Differential Effect of Level of Self-Regulation and Mindfulness Training on Coping Strategies Used by University Students

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.

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.

Factors associated with perceived resilience among unergraduate nursing students: findings of the first cross-sectional study in Palestine

BACKGROUND

Resilience has emerged as a concept that could explain and predict good academic and well-being of students in stressful and traumatic situations. This study was conducted to assess resilience and identify predictors of high or low resilience scores among future nurses in Palestine.

METHODS

This cross-sectional study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology statement. Undergraduate nursing students in all academic years were recruited and asked to complete a questionnaire that contained the Trait Resilience Scale and the State-Resilience Scale. Multiple linear regression models were used to identify predictors of higher resilience scores and to control for potentially confounding factors.

RESULTS

In this study, 290 students completed the questionnaire (response rate = 92.4%). The means of trait, state, and combined resilience scores were 71.4 (SD: 7.5), 62.7 (SD: 6.7), and 134.1 (SD: 12.8), respectively. There was a significant moderate positive correlation between state resilience scores and trait resilience scores (r = 0.63, p < 0.001). Having a study routine on daily basis predicted higher trait (β = -0.20, p < 0.001), state (β = -0.12, p = 0.032), and combined (β = -0.18, p = 0.001) resilience scores. Trait and combined resilience scores were predicted by the absence of chronic diseases (β = 0.12, p < 0.05), experiencing addiction issues (β = -0.11, p < 0.05), living in Israeli seized areas (β = 0.16, p < 0.05), and living in a house with enough number of rooms per siblings (β = 0.13, p < 0.05). On the other hand, state and combined resilience scores were predicted by being in the first academic year (β = -0.18, p < 0.01), and state resilience scores were predicted by living in urban areas (β = -0.12, p < 0.05).

CONCLUSIONS

Undergraduate nursing students in Palestine reported relatively high trait and state resilience scores. Higher trait, state, and combined resilience scores were predicted by having a study routine on daily basis. More studies are still needed to investigate the relationship between resilience scores, perceived well-being, willingness to care, and the future success of nursing students in Palestine.

App-based mindfulness meditation reduces perceived stress and improves self-regulation in working university students: A randomised controlled trial

We investigated whether a brief mindfulness meditation programme delivered via a smartphone app improves perceived stress, self-regulation and life satisfaction in part-time working university students. Mindfulness and cognitive reappraisal were analysed as potential mediators. A total of 64 university students working at least 20 h per week during the semester were randomised to either a mindfulness-based mobile intervention or a wait-list control condition. Participants in the intervention group were asked to complete one training session of 10-15 min per day using the app. Psychological measures were assessed via a self-report questionnaire at baseline and after 8 weeks. The online mindfulness programme was found to significantly decrease perceived stress (η_p ²  = .180, a large effect). It also increased self-regulation (η_p ²  = .195, a large effect), mindfulness (η_p ²  = .174; a large effect) and cognitive reappraisal (η_p ²  = .136, a medium effect). Increments in life satisfaction were not significant. Changes in self-regulation were mediated by increased mindfulness. Overall, the mobile application was effective in improving mental well-being and coping abilities in a non-clinical sample, encouraging further development of digital health treatments.

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.

Experiences of stressful situations and mindfulness training for persons with visual impairment

The aim of this study was to explore what persons with visual impairment (VI) experienced as stressful in their daily lives and their experiences with using mindfulness training (MT) to cope with stressful situations. In order to explore this we conducted semi-structured interviews with six persons with VI after finishing an 8-week MT course. Systematic text condensation was used to analyze the interviews. This qualitative study found that the participants described three main areas of stress: (1) lack of access to information, (2) social expectations, and (3) navigating the body through one’s surroundings. The participants’ experiences with using MT to cope with stressful situations resulted in emotion-based and problem-based strategies: (1) breathing anchor, (2) awareness of and reflection upon thoughts and feelings, (3) most things are doable, (4) tackling the situation in a new way, and (5) haste makes waste. Our respondents described using MT for coping with stressful situations in all the three main areas of stress. Based upon this study we propose that there is good reason to offer MT as stress management for persons with VI, but further study is required to confirm the health-promoting benefits of MT for this group.

