The effects of a brief online mindfulness‐based intervention on psychological distress
Researchers:
Francesca Cicconi, Natasha Griffiths, Andy Wyper
School of Psychology, University of Sussex, UK
Supervisors:
Dr Kate Cavanagh, Dr Clara Strauss, Dr Fergal Jones
Overview
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Why study the effects of mindfulness online?
Previous research
Aims of current study
Study design
Results and implications
Future research Why study online
mindfulness?
• Mindfulness‐based interventions can be effective in reducing psychological distress e.g. Hofmann, Sawyer, Witt & Oh (2010)
• However, courses currently require a lot of resources and a time commitment of 6 – 8 weeks
• Self‐guided ‘lower intensity’ online therapies may address these issues
Previous research
Krusche et al. (2012)
• Participants were encouraged to practice mindfulness daily for 30 minutes
• Online course based on traditional MBSR programmes
• Measured participants perceived stress pre‐ post‐
intervention and 1 month follow up
Previous research
Krusche et al. (2012) results
Perceived stress decreased significantly with an effect size of d =1.57.
Figure 1: Mean PSS scores before and after course and at 1 month follow‐up (N=100).
Previous research
Krusche et al. (2012) study limitations
•No control group
•No measure of mindfulness
•Included therapist run “interaction” sessions
•Only included data from first 100 completers •Paid £40 to sign up
Current study aims
In the current study we aimed to significantly
extend the existing literature by…
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implementing RCT study design
measuring mindfulness levels
exploring the mediating role of mindfulness
utilising a self‐guided ‘lower intensity’ mindfulness intervention
Research questions
Hypothesis 1
• Can a brief online mindfulness‐based programme significantly increase mindfulness?
Hypothesis 2
• Can a brief online mindfulness‐based programme significantly reduce psychological distress?
Hypothesis 3
• Does increase in mindfulness mediate the reduction?
Study Design
• Randomised control trial design
– Experimental group given access to online intervention for two weeks
– Wait list control, given access to intervention after 2 week wait period
• Self‐report questionnaire data captured pre‐ and post‐ intervention/control period
• Participants run on individual schedules to minimise
attrition
Demographics
• Non‐clinical population
– students and staff at University of Sussex
• Data collected from 104 participants
– mean age of 25 (SD = 6.44, range = 19‐51)
– 92 female participants, 12 male
Participant flow
& attrition
Attrition
Figure 2 – CONSORT diagram showing participant flow
INT
57.4%
WLC
30.0%
ALL
44.2%
Mindfulness
intervention
• 10 minute guided audio practice, based on PBCT Mindfulness Practice (Chadwick, 2006)
• Suitable for online audio delivery as
– seated exercise focusing on perception of somatic sensations and breathing
– short duration with narrator guidance throughout
• Female/male versions
• Daily practice recommended
• Delivered via university intranet microsite
Figure 3 ‐ Daily mindfulness practice page Figure 4 ‐ Journal page Figures 5 & 6 ‐ Mindfulness information supporting text pages Measures
Mindfulness
•FFMQ‐39 (Baer et al., 2006)
Psychological health
•PHQ‐4 (Kroenke, Spitzer, Williams, & Löwe, 2009)
– brief screening measure for anxiety and depression
•PSS‐10 (Cohen, Kamarck, & Mermelstein, 1983)
– subjective stress measure for non‐clinical populations
All measures reliable at baseline (Cronbach’s α’s
ranged from .75 to .96)
All measures performed pre‐ and post‐ intervention and wait control periods
Analysis Design
Hypothesis 1
•Mixed 2 x 2 repeated ANOVA (IVs: Time, Group. DV: FFMQ‐39 score)
Hypothesis 2
•Mixed 2 x 2 repeated ANOVA (IVs: Time, Group. DVs: PHQ‐4, PSS‐10 score)
Hypothesis 3
•Mediation analysis of relation between Group and change in PHQ‐4 and PSS‐10 with change in FFMQ‐39 as mediator variable
All analyses were completed using per protocol Hypothesis 1 result
Significant interaction effect of intervention on mindfulness level
F (1,56) = 10.10, p < .01, Cohen’s d = 0.85.
Experimental: post M=125.96 SD=22.16
WLC: post M=115.54, SD=22.19
Figure 7 ‐ Graph showing the change in FFMQ‐39 scores from baseline to post for each condition. Error bars showi 95% confidence intervals.
Hypothesis 2 results
Significant interaction effect of intervention on perceived stress level
F (1,56) = 12.09, p < .01, Cohen’s d =0.93
Experimental : post M=17.43 SD= 6.13 WLC: post M=21.17 SD=7.26 Figure 8 ‐ Graph showing the change in PSS‐10 scores from baseline to post for each condition. Error bars show 95% confidence intervals.
Hypothesis 2 results
Significant interaction effect of intervention on PHQ‐4 level
F (1,56) = 7.95, p < .01, Cohen’s d = 0.75.
Experimental: post M=3.83 SD=2.10 WLC: post M=4.80 SD=3.22 Figure 9 ‐ Graph showing the change in PHQ‐4 scores from baseline to post for each condition. Error bars show 95% confidence intervals.
Hypothesis 3 results
Change in mindfulness fully mediated relation between Group and change in perceived stress Pre-Post change in
FFMQ
12.12**
Group
Experimental /
Control
-.232***
Pre-post
change in PSS10
-5.98** unmediated model
-3.16 direct effect – after controlling for change in FFMQ ( p =.06)
p < .05 *
p < .01**
p < .001***
The mediatory effect of Pre-Post change in FFMQ on the association between
experimental condition and Pre-Post change in PSS-10 (unstandardised beta
values).
Hypothesis 3 results
Change in mindfulness fully mediated relation between Group and change in PHQ‐4 Pre-Post change in
FFMQ
12.12**
Group
Experimental /
Control
-.09***
Pre-post
change in
PHQ-4
-1.81** unmediated model
-.70 direct effect – after controlling for change in FFMQ ( p =.24)
p < .05 *
p < .01**
p < .001***
The mediatory effect of Pre-Post change in FFMQ on the association between
experimental condition and Pre-Post change in PHQ-4 (unstandardised beta
values).
Conclusions and implications
• Provides initial evidence that an online mindfulness‐
based intervention may increase mindfulness, which may explain reduction in psychological distress. • Further evidence that online mindfulness‐based interventions may reduce psychological distress.
• Highlights the possibility of self guided mindfulness being implemented in NHS services, such as IAPT.
Limitations and further research
• Sample characteristics:
– well‐educated, volunteers, computer literate students
– majority female
– non‐clinical • Attrition rate
• Wait list control vs. ‘active’ online task • Lack of follow‐up data post intervention
Thank you for
your time
For further information please contact:
Francesca Cicconi: [email protected]
Andy Wyper: [email protected]
Natasha Griffiths: [email protected]
Dr Kate Cavanagh: [email protected]
Dr Clara Strauss: [email protected]
Dr Fergal Jones: [email protected]