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Mindfulness app may help address physician anxiety, burnout

Mindfulness app may help address physician anxiety, burnout

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Credit: Brown University

PROVIDENCE, R.I. [Brown University] — As novel coronavirus cases continue to increase across the nation, health professionals on the front lines face frightening realities, rising anxiety and the very real potential for burnout.

“Health care providers are under tremendous pressure right now,” said Dr. Jud Brewer, director of research and innovation at the Mindfulness Center at Brown University. “Physician burnout was already reaching ‘epidemic’ proportions before this pandemic hit.”

In fact, a 2014 study found that nearly half of all physicians experience significant symptoms of burnout, and further research suggests that the risk is particularly high for those who perceive that they aren’t in control of what unfolds around them. Theoretically, this perceived lack of control leads to anxiety, which can then lead to burnout.

Brewer and his colleagues worked to address these conditions with a smartphone-app mindfulness training program called Unwinding Anxiety. They examined the app’s effects in a pilot study of 34 physicians, which appeared in JMIR mHealth and uHealth on Wednesday, April 1. The study was the first to test the effectiveness of an app-based mindfulness program as an intervention for anxiety in physicians.

“Clinicians need effective tools to help them reduce anxiety and burnout,” Brewer said. “Digital therapeutics are an ideal solution because people can use them in small doses, at home, on their own schedule. The app-based mindfulness training that we studied does just that: It provides short daily trainings — about 10 minutes per day — that people can access from their smartphone, and it gives them tools they can use throughout the day.”

The app aimed to reduce anxiety by helping users recognize maladaptive thought patterns and become less reactive to anxious thoughts. And it worked. Three months after using the app for 30 days, participants exhibited a 57% decrease in anxiety scores.

Brewer and his colleagues also found clear links between anxiety and certain aspects of burnout — cynicism and emotional exhaustion — which suggests that the app could effectively treat burnout as well. Sure enough, at the three-month follow-up, participants exhibited a 50% decrease in cynicism and a 20% decrease in emotional exhaustion.

“These results provide clear implications that this mindfulness-based digital therapeutic may be a useful tool for busy clinicians to both reduce anxiety and help build resilience against getting burnt out,” Brewer said.

He and his colleagues are already at work on the next steps: a randomized controlled trial of app-based mindfulness training for broader populations.

“The pharmaceutical industry hasn’t released any new anti-anxiety medications in decades and to my knowledge has no new drugs in the pipeline,” he said. “We need effective treatments, especially those that can be widely disseminated at low cost. Digital therapeutics, like app-based treatments, are the next wave of treatment.”

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Brewer owns stock in the company that developed and sells the mindfulness-based app, a point fully disclosed in the study. Another Brown University author on the study was Alexandra Roy, and additional contributors were Susan Druker from the University of Massachusetts and Dr. Elizabeth A. Hoge from Georgetown University.

The study was supported by a Carl Akins Risk Management grant from the University of Massachusetts Memorial Medical Group.

This news story was authored by contributing science writer Kerry Benson.

Media Contact
Kevin Stacey
kevin_stacey@brown.edu

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https://www.brown.edu/news/2020-04-01/burnout

Related Journal Article

http://dx.doi.org/10.2196/15608

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One city held a mass passport-getting event

A New Orleans congressman organized a way for people to apply for their passports en masse.

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While the number of Americans who do not have a passport has dropped steadily from more than 80% in 1990 to just over 50% now, a lack of knowledge around passport requirements still keeps a significant portion of the population away from international travel.

Over the four years that passed since the start of covid-19, passport offices have also been dealing with significant backlog due to the high numbers of people who were looking to get a passport post-pandemic. 

Related: Here is why it is (still) taking forever to get a passport

To deal with these concurrent issues, the U.S. State Department recently held a mass passport-getting event in the city of New Orleans. Called the "Passport Acceptance Event," the gathering was held at a local auditorium and invited residents of Louisiana’s 2nd Congressional District to complete a passport application on-site with the help of staff and government workers.

A passport case shows the seal featured on American passports.

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'Come apply for your passport, no appointment is required'

"Hey #LA02," Rep. Troy A. Carter Sr. (D-LA), whose office co-hosted the event alongside the city of New Orleans, wrote to his followers on Instagram  (META) . "My office is providing passport services at our #PassportAcceptance event. Come apply for your passport, no appointment is required."

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The event was held on March 14 from 10 a.m. to 1 p.m. While it was designed for those who are already eligible for U.S. citizenship rather than as a way to help non-citizens with immigration questions, it helped those completing the application for the first time fill out forms and make sure they have the photographs and identity documents they need. The passport offices in New Orleans where one would normally have to bring already-completed forms have also been dealing with lines and would require one to book spots weeks in advance.

These are the countries with the highest-ranking passports in 2024

According to Carter Sr.'s communications team, those who submitted their passport application at the event also received expedited processing of two to three weeks (according to the State Department's website, times for regular processing are currently six to eight weeks).

While Carter Sr.'s office has not released the numbers of people who applied for a passport on March 14, photos from the event show that many took advantage of the opportunity to apply for a passport in a group setting and get expedited processing.

Every couple of months, a new ranking agency puts together a list of the most and least powerful passports in the world based on factors such as visa-free travel and opportunities for cross-border business.

