Mindfulness in the Workplace

Professor David J. Lee

University off Miami Miller School
S off Medicine

Funding provided by NIOSH R01 0H03915 and the:

 Behavior Drives Health

Jama: US Burden of Disease Collaborators, 2013 2

 Defining Health

“Health is a state of complete physical, mental and social

well‐being and not merely the absence of disease or
infirmity”
‐Has not been amended since adoption in 1948

Perhaps we could amend by adding the goal of

maintaining well‐being even in the presence of disease
and infirmity

http://www.who.int/about/definition/en/print.html 3
 What is Mindfulness?
“Paying
“P i attention
tt ti iin a particular
ti l way: on purpose, iin
the present moment, and nonjudgmentally”
– Jon
J Kabot‐Zinn
K b t Zi

Mindfulness
Mi df l can be
b practiced
ti d in
i a variety
i t off settings
tti
Sitting
St di
Standing
Walking
E ti
Eating
Working

Kabat‐Zinn, 2004 4
 What is Mindfulness?
Key brain training activities:
focusingg attention on thoughts,
g , emotions,, and bodyy
sensations
simply observing them as they arise and pass away without
judgment

E l mindfulness
Examples i df l i
practices:
Meditation
Progressive
P i relaxation
l i
Yoga (some), Tai‐Chi

Kabat‐Zinn, 2004 5
Wh t are th
What the Benefits
B fit off mindfulness?
i df l ?

Range of psychological/cognitive benefits:

•Reduced psychological symptoms (depression, anxiety)

•Reduced emotional reactivity/enhanced behavioral
regulation
•Enhanced attentional skills
•Increase in compassion and altruistic behavior

6
Bohlmeijer, 2010; Keng, 2011; Weng, 2013; Jha, 2013
Wh t are th
What the Benefits
B fit off mindfulness?
i df l ?
•Some evidence for
enhanced coping
p g in
response to stressors
•Supportive of
“Broaden and Build”
theory of positive
emotions
•May lead to enhanced
Resiliency
Garland, 2010
7
Wh t are th
What the Benefits
B fit off mindfulness?
i df l ?

Mindfulness may extend life in groups living with disease

• Practiced 8.5x/ week

(
(recommendedd d
session= 20 minutes)

8
Schneider, 2012
Wh t are th
What the Benefits
B fit off mindfulness?
i df l ?
Mindfulness may extend life in the general population
Those who report practicing
yoga in previous 12 months
h d a lower
had l risk
i k off mortality
t lit

Hazard Ratio
Ratio=0
0.57
57
(95% CI= 0.36‐0.92)

(Kachen, unpublished data) 9

 H
How d
does mindfulness
i df l work?
k?

10
Holzel, 2011
 H
How d
does mindfulness
i df l work?
k?
•Mindfulness changes brain structure (and function)

8 weeks of sustained
practice (27 min/day)
/
increases grey matter
density in several
regions of the brain

11
Holzel, 2011
 Assessed rapid time-dependent genomic
changes during one 15 minute meditation
session of among experienced practitioners
(n=26) and also in novices before and after
8 weeks of relaxation response training
(
(n=26).
)
12
Bhasin, 2013
 Mindfulness changes short‐term gene functioning

Energy metabolism,
mitochondrial function,,
insulin secretion,
telomere maintenance

Inflammatoryy
response, stress‐
related p
pathways
y
13
Bhasin, 2013
 Prevalence of worker mindfulness
practices in the US
Mindfulness practices growing rapidly among workers
i the
in h US

B t nott allll workers

But k are equally
ll exposed.
d

http://www.bbc.co.uk/news/business‐21244171 14
 US Workers: Meditation
Service Workers

Laborers and Helpers

Operatives

Craft Workers

pp Workers
Administrative Support
2002
Sales Workers 2007

Technicians

Professionals

Officials & Managers

0 5 10 15 20 25

Percent
 US Workers: Yoga
Service Workers

Laborers and Helpers

Operatives

Craft Workers

Administrative Support Workers

2002
Sales Workers 2007

Technicians

Professionals

Officials & Managers

0 2 4 6 8 10 12 14 16 18 20

Percent
Prevalence of worker mindfulness
practices: the NHIS
Prevalence of worker mindfulness
practices: the NHIS
 Prevalence of worker mindfulness
practices in the US

Mindfulness practitioners already embedded in many workplaces!

Reaching out to these employees to inform the

design of a more mindful workplace

train the trainer

Potential pool for train‐the‐trainer
intervention models.

