Evaluation of Autonomic Nervous System Function During Sleep by Mindful Breathing Using a Tablet Device: Randomized Controlled Trial.

BACKGROUND: One issue to be considered in universities is the need for interventions to improve sleep quality and educational systems for university students. However, sleep problems remain unresolved. As a clinical practice technique, a mindfulness-based stress reduction method can help students develop mindfulness skills to cope with stress, self-healing skills, and sleep. OBJECTIVE: We aim to verify the effectiveness of mindful breathing exercises using a tablet device. METHODS: In total, 18 nursing students, aged 18-22 years, were randomly assigned and divided equally into mindfulness (Mi) and nonmindfulness (nMi) implementation groups using tablet devices. During the 9-day experimental period, cardiac potentials were measured on days 1, 5, and 9. In each sleep stage (sleep with sympathetic nerve dominance, shallow sleep with parasympathetic nerve dominance, and deep sleep with parasympathetic nerve dominance), low frequency (LF) value, high frequency (HF) value, and LF/HF ratios obtained from the cardiac potentials were evaluated. RESULTS: On day 5, a significant correlation was observed between sleep duration and each sleep stage in both groups. In comparison to each experimental day, the LF and LF/HF ratios of the Mi group were significantly higher on day 1 than on days 5 and 10. LF and HF values in the nMi group were significantly higher on day 1 than on day 5. CONCLUSIONS: The correlation between sleep duration and each sleep stage on day 5 suggested that sleep homeostasis in both groups was activated on day 5, resulting in similar changes in sleep stages. During the experimental period, the cardiac potentials in the nMi group showed a wide range of fluctuations, whereas the LF values and LF/HF ratio in the Mi group showed a decreasing trend over time. This finding suggests that implementing mindful breathing exercises using a tablet device may suppress sympathetic activity during sleep. TRIAL REGISTRATION: UMIN-CTR Clinical Trials Registry UMIN000054639; https://tinyurl.com/mu2vdrks.

Creating a Model for Mindfulness in Nursing Professional Development Using Concept Analysis.

Mindfulness has many benefits, but its mechanisms of action are not universally understood. This analysis explores mindfulness and informs a model for its practical applications in health care and professional development. A mindful nursing professional development practitioner can use metacognitive thought processes to enhance interpersonal connections and create better learning environments to facilitate practice change. The literature supports the testing of this model in nursing professional development.

Favorable Outcomes From an In-person and Online Feasibility Mindful Moment Pilot Study.

Long hours, inadequate staff, and increasingly complicated patients make nurses more vulnerable to increased levels of stress and burnout. Nurses skilled in exercising self-care practices are better equipped to manage complex clinical situations. The purpose of this pilot study was to evaluate the feasibility of short mindfulness sessions (Mindful Moment) practiced prior to a shift, available in person and online, on nurse burnout and perceived levels of stress. The 8-week Mindful Moment study consisted of 20-minute sessions delivered either in person or online that included yoga, self-reflection, and meditation. Nurse burnout was assessed using the Maslach Burnout Inventory at weeks 0, 4, and 8. Perceived stress was assessed using a visual analog scale before and after each Mindful Moment session. Descriptive statistics, pre/postintervention differences, and percent change calculations were used to evaluate study outcomes. Forty-seven nurses agreed to participate, with 20 nurses completing the study (43%). Participants were all female, aged 36.8 ± 9.8 years, with 12 ± 8.6 years of nursing experience. With respect to nurse burnout, there was a -31% change in emotional exhaustion (P = .079), a -31% change in depersonalization (P = .057), and a +10% change in personal accomplishment (P = .331). There were consistent reductions in nurses' perceived stress pre/post-Mindful Moment session, with percent changes ranging from -35% to 40%. Findings from this study suggest that practicing a brief Mindful Moment prior to the start of a shift is feasible and self-care interventions provide lower levels of burnout and perceived stress among this sample of nurses.

Effectiveness of using a meditation app in reducing anxiety and improving well-being during the COVID-19 pandemic: A structured summary of a study protocol for a randomized controlled trial.

