120 Chapter 7 SUMMARY AND GENERAL DISCUSSION Teaching is one of the most challenging professions, particularly for elementary school teachers in the Netherlands, where burnout and absenteeism are notably high (Lomas et al., 2017; Statistics Netherlands, 2022). Additionally, one in five elementary school teachers leaves the profession within five years, highlighting the need for stress-reducing interventions (Statistics Netherlands, 2022; Ministry of Education, Culture and Science, 2022). Despite the significant impact of stress on teachers’ well-being and performance (de Carvalho, 2021; Emerson et al., 2017; Lomas et al., 2017; McIntyre et al., 2017), there is a lack of research on stress interventions for this group (Jennings et al., 2017). Mindfulness-Based Stress Reduction (MBSR) has shown promise in reducing perceived stress (Khoury et al., 2015; Goldberg et al., 2018), but research on its use with elementary school teachers, especially outside the U.S., is limited. This thesis investigates the effectiveness of standard MBSR training in reducing stress among elementary school teachers in the Netherlands. In Chapter 2, an uncontrolled pilot study is outlined, encompassing a research sample of 71 elementary school teachers. Questionnaires were administered immediately before and after the training. Analyses revealed a significant reduction in perceived stress, along with significant increases in mental, emotional, and social well-being, as well as in mindfulness skills and self-compassion, following the completion of the standard MBSR training. Indications were also found that the training might have a larger effect on a) teachers with current or previous symptoms of mental health problems and/or b) teachers working in schools with more complex pupil populations. Chapter 3 outlines the study protocol for a pre-registered randomized-controlled trial (RCT) and an exploratory qualitative study. Inclusion criteria were: a) teaching at least two days a week in the same year group, b) ability to complete Dutch questionnaires three times during a school year, and c) flexibility to start MBSR in either September or March. Exclusion criteria included prior participation in Mindfulness-Based Cognitive Therapy, MBSR training, or any mindfulness workshop over three hours. The qualitative study recruited participants from the RCT for semi-structured interviews, focusing on the question: How did the MBSR program affect your ability to function as a teacher? Chapter 4 presents the results of the main RCT in 146 elementary school teachers who were randomly allocated to MBSR (n = 72) or wait list control condition (n = 74). Assessments were conducted pre- and postintervention, and at a three-month follow-up. The intervention was significantly more effective in decreasing perceived stress over time than the control condition. Large effects in favor of the intervention group were found for perceived stress at post-treatment and a moderate effect at follow-up. Analyses of secondary outcomes showed significant groupby-time interactions over the entire period for almost all secondary outcomes, with all effects favoring the intervention group. This includes the outcome measure of well-being as well as the proximal outcome measures: mindfulness skills, self-compassion, and emotion regulation. Outcomes which are directly related to perceived stress. Regarding
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