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College can be demanding, and up to one-third of college students report feeling highly stressed. High stress levels can be a significant problem since a third of all college students report current or past mood, anxiety, or substance use disorders which can be retriggered or worsened by stress.
Mindfulness training can effectively reduce stress, but many students who enroll in mindfulness programs drop out before completion. Virtual reality (VR) technology has shown promise to improve learning, and may perhaps increase treatment adherence.
Mondrego-Alarcón et al. [Behaviour Research and Therapy] compared the relative efficacy of mindfulness versus relaxation training in reducing college student stress, and explored whether VR added to the mindfulness program reduces attrition.
The researchers randomly assigned 280 Spanish college students (79% female; average age = 22 years) to a standard mindfulness program, a VR-enhanced mindfulness program, or an active relaxation control. All groups met in person once weekly for six weeks. The mindfulness programs emphasized mindfulness and self-compassion using the body scan, and sitting, walking, movement, and self-compassion meditations.
The standard mindfulness condition met in 90-minute group sessions, while the VR-enhanced mindfulness condition met in 75-minute group sessions coupled with brief individual VR-guided meditations.
The body scan VR-meditation included a visual simulation of the human body which successively highlighted body parts as participants attended to those parts. Another VR meditation involved a virtual nature walk with participants mindfully observing their thoughts.
The relaxation control group utilized progressive muscle relaxation and visual imagery but did not use VR. All participants were assessed at baseline, post-treatment, and 6-month follow-up on the primary self-report measure of perceived stress as well as on the secondary outcomes.
The results show that, relative to the relaxation group, mindfulness (d=-0.72) and VR-enhanced mindfulness (d=-0.59) groups showed less perceived stress after intervention. This superiority remained at 6-month follow-up. The effect was dose dependent for mindfulness—the more sessions participants attended, the less their stress—but not for relaxation. Increases in mindfulness and self-compassion both contributed to decreased stress.
At post-treatment, the standard mindfulness group also showed significantly greater improvements on the secondary outcome measures of trait anxiety (d = -.90), emotional suppression (d = -0.71), mindfulness (d = 1.01), and self-compassion (d = .1.10) than the relaxation group.
These relative improvements persisted at 6-month follow-up and were joined by additional improvements in state anxiety (d = -1.37), affect balance (d = 1.02), academic engagement (d = 1.14) and burnout (d = -1.60). The VR-enhanced mindfulness group performed similarly on these measures but did not outperform the standard mindfulness group.
VR-enhanced participants had significantly better attendance than standard mindfulness participants, who in turn had significantly better attendance than relaxation participants. Ninety-six percent of the VR-enhanced group attended at least half of all sessions, compared with 83% of the standard mindfulness and 70% of the relaxation group.
The study shows mindfulness training to be superior to relaxation training in reducing stress in college students. Adding VR correlates with improved attendance in this younger sample, but did not yield superior efficacy on stress reduction.
The study is limited by its reliance on self-report measures, and inability to determine whether any novel activity for young adults like VR would increase motivation to attend a behavioral intervention.
Modrego-Alarcón, M., López-del-Hoyo, Y., García-Campayo, J., Pérez-Aranda, A., Navarro-Gil, M., Beltrán-Ruiz, M., Morillo, H., Delgado-Suarez, I., Oliván-Arévalo, R., & Montero-Marin, J. (2021). Efficacy of a mindfulness-based programme with and without virtual reality support to reduce stress in university students: A randomized controlled trial. Behaviour Research and Therapy.
Link to study
A common worry among older adults is cognitive decline. Older adults may worry about possible cognitive decline even when standardized tests fail to reveal signs of cognitive deficits. Adults with subjective cognitive decline are often anxious about their perceived loss of ability and emotionally reactive to minor acts of forgetfulness.
Marchant et al. [Psychotherapy and Psychosomatics] conducted a randomized controlled study to test the effect of a mindfulness-based intervention on anxiety in older adults with subjective cognitive decline compared to health self-management program.
The researchers recruited 147 participants (average age=73 years; 65% female) from memory clinics located in four European cities. Participants were self-referred or referred by physicians to the clinics because of their subjective memory complaints, but performed normally on standardized cognitive tests. Clinic patients with mild cognitive impairment, dementia, depression and anxiety disorders were excluded from the study.
