Revealing subgroup-specific mechanisms of change via moderated mediation: A meditation intervention example.

OBJECTIVE: Effective psychosocial interventions exist for numerous mental health conditions. However, despite decades of research, limited progress has been made in clarifying the mechanisms that account for their beneficial effects. We know that many treatments work, but we know relatively little about why they work. Mechanisms of change may be obscured due to prior research collapsing across heterogeneous subgroups of patients with differing underlying mechanisms of response. Studies identifying baseline individual characteristics that predict differential response (i.e., moderation) may inform research on why (i.e., mediation) a particular subgroup has better outcomes to an intervention via tests of moderated mediation. METHOD: In a recent randomized controlled trial comparing a 4-week meditation app with a control condition in school system employees (N = 662), we previously developed a "Personalized Advantage Index" (PAI) using baseline characteristics, which identified a subgroup of individuals who derived relatively greater benefit from meditation training. Here, we tested whether the effect of mindfulness acquisition in mediating group differences in outcome was moderated by PAI scores. RESULTS: A significant index of moderated mediation (IMM = 1.22, 95% CI [0.30, 2.33]) revealed that the effect of mindfulness acquisition in mediating group differences in outcome was only significant among those individuals with PAI scores predicting relatively greater benefit from the meditation app. CONCLUSIONS: Subgroups of individuals may differ meaningfully in the mechanisms that mediate their response to an intervention. Considering subgroup-specific mediators may accelerate progress on clarifying mechanisms of change underlying psychosocial interventions and may help inform which specific interventions are most beneficial for whom. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Examining Equity in Access and Utilization of a Freely Available Meditation App.

Digital interventions have the potential to alleviate mental health disparities for marginalized and minoritized communities. The current study examined whether disparities in access and utilization of meditation in the United States (US) were reduced for a freely available meditation app. We analyzed demographic and usage data from US-based users of the Healthy Minds Program (HMP; N = 66,482) between October 2019 and July 2022. College education was associated with a greater likelihood of accessing (65.0% of users vs. 32.9% of the US population) and continuing to utilize the app (ß = .11-.17). Conversely, identifying as African American was associated lower likelihood of accessing (5.3% vs. 13.4% of US population) and continuing to utilize the app (ß = -.02-.03). African Americans were more likely to access content from an African American meditation teacher, but this did not appear to increase utilization. Additional efforts are warranted to identify factors which might reduce disparities.

Does variability across three universities in the implementation of a college course on human flourishing affect student outcomes?

OBJECTIVE: This study explores whether variability in the implementation of an undergraduate course on human flourishing is differentially associated with student outcomes. PARTICIPANTS: 101 students in the "Art and Science of Human Flourishing" course across three large, public, R1 universities in Fall 2018 participated in the study. METHODS: Formative course data included researcher observations of weekly class pedagogy, students' weekly meditation practice logs and end-of-course assessments, and pre/post surveys measuring changes in participating students' outcomes related to flourishing (e.g., attentional skills, social-emotional skills, perspectives on flourishing, mental and physical health). RESULTS: Although course pedagogy and student engagement varied across the three universities, students' outcomes were nonetheless similar. CONCLUSIONS: Variability in course implementation did not appear to differentially affect students' outcomes. We tentatively conclude that other institutions interested in offering the flourishing course may make limited adaptations to fit their pedagogical preferences without concern for altering its impact on students.

Personalized Prediction of Response to Smartphone-Delivered Meditation Training: Randomized Controlled Trial.

BACKGROUND: Meditation apps have surged in popularity in recent years, with an increasing number of individuals turning to these apps to cope with stress, including during the COVID-19 pandemic. Meditation apps are the most commonly used mental health apps for depression and anxiety. However, little is known about who is well suited to these apps. OBJECTIVE: This study aimed to develop and test a data-driven algorithm to predict which individuals are most likely to benefit from app-based meditation training. METHODS: Using randomized controlled trial data comparing a 4-week meditation app (Healthy Minds Program [HMP]) with an assessment-only control condition in school system employees (n=662), we developed an algorithm to predict who is most likely to benefit from HMP. Baseline clinical and demographic characteristics were submitted to a machine learning model to develop a "Personalized Advantage Index" (PAI) reflecting an individual's expected reduction in distress (primary outcome) from HMP versus control. RESULTS: A significant group × PAI interaction emerged (t658=3.30; P=.001), indicating that PAI scores moderated group differences in outcomes. A regression model that included repetitive negative thinking as the sole baseline predictor performed comparably well. Finally, we demonstrate the translation of a predictive model into personalized recommendations of expected benefit. CONCLUSIONS: Overall, the results revealed the potential of a data-driven algorithm to inform which individuals are most likely to benefit from a meditation app. Such an algorithm could be used to objectively communicate expected benefits to individuals, allowing them to make more informed decisions about whether a meditation app is appropriate for them. TRIAL REGISTRATION: ClinicalTrials.gov NCT04426318; https://clinicaltrials.gov/ct2/show/NCT04426318.

Absence of structural brain changes from mindfulness-based stress reduction: Two combined randomized controlled trials.

Studies purporting to show changes in brain structure following the popular, 8-week mindfulness-based stress reduction (MBSR) course are widely referenced despite major methodological limitations. Here, we present findings from a large, combined dataset of two, three-arm randomized controlled trials with active and waitlist (WL) control groups. Meditation-naïve participants (n = 218) completed structural magnetic resonance imaging scans during two visits: baseline and postintervention period. After baseline, participants were randomly assigned to WL (n = 70), an 8-week MBSR program (n = 75), or a validated, matched active control (n = 73). We assessed changes in gray matter volume, gray matter density, and cortical thickness. In the largest and most rigorously controlled study to date, we failed to replicate prior findings and found no evidence that MBSR produced neuroplastic changes compared to either control group, either at the whole-brain level or in regions of interest drawn from prior MBSR studies.

