Trial Outcomes & Findings for Remote Mindfulness Training Following Early Life Adversity (NCT NCT05516108)

NCT ID: NCT05516108

Last Updated: 2025-08-08

Results Overview

Recruitment benchmark: \>10% of people screened will be eligible

• Recruitment status: COMPLETED
• Study phase: PHASE1
• Target enrollment: 81 participants
• Primary outcome timeframe: assessed pre-enrollment
• Results posted on: 2025-08-08

Participant Flow

Participants were recruited into this study between August 2022 and March 2024. The study was advertised through "Pitt+Me," a registry of over 300,000 individuals in the Pittsburgh area interested in participating in research.

Participant milestones

Measure	Mindfulness Mindfulness intervention involving 14 foundational audio-guided lessons plus daily brief practice prompts. Lessons train meditation techniques for 3 mindfulness skills: concentration, sensory clarity, and equanimity. Practice prompts delivered 3x daily build on the skills trained in each lesson. Mindfulness: The mindfulness intervention includes 14 daily 20-minute audio lessons plus brief daily practice prompts. Lessons train specific meditation techniques through didactic explanation and guided practice. Based on the Unified Mindfulness system, lessons train 3 mindfulness skills: concentration, sensory clarity, and equanimity. Concentration, a state of stable attention on the intended target, enables participants to monitor present-moment physical and emotional body experiences. Sensory clarity, the monitoring of momentary experiences, involves detecting subtle sensations and discriminating between different experiences. Equanimity, an attitude of acceptance toward momentary experiences, is trained through 3 strategies: (a) body relaxation, (b) mental welcoming, and (c) a gentle tone of voice. Practice prompts build on the skills trained in each lesson, encouraging participants to practice brief moments of mindful awareness, mindfulness while doing daily tasks, or formal meditation.	Coping Coping intervention involving 14 foundational audio-guided lessons plus daily brief practice prompts. Lessons train techniques for 3 coping skills: reflection, reappraisal, and problem solving. Practice prompts delivered 3x daily build on the skills trained in each lesson. Coping: The coping intervention includes 14 daily 20-minute audio lessons plus brief daily practice prompts. Lessons train specific coping techniques through didactic explanation and guided practice. Lessons train coping skills (reflection, reappraisal, and problem solving) without encouraging focus on or acceptance of present experience (i.e., mindfulness skills). Participants are instructed to: (1) reflect and let their minds drift, (2) reframe or reappraise past and anticipated events, and (3) analyze and solve personal problems. Practice prompts build on the skills trained in each lesson, encouraging participants to take brief reflection breaks or to practice reappraisal or problem-solving skills.
Overall Study STARTED	42	39
Overall Study COMPLETED	37	34
Overall Study NOT COMPLETED	5	5

Reasons for withdrawal

Measure	Mindfulness Mindfulness intervention involving 14 foundational audio-guided lessons plus daily brief practice prompts. Lessons train meditation techniques for 3 mindfulness skills: concentration, sensory clarity, and equanimity. Practice prompts delivered 3x daily build on the skills trained in each lesson. Mindfulness: The mindfulness intervention includes 14 daily 20-minute audio lessons plus brief daily practice prompts. Lessons train specific meditation techniques through didactic explanation and guided practice. Based on the Unified Mindfulness system, lessons train 3 mindfulness skills: concentration, sensory clarity, and equanimity. Concentration, a state of stable attention on the intended target, enables participants to monitor present-moment physical and emotional body experiences. Sensory clarity, the monitoring of momentary experiences, involves detecting subtle sensations and discriminating between different experiences. Equanimity, an attitude of acceptance toward momentary experiences, is trained through 3 strategies: (a) body relaxation, (b) mental welcoming, and (c) a gentle tone of voice. Practice prompts build on the skills trained in each lesson, encouraging participants to practice brief moments of mindful awareness, mindfulness while doing daily tasks, or formal meditation.	Coping Coping intervention involving 14 foundational audio-guided lessons plus daily brief practice prompts. Lessons train techniques for 3 coping skills: reflection, reappraisal, and problem solving. Practice prompts delivered 3x daily build on the skills trained in each lesson. Coping: The coping intervention includes 14 daily 20-minute audio lessons plus brief daily practice prompts. Lessons train specific coping techniques through didactic explanation and guided practice. Lessons train coping skills (reflection, reappraisal, and problem solving) without encouraging focus on or acceptance of present experience (i.e., mindfulness skills). Participants are instructed to: (1) reflect and let their minds drift, (2) reframe or reappraise past and anticipated events, and (3) analyze and solve personal problems. Practice prompts build on the skills trained in each lesson, encouraging participants to take brief reflection breaks or to practice reappraisal or problem-solving skills.
Overall Study Time Commitment	3	1
Overall Study Reason Unknown	2	4

Baseline Characteristics

Remote Mindfulness Training Following Early Life Adversity

Baseline characteristics by cohort

Measure	Mindfulness n=42 Participants Mindfulness intervention involving 14 foundational audio-guided lessons plus daily brief practice prompts. Lessons train meditation techniques for 3 mindfulness skills: concentration, sensory clarity, and equanimity. Practice prompts delivered 3x daily build on the skills trained in each lesson. Mindfulness: The mindfulness intervention includes 14 daily 20-minute audio lessons plus brief daily practice prompts. Lessons train specific meditation techniques through didactic explanation and guided practice. Based on the Unified Mindfulness system, lessons train 3 mindfulness skills: concentration, sensory clarity, and equanimity. Concentration, a state of stable attention on the intended target, enables participants to monitor present-moment physical and emotional body experiences. Sensory clarity, the monitoring of momentary experiences, involves detecting subtle sensations and discriminating between different experiences. Equanimity, an attitude of acceptance toward momentary experiences, is trained through 3 strategies: (a) body relaxation, (b) mental welcoming, and (c) a gentle tone of voice. Practice prompts build on the skills trained in each lesson, encouraging participants to practice brief moments of mindful awareness, mindfulness while doing daily tasks, or formal meditation.	Coping n=39 Participants Coping intervention involving 14 foundational audio-guided lessons plus daily brief practice prompts. Lessons train techniques for 3 coping skills: reflection, reappraisal, and problem solving. Practice prompts delivered 3x daily build on the skills trained in each lesson. Coping: The coping intervention includes 14 daily 20-minute audio lessons plus brief daily practice prompts. Lessons train specific coping techniques through didactic explanation and guided practice. Lessons train coping skills (reflection, reappraisal, and problem solving) without encouraging focus on or acceptance of present experience (i.e., mindfulness skills). Participants are instructed to: (1) reflect and let their minds drift, (2) reframe or reappraise past and anticipated events, and (3) analyze and solve personal problems. Practice prompts build on the skills trained in each lesson, encouraging participants to take brief reflection breaks or to practice reappraisal or problem-solving skills.	Total n=81 Participants Total of all reporting groups
Age, Continuous	24.02 Years STANDARD_DEVIATION 3.11 • n=5 Participants	23.79 Years STANDARD_DEVIATION 3.50 • n=7 Participants	23.91 Years STANDARD_DEVIATION 3.29 • n=5 Participants
Sex: Female, Male Female	33 Participants n=5 Participants	36 Participants n=7 Participants	69 Participants n=5 Participants
Sex: Female, Male Male	9 Participants n=5 Participants	3 Participants n=7 Participants	12 Participants n=5 Participants
Ethnicity (NIH/OMB) Hispanic or Latino	3 Participants n=5 Participants	2 Participants n=7 Participants	5 Participants n=5 Participants
Ethnicity (NIH/OMB) Not Hispanic or Latino	39 Participants n=5 Participants	37 Participants n=7 Participants	76 Participants n=5 Participants
Ethnicity (NIH/OMB) Unknown or Not Reported	0 Participants n=5 Participants	0 Participants n=7 Participants	0 Participants n=5 Participants
Race (NIH/OMB) American Indian or Alaska Native	0 Participants n=5 Participants	0 Participants n=7 Participants	0 Participants n=5 Participants
Race (NIH/OMB) Asian	15 Participants n=5 Participants	8 Participants n=7 Participants	23 Participants n=5 Participants
Race (NIH/OMB) Native Hawaiian or Other Pacific Islander	0 Participants n=5 Participants	0 Participants n=7 Participants	0 Participants n=5 Participants
Race (NIH/OMB) Black or African American	6 Participants n=5 Participants	8 Participants n=7 Participants	14 Participants n=5 Participants
Race (NIH/OMB) White	18 Participants n=5 Participants	21 Participants n=7 Participants	39 Participants n=5 Participants
Race (NIH/OMB) More than one race	2 Participants n=5 Participants	2 Participants n=7 Participants	4 Participants n=5 Participants
Race (NIH/OMB) Unknown or Not Reported	1 Participants n=5 Participants	0 Participants n=7 Participants	1 Participants n=5 Participants
Region of Enrollment United States	42 Participants n=5 Participants	39 Participants n=7 Participants	81 Participants n=5 Participants

PRIMARY outcome

Timeframe: assessed pre-enrollment

Recruitment benchmark: >10% of people screened will be eligible

Outcome measures

Measure	Screening & Enrollment n=891 Participants All individuals who were pre-screened for eligibility before randomization.	Coping Coping intervention involving 14 foundational audio-guided lessons plus daily brief practice prompts. Lessons train techniques for 3 coping skills: reflection, reappraisal, and problem solving. Practice prompts delivered 3x daily build on the skills trained in each lesson. Coping: The coping intervention includes 14 daily 20-minute audio lessons plus brief daily practice prompts. Lessons train specific coping techniques through didactic explanation and guided practice. Lessons train coping skills (reflection, reappraisal, and problem solving) without encouraging focus on or acceptance of present experience (i.e., mindfulness skills). Participants are instructed to: (1) reflect and let their minds drift, (2) reframe or reappraise past and anticipated events, and (3) analyze and solve personal problems. Practice prompts build on the skills trained in each lesson, encouraging participants to take brief reflection breaks or to practice reappraisal or problem-solving skills.
Feasibility of Recruitment (Screened Eligible) Screened eligible at in-person screening	81 Participants	—
Feasibility of Recruitment (Screened Eligible) Pre-screened eligible but screened ineligible at in-person screening	56 Participants	—
Feasibility of Recruitment (Screened Eligible) Pre-screened eligible but did not attend in-person screening	112 Participants	—
Feasibility of Recruitment (Screened Eligible) Pre-screened ineligible	642 Participants	—

PRIMARY outcome

Timeframe: assessed across the entire 8-week study period

Retention benchmark: >80% retention through intervention and >75% retention through follow-up

Outcome measures

Measure	Screening & Enrollment n=42 Participants All individuals who were pre-screened for eligibility before randomization.	Coping n=39 Participants Coping intervention involving 14 foundational audio-guided lessons plus daily brief practice prompts. Lessons train techniques for 3 coping skills: reflection, reappraisal, and problem solving. Practice prompts delivered 3x daily build on the skills trained in each lesson. Coping: The coping intervention includes 14 daily 20-minute audio lessons plus brief daily practice prompts. Lessons train specific coping techniques through didactic explanation and guided practice. Lessons train coping skills (reflection, reappraisal, and problem solving) without encouraging focus on or acceptance of present experience (i.e., mindfulness skills). Participants are instructed to: (1) reflect and let their minds drift, (2) reframe or reappraise past and anticipated events, and (3) analyze and solve personal problems. Practice prompts build on the skills trained in each lesson, encouraging participants to take brief reflection breaks or to practice reappraisal or problem-solving skills.
Feasibility of Retention Retained through follow-up assessments	37 Participants	34 Participants
Feasibility of Retention Did not complete intervention	4 Participants	5 Participants
Feasibility of Retention Completed intervention but did not complete follow-up assessments	1 Participants	0 Participants

PRIMARY outcome

Timeframe: assessed across the entire 2-week intervention period

Population: study completers

Numbers represent percentages of intervention lessons completed in mindfulness and coping groups [calculated as (average number of lessons completed / 14 total lessons among all participants in each group) * 100]. The original adherence benchmark was an average completion of >85% of intervention lessons; reported percentages that are greater than that benchmark represent feasibility of intervention adherence.

