Taylor, Heather, Cavanagh, Kate, Field, Andy and Strauss, Clara (2022) Findings from a multi-site definitive randomised controlled trial of an unguided digital mindfulness-based self-help intervention to reduce healthcare worker stress in comparison to an active control. BJPsych Open. ISSN 2056-4724 (Accepted)

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Abstract

Background
Healthcare workers experience high levels of stress and poor mental health. Accessible, affordable and effective approaches to reducing stress are lacking. In-person mindfulness-based interventions (MBIs) can reduce healthcare worker stress but are not widely available or accessible for busy healthcare workers. Unguided digital mindfulness-based self-help (MBSH) interventions show promise and can be engaged with flexibly. However, their effectiveness at reducing healthcare worker stress has not yet been explored in a definitive multi-site trial.

Objective
We sought to investigate the effectiveness and mechanisms of action of an unguided digital MBSH application (Headspace) in reducing healthcare worker stress.

Methods
This was a definitive superiority randomised-controlled trial with 2182 National Health Service (NHS) England staff recruited online, allocated 1:1 to fully-automated Headspace (n=1095) or active-control (Moodzone, n=1087) for 4.5 months. Outcomes were: subscales of the short-form Depression, Anxiety and Stress (primary outcome) Scale; Short Warwick Edinburgh Mental Wellbeing Scale; Maslach Burnout Inventory; 15-item Five-Facet Mindfulness Questionnaire minus Observe items; short-form Self-Compassion Scale; Compassionate Love Scale; Penn State Worry Questionnaire; Brooding subscale of the Ruminative Response Scale and sickness absence.

Results
Intention-to-treat analysis found that Headspace led to greater reductions in stress over time than Moodzone (b=-0.31, 95% CI: -0.47,-0.14, P<.001) with small effects, and 100 out of 272 (36.76%) of Headspace participants who were experiencing at least mild levels of stress at baseline showed reliable improvement in stress over the course of the study, significantly more than the 66 out of 274 (24.09%) of Moodzone participants. Small effects of Headspace versus Moodzone were found for depression (b=-0.24, 95% CI: -0.40,-0.08, P=.003), anxiety (b=-0.19, 95% CI: -0.32,-06, P=.004), wellbeing (b=0.14, 95% CI: 0.05,0.23, P=.002), mindfulness (b=0.22, 95% CI: 0.09,0.34, P=.001), self-compassion (b=0.48, 95% CI: 0.33,0.64, P<.001), compassion-for-others (b=0.02, 95% CI: 0.00,0.04, P=.04) and worry (b=-0.30, 95% CI: -0.51,-0.09, P=.005), but not for burnout facets (bs=-0.19, -0.04, 0.13; all 95% CIs cross zero, Ps=0.65, 0.67 and 0.35), ruminative brooding (b=-0.06, 95% CI: -0.12,0.00, P=.06) or sickness absence (γ=0.09 95% CI: -0.18, 0.34). Per protocol effects of Headspace (n=454) versus Moodzone (n=283) over time were found on stress, self-compassion and compassion-for-others, but not other outcomes. Engagement (practice days/week) and improvements in self-compassion during the initial 1.5-month intervention period mediated pre-to-post-intervention improvements in stress. Improvements in mindfulness, rumination and worry did not mediate pre-to-post-intervention improvements in stress. No serious adverse events were reported.

Conclusions
An unguided digital MBSH intervention (Headspace) can reduce healthcare workers’ stress. Effect sizes are small but could have population level benefits. Unguided digital MBSH interventions can be part of the solution to reducing healthcare worker stress alongside potentially costlier but potentially more effective in-person MBIs, non-mindfulness courses and organisational-level interventions.

Item Type:	Article
Keywords:	Self-help, Mindfulness, Randomised control trial, Healthcare worker, NHS, Doctors, Nurses, Stress, Mental health, Burnout
Schools and Departments:	School of Psychology > Psychology
SWORD Depositor:	Mx Elements Account
Depositing User:	Mx Elements Account
Date Deposited:	18 Aug 2022 08:39
Last Modified:	18 Aug 2022 08:45
URI:	http://sro.sussex.ac.uk/id/eprint/107448

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