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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
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“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
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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
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“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”
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“Four studies set up independent data monitoring and ethics committees [52,85,92,171].”
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“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].”
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“Two studies reported a participant abandoning the MBP because s/he felt it was being counterproductive [52,186].”
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“One study actively monitored clinically meaningful adverse events with no significant differences between trial arms [52].”
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“…either in person or online through formats such as mindfulness-based stress reduction (MBSR), mindfulness based cognitive therapy (MBCT), or acceptance and commitment therapy (ACT) based training (Galante et al., 2018; Gallo et al., 2023; González-Martin et al., 2023; Simonsson et al., 2021).”
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“Mindfulness-based programs, grati - tude interventions, and self-compassion training have proven effective in improving emotional regulation, reducing stress, and promoting the calm affective states asso - ciated with psychological well-being (Neff & Germer, 2013 ; Galante et al., 2018 ).”
Chen, Z., Duan, W.-J., Huang, K., Yu, X., Zhang, G.-L., & Du, X.-Q. (2026) · Child & Youth Care Forum · doi:10.1007/s10566-026-09954-z
Toledo, M. C., Okamoto, M., Guerra-Domínguez, M. P., & Ballesteros-Valdés, R. (2026) · Research Square · doi:10.21203/rs.3.rs-9603205/v1
How AI Can Enhance Psychological Resilience
Gavankar, M. S., & Ghosh, S. (2026) · IGI Global eBooks · doi:10.4018/979-8-3373-7986-9.ch019
Zhang, Q., Zhang, Z., Xu, C., Xu, X., Li, M., Ma, J., & Li, Y. (2026) · Frontiers in Psychology · doi:10.3389/fpsyg.2026.1714878
“Existing research has established a solid foundation for the boosting eect of mindfulness on resilience (Galante et al., 2018; O’Connor et al., 2023; Tanaka et al., 2023).”
Koyuncu, F., & Yuceer, B. (2026) · Nurse Education in Practice · doi:10.1016/j.nepr.2026.104888
Simerly, G., Broman‐Fulks, J. J., Webb, R. M., & Emery, L. (2026) · Journal of American College Health · doi:10.1080/07448481.2026.2673432
“12,13 In addition, the frequency of mindfulness practice is negatively associated with symptom severity.”
Resilience Building and Enhancing Mental Health: A Scoping Review of School-to-University Programs
nakorn, S. N., & Chandler, G. E. (2026) · Journal of Psychosocial Nursing and Mental Health Services · doi:10.3928/02793695-20260619-02
Carson, W. O., Valenti, M., BEGAY, K. R., Carvajal, S. C., Carroll, S. R., YUAN, N., & Cordova-Marks, F. M. (2026) · Journal of American College Health · doi:10.1080/07448481.2026.2690492
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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