Outcome measures

Measure	Screening & Enrollment n=14 intervention lessons All individuals who were pre-screened for eligibility before randomization.	Coping n=14 intervention lessons Coping intervention involving 14 foundational audio-guided lessons plus daily brief practice prompts. Lessons train techniques for 3 coping skills: reflection, reappraisal, and problem solving. Practice prompts delivered 3x daily build on the skills trained in each lesson. Coping: The coping intervention includes 14 daily 20-minute audio lessons plus brief daily practice prompts. Lessons train specific coping techniques through didactic explanation and guided practice. Lessons train coping skills (reflection, reappraisal, and problem solving) without encouraging focus on or acceptance of present experience (i.e., mindfulness skills). Participants are instructed to: (1) reflect and let their minds drift, (2) reframe or reappraise past and anticipated events, and (3) analyze and solve personal problems. Practice prompts build on the skills trained in each lesson, encouraging participants to take brief reflection breaks or to practice reappraisal or problem-solving skills.
Feasibility of Adherence: Intervention Lessons	94.57 percentage of lessons completed	94.71 percentage of lessons completed

PRIMARY outcome

Timeframe: assessed across the entire 8-week study period

Population: intervention completers

Safety benchmark: <10% of participants showing substantial (>2SD) increases in anxiety, trauma, or depressive symptoms (using PROMIS Anxiety and Depression scales and Posttraumatic Stress Disorder Checklist-Civilian scale described in other outcomes below) combined to create treatment-emergent symptom rate

Outcome measures

Measure	Screening & Enrollment n=38 Participants All individuals who were pre-screened for eligibility before randomization.	Coping n=34 Participants Coping intervention involving 14 foundational audio-guided lessons plus daily brief practice prompts. Lessons train techniques for 3 coping skills: reflection, reappraisal, and problem solving. Practice prompts delivered 3x daily build on the skills trained in each lesson. Coping: The coping intervention includes 14 daily 20-minute audio lessons plus brief daily practice prompts. Lessons train specific coping techniques through didactic explanation and guided practice. Lessons train coping skills (reflection, reappraisal, and problem solving) without encouraging focus on or acceptance of present experience (i.e., mindfulness skills). Participants are instructed to: (1) reflect and let their minds drift, (2) reframe or reappraise past and anticipated events, and (3) analyze and solve personal problems. Practice prompts build on the skills trained in each lesson, encouraging participants to take brief reflection breaks or to practice reappraisal or problem-solving skills.
Feasibility of Safe Implementation: Incidence of Treatment-emergent Increases in Mental Health Symptoms No substantial (>2SD) symptom increase	35 Participants	34 Participants
Feasibility of Safe Implementation: Incidence of Treatment-emergent Increases in Mental Health Symptoms Substantial (>2SD) symptom increase at post-intervention or follow-up	3 Participants	0 Participants

PRIMARY outcome

Timeframe: assessed in-person at post-intervention laboratory assessment (an average of 4 weeks) and one-month follow-up laboratory assessment (an average of 8 weeks)

Population: study completers

Acceptability of interventions, with benchmark of >80% of participants giving positive ratings of treatment expectancies (>3 on 6-item Credibility/Expectancy Questionnaire)

Outcome measures

Measure	Screening & Enrollment n=37 Participants All individuals who were pre-screened for eligibility before randomization.	Coping n=34 Participants Coping intervention involving 14 foundational audio-guided lessons plus daily brief practice prompts. Lessons train techniques for 3 coping skills: reflection, reappraisal, and problem solving. Practice prompts delivered 3x daily build on the skills trained in each lesson. Coping: The coping intervention includes 14 daily 20-minute audio lessons plus brief daily practice prompts. Lessons train specific coping techniques through didactic explanation and guided practice. Lessons train coping skills (reflection, reappraisal, and problem solving) without encouraging focus on or acceptance of present experience (i.e., mindfulness skills). Participants are instructed to: (1) reflect and let their minds drift, (2) reframe or reappraise past and anticipated events, and (3) analyze and solve personal problems. Practice prompts build on the skills trained in each lesson, encouraging participants to take brief reflection breaks or to practice reappraisal or problem-solving skills.
Acceptability: Treatment Expectancies Post-intervention	95 percentage of treatment completers	91 percentage of treatment completers
Acceptability: Treatment Expectancies One-month follow-up	92 percentage of treatment completers	88 percentage of treatment completers

PRIMARY outcome

Timeframe: change in stress assessed in daily life for 1 week at three timepoints: pre-intervention ambulatory assessment, post-intervention ambulatory assessment (an average of 3 weeks), and one-month follow-up ambulatory assessment (an average of 7 weeks)

State perceived stress assessed in daily life four times per day for one week at three time points via Ecological Momentary Assessment (EMA), totaling up to 28 assessments at each time point. All 28 assessments at each of the three time points (pre-intervention ambulatory assessment, post-intervention ambulatory assessment, and one-month follow-up ambulatory assessment) were averaged in MLM analyses. Stress was assessed on a 1-7 Likert scale, with higher scores indicating higher perceived stress.

Outcome measures

Measure	Screening & Enrollment n=42 Participants All individuals who were pre-screened for eligibility before randomization.	Coping n=39 Participants Coping intervention involving 14 foundational audio-guided lessons plus daily brief practice prompts. Lessons train techniques for 3 coping skills: reflection, reappraisal, and problem solving. Practice prompts delivered 3x daily build on the skills trained in each lesson. Coping: The coping intervention includes 14 daily 20-minute audio lessons plus brief daily practice prompts. Lessons train specific coping techniques through didactic explanation and guided practice. Lessons train coping skills (reflection, reappraisal, and problem solving) without encouraging focus on or acceptance of present experience (i.e., mindfulness skills). Participants are instructed to: (1) reflect and let their minds drift, (2) reframe or reappraise past and anticipated events, and (3) analyze and solve personal problems. Practice prompts build on the skills trained in each lesson, encouraging participants to take brief reflection breaks or to practice reappraisal or problem-solving skills.
Change in Daily Life Subjective Stress: State Perceived Stress Pre-intervention	2.48 units on a scale Standard Error .13	2.5 units on a scale Standard Error .13
Change in Daily Life Subjective Stress: State Perceived Stress Post-intervention	2.56 units on a scale Standard Error .13	2.37 units on a scale Standard Error .13
Change in Daily Life Subjective Stress: State Perceived Stress One-month follow-up	2.46 units on a scale Standard Error .13	2.32 units on a scale Standard Error .13

PRIMARY outcome

Timeframe: change in stress assessed in daily life for 1 week at three timepoints: pre-intervention ambulatory assessment, post-intervention ambulatory assessment (an average of 3 weeks), and one-month follow-up ambulatory assessment (an average of 7 weeks)

Population: all available data; n=1 participant provided no data at pre-intervention, post-intervention, or follow-up

Daily perceived stress assessed in daily life each evening for one week at three time points via end-of day diary, totaling up to 7 assessments at each time point. All 7 assessments at each of the three time points (pre-intervention ambulatory assessment, post-intervention ambulatory assessment, and one-month follow-up ambulatory assessment) were averaged in MLM analyses. Stress was assessed on a 1-7 Likert scale, with higher scores indicating higher perceived stress.

Outcome measures

Measure	Screening & Enrollment n=41 Participants All individuals who were pre-screened for eligibility before randomization.	Coping n=39 Participants Coping intervention involving 14 foundational audio-guided lessons plus daily brief practice prompts. Lessons train techniques for 3 coping skills: reflection, reappraisal, and problem solving. Practice prompts delivered 3x daily build on the skills trained in each lesson. Coping: The coping intervention includes 14 daily 20-minute audio lessons plus brief daily practice prompts. Lessons train specific coping techniques through didactic explanation and guided practice. Lessons train coping skills (reflection, reappraisal, and problem solving) without encouraging focus on or acceptance of present experience (i.e., mindfulness skills). Participants are instructed to: (1) reflect and let their minds drift, (2) reframe or reappraise past and anticipated events, and (3) analyze and solve personal problems. Practice prompts build on the skills trained in each lesson, encouraging participants to take brief reflection breaks or to practice reappraisal or problem-solving skills.
Change in Daily Life Subjective Stress: Daily Perceived Stress Pre-intervention	3.01 units on a scale Standard Error .14	2.91 units on a scale Standard Error .15
Change in Daily Life Subjective Stress: Daily Perceived Stress Post-intervention	3.19 units on a scale Standard Error .15	2.69 units on a scale Standard Error .15
Change in Daily Life Subjective Stress: Daily Perceived Stress One-month follow-up	2.90 units on a scale Standard Error .15	2.63 units on a scale Standard Error .15

PRIMARY outcome

Timeframe: change in stress assessed in daily life for 1 week at three timepoints: pre-intervention ambulatory assessment, post-intervention ambulatory assessment (an average of 3 weeks), and one-month follow-up ambulatory assessment (an average of 7 weeks)

Stress events assessed on a binary scale (yes/no) in daily life four times per day for one week at three time points via Ecological Momentary Assessment (EMA), totaling up to 28 assessments at each time point. All 28 assessments at each of the three time points (pre-intervention ambulatory assessment, post-intervention ambulatory assessment, and one-month follow-up ambulatory assessment) were averaged in logistic MLM analyses. Outcomes are reported as mean percentage of surveys at each time point that stress events were endorsed, with higher percentages indicating more stress events.

