University study can be a life period of heightened psychological distress for many students. The development of new preventive and intervention programs to support well-being in university students is a fundamental challenge for mental health professionals. We designed an 8-week online mindfulness-based program (eMBP) combining a face-to-face approach, text, audio, video components, and support psychotherapy principles with a unique intensive reminder system using the Facebook Messenger and Slack applications in two separate runs (N = 692). We assessed the program's effect on mindful experiencing, perceived stress, emotion regulation strategies, self-compassion, negative affect, and quality of life. The results of the presented pilot study confirmed that eMBP is a feasible and effective tool in university students' mental health support. The students who completed the eMBP reported a reduction of perceived stress with a large effect size ( p η2 = 0.42) as well as a decrease of negative affect experience frequency and intensity ( p η2 = 0.31), an increase of being mindful in their life (Five Facet Mindfulness Questionnaire subscales: p η2 = 0.21, 0.27, 0.25, 0.28, 0.28), and a higher rate of self-compassion ( p η2 = 0.28) with a medium effect size. A small effect size was found in the frequency of using a cognitive reappraisal strategy ( p η2 = 0.073). One new result is the observation of an eMBP effect ( p η2 = 0.27) on the decrease in attributed importance to the quality-of-life components replicated in two consecutive runs of the program. The study affirms that mindfulness-based interventions can be effectively delivered in an eHealth form to university students.

1st Department of Neurology Faculty of Medicine Masaryk University and St Anne's University Hospital Brno Czechia

Department of Psychiatry Faculty of Medicine Masaryk University Brno Czechia

Department of Psychology and Psychosomatics Faculty of Medicine Masaryk University Brno Czechia

Department of Psychology Faculty of Arts Masaryk University Brno Czechia

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Aldao A., Nolen-Hoeksema S., Schweizer S. (2010). Emotion-regulation strategies across psychopathology: a meta-analytic review. Clin. Psychol. Rev. 30 217–237. 10.1016/j.cpr.2009.11.004 PubMed DOI

Alsubaie M., Abbott R., Dunn B., Dickens C., Keil T. F., Henley W., et al. (2017). Mechanisms of action in mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction (MBSR) in people with physical and/or psychological conditions: a systematic review. Clin. Psychol. Rev. 55 74–91. 10.1016/j.cpr.2017.04.008 PubMed DOI

Altschuler A., Rosenbaum E., Gordon P., Canales S., Avins A. L. (2012). Audio recordings of mindfulness-based stress reduction training to improve cancer patients’ mood and quality of life – a pilot feasibility study. Support. Care Cancer 20 1291–1297. 10.1007/s00520-011-1216-7 PubMed DOI

Andersson G. (2018). Internet interventions: past, present and future. Internet Interv. 12 181–188. 10.1016/j.invent.2018.03.008 PubMed DOI PMC

Andersson G., Cuijpers P. (2009). Internet-based and other computerized psychological treatments for adult depression: a meta-analysis. Cogn. Behav. Ther. 38 196–205. 10.1080/16506070903318960 PubMed DOI

Andersson G., Titov N. (2014). Advantages and limitations of Internet-based interventions for common mental disorders. World Psychiatry 13 4–11. 10.1002/wps.20083 PubMed DOI PMC

Baer R. A., Smith G. T., Lykins E., Button D., Krietemeyer J., Sauer S., et al. (2008). Construct validity of the five facet mindfulness questionnaire in meditating and nonmeditating samples. Assessment 15 329–342. 10.1177/1073191107313003 PubMed DOI

Barnes N., Hattan P., Black D. S., Schuman-Olivier Z. (2017). An examination of mindfulness-based programs in US medical schools. Mindfulness 8 489–494. 10.1007/s12671-016-0623-8 DOI

Beck A., Burdett M., Lewis H. (2015). The association between waiting for psychological therapy and therapy outcomes as measured by the CORE-OM. Br. J. Clin. Psychol. 54 233–248. 10.1111/bjc.12072 PubMed DOI

Benda J., Reichová A. (2016). Psychometrické charakteristiky èeské verze self-compassion scale (SCS-CZ). Cesk. Psychol. 60 120–136.

