Archives of

1. Introduction
Known as a major source of stress, occupational stress has become a widespread and costly workplace problem. In recent years, the United Nations introduced it as the disease of the 20th century, and the World Health Organization recognized it as a widespread problem [1]. Occupational stress is an adverse reaction to the pressure and burden of work. In other words, it is a disequilibrium between workplace demands and the person’s adaptability [2,3]. Correlated with a global and national recession, the recent rise in occupational stress can cause physical and psychological disorders as well as mental complications and emotional distress in employees [4,5].
Repeated interactions with clients can emotionally exhaust employees in the service sector, which requires extensive employee–client interaction [6]. Considered a reaction to persistent workplace stressors, emotional exhaustion includes the sense of inadequacy to present work-related information and a lack of emotional energy and perception that would convey a self-perception of emotional depletion [7]. Characterized by the sense of mental exhaustion or emotional depletion, it is a key component of burnout. This construct leads to various organizational outcomes such as excessive absenteeism and personal inadequacies (e.g., increased depression and mental health disorders) [8].
Occupational emotion is a major factor in stress-related conditions in the workplace [9]. Positive affect is achieved when a job helps employees achieve transcendental values or participate in altruistic activities. The positive affect of employees can impact group interactions beyond the personal level, such as group cooperation and team innovation. Positive affect is the current degree of fulfillment, eagerness, and progress toward the objective [10]. People with low positive affect feel languid, indifferent, and exhausted. Known as a normal stress response, negative affect means exhaustion after experiencing workplace stress, which typically leads to negative reactions to others and negative self-evaluation. Negative affect is more widespread in organizations than positive affect [11,12]. Studies have confirmed the importance of mental well-being and personal success outcomes of positive affect compared with negative affect [13]. The outcomes of negative affect include low self-esteem, dissatisfaction, stress, and physical symptoms [14].
With widespread evidence of its role in improving
Effects of Mindfulness-Based Stress Reduction on Positive Affect, Negative Affect, and Emotional Exhaustion of Employees With Occupational Stress
Maryam Soltani1ID, Hadi Farhadi1,2*ID, Gholamreza Manshaee1, Ali Mehdad1
1Department of Psychology, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran
2Addictive Behaviors Research Center, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran
*Corresponding Author: Hadi Farhadi, Email: farhadihadi@yahoo.com
Abstract
Background & Aims: An increase in occupational stress can cause physical and psychological disorders as well as mental complications and emotional distress in employees. The present study aimed to investigate the effects of mindfulness-based stress reduction (MBSR) on positive affect, negative affect, and emotional exhaustion of employees with occupational stress.
Materials and Methods: This quasi-experimental research adopted a pretest-posttest control group design with follow-up. The statistical population included all employees with occupational stress at public organizations in Isfahan (Isfahan Province, Iran) in 2021. The convenience sampling method was employed to select 30 employees, who were randomly assigned to two 15-member groups called the MBSR group and the control group. The members of the MBSR group participated in eight intervention sessions, whereas the members of the control group received no intervention. After the participants completed the positive and negative affect and emotional exhaustion questionnaires in three stages, the repeated measures analysis of variance (ANOVA) was used for data analysis in SPSS 26.
Results: The posttest and follow-up results indicated that the MBSR intervention decreased negative affect and exhaustion and increased positive affect in employees with occupational stress (P < 0.001). The repeated measures ANOVA results of within-group effects showed that the effects of treatment were persistent (P < 0.001).
Conclusion: According to the results, MBSR could improve positive affect and mitigate negative affect and emotional exhaustion in employees. Organizations can use MBSR courses to promote the psychological and emotional well-being of their staff.
Keywords: Mindfulness, Stress, Burnout, Professional, Emotions, Occupational health
Received: April 9, 2023, Accepted: July 5, 2023, ePublished: September 29, 2023
https://jhygiene.muq.ac.ir/
10.34172/AHS.12.3.1.442
Vol. 12, No. 3, 2023, 155-160
Original Article
© 2023 The Author(s); This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Soltani et al
156 Arch Hyg Sci. Volume 12, Number 3, 2023
psychological performance and well-being in clinical and
non-clinical settings, mindfulness has become a popular
psychological intervention worldwide [15]. Mindfulness
focuses attention on present internal and external
experiences and leads to acceptance of events without
change. It includes special and purposive attention in the
present without prejudice and judgment [16]. Although
most studies on mindfulness-based interactions in the
workspace explore its effects on occupational stress
[17,18], several studies mention cognitive-emotional
variables and improved workplace conditions [19,20].
