Ci a ion: Ghe a di-Dona o, E.C.d.S.;
Gimenez, L.B.H.; Fe nandes,
M.N.d.F.; Lacchini, R.; Cama go
Júnio , E.B.; Díaz-Se ano, K.V.;
Melchio , M.; Pé ez, R.G.;
Riquelme-Galindo, J.; Reisdo e , E.
Mind ulness P ac ice Reduces Hai
Co isol, Anxie y and Pe cei ed
S ess in Uni e si y Wo ke s:
Randomized Clinical T ial. Heal hca e
2023,11, 2875. h ps://doi.o g/
10.3390/heal hca e11212875
Academic Edi o s: Jespe Dahlgaa d
and Jose An onio Mon eal
Recei ed: 10 June 2023
Re ised: 19 Oc obe 2023
Accep ed: 30 Oc obe 2023
Published: 31 Oc obe 2023
Copy igh : © 2023 by he au ho s.
Licensee MDPI, Basel, Swi ze land.
This a icle is an open access a icle
dis ibu ed unde he e ms and
condi ions o he C ea i e Commons
A ibu ion (CC BY) license (h ps://
c ea i ecommons.o g/licenses/by/
4.0/).
heal hca e
A icle
Mind ulness P ac ice Reduces Hai Co isol, Anxie y and
Pe cei ed S ess in Uni e si y Wo ke s: Randomized
Clinical T ial
Edilaine C is ina da Sil a Ghe a di-Dona o 1,* , La issa Bessani Hidalgo Gimenez 1,
Ma ia Ney ian de Fá ima Fe nandes 2, Ricca do Lacchini 1, El on B ás Cama go Júnio 3,
K anya Vic o ia Díaz-Se ano 4, Melissa Melchio 4, Raquel Ga cía Pé ez 5, Jo ge Riquelme-Galindo 6
and Emilene Reisdo e 7
1Ribei ão P e o College o Nu sing, Uni e si y o São Paulo, A enida Bandei an es, 3900, Vila Mon e Aleg e,
Ribei ão P e o 14040-902, SP, B azil; [email p o ec ed] (L.B.H.G.); [email p o ec ed] (R.L.)
2Nu sing Depa men , Fede al Uni e si y o Ma anhão, A enida P incipal, 100 Residencial Dom A onso
Felippe, Impe a iz 65915-240, MA, B azil; [email p o ec ed]
3Facul y o Nu sing, Uni e si y o Rio Ve de, Fazenda Fon es do Sabe , Rio Ve de 75901-970, GO, B azil;
el onb asj @uni .edu.b
4School o Den is y o Ribei ão P e o, Uni e si y o São Paulo, A enida do Ca é, s/n, Vila Mon e Aleg e,
Ribei ão P e o 14040-904, SP, B azil; [email p o ec ed] (K.V.D.-S.); [email p o ec ed] (M.M.)
5Facul y o Heal h Sciences, Uni e si y o G anada, A enida de la Ilus ación, 18016 G anada, Spain;
aquelgp@ug .es
6HLA Vis ahe mosa Hospi al, A enida Denia, 03015 Alican e, Spain; [email p o ec ed]
7
Depa men o P o essional Nu sing and Allied Heal h, Facul y o Nu sing, MacEwan Uni e si y, 104 A enue
NW 10700, Edmon on, AB T5J 4S2, Canada; eisdo e [email p o ec ed]
*Co espondence: [email p o ec ed]
Abs ac :
Backg ound: Anxie y and s ess a e common men al heal h condi ions epo ed by uni-
e si y wo ke s. P ac ices o mind ulness ep esen one p omising app oach as an e ec i e and
easible means o educe s ess, imp o e men al heal h and p omo e well-being; howe e , he e a e
no clinical ials ha ha e combined long- e m s ess bioma ke s (hai co isol) and psychome ic
assessmen s in a sample o uni e si y wo ke s. Objec i e: This s udy in es iga ed he e ec i eness
o a mind ulness-based p og am on long- e m s ess, by measu ing hai co isol concen a ion and
pe cei ed s ess and anxie y among wo ke s who we e unde going high le els o s ess. Me hod:
We conduc ed a andomized clinical ial a wo k among he employees o a public uni e si y. We
compa ed a g oup ha ecei ed he eigh -week mind ulness in e en ion wi h he wai lis g oup who
ecei ed no in e en ion. Resul s: A o al o 30 pa icipan s we e included in he s udy, wi h n = 15
subjec s in he in e en ion g oup and n = 15 in he con ol g oup. Hai co isol, pe cei ed s ess and
anxie y signi ican ly educed a e he in e en ion compa ed o he con ol g oup, which had no
app eciable decline in he measu ed a iables. Conclusion: This clinical ial showed he e ec i eness
o a mind ulness p og am on men al heal h psychome ic measu es (pe cei ed s ess and anxie y) and
on a long- e m s ess bioma ke (hai co isol). I can be concluded ha an eigh -week mind ulness
p og am could be implemen ed as an e ec i e s a egy o educe s ess bioma ke s (hai co isol) as
well as pe cei ed s ess and anxie y, imp o ing he men al heal h o uni e si y wo ke s.
