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  • Reflect on the four peer-reviewed articles you critically appraised in Module 4, related to your clinical topic of interest and PICOT.  
  •  Article #1 Zhou, X., Guo, J., Lu, G., Chen, C., Xie, Z., Liu, J., & Zhang, C. (2020). Effects of mindfulness-based stress reduction on anxiety symptoms in young people: A systematic review and meta-analysis. Psychiatry Research, 289, 113002. https://doi.org/10.1016/j.psychres.2020.113002

Article #2 Porter, B., Oyanadel, C., Sáez-Delgado, F., Andaur, A., & Peñate, W. (2022). Systematic Review of Mindfulness-Based Interventions in Child-Adolescent Population: A Developmental Perspective. European Journal of Investigation in Health, Psychology and Education, 12(8), 1220–1243. https://doi.org/10.3390/ejihpe12080085

Article #3 Cohen, Z. P., Cosgrove, K. T., Akeman, E., Coffey, S., Teague, K., Hays-Grudo, J., Paulus, M. P., Aupperle, R. L., & Kirlic, N. (2021). The effect of a mindfulness-based stress intervention on neurobiological and symptom measures in adolescents with early life stress: a randomized feasibility study. BMC Complementary Medicine and Therapies, 21(1). https://doi.org/10.1186/s12906-021-03295-1

Article #4 Peter, A., Srivastava, R., Agarwal, A., & Singh, A. P. (2022). The Effect of Mindfulness-based Cognitive Therapy on Anxiety and Resilience of the School Going Early Adolescents with Anxiety. Journal of Indian Association for Child and Adolescent Mental Health, 18(2), 176–185. https://doi.org/10.1177/09731342221127959

 PICOT  question- The clinical issue of interest is the management of anxiety symptoms in adolescents aged 13-18 years. Adolescents often prevalent anxiety concern due to unique stressors and challenges. Addressing anxiety symptoms during this developmental stage can essential to promote healthy psychological development and improve short- and long-term quality of life.

  • Reflect on your current healthcare organization and think about potential opportunities for evidence-based change, using your topic of interest and PICOT as the basis for your reflection.
  • Consider the best method of disseminating the results of your presentation to an audience. 

Part 4: Recommending an Evidence-Based Practice Change

  • Briefly describe your healthcare organization, including its culture and readiness for change. (You may opt to keep various elements of this anonymous, such as your company name.)
  • Describe the current problem or opportunity for change. Include in this description the circumstances surrounding the need for change, the scope of the issue, the stakeholders involved, and the risks associated with change implementation in general.
  • Propose an evidence-based idea for a change in practice using an EBP approach to decision making. Note that you may find further research needs to be conducted if sufficient evidence is not discovered.
  • Describe your plan for knowledge transfer of this change, including knowledge creation, dissemination, and organizational adoption and implementation.
  • Explain how you would disseminate the results of your project to an audience. Provide a rationale for why you selected this dissemination strategy.
  • Describe the measurable outcomes you hope to achieve with the implementation of this evidence-based change.
  • Be sure to provide APA citations of the supporting evidence-based peer reviewed articles you selected to support your thinking.
  • Add a lessons learned section that includes the following:
    • A summary of the critical appraisal of the peer-reviewed articles you previously submitted
    • An explanation about what you learned from completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template (1-3 slides)


Evaluation Table

Use this document to complete the

evaluation table
requirement of the Module 4 Assessment,

Evidence-Based Project, Part 3A: Critical Appraisal of Research

Full
APA formatted citation of selected article.

Article #1

Article #2

Article #3

Article #4

Zhou, X., Guo, J., Lu, G., Chen, C., Xie, Z., Liu, J., & Zhang, C. (2020). Effects of mindfulness-based stress reduction on anxiety symptoms in young people: A systematic review and meta-analysis. Psychiatry Research, 289, 113002. https://doi.org/10.1016/j.psychres.2020.113002

Porter, B., Oyanadel, C., Sáez-Delgado, F., Andaur, A., & Peñate, W. (2022). Systematic Review of Mindfulness-Based Interventions in Child-Adolescent Population: A Developmental Perspective. European Journal of Investigation in Health, Psychology and Education, 12(8), 1220–1243. https://doi.org/10.3390/ejihpe12080085