A Path Analysis Model of Protection and Risk Factors for University Academic Stress: Analysis and Psychoeducational Implications for the COVID-19 Emergency

The aim of this research was to empirically validate hypothesized predictive relationships of protection and risk factors for experiencing academic stress. A synthesis of models-the presage-process-product model; the studying, learning and performing under stress competency model; and self- vs. external-regulatory theory-underlies the investigation and is important for assessment and guidance in stress situations within the university context. Over the course of an academic year, a sample of 564 Spanish university students voluntarily completed validated questionnaires, in an online format, on several psychological variables connected to academic stress. Correlational analysis and the path analysis model, within an ex post facto design, were used to build empirical models of the presage-process-product factors that constitute protection or risk factors in academic stress. Two statistically acceptable models appeared: one with protection factors and another with risk factors in predicting and preventing academic stress at a university. These results support the need for psychology units at university that have a preventive, health and education focus, going beyond the merely clinical. Focus on an individual is insufficient, given that there are also contextual factors that predispose academic stress. Discussion, conclusions, and implications for assessment and intervention in academic stress in university students and teachers, within the present COVID-19 crisis, are offered.

Cross-Sectional Study of Resilience, Positivity and Coping Strategies as Predictors of Engagement-Burnout in Undergraduate Students: Implications for Prevention and Treatment in Mental Well-Being

In a population of young adults, this study analyzes possible linear relations of resilience and positivity to coping strategies and engagement-burnout. The aim was to establish a model with linear, associative, and predictive relations, to identify needs and make proposals for therapeutic intervention in different student profiles. A population of 1,126 undergraduate students with different student profiles gave their informed, written consent, and completed validated questionnaires (CD-RISC Scale; Positivity; Coping Strategies of Stress; Engagement, and Burnout). An ex post-facto design involved bivariate association analyses, multiple regression and structural predictions. The results offered evidence of associations and predictive relationships between resilience factors, positivity, coping strategies and engagement-burnout. The factors of resilience and positivity had significant differential associations (positive and negative) with factors of coping strategies. Their negative relationship to burnout factors, and positive relation to engagement factors, is especially important. Results of structural analysis showed an acceptable model of relationships between variables. We conclude with practical implications for therapeutic intervention: (1) the proactive factors of resilience reflect a perception of self-efficacy and the ability to change adaptively; (2) the reactive factors of resilience are usually associated with withstanding experiences of change, uncertainty or trauma.

The Role of Gender and Age in the Emotional Well-Being Outcomes of Young Adults

Young adults face different stressors in their transition to college. Negative emotions such as stress can emerge from the demands they face. This study aimed at gaining an improved understanding of the role that gender and age play in the well-being of young adults. Coping strategies, resilience, self-regulation, and positivity were selected as indicators of well-being. Descriptive and inferential analysis have been conducted. Results show that well-being varies significantly with age and gender. Gender was predominantly involved in the acquisition of the well-being outcomes, highly predicting problem-focused coping strategies. No interaction effects were found between gender and age. An improved understanding of the developmental factors involved in well-being outcomes will enlighten future interventions aimed at improving young people’s resources to face adversity.

