The Selah trial: A preference-based partially randomized waitlist control study of three stress management interventions

Abstract

ABSTRACTObjectiveChronic stress can undermine psychological and physiological health. We sought to evaluate three stress management interventions among clergy, accounting for intervention preferences.MethodsUnited Methodist clergy in North Carolina enrolled in a partially randomized, preference-based waitlist control trial. The interventions were: mindfulness-based stress reduction (MBSR), Daily Examen prayer practice, and Stress Proofing (stress inoculation plus breathing skills). The intervention period spanned 12 weeks with a 12-week follow-up. Daily text message data were collected to assess practice across the 24 weeks. Co-primary outcomes were symptoms of stress using the Calgary Symptoms of Stress Inventory and 48-hour ambulatory heart rate variability (HRV) at 12-weeks post-intervention compared to waitlist control. Survey data were collected at 0, 12 and 24 weeks, with HRV collected at 0 and 12 weeks.Results255 participants (mean age=54 years old; 91% white; 48% female) were randomized and initiated an intervention (n=184) or waitlist control (n=71). Compared to waitlist control, lower stress symptoms were found for MBSR participants [Mean Difference (MD)=-0.30, 95% CI:-0.41,-0.20;p<.001] and Stress Proofing (MD=-0.27, 95% CI:-0.40,-0.14;p<.001) at 12 weeks, and Daily Examen participants not until 24 weeks (MD=-0.24, 95% CI:-0.41,-0.08). Only MBSR participants demonstrated improvement in HRV at 12 weeks (MD=+3.32 millisecond; 95% CI:0.21,6.44;p=.036).ConclusionsMBSR demonstrated robust improvement in self-reported and objective physical correlates of stress whereas Stress Proofing and Daily Examen resulted in improvements in self-reported correlates of stress only. These brief practices were sustainable and beneficial for an occupational sample during the COVID pandemic.RegistrationClinicalTrials.govidentifier:NCT04625777(https://clinicaltrials.gov/ct2/show/NCT04625777)