Bewick B., Koutsopoulou G., Miles J., Slaa E., Barkham M. (2010). Changes in undergraduate students’ psychological well−being as they progress through university. Stud. High. Educ. 35 633–645. 10.1080/03075070903216643 DOI

Bolinski F., Boumparis N., Kleiboer A., Cuijpers P., Ebert D. D., Riper H. (2020). The effect of e-mental health interventions on academic performance in university and college students: a meta-analysis of randomized controlled trials. Internet Interv. 20:100321. 10.1016/j.invent.2020.100321 PubMed DOI PMC

Cavanagh K. (2014). Geographic inequity in the availability of cognitive behavioural therapy in england and wales: a 10-year update. Behav. Cogn. Psychother. 42 497–501. 10.1017/S1352465813000568 PubMed DOI

Cavanagh K., Churchard A., O’Hanlon P., Mundy T., Votolato P., Jones F., et al. (2018). A randomised controlled trial of a brief online mindfulness-based intervention in a non-clinical population: replication and extension. Mindfulness 9 1191–1205. 10.1007/s12671-017-0856-1 PubMed DOI PMC

Cavanagh K., Millings A. (2013). (Inter)personal computing: the role of the therapeutic relationship in E-mental health. J. Contemp. Psychother. 43 197–206. 10.1007/s10879-013-9242-z DOI

Cavanagh K., Strauss C., Cicconi F., Griffiths N., Wyper A., Jones F. (2013). A randomised controlled trial of a brief online mindfulness-based intervention. Behav. Res. Ther. 51 573–578. 10.1016/j.brat.2013.06.003 PubMed DOI

Cavanagh K., Strauss C., Forder L., Jones F. (2014). Can mindfulness and acceptance be learnt by self-help? A systematic review and meta-analysis of mindfulness and acceptance-based self-help interventions. Clinical Psychology Review 34 118–129. 10.1016/j.cpr.2014.01.001 PubMed DOI

Chambers R., Gullone E., Allen N. B. (2009). Mindful emotion regulation: an integrative review. Clin. Psychol. Rev. 29 560–572. 10.1016/j.cpr.2009.06.005 PubMed DOI

Chrastina J., Ivanová K., Krejčířová O., Ježorská Š. (2014). Results of subjective quality of life research using SQUALA standardized questionnaire. Profese Online 7, 1–8.

Clough B. A., Casey L. M. (2011). Technological adjuncts to increase adherence to therapy: a review. Clin. Psychol. Rev. 31 697–710. 10.1016/j.cpr.2011.03.006 PubMed DOI

Crane R. S., Hecht F. M. (2018). Intervention integrity in mindfulness-based research. Mindfulness 9 1370–1380. 10.1007/s12671-018-0886-3 PubMed DOI PMC

Dahlin M., Joneborg N., Runeson B. (2005). Stress and depression among medical students: a cross-sectional study. Med. Educ. 39 594–604. 10.1111/j.1365-2929.2005.02176.x PubMed DOI

Danilewitz M., Koszycki D., Maclean H., Sanchez-Campos M., Gonsalves C., Archibald D., et al. (2018). Feasibility and effectiveness of an online mindfulness meditation program for medical students. Can. Med. Educ. J. 9 e15–e25. 10.36834/cmej.43041 PubMed DOI PMC

Davis M. C., Zautra A. J. (2013). An online mindfulness intervention targeting socioemotional regulation in fibromyalgia: results of a randomized controlled trial. Ann. Behav. Med. 46 273–284. 10.1007/s12160-013-9513-7 PubMed DOI

Demarzo M., Montero-Marin J., Puebla-Guedea M., Navarro-Gil M., Herrera-Mercadal P., Moreno-González S., et al. (2017). Efficacy of 8- and 4-session mindfulness-based interventions in a non-clinical population: a controlled study. Front. Psychol. 8:1343. 10.3389/fpsyg.2017.01343 PubMed DOI PMC

