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Pan Y, Li F, Liang H, Shen X, Bing Z, Cheng L, Dong Y. Effectiveness of Mindfulness-Based Stress Reduction on Mental Health and Psychological Quality of Life among University Students: A GRADE-Assessed Systematic Review. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2024; 2024:8872685. [PMID: 38414520 PMCID: PMC10898947 DOI: 10.1155/2024/8872685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 12/27/2023] [Accepted: 02/03/2024] [Indexed: 02/29/2024]
Abstract
Background Psychological distress is a progressive health problem that has been linked to decreased quality of life among university students. This meta-analysis reviews existing randomized controlled trials (RCTs) that have examined the effects of mindfulness-based stress reduction (MBSR) on the relief of psychosomatic stress-related outcomes and quality of life among university students. Methods The PubMed, EMBASE, Web of Science, PsycINFO (formerly PsychLit), Ovid MEDLINE, ERIC, Scopus, Google Scholar, ProQuest, and Cochrane Library databases were searched in November 2023 to identify the RCTs for analysis. Data on pathology (anxiety, depression, and perceived stress), physical capacity (sleep quality and physical health), and well-being (mindfulness, self-kindness, social function, and subjective well-being) were analyzed. Results Of the 276 articles retrieved, 29 met the inclusion criteria. Compared with control therapies, the pooled results suggested that MBSR had significant effects, reducing anxiety (SMD = -0.29; 95% CI: -0.49 to -0.09), depression (SMD = -0.32; 95% CI: -0.62 to -0.02), and perceived stress (SMD = -0.41; 95% CI: -0.60 to -0.29) and improving mindfulness (SMD = 0.34; 95% CI: 0.08 to 0.59), self-kindness (SMD = 0.57; 95% CI: 0.30 to 1.12), and physical health (SMD = -0.59; 95% CI: -1.14 to -0.04). No significant differences were observed in sleep quality (SMD = -0.20; 95% CI: -0.06 to 0.20), social function (SMD = -0.71; 95% CI: -2.40 to 0.97), or subjective well-being (SMD = 0.07; 95% CI: -0.18 to 0.32). The quality of the evidence regarding sleep quality and physical health outcomes was low. Conclusions MBSR therapy appears to be potentially useful in relieving functional emotional disorders. However, additional evidence-based large-sample trials are required to definitively determine the forms of mindfulness-based therapy that may be effective in this context and ensure that the benefits obtained are ongoing. Future studies should investigate more personalized approaches involving interventions that are tailored to various barriers and students' clinical characteristics. To optimize the effects of such interventions, they should be developed and evaluated using various designs such as the multiphase optimization strategy, which allows for the identification and tailoring of the most valuable intervention components.
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Affiliation(s)
- Yuanqing Pan
- Tianjin Vocational and Technical Normal University, Campbell China Network, Dagu Nan Lu, Hexi, Tianjin 300222, China
| | - Fusen Li
- Tianjin Vocational and Technical Normal University, Campbell China Network, Dagu Nan Lu, Hexi, Tianjin 300222, China
| | - Haiqian Liang
- Department of Neurosurgery, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, China
| | - Xiping Shen
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou 730000, Gansu, China
| | - Zhitong Bing
- Institute of Modern Physics, Chinese Academy of Sciences, 509 Nanchang Road, Chengguan 730000, Lanzhou, China
| | - Liang Cheng
- School of Computer Science, Beijing University of Posts and Telecommunications, Xitucheng Road, Haidian 100876, Beijing, China
| | - Yi Dong
- Tianjin Medical College, School of Pharmacy and Biotechnology, Department of Traditional Chinese Medicine, Liulin Road, Hexi, Tianjin 300222, China
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Mo Y, Lei Z, Chen M, Deng H, Liang R, Yu M, Huang H. Effects of self-help mindfulness-based cognitive therapy on mindfulness, symptom change, and suicidal ideation in patients with depression: a randomized controlled study. Front Psychol 2023; 14:1287891. [PMID: 38106401 PMCID: PMC10722434 DOI: 10.3389/fpsyg.2023.1287891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 11/09/2023] [Indexed: 12/19/2023] Open
Abstract
Objective This study aimed to evaluate the effects of self-help mindfulness-based cognitive therapy (MBCT-SH) on mindfulness, symptom change, and suicidal ideation in patients with depression. Methods For this randomized controlled study, 97 patients were randomly assigned to either the MBCT-SH (n = 48) or control (n = 49) group. The Five Facet Mindfulness Questionnaire (FFMQ), Hamilton Depression Rating Scale (HAMD-24), and Suicide Attitude Questionnaire (SAQ) were used to assess mindfulness, depression symptoms, and suicidal ideation, respectively, at baseline (T0), intervention week 4 (T1), intervention week 8 (T2), and 3-month follow-up (T3). The groups were also compared on treatment costs and readmission rates at a 6-month follow-up. Results In the MBCT-SH group, 46 of 48 participants (96%) completed the eight-week program. At T0, there were no statistically significant between-group differences in demographics, clinical characteristics, FFMQ, HAMD-24, or SAQ. Nor were there statistically significant differences on the HAMD-24 or SAQ between the MBCT-SH and control groups at T1 (p = 0.18 and p = 0.59, respectively), while mindfulness was significantly higher in the MBCT-SH group (t = 2.383, p = 0.019). At T2, there were significant between-group differences on the FFMQ, HAMD-24, and SAQ, all of which remained significant at T3. At the 6-month follow-up, per capita treatment costs were 5,298 RMB lower in the MBCT-SH group compared with the control group, while their readmission rates (6.1% and 4.2%, respectively) did not differ significantly. Conclusion These findings support the feasibility and effectiveness of MBCT-SH among patients with depression. Clinical trial registration http://www.chictr.org.cn, ChiCTR2300077850.
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Affiliation(s)
- Yuanyuan Mo
- Department of Psychiatry, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zhiying Lei
- Department of Nursing, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Mei Chen
- Department of Nursing, Dongguan People’s Hospital, The Tenth Affiliated Hospital of Southern Medical University, Dongguan, China
| | - Hongyan Deng
- Department of Psychiatry, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Rong Liang
- Department of Nursing, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Miaoyu Yu
- Department of Psychiatry, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Huiqiao Huang
- Department of Nursing, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
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Amanvermez Y, Karyotaki E, Cuijpers P, Ciharova M, Donker M, Hurks P, Salemink E, Spinhoven P, Struijs S, de Wit LM. A Guided, Internet-Based Stress Management Intervention for University Students With High Levels of Stress: Feasibility and Acceptability Study. JMIR Form Res 2023; 7:e45725. [PMID: 37948106 PMCID: PMC10674149 DOI: 10.2196/45725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 06/26/2023] [Accepted: 08/31/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Transitioning to adulthood and challenges in university life can result in increased stress levels among university students. Chronic and severe stress is associated with deleterious psychological and physiological effects. Digital interventions could succeed in approaching and helping university students who might be at risk; however, the experiences of students with internet-based stress management interventions are insufficiently understood. OBJECTIVE This study aims to explore the feasibility; acceptability; and changes in perceived stress, depressive symptoms, and quality of life from baseline to posttest assessment of a 5-session, internet-based stress management intervention guided by an e-coach, developed for university students experiencing high levels of stress. METHODS A single-arm study was conducted. Students were recruited from different channels, mainly from a web survey. Students were eligible if they (1) scored ≥20 on the Perceived Stress Scale-10, (2) were aged ≥18 years, and (3) were studying at one of the participating universities. Feasibility and acceptability of the intervention were investigated using several indications, including satisfaction (Client Satisfaction Questionnaire-8) and usability (System Usability Scale-10). We also investigated the indicators of intervention adherence using use metrics (eg, the number of completed sessions). Our secondary goal was to explore the changes in perceived stress (Perceived Stress Scale-10), depressive symptoms (Patient Health Questionnaire-9), and quality of life (EQ-5D-5L scale) from baseline to posttest assessment. In addition, we conducted semistructured interviews with intervention completers and noncompleters to understand user experiences in depth. For all primary outcomes, descriptive statistics were calculated. Changes from baseline to posttest assessment were examined using 2-tailed paired sample t tests or the Wilcoxon signed rank test. Qualitative data were analyzed using thematic analysis. RESULTS Of 436 eligible students, 307 (70.4%) students started using the intervention. Overall, 25.7% (79/307) completed the core sessions (ie, sessions 1-3) and posttest assessment. A substantial proportion of the students (228/307, 74.3%) did not complete the core sessions or the posttest assessment. Students who completed the core sessions reported high satisfaction (mean 25.78, SD 3.30) and high usability of the intervention (mean 86.01, SD 10.25). Moreover, this group showed large reductions in perceived stress (Cohen d=0.80) and moderate improvements in depression score (Cohen d=0.47) and quality of life (Cohen d=-0.35) from baseline to posttest assessment. Qualitative findings highlight that several personal and intervention-related factors play a role in user experience. CONCLUSIONS The internet-based stress management intervention seems to be feasible, acceptable, and possibly effective for some university students with elevated stress levels. However, given the high dropout rate and qualitative findings, several adjustments in the content and features of the intervention are needed to maximize the user experience and the impact of the intervention. TRIAL REGISTRATION Netherlands Trial Register 8686; https://onderzoekmetmensen.nl/nl/trial/20889. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1016/j.invent.2021.100369.
