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Meta-Analysis
. 2023 May 12;5(5):CD002892.
doi: 10.1002/14651858.CD002892.pub6.

Individual-level interventions for reducing occupational stress in healthcare workers

Sietske J Tamminga  1   2 , Lima M Emal  1   2 , Julitta S Boschman  1   2 , Alice Levasseur  3 , Anilkrishna Thota  4 , Jani H Ruotsalainen  5 , Roosmarijn Mc Schelvis  1   2   6 , Karen Nieuwenhuijsen #  1   2 , Henk F van der Molen #  1   2
Affiliations
Meta-Analysis

Individual-level interventions for reducing occupational stress in healthcare workers

Sietske J Tamminga et al. Cochrane Database Syst Rev. .

Abstract

Background: Healthcare workers can suffer from work-related stress as a result of an imbalance of demands, skills and social support at work. This may lead to stress, burnout and psychosomatic problems, and deterioration of service provision. This is an update of a Cochrane Review that was last updated in 2015, which has been split into this review and a review on organisational-level interventions. OBJECTIVES: To evaluate the effectiveness of stress-reduction interventions targeting individual healthcare workers compared to no intervention, wait list, placebo, no stress-reduction intervention or another type of stress-reduction intervention in reducing stress symptoms. SEARCH METHODS: We used the previous version of the review as one source of studies (search date: November 2013). We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PsycINFO, CINAHL, Web of Science and a trials register from 2013 up to February 2022.

Selection criteria: We included randomised controlled trials (RCT) evaluating the effectiveness of stress interventions directed at healthcare workers. We included only interventions targeted at individual healthcare workers aimed at reducing stress symptoms. DATA COLLECTION AND ANALYSIS: Review authors independently selected trials for inclusion, assessed risk of bias and extracted data. We used standard methodological procedures expected by Cochrane. We categorised interventions into ones that: 1. focus one's attention on the (modification of the) experience of stress (thoughts, feelings, behaviour); 2. focus one's attention away from the experience of stress by various means of psychological disengagement (e.g. relaxing, exercise); 3. alter work-related risk factors on an individual level; and ones that 4. combine two or more of the above. The crucial outcome measure was stress symptoms measured with various self-reported questionnaires such as the Maslach Burnout Inventory (MBI), measured at short term (up to and including three months after the intervention ended), medium term (> 3 to 12 months after the intervention ended), and long term follow-up (> 12 months after the intervention ended). MAIN RESULTS: This is the second update of the original Cochrane Review published in 2006, Issue 4. This review update includes 89 new studies, bringing the total number of studies in the current review to 117 with a total of 11,119 participants randomised. The number of participants per study arm was ≥ 50 in 32 studies. The most important risk of bias was the lack of blinding of participants. Focus on the experience of stress versus no intervention/wait list/placebo/no stress-reduction intervention Fifty-two studies studied an intervention in which one's focus is on the experience of stress. Overall, such interventions may result in a reduction in stress symptoms in the short term (standardised mean difference (SMD) -0.37, 95% confidence interval (CI) -0.52 to -0.23; 41 RCTs; 3645 participants; low-certainty evidence) and medium term (SMD -0.43, 95% CI -0.71 to -0.14; 19 RCTs; 1851 participants; low-certainty evidence). The SMD of the short-term result translates back to 4.6 points fewer on the MBI-emotional exhaustion scale (MBI-EE, a scale from 0 to 54). The evidence is very uncertain (one RCT; 68 participants, very low-certainty evidence) about the long-term effect on stress symptoms of focusing one's attention on the experience of stress. Focus away from the experience of stress versus no intervention/wait list/placebo/no stress-reduction intervention Forty-two studies studied an intervention in which one's focus is away from the experience of stress. Overall, such interventions may result in a reduction in stress symptoms in the short term (SMD -0.55, 95 CI -0.70 to -0.40; 35 RCTs; 2366 participants; low-certainty evidence) and medium term (SMD -0.41 95% CI -0.79 to -0.03; 6 RCTs; 427 participants; low-certainty evidence). The SMD on the short term translates back to 6.8 fewer points on the MBI-EE. No studies reported the long-term effect. Focus on work-related, individual-level factors versus no intervention/no stress-reduction intervention Seven studies studied an intervention in which the focus is on altering work-related factors. The evidence is very uncertain about the short-term effects (no pooled effect estimate; three RCTs; 87 participants; very low-certainty evidence) and medium-term effects and long-term effects (no pooled effect estimate; two RCTs; 152 participants, and one RCT; 161 participants, very low-certainty evidence) of this type of stress management intervention. A combination of individual-level interventions versus no intervention/wait list/no stress-reduction intervention Seventeen studies studied a combination of interventions. In the short-term, this type of intervention may result in a reduction in stress symptoms (SMD -0.67 95%, CI -0.95 to -0.39; 15 RCTs; 1003 participants; low-certainty evidence). The SMD translates back to 8.2 fewer points on the MBI-EE. On the medium term, a combination of individual-level interventions may result in a reduction in stress symptoms, but the evidence does not exclude no effect (SMD -0.48, 95% CI -0.95 to 0.00; 6 RCTs; 574 participants; low-certainty evidence). The evidence is very uncertain about the long term effects of a combination of interventions on stress symptoms (one RCT, 88 participants; very low-certainty evidence). Focus on stress versus other intervention type Three studies compared focusing on stress versus focusing away from stress and one study a combination of interventions versus focusing on stress. The evidence is very uncertain about which type of intervention is better or if their effect is similar.

