Results Summary
What was the research about?
People often feel stressed due to work, money, or health problems. Feeling stressed can affect physical and mental health. Learning how to reduce stress can help improve overall well-being.
One way to reduce stress is through mindfulness therapy. Mindfulness therapy helps people focus on the present and accept their feelings. Standard programs often include 8 to 12 weekly sessions of guided meditation exercises. But a program that long could be hard for people to complete.
In this study, researchers wanted to learn if a program with fewer sessions can help people as well as the longer ones. The research team compared two online mindfulness therapy programs:
- An eight-week program that included eight weekly 20-minute sessions.
- A three-week program that was a shorter version of the eight-week program. This version had three weekly 20-minute sessions.
The research team looked at how well the two programs worked to improve people’s well-being, stress, and other health outcomes. Well-being included people’s mood, energy, and interest in daily life.
What were the results?
Over 20 weeks, depression, anxiety, and mindfulness improved more among people in the eight-week program than people in the three-week program. But these differences were small and not meaningful. When the programs ended and after 20 weeks, people in the two programs didn’t differ in reports of well-being, stress, and ability to perform daily roles. People in both programs saw improvements in these outcomes.
Who was in the study?
The study included 4,436 people from 17 Patient-Powered Research Networks, or PPRNs. In PPRNs, patients, families, caregivers, and community members share health data with the network. PPRNs work closely with researchers to plan and conduct research.
Of people who participated, 88 percent were White, 2 percent were Black, 2 percent were Asian, 1 percent were American Indian/Alaska Native, 3 percent were multiracial, and 1 percent were another race. Also, 5 percent were Hispanic. The average age was 55, and 88 percent were women.
What did the research team do?
The research team assigned people by chance to one of the two groups. The first group received a standard online mindfulness therapy program for eight weeks. The second group received a three-week program. Both groups had weekly sessions, which included a new meditation exercise at each session and homework assignments.
People completed surveys asking about their mood, activity, and well-being every two weeks for two months, then monthly for three months. They also answered questions about their stress and mindfulness.
Mental health advocates and others from the PPRNs worked with the research team to plan the study.
What were the limits of the study?
Most people in the study were White women; findings may differ for people from other backgrounds or for men. Some people dropped out of the study. Findings may have differed if more people had stayed in the study.
Future research could compare the programs with people of different backgrounds.
How can people use the results?
People can use these results when considering options for improving well-being and reducing stress.
| How this project fits under PCORI’s Research Priorities MoodNetwork formerly was a Network Partner in PCORnet®, the National Patient-Centered Clinical Research Network. PCORnet® has been developed with funding from the Patient-Centered Outcomes Research Institute (PCORI). |
Professional Abstract
Objective
To compare the effectiveness of a standard eight-session mindfulness-based cognitive therapy (MBCT) program with a brief three-session mindfulness program on improving well-being among participants recruited through Patient-Powered Research Networks (PPRNs)
Study Design
| Design Element | Description |
|---|---|
| Design | Randomized controlled trial |
| Population | 4,436 adult members of 17 PPRNs; participants included caregivers and patients |
| Interventions/ Comparators |
|
| Outcomes |
Primary: well-being Secondary: stress, anxiety, depression, quality of life, psychosocial functioning, mindfulness practice |
| Timeframe | 20-week follow-up for primary outcome |
This randomized controlled trial compared the effectiveness of two self-guided online mindfulness programs in improving participant well-being.
The research team recruited 4,436 participants from 17 PPRNs, which are online communities in which patients, caregivers, and community members provide self-reported data and contribute to all aspects of research. The team randomly assigned participants to one of the two programs. The first was a widely used, standardized, eight-week MBCT program. The second was a shorter, three-week mindfulness program. Both programs included one session per week and taught a new meditation exercise at each session with weekly homework assignments.
Of the participants, 88% were White, 2% were Black, 2% were Asian, 1% were American Indian/Alaska Native, 3% were multiracial, and 1% were another race; 5% were Hispanic. The average age was 55, and 80% were female.
Participants in both groups completed online questionnaires every two weeks for two months and monthly during the three-month follow-up to report on primary and secondary outcomes. The questionnaires assessed participants’ well-being, mental health, quality of life, psychosocial functioning, and mindfulness practice.
Mental health advocates, caregivers, and clinicians provided guidance on the study design and on considerations related to sharing results throughout the study.
Results
When the program ended and at 20-week follow-up, participant well-being did not differ significantly between the two programs. Participant well-being improved in both programs.
Over the 20 weeks, depression (p<0.001), anxiety (p<0.05), and mindfulness (p<0.05) scores improved more among participants in the eight-week program than among participants in the three-week program; however, these differences were small and not considered clinically meaningful. Participants in the two programs did not differ significantly on any other outcomes. However, over the 20-week follow-up period, participants in both programs had significant improvement in all secondary outcomes.
Limitations
Most of the participants were White and female. The study also had a high level of attrition that was comparable to other research on online mindfulness programs. Results may have differed with greater participant retention or the inclusion of more people from other backgrounds.
Conclusions and Relevance
This study found no significant differences in participant well-being between the standard eight-week online MBCT program and a three-week online mindfulness program, suggesting that a shorter, less intensive mindfulness program may be as effective as a longer, more intensive one.
Future Research Needs
Future research could compare the effectiveness of mindfulness programs of different lengths with participants of diverse backgrounds.
| How this project fits under PCORI’s Research Priorities MoodNetwork formerly was a Network Partner in PCORnet®, the National Patient-Centered Clinical Research Network. PCORnet® has been developed with funding from the Patient-Centered Outcomes Research Institute (PCORI). |
Final Research Report
View this project's final research report.
Peer-Review Summary
Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.
The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments.
Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:
- This study hypothesized that mindfulness-based cognitive therapy would improve participant well-being more than a brief mindfulness intervention but found that the difference between the two treatments was statistically but not clinically significant. The reviewers asked whether the researchers’ threshold for clinical significance could be too large for such a diverse group of study participants. The researchers added a note in the report that their threshold for clinical significance was based on clinical studies where participants were likely to be much more similar to each other than they were in the present study.
- The reviewers questioned the use of linear models in the study analyses, stating that the seven assessment times over 20 weeks were more likely to show variable changes in the outcomes over time. The researchers acknowledged that this was likely to be the case and added later analyses to the report that allowed for variability in the outcome measures over time as a comparison to the pre-planned linear analyses.
- The reviewers pointed out also that the analyses the researchers conducted would only be valid if participant dropout was random, when in reality the participants who had dropped out of the study were those who were not benefitting from the treatment. The researchers acknowledged this possibility and added a limitation to the report that dropout was possibly not random, and the study results were skewed toward more positive results.
- The reviewers asked the researchers to provide more rationale for the moderator variables, and to adjust the results of moderator analyses for multiple comparisons. The researchers provided more information about the moderator variables they chose. However, they did not make statistical adjustments to their moderator analyses because these analyses were largely exploratory. Therefore, the researchers reported the unadjusted results for these analyses but also limited their interpretation of these results.