Using Personalized Anchors to Establish Routine Meditation Practice With a Mobile App: Randomized Controlled Trial

Chad Stecher, Mariah Sullivan, Jennifer Huberty, Chad Stecher, Mariah Sullivan, Jennifer Huberty

Abstract

Background: Physical and mental health benefits can be attained from persistent, long-term performance of mindfulness meditation with a mobile meditation app, but in general, few mobile health app users persistently engage at a level necessary to attain the corresponding health benefits. Anchoring or pairing meditation with a mobile app to an existing daily routine can establish an unconsciously initiated meditation routine that may improve meditation persistence.

Objective: The purpose of this study was to test the use of either personalized anchors or fixed anchors for establishing a persistent meditation app routine with the mobile app, Calm.

Methods: We conducted a randomized controlled trial and randomly assigned participants to one of 3 study groups: (1) a personalized anchor (PA) group, (2) fixed anchor (FA) group, or (3) control group that did not use the anchoring strategy. All participants received app-delivered reminder messages to meditate for at least 10 minutes a day using the Calm app for an 8-week intervention period, and app usage data continued to be collected for an additional 8-week follow-up period to measure meditation persistence. Baseline, week 8, and week 16 surveys were administered to assess demographics, socioeconomic status, and changes in self-reported habit strength.

Results: A total of 101 participants across the 3 study groups were included in the final analysis: (1) PA (n=56), (2) FA (n=49), and (3) control group (n=62). Participants were predominantly White (83/101, 82.2%), female (77/101, 76.2%), and college educated (ie, bachelor's or graduate degree; 82/101, 81.2%). The FA group had a significantly higher average odds of daily meditation during the intervention (1.14 odds ratio [OR]; 95% CI 1.02-1.33; P=.04), and all participants experienced a linear decline in their odds of daily meditation during the 8-week intervention (0.96 OR; 95% CI 0.95-0.96; P<.001). Importantly, the FA group showed a significantly smaller decline in the linear trend of their odds of daily meditation during the 8-week follow-up (their daily trend increased by 1.04 OR from their trend during the intervention; 95% CI 1.01-1.06; P=.03). Additionally, those who more frequently adhered to their anchoring strategy during the intervention typically used anchors that occurred in the morning and showed a significantly smaller decline in their odds of daily meditation during the 8-week follow-up period (1.13 OR; 95% CI 1.02-1.35; P=.007).

Conclusions: The FA group had more persistent meditation with the app, but participants in the FA or PA groups who more frequently adhered to their anchoring strategy during the intervention had the most persistent meditation routines, and almost all of these high anchorers used morning anchors. These findings suggest that the anchoring strategy can create persistent meditation routines with a mobile app. However, future studies should combine anchoring with additional intervention tools (eg, incentives) to help more participants successfully establish an anchored meditation routine.

Trial registration: ClinicalTrials.gov NCT04378530; https://ichgcp.net/clinical-trials-registry/NCT04378530.

Keywords: app engagement; behavioral persistence; habit formation; meditation; mental health; mindfulness; mobile meditation app; physical health; randomized controlled trial; routine.

Conflict of interest statement

Conflicts of Interest: CS and MS have no conflicts to declare. JH discloses that she receives an annual salary from Calm and holds stock within the company. However, her salary and equity are not dependent upon the results of her research.

©Chad Stecher, Mariah Sullivan, Jennifer Huberty. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 22.12.2021.

Figures

Figure 1
Figure 1
Study flow diagram of participant enrollment and randomization.
Figure 2
Figure 2
Daily percent of participants who performed any minutes of meditation.
Figure 3
Figure 3
Daily percent of participants in the high-meditation subgroup who performed any minutes of meditation.
Figure 4
Figure 4
Daily percent of participants who performed any minutes of anchored meditation.
Figure 5
Figure 5
Daily percent of participants who performed any minutes of meditation or any minutes of anchored meditations.
Figure 6
Figure 6
Average Self-Reported Behavioral Automaticity Index. SRBAI: Self-Reported Behavioral Automaticity Index.

