Disability and Rehabilitation

ISSN: 0963-8288 (Print) 1464-5165 (Online) Journal homepage: http://www.tandfonline.com/loi/idre20

Mindfulness in allied health and social care

professional education: a scoping review

Elizabeth Anne Kinsella, Kirsten Smith, Saara Bhanji, Rachelle Shepley,

Andreja Modor & Andrew Bertrim

To cite this article: Elizabeth Anne Kinsella, Kirsten Smith, Saara Bhanji, Rachelle Shepley,
Andreja Modor & Andrew Bertrim (2018): Mindfulness in allied health and social care professional
education: a scoping review, Disability and Rehabilitation, DOI: 10.1080/09638288.2018.1496150

To link to this article: https://doi.org/10.1080/09638288.2018.1496150

Published online: 05 Dec 2018.

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DISABILITY AND REHABILITATION
https://doi.org/10.1080/09638288.2018.1496150

RESEARCH ARTICLE

Mindfulness in allied health and social care professional education:

a scoping review
Elizabeth Anne Kinsellaa,b, Kirsten Smitha,b, Saara Bhanjia, Rachelle Shepleya, Andreja Modora and
Andrew Bertrima
a
School of Occupational Therapy, Western University, London, Canada; bGraduate Program in Health and Rehabilitation Science, Western
University, London, Canada

ABSTRACT ARTICLE HISTORY

Background: Investigations into the use of mindfulness with allied health and social care students, many Received 3 August 2016
of whom ultimately work in rehabilitation settings, is in the nascent stages and no systematic mapping of Revised 27 June 2018
the literature has occurred. The purpose of this scoping review was to identify, summarise, and describe Accepted 29 June 2018
the current state of knowledge on mindfulness in allied health and social care professional education.
KEYWORDS
Methods: Arksey and O’Malley’s scoping review methodology was adopted. Five data bases were Mindfulness; stress
searched; inclusion and exclusion criteria were applied; and 50 papers were identified for inclusion in management; rehabilitation
the study. education; health
Results: Quantitative studies depicted mindfulness interventions as contributing to: improved capacities professional education;
for mindfulness; decreases in stress, anxiety, and depression; improvements in academic skills, quality of allied health education;
life and well-being, and empathy; improved physiological measures and emotional regulation; and mixed quality of life
effects on burn-out. Qualitative studies highlighted: 1) mindfulness and self-care, 2) mindfulness within
professional practice placements, 3) mindfulness in the classroom, and 4) the cultivation of mind-
ful qualities.
Conclusions: The study has important implications for the education of future rehabilitation professions
and suggests that learning about mindfulness may be useful in assisting students to: manage academic
stress, anxiety, and depression; cultivate a physical and mental state of calm; be more present and
empathetic with clients; and be more focused and attentive in professional practice settings.

ä IMPLICATIONS FOR REHABILITATION

 Further exploration of mindfulness as a promising educational intervention for the professional prep-
aration of future rehabilitation practitioners in allied health and social care fields is recommended.
 Education and research about mindfulness and its potential opportunities for students in terms of
the mediation of stress, anxiety, depression, and the cultivation of empathy, academic skills, quality
of life, and resilience are recommended.
 Education and research about mindfulness and its potential for the cultivation of beneficial qualities
of mind such as attention, self-awareness, compassion, non-judgment, and acceptance are
recommended.
 Education and research about mindfulness as a potential means to develop capacities related to self-
care, professional practice placements, and classroom performance in students is recommended.

A scoping review
High levels of perceived stress have been documented in the lives
of allied health and social care students in many rehabilitation
professions [1,2]. For instance, significant levels of stress have
been reported in student populations in fields such as occupa-
tional therapy [3], physical therapy [4], speech-language path-
ology [5], audiology [6], nursing [7], social work [8], psychology
[9], medicine [10], and dentistry [11], as well as within the general
population of higher education students [12]. Factors contributing
to stress levels in these students may be related to changing con-
ditions of rehabilitation practice including: an explosion in rates
and amount of new knowledge required, the expansion of profes-
sionals’ roles in recent years, changes in how services are
delivered due to cost constraints, and the increased responsibil-
ities and accountabilities required of professionals [13,14]. In add-
ition to stress, studies have pointed to high levels of depression
[15–17], anxiety [16,17], burnout [18,19], and decreased quality of
life [18–20] throughout allied health and social care professional
students’ educational experience.
Stress and student performance
Participation in certain roles can lead to increased stress in one’s
life [21]. According to Severn et al. stress develops when the
“environment produces negative psychological and physiological
effects” [22,p.3]. It has been reported that certain levels of stress

CONTACT Elizabeth Anne Kinsella akinsell@uwo.ca School of Occupational Therapy, Elborn College, Western University, 1201 Western Road, Onario, London
N6G 1H1, Canada
ß 2018 Informa UK Limited, trading as Taylor & Francis Group
2 E. A. KINSELLA ET AL.
are necessary for academic growth, and that some individuals are
motivated during stressful conditions [23,24]. But research has
also indicated an inverted U-shaped curve between academic
stress and performance levels [25,26]. Jacob et al. report that low
levels of stress are related to low levels of performance, an opti-
mal level of stress is related to superior levels of performance and
high levels of stress are related to declines in academic perform-
ance [27]. Further, when stress levels become too high and are
not managed it can lead to unwanted health effects such as
increased inflammation, decreased bone density, memory loss,
weight gain, increased blood sugar, cholesterol levels, and trigly-
cerides [28].
Prolonged stress and the presence of multiple stressors have
been linked to anxiety, defined by Lazarus and Folkman as a
vague and uncomfortable feeling exacerbated by stress [29]. Kanji
et al. note that anxiety involves the emotional state of an individ-
ual in response to a particular event where symptoms of appre-
hension, tension, sweating, or increased blood pressure or heart
rate are experienced [30]. Stress related anxiety is reported to
negatively affect task performance by impeding concentration,
memory, and problem-solving abilities, which are all necessary
skills for success in higher education [31,32]. For students, high
levels of stress have also been reported to impair learning [26],
decrease productivity, and cultivate negative attitudes [6,23]. In
addition, high levels of stress have been associated with impaired
immune function, weight gain, reduced academic performance
[5], alcohol/drug abuse, relationship difficulties, depression, and
possibly suicide [33].
It has been suggested that stress does not necessarily result
solely from exposure to an external event but is also mediated by
an individual’s appraisal and response to a situation [29]. This sug-
gests that students have some capacity to choose responses to
stressful situations [34]. Assisting allied health and social care stu-
dents to develop effective approaches to respond to stress has
the potential to lead to fewer negative consequences during their
studies and to enhance their capacities for success in future prac-
tices in rehabilitation settings [34].
Mindfulness
The practice of mindfulness is one approach that has been sug-
gested as an effective mediator of stress, and which may have
implications for health professional education, given the conse-
quences of stress on student learning and performance, and on
their future roles as practitioners [14]. Williams and Kabat-Zinn
note that “while we get a great deal of training in our education
systems in thinking of all kinds, we have almost no exposure to
the cultivation of … what we call awareness [or mind-
fulness]” [35,p.15].
Mindfulness is variously defined [35]. The most frequently used
definitions in the literature are based on the work of Kabat-Zinn,
a leading scholar of mindfulness research in the West [36–41].
One definition of mindfulness by Kabat-Zinn involves the
“awareness that emerges through paying attention, on purpose,
in the present moment, and non-judgmentally to the unfolding of
experience moment by moment.” [38,p.145]. He notes that mind-
fulness “is cultivated by paying close attention to your moment-
to-moment experience while, as best you can, not getting caught
up in your ideas and opinions, likes and dislikes” [40,p.21].
Further, Kabat-Zinn suggests that mindfulness “aim[s] to help peo-
ple live each moment of their lives-even the painful ones, as fully
as possible” [37,p.260]. Mindfulness has its roots in Eastern tradi-
tions of Buddhism and has over the past 40 years been
increasingly taken up in the West, as the evidence base for mind-
fulness practices has grown [35]. According to Kabat-Zinn, the cul-
tivation of mindfulness involves more than compliance to step-
by-step instructions; this meditative awareness involves a shift in
perspective [41]. He identifies seven interconnected attitudinal
factors, which contribute to the cultivation of mindfulness prac-
tice; working on any one of these is suggested to lead to the cul-
tivation of others [41]. These factors may vary but are often
thought to include: non-judgement, patience, a beginner’s mind,
trust, non-striving, acceptance, and letting go [41].
Some researchers and clinicians have suggested that mindful-
ness practices should be integrated into Western health and social
care systems [42]. Mindfulness has been reported as an effective
approach for decreasing stress and anxiety levels within individu-
als [43,44]. It has been noted to improve coping abilities and
reduce emotional distress [45]. Mindfulness has also been
reported to improve the ability to sustain attention, problem-
solving, working memory, organisational capacities, academic per-
formance, and cognitive abilities [46,47]. Research on mindfulness
training has also documented improvements in psychological
well-being and mental health [14,48], and personal development
[49]. Finally, an emerging body of research points to the promis-
ing possibilities of mindfulness as an approach to help students
cope with stress and anxiety [17,34,50,51].
Despite the proliferation of applications of mindfulness with
diverse clinical populations and a body of literature that examines
the use of mindfulness within medicine [52,53] and with medical
students [54–59], investigations into the use of mindfulness with
other allied health and social care professions students is at an
early stage of development [21]. There is a need to examine
research in the area of mindfulness in relation allied health and
social care professions education, in order to disseminate this
knowledge to educators, students, university curriculum designers,
and researchers interested in integrating mindfulness into the
education of future practitioners, including rehabilitation practi-
tioners, and for researchers interested in contributing to this
emerging knowledge base.
Objective
The purpose of the research was to identify, summarise, and
describe the current state of knowledge on mindfulness in allied
health and social care professional education. For the purposes of
this study, allied health and social care professions included: occu-
pational therapy, physical therapy, social work, nursing, psych-
ology, counselling, speech-language pathology, and audiology
(many of whom will become future rehabilitation professionals).
Methodology
Study design
Given the exploratory nature of the study, a scoping review
guided by Arksey and O’Malley’s framework was undertaken [60].
A scoping review aims to map “key concepts underpinning a
research area and the main sources and types of evidence
available … especially where an area is complex or has not been
reviewed comprehensively before” [60,p.5]. A scoping review is
guided by the “requirement to identify all relevant literature
regardless of study design” [60,p.22]. To that end, the current
scoping review included a range of research methodologies.
A scoping review is distinguished from other types of reviews, in
that an effort is made to portray an overview of the breadth of
research in a field; appraisal of quality is not a part of the review

