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.

OBJECTIVE:Evaluate student effects of participating in an undergraduate academic course, Art and Science of Human Flourishing, that was offered in a synchronous, virtual format during the Fall 2020 semester at three universities. PARTICIPANTS:Three combined cohorts of undergraduate students from three universities (n = 168). METHODS:A pre/post/5-month follow-up, propensity-score matched evaluation was conducted. Measures assessed attention skills, social-emotional skills, flourishing, depressive symptoms, and sleep quality. RESULTS:Relative to comparisons, students in the course reported significant improvements in proximal outcomes related to mindfulness, compassion, and common humanity, as well as decreases in depressive symptoms. Improvements in distal outcomes of flourishing and depressive symptoms were significant at post-course but did not maintain significance at five-month follow-up. CONCLUSIONS:The academic study of human flourishing and contemplative education offers a promising and unique approach to supporting undergraduate mental health and well-being, even in virtual settings.

Digital technologies (DTs) have become ubiquitous. Adolescents are avid users of DTs. As access to and use of DTs has increased among adolescents, daily life and adolescent social interaction patterns have shifted in profound ways. Although the causal relationship between DT use and adolescent wellbeing is not clear, it is clear that the economy driving DT innovation is not designed to promote adolescent wellbeing. Yet, DTs possess characteristics that make them promising avenues for wellbeing promotion because of their accessibility, ability to scale up, and the potential for personalization. In this essay, we propose that strengthening adolescent wellbeing skills through DT interventions may provide the necessary conditions for adaptive adolescent DT use at a public health scale, leading to improved adolescent wellbeing.

Importance High levels of health care professional (HCP) distress portend negative consequences for HCPs and health systems. Objective To evaluate whether a 13-week digital well-being training could improve Mexican HCP distress and well-being. Design, Setting, and Participants This 2-arm randomized clinical trial was conducted between March 2023 and March 2024 with 13-week postintervention and 37-week follow-up end points. Participants included 2315 adults with no previous well-being training experience who worked in 762 participating health care facilities across 7 Mexican states. Participants were randomly assigned (1:1) using stratified permuted blocks to well-being training or wait-list control. Outcomes assessors and study data analyst were masked to condition assignment. Assessments and intervention were conducted remotely. Intervention The digital well-being training consisted of nine 2-hour zoom sessions and 13 weeks of the Healthy Minds Program smartphone app structured on the premise that well-being skills can be strengthened through psychoeducation and contemplative practice. Main Outcome The primary prespecified outcomes were participant-reported distress (aggregate of z-scored National Institutes of Health Toolbox perceived stress, and Perceived Stress and Patient Reported Outcomes Measurement Information System anxiety and depression scales; mean = 0, SD = 1) and the World Health Organization-5 measure of well-being (range 0-25). Results Among 2315 participants, 1693 (73.1%) identified as female; 778 (33.4%) nurses, 736 (31.7%) physicians, 187 (8.1%) psychologists, 183 (7.9%) administrators, 154 (6.7%) dentists, 75 (3.2%) social workers, 64 (2.8%) nutritionists, 55 (2.4%) laboratory technicians, 40 (1.7%) physical therapists, 29 (1.3%) health promoters, and 8 (<0.1%) other health professionals; the mean (SD) age was 34.7 (11.4) years. Relative to control, in intention-to-treat analyses the intervention group reported 13-week reductions in distress (adjusted standardized mean difference [SMD], -0.24; 95% CI, -0.32 to -0.16) and increases in well-being (adjusted SMD, 0.27; 95% CI, 0.18 to 0.35) that increased in magnitude at 37-week follow-up (distress, -0.36; 95% CI, -0.44 to -0.28; well-being, 0.42; 95% CI, 0.34 to 0.50). Primary outcomes were robust in sensitivity analyses. There were 10 adverse events (intervention: 0.05% [6 of 1157]; control: 0.04% [4 of 1158]). Conclusions and Relevance This randomized clinical trial found that scalable digital well-being training modestly improved Mexican HCP distress and well-being compared with a wait-list condition. As HCPs are essential to public health and report high levels of distress that interfere with their ability to provide optimal care, well-being training may be an avenue to better supporting HCPs.

