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A mindfulness-based intervention to increase resilience to stress in university students (the Mindful Student Study): a pragmatic randomised controlled trial.
Galante, J, Dufour, G, Vainre, M, Wagner, AP, Stochl, J, Benton, A, Lathia, N, Howarth, E, Jones, PB
The Lancet. Public health. 2018;3(2):e72-e81
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There has been a recent increase in students accessing university counselling services, though the reasons for this are currently unclear. Mindfulness-based stress reduction has gained increased attention as evidence has shown mindfulness training can improve anxiety and depression. The aim of this trial was to therefore assess whether a mindfulness course, Mindfulness Skills for Students (MSS), would improve university students’ resilience to stress. Participants were randomly assigned to either enrol in the 8-week MSS course alongside mental health support or receive mental health support alone. A total of 449 participants completed the study and self-reported psychological distress was the primary outcome. Students enrolled in MSS showed reduced distress scores during the examination period compared with those receiving support as usual. Based on these results, the authors conclude that offering mindfulness training could be an effective, feasible component of a wider university mental health strategies. Further controlled studies are required to better understand preventative mental health interventions for students.
Abstract
BACKGROUND The rising number of young people going to university has led to concerns about an increasing demand for student mental health services. We aimed to assess whether provision of mindfulness courses to university students would improve their resilience to stress. METHODS We did this pragmatic randomised controlled trial at the University of Cambridge, UK. Students aged 18 years or older with no severe mental illness or crisis (self-assessed) were randomly assigned (1:1), via remote survey software using computer-generated random numbers, to receive either an 8 week mindfulness course adapted for university students (Mindfulness Skills for Students [MSS]) plus mental health support as usual, or mental health support as usual alone. Participants and the study management team were aware of group allocation, but allocation was concealed from the researchers, outcome assessors, and study statistician. The primary outcome was self-reported psychological distress during the examination period, as measured with the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM), with higher scores indicating more distress. The primary analysis was by intention to treat. This trial is registered with the Australia and New Zealand Clinical Trials Registry, number ACTRN12615001160527. FINDINGS Between Sept 28, 2015, and Jan 15, 2016, we randomly assigned 616 students to the MSS group (n=309) or the support as usual group (n=307). 453 (74%) participants completed the CORE-OM during the examination period and 182 (59%) MSS participants completed at least half of the course. MSS reduced distress scores during the examination period compared with support as usual, with mean CORE-OM scores of 0·87 (SD 0·50) in 237 MSS participants versus 1·11 (0·57) in 216 support as usual participants (adjusted mean difference -0·14, 95% CI -0·22 to -0·06; p=0·001), showing a moderate effect size (β -0·44, 95% CI -0·60 to -0·29; p<0·0001). 123 (57%) of 214 participants in the support as usual group had distress scores above an accepted clinical threshold compared with 88 (37%) of 235 participants in the MSS group. On average, six students (95% CI four to ten) needed to be offered the MSS course to prevent one from experiencing clinical levels of distress. No participants had adverse reactions related to self-harm, suicidality, or harm to others. INTERPRETATION Our findings show that provision of mindfulness training could be an effective component of a wider student mental health strategy. Further comparative effectiveness research with inclusion of controls for non-specific effects is needed to define a range of additional, effective interventions to increase resilience to stress in university students. FUNDING University of Cambridge and National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care East of England.
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Effect of Mindfulness-Based Stress Reduction Therapy on Work Stress and Mental Health of Psychiatric Nurses.
Yang, J, Tang, S, Zhou, W
Psychiatria Danubina. 2018;30(2):189-196
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Many studies have found mindfulness-based stress reduction (MBSR) therapy to significantly reduce stress levels and enhance wellbeing. Among healthcare practitioners, psychiatric nurses experience higher stress and poorer mental health. Therefore the aim of this study was to examine the effects of MBSR on the mental health of 100 psychiatric nurses in China. Nurses were randomised to either receive psychological support including MBSR or to receive psychological support without MBSR weekly. Mental health assessments were taken at baseline and completion of the intervention. This study found that while all participants showed improvements in mental health, those receiving MBSR experienced significant improvement compared with the control group. Based on these results the authors conclude that MBSR therapy is conducive to reducing work-related stress of psychiatric nurses.
Abstract
BACKGROUND Psychiatric nurses are a special group of nursing staff, they experience greater work stress and lower mental health levels than regular nurses. In order to address this problem, the effect of mindfulness-based stress reduction (MBSR) therapy on work stress and mental health of psychiatric nurses is investigated in this study. SUBJECTS AND METHODS From August 2017 to November 2017, 100 psychiatric nurses, including 68 females and 32 males, were selected as participants from three hospitals in Hunan Province of China. They were randomly divided into the intervention and control groups, with 50 respondents in each group. MBSR therapy was used as psychological intervention in the intervention group. Before and after the intervention, the two groups were assessed with the Symptom Checklist-90 (SCL-90) scale, Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS), and Nursing Stress Scale. RESULTS (1) After the intervention, the SCL-90 score of the intervention group decrease significantly, and a statistically significant difference is observed with the figure before the intervention (P<0.001). No statistically significant difference is found in the control group (P>0.05). (2) After the intervention, the SDS and SAS scores of the intervention group decrease significantly, and a statistically significant difference is observed with the figures before the intervention (P<0.001). No statistically significant difference is found in the control group (P>0.05). (3) After the intervention, the Nursing Stress Scale score of the intervention group Nursing Stress Scale decrease significantly, and a statistically significant difference is observed with the figure before the intervention (P<0.001). No statistically significant difference is found in the control group (P>0.05). CONCLUSIONS MBSR therapy can reduce work stress, anxiety, depression, and other negative emotions among psychiatric nurses and improve their mental health.
