Psychological Mediators of Reduced Distress: Preregistered Analyses From a Randomized Controlled Trial of a Smartphone-Based Well-Being Training

Abstract

Understanding why interventions work is essential to optimizing them. Although mechanistic theories of meditation-based interventions (MBIs) exist, empirical evidence is limited. We randomly assigned 662 adults (79.9% reported clinical levels of anxiety or depressive symptoms) to a 4-week smartphone-based MBI or wait-list control condition early in the COVID-19 pandemic. Psychological distress and four theory-driven preregistered psychological mediators of well-being (mindful action, loneliness, cognitive defusion, and purpose) were assessed five times during the intervention period and at 3-month follow-up. In preregistered analyses, assignment to the intervention predicted significant gains on all mediators, which, in turn, significantly mediated follow-up distress (21.9%–62.5% of intervention effect on distress). No significant mediation pathway was observed in an exploratory multiple mediator analysis, but reduced loneliness accounted for 61.7% of the combined indirect effect. Multiple psychological pathways may mediate reduced distress in a digital MBI.

Keywords

distress meditation mobile health mechanisms mediation

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References

Alsubaie

Abbott

Dunn

Dickens

Keil

T. F.

Henley

Kuyken

(2017). Mechanisms of action in mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction (MBSR) in people with physical and/or psychological conditions: A systematic review. Clinical Psychology Review, 55, 74–91. https://doi.org/10.1016/j.cpr.2017.04.008

American Mindfulness Research Association. (2022). Mindfulness journal publications by year, 1980–2021. https://goamra.org/resources/

Baer

R. A.

Smith

G. T.

Lykins

Button

Krietemeyer

Sauer

Walsh

Duggan

Williams

J. M. G.

(2008). Construct validity of the five facet mindfulness questionnaire in meditating and nonmeditating samples. Assessment, 15(3), 329–342. https://doi.org/10.1177/1073191107313003

Cacioppo

J. T.

Cacioppo

(2018). The growing problem of loneliness. The Lancet, 391(10119), Article P426. https://doi.org/10.1016/S0140-6736(18)30142-9

Caspi

Houts

R. M.

Belsky

D. W.

Goldman-Mellor

S. J.

Harrington

Israel

Meier

M. H.

Ramrakha

Shalev

Poulton

Moffitt

T. E.

(2014). The p factor: One general psychopathology factor in the structure of psychiatric disorders? Clinical Psychological Science: A Journal of the Association for Psychological Science, 2(2), 119–137. https://doi.org/10.1177/2167702613497473

Cohen

Kamarck

Mermelstein

(1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24(4), 385–396.

Crane

R. S.

Brewer

Feldman

Kabat-Zinn

Santorelli

Williams

J. M. G.

Kuyken

(2017). What defines mindfulness-based programs? The warp and the weft. Psychological Medicine, 47(6), 990–999.

Cyranowski

J. M.

Zill

Bode

Butt

Kelly

M. A. R.

Pilkonis

P. A.

Salsman

J. M.

Cella

(2013). Assessing social support, companionship, and distress: NIH toolbox adult social relationship scales. Health Psychology: Official Journal of the Division of Health Psychology, American Psychological Association, 32(3), 293–301. https://doi.org/10.1037/a0028586

Dahl

C. J.

Lutz

Davidson

R. J.

(2015). Reconstructing and deconstructing the self: Cognitive mechanisms in meditation practice. Trends in Cognitive Sciences, 19, 515–523. https://doi.org/10.1016/j.tics.2015.07.001

10.

Dahl

C. J.

Wilson-Mendenhall

C. D.

Davidson

R. J.

(2020). The plasticity of well-being: A training-based framework for the cultivation of human flourishing. Proceedings of the National Academy of Sciences, USA, 117, 32197–32206. https://doi.org/10.1073/pnas.2014859117

11.

