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Objective: This study explores whether variability in the implementation of an undergraduate course on human flourishing is differentially associated with student outcomes. Participants: 101 students in the "Art and Science of Human Flourishing" course across three large, public, R1 universities in Fall 2018 participated in the study. Methods: Formative course data included researcher observations of weekly class pedagogy, students' weekly meditation practice logs and end-of-course assessments, and pre/post surveys measuring changes in participating students' outcomes related to flourishing (e.g., attentional skills, social-emotional skills, perspectives on flourishing, mental and physical health). Results: Although course pedagogy and student engagement varied across the three universities, students' outcomes were nonetheless similar. Conclusions: Variability in course implementation did not appear to differentially affect students' outcomes. We tentatively conclude that other institutions interested in offering the flourishing course may make limited adaptations to fit their pedagogical preferences without concern for altering its impact on students.

Educator mental health sits at the intersection of multiple pressing educational issues. We are among the first to provide estimates of school system employee (SSE) stress, anxiety, and depression during the COVID-19 pandemic. Most participants reported clinically meaningful anxiety and depressive symptoms (77.96% and 53.65%, respectively). Being in the lowest strata of family income was associated with higher stress, a greater likelihood of clinically significant depressive symptoms, and reduced intentions to continue in the same job, portending the current staffing shortages affecting schools. Supporting SSE mental health should become a policy priority.

Whereas the extraordinary pressures of the COVID-19 pandemic on student mental health have received considerable attention, less attention has been placed on educator well-being. School system employees play a vital role in society, and teacher levels of well-being are associated with the educational outcomes of young people. We extend extant research on the prevalence and correlates of educator distress during the pandemic by reporting on a pragmatic randomized wait-list controlled trial (N = 662; 64% teachers) of an innovative mental health promotion strategy implemented during the pandemic; a free 4-week smartphone-based meditation app designed to train key constituents of well-being (Healthy Minds Program [HMP]). Following our preregistered analysis plan and consistent with hypotheses, assignment to the HMP predicted significantly larger reductions in psychological distress, our primary outcome, at post intervention (Cohen's d = -0.53, 95% CI [-0.69, -0.38], p < 0.001) and at the 3-month follow-up (d = -0.33 [-0.48, -0.18], p < 0.001). Also consistent with hypotheses, we observed similar indications of immediate and sustained benefit following the HMP on all six preregistered secondary outcomes selected to tap skills targeted in the app (e.g., perseverative thinking, social connection, well-being; absolute ds = 0.19-0.42, all ps < 0.031 corrected except mindful action at follow-up). We found no evidence for elevated adverse events, and the HMP was equally effective among participants with elevated baseline anxiety and depressive symptoms. These data suggest that the HMP may be an effective and scalable approach to supporting the mental health and well-being of teachers and other school system employees, with implications for employee retention and performance and student outcomes.

Objective: Meditation apps are the most widely used mental health apps. The precise mechanisms underlying their effects remain unclear. In particular, the degree to which affect experienced during meditation is associated with outcomes has not been established. Method: We used the meditation app arm of a recently completed randomized controlled trial comparing a self-guided meditation app (Healthy Minds Program) to a waitlist control. Predominantly distressed public school employees (n = 243, 80.9% with clinically elevated depression and/or anxiety) reported positive and negative affect during meditation practice. Data were analyzed using two-level multivariate latent growth curve models (observations nested within participants) that simultaneously attended to both positive and negative affect. We examined whether positive and negative affect during meditation changed over time and whether these changes were associated with changes in psychological distress (parent trial's preregistered primary outcome) at posttest or 3-month follow-up. Results: On average, participants reported decreased negative affect but no change in positive affect during meditation over time. Increased positive affect and decreased negative affect during meditation were associated with improvements in distress at posttest and follow-up. Change in positive affect was a stronger predictor of distress at follow-up than change in negative affect. Conclusions: Despite notions embedded within mainstream mindfulness meditation training that deemphasize the importance of the affective experience of practice (i.e., nonjudgmental awareness of present moment experience, regardless of valence), results indicate that these experiences contain signals associated with outcomes. Monitoring affect during meditation may be worthwhile to guide intervention delivery (i.e., measurement-based care, precision medicine). What is the public health significance of this article?: This study suggests that affect experienced during meditation is associated with both short- and long-term changes in psychological distress that occur in the context of smartphone app-delivered meditation training. While both increases in positive affect and decreases in negative affect were associated with improvements in distress, increases in positive affect were the stronger predictor of long-term improvements in distress. [ABSTRACT FROM AUTHOR]

