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Rumination involves focusing on negative emotions repeatedly and is a risk factor for developing depression, anxiety, and self-injury. These negative outcomes increase in adolescence. The main goal of this study is to examine whether a mobile application designed to reduce rumination works with adolescents. The mobile application involves mindfulness exercises. Mindfulness means nonjudgmentally and deliberately paying attention. Adolescents will be randomly assigned to either the mindfulness group or a control group who uses a mobile application without mindfulness exercises. Both groups will use the app three times per day for three weeks and we will follow up with participants for six months. The investigators hypothesize that the mindfulness group will experience a reduction in rumination and symptoms of depression, anxiety and self-injury. They also expect that the mindfulness group will find the mobile app to be more engaging and will continue to use it beyond the 3 weeks.
Rumination, a perseverative cognitive process that involves dwelling on negative emotions, is a transdiagnostic risk factor for the development of depression, anxiety, and self-injurious behaviors. Thus, reducing the tendency to ruminate in adolescence, a time when many psychological disorders often first develop, has the potential for a large public health impact. This protocol involves testing the acceptability and efficacy of a newly developed mindfulness mobile application designed to reduce rumination.
Mindfulness involves paying attention to the present moment without judgement. If negative emotions arise, one notices them and how the body is feeling without becoming caught up in the emotion so that it can pass. In adult clinical studies, intensive mindfulness practice has been associated with successful treatment of psychopathology, including preventing the recurrence of depression, possibly through reducing rumination. Research with adolescents has suggested that a brief mindfulness exercise can interrupt the ruminative process. Thus, mindfulness appears to be a promising strategy to reduce the tendency to ruminate and prevent psychopathology.
A diverse sample of 150 high-ruminating 12-15 year-olds will be recruited from the community and randomly assigned to a 3-week mobile mindfulness intervention or an ecological momentary assessment (EMA)-only control condition. In both conditions, adolescents will be notified to use the mobile app three times per day to complete EMA questions. Based on mood ratings, participants in the mindfulness condition have a chance to receive a brief mindfulness exercise (i.e., 1-12 minutes long) at each use. At pre- and post-intervention and three follow-up periods (6 weeks,12 weeks, and 6 months), participants and their parents will report on adolescent anxiety and depression. Adolescents will also report on self-injurious thoughts and behaviors (SITBs), trait rumination, and mindfulness. During the intervention period, participants will report on state levels of rumination, mindfulness, and mood using the app. Participants will also report on their satisfaction with the app, while their optional continued use of the app will be monitored electronically for 6 months following the intervention period. The investigators will test intervention effects using multilevel modeling, examining the role of both state- and trait-level mediators. Based on preliminary pilot data, the investigators expect that the mindfulness intervention will reduce symptoms, and we anticipate this effect to be due to the mediating role of decreased rumination.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Mindfulness App | Experimental | Guided mindfulness exercises will be delivered via mobile app for three weeks. |
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| Control condition | No Intervention | Participants will use app for assessment for three weeks, but no mindfulness exercises will be delivered. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Mindfulness App | Behavioral | Mindfulness exercises will last 1-12 minutes. Each one asks participants to focus on something (e.g., breath, sounds, physical sensations) using guided instruction. |
| Measure | Description | Time Frame |
|---|---|---|
| Children's Response Styles Questionnaire | trait rumination (range = 0-39 with higher scores indicating more rumination) | baseline |
| Children's Response Styles Questionnaire | trait rumination (range = 0-39 with higher scores indicating more rumination) | 3 weeks (i.e., immediately post-intervention) |
| Children's Response Styles Questionnaire | trait rumination (range = 0-39 with higher scores indicating more rumination) | 6 weeks post intervention |
| Children's Response Styles Questionnaire | trait rumination (range = 0-39 with higher scores indicating more rumination) | 12 weeks post intervention |
| Children's Response Styles Questionnaire | trait rumination (range = 0-39 with higher scores indicating more rumination) | 6 months post intervention |
