with others-during the compassion-inducing video (Study 2). We discuss a potential mechanism of class-based influences on compassion, whereby lower-class individuals' are more attuned to others' distress, relative to their upper-class counterparts.
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Poor sleep is common in substance use disorders (SUDs) and is a risk factor for relapse. Within the context of a multicomponent, mindfulness-based sleep intervention that included mindfulness meditation (MM) for adolescent outpatients with SUDs (n = 55), this analysis assessed the contributions of MM practice intensity to gains in sleep quality and self-efficacy related to SUDs. Eighteen adolescents completed a 6-session study intervention and questionnaires on psychological distress, sleep quality, mindfulness practice, and substance use at baseline, 8, 20, and 60 weeks postentry. Program participation was associated with improvements in sleep and emotional distress, and reduced substance use. MM practice frequency correlated with increased sleep duration and improvement in self-efficacy about substance use. Increased sleep duration was associated with improvements in psychological distress, relapse resistance, and substance use-related problems. These findings suggest that sleep is an important therapeutic target in substance abusing adolescents and that MM may be a useful component to promote improved sleep.
Poor sleep is common in substance use disorders (SUDs) and is a risk factor for relapse. Within the context of a multicomponent, mindfulness-based sleep intervention that included mindfulness meditation (MM) for adolescent outpatients with SUDs (n = 55), this analysis assessed the contributions of MM practice intensity to gains in sleep quality and self-efficacy related to SUDs. Eighteen adolescents completed a 6-session study intervention and questionnaires on psychological distress, sleep quality, mindfulness practice, and substance use at baseline, 8, 20, and 60 weeks postentry. Program participation was associated with improvements in sleep and emotional distress, and reduced substance use. MM practice frequency correlated with increased sleep duration and improvement in self-efficacy about substance use. Increased sleep duration was associated with improvements in psychological distress, relapse resistance, and substance use-related problems. These findings suggest that sleep is an important therapeutic target in substance abusing adolescents and that MM may be a useful component to promote improved sleep.
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Demands faced by health care professionals include heavy caseloads, limited control over the work environment, long hours, as well as organizational structures and systems in transition. Such conditions have been directly linked to increased stress and symptoms of burnout, which in turn, have adverse consequences for clinicians and the quality of care that is provided to patients. Consequently, there exists an impetus for the development of curriculum aimed at fostering wellness and the necessary self-care skills for clinicians. This review will examine the potential benefits of mindfulness-based stress reduction (MBSR) programs aimed at enhancing well-being and coping with stress in this population. Empirical evidence indicates that participation in MBSR yields benefits for clinicians in the domains of physical and mental health. Conceptual and methodological limitations of the existing studies and suggestions for future research are discussed.
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Considerable research has disclosed how cognitive reappraisals and the modulation of emotional responses promote successful emotion regulation. Less research has examined how the early processing of emotion-relevant stimuli may create divergent emotional response consequences. Mindfulness—a receptive, non-evaluative form of attention—is theorized to foster emotion regulation, and the present study examined whether individual differences in mindfulness would modulate neural responses associated with the early processing of affective stimuli. Focus was on the late positive potential (LPP) of the event-related brain potential to visual stimuli varying in emotional valence and arousal. This study first found, replicating past research, that high arousal images, particularly of an unpleasant type, elicited larger LPP responses. Second, the study found that more mindful individuals showed lower LPP responses to high arousal unpleasant images, even after controlling for trait attentional control. Conversely, two traits contrasting with mindfulness—neuroticism and negative affectivity—were associated with higher LPP responses to high arousal unpleasant images. Finally, mindfulness was also associated with lower LPP responses to motivationally salient pleasant images (erotica). These findings suggest that mindfulness modulates neural responses in an early phase of affective processing, and contribute to understanding how this quality of attention may promote healthy emotional functioning.