Creating a culture of success: A framework for addressing at-risk student

The lack of diversity in nursing and the projected nursing shortage is a clarion call for higher education to create inclusive programs where all students can thrive. Despite an increase in enrollment, attrition remains an issue. To address the looming nursing shortage, colleges and universities are expected to increase the enrollments in baccalaureate and accelerated baccalaureate programs. As traditional and nontraditional students are admitted into nursing programs, institutions and nursing programs will be faced with tackling issues students who are historically labeled as "at-risk" may have. To help these students succeed, colleges and universities must come up with new ways to work with at-risk students. In this paper, we are proposing a new framework for how faculty in nursing programs can perceive "at-risk" students by systematically examining the factors that lead to this at-risk status. The framework proposes that students encounter a plethora of individual and institutional critical elements, categorized into domains. By understanding the critical elements that impact student outcomes, nursing programs will be better able to strategize ways to effectively support and sustain student success.

Psychological interventions to foster resilience in healthcare students

BACKGROUND

Resilience can be defined as maintaining or regaining mental health during or after significant adversities such as a potentially traumatising event, challenging life circumstances, a critical life transition or physical illness. Healthcare students, such as medical, nursing, psychology and social work students, are exposed to various study- and work-related stressors, the latter particularly during later phases of health professional education. They are at increased risk of developing symptoms of burnout or mental disorders. This population may benefit from resilience-promoting training programmes.

OBJECTIVES

To assess the effects of interventions to foster resilience in healthcare students, that is, students in training for health professions delivering direct medical care (e.g. medical, nursing, midwifery or paramedic students), and those in training for allied health professions, as distinct from medical care (e.g. psychology, physical therapy or social work students).

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, 11 other databases and three trial registries from 1990 to June 2019. We checked reference lists and contacted researchers in the field. We updated this search in four key databases in June 2020, but we have not yet incorporated these results.

SELECTION CRITERIA

Randomised controlled trials (RCTs) comparing any form of psychological intervention to foster resilience, hardiness or post-traumatic growth versus no intervention, waiting list, usual care, and active or attention control, in adults (18 years and older), who are healthcare students. Primary outcomes were resilience, anxiety, depression, stress or stress perception, and well-being or quality of life. Secondary outcomes were resilience factors.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected studies, extracted data, assessed risks of bias, and rated the certainty of the evidence using the GRADE approach (at post-test only).

MAIN RESULTS

We included 30 RCTs, of which 24 were set in high-income countries and six in (upper- to lower-) middle-income countries. Twenty-two studies focused solely on healthcare students (1315 participants; number randomised not specified for two studies), including both students in health professions delivering direct medical care and those in allied health professions, such as psychology and physical therapy. Half of the studies were conducted in a university or school setting, including nursing/midwifery students or medical students. Eight studies investigated mixed samples (1365 participants), with healthcare students and participants outside of a health professional study field. Participants mainly included women (63.3% to 67.3% in mixed samples) from young adulthood (mean age range, if reported: 19.5 to 26.83 years; 19.35 to 38.14 years in mixed samples). Seventeen of the studies investigated group interventions of high training intensity (11 studies; > 12 hours/sessions), that were delivered face-to-face (17 studies). Of the included studies, eight compared a resilience training based on mindfulness versus unspecific comparators (e.g. wait-list). The studies were funded by different sources (e.g. universities, foundations), or a combination of various sources (four studies). Seven studies did not specify a potential funder, and three studies received no funding support. Risk of bias was high or unclear, with main flaws in performance, detection, attrition and reporting bias domains. At post-intervention, very-low certainty evidence indicated that, compared to controls, healthcare students receiving resilience training may report higher levels of resilience (standardised mean difference (SMD) 0.43, 95% confidence interval (CI) 0.07 to 0.78; 9 studies, 561 participants), lower levels of anxiety (SMD -0.45, 95% CI -0.84 to -0.06; 7 studies, 362 participants), and lower levels of stress or stress perception (SMD -0.28, 95% CI -0.48 to -0.09; 7 studies, 420 participants). Effect sizes varied between small and moderate. There was little or no evidence of any effect of resilience training on depression (SMD -0.20, 95% CI -0.52 to 0.11; 6 studies, 332 participants; very-low certainty evidence) or well-being or quality of life (SMD 0.15, 95% CI -0.14 to 0.43; 4 studies, 251 participants; very-low certainty evidence). Adverse effects were measured in four studies, but data were only reported for three of them. None of the three studies reported any adverse events occurring during the study (very-low certainty of evidence).