Keywo ds: mind ulness; hai co isol; s ess; wo ke s; men al heal h
1. In oduc ion
Uni e si y wo ke s cons i u e a popula ion wi h signi ican a es o wo k o e load,
job dissa is ac ion, occupa ional s ess [
1
,
2
], anxie y and he use o non-asse i e coping
s a egies such as alcohol abuse [
3
]. Pe cei ed s ess is associa ed wi h highe le els o
anxie y and poo quali y o li e [
4
]. S a egies o managing and educing s ess can also
dec ease he occu ence o clinically signi ican anxie y [5].
Heal hca e 2023,11, 2875. h ps://doi.o g/10.3390/heal hca e11212875 h ps://www.mdpi.com/jou nal/heal hca e
Heal hca e 2023,11, 2875 2 o 11
The e is subs an ial scien i ic e idence ha mind ulness p ac ices educe subjec i e
s ess and inc ease he sense o well-being in wo ke s om di e en sec o s, p o iding
pa icula suppo o people su e ing om s ess [
6
–
9
]. Mind ulness has been associa ed
wi h lowe pe cei ed s ess and highe wo k engagemen in bo h c oss-sec ional and
longi udinal analyses [10].
Also, he p ac ice o mind ulness has been epo ed as a s a egy o educe le els
o anxie y and imp o e quali y o li e. The e ec s o he p ac ice in educing anxie y
symp oms ha e been explained by he impac o a mind ul men al s a e on eapp aisal,
wo y and umina ion [
11
]. Gi en he main men al heal h p oblems ela ed o s ess among
uni e si y wo ke s, a s udy ha a ge s his popula ion using mind ulness p og ams seems
highly ele an .
Pe sis en o p olonged s ess can ha e dele e ious e ec s on bodily mechanisms, and
he e a e many sys ems in he body ha indi idually o collec i ely egula e he le el o
s ess, including he hypo halamic-pi ui a y-ad enal axis (HPA axis), au onomic ne ous
sys em (ANS) and immune sys em. The HPA axis esponds o s esso s by sec e ing
co isol, a ho mone associa ed wi h psychological s ess, making he HPA axis a sys em
ha esponds o psychosocial s ess and in e ac s wi h he ANS and immune sys em.
Co isol is physiologically measu able h ough analysis o sali a, blood, u ine and hai
samples [12].
Se e al s udies ha e used co isol, conside ed a bioma ke o physiological s ess, as
a measu e o he e ec o mind ulness-based in e en ions. The accu a e measu emen
o co isol in sali a has been epo ed as a me hodological obs acle due o he a iabili y
esul ing om he ci cadian hy hm (i.e., diu nal luc ua ion) and he in luence o o al
condi ions, among o he ac o s [
13
]. Howe e , hai sampling is a me hod conside ed less
suscep ible o he me hodological obs acles epo ed in he assessmen o co isol, and i
is mo e accu a e o s udies ha aim o e i y he e ec s on physiological ac o s ele an
o he neu oendoc ine mechanism ha media es he e ec s o s esso s by egula ing
nume ous physiological p ocesses, such as he hypo halamic–pi ui a y–ad enal axis (HPA
axis) [
14
]. Hai co isol can e lec p olonged s ess exposu e, making i an ideal measu e
o assessing ulne able popula ions such as uni e si y wo ke s.
Assessmen o pe cei ed s ess is conside ed equally impo an , as he s ess esponse
is highly in luenced by he pe son’s pe cep ion o he s esso . The Pe cei ed S ess
Scale (PSS) is one o he mos common measu es o assessing global s ess pe cep ions.
I measu es he deg ee o which an indi idual pe cei es his/he li e as uncon ollable,
unp edic able and o e loaded wi hin he pas mon h [
15
]. The PSS is closely linked
wi h measu es o psychological s ess and sel - epo ed heal h (dep essi e and physical
symp oma ology) [
16
]; i is also co ela ed wi h biological ma ke s o s ess and disease [
17
].
The Pe cei ed S ess Scale (4-, 10-, and 14-i em e sions), wi h i s psychome ic p ope ies,
has been ansla ed in o di e en languages, including B azilian Po uguese [18].
A ecen clinical ial ha e alua ed he e ec o mind ulness-based in e en ions o
wo ke s p esen ed esul s o he measu e o pe cei ed s ess in g oups ha unde wen
sho - and long- e m mind ulness p og ams, conside ing he po en ial dose– esponse
e ec s o mind ulness aining a wo k [
19
]. In addi ion, se e al s udies conduc ed wi h
p ima y and seconda y eache s also poin ed o he e ec s o mind ulness as an e ec i e
s ess managemen s a egy [20–22].
Howe e , no s udies we e ound ha combined biological measu emen and psycho-
me ic assessmen in a sample o uni e si y wo ke s. The e o e, i is necessa y o unde ake
s udies p o iding e idence o he e ec i eness o he mind ulness p og am, in o de o sup-
po he ecommenda ion o he p ac ice o mind ulness o he ca e o uni e si y wo ke s
who p esen a high le el o s ess and associa ed anxie y.
