Intermittent mindfulness practice can be beneficial, and daily practice can be harmful. An in depth, mixed methods study of the "Calm" app's (mostly positive) effects

Factors Affecting Digital Tool Use in Client Interaction According to Mental Health Professionals: Interview Study

BACKGROUND

Digital tools and interventions are being increasingly developed in response to the growing mental health crisis, and mental health professionals (MHPs) considerably influence their adoption in client practice. However, how MHPs use digital tools in client interaction is yet to be sufficiently understood, which poses challenges to their design, development, and implementation.

OBJECTIVE

This study aimed to create a contextual understanding of how MHPs use different digital tools in clinical client practice and what characterizes the use across tools.

METHODS

A total of 19 Finnish MHPs participated in semistructured interviews, and the data were transcribed, coded, and inductively analyzed.

RESULTS

We found that MHP digital tool use was characterized by 3 distinct functions: communication, diagnosis and evaluation, and facilitating therapeutic change. The functions were addressed using analog tools, digitized tools that mimic their analog counterparts, and digital tools that use the possibilities native to digital. The MHP-client communication included various media alongside face-to-face meetings, the MHPs increasingly used digitized tools in client evaluation, and the MHPs actively used digitized materials to facilitate therapeutic change. MHP tool use was generally characterized by adaptability-it was negotiated in client interactions. However, there was considerable variance in the breadth of MHPs' digital toolbox. The existing clinical practices emphasized MHP-client interaction and invited incremental rather than radical developments, which challenged the achievement of the scalability benefits expected from digital tools.

CONCLUSIONS

MHPs use digitized and digital tools in client practice. Our results contribute to the user-centered research, development, and implementation of new digital solutions in mental health care by classifying them according to their function and medium and describing how MHPs use and do not use them.

Hybrid Delivery of Mindfulness Meditation and Perceived Stress in Pediatric Resident Physicians: A Randomized Clinical Trial of In-Person and Digital Mindfulness Meditation

Physicians are experiencing epidemic levels of work-related stress and burnout. Determine efficacy of mindfulness meditation delivered as a hybrid (in-person and digital) format to reduce perceived stress in pediatric residents. Pediatric residents (n = 66) were block randomized to a hybrid Mindful Awareness Practices (MAPs) intervention, comprised of one in-person 60-min session and 6-week access to a digitally delivered MAPs curriculum (n = 27) or wait-list control (n = 39). Perceived Stress Scale (PSS) was administered at baseline and post-intervention as the primary outcome measure. A priori secondary outcomes were measured using the Abbreviated Maslach Burnout Inventory-9, Beck Depression Inventory, Beck Anxiety Inventory, UCLA Loneliness Scale, and Pittsburgh Sleep Quality Index. After the first session, 58% participated at least one digital session (M = 2.0; SD = 1.3). MAPs participants showed significant decrease in PSS compared to controls, with between-group mean difference of 2.20 (95% CI 0.47-3.93) at post-intervention (effect size 0.91; 0.19-1.62). No secondary outcome group differences were detected. Exposure to a hybrid mindfulness intervention was associated with improvement in perceived stress among pediatric residents.Trial Registration: NCT03613441.

Feasibility and Acceptability of a Mindfulness-Based Smartphone App among Pregnant Women with Obesity

Maternal obesity is associated with an increased risk for prenatal depressive symptoms. Mindfulness-based interventions (MBIs) have been shown to reduce the risk of prenatal depression. This pilot study assesses the feasibility and acceptability of a smartphone-based MBI among pregnant women with obesity, and its potential for improving maternal mental and behavioral health outcomes. Five second-trimester pregnant women with a prepregnancy body mass index > 30 kg/m² participated in a 30-day audio-guided mindfulness practice using the Headspace app. All participants engaged in the pregnancy module, while three concurrently engaged in the mindful eating module. Daily engagement with the app was tracked and a post-trial survey assessed maternal acceptability. Validated pre- and post-trial questionnaires explored changes in perceived stress, anxiety, depression, and eating habits. All participants completed the study with varying levels of adherence to the prescribed daily practice; the average number of days of engagement was 23/30 (77%) for the pregnancy module and 20/30 (67%) for the mindful eating module. All subjects reported some degree of perceived benefit, and none reported negative experiences. Trends were observed for improvements in maternal mental wellbeing and eating behaviors. This pilot study shows that a smartphone-based MBI is feasible, acceptable, and perceived to provide benefit among pregnant women with obesity.

