Role of Internet Based Mindfulness Interventions for the Treatment of Mental Health

3825 words (15 pages) Essay

23rd Sep 2019 Health And Social Care Reference this

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Title:

The potential role of internet based mindfulness interventions for the treatment of mental health diseases

Proposal summary:

Mental health issues are common and affect many people in their life. It can result in decrease in productivity, physical and social health. Mental illness such as depression can be treated using drug therapy. However, due to drawbacks including adverse side effects, non-drug therapy such as mindfulness based intervention (MBI) could be a viable alternative. There is evidence supporting the use of mindfulness based interventions but it also has its disadvantages. For example, it requires patients to travel to receive their treatment. If the internet is introduced to these interventions, it could potentially resolve this problem. Studies have found an increased concentration of grey matter in brain regions after having MBIs. Furthermore, they have found that participants who had mindfulness meditation regularly had an increased thickness in some brain regions. Studies also indicated a poor patient adherence to the internet MBIs, this issue needs to be addressed. This study will be investigating the feasibility of internet based mindfulness interventions. A systematic review will be produced using reliable primary sources. Search criteria, inclusion, exclusion and quality assessment will be applied when selecting articles. Also, if data permits, a meta-analysis will be included in this study.

 

Background:

Mental health is a state of well-being. A positive state of mental health is a state in which a person is free from disease and has a full mental, physical and social capacity (WHO, 2014). Quality of life, level of stress, depression, and anxiety are dependent on the state of mental health. It is common for individuals to experience mental illness in their life, approximately 1 in 4 and 1 in 10 adults and children suffer from this. The biggest single cause of disability is mental health problems in the UK (NHS England, 2017b). Hence, more attention should be given by society. Improved mental health will lead to better outcomes for individuals. For example, an increase in productivity, physical and social health. Therefore, having an improved state of mental health will not only benefit individuals but society as a whole (NHS England, 2017a).

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Mental health can be improved by psychological interventions for which there are different options available. Psychological interventions are not only used in individuals with physical or mental illness, it is also used by groups of individuals who have stressful occupations including but not limited to firefighters, teachers and students (Michael, V. et al. 2017). Through this training individuals can cope with the daily stresses when they encounter challenges in life (Michael, V. et al. 2017).

There are different types of mindfulness based interventions (MBIs). For example, mindfulness based stress reduction (MBSR) and mindfulness based cognitive therapy (MBCT). These treatments usually last for 8 weeks with sessions lasting up to 2 hours (Benjamin, G.et al, 2018). MBSR is done repeatedly to achieve a less reactive judgmental thinking and behavior. Studies that have focused on MBSR have noticed a reduction on self-reported anxiety, depression, stress and more. Participants who received MBSR in these studies had experienced some changes in their brain. For instance, activation of the left frontal lobe had increased, areas of the brain that are correlated with experiential had increased activation and areas of the brain that are correlated in conceptual processing had decreased activation (Shian, K.et al, 2011). MBCT is oriented from MBSR and was designed for remitted depression. It aims to reduce negative thinking by altering individual’s emotions and thoughts. Some studies have noticed patients with 3 episodes of depression or more, had a decreased relapse rate after MBCT. However, MBCT does not seem to work the same way with patients who had less than 3 episodes. Studies also noticed that MBCT has an ability to improve symptoms of depression and thus lead to a better quality of life (Helen, S and John, D.,2004).

Drug treatments for mental illnesses such as depression are widely available and commonly used. For patients who start taking antidepressant drugs, they have to be monitored for 4 weeks which can cause inconvenience to them. Antidepressants are typically used in long term treatment; patients will need to keep taking them until their symptoms resolve. Withdrawal symptoms might appear due to sudden withdrawal or missing a dose. Antidepressants such as St John’s Wort interacts with many drugs such as anticoagulants and contraceptive pills which can reduce their effectiveness and lead to serious harm to the patient (NHS, 2016a). SSRIs such as sertraline can cause side effects such as confusion and constipation. To conclude, drug treatments can be inconvenient as they require patient commitment, pose unwanted side effects and potential drug interactions. Psychological interventions do not have the problems drug treatments have. This makes psychological interventions a better consideration in dealing with mental health.