Dimidjian

Gallop

Levy

Beck

Segal

Z. V.

(2023). Mediators of change in online mindfulness-based cognitive therapy: A secondary analysis of a randomized trial of mindful mood balance. Journal of Consulting and Clinical Psychology, 91(8), 496–502. https://doi.org/10.1037/ccp0000825

12.

Dunne

J. D.

Thompson

Schooler

(2019). Mindful meta-awareness: Sustained and non-propositional. Current Opinion in Psychology, 28, 307–311. https://doi.org/10.1016/j.copsyc.2019.07.003

13.

Eronen

M. I.

(2020). Causal discovery and the problem of psychological interventions. New Ideas in Psychology, 59, Article 100785. https://doi.org/10.1016/j.newideapsych.2020.100785

14.

Forman

E. M.

Herbert

J. D.

Juarascio

A. S.

Yeomans

P. D.

Zebell

J. A.

Goetter

E. M.

Moitra

(2012). The Drexel defusion scale: A new measure of experiential distancing. Journal of Contextual Behavioral Science, 1(1–2), 55–65. https://doi.org/10.1016/j.jcbs.2012.09.001

15.

Fresco

D. M.

Moore

M. T.

van Dulmen

M. H.

Segal

Z. V.

S. H.

Teasdale

J. D.

Williams

J. M. G.

(2007). Initial psychometric properties of the experiences questionnaire: Validation of a self-report measure of decentering. Behavior Therapy, 38(3), 234–246.

16.

Galante

Bekkers

M-J.

Gallacher

(2014). Effect of kindness-based meditation on health and well-being: A systematic review and meta-analysis. Journal of Consulting and Clinical Psychology, 82(6), 1101–1114. https://doi.org/10.1037/a0037249

17.

Goldberg

S. B.

(2022). A common factors perspective on mindfulness-based interventions. Nature Reviews Psychology, 1(10), 605–619.

18.

Goldberg

S. B.

Tucker

R. P.

Greene

P. A.

Davidson

R. J.

Wampold

B. E.

Kearney

D. J.

Simpson

T. L.

(2018). Mindfulness-based interventions for psychiatric disorders: A systematic review and meta-analysis. Clinical Psychology Review, 59, 52–60. https://doi.org/10.1016/j.cpr.2017.10.011

19.

Götz

O’Boyle

E. H.

Gonzalez-Mulé

Banks

G. C.

Bollmann

S. S.

(2021). The “Goldilocks Zone”: (Too) many confidence intervals in tests of mediation just exclude zero. Psychological Bulletin, 147(1), 95–114. https://doi.org/10.1037/bul0000315

20.

Graham

J. W.

(2009). Missing data analysis: Making it work in the real world. Annual Review of Psychology, 60, 549–576.

21.

Strauss

Bond

Cavanagh

(2015). How do mindfulness-based cognitive therapy and mindfulness-based stress reduction improve mental health and wellbeing? A systematic review and meta-analysis of mediation studies. Clinical Psychology Review, 37(Suppl. C), 1–12. https://doi.org/10.1016/j.cpr.2015.01.006

22.

Halsey

L. G.

Curran-Everett

Vowler

S. L.

Drummond

G. B.

(2015). The fickle P value generates irreproducible results. Nature Methods, 12(3), Article 3. https://doi.org/10.1038/nmeth.3288

23.

Hirshberg

M. J.

Frye

Dahl

C. J.

Riordan

K. M.

Vack

N. J.

Sachs

Goldman

Davidson

R. J.

Goldberg

S. B.

(2022). A randomized controlled trial of a smartphone-based well-being training in public school system employees during the COVID-19 pandemic. Journal of Educational Psychology, 114, 1895–1911. https://doi.org/10.1037/edu0000739

24.

Hirshberg

M. J.

Goldberg

S. B.

Schaefer

S. M.

Flook

Findley

Davidson

R. J.

(2018). 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. PLOS ONE, 13(12), Article e0207765. https://doi.org/10.1371/journal.pone.0207765

25.