This s udy in es iga ed he e ec o a mind ulness-based p og am on hai co isol,
pe cei ed s ess, mind ulness le els, and anxie y among wo ke s who we e unde going
high le els o s ess.
Heal hca e 2023,11, 2875 3 o 11
2. Ma e ials and Me hods
2.1. T ial Design
A andomized clinical ial (RCT) was conduc ed in acco dance wi h he ecommen-
da ions o he Consolida ed S anda ds o Repo ing T ials (CONSORT) [
23
]. I was an
in e en ion s udy o a con olled, andomized, pa allel, 2-a m clinical ial ype (in e en-
ion g oup wi h in e en ion e sus wai lis con ol g oup wi hou ea men ). The s udy
was egis e ed in he B azilian Clinical T ials Regis y (ReBec), T ial Regis a ion Numbe
(TRN): U1111-1179-7619. The p ocedu es o da a collec ion and analysis we e comple ed
in May 2019.
2.2. Pa icipan s and Rec ui men
Following app o al by he B azilian E hics Commi ee (p o ocol numbe 58376016.00000.
5393) in acco dance wi h The Code o E hics o he Wo ld Medical Associa ion (Decla a ion
o Helsinki), echnical-adminis a i e wo ke s om a Uni e si y in he S a e o São Paulo,
B azil we e ec ui ed o ake pa in he s udy (1704 wo ke s). All wo ke s exp essed hei
willingness o pa icipa e and signed an in o med consen o m. A eam o esea che s,
du ing he pe iod om Ma ch o Decembe 2017, pe sonally app oached all pa icipan s in
hei wo k en i onmen and applied a sociodemog aphic ques ionnai e and he Pe cei ed
S ess Scale (PSS 14) [
18
]. To ensu e da a accu acy, we excluded ce ain wo ke s om he
esea ch. Those who we e no ound a hei wo kplace a e h ee a emp s by he esea ch
eam (n = 163) o who we e on aca ion (n = 192) o sick lea e (n = 114) du ing he da a
collec ion pe iod we e excluded. Incomple e ma e ials (n = 42) and subjec s who did no
espond o he ques ionnai es (n = 264) we e excluded om he s udy, composing he losses
o he sc eening p ocess.
A o al o 929 olun ee s e u ned comple ed da a collec ion. This accoun ed o
54.51% o he o al non- eaching s a popula ion on campus. The selec ed 929 pa icipan s
answe ed a sociodemog aphic ques ionnai e and he Pe cei ed S ess Scale (PSS 14) [
18
].
Du ing he pe iod om Ma ch o Decembe 2017, he pa icipan s we e pe sonally ap-
p oached in hei espec i e wo kplaces by a eam o esea che s and in i ed o pa icipa e.
Wo ke s we e eligible o he clinical ial i hey me he c i e ia o high pe cei ed s ess
(sco e equal o o g ea e han 23 poin s), as measu ed by PSS 14 [
18
]. All wo ke s we e
in i ed o pe o m he s ess assessmen . Wo ke s who me one o wo o he ollowing
exclusion c i e ia we e no eligible o en ollmen in he s udy: egula medi a ion p ac ice
(a leas once a week in he pas 12 mon hs) and engagemen in psycho he apy o men al
heal h counseling. These exclusion c i e ia we e used o educe any po en ial con ounding
biases ha could a ec he in e en ion’s expec ed e ec .
A o al o 281 subjec s me he inclusion and exclusion c i e ia o he s udy and we e
andomized o he in e en ion g oup (IG) (pa icipa ed in he 8-week mind ulness p o-
g am) o he con ol g oup (CG) (placed on a wai ing lis ). Following he 8-week assessmen
pe iod, he wo ke s om he con ol g oup we e gi en he op ion o pa icipa ing in he
8-week mind ulness p og am.
2.3. Randomiza ion and Blinding
Sample size calcula ions we e pe o med by a s a is ician and indica ed ha 76 indi-
iduals we e needed in he in e en ion (38) and con ol (38) g oups.
The sample o he s udy was de e mined u ilizing a con enience me hod based on
pa icipan s’ a ailabili y. The numbe o en olled pa icipan s was de ined conside ing
hei a ailable ime o commi o he eigh weeks o in e en ion and da a collec ion, as
well as he cos -e ec i eness ela ed o human esou ces, in as uc u e and labo a o y
es s necessa y o espond o he objec i e o he s udy. Fo he pai ing o he g oups, age,
sex and le el o wo k (basic, echnical and highe ) we e conside ed, and pa icipan s we e
andomized in a 1:1 a io. Conside ing all he equi emen s men ioned abo e, a ailable
pa icipan s (n = 42) we e andomly assigned o ei he an in e en ion g oup (IG = 22) o
Heal hca e 2023,11, 2875 4 o 11
ecei e he 8-week mind ulness p og am o o a con ol g oup (CG = 20), which ecei ed
no in e en ion and emained on a wai ing lis .
