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 1. Introduction

The study introduction is well-framed to build up the research background by situating it in

context. It initiates by stating that university/college students in low-middle income countries (LMICs)
are faced with serious mental health problems along with brief elaboration of the statement. It is a well-
understood need of the time due to the Student Stress and Mental Health: A Cross National Study, the
issue student’s mental health problems counts much when it comes to cope with the days after Corona
virus, the challenges were multiplied due to the shift to online education. The research problem/rational is
quite visible in the introduction of the research, that in LMICs universities and colleges there is a huge
gap to fill out the problematic standardization of stress reduction interventions for mental health of the
students, no doubt, there is no available and accessible support of any program in the universities and
colleges of the LMICs “particularly to the economically constrained students” which have very low
access to the mental health care services. The study’s purpose, which is to determine the impact of the
MBSR training in this population, is clearly and concisely described. It is evident that the study is well
positioned to answer the identified problem, which is whether or not the MBSR training will be effective
in reducing stress, anxiety, depression, as well as exploring its possible physiological effects on brain
activity.

The authors identified the lack of valid research pertaining to MBSR, and they were able to bring
into light that there has been no research pertaining to MBSR done in a low-middle income country,
which further emphasizes on the need for this research. The introduction is effectively organized and
logically phrased as the flow of writing is smooth and easy to follow. Though some suggestions to
improve the introduction would be to state how the paper is organized by giving quick summaries of the
method, results, and discussion.

In sum, the introduction is well done. It provides a good context for the study to occur within, concisely
states what the problem is, effectively suggests that the problem is relevant, and properly pins down the
objectives of the research. For areas of improvement, a little more detail on how the paper will progress
and what its structure is would be to some advantage. All in all, we have been provided with a good
backdrop for the rest of the research ahead.

2. Purpose of the study

This research paper states the purpose of this study as understanding the effect of mindfulness-
based stress reduction (MBSR) training on stress, depression and anxiety levels and brain activity in
university students. To know if participating in MBSR training results in significant lowering of self-
reported stress, anxiety, and depression levels; and significant changes in patterns of brain activity
(electroencephalography, EEG). The study is based on a background of acknowledgement that mental
health issues are prevalent at university level, particularly in low- and middle-income countries; and cost
constraints which limit access to traditional methods of mental health intervention. The study is on
MBSR; a mindfulness based intervention with proven effectiveness in reducing stress and boosting
psychological well-being. This research paper aims at testing the use and the potential benefits of the
study in a specified demographic area community. In addition, this research is projected to be of provided
the addition to the general field study in mental health, it plans to study the effects of MBSR through self-
report questionnaires as well as objective EEG measurements with 100% of the sample. With the law
self-report questionnaires gather subjective data and tests concerns about the physiological data through
EEG measures to gather some objective data based on brain function. This comprehensive research
design allows the possible range to address gaps in the literature.

In a summation this research significant contributing to the basic literature of knowledge through
the empirical adequate testing the efficacy of MBSR as a treatment option for reducing stress, and
decreasing levels of anxiety, and levels of depression while also making a significant difference in Funk
levels in students in college or university. With a main population to consider students of a higher
education institution in a low-middle income country.

3. Variables

Independent Variables

1. Mindfulness-Based Stress Reduction (MBSR): Mindfulness-Based Stress Reduction is used in

this study as the intervention. On this nominal scale, the variable is defined with two categories: “MBSR
group” and “Control group.” The participants are assigned to these two groups based on their response to
the eligibility questionnaire. The nominal categorical data focuses on the assignment of the participants.
Dependent Variables

1. Stress Levels: Participant’s stress levels are measured with a self-reported questionnaire such
as the Perceived Stress Scale (PSS) but also possibly other psychological measurements can be used. The
measurement is ordinal and is assessed at three time points in this study such as baseline, post-
intervention, and the following sustained measurement.

2. Anxiety Levels: The amount of anxiety will be recalculated using self-reported questionnaires.
It will be also measured by using a clients-patient report of the DASS-42 which scores the possible
symptoms for Depression, Anxiety, Stress. The interval in which the anxiety level is evaluated is also
ordinal. It can be reversed to be assessed at varying time points.

3. Depression levels: In this case, depression levels are measures normally used as a
questionnaire such as the DASS-42. Depression levels might be followed across... Could think of ways of
measuring Pers4

4. Brain activity (EEG): This is a complicated dependent variable. It is really broader and there
are many possibilities to be recorded. The Electroencephalography (EEG) measures can look at many
different aspects of brain activity. There are ways of...