Authors' conclusions: Our review shows that there may be an effect on stress reduction in healthcare workers from individual-level stress interventions, whether they focus one's attention on or away from the experience of stress. This effect may last up to a year after the end of the intervention. A combination of interventions may be beneficial as well, at least in the short term. Long-term effects of individual-level stress management interventions remain unknown. The same applies for interventions on (individual-level) work-related risk factors. The bias assessment of the studies in this review showed the need for methodologically better-designed and executed studies, as nearly all studies suffered from poor reporting of the randomisation procedures, lack of blinding of participants and lack of trial registration. Better-designed trials with larger sample sizes are required to increase the certainty of the evidence. Last, there is a need for more studies on interventions which focus on work-related risk factors.

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Conflict of interest statement

ST: has declared no conflict of interest.

LE: has declared no conflict of interest.

JB: employed as Managing Editor for Cochrane Work up to July 2022. JB was not involved in the editorial process from that moment on.

AL: has declared no conflict of interest.

AT: has declared no conflict of interest.

JR: has declared no conflict of interest.

RS: has declared no conflict of interest.

KN: reports to be involved in a study eligible for inclusion (Gärtner 2013). KN was not involved in assessing this study for eligibility, it's data extraction or bias assessment.

HM: has declared no conflict of interest.

Cochrane Work managed the editorial process for this review. The author team had no influence on how the editorial team managed this review.

