Effects of a Mindfulness Meditation App on Subjective Well-Being: Active Randomized Controlled Trial and Experience Sampling Study

Mindful Self-Compassion Smartphone Intervention for Worker Mental Health in Japan: Protocol for a Randomized Controlled Trial

BACKGROUND

Mental health problems among workers cause enormous losses to companies in Japan. However, workers have been considered to have limited access to psychological support because of time constraints, which makes it difficult for them to engage in face-to-face psychological support interventions.

OBJECTIVE

This study aimed to present an intervention protocol that describes a randomized controlled trial to examine whether brief guided mindfulness meditation (MM) or self-compassion meditation (SCM) provided by a smartphone app is effective for mental health and work-related outcomes among workers.

METHODS

This is an open-label, 3-arm randomized controlled trial. The participants will be recruited through an open call on relevant websites with the following inclusion criteria: (1) employees who are working more than 20 hours per week, (2) between the ages of 18 and 54 years, (3) not on a leave of absence, (4) not business owners or students, and (5) not currently diagnosed with a mental disorder and have a Kessler Psychological Distress Scale-6 score below 13 points. We will include 200 participants and randomly assign them to an SCM course (n=67), an MM course (n=67), and a waitlist group (n=66). The intervention groups (SCM and MM) will be instructed to engage in daily guided self-help, self-compassion, and MMs lasting 6-12 minutes per day over 4 weeks. Primary outcomes will include psychological distress and job performance, and secondary outcomes will include somatic symptoms, cognitive flexibility, self-esteem, self-compassion, perceived stress, well-being, emotion regulation, work engagement, anger, psychological safety, and creativity. All procedures were approved by the ethics committee of the University of Tokyo (22-326). All participants will be informed of the study via the websites, and written informed consent will be collected via web-based forms.

RESULTS

The recruitment of participants began in December 2022, and the intervention began in January 2023. As of September 2023, a total of 375 participants have been enrolled. The intervention and data collection were completed in late October 2023.

CONCLUSIONS

This study will contribute to the development of effective self-care intervention content that will improve mental health, work performance, and related outcomes and promote mindful and self-compassionate attitudes when faced with distress.

TRIAL REGISTRATION

University Hospital Medical Information Network Clinical Trials Registry UMIN000049466; https://tinyurl.com/23x8m8nf.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/53541.

Emotions and cognition; a promising crossroad for brain tumor diagnosis and prevention

Cognitive and behavioral neuroscience is essential for understanding brain tumors and their effects. Researchers have realized that an important step is to start looking for cognitive impairment at the time of diagnosis to see what deficits the brain tumor has left the patient with. Then cognitive assessment should be made after the tumor has been removed to see how it changes. The aim of this study was to assess the current research on tumor diagnosis and prevention through a filter of emotion and cognition; and then look at what future steps need to be taken. This review reports what research has already been done and what research still needs to be accomplished, including addressing the need for more data on cognitive impairment while the brain tumor is active, in the literature.

Smartphone App-Delivered Mindfulness-Based Intervention for Mild Traumatic Brain Injury in Adolescents: Protocol for a Feasibility Randomized Controlled Trial

BACKGROUND

Concussion in children and adolescents is a significant public health concern, with 30% to 35% of patients at risk for prolonged emotional, cognitive, sleep, or physical symptoms. These symptoms negatively impact a child's quality of life while interfering with their participation in important neurodevelopmental activities such as schoolwork, socializing, and sports. Early psychological intervention following a concussion may improve the ability to regulate emotions and adapt to postinjury symptoms, resulting in the greater acceptance of change; reduced stress; and recovery of somatic, emotional, and cognitive symptoms.

OBJECTIVE

The primary objective of this study is to assess the feasibility of conducting a parallel-group (1:1) randomized controlled trial (RCT) to evaluate a digital therapeutics (DTx) mindfulness-based intervention (MBI) in adolescents aged 12 to <18 years. The attention-matched comparator intervention (a math game also used in previous RCTs) will be delivered on the same DTx platform. Both groups will be provided with the standard of care guidelines. The secondary objective is to examine intervention trends for quality of life; resilience; self-efficacy; cognition such as attention, working memory, and executive functioning; symptom burden; and anxiety and depression scores at 4 weeks after concussion, which will inform a more definitive RCT. A subsample will be used to examine whether those randomized to the experimental intervention group have different brain-based imaging patterns compared with those randomized to the control group.

METHODS

This study is a double-blind Health Canada-regulated trial. A total of 70 participants will be enrolled within 7 days of concussion and randomly assigned to receive the 4-week DTx MBI (experimental group) or comparator intervention. Feasibility will be assessed based on the recruitment rate, treatment adherence to both interventions, and retention. All outcome measures will be evaluated before the intervention (within 7 days after injury) and at 1, 2, and 4 weeks after the injury. A subset of 60 participants will undergo magnetic resonance imaging within 72 hours and at 4 weeks after recruitment to identify the neurophysiological mechanisms underlying the potential benefits from MBI training in adolescents following a concussion.

RESULTS

The recruitment began in October 2022, and the data collection is expected to be completed by September 2024. Data collection and management is still in progress; therefore, data analysis is yet to be conducted.

CONCLUSIONS

This trial will confirm the feasibility and resolve uncertainties to inform a future definitive multicenter efficacy RCT. If proven effective, a smartphone-based MBI has the potential to be an accessible and low-risk preventive treatment for youth at risk of experiencing prolonged postconcussion symptoms and complications.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05105802; https://classic.clinicaltrials.gov/ct2/show/NCT05105802.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/57226.

Development of Therapeutic Alliance and Social Presence in a Digital Intervention for Pediatric Concussion: Qualitative Exploratory Study

BACKGROUND

Despite the promising benefits of self-guided digital interventions for adolescents recovering from concussion, attrition rates for such interventions are high. Evidence suggests that adults can develop therapeutic alliance with self-guided digital interventions, which is in turn associated with intervention engagement. However, no research has examined whether adolescents develop therapeutic alliance with self-guided digital interventions and what factors are important to its development. Additionally, social presence-the extent to which digital encounters feel like they are occurring in person-may be another relevant factor to understanding the nature of the connection between adolescents and a self-guided digital intervention, though this has yet to be explored.

OBJECTIVE

This qualitative study explored the extent to which adolescents recovering from concussion developed therapeutic alliance and social presence during their use of a self-guided digital mindfulness-based intervention. Additionally, this study aimed to determine factors important to adolescents' development of therapeutic alliance and social presence with the intervention.

METHODS

Adolescents aged between 12 and 17.99 years who sustained a concussion were recruited from 2 sites: a pediatric emergency department up to 48 hours after a concussion and a tertiary care clinic over 1 month following a concussion to capture adolescents who had both acute and persisting symptoms after concussion. Participants (N=10) completed a 4-week mindfulness-based intervention delivered through a smartphone app. Within the app, participants listened to audio recordings of mindfulness guides (voice actors) narrating psychoeducation and mindfulness practices. At 4 weeks, participants completed questionnaires and a semistructured interview exploring their experience of therapeutic alliance and social presence with the mindfulness guides in the intervention.

RESULTS

Themes identified within the qualitative results revealed that participants developed therapeutic alliance and social presence by "developing a genuine connection" with their mindfulness guides and "sensing real people." Particularly important to the development of therapeutic alliance and social presence were the mindfulness guides' "personal backgrounds and voices," such that participants felt more connected to the guides by knowing information about them and through the guides' calm tone of voice in audio recordings. Quantitative findings supported qualitative results; participants' average score for therapeutic alliance was far above the scale midpoint, while the mixed results for social presence measures aligned with qualitative findings that participants felt that the mindfulness guides seemed real but not quite as real as an in-person connection would.