| Children's Depression Inventory | self-reported depressive symptoms (range = 0-54 with higher scores indicating more symptoms) | baseline |
| Children's Depression Inventory | self-reported depressive symptoms (range = 0-54 with higher scores indicating more symptoms) | 3 weeks (immediately post-intervention) |
| Children's Depression Inventory |
| Measure | Description | Time Frame |
|---|---|---|
| Five Facet Mindfulness Questionnaire Observing Subscale | trait mindfulness observing (range = 8-40 with higher scores indicating greater mindfulness) | baseline |
| Five Facet Mindfulness Questionnaire Observing Subscale |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Lori M Hilt, PhD | Lawrence University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Lawrence University | Appleton | Wisconsin | 54911 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 36622879 | Derived | Hilt LM, Swords CM, Webb CA. Randomized Controlled Trial of a Mindfulness Mobile Application for Ruminative Adolescents. J Clin Child Adolesc Psychol. 2025 Jan-Feb;54(1):99-112. doi: 10.1080/15374416.2022.2158840. Epub 2023 Jan 9. | |
| 36279218 | Derived | Webb CA, Swords CM, Lawrence HR, Hilt LM. Which adolescents are well-suited to app-based mindfulness training? A randomized clinical trial and data-driven approach for personalized recommendations. J Consult Clin Psychol. 2022 Sep;90(9):655-669. doi: 10.1037/ccp0000763. |
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| ID | Title | Description |
|---|---|---|
| FG000 | Mindfulness App | Guided mindfulness exercises will be delivered via mobile app for three weeks. Mindfulness App: Mindfulness exercises will last 1-12 minutes. Each one asks participants to focus on something (e.g., breath, sounds, physical sensations) using guided instruction. |
| FG001 | Control Condition | Participants will use app for assessment for three weeks, but no mindfulness exercises will be delivered. |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Baseline |
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| Post |
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| Six Week Follow-up |
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| Twelve Week Follow-up |
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| Six Month Follow-up |
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| ID | Title | Description |
|---|---|---|
| BG000 | Mindfulness App | Guided mindfulness exercises will be delivered via mobile app for three weeks. Mindfulness App: Mindfulness exercises will last 1-12 minutes. Each one asks participants to focus on something (e.g., breath, sounds, physical sensations) using guided instruction. |
| BG001 |
| Units | Counts |
|---|---|
| Participants |
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| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Children's Response Styles Questionnaire | trait rumination (range = 0-39 with higher scores indicating more rumination) | Posted | Mean | Standard Deviation | score on a scale | baseline |
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Baseline through 6-month follow-up.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Mindfulness App | Guided mindfulness exercises will be delivered via mobile app for three weeks. Mindfulness App: Mindfulness exercises will last 1-12 minutes. Each one asks participants to focus on something (e.g., breath, sounds, physical sensations) using guided instruction. |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Suicide Attempt | Social circumstances | Systematic Assessment | An adolescent participant reported a suicide attempt on their survey. We immediately intervened with both the parent and child. This adolescent was already seeing a mental health professional. |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Stress from noticing negative emotions | Psychiatric disorders | Non-systematic Assessment | Adolescents rated how anxious or sad they were feeling in the present moment when using the app. Some adolescents reported discomfort surrounding the acknowledgment of negative emotions. |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Lori Hilt | Lawrence University | 920-832-7050 | lori.m.hilt@lawrence.edu |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Jan 1, 2019 | Oct 10, 2021 | Prot_SAP_000.pdf |
| ICF | No | No | Yes | Informed Consent Form | Mar 25, 2019 | Oct 10, 2021 | ICF_001.pdf |
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| ID | Term |
|---|---|
| D000079562 | Rumination Syndrome |
| D003863 | Depression |
| D001008 | Anxiety Disorders |
| D016728 | Self-Injurious Behavior |
| ID | Term |
|---|---|
| D005767 | Gastrointestinal Diseases |
| D004066 | Digestive System Diseases |
| D001068 | Feeding and Eating Disorders |
| D001523 | Mental Disorders |
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Participants will be randomly assigned to the intervention group (i.e., mindfulness with ecological momentary assessment) or the control group (i.e., ecological momentary assessment only).
