Efficacy and Moderation of Mobile App-Based Programs for Mindfulness-Based Training, Self-Compassion Training, and Cognitive Behavioral Psychoeducation on Mental Health: Randomized Controlled Noninferiority Trial

Winnie Ws Mak, Alan Cy Tong, Sindy Yc Yip, Wacy Ws Lui, Floria Hn Chio, Amy Ty Chan, Celia Cy Wong, Winnie Ws Mak, Alan Cy Tong, Sindy Yc Yip, Wacy Ws Lui, Floria Hn Chio, Amy Ty Chan, Celia Cy Wong

Abstract

Background: Mindfulness-based interventions, self-compassion training, and cognitive behavioral therapy have garnered much evidence in its salutary effects on mental health. With increasing application of smartphone and mobile technology on health promotion, this study investigated the efficacy and possible moderators of mindfulness, self-compassion, and cognitive behavioral psychoeducation training mobile apps in the improvement of mental health.

Objective: The aim of this study was to examine the efficacy of 3 mobile app-based programs: mindfulness-based program, self-compassion program, and cognitive behavioral psychoeducation program in improving mental well-being and reducing psychological distress. Changes in mindful awareness and self-compassion were also assessed. To further delineate the suitability of each program for different types of individuals, individual difference variables (ie, discomfort with emotions and tolerance for ambiguity) were explored for potential moderation.

Methods: This study was a 3-arm, randomized, controlled, noninferiority trial examining the efficacy of mindfulness-based program, self-compassion program, and cognitive behavioral psychoeducation. Participants were randomized into either 1 of the 3 conditions. Throughout the 4-week, 28-session program, participants spent 10-15 min daily reviewing the course content and practicing various related exercises. At preprogram, postprogram, and 3-month follow-up, participants also completed Web-based measures of mental well-being, psychological distress, mindful-awareness, and self-compassion as well as the proposed moderators.

Results: Among the 2161 study participants, 508 and 349 completed the post- and 3-month follow-up assessment, respectively. All 3 conditions (mindfulness-based program: N=703; cognitive behavioral psychoeducation: N=753; self-compassion program: N=705) were found to be efficacious in improving mental well-being and reducing psychological distress. All conditions enhanced mindful awareness at postprogram. Significant interaction effect was found on self-compassion; cognitive behavioral psychoeducation and self-compassion program, but not mindfulness-based program, significantly enhanced self-compassion at postprogram. No significant differences regarding usage and users' satisfaction were found among the 3 conditions. None of the proposed moderators were found to be significant.

Conclusions: Mindfulness-based, self-compassion, and cognitive behavioral psychoeducation mobile apps were efficacious in improving mental well-being and reducing psychological distress among adults at postprogram and 3-month follow-up. Future app-based psychological training programs should consider gamification and personalization of content or feedback to enhance engagement and mitigate the high attrition rates that are common in app-based health promotion programs.

Trial registration: Chinese Clinical Trial Registry (ChiCTR) ChiCTR-TRC-13003468; http://www.chictr.org.cn/hvshowproject.aspx?id=6220 (Archived by WebCite at http://www.webcitation.org/734PlOz50).

Keywords: compassion; mental health; mindfulness; mobile apps.

Conflict of interest statement

Conflicts of Interest: The first author of the study, WWSM, is one of the developers of the content of the trials. The developer of the mobile app and website was Red Soldier Limited.

©Winnie WS Mak, Alan CY Tong, Sindy YC Yip, Wacy WS Lui, Floria HN Chio, Amy TY Chan, Celia CY Wong. Originally published in JMIR Mental Health (http://mental.jmir.org), 11.10.2018.

Figures

Figure 1
Figure 1
CONSORT flowchart of participants in our study. MBP: mindfulness-based program; SCP: self-compassion program; CBP: cognitive behavioral psychoeducation program.
Figure 2
Figure 2
Number of participants using the programs each week. MBP: mindfulness-based program; SCP: self-compassion program ; CBP: cognitive behavioral psychoeducation program.

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