Janssen et al. [21] reported that mindfulness-based stress
reduction (MBSR) improved mental health and promoted
occupational engagement and performance. Fernandes et
al [22] discovered that mindfulness-based interventions
for primary health specialists improved astuteness and
fatigue and reduced the risk of stress-related diseases. Kim
et al [23] concluded that MBSR reduced perceived stress
and negative affect significantly. Regarding the emotional
exhaustion of health specialists, Marotta et al [24] reported
that MBSR alleviated distress and occupational burnout.
Among the most important reasons for conducting this
research, the following can be mentioned: In Iran, many
treatments have been used to reduce occupational stress
and improve the psychological well-being of different
strata of society, but the method of mindfulness, which
is a new approach in third-wave cognitive-behavioral
treatments, has not been investigated. Therefore, this issue
is one of the reasons for choosing MBSR treatment over
other treatment approaches. Considering the prevalence
of the problem of occupational stress among employees
and taking into account the vacuum and lack of research
in this field, the necessity of conducting such research is
felt. Also, due to the problems and costs that job stress
has on employee productivity, it seems necessary to use an
effective treatment to control it. In addition, according to
the theoretical and research bases, it was concluded that
the treatment of stress reduction based on mindfulness
is an effective approach in the field of health and may
be effective in the field of occupational stress reduction.
Therefore, according to the research gap, the main objective
of the current study was to investigate the effectiveness of
MBSR on positive affect, negative affect, and emotional
exhaustion of employees with occupational stress. Based
on this, the most important hypotheses of the present
study were as follows: MBSR is effective on the positive
and negative affect of employees with occupational stress.
MBSR treatment is effective on the emotional exhaustion
of employees with occupational stress.
2. Materials and Methods
This quasi-experimental research adopted a pretestposttest
control group design with a one-month follow-up
period. The statistical population included all employees
with occupational stress in public organizations in
Isfahan (Isfahan Province, Iran) in 2021. To this end,
the convenience sampling technique was adopted to
select 30 employees, who were then randomly assigned
to two 15-member groups (i.e., MBSR and control).
The MBSR group received eight 45-minute sessions,
whereas the control group received no intervention. The
inclusion criteria were as follows: having an office job in
Isfahan, experiencing occupational stress [obtaining a
low score (score below 101) in the Occupational Stress
Questionnaire-HSE], being aged 25–55 years, and giving
informed consent. However, the exclusion criteria were
as follows: revoking consent, undergoing simultaneous
psychological or psychiatrist therapy, and being absent in
more than two therapy sessions.
2.1. Instruments
Emotional Exhaustion Scale: This 9-item questionnaire
was prepared based on the burnout subscales of the
Maslach and Jackson Burnout Inventory [25]. The items
were scored on a five-point Likert scale (ranging from 5
for “completely disagree” to 1 for “completely agree”) with
respective maximum and minimum scores of 45 and 9.
The validity of this scale was confirmed by Moalemi et al
[26] in the nursing community. Moreover, Moalemi et al
[26] reported a Cronbach’s alpha of 0.85 for the Emotional
Exhaustion Scale.
Positive Affect and Negative Affect Scale (PANAS):
Developed by Watson et al [27], this self-reporting scale
has 20 items (10 on positive affect and 10 on negative affect)
for measuring the intensity of positive and negative affect.
It is scored on a Likert scale from “completely agree” (5)
to “completely disagree” (1). Lotfi et al [28] evaluated and
confirmed the validity of the Persian version of PANAS
in Iranian society. Lotfi et al [28] reported a Cronbach’s
alpha of 0.85 for the PANAS.
