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Treatment - Mindfulness & Acceptance

Comparison of Symptom Trajectories in an Online Randomized Trial of Mindfulness-Based Interventions for Well-Being Based on Participant Engagement

(PS14-67) Comparison of Symptom Trajectories in an Online Randomized Trial of Mindfulness-based Interventions for Well-being Based on Participant Engagement

Sunday, November 17, 2024

10:30 AM – 11:30 AM EST

Location: Franklin Hall, Level 4, Marriott Downtown

Author(s)

IH

Ingrid Hsu, B.A.

Clinical Research Coordinator
Massachusetts General Hospital
Boston, Massachusetts, United States

Co-Author(s)

NA

Nur Akpolat, B.S.

Clinical Research Coordinator
Massachusetts General Hospital
Boston, Massachusetts, United States
SM

Sofia Montinola, B.A.

Clinical Research Coordinator
Massachusetts General Hospital
Boston, Massachusetts, United States
HK

Hadi R. Kobaissi, B.S.

Clinical Research Coordinator
Massachusetts General Hospital
Boston, Massachusetts, United States
Broghan F. O'Hearn, B.A.

Clinical Research Coordinator
Massachusetts General Hospital
Somerville, Massachusetts, United States
AA

Antonietta Alvarez Hernandez, B.A.

Clinical Research Coordinator II
Massachusetts General Hospital
Boston, Massachusetts, United States
CF

Caylin Faria, B.S.

Senior Clinical Research Coordinator
Massachusetts General Hospital
boston, Massachusetts, United States
SC

Saee Chitale, B.A.

Clinical Research Coordinator II
Massachusetts General Hospital
Boston, Massachusetts, United States
DR

Dustin J. Rabideau, Ph.D.

Associate Director, Biostatistics and Strategic Initiatives for MGH Biostatistic
Harvard University
Boston, Massachusetts, United States
CB

Chelsea Boccagno, Ph.D.

Clinical Fellow
Massachusetts General Hospital
Boston, Massachusetts, United States
Louisa Sylvia, Ph.D. (she/her/hers)

Associate Professor
Massachusetts General Hospital (MGH)
Boston, Massachusetts, United States
AN

Andrew A. Nierenberg, M.D.

Director of Dauten Family Center for Bipolar Innovation
Massachusetts General Hospital
Boston, Massachusetts, United States
MK

Masoud Kamali, M.D.

Psychiatrist
Massachusetts General Hospital
Boston, Massachusetts, United States

Abstract Text: Introduction: Self-guided online psychological interventions are becoming increasingly popular in research and clinical practice. However, attrition and participant non-engagement remain common. Here, we report how symptom trajectories differ in a randomized trial of two self-guided online mindfulness-based interventions for well-being, based on level of engagement.

Methods: Participants (N=4161) were adults (ages ≥ 18) recruited from 17 patient-powered research networks and randomized to either an 8-session online Mindfulness-Based Cognitive Therapy program or a 3-session online mindfulness intervention. All participants were assigned assessments during the intervention (weeks 0, 2, 4, 6, 8) and follow-up periods (weeks 12, 16, and 20). Assessments targeted well-being (WHO-5 Well-Being Index), ability to perform social roles (PROMIS: Ability to Participate in Social Roles and Activities Short form), and mindfulness facets (non-judgment and non-reactivity; Five Facet Mindfulness Questionnaire). Given comparable outcomes, participants across the two mindfulness interventions were combined and then stratified into three groups for this secondary analysis: engaged (N= 748; completed at least one therapy session and at least one assessment during both the intervention and follow-up periods), gradual non-engaged (GNE) (N=1046; completed at least one therapy session and at least one assessment during either the intervention or follow-up periods), and non-engaged (NE) (N=2367; completed no therapy sessions, regardless of assessment completion). Graphs including mean symptom trajectories and corresponding confidence intervals (CIs) over 20 weeks were compared descriptively.

Results: Overall, participants in the engaged group reported higher mean well-being, ability to perform social roles, non-judgment, and non-reactivity at baseline and follow-up relative to those in the GNE and NE groups. The CIs for the GNE and NE groups overlapped at almost all follow-up visits. Although the CIs for the engaged group were distinct from the other two groups at baseline and in the early weeks of the study, differences were not as apparent in the later assessment weeks. This reflected increased participant dropout, particularly in the NE and GNE groups, and fewer responses to the assessments leading to wide CIs.

Discussion: Our results suggest that more engaged participants reported higher mean well-being, ability to perform social roles, non-judgment, and non-reactivity at baseline and throughout the study. Participants with lower well-being and lower ability to perform social roles may not engage well in online mindfulness interventions. Individuals with higher mindfulness abilities at baseline may have resonated more with online mindfulness-based interventions and thus had fewer dropouts from the study. Due to the high dropout in the GNE and NE groups and widening confidence intervals across time, we are unable to clearly differentiate between the three groups during the follow-up phase. To increase participant representation and treatment adherence, future research should identify and address specific components of online mindfulness interventions that contribute to dropout and low engagement.