Prevalence of meditation-related adverse effects in a population-based sample in the United States.

OBJECTIVE: Meditation practice and meditation-based psychotherapies have become increasingly popular. Although psychological benefits associated with meditation are well-documented, potential risks are unclear. METHOD: We conducted a population-based survey to evaluate the occurrence of a broad range of meditation-related adverse effects (MRAE). RESULTS: Nine hundred and fifty three participants completed our screening survey, 470 endorsed lifetime exposure to meditation practice, and 434 completed a follow-up survey assessing MRAE (92.3% response rate). A higher proportion than hypothesized reported occurrence of MRAE (general item = 32.3%, 1+ specific item = 50.0%) and MRAE duration ≥1 month (10.4%). Anxiety, traumatic re-experiencing, and emotional sensitivity were the most common MRAE. Some degree of functional impairment was reported by 10.6% of participants, with impairment lasting ≥1 month for 1.2%. Childhood adversity was associated with elevated risk for MRAE. Participants reporting MRAE were equally glad to have practiced meditation as those not reporting MRAE. Additional correlates of MRAE were identified in exploratory analyses. CONCLUSION: MRAE are common, even in a sample with relatively modest amounts of experience. Identifying individuals at elevated risk for MRAE, being transparent and realistic about the possible range of effects, and increasing trauma-sensitivity are warranted to maximize benefits and minimize risks of meditation.

Understanding the Implementation of Informal Meditation Practice in a Smartphone-Based Intervention: A Qualitative Analysis.

Objectives: Informal practice (i.e., brief meditation practices incorporated spontaneously into daily activities) may be important for increasing the efficacy and accessibility of meditation-based interventions (MedBIs). However, the facilitators and barriers to engaging in informal practice are largely unknown. The current study aimed to investigate factors associated with the implementation of informal practice. Method: Participants were drawn from a randomized trial testing the effects of 5- versus 15-min daily meditation practice in a 4-week smartphone-delivered meditation training. Qualitative interviews on informal practice were conducted with 17 participants (mean age: 37.12 years; 82.35% female; 52.94% non-Latinx White) following the intervention. Given that prior knowledge on this topic is limited, inductive content analysis was utilized to characterize participants' experiences in relation to implementing informal practice. Results: Four overarching categories emerged from the data, namely (a) reported benefits of informal practice, (b) integration of informal practice, (c) perceived barriers to informal practice, and (d) recommended facilitators of informal practice. Conclusion: This study underscores the importance of addressing barriers and facilitators (e.g., providing personalized app features, reminders, social support, and repeating intervention content) to encourage individuals' informal practice. Findings provide suggestions for methods to increase engagement in informal practice, which may, in turn, increase the accessibility and effectiveness of MedBIs. Preregistration: The larger trial from which the qualitative interview participants were drawn was preregistered through clinicaltrials.gov (NCT05229406) and the Open Science Framework (https://osf.io/fszvj/?view_only=039b14ccbf8848bd99808c983070b635). The qualitative analyses reported here were not preregistered.

Situating Meditation Apps Within the Ecosystem of Meditation Practice: Population-Based Survey Study.

BACKGROUND: Meditation apps have the potential to increase access to evidence-based strategies to promote mental health. However, it is currently unclear how meditation apps are situated within the broader landscape of meditation practice and what factors may influence engagement with them. OBJECTIVE: This study aimed to clarify the prevalence and correlates of meditation app use in a population-based sample of individuals with lifetime exposure to meditation in the United States. In addition, we sought to identify the concerns and desired features of meditation apps among those with lifetime exposure to meditation. METHODS: A total of 953 participants completed an initial screening survey. Of these 953 participants, 434 (45.5%) reported lifetime exposure to meditation and completed a follow-up survey (434/470, 92.3% response rate) assessing their meditation app use, anxiety, depression, loneliness, initial motivation for meditation, and concerns about and desired features of meditation apps. RESULTS: Almost half (434/953, 45.5%) of the participants who completed the screening survey reported lifetime exposure to meditation. Among those with lifetime exposure to meditation (ie, meditators), more than half (255/434, 58.8%) had used meditation apps at least once in their lives, and 21.7% (94/434) used meditation apps weekly or daily (ie, active users). Younger age, higher anxiety, and a mental health motivation for practicing meditation were associated with lifetime exposure to meditation apps. Among meditators, those with lifetime exposure to meditation apps were more likely to report concerns about apps, including concerns regarding the cost and effectiveness of apps, time required for use, technical issues with apps, and app user-friendliness. Meditators who used meditation apps weekly or daily (ie, active users) were younger, less likely to be men and non-Latinx White individuals and have lower income, and more likely to have an initial spiritual motivation for meditation. Active users reported more concerns regarding usability and technical problems and were less likely to report disinterest in apps. Headspace and Calm were the most frequently used apps. Tips and reminders for practice, encouragement of "mini" practices, and mental health content were the most desired features. Participants were less interested in social features (eg, the ability to communicate with other users or teachers). CONCLUSIONS: Meditation apps are commonly used by meditators in the United States, with a higher use among certain demographic groups. Future studies may increase user engagement in meditation apps by addressing concerns (eg, cost and effectiveness) and incorporating desired features (eg, tips and reminders for practice).