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self-reported depressive symptoms (range = 0-54 with higher scores indicating more symptoms) |
| 6 weeks post intervention |
| Children's Depression Inventory | self-reported depressive symptoms (range = 0-54 with higher scores indicating more symptoms) | 12 weeks post intervention |
| Children's Depression Inventory | self-reported depressive symptoms (range = 0-54 with higher scores indicating more symptoms) | 6 months post intervention |
| Multidimensional Anxiety Scale for Children | self-reported anxiety symptoms (range = 0-117 with higher scores indicating more anxiety) | baseline |
| Multidimensional Anxiety Scale for Children | self-reported anxiety symptoms (range = 0-117 with higher scores indicating more anxiety) | 3 weeks (i.e., immediately post-intervention) |
| Multidimensional Anxiety Scale for Children | self-reported anxiety symptoms (range = 0-117 with higher scores indicating more anxiety) | 6 weeks post intervention |
| Multidimensional Anxiety Scale for Children | self-reported anxiety symptoms (range = 0-117 with higher scores indicating more anxiety) | 12 weeks post intervention |
| Multidimensional Anxiety Scale for Children | self-reported anxiety symptoms (range = 0-117 with higher scores indicating more anxiety) | 6 months post intervention |
| Self-injurious Thoughts and Behaviors Questionnaire | percent of participants engaged in self-injury over the past year | baseline |
| Self-injurious Thoughts and Behaviors Questionnaire | percent of participants that engaged in self-injury over the past 3 weeks | 3 weeks (i.e., immediately post-intervention) |
| Self-injurious Thoughts and Behaviors Questionnaire | percent of participants that engaged in self-injury over the past 6 weeks | 6 weeks post intervention |
| Self-injurious Thoughts and Behaviors Questionnaire | percent of time engaged in self-injury over the past 6 weeks | 12 weeks post intervention |
| Self-injurious Thoughts and Behaviors Questionnaire | percent of time engaged in self-injury over the past 3 months | 6 months post intervention |
| Pediatric Symptom Checklist Internalizing Scale | parent-reported internalizing symptoms (range = 0-10 with higher scores indicating more internalizing symptoms) | baseline |
| Pediatric Symptom Checklist Internalizing Scale | parent-reported internalizing symptoms (range = 0-10 with higher scores indicating more internalizing symptoms) | 3 weeks (i.e., immediately post-intervention) |
| Pediatric Symptom Checklist Internalizing Scale | parent-reported internalizing symptoms (range = 0-10 with higher scores indicating more internalizing symptoms) | 6 weeks post intervention |
| Pediatric Symptom Checklist Internalizing Scale | parent-reported internalizing symptoms (range = 0-10 with higher scores indicating more internalizing symptoms) | 12 weeks post intervention |
| Pediatric Symptom Checklist Internalizing Scale | parent-reported internalizing symptoms (range = 0-10 with higher scores indicating more internalizing symptoms) | 6 months post intervention |
| State Rumination | average state rumination during intervention period rated on a visual analog scale (range = 0-100 with higher scores indicating more rumination) | 3 weeks (i.e., immediately post-intervention) |
| State Mood | average sadness and anxiety during intervention period rated on visual analog scales (range = 0-100 with higher scores indicating more rumination) | 3 weeks (i.e., immediately post-intervention) |
| Daily App Use | Daily app use was determined by how many complete app uses were logged during the three-week intervention period. | 3 weeks (i.e., immediately post-intervention) |
| Continued Use | Number of times app was used after the 3 week intervention period | 6 months post intervention |
| Ease of Use | how easy app was to use (range = 1-7 with higher being easier to use) | 3 weeks (i.e., immediately post-intervention) |
trait mindfulness observing (range = 8-40 with higher scores indicating greater mindfulness)
| 3 weeks (i.e., immediately post-intervention) |
| Five Facet Mindfulness Questionnaire Observing Subscale | trait mindfulness observing (range = 8-40 with higher scores indicating greater mindfulness) | 6 weeks post intervention |
| Five Facet Mindfulness Questionnaire Observing Subscale | trait mindfulness observing (range = 8-40 with higher scores indicating greater mindfulness) | 12 weeks post intervention |
| Five Facet Mindfulness Questionnaire Observing Subscale | trait mindfulness observing (range = 8-40 with higher scores indicating greater mindfulness) | 6 months post intervention |
| Five Facet Mindfulness Questionnaire Describing Subscale | trait mindfulness describing (range = 8-40 with higher scores indicating greater mindfulness) | baseline |
| Five Facet Mindfulness Questionnaire Describing Subscale | trait mindfulness describing (range = 8-40 with higher scores indicating greater mindfulness) | 3 weeks (i.e., immediately post-intervention) |
