Twenty-four studies were included with 1,769 participants (2 studies did not report numbers). The studies were grouped into three parts. Part 1 contains the six rigorously designed studies (442 participants) with one of the studies reported in two separate reports, part 2 contains one study that violated randomisation (48 participants), and part 3 contains the remaining 17 studies (1,279 participants). Of the 24 studies, only eight used control groups or attempted to randomise participants.
The results derived from individual studies, without taking validity into account, revealed that medical trainees participating in stress-management programmes demonstrated:
1. Improved immunologic functioning.
2. Decreases in depression and anxiety.
3. Increased spirituality and empathy.
4. Enhanced knowledge of alternative therapies for future referrals.
5. Improved knowledge of the effects of stress.
6. Greater use of positive coping skills.
7. The ability to resolve role conflicts.
Despite these promising results, the studies had many limitations. Only four studies reviewed found no difference between experimental and control groups on standardised measures of psychological functioning, immune functioning, or health at post-assessment. Trainee achievement, as assessed by examination performance, was consistently not correlated with participation in stress-reduction programmes.
Although all of the studies reported results based on assessments immediately after the interventions, only four assessed participants a few months later, and one assessed participants one year later. While follow-ups supported the effectiveness of the interventions, the durations of stress management effects for the majority of the programmes remains unclear.