CONCLUSIONS

Our data suggest that adolescents can develop therapeutic alliance and social presence when using digital interventions with no direct human contact. Adolescents' development of therapeutic alliance and social presence with self-guided digital interventions can be bolstered by increasing human-like qualities (eg, real voices) within interventions. Maximizing therapeutic alliance and social presence may be a promising way to reduce attrition in self-guided digital interventions while providing accessible treatment.

The impact of mindfulness apps on psychological processes of change: a systematic review

Mindfulness-based interventions (MBIs) have demonstrated therapeutic efficacy for various psychological conditions, and smartphone apps that facilitate mindfulness practice can enhance the reach and impact of MBIs. The goal of this review was to summarize the published evidence on the impact of mindfulness apps on the psychological processes known to mediate transdiagnostic symptom reduction after mindfulness practice. A literature search from January 1, 1993, to August 7, 2023 was conducted on three databases, and 28 randomized controlled trials involving 5963 adults were included. Across these 28 studies, 67 outcome comparisons were made between a mindfulness app group and a control group. Between-group effects tended to favor the mindfulness app group over the control group in three psychological process domains: repetitive negative thinking, attention regulation, and decentering/defusion. Findings were mixed in other domains (i.e., awareness, nonreactivity, non-judgment, positive affect, and acceptance). The range of populations examined, methodological concerns across studies, and problems with sustained app engagement likely contributed to mixed findings. However, effect sizes tended to be moderate to large when effects were found, and gains tended to persist at follow-up assessments two to six months later. More research is needed to better understand the impact of these apps on psychological processes of change. Clinicians interested in integrating apps into care should consider app-related factors beyond evidence of a clinical foundation and use app databases to identify suitable apps for their patients, as highlighted at the end of this review.

Effectiveness of applied and casual games for young people's mental health: A systematic review of randomised controlled studies

Many youth experience mental health problems and digital games hold potential as mental health interventions. This systematic review provides an overview of randomised controlled studies assessing the effectiveness of digital applied and casual games for improving mental health in youth aged 6-24 years. A systematic search of PsycINFO, Web of Science and Pubmed yielded 145 eligible studies. Studies on (sub)clinical participant samples (n = 75) most often focused on attention-deficit/hyperactivity disorder (ADHD), autism and anxiety. Applied games were found most effective for improving social skills, verbal memory and anxiety, whereas casual games were found most effective for improving depression, anxiety and ADHD. Studies involving healthy youth (n = 70) were grouped into papers examining anxiety in medical settings, momentary effects on positive and negative affect, and papers employing a longitudinal design measuring mental health trait outcomes. Promising results were found for the use of games as distraction tools in medical settings, and for applied and casual games for improving momentary affect. Overall, our findings demonstrate the potential of digital games for improving mental health. Implications and recommendations for future research are discussed, such as developing evaluation guidelines, clearly defining applied games, harmonising outcome measures, including positive outcomes, and examining nonspecific factors that may influence symptom improvement as well.

Digital mindfulness training and cognitive functions: A preregistered systematic review of neuropsychological findings

Traditional mindfulness interventions have been frequently reported to be effective in improving cognitive functions. In recent years, however, traditional programs are being increasingly replaced by technology-enabled mindfulness training programs. The aim of the present systematic review (PROSPERO ID: CRD42021289480) is to evaluate the research evidence on their effects on cognitive functions. Empirical training studies in the realm of digital mindfulness training that fulfilled the inclusion criteria led to 19 studies and 1654 participants being included in this review from among the papers searched in PubMed, Scopus, and Web of Knowledge. Results support previous assumptions on the potential of digital mindfulness training, with the most robust effect on attention control, followed by executive regulation, memory, cognitive flexibility, and other cognitive functions. However, the number of studies that did not find significant changes at least equaled, if not exceeded, the number of studies that found increases. The heterogeneity of identified studies prompted us to discuss several aspects in order to help the future development of digital applications.

Acceptability, usability, and credibility of a mindfulness-based digital therapeutic for pediatric concussion: A mixed-method study

Background

The ability to cope with concussion symptoms and manage stress is an important determinant of risk for prolonged symptoms.

Objective

This open-label mixed-methods pilot study assessed the acceptability and credibility of a mindfulness-based intervention delivered through a digital therapeutic (DTx; therapeutic smartphone app) for pediatric concussion.

Methods

Participants aged 12 to 18 years were recruited from an emergency department within 48 hours of a concussion (acute cohort) or from a tertiary care clinic at least 1-month post-concussion (persisting symptoms cohort). Participants completed a novel 4-week mindfulness-based intervention, for 10 to 15 minutes/day, at a minimum of 4 days/week. At 2 weeks, participants completed a credibility and expectancy questionnaire. At 4 weeks, participants completed questionnaires assessing satisfaction, usability and working alliance, as well as a semi-structured phone interview.

Results

Ten participants completed the study outcomes (7 acute; 3 persisting symptoms). The intervention was perceived as credible (median/max possible = 6.50/9.00 [6.83,8.75]) and DTx was usable (median/max possible = 70.00/100.00 [55.00,82.50]). Participants rated their satisfaction with the DTx (median/max possible = 27.00/32.00 [24.50,29.50]) and the working alliance with the digital mindfulness guides (median/max possible = 3.92/5.00 [3.38-4.33]) as high. Four themes were identified from the qualitative data: (a) positive attributes; (b) negative attributes; (c) ideas for modifications; and (d) technical issues.

Conclusion

Results show modifications to the DTx, instructions and mindfulness intervention, and potential ways to increase adherence by leveraging positive attributes. A randomized control trial will assess the effectiveness of the DTx MBI to decrease the risk of persisting symptoms and reduce the symptom burden following pediatric concussion.

Exploring the added value of virtual reality biofeedback game DEEP in forensic psychiatric inpatient care-A qualitative study

Background

Low motivation and suboptimal cognitive skills are common among forensic psychiatric patients. By focusing on doing and experiencing, innovative technologies could offer an alternative to existing treatment for this patient group. One promising technology is DEEP, a VR biofeedback game that teaches diaphragmatic breathing, which has shown its potential in reducing stress in other populations. This exploratory study aimed at identifying if, how and for whom DEEP can be of added value in forensic mental healthcare.

Methods

This study used a qualitative approach. Six focus groups with 24 healthcare providers and 13 semi-structured interviews with forensic psychiatric inpatients were conducted in two Dutch forensic mental healthcare organizations. All healthcare providers and patients experienced DEEP before participating. The data were coded inductively, using the method of constant comparison.

Results

The data revealed six themes with accompanying (sub)codes, including (1) the possible advantages and (2) disadvantages of DEEP, (3) patient characteristics that could make DEEP more or (4) less suitable and beneficial, (5) ways DEEP could be used in current treatment, and (6) conditions that need to be met to successfully implement DEEP in forensic mental healthcare. The results showed that DEEP can offer novel ways to support forensic psychiatric patients in coping with negative emotions by practicing diaphragmatic breathing. Its appealing design might be suitable to motivate a broad range of forensic psychiatric patient groups. However, DEEP cannot be personalized, which might decrease engagement and uptake of DEEP long-term. Regarding its place in current care, DEEP could be structurally integrated in existing treatment programs or used ad hoc when the need arises. Finally, this study showed that both healthcare providers and patients would need practical support and information to use DEEP.

Conclusion

With its experience-based and gamified design, DEEP could be useful for forensic mental healthcare. It is recommended that patients and healthcare providers are included in the evaluation and implementation from the start. Besides, a multilevel approach should be used for formulating implementation strategies. If implemented well, DEEP can offer new ways to provide forensic psychiatric patients with coping strategies to better control their anger.

