Physicians work in an environment where high-stakes decisions, long hours, clinical uncertainty and administrative demands can accumulate into persistent stress. A new study from UCLA is testing whether a six-week meditation program focused on positive emotions can help physicians manage that burden.
The project, called FIERCE, is a randomized controlled trial designed to evaluate Building Emotional Strength Training (BEST), a remotely delivered mindfulness program based on the Buddhist practice known as the Four Immeasurables. The intervention emphasizes four qualities—loving-kindness, compassion, joy and equanimity—rather than focusing exclusively on stress reduction or attention training.
The study protocol was published September 9, 2026, in PLOS One by J. Richard T. Korecki, Diana Winston, Elizabeth Ko, Sun Yoo, Joshua Khalili and Julienne E. Bower. The researchers plan to enroll 90 full-time physicians with elevated stress and randomly assign 45 to BEST and 45 to a waitlist control group.
There are currently no outcome results showing that BEST reduces physician stress. Recruitment began December 2, 2025, and is expected to conclude in October 2026, while data collection is scheduled to continue through December. The research team expects to analyze the results in early 2027.
Why UCLA Is Studying Meditation In Physicians
Physician stress is different from ordinary workplace stress because clinical responsibilities can combine emotional pressure with decisions that directly affect patients.
The UCLA protocol identifies several occupation-specific factors, including high diagnostic and decision-making demands, long or irregular working hours and insufficient organizational support. The researchers also point to broader workplace factors such as workload, administrative responsibilities and scheduling as important contributors to physician distress.
The problem extends beyond how physicians feel during a workday. Persistent stress has been associated with depression, burnout, sleep problems and other adverse outcomes among healthcare professionals. The UCLA researchers also note that chronic stress may interact with inflammatory processes relevant to long-term health.
For broader background, the National Institute for Occupational Safety and Health provides extensive research on workplace stress, organizational factors and worker well-being. This distinction between individual coping strategies and workplace conditions is important for interpreting the UCLA study: meditation may potentially provide an individual tool, but it does not remove excessive workload, staffing problems or administrative burdens.
The researchers explicitly acknowledge this limitation. BEST is designed to address psychological processes at the individual level, while many major causes of physician stress operate at the organizational level. If the intervention proves useful, the researchers say it should complement—not replace—organizational efforts to improve working conditions.
The Trial Will Enroll 90 Physicians
The study has a relatively focused sample: 90 full-time physicians with elevated perceived stress.
Participants must be at least 18 years old, currently practicing medicine, fluent in English and able to participate in the six-week intervention. They must also score at least 4 on the four-item Perceived Stress Scale during the initial screening.
The researchers intentionally use relatively broad eligibility criteria. Physicians are not automatically excluded because of medical or psychiatric conditions or medication use. Instead, those characteristics will be documented at baseline so the research team can characterize the sample and conduct exploratory or sensitivity analyses when appropriate.
There are also important exclusions. Physicians with a consistent meditation practice of at least three days per week for five minutes per day are excluded, as are people who have previously completed a Four Immeasurables course. Regular tobacco use is another exclusion criterion because of its potential effect on immune measures, which are part of the study.
The sample will be recruited through UCLA Health networks, staff meetings, provider wellness events, newsletters and other recruitment channels. Because the intervention is delivered remotely, participants do not have to live in the Los Angeles area. Data and biological specimens will be securely stored at UCLA.
BEST Uses The Four Immeasurables As Its Foundation
The intervention differs from a basic mindfulness course because its central framework comes from the Four Immeasurables, a traditional Buddhist practice centered on cultivating specific emotional qualities.
BEST adapts this framework for a contemporary physician population while retaining the four core qualities of loving-kindness, compassion, sympathetic joy and equanimity. The program was developed by Diana Winston, director of UCLA Mindful, who has extensive experience teaching meditation.
The researchers describe the four qualities in practical psychological terms. Loving-kindness involves cultivating goodwill toward oneself and others. Compassion focuses on responding to suffering with care. Joy involves recognizing or cultivating positive emotional states, including appreciation of positive experiences. Equanimity concerns maintaining a more balanced response to difficult experiences.
Rather than treating these as abstract philosophical concepts, BEST connects them with clinical work.
The intervention includes examples related to physicians’ daily activities. For example, the protocol describes using a patient’s breathing through a stethoscope as a possible cue for mindful awareness. The researchers also intend the practices to be usable during ordinary clinical activities rather than restricted to formal meditation sessions.