process [60]. The five-step framework utilised involved: identifica-
tion of the research question; identification of relevant studies;
study selection; data extraction; and data synthesis [60].
Step 1: Identifying the research question
The research team met on several occasions to identify the
research question. This iterative process led to the refinement of
the question as follows: What is the current state of knowledge
regarding mindfulness in allied health and social care profes-
sions education?
Step 2: Identifying relevant studies
A reference librarian was consulted to guide the search strategy.
The following databases were included: Scopus, PubMed,
ProQuest Nursing and Allied Health, PsychINFO, and CINAHL. Key
terms included: (meditation OR mindfulness OR contemplation)
AND (allied health students OR occupational therapy students OR
physical therapy students OR speech-language pathology stu-
dents OR audiology students OR nursing students OR social work
students OR counselling students OR psychology students). The
search was limited to articles that were peer-reviewed, written in
English and published between January 2005 and December
2017. The initial search generated 2334 articles which were
uploaded in Mendeley reference management software. Three
Figure 1. Flowchart of study retrieval and selection process (adapted from PRISMA).
MINDFULNESS IN ALLIED HEALTH PROFESSIONS EDUCATION 3
hundred and sixty-nine duplicates were removed yielding a total
of 1965 articles for consideration.
Step 3: Study selection
The articles were screened according to inclusion criteria.
Included articles: addressed mindfulness in relation to allied
health and social care professional education; addressed mindful-
ness practices pertaining to allied health and social care profes-
sional students; included the terms “mindfulness” and/or
“meditation” and/or “contemplation”; included one or more of
the following groups “occupational therapy students, physical
therapy students, speech-language pathology students, audi-
ology students, nursing students, social work students, psych-
ology students”; published between 2005 and 2017; published
in English; and peer-reviewed or highly relevant dissertations.
Articles were excluded if they: included medical students
predominantly; were not available in English; represented
grey literature (with the exception of dissertations). Medical stu-
dents were not included within the study population as reviews
have been completed that explore stress management
programmes – including mindfulness – with medical practi-
tioners and students and a body of knowledge is accumulating
in this area [52,53].
The titles and abstracts of the 1965 articles were screened
yielding 109 articles. A manual search of the reference lists
yielded an additional five articles for a total of 114. Each article
4 E. A. KINSELLA ET AL.
was then reviewed and independently rated for relevance on a
scale of 1–6 by two raters. Fifty articles were rated 5 and
included in the final analysis. A summary of the study retrieval
and selection process is provided in Figure 1.
Step 4: Charting the data
Data were extracted from 50 articles according to: title, authors,
publication year, name of journal, location of study, research
objectives/question and purpose, research design, population, set-
ting, methodology, methods, how mindfulness was defined, base-
line/outcome measures, key findings, and limitations.
Step 5: Collating, summarising, and reporting the results
A descriptive analysis as well as thematic analyses of the quantita-
tive and qualitative data was undertaken. The descriptive analysis
involved collation of data according to various descriptive catego-
ries as presented below, with three members of the research
team participating in this collation, and two members crosscheck-
ing for accuracy. The thematic analysis took place in two parts,
with three team members working intensively on the quantitative
analysis, and three team members working intensively on the
qualitative analysis, two team members were involved in both the
quantitative and qualitative analysis to ensure integration. Each of
the quantitative and qualitative analyses involved independent
reviews of the relevant papers and data extractions by three team
members, independent mind mapping of emergent themes, fol-
lowed by small group and full team mind-mapping of themes
[61]. Intensive regular team meetings and discussions occurred,
and an iterative process was used to identify emerging themes
and to collate the data. Disagreements in interpretations were
negotiated through dialogue amongst team members and moder-
ated by the PI of the project.
Results
Descriptive analysis
Research designs included quantitative (27), mixed methods (6),
qualitative (13) and literature reviews (4). The most common
quantitative design utilised a quasi-experimental, pre/post-test
approach (15). Additional quantitative methodologies included
randomised controlled trials (6), correlational designs (3), cross-
sectional designs (2), and a single subject design (1). Mixed meth-
ods involved pre/post-test designs in addition to analysis of writ-
ten reflections (3), focus groups (2), and grounded theory (1). The
qualitative research included phenomenological studies (4), focus
groups (4), narrative studies (2) survey-based studies (2), and
grounded theory (1). There were also four literature
reviews included.
The 50 articles were published between January 2005 and
December 2017, with 35 published between 2013 and 2017, and
1–4 per year published between 2005 and 2012, demonstrating a
significant proliferation of studies in recent years. Thirty-six of the
studies were completed in the United States, with additional
articles published in each of the following countries: Korea (2),
Israel (2), Norway (2), Australia (2), United Kingdom (2), Canada
(1), China (1), Jordan (1), and 1 unspecified, suggesting greater
uptake in Western educational contexts. Articles were published
in 22 journals. Most frequent representation included 6 articles in
each of Nurse Education Today and Social Work Education, 3
articles in each of Mindfulness and Journal of Religion and
Spirituality in Social Work, 2 articles each in Journal of Nursing
Table 1. Keywords defining mindfulness.
Keywords n
Staying in the moment/Present moment awareness 36
Attention 24
Non-judgement 24
Self-awareness 16
Acceptance 8
Empathy/compassion 4
Not-defined 9
Education, Journal of Physical Therapy Education, Training and
Education in Professional Psychology, Journal of Counselling and
Development, Journal of Humanistic Psychology, Social Work with
Groups, and 1 article in a range of other journals. Two published
dissertations were included. The majority of the student popula-
tions were from nursing (16) and social work (12) disciplines. This
was followed by counselling (8), occupational therapy (3), physical
therapy (2), psychology (2), and speech-language pathology (1).
None of the studies included audiology. Six studies included stu-
dents from more than one discipline.
In terms of conceptualising mindfulness, it was most often
referred to in relation to “staying in the moment,” or “present-
moment awareness,” This was followed by references to
“attention,” “self-awareness,” “non-judgment,” “compassion,” and
“acceptance.” Thirty-one articles drew on the work of Jon Kabat-
Zinn [36–39,62,63] when defining mindfulness. Eight articles did
not include a definition of mindfulness and 11 articles drew on
authors other than Kabat-Zinn when defining mindfulness. The
most frequently cited definitions were that mindfulness “aim[s] to
help people live each moment of their lives-even the painful
ones, as fully as possible” [37,p.260] (cited in 9 articles) and
“mindfulness is paying attention on purpose in the present
moment and non-judgmentally to the unfolding of experience
moment by moment” [38,p.145] (cited in 8 articles). It is important
to note that many articles provided multi-faceted definitions of
mindfulness (See Table 1).
Various mindfulness-based interventions were utilised within
the studies. These included body scan, attention to breathing,
didactic learning methods, yoga, sitting meditation, guided medi-
tation, mindful movement, journaling, walking meditation, breath-
ing exercises, mindful eating, reflection, conscious relaxation
techniques, verbal sharing methods, compassion exercises, silent
retreats, visual imagery, and one used auditory exercises.
Most often 3 or 4 mindfulness exercises were used to comprise
an “intervention” protocol. See Table 2 for further details.
[17,48,64,67,70–72,75,78,80,84,85,88,89,91]
A variety of 47 different baseline or outcome measures were
used in the studies. It should be noted that some interventions
assessed multiple baseline and outcome measures. The measure-
ments focused on various constructs such as mindfulness (24
studies), stress/anxiety and burnout (11), well-being (9), physio-
logical measures (6), depression (4), and a range of other dimen-
sions (13). The most frequently utilised measurement tools were
The Perceived Stress Scale (9), The Mindfulness Attention Scale (8),
and the Five Facet Mindfulness Questionnaire (6). Refer to Table 3
for further details.
Thematic analysis of quantitative studies
Thirty-three of the studies used quantitative methodological ele-
ments in their designs including 27 quantitative studies and 6
mixed method designs. The main quantitative findings were
related to outcomes of mindfulness interventions with students
(18), and measures of stress (15), depression (7), and anxiety (6).
 MINDFULNESS IN ALLIED HEALTH PROFESSIONS EDUCATION 5

