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A brief online mindfulness intervention: study protocol for Indonesian undergraduate students, a randomized controlled trial

Trials volume 26, Article number: 155 (2025) Cite this article

Abstract

Background

Elevated levels of stress, anxiety, and depression persist among undergraduate students in Eastern countries, including Indonesia. Access to mental healthcare resources, however, remains difficult and costly for most young people. Furthermore, there is a strong tendency to avoid seeking professional help. The primary aim of this study is to investigate the effects of a brief 14-day online mindfulness intervention in reducing stress, anxiety, depressive symptoms, and repetitive negative thinking (RNT) among a representative sample of Indonesian undergraduate students. Given the mixed empirical evidence on the role of RNT in mindfulness, the secondary aim is to investigate the mediating role of RNT in the effects of mindfulness on stress, anxiety, and depressive symptoms.

Methods

Within this study, participants assigned to the mindfulness intervention will be compared to those allocated to psychoeducational and waitlist conditions. The Depression, Anxiety, and Stress Scale 21 (DASS-21), the Five Facet Mindfulness Questionnaires (FFMQ), and the Perseverative Thinking Questionnaire (PTQ) will be assessed at baseline, post-condition evaluation, and a subsequent follow-up assessment 3 months following the intervention period. Throughout the intervention phase, participants will complete daily questionnaires and have the option to maintain a daily journal.

Discussion

The findings from this randomized controlled trial will provide evidence for the possible effectiveness of a brief online mindfulness intervention on stress, anxiety, depression, and RNT. This online intervention could serve as an easily accessible and low-threshold strategy conducive to enhancing mental health and well-being of the Indonesian population.

Trial registration

NCT05882565 (ClinicalTrials.gov), retrospectively registered on May 21, 2023.

Peer Review reports

Background

Time in university is generally a stressful period of life, as a lot of students may face challenges both inside and outside academia [1]. Research indeed shows a high global prevalence of stress, anxiety, and depression among undergraduate students [2, 3]. Importantly, students in Eastern countries demonstrate higher levels of these mental health problems compared to those in Western countries (e.g., [4, 5]). This aligns with World Health Organization (WHO) findings [6], which indicate that Southeast Asia has the highest ranking of depression and anxiety cases in the world. In Indonesia, most people who follow and complete higher education at the undergraduate level (only 0.2% of the Indonesian population pursue higher education at the graduate level [7]). Most undergraduate students (40–80%) report severe to extremely severe levels of stress, anxiety, and depression ([8]; unpublished observationsFootnote 1). Nevertheless, only a small percentage of young people in Indonesia (< 5% [9]) receive treatment due to the unavailability of mental healthcare facilities [10] and high treatment costs [11]. In addition, Indonesian students tend not to seek help from others when experiencing mental health problems, as sharing personal or family experiences about mental issues is generally perceived as embarrassing [12]. The high prevalence of mental health problems, the lack of mental healthcare access, and a general disinclination to seek professional help emphasize the need for easily accessible interventions in Eastern countries that can be delivered online without professional supervision.

Mindfulness is an intervention suggested to generate positive psychological and physical outcomes and can be delivered remotely [13, 14]. Mindfulness aims to increase awareness of, and responses to, experiences that contribute to emotional distress or maladaptive behavior [15,16,17]. It encourages a non-critical and non-judgmental focus on ongoing experiences and an attitude of curiosity, transparency, and acceptance towards one’s experiences [18]. As such, it facilitates a shift from a self-centered to a more non-reactive perspective [19] by which emotional acceptance of uncomfortable negative experiences is enhanced [20]. Practicing mindfulness helps to focus one’s attention on the “here and now”; therefore, it aids in inhibiting negative information or discontinuing emotional distress [21, 22]. A meta-analytic review [23] concluded that online mindfulness has a large effect on reducing stress, and a small but significant beneficial impact on depression and anxiety. Furthermore, a recent systematic review [24] indicated that brief online mindfulness interventions can yield positive mental health outcomes (e.g., reduced stress, anxiety, and depressive symptoms) for both clinical and non-clinical populations. Additionally, this intervention appears particularly suitable for students, who often face time constraints [25] and may have limited or no previous experience with mindfulness practices [26].