This approach makes the trial especially relevant to the broader question of whether mindfulness routines can be integrated into demanding professional environments without requiring large amounts of additional time.
The Six-Week Program Is Delivered Remotely
BEST consists of six weekly group sessions, with each session lasting approximately 60 minutes.
The sessions are delivered through videoconferencing and are scheduled around the workday, with the researchers anticipating lunchtime sessions. This format was developed partly in consultation with physicians, who provided input on session length, scheduling and delivery methods.
The remote format serves two purposes. First, it removes the need for physicians to travel to a meditation center or research facility. Second, it allows UCLA researchers to recruit physicians across different healthcare systems rather than restricting participation to people living near the university.
The six sessions progress through different components of the program:
| Week | Main Focus |
|---|---|
| 1 | Introduction to mindfulness |
| 2 | Mindfulness and self-compassion |
| 3 | Self-directed kindness |
| 4 | Compassion |
| 5 | Equanimity |
| 6 | Joy |
Participants are also encouraged to practice at home. The protocol starts with five minutes per day and gradually increases the recommended practice period to 20 minutes per day over the six weeks.
This progression is notable because the intervention does not require physicians to immediately commit to long daily meditation sessions. Instead, practice time increases gradually as participants become familiar with the techniques.
The Primary Outcome Is Perceived Stress
The main question in the trial is straightforward: does BEST reduce perceived stress compared with a waitlist control?
Researchers will measure perceived stress using the 10-item Perceived Stress Scale, a widely used questionnaire that asks participants how often they have experienced situations as stressful during the previous month.
Scores range from 0 to 40, with higher scores indicating greater perceived stress. Participants complete the measure at baseline, midway through the intervention and after the six-week program.
The researchers selected perceived stress as the study’s single confirmatory primary outcome. This is important because the trial is testing several other outcomes, but those secondary measures will not carry the same confirmatory status.
The study’s statistical plan calls for comparing the BEST and waitlist groups after the intervention while adjusting for baseline stress scores.
The trial is designed to detect a moderate effect, with the researchers estimating that 90 enrolled participants would provide 80% statistical power to detect a between-group effect of approximately d = 0.58, assuming around 19% attrition.
That statistical target also tells readers something about what the study can and cannot establish. If BEST produces a small effect, the trial may not have enough statistical power to identify it reliably. A null result would therefore need to be interpreted alongside the study’s relatively modest sample size.
Researchers Will Also Examine Burnout, Depression And Sleep
Stress is the primary outcome, but the trial measures several additional dimensions of physician well-being.
Researchers will assess burnout, depressive symptoms, psychological well-being and sleep quality. They will also collect blood samples to examine inflammatory biomarkers associated with stress and long-term health.
These measurements allow the researchers to examine whether changes in perceived stress occur alongside changes in other psychological or biological outcomes.
The study will also explore potential mechanisms. The researchers are particularly interested in whether changes in compassion, positive emotions, equanimity and mindfulness help explain any changes in perceived stress.
That creates a more detailed research model than simply asking participants whether they feel better after six weeks.
If stress decreases while compassion and positive emotional states increase, researchers can examine whether those psychological changes statistically account for some of the intervention’s effects. However, the protocol makes clear that these mediation analyses are exploratory and that the planned sample provides relatively low statistical power for specific indirect effects.
For information about the broader scientific literature on meditation, the National Center for Complementary and Integrative Health’s meditation research provides an overview of evidence on mindfulness and meditation, including research on psychological health and well-being.
Blood Samples Add A Biological Dimension
One of the more distinctive elements of the UCLA trial is its inclusion of biological measurements.
Participants provide blood samples at baseline, midway through the program and after the six-week intervention. The samples are intended to help researchers evaluate inflammatory processes associated with stress.
This allows the researchers to examine whether any psychological changes are accompanied by measurable biological changes.
However, the presence of inflammatory biomarkers should not be interpreted as evidence that BEST will reduce inflammation. The trial is specifically designed to test that possibility.
The study also attempts to control for daily biological variation by asking participants to collect blood samples in the morning. This matters because immune and inflammatory markers can fluctuate according to factors such as time of day.
If the trial eventually identifies both psychological and biological changes, future research could investigate whether those changes are reproducible in larger physician populations.
The Control Group Will Receive BEST Later
The trial uses a waitlist control group rather than an active comparison intervention.
Forty-five participants will be randomized to BEST and 45 to the waitlist. The waitlist participants will complete the same assessments but will not participate in the meditation program during the initial study period. They will be offered BEST after the researchers finish collecting the relevant data.
