In this Assignment, you will identify an issue or opportunity for change within your healthcare organization and propose an idea for a change in practice supported by an EBP approach

Critical Appraisal Tool Worksheet

Critical Appraisal Tool Worksheet Template

Evaluation Table

Use this document to complete the evaluation table requirement of the Module 4 Assessment, Evidence-Based Project, Part 3A: Critical Appraisal of Research

Full APA formatted citation of selected article.	Article #1	Article #2	Article #3	Article #4
	Fumero, A., Peñate, W., Oyanadel, C., & Porter, B. (2020). The effectiveness of mindfulness-based interventions on anxiety disorders. A systematic meta-review.European Journal of Investigation in Health, Psychology and Education,10(3), 704–719. https://doi.org/10.3390/ejihpe10030052	Navarro-Haro, M. V., Modrego-Alarcón, M., Hoffman, H. G., López-Montoyo, A., Navarro-Gil, M., Montero-Marin, J., García-Palacios, A., Borao, L., & García-Campayo, J. (2019). Evaluation of a Mindfulness-Based Intervention With and Without Virtual Reality Dialectical Behavior Therapy® Mindfulness Skills Training for the Treatment of Generalized Anxiety Disorder in Primary Care: A Pilot Study.Frontiers in Psychology,10(55). https://doi.org/10.3389/fpsyg.2019.00055	Reangsing, C., Trakooltorwong, P., Maneekunwong, K., Thepsaw, J., & Oerther, S. (2023). Effects of online mindfulness-based interventions (mbis) on anxiety symptoms in adults: A systematic review and meta-analysis.BMC Complementary Medicine and Therapies,23(1). https://doi.org/10.1186/s12906-023-04102-9 12:55	Zhou, X., Guo, J., Lu, G., Chen, C., Xie, Z., Liu, J., & Zhang, C. (2020). Effects of mindfulness-based stress reduction on anxiety symptoms in young people: A systematic review and meta-analysis.Psychiatry Research,289, 113002. https://doi.org/10.1016/j.psychres.2020.113002
Evidence Level * (I, II, or III)	III	II	III	I
Conceptual Framework Describe the theoretical basis for the study ( If there is not one mentioned in the article, say that here).**	The study explores the utilization of mindfulness-based interventions to alleviate anxiety disorders, borrowing from the Buddhist mindfulness body principles and emotional management strategies	It studies mindfulness-based interventions, with and without virtual reality, in treating Generalized Anxiety Disorder in primary care, with a focus to improve treatment effectiveness and address specific challenges.	The theoretical framework that online mindfulness-based interventions (MBIs), which promote nonjudgmental awareness and self-regulation of thoughts and emotions, can effectively reduce anxiety symptoms in adults, with a focus on the accessibility and cost-effectiveness of online delivery.	The study is based on the assumption that anxiety is a prevalent and significant concern for young people which calls for effective interventions to address it.
Design/Method Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).	A systematic meta-review of existing literature reviews and meta-analyses. The inclusion criteria entailed narrative reviews, systematic reviews, and meta-analyses published in peer-reviewed journals	39 participants diagnosed with GAD were assigned to either Mindfulness-Based Intervention (MBI) group or an MBI with Virtual Reality Dialectical Behavior Therapy® (VR DBT®). Assessments were carried before and after the intervention and standardized procedure used to evaluate effectiveness	Systematic review and meta-analysis were used. Studies using RCT or quasi experimental design were adopted. Exclusion criteria entails studies that combine MBI with other therapies	systematic review and meta-analysis design. A number of key words were used in selecting studies
Sample/Setting The number and characteristics of patients, attrition rate, etc.	No sample as it was a systematic review	Aged between 18 and 65 years, diagnosed with GAD, speak and understands Spanish Exclusion criteria involved those pregnant, those diagnosed with OCD or other anxiety disorder and those receiving psychological treatment. Total sampling universe was 114 ,72 was excluded and 42 were eligible.2 lost before treatment initiation, therefore 39 were left.	Out of 4846 studies identified only 26 met the needed criteria of inclusion	Out of 237 studies 65 were excluded but 42 were included
Major Variables Studied List and define dependent and independent variables	dependent variables was anxiety symptoms while independent variables was Mindfulness-Based Interventions (MBIs)	Dependent Variables: GAD Symptoms Depression Emotion Regulation Mindfulness Interoceptive Awareness Independent Variables: Treatment Group Additional Demographic Variables	Dependent Variable: Anxiety Symptoms Independent Variables: Online Mindfulness-Based Interventions (MBIs), Control Group	Dependent Variable: Anxiety Symptoms Independent Variable: Mindfulness-Based Stress Reduction (MBSR) Control Variables: Control Conditions