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A successful clinical trial is dependent on recruitment. Between December 2003 and February 2006, our team successfully enrolled 289 participants in a large, single-center, randomized placebo-controlled trial (RCT) studying the impact of the patient-doctor relationship and acupuncture on irritable bowel syndrome (IBS) patients. This paper reports on the effectiveness of standard recruitment methods such as physician referral, newspaper advertisements, fliers, audio and video media (radio and television commercials) as well as relatively new methods not previously extensively reported on such as internet ads, ads in mass-transit vehicles and movie theater previews. We also report the fraction of cost each method consumed and fraction of recruitment each method generated. Our cost per call from potential participants varied from $3–$103 and cost per enrollment participant varied from $12–$584. Using a novel metric, the efficacy index, we found that physician referrals and flyers were the most effective recruitment method in our trial. Despite some methods being more efficient than others, all methods contributed to the successful recruitment. The iterative use of the efficacy index during a recruitment campaign may be helpful to calibrate and focus on the most effective recruitment methods.
A successful clinical trial is dependent on recruitment. Between December 2003 and February 2006, our team successfully enrolled 289 participants in a large, single-center, randomized placebo-controlled trial (RCT) studying the impact of the patient-doctor relationship and acupuncture on irritable bowel syndrome (IBS) patients. This paper reports on the effectiveness of standard recruitment methods such as physician referral, newspaper advertisements, fliers, audio and video media (radio and television commercials) as well as relatively new methods not previously extensively reported on such as internet ads, ads in mass-transit vehicles and movie theater previews. We also report the fraction of cost each method consumed and fraction of recruitment each method generated. Our cost per call from potential participants varied from $3–$103 and cost per enrollment participant varied from $12–$584. Using a novel metric, the efficacy index, we found that physician referrals and flyers were the most effective recruitment method in our trial. Despite some methods being more efficient than others, all methods contributed to the successful recruitment. The iterative use of the efficacy index during a recruitment campaign may be helpful to calibrate and focus on the most effective recruitment methods.
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Mindfulness-based Stress Reduction, a stress-reduction program, has increasing empirical support as a patient-care intervention. Its emphasis on self-care, compassion, and healing makes it relevant as an intervention for helping nurses manage stress and reduce burnout. This article describes the implementation of Mindfulness-based Stress Reduction in a hospital system as a way to lower burnout and improve well-being among nurses, using both quantitative and qualitative data.
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This article is the second in a series reporting on research exploring the effects of Mindfulness-based Stress Reduction on nurses and describes the quantitative data. The third article describes qualitative data. Treatment group participants reduced scores on 2 of 3 subscales of the Maslach Burn...
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Part III of the study on mindfulness-based stress reduction (MBSR) describes qualitative data and discusses the implications of the findings. Study analysis revealed that nurses found MBSR helpful. Greater relaxation and self-care and improvement in work and family relationships were among reported benefits. Challenges included restlessness, physical pain, and dealing with difficult emotions.
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Social comparison can elicit emotions such as envy, which can affect social interactions. The emergence and development of such social emotions through ontogeny, and their influence on social interaction, are unknown. We tested 182 children from 7 to 13 years of age with a novel monetary reward-and-punishment task measuring envy and Schadenfreude (i.e., gloating or taking delight in someone else’s misfortune). Children were either rewarded or punished in a trial-by-trial evaluation of their performance on a speeded reaction time task. In a social condition, feedback of their own and a competitor’s performance was given for each trial. Afterward, children rated how they felt about the outcome. The ratings suggest that when children won, they felt better if the competitor lost instead of winning (i.e., Schadenfreude). Conversely, when children lost, they felt worse if the competitor won instead of losing (i.e., envy). Crucially, levels of envy and Schadenfreude decreased with age. We also studied how these emotions relate to social decisions made separately during three resource allocation paradigms. In each, children chose between two options that differed in the distribution of valuable tokens between themselves and an anonymous other. The combination of choices allowed the measurement of inequity aversion (i.e., equality for all) and spite (i.e., self-profit to maximal disadvantage of the other). We found an age-related increase in inequity aversion and decrease in spite. Crucially, age-related changes in both envy and Schadenfreude predicted the developmental change in equity-related decisions. These findings shed light on the development of social emotions and demonstrate their importance in the development of prosocial behavior in children.
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The authors address 2 questions about embarrassment. First, Is embarrassment a distinct emotion? The evidence indicates that the antecedents, experience, and display of embarrassment, and to a limited extent its autonomic physiology, are distinct from shame, guilt, and amusement and share the dynamic, temporal characteristics of emotion. Second, What are the theoretical accounts of embarrassment? Three accounts focus on the causes of embarrassment, positioning that it follows the loss of self-esteem, concern for others' evaluations, or absence of scripts to guide interactions. A fourth account focuses on the effects of the remedial actions of embarrassment, which correct preceding transgressions. A fifth account focuses on the functional parallels between embarrassment and nonhuman appeasement. The discussion focuses on unanswered questions about embarrassment.