Outcome measures

Measure	Screening & Enrollment n=42 Participants All individuals who were pre-screened for eligibility before randomization.	Coping n=39 Participants Coping intervention involving 14 foundational audio-guided lessons plus daily brief practice prompts. Lessons train techniques for 3 coping skills: reflection, reappraisal, and problem solving. Practice prompts delivered 3x daily build on the skills trained in each lesson. Coping: The coping intervention includes 14 daily 20-minute audio lessons plus brief daily practice prompts. Lessons train specific coping techniques through didactic explanation and guided practice. Lessons train coping skills (reflection, reappraisal, and problem solving) without encouraging focus on or acceptance of present experience (i.e., mindfulness skills). Participants are instructed to: (1) reflect and let their minds drift, (2) reframe or reappraise past and anticipated events, and (3) analyze and solve personal problems. Practice prompts build on the skills trained in each lesson, encouraging participants to take brief reflection breaks or to practice reappraisal or problem-solving skills.
Change in Daily Life Objective Stress: Stress Events in the Past 2.5 Hours Pre-intervention	22.71 percentage of surveys with stressors Standard Error 2.26	18.5 percentage of surveys with stressors Standard Error 2.09
Change in Daily Life Objective Stress: Stress Events in the Past 2.5 Hours Post-intervention	15.84 percentage of surveys with stressors Standard Error 1.91	12.33 percentage of surveys with stressors Standard Error 1.72
Change in Daily Life Objective Stress: Stress Events in the Past 2.5 Hours One-month follow-up	15.31 percentage of surveys with stressors Standard Error 1.89	10.78 percentage of surveys with stressors Standard Error 1.6

PRIMARY outcome

Timeframe: change in stress assessed in daily life for 1 week at three timepoints: pre-intervention ambulatory assessment, post-intervention ambulatory assessment (an average of 3 weeks), and one-month follow-up ambulatory assessment (an average of 7 weeks)

Population: all available data; n=1 participant provided no data at pre-intervention, post-intervention, or follow-up

Daily stress events assessed in daily life each evening for one week at three time points via end-of day diary, totaling up to 7 assessments at each time point. All 7 assessments at each of the three time points (pre-intervention ambulatory assessment, post-intervention ambulatory assessment, and one-month follow-up ambulatory assessment) were averaged in logistic MLM analyses. Outcomes are reported as mean percentage of days at each time point that stress events were endorsed, with higher percentages indicating more stress events.

Outcome measures

Measure	Screening & Enrollment n=41 Participants All individuals who were pre-screened for eligibility before randomization.	Coping n=39 Participants Coping intervention involving 14 foundational audio-guided lessons plus daily brief practice prompts. Lessons train techniques for 3 coping skills: reflection, reappraisal, and problem solving. Practice prompts delivered 3x daily build on the skills trained in each lesson. Coping: The coping intervention includes 14 daily 20-minute audio lessons plus brief daily practice prompts. Lessons train specific coping techniques through didactic explanation and guided practice. Lessons train coping skills (reflection, reappraisal, and problem solving) without encouraging focus on or acceptance of present experience (i.e., mindfulness skills). Participants are instructed to: (1) reflect and let their minds drift, (2) reframe or reappraise past and anticipated events, and (3) analyze and solve personal problems. Practice prompts build on the skills trained in each lesson, encouraging participants to take brief reflection breaks or to practice reappraisal or problem-solving skills.
Change in Daily Life Objective Stress: Daily Stress Events Pre-intervention	65.93 percentage of days with stressors Standard Error 4.01	51.52 percentage of days with stressors Standard Error 4.46
Change in Daily Life Objective Stress: Daily Stress Events Post-intervention	57.54 percentage of days with stressors Standard Error 4.46	47.75 percentage of days with stressors Standard Error 4.69
Change in Daily Life Objective Stress: Daily Stress Events One-month follow-up	48.18 percentage of days with stressors Standard Error 4.61	46.08 percentage of days with stressors Standard Error 4.70

PRIMARY outcome

Timeframe: change in HR reactivity assessed in daily life for 1 week at three timepoints: pre-intervention ambulatory assessment, post-intervention ambulatory assessment (an average of 3 weeks), and one-month follow-up ambulatory assessment (an average of 7 weeks)

Population: all available data; n=5 participants provided no data at pre-intervention, post-intervention, or follow-up

Heart Rate (HR) measured continuously in daily life, with HR averaged in 30-minute windows around daily life stress reported via EMA up to four times per day for one week at three time points, totaling up to 28 windows at each time point. All (up to) 28 assessments at each of the three time points (pre-intervention ambulatory assessment, post-intervention ambulatory assessment, and one-month follow-up ambulatory assessment) were averaged in MLM analyses. Higher scores indicate higher HR in beats per minute (relative to an individual's average daily HR) at high stress moments (relative to an individual's average perceived stress).

Outcome measures

Measure	Screening & Enrollment n=39 Participants All individuals who were pre-screened for eligibility before randomization.	Coping n=37 Participants Coping intervention involving 14 foundational audio-guided lessons plus daily brief practice prompts. Lessons train techniques for 3 coping skills: reflection, reappraisal, and problem solving. Practice prompts delivered 3x daily build on the skills trained in each lesson. Coping: The coping intervention includes 14 daily 20-minute audio lessons plus brief daily practice prompts. Lessons train specific coping techniques through didactic explanation and guided practice. Lessons train coping skills (reflection, reappraisal, and problem solving) without encouraging focus on or acceptance of present experience (i.e., mindfulness skills). Participants are instructed to: (1) reflect and let their minds drift, (2) reframe or reappraise past and anticipated events, and (3) analyze and solve personal problems. Practice prompts build on the skills trained in each lesson, encouraging participants to take brief reflection breaks or to practice reappraisal or problem-solving skills.
Change in Daily Life Physiological Stress Reactivity Pre-intervention	5.82 beats per minute Standard Error .67	4.77 beats per minute Standard Error .68
Change in Daily Life Physiological Stress Reactivity Post-intervention	4.94 beats per minute Standard Error .69	6.49 beats per minute Standard Error .73
Change in Daily Life Physiological Stress Reactivity One-month follow-up	6.6 beats per minute Standard Error .73	5.80 beats per minute Standard Error .78

PRIMARY outcome

Timeframe: change from pre-intervention laboratory assessment to post-intervention laboratory assessment (an average of 4 weeks) and one-month follow-up laboratory assessment (an average of 8 weeks)

Circulating IL-6 assessed via dried blood spot (DBS), reported as raw concentration in pg/mL assessed via ProteinSimple Simple Plex Human IL-6 (3rd gen) on Ella instrument

Outcome measures

Measure	Screening & Enrollment n=42 Participants All individuals who were pre-screened for eligibility before randomization.	Coping n=39 Participants Coping intervention involving 14 foundational audio-guided lessons plus daily brief practice prompts. Lessons train techniques for 3 coping skills: reflection, reappraisal, and problem solving. Practice prompts delivered 3x daily build on the skills trained in each lesson. Coping: The coping intervention includes 14 daily 20-minute audio lessons plus brief daily practice prompts. Lessons train specific coping techniques through didactic explanation and guided practice. Lessons train coping skills (reflection, reappraisal, and problem solving) without encouraging focus on or acceptance of present experience (i.e., mindfulness skills). Participants are instructed to: (1) reflect and let their minds drift, (2) reframe or reappraise past and anticipated events, and (3) analyze and solve personal problems. Practice prompts build on the skills trained in each lesson, encouraging participants to take brief reflection breaks or to practice reappraisal or problem-solving skills.
Change in Circulating Inflammatory Markers pre-intervention	.365 pg/mL Standard Error .034	.266 pg/mL Standard Error .035
Change in Circulating Inflammatory Markers post-intervention	.343 pg/mL Standard Error .036	.267 pg/mL Standard Error .038
Change in Circulating Inflammatory Markers one-month follow-up	.344 pg/mL Standard Error .036	.279 pg/mL Standard Error .037

PRIMARY outcome

Timeframe: assessed pre-enrollment

Recruitment benchmark: >60% of those eligible will enroll

Outcome measures

Measure	Screening & Enrollment n=81 Participants All individuals who were pre-screened for eligibility before randomization.	Coping Coping intervention involving 14 foundational audio-guided lessons plus daily brief practice prompts. Lessons train techniques for 3 coping skills: reflection, reappraisal, and problem solving. Practice prompts delivered 3x daily build on the skills trained in each lesson. Coping: The coping intervention includes 14 daily 20-minute audio lessons plus brief daily practice prompts. Lessons train specific coping techniques through didactic explanation and guided practice. Lessons train coping skills (reflection, reappraisal, and problem solving) without encouraging focus on or acceptance of present experience (i.e., mindfulness skills). Participants are instructed to: (1) reflect and let their minds drift, (2) reframe or reappraise past and anticipated events, and (3) analyze and solve personal problems. Practice prompts build on the skills trained in each lesson, encouraging participants to take brief reflection breaks or to practice reappraisal or problem-solving skills.
Feasibility of Recruitment (Enrollment)	81 Participants	—

PRIMARY outcome

Timeframe: assessed across the entire 2-week intervention period

Population: study completers

Numbers represent percentages of intervention practice prompts completed in mindfulness and coping groups [calculated as (average number of prompts completed / 42 total prompts among all participants in each group) * 100]. The original adherence benchmark was an average completion of >60% of prompts; reported percentages that are greater than that benchmark represent feasibility of intervention practice prompt adherence.

Outcome measures

Measure	Screening & Enrollment n=42 intervention practice prompts All individuals who were pre-screened for eligibility before randomization.	Coping n=42 intervention practice prompts Coping intervention involving 14 foundational audio-guided lessons plus daily brief practice prompts. Lessons train techniques for 3 coping skills: reflection, reappraisal, and problem solving. Practice prompts delivered 3x daily build on the skills trained in each lesson. Coping: The coping intervention includes 14 daily 20-minute audio lessons plus brief daily practice prompts. Lessons train specific coping techniques through didactic explanation and guided practice. Lessons train coping skills (reflection, reappraisal, and problem solving) without encouraging focus on or acceptance of present experience (i.e., mindfulness skills). Participants are instructed to: (1) reflect and let their minds drift, (2) reframe or reappraise past and anticipated events, and (3) analyze and solve personal problems. Practice prompts build on the skills trained in each lesson, encouraging participants to take brief reflection breaks or to practice reappraisal or problem-solving skills.
Feasibility of Adherence: Intervention Practice Prompts	57.33 percentage of prompts completed	60.34 percentage of prompts completed

PRIMARY outcome

Timeframe: assessed for 1 week at three time points: pre-intervention ambulatory assessment, post-intervention ambulatory assessment (an average of 3 weeks), and one-month follow-up ambulatory assessment (an average of 7 weeks)

Population: study completers

Numbers represent percentages of ambulatory assessment surveys completed in mindfulness and coping groups [calculated as (average number of surveys completed / 105 total surveys among all participants in each group) * 100]. The original adherence benchmark was an average completion of >75% of ambulatory assessments; reported percentages that are greater than that benchmark represent feasibility of ambulatory assessment adherence.

Outcome measures

Measure	Screening & Enrollment n=105 ambulatory assessment surveys All individuals who were pre-screened for eligibility before randomization.	Coping n=105 ambulatory assessment surveys Coping intervention involving 14 foundational audio-guided lessons plus daily brief practice prompts. Lessons train techniques for 3 coping skills: reflection, reappraisal, and problem solving. Practice prompts delivered 3x daily build on the skills trained in each lesson. Coping: The coping intervention includes 14 daily 20-minute audio lessons plus brief daily practice prompts. Lessons train specific coping techniques through didactic explanation and guided practice. Lessons train coping skills (reflection, reappraisal, and problem solving) without encouraging focus on or acceptance of present experience (i.e., mindfulness skills). Participants are instructed to: (1) reflect and let their minds drift, (2) reframe or reappraise past and anticipated events, and (3) analyze and solve personal problems. Practice prompts build on the skills trained in each lesson, encouraging participants to take brief reflection breaks or to practice reappraisal or problem-solving skills.
Feasibility of Adherence: Ambulatory Assessments	86.28 percentage of surveys completed	87.53 percentage of surveys completed

PRIMARY outcome

Timeframe: assessed across the entire 8-week study period

Population: study completers

Numbers represent percentages of days on which wearable sensor (Fitbit) data and AWARE phone sensor data were collected in mindfulness and coping groups [calculated as (average number of days that Fitbit/AWARE data were collected / 56 days among all participants in each group) * 100]. The original adherence benchmark was collecting mobile sensor data on >75% of days; reported percentages that are greater than that benchmark represent feasibility of mobile sensor data collection adherence.