Figures

1
1
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2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Funnel plot (1.1 Any symptoms of stress‐related outcome (follow‐up up to 3 months after the end of the intervention)
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4
Funnel plot (1.2 Any symptoms of stress‐related outcome (follow‐up > 3 to 12 months after the end of the intervention))
5
5
Funnel plot (2.1 Any symptoms of stress‐related outcome (follow‐up up to 3 months after the end of the intervention))
6
6
Funnel plot (4.1 Any symptoms of stress‐related outcome (follow‐up up to 3 months after the end of the intervention))
1.1
1.1. Analysis
Comparison 1: ‘Focus one’s attention on the experience of stress (thoughts, feelings, behaviour)’ vs No intervention/wait list/placebo/no stress‐reduction intervention (SMD), Outcome 1: Any symptoms of stress‐related outcome (follow‐up up to 3 months after the end of the intervention)
1.2
1.2. Analysis
Comparison 1: ‘Focus one’s attention on the experience of stress (thoughts, feelings, behaviour)’ vs No intervention/wait list/placebo/no stress‐reduction intervention (SMD), Outcome 2:  Any symptoms of stress‐related outcome (follow‐up > 3 to 12 months after the end of the intervention)
1.3
1.3. Analysis
Comparison 1: ‘Focus one’s attention on the experience of stress (thoughts, feelings, behaviour)’ vs No intervention/wait list/placebo/no stress‐reduction intervention (SMD), Outcome 3: Any symptoms of stress‐related outcome (follow‐up >12 months)
1.4
1.4. Analysis
Comparison 1: ‘Focus one’s attention on the experience of stress (thoughts, feelings, behaviour)’ vs No intervention/wait list/placebo/no stress‐reduction intervention (SMD), Outcome 4: Psychological symptoms: anxiety and depression (follow‐up up to 3 months after the end of the intervention)
1.5
1.5. Analysis
Comparison 1: ‘Focus one’s attention on the experience of stress (thoughts, feelings, behaviour)’ vs No intervention/wait list/placebo/no stress‐reduction intervention (SMD), Outcome 5: Psychological symptoms: anxiety and depression (follow‐up > 3 to 12 months after the end of the intervention)
1.6
1.6. Analysis
Comparison 1: ‘Focus one’s attention on the experience of stress (thoughts, feelings, behaviour)’ vs No intervention/wait list/placebo/no stress‐reduction intervention (SMD), Outcome 6: Explanatory analysis ‐ subgroup  (short vs long duration of intervention): any symptoms of stress‐related outcome (follow‐up up to 3 months after the end of the intervention)
2.1
2.1. Analysis
Comparison 2:  ‘Focus one’s attention away from the experience of stress by means of relaxation, exercise or something else’ vs No intervention/wait list/placebo/no stress‐reduction intervention (SMD), Outcome 1: Any symptoms of stress‐related outcome (follow‐up up to 3 months after the end of the intervention)
2.2
2.2. Analysis
Comparison 2:  ‘Focus one’s attention away from the experience of stress by means of relaxation, exercise or something else’ vs No intervention/wait list/placebo/no stress‐reduction intervention (SMD), Outcome 2: Any symptoms of stress‐related outcome (follow‐up > 3 to 12 months after the end of the intervention)
2.3
2.3. Analysis
Comparison 2:  ‘Focus one’s attention away from the experience of stress by means of relaxation, exercise or something else’ vs No intervention/wait list/placebo/no stress‐reduction intervention (SMD), Outcome 3: Psychological symptoms: anxiety and depression (follow‐up up to 3 months after the end of the intervention)
2.4
2.4. Analysis
Comparison 2:  ‘Focus one’s attention away from the experience of stress by means of relaxation, exercise or something else’ vs No intervention/wait list/placebo/no stress‐reduction intervention (SMD), Outcome 4: Explanatory analysis ‐ subgroup (short vs long duration of intervention): any symptoms of stress‐related outcome (follow‐up up to 3 months after the end of the intervention)
3.1
3.1. Analysis
Comparison 3:  ‘Focus on work‐related risk factors on an individual level such as work demands’ vs No intervention/no stress‐reduction intervention (SMD), Outcome 1: Any symptoms of stress‐related outcome (follow‐up up to 3 months after the end of the intervention)
3.2
3.2. Analysis
Comparison 3:  ‘Focus on work‐related risk factors on an individual level such as work demands’ vs No intervention/no stress‐reduction intervention (SMD), Outcome 2: Any symptoms of stress‐related outcome (follow‐up > 3 to 12 months after the end of the intervention)
3.3
3.3. Analysis
Comparison 3:  ‘Focus on work‐related risk factors on an individual level such as work demands’ vs No intervention/no stress‐reduction intervention (SMD), Outcome 3: Any symptoms of stress‐related outcome (follow‐up >12 months)
3.4
3.4. Analysis
Comparison 3:  ‘Focus on work‐related risk factors on an individual level such as work demands’ vs No intervention/no stress‐reduction intervention (SMD), Outcome 4: Psychological symptoms: anxiety and depression (follow‐up > 3 to 12 months after the end of the intervention)
4.1
4.1. Analysis
Comparison 4: ‘Combination of interventions’ vs No intervention/wait list/no stress‐reduction intervention (SMD), Outcome 1: Any symptoms of stress‐related outcome (follow‐up up to 3 months after the end of the intervention)
4.2
4.2. Analysis
Comparison 4: ‘Combination of interventions’ vs No intervention/wait list/no stress‐reduction intervention (SMD), Outcome 2: Any symptoms of stress‐related outcome (follow‐up > 3 to 12 months after the end of the intervention)
4.3
4.3. Analysis
Comparison 4: ‘Combination of interventions’ vs No intervention/wait list/no stress‐reduction intervention (SMD), Outcome 3: Any symptoms of stress‐related outcome (follow‐up > 12 months)
4.4
4.4. Analysis
Comparison 4: ‘Combination of interventions’ vs No intervention/wait list/no stress‐reduction intervention (SMD), Outcome 4: Psychological symptoms: anxiety and depression (follow‐up up to 3 months after the end of the intervention)
4.5
4.5. Analysis
Comparison 4: ‘Combination of interventions’ vs No intervention/wait list/no stress‐reduction intervention (SMD), Outcome 5: Psychological symptoms: anxiety and depression (follow‐up > 3 to 12 months after the end of the intervention)
4.6
4.6. Analysis
Comparison 4: ‘Combination of interventions’ vs No intervention/wait list/no stress‐reduction intervention (SMD), Outcome 6: Psychological symptoms: anxiety and depression (follow‐up > 12 months after the end of the intervention)
5.1
5.1. Analysis
Comparison 5: Focus one’s attention on the experience of stress vs focus one’s attention away from the experience of stress, Outcome 1:  Any symptoms of stress‐related outcome (follow‐up up to 3 months)
5.2
5.2. Analysis
Comparison 5: Focus one’s attention on the experience of stress vs focus one’s attention away from the experience of stress, Outcome 2: Any symptoms of stress‐related outcome (follow‐up > 3 to 12 months after the end of the intervention)
5.3
5.3. Analysis
Comparison 5: Focus one’s attention on the experience of stress vs focus one’s attention away from the experience of stress, Outcome 3: Psychological symptoms: anxiety and depression (follow‐up up to 3 months)
5.4
5.4. Analysis
Comparison 5: Focus one’s attention on the experience of stress vs focus one’s attention away from the experience of stress, Outcome 4: Psychological symptoms: anxiety and depression (follow‐up > 3 to 12 months after the end of the intervention)
6.1
6.1. Analysis
Comparison 6:  ‘Combination of interventions’ vs focus one's attention on the experience of stress (SMD), Outcome 1: Any symptoms of stress‐related outcome (follow‐up up to 3 months)
6.2
6.2. Analysis
Comparison 6:  ‘Combination of interventions’ vs focus one's attention on the experience of stress (SMD), Outcome 2: Any symptoms of stress‐related outcome (follow‐up > 3 to 12 months after the end of the intervention)
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Update of

