Seattle’s “Big Dark” (October through February) is long and rainy, with average sunshine of 1.5 hours daily. Faster loss of sunlight than in any other contiguous US city increases the prevalence of seasonal affective disorder (SAD). Residents and fellows work long, variable hours and shifts, sometimes in dimly lit areas. Common themes discussed with institutional wellness counselors include sleep disruption, heavy workload, fatigue, and burnout. Low levels of sunlight exacerbate these metrics; studies show exposure to early morning bright light at 10,000 lux can result in substantial improvement by counteracting sleep deprivation effects and improving sustained attention.
In this poster presented at the 2025 ACGME Annual Educational Conferece, held February 20-22, 2025, in Nashville, Tennessee, Dipti Chrastka and team explain how their study found that exposure to bright lightboxes in dimly lit work rooms had a positive impact on resident well-being as measured by a decrease in reported fatigue and distress, and improvement in mood and concentration.
Poster Title: Enhancing Resident Well-Being with Lightbox Therapy: Evidence and Insights
Primary Author: Dipti Chrastka, LMFT
Co-Authors: Mackenzie. H. Holmberg, MD; Connor Fling, MD; Jennifer Best, MD
ACGME: Tell us about your academic and professional role.
Ms. Chrastka: I work as the Wellness Director for University of Washington (UW) Graduate Medical Education and have been in this role for five years. I am a licensed marriage and family therapist and have worked in the field of behavioral health for the last 35 years. In my current role, I provide leadership and strategic direction in the implementation and continuous improvement of programs that support resident and fellow well-being. This includes providing clinical supervision and programmatic direction for wellness and counseling services; as well as developing and implementing a comprehensive program that ensures the provision of professional, ethical, and quality counseling, consultation, referral, education, and outreach services that support residents and fellows in both ACGME-accredited and non-ACGME-accredited programs. I also oversee wellness presentations and events, and serve as a key leader and advocate for comprehensive and integrated attention to holistic resident and fellow health, wellness, and sustainability efforts.
ACGME: Can you briefly describe your research project for us?
Chrastka: We wanted to evaluate if lightboxes can be effective in counteracting sleep deprivation, fatigue, and low mood in residents during Seattle’s winter months. “The Big Dark” is a term for Seattle’s long, dark winters when there is less sunshine. Seattle has the shortest daylight hours (5.5 hours) in the continental US. Long working hours, shift work, administrative burdens, and working in windowless rooms can exacerbate the metrics of well-being, contributing to burnout. Our research project studied if residents would benefit from daily lightbox use (20 to 30 minutes in the morning). We picked two team rooms that were windowless to pilot this project. Lightboxes (10,000 lux) were placed next to resident workstations from December 2023 to mid-June 2024, and then again this winter [December 2024]. Residents completed the POMS 2 [Profile of Mood States] short questionnaire. They also shared their feedback with qualitative quotes.
ACGME: What inspired you to do this project?
Chrastka: During wellness visits, some of our residents and fellows shared their experiences of feeling tired, and lacking energy and motivation, resulting in decreased well-being. One of the attending physicians (who was a fellow at UW) suggested the lightboxes and shared some research supporting their use with medical residents and fellows. I learned more about “the Big Dark” and we decided to get feedback from the community through a survey tool. Program administrators, program directors, and residents shared their own experiences, identified windowless work rooms where lightboxes could be placed, and indicated whether they would like to participate in a pilot project. We got overwhelming responses and applied for a well-being grant. Our goal was to affect well-being on a system level, and this project lent itself well to our goal.
ACGME: What did you discover?
Chrastka: We discovered that daily lightbox use (10,000 lux for 20 to 30 minutes in the morning) improves well-being, mood, and energy levels. We heard very positive feedback from our residents. We also saw how easy it was to implement this project. It required coordination and collaboration with the chief residents and clear messaging to the residents. It was very successful.
ACGME: What was the main takeaway?
Chrastka: The main takeaway is that lightbox therapy is an accessible, non-invasive solution that is easy to implement in a hospital setting. Residents who deal with high levels of stress, long hours, and Seattle’s dark winter months can use lightboxes to positively impact their well-being.
ACGME: Who could benefit from this research?
Chrastka: This project can be scaled to add other sites. [In fact,] we added lightboxes to another team room last November. This research would benefit a large swath of our population, including health care professionals who do shift work, medical residents and fellows, students in general, anyone who may have symptoms of SAD, elderly individuals in care facilities with limited exposure to natural light, and even pregnant and new mothers (some research is looking at ways light therapy can reduce symptoms of prenatal or post-partum depression).