Mindfulness, art-based therapy a promising way to avoid burnout among healthcare workers

For many healthcare workers involved in palliative care, the intense emotions associated with end-of-life caregiving make them susceptible to a mental and physical fallout—a condition defined as burnout.

Around the world, a staggering number of healthcare workers are experiencing high levels of burnout, ranging from 47 percent to 70 percent in the United States and 71.8 percent to 80.7 percent in Singapore. The turnover rate of in-patient hospice workers is already alarming at 30 percent and soars sharply to 60 percent among homecare workers, sending ripples through care continuity and quality. [Acad Med 2011;86:1304-1310; Ann Acad Med Singap 2016;45:471-474; Singapore Med J 2018;59:50-54; J Aging Health 2010;22:713-733]

But the good news is that a novel multimodal therapeutic framework that integrates the reflective nature of mindfulness meditation with the expressive process of art-based therapy—known as the Mindful-Compassion Art-based Therapy (MCAT)—can effectively soften the intense stress experienced by healthcare workers who give palliative care.

In a local study that included 56 healthcare workers (mean age 44.4 years, 75 percent women) from the largest homecare hospice in Singapore, those who underwent 6 weeks of MCAT achieved a significant reduction in mental exhaustion compared with those assigned to a waitlist control. This decrease occurred simultaneously with improvements in overall emotional regulation, nonreactivity to intrusive thoughts, approach acceptance of death, and afterlife belief. [Front Psychol 2021;12:744443]

The favourable effects of MCAT “on mental exhaustion and emotional regulation were maintained [through the twelfth] week with new benefits identified, such as improvements in the ability to observe and describe one’s feelings, thoughts and emotions, to practice self-compassion and mindful awareness, and to experience a deepened sense of common humanity and elevated quality of life,” according to the investigators, led by Dr Andy Ho of Nanyang Technological University in Singapore.

“All significant findings are marked by medium to mostly large effect sizes, reflecting the clinical efficacy and positive residual effects of the intervention,” they added.

MCAT was delivered as a group-based intervention, conducted over 6 weeks for a total of 18 hours. Each session covered a unique topic aimed at promoting understanding, acceptance, and compassion for self and others to, in turn, cultivate psychological resilience and shared meaning. The sessions began with a check-in, followed by an interactive lecture, a mindfulness meditation, a facilitated expressive art-making session, a creative and reflective writing activity, small-group and large-group sharing, and ending with a mindful breathing check-out.

The outcomes were evaluated using the 16-items Maslach Burnout Inventory – General Survey, which looks at three domains of burnout, namely exhaustion, cynicism, and professional efficacy. Meanwhile, resilience was assessed using the 11-item Ego-Resilience Revised Scale, which examines active engagement with the world, problem-solving strategies, and integrated performance under stress.

“Protecting the mental health of healthcare workers is an urgent global public health priority. MCAT aims to mitigate the detrimental effects of burnout and to foster psychological resilience among the healthcare workers immersed in the field of palliative end-of-life care,” said Ho and his team.

“[The present] findings reflect the robust effectiveness and positive residual effects of MCAT for reducing burnout, building resilience, nurturing compassion, fostering collegial support, and promoting mental wellness among healthcare workers,” they added.

Ho and his team shared that there have been discussions centred around applying the MCAT in larger and more diverse caregiving contexts, such as family dementia care.