Table 2. Mindfulness interventions. suggested that individuals with moderate anxiety were the most
Mindfulness intervention n References likely to benefit from a short-term mindfulness programme [51].
Body Scan 18 [17,34,38,51, 64–74,75,76,84] Burnout. Four studies examined the effect of a mindfulness-
Attention to breathing 17 [34,48,51,64,65,67,74–77,78–83,89] based intervention on burnout experienced by allied health pro-
Didactic learning 16 [48,55,64,66,71,74,77,78,84–89,91] fessions students. Two of these studies reported no statistical dif-
(presentations,
assigned readings)
ferences in levels of student burnout following a mindfulness-
(Hatha) Yoga 15 [17,48,64,67,70–72,75,78,80,84,85,88,89,91] based intervention [70,101]. The remaining two studies reported a
Sitting meditation 14 [17,48,64–67,73,74,76,82,83,88,90,91] negative correlation between the two constructs: as mindfulness
Guided meditation 12 [48,51,90,77,79,67,86,87,74,75,89,92] increased, burnout decreased [94,100].
Mindful movement 11 [17,64,84,66,68,70,71,88,89,82,83]
Empathy. Three studies examined how mindfulness impacted
(stretching, Qi Gong)
Journaling 9 [48,84,79,85,91,88,76,81,92] empathy within allied health and social care students. Two studies
Walking meditation 9 [17,34,64,69,73,75,81,82,83] reported improvements in empathy following a mindfulness inter-
Breathing exercises 8 [17,64,77,78,85,68,69,75] vention [87,90]. One study found a short-term impact on empathy
(breathwork)
that was not sustained following the intervention [70].
Mindful eating 6 [12,64,78,67,68,89]
Reflection 5 [55,93,94,82,83] Academic skills. Two studies examined the effect of mindful-
Conscious relaxation exercises 5 [78,66,91,88,74] ness on skills necessary for academic success [86,93]. Both
Verbal sharing 5 [55,86,95,81,92] reported positive impacts of mindfulness. The first study sug-
Compassion exercises 3 [48,79,67] gested that mindfulness improved efficiency of executive atten-
Silent retreats 2 [70,81]
Visual imagery 2 [82,83] tion in student nurses [86]. The second study reported that
Hearing exercises 1 [65] mindfulness appeared to positively influence working memory
capacity in student nurses [93].
Quality of life and well-being. Two studies examined the
Other studies focused on topics such as mindfulness and burnout
effect of mindfulness on students’ overall quality of life and well-
(4), empathy (3), academic skills (2), quality of life (2), and physio- being. One reported a statistically significant increase in quality of
logical measures (2). One study reported on mindfulness in rela- life, particularly in the areas of health and functioning, social and
tion to resilience and emotional regulation. economic, and psychological and spiritual domains [68]. In this
Mindfulness. Eighteen studies explored the effects of a mind- study, the greatest overall improvement in quality of life scores
fulness-based intervention on professional students’ knowledge occurred with subjects who had the least amount of previous
and use of mindfulness. All studies indicated that students exposure to mindfulness. The second study reported that mindful-
experienced an increase in knowledge and use of mindfulness ness increased the overall well-being of the women in the
following a mindfulness-based intervention programme study [101].
[17,48,64–66,77–79,84,86,87,95,97]. In a number of studies, stu- Physiological measures. One study measured blood pressure
dents were reported to experience statistically significant increases (BP) and heart rate (HR) in relation to stress, anxiety, and depres-
in knowledge in areas of mindful awareness [77,78,84,87], self-com- sion scores. The study reported a statistically significant decrease
passion [48,84], accepting without judgement [77,78], observing in BP and HR, following a mindfulness-based intervention [51].
[77,78], self-efficacy [64,95], personal beliefs [64], and self-aware- Another study measured blood pressure and salivary cortisol in
ness [97]. One study found that mindfulness increased at a one- relation to stress and anxiety scores in physical therapy students.
month follow-up, suggesting that the group continued to develop Decreases in blood pressure were noted, however, no statistically
their capacities following the intervention [84]. Another study significant changes to cortisol levels were reported [99].
reported that those who benefited the most from the programme Resilience. The influence of dispositional mindfulness on meas-
had no previous exposure to mindfulness [65]. ures of resilience in nursing students was examined in one study.
Stress. Fifteen studies explored the effect of a mindfulness- The researchers reported that a disposition towards mindfulness
based intervention on students’ levels of perceived stress. The made the strongest contribution to resilience, ahead of other pre-
majority reported that the mindfulness-based intervention had a dictors of resilience such as admission to a transition support pro-
significant effect on decreasing students’ perceived stress levels gramme and anticipated employment at graduation [98].
[17,34,48,64,65,67,80,84–86,96,99]. One paper reported that mind- Emotional regulation. One study explored the impact of
fulness only led to a decrease in stress in the female students in mindfulness on emotional regulation [93]. The authors noted a
the study [101]. One study did not indicate a statistically signifi- direct effect of dispositional mindfulness on the ability to regulate
cant change in the level of perceived stress [68]. emotion in student nurses [93].
Depression. Seven studies investigated the impact of a mind-
fulness-based intervention on depression experienced by allied
health and social care professions students. Three of the studies Thematic analysis of qualitative studies
reported that a mindfulness-based intervention decreased levels Twenty-three articles were included in the thematic analysis of
of depression in students [17,48,69]. One study found that depres- qualitative studies. Thirteen studies employed qualitative method-
sion only decreased with female students [101]. The remaining ologies, six utilised a combination of qualitative and quantitative
three studies did not find a statistically significant difference in approaches, and four were literature reviews. Each of these 24
depression experienced by students following a mindfulness- studies discussed the affordances of mindfulness practice within
based intervention [34,51,67]. educational curricula and/or in the lives of allied health and social
Anxiety. Six studies examined the impact of a mindfulness- care students. Four overarching themes in the qualitative studies
based intervention on perceived anxiety levels experienced by were identified: (1) mindfulness and self-care, (2) mindfulness
students. All studies reported a significant decrease in student within professional practice placements, (3) mindfulness in the
anxiety levels following a mindfulness-based intervention, when classroom, and (4) the cultivation of mindful qualities (attention,
compared to baseline scores [17,34,48,51,67,68]. One study self-awareness, compassion, non-judgment, and acceptance).
6 E. A. KINSELLA ET AL.

Table 3. Baseline/outcome measures.