Who Sticks with Meditation? Rates and Predictors of Persistence in a Population-based Sample in the USA.

Objectives: Despite the well-documented psychological benefits of meditation practice, limited research has examined factors associated with meditation practice persistence. Like other health behaviors (e.g., exercise), non-persistence may undermine the effectiveness of meditation. Methods: We examined rates and correlates of meditation persistence using a population-based sample (n = 953) in the United States. Persistence was operationalized in two ways: number of lifetime practice sessions (i.e., lifetime persistence) and current practice frequency (i.e., current persistence). Consistent with the National Health Interview Survey, we defined meditation as mindfulness meditation, mantra meditation, and spiritual meditation. We examined factors related to the Reasoned Action Approach (RAA), a theory that has been used to explain adherence to health behaviors. Results: Almost half of the sample (49.3%) indicated lifetime exposure to meditation and a third (35.0%) indicated practice in the past year. Factors positively associated with persistence (lifetime and/or current) included having spoken with a meditation teacher, higher perceived effectiveness of meditation, higher meditation-positive subjective norms, lower perceived barriers, higher conscientiousness, higher wellbeing growth mindset, and retreat experience. Factors negatively associated with persistence included first exposure through various forms of technology and having a mental health motivation for practice. First exposure through a smartphone app and first exposure through friends and family were not associated with lifetime or current persistence. Findings were unchanged after controlling for demographics and applying a false discovery rate p-value adjustment. Conclusions: These findings provide insights into factors that may promote persistence with meditation which can guide the delivery of meditation training. Preregistration: This study was preregistered at the Open Science Framework (https://osf.io/4h86s).

Overall and Differential Attrition in Mindfulness-Based Interventions: A Meta-Analysis.

Objectives: Attrition is very common in longitudinal research, including randomized controlled trials (RCTs) testing psychological interventions. Establishing rates and predictors of attrition in mindfulness-based interventions (MBIs) can assist clinical trialists and intervention developers. Differential attrition in RCTs that compared MBIs with structure and intensity matched active control conditions also provides an objective metric of relative treatment acceptability. Methods: We aimed to evaluate rates and predictors of overall and differential attrition in RCTs of MBIs compared with matched active control conditions. Attrition was operationalized as loss to follow-up at post-test. Six online databases were searched. Results: Across 114 studies (n = 11,288), weighted mean attrition rate was 19.1% (95% CI [.16, .22]) in MBIs and 18.6% ([.16, .21]) in control conditions. In the primary model, no significant difference was found in attrition between MBIs and controls (i.e., differential attrition; odds ratio [OR] = 1.05, [0.92, 1.19]). However, in sensitivity analyses with trim-and-fill adjustment, without outliers, and when using different estimation methods (Peto and Mantel-Haenszel), MBIs yielded slightly higher attrition (ORs = 1.10 to 1.25, ps < .050). Despite testing numerous moderators of overall and differential attrition, very few significant predictors emerged. Conclusions: Results support efforts to increase the acceptability of MBIs, active controls, and/or RCTs, and highlight the possibility that for some individuals, MBIs may be less acceptable than alternative interventions. Further research including individual patient data meta-analysis is warranted to identify predictors of attrition and to characterize instances where MBIs may or may not be recommended. Meta-Analysis Review Registration: Open Science Framework (https://osf.io/c3u7a/).

