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Natural Medicine Journal

February 1, 2023

Transcendental Meditation for Healthcare Workers

Results from a randomized clinical trial

Ni-Cheng Liang

MD
Transcendental meditation may be a promising way to reduce burnout, insomnia, and anxiety amongst healthcare workers

Reference

Joshi SP, Wong AI, Brucker A, et al. Efficacy of transcendental meditation to reduce stress among health care workers: a randomized clinical trial. JAMA Netw Open. 2022;5(9):e2231917. 

Study Objective

To determine the effectiveness of transcendental meditation (TM) on reducing stress amongst healthcare workers

Key Takeaway

Among healthcare workers, Transcendental Meditation did not reduce stress over the 3-month study period. It did reduce the burnout characteristic of emotional exhaustion, as well as insomnia, and anxiety. 

Design

Single-center, open-label, randomized clinical trial

Participants

Investigators randomized 80 participants: 41 to TM and 39 to the control group. Demographics are as follows for the 80 participants:

  • Women, 66 (82.5%), with a mean age of 40
  • American Indian or Alaska Native, 1 (1.3%)
  • Asian, 5 (6.3%)
  • Black, 12 (15.0%)
  • White, 59 (73.8%)
  • Unknown or unreported race, 3 (3.8%)
  • Latinx, 4 (5.0%)
  • Non-Latinx, 76 (95.0%) 

Intervention

Participants in the TM group practiced TM 20 minutes twice daily for 3 months.

The control group received access to wellness resources such as mindfulness-based stress reduction, journaling workshops, stress and resilience training, and access to fitness and nutrition consultations.

Study Parameters Assessed

Investigators measured psychological distress using the Global Severity Index and changes in burnout using the Maslach Burnout Inventory. They measured insomnia using the Insomnia Severity Index and anxiety using the Generalized Anxiety Disorder-7 scale.

Primary Outcome

Between-group comparison of changes in acute psychological distress as measured by the total scores of the Global Severity Index (GSI-018) was the primary outcome of interest. All other indices were secondary outcome measures.

Key Findings

In the TM group, 38 participants (92.7%) adhered to the regime and practiced TM 20 minutes twice daily for 3 months. The TM group had a GSI-18 mean score reduction of 5.6 points, and the control group had a mean reduction of 3.6 points. This difference was not statistically significant (P=0.13).

However, the TM group had significantly greater reductions in the secondary end points compared to the control group:

  • Burnout. Maslach Burnout Inventory subscore: −8.0 points vs −2.6 points; between-group difference, −5.4 points; 95% CI, −9.2 to −1.6 points (P=0.006)
  • Insomnia. Insomnia Severity Scale score: −4.1 points vs −1.9 points; between-group difference, −2.2 points; 95% CI, −4.4 to 0 points (P=0.05)
  • Anxiety. Generalized Anxiety Disorder-7 score: −3.1 points vs −0.9 points; between-group difference, −2.2 points; 95% CI, −3.8 to −0.5 (P=0.01) 

Transparency

This study was funded by Grant 2678 from the Marcus Foundation (Joshi, Brucker, Chow, and Lee), Grant W81XWH-21-1-0977 from the US Department of Defense (Joshi, Brucker, Chow, Vaishnavi, and Lee), and Grant UL1TR002553 from the National Center for Advancing Translational Sciences and the National Institutes of Health Roadmap for Medical Research Initiative. Wong had equity in Ataia Medical outside the submitted work. Vaishnavi received grants from Duke University during the study. No other disclosures were reported.

Practice Implications & Limitations

Burnout is defined by 3 characteristics: emotional exhaustion, depersonalization, and a decreased sense of personal accomplishment. Burnout is a significant occupational hazard for healthcare workers, and the incidence of it is at epidemic levels, particularly for some subspecialties. In the Medscape 2022 Burnout Survey, on average, 47% of physicians reported characteristics of burnout, with rates up to 60% depending on subspecialty.1 Meditation has been suggested as a way of addressing individual factors related to healthcare worker burnout, especially mindfulness meditation.2,3

Burnout is defined by 3 characteristics: emotional exhaustion, depersonalization, and a decreased sense of personal accomplishment.

This is one of the few studies that have evaluated transcendental meditation (TM) as an intervention in comparison to a control group.4,5 TM is a type of meditation in which practitioners silently recite a single mantra (a sound without meaning) without concentration. Studies have demonstrated increased parasympathetic response leading to decreases in stress responsiveness in TM practitioners.6,7 Even though the acute psychological distress levels among the TM group in this study were not reduced a statistically significant amount compared to the control group, emotional exhaustion (a characteristic of burnout), insomnia, and anxiety levels were reduced. One reason for the study not reaching statistical significance between group comparisons is the low acute distress scores between the groups at baseline. Also, the GSI may not be the correct tool to assess psychological distress among healthcare workers. The results for the secondary outcomes provide support for further study of TM to decrease healthcare worker burnout.

Conflict-of-Interest Disclosure

The author is CEO of Awaken Breath, LLC, a consultant for 2ndMD, and a speaker for Astra Zeneca.

Categorized Under

Ni-Cheng Liang

MD

Ni-Cheng Liang, MD, is an integrative pulmonologist and mindfulness teacher. She is a leader and international speaker on mindfulness, antiracism, pulmonary medicine, and integrative medicine. She is a 4-time San Diego Top Doctor, was the San Diego American Lung Association Lung Health Provider of the Year 2019, and was named one of the 10 Powerful Women of the Mindfulness Movement 2021 by Mindful Magazine. She is passionate about reducing suffering among healthcare professionals.

References

  1. Physician burnout & depression report 2022: stress, anxiety, and anger. Medscape website. https://www.medscape.com/slideshow/2022-lifestyle-burnout-6014664?icd=ssl_login_success_221116#2.11/16/2022.
  2. Krasner MS, Epstein RM, Beckman H, et al. Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA. 2009;302(12):1284-1293.
  3. Epstein RM, Marshall F, Sanders M, Krasner MS. Effect of an Intensive mindful practice workshop on patient-centered compassionate care, clinician well-being, work engagement, and teamwork. J Contin Educ Health Prof. 2022;42(1):19-27.
  4. Azizoddin DR, Kvaternik N, Beck M, et al. Heal the healers: a pilot study evaluating the feasibility, acceptability, and exploratory efficacy of a Transcendental Meditation intervention for emergency clinicians during the coronavirus disease 2019 pandemic. J Am Coll Emerg Physicians Open. 2021;2(6):e12619.
  5. Leary S, Weingart K, Topp R, Bormann J. The effect of mantram repetition on burnout and stress among va staff. Workplace Health Saf. 2018;66(3):120-128.
  6. Bellehsen M, Stoycheva V, Cohen BH, Nidich S. A pilot randomized controlled trial of Transcendental Meditation as treatment for posttraumatic stress disorder in veterans. J Trauma Stress. 2022;35(1):22-31.
  7. Bujatti M, Riederer P. Serotonin, noradrenaline, dopamine metabolites in transcendental meditation-technique. J Neural Transm. 1976;39(3):257-267.

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