Mindful mindfulness reporting: Media portrayals of scientific evidence for meditation mobile apps

Promoting mental health is a major global challenge. As mindfulness meditation apps can help maintain and restore good mental health, it is important to understand how their efficacy and safety are portrayed in the media. This study systematically evaluates whether evidence from academic research is used to communicate the health effects of two popular mindfulness apps, Calm and Smiling Mind. A scoping review mapped research findings from 16 relevant articles, and a media analysis examined the types of evidence used in news reporting. Analysing 105 news articles revealed that 98% did not use evidence from academic research on app-based meditation to support health claims. Only 28.5% of articles included advice from a health expert, and 9.5% mentioned potential risks and alternative treatments. Stronger evidence-based reporting on the health effects of mindfulness apps is needed to enable people to make more informed decisions for their health and wellbeing.

Analysis of Mobile App-Based Mental Health Solutions for College Students: A Rapid Review

BACKGROUND

College students are one of the most susceptible age groups to mental health problems. With the growing popularity of mobile health (mHealth), there is an increasing need to investigate its implications for mental health solutions. This review evaluates mHealth interventions for addressing mental health problems among college students.

METHODS

An online database search was conducted. Articles were required to focus on the impact of mHealth intervention on student mental health. Fifteen of the 487 articles, initially pulled from the search query, were included in the review.

RESULTS

The review identified three primary aspects of mental health: depression, anxiety, and stress. Research that found statistically significant improvements following mHealth intervention involved study durations between four and eight weeks, daily app use, guided lessons using cognitive behavioral therapy, acceptance and commitment therapy, and meditation. The review's findings show that future work must address the concern of digital divide, gender and sex differences, and have larger sample sizes.

CONCLUSIONS

There is potential to improve depressive symptoms and other similar mental health problems among college students via mobile app interventions. However, actions must be taken to improve barriers to communication and better reach the younger generations.

Delivery of Complementary and Integrative Health Using Virtual Health Resources: A Scoping Review

Introduction: Complementary and integrative health (CIH) modalities promote overall health and well-being and can be beneficial for individuals with a range of conditions. Traditionally, CIH has been delivered in person. COVID-19 created a need to identify sustainable remote delivery options to assure access to CIH while practicing public health recommendations. This scoping review maps the opportunities and challenges to remotely delivered CIH. Materials and methods: A scoping review was conducted between June 2020 and October 2020 using the following search engines: PubMed, Academic Search Premier, PsycINFO, CINAHL, Cochrane Reviews, and the Cochrane Clinical Trial Collections. Search results investigating remote CIH delivery were restricted to articles written in English, published after 1990. Results: Of the 10,884 articles identified, after review for content and methods, 330 articles were included. Most articles were randomized controlled trials (n = 170), applied mindfulness (n = 203), and targeted mental and behavioral health conditions (n = 182). Interventions were primarily delivered through mobile applications (n = 151) and web-based platforms (n = 86). Most commonly reported barriers were adherence (n = 24), resource requirements (e.g., time and space) (n = 23), and technology-related issues (n = 21). Although most studies did not report facilitators (n = 217), most commonly reported facilitators were social and technologic supports, accessibility, usability, perceptions, and rewards. Participant outcomes measured were broad and included movement (n = 88), stress (n = 68), and pain (n = 54). Intervention characteristic outcomes most often measured were satisfaction and usability (n = 5). Conclusions: This scoping literature review identified many articles addressing remote delivery of CIH, but few reporting on the implementation of remotely delivered CIH. Findings suggest remotely delivered CIH, specifically mindfulness and meditation-based modalities, is a viable treatment option for a diverse range of health conditions. Feasibility studies and larger sample sizes are recommended to strengthen the scientific evidence.

Feasibility and acceptability of using a meditation app in adults with rheumatic disease

OBJECTIVE

Meditation is a stress-reduction and contemplative technique that can improve emotional distress in people with chronic disease and may be especially beneficial for patients with rheumatic diseases. However, patient access to in-person programs is challenging. The goal of this pilot study was to evaluate the feasibility/acceptability associated with physician-directed use of a widely available smartphone application (app), Calm©.

METHODS

In this single-arm, pre-post intervention study with recruitment over a 10-month period, adults with rheumatic disease were asked to use the app for ≥5 min/day for 30 days. Participants completed sociodemographic surveys and validated health related quality of life (HRQL) questionnaires from the Patient Reported Outcomes Information System (PROMIS) and NIH Toolbox at baseline and 30-days.

