Running Head: IN-PERSON VERSUS ONLINE MINDFULNESS 1

A Showdown: In-Person versus Online

Mindfulness-Based Interventions

Alex Conway

Randolph College
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A Showdown: In-Person versus Online Mindfulness-Based Interventions

Mindfulness is to pay attention on purpose, to observe and experience the present

moment “in a nonjudgmental and accepting manner” (Ivtzan et al., 2016; Keng, Smoski, &

Robins, 2011). It is a psychological trait, a religious tradition, a spiritual practice, and a way of

life that is anecdotally and empirically associated with a host of benefits. Yet alone, the

aforementioned attitudes, nonjudgement and acceptance, aptly characterize nearly all forms of

mindfulness.

Although it is relatively new to the Western world, people have practiced mindfulness for

millennia (Keng et al., 2011). The most structured and well-researched ancient practitioners are

the Buddhists (Keng et al., 2011). Buddhists utilize mindfulness in a way that contemporary

professionals might describe as wrap-around, or comprehensive – that is, they systematically

implement mindfulness into every facet of life, bracketing it with various philosophies, codes of

ethics, and spiritual beliefs (Keng et al., 2011). In contrast, over the past 60 to 70 years, perhaps

because of the ever-increasing pace of life or the expansion of mental health care, Western

societies have begun incorporating mindfulness strategically into clinical and therapeutic

practices (Keng et al., 2011). These practices are typically highly focused, serving to minimize

psychological distress and maximize psychological well-being (Keng et al., 2011). And although

they have splintered in several directions since their inception, in this paper, I will categorize

them all under the umbrella of mindfulness-based interventions (MBIs).

There are four major MBIs, all of which require in-person contact. Early researchers and

clinicians created these interventions to accomplish specific goals, so each includes

characteristics that distinguish it from the others. Kabat-Zinn (1982) developed Mindfulness-

Based Stress Reduction (MBSR) – a group-based program that relies on meditations, in-home
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practices, and a retreat – to treat chronic pain (as cited in Keng et al., 2011; Ivtzan et al., 2016).

Mindfulness-Based Cognitive Therapy (MBCT), a derivative of MBSR, combines mindfulness

training and cognitive therapy techniques to reduce recurrences of major depression (Keng et al.,

2011; Teasdale et al., 2000). Similarly, Dialectal Behavior Therapy coordinates cognitive-

behavioral therapy and Zen philosophy to minimize self-harm and regulate mood disorders, and

Acceptance and Commitment Therapy helps people align their values and behaviors to reduce

general psychological distress (Bach & Hayes, 2002; Keng et al., 2011). Each of these

approaches are successful, perhaps even more so than originally anticipated.

MBIs differ in application from ancient mindfulness practices, but researchers have

empirically established their success. In fact, these interventions often outperform their intended

functions, reducing many adverse psychological symptoms and improving short- and long-term

psychological and physiological well-being (Bach & Hayes, 2002; Baer, 2003; Baer, Lykins, &

Peter, 2012; Cruess et al, 2015; Keng et al., 2011, Ivtzan et al., 2016; Shearer, Hunt, Chowdhury,

& Nicol, 2016). Even brief – as few as one session – and unconventional MBIs have

demonstrated their competencies (Cruess et al., 2015; Shearer et al., 2016). This may be because

most MBIs continue to emphasize the time-honored component attitudes of nonjudgement and

acceptance. In recent years, recognition of the efficiency of MBIs, in tandem with the

technological revolution, has led to their increased ubiquity. One class of interventions in

particular has emerged and begun to thrive: online MBIs (OMBIs).

OMBIs may offer additional benefits without compromising results. In-person MBIs can

be time-consuming and expensive, and some people may avoid them because of stigmata

attached to receiving mental health care (Shearer et al., 2016). OMBIs could be a solution such

problems. They have the potential to help more people than in-person MBIs because they are
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time-convenient, user-friendly, globally accessible, discrete, and they may be as effective as in-

person MBIs.