Rates of attrition and engagement in randomized controlled trials of mindfulness apps: Systematic review and meta-analysis

Randomized controlled trials (RCT) have established the efficacy of mindfulness apps for numerous mental health and behavioral outcomes. However, studies of this kind are characterized by significant problems with attrition and engagement, making it challenging to interpret these findings and realize the full potential of mindfulness app-based solutions. This systematic review and meta-analysis aimed to examine rates of attrition from, and engagement in, mindfulness apps in 70 RCTs located through four databases. The weighted meta-analytic attrition rate from 9258 participants allocated to a mindfulness app was 24.7%. This estimate was higher (38.7%) when restricting analyses to larger studies (n ≥ 100 per condition) and for specific target samples (e.g., general population of adults). Studies that offered participants monetary compensation and required in-person enrolment methods were associated with the lowest attrition rates. Attrition was higher in mindfulness app conditions relative to waitlists, but was not different to placebo or active apps. Although engagement data were inadequately reported, qualitative synthesis highlighted clear problems with sustained user engagement with mindfulness apps. Findings have implications for powering, designing and appraising research trials of mindfulness apps, as well as the development of potentially effective retention and engagement strategies worthy of evaluation in future work.

The Effectiveness of Fully Automated Digital Interventions in Promoting Mental Well-Being in the General Population: Systematic Review and Meta-Analysis

BACKGROUND

Recent years have highlighted an increasing need to promote mental well-being in the general population. This has led to a rapidly growing market for fully automated digital mental well-being tools. Although many individuals have started using these tools in their daily lives, evidence on the overall effectiveness of digital mental well-being tools is currently lacking.

OBJECTIVE

This study aims to review the evidence on the effectiveness of fully automated digital interventions in promoting mental well-being in the general population.

METHODS

Following the preregistration of the systematic review protocol on PROSPERO, searches were carried out in MEDLINE, Web of Science, Cochrane, PsycINFO, PsycEXTRA, Scopus, and ACM Digital (initial searches in February 2022; updated in October 2022). Studies were included if they contained a general population sample and a fully automated digital intervention that exclusively used psychological mental well-being promotion activities. Two reviewers, blinded to each other's decisions, conducted data selection, extraction, and quality assessment of the included studies. Narrative synthesis and a random-effects model of per-protocol data were adopted.

RESULTS

We included 19 studies that involved 7243 participants. These studies included 24 fully automated digital mental well-being interventions, of which 15 (63%) were included in the meta-analysis. Compared with no intervention, there was a significant small effect of fully automated digital mental well-being interventions on mental well-being in the general population (standardized mean difference 0.19, 95% CI 0.04-0.33; P=.02). Specifically, mindfulness-, acceptance-, commitment-, and compassion-based interventions significantly promoted mental well-being in the general population (P=.006); insufficient evidence was available for positive psychology and cognitive behavioral therapy-based interventions; and contraindications were found for integrative approaches. Overall, there was substantial heterogeneity, which could be partially explained by the intervention duration, comparator, and study outcomes. The risk of bias was high, and confidence in the quality of the evidence was very low (Grading of Recommendations, Assessment, Development, and Evaluations), primarily because of the high rates of study dropout (average 37%; range 0%-85%) and suboptimal intervention adherence (average 40%).

CONCLUSIONS

This study provides a novel contribution to knowledge regarding the effectiveness, strengths, and weaknesses of fully automated digital mental well-being interventions in the general population. Future research and practice should consider these findings when developing fully automated digital mental well-being tools. In addition, research should aim to investigate positive psychology and cognitive behavioral therapy-based tools as well as develop further strategies to improve adherence and reduce dropout in fully automated digital mental well-being interventions. Finally, it should aim to understand when and for whom these interventions are particularly beneficial.

TRIAL REGISTRATION

PROSPERO CRD42022310702; https://tinyurl.com/yc7tcwy7.

The Effectiveness of a Neurofeedback-Assisted Mindfulness Training Program Using a Mobile App on Stress Reduction in Employees: Randomized Controlled Trial

BACKGROUND

Mindfulness-based training programs have consistently shown efficacy in stress reduction. However, questions regarding the optimal duration and most effective delivery methods remain.

OBJECTIVE

This research explores a 4-week neurofeedback-assisted mindfulness training for employees via a mobile app. The study's core query is whether incorporating neurofeedback can amplify the benefits on stress reduction and related metrics compared with conventional mindfulness training.

METHODS

A total of 92 full-time employees were randomized into 3 groups: group 1 received mobile mindfulness training with neurofeedback assistance (n=29, mean age 39.72 years); group 2 received mobile mindfulness training without neurofeedback (n=32, mean age 37.66 years); and group 3 were given self-learning paper materials on stress management during their first visit (n=31, mean age 38.65 years). The primary outcomes were perceived stress and resilience scales. The secondary outcomes were mindfulness awareness, emotional labor, occupational stress, insomnia, and depression. Heart rate variability and electroencephalography were measured for physiological outcomes. These measurements were collected at 3 different times, namely, at baseline, immediately after training, and at a 4-week follow-up. The generalized estimating equation model was used for data analysis.

RESULTS

The 4-week program showed significant stress reduction (Wald χ22=107.167, P<.001) and improvements in psychological indices including resilience, emotional labor, insomnia, and depression. A significant interaction was observed in resilience (time × group, Wald χ42=10.846, P=.02). The post hoc analysis showed a statistically significant difference between groups 1 (least squares mean [LSM] 21.62, SE 0.55) and 3 (LSM 19.90, SE 0.61) at the posttraining assessment (P=.008). Group 1 showed a significant improvement (P<.001) at the posttraining assessment, with continued improvements through the 1-month follow-up assessment period (LSM 21.55, SE 0.61). Physiological indices were analyzed only for data of 67 participants (22 in group 1, 22 in group 2, and 23 in group 3) due to the data quality. The relaxation index (ratio of alpha to high beta power) from the right electroencephalography channel showed a significant interaction (time × group, Wald χ22=6.947, P=.03), with group 1 revealing the highest improvement (LSM 0.43, SE 0.15) compared with groups 2 (LSM -0.11, SE 0.10) and 3 (LSM 0.12, SE 0.10) at the 1-month follow-up assessment.

CONCLUSIONS

The study demonstrated that the neurofeedback-assisted group achieved superior outcomes in resilience and relaxation during the 4-week mobile mindfulness program. Further research with larger samples and long-term follow-up is warranted.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03787407; https://clinicaltrials.gov/ct2/show/NCT03787407.

Mindfulness-Based Mobile Apps and Their Impact on Well-Being in Nonclinical Populations: Systematic Review of Randomized Controlled Trials

BACKGROUND

Mindfulness-based mobile apps have become popular tools for enhancing well-being in today's fast-paced world. Their ability to reduce geographical, financial, and social barriers makes them a promising alternative to traditional interventions.

OBJECTIVE

As most available apps lack a theoretical framework, this review aimed to evaluate their effectiveness and assess their quality. We expected to find small sample sizes, high dropout rates, and small effect sizes in the included studies.

METHODS

A systematic literature search was conducted using PsycInfo, PsycNet, PubMed, an institutional search engine (u:search), and Google Scholar. Randomized controlled trials assessing the impact of mobile mindfulness apps on well-being in nonclinical samples were included. Study selection, risk of bias (using the version 2 of the Cochrane risk-of-bias tool for randomized trials), and reporting quality (using selected CONSORT [Consolidated Standards of Reporting Trials] statement criteria) assessments were performed by 2 authors independently and discussed until a consensus was reached.

