Online Mindfulness-Based Stress Reduction for the Mental Health of Healthcare Professionals

This is a prospective, two-arm, randomized controlled trial using a wait-list control design. The planned sample size is 158 to 160 healthcare professionals. The sample size allows for approximately 20% attrition and is expected to provide 80% statistical power to detect a medium standardized effect of Cohen d = 0.50 using a two-sided significance level of 0.05.

After providing written informed consent, participants will undergo an eligibility and safety assessment and complete the baseline assessment (T0). Eligible participants will then be randomly assigned in a 1:1 ratio to the MBSR intervention group or the wait-list control group. Randomization will be performed by the principal investigator using a computer-generated random number sequence.

Participants and the principal investigator cannot be blinded to group assignment because participation in the MBSR program is apparent. A second investigator who is not involved in randomization will remain unaware of individual group assignments. The MBSR instructors will not participate in participant screening, randomization, data collection, or data analysis. Statistical analyses will be conducted using coded data by a statistician who will be unaware of the group labels.

The intervention will follow a standardized MBSR program structure and will consist of eight structured online group sessions delivered once weekly by videoconference. Each group is expected to include approximately 16 participants. The sessions will be delivered by instructors who have completed formal training in mindfulness-based cognitive and behavioral approaches. The same program structure, content, duration, and sequence will be used for all intervention groups.

Participants assigned to the wait-list control group will not receive the study intervention during the initial comparison period. They may continue to use any usual psychological or healthcare services available to them. After completing the 6-month assessment (T3), participants in the wait-list group will be offered the online MBSR program. An additional assessment (T4) will be completed by this group immediately after their MBSR program.

Questionnaire data will be collected electronically at baseline (T0), immediately after the initial intervention period (T1), 3 months after the intervention (T2), and 6 months after the intervention (T3). Each questionnaire assessment is expected to take approximately 25 to 35 minutes. Hair samples will be collected before MBSR, 1 month after MBSR, and 6 months after MBSR. Concentration of cortisol in hair will be examined as objective indicators related to stress.

The primary outcome is change in the total score of the Recovery Experience Questionnaire. Secondary outcomes include symptoms of anxiety, depression, and burnout; psychological well-being; professional quality of life; and personality traits. Associations between mental health outcomes and demographic, occupational, lifestyle, health-related, and significant life-event variables will also be explored.

Descriptive statistics will be used to summarize the study data, and the internal consistency of the questionnaires will be assessed. Baseline comparability between the two groups will be evaluated using statistical tests appropriate to the type and distribution of each variable. Changes in primary and secondary outcomes will be analyzed using mixed-effects models for repeated measurements. The main measure of intervention effectiveness will be the group-by-time interaction. Effect sizes and 95% confidence intervals will be reported. Correlation and regression models will be used for additional exploratory analyses.

Before enrollment, participants will be assessed for mental health conditions that could interfere with safe participation, including high suicide risk and suspected psychotic symptoms. Participants experiencing emotional deterioration during the study will be advised to contact the principal investigator and appropriate healthcare or emergency services. Participation may be discontinued when needed to protect the participant's health and well-being.

Inclusion criteria

• Employed at a healthcare institution at a minimum of 0.25 full-time equivalent.
• Has direct contact with patients.
• Provides personal healthcare services, including physicians, resident physicians, nurses, paramedics, physiotherapists, lifestyle medicine specialists, and other healthcare professionals.
• Aged 18 years or older.
• Able to understand Lithuanian.
• Has access to the internet and a smart device suitable for participating in the online MBSR program and completing the study questionnaires.

Exclusion criteria

• Currently participating in a structured mindfulness-based program or regularly practicing mindfulness-based meditation.
• Currently experiencing a mental health condition that may interfere with safe participation in the study, including high suicide risk or suspected psychotic symptoms.
• Unable, because of a health condition, to reasonably understand and assess their own interests.
• Younger than 18 years.
• A student whose participation in the biomedical study is related to their studies.
• Residing in a social care institution.
• Serving as active-duty military personnel.
• Imprisoned or otherwise deprived of liberty.
• An employee of the Clinic of Psychiatry, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, who is subordinate to a study investigator.