| Five Facet Mindfulness Questionnaire Describing Subscale | trait mindfulness describing (range = 8-40 with higher scores indicating greater mindfulness) | 6 weeks post intervention |
| Five Facet Mindfulness Questionnaire Describing Subscale | trait mindfulness describing (range = 8-40 with higher scores indicating greater mindfulness) | 12 weeks post intervention |
| Five Facet Mindfulness Questionnaire Describing Subscale | trait mindfulness describing (range = 8-40 with higher scores indicating greater mindfulness) | 6 months post intervention |
| Five Facet Mindfulness Questionnaire Awareness Subscale | trait mindfulness acting with awareness (range = 8-40 with higher scores indicating greater mindfulness) | baseline |
| Five Facet Mindfulness Questionnaire Awareness Subscale | trait mindfulness acting with awareness (range = 8-40 with higher scores indicating greater mindfulness) | 3 weeks (i.e., immediately post-intervention) |
| Five Facet Mindfulness Questionnaire Awareness Subscale | trait mindfulness acting with awareness (range = 8-40 with higher scores indicating greater mindfulness) | 6 weeks post intervention |
| Five Facet Mindfulness Questionnaire Awareness Subscale | trait mindfulness acting with awareness (range = 8-40 with higher scores indicating greater mindfulness) | 12 weeks post intervention |
| Five Facet Mindfulness Questionnaire Awareness Subscale | trait mindfulness acting with awareness (range = 8-40 with higher scores indicating greater mindfulness) | 6 months post intervention |
| Five Facet Mindfulness Questionnaire Nonjudging Subscale | trait mindfulness non-judging of inner experience (range = 8-40 with higher scores indicating greater mindfulness) | baseline |
| Five Facet Mindfulness Questionnaire Nonjudging Subscale | trait mindfulness non-judging of inner experience (range = 8-40 with higher scores indicating greater mindfulness) | 3 weeks (i.e., immediately post-intervention) |
| Five Facet Mindfulness Questionnaire Nonjudging Subscale | trait mindfulness non-judging of inner experience (range = 8-40 with higher scores indicating greater mindfulness) | 6 weeks post intervention |
| Five Facet Mindfulness Questionnaire Nonjudging Subscale | trait mindfulness non-judging of inner experience (range = 8-40 with higher scores indicating greater mindfulness) | 12 weeks post intervention |
| Five Facet Mindfulness Questionnaire Nonjudging Subscale | trait mindfulness non-judging of inner experience (range = 8-40 with higher scores indicating greater mindfulness) | 6 months post intervention |
| Five Facet Mindfulness Questionnaire Nonreactivity Subscale | trait mindfulness non-reactivity to inner experience (range = 7-35 with higher scores indicating greater mindfulness) | baseline |
| Five Facet Mindfulness Questionnaire Nonreactivity Subscale | trait mindfulness non-reactivity to inner experience (range = 7-35 with higher scores indicating greater mindfulness) | 3 weeks (i.e., immediately post-intervention) |
| Five Facet Mindfulness Questionnaire Nonreactivity Subscale | trait mindfulness non-reactivity to inner experience (range = 7-35 with higher scores indicating greater mindfulness) | 6 weeks post intervention) |
| Five Facet Mindfulness Questionnaire Nonreactivity Subscale | trait mindfulness non-reactivity to inner experience (range = 7-35 with higher scores indicating greater mindfulness) | 12 weeks post intervention) |
| Five Facet Mindfulness Questionnaire Nonreactivity Subscale | trait mindfulness non-reactivity to inner experience (range = 7-35 with higher scores indicating greater mindfulness) | 6 months post intervention) |
| State Mindfulness Bodily Sensations | average focus on bodily sensations during intervention period rated on visual analog scale (range = 0-100 with higher scores indicating more mindfulness) | 3 weeks (i.e., immediately post-intervention) |
| State Mindfulness Present Focus | average % focus on present moment (as opposed to past or future focus) during intervention period indicating more mindfulness | 3 weeks (i.e., immediately post-intervention) |
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| Control Condition |
Participants will use app for assessment for three weeks, but no mindfulness exercises will be delivered. |
| BG002 | Total | Total of all reporting groups |
| years |
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| Sex/Gender, Customized | Sex as reported by parent | Count of Participants | Participants |
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| Ethnicity (NIH/OMB) | Count of Participants | Participants |
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| Race/Ethnicity, Customized | Categorical measure, data collected at baseline | Count of Participants | Participants |
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| Region of Enrollment | Number | participants |
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| Children's Response Styles Questionnaire | trait rumination (range = 0-39 with higher scores indicating more rumination) | Mean | Standard Deviation | units on a scale |
