Stress clinical trials at UCSF
3 in progress, 0 open to new patients

Burnout and overwhelming stress are growing issues in medicine and are associated with mental illness, performance deficits and diminished patient care. Among surgical trainees, high dispositional mindfulness decreases these risks by 75% or more, and formal mindfulness training has been shown feasible and acceptable. In other high-stress populations formal mindfulness training has improved well-being, stress, cognition and performance, yet the ability of such training to mitigate stress and burnout across medical specialties, or to affect improvements in the cognition and performance of physicians, remains unknown. To address these gaps and thereby promote the wider adoption of contemplative practices within medical training, investigators have developed Enhanced Stress Resilience Training, a modified form of MBSR - streamlined, tailored and contextualized for physicians and trainees. Investigators propose to test Enhanced Stress Resilience Training (ESRT), versus active control and residency-as-usual, in mixed-specialty interns (from Emergency Medicine, Internal Medicine, Pediatrics, Family Practice, OBGYN and Surgery Departments) evaluated for well-being, cognition and performance changes at baseline, post-intervention and three or six-month follow-up.

Life Enhancing Activities for Family Caregivers is a six-week program designed to increase positive affect in people who care for a family member with dementia. The intervention consists of 6 weekly one-hour sessions conducted one-on-one with a trained facilitator to teach simple skills that are practiced at home in a study-supplied workbook. The program is preceded and followed by a 30-45 minute questionnaire. Follow-up assessments will be conducted at 1-month, 3-months, and 6-months post intervention. Primary hypothesis is that experimental subjects who participate in LEAF will demonstrate significantly greater improvements in psychological outcomes and will engage in more problem focused and positive appraisal forms of coping compared to the wait-list control condition.

Our understanding of the magnitude of physician burnout, its relationship to diminished performance and the development of mental and physical illness is crystalizing. Data now links burnout with diminished physician professionalism, patient outcomes, hospital economics and patient safety. Moreover, burnout appears to be a surrogate measure of distress among physicians. In a national survey of practicing surgeons, alcohol misuse and suicidal ideation were up to 3 times that of the general population. When burnout was present the likelihood increased 25% and 90%, respectively. Among physicians in general, burnout increases the likelihood of depressive symptoms 170%. In surgical trainees, there is alarming prevalence of distress symptoms, with a recent national survey (manuscript in preparation) showing 16% suicidal ideation, 32% moderate to severe depression, 58% high stress and 61% alcohol misuse or abuse among PGY-3s. It has been proposed that chronic and overwhelming stress in the absence of adequate coping skills promotes burnout and associated distress symptoms. It has also been posited that performance deficits, from surgical errors to poor professionalism, derive in large part from the deleterious effects of stress on cognition. Mindfulness mental training, most frequently in the form of Mindfulness-Based Stress Reduction (MBSR, as developed by John Kabat-Zinn), has been shown to protect or enhance cognition, well-being and physical health in multiple clinical populations and in healthy adults. Two decades of research have shown that MBSR and MBSR-based interventions create new habits in the brain subserved by organic, structural changes. Such interventions have been shown to protect cognitive function in pre-deployment marines and incarcerated juveniles; reduce relapse in major depressive disorder; enhance immune function in HIV+ males; reduce PTSD severity in veterans; enhance job performance in inner-city teachers; improve cognitive function and pro-social skills in children; increase professionalism and decrease burnout in PCPs; improve work satisfaction and engagement in numerous populations of health care workers; and diminish psychological stress in soldiers, physicians and professional athletes. This study seeks to demonstrate the feasibility of mindfulness training in surgical Interns while simultaneously providing objective pilot data on the effectiveness of mindfulness training in a randomized, controlled setting. In-coming surgical Interns will be recruited, randomized to mindfulness training or an active control group and undergo psychologic, physiologic, neurocognitive, neuroanatomic and performance assessments at baseline, post-intervention and one year later. Data will inform sample size calculations for subsequent, adequately-powered RCTs and will guide the creation of a feasible formal training model. Moreover, results could significantly impact formal medical training, the mental health of providers at every level, and the overall quality of patient care.