Advances in Health Sciences Education

, Volume 20, Issue 5, pp 1115–1134 | Cite as

Effects of a brief mindfulness-based intervention program for stress management among medical students: the Mindful-Gym randomized controlled study

  • Cheng Kar PhangEmail author
  • Firdaus Mukhtar
  • Normala Ibrahim
  • Shian-Ling Keng
  • Sherina Mohd. Sidik


Pursuing undergraduate medical training can be very stressful and academically challenging experience. A 5-week mindfulness-based stress management (MBSM/Mindful-Gym) program was developed to help medical students cope with stress. The aim of this study was to evaluate the effectiveness of the intervention in reducing stress among students in a medical school in Malaysia. Seventy-five medical students participated in the program. They were stratified according to years of studies and randomly allocated to intervention (N = 37) and control groups (N = 38). The following outcome variables were measured at pre- and post-intervention: mindfulness (with Mindful Awareness Attention Scale); perceived stress (with Perceived Stress Scale); mental distress (with General Health Questionnaire), and self-efficacy (with General Self-efficacy Scale). Hierarchical multiple regressions were used to analyse the effect of group (intervention vs. control) on changes in the outcome variables. There were significant improvements at one week post-intervention in all outcome variables: mindfulness (β = 0.19, ΔR2 = 0.04, p = .040, f 2 = 0.05), perceived stress (β = −0.26, ΔR2 = 0.07, p = .009, f 2 = 0.10); mental distress (β = −0.28, ΔR2 = 0.10, p = .003, f 2 = 0.15); and self-efficacy (β = 0.30, ΔR2 = 0.09, p < .001, f 2 = 0.21). Six months after the intervention, those who had joined the program reported higher self-efficacy compared to those in the control group (β = 0.24, ΔR2 = 0.06, p = .020, f 2 = 0.08); but there was no difference in other outcome measures. More than 90 % of the participants found the program applicable in helping patients and all reported that they would recommend it to others. This study indicates that the program is potentially an effective stress management program for medical students in Malaysia.


Mindfulness Medical students Stress management Mental health Coping 



This study was supported by the Department of Psychiatry, Faculty of Medicine & Health Sciences, UPM, and a research grant from UPM (Project Number: 04-05-11-1583RU). The authors would like to thank the medical students who participated in, and provided feedback for enhancement of the program.


  1. Agee, J. D., Danoff-Burg, S., & Grant, C. A. (2009). Comparing brief stress management courses in a community sample: Mindfulness skills and progressive muscle relaxation. Explore: The Journal of Science and Healing, 5(2), 104–109.CrossRefGoogle Scholar
  2. Alvi, T., Assad, F., Ramzan, M., & Khan, F. A. (2010). Depression, anxiety and their associated factors among medical students. Journal of the College of Physicians and Surgeons Pakistan, 20(2), 122–126.Google Scholar
  3. Barbosa, P., Raymond, G., Zlotnick, C., Wilk, J., Toomey, R., & Mitchell, J. (2013). Mindfulness-based stress reduction training is associated with greater empathy and reduced anxiety for graduate healthcare students. Education for Health: Change in Learning and Practice, 26(1), 9–14.Google Scholar
  4. Bondolfi, G., Jermann, F., Van der Linden, M., Gex-Fabry, M., Bizzini, L., Rouget, B. W., & Bertschy, G. (2010). Depression relapse prophylaxis with mindfulness-based cognitive therapy: Replication and extension in the Swiss health care system. Journal of Affective Disorders, 122(3), 224–231.CrossRefGoogle Scholar
  5. Bramness, J. G., Fixdal, T. C., & Vaglum, P. (1991). Effect of medical school stress on the mental health of medical students in early and late clinical curriculum. Acta Psychiatrica Scandinavica, 84(4), 340–345.CrossRefGoogle Scholar
  6. Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84(4), 822–848.CrossRefGoogle Scholar
  7. Buttner, T. R., & Dlugosch, G. E. (2013). Students’ stress: The relationship between self-efficacy, mindfulness and stress experience of students. Prevention and Health Promotion, 8(2), 106.Google Scholar
  8. Chan, D. W. (1991). Depressive symptoms and depressed mood among Chinese medical students in Hong Kong. Comprehensive Psychiatry, 32(2), 170–180.CrossRefGoogle Scholar
  9. Chiesa, A. A., & Serretti, A. A. (2009). Mindfulness-based stress reduction for stress management in healthy people: A review and meta-analysis. Journal of Alternative and Complementary Medicine (New York N.Y.), 15(5), 593–600.CrossRefGoogle Scholar
  10. Cohen, J. (1988). Statistical power analysis for the behavioural sciences (2nd ed.). Hillsdale: Lawrence Erlbaum Associates.Google Scholar
  11. Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24(4), 385–396.CrossRefGoogle Scholar
  12. Cook, R. J., & Sackett, D. L. (1995). The number needed to treat: A clinically useful measure of treatment effect. BMJ (Clinical Research Ed.), 310(6977), 452–454.CrossRefGoogle Scholar
  13. De Vibe, M., Solhaug, I., Tyssen, R., Friborg, O., Rosenvinge, J. H., Sørlie, T., & Bjørndal, A. (2013). Mindfulness training for stress management: A randomised controlled study of medical and psychology students. BMC Medical Education, 13(107). doi: 10.1186/1472-6920-13-107.
