Examining efficacy and potential mechanisms of mindfulness-based cognitive therapy for anxiety and stress reduction among college students in a cluster-randomized controlled trial

The pervasiveness of anxiety and stress among college students necessitates the investigation of potential alternative and accessible interventions which can be implemented into existing curricular and student-support programming to improve students' mental health. Mindfulness based cognitive therapy (MBCT) smartphone applications have shown promising outcomes in alleviating anxiety and stress. However, it is essential to gain insight into the feasibility and efficacy of such an interventional approach in a collegiate population, as well as explore potential underlying mechanisms, which could be better targeted to enhance the efficacy of future interventions for promoting mental health and well-being. The aims for this study were (1) to assess the efficacy of a 4-week MBCT intervention using the Sanvello smartphone application in reducing trait-level anxiety and chronic stress in college-aged young adults (n = 150) compared to a positive control group (n = 139), and (2) to examine potential mediators of this effect. Participants completed assessments of trait anxiety, chronic stress, cognitive reappraisal, cognitive refocusing, distractive refocusing, and negative automatic thoughts at pretest and following 4 weeks of the interventions. Analysis of primary outcomes revealed greater reductions in trait anxiety and chronic stress for the MBCT group, relative to the positive control group with small to moderate effect sizes. The anxiolytic and stress-reducing effects of the MBCT intervention were observed to be mediated by changes in negative automatic thoughts but not by changes in cognitive reappraisal, constructive refocusing, or distractive refocusing. Given the efficacy of the Sanvello smartphone application and the overwhelmingly strong assessments of the appropriateness and feasibility of it use; student support initiatives may be well served by adopting such a platform within the context of first-line treatment and prevention of high anxiety and chronic stress within first year college students. Registered at ClinicalTrials.gov [number NCT06019299].