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Affiliation(s)
- Yagmur Amanvermez
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Marketa Ciharova
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Marianne Donker
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Petra Hurks
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Elske Salemink
- Department of Clinical Psychology, Utrecht University, Utrecht, Netherlands
| | | | - Sascha Struijs
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Leonore M de Wit
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
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Leung T, Yang T, Xiao L, Xu C, Zhu C. Effects of Mobile Mindfulness Meditation on the Mental Health of University Students: Systematic Review and Meta-analysis. J Med Internet Res 2023; 25:e39128. [PMID: 36596239 PMCID: PMC9856434 DOI: 10.2196/39128] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/17/2022] [Accepted: 09/05/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Mobile mindfulness meditation (MMM) is a mindfulness meditation intervention implemented using mobile devices such as smartphones and apps. MMM has been used to help manage the mental health of university students. OBJECTIVE This study aims to evaluate the effectiveness of MMM on the mental health of university students in the areas of stress, anxiety, depression, mindfulness, well-being, and resilience. METHODS We conducted a systematic review and meta-analysis of the effectiveness of MMM on the mental health of university students. This study followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. An electronic literature search was performed on PubMed, Web of Science, EBSCO, Cochrane Library, and Embase databases, from inception to July 16, 2021. This study was conducted to identify studies that reported the effects of MMM on the primary outcomes including stress, anxiety, and depression, and on the secondary outcomes including mindfulness, well-being, and resilience. Two reviewers retrieved articles, evaluated quality, and extracted data independently. The methodological quality of the selected studies was determined using the Cochrane criteria for risk-of-bias assessment. Standardized mean differences (SMDs) for continuous outcomes and risk ratios for dichotomous outcomes were calculated. Sensitivity analyses and subgroup analyses were performed for results with high heterogeneity. The RevMan version 5.3 was used to perform meta-analysis. RESULTS A total of 10 studies, including 958 university students, were selected for this meta-analysis. Results of the primary outcome showed that the MMM groups were more effective than the control groups in decreasing stress (SMD -0.41, 95% CI -0.59 to -0.23; P<.001) and alleviating anxiety (SMD -0.29, 95% CI -0.50 to -0.09; P=.004). However, there was no difference between the MMM groups and the control groups in depression (SMD -0.14, 95% CI -0.30 to 0.03; P=.11). The use of either waitlist control or traditional face-to-face intervention in the control group was identified as the source of heterogeneity. Specifically, the waitlist control subgroup (SMD -0.33, 95% CI -0.53 to -0.13; P=.002) was superior when compared with the face-to-face subgroup (SMD 0.29, 95% CI -0.01 to 0.59; P=.06). Results of the secondary outcome showed that the MMM groups were more effective than the control groups in enhancing well-being (SMD 0.30, 95% CI 0.11-0.50; P=.003) and improving mindfulness (SMD 2.66, 95% CI 0.77-4.55; P=.006). Whether commercial sponsorship was obtained was considered as the source of heterogeneity. The "without company support" group (SMD 17.60, 95% CI 11.32-23.87; P<.001) was superior to the "with company support" group (SMD 1.17, 95% CI -0.82 to 3.15; P=.25) in raising the level of mindfulness. However, there was no difference between the MMM and control groups in resilience (SMD -0.06, 95% CI -0.26 to 0.15; P=.59). The evidence level of the results from the 10 studies was determined to be moderate to low. CONCLUSIONS MMM was an effective method to reduce stress and anxiety, and to increase the well-being and mindfulness of university students. However, further studies are needed to confirm our findings. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42022303585; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=303585.
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Affiliation(s)
| | - Ting Yang
- Department of Nursing, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Lei Xiao
- Department of Nursing, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Changxia Xu
- Department of Nursing, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Chunqin Zhu
- Department of Nursing, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
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Karing C. The efficacy of online mindfulness-based interventions in a university student sample: Videoconference- or podcast-delivered intervention. Appl Psychol Health Well Being 2022; 15:740-756. [PMID: 36214182 DOI: 10.1111/aphw.12408] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 09/27/2022] [Indexed: 11/29/2022]
Abstract
The increasing mental health issues among university students during the COVID-19 pandemic and the challenges of delivering face-to-face interventions during lockdowns have increased the demand for online interventions. The report presents results from a randomized controlled trial investigating the benefits of online mindfulness interventions delivered by videoconference or podcast during the early phase of the pandemic in Germany. Fifty university students were randomized to a mindfulness intervention conducted by videoconference (n = 25) or to an unguided training provided by podcasts (n = 25). All students participated in a 7-week mindfulness intervention. Outcome measures included mindfulness, depression, anxiety, and life satisfaction preintervention and postintervention. The study showed a larger reduction in depression in the videoconferencing group than in the podcast group across per protocol (PP) and intention-to-treat (ITT) analyses. There was a significant increase in mindfulness (PP and ITT samples) and life satisfaction (ITT sample) in both groups. The frequency of home practice was related to positive changes in outcomes but only for the videoconferencing group. The results suggest that mindfulness training delivered via videoconferencing can be a viable option to address depressive symptoms among students. However, both interventions were effective in increasing mindfulness and life satisfaction.
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Affiliation(s)
- Constance Karing
- Institute of Psychology, Department of Research Synthesis, Intervention and Evaluation, Friedrich-Schiller-University Jena, Jena, Germany
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Ferrari M, Allan S, Arnold C, Eleftheriadis D, Alvarez-Jimenez M, Gumley A, Gleeson JF. Digital Interventions for Psychological Well-being in University Students: Systematic Review and Meta-analysis. J Med Internet Res 2022; 24:e39686. [PMID: 36169988 PMCID: PMC9557766 DOI: 10.2196/39686] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Life at university provides important opportunities for personal growth; however, this developmental phase also coincides with the peak period of risk for the onset of mental health disorders. In addition, specific university lifestyle factors, including impaired sleep and academic and financial stress, are known to exacerbate psychological distress in students. As a result, university students have been identified as a vulnerable population who often experience significant barriers to accessing psychological treatment. Digital psychological interventions are emerging as a promising solution for this population, but their effectiveness remains unclear. OBJECTIVE This systematic review and meta-analysis aimed to assess digital interventions targeting psychological well-being among university students. METHODS Database searches were conducted on December 2, 2021, via Embase, MEDLINE, PsycINFO, and Web of Science. RESULTS A total of 13 eligible studies were identified, 10 (77%) of which were included in the meta-analysis. Mean pre-post effect sizes indicated that such interventions led to small and significant improvement in psychological well-being (Hedges g=0.32, 95% CI 0.23-0.4; P<.001). These effects remained, albeit smaller, when studies that included a wait-list control group were excluded (Hedges g=0.22, 95% CI 0.08-0.35; P=.002). An analysis of acceptance and commitment therapy approaches revealed small and significant effects (k=6; Hedges g=0.35, 95% CI 0.25-0.45; P<.001). CONCLUSIONS Digital psychological interventions hold considerable promise for university students, although features that optimize service delivery and outcomes require further assessment. TRIAL REGISTRATION PROSPERO CRD42020196654; https:/www.crd.york.ac.uk/prospero/display_record.php?RecordID=196654.
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Affiliation(s)
- Madeleine Ferrari
- Healthy Brain and Mind Research Centre, Australian Catholic University, Sydney, Australia
| | - Stephanie Allan
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Chelsea Arnold
- Healthy Brain and Mind Research Centre, Australian Catholic University, Melbourne, Australia
| | - Dina Eleftheriadis
- Healthy Brain and Mind Research Centre, Australian Catholic University, Melbourne, Australia
| | - Mario Alvarez-Jimenez
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
- Orygen, Melbourne, Australia
| | - Andrew Gumley
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - John F Gleeson
- Healthy Brain and Mind Research Centre, Australian Catholic University, Melbourne, Australia
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Lee CS, Bowman M, Wu JL. Preliminary outcomes from a single-session, asynchronous, online stress and anxiety management workshop for college students. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2022; 45:e20210448. [PMID: 35714057 PMCID: PMC10597389 DOI: 10.47626/2237-6089-2021-0448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 06/02/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Self-guided, asynchronous, online interventions may provide college students access to evidence-based care, while mitigating barriers like limited hours of service. Thus, we examined the preliminary effectiveness of a 45-minute, self-guided, asynchronous, online, dialectical behavior therapy (DBT)-informed stress and anxiety management workshop. College undergraduates (n = 131) were randomized to either workshop (n = 65) or waitlist control (n = 66) conditions. METHODS Participants in the workshop condition completed baseline measures of depression, stress, and anxiety, before completing the workshop. Participants in the waitlist control condition only completed the baseline measures. All participants were reassessed at 1-week follow-up. RESULTS Controlling for baseline measures, students in the workshop condition experienced significantly less stress and greater self-efficacy to regulate stress and anxiety at follow-up, compared to waitlist controls. CONCLUSION A 45-minute, self-guided, asynchronous, online DBT skills-informed stress and anxiety management workshop may reduce stress and improve self-efficacy to regulate stress and anxiety.
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Affiliation(s)
- Carol S. Lee
- Department of PsychologyNevada State CollegeHendersonNVUSA Department of Psychology, Nevada State College, Henderson, NV, USA.
| | - Margaret Bowman
- Department of PsychologyNevada State CollegeHendersonNVUSA Department of Psychology, Nevada State College, Henderson, NV, USA.
| | - Jenny L. Wu
- Department of Clinical PsychologyUniversity of Massachusetts BostonBostonMAUSA Department of Clinical Psychology, University of Massachusetts Boston, Boston, MA, USA.
