Effects of mindfulness-based stress reduction on sleep quality and academic stress of Chinese adolescents: a randomized controlled trial

ERCT Criteria Breakdown

• Level 1 Criteria

  • C

    Class-level RCT

    • Randomization was at the student level within one school, not at the class (or higher) level, and the intervention is not described as one-to-one tutoring.
    • "We randomly assigned these students to an experimental group of 31 (15 boys) and a control group of 31 (16 boys)." (p. 2)
    • Relevant Quotes: 1) "A total of 62 students signed up for MBSR program at a middle school in Changsha, Hunan province." (p. 2) 2) "We randomly assigned these students to an experimental group of 31 (15 boys) and a control group of 31 (16 boys)." (p. 2) 3) "Then they were randomly divided into experimental group and control group." (p. 3) Detailed Analysis: Criterion C requires randomization at the class level (or stronger), to reduce contamination when students within the same class interact and teachers may inadvertently apply aspects of the intervention to all students. The paper describes a single middle school and states that students were randomly assigned to experimental vs. control groups. There is no statement that intact classes (or schools) were randomized. The intervention is a group program plus homework practice, not one-to- one tutoring, so the tutoring exception does not apply. Final sentence: Criterion C is not met because students (not classes or schools) were randomized within one school and the intervention is not one-to-one tutoring.
  • E

    Exam-based Assessment

    • Outcomes were measured with self-report questionnaires/scales (PSQI, ASQ, FFMQ), not standardized exam-based academic assessments.
    • "Assessments using the Pittsburgh Sleep Quality Index (PSQI), the Academic Stress Questionnaire (ASQ), and the Five Factors Mindfulness Scale (FFMQ) were conducted before and after the intervention period." (p. 1)
    • Relevant Quotes: 1) "Assessments using the Pittsburgh Sleep Quality Index (PSQI), the Academic Stress Questionnaire (ASQ), and the Five Factors Mindfulness Scale (FFMQ) were conducted before and after the intervention period." (p. 1) 2) "Academic stress was measured by the Academic Stress Questionnaire (ASQ) (Chung, 2018)." (p. 2) 3) "Sleep quality over the past month was assessed with the Chinese version of Pittsburgh Sleep Quality Index (PSQI)..." (p. 3) 4) "The Five Facet Mindfulness Questionnaire (FFMQ) prepared by Baer et al. (2006) was used to measure Mindfulness." (p. 3) Detailed Analysis: Criterion E requires standardized exam-based assessments of educational outcomes (i.e., academic achievement tests/exams). This study measures sleep quality, academic stress, and mindfulness using self-report instruments (PSQI, ASQ, FFMQ). These are not standardized academic exams. Final sentence: Criterion E is not met because the outcomes are measured with questionnaire scales rather than standardized academic exams.
  • T

    Term Duration

    • Outcomes were measured immediately after an 8-week intervention, which is shorter than a full academic term (typically ~3-4 months).
    • "After the pre-test, the experimental group was given 8 weeks of MBSR training, while the control group was given no training." (p. 3)
    • Relevant Quotes: 1) "After the pre-test, the experimental group was given 8 weeks of MBSR training, while the control group was given no training." (p. 3) 2) "The experimental group participated in a 90-min mindfulness-based stress reduction program every Tuesday afternoon for eight weeks." (p. 3) 3) "After eight weeks, sleep quality, academic stress, and mindfulness scales were measured in both the intervention and control groups." (p. 3) Detailed Analysis: Criterion T requires that outcomes are measured at least one full academic term after the intervention begins (or that a shorter intervention has at least term-long follow-up). Here, the intervention lasts eight weeks and outcomes are measured immediately after eight weeks. Eight weeks is substantially shorter than a typical academic term (approximately 12-16 weeks), and the paper does not describe later follow-up measurement. Final sentence: Criterion T is not met because outcomes were measured at the end of an 8-week period, shorter than a full academic term.
  • D

