Six-year positive effects of a mindfulness-based intervention on mindfulness, coping and well-being in medical and psychology students; Results from a randomized controlled trial

A pragmatic randomized trial to examine the effect of combining healthy diet with mindfulness cognitive therapy to reduce depressive symptoms among university students in a low-resource setting: protocol for the NutriMind Project

BACKGROUND

Mental health disorders still rank as leading causes of morbidity worldwide despite increasing awareness and improvements in treatment. Notably, low- and middle-income countries like Uganda, are disproportionately affected by such disorders. The burden of depressive symptoms in these countries is particularly high among students, aggravated by poverty, malnutrition, and inadequate public health governance, yet it is clearly under-researched, making it hard to achieve several of UN Sustainability Development Goals. Current treatment options are insufficient to tackle the increased burden of depressive disease. This is more challenging for low-resource regions especially in Sub-Saharan Africa, suggesting the need for alternative treatments that can swiftly be applied if proven effective. The main aim of this randomized controlled trial (RCT) is therefore to examine if a low-cost healthy diet (based on local Ugandan foods) combined with easy-to access mindfulness cognitive therapy can reduce depressive symptoms among university students in Uganda.

METHODS

We will recruit female and male students at Makerere University, the largest public university in Uganda, to an open, intention-to-treat, two-armed RCT. Those who score above a predefined threshold on a self-reported assessment of depressive symptoms, measured by the Center for Epidemiological Studies - Depression score (CES-D), are eligible for study inclusion and will be randomized to either an intervention (n = 125) or a control (n = 125) group. The intervention group will receive educational group-based sessions on how to prepare a Mediterranean-type of healthy diet and how to adhere to the principles of mindfulness-based cognitive therapy. Outcome measures include self-reported depression symptoms, quality of life, and dietary intakes. In addition we will perform a cost-effectiveness analysis. The RCT intervention will last 9 months, followed by additional 15 months with regular data collections.

DISCUSSION

We here describe a novel approach to treat depressive symptoms among university students living in resource constraint settings, by combining a healthy diet with low threshold psychotherapy. If this intervention succeeds, our project can be viewed as a step towards evidence-based behavior practices for young adults with a common mental disorder (depression) that are beneficial to public mental health initiatives and management.

TRIAL REGISTRATION

The RCT is registered in ClinicalTrials.gov (ID: NCT05848973). The date of registration was August 14, 2023.

The association between child maltreatment, cognitive reappraisal, negative coping styles, and non-suicidal self-injury in adolescents with major depressive disorder

BACKGROUND

Non-suicidal self-injury (NSSI) is a significant public health concern among adolescents with major depressive disorders (MDD). Although previous research has linked child maltreatment (CM) to NSSI, the precise mechanisms remain unclear. This study aims to investigate the association between CM, cognitive reappraisal (CR), negative coping styles (NC) and NSSI in adolescents with MDD, from the perspectives of both Latent Variable Theory and the Network Theory of Mental Disorder.

METHODS

A sample of 651 adolescents with MDD was recruited from January to December 2023. Data on CM, CR, NC, and NSSI were collected through paper-based self-reported questionnaires. Data analysis primarily involved structural equation modeling and network analysis.

RESULTS

The reporting rate of NSSI among adolescents with MDD was 48.2%. CM showed a significant positive correlation with NSSI. NSSI was affected by CM through three paths: the mediating role of CR, the mediating role of NC, and the chain mediating role of both CR and NC. Emotional abuse (EA) was the central node, while NSSI, EA, and "The urge to cry quietly when faced with troubles"(NC10) were the key bridge nodes.

CONCLUSIONS

This study is the first to use both structural equation modeling and network analysis to explore the explore the relationship between CM, CR, NC, and NSSI in adolescents with MDD, providing a theoretical basis for future early prevention and targeted interventions for adolescents with MDD.

The shape of the change: Cumulative and incremental changes in daily mood during mobile-app-supported mindfulness training

Understanding of the exact trajectories of mood improvements during mindfulness practice helps to optimize mindfulness-based interventions. The Mindfulness-to-Meaning model expects mood improvements to be linear, incremental, and cumulative. Our findings align with this expectation. We used multilevel growth curve models to analyze daily changes in positive mood reported by 190 Polish participants during 42 days of a mobile-app-supported, mindfulness-based intervention. The daily positive mood increased among 83.68% of participants. Participants who started the training reported worse mood improved more and faster than participants with better mood at the baseline. Dispositional mindfulness and narcissism - individual difference variables associated with high vs. low emotion regulation ability, respectively - were not associated with mood improvement trajectories. A small group of participants (16.32%) showed a steady decline in positive mood during the intervention. The results underscore the importance of a more comprehensive understanding of individual variability in benefiting from mindfulness-based interventions.

Exploring the sustained impact of the Mindfulness-Based Stress Reduction program: a thematic analysis

Introduction

This study aimed to explore the time-varying impact of the Mindfulness-Based Stress Reduction (MBSR) program, specifically examining its effects on various variables 3 months, 1 year, and 3 years after program completion. Additionally, the study aimed to identify the barriers and facilitators in maintaining mindfulness practice over time and the preferred mindfulness practices among participants in three distinct time groups.

Methods

The study utilized a qualitative research design, conducting semi-structured interviews with 45 participants who had completed the 8-week MBSR program at different time points. Thematic analysis was employed to analyze the qualitative data obtained from the interviews, allowing for the identification of key themes and patterns.

Results

The findings revealed that the effectiveness of the MBSR program varied at different times and across different variables. Immediately after completing the program, participants experienced a significant decrease in stress levels and an increase in awareness. One year later, the program continued to have positive effects on inner calm, coping mechanisms, and relationships. Three years after completing the program, its long-term impact was observed in the adoption of a mindful lifestyle, increased compassion and kindness, and ongoing personal growth.

Discussion

The study highlights the transformative potential of the MBSR program beyond short-term symptom relief. The long-term effects observed in overall wellbeing emphasize the sustained efficacy of mindfulness-based interventions. The identified barriers and facilitators in maintaining mindfulness practice provide insights for program implementation and individual engagement. By understanding the long-term impact and preferences of participants, tailored interventions can be developed to maximize the benefits of the MBSR program for individuals over time.

Mindfulness and inhibitory control: Insights from the stop signal task with neutral and reward-associated stimuli

Mindfulness has been linked to enhanced inhibitory control, yet the dynamics of this relationship, especially in reward situations, are not well understood. Our cross-sectional study aimed to explore the relationship between trait mindfulness and a performance measure of inhibitory control as a function of reward context operationalized by stimuli characteristics, and temporal inhibitory demands. Thirty-six individuals aged 19 to 41 filled out the Mindful Attention Awareness Scale (MAAS) and performed a stop signal task (SST), that included both neutral (stone images) and reward-related (money images) stimuli. The SST encompassed four conditions: neutral go/neutral stop, neutral go/reward stop, reward go/neutral stop, and reward go/reward stop, requiring participants to suppress reactions either during or after encountering reward-related stimuli. The relevant index of inhibitory control is the stop signal reaction time (SSRT), a performance measure of inhibitory control. Our findings showed no notable variation in the relationship between the MAAS score and SSRT across the different conditions. However, there was an overall significant effect of MAAS score on SSRT, irrespective of condition. Results may reflect the benefit of mindfulness on inhibitory control after generalized reward exposure.

The Role of Dominant Spiritual and Religious Coping Modality on Psychological Predictors Among Nursing Students

Purpose: The current study aimed to examine the role of the dominant spiritual and religious coping modality on health-related variables and determinants, including stress overload, mindfulness, and impulsivity, among nursing students. Methods: A cross-sectional design was used to achieve the study goal. The authors recruited 1199 nursing students. The results showed that the mean for positive spiritual and religious coping was higher compared to negative spiritual and religious coping. Results: In the current study, 73.3% of nursing students predominantly used positive spiritual and religious coping compared to 17.6% in the neutral group and 9.1% in the negative spiritual and religious coping group. Positive spiritual and religious coping was positively correlated with mindfulness and stress overload and negatively correlated with impulsivity. According to the ANOVA results, students with positive spiritual and religious coping tended to have a significantly higher stress overload, higher mindfulness, and lower impulsivity compared to the neutral and negative spiritual and coping groups. Negative spiritual and religious coping group significantly differed from the neutral groups only in terms of impulsivity. Conclusion: The current study's findings help nursing students by determining dominant spiritual and religious coping modalities and provide valuable information in directing counseling efforts. Results and implications were discussed.

