Table 7.

Interventions details

#ID	Intervention description
#361	8-week web-based stress management (WSM) program based on mindfulness meditation principles, titled Stress Free Now. The WSM program is an 8-week online, interactive, educational program based on mindfulness meditation. Details of the intervention have been described elsewhere. Briefly, each week, participants are introduced to a new mindfulness theme and meditation technique. They are first given access to an introductory talk in written and audio formats on the theme or particular meditation technique of the week. Mindfulness meditation techniques are then provided in audio format that can be either directly played from the website or downloaded in a portable mp3 format. Daily articles provide an overview of the science underlying the benefits of meditation. Participants receive twice a week e-mail reminders to access the website and practice meditation. Participants can access the program from any computer with Internet access, either at work or home. For the ease and convenience of participants who did not have Internet at home, the introductory talks and meditation exercises were also provided on CDs in mp3 format. WSM group participants had access to the online program only.
#1378	No intervention.
#799	Participants randomized to the intervention received email instructions to download the app, and inviting them to a 1-h in-person introductory talk about meditation. In addition, the app contained several short introductory videos that explained the rationale for mindfulness meditation and described classic mindfulness techniques (e.g. focusing attention on the breath, observing thoughts without reacting to them). The mindfulness training program consisted of 45 meditation sessions lasting from 10 to 20 min. Participants could chose to meditate at any time during the day. In each session, listeners were instructed to sit in a chair and were led through pre-recorded mindfulness meditations. Each session was designed to be used once per day, for 45 days, to cultivate a state of mindful awareness and teach mindfulness skills. These meditations are in line with a two-component model of mindfulness, for which the first component is the regulation of attention in order to focus it on the present moment (e.g. through paying attention to the breath), and the second component is open monitoring in which thoughts and emotions that arise are treated with curiosity, openness, and acceptance (Bishop et al., 2004). The program begins with ‘Take 10’, 10 days of 10-min meditation sessions, followed by ‘Take 15’ (15 days of 15 min meditations) and then ‘Take 20’ (20 days of 20 min meditations). Participants must complete the meditations in the sequential order set by the program, and must complete each component before starting the next (e.g. Take 10 must be completed before Take 15 begins). Longer sessions included more time for silent meditation. Participants were given free access to the app, and no additional incentives. Participants in the intervention group received a weekly reminder email from research staff to encourage use of the app.
#337	The intervention is a web-based mindfulness training course, organized by the Mental Health Foundation through Wellmind Media. It combines elements of both Mindfulness-Based Stress Reduction (MBSR)and Mindfulness-Based Cognitive Therapy (MBCT). The main features include: Ten sessions each lasting 30 min with videos and interactive exercises led by leading mindfulness trainers. Twelve assignments to practice in daily life with supporting emails. Five guided meditation audio downloads. Online tools for reviewing progress. A course completion certificate. An overview. An aftercare pack sent by post including a printed guide to everyday mindfulness. The course may be completed within 4 weeks but it can be done at a convenient pace as there is no limit to completion. It teaches formal meditation skills and informal techniques that can be incorporated into daily activities. Participants can take breaks from the course and repeat any part at any time. If so they receive emails to remind them where they have reached. The software asks them to practice formal meditation exercises they have learned using the audio and video clips supplied, ideally every day. Participants can monitor their progress in terms of stress, anxiety and depression, using measures intrinsic to the online course at the start and end, and at 1 month following completion. Week 1: Introduction, Orientation, Stress Assessment, Stepping out of automatic pilot, Routine activity, Mindful eating, Body scan. Week 2: Reconnecting with body and breath, Mindful movement, Mindful Breathing, Event Awareness. Week 3: Working with difficulties, Breathing space, Sitting meditation, Stress Awareness. Week 4: Mindfulness in daily life, Breathing space and action step, Activity, awareness, stress, strategies.
#3641	On each Sunday over four weeks, all participants received information via email on how to complete the week's brief guided MBSR mediation. Each week had different educational tools and a video link describing the requirements for that week. Participants were allowed to complete the meditation at any time and were encouraged to find a quiet, comfortable space to practice the guided MBSR mediation. Using Google Forms, participants responded to surveys collecting baseline and post-intervention physiological data of blood pressure, heart rate, respiratory rate, and psychological data of the PSS-10 and MAAS instruments.
#2990	The intervention was a 4-week MBSR program that used a mobile application called Insight Timer, based on an abbreviated version of the 8-week MBSR program developed by Dr. Jon Kabat-Zinn (Pospos et al., 2018) (see Appendix D). In 2017, Pospos et al. reviewed web-based tools and mobile applications used to help mitigate burnout and found that the Insight Timer had several positive features for this mindfulness-based intervention. These features include that the application is free, it offers tracking of practice sessions, reminders to practice, a built-in timer, and a user interactive network (Pospos et al., 2018). To better orient the participants to the project and to provide background information on compassion fatigue and mindfulness, informational modules were given in block segments: Module 1: Overview of the project; Module 2: Instructions on how to complete pre and post surveys; Module 3: Download and use of the mobile application; Module 4: Logging of sessions/journaling; Module 5: Background and history of MBSR; Modules 6–9: Introduction to four formal mindfulness practices (body scan, mindful movement, walking meditation and sitting meditation); and Module 10: Overview of compassion fatigue and its subcomponents of burnout and secondary traumatic stress. These informational modules were pre-recorded by the author and available online to be accessed at the participants’ convenience throughout the intervention phase (see Appendix E). Participants were encouraged to practice any mindfulness practice of choice, found under the MBSR heading in Insight Timer, for 15 to 20 min a day for four weeks. The designated practice times emulated the Human Caring Theory’s “caring moment”, representing the actual event, to include time and location, in which providers gave themselves care (McCance, McKenna & Boore, 1999). Additionally, participants were encouraged to pay purposeful attention to their emotional, mental and physical responses both at work and at home.
#1073	During the 8-week D2M program, participants in both the self-compassion treatment group and the attention control group logged their PA minutes and modes using the MapMyRun website or smartphone application. A bout of PA had to be a minimum of 10 consecutive minutes ofMVPA. Additionally, team captains emailed all participants weekly motivational tips, team standings, and program reminders. Participants were able to send a “friend request” to other team members, which would allow them to see each other’s daily minutes of PA and total weekly minutes of PA. In addition to the D2M procedures, treatment group participants completed a 7-week self-compassion intervention that started the second week of D2M. The intervention aimed to improve selfkindness and understanding in face of perceived shortcomings or difficulties (i.e. missing a day of exercise), thereby, increasing PA motivation and behavior by using self-compassion meditation strategies. Employees in the treatment group were emailed an electronic link every day of the intervention to access the information via mp3 audio file podcast. The validated self-compassion intervention and a detailed description of each meditation podcast is in Table 1 and on the following website (www.selfcompassion.org). Participants were. instructed to listen to the podcast at least once per week for the following week, with the goal of listening to it as often as once per day. At the end of theD2Mchallenge, participants should have received seven different SC podcasts. Podcasts: Affectionate Breathing Meditation, Compassionate Body Scan, Loving-Kindness Meditation, SC/Loving Kindness Meditation, Noting your emotions Meditation, Soften, Soothe, Allow: Working with your emotions, SC Break.
#2986	Calm is a user-friendly and accessible application that is adaptable across smartphone, computer, and tablet devices and a leading app for mindfulness and sleep at the time of this study. Calm provides meditations that target novice and experienced users of all ages and vary in length from 3–30 min. Meditations are grouped into one of six categories: body (mindful movement and gentle stretching), scenes (nature scenes and sounds), meditate, sleep (restful sleep, and wake up feeling refreshed), music (focus, relax, sleep), and masterclass (audio programs taught by world renowned mindfulness experts). Among these six categories are ten sub-categories: sleep, anxiety, beginners, stress, self-care, inner peace, focus, emotions, less guidance, relationships, and personal growth. Participant received weekly scheduled reminder emails from the first author about completing the assessments for each week to increase the likelihood that we would obtain data during the baseline phase. Participant was only informed that she will be using a mindfulness-based intervention when prompted, without describing or identifying the app. The only instruction was to use the MA as often as deemed necessary each week.
