key: cord-0844841-0a1sx8gu authors: Xu, Joy; Jo, Helen; Noorbhai, Leena; Patel, Ami; Li, Amy title: Virtual mindfulness interventions to promote well-being in adults: A mixed-methods systematic review date: 2022-03-01 journal: J Affect Disord DOI: 10.1016/j.jad.2022.01.027 sha: ad6c99662c60b1f40326290ba5f3d6d84915ada5 doc_id: 844841 cord_uid: 0a1sx8gu BACKGROUND: With the onset of the COVID-19 pandemic, many have experienced drastic changes in their academic and social lives with ensuing consequences towards their physical and mental well-being. The purpose of this systematic review is to identify virtual mindfulness-based interventions for the well-being of adults aged 19 to 40 years in developed countries and examine the efficacy of these techniques/exercises. METHODS: This mixed-methods systematic review follows the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines with a registered PROSPERO protocol. With a convergent integrated synthesis approach, IEEE Xplore, PsychInfo, Web of Science and OVID were searched with a predetermined criteria and search strategy employing booleans and filters for peer-reviewed and gray literature. Data screening and extraction were independently performed by two authors, with a third author settling disagreements after reconciliation. Study quality of selected articles was assessed with two independent authors using the Mixed Methods Appraisal Tool (MMAT). Studies were analyzed qualitatively (precluding meta and statistical analysis) due to the heterogeneous study results from diverse study designs in present literature. RESULTS: Common mindfulness-based interventions used in the appraised studies included practicing basic mindfulness, Mindfulness-Based Stress Reduction (MBSR) programs, Mindfulness-Based Cognitive Therapy programs (MBCT) and the Learning 2 BREATHE (L2B) program. CONCLUSION: Studies implementing mindfulness interventions demonstrated an overall improvement in well-being. Modified versions of these interventions can be implemented in a virtual context, so adults can improve their well-being through an accessible format. Well-being is a subjective state without a universal definition due to its diverse manifestation in different individuals. According to the Centers for Disease Control, well-being can be defined as having a positive outlook on life and feeling content (Well-Being Concepts. Cdc.gov, 2018) . Beyond the mental aspect, well-being encompasses a holistic approach to health by integrating both physically and mentally positive aspects throughout daily activities (Well-Being Concepts. Cdc.gov, 2018) . Thereby, well-being serves as an important factor in maintaining the quality of life for all individuals. Within academia, well-being is a particularly vulnerable area as students transition through varying stressors, including changes in lifestyle, academic stress, and new responsibilities. The transition from adolescence to adulthood presents additional risks for poor well-being with potential consequences affecting one's academic and personal life (Hofmann and Gómez, 2017) . In 2019, the American College Health Association found 36.5% of US college students reporting stress as a major factor negatively affecting student's academic performance (Acha.org., 2021) . Amidst the COVID-19 pandemic, students face additional challenges; 71% of students from American public universities report a direct increase to stress levels due to the pandemic, which also contributes to more frequent depressive thoughts and higher levels of anxiety (Hofmann and Gómez, 2017) . Thus, there is a clear need for improving student well-being through personalized interventions. For students, these interventions may assist in managing stress levels, reducing anxiety, and improving cognitive awareness (improves learning skills and productivity). Mindfulness is a significant aspect of well-being. Mindfulness involves bringing awareness to present-moment experiences like thoughts, body sensations, and the environment (without judgement). Mindful awareness contrasts with the default mode of everyday life, where the state of attention for many individuals is inattention as the mind may wander or operate mindlessly. However, awareness of the present requires one to consider internal experiences including personal thoughts, feelings and sensations, which may elicit attention towards potentially negative emotions that certain individuals tend to suppress. For many individuals, the ability to confront and process negative thoughts and emotions is a difficult process. These aversive effects are illustrated by 11 laboratory studies, where healthy adult subjects preferred monotonous tasks or mild electrical shocks rather than being left alone in their own thoughts (Hofmann and Gómez, 2017) . However, mindfulness provides an opportunity for individuals to acknowledge these aspects and progressively improve habits or lifestyle choices. Bringing awareness to negative thoughts as they arise prevents them from spiraling out of control into further negative thought patterns. By