Effects of a mindfulness-based program on the occupational balance and mental health of university students. Protocol for a randomized controlled trial

OBJECTIVE

The aim is to examine whether the addition of Virtual Reality (VR) meditation training to a standard 8-week Mindfulness-Based Health Care Program (MBHC-VR) results in a significantly increased improvement in occupational, mental health, and psychological functioning versus MBHC-only in university students.

MATERIALS AND METHODS

A randomized controlled clinical trial with three arms (MBHC, MBHC-VR, Control Group), four assessment time points (pre-intervention, inter-session, post-intervention, and 3-month follow-up), and mixed methodology will be proposed. University students (undergraduate, master, or doctoral) interested in participating and who meet the inclusion/exclusion criteria will be included over two years. Data will be collected from different ad hoc questionnaires, several standardized tests, and an Ecological Momentary Assessment. We will use R software to carry out descriptive analyses (univariate and bivariate), multilevel modeling, and structural equation models to respond to the proposed objective. The qualitative analysis will be carried out using the MAXQDA program and the technique of focus groups.

DISCUSSION

It is expected that with the proposed intervention university students will learn to relate in a healthier way with their mental processes, so as to improve their occupational balance (OB) and their psychological well-being.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier NCT05929430.

Mindfulness training in medical education as a means to improve resilience, empathy, and mental health in the medical profession

The high rates of depression, burnout, and increased risk of suicide among medical students, residents, and physicians in comparison with other careers signal a mental health crisis within our profession. We contend that this crisis coupled with the inadequate acquisition of interpersonal skills during medical education results from the interaction between a challenging environment and the mental capital of individuals. Additionally, we posit that mindfulness-based practices are instrumental for the development of major components of mental capital, such as resilience, flexibility of mind, and learning skills, while also serving as a pathway to enhance empathy, compassion, self-awareness, conflict resolution, and relational abilities. Importantly, the evidence base supporting the effectiveness of mindfulness-based interventions has been increasing over the years, and a growing number of medical schools have already integrated mindfulness into their curricula. While we acknowledge that mindfulness is not a panacea for all educational and mental health problems in this field, we argue that there is currently an unprecedented opportunity to gather momentum, spread and study mindfulness-based programs in medical schools around the world as a way to address some longstanding shortcomings of the medical profession and the health and educational systems upon which it is rooted.

The effects of mindfulness-based interventions in medical students: a systematic review

The number of studies on the effects of mindfulness on healthcare professionals is increasing. The main aim of this study was to collate the quantitative results of original studies analyzing the effects of mindfulness-based interventions on a variety of outcomes in medical students. We also analyzed how the study design and characteristics of the intervention affect the results, and identified qualitative effects of mindfulness interventions. A literature search was performed in different databases in June 2020. Original articles meeting the following criteria were included: (1) at least 50% of the participants were medical students, (2) included a mindfulness intervention, (3) analyzed any outcome relating to mindfulness intervention, (4) peer-reviewed (5) written in English. Eventually, 31 articles including 24 different samples were included. Over half of the studies were RCTs. In over half of the studies, the intervention was 4- to 10-week original Mindfulness-Based Stress Reduction or Mindfulness-Based Cognitive Therapy or a modification of these. In general, satisfaction with the interventions was good. Based on a meta-analysis, after the intervention, the intervention group had statistically significantly fewer symptoms of stress and distress and had higher mindfulness than the controls. The beneficial effects persisted in follow-ups over months or years. Both long and shorter courses and courses with and without face-to-face sessions were effective. Both controlled and uncontrolled studies had statistically significant results. Qualitative results revealed potential factors behind the quantitative effects. The number of studies on mindfulness interventions in medical students has increased drastically. Mindfulness-based interventions seem to offer a good possibility to enhance medical students' well-being.

Enhancing self-care education amongst medical students: a systematic scoping review

BACKGROUND

Reports of emotional, existential and moral distress amongst medical students witnessing death and suffering of patients during their clinical postings have raised awareness on the need for better psycho-emotional support during medical school. Furthermore, the stress experienced by medical students stemming from the rigours of their academic curriculum underlines the need for greater awareness on mental health issues and better self-care practices across medical training. With such programmes lacking in most medical schools, we propose a systematic scoping review (SSR) to map and address our research question, "what is known about self-care education interventions amongst medical students?".

METHODS

We adopted the Systematic Evidence-Based Approach to guide a systematic scoping review (SSR in SEBA) of relevant articles published between 1st January 2000 and 30th June 2023 in PubMed, Embase, PsycINFO, ERIC, Google Scholar, and Scopus databases. The included articles were independently and concurrently thematically and content analysed, with complementary categories and themes combined using the Jigsaw Approach. The domains created from the Funnelling Process framed the discussion.

RESULTS

A total of 6128 abstracts were identified, 429 full-text articles evaluated, and 147 articles included. The 6 domains identified were definition, topics, pedagogy, influences, outcomes and assessment. Most interventions were promising, though peer-led mindfulness-based interventions showed most promise in enhancing engagement, positively impacting personal wellbeing, and improving patient care. Overall, however, self-care education was poorly recognized, adopted and integrated into curricula.

CONCLUSION

Greater dedicated time and conducive practice environments within medical school curricula is required to enhance medical student wellbeing. Host organizations must ensure faculty are appropriately selected to instil the importance of self-care, be trained to assess and personalize self-care interventions and provide longitudinal assessment and support. Further study into assessing self-care capabilities is required.

Measuring wellbeing: A scoping review of metrics and studies measuring medical student wellbeing across multiple timepoints

PURPOSE

Studies have demonstrated poor mental health in medical students. However, there is wide variation in study design and metric use, impairing comparability. The authors aimed to examine the metrics and methods used to measure medical student wellbeing across multiple timepoints and identify where guidance is necessary.

METHODS

Five databases were searched between May and June 2021 for studies using survey-based metrics among medical students at multiple timepoints. Screening and data extraction were done independently by two reviewers. Data regarding the manuscript, methodology, and metrics were analyzed.

RESULTS

221 studies were included, with 109 observational and 112 interventional studies. There were limited studies (15.4%) focused on clinical students. Stress management interventions were the most common (40.2%). Few (3.57%) interventional studies followed participants longer than 12 months, and 38.4% had no control group. There were 140 unique metrics measuring 13 constructs. 52.1% of metrics were used only once.

CONCLUSIONS

Unique guidance is needed to address gaps in study design as well as unique challenges surrounding medical student wellbeing surveys. Metric use is highly variable and future research is necessary to identify metrics specifically validated in medical student samples that reflect the diversity of today's students.

Mindfulness, coping, and disruptions as predictors of college student distress at the beginning of the COVID-19 pandemic

Objective: This research examined how stressors experienced by college students within the first month of the COVID-19 pandemic were associated with their reports of psychological distress, mindfulness, and coping strategies. Participants: Students attending 11 universities in the U.S. (N = 464, M age = 20.72, SD = 3.90, 91% female, 61% White, and 77% non-Hispanic) in early childhood education, child development, and family science classes participated.Methods: Students completed an online survey about pandemic-related disruptions, depressive symptoms, mindfulness, coping, and demographics.Results: Students whose families had more financial difficulties reported more disruptions. Depression and avoidant coping were positively correlated with distress, while mindfulness was inversely correlated with distress and depression. Disruptions, family financial status, depressive symptoms, mindfulness, and avoidant coping significantly predicted distress, controlling for university site and student sex, age, race, and ethnicity in multiple regression analyses. Avoidant coping significantly moderated (amplified) the effect of disruptions on distress. Conclusions: College student well-being can be supported through Campus programming that includes mindfulness practices and alternatives to avoidant strategies for coping with stress.

