Evidence-Based Practices to Reduce Clergy Stress and Improve Spiritual Well-being

The Duke Endowment prioritizes causal evidence – findings from randomized controlled trials (RCT) and certain quasi experimental studies – to identify approaches that deliver clear benefits for communities and generate learning for the field. In this article, we share how one organization – the Clergy Health Collaborative (CHC) at Duke University – used an RCT to study the impact of specific practices to reduce stress and improve mental well-being among United Methodist Church (UMC) clergy in North Carolina.

A Study in Stress Reduction

To be a member of the clergy is to know stress. Long hours, dealing with conflict and criticism, financial pressures, and carrying the emotional burdens of others can leave clergy with heightened levels of stress and anxiety. 

In 2019, the CHC at Duke University (then named the Clergy Health Initiative), with support from The Duke Endowment, set out to explore whether certain interventions could reduce stress, anxiety and depressive symptoms, and improve spiritual well-being among UMC clergy in North Carolina. In particular, the Endowment and CHC were interested in identifying practices that were practical for ministerial life, allowing pastors to care for themselves without interfering with their ability to give themselves fully to the Church. 

“The Duke Endowment’s founder, James B. Duke, recognized the critical role that churches play in supporting communities, and we have provided investments to uplift rural United Methodist churches in that role for more than 100 years. But if clergy members are stressed, anxious or depressed themselves, it takes a toll on their ability to provide care and leadership for their communities,” said Robb Webb, director of the Endowment’s Rural Church program area. 

“CHC had already explored several promising practices for stress management, but we wanted to dig deeper to determine what was effective specifically for pastors, and by extension, the churches and communities they serve,” added Kristen Richardson-Frick, associate director of the Rural Church program area. 

CHC developed a partially randomized, preference-based, waitlist-controlled trial, named ​“Spirited Life: SELAH.” The SELAH^[1] study ran from April 2020 to October 2021.

The research explored three promising interventions:

• MBSR is an evidence-based suite of tools such as breath work, meditation, yoga and awareness that emphasize being present for each moment of life and being aware of one’s experience without judging it in that moment. Although teaching the entire suite of tools is time-consuming, MBSR includes a particular practice, Loving Kindness Meditation, which has its own evidence base, allowing CHC to promote it following the study. 
• The Daily Examen is a centuries-old, simple but powerful 10- to 15-minute prayer that can be used to reflect on positive emotions, move past negative emotions and align with God’s work. There are many versions of the Daily Examen; SELAH study participants used a common, five-prompt version. 
• Stress Proofing is a physiology-focused approach that includes breathwork and changes to lifestyle habits to mitigate the effects of stress.

The SELAH study authors designated two primary outcomes of interest: Stress symptoms and heart rate variability (HRV). During the six-month period, researchers gathered self-reported information on stress symptoms via the Calgary Symptoms of Stress Inventory. Researchers gathered HRV data via 48-hour monitors before participants learned a practice and again at three months.

As exploratory outcomes, the authors measured anxiety symptoms using the Generalized Anxiety Disorder scale (GAD‑7), depressive symptoms using the Patient Health Questionnaire‑8 (PHQ‑8) and spiritual well-being using the Spiritual Well-Being scale.

The study began with an online workshop to explain the chosen practice to participating clergy, who were then invited to adopt the practice regularly within small cohorts (5−25 people, median of 8) for six months, with occasional online follow-up sessions. Ongoing participation was encouraged via daily automated texts personalized with an individual’s name. 

Over the six-month study^[2] 80 percent of MBSR participants reported an average practice of 30 minutes per day and 70 percent of Daily Examen and Stress Proofing participants reported daily practice.

By the end of the study, MBSR demonstrated positive effects on stress symptoms and HRV (the study’s primary outcomes). Daily Examen and Stress Proofing had positive effects on stress symptoms, but not HRV.

Among the exploratory outcomes, all three programs reduced anxiety and depressive symptoms, and the Daily Examen improved spiritual well-being at six months. 

Designed to Encourage Engagement

The original intent for the SELAH study was to incorporate an initial in-person retreat during the study, but the COVID-19 pandemic forced the creation of a virtual-only experience for participants. This offered a valuable lesson for researchers, who realized that these practices (initially hypothesized to be most effective when taught in-person) can also be effectively delivered and taken up into personal practice through virtual means, decreasing the cost and increasing accessibility. 

Two elements of the SELAH study were different from a traditional randomized controlled trial. The first was that participation in the SELAH study was based on preference: Researchers described each practice to be tested, and asked participants how feasible each practice would be for them and how interested they were in participating in each. Respondents ranked the approaches in order of preference. Those who had a clear preference were randomly assigned to the study group for that practice or to the waitlist (which served as the control group for this study). Those who had no preference were randomly assigned to a practice or the waitlist.

“Had we done a traditional trial where we just assigned people randomly to practices, we likely would have had people who out of the gate believe the practice to be a poor match for their personality or daily realities, and would be unlikely to practice it daily. Because stressors are a daily occurrence, our hope was for participants to engage in the practices almost daily,” said CHC Director Rae Jean Proeschold-Bell, Ph.D.

The second factor that differentiated the SELAH study from most randomized controlled trials was the fact that there were no limits on the number of participants – an aspect made possible by the all-virtual delivery of the stress management interventions and enough financial support to welcome all UMC clergy who were interested. 

“For SELAH, we were able to invite all of the nearly 2,000 UMC clergy who were serving in North Carolina at that time, and ultimately 19 percent participated,” said Proeschold-Bell. ​“Being able to invite everyone to participate also helped with larger uptake and spread once the study was concluded.”

Next Steps: Creating a Baseline for Broader Practice

CHC has done considerable work since the SELAH study concluded to share the findings statewide and then measure the uptake among clergy members. Because 19 percent of all UMC clergy in North Carolina had participated in the study, there was momentum to explore broader adoption. 

In addition to marketing the findings and practices broadly via multiple communication channels, CHC shared the practices in person and modeled them directly to hundreds of clergy and clergy leadership via gatherings hosted by North Carolina’s two United Methodist conferences. 

CHC does not suggest that clergy should adopt any single practice for the rest of their lives but does intentionally and continually remind clergy of the availability of MBSR (the program that had a positive impact on HRV) and the Daily Examen (the program that had a positive impact on spiritual well-being) as part of a suite of tools to use during stress-inducing times in their lives and careers.

To measure uptake, CHC added questions to its biennial statewide clergy health survey to ask about awareness of SELAH practices, any past practice and any current practice. Because the SELAH study ended in 2021, questions related to the practices have appeared in two surveys since then, in 2023 and 2025. 

Survey results showed growth in awareness and practice of MBSR and the Daily Examen over the two-year span, creating a baseline for further measurement. CHC will continue to educate North Carolina UMC clergy about MBSR and the Daily Examen and measure practice maintenance and uptake in subsequent biennial surveys.

Reaching Farther

The Duke Endowment hopes that the positive impacts of the SELAH study might spark interest in both MBSR and Daily Examen practices beyond UMC clergy in North Carolina. 

“The MBSR and Daily Examen practices are easy, inexpensive and align well with prayer and other spiritual practices that clergy already do by themselves and with their congregants, so they align well with The Duke Endowment’s focus on supporting rural UMC clergy,” said Webb. ​“But there is also great potential to benefit other denominations. We would love to see the evidence from the SELAH study encourage uptake of these practices across North Carolina and beyond.”