Resilience@Work Mindfulness Program: Results From a Cluster Randomized Controlled Trial With First Responders
Background: A growing body of research suggests that resilience training can play a pivotal role in creating mentally healthy workplaces, particularly with regard to protecting the long-term well-being of workers. Emerging research describes positive outcomes from various types of resilience training programs (RTPs) among different occupational groups. One specific group of workers that may benefit from this form of proactive resilience training is first responders. Given the nature of their work, first responders are frequently exposed to stressful circumstances and potentially traumatic events, which may impact their overall resilience and well-being over time.
Objective: This study aimed to examine whether a mindfulness-based RTP (the Resilience@Work [RAW] Mindfulness Program) delivered via the internet can effectively enhance resilience among a group of high-risk workers.
Methods: We conducted a cluster randomized controlled trial (RCT) comprising 24 Primary Fire and Rescue and Hazmat stations within New South Wales. Overall, 12 stations were assigned to the 6-session RAW Mindfulness Program and 12 stations were assigned to the control condition. A total of 143 active full-time firefighters enrolled in the study. Questionnaires were administered at baseline, immediately post training, and at 6-month follow-up. Measurements examined change in both adaptive and bounce-back resilience as well as several secondary outcomes examining resilience resources and acceptance and mindfulness skills.
Results: Mixed-model repeated measures analysis found that the overall test of group-by-time interaction was significant (P=.008), with the intervention group increasing in adaptive resilience over time. However, no significant differences were found between the intervention group and the control group in terms of change in bounce-back resilience (P=.09). At 6-month follow-up, the group receiving the RAW intervention had an average increase in their resilience score of 1.3, equating to a moderate-to-large effect size compared with the control group of 0.73 (95% CI 0.38-1.06). Per-protocol analysis found that compared with the control group, the greatest improvements in adaptive resilience were observed among those who completed most of the RAW program, that is, 5 to 6 sessions (P=.002).
Conclusions: The results of this RCT suggest that mindfulness-based resilience training delivered in an internet format can create improvements in adaptive resilience and related resources among high-risk workers, such as first responders. Despite a number of limitations, the results of this study suggest that the RAW Mindfulness Program is an effective, scalable, and practical means of delivering online resilience training in high-risk workplace settings. To the best of our knowledge, this is the first time a mindfulness-based RTP delivered entirely via the internet has been tested in the workplace.
Mindfulness-Based Resilience Training in the Workplace: Pilot Study of the Internet-Based Resilience@Work (RAW) Mindfulness Program
Background: The impact of mental illness on society is far reaching and has been identified as the leading cause of sickness absence and work disability in most developed countries. By developing evidence-based solutions that are practical, affordable, and accessible, there is potential to deliver substantial economic benefits while improving the lives of individual workers. Academic and industry groups are now responding to this public health issue. A key focus is on developing practical solutions that enhance the mental health and psychological resilience of workers. A growing body of research suggests resilience training may play a pivotal role in the realm of public health and prevention, particularly with regards to protecting the long-term well-being of workers.
Objective: Our aim is to examine whether a mindfulness-based resilience-training program delivered via the internet is feasible and engaging to a group of high-risk workers. Additionally, we aim to measure the effect of the Resilience@Work Resilience@Work Mindfulness program on measures of resilience and related skills.
Methods: The current pilot study recruited 29 full-time firefighters. Participants were enrolled in the 6-session internet-based resilience-training program and were administered questionnaires prior to training and directly after the program ended. Measurements examined program feasibility, psychological resilience, experiential avoidance, and thought entanglement.
Results: Participants reported greater levels of resilience after Resilience@Work training compared to baseline, with a mean increase in their overall resilience score of 1.5 (95% CI -0.25 to 3.18, t14=1.84, P=.09). Compared to baseline, participants also reported lower levels of psychological inflexibility and experiential avoidance following training, with a mean decrease of -1.8 (95% CI -3.78 to 0.20, t13=-1.94, P=.07). With regards to cognitive fusion (thought entanglement), paired-samples t tests revealed a trend towards reduction in mean scores post training (P=.12).
Conclusions: This pilot study of the Resilience@Work program suggests that a mindfulness-based resilience program delivered via the Internet is feasible in a high-risk workplace setting. In addition, the firefighters using the program showed a trend toward increased resilience and psychological flexibility. Despite a number of limitations, the results of this pilot study provide some valuable insights into what form of resilience training may be viable in occupational settings particularly among those considered high risk, such as emergency workers. To the best of our knowledge, this is the first time a mindfulness-based resilience-training program delivered wholly via the internet has been tested in the workplace.
Impact of alternative terminology for depression on help-seeking intention: A randomized online trial
Objective
People with depression experience barriers to seeking professional help. Different diagnostic terminology can influence people's treatment/management preferences. The aim of this study was to investigate how alternative depression diagnostic labels and recommendations impact help-seeking intentions and psychosocial outcomes.