  14. Dobkin, P. L., & Hutchinson, T. (2013). Teaching mindfulness in medical school: Where are we now and where are we going? Medical Education, 47(8), 768–779.CrossRefGoogle Scholar
  15. Dufon, M. A., & Christian, J. (2013). The formation and development of the mindful campus. New Directions for Teaching and Learning, 134, 65–72.CrossRefGoogle Scholar
  16. Dyrbye, L. N., Thomas, M. R., Huschka, M. M., Lawson, K. L., Novotny, P. J., Sloan, J. A., & Shanafelt, T. D. (2006a). A multicenter study of burnout, depression, and quality of life in minority and nonminority US medical students. Mayo Clinic Proceedings, 81(11), 1435–1442.CrossRefGoogle Scholar
  17. Dyrbye, L. N., Thomas, M. R., & Shanafelt, T. D. (2006b). Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students. Academic Medicine, 81(4), 354–373.CrossRefGoogle Scholar
  18. Erogul, M., Singer, G., McIntyre, T., & Stefanov, D. G. (2014). Abridged mindfulness intervention to support wellness in first-year medical students. Teaching and Learning in Medicine, 26(4), 350–356.CrossRefGoogle Scholar
  19. Firdaus, M., & Oei, T. P. S. (2011). A review on the prevalence of depression in Malaysia. Current Psychiatry Reviews, 7(3), 234–238.CrossRefGoogle Scholar
  20. Garland, E., Gaylord, S., & Park, J. (2009). The role of mindfulness in positive reappraisal. Explore: The Journal of Science and Healing, 5(1), 37–44.CrossRefGoogle Scholar
  21. Golderberg, D., & Williams, P. (1988). A user's guide to the general health questionnaire. Windsor: NFER-Nelson.Google Scholar
  22. Grepmair, L., Mitterlehner, F., Loew, T., Bachler, E., Rother, W., & Nickel, M. (2007). Promoting mindfulness in psychotherapists in training influences the treatment results of their patients: A randomized, double-blind, controlled study. Psychotherapy and Psychosomatics, 76(6), 332–338.CrossRefGoogle Scholar
  23. Grossman, P., Niemann, L., Schmidt, S., & Walach, H. (2004). Mindfulness-based stress reduction and health benefits: A meta-analysis. Journal of Psychosomatic Research, 57(1), 35–43.CrossRefGoogle Scholar
  24. Gupta, S. K. (2011). Intention-to-treat concept: A review. Perspectives in Clinical Research, 2(3), 109–112.CrossRefGoogle Scholar
  25. Haahr, M. (1998). RANDOM.ORG—True Random Number Service. Retrieved December 27, 2013, from
  26. Hassed, C., De Lisle, S., Sullivan, G., & Pier, C. (2009). Enhancing the health of medical students: Outcomes of an integrated mindfulness and lifestyle program. Advances in Health Sciences Education, 14(3), 387–398.CrossRefGoogle Scholar
  27. Holm, S. (1979). A simple sequentially rejective multiple test procedure. Scandinavian Journal of Statistics, 6(2), 65–70.Google Scholar
  28. IsHak, W., Nikravesh, R., Lederer, S., Perry, R., Ogunyemi, D., & Bernstein, C. (2013). Burnout in medical students: A systematic review. The Clinical Teacher, 10(4), 242–245.CrossRefGoogle Scholar
  29. Jain, S., Shapiro, S. L. P., Swanick, S., Roesch, S. C. P., Mills, P. J. P., Bell, I., et al. (2007). A randomized controlled trial of mindfulness meditation versus relaxation training: Effects on distress, positive states of mind, rumination, and distraction. Annals of Behavioral Medicine, 33(1), 11–21.CrossRefGoogle Scholar