References

    1. Tang Y, Hölzel Britta K, Posner MI. The neuroscience of mindfulness meditation. Nat Rev Neurosci. 2015 Apr;16(4):213–25. doi: 10.1038/nrn3916.nrn3916
    1. Tang Y, Rothbart MK, Posner MI. Neural correlates of establishing, maintaining, and switching brain states. Trends Cogn Sci. 2012 Jun;16(6):330–7. doi: 10.1016/j.tics.2012.05.001. S1364-6613(12)00107-6
    1. Huberty J, Green J, Glissmann C, Larkey L, Puzia M, Lee C. Efficacy of the mindfulness meditation mobile app “calm” to reduce stress among college students: randomized controlled trial. JMIR Mhealth Uhealth. 2019 Jun 25;7(6):e14273. doi: 10.2196/14273.
    1. Linardon J, Fuller-Tyszkiewicz M. Attrition and adherence in smartphone-delivered interventions for mental health problems: A systematic and meta-analytic review. J Consult Clin Psychol. 2020 Jan;88(1):1–13. doi: 10.1037/ccp0000459.2019-66487-001
    1. Athanas A, McCorrison J, Smalley S, Price J, Grady J, Wehner P, Campistron J, Schork Nj. Association between improvement in baseline mood and long-term use of a mindfulness and meditation app: observational study. JMIR Ment Health. 2019 May 08;6(5):e12617. doi: 10.2196/12617.
    1. Engen HG, Bernhardt BC, Skottnik L, Ricard M, Singer T. Structural changes in socio-affective networks: Multi-modal MRI findings in long-term meditation practitioners. Neuropsychologia. 2018 Jul 31;116(Pt A):26–33. doi: 10.1016/j.neuropsychologia.2017.08.024.S0028-3932(17)30318-4
    1. Lardone A, Liparoti M, Sorrentino P, Rucco R, Jacini F, Polverino A, Minino R, Pesoli M, Baselice F, Sorriso A, Ferraioli G, Sorrentino G, Mandolesi L. Mindfulness meditation is related to long-lasting changes in hippocampal functional topology during resting state: a magnetoencephalography study. Neural Plast. 2018;2018:5340717. doi: 10.1155/2018/5340717. doi: 10.1155/2018/5340717.
    1. Fredrickson BL, Boulton AJ, Firestine AM, Van Cappellen P, Algoe SB, Brantley MM, Kim SL, Brantley J, Salzberg S. Positive emotion correlates of meditation practice: a comparison of mindfulness meditation and loving-kindness meditation. Mindfulness (N Y) 2017 Dec;8(6):1623–1633. doi: 10.1007/s12671-017-0735-9.
    1. Adams ZW, Sieverdes JC, Brunner-Jackson B, Mueller M, Chandler J, Diaz V, Patel S, Sox LR, Wilder S, Treiber FA. Meditation smartphone application effects on prehypertensive adults' blood pressure: Dose-response feasibility trial. Health Psychol. 2018 Sep;37(9):850–860. doi: 10.1037/hea0000584. 2018-33466-001
    1. Lacaille J, Sadikaj G, Nishioka M, Carrière Kimberly, Flanders J, Knäuper Bärbel. Daily mindful responding mediates the effect of meditation practice on stress and mood: the role of practice duration and adherence. J Clin Psychol. 2018 Jan;74(1):109–122. doi: 10.1002/jclp.22489.
    1. Tang Y-Y, Lu Q, Fan M, Yang Y, Posner MI. Mechanisms of white matter changes induced by meditation. Proc Natl Acad Sci U S A. 2012 Jun 26;109(26):10570–4. doi: 10.1073/pnas.1207817109. 1207817109
    1. Shen H, Chen M, Cui D. Biological mechanism study of meditation and its application in mental disorders. Gen Psychiatr. 2020;33(4):e100214. doi: 10.1136/gpsych-2020-100214. gpsych-2020-100214
    1. Volpp KG. Knocking down barriers to behavior change. NEJM Catalyst. 2018;4(4):1. doi: 10.1056/CAT.18.0140.
    1. Petrovic D, de Mestral M, Bochud M, Bartley M, Kivimäki Mika, Vineis P, Mackenbach J, Stringhini S. The contribution of health behaviors to socioeconomic inequalities in health: A systematic review. Prev Med. 2018 Aug;113:15–31. doi: 10.1016/j.ypmed.2018.05.003.S0091-7435(18)30153-1
    1. Sriram U, Morgan EH, Graham ML, Folta SC, Seguin RA. Support and sabotage: a qualitative study of social influences on health behaviors among rural adults. J Rural Health. 2018 Dec;34(1):88–97. doi: 10.1111/jrh.12232.