Methods
Participants (18–70 years) were recruited using an online panel (Australia) to complete a randomized controlled trial. They read a hypothetical scenario where they discussed experiencing depressive symptoms with their GP and were randomized to receive one of four diagnoses ("depression," "burnout," "functional impairment syndrome" [fictitious label], no label [control]), and one of two follow-up recommendations ("clinical psychologist," "mind coach"). Primary outcome: help-seeking intention (5-point scale, higher = greater intention)" secondary outcomes: intention to speak to boss, self-stigma, worry, perceived severity, illness perceptions, and personal stigma.
Results
A total of 676 participants completed the survey. There was no main effect of diagnostic label on help-seeking intention or stigma outcomes. Intention to speak to a boss was higher with the depression compared to burnout label (MD=0.40, 95% CI: 0.14–0.66) and perceived severity was higher with the depression label compared to control (MD=0.48, 95% CI: 0.22–0.74) and all other labels. Those who received the "clinical psychologist" recommendation reported higher help-seeking intention (MD=0.43, 95% CI: 0.25–0.60) and treatment control (MD=0.69, 95% CI: 0.29–1.10) compared to the "mind coach" recommendation.
Conclusion
Findings highlight the success of efforts to promote help-seeking from clinical psychologists for depression. If burnout is considered a separate diagnostic entity to depression, greater awareness around what such a diagnosis means may be needed. Future research should examine how different terminologies surrounding other mental health conditions impact help-seeking and stigma.
Standing on my brother's shoulders: making peace with grief and suicide
"Tara's childhood was scarred by the debilitating mental illness of her father and by her mother's death from cancer when she was thirteen. Caught up in grief and despair, Tara and her older brother Adam developed a deep, caring bond, but Adam struggled silently with growing anxiety and depression. Four years after their mother's death, he committed suicide, throwing himself from his study window at Oxford University. Grief and insecurity threatened to engulf Tara, but eventually she found, within her brother's diaries, her reason to live. The story moves from London to Sydney as Tara rebuilds her life, firstly as a physiotherapist and then a firefighter. Through her search for understanding and a powerful dialogue with her brother, she eventually gains freedom from the past and a life of meaning. Trained in suicide prevention, the author hopes that Part 1 will allow the reader to identify risk factors for mental illness, as well as strategies that reduce the effect of trauma and loss. Part 2 seeks to give examples of techniques to improve resilience. And in Part 3 her story shows how we can aid post-traumatic growth and improve happiness levels through positive psychology."
A Violation of Coherence: A Narrative Inquiry Study of Firefighters’ Experiences of Exposure to Suicide
Emergency service workers are routinely exposed to potentially traumatic events involving sudden violent deaths, including suicide, in fulfilling their occupational roles. Yet, firefighters are a unique population of emergency service workers whose primary purpose is to protect life. How, then, do they experience the intentional act to end life when a person has died by suicide? The profound impact of exposure to suicide is well documented in the empirical literature, particularly in light of close relationships. However, exploration of the breadth and complexity of exposure in an occupational context is limited, particularly in those without an attachment relationship to the deceased, such as the experience of firefighters.
This doctoral study explores the experiences of firefighters exposed to suicide situated within the unique cultural and organisational context of firefighting, examining how firefighters live with and through the experience of exposure to suicide in their personal and professional lives. The study is grounded in narrative inquiry methodology, using a qualitative reflexive paradigm with an insider researcher perspective. In-depth semi-structured interviews elicited the stories of 20 firefighters based in Australia who had been exposed to suicide occupationally and personally. A reflexive thematic analysis was used to draw out meanings across and within the shared stories of firefighters.
The results of the analysis generated four themes collectively describing the lived experiences of firefighters exposed to suicide. The first two themes tell of the experience of exposure to suicide and how that exposure poses a threat to firefighters’ understanding of the world. This details the conflicts and discrepancies in the truth about the expectations and realities of the world firefighters exist within. The results show how exposure to suicide occurs in a liminal space triggered by not knowing why a person has died by suicide and the uncertainty this creates about the world around them, given the cultural nuances of control associated with firefighting as a profession. The final two themes reflect firefighters’ internal experience of exposure to suicide brought about by disruptions to temporality. ‘Fears for the future’ identifies how suicide is experienced as a threat to firefighters’ sense of safety, whilst ‘Reflections of the past’ captures how suicide is experienced as a retrospective reckoning, which is interpreted as a failure to protect life and an ultimate threat to a firefighter’s identity.
The study concludes that firefighters’ experiences of exposure to suicide can be understood as a violation of coherence that disrupts their familiar ways of understanding and being in the world. The results of the study situate a discussion about the philosophical and psychological theories that may better inform firefighter suicide exposure preparedness. Strategies are highlighted to better support those working within the field and enhance ways to offer postvention support to these first responders.
A violation of Coherence: A narrative inquiry study of firefighters' experiences of exposure to suicide
Audio files and interview transcripts with firefighters recorded between 2019-202 that form the raw dataset from which the analysis was conducted. Files which demonstrate the coding process are also included in the form of files drawn from NVIVO, excel spreadsheets and JPEG images of concept maps.