Mindfulness Intervention Improves Coping and Perceptions of Children's Behavior among Families with Elevated Risk

Mindfulness-informed interventions (MIIs) are increasingly common but have not been extensively studied among families with elevated levels of risk (e.g., those involved in child protective services and/or receiving financial assistance). These families often experience high rates of stressors that can impact coping strategies, interpersonal dynamics, and relationships. Given that mindfulness has been shown to promote health and wellbeing, this study used a sample from two pilot randomized controlled trials to test the extent to which a mindfulness-informed intervention improved coping strategies and perceptions of children's behavior among 53 families with elevated risk. A principal components analysis with a direct oblimin rotation revealed that cognitive-emotion coping strategies could be characterized by three factors: positive adaptation, negative adaptation, and positive refocusing. Intention-to-treat analysis indicated significant group by time differences, with intervention participants demonstrating improvements in positive refocusing coping, positive adaptation coping, and perceptions of children's behavior problems compared to participants in the waitlist control group. No significant differences were found for negative adaptation coping strategies. Findings provide preliminary support for the benefits of mindfulness training in a sample generally underrepresented in the mindfulness intervention literature.

Assessment of the human response to acute mental stress-An overview and a multimodal study

Numerous vital signs are reported in association with stress response assessment, but their application varies widely. This work provides an overview over methods for stress induction and strain assessment, and presents a multimodal experimental study to identify the most important vital signs for effective assessment of the response to acute mental stress. We induced acute mental stress in 65 healthy participants with the Mannheim Multicomponent Stress Test and acquired self-assessment measures (Likert scale, Self-Assessment Manikin), salivary α-amylase and cortisol concentrations as well as 60 vital signs from biosignals, such as heart rate variability parameters, QT variability parameters, skin conductance level, and breath rate. By means of statistical testing and a self-optimizing logistic regression, we identified the most important biosignal vital signs. Fifteen biosignal vital signs related to ventricular repolarization variability, blood pressure, skin conductance, and respiration showed significant results. The logistic regression converged with QT variability index, left ventricular work index, earlobe pulse arrival time, skin conductance level, rise time and number of skin conductance responses, breath rate, and breath rate variability (F1 = 0.82). Self-assessment measures indicated successful stress induction. α-amylase and cortisol showed effect sizes of -0.78 and 0.55, respectively. In summary, the hypothalamic-pituitary-adrenocortical axis and sympathetic nervous system were successfully activated. Our findings facilitate a coherent and integrative understanding of the assessment of the stress response and help to align applications and future research concerning acute mental stress.

Mindful Self-Compassion as an Antidote to Burnout for Mental Health Practitioners

The objective of this correlational study was to explore the relationship between levels of self-compassion and burnout for currently practicing mental health practitioners (MHPs) in the United States. All professionals are vulnerable to burnout based on various types of organizational stressors, but burnout is of particular concern for health care service providers who may need to adopt a stance of detachment, or emotional distance, as relief from intense workloads, with clients. The data were collected through an online survey. Regression analysis found that scores from Neff's Self-Compassion Scale were a significant negative predictor of levels of MHP burnout, as assessed by Schaufeli et al.'s Burnout Assessment Tool, p < 0.001. The implication of this finding is that cultivating self-compassion appears to be a pragmatic self-care strategy for MHPs to mitigate the negative effects of burnout. More educational and occupational training in self-compassion practices as self-care should be provided to help protect the physical and emotional well-being of MHPs. The deleterious systemic effects of burnout make MHP self-care an ethical issue, along with the need to identify protective factors, prevention, and treatment of burnout.

Mental and Physical Health Impacts of Mindfulness Training for College Undergraduates: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background

Universities increasingly offer mindfulness-based programs (MBPs) to improve student health and reduce their impact on overburdened psychological services. It is critical for evidence-based policy to determine for what health outcomes mindfulness programs are effective and under what conditions. Objectives were to: (a) perform a comprehensive analysis of the effects of mindfulness interventions on physical, mental, and behavioral health outcomes in college undergraduate students, and (b) examine moderators of intervention effects to identify factors that may help improve existing university mindfulness programs and guide the design of new programs.

Method

Systematic searches of five databases identified MBP randomized controlled trials for undergraduate students, measuring any health outcome. Analyses using robust variance estimation focused on standardized mean differences for outcomes between groups and modeled through coded study features.

Results

The 58 studies in the review primarily focused on mental health with fewer assessments of physical health or health behaviors. Overall, mindfulness interventions significantly outperformed both active and inactive controls (ps<.05), with the most marked effects on anxiety symptoms, depressive symptoms, and mindfulness; greater success appeared for clinical populations. Online programs performed equivalent to in-person, and non-MBP programs were equivalent to MBP programs after controlling for other factors. Publication bias and other quality issues also emerged.

Conclusions

Mindfulness programs improve well-being in college students, with the strongest evidence for reducing anxiety and depressive symptoms. More studies utilizing stronger methods are needed to evaluate mindfulness programs' effects on additional health outcomes and online interventions in clinical populations.

Effectiveness of attachment-based compassion therapy to reduce psychological distress in university students: a randomised controlled trial protocol

Introduction

Higher education, particularly university, is a challenge for many students that can lead to their mental health being seriously affected. The stress to which they are subject throughout their time at university can lead to anxiety and depression. "Third wave" psychotherapies, including compassion-based therapy, have been used to improve psychological outcomes, such as stress, anxiety, emotional distress and well-being. There are some signs that third wave psychotherapies reduce psychological distress in university students, but more and higher-quality studies are needed. In this randomised controlled trial (RCT), we hypothesise that the provision of attachment-based compassion therapy (ABCT) will be more effective than an active control group based on relaxation therapy for improving psychological distress in university students.

Methods and analysis

A two-arm RCT will be conducted involving 140 university undergraduate and postgraduate students from the University of Zaragoza and the National University of Distance Education (UNED) who reside in the autonomous community of Aragon, Spain. Interventions with either ABCT or relaxation therapy will be implemented, with an allocation ratio of 1:1 between groups. Both interventions will last six weeks and consist of six weekly group sessions lasting 1.5 h each. Data will be collected before and after the intervention, and there will be a follow-up at six months. The primary outcome will be psychological distress at post-intervention. Secondary outcomes will be depression, anxiety, stress and burnout symptoms, affectivity and emotional regulation. Attachment style, experiential avoidance, compassion (for others/oneself) and mindfulness skills will be measured as potential mechanistic variables. Intention-to-treat analysis will be performed using linear mixed regression models. The clinical significance of improvements will be calculated. Potential side effects will be monitored by an independent clinical psychologist.

Ethics and dissemination

This study was approved by the Clinical Research Ethics Committee of Aragón. Participant data will remain anonymous, and results will be submitted to peer-reviewed open-access journals and disseminated via conferences.

Clinical Trial Registration

ClinicalTrials.gov, identifier NCT05197595.

Transforming stress program on medical students' stress mindset and coping strategies: a quasi-experimental study

OBJECTIVE

Stress is a significant concern in medical education, and identifying effective ways to deal with stress may help with students' mental health and professional development. This study aimed to examine the effects of the Transforming Stress Program (TSP) amongst first-year medical students on their stress mindset and coping strategies when confronted with stressors.

METHODS

We conducted a quasi-experimental study at the University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam. A total of 409 first-year students at the Faculty of Medicine were divided into intervention group (205 students) and control group (204 students). The 10-week TSP was delivered as an extra-curricular course. The training adopts psychoeducation based on Dialectical Behavioral Therapy with mindfulness as a fundamental practice incorporated into each component of the program. The intervention group received the training in the first semester; the control group received identical program in the second semester. Stress Mindset Measurement and Brief Coping Orientation to Problems Experienced were measured before the intervention (T0), immediately after intervention on Intervention group (T1), and six months after intervention on Intervention group (T2).

RESULTS

At T1, the intervention group showed 65% improvements in stress mindset scores and increases in coping strategies scores in six domains (Problem solving, Social support, Humor, Religion, Venting, and Self-distraction) and decreases in three (Avoidance, Substance use, and Self-blame). The effect sizes were significant in all outcomes (Cohen's d > 0.2). Measurements of the control group did not change significantly in the same period. At T2, effects of the TSP were found decreased in some domains (Avoidance, Substance use, and Self-blame) compared to T1, but largely remained significantly better than T0.

CONCLUSIONS

The TSP is a feasible and effective approach that significantly enhanced medical students' stress mindset and coping strategies. Some effects were still observable 6 months after the intervention. The relatively intensive intervention requires support of the school administration and staff.

