Iranian Journal of Psychiatry and Behavioral Sciences

Published by: Kowsar

Effectiveness of Mindfulness-Based Stress Management in The Mental Health of Iranian University Students: A Comparison of Blended Therapy, Face-to-Face Sessions, and mHealth App (Aramgar)

Somaieh Borjalilu 1 , * , Mohammad Ali Mazaheri 2 and Alireza Talebpour 3
Authors Information
1 Department of Virtualization, Tehran University of Medical Sciences, Tehran, Iran
2 Department of Psychology & Education, Shahid Beheshti University, Tehran, Iran
3 Cyber Space Research Institute, Shahid Beheshti University, Tehran, Iran
Article information
  • Iranian Journal of Psychiatry and Behavioral Sciences: June 30, 2019, 13 (2); e84726
  • Published Online: May 12, 2019
  • Article Type: Original Article
  • Received: September 29, 2018
  • Revised: February 9, 2019
  • Accepted: April 12, 2019
  • DOI: 10.5812/ijpbs.84726

To Cite: Borjalilu S, Mazaheri M A, Talebpour A. Effectiveness of Mindfulness-Based Stress Management in The Mental Health of Iranian University Students: A Comparison of Blended Therapy, Face-to-Face Sessions, and mHealth App (Aramgar), Iran J Psychiatry Behav Sci. 2019 ; 13(2):e84726. doi: 10.5812/ijpbs.84726.

