<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT03784846</url>
  </required_header>
  <id_info>
    <org_study_id>1295787-14</org_study_id>
    <secondary_id>U01AT009841</secondary_id>
    <nct_id>NCT03784846</nct_id>
  </id_info>
  <brief_title>Mindfulness-Based Resilience Training for Aggression, Health, and Stress Among Law Enforcement Officers</brief_title>
  <official_title>Mindfulness-Based Resilience Training for Aggression, Health, and Stress Among Law Enforcement Officers</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>Pacific University</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
    <collaborator>
      <agency>National Institutes of Health (NIH)</agency>
      <agency_class>NIH</agency_class>
    </collaborator>
    <collaborator>
      <agency>National Center for Complementary and Integrative Health (NCCIH)</agency>
      <agency_class>NIH</agency_class>
    </collaborator>
  </sponsors>
  <source>Pacific University</source>
  <oversight_info>
    <has_dmc>Yes</has_dmc>
    <is_fda_regulated_drug>No</is_fda_regulated_drug>
    <is_fda_regulated_device>No</is_fda_regulated_device>
  </oversight_info>
  <brief_summary>
    <textblock>
      Law enforcement officers (LEOs) are exposed to significant stressors, elevating their risk&#xD;
      for aggression and excessive use of force, as well as mental health consequences, including&#xD;
      post-traumatic stress disorder, burnout, alcohol misuse, depression, and suicide. The&#xD;
      proposed study will identify, optimize and refine best clinical and research practices across&#xD;
      two sites to ensure success in a future multisite efficacy trial assessing preventative&#xD;
      effects of Mindfulness-Based Resilience Training on physiological, behavioral, and&#xD;
      psychological outcomes.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      Law enforcement officers (LEOs) are exposed to significant stressors, elevating their risk&#xD;
      for aggression and excessive use of force. Such dysfunctional stress reactivity can lead to&#xD;
      devastating consequences for their community, including unjustified shootings, severe&#xD;
      beatings, and fatal chokings. It can also lead to serious consequences for the LEOs,&#xD;
      including elevated incidence of post-traumatic stress disorder, burnout, alcohol misuse,&#xD;
      depression, and suicide. A recent meta-analysis of LEO stress reduction programs found little&#xD;
      evidence to demonstrate that such approaches are effective, highlighting the urgent need for&#xD;
      preventive interventions targeting the stress inherent to policing. Mindfulness training is a&#xD;
      promising approach with high-stress populations that has been shown effective in reducing&#xD;
      stress and increasing resilience. In a recent pilot feasibility study (R21AT008854), the&#xD;
      study team established initial feasibility, acceptability, and adherence to procedures in a&#xD;
      single-site RCT assessing Mindfulness-Based Resilience Training (MBRT), a preventive&#xD;
      intervention designed to improve LEO mental health and resilience, and reduce aggression and&#xD;
      excessive use of force. The R21 data suggest physiological mechanisms and potential clinical&#xD;
      benefit in a sample of LEOs. Relative to waitlist control, MBRT participants showed&#xD;
      improvements in stress reactivity, aggression, burnout, occupational stress, sleep&#xD;
      disturbance, and psychological flexibility. Implemented at two sites, the proposed study is&#xD;
      designed to establish optimal protocols and procedures for a future full-scale, multi-site&#xD;
      trial assessing effects of MBRT versus an attention control (Stress Management Education) and&#xD;
      a no-intervention control, on physiological, behavioral, and psychological outcomes. To&#xD;
      prepare for this future clinical trial, this study will: a) enhance efficiency of&#xD;
      recruitment, engagement and retention; b) optimize lab, assessment, and data management&#xD;
      procedures; c) optimize intervention training and ensure fidelity to intervention protocols;&#xD;
      and d) assess participant experience and optimize outcome measures across sites. The&#xD;
      long-term objective of this line of research is to develop an intervention that will reduce&#xD;
      violence and increase resilience among LEOs, as well as yield significant benefits for&#xD;
      communities and residents they serve.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Completed</overall_status>
  <start_date type="Actual">October 1, 2019</start_date>
  <completion_date type="Actual">June 30, 2022</completion_date>
  <primary_completion_date type="Actual">May 17, 2022</primary_completion_date>
  <phase>N/A</phase>
  <study_type>Interventional</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <allocation>Randomized</allocation>
    <intervention_model>Parallel Assignment</intervention_model>
    <intervention_model_description>Individually-Randomized Group Treatment</intervention_model_description>
    <primary_purpose>Prevention</primary_purpose>
    <masking>Single (Outcomes Assessor)</masking>
  </study_design_info>
  <primary_outcome>
    <measure>Change in Aggression</measure>
    <time_frame>baseline, post-intervention (week 8), 3-month followup, 6-month followup</time_frame>
    <description>Buss-Perry Aggression Questionnaire-Short Form. Scores range from 1-5, with higher scores indicating greater aggression.</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>Change in C-reactive Protein</measure>
    <time_frame>baseline, post-intervention (8 weeks), 3 month followup</time_frame>
    <description>Blood spot analysis of high-sensitivity C-reactive protein.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Change in Interleukin-6</measure>
    <time_frame>baseline, post-intervention (8 weeks), 3 month followup</time_frame>
    <description>Blood spot analysis of interleukin-6.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Change in Interleukin-10</measure>
    <time_frame>baseline, post-intervention (8 weeks), 3 month followup</time_frame>
    <description>Blood spot analysis of interleukin-10.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Change in Tumor Necrosis Factor-alpha</measure>
    <time_frame>baseline, post-intervention (8 weeks), 3 month followup</time_frame>
    <description>Blood spot analysis of tumor necrosis factor-alpha.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Change in Psychological Resilience</measure>
    <time_frame>baseline, post-intervention (8 weeks), 3 month followup, 6 month followup</time_frame>
    <description>Brief Resilience Scale. Scores range from 1-5, with higher scores indicating greater resilience.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Change in Alcohol Use</measure>
    <time_frame>baseline, post-intervention (8 weeks), 3 month followup, 6 month followup</time_frame>
    <description>Patient Reported Outcome Measurement System (PROMIS) Alcohol Use. Scores range from 39-77, with higher scores indicating greater alcohol use.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Change in Alcohol Use Negative Consequences</measure>
    <time_frame>baseline, post-intervention (8 weeks), 3 month followup, 6 month followup</time_frame>
    <description>Patient Reported Outcome Measurement System (PROMIS) Alcohol Use Negative Consequences.Scores range from 39-77, with higher scores indicating greater alcohol use negative consequences.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Change in Depression</measure>
    <time_frame>baseline, post-intervention (8 weeks), 3 month followup, 6 month followup</time_frame>
    <description>Patient Reported Outcome Measurement System (PROMIS) Depression. Scores range from 38-80, with higher scores indicating more depression.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Change in Suicidal Thinking</measure>
    <time_frame>baseline, post-intervention (8 weeks), 3 month followup, 6 month followup</time_frame>
    <description>Concise Heath Risk Tracking Scale-Self-Report. Scores range from 7-35, with higher scores indicating greater suicidal ideation.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Change in Trauma Symptoms</measure>
    <time_frame>baseline, post-intervention (8 weeks), 3 month followup, 6 month followup</time_frame>
    <description>PTSD Checklist for DSM-5. Scores ranges from 0-80, with higher scores indicating greater PTSD symptoms.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Change in Burnout</measure>
    <time_frame>baseline, post-intervention (8 weeks), 3 month followup, 6 month followup</time_frame>
    <description>Oldenburg Burnout Inventory. Scores range from 1-4, with higher scores indicating greater burnout.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Change in Sustained Attention</measure>
    <time_frame>baseline, post-intervention (8 weeks), 3 month followup, 6 month followup</time_frame>
    <description>Sustained Attention to Response Task. A computer-based go/no-go task that requires participants to withhold behavioral response to a single, infrequent target presented amongst a background of frequent non-targets. Increased errors indicates less sustained attention.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Change in Perceived Stress</measure>
    <time_frame>baseline, post-intervention (8 weeks), 3 month followup, 6 month followup</time_frame>
    <description>Perceived Stress Scale-10. Scores range from 0-40, with higher scores indicating greater perceived stress.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Change in Sleep Disturbance</measure>
    <time_frame>baseline, post-intervention (8 weeks), 3 month followup, 6 month followup</time_frame>
    <description>Patient Reported Outcome Measurement System (PROMIS) Sleep Disturbance. Scores range from 32-76, with higher scores indicating greater sleep disturbance.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Change in Self-Compassion</measure>
    <time_frame>baseline, post-intervention (8 weeks), 3 month followup, 6 month followup</time_frame>
    <description>Self-Compassion Scale-Short Form. Scores range from 1-5, with higher scores indicating greater self-compassion.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Change in Mindfulness</measure>
    <time_frame>baseline, post-intervention (8 weeks), 3 month followup, 6 month followup</time_frame>
    <description>Five Facet Mindfulness Questionnaire-Short Form. Scores range from 1-5, with higher scores indicating greater mindfulness.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Change in Interoceptive Awareness</measure>
    <time_frame>baseline, post-intervention (8 weeks), 3 month followup, 6 month followup</time_frame>
    <description>Multidimensional Assessment of Interoceptive Awareness-II. Scores range from 1-6, with higher scores indicating greater interoceptive awareness.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Treatment Acceptability</measure>
    <time_frame>post-intervention (8 weeks)</time_frame>
    <description>Postcourse satisfaction survey. Scores range from 4-16, with higher scores indicating greater treatment acceptability. Measure only administered to Mindfulness-Based Resilience Training and Stress Management Education arms.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Treatment Compliance</measure>
    <time_frame>post-intervention (8 weeks)</time_frame>
    <description>Objective assessment of duration of homework practice. Measure only administered to Mindfulness-Based Resilience Training and Stress Management Education arms.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Treatment Expectancy and Credibility</measure>
    <time_frame>baseline</time_frame>
    <description>Expectancy/Credibility Questionnaire. Scale for measuring treatment expectancy and rationale credibility for use in clinical outcome studies. Scores range from 7-21, with higher scores indicating greater expectancy and credibility.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Global Impression of Change</measure>
    <time_frame>post-intervention (8 weeks)</time_frame>
    <description>Clinical Global Impressions Scale. Measure of perceived change in functioning as a result of the intervention. Scores range from 3-21, with higher scores indicating a greater impression of change. Measure only administered to Mindfulness-Based Resilience Training and Stress Management Education arms.</description>
  </secondary_outcome>
  <number_of_arms>3</number_of_arms>
  <enrollment type="Actual">109</enrollment>
  <condition>Stress, Psychological</condition>
  <condition>Aggression</condition>
  <arm_group>
    <arm_group_label>Mindfulness-Based Resilience Training</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>MBRT is an 8-week program combining training in standardized mindfulness practices targeting factors that facilitate resilience, cognitive behavioral therapy (CBT), and psychoeducation. It contains experiential and didactic exercises including body scan, sitting and walking meditation, mindful movement and discussions.</description>
  </arm_group>
  <arm_group>
    <arm_group_label>Stress Management Education</arm_group_label>
    <arm_group_type>Active Comparator</arm_group_type>
    <description>SME was designed as an active control condition for other mindfulness-based intervention trials. SME uses a group-based didactic approach with modules on physiological and dietary effects of stress, time management, sleep physiology and insomnia, nutrition, exercise, stress hardiness, and factors mitigating impacts of stress.</description>
  </arm_group>
  <arm_group>
    <arm_group_label>No Intervention Control</arm_group_label>
    <arm_group_type>No Intervention</arm_group_type>
    <description>No contact control condition (other than baseline, post, and follow-up assessments)</description>
  </arm_group>
  <intervention>
    <intervention_type>Behavioral</intervention_type>
    <intervention_name>Mindfulness-Based Resilience Training</intervention_name>
    <description>MBRT is an 8-week program combining training in standardized mindfulness practices targeting factors that facilitate resilience, CBT, and psychoeducation. It contains experiential and didactic exercises including body scan, sitting and walking meditation, mindful movement and discussions.</description>
    <arm_group_label>Mindfulness-Based Resilience Training</arm_group_label>
  </intervention>
  <intervention>
    <intervention_type>Behavioral</intervention_type>
    <intervention_name>Stress Management Education</intervention_name>
    <description>SME was designed as an active control condition for other Mindfulness-Based Intervention trials. SME uses a group-based didactic approach with modules on physiological and dietary effects of stress, time management, sleep physiology and insomnia, nutrition, exercise, stress hardiness, and factors mitigating impacts of stress.</description>
    <arm_group_label>Stress Management Education</arm_group_label>
  </intervention>
  <eligibility>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
          -  be 21-65 years old (age limitations for both police departments),&#xD;
&#xD;
          -  demonstrate English fluency,&#xD;
&#xD;
          -  be a sworn, full-time, active status law enforcement officer,&#xD;
&#xD;
          -  agree to random assignment to condition, and&#xD;
&#xD;
          -  be willing to complete assessments at multiple time points and attend intervention&#xD;
             groups&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
          -  previous participation in MBSR, MBRT or a similar mindfulness course,&#xD;
&#xD;
          -  score in the severe range on brief screening measures of depression, suicidal&#xD;
             ideation, alcohol use, or PTSD, or&#xD;
&#xD;
          -  unable or unwilling to give written informed consent.&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>21 Years</minimum_age>
    <maximum_age>65 Years</maximum_age>
    <healthy_volunteers>Accepts Healthy Volunteers</healthy_volunteers>
  </eligibility>
  <location>
    <facility>
      <name>University of New Mexico</name>
      <address>
        <city>Albuquerque</city>
        <state>New Mexico</state>
        <zip>87106</zip>
        <country>United States</country>
      </address>
    </facility>
  </location>
  <location>
    <facility>
      <name>Pacific University</name>
      <address>
        <city>Forest Grove</city>
        <state>Oregon</state>
        <zip>97116</zip>
        <country>United States</country>
      </address>
    </facility>
  </location>
  <location_countries>
    <country>United States</country>
  </location_countries>
  <results_reference>
    <citation>Christopher M, Bowen S, Witkiewitz K. Mindfulness-based resilience training for aggression, stress and health in law enforcement officers: study protocol for a multisite, randomized, single-blind clinical feasibility trial. Trials. 2020 Feb 28;21(1):236. doi: 10.1186/s13063-020-4165-y.</citation>
    <PMID>32111233</PMID>
  </results_reference>
  <verification_date>June 2023</verification_date>
  <study_first_submitted>December 13, 2018</study_first_submitted>
  <study_first_submitted_qc>December 19, 2018</study_first_submitted_qc>
  <study_first_posted type="Actual">December 24, 2018</study_first_posted>