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| Children's Depression Inventory | self-reported depressive symptoms (range = 0-54 with higher scores indicating more symptoms) | Mean | Standard Deviation | units on a scale |
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| Multidimensional Anxiety Scale for Children | self-reported anxiety symptoms (range = 0-117 with higher scores indicating more anxiety) | Mean | Standard Deviation | units on a scale |
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| Self-injurious Thoughts and Behaviors Questionnaire | Self-reported lifetime engagement in nonsuicidal self-injury | Count of Participants | Participants |
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| Pediatric Symptom Checklist Internalizing Scale | parent-reported internalizing symptoms (range = 0-10 with higher scores indicating more internalizing symptoms) | Mean | Standard Deviation | units on a scale |
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| Five Facet Mindfulness Questionnaire Observing Subscale | trait mindfulness observing (range = 8-40 with higher scores indicating greater mindfulness) | Mean | Standard Deviation | units on a scale |
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| Five Facet Mindfulness Questionnaire Describing Subscale | trait mindfulness describing (range = 8-40 with higher scores indicating greater mindfulness) | Mean | Standard Deviation | units on a scale |
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| Five Facet Mindfulness Questionnaire Awareness Subscale | trait mindfulness acting with awareness (range = 8-40 with higher scores indicating greater mindfulness) | Mean | Standard Deviation | units on a scale |
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| Five Facet Mindfulness Questionnaire Nonjudging Subscale | trait mindfulness non-judging of inner experience (range = 8-40 with higher scores indicating greater mindfulness) | Mean | Standard Deviation | units on a scale |
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| Five Facet Mindfulness Questionnaire Nonreactivity Subscale | trait mindfulness non-reactivity to inner experience (range = 7-35 with higher scores indicating greater mindfulness) | Mean | Standard Deviation | units on a scale |
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| Units | Counts |
|---|---|
| Participants |
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| Primary | Children's Response Styles Questionnaire | trait rumination (range = 0-39 with higher scores indicating more rumination) | Number analyzed determined by number of adolescents that completed the questionnaire. | Posted | Mean | Standard Deviation | score on a scale | 3 weeks (i.e., immediately post-intervention) |
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| Primary | Children's Response Styles Questionnaire | trait rumination (range = 0-39 with higher scores indicating more rumination) | Posted | Mean | Standard Deviation | score on a scale | 6 weeks post intervention |
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| Primary | Children's Response Styles Questionnaire | trait rumination (range = 0-39 with higher scores indicating more rumination) | Posted | Mean | Standard Deviation | score on a scale | 12 weeks post intervention |
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| Primary | Children's Response Styles Questionnaire | trait rumination (range = 0-39 with higher scores indicating more rumination) | Posted | Mean | Standard Deviation | score on a scale | 6 months post intervention |
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| Primary | Children's Depression Inventory | self-reported depressive symptoms (range = 0-54 with higher scores indicating more symptoms) | Posted | Mean | Standard Deviation | score on a scale | baseline |
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| Primary | Children's Depression Inventory | self-reported depressive symptoms (range = 0-54 with higher scores indicating more symptoms) | Posted | Mean | Standard Deviation | score on a scale | 3 weeks (immediately post-intervention) |
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| Primary | Children's Depression Inventory | self-reported depressive symptoms (range = 0-54 with higher scores indicating more symptoms) | Posted | Mean | Standard Deviation | score on a scale | 6 weeks post intervention |
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| Primary | Children's Depression Inventory | self-reported depressive symptoms (range = 0-54 with higher scores indicating more symptoms) | Posted | Mean | Standard Deviation | score on a scale | 12 weeks post intervention |
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| Primary | Children's Depression Inventory | self-reported depressive symptoms (range = 0-54 with higher scores indicating more symptoms) | Posted | Mean | Standard Deviation | score on a scale | 6 months post intervention |
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| Primary | Multidimensional Anxiety Scale for Children | self-reported anxiety symptoms (range = 0-117 with higher scores indicating more anxiety) | Posted | Mean | Standard Deviation | score on a scale | baseline |