The internet plays a significant part in daily life and most individuals have devices that have access to the internet. This has created a new route for mindfulness intervention delivery. Internet based psychological intervention does not require participants to travel and it can be done in their own time which saves them time and money (Mark, A.et al, 2012). Patients are anonymous during treatment which differs to other forms of treatment delivery such as group intervention (Mark, A.et al, 2012). Internet based delivery enhances patient compliance, it is more convenient, cost effective and confidential in comparison to other routes. Under these circumstances, there is an urge to further investigate the importance of internet based intervention.

Findings on MBIs

There are articles investigating MBIs using brain imaging. One article found that the concentration of grey matter in the hippocampus, cerebellum, posterior cingulate cortex of participants had a pre-post increase after an 8-week course. These areas are linked with regulation of emotion, learning processes, memory processes, self-referential processing (Britta, K.et al, 2012). One study measured the differences between brain structure and activity between two groups, one which received regular MBI and another that received no intervention. It was shown that groups that have mindfulness meditation regularly have a rise in thickness in areas of the brain such as the prefrontal cortex and right anterior insula (Sara, W.et al, 2005). Increased concentration of grey matter was found in brain regions that operate while meditating. These regions are associated with functions such as attention, sensory processing and regulation of emotions. This data gives clues to how MBIs might work (Shian, K.et al, 2011).

One study investigated the quality of life and psychological status of breast cancer patients after mindfulness based training intervention. This study showed that these interventions improved quality of life, life expectancy and lead to a decrease in levels of stress and anxiety in breast cancer patients. However, due to exclusion of metastatic cancer patients, this study might not be able to represent breast cancer patients as a whole. Moreover, the study has shown that the effectiveness of mindfulness based training intervention is not affected by demographic characteristics (Somye, P.et al, 2018).

One study investigates the acceptability of internet MBIs. Although participants enjoyed its accessibility and anonymity, dropout rate was high with only 7% of completion. The reason of this was because it wasn’t user friendly. Hence, patient adherence concern was raised (Miriam, T.et al, 2018). There is a recent study of an internet based mindfulness resilience training programme which was the first of its kind, this was conducted in the workplace. The aim of the study was to test the feasibility of mindfulness training in high risk workers. It has successfully proved that internet based training is achievable in a high risk workplace environment. Furthermore, they have found that this training has improved resilience. The study has successfully showed that the skills required to improve resilience and psychological flexibility can be delivered online. However, the study only includes firefighters and there were only 29 participants. Also, within the 29 participants, 28 of them were male. The percentage of completion of all sessions was 38%. These bring up questions on how representable this study is to a larger population and to different occupations. A long term follow up of these participants was lacking, meaning there is uncertainty on how long the effects last. The control group for this study was non-existent, indicating that there was no baseline to compare the test and control group, so the variables were not minimised and bias may occur as a result (Sadhbh, B.et al, 2018).

The main problems of these studies are the small sample size, specific patient groups and no short term or long term follow up. Therefore, it will not be representative of a larger population. To address these issues, a meta-analysis and systematic review will be needed to provide a bigger picture of the efficacy of internet-based intervention.

Aims

The aim of this study is to determine the feasibility of internet based psychological interventions.