Measurement Identify primary statistics used to answer clinical questions ( You need to list the actual tests done).	Standardized Mean Difference (SMD) or Cohen's d was used to measure change in symptoms after the intervention administration.	1. Descriptive Statistics 2. Mixed Regression Models 3. t-tests 4. Correlation Analysis 5. ANCOVA (Analysis of Covariance) 6. Repeated Measures ANOVA (Analysis of Variance)	A variety of statistics to analysis and conclusions	1. Standardized Mean Difference (SMD) 2. Trim-and-Fill Method 3. Sensitivity Analysis
Data Analysis Statistical or Qualitative findings ( You need to enter the actual numbers determined by the statistical tests or qualitative data).	Positive Effectiveness (75%) Effect size (SMD) = 0.57, with a 95% confidence interval (CI) of 0.22–0.89	Diverse statistics were carried out	effect size across the 32 comparisons was g = 0.35 (95%CI = 0.09, 0.62, p = .009, I2 = 92%),	Not provided
Findings and Recommendations General findings and recommendations of the research	mindfulness-based interventions (MBIs)tend to be moderately effective in anxiety symptoms reduction. Study recommends application of more refined MBI protocols	Mindfulness-based intervention (MBI) and the MBI enhanced with virtual reality (VR) Dialectical Behavior Therapy (DBT®) mindfulness skills showed increased effectiveness in reducing symptoms of Generalized Anxiety Disorder (GAD).	Even though online mindfulness-based interventions are moderately effective on reducing anxiety symptoms. However, caution should be taken in interpretation to take care of quality of the results	mindfulness-based stress reduction (MBSR)intervention if effective in reduction of anxiety symptoms in young people which underscores its applicability in healthcare but recommends further exploration of its long-term effects.
Appraisal and Study Quality Describe the general worth of this research to practice. What are the strengths and limitations of study? What are the risks associated with implementation of the suggested practices or processes detailed in the research? What is the feasibility of use in your practice?	While the systematic reviews increased reliability, the study suffers from heterogeneity of MBI protocols and less focus on particular disorders for the said protocols. Feability use is high because of the present day increased adoption of mindfulness strategies	The study has demonstrated innovative approach model and fruitful outcomes. However, the small sample size and lack of long-term follow-up are limitations. The feasibility for its adoption will vary over different settings. There is need for further research to prove effectiveness of the models	Provides a comprehensive analysis but potential limitations like data gaps and its focus. Feasibility of its use in practice depends on accessibility to suitable platforms.	The study underscores the potential of MBSR in reducing anxiety in young people. However, this has been evidenced by few studies. Feasibility is depended on context-specific challenges and risks.
Key findings	(MBIs)are moderately effective in reducing anxiety symptoms, more so in clinical samples	That MBI is effective in treating GAD symptoms, depression, anxiety, and emotion dysregulation	online mindfulness-based interventions have a moderate positive effect to reduce anxiety symptom. This makes it a complement other method	The key finding was that MBSR significantly reduced anxiety symptoms in young people compared to control conditions, suggesting its potential effectiveness as a treatment option.
Outcomes	MBIs have the potential to reduce anxiety symptoms, especially clinical populations	In addition to the main finding VR in MBIs have potential to increase treatment adherence, but larger-scale studies are essential to validate these outcomes and assess their long-term sustainability.	Outcome of the study is online mindfulness-based interventions have a moderate positive effect to reduce anxiety symptom. This makes it a complement other method but more research is important to confirm its conclusions	The outcome is that mindfulness-based stress reduction (MBSR) has promising results in reduction of anxiety symptoms in young people.
General Notes/Comments	Study provides reliable findings applicable in care practice	Research has availed valuable insights into the potential benefits of incorporating VR into mindfulness-based interventions for GAD. However, the article calls for larger-scale studies and long-term follow-up are essential to confirm its effectiveness and feasibility in clinical practice.	Even though the study is promising, it requires more high-quality studies to confirm its effectiveness and feasibility for application as a complementary treatment in practice.	The study has given valuable insights into the potential of mindfulness-based stress reduction (MBSR) in managing anxiety symptoms among the young. However, it calls for more studies on possibility of publication bias.

