Effectiveness of online mindfulness-based interventions in improving mental health: A review and meta-analysis of randomised controlled trials

Abstract

Mindfulness-based interventions (MBIs) are increasingly being delivered through the Internet. Whereas numerous meta-analyses have investigated the effectiveness of face-to-face MBIs in the context of mental health and well-being, thus far a quantitative synthesis of the effectiveness of online MBIs is lacking. The aim of this meta-analysis was to estimate the overall effects of online MBIs on mental health. Fifteen randomised controlled trials were included in this study. A random effects model was used to compute pre-post between-group effect sizes, and the study quality of each of the included trials was rated. Results showed that online MBIs have a small but significant beneficial impact on depression (g=0.29), anxiety (g=0.22), well-being (g=0.23) and mindfulness (g=0.32). The largest effect was found for stress, with a moderate effect size (g=0.51). For stress and mindfulness, exploratory subgroup analyses demonstrated significantly higher effect sizes for guided online MBIs than for unguided online MBIs. In addition, meta-regression analysis showed that effect sizes for stress were significantly moderated by the number of intervention sessions. Effect sizes, however, were not significantly related to study quality. The findings indicate that online MBIs have potential to contribute to improving mental health outcomes, particularly stress. Limitations, directions for future research and practical implications are discussed.

The Efficacy and Acceptability of Third-Wave Behavioral and Cognitive eHealth Treatments: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…In addition, odds ratio was computed to investigate the ratio of the odds of participant attrition in third-wave eHealth groups relative to comparator conditions. A power analysis revealed that a sample size of 146 participants is required to detect the difference in attrition rates suggested by the most relevant metaanalytic review that investigated participant dropout (16% vs. 37%; OR = 3.08; Spijkerman et al, 2016). In accordance, the current meta-analyses all had 100% power to detect this estimated ES at α = .05.…”

“…In line with these findings, a recent meta-analytic review by Spijkerman et al (2016) found that online mindfulness-based interventions produced small to medium statistically significant benefits on depression, anxiety, and well-being outcomes at posttreatment relative to control conditions. In addition, this recent meta-analytic review also found that ESs did not significantly vary as a function of study population (i.e., nonclinical, somatic illnesses, or psychological illnesses).…”

“…In addition, this recent meta-analytic review also found that ESs did not significantly vary as a function of study population (i.e., nonclinical, somatic illnesses, or psychological illnesses). Spijkerman et al (2016), however, were unable to conduct subgroup analyses based on studies' type of comparison condition. Similarly, a systematic review by Cavanagh et al (2014) found that mindfulness-and acceptance-based self-help interventions had small statistically significant benefits on anxiety and depression outcomes relative to comparison conditions.…”

“…In accordance with Higgins et al (2011), studies with high or unclear risk of bias were compared with those at low risk of bias. In meta-regression analyses where a study included more than one comparison condition, the most common comparator across studies was chosen (Cavanagh et al, 2014;Spijkerman et al, 2016). In addition, funnel plots were visually inspected and Duval and Tweedie's (2000) trim-and-fill procedure was conducted to detect the presence of publication bias across studies and assess its impact on the metaanalyses.…”

“…Similarly, a recent meta-analytic review of 15 randomized controlled trials by Spijkerman, Pots, and Bohlmeijer (2016) also found that online mindfulness-based interventions (MBIs) were superior to control conditions in improving mental health outcomes, with small to medium statistically significant benefits on anxiety (g = 0.22), depression (g = 0.29), and well-being (g = 0.23). Although previous systematic reviews and meta-analyses have investigated the efficacy of thirdwave treatments delivered in their traditional format Hunot et al, 2013;Öst, 2008) and examined the effectiveness of mindfulness and acceptance-based self-help interventions (Cavanagh et al, 2014), as well as online MBIs in improving mental health (Spijkerman et al, 2016), to date there has not been a review of the evidence base for thirdwave behavioral and cognitive eHealth therapies. The steady increase in citations of "third wave" in the scientific literature (Dimidjian et al, 2016) and proliferation of eHealth interventions delivering this therapeutic content (Pierce, Twohig, & Levin, 2016) underscores the importance of systematically reviewing the evidence for the efficacy and acceptability of third-wave eHealth treatments.…”