    1. Macinko J, Upchurch DM. Factors associated with the use of meditation, US adults 2017. J Altern Complement Med. 2019 Sep;25(9):920–927. doi: 10.1089/acm.2019.0206.
    1. Gál Éva, Stefan S, Cristea IA. The efficacy of mindfulness meditation apps in enhancing users' well-being and mental health related outcomes: a meta-analysis of randomized controlled trials. J Affect Disord. 2021 Jan 15;279:131–142. doi: 10.1016/j.jad.2020.09.134.S0165-0327(20)32831-7
    1. Kellen M, Saxena D. Calm my headspace: motivations and barriers for adoption and usage of meditation apps during times of crisis. The 20th International Conference on Electronic Business; December 5-8, 2020; Hong Kong. 2020.
    1. Tan G. Calm meditation app hits $2 billion value with lightspeed, Goldman Backing. Bloomberg. [2021-01-01]. .
    1. Headspace and Snap Inc. team up for World Mental Health Day, launch new Headspace mini content to support Snapchatters' rising stress levels. Businesswire. 2020. Oct 09, [2021-01-01]. .
    1. Huberty J, Eckert R, Larkey L, Kurka J, Rodríguez De Jesús Sue A, Yoo W, Mesa R. Smartphone-based meditation for myeloproliferative neoplasm patients: feasibility study to inform future trials. JMIR Form Res. 2019 Apr 29;3(2):e12662. doi: 10.2196/12662. v3i2e12662
    1. Forbes L, Gutierrez D, Johnson SK. Investigating adherence to an online introductory mindfulness program. Mindfulness. 2017 Jul 14;9(1):271–282. doi: 10.1007/s12671-017-0772-4.
    1. Howells A, Ivtzan I, Eiroa-Orosa FJ. Putting the 'app' in happiness: A randomised controlled trial of a smartphone-based mindfulness intervention to enhance wellbeing. Journal of Happiness Studies. 2016;17:163–185. doi: 10.1007/s10902-014-9589-1.
    1. Torous J, Lipschitz J, Ng M, Firth J. Dropout rates in clinical trials of smartphone apps for depressive symptoms: A systematic review and meta-analysis. J Affect Disord. 2020 Feb 15;263:413–419. doi: 10.1016/j.jad.2019.11.167.S0165-0327(19)32606-0
    1. Fleming T, Bavin L, Lucassen M, Stasiak K, Hopkins S, Merry S. Beyond the trial: systematic review of real-world uptake and engagement with digital self-help interventions for depression, low mood, or anxiety. J Med Internet Res. 2018 Jun 06;20(6):e199. doi: 10.2196/jmir.9275. v20i6e199
    1. Meyerowitz-Katz G, Ravi S, Arnolda L, Feng X, Maberly G, Astell-Burt T. Rates of Attrition and Dropout in App-Based Interventions for Chronic Disease: Systematic Review and Meta-Analysis. J Med Internet Res. 2020 Sep 29;22(9):e20283. doi: 10.2196/20283. v22i9e20283
    1. Helander E, Kaipainen K, Korhonen I, Wansink B. Factors related to sustained use of a free mobile app for dietary self-monitoring with photography and peer feedback: retrospective cohort study. Journal of Medical Internet Research. 2014;16(4):e109. doi: 10.2196/jmir.3084.v16i4e109
    1. Stecher C, Mukasa B, Linnemayr S. Uncovering a behavioral strategy for establishing new habits: Evidence from incentives for medication adherence in Uganda. J Health Econ. 2021 May;77:102443. doi: 10.1016/j.jhealeco.2021.102443.S0167-6296(21)00028-X
    1. Biddle SJH. Sedentary behavior at the individual level: Correlates, theories, and interventions. In: Leitzmann M, Jochem C, Schmid D, editors. Sedentary Behavior Epidemiology: Springer Series on Epidemiology and Public Health. New York: Springer; 2018. p. 405.
    1. Linnemayr S, Stecher C. Behavioral economics matters for HIV research: the impact of behavioral biases on adherence to antiretrovirals (ARVs) AIDS Behav. 2015 Nov;19(11):2069–75. doi: 10.1007/s10461-015-1076-0. 10.1007/s10461-015-1076-0
    1. Kerst A, Zielasek J, Gaebel W. Smartphone applications for depression: a systematic literature review and a survey of health care professionals' attitudes towards their use in clinical practice. Eur Arch Psychiatry Clin Neurosci. 2020 Mar;270(2):139–152. doi: 10.1007/s00406-018-0974-3.10.1007/s00406-018-0974-3