Measure n Reference
Mindfulness
Mindfulness Attention Awareness Scale 8 [17,48,65,74,78,79,80,84]
Five Facet Mindfulness Questionnaire (FFMQ) 6 [50,80,87,94,96,100]
Self-Compassion Scale 3 [48,64,84]
Element: Self-concept Examination 1 [97]
27 Item survey – domains of knowledge, self-efficacy, and beliefs about mindfulness 1 [64]
Kentucky Inventory of Mindfulness 1 [78]
Toronto Mindfulness Scale 1 [87]
Langer 14-item Mindfulness Scale (LMS) 1 [95]
Freiberg Mindfulness Inventory 1 [86]
Cognitive and Affective Mindfulness Scale-Revised (CAMS-R) 1 [98]
Stress/anxiety/burnout
Perceived Stress Scale (PSS) 9 [48,64,65,67,68,84,85,96,98]
Maslach Burnout Inventory (MBI) 3 [55,70,94]
Spielberger’s State Anxiety Inventory (STAI) 1 [34]
Self-Rating Anxiety Scale 1 [51]
Perceived Medical School Stress 1 [55]
State/Trait Anxiety Inventory (STAI) 1 [48]
Depression, Anxiety and Stress Scale (DASS-21) 1 [17]
Psycho-social Wellbeing Index-Short Form (PWI-SF) 1 [34]
Burn Anxiety Inventory (BAI) 1 [70]
Hospital Depression and Anxiety Scale 1 [93]
Generalised Anxiety Disorder-7 (GAD-7) 1 [99]
Physiological
Heart rate 2 [51,64]
Blood pressure 2 [51,99]
Respiration 1 [64]
Salivary cortisol 1 [99]
Depression
Self-rating Depression Scale 1 [51]
Reflection Rumination Questionnaire (RRQ) 1 [48]
Beck Depression Inventory 1 [34]
Center for Epidemiologic Studies Depression Scale Revised (CESD-R) 1 [69]
Well-being
Professional quality of life scale – 5 (ProQOL5) 2 [98,100]
Ferrans and Powers “Quality of Life Index” – Generic III 1 [68]
General Health Questionnaire 1 [55]
Positive and Negative Affectivity Schedule (PANAS) 1 [48]
Emotion Regulation Questionnaire (ERQ) 1 [93]
Health-promoting Lifestyle Profile II (HPLP-II) 1 [80]
Brief Emotional Intelligence Scale 1 [94]
Difficulties in Emotion Regulation Scale (DERS) 1 [74]
Other
Jefferson Scale of Physician Empathy (JSPE) 2 [70,98]
Interpersonal Reactivity Index (IRI) 2 [70,73]
Attention-Network Test (ANT) 2 [67,96]
Therapist Presence Inventory 1 [87]
Clear Cut Communication with Patients Questionnaire (CCC) 1 [95]
Defining Issues Test 1 [86]
Course Evaluation Score 1 [66]
Almost Perfect Scale-Revised (APS-R) 1 [85]
Automated Operation Span Task (AOSPAN) 1 [93]
Connor-Davidson Resilience Scale 1 [98]

Mindfulness and self-care. The concept of self-care arose
repeatedly as an overarching theme in several articles
[71–74,85,88,89,91]. Self-care was defined as experiencing positive
physical, emotional, mental, and spiritual changes, as well as what
an individual does to improve a sense of subjective well-being to
enable positive outcomes [71,73]. In relation to self-care, mindful-
ness was reported to assist students to feel better equipped to
deal with stress in their lives [71,74,75,85,89]. Christopher and
Maris noted that students reported pronounced changes related
to self-care as a result of practicing mindfulness [72]. Students
reported less reactivity, more emotional openness and flexibility,
and increases in mental clarity, concentration, focus, and atten-
tion. Students also reported being better able to check how stress
manifested in their bodies as tension and noted mindfulness as a
means to monitor and adapt their stress response [72]. These
findings were corroborated in a study that reported increases in
students’ consciousness of stress and anxiety and improved abil-
ities to anticipate stress with greater awareness [91]. This study
quoted a student as follows:
I felt in the past that I had managed stress really well. However, after
completing several meditation [sessions], and realizing that being
stressed and overwhelmed were common during my practices, it seems
I might not have managed as well as I was portraying. I feel my
awareness of my level of stress has helped me to reduce the stress
before it becomes overwhelming. [91,p.163]
Further, Gockel and Deng reported that students identified
that mindfulness provided tools to support relaxation, manage
anxiety and to cope with challenges in their lives [89].

