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Mixed-methods evaluation comparing the impact of two different mindfulness approaches on stress, anxiety and depression in school teachers
  1. Charlotte Todd1,
  2. Roxanne Cooksey1,
  3. Helen Davies2,
  4. Clare McRobbie3,
  5. Sinead Brophy1
  1. 1 College of Medicine, Swansea University, Swansea, UK
  2. 2 College of Human and Health Sciences, Swansea University, Swansea, UK
  3. 3 c/o Swansea University, Swansea University, Swansea, UK
  1. Correspondence to Charlotte Todd; C.E.Todd{at}


Objectives This study compared the impact of two different 8-week mindfulness based courses (.b Foundations and Mindfulness-Based Stress Reduction (MBSR)), delivered to school teachers, on quantitative (stress, anxiety and depression) and qualitative (experience, acceptability and implementation) outcomes.

Design A mixed-methods design was employed. Matched-paired t-tests were used to examine change from baseline, with imputation conducted to account for those lost to follow-up. Qualitative methods involved 1:1 semistructured interviews (n=10). Thematic analysis was used to explore differences in experience between courses.

Setting Courses took place in UK primary schools or nearby leisure centres, 1:1 interviews took place via telephone.

Participants 44/69 teachers from schools in the UK were recruited from their attendance at mindfulness courses (.b and MBSR).

Interventions Participants attended either an MBSR (experiential style learning, 2 hours per week) or .b Foundations (more classroom focused learning, 1.5 hours per week) 8-week mindfulness course.

Outcome measures Stress (Perceived Stress Scale), anxiety and depression (Hospital Anxiety and Depression Scale) were evaluated in both groups at baseline (n=44), end of intervention (n=32) and 3-month follow-up (n=19).

Results Both courses were associated with significant reductions in stress (.b 6.38; 95% CI 1.74 to 11.02; MBSR 9.69; 95% CI 4.9 to 14.5) and anxiety (.b 3.36; 95% CI 1.69 to 5.0; MBSR 4.06; 95% CI 2.6 to 5.5). MBSR was associated with improved depression outcomes (4.3; 95% CI 2.5 to 6.11). No differences were found in terms of experience and acceptability. Four main themes were identified including preconceptions, factors influencing delivery, perceived impact and training desires/practical application.

Conclusion .b Foundations appears as beneficial as MBSR in anxiety and stress reduction but MBSR may be more appropriate for depression. Consideration over implementation factors may largely improve the acceptability of mindfulness courses for teachers. Further research with larger samples is needed.

  • mindfulness
  • teachers
  • stress
  • anxiety
  • depression
  • mixed methods

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  • Contributors The study was designed by CT, HD, CM and SB. Data collection was performed by CT. Quantitative data analysis was performed by SB (blinded), whilst qualitative analysis was performed by CT and RC. The first draft of the paper was written by CT and all authors provided critical input and revisions for all further drafts. All authors have read and approved the final manuscript.

  • Funding Funding to deliver the mindfulness courses was received from the National Union of Teachers (NUT). For evaluation, the work was undertaken with the support of The Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), a UKCRC Public Health Research Centre of Excellence. Joint funding (MR/KO232331/1) from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the Welsh Government and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged. The work was also undertaken with support of the Austin Bailey Foundation and the National Centre for Population Health and Wellbeing Research (NCPHWR).

  • Competing interests Three of the authors in this paper are mindfulness practitioners and have a strong prior belief in the benefits of mindfulness. This could be perceived as a potential conflict of interest. However, this is a study comparing two different methods of teaching mindfulness. The motivation for this research was to examine if .b Foundations and MBSR were equivalent or if one course was clearly better in a school environment. Indeed, one of the authors teaches both MBSR and .b Foundations, showing no bias to any particular method of teaching. These authors were not involved in the analysis of qualitative work or interpretation but contributed to the methods (how mindfulness was delivered) and design. One researcher who is also a mindfulness practitioner undertook the quantitative analysis, but was blinded to the course identity.

  • Ethics approval This study was approved by the University College of Human and Health Science Ethics Committee (reference number: 10416).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Further quotes from qualitative aspects used to generate codes and themes can be shared from the lead author on request.

  • Patient consent for publication Not required.

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