    Documented Control Group

    • The control group is clearly described (no training) and the paper reports sample sizes, demographics, and baseline comparability across groups.
    • "After the pre-test, the experimental group was given 8 weeks of MBSR training, while the control group was given no training." (p. 3)
    • Relevant Quotes: 1) "We randomly assigned these students to an experimental group of 31 (15 boys) and a control group of 31 (16 boys)." (p. 2) 2) "In the end, a total of 46 subjects completed the experiment, including 22 in the experimental group (10 boys) and 24 in the control group (12 boys)." (p. 2) 3) "After the pre-test, the experimental group was given 8 weeks of MBSR training, while the control group was given no training." (p. 3) 4) "TABLE 1 Demographic characteristics." (p. 4) 5) "Using independent sample t test analysis of baseline data experimental group and control group, according to the results, experimental group and control group before intervention sleep quality, academic stress and mindfulness scores had no significant difference (p 0.05)..." (p. 4) Detailed Analysis: Criterion D requires that the control group is well documented, including what it received, its size, and baseline characteristics/baseline comparability. The paper states the control group was given "no training," provides final group sizes, provides demographic characteristics (Table 1), and reports baseline equivalence on the main measured variables. Final sentence: Criterion D is met because the control group condition and baseline group characteristics/comparability are documented.

• Level 2 Criteria

  • S

    School-level RCT

    • This is not a school-level RCT because only students (not schools) were randomized and the study took place in one middle school.
    • "A total of 62 students signed up for MBSR program at a middle school in Changsha, Hunan province." (p. 2)
    • Relevant Quotes: 1) "A total of 62 students signed up for MBSR program at a middle school in Changsha, Hunan province." (p. 2) 2) "We randomly assigned these students to an experimental group of 31 (15 boys) and a control group of 31 (16 boys)." (p. 2) Detailed Analysis: Criterion S requires randomization among schools (or equivalent sites). This paper describes one middle school and random assignment of students, not assignment of multiple schools to intervention vs. control. Final sentence: Criterion S is not met because randomization is not at the school level.
  • I

    Independent Conduct

    • The paper does not document an independent external evaluator; "two independent researchers" double-checking data entry does not establish independence from intervention design/delivery.
    • "To ensure data accuracy, all data entries were double-checked by two independent researchers." (p. 3)
    • Relevant Quotes: 1) "Students in the experimental group participated in an 8-week MBSR program delivered by a professional MBSR instructor." (p. 3) 2) "To ensure data accuracy, all data entries were double-checked by two independent researchers." (p. 3) Detailed Analysis: Criterion I requires that the evaluation be conducted independently from the intervention designers/authors (e.g., external evaluation team or explicit third-party conduct of implementation and/or analysis). The paper notes delivery by a professional MBSR instructor but does not clarify whether the instructor/evaluators were independent of the authors or intervention adaptation. The "two independent researchers" statement refers to data-entry checking rather than independent evaluation of the intervention. Final sentence: Criterion I is not met because the paper does not clearly document independent conduct of implementation and evaluation.
  • Y

    Year Duration

    • Outcomes were measured after 8 weeks, far shorter than 75% of an academic year; additionally, per ERCT rules, if T is not met then Y is not met.
    • "After eight weeks, sleep quality, academic stress, and mindfulness scales were measured in both the intervention and control groups." (p. 3)
    • Relevant Quotes: 1) "After the pre-test, the experimental group was given 8 weeks of MBSR training, while the control group was given no training." (p. 3) 2) "After eight weeks, sleep quality, academic stress, and mindfulness scales were measured in both the intervention and control groups." (p. 3) Detailed Analysis: Criterion Y requires outcomes to be measured at least 75% of one academic year after the intervention begins. The study measures outcomes after eight weeks, which is far shorter than an academic year. Per the ERCT dependency rule provided, if Criterion T is not met, then Criterion Y is not met. Final sentence: Criterion Y is not met because the study tracks outcomes for only eight weeks from start to measurement.
  • B