#3556	I assisted participants in the use of the Mindfulness Coach App before intervention began by sending a link to a step-by-step tutorial site made exclusively for the application and its use in this study. Mindfulness Coach is an application developed by the Department of Veteran Affairs National Center for PTSD. Although developed by the VA and intended for use by veterans and current military members, the self-guided mindfulness course and teachings of mindfulness embedded in this app are appropriate for use by anyone who could benefit from practicing mindfulness. This application was free for download and therefore did not result in budgetary restraints for me in this study. At the beginning of the four week period, I asked treatment group participants to complete the nineteen-question mindfulness quiz embedded in the application. Based on results from this quiz, the application prescribed specific mindfulness meditation practices. The application assigned users the mindfulness practice through levels, and each level had certain mindfulness practice exercises to complete before moving to the next level. Along with the assigned levels of guided meditation, participants also had the option of choosing Practice Now in the application. This option allowed users to select various mindfulness sessions they wanted to practice immediately, and it allowed them to create a favorites list. Another option from the home screen that was included in the application was Track Progress. This allowed users the opportunity to create a goal for themselves, set and determine the frequency of the reminders, as well as provide access to practice logs that will track how long they have spent on a session during the entirety of their app use. I asked each participant turn on a mindfulness mastery reminder weekly. A website was created for treatment group participants with directions on how to use Mindfulness Coach smartphone application (discussed later in this section), and I offered additional assistance opportunities via email as well. Weekly reminders about use of the Mindfulness Coach app were sent to treatment group participants via Google Mail.
#1428	The main component of the Anchored app is a 30-day intervention (the “challenge”) in which users complete one task daily (5–10 min per day). The challenge features evidence-based therapeutic techniques delivered using a variety of formats including psychoeducational videos, mindfulness audio exercises, value-driven activity planning and goal-setting, and the development of coping skills. In addition to the HeadGear therapeutic content (centered around behavioral activation, mindfulness, and coping skills), Anchored incorporates cognitive therapeutic elements chosen for their effectiveness in universal workplace interventions, along with grounding exercises and relaxation techniques designed to target stress. These additional elements were included to provide a broad range of evidence-based strategies beyond the more behaviorally focused elements preferred by workers in MDIs. Users can also complete an optional risk calculator that assesses the risk for future common mental disorders and provides participants with personalized feedback regarding this risk. Other components of the Anchored app include a tracker for monitoring mood, physical activity, and sleep, a “toolbox” of skills (which is gradually filled in as the intervention is completed), and support service helplines. The 30-day challenge and additional core features of Anchored were based on the structure of the HeadGear app, with further changes intended to improve usability and engagement, such as modified layout and addition of the physical activity and sleep tracker, based on the expressed preferences of HeadGear users. Participants were encouraged to access Anchored daily for a period of 30 days.
#490	The game or the mindfulness app was installed on the participants’ personal smartphones. Participants in the mindfulness app condition were instructed to follow the free 5-day beginners’ program provided by Headspace. The participants received guidance on installing the apps, and how and when to use them on each day of the experiment.
#1346	Interested individuals were directed to their respective app store via online advertisements or the study website. Upon downloading the app, participants provided informed consent and were screened. Participants in the intervention arm used HeadGear, a smartphone application-based intervention centered on behavioral activation (BA) and mindfulness. The main component of the app is a 30-day intervention involving one 5–10 min ‘challenge’ per day. These ‘challenges’ feature evidence-based therapeutic techniques delivered using a variety of formats. At the commencement of the intervention, users complete a risk calculator that assesses risk for future common mental disorders and provides personalized feedback regarding this risk (Fernandez et al., 2017). The HeadGear app also includes a mood tracker, a toolbox of skills (which is filled as the intervention is completed) and support service helplines.
#460	The training program (“Mindfulness and compassion with self and others”) was developed by Schenström (2017). In total, the 6 weeks program encompasses 10 h of training; about 15 min of training per day, 6 days a week. The program involves an initial instruction video that provides an outline of the program and informs of the procedure involved in using the program. The program is organized in six steps involving different types of exercises with guided instructions (auditory files). The stepwise organization of exercises means that a new exercise is available only once the prior exercise in the predetermined sequence of exercises has been completed. The steps in the program are labeled: (1) Kind attention, (2) Kind awareness, (3) Loving kindness with oneself and others, (4) Self-compassion—part 1, (5) Self-compassion—part 2, (6) Compassion with others and Quiet Practice. The program involves standardmindfulness exercises such as breathing anchor and body scans, and compassion-focused exercises such as loving-kindness, and exercises of compassion with self and others. An overview of the individual exercises included as part of each of the six steps of the program is provided in Table 1 (e.g.: body scan, breathing anchor, meditation for thoughts and feelings, pause for self-compassion, etc.). Following completion of each of the exercises, instruction of an everyday exercise to be performed during the day is given (different exercises for the six steps). Participants can repeat exercises, and are presented with a graphical overview of completed steps and an overview of the forthcoming exercises within each step. The participants are also provided an online diary where their own reflections concerning the performed exercises may be registered.
#3073	Each week, intervention participants received a link via e-mail to a different podcast (mp3 audio file) containing a 20-min self-compassion meditation with the instructions: “Please try to listen to this meditation once per day for the next week.” The three guided self-compassion meditations are taught in the Mindful Self- Compassion program (Neff & Germer, 2013) and are freely available at selfcompassion.org. Each meditation is designed to increase the three facets of selfcompassion to varying degrees. For example, the first week’s meditation, a compassionate body scan, is designed primarily to facilitate mindfulness by asking the listener to get in touch with and “just notice” bodily sensations, and is very similar to the first in a series of guided meditations implemented in the widely accepted and researchedMindfulness-Based Stress Reduction program by Jon Kabat-Zinn (1982). The body scan implemented here directly incorporates self-compassionate content by asking listeners to place a hand on the heart as a reminder to be kind to themselves, designed to increase the self-kindness component of self-compassion. The second week’s meditation is grounded in the breath, again incorporating mindfulness, but also self-kindness and common humanity as listeners are asked to breathe in affection and kindness to themselves while breathing out affection and kindness toward others who are suffering. The third week’s meditation is a variant of a “loving-kindness” meditation, an ancient Buddhist practice designed to increase goodwill toward the self and others (Grossman, Niemann, Schmidt, & Walach, 2004), and focusing specifically on emphasizing compassion for feelings of perceived inadequacy or stress (Neff & Germer, 2013). Mindfulness is cultivated in this meditation by asking the listener to locate the sensations of these feelings in the body while soothing and comforting the self (self-kindness), and being asked to recognize that all people fail, make mistakes, and have serious life challenges (common humanity; Neff & Germer, 2013).