Objective: Effective psychosocial interventions exist for numerous mental health conditions. However, despite decades of research, limited progress has been made in clarifying the mechanisms that account for their beneficial effects. We know that many treatments work, but we know relatively little about why they work. Mechanisms of change may be obscured due to prior research collapsing across heterogeneous subgroups of patients with differing underlying mechanisms of response. Studies identifying baseline individual characteristics that predict differential response (i.e., moderation) may inform research on why (i.e., mediation) a particular subgroup has better outcomes to an intervention via tests of moderated mediation. Method: In a recent randomized controlled trial comparing a 4-week meditation app with a control condition in school system employees (N = 662), we previously developed a "Personalized Advantage Index" (PAI) using baseline characteristics, which identified a subgroup of individuals who derived relatively greater benefit from meditation training. Here, we tested whether the effect of mindfulness acquisition in mediating group differences in outcome was moderated by PAI scores. Results: A significant index of moderated mediation (IMM = 1.22, 95% CI [0.30, 2.33]) revealed that the effect of mindfulness acquisition in mediating group differences in outcome was only significant among those individuals with PAI scores predicting relatively greater benefit from the meditation app. Conclusions: Subgroups of individuals may differ meaningfully in the mechanisms that mediate their response to an intervention. Considering subgroup-specific mediators may accelerate progress on clarifying mechanisms of change underlying psychosocial interventions and may help inform which specific interventions are most beneficial for whom. What is the public health significance of this article?: Individuals receiving psychosocial interventions likely differ substantially in which intervention elements they respond to and in their causal pathways of change. This study demonstrates the utility of considering subgroup-specific mediators, which may accelerate progress on clarifying mechanisms of change underlying psychosocial interventions and may help inform which specific interventions are most beneficial for whom. [ABSTRACT FROM AUTHOR]

The present study explored prospective links between trait mindfulness and compassion on subsequent coping and compliance with Centers for Disease Control (CDC) guidelines and indirect effects via well‐being and internalized distress during the COVID‐19 pandemic. The study included N = 736 US college students who participated in a three‐wave longitudinal study across a single academic year. The first two assessment waves took place in 2018 and 2019, respectively, while the third wave took place in May 2020 during the COVID‐19 pandemic. Participants completed self‐report measures of trait mindfulness, compassion, well‐being, internalized distress, coping, and compliance with CDC health guidelines. Results of a series of autoregressive, cross‐lagged panel models revealed that trait mindfulness was associated with better coping via indirect effects of greater well‐being and lower internalized distress. Greater compassion was linked with greater adherence to CDC guidelines. Findings suggest that trait mindfulness and compassion may play a role in college students' coping and compliance during the pandemic. [ABSTRACT FROM AUTHOR]

Abstract Objective Participants Methods Results Conclusions Evaluate COVID-19 pandemic impacts on college student mental health.Three cohorts of college students (2018 n = 466; 2019 n = 459; 2020, n = 563; N = 1488) from three American universities. Participants were 71.4% female, 67.5% White, and 85.9% first-year students.Multivariable regression models and bivariate correlations were used to compare anxiety, depression, well-being, and search for meaning before and during the pandemic, and the relationships between pandemic health-compliance behaviors and mental health.Anxiety, depression, and well-being did not significantly worsen during compared to before (2019) the pandemic (ps = .329–.837). During the pandemic, more frequent in-person social interactions were correlated with lower anxiety (r = –0.17, p < .001) and depressive symptoms (r=-0.12, p = .008), and higher well-being (r = 0.16, p < .001), but also less handwashing (r = –0.11, p = .016) and face mask-wearing (r = –0.12, p = .008).We observed little evidence for pandemic impacts on college student mental health. Lower compliance with pandemic health guidelines was associated with better mental health. [ABSTRACT FROM AUTHOR]

The working alliance may be relevant in unguided smartphone-based interventions, but no validated measure exists. We evaluated the psychometric properties of the six-item Digital Working Alliance Inventory (DWAI) using a cross-sectional survey of meditation app users (n = 290) and the intervention arm of a randomized trial testing a smartphone-based meditation app (n = 314). Exploratory factor analysis suggested a single-factor solution which was replicated using longitudinal confirmatory factor analysis. The DWAI showed adequate internal consistency and test–retest reliability. Discriminant validity was supported by a lack of association with social desirability, psychological distress, and preference for a waitlist condition. Convergent validity was supported by positive associations with perceived app effectiveness and preference for an app condition. Supporting predictive validity, DWAI scores positively predicted self-reported and objective app utilization. When assessed at Weeks 3 or 4 of the intervention, but not earlier, DWAI scores predicted pre–post reductions in psychological distress. [ABSTRACT FROM AUTHOR]

Background: Mindfulness meditation has become a common method for reducing stress, stress-related psychopathology and some physical symptoms. As mindfulness programs become ubiquitous, concerns have been raised about their unknown potential for harm. We estimate multiple indices of harm following Mindfulness-Based Stress Reduction (MBSR) on two primary outcomes: global psychological and physical symptoms. In secondary analyses, we estimate multiple indices of harm on anxiety and depressive symptoms, discomfort in interpersonal relations, paranoid ideation and psychoticism. Methods: Intent-to-treat analyses with multiple imputations for missing data were used on pre- and post-test data from a large, observational dataset (n = 2155) of community health clinic MBSR classes and from MBSR (n = 156) and waitlist control (n = 118) participants from three randomized controlled trials conducted contemporaneous to community classes in the same city by the same health clinic MBSR teachers. We estimate the change in symptoms, proportion of participants with increased symptoms, proportion of participants reporting greater than a 35% increase in symptoms, and for global psychological symptoms, clinically significant harm. Results: We find no evidence that MBSR leads to higher rates of harm relative to waitlist control on any primary or secondary outcome. On many indices of harm across multiple outcomes, community MBSR was significantly preventative of harm. Conclusions: Engagement in MBSR is not predictive of increased rates of harm relative to no treatment. Rather, MBSR may be protective against multiple indices of harm. Research characterizing the relatively small proportion of MBSR participants that experience harm remains important. [ABSTRACT FROM AUTHOR]