The Effects of Teaching Mindfulness on Stress in Physical Therapy Students

High stress is exceedingly common in the higher education setting as a result of high expectations for students’ performance and an increasing workload. Keeping up on schoolwork, preparing to enter the workforce, and living independently all create a variety of stressors that can lead to decreased general well-being and academic success.1 For physical therapy students, this stress often persists after they begin practicing after college. Stress also continues to increase in existing clinicians and causes burnout and compassion fatigue.2 For this reason, a significant amount of research has been done on possible stress-reduction strategies and their effects on students’ and clinicians’ overall stress levels, well-being, and success. One of the primary subjects of this research is mindfulness, or the practice of intentionally pausing to become aware of the body. Mindfulness has been shown to reduce stress and anxiety, increase emotional resilience, and improve coping strategies.3,4  This article summarizes the findings of a June 2020 study from the Journal of Health Professions Education on the effects of teaching mindfulness to physical therapy students on their levels of stress.

Mindfulness as a Solution to Increased Stress in Physical Therapists

Researchers are especially interested in the applications of mindfulness for physical therapists due to the fact that students and professionals in the healthcare field tend to have above-average stress levels relative to those in other fields. Healthcare students often have to take more high-stakes exams, learn more content, and spend more time on classwork.5 Without learning how to effectively manage their stress, students struggle with school and subsequent transitions into internships or jobs, making them more likely to drop out, become depressed, and commit suicide.6,7 Furthermore, it is imperative for students to succeed both in their academics and in their development of stress reduction strategies in order to be successful as professionals.

Mindfulness is a promising option for students in this regard with the potential for lifelong benefits. The main goal of mindfulness practice is to focus on the breath, allowing one’s thoughts to become calm and centered on the present. By taking time to enjoy the present moment rather than worry about the future or ruminate about the past, mindfulness helps the individual more accurately respond to current situations and feel confident about their path. For physical therapists, mindfulness is a powerful tool that helps therapists view events objectively and make better decisions for them and their patients. Taking a new perspective on the results of an exam or the ramifications of a large caseload can greatly reduce stress and help to formulate an effective plan going forward. Additionally, reducing stress lowers the chances of burnout and academic fatigue.

How To Introduce Mindfulness to Physical Therapy Students?

In the study, the researchers investigated the effects of teaching mindfulness to physical therapy students by separating an advanced physical therapy class into an experimental group and a control group. The experimental group received normal course instruction in addition to a six-week mindfulness curriculum, while the control group continued with only normal course instruction. Immediately following the six-week period and in a follow-up after another eight weeks, the students in the experimental group were tested for their perceived levels of stress and mindfulness. The mindfulness curriculum was taught to the experimental group during the first 15 minutes of each class period and consisted of a combination of theoretical and experiential learning. In just 15 minutes per class twice a week, students in the experimental group learned about mindfulness through videos, lectures, guided meditation, and more. Additionally, the students learning about mindfulness were encouraged to practice outside of class and keep a Mindfulness Log to be turned in at the end of the study.

What are the Benefits of Mindfulness for Physical Therapy Students and Licensed Physical Therapists?

Students in the experimental group were tested using the Five Facet Mindfulness Questionnaire (FFMQ) and the Perceived Stress Scale (PSS) for levels of mindfulness and stress, respectively.8,9 The researchers also used a general survey to gather additional qualitative data about the students’ perceptions of mindfulness and their experiences as a whole. The FFMQ and PSS were each administered prior to the six-week period, immediately following, and an additional eight weeks later.

Significant improvements in score for the PSS were observed at both the immediate and follow-up tests among students who had learned about mindfulness. Out of a total scale from 0-40, with 0 indicating no stress and 40 indicating extreme stress, students from the experimental group averaged over six points lower immediately after the six-week educational period and over five points lower in the eight-week follow-up compared to the control group. These results were deemed statistically significant by a large margin (P=0.008 and 0.029, respectively), and suggest that mindfulness education is an effective tool for reducing stress in physical therapy students.

Similarly, students in the experimental group scored significantly higher on the FFMQ after the six-week study period. At this point, the experimental group averaged a score over 15 points higher than the control group, indicating a more mindful perception of the world and themselves. However, the results of the eight-week post-test were not statistically significant (P=0.061). The researchers observed that the follow-up results were approaching significance and posited that they would have been significant with a larger sample size. Regardless, the significant results illustrate a clear relationship between knowledge of mindfulness practices and an increase in mindful perceptions of the world.

The students expressed similar ideas within the qualitative interviews at the end of the study. The majority of those interviewed stated that the mindfulness activities and curriculum helped greatly with managing stress levels and anxiety. Many acknowledged that they had not previously heard of mindfulness or had very limited knowledge of the concept, and the researchers suggested that creating awareness is one of the major factors in encouraging students and professionals alike to learn more about mindfulness. Improved sleep, strategies for coping with stress and anxiety, and increased kindness were all reported among multiple students. All students also stated that they believe everyone should be exposed to mindfulness practice in order to have a chance to use it’s incredibly simple and effective tools for their benefit.

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The Future of Mindfulness and Physical Therapist Practice

The results of this study paint a clear picture of the efficacy and simplicity of mindfulness for stress reduction in physical therapy students. Combined with existing and emerging research both on students and healthcare professionals, it is clear that mindfulness can be a valuable tool for combating increased stress, compassion fatigue, and burnout at the professional and academic levels. At the most basic level, mindfulness presents a simple, effective, low-effort, and low-cost way to reduce stress and increase cognitive and emotional resilience in students and professionals alike.

REFERENCES:

1. J.K. Schwind, E. McCay, H. Beanlands, L.S. Martin, J. Martin, M. Binder. Mindfulness practice as a teaching-learning strategy in higher education: a qualitative exploratory pilot study. Nurse Educ Today, 50 (2017), pp. 92-96.

2. M.A. Campo, S. Weiser, K.L. Koenig. Job strain in physical therapists. Phys Ther, 89 (9) (2009), pp. 946-956.

3. B. Khoury, M. Sharma, S.E. Rush, C. Fournier. Mindfulness-based stress reduction: a meta-analysis. J Psychosom Res, 78 (6) (2015), pp. 519-528.

4. L. Haase, N.J.Thom, A. Shukla, P.W. Davenport, A.N. Simmons, E.A. Stanley, D.C. Johnson. Mindfulness-based training attenuates insula response to an aversive interoceptive challenge. Soc Cogn Affect Neurosci, 11 (1) (2014), pp. 182-190.

5. T. Jacob, E.B. Itchak, O. Raz. Stress among healthcare students – a cross disciplinary perspective. Physiother Theory Pract, 29 (5) (2012), pp. 401-412.

6. N.A. Yaghmour, T.P. Brigham, T. Richter, R.S. Miller, I. Philibert, D.C. Baldwin, T.J. Nasca. Causes of death of residents in ACGME-accredited programs 2000- 2014: implications for the learning environment. Acad Med, 92 (7) (2017), pp. 976-983.

7. S. Sen, H.R. Kranzler, J.H. Krystal, H. Speller, G. Chan, J. Gelernter, C. Guille. A prospective cohort study investigating factors associated with depression during medical internship. Arch Gen Psychiatr, 67 (6) (2010), pp. 557-565.

8. R.A. Baer, G.T. Smith, J. Hopkins, J. Krietemeyer, L. Toney. Using self-report assessment methods to explore facets of mindfulness. Assessment, 13 (1) (2006), pp. 27-45.

9. S. Cohen, T. Kamarck, R. Mermelstein. A global measure of perceived stress. J Health Soc Behav, 24 (4) (1983), pp. 385-396.

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