Effects of Mobile App-Based Mindfulness Practice on Healthcare Workers: a Randomized Active Controlled Trial

Shian-Ling Keng, Joseph Wei Ern Chin, Maleyka Mammadova, Irene Teo, Shian-Ling Keng, Joseph Wei Ern Chin, Maleyka Mammadova, Irene Teo

Abstract

Objectives: Amidst the COVID-19 pandemic, healthcare workers (HCWs) may be at greater risk of suffering from psychological distress compared to the general population. This study aimed to investigate the effects of mindfulness practice as delivered using Headspace on psychological and cognitive outcomes among HCWs in Singapore.

Methods: A total of 80 HCWs were recruited and randomly assigned to engage in either 3 weeks (10 min/day) of mindfulness practice using Headspace or an active control condition (Lumosity; involving playing cognitive games). Participants were administered several self-report measures and two working memory (digit span) tasks at pre- and post-intervention, and one-month follow-up.

Results: There were no significant between-condition changes on any outcome variables from pre- to post-intervention. From pre-intervention to 1-month follow-up, there were significantly greater improvements among Headspace participants on fear of COVID-19 (p = .005), compassion satisfaction (p = .007), trait mindfulness (p = .002), self-compassion (p = .005), sleep quality (p = .002), and the forward digit span task (p < .001). Several outcomes were mediated by increases in trait mindfulness or self-compassion.

Conclusions: Use of Headspace may lead to downstream benefits in reducing distress and improving psychological health outcomes among HCWs. The findings have implications for improving psychological support resources for HCWs amidst a pandemic.

Trial registration: ClinicalTrials.gov (Identifier: NCT04936893).

Keywords: COVID-19; Healthcare workers; Mindfulness; Mobile app interventions; Psychological health.

Conflict of interest statement

Conflicts of InterestThe authors declare no conflicts of interest.

© The Author(s) 2022.