Occupational Stress Questionnaire: This questionnaire was
developed by Cousins et al [29] in order to create a suitable
tool for measuring occupational stress. The questionnaire
consists of 35 questions in a 5-point Likert scale (never,
rarely, sometimes, often, and always) with a score of 1 being
unfavorable to 5 being favorable. The minimum score of
the questionnaire is 35 and the maximum score is 175, so a
high score in this questionnaire indicates low job stress, and
a low score indicates a high level of stress. Azad Marzabadi
and Gholami Fesharaki [30] reported a Cronbach’s alpha of
0.78 for the Occupational Stress Questionnaire.
2.2. Procedure
After screening based on the inclusion and exclusion
criteria, participants were randomly assigned to therapy
and control groups with a pretest for all members. Then,
for 60 minutes each week, the therapy group attended
eight 45-minute MBSR sessions based on the Kabat–Zinn
training package [31], whereas the control group received
no treatment. Table 1 presents an overview of the contents
Arch Hyg Sci. Volume 12, Number 3, 2023 157
Effects of mindfulness-based stress reduction on positive affect, negative
of MBSR sessions.
2.3. Data analysis
The repeated measures ANOVA and the Bonferroni post
hoc test were used for data analysis in SPSS 26.
3. Results
There were no significant differences between the two
groups in terms of demographic indicators including
gender, marital status, and age of employees (Table 2).
According to the descriptive statistics, the MBSR group
had lower post-test and follow-up scores in negative affect
and emotional exhaustion and higher positive affect than
their pretest means (Table 3).
Before mixed ANOVA, the homogeneity of variance
and normality of score distribution assumptions were
checked. Levene’s test for positive affect (F = 0.05,
P = 0.829) and negative affect (F = 1.07, P = 0.309) and
emotional exhaustion (F = 1.32, P = 0.275) confirmed the
homogeneity of variance assumption in the MBSR and
control groups. The Shapiro–Wilk test for normal score
distribution verified the normal distribution of scores in
positive affect (the Shapiro–Wilk test = 0.951, P = 0.174),
negative affect (the Shapiro–Wilk test = 0.975, P = 0.674),
and emotional exhaustion (the Shapiro–Wilk test = 0.950,
P = 0.167) with a similar distribution to the population.
With the covariance test, the intergroup effect was
examined by controlling the effect of the pretest on
posttest and follow-up scores of dependent variables.
After the pretest effects were eliminated, the results
indicated a significant difference in the average
intergroup scores of the experimental and control group
in posttest on positive affect (F = 116.81, P = 0.001),
negative affect (F = 130.62, P = 0.001), and emotional
exhaustion (F = 106.75, P = 0.001). In the follow-up stage,
there was also a significant difference in the average
between-group scores of the MBSR and control groups
(after the pretest effects were eliminated) in positive
affect (F = 162.81, P = 0.001), negative affect (F = 188.90,
P = 0.001), and emotional exhaustion (F = 127.84,
P = 0.001).
The persistence of therapy was examined through
the repeated measures ANOVA. The within-group
significance of time for positive affect (F = 101.19,
P = 0.001), negative affect (F = 164.92, P = 0.001),
and emotional exhaustion (F = 101.72, P = 0.001)
confirmed the significant difference between the three
measurements. The interaction effect of time with the
group was also significant in positive affect (F = 143.07,
P = 0.001), negative affect (F = 206.83, P = 0.001), and
emotional exhaustion (F = 116.92, P = 0.001) (Table 4).
Moreover, the Bonferroni post hoc test was used for
pairwise examination of the significance of the mean
difference in different stages of measuring dependent
variables. According to the results in Table 5, there was
a significant difference between the average pretest, posttest,
and follow-up scores of positive affect, negative
affect, and emotional exhaustion (P < 0.001).
Table 1. Overview of contents in mindfulness-based stress reduction (MBSR) sessions
Session Content Topics
1 Automatic guidance Explaining the session, treatment goals, and the need for mindfulness training and the automatic guidance system.
2 Overcoming obstacles Body scan exercise and providing feedback to participants, introducing the mindful breathing meditation
3 Mindful breathing Mindful sitting and feedback to participants and introducing the three-minute breathing space exercise
4 Staying in the moment Introducing the five-minute “seeing or hearing” exercise and repeating the mindful breathing and body scan exercises
5 Permission to attend
Breathing exercise, introducing the sitting meditation of “mindful breathing, body, sounds, and thoughts”, information
on stress, recognizing pleasant and unpleasant events on feelings, thoughts, and bodily sensations.