References

Fumero, A., Peñate, W., Oyanadel, C., & Porter, B. (2020). The effectiveness of mindfulness-based interventions on anxiety disorders. A systematic meta-review.European Journal of Investigation in Health, Psychology and Education,10(3), 704–719. https://doi.org/10.3390/ejihpe10030052

Navarro-Haro, M. V., Modrego-Alarcón, M., Hoffman, H. G., López-Montoyo, A., Navarro-Gil, M., Montero-Marin, J., García-Palacios, A., Borao, L., & García-Campayo, J. (2019). Evaluation of a Mindfulness-Based Intervention With and Without Virtual Reality Dialectical Behavior Therapy® Mindfulness Skills Training for the Treatment of Generalized Anxiety Disorder in Primary Care: A Pilot Study.Frontiers in Psychology,10(55). https://doi.org/10.3389/fpsyg.2019.00055

Reangsing, C., Trakooltorwong, P., Maneekunwong, K., Thepsaw, J., & Oerther, S. (2023). Effects of online mindfulness-based interventions (mbis) on anxiety symptoms in adults: A systematic review and meta-analysis.BMC Complementary Medicine and Therapies,23(1). https://doi.org/10.1186/s12906-023-04102-9

Zhou, X., Guo, J., Lu, G., Chen, C., Xie, Z., Liu, J., & Zhang, C. (2020). Effects of mindfulness-based stress reduction on anxiety symptoms in young people: A systematic review and meta-analysis.Psychiatry Research,289, 113002. https://doi.org/10.1016/j.psychres.2020.113002

PICO(T) Question:  In GAD patients, do mindfulness-based therapies, such as mindfulness-based stress reduction and mindfulness-based cognitive therapy, result in a greater reduction in anxiety symptoms compared to standard treatments or other non-mindfulness-based interventions, within the past five years?

My critical appraisal summary:

Anxiety disorder is a significant issue among populations, especially young people. It has the potential to lead to worse consequences in the long term. As such, the studies by Fumero et al., 2020, Navarro-Haro et al., 2019, Reangsing et al., 2023 and Zhou et al., 2020 provide the application of the mindfulness approach as the best model for dealing with anxiety. Educational settings and primary care settings should embrace Mindfulness-Based Interventions (MBIs) as the best intervention to deal with anxiety, especially among young people. It has demonstrated increased effectiveness among various age gaps, hence rooting for its adoption. The integration of virtual reality into MBIs is one of the best practices that can be used in managing anxiety. In their study, Navarro-Haro et al. (2019) underscored the effectiveness of the model in enhancing the treatment of anxiety. The approach is especially best preferred in cases of those who have been DSM-diagnosed with GAD.

As a more reliable model, Reangsing et al. (2023) have availed the alternative of Online Mindfulness-Based Interventions (MBIs), which is seen to have a moderate effect on reducing anxiety symptoms among adults. The approach is cost-effective and most accessible for most young people in areas that have issues with constrained reach to resources for condition management. Similarly, Zhou et al. (2020) have stressed the use of Mindfulness-Based Stress Reduction (MBSR) for Young People is an effective model that is well suited for young people and can be integrated into several educational institutions programs. However, several considerations have to be made when implementing these strategies. It would be important to train the staff who can correctly help implement the initiative for the fidelity of the program. Equally, it is essential to tailor the intervention to the age and the development stage of the individual. Lastly, it is equally important to have schedules and plans to assess the effectiveness of the programs in question.

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