References

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Grabbe 2020 {published data only}
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Gunasingam 2015 {published data only}
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Günüsen 2010 {published data only}
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Hersch 2016 {published data only}
    1. Hersch RK, Cook RF, Deitz DK, Kaplan S, Hughes D, Friesen MA, et al. Reducing nurses' stress: a randomized controlled trial of a web-based stress management program for nurses. Applied Nursing Research 2016;32:18-25. [DOI: 10.1016/j.apnr.2016.04.003] - DOI - PMC - PubMed
Hilcove 2021 {published data only}
    1. Hilcove K, Marceau C, Thekdi P, Larkey L, Brewer MA, Jones K. Holistic nursing in practice: mindfulness-based yoga as an intervention to manage stress and burnout. Journal of Holistic Nursing 2021;39(1):29-42. [DOI: 10.1177/0898010120921587] - DOI - PubMed
Ho 2021 {published data only}
    1. Ho AHY, Tan-Ho G, Ngo TA, Ong G, Chong PH, Dignadice D, et al. A novel mindful-compassion art therapy (MCAT) for reducing burnout and promoting resilience for end-of-life care professionals: a waitlist RCT protocol. Trials 2019;20(1):406. [DOI: ] - PMC - PubMed
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Huang 2020 {published data only}
    1. Huang H, Zhang H, Xie Y, Wang SB, Cui H, Li L, et al. Effect of Balint group training on burnout and quality of work life among intensive care nurses: a randomized controlled trial. Neurology Psychiatry and Brain Research 2020;35:16-21. [DOI: 10.1016/j.npbr.2019.12.002] - DOI
Huang 2020a {published data only}
    1. Huang, L, Harsh, J, Cui, H, Wu, J, Thai, J, Zhang, X, et al. A randomized controlled trial of Balint groups to prevent burnout among residents in China. Frontiers in Psychiatry 2020;10:- . [DOI: 10.3389/fpsyt.2019.00957] - DOI - PMC - PubMed
Janzarik 2022 {published data only}
    1. Janzarik G, Wollschlager D, Wessa M, Lieb K. A group intervention to promote resilience in nursing professionals: a randomised controlled trial. International Journal of Environmental Research and Public Health 2022;19(2):649. [DOI: ] - PMC - PubMed
Jensen 2006 {published and unpublished data}
    1. Jensen LD, Gonge H, Jors E, Ryom P, Foldspang A, Christensen MA, et al. Prevention of low back pain in female eldercare workers: randomized controlled work site trial. Spine 2006;31(16):1761-9. [PMID: ] - PubMed
Kavurmaci 2022 {published data only}
    1. Kavurmaci M, Tan M, Bahcecioglu Turan G. Determining the effect of yoga on job satisfaction and burnout of nurse academicians. Perspectives in Psychiatric Care 2022;58(1):404-10. [DOI: ] - PubMed
Kesselheim 2020 {published data only}
    1. Kesselheim J, Baker JN, Kersun L, Lee-Miller C, Moerdler S, Snaman JM, et al. Humanism and professionalism training for pediatric hematology-oncology fellows: results of a multicenter randomized trial. Pediatric Blood & Cancer 2020;67(11):e28308. [DOI: 10.1002/pbc.28308] - DOI - PubMed
Kharatzadeh 2020 {published data only}
    1. Kharatzadeh H, Alavi M, Mohammadi A, Visentin D, Cleary M. Emotional regulation training for intensive and critical care nurses. Nursing and Health Sciences 2020;22(2):445-53. [DOI: 10.1111/nhs.12679] - DOI - PubMed
Kim 2016 {published data only}
    1. Kim YI, Kim SM, Kim H, Han DH. The effect of high-frequency repetitive transcranial magnetic stimulation on occupational stress among health care workers: a pilot study. Psychiatry Investigation 2016;13(6):622-9. [DOI: 10.4306/pi.2016.13.6.622] - DOI - PMC - PubMed
Kline 2020 {published and unpublished data}
    1. Kline JA, VanRyzin K, Davis JC, Parra JA, Todd ML, Shaw LL, et al. Randomized trial of therapy dogs versus deliberative coloring (art therapy) to reduce stress in emergency medicine providers. Academic Emergency Medicine 2020;27(4):266-75. [DOI: 10.1111/acem.13939] - DOI - PubMed
Kurebayashi 2012 {published data only}
    1. Kurebayashi LF, Gnatta JR, Borges TP, Belisse G, Coca S, Minami A, et al. The applicability of auriculo-therapy with needles or seeds to reduce stress in nursing professionals. Revista da Escola de Enfermagem da USP 2012;46(1):89-95. - PubMed
Kurebayashi 2014 {published data only}
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Leao 2017 {published data only}
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Lebares 2021 {published data only}
    1. Lebares CC, Coaston TN, Delucchi KL, Guvva EV, Shen WT, Staffaroni AM, et al. Enhanced stress resilience training in surgeons: iterative adaptation and biopsychosocial effects in 2 small randomized trials. Annals of Surgery 2021;273(3):424-32. [DOI: ] - PMC - PubMed
Lee 1994 {published data only}
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Lee 2020 {published data only}