implementing personalized interventions, the transition towards practicing mindfulness can be eased to reduce negative responses to one's internal and external experiences. Mindfulness provides long-term management of well-being as individuals become aware of the root of negative emotions and resolve these issues rather than let them worsen in the future. With greater awareness of the present, individuals may confront and accept feelings of stress, anxiety, fear, hate, sadness with greater ease. Unhealthy ways of coping, suppression of stress, mental breakdowns, burn out, and physiological issues from chronic stressors can result from maladaptively addressing these negative emotions (Hofmann and Gómez, 2017) . The significance of mindfulness interventions are explored within research, but a gap in the present literature remains within virtual integrations of these interventions specifically targeted towards adults. Therefore, this systematic review assesses effective strategies to improve well-being within an academic context for adults from ages 19 to 40 years old. By identifying, appraising and integrating present literature, mindfulness-based interventions can be evaluated for most desirable outcomes. This mixed methods systematic review aims to answer the following research question: What mindfulness-based interventions can be integrated into a mobile application to promote wellbeing of individuals (students) between the ages of 19 and 40 years old? These findings may be integrated into the Felicity App, a virtual application targeting students in developed countries to provide productivity enhancement techniques through a mobile and web application. Productivity incorporates several facets, where well-being serves as an important aspect to improve productivity and proactively prevent demotivation and burnout by managing stress levels. A systematic review was conducted to assess mindfulness interventions in the context of well-being for students to improve productivity, motivation, and overall mental health. The current review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement [67] and the protocol is registered in PROSPERO, an international database of prospectively registered systematic reviews in health and social care. Virtual mindfulness interventions that can improve students' wellbeing were examined through this systematic review. The virtual element of these interventions may allow for multi-media incorporation, such as within a mobile application to help students improve their emotional and academic experience. Apps allow for interactive participation, accessibility and flexibility of options. Statistics Canada has determined that many people 15 years of age and older own a smartphone and 45.4% of those individuals check it every 30 minutes (Statistics Canada, 2021) . Thus, a smartphone app is accessible and virtual interventions through mobile apps can be seamlessly integrated into the lifestyles of this age demographic. The target audience for this application are adults between 19 and 40 years of age in developed countries located in North America, Asia, Australia and Europe. A mixed method study design was used to ensure qualitative and quantitative elements of the mindfulness-based intervention strategies are included in the systematic review. Quantitative data provides measurable information on how mindfulness-based interventions improve cognition and overall well-being for students. Qualitative data allowed for identification of patterns observed with mindfulness-based interventions and the perspectives associated with different intervention methods. Both forms of data are important to ensure the most effective mindfulness-based interventions are integrated and that optimal well-being strategies can be used by users. Due to the diverse study designs, subsequent study findings have shown significant heterogeneity and statistical analysis is precluded by qualitative analysis. IEEE Xplore, PsychInfo, Web of Science, ProQuest and OVID were searched for articles published between January 1980 and January 2021, using keywords related to mindfulness, productivity, wellness, and cognition in students. A broad range of keywords were used to ensure all relevant studies were included in the search, with accompanying filters and booleans (refer Appendix 1 for the full search strategy and Appendix 2 for the gray literature search strategy). For the implementation of gray literature, a search for articles was conducted in various databases and websites, specifically the National Center for Biotechnology Information (NCBI) and the Web of Science. The snowballing method was used to search Google Scholar to identify additional sources from references cited in conference proceedings and web pages. The search strategy was created by using keywords with different booleans and truncations. The specific words " mindfulness and student*, learn*, burnout or stress or motivat*, productiv*, cognit*, atten*, creativ*, virtual, intrinsic were used for extraction. Other specific words such