Nature-Based + Virtual Mindfulness for Stress in Healthcare Workers

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: National Institutes of Health Clinical Center (CC)

Disqualifiers: Acute psychiatric condition, Hearing impairment

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 14

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores ways to help healthcare workers who care for COVID-19 patients manage stress and improve resilience. It tests whether combining nature activities with virtual mindfulness exercises (Nature+Mindfulness) is more effective than nature activities alone (Nature Only). Participants will be divided into three groups to determine which approach works best. Healthcare workers who regularly work with COVID-19 patients and have access to online resources might be a good fit for this trial. As an unphased trial, this study offers participants the chance to contribute to innovative research aimed at enhancing mental well-being for healthcare professionals.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research has shown that combining activities in nature with online mindfulness exercises can lower stress and boost well-being, particularly for healthcare workers. One study found this method easy for participants to manage, resulting in reduced stress levels. Another study on mindfulness techniques also found these practices safe and effective in reducing burnout and work-related stress.

Activities such as hiking and biking in nature have improved mental health without major side effects. Mindfulness, which includes exercises like deep breathing and meditation, is also safe and helps manage stress. Overall, these methods are considered safe for most people, with no major side effects reported in the studies. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about these treatments because they combine nature-based activities with virtual mindfulness to address stress in healthcare workers in a novel way. Traditional treatments for stress, like medication and in-person therapy, often focus on mental exercises or pharmacological interventions alone. However, the Nature+Mindfulness approach integrates outdoor activities like hiking and kayaking with online mindfulness practices such as mindful breathing and body scans. This combination not only enhances mental health through mindfulness exercises but also leverages the therapeutic effects of nature, which can improve psychosocial health and foster supportive peer relationships. By offering these interventions online and locally, it provides accessible, flexible options for healthcare workers across the United States.

What evidence suggests that this trial's treatments could be effective for reducing stress in healthcare workers?

Research has shown that combining activities in nature with mindfulness practices effectively reduces stress and improves mental well-being. In this trial, participants in the Nature+Mindfulness arm will experience this combined approach. Studies have found that mindfulness-based stress reduction lowers anxiety, depression, and stress levels in healthcare workers. A recent study suggested that pairing nature experiences with audio mindfulness sessions could further enhance stress relief and improve overall mental health. Participants in the Nature Only arm will engage in nature-based activities without the mindfulness component. Other research highlights that mindfulness techniques effectively reduce burnout and work-related stress. These findings suggest that the combined Nature+Mindfulness approach may help healthcare workers manage stress more effectively. ^{1 4 6 7 8}

Who Is on the Research Team?

Ann Berger, MD

Principal Investigator

National Institutes of Health (NIH)

Are You a Good Fit for This Trial?

This trial is for healthcare workers over 18 who treat COVID-19 patients and can consent to participate. They must be fluent in English, have online access for study materials, and not have acute psychiatric conditions or unaided hearing impairments.

Inclusion Criteria

Is fluent in English

You are currently having a mental health crisis.

You are a healthcare worker who takes care of patients with COVID-19.

Exclusion Criteria

You have trouble hearing, even with the help of hearing aids or devices.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Nature-based Intervention

Participants engage in a three-day nature-based intervention including activities such as hiking, mountain-biking, and kayaking

1 week

3 days (in-person)

Virtual Mindfulness Intervention

Participants complete a 10-day virtual mindfulness intervention with daily exercises such as mindful breathing, body scan, and loving-kindness meditation

2 weeks

10 sessions (virtual)

Follow-up

Participants are monitored for stress-related symptoms and psychological resilience

8 weeks

1 visit (in-person or virtual)

What Are the Treatments Tested in This Trial?

Interventions

• Nature+Mindfulness
• Nature Only

Trial Overview The trial tests if nature-based activities combined with virtual mindfulness reduce stress more effectively than just nature activities or no intervention. Ninety participants will be randomly assigned to one of three groups and assessed over approximately 11 weeks.

How Is the Trial Designed?

