New Study of Mindfulness Apps & Online Programs

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HERE IS HOW

In 2021 alone, 16,581 publications on mindfulness were published in scientific journals. Given the research and consumer interest in mindfulness and other mental health apps, a group of researchers led by Catherine Begin conducted a scoping review to better understand mindfulness and self-compassion using apps and online platforms. They focused primarily on concerns related to work burnout and stress, but their findings may also be relevant to other mental health apps. Scoping reviews are designed to examine emerging evidence and summarize the evidence on a specific topic of interest. Recently published in the Journal for Technology and Behavioral Science, the study was designed to assess the current state of the literature on the use of online programs and mobile applications of self-compassion, mindfulness, and meditation  (digital mindfulness-based interventions; dMBIs). 

The focus on accessing mindfulness information through behavioral health technology is particularly relevant, given the remarkable popularity of mindfulness apps such as Headspace, Calm, Insight Timer, Palouse Mindfulness, UCLA Mindful, Mindfulness Coach, and HeadGear. According to the Headspace webpage, accessed February 2023 by the current author, “Headspace is part of Headspace Health, the world’s most accessible, comprehensive provider of mental health and well-being care. Headspace Health also consists of Headspace for Work and Ginger, who partner with over 2,500 companies and health plans to provide access to meditation, mindfulness, coaching, therapy, and psychiatry to their members and employees. Partners include Starbucks, Adobe, Delta Air Lines, ViacomCBS, Cigna, and Kaiser Permanente.” 

Similarly, Calm makes the following claim on their webpage, “We’re the #1 app for Sleep, Meditation and Relaxation, with over 100 million downloads and over 1.5M+ 5-star reviews. We’re honored to be an Apple BEST OF 2018 award winner, Apple’s App of the Year 2017, Google Play Editor’s Choice 2018, and to be named by the Center for Humane Technology as “the world’s happiest app” (accessed February 2023 by the current author).

Focus on Mindfulness Apps

The research team sought to better understand the applicability of mindfulness technology to workers. More specifically, the information they sought related to the type of intervention, population, advantages and disadvantages, measured outcomes, and advice for future research were gathered. They examined articles in MEDLINE (PubMed; Ovid), PsychInfo (Ovid), and Web of Science (Clarivate) for relevant articles. Their screening process resulted in the inclusion of 56 articles of the 4443 originally accessed. 

Selection criteria included the following:

1. Participants were workers
2. The intervention was individual, digital, mindfulness/self-compassion/meditation-based, and
3. Articles were available in French or English at the time of the review.

The researchers noted that while dMBIs offer advantages (e.g., low cost, accessibility, practicality, feasibility), implementation obstacles such as low engagement, motivation, and confidentiality concerns can increase. The selected articles examined work outcomes, mindfulness or self-compassion, and other psychological variables such as stress/anxiety, depression, resilience, and well-being. 

In establishing their rationale for the study, the researchers stated that several studies documenting the widespread use of these and similar apps among different populations and named the following publications (Gál et al., 2021; Linardon, 2020; Sevilla-Llewellyn-Jones et al., 2018).

Why Focus on Workers?

In explaining their focus on workers for their study, they cited the previous work with workers by Pospos and colleagues 2018 and Stratton and colleagues 2017. They further identified the following reasons for their focus on this population in dMBIs research because of the following:

1. Mindfulness and self-compassion could alleviate a work-related outcome (burnout)
2. The pandemic has exacerbated the need for interventions for workers while respecting social distancing and sanitary measures; and 
3. dMBIs could help overcome frequent obstacles to traditional methods of disseminating mindfulness and self-compassion interventions.

Mindfulness App Study Conclusions

The researchers came to the following observations and conclusions in reviewing their selected 56 published studies:

1. An important aspect that surfaced frequently is the ability for dMBIs to be individualized to one’s preferences and context (ex.: type of occupation). This observation supports previous research on developing technology that caters to the user’s experience, also known as UX Design.
2. Several papers reviewed by the research team also drew attention to the fact that dMBIs can be disadvantageous to people who use these apps instead of seeking a more in-depth therapeutic intervention when needed. 
3. The researchers also commented that some such interventions might be more helpful in preventing workplace difficulties and added that there might be a need to integrate security measures to help those who experience more serious difficulties. Those measures may include a link to a website or a free helpline number. 
4. They also mentioned the issue of confidentiality and suggested that app developers provide consumers with the protections they deserve. The importance of privacy considerations with mental health apps is a continued concern expressed by other app researchers who have issued warnings about the safety of protected health information collected.
5. The team also suggested that future research into mindfulness apps be channeled into identifying means of fostering engagement. They cited a meta-analysis that showed that participants only completed 43% of the mindfulness meditation exercises (Gál et al., 2021). The researchers suggested that future studies collect qualitative data and insights from participants who drop out of the studies, albeit oftentimes difficult to collect such data. They mentioned using reminders and notifications to stimulate engagement and adherence potentially. 
6. Lastly, the researchers stated the need for researchers to understand better when, in what context, and for whom these mindfulness apps are effective.

Discussion

Overall, the research team’s scoping review uncovered several key points that bear consideration when suggesting apps for a clinical population. Not all apps are created equal, nor are the publications focused on apps for behavioral healthcare created equal. 

As the clinician considers the massive market for mindfulness apps currently at many consumers’ fingertips, it is worth noting that research needs to catch up to the availability and popularity of apps. While a scoping review of sensors, wearables, and remote monitoring using app interventions has been published, and competencies have been developed for using apps in clinical care, guidelines evaluating app research are still in development. Behavioral practitioners seeking to establish beginning formal competency for more effectively using apps for clinical care are encouraged to attend Telehealth.org’s app learning activity.

Additional Reading

Armstrong, C. M., Ciulla, R. P., Edwards-Stewart, A., Hoyt, T., & Bush, N. (2018). Best practices of mobile health in clinical care: The development and evaluation of a competency-based provider training program. Professional Psychology: Research and Practice, 49(5-6), 355.

Bégin, C., Berthod, J., Martinez, L.Z. et al. Use of Mobile Apps and Online Programs of Mindfulness and Self-Compassion Training in Workers: A Scoping Review. J. technol. behav. sci. 7, 477–515 (2022). https://doi.org/10.1007/s41347-022-00267-

Edwards-Stewart, A., Alexander, C., Armstrong, C. M., Hoyt, T., & O’Donohue, W. (2019). Mobile applications for client use: Ethical and legal considerations. Psychological Services, 16(2), 281.

Schueller, S. M., Armstrong, C. M., Neary, M., & Ciulla, R. P. (2022). An introduction to core competencies for the use of mobile apps in cognitive and behavioral practice. Cognitive and Behavioral Practice, 29(1), 69-80.

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