There are multiple types of OMBIs and methods of employing them, and they seem to

work for most people. Researchers have empirically validated OMBIs as structured programs

(Gu, Cavanagh, & Strauss, 2018; Heckenberg, Hale, Kent, & Wright, 2018; Querstret, Cropley,

& Fife-Schaw, 2018; Tkatch et al., 2017), guided meditations (Bailey et al., 2018; Bostock,

Crosswell, Prather, & Steptoe, 2019), and as complements to other therapeutic techniques and

philosophies (Ivtzan et al., 2016). They also have administered OMBIs via computers and

smartphones (Bostock et al., 2019) to numerous samples, including the general population

(Bailey et al., 2018; Querstret et al., 2018), university staff and students (Cavanagh et al., 2018;

Gu, Cavanagh, & Strauss, 2018), direct-care workers (Heckenberg et al., 2018; Tkatch et al.,

2017), pharmaceutical and information-technology employees (Bostock et al., 2019), and

experienced and inexperienced meditators (Baer et al., 2012). Individually, the aforementioned

studies generally have linked OMBIs to favorable changes in psychological and physiological

distress and well-being, and meta-analyses support such findings (Jayawardene, Lohrmann, Erbe,

& Torabi, 2017; Spijkerman, Pots, & Bohlmeijer, 2016). Collectively, evidence suggests that

OMBIs should play a significant role in the future of mental wellness.

Past researchers have established the efficacy of in-person MBIs and OMBIs separately,

but to date, no one has compared the two directly. This study will do just that. I will recruit

participants and randomly assign them to participate in an 8-week in-person MBI condition or

OMBI condition. For both conditions, I will track attrition and measure six forms of

psychological distress and well-being at baseline, 4 weeks, 8 weeks, and 12 weeks (post-

intervention). Because there is no body of literature comparing in-person MBIs and OMBIs
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directly, my hypotheses are somewhat loosely developed. However, I hypothesize two primary

outcomes, both of which hinge on the inherent social component of group-based, in-person

MBIs. First, that those in the in-person MBI condition will demonstrate greater improvements in

all six measures of psychological distress compared to those in the OMBI condition. Second, that

the in-person MBI condition will experience lower attrition than the OMBI condition.

Methods

Participants

I will circulate a digital flier via Facebook, Twitter, Instagram to recruit a maximum of

90 participants from Lynchburg, Virginia and its surrounding counties. This flier will include the

following information: area of research (i.e., psychology and mindfulness), experiment timeline,

participant responsibilities, and contact information. Only those over the age of 18 and in good

health will be eligible to participate. Those who complete the study in its entirety will receive

$50 financial compensation.

Materials

I will use the online module “Be Mindful” as the intervention for participants in the

OMBI condition (“Be Mindful,” n.d.). Deliverable via computer or smart-device, this program

integrates MBSR and MBCT (Krusche et al., 2012). Mental Health Foundation and Wellmind

Media currently run this module (Krusche, Cyhlarova, King, & Williams, 2012). It was

developed by leading mindfulness instructors in the United Kingdom (UK), is supported by the

UK’s National Health Service, and has been deemed suitable for past research-oriented

interventions (“Be Mindful,” n.d.; Krusche et al., 2012; Querstret, Cropley, & Fife-Schaw, 2016;

Querstret et al., 2018).

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Measurements

I will record six psychological measures across two dimensions: distress and well-being.

For psychological distress, I will measure perceived stress, anxiety, and depression. For

psychological well-being, I will measure mindfulness, happiness, and self-efficacy.

Psychological distress. I will measure perceived stress using the 14-item Perceived

Stress Scale (PSS; Cohen, Kamarck, & Mermelstein, 1983). This inventory prompts responders

to reveal how often they have had certain thoughts and feelings associated with stress over the

past 30 days. Averaged across three samples, the PSS has a coefficient alpha reliability of .85.

I will measure anxiety using the Generalized Anxiety Disorder 7-item scale (GAD-7;

Spitzer, Kroenke, Williams, & Lowe, 2006). This scale offers statements such as, “Feeling

nervous, anxious, or on edge,” and asks respondents to report how often they have experienced

them in the past 14 days. Responses can range from “not at all” to “nearly every day.” The GAD-

7 has sufficient reliability and construct, criterion, factorial, and procedural validity.

I will measure depression using Beck’s Depression Inventory-II (BDI-II; Beck, Steer,

Ball, & Ranieri, 1996). This measure contains 21 items such as, “Suicidal thoughts or wishes,”

each of which is scored along a 4-point Likert scale. This inventory has strong internal

reliability, with a coefficient alpha of .82.