Participants were randomly assigned to a Caring Mindfulness Approach for Seniors (CMBAS) program, or a health self-management program. CMBAS was modeled after the Mindfulness Based Stress Reduction program, and held in groups for 2-hours per week for 8 weeks. The program was tailored to the needs of older adults and emphasized compassion and lovingkindness meditation.
The health self-management program had the same structure and format as CMBAS, and emphasized sleep hygiene, stress management, exercise, diet, communication, memory, and action plans for improving health. Participants completed the State-Trait Anxiety Inventory and the Geriatric Depression Scale at baseline, post-intervention, and 6-month follow-up.
The results showed significant reductions at post-intervention in trait anxiety for both CMBAS (d=0.31) and health self-management (d=0.26) groups without any statistically significant superiority found for CMBAS. The reductions in trait anxiety were maintained at 6-month follow-up for both groups.
The CMBAS group had a significant decline in state-anxiety at post-intervention, but this was not significantly different from the smaller decline in the health self-management group.
Approximately equal percentages of CMBAS (15%) and health self-management (14%) participants experienced clinically meaningful anxiety improvements. Neither intervention reduced depressive symptoms, but depressive symptoms were already low at baseline.
The multinational clinical trial showed an adapted mindfulness or health self-management intervention reduced trait anxiety in older adults with subjective cognitive decline immediately after intervention and at 6-months after intervention end.
The study is limited by its lack of a passive control group to determine if mere monitoring over time by the study team tends to reduce anxiety among people concerned over cognitive decline. The findings cannot be generalized to those with anxiety disorders as those eligible had only subclinical symptoms of anxiety.
Marchant, N. L., Barnhofer, T., Coueron, R.,...Molinuevo, J. L. (2021). Effects of a Mindfulness-Based Intervention versus Health Self-Management on Subclinical Anxiety in Older Adults with Subjective Cognitive Decline: The SCD-Well Randomized Superiority Trial. Psychotherapy and Psychosomatics.
Mindfulness training often results in mood benefits given that practitioners learn to experience discomfort without reactivity and cultivate positive emotions. However, little is known how mindfulness training affects shifts in daily positive and negative emotions.
People differ in how much their emotions vary over the course of a day (affect variability), how easily their emotions are aroused (affect instability), and how persistent emotions are once they are once aroused (affect inertia). Higher levels of negative emotional variability, instability, and inertia are observed in people with various mental health disorders. By contrast, people who are more mindful generally experience less negative affect variability, instability, and inertia.
Keng et al. [Mindfulness] tested the effect of Mindfulness-Based Stress Reduction (MBSR) on daily emotional shifts in a randomized study compared to an active control.
The researchers randomly assigned a non-clinical sample of 158 adult ethnic Chinese Singaporeans (average age=29 years; 59% female) to either MBSR or a music therapy-based stress reduction program. MBSR was delivered using the standard 8-week group protocol that included a half-day meditation retreat.
The music therapy control was matched to MBSR in terms of time duration and retreat, structure, and social support. Music therapy included supportive music and imagery, performance, receptive listening, composition, and improvisation.
Participants reported on their emotions 12 times daily for 3 days prior to and 3 days after the interventions in response to smartphone-delivered prompts. Prompts were issued an average of every half-hour between 9AM and 5PM. At each prompt, participants rated their experience of 17 different emotions.
Affect variability was measured using the standard deviation of ratings, inertia by rating intercorrelations between time points, and instability by the average squared differences between successive time points. Participants also completed a questionnaire of self-reported emotional regulation difficulties before and after the intervention.
The results showed that the MBSR group significantly decreased the variability and instability of negative emotions with a small-to-medium effect size, and significantly decreased emotional regulation difficulties relative to the music therapy group. MBSR showed significantly greater decreases in variability for anger, fear, guilt/shame, and sadness, and significantly greater decreases in instability for anger, fear guilt/shame, sadness, worry, frustration, and disgust.
MBSR participants were significantly less likely than those in music therapy to experience any increases in negative emotion larger than two standard deviations in magnitude. There were no differences by group on the average intensity of negative emotions, negative affect inertia, or any of the positive emotion variables.
The study shows MBSR, relative to music therapy, reduces the volatility of daily negative emotions and improves self-report of emotional regulation without necessarily changing the intensity of participants’ average daily positive or negative moods.