#1037	Clinicovery is the app that was used to deliver either the contents of the PsyCovidApp intervention or the control contents. The PsyCovidApp intervention was developed by a group of psychologists (MJSR, EG, CS, RJ, MEGB), psychiatrists (JGC, MGT), and experts in healthy lifestyle promotion (AMYJ, MBV), informed by findings from an exploratory qualitative study involving in-depth interviews with 9 health care workers seeking psychological support as a result of their professional activity during the COVID-19 pandemic (unpublished results). PsyCovidApp was specifically designed to prevent and mitigate the most frequent mental problems suffered by health care workers who are dealing with the COVID-19 emergency (depression, anxiety, posttraumatic stress, and burnout). A detailed description of the intervention is available elsewhere. In short, the self-managed psychoeducational intervention, based on cognitive-behavioral. therapy and mindfulness approaches, included written and audiovisual content targeting four areas: emotional skills, healthy lifestyle behavior, work stress and burnout, and social support. Additionally, the intervention included daily prompts (notifications) that included brief questionnaires to monitor mental health status, followed by short messages offering tailored information and resources based on the participants´responses. The contents are grouped into five main sections (see Box 1): emotional skills, lifestyle behavior, work stress and burnout, social support, and practical tools. Each section contains multiple modules, covering the following areas: (i) monitoring mental health status; (ii) educational materials about psychological symptoms (e.g. anxiety, worry, irritability, mood, stress, moral distress, etc.); (iii) practical tips to manage pandemic-related stressors (e.g. mindfulness, relaxation and breathing techniques, coping strategies, survival skills to emotional crises); (iv) healthy lifestyles and practical tips to promote them; (v) organizational and individual strategies to promote resilience and reduce stress at work and the burnout syndrome, and; (v) promotion of social support.
#3578	For this intervention, the nursing staff from this department attended a 20-min WebEx meeting where the concepts of CF and BO, the repercussions on patient care including an increase in medication-related errors and the impact that mindfulness has on the reduction of CF, BO, and documented medication errors were discussed. Headspace (2019) was the intervention employed to teach and reinforce mindfulness.
#2871	Based on the supportive-education nursing system described in self-care theory (Orem, 2001), project participants attended a two-hour educational session on Compassion Fatigue and Mindfulness led by the principal investigator (PI). The PI assisted all participants in installing the two well-known mindfulness-based applications on their smart devices. Participants were asked to use these applications to perform guided mindfulness meditations for a minimum of 5 days a week for the subsequent 6-week period. The first application, Headspace, was utilized for the first two weeks to help participants develop their mindfulness meditation practice. At the start of this project, Headspace was ranked as the top mindfulness application based on a mobile application rating system (Mani, Kavanagh, Hides, & Stoyanov, 2015). The first 10 meditations on Headspace spanning a 2-week period focused on developing proper mindfulness meditation technique. These 10 developmental meditations were free; any additional meditations on Headspace required a subscription fee. To minimize costs, a second application, Stop, Breathe & Think, was utilized for the last 4 weeks of guided mindfulness meditations. Stop, Breathe, and Think was ranked in the top 11 applications based on a mobile application rating system (Mani, Kavanagh, Hides, & Stoyanov, 2015) and was chosen due to cost. This application offered numerous free mediations, from which participants could select. Participants were instructed to perform guided meditations for approximately 10 min each day, 5 days a week, over the 6-week period.
#3761	Building on the potential benefits of teaching mindfulness to ECPs, the current evaluation examined reactions and perceived benefits from ECPs who participated in an online mindfulness-focused professional development module, Mindful Practice for ECE Professionals: Begin the Journey, developed by Julia Masterson Gest, and offered on demand from the Penn State Better Kid Care Program. The mindful practice module provides information about mindfulness, compassion, and mindfulness-based coping strategies to increase mental well-being (decrease reactivity and increase focused attention), with the ultimate goal of ECPs being more responsive and present in the ECE setting. The study drew on program evaluation data that was stripped of identifiers and shared in aggregate form. The methods used to conduct secondary data analyses were discussed and reviewed by the institutional review board at the University of Nebraska-Lincoln. Extending from Jennings and Greenberg’s (2009) prosocial classroom model, the module was designed to provide mindfulness and compassion as emotion regulation coping strategies for teachers to learn to effectively manage their emotions and workplace stressors. The module taught that practicing mindfulness increases ECP mental well-being and occupational well-being (e.g., decreased work stress and burnout) as well as contributes to a healthy classroom climate (e.g., effective classroom management). The mindful practice module includes watching videos, reading content, participating in check your knowledge questions, and completing reflection activities. The content and videos were created by working with experts in the field, such as Dr. Mark Greenberg, an expert on mindfulness and schools (see Table 1). The mindful practice module consisted of four primary objectives for respondents: (a) learn the definition of mindfulness and mindful practices, (b) plan ways to incorporate mindful practice into daily activities, (c) recognize how mindful practices relate to more effective teaching in the learning setting, and (d) understand how the use of mindful practice supports stress management.
#812	The intervention used in this study was an 8-week Mindfulness-Based Stress Reduction program delivered online. Participants were provided with a printed manual detailing the instructions for participation in the program. This included access to the website. The program consisted of weekly reading and videos as well as 30 min sessions of formal mindfulness meditation six days per week. Full details of the program can be accessed at https://palousemindfulness.com. Week 1: Simple Awareness, Introduction to the Body Scan, Body Scan Meditation Week 2: Attention and The Brain, Introduction to Sitting Meditation, Body Scan Meditation, Sitting Meditation Week 3: Dealing with Thoughts, Introduction to Yoga, Sitting Meditation, Mindful Yoga, Body Scan (one day this week) Week 4: Stress: Responding vs. Reacting, STOP: One-minute breathing, Space and Yoga, Mindful Yoga, Sitting Meditation Week 5: Dealing with Difficult Emotions/Sensations, Introduction to RAIN (Recognise/Accept/Investigate/Nourish), Sitting Meditation alternating with choice of other practices RAIN Meditation Week 6: Mindfulness and Communication, Introduction to Mountain and Lake Meditation, Choice of meditation practice, Mountain Meditation or Lake Meditation Week 7: Mindfulness and Compassion, Introduction to Lovingkindness, Meditation, Choice of meditation practice, Lovingkindness Meditation Week 8: Conclusion, Developing a Practice of Your Own
#3943	CYBERMEDITATION INTERVENTION: 6 week program; Five short, seated meditations based on system of yoga and meditation (SYM); The five SYM meditations were: Calming, Place in Nature, Nourishing, Releasing, and Spaciousness. Twice-weekly emails from a Yoga Therapist.
#3753	The participants completed an eight-week self-guided online mindfulness-based stress reduction (MBSR) course that was flee of charge and took about thirty minutes to one hour each week alongside thirty minutes of suggested daily practice (Palouse Mindfulness, 2017). The online course was created by a certified mindfulness-based stress reduction (MBSR) instructor, Dave Potter, who is a retired psychotherapist that received his training at the University of Massachusetts Medical School, where MBSR was founded by Jon Kabat-Zinn (Palouse Mindfulness, 2017). Each week of MBSR consisted of videos, readings, daily practices with practice sheets to record progress, and supplemental readings (Palouse Mindfulness, 2017).