Integrating mindfulness and connection practices into preservice teacher education results in durable automatic race bias reductions.

Automatic race bias, which is the tendency to associate positive attributes more quickly with White as compared to Black faces, reflects enculturation processes linked to inequitable teaching behaviors. In sample of undergraduate preservice teachers (N = 88), we examined whether a novel mindfulness and connection practice intervention without anti-bias content incorporated into undergraduate teacher education would result in reduced automatic race bias favoring White faces. Random assignment to the intervention predicted significantly reduced race preference for White child faces immediately after the intervention. These significant reductions persisted at the 6-month follow-up, which are the most durable reductions in automatic race bias reported to date in adults. Data from semi-structured interviews indicated that the intervention enhanced self-awareness and self-regulation while reducing automatic responding among preservice teachers. These qualities are instrumental to adaptive teaching and putative mechanisms for reducing automatic race bias. The potential value of integrating mindfulness and connection practices into undergraduate preservice teacher education is discussed.

Prevalence of harm in mindfulness-based stress reduction.

BACKGROUND: Mindfulness meditation has become a common method for reducing stress, stress-related psychopathology and some physical symptoms. As mindfulness programs become ubiquitous, concerns have been raised about their unknown potential for harm. We estimate multiple indices of harm following Mindfulness-Based Stress Reduction (MBSR) on two primary outcomes: global psychological and physical symptoms. In secondary analyses, we estimate multiple indices of harm on anxiety and depressive symptoms, discomfort in interpersonal relations, paranoid ideation and psychoticism. METHODS: Intent-to-treat analyses with multiple imputations for missing data were used on pre- and post-test data from a large, observational dataset (n = 2155) of community health clinic MBSR classes and from MBSR (n = 156) and waitlist control (n = 118) participants from three randomized controlled trials conducted contemporaneous to community classes in the same city by the same health clinic MBSR teachers. We estimate the change in symptoms, proportion of participants with increased symptoms, proportion of participants reporting greater than a 35% increase in symptoms, and for global psychological symptoms, clinically significant harm. RESULTS: We find no evidence that MBSR leads to higher rates of harm relative to waitlist control on any primary or secondary outcome. On many indices of harm across multiple outcomes, community MBSR was significantly preventative of harm. CONCLUSIONS: Engagement in MBSR is not predictive of increased rates of harm relative to no treatment. Rather, MBSR may be protective against multiple indices of harm. Research characterizing the relatively small proportion of MBSR participants that experience harm remains important.

Brief breath awareness training yields poorer working memory performance in the context of acute stress.

Mindfulness-based interventions that span multiple sessions over time appear to confer psychological benefits. However, the effects of brief periods of mindfulness meditation training are less clear, particularly on measures of cognitive functioning. This study assessed whether brief mindfulness practice (breath awareness) or training in two other contemplative practices - loving-kindness and gratitude - differentially impact working memory performance following acute physiological stress relative to an attentional control. Participants (n = 162) were randomly assigned to one of four training groups and completed the automated Operation Span (OSPAN) task pre-training and again after undergoing the cold pressor task. Three of the four groups improved in OSPAN performance, with loving-kindness, gratitude, and attentional control conditions showing increases in OSPAN relative to breath awareness. Changes in OSPAN were not correlated with changes in positive or negative affect. It appears that brief breath awareness training may not effectively buffer against acute stress in this predominantly meditation naïve sample and may in fact impair subsequent cognitive performance relative to a control or other contemplative practices. A granular approach is warranted to understand potentially distinct and contextually variable effects of different contemplative practices. Implications are discussed in light of the stress buffering hypothesis and Monitor and Acceptance Theory.Trial registration: ClinicalTrials.gov identifier: NCT02214264.

Divergent effects of brief contemplative practices in response to an acute stressor: A randomized controlled trial of brief breath awareness, loving-kindness, gratitude or an attention control practice.

Mindfulness practices are increasingly being utilized as a method for cultivating well-being. The term mindfulness is often used as an umbrella for a variety of different practices and many mindfulness-based interventions (MBIs) contain multiple styles of practice. Despite the diversity of practices within MBIs, few studies have investigated whether constituent practices produce specific effects. We randomized 156 undergraduates to one of four brief practices: breath awareness, loving-kindness, gratitude, or to an attention control condition. We assessed practice effects on affect following brief training, and effects on affect and behavior after provocation with a stressor (i.e., Cold pressor test). Results indicate that gratitude training significantly improved positive affect compared to breath awareness (d = 0.58) and loving-kindness led to significantly greater reductions in implicit negative affect compared to the control condition (d = 0.59) immediately after brief practice. In spite of gains in positive affect, the gratitude group demonstrated increased reactivity to the stressor, reporting the CPT as significantly more aversive than the control condition (d = 0.46) and showing significantly greater increases in negative affect compared to the breath awareness, loving-kindness, and control groups (ds = 0.55, 0.60, 0.65, respectively). Greater gains in implicit positive affect following gratitude training predicted decreased post-stressor likability ratings of novel neutral faces compared to breath awareness, loving-kindness, and control groups (ds = - 0.39, -0.40, -0.33, respectively) as well. Moreover, the gratitude group was significantly less likely to donate time than the loving-kindness group in an ecologically valid opportunity to provide unrewarded support. These data suggest that different styles of contemplative practice may produce different effects in the context of brief, introductory practice and these differences may be heightened by stress. Implications for the study of contemplative practices are discussed.