as teacher or professor or kindergarten or children or ADHD or GAD or TBI or injury aided in excluding material through the "not" function. This comprehensive set of sources were processed with more advanced screening to attain the most relevant literature. Specific filters were added to databases to screen full-texts when possible. The predetermined criteria for inclusion includes psychology studies published in English between 1980 and January 2021. Eligible study designs included randomized controlled trials (RCTs), meta-analyses, systematic reviews, and gray literature. To be included, studies must mention the impact of mindfulness interventions on any of the following: motivation, burnout, stress, learning, cognition, and productivity related topics. These interventions must be virtually transferable and excluded individual therapy. The study participants were adults between ages 19 and 40 of all genders, and residing in North America, Europe, Asia, or Australia. Studies with interventions targeted to individuals with a physical illness, mental illness, or learning disability were excluded. Any articles that were not available online and were published by organizations with conflicts of interest were also excluded from this systematic review (refer to Appendix 4 for a list of excluded studies). A predetermined, piloted screening tool was developed using the inclusion and exclusion criteria. The screening tool ensured that only relevant data would be collected from abstracts and full text articles. The pilot trial of the screening tool were conducted independently and prompted necessary revisions to improve precision. Modifications to the tool were prompted by discussions during reconciliation. A total of 915 articles were initially searched, with findings consisting of 71 gray literature and 844 peer reviewed articles. The database search results were combined, and duplicate articles (n = 20) were removed manually using Endnote (version 8) prior to the screening phase. Within study selection, titles and abstracts of 895 articles were screened by two independent authors on January 31, 2021. Any disagreements between the two independent authors were reconciled and disagreements were resolved with a third author. Prior to full-text screening, 3 gray literature and 116 peer-reviewed articles proceeded towards full-text screening with two independent authors, reconciliation, and a third author for resolving disagreements. After full text screening of the initial papers, a total of 22 studies remained. Upon initial study selection, reference lists of included articles were hand searched and screened for potential inclusion. During the first round of hand search screening, 1302 peer reviewed articles went through abstract screening by two independent authors using the piloted screening tool to produce 57 papers. Full texts were screened independently by the two authors, then reconciled to resolve any disagreements with a third author for resolution. In total, 17 studies from hand searches were included. Data extraction was performed in duplicate with two independent authors, with study characteristics including author, title, study duration, study population, location, intervention methods and results. In total, 39 studies were included in this systematic review. The Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of the articles included in the study. The MMAT is a critical appraisal tool used to assess qualitative, quantitative, and mixed methods studies. The MMAT provides an effective measure to appraise a wide variety of empirical studies. The tool has been tested for reliability and content validity, however, the literature on the quality of the MMAT lacks consensus. Articles are organized into five categories: (1) qualitative research, (2) randomized controlled trials, (3) non-randomized trials, (4) quantitative descriptive studies, and (5) mixed methods studies. Upon determining study category, quality ratings are provided according to subsequent criteria. Two independent reviewers appraised 39 articles using the MMAT. After individually assessing the articles, reviewers reconciled ratings and a third author resolved conflicts through discussion. Duplicate studies were removed after the review and a total of 32 quality appraised studies remained. Data extraction was completed by two independent reviewers and reconciled, with a third author for potential disagreements. A table was synthesized for the final study characteristics (refer to Appendix 3). The table consisted of the following information: first author, title, country, study design, duration, participants, type data, outcome, and quality/ design score. The quality/design score was obtained through the process of quality assessment using the MMAT. The study selection and screening process is outlined in Fig. 1 . A total of 32 studies are included in this systematic review. Of all the articles, 3 were qualitative studies, 5 were quantitative non randomized studies, 4 were quantitative descriptive studies, and 3 were mixed methods studies. The remaining 17 studies were quantitative randomized controlled trials. Of the 32 articles, Netherlands, Singapore, Japan and Australia contributed one study per country. 