    1. Lee S, Rozybakieva Z, Asimov M, Bagiyarova F, Tazhiyeva A, Ussebayeva N, et al. Coping strategy as a way to prevent emotional burnout in primary care doctors: a randomized controlled trial. Archives of the Balkan Medical Union 2020;55(3):398-409. [DOI: 10.31688/ABMU.2020.55.3.05] - DOI
Lee 2021 {published data only}
    1. Lee SN, Kim B, Park H. The effects of auricular acupressure on stress, anxiety, and depression of outpatient nurses in South Korea. Complementary Therapies in Clinical Practice 2021;44:101797. [DOI: 10.1016/j.ctcp.2021.101447] - DOI - PubMed
Lin 2015 {published data only}
    1. Lin Shu-Ling, Huang CY, Shiu SP, Yeh SH. Effects of yoga on stress, stress adaption, and heart rate variability among mental health professionals - a randomized controlled trial. Worldviews on Evidence-Based Nursing 2015;12(4):236-45. [DOI: ] - PubMed
Lin 2019 {published data only}
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Luthar 2017 {published data only}
    1. Luthar SS, Curlee A, Tye SJ, Engelman JC, Stonnington CM. Fostering resilience among mothers under stress: “Authentic Connections Groups” for Medical Professionals. Women's Health Issues 2017;27(3):382-90. [DOI: 10.1016/j.whi.2017.02.007] - DOI - PubMed
Mache 2015 {published data only}
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Mache 2016 {published data only}
    1. Mache S, Bernburg M, Baresi L, Groneberg DA, Bamberger B, Bradshaw B, et al. Evaluation of self-care skills training and solution-focused counselling for health professionals in psychiatric medicine: A pilot study. International Journal of Psychiatry in Clinical Practice 2016;20(4):239-44. [DOI: ] - PubMed
Mache 2017 {published data only}
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Mache 2018 {published data only}
    1. Mache S, Bernburg M, Baresi L, Groneberg D. Mental health promotion for junior physicians working in emergency medicine: evaluation of a pilot study. European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine 2018;25(3):191-8. [DOI: ] - PubMed
Mackenzie 2006 {published data only}
    1. Mackenzie CS, Poulin PA, Seidman-Carlson R. A brief mindfulness-based stress reduction intervention for nurses and nurse aides. Applied Nursing Research 2006;19(2):105-9. - PubMed
Mandal 2021 {published data only}
    1. Mandal S, Misra P, Sharma G, Sagar R, Kant S, Dwivedi SN, et al. Effect of structured yoga program on stress and professional quality of life among nursing ataff in a tertiary care hospital of Delhi—a small scale phase-II trial. Journal of Evidence-Based Integrative Medicine 2021;26:1-10. [DOI: 10.1177/2515690X21991998] - DOI - PMC - PubMed
Mao 2021 {published data only}
    1. Mao L, Huang L, Chen Q. Promoting resilience and lower stress in nurses and improving inpatient experience through emotional intelligence training in China: a randomized controlled trial. Nurse Education Today 2021;107:Epub. [DOI: 10.1016/j.nedt.2021.105130] - DOI - PubMed
Martins 2011 {published data only}
    1. Martins AE, Davenport MC, Del Valle MD, Di Lalla S, Dominguez P, Ormando L, et al. Impact of a brief intervention on the burnout levels of pediatric residents. Jornal de Pediatria 2011;87(6):493-8. - PubMed
McConachie 2014 {published data only}
    1. McConachie DA, McKenzie K, Morris PG, Walley RM. Acceptance and mindfulness-based stress management for support staff caring for individuals with intellectual disabilities. Research in Developmental Disabilities 2014;35(6):1216-27. [DOI: 10.1016/j.ridd.2014.03.005] - DOI - PubMed
McGonagle 2020 {published data only}
    1. McGonagle AK, Schwab L, Yahanda N, Duskey H, Gertz N, Prior L, et al. Coaching for primary care physician well-being: A randomized trial and follow-up analysis. Journal of Occupational Health Psychology 2020;25(5):297-314. [DOI: ] - PubMed
Mealer 2014 {published data only}
    1. Mealer M, Conrad D, Evans J, Jooste K, Solyntjes J, Rothbaum B, et al. Feasibility and acceptability of a resilience training program for intensive care unit nurses. American Journal of Critical Care 2014;23(6):e97-105. [DOI: 10.4037/ajcc2014747] - DOI - PubMed
Medisauskaite 2019 {published data only}
    1. Medisauskaite A, Kamau C. Reducing burnout and anxiety among doctors: randomized controlled trial. Psychiatry Research 2019;274:383-90. [DOI: 10.1016/j.psychres.2019.02.075] - DOI - PubMed
Melchior 1996 {published data only}
    1. Melchior ME, Philipsen H, Abu-Saad HH, Halfens RJ, Van De Berg AA, Gassman P. The effectiveness of primary nursing on burnout among psychiatric nurses in long-stay settings. Journal of Advanced Nursing 1996;24(4):694-702. - PubMed
Moench 2021 {published data only}
    1. Moench J, Billsten O. Randomized controlled trial: self-care Traumatic episode protocol, computerized EMDR treatment of COVID-19-related stress. Journal of EMDR Practice and Research 2021;15(2):99-113. [DOI: 10.1891/EMDR-D-20-00047] - DOI
