The effectiveness of self-help mindfulness-based cognitive therapy in a student sample: a randomised controlled trial

Psychometric properties of the short form of the Freiburg Mindfulness Inventory in the Arabic language

Interests in including mindfulness techniques in medical and psychological fields have been increasing recently. Accordingly, it is important to validate the short form of the Freiburg Mindfulness Inventory (FMI-14) to help professionals living in Arabic speaking countries. Thus, we aimed to validate the FMI-14 in the Arabic language (FMI-Ar) in Arabic-speaking university students from Lebanon. We carried-out a cross-sectional study between July and September 2021; 363 university students (mean age 22.65 ± 3.48 years, 61.7% females) were enrolled. The McDonald's omega and Cronbach's alpha values for the total score were excellent (0.92 for both). Confirmatory factor analysis of the one-factor model of the FMI-Ar showed satisfactory fit indices: χ2/df = 218.33/77 = 2.83, RMSEA = 0.071 [0.060-0.082], CFI = 0.92, and TLI = 0.90. Additionally, the FMI score was negatively associated with depression (r = -0.51; p = 0.001) and anxiety (r = -0.48; p < 0.001). All hypotheses (factor, convergent, and divergent validity) related to the FMI-Ar were verified in our study. Therefore, professionals can now benefit from the FMI-Ar, a suitable scale to measure mindfulness among Lebanese University students.

Mixed-Mode Mindfulness-based cognitive therapy for psychological resilience, Self Esteem and Stigma of patients with schizophrenia: a randomized controlled trial

BACKGROUND

People with schizophrenia often face challenges such as lower psychological resilience, reduced self-worth, and increased social stigma, hindering their recovery. Mindfulness-Based Cognitive Therapy (MBCT) has shown promise in boosting psychological resilience and self-esteem while diminishing stigma. However, MBCT demands professional involvement and substantial expenses, adding to the workload of professionals and the financial strain on patients. Mixed-mode Mindfulness-Based Cognitive Therapy (M-MBCT) integrates both "face-to-face" and "self-help" approaches to minimize staff effort and costs. This study aims to assess the impact of M-MBCT on the psychological resilience, self-esteem, and stigma in schizophrenia patients.

METHODS

This randomized, controlled, parallel-group, assessor-blinded clinical trial enrolled 174 inpatients with schizophrenia. Participants were randomly assigned to either the experimental or control group. The experimental group underwent an 8-week M-MBCT intervention, while the control group received standard treatment. Data collection employed the Connor-Davidson Resilience Scale (CD-RISC), Internalized Stigma of Mental Illness Scale (ISMI), and Rosenberg Self-Esteem Scale (RSES) before and after the intervention. Post-intervention, significant differences in ISMI, CD-RISC, and RSES scores were observed between the experimental and control groups.

RESULTS

In the experimental group, ISMI scores notably decreased, while CD-RISC and RSES scores significantly increased (P < 0.05). Multiple linear regression analysis identified age, education, and family history of mental illness as significant factors related to stigma (P < 0.05). Additionally, correlation analysis indicated a significant negative relationship between the reduction in CD-RISC scores and the reduction in ISMI scores (P < 0.05).

CONCLUSION

M-MBCT effectively enhanced psychological resilience and self-esteem while diminishing stigma in individuals with schizophrenia. M-MBCT emerges as a promising treatment option for schizophrenia sufferers.

TRIAL REGISTRATION

The trial was registered at the Chinese Clinical Trial Registry on 03/06/2023 ( www.chictr.org.cn ; ChiCTR ID: ChiCTR2300069071).

Effectiveness of Mindfulness-Based Stress Reduction on Mental Health and Psychological Quality of Life among University Students: A GRADE-Assessed Systematic Review

Background

Psychological distress is a progressive health problem that has been linked to decreased quality of life among university students. This meta-analysis reviews existing randomized controlled trials (RCTs) that have examined the effects of mindfulness-based stress reduction (MBSR) on the relief of psychosomatic stress-related outcomes and quality of life among university students.

Methods

The PubMed, EMBASE, Web of Science, PsycINFO (formerly PsychLit), Ovid MEDLINE, ERIC, Scopus, Google Scholar, ProQuest, and Cochrane Library databases were searched in November 2023 to identify the RCTs for analysis. Data on pathology (anxiety, depression, and perceived stress), physical capacity (sleep quality and physical health), and well-being (mindfulness, self-kindness, social function, and subjective well-being) were analyzed.

Results

Of the 276 articles retrieved, 29 met the inclusion criteria. Compared with control therapies, the pooled results suggested that MBSR had significant effects, reducing anxiety (SMD = -0.29; 95% CI: -0.49 to -0.09), depression (SMD = -0.32; 95% CI: -0.62 to -0.02), and perceived stress (SMD = -0.41; 95% CI: -0.60 to -0.29) and improving mindfulness (SMD = 0.34; 95% CI: 0.08 to 0.59), self-kindness (SMD = 0.57; 95% CI: 0.30 to 1.12), and physical health (SMD = -0.59; 95% CI: -1.14 to -0.04). No significant differences were observed in sleep quality (SMD = -0.20; 95% CI: -0.06 to 0.20), social function (SMD = -0.71; 95% CI: -2.40 to 0.97), or subjective well-being (SMD = 0.07; 95% CI: -0.18 to 0.32). The quality of the evidence regarding sleep quality and physical health outcomes was low.

Conclusions

MBSR therapy appears to be potentially useful in relieving functional emotional disorders. However, additional evidence-based large-sample trials are required to definitively determine the forms of mindfulness-based therapy that may be effective in this context and ensure that the benefits obtained are ongoing. Future studies should investigate more personalized approaches involving interventions that are tailored to various barriers and students' clinical characteristics. To optimize the effects of such interventions, they should be developed and evaluated using various designs such as the multiphase optimization strategy, which allows for the identification and tailoring of the most valuable intervention components.

Effects of self-help mindfulness-based cognitive therapy on mindfulness, symptom change, and suicidal ideation in patients with depression: a randomized controlled study

Objective

This study aimed to evaluate the effects of self-help mindfulness-based cognitive therapy (MBCT-SH) on mindfulness, symptom change, and suicidal ideation in patients with depression.

Methods

For this randomized controlled study, 97 patients were randomly assigned to either the MBCT-SH (n = 48) or control (n = 49) group. The Five Facet Mindfulness Questionnaire (FFMQ), Hamilton Depression Rating Scale (HAMD-24), and Suicide Attitude Questionnaire (SAQ) were used to assess mindfulness, depression symptoms, and suicidal ideation, respectively, at baseline (T0), intervention week 4 (T1), intervention week 8 (T2), and 3-month follow-up (T3). The groups were also compared on treatment costs and readmission rates at a 6-month follow-up.

Results

In the MBCT-SH group, 46 of 48 participants (96%) completed the eight-week program. At T0, there were no statistically significant between-group differences in demographics, clinical characteristics, FFMQ, HAMD-24, or SAQ. Nor were there statistically significant differences on the HAMD-24 or SAQ between the MBCT-SH and control groups at T1 (p = 0.18 and p = 0.59, respectively), while mindfulness was significantly higher in the MBCT-SH group (t = 2.383, p = 0.019). At T2, there were significant between-group differences on the FFMQ, HAMD-24, and SAQ, all of which remained significant at T3. At the 6-month follow-up, per capita treatment costs were 5,298 RMB lower in the MBCT-SH group compared with the control group, while their readmission rates (6.1% and 4.2%, respectively) did not differ significantly.

