doi:10.1016/j.brat.2021.103866engModrego-Alarcón, MartaLópez-del-Hoyo, YolandaGarcía-Campayo, JavierPérez-Aranda, AdriánNavarro-Gil, MayteBeltrán-Ruiz, MaríaMorillo, HéctorDelgado-Suarez, IreneOliván-Arévalo, RebecaMontero-Marin, JesúsEfficacy of a mindfulness-based programme with and without virtual reality support to reduce stress in university students: A randomized controlled trialART-2021-127119Objectives: To evaluate the efficacy of a mindfulness-based programme (MBP) for reducing stress in university students and its action mechanisms and to explore the capacity of virtual reality (VR) exposure to enhance adherence to the intervention. Methods: This randomized controlled trial (RCT) involved assessment time points of baseline, posttreatment, and 6-month follow-up. A total of 280 students from two Spanish universities were randomly assigned to ‘MBP’, ‘MBP + VR’, or ‘Relaxation’ (active controls). Perceived stress posttreatment was the primary outcome; wellbeing and academic functional outcomes were assessed as well. Multilevel mixed-effects models were performed to estimate the efficacy of the programme. Results: Both ‘MBP’ (B = -2.77, d = -0.72, p = .006) and ‘MBP + VR’ (B = -2.44, d = -0.59, p = .014) were superior to ‘Relaxation’ in improving stress, as well as most of the secondary outcomes, with medium-to-large effects posttreatment and at follow-up. The long-term effects of MBPs on stress were mediated by mindfulness and self-compassion in parallel. Treatment adherence was improved in the ‘MBP + VR’ group, with higher retention rates and session attendance (p < .001). Conclusions: This RCT supports the efficacy of an MBP compared to relaxation for reducing stress in university students through mindfulness and self-compassion as mechanisms of change. VR exposure may enhance treatment adherence.2021http://zaguan.unizar.es/record/14871410.1016/j.brat.2021.103866http://zaguan.unizar.es/record/148714oai:zaguan.unizar.es:148714info:eu-repo/grantAgreement/ES/DGA/B17-17Rinfo:eu-repo/grantAgreement/ES/ISCIII/CD20-00181info:eu-repo/grantAgreement/ES/ISCIII/RD16-0007-0005info:eu-repo/grantAgreement/ES/MECD/FPU15-00598Behaviour Research and Therapy 142 (2021), 103866 [16 pp.]by-nc-ndhttp://creativecommons.org/licenses/by-nc-nd/3.0/es/info:eu-repo/semantics/openAccess