A Mindfulness Based Cognitive Therapy (MBCT) Resiliency Program for Critical Care Nurses

The Intensive Care Unit (ICU) is a stressful environment for all critical care healthcare
providers. In the United States, there are more than 500,000 critical care (ICU) nurses that
treat the most seriously ill patients. These ICU nurses have especially challenging and
sometimes overwhelming jobs due to high patient mortality and morbidity, and frequent
encounters with ethical dilemmas. The repetitive exposure to these extreme stressors and the
inability to adjust to their difficult work environment may cause significant psychological
stress. The investigator's multidisciplinary research team was one of the first to identify
that ICU nurses have significantly high rates of psychological distress including: symptoms
of anxiety and depression, posttraumatic stress disorder (PTSD) and burnout syndrome (BOS).

Work-induced distress initiates a negative cycle that contributes to the unacceptably high
ICU nursing turnover rate. Nationally, nursing turnover rates range between 17-20% per year.
In the ICU, the growing nursing shortage is particularly concerning. Presently, there are no
interventions to reduce BOS in ICU nurses. Many stresses on ICU nurses are inherent to the
critical care environment such as performing cardiopulmonary resuscitation and the death of a
patient. Therefore, the investigators multidisciplinary research group has focused on
enhancing the ability of ICU nurses to adapt to their work environment.

Resiliency enables one to thrive in the face of adversity. Humans respond to stress and
trauma in a variety of ways. Some people are resilient; defined as the ability to succeed, to
live, and to develop in a positive way despite the stress or adversity that would normally
involve the real possibility of a negative outcome. In practice, resilient individuals
believe that what they do can have a positive impact on a situation, that some components of
the 'system' can be controlled or influenced by one's own actions, that persistent effort is
worthwhile, and that setbacks or potentially threatening events are inevitable and
surmountable. A variety of qualities are associated with resiliency including the ability to
engage the support of others, the belief that stress can be strengthening, and overall
optimism. Though some individuals are inherently resilient; resiliency can be learned.
Developing resiliency may be one strategy to prevent and treat symptoms of BOS. The
investigators have demonstrated that resilient ICU nurses were less likely to have symptoms
of anxiety, depression, PTSD, and BOS. The investigators also identified methods used by ICU
nurses to promote resiliency and emotional wellness. The investigators ICU nursing pilot
program also increased resiliency and decreased symptoms of BOS.

From the investigators prior studies, MBSR and CBT are two modalities currently used by
resilient ICU nurses. In the investigators most recent national survey, ICU nurses were eager
to learn MBSR and CBT techniques to help reduce symptoms of BOS. Mindfulness Based Cognitive
Therapy (MBCT) combines the best of MBSR and CBT, and may build resiliency and reduce BOS
symptoms. MBCT was developed by integrating the framework and practices of MBSR and CBT.
Classically incorporated into an 8 week course, MBCT uses mindfulness skills to help
individuals become aware of negative thoughts and feelings that are activated by stress. MBCT
also incorporates CBT techniques to develop a different relationship to those thoughts and
feelings, and interrupt the negative thought patterns.

Inclusion Criteria:

1. Adults ages 18 years or older

2. Employed as a critical care nurse and work at least 20 hours per week as an ICU

3. Baseline score of < 82 on the Connor-Davidson Resilience Scale (CD-RISC)

4. Positive symptoms of at least one BOS dimension using the Maslach Burnout Inventory
(MBI):

- emotional exhaustion score of >17,

- depersonalization score of >7, or

- a personal accomplishment score of < 31.

Exclusion Criteria:

1. A self-reported diagnosis of:

- bipolar or psychotic disorder,

- active substance dependence, or

- immediate risk of self-harm or need for hospitalization

2. Unwillingness to participate in the entire study protocol

3. Employment on a time limited contract (i.e. a traveling nurse)