These findings are in accord with the common training principle that mindfulness does not necessarily stamp out negative emotions, but helps one experience them with diminished reactivity.
Keng, S.-L., Tong, E. M. W., Yan, E. T. L., Ebstein, R. P., & Lai, P.-S. (2021). Effects of Mindfulness-Based Stress Reduction on Affect Dynamics: A Randomized Controlled Trial. Mindfulness.
Mindfulness requires cognitive effort and so practice places demands on a meditator’s attention. Many psychological disorders include impairment in attention as a symptom, and patients with attentional impairment may find mindfulness practice too frustrating to sustain. Medications that improve attentional focus may help mindfulness practitioners gain more from their practice.
Modafinil is a medication that improves attention in patients with daytime sleepiness due to problems sleeping. Its psychopharmacologic effects mirror some of the attentional improvements seen in mindfulness training.
Thomas et al. [Journal of Psychopharmacology] tested the effects of modafinil on self-reported state mindfulness, mind wandering, and vigilance among participants practicing mindfulness or relaxation training.
The researchers randomly assigned 80 healthy meditation-naïve participants (average age=25 years; 50% male) to one of four groups: modafinil + mindfulness, modafinil + relaxation, placebo + mindfulness, and placebo + relaxation. Participants were blinded to drug and practice type. On the first day of an eight-day intervention, participants received 200mg of modafinil or a placebo pill and trained in mindfulness or relaxation.
Participants completed assessments immediately before and two hours after medication delivery, and again immediately after initial meditation or relaxation on a variety of measures.
Over the next six days, participants engaged in daily home practice of mindfulness or relaxation techniques, and were then reassessed on the eighth day. Outcome measures included state and trait mindfulness, mood, mind-wandering, heart rate variability, and sustained attention.
Mindfulness and relaxation trainings were delivered as 10-minute audio recordings that contained brief instruction and practice. Mindfulness instructions involved focused attention on the breath.
Relaxation instructions involved abdominal breathing and intentional muscle relaxation. Both sets of instructions emphasized returning to task if one’s mind wandered.
Post-training mind-wandering was assessed by having participants practice either mindfulness or relaxation for 16 minutes, and click on a keyboard mouse whenever their minds wandered. Sustained attention was measured by response times to stimuli randomly presented on a computer screen. This task is known to be sensitive to both mindfulness training and modafinil.
Results from the single day experiment showed modafinil improved state mindfulness before (d=0.34) and after both mindfulness and relaxation training (d=0.45), and to a similar extent by group. Modafinil improved positive mood before (d=0.54) and after the trainings (d=0.60), and to a similar extent by group.
Heart rate variability (a sign of increased parasympathetic activity) increased in the mindfulness group but not the relaxation group (d=0.52). Modafinil significantly improved sustained attention in both groups (partial η2=0.07). There were no drug or group effects on subjective mind-wandering.
After eight days of home meditation or relaxation practice, all groups significantly improved on state mindfulness. Groups who received modafinil on the first day of the intervention showed significantly more weekly home practice (average = 55 mins) than those who received placebo (average = 36 mins).
The study shows that modafinil improves state mindfulness, sustained attention, and positive mood in a single-day experiment. When given at baseline, it increases practice effort over the course of about a week. Mindfulness training increases heart rate variability more than relaxation training, but there were no differences between the trainings on state mindfulness.
The absence of any difference between the groups on state mindfulness may be due to similarities between the trainings, as both involved breathing and instructions to maintain focus. The study is limited by the brevity of its trainings, and lack of emphasis on non-judgmental awareness in the mindfulness group.
Thomas, E. M., Freeman, T. P., Poplutz, P., Howden, K., Hindocha, C., Bloomfield, M., & Kamboj, S. K. (2021). Stimulating meditation: A pre-registered randomised controlled experiment combining a single dose of the cognitive enhancer, modafinil, with brief mindfulness training. Journal of Psychopharmacology.
[Link to study]
People with chronic obstructive pulmonary disease (COPD) suffer from shortness of breath that limits their physical activity. Other symptoms include wheezing, coughing, and an unpleasant awareness of breathing difficulty known as dyspnea. Standard care treatment includes medication and physical rehabilitation focused on breathing exercises.
Lin & Yeh [Clinical Rehabilitation] conducted a randomized controlled trial to test if a mindful walking program improves exercise capacity and reduces perceived difficulty in breathing among older adults with COPD compared to a standard care control.
