Jonathan Nicholas Davies

Mindfulness research faces two recurring methodological problems: near-universal reliance on weak control conditions that cannot isolate specific mechanisms from expectancy effects, and systematic exclusion of low-socioeconomic status (SES) populations through design assumptions that presuppose high literacy, quiet private spaces, and contemplative familiarity. We present the Standardized Open-source Mindfulness Architecture (SOMA), a modular stimulus library designed to address both challenges. SOMA comprises 88 audio/script assets: 32 pre-specified Mindfulness–Active Control session pairs across 16 practice modules, written at Grade 5–6 reading level and designed for noisy, shared environments. A pre-registered validation randomised controlled trial (RCT; N = 360; ClinicalTrials.gov NCT07556744) provides proof-of-concept. The data supported the predicted double dissociation (Condition × Measure: F(1, 358) = 185.95, p = 2.2 × 10−34, BF10 ≈ 9.5 × 1063) and experiential equity across SES strata (Hedges' g = −0.07; TOST-confirmed within ±0.40), yet a small credibility gap remained, favouring the Mindfulness condition.

The EQ Health and Wellbeing (EQ-HWB) is a new, generic instrument designed to evaluate quality-of-life across health, public health, and social care settings. The short form comprises nine items (EQ-HWB-9) and validation across diverse populations and contexts is required. We aimed to investigate the validity of the EQ-HWB-9 in an international sample of adults experiencing poor mental health who downloaded a meditation app. We further examined the impact of four item-level modifications on psychometric performance, including investigating a potential ordering effect for the 'activities' item (hypothesised in prior studies) and three minor changes to response options. The current study was embedded in a larger trial examining engagement with meditation via a free, downloadable app. Participants were randomised to complete the original (2022) and modified (2024) experimental version of the EQ-HWB-9. Psychometric evaluation included analyses of item distribution, known group and convergent validity, and responsiveness to change. There were no differences in demographic characteristics between the EQ-HWB original and modified versions at baseline (n = 865) or follow-up (n = 130). All psychometric tests supported the validity of the EQ-HWB-9 in this population. We found an ordering effect for the activities item, where the activities item showed a greater level of difficulty and a wider distribution over response options when asked before the mobility item, rather than after. There were no observable differences between versions for the other modifications. These findings add to growing literature supporting the EQ-HWB-9 as a suitable instrument for measuring quality-of-life across a range of settings. When the 'activities' item was presented first, as in the modified version, participants appeared to interpret the item more broadly, in line with the developers' intentions. Accordingly, our results support changing the item order of the first two items. Other modifications had little impact on outcomes, suggesting that further qualitative research will be required to inform decisions about their inclusion. Results from this study provide support towards finalisation of the instrument. The development of country-specific value-sets is now critical to support its application in economic evaluation.

Background/Objectives: Psychological benefits have been demonstrated across a variety of different meditation offerings. There remains, however, limited evidence clarifying how different ‘doses’ of meditation relate to benefits, highlighting fundamental limitations for clinical best practice. The present study aimed to examine dose–response effects across a range of daily mindfulness meditation durations in a well-powered randomized controlled experiment, while also investigating whether actual practice behaviour predicts improved outcomes, independent of assigned dose.Method: A total of 716 meditation-naïve, healthy adults were randomized to one of four daily mindfulness practice conditions (4-, 10-, 20-, or 30-minutes) over a 28-day online intervention. The primary outcome was wellbeing, and secondary outcomes included mindfulness-related constructs and mental health symptoms. Primary analyses used a constrained longitudinal design within an intention-to-treat approach to test for differences between assigned dose groups. Secondary per-protocol analyses were conducted to reduce effects of nonadherence. Exploratory analyses examined five measures of practice dose, alongside motivation and expectancy variables, as predictors of outcomes.Results: Significant improvements were observed across all outcomes and arms from baseline to post-intervention (|SMD| = 0.29–0.56, FDR-adjusted p < .05). We found no evidence of a dose–response effect based on assigned practice dose in either intention-to-treat or per-protocol analyses for any outcome (all p’s > .05). While 70.9% of those in the 10-minute group completed 2/3 of sessions, only 65.3% and 48.5% of participants did the same in the 20- and 30-minute groups, respectively. In exploratory analyses, practice engagement was significantly related to 8/10 outcomes ([β] = 0.05-0.14), while goal confidence was significantly related to 9/10 outcomes ([β] = 0.08-0.21), and time was significantly related to changes on all outcomes ([β] = 0.26-0.54; FDR-adjusted p < .05). Conclusions: These findings suggest that within the first 30 days of practice among non-clinical, beginner populations there is no evidence that longer doses (up to 30 min) are more beneficial than shorter doses (down to 5 min) of daily meditation, while practice engagement and confidence in the efficacy of meditation may impact effects.