OBJECTIVES: This interventional study will investigate the effect of daily use of a mindfulness app on measures of participant anxiety, well-being, and perceived outlook during the COVID-19 pandemic, by comparing pre-intervention survey responses to post-intervention survey responses. TRIAL DESIGN: Randomized, controlled trial with parallel assignment. Adults will be assigned either to daily use of a meditation app for 30 days or to a control group (no usage of meditation app) with a 1:1 equivalence allocation ratio. PARTICIPANTS: Inclusion Criteria: Participants must be 18 or older, have a smartphone, able to download apps to their smartphone, must be fluent in the English language, able to complete surveys on their own, and must be in the United States for the duration of the study. EXCLUSION CRITERIA: Current regular use of a mindfulness or meditation app, regular practice of mindfulness or meditation, regular therapy sessions, inability to complete surveys independently, or any mental health restrictions that would prevent participation. All data will be collected through the Insight Timer Meditation App and Google Forms. This trial is being conducted through the Lake Erie College of Osteopathic Medicine in Erie, PA, with all data collected digitally. INTERVENTION AND COMPARATOR: Intervention: Participants will be sent a link to a pre-intervention survey prior to first use of the mindfulness app. Participants will be instructed to use the Insight Timer app for 10 minutes daily for 30 days. At the end of the 30-day intervention period, participants will be sent a link for the post-intervention survey. Two months after the conclusion of the 30-day intervention period, participants will be sent a link for another post-intervention survey. Comparator: Participants will receive the same surveys, but will not use any mindfulness app for the 30-day intervention period. After this 30-day period, participants are invited to use the Insight Timer app if they so choose. MAIN OUTCOMES: The main outcomes are (1) anxiety as assessed by survey questions adapted from the GAD7, comparing pre-intervention to post-30-days of app usage and (2) well-being as assessed by survey questions adapted from the WHO-5, comparing pre-intervention and post-30-days of app usage. RANDOMIZATION: Participants will be allocated to interventions via a block random sequence generator with a 1:1 allocation ratio in blocks of 8. BLINDING (MASKING): No masking is being used in this study (open label). NUMBERS TO BE RANDOMIZED (SAMPLE SIZE): Approximately 75 participants will be randomized to each group, with an estimated enrollment of 150 participants. TRIAL STATUS: This study is protocol version number 27-126 and was approved on May 10, 2020. Recruitment began on August 19, 2020 and will end February 28, 2021. The study is estimated to complete on April 30, 2021. TRIAL REGISTRATION: This trial was registered to ClinicalTrials.gov on 30 April 2020. The ClinicalTrials.gov Identifier is NCT04369378 . FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional File 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.

Feasibility and Efficacy of the Addition of Heart Rate Variability Biofeedback to a Remote Digital Health Intervention for Depression.

A rise in the prevalence of depression underscores the need for accessible and effective interventions. The objectives of this study were to determine if the addition of a treatment component showing promise in treating depression, heart rate variability-biofeedback (HRV-B), to our original smartphone-based, 8-week digital intervention was feasible and whether patients in the HRV-B ("enhanced") intervention were more likely to experience clinically significant improvements in depressive symptoms than patients in our original ("standard") intervention. We used a quasi-experimental, non-equivalent (matched) groups design to compare changes in symptoms of depression in the enhanced group (n = 48) to historical outcome data from the standard group (n = 48). Patients in the enhanced group completed a total average of 3.86 h of HRV-B practice across 25.8 sessions, and were more likely to report a clinically significant improvement in depressive symptom score post-intervention than participants in the standard group, even after adjusting for differences in demographics and engagement between groups (adjusted OR 3.44, 95% CI [1.28-9.26], P = .015). Our findings suggest that adding HRV-B to an app-based, smartphone-delivered, remote intervention for depression is feasible and may enhance treatment outcomes.

Wearable sensor-based detection of stress and craving in patients during treatment for substance use disorder: A mixed methods pilot study.

