New Evidence in the Booming Field of Online Mindfulness: An Updated Meta-analysis of Randomized Controlled Trials

Abstract

Background There is a need to regularly update the evidence base on the effectiveness of online mindfulness-based interventions (MBIs), especially considering how fast this field is growing and developing. Objective This study presents an updated meta-analysis of randomized controlled trials assessing the effects of online MBIs on mental health and the potential moderators of these effects. Methods We conducted a systematic literature search in PsycINFO, PubMed, and Web of Science up to December 4, 2020, and included 97 trials, totaling 125 comparisons. Pre-to-post and pre-to-follow-up between-group effect sizes (Hedges g) were calculated for depression, anxiety, stress, well-being, and mindfulness using a random effects model. Results The findings revealed statistically significant moderate pre-to-post effects on depression (g=0.34, 95% CI 0.18-0.50; P<.001), stress (g=0.44, 95% CI 0.32-0.55; P<.001), and mindfulness (g=0.40, 95% CI 0.30-0.50; P<.001) and small effects on anxiety (g=0.26, 95% CI 0.18-0.33; P<.001). For well-being, a significant small effect was found only when omitting outliers (g=0.22, 95% CI 0.15-0.29; P<.001) or low-quality studies (g=0.26, 95% CI 0.12-0.41; P<.001). Significant but small follow-up effects were found for depression (g=0.25, 95% CI 0.12-0.38) and anxiety (g=0.23, 95% CI 0.13-0.32). Subgroup analyses revealed that online MBIs resulted in higher effect sizes for stress when offered with guidance. In terms of stress and mindfulness, studies that used inactive control conditions yielded larger effects. For anxiety, populations with psychological symptoms had higher effect sizes. Adherence rates for the interventions ranged from 35% to 92%, but most studies lacked clear definitions or cut-offs. Conclusions Our findings not only demonstrate that online MBIs are booming but also corroborate previous findings that online MBIs are beneficial for improving mental health outcomes in a broad range of populations. To advance the field of online MBIs, future trials should pay specific attention to methodological quality, adherence, and long-term follow-up measurements.

The Effects of Nonclinician Guidance on Effectiveness and Process Outcomes in Digital Mental Health Interventions: Systematic Review and Meta-analysis

“…Meta-analyses of posttreatment effects were conducted for all 3 comparisons, and meta-analyses of follow-up effects were conducted for the nonclinician-guided intervention versus unguided intervention and nonclinician-guided intervention versus control comparisons. Although both posttreatment standardized mean difference (SMD) and pretest-posttest control group ( d ppc2 ) [ 37 ] effect sizes have been utilized in similar meta-analyses [ 38 , 39 ], we determined that the posttreatment SMD effect size was most appropriate due to the lack of pre-post correlation values available from the included studies and the criticisms of pre-post effect size methods [ 40 ]. A sensitivity analysis was conducted comparing the 2 methods and resulted in the same pattern of findings.…”

The Effectiveness of a Nonguided Mindfulness App on Perceived Stress in a Nonclinical Dutch Population: Randomized Controlled Trial

“…This potential hypothesis is supported by the recent review of Borghouts [ 31 ], which points toward a generally higher engagement for guided (vs unguided) interventions and to the importance of social connectedness as a facilitator of user engagement. In addition, a recent meta-analysis [ 32 ] focusing specifically on web-based mindfulness found that web-based MBIs resulted in higher effect sizes for stress when offered guidance. As there was also no personal contact between the research team and the respondents, one could say that our study results may be similar to what one might expect to find in a real-world user situation, where despite high levels of app download, only a small portion of users actually use the apps for a longer period [ 33 , 34 ].…”

Personalized Mind–Body Medicine in Integrative Oncology: Meeting the Moment with Each Patient

“… 14 Furthermore, virtual delivery of MBM through meditation/well-being mobile applications and online interventions holds new promise for equitable access and delivery. 28 , 29 …”