RESULTS

The 28 included randomized controlled trials differed in well-being measures, apps, and intervention duration (7 to 56 days; median duration 28 days). A wide range of sample sizes (12 to 2282; median 161) and attrition rates (0% to 84.7%; median rate 23.4%) were observed. Most studies (19/28, 68%) reported positive effects on at least one aspect of well-being. The effects were presented using different metrics but were primarily small or small to medium in size. Overall risk of bias was mostly high.

CONCLUSIONS

The wide range of sample sizes, attrition rates, and intervention periods and the variation in well-being measures and mobile apps contributed to the limited comparability of the studies. Although most studies (16/28, 57%) reported small or small to medium effects for at least one well-being outcome, this review demonstrates that the generalizability of the results is limited. Further research is needed to obtain more consistent conclusions regarding the impact of mindfulness-based mobile apps on well-being in nonclinical populations.

Effects and mechanisms of an online short-term audio-based mindfulness program on positive affect: A randomized controlled trial including exploratory moderator analyses

This study investigated the effects and mechanisms of an online short-term audio-based mindfulness (SAM) intervention program on positive affect and explored how well-being and negative affect influenced these effects and mechanisms. Participants (N = 100) were randomized into an intervention group (n = 50) and a control group (n = 50). Those in the mindfulness group underwent 3 weeks of an online SAM program and completed the online measures four times, while those in the control group completed the measures twice. Participants completed measures including the World Health Organization Well-Being Index, the Freiburg Mindfulness Inventory, and the Positive and Negative Affect Schedule. The effects of measures in both groups were compared. Parallel process latent growth curve modeling analysis was used to explore the longitudinal moderated mediation effects. The results showed that SAM was effective at improving positive affect, mindfulness, well-being, and reducing negative affect. Mindfulness growth speed during the intervention period mediated the relationship between SAM and positive affect improvement speed. The moderation effects of baseline well-being and negative effect on mediation effects were found to be significant. The SAM program was effective for the general public and was more beneficial for those with medium/high well-being and low/medium negative affect.

The Effect of a Mindfulness Phone Application on NICU Nurses' Professional Quality of Life

BACKGROUND

Evidence suggests that mindfulness training using a phone application (app) may support neonatal intensive care unit (NICU) nurses in their high stress work. If effective, phone apps could improve nurses' professional quality of life (QOL) defined as compassion satisfaction (CS) and compassion fatigue (CF) that includes burnout (BO) and secondary traumatic stress (STS).

PURPOSE

To test the hypothesis that use of a mindfulness phone app will increase NICU nurses' professional QOL.

METHODS

Using a single-group, pre/posttest design, investigators invited a convenience sample of 54 NICU nurses from a 377-bed Magnet-recognized, nonprofit hospital to complete a demographic sheet and 2 established scales: the Professional Quality of Life scale, version 5 (ProQOL5), and the Mindfulness Attention Awareness Scale (MAAS). The intervention was nurses' using the mindfulness phone app, Premium Moodfit, for 3 weeks.

RESULTS

Response rate was 41% (N = 22). A paired t test for the 9 nurses who returned both pre- and posttest questionnaires showed that their STS fell from moderate to low (P = .003), while their low BO scores (P = .12) and moderate CS scores (P = .4) remained stable. Wilcoxon tests confirmed results: only STS decreased (P =.01). The hypothesis was partly supported.

IMPLICATIONS FOR PRACTICE AND RESEARCH

Using the Premium Moodfit mindfulness phone app may improve or maintain NICU nurses' professional QOL even under heightened stress. Individual nurses may independently access Moodfit and the free ProQOL5. Replication studies are warranted to confirm results and establish trends.

Web-based training for post-secondary student well-being during the pandemic: a randomized trial

Background: The COVID-19 pandemic has been a highly stressful period where post-secondary education moved to online formats. Coping skills like decentering and reappraisal appear to promote stress resilience, but limited research exists on cultivating these skills in online learning contexts.Methods: In a three-arm randomized trial design, we evaluated three-week, web-based interventions to gauge how to best cultivate mindfulness and stress-reappraisal skills and whether the proposed interventions led to improved mental health. Undergraduate participants (N = 183) were randomly assigned to stress mindset, mindfulness meditation, or mindfulness with choice conditions.Results: At the study level (baseline vs. post-intervention), decentering improved across all conditions. Mindfulness with choice significantly decreased negative affect and rumination compared to stress mindset, while stress mindset significantly enhanced stress mindset skills compared to both mindfulness groups. At the daily level (three sessions per week), stress mindset significantly increased positive affect compared to mindfulness meditation.Conclusions: Results suggest that student mental health can be remotely supported through brief web-based interventions. Mindfulness practices seem to be effective in improving students' negative mood and coping strategies, while stress mindset training can help students to adopt a stress-is-enhancing mindset. Additional work on refining and better matching students to appropriate interventions is needed.

Online Mindfulness Intervention, Mental Health and Attentional Abilities: A Randomized Controlled Trial in University Students During COVID-19 Lockdown

The COVID-19 pandemic has led to worldwide restrictive measures, raising concerns about mental health in young adults who were not particularly vulnerable to the virus itself. This study investigated the impact of these restrictions on mental and cognitive health of university students, and tested the efficacy of a brief online mindfulness meditation intervention in countering psychological distress and improving attentional abilities. Ninety-six university students forced into remote learning due to COVID-19 pandemic restrictions and with no experience in meditation were randomly assigned to either a passive control group (n = 48) or to an experimental group (n = 48) following daily, for 17 days, an online mindfulness intervention (10–20 min per day). Due to drop-out, 38 participants in each group were finally analyzed. Pre- and post-tests assessed participants’ mental health (psychological well-being, depression, anxiety, stress) and attentional abilities. The analysis of baseline data in comparison with normative scores and pre-pandemic statistics confirmed the expected psychological distress, but it did not reveal any attentional deficits in our participants. Pre-post change scores analyses showed a reduction in stress (p = 0.006, η_p² = 0.10), anxiety (p = 0.002, η_p² = 0.13), and depression (p = 0.025, η_p² = 0.07), and an improvement in well-being (p = 0.013, η_p² = 0.12) in the experimental group, but not in the control group. In both groups, no significant effect was found on attentional abilities. Our results confirmed the psychological vulnerability of higher education students in the midst of the remote learning period during the second COVID-19 lockdown in France, while suggesting preservation of attentional functioning. Although the tested mindfulness intervention did not enhance the attentional abilities in already good performing students, it did promote their mental health. This study offers additional evidence on the feasibility and efficacy of mindfulness-based interventions in students during psychologically straining periods, like the COVID-19 pandemic.

Factors Influencing Adherence to mHealth Apps for Prevention or Management of Noncommunicable Diseases: Systematic Review

Background

Mobile health (mHealth) apps show vast potential in supporting patients and health care systems with the increasing prevalence and economic costs of noncommunicable diseases (NCDs) worldwide. However, despite the availability of evidence-based mHealth apps, a substantial proportion of users do not adhere to them as intended and may consequently not receive treatment. Therefore, understanding the factors that act as barriers to or facilitators of adherence is a fundamental concern in preventing intervention dropouts and increasing the effectiveness of digital health interventions.

Objective

This review aimed to help stakeholders develop more effective digital health interventions by identifying factors influencing the continued use of mHealth apps targeting NCDs. We further derived quantified adherence scores for various health domains to validate the qualitative findings and explore adherence benchmarks.

Methods

A comprehensive systematic literature search (January 2007 to December 2020) was conducted on MEDLINE, Embase, Web of Science, Scopus, and ACM Digital Library. Data on intended use, actual use, and factors influencing adherence were extracted. Intervention-related and patient-related factors with a positive or negative influence on adherence are presented separately for the health domains of NCD self-management, mental health, substance use, nutrition, physical activity, weight loss, multicomponent lifestyle interventions, mindfulness, and other NCDs. Quantified adherence measures, calculated as the ratio between the estimated intended use and actual use, were derived for each study and compared with the qualitative findings.