In high-income countries (eHealth) interventions using the internet have gained acceptance [23] and have increasingly been implemented in prevention efforts and mental healthcare settings [27]. EHealth interventions offer benefits such as increased accessibility, convenience, and personalized treatments. However, the implementation of eHealth interventions is not without its challenges. Engagement and accessibility remain persistent issues that can significantly hinder their effectiveness. Such barriers often stem from factors including irrelevant or poorly tailored content, low intrinsic motivation, negative user experiences with digital platforms, and the absence of direct therapist support [28]. These issues may lead to reduced adherence, higher dropout rates, and diminished outcomes. Moreover, the design and duration of eHealth interventions critically shape user experience and intervention success. Interventions that are too lengthy, overly complex, or insufficiently interactive may overwhelm users, while too brief interventions may lack necessary depth [29]. Therefore, careful consideration of these elements is essential to establish efficacy and credibility. Given these challenges, eHealth interventions must be continuously refined and adapted to match diverse user needs and preferences, to ensure engagement and utility.

In low- and middle-income countries (LMICs), these interventions seem to be positively received. However, research on eHealth interventions remains insufficient, particularly in Southeast Asia [30]. Similarly, there are only a few studies dealing with the effects of eHealth interventions on students [31,32,33] in Indonesia, with findings suggesting that they are both relevant and applicable. Therefore, eHealth interventions can be considered a promising avenue for young Indonesians who need psychological help, highlighting the opportunity for further investigation.

Several studies investigated the mechanisms through which mindfulness aims to achieve its effects [14, 34]. One such mechanism is repetitive negative thinking (RNT), a cognitive style characterized by a persistent focus on negative content [35]. RNT has been identified as a key mediator in the relationship between mindfulness and reductions in stress, anxiety, and depressive symptoms [36]. Moreover, it has been consistently associated with the onset and persistence of anxiety and depression [37]. Our previous research involving Indonesian undergraduate students (unpublished observations1) also highlighted RNT as a central construct linking stress, anxiety, and depression. However, in contrast to earlier findings, recent studies have not supported RNT as a mediator of mindfulness effects, nor have they found RNT predictive of outcomes [38]. Similarly, Bolzenkotter [39] reported no evidence indicating that mindfulness diminishes the relationship between rumination and negative affect over time. Additionally, earlier research, as described by Spinhoven et al. [40], did not measure changes in RNT throughout interventions. Without tracking changes in RNT throughout the intervention period, it remains unclear whether shifts in RNT precede changes in outcomes. These conflicting findings suggest that while RNT remains a plausible mechanism underlying affective complaints and stress-related issues [41], further research is required to clarify its specific role in mindfulness interventions.

Research on mindfulness and mental health (interventions) in undergraduate students has predominantly focused on Western samples. Reported levels of stress, anxiety, and depressive symptoms in Eastern countries, however, are also high [4, 5], which warrants attention. In Indonesia, Listiyandini et al. [32] found that a mindfulness-based online intervention had a large and significant effect on stress, anxiety, and depression. However, this study involved a small sample of undergraduate students and did not use a control condition Therefore, we will investigate the effects of a brief online mindfulness intervention in Indonesia. The intervention will be compared to both an active control condition (psychoeducation) and a waitlist control condition. Psychoeducation has been widely used as an active control condition (e.g., [14, 42,43,44]). Previous studies have shown that active control conditions can sometimes yield effects similar to those of the primary intervention, which can complicate the identification of specific components responsible for behavioral change [45]. In the present study, the psychoeducation condition is matched in structure and duration to the mindfulness intervention but deliberately excludes the “active ingredients,” namely, mindfulness skills practice, to allow for a clearer assessment of the intervention’s unique effects.