    Balanced Control Group

    • The intervention group received substantial additional structured time and activities (weekly 90-min sessions plus daily practice) while the control group received no comparable substitute activity.
    • "Secondly, in the experimental design of this study, the control group did not complete any tasks." (p. 5)
    • Relevant Quotes: 1) "After the pre-test, the experimental group was given 8 weeks of MBSR training, while the control group was given no training." (p. 3) 2) "The experimental group participated in a 90-min mindfulness-based stress reduction program every Tuesday afternoon for eight weeks." (p. 3) 3) "Participants were required to practice for 30–45 min every day and to fill in a mindfulness diary..." (p. 3) 4) "Secondly, in the experimental design of this study, the control group did not complete any tasks." (p. 5) Detailed Analysis: Criterion B compares the nature, quantity, and quality of resources (time, structured activity, adult support) provided to intervention vs. control, unless the study explicitly frames extra resources as the treatment variable being tested. Here, the intervention includes additional instructor-led time (90 minutes weekly for 8 weeks) and required daily practice (30–45 minutes) plus diary completion. The control group is described as receiving "no training" and explicitly as not completing any tasks, meaning there is no active control that matches time/attention/structured engagement. The paper presents the intervention as an MBSR program (a package of content and practice), not as a test of "additional time" alone. Therefore, the large time/engagement imbalance remains a confound relative to a passive control. Final sentence: Criterion B is not met because the control group lacks a comparable substitute for the substantial additional time and structured activities required in the intervention group.

• Level 3 Criteria

  • R

    Reproduced

    • No independent replication of this specific study by other authors was found in the paper or via internet search as of the ERCT check date.
    • Relevant Quotes: 1) (No relevant statements in the paper indicate that this specific trial was independently replicated by a different research team.) Detailed Analysis: Criterion R requires independent replication by other researchers in a peer-reviewed outlet. This paper does not report that it is a replication, does not cite an independent replication of this specific study, and contains no replication identifier that would establish reproduced status. An internet search by DOI and title (performed as part of this ERCT check) did not identify an independent peer-reviewed replication of this specific trial as of 2026-03-13. Final sentence: Criterion R is not met because independent replication of this specific study was not found.
  • A

    All-subject Exams

    • Criterion A is not met because Criterion E is not met and the study does not use standardized academic exams across subjects.
    • Relevant Quotes: 1) "Assessments using the Pittsburgh Sleep Quality Index (PSQI), the Academic Stress Questionnaire (ASQ), and the Five Factors Mindfulness Scale (FFMQ) were conducted before and after the intervention period." (p. 1) Detailed Analysis: Criterion A requires all-subject standardized exam-based assessment, and the ERCT rule states that if Criterion E is not met then Criterion A is not met. This study does not use standardized academic exams and does not test academic outcomes across subjects. Final sentence: Criterion A is not met because standardized exam-based assessment is absent (so E fails), making all-subject exams impossible to satisfy.
  • G

    Graduation Tracking

    • Graduation tracking is not reported; additionally, per ERCT rules, if Y is not met then G is not met, and no follow-up paper reporting graduation tracking was found.
    • "Finally, the study also ignored the durability of MBSR interventions, the experimental group could be followed up in the future to further explore this issue." (p. 5)
    • Relevant Quotes: 1) "Finally, the study also ignored the durability of MBSR interventions, the experimental group could be followed up in the future to further explore this issue." (p. 5) Detailed Analysis: Criterion G requires follow-up tracking until participants graduate from the relevant educational stage. The paper explicitly states durability follow-up was ignored and frames any follow-up as something that "could be" done in the future, which indicates graduation tracking was not conducted in this study. Per the ERCT dependency rule provided, if Criterion Y is not met then Criterion G is not met. An internet search by DOI, title, and author names (performed as part of this ERCT check) did not identify a subsequent peer-reviewed follow-up paper reporting graduation tracking for this cohort as of 2026-03-13. Final sentence: Criterion G is not met because the study does not track participants to graduation (and Y is not met), and no graduation follow-up publication was found.
  • P

    Pre-Registered

    • No pre-registration link/ID or registration date is reported, and searches did not identify a public pre-registered protocol for this specific trial.
    • Relevant Quotes: 1) "The study was approved by the Hunan Normal University Ethics Committee (NSK-2020320)." (p. 2) 2) "The datasets presented in this study can be found in online repositories." (p. 7) Detailed Analysis: Criterion P requires a publicly accessible pre-registered protocol (with an ID/link) registered before data collection began. The paper reports ethics approval and a data availability statement, but it does not provide a trial registration number, a registry name (e.g., OSF/ClinicalTrials.gov/ChiCTR), or any pre-registration date. A search of the paper PDF for registration-related terms (e.g., "registered" and "pre-registered") found no matches, and an internet search by DOI/title did not identify a corresponding public pre-registration record as of 2026-03-13. Final sentence: Criterion P is not met because no pre-registration ID/link and pre-data-collection registration date are provided or found.