The researchers randomly assigned 84 older adult Taiwanese clinic patients (average age=72 years; 97% male) with mild-to-severe COPD to mindful walking added to treatment-as-usual or treatment-as-usual only. Participants in the mindful walking group engaged in mindful walking 5 days a week for 8 weeks.
The 35-minute daily mindful walking program included 5 minutes of meditation with focused diaphragmatic breathing, 5 minutes of stretching, 20 minutes of walking with controlled breathing, and a 5-minute cool down with gradually decelerating walking.
Controlled breathing while walking involved 3-second inhalations using diaphragmatic breathing and 6-second exhalations through pursed lips. Participants were trained on mindful walking on the first day of the program, then did their daily walking independently at home.
Treatment-as-usual included standard care medical education focused on medication, diet, and smoking cessation as well as a monthly telephone medical consultation.
Participants were evaluated at baseline, week 4 and 8 of treatment, and at 12-week follow-up after study end on walking distance within 10 minutes, perceived difficulty in breathing, heart rate variability, and interoceptive awareness.
Perceived difficulty in breathing was measured on a 10-point scale, with low scores indicating the absence of symptoms and the highest score indicating severe shortness of breath accompanied by panic. The interoceptive awareness measure included subscales on emotional awareness, attentional regulation, body listening, and noticing.
The results showed that the mindful walking group significantly increased distance walked in 10 minutes, whereas the control group decreased distance walked. The mindful walking group increased distance walked by an average of 29 meters, a clinically meaningful increase, while the control group decreased distance walked by an average of 8 meters.
This between-group difference was significant at 4, 8, and 12 weeks. Mindful walkers reported significantly less difficulty in breathing than controls.
This study shows that a mindful walking program can increase walking distance and decrease perceived breathing difficulties in COPD patients compared to a clinical treatment-as-usual.
The study is limited by the absence of an active control group, especially one that includes walking without mindfulness training. It is unclear how much benefit was gained from the mindfulness component relative to the physical demands of daily walking.
Lin, F.-L., & Yeh, M.-L. (2021). Walking and mindfulness improve the exercise capacity of patients with chronic obstructive pulmonary disease: A randomised controlled trial. Clinical Rehabilitation.
People often look forward to leisure vacations as relief from work and life routines, and to improve their well-being. Little is known about what types of vacations yield the most enduring benefits. For example, would a person benefit more from a leisure vacation, a meditation retreat, or a mixture of both?
It is commonly reported that the benefits of leisure-only vacations are short-lived upon return to mundane routines, and so it is possible that adding meditation to leisure vacations might support a more enduring sense of well-being.
Blasche et al. [PLOS One] conducting a naturalistic study to observe the relative psychological benefits of intensive meditation retreats, leisure vacations with meditation, and leisure vacations without meditation in a sample of people with previous meditation experience.
The researchers assessed 120 experienced meditators (average age=52 years, 59% female, average weekly meditation practice=5 hours) before and after an intensive meditation retreat, a leisure vacation with some mediation practice, or a leisure vacation without meditation. All participants were members or affiliates of a Buddhist organization who were planning a retreat or vacation.
The average length of retreats and vacations was 14-15 days. Intensive retreats included an average of 34 hours of meditation practice per week. Vacations with meditation included an average of 3 hours of meditation per week. Leisure-only vacations did not include meditation. Primary forms of meditation used were focused-attention and/or open monitoring meditation.
Participants were assessed 10 days before, 10 days after, and 10 weeks after their retreat or vacation on measures of fatigue, emotional well-being, and acting with mindful awareness. The study period was similar for all participants and spanned August to October of the same year.
The results show that all three retreats/vacations led to significant decreases in fatigue and increases in well-being and acting with awareness at immediate post assessment and 10-week follow-up. The intensive retreat and the vacation-with-meditation groups, however, had significantly higher levels of acting with awareness (d=0.50) than the leisure-only group at immediate post assessment and 10-week follow-up.
At 10-week follow-up, the intensive retreat and the vacation-with-meditation groups had significantly higher well-being (d=0.81; d=0.70) and significantly lower fatigue scores (d=0.60; d=0.62) than the leisure-only group.