  <results_first_submitted>May 11, 2023</results_first_submitted>
  <results_first_submitted_qc>June 9, 2023</results_first_submitted_qc>
  <results_first_posted type="Actual">July 3, 2023</results_first_posted>
  <last_update_submitted>June 9, 2023</last_update_submitted>
  <last_update_submitted_qc>June 9, 2023</last_update_submitted_qc>
  <last_update_posted type="Actual">July 3, 2023</last_update_posted>
  <responsible_party>
    <responsible_party_type>Principal Investigator</responsible_party_type>
    <investigator_affiliation>Pacific University</investigator_affiliation>
    <investigator_full_name>Michael Christopher, PhD</investigator_full_name>
    <investigator_title>Multiple Principal Investigator</investigator_title>
  </responsible_party>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Aggression</mesh_term>
    <mesh_term>Stress, Psychological</mesh_term>
  </condition_browse>
  <patient_data>
    <sharing_ipd>No</sharing_ipd>
  </patient_data>
  <provided_document_section>
    <provided_document>
      <document_type>Study Protocol and Statistical Analysis Plan: pre-COVID</document_type>
      <document_has_protocol>Yes</document_has_protocol>
      <document_has_icf>No</document_has_icf>
      <document_has_sap>Yes</document_has_sap>
      <document_date>November 5, 2019</document_date>
      <document_url>https://ClinicalTrials.gov/ProvidedDocs/46/NCT03784846/Prot_SAP_001.pdf</document_url>
    </provided_document>
    <provided_document>
      <document_type>Study Protocol and Statistical Analysis Plan: post-COVID</document_type>
      <document_has_protocol>Yes</document_has_protocol>
      <document_has_icf>No</document_has_icf>
      <document_has_sap>Yes</document_has_sap>
      <document_date>December 8, 2020</document_date>
      <document_url>https://ClinicalTrials.gov/ProvidedDocs/46/NCT03784846/Prot_SAP_002.pdf</document_url>
    </provided_document>
    <provided_document>
      <document_type>Informed Consent Form</document_type>
      <document_has_protocol>No</document_has_protocol>
      <document_has_icf>Yes</document_has_icf>
      <document_has_sap>No</document_has_sap>
      <document_date>March 4, 2021</document_date>
      <document_url>https://ClinicalTrials.gov/ProvidedDocs/46/NCT03784846/ICF_000.pdf</document_url>
    </provided_document>
  </provided_document_section>

  <clinical_results>

    <participant_flow>
      <pre_assignment_details>All enrolled participants were assigned to a study arm.</pre_assignment_details>
      <group_list>
        <group group_id="P1">
          <title>Mindfulness-Based Resilience Training (MBRT)</title>
          <description>MBRT is an 8-week program combining training in standardized mindfulness practices targeting factors that facilitate resilience, cognitive behavioral therapy (CBT), and psychoeducation. It contains experiential and didactic exercises including body scan, sitting and walking meditation, mindful movement and discussions.</description>
        </group>
        <group group_id="P2">
          <title>Stress Management Education (SME)</title>
          <description>SME was designed as an active control condition for other mindfulness-based intervention trials. SME uses a group-based didactic approach with modules on physiological and dietary effects of stress, time management, sleep physiology and insomnia, nutrition, exercise, stress hardiness, and factors mitigating impacts of stress.</description>
        </group>
        <group group_id="P3">
          <title>No Intervention Control</title>
          <description>No contact control condition (other than baseline, post, and follow-up assessments)</description>
        </group>
      </group_list>
      <period_list>
        <period>
          <title>Pre-COVID Study</title>
          <milestone_list>
            <milestone>
              <title>STARTED</title>
              <participants_list>
                <participants group_id="P1" count="17"/>
                <participants group_id="P2" count="14"/>
                <participants group_id="P3" count="5"/>
              </participants_list>
            </milestone>
            <milestone>
              <title>COMPLETED</title>
              <participants_list>
                <participants group_id="P1" count="6"/>
                <participants group_id="P2" count="3"/>
                <participants group_id="P3" count="0"/>
              </participants_list>
            </milestone>
            <milestone>
              <title>NOT COMPLETED</title>
              <participants_list>
                <participants group_id="P1" count="11"/>
                <participants group_id="P2" count="11"/>
                <participants group_id="P3" count="5"/>
              </participants_list>
            </milestone>
          </milestone_list>
          <drop_withdraw_reason_list>
            <drop_withdraw_reason>
              <title>Lost to Follow-up</title>
              <participants_list>
                <participants group_id="P1" count="3"/>
                <participants group_id="P2" count="3"/>
                <participants group_id="P3" count="2"/>
              </participants_list>
            </drop_withdraw_reason>
            <drop_withdraw_reason>
              <title>Withdrawal by Subject</title>
              <participants_list>
                <participants group_id="P1" count="1"/>
                <participants group_id="P2" count="2"/>
                <participants group_id="P3" count="1"/>
              </participants_list>
            </drop_withdraw_reason>
            <drop_withdraw_reason>
              <title>Discontinued by Researchers</title>
              <participants_list>
                <participants group_id="P1" count="7"/>
                <participants group_id="P2" count="6"/>
                <participants group_id="P3" count="2"/>
              </participants_list>
            </drop_withdraw_reason>
          </drop_withdraw_reason_list>
        </period>
        <period>
          <title>Post-COVID Study</title>
          <milestone_list>
            <milestone>
              <title>STARTED</title>
              <participants_list>
                <participants group_id="P1" count="33"/>
                <participants group_id="P2" count="24"/>
                <participants group_id="P3" count="16"/>
              </participants_list>
            </milestone>
            <milestone>
              <title>COMPLETED</title>
              <participants_list>
                <participants group_id="P1" count="29"/>
                <participants group_id="P2" count="17"/>
                <participants group_id="P3" count="15"/>
              </participants_list>
            </milestone>
            <milestone>
              <title>NOT COMPLETED</title>
              <participants_list>
                <participants group_id="P1" count="4"/>
                <participants group_id="P2" count="7"/>
                <participants group_id="P3" count="1"/>
              </participants_list>
            </milestone>
          </milestone_list>
          <drop_withdraw_reason_list>
            <drop_withdraw_reason>
              <title>Lost to Follow-up</title>
              <participants_list>
                <participants group_id="P1" count="3"/>
                <participants group_id="P2" count="5"/>
                <participants group_id="P3" count="1"/>
              </participants_list>
            </drop_withdraw_reason>
            <drop_withdraw_reason>
              <title>Withdrawal by Subject</title>
              <participants_list>
                <participants group_id="P1" count="1"/>
                <participants group_id="P2" count="2"/>
                <participants group_id="P3" count="0"/>
              </participants_list>
            </drop_withdraw_reason>
          </drop_withdraw_reason_list>
        </period>
      </period_list>
    </participant_flow>

    <baseline>
      <group_list>
        <group group_id="B1">
          <title>Mindfulness-Based Resilience Training</title>
          <description>MBRT is an 8-week program combining training in standardized mindfulness practices targeting factors that facilitate resilience, cognitive behavioral therapy (CBT), and psychoeducation. It contains experiential and didactic exercises including body scan, sitting and walking meditation, mindful movement and discussions.&#xD;
Mindfulness-Based Resilience Training: MBRT is an 8-week program combining training in standardized mindfulness practices targeting factors that facilitate resilience, CBT, and psychoeducation. It contains experiential and didactic exercises including body scan, sitting and walking meditation, mindful movement and discussions.</description>
        </group>
        <group group_id="B2">
          <title>Stress Management Education</title>
          <description>SME was designed as an active control condition for other mindfulness-based intervention trials. SME uses a group-based didactic approach with modules on physiological and dietary effects of stress, time management, sleep physiology and insomnia, nutrition, exercise, stress hardiness, and factors mitigating impacts of stress.&#xD;
Stress Management Education: SME was designed as an active control condition for other Mindfulness-Based Intervention trials. SME uses a group-based didactic approach with modules on physiological and dietary effects of stress, time management, sleep physiology and insomnia, nutrition, exercise, stress hardiness, and factors mitigating impacts of stress.</description>
        </group>
        <group group_id="B3">
          <title>No Intervention Control</title>
          <description>No contact control condition (other than baseline, post, and follow-up assessments)</description>
        </group>
        <group group_id="B4">
          <title>Total</title>
          <description>Total of all reporting groups</description>
        </group>
      </group_list>
      <analyzed_list>
        <analyzed>
          <units>Participants</units>
          <scope>Overall</scope>
          <count_list>
            <count group_id="B1" value="50"/>
            <count group_id="B2" value="38"/>
            <count group_id="B3" value="21"/>
            <count group_id="B4" value="109"/>
          </count_list>
        </analyzed>
      </analyzed_list>
      <measure_list>
        <measure>
          <title>Age</title>
          <units>Participants</units>
          <param>Count of Participants</param>
          <class_list>
            <class>
              <category_list>
                <category>
                  <title>&lt;=18 years</title>
                  <measurement_list>
                    <measurement group_id="B1" value="0"/>
                    <measurement group_id="B2" value="0"/>
                    <measurement group_id="B3" value="0"/>
                    <measurement group_id="B4" value="0"/>
                  </measurement_list>
                </category>
                <category>
                  <title>Between 18 and 65 years</title>
                  <measurement_list>
                    <measurement group_id="B1" value="50"/>
                    <measurement group_id="B2" value="38"/>
                    <measurement group_id="B3" value="21"/>
                    <measurement group_id="B4" value="109"/>
                  </measurement_list>
                </category>
                <category>
                  <title>&gt;=65 years</title>
                  <measurement_list>
                    <measurement group_id="B1" value="0"/>
                    <measurement group_id="B2" value="0"/>
                    <measurement group_id="B3" value="0"/>
                    <measurement group_id="B4" value="0"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <measure>
          <title>Age</title>
          <units>years</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="B1" value="40.22" spread="10.03"/>
                    <measurement group_id="B2" value="39.18" spread="8.06"/>
                    <measurement group_id="B3" value="38.90" spread="10.09"/>
                    <measurement group_id="B4" value="39.61" spread="9.33"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <measure>
          <title>Sex: Female, Male</title>
          <units>Participants</units>
          <param>Count of Participants</param>
          <class_list>
            <class>
              <category_list>
                <category>
                  <title>Female</title>
                  <measurement_list>
                    <measurement group_id="B1" value="12"/>
                    <measurement group_id="B2" value="9"/>
                    <measurement group_id="B3" value="5"/>
                    <measurement group_id="B4" value="26"/>
                  </measurement_list>
                </category>
                <category>
                  <title>Male</title>
                  <measurement_list>
                    <measurement group_id="B1" value="38"/>
                    <measurement group_id="B2" value="29"/>
                    <measurement group_id="B3" value="16"/>
                    <measurement group_id="B4" value="83"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <measure>
          <title>Ethnicity (NIH/OMB)</title>
          <units>Participants</units>
          <param>Count of Participants</param>
          <class_list>
            <class>
              <category_list>
                <category>
                  <title>Hispanic or Latino</title>
                  <measurement_list>
                    <measurement group_id="B1" value="16"/>
                    <measurement group_id="B2" value="9"/>
                    <measurement group_id="B3" value="4"/>
                    <measurement group_id="B4" value="29"/>
                  </measurement_list>
                </category>
                <category>
                  <title>Not Hispanic or Latino</title>
                  <measurement_list>
                    <measurement group_id="B1" value="32"/>
                    <measurement group_id="B2" value="29"/>
                    <measurement group_id="B3" value="16"/>
                    <measurement group_id="B4" value="77"/>
                  </measurement_list>
                </category>
                <category>
                  <title>Unknown or Not Reported</title>
                  <measurement_list>
                    <measurement group_id="B1" value="2"/>
                    <measurement group_id="B2" value="0"/>
                    <measurement group_id="B3" value="1"/>
                    <measurement group_id="B4" value="3"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <measure>
          <title>Race (NIH/OMB)</title>
          <units>Participants</units>
          <param>Count of Participants</param>
          <class_list>
            <class>
              <category_list>
                <category>
                  <title>American Indian or Alaska Native</title>
                  <measurement_list>
                    <measurement group_id="B1" value="1"/>
                    <measurement group_id="B2" value="0"/>
                    <measurement group_id="B3" value="0"/>
                    <measurement group_id="B4" value="1"/>
                  </measurement_list>
                </category>
                <category>
                  <title>Asian</title>
                  <measurement_list>
                    <measurement group_id="B1" value="1"/>
                    <measurement group_id="B2" value="0"/>
                    <measurement group_id="B3" value="1"/>
                    <measurement group_id="B4" value="2"/>
                  </measurement_list>
                </category>
                <category>
                  <title>Native Hawaiian or Other Pacific Islander</title>
                  <measurement_list>
                    <measurement group_id="B1" value="0"/>
                    <measurement group_id="B2" value="0"/>
                    <measurement group_id="B3" value="0"/>
                    <measurement group_id="B4" value="0"/>
                  </measurement_list>
                </category>
                <category>
                  <title>Black or African American</title>
                  <measurement_list>
                    <measurement group_id="B1" value="0"/>
                    <measurement group_id="B2" value="1"/>
                    <measurement group_id="B3" value="0"/>
                    <measurement group_id="B4" value="1"/>
                  </measurement_list>
                </category>
                <category>
                  <title>White</title>
                  <measurement_list>
                    <measurement group_id="B1" value="41"/>
                    <measurement group_id="B2" value="36"/>
                    <measurement group_id="B3" value="19"/>
                    <measurement group_id="B4" value="96"/>
                  </measurement_list>
                </category>
                <category>
                  <title>More than one race</title>
                  <measurement_list>
                    <measurement group_id="B1" value="4"/>
                    <measurement group_id="B2" value="1"/>
                    <measurement group_id="B3" value="1"/>
                    <measurement group_id="B4" value="6"/>
                  </measurement_list>
                </category>
                <category>
