***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND This study examined the effects of an 8-week stress reduction program based on training in mindfulness meditation . Previous research efforts suggesting this program may be beneficial in terms of reducing stress-related symptomatology and helping patients cope with chronic pain have been limited by a lack of adequate comparison control group . METHODS Twenty-eight individuals who volunteered to participate in the present study were r and omized into either an experimental group or a nonintervention control group . RESULTS Following participation , experimental subjects , when compared with controls , evidence d significantly greater changes in terms of : ( 1 ) reductions in overall psychological symptomatology ; ( 2 ) increase in overall domain-specific sense of control and utilization of an accepting or yielding mode of control in their lives , and ( 3 ) higher scores on a measure of spiritual experiences . CONCLUSIONS The techniques of mindfulness meditation , with their emphasis on developing detached observation and awareness of the contents of consciousness , may represent a powerful cognitive behavioral coping strategy for transforming the ways in which we respond to life events . They may also have potential for relapse prevention in affective disorders Background : Although mindfulness meditation interventions have recently shown benefits for reducing stress in various population s , little is known about their relative efficacy compared with relaxation interventions . Purpose : This r and omized controlled trial examines the effects of a 1-month mindfulness meditation versus somatic relaxation training as compared to a control group in 83 students ( M age=25 ; 16 men and 67 women ) reporting distress . Method : Psychological distress , positive states of mind , distractive and ruminative thoughts and behaviors , and spiritual experience were measured , while controlling for social desirability . Results : Hierarchical linear modeling reveals that both meditation and relaxation groups experienced significant decreases in distress as well as increases in positive mood states over time , compared with the control group ( p<.05 in all cases ) . There were no significant differences between meditation and relaxation on distress and positive mood states over time . Effect sizes for distress were large for both meditation and relaxation ( Cohen ’s d=1.36 and .91 , respectively ) , whereas the meditation group showed a larger effect size for positive states of mind than relaxation ( Cohen ’s d=.71 and .25 , respectively ) . The meditation group also demonstrated significant pre-post decreases in both distractive and ruminative thoughts/behaviors compared with the control group ( p<.04 in all cases ; Cohen ’s d=.57 for rumination and .25 for distraction for the meditation group ) , with mediation models suggesting that mindfulness meditation ’s effects on reducing distress were partially mediated by reducing rumination . No significant effects were found for spiritual experience . Conclusions : The data suggest that compared with a no-treatment control , brief training in mindfulness meditation or somatic relaxation reduces distress and improves positive mood states . However , mindfulness meditation may be specific in its ability to reduce distractive and ruminative thoughts and behaviors , and this ability may provide a unique mechanism by which mindfulness meditation reduces distress Psychosocial stress is a potent activator of the hypothalamus-pituitary-adrenal ( HPA ) axis . While neuroendocrine stress responses are essential for the maintenance of homeostasis , evidence suggests that excessive activation of the HPA axis constitutes a risk for disease and psychopathology . The purpose of the present study was to assess the effect of cognitive-behavioral stress management training on endocrine stress responses and cognitive appraisal under acute psychosocial stress among healthy young subjects . Forty-eight healthy , non-smoking male students without acute or chronic medical or psychiatric disorder on self report were r and omly assigned to receive group-based cognitive-behavioral stress management training either before or after a st and ardized psychosocial stress test ( Trier Social Stress Test , TSST ) .  