AUTHORS' CONCLUSIONS

For healthcare students, there is very-low certainty evidence for the effect of resilience training on resilience, anxiety, and stress or stress perception at post-intervention. The heterogeneous interventions, the paucity of short-, medium- or long-term data, and the geographical distribution restricted to high-income countries limit the generalisability of results. Conclusions should therefore be drawn cautiously. Since the findings suggest positive effects of resilience training for healthcare students with very-low certainty evidence, high-quality replications and improved study designs (e.g. a consensus on the definition of resilience, the assessment of individual stressor exposure, more attention controls, and longer follow-up periods) are clearly needed.

Effect of Levels of Self-Regulation and Situational Stress on Achievement Emotions in Undergraduate Students: Class, Study and Testing

Achievement emotions constitute one important variable among the many variables of students’ learning. The aim of this research was to analyze the differential effect of university students’ levels of self-regulation (1 = low, 2 = medium and 3 = high), and of their level of perceived stress in three academic situations (1 = class, 2 = study time and 3 = testing), on the type of achievement emotionality they experience (positive and negative emotions). The following hypotheses were established: (1) a higher level of student self-regulation would be accompanied by higher levels of positive emotionality and lower levels of negative emotionality and (2) a higher level of situational stress would predispose higher levels of negative emotionality and lower levels of positive emotionality. A total of 520 university students completed three self-reports with validated inventories. Descriptive, correlational, and structural prediction analyses (SEM) were performed, as well as 3 × 3 ANOVAs, under an ex post facto design by selection. The results showed overall fulfillment of the hypotheses, except for a few specific emotions. Implications for prevention and psychoeducational guidance in the sphere of university education are discussed.

Coping Strategies and Self-Efficacy in University Students: A Person-Centered Approach

In daily academic life, students are exposed to a wide range of potentially stressful situations which could negatively affect their academic achievement and their health. Among the factors that could be weakened by academic stress, attention has been paid to expectations of self-efficacy, which are considered one of the most important determinants for student engagement, persistence, and academic success. From a proactive perspective, research on academic stress has emphasized the importance of coping strategies in preventing harmful consequences. In recent years, there has been a growing interest in discovering the extent to which individuals are able to combine different coping strategies and the adaptive consequences this flexibility entails. However, studies using this person-centered approach are still scarce in the academic context. On that basis, this current study had two objectives: (a) to examine the existence of different profiles of university students based on how they combined different approach coping strategies (positive reappraisal, support seeking, and planning) and (b) to determine the existence of differences in general expectations of self-efficacy between those coping profiles. A total of 1,072 university students participated in the study. The coping profiles were determined by latent profile analysis (LPA). The differences in the self-efficacy variable were determined using ANCOVA, with gender, university year, and degree type as covariates. Four approach coping profiles were identified: (a) low generalized use of approach coping strategies; (b) predominance of social approach coping approaches; (c) predominance of cognitive approach coping approaches; and (d) high generalized use of approach coping strategies. The profile showed that a greater combination of the three strategies was related to higher general self-efficacy expectations and vice versa. These results suggest that encouraging flexibility in coping strategies would help to improve university students’ self-efficacy.