Figures

Fig. 1
Fig. 1
Study procedure

References

    1. Ahorsu DK, Lin CY, Imani V, Saffari M, Griffiths MD, Pakpour AH. The fear of COVID-19 scale: Development and initial validation. International Journal of Mental Health and Addiction. 2022;20:1537–1545. doi: 10.1007/s11469-020-00270-8.
    1. Baer RA. Self-compassion as a mechanism of change in mindfulness- and acceptance-based treatments. In: Baer RA, editor. Assessing mindfulness and acceptance processes in clients: Illuminating the theory and practice of change. Context Press; 2010. pp. 135–153.
    1. Baer RA, Smith GT, Hopkins J, Krietemeyer J, Toney L. Using self-report assessment methods to explore facets of mindfulness. Assessment. 2006;13(1):27–45. doi: 10.1177/1073191105283504.
    1. Bergen-Cico D, Possemato K, Cheon S. Examining the efficacy of a brief mindfulness-based stress reduction (brief MBSR) program on psychological health. Journal of American College Health. 2013;61(6):348–360. doi: 10.1080/07448481.2013.813853.
    1. Blanchard EB, Jones-Alexander J, Buckley TC, Forneris CA. Psychometric properties of the PTSD Checklist (PCL) Behaviour Research and Therapy. 1996;34(8):669–673. doi: 10.1016/0005-7967(96)00033-2.
    1. Blanck P, Perleth S, Heidenreich T, Kröger P, Ditzen B, Bents H, Mander J. Effects of mindfulness exercises as stand-alone intervention on symptoms of anxiety and depression: Systematic review and meta-analysis. Behaviour Research and Therapy. 2018;102:25–35. doi: 10.1016/j.brat.2017.12.002.
    1. Brand N, Hanson E, Godaert G. Chronic stress affects blood pressure and speed of short-term memory. Perceptual and Motor Skills. 2000;91(1):291–298. doi: 10.2466/pms.2000.91.1.291.
    1. Braun SE, Kinser PA, Rybarczyk B. Can mindfulness in health care professionals improve patient care? An integrative review and proposed model. Translational Behavioral Medicine. 2019;9(2):187–201. doi: 10.1093/tbm/iby059.
    1. Britton WB. Can mindfulness be too much of a good thing? The value of a middle way. Current Opinion in Psychology. 2019;28:159–165. doi: 10.1016/j.copsyc.2018.12.011.
    1. Buysse DJ, Reynolds CF, III, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Research. 1989;28(2):193–213. doi: 10.1016/0165-1781(89)90047-4.
    1. Cai H, Tu B, Ma J, Chen L, Fu L, Jiang Y, Zhuang Q. Psychological impact and coping strategies of frontline medical staff in Hunan Between January and March 2020 During the Outbreak of Coronavirus Disease 2019 (COVID-19) in Hubei, China. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research. 2020;26:e924171–1. doi: 10.12659/MSM.924171.
    1. Carmassi C, Foghi C, Dell'Oste V, Cordone A, Bertelloni CA, Bui E, Dell'Osso L. PTSD symptoms in healthcare workers facing the three coronavirus outbreaks: What can we expect after the COVID-19 pandemic. Psychiatry Research. 2020;292:113312. doi: 10.1016/j.psychres.2020.113312.
    1. Ceravolo D, Raines DA. The impact of a mindfulness intervention for nurse managers. Journal of Holistic Nursing. 2019;37(1):47–55. doi: 10.1177/0898010118781620.
    1. Chambers R, Lo BCY, Allen NB. The impact of intensive mindfulness training on attentional control, cognitive style, and affect. Cognitive Therapy and Research. 2008;32(3):303–322. doi: 10.1007/s10608-007-9119-0.
    1. Del Campo MT, Romo PE, de la Hoz RE, Villamor JM, Mahíllo-Fernández I. Anxiety and depression predict musculoskeletal disorders in health care workers. Archives of Environmental & Occupational Health. 2017;72(1):39–44. doi: 10.1080/19338244.2016.1154002.
    1. Del Re AC, Flückiger C, Goldberg SB, Hoyt WT. Monitoring mindfulness practice quality: An important consideration in mindfulness practice. Psychotherapy Research. 2013;23(1):54–66. doi: 10.1080/10503307.2012.729275.
    1. Di Muzio M, Diella G, Di Simone E, Novelli L, Alfonsi V, Scarpelli S, Annarumma L, Salfi F, Pazzaglia M, Gianini AM, De Gennaro L. Nurses and Night Shifts: Poor sleep quality exacerbates psychomotor performance. Frontiers in Neuroscience. 2020;14:1050. doi: 10.3389/fnins.2020.579938.
    1. Dobkin PL, Irving JA, Amar S. For whom may participation in a mindfulness-based stress reduction program be contraindicated? Mindfulness. 2012;3(1):44–50. doi: 10.1007/s12671-011-0079-9.