Outcome measures

Measure	Screening & Enrollment n=56 days of mobile sensor data collection All individuals who were pre-screened for eligibility before randomization.	Coping n=56 days of mobile sensor data collection Coping intervention involving 14 foundational audio-guided lessons plus daily brief practice prompts. Lessons train techniques for 3 coping skills: reflection, reappraisal, and problem solving. Practice prompts delivered 3x daily build on the skills trained in each lesson. Coping: The coping intervention includes 14 daily 20-minute audio lessons plus brief daily practice prompts. Lessons train specific coping techniques through didactic explanation and guided practice. Lessons train coping skills (reflection, reappraisal, and problem solving) without encouraging focus on or acceptance of present experience (i.e., mindfulness skills). Participants are instructed to: (1) reflect and let their minds drift, (2) reframe or reappraise past and anticipated events, and (3) analyze and solve personal problems. Practice prompts build on the skills trained in each lesson, encouraging participants to take brief reflection breaks or to practice reappraisal or problem-solving skills.
Feasibility of Adherence: Mobile Sensor Data % of days AWARE data collected	94.35 percentage of days	91.61 percentage of days
Feasibility of Adherence: Mobile Sensor Data % of days Fitbit data collected	86.95 percentage of days	86.40 percentage of days

SECONDARY outcome

Timeframe: change in affect assessed in daily life for 1 week at three timepoints: pre-intervention ambulatory assessment, post-intervention ambulatory assessment (an average of 3 weeks), and one-month follow-up ambulatory assessment (an average of 7 weeks)

State positive affect assessed in daily life four times per day for one week at three time points via Ecological Momentary Assessment (EMA), totaling up to 28 assessments at each time point. All 28 assessments at each of the three time points (pre-intervention ambulatory assessment, post-intervention ambulatory assessment, and one-month follow-up ambulatory assessment) were averaged in MLM analyses. Positive affect was assessed on a 1-7 Likert scale, with higher scores indicating higher positive affect.

Outcome measures

Measure	Screening & Enrollment n=42 Participants All individuals who were pre-screened for eligibility before randomization.	Coping n=39 Participants Coping intervention involving 14 foundational audio-guided lessons plus daily brief practice prompts. Lessons train techniques for 3 coping skills: reflection, reappraisal, and problem solving. Practice prompts delivered 3x daily build on the skills trained in each lesson. Coping: The coping intervention includes 14 daily 20-minute audio lessons plus brief daily practice prompts. Lessons train specific coping techniques through didactic explanation and guided practice. Lessons train coping skills (reflection, reappraisal, and problem solving) without encouraging focus on or acceptance of present experience (i.e., mindfulness skills). Participants are instructed to: (1) reflect and let their minds drift, (2) reframe or reappraise past and anticipated events, and (3) analyze and solve personal problems. Practice prompts build on the skills trained in each lesson, encouraging participants to take brief reflection breaks or to practice reappraisal or problem-solving skills.
Change in Daily Life Positive Affect: State Pre-intervention	3.87 units on a scale Standard Error .14	3.77 units on a scale Standard Error .14
Change in Daily Life Positive Affect: State Post-intervention	3.57 units on a scale Standard Error .14	3.80 units on a scale Standard Error .14
Change in Daily Life Positive Affect: State One-month follow-up	3.74 units on a scale Standard Error .14	3.75 units on a scale Standard Error .14

SECONDARY outcome

Timeframe: change in affect assessed in daily life for 1 week at three timepoints: pre-intervention ambulatory assessment, post-intervention ambulatory assessment (an average of 3 weeks), and one-month follow-up ambulatory assessment (an average of 7 weeks)

Population: all available data; n=1 participant provided no data at pre-intervention, post-intervention, or follow-up

Daily positive affect (composite of 9 positive affect items across 3 subscales: happiness (happy, pleased, and cheerful), calm (calm, at-ease, and relaxed), and vigor (lively, full-of-pep, and energetic), each assessed on a 1-7 Likert scale) assessed in daily life each evening for one week at three time points via end-of day diary, totaling up to 7 scores at each time point. All 7 composite scores at each of the three time points (pre-intervention ambulatory assessment, post-intervention ambulatory assessment, and one-month follow-up ambulatory assessment) were averaged in MLM analyses. Higher scores reflect higher positive affect.

Outcome measures

Measure	Screening & Enrollment n=41 Participants All individuals who were pre-screened for eligibility before randomization.	Coping n=39 Participants Coping intervention involving 14 foundational audio-guided lessons plus daily brief practice prompts. Lessons train techniques for 3 coping skills: reflection, reappraisal, and problem solving. Practice prompts delivered 3x daily build on the skills trained in each lesson. Coping: The coping intervention includes 14 daily 20-minute audio lessons plus brief daily practice prompts. Lessons train specific coping techniques through didactic explanation and guided practice. Lessons train coping skills (reflection, reappraisal, and problem solving) without encouraging focus on or acceptance of present experience (i.e., mindfulness skills). Participants are instructed to: (1) reflect and let their minds drift, (2) reframe or reappraise past and anticipated events, and (3) analyze and solve personal problems. Practice prompts build on the skills trained in each lesson, encouraging participants to take brief reflection breaks or to practice reappraisal or problem-solving skills.
Change in Daily Life Positive Affect: Daily Pre-intervention	3.30 units on a scale Standard Error .14	3.34 units on a scale Standard Error .14
Change in Daily Life Positive Affect: Daily Post-intervention	2.94 units on a scale Standard Error .14	3.32 units on a scale Standard Error .15
Change in Daily Life Positive Affect: Daily One-month follow-up	3.19 units on a scale Standard Error .14	3.36 units on a scale Standard Error .15

SECONDARY outcome

Timeframe: change in affect assessed in daily life for 1 week at three timepoints: pre-intervention ambulatory assessment, post-intervention ambulatory assessment (an average of 3 weeks), and one-month follow-up ambulatory assessment (an average of 7 weeks)

State negative affect assessed in daily life four times per day for one week at three time points via Ecological Momentary Assessment (EMA), totaling up to 28 assessments at each time point. All 28 assessments at each of the three time points (pre-intervention ambulatory assessment, post-intervention ambulatory assessment, and one-month follow-up ambulatory assessment) were averaged in MLM analyses. Negative affect was assessed on a 1-7 Likert scale, with higher scores indicating higher negative affect.

Outcome measures

Measure	Screening & Enrollment n=42 Participants All individuals who were pre-screened for eligibility before randomization.	Coping n=39 Participants Coping intervention involving 14 foundational audio-guided lessons plus daily brief practice prompts. Lessons train techniques for 3 coping skills: reflection, reappraisal, and problem solving. Practice prompts delivered 3x daily build on the skills trained in each lesson. Coping: The coping intervention includes 14 daily 20-minute audio lessons plus brief daily practice prompts. Lessons train specific coping techniques through didactic explanation and guided practice. Lessons train coping skills (reflection, reappraisal, and problem solving) without encouraging focus on or acceptance of present experience (i.e., mindfulness skills). Participants are instructed to: (1) reflect and let their minds drift, (2) reframe or reappraise past and anticipated events, and (3) analyze and solve personal problems. Practice prompts build on the skills trained in each lesson, encouraging participants to take brief reflection breaks or to practice reappraisal or problem-solving skills.
Change in Daily Life Negative Affect: State Pre-intervention	2.19 units on a scale Standard Error .11	2.06 units on a scale Standard Error .12
Change in Daily Life Negative Affect: State Post-intervention	2.34 units on a scale Standard Error .11	1.96 units on a scale Standard Error .12
Change in Daily Life Negative Affect: State One-month follow-up	2.21 units on a scale Standard Error .11	1.93 units on a scale Standard Error .12

SECONDARY outcome

Timeframe: change in affect assessed in daily life for 1 week at three timepoints: pre-intervention ambulatory assessment, post-intervention ambulatory assessment (an average of 3 weeks), and one-month follow-up ambulatory assessment (an average of 7 weeks)

Population: all available data; n=1 participant provided no data at pre-intervention, post-intervention, or follow-up

Daily negative affect (composite of 9 negative affect items across 3 subscales: anxiety (on edge, nervous, and tense), depression (sad, depressed, and unhappy), and hostility (hostile, resentful, and angry), each assessed on a 1-7 Likert scale) assessed in daily life each evening for one week at three time points via end-of day diary, totaling up to 7 scores at each time point. All 7 composite scores at each of the three time points (pre-intervention ambulatory assessment, post-intervention ambulatory assessment, and one-month follow-up ambulatory assessment) were averaged in MLM analyses. Higher scores reflect higher negative affect.

Outcome measures

Measure	Screening & Enrollment n=41 Participants All individuals who were pre-screened for eligibility before randomization.	Coping n=39 Participants Coping intervention involving 14 foundational audio-guided lessons plus daily brief practice prompts. Lessons train techniques for 3 coping skills: reflection, reappraisal, and problem solving. Practice prompts delivered 3x daily build on the skills trained in each lesson. Coping: The coping intervention includes 14 daily 20-minute audio lessons plus brief daily practice prompts. Lessons train specific coping techniques through didactic explanation and guided practice. Lessons train coping skills (reflection, reappraisal, and problem solving) without encouraging focus on or acceptance of present experience (i.e., mindfulness skills). Participants are instructed to: (1) reflect and let their minds drift, (2) reframe or reappraise past and anticipated events, and (3) analyze and solve personal problems. Practice prompts build on the skills trained in each lesson, encouraging participants to take brief reflection breaks or to practice reappraisal or problem-solving skills.
Change in Daily Life Negative Affect: Daily Pre-intervention	2.15 units on a scale Standard Error .11	1.99 units on a scale Standard Error .11
Change in Daily Life Negative Affect: Daily Post-intervention	2.19 units on a scale Standard Error .11	1.88 units on a scale Standard Error .11
Change in Daily Life Negative Affect: Daily One-month follow-up	2.13 units on a scale Standard Error .11	1.82 units on a scale Standard Error .11

SECONDARY outcome

Timeframe: change in interactions assessed in daily life for 1 week at three timepoints: pre-intervention ambulatory assessment, post-intervention ambulatory assessment (an average of 3 weeks), and one-month follow-up ambulatory assessment (an average of 7 weeks)

Number of social interactions assessed in daily life four times per day for one week at three time points via Ecological Momentary Assessment (EMA), totaling up to 28 assessments at each time point. All 28 assessments at each of the three time points (pre-intervention ambulatory assessment, post-intervention ambulatory assessment, and one-month follow-up ambulatory assessment) were averaged in MLM analyses. Higher numbers indicate more social interactions.