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Boyd N, Alexander DG. An online mindfulness intervention for medical students in South Africa: A randomised controlled trial. S Afr J Psychiatr 2022; 28:1840. [PMID: 35747337 PMCID: PMC9210716 DOI: 10.4102/sajpsychiatry.v28i0.1840] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 04/06/2022] [Indexed: 11/15/2022] Open
Abstract
Background Prior to the COVID-19 pandemic, an association was observed between medical students’ stress, possibly because of an intensive academic workload and clinical responsibilities, and mental ill health. The literature has shown the benefit of online mindfulness interventions for different mental health challenges. Unfortunately, there is a paucity of information on their benefit to medical students in South Africa. Aim The aim of this study was to explore whether medical students attending an online mindfulness-based intervention (MBI) would show improved resilience and stress management compared with attendance at an online supportive counselling (SC) programme. Secondary to this was the viability of the intervention, for which an in-depth understanding of participants’ experiences was sought. Setting The study setting was online through https://zoom.us/. Methods Forty-five participants were randomly allocated between two 6-week, teacher-facilitated groups. A repeated measures analysis of variance (ANOVA) of outcome, well-being, perceived stress and self-compassion scores conducted at three time points, as well as thematic analysis of participant feedback, contributed to quantitative and qualitative data. Results Participants in both the groups showed significant improvement over time in measures of well-being, perceived stress and subjective stress management. Participants in the mindfulness group showed a statistically significant treatment effect in mindfulness at programme completion. A decrease in self-compassion over time was observed in both the groups. Conclusion The results of this study indicate that in this South African medical student cohort, an online MBI and a SC programme are both feasible and show potential for reducing stress, increasing stress management and increasing resilience. Further study in this area is recommended.
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Affiliation(s)
- Nicola Boyd
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Debra G. Alexander
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Amanvermez Y, Zhao R, Cuijpers P, de Wit LM, Ebert DD, Kessler RC, Bruffaerts R, Karyotaki E. Effects of self-guided stress management interventions in college students: A systematic review and meta-analysis. Internet Interv 2022; 28:100503. [PMID: 35242591 PMCID: PMC8861419 DOI: 10.1016/j.invent.2022.100503] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND College students face several sources of stress. Self-guided stress management interventions offer an excellent opportunity for scaling up evidence-based interventions for self-management of these stresses. However, little is known about the overall effects of these interventions. Increasing this understanding is essential because self-guided stress management interventions might be a cost-effective and acceptable way of providing help to this important segment of the population during a critical life course stage. METHODS We carried out a systematic literature search of bibliographical databases (PubMed, PsycINFO, Embase, and Cochrane Library) for randomized controlled trials (RCTs) of self-guided stress management interventions published up through April 2020. We conducted two separate meta-analyses for perceived stress, depression, and anxiety. The first included interventions for general college student samples. The second included studies for students with high levels of perceived stress. RESULTS The first meta-analysis included 26 studies with 29 intervention-control comparisons based on a total of 4468 students. The pooled effect size was small but statistically significant (g = 0.19; 95% CI [0.10, 0.29]; p < 0.001). Results showed moderate heterogeneity across studies [I 2 = 48%; 95% CI (19, 66%)]. The second meta-analysis, included four studies based on a total of 491 students with high levels of stress. The pooled effect size was small but statistically significant (g = 0.34; 95% CI [0.16, 0.52]; p < 0.001). Results showed no heterogeneity across studies (I 2 = 0%; 95% CI [0, 79%]), but risk of bias was substantial. DISCUSSION Our results suggest that self-guided stress management programs may be effective when compared to control conditions, but with small average effects. These programs might be a useful element of a multi-component intervention system. Given the psychological barriers to treatment that exist among many college students, self-help interventions might be a good first step in facilitating subsequent help-seeking among students reluctant to engage in other types of treatment. More studies should be conducted to investigate these interventions, sample specifications, mediating effects, and individual-level heterogeneity of effects.
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Affiliation(s)
- Yagmur Amanvermez
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands,Corresponding author at: Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7-9, 1081 BT Amsterdam, the Netherlands.
| | - Ruiying Zhao
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Leonore M. de Wit
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - David D. Ebert
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum, Center for Public Health Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
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Reangsing C, Lauderman C, Schneider JK. Effects of Mindfulness Meditation Intervention on Depressive Symptoms in Emerging Adults: A Systematic Review and Meta-Analysis. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2022; 28:6-24. [PMID: 35085023 DOI: 10.1089/jicm.2021.0036] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Introduction: Depression in emerging adults (20-29 years of age), a transition from adolescence to adulthood, is a mental health problem globally. Antidepressants and psychotherapy have limited effectiveness and might not be available worldwide. Alternative and complementary treatments, such as mindfulness meditation, are growing. Objective: We examined the effects of mindfulness interventions on depression in emerging adults and explored the moderating effects of participants, methods, and intervention characteristics. Design: Systematic review and meta-analysis. Subjects: Emerging adults. Interventions: Mindfulness meditation interventions versus control groups. Outcomes measures: depressive symptoms. Results: Forty-five studies resulted in 49 comparisons, including 3479 participants (23.0-2.7 years old); 1826 participants practiced mindfulness and 1653 served as controls. Overall, mindfulness interventions showed significant reduction in depression compared with controls (g = 0.44, 95% confidence interval: 0.33-0.55). Mindfulness interventions conducted in Asian countries had a greater decrease in depression (g = 0.69) than studies conducted in North America (g = 0.44) or Europe (g = 0.23). Mindfulness interventions showed greater reductions in depression in studies with higher proportion of females (Slope = 0.010, τ2 = 0.07, Qbetween = 7.10, p = 0.008). Mindfulness interventions conducted in emerging adults with depressive disorders reduced depression more (g = 1.12) than in emerging adults without (g = 0.40). Providing mindfulness intervention in a group setting had a greater reduction of depression (g = 0.54) than on an individual basis (g = 0.30). More minutes of unstructured mindfulness practice per session showed a greater reduction in depressive symptoms (Slope = 0.016, Qbetween = 1.34, p = 0.035). Using intention-to-treat analyses showed a lower ES (g = 0.14) than not using it (g = 0.55). Other quality indicators were not significant moderators. Primary researchers did not report the adverse effects of mindfulness interventions. Conclusion: Mindfulness interventions somewhat improved depression in emerging adults. Because primary researchers did not report the adverse effects, mindfulness interventions should be used with caution. Future researchers might study the adverse effects of mindfulness interventions as well as the long-term effects.
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Affiliation(s)
- Chuntana Reangsing
- School of Nursing, Mae Fah Luang University, Muang, Chiangrai province, Thailand
| | - Christina Lauderman
- Trudy Busch Valentine School of Nursing, Saint Louis University, St. Louis, MO, USA
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Taylor H, Strauss C, Cavanagh K. Can a little bit of mindfulness do you good? A systematic review and meta-analyses of unguided mindfulness-based self-help interventions. Clin Psychol Rev 2021; 89:102078. [PMID: 34537665 DOI: 10.1016/j.cpr.2021.102078] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 06/30/2021] [Accepted: 08/24/2021] [Indexed: 12/18/2022]
Abstract
Over the last decade there has been an explosion of interest in mindfulness-based self-help (MBSH) interventions. While widely available and extensively promoted, there is little consensus on their impact in public health or healthcare contexts. We present a systematic review and meta-analyses of 83 randomized controlled trials, comparing unguided MBSH to control conditions on outcomes of depression, mindfulness, anxiety, stress and/or wellbeing/ quality of life. A random effects model was used to compute post-intervention, between-groups effect sizes for each outcome. MBSH demonstrated small, statistically significant effects at post-interventions for outcomes of depression (g = -0.23), mindfulness (g = 0.37) anxiety (g = -0.25), stress (g = -0.41) and wellbeing/ quality of life (g = 0.34). Significant effects were retained at follow-up for mindfulness, stress and wellbeing/ quality of life but not for depression or anxiety. Planned moderator analyses demonstrated significantly larger effects of MBSH when compared to inactive, versus active-control conditions on all outcomes except wellbeing/ quality of life, and non-digital MBSH interventions demonstrated significantly greater effects on depression, mindfulness and wellbeing/ quality of life outcomes than digitally-delivered MBSH. When studies that utilised samples selected for mental and physical health-related difficulties were respectively compared to studies that utilised unselected samples, no significant moderation effects were observed. In sum, these findings provide evidence for the effectiveness of unguided MBSH in public health settings and the practical, access-related implications of this are discussed.
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Affiliation(s)
- Heather Taylor
- School of Psychology, University of Sussex, Falmer, Brighton BN1 9QJ, UK.
| | - Clara Strauss
- School of Psychology, University of Sussex, Falmer, Brighton BN1 9QJ, UK; R&D Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Hove, BN3 7HZ, UK.
| | - Kate Cavanagh
- School of Psychology, University of Sussex, Falmer, Brighton BN1 9QJ, UK; R&D Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Hove, BN3 7HZ, UK.
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12
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Sommers-Spijkerman M, Austin J, Bohlmeijer E, Pots W. New Evidence in the Booming Field of Online Mindfulness: An Updated Meta-analysis of Randomized Controlled Trials. JMIR Ment Health 2021; 8:e28168. [PMID: 34279240 PMCID: PMC8329762 DOI: 10.2196/28168] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/05/2021] [Accepted: 05/16/2021] [Indexed: 12/26/2022] Open
Abstract
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.
