Reducing Stress and Burnout in Healthcare Professionals

This abridged program was designed by Dr. Rezvan Ameli who is an expert in mindfulness-based
practices/therapies and was in response to the expressed needs of the NIH clinical staff and
the NIH fellowship training program.

Participants completed all primary and secondary outcome measure questionnaires at week -1, 5
and 13. The control group completed all primary and secondary outcome measures at week -1,
and 5.

The program is described below:

The program consisted of 5 sessions. A class binder was prepared for the participants and
included information about mindfulness and its practice, practices covered in each session,
Practice Plan work sheets to design home practices, pertinent reference list, guide to online
services, programs and apps, selected poetry, and information regarding recorded instructions
for body scan and mindful breathing by the instructor which was made available on the
institution's website and could be downloaded by the participants. Each session was 1.5 hours
in length and was offered on Fridays from 3-4:30 pm. Classes were instructed by Rezvan Ameli,
Ph.D., clinical psychologist, an experienced mindfulness practitioner since 2003 and teacher
since 2008. In addition to her background as a licensed clinical psychologist, mindfulness
practitioner, teacher and writer (Ameli 2013), RA is a certified yoga teacher and is
registered with the Yoga Alliance (RYT-200).

Common Elements of the Sessions

The first 4 classes began with 20-25 minutes of mindful movement/ light yoga (TNH sounds
true, ITP kata). We did not include movements in the 5th (last) session due to time
constraints. The emphasis during mindful movements was on the coordination of movement and
the breath with the instruction that when the mind wandered away to gently bring it back and
refocus on the breath and movements. Participants were encouraged to only engage in movements
that felt comfortable but not straining, painful, or felt unsafe. Each class had a period of
"check in". During the first check in, participants shared their names, a brief statement
about the reason for their participation, and their current self-care practice/s if any.
Class guidelines including confidentiality were reviewed at this time. In subsequent
check-ins the participants addressed their questions regarding mindfulness practices and
class teachings, described their practice with a focus on self-care, their existing self-care
practices and new learnings from the class, and any obstacles to their practice and to their
self-care during the preceding week. Other common elements of the sessions included a period
of inquiry, i.e. question and answer, after each new practice was introduced, planning a week
of practice based on class learnings, post class ratings, and concluding the class with a
relevant poem. Home practice planning was done in dyads of participants who were then
encouraged to stay in touch, become a "buddy" to their class partner, and communicate during
the week about their practice. Every session included a period of mindful breathing. The
length of mindful breathing (sitting meditation) was gradually increased from 10 minutes in
the 1st session to 30 minutes in the 5th session.

Session Specific Practices

In addition to these common elements, each session included a theme and other specific
mindfulness practices as follows:

- Session 1- Theme: Introduction to mindfulness. This session included definition of
mindfulness and its foundations (Kabat-Zin, 1992), mindful breathing and body scan.

- Session 2- Theme: Enhancing Awareness & Focused Attention. This session included
mindfulness of sounds, a short body scan, mindful breathing, and mindful eating, i.e.
the "raisin exercise" (ref). In addition, a discussion of mindful consumption and its
relevance to self-care was explored (Ameli 2013).

- Session 3 -Theme: Awareness of pleasurable experiences. This session included
mindfulness of the breath (briefly incorporating sounds, body sensation, thoughts,
feelings and then focusing on the breath), and mindful walking. The importance of
awareness of pleasurable experiences were discussed and an exercise to enhance attention
to pleasurable experiences was performed in dyads (Ameli 2013).

- Session 4- Theme: Transformation of difficult emotions through mindfulness. In this
session the concept of transforming difficult emotions through the practice of
mindfulness was discussed, explored, and practiced. The acronym RAIN (recognize,
accept/allow, investigate, and non-identification) was utilized to facilitate this
practice.

- Session 5- Theme: Compassion. This session mindful breathing and a general discussion of
compassion, compassion towards self and other, and the practice of loving kindness
(Ameli 2013). The class was concluded with a "check-out" where participants briefly
shared their overall experiences and learnings and their goals/vision for future
self-care activities and practices.

Inclusion Criteria:

- Any National Institutes of Health (NIH) employee, contractor, or trainee willing and
able to participate in a 5-week mindfulness-based self-care course during the work
day.

- English speaking