You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
A mindfulness-based intervention to increase resilience to stress in university students (the Mindful Student Study): a pragmatic randomised controlled trial
Abstract 1:
Summary Background The rising number of young people going to university has led to concerns about an increasing dem and for student mental health services . We aim ed to assess whether provision of mindfulness courses to university students would improve their resilience to stress . Methods We did this pragmatic r and omised controlled trial at the University of Cambridge , UK . Students aged 18 years or older with no severe mental illness or crisis ( self-assessed ) were r and omly assigned ( 1:1 ) , via remote survey software using computer-generated r and om numbers , to receive either an 8 week mindfulness course adapted for university students ( Mindfulness Skills for Students [ MSS ] ) plus mental health support as usual , or mental health support as usual alone . Participants and the study management team were aware of group allocation , but allocation was concealed from the research ers , outcome assessors , and study statistician . The primary outcome was self-reported psychological distress during the examination period , as measured with the Clinical Outcomes in Routine Evaluation Outcome Measure ( CORE – OM ) , with higher scores indicating more distress . The primary analysis was by intention to treat . This trial is registered with the Australia and New Zeal and Clinical Trials Registry , number ACTRN12615001160527 . Findings Between Sept 28 , 2015 , and Jan 15 , 2016 , we r and omly assigned 616 students to the MSS group ( n=309 ) or the support as usual group ( n=307 ) . 453 ( 74 % ) participants completed the CORE – OM during the examination period and 182 ( 59 % ) MSS participants completed at least half of the course . MSS reduced distress scores during the examination period compared with support as usual , with mean CORE – OM scores of 0·87 ( SD 0·50 ) in 237 MSS participants versus 1·11 ( 0·57 ) in 216 support as usual participants ( adjusted mean difference −0·14 , 95 % CI −0·22 to −0·06 ; p=0·001 ) , showing a moderate effect size ( β −0·44 , 95 % CI −0·60 to −0·29 ; p<0·0001 ) . 123 ( 57 % ) of 214 participants in the support as usual group had distress scores above an accepted clinical threshold compared with 88 ( 37 % ) of 235 participants in the MSS group . On average , six students ( 95 % CI four to ten ) needed to be offered the MSS course to prevent one from experiencing clinical levels of distress . No participants had adverse reactions related to self-harm , suicidality , or harm to others . Interpretation Our findings show that provision of mindfulness training could be an effective component of a wider student mental health strategy . Further comparative effectiveness research with inclusion of controls for non-specific effects is needed to define a range of additional , effective interventions to increase resilience to stress in university students . Funding University of Cambridge and National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care East of Engl and


Title 2:
Prevention of Relapse/Recurrence in Major Depressive Disorder With Either Mindfulness-Based Cognitive Therapy or Cognitive Therapy
Abstract 2:
Objective : Both Mindfulness Based Cognitive Therapy ( MBCT ) and Cognitive Therapy ( CT ) enhance self-management of prodromal symptoms associated with depressive relapse , albeit through divergent therapeutic procedures . We evaluated rates of relapse in remitted depressed patients receiving MBCT and CT .  Decentering and dysfunctional attitudes were assessed as treatment-specific process markers . Method : Participants in remission from Major Depressive Disorder ( MDD ; N = 166 ) were r and omized to 8 weeks of either MBCT ( N = 82 ) or CT ( N = 84 ) and were followed for 24 months , with process markers measured every 3 months . Attendance in both treatments was high ( 6.3/8 session ) and treatment fidelity and competence were evaluated . Relapse was defined as a return of symptoms meeting the criteria for major depression on Module A of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders ( SCID ) . Results : Intention-to-treat analyses indicated no differences between MBCT and CT in either rates of relapse to MDD or time to relapse across 24 months of follow up . Both groups experienced significant increases in decentering and participants in CT reported greater reductions in dysfunctional attitudes . Within both treatments , participants who relapsed evidence d lower decentering scores than those who stayed well over the follow up . Conclusions : This is the first study to directly compare relapse prophylaxis following MBCT and CT directly . The lack of group differences in time to relapse supports the view that both interventions are equally effective and that increases in decentering achieved via either treatment are associated with greater protection . These findings lend credence to Teasdale et al. ’s ( 2002 ) contention that , even though they may be taught through dissimilar methods , CT and MBCT help participants develop similar metacognitive skills for the regulation of distressing thoughts and emotions