Regulating behaviour, such as sleep, was also identified as a
self-care objective that could potentially be facilitated through
engagement in mindfulness practice [73,75]. As an example, one
student noted:
My sleep has largely improved. [I] have a tendency to wake up in the
middle of the night and lie there for hours worrying about all the
things that I cannot do anything about at that moment … I find that
doing the exercises … clear[s] my mind and then I could go back to
sleep. [73,p.46]
In addition to sleep regulation, other physical improvements
were identified, including increased bodily awareness and sensitiv-
ity, and improved strength, balance, stamina, and flexibility
[66,76]. As one student in Newsome et al.’s study pointed out: “As
far as physical ailments, I feel as if I know my body a lot better
and I am able to recognise when I am starting to feel ill and then
I slow down and take care of myself” [66,p.1890]. Awareness and
reduction in physical pain were also described, for example “ … all
sensations are continually changing … even pain. Resisting the
discomfort actually increases it … but allowing it into open aware-
ness seems to take away its power” [66,p.272].
Incorporating mindfulness into the daily routine of health pro-
fessions students as a mechanism to enhance self-care was advo-
cated in several nursing and social work programmes as a means
of preventing early career burnout and job dissatisfaction
[81,89,102–104]. The risks of burnout were articulated by one stu-
dent as follows: “it’s irresponsible to be working with people
when you’re clouded, when you’re burnt out” [74,p.278]. Through
engaging in mindfulness, Wong reported that this student was
able “to stop and take time for herself to reconnect to her body,
heart and spirit … [something that was] absolutely crucial to her
effectiveness as a … practitioner” [81,p.278].
Mindfulness was also described as assisting students to culti-
vate confidence in themselves. Christopher and Maris reported
that mindfulness enhanced students’ confidence in their bodies
and physical characteristics, as well as their overall confidence
[72]. Wong noted that mindfulness practice was found to “spark a
healthier journey,” “boost confidence” and frequently “had a sig-
nificant impact on all aspects of (students’) being, not just the
physical but also the emotional” [81,p.275]. Similarly, Thomson
reported participants feeling as though they “regained a sense of
self” through mindfulness practice [75].
Mindfulness within the professional practice setting. A
number of studies reported on the benefits of mindfulness train-
ing when working in professional practice settings [66,71,73,74,
76,81–83,89,91,92,102–106]. One theme was the ability to connect
with patients, and be present to them on a deeper level:
When I was with patients I could be fully present … you
know … listening, looking … using all my senses, and not thinking of
something else, which I used to do. The assessments went really well as
a result … I was less judgmental and treated others with greater
acceptance [76, p.273].
Similarly, students variously reported that mindfulness practice
helped to “slow down” the therapeutic process [91], bring
moments into greater focus [82], and contribute to a greater
sense of empathy towards clients:
[Mindfulness] helped me to slow down and be more fully present in
the room and inside myself. It has increased my ability to help clients
to slow down and explore their current experience. I think before
taking this class, I was very action oriented in sessions, which came
across as agenda pushing. Now, I think my sessions move more slowly
and demonstrate more depth and true empathy. [91,p.165]
Wong found a burgeoning of empathy by nursing students
after receiving mindfulness training [81]. This was exemplified by
MINDFULNESS IN ALLIED HEALTH PROFESSIONS EDUCATION 7
one student who talked about taking more time “to make [a]
human connection … to know and understand [the] client in a
meaningful way, not just the problem [the client was] dealing
with” [81,p.275]. Similarly, Gockel and Deng reported that mind-
fulness helped students to develop strong therapeutic alliances
with their clients [89].
Another example of the benefits of mindfulness in the profes-
sional practice setting was related to handling stress. Willgens
and Sharf found that physiotherapy students who had failed their
clinical components exemplified qualities of “mindless” behaviours
such as self-deception, covering up deficiencies, oversimplification,
and delusion for ego preservation [107]. As one student stated
“we all had stress, but we never learned how to handle it effect-
ively in ways that would work in the clinic” [107,p.74] … “looking
back, [I realize] that I exuded all that stress onto my patients … it
affected everything I did” [107,p.73].
Mindfulness was noted as a tool that could help students cope
with stress on placement:
Mindfulness strategies were definitely helpful in trying to be present
and face my anxiety and be aware of it when I feel it coming on, and
then kind of come back to the session, and kind of mastering how
does that sort of happen in my own process, and then being able to
come back to be present with the client. I’d say the mindfulness
strategies were the most useful thing. [83,p.48]
Mindfulness approaches were identified as helping students to
connect and be present to clients, slow down and be present in
the therapeutic process, and to assist students to cope with the
stressors associated with patient care in a professional prac-
tice setting.
Mindfulness in the classroom. In terms of mindfulness in the
classroom, positive outcomes such as increased attention and
stress reduction were frequently reported to be of benefit
[71,73,83,85,89,92,102,104,105]. van der Riet highlighted the words
of one student who reported “it did help me focus a lot more
with my assignments and things. I did not even realise that it
would help but when I did realise, oh, that is a good thing”
[73,p.47]. Gockel et al. recounted the experience of social work
students who reported that mindfulness training “helped concen-
tration”; assisted to “re-encounter each class” anew; and “put me
in a good space for learning and role plays” [83,p.349].
Mindfulness was also identified as beneficial in helping to allevi-
ate academic stress. For instance, in the words of a student, mind-
fulness training “brought me into the room, calming me down
and making me open to [the] experience” [83,p.349]. Similarly,
Hutchinson and Janiszewski Goodin noted that:
Deep breathing meditation may be helpful to students prior to
beginning simulation learning for the purpose of creating a mental and
physical calm. The managing of or elimination of anxiety also reduces
self-doubt optimizing students’ full mental and physical presence
during simulation. [104,p.21–22]
One study noted that students reported changes to their per-
ception of the classroom through mindfulness training [74].
Participants reported their perceptions that the classroom became
a “safe space” and emphasised the positive effect of “feeling sup-
port and kindness from peers” [74,p.10]. Further participant
responses highlighted that these experiences differed from other
courses, and that the collaborative mindfulness training contrib-
uted to a sense of community within the classroom.
In short, descriptions of positive affordances of mindfulness in
the classroom were reported in a number of studies
[71,73,74,83,85,89,92,102,104,105], these included helping students
focus in class [73,83] reducing the anxiety associated with
8 E. A. KINSELLA ET AL.
academic pressures, [85,89,92,104] and contributing to a sense of
safety and community in the classroom [74].
Cultivating qualities of mindfulness. Mindfulness was fre-
quently described as assisting students in the cultivation of par-
ticular qualities, including attention, self-awareness, compassion,
non-judgment, and acceptance. These qualities are reflective of
Kabat-Zinn’s seven interconnected attitudinal factors that serve as
a foundation for mindfulness practice [40,41]. Although presented
separately they were often discussed in an intertwined manner,
and some examples could readily be placed in more than one
category below.
Attention. Mindfulness was frequently described as helping
students concentrate and focus their attention on the present
moment. Christopher and Maris found that mindfulness education
helped students focus on things that are in the present while set-
ting aside past or future stressors [72]. Christopher highlighted
students’ reports of shifting their attention to the present
moment and becoming aware of things as they really are [71]. A
student in Felton et al.’s study noted: “The first change that I
noticed after a couple of meetings was that … I started living
more in the present and enjoying minute-to-minute experience”
[91,p.162]. van der Riet et al. also described mindfulness as help-
ing students acquire the ability to bring their attention to the pre-
sent moment without judgment and with acceptance of what is
[73]. A student from Stew’s study stated: “I become aware of
whatever I pay attention to … like creating my own world”
[76,p.272]. Newsome et al. reported mindfulness practice as giving
students the time, space and urging to be more present, increase
awareness, slow down and to continue to learn to let go of fears,
anxiety or doubt:
In a lot of ways, I feel like this was the most important class I’ve
taken, just learning to be present in a different way. It has huge
implications in the counseling area … I have this new control over my
body where I can like, take a breath, and it’s a different kind of
breath than [I] ever knew how to take, and I feel like, oh, I feel
calmer now, and I feel centered, and in control of my body and I can
just be present to this person instead of being anxious inside. It’s just
huge. [66,p.1889]
Self-awareness. A number of studies highlighted the cultiva-
tion of greater self-awareness through mindfulness practices.
Students frequently reported more attunement to bodily sensa-
tions, emotions, and thoughts. In Birnbaum’s study, students were
found to observe from within, and to observe physical sensations
as well as mental and emotional contents, and to notice the rela-
tionship between the three [92]. Christopher and Maris noticed
that students were better able to acknowledge the messages
flowing from their bodies and become more sensitive to their
body’s needs for rest, hydration of movement after practicing
mindfulness [72]. Similarly, a student from Felton et al.’s
study noted:
I have a deep connection and awareness to my body through this class.
I found that I often hold my stress in different parts of my body,
particularly in my stomach … I can become so focused on my body
during stress that I lose sight of my tasks ahead and focus on negative
things about my body. This is a pattern that really came to light
throughout this semester. [91,p.163]
Self-awareness was frequently identified as assisting students
to recognise when stress was manifesting in their bodies [70,100]
and to enable effective utilisation of stress management and
mindfulness practices [73,92,103]. A student stated:
It helps you recognise when you get to that level of stress that you
need to calm down and take your time and … If you stress you are not
going to get anything done, you are not going to remember anything.
You are better off doing an hour’s calm study … It’s just recognising it.
[73], p.46
A number of studies also found that students developed a
greater sense of spiritual awareness. Mindfulness practice was
found to prompt reflection on life purpose, personal values, and
belief systems [98]. A student explained: “this class has also led
me to explore my own belief system and has expanded my know-
ledge about differing views of the world, life and spiritu-
ality” [66,p.1891].
Compassion. A number of studies described students’ devel-
opment of compassion towards themselves and others while
engaging in mindfulness practice [72,82,85,89,91,102]. Christopher
and Maris found that mindfulness improved students’ relation-
ships with themselves and others and decreased self-judgment
[72]. Students in their study reported a sense of acceptance, less
need to engage in self-critical thoughts, and greater appreciation
of their limitations, weaknesses, and imperfections. Gockel
reported that mindfulness training cultivated qualities such as
empathy and compassion amongst students [102]. In a study by
Thomas, students spoke of enhanced self-compassion following
mindfulness training [74]. Birnbaum also reported that levels of
compassion that arose with mindfulness amongst students,
enhanced group processes of sharing and discussion [92].
Moreover, Newsome et al. indicated that, after practicing mindful-
ness, students were able to cultivate a sense of self-compassion
in relation to self-care routines [84]. Similarly, a student in Beck
et al.’s study stated that because of mindfulness, “I’ll remember to
be kind to myself, forgive myself and to be in the present
moment” [85,p.902].
Non-judgment and acceptance. Mindfulness practice was also
frequently reported to help students “let go” of intrusive or nega-
tive thoughts without judging them as “bad” or engaging with
them, and to bring attention to the moment with acceptance of
what it is:
… the bit that I have probably enjoyed the most is the non-judgment
of thoughts and I do not think I am a particularly judgmental person
but you realise how much judgment you put on thoughts and how
much value you put on that being a good thought or a bad thought or
a good situation or a bad situation. [73,p.46]
Students, in a study by Felton et al., reported that they were
better able to accept things they had little or no control over;
and to let things work out on their own [91]. This accepting
attitude was described as helping students embrace and accept
life in good or bad times; and to non-judgmentally perceive
stress-inducing situations. Felton et al. reported that learning to
accept difficulties and view stress with acceptance allowed stu-
dents to become more comfortable while experiencing various
emotions. In the words of one student: “I am much more in
touch with my emotions, I am much more comfortable with
experiencing anger or sadness, allowing myself to feel them,
without judgment (sometimes) and not trying to bury them
deep inside me” [91,p.164]. Thomson reported similar findings,
where students spoke of enhanced abilities to accept stress and
manage emotions in critical situations [75]. Birnbaum noted that
students were able to turn to a neutral place where they could
work through complex experiences [92]. Gockel also indicated
that students were able to extend kindness to themselves and
others through mindfulness practice by receiving attention
infused with the quality of warmth and acceptance [102]. As a
student in Newsome et al.’s study noted: “I understand now one
must employ self-care in the form of self-compassion and non-
judgmental acceptance of self before one can relate and extend
these qualities to others” [84,p.308].

