A Mindfulness Program Addressing Sleep Quality and Stress: Transition to a Telehealth Format for Higher Education Students During COVID-19





Life stress, Occupational therapy, Sleep habits, Students, Telehealth


Many higher education students report sleep problems, further exemplified along with stress at the onset of the COVID-19 pandemic. Promising evidence supports the use of mindfulness programming, although synchronous telehealth sessions have not been adequately examined. This exploratory eight-session telehealth mindfulness program utilized a pretest-posttest quantitative design to examine changes in sleep quality and perceived stress for 16 higher education students enrolled at a health professions-focused university. Sleep quality changes were measured using the Pittsburgh Sleep Quality Index (Z=-3.234, p=0.0012, d=-0.808) and perceived stress with the Perceived Stress Scale (Z=-3.102, p=0.0019, d=-0.776), both of which were significant. The results suggest that synchronous mindfulness programming delivered via telehealth has the potential to improve sleep quality and perceived stress in students, however, future studies should consider the use of objective measurements of sleep duration and quality, and a control group.


Author Biographies

Sara Benham, Moravian University, Department of Rehabilitation Sciences, Bethlehem, PA USA

Sara has worked for over 15 years as an Occupational Therapist in inpatient rehabilitation settings and she is an Assistant Professor at Moravian University. Her specialization is in assistive technology and she holds an advanced certification as an Assistive Technology Practitioner (ATP) from the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA). Sara specializes in stroke neuro-rehabilitation through practice, research, and educational outreach.  Sara directs her research in pursuit of how technology may enable clients to increase participation in meaningful occupations. She has peer-reviewed publications on a variety of technological enhancements for performance across the lifespan, including telerehabilitation, virtual reality, electronic tablet technologies, aids for community mobility, 3D printing, and has published a textbook chapter on applications of technology for pediatrics. Sara has presented her work nationally and at the state level for over 25 presentations. In regards to national leadership, Sara serves as the Technology Coordinator for the American Association of Occupational Therapy (AOTA) Rehabilitation & Disability Special Interest Section (SIS), as a reviewer for the American Journal of Occupational Therapy, and serves on the Executive Committee for the Technology in Rehabilitation Networking Group of the American Congress of Rehabilitation Medicine (ACRM). 

Nabila Enam, University of the Sciences, Department of Occupational Therapy, Philadelphia, PA, USA

Nabila worked as a full-time clinician for many years prior to transitioning to academia. Most of her work has been with long-term care in community re-entry with adult traumatic brain injury population. Her clinical experiences also extended to inpatient and acute care facilities. She has served as a Senior Occupational Therapist. She continues to work as a per-diem therapist at a local hospital. Her research aims are to examine sleep and wellness across the lifespan.

Samanvita Ivaturi, Hackensack Meridian Health Nursing and Rehabilitation, Shrewsbury, NJ, USA

Samanvita graduated with her DrOT in 2021 and now practices as an Occupational Therapist for Hackensack Meridian Health Nursing and Rehabilitation. 


Ahmad, F., El Morr, C., Ritvo, P., Othman, N., & Moineddin, R. (2020). An eight-week, web-based, mindfulness virtual community intervention for students’ mental health: Randomized control trial. JMIR Mental Health, 7(2), e15520. https://doi.org/10.2196/15520

Amaral, A. P., Soares, M. J., Pinto, A. M., Pereira, A. T., Madeira, N., Bos, S. C., Marques, M., Roque C., & Macedo, A. Sleep difficulties in college students: The role of stress, affect and cognitive processes. Psychiatry Research, 260, 331-337. https://doi.org/10.1016/j.psychres.2017.11.072

American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74(Suppl. 2), 7412410010. https://doi.org/10.5014/ajot.2020.74S2001

Antonson, C., Thorsén, F., Sundquist, J., & Sundquist, K. (2018). Upper secondary school students’ compliance with two Internet-based self-help programmes: A randomised controlled trial. European Child & Adolescent Psychiatry, 27(2), 191-200. https://doi.org/10.1007/s00787-017-1035-6