AIMS: To determine the accuracy of a wearable sensor to detect and differentiate episodes of self-reported craving and stress in individuals with substance use disorders, and to assess acceptability, barriers, and facilitators to sensor-based monitoring in this population. METHODS: This was an observational mixed methods pilot study. Adults enrolled in an outpatient treatment program for a substance use disorder wore a non-invasive wrist-mounted sensor for four days and self-reported episodes of stress and craving. Continuous physiologic data (accelerometry, skin conductance, skin temperature, and heart rate) were extracted from the sensors and analyzed via various machine learning algorithms. Semi-structured interviews were conducted upon study completion, and thematic analysis was conducted on qualitative data from semi-structured interviews. RESULTS: Thirty individuals completed the protocol, and 43 % (N = 13) were female. A total of 41 craving and 104 stress events were analyzed. The differentiation accuracies of the top performing models were as follows: stress vs. non-stress states 74.5 % (AUC 0.82), craving vs. no-craving 75.7 % (AUC 0.82), and craving vs. stress 76.8 % (AUC 0.8). Overall participant perception was positive, and acceptability was high. Emergent themes from the exit interviews included a perception of connectedness and increased mindfulness related to wearing the sensor, both of which were reported as helpful to recovery. Barriers to engagement included interference with other daily wear items, and perceived stigma. CONCLUSIONS: Wearable sensors can be used to objectively differentiate episodes of craving and stress, and individuals in recovery from substance use disorder are accepting of continuous monitoring with these devices.

A Spanish adaptation of the mindfulness in parenting questionnaire.

BACKGROUND: The Mindfulness in Parenting Questionnaire (MIPQ) is a self-report instrument to measure how much parents practice mindful parenting. The main aim of this study was to analyze the psychometric properties of the Spanish version of the MIPQ. METHOD: A total of 271 parents of adolescents completed the MIPQ along with questionnaires about their mindfulness trait, parenting style, and their children's resilience and symptoms of depression. Their adolescent children completed questionnaires about their own depressive symptoms, their perception of their parents' parenting style, and their perceived stress. RESULTS: Factor analyses suggested a two-factor structure corresponding to Being in the Moment with the Child and Mindful Discipline. Moreover, the MIPQ showed good internal consistency and was related to parent's dispositional mindfulness and positive parenting as well as to adolescents' resilience and (negatively) to their depressive symptoms. CONCLUSION: The Spanish version of the MIPQ exhibits good psychometric properties and is an easily applicable test for the assessment of mindful parenting.

An Exploratory Study of a 3-Minute Mindfulness Intervention on Compassion Fatigue in Nurses.

This study shows that breathing mindfully for 3 minutes over a period of 4 weeks, positively affects compassion fatigue in nurses. A nonrandomized, pre/postintervention study was conducted using a 3-minute attentional breathing intervention. Thirty-two nurses participated over 4 weeks. The intervention demonstrated statistically significant reductions in compassion fatigue measures.

MensSans: aplicativo para prática do mindfulness direcionado a mulheres com câncer de mama / MensSans: app to practice mindfulness for women with breast cancer / MensSans: aplicación para la práctica del mindfulness dirigida a mujeres con cáncer de mama

Objetivo: apresentar o desenvolvimento de um protótipo de software (MensSans) para auxiliar mulheres com diagnóstico de câncer de mama na realização do tratamento terapêutico com Mindfulness. Métodos: o processo metodológico se fundamentou no modelo de prototipação e neste trabalho o projeto foi elaborado considerando as etapas de levantamento bibliográfico, definição de requisitos, projeto do sistema e implementação. Resultados: o aplicativo fornece o programa do Mindfulness seguindo o modelo de oito semanas, no qual uma sequência de materiais em texto e áudio é apresentada ao usuário para utilizar durante a semana, emitindo notificações de alerta nos horários previamente estabelecidos para as sessões. Conclusão: esta ferramenta promove uma interação saudável com a tecnologia podendo trazer benefícios instantâneos e duradouros em diferentes momentos do tratamento oncológico por meio um cronograma que colabora com o exercício integral e continuo da atenção plena

Objective: present the development of a prototype software (MensSans) to assist women diagnosed with breast cancer in performing the therapeutic treatment with Mindfulness. Methods: the methodological process was based on the prototyping model and in this work the project was elaborated considering the steps of bibliographic survey, definition of requirements, design of the system and implementation. Results: The application provides the Mindfulness program following the eight-week model, in which a sequence of text and audio materials is presented to the user to use during the week, issuing alert notifications at the preset times for sessions. Conclusion: this tool promotes a healthy interaction with technology that can bring instant and lasting benefits at different times of cancer treatment through a schedule that collaborates with the integral and continuous exercise of full attention