The alloca ion lis was gene a ed by a p o essional s a is ician using a andom numbe
able, and he sequence was concealed un il he pa icipan s we e assigned. Rec ui men
was conduc ed by he esea che , and ins uc o s who conduc ed he in e en ion we e
blinded o g oup assignmen . Pa icipan s we e andomly alloca ed o he in e en ion
g oup (IG) and con ol g oup (CG), wi hou he op ion o choose hei g oup. Consequen ly,
he selec ed pa icipan s we e in i ed o pa icipa e in he second phase o he s udy and
p o ided wi h a new in o med consen o m.
Da a ega ding he a iables in es iga ed (hai co isol, pe cei ed s ess, symp oms o
anxie y and le el o mind ulness) we e collec ed 2 weeks be o e he beginning o he s udy
and again a e he end o he s udy (12 weeks a e he i s da a collec ion).
This in e en ion could no be masked (pa icipan s knew which g oup hey we e
in and ins uc o s knew hey we e pe o ming he in e en ion); hus, o a oid esea ch
bias, he ins uc o s who pe o med he in e en ion had no con ac wi h he da a o any
app oach o he esea ch- ela ed p ocedu es. The s a is ical p o essional who pe o med
andomiza ion and analysis was blinded o he in e en ion.
2.4. Psychome ic Assessmen
Pe cei ed s ess was assessed by he Pe cei ed S ess Scale 14-i em e sion (PSS 14).
The PSS measu es he deg ee o which indi iduals pe cei e si ua ions as s ess ul [
18
]. The
o al sco e on he scale can ange om 0 (no s ess) o 56 (ex eme s ess) [15,18].
Anxie y was assessed by he Beck Anxie y In en o y (BAI), c ea ed by Beck e al.
(1988) [
24
]. I consis s o 21 ques ions abou how he indi idual has been eeling in he las
week, exp essed in common anxie y symp oms (such as swea ing and eelings o dis ess).
Each ques ion has 4 possible answe s; he one ha mos closely esembles he indi idual’s
men al s a e should be ma ked and anges om 0 o 63.
Mind ulness was assessed by he Fi e Face Mind ulness Ques ionnai e (FFMQ-BR).
This ins umen measu es le els o mind ulness in a mul idimensional way [
25
]. Al hough
lis ed as i e ace s, he au ho s who alida ed he B azilian e sion ecommend ha he
ins umen should be analyzed conside ing se en ace s, namely (1) non-judging o inne
expe ience, (2) ac ing wi h awa eness–au opilo , (3) obse ing, (4) desc ibing–posi i e
o mula ion, (5) desc ibing–nega i e o mula ion, (6) non- eac i i y o inne expe ience,
and (7) ac ing wi h awa eness–dis ac ion [25].
2.5. Hai Sample o Co isol Measu emen
Hai was sampled om he e ex pos e io o wo ke s’ heads. Using s e ile scisso s,
a s ip o app oxima ely 1.5 inches (3 cm) o hai was cu a he scalp whe e he e was
a hai leng h o a leas 1.5 inches (3 cm). This 3 cm leng h is conside ed o ep esen a
3-mon h e ospec i e measu e o hai co isol, assuming a 1 cm/mon h g ow h a e o
hai ; i is a commonly used leng h o sampling [
26
,
27
]. Samples we e s o ed in plas ic
ials labeled only by ID in a locked oom and a oom empe a u e acco ding o he s o age
s anda ds [28] o labo a o y assays.
2.6. Hai P ocessing and Co isol Assay
The samples we e sen o assay o he Labo a o y Specialized in Scien i ic Analysis
(LEAC) [
26
,
27
]. S a ing wi h
∼
50 mg o hai , wo washes wi h 40 mL o wa e ollowed by
wo washes wi h 40 mL o isop opanol on a (o bi al shake ) pla e o a ing a 130 pm o
3 min pe wash we e pe o med.
A e each se o washes, he hai samples we e cu in o small pieces using small
su gical scisso s. Samples we e pu in o disposable glass scin illa ion ials, and HPLC-
g ade me hanol was added a a olume o 100
µ
L/mg o hai . Nex , samples we e sonica ed
o 30 min ollowed by a 24 h incuba ion pe iod a 50
◦
C. A e incuba ion, samples we e
cen i uged o 30 min a 3000 pm, hen he supe na an was ans e ed in o sepa a e glass
Heal hca e 2023,11, 2875 5 o 11
ubes and he me hanol was e apo a ed unde a gen le s eam o ni ogen. Fo samples
whe e less han 30 mg o hai was a ailable, smalle olumes o he ex ac we e aliquo ed,
co esponding o 5, 10 o 15 mg o hai . Once he me hanol was emo ed, he d y pelle
was esuspended in 150–250
µ
L o phospha e bu e ed saline (PBS) a pH 7.0. Samples
we e o exed o 1 min, ollowed by ano he 30 s un il hey we e well mixed. Fo co isol
measu emen in he ex ac s, we used a comme cially a ailable sali a y co isol enzyme-
linked immunoso ben assay (ELISA) (Ca . #KAPDB290 (CTS)—Lo 150810—DiaSou ce)
acco ding o he manu ac u e ’s ins uc ions. The in a- and in e -assay coe icien o
a iance was below 10.3%.