  30. Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present, and future. Clinical Psychology: Science and Practice, 10(2), 144–156.Google Scholar
  31. Kang, C., & Whittingham, K. (2010). Mindfulness: A dialogue between buddhism and clinical psychology. Mindfulness, 1(3), 161–173.CrossRefGoogle Scholar
  32. Kaviani, H., Hatami, N., & Javaheri, F. (2012). The impact of mindfulness-based cognitive therapy (MBCT) on mental health and quality of life in a sub-clinically depressed population. Archives of Psychiatry and Psychotherapy, 14(1), 21–28.Google Scholar
  33. Kaviani, H., Javaheri, F., & Hatami, N. (2011). Mindfulness-based cognitive therapy (MBCT) reduces depression and anxiety induced by real stressful setting in non-clinical population. International Journal of Psychology and Psychological Therapy, 11(2), 285–296.Google Scholar
  34. Khoury, B., Lecomte, T., Fortin, G., Masse, M., Therien, P., Bouchard, V., & Hofmann, S. G. (2013). Mindfulness-based therapy: A comprehensive meta-analysis. Clinical Psychology Review, 33(6), 763–771.CrossRefGoogle Scholar
  35. Ko, S. M., Kua, E. H., & Fones, C. S. (1999). Stress and the undergraduates. Singapore Medical Journal, 627, 627–630.Google Scholar
  36. Krasner, M. S., Epstein, R. M., Beckman, H., Suchman, A. L., Chapman, B., Mooney, C. J., & Quill, T. E. (2009). Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA, 302(12), 1284–1293.CrossRefGoogle Scholar
  37. Krusche, A., Cyhlarova, E., & Williams, J. M. G. (2013). Mindfulness online: An evaluation of the feasibility of a web-based mindfulness course for stress, anxiety and depression. BMJ Open, 3(11). doi: 10.1136/bmjopen-2013-003498.
  38. Liu, X. C., Oda, S., Peng, X., & Asai, K. (1997). Life events and anxiety in Chinese medical students. Social Psychiatry and Psychiatric Epidemiology, 32(2), 63–67.CrossRefGoogle Scholar
  39. Lovibond, S., & Lovibond, P. (1995). Manual for the depression anxiety stress scales (2nd ed.). Sydney: Psychology Foundation.Google Scholar
  40. Mazwin, N. A. (2008). Fatwa Council says yoga with worshipping, chanting is prohibited. Kuala Lumpur: The Star Online.Google Scholar
  41. Moore, P. P. (2008). Introducing mindfulness to clinical psychologists in training: an experiential course of brief exercises. Journal of Clinical Psychology in Medical Settings, 15(4), 331–337.CrossRefGoogle Scholar
  42. Phang, C. K., & Oei, T. P. S. (2012). From Mindfulness to meta-mindfulness: Further integration of meta-mindfulness concept and strategies into cognitive-behavioral therapy. Mindfulness, 3(2), 104–116.Google Scholar
  43. Pinson, L., & Gray, G. E. (2003). Psychopharmacology: Number needed to treat: An underused measure of treatment effect. Psychiatric Services, 54(2), 145–154.CrossRefGoogle Scholar
  44. Pipe, T. B. P. R. N., Bortz, J. J. P. A. C. N., Dueck, A., Pendergast, D., Buchda, V., & Summers, J. (2009). Nurse leader mindfulness meditation program for stress management: A randomized controlled trial. Journal of Nursing Administration, 39(3), 130.CrossRefGoogle Scholar
  45. Quince, T. A., Wood, D. F., Parker, R. A., & Benson, J. (2012). Prevalence and persistence of depression among undergraduate medical students: A longitudinal study at one UK medical school. BMJ Open, 2(4). doi: 10.1136/bmjopen-2012-001519.
