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World J Psychiatry. Sep 19, 2025; 15(9): 107630
Published online Sep 19, 2025. doi: 10.5498/wjp.v15.i9.107630
Mindfulness-based stress reduction and mental health in department of emergency nurses: A narrative review
Rong-Rong Zhou, Ling-Long Chen, Le-Dan Lin, Medical Skills Training Center, The Third Clinical Institute Affiliated of Wenzhou Medical University, Wenzhou People’s Hospital, Wenzhou Maternal and Child Health Care Hospital, Wenzhou 325000, Zhejiang Province, China
ORCID number: Le-Dan Lin (0009-0001-9552-4063).
Author contributions: Zhou RR wrote the main manuscript; Chen LL performed data collection; Zhou RR, Chen LL, and Lin LD analyzed, interpreted results, and were informed of each step of manuscript processing; and all authors thoroughly reviewed and endorsed the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Le-Dan Lin, Medical Skills Training Center, The Third Clinical Institute Affiliated of Wenzhou Medical University, Wenzhou People’s Hospital, Wenzhou Maternal and Child Health Care Hospital, No. 299 Gu’an Road, Ouhai District, Wenzhou 325000, Zhejiang Province, China. 13957756235@163.com
Received: April 25, 2025
Revised: May 23, 2025
Accepted: July 4, 2025
Published online: September 19, 2025
Processing time: 123 Days and 3.2 Hours

Abstract

Emergency department nurses face severe occupational stress leading to anxiety, depression, and burnout, which significantly impair their well-being and patient-care quality. This narrative review examined the role of mindfulness-based stress reduction (MBSR) in addressing these challenges. Rooted in nonjudgmental present-moment awareness, MBSR enhances emotional regulation and reduces psychological distress by fostering adaptive coping strategies. Studies have demonstrated its efficacy in lowering anxiety, depressive symptoms, and emotional exhaustion, while improving workplace well-being, empathy, and job satisfaction. Mechanistically, MBSR improves interoceptive awareness and autonomic balance, as evidenced by physiological markers such as heart rate variability. However, gaps remain in long-term efficacy assessments, personalized interventions, and integration with multidisciplinary approaches. Future research should prioritize tailored biomarker-driven programs, longitudinal studies, and scalable implementation strategies in high-stress clinical settings. This review underscores MBSR’s potential as a sustainable, evidence-based tool to enhance emergency department nurses’ mental health and professional performance, advocating for broader adoption and further refinement of its practical applications.

Key Words: Job satisfaction; Emotional regulation; Mental health; Occupational stress; Mindfulness-based stress reduction; Emergency department nurses

Core Tip: This review explores the effectiveness of mindfulness-based stress reduction in improving mental health among emergency department nurses. It highlights mindfulness-based stress reduction’s benefits in reducing psychological stress, negative emotions, and occupational burnout, while enhancing emotional regulation and job satisfaction. Future research should focus on personalized interventions and long-term efficacy.



INTRODUCTION

Emergency department (ED) nurses face high-intensity pressure and complex emergencies during their daily work, making mental health issues increasingly prominent. Recently, multiple studies have shown that ED nurses working under prolonged high-stress conditions are prone to anxiety, depression, and occupational burnout, which significantly affect their work quality and overall well-being. Mindfulness-based stress reduction (MBSR) a psychological intervention based on mindfulness has demonstrated significant effects in various clinical settings. Research suggests that mindfulness can reduce emotional exhaustion by decreasing surface acting and enhancing job satisfaction[1]. The latest systematic review summarizing 11 cross-sectional studies revealed that the prevalence rates of depression, burnout, and stress among ED physicians and nurses were 15.5%-19.3%, 18%-71.4%, and 19.5%-22.7%, respectively[2]. This therapy helps nurses maintain focused and open attitudes in high-stress environments, thereby improving emotional regulation and job satisfaction. MBSR has also enhanced workplace well-being and empathy among nurses[3]. Through regular mindfulness practice, nurses can cope better with work-related stress and improve patient interactions. Additionally, MBSR has been proven effective in reducing anxiety and stress levels among nurses[4]. This study aimed to review the role of MBSR in enhancing the mental health of ED nurses and explore its effectiveness and application value to provide a reference and insight for psychological interventions in emergency nursing.