2 studies were from Taiwan and the remaining studies were from the USA. All included studies passed the initial screening criteria and was rated based on the MMAT. Among the 32 articles that were quality appraised 12 were rated an overall score of five, 16 were rated four, and 4 were rated three. None of the included studies were rated two or one stars. Data and results were extracted from the literature and synthesized into a study characteristics table (refer to Appendix 3). The main outcomes that met the inclusion and exclusion criteria and contributed to improved well-being were compared. The analysis of mindfulness interventions and their effectiveness resulted in the identification of five themes. 1 Basic mindfulness refers to an intervention involving focused attention to a sensory experience such as rhythmic breathing and attention monitoring. 2 MBSR refers to an 8-week Mindfulness-Based Stress Reduction program encompassing techniques for guided mindfulness using meditation, and a focus on opening up to a moment-by-moment experience. 3 L2B refers to the Learn 2 Breath program dedicated to the acronym BREATHE. The core themes established include: having a body awareness, understanding one's thoughts, working with one's feelings, the integration of thoughts, feelings and sensations, decreasing harmful self-judging thoughts, and making a conscious effort into integrating mindfulness practises in daily life. 4 MBCT refers to mindfulness-based cognitive therapy which focuses on acceptance and awareness of thoughts and emotions. 5 Unique Methods included different techniques that did not fit into established programs and were used for assessing positive emotions, feelings of meaning, and purpose. The five qualitative mindfulness themes that contributed to improving well-being were found to be interrelated and often had similar targets and outcomes. Strong correlations were determined between the implementation of mindfulness interventions and overall mental health. Students that practiced mindfulness reported lower levels of stress, depression, and sleep issues, leading to an overall increase in the well-being of adults (Shapiro et al., 1998) . Mindfulness interventions also decreased the frequency of experiencing negative emotions and enhanced attention to personal emotions (Zeidan et al., 2010) . Heightened awareness resulted in better regulation of their emotions so that students could experience greater equanimity and less reactivity (Zeidan et al., 2010) . In addition, students practicing mindfulness reported significantly less burnout compared to the control group (Sankoh, 2019) . Anxiety is a common symptom observed in adults experiencing constantly changing environments, particularly in individuals learning how to adapt to varying work flows and lifestyles (Nicole and LeBlanc, 2019). The effect of different mindfulness-based interventions (MBI) were assessed to observe its effect on improving anxiety in college students. A study by Bamber and Morpeth (2019) concluded that MBI with a focus on relationships/loving-kindness and insightful meditations were shown to have no significant effect on anxiety. However, students who participated in brief focused breathing exercises reported increased performances in difficult arithmetic tests, due to a reduction in anxiety after the exercises (de Bruin et al., 2015) . When students participated in MBI, a reduction of anxiety symptoms was reported (Potek, 2011; Stein, 2016) . These studies indicate that MBI with a focus on breathing can reduce anxiety levels in college students. MBI has also been shown to influence academic performance in students. Bellinger et al. (2015) determined an indirect benefit of mindfulness in improving math performance by reducing anxiety. Mindfulness interventions before quizzes improved performance, but short five minutes bi-weekly sessions of mindfulness had no significant effect on students' exam scores (Calma-Birling and Gurung, 2017). These findings suggest that brief mindfulness can be beneficial for enhancing knowledge retention of lecture content in the short term. Lin and Mai (2018) also found significant short-term improvements in academic performance. In the long-term, however, several studies found no significant improvements in academic performance after mindfulness interventions (Stein, 2016; Yamada and Victor, 2012) . In contrast, Cavanagh et al. (2019) found that mindfulness interventions resulted in better final exam performance in conjunction with cognitive reappraisal (which involves mentally reframing views of boredom, frustration, and anxiety to change their meaning and the emotions they arouse). Though mindfulness may not have directly impacted exam performance, mindfulness could increase student awareness of personal feelings (such as boredom) for recognition and proactively apply cognitive reappraisal techniques