Cohen, Z. P., Cosgrove, K. T., Akeman, E., Coffey, S., Teague, K., Hays-Grudo, J., Paulus, M. P., Aupperle, R. L., & Kirlic, N. (2021). The effect of a mindfulness-based stress intervention on neurobiological and symptom measures in adolescents with early life stress: a randomized feasibility study. BMC Complementary Medicine and Therapies, 21(1). https://doi.org/10.1186/s12906-021-03295-1

Peter, A., Srivastava, R., Agarwal, A., & Singh, A. P. (2022). The Effect of Mindfulness-based Cognitive Therapy on Anxiety and Resilience of the School Going Early Adolescents with Anxiety. Journal of Indian Association for Child and Adolescent Mental Health, 18(2), 176–185. https://doi.org/10.1177/09731342221127959


Evidence Level *

(I, II, or III)



II

I

II

II

Conceptual Framework

Describe the theoretical basis for the study (
If there is not one mentioned in the article, say that here).**

The study’s theoretical foundation is mindfulness-based stress reduction (MBSR) as a therapeutic intervention for youth anxiety symptoms.

The article does not explicitly mention a specific theoretical basis or conceptual framework for the study in the provided information.

The article describes the study’s theoretical foundation: mindfulness may reduce the negative consequences of early life stress on mental and physical health.

The theoretical basis of the research is mindfulness-based cognitive therapy (MBCT) to boost resilience and decrease anxiety in early teens.

Design/Method

Describe the design and how the study was carried out (In detail, including
inclusion/exclusion criteria).

The research used meta-analysis and systematic review. It includes RCTs comparing MBSR to controls in anxious youth. Exclusion criteria were not indicated in the published text, although inclusion criteria involved choosing 14 RCTs with 1489 participants. The meta-analysis writers searched and screened the literature to find relevant papers.

The study used a systematic review design, searched WoS, Scopus, PubMed, and EBSCO for English and Spanish papers with defined inclusion/exclusion criteria.

The study used a randomized controlled trial design. It included 40 adolescents with ≥3 ACEs, randomized to MBSR-T or control groups.

The study used a randomized control group design with 72 early adolescents, aged 10 to 14, receiving MBCT-C intervention or parental counseling.

Sample/Setting

The number and characteristics of

patients, attrition rate, etc.

The study included 14 RCTs comprising 1489 participants. Specific participant characteristics and attrition rates were not mentioned in the provided text.

The article reviewed 27 primary studies, but specific patient numbers and characteristics were not detailed. Attrition rates were not mentioned.

The research comprised 40 adolescents, 59% male, with a mean age of 14.3. In the MBSR-T group, 16 of 21 adolescents completed the intervention. The short summary does not disclose control group attrition or features.

The research included 72 10- to 14-year-olds. 33 completed MBCT-C, indicating attrition.

Major Variables Studied

List and define dependent and independent variables

Dependent Variable: Anxiety symptoms in young people, measured as the primary outcome to assess the effectiveness of MBSR.

Independent Variable: Mindfulness-Based Stress Reduction (MBSR), the therapeutic intervention applied to reduce anxiety symptoms.

Dependent variables include cognitive, socioemotional, symptoms, mindfulness, and visual-motor skills. Independent variables are mindfulness-based interventions in child-adolescent populations.

Dependent variable: Cortisol reactivity, immune markers, and depressive symptoms.

Independent variable: Mindfulness-Based Stress Reduction for Teens (MBSR-T) vs. Treatment as Usual (Control).

Dependent variable: Anxiety (measured by Spence Children’s Anxiety Scale and subdomains).

Independent variable: Mindfulness-based cognitive therapy (MBCT-C) intervention.

Measurement

Identify primary statistics used to answer clinical questions (
You need to list the actual tests done).

The study used a standardized mean difference (SMD) to measure the effect size of MBSR in reducing anxiety symptoms compared to control conditions in young people.

T-tests, ANOVAs, effect sizes, and correlation analyses were utilized to evaluate mindfulness-based therapies and outcomes across developmental stages.

Primary statistics: Linear mixed effects models to compare group (MBSR-T vs. Control) and time (baseline vs. follow-up) effects on cortisol reactivity and depressive symptoms.

Friedman’s Two-way Analysis of Variance, Mann–Whitney U test, and post hoc t-tests were used to compare PIBM and TWL anxiety, mindfulness, and resilience across time.

