The Selah trial: A preference-based partially randomized waitlist control study of three stress management interventions

Chronic stress undermines psychological and physiological health. We tested three remotely delivered stress management interventions among clergy, accounting for intervention preferences. United Methodist clergy in North Carolina enrolled in a partially randomized, preference-based waitlist control trial. The interventions were: mindfulness-based stress reduction (MBSR), Daily Examen prayer practice, and Stress Proofing (stress inoculation plus breathing skills). Co-primary outcomes were symptoms of stress (Calgary Symptoms of Stress Inventory) and 48-hour ambulatory heart rate variability (HRV) at 12 weeks compared to waitlist control. Survey data were collected at 0, 12, and 24 weeks and 48-hour ambulatory HRV at 0 and 12 weeks. The 255 participants were 91% White and 48% female. Forty-nine participants (22%) without a preference were randomly assigned between the three interventions (n = 40) and waitlist control (n = 9). Two hundred six participants (78%) with a preference were randomly assigned to waitlist control (n = 62) or their preferred intervention (n = 144). Compared to waitlist control, MBSR [mean difference (MD) = -0.30, 95% CI: -0.41, -0.20; P < .001] and Stress Proofing (MD = -0.27, 95% CI: -0.40, -0.14; P < .001) participants had lower stress symptoms at 12 weeks; Daily Examen participants did not until 24 weeks (MD = -0.24, 95% CI: -0.41, -0.08). MBSR participants demonstrated improvement in HRV at 12 weeks (MD = +3.32 ms; 95% CI: 0.21, 6.44; P = .036). MBSR demonstrated robust improvement in self-reported and objective physical correlates of stress; Stress Proofing and Daily Examen resulted in improvements in self-reported correlates of stress. These brief practices were sustainable and beneficial for United Methodist clergy during the heightened stressors of the COVID pandemic. ClinicalTrials.gov identifier: NCT04625777.