There is mounting evidence that mindfulness-based interventions bring about positive physical and mental health outcomes in both healthy (Brown and Ryan 2003
; Keng et al. 2011
) and clinical (Hilton et al. 2017
; Hofmann et al. 2010
) populations. Mindfulness aims to cultivate increased moment-to-moment awareness of one’s thoughts, feelings, and bodily sensations, while maintaining an open mind, free from distraction and judgment (Kabat-Zinn 1994
). A central tenet of mindfulness is that it does not aim to suppress or change direct experience, but rather the way in which present-moment experience is interpreted. By observing thoughts and feelings as mental events, rather than as reality or truths about the self, one can retrain negative thought patterns and reduce reactivity, thus fostering a greater sense of calm and well-being (Feldman et al. 2010
; Hoge et al. 2014
The most pervasive and well-established mindfulness-based interventions are mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT). These 8-week long, group-based interventions involve a combination of mindfulness and other stress reduction and cognitive techniques, with up to 45 min of home practice per day. MBSR and MBCT have been shown to convey a host of psychological benefits such as reduced stress and anxiety (Khoury et al. 2015
; Vøllestad et al. 2012
), reduced depressive symptomatology (Hofmann et al. 2010
), and increased quality of life in both cancer patients (Zhang et al. 2015
) and those with chronic pain (Hilton et al. 2017
). Further, these interventions have been linked to changes in executive functioning networks in the brain (Tang et al. 2012
). However, factors such as cost, time demands, and the requirement to attend sessions in person may act as barriers to enrolment for a significant proportion of the population, including young professionals, those with children, those with disabilities, and those living in rural areas.
Recently, digital mediums for mindfulness training, including mindfulness-based smartphone apps, have become widely available (Plaza et al. 2013
). Relative to in-person training, digital mediums are wider-reaching, demand less time, are more affordable, and may be more engaging. Digital mediums therefore have wide-reaching potential for improving public health. A recent meta-analysis of online mindfulness-based interventions has demonstrated significant beneficial impact on stress, anxiety, depression, and well-being, suggesting that digital mindfulness training may confer similar benefits to in-person training (Spijkerman et al. 2016
). In support of this, several recent studies suggest that mindfulness training delivered via a smartphone app can increase quality of life (van Emmerik et al. 2017
), well-being (Howells et al. 2014
), and self-reported mindfulness (Plaza García et al. 2017
), as well as reduce symptoms of depression (Ly et al. 2014b
Despite this shift, research focused on the efficacy of mindfulness-based smartphone apps (which are now highly popular) remains in its infancy. An important distinction between app-based mindfulness training and structured in-person training is that the former is self-guided and thus may involve lower overall durations of practice. While some studies suggest that very short mindfulness interventions can improve psychological well-being (Creswell et al. 2014
; Zeidan et al. 2011
), others argue that longer interventions are required (Baer et al. 2012
). In addition, previous studies of app-based mindfulness training have largely utilized inactive control groups (i.e., wait-list or no intervention) (Ly et al. 2014a
; van Emmerik et al. 2017
), or have focused on mindfulness as a sole outcome measure (Chittaro & Vianello 2016
; Plaza García et al. 2017
The present study aimed to assess whether completing the first 10 introductory sessions of the mindfulness-based smartphone app Headspace positively impacts stress, affect, and irritability, relative to an active control. Headspace features daily guided meditations delivered by former Buddhist monk Andy Puddicombe and was chosen due to its overwhelming popularity, with over 20 million global downloads at the time of writing. Headspace is also the highest scoring mindfulness app as per the Mobile Application Rating System (Mani et al. 2015
), and has previously been shown to convey a host of benefits, including increases in mindfulness (Bennike et al. 2017
; Morrison Wylde et al. 2017
; Wen et al. 2017
) and well-being (Howells et al. 2014
). Stress was chosen as an outcome measure for several reasons. First, it is one of the most commonly reported psychological health outcomes in mindfulness research, making it easy to weigh the present results against other mindfulness interventions and meta-analyses. Second, we posited that a very brief mindfulness intervention would be more likely to impact stress than other psychosocial outcomes (such as anxiety and depression), as stress is typically associated with larger overall effect sizes (Spijkerman et al. 2016
). In addition, affect and irritability were included as positive affect has previously been shown to increase following a brief in-person mindfulness intervention (Zeidan et al. 2010
), and Headspace has previously been shown to reduce aggressive behavior (DeSteno et al. 2017
A novel active control condition was utilized, which consisted of 10 excerpts from Andy Puddicombe’s audiobook The Headspace Guide to Meditation and Mindfulness. The sessions are narrated by Andy Puddicombe, are the same duration as the mindfulness meditation sessions, and were delivered via the Headspace app, thus closely matching the mindfulness intervention across key attributes. Specifically, the user flow through the app was identical in both the mindfulness and audiobook conditions, differing only with regards to actual session content. Compared to the active control, it was hypothesized that participants in the mindfulness intervention would demonstrate larger reductions in stress and irritability, and larger increases in positive affect.