                  <title>Unknown or Not Reported</title>
                  <measurement_list>
                    <measurement group_id="B1" value="3"/>
                    <measurement group_id="B2" value="0"/>
                    <measurement group_id="B3" value="0"/>
                    <measurement group_id="B4" value="3"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <measure>
          <title>Region of Enrollment</title>
          <units>participants</units>
          <param>Number</param>
          <class_list>
            <class>
              <title>United States</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="B1" value="50"/>
                    <measurement group_id="B2" value="38"/>
                    <measurement group_id="B3" value="21"/>
                    <measurement group_id="B4" value="109"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </measure_list>
    </baseline>

    <outcome_list>
      <outcome>
        <type>Primary</type>
        <title>Change in Aggression</title>
        <description>Buss-Perry Aggression Questionnaire-Short Form. Scores range from 1-5, with higher scores indicating greater aggression.</description>
        <time_frame>baseline, post-intervention (week 8), 3-month followup, 6-month followup</time_frame>
        <population>Numbers at post-intervention, 3-month followup, and 6-month followup reflect attrition or participants or lost to followup.</population>
        <group_list>
          <group group_id="O1">
            <title>Mindfulness-Based Resilience Training (MBRT)</title>
            <description>MBRT is an 8-week program combining training in standardized mindfulness practices targeting factors that facilitate resilience, cognitive behavioral therapy (CBT), and psychoeducation. It contains experiential and didactic exercises including body scan, sitting and walking meditation, mindful movement and discussions.</description>
          </group>
          <group group_id="O2">
            <title>Stress Management Education (SME)</title>
            <description>SME was designed as an active control condition for other mindfulness-based intervention trials. SME uses a group-based didactic approach with modules on physiological and dietary effects of stress, time management, sleep physiology and insomnia, nutrition, exercise, stress hardiness, and factors mitigating impacts of stress.</description>
          </group>
          <group group_id="O3">
            <title>No Intervention Control</title>
            <description>No contact control condition (other than baseline, post, and follow-up assessments)</description>
          </group>
        </group_list>
        <measure>
          <title>Change in Aggression</title>
          <description>Buss-Perry Aggression Questionnaire-Short Form. Scores range from 1-5, with higher scores indicating greater aggression.</description>
          <population>Numbers at post-intervention, 3-month followup, and 6-month followup reflect attrition or participants or lost to followup.</population>
          <units>score on a scale</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="33"/>
                <count group_id="O2" value="24"/>
                <count group_id="O3" value="16"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>Baseline</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="33"/>
                    <count group_id="O2" value="24"/>
                    <count group_id="O3" value="16"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="1.94" spread=".64"/>
                    <measurement group_id="O2" value="1.67" spread=".45"/>
                    <measurement group_id="O3" value="1.85" spread=".79"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>post-intervention (week 8)</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="31"/>
                    <count group_id="O2" value="18"/>
                    <count group_id="O3" value="15"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="1.72" spread=".48"/>
                    <measurement group_id="O2" value="1.68" spread=".57"/>
                    <measurement group_id="O3" value="1.98" spread=".82"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>3-month followup</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="29"/>
                    <count group_id="O2" value="16"/>
                    <count group_id="O3" value="16"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="1.63" spread=".50"/>
                    <measurement group_id="O2" value="1.58" spread=".37"/>
                    <measurement group_id="O3" value="1.84" spread=".76"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>6-month followup</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="29"/>
                    <count group_id="O2" value="17"/>
                    <count group_id="O3" value="15"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="1.57" spread=".46"/>
                    <measurement group_id="O2" value="1.69" spread=".60"/>
                    <measurement group_id="O3" value="1.78" spread=".66"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Change in C-reactive Protein</title>
        <description>Blood spot analysis of high-sensitivity C-reactive protein.</description>
        <time_frame>baseline, post-intervention (8 weeks), 3 month followup</time_frame>
        <population>Numbers at post-intervention and 3-month followup reflect attrition or participants or lost to followup.</population>
        <group_list>
          <group group_id="O1">
            <title>Mindfulness-Based Resilience Training (MBRT)</title>
            <description>MBRT is an 8-week program combining training in standardized mindfulness practices targeting factors that facilitate resilience, cognitive behavioral therapy (CBT), and psychoeducation. It contains experiential and didactic exercises including body scan, sitting and walking meditation, mindful movement and discussions.</description>
          </group>
          <group group_id="O2">
            <title>Stress Management Education (SME)</title>
            <description>SME was designed as an active control condition for other mindfulness-based intervention trials. SME uses a group-based didactic approach with modules on physiological and dietary effects of stress, time management, sleep physiology and insomnia, nutrition, exercise, stress hardiness, and factors mitigating impacts of stress.</description>
          </group>
          <group group_id="O3">
            <title>No Intervention Control</title>
            <description>No contact control condition (other than baseline, post, and follow-up assessments)</description>
          </group>
        </group_list>
        <measure>
          <title>Change in C-reactive Protein</title>
          <description>Blood spot analysis of high-sensitivity C-reactive protein.</description>
          <population>Numbers at post-intervention and 3-month followup reflect attrition or participants or lost to followup.</population>
          <units>units on a scale &quot;mg/L&quot;</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="33"/>
                <count group_id="O2" value="24"/>
                <count group_id="O3" value="16"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>baseline</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="33"/>
                    <count group_id="O2" value="24"/>
                    <count group_id="O3" value="16"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="1.22" spread="1.42"/>
                    <measurement group_id="O2" value=".61" spread=".62"/>
                    <measurement group_id="O3" value="2.11" spread="2.59"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>post-intervention (week 8)</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="31"/>
                    <count group_id="O2" value="18"/>
                    <count group_id="O3" value="15"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value=".99" spread="1.26"/>
                    <measurement group_id="O2" value=".80" spread="1.13"/>
                    <measurement group_id="O3" value="1.11" spread=".76"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>3-month followup</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="29"/>
                    <count group_id="O2" value="16"/>
                    <count group_id="O3" value="16"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value=".90" spread="1.06"/>
                    <measurement group_id="O2" value=".61" spread="2.41"/>
                    <measurement group_id="O3" value="1.66" spread=".58"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Change in Interleukin-6</title>
        <description>Blood spot analysis of interleukin-6.</description>
        <time_frame>baseline, post-intervention (8 weeks), 3 month followup</time_frame>
        <population>Numbers at post-intervention and 3-month followup reflect attrition or participants or lost to followup.</population>
        <group_list>
          <group group_id="O1">
            <title>Mindfulness-Based Resilience Training (MBRT)</title>
            <description>MBRT is an 8-week program combining training in standardized mindfulness practices targeting factors that facilitate resilience, cognitive behavioral therapy (CBT), and psychoeducation. It contains experiential and didactic exercises including body scan, sitting and walking meditation, mindful movement and discussions.</description>
          </group>
          <group group_id="O2">
            <title>Stress Management Education (SME)</title>
            <description>SME was designed as an active control condition for other mindfulness-based intervention trials. SME uses a group-based didactic approach with modules on physiological and dietary effects of stress, time management, sleep physiology and insomnia, nutrition, exercise, stress hardiness, and factors mitigating impacts of stress.</description>
          </group>
          <group group_id="O3">
            <title>No Intervention Control</title>
            <description>No contact control condition (other than baseline, post, and follow-up assessments)</description>
          </group>
        </group_list>
        <measure>
          <title>Change in Interleukin-6</title>
          <description>Blood spot analysis of interleukin-6.</description>
          <population>Numbers at post-intervention and 3-month followup reflect attrition or participants or lost to followup.</population>
          <units>units on a scale &quot;pg/mL&quot;</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="33"/>
                <count group_id="O2" value="24"/>
                <count group_id="O3" value="16"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>baseline</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="33"/>
                    <count group_id="O2" value="24"/>
                    <count group_id="O3" value="16"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value=".55" spread=".87"/>
                    <measurement group_id="O2" value=".37" spread=".30"/>
                    <measurement group_id="O3" value=".28" spread=".12"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>post-intervention (week 8)</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="31"/>
                    <count group_id="O2" value="18"/>
                    <count group_id="O3" value="15"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value=".58" spread=".91"/>
                    <measurement group_id="O2" value=".51" spread=".45"/>
                    <measurement group_id="O3" value=".23" spread=".38"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>3-month followup</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="29"/>
                    <count group_id="O2" value="16"/>
                    <count group_id="O3" value="16"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value=".37" spread=".28"/>
                    <measurement group_id="O2" value=".39" spread=".29"/>
                    <measurement group_id="O3" value=".23" spread=".11"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Change in Interleukin-10</title>
        <description>Blood spot analysis of interleukin-10.</description>
        <time_frame>baseline, post-intervention (8 weeks), 3 month followup</time_frame>
        <population>Numbers at post-intervention and 3-month followup reflect attrition or participants or lost to followup.</population>
        <group_list>
          <group group_id="O1">
            <title>Mindfulness-Based Resilience Training (MBRT)</title>
            <description>MBRT is an 8-week program combining training in standardized mindfulness practices targeting factors that facilitate resilience, cognitive behavioral therapy (CBT), and psychoeducation. It contains experiential and didactic exercises including body scan, sitting and walking meditation, mindful movement and discussions.</description>
          </group>
          <group group_id="O2">
            <title>Stress Management Education (SME)</title>
            <description>SME was designed as an active control condition for other mindfulness-based intervention trials. SME uses a group-based didactic approach with modules on physiological and dietary effects of stress, time management, sleep physiology and insomnia, nutrition, exercise, stress hardiness, and factors mitigating impacts of stress.</description>
          </group>
          <group group_id="O3">
            <title>No Intervention Control</title>
            <description>No contact control condition (other than baseline, post, and follow-up assessments)</description>
          </group>
        </group_list>
        <measure>
          <title>Change in Interleukin-10</title>
          <description>Blood spot analysis of interleukin-10.</description>
          <population>Numbers at post-intervention and 3-month followup reflect attrition or participants or lost to followup.</population>
          <units>units on a scale &quot;pg/mL&quot;</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="33"/>
                <count group_id="O2" value="24"/>
                <count group_id="O3" value="16"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>baseline</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="33"/>
                    <count group_id="O2" value="24"/>
                    <count group_id="O3" value="16"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value=".27" spread=".27"/>
                    <measurement group_id="O2" value=".28" spread=".20"/>
                    <measurement group_id="O3" value=".16" spread=".08"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>post-intervention (week 8)</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="31"/>
                    <count group_id="O2" value="18"/>
                    <count group_id="O3" value="15"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value=".20" spread=".16"/>
                    <measurement group_id="O2" value=".17" spread=".10"/>
                    <measurement group_id="O3" value=".13" spread=".12"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>3-month followup</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="29"/>
                    <count group_id="O2" value="16"/>
                    <count group_id="O3" value="16"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value=".21" spread=".13"/>
                    <measurement group_id="O2" value=".18" spread=".11"/>
                    <measurement group_id="O3" value=".11" spread=".07"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Change in Tumor Necrosis Factor-alpha</title>
        <description>Blood spot analysis of tumor necrosis factor-alpha.</description>
        <time_frame>baseline, post-intervention (8 weeks), 3 month followup</time_frame>
        <population>Numbers at post-intervention and 3-month followup reflect attrition or participants or lost to followup.</population>
        <group_list>
          <group group_id="O1">
            <title>Mindfulness-Based Resilience Training (MBRT)</title>
            <description>MBRT is an 8-week program combining training in standardized mindfulness practices targeting factors that facilitate resilience, cognitive behavioral therapy (CBT), and psychoeducation. It contains experiential and didactic exercises including body scan, sitting and walking meditation, mindful movement and discussions.</description>
          </group>
          <group group_id="O2">
            <title>Stress Management Education (SME)</title>
            <description>SME was designed as an active control condition for other mindfulness-based intervention trials. SME uses a group-based didactic approach with modules on physiological and dietary effects of stress, time management, sleep physiology and insomnia, nutrition, exercise, stress hardiness, and factors mitigating impacts of stress.</description>
          </group>
          <group group_id="O3">
            <title>No Intervention Control</title>
            <description>No contact control condition (other than baseline, post, and follow-up assessments)</description>
          </group>
        </group_list>
        <measure>
          <title>Change in Tumor Necrosis Factor-alpha</title>
          <description>Blood spot analysis of tumor necrosis factor-alpha.</description>
          <population>Numbers at post-intervention and 3-month followup reflect attrition or participants or lost to followup.</population>