This design allows researchers to compare changes in physicians receiving the intervention with changes occurring naturally over the same period.
However, a waitlist does not control for every factor associated with participating in a meditation program. Participants in BEST know they are receiving an intervention, interact with instructors and other physicians and spend time deliberately practicing. Those factors can influence expectations and behavior independently of the meditation techniques themselves.
An active-control trial would therefore be useful in later research to determine whether BEST provides benefits beyond participation in another structured wellness activity.
The Trial Is Designed Around Physician Schedules
One of the practical challenges of physician wellness programs is that the people most affected by occupational stress may have the least available time to participate.
The UCLA team designed BEST around this constraint.
The program is remote, group-based and scheduled during the workday. Each formal session lasts one hour, while home practice begins at five minutes and gradually increases. Researchers also consulted physicians during the intervention’s development to determine how the program could fit into clinical schedules.
This is more than a logistical detail. Feasibility is one of the study’s explicit aims.
The researchers have established benchmarks for recruitment, retention and adherence. They want to recruit the full 90 participants, retain at least 80% of randomized participants through the final assessment and have at least 80% of intervention participants attend three or more of the six sessions.
A meditation intervention that produces strong effects but cannot realistically fit into a physician’s working life would have limited practical value. By incorporating feasibility into the study design, UCLA is testing whether the program can function within the conditions of actual medical practice.
The Researchers Are Not Treating Meditation As A Solution To Systemic Stress
Perhaps the most important qualification in the UCLA protocol is its acknowledgement that physician burnout has structural causes.
Workload, administrative and clerical demands, electronic health record requirements, staffing and scheduling can all contribute to physician stress. A meditation program cannot directly change those conditions.
The researchers therefore describe BEST as a potential individual-level coping resource rather than a substitute for organizational reform.
This distinction prevents a common problem in wellness research: shifting responsibility for workplace stress entirely onto the individual experiencing it.
If BEST reduces perceived stress, that would demonstrate that physicians may gain a useful psychological resource from the intervention. It would not demonstrate that healthcare organizations can safely ignore excessive workloads or other workplace conditions.
If the intervention produces limited or no benefit, that would also need to be interpreted carefully. An individual-level intervention may have difficulty overcoming stressors created by an organizational environment.
Results Are Expected In Early 2027
The timing of the study is important because the UCLA researchers have not yet reported efficacy results.
Recruitment began December 2, 2025 and is expected to conclude in October 2026. Data collection is scheduled to continue through December 2026, followed by analysis. The protocol states that results are expected in early 2027.
The trial is registered under ClinicalTrials.gov identifier NCT07283744, and its statistical analysis plan was preregistered through the Open Science Framework before researchers accessed outcome data.
That preregistration is useful because it establishes the primary outcome and planned analytical framework before the results are known.
The protocol was also approved by the UCLA Institutional Review Board and states that the study will be conducted and reported according to CONSORT guidelines.
Readers should therefore resist headlines suggesting that UCLA has already proven meditation can reduce physician burnout. The current publication establishes the research question and experimental design, not the answer.
What The UCLA Study Could Add To Meditation Research
Project FIERCE is interesting because it tests a meditation model that combines mindfulness with explicitly positive and interpersonal emotional qualities.
Much of the public conversation around meditation focuses on attention, breathing or simply observing thoughts. BEST takes a different route by deliberately cultivating loving-kindness, compassion, joy and equanimity.
The study could therefore help answer several questions at once.
First, can this particular combination be delivered consistently to physicians working in demanding healthcare environments? Second, can a six-week remote program reduce perceived stress relative to a waitlist? Third, are changes in stress accompanied by differences in burnout, depressive symptoms, sleep or psychological well-being? And fourth, do inflammatory biomarkers change alongside psychological outcomes?
Those questions make the trial more than another test of whether physicians should meditate.
It is an attempt to examine which emotional qualities a meditation program can cultivate, whether those qualities translate into measurable changes in stress, and whether the intervention is practical for people working under sustained occupational pressure.
The answers will not be available until the trial is completed and analyzed.
For now, the strongest evidence-based statement is that UCLA researchers are conducting a randomized controlled trial of a six-week, remotely delivered meditation program involving 90 physicians with elevated stress, with perceived stress as the primary outcome and burnout, depression, sleep, well-being and inflammatory biomarkers among the additional measures.
That makes Project FIERCE a noteworthy test of whether a structured positive-emotion meditation approach can become a practical tool for physician well-being—while leaving open the larger question of how much individual meditation can accomplish without changes to the healthcare systems in which physicians work.