Aims and hypotheses

First, this study aims to investigate the effects of a brief online mindfulness intervention on stress, anxiety, depressive symptoms, and RNT in an Indonesian sample of undergraduate students. Several studies have reported long-term effects of a brief online mindfulness intervention on stress, anxiety, and depression in other populations [46, 47]. In addition, mixed results were found regarding the outcomes of a brief online mindfulness intervention on RNT [14, 34, 38, 40]. Based on these findings, it is hypothesized that undergraduate student participants in the mindfulness intervention and psychoeducation conditions will report less stress, anxiety, depressive symptoms, and RNT immediately after the intervention and at a 3-month follow-up compared to the waitlist control (e.g., [14, 48,49,50]). Psychoeducation can decrease mental health complaints, but, in line with previous studies [14, 42, 43], it is hypothesized that it will be less effective in reducing stress, anxiety, and depressive symptoms than the mindfulness intervention.

Second, this study aims to investigate the mediating role of RNT, which is to examine whether changes in RNT (i.e., a reduction) serve as a potential working mechanism through which the brief online mindfulness intervention achieves its effect. It is hypothesized that RNT mediates the effects of mindfulness on stress, anxiety, and depressive symptoms [14, 51].

Methods

Study design

The current study is a three-arm (the mindfulness, psychoeducation, and waitlist condition), double-blind randomized controlled trial (RCT) designed in accordance with The Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) statement. Figures 1 and 2 show the flow chart of the procedure and the SPIRIT Checklist provided in the Supplementary materials [52].

Fig. 1
figure 1

Flowchart of study procedure, based on CONSORT diagram

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Fig. 2
figure 2

Overview of the procedures and instruments (according to SPIRIT)

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We conducted a pilot study that included a qualitative assessment of participants’ experiences with the study procedures and the digital environment used to deliver the intervention. This provided valuable insights that informed improvements to several aspects of the study design, including participant engagement strategies and the scheduling of reminders.

Registration and ethics approval

This study has been approved by the local ethics committee of Universitas Kristen Maranatha, Indonesia (number 7/KEP/II/2021) and registered at clinicaltrials.gov (NCT05882565).

Participants

Inclusion and exclusion criteria

In order to be eligible to participate in this study, participants should be undergraduate university students meeting the following inclusion criteria: (a) having been admitted to one of the universities in Indonesia; (b) having good eyesight and hearing; (c) having access to the internet and familiarity with navigating the internet. Exclusion criteria are: (a) following a yoga/meditation mindfulness program at the time of study enrollment; (b) receiving psychological treatment at the time of study enrollment; and (c) alcohol or drug abuse.

Sample size

A statistical power analysis was performed to estimate the required sample size. Based on previous studies [13, 14, 34], we expect a small to medium effect size. Using G*Power [53], with an alpha level of 0.05 and a power of 0.80, a total sample of 153 participants (51 participants per condition) is required. To account for an anticipated attrition rate of 30%, the total sample size for this study is set at 199 participants (i.e., 66 participants per condition).

Recruitment

Undergraduate students will be recruited via advertisements in the students’ classes, social media posts (e.g., Instagram, WhatsApp), and through the websites of universities. Advertisements will be particularly shared at universities in (West) Java, considering the majority of higher education institutions (74%) in Indonesia are located here [7]. Participants will receive point credits or financial compensation for their participation.

Randomization and blinding

Participants are randomly assigned to one of the three conditions (mindfulness as the active condition, psychoeducation as the active control condition, or the waitlist condition) using a block randomization method with a 1:1:1 allocation ratio. Randomization is managed by a separate group of research assistants who are not involved in data collection. Both participants and the research assistants involved in data collection, as well as the project team, will be blind to the condition to which participants have been assigned. We do not anticipate any requirement for unblinding; however, if required, the project team (including the Principal Investigator, the Research Coordinator, and other members of the research team) will have access to condition allocations, and any unblinding will be reported.

When analyzing the data, the statistician will know that there are three different conditions (numbered with 1, 2, or 3) but will not be informed about what these three conditions entail.