Donker T., Blankers M., Hedman E., Ljotsson B., Petrie K., Christensen H. (2015). Economic evaluations of Internet interventions for mental health: a systematic review. Psychol. Med. 45 3357–3376. 10.1017/S0033291715001427 PubMed DOI

Dowd H., Hogan M. J., McGuire B. E., Davis M. C., Sarma K. M., Fish R. A., et al. (2015). Comparison of an online mindfulness-based cognitive therapy intervention with online pain management psychoeducation: a randomized controlled study. Clin. J. Pain 31 517–527. 10.1097/AJP.0000000000000201 PubMed DOI

Dyrbye L., Shanafelt T. (2016). A narrative review on burnout experienced by medical students and residents. Med. Educ. 50 132–149. 10.1111/medu.12927 PubMed DOI

Dyrbye L. N., Thomas M. R., Shanafelt T. D. (2006). Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students. Acad. Med. 81 354–373. 10.1097/00001888-200604000-00009 PubMed DOI

El Morr C., Ritvo P., Ahmad F., Moineddin R. (2020). Effectiveness of an 8-week web-based mindfulness virtual community intervention for university students on symptoms of stress, anxiety, and depression: randomized controlled trial. JMIR Ment. Health 7:e18595 10.2196/18595 PubMed DOI PMC

Eysenbach G. (2001). What is e-health? J. Med. Internet Res. 3:e20. 10.2196/jmir.3.2.e20 PubMed DOI PMC

Eysenbach G. (2005). The law of attrition. J. Med. Internet Res. 7:e11. 10.2196/jmir.7.1.e11 PubMed DOI PMC

Feldman G., Hayes A., Kumar S., Greeson J., Laurenceau J. P. (2007). Mindfulness and emotion regulation: the development and initial validation of the cognitive and affective mindfulness scale-revised (CAMS-R). J. Psychopathol. Behav. Assess. 29 177–190. 10.1007/s10862-006-9035-8 DOI

Fish J., Brimson J., Lynch S. (2016). Mindfulness interventions delivered by technology without facilitator involvement: what research exists and what are the clinical outcomes? Mindfulness 7 1011–1023. 10.1007/s12671-016-0548-2 PubMed DOI PMC

Forbes L., Gutierrez D., Johnson S. K. (2018). Investigating adherence to an online introductory mindfulness program. Mindfulness 9 271–282. 10.1007/s12671-017-0772-4 DOI

Fresco D. M., Moore M. T., van Dulmen M. H. M., Segal Z. V., Ma S. H., Teasdale J. D., et al. (2007). Initial psychometric properties of the experiences questionnaire: validation of a self-report measure of decentering. Behav. Ther. 38 234–246. 10.1016/j.beth.2006.08.003 PubMed DOI

Garland E. L., Gaylord S. A., Fredrickson B. L. (2011). Positive reappraisal mediates the stress-reductive effects of mindfulness: an upward spiral process. Mindfulness 2 59–67. 10.1007/s12671-011-0043-8 DOI

Garlow S. J., Rosenberg J., Moore J. D., Haas A. P., Koestner B., Hendin H., et al. (2008). Depression, desperation, and suicidal ideation in college students: results from the American foundation for suicide prevention college screening project at Emory University. Depress. Anxiety 25 482–488. 10.1002/da.20321 PubMed DOI

Goldberg S. B., Tucker R. P., Greene P. A., Davidson R. J., Wampold B. E., Kearney D. J., et al. (2017). Mindfulness-based interventions for psychiatric disorders: a systematic review and meta-analysis. Clin. Psychol. Rev. 59 52–60. 10.1016/j.cpr.2017.10.011 PubMed DOI PMC

Greeson J. M., Juberg M. K., Maytan M., James K., Rogers H. (2014). A randomized controlled trial of Koru: a mindfulness program for college students and other emerging adults. J. Am. Coll. Health 62 222–233. 10.1080/07448481.2014.887571 PubMed DOI PMC

Gross J. J., John O. P. (2003). Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. J. Pers. Soc. Psychol. 85 348–362. 10.1037/0022-3514.85.2.348 PubMed DOI

Gross J. J. (ed.). (2014). Handbook of Emotion Regulation., 2nd Edn New York, NY: Guilford Press.