Conclusion

These findings support the feasibility and effectiveness of MBCT-SH among patients with depression.

Clinical trial registration

http://www.chictr.org.cn, ChiCTR2300077850.

The State- and Trait-Level Effects and Candidate Mechanisms of Four Mindfulness-Based Cognitive Therapy (MBCT) Practices: Two Exploratory Studies

Objectives

The primary aim was to explore state- and trait-level effects and candidate mechanisms of four Mindfulness-Based Cognitive Therapy (MBCT) practices.

Method

One hundred sixty adults self-selected from the general population were randomized to one of four mindfulness practices: body scan, mindful movement, breath and body, and befriending. Study 1 explored state-level self-compassion, mindfulness, decentering (mechanisms), and pleasantness of thoughts, emotions, and body sensations at multiple time points using two single mindfulness sessions. Study 2 explored trait-level self-compassion, mindfulness, decentering, interoceptive awareness, attentional control (mechanisms), anxiety, depression, and psychological quality of life pre-post 2 weeks of daily practice.

Results

In study 1, state-level effects were demonstrated in all candidate mechanisms and outcomes within the whole sample across time points (d = 0.27 to 0.86), except for state decentering. After controlling for pre-scores and additional covariates, no between-group effects were found (p = 0.050 to 0.973). In study 2, trait-level effects were demonstrated in psychological quality of life and most candidate mechanisms within the whole sample (d = 0.26 to 0.64) but no between-group effects were found (p = 0.080 to 0.805). Within the whole sample, after controlling for pre-scores, changes in mindfulness, self-compassion, decentering, and interoceptive awareness (i.e. body listening) were associated with improvements in psychological quality of life (r = 0.23 to 0.40) and self-led mindfulness practice (r = 0.18 to 0.23).

Conclusions

Future research should test the generated hypotheses using well-designed, adequately powered, and theory-driven studies that address universal and specific mechanisms in different populations and contexts.

Pre-registration

This study is not pre-registered.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12671-023-02193-6.

Effects of the original zentangle method on older adults with depressive symptoms a randomized waitlist-controlled trial

Objectives: Depressive symptoms are common among older adults and many of them did not seek for professional help. Although Zentangle has been widely implemented in service centers for older adults in many societies, very limited empirical study has been conducted on the effects of this method. This study aims to evaluate the effects of Zentangle on community-dwelling older adults with depressive symptoms. Methods: A randomised waitlist-controlled trial of Zentangle was conducted. Forty-six community-dwelling older adults with mild to moderate depression were recruited and randomly assigned to a six session Zentangle group or a waitlist control group. The effects were examined by comparing the participants who received a six-week Zentangle intervention with those in the waitlist control group. Patient Health Questionnaire (PHQ-9), Self-compassion Scale - Short form (SCS-SF) and other mental health outcomes were assessed at baseline, post-intervention and six-week follow-up. Results: Repeated measure ANOVA revealed significant Time x Group effects for depression (F (2, 88) = 21.29, p < .001) and self-compassion (F (2, 88) = 18.50, p < .001) with a large net effect size. Six-week follow-up indicated that such improvements were sustained. Conclusion: This study provides preliminary support that the Zentangle programme is an effective alternative treatment approach for older adults with mild to moderate depression. The original Zentangle method can reduce depressive symptoms and cultivate self-compassion. Further research is necessary to expand our understanding of the underlying mechanisms of how the original Zentangle method works. Trial registration: ISRCTN66410347.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-023-04536-x.

Clinical Effectiveness and Cost-Effectiveness of Supported Mindfulness-Based Cognitive Therapy Self-help Compared With Supported Cognitive Behavioral Therapy Self-help for Adults Experiencing Depression: The Low-Intensity Guided Help Through Mindfulness (LIGHTMind) Randomized Clinical Trial

Importance

Depression is prevalent. Treatment guidelines recommend practitioner-supported cognitive behavioral therapy self-help (CBT-SH) for mild to moderate depression in adults; however, dropout rates are high. Alternative approaches are required.

Objective

To determine if practitioner-supported mindfulness-based cognitive therapy self-help (MBCT-SH) is superior to practitioner-supported CBT-SH at reducing depressive symptom severity at 16 weeks postrandomization among patients with mild to moderate depression and secondarily to examine if practitioner-supported MBCT-SH is cost-effective compared with practitioner-supported CBT-SH.

Design, Setting, and Participants

This was an assessor- and participant-blinded superiority randomized clinical trial with 1:1 automated online allocation stratified by center and depression severity comparing practitioner-supported MBCT-SH with practitioner-supported CBT-SH for adults experiencing mild to moderate depression. Recruitment took place between November 24, 2017, and January 31, 2020. The study took place in 10 publicly funded psychological therapy services in England (Improving Access to Psychological Therapies [IAPT]). A total of 600 clients attending IAPT services were assessed for eligibility, and 410 were enrolled. Participants met diagnostic criteria for mild to moderate depression. Data were analyzed from January to October 2021.

Interventions

Participants received a copy of either an MBCT-SH or CBT-SH workbook and were offered 6 support sessions with a trained practitioner.

Main Outcomes and Measures

The preregistered primary outcome was Patient Health Questionnaire (PHQ-9) score at 16 weeks postrandomization. The primary analysis was intention-to-treat with treatment arms masked.

Results

Of 410 randomized participants, 255 (62.2%) were female, and the median (IQR) age was 32 (25-45) years. At 16 weeks postrandomization, practitioner-supported MBCT-SH (n = 204; mean [SD] PHQ-9 score, 7.2 [4.8]) led to significantly greater reductions in depression symptom severity compared with practitioner-supported CBT-SH (n = 206; mean [SD] PHQ-9 score, 8.6 [5.5]), with a between-group difference of -1.5 PHQ-9 points (95% CI, -2.6 to -0.4; P = .009; d = -0.36). The probability of MBCT-SH being cost-effective compared with CBT-SH exceeded 95%. However, although between-group effects on secondary outcomes were in the hypothesized direction, they were mostly nonsignificant. Three serious adverse events were reported, all deemed not study related.

Conclusions and Relevance

In this randomized clinical trial, practitioner-supported MBCT-SH was superior to standard recommended treatment (ie, practitioner-supported CBT-SH) for mild to moderate depression in terms of both clinical effectiveness and cost-effectiveness. Findings suggest that MBCT-SH for mild to moderate depression should be routinely offered to adults in primary care services.

Trial Registration

isrctn.org Identifier: ISRCTN13495752.

A retrospective examination of changes in drinking motives during the early COVID-19 pandemic

OBJECTIVE

The COVID-19 pandemic has led to substantial changes in college student alcohol use. Changes in drinking motives may explain some of these changes in drinking patterns. The purpose of the present study is to explore how drinking motives and alcohol use have changed amongst college students considering the timeframes before and after the onset of COVID-19 pandemic (i.e., March 2020) in the United States. We hypothesized that there would be significant changes in drinking motives after March 2020, which would be significantly related to changes in alcohol use.

