The Effectiveness of a Nonguided Mindfulness App on Perceived Stress in a Nonclinical Dutch Population: Randomized Controlled Trial

The Effectiveness of a Digital Mental Fitness Program (Positive Intelligence) on Perceived Stress, Self-Compassion, and Ruminative Thinking of Occupational Therapy Undergraduate Students: Longitudinal Study

BACKGROUND

Health care students often endure numerous stressors throughout their undergraduate education that can have lasting negative effects on their mental well-being. Positive Intelligence (PQ) is a digital mental fitness program designed to enhance self-mastery and help individuals reach their potential by strengthening various "mental muscles."

OBJECTIVE

This study aims to evaluate the effectiveness of a 6-week app-delivered PQ program in reducing perceived stress, increasing self-compassion, and decreasing rumination tendencies among health care undergraduates. We hypothesized that students would show reductions in perceived stress, increases in self-compassion, and decreases in rumination tendencies by the end of the PQ program, compared with their preprogram scores. We adopted an exploratory approach for the 5-month follow-up due to the limited research consensus on the sustained effects of app-based programs over varying periods.

METHODS

The PQ program includes weekly hour-long videos, weekly group meetings, and daily 15-minute app-guided practices. Participants were first-year students from the occupational therapy program at a university in Singapore. Participants completed surveys measuring self-compassion, perceived stress, and rumination levels before and after the PQ program, and again at a 5-month follow-up. Data were analyzed using repeated measures ANOVA to assess differences across the pretest, immediate posttest, and follow-up posttest.

RESULTS

Out of 87 students enrolled in the study, the final sample consisted of 64 students (n=47, 73%, female; mean age 23 years, SD 5.06 years) with complete data. At the end of the 6 weeks, students exhibited significant increases in self-compassion (before the intervention: mean 3.07, SD 0.35; after the intervention: mean 3.34, SD 0.35; P<.001) and reductions in rumination tendencies (before the intervention: mean 3.57, SD 0.40; after the intervention: mean 3.27, SD 0.34; P<.001). However, no significant change in perceived stress levels was observed (before the intervention: 2.99, SD 0.14; after the intervention: mean 2.97, SD 0.16; P=.50). These effects were not influenced by the daily app-based practice of PQ exercises, and there were no sustained effects on self-compassion (mean 3.17, SD 0.27; P=.09) or rumination tendencies (mean 3.42, SD 0.38; P=.06) at the 5-month follow-up. Additionally, there was a significant increase in perceived stress at follow-up (mean 3.17, SD 0.21; P<.001) compared with pre- and postintervention levels.

CONCLUSIONS

The PQ program did not directly alter stress perceptions but may have reframed students' automatic negative thought processes, increased their awareness of self-sabotaging behaviors, and enhanced their self-compassion while reducing ruminative thinking. These findings highlight the importance of self-awareness for students' well-being. Students can benefit from practices such as mindfulness and peer discussions to enhance self-compassion and reduce rumination. Educators trained in the PQ program can foster a supportive environment that encourages self-compassion, challenges negative self-talk, and helps students manage stress.

The efficacy of mindfulness apps on symptoms of depression and anxiety: An updated meta-analysis of randomized controlled trials

Mindfulness apps have become popular tools for addressing symptoms of depression and anxiety. Since the publication of earlier meta-analyses evaluating the efficacy of mindfulness apps for depression and anxiety symptoms, over 20 randomized controlled trials (RCTs) have been conducted. There is a need for an updated meta-analysis that quantifies the effects of mindfulness apps on these symptoms and tests for potential moderators.. Random effects meta-analyses were conducted on 45 RCTs. Small, significant effect sizes were found for symptoms of depression (Ncomp = 46, N = 5852, g = 0.24, 95% CI = 0.17, 0.31, NNT = 13.57) and anxiety (Ncomp = 48, N = 6082, g = 0.28, 95% CI = 0.21, 0.35, NNT = 11.47) in favour of mindfulness apps over control groups. This effect was not explained by symptom deterioration in participants allocated to control groups. Effects remained stable when restricting analyses to lower risk of bias and larger sample trials. No significant moderators were observed, except trials that offered monetary compensation produced larger effects on depression. Non-significant effects were observed when comparing mindfulness apps to active therapeutic comparisons (g = -0.15 depression, g = 0.10 anxiety), though the number of studies was low. Growing evidence indicates that mindfulness apps can acutely reduce symptoms of depression and anxiety, although higher quality studies with longer follow-ups are needed.

Mobile Behavioral Health Coaching as a Preventive Intervention for Occupational Public Health: Retrospective Longitudinal Study

BACKGROUND

Researchers have recently proposed that behavioral health coaching (BHC) is effective in promoting proactive care among employees. However, to qualify as a preventive workplace intervention, more research is needed to evaluate whether BHC can further elevate well-being among moderately mentally healthy employees.

OBJECTIVE

Using real-world data, this study evaluates the preliminary effectiveness of app-based BHC against a nonrandomized control group with open access to self-help tools in improving well-being (ie, mood levels and perceived stress). The study also explores the active ingredients of BHC and dose-response associations between the number of BHC sessions and well-being improvements.

METHODS

Employees residing across Asia-Pacific countries (N=1025; mean age 30.85, SD 6.97 y) who reported moderately positive mood and medium levels of perceived stress in their first week of using the mental health app Intellect were included in this study. Users who were given access by their organizations to Intellect's BHC services were assigned to the "Coaching" condition (512/1025, 49.95%; mean age 31.09, SD 6.87 y), whereas other employees remained as "Control" participants (513/1025, 50.05%; mean age 30.61, SD 7.06 y). To evaluate effectiveness, monthly scores from the validated mood and stress sliders were aggregated into a composite well-being score and further examined using repeated-measure conditional growth models. Postcoaching items on "Perceived Usefulness of the BHC session" and "Working Alliance with my Coach" were examined as active ingredients of BHC using 1-1-1 multilevel mediation models. Finally, 2-way repeated-measure mixed ANOVA models were conducted to examine dose-response effects on well-being improvements between groups (coaching and control) across time.

RESULTS

Growth curve analyses revealed significant time by group interaction effects for composite well-being, where "Coaching" users reported significantly greater improvements in well-being than "Control" participants across time (composite well-being: F1,391=6.12; ηp2=0.02; P=.01). Among "Coaching" participants, dependent-sample 2-tailed t tests revealed significant improvements in composite well-being from baseline to 11 months (t512=1.98; Cohen d=0.17; P=.049). Improvements in "Usefulness of the BHC session" (β=.078, 95% Cl .043-.118; P<.001) and "Working Alliance" (β=.070, 95% Cl .037-.107; P<.001) fully mediated within-level well-being enhancements over time. Comparing against baseline or first month scores, significant time by group interactions were observed between the second and sixth months, with the largest effect size observed at the fifth month mark (first month vs fifth month: F1,282=15.0; P<.001; ηp2=0.051).

CONCLUSIONS

We found preliminary evidence that BHC is an effective preventive workplace intervention. Mobile-based coaching may be a convenient, cost-effective, and scalable means for organizations and governments to boost public mental health.