Endocrine and psychological stress responses were assessed with salivary free cortisol response and cognitive appraisal processes to the TSST . In comparison with the control group , subjects in the treatment group showed an attenuated endocrine response ( F ( 2.55/117.41 ) = 3.81 ; P = 0.02 ; effect size f(2 ) = 0.35 ) to the TSST . In addition , subjects in the SIT group had lower stress appraisal and higher control expectancies ( F ( 2/45 ) = 6.56 ; P = 0.003 , effect size f(2 ) = 0.29 ) compared to controls . Short group-based cognitive-behavioral stress management training reduces the neuroendocrine stress response to an acute stressor in healthy subjects . Therefore , stress management training may prove useful in preventing detrimental effects of stress-induced neuroendocrine The inability to cope successfully with the enormous stress of medical education may lead to a cascade of consequences at both a personal and professional level . The present study examined the short-term effects of an 8-week meditation-based stress reduction intervention on premedical and medical students using a well-controlled statistical design . Findings indicate that participation in the intervention can effectively ( 1 ) reduce self-reported state and trait anxiety , ( 2 ) reduce reports of overall psychological distress including depression , ( 3 ) increase scores on overall empathy levels , and ( 4 ) increase scores on a measure of spiritual experiences assessed at termination of intervention . These results ( 5 ) replicated in the wait-list control group , ( 6 ) held across different experiments , and ( 7 ) were observed during the exam period . Future research should address potential long-term effects of mindfulness training for medical and premedical students The challenges of providing exemplary undergraduate nursing education can not be underestimated in an era when burnout and negative mood states predictably lead to alarming rates of academic as well as career attrition . While the multi-dimensional nature of this complex issue has been extensively eluci date d , few rational strategies exist to reverse a disheartening trend recognizable early in the educational process that subsequently threatens to undermine the future viability of quality healthcare . This controlled prospect i ve crossover study examined the impact of a 6-session Recreational Music-making ( RMM ) protocol on burnout and mood dimensions as well as Total Mood Disturbance ( TMD ) in first year associate level nursing students . A total of 75 first year associate degree nursing students from Allegany College of Maryl and ( ACM ) participated in a 6-session RMM protocol focusing on group support and stress reduction utilizing a specific group drumming protocol .  Burnout and mood dimensions were assessed with the Maslach Burnout Inventory and the Profile of Mood States respectively . Statistically significant reductions of multiple burnout and mood dimensions as well as TMD scores were noted . Potential annual cost savings for the typical associate degree nursing program ( $ 16,800 ) and acute care hospital ( $ 322,000 ) were projected by an independent economic analysis firm . A cost-effective 6-session RMM protocol reduces burnout and mood dimensions as well as TMD in associate degree nursing students Mindfulness-based stress reduction ( MBSR ) has shown effectiveness for a variety of mental health conditions . However , it is not known for whom the intervention is most effective . In a r and omized controlled trial ( N = 30 ) , we explored whether individuals with higher levels of pretreatment trait mindfulness would benefit more from MBSR intervention . Results demonstrated that relative to a control condition ( n = 15 ) , MBSR treatment ( n = 15 ) had significant effects on several outcomes , including increased trait mindfulness , subjective well-being , and empathy measured at 2 and 12 months after treatment . However , relative to controls , MBSR participants with higher levels of pretreatment mindfulness showed a larger increase in mindfulness , subjective well-being , empathy , and hope , and larger declines in perceived stress up to 1 year after treatment Psychosocial stress leads to a release of cortisol . While this psychoneuroendocrine response helps to maintain physiological as well as psychological equilibrium under stress , exaggerated secretion of cortisol has been shown to have negative effects on somatic health and cognitive functioning . The study set out to examine the long-term effects of cognitive-behavioral stress management training on cortisol stress responses in healthy men and women . Eighty-three healthy subjects were r and omly assigned to cognitive-behavioral stress management ( CBSM ) training or a control condition . Four months after the CBSM , 76 subjects underwent a  st and ardized psychosocial stress test .  Salivary cortisol responses were assessed repeatedly before and after the stress test . Subjects in the CBSM group showed significantly reduced cortisol stress responses . With regard to gender , this effect was observed in both men and women . However , the magnitude of the CBSM effect on cortisol responses was smaller in women than in men . Use of oral contraceptives in women influenced the cortisol response , but did not have an impact on the  CBSM effect on cortisol . The results show that the previously reported attenuation of cortisol stress responses through CBSM persists and are observable in both men and women . Since stress-induced alterations of hypothalamus pituitary adrenal axis functioning are discussed to be involved in the onset and maintenance of both somatic and psychiatric conditions , similar interventions could be used for prevention and therapy of these detrimental stress effects Abstract The authors examined the effect of a 6-week