RESULTS

Thirty-five participants who were mostly well-educated (66% ≥college degree) females (91%) with a mean age of 50 (SD 13) completed baseline questionnaires; 18 participants completed post-study questionnaires ("full completers"). Full completers had higher baseline stress, anxiety, pain, and patient global assessment scores (p's <0.05) compared to partial completers. Full completers who provided data used the app on average for 283 min/30 days (SD 257; n = 16) and showed significant improvements in fatigue (-7.6 T-Score units, p = 0.017), with trends for improvement in perceived stress, anxiety, sleep disturbance, self-efficacy for managing symptoms, and pain intensity (p's <0.15).

CONCLUSIONS

A 30-day meditation, stress-reduction app used by patients with rheumatic disease revealed that this is a feasible non-pharmacologic modality to target HRQL and problematic symptoms like fatigue. More rigorous study on app use and potential effect is needed.

Rapid Evidence Review of Digital Cognitive-Behavioral Therapy for Adolescents With Depression

PURPOSE

We conducted a rapid evidence review to explore the benefits and harms of digital cognitive-behavioral therapy (dCBT) and the barriers to and facilitators of implementing dCBT for adolescents.

METHODS

We searched MEDLINE, PsycINFO, CENTRAL through December 6, 2021, for controlled trials conducted in settings highly applicable to the United States. Additionally, we searched relevant systematic reviews for eligible studies. Results were summarized qualitatively.

RESULTS

We included 12 trials (n = 1,575) that examined the effects of nine dCBT programs. Overall, dCBT was slightly superior to comparators in improving depression symptoms immediately post-intervention, but not at a longer follow-up. The use of dCBT did not appear to result in an increased risk for suicidal attempts or ideation; however, the number of events was very small. Potential barriers to implementing/maintaining dCBT are challenges engaging/retaining patients, developing infrastructure, and training therapists to facilitate dCBT. Data on harms or unintended negative consequences were not reported in the included studies.

CONCLUSIONS

A limited body of evidence suggests that dCBT programs might outperform control interventions for reducing depressive symptoms immediately post-intervention, but not at a longer follow-up. The safety of dCBT programs for adolescents with depression is understudied.

A Self-Managed Online Mindfulness Program in a University-Wide Learning Management System Orientation Site: A Real-World Ecological Validation Study

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.

Emergency Department Nurses' Experiences of a Mindfulness Training Intervention: A Phenomenological Exploration

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.

Emotion Self-Regulation in Neurotic Students: A Pilot Mindfulness-Based Intervention to Assess Its Effectiveness through Brain Signals and Behavioral Data

Neuroticism has recently received increased attention in the psychology field due to the finding of high implications of neuroticism on an individual’s life and broader public health. This study aims to investigate the effect of a brief 6-week breathing-based mindfulness intervention (BMI) on undergraduate neurotic students’ emotion regulation. We acquired data of their psychological states, physiological changes, and electroencephalogram (EEG), before and after BMI, in resting states and tasks. Through behavioral analysis, we found the students’ anxiety and stress levels significantly reduced after BMI, with p-values of 0.013 and 0.027, respectively. Furthermore, a significant difference between students in emotion regulation strategy, that is, suppression, was also shown. The EEG analysis demonstrated significant differences between students before and after MI in resting states and tasks. Fp1 and O2 channels were identified as the most significant channels in evaluating the effect of BMI. The potential of these channels for classifying (single-channel-based) before and after BMI conditions during eyes-opened and eyes-closed baseline trials were displayed by a good performance in terms of accuracy (~77%), sensitivity (76–80%), specificity (73–77%), and area-under-the-curve (AUC) (0.66–0.8) obtained by k-nearest neighbor (KNN) and support vector machine (SVM) algorithms. Mindfulness can thus improve the self-regulation of the emotional state of neurotic students based on the psychometric and electrophysiological analyses conducted in this study.