Effects of a mindfulness-based interventions on stress, burnout in nurses: a systematic review and meta-analysis

Background

Stress in the healthcare environment causes negative effects in nurses such as burnout, anxiety, and depression. The COVID-19 pandemic has resulted in increased pressure on medical staff globally, highlighting the potential benefits of mindfulness-based interventions in reducing nurses' stress levels. Despite numerous studies exploring the effect of mindfulness-based training on nurses, the results remain inconclusive.

Objective

To systematically evaluate the impact of mindfulness training on nurse's performance and increase the certainty of existing evidence.

Methods

This study searched various databases, including EBSCO, Embase, Web of Science, PubMed, ProQuest, Scopus, Cochrane Online Library, Wanfang, SinoMed, CNKI, and VIP, for randomized controlled trials on the impact of mindfulness-based interventions for nurses up until 02 December 2022. Two investigators independently screened and extracted data from the articles, while also assessing the risk of bias. The data was analyzed using RevMan 5.4 software.

Results

This review identified 15 studies out of the 2,171 records retrieved, consisting of a total of 1,165 participants who were randomized. Post-intervention analysis provided very-low certainty evidence of moderate effectiveness of mindfulness-based training in reducing stress [standardized mean difference (SMD) = -0.81; 95% confidence interval (CI) = -1.11 to -0.52], with no significant effect on anxiety (SMD = -0.30; 95% CI = -0.72 to 0.13) or depression (SMD = -0.24; 95% CI = -0.55 to 0.07). However, the training was effective in reducing burnout, as demonstrated by the lower scores for emotional exhaustion (SMD = -4.27; 95% CI = -5.94 to -2.59) and depersonalization (SMD = -2.89; 95% CI = -4.24 to -1.54) and higher scores for personal accomplishment (SMD = 2.81; 95% CI = 0.12 to 5.50). There was a sustained improvement in stress levels in the short-term (≤3 months), with delayed benefits for burnout. However, only two studies were available for later follow-ups, and there was no significant evidence of long-term effects.

Conclusion

Mindfulness-based training may be a viable intervention for improving the psychological wellbeing of nurses, including reducing stress, burnout.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023387081.

Psychophysiological stress response after a 6-week Mindful Self-Compassion training in psychiatric rehabilitation inpatients: a randomized post-test only study

Objectives

Mindfulness-based interventions (including self-compassion interventions) are effective in improving stress management at psychological and physical levels. Mindful Self-Compassion (MSC) is a newly developed program particularly aimed at increasing self-compassion. The main objective of this study was to determine whether the psychophysiological stress response during a social-evaluative speaking task differs in inpatients participating in the MSC or the Progressive Muscle Relaxation (PMR) program at the end of their 6-week psychiatric rehabilitation stay (i.e., post-test only design).

Method

Data from 50 inpatients (25 MSC, 25 PMR, 35 female) aged 19 to 76 years (M = 47.22, SD = 12.44) were analyzed in terms of psychophysiological stress response. For this purpose, heart rate variability, heart rate, and blood pressure were assessed together with several psychometric variables: positive and negative affect (PANAS), subjective stress perception (Visual Analog Scale), self-compassion (Self-Compassion Scale), cognitive reappraisal and suppression (Emotion Regulation Questionnaire), psychological distress (Brief Symptom Inventory-18), and appraisal and rumination (selected items).

Results

After correction for alpha inflation no differences in the psychophysiological stress response and psychometric parameters between the MSC and PMR group were found.

Discussion

In general, our results indicate that MSC is not superior to PMR training. However, more research with clinical randomized controlled trials investigating larger samples are needed to further affirm these initial findings.

Digital Therapy: Alleviating Anxiety and Depression in Adolescent Students During COVID-19 Online Learning - A Scoping Review

The learning method has changed from offline to online since Coronavirus Disease 2019 pandemic cause mental health problems in students such as stress, anxiety, and even depression. Interventions to reduce mental health problems in adolescents need to be carried out digitally to reduce the transmission of Coronavirus Disease 2019. The purpose of this study is to explore methods of digital therapy to reduce symptoms of anxiety and depression among students during the Coronavirus Disease 2019. A scoping review study design was used in this study. Database the study from CINAHL, PubMed, and Scopus databases. This study used PRISMA Extension for Scoping Reviews (PRISMA-ScR) and for quality appraisal used JBI Quality Appraisal. The inclusion criteria for articles in this study are full text, randomized control trial or quasi-experiment research design, English language, students sample, and the publication period during COVID-19 pandemic (2019-2022). There were found 13 articles discussing digital therapy and it was found that the digital therapy model to reduce anxiety and depression includes directions through digital modules, directions via video, and asynchronous discussions via online meeting. The sample range in this study is 37-1986 students. Most of the articles come from developed countries. Delivery services of digital therapy consist of three phases, namely psycho-education, problem-solving, and implementation of problem-solving strategies. The authors found that there are four digital therapy methods, namely Improving psychological abilities, Bias-modification intervention, Self-help intervention, and Mindfulness intervention. The implementation of digital therapy must still pay attention to various aspects that affect students, so that therapists need to pay attention to physical, psychological, spiritual, and cultural aspects. Here we highlight, digital therapy interventions are proven for improving mental health by reducing depression and anxiety levels among students during the COVID-19 pandemic by paying attention to all aspects that affect students.

Mindfulness Intervention for Improving Psychological Wellbeing Among Students During COVID-19 Pandemic: A Scoping Review

The COVID-19 pandemic can cause mental health problems such as stress, social anxiety, depression, and decrease social life on students. Mental health problems need to be taken seriously to develop the stage of development and improve the psychological well-being of students on learning in the school. The aim of this study was to explore mindfulness interventions to improve psychological well-being among students. This study used the Scoping Review method. Literature from CINAHL, PubMed, and Scopus databases. The keywords used in English are psychological wellbeing, students, and mindfulness. The inclusion criteria were full text, study design randomized control trial or quasi-experimental, English language, population and sample were students, and the publication period is the last 10 years (2013-2022). From 2194 articles based on initial research, we found 10 articles were analyzed related to mindfulness interventions consisting of several methods, namely internet-based mindfulness, mindfulness-based intervention, and mindfulness-based stress reduction. Most of samples the study from the United States with the range samples were 20-166 students. Mindfulness interventions can be carried out improve the psychological well-being of students. Mindfulness therapy is done by fully concentrating the mind in meditation so that it can improve psychological health. Providing mindfulness therapy involves health workers such as nurses and psychologists to provide comprehensive therapy covering both physical and psychological aspects.

Understanding students' motivations for participating in a mindfulness course: a qualitative analysis of medical students' views

OBJECTIVES

Improving medical students' wellbeing and empowerment through curricular activities is a topic of interest worldwide. Mindfulness-based interventions (MBIs) are increasingly implemented in medical education often as part of elective courses. To better understand training outcomes and adjust curriculum to students' needs, we will explore why will medical students participate in meditation-based education?

METHODS

We analyzed 29 transcripts from the first session of an 8-week MBSR program offered to medical students in French. Transcripts were coded and analyzed using a qualitative content thematic analysis and the constant comparison method.

RESULTS

Analyses resulted in three themes describing students' motivation: (1) Medical education and the physician's role, i.e. improving interpersonal skills, acquiring skills oriented toward a more integrative medicine, being more productive in a highly competitive context. (2) Caring for my health i.e. aiming at stress reduction, emotion regulation, and improving self-compassion. (3) A quest for meaning, i.e. optimizing meaning of care, and meaning of life.

CONCLUSION

The results highlight the congruence between the perceived motivations and the evidence on the effect of mindfulness on self-care, the development of humanistic medical skills, and the meaning of care. Some findings raise the issue of the limits of using mindfulness to enhance one's productivity. Notably, participants articulated the need for self-care as in mindfulness training, with the ability to care for others.

Effectiveness of training programs based on mindfulness in reducing psychological distress and promoting well-being in medical students: a systematic review and meta-analysis

BACKGROUND

Medical schools have used mindfulness meditation as a strategy to assist students in stress management. This study aimed to seek evidence regarding the effectiveness of mindfulness-based training programs in reducing psychological distress and promoting the well-being of medical students.

