Feasibility of a Compassionate Mindful Resilience Programme for Thai Secondary School Students

Feasibility Study of a Compassionate Mindful Resilience (CMR) Intervention to Improve Mental Health Well-being Outcomes Among Youth in Thailand

This study is a single-arm feasibility trial designed to evaluate the implementation, acceptability, and preliminary effects of a culturally adapted Compassionate Mindful Resilience (CMR) intervention among adolescents in Thailand. The study is conducted in a secondary school setting and targets students aged 16 to 18 years.

Adolescence is a period of heightened emotional vulnerability and academic pressure. In Thailand, rising levels of stress and anxiety among young people make school-based preventive interventions a public health priority. While mindfulness-based interventions have shown benefits in Western contexts, evidence on compassion-focused programmes culturally adapted for Thai adolescents remains limited.

All participants enrolled in the study will receive the CMR intervention. The program consists of four weekly group sessions, each lasting approximately 90 minutes, delivered after school hours to minimize disruption to academic activities. Sessions include guided mindfulness practices, group discussions, and practical exercises aimed at increasing present-moment awareness, cultivating self-compassion, improving emotional regulation, and strengthening resilience.

The primary objective of the study is to assess feasibility. Feasibility outcomes include recruitment rate, retention rate, session attendance, intervention fidelity, and participant acceptability. These indicators will inform whether the intervention can be delivered as planned in a Thai school setting and whether progression to a larger-scale trial is justified.

Secondary objectives explore preliminary changes in mental health-related outcomes. These include mindfulness, self-compassion, resilience, and overall well-being, measured using validated Thai-language instruments before and after completion of the intervention. Although the study is not powered to test effectiveness, these data will provide estimates of variability and potential effect sizes to inform the design of a future randomized controlled trial.

Participant safety is addressed through a predefined distress protocol. A school counselor is available during all intervention sessions to provide immediate support if participants experience emotional distress. Ethical approval has been obtained from the relevant institutional ethics committee, and written assent from participants, along with parental or guardian consent, is required prior to enrollment.

Detailed Description Study Framework and Theoretical Basis This feasibility study constitutes Phase 3 of a comprehensive research project designed to address the rising rates of stress, anxiety, and substance use risks among Thai adolescents. The intervention utilizes the Compassionate Mindful Resilience (CMR) programme, which integrates secular mindfulness with compassion-based approaches to enhance cognitive resilience and emotional regulation. While MBIs have shown efficacy in adult populations, this study evaluates a culturally adapted version specifically for the Thai secondary school context, where collectivist values and Buddhist traditions may influence implementation.

Trial Design and Procedural Workflow The study employs a single-arm, pre-post feasibility design. This approach is selected to evaluate implementation parameters and participant engagement prior to committing to a full-scale randomized controlled trial (RCT).

• Intervention Delivery: The CMR programme consists of eight modules delivered over four weekly 90-minute group sessions. Sessions are conducted after school hours (16:00-17:30) to minimize academic disruption and mitigate potential stigma associated with mental health initiatives.
• Fidelity and Facilitation: The programme is delivered by a PhD candidate trained in CMR under academic supervision from Queen's University Belfast. Delivery fidelity is maintained through adherence checklists, session logs, and standardized recap materials for participants who miss sessions.
• Stratified Sampling: To ensure developmental diversity, the study utilizes stratified random sampling across Grades 10, 11, and 12, aimed at achieving a balanced representation from the student population.

Technical Application of Participation Models

The research process incorporates established participatory frameworks to assess the depth of stakeholder engagement:

• Hart's Ladder of Children's Participation: Evaluates whether youth involvement moves beyond tokenism to "Consulted but Informed" and "Adult-Initiated Shared Decisions"
• Arnstein's Ladder of Participation: Used to track the transition toward "Partnership" and "Delegated Power" during the co-production and evaluation phases.

Statistical Analysis Plan

The analysis focuses on determining the feasibility of the protocol for future larger-scale implementation:

• Feasibility Metrics: Recruitment rates, consent rates, session attendance, and participant retention will be analyzed using descriptive statistics.
• Preliminary Effectiveness: Quantitative changes in psychosocial outcomes will be assessed using paired t-tests where distributional assumptions are met, and Wilcoxon signed-rank tests where they are not, following assessment of normality. Effect sizes will be calculated using the metric appropriate to the test applied (Cohen's d for parametric comparisons; r = Z/√N for non-parametric comparisons) to estimate the magnitude of change and inform future power calculations.
• Exposure Analysis: An exploratory subset analysis will be reported for participants who attend at least 75% of the sessions (three out of four) to investigate dose-response relationships.

Qualitative Process Evaluation To complement quantitative data, a process evaluation will explore the acceptability and contextual relevance of the programme.

• Thematic Analysis: Post-intervention focus groups and brief exit interviews will be audio-recorded, transcribed verbatim in Thai, and translated into English.
• Analytical Rigor: Qualitative data will be managed using NVivo software and analyzed via Reflexive Thematic Analysis. A second coder will review a subset of transcripts to ensure credibility and an audit trail will be maintained.

Data Security and Transfer Protocols

• Pseudonymization: All data are de-identified at the source using study codes; identifiable information remains in Thailand and is not transferred.
• Electronic Management: Scanned documents and audio transcripts are stored on encrypted, password-protected systems with role-based access.
• Cross-Border Transfer: Pseudonymized data transferred for analysis utilize encrypted channels in compliance with university governance and data protection legislation.

Inclusion Criteria:

• Adolescents between 16 and 18 years of age at the time of enrollment.
• Current students in Grades 10 to 12 (Mathayom 4-6) at a Thai Secondary School in Northeastern Thailand.
• Willingness to engage in a mindfulness-based intervention programme.
• Ability to understand and communicate in the Thai language.
• Ability to provide informed consent (dual consent from both the student and a parent/legal guardian is required).

Exclusion Criteria:

• Significant mental health conditions that may impede participation, such as schizophrenia, bipolar I disorder, or severe major depression with psychotic features.
• Cognitive impairments that prevent comprehension of the mindfulness intervention.
• Concurrent involvement in another psychological intervention that might confound the study results.