    1. Rothman AJ, Gollwitzer PM, Grant AM, Neal DT, Sheeran P, Wood W. Hale and hearty policies: how psychological science can create and maintain healthy habits. Perspect Psychol Sci. 2015 Nov;10(6):701–5. doi: 10.1177/1745691615598515.10/6/701
    1. Gardner B. A review and analysis of the use of 'habit' in understanding, predicting and influencing health-related behaviour. Health Psychol Rev. 2015;9(3):277–95. doi: 10.1080/17437199.2013.876238.
    1. Wood W, Neal DT. Healthy through habit: Interventions for initiating & maintaining health behavior change. Behavioral Science & Policy. 2016;2(1):71–83. doi: 10.1353/bsp.2016.0008.
    1. Gollwitzer PM. Implementation intentions: Strong effects of simple plans. American Psychologist. 1999;54(7):493–503. doi: 10.1037/0003-066x.54.7.493.
    1. Orbell S, Hodgkins S, Sheeran P. Implementation intentions and the theory of planned behavior. Pers Soc Psychol Bull. 1997 Sep;23(9):945–954. doi: 10.1177/0146167297239004.
    1. Armitage CJ, Arden MA. How useful are the stages of change for targeting interventions? Randomized test of a brief intervention to reduce smoking. Health Psychol. 2008 Nov;27(6):789–98. doi: 10.1037/0278-6133.27.6.789.2008-16224-015
    1. O'Carroll RE, Chambers JA, Dennis M, Sudlow C, Johnston M. Improving adherence to medication in stroke survivors: a pilot randomised controlled trial. Ann Behav Med. 2013 Dec;46(3):358–68. doi: 10.1007/s12160-013-9515-5.
    1. Brown I, Sheeran P, Reuber M. Enhancing antiepileptic drug adherence: a randomized controlled trial. Epilepsy Behav. 2009 Dec;16(4):634–9. doi: 10.1016/j.yebeh.2009.09.014.S1525-5050(09)00514-9
    1. Lally P, Chipperfield A, Wardle J. Healthy habits: efficacy of simple advice on weight control based on a habit-formation model. Int J Obes (Lond) 2008 Apr;32(4):700–7. doi: 10.1038/sj.ijo.0803771.0803771
    1. Sheeran P, Orbell S. Implementation intentions and repeated behaviour: augmenting the predictive validity of the theory of planned behaviour. Eur. J. Soc. Psychol. 1999 Mar;29(2-3):349–369. doi: 10.1002/(sici)1099-0992(199903/05)29:2/3<349::aid-ejsp931>;2-y.
    1. Gardner B, de Bruijn G, Lally P. A systematic review and meta-analysis of applications of the Self-Report Habit Index to nutrition and physical activity behaviours. Ann Behav Med. 2011 Oct;42(2):174–87. doi: 10.1007/s12160-011-9282-0.
    1. Verplanken B, Faes S. Good intentions, bad habits, and effects of forming implementation intentions on healthy eating. Eur. J. Soc. Psychol. 1999 Aug;29(5-6):591–604. doi: 10.1002/(sici)1099-0992(199908/09)29:5/6<591::aid-ejsp948>;2-h.
    1. Beeken RJ, Croker H, Morris S, Leurent B, Omar R, Nazareth I, Wardle J. Study protocol for the 10 Top Tips (10TT) trial: randomised controlled trial of habit-based advice for weight control in general practice. BMC Public Health. 2012 Aug 16;12:667. doi: 10.1186/1471-2458-12-667. 1471-2458-12-667
    1. Head KJ, Noar SM, Iannarino NT, Grant Harrington Nancy. Efficacy of text messaging-based interventions for health promotion: a meta-analysis. Soc Sci Med. 2013 Nov;97:41–8. doi: 10.1016/j.socscimed.2013.08.003.S0277-9536(13)00447-4
    1. Noar SM, Harrington NG, Aldrich RS. The role of message tailoring in the development of persuasive health communication messages. Annals of the International Communication Association. 2016 May 18;33(1):73–133. doi: 10.1080/23808985.2009.11679085.
    1. de Vries RAJ, Truong KP, Zaga C, Li J, Evers V. A word of advice: how to tailor motivational text messages based on behavior change theory to personality and gender. Pers Ubiquit Comput. 2017 Jun 15;21(4):675–687. doi: 10.1007/s00779-017-1025-1.
    1. Rimer BK, Kreuter MW. Advancing tailored health communication: A persuasion and message effects perspective. Journal of Communication. 2006;56(1):S184–S201. doi: 10.1111/j.1460-2466.2006.00289.x.
