Smartphone-Based Mindfulness and Mentalization Ecological Momentary Interventions for Common Mental Health Problems: Pilot Randomized Controlled Trial
Bibliographic record
Abstract
Background: Accessible ecological momentary interventions deliver brief, real-time support integrated into daily routines. Interpersonal dynamics and maladaptive coping mechanisms can contribute to an individual's anxiety and depression. Both mindfulness and mentalization represent psychological constructs with the potential to mitigate the negative impact of interpersonal stressors. Objective: This study aims to assess the feasibility and acceptability of an automated mindfulness- and mentalization-based ecological momentary intervention for common mental health problems as delivered via a mobile phone app. Methods: The design was a parallel-group pilot randomized controlled trial with 1:1 allocation ratio and exploratory framework. Recruitment of participants experiencing common mental health issues was internet-based from a university setting. Eligible participants were randomly allocated to fully automated mindfulness- or mentalization-based ecological momentary interventions via computer-generated randomization. Participants were blind to the alternative intervention options. Outcomes were self-assessed through questionnaires after 4 weeks. Primary outcomes were feasibility (recruitment, retention, and adherence) and acceptability (satisfaction ratings and qualitative feedback). Secondary outcomes included changes in depression (Patient Health Questionnaire-9 [PHQ-9]) and anxiety (Generalized Anxiety Disorder Questionnaire-7 [GAD-7]) scores. Results: A total of 84 participants were randomized (42 to each group). The interventions demonstrated good feasibility with an 89.2% retention rate and a mean adherence of 87.69% (SD 11.3%) across both groups. Acceptability ratings were positive, with favorable scores for ease of engagement (mean 5.20, SD 1.6), overall enjoyment (mean 5.15, SD 1.2), and likelihood of recommending the app (mean 5.11, SD 1.6) on a 7-point scale. For primary outcomes, both groups showed significant within-group reductions in PHQ-9 and GAD-7 scores, with moderate to large effect sizes (Cohen d=-0.68 to -0.81), with no significant difference between groups. Both treatments demonstrated clinically significant change, with 33 (44%) participants in both groups no longer meeting caseness criteria for anxiety and depression. Mindfulness performed better on improving assertiveness and perceived support compared to mentalization in the ecological momentary assessment data. One unintended harm was reported in the mindfulness arm, whereas none was reported in the mentalization arm. Conclusions: This pilot trial suggests that both mindfulness- and mentalization-based ecological momentary interventions are feasible and acceptable for individuals with common mental health problems and warrant further evaluation.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.004 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.011 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".