Effectiveness of Neurofeedback-Assisted and Conventional 6-Week Web-Based Mindfulness Interventions on Mental Health of Chinese Nursing Students: Randomized Controlled Trial (Preprint)

Abstract

BACKGROUND: Nursing students experience disproportionately high rates of mental health challenges, underscoring the urgent need for innovative, scalable interventions. Web-based mindfulness programs, and more recently, neurofeedback-enhanced approaches, present potentially promising avenues for addressing this critical issue. OBJECTIVE: This study aimed to explore the effectiveness of the neurofeedback-assisted online mindfulness intervention (NAOM) and the conventional online mindfulness intervention (COM) in reducing mental health symptoms among Chinese nursing students. METHODS: A 3-armed randomized controlled trial was conducted among 147 nursing students in Beijing, China, using a 6-week web-based mindfulness program. Participants received NAOM, COM, or general mental health education across 6 weeks. Electroencephalogram and validated tools such as the Patient Health Questionnaire and the Generalized Anxiety Disorder Questionnaire were used to primarily assess symptoms of depression and anxiety at baseline, immediately after the intervention, and at 1 and 3 months after the intervention. Generalized estimating equations were used to evaluate the effects of intervention and time. RESULTS: A total of 155 participants enrolled in the study, and 147 finished all assessments. Significant reductions in the symptoms of depression, anxiety, and fatigue were observed in the NAOM (mean difference [MD]=−3.330, Cohen d=0.926, P<.001; MD=−3.468, Cohen d=1.091, P<.001; MD=−2.620, Cohen d=0.743, P<.001, respectively) and the COM (MD=−1.875, Cohen d=0.490, P=.03; MD=−1.750, Cohen d=0.486, P=.02; MD=−2.229, Cohen d=0.629, P=.01, respectively) groups compared with the control group at postintervention assessment. Moreover, the NAOM group showed significantly better effects than the COM group in alleviating depressive symptoms (MD=−1.455; Cohen d=0.492; P=.04) and anxiety symptoms (MD=−1.718; Cohen d=0.670; P=.04) and improving the level of mindfulness (MD=−3.765; Cohen d=1.245; P<.001) at the postintervention assessment. However, no significant difference except for the anxiety symptoms was observed across the 3 groups at the 1- and 3-month follow-ups. CONCLUSIONS: This 6-week web-based mindfulness intervention, both conventional and neurofeedback-assisted, effectively alleviated mental health problems in the short term among nursing students. The addition of neurofeedback demonstrated greater short-term benefits; however, but these effects were not sustained over the long term. Future research should focus on long-term interventions using a more robust methodological approach. CLINICALTRIAL: Chinese Clinical Trial Registry (ChiCTR) ChiCTR2400080314; https://www.chictr.org.cn/bin/project/edit?pid=211845