Efficacy and Moderation of Mobile App–Based Programs for Mindfulness-Based Training, Self-Compassion Training, and Cognitive Behavioral Psychoeducation on Mental Health: Randomized Controlled Noninferiority Trial
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Abstract
Background: Mindfulness-based interventions, self-compassion training, and cognitive behavioral therapy have garnered much evidence in its salutary effects on mental health. With increasing application of smartphone and mobile technology on health promotion, this study investigated the efficacy and possible moderators of mindfulness, self-compassion, and cognitive behavioral psychoeducation training mobile apps in the improvement of mental health. Objective: The aim of this study was to examine the efficacy of 3 mobile app–based programs: mindfulness-based program, self-compassion program, and cognitive behavioral psychoeducation program in improving mental well-being and reducing psychological distress. Changes in mindful awareness and self-compassion were also assessed. To further delineate the suitability of each program for different types of individuals, individual difference variables (ie, discomfort with emotions and tolerance for ambiguity) were explored for potential moderation. Methods: This study was a 3-arm, randomized, controlled, noninferiority trial examining the efficacy of mindfulness-based program, self-compassion program, and cognitive behavioral psychoeducation. Participants were randomized into either 1 of the 3 conditions. Throughout the 4-week, 28-session program, participants spent 10-15 min daily reviewing the course content and practicing various related exercises. At preprogram, postprogram, and 3-month follow-up, participants also completed Web-based measures of mental well-being, psychological distress, mindful-awareness, and self-compassion as well as the proposed moderators. Results: Among the 2161 study participants, 508 and 349 completed the post- and 3-month follow-up assessment, respectively. All 3 conditions (mindfulness-based program: N=703; cognitive behavioral psychoeducation: N=753; self-compassion program: N=705) were found to be efficacious in improving mental well-being and reducing psychological distress. All conditions enhanced mindful awareness at postprogram. Significant interaction effect was found on self-compassion; cognitive behavioral psychoeducation and self-compassion program, but not mindfulness-based program, significantly enhanced self-compassion at postprogram. No significant differences regarding usage and users’ satisfaction were found among the 3 conditions. None of the proposed moderators were found to be significant. Conclusions: Mindfulness-based, self-compassion, and cognitive behavioral psychoeducation mobile apps were efficacious in improving mental well-being and reducing psychological distress among adults at postprogram and 3-month follow-up. Future app-based psychological training programs should consider gamification and personalization of content or feedback to enhance engagement and mitigate the high attrition rates that are common in app-based health promotion programs. Trial Registration: Chinese Clinical Trial Registry (ChiCTR) ChiCTR-TRC-13003468; http://www.chictr.org.cn/hvshowproject.aspx?id=6220 (Archived by WebCite at http://www.webcitation.org/734PlOz50)
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In one large study of a mindfulness intervention using a mobile app, only 24% of participants completed the intervention.
“For example, in one large study of a mindfulness intervention using a mobile app, only 24% of participants completed the intervention (Mak et al., 2018).”
From Emergency department nurses' experiences of a mindfulness training intervention: A phenomenological exploration (2023) · cites this paper as Mak et al., 2018
The Discussion (Limitations and Future Directions; page unavailable) reports 76.5% attrition at postprogram, leaving about 24% retained. But the Methods (Program Evaluation Outcome; page unavailable) distinguish completing a postprogram assessment from using the intervention sessions, and the attrition figure covers all three app programs rather than the mindfulness program alone. The paper therefore does not establish that only 24% completed the mindfulness intervention. (LLM, conf=0.88)
Experimental — accuracy not yet measuredRCTs primarily examining constructive or deconstructive practices are rare.
“RCTs primarily examining constructive or deconstructive practices are rare (with some promising exceptions) [66,67].”
From Testing the efficacy of a multicomponent, self-guided, smartphone-based meditation app: Three-armed randomized controlled trial (2020) · cites this paper as [66]
The Methods (Trial Design; page unavailable) describe this paper as an RCT that includes self-compassion training, so it supports the citation as a promising exception. The Discussion (Principal Findings—Efficacy and Application; page unavailable) calls rigorous RCTs of mobile mindfulness and self-compassion apps few, but does not establish that RCTs of constructive or deconstructive practices generally are rare. (LLM, conf=0.85)
Experimental — accuracy not yet measured
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- Authors
- Mak, W. W., Tong, A. C., Yip, S. Y., Lui, W. W., Chio, F. H., Chan, A. T., & Wong, C. C.
- Affiliations
- Chinese University of Hong Kong (HK)
- Hospital Authority (HK)
- Hong Kong Shue Yan University (CN)
- University of Houston (US)
- Corresponding author
- Mak, Winnie WS
- Venue
- JMIR Mental Health
- Publisher
- JMIR Publications Inc.
- Published
- 2018-10-11
- Volume
- 5
- Issue
- 4
- Pages
- e60
- ISSN
- 2368-7959 (ISSN-L)
- PMC
- PMC6231823
- OpenAlex
- W2887240541
- Cited by
- 123
- References
- 80
- Citations by year
- 2026: 13 · 2025: 19 · 2024: 11 · 2023: 20 · 2022: 17 · 2021: 16 · 2020: 19 · 2019: 8
- FWCI
- 13.56
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JMIR Mental Health (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Health and Medical Research Fund (11121081)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Keywords
- mobile application, mindfulness training, self-compassion training, mental health, psychological distress, psychological well-being, mindful awareness, self-compassion, moderators, emotional discomfort, ambiguity tolerance, digital mental health interventions, non-inferiority, adults
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