ArticleLiterature Review

The efficacy of mindfulness meditation apps in enhancing users’ well-being and mental health related outcomes: a meta-analysis of randomized controlled trials

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Abstract

Background Mindfulness applications are popular tools for improving well-being, but their effectiveness is unclear. We conducted a meta-analysis of randomized controlled trials (RCTs) that employed a mindfulness meditation app as the main intervention to improve users’ well-being and mental-health related outcomes. Methods A systematic search was conducted in PsycINFO, PubMed, Web of Science, ProQuest Dissertations and Theses Global, the Cochrane Library, Open Grey and ResearchGate through June, 2020. Effects were calculated as standardized mean difference (Hedges’ g) between app-delivered mindfulness interventions and control conditions at post-test and pooled with a random-effects model. Results From 2637 records, we selected 34 trials (N = 7566). Significant effect sizes were found at post-test for perceived stress (n = 15; g = 0.46, 95% CI [0.24, .68], I2= 68%), anxiety (n = 15; g = 0.28, 95% CI [0.16, .40], I2= 35%), depression (n = 15; g = 0.33, 95% CI [0.24, .43], I2= 0%), and psychological well-being (n = 5; g = 0.29, 95% CI [0.14, .45], I2= 0%). No significant effects were found for distress at post-test (n = 6; g = 0.10, 95% CI [-0.02, .22], I2= 11%) and general well-being (n = 5; g = 0.14, 95% CI [-0.02, 0.29], I2 = 14%). Conclusion and limitations Mindfulness apps seem promising in improving well-being and mental-health, though results should be interpreted carefully due to the small number of included studies, overall uncertain risk of bias and heterogeneity.

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... Active interventions could include interventions that were designed to control for active components (such as time and attention) but not to provide therapeutic ingredients (e.g., attentional control) as well as interventions that were designed to provide therapeutic benefit (i.e., other interventions). However, instead of separating comparison conditions based on whether they were active or inactive, some meta-analyses [39] separated comparison conditions based on whether they were intended to be therapeutic [32]. Thus, effect sizes based on the combination of inactive conditions (e.g., waitlist) and active conditions not intended to be therapeutic (e.g., attentional control) were coded as non-specific controls. ...
... Several meta-analyses indicated high risk of bias related to blinding of personnel and participants, while also indicating that outcome assessors were blind [48]. It appeared that authors may have considered a lack of interaction with study personnel as reflecting low risk of bias for outcome assessors when outcomes were self-reported [39]. Although many of the included meta-analyses assessed publication bias, this was often done using the full sample of studies (i.e., not separated by comparison condition type). ...
... Compared to inactive controls, smartphone interventions showed highly suggestive evidence of small magnitude effects on anxiety in the general population (d = 0.32 [21]) and among those with elevated symptoms (d = 0.45 [38]). Compared to inactive controls, meditation apps showed suggestive evidence of small magnitude effects (d = 0.31 [39]). There was weak evidence of small magnitude effects of apps compared to inactive controls among those with elevated symptoms (d = 0.49 [20]), downgraded from highly suggestive due to the small Inactive = no active comparison (e.g., assessment only, waitlist control); Non-specific = non-specific controls (i.e., not intended to be therapeutic); Active = active comparison that may or may not have included therapeutic ingredients; Specific = specific active controls (i.e., intended to be therapeutic); Adjunct = mobile phone-based intervention tested as adjunct to another intervention. ...
Article
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Mobile phone-based interventions have been proposed as a means for reducing the burden of disease associated with mental illness. While numerous randomized controlled trials and meta-analyses have investigated this possibility, evidence remains unclear. We conducted a systematic meta-review of meta-analyses examining mobile phone-based interventions tested in randomized controlled trials. We synthesized results from 14 meta-analyses representing 145 randomized controlled trials and 47,940 participants. We identified 34 effect sizes representing unique pairings of participants, intervention, comparisons, and outcome (PICO) and graded the strength of the evidence as using umbrella review methodology. We failed to find convincing evidence of efficacy (i.e., n > 1000, p < 10 ⁻⁶ , I ² < 50%, absence of publication bias); publication bias was rarely assessed for the representative effect sizes. Eight effect sizes provided highly suggestive evidence (i.e., n > 1000, p < 10 ⁻⁶ ), including smartphone interventions outperforming inactive controls on measures of psychological symptoms and quality of life ( d s = 0.32 to 0.47) and text message-based interventions outperforming non-specific controls and active controls for smoking cessation ( d s = 0.31 and 0.19, respectively). The magnitude of effects and strength of evidence tended to diminish as comparison conditions became more rigorous (i.e., inactive to active, non-specific to specific). Four effect sizes provided suggestive evidence, 14 effect sizes provided weak evidence, and eight effect sizes were non-significant. Despite substantial heterogeneity, no moderators were identified. Adverse effects were not reported. Taken together, results support the potential of mobile phone-based interventions and highlight key directions to guide providers, policy makers, clinical trialists, and meta-analysts working in this area.
... In a review of 52 commercially available anxiety apps, the authors reported that 67.3% did not include health care professionals in their creation and only 3.8% were supported by robust research [19]. Nonetheless, the growing evidence base suggests the potential efficacy of MHapps [33][34][35]. For example, Firth et al [34] found app-delivered interventions to be effective in decreasing anxiety (Hedges g=0.32, 95% CI 0.17-0.48) ...
... 95% CI 0.14-0.45) [35]. Other reviewers corroborated this research, reporting positive findings for mindfulness apps in improving overall mental health (g=0.23, ...
... With respect to evidence of the effectiveness of MHapps for the general public, McKay and colleagues [39] reviewed commercially available healthy lifestyle apps, and found that behavior change strategies mainly focused on rehearsal or practice (of new habits) and self-monitoring. A recent meta-analysis found a small effect of mindfulness MHapps for psychological well-being but found no significant effects for general well-being [35]. Building on these findings could provide support for MHapps that are underpinned by other psychological theories and highlight benefits for a broader sample of users. ...
Article
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Background: Among the general public, there appears to be a growing need and interest in receiving digital mental health and well-being support. In response to this, mental health apps (MHapps) are becoming available for monitoring, managing, and promoting positive mental health and well-being. Thus far, evidence supports favorable outcomes when users engage with MHapps, yet there is a relative paucity of reviews on apps that support positive mental health and well-being. Objective: We aimed to systematically review the available research on MHapps that promote emotion regulation, positive mental health, and well-being in the general population aged 18-45 years. More specifically, the review aimed at providing a systematic description of the theoretical background and features of MHapps while evaluating any potential effectiveness.
... Although somewhat limited, existing data with POC samples are promising 38 . In the case of app-based MM, multiple metanalyses show that these interventions are effective in reducing overall stress, anxiety, and depression [44][45][46] , as well as increasing mindfulness and self-compassion 45,46 . To our knowledge, experiential avoidance, rumination, and emotion suppression have not been examined as potential clinical targets in appbased MM. ...
... For any additional practice, participants will be able to select any meditation from the Ten Percent Happier library based on their preferences. This highly structured 4-week introductory course may be more likely to provide the foundation necessary for participants to benefit from MM compared with less structured programs often seen in app-based MBI research 44 . ...
... Despite extensive evidence showing the negative mental health effects of race-related stress in POC [6][7][8][9][10][11][12][13][14][15] and the promise of MM to help these individuals cope [18][19][20][21][22]24,[28][29][30]75 , this EBT continues to be understudied in this high-risk population in both traditional 28,33,34 and digital formats [44][45][46] . As such, this study seeks to address gaps in the literature by 1) recriminating a sample composed of only POC who report elevated levels of race-related stress, and 2) testing the acceptability and effectiveness of a self-guided app-based MM intervention. ...
Preprint
BACKGROUND People of color (POC) who experience race-related stress are at risk of developing mental health problems, including high levels of stress, anxiety, and depression. Mindfulness meditation (MM) may be especially well suited to help POC cope, given their emphasis on gaining awareness and acceptance of emotions associated with discriminatory treatment. However, MM rarely reaches POC, and the use of digital approaches could reduce this treatment gap by addressing traditional barriers to care. OBJECTIVE The current study will test the effectiveness of a self-directed app-based mindfulness meditation program among POC who experience elevated levels of race-related stress. Similarly, important implementation outcomes, including treatment acceptability, adherence, and satisfaction will be examined. METHODS Participants (n = 80) will be recruited online, sending emails to relevant listservs, and posting fliers in communities of color. Eligible participants will be block randomized to either 1) the intervention group (n = 40) where they will complete a self-directed 4-week MM program, or 2) a wait-list control condition (n = 40) that will receive access to the app after study completion. All participants will complete measures at baseline, mid-, and post-treatment. Primary outcomes include changes in stress, anxiety, and depression. Secondary outcomes include changes in mindfulness, self-compassion, rumination, emotion suppression, and experiential avoidance. Exploratory analyses will examine whether changes in primary outcomes are mediated by changes in the secondary outcomes. Finally, treatment acceptability, adherence, and satisfaction will be examined descriptively. RESULTS Recruitment began in October 2021. Data will be analyzed using multilevel modeling, a statistical methodology that accounts for the dependence among repeated observations. Considering issues of attrition in self-directed digital interventions and their potential effects on statistical significance and treatment effect sizes, we will examine data using both intention-to-treat and per-protocol analyses. CONCLUSIONS To our knowledge, this will be the first study to provide data on the effectiveness of an app-based mindfulness program for POC recruited based on elevated race-related stress, a high-risk population. Findings will also provide important information regarding whether a self-directed app-based MM interventions are an acceptable treatment among this underserved population. CLINICALTRIAL ClinicalTrials.gov NCT05027113; https://clinicaltrials.gov/ct2/show/NCT05027113
... Although somewhat limited, existing data with POC samples are promising [40]. In the case of app-based mindfulness meditation, multiple meta-analyses show that these interventions effectively reduce overall stress, anxiety, and depression [46][47][48] and increase mindfulness and self-compassion [47,48]. To our knowledge, experiential avoidance, rumination, and emotion suppression have not been examined as potential clinical targets in app-based mindfulness meditation. ...
... For any additional practice, participants will be able to select any meditation from the Ten Percent Happier library based on their preferences. This highly structured 4-week introductory course may be more likely to provide the foundation necessary for participants to benefit from mindfulness meditation compared with less structured programs often seen in app-based mindfulness meditation research [46]. Moreover, short-term app-based mindfulness meditation interventions (ie, 4 weeks or less) lead to lower attrition rates compared with longer programs [49]. ...
... Despite extensive evidence showing the negative mental health effects of race-related stress in POC [6][7][8][9][10][11][14][15][16][17] and the promise of mindfulness meditation to help these individuals cope [20][21][22][23][24]26,[30][31][32]79], this evidence-based treatment continues to be understudied among this high-risk population in both traditional [30,35,36] and digital formats [46][47][48]. As such, this study seeks to address gaps in the literature by (1) recruiting a sample exclusively composed of POC who report elevated levels of race-related stress and (2) testing the acceptability and effectiveness of a self-guided app-based mindfulness meditation intervention. ...
Article
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Background: People of color (POC) who experience race-related stress are at risk of developing mental health problems, including high levels of stress, anxiety, and depression. Mindfulness meditation may be especially well suited to help POC cope, given its emphasis on gaining awareness and acceptance of emotions associated with discriminatory treatment. However, mindfulness meditation rarely reaches POC, and digital approaches could reduce this treatment gap by addressing traditional barriers to care. Objective: This study will test the effectiveness of a self-directed app-based mindfulness meditation program among POC who experience elevated levels of race-related stress. Implementation outcomes such as treatment acceptability, adherence, and satisfaction will be examined. Methods: Participants (n=80) will be recruited online by posting recruitment materials on social media and sending emails to relevant groups. In-person recruitment will consist of posting flyers in communities with significant POC representation. Eligible participants will be block randomized to either the intervention group (n=40) that will complete a self-directed 4-week mindfulness meditation program or a wait-list control condition (n=40) that will receive access to the app after study completion. All participants will complete measures at baseline, midtreatment, and posttreatment. Primary outcomes include changes in stress, anxiety, and depression, and secondary outcomes constitute changes in mindfulness, self-compassion, rumination, emotion suppression, and experiential avoidance. Exploratory analyses will examine whether changes in the secondary outcomes mediate changes in primary outcomes. Finally, treatment acceptability, adherence, and satisfaction will be examined descriptively. Results: Recruitment began in October 2021. Data will be analyzed using multilevel modeling, a statistical methodology that accounts for the dependence among repeated observations. Considering attrition issues in self-directed digital interventions and their potential effects on statistical significance and treatment effect sizes, we will examine data using both intention-to-treat and per-protocol analyses. Conclusions: To our knowledge, this will be the first study to provide data on the effectiveness of a self-directed app-based mindfulness meditation program for POC recruited based on elevated race-related stress, a high-risk population. Similarly, meaningful clinical targets for POC affected by stressors related to race will be examined. Findings will provide important information regarding whether this type of intervention is an acceptable treatment among these marginalized groups. Trial Registration: ClinicalTrials.gov NCT05027113; https://clinicaltrials.gov/ct2/show/NCT05027113 International Registered Report Identifier (IRRID): DERR1-10.2196/35196
... 6 Using mobile apps to meditate has no known risks or side effects, 1 may reduce stigma, is cost-effective, and may increase the accessibility for pregnant women. 7 Over 260 mindfulness meditation apps have been identified in published literature, but many commercially available apps have a low evidence base for their efficacy, particularly among pregnant users. 7 Few meditation apps exist that are designed specifically for pregnancy and only a few general meditation apps (i.e. ...
... 7 Over 260 mindfulness meditation apps have been identified in published literature, but many commercially available apps have a low evidence base for their efficacy, particularly among pregnant users. 7 Few meditation apps exist that are designed specifically for pregnancy and only a few general meditation apps (i.e. not specifically developed with content for pregnant women) have included meditation content for pregnancy. ...