Intervention and conditions

Mindfulness intervention

Participants in the mindfulness intervention will receive a self-guided, brief online mindfulness intervention, the content of which is based on studies by Cavanagh et al. [13, 14]. The mindfulness intervention begins with an introduction to the concept of mindfulness, including its definition, theoretical foundation, and the potential benefits of regular practice (what is mindfulness?). Participants then receive instructions on how to engage with the guided audio sessions designed to cultivate mindfulness skills (daily mindfulness practice). Practical strategies for incorporating mindfulness into routine daily activities are provided to encourage real-life application of the techniques (everyday mindfulness activities). To support participant understanding, common questions and challenges related to mindfulness are addressed (daily practice FAQs). The purpose and objectives of this study, along with participants’ responsibilities, are outlined (study information). Lastly, contact information for the research team and relevant external mental health resources are provided for participants who seek further mental health support (help and assistance).

Materials related to the concept of mindfulness include a video, embedded text, and a downloadable PDF article. The intervention spans 14 days in total. Each day, participants are invited to listen to a 10-min guided audio session that offers instruction in mindfulness practice. This same session is repeated daily, providing participants with a structured intervention to observe their body, breath, thoughts, and emotions with non-judgmental awareness. In the first week, they are instructed to apply these skills in everyday activities (e.g., brushing their teeth, showering) in order to integrate the mindfulness skills into their daily routines. In the second week, participant will continue their practice by learning to walk in a mindful manner. Throughout the intervention, participants will receive daily reminders to support their practice, and standardized “hint and tips,” provided every 3 days to encourage them to engage in the intervention. Participants are also offered to write an online daily journal, which is optional.

Psychoeducation condition

The online psychoeducation procedure is modified from the study by Harrer et al. [43, 54], in which university students with depressive symptoms were instructed to listen to 14 audio sessions on stress, each accompanied by related reading materials. The psychoeducation begins by introducing the concept of stress, including its definition, types, typical responses, and effects (introduction). Participants are then presented with information on common stressors in student life, along with an overview of Lazarus’ transactional model of stress (causes of stress). This is followed by an explanation of the varying effects of stress among individuals, addressing both short- and long-term consequences and highlighting personal differences in stress responses (does stress have the same effect on all individuals?). The physiological aspects of stress are then discussed, including bodily responses and a brief overview of the evolutionary theory behind stress reactions (what effect does stress have on the body?). Participants are introduced to common dysfunctional thought patterns that may arise under stress, along with five reappraisal techniques aimed at promoting more adaptive thinking (cognitive appraisal). Strategies for coping with stress and the internal and external resources available to support stress reduction are then outlined (coping and resources). Finally, key points from each topic are reviewed to consolidate understanding (summary). Furthermore, the focus of the study and the tasks that participants need to complete are outlined (study information). Information on the researchers’ contact information and external support is available for participants seeking further assistance with their mental health concerns (help and assistance).

In line with the mindfulness condition, the audio sessions will be set to 10 min and made accessible once daily for 14 days. After listening, participants will also have the option to read a text version of the session. In addition, they will receive regular reminders to continue their sessions and will have access to an optional online daily journal.

Waitlist control condition

Participants in the waitlist control condition will not receive any kind of treatment. However, they can fill out an optional daily journal during the 14 days.

Digital platform features

The website used to deliver the mindfulness intervention, psychoeducation, and assessments across all conditions features several interactive boxes, each representing a specific day of the program. Each box includes a “Start” button to initiate the daily session, which automatically changes to “Finished” upon completion. A “Journal” button is also available, allowing participants to record their reflections or experiences for that day. The platform includes an automatic saving function and a built-in timer to log both user responses and the duration of each session. It begins recording the duration of each audio session as soon as participants turn on the playback, and it also logs the time taken to complete the pre- and post-session questions. This real-time tracking minimizes the risk of data loss in the event of an internet connection interruption during the activities.

To ensure step-by-step engagement, access to the next day’s audio session is restricted until the previous day’s intervention has been completed. To maintain standardized delivery, the audio sessions are configured to play only once, which prevents repeated playback.