Results

The literature search yielded 2862 potentially relevant articles, of which 99 (3.46%) were included as part of the inclusion criteria. A total of 4 intervention-related factors indicated positive effects on adherence across all health domains: personalization or tailoring of the content of mHealth apps to the individual needs of the user, reminders in the form of individualized push notifications, user-friendly and technically stable app design, and personal support complementary to the digital intervention. Social and gamification features were also identified as drivers of app adherence across several health domains. A wide variety of patient-related factors such as user characteristics or recruitment channels further affects adherence. The derived adherence scores of the included mHealth apps averaged 56.0% (SD 24.4%).

Conclusions

This study contributes to the scarce scientific evidence on factors that positively or negatively influence adherence to mHealth apps and is the first to quantitatively compare adherence relative to the intended use of various health domains. As underlying studies mostly have a pilot character with short study durations, research on factors influencing adherence to mHealth apps is still limited. To facilitate future research on mHealth app adherence, researchers should clearly outline and justify the app’s intended use; report objective data on actual use relative to the intended use; and, ideally, provide long-term use and retention data.

Growing pains: Lessons learned from a failed mobile mindfulness clinical trial for patients with complex care needs

This paper discusses lessons learned from a failed clinical trial investigating the use of a mobile application (app) to deliver a mindfulness intervention to middle-aged and older adults receiving services at a rehabilitation hospital in Ontario, Canada. A randomized controlled trial with 82 participants was planned, with the experimental group receiving access to a mindfulness app and a wait-list control group receiving access to the app after 4 weeks; however, the study could not be completed due to low recruitment rates. This implementation failure was considered from the perspective of the PARIHS framework. More specifically, Three key recruitment challenges were identified, and recommendations for future research provided. Firstly, the increasingly complex care needs of the study population appeared to influence eligibility; it would be beneficial for future research to consider adopting strategies to better understand the needs of the target population. Secondly, participants’ stage of care and readiness of change likely negatively influenced compliance and retention in this study, and should be assessed in future research. Finally, a lack of clinician integration into the research team negatively impacted recruitment in this study; future studies should consider integrating direct service providers into the research team as this may increase buy-in and referral rates. The challenges and recommendations outlined can inform design and implementation of future studies in this area.

Predictors and potentiators of psychedelic-occasioned mystical experiences

Mystical experiences are often described as being among the most profound and meaningful events of a person’s life. Their occurrence, while a normal but uncommon phenomenon, is reliably occasioned by psychedelic substances under the appropriate conditions, although care is needed around the context of usage to help ensure safe and beneficial experiences. The occurrence of mystical experiences in psychedelic sessions is a key mediator of the sustained psychological benefits reported in both healthy and clinical populations. Certain factors including set and setting, drug dosage, trait absorption, drug type, intention and states of surrender and acceptance all predict or influence the occurrence of mystical experiences. Various additional factors may further contribute to the occurrence and intensity of mystical experiences and enhance their long-term benefits, including music, meditation and spiritual practices and nature-based settings. This review examines these factors and considers how they might be optimised to increase the chances of a mystical experience occurring, while also considering factors that are negatively associated with mystical experiences with suggestions on how these might be mitigated where applicable. Finally, potential future research avenues for furthering our knowledge of psychedelic mystical experiences and how their benefits might be enhanced is suggested. Maximising the potential for the occurrence of mystical experiences is an important aspect of the beneficial application of psychedelics.

Mobile phone-based interventions for mental health: A systematic meta-review of 14 meta-analyses of randomized controlled trials

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 (ds = 0.32 to 0.47) and text message-based interventions outperforming non-specific controls and active controls for smoking cessation (ds = 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.

Effects of a Mindfulness App on Employee Stress in an Australian Public Sector Workforce: Randomized Controlled Trial

Background

Workplace-based mindfulness programs have good evidence for improving employee stress and mental health outcomes, but less is known about their effects on productivity and citizenship behaviors. Most of the available evidence is derived from studies of mindfulness programs that use class-based approaches. Mindfulness apps can increase access to training, but whether self-directed app use is sufficient to realize benefits equivalent to class-based mindfulness programs is unknown.

Objective

We assessed the effectiveness of a mindfulness app, both with and without supporting classes, for reducing employees’ perceived stress. Changes in mindfulness, mental health, quality of life, perceptions of job demand, control and support, productivity indicators, organizational citizenship, and mindful behaviors at work were also investigated.

Methods

Tasmanian State Service employees were invited by the Tasmanian Training Consortium to a 3-arm randomized controlled trial investigating the effects of a mindfulness app on stress. The app used in the Smiling Mind Workplace Program formed the basis of the intervention. The app includes lessons, activities, and guided meditations, and is supported by 4 instructional emails delivered over 8 weeks. Engagement with the app for 10-20 minutes, 5 days a week, was recommended. Reported data were collected at baseline (time point 0), 3 months from baseline (time point 1 [T1]), and at 6-month follow-up (time point 2). At time point 0, participants could nominate a work-based observer to answer surveys about participants’ behaviors. Eligible participants (n=211) were randomly assigned to self-guided app use plus four 1-hour classes (app+classes: 70/211, 33.2%), self-guided app use (app-only: 71/211, 33.6%), or waitlist control (WLC; 70/211, 33.2%). Linear mixed effects models were used to assess changes in the active groups compared with the WLC at T1 and for a head-to-head comparison of the app+classes and app-only groups at follow-up.

Results

App use time was considerably lower than recommended (app+classes: 120/343 minutes; app-only: 45/343 minutes). Compared with the WLC at T1, no significant change in perceived stress was observed in either active group. However, the app+classes group reported lower psychological distress (β=−1.77, SE 0.75; P=.02; Cohen d=–0.21) and higher mindfulness (β=.31, SE 0.12; P=.01; Cohen d=0.19). These effects were retained in the app+classes group at 6 months. No significant changes were observed for the app-only group or for other outcomes. There were no significant changes in observer measures at T1, but by time point 2, the app+classes participants were more noticeably mindful and altruistic at work than app-only participants.

Conclusions

Including classes in the training protocol appears to have motivated engagement and led to benefits, whereas self-guided app use did not realize any significant results. Effect sizes were smaller and less consistent than meta-estimates for class-based mindfulness training.

Trial Registration

Australian New Zealand Clinical Trials Register ACTRN12617001386325; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372942&isReview

Pilot evaluation of the stop, breathe & think mindfulness app for student clients on a college counseling center waitlist

Objectives: College counseling centers face significant challenges meeting the mental health needs of their students and waitlists are common. Mobile apps offer a promising solution to increase access to resources while students wait for services. Methods: This pilot randomized controlled trial evaluated the feasibility and acceptability of a publicly available mindfulness app. Students on a counseling center waitlist (n = 23) were randomized to use the app or not, with assessments completed over four weeks. Results: Recruitment over three semesters was slow, leading to an underpowered trial. Participants reported high satisfaction and moderate app usage. Very preliminary support was found for potential app efficacy relative to the control condition, particularly for depression, anxiety, and overall distress. Weaker, mixed effects were found for mindfulness and values processes. Conclusions: Overall, these results provide mixed findings suggesting the potential benefits, but also challenges in using a mindfulness app for students waiting to receive counseling services.

Understanding what we know so far about young people's engagement with wellbeing apps. A scoping review and narrative synthesis

Background

Increased levels of wellbeing contribute to people being more productive, resilient, physically healthy and showing lower levels of mental illness. Using mobile apps to increase wellbeing in young people is becoming the method of choice. This study sought to critically appraise the current evidence base with regards to young people's (16–24 years of age) engagement with wellbeing apps.