METHODS

Participants for the current study were undergraduate students reporting lifetime alcohol use (n = 198, M_age = 21.3, 66.7% female, 86.4% White) recruited through online advertisements in classes to complete an online survey in April 2020. Participants were asked to report on their drinking motives and alcohol use considering the timeframes before and after the onset of closures and stay-at-home orders during the COVID-19 pandemic (i.e., before and since March 2020).

RESULTS

Paired samples t-tests revealed that endorsement of social (t[171) = 12.79, p < .001, d = 1.16) and conformity motives significantly decreased (t[170] = 4.46, p < .001, d = 0.31), while endorsement of coping motives significantly increased (t[172] = -2.70, p = .008, d = .15) after the onset of COVID-19. Linear regression analyses, controlling for drinking motives before March 2020, revealed that changes in enhancement (β = -.47, p < .001) and coping motives (β = -.22, p = .04) were significantly associated with changes in alcohol use quantity.

CONCLUSIONS

Findings of the present study support the need for interventions to target coping and social drinking to reduce risk for alcohol use.

Group Nature-Based Mindfulness Interventions: Nature-Based Mindfulness Training for College Students with Anxiety

The mental health crisis across college campuses is accelerating, with anxiety listed as the top mental health issue for undergraduate college students. Although evidence suggests the COVID-19 pandemic escalated the mental health crisis on college campuses, pre-COVID-19 anxiety among college students was on the rise. Research supports Mindfulness Based Interventions (MBIs) to reduce anxiety among college students. Additionally, exposure to natural environments, which are accessible to students on college campuses, is effective in reducing anxiety. While brief nature-based mindfulness interventions appear effective in reducing anxiety among college students, these interventions are often offered in isolation without social interaction among group members and lack intentional integration of mindfulness and nature-related theories. The purpose of this work is to describe a framework for integrating the use of Mindfulness and Attention Restoration Theory (ART) in an innovative psychoeducational group intervention, Nature-Based Mindfulness Training © (NBMT), for college students with anxiety. In conclusion, we argue for the need to intentionally integrate mindfulness and nature into nature-based mindfulness interventions as an effective and sustainable means to reduce anxiety. Limitations and areas for future research are described.

Effects of self-guided stress management interventions in college students: A systematic review and meta-analysis

BACKGROUND

College students face several sources of stress. Self-guided stress management interventions offer an excellent opportunity for scaling up evidence-based interventions for self-management of these stresses. However, little is known about the overall effects of these interventions. Increasing this understanding is essential because self-guided stress management interventions might be a cost-effective and acceptable way of providing help to this important segment of the population during a critical life course stage.

METHODS

We carried out a systematic literature search of bibliographical databases (PubMed, PsycINFO, Embase, and Cochrane Library) for randomized controlled trials (RCTs) of self-guided stress management interventions published up through April 2020. We conducted two separate meta-analyses for perceived stress, depression, and anxiety. The first included interventions for general college student samples. The second included studies for students with high levels of perceived stress.

RESULTS

The first meta-analysis included 26 studies with 29 intervention-control comparisons based on a total of 4468 students. The pooled effect size was small but statistically significant (g = 0.19; 95% CI [0.10, 0.29]; p < 0.001). Results showed moderate heterogeneity across studies [I ² = 48%; 95% CI (19, 66%)]. The second meta-analysis, included four studies based on a total of 491 students with high levels of stress. The pooled effect size was small but statistically significant (g = 0.34; 95% CI [0.16, 0.52]; p < 0.001). Results showed no heterogeneity across studies (I ² = 0%; 95% CI [0, 79%]), but risk of bias was substantial.

DISCUSSION

Our results suggest that self-guided stress management programs may be effective when compared to control conditions, but with small average effects. These programs might be a useful element of a multi-component intervention system. Given the psychological barriers to treatment that exist among many college students, self-help interventions might be a good first step in facilitating subsequent help-seeking among students reluctant to engage in other types of treatment. More studies should be conducted to investigate these interventions, sample specifications, mediating effects, and individual-level heterogeneity of effects.

Effects of Mindfulness Meditation Intervention on Depressive Symptoms in Emerging Adults: A Systematic Review and Meta-Analysis

Introduction: Depression in emerging adults (20-29 years of age), a transition from adolescence to adulthood, is a mental health problem globally. Antidepressants and psychotherapy have limited effectiveness and might not be available worldwide. Alternative and complementary treatments, such as mindfulness meditation, are growing. Objective: We examined the effects of mindfulness interventions on depression in emerging adults and explored the moderating effects of participants, methods, and intervention characteristics. Design: Systematic review and meta-analysis. Subjects: Emerging adults. Interventions: Mindfulness meditation interventions versus control groups. Outcomes measures: depressive symptoms. Results: Forty-five studies resulted in 49 comparisons, including 3479 participants (23.0-2.7 years old); 1826 participants practiced mindfulness and 1653 served as controls. Overall, mindfulness interventions showed significant reduction in depression compared with controls (g = 0.44, 95% confidence interval: 0.33-0.55). Mindfulness interventions conducted in Asian countries had a greater decrease in depression (g = 0.69) than studies conducted in North America (g = 0.44) or Europe (g = 0.23). Mindfulness interventions showed greater reductions in depression in studies with higher proportion of females (Slope = 0.010, τ² = 0.07, Q_between = 7.10, p = 0.008). Mindfulness interventions conducted in emerging adults with depressive disorders reduced depression more (g = 1.12) than in emerging adults without (g = 0.40). Providing mindfulness intervention in a group setting had a greater reduction of depression (g = 0.54) than on an individual basis (g = 0.30). More minutes of unstructured mindfulness practice per session showed a greater reduction in depressive symptoms (Slope = 0.016, Q_between = 1.34, p = 0.035). Using intention-to-treat analyses showed a lower ES (g = 0.14) than not using it (g = 0.55). Other quality indicators were not significant moderators. Primary researchers did not report the adverse effects of mindfulness interventions. Conclusion: Mindfulness interventions somewhat improved depression in emerging adults. Because primary researchers did not report the adverse effects, mindfulness interventions should be used with caution. Future researchers might study the adverse effects of mindfulness interventions as well as the long-term effects.

Teachers "Finding Peace in a Frantic World": An Experimental Study of Self-Taught and Instructor-Led Mindfulness Program Formats on Acceptability, Effectiveness, and Mechanisms

Mindfulness training (MT) is considered appropriate for school teachers and enhances well-being. Most research has investigated the efficacy of instructor-led MT. However, little is known about the benefits of using self-taught formats, nor what the key mechanisms of change are that contribute to enhanced teacher well-being. This study compared instructor-led and self-taught MT based on a book (Williams & Penman, 2011) in a sample of secondary school teachers. We assessed expectancy, the degree to which participants believed the intervention was effective, their program engagement, well-being and psychological distress, and evaluated whether mindfulness and self-compassion skills acted as mediators of outcomes. In total, 206 teachers from 43 schools were randomized by school to an instructor-led or self-taught course—77% female, mean age 39 years (SD = 9.0). Both MT formats showed similar rates of participant expectancy and engagement, but the instructor-led arm was perceived as more credible. Using linear mixed-effects models, we found the self-taught arm showed significant pre-post improvements in self-compassion and well-being, while the instructor-led arm showed such improvements in mindfulness, self-compassion, well-being, perceived stress, anxiety, depression, and burnout. Changes over time significantly differed between the groups in all these outcomes, favoring the instructor-led arm. The instructor-led arm, compared with the self-taught, indirectly improved teacher outcomes by enhancing mindfulness and self-compassion as mediating factors. Mindfulness practice frequency had indirect effects on teacher outcomes through mindfulness in both self-taught and instructor-led arms. Our results suggest both formats are considered reasonable, but the instructor-led is more effective than the self-taught. Trial registration: ISRCTN18013311.