Outcome (measurements)

Primary outcome measures

Stress, anxiety and depression

The Depression Anxiety Stress Scale-21 (DASS-21 short version [55]) will be administered to measure depressive symptoms, anxiety, and stress. It consists of 21 items that have to be rated on a four-point Likert scale (0 = “did not apply to me at all” to 4 = “applied to me very much or most of the time”). In our previous research involving Indonesian undergraduate students, the DASS-21 demonstrated strong internal consistency for the subscales (α = 0.81–0.88; Yan et al., unpublished observations1). This finding was consistent with another study that indicated internal consistency levels from good to excellent (α = 0.85–0.92 [56]).

Secondary outcome measures

Mindfulness

Change in mindfulness will be measured using the Five Facet Mindfulness Questionnaire (FFMQ [57]). The FFMQ includes 39 items, which have to be rated on a five-point Likert scale (1 = “never or very rarely true” to 5 = “very often or always true”). It includes five components: observing, describing, non-judging, non-reactivity, and acting with awareness. The internal consistency was found to be adequate in an Indonesian sample (α = 0.53–0.84 [58]).

Repetitive negative thinking (RNT)

Changes in trait RNT will be measured using the Perseverative Thinking Questionnaire (PTQ [59]). The PTQ includes 15 items that have to be rated on a five-point Likert scale (1 = “never” to 5 = “almost always”). Our previous study involving Indonesian undergraduate students demonstrated excellent internal consistency (α = 0.95; Yan et al., unpublished observations1). Additional support comes from a Middle Eastern (Iranian) sample, where internal consistency was also found to be high (ω = 0.92 [60]).

Daily questions

Daily questions will be administered right before (i.e., process-based questions, momentary RNT questions, mood questions) and after (mood questions, daily journal) listening to the audio sessions.

Process-based questions

To check session adherence and performance, questions regarding context (i.e., whether the participants are in a quiet place, how their sitting position is (for the mindfulness intervention condition only), and the existence of company) will be asked. A reminder will also appear on the screen with advice to seek a quiet place to do the intervention, without company (if possible), or to sit in a comfortable position with the feet flat on the floor (mindfulness intervention condition only). Furthermore, to monitor participants’ engagement with the mindfulness activities, they are asked to complete a brief daily report on the duration, frequency, and extent to which they incorporated mindfulness into their daily routines.

Momentary repetitive negative thinking

To assess changes in momentary RNT, items about repetitive negative thoughts will be administered (e.g., “today, the same thought kept haunting my mind again and again,” or “today, I got stuck on certain issues and could not continue”). Each question should be answered using a seven-point Likert scale ranging from 1 = “never” to 7 = “every time.”

Mood questions

In order to obtain information about feelings of happiness, sadness, anger, and tiredness, 4 items will be administered; (i.e., (1) I feel happy at the moment, (2) I feel sad at the moment, (3) I feel angry at the moment, (4) I feel tired at the moment). Participants will rate each item using a seven-point Likert scale (1 = “very untrue of me” to 7 = “very true of me”).

Daily journal

In order to obtain additional information about participants’ experiences, thoughts, feelings, or difficulties regarding the intervention, participants are asked to fill out an (optional) daily journal after completing the daily mindfulness or psychoeducation audio session. The same instructions will be provided to the waitlist condition.

Procedures

All participants are asked to provide informed consent when they join the study. Then, they will be randomized into three conditions. In each condition, participants should first complete a set of online questionnaires sent via Qualtrics, as a baseline measure. After completing the baseline questionnaires, participants receive a unique code to sign in on the study website, through which the mindfulness intervention, psychoeducation, or waitlist is delivered.

Participants in the mindfulness intervention will receive general information about mindfulness on the start day (day 0). The intervention will begin the following day with a guided audio session and will continue daily through day 14. Before beginning each audio session, participants are asked to complete a set of daily questions to ensure an appropriate setting for mindfulness practice (e.g., Are you in a quiet room at the moment? Are you alone? Are you sitting comfortably with your feet flat on the floor?). Momentary RNT and mood (happiness, sadness, anger, and tiredness) will be assessed immediately before and after each audio session. Lastly, after each session, participants will report on their practice that day (e.g., practice duration, frequency, and the extent to which they applied mindfulness principles to daily life.