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Affiliation(s)
- Marion Sommers-Spijkerman
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht, Netherlands
| | - Judith Austin
- Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Ernst Bohlmeijer
- Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Wendy Pots
- Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
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Orosa-Duarte Á, Mediavilla R, Muñoz-Sanjose A, Palao Á, Garde J, López-Herrero V, Bravo-Ortiz MF, Bayón C, Rodríguez-Vega B. Mindfulness-based mobile app reduces anxiety and increases self-compassion in healthcare students: A randomised controlled trial. MEDICAL TEACHER 2021; 43:686-693. [PMID: 33645416 DOI: 10.1080/0142159x.2021.1887835] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To compare the effect of a mindfulness-based mobile application versus an in-person mindfulness-based training program in terms of reducing anxiety and increasing empathy, self-compassion, and mindfulness in a population of healthcare students. METHODS The authors conducted a single-blind, randomised controlled trial with three parallel groups. Participants were allocated to the mobile app, the in-person mindfulness-based program (IMBP), or a control group. Assessments at baseline and postintervention (8 weeks) included measures of anxiety, empathy, self-compassion, and mindfulness. RESULTS Of 168 students randomised, 84 were analysed on an intention-to-treat basis (app: n = 31; IMBP: n = 23; control: n = 30). The mobile app group showed a large effect size for reductions in trait anxiety compared with controls (g = 0.85, p = 0.003), and a medium, nonsignificant effect compared with the IMBP group (g = 0.52, p = 0.152). Participants from both interventions experienced a significant increase in self-compassion and mindfulness compared with controls. Levels of empathy remained unchanged for the 3 arms. CONCLUSIONS A mobile app can be as effective as an IMBP in reducing anxiety and increasing self-compassion and mindfulness among healthcare students.
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Affiliation(s)
- Álvaro Orosa-Duarte
- Psychiatry, Clinical Psychology and Mental Health Department, La Paz University Hospital, Madrid, Spain
- Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain
| | - Roberto Mediavilla
- Psychiatry, Clinical Psychology and Mental Health Area, La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain
- Faculty of Psychology, National University of Distance Education (UNED), Madrid, Spain
| | - Ainoa Muñoz-Sanjose
- Psychiatry, Clinical Psychology and Mental Health Department, La Paz University Hospital, Madrid, Spain
- Psychiatry, Clinical Psychology and Mental Health Area, La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Ángela Palao
- Psychiatry, Clinical Psychology and Mental Health Department, La Paz University Hospital, Madrid, Spain
- Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain
- Psychiatry, Clinical Psychology and Mental Health Area, La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Joaquín Garde
- Psychiatry, Clinical Psychology and Mental Health Department, La Paz University Hospital, Madrid, Spain
- Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain
| | | | - María-Fe Bravo-Ortiz
- Psychiatry, Clinical Psychology and Mental Health Department, La Paz University Hospital, Madrid, Spain
- Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain
- Psychiatry, Clinical Psychology and Mental Health Area, La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Carmen Bayón
- Psychiatry, Clinical Psychology and Mental Health Department, La Paz University Hospital, Madrid, Spain
- Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain
- Psychiatry, Clinical Psychology and Mental Health Area, La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Beatriz Rodríguez-Vega
- Psychiatry, Clinical Psychology and Mental Health Department, La Paz University Hospital, Madrid, Spain
- Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain
- Psychiatry, Clinical Psychology and Mental Health Area, La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain
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14
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Světlák M, Linhartová P, Knejzlíková T, Knejzlík J, Kóša B, Horníčková V, Jarolínová K, Lučanská K, Slezáčková A, Šumec R. Being Mindful at University: A Pilot Evaluation of the Feasibility of an Online Mindfulness-Based Mental Health Support Program for Students. Front Psychol 2021; 11:581086. [PMID: 33505332 PMCID: PMC7829670 DOI: 10.3389/fpsyg.2020.581086] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/30/2020] [Indexed: 12/15/2022] Open
Abstract
University study can be a life period of heightened psychological distress for many students. The development of new preventive and intervention programs to support well-being in university students is a fundamental challenge for mental health professionals. We designed an 8-week online mindfulness-based program (eMBP) combining a face-to-face approach, text, audio, video components, and support psychotherapy principles with a unique intensive reminder system using the Facebook Messenger and Slack applications in two separate runs (N = 692). We assessed the program's effect on mindful experiencing, perceived stress, emotion regulation strategies, self-compassion, negative affect, and quality of life. The results of the presented pilot study confirmed that eMBP is a feasible and effective tool in university students' mental health support. The students who completed the eMBP reported a reduction of perceived stress with a large effect size ( p η2 = 0.42) as well as a decrease of negative affect experience frequency and intensity ( p η2 = 0.31), an increase of being mindful in their life (Five Facet Mindfulness Questionnaire subscales: p η2 = 0.21, 0.27, 0.25, 0.28, 0.28), and a higher rate of self-compassion ( p η2 = 0.28) with a medium effect size. A small effect size was found in the frequency of using a cognitive reappraisal strategy ( p η2 = 0.073). One new result is the observation of an eMBP effect ( p η2 = 0.27) on the decrease in attributed importance to the quality-of-life components replicated in two consecutive runs of the program. The study affirms that mindfulness-based interventions can be effectively delivered in an eHealth form to university students.
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Affiliation(s)
- Miroslav Světlák
- Department of Psychiatry, Faculty of Medicine, Masaryk University, Brno, Czechia.,Department of Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Pavla Linhartová
- Department of Psychiatry, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Terezia Knejzlíková
- Department of Psychiatry, Faculty of Medicine, Masaryk University, Brno, Czechia.,Department of Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Jakub Knejzlík
- Department of Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Barbora Kóša
- Department of Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Veronika Horníčková
- Department of Psychology, Faculty of Arts, Masaryk University, Brno, Czechia
| | - Kristýna Jarolínová
- Department of Psychology, Faculty of Arts, Masaryk University, Brno, Czechia
| | - Klaudia Lučanská
- Department of Psychology, Faculty of Arts, Masaryk University, Brno, Czechia
| | - Alena Slezáčková
- Department of Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Brno, Czechia.,Department of Psychology, Faculty of Arts, Masaryk University, Brno, Czechia
| | - Rastislav Šumec
- Department of Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Brno, Czechia.,First Department of Neurology, Faculty of Medicine, Masaryk University and St. Anne's University Hospital, Brno, Czechia
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15
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Küchler AM, Schultchen D, Pollatos O, Moshagen M, Ebert DD, Baumeister H. StudiCare mindfulness-study protocol of a randomized controlled trial evaluating an internet- and mobile-based intervention for college students with no and "on demand" guidance. Trials 2020; 21:975. [PMID: 33243300 PMCID: PMC7691111 DOI: 10.1186/s13063-020-04868-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 11/04/2020] [Indexed: 11/17/2022] Open
Abstract
Background College is an exciting but also challenging time with an increased risk for mental health issues. Only a minority of the college students concerned get professional help, a problem that might be improvable by internet- and mobile-based interventions (IMIs). However, adherence of IMIs is a concern. While guidance might be a solution, it is resource-intensive, derailing potential implementation on population level. The first aim of this trial is to evaluate the efficacy of the IMI StudiCare Mindfulness (StudiCare-M) for college students with “on demand” and no guidance. The second aim is to examine potential moderators and mediators, contributing to the questions of “how” and “for whom” such interventions work. Methods In this three-armed randomized controlled trial, both an unguided and “guidance on demand” (GoD) condition of StudiCare-M are compared to a waitlist control group. StudiCare-M is based on principles of acceptance and commitment therapy and stress management and consists of 7 modules plus two booster sessions. Participants in the GoD condition may ask their e-coach for support whenever needed. A total of 387 college students with moderate to low mindfulness are recruited at 15+ cooperating universities in Germany, Austria, and Switzerland via circular emails. Assessments take place before as well as 1, 2, and 6 months after randomization. The primary outcome is mindfulness. Secondary outcomes include stress, depression, anxiety, interoception, presenteeism, wellbeing, intervention satisfaction, adherence, and potential side effects. Among examined moderators and mediators are sociodemographic variables, pre-treatment symptomatology, treatment expectancy, self-efficacy, cognitive fusion, emotion regulation, and alexithymia. All data will be analyzed according to intention-to-treat (ITT) principles. Discussion Providing effective interventions to help college students become more resilient can make a valuable contribution to the health and functionality of future society. If effective under the condition of minimal or no guidance, StudiCare-M offers a low-threshold potentially resource-efficient possibility to enhance college student mental health on a population level. Moderation- and mediation analyses will deliver further insights for optimization of target groups and intervention content. Trial registration WHO International Clinical Trials Registry Platform via the German Clinical Studies Trial Register DRKS00014774. Registered on 18 May 2018.
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Affiliation(s)
- Ann-Marie Küchler
- Department of Clinical Psychology and Psychotherapy, Institute for Psychology and Education, Ulm University, Albert-Einstein-Allee 47, 89081, Ulm, Germany.
| | - Dana Schultchen
- Department of Clinical and Health Psychology, Ulm University, Ulm, Germany
| | - Olga Pollatos
- Department of Clinical and Health Psychology, Ulm University, Ulm, Germany
| | - Morten Moshagen
- Department of Quantitative Methods in Psychology, Ulm University, Ulm, Germany
| | - David D Ebert
- Department of Clinical, Neuro- & Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute for Psychology and Education, Ulm University, Albert-Einstein-Allee 47, 89081, Ulm, Germany
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16
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Matis J, Svetlak M, Slezackova A, Svoboda M, Šumec R. Mindfulness-Based Programs for Patients With Cancer via eHealth and Mobile Health: Systematic Review and Synthesis of Quantitative Research. J Med Internet Res 2020; 22:e20709. [PMID: 33196452 PMCID: PMC7704284 DOI: 10.2196/20709] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/22/2020] [Accepted: 09/30/2020] [Indexed: 01/07/2023] Open
Abstract
Background eHealth mindfulness-based programs (eMBPs) are on the rise in complex oncology and palliative care. However, we are still at the beginning of answering the questions of how effective eMBPs are and for whom, and what kinds of delivery modes are the most efficient. Objective This systematic review aims to examine the feasibility and efficacy of eMBPs in improving the mental health and well-being of patients with cancer, to describe intervention characteristics and delivery modes of these programs, and to summarize the results of the included studies in terms of moderators, mediators, and predictors of efficacy, adherence, and attrition. Methods In total, 4 databases (PubMed, PsycINFO, Scopus, and Web of Knowledge) were searched using relevant search terms (eg, mindfulness, program, eHealth, neoplasm) and their variations. No restrictions were imposed on language or publication type. The results of the efficacy of eMBPs were synthesized through the summarizing effect estimates method. Results
A total of 29 published papers describing 24 original studies were included in this review. In general, the results indicate that eMBPs have the potential to reduce the levels of stress, anxiety, depression, fatigue, sleep problems, and pain, and improve the levels of mindfulness, posttraumatic growth, and some parameters of general health. The largest median of Cohen d effect sizes were observed in reducing anxiety and depression (within-subject: median −0.38, IQR −0.62 to −0.27; between-group:
median −0.42, IQR −0.58 to −0.22) and facilitating posttraumatic growth (within-subject: median 0.42, IQR 0.35 to 0.48;
between-group: median 0.32, IQR 0.22 to 0.39). The efficacy of eMBP may be comparable with that of parallel, face-to-face
MBPs in some cases. All studies that evaluated the feasibility of eMBPs reported that they are feasible for patients with cancer.