Article
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Objective The objectives of this study were to explore the satisfaction of pregnant or recently pregnant women with the existing Calm app content (i.e. non-pregnancy) and preferences and recommendations for the types of pregnancy-specific content that would be helpful to pregnant women. Methods This study was a national cross-sectional survey of subscribers to a meditation mobile app (i.e. Calm). Eligible participants were currently pregnant or recently pregnant (within the past 12 months) and used Calm during their pregnancy. Participants were asked about their Calm usage and perceived benefits of Calm during pregnancy, and interest in pregnancy-specific content. Descriptive statistics were used to characterize the sample. Results Participants ( N = 111) were on average 34 years old (SD = 5.4) and half of the sample was currently pregnant ( N = 55). The most common reasons for using the Calm app during pregnancy was for sleep problems (29%; n = 31) or anxiety (27%; n = 29). Women reported Calm was most helpful for improving sleep (32%; n = 32), anxiety (25%; n = 25), and stress (21%; n = 21). Nearly all women wanted pregnancy-specific meditation content within the app (98%; n = 98) and expressed interest in topics including pregnancy-related anxiety (68%; n = 67), postpartum (50%; n = 49), pregnancy-related sleep problems (41%; n = 40), and labor and delivery (38%; n = 37). Conclusion Women who used the Calm app during pregnancy found it helpful for improving sleep, anxiety, and stress but desire pregnancy-specific content. Future meditation mobile app studies should utilize pregnancy-specific content and test the feasibility and efficacy of sleep and mental health in pregnant women.
... To date, Headspace and Calm are the leading mindfulness meditation apps with 65 and 100 million total downloads, respectively [2,3]. Interventions using mindfulness meditation apps indicate small-to medium-sized effects on improvements in depression and anxiety, life satisfaction, and positive affect [4], and greater engagement with mental health apps is associated with larger reductions in mental health symptoms [5]. Thus, mindfulness meditation apps are easily accessible, feasible, and cost-effective tools for promoting mental health and well-being on a large scale [4]. ...
... Interventions using mindfulness meditation apps indicate small-to medium-sized effects on improvements in depression and anxiety, life satisfaction, and positive affect [4], and greater engagement with mental health apps is associated with larger reductions in mental health symptoms [5]. Thus, mindfulness meditation apps are easily accessible, feasible, and cost-effective tools for promoting mental health and well-being on a large scale [4]. Despite the potential benefits of using these apps, not everyone remains engaged [5], and existing mobile Health strategies to increase mindfulness meditation app engagement have yet to identify techniques that can increase participation, both among subscribers who are active users (ie, currently using an app on a regular or semiregular basis) and those who are inactive users (ie, those who subscribed to an app but did not or no longer use it). ...
Article
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Background Mindfulness meditation smartphone apps may improve mental health but lack evidence-based behavioral strategies to encourage their regular use for attaining mental health benefits. In October 2019, the Calm mindfulness meditation app introduced a mood check-in feature, but its effects on participation in meditation have yet to be tested. Objective The objective of this study was to investigate how a mood check-in feature impacts meditation behavior in Calm app subscribers. Methods This was a retrospective longitudinal analysis of mobile app usage data from a random sample of first-time subscribers to the Calm app (n=2600) who joined in summer 2018 or summer 2019. The mood check-in feature allows users to rate their mood using an emoji after completing a meditation session and displays a monthly calendar of their past mood check-ins. Regression analyses were used to compare the rate of change in meditation behavior before and after the introduction of mood check-ins and to estimate how usage of mood check-ins was associated with individuals’ future meditation behavior (ie, intent-to-treat effects). Additional regression models examined the heterogenous effect of mood check-ins between subscribers who were active or inactive users prior to the introduction to mood check-ins (ie, above or below the median number of weeks with any meditation within their cohort). In order to confirm the specific associations between mood check-ins and meditation engagement, we modeled the direct relationship between the use of mood check-ins in previous weeks and subsequent meditation behavior (ie, treatment on the treated effects). ResultsDuring the first 9 months of their subscription, the 2019 cohort completed an average of 0.482 more sessions per week (95% CI 0.309 to 0.655) than the 2018 cohort; however, across both cohorts, average weekly meditation declined (–0.033 sessions per week, 95% CI –0.035 to –0.031). Controlled for trends in meditation before mood check-ins and aggregate differences between the 2018 and 2019 samples, the time trend in the number of weekly meditation sessions increased by 0.045 sessions among the 2019 cohort after the introduction of mood check-ins (95% CI 0.039 to 0.052). This increase in meditation was most pronounced among the inactive subscribers (0.063 sessions, 95% CI 0.052 to 0.074). When controlled for past-week meditation, use of mood check-ins during the previous week was positively associated with the likelihood of meditating the following week (odds ratio 1.132, 95% CI 1.059 to 1.211); however, these associations were not sustained beyond 1 week. Conclusions Using mood check-ins increases meditation participation in Calm app subscribers and may be especially beneficial for inactive subscribers. Mobile apps should consider incorporating mood check-ins to help better engage a wider range of users in app-based meditation, but more research is warranted.
... Although this study was not designed to test efficacy, we found significant reductions in all outcome variables with small to medium effect sizes. The evidence regarding effectiveness of mHealth apps is limited and mixed [53,54,[56][57][58][59][60][61][62][63][64]. While several randomized controlled trials have shown these apps to be effective at reducing stress, anxiety, depression, or PTSD symptoms [53,54,57,59], some have not reported positive results [60,61,64]. ...
... While several randomized controlled trials have shown these apps to be effective at reducing stress, anxiety, depression, or PTSD symptoms [53,54,57,59], some have not reported positive results [60,61,64]. In addition, many studies report only significant pre-post results [56,58,62,63], thus limiting generalizability of the findings. Finally, several reviews have found that the majority of currently available mHealth apps are not evidence based, and lack a strong theoretical basis and research to support efficacy [65][66][67][68]. ...
Article
Background: The SARS-CoV-2 pandemic has led to concerns about mental health resulting from regional and national lockdowns, social isolation, job loss, and concern about disease exposure. Objective: We describe results of the pilot feasibility study of the See Me Serene mHealth app. The app provides users with immersive, vivid, nature experiences to reduce stress and anxiety related to COVID-19 and other isolation. The goals of the study were to develop the See Me Serene app and test the feasibility and acceptability of study procedures, and explore the potential impact of the app on stress and anxiety. Methods: We developed and tested the See Me Serene app and our study procedures for feasibility, and gathered preliminary data with a goal of 100 participants. The research was conducted in two phases: 1) development and internal testing of the app; and 2) feasibility and pilot testing with participants recruited online through earned media (e.g., news stories), presentations at a university campus, and social media (e.g., online sharing of earned media and presentations). The feasibility study employed a mixed-methods, within-subjects, pre-/post-test design. At baseline and 30-day follow-up, we assessed stress-related variables via validated self-report measures and saliva for determination of cortisol concentrations. Results: We met or surpassed all our feasibility benchmarks for recruitment (101 participants recruited), retention (91% of 30-day assessment completed), and data collection (99 participants completed all baseline data; 85% of salivary cortisol samples returned). Participants adhered to the intervention. On average, participants listened to 48.2 audio files over 30 days or approximately 1.6 audio files per day. Participants were satisfied with the app with 86.7% rating the as helpful in dealing with stress and anxiety. The app showed the potential to reduce stress, anxiety, loneliness, and worry. We did not find significant differences in cortisol levels over time. Our findings suggest that future research is warranted to test the efficacy of the See Me Serene app with a representative, diverse sample. Conclusions: There is need for evidence based and easily disseminable stress-reduction interventions. See Me Serene is a feasible intervention and has the potential to reduce stress related to COVID-19 and other forms of social isolation. More research on See Me Serene is warranted. Clinicaltrial:
... Woebot) or mindfulness-based meditation (e.g. InsightTimer, Headspace)) can reduce stress, depression, anxiety and improve psychological well-being (Firth et al., 2017a(Firth et al., , 2017bGál, Ștefan, & Cristea, 2021;Rathbone, Clarry, & Prescott, 2017). In an Australian study, it was found that among young men with MH issues, talking online helped (81%), and these men were also satisfied or very satisfied with the online help they received (83%) (Collin et al., 2011). ...
Article
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Background: Gay, bisexual and other men who have sex with men (GBMSM) are at far greater risk of experiencing poor mental health (MH) than wider society. This disparity was exacerbated by additional 'unique to sexual minority status' COVID-19 stressors. Objective: This sequential, mixed-methods study examined remote MH help-seeking among GBMSM in the U.K. and Ireland during the first COVID-19 lockdown. Methods and Results: Quantitative survey data (n = 1368), analysed with logistic regression, suggested GBMSM experiencing moderate-to-severe anxiety and those with a past MH diagnosis were most likely to seek MH support. Thematic analysis of qualitative interview (n = 18) data identified multiple barriers and enablers to GBMSM seeking remote MH help, with the help primarily sought from GBMSM-facing organisations and generic online resources. Finally, the behaviour change wheel was used to generate theoretically informed recommendations to promote MH help-seeking among GBMSM in Scotland. Implications: We discuss how applying these recommendations in the short, medium and long term will begin to address GBMSM's MH needs, post COVID-19.
... The evidence supporting the use of mindfulness meditation mobile applications (apps) for improving mental health is promising [7] and may be particularly helpful for self-managing mental health during COVID-19 while maintaining quarantine and social distancing guidelines. However, meditation behaviors of pregnant women during the pandemic is unknown. ...
... Furthermore, for well-being, the effect size in this evaluation (0.51) was above the previously observed range (k=5; effect size range: 0.14-0.45) [88]. ...
Article
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Background: There is growing evidence suggesting that the emotional wellbeing of the general public has been negatively affected within the past year. Consequently, there has been an increase in demand for wellbeing support. Whilst there is substantial empirical support for mental health apps that target diagnosed conditions, there is less research on emotional wellbeing apps. Amongst existing wellbeing apps, few studies have been conducted on apps that are based on lived experience and those that seek to enhance user's understanding of their emotional patterns. Thus, the acceptability of these novel apps will require further evaluation before upscaling. Objective: The primary aim of this evaluation is to describe the acceptability, engagement, and preliminary outcomes of using an app (Paradym) designed to promote emotional wellbeing and positive mental health. Methods: This is a pre- and post -mixed methods single-arm evaluation, aggregate with digital analytics data. We anonymously collected real world data on demographics, wellbeing, usability and acceptance of the app using validated questionnaires and open-ended questions. Participants tested the app for a minimum of 2 weeks before completing follow up measures. Google Analytics was used to record levels of app engagement. Chi Square and t-tests were conducted to analyze quantitative data, and a thematic analysis approach was adopted for qualitative data. Results: A total of 115 participants completed baseline questionnaires, of which 91 (79.13%) users downloaded the app. The sample was diverse in terms of ethnicity, including 50 (43.5%) people self-identifying as belonging to minority ethnic groups. The majority of the sample were females (78, 67.24%) and between the ages 18-25 (39, 33.62%). Thirty-four app users who completed questionnaires at baseline and follow-up provided valuable feedback to inform future directions of Paradym. Favorable themes emerged describing the app's content, functionality and underlying principles. Although usability feedback varied across items, a considerable number of participants (22, 64.7%) found that the app was easy to use. Google Analytics revealed that at least 27 (80%) persons used the app on a daily basis. Based on preliminary observations, app users experienced increased mental wellbeing. Post hoc analyses indicated that the reduction in depression scores (t33 = -2.16) and the increase on the wellbeing measures (t33 = 2.87) were statistically significant. No adverse events were reported during the evaluation period. Conclusions: The findings of this evaluation are encouraging and document positive preliminary evidence for the Paradym app. Clinicaltrial:
... Second, several biological and psychological variables may be also collected and analyzed within various populations; for example, in work and organization-related contexts, where employees experience high levels of work stress (Lucini et al., 2007;Fessell and Cherniss, 2020). Third, an interesting line of research may be to examine test anxiety, together with physiological and psychological measures, to assess other interventions, such as mindfulness and relaxing activities (e.g., yoga), or examine the effect on students with learning disabilities and/or attention deficit hyperactivity disorders (Gabriely et al., 2020;Gál et al., 2021). ...
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Test anxiety remains a challenge for students and has considerable physiological and psychological impacts. The routine practice of slow, Device-Guided Breathing (DGB) is a major component of behavioral treatments for anxiety conditions. This paper addresses the effectiveness of using DGB as a self-treatment clinical tool for test anxiety reduction. This pilot study sample included 21 healthy men and women, all college students, between the ages of 20 and 30. Participants were randomly assigned to two groups: DGB practice ( n = 10) and wait-list control ( n = 11). At the beginning and the end of 3-weeks DGB training, participants underwent a stress test, followed by measures of blood pressure and reported anxiety. Anxiety reduction in the DGB group as compared to controls was not statistically significant, but showed a large effect size. Accordingly, the clinical outcomes suggested that daily practice of DGB may lead to reduced anxiety. We assume that such reduction may lead to improved test performance. Our results suggest an alternative treatment for test anxiety that may also be relevant for general anxiety, which is likely to increase due to the ongoing COVID-19 pandemic.
... Furthermore, for well-being, the effect size in this evaluation (0.51) was above the previously observed range (k=5; effect size range: 0.14-0.45) [88]. ...
Article
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Background: There is growing evidence suggesting that the emotional well-being of the public has been negatively affected in the past year. Consequently, demand for well-being support has increased. Although there is substantial empirical support for mental health apps that target diagnosed conditions, there is less research on emotional well-being apps. Among existing well-being apps, few studies have been conducted on apps that are based on lived experience and those that seek to enhance users' understanding of their emotional patterns. Thus, the acceptability of these novel apps requires further evaluation before upscaling.
... A study by [40] raised a concern about how little educational value the socalled Educational Apps sold in the Apple App Store and Google Play Store have yet everyday new Educational Apps are added to the marketplaces without a proper regulation that give this title, [29] expressed concern on the lack of studies on the influence of mobile learning tools applied in the educational field, [44] mentions the lack of studies between the creativity of early age students and game-based learning environment, [45,46] also mentions the lack of studies confirming the efficiency of fitness apps to educate for proper exercising and feeding habits, [47] concludes in his research that the certain apps to teach about business negotiation do not have an adequate educational quality and [48] expressed the lack of understanding and awareness of apps focused on pharmacological education. ...
Article
As the use of Educational Apps rises every day and the population begins its use at an increasingly early age, it becomes relevant to understand the positive and negative aspects of this technological tool. However, the information may seem overwhelming, especially for those starting investigations on this topic. For this reason, a Systematic Literature Review was conducted on 119 published scientific papers, in order to create a work that synthesizes all the recent data about most used keywords, funding aid, authors and publishing journals, just to name a few. Additional data also reveals the need, expressed by authors and backed by their research, to evaluate the effectiveness of the Educational Apps. As an additional point, some solutions are offered to deal with the aforementioned problem, as well as some recommendations for the correct development of applications.
... Smartphone interventions have been increasingly trialled in recent years and hold many advantages, including that they can be easily tailored to the participant's needs and provide a more comfortable private environment that can be accessed anonymously, at a time and location of choice [89,90]. Mindfulness applications are very common among the domain of mental health and wellbeing, and meta-analyses have started to explore the effectiveness of mindfulness-based interventions [91]. With regard to music, there are only a few studies attesting the effectiveness of music for the regulation of mood and distress via smartphone applications [64,92]; however, none of them has explored the regulation of thoughts and/or mental states. ...
