Efficacy of a Gamified Blended Mindfulness Program to Reduce Burnout, Stress, and Anxiety in Nursing Students: A Randomized Controlled Trial

Efficacy of a Gamified Blended Mindfulness Program to Reduce Burnout, Stress, and Anxiety in Nursing Students

The primary purpose of this randomized controlled trial is to evaluate the efficacy of a 12-week gamified blended mindfulness intervention in reducing academic burnout, perceived stress, and anxiety among first-year nursing students. Nursing students frequently face high academic and clinical demands that deplete their psychological resources, leading to high levels of stress and emotional exhaustion during their training. While mindfulness interventions can mitigate these negative effects, adherence to standard digital programs often remains a challenge.

To address this, the study investigates the impact of incorporating gamification elements into a mindfulness program. Participants are randomly assigned to one of three groups: a minimal-treatment control group, a standard blended mindfulness group, or a gamified blended mindfulness group. The intervention spans 12 weeks and consists of 24 guided meditation sessions (16 online and 8 in-person).

The central hypothesis is that the gamified architecture will act as a behavioral reinforcement mechanism, improving student adherence to the program. Consequently, researchers hypothesize that participants in the gamified group will exhibit significantly lower post-intervention levels of emotional exhaustion, perceived stress, and anxiety compared to those in both the standard mindfulness intervention and the control group.

Study Overview

• Status: Completed
• Conditions: Anxiety; Burnout Syndrome; Psychological Stress, Anxiety, and Depression Associated With Academic Pressure
• Intervention / Treatment: Behavioral: Psychoeducation and Free App Recommendation; Behavioral: Standard Blended Mindfulness Program; Behavioral: Gamified Blended Mindfulness Program

• Study Type: Interventional
• Enrollment (Actual): 127
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Spain
  • Ceuta
    • Ceuta, Ceuta, Spain, 51005
      • Ceuta

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Enrolled as a first-year undergraduate nursing student at the Ceuta Campus of the University of Granada (Spain).
• Aged 18 years or older.
• Voluntarily provide informed consent prior to participation.

Exclusion Criteria:

• Pre-existing clinical diagnosis of anxiety or depressive disorders.
• Current use of prescribed psychotropic medications (concurrent psychopharmacological treatment).

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Control Group; Participants in this control cohort (CG) receive a single-session minimal psychoeducational intervention rather than a structured multi-week mindfulness program.	Behavioral: Psychoeducation and Free App Recommendation; Participants receive baseline information regarding the definition and health effects of meditation, alongside advice on how to independently practice it using free sessions available on a mobile application.
Active Comparator: Intervention Group 1; Participants in this group (IG1) receive a structured 12-week blended mindfulness-based stress-reduction program without any gamification elements.	Behavioral: Standard Blended Mindfulness Program; A 12-week program consisting of 24 guided meditation sessions (16 online and 8 in-person). Sessions are led by a mindfulness expert, last between 15 and 30 minutes, and focus on breathing techniques and guided meditation practices.
Experimental: Intervention Group 2; articipants in this group (IG2) receive the standard 12-week blended mindfulness program enhanced with a structured gamified architecture designed to increase adherence and engagement.	Behavioral: Gamified Blended Mindfulness Program; A 12-week, 24-session blended mindfulness program (15-30 minutes per session) integrated with gamification elements. Participants earn one point per completed session to enter a draw for a premium nursing training app subscription. The system also provides weekly automated score updates and a final anonymized leaderboard.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Academic Burnout: Emotional Exhaustion	Assessed using the Emotional Exhaustion subscale of the Maslach Burnout Inventory-Student Survey (MBI-SS). This subscale consists of 5 items rated on a 7-point frequency scale ranging from 0 (never) to 6 (daily). Higher scores indicate higher levels of emotional exhaustion.	Baseline (T0) and immediately following the 12-week intervention period (T1).

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Academic Burnout: Cynicism	Assessed using the Cynicism subscale of the Maslach Burnout Inventory-Student Survey (MBI-SS). It consists of 4 items rated on a 7-point scale (0 = never to 6 = daily). Higher scores indicate higher levels of cynicism toward studies.	Baseline (T0) and immediately following the 12-week intervention period (T1).
Academic Burnout: Academic Efficacy	ssessed using the Academic Efficacy subscale of the Maslach Burnout Inventory-Student Survey (MBI-SS). It consists of 6 items rated on a 7-point scale (0 = never to 6 = daily). Higher scores indicate higher levels of academic efficacy (considered a protective factor against burnout).	Baseline (T0) and immediately following the 12-week intervention period (T1).
Perceived Stress	Assessed using the 10-item Perceived Stress Scale (PSS). Higher total scores indicate higher levels of perceived stress.	Baseline (T0) and immediately following the 12-week intervention period (T1).
Anxiety	Assessed using the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS). This subscale consists of 7 items, each scored from 0 to 3, with subscale totals ranging from 0 to 21. Higher scores indicate higher levels of anxiety symptomatology.	Baseline (T0) and immediately following the 12-week intervention period (T1).
Depression	Assessed using the depression subscale of the Hospital Anxiety and Depression Scale (HADS). This subscale consists of 7 items, each scored from 0 to 3, with subscale totals ranging from 0 to 21. Higher scores indicate higher levels of depressive symptomatology.	Baseline (T0) and immediately following the 12-week intervention period (T1).
Student Engagement	Evaluated using the 9-item short version of the Utrecht Work Engagement Scale for Students (UWES-9). All items use a 0-6 frequency scale. Higher scores indicate higher levels of academic work engagement.	Baseline (T0) and immediately following the 12-week intervention period (T1).
Dispositional Mindfulness	Measured by the Mindful Attention Awareness Scale (MAAS). This is a 15-item instrument designed to assess core characteristics of dispositional mindfulness, specifically open awareness and attention to the present moment. Higher scores denote greater mindfulness.	Baseline (T0) and immediately following the 12-week intervention period (T1).

Collaborators and Investigators

• Sponsor: Universidad de Granada

Study record dates

Study Major Dates

• Study Start (Actual): February 1, 2025
• Primary Completion (Actual): September 5, 2025
• Study Completion (Actual): March 1, 2026

Study Registration Dates

• First Submitted: July 7, 2026
• First Submitted That Met QC Criteria: July 7, 2026
• First Posted (Actual): July 13, 2026

Study Record Updates

• Last Update Posted (Actual): July 13, 2026
• Last Update Submitted That Met QC Criteria: July 7, 2026
• Last Verified: July 1, 2025

More Information

Terms related to this study

• Keywords: Nursing Students; Mental Health Promotion
• Additional Relevant MeSH Terms: Mental Disorders; Behavioral Symptoms; Behavior; Burnout, Psychological; Anxiety Disorders; Stress, Psychological
• Other Study ID Numbers: 4638/CEIH/2024

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No