2.7. In e en ion: 8-Week Mind ulness P og am
Pa icipan s andomized o he 8-week mind ulness p og am a ended weekly in-
pe son 120 min mind ulness-based p ac ice g oup sessions o 8 consecu i e weeks. The
ins uc o p og essi ely p omo ed and guided o mal p ac ices wi h he pa icipan s and
media ed he exchange o expe iences in each weekly session. Such o mal p ac ices equi e
cogni i e e o s, especially a en ion, which g adually e ol e h oughou he eigh weeks,
based on di e en pe sonal p ocesses ocused on b ea hing, he body, sensa ions, sounds,
hough s and emo ions. In addi ion, he e was a 4 h imme sion session in a la ge space
wi h an added na u al a ea ( ees, plan s and g ass loo ). The p og am was led by heal h
p o essionals, skilled acili a o s and mind ulness ins uc o s who we e ce i ied expe s
in p o iding guidance o lea ning mind ulness p ac ices. Thei expe ise inc eased he
chances o success ul a ainmen o a s a e o mind ulness by he pa icipan s [
29
]. The
p og am consis ed o mind ulness p ac ice aining in a secula con ex , ollowing he oun-
da ions o he Mind ulness-Based S ess Reduc ion (MBSR) p og am [
30
] and ecommen-
da ions om he UK Ne wo k o Mind ulness-Based Teache s Good P ac ice Guidelines
o Teaching Mind ulness-based Cou ses [
31
]. The ollowing opics we e discussed du ing
he 8 sessions: change is easy, b ea hing is na u al, keeping he body conscious, jus be,
momen by momen , welcoming emo ions, li ing mind ulness, cul i a ing peace.
Du ing ace- o- ace mee ings, pa icipan s we e ins uc ed o pe o m he p ac ices
daily a home o he es o each week. Rele an eadings and audio ma e ial we e o e ed
o suppo he p ac ice. Audio was made a ailable o pa icipan s in di e se ways: e-mail,
Wha sApp
®
o Compac Disc (CD), acco ding o he p e e ence indica ed by he pa icipan .
Audio iles con ained a guided p ac ice (5-, 10-, 20-, and 30-min body scans and guided
medi a ion wi h di e en posi ions and ancho s) eco ded by he mind ulness ins uc o s. A
simple habi change was guided each week wi h he pu pose o enhancing he ecogni ion
o au oma ic beha io s. A dia y was also o e ed weekly, in which pa icipan s we e
encou aged o egis e hei p ac ices a home. The dia y was op ional and no used in
he p esen analysis. The main pu pose was o s imula e and o ganize he in eg a ion o
p ac ices in he pa icipan s’ daily li es.
2.8. S a is ical App oach
To compa e hai co isol, pe cei ed s ess (PSS14), anxie y (BAI) and mind ulness
(FFMQ) a p e-in e en ion (T0) and pos -in e en ion (T1) imes in each g oup, he
Wilcoxon es o ela ed samples was used. To compa e he di e ences be ween he
in e en ion g oup and con ol g oup, he non-pa ame ic Wilcoxon ank sum es was
used. The da a we e analyzed using he s a is ical so wa e STATA 11 edi ion.
3. Resul s
A o al o 30 olun ee s comple ed he s udy, wi h a loss o 28.6% o pa icipan s who
had s a ed he s udy (42): se en om he in e en ion g oup and i e om he wai lis
con ol g oup. Follow-up was los due o wi hd awal ( ou pa icipan s epo ed a lack o
ime and one pa icipan mo ed o ano he ci y), incomple e in e en ion ( h ee pa icipan s
comple ed less han 60% o he in e en ion p og am), and loss o he pos -in e en ion
assessmen pe iod ( ou pa icipan s we e una ailable o pos -in e en ion da a collec ion).

Heal hca e 2023,11, 2875 6 o 11
The demog aphic da a and hai co isol, pe cei ed s ess, anxie y and mind ulness baseline
sco es a e p esen ed by g oup in Table 1.
Table 1.
Demog aphic cha ac e is ics and le els o co isol, pe cei ed s ess, dep ession and anxie y
o s essed uni e si y wo ke s (n = 30).
Va iable In e en ion G oup (n = 15) Wai Lis Con ol G oup (n = 15)
Age, mean (SD) 41.4 (7.6) 40.5 (8.2) p= 0.865
Educa ion, numbe (%)
p= 0.406
High school 4 (26.7) 4 (26.7)
G adua e 5 (33.3) 6 (40.0)
Pos g adua e 6 (40.0) 5 (33.3)
Wo king hou s, mean (SD) 39.7 (1.0) 39.3 (2.6) p= 0.281
Wo king yea s, mean (SD) 14.8 (7.5) 12.3 (7.0) p= 0.639
Le el o mind ulness (FFMQ Sco e)
111.1 (17.7) 115.5 (17.7) p= 0.367
FFMQ-BR: Fi e Face Mind ulness Ques ionnai e (B azilian Ve sion); SD: s anda d de ia ion.