Mindfulness training enhances teachers’ well-being. This study compared two different mindfulness training formats with a sample of 206 secondary school teachers using an experimental design. Results suggested that teachers’ well-being was increased in both formats of delivery and both generated similar expectancy and engagement with the mindfulness practice; but the instructor-led format appeared to be more credible and effective and was also able to reduce teachers’ stress, anxiety, depressive symptomatology, and burnout. In contrast, the self-taught program might be useful for those teachers who cannot access or commit to an instructor-led program, provided they engage with mindfulness practice. This study suggests two forms for teachers to learn mindfulness, instructor-led and self-taught, as a way to support well-being, each with its own advantages.

Can a little bit of mindfulness do you good? A systematic review and meta-analyses of unguided mindfulness-based self-help interventions

Over the last decade there has been an explosion of interest in mindfulness-based self-help (MBSH) interventions. While widely available and extensively promoted, there is little consensus on their impact in public health or healthcare contexts. We present a systematic review and meta-analyses of 83 randomized controlled trials, comparing unguided MBSH to control conditions on outcomes of depression, mindfulness, anxiety, stress and/or wellbeing/ quality of life. A random effects model was used to compute post-intervention, between-groups effect sizes for each outcome. MBSH demonstrated small, statistically significant effects at post-interventions for outcomes of depression (g = -0.23), mindfulness (g = 0.37) anxiety (g = -0.25), stress (g = -0.41) and wellbeing/ quality of life (g = 0.34). Significant effects were retained at follow-up for mindfulness, stress and wellbeing/ quality of life but not for depression or anxiety. Planned moderator analyses demonstrated significantly larger effects of MBSH when compared to inactive, versus active-control conditions on all outcomes except wellbeing/ quality of life, and non-digital MBSH interventions demonstrated significantly greater effects on depression, mindfulness and wellbeing/ quality of life outcomes than digitally-delivered MBSH. When studies that utilised samples selected for mental and physical health-related difficulties were respectively compared to studies that utilised unselected samples, no significant moderation effects were observed. In sum, these findings provide evidence for the effectiveness of unguided MBSH in public health settings and the practical, access-related implications of this are discussed.

Is clinician-supported use of a mindfulness smartphone app a feasible treatment for depression? A mixed-methods feasibility study

Depression is the leading cause of disability globally and has serious consequences for the individual, their family and for society. Effective, accessible and affordable treatments are urgently needed. In-person group-based mindfulness-based interventions are an effective treatment for depression, but are not widely available and can be costly. Clinician supported use of mindfulness self-help resources such as mindfulness smartphone applications could widen access at a reduced cost, but there are key feasibility questions that need answering. This is a mixed-methods feasibility study of a blended intervention involving the mindfulness smartphone app Headspace alongside six clinician support sessions with mental health treatment seeking adults experiencing moderate to moderately severe symptoms of depression. In line with recommendations for feasibility studies, we examine whether: (1) it is possible to recruit participants to this novel intervention, (2) participants engage with the intervention, (3) participants and clinicians find the intervention acceptable, and (4) pre-post outcomes on measures of depression (primary outcome), anxiety, wellbeing, mindfulness, self-compassion, rumination and worry indicate effectiveness. Findings show that recruitment is feasible with 54 participants enrolled in the intervention within a 6-month window. In terms of engagement, 44.4% completed at least 80% of recommended Headspace sessions and 72.2% of participants attended at least three clinician support sessions. Clinician-supported Headspace was deemed acceptable by participants and clinicians. Pre-post effect sizes were statistically significant and in the small-medium or medium-large range on all outcomes, with an effect size of d = 0.69 (95% CI: 0.34-1.04) for the primary outcome of depression symptom severity. The number of Headspace sessions engaged with was associated with greater reduction in depression symptom severity. Findings suggest that a blended intervention combining Headspace with clinician support has potential as a first-line treatment for moderate/moderately severe depression, but findings are too preliminary to recommend the intervention outside of a research trial. Important caveats are noted including the need for future research to examine predictors of engagement with Headspace sessions so that engagement can be enhanced, to measure the longer term effects of such interventions and to better understand the potential for lasting negative effects of the intervention so that these can be minimised.

The Mental Health and Wellbeing of University Students: Acceptability, Effectiveness, and Mechanisms of a Mindfulness-Based Course

Mental health problems are relatively common during university and adversely affect academic outcomes. Evidence suggests that mindfulness can support the mental health and wellbeing of university students. We explored the acceptability and effectiveness of an 8-week instructor-led mindfulness-based course ("Mindfulness: Finding Peace in a Frantic World"; Williams and Penman, 2011) on improving wellbeing and mental health (self-reported distress), orientation and motivation towards academic goals, and the mechanisms driving these changes. Eighty-six undergraduate and post-graduate students (>18 years) participated. Students engaged well with the course, with 36 (48.0%) completing the whole programme, 52 (69.3%) attending 7 out of 8 sessions, and 71 (94.7%) completing at least half. Significant improvements in wellbeing and mental health were found post-intervention and at 6-week follow-up. Improvements in wellbeing were mediated by mindfulness, self-compassion, and resilience. Improvements in mental health were mediated by improvements in mindfulness and resilience but not self-compassion. Significant improvements in students' orientation to their academic goal, measured by "commitment" to, "likelihood" of achieving, and feeling more equipped with the "skills and resources" needed, were found at post-intervention and at 6-week follow-up. Whilst exploratory, the results suggest that this mindfulness intervention is acceptable and effective for university students and can support academic study.

Efficacy of a mindfulness-based programme with and without virtual reality support to reduce stress in university students: A randomized controlled trial

OBJECTIVES

To evaluate the efficacy of a mindfulness-based programme (MBP) for reducing stress in university students and its action mechanisms and to explore the capacity of virtual reality (VR) exposure to enhance adherence to the intervention.

METHODS

This randomized controlled trial (RCT) involved assessment time points of baseline, posttreatment, and 6-month follow-up. A total of 280 students from two Spanish universities were randomly assigned to 'MBP', 'MBP + VR', or 'Relaxation' (active controls). Perceived stress posttreatment was the primary outcome; wellbeing and academic functional outcomes were assessed as well. Multilevel mixed-effects models were performed to estimate the efficacy of the programme.

RESULTS

Both 'MBP' (B = -2.77, d = -0.72, p = .006) and 'MBP + VR' (B = -2.44, d = -0.59, p = .014) were superior to 'Relaxation' in improving stress, as well as most of the secondary outcomes, with medium-to-large effects posttreatment and at follow-up. The long-term effects of MBPs on stress were mediated by mindfulness and self-compassion in parallel. Treatment adherence was improved in the 'MBP + VR' group, with higher retention rates and session attendance (p < .001).