We developed a self-report measure of psychological well-being for teens and adults, the Healthy Minds Index, based on a novel theory that four trainable pillars underlie well-being: awareness, connection, insight, and purpose. Ninety-seven items were developed and revised by experts and guided by qualitative testing with teens (n = 32; average age = 16.0 years). After assessing the internal validity and factor structure in teens (n = 1607; average age = 16.7 years) and adults (n = 420; average age = 45.6 years), we reduced the survey to 17 items. We then validated the factor structure, internal and convergent and divergent validity, and retest reliability of the 17-item Healthy Minds Index in two new teen samples (study 1: n = 1492, average age = 15.7 years; study 2: n = 295, average age = 16.1 years), and one adult sample (n = 285; average age = 45.3 years). The Healthy Minds Index demonstrated adequate validity and provided a comprehensive measure of a novel theory of psychological well-being that includes two domains not found in other conceptualizations of this construct—awareness and insight. This measure will be invaluable for primary research on well-being and as a translational tool to assess the impact and efficacy of widely used behavioral training programs on these core dimensions of wellbeing.

Early career teacher attrition disrupts school continuity, precludes many of those who leave from achieving expertise, and drains economic resources from school systems. In a longitudinal cluster randomized controlled trial (k = 8, n = 98), we examined the impact of a 9-week meditation-based intervention on undergraduate preservice teachers' rates of attrition from teaching approximately 4 years later. The odds of attrition among intervention group participants 3 years into their teaching careers were significantly reduced by at least 77.0% regardless of modeling approach (Odds ratios = 0.13-0.23, ps ≤ 0.013) compared to teacher education as usual controls. In benefit-cost analyses, we estimated that for every $1 spent on the intervention, hiring districts saved $3.43 in replacement teacher costs. Additional research is required to replicate the core finding of reduced attrition and understand the pathways through which the intervention caused these reductions.

More research is needed to understand the effects of school-based mindfulness programs in the years prior to adolescence, which represent a critical juncture and transitional period of development. The present study investigated mindfulness with elementary school students using random assignment and objective measures. The sample included 292 fifth graders from 21 classrooms randomly assigned to an 8-week mindfulness training or wait-list control group. Students were assessed at pre- and post-intervention on behavioral measures of executive functioning and teacher-rated social emotional competence, along with end of year social-emotional learning report card grades. Analyses using hierarchal linear modeling found that students in the intervention group demonstrated significant gains on a computerized task of cognitive flexibility, and end of year social-emotional learning grades controlling for prior year grades, but not teacher reported social emotional competence. Taken together these findings point to a simple, yet promising method for bolstering students' cognitive and social emotional skills.

Objective: Effective psychosocial interventions exist for numerous mental health conditions. However, despite decades of research, limited progress has been made on clarifying the mechanisms that account for their beneficial effects. We know that many treatments work, but we know relatively little about why they work. Mechanisms of change may be obscured due to prior research collapsing across heterogeneous subgroups of patients with differing underlying mechanisms of response. Studies identifying baseline individual characteristics that predict differential response (i.e., moderation) may inform research on why (i.e., mediation) a particular subgroup has better outcomes to an intervention via tests of moderated mediation. Method: In a recent randomized controlled trial comparing a 4-week meditation app with a control condition in school system employees (N=662), we previously developed a “Personalized Advantage Index” (PAI) using baseline characteristics, which identified a subgroup of individuals who derived relatively greater benefit from meditation training. Here, we tested whether the effect of mindfulness acquisition in mediating group differences in outcome was moderated by PAI scores. Results: A significant index of moderated mediation (IMM=1.22, 95% CI: 0.30, 2.33) revealed that the effect of mindfulness acquisition in mediating group differences in outcome was only significant among those individuals with PAI scores predicting relatively greater benefit from the meditation app. Conclusions: Subgroups of individuals may differ meaningfully in the mechanisms that mediate their response to an intervention. Considering subgroup-specific mediators may accelerate progress on clarifying mechanisms of change underlying psychosocial interventions and may help inform which specific interventions are most beneficial for whom.

This cohort study examines the association of a college course designed to strengthen skills for mental health taken in 2018 or 2019 with measures of anxiety, depression, and flourishing during the early months of the SARS-CoV-2 pandemic in 2020.

Bidirectional associations between changes in symptoms and alliance are established for in-person psychotherapy. Alliance may play an important role in promoting engagement and effectiveness within unguided mobile-health (mHealth) interventions. Using models disaggregating alliance and psychological distress into within- and between-persons components (random intercept cross-lagged panel model), we report bidirectional associations between alliance and distress over the course of a 4-week smartphone-based meditation intervention ( n = 302, 80.0% elevated depression/anxiety). Associations were stable across time, and effect sizes were similar to those observed for psychotherapy (distress to alliance: βs = −0.13 to −0.14; alliance to distress: βs = −0.09 to −0.10). Alliance may be worth measuring to improve the acceptability and effectiveness of mHealth tools. Further empirical and theoretical work characterizing the role and meaning of alliance in unguided mHealth is warranted.