This study finds that intensive retreats and vacations infused with some meditation practice enhance acting with mindful awareness better than leisure-only vacations out to 10 weeks after the vacation ends. The well-being and fatigue benefits of a vacation lacking meditation fade more quickly over time than similar benefits derived from intensive retreats or vacations that include some meditation practice.
It is surprising that the results did not show a superiority of intensive retreats over vacations that included meditation in terms of acting with awareness. These were all experienced meditators, however, and so there may be a ceiling on their ability to improve on a mindfulness measure. Findings are limited by the use of a naturalistic study design that lacked randomization to groups.
Blasche, G., deBloom, J., Chang, A., & Pichlhoefer, O. (2021). Is a meditation retreat the better vacation? Effect of retreats and vacations on fatigue, emotional well-being, and acting with awareness. PLOS ONE, 16(2), e0246038.
Brain imaging studies find that mindfulness training can change the human brain’s functional connectivity. That is, the degree to which various brain regions jointly covary in their activity. However, the causal direction of brain connectivity remains unknown due to the limitations of functional connectivity analyses that only indicate if synchrony occurs, but cannot clarify the brain regions that initiate these changes.
Effective connectivity analyses is a newer method that may be able to uncover the temporal sequence of brain functional activity
Santarnecchi et al. [Journal of Neuroscience Research] tested the effects of MBSR on brain activity compared to an inactive control group of healthy participants using fMRI functional and effective connectivity analyses of brain regions in a randomized controlled trial.
The researchers randomly assigned 46 meditation-naïve Italian adults (average age=30 years; 52% female) to either MBSR program or a wait-list control. MBSR was delivered in the standard 8-week group-based format that included 45 minutes of daily homework and a 7-hour retreat.
All participants underwent neuroimaging before and after the intervention period, both during a resting state and while engaging in mindfulness of the breath and body. Pre-treatment conditions and the post-treatment control condition were told to attend to sensations of breathing and bodily sensations, while the post-treatment MBSR condition was instructed to meditate as they had been taught in MBSR.
Imaging results showed that MBSR resulted in significant decreases in local regional homogeneity in the right anterior putamen and the right insula during the resting state compared to controls.
MBSR also resulted in a significant decrease in right cerebellum regional homogeneity during mindfulness practice compared to controls. Regional homogeneity is a measure of the degree to which adjacent fMRI voxels within a brain region show synchronous activity.
The effective connectivity analysis using the above regions as seeds revealed a number of functional changes as a result of mindfulness training:
During the resting state, the anterior cingulate cortex decreased its excitatory influence on the right anterior putamen.
During mindfulness practice, the right cerebellum decreased its inhibitory effect on the right posterior putamen and right orbitofrontal cortex; the left posterior putamen decreased its excitatory influence on the right cerebellum; and the left somatosensory cortex increased its inhibitory effect on the right cerebellum.
The role of the putamen is prominent in several of these findings. This makes sense as the anterior putamen is involved in executive functioning and attention, while the posterior putamen is involved in somatosensory processing. These processes play key roles in the attentional control and awareness of bodily sensations that are central to mindfulness.
This study uses a novel brain imaging methodology and shows that MBSR alters the influences of the anterior cingulate and orbitofrontal cortexes on the putamen, and the putamen on the cerebellum. Findings highlight the temporal patterns that play a key role in brain activity correlated with mindfulness training.
The study interpretation is limited by not including respiration and cardiac rates as covariates, as these might affect changes in the blood oxygenation levels that generate fMRI images.
Santarnecchi, E., Egiziano, E., D’Arista, S., Gardi, C., Romanella, S. M., Mencarelli, L., Rossi, S., Reda, M., & Rossi, A. (2021). Mindfulness-based stress reduction training modulates striatal and cerebellar connectivity. Journal of Neuroscience Research.
Link to article
Mild Cognitive Impairment (MCI) is a decline in cognitive performance that is more severe than that of normal aging, yet less severe than that of dementia. Patients with MCI are at risk for developing dementia, and researchers are interested in treatments that can forestall or prevent the progression to dementia onset.
Since mindfulness-based interventions are associated with improvements in attention and increases in brain gray matter cortical thickness, they may be able to help slow or prevent the progression to dementia.
Yu et al. [Journal of Psychiatric Research] compared changes in cognitive functioning and brain cortical thickness in older adults with MCI who participated in either a nine-month mindfulness-based intervention or a control group.