CONCLUSIONS

This RCT supports the efficacy of an MBP compared to relaxation for reducing stress in university students through mindfulness and self-compassion as mechanisms of change. VR exposure may enhance treatment adherence.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03771300.

A systematic review and meta-analysis of psychological interventions to improve mental wellbeing

Our current understanding of the efficacy of psychological interventions in improving mental states of wellbeing is incomplete. This study aimed to overcome limitations of previous reviews by examining the efficacy of distinct types of psychological interventions, irrespective of their theoretical underpinning, and the impact of various moderators, in a unified systematic review and meta-analysis. Four-hundred-and-nineteen randomized controlled trials from clinical and non-clinical populations (n = 53,288) were identified for inclusion. Mindfulness-based and multi-component positive psychological interventions demonstrated the greatest efficacy in both clinical and non-clinical populations. Meta-analyses also found that singular positive psychological interventions, cognitive and behavioural therapy-based, acceptance and commitment therapy-based, and reminiscence interventions were impactful. Effect sizes were moderate at best, but differed according to target population and moderator, most notably intervention intensity. The evidence quality was generally low to moderate. While the evidence requires further advancement, the review provides insight into how psychological interventions can be designed to improve mental wellbeing.

Training School Teachers to Deliver a Mindfulness Program: Exploring Scalability, Acceptability, Effectiveness, and Cost-effectiveness

BACKGROUND

There is growing research support for the use of mindfulness training (MT) in schools, but almost no high-quality evidence about different training models for people wishing to teach mindfulness in this setting. Effective dissemination of MT relies on the development of scalable training routes.

OBJECTIVE

To compare 4 training routes for school teachers wishing to deliver MT differing in intensity and potential scalability, considering teaching competency, training acceptability, and cost-effectiveness.

METHODS

Schools were randomized to an existing route comprising an 8-session instructor-led personal mindfulness course, combined with 4-day MT program training, or 1 of 3 more scalable, lower intensity, alternatives: an instructor-led personal mindfulness course combined with 1-day MT program training, a self-taught personal mindfulness course (delivered through a course book) combined with 4-day MT program training, and a self-taught personal mindfulness course combined with 1-day MT program training.

RESULTS

Attrition from training was substantial across all routes. The instructor-led course was more effective than the self-taught course in increasing teachers' personal mindfulness skills. Even the most intensive (existing) training route brought only 29% of the teachers commencing training, and 56% of those completing the study protocol, to the required minimum competency threshold (an advanced beginner rating on an adapted version of the Mindfulness-based Interventions Teaching Assessment Criteria). The differences in levels of competency achieved by existing training compared with the more scalable alternatives were modest, with economic evaluation suggesting that the existing route was both more expensive and more effective than lower intensity alternatives, but with no statistically significant differences between routes.

CONCLUSIONS

This research questions the move toward abbreviating teacher training to increase scalability and suggests instead that many teachers require additional support to ensure competency from first delivery of MT in the classroom.

Adverse events in meditation practices and meditation-based therapies: a systematic review

OBJECTIVE

Meditation techniques are widely used as therapy and wellbeing practices, but there are growing concerns about its potential for harm. The aim of the present study is to systematically review meditation adverse events (MAEs), investigating its major clinical categories and its prevalence.

METHOD

We searched PubMed, PsycINFO, Scopus, Embase and AMED up to October 2019. Eligible studies included original reports of meditation practices (excluding related physical practices such as Yoga postures) with adult samples across experimental, observational and case studies. We identified a total of 6742 citations, 83 of which met the inclusion criteria for MAEs with a total of 6703 participants who undertook meditation practice.

RESULTS

Of the 83 studies analysed, 55 (65%) included reports of at least one type of MAE. The total prevalence of adverse events was 8.3% (95% CI 0.05-0.12), though this varied considerably across types of studies - 3.7% (95% CI 0.02-0.05) for experimental and 33.2% (95% CI 0.25-0.41) for observational studies. The most common AEs were anxiety (33%, 18), depression (27%, 15) and cognitive anomalies (25%, 14); gastrointestinal problems and suicidal behaviours (both 11%, 6) were the least frequent.

CONCLUSION

We found that the occurrence of AEs during or after meditation practices is not uncommon, and may occur in individuals with no previous history of mental health problems. These results are relevant both for practitioners and clinicians, and contribute to a balanced perspective of meditation as a practice that may lead to both positive and negative outcomes.

Positive intervention for depression and teacher-student relationship in Iranian high school girl students with moderate/mild depression: a pilot randomized controlled trial

BACKGROUND

Positive intervention (PI) is a modern and therapeutic approach broadly based on the principles of positive psychology (Rashid in J Posit Psychol 1:25-40, 2014). PI effects at schools have received little attention to date. However, since PI offers a focus on the positive aspects of human experience (Seligman and Csikszentmihalyi in Am Psychol 55:5-14, 2000), we hypothesized that it could exert positive changes in the teacher-student relationship (TSR) and depression symptoms. Therefore, the mentioned pilot study conducted in this article aimed at evaluating PI effects on depression and TSR among Iranian high school girl students with moderate/mild depression.

METHOD

In this research, 60 eligible female students (aged 15-18) with a Beck Depression Inventory-II (BDI-II) mild-moderate depression diagnosis, were randomly divided into PI (n = 30) and control groups (n = 30) at the time of entering the study and 2 months later following their assessments through the Inventory of TSR (IT-SR) and BDI-II. The intervention group participated in 8-week 2 h group sessions of PI and the control group was evaluated without any intervention.

RESULTS

The study was completed with a total number of 49 girls [PI group (n = 24), and control group (n = 25)] and everybody participate in 8 sessions. The intervention group was effective on the variables of BDI-II and IT-SR in a way that the involved girls increased their communication (p = 0.001, d = 0.17), trust (p = 0.001 d = 0.14) after PI training and decreased alienation (p = 0.012, d = 0.11) and depression (p = 0.001, d = 0.15) among other high school students.

CONCLUSION

This intervention could function as an unspecific component of a stepped care approach for teenage girls suffering from depression. This study recommends more RCT with large sample sizes among high school boys students and follow-up.

Use of Meditation and Cognitive Behavioral Therapies for the Treatment of Stress, Depression and Anxiety in Students. A Systematic Review and Meta-Analysis

The prevalence of mental health problems within students due to high academic demands and learning difficulties is a current challenge the field of education. The aim of this study is to review the scientific literature in order to analyze the effect produced by cognitive-behavioral programs and meditation strategies on stress, anxiety, and depression in students. A further aim is to identify the determinants of treatment success. The bibliographic search was carried out using Web of Science, specifically in the categories of "Education and Educational Research" and "Psychology", obtaining a sample of 122 articles published between 2007 and 2018. Studies were included which had a pre-experimental or quasi-experimental design and included pre-test and post-test phases. Following application of inclusion criteria, 34 articles were selected for inclusion in a meta-analysis of the random effects of each variable. This obtained an average effect size of -0.41 for stress, -0.37 for anxiety, and -0.30 for depression. Three moderating variables were analyzed, with significant correlations being found for the type of treatment relating to stress (Q = 11.01, df = 2, p = 0.004, R2 = 0.294) and depression (Q = 6.14, df = 2, p = 0.048; R2 = 0.436). The stage of education of the individuals was also found to impact upon anxiety intervention success (Q = 13.093 df = 2, p = 0.0009, R2 = 0.196). Interventions mainly addressed the importance of meditation strategies, mindfulness programs, and cognitive-behavioral therapy to reduce stress, anxiety, and depression in students. This supports the need to increase research at an early age, considering the treatment of mental health as a key factor influencing academic performance and quality of life.