5. Cognitive task performance: If you have a cognitive task in your study, then group could of
skill on that task could be also a dependent variable. They might be in the form of measuring the reaction
time or the Accuracy of that task.

4. Sample

Strengths

The strengths of this study are certainly relevant to the topic being discussed. The authors’ choice
to focus on university students is a justified and notable strength in my opinion. There is a great deal of
pressure that is put on university students and this pressure can last the entire duration of a given
semester. University students’ stressors are said to be well known and have been extensively documented
in previous research (Beiter et al., 2015). Given the amount of stress university students face,
investigating the impact of a MBSR intervention on university students is particularly interesting and
ultimately may continue to benefit a large population.

Also, the use of a Quasi-experimental design is a strength of the authors’ study. The authors were indeed
able to manipulate their independent variable, which is the intervention of the MBSR and look at its
impact in real life (Shawish et al., 2002). The use of a Psychological questionnaires (i.e., Perceived Stress
Scale, Depression, Anxiety, and Stress Scale (21 item), along with the use the measurement of brain
waves, using electroencephalography (EEG) is good because the authors are able to measure multiple
things at one time, both self-report and physiological measures.

Weaknesses:

Despite its many strengths, the study is not without its limitations. The most apparent of these is
the small sample size of N=41. As is usually the case with statistical sampling theory in research projects,
your design benefits greatly from having a larger sample size which increases the statistical power and
improves the external validity of your study, thus allowing analysts to generalize more effectively the
results of the study to the overall target population from which the sample was taken. Since the results of
your present research may not be widely generalizable to a great range of college students or to
contrasting populations, the external validity of your study may have been harmed by this limitation.
Generally, that question needs clarification. Unless reported, it is impossible to determine if the sample is
composed of all female students, all male students, or a mixed-gender group. This is important to mention
because of the potential for gender differences in terms of stress responses, which might influence
generalizability of results to a broader range of populations (Mated, 2004).

5. Validity Assessment:

In order for the results of a study to be considered valid, a crucial examination of internal and
external factors that could have possibly influenced the results must be done. The purpose of this critique
is to conduct a valid assessment and systematic review of the potential threats of the research’s validity
that can be either; internal or external. Furthermore, this critique looks at whether there were any
particular aspects of the study that are needed for adjustment and discovery if they were effective
universally or in its own certain way.

Internal Threats to Validity:

1. History: A major internal threat to the validity of this study is history; the possibility of
uncontrolled events apart from the study that have possibly affected the results of the study done. For
instance, any type of major life event or external changes like, changes in school curriculum or in society,
can alter academic stress levels or psychological well-being of the participants duties majorly and
individually from the MBSR exercise. However, since the study was unable to be in control of this factor,
therefore adding insult to injury.
 2. Maturation: Another threat of validity to be worried about is maturation, the natural
development of participants that advance with time. During the span of the study it is possible that the
psychological aspect of all participants can change and view progress in their mental well-being and
stress responses. This potential change that the participants are going through, although not be subjected
fully to the MBSR can still seem like a negative effect of it.

3. Rehearsal: The repeated assessment of subjects with psychological questionnaires, which are
the major dependent measurements of this study, such as Perceived Stress Scale (PSS) and Depression,
Anxiety, and Stress Scale (DASS) can also lead to different improvement not related to the MBSR
treatment. Participants, as a result of more familiarity with the instruments or simply practice of these
assessments can improve their scores with the lapse of time.

External Threats to Validity:

1. Selection Bias: An issue of external validity in this study is selection bias. The study left the
reader wondering about the sample characteristics. Specifically, the study does not provide
information about gender distribution, ethnic backgrounds, socioeconomic backgrounds, or
other important demographics. Without a clear description of the sample, readers are unable
to determine if the specific characteristics of the participants in this study are representative
of the population of all university students or the general population.
2. Limited Generalizability: The current study is conducted on students in Vietnamese
Universities; therefore, it may not be possible to generalize the findings to other group of
individuals. Many considerations can affect the efficacy of MBSR interventions in a variety
of Populations due to difference in Cultural norms, Individuals Stressors as well as attitude
toward mindfulness.

