Top

Published in:

Open Access 01-10-2013 | Original Article

Feasibility of an Online Mindfulness Program for Stress Management—A Randomized, Controlled Trial

Authors: Thomas J. Morledge, MD, Didier Allexandre, PhD, Emily Fox, MBA, MSSA, LSW, Alex Z. Fu, PhD, Mitchell K. Higashi, PhD, Denise T. Kruzikas, PhD, MPH, Sissi V. Pham, Pharm D, Pat Ray Reese, PhD

Published in: Annals of Behavioral Medicine | Issue 2/2013

Abstract

Background

Chronic stress affects many Americans. Stress management programs may be prohibitively expensive or have limited access.

Purpose

This study aims to determine feasibility of an 8-week Internet-based stress management program (ISM) based on mindfulness principles in reducing stress in a 12-week, parallel, randomized, controlled trial.

Methods

Participants were randomly allocated to ISM, ISM plus online message board (ISM+), or control groups. Perceived stress, mindfulness, self-transcendence, psychological well-being, vitality, and quality of life were measured at baseline, week 8, and week 12 using standard validated questionnaires.

Results

ISM and ISM+ groups demonstrated statistically significant improvements compared with control on all measures except vitality and physical health.

Conclusions

The ISM program effectively and sustainably reduced measures of stress. The magnitude of improvement is comparable to traditional mindfulness programs, although fewer participants were engaged. This feasibility study provides strong support for online stress management programs, which increase access at a fraction of cost of traditional programs.

Cohen S, Janicki-Deverts D, Miller GE. Psychological stress and disease. JAMA. 2007;298(14):1685-1687.PubMedCrossRef

Yusuf S, Hawken S, Ounpuu S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): Case–control study. Lancet. 2004;364(9438):937-952. doi:10.1016/S0140-6736(04)17018-9.PubMedCrossRef

O’Donnell MJ, Xavier D, Liu L, et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): A case–control study. Lancet. 2010;376(9735):112-123. doi:10.1016/S0140-6736(10)60834-3.PubMedCrossRef

Lucini D, Di Fede G, Parati G, Pagani M. Impact of chronic psychosocial stress on autonomic cardiovascular regulation in otherwise healthy subjects. Hypertension. 2005;46:1201-1206. doi:10.1161/01.HYP.0000185147.32385.4b.PubMedCrossRef

Siegrist J. Chronic psychosocial stress at work and risk of depression: Evidence from prospective studies. Eur Arch Psychiatr Clin Neurosci. 2008; 258 Suppl:115–9. doi:10.1007/s00406-008-5024-0.

McEwen BS. Protection and damage from acute and chronic stress: Allostasis and allostatic overload and relevance to the pathophysiology of psychiatric disorders. Ann N Y Acad Sci. 2004;1032:1-7. doi:10.1196/annals.1314.001.PubMedCrossRef

Epel ES, Blackburn EH, Lin J, et al. Accelerated telomere shortening in response to life stress. Proc Natl Acad Sci U S A. 2004;101(49):17312-17315. doi:10.1073/pnas.0407162101.PubMedCrossRef

Azagba S, Sharaf MF. Psychosocial working conditions and the utilization of health care services. BMC Publ Health. 2011;11:642. doi:10.1186/1471-2458-11-642.CrossRef

Baer RA. Mindfulness training as a clinical intervention: A conceptual and empirical review. Clin Psychol Sci Pract. 2003;10(2):125-143.CrossRef

10.

Shapiro SL, Oman D, Thoresen CE, Plante TG, Flinders T. Cultivating mindfulness: Effects on well-being. J Clin Psychol. 2008;64(7):840-862.PubMedCrossRef

11.

Chiesa A, Serretti A. Mindfulness-based stress reduction for stress management in healthy people: A review and meta-analysis. J Altern Complement Med. 2009;15(5):593-600.PubMedCrossRef

12.

Kabat-Zinn J. Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. New York, NY: Delta; 1990.

13.

Grossman P, Tiefenthaler-Gilmer U, Raysz A, Kesper U. Mindfulness training as an intervention for fibromyalgia: Evidence of postintervention and 3-year follow-up benefits in well-being. Psychother Psychosom. 2007;25:226-233.CrossRef

14.

Veehof MM, Oskam MJ, Schreurs KMG, Bohlmeijer ET. Acceptance-based interventions for the treatment of chronic pain: A systematic review and meta-analysis. Pain. 2011;152(3):533-542. doi:10.1016/j.pain.2010.11.002.PubMedCrossRef

15.