The researchers randomly assigned 54 Singaporean adults (average age=71; 74% female) diagnosed with MCI to either a mindfulness training or health education program. MCI diagnosis was based on subjective reports of cognitive difficulty and a battery of objective neuropsychological tests with final diagnosis made by expert panel consensus. Both interventions met in 45-minute group sessions on a weekly basis for the first 3 months, and then on a monthly basis for the final 6 months of the study.
The mindfulness program included exercises in focused sensory attention, the body scan, walking meditation, and gentle movement meditation. The health education control included didactic instruction on chronic illness, medication compliance, diet, exercise, and relaxation.
Participants were assessed at baseline, 3 months, and 9 months. Assessments included CT scans of the brain and neuropsychological measures of working memory (digit span), divided attention (a trail making task with interference), verbal memory, verbal fluency and, visuospatial processing. CT scans of the brain were evaluated for region of interest changes in gray matter cortical thickness. Regions of interest, including the anterior cingulate cortex, orbitofrontal cortex, frontal pole, and insula, were based on findings from previous mindfulness studies.
Neuropsychological test results at 9 months showed the mindfulness group improved significantly more on cognitive performance than controls (partial η2= 0.44). Subsequent post-hoc analyses showed this superiority was mostly due to improvements in working memory (partial η2= 0.18) and divided attention (partial η2= 0.13). The significance of the post-hoc analyses did not survive correction for multiple tests of significance.
CT scan results at 9 months showed that the mindfulness group showed significantly greater CT scan region of interest increases in cortical thickness (partial η2= 0.67) than controls. Subsequent post-hoc analyses showed this was primarily due to significantly greater increases in right frontal pole (partial η2= 0.21) cortical thickness, and significantly greater decreases in left anterior cingulate cortex cortical thickness (partial η2= 0.21).
The gains in right frontal cortical thickness are consonant with gains in executive cognitive function. The decrease in cingulate cortex cortical thickness was unexpected, but not necessarily a bad outcome as it could reflect reductions in negative emotional reactivity. The significance of these post-hoc analyses did not survive correction for multiple tests of significance.
Yu, J., Rawtaer, I., Feng, L., Fam, J., Kumar, A. P., Kee-Mun Cheah, I., Honer, W. G., Su, W., Lee, Y. K., Tan, E. C., Kua, E. H., & Mahendran, R. (2021). Mindfulness intervention for mild cognitive impairment led to attention-related improvements and neuroplastic changes: Results from a 9-month randomized control trial. Journal of Psychiatric Research, 135, 203–211.
A majority of Americans report sleep problems, and over 50 million Americans meet diagnostic criteria for a sleep disorder. Sleep disorders are associated with many impairments in daytime functioning such as work performance, fatigue, and sleepiness. Sleep aid medications can help in the short-term but are not recommended for long-term use.
Cognitive-behavioral therapies show promise yet can be costly and difficult to access in some regions. Since stress and worry are known to contribute to sleep difficulties, mindfulness training may also aid in resolving problems sleeping.
Huberty et al. [PLOS One] tested the effects of a brief daily use of a mindfulness meditation smartphone app compared to waitlist controls on sleep disturbance symptoms among people reporting elevated insomnia symptoms.
The researchers randomly assigned 263 participants (average age=45 years; 75% female; 57% Caucasian) reporting elevated insomnia symptoms (an Insomnia Severity Index Score >10) to an app-based mindfulness training or a waitlist control. Many of the participants reported having received prior diagnoses such as insomnia (25%), restless leg syndrome (22%), sleep apnea (16%), night terrors (12%) and narcolepsy (5%).
The mindfulness group was assigned to meditate at least 10 minutes daily using the smartphone Calm app over an 8-week period. The Calm app is a commercially available app containing guided meditations derived from Mindfulness-Based Stress Reduction (MBSR) and Vipassana meditation.
Self-report ratings of daytime fatigue, daytime sleepiness, and cognitive and somatic pre-sleep arousal were assessed at baseline, mid-treatment (4 weeks) and post-treatment (8 weeks). Participants in the mindfulness group also kept a daily sleep quality diary for the 8-week period.
The results showed that the mindfulness group spent an average of 15 minutes per day using the Calm app. At post-treatment, the mindfulness group reported significantly greater decreases in fatigue (d=0.23), daytime sleepiness (d=0.30), and cognitive (d=0.33), and somatic pre-sleep arousal (d=0.46) than controls. Mindfulness participants also reported significant improvements in sleep quality (d=0.13) over time, reporting that they fell asleep faster (d=-0.03) and slept longer (d=0.90).