Discussion and implications
The findings of this study have important implications for the
education of future rehabilitation practitioners in allied health and
social care professions, professional practice placements, and
future research.
Implications for allied health and social care education
At a time when high levels of stress, anxiety, and depression are
being noted in student populations in many rehabilitation disci-
plines, the introduction of mindfulness education into the curricu-
lum of allied health and social care trainees may offer affordances
for mitigating some of the challenging conditions of contempor-
ary education and practice.
The findings of this scoping review suggest that mindfulness
educational interventions have the potential to make important
contributions to the education of future practitioners. Mindfulness
interventions may offer benefits for students in the management
of high levels of anxiety, stress, and depression [17,34,48,
51,54,64,65,67–69,72,73,80,83,85,89,92,96,99,101,103,104]; in the
development of academic skills including attention and concen-
tration for learning [71,73–75,81,82,86,93,97,105]; and in the
development of empathy and positive relationships necessary for
professional practice [70,72,74,76,81,82,85,87,89–92,102,107].
Mindfulness educational interventions may also have potential to
foster positive qualities of mind [66,71–76,83,91–93], to improve
self-management, including self-awareness and self-care
[30,64,66,70–76,84,85,88,89,91,92,95,97,100,102], to contribute to
increased perceptions of quality of life [68,93,96,101], and in the
promotion of resilience [69,98]. Quantitative studies of mindful-
ness were divided on whether it was effective in mitigating stu-
dent burnout, while qualitative studies highlighted a perceived
reduction, suggesting the need for further research in
this domain.
As evidence continues to grow about the affordances of mind-
fulness educational interventions, university programmes charged
with the education of future practitioners in rehabilitation-related
disciplines may do well to consider the integration of such pro-
grammes into mainstream educational curricula. It is interesting
to note that one study highlighted a strong sense of community
and perceptions of a “safe space” in the mindfulness classroom
[74], and others noted greater effects among students who had
little or no previous exposure to mindfulness [65].
Implications for professional practice placements
A number of the studies in the review suggest that mindfulness has
the potential to assist students to cultivate qualities of mind benefi-
cial for professional practice such as awareness, self-awareness, non-
judgement, acceptance, attention, and compassion with self and
others, amongst others. Further, mindfulness interventions were
attributed with helping students to relate with patients on a deeper
level. A number of studies reported that students were more
focused, empathetic, present, and accepting in their professional
relationships with patients. In some instances, mindfulness was
found to help students slow down the therapy process and to be
less judgmental as they listened to the stories of individuals.
Mindfulness may also have value in assisting students to manage
stress in the professional practice setting. A number of studies sug-
gested that students became more aware of emotions in practice,
contributing to greater capacity to handle challenging situations
with patients in the professional practice milieu. Furthermore,
given the burgeoning use of mindfulness interventions in
MINDFULNESS IN ALLIED HEALTH PROFESSIONS EDUCATION 9
the rehabilitation of clients in health and social care in recent years,
the opportunity for students to learn about and experience mindful-
ness may well have important implications for the development of
their capabilities to apply it with others in future therapeutic work.
Implications for research
The findings of the review have important implications for guiding
future research. The review points to a proliferation of research into
applications of mindfulness in the education of allied health and
social care professions – particularly over the last 4 years with 35
articles being published during this time. The review also points to a
significant increase of attention to research in this area, especially in
the Western world, with a predominance of articles being published
in the United States where the term “mindfulness” has become pop-
ularised. Given the preponderance of research in the United States,
further research that explores the relevance of mindfulness, or
diverse culturally relevant forms of contemplative pedagogy, in
other parts of the world may be warranted.
One challenge is to address the diverse ways in which mindful-
ness is operationalised, implemented and studied. Further studies
that identify optimal mindfulness educational intervention proto-
cols and that develop practical resources for educators are
needed. As the majority of papers focused on nursing and social
work education, more research in fields of occupational therapy,
physical therapy, psychology, speech-language pathology, and
audiology education are recommended. As only six of the reviews
involved more than one discipline future research would do well
to examine interprofessional approaches to mindfulness educa-
tion. Further research that investigates whether students transfer
their learning about mindfulness into rehabilitation and other
health and social care professional settings post-graduation, as
well as research into educational interventions with professional
practitioners post-graduation, would be a useful addition to the
literature. Given the interesting finding about mindfulness as con-
tributing to students’ sense of community and a safe space, fur-
ther research about the affordances of mindfulness in fostering
positive educational communities is warranted.
Strengths and limitations
The strengths of the study include the systematic nature of the
review and the implementation of a rigorous analysis process. The
study included a large quantity and range of papers from various
allied health and social care disciplines. Limitations include the
exclusion of studies published in languages other than English,
and the decision not to include various forms of grey literature
(beyond directly relevant doctoral dissertations), which may have
led to some important research being excluded. It is also import-
ant to note that the vast majority of mindfulness literature in this
review comes from the West, with few studies from East Asia des-
pite the concept of mindfulness being based on Eastern tenets.
The terminology of “mindfulness” may have precluded attention
to important studies on similar constructs from other parts of the
world. The study excluded medical health disciplines given the
existence of a body of literature in that field and in order to man-
age the size of review. Nonetheless, there may have been add-
itional insights rendered from inclusion of that body of literature.
Conclusions
This study has identified, summarised, and described 12 years of
peer-reviewed scholarship in the area of mindfulness in allied
10 E. A. KINSELLA ET AL.
health and social care professions education, recognising that
many of these practitioners will enter the field of rehabilitation.
This review identifies how mindfulness is being conceptualised in
contemporary scholarship, and maps the types of mindfulness
approaches, and intervention protocols being used in educational
contexts. The review highlights the balance between quantitative
and qualitative research in the field, and notes that the vast
majority of studies are located in the United States. The results
point to the fruitful possibilities of mindfulness educational inter-
ventions for allied health and social care professions students.
Both quantitative and qualitative studies point to potential affor-
dances related to the cultivation of mindful qualities such as:
attention, self-awareness, compassion, non-judgment, and accept-
ance. An analysis of quantitative studies points to potential bene-
fits in terms of the mediation of stress, anxiety, depression,
empathy, quality of life, academic skills, management of physio-
logical measures, and resilience in students. Qualitative studies
point to contributions in terms of self-care, professional practice
placements, classroom performance, and the cultivation of qual-
ities of mind. In view of the results, directions for further research
on mindfulness and its promise for education and practice in
rehabilitation professions are recommended.
What the study has added
This study has mapped the current state of the peer-reviewed lit-
erature on mindfulness-based interventions in the professional
education of students in the rehabilitation disciplines of occupa-
tional therapy, physical therapy, social work, counselling, psych-
ology, nursing, speech-language pathology, and audiology. The
potential affordances of mindfulness-based educational interven-
tions have been discussed, with a consideration of implications
for education, professional practice placements, and research.
Disclosure statement
No potential conflict of interest was reported by the authors.
Funding
This research is supported in part through an internal grant from
Western University, and through a grant from the Social Science
and Humanities Research Council of Canada [grant number 435-
2018-1451].
References
[1] Omigbodun O, Odukogbe A, Omigbodun A, et al.
Stressors and psychological symptoms in students of
medicine and allied health professions in Nigeria. Soc
Psychiat Epidemiol. 2006;41:415–421.
[2] Tucker B, Jones S, Mandy A, et al. Physiotherapy students’
sources of stress, perceived course difficulty, and paid
employment: comparison between Western Australia and
United Kingdom. Physiother Theory Pract. 2006;22:
317–328.
[3] Everly J, Poff D, Lamport N, et al. Perceived stressors and
coping strategies of occupational therapy students. Am J
Occup Ther. 1994;48:1022–1028.
[4] Nerdrum P, Rusten T, Helge Rnnestad M. Psychological
distress among nursing, physiotherapy and occupational
therapy students: a longitudinal and predictive study.
Scand J Educ Res. 2009;53:363–378.
[5] Beck A, Verticchio H. Facilitating speech-language path-
ology graduate students abilities to manage stress: a pilot
study. Contemp Issues Commun Sci Disord. 2014;41:
24–38.
[6] Ross E. Burnout and self-care in the practice of speech
pathology and audiology: an ecological perspective. In
Fourie RJ, editor. Therapeutic processes for communica-
tion disorders. Hove [East Sussex] (NY): Psychology Press;
2011. p. 213–228.
[7] Watson R, Deary I, Thompson D, et al. A study of stress
and burnout in nursing students in Hong Kong: a ques-
tionnaire survey. Int J Nurs Stud. 2008;45:1534–1542.
[8] Collins S, Coffey M, Morris L. Social work students: stress,
support and well-being. Br J Soc Work. 2010;40:963–982.
[9] Myers S, Sweeney A, Popick V, et al. Care practices and
perceived stress levels among psychology graduate stu-
dents. Train Educ Prof Psychol. 2012;6:55–66.
[10] Finkelstein C, Brownstein A, Scott C, et al. Anxiety and
stress reduction in medical education: an intervention.
Med Educ. 2007;41:258–264.
[11] Pau A, Rowland M, Naidoo S, et al. Emotional intelligence
and perceived stress in dental undergraduates: a multi-
national survey. J Dent Educ. 2007;71:197–204.
[12] Robotham D. Stress among higher education students:
towards a research agenda. High Educ. 2008;56:735–746.
[13] Higgs J, Hunt A, Higgs C, et al. Physiotherapy education
in the changing international healthcare and educational
context. Adv Physiother. 1999;1:17–26.
[14] Lomas T, Medina JC, Ivtzan I, et al. A systematic review of
the impact of mindfulness on the well-being of healthcare
professionals. J Clin Psychol. 2017;74:319–355.
[15] Chen C, Chen Y, Sung H, et al. The prevalence and related
factors of depressive symptoms among junior college
nursing students: a cross-sectional study. J Psychiatr Ment
Health Nurs. 2015;22:590–598.
[16] Rummell C. An exploratory study of psychology graduate
student workload, health, and program satisfaction. Prof
Psychol Res Pr. 2015;46:391–399.
[17] Song Y, Lindquist R. Effects of Mindfulness-Based Stress
Reduction on depression, anxiety, stress and mindfulness
in Korean nursing students. Nurse Educ Today.
2015;35:86–90.
[18] Dyrbye N, Thomas M, Huschka M, et al. A multicenter
study of burnout, depression, and quality of life in minor-
ity and nonminority US medical students. Mayo Clin Proc.
2006;81:1435–1442.
[19] Garcia-Izquierdo M, Rios-Risquez M, Carrillo-Garcia C, et al.
The moderating role of resilience in the relationship
between academic burnout and the perception of psy-
chological health in nursing students. J Educ Psychol.
2018;38:i.
[20] Pagnin D, de Queiroz V. Influence of burnout and sleep
difficulties on the quality of life among medical students.
Springerplus. 2015;4:676–677.
[21] Pfeifer TA, Kranz PL, Scoggin AE. Perceived stress in occu-
pational therapy students. Occup Ther Int.
2008;15:221–231.
[22] Severn M, Searchfield G, Huggard P. Occupational stress
among audiologists: compassion satisfaction, compassion
fatigue, and burnout. Int J Audiol. 2012;51:3–9.
[23] Lincoln M, Adamson B, Covic T. Perceptions of stress, time
management and coping strategies of speech pathology