Vøllestad J, Sivertsen B, Nielsen GH. Mindfulness-based stress reduction for patients with anxiety disorders: Evaluation in a randomized controlled trial. Behav Res Ther. 2011;49(4):281-288. doi:10.1016/j.brat.2011.01.007.PubMedCrossRef

16.

Sephton SE, Salmon P, Weissbecker I, et al. Mindfulness meditation alleviates depressive symptoms in women with fibromyalgia: Results of a randomized clinical trial. Arthritis Rheum. 2007;57(1):77-85. doi:10.1002/art.22478.PubMedCrossRef

17.

Gaylord S, Palsson OS, Garland EL, et al. Mindfulness Training reduces the severity of irritable bowel syndrome in women: Results of a randomized controlled trial. Am J Gastroenterol. 2011;106(9):1678-1688. doi:10.1038/ajg.2011.184.PubMedCrossRef

18.

Barak A, Hen L, Boniel-Nissim M, Shapira N. A comprehensive review and a meta-analysis of the effectiveness of internet-based psychotherapeutic interventions. J Technol Hum Serv. 2008;26:109-160.CrossRef

19.

Meyer B, Berger T, Caspar F, Beevers CG, Andersson G, Weiss M. Effectiveness of a novel integrative online treatment for depression (Deprexis): Randomized controlled trial. J Med Internet Res. 2009;11(2):e15.PubMedCrossRef

20.

Thompson NJ, Walker ER, Obolensky N, et al. Distance delivery of mindfulness-based cognitive therapy for depression: Project UPLIFT. Epilepsy Behav. 2010;19(3):247-254.PubMedCrossRef

21.

Ljotsson B, Hedman E, Lindfors P, et al. Long-term follow-up of internet-delivered exposure and mindfulness based treatment for irritable bowel syndrome. Behav Res Ther. 2011;49(1):58-61.PubMedCrossRef

22.

Gardner-Nix J, Backman S, Barbati J, Grummitt J. Evaluating distance education of a mindfulness-based meditation programme for chronic pain management. J Telemed Telecare. 2008;14(2):88-92.PubMedCrossRef

23.

Wolever RQ, Bobinet KJ, McCabe K, et al. Effective and viable mind-body stress reduction in the workplace: A randomized controlled trial. J Occup Heal Psychol. 2012;17(2):246-258.CrossRef

24.

Gluck TM, Maercker A. A randomized controlled pilot study of a brief Web-based mindfulness training. BMC Psychiatry. 2011;11:175.PubMedCrossRef

25.

Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Heal Soc Behav. 1983;24:386-396.CrossRef

26.

Brown KW, Ryan RM. The benefits of being present: Mindfulness and its role in psychological well-being. J Personal Soc Psychol. 2003;84(4):822-848.CrossRef

27.

Levenson MR, Jennings PA, Aldwin CM, Shiraishi RW. Self-transcendence: Conceptualization and measurement. Int J Aging Hum Dev. 2005;60(2):127-143.PubMedCrossRef

28.

Ryff C. Happiness is everything, or is it? Explorations on the meaning of psychological well-being. J Pers Soc Psychol. 1989;57:1069-1081.CrossRef

29.

Ryan RM, Frederick C. On energy, personality and health: Subjective vitality as a dynamic reflection of well-being. J Personal. 1997;65:529-565.CrossRef

30.

The RAND-36 measure of health-related quality of life. UCLA School of Medicine, Los Angeles, CA, USA. Santa Monica, CA, USA; 2001, Vol. 33, No. 5: Pages 350–357.

31.

Hays RD, Sherbourne CD, Mazel RM. The RAND 36-Item Health Survey 1.0. Health Econ. 1993;2(3):217-227.PubMedCrossRef

32.

Cohen S, Williamson G. Perceived stress in a probability sample of the U.S. In: Spacapam S, Oskamp S, eds. The social psychology of health: Claremont Symposium on Applied Social Psychology. Newbury Park, CA: Sage; 1988.

33.

Rothman KJ. No adjustments are needed for multiple comparisons. Epidemiology. 1990;1(1):43-46.PubMedCrossRef

34.

Melville KM, Casey LM, Kavanagh DJ. Dropout from Internet-based treatment for psychological disorders. Br J Clin Psychol. 2010;49(Pt 4):455-471.PubMedCrossRef

35.

Verheijden MW, Jans MP, Hildebrandt VH, Hopman-Rock M. Rates and determinants of repeated participation in a Web-based behavior change program for healthy body weight and healthy lifestyle. J Med Internet Res. 2007;9(1):e1.PubMedCrossRef

36.

