Impact of App-Delivered Mindfulness Meditation on Functional Connectivity, Mental Health, and Sleep Disturbances Among Physician Assistant Students: Randomized, Wait-list Controlled Pilot Study

Abstract

Background Health care provider and trainee burnout results in substantial national and institutional costs and profound social effects. Identifying effective solutions and interventions to cultivate resilience among health care trainees is critical. Although less is known about the mental health needs of physician assistants (PAs) or PA students, accumulating research indicates that they experience similarly alarming rates of burnout, depression, and emotional exhaustion. Mobile app–delivered mindfulness meditation may be an effective part of salubrious programming to bolster long-term resilience and health among PA students. Objective This study aims to examine the impact of app-delivered mindfulness meditation on self-reported mental health symptoms among PA students. A secondary aim is to investigate changes in brain connectivity to identify neurobiological changes related to changes in mental health symptoms. Methods We recruited PA students enrolled in their third semester of PA school and used a longitudinal, randomized, wait-list–controlled design. Participants randomized to the mindfulness group were provided 1-year subscriptions to the 10% Happier app, a consumer-based meditation app, and asked to practice every day for 8 weeks. Before randomization and again after completion of the 8-week program, all participants completed resting-state functional magnetic resonance imaging as well as self-report assessments of burnout, depression, anxiety, and sleep impairment. App use was acquired as a measure of mindfulness practice time. Results PA students randomized to the mindfulness group reported improvements in sleep impairment compared with those randomized to the wait-list control group (ηp2=0.42; P=.01). Sleep impairment decreased significantly in the mindfulness group (19% reduction; P=.006) but not in the control group (1% reduction; P=.71). There were no other significant changes in mental health for those randomized to app-delivered mindfulness. Across all students, changes in sleep impairment were associated with increased resting-state functional connectivity between the medial prefrontal cortex (a component of the default mode network) and the superior temporal gyrus, as well as between areas important for working memory. Changes in connectivity predicted categorical conversion from impaired to nonimpaired sleep in the mindfulness group. Conclusions This pilot study is the first to examine app-based mindfulness for PA students’ mental health and investigate the impact of mindfulness on PA students’ brain function. These findings suggest that app-delivered mindfulness may be an effective tool to improve sleep dysfunction and that it may be an important part of the programming necessary to reduce the epidemic of suffering among health profession trainees.

Strategies for Improving Mental Health in Physician Assistant Students

“…15 A randomized controlled trial of 200 PA students using an app to deliver mindfulness meditation showed improved sleep in the group using mindfulness meditation while the control group did not. 16 However, there was no significant improvement in burnout, depression, or anxiety associated with this mindfulness meditation. Despite this, there is evidence that PA students are interested in participating in wellness interventions.…”

The Effect of a Mindfulness Phone Application on NICU Nurses' Professional Quality of Life

“…In one stratified, randomized controlled trial, medical students using the Headspace app reported lower stress and more general well-being (N = 88)14; in another trial, undergraduates using the Calm app improved their self-compassion and mindfulness and reduced stress levels more than controls (N = 88) 11. Findings from a third trial suggested that the 10% Happier app produced sleep improvements and a positive relationship between mindfulness practice and brain connectivity among 14 physician assistant students, albeit no detectable change in anxiety or BO 12. Thus, given the potential for mindfulness phone apps to reduce BO, improve self-compassion, and facilitate other positive outcomes, this study's hypothesis was that practicing self-guided mindfulness via a phone app will improve NICU nurses' professional QOL, specifically by reducing their CF and increasing their CS.…”

Efficacy and feasibility of the minimal therapist-guided four-week online audio-based mindfulness program ‘Mindful Senses’ for burnout and stress reduction in medical personnel: A randomized controlled trial

“…Previous studies have reported equivocal effects of full online MBIs on burnout [20–22] and stress [23, 24] in medical personnel. Earlier studies were limited by lack of randomization [22–24], lack of a control group [22–24] or attention control group [21], underpowered sample size [20,21,23], and had high dropout rates [22, 24]. The outcome effect sizes in many studies have been merely small-to-medium [23, 24].…”