Mindfulness and Coaching to Improve Learning Abilities in University Students: A Pilot Study

This pilot study investigated the effects of a short 10-module intervention called MEL (Mindful Effective Learning), which integrates mindfulness, coaching, and training on study strategies, to improve learning abilities among university students. Inspired by ample research on the learning topics that points out how effective learning and good academic results depend simultaneously on self-regulation while studying combined with emotional and motivational factors, the intervention aimed to train students simultaneously in these three aspects. The intervention group participants (N = 21) and the control group participants (N = 24) were surveyed pre- and post-intervention with the Italian questionnaire AMOS (Abilities and Motivation to Study) and the Italian version of the Mindful Attention Awareness Scale (MAAS). The results showed that, regarding self-regulation in study, trained students improved their self-awareness, self-evaluation ability, metacognition skills, and organizational and elaborative ability to manage study materials; regarding emotional aspects, they improved their anxiety control; regarding motivation they developed an incremental theory of Self and improved their confidence in their own intelligence. Moreover, two follow-up self-report surveys were conducted, and trained students reported positive assessments of the MEL intervention. Findings suggest that a short intervention based on mindfulness and coaching and training on study strategies may improve students' effective learning.

Implications of Unconnected Micro, Molecular, and Molar Level Research in Psychology: The Case of Executive Functions, Self-Regulation, and External Regulation

The proliferation of research production in Psychology as a science has been increasing exponentially. This situation leads to the necessity of organizing the research production into different levels of analysis that make it possible to delimit each research domain. The objective of this analysis is to clearly distinguish the different levels of research: micro-analysis, molecular, and molar. Each level is presented, along with an analysis of its benefits and limitations. Next, this analysis is applied to the topics of Executive Functions, Self-Regulation, and External Regulation. Conclusions, limitations, and implications for future research are offered, with a view toward a better connection of research production across the different levels, and an allusion to ethical considerations.

Characteristics, Structure, and Effects of an On-Line Tool for Improvement in Adolescents' Competency for Interaction With Alcohol: The e-ALADOTM Utility

This research report aims to present the characteristics, structure and effects of a psychoeducational technological innovation (called the e-ALADO Program) for the prevention of alcohol intake in adolescents. Based on the Competency model for interaction with alcohol, this program consists of a total of 24 lessons that promote conceptual, procedural, and attitudinal learning, in ICT format (www.alado.es). The hypothesis of this validation study established that adolescents treated with the program would improve their levels of competence and their interaction behavior with alcohol, depending of their personal level of self-regulation. A total of 148 adolescents from 12 to 16 years of age from three Spanish educational centers with different sociocultural contexts participated. A quasi-experimental methodology with repeated measures and use of inferential analysis was used (ANOVAs and MANOVAs). The results show a main principal effect of the Treatment variable, of the Self-Regulation Level variable, and an interaction effect of Treatment × Self-regulation in the conceptual and attitudinal subcompetence for interaction with alcohol. The results are discussed in the face of new technological developments that allow the evaluation and intervention in the prevention of alcohol intake with adolescents. An important implication of this work is related to the importance of self-regulation as a psychological variable. Also, the suitability of psychoeducational interventions with new technological formats in the prevention of adolescents' alcohol intake as entrepreneurial activity.

Mindful Learning Improves Positive Feelings of Cancer Patients' Family Caregivers

Positive feelings are an important health dimension for family caregivers of cancer patients. The aim of this study was to investigate whether Langerian mindfulness is a valid proactive method to increase the positive feelings of family caregivers for cancer patients. Participants were randomly assigned to either a mindfulness group or a mindlessness group and completed the Caregiver Reaction Assessment (CRA) as a measure of caregivers' feelings before the intervention. Subsequently, both groups were given four sessions of mindfulness training using "innovation classification". Finally, participants completed the Langer Mindfulness Scale (LMS) and the Positive Aspects of Caregiving (PAC) scale as post-intervention measures. The results revealed that participants in the mindfulness and mindlessness groups differed significantly in LMS and PAC scores, with the mindfulness group having higher levels of positive feelings than those in the mindlessness group. The results also indicated that mindfulness level significantly predicted positive feelings of caregivers. Thus mindful interventions may play a meaningful role in promoting family caregivers' spirituality and faith, improving the willingness of sharing their thoughts, beliefs, and grief, which could be useful for increasing the positive feelings of caregivers.