Outcome measures

Measure	Screening & Enrollment n=42 Participants All individuals who were pre-screened for eligibility before randomization.	Coping n=39 Participants Coping intervention involving 14 foundational audio-guided lessons plus daily brief practice prompts. Lessons train techniques for 3 coping skills: reflection, reappraisal, and problem solving. Practice prompts delivered 3x daily build on the skills trained in each lesson. Coping: The coping intervention includes 14 daily 20-minute audio lessons plus brief daily practice prompts. Lessons train specific coping techniques through didactic explanation and guided practice. Lessons train coping skills (reflection, reappraisal, and problem solving) without encouraging focus on or acceptance of present experience (i.e., mindfulness skills). Participants are instructed to: (1) reflect and let their minds drift, (2) reframe or reappraise past and anticipated events, and (3) analyze and solve personal problems. Practice prompts build on the skills trained in each lesson, encouraging participants to take brief reflection breaks or to practice reappraisal or problem-solving skills.
Change in Daily Life Social Interactions: Interactions in the Past 2.5 Hours Pre-intervention	2.79 number of interactions Standard Error .26	2.96 number of interactions Standard Error .27
Change in Daily Life Social Interactions: Interactions in the Past 2.5 Hours Post-intervention	3.09 number of interactions Standard Error .26	2.84 number of interactions Standard Error .27
Change in Daily Life Social Interactions: Interactions in the Past 2.5 Hours One-month follow-up	3.30 number of interactions Standard Error .26	2.69 number of interactions Standard Error .27

SECONDARY outcome

Timeframe: change in interactions assessed in daily life for 1 week at three timepoints: pre-intervention ambulatory assessment, post-intervention ambulatory assessment (an average of 3 weeks), and one-month follow-up ambulatory assessment (an average of 7 weeks)

Population: all available data; n=1 participant provided no data at pre-intervention, post-intervention, or follow-up

Number of social interactions assessed in daily life each evening for one week at three time points via end-of day diary, totaling up to 7 assessments at each time point. All 7 assessments at each of the three time points (pre-intervention ambulatory assessment, post-intervention ambulatory assessment, and one-month follow-up ambulatory assessment) were averaged in MLM analyses. Higher numbers indicate more social interactions.

Outcome measures

Measure	Screening & Enrollment n=41 Participants All individuals who were pre-screened for eligibility before randomization.	Coping n=39 Participants Coping intervention involving 14 foundational audio-guided lessons plus daily brief practice prompts. Lessons train techniques for 3 coping skills: reflection, reappraisal, and problem solving. Practice prompts delivered 3x daily build on the skills trained in each lesson. Coping: The coping intervention includes 14 daily 20-minute audio lessons plus brief daily practice prompts. Lessons train specific coping techniques through didactic explanation and guided practice. Lessons train coping skills (reflection, reappraisal, and problem solving) without encouraging focus on or acceptance of present experience (i.e., mindfulness skills). Participants are instructed to: (1) reflect and let their minds drift, (2) reframe or reappraise past and anticipated events, and (3) analyze and solve personal problems. Practice prompts build on the skills trained in each lesson, encouraging participants to take brief reflection breaks or to practice reappraisal or problem-solving skills.
Change in Daily Life Social Interactions: Daily Post-intervention	13.60 number of interactions Standard Error .79	11.18 number of interactions Standard Error .82
Change in Daily Life Social Interactions: Daily Pre-intervention	12.69 number of interactions Standard Error .78	11.59 number of interactions Standard Error .80
Change in Daily Life Social Interactions: Daily One-month follow-up	14.61 number of interactions Standard Error .80	11.25 number of interactions Standard Error .82

SECONDARY outcome

Timeframe: change in awareness assessed in daily life for 1 week at three timepoints: pre-intervention ambulatory assessment, post-intervention ambulatory assessment (an average of 3 weeks), and one-month follow-up ambulatory assessment (an average of 7 weeks)

Population: all available data; n=1 participant provided no data at pre-intervention, post-intervention, or follow-up

Mindful awareness (composite 3-item scale: "Today, I paid attention to what I was doing in the present moment" / "Today, I noticed body sensations come and go" / "Today, I noticed pleasant and unpleasant thoughts and emotions", each item assessed on a 1-7 Likert scale) assessed in daily life each evening for one week at three time points via end-of-day diary, totaling up to 7 scores at each time point. All 7 composite scores at each of the three time points (pre-intervention ambulatory assessment, post-intervention ambulatory assessment, and one-month follow-up ambulatory assessment) were averaged in MLM analyses. Higher composite scores reflect higher mindful awareness.

Outcome measures

Measure	Screening & Enrollment n=41 Participants All individuals who were pre-screened for eligibility before randomization.	Coping n=39 Participants Coping intervention involving 14 foundational audio-guided lessons plus daily brief practice prompts. Lessons train techniques for 3 coping skills: reflection, reappraisal, and problem solving. Practice prompts delivered 3x daily build on the skills trained in each lesson. Coping: The coping intervention includes 14 daily 20-minute audio lessons plus brief daily practice prompts. Lessons train specific coping techniques through didactic explanation and guided practice. Lessons train coping skills (reflection, reappraisal, and problem solving) without encouraging focus on or acceptance of present experience (i.e., mindfulness skills). Participants are instructed to: (1) reflect and let their minds drift, (2) reframe or reappraise past and anticipated events, and (3) analyze and solve personal problems. Practice prompts build on the skills trained in each lesson, encouraging participants to take brief reflection breaks or to practice reappraisal or problem-solving skills.
Change in Daily Life Mindfulness: Awareness Pre-intervention	3.76 score on a scale Standard Error .15	3.70 score on a scale Standard Error .16
Change in Daily Life Mindfulness: Awareness Post-intervention	3.98 score on a scale Standard Error .16	4.10 score on a scale Standard Error .16
Change in Daily Life Mindfulness: Awareness One-month follow-up	4.03 score on a scale Standard Error .16	4.10 score on a scale Standard Error .16

SECONDARY outcome

Timeframe: change in acceptance assessed in daily life for 1 week at three timepoints: pre-intervention ambulatory assessment, post-intervention ambulatory assessment (an average of 3 weeks), and one-month follow-up ambulatory assessment (an average of 7 weeks)

Population: all available data; n=1 participant provided no data at pre-intervention, post-intervention, or follow-up

Mindful acceptance (composite 2-item scale: "Today, I was able to step back and be aware of distressing thoughts, emotions, and sensations, without being taken over by them" / "Today, I did not want to feel the way I was feeling", each item assessed on a 1-7 Likert scale) assessed in daily life each evening for one week at three time points via end-of-day diary, totaling up to 7 scores at each time point. All 7 composite scores at each of the three time points (pre-intervention ambulatory assessment, post-intervention ambulatory assessment, and one-month follow-up ambulatory assessment) were averaged in MLM analyses. Higher composite scores reflect higher acceptance.

Outcome measures

Measure	Screening & Enrollment n=41 Participants All individuals who were pre-screened for eligibility before randomization.	Coping n=39 Participants Coping intervention involving 14 foundational audio-guided lessons plus daily brief practice prompts. Lessons train techniques for 3 coping skills: reflection, reappraisal, and problem solving. Practice prompts delivered 3x daily build on the skills trained in each lesson. Coping: The coping intervention includes 14 daily 20-minute audio lessons plus brief daily practice prompts. Lessons train specific coping techniques through didactic explanation and guided practice. Lessons train coping skills (reflection, reappraisal, and problem solving) without encouraging focus on or acceptance of present experience (i.e., mindfulness skills). Participants are instructed to: (1) reflect and let their minds drift, (2) reframe or reappraise past and anticipated events, and (3) analyze and solve personal problems. Practice prompts build on the skills trained in each lesson, encouraging participants to take brief reflection breaks or to practice reappraisal or problem-solving skills.
Change in Daily Life Mindfulness: Acceptance Pre-intervention	4.25 score on a scale Standard Error .14	4.35 score on a scale Standard Error .14
Change in Daily Life Mindfulness: Acceptance Post-intervention	4.33 score on a scale Standard Error .14	4.74 score on a scale Standard Error .15
Change in Daily Life Mindfulness: Acceptance One-month follow-up	4.63 score on a scale Standard Error .14	4.82 score on a scale Standard Error .15

OTHER_PRE_SPECIFIED outcome

Timeframe: collected continuously for 8 weeks

Passive sensor data from smartphones (location, activity, screen status, battery, weather, time zone, communication) and wearable devices (heart rate, activity, sleep) combined to develop machine learning models predicting state stress

Outcome measures

Outcome data not reported

OTHER_PRE_SPECIFIED outcome

Timeframe: change from pre- to post-practice across two-week intervention period

State stress following intervention practice used to evaluate immediate benefit of practice delivered at high-stress moments

Outcome measures

Outcome data not reported

OTHER_PRE_SPECIFIED outcome

Timeframe: daily stress across two-week intervention period

End-of-day stress on days with intervention practice used to evaluate day-level benefit of practice delivered at high-stress moments

Outcome measures

Outcome data not reported

OTHER_PRE_SPECIFIED outcome

Timeframe: pre-intervention

Assessed via the Childhood Trauma Questionnaire (a 28-item scale with three 5-item abuse subscales - physical, sexual, and emotional abuse - ranging from 5-25, with higher scores indicating higher childhood trauma)

Outcome measures

Measure	Screening & Enrollment n=42 Participants All individuals who were pre-screened for eligibility before randomization.	Coping n=39 Participants Coping intervention involving 14 foundational audio-guided lessons plus daily brief practice prompts. Lessons train techniques for 3 coping skills: reflection, reappraisal, and problem solving. Practice prompts delivered 3x daily build on the skills trained in each lesson. Coping: The coping intervention includes 14 daily 20-minute audio lessons plus brief daily practice prompts. Lessons train specific coping techniques through didactic explanation and guided practice. Lessons train coping skills (reflection, reappraisal, and problem solving) without encouraging focus on or acceptance of present experience (i.e., mindfulness skills). Participants are instructed to: (1) reflect and let their minds drift, (2) reframe or reappraise past and anticipated events, and (3) analyze and solve personal problems. Practice prompts build on the skills trained in each lesson, encouraging participants to take brief reflection breaks or to practice reappraisal or problem-solving skills.
Early Life Adversity: Childhood Trauma Emotional abuse score	14.76 CTQ score Standard Error 0.61	13.56 CTQ score Standard Error 0.64
Early Life Adversity: Childhood Trauma Physical abuse score	8.07 CTQ score Standard Error 0.57	7.72 CTQ score Standard Error 0.59
Early Life Adversity: Childhood Trauma Sexual abuse score	6.88 CTQ score Standard Error 0.60	7.10 CTQ score Standard Error 0.62

OTHER_PRE_SPECIFIED outcome

Timeframe: pre-intervention

Early Life Adversity assessed via the Childhood Experiences of Care and Abuse Inventory (a 16-item scale referencing mother and father figures, with an 8-item emotional neglect subscale ranging from 8-40, where higher scores indicate higher levels of emotional neglect)

