In recent years, mindfulness in the scientific community has received a great deal of attention and is defined as moment-by-moment awareness of the experience gained from targeted attention along with the uncritical acceptance of existing experiences
[1]. Most studies have focused on evaluating the effectiveness of mindfulness-based interventions. Accordingly, mindfulness training interventions have recently been associated with a variety of health outcomes, such as pain reduction
[2], anxiety, and depression
[3], as well as reduced rumination
[4].
Mindfulness is a therapeutic process that focuses on purposeful and non-judgmental attention along with accepting experiences, confessing to them, living in the moment, reducing consciousness and distressing behaviors significantly
[5], and encouraging the person to reduce conflict with thoughts and feelings. The person becomes aware of the automatic functions of the mind and daily activities when practicing mindfulness exercises and provides the necessary context for moment-by-moment awareness of thoughts, feelings, and control
[6]. Mindfulness in two-way interactions can improve mental and physical health
[7] and establish an artistic interaction among physical, cognitive, and emotional processes
[8].
Depression, anxiety, and stresses of modern life cause severe injuries to the human body and psyche and increase physical illnesses, anxiety, and depression
[9]. One of the concerns of the educational system is the issue of student anxiety, which is difficult for many students to endure
[10]. Anxiety is a familiar word for educated people and is one of the most essential motivational and cognitive variables that significantly affect academic achievement, learning, performance, as well as attention, focus, and retrieval of learner's information
[11]. The existence of anxiety at a moderate level is considered a conciliatory response
[12]; however, severe anxiety is the cause of many physical illnesses, mental illnesses, behavioral disturbances, and adverse reactions. Such responses may manifest as decreased attention and concentration, increased forgetfulness and distraction, increased error rate, decreased creative capacity, unpredictable response speed, reduced organizational power, as well as short and long-term memory impairment
[13]. As anxiety increases, many aspects of psychological indicators decline, one of which is the quality of life
[14].
Some researchers believe that the quality of life is the amount of enjoyment that individuals receive from their lives. The most important opportunity and potential for enjoying are a happy and healthy physical and psychological life
[15]. Another important psychological factor in students’ mental health that protects them from stress and depression is perceived academic control. Perceived academic control is one of the variables consistent with optimism that enhances student’s cognitive performance and commitment to obtaining a degree
[16]. Perceived academic control refers to the use of a set of methods and tools aimed at reading thought, controlling, and mastering academic behavior. Since it is linked to human beliefs, it plays a role in people's cognitive appraisal of events
[17]. Perceived academic control is consciously assessed as learners' beliefs of their ability (high or low) to influence academic outcomes
[18]. Studies aimed at examining perceived academic control in the classroom have shown that learners with high academic control (those with an internal control source) have a high degree of control over their academic performances and are more eager to learn, compared to those with a low perceived academic control (those with external control resources)
[19].
The results of a study performed by Aránega, Sánchez, and Pérez
[20] showed that mindfulness training in Spanish students was effective in lowering their stress levels. In another study, Riet, Levett-Jones, and Aquino-Russell found that mindfulness meditation had a positive effect on stress, anxiety, depression, burnout, wellbeing, and empathy in nursing students. Findings from Kinser et al.
[21] showed that mindfulness training significantly reduced perceived stress, anxiety, and specific aspects of burnout in health care professionals and trainees after the intervention. In the studies conducted by Greeson, Toohey, and Pearce
[22], they reported that mindfulness awareness workshops had a significant effect on students' stress reduction, subjectivity, and self-care (i.e., exercise, sleep, and social support).
A review of past studies has shown that mindfulness plays an essential role in people's lives. However, in the mentioned studies, mindfulness has been examined with other variables, such as death anxiety, positive and negative emotions, mental health, marital satisfaction, academic self-concept, depression, and assertiveness. However, researchers, in particular, have not examined the effectiveness of mindfulness training on reducing anxiety, improving quality of life, and perceived academic control of students. Many students have good cognitive abilities; however, since they are not capable of thinking constructively in different situations, they have poor academic performance and low quality of life. Anxiety also harms the efficiency and flourishing of their talents, which can limit the potential of educational opportunities for them. The present study can help identify the variables that influence student life and improve the educational process. Therefore, given the high prevalence of these psychological symptoms and the effects of these symptoms on students' performance and health, the main question of the present study was whether mindfulness training has an impact on reducing anxiety as well as improving the quality of life and perceived academic control of students?
Objectives
The present study aimed to determine the effectiveness of mindfulness training on reducing anxiety and improving the quality of life as well as perceived academic control of students.
Materials and Methods
This quasi-experimental study was conducted based on a pretest-posttest design with a control group. The study population consisted of all undergraduate students of Sari Branch, Islamic Azad University, Sari, Iran, in the academic year 2018-19. Initially, undergraduate students were identified and screened using the Beck anxiety scale, World Health Organization quality of life questionnaire, and perceived academic control scale by Perry et al. Subsequently, those who obtained the cut-off scores above 16 in anxiety, lower than 70 in quality of life, and lower than 20 in academic control were selected as participants.