Methods

A systematic review of the literature and narrative synthesis was conducted to investigate users’ characteristics and other potential engagement elements. A total of 11,245 titles, 160 abstracts and 68 full-text articles published between 2002 and 2021 were screened, of which 22 studies were included.

Results

Main themes/findings indicated that a user's engagement with wellbeing apps was dependant on the presence of strong identity elements, including motivation, mood and values; design elements such as meaningful rewards, short duration of studies and seamless automatic delivery with low contact with researchers; and being innovative and contextualised. The majority of the studies did not report outcomes by social determinants such as ethnicity, education and others.

Conclusion

This research reflects on the need to consider participants’ individuality when designing app mediated wellbeing interventions.

Effects of a Single Yoga Session on Cardiac Interoceptive Accuracy and Emotional Experience

BACKGROUND

There is an increasing body of research supporting the idea that cardiac interoceptive accuracy (IAc) can be improved by training. Findings concerning the effects of a single yoga session on IAc and the related construct emotional experience are sparse. The aim of this study was to examine if a single yoga session increases IAc and improves emotional experience.

METHODS

137 students were randomly assigned to a 20-min yoga session (n = 47), an endurance session (n = 46), or an inactive control condition (n = 44). IAc and emotional experience were assessed before and after the sessions.

RESULTS

There were no significant changes in IAc, or positive and negative affect. IAc at baseline and the change in positive effect were found as predictors for IAc after the yoga session.

CONCLUSION

A 20-min yoga session seems to be not applicable to improve IAc and emotional experience. Future studies should investigate long-term interventions and diverse healthy and clinical populations.

Mobile Apps That Promote Emotion Regulation, Positive Mental Health, and Well-being in the General Population: Systematic Review and Meta-analysis

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.

Acceptability, Engagement, and Exploratory Outcomes of an Emotional Well-being App: Mixed Methods Preliminary Evaluation and Descriptive Analysis

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.

OBJECTIVE

This evaluation aims to describe the acceptability, engagement, and preliminary outcomes of using an app (Paradym) designed to promote emotional well-being and positive mental health.

METHODS

This is a pre-post, mixed-methods, single-arm evaluation that is aggregated with digital analytics data. We anonymously collected real-world data on the demographics and well-being of the participants as well as the 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 the follow-up measures. Google Analytics was used to record the level of app engagement. Chi-square and 2-tailed 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 79.1% (91/115) users downloaded the app. The sample was diverse in terms of ethnicity, including 43.4% (50/115) people who self-identified as belonging to minority ethnic groups. Most of the participants were female (78/115, 67.8%) and between the ages of 18 and 25 years (39/115, 33.9%). A total of 34 app users who completed questionnaires at baseline and follow-up provided valuable feedback to inform the 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 (22/34, 64%) found that the app was easy to use. Google Analytics revealed that at least 79% (27/34) of people used the app daily. On the basis of preliminary observations, app users experience increased mental well-being. Post hoc analyses indicated that the reduction in depression scores (t₃₃=-2.16) and the increase in the well-being measures (t₃₃=2.87) were statistically significant. No adverse events were reported during the follow-up period.

CONCLUSIONS

The findings of this evaluation are encouraging and document positive preliminary evidence for the Paradym app.

The Effects of a Standardized Cognitive-Behavioural Therapy and an Additional Mindfulness-Based Training on Interoceptive Abilities in a Depressed Cohort

BACKGROUND

Interoceptive accuracy and sensibility are decreased in depressive samples. However, different studies showed that cognitive-behavioural therapy (CBT) and mindfulness interventions are promising approaches to improve interoceptive abilities. Based on these findings, the study aims to investigate the pre-post effect of CBT in a depressive sample. Additionally, we examined the effect of mindfulness-based stress reduction (MBSR) training in the context of CBT.

METHODS

Sixty depressive patients were investigated over four weeks, with two conditions-CBT vs. CBT + MBSR. Further, the changes in interoceptive abilities (interoceptive accuracy and sensibility) of the depressive patients were compared to baseline data of healthy controls.

RESULTS

The depressive patients showed significantly higher levels of depression and lower mindfulness and interoceptive abilities than healthy controls. The depressive sample showed a significant decrease in depressive symptoms and increased mindfulness and interoceptive abilities after CBT. Lastly, depressive patients of the CBT + MBSR condition did not differ from those who only received CBT in the levels of depression, mindfulness or interoceptive abilities over the time course.

DISCUSSION

This study demonstrates a positive effect of CBT on interoceptive abilities in a depressive sample. It is shown that the depressive sample did not profit from additional mindfulness training. It can be concluded that CBT is an efficient treatment, resulting in increased interoceptive abilities. Unexpectedly, the combination of CBT and MBSR has no additional effect on these changes. Future studies should investigate the effect of MBSR as a stand-alone therapy.

Brief daily self-care reflection for undergraduate well-being: a randomized control trial of an online intervention

There is a limited research on the effects of self-care, specifically the importance of taking time to reflect on one's self-care habits. Healthy undergraduate students (N = 95) were assigned to either a self-care intervention or passive control condition. The intervention group (N = 52) was prompted daily via email with questions about self-care habits and plans over three weeks, whereas the control group (N = 43) only completed baseline and post-assessments. Primary outcome variables included subjective happiness, positive and negative affect, and stress. Explanatory variables included mindfulness, self-compassion, and active coping tendency. Stress and negative affect decreased in the intervention group relative to the control group, but no interaction was observed for happiness and positive affect. There was no evidence that these effects were moderated by participant mindfulness, coping tendency, or self-compassion. These results suggest that even a very brief daily reflection on self-care can have powerful effects in promoting resilience against the accumulation of negative affect and stress over the term.

New Evidence in the Booming Field of Online Mindfulness: An Updated Meta-analysis of Randomized Controlled Trials

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.

Improvements in Health Might Contradict Adherence to Mobile Health Interventions: Findings from a Self-Care Cancer App Study

Background: Cancer patients often suffer from high levels of distress. Mobile health (mHealth) applications might be an innovative way to deliver mindfulness and relaxation interventions for cancer patients. However, data about the implementation of apps in health care are lacking. Adherence to mHealth interventions is an important indicator for a successful implementation and might be needed to maximize treatment effects. However, the decrease in distress might reduce the motivation of patients to engage in such self-care tools in the long run. Therefore, the aim of this analysis was to investigate the association between the course of distress over time and the adherence to a relaxation self-care app in cancer patients. Methods: We developed an app for cancer patients (CanRelax) and 83 patients who participated in the prospective observational study used the app at least once. The evaluation was guided by the RE-AIM framework, and this analysis focused on the implementation of the app. Patients were grouped into five subgroups according to their course of distress over 10 weeks (Distress Thermometer). These subgroups of patients were compared with each other to identify different user groups. Findings: About half of the patients were adherent over 10 weeks. However, a decrease in distress was associated with lower adherence to the app intervention, whereas patients with moderate distress or an increase in distress showed more adherence. Conclusion: Adherence to an app intervention might be also driven by patients' distress level. A decrease in distress might reduce patients' motivation to continue with a self-care intervention. The interplay between adherence and treatment outcomes should be explored in upcoming mHealth trials to get a better understanding for the implementation of such interventions. Encouraging patients to continue self-care interventions is a major challenge in integrative medicine if they are delivered digitally. The Clinical Trial Registration number: DRKS00010481.