mind/body intervention on college students ' psychological distress , anxiety , and perception of stress . One hundred twenty-eight students were r and omly assigned to an experimental group ( n = 63 ) or a waitlist control group ( n = 65 ) . The experimental group received 6 90-minute group-training sessions in the relaxation response and cognitive behavioral skills . The Symptom Checklist-90-Revised , Spielberger State-Trait Anxiety Inventory , and the Perceived Stress Scale were used to assess the students ' psychological state before and after the intervention . Ninety students ( 70 % of the initial sample ) completed the post assessment measure . Significantly greater reductions in psychological distress , state anxiety , and perceived stress were found in the experimental group . This brief mind/body training may be useful as a preventive intervention for college students , according to the authors , who called for further research to determine whether the observed treatment effect can be sustained over a longer period of time The purpose of this study was to compare the effects of Benson 's relaxation technique ( BRT ) with Benson 's technique augmented with GSR biofeedback ( i.e. , biofeedback-aided relaxation , BAR ) on the psychological stress symptoms of well college students . Seventy-eight normotensive college students were r and omly assigned to one of three groups : the BRT group , the BAR group , and a control group . The BRT and BAR students were asked to practice their respective relaxation technique daily for an eight-week period . Pre- and postintervention , all subjects were administered a state-anxiety inventory and a profile-of-mood state ( POMS ) test . Posttest analysis indicated that the BAR group had significantly lower state anxiety and POMS than the BRT and control groups ( p less than 0.05 ) . It was evident from the results that BAR did augment BRT in lowering psychological stress symptoms . Part of the effectiveness was due to the expectation of relief on the part of the BAR group . It was recommended that nurses study the effects of BAR in clinical setting This study examined the effectiveness of audiotaped imagery in reducing anxiety and improving test performance among first-year nursing students . Volunteer subjects were r and omly assigned to three groups , imagery-only , imagery/relaxation , and a no-treatment control group .  Pottest state anxiety scores in these groups were significantly lower ( p = .001 ) than in the no-treatment control group . Test performance did not differ significantly ( p = .067 ) . Subjects using the audiotaped imagery reported an increased sense of well-being , improved ability to sleep , greater energy , and improved self-confidence OBJECTIVE This study aim ed to determine whether the practice of mindfulness reduces the level of stress experienced by senior medical students . METHODS We carried out a multicentre , single-blinded , r and omised controlled trial with intention-to-treat analysis in three clinical schools attached to the University of Tasmania , Hobart , Tasmania . Participants included 66 medical students in their final 2 years of study in 2009 . Participants were block-r and omised to either an intervention or a usual care control group . The intervention used an audio CD of guided mindfulness practice design ed and produced for this trial . Participants were advised to use the intervention daily over the 8 weeks of the trial . All participants completed two self-report question naires , at baseline and at 8 weeks , respectively . The intervention group also completed a question naire at 16 weeks to provide follow-up data . The primary outcome measure was the difference over time in scores on the Perceived Stress Scale ( PSS ) . The secondary outcome measure referred to differences over time in scores on the subscales of the Depression , Anxiety and Stress Scale ( DASS ) . RESULTS Mean baseline scores on the PSS and the stress component of the DASS were 15.7 ( maximal score of 40 ) and 13.2 ( maximal score of 42 ) , respectively , both of which exceed scores in age-matched normative control data . Using multivariable analysis , participants in the intervention group demonstrated significant reductions in scores on the PSS ( - 3.44 , 95 % confidence interval [ CI ] - 6.20 to - 0.68 ; p < 0.05 ) and the anxiety component of the DASS ( - 2.82 , 95 % CI - 4.99 to - 0.64 ; p < 0.05 ) . A borderline significant effect was demonstrated on the stress component of the DASS ( - 3.69 , 95 % CI - 7.38 to 0.01 ; p = 0.05 ) . Follow-up at 8 weeks post-trial revealed that the effect was maintained . CONCLUSIONS Mindfulness practice reduced stress and anxiety in senior medical students . Stress is prevalent in medical students and can have adverse effects on both student health and patients . A simple , self-administer 
    Output:
    
Secondary outcomes included lower levels of depression and cortisol .
This review provides evidence that cognitive , behavioral , and mindfulness interventions are effective in reducing stress in university students .