METHODS

We conducted a systematic review and meta-analysis. Cochrane Library, Embase, PubMed/MEDLINE, PsycINFO/PsycNet, LILACS/BVS, ERIC (ProQuest), Web of Science, OpenGrey, and Google Scholar were searched for randomized clinical trials published until March 2022, without time or language restrictions. Two authors independently screened the articles, extracted data using a standardized extraction form, and assessed the methodological quality of the included studies using the Cochrane's Risk of Bias 2 (ROB 2) tool and the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool.

RESULTS

Of the 848 articles retrieved, 8 met the inclusion criteria. Mindfulness-based training improved the outcomes: mindfulness (small post-intervention effect: SMD = 0.29; 95% CI: 0.03 to 0.54; p = 0.03; I² = 46%; high evidence quality, and small effect at follow-up: SMD = 0.37; 95% CI: 0.04 to 0.70; p = 0.03; I² = 53%; low evidence quality), psychological well-being/health (there was no statistically significant difference between the groups in the post-intervention effect: SMD =  - 0.27; 95% CI: - 0.67 to 0.13; p = 0.18; I² = 76%; moderate evidence quality, and a significant difference at follow-up: SMD =  - 0.73; 95% CI: - 1.23 to - 0.23; p = 0.004; I² = 61%; low evidence quality), and stress (small post-intervention effect: SMD =  - 0.29; CI of 95%: - 0.56 to - 0.02; p = 0.04; I² = 57%; moderate evidence quality, and moderate effect at follow-up: SMD =  - 0.45, 95% CI: - 0.67 to - 0.22, p = 0.0001, I² = 0%, moderate evidence quality). The quality of evidence for the anxiety, depression, and resilience outcomes is low and for the empathy outcome, very low.

CONCLUSION

The results indicate that the students who participated in the mindfulness training perceived improvements in the stress and psychological distress symptoms and improved health perception and psychological well-being. However, the significant heterogeneity among studies should be considered when interpreting these findings.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020153169.

Medical students' coping with stress and its predictors: a cross-sectional study

Objectives

To analyse stress coping styles of medical students at different time points of medical education and to identify predictors of functional coping.

Methods

A cross-sectional study was conducted among medical students (N = 497, 361 women and 136 men) before year one (n = 141), after year one (n = 135) and after year five (n = 220). Students answered the Brief Coping Orientation to Problems Experienced Inventory, the Work-Related Behaviour and Experience Patterns, the Perceived Medical School Stress Instrument and the Maslach Burnout Inventory. Multiple regression was used to examine factors associated with functional coping.

Results

Single factor ANOVA indicated a significant difference for functional coping between the time points (F (2, 494) = 9.52, p < .01), with fifth-year students scoring significantly higher than students before or after year one. There was a significant difference in dysfunctional coping (F (2, 494) = 12.37, p < .01), with students before year one and after year five scoring higher than those after year one. Efficacy (β = 0.15, t (213) = 4.66, p < .01), emotional distancing (β = 0.04, t (213) = 3.50, p < .01) and satisfaction with life (β = 0.06, t (213) = 4.87, p < .01) were positive predictors of functional coping.

Conclusions

Scores for both functional and dysfunctional coping vary during medical education. The reasons for low coping scores after year one require further explanation. These findings represent a starting point for investigations into how to promote functional coping during early medical education.

A Scoping Review of the Online Interventions by Nurses for Reducing Negative Impact of Bullying on Students

The incidents of bullying on students have increased every year. The negative impacts of bullying are physical problems, psychological problems such as depression and anxiety, and even risk of suicide. Interventions by online to reduce the negative impact of bullying are more effective and efficient. The aim of this study is to explore method of online-based nursing intervention on students for reducing the negative impact of bullying. This study used a scoping review method. The literature from three databases were PubMed, CINAHL, and Scopus. PRISMA Extension for Scoping Reviews was used for search strategy and we used keywords were "nursing care OR nursing intervention" AND "bullying OR victimization" AND "online OR digital" AND "student". The inclusion criteria for articles were primary research, the design of articles are randomized control trial or quasi-experimental, samples were students, and the setting time of publication is last 10 years (2013-2022). We found 686 articles based on initial research, after elimination based on inclusion and exclusion criteria, and found 10 articles discussing about online-based interventions by nurses on students for reducing the negative effects of bullying. The range of respondents in this study is 31-2771 respondents. The method used for the online-based nursing intervention were improving students' skills, increasing social skills, and counseling. The types of media used are videos, audio, modules, and online discussions. Online interventions were effective and efficient so that they are easily accessible to participants, however, it causes difficulties for participants to access interventions due to internet network disruptions. The potential of online-based nursing interventions is effective to reduce the negative impact of bullying with give full attention in physical, psychological, spiritual, and cultural aspect.

Effect of online mindfulness-based physical exercise program on psychological well-being and life satisfaction during the Covid-19 pandemic

The aim of this study was to examine the effectiveness of a mindfulness-based physical exercise program on university students' psychological well-being and life satisfaction. In the study, a randomized control group pre-test, post-test, and follow-up test design was used. The study group consisted of 60 students (30 in an experimental group and 30 in a control group) continuing their education in different faculties of a foundation university during the Covid-19 pandemic in Turkey. A personal information questionnaire, Psychological Well-Being Scale and Life Satisfaction Scale were used to collect the study data. The Mindfulness-Based Physical Exercise Program was implemented in the experimental group, once a week for 8 sessions. The results suggested significant differences between the psychological well-being and life satisfaction post-test scores of the experimental and control groups in favor of the experimental group. In the sub-dimensions of psychological well-being, significant differences were found between the experimental and control groups in post-test scores of environmental mastery, personal growth, and purpose in life. There was no significant difference between the psychological well-being, positive relationships with others, autonomy, environmental mastery, purpose in life, and self-acceptance sub-dimensions except personal growth sub-dimensions, and life satisfaction post-test and follow-up test scores of the university students in the experimental group. In the post-test comparisons of two groups, a significant difference was found between total psychological well-being, environmental mastery, personal growth, purpose in life, and self-acceptance, in favor of the experimental group.

How are Medical Institutions Supporting the Well-being of Undergraduate Students? A Scoping Review

INTRODUCTION

Medical students experience significant stress and impacts on mood due to multiple factors. Unmitigated stress impacts both physical and mental health while increasing the risk of unethical behavior. It is important for medical institutions to identify strategies that effectively reduce perceived stress and improve the well-being of their students.

METHODS

The authors undertook a scoping review of the literature to identify strategies implemented by medical educational programs to improve the well-being of medical students.

RESULTS

Of 1068 articles identified, 19 studies met the inclusion criteria. Interventions were categorized as mindfulness-based programs, reflection groups, curriculum changes, and 'miscellaneous.' All studies assessed outcomes of student stress/resilience, as well as additional domains including academic performance, mental health, and interpersonal skills. Some also assessed the acceptability of the intervention to students.

CONCLUSIONS

Despite the heterogeneity of interventions and outcome measures, a clear theme emerged that institutionally-provided strategies to promote student well-being tend to be effective when students opt into the program. It was noted that adding mandatory content or activities to a medical program without creating adequate space or support for it can have the opposite effect. Further high quality intervention studies involving randomization, blinding and rigorous controls are warranted.

Effectiveness of Mindfulness and Positive Strengthening mHealth Interventions for the Promotion of Subjective Emotional Wellbeing and Management of Self-Efficacy for Chronic Cardiac Diseases

Intervention in health prevention and treatment via mobile phones is becoming a key element on health promotion. Testing the efficacy of these mobile health (mHealth) psychological interventions for cardiovascular health is necessary as it is a chronic pathology, and it can influence the affective and cognitive states of patients. This research aimed to analyze the effectiveness of two brief psychological interventions-mindfulness and positive strengthening-to promote subjective emotional wellbeing and disease management self-efficacy using mHealth. This was a three-arm intervention and feasibility study, with a pre-post design and three follow-up measures with 105 patients (93 completed all phases) with cardiovascular diseases. Group 1 and 2 received the mindfulness or strengthening intervention, and Group 3 was the control group. The positive-negative affect and management self-efficacy for chronic and cardiovascular diseases were analyzed over time, while anxiety and depression levels were assessed at the beginning of the study. The results showed that mindfulness and positive strengthening interventions both had a positive effect on participants' affective state and management self-efficacy for the disease in comparison with the control group over time, even after controlling for baseline anxiety and depression levels. Positive strengthening seems to be more effective for improving cardiac self-efficacy, while mindfulness practice was significantly more effective at reducing negative affect at the first face-to-face evaluation.