Participants in the psychoeducation condition will receive information about the content and their tasks on the start day (day 0). The intervention will begin the following day and continue through day 14. Participants will receive the same set of questions before and after each audio session as in the mindfulness condition, assessing RNT, mood, and the optional use of a daily journal. However, questions about the duration and frequency of practice will be omitted as they are not applicable.

Participants in the waitlist control condition will receive information on their involvement in the study on the start day (day 0). From that day onward, they will be asked once daily to complete the same RNT and mood questions as those given to participants in the mindfulness and psychoeducation condition.

Participants in all conditions are asked to complete the same set of questionnaires as a post-condition measure on day 15. A follow-up assessment will be conducted three months after the intervention, during which participants will complete the same questionnaires. Participants in the psychoeducation and waitlist control conditions will have the opportunity to access the mindfulness intervention after completing the follow-up assessment (see the RCT protocol flow diagram in Fig. 1 and the study overview in Fig. 2).

Data management

All study-related data will be electronically stored for 10 years (after inclusion has ended) on secured servers with restricted access at the Universitas Kristen Maranatha (Indonesia) repository and can only be accessed by authorized researchers or a data management officer. To ensure confidentiality and security, the data from each participant will be anonymized with a unique participant code. If a participant chooses to withdraw from the study, only the information collected up until that point will be used for the analyses.

Six months after the publication, we will provide a complete data set to the open data repository (repository.maranatha.edu). Study results will be published in (inter-)national, peer-reviewed scientific journals.

Monitoring

The Principal Investigator oversees the trial and provides supervision to the Research Coordinator, who is responsible for the daily monitoring and coordination of study activities with support from research assistants. To facilitate effective trial management, the Research Coordinator and assistants hold weekly meetings and maintain regular communication through e-mails and social media platforms to address operational issues related to the trial in a timely manner.

This study does not involve a Data Monitoring Committee, as it is considered a low-risk intervention. However, the project team (Principal Investigator, Research Coordinator, and other members of the team) monitors the trial conduct regularly. The project team reviews trial progress on a weekly basis and addresses any issues that arise during the trial conduct to ensure the study adheres to ethical and procedural standards.

Any modifications to the protocol that may impact the conduct of the study or involve administrative changes will be reviewed and stored by the Principal Investigator. If any deviations occur, they will be documented using a breach report form and updated on the clinical trial registry (ClinicalTrials.gov and Open Science Framework [OSF]). Substantial amendments to the research protocol will be communicated to the sponsor and addressed to all relevant parties (i.e., ethics committee, trial register).

Statistical analyses

Based on the Consolidated Standards of Reporting Trials (CONSORT [61]), an intention to treat (ITT) analysis will first be carried out. Missing data will be imputed using the MissForest package in R. Sensitivity analyses will be done to investigate the robustness of findings for the imputed and non-imputed datasets. Similarly, differences between analyses including and excluding multivariate outliers will be reported. If the three conditions differ in terms of potential confounders (despite randomization), we will include these variables as covariates in the analyses.

The analysis for the primary outcome measures (i.e., stress, anxiety, depression, and RNT) will be conducted using linear mixed-effects models (LMEM) in R [62]. Each model will include one of the outcome measures as the dependent variable (model 1: depressive symptoms; model 2: anxiety symptoms; model 3: stress symptoms; model 4: RNT). All models will have the independent variables time (baseline, post-condition, 3-month follow-up), the condition (mindfulness, psychoeducation, waitlist), and the interaction between time and condition as fixed effects. The interaction represents the effect of the intervention on the change of the outcome variable over time. In addition, the models include per-participant random intercepts and random slopes over time. To assess the secondary outcome, a cross-lagged panel model (CLPM) will be used to examine whether changes in momentary levels of RNT predict stress, anxiety, and depression and for whom this treatment works best. P-levels will be adjusted using the Holm-Bonferroni correction for multiple comparisons [63].

