App-Based Mindfulness for Attenuation of Subjective and Physiological Stress Reactivity in a Population With Elevated Stress: Randomized Controlled Trial.

BACKGROUND: Stress-related mental health disorders have steadily increased and contributed to a worldwide disease burden with up to 50% experiencing a stress-related mental health disorder worldwide. Data suggest that only approximately 20%-65% of individuals receive treatment. This gap in receiving treatment may be attributed to barriers such as limited treatment access, negative stigma surrounding mental health treatment, approachability (ie, not having a usual treatment plan or provider), affordability (ie, lack of insurance coverage and high treatment cost), and availability (ie, long waits for appointments) leaving those who need treatment without necessary care. To mitigate the limited access mental health treatment, there has been a rise in the application and study of digital mental health interventions. As such, there is an urgent need and opportunity for effective digital mental health interventions to alleviate stress symptoms, potentially reducing adverse outcomes of stress-related disorders. OBJECTIVE: This study examined if app-based guided mindfulness could improve subjective levels of stress and influence physiological markers of stress reactivity in a population with elevated symptoms of stress. METHODS: The study included 163 participants who had moderate to high perceived stress as assessed by the Perceived Stress Scale (PSS-10). Participants were randomly allocated to 1 of 5 groups: a digital guided program designed to alleviate stress (Managing Stress), a digital mindfulness fundamentals course (Basics), digitally delivered breathing exercises, an active control intervention (Audiobook), and a Waitlist Control group. The 3 formats of mindfulness interventions (Managing Stress, Basics, and Breathing) all had a total duration of 300 minutes spanning 20-30 days. Primary outcome measures were perceived stress using the PSS-10, self-reported sleep quality using the Pittsburgh Sleep Quality Index, and trait mindfulness using the Mindful Attention Awareness Scale. To probe the effects of physiological stress, an acute stress manipulation task was included, specifically the cold pressor task (CPT). Heart rate variability was collected before, during, and after exposure to the CPT and used as a measure of physiological stress. RESULTS: The results showed that PSS-10 and Pittsburgh Sleep Quality Index scores for the Managing Stress (all P<.001) and Basics (all P≤.002) groups were significantly reduced between preintervention and postintervention periods, while no significant differences were reported for the other groups. No significant differences among groups were reported for Mindful Attention Awareness Scale (P=.13). The physiological results revealed that the Managing Stress (P<.001) and Basics (P=.01) groups displayed reduced physiological stress reactivity between the preintervention and postintervention periods on the CPT. There were no significant differences reported for the other groups. CONCLUSIONS: These results demonstrate efficacy of app-based mindfulness in a population with moderate to high stress on improving self-reported stress, sleep quality, and physiological measures of stress during an acute stress manipulation task. TRIAL REGISTRATION: ClinicalTrials.gov NCT05832632; https://www.clinicaltrials.gov/ct2/show/NCT05832632.

Navigating the ethics of Internet-guided self-help interventions.

Internet-guided self-help (IGSH) programs have proliferated recently to treat common mental health problems such as anxiety and depression. However, technology has outpaced the development of ethical guidelines for this mode of delivery. We examine ethical challenges in this new space, including defining the role "guides" play in treatment, crisis management, and user selection and screening. IGSH programs can provide safe and ethical care when they (a) coordinate care effectively with other systems; (b) provide competent and well-defined guidance; and (c) reach users that are appropriate for and well-educated about the services they are going to receive. We argue that jurisdictional practice constraints and outdated regulatory and ethical guidelines may impede the ability of IGSH programs to maintain or even improve performance when faced with greater demand, larger populations, heterogeneous settings, and the desire for large-scale dissemination.

Developing a Novel Measure of Body Satisfaction Using Virtual Reality.

Body image disturbance (BID), considered a key feature in eating disorders, is a pervasive issue among young women. Accurate assessment of BID is critical, but the field is currently limited to self-report assessment methods. In the present study, we build upon existing research, and explore the utility of virtual reality (VR) to elicit and detect changes in BID across various immersive virtual environments. College-aged women with elevated weight and shape concerns (n = 38) and a non-weight and shape concerned control group (n = 40) were randomly exposed to four distinct virtual environments with high or low levels of body salience and social presence (i.e., presence of virtual others). Participants interacted with avatars of thin, normal weight, and overweight body size (BMI of approximately 18, 22, and 27 respectively) in virtual social settings (i.e., beach, party). We measured state-level body satisfaction (state BD) immediately after exposure to each environment. In addition, we measured participants' minimum interpersonal distance, visual attention, and approach preference toward avatars of each size. Women with higher baseline BID reported significantly higher state BD in all settings compared to controls. Both groups reported significantly higher state BD in a beach with avatars as compared to other environments. In addition, women with elevated BID approached closer to normal weight avatars and looked longer at thin avatars compared to women in the control group. Our findings indicate that VR may serve as a novel tool for measuring state-level BID, with applications for measuring treatment outcomes. Implications for future research and clinical interventions are discussed.

Decreasing body dissatisfaction using a brief conditioning intervention.

OBJECTIVE: Body dissatisfaction in females is common and a risk factor for the development of an eating disorder. This study tested whether body dissatisfaction could be improved using a brief conditioning intervention in which photographs of participants' bodies were selectively paired with positive social stimuli (smiling faces) and photographs of other bodies were paired with neutral or negative social stimuli (neutral and frowning faces). METHOD: 39 women (mean age = 22.46; 64.1% Caucasian) with high body dissatisfaction were randomized to either the evaluative conditioning intervention (n = 22) or to a delayed waitlist control condition (n = 17). Body dissatisfaction (specifically, shape and weight concern), restraint, eating concern, and self-esteem were assessed at baseline, post treatment and again after four and 12 weeks. RESULTS: Compared to women in the delayed waitlist control condition, women in the treatment condition demonstrated a significant decrease in shape and weight concern, and a significant increase in self-esteem. Similar trends were found for the control condition after they completed the intervention. Changes at post treatment related to body dissatisfaction were maintained at 12-week follow-up. CONCLUSIONS: Repeatedly pairing photographs of an individual's body with positive social feedback may lead to improved body image and self-esteem.

Designing virtual environments to measure behavioral correlates of state-level body satisfaction.

Virtual reality (VR) offers a unique method for eliciting state-variable fluctuations in body satisfaction and associated behaviors by allowing near-perfect control over environmental factors. Greater variability in momentary body satisfaction is associated with more problematic eating behavior and cognitive styles predictive of eating disorders. The field currently lacks a model for understanding environmental variables and everyday events that tend to influence fluctuations in state body satisfaction. This study proposes a model of state-level body satisfaction and presents a method for measuring changes as they occur. We aim to investigate body comparison, selective attention and body checking behaviors in relation to self-report levels of state body satisfaction. We additionally assess interpersonal correlates of state body satisfaction using VR to measure personal distance between subjects and avatars of varying body sizes. 80 female college students with varying levels of weight and shape concerns will be exposed to five virtual environments designed to elicit varying levels of body dissatisfaction: (a) an empty room; (b) an empty beach; (c) a beach populated with avatars; (d) an empty party scene; (e) a party scene populated with avatars. Self-report body satisfaction was measured immediately following each exposure. A tracking system automatically tracked subjects' head orientation and body translation to measure visual gaze and personal space behavior relative to each virtual human within the environment. Data collection is currently underway and expected to be completed by May 2013. Preliminary data and development of the VR model for state-variable assessment will be presented.