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| Primary | Multidimensional Anxiety Scale for Children | self-reported anxiety symptoms (range = 0-117 with higher scores indicating more anxiety) | Posted | Mean | Standard Deviation | score on a scale | 3 weeks (i.e., immediately post-intervention) |
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| Primary | Multidimensional Anxiety Scale for Children | self-reported anxiety symptoms (range = 0-117 with higher scores indicating more anxiety) | Posted | Mean | Standard Deviation | score on a scale | 6 weeks post intervention |
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| Primary | Multidimensional Anxiety Scale for Children | self-reported anxiety symptoms (range = 0-117 with higher scores indicating more anxiety) | Posted | Mean | Standard Deviation | score on a scale | 12 weeks post intervention |
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| Primary | Multidimensional Anxiety Scale for Children | self-reported anxiety symptoms (range = 0-117 with higher scores indicating more anxiety) | Posted | Mean | Standard Deviation | score on a scale | 6 months post intervention |
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| Primary | Self-injurious Thoughts and Behaviors Questionnaire | percent of participants engaged in self-injury over the past year | Posted | Count of Participants | Participants | baseline |
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| Primary | Self-injurious Thoughts and Behaviors Questionnaire | percent of participants that engaged in self-injury over the past 3 weeks | Posted | Count of Participants | Participants | 3 weeks (i.e., immediately post-intervention) |
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| Primary | Self-injurious Thoughts and Behaviors Questionnaire | percent of participants that engaged in self-injury over the past 6 weeks | Posted | Count of Participants | Participants | 6 weeks post intervention |
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| Primary | Self-injurious Thoughts and Behaviors Questionnaire | percent of time engaged in self-injury over the past 6 weeks | Posted | Count of Participants | Participants | 12 weeks post intervention |
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| Primary | Self-injurious Thoughts and Behaviors Questionnaire | percent of time engaged in self-injury over the past 3 months | Posted | Count of Participants | Participants | 6 months post intervention |
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| Primary | Pediatric Symptom Checklist Internalizing Scale | parent-reported internalizing symptoms (range = 0-10 with higher scores indicating more internalizing symptoms) | Posted | Mean | Standard Deviation | score on a scale | baseline |
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| Primary | Pediatric Symptom Checklist Internalizing Scale | parent-reported internalizing symptoms (range = 0-10 with higher scores indicating more internalizing symptoms) | Posted | Mean | Standard Deviation | score on a scale | 3 weeks (i.e., immediately post-intervention) |
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| Primary | Pediatric Symptom Checklist Internalizing Scale | parent-reported internalizing symptoms (range = 0-10 with higher scores indicating more internalizing symptoms) | Posted | Mean | Standard Deviation | score on a scale | 6 weeks post intervention |
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| Primary | Pediatric Symptom Checklist Internalizing Scale | parent-reported internalizing symptoms (range = 0-10 with higher scores indicating more internalizing symptoms) | Posted | Mean | Standard Deviation | score on a scale | 12 weeks post intervention |
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| Primary | Pediatric Symptom Checklist Internalizing Scale | parent-reported internalizing symptoms (range = 0-10 with higher scores indicating more internalizing symptoms) | Posted | Mean | Standard Deviation | score on a scale | 6 months post intervention |
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| Primary | State Rumination | average state rumination during intervention period rated on a visual analog scale (range = 0-100 with higher scores indicating more rumination) | Posted | Mean | Standard Deviation | units on a scale | 3 weeks (i.e., immediately post-intervention) |
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| Primary | State Mood | average sadness and anxiety during intervention period rated on visual analog scales (range = 0-100 with higher scores indicating more rumination) | Posted | Mean | Standard Deviation | units on a scale | 3 weeks (i.e., immediately post-intervention) |
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| Primary | Daily App Use | Daily app use was determined by how many complete app uses were logged during the three-week intervention period. | Posted | Mean | Standard Deviation | App uses | 3 weeks (i.e., immediately post-intervention) |
