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 described at the individual student level, not at the class (or school) level, and no tutoring exception applies.
    • "We randomly assigned these students to an experimental group of 31 (15 boys) and a control group of 31 (16 boys)."
    • Relevant Quotes: 1) "Methods: A total of 46 students were recruited and randomly assigned to either the experimental group (n=22), which participated in the 8-week MBSR program, or the control group (n=24), which received no intervention." (p. 1) 2) "A total of 62 students signed up for MBSR program at a middle school in Changsha, Hunan province. 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: ERCT Criterion C requires randomization at the class level (or stronger, e.g., school level) to reduce contamination across treatment and control. In this paper, the unit of randomization is consistently described as "students" being assigned to experimental vs. control groups within a single middle school. The intervention is a group-based MBSR program, not a one-to-one tutoring/personal teaching intervention, so the tutoring exception does not apply. Because randomization was not at the class level (or school level), the study does not satisfy Criterion C. Criterion C is not met because assignment was at the individual student level rather than at the class (or school) level.
  • E

    Exam-based Assessment

    • Outcomes were measured with self-report questionnaires (PSQI, ASQ, FFMQ) rather than standardized exam-based achievement 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."
    • 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: ERCT Criterion E requires standardized exam-based assessment of educational achievement outcomes (e.g., state/national standardized academic tests). This study evaluates sleep quality, academic stress, and mindfulness using named psychometric questionnaires rather than academic examinations. Therefore, the study does not meet the exam-based assessment requirement. Criterion E is not met because the outcomes are questionnaires, not standardized exam-based academic achievement measures.
  • T

    Term Duration

    • Outcomes were measured after an 8-week program, which is shorter than a full academic term and not documented as term-long follow-up.
    • "After the pre-test, the experimental group was given 8 weeks of MBSR training, while the control group was given no training."
    • 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: ERCT Criterion T requires outcomes to be measured at least one full academic term after the intervention begins (typically about 3 to 4 months). The study describes an 8-week intervention and states that the post-test measurements occurred "After eight weeks," i.e., immediately at the end of the program. Eight weeks is materially shorter than an academic term, and no later follow-up assessment is reported. Criterion T is not met because outcomes were measured after 8 weeks, rather than at least one academic term after the intervention began.
  • D

    Documented Control Group

    • The paper documents the control condition ("no training"), group sizes, and baseline comparability information.
    • "After the pre-test, the experimental group was given 8 weeks of MBSR training, while the control group was given no training."
    • Relevant Quotes: 1) "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) 2) "After the pre-test, the experimental group was given 8 weeks of MBSR training, while the control group was given no training." (p. 3) 3) "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), different variables of the experimental group and control group before intervention is homogeneous, grouping is also reasonable." (p. 4) Detailed Analysis: ERCT Criterion D requires the control group to be documented well enough to support valid comparisons (e.g., who is in the control group, what the control group receives, and baseline characteristics/comparability). The paper specifies the final group sizes, explicitly describes that the control group received "no training," and reports baseline comparability testing between groups for the measured variables. While the control condition is minimal, it is still clearly described and accompanied by baseline comparability reporting. Criterion D is met because the control condition and baseline comparability information are documented.

• Level 2 Criteria

  • S

    School-level RCT

    • Participants came from a single middle school and randomization was not performed at the school level.
    • "A total of 62 students signed up for MBSR program at a middle school in Changsha, Hunan province."
    • 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: ERCT Criterion S requires school-level randomization (schools/sites as the unit of assignment). The paper describes a single middle school and random assignment of students within that school, not randomization of multiple schools. Criterion S is not met because randomization did not occur at the school level.
  • I

    Independent Conduct

    • The paper does not explicitly state that the intervention delivery and evaluation were conducted independently from the intervention designers.
    • "Students in the experimental group participated in an 8-week MBSR program delivered by a professional MBSR instructor."
    • 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: ERCT Criterion I requires evidence that the trial was conducted independently from the intervention designers/providers (e.g., an external evaluation team), reducing bias in implementation, measurement, and analysis. The paper notes that a "professional MBSR instructor" delivered the program, but it does not clarify whether this instructor (or the research team) is independent from those responsible for designing/adapting the intervention. The phrase "two independent researchers" refers to data entry checking and does not establish independent trial conduct or independent outcome assessment. Criterion I is not met because there is no explicit statement of independent (third-party) conduct of the trial.
  • Y