Practicing Mindfulness through mHealth Applications: Emerging Adults' Health-Enhancing and Inhibiting Experiences

Mindfulness-based interventions (MBIs) and practices (MBPs) can promote better health outcomes. Although MBIs and MBPs were developed to be delivered in-person, mobile health (mHealth) tools such as apps have made these more accessible. Mindfulness apps (MAs) are popular among emerging adults (EAs) who have the highest ownership of smartphones and who are also at risk for distress. While adverse effects have been observed with MBIs/MBPs, this has not been examined when mindfulness is practiced using apps. We interviewed EAs (n = 22) to capture their motivations for using these apps and identified health-inhibiting and enhancing experiences. Data were thematically analyzed using the constant comparative method. Motivations for app use included accessibility, convenience, and stress/health management. EAs described health-enhancing outcomes (reduced distress, improved physical symptoms, increased focus) and health-inhibiting outcomes (worsened distress, performance uncertainty, dependency development, worsened physical health). They provided suggestions for improving apps (e.g., feedback option). These findings illustrate benefits and risks that EAs may encounter when practicing mindfulness using apps, which can inform the best practices for app design.

Just-in-Time Adaptive Mechanisms of Popular Mobile Apps for Individuals With Depression: Systematic App Search and Literature Review

BACKGROUND

The number of smartphone apps that focus on the prevention, diagnosis, and treatment of depression is increasing. A promising approach to increase the effectiveness of the apps while reducing the individual's burden is the use of just-in-time adaptive intervention (JITAI) mechanisms. JITAIs are designed to improve the effectiveness of the intervention and reduce the burden on the person using the intervention by providing the right type of support at the right time. The right type of support and the right time are determined by measuring the state of vulnerability and the state of receptivity, respectively.

OBJECTIVE

The aim of this study is to systematically assess the use of JITAI mechanisms in popular apps for individuals with depression.

METHODS

We systematically searched for apps addressing depression in the Apple App Store and Google Play Store, as well as in curated lists from the Anxiety and Depression Association of America, the United Kingdom National Health Service, and the American Psychological Association in August 2020. The relevant apps were ranked according to the number of reviews (Apple App Store) or downloads (Google Play Store). For each app, 2 authors separately reviewed all publications concerning the app found within scientific databases (PubMed, Cochrane Register of Controlled Trials, PsycINFO, Google Scholar, IEEE Xplore, Web of Science, ACM Portal, and Science Direct), publications cited on the app's website, information on the app's website, and the app itself. All types of measurements (eg, open questions, closed questions, and device analytics) found in the apps were recorded and reviewed.

RESULTS

None of the 28 reviewed apps used JITAI mechanisms to tailor content to situations, states, or individuals. Of the 28 apps, 3 (11%) did not use any measurements, 20 (71%) exclusively used self-reports that were insufficient to leverage the full potential of the JITAIs, and the 5 (18%) apps using self-reports and passive measurements used them as progress or task indicators only. Although 34% (23/68) of the reviewed publications investigated the effectiveness of the apps and 21% (14/68) investigated their efficacy, no publication mentioned or evaluated JITAI mechanisms.

CONCLUSIONS

Promising JITAI mechanisms have not yet been translated into mainstream depression apps. Although the wide range of passive measurements available from smartphones were rarely used, self-reported outcomes were used by 71% (20/28) of the apps. However, in both cases, the measured outcomes were not used to tailor content and timing along a state of vulnerability or receptivity. Owing to this lack of tailoring to individual, state, or situation, we argue that the apps cannot be considered JITAIs. The lack of publications investigating whether JITAI mechanisms lead to an increase in the effectiveness or efficacy of the apps highlights the need for further research, especially in real-world apps.

A Teaching Kitchen Medical Groups Visit with an eHealth Platform for Hypertension and Cardiac Risk Factors: A Qualitative Feasibility Study

Introduction: Our Whole Lives-Hypertension (OWL-H) is an eHealth toolkit for hypertension and cardiac risks factors. It is a hybrid online self-management platform that teaches blood pressure (BP) self-monitoring and evidence-based lifestyle modifications combined with in-person teaching kitchen medical group visit. Qualitative feedback from participants regarding the facilitators and barriers of using OWL-H has been discussed in this article. Methods: The OWL-H platform was pilot tested in a pre-post trial with two cohorts of participants with hypertension (N = 24). The online intervention utilized OWL-H for teaching mindfulness meditation, the Dietary Approaches to Stop Hypertension nutrition plan, and evidence-based strategies for lifestyle modifications. Three in-person teaching kitchen medical group visits were held to demonstrate cooking skills to reinforce the online platform. Semi-structured focus group discussions (FGDs) were held after the intervention. Results: Fourteen of the 24 participants in the trial participated in the FGDs, and 1 participant provided feedback in a solo interview. Major themes that emerged included: (1) participants' request to tailor OWL-H's recipes and meal planning to suit their own dietary needs or preferences, to personalize the Home Practices (e.g., meditation) according to individual preferences (e.g., addition of nature sounds or guided visual imagery); (2) the strengths and weaknesses of OWL-H as a BP self-monitoring tool; (3) the need for community support in managing BP; and (4) participants noted lack of time, work and commute, Internet connectivity, stress, and sickness as obstacles in using OWL-H. Participants described feeling outpaced by the growth of technology and raised concerns of poor Internet connectivity hampering their use of OWL-H. Conclusion: OWL-H and the accompanying teaching kitchen medical group visit are potential tools to help reduce hypertension and cardiac risk factors. The intervention was found to have acceptability among people with lower income. Clinical Trials Registration#: NCT03974334.