#1234	COVID-19 Anxiety and Stress Resilience Training (COAST). COAST comprises 4 intervention modules to increase resilience to stress due to the COVID-19 pandemic. These modules were made available on a website for free and self-paced perusal by our participants. The self-paced option appeared relevant to adapt to the busy schedule of health care workers during the pandemic. All 4 modules are standalone modules, targeting (1) self-efficacy, (2) sleep quality, (3) mindfulness, and (4) gratitude and positive reframing. The choice of these module topics was. based on previous reports that identified them as useful targets to improve resilience to stress and adversity [25–28] and on the target population’s documented preference for e-mental health interventions to be focused on well-being rather than on ill health. Each module contained explanations and mini-interventions that users could engage with in their daily lives, based on previous results and protocols and adapted for web-based use. The self-efficacy module was based on the findings that activating autobiographic memories of perceived self-efficacy can help strengthen clinically relevant factors for tolerating distress and promote relevant cognitive processes and problem-solving that might help patients recover from stress. Users are asked to recall 3 memories of situations that they handled well and write down which hurdles they overcame and which traits, qualities, and strengths helped them overcome these hurdles. The sleep module consists of a worry diary and tips for better sleep hygiene, both proposed by Altena et al. and the European Academy for Cognitive-Behavioral Therapy for Insomnia. The module on mindfulness includes various audio files with guided meditations. Studies on populations of health care workers found mindfulness to be associated with reduced depressive symptoms,more adaptive defense mechanisms against stress, lower burnout and stress levels, and higher life satisfaction. These findings are supported by a meta-analysis that reported mindfulness-based interventions to be an effective tool to help medical personnel cope with stress. COAST’s gratitude module involves a gratitude diary, which users can fill in daily
#763	Resilience @ work The RAW program is a mindfulness-based intervention, which also draws on ACT and has significant emphasis on self-compassion and acceptance skills. The intervention involves completing 6 internet-based training sessions. Each session takes about 20–25 min to complete on a tablet or computer. It was anticipated that an engaging and interactive program would help address the issue of adherence; a challenge that employers frequently encounter when offering resilience training and support to their workers. Rather than having to read through lengthy paragraphs on a website, the RAW program engages workers in the process of learning by utilizing a combination of interactive exercises, audio, and animation (see Fig. 2). Participants were able to download mindfulness tracks to their own device for continued practice. Participants also had the opportunity to sign up for text-message reminders and/or reminder emails. A podcast accompanied each RAW session with additional mindfulness tracks to encourage skills development. Podcasts were not a mandatory part of the training but were available via a website for those participants who chose to use them. Each session teaches a new strategy to cultivate psychological resilience and involves a combination of psycho-education and mindfulness training. The program also interweaves simple quotes and messages from the eastern philosophies of Buddhism and Yogic teaching traditions from which mindfulness has its origins. 1. Introduction to mindfulness, resilience and psychological well-being Mindfulness tracks: Drop Anchor, Take 10, Leaves on a Stream 2. Mindfulness skills, Understanding your reactive mind versus wise mind, Recognizing unhelpful mind chatter and managing uncomfortable and unhelpful thoughts (cognitive defusion); Recognizing your values exercise Mindfulness tracks: Mindful Breathing, Defusion Technique; Notice it, Name it, Let it Go(I’m having the thought that…) Defusion Technique 2: Thank you Mind 3. Revision of cognitive defusion, Introduction to mindfulness with emotions, The reactive mind and avoidance, Understanding how values are linked to emotions; Valued action check. Mindfulness tracks: Creating Space (mindfulness with emotions), Mindful Body Scan, The Golden Room 4. The problem with avoidance, Recognizing avoidance strategies versus adaptive strategies. Mindfulness tracks: Creating Space, A Mindful Break (mindfulness with words), Surfing Waves 5. Self-care and support, The compassion myth, barriers to accessing compassion, compassion fatigue, self-compassion actions & resilience; Identifying mindful support (compassionate, nonjudgmental and mindful); Valued action check. Mindfulness tracks: A Kind and Gentle Hand (loving-kindness practice) A Safe Place (compassion-focused mindfulness) A Bird’s Eye View 6. Compassion-focused mindfulness; Gratitude practice, optimism and resilience, identify and celebrate the milestones; Creating a personalized action plan to practice skills Mindfulness tracks: Breathing in the Present Moment A Golden Moment exercise. Being Kind to your old wounds
#842	Firefighters assigned to the intervention group received the RAW Mindfulness Program. FRNSW granted firefighters who were enrolled in the study permission to access the program at work. Tablets (iPads) were made available in the stations for firefighters to complete the online program. The RAW program is a mindfulness-based intervention, which also draws on ACT and has a significant emphasis on self-compassion and acceptance skills. The intervention comprises 6 online training sessions. Each session takes about 20 to 25 min to complete. A combination of interactive exercises, audio, and animation is used to teach resilience skills. An overview of the core strategies and skills taught in the RAW program is outlined in Table 1) Participants were able to download mindfulness tracks to their own device for continued practice. Each session was provided in a sequential order, with completion of the first module unlocking access to the next and so on. There was a 3-day break in between each session to encourage skills practice. Therefore, the minimum amount of time a participant could complete the training was 3.5 weeks and the maximum was 6 weeks. Participants also had the opportunity to sign up for text message and/or email reminders. 1. Introduction to mindfulness, resilience and psychological well-being Mindfulness tracks: Drop Anchor, Take 10, Leaves on a Stream 2. Mindfulness skills, Understanding your reactive mind versus wise mind, Recognizing unhelpful mind chatter and managing uncomfortable and unhelpful thoughts (cognitive defusion); Recognizing your values exercise Mindfulness tracks: Mindful Breathing, Defusion Technique; Notice it, Name it, Let it Go(I’m having the thought that…) Defusion Technique 2: Thank you Mind 3. Revision of cognitive defusion, Introduction to mindfulness with emotions, The reactive mind and avoidance, Understanding how values are linked to emotions; Valued action check. Mindfulness tracks: Creating Space (mindfulness with emotions), Mindful Body Scan, The Golden Room 4. The problem with avoidance, Recognizing avoidance strategies versus adaptive strategies. Mindfulness tracks: Creating Space, A Mindful Break (mindfulness with words), Surfing Waves 5. Self-care and support, The compassion myth, barriers to accessing compassion, compassion fatigue, self-compassion actions & resilience; Identifying mindful support (compassionate, nonjudgmental and mindful); Valued action check. Mindfulness tracks: A Kind and Gentle Hand (loving-kindness practice) A Safe Place (compassion-focused mindfulness) A Bird’s Eye View 6. Compassion-focused mindfulness; Gratitude practice, optimism and resilience, identify and celebrate the milestones; Creating a personalized action plan to practice skills Mindfulness tracks: Breathing in the Present Moment A Golden Moment exercise. Being Kind to your old wounds
#3662	Am I Hungry ? After successfully downloading the application, participants were prompted to watch the recorded Panopto educational video about health promotion through ME and how to use the mobile application (Appendix E). Towards the end of the educational video, the participants were encouraged to open the app on their personal cell phone and were then talked through a sample of steps imbedded within the app to familiarize them with its multiple functions. To conclude the educational video, the participants were encouraged to engage playfully with the app on their own to become more familiar with its features, progressing through the mindfulness cycle by selecting options of their choice. The participants were instructed that they were being asked to use the mobile app every time they wanted to eat for a period of four weeks, whether at home, work, or elsewhere.
#517	The curriculum (http://mind-bodyhealth.osu.edu) was described to potential participants as a way to help health professionals become more personally resilient and to be more effective in helping patients manage stress. The mindfulness training included three 1-h modules: (a) Introduction to Mindfulness, (b) Mindfulness in Daily Life, and (c) Mindful Breathing and Walking. Participants were allowed to complete the modules in any order. For this project, we focused on participants who enrolled in any of the 3 mindfulness modules and completed the self-reflection exercises imbedded in them. Each module began with a case. Modules also included clinically relevant didactic information about mindfulness with hyperlinks to peer-reviewed research. Summary tables described the physiologic, cognitive, and clinical effects of mindfulness practices. To assist in clinical application, modules offered tips for teaching mindfulness skills to patients and resources such as books, articles, and websites. Each module included links to free, downloadable MP3 recordings of guided mind–body practices to support experiential learning. Audio recordings were paired with printed directions for the guided practices; there were also links to YouTube videos of mindfulness practices to support experiential learning for both auditory and visual learners. The length of the practice recordings varied from 5 to 20 minutes. The initial case was followed by 1 to 3 self-reflection exercises, some of which were repeated at the end of the module. Self-reflection questions were included to engage learners and help them reflect on qualities that might be affected by mind–body training. The self-reflection opportunities were standard instruments to assess mindfulness.
