App-based Mindfulness Training for Adolescent Rumination: Predictors of Immediate and Cumulative Benefit

Overview

Journal Mindfulness (N Y)

Publisher Springer

Specialty Psychiatry

Date 2022 Apr 18

PMID 35432625

Authors

Christian A Webb

Caroline M Swords

Laura Murray

Lori M Hilt

Affiliations

Soon will be listed here.

Abstract

Objectives: Rumination is a transdiagnostic risk factor for depression and anxiety, which surge during the adolescent years. Mindfulness training - with its emphasis on metacognitive awareness and present-moment attention - may be effective at reducing rumination. Mindfulness apps offer a convenient, engaging, and cost-effective means for accessing mindfulness training for teens. Despite their increasing popularity among adolescents, no study to date has investigated which teens are well-suited to app-based mindfulness training.

Methods: Eighty adolescents ( age = 14.01 years, 45% girls) with elevated rumination were enrolled in a 3-week trial of app-based mindfulness training. Repeated daily ecological momentary assessment (EMA) surveys assessed problem-focused and emotion-focused rumination immediately prior to and following each mindfulness exercise. Elastic net regularization (ENR) models tested baseline predictors of "immediate" (post-mindfulness exercise) and "cumulative" (post-3-week intervention) benefit from app-based mindfulness training.

Results: Ninety percent (72/80) of adolescents completed the 3-week trial, and the mean number of mindfulness exercises completed was 28.7. Baseline adolescent characteristics accounted for 14%-25% of the variance in outcomes (i.e., reduction in problem-focused or emotion-focused rumination). Higher baseline rumination, and lower emotional suppression, predicted better immediate and cumulative outcomes. In contrast, female gender and older age predicted better immediate, but not cumulative, outcomes. Differences in results across outcome timeframes (immediate vs. cumulative) are discussed.

Conclusions: Findings from this study highlight the potential of data-driven approaches to inform which adolescent characteristics may predict benefit from engaging with an app-based mindfulness training program. Additional research is needed to test these predictive models against a comparison (non-mindfulness) condition.

Citing Articles

Effective elements of eHealth interventions for mental health and well-being in children and adolescents: A systematic review.

Dietvorst E, de Vries L, van Eijl S, Mesman E, Legerstee J, Keijsers L Digit Health. 2024; 10:20552076241294105.

PMID: 39525561 PMC: 11544686. DOI: 10.1177/20552076241294105.

Brain mechanisms of rumination and negative self-referential processing in adolescent depression.

Murray L, Jaffe N, Tierney A, Pidvirny K, Balkind E, Abbasi B J Affect Disord. 2024; 366:83-90.

PMID: 39191310 PMC: 11468901. DOI: 10.1016/j.jad.2024.08.114.

Testing the Effectiveness of a Mindfulness- and Acceptance-Based Smartphone App for Nurses Traumatized by the COVID-19 Pandemic: A Pilot Study.

Reyes PhD Msn Rn A, Fudolig PhD M, Sharma Mbbs PhD McHes M, S Evangelista PhD Rn Faan L Issues Ment Health Nurs. 2024; 45(10):1034-1045.

PMID: 39173125 PMC: 11722598. DOI: 10.1080/01612840.2024.2385571.

Ruminative Variability Predicts Increases in Depression and Social Anxiety.

Bean C, Ciesla J Cognit Ther Res. 2024; 48(3):511-525.

PMID: 39108323 PMC: 11299773. DOI: 10.1007/s10608-023-10451-z.

Which client with generalized anxiety disorder benefits from a mindfulness ecological momentary intervention versus a self-monitoring app? Developing a multivariable machine learning predictive model.

Zainal N, Newman M J Anxiety Disord. 2024; 102:102825.

PMID: 38245961 PMC: 10922999. DOI: 10.1016/j.janxdis.2024.102825.