No di e ences we e ound in baseline le els o hai co isol o any o he psychological
ou come a iables (mind ulness, pe cei ed s ess and anxie y), indica ing ha he andom-
iza ion was success ul. The e was no signi ican di e ence in baseline co isol le el o age,
educa ion, wo king hou s and wo king yea s (all p> 0.05) (Table 1).
Pa icipan s who comple ed he eigh -week mind ulness p og am had hei hai
co isol le els signi ican ly educed. The Wilcoxon signed ank es esul s show ha he
hai co isol median p esen ed by he in e en ion g oup a e he in e en ion was educed
by 3.9 pg/mg (z: 2.953, p: 0.003), while he hai co isol o he con ol g oup showed no
signi ican change du ing he s udied pe iod. Also, he psychome ic e alua ion o he
pa icipan s who comple ed he mind ulness p og am showed a signi ican dec ease in he
median pe cei ed s ess (z: 2.160, p: 0.031) and symp oms o anxie y (z: 2.074, p: 0.038) as
well as inc eased le els o mind ulness (z: 1.992, p: 0.046) pos -in e en ion (Table 2).
Table 2.
Compa ison o he le el o hai co isol, anxie y and pe cei ed s ess in a mind ulness
aining in e en ion clinical ial be o e and a e he in e en ion (n = 30).
Va iable CG (n = 15) Wilcoxon Signed
Rank Tes (p)EG (n = 15) Wilcoxon Signed
Rank Tes (p)
Wilcoxon Rank
Sum Tes
Hai co isol
T0 median (SD) 15.6 (12.1) z:−0.795,
p: 0.426
18.9 (8.7) z: 2.953,
p: 0.003
z: 0.892,
p: 0.372
T1 median (SD) 18.1 (13.0) 15.0 (5.3) z:−1.805,
p: 0.003
Pe cei ed s ess
T0 median (SD) 31 (6.2) z: 0.258,
p: 0796
32 (8.2) z: 2.160,
p: 0.031
z: 0.021,
p: 0.983
T1 median (SD) 32 (4.8) 24 (7.8) z:−2.599,
p< 0.001
Anxie y
T0 median (SD) 11 (8.4) z: 1.082,
p: 0.279
10 (6.5) z: 2.074,
p: 0.038
z:−0.520,
p: 0.603
T1 median (SD) 11 (6.8) 5 (5.3) z:−2.082,
p: 0.037
Le el o mind ulness
T0 median (SD) 119 (17.5) z:−0.934
p: 0.3502
113 (15.6) z: 1.992
p: 0.046
z: 0.512,
p: 0.609
T1 median (SD) 113 (17.7) 127 (15.9) z:−1.848,
p: 0.065
Alpha c i e ia = 0.05; CG: Con ol G oup; IG: In e en ion G oup; SD: s anda d de ia ion.
Heal hca e 2023,11, 2875 7 o 11
The Wilcoxon ank sum es p esen s a compa ison be ween he con ol and in e en-
ion g oups a he median le el o co isol, anxie y, pe cei ed s ess and le el o mind ulness
be o e and a e he in e en ion (Table 2). The esul s show ha he in e en ion dec eased
he median hai co isol alues (z:
−
1.805, p: 0.071) as well as symp oms o pe cei ed
s ess (z:
−
2.599, p< 0.001) and median anxie y (z:
−
2.082, p: 0.037) when compa ed wi h
he con ol g oup. The in e en ion g oup also expe ienced an inc ease in he le el o
mind ulness (z:
−
1.848, p: 0.065). This esul did no occu in he con ol g oup, and no
signi ican di e ence was ound be ween he medians a baseline and a e eigh weeks in
ha g oup.
The esul ega ding he e ec i eness o he mind ulness p og am in ela ion o he
con ol g oup, conside ing he e olu ion o he s udy e ec a iables, e ealed ha he
in e en ion educed he isk o wo sening hai co isol by 88.8%, pe cei ed s ess by 54.6%
and anxie y by 50.0%. The pe cen age o wo sening symp oms was 6.7% in he in e en ion
g oup e sus 60.0% in he con ol g oup o hai co isol, 33.3% e sus 77.3% o pe cei ed
s ess, and 23% e sus 53.3% o anxie y symp oms (Table 3).
Table 3. T ea men e ec i eness o mind ulness p og am in in e en ion and con ol g oups.
Va iable In e en ion G oup (n = 15) Con ol G oup (n = 15) T ea men
E ec i eness (RRR)
Inc eased hai co isol
Yes 1 (6.7%) 9 (60.0%) 88.8%
No 14 (93.3%) 6 (40.0%)
Pe cei ed s ess
Yes 5 (33.3%) 11 (77.3%) 54.6%
No 10 (66.7%) 4 (26.7%)
Anxie y
Yes 4 (26.7%) 8 (53.3%) 50.0%
No 11 (77.3%) 7 (43.7%)
RRR = Rela i e educ ion in he isk o wo sening symp oms.
