JMIR Publications

ABSTRACT

Background:

Nursing students experience a disproportionately high burden of mental health challenges, underscoring the urgent need for innovative, scalable interventions. Online mindfulness programs, and more recently neurofeedback-enhanced approaches, present potentially promising avenues for addressing this critical issue.

Objective:

This study aims to explore the effectiveness of the neurofeedback-assisted online mindfulness intervention (NAOM) and the conventional online mindfulness intervention (COM) in reducing mental health symptoms among Chinese nursing students.

Methods:

A three-armed randomized controlled trial was conducted among 147 nursing students in Beijing, China using a six-week online mindfulness program. Participants received neurofeedback-assisted online mindfulness intervention, conventional online mindfulness interventions, or general mental health education over the next six weeks. Electroencephalogram (EEG) and validated tools such as the Patient Health Questionnaire (PHQ-9), and the Generalized Anxiety Disorder Questionnaire (GAD-7) were utilized to assess primarily symptoms of depression and anxiety at baseline, immediately after intervention, 1 month and 3 months after intervention. Generalized estimation equations (GEE) were used to evaluate the effects of intervention and time.

Results:

A total of 155 participants enrolled in the study, and 147 finished all assessments. Significant reductions in symptoms of depression, anxiety, and fatigue were observed in the NAOM (MD=-3.330, Cohen’s d=0.926, P<.001; MD=-3.468, Cohen’s d=1.091, P<.001; MD=-2.620, Cohen’s d=0.743, P<.001, respectively) and the COM (MD=-1.875, Cohen’s d=0.490, P=.03; MD=-1.750, Cohen’s d=0.486, P=.02; MD=-2.229, Cohen’s d=0.629, P=.01, respectively) groups compared with the control group at post-intervention assessment. Moreover, the NAOM group showed significantly better effects than the COM group in alleviating depressive symptoms (MD=-1.455, Cohen’s d=0.492, P=.04), and anxiety symptoms (MD=-1.718, Cohen’s d=0.670, P=.042), and improving the level of mindfulness (MD=-3.765, Cohen’s d=1.245, P<.001) at the post-intervention assessment. However, no significant difference except for the anxiety symptoms was observed across the three groups at the 1-month and 3-month follow-ups.

Conclusions:

This six-week online mindfulness intervention, both the conventional and neurofeedback-assisted, effectively alleviated mental health problems in the short term among nursing students. The addition of neurofeedback demonstrated greater short-term benefits; however, this effect was not maintained long-term. Future research should focus on long term interventions using a more robust methodologic approach. Clinical Trial: The trial was prospectively registered on the Chinese Clinical Trial Registry (ID: ChiCTR2400080314) on January 25th, 2024.