Copyright © 2019, Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
1. Background
2. Objectives
3. Materials and Methods
4. Results
5. Discussion
  • 1. Harrer M, Adam SH, Fleischmann RJ, Baumeister H, Auerbach R, Bruffaerts R, et al. Effectiveness of an internet- and app-based intervention for college students with elevated stress: Randomized controlled trial. J Med Internet Res. 2018;20(4). e136. doi: 10.2196/jmir.9293. [PubMed: 29685870]. [PubMed Central: PMC5938594].
  • 2. Nguyen-Feng VN, Greer CS, Frazier P. Using online interventions to deliver college student mental health resources: Evidence from randomized clinical trials. Psychol Serv. 2017;14(4):481-9. doi: 10.1037/ser0000154. [PubMed: 29120206].
  • 3. Kahn JH, Kasky-Hernández LM, Ambrose P, French S. Stress, depression, and anxiety among transitioning college students: The family as a protective factor. J First Year Experience Student Transit. 2017;29(2):11-25.
  • 4. Malekian KA, Khan A. Determinants of burnout and stress on students health: A study of Iranian expatriate international students. Sains Humanika. 2017;9(1-4). doi: 10.11113/sh.v9n1-4.1125.
  • 5. Eisenberg D, Hunt J, Speer N. Help seeking for mental health on college campuses: Review of evidence and next steps for research and practice. Harv Rev Psychiatry. 2012;20(4):222-32. doi: 10.3109/10673229.2012.712839. [PubMed: 22894731].
  • 6. Gulliver A, Griffiths KM, Christensen H. Barriers and facilitators to mental health help-seeking for young elite athletes: A qualitative study. BMC Psychiatry. 2012;12:157. doi: 10.1186/1471-244X-12-157. [PubMed: 23009161]. [PubMed Central: PMC3514142].
  • 7. Escoffery C, Miner KR, Adame DD, Butler S, McCormick L, Mendell E. Internet use for health information among college students. J Am Coll Health. 2005;53(4):183-8. doi: 10.3200/JACH.53.4.183-188. [PubMed: 15663067].
  • 8. Spek V, Cuijpers P, Nyklicek I, Riper H, Keyzer J, Pop V. Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: A meta-analysis. Psychol Med. 2007;37(3):319-28. doi: 10.1017/S0033291706008944. [PubMed: 17112400].
  • 9. Boschen MJ. Mobile telephones and psychotherapy: I: Capability and applicability. Behav Therap. 2009;32(8):168-75.
  • 10. Kazdin AE, Blase SL. Rebooting psychotherapy research and practice to reduce the burden of mental illness. Perspect Psychol Sci. 2011;6(1):21-37. doi: 10.1177/1745691610393527. [PubMed: 26162113].
  • 11. Heron KE, Smyth JM. Ecological momentary interventions: Incorporating mobile technology into psychosocial and health behaviour treatments. Br J Health Psychol. 2010;15(Pt 1):1-39. doi: 10.1348/135910709X466063. [PubMed: 19646331]. [PubMed Central: PMC2800172].
  • 12. Luxton DD, McCann RA, Bush NE, Mishkind MC, Reger GM. mHealth for mental health: Integrating smartphone technology in behavioral healthcare. Prof Psychol Res Pract. 2011;42(6):505-12. doi: 10.1037/a0024485.
  • 13. Rathbone AL, Prescott J. The use of mobile apps and SMS messaging as physical and mental health interventions: Systematic review. J Med Internet Res. 2017;19(8). e295. doi: 10.2196/jmir.7740. [PubMed: 28838887]. [PubMed Central: PMC5590007].
  • 14. Burgess PM, Pirkis JE, Slade TN, Johnston AK, Meadows GN, Gunn JM. Service use for mental health problems: Findings from the 2007 National Survey of Mental Health and Wellbeing. Aust N Z J Psychiatry. 2009;43(7):615-23. doi: 10.1080/00048670902970858. [PubMed: 19530018].
  • 15. Firth J, Torous J, Carney R, Newby J, Cosco TD, Christensen H, et al. Digital technologies in the treatment of anxiety: Recent innovations and future directions. Curr Psychiatry Rep. 2018;20(6):44. doi: 10.1007/s11920-018-0910-2. [PubMed: 29779065].
  • 16. Stawarz K, Preist C, Tallon D, Wiles N, Coyle D. User experience of cognitive behavioral therapy apps for depression: An analysis of app functionality and user reviews. J Med Internet Res. 2018;20(6). e10120. doi: 10.2196/10120. [PubMed: 29875087]. [PubMed Central: PMC6010839].
  • 17. Pramana G, Parmanto B, Kendall PC, Silk JS. The SmartCAT: An m-health platform for ecological momentary intervention in child anxiety treatment. Telemed J E Health. 2014;20(5):419-27. doi: 10.1089/tmj.2013.0214. [PubMed: 24579913]. [PubMed Central: PMC4011472].
  • 18. Ben-Zeev D, Scherer EA, Wang R, Xie H, Campbell AT. Next-generation psychiatric assessment: Using smartphone sensors to monitor behavior and mental health. Psychiatr Rehabil J. 2015;38(3):218-26. doi: 10.1037/prj0000130. [PubMed: 25844912]. [PubMed Central: PMC4564327].