Objetivo: presentar el desarrollo de un prototipo de software (MensSans) para ayudar a las mujeres con diagnóstico de cáncer de mama a realizar el tratamiento terapéutico con Mindfulness. Métodos: el proceso metodológico se basó en el modelo de prototipación y en este trabajo el proyecto se elaboró considerando las etapas de estudio bibliográfico, definición de requisitos, diseño del sistema y la implementación. Resultados: la aplicación proporciona el programa del Mindfulness siguiendo el modelo de ocho semanas, en el que se presenta una secuencia de texto y audio al usuario para su uso durante la semana, emitiendo notificaciones de alerta en los horarios previamente establecidos para las sesiones. Conclusión: esta herramienta promueve una interacción saludable con la tecnología y puede aportar beneficios instantáneos y duraderos en diferentes momentos del tratamiento oncológico a través de un cronograma que colabora con el ejercicio completo y continuo de la atención plena

Efficacy of the Mindfulness Meditation Mobile App "Calm" to Reduce Stress Among College Students: Randomized Controlled Trial.

BACKGROUND: College students experience high levels of stress. Mindfulness meditation delivered via a mobile app may be an appealing, efficacious way to reduce stress in college students. OBJECTIVE: We aimed to test the initial efficacy and sustained effects of an 8-week mindfulness meditation mobile app-Calm-compared to a wait-list control on stress, mindfulness, and self-compassion in college students with elevated stress. We also explored the intervention's effect on health behaviors (ie, sleep disturbance, alcohol consumption [binge drinking], physical activity, and healthy eating [fruit and vegetable consumption]) and the feasibility and acceptability of the app. METHODS: This study was a randomized, wait-list, control trial with assessments at baseline, postintervention (8 weeks), and at follow-up (12 weeks). Participants were eligible if they were current full-time undergraduate students and (1) at least 18 years of age, (2) scored ≥14 points on the Perceived Stress Scale, (3) owned a smartphone, (4) were willing to download the Calm app, (5) were willing to be randomized, and (7) were able to read and understand English. Participants were asked to meditate using Calm at least 10 minutes per day. A P value ≤.05 was considered statistically significant. RESULTS: A total of 88 participants were included in the analysis. The mean age (SD) was 20.41 (2.31) years for the intervention group and 21.85 (6.3) years for the control group. There were significant differences in all outcomes (stress, mindfulness, and self-compassion) between the intervention and control groups after adjustment for covariates postintervention (all P<.04). These effects persisted at follow-up (all P<.03), except for the nonreacting subscale of mindfulness (P=.08). There was a significant interaction between group and time factors in perceived stress (P=.002), mindfulness (P<.001), and self-compassion (P<.001). Bonferroni posthoc tests showed significant within-group mean differences for perceived stress in the intervention group (P<.001), while there were no significant within-group mean differences in the control group (all P>.19). Similar results were found for mindfulness and self-compassion. Effect sizes ranged from moderate (0.59) to large (1.24) across all outcomes. A significant group×time interaction in models of sleep disturbance was found, but no significant effects were found for other health behaviors. The majority of students in the intervention group reported that Calm was helpful to reduce stress and stated they would use Calm in the future. The majority were satisfied using Calm and likely to recommend it to other college students. The intervention group participated in meditation for an average of 38 minutes/week during the intervention and 20 minutes/week during follow-up. CONCLUSIONS: Calm is an effective modality to deliver mindfulness meditation in order to reduce stress and improve mindfulness and self-compassion in stressed college students. Our findings provide important information that can be applied to the design of future studies or mental health resources in university programs. TRIAL REGISTRATION: ClinicalTrials.gov NCT03891810; https://clinicaltrials.gov/ct2/show/NCT03891810.

A Brief Spanish Version of the Child and Adolescent Mindfulness Measure (CAMM). A Dispositional Mindfulness Measure.