4. Discussion
As a con ex ha gene a es s ess ul si ua ions, he uni e si y en i onmen has d awn
he a en ion o he scien i ic communi y, which has sough ways o be e unde s and he
di e se ac o s ha in luence his condi ion and o p omo e s a egies ha he uni e si y
communi y can employ o imp o e s ess managemen , such as mind ulness in e en ions.
Since he li e a u e poin s o he high le els o s ess among uni e si y wo ke s, and
in o de o make he e idence mo e obus , ou s udy used ins umen s based on he
indi iduals’ pe cep ions and in eg a ed objec i e ways o measu ing s ess le els, which
dis inguishes ou wo k om some ea lie s udies.
In his s udy, we e alua ed he e ec s o an eigh -week mind ulness p og am on s ess
and anxie y compa ed o he esul s o he wai -lis ed con ol g oup ha did no ecei e he
in e en ion. Uni e si y wo ke s wi h a high le el o pe cei ed s ess we e e alua ed in
bo h he in e en ion and con ol g oups in ela ion o pe cei ed s ess, anxie y and hai
co isol le els, he la e being conside ed he mos eliable bioma ke o ch onic s ess and
he mos widely used alida ion es [12].
The e was a signi ican e ec o s udy condi ions on changes in hai co isol, pe cei ed
s ess, and symp oms o anxie y. Wo ke s had signi ican educ ions in co isol le els a e
he in e en ion compa ed wi h hose in he con ol g oup, who had no app eciable decline.
Pe cei ed s ess and symp oms o anxie y also educed signi ican ly, which did no occu
in he con ol g oup.
The inc ease in he sco es o he mind ulness assessmen , which occu ed only in he
in e en ion g oup, shows ha he in e en ion was success ul, allowing his e ec o be
linked o he se o a iables analyzed.
Ou indings a e consis en wi h p e ious s udies ha ha e e alua ed he e ec
o a mind ulness p og am on pe cei ed s ess educ ion in o he se ings and
Heal hca e 2023,11, 2875 8 o 11
popula ions [
6
–
9
,
21
]. Mind ulness-based in e en ions p omo e b ain esponses a he
le el o egula ion and eac i i y. Thus, one explana ion o unde s anding he educ ion in
s ess le els esul ing om he p ac ice o mind ulness is ha i p omo es he egula ion o
eac i i y o s ess in he HPA axis [32].
Rega ding anxie y symp oms, ou esul s a e also in line wi h p e ious e idence,
which concluded ha mind ulness-based p og ams a e e ec i e in educing anxie y [33].
One o he o iginal con ibu ions o his s udy was o e alua e psychome ic pa am-
e e s (pe cei ed s ess and anxie y) oge he wi h a biological s ess ma ke (capilla y
co isol); hus, ega ding he esul s in he e alua ion o hai co isol, he dec ease in his
long- e m s ess ma ke was also epo ed in a s udy ca ied ou wi h unde g adua e
heal hca e s uden s [
34
]. Hai co isol assessmen is an excellen bioma ke o ch onic
s ess, co ela ing wi h sali a y co isol le els, which has been co obo a ed by se e al
s udies on s ess in di e en popula ions [35]. The co isol a ailable in he hai ep esen s
he pe cen age o his bioma ke ha di uses om he blood in o he g owing hai ollicles
and is inco po a ed in o he hai wi hou unde going deg ada ion [36,37].
One c ucial disco e y o his s udy is ha he con ol g oup wi nessed a subs an ial
ele a ion in co isol le els o e he cou se o he s udy. This no ewo hy inding emphasizes
he signi icance o including all pa icipan s in he s udy, ensu ing ha e e yone can eap
he bene i s o he in e en ion. The obse ed inc ease in co isol le els wi hin he con ol
g oup unde sco es he po en ial impac o he in e en ion in mi iga ing s ess and i s
ela ed physiological esponses.
In assessing he e ec i eness o he ea men by he ela i e educ ion a e in he isk
o wo sening symp oms, we highligh he pe cen age o pa icipan s in he con ol g oup
who had inc eased hai co isol (60.0%), compa ed wi h only one pa icipan (6.7%) in he
in e en ion g oup.
Conside ing ha he e ec i eness o he ea men o pe cei ed s ess and anxie y
was lowe han ha ound o capilla y co isol, despi e being ele an and posi i e, i is
obse ed ha he physiological esul p ecedes he psychome ic one. Since he BAI and
PSS o e acu e measu es o psychological dis ess while hai co isol measu es mo e ch onic
s ess, hese migh ac ually be e e sed. This could be explained by he li e a u e sugges ing
ha mind ulness can ac ually inc ease one’s awa eness o subjec i e anxie y and s ess mo e
acu ely, since hey a e no longe a oiding i ; his makes one be e able o cope wi h i long-
e m bu migh mask some o he indings o sel - epo ed da a o hese cons uc s [
38
].
