Occupational stress among healthcare providers is widespread; the source reports that nearly 80% of providers experience adverse psychological symptoms such as depression, burnout, and sleep disturbance related to workplace stressors. Physicians face specific stressors—high decision-making and diagnostic burden, long and irregular hours, and limited organizational support—that may increase risk for distress and associated occupational and patient-level harms. Elevated stress can also stimulate pro-inflammatory biology, linking psychosocial distress to long-term physical health risks.
Individual-level interventions can complement organizational solutions. Mindfulness-based interventions (MBIs) have shown promise across populations, but evidence in physicians is mixed: for example, Mindfulness-Based Stress Reduction (MBSR) reduced anxiety, depression, and perceived stress in some meta-analyses but did not consistently reduce burnout. The specific content of mindfulness practice may therefore matter for physician distress. Practices derived from the Buddhist Four Immeasurables—loving-kindness, compassion, sympathetic joy, and equanimity—may cultivate prosocial positive emotions that could reduce stress and improve social and biological outcomes. The complete Four Immeasurables program has not previously been tested in a randomized trial in physicians.
The trial evaluates the feasibility and efficacy of a manualized intervention, Building Emotional Strength Training (BEST), based on the Four Immeasurables, delivered remotely to full-time physicians. Ninety physicians with elevated stress will be randomized to BEST or a waitlist control (WLC). Aim 1 assesses feasibility of delivering BEST in a workplace setting. Aim 2 tests effects on perceived stress (primary outcome). Aim 3 evaluates effects on negative (depressive symptoms, burnout) and positive psychosocial outcomes (psychological well-being, sleep quality). Aim 4 examines effects on inflammatory biomarkers. An exploratory aim will investigate mediators including compassion for self and others, positive emotions, equanimity, and mindfulness.
This is a single-site, two-arm, parallel-group randomized controlled trial with 1:1 allocation. Ninety participants will be randomized to BEST (n = 45) or WLC (n = 45). Primary, secondary, and exploratory measures are collected at baseline (T1), mid-course at week 3 (T2), and post-intervention at week 6 (T3). The trial was registered on ClinicalTrials.gov (NCT07283744) prior to recruitment and the analysis plan was preregistered on the Open Science Framework. Reporting will follow CONSORT guidelines.
Eligibility criteria: currently practicing physician (M.D. or D.O.), age ≥18, willing and able to attend the six-week intervention, fluent in English, internet and email access, and a score ≥4 on the PSS-4 screening measure. Exclusions: a current regular meditation practice (≥3 days/week for ≥5 minutes/day), prior participation in a Four Immeasurables course, and regular tobacco use. The trial intentionally permits medical or psychiatric conditions and medication use to enhance generalizability; these are characterized at baseline for potential sensitivity analyses.
Recruitment is remote and leverages relationships with UCLA Health departments, staff wellness contacts, staff meetings, campus flyers, wellness events, and provider-focused newsletters. Cohorts of 20–30 physicians will be formed to achieve desired group sizes of 10–15 for the intervention.
A block randomization sequence was generated in advance using the blockrand function in R to allocate participants 1:1. The principal investigator conducts eligibility screening, consent, baseline assessment, and informs participants of assignment after baseline completion. Allocation concealment did not use personnel separation; instead, the pre-generated sequence and objective eligibility criteria were used to limit potential enrollment bias. This is an open-label trial: participants, instructors, and the principal investigator are unblinded. To mitigate bias, the study includes an objective inflammatory outcome, automated distribution of Qualtrics assessment links, and preregistration of outcomes and analysis plans.
The BEST program is a six-week, remotely delivered mindfulness intervention based on the Four Immeasurables (loving-kindness, compassion, joy, equanimity). It is a manualized course designed to cultivate distinct prosocial emotional qualities through structured practice. The intervention aims to enhance positive psychological states that may reduce distress in physicians constrained by time and scheduling.
Primary outcome: perceived stress, assessed using standardized self-report measures with the PSS-4 used at screening. Secondary outcomes include burnout, depressive symptoms, psychological well-being, and sleep quality. Exploratory mediator variables include compassion for self and others, positive affect, equanimity, and mindfulness. Assessments are administered via Qualtrics at baseline, mid-course (reduced battery focused on the primary outcome and mediators), and post-intervention. Baseline and post-intervention assessments include full questionnaire batteries (estimated 20–30 minutes) and at-home blood specimen collection (estimated 10 minutes).
Participants receive at-home blood collection kits mailed by the study team and are instructed to collect samples in the morning to control for diurnal variation in immune parameters. A second blood kit is mailed for the post-intervention collection. The source describes use of blood samples to assess inflammatory biomarkers relevant to stress-related biology but does not provide full details of the blood processing, assay methods, or storage procedures in the available text; those specifics were not reported in the source provided.
The trial has IRB approval from UCLA (IRB-25–1518). All data and biological specimens are securely stored at UCLA regardless of participant location. Assessment links are distributed automatically to separate outcome collection from personnel aware of allocation. Adverse or serious events will be reported to investigators and the IRB within 24 hours. Recruitment began December 2, 2025, is expected to conclude by October 2026, with data collection through December 2026 and results anticipated in early 2027.
This trial addresses a gap by testing a complete Four Immeasurables-based MBI delivered remotely to physicians. It aims to reduce perceived stress and examine psychosocial and inflammatory outcomes while exploring mechanisms of change. Limitations acknowledged in the protocol include the open-label design and allocation procedures that did not use personnel separation; mitigation strategies include objective biomarker outcomes and preregistered analyses. The source does not report final laboratory methods or analytic results; those will be available after study completion.