Your body can fight stress better when it is fit. Eat healthy, well-balanced meals. Learn to manage your time more effectively.
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Set limits appropriately and learn to say no to requests that would create excessive stress in your life. Make time for hobbies, interests, and relaxation. Get enough rest and sleep. Your body needs time to recover from stressful events. Don't rely on alcohol, drugs, or compulsive behaviors to reduce stress. Seek out social support. Spend enough time with those you enjoy. More studies are needed to address the existing limitations of mindfulness meditation interventions and explore more convenient ways to deliver mindfulness meditation in order to encourage participation and increase accessibility among college students.
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Many college students have expressed being receptive to online mental health treatments, with one study reporting that college students were more likely to seek help online than face-to-face [ 47 ]. The development of mobile health apps has been increasing exponentially, and the use of apps has been reported to improve the efficiency of health care delivery and the effectiveness of treatment [ 48 ]. It is also important to note that while apps may offer the ability for increased access to health information, remote care, and user autonomy [ 49 ], there is a need to ensure safety of users, as there is no regulatory oversight.
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Independent testing of mobile apps is highly warranted. Mindfulness meditation mobile apps may be a promising approach to reduce stress and address the barriers for stress management reported by college students. Although the popularity of mindfulness apps is increasing, only a few studies have examined the feasibility and efficacy of such mindfulness-based mobile apps for reducing stress among college students.
We also explored the feasibility ie, acceptability and demand of the intervention delivered via the mobile app and examined the sustained effects at 12 weeks from baseline of the intervention on stress, mindfulness, and self-compassion. Additionally, exploratory analyses examined the potential effects of the mindfulness intervention on health behaviors ie, sleep disturbance, alcohol consumption [binge drinking], physical activity, and healthy eating [fruit and vegetable consumption].
We hypothesized that college students in the intervention group would have significant improvements in perceived stress as compared to the wait-list control. We also hypothesized that stress, mindfulness, and self-compassion would have sustained effects in the intervention group as compared to the wait-list control.
Finally, we hypothesized that the intervention may improve health behaviors.
The findings from this study will provide important insights on the potential stress-reducing effects of a consumer-based mindfulness meditation mobile app ie, Calm and could be applied to the design of future mindfulness meditation interventions in stressed college students. All participants provided electronic consent prior to participation in the study. The datasets generated or analyzed during the study are available from the corresponding author upon request. This study was a randomized, wait-list control trial trial registration: ClinicalTrials.
Participants randomized to the intervention group participated in an 8-week mindfulness meditation mobile app intervention of at least 10 minutes per day. Those randomized to the wait-list control group received the intervention after 12 weeks. Participants were recruited between January and April via social media ie, Facebook and Instagram , email listservs, and flyers and by emailing university professors.
Interested students were sent an eligibility survey via Qualtrics ie, online survey database. Eligible participants were sent a link via Qualtrics to an online intake video that was approximately 5 minutes long. Participants were required to view the video in its entirety and correctly answer three follow-up questions regarding information presented in the video eg, how long will you be asked to participate in mediation?
If participants missed a question, they were redirected to watch the video again and answer the questions until all three were answered correctly. Once the questions were answered correctly, participants were sent the informed consent and baseline questionnaire via Qualtrics software Qualtrics, Provo, UT. After the informed consent and baseline questionnaire was completed, participants were randomized into the intervention group or the wait-list control group.
Participants were randomized using a list created from an online randomization tool randomizer. After participants completed baseline assessments, a research team member unblinded allocated participants to a group using the randomization list. Study staff and participants were unblinded to group allocation. After randomization, the intervention group was emailed instructions on how to download the Calm mobile app. Calm is a consumer-based mindfulness meditation mobile app that offers a range of mindfulness meditation practice guide modules that vary in length, instruction, and content.
Mindfulness meditation is the practice of moment-to-moment awareness in which the person purposefully focuses on the present without judgement. Vipassana is a technique of mindfulness that explores how the mind influences the body and how the body influences the mind ie, objective observation of physical sensations in the body [ 56 ]. The goal is to sharpen concentration, maintain awareness, and develop equanimity by releasing habitual tendencies toward craving and aversion. Calm also integrates some cognitive behavioral therapy CBT techniques into the meditation sessions on occasion.
The CBT-influenced sessions encourage users to develop awareness of their thoughts, interpretations, and emotional and physiological responses in order to alter their perception of a situation or create a new, more balanced thought process [ 57 ]. Calm also offers other individual guided and unguided eg, a brief introductory guidance followed by a chosen period of silence or sounds from nature meditations. For each minute session, after a principle was discussed, a related mindfulness meditation exercise was introduced and guided eg, body scan, breath focus, and loving kindness. If participants were not achieving 30 minutes of meditation per week, they were sent a text reminder to meditate.