  • 19. Villani D, Grassi A, Cognetta C, Toniolo D, Cipresso P, Riva G. Self-help stress management training through mobile phones: An experience with oncology nurses. Psychol Serv. 2013;10(3):315-22. doi: 10.1037/a0026459. [PubMed: 23937091].
  • 20. Coulon SM, Monroe CM, West DS. A systematic, multi-domain review of mobile smartphone apps for evidence-based stress management. Am J Prev Med. 2016;51(1):95-105. doi: 10.1016/j.amepre.2016.01.026. [PubMed: 26993534].
  • 21. Mani M, Kavanagh DJ, Hides L, Stoyanov SR. Review and evaluation of mindfulness-based iPhone apps. JMIR Mhealth Uhealth. 2015;3(3). e82. doi: 10.2196/mhealth.4328. [PubMed: 26290327]. [PubMed Central: PMC4705029].
  • 22. Christmann CA, Hoffmann A, Bleser G. Stress management apps with regard to emotion-focused coping and behavior change techniques: A content analysis. JMIR Mhealth Uhealth. 2017;5(2). e22. doi: 10.2196/mhealth.6471. [PubMed: 28232299]. [PubMed Central: PMC5344985].
  • 23. Kooistra LC, Ruwaard J, Wiersma JE, van Oppen P, van der Vaart R, van Gemert-Pijnen J, et al. Development and initial evaluation of blended cognitive behavioural treatment for major depression in routine specialized mental health care. Internet Interv. 2016;4:61-71. doi: 10.1016/j.invent.2016.01.003. [PubMed: 30135791]. [PubMed Central: PMC6096194].
  • 24. Titzler I, Saruhanjan K, Berking M, Riper H, Ebert DD. Barriers and facilitators for the implementation of blended psychotherapy for depression: A qualitative pilot study of therapists' perspective. Internet Interv. 2018;12:150-64. doi: 10.1016/j.invent.2018.01.002. [PubMed: 30135779]. [PubMed Central: PMC6096333].
  • 25. Mansson KN, Skagius Ruiz E, Gervind E, Dahlin M, Andersson G. Development and initial evaluation of an Internet-based support system for face-to-face cognitive behavior therapy: A proof of concept study. J Med Internet Res. 2013;15(12). e280. doi: 10.2196/jmir.3031. [PubMed: 24326065]. [PubMed Central: PMC3868964].
  • 26. Kleiboer A, Smit J, Bosmans J, Ruwaard J, Andersson G, Topooco N, et al. European COMPARative effectiveness research on blended depression treatment versus treatment-as-usual (E-COMPARED): Study protocol for a randomized controlled, non-inferiority trial in eight European countries. Trials. 2016;17(1):387. doi: 10.1186/s13063-016-1511-1. [PubMed: 27488181]. [PubMed Central: PMC4972947].
  • 27. Schuster R, Leitner I, Carlbring P, Laireiter AR. Exploring blended group interventions for depression: Randomised controlled feasibility study of a blended computer- and multimedia-supported psychoeducational group intervention for adults with depressive symptoms. Internet Interv. 2017;8:63-71. doi: 10.1016/j.invent.2017.04.001. [PubMed: 30135830]. [PubMed Central: PMC6096250].
  • 28. Ly KH, Topooco N, Cederlund H, Wallin A, Bergstrom J, Molander O, et al. Smartphone-supported versus full behavioural activation for depression: A randomised controlled trial. PLoS One. 2015;10(5). e0126559. doi: 10.1371/journal.pone.0126559. [PubMed: 26010890]. [PubMed Central: PMC4444307].
  • 29. Firth J, Torous J, Nicholas J, Carney R, Rosenbaum S, Sarris J. Can smartphone mental health interventions reduce symptoms of anxiety? A meta-analysis of randomized controlled trials. J Affect Disord. 2017;218:15-22. doi: 10.1016/j.jad.2017.04.046. [PubMed: 28456072].
  • 30. Morrison LG, Geraghty AWA, Lloyd S, Goodman N, Michaelides DT, Hargood C, et al. Comparing usage of a web and app stress management intervention: An observational study. Internet Interv. 2018;12:74-82. doi: 10.1016/j.invent.2018.03.006. [PubMed: 30135771]. [PubMed Central: PMC6096327].
  • 31. Topooco N, Riper H, Araya R, Berking M, Brunn M, Chevreul K, et al. Attitudes towards digital treatment for depression: A European stakeholder survey. Internet Interv. 2017;8:1-9. doi: 10.1016/j.invent.2017.01.001. [PubMed: 30135823]. [PubMed Central: PMC6096292].
  • 32. Abbasalizad Farhangi M, Dehghan P, Jahangiry L. Mental health problems in relation to eating behavior patterns, nutrient intakes and health related quality of life among Iranian female adolescents. PLoS One. 2018;13(4). e0195669. doi: 10.1371/journal.pone.0195669. [PubMed: 29702683]. [PubMed Central: PMC5922554].
  • 33. Kousha M, Bagheri HA, Heydarzadeh A. Emotional intelligence and anxiety, stress, and depression in Iranian resident physicians. J Family Med Prim Care. 2018;7(2):420-4. doi: 10.4103/jfmpc.jfmpc_154_17. [PubMed: 30090787]. [PubMed Central: PMC6060923].
  • 34. Verkuil B, Brosschot JF, Meerman EE, Thayer JF. Effects of momentary assessed stressful events and worry episodes on somatic health complaints. Psychol Health. 2012;27(2):141-58. doi: 10.1080/08870441003653470. [PubMed: 21038174].