Objective: Meditation apps are the most widely used mental health apps. The precise mechanisms underlying their effects remain unclear. In particular, the degree to which affect experienced during meditation is associated with outcomes has not been established. Method: We used the meditation app arm of a recently completed randomized controlled trial comparing a self-guided meditation app (Healthy Minds Program) to a waitlist control. Predominantly distressed public school employees (n = 243, 80.9% with clinically elevated depression and/or anxiety) reported positive and negative affect during meditation practice. Data were analyzed using two-level multivariate latent growth curve models (observations nested within participants) that simultaneously attended to both positive and negative affect. We examined whether positive and negative affect during meditation changed over time and whether these changes were associated with changes in psychological distress (parent trial's preregistered primary outcome) at posttest or 3-month follow-up. Results: On average, participants reported decreased negative affect but no change in positive affect during meditation over time. Increased positive affect and decreased negative affect during meditation were associated with improvements in distress at posttest and follow-up. Change in positive affect was a stronger predictor of distress at follow-up than change in negative affect. Conclusions: Despite notions embedded within mainstream mindfulness meditation training that deemphasize the importance of the affective experience of practice (i.e., nonjudgmental awareness of present moment experience, regardless of valence), results indicate that these experiences contain signals associated with outcomes. Monitoring affect during meditation may be worthwhile to guide intervention delivery (i.e., measurement-based care, precision medicine).

Despite growing popularity, associations between dosage and outcomes in meditation-app interventions have not been established. We examined this relationship using a range of operationalizations of dosage (e.g., minutes of use, days of use, number and type of activities completed) and strategies for modeling outcomes (e.g., ordinary least squares regression, multilevel modeling, latent class analysis). We used data from a recently completed randomized controlled trial that tested a meditation app ( N = 662; 80.4% with elevated depression/anxiety) that included psychological distress as its preregistered primary outcome. Across 41 models, whether an association was detected and the shape and direction of this association varied. Although several models indicated that higher dosage was associated with larger decreases in psychological distress, many models failed to show this relationship, and some even showed the opposite. These results may have implications for optimizing and studying dosage in meditation apps and for open-science practices.

We investigated whether informal meditation practice (i.e., engagement of meditative techniques outside a period of formal meditation) was associated with outcomes in smartphone-based loving-kindness and compassion training. Clinically distressed meditation-naïve participants (n = 351) completed measures of psychological distress, loneliness, empathy, and prosociality at baseline and following a two-week intervention. Informal practice, psychological distress, and loneliness were also assessed daily. Steeper increases in informal practice were correlated with pre-post improvements in distress (r = -.18, p = .008) and loneliness (r = -.19, p = .009) but not empathy or prosociality. Using a currently recommended analytic approach for establishing cross-lagged effects in longitudinal data (latent curve model with structured residuals), higher current-day informal practice was associated with decreased next-day distress but not decreased next-day loneliness. No cross-lagged associations emerged from distress or loneliness to informal practice. Findings suggest that further investigation into a potential causal role of informal practice is warranted. Future studies manipulating informal practice are needed.

BACKGROUND:Profound negative implications of adverse childhood experiences (ACEs) have raised public health concern worldwide. METHOD:This systematic review and meta-analysis examined associations of three types of ACEs (abuse, neglect, and household dysfunctions) with experiential (emotional quality of momentary and everyday experiences) and reflective (judgments about life satisfaction, sense of meaning, and ability to pursue goals that can include and extend beyond the self) facets of emotional well-being (EWB) and educational achievement. The systematic review yielded 100 studies with 176 effect sizes that met criteria for inclusion in the meta-analysis. RESULTS:ACEs were related particularly strongly to lower EWB, r = -0.32, p < .001; [95 % CI: -0.44 to 0.01], but also to lower educational achievement, r = -0.18, p < .001; [95 % CI: -0.21 to -0.05]. Associations were stronger for abuse and composite indicators of ACEs than for household dysfunctions. Associations of ACEs with EWB and educational achievement were stronger in childhood and adolescence than in emerging or later adulthood. Associations did not differ for males and females or for Eastern versus Western cultural groups. Analyses provided evidence for the causal role of ACEs in the development of lower EWB and academic achievement as well as their reciprocal associations. LIMITATIONS:There is no standard conceptualization of well-being and studies are not always clear about the types of ACEs examined, with limited research on educational achievement. CONCLUSION:Findings have important implications for mental health professionals, policy makers and social service agencies in developing resources and intervention services that target ACEs to protect individuals and promote well-being and academic achievement.