Backhaus, J., Junghanns, K., Broocks, A., Riemann, D., & Hohagen, F. (2002). Test-retest reliability and validity of the Pittsburgh Sleep Quality Index in primary insomnia. Journal of Psychosomatic Research, 53(3), 737-740. https://doi.org/10.1016/S0022-3999(02)00330-6

Barnhofer, T., Crane, C., Hargus, E., Amarasinghe, M., Winder, R., & Williams, M. G. (2009). Mindfulness-based cognitive therapy as a treatment for chronic depression: A preliminary study. Behavior Research and Therapy, 47(5), 366-373. https://doi.org/10.1016/j.brat.2009.01.019

Becker S. P., Jarret, M. A., Luebbe, A. M., Garner, A. A., Burns, L., & Kofler, M. J. (2018). Sleep in a large, multi-university sample of college students: sleep problem prevalence, sex differences, and mental health correlates. Sleep Health, 4(2), 174-181. https://doi.org/10.1016/j.sleh.2018.01.001

Black, D. S., O’Reilly, G. A., & Olmstead, R. (2015). Mindfulness meditation and improvement in sleep quality and daytime impairment among older adults with sleep disturbances: A randomized clinical trial. JAMA Internal Medicine, 175(4), 494-501. https://doi.org/10.1001/jamainternmed.2014.8081

Benham, G. (2019). The Sleep Health Index: Correlations with standardized stress and sleep measures in a predominantly Hispanic college student population. Sleep Health, 5(6), 587-591. https://doi.org/10.1016/j.sleh.2019.07.007

Benham, G. (2021). Stress and sleep in college students prior to and during the COVID‐19 pandemic. Stress and Health, 37(3), 504-515. https://doi.org/10.1002/smi.3016

Buysse, D. J., Reynolds, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index (PSQI): A new instrument for psychiatric research and practice. Psychiatry Research, 28(2), 193-213. https://doi.org/10.1016/0165-1781(89)90047-4

Cason J., Hartmann, K., Jacobs, K., & Richmond, T. (2013). Telehealth. American Journal of Occupational Therapy, 67(6), S69-S90. https://doi.org/10.5014/ajot.2013.67S69

Cavanagh, K., Churchard, A., O’Hanlon, P., Mundy, T., Votolato, P., Jones, F., ... Strauss, C. (2018). A randomised controlled trial of a brief online mindfulness-based intervention in a non-clinical population: Replication and extension. Mindfulness, 9(4), 1191-1205. https://doi.org/10.1007/s12671-017-0856-1

Center for Disease Control and Prevention. (2017, May 2). Sleep and sleep disorders: Data and statistics. https://www.cdc.gov/sleep/data_statistics.html

Cohen, J. (1998). Statistical Power Analysis for the Behavioral Sciences (2nd ed.). Hillsdale, NJ: Erlbaum.

Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24(4), 385-396. https://doi.org/10.2307/2136404

Cohen, S. & Williamson, G. M. (1988). Perceived stress in a probability sample of the United States. In S. Spacapan & S. Oskamp (Eds.), The Claremont Symposium on Applied Social Psychology. The social psychology of health (p. 31–67). Sage Publications, Inc.

Cuncic, A. (2020, August 28). A free mindfulness meditation track for social anxiety disorder. Very well mind. https://www.verywellmind.com/a-basic-mindfulness-meditation-script-for-sad-3024820

Dietch, J. R., Taylor, D. J., Sethi, K., Kelly, K., Bramoweth, A. D., & Roane, B. M., (2016). Psychometric evaluation of the PSQI in U.S. college students. Journal of Clinical Sleep Medicine, 12(8), 1121–1129. https://doi.org/10.5664/jcsm.6050

Du, C., Zan, M. C. H., Cho, M. J., Fenton, J. I., Hsiao, P. Y., Hsiao, R., Keaver, L., Lai, C-C., Lee, H., Ludy, M-J., Shen, W., Swee, W.C.S., Thrivikraman, J., Tseng, K-W., Tseng, W-C., Tucker, R.M. (2020). Increased Resilience Weakens the Relationship between Perceived Stress and Anxiety on Sleep Quality: A Moderated Mediation Analysis of Higher Education Students from 7 Countries. Clocks & Sleep, 2(3), 334–353. http://dx.doi.org/10.3390/clockssleep2030025