Potential moderators, mediators, and predictors of the efficacy, attrition, and adherence of eMBPs are discussed.
Conclusions Although the effects of the reviewed studies were highly heterogeneous, the review provides evidence that eMBPs are an appropriate way for mindfulness practice to be delivered to patients with cancer. Thus far, existing eMBPs have mostly attempted to convert proven face-to-face mindfulness programs to the eHealth mode. They have not yet fully exploited the potential of eHealth technology.
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Affiliation(s)
- Juraj Matis
- Department of Psychology, Faculty of Arts, Masaryk University, Brno, Czech Republic
| | - Miroslav Svetlak
- Department of Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Department of Psychiatry, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Alena Slezackova
- Department of Psychology, Faculty of Arts, Masaryk University, Brno, Czech Republic.,Department of Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Marek Svoboda
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Rastislav Šumec
- Department of Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,First Department of Neurology, Faculty of Medicine, Masaryk University and St. Anne's University Hospital, Brno, Czech Republic
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Dekker I, De Jong EM, Schippers MC, De Bruijn-Smolders M, Alexiou A, Giesbers B. Optimizing Students' Mental Health and Academic Performance: AI-Enhanced Life Crafting. Front Psychol 2020; 11:1063. [PMID: 32581935 PMCID: PMC7286028 DOI: 10.3389/fpsyg.2020.01063] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 04/27/2020] [Indexed: 12/30/2022] Open
Abstract
One in three university students experiences mental health problems during their study. A similar percentage leaves higher education without obtaining the degree for which they enrolled. Research suggests that both mental health problems and academic underperformance could be caused by students lacking control and purpose while they are adjusting to tertiary education. Currently, universities are not designed to cater to all the personal needs and mental health problems of large numbers of students at the start of their studies. Within the literature aimed at preventing mental health problems among students (e.g., anxiety or depression), digital forms of therapy recently have been suggested as potentially scalable solutions to address these problems. Integrative psychological artificial intelligence (AI) in the form of a chatbot, for example, shows great potential as an evidence-based solution. At the same time, within the literature aimed at improving academic performance, the online life-crafting intervention in which students write about values and passions, goals, and goal-attainment plans has shown to improve the academic performance and retention rates of students. Because the life-crafting intervention is delivered through the curriculum and doesn't bear the stigma that is associated with therapy, it can reach larger populations of students. But life-crafting lacks the means for follow-up or the interactiveness that online AI-guided therapy can offer. In this narrative review, we propose to integrate the current literature on chatbot interventions aimed at the mental health of students with research about a life-crafting intervention that uses an inclusive curriculum-wide approach. When a chatbot asks students to prioritize both academic as well as social and health-related goals and provides personalized follow-up coaching, this can prevent -often interrelated- academic and mental health problems. Right on-time delivery, and personalized follow-up questions enhance the effects of both -originally separated- intervention types. Research on this new combination of interventions should use design principles that increase user-friendliness and monitor the technology acceptance of its participants.
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Affiliation(s)
- Izaak Dekker
- Department of Technology and Operations Management, Rotterdam School of Management, Erasmus University, Rotterdam, Netherlands
- Research Centre Urban Talent, Rotterdam University of Applied Sciences, Rotterdam, Netherlands
| | - Elisabeth M. De Jong
- Department of Technology and Operations Management, Rotterdam School of Management, Erasmus University, Rotterdam, Netherlands
| | - Michaéla C. Schippers
- Department of Technology and Operations Management, Rotterdam School of Management, Erasmus University, Rotterdam, Netherlands
| | - Monique De Bruijn-Smolders
- Department of Technology and Operations Management, Rotterdam School of Management, Erasmus University, Rotterdam, Netherlands
- Research Centre Urban Talent, Rotterdam University of Applied Sciences, Rotterdam, Netherlands
| | - Andreas Alexiou
- Department of Technology and Operations Management, Rotterdam School of Management, Erasmus University, Rotterdam, Netherlands
- Department of Management, Tilburg School of Economics and Management, Tilburg University, Tilburg, Netherlands
| | - Bas Giesbers
- Information Management and Consulting, Rotterdam School of Management, Erasmus University, Rotterdam, Netherlands
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18
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Schultchen D, Küchler AM, Schillings C, Weineck F, Karabatsiakis A, Ebert DD, Baumeister H, Pollatos O. Effectiveness of a guided online mindfulness-focused intervention in a student population: Study protocol for a randomised control trial. BMJ Open 2020; 10:e032775. [PMID: 32209621 PMCID: PMC7202707 DOI: 10.1136/bmjopen-2019-032775] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 02/07/2020] [Accepted: 03/04/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Previous studies show that university students experience higher psychological stress than the general population, resulting in increased vulnerability for mental disorders for the student population. Online mindfulness interventions will be delivered to students as a potentially promising and more flexible approach compared to face-to-face interventions with the aim of improving their mental health. This study purposes to investigate the effectiveness of a guided online mindfulness-focused intervention for university students by using both self-reported and psychobiological measures. METHODS AND ANALYSES In this multicentre, two-armed randomised controlled trial with a parallel design, a guided version of the online mindfulness-focused intervention 'StudiCare Mindfulness' will be compared with a waitlist control group. In total, 120 participants will be recruited at different universities (of Applied Sciences) in (Neu-) Ulm. Data will be assessed prior to randomisation, after eight weeks (post-intervention) and six months after randomisation (follow-up). The primary outcome measure is mindfulness. The secondary outcome measures include depression, anxiety and stress levels, well-being, interoceptive sensibility, emotion regulation and alexithymia. Psychobiological parameters comprise interoceptive accuracy, hair cortisol and FKBP5 genotype. Sociodemographic variables, treatment expectations, side and adverse side effects, as well as intervention satisfaction and adherence will be assessed. All data analyses will be conducted according to the intention-to-treat principle. ETHICS AND DISSEMINATION All study procedures have been approved by the Ethics Committee of Ulm University (application No. 48/18). The findings will be disseminated widely through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER DRKS00014701.
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Affiliation(s)
- Dana Schultchen
- Department of Clinical & Health Psychology, Ulm University, Ulm, Baden-Württemberg, Germany
| | - Ann-Marie Küchler
- Department of Clinical Psychology & Psychotherapy, Ulm University, Ulm, Baden-Württemberg, Germany
| | - Christine Schillings
- Department of Clinical & Health Psychology, Ulm University, Ulm, Baden-Württemberg, Germany
| | - Felicitas Weineck
- Department of Clinical & Health Psychology, Ulm University, Ulm, Baden-Württemberg, Germany
| | | | - David D Ebert
- Department of Clinical, Neuro- & Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Harald Baumeister
- Department of Clinical Psychology & Psychotherapy, Ulm University, Ulm, Baden-Württemberg, Germany
| | - Olga Pollatos
- Department of Clinical & Health Psychology, Ulm University, Ulm, Baden-Württemberg, Germany
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Seabrook E, Kelly R, Foley F, Theiler S, Thomas N, Wadley G, Nedeljkovic M. Understanding How Virtual Reality Can Support Mindfulness Practice: Mixed Methods Study. J Med Internet Res 2020; 22:e16106. [PMID: 32186519 PMCID: PMC7113800 DOI: 10.2196/16106] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 12/09/2019] [Accepted: 12/31/2019] [Indexed: 01/02/2023] Open
Abstract
Background Regular mindfulness practice has been demonstrated to be beneficial for mental health, but mindfulness can be challenging to adopt, with environmental and personal distractors often cited as challenges. Virtual reality (VR) may address these challenges by providing an immersive environment for practicing mindfulness and by supporting the user to orient attention to the present moment within a tailored virtual setting. However, there is currently a limited understanding of the ways in which VR can support or hinder mindfulness practice. Such an understanding is required to design effective VR apps while ensuring that VR-supported mindfulness is acceptable to end users. Objective This study aimed to explore how VR can support mindfulness practice and to understand user experience issues that may affect the acceptability and efficacy of VR mindfulness for users in the general population. Methods A sample of 37 participants from the general population trialed a VR mindfulness app in a controlled laboratory setting. The VR app presented users with an omnidirectional video of a peaceful forest environment with a guided mindfulness voiceover that was delivered by a male narrator. Scores on the State Mindfulness Scale, Simulator Sickness Questionnaire, and single-item measures of positive and negative emotion and arousal were measured pre- and post-VR for all participants. Qualitative feedback was collected through interviews with a subset of 19 participants. The interviews sought to understand the user experience of mindfulness practice in VR. Results State mindfulness (P<.001; Cohen d=1.80) and positive affect (P=.006; r=.45) significantly increased after using the VR mindfulness app. No notable changes in negative emotion, subjective arousal, or symptoms of simulator sickness were observed across the sample. Participants described the user experience as relaxing, calming, and peaceful. Participants suggested that the use of VR helped them to focus on the present moment by using visual and auditory elements of VR as attentional anchors. The sense of presence in the virtual environment (VE) was identified by participants as being helpful to practicing mindfulness. Interruptions to presence acted as distractors. Some uncomfortable experiences were discussed, primarily in relation to video fidelity and the weight of the VR headset, although these were infrequent and minor. Conclusions This study suggests that an appropriately designed VR app can support mindfulness practice by enhancing state mindfulness and inducing positive affect. VR may help address the challenges of practicing mindfulness by creating a sense of presence in a tailored VE; by allowing users to attend to visual and auditory anchors of their choice; and by reducing the scope of the content in users’ mind-wandering. VR has the unique capability to combine guided mindfulness practice with tailored VEs that lend themselves to support individuals to focus attention on the present moment.