#880	The Web-based mindfulness intervention was modeled after Mindfulness-Based Stress Reduction, which has been shown to be effective for a variety of physical and mental conditions [10,11,33–35]. Clinicians and investigators trained in mindfulness developed the intervention to meet the specific needs of 9–1-1 telecommunicators. After consultation with stakeholders at the enrolled call centers, intervention developers adapted the intervention content from the traditional in-person format to an abbreviated Webbased format to address logistical concerns. The intervention’s 7 Web-based lessons were hosted on the learning management system of the Northwest Center for Public Health Practice at the University of Washington (Figs. 1 and 2). Each lesson started with a short video that introduced that week’s theme and was followed by a short reading. The next section of the lessons consisted of 1 longer (10 to 14 min) daily practice with guided audio that introduced formalized meditation skills, such as body scan and loving-kindness, and 1 to 2 brief drop-in mindfulness practices focused on incorporating mindfulness activities into daily life. Some of these practices, such as body awareness at your desk and mindfully ending a call, were tailored specifically for the emergency response call center environment. Each lesson also included a weekly check-in survey and an optional moderated discussion board. The estimated time to complete each lesson was between 20 and 30 min. After completion of a baseline survey, the participants randomized to the intervention (N = 161) were contacted twice weekly throughout the intervention period. One email contained a link to the weekly training lesson, whereas the second email provided suggestions for incorporating mindfulness skills into daily life. Call center managers were highly encouraged to provide the study participants with a designated time during work to complete the intervention. Participants were asked to complete 1 lesson per week over a 7- week period and were encouraged to complete the lessons on a designated weekday as their work schedules allowed. However, lessons from previous weeks could be accessed throughout the intervention period. Participants were instructed to do the daily practice with guided audio for approximately 10 min for at least 6 out of 7 days a week and were encouraged to do the drop-in practices as often as they were able to.
#2849	N.A.
#2967	Participants were provided with a written guide including screen-shot pictures to explain the features of Insight Timer (Insight Network Inc., 2016) and the process of downloading the application to a smartphone device. Participants were encouraged to begin their first mindfulness practice immediately and integrate it into their daily lives for 30 days. Participants were invited to explore the app and use any of its features, including the library of 2,156 guided practices for activities including sitting meditation, walking meditation, yoga, mindful eating, prayer, and chanting. Between these questionnaires, the participants utilized the smartphone application Insight Timer (Insight Network, Inc., 2016) on a daily basis.
#3289	A mindfulness intervention based upon Dr. Dan Siegel’s Wheel of Awareness (Siegel, 2018) was introduced during a 20-min, asynchronous recorded session, available via the internet for one week to participants. The Wheel of Awareness is a guided intervention, led by Dr. Siegel on the website MindSight. Mindsight is accessible via computer, phone, and tablet. Users of the intervention do not incur any charges. Participants are introduced to the ideas of conscious knowing versus known facts, experiences, and feelings. Nurses partaking in the project were asked to participate in the 5–7 min, self-guided practice, individually, on a daily basis throughout the four-week study. Participants were given access to view and practice the voice-guided practice in any setting, at any time of the day. Actual days of practice were reported by the participant at the end of the four weeks.
#2286	Upon completing the pre-test survey, participants will be redirected to the meditation page, where the instructions of the mindfulness intervention and the five-minute mindfulness meditation audio file are located. Participants will be asked to bookmark the meditation page for reference use throughout the participation duration. Participants will be asked to practice the five-minute mindfulness meditation once a day at any convenient location and time of the day, except during driving or operating machinery equipment, for seven consecutive days, beginning from the same day that participants completed the pre-test survey
#1484	Intervention arm subjects were provided instructions on downloading a free phone-based meditation application (“Stress Free Now Meditations for Healers,” Cleveland Clinic, Cleveland, OH) with twelve guided meditations, ranging in length from approximately 3.5 to 21 min, and instructed to use the application on a weekly basis for 90 days.
#2026	N.A.
#730	N.A.
#871	The online intervention (Destress 9–1-1) comprised seven modules each completed on a weekly basis. Two emails were sent each week: one introducing the weekly theme and one providing practice reminders. Completion times for each module ranged from 20 to 30 min and included a short video introducing the weekly theme, text describing themes and activities, an audio-guided meditation exercise, suggestions for daily mindfulness activities and a moderated discussion board. Audio-guided exercises were recorded by the second author. Exercises were largely meditation-based or designed to enhance mindfulness during daily activities (ie, mindful movement). The online intervention was developed by clinicians trained in mindfulness-based approaches. The training was informed by Mindfulness-Based Stress Reduction (MBSR), which is an evidence-based programme originally implemented in-person however, the adapted intervention in this study differs from formal MBSR in length, format (online) and expectations for outside practice (5–10 min daily vs 20–45 min daily in MBSR). Participants were asked at each weekly check-in the number of days that they practised mindfulness using the guided audio and whether the participant incorporated mindfulness into their daily life. In addition, the online training system tracked participants’ progress through each lesson, allowing the researchers to accurately assess the number of lessons completed by each participant.
#1437	We selected those basic mindfulness exercises that were less demanding on the environment and space, and set the length of each exercise in 8–10 min, which would be more convenient for medical staff to understand and use. Except for the introduction to MBSR in the first section, we wrote 12 sessions of mindfulness exercises followed one audio session every 2 h per day and modified repeatedly. On Jan 30th, the first session of MBSR was recorded through the Himalaya APP, a free audio APP in China, and totally finished on Feb 3rd with all the 13 sessions of the MBSR exercise album. The MBSR album included mindfulness breathing, mindfulness body scan, meditation, emotional awareness, five senses training, mindfulness diet, walking mindfulness exercise and mindfulness body awareness, etc. At the same time, we incorporated the mindfulness blessing into each section and reflected it in the naming of each section.
#1361	In the intervention period, participants were first instructed to read materials that introduced the concept of self-compassion and the two intervention materials they would receive. Body Scan was delivered on the second week while Self-compassionate Breathing was delivered on the third week. These two guided meditation materials were adapted from the guided meditations posted on the website Self-compassion. org by Dr. Kristin Neff. The Body Scan was used to help individuals to be more mindful toward their physical and psychological status, which is also one of the components of self-compassion (Neff, 2003). The Self-compassionate Breathing was used to help individuals foster a compassionate attitude toward themselves. These two meditations are commonly used in self-compassion trainings.
#1214	During the 8-week program period, the participants had access to weekly mindfulness practice and self-practice activities in the application. After each session, the participants were asked to self-report the weekly variables. The mindfulness intervention program includes attending to body sensations, stretching, and relaxation exercises in a guided audio clip. Participants were introduced to an 8-week mindfulness intervention program consisting of four modules. To manage the intervention program and data collection remotely, facilitators from their respective companies were assigned to 22 clusters of participants, with each cluster ranging from a team size of 4 to 16 individuals. They were guided and reminded to complete their modules and weekly surveys. Awakened Mind® was the software of choice as it conducts the intervention using scientific methods and educational oriented content for participants to learn more about mindfulness while practising it. A quick outline of each module is as follows: Module 1 includes an introductory program to mindfulness meditation, breathing, and relaxation techniques. Module 2 introduces fundamentals of mindfulness and mindlessness (i.e., mind wandering) and concept of acceptance. Module 3 involves attentional awareness and body scanning exercises. Module 4 includes mindfulness and how the techniques of mindfulness could be adapted to overcome potential workplace challenges. The current study was conducted using Awakened Mind® as the modules include attentional qualities of mindfulness and the practice of acceptance without evaluation or interpretation of events occurring in the external environment (Baer, 2003; Shapiro et al., 2006).