Dispositional Mindfulness (DM) is the awareness of the thoughts and feelings in the present moment. DM in children and adolescents has been related to mechanisms of change in mindfulness-based interventions, which have shown significant mediation relationships with mental health outcomes (for instance, lower social anxiety, depression symptoms, or perceived stress). However, the assessment of DM among children and adolescents is being unsatisfactory due cultural biases and/or reliability issues. In this study, we examined the psychometric properties of the Spanish version of the Child and Adolescent Mindfulness Measure (CAMM) in a sample of 687 children and adolescents between 8 and 16 years old. Although the CAMM has been validated in English, Portuguese, Italian, and Catalonian versions, until now no data has been reported in a Spanish context. Results showed that the best CAMM factor structure was constituted by five items from the original version (1, 4, 7, 8, and 9). These items defined dispositional mindfulness. The rest of the items (2, 3, 5, 6, and 10) were eliminated from the Spanish final version. The analyses revealed good reliability and internal consistency for the Spanish version of the CAMM. As we expected, the confirmatory factor analysis showed the unidimensional structure of the CAMM.

A Mobile-Based Mindfulness and Social Support Program for Adolescents and Young Adults With Sarcoma: Development and Pilot Testing.

BACKGROUND: Approximately 70,000 adolescents and young adults (AYA) are diagnosed with cancer each year in the United States. Sarcomas carry a particularly high symptom burden and are some of the most common cancers among AYA. Recent work has documented significant levels of unmet needs among AYA with cancer, particularly the need for psychosocial support. Mobile technology may be a cost-effective and efficient way to deliver a psychosocial intervention to AYA with cancer and cancer survivors. OBJECTIVE: The two aims of this study were to (1) develop a pilot version of a mobile-based mindfulness and social support program and (2) evaluate program usage and acceptability. An exploratory aim was to examine change in psychosocial outcomes. METHODS: Thirty-seven AYA with sarcoma or sarcoma survivors, parents, and health care providers participated in the study. Semistructured interviews were conducted with 10 AYA, parents of five of the adolescents, and six health care providers. Themes from the interviews helped to inform the development of a mobile-based mindfulness pilot program and a companion Facebook-based social support group. Twenty AYA consented to participate in a single-arm pre-post evaluation of the program; 17 downloaded the app and joined the Facebook group. Seven of these participants had participated in the semistructured interviews. Six additional health care providers consented to participate in the evaluation stage. RESULTS: On average, participants completed 16.9 of the 28 unique sessions and used the mindfulness app for a mean 10.2 (SD 8.2) days during the 28-day evaluation period. The majority of participants (16/17) engaged in the social group and posted at least one reply to the moderator's prompts. The mean number of responses per person to the moderator of the social group was 15.2 of 31 (49%, range 0%-97%). Both AYA and health care providers responded positively to the Mindfulness for Resilience in Illness program and offered useful recommendations for improvements. Exploratory psychosocial analyses indicated there were no significant differences from pretest to posttest on measures of perceived social support, mindfulness, body image, or psychological functioning. CONCLUSIONS: This study offers preliminary support for the feasibility and acceptability of a mobile-based mindfulness and Facebook-based social support program for AYA with sarcoma. The feedback from AYA and health care providers will assist in creating a fully developed intervention. TRIAL REGISTRATION: ClinicalTrials.gov NCT03130751; https://clinicaltrials.gov/ct2/show/NCT03130751.

Theory-Based Predictors of Mindfulness Meditation Mobile App Usage: A Survey and Cohort Study.

BACKGROUND: Mindfulness meditation has become increasingly popular over the last few years, due in part to the increase in mobile apps incorporating the practice. Although studies have demonstrated the potential of mindfulness meditation to positively impact health, little has been uncovered about what predicts engagement in mindfulness meditation. Understanding the predictors of mindfulness meditation may help practitioners and phone app developers improve intervention strategies and app experience. OBJECTIVE: The purpose of this study was to use the Theory of Planned Behavior and Temporal Self-Regulation Theory to determine factors predicting mindfulness meditation mobile app use. METHODS: The sample consisted of 85 undergraduate students with no prior mindfulness meditation experience. During their first laboratory visit, participants completed tasks to measure their executive functioning and a survey to measure Theory of Planned Behavior constructs about mindfulness meditation. Over the following 2 weeks, participants logged the days and minutes that they practiced mindfulness meditation using a phone app. Hierarchical regression modeling was used to analyze the data. RESULTS: After controlling for demographic factors, participant subjective norms (beta=14.51, P=.001) and intentions (beta=36.12, P=.001) were predictive of the number of minutes practicing mindfulness. Participant executive functioning did not predict mindfulness meditation practice, nor did it moderate the link between intentions and mindfulness meditation practice. Participant attitudes (beta=0.44, P<.001) and perceived control (beta=0.42, P=.002) were positively associated with intentions to practice mindfulness. CONCLUSIONS: These results suggest that among college student populations, the Theory of Planned Behavior may be useful in predicting the use of mindfulness meditation phone apps. However, participant executive functioning was not a predictor or moderator of mindfulness practice, and Temporal Self-Regulation Theory may be less useful for explaining mindfulness meditation behaviors using phone apps over a short period of time among college students. The results have implications for public health professionals, suggesting that a focus on subjective norms and intentions may promote mindfulness meditation practice using phone apps.