A systematic review of prevention programs targeting depression, anxiety, and stress in university students

BACKGROUND

Given the prevalence of anxiety, depression, and stress among university students, it is important to assess the effectiveness of prevention programs for these problems. Beyond examining effect sizes, applying a common elements approach can enhance our understanding of which practice elements are most frequently included in symptom-reducing programs.

METHOD

This review examined effective (i.e., outcome-producing) prevention programs targeting depression, anxiety, and/or stress in university students. Programs could be delivered in a group-based, online/computer-delivered, or self-administered format and at the universal, selective, or indicated prevention level.

RESULTS

The resulting sample of 62 articles covered 68 prevention programs for college, graduate, or professional students across 15 countries. Average effect sizes for programs were moderate (overall g = 0.65), regardless of delivery format or prevention level. The most common practice elements (overall and for programs producing large effects) were: psychoeducation (72%), relaxation (69%), and cognitive monitoring/restructuring (47%). Many programs were limited by: (a) symptom target-outcome mismatches, (b) disproportionately female samples, and (c) inconsistently reported adherence data.

LIMITATIONS

Commonness of practice elements across outcome-producing interventions does not imply their extensiveness nor unique contribution to effectiveness. Coding was based on information in articles rather than manuals, and inter-rater reliability was moderate for some practice elements.

CONCLUSION

The outcome-producing prevention programs in our sample had common practice elements and produced moderate reduction in symptoms overall. Future research of depression, anxiety, and stress prevention programs for university students can investigate practice elements' unique and combined impact on outcomes, further explore under-tested practice elements, and use findings to inform intervention design.

Can Mindfulness-Based Training Improve Positive Emotion and Cognitive Ability in Chinese Non-clinical Population? A Pilot Study

OBJECTIVE

Based on eastern philosophy, mindfulness is becoming popular for human being's mental health and well-being in western countries. In this study, we proposed to explore the effectiveness and potential pathway of mindfulness-based training (MBT) on Chinese Non-clinical higher education students' cognition and emotion.

METHODS

A paired control design was used. 48 higher education students (24 in MBT group, 24 in control group) were recruited in the study. The MBT group engaged in a 12-week MBT. A package of measurements, including sustained attention tasks (The Continuous Performance Test, CPT), executive function task (Stroop) for cognitive functions, the self-reported mindfulness levels (The Mindful Attention Awareness Scale, MAAS) and emotion (The Profile of Mood States, POMS), were apply for all participants at baseline and every 4 weeks during next 12 weeks.

RESULTS

There were no differences in baseline demographic variables between two groups. Over the 12-week training, participants assigned to MBT group had a significantly greater reduction in CPT reaction time (Cohen's d 0.72), significantly greater improvement in positive emotion (Vigor-Activity, VA) (Cohen's d 1.08) and in MAAS (Cohen's d 0.49) than those assigned to control group. And, MAAS at 4th week could significantly predict the CPT RT and VA at 8th week in the MBT group. VA at 4th week could significantly predict the CPT RT at 8th week (B = 4.88, t = 2.21, p = 0.034, R2 = 0.35).

CONCLUSION

This study shows the efficiency of 12-week MBT on Chinese Non-clinical students' cognition and emotion. Mindfulness training may impact cognition and emotion through the improvement in mindfulness level, and may impact cognition through the improvement in positive emotion.

Self-Help for Social Anxiety: Randomized Controlled Trial Comparing a Mindfulness and Acceptance-Based Approach With a Control Group

There are many barriers to the delivery of evidence-based treatment, including geographical location, cost, and stigma. Self-help may address some of these factors but there is a paucity of research on the efficacy of self-help for many problems, including social anxiety. The present research evaluated the efficacy of a mindfulness and acceptance-based self-help approach for the treatment of social anxiety. Individuals seeking help for social anxiety or shyness were recruited from the community. Participants (N = 117) were randomly assigned to a book (n = 58) or wait-list control condition (n = 59) on a 1:1 ratio. Hierarchical linear modelling results supported the efficacy of the self-help condition with between-group effect sizes on social anxiety outcomes ranging from .74 to .79. Significant change was also observed on self-compassion, mindfulness, acceptance, and depression. Some variables, including social anxiety and acceptance, were assessed weekly for those in the book condition. Additional participants (n = 35) were recruited for the book condition increasing the sample size to 93 for the latent change score modelling analyses. A unidirectional model was supported: increases in acceptance were associated with subsequent decreases in social anxiety. Overall these results support the use of a mindfulness and acceptance-based self-help approach for social anxiety.

Efficacy of the Mindfulness Meditation Mobile App "Calm" to Reduce Stress Among College Students: Randomized Controlled Trial

Background

College students experience high levels of stress. Mindfulness meditation delivered via a mobile app may be an appealing, efficacious way to reduce stress in college students.

Objective

We aimed to test the initial efficacy and sustained effects of an 8-week mindfulness meditation mobile app—Calm—compared to a wait-list control on stress, mindfulness, and self-compassion in college students with elevated stress. We also explored the intervention’s effect on health behaviors (ie, sleep disturbance, alcohol consumption [binge drinking], physical activity, and healthy eating [fruit and vegetable consumption]) and the feasibility and acceptability of the app.

Methods

This study was a randomized, wait-list, control trial with assessments at baseline, postintervention (8 weeks), and at follow-up (12 weeks). Participants were eligible if they were current full-time undergraduate students and (1) at least 18 years of age, (2) scored ≥14 points on the Perceived Stress Scale, (3) owned a smartphone, (4) were willing to download the Calm app, (5) were willing to be randomized, and (7) were able to read and understand English. Participants were asked to meditate using Calm at least 10 minutes per day. A P value ≤.05 was considered statistically significant.

Results

A total of 88 participants were included in the analysis. The mean age (SD) was 20.41 (2.31) years for the intervention group and 21.85 (6.3) years for the control group. There were significant differences in all outcomes (stress, mindfulness, and self-compassion) between the intervention and control groups after adjustment for covariates postintervention (all P<.04). These effects persisted at follow-up (all P<.03), except for the nonreacting subscale of mindfulness (P=.08). There was a significant interaction between group and time factors in perceived stress (P=.002), mindfulness (P<.001), and self-compassion (P<.001). Bonferroni posthoc tests showed significant within-group mean differences for perceived stress in the intervention group (P<.001), while there were no significant within-group mean differences in the control group (all P>.19). Similar results were found for mindfulness and self-compassion. Effect sizes ranged from moderate (0.59) to large (1.24) across all outcomes. A significant group×time interaction in models of sleep disturbance was found, but no significant effects were found for other health behaviors. The majority of students in the intervention group reported that Calm was helpful to reduce stress and stated they would use Calm in the future. The majority were satisfied using Calm and likely to recommend it to other college students. The intervention group participated in meditation for an average of 38 minutes/week during the intervention and 20 minutes/week during follow-up.