Distress and retaliatory aggression in response to witnessing intergroup exclusion are greater on higher levels of collective narcissism

The negative consequences of personal exclusion have been demonstrated by multiple studies. Less is known about the consequences of witnessing one's own group being excluded by other groups, although studies suggest exclusion can be experienced vicariously and negatively affects members of the excluded group. Results of the present lab‐based experiment (N = 153) indicate, in line with our predictions, that witnessing intergroup exclusion (a national majority excluded by a minority, manipulated by an adapted intergroup Cyberball paradigm) produced a sense of personal exclusion. It also increased self‐reported distress and behavioral aggression measured in the Taylor Aggression Paradigm), especially among participants high on collective narcissism: a belief that the exaggerated greatness of the in‐group is not sufficiently appreciated by others. Contrary to expectations, a short mindful decentration intervention (instructing participants to observe thoughts and emotions as transient mental products without engaging with them) delivered while participants were witnessing intergroup exclusion (vs. inclusion) produced changes in heart rate variability reactivity indicative of emotional arousal, especially among collective narcissists. We concluded that collective narcissism is associated with distress in the face of intergroup exclusion, aggressive retaliation, and in consequence, it is a risk‐factor predisposing group members to stress‐related health and psychosocial problems. Furthermore, a mindful decentration, despite being an effective strategy to reduce maladaptive stress in most people, may be counterproductive in addressing high collective narcissists' responses to threat to the in‐group's image.

This study demonstrated that mindfulness‐based interventions may not mitigate, but rather exacerbate the distressing effects of observed intergroup exclusion in individuals scoring high on collective narcissism. The finding was observed on the psychophysiological level (HF HRV), but not on the psychological level (self‐reported distress), indicating that individuals high in collective narcissism may not consciously perceive, or choose to report their stronger reactions occurring after a mindfulness‐based intervention.

A Qualitative Study Comparing Mindfulness and Shinrin-Yoku (Forest Bathing): Practitioners’ Perspectives

The boundary between mindfulness and forest bathing, two conceptually related therapies, is unclear. Accordingly, this study reports the strengths and challenges, similarities and differences, and barriers and facilitators for both. Semi-structured interviews were conducted with seven trained and experienced practitioners of both mindfulness and forest bathing. Reflexive thematic analysis revealed four main themes: (i) differences between the approaches; (ii) the benefits of forest bathing; (iii) biophilia through forest bathing; and (iv) inward versus outward attentional focus as a distinction between the approaches. Both practices were found to benefit well-being, but practitioners revealed key barriers to mindfulness. For vulnerable groups experiencing mental health challenges or difficulties achieving a meditative state, mindfulness may introduce well-being risks. By offering a gentler, more intuitive approach that encourages outward attentional focus, forest bathing was found to overcome this barrier. Forest bathing is suitable for all groups, but adaptations are recommended for those expressing fear or discomfort in forested environments. The findings inform how to position both approaches in practice, as a first step towards social prescribing recommendations. Wider implications concern forest bathing’s potential to impact environmental well-being. Future research must garner comparative data, involve young people, and explore the feasibility of a forest bathing social prescription.

Barriers and facilitators to engaging individuals and families with autism spectrum disorder in mindfulness and acceptance-based therapies: a meta-synthesis

PURPOSE

Third-wave psychological therapies can benefit individuals and families living with autism spectrum disorder (ASD). To date, little is known about individuals' perceptions and experiences of therapy. This meta-synthesis aimed to capture participants' own reflections of mindfulness and acceptance-based therapies, including potential barriers and facilitators to therapy engagement.

MATERIALS AND METHODS

Database searches identified 10 independent studies targeting caregivers (N_studies = 3), dyadic parent-child interventions (N_studies = 6), or adults with ASD (N_studies = 1). Studies were subject to quality assessment and thematically analysed.