Gu J., Cavanagh K., Strauss C. (2017). Investigating the specific effects of an online mindfulness-Based self-help intervention on stress and underlying mechanisms. Mindfulness 9 1245–1257. 10.1007/s12671-017-0867-y PubMed DOI PMC

Harrer M., Adam S. H., Baumeister H., Cuijpers P., Karyotaki E., Auerbach R. P., et al. (2019). Internet interventions for mental health in university students: a systematic review and meta-analysis. Int. J. Methods Psychiatr. Res. 28:e1759. 10.1002/mpr.1759 PubMed DOI PMC

Hayes S. C., Villatte M., Levin M., Hildebrandt M. (2011). Open, aware, and active: contextual approaches as an emerging trend in the behavioral and cognitive therapies. Annu. Rev. Clin. Psychol. 7 141–168. 10.1146/annurev-clinpsy-032210-104449 PubMed DOI

Hayes S. C. (2016). Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies – republished article. Behav. Ther. 47 869–885. 10.1016/j.beth.2016.11.006 PubMed DOI

Hedman E., Ljótsson B., Lindefors N. (2012). Cognitive behavior therapy via the Internet: a systematic review of applications, clinical efficacy and cost-effectiveness. Expert Rev. Pharmacoecon. Outcomes Res. 12 745–764. 10.1586/erp.12.67 PubMed DOI

Hesser H., Gustafsson T., Lunden C., Henrikson O., Fattahi K., Johnsson E., et al. (2012). A randomized controlled trial of Internet-delivered cognitive behavior therapy and acceptance and commitment therapy in the treatment of tinnitus. J. Consult. Clin. Psychol. 80 649–661. 10.1037/a0027021 PubMed DOI

Higgins J., Altman D., Sterne J. (2011). Assessing Risk of Bias in Included Studies. Cochrane Handbook for Systematic Reviews of Interventions. Available online at: http://handbook-5-1.cochrane.org/ (accessed June 25, 2020).

Hölzel B. K., Lazar S. W., Gard T., Schuman-olivier Z., Vago D. R., Ott U. (2011). How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspect. Psychol. Sci. 6 537–559. 10.1177/1745691611419671 PubMed DOI

Howells A., Ivtzan I., Eiroa-Orosa F. J. (2016). Putting the ‘app’ in happiness: a randomised controlled trial of a smartphone-based mindfulness intervention to enhance well-being. J. Happiness Stud. 17 163–185. 10.1007/s10902-014-9589-1 DOI

Kabat-Zinn J. (2013a). Full Catastrophe Living (Revised Edition): Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness. New York, NY: Bantam Books.

Kabat-Zinn J. (2013b). What is Mindfulness? Resource Document.Youtube.com. Available online at: https://www.youtube.com/watch?v=HmEo6RI4Wvs&t=104s (accessed June 25, 2018)

Kabat-Zinn J. (2015). Mindfulness: 9 attitudes. Resource Document. Youtube.com Available online at: https://www.youtube.com/watch?v=2n7FOBFMvXg&t=1323s (accessed June 25, 2018)

Kabat-Zinn J. (2017). “Mindfulness in Everyday Life” by Jon Kabat-Zinn with Oprah Winfrey. Resource Document. Youtube.com. Available online at: https://www.youtube.com/watch?v=D5r2sBQM31k&t=193s (accessed June 25, 2018)

Kelders S. M., Kok R. N., Ossebaard H. C., Van Gemert-Pijnen J. E. W. C. (2012). Persuasive system design does matter: a systematic review of adherence to web-based interventions. J. Med. Internet Res. 14:e152. 10.2196/jmir.2104 PubMed DOI PMC