    Year Duration

    • Outcomes were measured after 8 weeks, which is far less than 75% of an academic year, and criterion T is not met.
    • "After eight weeks, sleep quality, academic stress, and mindfulness scales were measured in both the intervention and control groups."
    • 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: ERCT Criterion Y requires outcome measurement at least 75% of an academic year after the intervention begins. The study reports an 8-week program with measurement occurring "After eight weeks," which is substantially shorter than a typical school year and below the 75% threshold. Additionally, ERCT rules specify that if Criterion T is not met, then Criterion Y is not met; here T is not met. Criterion Y is not met because the follow-up duration is 8 weeks and Criterion T is not met.
  • B

    Balanced Control Group

    • The intervention provided additional time and structured activities, but these resources are integral to the MBSR package being tested against a no-intervention control.
    • "After the pre-test, the experimental group was given 8 weeks of MBSR training, while the control group was given no training."
    • 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 to record the practice process and questions." (p. 3) 4) "Secondly, in the experimental design of this study, the control group did not complete any tasks." (p. 5) Detailed Analysis: ERCT Criterion B evaluates whether time/resources are balanced across groups, unless the additional time/resources are explicitly integral to the treatment package being evaluated (i.e., the study is testing that package as delivered). The intervention consists of scheduled instructor-led sessions and daily home practice with a diary, while the control group received "no training" and "did not complete any tasks." This is an unbalanced design in terms of time and attention, but the extra time and structured practice are not described as optional add-ons; they are core components of the MBSR program being tested versus no intervention. Therefore, under the ERCT Criterion B rule that allows integral treatment resources to differ from business-as-usual controls when those resources are part of what is being evaluated, Criterion B is considered satisfied (while noting that this choice of control limits isolation of mindfulness content from non-specific attention/time effects). Criterion B is met because the additional time and activities are integral to the MBSR intervention package that the study evaluates against a no-intervention control.

• Level 3 Criteria

  • R

    Reproduced

    • No independent replication of this specific trial was found in searches of the DOI/title as of 2026-03-14.
    • Relevant Quotes: 1) (No statements about replication of this specific trial were found in the paper.) (p. 1–9) Detailed Analysis: ERCT Criterion R requires evidence that the study has been independently replicated by other researchers (different author team) in a peer-reviewed publication. The paper does not claim replication, and searches using the DOI and full title (e.g., via the publisher page and PubMed record) did not identify an independent replication study that explicitly reproduces this specific trial. Criterion R is not met because no independent replication of this specific RCT was identified as of 2026-03-14.
  • A

    All-subject Exams

    • Criterion E is not met and the study does not report standardized exam outcomes across core 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: ERCT Criterion A requires standardized exam-based assessment across all main subjects, and ERCT rules specify that if Criterion E is not met then Criterion A is not met. This study does not use standardized academic exams and does not assess academic achievement across school subjects. Criterion A is not met because Criterion E is not met and no all-subject standardized exam outcomes are reported.
  • G

    Graduation Tracking

    • The paper reports no long-term follow-up (it notes durability was ignored), and criterion Y is not met.
    • "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."
    • 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: ERCT Criterion G requires tracking participants until graduation (a long- term endpoint). The paper explicitly states it "ignored the durability" of the intervention and suggests the group "could be followed up in the future," indicating that graduation tracking was not performed. Additionally, ERCT rules specify that if Criterion Y (year duration) is not met, then Criterion G is not met; here Y is not met. A search for subsequent follow-up publications by the same authors about this specific cohort (using the DOI/title/author names) did not identify a graduation-tracking follow-up paper as of 2026-03-14. Criterion G is not met because there is no graduation tracking and Criterion Y is not met.
  • P

    Pre-Registered

    • The paper does not mention a registry ID or protocol pre-registration date, and no corresponding registration record could be verified.
    • Relevant Quotes: 1) (No trial registration, pre-registration, registry ID, or registration date is reported in the paper.) (p. 1–9) Detailed Analysis: ERCT Criterion P requires a publicly accessible pre-registered protocol (with a registry/platform and identifier) and evidence that registration occurred before data collection began. The paper includes ethics approval information but provides no registration identifier or pre-registration statement. Because no registry information is provided in the paper, there is no specific protocol record to validate against a database entry. Criterion P is not met because the paper provides no evidence of pre-registration (no registry/platform and ID/date).