Amy Wolfe, MD
Attending Physician
Children's National
Washington, D.C., District of Columbia
Disclosure information not submitted.
Lamia Soghier, MD, FAAP
Associate Professor of Pediatrics
Children's National
Washington, District of Columbia, United States
Disclosure information not submitted.
Pamela Hinds, PhD, RN, FAAN
Executive Director, Department of Nursing Science, Professional Practice & Quality
Children's National, United States
Disclosure information not submitted.
Vicki Freedenberg, PhD, RN
Assistant Professor of Pediatrics
Children's National, United States
Disclosure information not submitted.
Title: A Feasibility Study of a Mindfulness Training Program’s Effect on Clinician Physiologic Parameters
Introduction: Stress and burnout occur in approximately 50% of clinicians. Excessive stress results in overactivation of the sympathetic nervous system (SNS) causing increased heart rate (HR) and decreased heart rate variability (HRV). Mindfulness may be a potential coping mechanism to combat stress, improve resiliency and help individuals regulate physiologic responses of the autonomic nervous system (ANS). Before widespread implementation of such interventions, it is important to identify an objective biomarker of ANS tone, such as HRV, that can be measured non-invasively and capture individual responses to mindfulness activities. We aimed to determine the feasibility of measuring ANS activity using a non-invasive watch during a mindfulness training program.
Methods: Participants of a mindful mentors training program designed to teach mindfulness techniques to hospital staff were recruited sequentially. Subjective measures of mindfulness (mindful attention awareness scale (MAAS)), stress (state trait anxiety inventory (STAI)) and objective measures using photoplethysmography (PPG) sensors on the E4 wristband were captured during three different eight hour-periods (baseline, mindfulness session 1, 2).
Results: Of the 60 mindful mentor participants, nearly 50% (29) volunteered for this embedded study. Due to resource limitations of the smart watch, the first four participants were selected (two nurse practitioners, two physicians). Mean and max HR decreased from baseline for all participants. Mindfulness (MAAS) increased (46 vs. 61) and subjective stress (STAI) decreased (50 vs. 36) post-intervention. These subjective findings from the embedded cohort mirrored those in the larger cohort where increased mindfulness (P = .002), decreased stress (P < .0001) and burnout (P < .0001) were found. Due to significant movement artifact, HRV was challenging to accurately analyze.
Conclusions: Recruitment and enthusiasm were strong in this feasibility study that explored the effects of mindfulness training on physiologic parameters. We found important limitations of non-invasive wristwatch wearable technology in accurately capturing HRV when movement is present. Future studies will explore other non-invasive devices that use electrocardiogram (ECG) instead of PPG to capture HRV data more accurately amongst a larger cohort.