Outcome measures

Measure	Screening & Enrollment n=42 Participants All individuals who were pre-screened for eligibility before randomization.	Coping n=39 Participants Coping intervention involving 14 foundational audio-guided lessons plus daily brief practice prompts. Lessons train techniques for 3 coping skills: reflection, reappraisal, and problem solving. Practice prompts delivered 3x daily build on the skills trained in each lesson. Coping: The coping intervention includes 14 daily 20-minute audio lessons plus brief daily practice prompts. Lessons train specific coping techniques through didactic explanation and guided practice. Lessons train coping skills (reflection, reappraisal, and problem solving) without encouraging focus on or acceptance of present experience (i.e., mindfulness skills). Participants are instructed to: (1) reflect and let their minds drift, (2) reframe or reappraise past and anticipated events, and (3) analyze and solve personal problems. Practice prompts build on the skills trained in each lesson, encouraging participants to take brief reflection breaks or to practice reappraisal or problem-solving skills.
Early Life Adversity: Emotional Neglect Mother figure neglect	13.67 CECA-Q score Standard Error 1.04	10.51 CECA-Q score Standard Error 1.08
Early Life Adversity: Emotional Neglect Father figure neglect	18.12 CECA-Q score Standard Error 1.20	17.15 CECA-Q score Standard Error 1.25

OTHER_PRE_SPECIFIED outcome

Timeframe: pre-intervention

Childhood SES indexed via parental educational attainment, ranging from less than high school education to doctoral degree (1 = No High School Diploma, 2 = GED, 3 = High School Diploma, 4 = Technical Training, 5 = Some College, no degree, 6 = Associate Degree, 7 = Bachelor's Degree, 8 = Master's Degree, 9 = MD, PhD, JD, or PharmD), with higher scores indicating higher educational attainment

Outcome measures

Measure	Screening & Enrollment n=42 Participants All individuals who were pre-screened for eligibility before randomization.	Coping n=39 Participants Coping intervention involving 14 foundational audio-guided lessons plus daily brief practice prompts. Lessons train techniques for 3 coping skills: reflection, reappraisal, and problem solving. Practice prompts delivered 3x daily build on the skills trained in each lesson. Coping: The coping intervention includes 14 daily 20-minute audio lessons plus brief daily practice prompts. Lessons train specific coping techniques through didactic explanation and guided practice. Lessons train coping skills (reflection, reappraisal, and problem solving) without encouraging focus on or acceptance of present experience (i.e., mindfulness skills). Participants are instructed to: (1) reflect and let their minds drift, (2) reframe or reappraise past and anticipated events, and (3) analyze and solve personal problems. Practice prompts build on the skills trained in each lesson, encouraging participants to take brief reflection breaks or to practice reappraisal or problem-solving skills.
Early Life Adversity: Childhood SES Indexed Via Parental Education Maternal education	6.12 SES Score (Parental Education) Standard Error 0.32	6.46 SES Score (Parental Education) Standard Error 0.33
Early Life Adversity: Childhood SES Indexed Via Parental Education Paternal education	5.95 SES Score (Parental Education) Standard Error 0.35	5.95 SES Score (Parental Education) Standard Error 0.37

OTHER_PRE_SPECIFIED outcome

Timeframe: pre-intervention

Childhood SES assessed via National Comorbidity Survey: Adolescents item assessing government food assistance

Outcome measures

Measure	Screening & Enrollment n=42 Participants All individuals who were pre-screened for eligibility before randomization.	Coping n=39 Participants Coping intervention involving 14 foundational audio-guided lessons plus daily brief practice prompts. Lessons train techniques for 3 coping skills: reflection, reappraisal, and problem solving. Practice prompts delivered 3x daily build on the skills trained in each lesson. Coping: The coping intervention includes 14 daily 20-minute audio lessons plus brief daily practice prompts. Lessons train specific coping techniques through didactic explanation and guided practice. Lessons train coping skills (reflection, reappraisal, and problem solving) without encouraging focus on or acceptance of present experience (i.e., mindfulness skills). Participants are instructed to: (1) reflect and let their minds drift, (2) reframe or reappraise past and anticipated events, and (3) analyze and solve personal problems. Practice prompts build on the skills trained in each lesson, encouraging participants to take brief reflection breaks or to practice reappraisal or problem-solving skills.
Early Life Adversity: Childhood SES Indexed by Government Food Assistance	14 Participants	11 Participants

OTHER_PRE_SPECIFIED outcome

Timeframe: pre-intervention

Early Life Adversity assessed via Adverse Childhood Experiences Survey (using a 5-item domestic violence subscale, ranging from 0-10, with higher scores indicating higher levels of domestic violence)

Outcome measures

Measure	Screening & Enrollment n=42 Participants All individuals who were pre-screened for eligibility before randomization.	Coping n=39 Participants Coping intervention involving 14 foundational audio-guided lessons plus daily brief practice prompts. Lessons train techniques for 3 coping skills: reflection, reappraisal, and problem solving. Practice prompts delivered 3x daily build on the skills trained in each lesson. Coping: The coping intervention includes 14 daily 20-minute audio lessons plus brief daily practice prompts. Lessons train specific coping techniques through didactic explanation and guided practice. Lessons train coping skills (reflection, reappraisal, and problem solving) without encouraging focus on or acceptance of present experience (i.e., mindfulness skills). Participants are instructed to: (1) reflect and let their minds drift, (2) reframe or reappraise past and anticipated events, and (3) analyze and solve personal problems. Practice prompts build on the skills trained in each lesson, encouraging participants to take brief reflection breaks or to practice reappraisal or problem-solving skills.
Early Life Adversity: Domestic Violence ACES domestic violence	10 Participants	5 Participants
Early Life Adversity: Domestic Violence ACES criminal behavior	1 Participants	4 Participants

OTHER_PRE_SPECIFIED outcome

Timeframe: change from pre-intervention to post-intervention (an average of 4 weeks) and one-month follow-up (an average of 8 weeks)

Circulating CRP assessed via dried blood spot (DBS) [additional funding needed to assess]

Outcome measures

Outcome data not reported

OTHER_PRE_SPECIFIED outcome

Timeframe: change from pre-intervention to post-intervention (an average of 4 weeks) and one-month follow-up (an average of 8 weeks)

Circulating TNF assessed via dried blood spot (DBS) [additional funding needed to assess]

Outcome measures

Outcome data not reported

OTHER_PRE_SPECIFIED outcome

Timeframe: change from pre-intervention to post-intervention (an average of 4 weeks) and one-month follow-up (an average of 8 weeks)

Circulating IL-8 assessed via dried blood spot (DBS) [additional funding needed to assess]

Outcome measures

Outcome data not reported

OTHER_PRE_SPECIFIED outcome

Timeframe: change from pre-intervention to post-intervention (an average of 4 weeks) and one-month follow-up (an average of 8 weeks)

Circulating IL-10 assessed via dried blood spot (DBS) [additional funding needed to assess]

Outcome measures

Outcome data not reported

OTHER_PRE_SPECIFIED outcome

Timeframe: change from pre-intervention laboratory assessment to post-intervention laboratory assessment (an average of 4 weeks) and one-month follow-up laboratory assessment (an average of 8 weeks)

Assessed in-person via PROMIS Anxiety, a 4-item scale with raw scores ranging from 4-20 and converted to t-scores, with t-scores of 50 (standard deviation = 10) representing the average for the US general population and higher t-scores indicating higher anxiety

Outcome measures

Measure	Screening & Enrollment n=42 Participants All individuals who were pre-screened for eligibility before randomization.	Coping n=39 Participants Coping intervention involving 14 foundational audio-guided lessons plus daily brief practice prompts. Lessons train techniques for 3 coping skills: reflection, reappraisal, and problem solving. Practice prompts delivered 3x daily build on the skills trained in each lesson. Coping: The coping intervention includes 14 daily 20-minute audio lessons plus brief daily practice prompts. Lessons train specific coping techniques through didactic explanation and guided practice. Lessons train coping skills (reflection, reappraisal, and problem solving) without encouraging focus on or acceptance of present experience (i.e., mindfulness skills). Participants are instructed to: (1) reflect and let their minds drift, (2) reframe or reappraise past and anticipated events, and (3) analyze and solve personal problems. Practice prompts build on the skills trained in each lesson, encouraging participants to take brief reflection breaks or to practice reappraisal or problem-solving skills.
Change in Global Psychosocial Stress: Anxiety Mean Anxiety Score (Pre-Intervention)	61.37 t-score Standard Error 1.13	60.29 t-score Standard Error 1.17
Change in Global Psychosocial Stress: Anxiety Mean Anxiety Score (Post-Intervention)	58.97 t-score Standard Error 1.16	56.99 t-score Standard Error 1.22
Change in Global Psychosocial Stress: Anxiety Mean Anxiety Score (1 Month Follow Up)	58.56 t-score Standard Error 1.17	56.94 t-score Standard Error 1.22

OTHER_PRE_SPECIFIED outcome

Timeframe: change from pre-intervention laboratory assessment to post-intervention laboratory assessment (an average of 4 weeks) and one-month follow-up laboratory assessment (an average of 8 weeks)

Assessed in-person via PROMIS Depression, a 4-item scale with raw scores ranging from 4-20 and converted to t-scores, with t-scores of 50 (standard deviation = 10) representing the average for the US general population and higher t-scores indicating higher depressive symptoms

Outcome measures

Measure	Screening & Enrollment n=42 Participants All individuals who were pre-screened for eligibility before randomization.	Coping n=39 Participants Coping intervention involving 14 foundational audio-guided lessons plus daily brief practice prompts. Lessons train techniques for 3 coping skills: reflection, reappraisal, and problem solving. Practice prompts delivered 3x daily build on the skills trained in each lesson. Coping: The coping intervention includes 14 daily 20-minute audio lessons plus brief daily practice prompts. Lessons train specific coping techniques through didactic explanation and guided practice. Lessons train coping skills (reflection, reappraisal, and problem solving) without encouraging focus on or acceptance of present experience (i.e., mindfulness skills). Participants are instructed to: (1) reflect and let their minds drift, (2) reframe or reappraise past and anticipated events, and (3) analyze and solve personal problems. Practice prompts build on the skills trained in each lesson, encouraging participants to take brief reflection breaks or to practice reappraisal or problem-solving skills.
Change in Global Psychosocial Stress: Depressive Symptoms Mean Depressive Score (Pre-Intervention)	56.90 t-score Standard Error 1.29	53.76 t-score Standard Error 1.34
Change in Global Psychosocial Stress: Depressive Symptoms Mean Depressive Score (Post-Intervention)	55.76 t-score Standard Error 1.35	50.54 t-score Standard Error 1.42
Change in Global Psychosocial Stress: Depressive Symptoms Mean Depressive Score (1 Month Follow Up)	55.86 t-score Standard Error 1.39	52.39 t-score Standard Error 1.45

OTHER_PRE_SPECIFIED outcome

Timeframe: change from pre-intervention laboratory assessment to post-intervention laboratory assessment (an average of 4 weeks) and one-month follow-up laboratory assessment (an average of 8 weeks)

Assessed in-person via PROMIS Social Isolation, a 14-item scale with raw scores ranging from 14 to 70 and converted to t-scores, with t-scores of 50 (standard deviation = 10) representing the average for the US general population and higher t-scores indicating higher social isolation