Adherence to the mindfulness intervention and psychoeducation will be checked based on (1) the number of minutes they have listened to the audio session each day of the 14-day period and (2) if the set of daily questions (which are administered before and after each audio session) were completed within 30 min before the start and 30 min after the audio session. Data from participants will be excluded if they completed < 70% of the total sessions. For the waitlist control condition, data from participants who completed < 70% of the daily questions over the 14-day period will be excluded. We will also perform diagnostic tests to detect outliers.

Discussion

This RCT investigates the effects of a brief online mindfulness intervention for undergraduate students on stress, anxiety, depressive symptoms, and RNT in Indonesia. To this end, a mindfulness intervention (active condition) will be compared to psychoeducation (active control condition) and a waitlist control condition to examine its effectiveness and to explore the specific mechanisms of change underlying the observed outcomes. Previous studies, mostly in Western countries, have already demonstrated the potential of mindfulness in reducing stress, anxiety, and depressive symptoms in various samples (i.e., non-clinical, subclinical, and clinical [13, 64, 65]). Moreover, recent studies conducted in Indonesia showed promising results and a high acceptance of online interventions [27, 32, 33]. In addition, the role of RNT will be investigated, as several studies [66, 67] have linked it to psychological distress and suggested that it may mediate the relationship between mindfulness and distress [68]. While mindfulness encourages awareness in the present moment without judgment to promote stress adaptation, RNT involves evaluating past events (rumination) or the future (worry), which tends to lead to inflexibility and self-criticism [68]. Although previous studies found a negative association between mindfulness and RNT [69], findings have been mixed. These inconclusive results underscore the importance of examining RNT more closely in the context of the current study.

The main strength of this study is the use of an RCT design for a 14-day online mindfulness intervention with a large sample and a 3-month follow-up. As such, this RCT attempts to shed light on new treatment avenues for stress-related issues in LMICs such as Indonesia. The mindfulness scripts from Cavanagh et al. [13, 14], which have demonstrated effectiveness, were adapted to better suit Indonesian undergraduate students. In support of the intervention, the online platform was developed to deliver the trials in a controlled, reliable, and user-friendly environment while enabling real-time data collection. To ensure the quality and cultural appropriateness of the audio sessions, a clinical psychologist with over 10 years of experience was involved in reviewing and adapting the scripts based on Cavanagh et al. [13, 14] and Harrer et al. [43, 54]. Additionally, a pilot study with ten students was conducted to assess the accessibility and acceptability of the platform. Based on their feedback, the reminder schedule was modified from every three days (as originally implemented by Cavanagh et al. [13]) to daily reminders.

Querstret et al. [70] reported large effect sizes for reductions in stress, anxiety, and depression following a mindfulness intervention over time. However, not all studies have examined the effects of time on these outcomes. In the present study, data will be collected at a 3-month follow-up to explore the potential long-term effects of mindfulness. To obtain more precise estimates, robust statistical techniques, such as mixed-effects models, will be employed, accounting for both fixed and random effects [71]. For handling missing data, the MissForest imputation method was chosen, as it has consistently demonstrated lower imputation errors compared to other techniques [72,73,74].

This study has several limitations. First, although the intervention is delivered remotely, it still requires ongoing contact and participant management over the 14-day period to maintain compliance. Second, the level of experimental control in an online setting, particularly in the absence of direct researcher interaction, is inherently lower than in laboratory-based interventions. To address these challenges, research assistants were tasked with sending automatic reminders to encourage adherence. They were also available to assist participants by answering any questions and providing clarifications when needed throughout the study.

In conclusion, should the ongoing brief online mindfulness treatment intervention prove effective in reducing stress, anxiety, depression, and RNT, it could offer an accessible, low-threshold approach to improving mental well-being among the Indonesian population (e.g., graduate students, workers, older adults). This may help address key challenges related to the high cost of healthcare and limited access to mental health services in Indonesia.