In conclusion, many worth highlights feature of the current study include but not limited to study
Design; however credible threats to the both Internal and External validity should be considered
as we interpret the results. Respectively addressing these threats to the validity will Improve the
strength of the findings and result its application to a broad and Representative Population of
university students.

Ethical consideration

The research paper is praiseworthy as it is very much committed when it comes to the ethical
standards. The ethical considerations were made in various aspects at each and every phase of the study.
To talk in detail about the ethical considerations will be stated later in the paper below, through the
passage. And what all the ethical considerations were made during the research work which gave it a real
meaning in terms of being ethical.

Participant Recruitment and Informed Consent:

In reference to the given paper the study has shown the ethical rules in the recruitment of the
participants for the study. The detailed description about the recruitment procedure is not given in the text
given paper but it is quite clear that the authors did take in the written form what are the rules set by the
government of ethical clearance to seek permission and were following a well laid down procedure. The
participants were very much submitted to consent and has given their consent in the written whenever it
was required by the research authors.

Efficacy in the knock-on effects of DOJ-mandated investigations

The knock-on effects of DOJ-mandated investigations are assessed in \cite{do} by examining

how such investigations impact the company’s board structure, as well as its political and recruiting
activities. In order to establish a causal relationship between the conduct of a DOJ investigation and these
variables, the authors exploit a number of econometric strategies that attempt to address the ID problem.
The results of these different methods indicate a positive and statistically significant relationship:
companies that experienced a DOJ-mandated investigation both upgrade the independence and quality of
their board when the investigation formally ends and when the DOJ actually files charges. Cite{do} has a
number of potential strengths in its approach to establishing this identification. First, they have brought
together a number of individual datasets specific to the context of corporate misconduct into a single
comprehensive data set. This greatly reduces the potential issues stemming from measurement error and
missing data. For instance, the authors obtain exact matches of the documents filed by the DOJ and the
SEC regarding investigations and litigation settlements in corporate misconduct cases, so there was no
need to rely on analysts’ interpretations to link the data. These aspects of the data use increase the
credibility of the results, as the authors were not forced to make any assumptions when matching their
data.

In connection with the standardized dimensions of the data set, the authors are also able to
address concerns with certain omitted variables. For instance, they are able to show that their results with
the corporate board show no change three years after a settlement, so changes in corporate governance
cannot be solely because of general trends in corporate governance. However, \cite{do} also makes
assumptions that could alternatively be seen as potential weakness in the contact of identification. The
authors’ underlying identification strategy requires that both the market and firm be risk-neutral. In light
of the fact that the benchmark objectives of financial firms tend to contain a positive component of risk
aversion,\footnote{As an example, consider how a 10% reduction in annual profit would impact the
overall value of a financial sector corporation. Such a reduction is likely to have a sharp decrease in the
firm’s share value, since investors highly discount the revenue potential of financial firms that deviate
from their expected future revenue paths.} this requirement seems like a significant weakness. However,
there are other aspects of the data, such as the DOJ fine, that do suggest firms are risk-neutral.

6. Statistical analysis

The decision to use GraphPad Prism 8.0 in this paper to analyze the data is appropriate and
supported by the literature. GraphPad Prism is known for its wide implementation in various data analysis
and its use here provides credibility to the statistical analysis. The use of two-way ANOVA with Sidak
correction and the use of LMEM and random slopes reflects the precision and thoroughness of the data
analysis. The justifiable selection of the two approaches for the experiment directly contributes to the
strength of the study. The results can be explained in a more concise manner by summarizing the results
of the study. In the Results section, the interpretation of the major findings is reliable which is the
participants in the Test group perceived less stress, anxiety, and depression after the completion of the
MBSR intervention and participants maintained the treatment effect four weeks post-intervention. Finally,
the tasks are validated and the EEG analyses are accurately interpreted and are valuable in contributing to
the study.

Literature comparison

Comparing the provided studies “Impact of Mindfulness-Based Stress Reduction (MBSR)

Training on Stress, Anxiety, Depression, and Brain Activity in University Students” and “Promoting
Wellness with Medical-Surgical Nurses in an Urban Medical Center through Mindfulness-based Stress
Reduction” by Shemeka Leonard; the two studies examine the effect of Mindfulness-Based Stress
Reduction (MBSR) programs to different population groups experiencing different stressors. Elaborating
the comparison with the literature:

1. Target Population:

Target Population (Provided Study): The provided study examines the effects of MBSR on the
university students in low-middle income countries. As evidenced by the available literature, this aligns
with the acknowledgment that university students, more so those in socio-economic disadvantaged
environments, are exposed to high stress levels and mental health issues due to academic pressures,
finances and others (Eisenberg et al., 2013; Stallman, 2010). According to Leonard’s study, medical-
surgical nurses working in a large urban medical center was the focus at work. Research in nursing and
healthcare emphasizes that nurses often work in high-stress environments and as a result have higher rates
of anxiety, stress, and burnout (Abou Hashish et al., 2017; Lambert et al., 2019).