Montaner 2021 {published data only}
    1. Montaner X, Tarrega S, Pulgarin M, Moix J. Effectiveness of acceptance and commitment therapy (ACT) in professional dementia caregivers burnout. Clinical Gerontologist 2021;45:1-12. [DOI: ] - PubMed
Montibeler 2018 {published data only}
    1. Montibeler J, Domingos TS, Braga EM, Gnatta JR, Kurebayashi LFS, Kurebayashi AK. Effectiveness of aromatherapy massage on the stress of the surgical center nursing team: a pilot study. Efetividade da massagem com aromaterapia no estresse da equipe de enfermagem do centro cirurgico: estudo-piloto 2018;52:03348. [DOI: ] - PubMed
Moody 2013a {published and unpublished data}
    1. Moody K, Kramer D, Santizo RO, Magro L, Wyshogrod D, Ambrosio J, et al. Helping the helpers: mindfulness training for burnout in pediatric oncology--a pilot program. Journal of Pediatric Oncology Nursing 2013;30(5):275-84. - PubMed
Norvell 1987 {published data only}
    1. Norvell N, Belles D, Brody S, Freund A. Worksite stress management for medical care personnel: results from a pilot program. Journal for Specialists in Group Work 1987;57:118-26.
Novoa 2014 {published data only}
    1. Novoa MP, Cain DS. The effects of reiki treatment on mental health professionals at risk for secondary traumatic stress: a placebo control study. Best Practices in Mental Health: An International Journal 2014;10(1):31-46.
OBrien 2019 {published data only}
    1. O'Brien WH, Singh WS, Horan K, Moeller MT, Wasson R, Jex SM. Group-based acceptance and commitment therapy for nurses and nurse aides working in long-term care residential settings. Journal of Alternative and Complementary Medicine (New York, N.Y.) 2019;25(7):753-61. [DOI: ] - PubMed
Oman 2006 {published data only}
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Ozbas 2016 {published data only}
    1. Ozbas AA, Tel H. The effect of a psychological empowerment program based on psychodrama on empowerment perception and burnout levels in oncology nurses: Psychological empowerment in oncology nurses. Palliative & Supportive Care 2016;14(4):393-401. [DOI: ] - PubMed
Ozgundondu 2019 {published data only}
    1. Ozgundondu B, Gok MZ. Effects of progressive muscle relaxation combined with music on stress, fatigue, and coping styles among intensive care nurses. Intensive & Critical Care Nursing 2019;54:54-63. [DOI: 10.1016/j.iccn.2019.07.007] - DOI - PubMed
Palumbo 2012 {published data only}
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Pehlivan 2020 {published and unpublished data}
    1. Pehlivan T, Güner P. Effect of a compassion fatigue resiliency program on nurses’ professional quality of life, perceived stress, resilience: a randomized controlled trial. Journal of Advanced Nursing 2020;76(12):3584-96. [DOI: 10.1111/jan.14568] - DOI - PubMed
PelitAksu 2020 {published data only}
    1. Pelit‐Aksu S, Özkan‐Şat S, Yaman‐Sözbi̇r S, Şentürk‐Erenel A. Effect of progressive muscle relaxation exercise on clinical stress and burnout in student nurse interns. Perspectives in Psychiatric Care 2020;57 ((3)):1095-102. [DOI: 10.1111/ppc.12662] - DOI - PubMed
Peterson 2008 {published data only}
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Prado 2018 {published data only}
    1. Prado JM, Kurebayashi LF, Silva MJ. Experimental and placebo auriculotherapy for stressed nurses: randomized controlled trial. Auriculoterapia verdadeira e placebo para enfermeiros estressados: ensaio clinico randomizado 2018;52:e03334. [DOI: ] - PubMed
Redhead 2011 {published data only}
    1. Redhead K, Bradshaw T, Braynion P, Doyle M. An evaluation of the outcomes of psychosocial intervention training for qualified and unqualified nursing staff working in a low-secure mental health unit. Journal of Psychiatric and Mental Health Nursing 2011;18(1):59-66. - PubMed
Reynolds 1993 {published data only}
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Riley 2017 {published data only}
    1. Riley KE, Park CL, Wilson A, Sabo AN, Antoni MH, Braun TD, et al. Improving physical and mental health in frontline mental health care providers: yoga-based stress management versus cognitive behavioral stress management. Journal of Workplace Behavioral Health 2017;32(1):26-48. [DOI: ] - PMC - PubMed
Saganha 2012 {published data only}
    1. Saganha JP, Doenitz C, Greten T, Efferth T, Greten HJ. Qigong therapy for physiotherapists suffering from burnout: a preliminary study. Journal of Chinese Integrative Medicine 2012;10(11):1233-9. - PubMed
Sampson 2019 {published data only}
    1. Sampson M, Melnyk BM, Hoying J. Intervention effects of the MINDBODYSTRONG cognitive behavioral skills building program on newly licensed registered nurses' mental health, healthy lifestyle behaviors, and job satisfaction. Journal of Nursing Administration 2019;49(10):487-95. [DOI: ] - PubMed
