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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
Open accessAbstract
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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“As both a skill and a therapy, mindfulness has been shown to improve symptoms of anxiety, depression, stress, and other mental states (Galante et al. 2018; Ji et al. 2021; Johannsen et al. 2022; Zhu et al. 2021).”
From Changes in Mental Health and EEG Biomarkers of Undergraduates Under Different Patterns of Mindfulness (2024) · cites this paper as Galante et al. 2018
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Systematic reviews conducted on the effectiveness of meditation programs and mindfulness-based intervention programs led to improvements in resilience to stress, anxiety and depression among university students and other populations, whether delivered offline [9] or online [10–14].”
From Effectiveness of online mindfulness interventions on medical students’ mental health: a systematic review (2021) · cites this paper as [9]
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“However, none of neuroscientific studies have explored whether and how brief mindfulness training influences certain psychological features especially social support in college students during the COVID-19 pandemic.”
From Changes in Mental Health and EEG Biomarkers of Undergraduates Under Different Patterns of Mindfulness (2024) · cites this paper as Galante et al. 2018
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“Although personality traits are relatively stable through time they are not cast in stone and can be enhanced, as research has shown, through specific interventions (for reviews and metanalyses see Galante et al., 2018; Gilmartin et al., 2017; Jayawardene et al., 2017; McConville et al., 2017; Quaglia et al., 2016; Spinelli et al., 2018).”
From Specific mindfulness traits protect against negative effects of trait anxiety on medical student wellbeing during high-pressure periods (2021) · cites this paper as Galante et al., 2018
Experimental — accuracy not yet measuredIn the citing paper
“We know from trials in older students that the key skills taught during MT can protect against deterioration in mental health during periods of stress, even if there are no apparent MT-related mental health benefits prior to the onset of stress.11”
In the citing paper
“Four studies set up independent data monitoring and ethics committees [52,85,92,171].”
In the citing paper
“The direction of this bias could favour the effects of MBPs because participants who feel unwell may be less likely to attend assessment sessions or complete self–reported outcomes [52].”
In the citing paper
“Two studies reported a participant abandoning the MBP because s/he felt it was being counterproductive [52,186].”
In the citing paper
“One study actively monitored clinically meaningful adverse events with no significant differences between trial arms [52].”
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InfluentialEffects of flower essences on nursing students’ stress symptoms: a randomized clinical trial
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“2016), reduce anxiety (Yamada & Victor, 2012), increase concentration (Mapel, 2012), generate habits, and better study planning abilities (Broderick & Jennings, 2012), reduces stress and improves psychological well-being (Galante et al., 2018).”
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Sarfraz, A., Siddiqui, S., Galante, J., & Sikander, S. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20085512 · Cited by 14
Self-citationThe contribution of mindfulness in the association between L2 learners’ engagement and burnout
Wu, J., & Zhao, Q.-F. (2023) · Heliyon · doi:10.1016/j.heliyon.2023.e21769 · Cited by 17
“According to this study, mindfulness may improve pupils ’ general well-being [46,47].”
MethodSim, S., Maldonado, I., Castelnau, P., Barantin, L., Hage, W. E., Andersson, F., & Cottier, J. (2023) · Journal of neuroradiology = Journal de neuroradiologie · doi:10.1016/j.neurad.2023.11.002 · Cited by 12
The relationship between study skills and depressive symptoms among medical residents
AlFaris, E., AlMughthim, M., Irfan, F., Maflehi, N. A., Ponnamperuma, G. G., Alfaris, H., Ahmed, A. M. A., & van der Vleuten, C. P. M. (2019) · BMC Medical Education · doi:10.1186/s12909-019-1870-x · Cited by 14
Lai, A. Y. K., Sit, S. M.-M., Lai, T. T.-K., Wang, M. P., Kong, C., Cheuk, J., Feng, Y., Ip, M., & Lam, T.-H. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.673531 · Cited by 15
Influencing factors of anxiety and depression of discharged COVID-19 patients in Wuhan, China
Dai, Z., Xiao, W., Wang, H., Wu, Y., Huang, Y., Si, M., Fu, J., Chen, X., Jia, M., Leng, Z., et al. (2022) · PLoS ONE · doi:10.1371/journal.pone.0276608 · Cited by 15
“Similar to peace of mind, the effect of mindfulness intervention on improving psychological resilience was obvious [69].”
BackgroundGalante, J., Montero-Marín, J., Vainre, M., Dufour, G., García-Campayo, J., & Jones, P. B. (2024) · PLoS ONE · doi:10.1371/journal.pone.0305928 · Cited by 13
Self-citationNarrative creativity training: A new method for increasing resilience in elementary students
Fletcher, A., Enciso, P. E., & Benveniste, M. (2023) · Journal of Creativity · doi:10.1016/j.yjoc.2023.100061 · Cited by 13
Parpottas, P., Vogazianos, P., & Pezirkianidis, C. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph21010022 · Cited by 16
“Past studies suggested some interventions, which can facilitate resilience such as mindfulness [80], resilience journal intervention [81], and coping intervention, which is provided on a group level [82].”
BackgroundLister, K., Andrews, K., Buxton, J., Douce, C., & Seale, J. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1076985 · Cited by 13
Reflective peer observations of university teaching: A Canadian case study
Kanuka, H., & Sadowski, C. A. (2020) · Journal of University Teaching and Learning Practice · doi:10.53761/1.17.5.20 · Cited by 13
“The most researched intervention of this type has been Kabat-Zinn’s (2013) Mindfulness-based stress reduction course, which reduces anxiety (Galante et al., 2018), addictions (Garland & Howard, 2018) and eating disorders.”