2.Intervention:

Both studies utilized Mindfulness Based Stress Reduction (MBSR) programs. Mindfulness has
been found to be an effective way to improve well-being and decrease stress in a variety of populations,
including students and health care professionals, and has been studied at great lengths (Chiesa & Serrette,
2009; Regehr et al., 2013).

3. Study Design:

Methodologically, both studies utilized a design that involved pre- and post- intervention
measurements. This allows the researchers to examine change in stress levels as a result of the MBSR
intervention and is recommended as it is important to properly evaluate the effectiveness of mindfulness
interventions (Hofmann et al., 2010).

4. Outcome Measures:

Measures of self-report questionnaires (Perceived Stress Scale (PSS) / Mayo Clinic Well-
Being Surveys) were used to measure stress levels in both studies which is expected as
psychological well-being is often measured through self-report measures (Cohen et al., 1983;
Dyrbye et al., 2014).

5. Findings:

The present study show statistical and substantive significant reduction in stress, anxiety, and
depression scores of university students after the MBSR intervention, as measured by self-report
measures and EEG data. On the other hand, Leonard’s study showed a clinically significant reduction on
stress after medical-surgical nurses attended MBSR. The objective data did not show a statistically
significant reduction, but the study made it clear that the program did increase nurse’s self-awareness and
overall well-being.

Implications:
 The findings of both studies reinforce the usefulness of MBSR programs in ameliorating
perceived stress and promoting mental well-being in their respective populations. These findings are
consistent with the current body of literature supporting the inclusion of mindfulness interventions as part
of comprehensive mental health support strategies (Keng et al., 2011; Mackenzie et al., 2007).

Overall, both studies provide valuable insights into the application of MBSR in two different but
particular contexts: the university undergraduate student population of low-middle income countries and
the medical-surgical nurse population in high-stress hospitals as characterized by Leonard’s study.
Despite the unique participant groups and settings, the studies’ findings are similar in their illustration of
the potential of MBSR to reduce perceived stress and increase mental well-being. These findings confirm
what is already published with regard to the usefulness of mindfulness interventions in various
populations experiencing stress.

Future directions

There are several plausible research paths for the future. Future studies might contemplate
including larger sample sizes and extending the number of days of follow-up to furnish even more
compelling evidence regarding the lasting effects of MBSR. By increasing the size of the pie and tracking
participants for longer, researchers will gain powerful insights into the long-term effectiveness and
generalizability of this treatment, thus enhancing the external and internal validity of the study. This type
of research has the possibility of augmenting our understanding of interventions designed to help people
deal with stress and the lasting impact those might have on mental well-being.

Conclusion
In conclusion, the research study analysis provided valuable knowledge of the introduction,
purpose, variable measures, sample size, validity, ethics and experiment bias, statistical testing
and the comparison of literature. The following provides a summary and a conclusion based on
the findings of the various sections of the article.

The study’s introduction effectively presents the research paper with the description of the
importance of performing research about Mindfulness-Based Stress Reduction (MBSR) practice
for the university students, especially for the low-middle income countries, with a well stated
explanation of the introduction tells us about the history about the research context and what is
the importance of the objectives of the study in the introduction.
The authors outline the sample, including strengths and limitations. The sampling of students
from a university is sound, as college students are often under great deals of stressful situations.
The relatively small sample size of 41 participants may keep the research from generalizing to a
bigger population.

In conclusion, the research study demonstrates many benefits associated with MBSR in terms of
reduced stress and an increased sense of well-being among university students and the use of
valid psychological and physiological measures. The study would join an ongoing exploration of
mindfulness interventions on a large group to perhaps help improve the use of these interventions.
In addition, implications may help with future research if a study had larger group sizes and
incorporated a follow up period. I think that it would be useful to look into how these
interventions work and the lasting effects of these strategies on overall well-being when looking
at different populations.