to reframe them. Mindfulness interventions played a role in enhancing metacognitive ability. The implementation of meditation exercises were shown to enhance introspective accuracy including visceral sensations, affective states, and ongoing performance on tasks. Meditation exercises focused on breathing enhanced metacognitive ability for memory, but there were no significant improvements in perceptual decisions (Baird et al., 2014) . Although many papers reported that mindfulness led to more positive emotional experiences, interventions did not produce significantly higher levels of emotional intelligence (Sankoh, 2019) . In addition, interventions reduce mind wandering on tasks requiring sustained attention which may be beneficial for college students, as most schoolwork requires sustained attention (Rahl et al., 2017) . Students also report being more "on-task" after mindfulness training (Rahl et al., 2017) . Yamada and Victor (2012) found that 81% of students self-reported positive effects of mindful awareness practices on their learning, indicating that students enjoy this practice. In terms of memory, a short-term 15-minute mindfulness practice had no impact on working memory tasks (Quek et al., 2021) . Working memory refers to the ability to temporarily store and use the information to solve problems. A week-long mindfulness intervention did not increase working memory or decrease mind wandering, yet it prevented stress-related working memory impairments, which suggests short-term mindfulness has indirect benefits to working memory (Banks et al., 2015) . However, a more extended approach where focused attention meditation was practiced for two weeks showed significant improvements in memory (Baird et al., 2014) . This systematic review provides an examination of the current literature regarding the impact of mindfulness interventions to improve well-being along with academic success. Generally, practicing mindfulness improved mental health and had positive psychological results, but the outcomes for academic performance were mixed. Five different intervention strategies will be discussed in depth for potential implementation. Considering the COVID-19 worldwide pandemic, it is important that these strategies can be applied successfully in virtual settings as well. Many studies included in this review incorporated generic mindfulness techniques rather than following specific programs. Common exercises included in sessions are rhythmic breathing, meditation, attention monitoring, and acceptance. Baird et al. (2014) identified basic mindfulness as meditation exercises requiring focused attention to some aspect of sensory experience. Wei Lin and Mai (2018) introduced basic sitting meditation to students to stabilize the mind and rhythmic breathing exercises to increase focus and self awareness. Rhythmic breathing involves focusing the attention on one's nostrils, and the act of breathing (Lin and Mai, 2018) . Results from this study showed that those who completed these basic MM were able to sustain their focus, improving learning. Mindfulness questionnaires also indicated that students felt an increased amount of mindfulness after completing the meditations, compared to the control group (Lin and Mai, 2018) . Other forms of basic mindfulness focus on attention monitoring and acceptance. Attention monitoring trains students to focus on breathing and somatic sensations, thoughts and emotions, and meta-awareness of cognitive, emotional and physical events (Rahl et al., 2017) . Acceptance trains students to have non-judgemental attitudes towards these thoughts and sensations (Rahl et al., 2017) . Many other studies were conducted in which students were trained in these MM practices as an anchor for attention, so that they could sustain their attention on sensations and emotions without being distracted (Baird et al., 2014) . Generally, implementations of these techniques enhanced students' ability to sustain attention which improved short-term academic and task performance (Zeidan et al., 2010; Stein, 2016; Brown et al., 2016; Bernardez et al., 2020; Shapiro et al., 2008) . A common mindfulness intervention that is effective for improving college student well-being is the Mindfulness-Based Stress Reduction (MBSR) program lasting 8 weeks (Sankoh, 2019) . MBSR is a form of guided meditation to improve mindfulness. Jain et al. (2007) examined the effect of the MBSR program on full-time medical students, nursing graduate students, and undergraduate students enrolled in a premedical program. The study compared mindfulness meditation (MM) and somatic relaxation (SR) given in the MBSR format focusing on the improvement of students' well-being. The MM intervention consisted of guided body scan meditation, where one gradually focuses their attention to each part of the body, sitting meditation, Hatha yoga (which consists of stretching the body through gentle movements), walking meditation, and loving-kindness meditation, where one expresses feelings of love and kindness to oneself and others (Jain