Feasibility and Acceptability of an Online Mindfulness-Based Intervention for Stress Reduction and Psychological Wellbeing of University Students in Pakistan: A Pilot Randomized Controlled Trial

The rise in mental health concerns of university students is causing a serious hinderance to their wellbeing, impeding their functioning. The socio-economic and political friction in low- and middle-income countries adds to their vulnerability and calls for a cost-effective indigenous intervention. Consequently, this study aimed to inform a large definitive trial by assessing the feasibility and acceptability of a randomized controlled trial (RCT) design evaluating a culturally adapted online Mindfulness Training Course (MTC) used to improve stress and wellbeing among Pakistani university students. A two-arm pilot randomized controlled trial was conducted. University students (n = 156) were randomly assigned to either the MTC group (n = 80) or Wait-list (WL) control group (n = 76) and completed baseline and post-intervention self-report measures for mindfulness, stress and psychological wellbeing. Additionally, semi-structured interviews were conducted with consenting MTC group participants (n = 18) to explore their views about MTC, employing reflexive thematic analysis. Of 80 participants randomized to the MTC group, 32 completed the course, whereas, from the 156 randomized participants, 102 completed assessment surveys. Feasibility and acceptability indicators showed high recruitment, compliance, and adherence to MTC, with practical steps for randomization and online data collection. Further results showed higher levels of mindfulness and psychological wellbeing and lowered stress levels in the MTC group compared to the control group. The attrition and dropout rates were high; however, the feedback from participants who completed the MTC was highly positive and encouraging. In conclusion, if the trial proceeds with increased outreach in a large-scale RCT, the recruitment might be revised to reduce attrition rates. Further recommendations are discussed.

[1]  Salma Siddiqui,et al.  CULTURAL ADAPTATION OF A MINDFULNESS-BASED INTERVENTION FOR YOUNG ADULTS: AN APPLICATION OF HEURISTIC FRAMEWORK , 2023, Pakistan Journal of Social Research.

[2]  Addressing Students’ Stress in Higher Education Through an Online Mindfulness Training Course , 2022, EHSSA-22 & BLTST-22 May 25-27, 2022 Barcelona (Spain).

[3]  M. Petticrew,et al.  A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance , 2021, BMJ.

[4]  S. Fernández-Carriba,et al.  Feasibility of a Brief Online Mindfulness and Compassion-Based Intervention to Promote Mental Health Among University Students During the COVID-19 Pandemic , 2021, Mindfulness.

[5]  Peter B. Jones,et al.  A follow‐up study to a randomised control trial to investigate the perceived impact of mindfulness on academic performance in university students , 2019, Counselling and Psychotherapy Research.

[6]  C. Sutton,et al.  Determining sample size for progression criteria for pragmatic pilot RCTs: the hypothesis test strikes back! , 2020, Pilot and Feasibility Studies.

[7]  M. Freedman,et al.  A Pilot Randomized Controlled Trial of a Mindfulness Program for Filipino Children , 2019, Mindfulness.

[8]  Peter B. Jones,et al.  Mindfulness-Based Interventions for University Students: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. , 2019, Applied psychology. Health and well-being.

[9]  J. Michalak,et al.  Implementation and Dissemination of Mindfulness-Based Interventions , 2019, Mindfulness.

[10]  R. Chiva-Gómez,et al.  Mindfulness and academic performance: The role of compassion and engagement , 2019, Innovations in Education and Teaching International.

[11]  S. Lambert,et al.  An online mindfulness-based intervention for undergraduate pharmacy students: Results of a mixed-methods feasibility study. , 2019, Currents in pharmacy teaching & learning.

[12]  A. L. Lucchetti,et al.  Effects of a Required Large-Group Mindfulness Meditation Course on First-Year Medical Students’ Mental Health and Quality of Life: a Randomized Controlled Trial , 2019, Journal of General Internal Medicine.

[13]  Virginia Braun,et al.  Reflecting on reflexive thematic analysis , 2019, Qualitative Research in Sport, Exercise and Health.

[14]  Gillian Lancaster,et al.  A guide to the reporting of protocols of pilot and feasibility trials , 2019, Pilot and Feasibility Studies.

[15]  B. Ajilchi,et al.  Applying mindfulness training to enhance the mental toughness and emotional intelligence of amateur basketball players , 2019, Australasian psychiatry : bulletin of Royal Australian and New Zealand College of Psychiatrists.

[16]  S. Jesus,et al.  Effects of a brief mindfulness-based intervention on emotional regulation and levels of mindfulness in senior students , 2018, Psicologia, reflexao e critica : revista semestral do Departamento de Psicologia da UFRGS.

[17]  B. Dunn,et al.  Feasibility and Acceptability of Mindfulness-based Cognitive Therapy Compared with Mindfulness-based Stress Reduction and Treatment as Usual in People with Depression and Cardiovascular Disorders: a Three-Arm Randomised Controlled Trial , 2018, Mindfulness.

[18]  Syed Shahzad Ali,et al.  Frequency of depression, anxiety and stress among the undergraduate physiotherapy students , 2018, Pakistan journal of medical sciences.

[19]  K. Cavanagh,et al.  A Randomised Controlled Trial of a Brief Online Mindfulness-Based Intervention in a Non-clinical Population: Replication and Extension , 2018, Mindfulness.