The Effectiveness of Mindfulness-Based-Stress-Reduction for Military Cadets on Perceived Stress

This study aimed to develop a program of mindfulness-based stress reduction for military cadets (MBSR-MC). On the basis of a pretest-posttest design, participants were assigned to either a control or an experimental group to examine the effectiveness of MBSR-MC. First, 60 volunteering cadets of National Defense University were randomly assigned to the MBSR-MC group (n = 30) and the control group (n = 30). In the pretest, all participants were required to complete the Taiwanese version of the Five Facet Mindfulness Questionnaire (T-FFMQ) and a perceived stress scale (PSS). Subsequently, the MBSR-MC group participated in the 8-week MBSR-MC program, whereas the control group did not receive any experimental treatment. One week following the completion of the program, a posttest consisted of the same questions as the pretest was conducted. Statistical analysis showed that (1) Comparing with the control group, the MBSR-MC group showed superior performance in three subscales of T-FFMQ, namely Acting with awareness, Non-judgment, and Non-reactivity. However, no significant difference was found in the remaining two facets: Observing and Describing. (2) The perceived stress score of the MBSR-MC group was significantly lower than that of the control group. Furthermore, an analysis of mediating effect showed that Acting with awareness, Non-judgment, and Non-reactivity were mediating variables of the relationship between MBSR-MC and perceived stress. The aforementioned results indicated that MBSR-MC training significantly increased military cadets' Acting with awareness, Non-judgment, and Non-reactivity, thereby significantly reducing their perceived stress. Therefore, this study supported the effectiveness of the MBSR-MC program on perceived stress.

Exploring the relationship between mindfulness and rock-climbing: a controlled study

Mindfulness is a meditative practice that has received increasing attention within positive psychology as an effective tool to increase wellbeing and decrease anxiety. Previous research has demonstrated that rock-climbers have a higher endorsement of mindfulness and life satisfaction than the general population; yet to date, no research has empirically explored the relationship between mindfulness and rock-climbing. In the current study fifty-nine participants ($$ \overline{\mathrm{x}} $$ x ¯ = 20.63, SD = 1.60) were asked to complete measures of mindfulness, wellbeing and anxiety before and after participating in an ‘intervention’. The intervention consisted of a mindfulness activity followed by either indoor bouldering (a form of rock-climbing) versus a physical activity control. A mixed ANOVA revealed that participation in bouldering increased the measure of mindfulness significantly more than the control activity; however, no significant group differences were found for the measures of wellbeing and anxiety. A regression analysis then revealed that group condition accounted for 33% of the variance in post-intervention mindfulness levels when controlling for baseline levels of mindfulness. This is the first study to experimentally demonstrate that engagement with rock-climbing increases mindfulness in young adults. Theoretically, the results have implications for our understanding of “flow” and optimal human experience. Practically, the study highlights the potential to implement rock-climbing as a resilience-building activity and integrate the sport within therapeutic frameworks.

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.

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

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.

The Impact of App-Delivered Mindfulness Meditation on Functional Connectivity and Self-Reported Mindfulness Among Health Profession Trainees

Objectives

Previous research indicates that mindfulness meditation reduces anxiety and depression and enhances well-being. We examined the impact of app-delivered mindfulness meditation on resting state functional MRI (fMRI) connectivity among physician assistant (PA) students and surgery residents.

Methods

PA students and residents were randomized to receive a popular meditation app or to wait-list control group. Before and after the 8-week meditation period, we acquired fMRI scans of participants’ resting state, and participants completed a self-report measure of mindfulness. We used a 2 × 2, within- and between-group factorial design and leveraged a whole-brain connectome approach to examine changes in within- and between-network connectivity across the entire brain, and to examine whether changes in connectivity were associated with app use or to changes in self-reported mindfulness.

Results

Meditation practitioners exhibited significantly stronger connectivity between the frontoparietal network and the left and right nucleus accumbens and between the default mode (DMN) and salience networks, among other regions. Mindfulness practice time was correlated with increased connectivity between the lateral parietal cortex and the supramarginal gyrus, which were also positively correlated with increased scores on the “Describing” subscale of the Five Facet Mindfulness Questionnaire between baseline and post-meditation. These findings are consistent with previous research indicating that mindfulness-based interventions alter functional connectivity within the DMN and between the DMN and other networks both during meditation and at rest, as well as increased connectivity in systems important for emotion and reward.

Conclusions

Recent commentaries call for healthcare provider and trainee wellness programs that are sustainable and preventive in nature rather than reactive; these data indicate that even brief sessions of app-delivered mindfulness practice are associated with functional connectivity changes in a dose-dependent manner.

Electronic supplementary material

The online version of this article (10.1007/s12671-020-01502-7) contains supplementary material, which is available to authorized users.

Can Acceptance, Mindfulness, and Self-Compassion Be Learned by Smartphone Apps? A Systematic and Meta-Analytic Review of Randomized Controlled Trials

The potential health benefits of acceptance, mindfulness, and self-compassion are well-documented. However, interventions that teach these principles typically rely on face-to-face delivery, which can limit their dissemination. Delivering these interventions through smartphone apps could help overcome this. This meta-analysis examined whether principles of acceptance, mindfulness, and self-compassion can be learned through smartphone apps. Twenty-seven randomized controlled trials were included. Smartphone apps that included acceptance and/or mindfulness components resulted in significantly higher levels of acceptance/mindfulness than comparison conditions (k = 33; g = 0.29; 95% CI = 0.17, 0.41). These effects were moderated by the type of comparison and whether reminders to engage were offered. Smartphone apps also resulted in significantly lower levels of psychological distress than comparisons (k = 22; g = -0.32; 95% CI = -0.48, -0.16). Meta-regression revealed a negative relationship between the effect sizes for mindfulness/acceptance and the effect sizes for distress. Smartphone apps produced significantly greater increases in self-compassion than comparisons (k = 9; g = 0.31; 95% CI = 0.07, 0.56), although the quality of RCTs in this analysis was poor. Findings suggest that principles of acceptance, mindfulness, and self-compassion may be learned through cheap, easily accessible, and low-intensity interventions delivered via smartphone apps. However, the quality of available evidence is poor, as low risk of bias was noted in few trials (18%) and the observed effects were likely explained by a digital placebo.

Mindfulness Meditation Improves Visual Short-Term Memory

Research into the effects of mindfulness meditation on behavioral outcomes has received much interest in recent years, with benefits for both short-term memory and working memory identified. However, little research has considered the potential effects of brief mindfulness meditation interventions or the nature of any benefits for visual short-term memory. Here, we investigate the effect of a single, 8-minute mindfulness meditation intervention, presented via audio recording, on a short-term memory task for faces. In comparison with two control groups (listening to an audiobook or simply passing the time however they wished), our mindfulness meditation participants showed greater increases in visual short-term memory capacity from pre- to post-intervention. In addition, only mindfulness meditation resulted in significant increases in performance. In conclusion, a single, brief mindfulness meditation intervention led to improvements in visual short-term memory capacity for faces, with important implications regarding the minimum intervention necessary to produce measurable changes in short-term memory tasks.

Android and iPhone Mobile Apps for Psychosocial Wellness and Stress Management: Systematic Search in App Stores and Literature Review

BACKGROUND

In an oversaturated market of publicly available mobile apps for psychosocial self-care and stress management, health care providers, patients, and consumers interested in mental health-related apps may wonder which, if any, are efficacious. Readily available metrics for consumers include user popularity and media buzz rather than scientific evidence.

OBJECTIVE

This systematic review aimed to (1) examine the breadth of therapeutic contents and features of psychosocial wellness and stress management apps available to self-help seekers for public download and (2) determine which of these apps have original research support.

METHODS

First, we conducted a systematic review of publicly available apps on the iPhone App Store (Apple Inc) and Android Google Play (Google LLC) platforms using conventional self-help-seeking search terms related to wellness and stress. The results were limited to English-language apps available for free download. In total, 2 reviewers independently evaluated all apps and discussed the findings to reach 100% consensus regarding inclusion. Second, a literature review was conducted on the included apps to identify supporting studies with original data collection.