I is alid o also conside he subjec i i y inhe en o he psychome ic assessmen using
sel - epo scales [
39
] and, on he o he hand, he unconscious main enance o a condi ion
ha gua an ees he pa icipan ’s eligibili y o p o essional assis ance on an in apsychic
le el o hese wo ke s.
We o e e idence based on alida ed psychome ic ins umen s and a eliable bioma ke
o ch onic s ess— he mos widely used alida ion es , hai co isol [
12
]— ega ding he
bene i s o he mind ulness p og am, which con ibu es o he p omo ion o men al heal h
and he p e en ion o illness among uni e si y wo ke s. The implemen a ion o mind ulness
p ac ices in he ou ine o hese wo ke s could cons i u e an impo an s a egy o managing
s ess and i s long- e m consequences o he men al heal h and well-being o wo ke s in he
uni e si y con ex .
5. Conclusions
The mind ulness-based in e en ion o uni e si y wo ke s sample showed imp o e-
men in a long- e m s ess bioma ke , accessed by hai co isol concen a ion, as well as in
pe cei ed s ess and anxie y symp oms, measu ed by sel - epo ed scales. The e ec i eness
o he in e en ion compa ed o he con ol g oup was highligh ed and co obo a ed by
he wo sening o he condi ion in wo ke s who did no ecei e suppo o s ess manage-
men . Such esul s aise impo an ques ions abou s ess in uni e si y wo ke s and i s
ela ionship wi h he condi ions o he academic en i onmen .
Heal hca e 2023,11, 2875 9 o 11
The eigh -week mind ulness-based in e en ion p og am was ele an o he p o-
mo ion o men al heal h and could con ibu e o he p e en ion o diseases in uni e si y
wo ke s. Fu he s udies a e needed o e alua e he e ec i eness o he in e en ion
p og am, including o he men al heal h pa ame e s.
Some limi a ions o conside a e ha he con ol g oup pa icipan s knew hey we e
included in he wai lis condi ion, and ele an da a ela ed o ace and e hnici y we e no
collec ed. The small sample size limi ed he gene alizabili y o he esul s. We conside ed
ha he sample size was limi ed by an in e en ion ha las ed eigh weeks, since ha
equi ed a commi men no e e yone was willing o make. Ano he possible limi a ion o
he s udy is he d opou a e o 28.6%. Al hough adi ional andomized con olled ials
accep a d opou a e o up o 20% [
40
], i has been no ed ha in mind ulness s udies, a a e
o 16–29% is equen ly epo ed [41].
Au ho Con ibu ions:
Concep ualiza ion, E.C.d.S.G.-D., L.B.H.G. and J.R.-G.; me hodology, E.C.d.S.G.-
D., M.N.d.F.F., R.L. and E.B.C.J.; so wa e, R.L. and E.R.; alida ion, E.C.d.S.G.-D., K.V.D.-S., M.M. and
J.R.-G.; o mal analysis, E.C.d.S.G.-D., K.V.D.-S. and E.R.; in es iga ion, E.C.d.S.G.-D., L.B.H.G., M.N.d.F.F.,
K.V.D.-S., M.M. and R.G.P.; esou ces, E.C.d.S.G.-D., M.N.d.F.F., E.B.C.J. and K.V.D.-S.; da a cu a ion,
L.B.H.G., M.N.d.F.F., E.B.C.J. and E.R.; w i ing—o iginal d a p epa a ion, E.C.d.S.G.-D., L.B.H.G.,
M.N.d.F.F., E.B.C.J., K.V.D.-S., M.M. and E.R.; w i ing— e iew and edi ing, E.C.d.S.G.-D., M.N.d.F.F.,
K.V.D.-S., R.G.P. and E.R.; isualiza ion, E.C.d.S.G.-D., M.N.d.F.F., K.V.D.-S. and R.G.P.; supe i-
sion, E.C.d.S.G.-D., L.B.H.G., M.N.d.F.F., K.V.D.-S. and J.R.-G.; p ojec adminis a ion, E.C.d.S.G.-D.;
unding acquisi ion, E.C.d.S.G.-D. All au ho s ha e ead and ag eed o he published e sion o
he manusc ip .
Funding:
This esea ch was unded by he Na ional Council o Scien i ic and Technological
De elopmen —CNPq, announcemen MCTI/CNPq 01/2016, p ocess numbe .
Ins i u ional Re iew Boa d S a emen :
The s udy was conduc ed in acco dance wi h he Decla a ion
o Helsinki and app o ed by he Ins i u ional Re iew Boa d o he School o Nu sing o he Uni e si y
o Sao Paulo (p o ocol numbe 58376016.00000.5393, 21 Ap il 2020).
In o med Consen S a emen :
In o med consen was ob ained om all subjec s in ol ed in he s udy.
Da a A ailabili y S a emen :
The da a p esen ed in his s udy a e a ailable on eques om he
co esponding au ho . The da a a e no publicly a ailable due o local e hical legisla ion.
Con lic s o In e es : The au ho s decla e no con lic o in e es .
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