JMIR Publications

ABSTRACT

Introduction: Mindfulness meditation has demonstrated modest benefits for mental health and wellbeing, although the relationship between practice dose and outcomes is unclear. Meta-analyses and randomized controlled trials have shown mixed results so far, although such results may stem from methodological issues rather than reflecting the absence of an underlying effect. Research outside structured programs suggests that long-term practice time is linked to positive outcomes, but bias due to self-selection over time may explain these results. The proposed trial aims to test dose-response effects for an online mindfulness meditation course, examining outcomes and participant engagement across different practice doses. In this pragmatic randomized controlled trial, we hypothesize that larger doses of mindfulness training will yield significantly larger effects, and different doses will be significantly associated with variation in participant engagement, with lower engagement evident for higher doses. Methods and analysis: At least 688 healthy adults aged between 18-65 years will be randomised to join one of three 4-week online mindfulness courses with daily practices of varying lengths (i.e. 10-mins, 20-mins, or 30-mins) against a minimally active control condition (3-4 mins). Psychological wellbeing will be measured using the Warwick-Edinburgh Mental Well-being Scale at baseline, mid-intervention, postintervention, and 1-month follow-up. Secondary outcomes are psychological distress, anxiety, depression, social anxiety, nonattachment, trait mindfulness, decentering, equanimity, repetitive negative thoughts, emotion regulation, attention control, and emotional reactivity. Other outcomes will be collected weekly and daily during the intervention period. The primary analysis will be undertaken following the intention-to-treat approach. We will also conduct per-protocol secondary analyses on all outcomes (i.e. primary and secondary). We will also systematically monitor for possible adverse experiences. Discussion: The study will contribute to the evidence-based for mindfulness meditation, and the question of how much practice people need to engage in to improve wellbeing and other psychological outcomes. Trial registration number: The study has been prospectively registered at ClinicalTrials.gov with the identifier NCT06378450.