In January, global citizenship and financial advisory firm Arton Capital identified United Arab Emirates as having the most powerful passport in 2024. While the United States topped the list of one such ranking in 2014, worsening relations with a number of countries as well as stricter immigration rules even as other countries have taken strides to create opportunities for investors and digital nomads caused the American passport to slip in recent years.

A UAE passport grants holders visa-free or visa-on-arrival access to 180 of the world’s 198 countries (this calculation includes disputed territories such as Kosovo and Western Sahara) while Americans currently have the same access to 151 countries.

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Fast-food chain closes restaurants after Chapter 11 bankruptcy

Several major fast-food chains recently have struggled to keep restaurants open.

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Competition in the fast-food space has been brutal as operators deal with inflation, consumers who are worried about the economy and their jobs and, in recent months, the falling cost of eating at home. 

Add in that many fast-food chains took on more debt during the covid pandemic and that labor costs are rising, and you have a perfect storm of problems. 

It's a situation where Restaurant Brands International (QSR) has suffered as much as any company.  

Related: Wendy's menu drops a fan favorite item, adds something new

Three major Burger King franchise operators filed for bankruptcy in 2023, and the chain saw hundreds of stores close. It also saw multiple Popeyes franchisees move into bankruptcy, with dozens of locations closing.

RBI also stepped in and purchased one of its key franchisees.

"Carrols is the largest Burger King franchisee in the United States today, operating 1,022 Burger King restaurants in 23 states that generated approximately $1.8 billion of system sales during the 12 months ended Sept. 30, 2023," RBI said in a news release. Carrols also owns and operates 60 Popeyes restaurants in six states." 

The multichain company made the move after two of its large franchisees, Premier Kings and Meridian, saw multiple locations not purchased when they reached auction after Chapter 11 bankruptcy filings. In that case, RBI bought select locations but allowed others to close.

Burger King lost hundreds of restaurants in 2023.

Image source: Chen Jianli/Xinhua via Getty

Another fast-food chain faces bankruptcy problems

Bojangles may not be as big a name as Burger King or Popeye's, but it's a popular chain with more than 800 restaurants in eight states.

"Bojangles is a Carolina-born restaurant chain specializing in craveable Southern chicken, biscuits and tea made fresh daily from real recipes, and with a friendly smile," the chain says on its website. "Founded in 1977 as a single location in Charlotte, our beloved brand continues to grow nationwide."

Like RBI, Bojangles uses a franchise model, which makes it dependent on the financial health of its operators. The company ultimately saw all its Maryland locations close due to the financial situation of one of its franchisees.

Unlike. RBI, Bojangles is not public — it was taken private by Durational Capital Management LP and Jordan Co. in 2018 — which means the company does not disclose its financial information to the public. 

That makes it hard to know whether overall softness for the brand contributed to the chain seeing its five Maryland locations after a Chapter 11 bankruptcy filing.

Bojangles has a messy bankruptcy situation

Even though the locations still appear on the Bojangles website, they have been shuttered since late 2023. The locations were operated by Salim Kakakhail and Yavir Akbar Durranni. The partners operated under a variety of LLCs, including ABS Network, according to local news channel WUSA9

The station reported that the owners face a state investigation over complaints of wage theft and fraudulent W2s. In November Durranni and ABS Network filed for bankruptcy in New Jersey, WUSA9 reported.

"Not only do former employees say these men owe them money, WUSA9 learned the former owners owe the state, too, and have over $69,000 in back property taxes."

Former employees also say that the restaurant would regularly purchase fried chicken from Popeyes and Safeway when it ran out in their stores, the station reported. 

Bojangles sent the station a comment on the situation.

"The franchisee is no longer in the Bojangles system," the company said. "However, it is important to note in your coverage that franchisees are independent business owners who are licensed to operate a brand but have autonomy over many aspects of their business, including hiring employees and payroll responsibilities."

Kakakhail and Durranni did not respond to multiple requests for comment from WUSA9.

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Industrial Production Increased 0.1% in February

From the Fed: Industrial Production and Capacity Utilization
Industrial production edged up 0.1 percent in February after declining 0.5 percent in January. In February, the output of manufacturing rose 0.8 percent and the index for mining climbed 2.2 p…

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From the Fed: Industrial Production and Capacity Utilization
Industrial production edged up 0.1 percent in February after declining 0.5 percent in January. In February, the output of manufacturing rose 0.8 percent and the index for mining climbed 2.2 percent. Both gains partly reflected recoveries from weather-related declines in January. The index for utilities fell 7.5 percent in February because of warmer-than-typical temperatures. At 102.3 percent of its 2017 average, total industrial production in February was 0.2 percent below its year-earlier level. Capacity utilization for the industrial sector remained at 78.3 percent in February, a rate that is 1.3 percentage points below its long-run (1972–2023) average.
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Click on graph for larger image.

This graph shows Capacity Utilization. This series is up from the record low set in April 2020, and above the level in February 2020 (pre-pandemic).

Capacity utilization at 78.3% is 1.3% below the average from 1972 to 2022.  This was below consensus expectations.

Note: y-axis doesn't start at zero to better show the change.


Industrial Production The second graph shows industrial production since 1967.

Industrial production increased to 102.3. This is above the pre-pandemic level.

Industrial production was above consensus expectations.

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