Objectives

  • To identify the effectiveness of internet MBIs
  • To identify what group of people it is most beneficial for
  • To find out patient adherence to internet MBIs
  • Produce a meta-analysis and a systematic review

Intended design and methods of investigation

Literature search

Reliable sources such as PubMed, Scopus, Web of Science and Google Scholar will be used as a database for this systematic review. Each database will be searched for literatures with publication dates within 10 years. Search terms for mindfulness based intervention is ‘Mindful*’. Search terms for mental health are ‘Mental health’ OR ‘Depress*’ OR ‘Stress*’ OR ‘Anxiety’. Search terms for internet are ‘internet-based’ OR ‘web’ OR ‘mobile’ OR ‘phone’ OR ‘computer’.  Mindfulness based intervention, mental health, internet search terms will be connected with ‘AND’ when searching for literatures. Filter will also be applied in order to eliminate irrelevant articles.

Inclusion criteria

Different age groups will be included in this study. Studies with randomised controlled design will be included. Only internet based intervention will be included. Only mindfulness based interventions are included. Any device that has access to the internet are included.

Exclusion criteria

Non-English studies will be excluded. Mind body intervention such as Yoga and Tai Chi will be excluded. Face to face interventions are excluded. Short term interventions (<8 weeks) will be excluded.

Plan

Approximately 20 or less articles should be left after applying eligible criteria. A PRIMA diagram will be used to help and show the selection of studies. Quality of articles will be assessed using JADAD scale. Articles that score more than three on JADAD scale will be considered. Articles will only be considered when they have a relatively large sample size.

Meta-analysis will be able to provide a precise estimation of the effectiveness of internet-MBIs. It is the most reliable and powerful evidence hence it is at the top of the hierarchy of evidence. If there is enough data and it is homogeneous, a meta-analysis will be made. Homogeneity test such as Cochran’s Q statistics and chi-squared test will be used to test for homogeneity of data. However, these two tests can only detect homogeneity among large numbers of trails. A meta-analysis will be performed using software such as Revman. A forest plot will be included in the study to help summarise studies and to present the results of the meta-analysis. Summary effect estimate identification will be included. Funnel plot will be used to identify publication bias of the results of the meta-analysis (Haidich, A. 2010). If there is not enough data or the data is heterogeneous, only a systematic review will be made.

Data such as measurement method, delivery route, follow up duration, adherence will be used to determine the feasibility of web based MBIs. Examples for measurement are resilience scale, stress scale, anxiety scale, fatigue scale and quality of life. Results found in the study will be summarised into a table. Pre-post effect size is applied to calculate how important the differences are. A risk of bias evaluation should be conducted at the beginning of the study. Recommendation for future research in this field should be made. In discussion, the limitations of the literature should be included.

GANTT Chart

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Bibliography

Benjamin, G., Jonathan G., Paola, P., Marasha, J., Gaella, D. (2018). Mindfulness-Based Interventions in Psychiatry [online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5870875/ [Accessed 8th Nov. 2018]

 

(This study discusses the role of MBIs in treating psychiatric disorder. This study is useful because it explains the mechanism of how MBIs work.)

Britta, K., James, C., Mark, V., Christina, C., Sita, M., Tim, G., Sara, W. (2012) Mindfulness practice leads to increases in regional brain gray matter density [online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004979/ [Accessed 9th Nov. 2018]

(This study found out the relationship between grey matter concentration and MBSR. This study is useful because it explains which regions in the brain was affected by MBSR.)

 

Haidich, A (2010). Meta-analysis in medical research [online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3049418/ [Accessed 13th Nov. 2018]

(This contains information on conducting a meta-analysis. This is useful because it gives information on when and how to use it.) 

Helen, S and John, D (2004). Mindfulness-Based Cognitive Therapy for Depression: Replication and Exploration of Differential Relapse Prevention Effects [online] Available at: https://search.proquest.com/docview/614401124?accountid=15390  [Accessed 7th Nov. 2018]

 

(This study was investigating the efficacy of MBCT in depression. This study is useful because it indicates how participants were affected by MBCT.)