et al., 2007) . The SR intervention consisted of muscle relaxation and breathing exercises. The results indicate that MM interventions given in the MBSR format enhance positive mindsets and reduce ruminative and distractive thoughts associated with depressed moods, increasing cognitive ability (Jain et al., 2007) . Another study was conducted on medical students using the MM interventions stated in the previous study (Shapiro et al., 1998) . Medical students were given training in all of the interventions over 8 weeks. The MM interventions given over the MBSR program in this study were shown to improve psychological well-being, reduce state and trait anxiety, and increase empathy (Shapiro et al., 1998) . A derivative of MBSR was used to assess the effect of mindfulness practices on student learning in a course. The study consisted of a 10 min sitting meditation routine led by an instructor at the beginning of each class (Yamada and Victor, 2012) . Students in the intervention group reported a better cognitive experience by participating in the 10 min mindfulness activity before class (Yamada and Victor, 2012) . However, the final exam scores showed no significant improvement for the course between the intervention group and the control group without training (Yamada and Victor, 2012) . Studies were also conducted comparing MBSR and E. Easwaran's 1978/1991 eight-point program (EPP) on improving mindfulness in college students. No significant differences were found between MBSR and EPP, and both were found to reduce stress (Jain et al., 2007; Oman et al., 2008 ). An 8-week long MBSR program with 7 weekly two-hour classes was set up for students (Johnson, 2016) . The group which participated in the MBSR program showed significant improvements on the Mindfulness Attention and Awareness scale, and improvements with working memory capacity and visual threshold (Yamada and Victor, 2012) . Sankoh (2019) created a modified 8-week MBSR course for medical and premedical students with reduced class times to match the students schedules. Students were also encouraged to use the Headspace mobile app to practice mindfulness during their own time (Sankoh, 2019) . Little significance was found in mindfulness scores between students who participated in the modified MBSR compared to those who did not (Sankoh, 2019) . Those who did the course reported feeling smaller impacts of burn out, compared to those who did not do the course (Sankoh, 2019) . Articles in this review show strong evidence that MBSR programs can be an effective method for students to increase mindfulness and reduce stress (Sankoh, 2019) . They can also be modified to fit the lifestyles of students, and still have a significant improvement on well-being. Mindfulness meditation can be taught in the form of Mindfulnessbased cognitive therapy (MBCT). The goal of Mindfulness meditation (MM) was to promote awareness and acceptance of thoughts and emotions rather than the suppression of them (Banks et al., 2015) . Participants were taught to focus on breathing and take note of any mind wandering that occurs, promoting acceptance, rather than judge oneself for it (Banks et al., 2015) . Focusing the mind on simple breathing was encouraged (Banks et al., 2015) . Results of this study indicated that MM did not improve mind wandering, or working memory, but did have a strong significance in improving mindfulness in students (Banks et al., 2015) . A popular intervention revolved around specific focused-attention meditation and breathing called Learning to BREATHE (L2B) (Cavanagh et al., 2019) . In these techniques, students were told to choose a specific task (such as breathing), recognize when the brain becomes distracted from the task, be able to shift attention back to breathing, and have strong cognitive understanding of distractors (Calma-Birling and Gurung, 2017) . Core practises included a body scan, maintaining mindfulness of thoughts, emotions and movements (Metz et al., 2013) . These breathing exercises were successful when performed right before small quizzes, but not in long-term effects on scores (Metz et al., 2013) . Additionally, the goals for the program involved gradually building up inner strength and empowerment through the commonly used structure of 8 sessions (Metz et al., 2013) . The program hoped to enhance the students' skills in regulating emotions, improve management of stressful situations, and improve learning processes (Metz et al., 2013) . As a result, this program was successful for stress reduction and management, self-regulation, and improvements towards a healthier lifestyle (e. g. more exercise and less alcohol consumption) (Dvořáková et al., 2017) . Finally, participants in the program demonstrated high gains in emotion regulation above all (Metz et al., 2013) . Overall, L2B is an effective method for long term emotional/stress regulation. Some papers presented unique mindfulness interventions that were applicable to their specific research aims without using pre-existing programs. Instead of using general mindfulness