Linking University Students' Mindfulness to Positive Adjustment Amidst COVID-19 Pandemic: a 6-month Cross-Lagged Panel Design

Objectives

In the face of a global pandemic, research on wellness-fostering resources is urgently needed, especially with longitudinal designs and diverse samples. According to the mindfulness-to-meaning theory and broaden-and-build theory, this study examined the reciprocal associations among a group of Chinese university students' trait mindfulness, positive and negative affect, and use of positive coping strategies, including positive reappraisal, planning, and seeking of emotional support during the COVID-19 pandemic.

Methods

Participants were 247 Hong Kong university students (M _age = 20.96, SD = 2.38; female = 86%) who completed survey measures of mindfulness, positive and negative affect, and positive coping strategies at baseline and 6-month follow-up. Data were analysed using a cross-lagged panel design, controlling for participants' age.

Results

The proposed reciprocal model exhibited an excellent fit with the data. There was a reciprocal association between trait mindfulness and positive affect over time. However, no significant reciprocal effect was found among mindfulness, negative affect, and positive coping strategies.

Conclusions

Theoretically, the current findings extended the two theories to a non-Western population during a critical time and suggested a long-term reciprocal association between positive affect and mindfulness. Our study provided important insight into university students' positive well-being during COVID-19 and demonstrated the wellness-fostering effect of mindfulness.

Effects of the Interculturality and Mindfulness Program (PIM) on University Students: A Quasi-Experimental Study

Rates of mental health issues have been increasing among university students. This study investigates the effects of the Interculturality and Mindfulness Program (PIM) on academic students on mindfulness, emotional regulation, depression, anxiety, stress, life satisfaction, optimism, positive solitude, and loneliness. A quasi-experimental research was conducted, with pre- and post-test comparative measurements in three groups: in-person (IG), synchronous online (OG), and passive control (CG). A diverse group of students (n = 150; mean age = 25.4 ± 8.31) participated from two universities in Portugal. When compared to the CG, both active groups (IG and OG) demonstrated a beneficial interaction effect in acceptance, positive solitude, optimism, and mindfulness. The IG demonstrated a positive interaction effect in awareness and satisfaction with life, whereas the OG indicated a favorable interaction effect in impulse. When analyzing the intra-group effects, both active groups presented a significant improvement in stress, emotion regulation, mindfulness, positive solitude, and optimism. The OG demonstrated an improvement in awareness and loneliness. The main limitations of this research are that students were not randomly assigned, and groups were heterogeneous in nationality, education level, and sex. Nonetheless, PIM has indicated beneficial results in both IG and OG, and is a promising intervention for the prevention of mental health issues (e.g., stress, difficulties in emotional regulation, and loneliness), as well as for the promotion of well-being (e.g., positive solitude, mindfulness, life satisfaction, and optimism).

The Mediating Effect of Self-Efficacy and Coping Strategy in Relation to Job Stress and Psychological Well-Being of Home-Visiting Care Workers for Elderly during the COVID-19 Pandemic

The purpose of this study was to analyze the mediating effect of self-efficacy and coping strategy in the relationship between job stress and the psychological well-being of care workers. The subjects were 112 home-visiting care workers, and data were collected at four home-visiting nursing centers in a metropolitan city and a small and medium-sized city from July to August 2022. The collected data were analyzed by descriptive statistics, t-test, ANOVA, Pearson's correlation co-efficient, multiple linear regression, and Sobel test. The mean score of psychological well-being was 3.33 ± 0.46 out of a possible 5. The subject's psychological well-being was correlated with self-efficacy (r = 0.64, p < 0.001), problem-solving-focused coping (r = 0.58, p < 0.001), social-support-seeking coping (r = 0.34, p < 0.001), job stress (r = -0.31, p = 0.001), avoidance-focused coping (r = -0.37, p < 0.001). Self-efficacy (Z = -4.92, p < 0.001), problem-solving-focused coping (Z = -2.56, p = 0.010), and avoidance-focused coping (Z = -3.07, p = 0.002) had a mediating effect in the relationship between job stress and psychological well-being of the subjects during the COVID-19 pandemic. Based on these results, the psychological well-being nursing intervention program for home-visiting care workers need to include job stress, problem-solving-focused coping, and avoidance-focused coping.

Mindfulness and psychological well-being in adolescents: the mediating role of self-compassion, emotional dysregulation and cognitive flexibility

INTRODUCTION

Adolescence is a critical period of growth. Mental health during adolescence is one of the most important determinants of mental health in adulthood. The aim of this study was to analyze the relationship between mindfulness and psychological well-being of adolescents considering the mediating role of self-compassion, emotional dysregulation and cognitive flexibility.

METHODS

The method of this research is cross-sectional. The research population was adolescents (elementary, first and second high school) in Zanjan, Iran in 2021, whose approximate number was 14,000. Data through adolescent mindfulness questionnaires (Brown, West, Loverich, and Biegel, 2011), short form of psychological well-being questionnaire (Ryff and Keyes, 1995), short form of self-compassion scale (Raes et al., 2011), difficulty in Emotion regulation (Gratz and Roemer, 2004) and cognitive flexibility (Dennis and Vander Wal, 2010) were collected. Data analysis was performed using Pearson correlation coefficient and path analysis with SPSS-26 and lisrel-10.2 software.

RESULTS

According the results, in addition to the fact that mindfulness is directly and positively related to psychological well-being (p < 0.05), it is also indirectly through self-compassion and Cognitive flexibility has a positive and significant relationship with psychological well-being and also mindfulness has an indirect, negative and significant relationship with psychological well-being through emotional dysregulation (p < 0.05). The results supported the goodness of model fit and confirmation of hypotheses.

CONCLUSION

Therefore, it is recommended that practitioners provide the basis for promoting psychological well-being through mindfulness, emotional dysregulation, self-compassion and cognitive flexibility.

Seeing attractive faces challenges inhibitory control, especially when mindful

Previous studies have suggested positive effects of mindfulness on inhibitory control (stopping behaviour). However, scarce previous studies suggest the relationship may depend on context. We provide first evidence that inhibitory control is challenged when perceiving attractive faces, especially when being mindful. Specifically, we investigated the relationship between mindfulness and inhibitory control and the moderating role of a social reward context (being exposed to attractive opposite sex faces). Participants (n = 50) between 18–43 years old (M = 25, SD = 5.4) filled out questionnaires assessing standard demographic variables and dispositional mindfulness. Subsequently, they performed a Go/No-go task with a neutral condition and attractive faces condition. Results showed that inhibitory control was challenged in the attractive condition relative to the neutral condition, p = 0.019. Dispositional mindfulness was negatively correlated with inhibitory performance, but only in the attractive faces condition (r = -0.32, p = 0.024). Results did not support a moderating role of gender. Finally, though post-hoc, higher mindfulness was associated with reduced perceived attractiveness of presented faces (r = -0.33, p = 0.019). However, the relationship between mindfulness and reduced inhibitory control could not be explained by mindfulness associated reduced attractiveness. Taken together, results show that mindfulness challenges inhibitory control when perceiving attractive faces. This implies that mindfulness interventions aimed at enhancing inhibitory control, may not render the desired effect in a context of being exposed to attractive faces. Though certainly plausible, it remains an open question whether results generalize to other reward contexts as well.

Effects of a Mindfulness-Based Weight Loss Intervention on Long-Term Psychological Well-Being Among Adults with Obesity: Secondary Analyses from the Supporting Health by Integrating Nutrition and Exercise (SHINE) Trial

Objective

This study tested whether a mindfulness-based intervention for obesity that included components aimed at emotion regulation and mindful eating improved psychological outcomes including stress, anxiety, positive emotion, and depression, during the intervention period and at longer-term follow-up.

Methods

Adults with obesity (N=194) were randomized to a 5.5-month diet-exercise weight loss intervention with or without mindfulness training focused on emotion regulation and mindful eating. Participants completed self-report measures of mindfulness and psychological well-being, which were planned secondary outcomes, at baseline, mid-intervention (3 months), and at 6-, 12-, and 18-months post-baseline (maintenance period). Mixed effects models and linear regression were used to test between- and within-group changes in psychological well-being. Finally, this study explored whether changes in mindfulness (from baseline to each 6- and 18-months post-baseline) mediated the effects of intervention arm on changes in psychological outcomes during those respective time periods. This study explored whether changes in mindfulness from baseline to 6 months mediated the effects of intervention arm on changes in psychological outcomes from baseline to 18 months.