Eberth, J., & Sedlmeier, P. (2012). The effects of mindfulness meditation: A meta-analysis. Mindfulness, 3(3), 174–189. https://doi.org/10.1007/s12671-012-0101-x

Eskildsen, A., Dalgaard, V. L., Nielsen, K. J., Andersen, J. H., Zachariae, R., Olsen, L. R., Jorgensen, A., & Christiansen, D. H. (2015). Cross-cultural adaptation and validation of the Danish consensus version of the 10-item Perceived Stress Scale. Scandinavian Journal of Work, Environment, and Health, 41(5), 486-490. https://doi.org/10.5271/sjweh.3510

Friedrich, A., & Schlarb, A. A. (2017). Let’s talk about sleep: A systematic review of psychological interventions to improve sleep in college students. Journal of Sleep Research, 27(1), 4-22. https://doi.org/10.1111/jsr.12568

Garret, R., Liu, S., & Young, S. D. (2017). A longitudinal analysis of stress among incoming college freshmen. Journal of American College Health, 65(5), 331-338. http://doi.org/10.1080/07448481.2017.1312413x

Greeson, J. M., Juber, M. K., Maytan, M., James, K., & Rogers, H. (2014). A randomized control trial of Koru: A mindfulness program for college students and other emerging adults. Journal of American College Health, 62(4), 222-233. https://doi.org/10.1080/07448481.2014.887571

Hirshkowitz, M., Whiton, K., Albert, S.M., Alessi, C., Bruni, O., DonCarlos L., Hazen, N., Herman, J., Hillard, P. J. A., Kattz, E. S., Kheirandish-Gozal, L., Neubauer, D. N., O’Donnell, A. E., Ohayon, M., Peever, J., Rawding, R., Sachdeva, R. C., Setters, B., Vitiello, M. V., Ware, J. C. (2015). National Sleep Foundation's updated sleep duration recommendations: final report. Sleep Health, 1(4), 233-243. https://doi.org/10.1016/j.sleh.2015.10.004

Hershner S. (2015). Is sleep a luxury that college students cannot afford? Sleep Health. 1(1), 13-14. https://doi.org/10.1016/j.sleh.2014.12.006

Ho, E. C. M. & Siu, A, M. H. (2018). Occupational therapy practice in sleep management: A review of conceptual models and research evidence. Occupational Therapy International, 2018. https://doi.org/10.1155/2018/8637498

Huberty J., Green, J., Glissmann, C., Larkey, L., Puzia, M., & Lee, C. (2019). Efficacy of the mindfulness meditation mobile app “Calm” to reduce stress among college students: Randomized controlled trial. JMIR: mHealth and uHealth, 7(6). https://doi.org/10.2196/14273

Janssen, M., Heerkens, Y., Kuijer, W., Van der Heidjen, B., & Engels, J. (2018). Effects of mindfulness-based stress reduction on employees’ mental health: A systematic review. Plos One, 13(1). https://doi.org/10.1371/journal.pone.0191332

Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present, and future. Clinical Psychology: Science and Practice, 10(2), 144–156. https://doi.org/10.1093/clipsy.bpg016

Lee, E. H. (2012). Review of the psychometric evidence of the Perceived Stress Scale. Asian Nursing Research, 6(4), 121-127. https://doi.org/10.1016/j.anr.2012.08.004

Leland, N. E., Marcione, N., Schepens Niemiec, S. L., Kelkar, K., Fogelberg, D. (2014). What is occupational therapy’s role in addressing sleep problems among older adults. OTJR: Occupation, Participation and Health, 34(3), 141-149. https://doi.org/10.3928/15394492-20140513-01

Lemma, S., Gelaye, B., Berhane, Y., Worku, A., & Williams, M. A. (2012). Sleep quality and its psychological correlates among university students in Ethiopia: A cross-sectional study. BMC Psychiatry, 12(1), 1-7. https://doi.org/10.1186/1471-244X-12-237