#2492	We designed an intervention to train the use of mindfulness as a cognitive–emotional segmentation strategy. For our study, we selected from the MBCT and MBSR brief mindfulness exercises that can easily be integrated into daily life. Altogether, our intervention consisted of three modules and spanned 3 weeks. Each module comprised two parts: In PART A, participants received basic information input combined with practical exercises of approximately 20 min for the weekend. PART B was a daily task of approximately 3–5 min for the following five working days. Participants received information and instructions online in a written, downloadable format. Audio files for the mindfulness exercises were available on the project homepage. For the daily task, we offered a reminder with up to three SMS per week on Monday, Wednesday, and/or Friday. Alternatively, we sent a reminder e-mail at the beginning of the week. Module 1: Reflecting segmentation Module 2: Mindfulness and being in the present moment Module 3: Mindfulness and coping with undesired thoughts and feelings
#3747	We created an online intervention to train mindfulness and positive activities in the work context building on the positive-activity model (Lyubomirsky & Layous, 2013), broaden and-build theory (Fredrickson, 2001) and the two-component model of mindfulness (Bishop et al., 2004). The intervention consisted of three modules practised over three consecutive weeks. The mindfulness meditation exercises were based on mindfulness-based cognitive therapy (MBCT; Segal et al., 2002) and mindfulness-based stress reduction (MBSR; Kabat-Zinn, 1982, 2007) exercises and were adapted from Michel et al. (2014). The exercises concerning positive activitieswere adapted from existing research in positive psychology (Layous, Nelson,&Lyubomirsky, 2013; Layous et al., 2012; Seligman et al., 2005).We used positive activities that had been empirically shown to be effective and that could easily be transferred to the working context. The experimental group were given access to the e-learning platform Moodle (Dougiamas, 2011) containing all of the material needed for the intervention. They were encouraged to familiarize themselves with the e-learning platform and start the intervention in the following week. Module 1: Reflecting segmentation Module 2: Mindfulness and being in the present moment Module 3: Mindfulness and coping with undesired thoughts and feelings
#1097	The current intervention consisted of an online 8-week mindfulness-based program developed by SIGMA Assessment Systems Inc, based on Dr. Jon Kabat-Zinn’s mindfulness based stress reduction (MBSR) program (Kabat-Zinn, 1982,1990) and the mindfulness-based cognitive therapy (MBCT) program (Segal et al., 2002). The program presented mindfulness information and techniques in an online format. An outline of the content can be seen in Table 2) Content consisted of short videos (6–12 min long), brief guided meditation practices (3–20 min long with an average length of 10 min), and suggestions for how to integrate mindfulness into daily activities at work. Participants received a weekly email introducing that week’s theme and content, and were directed from that email to login to the program platform. Participants were asked to watch the weekly video and practice the guided meditations 6 out of 7 days a week (for a total of 144 – 480 min depending on the length of the meditation practice). A meditation tracker allowed participants to log the date, length of practice, and time of day (morning, afternoon, evening, or overnight) they completed a meditation and participants were encouraged to use the tracker. Participants could access the program on any internet connected compatible device (i.e., smartphone, computer, or tablet) and could access the program 24 h a day while at work or at home. Topics: Foundations of Mindfulness; The Mind–Body Connection; Motivation and Communication; Emotional Intelligence; Slow Brain, Fast Brain; Creativity and Innovation; Judgment and Decision-Making; Moving Forward with Mindfulness.
#1305	The meditation app (M-App) was developed in consultation with two meditation training experts, two app developers and two geriatric social workers based in Mumbai and Pretoria respectively. The M-App had short videos, instructor voice-guided learning sessions, and self-practice component. Short videos were lecture demonstrations and instrumental music to facilitate stillness and centering as integral to the meditation repertoire. The leisure app (L-App) was developed in consultation with two app developers. and two geriatric social workers in Mumbai and Pretoria respectively. App usage frequency (once-twice a day, several times a day), content perused (videos/learning sessions or both) and self-practice (M-App users only), were auto-recorded through an in-built feature in the app. Lesson: Prayer or sitting in simple silence (3 min), Instant Relaxation Technique (IRT) in supine position with isometric contraction of the muscles(4 min), Tree posture (i.e. standing still) and centering in tree posture (3 min), Deep breathing and focusing on flow of breath and the rhythm. This is accompanied by instructions to live in the present moment, appreciate the surroundings, think about the self, thoughts on meaningful others, appreciating meaningful relationships, build compassion for others especially the vulnerable (6 min), Deep relaxation technique (DRT) in supine position (4 min). Videos: Meditation with instrumental music, Meditation with nature, Silent meditation.
#520	(a) Gratitude focused Meditation, (b) Positive- or Sacred-Word-focused Meditation, and (c) Loving-kindness/Compassion-focused Meditation Each module took approximately 1 h to complete. Modules contained descriptions of each meditation technique; discussions of available scientific evidence regarding risks and benefits of each approach; links to guided practices to encourage experiential learning; suggestions for incorporating each technique into clinical practice; and pre- and post module self-reflection exercises. Self reflection exercises used validated instruments to measure gratitude, well-being, self-compassion, and confidence in providing compassionate care
#331	Participants were asked to listen to a 20-min mindfulness/stress-reduction audio program twice a week for 6 weeks and review a weekly lesson online. The weekly lessons outlined basic tenets of mindfulness, included imagery and stress self-awareness exercises, and touched on basic mindfulness principles. In addition to weekly lessons, a blog in which study participants could contribute thoughts, feelings, and ideas was available. Week 1 – an introduction to mindfulness Week 2 – a reminder to maintain a healthy and respectful relationship with food Week 3 – steps to take when feeling nervous or anxious Week 4 – the value of physical activity while mentally focusing inward Week 5 – the cathartic value of journaling Week 6 – the value of ongoing mindfulness practice, the importance of understanding potential obstacles, and the benefit of developing a plan to move forward.
#1002	The app-based MT program teaches individuals to understand how anxious worry is developed and perpetuated through reinforcement learning, how to recognize these anxiety habit loops, and how to bring mindful awareness to moments of stress and worry, so they can uncouple feelings of anxiety from reactive worry thinking and mindfully work with habitual mind states that perpetuate and reinforce anxiety. This process helps individuals “unlearn” or extinguish worry at a core mechanistic level. This experiential education is delivered via a smartphone-based platform, which includes a progression of more than 30 daily modules of brief didactic and experience-based MT (videos and animations, approximately 10 min/day, see Textbox 1), app-triggered check-ins, user-initiated guided meditations (5–15 min), and brief (30 s) on-demand mindfulness exercises to help disrupt anxiety cycles in vivo. The content for this intervention was developed based upon a combination of clinical experience for individuals with anxiety and previously developed in-person and app-based MT protocols for habit change that have yielded clinically meaningful outcomes such as cessation of smoking or overeating. Modules 1–7: goals; curiosity; reinforcement learning; body scan; self-monitoring Modules 8–14: noting practice; RAIN; barriers to change; reinforce concepts Modules 15–21: noting practice (cont’d); RAIN (cont’d); thinking vs knowing; (un)resistance Modules 22–30: noting practice (cont’d); RAIN (cont’d); working with uncertainty and change Modules 30 + : Reinforcing concepts via “theme weeks” + individual customization via “personal week”
#3666	An asynchronous narrated educational PowerPoint presentation on project purpose, aims and a brief overview of the UCLA Mindful application was delivered through email to the participants. Online orientation to the mobile application through PowerPoint included education on choosing a basic meditation of their choice through the application. Participants were instructed to use the application once before their shift for 5–10 min. Participants were given the choice of which mindfulness meditation they wanted to participate in each day on this mobile application, UCLA Mindful. Developed by UCLA Health in partnership with UCLA’s MARC (The Mindful Awareness Research Center), UCLA Mindful is an application designed to allow the person to practice mindfulness meditation anywhere, anytime with the guidance of the UCLA MARC (UCLA, 2020). MARC is an educational and research created to bring a renowned mental health research institution the ancient art of mindful awareness in a scientifically supported and rigorous form (UCLA, 2020). The home screen displays a “getting started” button which gives an introduction to the guided mindfulness meditation through video as well as a “basic meditations” button that the user can choose from including “breathing beditation” and “breath, sound, body meditation” with associated times for each exercise. UCLA Mindful application was first developed in 2016 and has dedicated research to the use of mindfulness meditation. UCLA Mindful is available for free download on the iOS and Android platforms, enabling feasible implementation for this project. Immediately following the PowerPoint presentation, the participants completed the initial MBI-HSSMP pretest. After the participants downloaded the UCLA Mindful to their mobile devices, the providers used this app for 5–10 min before they went to work each day for seven days.