  • 35. Thompson ER. Development and validation of an internationally reliable short-form of the positive and negative affect schedule (PANAS). J Cross Cult Psychol. 2016;38(2):227-42. doi: 10.1177/0022022106297301.
  • 36. Lesage FX, Berjot S, Deschamps F. Clinical stress assessment using a visual analogue scale. Occup Med (Lond). 2012;62(8):600-5. doi: 10.1093/occmed/kqs140. [PubMed: 22965867].
  • 37. Alkoby A, Pliskin R, Halperin E, Levit-Binnun N. An eight-week mindfulness-based stress reduction (MBSR) workshop increases regulatory choice flexibility. Emotion. 2018. doi: 10.1037/emo0000461. [PubMed: 29952613].
  • 38. Asghari A, Saed F, Dibajnia P. Psychometric properties of the depression anxiety stress scales-21 (DASS-21) in a non-clinical Iranian sample. Int J Psychol. 2008;2(2):82-102.
  • 39. Montero-Marin J, Gaete J, Araya R, Demarzo M, Manzanera R, Álvarez de Mon M, et al. Impact of a blended web-based mindfulness programme for general practitioners: A pilot study. Mindfulness. 2018;9(1):129-39. doi: 10.1007/s12671-017-0782-2.
  • 40. Lauricella S. Mindfulness meditation with undergraduates in face-to-face and digital practice: A formative analysis. Mindfulness. 2013;5(6):682-8. doi: 10.1007/s12671-013-0222-x.
  • 41. Erbe D, Eichert HC, Riper H, Ebert DD. Blending face-to-face and internet-based interventions for the treatment of mental disorders in adults: Systematic review. J Med Internet Res. 2017;19(9). e306. doi: 10.2196/jmir.6588. [PubMed: 28916506]. [PubMed Central: PMC5622288].
  • 42. Wentzel J, van der Vaart R, Bohlmeijer ET, van Gemert-Pijnen JE. Mixing online and face-to-face therapy: How to benefit from blended care in mental health care. JMIR Ment Health. 2016;3(1). e9. doi: 10.2196/mental.4534. [PubMed: 26860537]. [PubMed Central: PMC4764785].
  • 43. Torous J, Nicholas J, Larsen ME, Firth J, Christensen H. Clinical review of user engagement with mental health smartphone apps: Evidence, theory and improvements. Evid Based Ment Health. 2018;21(3):116-9. doi: 10.1136/eb-2018-102891. [PubMed: 29871870].
  • 44. Silva Almodovar A, Surve S, Axon DR, Cooper D, Nahata MC. Self-directed engagement with a Mobile App (Sinasprite) and its effects on confidence in coping skills, depression, and anxiety: Retrospective longitudinal study. JMIR Mhealth Uhealth. 2018;6(3). e64. doi: 10.2196/mhealth.9612. [PubMed: 29549066]. [PubMed Central: PMC5878360].
  • 45. Sandrick J, Tracy D, Eliasson A, Roth A, Bartel J, Simko M, et al. Effect of a counseling session bolstered by text messaging on self-selected health behaviors in college students: A preliminary randomized controlled trial. JMIR Mhealth Uhealth. 2017;5(5). e67. doi: 10.2196/mhealth.6638. [PubMed: 28526664]. [PubMed Central: PMC5451640].
  • 46. Crandall KJ, Steward K, Warf TM. A mobile app for reducing perceived stress in college students. Am J Health Stud. 2016;31(2):68-73.
  • 47. Ly KH, Asplund K, Andersson G. Stress management for middle managers via an acceptance and commitment-based smartphone application: A randomized controlled trial. Internet Intervent. 2014;1(3):95-101. doi: 10.1016/j.invent.2014.06.003.
  • 48. Schuster R, Sigl S, Berger T, Laireiter AR. Patients' experiences of web- and mobile-assisted group therapy for depression and implications of the group setting: Qualitative follow-up study. JMIR Ment Health. 2018;5(3). e49. doi: 10.2196/mental.9613. [PubMed: 29997106]. [PubMed Central: PMC6060305].
  • 49. Schuster R, Fichtenbauer I, Sparr VM, Berger T, Laireiter AR. Feasibility of a blended group treatment (bGT) for major depression: Uncontrolled interventional study in a university setting. BMJ Open. 2018;8(3). e018412. doi: 10.1136/bmjopen-2017-018412. [PubMed: 29530905]. [PubMed Central: PMC5857649].
  • 50. Cheung K, Ling W, Karr CJ, Weingardt K, Schueller SM, Mohr DC. Evaluation of a recommender app for apps for the treatment of depression and anxiety: An analysis of longitudinal user engagement. J Am Med Inform Assoc. 2018;25(8):955-62. doi: 10.1093/jamia/ocy023. [PubMed: 29659857]. [PubMed Central: PMC6077782].
  • 51. Mohr DC, Tomasino KN, Lattie EG, Palac HL, Kwasny MJ, Weingardt K, et al. IntelliCare: An eclectic, skills-based app suite for the treatment of depression and anxiety. J Med Internet Res. 2017;19(1). e10. doi: 10.2196/jmir.6645. [PubMed: 28057609]. [PubMed Central: PMC5247623].
Creative Commons License Except where otherwise noted, this work is licensed under Creative Commons Attribution Non Commercial 4.0 International License .

Search Relations:



Create Citiation Alert
via Google Reader

Readers' Comments