Lemma S., Berhane, Y., Worke, A., Gelaye, B., & Williams, M. A. (2015). Good quality sleep is associated with better academic performance among university students in Ethiopia. Sleep and Breathing, 18(2), 257-263. https://doi.org/10.1007/s11325-013-0874-8

Li, C., Kee, Y. H., & Lam, L. S. (2018). Effect of brief mindfulness induction on university athletes’ sleep quality following night training. Frontiers in Psychology, 9(508). https://doi.org/10.3389/fpsyg.2018.00508

Liu, Y., Croft, J. B., Wheaton, A. G., Perry, G. S., Chapman, D. P., Strine, T. W., McKnight-Eily, L. R., & Presley-Cantrell, L. (2013). Association between perceived insufficient sleep, frequent mental distress, obesity and chronic diseases among US adults, 2009 behavioral risk factor surveillance system. BMC Public Health, 13(84). https://doi.org/10.1186/1471-2458-13-84

Lund, H. G., Reider, B. D., Whiting, A. B., & Prichard J. R. (2010). Sleep patterns and predictors of disturbed sleep in a large population of college students. Journal of Adolescent Health, 46(2), 124-132. https://doi.org/10.1016/j.jadohealth.2009.06.016

Mak, W. W., Chio, F. H., Chan, A. T., Lui, W. W., & Wu, E. K. (2017). The efficacy of internet-based mindfulness training and cognitive-behavioral training with telephone support in the enhancement of mental health among college students and young working adults: Randomized controlled trial. Journal of Medical Internet Research, 19(3), e84. https://doi.org/10.2196/jmir.6737

Mirghani, H. O., Mohammed, O. S., Almurtadha, Y. M., & Ahmed, M. S. (2015). Good sleep quality is associated with better academic performance among Sudanese medical students. BMC Reseach Notes 8, 706. https://doi.org/10.1186/s13104-015-1712-9

Shreffler, J., Petrey, J., & Huecker, M. (2020). The impact of COVID-19 on healthcare worker wellness: A scoping review. The Western Journal of Emergency Medicine, 21(5), 1059–1066. https://doi.org/10.5811/westjem.2020.7.48684

Singh, J. & Singh, J. (2020). COVID-19 and its impact on society. Electronic Research Journal of Social Sciences and Humanities, 2(1), 168-172. https://ssrn.com/abstract=3567837

Spadaro, K. C. & Hunker, D. F. (2016). Exploring the effects of an online asynchronous mindfulness meditation intervention with nursing students on stress, mood, and cognition: A descriptive study. Nurse Education Today, 39, 163-169. http://dx.doi.org/10.1016/j.nedt.2016.02.006

Tester, N. J. & Foss, J. J. (2018). Sleep as an occupational need. American Journal of Occupational Therapy, 72(1), 7201347010. https://doi.org/10.5014/ajot.2018.020651

The Mindful Movement. (2018, March 26). Relax into this present moment: A 15-minute guided mindfulness meditation [Video]. YouTube. https://www.youtube.com/watch?v=GGn1Vhdv0jw&ab_channel=TheMindfulMovement

Wang, X., Hegde, S., Son, C., Keller, B., Smith, A., & Sasangohar, F. (2020). Investigating mental health of US college students during the COVID-19 pandemic: Cross-sectional survey study. Journal of Medical Internet Research, 22(9), e22817. https://doi.org/10.2196/22817

Yilmaz, D., Tanrikulu, F., & Dikmen, Y. (2017). Research on sleep quality and the factors affecting the sleep quality of the nursing students. Current Health Sciences Journal, 43(1), 20. https://doi.org/10.12865/CHSJ.43.01.03




How to Cite

Benham, S., Enam, N., & Ivaturi, S. (2022). A Mindfulness Program Addressing Sleep Quality and Stress: Transition to a Telehealth Format for Higher Education Students During COVID-19. International Journal of Telerehabilitation, 14(1). https://doi.org/10.5195/ijt.2022.6439



Clinical Practice - COVID 19