  46. Ree, M. J., & Craigie, M. A. (2007). Outcomes following mindfulness-based cognitive therapy in a heterogeneous sample of adult outpatients. Behaviour Change, 24(2), 70–86.CrossRefGoogle Scholar
  47. Roberts, L. W. (2010). Understanding depression and distress among medical students. JAMA: Journal of the American Medical Association, 304(11), 1231–1233.CrossRefGoogle Scholar
  48. Roh, M. S., Jeon, H. J., Kim, H., Han, S. K., & Hahm, B. J. (2010). The prevalence and impact of depression among medical students: A nationwide cross-sectional study in South Korea. Academic Medicine, 85(8), 1384–1390.CrossRefGoogle Scholar
  49. Rosenthal, J. M., & Okie, S. (2005). White coat, mood indigo: Depression in medical school. New England Journal of Medicine, 353(11), 1085–1088.CrossRefGoogle Scholar
  50. Rosenzweig, S., Reibel, D. K., Greeson, J. M., Brainard, G. C., & Hojat, M. (2003). Mindfulness-based stress reduction lowers psychological distress in medical students. Teaching and Learning in Medicine, 15(2), 88–92.CrossRefGoogle Scholar
  51. Ryan, A., Safran, J. D., Doran, J. M., & Muran, J. C. (2012). Therapist mindfulness, alliance and treatment outcome. Psychotherapy Research, 22(3), 289–297.CrossRefGoogle Scholar
  52. Saipanish, R. (2003). Stress among medical students in a Thai medical school. Medical Teacher, 25(5), 502–506.CrossRefGoogle Scholar
  53. Schlomer, G. L., Bauman, S., & Card, N. A. (2010). Best practices for missing data management in counseling psychology. Journal of Counseling Psychology, 57(1), 1–10.CrossRefGoogle Scholar
  54. Schulz, K. F., Altman, D. G., & Moher, D. (2010). CONSORT 2010 statement: Updated guidelines for reporting parallel group randomized trials. Annals of Internal Medicine, 152(11), 726–732.CrossRefGoogle Scholar
  55. Schwarzer, R., & Jerusalem, M. (1995). Generalized self-efficacy scale. In J. Weinman, S. Wright, & M. Johnston (Eds.), Measures in health psychology: A user’s portfolio. Causal and control beliefs (pp. 35–37). Windsor: NFER-Nelson.Google Scholar
  56. Schwenk, T. L., Davis, L., & Wimsatt, L. A. (2010). Depression, stigma, and suicidal ideation in medical students. JAMA: Journal of the American Medical Association, 304(11), 1181–1190.CrossRefGoogle Scholar
  57. Shapiro, S. L., Schwartz, G. E., & Bonner, G. (1998). Effects of mindfulness-based stress reduction on medical and premedical students. Journal of Behavioral Medicine, 21(6), 581–599.CrossRefGoogle Scholar
  58. Shapiro, S. L., Shapiro, D. E., & Schwartz, G. E. R. (2000). Stress management in medical education: A review of the literature. Academic Medicine, 75(7), 748–759.CrossRefGoogle Scholar
  59. Sherina, M. S., & Kanesan, N. (2003). The prevalence of depression among medical students. Malaysia Journal of Psychiatry, 11(1), 12–17.Google Scholar
  60. Shiralkar, M. T., Harris, T. B., Eddins-Folensbee, F. F., & Coverdale, J. H. (2013). A systematic review of stress-management programs for medical students. Academic Psychiatry, 37(3), 158–164.CrossRefGoogle Scholar
  61. Singh, A., Lal, A., & Shekhar, A. (2010). Prevalence of depression among medical students of a private medical college in India. Online Journal of Health and Allied Sciences, 9(4), from
  62. Smith, S., & Hayes, S. C. (2005). Get out of your mind and into your life: The new acceptance and commitment therapy (p. 190). Oakland: New Harbinger Publications.Google Scholar
  63. Soper, D. S. (2013). Free a priori sample size calculator for hierarchical multiple regression (Software). Retrieved on December 28, 2013, from
  64. Teasdale, J. D., Segal, Z. V., Williams, J. M. G., Ridgeway, V. A., Soulsby, J. M., & Lau, M. A. (2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology, 68(4), 615–623.CrossRefGoogle Scholar