techniques, studies used cognitive reappraisal interventions, positive psychology interventions (PPIs), and somatic psychoeducation (Cavanagh et al., 2019; Young et al., 2020; Yamaji, 2016) . Through cognitive reappraisal interventions, there was a focus on normalizing emotions in a college classroom setting (Cavanagh et al., 2019) . Mindful ways of approaching emotional experiences were introduced, rather than techniques for reappraisal (Calma-Birling and Gurung, 2017). PPIs were used for students taking a positive psychology course (Young et al., 2020) . One study researched the effects of a somatic psychoeducation experimental course on well-being by organizing activities designed to increase somatic awareness and trust between other people (Yamaji, 2016) . One way that mindfulness interventions can be introduced into virtual platforms is through breathing reminders. Users can choose to receive reminders to breathe and focus their attention on body sensations and present emotions. Notifications to 'remember to breathe' could appear hourly or whenever the user decides upon routinely. The pop up reminder could also include a link to more detailed meditation practices or an image with a quick exercise. One limitation is that pop up notifications are easily dismissible. Another feature that can be incorporated is modified versions of preexisting mindfulness programs, like MBSR (8 weeks) and L2B (6 weeks). The programs introduce different mindfulness related topics weekly so the same topics could be presented in the virtual application as simplified exercises. Guidance on activities could be given through an audio recording or through written instructions where students will be completing tasks in an individual setting. Activities that could potentially be included are body scan meditation, hatha yoga, walking meditation, and loving-kindness meditation. Each activity is useful for targeting symptoms influencing the well-being of students. Literature with varying study designs were included for this systematic review, resulting in high heterogeneity precluding statistical analysis. Incorporating qualitative, quantitative, and mixed method studies enabled a qualitative analysis of present data. Self reports and surveys were analyzed to gain more insight into how mindfulness interventions impact individual experiences and overall well-being. This systematic review included articles with participants from North America, Europe, Asia, or Australia but excluded other countries, which may lead to potential bias in data. Of the 26 studies from North America, all studies were conducted in the US. 4 studies were conducted in Eastern and Southern countries of Asia, specifically Taiwan, Singapore and Japan. Only 1 study was conducted in Europe. Studies only from one country may be a poor representation of the region as a whole. In addition, only studies written in the English language were included in this systematic review which can narrow the scope of literature findings. Due to the heterogeneity of study design and findings, further research (including additional quality assessment and statistical analysis) is required to determine the efficacy of virtual mindfulness interventions within well-being. In this systematic review, the effect of different mindfulness-based interventions on the well-being of college students was studied. The symptoms to be targeted by mindfulness-based interventions were investigated, as well as the procedures and outcomes of the interventions. Specific criteria were used to include articles relevant to the application of implementing mindfulness-based interventions on the Felicity App. Screening criteria was developed and quality appraisal was used to ensure only relevant articles were included in the review. However, more research should be done on whether mindfulness practices can improve academic performance and their impact on cognition. This systematic review was funded in part by a grant from The Duke of Edinburgh's International Award through the P2P program and in partnership with the federal government of Canada. The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Search Results IEEE Xplore (motivat*) OR (burnout) OR (student) OR (virtual) AND (mindfulness) 65 PsychInfo ((mindfulness and student* and learn* and (burnout or stress or motivat* or productiv* or cognit* or atten* or creativ*)) not (teacher or professor or kindergarten or children or ADHD or GAD or TBI or injury)).mp. [mp=title, abstract, heading word, Intervention outcomes across three years indicate improvements in well-being, positive affect, negative affect and clinical well-being categories. Intervention buffered against semester stress. Practice frequency had little effect on well-being, however well-being gains were higher for students with low baseline well-being and those who valued happiness moresuggesting positive education interventions have greater value for some students 1/***** Excluded Studies from Quality Appraisal Roepstorff, A. 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