Hoge

E. A.

Bui

Mete

Dutton

M. A.

Baker

A. W.

Simon

N. M.

(2023). Mindfulness-based stress reduction vs escitalopram for the treatment of adults with anxiety disorders: A randomized clinical trial. JAMA Psychiatry, 80(1), 13–21. https://doi.org/10.1001/jamapsychiatry.2022.3679

26.

Holwerda

T. J.

Deeg

D. J. H.

Beekman

A. T. F.

Tilburg

T. G.

van Stek

M. L.

Jonker

Schoevers

R. A.

(2014). Feelings of loneliness, but not social isolation, predict dementia onset: Results from the Amsterdam Study of the Elderly (AMSTEL). Journal of Neurology, Neurosurgery & Psychiatry, 85(2), 135–142. https://doi.org/10.1136/jnnp-2012-302755

27.

Hölzel

B. K.

Lazar

S. W.

Gard

Schuman-Olivier

Vago

D. R.

Ott

(2011). How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspectives on Psychological Science, 6(6), 537–559.

28.

Bentler

P. M.

(1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1–55. https://doi.org/10.1080/10705519909540118

29.

Kabat-Zinn

(2013). Full catastrophe living, revised edition: How to cope with stress, pain and illness using mindfulness meditation. Hachette UK.

30.

Kalin

N. H.

(2020). The critical relationship between anxiety and depression. American Journal of Psychiatry, 177(5), 365–367.

31.

Kazdin

A. E.

(2007). Mediators and mechanisms of change in psychotherapy research. Annual Review of Clinical Psychology, 3(1), 1–27. https://doi.org/10.1146/annurev.clinpsy.3.022806.091432

32.

Lee

C. M.

Cadigan

J. M.

Rhew

I. C.

(2020). Increases in loneliness among young adults during the COVID-19 pandemic and association with increases in mental health problems. Journal of Adolescent Health, 67(5), 714–717. https://doi.org/10.1016/j.jadohealth.2020.08.009

33.

Lee

S. L.

Pearce

Ajnakina

Johnson

Lewis

Mann

Pitman

Solmi

Sommerlad

Steptoe

Tymoszuk

Lewis

(2021). The association between loneliness and depressive symptoms among adults aged 50 years and older: A 12-year population-based cohort study. The Lancet Psychiatry, 8(1), 48–57. https://doi.org/10.1016/S2215-0366(20)30383-7

34.

Lin

(2018). Bias caused by sampling error in meta-analysis with small sample sizes. PLOS ONE, 13(9), Article e0204056. https://doi.org/10.1371/journal.pone.0204056

35.

Linardon

Fuller-Tyszkiewicz

(2020). Attrition and adherence in smartphone-delivered interventions for mental health problems: A systematic and meta-analytic review. Journal of Consulting and Clinical Psychology, 88(1), 1–13. https://doi.org/10.1037/ccp0000459

36.

Lindsay

E. K.

Creswell

J. D.

(2017). Mechanisms of mindfulness training: Monitor and acceptance theory (MAT). Clinical Psychology Review, 51, 48–59. https://doi.org/10.1016/j.cpr.2016.10.011

37.

Lutz

Jha

A. P.

Dunne

J. D.

Saron

C. D.

(2015). Investigating the phenomenological matrix of mindfulness-related practices from a neurocognitive perspective. American Psychologist, 70(7), 632–658.

38.

MacCallum

R. C.

Browne

M. W.

Sugawara

H. M.

(1996). Power analysis and determination of sample size for covariance structure modeling. Psychological Methods, 1(2), 130–149.

39.

MacKinnon

D. P.

Pirlott

A. G.

(2015). Statistical approaches for enhancing causal interpretation of the M to Y relation in mediation analysis. Personality and Social Psychology Review, 19(1), 30–43. https://doi.org/10.1177/1088868314542878

40.

Muthén

(2018). Mplus. The comprehensive modelling program for applied researchers: User’s guide, 5 (Version 8) [Computer software].