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The authors propose that people in relationships become emotionally similar over time--as this similarity would help coordinate the thoughts and behaviors of the relationship partners, increase their mutual understanding, and foster their social cohesion. Using laboratory procedures to induce and assess emotional response, the authors found that dating partners (Study 1) and college roommates (Studies 2 and 3) became more similar in their emotional responses over the course of a year. Further, relationship partners with less power made more of the change necessary for convergence to occur. Consistent with the proposed benefits of emotional similarity, relationships whose partners were more emotionally similar were more cohesive and less likely to dissolve. Discussion focuses on implications of emotional convergence and on potential mechanisms.
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Brosnan's research on chimpanzees and capuchin monkeys provides invaluable clues to unlocking the complex nature of human morality. Elaborating upon her claims, we explore the role of emotions in basic social interactions, social regulation processes, and morality, all of which may be crucial to both human and nonhuman communities. We then turn to a conceptualization of teasing and play as forums for negotiating norms and the boundaries of acceptable behavior, and focus on the role of emotions in assessing the moral character of others. Finally, we consider points of convergence and departure between human responses to relative deprivation and those observed by Brosnan in primates. We conclude that work such as Brosnan's paves the way for fruitful collaborations between scholars of morality from diverse fields.
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People believe they see emotion written on the faces of other people. In an instant, simple facial actions are transformed into information about another's emotional state. The present research examined whether a perceiver unknowingly contributes to emotion perception with emotion word knowledge. We present 2 studies that together support a role for emotion concepts in the formation of visual percepts of emotion. As predicted, we found that perceptual priming of emotional faces (e.g., a scowling face) was disrupted when the accessibility of a relevant emotion word (e.g., anger) was temporarily reduced, demonstrating that the exact same face was encoded differently when a word was accessible versus when it was not. The implications of these findings for a linguistically relative view of emotion perception are discussed.
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BACKGROUND: Relationships between aberrant social functioning and depression have been explored via behavioral, clinical, and survey methodologies, highlighting their importance in the etiology of depression. The neural underpinnings of these relationships, however, have not been explored.
METHODS: Nine depressed participants and 14 never-depressed control subjects viewed emotional and neutral pictures at two functional magnetic resonance imaging (fMRI) scanning sessions approximately 22 weeks apart. In the interim, depressed patients received the antidepressant Venlafaxine. Positively rated images were parsed into three separate comparisons: social interaction, human faces, and sexual images; across scanning session, activation to these images was compared with other positively rated images.
RESULTS: For each of the three social stimulus types (social interaction, faces, sexual images), a distinguishable circuitry was activated equally in non-depressed control subjects and post-treatment depressed subjects but showed a hypo-response in the depressed group pre-treatment. These structures include regions of prefrontal, temporal, and parietal cortices, insula, basal ganglia, and the hippocampus.
CONCLUSIONS: The neural hypo-response to positively valenced social stimuli that is observed in depression remits as response to antidepressant medication occurs, suggesting a state-dependent deficiency in response to positive social incentives. These findings underscore the importance of addressing social dysfunction in research and treatment of depression.
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In this paper I discuss how expressive behavior relates to personality and psychopathology, integrating recent findings from my laboratory and the insights of Charles Darwin on this topic. In the first part of the paper I challenge the view, in part espoused by Darwin, that humans are equipped to convey only a limited number of emotions with nonverbal behavior. Our lab has documented displays for several emotions, including embarrassment, love, desire, compassion, gratitude, and awe, to name just a few states that previously were thought not to possess a distinct display. I then present an argument for how individual differences in emotion, although fleeting, shape the social environment. This argument focuses on the functions of nonverbal display: to provide information to others, to evoke responses, and to serve as incentives of preceding or ensuing social behavior. This reasoning sets the stage for the study of the relationships between personality, psychopathology, and expressive behavior, to which I turn in the final part of the paper. Here I show that basic personality traits (e.g., extraversion, agreeableness) and psychological disorders (e.g., externalizing disorder in children, autism) have expressive signatures that shape social interactions and environments in profound ways that might perpetuate and transmit the trait or disorder.
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