          <units>units on a scale &quot;pg/mL&quot;</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="33"/>
                <count group_id="O2" value="24"/>
                <count group_id="O3" value="16"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>baseline</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="33"/>
                    <count group_id="O2" value="24"/>
                    <count group_id="O3" value="16"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="2.25" spread=".81"/>
                    <measurement group_id="O2" value="2.20" spread=".66"/>
                    <measurement group_id="O3" value="1.87" spread=".45"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>post-intervention (week 8)</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="31"/>
                    <count group_id="O2" value="18"/>
                    <count group_id="O3" value="15"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="2.02" spread=".68"/>
                    <measurement group_id="O2" value="1.71" spread=".39"/>
                    <measurement group_id="O3" value="1.70" spread=".62"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>3-month followup</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="29"/>
                    <count group_id="O2" value="16"/>
                    <count group_id="O3" value="16"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="1.76" spread=".61"/>
                    <measurement group_id="O2" value="1.71" spread=".35"/>
                    <measurement group_id="O3" value="1.66" spread=".27"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Change in Psychological Resilience</title>
        <description>Brief Resilience Scale. Scores range from 1-5, with higher scores indicating greater resilience.</description>
        <time_frame>baseline, post-intervention (8 weeks), 3 month followup, 6 month followup</time_frame>
        <population>Numbers at post-intervention, 3-month followup, and 6-month followup reflect attrition or participants or lost to followup.</population>
        <group_list>
          <group group_id="O1">
            <title>Mindfulness-Based Resilience Training (MBRT)</title>
            <description>MBRT is an 8-week program combining training in standardized mindfulness practices targeting factors that facilitate resilience, cognitive behavioral therapy (CBT), and psychoeducation. It contains experiential and didactic exercises including body scan, sitting and walking meditation, mindful movement and discussions.</description>
          </group>
          <group group_id="O2">
            <title>Stress Management Education (SME)</title>
            <description>SME was designed as an active control condition for other mindfulness-based intervention trials. SME uses a group-based didactic approach with modules on physiological and dietary effects of stress, time management, sleep physiology and insomnia, nutrition, exercise, stress hardiness, and factors mitigating impacts of stress.</description>
          </group>
          <group group_id="O3">
            <title>No Intervention Control</title>
            <description>No contact control condition (other than baseline, post, and follow-up assessments)</description>
          </group>
        </group_list>
        <measure>
          <title>Change in Psychological Resilience</title>
          <description>Brief Resilience Scale. Scores range from 1-5, with higher scores indicating greater resilience.</description>
          <population>Numbers at post-intervention, 3-month followup, and 6-month followup reflect attrition or participants or lost to followup.</population>
          <units>score on a scale</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="33"/>
                <count group_id="O2" value="24"/>
                <count group_id="O3" value="16"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>Baseline</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="33"/>
                    <count group_id="O2" value="24"/>
                    <count group_id="O3" value="16"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="3.71" spread=".74"/>
                    <measurement group_id="O2" value="4.00" spread=".47"/>
                    <measurement group_id="O3" value="3.99" spread=".40"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>post-intervention</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="31"/>
                    <count group_id="O2" value="18"/>
                    <count group_id="O3" value="15"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="4.08" spread=".65"/>
                    <measurement group_id="O2" value="4.11" spread=".49"/>
                    <measurement group_id="O3" value="3.90" spread=".67"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>3-month followup</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="29"/>
                    <count group_id="O2" value="16"/>
                    <count group_id="O3" value="16"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="3.98" spread=".72"/>
                    <measurement group_id="O2" value="4.10" spread=".41"/>
                    <measurement group_id="O3" value="4.03" spread=".41"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>6-month followup</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="29"/>
                    <count group_id="O2" value="17"/>
                    <count group_id="O3" value="15"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="4.04" spread=".66"/>
                    <measurement group_id="O2" value="4.01" spread=".52"/>
                    <measurement group_id="O3" value="3.83" spread=".67"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Change in Alcohol Use</title>
        <description>Patient Reported Outcome Measurement System (PROMIS) Alcohol Use. Scores range from 39-77, with higher scores indicating greater alcohol use.</description>
        <time_frame>baseline, post-intervention (8 weeks), 3 month followup, 6 month followup</time_frame>
        <population>Numbers at post-intervention, 3-month followup, and 6-month followup reflect attrition or participants or lost to followup.</population>
        <group_list>
          <group group_id="O1">
            <title>Mindfulness-Based Resilience Training (MBRT)</title>
            <description>MBRT is an 8-week program combining training in standardized mindfulness practices targeting factors that facilitate resilience, cognitive behavioral therapy (CBT), and psychoeducation. It contains experiential and didactic exercises including body scan, sitting and walking meditation, mindful movement and discussions.</description>
          </group>
          <group group_id="O2">
            <title>Stress Management Education (SME)</title>
            <description>SME was designed as an active control condition for other mindfulness-based intervention trials. SME uses a group-based didactic approach with modules on physiological and dietary effects of stress, time management, sleep physiology and insomnia, nutrition, exercise, stress hardiness, and factors mitigating impacts of stress.</description>
          </group>
          <group group_id="O3">
            <title>No Intervention Control</title>
            <description>No contact control condition (other than baseline, post, and follow-up assessments)</description>
          </group>
        </group_list>
        <measure>
          <title>Change in Alcohol Use</title>
          <description>Patient Reported Outcome Measurement System (PROMIS) Alcohol Use. Scores range from 39-77, with higher scores indicating greater alcohol use.</description>
          <population>Numbers at post-intervention, 3-month followup, and 6-month followup reflect attrition or participants or lost to followup.</population>
          <units>score on a scale</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="33"/>
                <count group_id="O2" value="24"/>
                <count group_id="O3" value="16"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>baseline</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="33"/>
                    <count group_id="O2" value="24"/>
                    <count group_id="O3" value="16"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="46.62" spread="7.48"/>
                    <measurement group_id="O2" value="45.50" spread="7.46"/>
                    <measurement group_id="O3" value="44.42" spread="5.79"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>post-intervention (8 weeks)</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="31"/>
                    <count group_id="O2" value="18"/>
                    <count group_id="O3" value="15"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="46.95" spread="7.60"/>
                    <measurement group_id="O2" value="48.54" spread="6.58"/>
                    <measurement group_id="O3" value="45.73" spread="6.50"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>3-month followup</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="29"/>
                    <count group_id="O2" value="16"/>
                    <count group_id="O3" value="16"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="48.00" spread="7.72"/>
                    <measurement group_id="O2" value="49.01" spread="6.51"/>
                    <measurement group_id="O3" value="45.78" spread="6.20"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>6-month followup</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="29"/>
                    <count group_id="O2" value="17"/>
                    <count group_id="O3" value="15"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="47.82" spread="6.82"/>
                    <measurement group_id="O2" value="46.65" spread="7.74"/>
                    <measurement group_id="O3" value="48.98" spread="5.94"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Change in Alcohol Use Negative Consequences</title>
        <description>Patient Reported Outcome Measurement System (PROMIS) Alcohol Use Negative Consequences.Scores range from 39-77, with higher scores indicating greater alcohol use negative consequences.</description>
        <time_frame>baseline, post-intervention (8 weeks), 3 month followup, 6 month followup</time_frame>
        <population>Numbers at post-intervention, 3-month followup, and 6-month followup reflect attrition or participants or lost to followup.</population>
        <group_list>
          <group group_id="O1">
            <title>Mindfulness-Based Resilience Training (MBRT)</title>
            <description>MBRT is an 8-week program combining training in standardized mindfulness practices targeting factors that facilitate resilience, cognitive behavioral therapy (CBT), and psychoeducation. It contains experiential and didactic exercises including body scan, sitting and walking meditation, mindful movement and discussions.</description>
          </group>
          <group group_id="O2">
            <title>Stress Management Education (SME)</title>
            <description>SME was designed as an active control condition for other mindfulness-based intervention trials. SME uses a group-based didactic approach with modules on physiological and dietary effects of stress, time management, sleep physiology and insomnia, nutrition, exercise, stress hardiness, and factors mitigating impacts of stress.</description>
          </group>
          <group group_id="O3">
            <title>No Intervention Control</title>
            <description>No contact control condition (other than baseline, post, and follow-up assessments)</description>
          </group>
        </group_list>
        <measure>
          <title>Change in Alcohol Use Negative Consequences</title>
          <description>Patient Reported Outcome Measurement System (PROMIS) Alcohol Use Negative Consequences.Scores range from 39-77, with higher scores indicating greater alcohol use negative consequences.</description>
          <population>Numbers at post-intervention, 3-month followup, and 6-month followup reflect attrition or participants or lost to followup.</population>
          <units>score on a scale</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="33"/>
                <count group_id="O2" value="24"/>
                <count group_id="O3" value="16"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>baseline</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="33"/>
                    <count group_id="O2" value="24"/>
                    <count group_id="O3" value="16"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="40.67" spread="5.44"/>
                    <measurement group_id="O2" value="40.35" spread="5.21"/>
                    <measurement group_id="O3" value="40.49" spread="4.91"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>post-intervention (8 weeks)</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="31"/>
                    <count group_id="O2" value="18"/>
                    <count group_id="O3" value="15"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="40.98" spread="4.99"/>
                    <measurement group_id="O2" value="41.06" spread="5.35"/>
                    <measurement group_id="O3" value="41.03" spread="4.80"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>3-month followup</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="29"/>
                    <count group_id="O2" value="16"/>
                    <count group_id="O3" value="16"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="40.81" spread="5.40"/>
                    <measurement group_id="O2" value="41.06" spread="4.93"/>
                    <measurement group_id="O3" value="42.53" spread="5.47"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>6-month followup</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="29"/>
                    <count group_id="O2" value="17"/>
                    <count group_id="O3" value="15"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="41.26" spread="5.17"/>
                    <measurement group_id="O2" value="40.81" spread="5.34"/>
                    <measurement group_id="O3" value="40.74" spread="5.51"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Change in Depression</title>
        <description>Patient Reported Outcome Measurement System (PROMIS) Depression. Scores range from 38-80, with higher scores indicating more depression.</description>
        <time_frame>baseline, post-intervention (8 weeks), 3 month followup, 6 month followup</time_frame>
        <population>Numbers at post-intervention, 3-month followup, and 6-month followup reflect attrition or participants or lost to followup.</population>
        <group_list>
          <group group_id="O1">
            <title>Mindfulness-Based Resilience Training (MBRT)</title>
            <description>MBRT is an 8-week program combining training in standardized mindfulness practices targeting factors that facilitate resilience, cognitive behavioral therapy (CBT), and psychoeducation. It contains experiential and didactic exercises including body scan, sitting and walking meditation, mindful movement and discussions.</description>
          </group>
          <group group_id="O2">
            <title>Stress Management Education (SME)</title>
            <description>SME was designed as an active control condition for other mindfulness-based intervention trials. SME uses a group-based didactic approach with modules on physiological and dietary effects of stress, time management, sleep physiology and insomnia, nutrition, exercise, stress hardiness, and factors mitigating impacts of stress.</description>
          </group>
          <group group_id="O3">
            <title>No Intervention Control</title>
            <description>No contact control condition (other than baseline, post, and follow-up assessments)</description>
          </group>
        </group_list>
        <measure>
          <title>Change in Depression</title>
          <description>Patient Reported Outcome Measurement System (PROMIS) Depression. Scores range from 38-80, with higher scores indicating more depression.</description>
          <population>Numbers at post-intervention, 3-month followup, and 6-month followup reflect attrition or participants or lost to followup.</population>
          <units>score on a scale</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="33"/>
                <count group_id="O2" value="24"/>
                <count group_id="O3" value="16"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>baseline</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="33"/>
                    <count group_id="O2" value="24"/>
                    <count group_id="O3" value="16"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="50.15" spread="7.99"/>
                    <measurement group_id="O2" value="48.17" spread="6.69"/>
                    <measurement group_id="O3" value="48.22" spread="7.56"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>post-intervention (week 8)</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="31"/>
                    <count group_id="O2" value="18"/>
                    <count group_id="O3" value="15"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="49.22" spread="5.74"/>
                    <measurement group_id="O2" value="48.02" spread="8.66"/>
