DOI: 10.5061/dryad.0zpc8672x
title: Design and implementation of a brief digital mindfulness and compassion training app for health care professionals: cluster randomized controlled trial

description: Background: Several studies show that intense work schedules make health
 care professionals particularly vulnerable to emotional
 exhaustion and burnout. Objective: In this scenario, promoting
 self-compassion and mindfulness may be beneficial for well-being. Notably,
 scalable, digital app–based methods may have the potential to
 enhance self-compassion and mindfulness in health care professionals.
 Methods: In this study, we designed and implemented a scalable, digital
 app–based, brief mindfulness and compassion training program
 called “WellMind” for health care professionals. A total of 22 adult
 participants completed up to 60 sessions of WellMind training,
 5-10 minutes in duration each, over 3 months. Participants completed
 behavioral assessments measuring self-compassion and mindfulness
 at baseline (preintervention), 3 months (postintervention), and 6 months
 (follow-up). In order to control for practice effects on the
 repeat assessments and calculate effect sizes, we also studied a
 no-contact control group of 21 health care professionals who only
 completed the repeated assessments but were not provided any training.
 Additionally, we evaluated preand postintervention neural
 activity in core brain networks using electroencephalography source
 imaging as an objectiveneurophysiological training outcome. Results:
 Findings showed a post- versus preintervention increase in self-compassion
 (Cohen d=0.57; P=.007) and state-mindfulness (d=0.52; P=.02) only
 in the WellMind training group, with improvements in self-compassion
 sustained at follow-up (d=0.8; P=.01). Additionally, WellMind
 training durations correlated with the magnitude of improvement in
 self-compassion across human participants (ρ=0.52; P=.01).
 Training-related neurophysiological results revealed plasticity specific
 to the default mode network (DMN) that is implicated in
 mind-wandering and rumination, with DMN network suppression selectively
 observed at the postintervention time point in the WellMind group
 (d=–0.87; P=.03). We also found that improvement in
 self-compassion was directly related to the extent of DMN
 suppression (ρ=–0.368; P=.04). Conclusions: Overall, promising behavioral
 and neurophysiological findings from this first study demonstrate the
 benefits of brief digital mindfulness and compassion training for
 health care professionals and compel the scale-up of the digital
 intervention.
description: Participants A total of 43 human subjects
 participated in the study (mean age: 28.77 ± 4.13, range: 23-43 years, 20
 males). All subjects were fluent in English. Each participant gave written
 informed consent in accordance with the Declaration of Helsinki before
 participating in the experiment. All the experimental procedures were
 approved by the Institutional Review Board of University of California San
 Diego (UCSD) (protocol #180140). Participants were recruited from the UCSD
 School of Medicine during Spring 2021-Fall 2022 via email advertisements
 and campus flyers. Participants provided demographic
 data with regards to age, gender and ethnicity. All participants were
 healthy adults, i.e., did not have any current medical diagnosis nor were
 taking any current psychotropic medications. Healthy status and
 affiliation to the UCSD School of Medicine were the only eligibility
 criteria.<br>Participants completed the Maslach Burnout Inventory
 (MBI) at time of screening; MBI scores did not reflect high burnout in our
 sample as all scores were less than the mid-score of the MBI score
 range. Study Design The study
 design was interventional and cluster randomized. Of the total 43 study
 participants, 22 enrolled in the digital WellMind intervention group and
 21 were part of the no-contact control group. Participants were cluster
 randomized based on the quarter of enrollment to the WellMind or control
 group. This was done because individuals within each academic quarter (but
 not across quarters) were working/studying together and hence, knew each
 other professionally and could reveal components of the study intervention
 to each other. The WellMind group participants received the digital app
 intervention and had periodic email contact from our research team during
 intervention, at about once every two weeks frequency, to ensure
 compliance and help troubleshoot any issues faced by the participants. On
 the other hand, the no-contact control group had no interaction with the
 study research team nor any digital training resource provided to them
 between their pre and post assessment time points.
