Formal Versus Informal Mindfulness Among University Students With and Without Recent Nonsuicidal Self-injury
Condition: Nonsuicidal Self-injury; Mindfulness; Stress; Well-Being
MeSH terms: Wounds and Injuries; Self-Injurious Behavior
Study type: Interventional

Summary: 
      The present study will use a randomized controlled design to investigate group differences
      between students with and without a history of nonsuicidal self-injury (NSSI) in response to
      a single-session mindfulness induction across conditions (formal mindfulness induction,
      informal mindfulness induction, active control task) in terms of the intervention's
      acceptability and effectiveness. Effectiveness will be inferred via pre-post changes in state
      mindfulness, state stress, and state well-being.
    

Detailed description: 
      As university students have reported increasing levels of stress and difficulty coping with
      the challenges of university, student services have had to consider alternative approaches to
      meet the demand for student support. Thus, universities have moved beyond traditional mental
      health services to instructional, resilience-building approaches to enhance students'
      resilience and coping capacity. Mindfulness is a common foundation of these approaches due to
      the substantial evidence demonstrating the mental health and well-being benefits of
      mindfulness in university students. However, subgroups within the university student
      population may respond differently to standard mindfulness instruction.

      Specifically, research suggests that university students who engage in non-suicidal
      self-injury (NSSI; the deliberate destruction of one's bodily tissue in the absence of lethal
      intent) may respond to mindfulness practice differently than students without such a history.
      Students with a history of NSSI are particularly prone to experiencing challenges in terms of
      stress, coping, and well-being in the university context. Thus, these students stand to
      benefit greatly from mindfulness-based programming that is adapted to their needs.

      Standard mindfulness instruction generally consists of a combination of formal and informal
      practice. Formal practices can be conceptualized as structured, sustained attentional guided
      activities in which mindfulness is practiced within an allotted period of time (e.g., sitting
      meditation, body scan), whereas informal practices are brief and unstructured, and focus on
      the experience of one's senses during routine activities (e.g., becoming aware of the feeling
      of water on one's hands while washing them). Formal practice often requires sustained
      attention on one's inner experience (i.e., thoughts and emotions) and bodily sensations.
      Thus, existing difficulties with emotion regulation, self-criticism, and a potentially
      complex relationship with their body may render this common component of formal mindfulness
      practice sub-optimally effective among students with a history of NSSI.

      By contrast, informal mindfulness strategies that are brief and unstructured may be more
      appropriate for these students. Nevertheless, only a few studies have attempted to parse out
      the benefits of formal and/or informal practice, and the results suggest benefits of informal
      mindfulness that are distinct from formal mindfulness. Furthermore, a recent systematic
      review examining the benefits of informal mindfulness concluded that informal practices may
      be more acceptable among those already experiencing difficulties with emotion regulation
      (e.g., those with recent NSSI engagement). The need for additional studies exploring the
      potentially differential acceptability and effectiveness of formal and informal mindfulness
      instruction among groups with unique intrapersonal needs was underscored.

      Thus, the present study will use an online, parallel-group, randomized controlled design to
      investigate group differences between students with and without a history of NSSI in response
      to a single-session mindfulness induction across conditions (formal mindfulness induction,
      informal mindfulness induction, active control task) in terms of the intervention's
      acceptability and effectiveness. Effectiveness will be inferred via pre-post changes in state
      mindfulness, state stress, and state well-being.

      Primary (state mindfulness) and secondary (state stress, state well-being, and acceptability)
      outcomes will be assessed immediately pre- and post-intervention. It is hypothesized that
      university students with a history of NSSI will report greater improvements in state
      mindfulness, state stress, and state well-being (Hypothesis 1a; superiority) as well as
      greater acceptability (Hypothesis 2a; superiority) in the IM condition, compared to those in
      the FM and control conditions. University students with a history of NSSI are also expected
      to report greater improvements in state mindfulness, state stress, and state well-being
      (Hypothesis 1b; superiority) as well as greater acceptability (Hypothesis 2b; superiority) in
      the FM condition, compared to those in control condition. Conversely, university students
      without a history of NSSI are expected to report noninferior improvements in state
      mindfulness, state stress, and state well-being (Hypothesis 1c; noninferiority) and
      noninferior acceptability (Hypothesis 2c; noninferiority) in the IM condition, compared to
      those in the FM. However, these students are expected to report greater improvements in state
      mindfulness, state stress, and state well-being (Hypothesis 1d; superiority) as well as
      greater acceptability (Hypothesis 2d; superiority) in the IM and FM conditions, compared to
      those in the control condition.
    

Intervention name(s): Formal mindfulness induction; Informal mindfulness induction; Active control task
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): The formal mindfulness induction will consist of a 10-minute audio recording of a sitting meditation, guiding the participant to consciously and repeatedly bring their attention to their breath and inner experience with nonjudgmental acceptance.; The informal mindfulness induction will consist of on-screen instructions guiding participants through the completion of four routine tasks (washing hands, drinking water, laying down, listening to music) with mindful awareness and acceptance over the course of 10 minutes.; Participants assigned to the active control condition will be prompted to download a single-page document containing 100 letters, numbers, and symbols, and a grid of 100 boxes. Following along with a guided audio, participants will be instructed to place all of the characters in the grid in a specific order over the course of 10 minutes. A version of this task has been used in previous studies by our team (Carsley & Heath, 2019; Petrovic et al., 2022) and has been shown not to impact mindfulness levels, and was thus deemed an appropriate neutral attention task for this study.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Prevention
Keywords: Nonsuicidal Self-injury; Mindfulness; Stress; Well-Being; University Students