An interventional study of Mindfulness-Based Stress Reduction - Virtual Reality and Stress tip sheet in Type 1 Diabetes, sponsored by Wayne State University. Not yet recruiting at 2 sites in United States. Open to participants aged 16 Years to 20 Years. Per ClinicalTrials.gov, last updated 2026-08-28.
Sponsored by Wayne State University · Not applicable, Interventional, and Treatment
The goal of this study is to learn if Mindfulness-Based Stress Reduction (MBSR) can be delivered using virtual reality (VR) technology to emerging adults (youth 16-20 years old) with type 1 diabetes and high levels of stress reactivity. If successful, MBSR-VR has the potential to reach many people who may be living in different places who might not have access to programs like MBSR. This is important because young adults with a chronic illness like diabetes and high levels of stress have been shown to have worse health than young adults with lower stress and young adults without diabetes. This study has not been designed to determine if MBSR-VR improves the health of young adults with diabetes (improves their glycemic control),their feelings of distress (this includes stress, depression, and anxiety), or their mindfulness (being more aware of their thoughts, feelings, actions, and environment) but we will look to see if people are reporting improvements in these areas.
The goal of this research is to assess the feasibility of a highly scalable intervention, Mind-fulness-Based Stress Reduction (MBSR) delivered virtually enhanced with virtual reality (VR), for improving health outcomes through the reduction of stress in a high-risk population, emerging adults (EAs; 16-20 years) with high levels of stress reactivity. The primary aim of this project is to adapt MBSR for virtual delivery enhanced with VR in collaboration with a Youth Community Advisory Board (YCAB, composed of five EAs with T1D) and to assess feasibility and the acceptability of MBSR-VR for EAs with T1D and elevated levels of stress reactivity. This feasibility study will use a multi-center randomized controlled pilot study design with 48 EAs with T1D and elevated stress (as as-sessed with the Perceived Stress Reactivity Scale). EAs will be randomized in a 1:1 ratio to MBSR-VR or treat-ment as usual (TAU, standard care control). Three cohorts of 16 participants, 48 total, will be enrolled through two clinical research centers (CRCs) at Wayne State University (WSU) in Detroit, Michigan and Johns Hopkins University (JHU) in Baltimore, Maryland. The WSU site will recruit via the T1D Exchange (T1DX) and JHU via their affiliate diabetes clinics. Participants will enter the study during an 8-week period during which research staff will obtain informed consent and assess eligibility via a stress screener; eligible participants will continue with their baseline data collection (T1). Once 16 participants have enrolled, they will be randomized in a single block, 8 to MBSR and 8 to TAU, and those assigned to MBSR will be oriented to the VR technology. All partici-pants will continue to receive standard medical care from their usual diabetes care provider. Treatment groups will run for 9 weeks followed by a 4-week post-treatment data collection (T2) period. The YCAB will assist with monitoring study progress and refining study procedures (e.g., recruitment strategies) over the course of the trial. Feasibility and acceptability will be established through achieving recruitment, retention and intervention bench-marks. Recruitment feasibility will be established by accruing 8 participants every 4 weeks (16 over 8 weeks) and fewer than 15% excluded due to lack of access to an internet-enabled device. Retention feasibility will be established with 85% retention at the end of treatment data collection and \<15% of dropouts due to technology challenges that impeded study participation. Intervention feasibility will be established if EAs attend ≥5 of 9 MSBR intervention sessions, ≥90% of the intervention content is delivered, staff collect >75% of self-practice diaries, MBSR fidelity ratings are ≥4 out of 5 on average, and EAs express satisfaction via qualitative interviews and quantitative assessment (≥3 out of 4).
Exclusion Criteria:
Participants will receive a 9-week virtually delivered Mindfulness-Based Stress Reduction program enhanced with virtual reality (MBSR-VR). The intervention includes instructor-led mindfulness training, guided meditation practices, and home-based mindfulness exercises delivered remotely using video conferencing and virtual reality technology. Participants will be asked to complete weekly sessions and engage in regular mindfulness practice throughout the intervention period.
Behavioral: Mindfulness-Based Stress Reduction - Virtual Reality
Emerging adults assigned to TAU will be offered a stress management tip sheet and will otherwise continue to manage their stress using their usual manner. No other treatment services will be offered and they will not be prevented from seeking alternative treatment independent of the research study.
Other: Stress tip sheet
Participants will receive group-delivered MBSR adapted for emerging adults with type 1 diabetes and virtual delivery including virtual reality technology. The intervention consists of instruction and practice in meditation, use of mindfulness techniques, the mind-body connection, and group discussions focused on mindfulness practice. MBSR intervention content includes 1) practicing a variety of mindfulness meditations, including sitting meditation, walking meditation, body scan, and mindful movement/gentle yoga; 2) learning to pay attention to, observe and describe moment-to moment experience in a way that promotes acceptance; 3) understanding stress reactions (stress symptoms, causes, effects) and how to create a mindful response to stressful situations; and 4) facilitators and barriers to applying mindfulness to everyday activities including eating, listening, communicating, walking and other activities.
Also known as: MBSR-VR
Participants will receive an educational stress management tip sheet developed by the American Diabetes Association. The resource provides information about the relationship between stress and diabetes, strategies for recognizing signs of stress, and practical techniques for coping with stress, including relaxation, physical activity, social support, and healthy self-care behaviors.