Article
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Research has shown that mind-wandering, negative mood, and poor wellbeing are closely related, stressing the importance of exploring contexts or tools that can stimulate positive thoughts and images. While music represents a promising option, work on this topic is still scarce with only a few studies published, mainly featuring laboratory or online music listening tasks. Here, I used the experience sampling method for the first time to capture mind-wandering during personal music listening in everyday life, aiming to test for the capacity of music to facilitate beneficial styles of mind-wandering and to explore its experiential characteristics. Twenty-six participants used a smart-phone application that collected reports of thought, mood, and emotion during music listening or other daily-life activities over 10 days. The application was linked to a music playlist, specifically assembled to induce positive and relaxing emotions. Results showed that mind-wandering evoked during music and non-music contexts had overall similar characteristics, although some minor differences were also observed. Most importantly, music-evoked emotions predicted thought valence, thereby indicating music as an effective tool to regulate thoughts via emotion. These findings have important applications for music listening in daily life as well as for the use of music in health interventions.
... Fourth, unlike the other psychotherapies, mindfulness does not require family involvement, thus favoring its more widespread use. Finally, its application has been actively promoted in recent years, and even apps and podcasts have been designed to facilitate its use by the population (47). All these reasons may therefore explain why mindfulness is the psychotherapeutic modality that most captures the media's attention. ...
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Background The Internet has become the main source of information on health issues, and information now determines the therapeutic preferences of patients. For this reason, it is relevant to analyze online information discussing psychotherapy. Objective To investigate tweets posted by 25 major US media outlets between 2009 and 2019 concerning psychotherapy. Methods We investigated tweets posted by 25 major US media outlets about psychotherapy between January 2009 and December 2019 as well as the likes generated. In addition, we measured the sentiment analysis of these tweets. Results Most of the tweets analyzed focused on Mindfulness (5,498), while a low number were related to Psychoanalysis (376) and even less to Cognitive-Behavioral Therapy (61). Surprisingly, Computer-supported therapy, Psychodynamic therapy, Systemic therapy, Acceptance and commitment therapy, and Dialectical behavior therapy did not generate any tweet. In terms of content, efficacy was the main focus of the posted tweets, receiving Cognitive-Behavioral Therapy and Mindfulness a positive appraisal. Conclusions US media outlets focused their interest on Mindfulness which may have contributed to the growing popularity in the past years of this therapeutic modality.
... In addition to anonymity, mental health apps encourage self-paced treatment (Cowpertwait and Clarke, 2013;Kuijpers et al., 2013). Secular mindfulness, developed on evidence-based psychological principles and used to focus and regulate one's thoughts and feelings, is well-suited to an app format with user satisfaction and acceptability demonstrated among the general population (Gál et al., 2021;Sommers-Spijkerman et al., 2021). However, evaluations of real-world psychological app trials have largely ignored the specific requirements of individuals with ASD with less than 5% of 'Autism' apps having empirical evidence supporting their use (Baumel et al., 2019;Kim et al., 2017;Linardon and Fuller-Tyszkiewicz, 2020). ...
Article
Background. We undertook a trial to examine the feasibility of a self-guided mindfulness app, Smiling Mind, for children and adults with Autism Spectrum Disorder (ASD) and their parents. The trial encountered problems in recruitment, enrollment and retention which are described here. Methods. Of 169 eligible participants, only 22 consented and were randomly assigned to Smiling Mind (n = 12) or an attention control condition (n = 10). A further six participants withdrew during the study. Barriers to trial participation were subsequently explored through semi-structured interviews, to form case studies, and a follow-up survey. Results. Interview and survey data highlighted parents’ competing time commitments as a key barrier to participation. For children and adults with ASD, distraction and boredom were major challenges to engagement. Conclusions. A number of modifiable variables in our recruitment procedures and intervention design ultimately resulted in a sample size that was too small to draw any firm conclusions from. Future ASD research can maximize sampling by broadening recruitment strategies and partnering with community services and schools. Engagement in mindfulness could also be improved by incorporating regular communication to motivate time poor participants.
... Considering the pandemic conditions and the difficulty in getting professional help, developing mindfulness practices via the internet is especially interesting. Mindfulness meditation apps have low or medium effects on perceived stress or anxiety symptoms, although there is no evidence of their long-term effectiveness [33]. Other online mindfulness-based interventions are also promising, with the most promising findings for stress [34]. ...
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Social distancing plays a leading role in controlling the spread of coronavirus. However, prolonged lockdown can lead to negative consequences in terms of mental health. The goal of the research is to examine the relationship between anxiety and general psychosomatic functioning during the COVID-19 pandemic; the impact of psychological flexibility and mindfulness is also considered. Variables were measured with self-report questionnaires and symptom checklists. The sample included 170 people (M = 27.79, SD = 8.16). Pearson's correlation, stepwise regression, and path analysis were conducted. The results showed a significant positive relationship between state anxiety and somatic and psychological responses to the pandemic. Path analysis revealed that mindfulness had a direct negative impact on and decreased the level of state anxiety (b = −0.22, p = 0.002), whereas psychological flexibility influenced the variable indirectly (b = 0.23, p = 0.002) by enhancing psychosomatic functioning (b = −0.64, p < 0.001). Psychological flexibility and mindfulness may mediate the development of mental disorders and facilitate achieving overall wellbeing. The study points to the usefulness of mindfulness practice as a form of self-help with anxiety symptoms; this is crucial during the pandemic because contact with clients is restricted.
... Future quantitative work could also clarify the mechanisms by which meditation training may reduce affective polarization. It would be valuable to replicate the current study using a highly scalable selfguided meditation intervention (e.g., delivered via smartphone app; Gál et al., 2021), which could represent a feasible pathway to effecting changes in social discourse. ...
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Objectives The European Union Brexit referendum has split the British electorate into two camps, with high levels of affective polarization between those who affiliate with the Remain side (Remainers) and the Leave side (Leavers) of the debate. Previous research has shown that a brief meditation intervention can reduce affective polarization, but no study has thus far investigated the effects of an 8-week mindfulness program on affective polarization. This is what will be examined in this study. Methods The present study used a randomized waitlist control design (n = 177) with a 1-month post-intervention follow-up to investigate whether an 8-week mindfulness program delivered online would have an effect on affective polarization among Remainers and Leavers. Results Results showed significantly greater reductions in affective polarization over time for participants in the mindfulness condition relative to participants in the waitlist control condition (time X group B = − 0.087, p = .024). Conclusions Taken together, the findings highlight the potential of mindfulness training as a means to reduce intergroup biases in political contexts. Trial Registration Preregistered on the Open Science Framework at https://osf.io/px8m2.
... A recent meta-analysis found promising results for smartphone-delivered mindfulness meditation apps in clinical and non-clinical populations for multiple psychological outcomes including anxiety, depressive symptoms, quality of life and perceived stress. 30 Moreover, smartphone-delivered apps including mindfulness and acceptance components seem to improve both components. 32 Given the emotional burden of infertility 5 and its treatment, 6 7 33 and the time cost of fertility treatment, people experiencing infertility require easily accessible, low intensive strategies to improve their mental health. ...
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Introduction Infertility and its treatment bring a considerable emotional burden. Increasing evidence demonstrates the effectiveness of smartphone-delivered mindfulness apps for reducing symptoms of emotional distress in both clinical and non-clinical populations. Evidence on this topic in women, men and couples experiencing infertility is currently under-represented. The aim of the MoMiFer study is, therefore, to investigate the efficacy of a stand-alone mobile mindfulness app on symptoms of emotional distress and fertility-related quality of life in people experiencing infertility. Methods and analysis This study is an exploratory randomised controlled trial (RCT) with open enrollment. The primary outcomes are symptoms of emotional distress and fertility-related quality of life. Secondary outcomes are mindfulness skills, repetitive negative thinking, self-compassion, user-rated quality of the stand-alone mobile mindfulness app and use of the app. Experience sampling method and standardised self-report questionnaires are combined within a repeated measures design to measure the effects of the stand-alone mobile mindfulness app on the primary and secondary outcomes, apart from the use of the app. The latter will be evaluated through app tracking. People, including women, men and couples, experiencing infertility (n=60) will be randomised to an intervention group receiving the stand-alone mobile mindfulness app for 3 months or a wait-list control group. The app follows the format and content of Mindfulness-Based Stress Reduction. Data will be collected at baseline, at 1.5 months and 3 months after randomisation. Analysis will be according to intention to treat and based on general linear modelling and multilevel mixed-effects modelling. Ethics and dissemination This study received approval from the Medical Ethical Committee of the Leuven University Hospital (Belgium). The findings of this exploratory RCT will be disseminated through presentations at public lectures, scientific institutions and meetings, and through peer-reviewed scientific articles. Trial registration number NCT04143828 .
... Not all participants used the meditation app as instructed. Choosing not to adhere to or complete mindfulness meditation interventions is common (Cavanagh et al., 2014;Gál et al., 2021;Parsons et al., 2017;Shapiro et al., 2005). For example, in one large study of a mindfulness intervention using a mobile app, only 24% of participants completed the intervention (Mak et al., 2018). ...
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Purpose: The purpose of this study was to explore emergency care nurses' experiences of an intervention to increase compassion and empathy and reduce stress through individual mindfulness training delivered via workshops and a smartphone application. We also explored how the nurses felt about the practical and technical aspects of the intervention. Design: Qualitative interview study. Method: Individual interviews were conducted with eight of the 56 participants in the intervention study and used phenomenological analysis to illuminate how they made sense of their lived experiences of mindfulness training. Findings: Three themes illuminated the nurses' experiences: becoming aware, changing through mindfulness, and gaining the tools for mindfulness through workshops and the mobile application. The first two themes expressed personal experiences, whereas the third expressed experiences of the practical and technical aspects of the intervention. Most nurses found the mobile application easy to use and effective. Conclusions: Emergency care nurses can feel that the awareness and changes that come with mindfulness training benefit them, their colleagues, and the patients for whom they care. The findings also provide insights into the challenges of practicing mindfulness in a busy emergency care setting and into the practical aspects of using a smartphone application to train mindfulness.
... Many studies have reported that trait mindfulness is negatively correlated with PTSS (Chen et al., 2019;Reffi et al., 2019;Wen et al., 2021) and a meta-analysis found that mindfulness-based interventions can reduce PTSS (Hopwood & Schutte, 2017). Therefore, mindfulness may help alleviate PTSS caused by Previous studies have reported that physical and mental health are improved after standard group mindfulness training (Gál et al., 2020). Unlike traditional face-to-face mindfulness intervention, smart mobile phone applications and web-based platforms can provide new avenues for autonomous mindfulness exercises. ...
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Investigating the contributing factors of post-traumatic stress symptoms (PTSS) has always been an important topic in the field of traumatic psychology research. The current study explored the influences of pandemic/epidemic experiences, meditation experiences, and trait mindfulness on PTSS and the mediating role of emotional resilience during the COVID-19 pandemic. A total of 522 participants in Hubei province completed the Five Facet Mindfulness Questionnaire, the Adolescents’ Emotional Resilience Questionnaire, and the PTSD Checklist for DSM-5. The results showed that (1) participants who had family or friends diagnosed with COVID-19 scored higher on avoidance. (2) Participants who had family or friends had been diagnosed with SARS or H1N1 scored higher on PTSS. (3) Participants with meditation experience scored significantly higher on all dimensions of PTSS, other than avoidance. (4) The mediating role of recovering from negative emotions in the relationship between trait mindfulness and PTSS was significant (95%CI= [-0.212, -0.094]), while the generating positive emotion was not significant (95%CI= [-0.050, 0.071]). Individuals with pandemic/epidemic experience are more likely to have a high level of PTSS. Individuals who have meditation experience also express a higher level of PTSS, which may be a result of the quality of meditation. Trait mindfulness and the ability to recover from negative emotions were protective factors against PTSS.
... Similarly, Spijkerman et al.'s (2016) meta-analytic review of 15 randomised controlled trials revealed support for online MBIs, and also demonstrated that the largest effect was on stress, with a moderate effect size. There is also now increasing research evidence for the efficacy and value of mindfulness apps (e.g., Smiling Mind, 2021; Headspace, 2022) for improving wellbeing (Howells et al., 2016;Flett et al., 2019;Gál et al., 2021;Lahtinen et al., 2021;Orosa-Duarte et al., 2021). ...
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The efficacy of mindfulness-based interventions in randomised-controlled trials and large experimental studies has been demonstrated in university student populations. Whilst these investigations have provided insight into the nature of the delivery of mindfulness-based practices, there has been little research in the implementation of self-managed online student wellbeing and mindfulness programs at university. This ecological validation study conducted in 2020 evaluated a real-world implementation of a large, university-wide, online mindfulness-based program that was accessible fully online via the tertiary institutions’ Learning Management System (LMS) student orientation site. The total sample included 833 participants from a range of disciplines and faculties at Monash University, Australia. At the end of the study, 236 (28.3%) participants were retained and completed the follow-up survey. Participants had the option to engage with the fully self-managed online mindfulness program for a 12-week semester. The mindfulness practices were pre-recorded, audio-guided sessions, and 10–15 min in length. Baseline and end of semester questionnaires included the 14-item Warwick-Edinburgh Mental Wellbeing Scale, 10-item Perceived Stress Scale and the 18-item Five Facet Mindfulness Questionnaire. Participants who engaged with the mindfulness program over 3 or more weeks showed significant improvements in all three outcome measures, and all participants showed significant improvements in wellbeing at the end of semester. Learning analytics obtained via the LMS revealed that 58.6% (n = 489) had not logged into the mindfulness program at all, almost a third (31.0%, n = 259) logged into the program materials once or twice, and 10.2% (n = 85) of the whole sample engaged with the program actively, having logged in three or more times. The total number of student logins peaked in week 2, reduced between week 2 and week 7 and thereafter activity remained stable until the end of the semester. We hypothesise that the changes in wellbeing, stress and mindfulness at the end of the semester seen in the low engagement participants may partly be explained by the circumstances of COVID-19 restrictions improving. This study has revealed and discusses the complexities of student behaviour and implications for implementing an online mindfulness program in the real- world setting of a university.
... A recent meta-analysis of 34 randomized trials of mindfulness apps found significant small-medium improvements on stress, anxiety, depression, and psychological well-being (g = 0.28-0.46) across healthy, psychiatric, and medical samples, though the number of studies was low for specific populations and outcomes (Gál et al. 2020). Huberty et al. (2019) recently analyzed the clinical characteristics, usage patterns, and changes in health outcomes of 12,151 paying Calm subscribers. ...
