ASSESSMENT OF REFLECTIVE MINDFULNESS AND EMOTIONAL REGULATION TRAINING IN NURSING STUDENTS FOR EMOTIONAL AND PSYCHOLOGICAL REGULATION

Abstract

Background: Nursing students experience considerable academic workload, clinical exposure, and performance pressures that can adversely affect emotional regulation, psychological wellbeing, and academic functioning. In low and middle-income countries, limited access to structured mental health support within educational institutions further amplifies these challenges. Reflective mindfulness combined with emotional regulation training has emerged as a promising, low-cost intervention to enhance psychological resilience, yet robust controlled evidence from such settings remains scarce. Objective: To evaluate the effectiveness of an eight-week reflective mindfulness and emotional regulation training program on emotional regulation, mindfulness, perceived stress, and psychological wellbeing among undergraduate nursing students. Study Design: Prospective controlled trial. Settings: A tertiary care nursing institute in Pakistan. Duration of Study: January to July 2025. Methods: Ninety undergraduate nursing students were enrolled and randomly assigned to an intervention group receiving reflective mindfulness and emotional regulation training in addition to routine academics (n = 45) or a control group receiving only the usual academic routine (n = 45). Primary outcomes were emotional regulation assessed using the Difficulties in Emotion Regulation Scale and mindfulness assessed using the Mindful Attention Awareness Scale. Perceived stress and psychological wellbeing were evaluated using the Perceived Stress Scale and WHO 5 Wellbeing Index. Secondary outcomes included anxiety, depressive symptoms, sleep quality, and self-rated academic functioning. Assessments were conducted at baseline and at 8 weeks post-intervention. Analysis of covariance was applied to compare post-intervention outcomes between groups while adjusting for baseline values. Effect sizes were calculated using Cohen's d. Results: Baseline demographic and psychological characteristics were comparable between groups. At eight weeks, the intervention group demonstrated significantly greater improvements in emotional regulation, mindfulness, perceived stress, and wellbeing compared with the control group (all p < 0.001). Moderate to large effect sizes were observed for emotional regulation (d = 0.95), perceived stress (d = 0.90), and mindfulness (d = 0.84). Significant reductions were also noted in anxiety, depressive symptoms, and sleep disturbances, along with improvements in self-rated academic functioning. Clinically meaningful stress reduction was achieved by 66.7 per cent of students in the intervention group compared with 22.2 per cent in the control group (p < 0.001). Participation in the training program independently predicted stress reduction after multivariable adjustment. Conclusion: Reflective mindfulness and emotional regulation training is an effective intervention for improving emotional regulation, reducing psychological distress, and enhancing wellbeing among nursing students. Incorporating such structured programs into undergraduate nursing curricula may substantially strengthen students' resilience and academic functioning, particularly in resource-constrained educational settings.