Benefits Column Comes to Work

Mindful living is one of the top 10 trends for 2014 and beyond -- and perhaps for good reason. New research has shown that mindfulness-based and therapeutic yoga programs can be effective interventions to target employees' high stress levels, sleep quality and stress response. So should HR professionals consider adding such  programs to their employee-benefits mix?

Monday, February 10, 2014
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I can't recall a time when I didn't know something about yoga and eastern philosophy -- enough to be dangerous, some would say. My early experience came from imitating my mom every weekday morning as she commandeered the family room to follow a television program called Yoga for Health.

Before you write me off as a navel-gazer, let me add I am a work in progress when it comes to mindfulness -- a focus on present-moment awareness without judgment. Friends who are relatively recent yoga devotees cluck their tongues when I freely admit I struggle with one aspect of a mindfulness practice: meditation. Every attempt I make to sit in solitude becomes a constant dance of shuttling thoughts out of my brain.

About nine months ago, a friend asked me to partake in an overnight mindfulness retreat so I could provide feedback to the executive director about my experience. That's where I met Cheryl Jones, an expert in mindfulness-based stress reduction as well as someone with extensive wellness training and a spirituality certificate. If I learned only one thing from Jones, it was that my morning ritual of 10 minutes of downward-facing dog was as much a meditation as my friends' seated practices. (Not only is yoga an acceptable mindfulness-meditation technique, so are standing, walking, lying down and, yes, sitting.)

Jones' reassurance came just in time, because it seems as though 2014 is the kick-off of the mindfulness era.

Since the last quarter, almost daily media releases seem to appear about mindfulness. In December 2013, JWT -- one of the world's largest marketing-communications brands -- forecasted "mindful living" as one of the "10 trends that will shape our world in 2014 and beyond." Quickly on the heels of that report, the Huffington Post ran an article indicating that FOMO (fear of missing out) was being replaced by a desire for JOMO (joy of missing out). It's not surprising the Huff Post jumped on this trend since Arianna Huffington has been addressing mindfulness meditation in forums that range from Squawk Box to the University of Virginia Health System's Contemplative Sciences Center.

On Jan. 6, 2014, a Johns Hopkins research group released, in JAMA Internal Medicine, a meta-analysis of studies that used meditation as a treatment to improve well-being. The authors assessed 47 published research reports that met their criteria of using randomized-clinical trials -- the gold standard of research. They examined whether meditation programs reduced psychological stress and improved stress-related outcomes, including substance use, eating habits, sleep, pain and weight.

The paper produced a range of conclusions. The researchers found moderate evidence that mindfulness- meditation programs improved levels of anxiety, depression and pain in subjects as compared with people in control groups. However, there was insufficient evidence to evaluate meditation's impact on stress-related behaviors such as substance use, sleep, nutrition and weight. And, while there was no evidence that meditation programs were better than any other active treatment approach such as drugs and exercise, it was an equivalent alternative. Mindfulness meditation used to treat depression, for example, had the same effect as antidepressants -- without the associated toxicities -- and that makes this methodology a reasonable and cost-effective alternate to pharmacologic intervention.

What finally pushed my fingers to the keyboard was an article announcing that Aetna's CEO Mark Bertolini was going to appear on a panel with actor Goldie Hawn on how mindful meditation should be applied to health, education and leadership at the World Economic Forum in Davos, Switzerland, on Jan. 23, 2014.

Bertolini is far from the first business leader who believes in and uses mindfulness meditation as a lifestyle strategy. Bill George, who sits on the boards at Goldman Sachs and Exxon Mobil, and News Corp Chairman Rupert Murdoch have publicly discussed practicing meditation.

In 2009, Bertolini inspired Aetna leaders to introduce mindfulness meditation to the company's employees. By 2010, the Hartford, Conn.-based health-insurance company kicked off a 12-week pilot with California- and Connecticut-based employees.

The outside researchers who assisted in the pilot randomized 239 employee volunteers into a therapeutic yoga worksite-stress-reduction program, one of two mindfulness-based programs (in-person or online), or a control group that participated only in an assessment.