A total of 40 individuals were randomly divided into two groups of case (n=20) and control (n=20) based on the inclusion criteria and results of the pretest. The inclusion criteria were: 1) age range between 19 and 23 years, 2) undergraduate students in the academic year of 2018-19, 3) no use of psychiatric drugs, and 4) no use of educational program before and during mindfulness intervention. On the other hand, the students with a history of psychotic disorders, mania, hypomania, personality disorders, cognitive impairments, such as dementia, substance abuse, hearing or speech problems, and those who received psychotherapies during the month before the study and were absent for more than two sessions were excluded from the study.
Beck Anxiety Questionnaire
It is a 21-item self-report questionnaire aimed to measure the severity of anxiety in adolescents and adults. The subjects were asked to choose one of four options indicating the severity of anxiety. The items are scored based on a 4-point Likert scale from 0-3. Each of the test items describes one of the most common symptoms of anxiety (i.e., mental, physical, and phobic symptoms). Therefore, the total score of this questionnaire is ranged from 0 to 63. The score ranges of 0-7, 8-15, 16-25, and 26-63 indicate no or the least, mild, moderate, and severe level of anxiety, respectively
[23]. Beck
[24] estimated the internal consistency of this tool (Cronbach's alpha) at 0.92. Moreover, the validity of this questionnaire was obtained at 0.75 using the test-retest method with the correlation coefficient from 0.30 to 0.76. In the present study, the reliability of this questionnaire was determined at 0.87 using Cronbach's alpha
.
World Health Organization Quality of Life Questionnaire
This self-report tool was designed by the World Health Organization to assess people's quality of life. This 26-item questionnaire is a short version of the World Health Organization Quality of Life Questionnaire. The first two questions assess the quality of life and overall health of the individual, and the other 24 questions examine the four main domains, including physical health, mental health, social relationships, and environmental health. The participants were asked to answer each question on a 5-point Likert scale. This test was standardized in Iran by Nedjat et al.
[25] and Cronbach's alpha coefficients of the physical health, mental health, social relationships, and environmental health were obtained at 0.87, 0.74, 0.55, and 0.74, respectively. These coefficients indicated the optimal reliability of the test. In the present study, the reliability of the questionnaire was estimated to be 0.92 using Cronbach's Alpha Coefficient.
Perceived academic control Questionnaire
This 8-item questionnaire consists of two subscales, namely academic responsibility and controllability with positive (n=4) and negative (n=4) sentences that are scored from strongly agree (1) to disagree (5)
[26]. In a study conducted by Perry et al.
[27], the reliability of this scale was obtained at 0.80 using Cronbach's Alpha. The Iranian version of this scale was validated by Esfandiari et.al
[28] with the validity and reliability of 0.77 and 0.82, respectively. In the present study, the reliability of the questionnaire was obtained at 0.91 using Cronbach's Alpha.
The experimental group was subjected to eight 2-h mindfulness training sessions for two months. On the other hand, the control group received no pieces of training. The contents of the training sessions were selected based on the Browns and Marlatt Mindfulness protocol. Table 1 tabulates the stages of the training sessions as follows:
After the end of the sessions, posttest sessions were administered for both groups. The data were analyzed in SPSS software (version 25) using covariance analysis.
Results
According to the results of the Skewness and Kurtosis tests, the research variables were normally distributed. The Skewness and Kurtosis of all the variables were obtained at the range of ±2. Moreover, the results of the Kolmogorov-Smirnov test indicated that the assumption of a normal distribution of variables could not be rejected (P˃0.05). The level of significance for all three variables (i.e., anxiety, quality of life, and perceived academic control) was more than 0.05 indicating the normal distribution of variables. Furthermore, Leven's test results showed that the significance level for all variables was greater than 0.05 (P<0.05), which indicated that the distribution of dependent variables at the group level (confounding variable) was homogeneous and similar.
According to Table 3, the results of univariate analysis of covariance (ANCOVA) showed that mindfulness intervention influenced all three main variables, namely anxiety, quality of life, and perceived academic control (P<0.05). The level of significance for all three main variables was less than the presumed value of 0.05, which indicated that mindfulness caused a significant decrease in anxiety and a significant increase in the quality of life and perceived academic control. Similarly, a comparison of the mean of the control and case groups showed that the rates of anxiety reduction were 0.14 and 2.24 in the control and case groups, respectively. Furthermore, the level of increase in the quality of life of the control and case groups were determined at 0.32 and 8.33, respectively. In addition, the rates of increased perceived academic control were estimated at 0.22 in the control and 4.38 in the case groups. The effect size indicated the extent of the impact of the intervention on the dependent variables. Comparison of the effect sizes showed that mindfulness had the greatest effect on