                    <measurement group_id="O3" value="47.55" spread="9.17"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>3-month followup</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="29"/>
                    <count group_id="O2" value="16"/>
                    <count group_id="O3" value="16"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="49.50" spread="7.36"/>
                    <measurement group_id="O2" value="49.01" spread="7.87"/>
                    <measurement group_id="O3" value="47.13" spread="5.93"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>6-month followup</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="29"/>
                    <count group_id="O2" value="17"/>
                    <count group_id="O3" value="15"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="48.98" spread="7.35"/>
                    <measurement group_id="O2" value="48.14" spread="8.07"/>
                    <measurement group_id="O3" value="46.73" spread="9.49"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Change in Suicidal Thinking</title>
        <description>Concise Heath Risk Tracking Scale-Self-Report. Scores range from 7-35, with higher scores indicating greater suicidal ideation.</description>
        <time_frame>baseline, post-intervention (8 weeks), 3 month followup, 6 month followup</time_frame>
        <population>Numbers at post-intervention, 3-month followup, and 6-month followup reflect attrition or participants or lost to followup.</population>
        <group_list>
          <group group_id="O1">
            <title>Mindfulness-Based Resilience Training (MBRT)</title>
            <description>MBRT is an 8-week program combining training in standardized mindfulness practices targeting factors that facilitate resilience, cognitive behavioral therapy (CBT), and psychoeducation. It contains experiential and didactic exercises including body scan, sitting and walking meditation, mindful movement and discussions.</description>
          </group>
          <group group_id="O2">
            <title>Stress Management Education (SME)</title>
            <description>SME was designed as an active control condition for other mindfulness-based intervention trials. SME uses a group-based didactic approach with modules on physiological and dietary effects of stress, time management, sleep physiology and insomnia, nutrition, exercise, stress hardiness, and factors mitigating impacts of stress.</description>
          </group>
          <group group_id="O3">
            <title>No Intervention Control</title>
            <description>No contact control condition (other than baseline, post, and follow-up assessments)</description>
          </group>
        </group_list>
        <measure>
          <title>Change in Suicidal Thinking</title>
          <description>Concise Heath Risk Tracking Scale-Self-Report. Scores range from 7-35, with higher scores indicating greater suicidal ideation.</description>
          <population>Numbers at post-intervention, 3-month followup, and 6-month followup reflect attrition or participants or lost to followup.</population>
          <units>score on a scale</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="33"/>
                <count group_id="O2" value="24"/>
                <count group_id="O3" value="16"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>baseline</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="33"/>
                    <count group_id="O2" value="24"/>
                    <count group_id="O3" value="16"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="8.91" spread="2.39"/>
                    <measurement group_id="O2" value="8.16" spread="2.23"/>
                    <measurement group_id="O3" value="8.20" spread="2.65"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>post-intervention (week 8)</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="31"/>
                    <count group_id="O2" value="18"/>
                    <count group_id="O3" value="15"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="8.74" spread="2.67"/>
                    <measurement group_id="O2" value="8.05" spread="2.25"/>
                    <measurement group_id="O3" value="9.57" spread="4.18"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>3-month followup</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="29"/>
                    <count group_id="O2" value="16"/>
                    <count group_id="O3" value="16"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="8.90" spread="3.34"/>
                    <measurement group_id="O2" value="8.58" spread="2.62"/>
                    <measurement group_id="O3" value="8.27" spread="1.98"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>6-month followup</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="29"/>
                    <count group_id="O2" value="17"/>
                    <count group_id="O3" value="15"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="8.07" spread="1.73"/>
                    <measurement group_id="O2" value="8.44" spread="2.64"/>
                    <measurement group_id="O3" value="8.21" spread="2.19"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Change in Trauma Symptoms</title>
        <description>PTSD Checklist for DSM-5. Scores ranges from 0-80, with higher scores indicating greater PTSD symptoms.</description>
        <time_frame>baseline, post-intervention (8 weeks), 3 month followup, 6 month followup</time_frame>
        <population>Numbers at post-intervention, 3-month followup, and 6-month followup reflect attrition or participants or lost to followup.</population>
        <group_list>
          <group group_id="O1">
            <title>Mindfulness-Based Resilience Training (MBRT)</title>
            <description>MBRT is an 8-week program combining training in standardized mindfulness practices targeting factors that facilitate resilience, cognitive behavioral therapy (CBT), and psychoeducation. It contains experiential and didactic exercises including body scan, sitting and walking meditation, mindful movement and discussions.</description>
          </group>
          <group group_id="O2">
            <title>Stress Management Education (SME)</title>
            <description>SME was designed as an active control condition for other mindfulness-based intervention trials. SME uses a group-based didactic approach with modules on physiological and dietary effects of stress, time management, sleep physiology and insomnia, nutrition, exercise, stress hardiness, and factors mitigating impacts of stress.</description>
          </group>
          <group group_id="O3">
            <title>No Intervention Control</title>
            <description>No contact control condition (other than baseline, post, and follow-up assessments)</description>
          </group>
        </group_list>
        <measure>
          <title>Change in Trauma Symptoms</title>
          <description>PTSD Checklist for DSM-5. Scores ranges from 0-80, with higher scores indicating greater PTSD symptoms.</description>
          <population>Numbers at post-intervention, 3-month followup, and 6-month followup reflect attrition or participants or lost to followup.</population>
          <units>score on a scale</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="33"/>
                <count group_id="O2" value="24"/>
                <count group_id="O3" value="16"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>baseline</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="37.76" spread="14.39"/>
                    <measurement group_id="O2" value="33.36" spread="9.12"/>
                    <measurement group_id="O3" value="31.53" spread="12.13"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>post-intervention (week 8)</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="34.32" spread="11.69"/>
                    <measurement group_id="O2" value="30.74" spread="8.77"/>
                    <measurement group_id="O3" value="33.36" spread="15.35"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>3-month followup</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="34.07" spread="12.57"/>
                    <measurement group_id="O2" value="32.29" spread="10.26"/>
                    <measurement group_id="O3" value="33.20" spread="11.94"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>6-month followup</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="31.93" spread="11.74"/>
                    <measurement group_id="O2" value="31.61" spread="11.08"/>
                    <measurement group_id="O3" value="32.07" spread="13.09"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Change in Burnout</title>
        <description>Oldenburg Burnout Inventory. Scores range from 1-4, with higher scores indicating greater burnout.</description>
        <time_frame>baseline, post-intervention (8 weeks), 3 month followup, 6 month followup</time_frame>
        <population>Numbers at post-intervention, 3-month followup, and 6-month followup reflect attrition or participants or lost to followup.</population>
        <group_list>
          <group group_id="O1">
            <title>Mindfulness-Based Resilience Training (MBRT)</title>
            <description>MBRT is an 8-week program combining training in standardized mindfulness practices targeting factors that facilitate resilience, cognitive behavioral therapy (CBT), and psychoeducation. It contains experiential and didactic exercises including body scan, sitting and walking meditation, mindful movement and discussions.</description>
          </group>
          <group group_id="O2">
            <title>Stress Management Education (SME)</title>
            <description>SME was designed as an active control condition for other mindfulness-based intervention trials. SME uses a group-based didactic approach with modules on physiological and dietary effects of stress, time management, sleep physiology and insomnia, nutrition, exercise, stress hardiness, and factors mitigating impacts of stress.</description>
          </group>
          <group group_id="O3">
            <title>No Intervention Control</title>
            <description>No contact control condition (other than baseline, post, and follow-up assessments)</description>
          </group>
        </group_list>
        <measure>
          <title>Change in Burnout</title>
          <description>Oldenburg Burnout Inventory. Scores range from 1-4, with higher scores indicating greater burnout.</description>
          <population>Numbers at post-intervention, 3-month followup, and 6-month followup reflect attrition or participants or lost to followup.</population>
          <units>score on a scale</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="33"/>
                <count group_id="O2" value="24"/>
                <count group_id="O3" value="16"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>baseline</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="33"/>
                    <count group_id="O2" value="24"/>
                    <count group_id="O3" value="16"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="2.40" spread=".46"/>
                    <measurement group_id="O2" value="2.36" spread=".35"/>
                    <measurement group_id="O3" value="2.38" spread=".36"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>post-intervention (week 8)</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="31"/>
                    <count group_id="O2" value="18"/>
                    <count group_id="O3" value="15"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="2.39" spread=".44"/>
                    <measurement group_id="O2" value="2.36" spread=".29"/>
                    <measurement group_id="O3" value="2.33" spread=".26"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>3-month followup</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="29"/>
                    <count group_id="O2" value="16"/>
                    <count group_id="O3" value="16"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="2.34" spread=".38"/>
                    <measurement group_id="O2" value="2.33" spread=".30"/>
                    <measurement group_id="O3" value="2.36" spread=".24"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>6-month followup</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="29"/>
                    <count group_id="O2" value="17"/>
                    <count group_id="O3" value="15"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="2.32" spread=".42"/>
                    <measurement group_id="O2" value="2.42" spread=".35"/>
                    <measurement group_id="O3" value="2.37" spread=".28"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Change in Sustained Attention</title>
        <description>Sustained Attention to Response Task. A computer-based go/no-go task that requires participants to withhold behavioral response to a single, infrequent target presented amongst a background of frequent non-targets. Increased errors indicates less sustained attention.</description>
        <time_frame>baseline, post-intervention (8 weeks), 3 month followup, 6 month followup</time_frame>
        <population>Numbers at post-intervention, 3-month followup, and 6-month followup reflect attrition or participants or lost to followup.</population>
        <group_list>
          <group group_id="O1">
            <title>Mindfulness-Based Resilience Training (MBRT)</title>
            <description>MBRT is an 8-week program combining training in standardized mindfulness practices targeting factors that facilitate resilience, cognitive behavioral therapy (CBT), and psychoeducation. It contains experiential and didactic exercises including body scan, sitting and walking meditation, mindful movement and discussions.</description>
          </group>
          <group group_id="O2">
            <title>Stress Management Education (SME)</title>
            <description>SME was designed as an active control condition for other mindfulness-based intervention trials. SME uses a group-based didactic approach with modules on physiological and dietary effects of stress, time management, sleep physiology and insomnia, nutrition, exercise, stress hardiness, and factors mitigating impacts of stress.</description>
          </group>
          <group group_id="O3">
            <title>No Intervention Control</title>
            <description>No contact control condition (other than baseline, post, and follow-up assessments)</description>
          </group>
        </group_list>
        <measure>
          <title>Change in Sustained Attention</title>
          <description>Sustained Attention to Response Task. A computer-based go/no-go task that requires participants to withhold behavioral response to a single, infrequent target presented amongst a background of frequent non-targets. Increased errors indicates less sustained attention.</description>
          <population>Numbers at post-intervention, 3-month followup, and 6-month followup reflect attrition or participants or lost to followup.</population>
          <units>errors</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="33"/>
                <count group_id="O2" value="24"/>
                <count group_id="O3" value="16"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>baseline</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="33"/>
                    <count group_id="O2" value="24"/>
                    <count group_id="O3" value="16"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="17.03" spread="13.50"/>
                    <measurement group_id="O2" value="16.00" spread="53.10"/>
                    <measurement group_id="O3" value="31.42" spread="37.16"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>post-intervention (week 8)</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="31"/>
                    <count group_id="O2" value="18"/>
                    <count group_id="O3" value="15"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="15.86" spread="30.28"/>
                    <measurement group_id="O2" value="13.50" spread="20.00"/>
                    <measurement group_id="O3" value="30.71" spread="30.01"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>3-month followup</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="29"/>
                    <count group_id="O2" value="16"/>
                    <count group_id="O3" value="16"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="15.33" spread="18.88"/>
                    <measurement group_id="O2" value="9.30" spread="11.06"/>
                    <measurement group_id="O3" value="25.35" spread="20.48"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>6-month followup</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="29"/>
                    <count group_id="O2" value="17"/>
                    <count group_id="O3" value="15"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="15.88" spread="27.22"/>
                    <measurement group_id="O2" value="9.53" spread="6.89"/>
                    <measurement group_id="O3" value="29.23" spread="63.90"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Change in Perceived Stress</title>
        <description>Perceived Stress Scale-10. Scores range from 0-40, with higher scores indicating greater perceived stress.</description>
