A Systematic Review of Electronic Mindfulness-Based Therapeutic Interventions for Weight, Weight-Related Behaviors, and Psychological Stress

Systematic review of family-based interventions integrating cultural and family resilience components to improve Black adolescent health outcomes

BACKGROUND

Past reviews have shown that culturally salient resilience interventions buffer the negative effects of racial discrimination on psychological and behavioral outcomes among Black youth. However, these prior reviews neglect to integrate trials targeting physical health and/or health-promoting outcomes, synthesize trials based on methodological rigor, or systematically assess efficacy or resilience intervention components.

PURPOSE

This systematic review expands on past research by (1) providing an up to-date literature review on family-based cultural resilience interventions across a range of health-related outcomes (physical health, health behaviors, health risk-taking behaviors, and psychological), (2) evaluating the rigor of these interventions, (3) analyzing the efficacy of rigorous interventions, and (4) describing the resilience intervention components of rigorous interventions.

METHODS

Using the PRISMA guidelines, a systematic search was conducted from 1992 to 2022. Studies were included if they were family-based resilience interventions targeting health-related outcomes among Black adolescents ages 10-17 years.

RESULTS

Fifteen studies met inclusion criteria, 10 of which were not included in past reviews. Overall, 10 trials demonstrated high methodological rigor, 9 of which were efficacious. Most rigorous, efficacious trials targeted health risk-taking behaviors outcomes (~66%), whereas none targeted health promotion behaviors (physical activity, diet). Resilience components of rigorous efficacious interventions included racial socialization (racial coping, cultural pride) and family resilience (communication, routine), with fewer integrating racial identity (self-concept, role models) and cultural assets (spirituality, communalism).

CONCLUSIONS

These findings suggest the need to replicate existing rigorous strengths-based resilience interventions and address broader outcomes, including health-promoting behaviors, in the future.

Supporting Weight Loss Among Parents of Children With a Disability: Lessons Learned From a Single-Arm Pilot Study

This study assessed weight change in the parents of children with disabilities following a 12-week, remotely delivered weight loss program focused on lifestyle modifications and found a significant median weight reduction of 3 kg from baseline to week 12.

Psychological Interventions and Those With Elements of Positive Psychology for Child and Youth Mental Health During the COVID-19 Pandemic: Literature Review, Lessons Learned, and Areas for Future Knowledge Dissemination

BACKGROUND

There was a marked decline in child and teenage mental health worldwide during the pandemic, with increasing prevalence of depression, anxiety, and suicide. Research indicates that positive psychological interventions may be beneficial for mental health.

OBJECTIVE

The aims of this review were to evaluate positive psychological interventions for child and youth mental health implemented during the COVID-19 pandemic and assess overall effectiveness for mental health and knowledge.

METHODS

We undertook a literature search of PubMed, MEDLINE, and Google Scholar for all eligible studies on digital and hybrid in-person psychological interventions for youth mental health during the COVID-19 pandemic. A particular emphasis was placed on positive psychological interventions or interventions that had components of positive psychology, including gratitude, acceptance, positive emotions, or resilience building.

RESULTS

A total of 41 interventions were included in this review. Most of the interventions were digital. Overall, most of the interventions assisted with one or more mental health or psychological indicators, such as depression, anxiety, posttraumatic stress disorder, stress, and resilience. However, findings were mixed when it came to targeting both depression and anxiety together. The interventions that promoted youth mental health most often had a range of diverse positive psychology components and were evidence based. Not all studies measured changes in mindfulness. Few studies examined knowledge acquired on mental health self-care, managing mental health problems, knowledge of positive psychological techniques, mindfulness knowledge, or mental health self-efficacy.

CONCLUSIONS

Diverse multicomponent interventions appear to assist with youth mental health overall, although their effects on both depression and anxiety are less clear. There is also a need for more research on knowledge gains to determine whether the interventions improved knowledge on mental health-supportive behaviors, which may be sustained beyond the intervention. Finally, more studies need to evaluate whether the interventions assisted with increasing self-efficacy for practicing positive psychological techniques as well as changes in mindfulness levels. Future studies should not only assess effectiveness for mental health outcomes but also assess knowledge translation, with valid measures of knowledge and self-efficacy for mental health-supportive behaviors and positive psychological skills acquired (eg, the ability to practice mindfulness).

Mind Your Heart: A Mindful Eating and Diet Education eHealth Program

OBJECTIVE

Examine user perceptions of the Mind Your Heart (MYH) program, a mindful eating and nutrition education program delivered via an eHealth system.

METHODS

Sixteen participants (41.5 ± 13.1 years) completed sample MYH lessons over 3 weeks. We examined changes in mindfulness from the State Mindfulness Scale via text messages sent 3 times per week. We assessed MYH user perceptions in a semistructured interview after 3 weeks. Analyses included Spearman's correlation, repeated measures ANOVA, and thematic analysis.

RESULTS

State Mindfulness Scale scores were significantly improved (F[1,15] = 5.35, P = 0.01) from week 1 (M = 2.28 ± 0.80) to week 3 (M = 2.75 ± 1.04). Four themes emerged: (1) MYH is supportive of health goals, (2) text messages act as an intervention, (3) facilitators or inhibitors of use, and (4) enhancing engagement.