This experimental study shows a mindfulness training app reduces pre-sleep arousal and daytime fatigue and sleepiness in persons reporting sleep difficulties. App users also reported improved sleep quality. These results are important because they show the promise of an easily-accessed, inexpensive, non-intensive mindfulness training people can perform on their own at home.
The study is limited by reliance only on self-report measures and a control group that received no intervention nor completed sleep diaries. It is possible that any app supporting daily wellness and motivating new behavior could lead to similar improvements in sleep.
Huberty, J. L., Green, J., Puzia, M. E., Larkey, L., Laird, B., Vranceanu, A.-M., Vlisides-Henry, R., & Irwin, M. R. (2021). Testing a mindfulness meditation mobile app for the treatment of sleep-related symptoms in adults with sleep disturbance: A randomized controlled trial. PLOS ONE, 16(1), e0244717.
The human heart beats about 100,000 times per day. The time interval between each heartbeat changes from moment to moment. Heart rate variability (HRV) is a measure of these time fluctuations between heartbeats over time. When relaxed, our hearts show greater momentary beat-to-beat variation, and so greater HRV. This is due to the predominance of parasympathetic over sympathetic nervous system activity when we are not under stress. Researchers consider increases in HRV to be an objective measure of stress reduction.
Preliminary studies show mindfulness meditation increases HRV. However, these studies often rely on one-time measurements, leaving little known about the persistence of HRV changes over time. Kirk et al. [PLOS One] studied short- and longer-term changes in HRV before, during, and after an app-based mindfulness training compared to two control groups. The study is unique in obtaining HRV measures in participants’ home environments rather than in a laboratory setting.
The researchers randomly assigned 90 Danish participants (average age = 37 years; 70% female) to a 10-day mindfulness training using the Headspace app, a 10-day app-based music listening control condition, or a no-intervention control. The Headspace guided meditation sessions were 20-minutes in length on days 1-5, and 30-minutes in length on days 6-10. Mindfulness training included focused-attention on the breath and body, awareness of mind-wandering, and developing a non-judgmental attitude.
The music listening app consisted of a playlist of 20 two- to four-minute music tracks offered in 20- and 30-minute installments. The inactive control group conducted their lives as usual during the 10-day intervention period.
All participants had their HRVs continuously monitored using a wearable device while going about their normal daily activities for 48 hours prior to and 48 hours following the intervention period. In addition, participants in the mindfulness and music groups had their HRVs monitored whenever they were using the assigned intervention app, allowing researchers to monitor HRV over the 10 intervention days. They also completed self-report measures of perceived stress and mindfulness (the Mindful Attention Awareness Scale).
Results showed significantly larger increases in mindfulness (η2p=.14) and larger decreases in perceived stress (η2p=.08) after intervention for the mindfulness group over each control groups. The mindfulness group showed significantly greater increases in average daytime (η2p=.12) and nighttime (η2p=.30) HRV after intervention than each control group.
Increases in post-intervention daytime HRV (r=.47) and nighttime HRV (r=.44) were significantly correlated with total minutes of meditation practice during intervention. Music group nighttime increases in HRV were also correlated with time spent listening to music (r=.36).
There were also acute HRV effects that occurred while meditating or listening to music. The mindfulness group showed a significant 13 millisecond average increase in HRV over baseline while meditating. The music group showed a significant 9 millisecond increase over baseline while listening to music.
The mindfulness group showed a respiration rate that significantly decreased by four breaths a minute compared to baseline while meditating, while the music group did not slow respiration while listening to music.
The study shows that an app-delivered 10-day mindfulness intervention increases HRV while meditating, and that increases in HRV persist for 48 hours after the 10-day training period. Total minutes of meditation correlated with increased HRV. The study demonstrates the feasibility of assessing HRV as an objective biomarker in naturalistic environments outside the laboratory. The analysis in the study is limited by not adjusting for respiration rate and tidal volume which can directly impact HRV.
Kirk, U., & Axelsen, J. L. (2020). Heart rate variability is enhanced during mindfulness practice: A randomized controlled trial involving a 10-day online-based mindfulness intervention. PLOS ONE, 15(12), e0243488.
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