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Sawyer 2021 {published and unpublished data}
    1. Sawyer AT, Bailey AK, Green JF, Sun J, Robinson PS. Resilience, insight, self-compassion, and empowerment (RISE): a randomized controlled trial of a psychoeducational group program for nurses. Journal of the American Psychiatric Nurses Association 2021;Epub ahead of print(-):10783903211033338. [DOI: ] - PubMed
Schrijnemaekers 2003 {published data only}
    1. Schrijnemaekers VJ, Van Rossum E, Candel MJ, Frederiks CM, Derix MM, Sielhorst H, et al. Effects of emotion-oriented care on work-related outcomes of professional caregivers in homes for elderly persons. Journals of Gerontology Series B-Psychological Sciences & Social Sciences 2003;58(1):S50-7. - PubMed
Schroeder 2018 {published data only}
    1. Schroeder DA, Stephens E, Colgan D, Hunsinger M, Rubin D, Christopher MS. A brief mindfulness-based intervention for primary care physicians: a pilot randomized controlled trial. American Journal of Lifestyle Medicine 2018;12(1):83-91. [DOI: 10.1177/1559827616629121] - DOI - PMC - PubMed
Seidel 2021 {published data only}
    1. Seidel LW, Dane FC, Carter KF. Brief mindfulness practice course for healthcare providers. Journal of Nursing Administration 2021;51(7-8):395-400. [DOI: ] - PubMed
Shapiro 2005 {published data only}
    1. Shapiro SL, Astin JA, Bishop SR, Cordova M. Mindfulness-based stress reduction for health care professionals: results from a randomized trial. International Journal of Stress Management 2005;12(2):164-76.
Sharif 2013 {published data only}
    1. Sharif F, Rezaie S, Keshavarzi S, Mansoori P, Ghadakpoor S. Teaching emotional intelligence to intensive care unit nurses and their general health: a randomized clinical trial. International Journal of Occupational and Environmental Medicine 2013;4(3):141-8. - PubMed
Shin 2020 {published data only}
    1. Shin YK, Lee SY, Lee JM, Kang P, Seol GH. Effects of short-term inhalation of patchouli oil on professional quality of life and stress levels in emergency nurses: randomized controlled trial. Journal of Alternative and Complementary Medicine (New York, N.Y.) 2020;26(11):1032-8. [DOI: ] - PubMed
Sood 2011 {published data only}
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Stanton 1988 {published data only}
    1. Stanton HE. Relaxation, deepening, and ego-enhancement: a stress reduction "package". Australian Psychologist 1988;23:315-22.
Tonarelli 2018 {published data only}
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Tsai 1993 {published data only}
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Verdes Montenegro Atalaya 2021 {published data only}
    1. Verdes-Montenegro-Atalaya JC, Perula-de Torres LA, Lietor-Villajos N, Bartolome-Moreno C, Moreno-Martos H, Rodriguez L, et al. Effectiveness of a mindfulness and self-compassion standard training Program versus an abbreviated Ttraining program on stress in tutors and resident Intern Ssecialists of family and community Medicine and nursing in Spain. International Journal of Environmental Research and Public Health 2021;18(19):10230. [DOI: ] - PMC - PubMed
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West 1984 {published data only}
    1. West DJ Jr, Horan JJ, Games PA. Component analysis of occupational stress inoculation applied to registered nurses in an acute care hospital setting. Journal of Counseling Psychology 1984;31(2):209-18.
West 2014 {published and unpublished data}
    1. West CP, Dyrbye LN, Rabatin JT, Call TG, Davidson JH, Multari A, et al. Intervention to promote physician well-being, job satisfaction, and professionalism: a randomized clinical trial. JAMA Internal Medicine 2014;174(4):527-33. [DOI: 10.1001/jamainternmed.2013.14387] - DOI - PubMed
West 2021 {published and unpublished data}
    1. West CP, Dyrbye LN, Satele DV, Shanafelt TD. Colleagues Meeting to Promote and Sustain Satisfaction (COMPASS) groups for physician well-being: a randomized clinical trial. Mayo Clinic Proceedings 2021;96(10):2606-14. [DOI: ] - PubMed
Xie 2020 {published data only}
    1. Xie C, Zeng Y, Lv Y, Li X, Xiao J, Hu X. Educational intervention versus mindfulness-based intervention for ICU nurses with occupational burnout: a parallel, controlled trial. Complementary Therapies in Medicine 2020;52(Aug):102485.. [DOI: 10.1016/j.ctim.2020.102485] - DOI - PubMed
Yazdani 2010 {published data only}
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Yung 2004 {published data only}
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Zarvijani 2021 {published data only}
    1. Zarvijani SAH, Moghaddam LF, Parchebafieh S. Acceptance and commitment therapy on perceived stress and psychological flexibility of psychiatric nurses: a randomized control trial. BMC Nursing 2021;20(1):239 . [DOI: 10.1186/s12912-021-00763-4] - DOI - PMC - PubMed

