MBCARE, a mindfulness- and self-compassion-based intervention to decrease burnout and promote self-compassion in health care providers

Abstract

Background

Mindfulness and compassion training have individually shown significant effects on health care professionals’ (HCPs’) skills, reducing stress, anxiety, and burnout. This study evaluated the impact of a combined mindfulness and self-compassion intervention on HCPs’ wellness.

Methods

Seventeen nurses and doctors at a teaching university hospital in France volunteered for the Mindfulness-Based Compassion and Resilience Enhancement (MBCARE) program, a four-week mindfulness and self-compassion training delivered in eight three-hour sessions over four days (one day per week), with 100% attendance. We collected primary data (mindfulness skills, burnout scores, self-compassion, and emotional coping via face-reader evaluations) before and after the intervention.

Results

MBCARE was associated with reduced burnout, with emotional exhaustion scores decreasing (MΔ = -4.27, t = 1.95, p = .04) and personal accomplishment scores increasing (MΔ = 2.73, z = 2.48, p = .007) among 12 health care professionals. Patient-perceived centeredness of care showed a ceiling effect, with no significant changes. In a socio-affective video task (n = 7), positive affect increased post-training (p < .05), while negative affect remained stable. Time and availability constraints limited participation, but the program was feasible. Professional contextualization may support skill application, potentially improving emotional regulation and self-compassion, though further research is needed to confirm these effects.

Conclusions

Implementing mindfulness and compassion training for HCPs faces time and availability constraints but meets their needs. Contextualizing the training to professional settings enhances HCPs’ ability to apply new skills, yielding benefits in emotional stability and self-compassion.

Background

Physician burnout, a work-related syndrome involving emotional exhaustion, depersonalization, and reduced personal accomplishment, has reached epidemic levels worldwide. Despite definitional debates, burnout pervades health care providers (HCPs), affecting physicians, nurses, pharmacists, and students through stress, detachment, and poor job satisfaction. The SARS-CoV- 2 pandemic exacerbated these issues, unlike in fields like the military, where stress resilience training is standard.

In France, burnout rates range from 38 to 52% among physicians and 21% among nurses with five years’ experience [1, 2]. Burnout correlates with sleep deprivation, increased medical errors, and poorer care quality. A meta-analysis of 47 studies on 42,473 physicians found burnout doubles the odds of unsafe care, unprofessional behavior, and low patient satisfaction [3], a trend also observed in nurses.

Patient-centered care, emphasizing patients’ values, needs, and desires, relies on effective communication, partnership, and health promotion, yielding benefits like improved satisfaction and fewer diagnostic tests. Its five components—biopsychosocial perspective, patient-as-person, shared power, therapeutic alliance, and doctor-as-person—require training and HCP wellness. However, delivering such care demands emotional resilience and empathy, qualities eroded by burnout, suggesting a need for interventions like mindfulness training to support both HCP well-being and patient care quality.

Mindfulness-Based Compassion and Resilience Enhancement program (MBCARE), is a training combining mindfulness and self-compassion contextualized for professional settings, as has been proposed (as a tailored intervention for HCPs) in our previous article [4]. This program characterizes by a combination of exercises and approaches based on the Mindfulness Based Stress Reduction Program and the Self Compassion program.

Mindfulness-Based Stress Reduction (MBSR), developed by Kabat-Zinn in the 1970 s, enhances well-being, reduces stress, and boosts empathy among HCPs [9]. Self-compassion, defined as treating oneself with kindness, recognizing shared human struggles, and maintaining mindful awareness during distress [6], reduces anxiety and increases life satisfaction. Combining mindfulness, which enhances present-moment awareness and stress reduction, with self-compassion, which fosters emotional resilience and self-care, addresses both external pressures (e.g., patient suffering) and internal challenges (e.g., self-criticism under stress). This dual approach aims to reduce burnout while enhancing patient-centered care, a synergy not fully captured by standalone interventions. Given the high burnout rates among French HCPs (38%–52% for physicians, 21% for nurses), we selected MBCARE to address both burnout and patient-centered care in a single intervention. While mindfulness-based programs like MBSR are widely studied, MBCARE’s unique integration of self-compassion and professional contextualization remains underexplored, particularly among HCPs in academic hospitals. This study is, to our knowledge, the first to evaluate MBCARE’s impact in this setting.