    1. Duarte J, Pinto-Gouveia J. Mindfulness, self-compassion and psychological inflexibility mediate the effects of a mindfulness-based intervention in a sample of oncology nurses. Journal of Contextual Behavioral Science. 2017;6(2):125–133. doi: 10.1016/j.jcbs.2017.03.002.
    1. Duchemin A-M, Steinberg BA, Marks DR, Vanover K, Klatt M. A Small randomized pilot study of a workplace mindfulness-based intervention for surgical intensive care unit personnel: Effects on salivary α-amylase levels. Journal of Occupational and Environmental Medicine. 2015;57(4):393–399. doi: 10.1097/jom.0000000000000371.
    1. Ferini-Strambi L, Zucconi M, Casoni F, Salsone M. COVID-19 and sleep in medical staff: Reflections, clinical evidences, and perspectives. Current Treatment Options in Neurology. 2020;22(10):1–6. doi: 10.1007/s11940-020-00642-4.
    1. Fissler M, Winnebeck E, Schroeter T, Gummersbach M, Huntenburg JM, Gaertner M, Barnhofer T. An investigation of the effects of brief mindfulness training on self-reported interoceptive awareness, the ability to decenter, and their role in the reduction of depressive symptoms. Mindfulness. 2016;7(5):1170–1181. doi: 10.1007/s12671-016-0559-z.
    1. Fortney L, Luchterhand C, Zakletskaia L, Zgierska A, Rakel D. Abbreviated mindfulness intervention for job satisfaction, quality of life, and compassion in primary care clinicians: A pilot study. Annals of Family Medicine. 2013;11(5):412–420. doi: 10.1370/afm.1511.
    1. Foureur M, Besley K, Burton G, Yu N, Crisp J. Enhancing the resilience of nurses and midwives: Pilot of a mindfulness-based program for increased health, sense of coherence and decreased depression, anxiety and stress. Contemporary Nurse. 2013;45(1):114–125. doi: 10.5172/conu.2013.45.1.114.
    1. Goldberg SB, Del Re AC, Hoyt WT, Davis JM. The secret ingredient in mindfulness interventions? A case for practice quality over quantity. Journal of Counseling Psychology. 2014;61(3):491–497. doi: 10.1037/cou0000032.
    1. Goodman MJ, Schorling JB. A mindfulness course decreases burnout and improves well-being among healthcare providers. The International Journal of Psychiatry in Medicine. 2012;43(2):119–128. doi: 10.2190/PM.43.2.b.
    1. Hayes, A. F. (2017). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. Guilford Publications.
    1. Heeren A, Philippot P. Changes in ruminative thinking mediate the clinical benefits of mindfulness: Preliminary findings. Mindfulness. 2011;2(1):8–13. doi: 10.1007/s12671-010-0037-y.
    1. Henry JD, Crawford JR. The short-form version of the Depression Anxiety Stress Scales (DASS-21): Construct validity and normative data in a large non-clinical sample. British Journal of Clinical Psychology. 2005;44(2):227–239. doi: 10.1348/014466505X29657.
    1. Hevezi JA. Evaluation of a meditation intervention to reduce the effects of stressors associated with compassion fatigue among nurses. Journal of Holistic Nursing. 2016;34(4):343–350. doi: 10.1177/0898010115615981.
    1. Hooper C, Craig J, Janvrin DR, Wetsel MA, Reimels E. Compassion satisfaction, burnout, and compassion fatigue among emergency nurses compared with nurses in other selected inpatient specialties. Journal of Emergency Nursing. 2010;36(5):420–427. doi: 10.1016/j.jen.2009.11.027.
    1. Hotchkiss JT, Lesher R. Factors predicting burnout among chaplains: Compassion satisfaction, organizational factors, and the mediators of mindful self-care and secondary traumatic stress. Journal of Pastoral Care & Counseling. 2018;72(2):86–98. doi: 10.1177/1542305018780655.
    1. International Wellbeing Group (2013). Personal Wellbeing Index: 5th Edition.
    1. Kabat-Zinn J. Full catastrophe living. Random House; 1990.
    1. Kabat-Zinn J. Mindfulness-based interventions in context: Past, present, and future. Clinical Psychology: Science and Practice. 2003;10(2):144–156. doi: 10.1093/clipsy.bpg016.
    1. Kase SM, Gribben JL, Guttmann KF, Waldman ED, Weintraub AS. Compassion fatigue, burnout, and compassion satisfaction in pediatric subspecialists during the SARS-CoV-2 pandemic. Pediatric Research. 2022;91:143–148. doi: 10.1038/s41390-021-01635-y.