41.

Nguyen

T. Q.

Schmid

Stuart

E. A.

(2020). Clarifying causal mediation analysis for the applied researcher: Defining effects based on what we want to learn. Psychological Methods, 26, 255–271. https://doi.org/10.1037/met0000299

42.

Pilkonis

P. A.

Choi

S. W.

Reise

S. P.

Stover

A. M.

Riley

W. T.

Cella

, & PROMIS Cooperative Group. (2011). Item banks for measuring emotional distress from the Patient-Reported Outcomes Measurement Information System (PROMIS®): Depression, anxiety, and anger. Assessment, 18(3), 263–283. https://doi.org/10.1177/1073191111411667

43.

Preacher

K. J.

Hayes

A. F.

(2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40(3), 879–891. https://doi.org/10.3758/BRM.40.3.879

44.

Rico-Uribe

L. A.

Caballero

F. F.

Martín-María

Cabello

Ayuso-Mateos

J. L.

Miret

(2018). Association of loneliness with all-cause mortality: A meta-analysis. PLOS ONE, 13(1), Article e0190033. https://doi.org/10.1371/journal.pone.0190033

45.

Rohrer

J. M.

Hünermund

Arslan

R. C.

Elson

(2022). That’s a lot to process! Pitfalls of popular path models. Advances in Methods and Practices in Psychological Science, 5(2). https://doi.org/10.1177/25152459221095827

46.

Ruscio

A. M.

Seitchik

A. E.

Gentes

E. L.

Jones

J. D.

Hallion

L. S.

(2011). Perseverative thought: A robust predictor of response to emotional challenge in generalized anxiety disorder and major depressive disorder. Behaviour Research and Therapy, 49(12), 867–874. https://doi.org/10.1016/j.brat.2011.10.001

47.

Ryff

C. D.

Keyes

C. L.

(1995). The structure of psychological well-being revisited. Journal of Personality and Social Psychology, 69(4), 719–727.

48.

Schoemann

A. M.

Boulton

A. J.

Short

S. D.

(2017). Determining power and sample size for simple and complex mediation models. Social Psychological and Personality Science, 8(4), 379–386. https://doi.org/10.1177/1948550617715068

49.

Seligman

(2018). PERMA and the building blocks of well-being. The Journal of Positive Psychology, 13(4), 333–335.

50.

Shapiro

S. L.

Carlson

L. E.

Astin

J. A.

Freedman

(2006). Mechanisms of mindfulness. Journal of Clinical Psychology, 62(3), 373–386.

51.

Simonsohn

Simmons

Nelson

L. D.

(2022). Above averaging in literature reviews. Nature Reviews Psychology, 1(10), Article 10. https://doi.org/10.1038/s44159-022-00101-8

52.

Sims

Anders

Inglis

Lortie-Forgues

(2022). Quantifying “promising trials bias” in randomized controlled trials in education. Journal of Research on Educational Effectiveness, 16(4), 663–680. https://doi.org/10.1080/19345747.2022.2090470

53.

Steger

M. F.

Frazier

Oishi

Kaler

(2006). The meaning in life questionnaire: Assessing the presence of and search for meaning in life. Journal of Counseling Psychology, 53(1), 80–93.

54.

Vago

D. R.

Silbersweig

D. A.

(2012). Self-awareness, self-regulation, and self-transcendence (S-ART): A framework for understanding the neurobiological mechanisms of mindfulness. Frontiers in Human Neuroscience, 6, Article 296. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3480633/

55.

van der Velden

A. M.

Kuyken

Wattar

Crane

Pallesen

K. J.

Dahlgaard

Fjorback

L. O.

Piet

. (2015). A systematic review of mechanisms of change in mindfulness-based cognitive therapy in the treatment of recurrent major depressive disorder. Clinical Psychology Review, 37, 26–39. https://doi.org/10.1016/j.cpr.2015.02.001

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