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Does forming implementation intentions help people with mental health problems to achieve goals? A meta-analysis of experimental studies with clinical and analogue samples.
Toli, A, Webb, TL, Hardy, GE
The British journal of clinical psychology. 2016;55(1):69-90
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There is often a gap between goal setting and goal attainment, and this is likely worsened by mental health problems. While forming implementation intentions (if-then planning) has been shown to be a useful technique for bridging this gap, the extent to which planning can help people with mental health problems has not yet been systematically examined. Implementation intentions (if-then planning) are designed to present good opportunities to act ('if') together with the cognitive or behavioural responses to these ('then'). For example, a person with anxiety may form an implementation intention that 'if' they begin to feel anxious or under-pressure, they will 'then' use deep breathing for 5 minutes to relax. The aim of this meta-analysis was to investigate the effect of implementation intentions (if-then planning) on goal attainment among people with clinically diagnosed mental health disorders. A total of 29 experimental studies were included in the analysis. Based on the current literature, this study found forming implementation intentions had a beneficial impact on goal attainment across a range of various mental health disorders. Based on these results, the authors conclude that forming implementation intentions can be an effective strategy to integrate into treatment approaches for patients with mental health diagnoses.
Abstract
OBJECTIVE People struggle to act on the goals that they set themselves, and this gap between intention and action is likely to be exacerbated by mental health problems. Evidence suggests that forming specific if-then plans (or 'implementation intentions') can promote goal attainment and a number of studies have applied such techniques in clinical contexts. However, to date, the extent to which planning can help people with mental health problems has not been systematically examined. METHOD The present review used meta-analysis to investigate the effect of if-then planning on goal attainment among people with a DSM-IV/ICD-10 diagnosis (i.e., clinical samples) or scores above a relevant cut-off on clinical measures (i.e., analogue samples). In total, 29 experimental studies, from 18 records, met the inclusion criteria. RESULTS Excluding one outlying (very large) effect, forming implementation intentions had a large-sized effect on goal attainment (d+ = 0.99, k = 28, N = 1,636). Implementation intentions proved effective across different mental health problems and goals, and in studies with different methodological approaches. CONCLUSIONS Taken together, the findings suggest that forming implementation intentions can be a useful strategy for helping people with mental health problems to achieve various goals and might be usefully integrated into existing treatment approaches. However, further studies are needed addressing a wider range of mental health problems.
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Patient-centered culturally sensitive health care: model testing and refinement.
Tucker, CM, Marsiske, M, Rice, KG, Nielson, JJ, Herman, K
Health psychology : official journal of the Division of Health Psychology, American Psychological Association. 2011;30(3):342-50
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Patient-centred culturally sensitive health care is based on views of culturally diverse patients rather than the views of health care professionals. Empowering patients to share their views concerning culturally sensitive health care is a manifestation of patient centeredness. This study presents an empirical evaluation of a literature-based Patient Centred Culturally Sensitive Health Care Model. The model was designed to explain the link between patient-centred culturally sensitive health care and patients’ treatment adherence, health promoting behaviours, and health outcomes. A total of 229 patients participated in this study, out of which 110 were African American and 119 self-identified as non-Hispanic White American. Results revealed significant links between patient-perceived provider cultural sensitivity and patient adherence to provider recommended treatment regimen variables, with some differences in associations emerging by race/ethnicity. Among both racial/ethnic groups, providing cultural sensitivity had direct effects on trust and satisfaction with care. The effect on care satisfaction was stronger for the African American patients whereas the effect on trust was stronger for the White American patients. Authors conclude that empowering racial/ethnic minorities and individuals with low household incomes to have increased control in patient-provider interactions and in community participatory health promotion interventions may be an important strategy for improving their health and health care utilization.
Abstract
OBJECTIVES This article presents the results of an empirical test of a literature-based Patient-Centered Culturally Sensitive Health Care Model. The model was developed to explain and improve health care for ethnically diverse patients seen in community-based primary care clinics. DESIGN Samples of predominantly low-income African American (n = 110) and non-Hispanic White American (n = 119) patients were recruited to complete questionnaires about their perceived health care provider cultural sensitivity and adherence to their provider's treatment regimen recommendations. MAIN OUTCOME MEASURES Patients completed written measures of their perceived provider cultural sensitivity, trust in provider, interpersonal control, satisfaction with their health care provider, physical stress, and adherence to provider-recommended treatment regimen variables (i.e., engagement in a health promoting lifestyle, and dietary and medication adherence). RESULTS Two-group path analyses revealed significant links between patient-perceived provider cultural sensitivity and adherence to provider treatment regimen recommendations, with some differences in associations emerging by race/ethnicity. CONCLUSION The findings provide empirical support for the potential usefulness of the Patient-Centered Culturally Sensitive Health Care Model for explaining the linkage between the provision of patient-centered, culturally sensitive health care, and the health behaviors and outcomes of patients who experience such care.