Mark, A., Lindsey, C., Brandilyn, R., Larry, D. (2012). Employee’s Preferences for Access to Mindfulness-Based Cognitive Therapy to Reduce the Risk of Depressive Relapse—A Discrete Choice Experiment [online] Available at: https://link.springer.com/article/10.1007%2Fs12671-012-0108-3[Accessed 7th Nov. 2018]

(This study investigates the preference of employees for MBCT delivery method. This study is useful because it gives explanation on why people prefer certain delivery methods.)

Michael, V., Arild, B., Sabina, F., Gunvor, D., Even, H., Emily, S. (2017). Mindfulness-based stress reduction (MBSR) for improving health, quality of life and social functioning in adults: a systematic review and meta-analysis [online] Available at: https://campbellcollaboration.org/media/k2/attachments/0107_De_Vibe_Mindfulness_update_review.pdf [Accessed 4th Nov. 2018]

 

(The study discusses the effectiveness of MBSR. This study is useful because it discusses the efficacy of non-internet based MBIs.)

NHS (2016a). Treatment clinical depression [online] Available at:

https://www.nhs.uk/conditions/clinical-depression/treatment/ [Accessed 2ndNov. 2018]

(It has treatment information for depression.)

NHS England (2017a). About mental health [online] Available at: https://www.england.nhs.uk/mental-health/about/ [Accessed 2nd Nov. 2018]

(It provides information on how many people are affected by mental illness and how it has affected them.)

NHS England (2018b). Adults [online] Available at:

https://www.england.nhs.uk/mental-health/adults/ [Accessed 2nd Nov. 2018]

 

(It explains why mental illness is a problem in the UK.)

Miriam, T., Ellinor K., Heather, R., Jane, F., Susan, A. (2018). Feasibility and Acceptability of a Web-Based Treatment with Telephone Support for Postpartum Women With Anxiety: Randomized Controlled Trial [online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5938691/ [Accessed 10th Nov. 2018]

 

(This study investigates the feasibility and acceptability of internet BMIs. It is useful because it found out reasons of why patient had a low adherence to the programme.)

Sadhbh, B., Fiona, S., Richard, B., Tara, L., Samuel, H. (2018). Mindfulness-Based Resilience Training in the Workplace: Pilot Study of the Internet-Based [email protected] (RAW) Mindfulness Program [online] Available at: https://www.jmir.org/2018/9/e10326/ [Accessed 4th Nov. 2018]

 

(This study found that internet based MBI is working in workplace setting. This study is useful because it is beneficial to have a pilot study before conducting a full scale research.)

Sara, W., Catherine, E., Rachel, H., Jeremy, R., Douglas, N., Michael, T., Metta, M., Brain, T., Jeffery A., Herbert, B., Scott, R., Christopher, M., Bruce, F. (2005). meditation experience is associated with increased cortical thickness [online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361002/ [Accessed 6th Nov. 2018]

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(This study found that there is an increase of cortical thickness in participants who received BMI. This study is useful because it shows that regions that is responsible for attention and sensory processing had an increase in cortical thickness.)

Shian, K., Moria, J., Clive, J. (2011). Effects of mindfulness on psychological health: A review of empirical studies [online] Available at: https://greatergood.berkeley.edu/images/uploads/Keng-Mindfulness_Review_and_Conceptions.pdf [Accessed 5th Nov. 2018]

 

(This study found that mental health is positively associated with MBIs. This study is useful because it includes finding of immediate effects of MBIs.)

Somye, P., Fatemeh, P., Hassan, N., Parisa, S., Asma, T., Milad, B. (2018). Investigating the Effect of Mindfulness-Based Training on Psychological Status and Quality of Life in Patients with Breast Cancer [online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6165667/ [Accessed 5th Nov. 2018]

 

(This study found that MBI can improve quality of life for breast cancer patient. This study is useful because it is essential to identify how effective MBI is against groups that undergo lots of stress.)

WHO (2014). Mental health: a state of well-being [online] Available at: http://www.who.int/features/factfiles/mental_health/en/ [Accessed 2nd Nov.2018]

 

(It gives the definition and explaining what mental health is. It explains it clearly.)