Results

Participants randomized to the mindfulness arm had significant increases in positive emotions at all follow-up times compared to controls. There were statistically significant increases in mindfulness, psychological flexibility, and reflection, as well as decreases in anxiety and depressive symptoms at 12 months compared to control participants. These changes remained significant for psychological flexibility and reflection at 18 months. There were no significant differences in perceived stress. Among mindfulness participants, greater increases in mindfulness from 6-18 months was associated with greater positive emotions and psychological flexibility as well as lower perceived stress, anxiety, depressive symptoms, and rumination at 18 months, adjusting for 6-month values. Mediation analyses indicated that randomization to the mindfulness intervention arm was associated with 6-month increases in mindfulness, and these increases were in turn associated with improved psychological outcomes at 6 months and 18 months. Changes from baseline to 18 months did not mediate 18-month changes in psychological outcomes.

Conclusions

Mindfulness training in emotion regulation and mindful eating may provide greater longer-term psychological well-being benefits in non-clinical populations with obesity compared to conventional diet-exercise interventions.

Mindful Lawyering: a Pilot Study on Mindfulness Training for Law Students

Objectives

Many US law schools are now offering elective courses in mindfulness training to alleviate disproportionately high levels of anxiety, depression, stress, and disordered alcohol use among law students. To date, empirical evidence on the effectiveness of these courses has been lacking. The aim of this pilot study was to explore the feasibility and impact of a 13‐week mindfulness course, “Mindful Lawyering,” specifically tailored to law students. The primary hypothesis was that mindfulness training would be significantly correlated with improvements in well-being and mindfulness.

Methods

The design was a non-randomized, quasi-experimental study involving 64 law students. The mindfulness group was 31 students taking Mindful Lawyering; the comparison group was 33 students taking other law school courses. Outcome measures were the Depression, Anxiety, and Stress Scale; the Positive and Negative Affect Scale; the Alcohol Use Disorders Identification Test; and the Five Facet Mindfulness Questionnaire.

Results

Results provide promising evidence to support the hypothesis. The mindfulness group showed significantly greater improvement on measures of stress (p < .001, d = 1.15), anxiety (p < .001, d = . 90), depression (p = .012, d = .66), negative affect (p = .002, d = .81), disordered alcohol use (p = .011, d = .67), and mindfulness (p < .001, d = 1.32) from pre to post relative to the comparison group. The course was well accepted and feasible for law students.

Conclusions

Findings from the current study suggest that mindfulness training may occasion improvements in the well-being of law students. More research is needed to replicate these findings in larger, randomized samples of law students.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12671-022-01965-w.

Comparison of two different mindfulness interventions among health care students in Finland: a randomised controlled trial

We investigated the short- and long-term effects of two different evidence-based mindfulness training on students' stress and well-being. A randomised controlled trial with three measurement points (baseline, post-intervention, and 4 months post-intervention) was conducted among undergraduate students of medicine, dentistry, psychology, and logopaedics at the University of Helsinki. The participants were randomly assigned into three groups: (1) face-to-face mindfulness training based on the Mindfulness Skills for Students course (n = 40), (2) a web-based Student Compass program using Mindfulness and Acceptance and Commitment therapy (n = 22), and (3) a control group that received mental health support as usual (n = 40). The primary outcome was psychological distress measured using the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM). Secondary outcomes included hair cortisol concentrations and a wide range of well-being indicators. Psychological distress increased in all the groups from baseline to post-intervention, but significantly less so in the intervention groups than in the control group. At 4-month follow-up, were found no differences between the primary outcomes of the control and intervention groups, but the participants who continued practising mindfulness at least twice a week were less stressed than the others. Our results suggest that participating in a mindfulness course may mitigate health care students' psychological distress during the academic year, but only if the participants continue practising mindfulness at least twice a week.

Investigation of the Relationships Between Mindfulness, Wisdom, Resilience and Life Satisfaction in Turkish Adult Population

There are many factors that are thought to affect life satisfaction. One of these factors is mindfulness. In addition, it has been observed that resilience and wisdom are associated with both mindfulness and life satisfaction. This study aims to examine the associations between mindfulness, resilience, wisdom, and life satisfaction. Participants consist of 1158 Turkish young adults (79.9% females) between the ages of 18 and 58 (Mage = 21.28, SD = 5.31). Mindfulness Scale, Brief Resilience Scale, San Diego Wisdom Scale, and Life Satisfaction Scale were used as the data collection tools. Structural Equation Modelling and Bootstrapping method were used to examine the role of resilience and wisdom in the relationship between mindfulness and life satisfaction. The results of the structural equation analysis showed that resilience and wisdom had a significant mediating role in the relationship between mindfulness and life satisfaction, and that the role of wisdom was stronger than resilience. The results of the bootstrapping analysis showed that the indirect effects of mindfulness on life satisfaction are significant. We conclude that mindfulness, accompanied by wisdom and resilience, can lead to an increase in life satisfaction. Theoretical and practical implications and limitations were discussed.

Intentions to use ride-sourcing services in Vietnam: What happens after three months without COVID-19 infections?

The COVID-19 pandemic has brought new risks and stress for paid transport users worldwide. COVID-19 has changed mobility dynamics worldwide, including low- and middle-income countries (e.g., Vietnam). The present study aims to provide an in-depth understanding of ride-sourcing passengers' behavioural intentions when COVID-19 pandemic management successfully prevented community transmission by extending the TPB with two constructs: perceived virus infection risk and problem-focused coping. Using self-administered questionnaires, data were collected from ride-sourcing customers in Ho Chi Minh City (Vietnam). A total of 540 responses were used for validating the proposed theorethical model. The structural equation model results indicate that problem-focused coping is a multi-faceted construct with two dimensions: problem-solving and self-protection. Also, problem-focused coping has the highest total effect on the intention to use ride-sourcing services following a period of COVID-19 suppression (3 months without identified cases). The findings also reveal that attitude partially mediates the link between problem-focused coping and behavioural intention. The results of this study could be used to develop strategies to promote ride-sourcing services in the aftermath of the COVID-19 pandemic.

Reduced Anxiety Associated to Adaptive and Mindful Coping Strategies in General Practitioners Compared With Hospital Nurses in Response to COVID-19 Pandemic Primary Care Reorganization

COVID-19 pandemic imposed psychosocial stress increasing in frontline healthcare workers, who managed by responding with different coping strategies. General practitioners were targeted by an extraordinary increase in the demand for reception, diagnosis and treatment from all patients even if working in solo. In Italy, the emergency changed risk assumption and roles in between primary care, unraveling the emotional distress of general practitioners, who suffered not only for isolation, but also emotional threatens. In this correlational study we wanted to evaluate trait anxiety and stress as perceived by general practitioners working in individual ambulatory practice room, and by hospital ward nurses working in group, during a chronic phase (February-May 2021) of COVID-19 pandemic. Our hypothesis is that a different work social organization in clinic contest as for general practitioners compared with nurses could induce adaptive or non-adaptive coping to stress under emergency and mindful attitude could be crucial. A number of 37 general practitioners, and 36 nurses were taken from the sanitary district of ASL1 Avezzano-Sulmona-L'Aquila in Italy. For our analyses we used the Health Professions Stress and Coping Scale to assess the risk of burn-out, and detect the coping strategies. We also used the Cognitive and Affective Mindfulness Scale-Revised, investigating whether clinicians used an eventual mindful attitude to prevent anxiety and responding with adaptive coping strategies. General practitioners reported high levels of anxiety, associated to an increased use of emotional distress. Mindful attitude was protective for anxiety in both general practitioners and nurses. As anxiety increased, it was coped by increasing the demand for social support. This coping strategy correlated with emotional distress and when enhanced, it corresponded to avoidance of the problem. Mindful attitude addressed general practitioners to adaptive coping strategies as the solution of the problem. On the other side, nurses accepted the problem but addressed it to others, by avoiding solving it themselves as beyond their role and organizational responsibility. In conclusion, mindful attitude can prevent dysfunctional reactive behaviors among clinicians at the forefront of emergency and reduce emotional distress for isolation as suffered by general practitioners.