Conclusions

Calm is an effective modality to deliver mindfulness meditation in order to reduce stress and improve mindfulness and self-compassion in stressed college students. Our findings provide important information that can be applied to the design of future studies or mental health resources in university programs.

Trial Registration

ClinicalTrials.gov NCT03891810; https://clinicaltrials.gov/ct2/show/NCT03891810

A Mindfulness-Based Intervention: Differential Effects on Affective and Processual Evolution

OBJECTIVES

A 20-minutes-a-day, self-help, mindfulness-based intervention was conducted for 6 weeks with a French community sample. First, the intervention effects on affective and functioning variables were evaluated. Then, a differential approach was used to examine improvement potentiality and the perceived benefits of mindfulness according to the participants' baseline mindfulness competencies.

METHOD

Participants were non-randomly assigned to a control group on the waiting list (n = 44) or a mindfulness group (n = 47). Self-report measures assessed anxiety, depression, psychological distress, mindfulness, negative self-oriented cognition, and experiential avoidance.

RESULTS

Improvements in the variables were observed for the mindfulness group but not for the control group, with effect sizes ranging between .53 and .88. Low baseline levels of mindfulness predicted greater improvement in mindfulness (r = -0.55, p < .001) than high baseline levels.

CONCLUSIONS

Mindfulness practice elicited several positive outcomes regarding affective variables, highlighting emotional functioning changes.

Mindfulness-based cognitive therapy in patients with depression: current perspectives

Mindfulness-based cognitive therapy (MBCT) was developed to prevent relapse in individuals with depressive disorders. This widely used intervention has garnered considerable attention and a comprehensive review of current trends is warranted. As such, this review provides an overview of efficacy, mechanisms of action, and concludes with a discussion of dissemination. Results provided strong support for the efficacy of MBCT despite some methodological shortcomings in the reviewed literature. With respect to mechanisms of action, specific elements, such as mindfulness, repetitive negative thinking, self-compassion and affect, and cognitive reactivity have emerged as important mechanisms of change. Finally, despite a lack of widespread MBCT availability outside urban areas, research has shown that self-help variations are promising. Combined with findings that teacher competence may not be a significant predictor of treatment outcome, there are important implications for dissemination. Taken together, this review shows that while MBCT is an effective treatment for depression, continued research in the areas of efficacy, mechanisms of action, and dissemination are recommended.

A Randomised Controlled Trial of a Brief Online Mindfulness-Based Intervention in a Non-clinical Population: Replication and Extension

Building on previous research, this study compared the effects of two brief, online mindfulness-based interventions (MBIs; with and without formal meditation practice) and a no intervention control group in a non-clinical sample. One hundred and fifty-five university staff and students were randomly allocated to a 2-week, self-guided, online MBI with or without mindfulness meditation practice, or a wait list control. Measures of mindfulness, perceived stress, perseverative thinking and anxiety/depression symptoms within were administered before and after the intervention period. Intention to treat analysis identified significant differences between groups on change over time for all measured outcomes. Participation in the MBIs was associated with significant improvements in all measured domains (all ps < 0.05), with effect sizes in the small to medium range (0.25 to 0.37, 95% CIs 0.11 to 0.56). No significant changes on these measures were found for the control group. Change in perseverative thinking was found to mediate the relationship between condition and improvement on perceived stress and anxiety/depression symptom outcomes. Contrary to our hypotheses, no differences between the intervention conditions were found. Limitations of the study included reliance on self-report data, a relatively high attrition rate and absence of a longer-term follow-up. This study provides evidence in support of the feasibility and effectiveness of brief, self-guided MBIs in a non-clinical population and suggests that reduced perseverative thinking may be a mechanism of change. Our findings provide preliminary evidence for the effectiveness of a mindfulness psychoeducation condition, without an invitation to formal mindfulness meditation practice. Further research is needed to confirm and better understand these results and to test the potential of such interventions.

Barriers to Mindfulness: a Path Analytic Model Exploring the Role of Rumination and Worry in Predicting Psychological and Physical Engagement in an Online Mindfulness-Based Intervention

Little is known about the factors associated with engagement in mindfulness-based interventions (MBIs). Moreover, engagement in MBIs is usually defined in terms of class attendance (‘physical engagement’) only. However, in the psychotherapy literature, there is increasing emphasis on measuring participants’ involvement with interventions (‘psychological engagement’). This study tests a model that rumination and worry act as barriers to physical and psychological engagement in MBIs and that this in turn impedes learning mindfulness. One hundred and twenty-four participants were given access to a 2-week online mindfulness-based self-help (MBSH) intervention. Self-report measures of mindfulness, rumination, worry, positive beliefs about rumination, positive beliefs about worry and physical and psychological engagement were administered. A path analysis was used to test the linear relationships between the variables. Physical and psychological engagement were identified as two distinct constructs. Findings were that rumination and worry both predicted psychological disengagement in MBSH. Psychological engagement predicted change in the describe, act with awareness, non-judge and non-react facets of mindfulness while physical engagement only predicted changes in the non-react facet of mindfulness. Thus, rumination and worry may increase risk of psychological disengagement from MBSH which may in turn hinder cultivating mindfulness. Future suggestions for practice are discussed.

Mindfulness for Novice Pediatric Nurses: Smartphone Application Versus Traditional Intervention

PURPOSE

The current study compares the effects of a traditionally delivered mindfulness (TDM) intervention to a smartphone delivered mindfulness (SDM) intervention, Headspace, an audio-guided mindfulness meditation program, in a group of novice nurses.

DESIGN AND METHODS

Novice nurses participating in a pediatric nurse residency program were asked to participate in either a TDM or SDM intervention. Participants (N=95) completed self-administered pencil and paper questionnaires measuring mindfulness skills, and risk and protective factors at the start of their residency and three months after entering the program.

RESULTS

Nurses in the SDM group reported significantly more "acting with awareness" and marginally more "non-reactivity to inner experience" skills compared to the TDM group. The smartphone intervention group also showed marginally more compassion satisfaction and marginally less burnout. Additionally, nurses in the SDM group had lower risk for compassion fatigue compared to the TDM group, but only when the nurses had sub-clinical posttraumatic symptoms at the start of the residency training program.

CONCLUSIONS

Smartphone delivered mindfulness interventions may provide more benefits for novice nurses than traditionally delivered mindfulness interventions. However, the smart-phone intervention may be better indicated for nurses without existing symptoms of posttraumatic stress.

PRACTICE IMPLICATIONS

Mindfulness interventions delivered through smartphone applications show promise in equipping nurses with important coping skills to manage stress. Because of the accessibility of smartphone applications, more nurses can benefit from the intervention as compared to a therapist delivered intervention. However, nurses with existing stress symptoms may require alternate interventions.

Efficacy of 8- and 4-Session Mindfulness-Based Interventions in a Non-clinical Population: A Controlled Study

Background: Many attempts have been made to abbreviate mindfulness programmes in order to make them more accessible for general and clinical populations while maintaining their therapeutic components and efficacy. The aim of this study was to assess the efficacy of an 8-week mindfulness-based intervention (MBI) programme and a 4-week abbreviated version for the improvement of well-being in a non-clinical population.