BackgroundLatino, F., Tafuri, F., Maisuradze, M., & Tafuri, M. G. (2025) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph22111605 · Cited by 12
“Although resilience and perceived stress are conceptually related, their temporal dynamics may differ [55].”
Prophylactic action of ayahuasca in a non-human primate model of depressive-like behavior
Grilo, M. L. P. D. M., de Sousa, G. M., de Mendonça, L. A. C., Soares, B. L., de Sousa, M. B. C., Palhano-Fontes, F., de Araújo, D. B., Perkins, D., Hallak, J. E. C., & Coelho, N. L. G. (2022) · Frontiers in Behavioral Neuroscience · doi:10.3389/fnbeh.2022.901425 · Cited by 16
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“Despite these limitations, we strongly believe that this study’s findings, implications and recommendations are invaluable and call for better management of the challenges and psychological problems faced by students, leading to a positive educational environment in the future.”
BackgroundSaux, O. L., Canada, B., Debarnot, U., Haouhache, N. E. H., Lehot, J.-J., Binay, M., Cortet, M., Rimmelé, T., Duclos, A., Rode, G., et al. (2024) · Academic Medicine · doi:10.1097/acm.0000000000005714 · Cited by 14
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“Implementing targeted interventions, such as mindfulness training or cognitive-behavioral approaches, can equip students with effective coping strategies to manage stress and negative emotions arising from comparative thinking (Galante et al., 2018).”
Mobile Applications for stress management
Anagnostou, M., & Drigas, A. S. (2022) · Scientific Electronic Archives · doi:10.36560/15220221507 · Cited by 12
Mindfulness training in higher education students
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Chung, J., Mundy, M. E., & McKenzie, S. P. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.869765 · Cited by 11
“Furthermore, the evaluation of mindfulnessbased online programs during the pandemic have supported their value in reducing anxiety, stress and increased selfcompassion (González-García et al., 2021; Simonsson et al., 2021; Sun et al., 2021).”
BackgroundPark, H., Noh, K., Choi, S., & Min, J. J. (2023) · International Journal of Intercultural Relations · doi:10.1016/j.ijintrel.2023.101815 · Cited by 17
Lister, K., & Allman, Z. (2024) · Frontiers in Education · doi:10.3389/feduc.2023.1157614 · Cited by 19
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Vidić, Ž. (2024) · Current Psychology · doi:10.1007/s12144-024-06395-6 · Cited by 11
“While research on gender differences is not extensive, results suggest females derive greater benefit in the form of stress reduction (Galante et al., 2018).”
García-Pérez, L., Atencia-Rodríguez, M. E., González, M. D. M. C., & Ruz, R. P. (2025) · Journal of American College Health · doi:10.1080/07448481.2025.2492174 · Cited by 15
“These included various forms such as Mindfulness Meditation, 34,36,39,41,48 and Mindfulness-Based Stress Reduction Program (MBSR).”
The Benefits of Mindfulness for University Students
Maher, C. M. (2021) · Building Healthy Academic Communities Journal · doi:10.18061/bhac.v5i1.7735 · Cited by 15
“One must refer to their clinician or healthcare provider regarding the mental health care protocol best suited to their individual needs (Galante et al., 2018).”
BackgroundMethodInfluentialDuffy, B. E., Rose-Wiles, L., & Loesch, M. F. (2021) · The Journal of Academic Librarianship · doi:10.1016/j.acalib.2021.102329 · Cited by 11
Boyd, N., & Alexander, D. (2022) · South African Journal of Psychiatry · doi:10.4102/sajpsychiatry.v28i0.1840 · Cited by 15
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“Importantly, mindfulness components have been included in previous prevention and resilience programs targeting university students (Akeman et al., 2020; Galante et al., 2018; Rith-Najarian et al., 2019), potentially indicating promise for this type of approach more broadly.”
Background
Metadata
- Authors
- Galante, J., Dufour, G., Vainre, M., Wagner, A. P., Stochl, J., Benton, A., Lathia, N., Howarth, E., & Jones, P. B.
- Affiliations
- University of Cambridge (GB)
- National Institute for Health and Care Research (GB)
- University of East Anglia (GB)
- University College London (GB)
- Corresponding author
- Galante, Julieta
- ORCID
- Venue
- The Lancet Public Health
- Publisher
- Elsevier BV
- Published
- 2018-02
- Volume
- 3
- Issue
- 2
- Pages
- e72-e81
- ISSN
- 2468-2667 (ISSN-L)
- PMC
- PMC5813792
- OpenAlex
- W2778288638
- Cited by
- 516
- References
- 31
- Citations by year
- 2026: 42 · 2025: 69 · 2024: 67 · 2023: 68 · 2022: 71 · 2021: 86 · 2020: 56 · 2019: 46 · 2018: 9
- FWCI
- 37.99
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- The Lancet Public Health (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UEA Digital Repository (University of East Anglia) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Apollo (University of Cambridge) (submittedVersion, cc-by)
- Apollo (cc-by)
- Funders
- National Institute for Health Research
- University of Cambridge
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Social Sciences › Psychology › Developmental and Educational Psychology › Student Stress and Coping
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- mindfulness-based interventions, stress resilience, university students, student mental health, psychological distress, exam period, mental health support, CORE-OM, student well-being, academic stress, student satisfaction, student engagement, student attendance
- MeSH terms
- Adolescent, Adult, Female, United Kingdom, Health Promotion, Humans, Male, Mental Health Services, Stress, Psychological, Student Health Services, Students, Universities, Program Evaluation, Resilience, Psychological, Young Adult, Mindfulness
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