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| Primary | Continued Use | Number of times app was used after the 3 week intervention period | Posted | Mean | Standard Deviation | number of app uses | 6 months post intervention |
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| Primary | Ease of Use | how easy app was to use (range = 1-7 with higher being easier to use) | Posted | Mean | Standard Deviation | units on a scale | 3 weeks (i.e., immediately post-intervention) |
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| Secondary | Five Facet Mindfulness Questionnaire Observing Subscale | trait mindfulness observing (range = 8-40 with higher scores indicating greater mindfulness) | Posted | Mean | Standard Deviation | score on a scale | baseline |
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| Secondary | Five Facet Mindfulness Questionnaire Observing Subscale | trait mindfulness observing (range = 8-40 with higher scores indicating greater mindfulness) | Posted | Mean | Standard Deviation | score on a scale | 3 weeks (i.e., immediately post-intervention) |
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| Secondary | Five Facet Mindfulness Questionnaire Observing Subscale | trait mindfulness observing (range = 8-40 with higher scores indicating greater mindfulness) | Posted | Mean | Standard Deviation | score on a scale | 6 weeks post intervention |
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| Secondary | Five Facet Mindfulness Questionnaire Observing Subscale | trait mindfulness observing (range = 8-40 with higher scores indicating greater mindfulness) | Posted | Mean | Standard Deviation | score on a scale | 12 weeks post intervention |
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| Secondary | Five Facet Mindfulness Questionnaire Observing Subscale | trait mindfulness observing (range = 8-40 with higher scores indicating greater mindfulness) | Posted | Mean | Standard Deviation | score on a scale | 6 months post intervention |
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| Secondary | Five Facet Mindfulness Questionnaire Describing Subscale | trait mindfulness describing (range = 8-40 with higher scores indicating greater mindfulness) | Posted | Mean | Standard Deviation | score on a scale | baseline |
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| Secondary | Five Facet Mindfulness Questionnaire Describing Subscale | trait mindfulness describing (range = 8-40 with higher scores indicating greater mindfulness) | Posted | Mean | Standard Deviation | score on a scale | 3 weeks (i.e., immediately post-intervention) |
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| Secondary | Five Facet Mindfulness Questionnaire Describing Subscale | trait mindfulness describing (range = 8-40 with higher scores indicating greater mindfulness) | Posted | Mean | Standard Deviation | score on a scale | 6 weeks post intervention |
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| Secondary | Five Facet Mindfulness Questionnaire Describing Subscale | trait mindfulness describing (range = 8-40 with higher scores indicating greater mindfulness) | Posted | Mean | Standard Deviation | score on a scale | 12 weeks post intervention |
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| Secondary | Five Facet Mindfulness Questionnaire Describing Subscale | trait mindfulness describing (range = 8-40 with higher scores indicating greater mindfulness) | Posted | Mean | Standard Deviation | score on a scale | 6 months post intervention |
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| Secondary | Five Facet Mindfulness Questionnaire Awareness Subscale | trait mindfulness acting with awareness (range = 8-40 with higher scores indicating greater mindfulness) | Posted | Mean | Standard Deviation | score on a scale | baseline |
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| Secondary | Five Facet Mindfulness Questionnaire Awareness Subscale | trait mindfulness acting with awareness (range = 8-40 with higher scores indicating greater mindfulness) | Posted | Mean | Standard Deviation | score on a scale | 3 weeks (i.e., immediately post-intervention) |
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| Secondary | Five Facet Mindfulness Questionnaire Awareness Subscale | trait mindfulness acting with awareness (range = 8-40 with higher scores indicating greater mindfulness) | Posted | Mean | Standard Deviation | score on a scale | 6 weeks post intervention |
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| Secondary | Five Facet Mindfulness Questionnaire Awareness Subscale | trait mindfulness acting with awareness (range = 8-40 with higher scores indicating greater mindfulness) | Posted | Mean | Standard Deviation | score on a scale | 12 weeks post intervention |
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| Secondary | Five Facet Mindfulness Questionnaire Awareness Subscale | trait mindfulness acting with awareness (range = 8-40 with higher scores indicating greater mindfulness) | Posted | Mean | Standard Deviation | score on a scale | 6 months post intervention |