After the 8-week intervention, participants still had access to calm and could use it at their own leisure for 1 additional month 12 weeks from baseline. Participants randomized to the wait-list control group received an email with their group assignment and stating that they would receive access to the Calm app after 12 weeks. They were also asked not to participate in any mindfulness activities eg, yoga, meditation, and qigong during this time.
After 8 weeks, participants received a Qualtrics link to the postassessment same surveys that the intervention group received. After 12 weeks, participants were sent a Qualtrics link to the follow-up assessment same surveys that the intervention group received and an email with instructions on how to download Calm and the assigned username and password. Both the intervention and wait-list control groups were administered three surveys—at baseline week 0 , postintervention week 8 , and at follow-up week 12 —to assess perceived stress, mindfulness, self-compassion, health behaviors, and feasibility outcomes via online surveys Qualtrics.
Data on demographics, mental health history, medication use, and counseling activities were collected at baseline. Participants could choose to receive their gift card from Starbucks, Target, or Amazon.
Calm memberships were provided to participants for free during the study. Stress was measured using the PSS [ 58 , 59 ]. This scale is a item inventory used for the assessment of perceived stress. The scale measures the degree to which situations are appraised as stressful. The response items are rated on a 5-point Likert scale ranging from 0 never to 4 very often.
Scores range from 0 to 40, with higher scores indicating higher levels of perceived stress. The PSS has been shown to be reliable in undergraduate college samples [ 58 , 59 ]; in this study, the alpha coefficient for baseline PSS scores was 0. The FFMQ is a item self-report inventory used for the assessment of multiple constructs of mindfulness skills.
The inventory assesses five subscales: observing, describing, acting with awareness, nonjudgment of inner experience, and nonreactivity to inner experience. The response items are rated on a 5-point Likert scale ranging from 1 never or very rarely true to 5 very often or always true. The facet scores range from 8 to 40, with the exception of nonreactivity to inner experience, which ranges from 7 to Higher scores indicate higher levels of mindfulness. The five FFMQ subscales have high internal reliability, test-retest reliability, and validity in undergraduate samples [ 60 ].
Consistent with this research, the FFMQ subscale reliability in this study was found to be high at baseline, alpha coefficients were between 0. The SCS-SF is a item survey assessing three subscales: self-kindness versus self-judgment, common humanity versus isolation, and mindfulness versus over-identification.
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The response items are rated on a 5-point Likert scale ranging from 1 almost never to 5 almost always. Higher scores indicate higher levels of self-compassion. Health behaviors measured included sleep disturbance, alcohol consumption ie, binge drinking , physical activity, and fruit and vegetable consumption. Specifically, items from the YRBS survey inquired about whether participants had consumed alcohol ie, engaged in binge drinking; for women, consuming four consecutive alcoholic beverages in a 2-hour period; for men, five alcoholic beverages at any point during the past 7 days, engaged in at least minutes of physical activity during the past 7 days, and eaten five servings of fruits or vegetables on most of the past 7 days.
Feasibility measures included acceptability and demand. Acceptability was measured with a satisfaction survey postintervention week 8. Adherence to meditation was recorded in weekly reports from the Calm informatics team. Reports included the date and time of each meditation participated in, the title of the meditation, and the duration of participation ie, the time spent viewing the meditation for each participant.
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General linear models GLMs were used to examine differences in means between groups at baseline and to test the initial efficacy of the intervention, examining mean differences of change ie, change scores for perceived-stress, mindfulness, and self-compassion after 8 weeks of mindfulness meditation between the intervention and control groups after adjustment for covariates age, gender, and race.
GLMs were also used to evaluate changes in sleep disturbances; however, because sleep was exploratory, covariates were not included in these models. The McNemar tests were used to examine changes in other exploratory outcome variables ie, binge drinking, physical activity, and healthy eating , which were coded dichotomously.
Feasibility potential was examined using adherence to the intervention. Adherence was calculated by averaging the weekly meditation minutes provided by the reports from the Calm informatics team. Acceptability measures and type of meditation were summarized using frequency with percentages. The Cohen d statistic was used to compute effect size. A total of Arizona State University students completed the eligibility questionnaire. Baseline characteristics of the study participants are presented in Table 1.
The mean age SD , adjusted for gender and race, was Table 2 describes the means of perceived stress, mindfulness, and self-compassion between the intervention and control groups at baseline, postintervention, and at follow-up. The baseline mean SD scores of self-reported stress intervention: Table 3 summarizes the results of 8 weeks of meditation on changes in stress, mindfulness, and self-compassion, testing the initial efficacy of the intervention compared to wait-list control participants.
Scores are adjusted for age, gender, and race. Additional analyses using linear mixed models were used to examine effects of the intervention compared to control over time, including initial and sustained effects.