Psychological well-being. I will measure mindfulness using the Freiburg Mindfulness

Inventory (FMI; Walach, Buchheld, Buttenmüller, Kleinknecht, & Schmidt, 2006). This 14-item

inventory asks respondents to respond along a 4-point Likert scale to statements such as, “I am

able to appreciate myself.” It has sufficient internal reliability (α = .91).

I will measure happiness using the Pemberton Happiness Index (PHI; Hervás & Vázquez,

2013). This 21-item inventory has two subscales: remembered (PHI-RW) and experienced (PHI-
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EW) well-being. The PHI-RW consists of 10 retrospective questions that respondents answer

along a 10-point Likert scale, and the PHI-EW is comprised of 10 “yes” or “no” questions that

determine well-being over the previous day. This assessment has a coefficient alpha of .89.

I will measure self-efficacy using the Generalized Self-efficacy Scale (GSE; Schwarzer

& Jerusalem, 1995). This scale contains items such as, “I can usually handle whatever comes my

way,” each of which is responded to along a 4-point Likert scale. This measure has strong

internal reliability, with a coefficient alpha of .89.

Procedure

I will prescreen all recruits using a digital checklist (Google Forms) before admitting

them into this study. This checklist will serve two purposes. One, to collect participants’

demographic information. Two, to prescreen participants medically. Only those who report

severe medical issues (e.g., heart complications, dementia, seizures) that might endanger

themselves or others, compromise results, or prevent access to research locations will be

considered ineligible to participate.

After prescreening, I will randomly assign participants to an in-person MBI condition or

an OMBI condition. Participants will receive notification of their assignments via email, and

based on those assignments, they will report to one of two locations at a specified time and date.

Those in the in-person MBI condition will report to Randolph College’s Smith Theatre, while

those in the OMBI condition will report to Randolph College’s psychology lab. In these

meetings, I will record baseline measures and provide participants with instructions regarding

their responsibilities.

In the 8 weeks following the initial meetings, those in the in-person MBI condition will

meet at Smith Theatre two times per week with a qualified and experienced facilitator to practice
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the Segal et al. (2002) Mindfulness-Based Cognitive Therapy model (as cited in Evans, 2007).

This model includes structured classes that provide mindfulness education, extensive training in

various forms of meditation and yoga, and 45 min guided meditations for participants to

complete daily as homework (Evans, 2007). Participants will self-report the number of guided

meditations they complete during the last meeting of each week, and at 4 weeks, 8 weeks, and 12

weeks I will collect participants’ psychological measures via email.

Those in the OMBI condition will complete an online module that integrates MBSR and

MBCT (“Be Mindful,” n.d.; Krusche et al., 2012). It consists of 10 interactive (i.e., synchronous)

learning sessions, and follows a class sequence similar to that of the in-person MBI condition

(Krusche et al., 2012). Outside of interactive sessions, participants will learn various meditation

techniques via video and email. Each week, they will report the frequency with which they

practiced these techniques at home (this data is recorded automatically by the module; Krusche

et al., 2012). I will collect psychological measures from those in the OMBI condition via email at

4 weeks, 8 weeks, and 12 weeks.

Planned Analyses and Predicted Results

I will use a 2 (condition) × 4 (time) repeated measures ANOVA to analyze condition

differences for each psychological variable – perceived stress, anxiety, depression, mindfulness,

happiness, and self-efficacy – at baseline, 4 weeks, 8 weeks, and 12 weeks (post-intervention).

Additionally, I will use an independent-samples t-test to compare the conditions’ attrition rates.

Because the in-person MBI condition inherently includes a social component

(participants meet and greet, spend hours in joint-attention, etc.), it is possible that participants in

this condition will be excited to participate and, therefore, devote more time to their mindfulness

practices, or even focus more during their sessions than those in the OMBI condition. For this
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reason, I hypothesize that those in the in-person MBI condition will experience the greatest

improvements in overall psychological health. Specifically, I hypothesize that those in the in-

person MBI condition will report lesser psychological distress and greater psychological well-

being than those in the OMBI condition at 4 weeks, 8 weeks, and 12 weeks. Also because of the

in-person MBI’s inherent social component, I hypothesize that the in-person MBI condition will

experience lower attrition than the OMBI condition.

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