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 critical developmental period associated with increased emotional vulnerability, academic pressure, and exposure to mental health risks. In Thailand, recent evidence indicates rising levels of stress, anxiety, and reduced psychological well-being among young people. School-based preventive interventions that strengthen internal coping skills are therefore a public health priority. While mindfulness-based interventions have demonstrated benefits in Western contexts, there is limited evidence regarding compassion-focused mindfulness programs that are culturally adapted for Thai adolescents.
The CMR intervention is a structured, manualized behavioral program that integrates mindfulness, self-compassion, and resilience-building skills. The program was originally developed by MindfulnessUK and subsequently adapted for the Thai adolescent context through a co-production process involving students, teachers, and school counselors. Cultural adaptations focused on language use, contextual relevance of examples, and alignment with the Thai educational environment, while maintaining fidelity to the core theoretical framework.
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. Home practice activities are encouraged between sessions to support skill integration into daily life.
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.
Overall, this feasibility study will generate critical information on the practicality, acceptability, and preliminary impact of the Compassionate Mindful Resilience program for adolescents in Thailand. The findings will guide the development of a future definitive trial and contribute to the evidence base for culturally appropriate, school-based mental health promotion interventions in low- and middle-income settings.
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.
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.
Single group
Four-Week Compassionate Mindful Resilience (CMR) Intervention
BehavioralA group-based behavioral intervention delivered over four weekly 90-minute sessions (6 hours total contact time). The program integrates mindfulness, self-compassion, and resilience training through eight modules. Technical components include: * Mindfulness \& Awareness: Breathing practices, body scans, and "being mode" vs "doing mode". * Emotional Intelligence: Application of the RAIN (Recognise, Acknowledge, Investigate, Nurture), HEARTS, and STOP (Stop, Take a breath, Observe, Proceed) models. * Resilience Building: Cognitive reappraisal, affectionate breathing, and social connection strategies. * Impulse Management: "Urge surfing" meditations and mindful decision-making to support substance-use prevention. * Home Practice: Daily 10-minute meditation, journaling, and mindful movement.
Recruitment Rate
This measure represents the proportion of eligible students who provide informed consent. It is measured as a percentage, calculated as: (Number of Consented Participants / Number of Eligible Students Invited) x 100. The target for success is a recruitment rate of 70% or higher.
Retention Rate
This measure represents the proportion of enrolled participants who complete the study and provide post-intervention data. It is measured as a percentage, calculated as: (Number of Participants Providing Post-Intervention Data / Number Enrolled) x 100. The target for success is a retention rate of 80% or higher.
Session Attendance
This measure tracks participant adherence based on the total number of sessions attended. It is calculated as the mean number of sessions attended out of the 4 scheduled sessions. Scores range from 0 to 4 sessions, where a higher number indicates greater attendance.
Change in Mindfulness Scores (Srithanya Sati Scale)
This outcome assesses the change in dispositional mindfulness using the Srithanya Sati Scale, an 11-item self-report questionnaire. The total score is calculated as the sum of all 11 items. The minimum score is 11 and the maximum score is 44. Higher scores indicate greater levels of mindfulness. The "Change" is calculated by subtracting the Baseline (Week 0) total score from the Post-intervention (Week 4) total score.
Change in Self-Compassion Scores (SCS-Y Thai version)
This outcome assesses the change in how youth treat themselves with kindness during difficult times using a 17-item scale. Each item is rated on a 5-point scale. The total score is calculated as the mean of all 17 items (after reverse-scoring negative items). The minimum score is 1.0 and the maximum score is 5.0. Higher scores indicate higher levels of self-compassion. The "Change" is calculated by subtracting the Baseline (Week 0) mean score from the Post-intervention (Week 4) mean score.
Change in Resilience Scores (CD-RISC-10)
This outcome assesses the change in psychological resilience using a 10-item scale. Each item is rated on a 5-point scale (0-4). The total score is calculated as the sum of all 10 items. The minimum score is 0 and the maximum score is 40. Higher scores represent greater psychological resilience. The "Change" is calculated by subtracting the Baseline (Week 0) total score from the Post-intervention (Week 4) total score.
Change in Subjective Well-being (WHO-5 Well-being Index)
This outcome measures the change in subjective psychological well-being using a 5-item scale. The total score is calculated as the raw sum of the 5 items. The minimum score is 0 and the maximum score is 25. Higher scores indicate better subjective well-being. The "Change" is calculated by subtracting the Baseline (Week 0) raw score from the Post-intervention (Week 4) raw score.
Qualitative Assessment of Intervention Acceptability: Focus Groups
Semi-structured post-intervention focus groups will be conducted to explore participants' perceptions of the programme's relevance, delivery format, and overall value. Data will be analyzed using thematic analysis to identify recurring themes regarding shifts in emotional regulation skills, stress management, and the real-world application of CMR strategies. Unit of Measure: Qualitative themes.
Qualitative Exploration: Barriers to Engagement (Low-Attendance Interviews)
Semi-structured interviews with participants attending \<3 sessions to identify structural or personal barriers. Unit of Measure: Qualitative themes identified through thematic analysis.
Qualitative Assessment of Substance Use Coping and Behaviors
This outcome explores participants' perceptions of changes in their substance use behaviors and their ability to apply Compassionate Mindful Resilience (CMR) strategies to cope with peer or family substance exposure. Data will be collected through semi-structured focus groups and interviews (as outlined in the Focus Group Guide). Analysis will focus on themes such as the application of "urge surfing" and emotional regulation in high-risk situations. Unit of Measure: Qualitative themes identified through thematic analysis.
Qualitative Assessment of Intervention Acceptability: Exit Interviews
Brief individual exit interviews will be conducted post-intervention to gather specific feedback on the participant's personal experience with the intervention. The analysis will focus on identifying individual perspectives regarding the intervention's feasibility, perceived impact on daily life, and suggestions for program improvement. Unit of Measure: Qualitative themes identified through thematic analysis.
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