Text Messaging to Enhance Mindfulness-Based Smoking Cessation Treatment: Program Development Through Qualitative Research.

BACKGROUND: Mindfulness-based programs show promise for promoting smoking cessation in diverse populations. Mobile health strategies could increase treatment engagement and in-the-moment support, thus enhancing the effects of mindfulness-based smoking cessation interventions. However, most mobile health programs have been developed without sufficient input from the target population. OBJECTIVE: By eliciting input from the target population, predominantly low socioeconomic status (SES) African American adult smokers, throughout the development of an SMS (short message service) text messaging program that teaches mindfulness for smoking cessation, we aimed for the resulting program to be optimally effective and consistent with participants' needs and preferences. METHODS: Two qualitative studies (N=25) were conducted with predominantly low SES, African American adult smokers. In Study 1 (initial qualitative input; n=15), participants engaged in focus groups to provide suggestions for program development. In Study 2 (abbreviated trial; n=10), participants received a 1-week version of the SMS text messaging program and provided feedback through in-depth interviews. RESULTS: In Study 1, participants suggested that the SMS text messaging program should be personalized and interactive (ie, involve two-way messaging); provide strategies for coping with cravings and recovering from smoking lapses; involve relatively short, to-the-point messages; and include pictures. In Study 2, participants were highly engaged with the texts, indicated that the program was useful, and provided additional suggestions for improvement. CONCLUSIONS: Eliciting feedback from the target population throughout the intervention development process allowed for iterative revisions to increase feasibility, acceptability, and effectiveness. Overall, SMS text messaging appears to be a feasible, appealing way to provide in-the-moment personalized support and encourage mindfulness among low-income African American smokers.

Translation and content validity of a brief scale of mindfulness for Peruvian adolescents. / Traducción y validez de contenido de una escala breve de mindfulness para adolescentes peruanos.

OBJECTIVE: To translate into Spanish and analyze the evidence of validity based on the content of the items in the brief version of the Mindful Attention Awareness Scale of 5 items (MAAS-5). METHOD: An instrumental study that involved the translation to Spanish of the items of the short version of the MAAS-5 scale, using the back-translation procedure. We analyzed the evidence of validity based on the test content, with the participation of a total of 14 expert judges. The degree of clarity, coherence and relevance of the items was quantified using the Aiken V coefficient and their 95% confidence intervals using an ad hoc template developed in the MS Excel program. RESULTS: The items of the MAAS-5 show favourable evaluations of their clarity, coherence and relevance, where all the values of V were statistically significant and greater than 0.70. On the other hand, the lower limit of 95% confidence intervals of all the items satisfies the criterion at population level (Li˃0.59). CONCLUSION: The empirical evidence of validity based on the test content of the MAAS-5 reports that all are sufficiently relevant, coherent and clear to adequately represent the construct mindfulness, both at sample and population level. This suggests that the MAAS-5 can be a brief and useful measure to assess mindfulness. On the other hand we suggest carrying out further studies that analyze other sources of evidence of validity of the MAAS-5.

Smartphone Applications for Mindfulness Interventions with Suicidality in Asian Older Adults: A Literature Review.

Elderly suicide is a rising concern. Despite the advent of mobile technology, there remained a gap in the evidence base as to whether smartphone applications could be used for mindfulness intervention for suicidality in Asian older adults. This paper aimed to review recent research relevant to smartphone applications that could be used in providing mindfulness interventions for suicidality to Asian older adults. The inclusion criteria for this review were papers published in peer-reviewed journals from 2008 to 2018 with the usage of specific search terms, namely, 'smartphone application', 'mobile application', and 'mindfulness', assessed against the inclusion criteria and screened by an experienced Asian clinician to be of clinical utility for mindfulness intervention for suicidality with Asian older adults. Initial search on databases yielded 236 results. A total of 35 full text papers that fit the inclusion criteria were assessed for eligibility and 10 papers were included in the current review. This review highlighted the paucity of rigorous empirically validated research into effective smartphone applications that can be used for mindfulness interventions for suicidality with Asian older adults.