Title:

The potential role of internet based mindfulness interventions for the treatment of mental health diseases

Proposal summary:

Mental health issues are common and affect many people in their life. It can result in decrease in productivity, physical and social health. Mental illness such as depression can be treated using drug therapy. However, due to drawbacks including adverse side effects, non-drug therapy such as mindfulness based intervention (MBI) could be a viable alternative. There is evidence supporting the use of mindfulness based interventions but it also has its disadvantages. For example, it requires patients to travel to receive their treatment. If the internet is introduced to these interventions, it could potentially resolve this problem. Studies have found an increased concentration of grey matter in brain regions after having MBIs. Furthermore, they have found that participants who had mindfulness meditation regularly had an increased thickness in some brain regions. Studies also indicated a poor patient adherence to the internet MBIs, this issue needs to be addressed. This study will be investigating the feasibility of internet based mindfulness interventions. A systematic review will be produced using reliable primary sources. Search criteria, inclusion, exclusion and quality assessment will be applied when selecting articles. Also, if data permits, a meta-analysis will be included in this study.

 

Background:

Mental health is a state of well-being. A positive state of mental health is a state in which a person is free from disease and has a full mental, physical and social capacity (WHO, 2014). Quality of life, level of stress, depression, and anxiety are dependent on the state of mental health. It is common for individuals to experience mental illness in their life, approximately 1 in 4 and 1 in 10 adults and children suffer from this. The biggest single cause of disability is mental health problems in the UK (NHS England, 2017b). Hence, more attention should be given by society. Improved mental health will lead to better outcomes for individuals. For example, an increase in productivity, physical and social health. Therefore, having an improved state of mental health will not only benefit individuals but society as a whole (NHS England, 2017a).

Mental health can be improved by psychological interventions for which there are different options available. Psychological interventions are not only used in individuals with physical or mental illness, it is also used by groups of individuals who have stressful occupations including but not limited to firefighters, teachers and students (Michael, V. et al. 2017). Through this training individuals can cope with the daily stresses when they encounter challenges in life (Michael, V. et al. 2017).

There are different types of mindfulness based interventions (MBIs). For example, mindfulness based stress reduction (MBSR) and mindfulness based cognitive therapy (MBCT). These treatments usually last for 8 weeks with sessions lasting up to 2 hours (Benjamin, G.et al, 2018). MBSR is done repeatedly to achieve a less reactive judgmental thinking and behavior. Studies that have focused on MBSR have noticed a reduction on self-reported anxiety, depression, stress and more. Participants who received MBSR in these studies had experienced some changes in their brain. For instance, activation of the left frontal lobe had increased, areas of the brain that are correlated with experiential had increased activation and areas of the brain that are correlated in conceptual processing had decreased activation (Shian, K.et al, 2011). MBCT is oriented from MBSR and was designed for remitted depression. It aims to reduce negative thinking by altering individual’s emotions and thoughts. Some studies have noticed patients with 3 episodes of depression or more, had a decreased relapse rate after MBCT. However, MBCT does not seem to work the same way with patients who had less than 3 episodes. Studies also noticed that MBCT has an ability to improve symptoms of depression and thus lead to a better quality of life (Helen, S and John, D.,2004).

Drug treatments for mental illnesses such as depression are widely available and commonly used. For patients who start taking antidepressant drugs, they have to be monitored for 4 weeks which can cause inconvenience to them. Antidepressants are typically used in long term treatment; patients will need to keep taking them until their symptoms resolve. Withdrawal symptoms might appear due to sudden withdrawal or missing a dose. Antidepressants such as St John’s Wort interacts with many drugs such as anticoagulants and contraceptive pills which can reduce their effectiveness and lead to serious harm to the patient (NHS, 2016a). SSRIs such as sertraline can cause side effects such as confusion and constipation. To conclude, drug treatments can be inconvenient as they require patient commitment, pose unwanted side effects and potential drug interactions. Psychological interventions do not have the problems drug treatments have. This makes psychological interventions a better consideration in dealing with mental health.

