Mindful Response to Adversity: A Brief Stress Resilience Training for Improving Mental Health in Students
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Loneliness
- Sponsor
- Carnegie Mellon University
- Enrollment
- 114
- Locations
- 1
- Primary Endpoint
- Daily Depression
- Status
- Completed
- Last Updated
- 6 years ago
Overview
Brief Summary
The investigators will conduct an intervention study with the aim of improving stress resilience and mental health outcomes in at-risk freshman students. Participants will attend a group training session, led by a professional instructor, about responding to adversity, which will include a description of the skills, a writing and sharing activity focused on the proposed approach, and a practice session. Following the training, participants will be instructed to practice the skills that the participants just learned during a group version of a standard stress-induction task called the Trier Social Stress Task (the TSST-G).
Detailed Description
The investigators will conduct an intervention study with the aim of improving stress resilience and mental health outcomes in at-risk freshman students. The investigators will also work closely with institutional officials to assess whether the intervention can improve student well-being. Specifically, the project aims to teach freshman students (who are at high risk for depression) skills in how to foster a mindful response to adversity at the beginning of the school term, along with periodic support reminders (via text message) during high stress/vulnerability periods over the course of the semester. The investigators will adopt a randomized controlled trial approach to rigorously evaluate whether this intervention can be adopted as a standard onboarding program for all incoming freshman students during the first weeks of orientation on the CMU campus. Participants will come for the study session and provide a dried blood spot sample and complete a battery of self-report questionnaires. Participants will attend a group training session, led by a professional instructor, about responding to adversity, which will include a description of the skills, a writing and sharing activity focused on the proposed approach, and a practice session. Following the training, participants will be instructed to practice the skills that the participants just learned during a group version of a standard stress-induction task called the Trier Social Stress Task (the TSST-G). Salivary cortisol measures will be collected throughout the TSST-G. The treatment condition will be trained in techniques designed to teach a "mindful approach to adversity". These techniques will include: normalizing, attention, equanimity, non-judgment, de-centering, accepting of experiences, and impermanence. Participants will be instructed on the mindset, asked to write about an instance of non-judgment and share with a partner, and then guided through a short training designed to practice each skill. The control condition will be trained in techniques designed to teach a typical narrative self-analysis / strengths-based approach to adversity. These techniques will include: choosing the best approach, minimizing stress, and identifying and enhancing personal strengths. Participants will be instructed on the mindset, asked to write about an instance of personal strength and share with a partner, and then guided through a short training designed to practice each skill. Daily diary measures will be collected for 7 days following the study session and 1 week before the follow-up session. Microhit boosters will be sent to participants at self-identified high stress periods, which remind participants of the training session skills. Participants will come for the follow-up session and provide a dried blood spot sample and complete a battery of self-report questionnaires.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Full-time first-year student at Carnegie Mellon University.
- •Adult (age 18+)
- •Must own a data-enabled smartphone
- •Scores indicating moderate to high levels of depressive symptomatology (composite score \> or equal to 2 on the short-form (6-item) Beck Depression Inventory).
Exclusion Criteria
- •Potential participants who score a 0 or a 1 on the 6-item BDI section will not be eligible.
Outcomes
Primary Outcomes
Daily Depression
Time Frame: Change in daily depression assessed daily for seven days during week 2 and week 16 of the study.
In a daily diary, participants are asked at the end of the day to identify the extent to which they endorse symptoms measuring depressive symptomatology (i.e. "feeling hopeless about the future", "feeling blue") for that day. Analyses will use multilevel modeling to test for a time by condition interaction showing lower daily depressive symptomatology at post-treatment in the equanimity compared to the strength based group.
Depression I
Time Frame: Change in depression over 4-month period.
Evaluated using the validated 21-item Beck Depression Inventory (BDI), which is designed to measure characteristic attitudes and symptoms of depression. The score for each item ranges between 0-3, where 0 denotes less depression (e.g. "I do not feel sad") and 3 denotes more depression (e.g. "I am so dan and unhappy that I can't stand it"). Total score will be between 0-63, where 0 indicates no depression and 63 indicates extreme depression. The score is a total of 21 questions and the following is a typical subscale range distribution: 1-10: These ups and downs are considered normal 11-16: Mild mood disturbance 17-20: Borderline clinical depression 21-30: Moderate depression 31-40: Severe depression over 40: Extreme depression Analyses will use multilevel modeling to test for a time by condition interaction showing lower depressive symptomatology at post-treatment in the equanimity compared to the strength based treatment group.