Brief Mindfulness Intervention for Emotional Distress, Resilience, and Compassion in Family Physicians During COVID-19: A Pilot Study

Background and Objective

There are high rates of professional burnout among family physicians and trainees. We undertook this study to investigate whether a brief mindfulness intervention could help manage burnout and improve well-being among family physicians in a residency program.

Methods

A total of 21 family physicians participated in a brief, 8-week mindfulness program. We used a single-sample, pre/post design at a Midwestern family medicine residency program. At two points in time (baseline and postintervention), participants completed an online survey measuring burnout, depression, anxiety, stress, perceived resilience, and compassion. We used linear mixed models to estimate the effect of the intervention on the outcome measures.

Results

Participants had improvements after the 8-week intervention. At postintervention, they had significantly better scores on anxiety (P<.004), stress (P<.001), perceived resilience (P<.001), and compassion (P<.001). There were no significant changes on the personal accomplishment, emotional exhaustion, and depersonalization subscales of either the abbreviated Maslach Burnout Inventory or the depression subscale of the Depression Anxiety Stress Scales-21.

Conclusion

This brief mindfulness program was associated with significant reduction in the scores of anxiety and stress as well as significant improvement in perceived resilience and compassion scores. Brief mindfulness interventions may be a convenient and effective approach to support and improve health and well-being among family physicians.

Promoting Wellbeing among Family Medicine Trainees: A Hermeneutic Review of Intervention Mechanisms of Change and their Delivery Methods

PHENOMENON

Efforts to promote wellbeing and reduce burnout amongst postgraduate medical trainees have been hampered by little consideration of interventions' underlying mechanisms, as well as how interventions are delivered. The critical role of trainee specialty has also been overlooked, despite the unique personal and work-based stressors faced among subgroups - such as those completing Family Medicine/General Practice. A consolidation of intervention research can help to guide the design, implementation and evaluation of future targeted programs and potentially enhance their effectiveness. The present hermeneutic literature review addresses this gap.

APPROACH

The Embase, Ovid Medline, and Ovid PsycINFO databases were searched for articles exploring wellbeing and related concepts of burnout and stress amongst Family Medicine/General Practice trainees. Thirty-one studies were identified through seven iterative rounds, with articles that offered novel insights and/or addressed knowledge gaps identified in each round and analyzed, followed by refinement of the overarching coding structure. Thematic analysis was conducted by two researchers.

FINDINGS

Proposed and enacted wellbeing interventions typically involved a combination of individualistic (e.g., self-awareness), organizational (e.g., increasing policy flexibility), and cultural (e.g., leadership) strategies. Change mechanisms were interpersonal (e.g., comradery) and, to a greater extent, intrapersonal (e.g., normalizing and accepting feelings of insecurity). Key delivery methods included the need to ingrain trainee wellness into daily work life and the importance of contextualizing interventions to increase their relevance, acceptance, and effectiveness.

INSIGHTS

The present review identifies and consolidates key mechanisms of change intrinsic to wellbeing-promotion interventions, alongside delivery methods. These findings provide guidance for practice and research to identify these attributes of interventions in the design and evaluation stages. This, in turn, will enhance the clarity of what is being evaluated, facilitating more informed comparisons between evaluations.

What is the mindful personality? Implications for physical and psychological health

Given the paucity of research examining relationships between mindfulness and specific facets of personality, we conducted detailed analyses to explore associations between personality facets, dispositional mindfulness, and health. Overall, 781 participants completed the Five Factor Mindfulness Questionnaire (FFMQ), the Big Five Inventory-2 (BFI-2) to measure personality factors and facets, and the RAND 36-Item Health Survey 1.0 (RAND-36). As expected, BFI-2 factors and facets and FFMQ subscales, except Observing, were consistently correlated. Canonical correlations of BFI-2 facets and FFMQ subscales provided two statistically significant functions. Function 1, Self-Regulation, included FFMQ Acting with Awareness, Non-Judging, and Non-Reacting, as well as BFI-2 Negative Emotionality (Anxiety, Depression, Emotional Volatility), Conscientiousness (Productiveness, Responsibility), and Extraversion (Assertiveness, Energy). Function 2, Self-Awareness, comprised of FFMQ Describing and Observing, and all facets of Open-Mindedness. A latent profile analysis produced three latent profiles: Self-Regulation was defined by higher FFMQ subscales as well as higher Extraversion (all facets), Agreeableness (all facets), Conscientiousness (all facets), and lower Negative Emotionality (all facets); Self-Dysregulation was defined by lower scores on most FFMQ subscales, BFI-2 Extraversion facet scores, Agreeableness (Trust), Conscientiousness (Productiveness), and higher Negative Emotionality facets; and, an Average profile included midrange levels of mindfulness and personality facets. Further, there were statistically significant differences in RAND-36 physical and psychological health based on the latent profiles. The novel findings examining the facet-level relationship between personality and mindfulness contribute to prior inconclusive literature. These results presenting a nuanced understanding of the association between dispositional mindfulness and personality provide preliminary information suggesting that self-regulation can affect health.

"Flourish in the Clerkship Year": a Curriculum to Promote Wellbeing in Medical Students

The stresses of medical training can lead to burnout and other adverse outcomes. The Flourish curriculum was designed to mitigate negative effects of stress among clerkship students through debriefing and skills-building activities that foster practical wisdom: mindfulness, appreciative practice, story-telling/listening, and reflection. Students rated the curriculum highly, felt it addressed common concerns about clerkships, and were able to apply techniques from the curriculum to their clinical work. This framework can help students process their experiences and benefit from peer support, mentorship, and reflection. Fostering medical students' wisdom capacities for reflection and compassion may be protective against burnout during their training.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-022-01522-z.

Mindfulness-based interventions in undergraduate students: a systematic review

ObjectiveTo describe how mindfulness-based intervention (MBIs) are held with undergraduate students, systematize the outcomes of these interventions and indicate possible limitations. Method: Systematic searches were performed in seven databases in January 2019 with the following descriptors: ("mindfulness intervention" AND ("undergraduate" OR "college" OR "students"). Results: A total of 510 articles were found, and 19 articles fully met the inclusion criteria. The searches showed a visible growth in this field of research as articles publications increased in the past years. Regardless of intervention's length, most studies reported beneficial effects. The examination of Anxiety, Stress, and Depression constructs have shown to be predominant. Even though study designs were mostly randomized controlled trials (RCT), it was noticed a shortage use of physiological measures and follow-up assessments. Conclusions: Nonetheless, MBIs have shown to be promising interventions to promote mental health in academic settings.

Experiences of Clinical Clerkship Students With Mindfulness-Based Stress Reduction: A Qualitative Study on Long-Term Effects

Purpose

To explore the mindfulness practice, its long-term effects, facilitators and barriers, in clinical clerkship students 2 years after participation in an 8-week mindfulness-based stress reduction (MBSR) training.

Method

A qualitative study was performed by semi-structured in-depth interviews with 16 clinical clerkship students selected by purposive sampling. Students had participated in a MBSR training 2 years before and were asked about their current mindfulness practice, and the long-term effects of the MBSR training. Thematic analysis was conducted using the constant comparison method. Data saturation was reached after 16 interviews.

Results

Most interviewees were still engaged in regular, predominantly informal, mindfulness practice, although some discontinued mindfulness practice and reported an “unchanged lifestyle.” Three main themes came forward; (1) “focused attention and open awareness” during daily activities as core elements of long-term mindfulness practice; (2) “changes in behavior and coping” that resulted from taking a pause, reflecting, recognizing automatic behavioral patterns and making space for a conscious response; (3) “integration in personal and professional life” by enhanced enjoyment of daily activities, improved work-life-balance and making different career choices. Barriers and facilitators in starting and maintaining mindfulness practice were (1) understanding and intention as “pre-conditions”; (2) practical, personal, and professional factors of students in maintaining practice.

Conclusion

Two years after participation in a MBSR training, many interviewees were still engaged in (mostly informal) mindfulness practice contributing to both personal and professional changes. In light of the high clerkship demands, MBSR training could be a valuable addition to medical curricula, supporting medical students in developing necessary competencies to become well-balanced professionals.

Coping with the crisis: A mindfulness manipulation positively affects the emotional regulation of action crises