Outcome measures

Measure	Screening & Enrollment n=42 Participants All individuals who were pre-screened for eligibility before randomization.	Coping n=39 Participants Coping intervention involving 14 foundational audio-guided lessons plus daily brief practice prompts. Lessons train techniques for 3 coping skills: reflection, reappraisal, and problem solving. Practice prompts delivered 3x daily build on the skills trained in each lesson. Coping: The coping intervention includes 14 daily 20-minute audio lessons plus brief daily practice prompts. Lessons train specific coping techniques through didactic explanation and guided practice. Lessons train coping skills (reflection, reappraisal, and problem solving) without encouraging focus on or acceptance of present experience (i.e., mindfulness skills). Participants are instructed to: (1) reflect and let their minds drift, (2) reframe or reappraise past and anticipated events, and (3) analyze and solve personal problems. Practice prompts build on the skills trained in each lesson, encouraging participants to take brief reflection breaks or to practice reappraisal or problem-solving skills.
Change in Global Psychosocial Stress: Social Isolation Mean Social Isolation Score (Pre-Intervention)	53.64 t-score Standard Error 1.42	50.55 t-score Standard Error 1.48
Change in Global Psychosocial Stress: Social Isolation Mean Social Isolation Score (Post-Intervention)	51.52 t-score Standard Error 1.45	49.64 t-score Standard Error 1.52
Change in Global Psychosocial Stress: Social Isolation Mean Social Isolation Score (1 Month Follow Up)	51.29 t-score Standard Error 1.46	48.80 t-score Standard Error 1.52

OTHER_PRE_SPECIFIED outcome

Timeframe: change from pre-intervention laboratory assessment to post-intervention laboratory assessment (an average of 4 weeks) and one-month follow-up laboratory assessment (an average of 8 weeks)

Assessed in-person via Perceived Stress Scale (a 10-item scale ranging from 0-40, with higher scores indicating higher perceived stress)

Outcome measures

Measure	Screening & Enrollment n=42 Participants All individuals who were pre-screened for eligibility before randomization.	Coping n=39 Participants Coping intervention involving 14 foundational audio-guided lessons plus daily brief practice prompts. Lessons train techniques for 3 coping skills: reflection, reappraisal, and problem solving. Practice prompts delivered 3x daily build on the skills trained in each lesson. Coping: The coping intervention includes 14 daily 20-minute audio lessons plus brief daily practice prompts. Lessons train specific coping techniques through didactic explanation and guided practice. Lessons train coping skills (reflection, reappraisal, and problem solving) without encouraging focus on or acceptance of present experience (i.e., mindfulness skills). Participants are instructed to: (1) reflect and let their minds drift, (2) reframe or reappraise past and anticipated events, and (3) analyze and solve personal problems. Practice prompts build on the skills trained in each lesson, encouraging participants to take brief reflection breaks or to practice reappraisal or problem-solving skills.
Change in Global Psychosocial Stress: Perceived Stress Mean PSS Score (Pre-Intervention)	21.60 score on a scale Standard Error 0.91	20.85 score on a scale Standard Error 0.94
Change in Global Psychosocial Stress: Perceived Stress Mean PSS Score (Post-Intervention)	20.42 score on a scale Standard Error 0.96	16.92 score on a scale Standard Error 1.01
Change in Global Psychosocial Stress: Perceived Stress Mean PSS Score (1-Month Follow-Up)	18.21 score on a scale Standard Error 0.99	16.81 score on a scale Standard Error 1.04

OTHER_PRE_SPECIFIED outcome

Timeframe: change from pre-intervention laboratory assessment to post-intervention laboratory assessment (an average of 4 weeks) and one-month follow-up laboratory assessment (an average of 8 weeks)

Assessed in-person via Post-Traumatic Stress Disorder Checklist for Civilians (PCL-C), a 17-item scale ranging from 17-85, with higher scores indicating higher levels of trauma, and scores of 30 or greater indicating at least moderately severe PTSD symptoms

Outcome measures

Measure	Screening & Enrollment n=42 Participants All individuals who were pre-screened for eligibility before randomization.	Coping n=39 Participants Coping intervention involving 14 foundational audio-guided lessons plus daily brief practice prompts. Lessons train techniques for 3 coping skills: reflection, reappraisal, and problem solving. Practice prompts delivered 3x daily build on the skills trained in each lesson. Coping: The coping intervention includes 14 daily 20-minute audio lessons plus brief daily practice prompts. Lessons train specific coping techniques through didactic explanation and guided practice. Lessons train coping skills (reflection, reappraisal, and problem solving) without encouraging focus on or acceptance of present experience (i.e., mindfulness skills). Participants are instructed to: (1) reflect and let their minds drift, (2) reframe or reappraise past and anticipated events, and (3) analyze and solve personal problems. Practice prompts build on the skills trained in each lesson, encouraging participants to take brief reflection breaks or to practice reappraisal or problem-solving skills.
Change in Global Psychosocial Stress: Trauma Symptoms Mean PCL Score (Pre-Intervention)	40.19 score on a scale Standard Error 1.89	40.21 score on a scale Standard Error 1.97
Change in Global Psychosocial Stress: Trauma Symptoms Mean PCL Score (Post-Intervention)	35.76 score on a scale Standard Error 1.95	31.44 score on a scale Standard Error 2.04
Change in Global Psychosocial Stress: Trauma Symptoms Mean PCL Score (1 Month Follow Up)	34.63 score on a scale Standard Error 1.96	32.18 score on a scale Standard Error 2.04

OTHER_PRE_SPECIFIED outcome

Timeframe: change from pre-intervention laboratory assessment to post-intervention laboratory assessment (an average of 4 weeks) and one-month follow-up laboratory assessment (an average of 8 weeks)

Assessed in-person via Cambridge Depersonalization Scale (a 29-item scale ranging from 0-116, assessing frequency and duration of depersonalization symptoms, with higher scores indicating greater depersonalization)

Outcome measures

Measure	Screening & Enrollment n=42 Participants All individuals who were pre-screened for eligibility before randomization.	Coping n=39 Participants Coping intervention involving 14 foundational audio-guided lessons plus daily brief practice prompts. Lessons train techniques for 3 coping skills: reflection, reappraisal, and problem solving. Practice prompts delivered 3x daily build on the skills trained in each lesson. Coping: The coping intervention includes 14 daily 20-minute audio lessons plus brief daily practice prompts. Lessons train specific coping techniques through didactic explanation and guided practice. Lessons train coping skills (reflection, reappraisal, and problem solving) without encouraging focus on or acceptance of present experience (i.e., mindfulness skills). Participants are instructed to: (1) reflect and let their minds drift, (2) reframe or reappraise past and anticipated events, and (3) analyze and solve personal problems. Practice prompts build on the skills trained in each lesson, encouraging participants to take brief reflection breaks or to practice reappraisal or problem-solving skills.
Change in Global Psychosocial Stress: Depersonalization Mean CDS Score (Pre-Intervention)	58.31 score on a scale Standard Error 6.02	52.15 score on a scale Standard Error 6.25
Change in Global Psychosocial Stress: Depersonalization Mean CDS Score (Post-Intervention)	47.49 score on a scale Standard Error 6.16	36.30 score on a scale Standard Error 6.45
Change in Global Psychosocial Stress: Depersonalization Mean CDS Score (1 Month Follow Up)	43.94 score on a scale Standard Error 6.19	30.83 score on a scale Standard Error 6.45

OTHER_PRE_SPECIFIED outcome

Timeframe: change from pre-intervention laboratory assessment to post-intervention laboratory assessment (an average of 4 weeks) and one-month follow-up laboratory assessment (an average of 8 weeks)

Assessed in-person via Pittsburgh Sleep Quality Index (6-item short form, ranging from 0-12, with higher scores indicating worse sleep)

Outcome measures

Measure	Screening & Enrollment n=42 Participants All individuals who were pre-screened for eligibility before randomization.	Coping n=39 Participants Coping intervention involving 14 foundational audio-guided lessons plus daily brief practice prompts. Lessons train techniques for 3 coping skills: reflection, reappraisal, and problem solving. Practice prompts delivered 3x daily build on the skills trained in each lesson. Coping: The coping intervention includes 14 daily 20-minute audio lessons plus brief daily practice prompts. Lessons train specific coping techniques through didactic explanation and guided practice. Lessons train coping skills (reflection, reappraisal, and problem solving) without encouraging focus on or acceptance of present experience (i.e., mindfulness skills). Participants are instructed to: (1) reflect and let their minds drift, (2) reframe or reappraise past and anticipated events, and (3) analyze and solve personal problems. Practice prompts build on the skills trained in each lesson, encouraging participants to take brief reflection breaks or to practice reappraisal or problem-solving skills.
Change in Sleep Quality Mean PSQI Score (Pre-Intervention)	4.14 score on a scale Standard Error 0.37	4.28 score on a scale Standard Error 0.38
Change in Sleep Quality Mean PSQI Score (Post-Intervention)	4.13 score on a scale Standard Error 0.33	3.20 score on a scale Standard Error 0.35
Change in Sleep Quality Mean PSQI Score (1 Month Follow Up)	3.81 score on a scale Standard Error 0.34	3.85 score on a scale Standard Error 0.35

OTHER_PRE_SPECIFIED outcome

Timeframe: change from pre-intervention laboratory assessment to post-intervention laboratory assessment (an average of 4 weeks) and one-month follow-up laboratory assessment (an average of 8 weeks)

Assessed in-person via PROMIS Life Satisfaction, a 5-item scale with raw scores ranging from 5-35 and converted to t-scores, with t-scores of 50 (standard deviation = 10) representing the average for the US general population and higher t-scores indicating higher life satisfaction

Outcome measures

Measure	Screening & Enrollment n=42 Participants All individuals who were pre-screened for eligibility before randomization.	Coping n=39 Participants Coping intervention involving 14 foundational audio-guided lessons plus daily brief practice prompts. Lessons train techniques for 3 coping skills: reflection, reappraisal, and problem solving. Practice prompts delivered 3x daily build on the skills trained in each lesson. Coping: The coping intervention includes 14 daily 20-minute audio lessons plus brief daily practice prompts. Lessons train specific coping techniques through didactic explanation and guided practice. Lessons train coping skills (reflection, reappraisal, and problem solving) without encouraging focus on or acceptance of present experience (i.e., mindfulness skills). Participants are instructed to: (1) reflect and let their minds drift, (2) reframe or reappraise past and anticipated events, and (3) analyze and solve personal problems. Practice prompts build on the skills trained in each lesson, encouraging participants to take brief reflection breaks or to practice reappraisal or problem-solving skills.
Change in Global Psychosocial Resilience: Life Satisfaction Mean Life Satisfaction Score (Pre-Intervention)	41.47 t-score Standard Error 1.30	45.34 t-score Standard Error 1.35
Change in Global Psychosocial Resilience: Life Satisfaction Mean Life Satisfaction Score (Post-Intervention)	42.35 t-score Standard Error 1.42	46.92 t-score Standard Error 1.49
Change in Global Psychosocial Resilience: Life Satisfaction Mean Life Satisfaction Score (1 Month Follow Up)	43.79 t-score Standard Error 1.59	48.24 t-score Standard Error 1.65

OTHER_PRE_SPECIFIED outcome

Timeframe: change from pre-intervention laboratory assessment to post-intervention laboratory assessment (an average of 4 weeks) and one-month follow-up laboratory assessment (an average of 8 weeks)

Assessed in-person via PROMIS Positive Affect, a 15-item scale with raw scores ranging from 15-75 and converted to t-scores, with t-scores of 50 (standard deviation = 10) representing the average for the US general population and higher t-scores indicating higher positive affect