Methods

This study investigated the Mindfulness-Based Compassion and Resilience Enhancement (MBCARE) program’s impact on volunteering HCPs. Participants were recruited via a newsletter from Assistance Publique-Hôpitaux de Paris, advertising mental training to reduce stress and improve care quality. All provided informed consent for the associated research, unaware of specific content until pre-testing. The program was free, offered at an academic teaching hospital in Paris, France, with an information session outlining content and evaluation methods.

Participant selection

Participants were included if they were HCPs (nurses, doctors, or other staff) at Assistance Publique-Hôpitaux de Paris, volunteered via the newsletter, and confirmed availability for all four sessions. Exclusion criteria included prior experience with mindfulness or compassion training, current psychiatric conditions, addictions, or use of psychiatric medications, assessed during pre-training interviews.

Twenty-three applicants were enrolled (17 nurses/doctors, 6 other HCPs), with no dropouts. For homogeneity, only nurses and doctors (n = 17) were analyzed; of these, 12 completed all questionnaires due to time constraints, and 7 participated in the Socio-Affective Video Task (SOVT) based on availability. See Fig. 1 for a recruitment flowchart.

Fig. 1

Flowchart of the participants included in the study

Intervention

The MBCARE program was a four-week intervention consisting of eight three-hour sessions delivered over four days (one day per week, totaling 24 h), supplemented by 30 min of daily guided meditation. Two groups were trained based on availability: Group 1 (May 22, 29, June 5, 12, 2018) and Group 2 (June 8, 15, 22, 29, 2018). Built on MBSR, MBCARE incorporated Mindfulness-Based Self-Compassion and Compassion-Focused Therapy, contextualized for HCP stressors [4]. Three teachers, each with over 10 years of personal mindfulness practice and certified in MBSR or Mindfulness-Based Cognitive Therapy (MBCT), delivered the program in pairs, uninvolved in the research.

Measures

Participants (n = 12) completed pre- and post-intervention questionnaires:

• Burnout: Maslach Burnout Inventory–Human Service Survey (French version; within-subject design), assessing emotional exhaustion and personal accomplishment (depersonalization omitted due to poor internal consistency).

• Mindfulness: Five Facets Mindfulness Questionnaire French version; [23]

• Self-Compassion: Self-Compassion Scale (French version) CC BY 4.0, 26 items across six subscales [24].

• Patient-Centeredness: Consultation Care Measure [21] completed by patients pre- and post-program (between-subjects design), translated and back-translated from French.

• Emotional Coping: SOVT [8] exposed 7 HCPs to high- and low-emotion videos (10–18 s) (Logitech Brio Ultra HD4 K, 30 cm distance, 5–30 frames/s, 1920 × 1080). Facial expressions were coded using FaceReader software (Noldus), which automatically analyzes video frames for valence (positive/negative affect) and arousal based on the ‘Western’ model with continuous calibration. To mitigate practice effects from repeated video exposure, pre- and post-training sessions were spaced one month apart, and participants were not informed of the repetition until after the study.”

Ethical approval was granted by the INSEAD-Sorbonne University Behavioral Lab Ethics Committee (April 6, 2018), adhering to the Declaration of Helsinki and French data protection laws.

Results

Effects of the MBCARE program on burnout

Emotional exhaustion scores decreased post-MBCARE (M = 20.91, SD = 9.26 pre-training; M = 16.64, SD = 9.36 post-training; t(11) = 1.95, p = 0.04), with two participants previously at high risk (> 30) no longer meeting this threshold. Personal accomplishment scores increased (M = 40.00, SD = 4.73 pre-training; M = 42.73, SD = 4.73 post-training; z = 2.48, p = 0.007), with two participants previously at high risk (< 33) no longer meeting this threshold. These findings are based on 12 participants who completed all questionnaires, and no control group was included (Table 1).

