March 20, 2018
For years, stress management programs have looked at how to manage the negative: targeting stress and burnout for turnaround. Thus, when Matthew M. Clark, Ph.D., L.P., a psychologist at Mayo Clinic's campus in Rochester, Minnesota, was asked to work with Dan Abraham Healthy Living Center (DAHLC) — Mayo Clinic's employee wellness center — he led the stress management domain to focus on positive functioning.
Dr. Clark's DAHLC role involves researching and implementing stress alleviation programs such as wellness coaching and stress management groups. Research from this work, such as a DAHLC member cohort study observing employee stress and health behaviors, published in the September 2016 Journal of Occupational and Environmental Medicine, found high stress in one-sixth of participants. While each survey year those experiencing high stress changed, having high stress was associated with negative health behaviors, such as fewer DAHLC visits, impaired mental health, poor nutritional habits and lower perceived overall health.
Over time, Dr. Clark and colleagues began turning the paradigm to the positive, asking, "What if, instead of trying to manage employees' negative life aspects such as stress and burnout, we looked at building positive life aspects, good things we want to see grow?"
Rather than focusing solely on becoming stress-free, this wellness model targets resiliency: the ability to achieve and have a good quality of life, something that employees could work on daily. This emphasis change led to Dr. Clark's DAHLC title becoming resiliency domain leader.
A novel study
Dr. Clark and colleagues noted a dearth of research on happiness's role in bolstering health care employees' workplace function. Researchers posited as individuals' happiness relates to willful choices, a study designed to boost intentionality could increase happiness and other well-being measures.
Amit Sood, M.D., a Mayo Clinic internist in Rochester, Minnesota, had designed such an intervention, Stress Management and Resiliency Training (SMART), with demonstrated effectiveness improving various quality of life domains, yet not happiness specifically. The researchers designed a study observing SMART efficacy for increasing health care worker happiness and well-being.
DAHLC members volunteered for this study — a prospective, nonrandomized, single-arm trial — and received the SMART intervention between 2013 and 2017. It involved six months' participation: three months' in-person SMART intervention and three months' post-intervention follow-up. Investigators used these tools to determine outcome at baseline, intervention end and three months' post-intervention:
- Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being
- Gratitude Scale
- Mindful Attention Awareness Scale
- Perceived Stress Scale
- Subjective Happiness Survey
- Satisfaction With Life Scale
Researchers found statistically significant improvements in all domains, including subjective happiness, gratitude, life satisfaction, mindfulness, spiritual well-being and stress levels. They also noted strong engagement rates, indicated by few participant dropouts. Findings were published in Mayo Clinic Proceedings: Innovations, Quality & Outcomes' December 2017 issue.
Dr. Clark believes these findings also may apply in depression treatment. Many patients reported as depression worsened, their health behaviors became more negative. Therefore, part of a depression recovery plan may include a wellness intervention. While patients can start feeling better through depression treatment, their lifestyles may have fallen apart, prompting behaviors such as missing yoga because they feel bad or eating junk food for comfort. At some recovery juncture, however, actively working on wellness and resiliency could be appropriate as part of a comprehensive depression relapse prevention plan, says Dr. Clark.
To examine how resiliency programs could complement depression treatment, the Mayo Clinic Depression Center is conducting a single-arm pilot study providing SMART to patients being treated for depression, observing recovery impact and ability to benefit from SMART.
For future research
Dr. Clark indicates a randomized, controlled study of increasing health care workers' happiness and additional studies investigating resilience programs for patients with depression should be explored.
Though he feels stress groups are useful, Dr. Clark notes such programs aren't scalable for thousands of medical center workers, since these groups only facilitated 300 participants yearly at Mayo Clinic. To broaden the scope, he's now looking at large participant group interventions. One possible avenue for resiliency improvement at the workplace is a wellness champions program, where individual employees volunteer to promote wellness with co-workers. This program, discussed in a 2016 issue of American Journal of Health Behavior, has demonstrated benefit and is a future research focus.
For more information
Berkland BE, et al. A worksite wellness intervention: Improving happiness, life satisfaction, and gratitude in health care workers. Mayo Clinic Proceedings: Innovations, Quality & Outcomes. 2017;1:203.
Clark MM, et al. High stress and negative health behaviors: A five-year wellness center member cohort study. Journal of Occupational and Environmental Medicine. 2016;58:868.
Wieneke KC, et al. Development and impact of a worksite wellness champions program. American Journal of Health Behavior. 2016;40:215.