 Sample Size and Power The sample size within
 each group was powered to detect medium effect size pre/post differences
 (Cohen’s d &gt;0.6), at beta power of 0.8 and alpha level of 0.05.
 Between-group differences met criteria for investigating only large effect
 size outcomes (Cohen’s d &gt;0.8) at beta power of 0.8 and alpha level
 of 0.05. Effect sizes were calculated a priori using the G*Power
 software. Intervention The
 WellMind digital intervention was deployed on the BrainE© platform
 implemented in Unity and available on both iOS and Android phone devices.
 This digital program is HIPAA-compliant and secured by
 password-protection, and each user interacts via an alphanumeric study ID
 that is not linked to any personal health information. Participants
 accessed the app in their own free time and engaged in breath-focused
 mindfulness training with each session of 5-10 minutes duration for up to
 60 sessions. The training was delivered in a game-like format and was
 performance-adaptive. Specifically, individuals were requested to close
 their eyes, pay attention to their breathing and tap the mobile screen
 after a specific number of breaths. The app monitored consistency of tap
 responses. If the user was distracted based on low consistency of breath
 monitoring taps, a gentle chime reminded the user to let go of the
 distraction and revert their attention back to mindful breathing.
 Initially, at level 1, participants tapped the screen after each breath.
 If they were able to do this consistently for three repeats of level 1 of
 1 minute duration each, they graduated to level 2 and tracked two breaths
 at a time for 2 minutes, and so on. Thus, in the performance-adaptive
 task, the level reflected the number of minutes spent at that level and
 the number of breaths the participant was requested to repeatedly monitor.
 The max achievable level was level 10, i.e. monitoring 10 breaths at a
 time for up to 10 minutes. When the user graduated to the max level, they
 stayed at this level until end of all assigned sessions, i.e. 60 sessions.
 Also within the game-like format, when the participant opened their eyes
 at the end of a level, a peaceful nature scene would slowly unveil as a
 form of training reward. Overall, this digital
 meditative practice is considered closed-loop because of its
 performance-adaptive feature. Consistent attention to breathing is
 emphasized over say other types of breathing techniques like deep
 breathing. The moment-to-moment performance tracking further allows
 quantification of the attentive focus during each session that is not
 possible with traditional non-digital meditation.
description: The submitted dataset pertains to our manuscript entitled: "BriDesign
 and implementation of a brief digital mindfulness and compassion training
 app for health care professionals: cluster randomized controlled
 trial". Sheet1 contains the Demographics & Behavioral Outcomes
 data. Group: Wellmind (Intervention group), Control (No-contact control
 group) GroupID: 1 (Wellmind) or 2 (Control) Age: Age of each participant
 Gender: Subject Gender, 1: male, 2: female, 3: other Pre-mbiexhaustion:
 Pre-Maslach Burnout Inventory exhaustion score Pre-mbiaccomplishment:
 Pre-Maslach Burnout Inventory accomplishment score
 Pre-mbidepersonalization: Pre-Maslach Burnout Inventory depersonalization
 score Pre-selfcompassion: Pre-selfcompassion score Pre-CSR:
 Pre-compassionate self-responding score Pre-USR:Pre-uncompassionate
 self-responding score Pre-trait mindfulnessscore: Pre-trait mindfulness
 score Pre-state mindfulness: Pre-state mindfulness score
 Post-mbiexhaustion: Post-Maslach Burnout Inventory exhaustion score
 Post-mbiaccomplishment: Post-Maslach Burnout Inventory accomplishment
 score Post-mbidepersonalization: Post-Maslach Burnout Inventory
 depersonalization score Post-selfcompassion: Post-selfcompassion score
 Post-CSR: Post-compassionate self-responding score
 Post-USR:Post-uncompassionate self-responding score Post-trait
