Scholars@Duke publication: Exploration of the Mediators and Moderators of Mindfulness-Based Stress Reduction Among Clergy: Secondary Analysis of Data From the Selah Trial, a Preference-Based Randomized Wait-List-Controlled Trial

Exploration of the Mediators and Moderators of Mindfulness-Based Stress Reduction Among Clergy: Secondary Analysis of Data From the Selah Trial, a Preference-Based Randomized Wait-List-Controlled Trial

Publication , Journal Article

Rash, JA; Eagle, DE; Tice, LC; Proeschold-Bell, RJ

Published in: International Journal of Stress Management

January 1, 2025

We conducted a secondary analysis of the Selah trial, a preference-based, partially randomized, wait-listcontrolled trial, to evaluate mediators and effect modifiers of a mindfulness-based stress reduction (MBSR) intervention. Participants were United Methodist clergy enrolled in the Selah trial and allocated to MBSR or wait-list control. Interventions spanned 12 weeks. Self-reported symptoms of stress and cardiac vagal control (CVC) were coprimary outcomes. Participants completed surveys collected 48-hr heart rate data preand postintervention and responded to daily text messages to record MBSR practice. Ninety-six participants (Mage = 52.4 years; 92% White; 49% female) were allocated to MBSR (n = 54) or wait-list control (n = 42), with 11 participants completing MBSR following the waiting period. Participants allocated to MBSR evidenced significantly greater change in symptoms of stress, MDiff = 0.248, 95% CI [0.13, 0.37]; CVC, MDiff = 2.30, 95% CI [0.13, 4.47]; mindfulness,MDiff = 1.26, 95% CI [0.27, 3.79]; self-reported reactivity to stressors, MDiff = 6.09, 95% CI [3.00, 9.19]; and positive mental health, MDiff = 3.54, 95% CI [0.69, 6.39], relative to wait-list control. Improvement in symptoms of stress was partially mediated by a change in mindfulness and perceived stress reactivity. Effects were not modified by a preference for MBSR intervention, minutes of daily practice, or sex. Finally, changes in symptoms of stress and CVC were bidirectionally related, acting as a partial mediator and suppressor variable, respectively. Results support a central, biological stress resilience pathway underlying the effects of MBSR on health-related outcomes, which is consistent with the mechanistic stress buffering framework.