Compared with the control group, the mind-body interventions showed statistically significant greater improvements on participants' perceived stress and sleep difficulties. Both the mindfulness and yoga interventions demonstrated significant improvements in heart-rhythm coherence, which is a measure of how the body handles stress.

What was most interesting was the online and in-person mindfulness programs produced essentially the same results.

The researchers concluded that both mindfulness-based and therapeutic yoga programs might be effective interventions to target employees' high stress levels, sleep quality and stress response.

Further, among all employees who were screened for the study, those reporting the highest stress level accrued nearly $2,000 more in medical costs (an aggregate number, including costs associated with emergency department visits and prescription-drug use) for the year before the study began than those reporting the lowest stress levels. It is not known yet whether the highly stressed employees' healthcare costs dropped compared with their pre-participation levels or the control group -- although there is a temptation to project that effect.

So should HR professionals consider adding mind-body programs to their employee-benefits offerings? Here are my initial thoughts:

·              I agree with JWT's projection concerning the population's growing desire for mindful living. If clothes make the person, take note that sales of yoga clothing and other activewear is the fastest-growing segment of the U.S. apparel industry. Even if we haven't fully embraced mindfulness meditation, we are dressing the part.

·              According to a 2012 survey conducted by the Society of Human Resource Management, the top two health conditions employees want to address are obesity and stress (along other mental-health issues.) In my experience, most employers pay scant attention to the problem of stress and defer to employee-assistance programs as a check-the-box solution -- despite poor utilization of this service. Mind-body programs specifically target stress resilience and are appealing to workers.

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·              Mindfulness meditation appears to be as effective as other therapies such as drugs and exercise in improving employees' abilities to reduce stress and sleep difficulties and improve participants' anxiety, depression and pain perceptions. The difference is that mind-body programs don't have the side effects associated with prescription-drug use and, unlike exercise programs, only require five to 15 minutes a day to achieve their outcomes.

·                     Online mind-body programs are as effective as in-person classes. This gives HR executives the ability to easily offer these programs to all employees, including those who work remotely. It also allows employees to tailor the programs to meet their needs and time demands.

·              Mindfulness meditation programs appear to work with people from all socioeconomic backgrounds. School-based meditation and yoga programs have been remarkably effective with at-risk youth.

·                     Adding mindfulness as an underlying component of a company's disease- and lifestyle- management programs may improve these initiatives' results.

Cheryl Jones, my mindfulness-retreat leader, also happens to be Aetna's wellness clinical program design lead. She has been vigilant in making mindfulness a driving force underneath all the company's programs. Aetna's Healthy Lifestyle coaches are trained in mindfulness and practice it in their own lives.

As a result of this focus, coaches help employees address what is important to them in the moment they are in. If employees identify that they are dealing with caregiving issues, the coaches talk the worker through how they can take care of themselves in these situations. Coaches may also refer employees to the employee-assistance programs and specialty coaches who can help them address specific, situation-related questions, such as finding assistive living services for employees' parents.

When all is said and done, mind-body programs seem to be at least as effective as lifestyle-management programs and bring benefits such as decreased stress and sleep challenges, and improved cardiac responses to stressful situations.

Researchers such as RAND Corp.'s Soeren Mattke indicate lifestyle-management programs do not decrease healthcare costs to nearly the same levels as disease-management programs. However, Mattke related on the CoHealth radio show I co-host that employees with chronic health conditions achieve even better results when they participate in both disease- and lifestyle-management initiatives.

Finally, as Mattke said and I agree, there are other reasons to offer lifestyle-management programs, including mind-body therapies, to your worksite. Mind-body curriculums will most likely please a growing portion of your employee population and improve your workers' perceptions of the workplace culture. And that may be an employer's greatest consideration of all.

Carol Harnett is a widely respected consultant, speaker, writer and trendspotter in the fields of employee benefits, health and productivity management, health and performance innovation, and value-based health. Follow her on Twitter via @carolharnett and on her video blog, The Work.Love.Play.Daily.


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