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Affiliation(s)
- Elizabeth Seabrook
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Melbourne, Australia
| | - Ryan Kelly
- School of Computing and Information Systems, University of Melbourne, Melbourne, Australia
| | - Fiona Foley
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Melbourne, Australia
| | - Stephen Theiler
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Neil Thomas
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Melbourne, Australia
| | - Greg Wadley
- School of Computing and Information Systems, University of Melbourne, Melbourne, Australia
| | - Maja Nedeljkovic
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Melbourne, Australia
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Apolinário-Hagen J, Drüge M, Fritsche L. Cognitive Behavioral Therapy, Mindfulness-Based Cognitive Therapy and Acceptance Commitment Therapy for Anxiety Disorders: Integrating Traditional with Digital Treatment Approaches. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1191:291-329. [DOI: 10.1007/978-981-32-9705-0_17] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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21
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Lippmann M, Laudel H, Heinzle M, Narciss S. Relating Instructional Design Components to the Effectiveness of Internet-Based Mindfulness Interventions: A Critical Interpretive Synthesis. J Med Internet Res 2019; 21:e12497. [PMID: 31774413 PMCID: PMC6906627 DOI: 10.2196/12497] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 08/17/2019] [Accepted: 09/26/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Internet-based mindfulness interventions are a promising approach to address challenges in the dissemination and implementation of mindfulness interventions, but it is unclear how the instructional design components of such interventions are associated with intervention effectiveness. OBJECTIVE The objective of this study was to identify the instructional design components of the internet-based mindfulness interventions and provide a framework for the classification of those components relative to the intervention effectiveness. METHODS The critical interpretive synthesis method was applied. In phase 1, a strategic literature review was conducted to generate hypotheses for the relationship between the effectiveness of internet-based mindfulness interventions and the instructional design components of those interventions. In phase 2, the literature review was extended to systematically explore and revise the hypotheses from phase 1. RESULTS A total of 18 studies were identified in phase 1; 14 additional studies were identified in phase 2. Of the 32 internet-based mindfulness interventions, 18 were classified as more effective, 11 as less effective, and only 3 as ineffective. The effectiveness of the interventions increased with the level of support provided by the instructional design components. The main difference between effective and ineffective interventions was the presence of just-in-time information in the form of reminders. More effective interventions included more supportive information (scores: 1.91 in phases 1 and 2) than less effective interventions (scores: 1.00 in phase 1 and 1.80 in phase 2), more part-task practice (scores: 1.18 in phase 1 and 1.60 in phase 2) than less effective interventions (scores: 0.33 in phase 1 and 1.40 in phase 2), and provided more just-in-time information (scores: 1.35 in phase 1 and 1.67 in phase 2) than less effective interventions (scores: 0.83 in phase 1 and 1.60 in phase 2). The average duration of more effective, less effective, and ineffective interventions differed for the studies of phase 1, with more effective interventions taking up more time (7.45 weeks) than less effective (4.58 weeks) or ineffective interventions (3 weeks). However, this difference did not extend to the studies of phase 2, with comparable average durations of effective (5.86 weeks), less effective (5.6 weeks), and ineffective (7 weeks) interventions. CONCLUSIONS Our results suggest that to be effective, internet-based mindfulness interventions must contain 4 instructional design components: formal learning tasks, supportive information, part-task practice, and just-in-time information. The effectiveness of the interventions increases with the level of support provided by each of these instructional design components.
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Affiliation(s)
- Marie Lippmann
- Department of Psychology, California State University, Chico, CA, United States
| | - Helena Laudel
- Psychology of Learning and Instruction, Faculty of Psychology - School of Science, Technische Universität Dresden, Dresden, Germany
| | - Marlene Heinzle
- Department of Media, Cognition and Communication, Faculty of Humanities, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Narciss
- Psychology of Learning and Instruction, Faculty of Psychology - School of Science, Technische Universität Dresden, Dresden, Germany
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22
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Lattie EG, Adkins EC, Winquist N, Stiles-Shields C, Wafford QE, Graham AK. Digital Mental Health Interventions for Depression, Anxiety, and Enhancement of Psychological Well-Being Among College Students: Systematic Review. J Med Internet Res 2019; 21:e12869. [PMID: 31333198 PMCID: PMC6681642 DOI: 10.2196/12869] [Citation(s) in RCA: 270] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 05/29/2019] [Accepted: 06/14/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND College students are increasingly reporting common mental health problems, such as depression and anxiety, and they frequently encounter barriers to seeking traditional mental health treatments. Digital mental health interventions, such as those delivered via the Web and apps, offer the potential to improve access to mental health treatment. OBJECTIVE This study aimed to review the literature on digital mental health interventions focused on depression, anxiety, and enhancement of psychological well-being among samples of college students to identify the effectiveness, usability, acceptability, uptake, and adoption of such programs. METHODS We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (registration number CRD42018092800), and the search strategy was conducted by a medical research librarian in the following databases: MEDLINE (Ovid), EMBASE (Elsevier), PsycINFO (EbscoHost), the Cochrane Library (Wiley), and Web of Science (Thomson Reuters) from the date of inception to April 2019. Data were synthesized using a systematic narrative synthesis framework, and formal quality assessments were conducted to address the risk of bias. RESULTS A total of 89 studies met the inclusion criteria. The majority of interventions (71/89, 80%) were delivered via a website, and the most common intervention was internet-based cognitive behavioral therapy (28, 31%). Many programs (33, 37%) featured human support in the form of coaching. The majority of programs were either effective (42, 47%) or partially effective (30, 34%) in producing beneficial changes in the main psychological outcome variables. Approximately half of the studies (45, 51%) did not present any usability or acceptability outcomes, and few studies (4, 4%) examined a broad implementation of digital mental health interventions on college campuses. Quality assessments revealed a moderate-to-severe risk of bias in many of the studies. CONCLUSIONS Results suggest that digital mental health interventions can be effective for improving depression, anxiety, and psychological well-being among college students, but more rigorous studies are needed to ascertain the effective elements of these interventions. Continued research on improving the user experience of, and thus user engagement with, these programs appears vital for the sustainable implementation of digital mental health interventions on college campuses.
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Affiliation(s)
- Emily G Lattie
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL, United States
| | - Elizabeth C Adkins
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL, United States
| | - Nathan Winquist
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL, United States
| | - Colleen Stiles-Shields
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Q Eileen Wafford
- Galter Health Sciences Library and Learning Center, Northwestern University, Chicago, IL, United States
| | - Andrea K Graham
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL, United States
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23
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Recent Developments in Digital Mental Health Interventions for College and University Students. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s40501-019-00178-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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24
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Rodrigues MF, Campos C, Pelucio L, Barreto I, Machado S, Appolinario JC, Nardi AE, Levitan M. Patients' Comprehension of Mindfulness-Based Cognitive Behavioral Therapy in an Outpatient Clinic for Resistant Depression: A Cross-Sectional Study. Front Psychol 2019; 10:271. [PMID: 30809181 PMCID: PMC6379306 DOI: 10.3389/fpsyg.2019.00271] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 01/28/2019] [Indexed: 11/30/2022] Open
Abstract
The current study investigated the comprehension of mindfulness-based cognitive behavioral therapy (MBCT) by patients with resistant depression at the Psychiatry Institute of the Federal University of Rio de Janeiro, Brazil. This was the first time the model was used in the institution to treat these patients. In this study, 45 patients were invited to participate in a baseline session of MBCT that consisted in the explanation of the model and experimental exercises conducted by two experienced therapists. Twenty eight patients accepted to participate. At the end of the intervention, the patients completed a self-administered questionnaire designed by our ambulatory to assess their understanding of the method’s goals. Patients with anxiety disorder was also accessed for group comparison. More than 75% of the patients rated the intervention as comprehensible and workable. Compared to patients with depression, patients with anxiety had a better understanding of the mindfulness framework (6.5%) and the meaning of cognitive behavioral therapy (17.6%). Patients that completed the intervention described the baseline session of MBCT as comprehensive and acceptable. These results may allow possible future developments in the practice of mindfulness as a treatment applicable in many condition and settings even in the Brazilian context.