American Psychological Association. Latest APA Survey Reveals Deepening Concerns About Connection Between Chronic Disease and Stress; 11 January 2012

37.

Ringash J, O’Sullivan B, Bezjak A, Relmeier DA. Interpreting clinically significant changes in patient-reported outcomes. Cancer. 2007;110(1):196-202.PubMedCrossRef

38.

Norman GR, Sloan JA, Wyrwich KW. Interpretation of changes in health-related quality of life: The remarkable universality of half a standard deviation. Med Care. 2003;41:582-592.PubMed

39.

Carmody J, Baer RA. Relationships between mindfulness practice and levels of mindfulness, medical and psychological symptoms and well-being in a mindfulness-based stress reduction program. J Behav Med. 2008;31(1):23-33.PubMedCrossRef

40.

Nyklicek I, Kuijpers KF. Effects of mindfulness-based stress reduction intervention on psychological well-being and quality of life: Is increased mindfulness indeed the mechanism? Ann Behav Med Publ Soc Behav Med. 2008;35(3):331-340.CrossRef

41.

Dobkin PL, Zhao Q. Increased mindfulness—the active component of the mindfulness-based stress reduction program? Complement Ther Clin Pract. 2011;17(1):22-27.PubMedCrossRef

42.

Bohlmeijer E, Prenger R, Taal E, Cuijpers P. The effects of mindfulness-based stress reduction therapy on mental health of adults with a chronic medical disease: A meta-analysis. J Psychosom Res. 2010;68(6):539-544.PubMedCrossRef

43.

Grossman P, Niemann L, Schmidt S, Walach H. Mindfulness-based stress reduction and health benefits: A meta-analysis. J Psychosom Res. 2004;57:35-43.PubMedCrossRef

44.

Fang CY, Reibel DK, Longacre ML, Rosenzweig S, Campbell DE, Douglas SD. Enhanced psychosocial well-being following participation in a mindfulness-based stress reduction program is associated with increased natural killer cell activity. J Altern Complement Med. 2010;16(5):531-538.PubMedCrossRef

45.

Ware JE, Snow KK, Kosinski M, Gandek B. SF-36 health survey: Manual and interpretation guide. Boston, MA: Nimrod Press; 1993.

46.

Moritz S, Quan H, Rickhi B, Liu M, et al. A home study-based spirituality education program decreases emotional distress and increases quality of life—a randomized, controlled trial. Altern Ther Health Med. 2006;12(6):26-35.PubMed

47.

Cleveland Clinic Wellness Website. www.ClevelandClinicWellness.com/Relax. Accessed 14 March 2013.

48.

University of Massachusetts Medical School. Center for Mindfulness in Medicine, Health Care, and Society. Stress Reduction Program, Tuition & Payment Plans. http://www.umassmed.edu/Content.aspx?id=41308. Accessed 14 March 2013

Title: Feasibility of an Online Mindfulness Program for Stress Management—A Randomized, Controlled Trial
Authors: Thomas J. Morledge, MD
Didier Allexandre, PhD
Emily Fox, MBA, MSSA, LSW
Alex Z. Fu, PhD
Mitchell K. Higashi, PhD
Denise T. Kruzikas, PhD, MPH
Sissi V. Pham, Pharm D
Pat Ray Reese, PhD
Publication date: 01-10-2013
Publisher: Springer US
Published in: Annals of Behavioral Medicine / Issue 2/2013
Print ISSN: 0883-6612
Electronic ISSN: 1532-4796
DOI: https://doi.org/10.1007/s12160-013-9490-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Feasibility of an Online Mindfulness Program for Stress Management—A Randomized, Controlled Trial

Abstract

Background

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2013

Pain Fear Avoidance and Pain Acceptance: A Cross-Sectional Study Comparing Their Influence on Adjustment to Chronic Pain Across Three Samples of Patients

Sources of Uncertainty and Their Association with Medical Decision Making: Exploring Mechanisms in Fanconi Anemia

Behavioral Impacts of Sequentially versus Simultaneously Delivered Dietary Plus Physical Activity Interventions: the CALM Trial

Six-Month Outcomes from Living Well with Diabetes: A Randomized Trial of a Telephone-Delivered Weight Loss and Physical Activity Intervention to Improve Glycemic Control

Effects of Anger Awareness and Expression Training versus Relaxation Training on Headaches: A Randomized Trial

Physical Activity and Health Outcomes Among HIV-Infected Men Who Have Sex with Men: A Longitudinal Mediational Analysis