Training for Awareness, Resilience and Action (TARA) for Medical Students: A Single-arm Mixed Methods Pilot Study to Evaluate an Indicated Prevention of Mental Disorders and Stress-related Symptoms

The primary aim of this study was to investigate the feasibility and acceptability of TARA as indicated prevention of symptoms of depression and anxiety and stress-related symptoms in self-selected medical students. The investigators also aimed to qualitatively explore the students' experiences of participating in TARA both during and after the program as well as at a two-year follow-up. The study was designed as a single arm pre-post intervention study.

Participants and procedures Participants were recruited from Umeå University School of Medicine. The University is located in the north of Sweden and enrolls 130 medical students per semester. Participants were recruited from the second and fourth semester through oral and written information at a mandatory class on professional development, including in total approximately 225 students. In addition to being a medical student there were no specific inclusion or exclusion criteria. Participants were allocated to one of two TARA-groups based on their personal weekday preference, since the groups are held on different days of the week.

Before inclusion, participants provided written informed consent. Study participation was voluntary and could be cancelled by the participant at any time.

Groups were held in premises provided by the university hospital. Each session for a given group was led by the same two facilitators, with expertise in contemplative practices and clinical psychology or psychiatry. The facilitators' role during sessions was to teach specific content and to model a collaborative, inclusive, non-judgmental, and supportive attitude. Continuous supervision and training of facilitators was provided by the principal investigator who also monitored fidelity to the manual, both in terms of content adherence and the process of delivery. The facilitators were videotaped to facilitate supervision and implementation of the protocol.

Assessment procedures At baseline, before the intervention, self-report of sociodemographic background and outcome measures were collected online, for details see outcome measures. After the intervention, and at a two-year follow-up outcome measures were repeated. Participants who did not provide data at the time of the data collection were reminded by the research team through email and/or telephone. The TARA-participants provided brief self-assessment and session-evaluation on paper at the beginning and end of each session.