students on clinical placement. Adv Speech Lang Pathol.
2004;6:91–99.
[24] Rizzolo D, Zipp G, Stiskal D, et al. Stress management
strategies for students: the immediate effects of yoga,
humor, and reading on stress. J Coll Teach Learn.
2011;6:79–88.
[25] Sarid O, Anson O, Yaari A, et al. Academic stress, immuno-
logical reaction, and academic performance among stu-
dents of nursing and physiotherapy. Res Nurs Health.
2004;27:370–377.
[26] Seaward B. Managing stress: principles and strategies for
health and wellbeing. 3rd ed. Boston (MA): Jones and
Barlett; 2011.
[27] Jacob T, Itzchak E, Raz O. Stress among health care stu-
dents - a cross disciplinary perspective. Physiother Theory
Pract. 2013;29:401–412.
[28] McCall T. Yoga as medicine: the yogic prescription for
health and healing. New York (NY): Bantam; 2007.
[29] Lazarus R, Folkman S. Stress, appraisal, and coping. New
York (NY): Springer; 1984.
[30] Kanji N, White A, Ernst E. Autogenic training to reduce
anxiety in nursing students: randomized control trial. J
Adv Nurs. 2006;53:729–735.
[31] Beddoe A, Murphy S. Does mindfulness decrease stress
and foster empathy among nursing students? J Nurs
Educ. 2004;43:305–312.
[32] Goff A. Stressors, academic performance and learned
resourcefulness in baccalaureate nursing students. Int J
Nurs Educ Scholarsh. 2011;8:1–20.
[33] Shapiro S, Schwartz G, Bonner G. Effects of Mindfulness-
Based stress reduction on medical and premedical stu-
dents. J Behav Med. 1998;21:581–599.
[34] Kang YS, Choi SY, Ryu E. The effectiveness of a stress cop-
ing program based on mindfulness meditation on the
stress, anxiety, and depression experienced by nursing
students in Korea. Nurse Educ Today. 2009;29:538–543.
[35] Williams GM, Kabat-Zinn J. Mindfulness: diverse perspec-
tives on its meaning, origins and applications. New York
(NY): Routledge; 2013
[36] Kabat-Zinn J. Full catastrophe living: using the wisdom of
your body and mind to face stress, pain and illness. New
York (NY): Delta; 1990.
[37] Kabat-Zinn J. Mindfulness meditation: health benefits of
an ancient Buddhist practice. In Goleman D, Gurin J, edi-
tors. Mind/body medicine. New York (NY): Consumer
Reports Books; 1993. p. 259–276.
[38] Kabat-Zinn J. Mindfulness-Based interventions in context:
past, present, future. Clin Psychol. 2003;10:144–156.
[39] Kabat-Zinn J. Coming to our senses. New York (NY):
Hyperion; 2005.
[40] Kabat-Zinn J. Full catastrophe living: using the wisdom of
your body and mind to face stress, pain, and illness. New
York (NY): Bantam; 2013.
[41] Kabat-Zinn J. Some reflections on the origins of MBSR,
skillful means and the trouble with maps. In Williams GM,
Kabat-Zinn J, editors. Mindfulness: diverse perspectives on
its meaning, origins and applications. New York (NY):
Routledge; 2013.
[42] Galantino M, Baime M, Maguire M, et al. Association of
psychological and physiological measures of stress in
health-care professionals during an 8-week mindfulness
meditation program: mindfulness in practice. Stress
Health. 2005;21:255–261.
MINDFULNESS IN ALLIED HEALTH PROFESSIONS EDUCATION 11
[43] Brinkborg H, Michanek J, Hesser H, et al. Acceptance and
commitment therapy for the treatment of stress among
social workers: a randomized controlled trial. Behav Res
Ther. 2011;49:389–398.
[44] Lengacher C, Reich R, Paterson C, et al. The effects of mind-
fulness based stress reduction on objective and subjective
sleep parameters in women with breast cancer: a random-
ized controlled trial. Psychooncology. 2015;24:424–432.
[45] Rosenzweig S, Reibel D, Greeson J, et al. Mindfulness-
based stress reduction lowers psychological distress in
medical students. Teach Learn Med. 2003;15:88–92.
[46] Tang Y. Yang L, Leve L, Harold G. Improving executive
function and its neurobiological mechanisms through a
mindfulness-based intervention: advances within the field
of developmental neuroscience. Child Dev Perspect.
2012;6:361–366.
[47] Deckro G, Ballinger K, Hoyt M, et al. The evaluation of a
mind/body intervention to reduce psychological distress
and perceived stress in college students. J Am Coll
Health. 2002;50:281–287.
[48] Shapiro SL, Brown KW, Biegel GM. Teaching self-care to
caregivers: effects of Mindfulness-Based Stress Reduction
on the mental health of therapists in training. Train Educ
Prof Psychol. 2007;1:105–115.
[49] Cohen-Katz J, Wiley SD, Capuano T, et al. The effects of
mindfulness-based stress reduction on nurse stress and
burnout, part II: a quantitative and qualitative study.
Holist Nurs Pract. 2005;19:26–35.
[50] Warnecke E, Quinn S, Ogden K, et al. A randomised con-
trolled trial of the effects of mindfulness practice on med-
ical student stress levels. Med Educ. 2011;45:381–388.
[51] Chen Y, Yang X, Wang L, et al. A randomized controlled
trial of the effects of brief mindfulness meditation on anx-
iety symptoms and systolic blood pressure in Chinese
nursing students. Nurse Educ Today. 2013;33:1166–1172.
[52] Regehr C, Glancy D, Pitts A, et al. Interventions to reduce
the consequences of stress in physicians: a review and
meta-analysis . J Nerv Ment Dis. 2014;202:353–359.
[53] Shiralkar M, Harris T, Eddins-Folensbee F, et al. A system-
atic review of stress-management programs for medical
students. Acad Psychiatry. 2013;37:158–164.
[54] Alexander C, Sheeler RD, Rasmussen NH, et al. Teaching
an experimental mind-body method to medical students
to increase interpersonal skills: a pilot study. Acad
Psychiatry. 2015;39:316–319.
[55] de Vibe M, Solhaug I, Tyssen R, et al. Does personality mod-
erate the effects of mindfulness training for medical and
psychology students? Mindfulness (NY). 2015;6:281–289.
[56] Erogul M, Singer G, McIntyre T, et al. Abridged
Mindfulness intervention to support wellness in first-year
medical students. Teach Learn Med. 2014;26:350–356.
[57] Gordon J. Mind-body skills group for medical students:
reducing stress, enhancing commitment, and promoting
patient-centered care. BMC Med Educ. 2014;14:198.
[58] Hassed C, de Lisle S, Sullivan G, et al. Enhancing the
health of medical students: outcomes of an integrated
mindfulness and lifestyle program. Adv Health Sci Educ.
2009;14:387–398.
[59] Phang C, Mukhtar F, Ibrahim N, et al. Effects of a brief
mindfulness-based intervention program for stress man-
agement among medical students: the mindful-gym
randomized controlled study. Adv Health Sci Educ.
2015;20:1115–1398.
12 E. A. KINSELLA ET AL.
[60] Arksey H, O’Malley L. Scoping studies: towards a meth-
odological framework. Soc Res Methodol. 2005;8:19–32.
[61] Davies M. Correct mapping, mind mapping and argument
mapping: what are the differences and do they matter?
High Educ. 2011;62:279–301.
[62] Kabat-Zinn J. Wherever you go, there you are: mindful-
ness meditation in everyday life. New York (NY): Hyperion;
1994.
[63] Kabat-Zinn J. Full catastrophe living: using the wisdom of
your body and mind to face stress, pain and illness. 15th
ed. New York (NY): Bantam Dell; 2005.
[64] Botta AA, Cadet JT, Maramaldi P. Reflections on a quanti-
tative, group-based mindfulness study with social work
students. Soc Work Groups. 2015;38:93–105.
[65] Schwarze M, Gerler E. Using Mindfulness-Based Cognitive
Therapy in individual counseling to reduce stress and
increase mindfulness: an exploratory study with nursing
students. Prof Counse. 2015;5:39–52.
[66] Newsome S, Christopher J, Dahlen P, et al. Teaching coun-
selors self-care through mindfulness practices. Teach Coll
Rec. 2006;108:1881–1900.
[67] Spadaro KC, Hunker DF. Exploring the effects of an online
asynchronous mindfulness meditation intervnetion with
nursing students on stress, mood and cognition: a
descriptive study. Nurse Educ Today. 2016;39:163–169.
[68] Bonifas RP, Napoli M. Mindfully increasing quality of life: a
promising curriculum for MSW students. J Soc Work Educ.
2014;33:469–484.
[69] Alsaraireh FA, Aloush SM. Mindfulness meditation versus
physical exercise in the management of depression
among nursing students. J Nurs Educ. 2017;56:599–604.
[70] Barbosa P, Raymond G, Zlotnick C, et al. Mindfulness
based stress reduction training is associated with greater
empathy and reduced anxiety for graduate healthcare stu-
dents. Educ Health. 2013;26:9–14.
[71] Christopher JC, Christopher SE, Dunnagan T, et al.
Teaching self-care through mindfulness practices: the
application of yoga, meditation, and qigong to counselor
training. J Human Psychol. 2006;46:494–509.
[72] Christopher JC, Maris JA. Integrating mindfulness as self-
care into counselling and psychotherapy training. Counse
Psychother Res. 2010;10:114–125.
[73] van der Riet P, Rossiter R, Kirby D, et al. Piloting a stress
management and mindfulness program for undergraduate
nursing students: student feedback and lessons learned.
Nurse Educ Today. 2015;35:44–49.
[74] Thomas JT. Brief mindfulness training in the social work
practice classroom. J Soc Work Educ. 2017;36:102–118.
[75] Thomson D, Gowing F, English M, et al. Exploring the role
of mindfulness as a potential self-management strategy
for physiotherapy students when on clinical placement.
Int J PractBased Learn Health Soc Care. 2017;5:19–37.
[76] Stew G. Mindfulness training for occupational therapy stu-
dents. Br J Occup Ther. 2011;74:269–276.
[77] Lee JL, Himmelheber SA. Field education in the present
moment: evaluating a 14-week pedagogical model to increase
mindfulness practice. J Soc Work Educ. 2016;52:473–483.
[78] Napoli M, Bonifas R. From theory toward empathic self-
care: creating a mindful classroom for social work stu-
dents. J Soc Work Educ. 2011;30:635–649.
[79] Reid DT, Reid TD. Teaching mindfulness to occupational
therapy students: pilot evaluation of an online curriculum.
Can J Occup Ther. 2013;80:42–48.
[80] Drew BL, Motter T, Ross R, et al. Care for the caregiver:
evaluation of mind-body self-care for accelerated nursing
students. Holist Nurs Pract. 2016;30:148–154.
[81] Wong YLR. Returning to silence, connecting to wholeness:
contemplative pedagogy for critical social work education.
J Relig Spiritual Soc Work. 2013;32:269–285.
[82] Gockel A, Burton D, James S, et al. Introducing mindful-
ness as a self-care and clinical training strategy for begin-
ning social work students. Mindfulness (NY).
2013;4:343–353.
[83] Gockel A, Cain T, Malove S, et al. Mindfulness as clinical
training: student perspectives on the utility of mindfulness
training in fostering clinical intervention skills. J Relig
Spiritual Soc Work. 2013;32:36–59.
[84] Newsome S, Waldo M, Gruszka C. Mindfulness group
work: preventing stress and increasing self-compassion
among helping professionals in training. J Special Group
Work. 2012;37:297–311.
[85] Beck AR, Verticchio H, Seeman S, et al. A mindfulness
practice for communication sciences and disorders under-
graduate and speech-language pathology graduate stu-
dents: effects on stress, self-compassion, and
perfectionism. Am J Speech Lang Pat. 2017;26:893–907.
[86] Sanko J, Mckay M, Rogers S. Exploring the impact of
mindfulness meditation training in pre-licensure and post
graduate nurses. Nurse Educ Today. 2016;45:142–147.
[87] Swift JK, Callahan JL, Dunn R, et al. A randomized-con-
trolled crossover trial of mindfulness for student psycho-
therapists. Train Educ Prof Psyc. 2017;11:235–242.
[88] Schure MB, Christopher J, Christopher S. Mind-body medi-
cine and the art of self-care: teaching mindfulness to
counseling students through yoga, meditation, and
qigong. J Couns Dev. 2008;86:47–56.
[89] Gockel A, Deng X. Mindfulness training as social work
pedagogy: exploring benefits, challenges, and issues for
consideration in integrating mindfulness into social work
education. J Relig Spiritual Soc Work. 2016;35:222–244.
[90] Leppma M, Young ME. Loving-kindness meditation and
empathy: a wellness group intervention for counseling
students. J Couns Dev. 2016;94:297–305.
[91] Felton TM, Coates L, Christopher JC. Impact of mindful-
ness training on counseling students’ perceptions of
stress. Mindfulness. 2015;6:159–169.
[92] Birnbaum L. The use of mindfulness training to create an
“accompanying place” for social work students. J Soc
Work Educ. 2008;27:837–852.
[93] Dubert CJ, Schumacher AM, Locker LJ, et al. Mindfulness
and emotion regulation among nursing students: investi-
gating the mediation effect of working memory capacity.
Mindfulness. 2016;7:1061–1070.
[94] Testa D, Sangganjanavanich VF. Contribution of mindful-
ness and emotional intelligence to burnout among coun-
selling interns. Couns. Educ Superv. 2016;55:95–108.
[95] Sundling V, Sundler AJ, Holmstro €m IK, et al. Mindfulness
predicts student nurses’ communication self-efficacy: a
cross-national comparative study. Patient Educ Couns.
2017;100:1558–1563.
[96] Burger KG, Lockhart JS. Meditation’s effect on attentional
efficiency, stress and mindfulness characteristics of nurs-
ing students. J Nurs Educ. 2017;56:430–434.
[97] Scheick MD, Scheick DM. Developing self-aware mindful-
ness to manage countertransference in the nurse-client

