There were significant improvements and moderate Cohen d effect sizes in the online MBCR group relative to controls after MBCR for total scores of mood disturbance ( d = 0.44 , p = .049 ) , stress symptoms ( d = 0.49 , p = .021 ) , spirituality ( d = 0.37 , p = .040 ) , and mindfully acting with awareness ( d = 0.50 , p = .026 ) .