CONCLUSIONS AND IMPLICATIONS

Based on participant feedback, the final version of MYH should include example-based learning to translate abstract concepts like mindful eating into action.

The Effect of Online-Delivered Guided Imagery Relaxation on Stress and Well-Being of Primary School Children

Background

In the context of the coronavirus (COVID-19) pandemic, effectively coping with daily stressors is crucial for children who experience restrictions on physical movement and social activities. We examined the effects of the online-delivered guided imagery relaxation (GIR) technique on the stress and well-being of primary school children.

Methods

Thirty-four (N = 34) 11-year-old students were randomly assigned to either intervention (n = 17) or waitlist-control (n = 17) groups. The participants from the intervention group were required to attend a 4-week online GIR session and practice the techniques daily for 5 min-10 min. The Stress in Children (SiC) questionnaire, the Strengths and Difficulties Questionnaire-Parent Reported (SDQ-PR) and tracking form were administered pre- and post-intervention.

Results

Eleven (64.7%) participants attended all sessions and eight (47.0%) completed daily practices. Mixed-model ANOVA indicated no significant difference between participants from intervention and waitlist-control groups across pre- and post-intervention time points, with P-values greater than 0.05 for stress and well-being.

Conclusion

Issues regarding online intervention, including managing children's activities from a distance, Internet connectivity, and time limitations might have affected their adherence and the research outcome. Nonetheless, the online-delivered GIR technique is a promising intervention modality. However, its implementation should be improvised to be more impactful.

Does mindful eating affect the diet quality of adults?

OBJECTIVES

This study aimed to examine the relationship between mindful eating and diet quality among adults in Turkey.

METHODS

A total of 207 adults, 138 women (66.7% of 207) and 69 men (33.3%), participated. This cross-sectional survey was carried out among adults aged 20-50 y. The following data were collected from face-to-face interviews: sociodemographic variables, health information, nutritional habits, anthropometric measurements, 24-h dietary records, and scores from the Mindful Eating Questionnaire (MEQ), Mediterranean Diet Adherence Screener (MEDAS), and Healthy Eating Index-2015 (HEI-2015).

RESULTS

The mean MEDAS scores of females were higher than those of males (P = 0.012). The mean HEI-2015 scores did not significantly differ between females and males (P > 0.05). The mean scores of the MEQ (P = 0.024) and its disinhibition (P = 0.005) and emotional eating (P = 0.000) subfactors were higher in males than in females. The MEQ mean score was negatively associated with daily energy (P = 0.038), carbohydrate (P = 0.046), and fat intake (P = 0.036). As the MEQ mean score increased, the greens and beans score (P = 0.009) and dairy intake score (P = 0.031) increased. A positive correlation was present between the eating discipline subfactor of the MEQ score and both the HEI-2015 (P = 0.002) and MEDAS mean scores (P = 0.001). However, no significant correlation was found between the mean MEQ and HEI-2015 scores and the MEDAS mean scores (P > 0.05).

CONCLUSIONS

Developing mindful eating might be helpful for individual health promotion and quality of life by providing improvements in diet quality of adults.

Effect of a novel telehealth device for dietary cognitive behavioral intervention in overweight or obesity care

Obesity has become a major public health issue which relate to numerous physical problems and highly comorbid with depression and anxiety. Recently, some studies of technology-based interventions for weight reduction emerged to overcome the barriers from time, cost and distance. Mood component and eating behavior related to obesity are less discussed so far with technology-based intervention though. This pilot study was aimed to investigate the effect of telehealth assisted intervention on weight reduction, mood status, and eating behavior change under a smartphone application (app) with novel 3D food picture recognition and incorporated with cognitive behavioral training programs. Adult aged 30-60 years old with overweight were recruited and randomly assigned to control-first group and intervention-first group. In period 1, control-first group had regular life and intervention-first group underwent app intervention; in period 2, two groups went crossover. Body composition and psychological/behavioral questionnaires were collected at baseline, end of period 1, and end of period 2. Nonparametric statistics was performed for data analyzing. A total of 20 participants were enrolled. In control-first group, there were statistically significant reduction in body weight (- 0.55 kg, p = 0.02) and change of body weight percentage (- 0.6%, p = 0.02) after App use. In intervention-first group, the fat percentage decreased by 0.4% after App use in period 1, and increased by 0.05% in period 2. The integrated crossover data revealed that subjects of App group had significant improvements in mindful eating behavior. This pilot study showed the effectiveness in using CogniNU app for weight control and eating behavior. The difference of short-term and long-term effectiveness of technology-based weight control intervention deserves more investigation in the future.Clinical Trial Registration: ISRCTN16082909.

Effects of Mindfulness Exercise Guided by a Smartphone App on Negative Emotions and Stress in Non-Clinical Populations: A Systematic Review and Meta-Analysis

Background

Studies have acknowledged that mindfulness exercise guided by a smartphone app has a positive impact on mental health and physical health. However, mindfulness guided by a smartphone app on mental health is still in its infancy stage. Therefore, we conducted a meta-analysis evaluating the effect of mindfulness intervention guided by a smartphone app on negative emotions and stress in a non-clinical population with emotional symptoms.

Methods

We searched major databases, namely, Web of Science, PubMed, Scopus, China National Knowledge Infrastructure (CNKI), and Wanfang, to identify all of the relevant studies published in English or Chinese from their inception until November 9, 2021. The methodological quality of the included studies was assessed with Cochrane risk-of-bias bias assessment tool. Two researchers independently conducted document retrieval, study selection, data extraction, and methodological quality evaluation.

Result

A total of eight studies were included in the study, with 574 subjects (experimental group: 348; control group: 226). A random effects model was selected to combine effect sizes. The results of the meta-analysis showed that mindfulness exercise guided by a smartphone app reduced negative emotions [standardized mean difference (SMD) = −0.232, 95% CI: −0.398 to −0.066, p = 0.006], depressive symptoms (SMD = −0.367, 95% CI: −0.596 to −0.137, p = 0.002), and anxiety symptoms (SMD = −0.490, 95% CI: −0.908 to −0.071, p = 0.022).

Conclusions

The findings indicate the potentially beneficial effect of mindfulness exercise guided by a smartphone app on symptoms of depression and anxiety among individuals in a non-clinical population with emotional symptoms. Considering the small number and overall methodological weakness of the included studies and lack of randomized controlled trials (RCTs), the results should be interpreted with caution, and future rigorously designed RCTs are warranted to provide more reliable evidence.

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

BACKGROUND

Mindfulness has become increasingly popular, and positive outcomes have been reported for mindfulness-based interventions (MBIs) in reducing stress. These findings make room for innovative perspectives on how MBIs could be applied, for instance through mobile health (mHealth).

OBJECTIVE

The aim of this study is to investigate whether a nonguided mindfulness mobile app can decrease perceived stress in a nonclinical Dutch population over the course of 8 weeks, with follow-up at 6 months.

METHODS

A randomized controlled trial was performed to compare an experimental group that made use of a structured 8-week mHealth mindfulness program and a control group after 8 weeks, with follow-up after 6 months. Participants were recruited via a national television program. The primary outcome measure was perceived stress as measured by the Perceived Stress Scale, secondary outcomes were symptoms of burnout (measured using the visual analog scale [VAS]) and psychological symptoms (measured using the Four-Dimensional Symptom Questionnaire [4DSQ] at follow-up). Outcomes were analyzed using a multilevel regression model.

RESULTS

At baseline, 587 respondents were included. Results showed no postintervention differences between groups for the level of perceived stress. With regard to the secondary outcome measures, the VAS for emotional exhaustion and physical exhaustion showed significantly lower scores for the experimental group after 8 weeks (P=.04 and P=.01, respectively), but not at follow-up. There were no differences between groups for psychological symptoms measured using the 4DSQ.

CONCLUSIONS

These findings do not support our hypothesis that using the mindfulness app would reduce stress levels. However, our findings related to diminished exhaustion at 8 weeks are encouraging and require further investigation.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05246800; https://clinicaltrials.gov/show/NCT05246800.

Online Mindfulness Experience for Emotional Support to Healthcare staff in times of Covid-19

During the first confinement in Spain, between the months of March to June 2020, Information and Communication Technologies strategies were implemented in order to support health workers in the Wellbeing of Mental Health. Faced with so much uncertainty about the pandemic, an Online Mindfulness course. The objective of the course was to support healthcare professionals in Castilla y León in managing stress, anxiety and other emotional disturbances generated by coping with a situation as uncertain and unexpected as a pandemic, in order to manage emotions and thoughts that can lead to suicidal ideation. The motivations for the demand, reasons or motivations in which the health professionals of Castilla y León decided to participate in the mindfulness course in the first wave of Covid-19 in Spain are described. The descriptive and inferential statistical analysis of the customer satisfaction survey applied at the end of the mindfulness course, to the health professionals who participated in a satisfaction survey (CSQ-8: Client Satisfaction Questionnaire). Professional were asked to complete a survey based on (CSQ-8: Client Satisfaction Questionnaire) whose Cronbach's alpha = 0.917 is why the instrument used with N = 130 participants has high reliability. The 66% answered with a highly satisfied that they would return to the mindfulness online course. The 93% of the people who answered the satisfaction survey were women, of which they are professionals in the nursing area, with a participation of around 62%. In relation to the online system used in the Mindfulness intervention, 74% expressed that they fully agreed that it has been easy to use the online system for the mindfulness intervention. Health Professionals responded with 58% high satisfaction and 36% satisfaction, making a total of 94% on the help received in the online mindfulness courses to solve their problems. There is no difference between the age groups of the professionals who have preferred the Mindfulness online course (p = 0.672).

Online Isha Upa Yoga for student mental health and well-being during COVID-19: A randomized control trial

College students experienced increased stress and anxiety during the COVID-19 pandemic. This study evaluated the effect of brief online Isha Upa Yoga modules on undergraduates' mental health and well-being. Randomized control trial (RCT) with waitlist control crossover (N = 679). The intervention group was instructed to learn and practice the modules daily for 12 weeks. At the end of the 4-week RCT, the control group was instructed to learn and practice the modules for the remaining 8 weeks. Primary outcomes included stress and well-being. Secondary outcomes included anxiety, depression, resilience, positive affect and negative affect. Linear mixed-effects models were used for analyses. Isha Upa Yoga significantly reduced stress (Group [intervention, control] × Time [baseline, Week 4] interaction, p = .009, d = .27) and increased well-being (Group × Time interaction p = .002, d = .32). By the study's end, the intervention and control groups experienced significant improvements in well-being (p < .001, p < .001), stress (p < .001, p < .001), anxiety (p < .001, p < .001), depression (p < .001, p = .004), positive affect (p = .04, p < .001), and negative affect (p < .001, p < .001). Online Isha Upa Yoga shows promise for mitigating the pandemic's negative impact on undergraduates' mental health and improving their well-being.

What Are We Measuring When We Evaluate Digital Interventions for Improving Lifestyle? A Scoping Meta-Review

Background: Lifestyle Medicine (LM) aims to address six main behavioral domains: diet/nutrition, substance use (SU), physical activity (PA), social relationships, stress management, and sleep. Digital Health Interventions (DHIs) have been used to improve these domains. However, there is no consensus on how to measure lifestyle and its intermediate outcomes aside from measuring each behavior separately. We aimed to describe (1) the most frequent lifestyle domains addressed by DHIs, (2) the most frequent outcomes used to measure lifestyle changes, and (3) the most frequent DHI delivery methods. Methods: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-ScR) Extension for Scoping Reviews. A literature search was conducted using MEDLINE, Cochrane Library, EMBASE, and Web of Science for publications since 2010. We included systematic reviews and meta-analyses of clinical trials using DHI to promote health, behavioral, or lifestyle change. Results: Overall, 954 records were identified, and 72 systematic reviews were included. Of those, 35 conducted meta-analyses, 58 addressed diet/nutrition, and 60 focused on PA. Only one systematic review evaluated all six lifestyle domains simultaneously; 1 systematic review evaluated five lifestyle domains; 5 systematic reviews evaluated 4 lifestyle domains; 14 systematic reviews evaluated 3 lifestyle domains; and the remaining 52 systematic reviews evaluated only one or two domains. The most frequently evaluated domains were diet/nutrition and PA. The most frequent DHI delivery methods were smartphone apps and websites. Discussion: The concept of lifestyle is still unclear and fragmented, making it hard to evaluate the complex interconnections of unhealthy behaviors, and their impact on health. Clarifying this concept, refining its operationalization, and defining the reporting guidelines should be considered as the current research priorities. DHIs have the potential to improve lifestyle at primary, secondary, and tertiary levels of prevention-but most of them are targeting clinical populations. Although important advances have been made to evaluate DHIs, some of their characteristics, such as the rate at which they become obsolete, will require innovative research designs to evaluate long-term outcomes in health.

Effectiveness of a mindfulness-based mobile application for the treatment of depression in ambulatory care: study protocol for a randomized controlled trial (Preprint)

Background

Patients with major depressive disorder (MDD) often experience relapses despite regular treatment with pharmacotherapy and psychotherapy. Further, long waiting lists and more demand than treatment capacity characterize ambulatory settings. Mindfulness-based interventions proved to be effective in relapse prevention in MDD. Next, mindfulness-based interventions in the form of free mobile applications can be an effective augmentation of the treatment as usual and can fill a gap in ambulatory care.

Objective

Given this background, the aim of this randomized controlled study is to assess the effectiveness of additional MBI via a mobile app on the symptom severity and stress levels, compared to treatment as usual.

Methods

A total of 140 individuals with MDD will be randomly allocated to the intervention or control condition. The intervention consists of the daily use of the mindfulness mobile application Headspace for thirty days (up to 10 minutes a day). The control condition will be treatment as usual. At baseline and four weeks later, the following key outcome dimensions will be assessed: self-rated (Beck Depression Inventory) and experts’ rated symptoms of MDD (Hamilton Depression Rating Scale); secondary outcome variables will be blood pressure, heart rate, and respiratory rate and changes in tobacco and alcohol consumption and medication as a proxy of perceived stress.

Results

This study was funded in February 2021 and approved by the institutional review board on April 15, 2021, and it started in May 2021. As of December 2021, we enrolled 30 participants. The findings are expected to be published in spring 2023.

Conclusions

We hypothesize that compared to the control conditions, individuals with MDD of the mobile app-condition will have both lower self- and experts’ rated symptoms of MDD and more favorable stress-related levels. While the risk for medical events is low, the immediate benefit for participants could be a decrease in symptom severity and reduction of the stress level.

Trial Registration

Clinical Trials.gov NCT05060393; https://clinicaltrials.gov/ct2/show/NCT05060393.

International Registered Report Identifier (IRRID)

DERR1-10.2196/33423

The Use of Self-Help Strategies in Obesity Treatment. A Narrative Review Focused on Hypnosis and Mindfulness

PURPOSE OF REVIEW

The aim of this narrative review was to summarize the evidence evaluating the possibilities and limitations of self-hypnosis and mindfulness strategies in the treatment of obesity.

RECENT FINDINGS

Psychological factors, such as mood disorders and stress, can affect eating behaviors and deeply influence weight gain. Psychological approaches to weight management could increase the motivation and self-control of the patients with obesity, limiting their impulsiveness and inappropriate use of food. The cognitive-behavioral therapy (CBT) represents the cornerstone of obesity treatment, but complementary and self-directed psychological interventions, such as hypnosis and mindfulness, could represent additional strategies to increase the effectiveness of weight loss programs, by improving dysfunctional eating behaviors, self-motivation, and stimulus control. Both hypnosis and mindfulness provide a promising therapeutic option by improving weight loss, food awareness, self-acceptance of body image, and limiting food cravings and emotional eating. Greater effectiveness occurs when hypnosis and mindfulness are associated with other psychological therapies in addition to diet and physical activity. Additional research is needed to determine whether these strategies are effective in the long term and whether they can be routinely introduced into the clinical practice.

Predictive Analysis of Factors Influencing Depression Status of Nurses in the COVID-19 Pandemic Intensive Care Unit

Purpose: Understand the effects of the COVID-19 pandemic on depression in intensive care unit (ICU) nurses, analyze high-risk factors, and propose appropriate measures to maintain physical and mental health. Methods: A total of 78 nurses in ICU of Beijing Ditan Hospital affiliated with Capital Medical University (Beijing area, COVID-19 patient designated hospital) were investigated with self-rating depression scale (SDS). The Cronbach'sαcoefficient was 0.874, the content validity was 0.853, and the internal consistency was good. General information for the questionnaire: gender, marriage, education, age, title, length of service, ICU years of service, COVID-19 pandemic training, concerns about the COVID-19 pandemic, and current health status. Results: According to the SDS scale score, ICU nurses had a total depression score of 51.36 ± 11.667, and the prevalence rate of depression was 44.9% (35/78). Multi-line regression analysis shows that stress perception, work experience in critical diseases, education and other total scores are risk factors for the occurrence of depression. Conclusion: Work experience in critical illness (β = 9.930, P < 0.001) had a positive predictive effect on the total score of depression, while stress perception (β = -0.884, P < 0.001) and education (β = -6.061, P < 0.001) had a negative predictive effect on the total score of depression, and explained 52.7% variation. These findings point to the need for interventions to address psychological distress and provide the necessary support.

The effects of mobile apps on stress, anxiety, and depression: overview of systematic reviews

OBJECTIVES

Despite a large number of mobile apps in the field of mental health, it is difficult to find a useful and reliable one, mainly due to the fact that the effectiveness of many apps has not been assessed scientifically. The present study aimed to assess the effects of mental health apps on managing the symptoms of stress, anxiety, and depression.

METHODS

A comprehensive literature search was conducted in PubMed, Scopus, EMBASE, Cochrane, and Web of Science databases for the papers published from 2000 to 2019. Studies were included if they reviewed articles or mobile apps for their effectiveness in stress, anxiety, and depression. The reviews that had considered mobile apps or web-based mobile applications as an intervention or part of intervention were included, as well.

RESULTS

A total of 4,999 peer-reviewed articles were identified, out of which nine systematic reviews met the inclusion criteria. Seven systematic reviews measured depression outcomes, three measured stress, and five systematic reviews measured anxiety symptoms. The applications that used behavior change strategies, such as Cognitive Behavioral Therapy, Acceptance and Commitment Therapy, and Behavioral Activation, reported significant effects on depression, anxiety, and stress.

CONCLUSION

It seems that mental health apps can be promising media for reducing depressive symptoms. This field is an emerging area of mobile health, and further research should be done in future in order to reach conclusive evidence.

Effects of a Brief Electronic Mindfulness-Based Intervention on Relieving Prenatal Depression and Anxiety in Hospitalized High-Risk Pregnant Women: Exploratory Pilot Study

Background

Peripartum depression and anxiety disorders are highly prevalent and are correlated with adverse maternal and neonatal outcomes. Antenatal care in Germany does not yet include structured screening and effective low-threshold treatment options for women facing peripartum depression and anxiety disorders. Mindfulness-based interventions (MBIs) are increasingly becoming a focus of interest for the management of such patients. Studies have shown a decrease in pregnancy-related stress and anxiety in expectant mothers following mindfulness programs.

Objective

The aim of this study was to explore the clinical effectiveness of a 1-week electronic course of mindfulness on prenatal depression and anxiety in hospitalized, high-risk pregnant women. We hypothesized that participating in a 1-week electronic MBI (eMBI) could alleviate symptoms of depression and anxiety during the hospital stay.

Methods

A prospective pilot study with an explorative study design was conducted from January to May 2019 in a sample of 68 women hospitalized due to high-risk pregnancies. After enrolling into the study, the participants were given access to an eMBI app on how to deal with stress, anxiety, and symptoms of depression. Psychometric parameters were assessed via electronic questionnaires comprising the Edinburgh Postnatal Depression Scale (EPDS), State-Trait Anxiety Inventory (STAI-S), and abridged version of the Pregnancy-Related Anxiety Questionnaire (PRAQ-R).

Results

We observed a high prevalence of peripartum depression and anxiety among hospitalized high-risk pregnant women: 39% (26/67) of the study participants in the first assessment and 41% (16/39) of the participants in the second assessment achieved EPDS scores above the cutoff value for minor/major depression. The number of participants with anxiety levels above the cutoff value (66% [45/68] of the participants in the first assessment and 67% [26/39] of the participants in the second assessment) was significantly more than that of the participants with anxiety levels below the cutoff value, as measured with the STAI-S. After completing the 1-week electronic course on mindfulness, the participants showed a significant reduction in the mean state anxiety levels (P<.03). Regarding pregnancy-related anxiety, participants who completed more than 50% of the 1-week course showed lower scores in PRAQ-R in the second assessment (P<.05). No significant changes in the EPDS scores were found after completing the intervention.

Conclusions

Peripartum anxiety and depression represent a relevant health issue in hospitalized pregnant patients. Short-term eMBIs could have the potential to reduce anxiety levels and pregnancy-related anxiety. However, we observed that compliance to eMBI seems to be related to lower symptoms of pregnancy-related stress among high-risk patients. eMBIs represent accessible mental health resources at reduced costs and can be adapted for hospitalized patients during pregnancy.

Third-wave cognitive behaviour therapies for weight management: A systematic review and network meta-analysis

This systematic review and network meta-analysis synthesized evidence on the effects of third-wave cognitive behaviour therapies (3wCBT) on body weight, and psychological and physical health outcomes in adults with overweight or obesity. Studies that included a 3wCBT for the purposes of weight management and measured weight or body mass index (BMI) pre-intervention and ≥ 3 months post-baseline were identified through database searches (MEDLINE, CINAHL, Embase, Cochrane database [CENTRAL], PsycINFO, AMED, ASSIA, and Web of Science). Thirty-seven studies were eligible; 21 were randomized controlled trials (RCT) and included in the network meta-analyses. Risk of bias was assessed using RoB2, and evidence quality was assessed using GRADE. Random-effects pairwise meta-analysis found moderate- to high-quality evidence suggesting that 3wCBT had greater weight loss than standard behavioural treatment (SBT) at post-intervention (standardized mean difference [SMD]: -0.09, 95% confidence interval [CI]: -0.22, 0.04; N = 19; I2 = 32%), 12 months (SMD: -0.17, 95% CI: -0.36, 0.02; N = 5; I2 = 33%), and 24 months (SMD: -0.21, 95% CI: -0.42, 0.00; N = 2; I2 = 0%). Network meta-analysis compared the relative effectiveness of different types of 3wCBT that were not tested in head-to-head trials up to 18 months. Acceptance and commitment therapy (ACT)-based interventions had the most consistent evidence of effectiveness. Only ACT had RCT evidence of effectiveness beyond 18 months. Meta-regression did not identify any specific intervention characteristics (dose, duration, delivery) that were associated with greater weight loss. Evidence supports the use of 3wCBT for weight management, specifically ACT. Larger trials with long-term follow-up are needed to identify who these interventions work for, their most effective components, and the most cost-effective method of delivery.

Relating Instructional Design Components to the Effectiveness of Internet-Based Mindfulness Interventions: A Critical Interpretive Synthesis

BACKGROUND

Internet-based mindfulness interventions are a promising approach to address challenges in the dissemination and implementation of mindfulness interventions, but it is unclear how the instructional design components of such interventions are associated with intervention effectiveness.

OBJECTIVE

The objective of this study was to identify the instructional design components of the internet-based mindfulness interventions and provide a framework for the classification of those components relative to the intervention effectiveness.

METHODS

The critical interpretive synthesis method was applied. In phase 1, a strategic literature review was conducted to generate hypotheses for the relationship between the effectiveness of internet-based mindfulness interventions and the instructional design components of those interventions. In phase 2, the literature review was extended to systematically explore and revise the hypotheses from phase 1.

RESULTS

A total of 18 studies were identified in phase 1; 14 additional studies were identified in phase 2. Of the 32 internet-based mindfulness interventions, 18 were classified as more effective, 11 as less effective, and only 3 as ineffective. The effectiveness of the interventions increased with the level of support provided by the instructional design components. The main difference between effective and ineffective interventions was the presence of just-in-time information in the form of reminders. More effective interventions included more supportive information (scores: 1.91 in phases 1 and 2) than less effective interventions (scores: 1.00 in phase 1 and 1.80 in phase 2), more part-task practice (scores: 1.18 in phase 1 and 1.60 in phase 2) than less effective interventions (scores: 0.33 in phase 1 and 1.40 in phase 2), and provided more just-in-time information (scores: 1.35 in phase 1 and 1.67 in phase 2) than less effective interventions (scores: 0.83 in phase 1 and 1.60 in phase 2). The average duration of more effective, less effective, and ineffective interventions differed for the studies of phase 1, with more effective interventions taking up more time (7.45 weeks) than less effective (4.58 weeks) or ineffective interventions (3 weeks). However, this difference did not extend to the studies of phase 2, with comparable average durations of effective (5.86 weeks), less effective (5.6 weeks), and ineffective (7 weeks) interventions.

CONCLUSIONS

Our results suggest that to be effective, internet-based mindfulness interventions must contain 4 instructional design components: formal learning tasks, supportive information, part-task practice, and just-in-time information. The effectiveness of the interventions increases with the level of support provided by each of these instructional design components.

An online mindfulness-based intervention for undergraduate pharmacy students: Results of a mixed-methods feasibility study

INTRODUCTION

Stress negatively impacts pharmacy students' physical and mental health. Mindfulness has been shown to improve student wellbeing. The purpose of this study was to assess the feasibility and acceptability of an online mindfulness-based intervention and determine its effect on student wellbeing.

METHODS

A quasi-randomised controlled trial was conducted at four pharmacy schools in Ireland. The intervention group took part in a four-week online mindfulness course. The control group received usual education, with delayed access to the course. Participants completed the Perceived Stress Scale, the General Health Questionnaire, the Jefferson Scale of Empathy - Health Profession Student version, the Maslach Burnout Inventory Student Survey (MBI-SS), and the Five Facet Mindfulness Questionnaire at baseline and post-intervention. Answers provided to questions about the experience of participating in the course were analysed using thematic analysis.

RESULTS

Of the 52 participants, no significant differences were found between the intervention and control groups at baseline. Post-intervention, an increase in professional efficacy, as measured by the MBI-SS, was found in the intervention group (p = 0.004). There was also an increase in observing scores (p = 0.003). Males showed greater improvements in stress (p = 0.04) and non-judgement (p = 0.03) levels. Only females demonstrated improvement in professional efficacy (p = 0.002). Participants self-reported stress reduction and increased awareness of emotions.

CONCLUSION

This study provides insights into the feasibility and acceptability of an online mindfulness course for pharmacy students. Findings will inform the future design and implementation of larger studies.

Mindful Eating Mobile Health Apps: Review and Appraisal

BACKGROUND

Mindful eating is an emerging area of research for managing unhealthy eating and weight-related behaviors such as binge eating and emotional eating. Although there are numerous commercial mindful eating apps available, their quality, effectiveness, and whether they are accurately based on mindfulness-based eating awareness are unknown.

OBJECTIVE

This review aimed to appraise the quality of the mindful eating apps and to appraise the quality of content on mindful eating apps.

METHODS

A review of mindful eating apps available on Apple iTunes was undertaken from March to April 2018. Relevant apps meeting the inclusion criteria were subjectively appraised for general app quality using the Mobile App Rating Scale (MARS) guidelines and for the quality of content on mindful eating. A total of 22 apps met the inclusion criteria and were appraised.

RESULTS

Many of the reviewed apps were assessed as functional and had moderate scores in aesthetics based on the criteria in the MARS assessment. However, some received lower scores in the domains of information and engagement. The majority of the apps did not teach users how to eat mindfully using all five senses. Hence, they were scored as incomplete in accurately providing mindfulness-based eating awareness. Instead, most apps were either eating timers, hunger rating apps, or diaries. Areas of potential improvement were in comprehensiveness and diversity of media, in the quantity and quality of information, and in the inclusion of privacy and security policies. To truly teach mindful eating, the apps need to provide guided examples involving the five senses beyond simply timing eating or writing in a diary. They also need to include eating meditations to assist people with their disordered eating such as binge eating, fullness, satiety, and craving meditations that may help them with coping when experiencing difficulties. They should also have engaging and entertaining features delivered through diverse media to ensure sustained use and interest by consumers.

CONCLUSIONS

Future mindful eating apps could be improved by accurate adherence to mindful eating. Further improvement could be achieved by ameliorating the domains of information, engagement, and aesthetics and having adequate privacy policies.

The Mindfulness App Trial for Weight, Weight-Related Behaviors, and Stress in University Students: Randomized Controlled Trial

Background

University students are at risk of weight gain during their studies. Key factors related to weight gain in this population include unhealthy weight-related behaviors because of stress. Mindfulness holds promise for weight management. However, there has not been any previous trial that has explored the effectiveness of a student-tailored mindfulness app for stress, weight-related behaviors, and weight. There is limited evidence that current mindfulness apps use evidence-based mindfulness techniques. A novel app was developed that combined evidence-based, mindfulness-based stress reduction and mindful eating (ME) techniques that were tailored to university students, with student-relevant themes for targeting weight behaviors, weight, and stress.

Objectives

The aim of this study was to test the effectiveness, acceptability, and feasibility of a student-tailored mindfulness app for weight, weight-related behaviors, and stress. Testing this app in a rigorous randomized controlled trial (RCT) for these outcomes is a novelty and contribution to this emerging field.

Methods

A 2-arm RCT of an 11-week duration was undertaken at the University of Queensland. Students were either randomized to the mindfulness app (n=45) or to a behavioral self-monitoring electronic diary (e-diary; n=45) for diet and exercise. Analysis of covariance was used to compare differences in weight, stress, mindfulness, ME, physical activity, and eating behaviors between both groups.

Results

Neither the mindfulness app group nor the e-diary group lost weight and there were no differences between the groups at follow-up. The mindfulness app group had significantly lower stress levels (P=.02) (adherers only), lower emotional eating (P=.02), and uncontrolled eating (P=.02) as well as higher mindfulness (P≤.001) and ME levels overall (P≤.001). The e-diary group had higher metabolic equivalents of moderate activity levels (P≤.01). However, the effect sizes were small. Regular adherence to mindfulness exercises in the app was low in the group. The majority of students (94%) liked the app and found it to be acceptable. Compared with other exercises, the most helpful reported meditation was the short breathing exercise observing the breath (39.4% [13/33] preferred it).

This was the first RCT that tested a mindfulness app for weight and weight-related behaviors in students. The modest level of user adherence likely contributes to the lack of effect on weight loss. However, there was a small, albeit promising, effect on weight-related eating behavior and stress.

Conclusions

A mindfulness app demonstrated effectiveness for stress, eating behaviors, mindfulness, and ME, but the effect sizes were small. Future studies should be conducted over longer periods of time and with greater participant compliance.

Trial Registration

Australian New Zealand Trial Registry ACTRN12616001349437; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371370 (Archived by WebCite at http://www.webcitation.org/761cc2K6ft)

Findings From a Randomized Trial of Weight Gain Prevention Among Overweight Puerto Rican Young Adults

OBJECTIVE

Assess impact of multimodality weight gain prevention intervention.

METHODS

Randomized clinical trial among 39 overweight young Puerto Rico college students using 10 weekly peer-support sessions promoting dietary, physical activity, and other lifestyle changes enhanced by stress-reduction and mindfulness approaches. Body mass index (BMI) and self-reported behaviors were measured at baseline and at 10 weeks and 6 months after baseline.

RESULTS

At the completion of the intervention, BMIs in the experimental arm were 0.8 units lower than at baseline (z = -3.0; P = .008) and 1.2 lower at 6 months after baseline (z = -4.1; P < .001); BMIs in the control arm were 0.7 higher (z = 2.7; P = .02) at 10 weeks and 0.8 higher at 6 months (z = 3.1; P = .005). Group × time interaction confirmed that BMI differed significantly over time between arms (χ² = 26.9; degrees of freedom = 2; P < .001). Analysis of behavioral changes was mostly inconclusive although the experimental arm reported a considerable increase in walking at 10 weeks. Qualitative data suggested that yoga and mindfulness components were particularly useful for motivating participants to maintain healthier lifestyle patterns.

CONCLUSIONS

Body mass index in the experimental arm decreased at the end of intervention and was maintained at 6 months' follow-up.

Mobile App Tools for Identifying and Managing Mental Health Disorders in Primary Care

PURPOSE OF REVIEW

Mental health apps are intriguing yet challenging tools for addressing barriers to treatment in primary care. In the current review, we seek to assist primary care professionals with evaluating and integrating mental health apps into practice. We briefly summarize two leading frameworks for evaluating mental health apps and conduct a systematic review of mental health apps across a variety of areas commonly encountered in primary care.

RECENT FINDINGS

Existing frameworks can guide professionals and patients through the process of identifying apps and evaluating dimensions such as privacy and security, credibility, and user experience. For specific apps, several problem areas appear to have relatively more scientific evaluation in the current app landscape, including PTSD, smoking, and alcohol use. Other areas such as eating disorders not only lack evaluation, but contain a significant subset of apps providing potentially harmful advice.

SUMMARY

Overall, individuals seeking mental health apps will likely encounter strengths such as symptom tracking and psychoeducational components, while encountering common weaknesses such as insufficient privacy settings and little integration of empirically-supported techniques. While mental health apps may have more promise than ever, significant barriers to finding functional, usable, effective apps remain for health professionals and patients alike.

Third-wave cognitive behaviour therapies for weight management: systematic review and network meta-analysis protocol

INTRODUCTION

Behavioural and cognitive behavioural programmes are commonly used to assist with weight management, but there is considerable scope to improve their effectiveness, particularly in the longer term. Third-wave cognitive behaviour therapies (CBTs) have this potential and are increasingly used. This systematic review will assess the effect of third-wave CBTs for weight management on weight, psychological and physical health outcomes in adults with overweight or obesity.

METHODS AND ANALYSIS

The systematic review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidance. We will include studies of any third-wave CBTs focusing on weight loss or weight maintenance for adults with a body mass index (BMI) ≥25kg/m2. Eligible study designs will be randomised control trials, non-randomised trials, prospective cohort and case series. Outcomes of interest will be body weight/BMI, psychological and physical health, and adherence. We will search the following databases from inception to 16 January 2018: MEDLINE, CINAHL, Embase, Cochrane database (CENTRAL), PsycINFO, AMED, ASSIA and Web of Science. The search strategy will be based on the concepts: (1) third-wave CBTs and (2) overweight, obesity or weight management. No restrictions will be applied. We will search reference lists of relevant reviews and included articles. Two independent reviewers will screen articles for eligibility using a two-stage process. Two independent reviewers will extract data, assess risk of bias using Risk of Bias 2.0, Risk of Bias in Non-randomised studies of Interventions or Risk of Bias in Non-randomised Studies of Exposures checklist and assess quality using the Grading of Recommendations Assessment, Development and Evaluation tool. A random-effects network meta-analysis of outcomes, and sub-group analyses and meta-regression will be conducted, where data permit. If not appropriate, a narrative synthesis will be undertaken.

ETHICS AND DISSEMINATION

Ethical approval is not required as no primary data will be collected. The completed systematic review will be disseminated in a peer-reviewed journal, presented at conferences and used to inform the development of a weight management programme.

PROSPERO REGISTRATION NUMBER

CRD42018088255.