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Affiliation(s)
- Michele F Rodrigues
- Treatment Resistant Depression Ambulatory, Psychiatry Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carlos Campos
- Center for Rehabilitation Research, School of Health, Polytechnic Institute of Porto, Porto, Portugal
| | - Luisa Pelucio
- Treatment Resistant Depression Ambulatory, Psychiatry Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Izabel Barreto
- Treatment Resistant Depression Ambulatory, Psychiatry Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Sergio Machado
- Treatment Resistant Depression Ambulatory, Psychiatry Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jose C Appolinario
- Treatment Resistant Depression Ambulatory, Psychiatry Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Antonio E Nardi
- Treatment Resistant Depression Ambulatory, Psychiatry Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Michelle Levitan
- Treatment Resistant Depression Ambulatory, Psychiatry Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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25
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Walsh KM, Saab BJ, Farb NA. Effects of a Mindfulness Meditation App on Subjective Well-Being: Active Randomized Controlled Trial and Experience Sampling Study. JMIR Ment Health 2019; 6:e10844. [PMID: 30622094 PMCID: PMC6329416 DOI: 10.2196/10844] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 09/23/2018] [Accepted: 11/01/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Mindfulness training (MT) includes a variety of contemplative practices aimed at promoting intentional awareness of experience, coupled with attitudes of nonjudgment and curiosity. Following the success of 8-week, manualized group interventions, MT has been implemented in a variety of modalities, including smartphone apps that seek to replicate the success of group interventions. However, although smartphone apps are scalable and accessible to a wider swath of population, their benefits remain largely untested. OBJECTIVE This study aimed to investigate a newly developed MT app called Wildflowers, which was codeveloped with the laboratory for use in mindfulness research. It was hypothesized that 3 weeks of MT through this app would improve subjective well-being, attentional control, and interoceptive integration, albeit with weaker effects than those published in the 8 week, manualized group intervention literature. METHODS Undergraduate students completed 3 weeks of MT with Wildflowers (n=45) or 3 weeks of cognitive training with a game called 2048 (n=41). State training effects were assessed through pre- and postsession ratings of current mood, stress level, and heart rate. Trait training effects were assessed through pre- and postintervention questionnaires canvassing subjective well-being and behavioral task measures of attentional control and interoceptive integration. State and trait training data were analyzed in a multilevel model using emergent latent factors (acceptance, awareness, and openness) to summarize the trait questionnaire battery. RESULTS Analyses revealed both state and trait effects specific to MT; participants engaging in MT demonstrated improved mood (r=.14) and a reduction of stress (r=-.13) immediately after each training session compared with before the training session and decreased postsession stress over 3 weeks (r=-.08). In addition, MT relative to cognitive training resulted in greater improvements in attentional control (r=-.24). Interestingly, both groups demonstrated increased subjective ratings of awareness (r=.28) and acceptance (r=.23) from pre- to postintervention, with greater changes in acceptance for the MT group trending (r=.21). CONCLUSIONS MT, using a smartphone app, may provide immediate effects on mood and stress while also providing long-term benefits for attentional control. Although further investigation is warranted, there is evidence that with continued usage, MT via a smartphone app may provide long-term benefits in changing how one relates to their inner and outer experiences. TRIAL REGISTRATION ClinicalTrials.gov NCT03783793; https://clinicaltrials.gov/ct2/show/NCT03783793 (Archived by WebCite at http://www.webcitation.org/75EF2ehst).
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Affiliation(s)
- Kathleen Marie Walsh
- Department of Psychological Clinical Science, University of Toronto Scarborough, Toronto, ON, Canada
| | - Bechara J Saab
- Mobio Interactive Inc, Biomedical Zone, St. Michael's Hospital, Toronto, ON, Canada.,Preclinical Laboratory for Translational Research into Affective Disorders, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.,Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland.,Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Norman As Farb
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, Canada
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26
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Breedvelt JJF, Amanvermez Y, Harrer M, Karyotaki E, Gilbody S, Bockting CLH, Cuijpers P, Ebert DD. The Effects of Meditation, Yoga, and Mindfulness on Depression, Anxiety, and Stress in Tertiary Education Students: A Meta-Analysis. Front Psychiatry 2019; 10:193. [PMID: 31068842 PMCID: PMC6491852 DOI: 10.3389/fpsyt.2019.00193] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 03/18/2019] [Indexed: 12/23/2022] Open
Abstract
Background: Meditation, yoga, and mindfulness are popular interventions at universities and tertiary education institutes to improve mental health. However, the effects on depression, anxiety, and stress are unclear. This study assessed the effectiveness of meditation, yoga, and mindfulness on symptoms of depression, anxiety, and stress in tertiary education students. Methods: We searched Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, PsycINFO and identified 11,936 articles. After retrieving 181 papers for full-text screening, 24 randomized controlled trials were included in the qualitative analysis. We conducted a random-effects meta-analysis amongst 23 studies with 1,373 participants. Results: At post-test, after exclusion of outliers, effect sizes for depression, g = 0.42 (95% CI: 0.16-0.69), anxiety g = 0.46 (95% CI: 0.34-0.59), stress g = 0.42 (95% CI: 0.27-0.57) were moderate. Heterogeneity was low (I 2 = 6%). When compared to active control, the effect decreased to g = 0.13 (95% CI: -0.18-0.43). No RCT reported on safety, only two studies reported on academic achievement, most studies had a high risk of bias. Conclusions: Most studies were of poor quality and results should be interpreted with caution. Overall moderate effects were found which decreased substantially when interventions were compared to active control. It is unclear whether meditation, yoga or mindfulness affect academic achievement or affect have any negative side effects.
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Affiliation(s)
- Josefien J F Breedvelt
- Department of Psychiatry, Academic Medical Center, Amsterdam University Medical Center, Amsterdam, Netherlands.,Research Department, Mental Health Foundation, London, United Kingdom
| | - Yagmur Amanvermez
- Department of Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Mathias Harrer
- Department of Psychology, Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Eirini Karyotaki
- Department of Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Simon Gilbody
- Mental Health and Addictions Research Group, Department of Health Sciences, University of York, York, United Kingdom
| | - Claudi L H Bockting
- Department of Psychiatry, Academic Medical Center, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - David D Ebert
- Department of Psychology, Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
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27
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Danilewitz M, Koszycki D, Maclean H, Sanchez-Campos M, Gonsalves C, Archibald D, Bradwejn J. Feasibility and effectiveness of an online mindfulness meditation program for medical students. CANADIAN MEDICAL EDUCATION JOURNAL 2018; 9:e15-e25. [PMID: 30498540 PMCID: PMC6260511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND The need to incorporate tools to promote medical student wellness in medical education is underscored by the concerning rates of psychological distress among them. The objective of this prospective cohort study was to obtain preliminary data on the feasibility and effectiveness of an online mindfulness intervention for medical student wellness. METHODS A convenience sample of 52 medical students consented to participate in this study. Feasibility was assessed by ease of recruitment, number of modules completed, satisfaction with the program, and adherence to a regular meditation practice. Participants completed the Maslach Burnout Inventory, the Jefferson Scale of Empathy-medical student version, the Five Face of Mindfulness Questionnaire-short form, and the Self Compassion Scale-short form pre and post intervention. RESULTS The convenience sample was recruited within a two-month period. Forty-five participants completed at least one of seven modules. Descriptive statistics (mean±standard deviation) revealed that the mean number of modules completed was 4.85±2.7. Mean satisfaction with the modules was 7.07±1.1 out of 10. Adherence to a regular formal meditation practice was poor; the average amount of formal meditation practice per module was 34.14±27.44 minutes. Self-compassion and the "observe and describe" facets of mindfulness practice significantly statistically increased from baseline, but no such change was observed for levels of burnout and empathy. CONCLUSION The present study indicates that an online mindfulness meditation program may be of interest to medical students. The results did not provide any evidence that the program was effective but we believe further research and development is warranted.
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Affiliation(s)
| | - Diana Koszycki
- Univeristy of Ottawa, Ontario, Canada
- Institut du Savoir – l’Hôpital Montfort, Ontario, Canada
- University of Ottawa Brain and Mind Research Institute, Ontario, Canada
| | - Heather Maclean
- Univeristy of Ottawa, Ontario, Canada
- The Ottawa Hospital, Ontario, Canada
| | | | - Carol Gonsalves
- Univeristy of Ottawa, Ontario, Canada
- The Ottawa Hospital, Ontario, Canada
| | - Douglas Archibald
- Univeristy of Ottawa, Ontario, Canada
- Bruyère Research Institute, Ontario, Canada
| | - Jacques Bradwejn
- Univeristy of Ottawa, Ontario, Canada
- Institut du Savoir – l’Hôpital Montfort, Ontario, Canada
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28
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Ma Y, She Z, Siu AFY, Zeng X, Liu X. Effectiveness of Online Mindfulness-Based Interventions on Psychological Distress and the Mediating Role of Emotion Regulation. Front Psychol 2018; 9:2090. [PMID: 30429816 PMCID: PMC6220599 DOI: 10.3389/fpsyg.2018.02090] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 10/10/2018] [Indexed: 11/13/2022] Open
Abstract
Online mindfulness-based intervention as a feasible and acceptable approach has received mounting attention in recent years, yet more evidence is needed to demonstrate its effectiveness. The primary objective of this study was to examine the effects of online mindfulness-based programs on psychological distress (depression and anxiety). The randomized controlled intervention design consisted of four conditions: group mindfulness-based intervention (GMBI), self-direct mindfulness-based intervention (SDMBI), discussion group (DG) and blank control group (BCG). The program lasted 8 weeks and a total of 76 participants completed the pre- and post-test. Results showed that participants in GMBI and SDMBI had significant pre- and post-test differences on mindfulness, emotion regulation difficulties, and psychological distress, with medium to large effect sizes. In addition, ANCOVA results indicated significant effects of group membership on post-test scores of mindfulness, depression and anxiety when controlling the pretest scores, with medium to large effect sizes. The GMBI appeared to exert the greatest effects on outcome variables in comparison with other groups. In addition, changes in emotion regulation difficulties across groups could mediate the relationship between changes in mindfulness dimensions (Observing and Describing) and changes in psychological distress across groups. These results provided encouraging evidence for the effectiveness of online mindfulness-based interventions in reducing psychological distress, and the possible mediating role of emotion regulation, while also underlining the importance of group discussion in online mindfulness-based interventions.