PRINCIPLES AND MECHANISMS OF MBSR

Mindfulness is the practice of focusing attention on the present moment without judgment. It emphasizes conscious and nonjudgmental awareness of the present, forming a core method in Buddhist meditation. The three fundamental elements of mindfulness - intention, attention, and attitude (IAA) - work together to create a cyclical process that helps individuals better perceive and manage their emotions and thoughts[5,6]. Intention refers to the conscious choice to cultivate awareness and empower individuals to better navigate daily stressors and challenges. Attention involves training the mind to focus on present-moment experiences, free from distractions of past regrets or future anxieties. This capacity for a present-centered focus is recognized as a critical factor in improving mental health. Attitude emphasizes approaching one’s feelings and thoughts with kindness, curiosity, and nonjudgment. This attitude helps mitigate the impact of negative emotions while fostering positive emotional states.

MBSR aims to alleviate stress and improve mental health by cultivating mindfulness awareness. MBSR involves training in mindfulness meditation, yoga, and self-regulation techniques. This enables individuals to enhance their understanding of their present experiences, thereby reducing stress responses and promoting psychological and physiological well-being. Studies have shown that MBSR can effectively reduce psychological and physiological stress responses. For example, one study found that mindfulness meditation training alleviated self-reported psychological stress while increasing cortisol responses to social evaluative stress, suggesting that mindfulness meditation may reduce psychological stress appraisal by fostering adaptive coping efforts[7]. Furthermore, MBSR has been shown to improve heart rate variability (HRV), which is associated with better health outcomes[8].

The psychophysiological mechanisms underlying MBSR may involve multiple mechanisms. First, mindfulness training enhances sensitivity to interoceptive signals, aiding in the selection of more adaptive emotional regulation strategies, thereby improving mental health and subjective well-being[9]. Second, mindfulness interventions may improve emotion regulation and coping abilities by reducing psychological inflexibility and distress tolerance[10]. Research has also suggested that MBSR can improve the mental health of patients with schizophrenia by reducing negative emotions and increasing HRV[11]. Additionally, the application of MBSR in different populations has shown positive effects. For example, mindfulness training in obese adults sustains positive emotions and adaptive cardiovascular response patterns[12]. In cancer survivors, MBSR significantly reduces fatigue interference and depressive symptoms while enhancing the quality of life[13]. Beyond healthcare, MBSR has demonstrated efficacy in corporate wellness programs and educational settings. The core approach lies in focusing attention on breathing, physical sensations or the environment, helping individuals break the negative thinking cycle and establish a healthier emotional coping mechanism.

RESEARCH PROGRESS ON THE EFFECTIVENESS OF MBSR IN ED NURSES’ MENTAL HEALTH
Alleviation of psychological stress

MBSR has shown significant effectiveness in reducing perceived stress levels among ED nurses. Studies have indicated that MBSR effectively reduces nurses’ work-related stress and psychological pressure, thereby improving their overall mental health[14]. Given the high-pressure environment of the ED, nurses frequently encounter various urgent situations and heavy workloads that significantly affect their mental well-being. Participation in MBSR programs allows nurses to develop better stress management skills, enhance self-awareness, and maintain a more stable psychological state at work[15]. Research indicates that nurses who participate in MBSR exhibit significant improvements in emotional regulation, enabling them to remain calm and rational when faced with workplace challenges[16]. This improvement in emotion regulation benefits nurses’ psychological health, work efficiency, and patient-care quality[17]. MBSR training also helps nurses cope better with workplace stress and challenges, reduces burnout and compassion fatigue, and increases job satisfaction and professional fulfillment[18]. Additionally, studies have found that MBSR helps nurses reduce anxiety and depressive symptoms and increases self-compassion and mindfulness levels, all of which are crucial for emotional regulation[19].

