Testing the Efficacy of a Multicomponent, Self-Guided, Smartphone-Based Meditation App: Three-Armed Randomized Controlled Trial

Simon B Goldberg, Theodore Imhoff-Smith, Daniel M Bolt, Christine D Wilson-Mendenhall, Cortland J Dahl, Richard J Davidson, Melissa A Rosenkranz, Simon B Goldberg, Theodore Imhoff-Smith, Daniel M Bolt, Christine D Wilson-Mendenhall, Cortland J Dahl, Richard J Davidson, Melissa A Rosenkranz

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 aims to evaluate the efficacy of 2 versions of a self-guided, smartphone-based meditation app-the Healthy Minds Program (HMP)-which includes training in mindfulness (Awareness), along with practices designed to cultivate positive relationships (Connection) or insight into the nature of the self (Insight).

Methods: A three-arm, fully remote RCT compared 8 weeks of one of 2 HMP conditions (Awareness+Connection and Awareness+Insight) with a waitlist control. Adults (≥18 years) without extensive previous meditation experience were eligible. The primary outcome was psychological distress (depression, anxiety, and stress). Secondary outcomes were social connection, empathy, compassion, self-reflection, insight, rumination, defusion, and mindfulness. Measures were completed at pretest, midtreatment, and posttest between October 2019 and April 2020. Longitudinal data were analyzed using intention-to-treat principles with maximum likelihood.

Results: A total of 343 participants were randomized and 186 (54.2%) completed at least one posttest assessment. The majority (166/228, 72.8%) of those assigned to HMP conditions downloaded the app. The 2 HMP conditions did not differ from one another in terms of changes in any outcome. Relative to the waitlist control, the HMP conditions showed larger improvements in distress, social connectedness, mindfulness, and measures theoretically linked to insight training (d=-0.28 to 0.41; Ps≤.02), despite modest exposure to connection- and insight-related practice. The results were robust to some assumptions about nonrandom patterns of missing data. Improvements in distress were associated with days of use. Candidate mediators (social connection, insight, rumination, defusion, and mindfulness) and moderators (baseline rumination, defusion, and empathy) 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 attempt to increase study retention and user engagement.

Trial registration: ClinicalTrials.gov NCT04139005; https://ichgcp.net/clinical-trials-registry/NCT04139005.

Keywords: compassion; loneliness; meditation; mindfulness; mobile health; mobile phone; randomized controlled trial.

Conflict of interest statement

Conflicts of Interest: RD is the founder, president, and serves on the board of directors for the nonprofit organization, Healthy Minds Innovations, Inc. CD is Chief Contemplative Officer for Healthy Minds Innovations, Inc. CW has served as a paid consultant and content contributor for Healthy Minds Innovations, Inc.

©Simon B Goldberg, Theodore Imhoff-Smith, Daniel M Bolt, Christine D Wilson-Mendenhall, Cortland J Dahl, Richard J Davidson, Melissa A Rosenkranz. Originally published in JMIR Mental Health (http://mental.jmir.org), 27.11.2020.

Figures

Figure 1
Figure 1
CONSORT (Consolidated Standards of Reporting Trials) diagram. Mid=week 4 assessment; Post=week 8 assessment.
Figure 2
Figure 2
Longitudinal changes in psychological distress, social connectedness, defusion, and mindfulness by group. The figure displays observed means and SEs (error bars=1 SE) based on all available data (n=343). CO: Awareness+Connection; IN: Awareness+Insight; WL: waitlist.
Figure 3
Figure 3
Healthy Minds Program app usage predicting longitudinal changes in psychological distress, defusion, insight, and mindfulness in active conditions (FDR-corrected Ps≤.04). Usage=median split of days of use (n=228). HMP: Healthy Minds Program; WL: waitlist.

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