Keng S. L., Smoski M. J., Robins C. J. (2011). Effects of mindfulness on psychological health: a review of empirical studies. Clin. Psychol. Rev. 31 1041–1056. 10.1016/j.cpr.2011.04.006 PubMed DOI PMC

Keyes C. L. M., Eisenberg D., Perry G. S., Dube S. R., Kroenke K., Dhingra S. S. (2012). The relationship of level of positive mental health with current mental disorders in predicting suicidal behavior and academic impairment in college students. J. Am. Coll. Health 60 126–133. 10.1080/07448481.2011.608393 PubMed DOI

Kořínek D., Benda J., Žitník J. (2019). Psychometric characteristics of the short Czech version of the five facet mindfulness questionnaire. Cesk. Psychol. 63 55–70.

Kožený J. (1993). Subjective emotional balance questionnaire (DEP 36): exploratory and confirmatory analysis. Ceskoslovenska Psychol. 37 523–533.

Krusche A., Cyhlarova E., King S., Williams J. M. G. (2012). Mindfulness online: a preliminary evaluation of the feasibility of a web-based mindfulness course and the impact on stress. BMJ Open 2:e000803. 10.1136/bmjopen-2011-000803 PubMed DOI PMC

Krusche A., Cyhlarova E., Williams J. M. G. (2013). Mindfulness online: an evaluation of the feasibility of a web-based mindfulness course for stress, anxiety and depression. BMJ Open 3:e003498. 10.1136/bmjopen-2013-003498 PubMed DOI PMC

Kubo A., Altschuler A., Kurtovich E., Hendlish S., Laurent C. A., Kolevska T., et al. (2018). A pilot mobile-based mindfulness intervention for cancer patients and their informal caregivers. Mindfulness 9 1885–1894. 10.1007/s12671-018-0931-2 PubMed DOI PMC

Kumaraswamy N. (2013). Academic stress, anxiety and depression among college students-a brief review. Int. Rev. Soc. Sci. Humanit. 5 135–143.

Kvillemo P., Brandberg Y., Bränström R. (2016). Feasibility and outcomes of an Internet-based mindfulness training program: a pilot randomized controlled trial. JMIR Ment. Health 3:e33. 10.2196/mental.5457 PubMed DOI PMC

Lappalainen P., Langrial S., Oinas-Kukkonen H., Tolvanen A., Lappalainen R. (2015). Web-based acceptance and commitment therapy for depressive symptoms with minimal support: a randomized controlled trial. Behav. Modif. 39 805–834. 10.1177/0145445515598142 PubMed DOI

Lattie E. G., Kashima K., Duffecy J. L. (2019). An open trial of internet-based cognitive behavioral therapy for first year medical students. Internet Interv. 18:100279. 10.1016/j.invent.2019.100279 PubMed DOI PMC

Lebois L. A. M., Papies E. K., Gopinath K., Cabanban R., Quigley K. S., Krishnamurthy V., et al. (2015). A shift in perspective: decentering through mindful attention to imagined stressful events. Neuropsychologia 75 505–524. 10.1016/j.neuropsychologia.2015.05.030 PubMed DOI PMC

Lee R. A., Jung M. E. (2018). Evaluation of an mhealth app (destressify) on university students’ mental health: pilot trial. J. Med. Internet Res. 5:e2. 10.2196/mental.8324 PubMed DOI PMC

López A., Sanderman R., Ranchor A. V., Schroevers M. J. (2018). Compassion for others and self-compassion: levels, correlates, and relationship with psychological well-being. Mindfulness 9 325–331. 10.1007/s12671-017-0777-z PubMed DOI PMC

Lynch S., Gander M.-L., Kohls N., Kudielka B., Walach H. (2011). Mindfulness-based coping with university life: a non-randomized wait-list-controlled pilot evaluation. Stress Health 27 365–375. 10.1002/smi.1382 DOI

Mani M., Kavanagh D. J., Hides L., Stoyanov S. R. (2015). Review and evaluation of mindfulness-based iPhone apps. JMIR MHealth and UHealth 3:e82. 10.2196/mhealth.4328 PubMed DOI PMC

Marsova K. (2016). Emotional Awareness, Emotion Regulation and Well-Being in Adolescents (Diploma thesis). Available online at: https://is.muni.cz/auth/th/i3rnd/ (accessed June 25, 2020).

