Adolescent Mindfulness Mobile App Study (RCT) (AMMASRCT)

Rumination involves focusing on negative emotions repeatedly and is a risk factor for developing depression, anxiety, and self-injury. These negative outcomes increase in adolescence. The main goal of this study is to examine whether a mobile application designed to reduce rumination works with adolescents. The mobile application involves mindfulness exercises. Mindfulness means nonjudgmentally and deliberately paying attention. Adolescents will be randomly assigned to either the mindfulness group or a control group who uses a mobile application without mindfulness exercises. Both groups will use the app three times per day for three weeks and we will follow up with participants for six months. The investigators hypothesize that the mindfulness group will experience a reduction in rumination and symptoms of depression, anxiety and self-injury. They also expect that the mindfulness group will find the mobile app to be more engaging and will continue to use it beyond the 3 weeks.

Rumination, a perseverative cognitive process that involves dwelling on negative emotions, is a transdiagnostic risk factor for the development of depression, anxiety, and self-injurious behaviors. Thus, reducing the tendency to ruminate in adolescence, a time when many psychological disorders often first develop, has the potential for a large public health impact. This protocol involves testing the acceptability and efficacy of a newly developed mindfulness mobile application designed to reduce rumination. Mindfulness involves paying attention to the present moment without judgement. If negative emotions arise, one notices them and how the body is feeling without becoming caught up in the emotion so that it can pass. In adult clinical studies, intensive mindfulness practice has been associated with successful treatment of psychopathology, including preventing the recurrence of depression, possibly through reducing rumination. Research with adolescents has suggested that a brief mindfulness exercise can interrupt the ruminative process. Thus, mindfulness appears to be a promising strategy to reduce the tendency to ruminate and prevent psychopathology. A diverse sample of 150 high-ruminating 12-15 year-olds will be recruited from the community and randomly assigned to a 3-week mobile mindfulness intervention or an ecological momentary assessment (EMA)-only control condition. In both conditions, adolescents will be notified to use the mobile app three times per day to complete EMA questions. Based on mood ratings, participants in the mindfulness condition have a chance to receive a brief mindfulness exercise (i.e., 1-12 minutes long) at each use. At pre- and post-intervention and three follow-up periods (6 weeks,12 weeks, and 6 months), participants and their parents will report on adolescent anxiety and depression. Adolescents will also report on self-injurious thoughts and behaviors (SITBs), trait rumination, and mindfulness. During the intervention period, participants will report on state levels of rumination, mindfulness, and mood using the app. Participants will also report on their satisfaction with the app, while their optional continued use of the app will be monitored electronically for 6 months following the intervention period. The investigators will test intervention effects using multilevel modeling, examining the role of both state- and trait-level mediators. Based on preliminary pilot data, the investigators expect that the mindfulness intervention will reduce symptoms, and we anticipate this effect to be due to the mediating role of decreased rumination.

Participants will be randomly assigned to the intervention group (i.e., mindfulness with ecological momentary assessment) or the control group (i.e., ecological momentary assessment only).

Participants will use app for assessment for three weeks, but no mindfulness exercises will be delivered.

Mindfulness exercises will last 1-12 minutes. Each one asks participants to focus on something (e.g., breath, sounds, physical sensations) using guided instruction.

parent-reported internalizing symptoms (range = 0-10 with higher scores indicating more internalizing symptoms)

parent-reported internalizing symptoms (range = 0-10 with higher scores indicating more internalizing symptoms)

parent-reported internalizing symptoms (range = 0-10 with higher scores indicating more internalizing symptoms)

parent-reported internalizing symptoms (range = 0-10 with higher scores indicating more internalizing symptoms)

parent-reported internalizing symptoms (range = 0-10 with higher scores indicating more internalizing symptoms)

average state rumination during intervention period rated on a visual analog scale (range = 0-100 with higher scores indicating more rumination)

average sadness and anxiety during intervention period rated on visual analog scales (range = 0-100 with higher scores indicating more rumination)

Daily app use was determined by how many complete app uses were logged during the three-week intervention period.

trait mindfulness acting with awareness (range = 8-40 with higher scores indicating greater mindfulness)

trait mindfulness acting with awareness (range = 8-40 with higher scores indicating greater mindfulness)

trait mindfulness acting with awareness (range = 8-40 with higher scores indicating greater mindfulness)

trait mindfulness acting with awareness (range = 8-40 with higher scores indicating greater mindfulness)

trait mindfulness acting with awareness (range = 8-40 with higher scores indicating greater mindfulness)

trait mindfulness non-judging of inner experience (range = 8-40 with higher scores indicating greater mindfulness)

trait mindfulness non-judging of inner experience (range = 8-40 with higher scores indicating greater mindfulness)

trait mindfulness non-judging of inner experience (range = 8-40 with higher scores indicating greater mindfulness)

trait mindfulness non-judging of inner experience (range = 8-40 with higher scores indicating greater mindfulness)

trait mindfulness non-judging of inner experience (range = 8-40 with higher scores indicating greater mindfulness)

trait mindfulness non-reactivity to inner experience (range = 7-35 with higher scores indicating greater mindfulness)

trait mindfulness non-reactivity to inner experience (range = 7-35 with higher scores indicating greater mindfulness)

trait mindfulness non-reactivity to inner experience (range = 7-35 with higher scores indicating greater mindfulness)

trait mindfulness non-reactivity to inner experience (range = 7-35 with higher scores indicating greater mindfulness)

trait mindfulness non-reactivity to inner experience (range = 7-35 with higher scores indicating greater mindfulness)

average focus on bodily sensations during intervention period rated on visual analog scale (range = 0-100 with higher scores indicating more mindfulness)

average % focus on present moment (as opposed to past or future focus) during intervention period indicating more mindfulness

Inclusion Criteria: adolescent between the ages of 12 and 15 years at least moderate levels of rumination (mean score of 2 or above on a 1-4 scale) on the two screening questions Exclusion Criteria: serious physical or cognitive disability that prevents adolescent from using a mobile device, because that is the intervention delivery method inadequate English proficiency to complete questionnaires

Webb CA, Swords CM, Lawrence HR, Hilt LM. 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 Sep;90(9):655-669. doi: 10.1037/ccp0000763.