6 Thoughts are not facts Mindful yoga exercise, introducing the different subject of seeing thoughts or surrogate thoughts, and sitting meditation
7
How to take the best
care of myself?
Introducing mental health and listing delightful activities and exercises from previous sessions
8 Acceptance and change Body scan exercise, checking and discussing programs
Table 2. Demographic variables of the participants
Variables MBSR group Control group P
Mean (SD) age (years) 35.68 ± 7.57 37.38 ± 7.81 0.549
Marital status
Single 8 (53.33%) 7 (46.67%)
0.719
Married 7 (46.67%) 8 (53.33%)
Gender
Male 8 (53.33%) 9 (60.0%)
0.717
Female 7 (46.67%) 6 (40.0%)
Table 3. Mean (SD) of research variables in experimental and control groups
Variables Phases
MBSR group Control group P (between
Mean ± SD Mean ± SD groups)
Positive
affect
Pre-test 29.00 ± 1.73 28.33 ± 1.68 0.291
Post-test 38.60 ± 2.86 27.60 ± 1.80 0.001
Follow-up 39.80 ± 2.62 27.33 ± 1.79 0.001
Negative
affect
Pre-test 37.13 ± 2.32 35.46 ± 2.77 0.084
Post-test 26.06 ± 3.71 36.00 ± 2.36 0.001
Follow-up 24.73 ± 3.39 36.33 ± 2.05 0.001
Emotional
exhaustion
Pre-test 36.33 ± 2.49 34.73 ± 3.15 0.134
Post-test 24.26 ± 4.41 35.06 ± 2.89 0.001
Follow-up 25.20 ± 4.30 35.13 ± 2.87 0.001
Soltani et al
158 Arch Hyg Sci. Volume 12, Number 3, 2023
4. Discussion
The present study aimed to investigate the effects of
MBSR on positive affect, negative affect, and emotional
exhaustion of employees with occupational stress. The
results illustrated that MBSR alleviated the negative
affect and exhaustion and improved the positive affect of
employees with occupational stress in the posttest with a
persistent effect.
Regarding the effects of MBSR on positive affect
and negative affect, the results are consistent with the
findings reported by Kim et al [23]. Also, in line with
the current study, Mirzaee and Shairi [32] reported that
MBSR was effective in reducing depression symptoms
and negative emotions in non-clinical population.
Goudarzi et al [33] reported that cognitive therapy
based on mindfulness is effective to enhance positive
affect in people with depression symptoms. Mindfulness
techniques are designed to improve clients’ awareness
and alter challenging circumstances, including emotional
states and situations, without automatic and habitual
reactions. Mindfulness training enables individuals to
accept emotional experiences as separate elements and
transitory states that could change. The explicit and
implicit emotional states of mindful people are more
compatible, and the greater awareness of emotions
enables them to moderate their response to negative
stimuli [15]. After relaxation and mindfulness-based
exercises and discussion, employees observe their feelings
and emotional states with a non-judgmental approach.
Instead of avoiding cognitive, emotional, and physical
occupational stressors, they were trained to survey and
question these experiences and their roots [16]. These
outcomes can back the effects of MBSR on positive affect
and negative affect.
Regarding the effects of MBSR on emotional
exhaustion, the findings are in line with the results
reported by Menardo et al [18] and Fernandes et al [22].
Mindfulness trains individuals to be aware of their mental
states at every moment and focus on different mental
approaches. Perceiving internal and external realities
openly and clearly, mindful individuals can properly
deal with various thoughts, emotions, and experiences
(both pleasant and unpleasant) [21]. By improving selfregulation
and strengthening social relationships in the
workplace, mindfulness makes employees more flexible
in the face of challenges and promotes performance. It is
therefore a novel approach for establishing more effective
relations with life in order to relieve pains, enrich life,
and make it more meaningful in the workspace. When
they discover uncontrollable stressors outside life, such
as workspace, while methods of countering stress and
responding to workplace stressors can be changed,
mindfulness exercises lead to positive changes to the
psychological functions of employees. In addition to
lower stress, they also experience lower emotional
exhaustion.
