The Selah pilot study of spiritual, mindfulness, and stress inoculation practices on stress-related outcomes: A non-randomized participant preference control pilot study

Background The job-demand-control-support model indicates that clergy are at high risk for chronic stress and adverse health outcomes. Methods A non-randomized participant preference design with a control group was used to evaluate the feasibility, acceptability, and range of outcome effect sizes for four potentially stress-reducing interventions: stress inoculation training, mindfulness-based stress reduction (MBSR), the Daily Examen, and Centering Prayer. All United Methodist clergy in North Carolina were eligible and recruited via email to attend their preferred intervention: in-person workshops of one (Daily Examen, Centering Prayer) or two days (stress inoculation training) at retreat centers, or eight weekly online 90-minute sessions (MBSR). Surveys at 0, 3, and 12 weeks assessed symptoms of stress, anxiety, and perceived stress reactivity. Heart rate variability was assessed at baseline and 12 weeks using data from 24h ambulatory heart rate monitoring. A patched-up control group was recruited after recruitment commenced. A subset of participants completed in-depth interviews and reported skill practice using daily text messages. Standardized mean differences with 95% and 75% confidence intervals were calculated for each intervention relative to control to determine the range of effect sizes likely to be observed in a definitive trial. Results 78 clergy participated in an intervention and 7 provided data as a control group. The daily percentage of participants engaging in stress management practices ranged from 47% (MBSR) to 69% (Examen). Every participant interviewed (n=23) reported that learning content was acceptable and they would recommend their intervention to others. Small-to-large effect sizes on measures of stress and anxiety were observed for Daily Examen, stress inoculation, and MBSR relative to control. Little evidence for change in HRV was observed between intervention and control, with the most favorable effects observed for MBSR. Results were mixed for Centering Prayer. Conclusions All four interventions were feasible and acceptable, with the best trends in outcomes for MBSR, although other interventions were promising. Participants welcomed daily text messages reminding them to engage in practice and wore ambulatory heart rate monitoring devices without incident. Three-week survey data did not contribute to study findings. Trial registration: ClinicalTrials.gov trial registration number: NCT04625777, November 12, 2020 (retrospectively registered).