The acceptability and effectiveness of mindfulness breathing meditation intervention on mental health and cognitive functions

Hooi Ling Yut

The acceptability and effectiveness of mindfulness breathing meditation intervention on mental health and cognitive functions

Publication Date

July 25, 2026

Creator

Hooi Ling Yut

University of Nottingham, Malaysia

Abstract

Mental health problems have increased particularly during and after the Covid-19 pandemic. While researchers had investigated the effectiveness of Mindfulness-Based Stress Reduction (MBSR) program on mental well-being and cognitive functions, it may not always be accessible to every individual due to high cost and time (eight weeks) requirements. This thesis examined the effectiveness and acceptability of a cost-effective and easy-to-learn mindfulness breathing meditation (MBM) intervention, across multiple delivery formats such as physical, online, and immersive virtual reality (VR) among young and middle-aged adults through a progressive series of four interrelated studies conducted in Malaysia (Studies 1 to 3) and China (Study 4). Study 1 investigated a five-week online MBM intervention during the Covid-19 pandemic, demonstrating significant reduction in perceived stress levels and improvements in attention, inhibitory control, and working memory compared to an active control (AC) group. Participants in the MBM group also self-reported high acceptability towards the intervention. Building on these findings, Study 2 adopted a more structured experimental design by involving physiological (i.e., heart rate variability; HRV) and behavioral (i.e., eye-tracking) measures to examine a four-week online MBM intervention with a three-month follow-up on MBM practice adherence. Participants in the MBM group again reported significant reduction in the perceived stress levels and improvement in cognitive flexibility compared to the AC group, however, no significant changes were found in HRV, attention, and inhibitory control. The three-month follow-up also highlighted challenges in sustaining long-term MBM practices adherence. To address adherence challenges, Study 3 examined whether a brief, single-session MBM intervention delivered through VR or non-VR formats could show comparable benefits. Following a standardized stress test, both virtual reality breathing meditation (VRBM) and conventional mindfulness breathing meditation (CMBM) interventions showed significant reduction in state anxiety and stress levels as measured by galvanic skin responses (GSR). Both interventions received high acceptability ratings and were suitable for individuals with limited time or motivation for sustained meditation practices. However, no significant change was found in HRV in both interventions, suggesting that short-term MBM interventions may not influence autonomic regulation. Finally, Study 4 compared a three-day physical mindfulness breathing meditation (PMBM) and online mindfulness breathing meditation (OMBM) interventions with an AC group, using a multi-method design. Both interventions enhanced state mindfulness, attention, and inhibitory control compared to the AC group, however, no significant improvement was found in HRV. The interview findings showed that regardless of the delivery formats, both interventions were perceived as feasible and beneficial in protecting mental health and enhancing cognitive functions, while also identifying challenges in long-term motivation and practices adherence once the structured intervention was concluded. Across four empirical studies, this thesis addressed critical gaps in MBM and advances theoretical and practical understanding of the MBM interventions on mental health and cognitive functions in a non-Western (e.g., Malaysian and Mainland Chinese) and non-clinical (i.e., healthy young-to-middle-aged adults) population across multiple delivery formats. The integration of psychophysiological, cognitive behavioral, and subjective measures reflects a methodologically rich and multidimensional approach that goes beyond the typical reliance on only the subjective outcomes. The use of a randomized controlled trial and an AC (music therapy) group lend credibility to the findings. This thesis also contributes to both the theoretical and practical understating of MBM intervention. From a theoretical perspective, the findings highlight that the benefits of MBM may arise from top-down executive control and emotional regulation mechanisms, rather than short-term physiological modulation or autonomic regulation. From a practical perspective, this thesis supports the incorporation of MBM intervention into mental health programs. Institutions could consider embedding MBM into their wellness strategies and offering MBM as part of the psychological support services to protect mental well-being and enhance cognitive functioning.

Item Type

ethesis

Thesis Type

PhD

Supervisors

Wong, Hoo Keat

University of Nottingham, Malaysia

Chen, Po Ling

University of Nottingham, Malaysia

de Vries, Marieke

Utrecht University

Tan, Kok Wei