References to studies excluded from this review

Adair 2020 {published data only}
    1. Adair KC, Rodriguez-Homs, LG, Masoud S, Mosca PaulJ, Sexton, JB. Gratitude at work: prospective cohort study of a web-based, single-exposure well-being intervention for health care workers. Journal of Medical Internet Research 2020;22(5):e15562. [DOI: ] - PMC - PubMed
Akyurek 2020 {published data only}
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Ali 2011 {published data only}
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Alkhawaldeh 2020 {published data only}
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Ameli 2020 {published data only}
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Anonymous 2021 {published data only}
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Aronson 2022 {published data only}
    1. Aronson M, Henderson T, Dodd KW, Cirone M, Putman M, Salzman D, et al. Effects of brief mental skills training on emergency medicine residents’ stress response during a simulated resuscitation: a prospective randomized trial. Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health 2022;23(1):79-85. [DOI: 10.5811/westjem.2021.10.53892] - DOI - PMC - PubMed
Barbosa 2016 {published data only}
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Barrett 2021 {published data only}
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Beck 2018 {published data only}
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Behzadi 2021 {published data only}
    1. Behzadi S, Alizadeh Z, Samani NK, Ghasemi A, Fereidouni Z, Kargar L, et al. Effect of stress management on job stress of intensive care unit nurses in hospitals affiliated to the University of Medical Sciences. Archivos Venezolanos de Farmacologia y Terapeutica 2021;40(8):824-7. [DOI: 10.5281/zenodo.5791329] - DOI
Bielderman 2021 {published data only}
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    1. Moody K, Kramer D, Santizo RO, Magro L, Wyshogrod D, Ambrosio J, et al. Helping the helpers: mindfulness training for burnout in pediatric oncology--a pilot program. Journal of Pediatric Oncology Nursing 2013;30(5):275-84. [DOI: 10.1177/1043454213504497] - DOI - PubMed
Moyle 2013 {published data only}
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Muller 2016 {published data only}
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Navidian 2019 {published data only}
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Nazari 2015 {published data only}
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Niva 2021 {published data only}
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Nourian 2021 {published data only}
    1. Nourian M, Nikfarid L, Khavari AM, Barati M, Allahgholipour AR. The impact of an online mindfulness-based stress reduction program on sleep quality of nurses working in covid-19 care units: a clinical trial. Holistic Nursing Practice 2021;35(5):257-63. [DOI: 10.1097/HNP.0000000000000466] - DOI - PubMed
Ozturk 2021 {published data only}
    1. Ozturk, FO, Tezel, A. Effect of laughter yoga on mental symptoms and salivary cortisol levels in first‐year nursing students: a randomized controlled trial. International Journal of Nursing Practice (John Wiley & Sons, Inc.) 2021;27(2):1-10. [DOI: 10.1111/ijn.12924] - DOI - PubMed
Pehlivan 2019 {published data only}
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Penprase 2015 {published data only}
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Perula deTorres 2021 {published data only}
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Poulsen 2015 {published data only}
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Procaccia 2021 {published data only}
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Rollins 2016 {published data only}
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Romig 2012 {published data only}
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Ruotsalainen 2014 {published data only}
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Ruotsalainen 2015 {published data only}
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Ruotsalainen 2016 {published data only}
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Safarzei 2016 {published data only}
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Saffari 2021 {published data only}
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Salles 2013 {published data only}
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Salyers 2019 {published data only}
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Sampson 2020a {published data only}
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Sargazi 2018 {published data only}
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Seo 2014 {published data only}
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Shaw 2021 {published data only}
    1. Shaw WS, McLellan RK, Besen E, Namazi S, Nicholas K, Dugan AG, et al. A worksite self-management program for workers with chronic health conditions improves worker engagement and retention, but not workplace function. Journal of OccupationalRehabilitation 2021;Mar;32(1):77-86. [DOI: 10.1007/s10926-021-09983-6] - DOI - PMC - PubMed
Siedsma 2015 {published data only}
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Silva Junior 2016 {published data only}
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Smith 2019 {published data only}
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Smith 2021 {published data only}
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Smoktunowicz 2021 {published and unpublished data}
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Valley 2017 {published data only}
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References to studies awaiting assessment

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    1. Perez V, Menendez-Crispin EJ, Sarabia-Cobo C, Lorena P, Fernandez-Rodriguez A, Gonzalez-Vaca J. Mindfulness-based intervention for the reduction of compassion fatigue and burnout in nurse caregivers of institutionalized older persons with dementia: a randomized controlled trial. International Journal of Environmental Research and Public Health 2022;19(18):11441. - PMC - PubMed
Purdie 2022 {published data only}
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Rogala 2016 {published data only}
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