Motivation for Meditation and its Association with Meditation Practice in a National Sample of Internet Users.

Objectives: There is limited understanding of what motivates people to initiate and sustain a meditation practice. This study investigates initial and current motivations for meditation, demographic variability in motivations, and associations with ongoing and lifetime meditation practice. Methods: A national sample of internet users were recruited to examine initial and current motivations for meditation practice. Results: 953 participants completed initial screening and 470 (49.3%) reported exposure to meditation practice. 434 (92.3%) completed a follow-up assessment. Participants most frequently reported mental health/stress alleviation as an initial motivation (n = 322, 74.2%) followed by spiritual (n = 122, 28.1%), physical health (n = 69, 15.9%), awakening/enlightenment (n = 64, 14.7%), cultural (n = 51, 11.8%) and other (n = 33, 7.6%). Participants reported a mean of 1.52 (SD = 0.83) initial motivations. Among those currently meditating, a significant increase in the number of motivations was found between initial and current motivations (1.60 [SD = 0.89] and 2.11 [SD = 1.16]), for initial and current motivations, respectively, Cohen's d = 0.45). The number of motivations was positively associated with meditation practice. Initial mental health motivation was found to be negatively associated with current and lifetime meditation practice, whereas spiritual motivation was found to be positively associated. Conclusions: While meditation started as a tool for spiritual attainment, findings suggest that it is predominantly used in the U.S. for mental health support and to manage stress. Findings suggest that both type and number of motivations may relate to the course of practice.

Mobile phone-based interventions for mental health: A systematic meta-review of 14 meta-analyses of randomized controlled trials.

Mobile phone-based interventions have been proposed as a means for reducing the burden of disease associated with mental illness. While numerous randomized controlled trials and meta-analyses have investigated this possibility, evidence remains unclear. We conducted a systematic meta-review of meta-analyses examining mobile phone-based interventions tested in randomized controlled trials. We synthesized results from 14 meta-analyses representing 145 randomized controlled trials and 47,940 participants. We identified 34 effect sizes representing unique pairings of participants, intervention, comparisons, and outcome (PICO) and graded the strength of the evidence as using umbrella review methodology. We failed to find convincing evidence of efficacy (i.e., n > 1000, p < 10-6, I 2 < 50%, absence of publication bias); publication bias was rarely assessed for the representative effect sizes. Eight effect sizes provided highly suggestive evidence (i.e., n > 1000, p < 10-6), including smartphone interventions outperforming inactive controls on measures of psychological symptoms and quality of life (ds = 0.32 to 0.47) and text message-based interventions outperforming non-specific controls and active controls for smoking cessation (ds = 0.31 and 0.19, respectively). The magnitude of effects and strength of evidence tended to diminish as comparison conditions became more rigorous (i.e., inactive to active, non-specific to specific). Four effect sizes provided suggestive evidence, 14 effect sizes provided weak evidence, and eight effect sizes were non-significant. Despite substantial heterogeneity, no moderators were identified. Adverse effects were not reported. Taken together, results support the potential of mobile phone-based interventions and highlight key directions to guide providers, policy makers, clinical trialists, and meta-analysts working in this area.

Does meditation training promote pro-environmental behavior? A cross-sectional comparison and a randomized controlled trial.

Meditation training may promote pro-environmental behavior and related variables, though limited research has tested this experimentally. We investigated whether short- or long-term meditation training were associated with pro-environmental behavior, environmental attitudes, and sustainable well-being (i.e., well-being per unit consumption). In a cross-sectional comparison, long-term meditators (n=31; mean=9,154 meditation hours) displayed greater environmental attitudes (d=0.63) but not pro-environmental behavior or sustainable well-being compared to meditation-naïve participants (ds=-0.14-0.27). In a randomized controlled trial (n=125), eight-week training in Mindfulness-Based Stress Reduction did not significantly improve target variables relative to waitlist or structurally-matched active control (ds=-0.38-0.43). However, relative to waitlist, randomization to either meditation or active control predicted increases in pro-environmental behavior (d=-0.40) and sustainable well-being (d=0.42), although the latter finding was not robust to multiple imputation. While meditation training may promote pro-environmental behavior and its antecedents, the training investigated here does not appear to be uniquely effective.