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Affiliation(s)
- Ying Ma
- School of Education, Shaanxi Normal University, Xi’an, China
| | - Zhaozhuo She
- Beijing Key Laboratory of Learning and Cognition, Capital Normal University, Beijing, China
| | | | - Xianglong Zeng
- Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Xinghua Liu
- Beijing Key Laboratory of Learning and Cognition, Capital Normal University, Beijing, China
- School of Psychological and Cognitive Sciences, Peking University, Beijing, China
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29
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Radovic A, Gmelin T, Hua J, Long C, Stein BD, Miller E. Supporting Our Valued Adolescents (SOVA), a Social Media Website for Adolescents with Depression and/or Anxiety: Technological Feasibility, Usability, and Acceptability Study. JMIR Ment Health 2018; 5:e17. [PMID: 29483067 PMCID: PMC5847821 DOI: 10.2196/mental.9441] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 01/08/2018] [Accepted: 01/08/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Supporting Our Valued Adolescents (SOVA), a social media website for adolescents, was designed to increase mental health literacy and address negative health beliefs toward depression and/or anxiety diagnosis and treatment. This stakeholder-informed site underwent iterative user testing to evolve into its current version with daily blog posts, round-the-clock site moderation, and Web-based peer interaction to create an online support community. OBJECTIVE The aim of this study was to evaluate the technological feasibility (at least 100 users on the site, logging in 12 to 18 times in the first 6 weeks) and acceptability of the SOVA site determined by the System Usability Scale (SUS). METHODS Adolescents and young adults (aged 14-26 years) with a self-reported history of depressive and/or anxiety symptoms were recruited to access the research website (sova.pitt.edu). Participants were screened out if they reported active suicidality or a prior suicide attempt. Baseline survey measures included demographics, symptomatology using the Patient Health Questionnaire-9 modified for adolescents (PHQ-9A) and Screen for Child Anxiety Related Disorders (SCARED-C), and mental health treatment history. The 6-week follow-up measures taken in addition to the symptomatology, included feasibility (total number of log-ins), usability, and acceptability of SOVA using SUS. RESULTS Most of the 96 participants identified as female (75% [72/96]) and white (67% [64/96]). Most participants (73% [70/96]) reported having taken prior professional psychological help. The average PHQ-9A score was 11.8 (SD 5.5), and for SCARED-C, 85% (80/94) of the participants reported a score consistent with being susceptible to a diagnosed anxiety disorder. There were 46% (41/90) of eligible users who ever logged in. Out of the total users who ever logged in, the mean of total log-ins over the entire study was 4.1 (SD 6.9). Median number of users rated the user-friendliness of the site as "good." The average SUS score was 71.2% (SD 18.7), or a "C-grade," which correlated to an acceptable range. The participants reported to have liked the "easy-to-understand format" and "positive, helpful atmosphere," but they also reported a desire for greater social interaction. Iterative recruitment resulted in incremental improvements to the site. CONCLUSIONS The SOVA site met feasibility goals of recruiting almost 100 users and establishing acceptable usability. Subsequent interventions are planned to increase site engagement and to evaluate efficacy in increasing uptake of primary care-recommended depression and/or anxiety treatment.
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Affiliation(s)
- Ana Radovic
- Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Theresa Gmelin
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jing Hua
- Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Cassandra Long
- Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Bradley D Stein
- Research and Development Corporation, Pittsburgh, PA, United States
| | - Elizabeth Miller
- Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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30
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Lee RA, Jung ME. Evaluation of an mHealth App (DeStressify) on University Students' Mental Health: Pilot Trial. JMIR Ment Health 2018; 5:e2. [PMID: 29362209 PMCID: PMC5801522 DOI: 10.2196/mental.8324] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 10/25/2017] [Accepted: 12/14/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND One in five Canadians experience mental health issues with those in the age range of 15 to 24 years being most at risk of a mood disorder. University students have shown significantly higher rates of mental health problems than the general public. Current university support services are limited by factors such as available staff and finances, and social stigma has frequently been identified as an additional barrier that prevents students from accessing these resources. Mobile health (mHealth) apps are one form of alternative health support that is discrete and accessible to students, and although they are recognized as a promising alternative, there is limited research demonstrating their efficacy. OBJECTIVE The aim of this study was to evaluate a mindfulness-based app's ("DeStressify") efficacy on stress, anxiety, depressive symptomology, sleep behavior, work or class absenteeism, work or school productivity, and quality of life (QoL) among university students. METHODS Full-time undergraduate students at a Canadian university with smartphones and Internet access were recruited through in-class announcements and on-campus posters. Participants randomized into an experimental condition were given and instructed to use the DeStressify app 5 days a week for 4 weeks. Control condition participants were wait-listed. All participants completed pre- and postintervention Web-based surveys to self-assess stress, anxiety, depressive symptomatology, sleep quality, and health-related QoL. RESULTS A total of 206 responses were collected at baseline, with 163 participants completing the study (86 control, 77 experimental). Using DeStressify was shown to reduce trait anxiety (P=.01) and improve general health (P=.001), energy (P=.01), and emotional well-being (P=.01) in university students, and more participants in the experimental condition believed their productivity improved between baseline and postintervention measurements than the number of participants expected to believe so randomly by chance (P=.01). The app did not significantly improve stress, state anxiety, physical and social functioning, and role limitations because of physical or emotional health problems or pain (P>.05). CONCLUSIONS Mindfulness-based apps may provide an effective alternative support for university students' mental health. Universities and other institutions may benefit from promoting the use of DeStressify or other mindfulness-based mHealth apps among students who are interested in methods of anxiety management or mindfulness-based self-driven health support. Future steps include examining DeStressify and similar mHealth apps over a longer period and in university staff and faculty.
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Affiliation(s)
- Rebecca Anne Lee
- Faculty of Health and Social Development, University of British Columbia, Kelowna, BC, Canada
| | - Mary Elizabeth Jung
- Faculty of Health and Social Development, University of British Columbia, Kelowna, BC, Canada
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Beiwinkel T, Eißing T, Telle NT, Siegmund-Schultze E, Rössler W. Effectiveness of a Web-Based Intervention in Reducing Depression and Sickness Absence: Randomized Controlled Trial. J Med Internet Res 2017; 19:e213. [PMID: 28619701 PMCID: PMC5491897 DOI: 10.2196/jmir.6546] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 01/20/2017] [Accepted: 03/27/2017] [Indexed: 12/21/2022] Open
Abstract
Background Depression is highly prevalent in the working population and is associated with significant loss of workdays; however, access to evidence-based treatment is limited. Objective This study evaluated the effectiveness of a Web-based intervention in reducing mild to moderate depression and sickness absence. Methods In an open-label randomized controlled trial, participants were recruited from a large-scale statutory health insurance and were assigned to two groups. The intervention group had access to a 12 week Web-based program consisting of structured interactive sessions and therapist support upon request. The wait-list control group had access to unguided Web-based psycho-education. Depressive symptoms were self-assessed at baseline, post-treatment, and follow-up (12 weeks after treatment) using the Patient Health Questionnaire (PHQ-9) and Beck Depression Inventory (BDI-II) as primary outcome measures. Data on sickness absence was retrieved from health insurance records. Intention-to-treat (ITT) analysis and per-protocol (PP) analysis were performed. Results Of the 180 participants who were randomized, 88 completed the post-assessment (retention rate: 48.8%, 88/180). ITT analysis showed a significant between-group difference in depressive symptoms during post-treatment in favor of the intervention group, corresponding to a moderate effect size (PHQ-9: d=0.55, 95% CI 0.25-0.85, P<.001, and BDI-II: d=0.41, CI 0.11-0.70, P=.004). PP analysis partially supported this result, but showed a non-significant effect on one primary outcome (PHQ-9: d=0.61, 95% CI 0.15-1.07, P=.04, and BDI-II: d=0.25 95% CI −0.18 to 0.65, P=.37). Analysis of clinical significance using reliable change index revealed that significantly more participants who used the Web-based intervention (63%, 63/100) responded to the treatment versus the control group (33%, 27/80; P<.001). The number needed to treat (NNT) was 4.08. Within both groups, there was a reduction in work absence frequency (IG: −67.23%, P<.001, CG: −82.61%, P<.001), but no statistical difference in sickness absence between groups was found (P=.07). Conclusions The Web-based intervention was effective in reducing depressive symptoms among adults with sickness absence. As this trial achieved a lower power than calculated, its results should be replicated in a larger sample. Further validation of health insurance records as an outcome measure for eHealth trials is needed. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 02446836; http://www.isrctn.com/ISRCTN02446836 (Archived by WebCite at http://www.webcitation.org/6jx4SObnw)
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Affiliation(s)
- Till Beiwinkel
- Innovation Incubator, Competence Tandem Integrated Care, Leuphana University of Lüneburg, Lüneburg, Germany
| | - Tabea Eißing
- Innovation Incubator, Competence Tandem Integrated Care, Leuphana University of Lüneburg, Lüneburg, Germany
| | - Nils-Torge Telle
- Innovation Incubator, Competence Tandem Integrated Care, Leuphana University of Lüneburg, Lüneburg, Germany
| | | | - Wulf Rössler
- Innovation Incubator, Competence Tandem Integrated Care, Leuphana University of Lüneburg, Lüneburg, Germany.,Institute of Psychiatry, Laboratory of Neuroscience (LIM 27), University of Sao Paulo, Sao Paulo, Brazil.,Psychiatric University Hospital, Zürich University, Zürich, Switzerland.,Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
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