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Objectives Cardiovascular disease (CVD) is the leading cause of death worldwide and is highly comorbid with emotional disorders. Mindfulness meditation can improve health outcomes in people with CVD. Calm is the most popular smartphone meditation app, but the usage patterns among people with CVD have not been explored.Methods We conducted a secondary analysis of a cross-sectional survey study among N = 1512 Calm subscribers with CVD to explore user characteristics, usage patterns, and health changes, and compare the results among those with and without co-occurring anxiety or depression.ResultsUsers were primarily white (83%), female (74%), and had relatively high income (45% with > $100,000/year). Most (67%) used Calm at least 5 ×/week and started using Calm to help with sleep (69%) and stress (67%). More users with anxiety or depression, compared to CVD-only, started Calm to help with stress (71% vs. 64%) and anxiety or depression (77% vs. 37%), and used components incorporating sounds and physical movements more often (all p’s < 0.05). Most participants reported changes in sleep, stress, and physical and mental health (60–79%), though changes were more prevalent among those with anxiety or depression (p’s < 0.001). More frequent Calm use was associated with greater health changes (p’s < 0.05).Conclusions Calm users with CVD use the app regularly to help with health promotion and, particularly those with anxiety or depression, perceive health changes from their Calm use. Randomized controlled trials are needed to establish the efficacy and optimal dose of Calm use for people with CVD.
Article
Background: There is a need to regularly update the evidence base on the effectiveness of online mindfulness-based interventions (MBIs), especially considering how fast this field is growing and developing. Objective: This study presents an updated meta-analysis of randomized controlled trials assessing the effects of online MBIs on mental health and the potential moderators of these effects. Methods: We conducted a systematic literature search in PsycINFO, PubMed, and Web of Science up to December 4, 2020, and included 97 trials, totaling 125 comparisons. Pre-to-post and pre-to-follow-up between-group effect sizes (Hedges g) were calculated for depression, anxiety, stress, well-being, and mindfulness using a random effects model. Results: The findings revealed statistically significant moderate pre-to-post effects on depression (g=0.34, 95% CI 0.18-0.50; P<.001), stress (g=0.44, 95% CI 0.32-0.55; P<.001), and mindfulness (g=0.40, 95% CI 0.30-0.50; P<.001) and small effects on anxiety (g=0.26, 95% CI 0.18-0.33; P<.001). For well-being, a significant small effect was found only when omitting outliers (g=0.22, 95% CI 0.15-0.29; P<.001) or low-quality studies (g=0.26, 95% CI 0.12-0.41; P<.001). Significant but small follow-up effects were found for depression (g=0.25, 95% CI 0.12-0.38) and anxiety (g=0.23, 95% CI 0.13-0.32). Subgroup analyses revealed that online MBIs resulted in higher effect sizes for stress when offered with guidance. In terms of stress and mindfulness, studies that used inactive control conditions yielded larger effects. For anxiety, populations with psychological symptoms had higher effect sizes. Adherence rates for the interventions ranged from 35% to 92%, but most studies lacked clear definitions or cut-offs. Conclusions: Our findings not only demonstrate that online MBIs are booming but also corroborate previous findings that online MBIs are beneficial for improving mental health outcomes in a broad range of populations. To advance the field of online MBIs, future trials should pay specific attention to methodological quality, adherence, and long-term follow-up measurements.
Article
Introduction: The past several years have witnessed a significant increase in interest among the public in mindfulness with an unmistakable growth in the scientific literature investigating mindfulness-based therapies. A myriad of therapeutic uses of mindfulness have been studied. Given this burgeoning interest, the authors' objective was to conduct a broad-sweeping bibliometric analysis over the past two decades to describe overarching trends in the publications of randomized controlled trials (RCTs) investigating mindfulness to broadly identify both strengths and gaps in this field and inform a strategic plan for further advancing this research area. Materials and Methods: The authors retrieved mindfulness-focused RCTs available on PubMed in the past two decades (2000-2019). They synthesized the literature with respect to publication numbers, countries of publication, journal type, areas of research focus, characteristics of study designs, sample size, and trends in remote intervention delivery. Results: The resulting 1389 publications represent a near exponential growth trend over the past 20 years. Publications from the top three countries (the United States, the United Kingdom, and the Netherlands) with the highest productivity accounted for 60% of total number of publications. The most published modalities include acceptance-based therapy (n = 260), mindfulness-based stress reduction (n = 238), mindfulness-based cognitive therapy (n = 174), and dialectical behavior therapy (n = 82). Stress, depression, anxiety, pain, cancer, diet/healthy eating, and sleep were the most common major areas of focus. Studies included active (46%) or inactive controls (44%), and increasingly more studies with both types of controls (10%). The top 10 journals that published the most mindfulness RCTs were from behavioral sciences and psychiatry or psychology. There were 187 RCTs utilizing remote delivery, with 146 (87.1%) in the most recent 5 years. Conclusion: Publications of mindfulness-focused RCTs show a continuous increasing trend. Mindfulness research from non-Western countries and studies published in biomedical journals were less prevalent and potentially represent future opportunities. Trends of studies with both inactive and active controls support an overall advancement in research methodology. There has been a significant expansion of studies of remotely delivered mindfulness interventions. Future research might consider evaluation of a broader range of modalities and further examine optimal delivery formats.
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Purpose of Review We summarized peer-reviewed literature investigating the effect of virtual mindfulness-based interventions (MBIs) on sleep quality. We aimed to examine the following three questions: (1) do virtual MBIs improve sleep quality when compared with control groups; (2) does the effect persist long-term; and (3) is the virtual delivery method equally feasible compared to the in-person delivery method? Recent Findings Findings suggest that virtual MBIs are equivalent to evidence-based treatments, and to a limited extent, more effective than non-specific active controls at reducing some aspects of sleep disturbance. Overall, virtual MBIs are more effective at improving sleep quality than usual care controls and waitlist controls. Studies provide preliminary evidence that virtual MBIs have a long-term effect on sleep quality. Moreover, while virtual MBI attrition rates are comparable to in-person MBI attrition rates, intervention adherence may be compromised in the virtual delivery method. Summary This review highlights virtual MBIs as a potentially effective alternative to managing sleep disturbance during pandemic-related quarantine and stay-at-home periods. This is especially relevant due to barriers of accessing in-person interventions during the pandemic. Future studies are needed to explore factors that influence adherence and access to virtual MBIs, with a particular focus on diverse populations.
Article
Background: The benefits of mindfulness interventions are well-known, but their challenges and individual differences in reactions to these challenges are much less clear. Methods: The study used a mixed-methods design to investigate the individual trajectories of daily experiences during meditation in a sample of novice volunteers participating in a 3-week, distance-based, guided meditation intervention (N = 175). Results: Multilevel modelling revealed individual differences in the change trajectories of the experiences of effort, meaning, and boredom during meditation, indicating that meditation gradually became less effortful, less boring, more interesting, and more important over the 3 weeks. The individual differences in the levels of these experiences and their change trends were associated with baseline differences in well-being, reflective processes, self-management, and self-control skills, as well as autonomous motivation to engage in the course. Conclusions: Individuals who are initially more autonomous and mindful find it easier to engage with online mindfulness interventions and draw more benefits from the process, whereas those with lower self-regulation skills or higher proneness to rumination are more likely to experience mindfulness as effortful and boring, and, eventually, to give it up.
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V monografiji avtorice predstavljajo ugotovitve več raziskav, ki so jih izvedle v zadnjih desetih letih, in jih umestijo na področje pozitivne psihologije, ki se je kot znanstvena disciplina uveljavila po letu 2000. Kot teoretični okvir v prvem poglavju predstavijo raziskave laičnega pojmovanja sreče in teoretične modele subjektivnega blagostanja. Poudarek na znanstveni ustreznosti merskih instrumentov v pozitivni psihologiji je spodbudil interes za konstrukt subjektivnega blagostanja tudi na drugih področjih psihologije.
Article
Background: Among the general public, there appears to be a growing need and interest in receiving digital mental health and well-being support. In response to this, mental health apps (MHapps) are becoming available for monitoring, managing, and promoting positive mental health and well-being. Thus far, evidence supports favorable outcomes when users engage with MHapps, yet there is a relative paucity of reviews on apps that support positive mental health and well-being. Objective: We aimed to systematically review the available research on MHapps that promote emotion regulation, positive mental health, and well-being in the general population aged 18-45 years. More specifically, the review aimed at providing a systematic description of the theoretical background and features of MHapps while evaluating any potential effectiveness. Methods: A comprehensive literature search of key databases, including MEDLINE (via Ovid), EMBASE (via Ovid), PsycINFO (via Ovid), Web of Science, and the Cochrane Register of Controlled Trials (CENTRAL), was performed until January 2021. Studies were included if they described standalone mental health and well-being apps for adults without a formal mental health diagnosis. The quality of all studies was assessed against the Mixed Methods Appraisal Tool. In addition, the Cochrane Risk-of-Bias tool (RoB-2) was used to assess randomized control trials (RCTs). Data were extracted using a modified extraction form from the Cochrane Handbook of Systematic Reviews. A narrative synthesis and meta-analysis were then undertaken to address the review aims. Results: In total, 3156 abstracts were identified. Of these, 52 publications describing 48 MHapps met the inclusion criteria. Together, the studies evaluated interventions across 15 countries. Thirty-nine RCTs were identified suggesting some support for the role of individual MHapps in improving and promoting mental health and well-being. Regarding the pooled effect, MHapps, when compared to controls, showed a small effect for reducing mental health symptoms (k=19, Hedges g=-0.24, 95% CI -0.34 to -0.14; P<.001) and improving well-being (k=13, g=0.17, 95% CI 0.05-0.29, P=.004), and a medium effect for emotion regulation (k=6, g=0.49, 95% CI 0.23-0.74, P<.001). There is also a wide knowledge base of creative and innovative ways to engage users in techniques such as mood monitoring and guided exercises. Studies were generally assessed to contribute unclear or a high risk of bias, or to be of medium to low methodological quality. Conclusions: The emerging evidence for MHapps that promote positive mental health and well-being suggests promising outcomes. Despite a wide range of MHapps, few apps specifically promote emotion regulation. However, our findings may position emotion regulation as an important mechanism for inclusion in future MHapps. A fair proportion of the included studies were pilot or feasibility trials (k=17, 33%), and full-scale RCTs reported high attrition rates and nondiverse samples. Given the number and pace at which MHapps are being released, further robust research is warranted to inform the development and testing of evidence-based programs.
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The Learning Sciences, and specifically Mind, Brain, (Health), and Education science, contribute to our understanding of the teaching-learning dynamic. This brief (8,000 word) article captures the highlights of human understanding about the brain and its role in learning from ancient civilizations to the present.
Article
Background: Physical and mental health benefits can be attained from persistent, long-term performance of mindfulness meditation with a mobile meditation app, but in general, few mobile health app users persistently engage at a level necessary to attain the corresponding health benefits. Anchoring or pairing meditation with a mobile app to an existing daily routine can establish an unconsciously initiated meditation routine that may improve meditation persistence. Objective: The purpose of this study was to test the use of either personalized anchors or fixed anchors for establishing a persistent meditation app routine with the mobile app, Calm. Methods: We conducted a randomized controlled trial and randomly assigned participants to one of 3 study groups: (1) a personalized anchor (PA) group, (2) fixed anchor (FA) group, or (3) control group that did not use the anchoring strategy. All participants received app-delivered reminder messages to meditate for at least 10 minutes a day using the Calm app for an 8-week intervention period, and app usage data continued to be collected for an additional 8-week follow-up period to measure meditation persistence. Baseline, week 8, and week 16 surveys were administered to assess demographics, socioeconomic status, and changes in self-reported habit strength. Results: A total of 101 participants across the 3 study groups were included in the final analysis: (1) PA (n=56), (2) FA (n=49), and (3) control group (n=62). Participants were predominantly White (83/101, 82.2%), female (77/101, 76.2%), and college educated (ie, bachelor's or graduate degree; 82/101, 81.2%). The FA group had a significantly higher average odds of daily meditation during the intervention (1.14 odds ratio [OR]; 95% CI 1.02-1.33; P=.04), and all participants experienced a linear decline in their odds of daily meditation during the 8-week intervention (0.96 OR; 95% CI 0.95-0.96; P<.001). Importantly, the FA group showed a significantly smaller decline in the linear trend of their odds of daily meditation during the 8-week follow-up (their daily trend increased by 1.04 OR from their trend during the intervention; 95% CI 1.01-1.06; P=.03). Additionally, those who more frequently adhered to their anchoring strategy during the intervention typically used anchors that occurred in the morning and showed a significantly smaller decline in their odds of daily meditation during the 8-week follow-up period (1.13 OR; 95% CI 1.02-1.35; P=.007). Conclusions: The FA group had more persistent meditation with the app, but participants in the FA or PA groups who more frequently adhered to their anchoring strategy during the intervention had the most persistent meditation routines, and almost all of these high anchorers used morning anchors. These findings suggest that the anchoring strategy can create persistent meditation routines with a mobile app. However, future studies should combine anchoring with additional intervention tools (eg, incentives) to help more participants successfully establish an anchored meditation routine. Trial registration: ClinicalTrials.gov NCT04378530; https://clinicaltrials.gov/ct2/show/NCT04378530.
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Background Stress can compromise parental well-being and may contribute to harsh and critical parenting styles, which are in turn associated with children's conduct problems. Coronavirus disease 2019 (COVID-19)-related restrictions are likely to have exacerbated parental stress as, for many, UK-based family life was altered considerably. Mindfulness has been demonstrated to improve stress management and emotion regulation when delivered to parents in person, however, more accessible online interventions are under-researched. Aims To provide preliminary data on family well-being and parent–child relationships as well as the acceptability and usability of the Headspace app – a self-delivered mindfulness-based intervention – for parents in low-risk families during the early days of the COVID-19 pandemic. Method We provided 12 parents with access to Headspace, and collected qualitative data (semi-structured interviews and 5 minute speech samples) immediately following the initial COVID-19 lockdown in the UK. The resulting transcripts were thematically analysed. Results Most parents reported Headspace to be acceptable and useful – improvements in parents’ own sleep were particularly noted – and there was high adherence to the intervention. However, difficulties related to family well-being and parent–child relationships following the lockdown were also reported. Conclusions As a result of the confounding impact of COVID-19 restrictions, and varied access to app content, we were unable to determine any outcomes to be a result of practising mindfulness specifically. However, COVID-19 has had a profound impact on many UK-based families, including those previously at low risk, and our results demonstrate that Headspace may have beneficial effects for parents. There is a need to more rigorously test this tool with a broader range of families.