McCoy C. E. (2017). Understanding the intention-to-treat principle in randomized controlled trials. West. J. Emerg. Med. 18 1075–1078. 10.5811/westjem.2017.8.35985 PubMed DOI PMC

Mingyur Y. (2007). The Joy of Living: Unlocking the Secret and Science of Happiness. London: Bantam Books.

Mortier P., Demyttenaere K., Auerbach R. P., Green J. G., Kessler R. C., Kiekens G., et al. (2015). The impact of lifetime suicidality on academic performance in college freshmen. J. Affect. Disord. 186 254–260. 10.1016/j.jad.2015.07.030 PubMed DOI PMC

Mulder R., Murray G., Rucklidge J. (2017). Common versus specific factors in psychotherapy: opening the black box. Lancet Psychiatry 4 953–962. 10.1016/S2215-0366(17)30100-1 PubMed DOI

Neff K. (2003). Self-compassion: an alternative conceptualization of a healthy attitude toward oneself. Self Identity 2 85–101. 10.1080/15298860309032 DOI

Ormrod J. A., Kennedy L., Scott J., Cavanagh K. (2010). Computerised cognitive behavioural therapy in an adult mental health service: a pilot study of outcomes and alliance. Cogn. Behav. Ther. 39 188–192. 10.1080/16506071003675614 PubMed DOI

Querstret D., Cropley M., Fife-Schaw C. (2018). The effects of an online mindfulness intervention on perceived stress, depression and anxiety in a non-clinical sample: a randomised waitlist control trial. Mindfulness 9 1825–1836. 10.1007/s12671-018-0925-0 PubMed DOI PMC

Raes F., Pommier E., Neff K. D., Van Gucht D. (2011). Construction and factorial validation of a short form of the self-compassion scale. Clin. Psychol. Psychother. 18 250–255. 10.1002/cpp.702 PubMed DOI

Rahimi-Ardabili H., Reynolds R., Vartanian L. R., McLeod L. V. D., Zwar N. (2018). A systematic review of the efficacy of interventions that aim to increase self-compassion on nutrition habits, eating behaviours, body weight and body image. Mindfulness 9 388–400. 10.1007/s12671-017-0804-0 DOI

Random House (2020). Mindfulness and Meditation Downloads. Random House. Available online at: https://www.penguinrandomhouse.com/mindfulness-meditation-downloads/ (accessed June 17, 2020)

Regehr C., Glancy D., Pitts A. (2013). Interventions to reduce stress in university students: a review and meta-analysis. J. Affect. Disord. 148 1–11. 10.1016/j.jad.2012.11.026 PubMed DOI

Ricard M. (2016). 5 Ways to Be Happy With the Happiest Man on Earth Resource document.Youtube.com. Available online at: https://www.youtube.com/watch?v=Xu2Oz1kGrjI (accessed June 25, 2018)

Rosenzweig S., Reibel D. K., Greeson J. M., Brainard G. C., Hojat M. (2003). Mindfulness-based stress reduction lowers psychological distress in medical students. Teach. Learn. Med. 15 88–92. 10.1207/S15328015TLM1502_03 PubMed DOI

Schanche E. (2013). The transdiagnostic phenomenon of self-criticism. Psychotherapy 50 316–321. 10.1037/a0032163 PubMed DOI

Schlotz W., Yim I. S., Zoccola P. M., Jansen L., Schulz P. (2011). The perceived stress reactivity scale: measurement invariance, stability, and validity in three countries. Psychol. Assess. 23 80–94. 10.1037/a0021148 PubMed DOI

Schwebel F. J., Larimer M. E. (2018). Using text message reminders in health care services: a narrative literature review. Internet Interv. 13 82–104. 10.1016/j.invent.2018.06.002 PubMed DOI PMC

Segal Z. V., Williams J. M. G., Teasdale J. D. (2002). Mindfulness-Based Cognitivetherapy for Depression: A New Approach to Preventing Relapse. New York, NY: GuilfordPress.