Title 3:
Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy.
Abstract 3:
This study evaluated mindfulness-based cognitive therapy ( MBCT ) , a group intervention design ed to train recovered recurrently depressed patients to disengage from dysphoria-activated depressogenic thinking that may mediate relapse/recurrence . Recovered recurrently depressed patients ( n = 145 ) were r and omized to continue with treatment as usual or , in addition , to receive MBCT .  Relapse/recurrence to major depression was assessed over a 60-week study period . For patients with 3 or more previous episodes of depression ( 77 % of the sample ) , MBCT significantly reduced risk of relapse/recurrence . For patients with only 2 previous episodes , MBCT did not reduce relapse/recurrence .  MBCT offers a promising cost-efficient psychological approach to preventing relapse/recurrence in recovered recurrently depressed patients


Title 4:
A naturalistic study of alexithymia among psychiatric outpatients treated in an integrated group therapy program.
Abstract 4:
OBJECTIVES Alexithymia is common among psychiatric out patients and can complicate treatment . There has been little research into whether alexithymia can be modified by psychological intervention , and whether change in alexithymia is related to other areas of improvement . The purpose of the present study was to examine whether participation in an integrated group therapy program could effect change in alexithymia , and whether such change is related to improvement in interpersonal functioning . DESIGN AND METHODS Sixty-eight consecutively admitted psychiatric out patients to a comprehensive group therapy program  were evaluated at baseline , post-therapy , and 3-month follow-up using the  Toronto Alexithymia Scale 20 , the Beck Depression Inventory , and the Inventory of Interpersonal Problems-28 .  Associations among variables were evaluated with correlations and among group comparisons with t test , ANOVA , chi-square tests , and logistic regression . Change in alexithymia was examined using repeated measures ANOVA , controlling for change in depressive symptoms . RESULTS Alexithymia , particularly difficulty identifying feelings , decreased significantly during the treatment period . Post-therapy levels of alexithymia were maintained during the 3 months following treatment completion . Changes in alexithymia were significantly associated with changes in interpersonal problems , both during therapy and during the follow-up period . CONCLUSIONS The results of our study suggest that a comprehensive , integrated group therapy program can affect change in alexithymia , and that such change can be maintained once therapy is completed . Also , modifying alexithymia may contribute to improvement in interpersonal functioning


Title 5:
Exploring the Benefits of Group Psychotherapy in Reducing Alexithymia in Coronary Heart Disease Patients: A Preliminary Study
Abstract 5:
Background : Although there is preliminary evidence that alexithymia may influence the course of coronary heart disease ( CHD ) , there are no studies exploring attempts to modify alexithymic characteristics in cardiac patients . Method : Twenty post-myocardial infa rct ion ( MI ) patients ( 19 men and 1 woman ) were placed in a treatment group , which received weekly group psychotherapy for 4 months . Seventeen post-MI patients ( 16 men and 1 woman ) were placed in a comparison group which received two educational sessions over a period of 1 month . All subjects completed the Toronto Alexithymia Scale ( TAS ) before the start of group therapy , at the end of the 4-month period , and in follow-up assessment after 6-month , 1-year , and 2-year intervals . Results : In the psychotherapy treatment group , there was a significant reduction in the mean TAS score following group therapy , which was maintained over the 2-year follow-up period . In the educational group , there were no significant changes in mean TAS scores between the initial testing and any of the follow-up intervals . On an individual basis , a decrease to a lower level of TAS scores occurred in a higher percentage of patients in the treatment group than in the educational group . Over the 2-year follow-up period , patients with decreased alexithymia following group therapy experienced fewer cardiac events ( reinfa rct ion , sudden cardiac death , or rehospitalization for rhythm disorder or severe angina ) than patients whose alexithymia remained unchanged . Conclusions : The results indicate that group psychotherapy is able to decrease alexithymia and that for many patients this change can be maintained for at least 2 years . A reduction in the degree of alexithymia seems to influence favorably the clinical course of CHD
Findings from our study should be replicated in further research with larger sample s ; however , the results indicate that mindfulness-based interventions may be an effective treatment in reducing alexithymia