Article
Background: Mindfulness has become increasingly popular, and positive outcomes have been reported for mindfulness-based interventions (MBIs) in reducing stress. These findings make room for innovative perspectives on how MBIs could be applied, for instance through mobile health (mHealth). Objective: The aim of this study is to investigate whether a nonguided mindfulness mobile app can decrease perceived stress in a nonclinical Dutch population over the course of 8 weeks, with follow-up at 6 months. Methods: A randomized controlled trial was performed to compare an experimental group that made use of a structured 8-week mHealth mindfulness program and a control group after 8 weeks, with follow-up after 6 months. Participants were recruited via a national television program. The primary outcome measure was perceived stress as measured by the Perceived Stress Scale, secondary outcomes were symptoms of burnout (measured using the visual analog scale [VAS]) and psychological symptoms (measured using the Four-Dimensional Symptom Questionnaire [4DSQ] at follow-up). Outcomes were analyzed using a multilevel regression model. Results: At baseline, 587 respondents were included. Results showed no postintervention differences between groups for the level of perceived stress. With regard to the secondary outcome measures, the VAS for emotional exhaustion and physical exhaustion showed significantly lower scores for the experimental group after 8 weeks (P=.04 and P=.01, respectively), but not at follow-up. There were no differences between groups for psychological symptoms measured using the 4DSQ. Conclusions: These findings do not support our hypothesis that using the mindfulness app would reduce stress levels. However, our findings related to diminished exhaustion at 8 weeks are encouraging and require further investigation. Trial registration: ClinicalTrials.gov NCT05246800; https://clinicaltrials.gov/show/NCT05246800.
Article
Background Despite numerous gaps in the literature, mindfulness training in the workplace is rapidly proliferating. Many “online” or “digital mindfulness” programs do not distinguish between live teaching and recorded or asynchronous sessions, yet differences in delivery mode (eg, face-to-face, online live, online self-guided, other) may explain outcomes. Objective The aim of this study was to use existing data from an online mindfulness solutions company to assess the relative contribution of live and recorded mindfulness training to lower perceived stress in employees. Methods Perceived stress and the amount of live and recorded online mindfulness training accessed by employees were assessed during eMindful’s One-Percent Challenge (OPC). The OPC is a 30-day program wherein participants are encouraged to spend 1% of their day (14 minutes) practicing mindfulness meditation on the platform. We used linear mixed-effects models to assess the relationship between stress reduction and usage of components of the eMindful platform (live teaching and recorded options) while controlling for potential reporting bias (completion) and sampling bias. Results A total of 8341 participants from 44 companies registered for the OPC, with 7757 (93.00%) completing stress assessments prior to the OPC and 2360 (28.29%) completing the postassessment. Approximately one-quarter of the participants (28.86%, 2407/8341) completed both assessments. Most of the completers (2161/2407, 89.78%) engaged in the platform at least once. Among all participants (N=8341), 8.78% (n=707) accessed only recorded sessions and 33.78% (n=2818) participated only in the live programs. Most participants engaged in both live and recorded options, with those who used any recordings (2686/8341, 32.20%) tending to use them 3-4 times. Controlling for completer status, any participation with the eMindful OPC reduced stress (B=–0.32, 95% CI –0.35 to –0.30, SE=0.01, t2393.25=–24.99, P<.001, Cohen d=–1.02). Participation in live programs drove the decrease in stress (B=–0.03, SE=0.01, t3258.61=–3.03, P=.002, d=–0.11), whereas participation in recorded classes alone did not. Regular practice across the month led to a greater reduction in stress. Conclusions Our findings are in stark contrast to the rapid evolution of online mindfulness training for the workplace. While the market is reproducing apps and recorded teaching at an unprecedented pace, our results demonstrate that live mindfulness programs with recorded or on-demand programs used to supplement live practices confer the strongest likelihood of achieving a significant decrease in stress levels.
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Abstrak Pandemi COVID-19 menyebabkan berbagai krisis pada kehidupan sosial, ekonomi dan kesehatan mental masyarakat.. Kesejahteraan psikologis yang baik pada situasi pandemi sangat diperlukan karena keadaan emosi yang positif dapat meningkatkan imunitas. Tujuan dari penelitian ini adalah untuk mengidentifikasi pengaruh intervensi mindfulness terhadap kesejahteraan psikologis dalam situasi krisi pandemi COVID-19.Penelitian ini merupakan semi systematic literature review. Pencarian literatur dilakukan melalui database online seperti Science Direct, PubMed, dan Google Schoolar dengan kata kunci"mindfulness", "psychological well being", "Mental health" dan "Covid-19". Artikel diseleksi menggunakan kerangka PRISMA. Hasil didapatkan 8 artikel yang memenuhi kriteria inklusi. Berdasarkan hasil analisis dari 8 artikel Intervensi mindfulness dapat meningkatkan fleksibilitas emosional dapat meminimalkan kemungkinan terhadap stress, kecemasan, dan kesejahteraan psikologis. Dapat disimpulkan bahwa intervensi mindfulness memiliki pengaruh yang positif terhadap peningkatan kesejahteraan psikologis pada krisis pandemi COVID-19. Abstract The COVID-19 pandemic has caused various crises in people's social, economic and mental health. High psychological well-being in a pandemic situation is very necessary because a positive emotional state can increase immunity. The purpose of this study was to identify the effect of mindfulness interventions on psychological well-being in the crisis situation of COVID-19 pandemic. This study is a semi-systematic literature review. Literature searches were conducted through online databases such as Science Direct, PubMed, and Google Schoolar with the keywords "mindfulness", "psychological well being", "Mental health" and "Covid-19". Articles were selected using the PRISMA framework. The results obtained 8 articles that meet the inclusion criteria. Based on the results analysis of the 8 articles, mindfulness interventions can increase emotional flexibility and minimize the possibility of stress, anxiety, and increase psychological well-being. It can be concluded that mindfulness interventions have a positive effect on improving psychological well-being during the COVID-19 pandemic crisis.
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Purpose: This study aimed to systematically evaluate the content and effect of using Korean mobile apps for mental health care as reported in previous studies.Methods: We conducted a systematic review according to PRISMA guidelines. Randomized controlled trials published up to May 2021 were searched in the PubMed, Cochrane Library, EMBASE, CINAHL, PsycINFO, RISS, KISS, and KoreaMed databases. We used the Cochrane risk-of-bias tool version 2 for randomized trials to evaluate the selected studies.Results: Out of 3,374 articles retrieved, 12 were selected. These studies included people with mental disorders (mood disorder, panic disorder, or obsessive-compulsive disorder), psychiatric symptoms (depression, anxiety, attention deficit, etc.), and people in specific groups (college students or nurses). The apps were based on cognitive-behavioral therapy, cognitive training, well-being cognition technique, or relaxation techniques. The apps were effective in reducing depression, anxiety, panic attacks, attention deficit, negative emotions, and dysfunctional attitudes, and boosting memory and positive emotions.Conclusion: Mobile apps with well-established, theory-based content can serve as an effective intervention for managing several mental health symptoms. However, the scope of the research subjects and symptoms in Korea remains limited. Further studies with more varied populations and symptoms are required.
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This paper provides a framework for understanding why, when, and how to adapt mindfulness-based programs (MBPs) to specific populations and contexts, based on research that developed and adapted multiple MBPs. In doing so, we hope to support teachers, researchers and innovators who are considering adapting an MBP to ensure that changes made are necessary, acceptable, effective, cost-effective, and implementable. Specific questions for reflection are provided such as: (1) Why is an adaptation needed? (2) Does the theoretical premise underpinning mainstream MBPs extend to the population you are considering? (3) Do the benefits of the proposed adaptation outweigh the time and costs involved to all in research and implementation? (4) Is there already an evidenced-based approach to address this issue in the population or context? Fundamental knowledge that is important for the adaptation team to have includes: (1) essential ingredients of MBPs, (2) etiology of the target health outcome, (3) existing interventions that work for the health outcome, population, and context, (4) delivery systems and settings, and (5) culture, values, and communication patterns of the target population. A series of steps to follow for adaptations is provided, as are case examples. Adapting MBPs happens not only by researchers, but also by MBP teachers and developers, who endeavour to best serve the populations and contexts they work within. We hope that these recommendations for best practice provide a practical framework for skilfully understanding why, when, and how to adapt MBPs; and that this careful approach to adaptation maximizes MBP safety and efficacy.
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Objectives: To evaluate the feasibility of a randomised trial of a modified, pre-existing, mindfulness meditation smartphone app for women with chronic pelvic pain. Design: Three arm randomised feasibility trial. Setting: Women were recruited at two gynaecology clinics in the UK. Interventions were delivered via smartphone or computer at a location of participants choosing. Participants: Women were eligible for the study if they were over 18, had been experiencing organic or non-organic chronic pelvic pain for 6 months or more, and had access to a computer or smartphone. 90 women were randomised. Interventions: Daily mindfulness meditation delivered by smartphone app, an active control app which delivered muscle relaxation techniques, and usual care without app. Interventions were delivered over 60 days. Primary and secondary outcome measures: Outcomes included length of recruitment, follow-up rates, adherence to the app interventions, and clinical outcomes measured at baseline, two, three and 6 months. Results: The target sample size was recruited in 145 days. Adherence to the app interventions was extremely low (mean app use 1.8 days mindfulness meditation group, 7.0 days active control). Fifty-seven (63%) women completed 6-month follow-up, and 75 (83%) women completed at least one postrandomisation follow-up. The 95% CIs for clinical outcomes were consistent with no benefit from the mindfulness meditation app; for example, mean differences in pain acceptance scores at 60 days (higher scores are better) were -2.3 (mindfulness meditation vs usual care, 95% CI: -6.6 to 2.0) and -4.0 (mindfulness meditation vs active control, 95% CI: -8.1 to 0.1). Conclusions: Despite high recruitment and adequate follow-up rates, demonstrating feasibility, the extremely low adherence suggests a definitive randomised trial of the mindfulness meditation app used in this study is not warranted. Future research should focus on improving patient engagement. Trial registration numbers: NCT02721108; ISRCTN10925965; Results.
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Background: Compulsive Internet use (CIU) refers to those individuals who experience a loss of control regarding their online use. Although suffered by a minority, a much larger proportion of adults report to be experiencing early signs of CIU, which can become more problematic if sustained over time, especially when used as a coping mechanism for stress. Since compulsive behaviors are characterized by executing behaviors on "automatic pilot," mindfulness techniques, which help individuals relate more consciously with their environment, could help develop a more adaptive relationship with technology. However, mindfulness interventions are often lengthy hence not ideal for busy individuals with early signs of CIU. Aims: This study tested the effectiveness of a brief mindfulness intervention (10 min a day for 2 weeks) to reduce CIU and anxiety and depression symptoms, in relation to an equivalent length classic arousal descending technique (i.e., gradual-muscle-relaxation), and a wait-list control group. Methods: A randomized controlled trial (RCT) was used with assessments at pre- and post-phases. Participants showing initial signs of CIU were allocated to a mindfulness-group (n = 343), gradual-relaxation (n = 301), or a wait-list control group (n = 350). Results: The mindfulness and gradual-muscle-relaxation participants were equally effective in reducing anxiety and depression. The mindfulness intervention was more effective reducing CIU symptoms. Discussion: Given the large sample sizes of this RCT, these results are promising, although follow-up studies are needed. Considering health hazards of the "always-on-culture" and the popularity of bite-sized learning, the effectiveness of easy-to fit-in daily life health practices is a positive development.
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Background: Myeloproliferative neoplasm (MPN) patients often report high symptom burden that persists despite the best available pharmacologic therapy. Meditation has gained popularity in recent decades as a way to manage cancer patient symptoms. Objective: The aim of this study was to examine the feasibility of 2 different consumer-based meditation smartphone apps in MPN patients and to examine the limited efficacy of smartphone-based meditation on symptoms compared with an educational control group. Methods: Patients (n=128) were recruited nationally through organizational partners and social media. Eligible and consented patients were enrolled into 1 of 4 groups, 2 of which received varying orders of 2 consumer-based apps (10% Happier and Calm) and 2 that received one of the apps alone for the second 4 weeks of the 8-week intervention after an educational control condition. Participants were asked to perform 10 min of meditation per day irrespective of the app and the order in which they received the apps. Feasibility outcomes were measured at weeks 5 and 9 with a Web-based survey. Feasibility outcomes were acceptability, demand, and limited efficacy for depression, anxiety, pain intensity, sleep disturbance, sexual function, quality of life, global health, and total symptom burden. Results: A total of 128 patients were enrolled across all 4 groups, with 73.4% (94/128) patients completing the intervention. Of the participants who completed the 10% Happier app, 61% (46/76) enjoyed it, 66% (50/76) were satisfied with the content, and 77% (59/76) would recommend to others. Of those who completed the Calm app, 83% (56/68) enjoyed it, 84% (57/68) were satisfied with the content, and 97% (66/68) would recommend to others. Of those who completed the educational control, 91% (56/61) read it, 87% (53/61) enjoyed it, and 71% (43/61) learned something. Participants who completed the 10% Happier app averaged 31 (SD 33) min/week; patients completing the Calm app averaged 71 (SD 74) min/week. 10% Happier app participants saw small effects on anxiety (P<.001 d=-0.43), depression (P=.02; d=-0.38), sleep disturbance (P=.01; d=-0.40), total symptom burden (P=.13; d=-0.27), and fatigue (P=.06; d=-0.30), and moderate effects on physical health (P<.001; d=0.52). Calm app participants saw small effects on anxiety (P=.29; d=-0.22), depression (P=.09; d=-0.29), sleep disturbance (P=.002; d=-0.47), physical health (P=.005; d=0.44), total symptom burden (P=.13; d=-0.27), and fatigue (P=.13; d=-0.27). Educational control participants (n=61) did not have effects on any patient-reported outcome except for a moderate effect on physical health (P<.001; d=0.77). Conclusions: Delivering meditation via the Calm app is feasible and scored higher in terms of feasibility when compared with the 10% Happier app. The Calm app will be used to implement a randomized controlled trial, testing the effects of meditation on symptom burden in MPNs. Trial registration: ClinicalTrials.gov NCT03726944; https://clinicaltrials.gov/ct2/show/NCT03726944 (Archived by WebCite at http://www.webcitation.org/77MVdFJwM).