Outcome measures

Measure	Screening & Enrollment n=42 Participants All individuals who were pre-screened for eligibility before randomization.	Coping n=39 Participants Coping intervention involving 14 foundational audio-guided lessons plus daily brief practice prompts. Lessons train techniques for 3 coping skills: reflection, reappraisal, and problem solving. Practice prompts delivered 3x daily build on the skills trained in each lesson. Coping: The coping intervention includes 14 daily 20-minute audio lessons plus brief daily practice prompts. Lessons train specific coping techniques through didactic explanation and guided practice. Lessons train coping skills (reflection, reappraisal, and problem solving) without encouraging focus on or acceptance of present experience (i.e., mindfulness skills). Participants are instructed to: (1) reflect and let their minds drift, (2) reframe or reappraise past and anticipated events, and (3) analyze and solve personal problems. Practice prompts build on the skills trained in each lesson, encouraging participants to take brief reflection breaks or to practice reappraisal or problem-solving skills.
Change in Global Psychosocial Resilience: Positive Affect Mean Positive Affect Score (Pre-Intervention)	41.09 t-score Standard Error 1.17	44.16 t-score Standard Error 1.22
Change in Global Psychosocial Resilience: Positive Affect Mean Positive Affect Score (Post-Intervention)	41.96 t-score Standard Error 1.24	45.15 t-score Standard Error 1.30
Change in Global Psychosocial Resilience: Positive Affect Mean Positive Affect Score (1 Month Follow Up)	42.53 t-score Standard Error 1.28	44.16 t-score Standard Error 1.34

OTHER_PRE_SPECIFIED outcome

Timeframe: change from pre-intervention laboratory assessment to post-intervention laboratory assessment (an average of 4 weeks) and one-month follow-up laboratory assessment (an average of 8 weeks)

Assessed in-person via PROMIS Self-Efficacy, a 4-item scale with raw scores ranging from 4-20 and converted to t-scores, with t-scores of 50 (standard deviation = 10) representing the average for the US general population and higher t-scores indicating higher self-efficacy

Outcome measures

Measure	Screening & Enrollment n=42 Participants All individuals who were pre-screened for eligibility before randomization.	Coping n=39 Participants Coping intervention involving 14 foundational audio-guided lessons plus daily brief practice prompts. Lessons train techniques for 3 coping skills: reflection, reappraisal, and problem solving. Practice prompts delivered 3x daily build on the skills trained in each lesson. Coping: The coping intervention includes 14 daily 20-minute audio lessons plus brief daily practice prompts. Lessons train specific coping techniques through didactic explanation and guided practice. Lessons train coping skills (reflection, reappraisal, and problem solving) without encouraging focus on or acceptance of present experience (i.e., mindfulness skills). Participants are instructed to: (1) reflect and let their minds drift, (2) reframe or reappraise past and anticipated events, and (3) analyze and solve personal problems. Practice prompts build on the skills trained in each lesson, encouraging participants to take brief reflection breaks or to practice reappraisal or problem-solving skills.
Change in Global Psychosocial Resilience: Self-Efficacy Mean Self-efficacy Score (Pre-Intervention)	44.60 t-score Standard Error 1.47	45.32 t-score Standard Error 1.53
Change in Global Psychosocial Resilience: Self-Efficacy Mean Self-efficacy Score (Post-Intervention)	45.73 t-score Standard Error 1.52	47.40 t-score Standard Error 1.59
Change in Global Psychosocial Resilience: Self-Efficacy Mean Self-efficacy Score (1 Month Follow Up)	48.22 t-score Standard Error 1.53	47.55 t-score Standard Error 1.59

OTHER_PRE_SPECIFIED outcome

Timeframe: change from pre-intervention laboratory assessment to post-intervention laboratory assessment (an average of 4 weeks) and one-month follow-up laboratory assessment (an average of 8 weeks)

Five Facet Mindfulness Questionnaire-Short Form (a 24-item scale including five subscales - observing, describing, acting with awareness, nonreactivity, and nonjudgment, with average scores ranging from 1-5 and higher scores indicating higher mindfulness)

Outcome measures

Measure	Screening & Enrollment n=42 Participants All individuals who were pre-screened for eligibility before randomization.	Coping n=39 Participants Coping intervention involving 14 foundational audio-guided lessons plus daily brief practice prompts. Lessons train techniques for 3 coping skills: reflection, reappraisal, and problem solving. Practice prompts delivered 3x daily build on the skills trained in each lesson. Coping: The coping intervention includes 14 daily 20-minute audio lessons plus brief daily practice prompts. Lessons train specific coping techniques through didactic explanation and guided practice. Lessons train coping skills (reflection, reappraisal, and problem solving) without encouraging focus on or acceptance of present experience (i.e., mindfulness skills). Participants are instructed to: (1) reflect and let their minds drift, (2) reframe or reappraise past and anticipated events, and (3) analyze and solve personal problems. Practice prompts build on the skills trained in each lesson, encouraging participants to take brief reflection breaks or to practice reappraisal or problem-solving skills.
Change in Global Mindfulness Mean Global Mindfulness Score (Pre-Intervention)	3.10 score on a scale Standard Error 0.07	3.15 score on a scale Standard Error 0.08
Change in Global Mindfulness Mean Global Mindfulness Score (Post-Intervention)	3.27 score on a scale Standard Error 0.08	3.44 score on a scale Standard Error 0.09
Change in Global Mindfulness Mean Global Mindfulness Score (1 Month Follow Up)	3.39 score on a scale Standard Error 0.09	3.49 score on a scale Standard Error 0.10

OTHER_PRE_SPECIFIED outcome

Timeframe: change from pre-intervention laboratory assessment to post-intervention laboratory assessment (an average of 4 weeks) and one-month follow-up laboratory assessment (an average of 8 weeks)

Acceptance and Action Questionnaire-II (a 7-item scale ranging from 7-49, with higher scores indicating higher experiential avoidance)

Outcome measures

Measure	Screening & Enrollment n=42 Participants All individuals who were pre-screened for eligibility before randomization.	Coping n=39 Participants Coping intervention involving 14 foundational audio-guided lessons plus daily brief practice prompts. Lessons train techniques for 3 coping skills: reflection, reappraisal, and problem solving. Practice prompts delivered 3x daily build on the skills trained in each lesson. Coping: The coping intervention includes 14 daily 20-minute audio lessons plus brief daily practice prompts. Lessons train specific coping techniques through didactic explanation and guided practice. Lessons train coping skills (reflection, reappraisal, and problem solving) without encouraging focus on or acceptance of present experience (i.e., mindfulness skills). Participants are instructed to: (1) reflect and let their minds drift, (2) reframe or reappraise past and anticipated events, and (3) analyze and solve personal problems. Practice prompts build on the skills trained in each lesson, encouraging participants to take brief reflection breaks or to practice reappraisal or problem-solving skills.
Change in Global Experiential Avoidance Mean AAQ-II Score (Pre-Intervention)	27.38 score on a scale Standard Error 1.37	25.38 score on a scale Standard Error 1.43
Change in Global Experiential Avoidance Mean AAQ-II Score (Post-Intervention)	24.32 score on a scale Standard Error 1.40	20.93 score on a scale Standard Error 1.47
Change in Global Experiential Avoidance Mean AAQ-II Score (1 Month Follow Up)	23.08 score on a scale Standard Error 1.41	22.02 score on a scale Standard Error 1.47

OTHER_PRE_SPECIFIED outcome

Timeframe: change from pre-intervention laboratory assessment to post-intervention laboratory assessment (an average of 4 weeks) and one-month follow-up laboratory assessment (an average of 8 weeks)

Distress Tolerance Scale (a 15-item scale ranging from 1-5, with higher scores indicating higher distress tolerance)

Outcome measures

Measure	Screening & Enrollment n=42 Participants All individuals who were pre-screened for eligibility before randomization.	Coping n=39 Participants Coping intervention involving 14 foundational audio-guided lessons plus daily brief practice prompts. Lessons train techniques for 3 coping skills: reflection, reappraisal, and problem solving. Practice prompts delivered 3x daily build on the skills trained in each lesson. Coping: The coping intervention includes 14 daily 20-minute audio lessons plus brief daily practice prompts. Lessons train specific coping techniques through didactic explanation and guided practice. Lessons train coping skills (reflection, reappraisal, and problem solving) without encouraging focus on or acceptance of present experience (i.e., mindfulness skills). Participants are instructed to: (1) reflect and let their minds drift, (2) reframe or reappraise past and anticipated events, and (3) analyze and solve personal problems. Practice prompts build on the skills trained in each lesson, encouraging participants to take brief reflection breaks or to practice reappraisal or problem-solving skills.
Change in Global Distress Tolerance Mean DTS Score (Pre-Intervention)	3.16 score on a scale Standard Error 0.13	3.30 score on a scale Standard Error 0.14
Change in Global Distress Tolerance Mean DTS Score (Post-Intervention)	3.50 score on a scale Standard Error 0.14	3.61 score on a scale Standard Error 0.14
Change in Global Distress Tolerance Mean DTS Score (1 Month Follow Up)	3.49 score on a scale Standard Error 0.14	3.67 score on a scale Standard Error 0.15

OTHER_PRE_SPECIFIED outcome

Timeframe: change from pre-intervention laboratory assessment to post-intervention laboratory assessment (an average of 4 weeks) and one-month follow-up laboratory assessment (an average of 8 weeks)

Self-Compassion Scale (a 25-item scale ranging from 1-5, with higher scores indicating higher self-compassion)

Outcome measures

Measure	Screening & Enrollment n=42 Participants All individuals who were pre-screened for eligibility before randomization.	Coping n=39 Participants Coping intervention involving 14 foundational audio-guided lessons plus daily brief practice prompts. Lessons train techniques for 3 coping skills: reflection, reappraisal, and problem solving. Practice prompts delivered 3x daily build on the skills trained in each lesson. Coping: The coping intervention includes 14 daily 20-minute audio lessons plus brief daily practice prompts. Lessons train specific coping techniques through didactic explanation and guided practice. Lessons train coping skills (reflection, reappraisal, and problem solving) without encouraging focus on or acceptance of present experience (i.e., mindfulness skills). Participants are instructed to: (1) reflect and let their minds drift, (2) reframe or reappraise past and anticipated events, and (3) analyze and solve personal problems. Practice prompts build on the skills trained in each lesson, encouraging participants to take brief reflection breaks or to practice reappraisal or problem-solving skills.
Change in Global Self-Compassion Mean SCS Score (Pre-Intervention)	2.63 score on a scale Standard Error 0.11	2.84 score on a scale Standard Error 0.11
Change in Global Self-Compassion Mean SCS Score (Post-Intervention)	2.97 score on a scale Standard Error 0.12	3.20 score on a scale Standard Error 0.12
Change in Global Self-Compassion Mean SCS Score (1 Month Follow Up)	3.17 score on a scale Standard Error 0.13	3.26 score on a scale Standard Error 0.13

Adverse Events

Mindfulness

Serious events: 0 serious events

Other events: 0 other events

Deaths: 0 deaths

Coping

Serious events: 0 serious events

Other events: 0 other events

Deaths: 0 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Adverse event data not reported

Additional Information

Emily K Lindsay, PhD

University of Pittsburgh

Phone: 412-601-0585

Email: emily.lindsay@pitt.edu

Results disclosure agreements

• Principal investigator is a sponsor employee
• Publication restrictions are in place