#3125	The treatment included in-app guided breathing training modules modeled after mindfulness-based stress reduction (MBSR) programs and four wearable-based treatment components: (a) wearing of the device itself, (b) tracking and visualization of past physiological states, (c) visual real-time biofeedback, and (d) realtime notifications on significant and sustained changes of the user’s respiratory patterns. These components are described below and summarized in Table 1) In-app mindfulness-based breathing sessions. The smartphone app included auditory guided breathing sessions called “Boosts” inspired by elements of “low-dose” MBSR (Klatt et al., 2009). MBSR was chosen because of it employs respiration as a tool for training attention and self-regulation. The intervention sessions taught participants about features of the app, the link between cognitive– emotional states and respiratory patterns, and methods of using breathing practices to cultivate control of one’s autonomic nervous system to avoid maladaptive responses to stress. Each week, participants in the treatment group received an e-mail that prompted them to listen to one of five 6–9-min sessions (the last e-mail prompted them to complete the final two boosts; see Table 2). The total duration of these sessions was 37.5 min. These sessions also recommended using the Spire app to incorporate these techniques into daily life. The slow breath Streaks and box breathing Notifications and the calming breath Goals and the natural breath Progress and the mirror technique
#4452	The smartphone application utilized for this scholarly project was Headspace TM. It was formally launched in 2010 and includes meditations, animations, articles, and videos all with the mission to improving health and happiness. Scientific rigor is valued by the company and they are dedicated to furthering the field of mindfulness meditation through clinically validated research. They are focused on improving digital health solutions and are partnered with several large academic and research institutions with the goal of conducting large mindfulness trials. Participants began the self-guided intervention utilizing mindfulness via Headspace TM starting on November 18, 2020. Electronic instructions on the intervention itself were sent for review, along with instructions on how to download a free subscription to HeadSpace TM. Participants were instructed on how to navigate the application and which section of the application to use. The intervention involved each individual clinician listening to a brief guided meditation approximately 5 to 10 min long. Clinicians were asked to complete a mindful meditation when they need a moment to relax, refocus or calm their thoughts. They were encouraged to do this when it was most convenient for them – before work, after work, or during the workday. The goal was to not pull staff away from patient care, and to allow the participants to listen at a time that was most convenient for them. This was not meant to feel mandatory but rather to be viewed as a tool to reduce their stress. There was no requirement on the number of times they should log on, but they were instructed that literature shows the more one participates, the better mindfulness works. Within the application, there is a section called Basics, intended for beginners, that has 10 sessions ranging from 3 to 10 min. This section guided the participant through how to begin meditation, including time of day, body positions, and best locations for meditation. It gave the participant an option for either a male or female voice to guide them through a meditation. HeadSpace TM also has a search option that allowed the participants to tailor the meditation specifically to their needs. For this DNP project, the Basics section was used so that the participants all experienced the same meditations, ensuring greater rigor for the intervention. The goal was to listen daily, but participants were encouraged to do as much as they could, in order to determine the feasibility of this intervention. At the end of the 3-week period, participants were asked to reflect on their amount of participation.
#3210	The Advanced Law Enforcement Resilience Training (A.L.E.R.T.) program is a psychoeducational program designed specifically to help police enhance and maintain psychological resilience despite experiencing chronic stress. This program integrated a component of an empirically supported intervention (i.e., mindfulness) into a one-time training and a mobile app to allow police to practice mindfulness skills over time. The primary goal of the A.L.E.R.T. program was to increase police psychological resilience and effectiveness at managing stress by delivering a comprehensive training to proactively target potential coping deficits. The learning objectives of this program were to: 1) increase knowledge of the relationship between stress and negative outcomes, 2) increase knowledge of mindfulness and its utility for managing stress, 3) increase the frequency with which police utilize mindfulness principles and practices (e.g., awareness and acceptance of thoughts and emotions), and 4) decrease burnout in police while perceived stress may not change. APP: The last 30 min of the A.L.E.R.T. in-person training was dedicated to downloading and educating participants on how to use and the specific features of the A.L.E.R.T. mobile app. The app contained 4 categories of mindfulness practice exercises that complemented the inperson training. For example, within the ONE WAY skills were located within the Fundamental Skills category. The other categories included general practice exercises (i.e., Practice Exercises), and specific exercises to be practiced in distressing moments (i.e., In the Moment) and after a mentally and/or physically demanding day (i.e., After a Stressful Day). See Appendix A for A.L.E.R.T. In-Person and Mobile App Training Outline.
#692	The Benevolent Midwifery Project is a webbased module built through wordpress.com that was used and evaluated as the intervention. Prior to the implementation of the project, participants were provided with welcome packets containing lavenderfilled eye pillows for relaxation, a letter describing the intervention, password information for access to the website and modules, and the pre- and posttest. scales. The content included 16 modules in the form of interactive web pages. Photographic demonstration, audio files, videos, and written instructions were provided for ease of participation. Risks, benefits, and contraindication for each module were discussed. The modules were engaged in daily for a minimum of 4 days a week over a 4-week period. The modalities of yoga, meditation, and MBSR techniques were used on an alternating basis throughout the 4 weeks. Each day’s module took approximately 5 to 30 min to complete, dependent on the module chosen by the participant (see Table 2). For logistical reasons, the props seen in the modules (bolsters, chairs, and blankets) were not provided to each participant. However, suggestions were made for using alternative to these props, each of which are easily found in the home, office, or call room setting. During Week 1, each modality was described in detail and introduced conceptually as well as experientially. These included introductions and beginning practices to the modalities of meditation, yoga, and MSBR. An example of the yoga modality example from Week 1 may be seen in Fig. 1. Week 2 expanded on the basic knowledge explored in Week 1, including yoga poses such as “legs up the wall” and “supported backbend,” a mindful eating exercise, and a meditation on awareness (see Fig. 2). Week 3 used longer and more in-depth MBSR and meditation practices that included loving kindness meditation and body scan, and introduced yoga sequences as opposed to single postures, with modifications (see Fig. 3). Week 4 further developed the yoga sequences of Week 3 and introduced more advanced concepts in meditation and MBSR with the addition of external cues such as music.
#3229	The treatment condition included a five-minute video introducing mindfulness (The Power of Mindfulness; ww.palousemindfulness.com). The session ended with an interactive online 60-s mindfulness stress-reduction exercise (Appendix J). This online 60-s group breathing exercise (www.connectedbreath.co) is a meditation tool to decrease stress and anxiety and bring awareness to the moment. It featured a galaxy image with one large bright star. A series of prompts guided the participant through breathing, and they watched as the star got bigger and smaller according to the ebb and flow of breathing in and out. Distant stars in the galaxy represented the people in the world they were currently connected to and partaking in the group breathing exercise. As more people connected to the online exercise more stars appeared in the background.