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Background College students experience high levels of stress. Mindfulness meditation delivered via a mobile app may be an appealing, efficacious way to reduce stress in college students. Objective We aimed to test the initial efficacy and sustained effects of an 8-week mindfulness meditation mobile app—Calm—compared to a wait-list control on stress, mindfulness, and self-compassion in college students with elevated stress. We also explored the intervention’s effect on health behaviors (ie, sleep disturbance, alcohol consumption [binge drinking], physical activity, and healthy eating [fruit and vegetable consumption]) and the feasibility and acceptability of the app. Methods This study was a randomized, wait-list, control trial with assessments at baseline, postintervention (8 weeks), and at follow-up (12 weeks). Participants were eligible if they were current full-time undergraduate students and (1) at least 18 years of age, (2) scored ≥14 points on the Perceived Stress Scale, (3) owned a smartphone, (4) were willing to download the Calm app, (5) were willing to be randomized, and (7) were able to read and understand English. Participants were asked to meditate using Calm at least 10 minutes per day. A P value ≤.05 was considered statistically significant. ResultsA total of 88 participants were included in the analysis. The mean age (SD) was 20.41 (2.31) years for the intervention group and 21.85 (6.3) years for the control group. There were significant differences in all outcomes (stress, mindfulness, and self-compassion) between the intervention and control groups after adjustment for covariates postintervention (all P
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Purpose: To assess feasibility and preliminary efficacy of a mobile/online-based (mHealth) mindfulness intervention for cancer patients and their caregivers to reduce distress and improve quality of life (QoL). Material and methods: Two-arm randomized controlled trial within Kaiser Permanente Northern California targeting cancer patients who received chemotherapy and their informal caregivers. The intervention group received a commercially available mindfulness program for 8 weeks. The wait-list control group received usual care. We assessed feasibility using retention and adherence rates and obtained participant-reported data on distress, QoL, sleep, mindfulness, and posttraumatic growth before and immediately after the intervention. Results: Ninety-seven patients (median age 59 years; female 69%; 65% whites) and 31 caregivers (median age 63 years; female 58%; 77% whites) were randomized. Among randomized participants, 74% of the patients and 84% of the caregivers completed the study. Among those in the intervention arm who initiated the mindfulness program, 65% practiced at least 50% of the days during the intervention period. We observed significantly greater improvement in QoL among patients in the intervention arm compared with controls. Caregivers in the intervention group experienced increased mindfulness compared with controls. Participants appreciated the convenience of the intervention and the mindfulness skills they obtained from the program. Conclusion: We demonstrated the feasibility of conducting a randomized trial of an mHealth mindfulness intervention for cancer patients and their informal caregivers. Results from fully powered efficacy trials would inform the potential for clinicians to use this scalable intervention to help improve QoL of those affected by cancer and their caregivers.
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Background: Stress is an important part of a college student’s life. Psycho-technology has greatly helped students cope more effe tively with stress. Objectives: The aim of the present study was to compare the effectiveness of three methods of intervention for stress manageme in students based on mindfulness-based stress reduction, including blended therapy, smartphone mobile application, and face-t face therapy. Methods: A quasi-experimental study was designed with pretests, posttests, and follow-ups for a month on randomly selected st dents. The first group was treated by the Aramgar application only, the second group by both the face-to-face therapy and Aramg application, and the third group by the face-to-face therapy only. The DASS-21 was utilized for both pretest and posttest administr tion. The ANOVA and post hoc tests were applied to analyze the data. Results: The mean age of the participants was 24.29 ± 3.21 years. There was a significant difference in the mean score reduction depression, stress, and anxiety between the three groups (P < 0.001). The post hoc test showed that the blended therapy group h the greatest mean score reduction on stress, depression, and anxiety among the three groups. Conclusions: The blended approach could improve the mental health of students more than the two other approaches. Ther fore, the use of mobile platforms of new technologies is highly suggested along with face-to-face interventions in clinics to suppo people within their daily routine.
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Background: Despite substantial improvements in technology and the increased demand for technology-enabled behavioral health tools among consumers, little progress has been made in easing the burden of mental illness. This may be because of the inherent challenges of conducting traditional clinical trials in a rapidly evolving technology landscape. Objective: This study sought to validate the effectiveness of Pacifica, a popular commercially available app for the self-management of mild-to-moderate stress, anxiety, and depression. Methods: A total of 500 adults with mild-to-moderate anxiety or depression were recruited from in-app onboarding to participate in a randomized waitlist controlled trial of Pacifica. We conducted an all-virtual study, recruiting, screening, and randomizing participants through a Web-based participant portal. Study participants used the app for 1 month, with no level of use required, closely mimicking real-world app usage. Participants in the waitlist group were given access to the app after 1 month. Measurements included self-reported symptoms of stress, anxiety, depression, and self-efficacy. We performed an intent-to-treat analysis to examine the interactive effects of time and condition. Results: We found significant interactions between time and group. Participants in the active condition demonstrated significantly greater decreases in depression, anxiety, and stress and increases in self-efficacy. Although we did not find a relationship between overall engagement with the app and symptom improvement, participants who completed relatively more thought record exercises sustained improvements in their symptoms through the 2-month follow-up to a greater degree than those who completed fewer. In addition, we found that participants who reported concomitantly taking psychiatric medications during the trial benefitted less from the app, as measured by the symptoms of anxiety and stress. Conclusions: This study provides evidence that Pacifica, a popular commercially available self-help app, is effective in reducing self-reported symptoms of depression, anxiety, and stress, particularly among individuals who utilize thought records and are not taking psychiatric medication. Trial registration: ClinicalTrials.gov NCT03333707; https://clinicaltrials.gov/ct2/show/NCT03333707 (Archived by WebCite at http://www.webcitation.org/78YE07ADB).
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Background Previous evidence suggests that mindfulness training may improve aspects of psychosocial well-being. Whilst mindfulness is traditionally taught in person, consumers are increasingly turning to mindfulness-based smartphone apps as an alternative delivery medium for training. Despite this growing trend, few studies have explored whether mindfulness delivered via a smartphone app can enhance psychosocial well-being within the general public. Methods The present pilot randomised controlled trial compared the impact of engaging with the self-guided mindfulness meditation (MM) app ‘Headspace’ (n = 38) for a period of 10 or 30 days, to a wait-list (WL) control (n = 36), using a cohort of adults from the general population. The Satisfaction with Life Scale, Perceived Stress Scale, and Wagnild Resilience Scale were administered online at baseline and after 10 and 30 days of the intervention. Results Twelve participants (MM n = 9, WL n = 3) were lost to follow-up for unknown reasons. Relative to the WL control, the MM app positively impacted self-reported satisfaction with life, stress, and resilience at day 10, with further improvements emerging at day 30 (Cohen’s d = 0.57, 1.42, 0.63 respectively). The rate of improvement was largest at the 10-day assessment point, dropping moderately by day 30. Participants that rated the MM app as easy to engage with experienced the largest self-reported benefits. Moreover, the MM app was able to protect against an unexpected increase in perceived stress that emerged in the control group. Conclusions This pilot randomised controlled trial shows that self-reported improvements in psychosocial outcomes can be achieved at low cost through short-term engagement with a mindfulness-based smartphone app, and should be followed up with more substantive studies. Trial registration ISRCTN ISRCTN34618894.
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Efforts to improve the well-being of healthcare professionals include mindfulness-based interventions (MBIs). To understand the value of such initiatives, we conducted a systematic review and meta-analysis of empirical studies pertaining to the use of MBIs with healthcare professionals. Databases were reviewed from the start of records to January 2016 (PROSPERO registration number: CRD42016032899). Eligibility criteria included empirical analyses of well-being outcomes acquired in relation to MBIs. Forty-one papers met the eligibility criteria, consisting of a total of 2101 participants. Studies were examined for two broad classes of well-being outcomes: (a) “negative” mental health measures such as anxiety, depression, and stress; (b) “positive” indices of well-being, such as life satisfaction, together with outcomes associated with well-being, such as emotional intelligence. MBIs were generally associated with positive outcomes in relation to most measures (albeit with moderate effect sizes), and mindfulness does appear to improve the well-being of healthcare professionals. However, the quality of the studies was inconsistent, so further research is needed, particularly high-quality randomised control trials.
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Mindfulness-based interventions (MBIs) have emerged as alternative treatments to treat anxiety and stress-related disorders. The aim of this study is to investigate the effectiveness of MBIs if compared to control interventions and cognitive behavioral therapy (CBT) to improve internalizing symptoms in patients with anxiety and stress-related disorders. We performed a systematic review and multilevel meta-analysis of randomized controlled trials. Outcomes were anxiety, stress, and depression rating scales (internalizing symptoms), further classified as pertaining to distress and fear symptom domains. A total of 40 outcomes were retrieved from 10 studies. MBIs were superior to control interventions for internalizing and distress, but not for fear symptoms. CBT was not superior to MBIs for internalizing and distress, but CBT was superior to MBIs for fear symptoms. The majority of the included studies have a high risk of bias and small sample size, and we found evidence of publication bias for some outcomes. Therefore, results should be interpreted cautiously. MBIs seem promising therapeutic options for treating distress symptoms in anxiety disorders; however, more research is needed to recommend MBIs as first-line treatments. MBIs do not seem effective to treat fear symptoms, for which CBT is significantly more effective.
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Background Mindfulness training (MT) includes a variety of contemplative practices aimed at promoting intentional awareness of experience, coupled with attitudes of nonjudgment and curiosity. Following the success of 8-week, manualized group interventions, MT has been implemented in a variety of modalities, including smartphone apps that seek to replicate the success of group interventions. However, although smartphone apps are scalable and accessible to a wider swath of population, their benefits remain largely untested. Objective This study aimed to investigate a newly developed MT app called Wildflowers, which was codeveloped with the laboratory for use in mindfulness research. It was hypothesized that 3 weeks of MT through this app would improve subjective well-being, attentional control, and interoceptive integration, albeit with weaker effects than those published in the 8 week, manualized group intervention literature. Methods Undergraduate students completed 3 weeks of MT with Wildflowers (n=45) or 3 weeks of cognitive training with a game called 2048 (n=41). State training effects were assessed through pre- and postsession ratings of current mood, stress level, and heart rate. Trait training effects were assessed through pre- and postintervention questionnaires canvassing subjective well-being and behavioral task measures of attentional control and interoceptive integration. State and trait training data were analyzed in a multilevel model using emergent latent factors (acceptance, awareness, and openness) to summarize the trait questionnaire battery. Results Analyses revealed both state and trait effects specific to MT; participants engaging in MT demonstrated improved mood (r=.14) and a reduction of stress (r=−.13) immediately after each training session compared with before the training session and decreased postsession stress over 3 weeks (r=−.08). In addition, MT relative to cognitive training resulted in greater improvements in attentional control (r=−.24). Interestingly, both groups demonstrated increased subjective ratings of awareness (r=.28) and acceptance (r=.23) from pre- to postintervention, with greater changes in acceptance for the MT group trending (r=.21). Conclusions MT, using a smartphone app, may provide immediate effects on mood and stress while also providing long-term benefits for attentional control. Although further investigation is warranted, there is evidence that with continued usage, MT via a smartphone app may provide long-term benefits in changing how one relates to their inner and outer experiences. Trial Registration ClinicalTrials.gov NCT03783793; https://clinicaltrials.gov/ct2/show/NCT03783793 (Archived by WebCite at http://www.webcitation.org/75EF2ehst)
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We present the results of a pre-registered randomised controlled trial (RCT) that tested whether two smartphone-based mindfulness meditation applications (apps) lead to improvements in mental health. University students (n = 208, aged 18 to 49) were randomly assigned to use one of the three apps: Headspace, Smiling Mind, or Evernote (control group). Participants were instructed to use their assigned app for 10 min each day for 10 days, after which they received an extended 30 days’ access to continue practicing at their discretion. Participants completed measures of depressive symptoms, anxiety, stress, college adjustment, flourishing, resilience, and mindfulness at baseline, after the 10-day intervention, and after the 30-day continued access period. App usage was measured by self-report. Mindfulness app usage was high during the 10-day period (used on 8 of 10 days), but low during the 30-day extended use period (less than 20% used the app 2+ times per week). Mindfulness app users showed significant improvements in depressive symptoms, college adjustment, resilience (Smiling Mind only), and mindfulness (Headspace only) from baseline to the end of 10 days relative to control participants. Participants who continued to use the app frequently were more likely to maintain improvements in mental health, e.g. in depressive symptoms and resilience (Headspace only), until the end of the 30-day period. Thus, brief mobile mindfulness meditation practice can improve some aspects of negative mental health in the short term and may strengthen positive mental health when used regularly. Further research is required to examine the long-term effects of these apps.
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Background: Mindfulness-based interventions, self-compassion training, and cognitive behavioral therapy have garnered much evidence in its salutary effects on mental health. With increasing application of smartphone and mobile technology on health promotion, this study investigated the efficacy and possible moderators of mindfulness, self-compassion, and cognitive behavioral psychoeducation training mobile apps in the improvement of mental health. Objective: The aim of this study was to examine the efficacy of 3 mobile app-based programs: mindfulness-based program, self-compassion program, and cognitive behavioral psychoeducation program in improving mental well-being and reducing psychological distress. Changes in mindful awareness and self-compassion were also assessed. To further delineate the suitability of each program for different types of individuals, individual difference variables (ie, discomfort with emotions and tolerance for ambiguity) were explored for potential moderation. Methods: This study was a 3-arm, randomized, controlled, noninferiority trial examining the efficacy of mindfulness-based program, self-compassion program, and cognitive behavioral psychoeducation. Participants were randomized into either 1 of the 3 conditions. Throughout the 4-week, 28-session program, participants spent 10-15 min daily reviewing the course content and practicing various related exercises. At preprogram, postprogram, and 3-month follow-up, participants also completed Web-based measures of mental well-being, psychological distress, mindful-awareness, and self-compassion as well as the proposed moderators. Results: Among the 2161 study participants, 508 and 349 completed the post- and 3-month follow-up assessment, respectively. All 3 conditions (mindfulness-based program: N=703; cognitive behavioral psychoeducation: N=753; self-compassion program: N=705) were found to be efficacious in improving mental well-being and reducing psychological distress. All conditions enhanced mindful awareness at postprogram. Significant interaction effect was found on self-compassion; cognitive behavioral psychoeducation and self-compassion program, but not mindfulness-based program, significantly enhanced self-compassion at postprogram. No significant differences regarding usage and users' satisfaction were found among the 3 conditions. None of the proposed moderators were found to be significant. Conclusions: Mindfulness-based, self-compassion, and cognitive behavioral psychoeducation mobile apps were efficacious in improving mental well-being and reducing psychological distress among adults at postprogram and 3-month follow-up. Future app-based psychological training programs should consider gamification and personalization of content or feedback to enhance engagement and mitigate the high attrition rates that are common in app-based health promotion programs. Trial registration: Chinese Clinical Trial Registry (ChiCTR) ChiCTR-TRC-13003468; http://www.chictr.org.cn/hvshowproject.aspx?id=6220 (Archived by WebCite at http://www.webcitation.org/734PlOz50).
