18 Chapter 1 the working mechanisms of MBSR and teacher experiences could add value to future interventions. This thesis Aim The primary aim of this thesis was to investigate the effectiveness of a standard MBSR program in reducing perceived stress among teachers in Dutch primary education. The secondary aim was to examine the effects of MBSR on teachers’ mental health, teacher skills, the pupil-teacher relationship and the perceived quality of the classroom climate. The third aim was to gain deeper insights into the demographic or individual characteristics that are most conducive to the optimal effectiveness of the MBSR program. Additionally, we aimed to investigate possible mediators that influence treatment outcomes, encompassing mindfulness skills, self-compassion, and emotion regulation skills. Due to the absence of similar research in the Netherlands, we conducted a preliminary uncontrolled pilot study on the effects of standard MBSR on elementary school teachers in Rotterdam establishing a solid foundation for a well-conducted RCT. The subsequent superiority RCT, comparing MBSR to a waiting list control condition with a 3-month follow-up, was conducted with elementary school teachers in a large urban area. Additionally, in-depth qualitative interviews were conducted to explore the personal experiences of teachers, further revealing underlying mechanisms. Outline Chapter 2 describes an uncontrolled pilot study comprising 71 elementary school teachers. The research questions in this chapter are: Does the MBSR-training reduce the perceived stress of teachers in primary schools? Does the MBSR-training improve mindfulness skills, self-compassion and mental health of the teachers? Is standard MBSR feasible to offer in this setting, and what is its provisional effectiveness? Chapter 3 describes the design and protocol of Mindfulness-Based Stress Reduction as an intervention for elementary school teachers. This chapter provides a comprehensive overview of both the randomized controlled trial and qualitative study. It furnishes detailed information on various methodological aspects of the trial, encompassing its design, eligibility criteria, study procedure, sample size calculation, research questions, outcome measures, and statistical analyses. Answering important questions it elucidates the study’s objectives and the anticipated impact of its findings, particularly concerning the effects of MBSR training on elementary school teachers’ perceived stress, mental health, mindfulness skills, self-compassion, emotion regulation, self-efficacy, as well as their perceived pupil-teacher relationship and classroom climate quality. Chapter 4 presents the results of the main RCT (n = 146 teachers) and answers the following research questions: Does participation in a standard MBSR training lead to a decrease in perceived stress and an enhancement in well-being among elementary school teachers? To what degree do mindfulness skills, emotion regulation, and self-compassion serve
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