PHIT for Duty, a Mobile Application for Stress Reduction, Sleep Improvement, and Alcohol Moderation.

Post-traumatic stress and other problems often occur after combat, deployment, and other military operations. Because techniques such as mindfulness meditation show efficacy in improving mental health, our team developed a mobile application (app) for individuals in the armed forces with subclinical psychological problems as secondary prevention of more significant disease. Based on the Personal Health Intervention Toolkit (PHIT), a mobile app framework for personalized health intervention studies, PHIT for Duty integrates mindfulness-based relaxation, behavioral education in sleep quality and alcohol use, and psychometric and psychophysiological data capture. We evaluated PHIT for Duty in usability and health assessment studies to establish app quality for use in health research. Participants (N = 31) rated usability on a 1 (very hard) to 5 (very easy) scale and also completed the System Usability Scale (SUS) questionnaire (N = 9). Results were (mean ± SD) overall (4.5 ± 0.6), self-report instruments (4.5 ± 0.7), pulse sensor (3.7 ± 1.2), sleep monitor (4.4 ± 0.7), sleep monitor comfort (3.7 ± 1.1), and wrist actigraphy comfort (2.7 ± 0.9). The average SUS score was 85 ± 12, indicating a rank of 95%. A comparison of PHIT-based assessments to traditional paper forms demonstrated a high overall correlation (r = 0.87). These evaluations of usability, health assessment accuracy, physiological sensing, system acceptability, and overall functionality have shown positive results and affirmation for using the PHIT framework and PHIT for Duty application in mobile health research.

Impact of In-Person and Virtual World Mindfulness Training on Symptoms of Post-Traumatic Stress Disorder and Attention Deficit and Hyperactivity Disorder.

Mindfulness meditation training has been shown to reduce stress and improve short-term memory for military personnel. However, no studies have investigated the effects of in-person and virtual world (VW) mindfulness training on Post-Traumatic Stress Disorder (PTSD) or Attention Deficit Hyperactivity Disorder (ADHD) symptoms. In this study, U.S. military active duty service members and veterans were pseudo-randomized into two mindfulness training groups: in-person (IP) and online via a VW, and a wait-list control group. Volunteers answered a demographic questionnaire, and completed the PTSD Checklist-Military Version (PCL-M) and ADHD Current Symptoms Scale before and after training. The results showed practical and clinically relevant reductions in PTSD symptoms, particular for the IP group, but did not show statistical relevance with hypothesis testing. Results also showed post-training reductions in ADHD symptoms for both IP and VW groups, but no change for the control group. To investigate the effects of initial ADHD symptoms, IP and VW groups were combined into a single Mindfulness Training group. Those with high-initial ADHD symptoms attending training showed improvements, but the control group did not. These results expand research on the mindfulness training, and suggest that IP mindfulness training, rather than VW training, may be of greater benefit for those with PTSD symptoms, while either delivery system appears adequate for reducing attentional symptoms.

EMOTEO: A Smartphone Application for Monitoring and Reducing Aversive Tension in Borderline Personality Disorder Patients, a Pilot Study.

PURPOSE: We developed a smartphone application (App; EMOTEO: emotion-meteo [weather forecast]) to help borderline personality disorder (BPD) patients to monitor and regulate their inner tension. The App proposes targeted mindfulness-based exercises. DESIGN AND METHODS: We assessed the usability and efficiency of this App for monitoring and reduction of aversive tension in 16 BPD participants over a 6-month period. FINDINGS: We recorded a mean of 318.1 sessions (SD = 166.7) per participants, with a high level of satisfaction. There was a significant decrease in aversive tension (p < .05) and the App was mainly used around 10 a.m. and 9 p.m. PRACTICE IMPLICATIONS: EMOTEO was user-friendly and efficient in reducing aversive tension in BPD patients.