The internet plays a significant part in daily life and most individuals have devices that have access to the internet. This has created a new route for mindfulness intervention delivery. Internet based psychological intervention does not require participants to travel and it can be done in their own time which saves them time and money (Mark, A.et al, 2012). Patients are anonymous during treatment which differs to other forms of treatment delivery such as group intervention (Mark, A.et al, 2012). Internet based delivery enhances patient compliance, it is more convenient, cost effective and confidential in comparison to other routes. Under these circumstances, there is an urge to further investigate the importance of internet based intervention.

Findings on MBIs

There are articles investigating MBIs using brain imaging. One article found that the concentration of grey matter in the hippocampus, cerebellum, posterior cingulate cortex of participants had a pre-post increase after an 8-week course. These areas are linked with regulation of emotion, learning processes, memory processes, self-referential processing (Britta, K.et al, 2012). One study measured the differences between brain structure and activity between two groups, one which received regular MBI and another that received no intervention. It was shown that groups that have mindfulness meditation regularly have a rise in thickness in areas of the brain such as the prefrontal cortex and right anterior insula (Sara, W.et al, 2005). Increased concentration of grey matter was found in brain regions that operate while meditating. These regions are associated with functions such as attention, sensory processing and regulation of emotions. This data gives clues to how MBIs might work (Shian, K.et al, 2011).

One study investigated the quality of life and psychological status of breast cancer patients after mindfulness based training intervention. This study showed that these interventions improved quality of life, life expectancy and lead to a decrease in levels of stress and anxiety in breast cancer patients. However, due to exclusion of metastatic cancer patients, this study might not be able to represent breast cancer patients as a whole. Moreover, the study has shown that the effectiveness of mindfulness based training intervention is not affected by demographic characteristics (Somye, P.et al, 2018).

One study investigates the acceptability of internet MBIs. Although participants enjoyed its accessibility and anonymity, dropout rate was high with only 7% of completion. The reason of this was because it wasn’t user friendly. Hence, patient adherence concern was raised (Miriam, T.et al, 2018). There is a recent study of an internet based mindfulness resilience training programme which was the first of its kind, this was conducted in the workplace. The aim of the study was to test the feasibility of mindfulness training in high risk workers. It has successfully proved that internet based training is achievable in a high risk workplace environment. Furthermore, they have found that this training has improved resilience. The study has successfully showed that the skills required to improve resilience and psychological flexibility can be delivered online. However, the study only includes firefighters and there were only 29 participants. Also, within the 29 participants, 28 of them were male. The percentage of completion of all sessions was 38%. These bring up questions on how representable this study is to a larger population and to different occupations. A long term follow up of these participants was lacking, meaning there is uncertainty on how long the effects last. The control group for this study was non-existent, indicating that there was no baseline to compare the test and control group, so the variables were not minimised and bias may occur as a result (Sadhbh, B.et al, 2018).

The main problems of these studies are the small sample size, specific patient groups and no short term or long term follow up. Therefore, it will not be representative of a larger population. To address these issues, a meta-analysis and systematic review will be needed to provide a bigger picture of the efficacy of internet-based intervention.

Aims

The aim of this study is to determine the feasibility of internet based psychological interventions.

Objectives

  • To identify the effectiveness of internet MBIs
  • To identify what group of people it is most beneficial for
  • To find out patient adherence to internet MBIs
  • Produce a meta-analysis and a systematic review

Intended design and methods of investigation

Literature search

Reliable sources such as PubMed, Scopus, Web of Science and Google Scholar will be used as a database for this systematic review. Each database will be searched for literatures with publication dates within 10 years. Search terms for mindfulness based intervention is ‘Mindful*’. Search terms for mental health are ‘Mental health’ OR ‘Depress*’ OR ‘Stress*’ OR ‘Anxiety’. Search terms for internet are ‘internet-based’ OR ‘web’ OR ‘mobile’ OR ‘phone’ OR ‘computer’.  Mindfulness based intervention, mental health, internet search terms will be connected with ‘AND’ when searching for literatures. Filter will also be applied in order to eliminate irrelevant articles.