Improvement in negative

Emotions MBSR has demonstrated remarkable effectiveness in improving negative emotions among ED nurses. Studies have shown that mindfulness interventions significantly reduce anxiety and depression levels while alleviating emotional exhaustion[20]. A systematic review and meta-analysis of mindfulness interventions for anxiety management among healthcare professionals found that mindfulness significantly reduced anxiety and stress[3]. Mindfulness interventions improved nurses’ professional quality of life and reduced psychological distress[3]. Another study that applied mindfulness interventions to psychiatric ward nurses revealed that those in the mindfulness intervention group exhibited significantly improved workplace well-being and empathy levels[21]. Mindfulness interventions are effective in nurses and other high-stress groups. For example, mindfulness interventions have improved mental health and autonomic nervous system balance in high-burden caregivers, significantly increasing well-being scores and reduced anxiety levels[22].

Reduction of occupational burnout

MBSR and emotional management training significantly enhanced ED nurses’ mindfulness levels and improved their emotional regulation and job satisfaction. Studies have indicated that mindfulness training effectively reduces emotional exhaustion and job-related stress among nurses, thereby increasing job satisfaction and overall well-being[23]. Additionally, mindfulness training improves emotional regulation strategies, such as surface and deep acting, and enhances emotional intelligence and self-efficacy, further boosting job performance and satisfaction[24,25]. Mindfulness training reduces emotional exhaustion, enhances nurses’ ability to regulate negative emotions, and lowers the risk of occupational burnout[26]. By cultivating mindfulness, nurses can better accept and process negative emotions encountered at work, thereby improving their emotional regulation skills and job satisfaction[27]. Moreover, mindfulness training enhances nurses' positive emotions and resilience and increases job satisfaction[28].

Enhancement of overall psychological well-being

Mindfulness practice helps ED nurses manage workplace stress, reduce negative emotions, and improve life satisfaction[29]. Through mindfulness exercises, nurses can better regulate emotions, decrease anxiety and depression, and enhance positive emotions[13]. Mindfulness improves emotional regulation abilities, enabling nurses to remain calm and focus on work pressures. Studies have found that mindfulness is significantly associated with emotional differentiation, reduced emotional instability, improved emotional balance, and improved self-reported mental health[13]. This enhancement in emotional regulation benefits nurses' personal well-being and patient-care quality. Table 1 summarizes the research progress on the effectiveness of MBSR in ED nurses’ mental health in the past five years[30-34].

Table 1 Summary of key studies on mindfulness-based stress reduction Interventions for emergency department nurses’ mental health in the past five years.
Ref.
Sample size
Type of research
Intervention duration
Intervention method
Results
Argyriadis et al[30], 2023n = 14Randomized controlled trial10 daysMindfulness-based interventionAfter the intervention, nurses showed improvement in cognitive function, professional relationships, personal satisfaction, communication with patients and caregivers, sleep quality, and reduction of negative emotions and behaviors
Joseph and Jose[31], 2024n = 531Systematic reviewNAMindfulness-based interventionMindfulness-centered interventions can be an effective strategy to cope with distress and burnout and in building compassion and resilience
Marotta et al[32], 2022n = 50Cross-sectional survey8 weeksMBSRThe intervention enhanced participants' psychological well-being, reduced perceived stress and emotional exhaustion, and alleviated fear of COVID-19
Xu et al[33], 2022n = 148Randomized controlled trial10 minutes/day, 4 weeksUse app to practice daily 10 minutes app-guided mindfulness for 4 weeksMindfulness apps can significantly lower perceived stress levels in emergency department staff and improve burnout, mindfulness, and well-being
Anderson et al[34], 2021n = 25Pre-/post-interventional design8 weeksMBSRNurses displayed increased life satisfaction, reduced perceived stress, and heightened mindfulness awareness, with improvements in perceived stress and mindfulness awareness sustained four months after the program ended
FUTURE RESEARCH DIRECTIONS AND OUTLOOK
Personalized intervention programs

To further enhance the effectiveness of MBSR, future research should consider personalized intervention plans that would help tailor treatment programs based on individuals’ specific needs and genetic characteristics. For example, studies have found that genetic variations may affect the response of breast cancer survivors to MBSR, suggesting that personalized intervention plans can be developed using genetic testing[35]. Truscott analyzed studies published over the past five years on the impact of MBSR programs on reducing nurses’ perceived stress levels. The research indicators included patient-care quality and safety, stress-related nurse turnover costs, and work efficiency. The results showed that MBSR effectively reduced nurses’ perceived stress levels, thereby improving patient outcomes, increasing job satisfaction, and reducing stress-related organizational costs[23]. Additionally, while existing studies have demonstrated the efficacy of MBSR in diverse clinical settings, most have focused on tertiary hospitals and nurses with intermediate to senior qualifications. However, limited evidence exists regarding its applicability to community hospitals and novice nurses. Future studies should prioritize diverse populations, including nurses from various hospital tiers and career stages, to ensure the generalizability of MBSR interventions.