One limitation of this study is its restriction on
government employees, which calls for caution when
generalizing results to other samples. This study also
employed a self-reporting questionnaire for measuring
employees’ positive affect and negative affect. It is
therefore recommended to measure the positive affect
and negative affect of employees with other instruments,
such as pulse and blood pressure. It is also recommended
to replicate this study on private-sector employees.
5. Conclusion
MBSR mitigated negative affect and emotional exhaustion
and improved positive affect in employees with
occupational stress. Therefore, organizations can employ
experienced psychologists and hold MBSR courses to
promote the psychological and emotional well-being of
their staff.
Acknowledgments
This article was extracted from a part of the PhD dissertation
of Maryam Soltani in the Department of Psychology, Isfahan
(Khorasgan), Islamic Azad University, Isfahan, Iran. The researchers
wish to thank all the individuals who participated in the study.
Table 4. Repeated measurement results for the effects of time and interaction time and group
Variable Source SS df MS F P η2
Positive affect
Time 438.82 1.13 387.23 101.16 0.01 0.78
Time × group 620.42 1.13 547.48 143.07 0.01 0.83
Negative affect
Time 727.75 1.14 637.22 164.92 0.01 0.85
Time × group 612.68 1.14 799.15 206.83 0.01 0.88
Emotional exhaustion
Time 527.35 1.11 472.86 101.72 0.01 0.78
Time × group 606.15 1.11 543.52 116.92 0.01 0.80
MS, mean sum of squares; SS, sum of squares; df, degrees of freedom.
Table 5. Results of pairwise comparison of the research variables
Variables Phases Mean difference SE P
Positive affect
Pre-test–post-test -4.43 0.46 0.001
Pre-test–follow-up -4.90 0.45 0.001
Negative affect
Pre-test–post-test 5.76 0.47 0.001
Pre-test–follow-up 6.26 0.45 0.001
Emotional
exhaustion
Pre-test–post-test 4.86 0.50 0.001
Pre-test–follow-up 5.36 0.49 0.001
SE, standard error.
Arch Hyg Sci. Volume 12, Number 3, 2023 159
Effects of mindfulness-based stress reduction on positive affect, negative
Authors’ Contribution
Conceptualization: Maryam Soltani, Hadi Farhadi, Gholamreza
Manshaee, Ali Mehdad.
Formal analysis: Maryam Soltani, Hadi Farhadi, Gholamreza
Manshaee, Ali Mehdad.
Funding acquisition: Maryam Soltani, Hadi Farhadi, Gholamreza
Manshaee, Ali Mehdad.
Methodology: Maryam Soltani, Hadi Farhadi, Gholamreza
Manshaee, Ali Mehdad.
Project administration: Maryam Soltani, Hadi Farhadi, Gholamreza
Manshaee, Ali Mehdad.
Resources: Maryam Soltani, Hadi Farhadi, Gholamreza Manshaee,
Ali Mehdad.
Software: Maryam Soltani, Hadi Farhadi, Gholamreza Manshaee,
Ali Mehdad.
Supervision: Maryam Soltani, Hadi Farhadi, Gholamreza
Manshaee, Ali Mehdad.
Validation: Maryam Soltani, Hadi Farhadi, Gholamreza Manshaee,
Ali Mehdad.
Visualization: Maryam Soltani, Hadi Farhadi, Gholamreza
Manshaee, Ali Mehdad.
Writing–original draft: Maryam Soltani, Hadi Farhadi, Gholamreza
Manshaee, Ali Mehdad.
Writing–review & editing: Maryam Soltani, Hadi Farhadi,
Gholamreza Manshaee, Ali Mehdad.
Competing Interests
The author declares that the author has no conflict of interest.
Ethical Approval
The written consent has been obtained from all participants.
The Ethics Review Board of Islamic Azad University-Isfahan
(Khorasgan) Branch, approved the present study (code: IR.IAU.
KHUISF.REC.1399.128).
Funding
This study did not receive any funding.
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