[20]  Peter B. Jones,et al.  A mindfulness-based intervention to increase resilience to stress in university students (the Mindful Student Study): a pragmatic randomised controlled trial , 2017, The Lancet. Public health.

[21]  A. Adil,et al.  Role of Mindfulness and Psychological Wellbeing Between External Locus of Control and Depression: A Moderated Mediation Model , 2017 .

[22]  J. Brewer,et al.  What defines mindfulness-based programs? The warp and the weft , 2016, Psychological Medicine.

[23]  M. Campbell,et al.  CONSORT 2010 statement: extension to randomised pilot and feasibility trials , 2016, British Medical Journal.

[24]  M. Khan,et al.  Economic Burden of Mental Illnesses in Pakistan. , 2016, The journal of mental health policy and economics.

[25]  Joanne Kraenzle Schneider,et al.  Mindfulness-based meditation to decrease stress and anxiety in college students: A narrative synthesis of the research , 2016 .

[26]  J. Bauer,et al.  Students and Teachers Benefit from Mindfulness-Based Stress Reduction in a School-Embedded Pilot Study , 2016, Front. Psychol..

[27]  Wendy T. M. Pots,et al.  Effectiveness of online mindfulness-based interventions in improving mental health: A review and meta-analysis of randomised controlled trials. , 2016, Clinical psychology review.

[28]  E. Kozasa,et al.  Positive Effects of a Stress Reduction Program Based on Mindfulness Meditation in Brazilian Nursing Professionals: Qualitative and Quantitative Evaluation. , 2016, Explore.

[29]  Sona Dimidjian,et al.  Prospects for a clinical science of mindfulness-based intervention. , 2015, The American psychologist.

[30]  M. Sherina,et al.  Effects of a DVD-Delivered Mindfulness-Based Intervention for Stress Reduction in Medical Students: A Randomized Controlled Study , 2015 .

[31]  K. Tobin,et al.  Facing the grand challenges through heuristics and mindfulness , 2015 .

[32]  Esther V. Garza,et al.  International Student's Challenge and Adjustment to College , 2015 .

[33]  Normala Ibrahim,et al.  Effects of a brief mindfulness-based intervention program for stress management among medical students: the Mindful-Gym randomized controlled study , 2015, Advances in Health Sciences Education.

[34]  Gillian A Lancaster,et al.  Pilot and feasibility studies come of age! , 2015, Pilot and Feasibility Studies.

[35]  W. Mak,et al.  Enhancing Web-Based Mindfulness Training for Mental Health Promotion With the Health Action Process Approach: Randomized Controlled Trial , 2015, Journal of medical Internet research.

[36]  A. Waqas,et al.  Public stigma associated with mental illnesses in Pakistani university students: a cross sectional survey , 2014, PeerJ.

[37]  Kate Cavanagh,et al.  Can mindfulness and acceptance be learnt by self-help?: a systematic review and meta-analysis of mindfulness and acceptance-based self-help interventions. , 2014, Clinical psychology review.

[38]  J. García-Campayo,et al.  Mindfulness-based stress reduction (MBSR) in perceived stress and quality of life: an open, uncontrolled study in a Brazilian healthy sample. , 2014, Explore.

[39]  C. Gallo,et al.  Mental health research priorities in low- and middle-income countries of Africa, Asia, Latin America and the Caribbean , 2009, British Journal of Psychiatry.

[40]  Eunjung Ryu,et al.  The effectiveness of a stress coping program based on mindfulness meditation on the stress, anxiety, and depression experienced by nursing students in Korea. , 2009, Nurse education today.

[41]  M. Marcus.  What Are Young Adults Saying About Mental Health? a Qualitative Analysis of Internet Blogs , 2009 .

[42]  Karlijn F. Kuijpers,et al.  Effects of Mindfulness-Based Stress Reduction Intervention on Psychological Well-being and Quality of Life: Is Increased Mindfulness Indeed the Mechanism? , 2008, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[43]  M. Barrera,et al.  A heuristic framework for the cultural adaptation of interventions , 2006 .

[44]  S. Mahmood,et al.  Prevalence of depression, anxiety and their associated factors among medical students in Karachi, Pakistan. , 2006, JPMA. The Journal of the Pakistan Medical Association.

[45]  Gregory T. Smith,et al.  Using Self-Report Assessment Methods to Explore Facets of Mindfulness , 2006, Assessment.

[46]  Steven A. Julious,et al.  Sample size of 12 per group rule of thumb for a pilot study , 2005 .

[47]  J. Kabat-Zinn,et al.  Mindfulness-Based Interventions in Context: Past, Present, and Future , 2003 .

[48]  M. Barkham,et al.  Towards a standardised brief outcome measure: Psychometric properties and utility of the CORE–OM , 2002, British Journal of Psychiatry.

[49]  J. Kabat-Zinn,et al.  An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results. , 1982, General hospital psychiatry.

[50]  Z. Segal,et al.  Mindfulness-Based Cognitive Therapy: Theoretical Rationale and Empirical Status. , 2004 .

[51]  C. Ryff.  Happiness is everything, or is it? Explorations on the meaning of psychological well-being. , 1989 .