Abstract
There have been dramatic and concerning increases in rates of psychological distress in students enrolled in
U.S. colleges and universities over the last decade. The majority of college students in the last year experienced
mental health problems, and if left untreated, symptoms of these problems have serious individual and public
health consequences, both in the short- and long-term. However, the vast majority of students do not receive
professional mental health support because traditional treatments are perceived as ineffective and
inconvenient, and because on-campus resources cannot meet the demand of students needing support. As a
result, it is critical to identify acceptable and effective interventions to address what is being called a “campus
mental health crisis”. Mindfulness-based interventions (MBIs) are very well-liked by college students, most of
whom are late adolescents; in addition, they are effective at increasing mindfulness and emotion regulation as
well as reducing stress and depression. However, MBI effects have typically been small-to-moderate. Outside of
the mindfulness literature, technological supplements to group-based programs like MBIs have been found to
be effective at increasing intervention efficacy. Our team developed the first multi-modal adaptive supplement
to an MBI (5K01AT009592), Learning to BREATHE PLUS (L2B PLUS), which supplements an evidence-based
group MBI with multiple methods of support for practicing mindfulness in daily life. Our program of research
provides evidence at a single-site that L2B PLUS is feasible and highly acceptable to adolescents, results in
sustained levels of engagement across the group program period, and appears to be more effective than the
standard, Learning to BREATHE group program (L2B) for increasing daily mindfulness practice and
consistency of mindfulness during stress as well as reducing psychological distress; in turn, L2B appears more
effective in reducing stress-related behavior compared to an active, didactic health education control
(HealthEd). Building directly on our prior work, the proposed R01 study is a multi-site, pilot randomized
controlled trial implemented at four sites in order to prepare for a future multi-site efficacy trial testing the
effects of L2B PLUS relative to the standard L2B program and HealthEd on depression, anxiety, and stress.
Specific aims of the current proposal are to: 1) evaluate multi-site fidelity of training and implementation of 6-
week L2B PLUS, 6-week L2B, and 6-week HealthEd to college students experiencing stress, 2) test multi-site
feasibility and acceptability of recruitment, retention, and protocol adherence for a randomized controlled trial
(RCT) involving L2B PLUS, L2B, and HealthEd, and 3) modify training/implementation and protocol for a
future, fully powered multi-site efficacy trial. Completion of these aims will prepare us for an adequately-
powered, multi-site efficacy trial, and ultimately inform a complementary and integrative approach to
supporting college students experiencing problems with stress.