        <time_frame>baseline, post-intervention (8 weeks), 3 month followup, 6 month followup</time_frame>
        <population>Numbers at post-intervention, 3-month followup, and 6-month followup reflect attrition or participants or lost to followup.</population>
        <group_list>
          <group group_id="O1">
            <title>Mindfulness-Based Resilience Training (MBRT)</title>
            <description>MBRT is an 8-week program combining training in standardized mindfulness practices targeting factors that facilitate resilience, cognitive behavioral therapy (CBT), and psychoeducation. It contains experiential and didactic exercises including body scan, sitting and walking meditation, mindful movement and discussions.</description>
          </group>
          <group group_id="O2">
            <title>Stress Management Education (SME)</title>
            <description>SME was designed as an active control condition for other mindfulness-based intervention trials. SME uses a group-based didactic approach with modules on physiological and dietary effects of stress, time management, sleep physiology and insomnia, nutrition, exercise, stress hardiness, and factors mitigating impacts of stress.</description>
          </group>
          <group group_id="O3">
            <title>No Intervention Control</title>
            <description>No contact control condition (other than baseline, post, and follow-up assessments)</description>
          </group>
        </group_list>
        <measure>
          <title>Change in Perceived Stress</title>
          <description>Perceived Stress Scale-10. Scores range from 0-40, with higher scores indicating greater perceived stress.</description>
          <population>Numbers at post-intervention, 3-month followup, and 6-month followup reflect attrition or participants or lost to followup.</population>
          <units>score on a scale</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="33"/>
                <count group_id="O2" value="24"/>
                <count group_id="O3" value="16"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>baseline</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="33"/>
                    <count group_id="O2" value="24"/>
                    <count group_id="O3" value="16"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="24.45" spread="6.13"/>
                    <measurement group_id="O2" value="23.16" spread="4.60"/>
                    <measurement group_id="O3" value="22.93" spread="6.52"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>post-intervention (week 8)</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="31"/>
                    <count group_id="O2" value="18"/>
                    <count group_id="O3" value="15"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="23.39" spread="5.71"/>
                    <measurement group_id="O2" value="22.05" spread="4.39"/>
                    <measurement group_id="O3" value="22.86" spread="7.37"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>3-month followup</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="29"/>
                    <count group_id="O2" value="16"/>
                    <count group_id="O3" value="16"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="22.66" spread="6.61"/>
                    <measurement group_id="O2" value="23.65" spread="5.90"/>
                    <measurement group_id="O3" value="22.47" spread="7.26"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>6-month followup</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="29"/>
                    <count group_id="O2" value="17"/>
                    <count group_id="O3" value="15"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="22.97" spread="6.31"/>
                    <measurement group_id="O2" value="24.00" spread="4.23"/>
                    <measurement group_id="O3" value="23.00" spread="5.48"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Change in Sleep Disturbance</title>
        <description>Patient Reported Outcome Measurement System (PROMIS) Sleep Disturbance. Scores range from 32-76, with higher scores indicating greater sleep disturbance.</description>
        <time_frame>baseline, post-intervention (8 weeks), 3 month followup, 6 month followup</time_frame>
        <population>Numbers at post-intervention, 3-month followup, and 6-month followup reflect attrition or participants or lost to followup.</population>
        <group_list>
          <group group_id="O1">
            <title>Mindfulness-Based Resilience Training (MBRT)</title>
            <description>MBRT is an 8-week program combining training in standardized mindfulness practices targeting factors that facilitate resilience, cognitive behavioral therapy (CBT), and psychoeducation. It contains experiential and didactic exercises including body scan, sitting and walking meditation, mindful movement and discussions.</description>
          </group>
          <group group_id="O2">
            <title>Stress Management Education (SME)</title>
            <description>SME was designed as an active control condition for other mindfulness-based intervention trials. SME uses a group-based didactic approach with modules on physiological and dietary effects of stress, time management, sleep physiology and insomnia, nutrition, exercise, stress hardiness, and factors mitigating impacts of stress.</description>
          </group>
          <group group_id="O3">
            <title>No Intervention Control</title>
            <description>No contact control condition (other than baseline, post, and follow-up assessments)</description>
          </group>
        </group_list>
        <measure>
          <title>Change in Sleep Disturbance</title>
          <description>Patient Reported Outcome Measurement System (PROMIS) Sleep Disturbance. Scores range from 32-76, with higher scores indicating greater sleep disturbance.</description>
          <population>Numbers at post-intervention, 3-month followup, and 6-month followup reflect attrition or participants or lost to followup.</population>
          <units>score on a scale</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="33"/>
                <count group_id="O2" value="24"/>
                <count group_id="O3" value="16"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>baseline</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="33"/>
                    <count group_id="O2" value="24"/>
                    <count group_id="O3" value="16"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="54.35" spread="7.32"/>
                    <measurement group_id="O2" value="52.48" spread="7.80"/>
                    <measurement group_id="O3" value="53.48" spread="9.88"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>post-intervention (week 8)</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="31"/>
                    <count group_id="O2" value="18"/>
                    <count group_id="O3" value="15"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="52.03" spread="7.72"/>
                    <measurement group_id="O2" value="54.38" spread="6.44"/>
                    <measurement group_id="O3" value="53.11" spread="9.26"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>3-month followup</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="29"/>
                    <count group_id="O2" value="16"/>
                    <count group_id="O3" value="16"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="51.45" spread="7.87"/>
                    <measurement group_id="O2" value="52.93" spread="7.65"/>
                    <measurement group_id="O3" value="53.85" spread="7.97"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>6-month followup</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="29"/>
                    <count group_id="O2" value="17"/>
                    <count group_id="O3" value="15"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="51.36" spread="6.62"/>
                    <measurement group_id="O2" value="51.51" spread="7.78"/>
                    <measurement group_id="O3" value="52.90" spread="9.79"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Change in Self-Compassion</title>
        <description>Self-Compassion Scale-Short Form. Scores range from 1-5, with higher scores indicating greater self-compassion.</description>
        <time_frame>baseline, post-intervention (8 weeks), 3 month followup, 6 month followup</time_frame>
        <population>Numbers at post-intervention, 3-month followup, and 6-month followup reflect attrition or participants or lost to followup.</population>
        <group_list>
          <group group_id="O1">
            <title>Mindfulness-Based Resilience Training (MBRT)</title>
            <description>MBRT is an 8-week program combining training in standardized mindfulness practices targeting factors that facilitate resilience, cognitive behavioral therapy (CBT), and psychoeducation. It contains experiential and didactic exercises including body scan, sitting and walking meditation, mindful movement and discussions.</description>
          </group>
          <group group_id="O2">
            <title>Stress Management Education (SME)</title>
            <description>SME was designed as an active control condition for other mindfulness-based intervention trials. SME uses a group-based didactic approach with modules on physiological and dietary effects of stress, time management, sleep physiology and insomnia, nutrition, exercise, stress hardiness, and factors mitigating impacts of stress.</description>
          </group>
          <group group_id="O3">
            <title>No Intervention Control</title>
            <description>No contact control condition (other than baseline, post, and follow-up assessments)</description>
          </group>
        </group_list>
        <measure>
          <title>Change in Self-Compassion</title>
          <description>Self-Compassion Scale-Short Form. Scores range from 1-5, with higher scores indicating greater self-compassion.</description>
          <population>Numbers at post-intervention, 3-month followup, and 6-month followup reflect attrition or participants or lost to followup.</population>
          <units>score on a scale</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="33"/>
                <count group_id="O2" value="24"/>
                <count group_id="O3" value="16"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>baseline</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="33"/>
                    <count group_id="O2" value="24"/>
                    <count group_id="O3" value="16"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="3.35" spread=".66"/>
                    <measurement group_id="O2" value="3.52" spread=".58"/>
                    <measurement group_id="O3" value="3.16" spread=".73"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>post-intervention (week 8)</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="31"/>
                    <count group_id="O2" value="18"/>
                    <count group_id="O3" value="15"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="3.52" spread=".64"/>
                    <measurement group_id="O2" value="3.54" spread=".59"/>
                    <measurement group_id="O3" value="3.40" spread=".83"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>3-month followup</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="29"/>
                    <count group_id="O2" value="16"/>
                    <count group_id="O3" value="16"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="3.61" spread=".57"/>
                    <measurement group_id="O2" value="3.56" spread=".52"/>
                    <measurement group_id="O3" value="3.41" spread=".76"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>6-month followup</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="29"/>
                    <count group_id="O2" value="17"/>
                    <count group_id="O3" value="15"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="3.66" spread=".53"/>
                    <measurement group_id="O2" value="3.45" spread=".55"/>
                    <measurement group_id="O3" value="3.38" spread=".76"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Change in Mindfulness</title>
        <description>Five Facet Mindfulness Questionnaire-Short Form. Scores range from 1-5, with higher scores indicating greater mindfulness.</description>
        <time_frame>baseline, post-intervention (8 weeks), 3 month followup, 6 month followup</time_frame>
        <population>Numbers at post-intervention, 3-month followup, and 6-month followup reflect attrition or participants or lost to followup.</population>
        <group_list>
          <group group_id="O1">
            <title>Mindfulness-Based Resilience Training (MBRT)</title>
            <description>MBRT is an 8-week program combining training in standardized mindfulness practices targeting factors that facilitate resilience, cognitive behavioral therapy (CBT), and psychoeducation. It contains experiential and didactic exercises including body scan, sitting and walking meditation, mindful movement and discussions.</description>
          </group>
          <group group_id="O2">
            <title>Stress Management Education (SME)</title>
            <description>SME was designed as an active control condition for other mindfulness-based intervention trials. SME uses a group-based didactic approach with modules on physiological and dietary effects of stress, time management, sleep physiology and insomnia, nutrition, exercise, stress hardiness, and factors mitigating impacts of stress.</description>
          </group>
          <group group_id="O3">
            <title>No Intervention Control</title>
            <description>No contact control condition (other than baseline, post, and follow-up assessments)</description>
          </group>
        </group_list>
        <measure>
          <title>Change in Mindfulness</title>
          <description>Five Facet Mindfulness Questionnaire-Short Form. Scores range from 1-5, with higher scores indicating greater mindfulness.</description>
          <population>Numbers at post-intervention, 3-month followup, and 6-month followup reflect attrition or participants or lost to followup.</population>
          <units>score on a scale</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="33"/>
                <count group_id="O2" value="24"/>
                <count group_id="O3" value="16"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>baseline</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="33"/>
                    <count group_id="O2" value="24"/>
                    <count group_id="O3" value="16"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="3.48" spread=".68"/>
                    <measurement group_id="O2" value="3.53" spread=".47"/>
                    <measurement group_id="O3" value="3.63" spread=".74"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>post-intervention (week 8)</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="31"/>
                    <count group_id="O2" value="18"/>
                    <count group_id="O3" value="15"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="3.56" spread=".45"/>
                    <measurement group_id="O2" value="3.61" spread=".41"/>
                    <measurement group_id="O3" value="3.56" spread=".84"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>3-month followup</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="29"/>
                    <count group_id="O2" value="16"/>
                    <count group_id="O3" value="16"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="3.60" spread=".60"/>
                    <measurement group_id="O2" value="3.51" spread=".29"/>
                    <measurement group_id="O3" value="3.65" spread=".58"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>6-month followup</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="29"/>
                    <count group_id="O2" value="17"/>
                    <count group_id="O3" value="15"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="3.62" spread=".45"/>
                    <measurement group_id="O2" value="3.51" spread=".45"/>
                    <measurement group_id="O3" value="3.61" spread=".64"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Change in Interoceptive Awareness</title>
        <description>Multidimensional Assessment of Interoceptive Awareness-II. Scores range from 1-6, with higher scores indicating greater interoceptive awareness.</description>
        <time_frame>baseline, post-intervention (8 weeks), 3 month followup, 6 month followup</time_frame>
        <population>Numbers at post-intervention, 3-month followup, and 6-month followup reflect attrition or participants or lost to followup.</population>
        <group_list>
          <group group_id="O1">
            <title>Mindfulness-Based Resilience Training (MBRT)</title>
            <description>MBRT is an 8-week program combining training in standardized mindfulness practices targeting factors that facilitate resilience, cognitive behavioral therapy (CBT), and psychoeducation. It contains experiential and didactic exercises including body scan, sitting and walking meditation, mindful movement and discussions.</description>
          </group>
          <group group_id="O2">