#3096	The content of the mindfulness practices is based on the content o f the Mindful Breathing and Body Scan exercises used in the traditional MBSR program given by a trained teacher to live participants. The introduction to mindfulness explains the concept of mindfulness, and how it can reduce suffering and improve quality of life. The mindful breathing practice helps the practitioner learn single-pointed concentration on the breath, to recognize when the mind has wandered from its attention on the practice, and bring it back. Through this practice of sustained attention, the practitioner experiences a strengthening ability to concentrate and maintain attention on a chosen object, as well a vivid exposure to the mind’s habits of distraction. The body scan practice helps the practitioner learn to place attention in the parts o f the body starting at the feet and slowly moving up to the head. Through this repeated succession of placing, lifting, and moving attention, the practitioner gains greater mastery in the use o f attention as it moves from one experience to the next. The author does not have permission to reproduce the scripts for these modules because o f copyright restrictions The mindfulness intervention group’s e-mail provided instructions on how to access the intervention materials online (three audio files: an introduction to mindfulness training, a mindful breathing exercise, and a body scan exercise). The e-mail specified that participants listen to the audio introduction on the first day o f the study, and listen to and follow the mindful breathing practice that day and each day for the first week. They were then instructed to listen to and follow the body scan practice each day during the second week. In weeks 3–8 o f the intervention, they were asked to choose either exercise for their daily practice.
#974	The interventions will combine two types of practice, with each week consisting of two audio-guided active sessions (Mondays and Thursdays; about 30 min each) and home assignments, which will be accompanied by handouts and worksheets (Tuesdays, Wednesdays, Fridays, Saturdays; about 15 min each day). The first and the last session will serve as an introductory and a closing session, respectively, and will be purely psychoeducational. The main focus of the first session will be on introducing the intervention as well as on increasing the knowledge of core concepts of CBT or mindfulness (i.e., explaining the theoretical framework of the intervention). The last session, on the other hand, will be prepared in such a way that it encourages the participants to continue using the techniques they have learned and that it facilitates the transfer of the newly acquired knowledge into everyday life. In contrast, the central ten sessions will be built around the exercises selected in the preliminary study, ordered in such a way that participants first start with simple and basic exercises and then gradually build upon them (in mindfulness by expanding on the initial experience with the body scan and bringing awareness to the present moment; in CBT by expanding on the initial realization that thoughts are not facts and the ABC model). During the audio-guided session, participants will be taught psychoeducational elements that are specifically relevant for the given exercise and will be guided through their first experience performing the exercise. They will then be encouraged to repeat the exercises on their own in the days that follow, using handouts and worksheets to guide and record their progress. The content of some of the exercises (in both interventions) will be adapted for the working context. During the intervention period, participants from both intervention groups will receive e-mail notifications every Monday and Thursday with information about the assignments and exercises. The initial e-mail will include instructions on how to access the online platform with CBT and MBSR exercises. The notification every Monday will remind participants to fill out the weekly questionnaire before they start with the new exercise. All exercises from previous weeks will be visible on the online platform. Upcoming exercises will not yet be available to ensure that participants will not skip the activities or perform them in random order. The online platform will automatically monitor whether the participants followed the instructions and performed the respective exercises. In case of non-compliance, reminders will be sent out the following day. After the intervention, participants from the waitlist control groups will receive access to the online platform and all intervention materials, which they can perform in any order. They will receive weekly emails reminding them to perform the exercises and encouraging them to practice them. After the intervention, each participant will have the opportunity to request individualized feedback on his or her results.
#4457	The online RT for Healthcare Workers course consists of didactic materials delivered in pre-recorded videos by experienced doctoral level clinicians, testimonials of healthcare workers about their experiences during the pandemic and their use of the skills taught in the course, and brief experiential exercises. Session 1 (19 min) focused on the concept of resilience and mindfulness skills (Potes et al., 2018); session 2 (16 min) focused on enhancing cognitive flexibility via cognitive behavioral (Beck et al., 1979) and mentalization (Daubney & Bateman, 2015) skills; and session 3 (12 min) focused on the development of self-compassion (Neff & Germer, 2013). All three sessions emphasized ways to implement these concepts and skills in everyday life, highlighting specific challenges faced by healthcare workers during the COVID-19 pandemic.
#4462	(1) Anxious Lawyer: The book also outlines an 8-week program (detailed in Table 1.1) that pairs specific readings with both formal and informal mindfulness practices. Formal practices include guided meditations, which are presented in written form in the text and are also available in audio form narrated by the authors of the book at www.theanxiouslawyer.com. Informal practices encourage contemplation and suggest ways in which mindfulness can be incorporated into the activities of everyday life. Readers are encouraged to track their experiences with the various practices each week by completing meditation logs. The logs, which provide space to record the time and length spent practicing each day and notes regarding both the formal and informal activities, are included at the end of each chapter. Weekly emails that specified the book sections to be read and provided links to online guided meditations; this material was also available via a website (http://theanxiouslawyer.com/syllabus/). Topics: Beginning to meditate, mindfulness, clarity, compassion toward others, self-compassion, mantra repetition, heartfulness, gratitude. (2) Mindful Pause: Mindful Pause was designed to provide background information and the motivation to develop a daily mindfulness meditation practice. Each iteration of the Mindful Pause program was conducted over 30 consecutive days. Throughout the program, participants were sent daily emails containing brief information on topics including mindfulness and meditation, the management of stress and anxiety, and the use of cognitive resetting to address maladaptive patterns of thought. Emails also contained links to 6-min, online guided meditations narrated by Cho. Additional program details are available at https://jeenacho.com/mindful-pause/. Participants in the experimental condition were then invited to attend a 1-h webinar that provided an introduction to mindfulness and an overview of the study timeline.
#4463	First, an orientation presentation was emailed to LEOs, which detailed emotional wellness tips from a licensed psychologist for managing stress throughout a shift. Along with best practice recommendations, the presentation outlined the role of the intervention in targeting LEO stress and introduced to the heartrate monitor and stress continuum monitor build into the watch (Fig. 2). The heart rate displayed real time heart rate of the wearer. The stress continuum was another visual display of heart rate, which was standardized and ranged from 1 to 100. During the presentation, LEOs were also introduced two wellness options to use in the field: 1) A 1-min meditation breathing exercise that was already built into the smart watch, and 2) the Calm app™, which provided a mix of guided meditations and mindfulness exercises for LEOs needing a longer decompression period. The Calm app was downloaded on their phone and smart watch during the in-person set up session (see more below). Watch capabilities are presented in Fig. 2. At the end of the presentation, a link was provided to LEOs to sign up for a watch set-up time. Second, participants attended an in-person set-up session for consent and to watch configuration. At this session, we activated participants’ watches, measured their resting heart rates (RHR), and educated them on the brief wellness interventions available on the watch for use in the field. LEOs were randomly assigned to a predetermined threshold (50, 60, 70%, or 80% higher than RHR) for intervention notification. The purpose of randomizing thresholds was for two reasons. First, there is limited research available on a universal elevated heart rate indicative of high stress due to several factors that impact heart rate. Previous research has found that a single measurement of heart rate is only useful when it’s well out of the expected range of normal (Mackenzie et al. 2006). Second, as this was a pilot study, we wanted to assess various thresholds to identify the percentage above RHR most beneficial for LEO notification (regular but not over-notification of high stress). Participants also completed a brief, 8-item demographic survey. Third, LEOs were instructed to wear the watch during the entirety of their shift for 30 calendar days. When participants’ heart rates or stress continuums reached their predetermined threshold for a period of ten minutes or greater, the watch notified the LEOs that they were experiencing heightened physical stress via a vibration mechanism on the watch. After notification, two mental health interventions were available in real time through the watch: (1) a 1-min, meditation breathing exercise; and (2) the Calm app™.