Background: Meditation apps are increasingly popular but face significant engagement challenges. Most research does not meaningfully capture real-world engagement or associated user characteristics. Engagement patterns and reasons for engaging or disengaging remain relatively unexplored. Objective: This study aimed to examine Medito app user engagement over the first 30 days after download and how intended use, demographics, user traits, and mental health factors predict engagement. Methods: A prospective online survey was conducted among 668 Medito app users from 30 countries. Factors assessed included demographic factors (eg, age, sex, education, employment, and country of residence); user factors (eg, number of apps tried, hours of experience, meditation-related adverse events, expectations, readiness to change, and personality); and mental health factors (eg, quality of life, perceived stress, psychological distress, well-being, and satisfaction with life). Detailed engagement data included days of use, meditations completed, app opens, and minutes of use obtained via a data-sharing agreement with Medito. Minutes of use in the first 30 days after download served as the main outcome variable. Results: App use was relatively low, with 50% (328/655) of users engaging for a total of 16 minutes or less in the first month after download (median 16.11, IQR 0‐74.51 min). Fewer than 20% (124/655, 18.86%) of users continued using the app after 14 days. Intended use (mean 418.56, SD 472.5) significantly exceeded actual use (mean 70.02 , SD 176.81; d =0.710; P <.001). In terms of user factors, expectation match (ie, extent to which outcomes from the app matched initial expectations; ρ = 0.214; P =.002), expectations for anxiety (ρ=0.102; P =.01), expectations for attention or focus (ρ=0.091; P =.02), and conscientiousness (ρ=0.124; P =.003) were associated with higher engagement. Neuroticism was negatively associated with engagement (ρ=−0.103; P =.010). For mental health factors, satisfaction with life (ρ=0.123; P =.002) and well-being (ρ=0.135, P <.001) were associated with higher engagement, while perceived stress (ρ=−0.107; P =.007), psychological distress (ρ=−0.138, P <.001) , and quality of life (ρ=−0.100; P =.011) were associated with lower engagement. Only readiness to change showed unique associations with higher engagement (semipartial r =0.156; P <.001). Regression analysis showed that only perceived stress predicted higher engagement (β=.020; P =.04). However, when mental health was included as a single component, expectations for anxiety (β=.015; P =.049) and readiness to change (β=.011; P =.048) predicted greater engagement, and mental ill health predicted lower engagement (β=−0.008; P =.049). Conclusions: Overall, app engagement is generally quite low. Acute stress motivated meditation app use, while chronic stress disrupted it. Engagement is optimal when experiences match expectations and users are prepared to make a change. More transparency is necessary in the promotion of meditation apps so that users have a realistic understanding of the time and effort required to achieve benefits.

Hi Marcelo, Thank you for continuing to move the dose–response agenda forward. I broadly agree with the need to move beyond simplistic notions of practice amount as the primary determinant of outcomes. This manuscript addresses an important and und...

Contemplative practices (including meditation and yoga) are increasingly popular worldwide, especially as alternatives and/or complements to mental health treatment. However, nationally representative samples that allow for accurate estimates of prevalence and relation to mental health are scarce. We conducted a nationally representative, cross-sectional survey in Australia and New Zealand ( N = 2640). Sampling was stratified by age, gender, ancestry/ethnicity, region and income. Two pre-registered questions were analysed to explore participants’ engagement in contemplative practices and associations to psychological distress and mental healthcare use. We used posthoc regression analyses to further clarify relationships between variables. Overall, 70% of participants engaged in contemplative practices over the past year, most commonly meditation (31%), relaxation (25%), breathing techniques (24%), and yoga (21%). Improving health and wellbeing were the primary motivations for practice. All contemplative practice users reported significantly higher psychological distress and mental healthcare use than non-practitioners ( p ’srelaxation = 0.02, β _yoga = − 0.03, n.s. ). For meditators, the association disappeared when we accounted for mental healthcare use (β _meditation = 0.01, n.s. ). Breathing practice was associated with increased distress in all models (β _breathing = 0.04–0.11, p’s< 0.05). Notably, meditators and relaxation practitioners with unmet healthcare needs reported less distress than non-practitioners with unmet needs ( d _meditation =0.38, d _relaxation =0.35). Contemplative practices are widespread among Australians and New Zealanders and may play a complementary and/or alternative role in managing mental health. Further research is needed to study their complex associations with mental health, and which types of contemplative practices are beneficial and safe for whom.

Objectives: The prevalence of mental health disorders globally is increasing, and contemplative practices (such as meditation/mindfulness) are recommended by many health professionals to address this issue. These practices now need to be carefully evaluated for safety, effectiveness, and cost-effectiveness. We aimed to investigate key data to inform future economic evaluations in this area via a cross-sectional, nationally representative survey of the Australian population. Method: We compared quality-of-life scores across groups using regression analysis to account for group differences. Self-reported health service use (general, mental, complementary) was compared across groups (not needed, unmet need, used service) and index-scores. Self-reported practice cost estimates were investigated across contemplative practices (e.g. meditation, yoga) for a range of cost types (e.g. classes, travel, donations). Results: The sample included 445 meditators, 1034 other contemplative practitioners and 586 non-practitioners, with large demographic differences between groups. Unadjusted quality-of-life scores were significantly higher for non-practitioners compared to practitioners. Differences were maintained when demographic variables were added to the model, but not when mental health service use was included as a covariate. We estimated that 8.9% of the sample had unmet mental-health service need and that this was highest in the meditation group (13.9%) compared to the non-practitioner group (2.4%). The average cost of any contemplative practice (including meditation) was estimated at $1,281 per person. Conclusions: This study provides preliminary evidence on potentially suitable variables for estimating costs and effects for conducting cost-effectiveness studies of contemplative practices. EQ-HWB-9 index scores performed well as an outcome measure in this population. Preregistration: The initial study was preregistered at Open Science Framework osf.io/etkh4. The current paper is additional to the preregistered research questions.