US‐based questionnaire available online:

Download file: qalthealt.pdf at:
ftp://ftp cdc gov/pub/Health Statistics/NCHS/Survey Questionnaires/NHIS/2012/English
ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Survey_Questionnaires/NHIS/2012/English

19
 P
Proven ( id
(evidence‐based)
b d) Mindfulness
Mi df l
Interventions
Mindfulness based Stress Reduction (MBSR)
Mindfulness‐based

Strongestt evidence
St id base
b for
f iimproving
i psychological
h l i l
health/reducing stress reactivity

8‐week program effective in clinical & non‐clinical

populations
l ti

Fjorback, 2011; Grossman, 2004; Bohlmeijer, 2010 20

 P
Proven ( id
(evidence‐based)
b d) mindfulness
i df l
Interventions
Mindfulness based Cognitive Therapy (MBCT)
Mindfulness‐based

UK/US intervention drawing from MBSR specifically

designed to prevent relapse in those with a history of
depression

NHS‐ approved intervention

Probably not a viable option for workplace delivery
Fjorback, 2011; Piet, 2011; Kuyken, 2012
21
B
Benefits
fit off Worker
W k Mindfulness
Mi df l P
Practices
ti

Most of the available studies in literature limited:

– number of subjects evaluated
– quality of the research designs

MBSR‐‐‐ effective in diverse workplace settings?

? Dose– promising but mixed results so far

? Deliveryy format

22
Wolever, 2012; Malarkey, 2013; Mackenzie, 2006; Klatt, 2009
 O G
One Good
d Workplace
W k l Example
E l

Brings together
scientists, the
private sector,
andd employer.
l

Real challenges to
make the science
sound and ethical

Perfect storm of opportunity?

pp y Aetna exec claims 11:1 ROI

Wolever, 2012; http://www2.macleans.ca/2013/04/21/the‐battle‐for‐buddha/ 23

 O G
One Good
d Workplace
W k l Example
E l

Sophisticated
research design
comparing
workplace‐
k l
feasible
mindfulness
offerings +
examination of
delivery
approaches
( 297)
(n=297)
24
Wolever, 2012
B
Benefits
fit off W
Worker
k Mindfulness
Mi df l P
Practices
ti

Most examined components not significantly different from the control

group
Each point on the PSS scale associated with nearly $100 increase in medical
costs in this workforce

25
Wolever, 2012
 UK Resources for Bringing
g g Mindfulness
into the Workplace

Brings together:
Teacher trainingg opportunities
pp
Review of emerging
mindfulness research
Listings for mindfulness courses
offered to the ppublic

http://www exeter mindfulness network org/

http://www.exeter‐mindfulness‐network.org/

26
 UK Resources for Bringing
g g Mindfulness
into the Workplace
Website sponsored by the
Mental Health Foundation

Search feature allowing users

to locate local mindfulness
offerings
g

Online PSS test and

Access to online
l mindfulness
df l
course with preliminary
htt //b i df l
http://bemindful.co.uk/
k/ evidence of efficacy
27
(Krusche, 2012)
 UK Resources for Bringing
g g Mindfulness
into the Workplace

Brings MBSR into

the workplace

http://www mindfulness works com/index php

http://www.mindfulness‐works.com/index.php
28
 UK Resources for Bringing
g g Mindfulness
into the Workplace

http://www.mindfulnessworks.co.uk/index.html
29
UK Resources for Bringing
g g Mindfulness
into the Workplace

http://workwithmindfulness.com/index.htm
30
l
A Tentative Mindful Workplace Agenda

Well established mindfulness interventions alreadyy in UK

workplaces
Research on these interventions makingg it to peer‐
p
reviewed literature?
Are research ppartnerships
p viable?
The collision of priorities?
Practical limitations with respect to research design and
funding
Process evaluation focus?

31
 A Tentative Mindful Workplace Agenda

(van Berkel, 2013) 32

 A Tentative Mindful Workplace Agenda

(van Berkel, 2013) 33

 Perceived organization and supervisor support for
participating in the
h intervention was positively
l correlated
l d
with compliance.
Trainer/coach
/ h relationship
l h associated
d with
hhhigher
h
satisfaction and compliance
Gi
Given the
h association
i i b between compliance
li andd
satisfaction:
Organizational
O i ti l context
t t should
h ld nott b
be iignored
d and
d th
thatt program
development should include the involvement of employer and
employee.
employee

(van Berkel, 2013) 34

 A Tentative Mindful Workplace Agenda

Need for a focus on employer needs:

Are workplace mindfulness interventions cost‐effective?
Can they accelerate return‐to‐work (long term sick
absence)?
Can they prevent cases of long term absence?
Can they improve productivity?

35
A Tentative Mindful Workplace Agenda

Eyes on the prize: reach and sustainability

Optimizing effectiveness by matching person to

practice
No easy task

Continuous qualitative research to address

sustainability
36
 “Take-Away”
Take Away
Research on the beneficial health effects of mindfulness
practices well established

Research on the benefits of establishing workplace

mindfulness offerings more limited, but suggestive of
benefits to the employee and possibly, employer

Resources for establishing mindful workplaces

particularly strong in the UK

Just beginning the journey!

37
Thank you

38
References

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References

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References

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References

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References

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