    1. Sahin C, Courtney KL, Naylor PJ, E Rhodes Ryan. Tailored mobile text messaging interventions targeting type 2 diabetes self-management: A systematic review and a meta-analysis. Digit Health. 2019;5:2055207619845279. doi: 10.1177/2055207619845279. 10.1177_2055207619845279
    1. Mayer JE, Fontelo P. Meta-analysis on the effect of text message reminders for HIV-related compliance. AIDS Care. 2017 Apr;29(4):409–417. doi: 10.1080/09540121.2016.1214674.
    1. Bull FC, Kreuter MW, Scharff DP. Effects of tailored, personalized and general health messages on physical activity. Patient Education and Counseling. 1999 Feb;36(2):181–192. doi: 10.1016/s0738-3991(98)00134-7.
    1. Sanders MJ, Van Oss T. Using daily routines to promote medication adherence in older adults. Am J Occup Ther. 2013;67(1):91–9. doi: 10.5014/ajot.2013.005033.
    1. Fournier M, d'Arripe-Longueville F, Rovere C, Easthope CS, Schwabe L, El Methni J, Radel R. Effects of circadian cortisol on the development of a health habit. Health Psychol. 2017 Nov;36(11):1059–1064. doi: 10.1037/hea0000510.2017-27629-001
    1. Gardner B, Abraham C, Lally P, de Bruijn G. Towards parsimony in habit measurement: testing the convergent and predictive validity of an automaticity subscale of the Self-Report Habit Index. Int J Behav Nutr Phys Act. 2012 Aug 30;9:102. doi: 10.1186/1479-5868-9-102. 1479-5868-9-102
    1. Huberty J, Puzia ME, Green J, Vlisides-Henry RD, Larkey L, Irwin MR, Vranceanu A. A mindfulness meditation mobile app improves depression and anxiety in adults with sleep disturbance: Analysis from a randomized controlled trial. Gen Hosp Psychiatry. 2021;73:30–37. doi: 10.1016/j.genhosppsych.2021.09.004. S0163-8343(21)00132-8
    1. Huberty J, Vranceanu A-M, Carney C, Breus M, Gordon M, Puzia ME. Characteristics and usage patterns among 12,151 paid subscribers of the Calm meditation app: cross-sectional survey. JMIR Mhealth Uhealth. 2019 Nov 03;7(11):e15648. doi: 10.2196/15648. v7i11e15648
    1. GLIMMPSE: General Linear Mixed Model Power and Sample Size. Glimmpse. [2021-01-01].
    1. Pollak RA. Habit formation and dynamic demand functions. Journal of Political Economy. 1970 Jul;78(4, Part 1):745–763. doi: 10.1086/259667.
    1. Ryder He, Heal GM. Optimal Growth with Intertemporally Dependent Preferences. The Review of Economic Studies. 1973 Jan;40(1):1–31. doi: 10.2307/2296736.
    1. Hagger MS, Rebar AL, Mullan B, Lipp OV, Chatzisarantis NLD. The subjective experience of habit captured by self-report indexes may lead to inaccuracies in the measurement of habitual action. Health Psychol Rev. 2015;9(3):296–302. doi: 10.1080/17437199.2014.959728.
    1. McWilliams L, Bellhouse S, Yorke J, Lloyd K, Armitage CJ. Beyond "planning": a meta-analysis of implementation intentions to support smoking cessation. Health Psychol. 2019 Dec;38(12):1059–1068. doi: 10.1037/hea0000768.2019-45873-001
    1. Adriaanse MA, Vinkers CDW, De Ridder DT, Hox JJ, De Wit JBF. Do implementation intentions help to eat a healthy diet? A systematic review and meta-analysis of the empirical evidence. Appetite. 2011 Feb;56(1):183–93. doi: 10.1016/j.appet.2010.10.012. S0195-6663(10)00532-5
    1. Tam L, Bagozzi RP, Spanjol J. When planning is not enough: the self-regulatory effect of implementation intentions on changing snacking habits. Health Psychol. 2010 May;29(3):284–292. doi: 10.1037/a0019071.2010-09923-007
    1. Gardner B, Phillips LA, Judah G. Habitual instigation and habitual execution: Definition, measurement, and effects on behaviour frequency. Br J Health Psychol. 2016 Sep;21(3):613–30. doi: 10.1111/bjhp.12189.
    1. Lally P, van Jaarsveld CHM, Potts HWW, Wardle J. How are habits formed: modelling habit formation in the real world. Eur. J. Soc. Psychol. 2009 Jul 16;40(6):998–1009. doi: 10.1002/ejsp.674.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel