Smartphone Apps Effective for Mindfulness Program Delivery

Liam Davenport

April 15, 2019

WARSAW, Poland — Delivering mindfulness training via a smartphone app could significantly reduce anxiety, especially among individuals who don't have the time to attend a weekly program, new research shows.

A team from La Paz University Hospital in Madrid, Spain, randomly assigned more than 90 medical and other healthcare students to one of three groups: a modular mindfulness app on their smartphone, a standard mindfulness session-based stress reduction program, or a control group.

Although the app group did not achieve the higher adherence rates that the researchers had expected, it showed significant improvements from baseline in comparison with the control group.

The findings, presented here at the European Psychiatric Association (EPA) 2019 Congress, indicated that the traditional mindfulness program was not associated with significant reductions in anxiety.

A "Promising Field"

Álvaro Orosa-Duarte, MD, a psychiatry resident at La Paz University Hospital, who presented the research, said that the smartphone application "is an effective tool for reducing anxiety symptoms among healthcare students."

"We will keep on researching smartphone applications; we think that this is promising field," he added.

Orosa-Duarte pointed out that healthcare students have greater levels of anxiety and depression than the general population.

While mindfulness-based stress reduction (MBSR) programs have been shown to be effective at reducing anxiety in medical students, they have a high dropout rate, largely due to the students lacking the time to participate in the program.

Hypothesizing that the use of the latest technologies helps improve adherence, Orosa-Duarte and colleagues conducted a randomized, rater-blind controlled clinical trial in medical, nursing, psychology, and nutrition students.

From an initial 140 students screened, 92 were randomly assigned to a mindfulness-based intervention delivered via a smartphone app (REM Volver a casa, Espacio de Formación en Salud y Psicoterapia; n = 50), an MBSR program (n = 45), or a control group (n = 45).

The app, which was provided to the participants free of charge, and the MBSR program consisted of eight modules or sessions, while the control group was a waiting list to gain access to the app.

The majority (76%) of the participants were studying medicine, while 13% were studying nursing, 6% psychology and the remaining 5% nutrition.

The students were ages 20 to 25 years and 84% were women.

After being randomly assigned, 42 students in the app group completed the baseline evaluation, and 30 remained in the study until the 8-week evaluation, producing a dropout rate of 40%. Thirty-five students in the MBSR group completed the baseline evaluation and 26 participated in the 8-week assessment, at a dropout rate of 42.2%.

Overall, 12 students completed less than five sessions of the MBSR program, and 14 completed at least five.

The dropout rate in the control group was 18.7%.

Less Anxiety

On an intention-to-treat analysis, the researchers found that compared with controls, those who used the app had significantly greater improvements in scores on the State-Trait Anxiety Inventory (STAI) between baseline and 8-week follow-up (P < .004).

This applied to both state and trait anxiety on the STAI, with app users showing significant improvements from baseline (P = .000 for both) whereas control students showed no significant changes on either measure.

Furthermore, there were no significant differences between controls and participants in the MBSR program in terms of changes in STAI scores during the course of the study.

Following the presentation, Orosa-Duarte said that the high dropout rate seen in their study "is consistent with prior research."

However, he noted that although researchers knew the number of sessions students attended in the MBSR program, they were not able to measure the time spent using the app, and therefore couldn’t compare compliance between the active interventions.

Paweł Gosek, MD, PhD, from the Institute of Psychiatry and Neurology, Warsaw, Poland, who co-chaired the session, asked whether Orosa-Duarte and colleagues will take the app "beyond [the] student group and into the general patient population."

Orosa-Duarte said that, at their hospital, they are using the app "as part of our day-to-day practice with the clinical population."

He explained that the study "was a part of a teaching project, and they were assessing other measures apart from anxiety, like empathy and compassion, as they are related to the doctor–patient relationship."

"So it was for students," Orosa-Duarte acknowledged, "but we are interested in the clinical population as well."

Orosa-Duarte and Gosek have disclosed no relevant financial relationships.

European Psychiatric Association (EPA) 2019 Congress: Abstract OC-0020. Presented April 7, 2019.

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