    1. Kemper KJ, Mo X, Khayat R. Are mindfulness and self-compassion associated with sleep and resilience in health professionals? Journal of Alternative and Complementary Medicine. 2015;21(8):496–503. doi: 10.1089/acm.2014.0281.
    1. Keng SL, Smoski MJ, Robins CJ. Effects of mindfulness on psychological health: A review of empirical studies. Clinical Psychology Review. 2011;31(6):1041–1056. doi: 10.1016/j.cpr.2011.04.006.
    1. Keng SL, Smoski MJ, Robins CJ, Ekblad AG, Brantley JG. Mechanisms of change in mindfulness-based stress reduction: Self-compassion and mindfulness as mediators of intervention outcomes. Journal of Cognitive Psychotherapy. 2012;26(3):270–280. doi: 10.1891/0889-8391.26.3.270.
    1. Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, Wu J, Du H, Chen T, Li R, Tan H, Kang L, Yao L, Huang M, Wang H, Wang G, Liu Z, Hu S. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Network Open. 2020;3(3):e203976–e203976. doi: 10.1001/jamanetworkopen.2020.3976.
    1. Lau ALD, Cummins RA, Mcpherson W. An investigation into the cross-cultural equivalence of the personal wellbeing index. Social Indicators Research. 2005;72:403–430. doi: 10.1007/s11205-004-0561-z.
    1. Liang Y, Chen M, Zheng X, Liu J. Screening for Chinese medical staff mental health by SDS and SAS during the outbreak of COVID-19. Journal of Psychosomatic Research. 2020;133:110102. doi: 10.1016/j.jpsychores.2020.110102.
    1. Liu K, Yin T, Shen Q. Relationships between sleep quality, mindfulness and work-family conflict in Chinese nurses: A cross-sectional study. Applied Nursing Research. 2020;55:151250. doi: 10.1016/j.apnr.2020.151250.
    1. Lovibond SH, Lovibond PF. Manual for the depression anxiety stress scales. Psychology Foundation; 1995.
    1. Luken, M., & Sammons, A. (2016). Systematic review of mindfulness practice for reducing job burnout. American Journal of Occupational Therapy, 70(2), 7002250020p1–7002250020p10. 10.5014/ajot.2016.016956
    1. Maharaj S, Lees T, Lal S. Negative mental states and their association to the cognitive function of nurses. Journal of Psychophysiology. 2019;33:207–218. doi: 10.1027/0269-8803/a000223.
    1. Mani M, Kavanagh DJ, Hides L, Stoyanov SR. Review and evaluation of mindfulness-based iPhone apps. JMIR mHealth and uHealth. 2015;3(3):e82. doi: 10.2196/mhealth.4328.
    1. McLaughlin KA, Nolen-Hoeksema S. Rumination as a transdiagnostic factor in depression and anxiety. Behaviour Research and Therapy. 2011;49(3):186–193. doi: 10.1016/j.brat.2010.12.006.
    1. Neff KD. The development and validation of a scale to measure self-compassion. Self and Identity. 2003;2(3):223–250. doi: 10.1080/15298860309027.
    1. Ng, K. Y. Y., Zhou, S., Tan, S. H., Ishak, N. D. B., Goh, Z. Z. S., Chua, Z. Y., Chia, J. M. X., Chew, E. L., Shwe, T., Mok, J. K. Y., Leong, S. S., Lo, J. S. Y., Ang, Z. L. T., Leow, J. L., Lam, C. W. J., Kwek, J. W., Dent, R., Tuan, J., Lim, S. T., Hwang, W. Y. K., … Ngeow, J. (2020). Understanding the psychological impact of COVID-19 pandemic on patients with cancer, their caregivers, and health care workers in Singapore. JCO Global Oncology, 6, 1494–1509. 10.1200/go.20.00374
    1. Orosa-Duarte Á, Mediavilla R, Muñoz-Sanjose A, Palao Á, Garde J, López-Herrero V, Bravo-Ortiz M-F, 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(6):686–693. doi: 10.1080/0142159X.2021.1887835.
    1. Pappa S, Ntella V, Giannakas T, Giannakoulis VG, Papoutsi E, Katsaounou P. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain, Behavior, and Immunity. 2020;88:901–907. doi: 10.1016/j.bbi.2020.05.026.
    1. Pearson (2021). Telepractice and the WAIS-IV.
    1. Plaza I, Demarzo MMP, Herrera-Mercadal P, García-Campayo J. Mindfulness-based mobile applications: Literature review and analysis of current features. JMIR mHealth and uHealth. 2013;1(2):e24. doi: 10.2196/mhealth.2733.
    1. Richards, D., & Martin, W. (2012). The effects of a brief mindfulness intervention on self-compassion among undergraduate college students [Paper presentation]. American Counseling Association Conference, San Francisco, CA, USA.