Depression II
Time Frame: Change in depression over 4-month period.
Evaluated using the validated 20-item Center for Epidemiologic Studies Depression scale (CES-D), which is designed to measure characteristic attitudes and symptoms of depression. There are 20 questions and the score for each item ranges between 0-3. For most questions, a lower score indicates lack of depression and a higher score indicates high depression (e.g. in response to the statement "I felt fearful" a 0 indicates rarely and 3 indicates most or all of the time). Questions 4, 8, 12, and 16 are reverse scored. The score is the sum of the 20 questions. Possible range is 0-60. A score of 16 points or more is considered depressed. Analyses will use multilevel modeling to test for a time by condition interaction showing lower depressive symptomatology at post-treatment in the equanimity compared to the strength based treatment group.
Daily Social Connection
Time Frame: Change in daily social connection assessed daily for seven days during week 2 and week 16 of the study.
Following Hawkley et al. (2007) and our previous studies, end-of-day daily diary questions will assess the amount of time spent interacting with others and the extent to which social interactions throughout the day were perceived as positive. Example items: "How much time did you spend today with others, talking or listening to them?" (0 = little or none of the day to 4 = most or all of the day) and "How many positive interactions did you have today (e.g., supportive, enjoyable, rewarding, affirming)?" (0 = one, 1 = several, 2 = many). Analyses will use multilevel modeling to test for a time by condition interaction showing increased daily social connection at post-treatment in the equanimity compared to the strength based group.
Daily Belonging
Time Frame: Change in loneliness over 4-month period.
End-of-day daily diary questions will measure feelings of belonging and closeness at school. Example items: "I felt like I belong in school" and "I felt like no one really knew me well at school (reverse-scored)" (0= Not at all, 4= Extremely). Analyses will use multilevel modeling to test for a time by condition interaction showing increased daily social belonging at post-treatment in the equanimity compared to the strength based group.
Loneliness
Time Frame: Change in loneliness over 4-month period.
Evaluated using the University of California, Los Angeles (UCLA) Loneliness Scale. The University of California, Los Angeles (UCLA) Loneliness scale is designed to measure one's subjective feelings of loneliness as well as feelings of social isolation. A 20-item scale designed to measure one's subjective feelings of loneliness as well as feelings of social isolation. Participants rate each item as either A ("I always feels this way"), O ("I often feel this way"), S ("I sometimes feel this way"), R ("I rarely feel this way"), N ("I never feel this way"). Scores are summed from each item and higher scores indicate greater degrees of loneliness. Scores of 15-20 indicate average level of loneliness; 21-30 indicate frequent loneliness; 31-40 indicate severe loneliness. Analyses will use multilevel modeling to test for a time by condition interaction showing decreased loneliness at post-treatment in the equanimity compared to the strength based group.
Secondary Outcomes
- Occurrences of Daily Acceptance(Assessed daily for seven days during week 2 and week 16 of the study.)
- Physical Activity (FitBit)(Assessed daily during week 2-17 of the study.)
- Academic performance(Change in GPA between semester immediately prior to enrollment and semester during enrollment in the study (approximately 5 months).)
- Sleep (FitBit)(Assessed daily during week 2-17 of the study.)
- Concentrations of pro-inflammatory gene expression(Change in gene expression over weeks 1 and weeks 17 of the study.)
- Concentrations of C-Reactive Protein(Change in CRP over 4-month period.)
- Concentrations of salivary cortisol(Four cortisol samples will be collected at the baseline session. One sample before and three samples after the acute stress challenge using the TSST.)
- Perceived Stress(Change in perceived stress over 4-month period.)
- Subjective Social Status(Measured at baseline only.)
- Daily Resilience using the Brief Resilience Scale(Assessed daily for seven days during week 2 and week 16 of the study.)
- Daily Occurrence of Stress and Successful Coping Scale(Assessed daily for seven days during week 2 and week 16 of the study.)
- Daily State Mindfulness Scale(Assessed daily for seven days during week 2 and week 16 of the study.)