Table 1 Effects of MBCARE on burnout

Effects on patient-centered relationships

High mean scores across all Consultation Care Measure dimensions showed a ceiling effect, with no significant changes (Table 2).

Table 2 Effects on patient-centered relationships

Effects on mindfulness skills

No significant change was observed in Five Facets Mindfulness Questionnaire scores (Table 3).

Table 3 Effects on mindfulness skills

Effects on self-compassion skills

Self-compassion scores increased significantly post-training (p < 0.05; Table 4).

Table 4 Effects on self-compassion

Effects on emotional coping

In the Socio-Affective Video Task (n = 7), positive affect scores increased post-training (M = 4.65, SD = 4.42 pre-training; M = 10.97, SD = 10.89 post-training; p < 0.05), while negative affect scores showed no change (M = 57.65, SD = 27.83 pre-training; M = 60.21, SD = 15.22 post-training; p = NS) (Table 5). A mixed-model ANOVA indicated a stimulus × order effect on valence (F(1,3) = 41.78, p = 0.007, η² = 0.93), suggesting more positive emotional responses post-training. These results are preliminary due to the small subsample and lack of a control condition (Fig. 2).

Table 5 Effects on emotional coping

Fig. 2

Changes in valence composite scores before and after MBCARE training: Pre-training (M = − 0.0055, SD = 0.19) and Post-training (M = 0.080, SD = 0.24), based on Socio-Affective Video Task (n = 7). Error bars reflect standard deviations, and results should be interpreted cautiously due to the small subsample

Discussion

This study suggests that the Mindfulness-Based Compassion and Resilience Enhancement (MBCARE) program is feasible and may contribute to reducing burnout and enhancing self-compassion and emotional coping among health care professionals (HCPs) in a hospital setting. The observed reduction in emotional exhaustion (MΔ = − 4.27, p = 0.04) and increase in personal accomplishment (MΔ = 2.73, p = 0.007) align with prior mindfulness-based interventions [5], though the small sample (n = 12 for questionnaires, n = 7 for SOVT) and absence of a control group limit causal inferences. The increase in positive affect during the Socio-Affective Video Task (p < 0.05) is consistent with compassion training effects [8], but requires validation with larger samples. The lack of improvement in mindfulness skills (p = NS) may reflect the program’s brief four-week duration, suggesting a longer intervention could yield broader effects. MBCARE’s contextualization to professional scenarios likely supported skill application, as participants reported using techniques in workplace challenges, though this anecdotal feedback warrants systematic evaluation. Given the small scale and preliminary nature of these findings, MBCARE shows potential as an intervention for HCPs, but its efficacy and scalability require further investigation.

The contextualization of MBCARE’s meditation exercises to professional scenarios (e.g., patient-caregiver conflicts, inter-staff tensions) likely facilitated skill transfer, distinguishing it from generic MBSR programs. This approach may enhance ecological validity, as HCPs reported applying techniques directly to workplace challenges, a finding consistent with Lamothe et al. [10], who noted contextualized mindfulness training improved nurses’ job satisfaction more than standard protocols (p < 0.05). The absence of adverse events, likely due to expert instructors and pre-screening, aligns with Goodman and Schorling [11], who found no significant side effects in mindfulness interventions for HCPs when delivered by experienced facilitators. However, time constraints—highlighted by participants’ limited availability—suggest a longer format could deepen mindfulness benefits, as seen in West et al. [12], where a 10-week intervention yielded greater stress reduction (ΔM = − 6.8) than shorter programs. MBCARE’s significant self-compassion gains (ΔM = 19.98, p < 0.05) may reflect its emphasis on self-kindness, a mechanism [5, 12] links to reduced self-criticism and improved resilience under stress. This could explain the increased positive affect in SOVT, as self-compassion may reframe emotional responses to others’ suffering, reducing empathic distress—a common burnout precursor [14]. As holistic care gains traction globally, integrating such mind–body skills into HCP training could enhance both provider well-being and patient outcomes, a shift supported by Epstein and Street [15], who advocate for clinician self-awareness as a cornerstone of patient-centered care.