A newer, more accessible form of online, self-guided mindfulness interventions have begun to show considerable promise as a means to improve psychosocial well-being (Spijkerman et al. 2016
). Online mindfulness interventions have successfully been used to reduce stress in a cohort of university students (Cavanagh et al. 2013
) and reduce anxiety, depression, and insomnia in a patient population (Boettcher et al. 2014
). However, evidence specifically supporting the efficacy of mindfulness-based smartphone apps is scarce (Mani et al. 2015
). In 2012, global smartphone shipments grew 46% to 722 million units, and there are now more than a thousand commercially available mindfulness apps. In this study, completing a brief, 10-day introductory program of a popular mindfulness app reduced average levels of self-reported stress and irritability and increased average mood ratings in our study cohort. These results were robust across both complete case and ITT analyses. Our study extends a growing body of research investigating self-help methods for increasing the dissemination of mindfulness-based interventions and suggest that mindfulness training delivered through a smartphone app has the potential to improve aspects of psychosocial well-being.
Our findings are largely consistent with previous reports that mindfulness training delivered through in-person or online formats has a beneficial impact on stress (Khoury et al. 2015
), positive affect (Garland et al. 2015
; Keng et al. 2011
), and emotional reactivity and regulation (Britton et al. 2012
; Hill and Updegraff 2012
). When examining effect sizes associated with stress, recent meta-analyses have reported moderate between-group Cohen’s d
effect sizes for both online (d
= 0.40; Spijkerman et al. 2016
) and in-person (d
= 0.51; Gotink et al. 2015
) interventions. This is consistent with a between-group effect size of d
= 0.45 for the event load subscale of the SOS reported in the present study and suggests that mindfulness training via Headspace is at least as affective at reducing stress associated with external pressure as other digital platforms or in-person programs. Moreover, relative to several studies included in the aforementioned meta-analyses, the present study utilized a more conservative control group, and a significantly shorter intervention.