The present study explored prospective links between trait mindfulness and compassion on subsequent coping and compliance with Centers for Disease Control (CDC) guidelines and indirect effects via well-being and internalized distress during the COVID-19 pandemic. The study included N = 736 US college students who participated in a three-wave longitudinal study across a single academic year. The first two assessment waves took place in 2018 and 2019, respectively, while the third wave took place in May 2020 during the COVID-19 pandemic. Participants completed self-report measures of trait mindfulness, compassion, well-being, internalized distress, coping, and compliance with CDC health guidelines. Results of a series of autoregressive, cross-lagged panel models revealed that trait mindfulness was associated with better coping via indirect effects of greater well-being and lower internalized distress. Greater compassion was linked with greater adherence to CDC guidelines. Findings suggest that trait mindfulness and compassion may play a role in college students' coping and compliance during the pandemic.

Objective This study explores whether variability in the implementation of an undergraduate course on human flourishing is differentially associated with student outcomes.Participants 101 students in the “Art and Science of Human Flourishing” course across three large, public, R1 universities in Fall 2018 participated in the study.Methods Formative course data included researcher observations of weekly class pedagogy, students’ weekly meditation practice logs and end-of-course assessments, and pre/post surveys measuring changes in participating students’ outcomes related to flourishing (e.g., attentional skills, social-emotional skills, perspectives on flourishing, mental and physical health).Results Although course pedagogy and student engagement varied across the three universities, students’ outcomes were nonetheless similar.Conclusions Variability in course implementation did not appear to differentially affect students’ outcomes. We tentatively conclude that other institutions interested in offering the flourishing course may make limited adaptations to fit their pedagogical preferences without concern for altering its impact on students.

Data from the early months of the COVID-19 pandemic raised concerns about pandemic impacts on college student mental health. However, early pandemic phase effects on mental health may be transient and high symptom prevalence rates, while alarming, may reflect a continuation of pre-pandemic trends rather than pandemic effects. We evaluated pandemic impacts on mental health in Fall 2020 as well as the relationship between social and health behaviors and mental health during this phase of the pandemic. In a cross-sectional cohort design, we used multivariable regression analyses to compare college student levels of anxiety, depression, well-being, and search for meaning in life before (2018 n=466; 2019 n=459) and during the pandemic (2020, n=563; N=1488; i.e., pandemic cohort). We used Pearson correlation matrices and multivariable regression to examine the relationship between social and health behaviors with pandemic mental health outcomes. Finally, we plot trajectories of change in our data as an extension of published long-term trends (2007-2017) in college student anxiety, depression, and well-being to descriptively examine whether the pandemic appears to have accelerated pre-pandemic trends in deteriorating college student mental health. Levels of anxiety, depression, and well-being did not significantly differ in the 2019 pre-pandemic and pandemic cohorts (Ps>.05). The pandemic cohort reported significantly higher search for meaning in life (P=.014, Cohen’s d=0.15), a predictor of later depressive symptoms. In the pandemic cohort, more frequent in-person social interactions were associated with lower anxiety (r =-0.17, P<.001) and depressive symptoms (r =-0.12, P<.01), and higher well-being (r =-0.16, P<.001). Social videoconferencing was associated with higher well-being (r =0.11, P<.05), but only in-person social interactions explained unique variance in well-being when modeled together. In-person social interactions were also associated with less handwashing (r =-0.11, P<.05) and face mask wearing (r =-0.12, P<.01). Plotting our data as an extension of published longitudinal trends in college student mental health did not reveal evidence for pandemic-specific accelerations in worsening college student mental health. Across the three universities sampled in this study, we find little evidence for deleterious pandemic-specific impacts on college student mental health. Instead, our data appears consistent with a decades long trend in worsening college student mental health. During the pandemic, college students may behave in ways that increase the risk of infection (e.g., in-person social interactions and less facemask wearing) but are associated with improved mental health and well-being. Although we find little evidence for pronounced pandemic effects on mental on college student mental health, prevalence rates of anxiety and depressive symptoms are alarmingly high, highlighting the need to attend to college student mental health and well-being. not applicable

Digital interventions have the potential to alleviate mental health disparities for marginalized and minoritized communities. The current study examined whether disparities in access and utilization of meditation in the United States (US) were reduced for a freely available meditation app. We analyzed demographic and usage data from US-based users of the Healthy Minds Program (HMP; N = 66,482) between October 2019 and July 2022. College education was associated with a greater likelihood of accessing (65.0% of users vs. 32.9% of the US population) and continuing to utilize the app ( β = 0.11–0.17). Conversely, identifying as African American was associated lower likelihood of accessing (5.3% vs. 13.4% of the US population) and continuing to utilize the app ( β = −0.02–0.03). African Americans were more likely to access content from an African American meditation teacher, but this did not appear to increase utilization. Additional efforts are warranted to identify factors that might reduce disparities.