RESULTS

Caregivers highlighted a need to adapt the length and frequency of daily mindfulness practice around busy lifestyles. Adults with ASD also identified therapy barriers, although these data were less robust. Children with ASD focused on therapy benefits.

CONCLUSIONS

All three participant groups commented on the importance of mindfulness as a method to enhance self-awareness, self-regulation and self-care. Peer support provided in group-based therapy was also seen as beneficial. Future research should examine the application of mindfulness therapies to adults with ASD, with little currently known about this cohort's therapy experiences. Whether traditional mindfulness approaches can be effectively modified to accommodate ongoing, cumulative daily demands these families experience also requires investigation.Implications for rehabilitationIndividuals with autism spectrum disorders (ASD) and their caregivers often experience high levels of anxiety and stress.Mindfulness and acceptance-based therapies can enhance an individual's self-awareness and self-regulation, thereby reducing distress - with benefits extending to familiesGroup-based therapy is an important adjunct to the support of caregivers developing mindfulness-awareness.

The effects of app-based mindfulness practice on the well-being of university students and staff

Mental health problems like anxiety, depression, and stress have been increasing in many countries and the 2020 COVID-19 pandemic has further exacerbated their toll. Mindfulness-based interventions have been shown to provide evidence-based treatments for anxiety and depression, and accumulating evidence is emerging in support of using mindfulness apps yielding small-to-moderate treatment effects. The study was a 4-week randomized controlled trial with 561 university students and staff as participants, divided into a treatment group (mindfulness app) and an active control group (psychoeducational online content). Depression, anxiety, and stress were evaluated as primary study outcomes. Saliva cortisol samples were also collected from a subgroup of the treatment arm (n = 29). Using the mindfulness app for four weeks resulted in small reductions in stress (d = .16), and depression (d = .16). Attrition was 28.0%. Subjects who practiced more did not experience additional improvement in wellbeing. Mindfulness apps offer modest but clear benefits to users in terms of improved mental health. They present a promising supplement to traditional mental health services.

A randomized controlled trial of an app-delivered mindfulness program among university employees: effects on stress and work-related outcomes

Purpose

The purpose of this paper is to evaluate the impact on stress and work-related outcomes of an app-delivered mindfulness-based program (MBP; Headspace®) offered to employees in a UK higher education (HE) institution.

Design/methodology/approach

Using a randomized waitlist control trial design, participants were randomly allocated to be offered a mindfulness-based program (MBP) immediately for 2 months or after a waiting list period of 2 months (WLC). Data were analyzed using Intention to Treat (ITT; MBP n = 62; WLC n = 63); with supplementary analysis restricting to those who completed all measures; (MBP n = 45; WLC n = 56) and then further restricting the MBP group to those who completed at least foundation level 1 of the app; (MBP n = 31; WLC n = 56).

Findings

The ITT analysis showed significant increases in several aspects of mindfulness and a significant reduction in perceived stress but no significant effects for work-related outcomes. Analysis restricted to MBP participants who completed the app foundation course showed a similar pattern but in addition showed significant increases in work-life balance and the emotional aspect of job engagement.

Practical implications

The offer of the Headspace® app in the HE sector may result in reduced perceived stress. If improvements in work-related outcomes are also to be seen, then users need to be encouraged to complete a minimum level of practice.

Originality/value

Effect size estimates for stress and work-related outcomes of an app-delivered MBP contribute to the evolving picture of MBPs in the workplace.

Smartphone apps for the treatment of mental health conditions: status and considerations

Clinical and research interest in the potential of mobile health apps for the management of mental health conditions has recently been given added impetus by growing evidence of consumer adoption. In parallel, there is now a developing evidence base that includes meta-analyses demonstrating reductions in symptoms of depression and anxiety, and reduction in suicidal ideation. While these findings are encouraging, recent research continues to identify a number of potential barriers to the widespread adoption of mental health apps. These challenges include poor data governance and data sharing practices; questions of clinical safety relating to the management of adverse events and potentially harmful content; low levels of user engagement and the possibility of 'digital placebo' effects; and workforce barriers to integration with clinical practice. Current efforts to address these include the development of new models of care, such as 'digital clinics' that integrate health apps. Other contemporary innovations in the field such as digital sensing and just-in-time adaptive interventions are showing early promise for providing accessible and personalised care.