Inclusion criteria

Different age groups will be included in this study. Studies with randomised controlled design will be included. Only internet based intervention will be included. Only mindfulness based interventions are included. Any device that has access to the internet are included.

Exclusion criteria

Non-English studies will be excluded. Mind body intervention such as Yoga and Tai Chi will be excluded. Face to face interventions are excluded. Short term interventions (<8 weeks) will be excluded.

Plan

Approximately 20 or less articles should be left after applying eligible criteria. A PRIMA diagram will be used to help and show the selection of studies. Quality of articles will be assessed using JADAD scale. Articles that score more than three on JADAD scale will be considered. Articles will only be considered when they have a relatively large sample size.

Meta-analysis will be able to provide a precise estimation of the effectiveness of internet-MBIs. It is the most reliable and powerful evidence hence it is at the top of the hierarchy of evidence. If there is enough data and it is homogeneous, a meta-analysis will be made. Homogeneity test such as Cochran’s Q statistics and chi-squared test will be used to test for homogeneity of data. However, these two tests can only detect homogeneity among large numbers of trails. A meta-analysis will be performed using software such as Revman. A forest plot will be included in the study to help summarise studies and to present the results of the meta-analysis. Summary effect estimate identification will be included. Funnel plot will be used to identify publication bias of the results of the meta-analysis (Haidich, A. 2010). If there is not enough data or the data is heterogeneous, only a systematic review will be made.

Data such as measurement method, delivery route, follow up duration, adherence will be used to determine the feasibility of web based MBIs. Examples for measurement are resilience scale, stress scale, anxiety scale, fatigue scale and quality of life. Results found in the study will be summarised into a table. Pre-post effect size is applied to calculate how important the differences are. A risk of bias evaluation should be conducted at the beginning of the study. Recommendation for future research in this field should be made. In discussion, the limitations of the literature should be included.

GANTT Chart

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Bibliography

Benjamin, G., Jonathan G., Paola, P., Marasha, J., Gaella, D. (2018). Mindfulness-Based Interventions in Psychiatry [online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5870875/ [Accessed 8th Nov. 2018]

 

(This study discusses the role of MBIs in treating psychiatric disorder. This study is useful because it explains the mechanism of how MBIs work.)

Britta, K., James, C., Mark, V., Christina, C., Sita, M., Tim, G., Sara, W. (2012) Mindfulness practice leads to increases in regional brain gray matter density [online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004979/ [Accessed 9th Nov. 2018]

(This study found out the relationship between grey matter concentration and MBSR. This study is useful because it explains which regions in the brain was affected by MBSR.)

 

Haidich, A (2010). Meta-analysis in medical research [online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3049418/ [Accessed 13th Nov. 2018]

(This contains information on conducting a meta-analysis. This is useful because it gives information on when and how to use it.) 

Helen, S and John, D (2004). Mindfulness-Based Cognitive Therapy for Depression: Replication and Exploration of Differential Relapse Prevention Effects [online] Available at: https://search.proquest.com/docview/614401124?accountid=15390  [Accessed 7th Nov. 2018]

 

(This study was investigating the efficacy of MBCT in depression. This study is useful because it indicates how participants were affected by MBCT.)

Mark, A., Lindsey, C., Brandilyn, R., Larry, D. (2012). Employee’s Preferences for Access to Mindfulness-Based Cognitive Therapy to Reduce the Risk of Depressive Relapse—A Discrete Choice Experiment [online] Available at: https://link.springer.com/article/10.1007%2Fs12671-012-0108-3[Accessed 7th Nov. 2018]

(This study investigates the preference of employees for MBCT delivery method. This study is useful because it gives explanation on why people prefer certain delivery methods.)

