Targeting anxiety to improve sleep disturbance: A randomized clinical trial of app-based mindfulness training
M. Gao, Alexandra Roy, Alana Deluty, K. Sharkey, Elizabeth A Hoge, Tao Liu, Judson A. Brewer
Psychosomatic Medicine April 14, 2022 DOI: 10.1097/psy.0000000000001083 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Peer reviewed |
|---|---|
| Sample size | 80 |
| Population | Adults reporting worry that interfered with sleep |
| Interventions | App-based mindfulness training Treatment as usual |
| Duration | 2-month primary assessment with 4-month follow-up |
| Topics | Anxiety Meditation |
| Registration | NCT03684057 |
| Key findings | App-based mindfulness training added to usual care reduced self-reported worry-related sleep disturbances by 27% at two months versus 6% with usual care alone, with reductions mediated by decreased worry and improved nonreactivity. Fitbit-measured total sleep time and estimated sleep efficiency did not differ significantly between groups, though the authors suggest the app may still help people whose worry interferes with sleep. |
Abstract
ABSTRACT Objective Sleep disturbance is experienced by nearly 20% of Americans and is highly comorbid with anxiety. Sleep disturbances may predict the development of anxiety disorders. Mindfulness training (MT) has shown efficacy for anxiety yet remains limited by in-person-based delivery. Digitally delivered MT may target habitual worry processes, yet its effects on sleep have not been studied. This study tested if app-based MT for anxiety could reduce worry and improve sleep and examined the underlying mechanisms.
Methods: Individuals reporting worry interfering with sleep were randomized to treatment as usual (TAU; n = 40) or TAU + app-based MT (n = 40). Treatment-related changes in worry-related sleep disturbances (WRSDs), worry, nonreactivity, and anxiety were evaluated via self-report questionnaires at 1 and 2 months after treatment initiation. Fitbit devices were used to record total sleep time and estimate sleep efficiency. At 2 months, TAU received access to app-based MT, and both groups were reassessed at 4 months.
Results: In a modified intent-to-treat analysis, WRSD scores decreased by 27% in TAU + MT (n = 36) and 6% in TAU (n = 35) at 2 months (median [IQR] change = 11 [4.3] versus 15 [5.0], p = .001). These WRSD reductions were mediated by decreased worry, particularly improved nonreactivity (p values < .001). At 4 months, TAU reported a significant 29% reduction after beginning app-based MT at 2 months and TAU + MT maintained its gains. No significant between-group differences in average estimated total sleep time or sleep efficiency were found after 2 months of using the app.
Conclusions: Few mindfulness-related apps have been evaluated for clinical efficacy and/or mechanism. Results from this study demonstrate a mechanistic link between MT and increased emotional nonreactivity, decreased worry, and reduction in reported sleep disturbances, suggesting that app-based MT may be a viable option to help individuals who report that worry interferes with their sleep.
Trial Registration: ClinicalTrials.gov identifier: NCT03684057.
Comparable studies
Other randomized controlled trials on anxiety, most cited first.
Citations in the library
Cited by 7
- The efficacy of mindfulness apps on symptoms of depression and anxiety: An updated meta-analysis of randomized controlled trials. Clinical Psychology Review February 1, 2024
- The meditation app revolution. American Psychologist August 7, 2025
- Digital Mindfulness Training for Burnout Reduction in Physicians: Clinician-Driven Approach. JMIR Formative Research January 24, 2025
- Design and effectiveness evaluation of a web-based microplatform for mindfulness intervention for organ donor family members. Internet Interventions June 17, 2026
- The Relationship between Mindfulness Level and Anxiety in College Students: The Mediating Roles of Rumination and Sleep Journal of Medicine and Physical Education April 1, 2026
and 2 more in the library
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