Accepted for/Published in: JMIR Mental Health
Date Submitted: Aug 28, 2020
Date Accepted: Oct 26, 2020
Awareness, Connection, and Insight: Testing a Multi-Component, Self-Guided, Smartphone-Based Meditation App in a Three-Armed Randomized Controlled Trial
ABSTRACT
Background:
A growing number of randomized controlled trials (RCTs) suggest psychological benefits associated with meditation training delivered via mobile health. However, research in this area has primarily focused on mindfulness, only one of many meditative techniques.
Objective:
This study evaluated the efficacy of two versions of a self-guided, smartphone-based meditation app – the Healthy Minds Program (HMP) – that includes training in mindfulness along with practices designed to cultivate positive relationships (connection) or insight into the nature of self (insight).
Methods:
A three-arm, fully remote RCT compared eight weeks of each of two HMP conditions to a waitlist control. Adults (≥18 years) without extensive previous meditation experience were eligible. The primary outcome was psychological distress (depression, anxiety, stress). Secondary outcomes were social connection, empathy, compassion, self-reflection, insight, rumination, defusion, and mindfulness. Measures were completed at pre-test, mid-treatment, and post-test between October 2019 and April 2020. Longitudinal data were analyzed using intention-to-treat principles with maximum likelihood.
Results:
343 participants were randomized and 186 (54.2%) completed mid-treatment and/or post-test assessments. The majority (72.8%) of those assigned to HMP conditions downloaded the app. The two HMP conditions did not differ from one another in change on any outcomes. Relative to waitlist, the HMP conditions showed larger improvements in distress, social connectedness, mindfulness, and measures theoretically linked to insight training (ds=-0.28 to 0.41), despite very modest exposure to connection- and insight-related practice. Results were robust to some assumptions about non-random patterns of missing data. Improvements on distress was associated with days of use. Candidate mediators and moderators of changes in distress were identified.
Conclusions:
This study provides initial evidence of efficacy for the HMP app in reducing distress and improving outcomes related to well-being, including social connectedness. Future studies should make efforts to increase study retention and user engagement. Clinical Trial: ClinicalTrials.gov NCT04139005
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