Data Analysis Statistical or

Qualitative findings

(
You need to enter the actual numbers determined by the statistical tests or qualitative data).

The study found that MBSR significantly reduced anxiety symptoms in young people compared to control conditions with a Standardized Mean Difference (SMD) of -0.14.

Statistics and qualitative data aren’t included. The article presents a systematic review of research without statistical outcomes.

Statistical results: The MBSR-T group had medium effects with meaningful trends (Cohen’s d =.56) for anticipatory cortisol. MBSR-T reduced depression symptoms somewhat (Cohen’s d =.69). In inflammatory marker models, no significant effects were detected.

The study found significant improvements in anxiety, mindfulness, and resilience in the PIBM group over time (p < 0.05) compared to the TWL grou

Findings and Recommendations

General findings and recommendations of the research

Mindfulness-based stress reduction (MBSR) reduces youth anxiety, according to the research. Recommendations include more research into the long-term impacts of MBSR.

The study found substantial differences in child-adolescent mindfulness-based intervention features, evaluation methodologies, and results. Recommendations include a shift toward a more integrated paradigm for measuring children and adolescents’ growth in mindfulness and cognitive-socioemotional abilities.

The research showed that a group-based MBSR-T intervention for adolescents with early life stress may decrease cortisol reactivity and depressive symptoms.

Recommendations: The population in this category needs larger research to evaluate mindfulness therapies.

Results: MBCT-C decreased anxiety and increased resilience in early adolescents, although TWL showed no improvement.

Recommendation: Use MBCT-C in schools to combat early adolescent anxiety. More study is required to confirm results.


Appraisal and Study Quality

Describe the general worth of this research to practice.

What are the strengths and limitations of study?

What are the risks associated with implementation of the suggested practices or processes detailed in the research?

What is the feasibility of use in your practice?

Strengths include a meta-analysis design and a systematic review. Limitations include publication bias. Implementing MBSR may need training and resources. Resource availability and patient population determine feasibility.

Strengths: Systematic review. Highlighted MBI versions. Identified integrative perspective need.

Limitations: No numbers.

Risks: Uneven methods may provide variable outcomes.

Feasibility: Informs practice but needs further investigation.

Strengths: Feasibility, possible advantages for early-life stressed adolescents.

Limitations: Small sample size, exploratory results, and irrelevant results.

Risks: Insufficient evidence, resources.

Feasibility: May be practical for study but needs bigger practice trials.

Strengths: Good trial design, strong findings, early adolescent mental health benefits.

Limitations: Single-site, small sample, bias possibility.

Risks: Resource-intensive, little evidence.

Feasibility: Possible in well-defined contexts.

Key findings



Mindfulness-based stress reduction (MBSR) significantly reduced anxiety symptoms in young people, but effects varied with intervention duration, indicating its potential as a therapeutic approach.

Key findings include differing impacts of mindfulness-based therapies in child-adolescent groups and the need for an integrated viewpoint.

Feasibility of MBSR-T for adolescents with early life stress, potential moderate effects on cortisol reactivity and depressive symptom reduction.

Key results show that mindfulness-based cognitive therapy (MBCT) reduces anxiety and boosts resilience in early teens.

Outcomes



MBSR demonstrated efficacy in reducing anxiety symptoms in young people, suggesting its potential as an effective intervention for anxiety management.

Cognitive, socioemotional, symptom, mindfulness, and visual-motor outcomes varied. Effects were consistent in certain areas but varied throughout developmental phases.

Improved feasibility of MBSR-T for adolescents with early life stress, potential benefits in terms of cortisol reactivity and depressive symptom reduction.

Early adolescents showed substantial improvements in anxiety, mindfulness, and resilience after MBCT-C training.

General Notes/Comments

MBSR may help youth manage anxiety, according to the research. More research and implementation are needed.

The study presents a comprehensive assessment of mindfulness-based therapies in child-adolescent populations, emphasizing the need for standardization and integration.

The findings suggests mindfulness meditation may reduce cortisol and depression symptoms in ELS-exposed adolescents, but bigger studies are needed.

The research shows MBCT-C can treat early adolescent anxiety. Limitations include a limited sample and a single-site study, necessitating more research.

Critical Appraisal Tool Worksheet Template

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