relationship: an evaluation and developmental study. J
Prof Nurs. 2011;27:114–123.
[98] Chamberlain D, Williams A, Stanley D, et al. Dispositional
mindfulness and employment status as predictors of resili-
ence in third year nursing students: a quantitative study.
Nurs Open. 2016;3:212–221.
[99] Chambers J, Phillips B, Burr M, et al. Effects of meditation
on stress levels of physical therapist students. J Phys Ther
Educ. 2016;30:33–39.
[100] Decker JT, Brown JLC, Ong J, et al. Mindfulness, compas-
sion fatigue, and compassion satisfaction among social
work interns. Soc Work Christianity. 2015;42:28–42.
[101] de Vibe M, Solhaug I, Tyssen R, et al. Mindfulness training
for stress management: a randomised controlled study of
medical and psychology students. BMC Med Educ.
2013;13:107–111.
MINDFULNESS IN ALLIED HEALTH PROFESSIONS EDUCATION 13
[102] Gockel A. The promise of mindfulness for clinical practice
education. Smith CollStud Soc Work. 2010;80:248–268.
[103] Gura ST. Mindfulness in occupational therapy education.
Occup Ther Health Care. 2010;24:266–273.
[104] Hutchinson T, Janiszewski Goodin H. Nursing student anx-
iety as a context for teaching/learning. J Holist Nurs.
2013;31:19–24.
[105] Lynn R. Mindfulness in social work education. J Soc Work
Educ. 2010;29:289.
[106] Maris JA. The impact of a mind/body medicine class on
counselor training: a personal journey. J Human Psychol.
2009;49:229–235.
[107] Willgens A, Sharf R. Failure in clinical education: using
mindfulness as a conceptual framework to explore the
lived experiences of 8 physical therapists. J Phys Ther
Educ. 2015;29:70–80.