The job-demand-control-support model indicates that clergy are at high risk for chronic stress and adverse health outcomes. A multi-group pre-test-post-test design 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. Surveys at 0, 3, and 12 weeks assessed symptoms of stress, anxiety, and perceived stress reactivity. Heart rate variability (HRV) was assessed at baseline and 12 weeks using 24 h ambulatory heart rate monitoring data. 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 the change observed in each intervention from baseline to 3 and 12 weeks post-baseline to determine the range of effect sizes likely to be observed in a definitive trial. 71 clergy participated in an intervention. The daily percentage of participants engaging in stress management practices ranged from 47% (MBSR) to 69% (Examen). Results suggest that participation in Daily Examen, stress inoculation, or MBSR interventions could plausibly result in improvement in stress and anxiety at 12 weeks with small-to-large effect sizes. Small effect sizes on change in HRV were plausible for MBSR and Centering Prayer from baseline to 12 weeks. All four interventions were feasible and acceptable, although Centering Prayer had lower enrollment and mixed results.

BackgroundThe job-demand-control-support model indicates that clergy are at high risk for chronic stress and adverse health outcomes.MethodsA 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.Results78 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.ConclusionsAll 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).

Abstract Introduction Like many helping professionals in emotional labor occupations, clergy experience high rates of mental and physical comorbidities. Regular stress management practices may reduce stress-related symptoms and morbidity, but more research is needed into what practices can be reliably included in busy lifestyles and practiced at a high enough level to meaningfully reduce stress symptoms. Methods and analysis The overall design is a preference-based randomized waitlist control trial. United Methodist clergy in North Carolina will be eligible to participate. The intervention and waitlist control groups will be recruited by email. The interventions offered are specifically targeted to clergy preference and include mindfulness-based stress reduction, Daily Examen, and stress inoculation training. Surveys will be conducted at 0, 12, and 24 weeks with heart rate data collected at 0 and 12 weeks. The primary outcomes for this study are self-reported symptoms of stress and heart rate at week 12 for each intervention compared to waitlist control; the secondary outcome is symptoms of anxiety comparing each intervention vs waitlist control. Ethics and dissemination Ethical approval was obtained from the Duke University Campus IRB (2019-0238). The results will be made available to researchers, funders, and members of the clergy community. Strengths and limitations of this study While evidence-based stress reduction practices such as mindfulness-based stress reduction (MBSR) exist, a wider variety of practices should be tested to appeal to different individuals. Clergy in particular may prefer, and consequently enact, spiritual practices like the Daily Examen, and individuals such as clergy who spend most of their time thinking and feeling may prefer experiential-based practices like stress inoculation training. If efficacious, the Daily Examen and stress inoculation training practices have high feasibility in that they require few minutes per day. This study is limited by the inclusion of Christian clergy of only one denomination. Trial registration ClinicalTrials.gov NCT04625777. November 12, 2020.