Shapiro S. L., Carlson L. E., Astin J. A., Freedman B. (2006). Mechanisms of mindfulness. J. Clin. Psychol. 62 373–386. 10.1002/jclp.20237 PubMed DOI

Siegel R. D. (2010). The Mindfulness Solution: Everyday Practices for Everyday Problems. New York: Guilford Press.

Spijkerman M. P. J., Pots W. T. M., Bohlmeijer E. T. (2016). Effectiveness of online mindfulness-based interventions in improving mental health: a review and meta-analysis of randomised controlled trials. Clin. Psychol. Rev. 45 102–114. 10.1016/j.cpr.2016.03.009 PubMed DOI

Tang Y.-Y., Holzel B. K., Posner M. I. (2015). Traits and states in mindfulness meditation. Nat. Rev. Neurosci. 17 59–59. 10.1038/nrn.2015.7 PubMed DOI

Tomlinson E. R., Yousaf O., Vittersø A. D., Jones L. (2018). Dispositional mindfulness and psychological health: a systematic review. Mindfulness 9 23–43. 10.1007/s12671-017-0762-6 PubMed DOI PMC

Vago D. R., David S. A. (2012). Self-awareness, self-regulation, and self-transcendence (S-ART): a framework for understanding the neurobiological mechanisms of mindfulness. Front. Hum. Neurosci. 6:296. 10.3389/fnhum.2012.00296 PubMed DOI PMC

Van Dam N. T., van Vugt M. K., Vago D. R., Schmalzl L., Saron C. D., Olendzki A., et al. (2018). Mind the hype: a critical evaluation and prescriptive agenda for research on mindfulness and meditation. Perspect. Psychol. Sci. 13 36–61. 10.1177/1745691617709589 PubMed DOI PMC

Wahbeh H., Svalina M. N., Oken B. S. (2014). Group, one-on-one, or internet? preferences for mindfulness meditation delivery format and their predictors. Open Med. J. 1 66–74. 10.2174/1874220301401010066 PubMed DOI PMC

Warnecke E., Quinn S., Ogden K., Towle N., Nelson M. R. (2011). A randomised controlled trial of the effects of mindfulness practice on medical student stress levels. Med. Educ. 45 381–388. 10.1111/j.1365-2923.2010.03877.x PubMed DOI

Wells C., Malins S., Clarke S., Skorodzien I., Biswas S., Sweeney T., et al. (2020). Using smart−messaging to enhance mindfulness−based cognitive therapy for cancer patients: a mixed methods proof of concept evaluation. Psychooncology 29 212–219. 10.1002/pon.5256 PubMed DOI PMC

Williams M., Penman D. (2011). Mindfulness: A Practical Guide to Finding Peace in a Frantic World. London: Hachette.

Wong K. P., Bonn G., Tam C. L., Wong C. P. (2018). Preferences for online and/or face-to-face counseling among university students in Malaysia. Front. Psychol. 9:64. 10.3389/fpsyg.2018.00064 PubMed DOI PMC

Zannotti M., Pringuey D. (1992). A method for quality of life assessment in psychiatry: the S-QUA-L-A (Subjective QUAlity of Life Analysis). Qual. Life News Lett. 4 1–8.

Zernicke K. A., Campbell T. S., Speca M., Mccabe-Ruff K., Flowers S., Carlson L. E. (2014). A randomized wait-list controlled trial of feasibility and efficacy of an online mindfulness-based cancer recovery program: the eTherapy for cancer applying mindfulness trial. Psychosom. Med. 76 257–267. 10.1097/PSY.0000000000000053 PubMed DOI

Self-compassion in medical students: a pilot study of its association with professionalism pressure