Method: A quasi-experimental, controlled, pilot study was conducted with pre-post and 6-month follow-up measurements and three study conditions (8- and 4-session MBI programmes and a matched no-treatment control group, with a sample of 48, 46, and 47 participants in each condition, respectively). Undergraduate students were recruited, and mindfulness, positive and negative affect, self-compassion, resilience, anxiety, and depression were assessed. Mixed-effects multi-level analyses for repeated measures were performed.

Results: The intervention groups showed significant improvements compared to controls in mindfulness and positive affect at the 2- and 6-month follow-ups, with no differences between 8- vs. 4-session programmes. The only difference between the abbreviated MBI vs. the standard MBI was found in self-kindness at 6 months, favoring the standard MBI. There were marginal differences in anxiety between the controls vs. the abbreviated MBI, but there were differences between the controls vs. the standard MBI at 2- and 6-months, with higher levels in the controls. There were no differences in depression between the controls vs. the abbreviated MBI, but differences were found between the controls vs. the standard MBI at 2- and 6-months, favoring the standard MBI. There were no differences with regard to negative affect and resilience.

Conclusion: To our knowledge, this is the first study to directly investigate the efficacy of a standard 8-week MBI and a 4-week abbreviated protocol in the same population. Based on our findings, both programmes performed better than controls, with similar effect size (ES). The efficacy of abbreviated mindfulness programmes may be similar to that of a standard MBI programme, making them potentially more accessible for a larger number of populations. Nevertheless, further studies with more powerful designs to compare the non-inferiority of the abbreviated protocol and addressing clinical populations are warranted.

Clinical Trials.gov Registration ID: NCT02643927

Positive psychotherapy for depression and self-efficacy in undergraduate nursing students: A randomized, controlled trial

Nursing students across the globe experience depressive symptoms, and many interventions have been used to alleviate their depression. However, few interventions focus on students' personal strengths and advantages. The aim of the present study was to explore the effects of an 8-week group positive psychotherapy (PPT) programme on depression and self-efficacy in full-time undergraduate nursing students. A randomized, controlled trial was conducted for 76 nursing students (34 in the experimental group, 42 in the control group). The Beck Depression Inventory-II and the General Self-Efficacy Scale were used to collect data prior to, immediately after PPT, 3 months', and 6 months' post-PPT. Repeated-measures analysis of variance indicated that the intervention significantly alleviated depression and improved self-efficacy (each P < 0.05); the effect of time and time-group interaction was also significant (each P < 0.05). The findings suggest that PPT could significantly relieve depressive symptoms and improve self-efficacy. We recommend that PPT is effective in alleviating depression and improving self-efficacy in undergraduate nursing students. Academic mental health nurses should appreciate the value of PPT and consider incorporating it in psychological support methods in order to facilitate nursing students' mental health.

A Qualitative Study with Healthcare Staff Exploring the Facilitators and Barriers to Engaging in a Self-Help Mindfulness-Based Intervention

In order to increase the cost-efficiency, availability and ease of accessing and delivering mindfulness-based interventions (MBIs), clinical and research interest in mindfulness-based self-help (MBSH) interventions has increased in recent years. Several studies have shown promising results of effectiveness of MBSH. However, like all self-help interventions, dropout rates and disengagement from MBSH are high. The current study explored the facilitators and barriers of engaging in a MBSH intervention. Semi-structured interviews with members of healthcare staff who took part in an MBSH intervention (n = 16) were conducted. A thematic analysis approach was used to derive central themes around engagement from the interviews. Analyses resulted in four overarching themes characterising facilitation and hindrance to engagement in MBSH. These are "attitude towards engagement", "intervention characteristics", "process of change" and "perceived consequences". Long practices, emerging negative thoughts and becoming self-critical were identified as the key hindrances, whilst need for stress reduction techniques, shorter practices and increased sense of agency over thoughts were identified as the key facilitators. Clinical and research implications are discussed.

Mindfulness practice as a teaching-learning strategy in higher education: A qualitative exploratory pilot study

BACKGROUND

Students in higher education are experiencing stress and anxiety, such that it impedes their academic success and personal wellbeing. Brief mindfulness meditation and lovingkindness meditation are two aspects of mindfulness practice that have the potential to decrease students' feelings of anxiety and stress, and increase their sense of wellbeing and capacity for compassion for self and for others.

PURPOSE

To explore how undergraduate and graduate students experience brief instructor-guided mindfulness practice; specifically, on their feelings of stress and anxiety, and their sense of wellbeing.

STUDY DESIGN

Qualitative exploratory pilot study.

PARTICIPANTS AND SETTING

Fifty-two graduate and undergraduate students in different disciplines within a community services faculty of an urban university.

METHODS

Brief (five-minute) instructor-guided mindfulness practices were offered over eight weeks at the beginning and end of classes. Participating students were asked to also engage in individual home practice of five to fifteen-minute mindful breathing four to five times a week and to keep a log of their experiences. At end of term, individual and group feedback (N=13) was elicited from participating students. Six of the seven instructors who guided the mindfulness practices shared their experiences of the mindfulness activities.

OUTCOMES

Students reported an increased sense of calm, and a decreased feeling of anxiety. Lovingkindness meditation was mostly perceived as a positive way to close the class. Their instructors also observed that the brief mindful breathing practice at start of class helped students become more grounded and focused before engaging in the course content. Challenges encountered focused on the need to provide more in-depth information about mindfulness, as it relates to higher education teaching-learning contexts, to both students and participating instructors.

CONCLUSIONS

Implications for education suggest further research that includes fuller experiential training of participating instructors, as well as provision of a more comprehensive background on mindfulness to students.

A Web-Based Mindfulness Stress Management Program in a Corporate Call Center: A Randomized Clinical Trial to Evaluate the Added Benefit of Onsite Group Support

Objective:

The objective of this study is to determine the effectiveness of an 8-week web-based, mindfulness stress management program (WSM) in a corporate call center and added benefit of group support.

Methods:

One hundred sixty-one participants were randomized to WSM, WSM with group support, WSM with group and expert clinical support, or wait-list control. Perceived stress, burnout, emotional and psychological well-being, mindfulness, and productivity were measured at baseline, weeks 8 and 16, and 1 year.

Results:

Online usage was low with participants favoring CD use and group practice. All active groups demonstrated significant reductions in perceived stress and increases in emotional and psychological well-being compared with control. Group support improved participation, engagement, and outcomes.

Conclusion:

A self-directed mindfulness program with group practice and support can provide an affordable, effective, and scalable workplace stress management solution. Engagement may also benefit from combining web-based and traditional CD delivery.

Mindfulness-based cognitive therapy for depression: trends and developments

Mindfulness-based cognitive therapy (MBCT) was developed as a psychological intervention for individuals at risk of depressive relapse. Possible mechanisms of change for this intervention are in line with its theoretical underpinnings, and include increases in mindfulness and/or decreases in negative repetitive thoughts. This review provides an overview of current trends in MBCT research, including efficacy and questions regarding the specific effects of MBCT in light of recent comparisons with structurally equivalent control conditions, mechanisms of change, and moderators of treatment outcome. In addition, future directions are discussed, such as challenges with training an adequate number of therapists and disseminating this therapy.