    1. Sauer S, Baer RA. Mindfulness and decentering as mechanisms of change in mindfulness-and acceptance-based interventions. In: Baer RA, editor. Assessing mindfulness and acceptance processes in clients: Illuminating the theory and practice of change. Context Press; 2010. pp. 25–50.
    1. Shapiro SL, Astin JA, Bishop SR, Cordova M. Mindfulness-based stress reduction for health care professionals: Results from a randomized trial. International Journal of Stress Management. 2005;12(2):164–176. doi: 10.1037/1072-5245.12.2.164.
    1. Shechter, A., Diaz, F., Moise, N., Anstey, D. E., Ye, S., Agarwal, S., Birk, J., Brodie, D., Cannone, D., Chang, B., Claassen, J., Cornelius, T., Derby, L., Dong, M., Givens, R. C., Hochman, B., Homma, S., Kronish, I. M., Lee, S., Manzano, W., … Abdallaa, M. (2020). Psychological distress, coping behaviors, and preferences for support among New York healthcare workers during the COVID-19 pandemic. General Hospital Psychiatry, 66, 1–8. 10.1016/j.genhosppsych.2020.06.007
    1. Slonim J, Kienhuis M, Di Benedetto M, Reece J. The relationships among self-care, dispositional mindfulness, and psychological distress in medical students. Medical Education Online. 2015;20(1):27924. doi: 10.3402/meo.v20.27924.
    1. Spijkerman MPJ, Pots WTM, Bohlmeijer ET. Effectiveness of online mindfulness-based interventions in improving mental health: A review and meta-analysis of randomised controlled trials. Clinical Psychology Review. 2016;45:102–114. doi: 10.1016/j.cpr.2016.03.009.
    1. Spinhoven P, Drost J, de Rooij M, van Hemert AM, Penninx BW. A longitudinal study of experiential avoidance in emotional disorders. Behavior Therapy. 2014;45(6):840–850. doi: 10.1016/j.beth.2014.07.001.
    1. Stamm, B. H. (2010). The concise ProQOL manual.
    1. Tempesta D, Cipolli C, Desideri G, De Gennaro L, Ferrara M. Can taking a nap during a night shift counteract the impairment of executive skills in residents? Medical Education. 2013;47(10):1013–1021. doi: 10.1111/medu.12256.
    1. Vinstrup J, Jakobsen MD, Andersen LL. Poor sleep is a risk factor for low-back pain among healthcare workers: Prospective cohort study. International Journal of Environmental Research and Public Health. 2020;17(3):996. doi: 10.3390/ijerph17030996.
    1. Wasson RS, Barratt C, O’Brien WH. Effects of mindfulness-based interventions on self-compassion in health care professionals: A meta-analysis. Mindfulness. 2020;11(8):1914–1934. doi: 10.1007/s12671-020-01342-5.
    1. Weathers, F. W., Litz, B. T., Herman, D. S., Huska, J. A. & Keane, T. M. (1993). The PTSD checklist: reliability, validity, and diagnostic utility. Paper presented at the Annual Meeting of the International Society for Traumatic Stress Studies, San Antonio, TX, USA.
    1. Wechsler, D. (2008). Wechsler Adult Intelligence Scale—Fourth Edition Administration and Scoring Manual. Pearson.
    1. Wen L, Sweeney TE, Welton L, Trockel M, Katznelson L. Encouraging mindfulness in medical house staff via smartphone app: A pilot study. Academic Psychiatry. 2017;41(5):646–650. doi: 10.1007/s40596-0170768-3.
    1. Winbush NY, Gross CR, Kreitzer MJ. The effects of mindfulness-based stress reduction on sleep disturbance: A systematic review. Explore. 2007;3(6):585–591. doi: 10.1016/j.explore.2007.08.003.
    1. Wylde CM, Mahrer NE, Meyer RM, Gold JI. Mindfulness for novice pediatric nurses: Smartphone application versus traditional intervention. Journal of Pediatric Nursing. 2017;36:205–212. doi: 10.1016/j.pedn.2017.06.008.
    1. Yang E, Schamber E, Meyer RM, Gold JI. Happier healers: Randomized controlled trial of mobile mindfulness for stress management. The Journal of Alternative and Complementary Medicine. 2018;24(5):505–513. doi: 10.1089/acm.2015.0301.
    1. Zeidan F, Johnson SK, Diamond BJ, David Z, Goolkasian P. Mindfulness meditation improves cognition: Evidence of brief mental training. Consciousness and Cognition. 2010;19(2):597–605. doi: 10.1016/j.concog.2010.03.014.
    1. Zollars I, Poirier TI, Pailden J. Effects of mindfulness meditation on mindfulness, mental well-being, and perceived stress. Currents in Pharmacy Teaching and Learning. 2019;11(10):1022–1028. doi: 10.1016/j.cptl.2019.06.005.

Source: PubMed

3
Subscribe