Mobile Mindfulness Intervention on an Acute Psychiatric Unit: Feasibility and Acceptability Study

Abstract

BackgroundAggression and violence on acute psychiatric inpatient units is extensive and leads to negative sequelae for staff and patients. With increasingly acute inpatient milieus due to shorter lengths of stay, inpatient staff is limited in training and time to be able to provide treatments. Mobile technology provides a new platform for offering treatment on such units, but it has not been tested for feasibility or usability in this particular setting.ObjectiveThe aim of this study was to examine the feasibility, usability, and acceptability of a brief mindfulness meditation mobile phone app intended to reduce anger and aggression in acute psychiatric inpatients with schizophrenia, schizoaffective disorder, or bipolar disorder, and a history of violence.MethodsParticipants were recruited between November 1, 2015 and June 1, 2016. A total of 13 inpatients at an acute care state hospital carried mobile phones for 1 week and were asked to try a commercially available mindfulness app called Headspace. The participants completed a usability questionnaire and engaged in a qualitative interview upon completion of the 7 days. In addition, measures of mindfulness, state and trait anger, and cognitive ability were administered before and after the intervention.ResultsOf the 13 enrolled participants, 10 used the app for the 7 days of the study and completed all measures. Two additional participants used the app for fewer than 7 days and completed all measures. All participants found the app to be engaging and easy to use. Most (10/12, 83%) felt comfortable using Headspace and 83% (10/12) would recommend it to others. All participants made some effort to try the app, with 6 participants (6/12, 50%) completing the first 10 10-minute “foundation” guided meditations.ConclusionsThis is the first known study of the use of a commercially available app as an intervention on acute psychiatric inpatient units. Acutely ill psychiatric inpatients at a state hospital found the Headspace app easy to use, were able to complete a series of meditations, and felt the app helped with anxiety, sleep, and boredom on the unit. There were no instances of an increase in psychotic symptoms reported and there were no episodes of aggression or violence noted in the record.

Factors affecting implementation of digital health interventions for people with psychosis or bipolar disorder, and their family and friends: a systematic review

“…[28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] The only study published prior to 2007 involved a telehealth digital intervention. 45 Most of the studies used mixed methods, 28,29,31,32,34,35,[37][38][39][40][41][42][43][44][45][46][47][48][49][50] four used quantitative methods 30,33,36,51 and two studies used qualitative methodology. 52,53 The majority of the studies were feasibility and acceptability trials (42%), 29, 35, 36, 38, 40, 42-44, 50, 53 eight were designed to look specifically at implementation (31%), 28, 30, 32, 45-47, 49, 52 five were pilot studies (19%), 31,39,…”

“…44,53 A mindfulness app was found to be a welcome change from medication or face-to-face interactions in an inpatient unit, helping to relieve boredom and giving users a positive activity to focus on. 42 The privacy and anonymity of online digital interventions was reported as an advantage by some, 53 but fears about cybersecurity were also a barrier, with one person declining to take part in a study due to privacy concerns 48 and other users worried about privacy when using a digital intervention on a public computer. 53…”

“…Infrastructure problems included lack of access to computers, printers 46,52,53 , space 28,34,52,53 , equipment 28,47,52 , or Wi-Fi/internet access. 42,47,52,53 Whilst cost was cited as a factor for this, there was a sense across these studies that there had been a failure in implementation planning across all types of interventions. 32,34,47,52 The availability of staff trained to implement interventions was also limited due to a lack of investment in their training, the high demands of their clinical workload and a rapid staff turnover.…”

“…Attitudes and beliefs about digital interventions were crucial implementation factors for both staff and users. Positive beliefs that the intervention would help management of symptoms, 38,42 enthusiasm and interest in the intervention, 34,46,52 trust in the team delivering the intervention, and the knowledge that it had been developed by other service users 40 were all cited as factors in increasing end user engagement. However, negative attitudes to IT generally, 52 the preference for face-to-face interventions and lack of interest in digital interventions meant that while users may formally complete sessions, these sessions were less successful as they were more interested in browsing other websites, did not interact with staff in sessions, and did not utilise the available peer support.…”

“…However, negative attitudes to IT generally, 52 the preference for face-to-face interventions and lack of interest in digital interventions meant that while users may formally complete sessions, these sessions were less successful as they were more interested in browsing other websites, did not interact with staff in sessions, and did not utilise the available peer support. 46 From a staff perspective, the belief that the software was a well-developed time-saving resource fostered a positive attitude that could in turn motivate users to be more responsive and more engaged in the intervention 32,39,42,52 while scepticism, and negativity were reported as barriers. 32,34,45,52 Some members of staff lacked IT skills and were reluctant to use digital technology in daily clinical practice digital intervention 52 whilst others recognised the importance and necessity for staff engagement from the onset of the process to support the successful implementation .…”