RESULTS

We screened 3287 apps and found 1009 psychosocial wellness and stress management apps. Content varied widely. The most common evidence-based strategy was mindfulness-meditation, followed by positive psychology and goal setting. Most apps were intended to be used as self-help interventions, with only 1.09% (11/1009) involving an electronic therapist and 1.88% (19/1009) designed as a supplement to in-person psychotherapy. Only 4.66% (47/1009) of apps targeted individuals with psychological disorders, and less than 1% of apps (6/1009, 0.59%) targeted individuals with other chronic illnesses. Approximately 2% (21/1009, 2.08%) were supported by original research publications, with a total of 25 efficacy studies and 10 feasibility studies. The Headspace mindfulness app had the most evidence, including 8 efficacy studies. Most other scientifically backed apps were supported by a single feasibility or efficacy study.

CONCLUSIONS

Only 2.08% (21/1009) of publicly available psychosocial wellness and stress management mobile apps discoverable to self-help seekers have published, peer-reviewed evidence of feasibility and/or efficacy. Clinicians and investigators may use these findings to help patients and families navigate the volume of emerging digital health interventions for stress management and wellness.

A Smartphone App-Based Mindfulness Intervention for Cancer Survivors: Protocol for a Randomized Controlled Trial

Background

Cancer patients transitioning to survivorship after completing cancer treatments need psychosocial interventions to manage stressors such as anxiety, depression, and fear of cancer recurrence. Mindfulness-based interventions (MBIs) are effective for treating these symptoms; however, cancer survivors are often unable to participate in face-to-face interventions because of difficulties such as work and family commitments, treatment-related side-effects, scheduling conflicts, and geography. Smartphone app–based MBIs are an innovative way to deliver psychosocial cancer care and can overcome several such difficulties, since patients can participate at their own convenience.

Objective

The SEAMLESS (Smartphone App–Based Mindfulness Intervention for Cancer Survivors) study aims to evaluate the efficacy of a tailored app-based mindfulness intervention for cancer survivors (the Am Mindfulness-Based Cancer Survivorship—MBCS—Journey) for treating (1) symptoms of stress (primary outcome), as well as (2) fear of cancer recurrence, anxiety, depression, fatigue, and overall physical functioning (secondary outcomes). This is the first Canadian efficacy trial of a tailored mindfulness app intervention in cancer survivors.

Methods

This is a randomized waitlist-controlled trial, which will evaluate the effectiveness of Am MBCS for impacting the primary and secondary outcomes in cancer survivors who have completed all their cancer treatments. Outcomes will be assessed using web-based surveys with validated psychometric instruments at (1) baseline, (2) mid-intervention (2 weeks later), (3) immediately postintervention (4 weeks), (4) 3 months postbaseline, (5) 6 months postbaseline, and (6) 12 months postbaseline. The waitlist group will complete all assessments and will cross over to the intervention condition after the 3-month assessment. In addition, data will be obtained by the smartphone app itself, which includes users’ engagement with the app-based intervention, their emotional state (eg, angry and elated) from a user-inputted digital emotion-mapping board, and psychobiometric data using photoplethysmography technology.

Results

The study received ethics approval in September 2018 and recruitment commenced in January 2019. Participants are being recruited through a provincial cancer registry, and the majority of participants currently enrolled are breast (44/83, 53%) or colorectal (17/83, 20%) cancer survivors, although some survivors of other cancer are also present. Data collection for analysis of the primary outcome time-point will be complete by September 2019, and the follow-up data will be collected and analyzed by September 2020. Data will be analyzed to determine group differences using linear mixed modelling statistical techniques.

Conclusions

Cancer care providers are uncertain about the efficacy of app-based mindfulness interventions for patients, which are available in great supply in today’s digital world. This study will provide rigorously evaluated efficacy data for an app-based mindfulness intervention for cancer survivors, which if helpful, could be made available for psychosocial care at cancer centers worldwide.

Trial Registration

ClinicalTrials.gov NCT03484000; https://clinicaltrials.gov/ct2/show/NCT03484000

International Registered Report Identifier (IRRID)

DERR1-10.2196/15178

A New Mental Health Mobile App for Well-Being and Stress Reduction in Working Women: Randomized Controlled Trial

BACKGROUND

Although the availability and use of mobile mental health apps has grown exponentially in recent years, little data are available regarding their efficacy.

OBJECTIVE

This study aimed to evaluate the effectiveness of an app developed to promote stress management and well-being among working women compared with a control app.

METHODS

Female employees at a private hospital were invited to participate in the study via mailing lists and intranet ads. A total of 653 individuals self-enrolled through the website. Eligible participants were randomized between control (n=240) and intervention (n=250) groups. The well-being mobile app provides an 8-week program with 4 classes per week (including a brief theoretical portion and a 15-min guided practice). The active control app also provided 4 assessments per week that encouraged participants to self-observe how they were feeling for 20 min. We also used the app to conduct Web-based questionnaires (10-item Perceived Stress Scale and 5-item World Health Organization Well-Being Index) and ask specific questions to assess subjective levels of stress and well-being at baseline (t₁), midintervention (t₄=4 weeks after t₁) and postintervention (t₈=8 weeks after t₁). Both apps were fully automated without any human involvement. Outcomes from the control and intervention conditions at the 3 time points were analyzed using a repeated measures analysis of variance.

RESULTS

Among the randomized participants (n=490), 185 participants were excluded at the 4-week follow-up and another 79 at the 8-week follow-up because of noncompliance with the experimental protocol. Participants who did not complete t₄ and t₈ assessments were equally distributed between groups (t₄: control group=34.6% [83/240] and intervention group=40.8% [102/250]; P=.16; t₈: control group=29.9% [47/157] and intervention group=21.6% [32/148]; P=.10). Both groups showed a significant increase in general well-being as a function of time (F_2,426=5.27; P=.006), but only the intervention group presented a significant increase in work-related well-being (F_2,426=8.92; P<.001), as well as a significant reduction in work-related and overall stress (F_2,426=5.50; P=.004 and F_2,426=8.59; P<.001, respectively).

CONCLUSIONS

The well-being mobile app was effective in reducing employee stress and improving well-being.

TRIAL REGISTRATION

Clinicaltrials.gov NCT02637414; https://clinicaltrials.gov/ct2/show/NCT02637414.

Efficacy of the Mindfulness Meditation Mobile App "Calm" to Reduce Stress Among College Students: Randomized Controlled Trial

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.

Results

A 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<.04). These effects persisted at follow-up (all P<.03), except for the nonreacting subscale of mindfulness (P=.08). There was a significant interaction between group and time factors in perceived stress (P=.002), mindfulness (P<.001), and self-compassion (P<.001). Bonferroni posthoc tests showed significant within-group mean differences for perceived stress in the intervention group (P<.001), while there were no significant within-group mean differences in the control group (all P>.19). Similar results were found for mindfulness and self-compassion. Effect sizes ranged from moderate (0.59) to large (1.24) across all outcomes. A significant group×time interaction in models of sleep disturbance was found, but no significant effects were found for other health behaviors. The majority of students in the intervention group reported that Calm was helpful to reduce stress and stated they would use Calm in the future. The majority were satisfied using Calm and likely to recommend it to other college students. The intervention group participated in meditation for an average of 38 minutes/week during the intervention and 20 minutes/week during follow-up.

Conclusions

Calm is an effective modality to deliver mindfulness meditation in order to reduce stress and improve mindfulness and self-compassion in stressed college students. Our findings provide important information that can be applied to the design of future studies or mental health resources in university programs.

Trial Registration

ClinicalTrials.gov NCT03891810; https://clinicaltrials.gov/ct2/show/NCT03891810