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| Secondary | Five Facet Mindfulness Questionnaire Nonjudging Subscale | trait mindfulness non-judging of inner experience (range = 8-40 with higher scores indicating greater mindfulness) | Posted | Mean | Standard Deviation | score on a scale | baseline |
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| Secondary | Five Facet Mindfulness Questionnaire Nonjudging Subscale | trait mindfulness non-judging of inner experience (range = 8-40 with higher scores indicating greater mindfulness) | Posted | Mean | Standard Deviation | score on a scale | 3 weeks (i.e., immediately post-intervention) |
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| Secondary | Five Facet Mindfulness Questionnaire Nonjudging Subscale | trait mindfulness non-judging of inner experience (range = 8-40 with higher scores indicating greater mindfulness) | Posted | Mean | Standard Deviation | score on a scale | 6 weeks post intervention |
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| Secondary | Five Facet Mindfulness Questionnaire Nonjudging Subscale | trait mindfulness non-judging of inner experience (range = 8-40 with higher scores indicating greater mindfulness) | Posted | Mean | Standard Deviation | score on a scale | 12 weeks post intervention |
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| Secondary | Five Facet Mindfulness Questionnaire Nonjudging Subscale | trait mindfulness non-judging of inner experience (range = 8-40 with higher scores indicating greater mindfulness) | Posted | Mean | Standard Deviation | score on a scale | 6 months post intervention |
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| Secondary | Five Facet Mindfulness Questionnaire Nonreactivity Subscale | trait mindfulness non-reactivity to inner experience (range = 7-35 with higher scores indicating greater mindfulness) | Posted | Mean | Standard Deviation | score on a scale | baseline |
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| Secondary | Five Facet Mindfulness Questionnaire Nonreactivity Subscale | trait mindfulness non-reactivity to inner experience (range = 7-35 with higher scores indicating greater mindfulness) | Posted | Mean | Standard Deviation | score on a scale | 3 weeks (i.e., immediately post-intervention) |
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| Secondary | Five Facet Mindfulness Questionnaire Nonreactivity Subscale | trait mindfulness non-reactivity to inner experience (range = 7-35 with higher scores indicating greater mindfulness) | Posted | Mean | Standard Deviation | score on a scale | 6 weeks post intervention) |
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| Secondary | Five Facet Mindfulness Questionnaire Nonreactivity Subscale | trait mindfulness non-reactivity to inner experience (range = 7-35 with higher scores indicating greater mindfulness) | Posted | Mean | Standard Deviation | score on a scale | 12 weeks post intervention) |
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| Secondary | Five Facet Mindfulness Questionnaire Nonreactivity Subscale | trait mindfulness non-reactivity to inner experience (range = 7-35 with higher scores indicating greater mindfulness) | Posted | Mean | Standard Deviation | score on a scale | 6 months post intervention) |
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| Secondary | State Mindfulness Bodily Sensations | average focus on bodily sensations during intervention period rated on visual analog scale (range = 0-100 with higher scores indicating more mindfulness) | Posted | Mean | Standard Deviation | units on a scale | 3 weeks (i.e., immediately post-intervention) |
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| Secondary | State Mindfulness Present Focus | average % focus on present moment (as opposed to past or future focus) during intervention period indicating more mindfulness | Posted | Mean | Standard Deviation | percentage of time focused on present | 3 weeks (i.e., immediately post-intervention) |
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| 0 |
| 72 |
| 1 |
| 72 |
| 8 |
| 72 |
| EG001 | Control Condition | Participants will use app for assessment for three weeks, but no mindfulness exercises will be delivered. | 0 | 80 | 0 | 80 | 5 | 80 |
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| Onset of Non-suicidal Self-Injury | Psychiatric disorders | Systematic Assessment | Adolescents reported the onset of self-injury. |
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| Onset of Passive Suicidal Ideation | Psychiatric disorders | Systematic Assessment |
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| Discomfort from Mindfulness Activity | Psychiatric disorders | Systematic Assessment | One adolescent reported focusing on sounds sometimes made them stressed when they were meditating in a chaotic environment. Another participant noticed that they had a headache once when completing a mindfulness exercise from focusing. |
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Not provided
Not provided
| D001526 | Behavioral Symptoms |
| D001519 | Behavior |