Putting the 'app' in Happiness: A Randomised Controlled Trial of a Smartphone-Based Mindfulness Intervention to Enhance Wellbeing

Smartphones are revolutionizing approaches to wellbeing investment. Those seeking greater happiness can engage with thousands of downloadable self-help applica- tions instantly, yet their effectiveness remains largely unknown. This investigation explored the viability of delivering a positive psychological intervention in application format to authentic happiness seekers. A smartphone-based randomized-controlled trial was conducted with a diverse self-selecting pool, randomly assigned to engage with an empirically supported mindfulness intervention (n = 57) or a control intervention (n = 64) for 10 days. The study explored smartphone methodology, the importance of empirically based content for wellbeing enhancement and the extent to which user expe- rience related to wellbeing gains. Results of repeated measures ANOVAs showed statis- tically significant increases in positive affect with a medium effect size and reduced depressive symptoms with a small effect size, although no statistically significant differ- ences in satisfaction with life, flourishing or negative affect were found. No statistically significant gains were observed in the control condition. Ratings of task enjoyment were positively correlated (Pearson's r) with positive affect increase. Findings support the viability of smartphone-based interventions to significantly enhance elements of wellbeing, underscoring the importance of application content and the role of person-activity fit. This investigation presents implications for happiness seeking strategies in the real world whilst showcasing a dynamic method of intervention delivery that can benefit future research and practice. If the greatest mission of positive psychology is to enhance global flourishing, the potential of smartphone-based interventions may play a vital role

Putting the ‘app’ in Happiness: A Randomised Controlled Trial of a Smartphone-Based Mindfulness Intervention to Enhance Wellbeing

Smartphones are revolutionizing approaches to wellbeing investment. Those seeking greater happiness can engage with thousands of downloadable self-help applications instantly, yet their effectiveness remains largely unknown. This investigation explored the viability of delivering a positive psychological intervention in application format to authentic happiness seekers. A smartphone-based randomized-controlled trial was conducted with a diverse self-selecting pool, randomly assigned to engage with an empirically supported mindfulness intervention (n = 57) or a control intervention (n = 64) for ten days. The study explored smartphone methodology, the importance of empirically based content for wellbeing enhancement and the extent to which user experience related to wellbeing gains. Results of repeated measures ANOVAs showed statistically significant increases in positive affect with a medium effect size and reduced depressive symptoms with a small effect size, although no statistically significant differences in satisfaction with life, flourishing or negative affect were found. No statistically significant gains were observed in the control condition. Ratings of task enjoyment were positively correlated (Pearson's r) with positive affect increase. Findings support the viability of smartphone-based interventions to significantly enhance elements of wellbeing, underscoring the importance of application content and the role of person-activity fit. This investigation presents implications for happiness seeking strategies in the real world whilst showcasing a dynamic method of intervention delivery that can benefit future research and practice. If the greatest mission of positive psychology is to enhance global flourishing, the potential of smartphone-based interventions may play a vital role

Putting the 'app' in Happiness: A Randomised Controlled Trial of a Smartphone-Based Mindfulness Intervention to Enhance Wellbeing

Smartphones are revolutionizing approaches to wellbeing investment. Those seeking greater happiness can engage with thousands of downloadable self-help applica- tions instantly, yet their effectiveness remains largely unknown. This investigation explored the viability of delivering a positive psychological intervention in application format to authentic happiness seekers. A smartphone-based randomized-controlled trial was conducted with a diverse self-selecting pool, randomly assigned to engage with an empirically supported mindfulness intervention (n = 57) or a control intervention (n = 64) for 10 days. The study explored smartphone methodology, the importance of empirically based content for wellbeing enhancement and the extent to which user expe- rience related to wellbeing gains. Results of repeated measures ANOVAs showed statis- tically significant increases in positive affect with a medium effect size and reduced depressive symptoms with a small effect size, although no statistically significant differ- ences in satisfaction with life, flourishing or negative affect were found. No statistically significant gains were observed in the control condition. Ratings of task enjoyment were positively correlated (Pearson's r) with positive affect increase. Findings support the viability of smartphone-based interventions to significantly enhance elements of wellbeing, underscoring the importance of application content and the role of person-activity fit. This investigation presents implications for happiness seeking strategies in the real world whilst showcasing a dynamic method of intervention delivery that can benefit future research and practice. If the greatest mission of positive psychology is to enhance global flourishing, the potential of smartphone-based interventions may play a vital role

Intravenous alteplase for stroke with unknown time of onset guided by advanced imaging: systematic review and meta-analysis of individual patient data

Background: Patients who have had a stroke with unknown time of onset have been previously excluded from thrombolysis. We aimed to establish whether intravenous alteplase is safe and effective in such patients when salvageable tissue has been identified with imaging biomarkers. Methods: We did a systematic review and meta-analysis of individual patient data for trials published before Sept 21, 2020. Randomised trials of intravenous alteplase versus standard of care or placebo in adults with stroke with unknown time of onset with perfusion-diffusion MRI, perfusion CT, or MRI with diffusion weighted imaging-fluid attenuated inversion recovery (DWI-FLAIR) mismatch were eligible. The primary outcome was favourable functional outcome (score of 0–1 on the modified Rankin Scale [mRS]) at 90 days indicating no disability using an unconditional mixed-effect logistic-regression model fitted to estimate the treatment effect. Secondary outcomes were mRS shift towards a better functional outcome and independent outcome (mRS 0–2) at 90 days. Safety outcomes included death, severe disability or death (mRS score 4–6), and symptomatic intracranial haemorrhage. This study is registered with PROSPERO, CRD42020166903. Findings: Of 249 identified abstracts, four trials met our eligibility criteria for inclusion: WAKE-UP, EXTEND, THAWS, and ECASS-4. The four trials provided individual patient data for 843 individuals, of whom 429 (51%) were assigned to alteplase and 414 (49%) to placebo or standard care. A favourable outcome occurred in 199 (47%) of 420 patients with alteplase and in 160 (39%) of 409 patients among controls (adjusted odds ratio [OR] 1·49 [95% CI 1·10–2·03]; p=0·011), with low heterogeneity across studies (I 2=27%). Alteplase was associated with a significant shift towards better functional outcome (adjusted common OR 1·38 [95% CI 1·05–1·80]; p=0·019), and a higher odds of independent outcome (adjusted OR 1·50 [1·06–2·12]; p=0·022). In the alteplase group, 90 (21%) patients were severely disabled or died (mRS score 4–6), compared with 102 (25%) patients in the control group (adjusted OR 0·76 [0·52–1·11]; p=0·15). 27 (6%) patients died in the alteplase group and 14 (3%) patients died among controls (adjusted OR 2·06 [1·03–4·09]; p=0·040). The prevalence of symptomatic intracranial haemorrhage was higher in the alteplase group than among controls (11 [3%] vs two [<1%], adjusted OR 5·58 [1·22–25·50]; p=0·024). Interpretation: In patients who have had a stroke with unknown time of onset with a DWI-FLAIR or perfusion mismatch, intravenous alteplase resulted in better functional outcome at 90 days than placebo or standard care. A net benefit was observed for all functional outcomes despite an increased risk of symptomatic intracranial haemorrhage. Although there were more deaths with alteplase than placebo, there were fewer cases of severe disability or death. Funding: None