Recruitment Feasibility / Number Screened
The ability to successfully identify and screen for study eligibility the target number of participants within the planned study timeline.
Time frame: From recruitment initiation to recruitment termination / 18 months
Recruitment Feasibility / Number Enrolled
The ability to successfully enroll the target number of participants within the planned study timeline.
Time frame: From recruitment initiation to recruitment termination / 18 months
Retention Feasibility / Number Retained
The ability to successfully retain participants in the study.
Time frame: From date of first participant enrollment to date of last participant completion / 18 months
Intervention Feasibility / Number of MBSR treatment sessions attended
Participants' willingness and ability to engage with and complete the intervention as designed.
Time frame: From date of treatment initiation to date of treatment termination / 9 weeks
Intervention Fidelity / Concise Fidelity for Mindfulness-Based Interventions (CoFi-MBI)
The CoFi-MBI assesses three domains of intervention fidelity: content delivery (6 Y/N items), participant engagement (5-point Likert scale, 2 items), and technology challenges (5-point Likert scale, 1 item).Cohort level summary scales are calculated as the percentage of sessions each content element was present with higher scores indicating greater fidelity, the mean level of participant engagement with higher scores indicating greater fidelity, and technology obstacles experienced across sessions with lower scores indicating greater fidelity.
Time frame: From date of treatment initiation to date of treatment termination / 9 weeks
Intervention Acceptability / 18) Acceptability of Intervention Measure (AIM) | Intervention Appropriateness Measure (IAM) | Feasibility of Intervention Measure (FIM)
Participants' satisfaction with the intervention protocol in 3 domains assessed with 4 items in each domain: acceptability, appropriateness, and feasibility. Scores are computed by taking the mean of the 4 items comprising each scale with higher scores indicating greater satisfaction.
Time frame: From date of treatment initiation to date of treatment termination / 9 weeks
Glycemic control / Hemoglobin A1c (HbA1c)
Hb1Ac will be obtained by using the Accubase A1c test kit
Time frame: Baseline/0 month, Treatment End/3 months
Glycemic control / Mean blood glucose
Mean blood glucose will be obtained via 14-day manual download of glucometer data or direct download of continuous glucose monitor (CGM) data
Time frame: Baseline/0 month, Treatment End/3 months
Psychological distress / Stress Reactivity
Stress Reactivity will be assessed using the 23-item Perceived Stress Reactivity Scale (PSRS), a psychometrically valid, self-report measure assessing individuals' perceived reactivity to work overload, social evaluation, social conflicts, failure, and prolonged reactivity. A mean PSRS scores \>18 in males and \>23 in females is the cut point defining "high stress reactivity".
Time frame: Baseline/0 month, Treatment End/3 months
Psychological distress / Perceived stress
General psychological stress will be measured with the 10-item Perceived Stress Scale (PSS), a self-report questionnaire assessing perceptions of stress.
Time frame: Baseline/0 month, Treatment End/3 months
Psychological distress / Diabetes-specific stress
Diabetes-specific stress will be measured using the 20-item Problem Areas in Diabetes (PAID) scale, a self-report questionnaire assessing diabetes-specific emotional distress. Participants use a 5-point Likert scale ranging from 0 = "no problem" to 4 = "a serious problem" to rate their distress. Items are summed and multiplied by 1.25 to generate a score of 0-100 with higher scores indicating greater emotional distress.
Time frame: Baseline/0 month, Treatment End/3 months
Psychological distress / Depression
Symptoms of depression will be assessed with 8-item Patient Reported Outcomes Measurement Information System (PROMIS) Pediatric Short-Version Depression Scale, a self-report measure assessing negative mood (e.g., sadness, unhappiness), negative self-view (e.g., feelings of worthlessness, self-criticism), loneliness and social alienation, and reduced positive affect and engagement (e.g., difficulty having fun, loss of enjoyment).
Time frame: Baseline/0 month, Treatment End/3 months
Psychological distress / Anxiety
Symptoms of anxiety will be assessed with 29-item Patient Reported Outcomes Measurement Information System (PROMIS) Adult Anxiety Scale, a self-report measure assessing fear (e.g., fearfulness, feelings of panic), anxious misery (e.g., worry, dread), hyperarousal (e.g., tension, nervousness, restlessness), and somatic symptoms related to arousal (e.g., cardiovascular symptoms, dizziness).
Time frame: Baseline/0 month, Treatment End/3 months
Mindfulness
Mindfulness will be measured using the 39-item Five Facet Mindfulness Questionnaire (FFMQ), a self-report measure assessing five behaviors associated with mindfulness: observing, describing, acting with awareness, non-reactivity to inner experience, and non-judging of inner experience.
Time frame: Baseline/0 month, Treatment End/3 months
Plan to share: Yes — Deidentified data produced during the project will be preserved and shared under a fully executed data use agreement. IPD data will include non-identifying demographics, biomedical, psychological, behavioral, and treatment delivery information. The final patient level dataset will include demographics, primary and secondary outcomes as well as mediators and treatment delivery data.
Supporting information: Study protocol, Icf
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Wayne State University