Trial status

This project officially started in February 2021 with ethical approval number 7/KEP/II/2021. The protocol is based on the 15 February 2023 version (protocol version 1). Recruitment began on 20 February 2023, and we anticipate concluding the recruitment phase by May 2024, and the overall data collection is expected to end in July 2024. The recruitment is taking longer than anticipated due to the COVID-19 pandemic and some technical problems from the website (platform).

Data availability

Not applicable. The manuscript does not report data. The datasets consecutively generated or analyzed after data collection will be available publicly in the open data repository (repository.maranatha.edu).

Notes

  1. Yan, K., Ikani, N., Yusainy, C., Guineau, M., Witteman, C., & Spijker, J. Mapping stress, anxiety, and depression experienced by non-Western undergraduate students: A network analysis.

Abbreviations

CLPM:

Cross-lagged panel model

CONSORT:

Consolidated Standards of Reporting Trials

DASS-21:

Depression, Anxiety, and Stress Scale 21

FFMQ:

The Five Facet Mindfulness Questionnaires (FFMQ)

ITT:

Intention to treat

LMEM:

Linear mixed-effects models

LMICs:

Low- and middle-income countries

PTQ:

The Perseverative Thinking Questionnaire (PTQ)

RCT:

Randomized controlled trial

RNT:

Repetitive negative thinking

OSF:

Open Science Framework

WHO:

World Health Organization

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Acknowledgements

We would like to thank Sianiwati S. Hidayat and Wolfgang Prawoto for their helpfulness in checking the translation and back translation regarding the scripts for the interventions.

Funding

This work was supported by Universitas Kristen Maranatha, Indonesia (for the main funding) and Radboud University, The Netherlands (for additional funding). The costs of online-platform development used in the current study and reimbursement of participants for their participation were shared between Maranatha and Radboud University. Furthermore, Maranatha covered the open access publication costs. These funding sources had no role in the design of this study and will not have any role during its execution, analyses, interpretation of the data, or decision to submit results. However, the study was reviewed by the ethics committee of Universitas Kristen Maranatha before the funding was obtained.

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Authors and Affiliations

  1. Behavioural Science Institute, Radboud University, Thomas Van Aquinostraat 4, 6525 GD, Nijmegen, The Netherlands

    Ka Yan, Cilia Witteman & Jan Spijker

  2. Fakultas Psikologi, Universitas Kristen Maranatha, Bandung, Indonesia

    Ka Yan

  3. Department of Developmental Psychology, Tilburg University, Tilburg, The Netherlands

    Nessa Ikani

  4. Depression Expertise Center, Pro Persona, Institute for Integrated Mental Health Care, Nijmegen, The Netherlands

    Nessa Ikani & Jan Spijker

  5. Overwaal, Centre of Expertise for Anxiety, Obsessive-Compulsive, and Posttraumatic Stress Disorders, Pro Persona, Institute for Integrated Mental Health Care, Nijmegen, The Netherlands

    Nessa Ikani

  6. Psychology Department Faculty of Social and Political Sciences, Brawijaya University, Malang, Indonesia

    Cleoputri Yusainy

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Contributions

All authors participated in the design of the study. KY wrote the manuscript and coordinates and carries out recruitment and data collection. NI, CY, CW, and JS commented on and revised the manuscript. All authors have approved the final manuscript.

Corresponding author

Correspondence to Ka Yan.

Ethics declarations

Ethics approval and consent to participate

The study was approved by the ethics committee of Universitas Kristen Maranatha, Indonesia (number 7/KEP/II/2021) at the Faculty of Medicine. All methods were performed in accordance with the relevant guidelines and regulations of the Declaration of Helsinki. Written, informed consent to participate will be obtained from all participants.

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Not applicable.

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The authors declare that they have no competing interests to disclose.

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Cilia Witteman is deceased.

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Yan, K., Ikani, N., Yusainy, C. et al. A brief online mindfulness intervention: study protocol for Indonesian undergraduate students, a randomized controlled trial. Trials 26, 155 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s13063-025-08858-y

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