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Purpose Mindfulness-based cognitive therapy (MBCT) has been shown to alleviate psychological distress in patients with cancer. However, patients experience barriers to participating in face-to-face MBCT. Individual Internet-based MBCT (eMBCT) could be an alternative. The study aim was to compare MBCT and eMBCT with treatment as usual (TAU) for psychological distress in patients with cancer. Patients and Methods We obtained ethical and safety approval to include 245 patients with cancer with psychological distress (≥ 11 on the Hospital Anxiety and Depression Scale) in the study. They were randomly allocated to MBCT (n = 77), eMBCT (n = 90), or TAU (n = 78). Patients completed baseline (T0) and postintervention (T1) assessments. The primary outcome was psychological distress on the Hospital Anxiety and Depression Scale. Secondary outcomes were psychiatric diagnosis, fear of cancer recurrence, rumination, health-related quality of life, mindfulness skills, and positive mental health. Continuous outcomes were analyzed using linear mixed modeling on the intention-to-treat sample. Because both interventions were compared with TAU, the type I error rate was set at P < .025. Results Compared with TAU, patients reported significantly less psychological distress after both MBCT (Cohen’s d, .45; P < .001) and eMBCT (Cohen’s d, .71; P < .001) . In addition, post-treatment prevalence of psychiatric diagnosis was lower with both MBCT (33% improvement; P = .030) and eMBCT (29% improvement; P = .076) in comparison with TAU (16%), but these changes were not statistically significant. Both interventions reduced fear of cancer recurrence and rumination, and increased mental health–related quality of life, mindfulness skills, and positive mental health compared with TAU (all Ps < .025). Physical health–related quality of life did not improve ( P = .343). Conclusion Compared with TAU, MBCT and eMBCT were similarly effective in reducing psychological distress in a sample of distressed heterogeneous patients with cancer.
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College student anxiety is a rising recurrent problem. It is the foremost diagnosed and treated mental health condition and has many negative consequences, including attrition and course failure. Mindfulness meditation (MM) is an approach to anxiety reduction comprised of self-regulation and orientation. Meta-analyses have been conducted on MM with adults and children, but not with college age students who are unique in that they have a distinctive set of stressors. Therefore, we examined the effects of MM on anxiety in college students by conducting a meta-analysis. We searched 11 electronic databases, hand searched select journals, and unpublished literature. We located 25 primary studies, providing 28 comparisons, with 1492 participants. The overall summary effect was .56 (p < .001). Major, level of study, MM practice outside of the intervention, and number of sessions moderated the effects of MM on anxiety. Future researchers should examine the specific needs of subgroups: men vs. women, and graduate vs. undergraduate students. Additionally, researchers should test interventions that fit the needs of today’s college students, by limiting outside practice and offering a minimum of eight instructor-led sessions.
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We investigated whether a mindfulness meditation program delivered via a smartphone application could improve psychological well-being, reduce job strain, and reduce ambulatory blood pressure during the workday. Participants were 238 healthy employees from two large United Kingdom companies that were randomized to a mindfulness meditation practice app or a wait-list control condition. The app offered 45 prerecorded 10- to 20-min guided audio meditations. Participants were asked to complete one meditation per day. Psychosocial measures and blood pressure throughout one working day were measured at baseline and eight weeks later; a follow-up survey was also emailed to participants 16 weeks after the intervention start. Usage data showed that during the 8-week intervention period, participants randomized to the intervention completed an average of 17 meditation sessions (range 0–45 sessions). The intervention group reported significant improvement in well-being, distress, job strain, and perceptions of workplace social support compared to the control group. In addition, the intervention group had a marginally significant decrease in self-measured workday systolic blood pressure from pre- to post-intervention. Sustained positive effects in the intervention group were found for well-being and job strain at the 16-week follow-up assessment. This trial suggests that short guided mindfulness meditations delivered via smartphone and practiced multiple times per week can improve outcomes related to work stress and well-being, with potentially lasting effects.
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Background: Arguments for including mindfulness instruction in higher education have included claims about the benefits of mindfulness practice for critical thinking. While there is theoretical support for this claim, empirical support is limited. The aim of this study was to test this claim by investigating the effects of an online mindfulness intervention on executive function, critical thinking skills and associated thinking dispositions. Method: Participants recruited from a university were randomly allocated, following screening, to either a mindfulness meditation group or a sham meditation group. Both the researchers and the participants were blind to group allocation. The intervention content for both groups was delivered through the Headspace online application, an application which provides guided meditations to users. Both groups were requested to complete 30 guided mindfulness meditation sessions across a 6 week period. Primary outcome measures assessed mindfulness, executive functioning, critical thinking, actively open-minded thinking and need for cognition. Secondary outcome measures assessed wellbeing, positive and negative affect, and real-world outcomes. Results: In a series of full-information maximum likelihood analyses, significant increases in mindfulness dispositions and critical thinking scores were observed in both the mindfulness meditation and sham meditation groups. However, no significant effects of group allocation were observed for either primary or secondary measures. Furthermore, mediation analyses testing the indirect effect of group allocation through executive functioning performance did not reveal a significant result and moderation analyses showed that the effect of the intervention did not depend on baseline levels of the key thinking dispositions, actively open-minded thinking and need for cognition. Conclusion: No evidence was found to suggest that engaging in guided mindfulness practice for 6 weeks using the online intervention method applied in this study improves critical thinking performance. While further research is warranted, claims regarding the benefits of mindfulness practice for critical thinking should be tempered in the meantime. Trial registration: The study was initially registered in the AEA Social Science Registry before the recruitment was initiated (RCT ID: AEARCTR-0000756; 14/11/2015) and retrospectively registered in the ISRCTN registry ( RCT ID: ISRCTN16588423 ) in line with requirements for publishing the study protocol.
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Mindfulness training, which involves observing thoughts and feelings without judgment or reaction, has been shown to improve aspects of psychosocial well-being when delivered via in-person training programs such as mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT). Less is known about the efficacy of digital training mediums, such as smartphone apps, which are rapidly rising in popularity. In this study, novice meditators were randomly allocated to an introductory mindfulness meditation program or to a psychoeducational audiobook control featuring an introduction to the concepts of mindfulness and meditation. The interventions were delivered via the same mindfulness app, were matched across a range of criteria, and were presented to participants as well-being programs. Affect, irritability, and two distinct components of stress were measured immediately before and after each intervention in a cohort of healthy adults. While both interventions were effective at reducing stress associated with personal vulnerability, only the mindfulness intervention had a significant positive impact on irritability, affect, and stress resulting from external pressure (between group Cohen’s d = 0.44, 0.47, 0.45, respectively). These results suggest that brief mindfulness training has a beneficial impact on several aspects of psychosocial well-being, and that smartphone apps are an effective delivery medium for mindfulness training.
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Background: One in five Canadians experience mental health issues with those in the age range of 15 to 24 years being most at risk of a mood disorder. University students have shown significantly higher rates of mental health problems than the general public. Current university support services are limited by factors such as available staff and finances, and social stigma has frequently been identified as an additional barrier that prevents students from accessing these resources. Mobile health (mHealth) apps are one form of alternative health support that is discrete and accessible to students, and although they are recognized as a promising alternative, there is limited research demonstrating their efficacy. Objective: The aim of this study was to evaluate a mindfulness-based app's ("DeStressify") efficacy on stress, anxiety, depressive symptomology, sleep behavior, work or class absenteeism, work or school productivity, and quality of life (QoL) among university students. Methods: Full-time undergraduate students at a Canadian university with smartphones and Internet access were recruited through in-class announcements and on-campus posters. Participants randomized into an experimental condition were given and instructed to use the DeStressify app 5 days a week for 4 weeks. Control condition participants were wait-listed. All participants completed pre- and postintervention Web-based surveys to self-assess stress, anxiety, depressive symptomatology, sleep quality, and health-related QoL. Results: A total of 206 responses were collected at baseline, with 163 participants completing the study (86 control, 77 experimental). Using DeStressify was shown to reduce trait anxiety (P=.01) and improve general health (P=.001), energy (P=.01), and emotional well-being (P=.01) in university students, and more participants in the experimental condition believed their productivity improved between baseline and postintervention measurements than the number of participants expected to believe so randomly by chance (P=.01). The app did not significantly improve stress, state anxiety, physical and social functioning, and role limitations because of physical or emotional health problems or pain (P>.05). Conclusions: Mindfulness-based apps may provide an effective alternative support for university students' mental health. Universities and other institutions may benefit from promoting the use of DeStressify or other mindfulness-based mHealth apps among students who are interested in methods of anxiety management or mindfulness-based self-driven health support. Future steps include examining DeStressify and similar mHealth apps over a longer period and in university staff and faculty.
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Objective: Mindfulness recently attracted growing interest beyond classical therapeutic contexts and has been adopted in preventive labor contexts and occupational health. In this study, we evaluated the effectiveness of a mobile mindfulness training app regarding work and health indicators. Methods: Participants were employees and assigned randomly to the intervention and control groups. 146 employed participants in the intervention group used the mobile application ‘7mind’ for 14 days. Comparisons were made with 160 employed participants from the control group, who were given access to the app after finishing the study (wait-list control). Results: After two weeks of use, significant effects of the training were indicated by better results for the intervention group as compared to the control group. Some of the effect sizes can be considered as large: participants in the intervention group improved in measures of mindfulness, work engagement, job satisfaction, emotional exhaustion, emotional intelligence, innovation and creativity, and self-efficacy. Conclusion: Conventional mindfulness training programs are organized in groups. Our study demonstrates for the first time the effectiveness of a mobile mindfulness training app in the work context. The mobile app offers an easy and flexible access to training mindfulness and improving work and health-related indicators.
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Mindfulness interventions have increasingly been incorporated in elementary and high school classrooms to support students’ mental health and well-being; however, there is little research examining the specific factors contributing to the effectiveness of the interventions. The purpose of this meta-analysis was to examine the specific effects of and moderators contributing to school-based mindfulness interventions for mental health in youth. A systematic review of studies published in PsycINFO, ERIC, Social Work Abstracts, Social Services Abstracts, and CINAHL was conducted. A total of 24 studies (n = 3977) were included in the meta-analysis. Overall, mindfulness interventions were found to be helpful, with small to moderate significant effects pre-post intervention compared to control groups (Hedges’ g = 0.24, p < .001); however, interventions that were delivered during late adolescence (15–18) and that consisted of combinations of various mindfulness activities had the largest effects on mental health and well-being outcomes. Furthermore, the effects on specific mindfulness and mental health outcomes differed according to whether the intervention was delivered by an outside facilitator compared to trained educators/teachers. These results suggest that individual differences and program characteristics can impact receptivity and effectiveness of mindfulness training. These findings represent a significant contribution as they can be used to inform future designs and applications of mindfulness interventions in the school setting.
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The rapid advances and adoption of smartphone technology presents a novel opportunity for delivering mental health interventions on a population scale. Despite multi-sector investment along with wide-scale advertising and availability to the general population, the evidence supporting the use of smartphone apps in the treatment of depression has not been empirically evaluated. Thus, we conducted the first meta-analysis of smartphone apps for depressive symptoms. An electronic database search in May 2017 identified 18 eligible randomized controlled trials of 22 smartphone apps, with outcome data from 3,414 participants. Depressive symptoms were reduced significantly more from smartphone apps than control conditions (g=0.38, 95% CI: 0.24-0.52, p<0.001), with no evidence of publication bias. Smartphone interventions had a moderate positive effect in comparison to inactive controls (g=0.56, 95% CI: 0.38-0.74), but only a small effect in comparison to active control conditions (g=0.22, 95% CI: 0.10-0.33). Effects from smartphone-only interventions were greater than from interventions which incorporated other human/computerized aspects along the smartphone component, although the difference was not statistically significant. The studies of cognitive training apps had a significantly smaller effect size on depression outcomes (p=0.004) than those of apps focusing on mental health. The use of mood monitoring softwares, or interventions based on cognitive behavioral therapy, or apps incorporating aspects of mindfulness training, did not affect significantly study effect sizes. Overall, these results indicate that smartphone devices are a promising self-management tool for depression. Future research should aim to distil which aspects of these technologies produce beneficial effects, and for which populations.
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Purpose: This systematic review aims to summarize eHealth studies with mindfulness- and relaxation-based interventions for medical conditions and to determine whether eHealth interventions have positive effects on health. Method: A comprehensive search of five databases was conducted for all available studies from 1990 to 2015. Studies were included if the intervention was mainly technology delivered and included a mindfulness- or relaxation-based intervention strategy and if patients with a medical condition were treated. Treatment effects were summarized for different outcomes. Results: A total of 2383 records were identified, of which 17 studies with 1855 patients were included in this systematic review. These studies were conducted in patients with irritable bowel syndrome, chronic fatigue syndrome, cancer, chronic pain, surgery, and hypertension. All but one study were delivered online through a web-based platform; one study delivered the intervention with iPods. The studies indicate that mindfulness- and relaxation-based eHealth interventions can have positive effects on patients' general health and psychological well-being. No effects were found for stress or mindfulness. Only five studies reported economic analyses of eHealth interventions without any clear conclusion. Conclusion: There is some evidence that mindfulness- and relaxation-based eHealth interventions for medical conditions can have positive effects on health outcomes. Therefore, such interventions might be a useful addition to standard medical care. No app studies were retrieved, even though a vast number of smartphone apps exist which aim at increasing users' health. Therefore, more studies investigating those health apps are needed.
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Although several hundreds of apps are available that (cl)aim to promote mindfulness, only a few methodologically sound studies have evaluated the efficacy of these apps. This randomized waiting-list controlled trial therefore tested the hypothesis that one such app (the VGZ Mindfulness Coach) can achieve immediate and long-term improvements of mindfulness, quality of life, general psychiatric symptoms, and self-actualization. One hundred ninety-one experimental participants received the VGZ Mindfulness Coach, which offers 40 mindfulness exercises and background information about mindfulness without any form of therapeutic guidance. Compared to 186 control participants, they reported large (Cohen’s d = 0.77) and statistically significant increases of mindfulness after 8 weeks and small-to-medium increases of the Observing, Describing, Acting with awareness, Nonjudging, and Nonreactivity mindfulness facets as measured with the Five Facet Mindfulness Questionnaire (Cohen’s d = 0.66, 0.26, 0.49, 0.34, and 0.43, respectively). Also, there were large decreases of general psychiatric symptoms (GHQ-12; Cohen’s d = −0.68) and moderate increases of psychological, social, and environmental quality of life (WHOQOL-BREF; Cohen’s d = 0.38, 0.38, and 0.36, respectively). Except for social quality of life, these gains were maintained for at least 3 months. We conclude that it is possible to achieve durable positive effects on mindfulness, general psychiatric symptoms, and several aspects of quality of life at low costs with smartphone apps for mindfulness such as the VGZ Mindfulness Coach. Electronic supplementary material The online version of this article (doi:10.1007/s12671-017-0761-7) contains supplementary material, which is available to authorized users.