            <title>Stress Management Education (SME)</title>
            <description>SME was designed as an active control condition for other mindfulness-based intervention trials. SME uses a group-based didactic approach with modules on physiological and dietary effects of stress, time management, sleep physiology and insomnia, nutrition, exercise, stress hardiness, and factors mitigating impacts of stress.</description>
          </group>
          <group group_id="O3">
            <title>No Intervention Control</title>
            <description>No contact control condition (other than baseline, post, and follow-up assessments)</description>
          </group>
        </group_list>
        <measure>
          <title>Change in Interoceptive Awareness</title>
          <description>Multidimensional Assessment of Interoceptive Awareness-II. Scores range from 1-6, with higher scores indicating greater interoceptive awareness.</description>
          <population>Numbers at post-intervention, 3-month followup, and 6-month followup reflect attrition or participants or lost to followup.</population>
          <units>score on a scale</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="33"/>
                <count group_id="O2" value="24"/>
                <count group_id="O3" value="16"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>baseline</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="33"/>
                    <count group_id="O2" value="24"/>
                    <count group_id="O3" value="16"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="3.89" spread=".64"/>
                    <measurement group_id="O2" value="3.77" spread=".61"/>
                    <measurement group_id="O3" value="3.62" spread=".51"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>post-intervention (week 8)</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="31"/>
                    <count group_id="O2" value="18"/>
                    <count group_id="O3" value="15"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="4.19" spread=".50"/>
                    <measurement group_id="O2" value="3.82" spread=".52"/>
                    <measurement group_id="O3" value="3.89" spread=".55"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>3-month followup</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="29"/>
                    <count group_id="O2" value="16"/>
                    <count group_id="O3" value="16"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="4.22" spread=".61"/>
                    <measurement group_id="O2" value="4.00" spread=".50"/>
                    <measurement group_id="O3" value="3.67" spread=".66"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>6-month followup</title>
              <analyzed_list>
                <analyzed>
                  <units>Participants</units>
                  <scope>Class</scope>
                  <count_list>
                    <count group_id="O1" value="29"/>
                    <count group_id="O2" value="17"/>
                    <count group_id="O3" value="15"/>
                  </count_list>
                </analyzed>
              </analyzed_list>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="4.19" spread=".55"/>
                    <measurement group_id="O2" value="3.87" spread=".79"/>
                    <measurement group_id="O3" value="3.62" spread=".59"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Treatment Acceptability</title>
        <description>Postcourse satisfaction survey. Scores range from 4-16, with higher scores indicating greater treatment acceptability. Measure only administered to Mindfulness-Based Resilience Training and Stress Management Education arms.</description>
        <time_frame>post-intervention (8 weeks)</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Mindfulness-Based Resilience Training (MBRT)</title>
            <description>MBRT is an 8-week program combining training in standardized mindfulness practices targeting factors that facilitate resilience, cognitive behavioral therapy (CBT), and psychoeducation. It contains experiential and didactic exercises including body scan, sitting and walking meditation, mindful movement and discussions.</description>
          </group>
          <group group_id="O2">
            <title>Stress Management Education (SME)</title>
            <description>SME was designed as an active control condition for other mindfulness-based intervention trials. SME uses a group-based didactic approach with modules on physiological and dietary effects of stress, time management, sleep physiology and insomnia, nutrition, exercise, stress hardiness, and factors mitigating impacts of stress.</description>
          </group>
        </group_list>
        <measure>
          <title>Treatment Acceptability</title>
          <description>Postcourse satisfaction survey. Scores range from 4-16, with higher scores indicating greater treatment acceptability. Measure only administered to Mindfulness-Based Resilience Training and Stress Management Education arms.</description>
          <units>score on a scale</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="31"/>
                <count group_id="O2" value="18"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="13.94" spread="2.43"/>
                    <measurement group_id="O2" value="12.28" spread="2.52"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Treatment Compliance</title>
        <description>Objective assessment of duration of homework practice. Measure only administered to Mindfulness-Based Resilience Training and Stress Management Education arms.</description>
        <time_frame>post-intervention (8 weeks)</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Mindfulness-Based Resilience Training (MBRT)</title>
            <description>MBRT is an 8-week program combining training in standardized mindfulness practices targeting factors that facilitate resilience, cognitive behavioral therapy (CBT), and psychoeducation. It contains experiential and didactic exercises including body scan, sitting and walking meditation, mindful movement and discussions.</description>
          </group>
          <group group_id="O2">
            <title>Stress Management Education (SME)</title>
            <description>SME was designed as an active control condition for other mindfulness-based intervention trials. SME uses a group-based didactic approach with modules on physiological and dietary effects of stress, time management, sleep physiology and insomnia, nutrition, exercise, stress hardiness, and factors mitigating impacts of stress.</description>
          </group>
        </group_list>
        <measure>
          <title>Treatment Compliance</title>
          <description>Objective assessment of duration of homework practice. Measure only administered to Mindfulness-Based Resilience Training and Stress Management Education arms.</description>
          <units>minutes</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="31"/>
                <count group_id="O2" value="18"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="211.66" spread="186.62"/>
                    <measurement group_id="O2" value="65.45" spread="68.45"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Treatment Expectancy and Credibility</title>
        <description>Expectancy/Credibility Questionnaire. Scale for measuring treatment expectancy and rationale credibility for use in clinical outcome studies. Scores range from 7-21, with higher scores indicating greater expectancy and credibility.</description>
        <time_frame>baseline</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Mindfulness-Based Resilience Training (MBRT)</title>
            <description>MBRT is an 8-week program combining training in standardized mindfulness practices targeting factors that facilitate resilience, cognitive behavioral therapy (CBT), and psychoeducation. It contains experiential and didactic exercises including body scan, sitting and walking meditation, mindful movement and discussions.</description>
          </group>
          <group group_id="O2">
            <title>Stress Management Education (SME)</title>
            <description>SME was designed as an active control condition for other mindfulness-based intervention trials. SME uses a group-based didactic approach with modules on physiological and dietary effects of stress, time management, sleep physiology and insomnia, nutrition, exercise, stress hardiness, and factors mitigating impacts of stress.</description>
          </group>
          <group group_id="O3">
            <title>No Intervention Control</title>
            <description>No contact control condition (other than baseline, post, and follow-up assessments)</description>
          </group>
        </group_list>
        <measure>
          <title>Treatment Expectancy and Credibility</title>
          <description>Expectancy/Credibility Questionnaire. Scale for measuring treatment expectancy and rationale credibility for use in clinical outcome studies. Scores range from 7-21, with higher scores indicating greater expectancy and credibility.</description>
          <units>score on a scale</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="33"/>
                <count group_id="O2" value="24"/>
                <count group_id="O3" value="16"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="15.61" spread="3.75"/>
                    <measurement group_id="O2" value="15.60" spread="2.90"/>
                    <measurement group_id="O3" value="15.53" spread="2.20"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Global Impression of Change</title>
        <description>Clinical Global Impressions Scale. Measure of perceived change in functioning as a result of the intervention. Scores range from 3-21, with higher scores indicating a greater impression of change. Measure only administered to Mindfulness-Based Resilience Training and Stress Management Education arms.</description>
        <time_frame>post-intervention (8 weeks)</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Mindfulness-Based Resilience Training (MBRT)</title>
            <description>MBRT is an 8-week program combining training in standardized mindfulness practices targeting factors that facilitate resilience, cognitive behavioral therapy (CBT), and psychoeducation. It contains experiential and didactic exercises including body scan, sitting and walking meditation, mindful movement and discussions.</description>
          </group>
          <group group_id="O2">
            <title>Stress Management Education (SME)</title>
            <description>SME was designed as an active control condition for other mindfulness-based intervention trials. SME uses a group-based didactic approach with modules on physiological and dietary effects of stress, time management, sleep physiology and insomnia, nutrition, exercise, stress hardiness, and factors mitigating impacts of stress.</description>
          </group>
        </group_list>
        <measure>
          <title>Global Impression of Change</title>
          <description>Clinical Global Impressions Scale. Measure of perceived change in functioning as a result of the intervention. Scores range from 3-21, with higher scores indicating a greater impression of change. Measure only administered to Mindfulness-Based Resilience Training and Stress Management Education arms.</description>
          <units>score on a scale</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="31"/>
                <count group_id="O2" value="18"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="16.19" spread="2.10"/>
                    <measurement group_id="O2" value="14.22" spread="1.66"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
    </outcome_list>

    <reported_events>
      <time_frame>The adverse event was followed for 6 months.</time_frame>
      <group_list>
        <group group_id="E1">
          <title>Mindfulness-Based Resilience Training</title>
          <description>MBRT is an 8-week program combining training in standardized mindfulness practices targeting factors that facilitate resilience, cognitive behavioral therapy (CBT), and psychoeducation. It contains experiential and didactic exercises including body scan, sitting and walking meditation, mindful movement and discussions.&#xD;
Mindfulness-Based Resilience Training: MBRT is an 8-week program combining training in standardized mindfulness practices targeting factors that facilitate resilience, CBT, and psychoeducation. It contains experiential and didactic exercises including body scan, sitting and walking meditation, mindful movement and discussions.</description>
        </group>
        <group group_id="E2">
          <title>Stress Management Education</title>
          <description>SME was designed as an active control condition for other mindfulness-based intervention trials. SME uses a group-based didactic approach with modules on physiological and dietary effects of stress, time management, sleep physiology and insomnia, nutrition, exercise, stress hardiness, and factors mitigating impacts of stress.&#xD;
Stress Management Education: SME was designed as an active control condition for other Mindfulness-Based Intervention trials. SME uses a group-based didactic approach with modules on physiological and dietary effects of stress, time management, sleep physiology and insomnia, nutrition, exercise, stress hardiness, and factors mitigating impacts of stress.</description>
        </group>
        <group group_id="E3">
          <title>No Intervention Control</title>
          <description>No contact control condition (other than baseline, post, and follow-up assessments)</description>
        </group>
      </group_list>
      <serious_events>
        <category_list>
          <category>
            <title>Total</title>
            <event_list>
              <event>
                <sub_title>Total, all-cause mortality</sub_title>
                <counts group_id="E1" subjects_affected="0" subjects_at_risk="50"/>
                <counts group_id="E2" subjects_affected="0" subjects_at_risk="38"/>
                <counts group_id="E3" subjects_affected="0" subjects_at_risk="21"/>
              </event>
              <event>
                <sub_title>Total, serious adverse events</sub_title>
                <counts group_id="E1" subjects_affected="0" subjects_at_risk="50"/>
                <counts group_id="E2" subjects_affected="0" subjects_at_risk="38"/>
                <counts group_id="E3" subjects_affected="0" subjects_at_risk="21"/>
              </event>
            </event_list>
          </category>
        </category_list>
      </serious_events>
      <other_events>
        <frequency_threshold>0</frequency_threshold>
        <default_assessment>Non-systematic Assessment</default_assessment>
        <category_list>
          <category>
            <title>Total</title>
            <event_list>
              <event>
                <sub_title>Total, other adverse events</sub_title>
                <counts group_id="E1" subjects_affected="1" subjects_at_risk="50"/>
                <counts group_id="E2" subjects_affected="0" subjects_at_risk="38"/>
                <counts group_id="E3" subjects_affected="0" subjects_at_risk="21"/>
              </event>
            </event_list>
          </category>
          <category>
            <title>Respiratory, thoracic and mediastinal disorders</title>
            <event_list>
              <event>
                <sub_title>Participant contracted COVID-19</sub_title>
                <counts group_id="E1" events="1" subjects_affected="1" subjects_at_risk="50"/>
                <counts group_id="E2" events="0" subjects_affected="0" subjects_at_risk="38"/>
                <counts group_id="E3" events="0" subjects_affected="0" subjects_at_risk="21"/>
              </event>
            </event_list>
          </category>
        </category_list>
      </other_events>
    </reported_events>

    <certain_agreements>
      <pi_employee>All Principal Investigators ARE employed by the organization sponsoring the study.</pi_employee>
      <restrictive_agreement>There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed. </restrictive_agreement>
    </certain_agreements>
    <point_of_contact>
      <name_or_title>Michael Christopher, Ph.D.</name_or_title>
      <organization>Pacific University</organization>
      <phone>503-352-2498</phone>
      <email>mchristopher@pacificu.edu</email>
    </point_of_contact>
  </clinical_results>
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT03784846
org study id: 1295787-14
secondary id: U01AT009841
nct id: NCT03784846
lead sponsor: 
collaborator: 
collaborator: 
has dmc: Yes
is fda regulated drug: No
is fda regulated device: No
Law enforcement officers (LEOs) are exposed to significant stressors, elevating their risk
      for aggression and excessive use of force, as well as mental health consequences, including
      post-traumatic stress disorder, burnout, alcohol misuse, depression, and suicide. The
      proposed study will identify, optimize and refine best clinical and research practices across
      two sites to ensure success in a future multisite efficacy trial assessing preventative
      effects of Mindfulness-Based Resilience Training on physiological, behavioral, and
      psychological outcomes.