Despite these strengths, MBCARE’s brief duration and small sample highlight areas for refinement. The lack of mindfulness skill improvement contrasts with longer interventions like Cohen-Katz et al. [16], where an eight-week MBSR program for nurses increased mindfulness scores by 12 points (p < 0.001), suggesting that extending MBCARE to 8–10 weeks could yield broader benefits. The significant emotional coping findings, however, align with Singer and Klimecki [17], who propose that compassion training shifts affective responses from distress to prosocial motivation, a mechanism potentially amplified by MBCARE’s professional focus. This study’s ceiling effect in patient-centeredness scores (Table 2) mirrors Stewart et al. [18], where high baseline patient satisfaction limited detectable change, indicating a need for more sensitive measures in future trials. The absence of a control group and reliance on self-selected volunteers further temper conclusions, as motivated participants may overestimate benefits—a bias noted in mindfulness research by Baer [22]. Nonetheless, MBCARE’s feasibility in a real-world hospital setting, coupled with its burnout reduction, supports its potential scalability. Future research could explore its mechanisms (e.g., via neuroimaging, as in Desbordes et al., 20) and test it across diverse HCP populations, such as rural practitioners or non-clinical staff, to broaden its impact.

Limitations

This study has several limitations that constrain its findings. The small sample (n = 17 nurses/doctors, with n = 12 for questionnaires and n = 7 for the Socio-Affective Video Task) limits statistical power and generalizability to broader HCP populations. The absence of a control group prevents definitive attribution of outcomes to MBCARE, as observed changes could reflect placebo effects, regression to the mean, or external factors. Self-selected volunteers, recruited via a newsletter, may have been more motivated or predisposed to mindfulness practices, potentially inflating perceived benefits—a bias common in mindfulness research [22]. The four-week duration, shorter than standard eight-week programs like MBSR, likely limited mindfulness skill development, as evidenced by non-significant changes in mindfulness scores. The one-month follow-up may not capture sustained effects or detect delayed benefits, such as improved patient outcomes. Additionally, the ceiling effect in patient-centeredness scores suggests the measure may lack sensitivity to detect subtle changes in this context, and the reliance on self-reports for most outcomes risks response bias. These constraints highlight the preliminary nature of the findings and the need for caution in interpreting MBCARE’s impact.

Future directions

Larger, controlled trials should confirm MBCARE’s efficacy, extend follow-up to assess long-term impacts, and test its applicability across diverse HCP roles and settings.

Conclusion

Burnout among health care professionals (HCPs) underscores the need for effective interventions, and the Mindfulness-Based Compassion and Resilience Enhancement (MBCARE) program offers a potential approach. This study suggests that a brief, contextualized mindfulness and self-compassion training may help reduce emotional exhaustion (p = 0.04), increase personal accomplishment (p = 0.007), and support emotional resilience when confronting others’ suffering (p < 0.05) among a small group of HCPs (n = 12–17). However, the small sample, lack of a control group, and short duration limit the ability to draw definitive conclusions about its efficacy. MBCARE’s professional focus may facilitate skill application, but broader validation is needed to confirm its impact. By fostering tools to navigate workplace stress, MBCARE could contribute to HCP well-being and patient care, pending further research to establish its scalability and long-term effects.

While further refinement and broader validation are warranted, this work lays a foundation for a future where caregiver well-being is as sacrosanct as patient care—a vision where resilience and compassion, cultivated within, radiate outward to heal both healer and healed.