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Objective: The purpose of this pilot study was to test the feasibility of delivering the mobile Mindfulness-Based Stress Reduction for Breast Cancer (mMBSR(BC)) program using an iPad and to evaluate its impact on symptom improvement. Methods: A single group, pre-posttest design was implemented among female stages 0-III breast cancer survivors (BCS) who completed treatment. Data were collected at baseline and week 6 on measures of psychological and physical symptoms and quality of life. The mMBSR(BC) program is a standardized, stress-reducing intervention that combines sitting and walking meditation, body scan and yoga and is designed to deliver weekly 2-hour sessions for 6 weeks using an iPad. Results: The mean age of the 15 enrolled BCS was 57 years; one participant was non-Hispanic Black, and 14 were non-Hispanic White. Of the 13 who completed the study, there were significant improvements from baseline to 6 weeks post-mMBSR(BC) in psychological and physical symptoms of depression, state anxiety, stress, fear of recurrence, sleep quality, fatigue and quality of life (p's < 0.05). Effect sizes for improvements of multiple symptoms ranged from medium to large. Conclusions: These results provide preliminary support that the mMBSR(BC) program may be feasible and acceptable, showing a clinical impact on decreasing psychological and physical symptoms. This mobile-based program offers a delivery of a standardized MBSR(BC) intervention to BCS that is convenient for their own schedule while decreasing symptom burden in the survivorship phase after treatment for breast cancer.
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The psychological treatment of mental health problems is beginning to undergo a sea-change driven by the widespread availability of digital technology. In this paper we provide an overview of the developments to date and those in the pipeline. We describe the various uses of digital interventions and consider their likely impact on clinical practice, clinical services and the global dissemination of psychological treatments. We note the importance of online clinics, blended treatment, digital assessment and digital training.
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Background Mindfulness training (MT) programs represent an approach to attention training with well-validated mental health benefits. However, research supporting MT efficacy is based predominantly on weekly-meeting, facilitator-led, group-intervention formats. It is unknown whether participants might benefit from neurofeedback-assisted, technology-supported MT (N-tsMT), in which meditation is delivered individually, without the need for a facilitator, travel to a training site, or the presence of a supportive group environment. Mirroring the validation of group MT interventions, the first step in addressing this question requires identifying whether N-tsMT promotes measurable benefits. Here, we report on an initial investigation of a commercial N-tsMT system. Methods In a randomized, active control trial, community-dwelling healthy adult participants carried out 6 weeks of daily practice, receiving either N-tsMT (n = 13), or a control condition of daily online math training (n = 13). Training effects were assessed on target measures of attention and well-being. Participants also completed daily post-training surveys assessing effects on mood, body awareness, calm, effort, and stress. ResultsAnalysis revealed training effects specific to N-tsMT, with attentional improvements in overall reaction time on a Stroop task, and well-being improvements via reduced somatic symptoms on the Brief Symptom Inventory. Attention and well-being improvements were correlated, and effects were greatest for the most neurotic participants. However, secondary, exploratory measures of attention and well-being did not show training-specific effects. N-tsMT was associated with greater body awareness and calm, and initially greater effort that later converged with effort in the control condition. Conclusions Preliminary findings indicate that N-tsMT promotes modest benefits for attention and subjective well-being in a healthy community sample relative to an active control condition. However, the findings would benefit from replication in a larger sample, and more intensive practice or more comprehensive MT instruction might be required to promote the broader benefits typically reported in group format, facilitated MT. Trial registrationCurrent Controlled Trials ISRCTN43629398. Retrospectively registered on June 16, 2016.
Article
Objective and Design: In a pragmatic, randomised, waitlist-controlled trial we tracked 250 first-year university students who were randomly assigned to 3 months of a mindfulness meditation app (Headspace) to use at their discretion in either semester 1 (intervention, n = 124) or semester 2 (waitlist, n = 126). Main Outcome Measures: Students reported their distress, college adjustment, resilience, self-efficacy, and mindfulness, at 3 timepoints: the beginning of semester 1, the beginning of semester 2, and the end of the academic year. With participants’ permission, the university provided academic achievement data and Headspace provided app use data. Results: Evidence for improvements in distress at the beginning of semester 2 was weak (intervention vs. waitlist) and app use was low (M = 7.91, SD = 15.16 sessions). Nevertheless, intervention participants who used the app more frequently reported improvements in psychological distress (−5 points, R² change = .12) and college adjustment (+10 points, R² change = .09) when compared to non-users. App initiation and persistence beyond the first week was higher when the app was provided in semester 1 than semester 2 (66.1% vs. 44.4%; 46.0% vs. 32.5%). Conclusion: Headspace use was associated with small improvements in distress and college adjustment in first-year university students. Intervening at the beginning of the academic year may encourage uptake.
Article
Objectives: Although the efficacy of smartphone-delivered interventions for mental health problems is emerging, randomized controlled trials (RCTs) of smartphone interventions are characterized by high rates of attrition and low adherence. High attrition and low adherence may threaten the validity of RCT findings, so a better understanding of these phenomena is needed. We examined attrition and adherence in 70 RCTs of smartphone interventions. Method: Four online databases were searched for RCTs of mental health interventions delivered via smartphones. Results: The mean meta-analytic study attrition rate was 24.1% (95% CI [19.3, 29.6]) at short-term follow up and 35.5% (95% CI [26.7, 45.3]) at longer-term follow up. These rates varied according to target mental health condition. Attrition rates were significantly lower in trials that delivered an acceptance-based intervention, offered participants monetary compensation, and reminded participants to engage in the intervention, and were significantly higher in trials that used an online enrollment method (relative to telephone or in-person enrollment). No participant-level baseline characteristic reliably predicted attrition. Evidence of attrition bias came from many RCTs not conducting intention-to-treat analyses. However, the mean difference in the between-groups effect size on primary outcomes in trials that reported both per protocol an intention-to-treat analyses was only Δd = 0.18. Adherence rates were also suboptimal based on our qualitative synthesis; several participants failed to download the intervention, and intervention usage consistently declined over the course of the trial. Conclusion: Study attrition and low adherence are common, problematic, and may undermine the validity of findings in RCTs of smartphone-delivered interventions for mental health problems. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Article
Trial settings that include proactive recruitment, human contact, and assessment procedures may substantially impact the way users engage with unguided e-mental health programs and the generalizability of reported findings. This study examined the impact of trial setting on user behavior by directly comparing reported user engagement in trial-based research and objective measures of real-world usage of the same unguided mental health programs. The authors conducted a systematic search for papers reporting user engagement with off-the-shelf unguided e-mental health programs. Real-world usage was obtained from a panel that presents aggregated nonpersonal information on user engagement with digital programs across the world. A total of 13 papers yielding 14 comparable usage metrics met all inclusion criteria. In three papers reporting the use of programs by lay users without any proactive trial procedures, the ratios calculated by dividing the usage reported in the paper by the usage documented within the objective dataset were 0.84, 1.05, and 1.27—suggesting a sufficient criterion validity for our examination. In studies that proactively recruited users and included pre- to post-assessment procedures (11 comparisons), the median program usage rate reported was 4.06 times higher (IQR = 4.49) than the real-world usage of the same program. Severity of clinical symptoms, in-person versus remote assessment procedures, study design, and program cost had no impact on these differences. The results suggest that trial settings have a large impact on user engagement with unguided interventions and, therefore, on the generalizability of the findings to the real world.
Article
Although impressive progress has been made toward developing empirically‐supported psychological treatments, the reality remains that a significant proportion of people with mental health problems do not receive these treatments. Finding ways to reduce this treatment gap is crucial. Since app‐supported smartphone interventions are touted as a possible solution, access to up‐to‐date guidance around the evidence base and clinical utility of these interventions is needed. We conducted a meta‐analysis of 66 randomized controlled trials of app‐supported smartphone interventions for mental health problems. Smartphone interventions significantly outperformed control conditions in improving depressive (g=0.28, n=54) and generalized anxiety (g=0.30, n=39) symptoms, stress levels (g=0.35, n=27), quality of life (g=0.35, n=43), general psychiatric distress (g=0.40, n=12), social anxiety symptoms (g=0.58, n=6), and positive affect (g=0.44, n=6), with most effects being robust even after adjusting for various possible biasing factors (type of control condition, risk of bias rating). Smartphone interventions conferred no significant benefit over control conditions on panic symptoms (g=–0.05, n=3), post‐traumatic stress symptoms (g=0.18, n=4), and negative affect (g=–0.08, n=5). Studies that delivered a cognitive behavior therapy (CBT)‐based app and offered professional guidance and reminders to engage produced larger effects on multiple outcomes. Smartphone interventions did not differ significantly from active interventions (face‐to‐face, computerized treatment), although the number of studies was low (n≤13). The efficacy of app‐supported smartphone interventions for common mental health problems was thus confirmed. Although mental health apps are not intended to replace professional clinical services, the present findings highlight the potential of apps to serve as a cost‐effective, easily accessible, and low intensity intervention for those who cannot receive standard psychological treatment.
Article
Objective. Roughly 35% of college students report depression as a significant concern, which unaddressed, can lead to an increased likelihood to quit school and develop comorbid conditions. Traditional depression interventions are useful; however, they are often expensive, stigmatizing, tedious, and time-intensive. We examined a prescribed mindfulness meditation regimen, which incorporates gamification principles, in reducing symptoms of depression compared to a control group. Materials and methods. We recruited and randomly assigned 72 college students to an experimental group (n = 33) or a control group (n = 39). The prescription for experimfiental group participants was ten 10-minute mobile mindfulness meditation sessions over a 14-day period; control group participants continued with business as usual. The Patient Health Questionnaire (PHQ-9) was used to test our hypothesis. Results. Repeated-measures ANOVA demonstrated a significant interaction of group by time for depression scores, supporting the hypothesis that experimental group participants would significantly decrease their depression symptom severity compared to control group participants post-intervention. Within-subjects contrasts and between-group analyses showed a significant decrease in depression symptom severity scores. Conclusion. Prescribed use of a gamified mindfulness meditation application significantly decreased depression symptom severity as measured by the PHQ-9. College students and mental health providers should consider these fun, inexpensive, and non-stigmatizing applications as a feasible intervention for college students to improve symptoms associated with depression.
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The waiting list is an inadequate benchmark for estimating the effectiveness of psychotherapy for depression - Volume 28 Issue 3 - Ioana A. Cristea
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(Reprinted with permission from Behaviour Research and Therapy 88 (2017) 19-25).
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Background Patients who are sick enough to be admitted to an intensive care unit (ICU) commonly experience symptoms of psychological distress after discharge, yet few effective therapies have been applied to meet their needs. Methods Pilot randomised clinical trial with 3-month follow-up conducted at two academic medical centres. Adult (≥18 years) ICU patients treated for cardiorespiratory failure were randomised after discharge home to 1 of 3 month-long interventions: a self-directed mobile app-based mindfulness programme; a therapist-led telephone-based mindfulness programme; or a web-based critical illness education programme. Results Among 80 patients allocated to mobile mindfulness (n=31), telephone mindfulness (n=31) or education (n=18), 66 (83%) completed the study. For the primary outcomes, target benchmarks were exceeded by observed rates for all participants for feasibility (consent 74%, randomisation 91%, retention 83%), acceptability (mean Client Satisfaction Questionnaire 27.6 (SD 3.8)) and usability (mean Systems Usability Score 89.1 (SD 11.5)). For secondary outcomes, mean values (and 95% CIs) reflected clinically significant group-based changes on the Patient Health Questionnaire depression scale (mobile (−4.8 (−6.6, −2.9)), telephone (−3.9 (−5.6, −2.2)), education (−3.0 (−5.3, 0.8)); the Generalized Anxiety Disorder scale (mobile −2.1 (−3.7, −0.5), telephone −1.6 (−3.0, −0.1), education −0.6 (−2.5, 1.3)); the Post-Traumatic Stress Scale (mobile −2.6 (−6.3, 1.2), telephone −2.2 (−5.6, 1.2), education −3.5 (−8.0, 1.0)); and the Patient Health Questionnaire physical symptom scale (mobile −5.3 (−7.0, −3.7), telephone −3.7 (−5.2, 2.2), education −4.8 (−6.8, 2.7)). Conclusions Among ICU patients, a mobile mindfulness app initiated after hospital discharge demonstrated evidence of feasibility, acceptability and usability and had a similar impact on psychological distress and physical symptoms as a therapist-led programme. A larger trial is warranted to formally test the efficacy of this approach. Trial registration number Results, NCT02701361.
Article
Objective The primary objective was to evaluate the efficacy of commercially available mobile app‐delivered mindfulness training (AMT), compared to waitlist control (WC), on quality of life (QOL) among women diagnosed with breast cancer. The secondary outcome was dispositional mindfulness. Enrollment, app utilization, and study completion are reported as feasibility objectives. Methods Women diagnosed with breast cancer ≤ 5 years (n=112) were randomized to AMT (n=57) or WC (n=55), over 8‐weeks, with 4 weeks of follow‐up. We conducted linear mixed effects models to examine group by observation interactions on QOL and dispositional mindfulness at baseline, during intervention (5‐weeks), post‐intervention (9‐weeks), and follow‐up (12‐weeks post‐baseline). Results Participants assigned to AMT reported higher QOL, compared to those assigned to WC, from baseline through follow‐up t(258.40)=3.09, p < 0.01, 95% CI [2.71, 11.90]. Participants assigned to AMT also reported higher dispositional mindfulness, compared to those assigned to WC, from baseline through follow‐up t(268.44)=2.04, p=0.04, 95% CI [0.01, 0.57]. App utilization data was obtained from 34 participants. Fewer participants assigned to AMT completed all study assessments, compared to participants assigned to WC, (χ2 (1)=7.07, p=0.008). Conclusions Findings suggest commercially available AMT may proffer some benefit to women seeking to enhance their QOL following breast cancer diagnosis.