References

Gu J, Strauss C, Bond R, Cavanagh K . 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. Clin Psychol Rev. 2015; 37:1-12. DOI: 10.1016/j.cpr.2015.01.006. View

Cohen Z, DeRubeis R . Treatment Selection in Depression. Annu Rev Clin Psychol. 2018; 14:209-236. DOI: 10.1146/annurev-clinpsy-050817-084746. View

Stekhoven D, Buhlmann P . MissForest--non-parametric missing value imputation for mixed-type data. Bioinformatics. 2011; 28(1):112-8. DOI: 10.1093/bioinformatics/btr597. View

Gibb B, Grassia M, Stone L, Uhrlass D, McGeary J . Brooding rumination and risk for depressive disorders in children of depressed mothers. J Abnorm Child Psychol. 2011; 40(2):317-26. PMC: 3253178. DOI: 10.1007/s10802-011-9554-y. View

Watkins E, Nolen-Hoeksema S . A habit-goal framework of depressive rumination. J Abnorm Psychol. 2014; 123(1):24-34. DOI: 10.1037/a0035540. View

Webb C, Cohen Z, Beard C, Forgeard M, Peckham A, Bjorgvinsson T . Personalized prognostic prediction of treatment outcome for depressed patients in a naturalistic psychiatric hospital setting: A comparison of machine learning approaches. J Consult Clin Psychol. 2019; 88(1):25-38. PMC: 6924628. DOI: 10.1037/ccp0000451. View

Watkins E, Roberts H . Reflecting on rumination: Consequences, causes, mechanisms and treatment of rumination. Behav Res Ther. 2020; 127:103573. DOI: 10.1016/j.brat.2020.103573. View

McLaughlin K, Nolen-Hoeksema S . Rumination as a transdiagnostic factor in depression and anxiety. Behav Res Ther. 2011; 49(3):186-93. PMC: 3042543. DOI: 10.1016/j.brat.2010.12.006. View

Tang R, Braver T . Towards an Individual Differences Perspective in Mindfulness Training Research: Theoretical and Empirical Considerations. Front Psychol. 2020; 11:818. PMC: 7248295. DOI: 10.3389/fpsyg.2020.00818. View

10.

Twenge J, Cooper A, Joiner T, Duffy M, Binau S . Age, period, and cohort trends in mood disorder indicators and suicide-related outcomes in a nationally representative dataset, 2005-2017. J Abnorm Psychol. 2019; 128(3):185-199. DOI: 10.1037/abn0000410. View

11.

Derryberry D, Reed M . Anxiety-related attentional biases and their regulation by attentional control. J Abnorm Psychol. 2002; 111(2):225-36. DOI: 10.1037//0021-843x.111.2.225. View

12.

Webb C, Swords C, Lawrence H, Hilt L . Which adolescents are well-suited to app-based mindfulness training? A randomized clinical trial and data-driven approach for personalized recommendations. J Consult Clin Psychol. 2022; 90(9):655-669. PMC: 9886135. DOI: 10.1037/ccp0000763. View

13.

Friedman J, Hastie T, Tibshirani R . Regularization Paths for Generalized Linear Models via Coordinate Descent. J Stat Softw. 2010; 33(1):1-22. PMC: 2929880. View

14.

Lyubomirsky S, Tucker K, Caldwell N, Berg K . Why ruminators are poor problem solvers: clues from the phenomenology of dysphoric rumination. J Pers Soc Psychol. 1999; 77(5):1041-60. DOI: 10.1037//0022-3514.77.5.1041. View

15.

Deyo M, Wilson K, Ong J, Koopman C . Mindfulness and rumination: does mindfulness training lead to reductions in the ruminative thinking associated with depression?. Explore (NY). 2009; 5(5):265-71. DOI: 10.1016/j.explore.2009.06.005. View

16.

Aldao A, Nolen-Hoeksema S, Schweizer S . Emotion-regulation strategies across psychopathology: A meta-analytic review. Clin Psychol Rev. 2009; 30(2):217-37. DOI: 10.1016/j.cpr.2009.11.004. View

17.

Nolen-Hoeksema S . Responses to depression and their effects on the duration of depressive episodes. J Abnorm Psychol. 1991; 100(4):569-82. DOI: 10.1037//0021-843x.100.4.569. View

18.

Hilt L, McLaughlin K, Nolen-Hoeksema S . Examination of the response styles theory in a community sample of young adolescents. J Abnorm Child Psychol. 2010; 38(4):545-56. PMC: 2848704. DOI: 10.1007/s10802-009-9384-3. View

19.

Wasil A, Gillespie S, Shingleton R, Wilks C, Weisz J . Examining the Reach of Smartphone Apps for Depression and Anxiety. Am J Psychiatry. 2020; 177(5):464-465. DOI: 10.1176/appi.ajp.2019.19090905. View

20.

Hilt L, Swords C . Acceptability and Preliminary Effects of a Mindfulness Mobile Application for Ruminative Adolescents. Behav Ther. 2021; 52(6):1339-1350. DOI: 10.1016/j.beth.2021.03.004. View