JMIR Publications

ABSTRACT

Background:

While text messaging has the potential to be the core intervention modality, it was often used as an adjunct only. To improve health and alleviate the distress related to insomnia, pain, and dysregulated eating of people living in urban areas, text-messaging based mindfulness-based interventions were designed and evaluated with three randomized controlled trials.

Objective:

Investigate the effectiveness and mediating mechanisms of text-messaging based mindfulness-based interventions for people with distress related to insomnia, pain, or dysregulated eating.

Methods:

333, 235, and 351 participants were recruited online and randomized to experimental and waitlist control conditions for insomnia, pain, and dysregulated eating respectively. Participants experienced 21 days of intervention through WhatsApp messenger. Participants completed pre-, post-, 1-month follow-up, and 3-month follow-up self-report questionnaires online. Intervention was delivered through the broadcast function. Participants’ queries were answered by study technicians. Primary outcomes included insomnia severity, pre-sleep arousal, pain intensity, pain acceptance, and eating behaviors. Secondary outcomes included mindfulness, depression, anxiety, mental well-being, and functional impairments. Mindfulness, dysfunctional beliefs, and attitudes of sleep, pain catastrophizing, and reactivity to food cues were hypothesized to mediate the relationship between the intervention and outcomes.

Results:

For all three studies, whilst most outcomes had improved significantly at 1-month follow up compared to waitlist control condition, some effects sustained at 3-month follow up for both primary outcomes (e.g. insomnia, pain, and dysregulated eating indicators) and secondary outcomes (e.g. depressive and anxiety symptoms). In the intervention for insomnia, mediation analyses showed that dysfunctional beliefs and attitudes of sleep mediated the effect of the intervention on all primary outcomes and most secondary outcomes at both 1-month and 3-month follow up, whereas mindfulness mediated the intervention effect on pre-sleep arousal at 1-month and 3-month follow up. In the intervention for pain, pain catastrophizing mediated the effect of intervention on pain intensity and functioning at both 1-month and 3-month, whereas mindfulness was only found to be mediating the effect of intervention on anxiety and depressive symptoms but not primary outcomes. In the intervention for dysregulated eating, power of food mediated the effect of intervention on both uncontrolled and emotional eating at both 1-month and 3-month follow-up, and mindfulness was also found to mediate the effect on depressive symptoms at both 1-month and 3-month.

Conclusions:

This study provided evidence that mindfulness-based intervention delivered through text messaging was effective in improving distress related to sleep, pain, and dysregulated eating. Text-messaging has the potential to be a core intervention modality to improve health for people living a fast-paced lifestyle. Clinical Trial: Clinical Research & Biostatistics, Clinical Trials Registry, Reference Number: CUHK_CCRB00559