A Randomized Controlled Trial of a Smartphone-Based Well-Being Training in Public School System Employees During the COVID-19 Pandemic

Abstract

While the extraordinary pressures of the COVID-19 pandemic on student mental health have received considerable attention, less attention has been placed on the well-being of school system employees despite their vital role in society and the education of young people. The need for innovative mental health promotion strategies that are acceptable, accessible, and scalable has never been more evident. In a remote pragmatic randomized wait-list controlled trial of Wisconsin public school system employees (N=662) during the COVID-19 pandemic, we investigate a candidate program: a freely available four-week smartphone-based meditation app designed to train key constituents of well-being (Healthy Minds Program; HMP). Following our preregistered analysis plan and consistent with hypotheses, assignment to the HMP predicted significantly larger reductions in psychological distress, our primary outcome, at post-intervention (standardized mean difference (SMD)=-0.52 95% CI [-0.68 to -0.37], P<0.0001) and at the three-month follow-up (SMD=-0.33 [-0.48 to -0.18], P<0.001). Also consistent with hypotheses, similar indications of immediate and sustained benefit following the HMP were observed on all six preregistered secondary outcomes selected to tap skills targeted in the app (absolute value SMDs=0.19 to 0.42, all Ps<0.031 corrected). Secondary outcomes included an antecedent to anxiety and depression (perseverative thinking) and a measure of loneliness. We found no evidence for elevated adverse effects in the HMP group and the HMP was at least as effective in subsample analyses involving participants with elevated anxiety and depressive symptoms at baseline. These data suggest that the HMP has promise as an acceptable, accessible, and scalable mental health intervention.

Personalized prediction of response to smartphone-delivered meditation training

“…Individuals with more negative PAI scores -reflecting relatively stronger meditation app (i.e., HMP) recommendations -had better outcomes if randomly assigned to the meditation app relative to the control condition. As expected given the positive effect of treatment condition on reductions in change in distress (Hirshberg et al, 2021), the models typically predicted greater benefit from HMP versus the control condition. However, the predicted benefits of HMP were not always large and, in some cases, the PAI model predicted either relatively small betweengroup differences in outcome ("yellow zone" in Figure 3) or even better outcomes in the control condition ("red zone" in Figure 3).…”

“…The current study involved secondary analysis of a large-scale randomized controlled trial (RCT) comparing a meditation-based smartphone app, the Healthy Minds Program (HMP), with an assessment-only control condition (Hirshberg et al, 2021). The RCT was conducted in a sample of school district employees (n = 662) in the state of Wisconsin during the COVID-19 pandemic.…”

“…Wisconsin school district employees were recruited via email and other electronic media between mid-June 2020 to late-August 2020 (for a full description of study procedures, see Hirshberg et al, 2021). Eligible participants were adults (≥18 years of age) currently employed by a Wisconsin school who owned a smartphone capable of downloading the HMP, who had limited exposure to meditation or the HMP app, and depressive symptoms below the severe range (T-score < 70 on Patient-Reported Outcomes Information System [PROMIS] Depression; Pilkonis et al, 2011).…”

Effects of a mindfulness-based intervention and a health self-management programme on psychological well-being in older adults with subjective cognitive decline: Secondary analyses from the SCD-Well randomised clinical trial

“…Although 8-week MBIs in younger healthy populations have exerted a positive impact on measures of global well-being as well as dimensions of awareness, connection, and insight (e.g., Goldberg et al, 2020), in older adults with SCD, eight weeks of practice might be too brief for measurable and clinically meaningful changes in facets of psychological well-being to manifest. Notably, in MBIs in younger healthy populations, effect sizes of change in measures of psychological distress tend to be larger than those of changes in well-being dimensions (e.g., Goldberg et al, 2020;Hirshberg et al, 2022). This pattern also emerges in the context of the SCD-Well trial and is in line with the fact that standard MBIs, derived from the generic mindfulnessbased stress reduction programme, are mainly targeted at helping participants develop more adaptive responses to psychological distress.…”

Educators Are Not Alright: Mental Health During COVID-19

“…Through public web postings and a midsize urban district’s newsletter, we recruited 662 SSEs (65.11% [431] instructional staff, 48.34% [320] lead classroom teachers) in Wisconsin to participate in a fully remote randomized controlled trial of a meditation-based well-being smartphone application (Hirshberg et al, 2022). Participants came from 40 districts and were slightly more racially diverse and female than SSEs across the state (Supplemental Materials [SM] Table S1).…”