Mindfulness meditation is now practiced broadly in both religious and secular contexts, with numerous studies indicating potential benefits across a range of psychosocial domains. However, despite significant research effort, we still know little about dose-response effects—how frequently or for how long individuals might need to practice mindfulness meditation to achieve certain practice goals. Increasingly, recommended amounts of practice are becoming shorter, with unclear effects on outcomes. We review and critically appraise the state of knowledge about dose-response effects drawn from empirical investigations, traditional sources, and trends in contemporary teaching and practice. We argue that limitations inherent to the range of doses and analytic approaches used in previous studies reduce our ability to inform the dose-response question. We propose a practical research agenda that prioritizes the question of dose response, incorporating design features optimized specifically to understand the dose-response relationship and how it might vary between outcomes and individuals. Prioritizing the dose-response agenda will allow us to reconcile differences between knowledge sources and enable us to optimize mindfulness programs based on individuals, their goals, and the context in which they practice. Mindfulness meditation is now practiced broadly in both religious and secular contexts, with numerous studies indicating potential benefits across a range of psychosocial domains. However, despite significant research effort, we still know little about dose-response effects—how frequently or for how long individuals might need to practice mindfulness meditation to achieve certain practice goals. Increasingly, recommended amounts of practice are becoming shorter, with unclear effects on outcomes. We review and critically appraise the state of knowledge about dose-response effects drawn from empirical investigations, traditional sources, and trends in contemporary teaching and practice. We argue that limitations inherent to the range of doses and analytic approaches used in previous studies reduce our ability to inform the dose-response question. We propose a practical research agenda that prioritizes the question of dose response, incorporating design features optimized specifically to understand the dose-response relationship and how it might vary between outcomes and individuals. Prioritizing the dose-response agenda will allow us to reconcile differences between knowledge sources and enable us to optimize mindfulness programs based on individuals, their goals, and the context in which they practice.

Background: Meditation apps are increasingly popular, yet there is limited understanding of how much users actually engage with them. While meditation apps show promise for supporting mental health, engagement in real-world settings appears to be notably low. The patterns of app use and the factors that influence usage remain relatively unclear. Objective: This study aims to examine the extent of meditation app use and the factors associated with user engagement. Methods: We conducted a cross-sectional survey of 536 recent meditation app users across 5 English-speaking countries. Engagement data were collected via self-report and app-verified screenshots. Assessed factors included user characteristics (age, education, income, sex, country, personality, self-efficacy, readiness and expectations for change, self-compassion, and quality of life), mental health (distress, well-being, life satisfaction, anxiety, depression, support, and stress), and app-related elements (therapeutic alliance, appeal, functionality, aesthetics, information, quality, and perceived impact). The 4 outcome variables representing engagement were app-verified minutes, self-reported minutes, app-verified minutes per year (adjusted for app download date), and self-reported minutes per year (adjusted for app download date). Associations between app use and variables of interest were examined using correlations. Factors with significant associations were then included in multivariable regression models to identify those most strongly associated with engagement. Results: Age (ρ=0.13-0.15, PPFDR, where FDR is false discovery rate), expectations for sleep (ρ=0.12-0.33, PFDR<.05), and expectations for thriving (ρ=0.12-0.18, PFDR<.05) were associated with all outcome measures except adjusted objective minutes. Readiness to change was associated with all outcome measures (ρ=0.24-0.33, PFDR<.05). Among app factors, appeal (ρ=0.18-0.23, PFDR<.05) and perceived impact (ρ=0.23-0.32, PFDR<.05) were associated with all outcome measures except adjusted self-report minutes, while perceived quality (r=0.28-0.51, PFDR<.05) was associated with all outcome measures. Robust linear regressions showed that greater readiness to change (β=0.005-0.026, P=.006-.02), higher education level (β=0.029-0.540, P<.001), and higher openness (β=0.004-0.010, P=.008-.03) were associated with increased engagement. Additionally, greater expectations for sleep (β=0.004-0.009, P=.02-.04), greater expectation match (β=0.023, P=.03), and higher perceived app quality (β=0.008-0.042, P=.001-.01) were uniquely associated with increased engagement. Conclusions: Most individuals who download meditation apps engage minimally. Our findings suggest that users who are more educated, open to new experiences, and hold strong beliefs in the effectiveness of meditation apps are more likely to use them regularly. Longitudinal studies are needed to examine patterns of use and strengthen causal inferences.

Meditation use has grown significantly in recent decades. However, population prevalence data is largely absent in Australasia. We surveyed adults in Austr