Our results also expand a small but growing body of work suggesting that app-based mindfulness training increases aspects of well-being (Howells et al. 2014
; van Emmerik et al. 2017
). However, most online or app-based mindfulness studies have utilized wait-list control groups. Use of inactive controls has previously been raised as a methodological limitation, as they do not account for non-specific effects of intervention engagement and can limit interpretation of study findings (Davidson and Kaszniak 2015
). This was addressed in the present study by utilizing an audiobook-based active control comparison. This revealed that stress relating to personal vulnerability was effectively reduced by both the mindfulness and audiobook interventions, suggesting that this benefit was not unique to the practice of mindfulness. Since the majority of previous studies have utilized global measures of stress, it is difficult to compare this result to the existing literature. In addition, it remains unknown whether a group × time interaction would have emerged if a longer intervention period had been used. By contrast, the event load subscale of the SOS exhibited reduced scores following the mindfulness intervention, but not the audiobook control. This suggests that the ability to cope with external pressure, particularly when demand overwhelms resource, is selectively improved by mindfulness training, and may emerge as an early benefit. Previous research has attributed reductions in stress following mindfulness training to increases in dispositional mindfulness and decentering (Carmody and Baer 2007
; Feldman et al. 2010
), which might in turn mediate increased cognitive and behavioral flexibility, and a greater sense of goal-directedness (Carmody et al. 2009
An important but understudied question is how much mindfulness practice is needed in order for improvements in well-being to emerge. While some studies suggest that just a single session of meditation can improve mood (Johnson et al. 2013
), others have reported that measurable reductions in stress require at least 4 weeks of consistent practice (Baer et al. 2012
). In the present study, just 10 sessions of Headspace were sufficient to positively impact stress, affect, and irritability. This is consistent with a previous report that 10 days of Headspace increased positive affect and reduced depressive symptoms in a cohort of “happiness seekers” (Howells et al. 2014
). These results may have implications for reducing the burden of stress-related illness on economic and public health (Wiegner et al. 2015
), especially when considering the low cost and accessibility of digital health platforms. However, substantial further research is needed before definitive conclusions can be drawn.
Digital delivery mediums may have the potential to address some of the methodological challenges associated with traditional interventions such as MBSR. For example, estimating the quantity or dose of mindfulness training in meditation research is often problematic (Davidson and Kaszniak 2015
). This is particularly true for interventions that involve self-reported home practice or engagement with an active control that cannot be directly measured. In this study, both the mindfulness and audiobook interventions were delivered via the same smartphone app, allowing engagement to be accurately tracked, and ensuring equal dosage across conditions. A further benefit of using the same delivery medium for both interventions is the ability to match user experience, with both programs featuring the same voice and visual interface.
Limitations and Future Research
The present study has a number of limitations. First, the decision to focus on a brief intervention period precluded investigation of how the reported effects may change over longer periods of practice. Further, no follow-up data were collected, and the extent to which participants in the mindfulness group continued to engage with meditation after the 10-day program was not measured. However, a recent study using an app-based mindfulness intervention revealed benefits that persisted for at least 3 months (van Emmerik et al. 2017
Second, the results are limited by a modest sample size, with 69 total individuals across both intervention groups (87 for the ITT analysis). In particular, our exploratory analysis investigating modulators of score change was underpowered. Understanding who is most likely to benefit from an app-based mindfulness intervention is an important ongoing question, and future studies should attempt to replicate and expand upon our results with larger study cohorts.
Third, in an effort to keep the assessment phase as short as possible, we chose not to include a measure of mindfulness. Thus, we cannot be sure whether the benefits associated with the intervention are due to increases in mindfulness or another mechanism. However, several previous studies have reported increases in mindfulness following Headspace use (Bennike et al. 2017
; Wen et al. 2017
), suggesting that mindfulness likely increased in our study cohort.
Fourth, we cannot exclude the possibility that some participants in the audiobook (control) group may have sought out information regarding the Headspace app (or mindfulness in general), and subsequently engaged with meditation-related content outside of the audiobook (thus contaminating allocation to the control group). However, the potential for such contamination would likely have been reduced by the brevity of our intervention.
Fifth, participants’ scores at baseline suggest that on average, both groups were close to the general population mean on the SOS (cf. Amirkhan 2012
), the SPANE (cf. Diener et al. 2009
), and the BITe (cf. Holtzman et al. 2015
). Thus, although previous studies suggest that mindfulness is effective at reducing symptomatology and improving well-being in patient populations (Hofmann et al. 2010
; Reibel et al. 2001
), caution should be applied when attempting to extrapolate the findings reported here to other cohorts. Similarly, the majority of participants in our study identified as White/Caucasian, had a university degree, and had positive expectations about the benefits of meditation prior to beginning the intervention. These characteristics substantially limit the generalizability of the results, and future studies should attempt to investigate app-based mindfulness training in more diverse study cohorts.