Rates of attrition and engagement in randomized controlled trials of mindfulness apps: Systematic review and meta-analysis.
Behaviour Research and Therapy October 14, 2023 DOI: 10.1016/j.brat.2023.104421 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Systematic review and meta-analysis Randomized Qualitative Peer reviewed |
|---|---|
| Sample size | 9,258 |
| Population | Participants allocated to mindfulness app conditions across 70 randomized controlled trials, including general adult populations and other target samples |
| Intervention | Mindfulness apps |
| Topics | Meditation |
| Keywords | Humans Mental health Adult Mobile applications Meta-analysis Randomized controlled trials Systematic review Attrition Digital health |
| Key findings | The weighted meta-analytic attrition rate from mindfulness apps was 24.7% across 9,258 participants, and 38.7% when restricted to larger studies (n ≥ 100 per condition) and certain target samples. Attrition was higher than in waitlist conditions but not different from placebo or active apps. Monetary compensation and in-person enrollment were associated with lower attrition, and engagement data were inadequately reported despite qualitative evidence of problems with sustained engagement. |
Abstract
Randomized controlled trials (RCT) have established the efficacy of mindfulness apps for numerous mental health and behavioral outcomes. However, studies of this kind are characterized by significant problems with attrition and engagement, making it challenging to interpret these findings and realize the full potential of mindfulness app-based solutions. This systematic review and meta-analysis aimed to examine rates of attrition from, and engagement in, mindfulness apps in 70 RCTs located through four databases. The weighted meta-analytic attrition rate from 9258 participants allocated to a mindfulness app was 24.7%. This estimate was higher (38.7%) when restricting analyses to larger studies (n ≥ 100 per condition) and for specific target samples (e.g., general population of adults). Studies that offered participants monetary compensation and required in-person enrolment methods were associated with the lowest attrition rates. Attrition was higher in mindfulness app conditions relative to waitlists, but was not different to placebo or active apps. Although engagement data were inadequately reported, qualitative synthesis highlighted clear problems with sustained user engagement with mindfulness apps. Findings have implications for powering, designing and appraising research trials of mindfulness apps, as well as the development of potentially effective retention and engagement strategies worthy of evaluation in future work.
Comparable studies
Other systematic reviews and meta-analyses on meditation, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Meditation Programs for Psychological Stress and Well-being Diverse adult clinical populations | 2014 | Meta-analysis | n = 3,515 |
| Mindfulness-Based Stress Reduction for Stress Management in Healthy People: A Review and Meta-Analysis Healthy subjects | 2009 | Systematic review and meta-analysis | |
| The psychological effects of meditation: A meta-analysis. Nonclinical groups of adult meditators | 2012 | Meta-analysis | n = 163 |
| Efficacy of Mindfulness-Based Cognitive Therapy in Prevention of Depressive Relapse Adults with recurrent depression in full or partial remission | 2016 | Meta-analysis of individual patient data from randomized controlled trials | n = 1,258 |
| Mindfulness‐Based Stress Reduction and Mindfulness‐Based Cognitive Therapy – a systematic review of randomized controlled trials | 2011 | Systematic review |
Citations in the library
Cited by 22
- 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
- Supported Mindfulness-Based Self-Help Intervention as an Adjunctive Treatment for Rapid Symptom Change in Emotional Disorders: A Practice-Oriented Multicenter Randomized Controlled Trial. Psychotherapy and Psychosomatics 2025
- Lightening the mind with audiovisual stimulation as an accessible alternative to breath-focused meditation for mood and cognitive enhancement. Scientific Reports October 26, 2024
- Psychoneuroimmunology of Mindfulness: What works, how it works, and for whom? Brain, Behavior, & Immunity - Health July 1, 2025
- The Mindful Way From Information to Knowledge, to Wisdom, and to Life: Perspectives on Mindfulness (-Based Cognitive Therapy) for Higher Education. Mindfulness 2025
and 17 more in the library
Cites 19
- The Empirical Status of Mindfulness-Based Interventions: A Systematic Review of 44 Meta-Analyses of Randomized Controlled Trials Perspectives on Psychological Science February 16, 2021
- Mindfulness on-the-go: Effects of a mindfulness meditation app on work stress and well-being. Journal of Occupational Health Psychology May 3, 2018
- Testing the Efficacy of a Multicomponent, Self-Guided, Smartphone-Based Meditation App: Three-Armed Randomized Controlled Trial JMIR Mental Health November 27, 2020
- App‐based mindfulness meditation reduces perceived stress and improves self‐regulation in working university students: A randomised controlled trial Applied Psychology: Health and Well-Being December 27, 2021
- Mindfulness-based cognitive therapy for depression. Industrial Psychiatry Journal October 29, 2024
and 14 more in the library