 mindfulnessscore: Post-trait mindfulness score Post-state mindfulness:
 Post-state mindfulness score Followup -mbiexhaustion: Followup -Maslach
 Burnout Inventory exhaustion score Followup -mbiaccomplishment: Followup
 -Maslach Burnout Inventory accomplishment score Followup
 -mbidepersonalization: Followup -Maslach Burnout Inventory
 depersonalization score Followup -selfcompassion: Followup -selfcompassion
 score Followup -CSR: Followup -compassionate self-responding score
 Followup -USR:Followup -uncompassionate self-responding score Followup
 -trait mindfulnessscore: Followup -trait mindfulness score Followup -state
 mindfulness: Followup -state mindfulness score WellMind Sessions: Number
 of days Wellmind participants spent on intervention program
 FinalBreathLevels: Maximum level of training progression each Wellmind
 partipcipants reach at the end of the training. Sheet2 contains the
 aligned Demographics, Behavior and Neural data. Group: Wellmind
 (Intervention group), Control (No-contact control group) GroupID: 1
 (Wellmind) or 2 (Control) Age: Age of each participant Gender: Subject
 Gender, 1: male, 2: female, 3: other Pre-mbiexhaustion: Pre-Maslach
 Burnout Inventory exhaustion score Pre-mbiaccomplishment: Pre-Maslach
 Burnout Inventory accomplishment score Pre-mbidepersonalization:
 Pre-Maslach Burnout Inventory depersonalization score Pre-selfcompassion:
 Pre-selfcompassion score Pre-CSR: Pre-compassionate self-responding score
 Pre-USR:Pre-uncompassionate self-responding score Pre-trait
 mindfulnessscore: Pre-trait mindfulness score Pre-state mindfulness:
 Pre-state mindfulness score Post-mbiexhaustion: Post-Maslach Burnout
 Inventory exhaustion score Post-mbiaccomplishment: Post-Maslach Burnout
 Inventory accomplishment score Post-mbidepersonalization: Post-Maslach
 Burnout Inventory depersonalization score Post-selfcompassion:
 Post-selfcompassion score Post-CSR: Post-compassionate self-responding
 score Post-USR:Post-uncompassionate self-responding score Post-trait
 mindfulnessscore: Post-trait mindfulness score Post-state mindfulness:
 Post-state mindfulness score Followup -mbiexhaustion: Followup -Maslach
 Burnout Inventory exhaustion score Followup -mbiaccomplishment: Followup
 -Maslach Burnout Inventory accomplishment score Followup
 -mbidepersonalization: Followup -Maslach Burnout Inventory
 depersonalization score Followup -selfcompassion: Followup -selfcompassion
 score Followup -CSR: Followup -compassionate self-responding score
 Followup -USR:Followup -uncompassionate self-responding score Followup
 -trait mindfulnessscore: Followup -trait mindfulness score Followup -state
 mindfulness: Followup -state mindfulness score Difference-selfcompassion:
 Difference-selfcompassion score Difference-state mindfulness:
 Difference-state mindfulness score WellMind Sessions: Number of days
 Wellmind participants spent on intervention program FinalBreathLevels:
 Maximum level of training progression each Wellmind partipcipants reach at
 the end of the training. FPN_Pre: Pre- Fronto-Parietal Network Source
 Activity CON_Pre: Pre- Cingulo-Opercular Network Source Activity DMN_Pre:
 Pre- Default Mode Network Source Activity FPN_Post: Post- Fronto-Parietal
 Network Source Activity CON_Post: Post- Cingulo-Opercular Network Source
 Activity DMN_Post: Post- Default Mode Network Source Activity FPN_PostPre:
 Difference in Post minus Pre- Fronto-Parietal Network Source Activity
 CON_PostPre: Difference in Post minus Pre- Cingulo-Opercular Network
 Source Activity DMN_PostPre: Difference in Post minus Pre- Default Mode
 Network Source Activity Sheet3 contains the 'Key' for
 Demographics categorical variables and abbreviations used in sheets 1 and
 2. Gender: 1: Male 2: Female Abbreviations used in Sheets 1 & 2 ```
 MBI: Maslach Burnout Inventory CSR: Compassionate Self Responding USR:
 Uncompassionate Self Responding FPN: Fronto-Parietal Network CON:
 Cingulo-Opercular Network DMN: Default Mode Network ```