Michael, V., Arild, B., Sabina, F., Gunvor, D., Even, H., Emily, S. (2017). Mindfulness-based stress reduction (MBSR) for improving health, quality of life and social functioning in adults: a systematic review and meta-analysis [online] Available at: https://campbellcollaboration.org/media/k2/attachments/0107_De_Vibe_Mindfulness_update_review.pdf [Accessed 4th Nov. 2018]

 

(The study discusses the effectiveness of MBSR. This study is useful because it discusses the efficacy of non-internet based MBIs.)

NHS (2016a). Treatment clinical depression [online] Available at:

https://www.nhs.uk/conditions/clinical-depression/treatment/ [Accessed 2ndNov. 2018]

(It has treatment information for depression.)

NHS England (2017a). About mental health [online] Available at: https://www.england.nhs.uk/mental-health/about/ [Accessed 2nd Nov. 2018]

(It provides information on how many people are affected by mental illness and how it has affected them.)

NHS England (2018b). Adults [online] Available at:

https://www.england.nhs.uk/mental-health/adults/ [Accessed 2nd Nov. 2018]

 

(It explains why mental illness is a problem in the UK.)

Miriam, T., Ellinor K., Heather, R., Jane, F., Susan, A. (2018). Feasibility and Acceptability of a Web-Based Treatment with Telephone Support for Postpartum Women With Anxiety: Randomized Controlled Trial [online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5938691/ [Accessed 10th Nov. 2018]

 

(This study investigates the feasibility and acceptability of internet BMIs. It is useful because it found out reasons of why patient had a low adherence to the programme.)

Sadhbh, B., Fiona, S., Richard, B., Tara, L., Samuel, H. (2018). Mindfulness-Based Resilience Training in the Workplace: Pilot Study of the Internet-Based [email protected] (RAW) Mindfulness Program [online] Available at: https://www.jmir.org/2018/9/e10326/ [Accessed 4th Nov. 2018]

 

(This study found that internet based MBI is working in workplace setting. This study is useful because it is beneficial to have a pilot study before conducting a full scale research.)

Sara, W., Catherine, E., Rachel, H., Jeremy, R., Douglas, N., Michael, T., Metta, M., Brain, T., Jeffery A., Herbert, B., Scott, R., Christopher, M., Bruce, F. (2005). meditation experience is associated with increased cortical thickness [online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361002/ [Accessed 6th Nov. 2018]

(This study found that there is an increase of cortical thickness in participants who received BMI. This study is useful because it shows that regions that is responsible for attention and sensory processing had an increase in cortical thickness.)

Shian, K., Moria, J., Clive, J. (2011). Effects of mindfulness on psychological health: A review of empirical studies [online] Available at: https://greatergood.berkeley.edu/images/uploads/Keng-Mindfulness_Review_and_Conceptions.pdf [Accessed 5th Nov. 2018]

 

(This study found that mental health is positively associated with MBIs. This study is useful because it includes finding of immediate effects of MBIs.)

Somye, P., Fatemeh, P., Hassan, N., Parisa, S., Asma, T., Milad, B. (2018). Investigating the Effect of Mindfulness-Based Training on Psychological Status and Quality of Life in Patients with Breast Cancer [online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6165667/ [Accessed 5th Nov. 2018]

 

(This study found that MBI can improve quality of life for breast cancer patient. This study is useful because it is essential to identify how effective MBI is against groups that undergo lots of stress.)

WHO (2014). Mental health: a state of well-being [online] Available at: http://www.who.int/features/factfiles/mental_health/en/ [Accessed 2nd Nov.2018]

 

(It gives the definition and explaining what mental health is. It explains it clearly.)

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