  65. Turakitwanakan, W., Mekseepralard, C., & Busarakumtragul, P. (2013). Effects of mindfulness meditation on serum cortisol of medical students. Journal of the Medical Association of Thailand, 96(SUPPL 1), S90–S95.Google Scholar
  66. Walter, G., Soh, N. L.-W., Norgren Jaconelli, S., Lampe, L., Malhi, G. S., & Hunt, G. (2013). Medical students’ subjective ratings of stress levels and awareness of student support services about mental health. Postgraduate Medical Journal, 89(1052), 311–315.CrossRefGoogle Scholar
  67. Warnecke, E., Quinn, S., Ogden, K., Towle, N., & Nelson, M. R. (2011). A randomised controlled trial of the effects of mindfulness practice on medical student stress levels. Medical Education, 45(4), 381–388.CrossRefGoogle Scholar
  68. Weinstein, N., Brown, K. W., & Ryan, R. M. (2009). A multi-method examination of the effects of mindfulness on stress attribution, coping, and emotional well-being. Journal of Research in Personality, 43(3), 374–385.CrossRefGoogle Scholar
  69. Williams, P. M., & Penman, D. D. (2011). Mindfulness: A practical guide to finding peace in a frantic world (p. 288). London: Piatkus.Google Scholar
  70. Williams, J. M. G., Russell, I., & Russell, D. (2008). Mindfulness-based cognitive therapy: Further issues in current evidence and future research. Journal of Consulting and Clinical Psychology, 76(3), 524–529.CrossRefGoogle Scholar
  71. Yusoff, M. S. B. (2011). Effects of a brief stress reduction intervention on medical studentss depression, anxiety and stress during stressful period. Asean Journal of Psychiatry, 12(1), from
  72. Yusoff, M. S. B. (2013). Interventions on medical students’ psychological health: A meta-analysis. Journal of Taibah University Medical Sciences, 9(1), 1–13.CrossRefGoogle Scholar
  73. Yusoff, M. S. B., & Abdul Rahim, A. F. (2010). Impact of medical student well-being workshop on the medical student’s stress level: A prelimiary study. Asean Journal of Psychiatry, 11(1), from
  74. Yusoff, M. S. B., Abdul Rahim, A. F., & Yaacob, M. J. (2010a). Prevalence and sources of stress among Universiti Sains Malaysia medical students. Malaysian Journal of Medical Sciences, 17(1), 30–37.Google Scholar
  75. Yusoff, M. S. B., Abdul Rahim, A. F., & Yaacob, M. J. (2011). Depression among final year medical students in universiti sains malaysia (USM): Associated, risk and determinant factors. European Psychiatry, 26(Supple 1), 706.CrossRefGoogle Scholar
  76. Yusoff, M. S. B., & Esa, A. R. (2012). Stress management for medical students: A systematic review. In A. Lopez-Varela (Ed.), Social Sciences and Cultural StudiesIssues of Language, Public Opinion, Education and Welfare. InTech. doi: 10.5772/37095.
  77. Yusoff, M. S. B., Yaacob, M. J., & Rahim, A. F. A. (2010b). The sensitivity, specificity and reliability of the malay version 12-items general health questionnaire (GHQ-12) in detecting distressed medical students. ASEAN Journal of Psychiatry, 11(2), 135–142.Google Scholar
  78. Zaid, Z. A., Chan, S. C., & Ho, J. J. (2007). Emotional disorders among medical students in a Malaysian private medical school. Singapore Medical Journal, 48(10), 895–899.Google Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  • Cheng Kar Phang
    • 1
    Email author
  • Firdaus Mukhtar
    • 1
  • Normala Ibrahim
    • 1
  • Shian-Ling Keng
    • 2
  • Sherina Mohd. Sidik
    • 1
  1. 1.Department of Psychiatry, Faculty of Medicine and Health SciencesUniversiti Putra Malaysia (UPM)SerdangMalaysia
  2. 2.Department of PsychologyNational University of SingaporeSingaporeSingapore

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