Law enforcement officers (LEOs) are exposed to significant stressors, elevating their risk
      for aggression and excessive use of force. Such dysfunctional stress reactivity can lead to
      devastating consequences for their community, including unjustified shootings, severe
      beatings, and fatal chokings. It can also lead to serious consequences for the LEOs,
      including elevated incidence of post-traumatic stress disorder, burnout, alcohol misuse,
      depression, and suicide. A recent meta-analysis of LEO stress reduction programs found little
      evidence to demonstrate that such approaches are effective, highlighting the urgent need for
      preventive interventions targeting the stress inherent to policing. Mindfulness training is a
      promising approach with high-stress populations that has been shown effective in reducing
      stress and increasing resilience. In a recent pilot feasibility study (R21AT008854), the
      study team established initial feasibility, acceptability, and adherence to procedures in a
      single-site RCT assessing Mindfulness-Based Resilience Training (MBRT), a preventive
      intervention designed to improve LEO mental health and resilience, and reduce aggression and
      excessive use of force. The R21 data suggest physiological mechanisms and potential clinical
      benefit in a sample of LEOs. Relative to waitlist control, MBRT participants showed
      improvements in stress reactivity, aggression, burnout, occupational stress, sleep
      disturbance, and psychological flexibility. Implemented at two sites, the proposed study is
      designed to establish optimal protocols and procedures for a future full-scale, multi-site
      trial assessing effects of MBRT versus an attention control (Stress Management Education) and
      a no-intervention control, on physiological, behavioral, and psychological outcomes. To
      prepare for this future clinical trial, this study will: a) enhance efficiency of
      recruitment, engagement and retention; b) optimize lab, assessment, and data management
      procedures; c) optimize intervention training and ensure fidelity to intervention protocols;
      and d) assess participant experience and optimize outcome measures across sites. The
      long-term objective of this line of research is to develop an intervention that will reduce
      violence and increase resilience among LEOs, as well as yield significant benefits for
      communities and residents they serve.
allocation: Randomized
intervention model: Parallel Assignment
intervention model description: Individually-Randomized Group Treatment
primary purpose: Prevention
masking: Single (Outcomes Assessor)
measure: Change in Aggression
time frame: baseline, post-intervention (week 8), 3-month followup, 6-month followup
description: Buss-Perry Aggression Questionnaire-Short Form. Scores range from 1-5, with higher scores indicating greater aggression.
measure: Change in C-reactive Protein
time frame: baseline, post-intervention (8 weeks), 3 month followup
description: Blood spot analysis of high-sensitivity C-reactive protein.
measure: Change in Interleukin-6
time frame: baseline, post-intervention (8 weeks), 3 month followup
description: Blood spot analysis of interleukin-6.
measure: Change in Interleukin-10
time frame: baseline, post-intervention (8 weeks), 3 month followup
description: Blood spot analysis of interleukin-10.
measure: Change in Tumor Necrosis Factor-alpha
time frame: baseline, post-intervention (8 weeks), 3 month followup
description: Blood spot analysis of tumor necrosis factor-alpha.
measure: Change in Psychological Resilience
time frame: baseline, post-intervention (8 weeks), 3 month followup, 6 month followup
description: Brief Resilience Scale. Scores range from 1-5, with higher scores indicating greater resilience.
measure: Change in Alcohol Use
time frame: baseline, post-intervention (8 weeks), 3 month followup, 6 month followup
description: Patient Reported Outcome Measurement System (PROMIS) Alcohol Use. Scores range from 39-77, with higher scores indicating greater alcohol use.
measure: Change in Alcohol Use Negative Consequences
time frame: baseline, post-intervention (8 weeks), 3 month followup, 6 month followup
description: Patient Reported Outcome Measurement System (PROMIS) Alcohol Use Negative Consequences.Scores range from 39-77, with higher scores indicating greater alcohol use negative consequences.
measure: Change in Depression
time frame: baseline, post-intervention (8 weeks), 3 month followup, 6 month followup
description: Patient Reported Outcome Measurement System (PROMIS) Depression. Scores range from 38-80, with higher scores indicating more depression.
measure: Change in Suicidal Thinking
time frame: baseline, post-intervention (8 weeks), 3 month followup, 6 month followup
description: Concise Heath Risk Tracking Scale-Self-Report. Scores range from 7-35, with higher scores indicating greater suicidal ideation.
measure: Change in Trauma Symptoms
time frame: baseline, post-intervention (8 weeks), 3 month followup, 6 month followup
description: PTSD Checklist for DSM-5. Scores ranges from 0-80, with higher scores indicating greater PTSD symptoms.
measure: Change in Burnout
time frame: baseline, post-intervention (8 weeks), 3 month followup, 6 month followup
description: Oldenburg Burnout Inventory. Scores range from 1-4, with higher scores indicating greater burnout.
measure: Change in Sustained Attention
time frame: baseline, post-intervention (8 weeks), 3 month followup, 6 month followup
description: Sustained Attention to Response Task. A computer-based go/no-go task that requires participants to withhold behavioral response to a single, infrequent target presented amongst a background of frequent non-targets. Increased errors indicates less sustained attention.
measure: Change in Perceived Stress
time frame: baseline, post-intervention (8 weeks), 3 month followup, 6 month followup
description: Perceived Stress Scale-10. Scores range from 0-40, with higher scores indicating greater perceived stress.
measure: Change in Sleep Disturbance
time frame: baseline, post-intervention (8 weeks), 3 month followup, 6 month followup
description: Patient Reported Outcome Measurement System (PROMIS) Sleep Disturbance. Scores range from 32-76, with higher scores indicating greater sleep disturbance.
measure: Change in Self-Compassion
time frame: baseline, post-intervention (8 weeks), 3 month followup, 6 month followup
description: Self-Compassion Scale-Short Form. Scores range from 1-5, with higher scores indicating greater self-compassion.
measure: Change in Mindfulness
time frame: baseline, post-intervention (8 weeks), 3 month followup, 6 month followup
description: Five Facet Mindfulness Questionnaire-Short Form. Scores range from 1-5, with higher scores indicating greater mindfulness.
measure: Change in Interoceptive Awareness
time frame: baseline, post-intervention (8 weeks), 3 month followup, 6 month followup
description: Multidimensional Assessment of Interoceptive Awareness-II. Scores range from 1-6, with higher scores indicating greater interoceptive awareness.
measure: Treatment Acceptability
time frame: post-intervention (8 weeks)
description: Postcourse satisfaction survey. Scores range from 4-16, with higher scores indicating greater treatment acceptability. Measure only administered to Mindfulness-Based Resilience Training and Stress Management Education arms.
measure: Treatment Compliance
time frame: post-intervention (8 weeks)
description: Objective assessment of duration of homework practice. Measure only administered to Mindfulness-Based Resilience Training and Stress Management Education arms.
measure: Treatment Expectancy and Credibility
time frame: baseline
description: Expectancy/Credibility Questionnaire. Scale for measuring treatment expectancy and rationale credibility for use in clinical outcome studies. Scores range from 7-21, with higher scores indicating greater expectancy and credibility.
measure: Global Impression of Change
time frame: post-intervention (8 weeks)
description: Clinical Global Impressions Scale. Measure of perceived change in functioning as a result of the intervention. Scores range from 3-21, with higher scores indicating a greater impression of change. Measure only administered to Mindfulness-Based Resilience Training and Stress Management Education arms.
arm group label: Mindfulness-Based Resilience Training
arm group type: Experimental
description: MBRT is an 8-week program combining training in standardized mindfulness practices targeting factors that facilitate resilience, cognitive behavioral therapy (CBT), and psychoeducation. It contains experiential and didactic exercises including body scan, sitting and walking meditation, mindful movement and discussions.
arm group label: Stress Management Education
arm group type: Active Comparator
description: SME was designed as an active control condition for other mindfulness-based intervention trials. SME uses a group-based didactic approach with modules on physiological and dietary effects of stress, time management, sleep physiology and insomnia, nutrition, exercise, stress hardiness, and factors mitigating impacts of stress.
arm group label: No Intervention Control
arm group type: No Intervention
description: No contact control condition (other than baseline, post, and follow-up assessments)
intervention type: Behavioral
intervention name: Mindfulness-Based Resilience Training
description: MBRT is an 8-week program combining training in standardized mindfulness practices targeting factors that facilitate resilience, CBT, and psychoeducation. It contains experiential and didactic exercises including body scan, sitting and walking meditation, mindful movement and discussions.
arm group label: Mindfulness-Based Resilience Training
intervention type: Behavioral
intervention name: Stress Management Education
description: SME was designed as an active control condition for other Mindfulness-Based Intervention trials. SME uses a group-based didactic approach with modules on physiological and dietary effects of stress, time management, sleep physiology and insomnia, nutrition, exercise, stress hardiness, and factors mitigating impacts of stress.
arm group label: Stress Management Education
criteria: 
gender: All
minimum age: 21 Years
maximum age: 65 Years
healthy volunteers: Accepts Healthy Volunteers
facility: 
facility: 
country: United States
citation: Christopher M, Bowen S, Witkiewitz K. Mindfulness-based resilience training for aggression, stress and health in law enforcement officers: study protocol for a multisite, randomized, single-blind clinical feasibility trial. Trials. 2020 Feb 28;21(1):236. doi: 10.1186/s13063-020-4165-y.
PMID: 32111233
responsible party type: Principal Investigator
investigator affiliation: Pacific University
investigator full name: Michael Christopher, PhD
investigator title: Multiple Principal Investigator
mesh term: Aggression
mesh term: Stress, Psychological
sharing ipd: No
provided document: 
provided document: 
provided document: 
participant flow: 
baseline: 
outcome list: 
reported events: 
certain agreements: 
point of contact: 