Smartphone apps teach mindfulness, self-compassion to reduce depression

Smartphones may provide a cheap and accessible means by which to teach the principles of acceptance, mindfulness, and self-compassion, which can potentially reduce depression and distress, according to a new meta-analysis.

“A growing number of randomized controlled trials (RCTs) are beginning to examine the effects of smartphone apps that are based on principles of acceptance, mindfulness, and self-compassion,” researchers said. “This meta-analysis thus examined whether mindfulness, acceptance, and self-compassion can be learnt through these smartphone apps.”

A total of 27 RCTs qualified for the meta-analysis, contributing 31 app-supported smartphone intervention conditions. Quality of the studies varied: 62.9 percent of the trials reported appropriate sequence generation, 48.1 percent provided data for the calculation of intent-to-treat effect sizes, 18.5 percent had adequate concealment, and 100 percent used self-reported questionnaires. [Behav Ther 2020;51;646-658]

Researchers found a statistically significant pooled effect size of smartphone apps on acceptance and mindfulness (g, 0.29, 95 percent confidence interval [CI], 0.17–0.41). This remained significant even when analysis was limited to trials with a low risk of bias.

Subgroup analyses revealed that the effects of the smartphone apps on acceptance and mindfulness were stronger in studies that used an inactive comparator and in apps that offered active reminders to the users. Population characteristics, the presence of professional support, or engaging in other intervention programmes did not significantly impact the pooled effect size.

Similarly, the pooled effect size on self-compassion was statistically significant (g, 0.31, 95 percent CI, 0.07–0.56). However, only seven trials were used for this analysis, and none had a low risk of bias; no subgroup analysis could be performed.

Cumulative analysis of 12 trials also showed that smartphone apps were significantly effective at reducing depression and distress (g, –0.32, 95 percent CI, –0.48 to –0.16).

Subsequent meta-regression analysis revealed a statistically significant and inverse correlation between mindfulness/acceptance and depression/distress (slope, –0.48, 95 percent CI, –1.01 to 0.04; p=0.035). Removing one extreme outlier strengthened this interaction (slope, –0.97, 95 percent CI, –1.26 to –0.69; p<0.001).

“Smartphone apps that included acceptance and/or mindfulness components resulted in significant but small improvements in acceptance and mindfulness skills relative to control conditions,” the researchers said. “Smartphone apps that contain acceptance and mindfulness components may also lead to small improvements in self-compassion, although the quality of the available evidence was poor.”

Several important limitations need to be taken into consideration, they cautioned. In some analyses, for example, the evidence available was scarce or was of low quality. The high risk of bias in many of the included trials, as well as the limit of analysis on short-term app effects, are also methodological shortcomings that need to be addressed in future studies.

“Present findings suggest that principles of acceptance, mindfulness, and self-compassion may be acquired through mental health smartphone apps,” the researchers said. “However, the extent to which these effects are explained by the intervention components themselves or by a ‘digital placebo’ are yet to be determined.”