58 Chapter 4 personal-level achievements that may be realized during, directly after, or shortly following the intervention, potentially serving as working mechanisms in enhancing mental health outcomes related to stress and well-being. Distal outcomes, on the other hand, represent effects of the MBSR program observable in the teaching environment, which may require a longer duration for observation. Specifically, we expect the MBSR program to yield improvements in proximal outcomes such as mindfulness skills, emotion regulation, and self-compassion. Concurrently, we anticipate positive developments in distal outcomes, encompassing teacher self-efficacy, perceived pupil-teacher relationships, and the overall quality of the classroom climate as distal (secondary) outcomes. This multifaceted approach allows for a comprehensive evaluation of the MBSR program’s impact, both on the personal well-being of participating teachers and the broader teaching environment. MATERIALS AND METHODS Study Design Figure 2 Study design This study employed an RCT to assess the efficacy of MBSR compared to a waiting list control condition in alleviating perceived stress among elementary school teachers. The stratified random sampling was conducted at an individual level, taking into account factors such as school weight and gender. Assessments took place before and after the MBSR program or waiting list period (September and November), and at three months follow-up (March, within the same school year). Teachers in the control group were offered to participate in MBSR after the follow-up assessment within the same school year. Recruitment took place in a large urban area in the Netherlands, in three consecutive school years: 2019-2020, 2020-2021 and 2021-2022. See Figure 2 for an overview of the
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