Group I: Nature+Mindfulness Experimental Treatment 1 Intervention

In the combined nature-based and virtual mindfulness intervention, participants will complete the nature intervention followed by the mindfulness intervention. The virtual mindfulness intervention is 10 days long and offered online. Each day the participant will receive a notification that a new mindfulness audio is ready for viewing, which is from 10 to 25 minutes long. Mindfulness exercises include mindful breathing, body scan, and loving-kindness meditation. Participants can view the daily audio as many times as they wish but cannot view the next day's content to maintain treatment fidelity. At the end of each day, participants will be asked to indicate if they viewed the mindfulness audio to track adherence.

Group II: Nature Only Active Control 1 Intervention

The nature-based intervention is three days long, is offered at various locations throughout the United States, and includes activities such as hiking, mountain-biking, and kayaking. The healthcare workers can participate in the programs that are offered locally pending availability. Each program will enroll between 15 and 30 healthcare workers. All First Descents nature-based interventions have been intentionally designed with input from more than 450 hospital partners nationwide to improve psychosocial health, nurture supportive peer relationships, and better position healthcare workers to carry out their critical mission. There is no cost to attend, and meals and lodging are included. Special precautions against SARS-CoV-2 transmission are implemented.

Group III: Control Active Control 1 Intervention

The control group will complete the first three assessments similar to the two treatment groups but will not participate in the nature-based or virtual mindfulness interventions. At the end of their study participation (\~week 3), they will be offered the opportunity to partake in the nature-based and virtual mindfulness interventions.

Who Is Running the Clinical Trial?

National Institutes of Health Clinical Center (CC)

Lead Sponsor

Trials

391

Recruited

30,880,000+

Published Research Related to This Trial

A mindfulness-based training program called Focusing significantly reduced perceived stress among 20 healthcare workers, with stress levels decreasing from an average of 21.4 to 17.5 after the intervention (P=0.0195).

Participants reported qualitative improvements such as increased calmness, better emotional self-regulation, and enhanced coping skills, indicating that the training effectively helped them manage work-related stress.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The educational intervention "Focusing" as a strategy to stress reduction among health care workers: a pilot study in an Italian teaching hospital. Rinaldi, A., Tecchio, R., Perugino, S., et al.[2020]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC7511255/

The Effectiveness of Mindfulness-Based Stress Reduction ... The reviewed literature suggested that MBSR was effective in reducing HCPs experiences of anxiety, depression and stress.

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12105617/

Effects of a combined nature-based and audio ... The present study proposes to combine a nature-based program with an audio-based mindfulness intervention to address stress and promote psychosocial-spiritual ...

3. nature.com nature.com/articles/s41598-023-35483-z

Improving stress management, anxiety, and mental well ... Empirical research shows that mindfulness-based therapies can reduce stress and anxiety, as well as psychological distress, chronic pain, and ...

4. bmcnurs.biomedcentral.com bmcnurs.biomedcentral.com/articles/10.1186/s12912-025-03507-w

A systematic review of mindfulness-based interventions to ... This review aimed to evaluate the effectiveness of mindfulness-based interventions (MBIs) in mitigating burnout and occupational stress among ICU nurses.

5. greatergood.berkeley.edu greatergood.berkeley.edu/images/uploads/Shapiro-Mindfulness_on_Stress_Reduction_for_Health_Care_Professional.pdf

Mindfulness-Based Stress Reduction for Health Care ... Research demonstrates that mindfulness interventions can effectively reduce stress, anxiety, and depression in both clinical and nonclinical popu- lations ( ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11303674/

Health Workers' Mindfulness-Based Stress Reduction and ... This study proposed that mindfulness-based stress reduction and protecting mental health are important for health workers.

7. peerj.com peerj.com/articles/19109/

Effects of a combined nature-based and audio ... A combined nature-based and audio-based virtual mindfulness intervention on stress and wellbeing of COVID-19 healthcare workers: a randomized controlled trial

8. sciencedirect.com sciencedirect.com/science/article/pii/S2352827321002093

Nature-based outdoor activities for mental and physical ... NBIs, specifically gardening, green exercise and nature-based therapy, are effective for improving mental health outcomes in adults.