Many hospital clinicians can likely identify with the problems Patty J. Lee, MD, witnessed among her coworkers at the Duke University Medical Center. “The fatigue, the overwork, the high stress, and the end result, which we call moral injury or burnout,” said Dr. Lee, a professor of medicine, cell biology, and pathology. “I've seen many of the intensive care unit nurses I've worked with for years just break down in tears and leave, especially during COVID.” But even before the pandemic, she had found a tool that helped her deal with her own stress—Transcendental Meditation.
Dr. Lee initially learned about meditation by attending an info session promoted in a yoga class. She was impressed by the published data supporting its effectiveness, so she went through four sessions with a certified teacher. “Then within a few days, I noticed I was different. I was still having the same stresses. Nothing else changed about my life, other than the fact that I did this instruction. But I was sleeping better, I felt that I was more efficient and focused. I just felt better, more grounded even in the midst of chaos.”
She tried to spread the word to colleagues but didn't get much response, possibly in part due to the cost and time required to learn meditation, she thought. “When COVID hit, these opportunities arose to run clinical trials on health-provider well-being, resilience, and anti-burnout tools,” Dr. Lee said. “I saw this as a way to not only study but also equalize the availability of a wellness tool, so that cost was less of an issue.”
How it works
To test the impact of making meditation instruction more widely available, Dr. Lee and colleagues recruited 80 patient-facing hospital staff who showed potential to benefit based on their biological responses to a stressful script. Half were randomized to be controls and had usual access to wellness resources. The other half received four days of instruction in Transcendental Meditation—an initial one-on-one encounter with a certified teacher followed by three 75-minute group sessions. They then were instructed to practice meditation on their own for 20 minutes twice daily.
When surveyed three months later, the meditators had significant decreases in chronic stress measures of emotional exhaustion, insomnia, and anxiety compared to controls, according to results published by JAMA Network Open on Sept. 19. “We showed exactly what every other publication has showed about [Transcendental Meditation], although this was the first time it was done in this many health care providers in a randomized fashion,” said Dr. Lee. The participants did not have a statistically significant decrease in acute psychological distress scores compared to controls, possibly because acute distress scores were low in both groups at baseline, said Dr. Lee, who was particularly pleased by the participants' high adherence (92%) to daily meditation home practice.
Dr. Lee and colleagues are conducting a second, larger trial of meditation by hospital staff, this time funded by the Department of Defense. “It's 280, instead of 80, people, and we included an additional intervention called Effective Resolution Methodology, a form of coaching. We're still enrolling, and it's going to be another three or four years [for final results] because it's a longitudinal study,” she said.
In both trials, a major challenge has been getting a diverse population of hospital staff to participate. “We're not getting the men—more than 80% are women. And very few are physicians. They're mostly nurses, research coordinators, front desk staff. No trainees,” said Dr. Lee. “Perhaps men are less likely to look for these tools, or men may believe that meditation is less relevant to their needs.”
Another barrier may be the perception of meditation in our society, she added. “Meditation is still not really considered all that mainstream, especially amongst health providers. For mindfulness, there may be a little higher acceptance, but even mindfulness is not commonly practiced. There may also be some discomfort with doing things that hint of mind-body connections.”
Words of wisdom
For clinicians who are interested in giving meditation a try, Dr. Lee recommends visiting the websites of the David Lynch Foundation or the Maharishi Foundation, which lists certified instructors around the country. “Every major city has at least one instructor,” she said. “I think this is the beginning of a transformative way to approach health provider wellness.”