Long-term follow-ups

Long-term follow-up studies can help us understand the long-term effects and sustainability of MBSR, thereby providing solid evidence for its application in emergency care[36]. For example, a randomized clinical trial compared the effects of MBSR and headache education on migraines. This study included 89 adult patients who experienced 4-20 migraine days per month. The results showed that both groups experienced a reduction in migraine frequency; however, no significant difference was shown between the groups. However, the MBSR group showed significant improvements in disability, quality of life, self-efficacy, pain catastrophizing, and depression scores and a decrease in experimentally induced pain intensity and unpleasantness, indicating that MBSR may help reduce the overall burden of migraine. However, larger-scale studies are needed to further verify these results[37].

Integrated psychological interventions

Integrated psychological interventions show promise. Combining MBSR with other psychological therapies such as cognitive-behavioral therapy may enhance its effects[38]. In mental health, MBSR has been shown to reduce occupational stress among mental health professionals and improve their mindfulness skills[39]. For patients with cardiovascular diseases, MBSR helps reduce depression and stress; however, its effects on cardiovascular risk factors and quality of life remain unclear[40]. In patients with traumatic brain injury, MBSR reduces chronic stress and depressive symptoms[41].

Application of biomarkers

The application of biomarkers can provide a deeper understanding of how MBSR affects physical and mental health, helping to optimize intervention strategies. For example, biomarkers like HRV and cortisol levels offer objective measures of MBSR’s psychophysiological impact, enabling real-time intervention adjustments[7]. Cultural context also plays a role in MBSR implementation; mindfulness practices rooted in Buddhist traditions may face resistance in secular or religiously conservative settings. A comparative study in Iran and Sweden found higher adherence rates in Iran, where mindfulness was framed as a secular coping strategy rather than a spiritual practice[3]. Tailoring interventions that align with cultural norms and values is critical for global scalability.

Implementation challenges and practical considerations

Despite MBSR’s benefits, practical barriers hinder its widespread adoption. For instance, a randomized trial in a United States hospital revealed that 40% of nurses withdrew from the program because of conflicting shift schedules[23]. Additionally, institutional support remains limited; only 15% of surveyed hospitals in a 2023 study allocated dedicated time to mindfulness training[36]. Addressing these challenges requires scalable formats (e.g., mobile app-based modules) and policy-level interventions to prioritize staff well-being.

CONCLUSION

MBSR demonstrated multidimensional benefits in improving ED nurses’ mental health. By fostering present-moment awareness and acceptance, MBSR significantly reduces anxiety, depression, and occupational burnout, while enhancing emotional regulation and job satisfaction, ultimately improving overall psychological well-being. Through mindfulness meditation and self-regulation techniques, MBSR helps nurses remain calm in high-pressure environments, reduces the impact of negative emotions on work, and enhances empathy and patient-care quality. The application of MBSR in emergency nursing is particularly valuable as it alleviates nurses’ psychological stress and indirectly optimizes healthcare service quality. Future efforts should integrate personalized interventions, long-term evaluations, and interdisciplinary approaches to enhance MBSR’s adaptability and effectiveness in various clinical settings, ultimately promoting mental health and professional efficiency among healthcare workers.

Footnotes

Provenance and peer review: Unsolicited article; Externally peer reviewed.

Peer-review model: Single blind

Specialty type: Psychiatry

Country of origin: China

Peer-review report’s classification

Scientific Quality: Grade B, Grade C

Novelty: Grade B, Grade C

Creativity or Innovation: Grade B, Grade B

Scientific Significance: Grade C, Grade C

P-Reviewer: Cialowicz M; Van Doan H S-Editor: Bai Y L-Editor: A P-Editor: Zhang L

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