Can Acceptance, Mindfulness, and Self-Compassion Be Learned by Smartphone Apps? A Systematic and Meta-Analytic Review of Randomized Controlled Trials

doi:10.1016/j.beth.2019.10.002

Behavior Therapy

Volume 51, Issue 4, July 2020, Pages 646-658

https://doi.org/10.1016/j.beth.2019.10.002 Get rights and content

Highlights

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Examined if acceptance, mindfulness, and self-compassion can be learnt by apps.
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Twenty-seven trials were examined in a meta-analysis.
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Apps resulted in small improvements in acceptance, mindfulness, and compassion.
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Quality of evidence was poor due to many high-risk of bias trials.

Abstract

The potential health benefits of acceptance, mindfulness, and self-compassion are well-documented. However, interventions that teach these principles typically rely on face-to-face delivery, which can limit their dissemination. Delivering these interventions through smartphone apps could help overcome this. This meta-analysis examined whether principles of acceptance, mindfulness, and self-compassion can be learned through smartphone apps. Twenty-seven randomized controlled trials were included. Smartphone apps that included acceptance and/or mindfulness components resulted in significantly higher levels of acceptance/mindfulness than comparison conditions (k = 33; g = 0.29; 95% CI = 0.17, 0.41). These effects were moderated by the type of comparison and whether reminders to engage were offered. Smartphone apps also resulted in significantly lower levels of psychological distress than comparisons (k = 22; g = −0.32; 95% CI = −0.48, −0.16). Meta-regression revealed a negative relationship between the effect sizes for mindfulness/acceptance and the effect sizes for distress. Smartphone apps produced significantly greater increases in self-compassion than comparisons (k = 9; g = 0.31; 95% CI = 0.07, 0.56), although the quality of RCTs in this analysis was poor. Findings suggest that principles of acceptance, mindfulness, and self-compassion may be learned through cheap, easily accessible, and low-intensity interventions delivered via smartphone apps. However, the quality of available evidence is poor, as low risk of bias was noted in few trials (18%) and the observed effects were likely explained by a digital placebo.

Section snippets

Search Strategy and Study Selection

Three major online databases (PsycINFO, Medline, and Cochrane database of randomized controlled trials) were searched in December 2018 (and updated in March 2019) using the following search terms: smartphone* OR “mobile phone” OR “cell phone” OR “mobile app*” OR iphone OR android OR mhealth OR m-health OR “cellular phone” OR “mobile device*” OR mobile-based OR “mobile health” OR tablet-based AND random* OR trial* OR allocat* AND mindful* OR accept* OR ACT OR meditate* OR compass*. Reference

Results

A flowchart of the literature search is presented in Figure 1. Twenty-seven RCTs, with 31 app-supported smartphone intervention conditions, met full inclusion criteria. Most trials delivered an app that was entirely based on mindfulness and acceptance interventions, and one trial delivered an app that was entirely based on compassion-focused principles. The other trials (k = 7) delivered multicomponent apps (i.e., contained some components of acceptance, mindfulness, or compassion among other

Discussion

Accumulating research indicates that learning acceptance, mindfulness, and self-compassion skills are temporally and causally linked with mental health and well-being improvements (Gu et al., 2015, Wahl et al., 2013). However, interventions that teach these principles usually rely on face-to-face contact with a therapist, which can limit their dissemination (Kazdin, 2017). Translating these interventions for delivery via smartphone devices has the potential to overcome these issues of

Conflict of Interest Statement

The author declares that there are no conflicts of interest.

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View full text

Can Acceptance, Mindfulness, and Self-Compassion Be Learned by Smartphone Apps? A Systematic and Meta-Analytic Review of Randomized Controlled Trials

Highlights

Abstract

Section snippets

Search Strategy and Study Selection

Results

Discussion

Conflict of Interest Statement

Behavior Therapy

Drug and Alcohol Dependence

Clinical Psychology Review

Behaviour Research and Therapy

Journal of Affective Disorders

Clinical Psychology Review

Clinical Psychology Review

Behavior Therapy

Clinical Psychology Review

Behaviour Research and Therapy

Behavior Therapy

Journal of Contextual Behavioral Science

Clinical Psychology Review

Schizophrenia Research

Pain

Journal of Contextual Behavioral Science

Journal of Contextual Behavioral Science

Clinical Psychology Review

Internet interventions

The Lancet Psychiatry

Journal of Contextual Behavioral Science

Impact of metacognitive acceptance on body dissatisfaction and negative affect: Engagement and efficacy

Journal of Consulting and Clinical Psychology

Construct validity of the five facet mindfulness questionnaire in meditating and nonmeditating samples

Assessment

Mental health smartphone apps: Review and evidence-based recommendations for future developments

JMIR Mental Health

Self-compassion: Conceptualizations, correlates, and interventions

Review of General Psychology

Entwicklung und Validierung eines Fragebogens zur standardisierten Selbsteinschätzung emotionaler Kompetenzen (SEK-27)

Zeitschrift für Psychiatrie, Psychologie und Psychotherapie

Mindfulness: A proposed operational definition

Clinical Psychology: Science and Practice

Introduction to meta-analysis

The benefits of being present: Mindfulness and its role in psychological well-being

Journal of Personality and Social Psychology

The assessment of present-moment awareness and acceptance: The Philadelphia Mindfulness Scale

Assessment

Mindfulness and the attenuation of post-event processing in social phobia: An experimental investigation

Cognitive Behaviour Therapy

Effects of mindfulness training programmes delivered by a self-directed mobile app and by telephone compared with an education programme for survivors of critical illness: a pilot randomised clinical trial. Thorax, (no pagination)

Efficacy of cognitive–behavioural therapy and other psychological treatments for adult depression: Meta-analytic study of publication bias

The British Journal of Psychiatry

Trim and fill: A simple funnel-plot–based method of testing and adjusting for publication bias in meta-analysis

Biometrics

Self-guided internet-based and mobile-based stress management for employees: results of a randomised controlled trial

Occupational and Environmental Medicine

Internet- and mobile-based stress management for employees with adherence-focused guidance: efficacy and mechanism of change

Scandinavian Journal of Work, Environment & Health

The law of attrition

Journal of Medical Internet Research

A randomized controlled trial of mindfulness versus yoga: Effects on depression and/or anxiety in college students

Journal of the American Psychiatric Nurses Association

Mindfulness and emotion regulation: The development and initial validation of the Cognitive and Affective Mindfulness Scale-Revised (CAMS-R)

Journal of Psychopathology and Behavioral Assessment

The efficacy of smartphone-based mental health interventions for depressive symptoms: A meta-analysis of randomized controlled trials

World Psychiatry

Mobile mindfulness meditation: A randomised controlled trial of the effect of two popular apps on mental health

Mindfulness.

Craving to Quit: A Randomized Controlled Trial of Smartphone app-based Mindfulness Training for Smoking Cessation