Ultrabrief Mindfulness Intervention for Highly Stressed Professionals: A Pilot Open Trial

Introduction

Stress is a significant contributor to the onset and maintenance of disease, ¹ and interventions to reduce stress are of high interest. Mindfulness interventions (MIs) yield wide-ranging health benefits ² ; however, a limitation of MI participation is often the time commitment (e.g., weekly 2.5 h meetings and daily 45 min practice for 2 months ³ ), and this barrier is particularly salient for those in demanding occupations. The purpose of this study was to evaluate an ultrabrief MI for outcomes affected by stress (i.e., mental health and quality of life [QoL]) among individuals in a demanding high-stress occupation: public school principals. ⁴

Methods

A director of a high-poverty urban school district approached the first author seeking assistance for principals' occupational stress. The district's elementary school principals were provided a presentation on the deleterious effects of stress and the relationship between MI and stress, followed by elective enrollment to participate in an ultrabrief MI. Self-report measures were collected pre-post intervention from principals who consented to participate. This research was reviewed and approved by the Syracuse University institutional review board.

Evidence of selected measures' strong psychometric properties is found in accompanying citations. The Brief Symptom Inventory-18 (BSI-18) ⁵ is a screener for high-prevalence psychiatric disorders. Higher scores indicate greater psychopathology, and clinically significant scores indicate need for psychiatric evaluation. The World Health Organization quality of life assessment, abbreviated version (WHOQOL-BREF), ⁶ is a brief measure of QoL. Higher scores indicate more positive QoL. Feasibility was measured by attendance to intervention sessions, and by ecological momentary assessment (through text messages) of mindfulness practice. Acceptability was measured through written responses to open-ended questions about participant's perceptions of the MI.

The ultrabrief MI was developed to establish a daily mindfulness practice. Two 1-hour sessions were held 3 weeks apart, followed by 5 weeks of personal practice. Session 1: participants were provided didactic instruction on the “3-minute breathing space,” ⁷ psychoeducation on core concepts (i.e., self-regulated attention, present moment, nonjudgment, and dialects of acceptance and change), and brief motivational interviewing ⁸ to encourage daily practice. Between sessions, participants received daily weekday practice reminders through text message; reminder frequency was reduced to weekly after session 2. Session 2: Participants were provided semistructured group discussion of personal practice and received didactic instruction adapted from established MI curricula ³ (i.e., self-responsibility of habits, universality of wandering mind, futility of thought control, practice to recognize habitual stress, and practice as a response to stress).

Given the anticipated small sample size, the nonparametric Wilcoxon signed-rank test was selected to evaluate pre-post intervention changes. A two-sided statistical significance threshold was set 0.05.

Results

Eleven principals participated in the MIs, and pre-post measures were completed by six participants (Table 1). Participants reported significant decreases on the BSI-18, and the two participants with clinically significant preintervention scores reduced to nonclinical levels postintervention. Participants reported significant gains on the WHOQOL-BREF. Eight participants (73%) attended the first session and five participants (45%) attended both. During the 3 weeks of daily reminders, participants reported practicing 49% of weekdays; during the 5 weeks of weekly reminders participants reported practicing 32% of weekdays. Acceptability data indicated participants' positive perceptions of MIs (e.g., “It seemed to help with the stress”). Acceptability data also indicated that participants experienced two barriers to engaging in the MI: not having the time to attend the sessions or practice and forgetting to practice during the workday.

Discussion

Results indicate that ultrabrief MIs may benefit mental health and QoL in highly stressed samples. Feasibility data indicate that about half of participants were able to fully participate in the intervention, similar to attrition levels in other brief MI studies, ⁹ and acceptability data suggests the MI was well received. Acceptability data indicate that not having the time during the workday for the MI and forgetting to practice were the major barriers to full participation.

This study developed a time-limited MI to reduce stress in a sample of busy professionals. Future research into ultrabrief MI in demanding work environments should consider systems-level collaboration with partnering institutions to create regular protected time for participation, measurement of nonself-report health indicators (e.g., physiologic stress and health care utilization), and consideration of temporary contextual factors that acutely alter stress (e.g., fluctuating occupational demands). Future investigation into ultrabrief MI for individuals with heightened stress and lack of personal practice time is needed.