Usage Patterns of the Calm Meditation App Among People with Cardiovascular Disease

Abstract

Objectives

Cardiovascular disease (CVD) is the leading cause of death worldwide and is highly comorbid with emotional disorders. Mindfulness meditation can improve health outcomes in people with CVD. Calm is the most popular smartphone meditation app, but the usage patterns among people with CVD have not been explored.

Methods

We conducted a secondary analysis of a cross-sectional survey study among N = 1512 Calm subscribers with CVD to explore user characteristics, usage patterns, and health changes, and compare the results among those with and without co-occurring anxiety or depression.

Results

Users were primarily white (83%), female (74%), and had relatively high income (45% with > $100,000/year). Most (67%) used Calm at least 5 ×/week and started using Calm to help with sleep (69%) and stress (67%). More users with anxiety or depression, compared to CVD-only, started Calm to help with stress (71% vs. 64%) and anxiety or depression (77% vs. 37%), and used components incorporating sounds and physical movements more often (all p’s < 0.05). Most participants reported changes in sleep, stress, and physical and mental health (60–79%), though changes were more prevalent among those with anxiety or depression (p’s < 0.001). More frequent Calm use was associated with greater health changes (p’s < 0.05).

Conclusions

Calm users with CVD use the app regularly to help with health promotion and, particularly those with anxiety or depression, perceive health changes from their Calm use. Randomized controlled trials are needed to establish the efficacy and optimal dose of Calm use for people with CVD.

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Fig. 1

References

  1. Abbott, R. A., Whear, R., Rodgers, L. R., Bethel, A., Thompson Coon, J., Kuyken, W., Stein, K., & Dickens, C. (2014). Effectiveness of mindfulness-based stress reduction and mindfulness based cognitive therapy in vascular disease: a systematic review and meta-analysis of randomised controlled trials. Journal of Psychosomatic Research, 76(5), 341–351. https://doi.org/10.1016/j.jpsychores.2014.02.012.

    Article  PubMed  Google Scholar 

  2. Adams, Z. W., Sieverdes, J. C., Brunner-Jackson, B., Mueller, M., Chandler, J., Diaz, V., Patel, S., Sox, L. R., Wilder, S., & Treiber, F. A. (2018). Meditation smartphone application effects on prehypertensive adults’ blood pressure: dose-response feasibility trial. Health Psychology : Official Journal of the Division of Health Psychology, American Psychological Association, 37(9), 850–860. https://doi.org/10.1037/hea0000584.

    Article  Google Scholar 

  3. Banerjee, M., Cavanagh, K., & Strauss, C. (2017). A qualitative study with healthcare staff exploring the facilitators and barriers to engaging in a self-help mindfulness-based intervention. Mindfulness, 8, 1653–1664. https://doi.org/10.1007/s12671-017-0740-z.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Braveman, P. A., Cubbin, C., Egerter, S., Williams, D. R., & Pamuk, E. (2010). Socioeconomic disparities in health in the United States: what the patterns tell us. American Journal of Public Health, 100(Suppl 1), S186–S196. https://doi.org/10.2105/AJPH.2009.166082.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Brondolo, E., Byer, K., Gianaros, P. J., Liu, C., Prather, A. A., Thomas, K., Woods-Giscombé, C. L., Beatty, L., DiSandro, P., & Keita, G. P. (2017). Stress and health disparities: contexts, mechanisms, and interventions among racial/ethnic minority and low socioeconomic status populations. American Psychological Association. https://doi.org/10.1037/e500202018-001.

  6. Crane, C., Crane, R. S., Eames, C., Fennell, M. J. V., Silverton, S., Williams, J. M. G., & Barnhofer, T. (2014). The effects of amount of home meditation practice in mindfulness based cognitive therapy on hazard of relapse to depression in the staying well after depression trial. Behaviour Research and Therapy, 63, 17–24. https://doi.org/10.1016/j.brat.2014.08.015.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Davidson, R. J., Kabat-Zinn, J., Schumacher, J., Rosenkranz, M., Muller, D., Santorelli, S. F., Urbanowski, F., Harrington, A., Bonus, K., & Sheridan, J. F. (2003). Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic Medicine, 65(4), 564–570. https://doi.org/10.1097/01.PSY.0000077505.67574.E3.

    Article  Google Scholar 

  8. Dickens, C., Cherrington, A., Adeyemi, I., Roughley, K., Bower, P., Garrett, C., Bundy, C., & Coventry, P. (2013). Characteristics of psychological interventions that improve depression in people with coronary heart disease: a systematic review and meta-regression. Psychosomatic Medicine, 75(2), 211–221. https://doi.org/10.1097/PSY.0b013e31827ac009.

    Article  PubMed  Google Scholar 

  9. Framke, E., Sørensen, J. K., Andersen, P. K., Svane-Petersen, A. C., Alexanderson, K., Bonde, J. P., Farrants, K., Flachs, E. M., Hanson, L. L. M., Nyberg, S. T., Villadsen, E., Kivimäki, M., Rugulies, R., & Madsen, I. E. H. (2020). Contribution of income and job strain to the association between education and cardiovascular disease in 1.6 million Danish employees. European Heart Journal, 41(11), 1164–1178. https://doi.org/10.1093/eurheartj/ehz870.

    Article  PubMed  Google Scholar 

  10. Gál, É., Ștefan, S., & Cristea, I. A. (2020). The efficacy of mindfulness meditation apps in enhancing users’ well-being and mental health related outcomes: a meta-analysis of randomized controlled trials. Journal of Affective Disorders. https://doi.org/10.1016/j.jad.2020.09.134.

  11. Goldberg, S. B., Tucker, R. P., Greene, P. A., Davidson, R. J., Wampold, B. E., Kearney, D. J., & Simpson, T. J. (2018). Mindfulness-based interventions for psychiatric disorders: a systematic review and meta-analysis. Clinical Psychology Review, 59, 52–60. https://doi.org/10.1016/j.cpr.2017.10.011.

    Article  PubMed  Google Scholar 

  12. Gu, J., Strauss, C., Bond, R., & Cavanagh, K. (2015). How do mindfulness-based cognitive therapy and mindfulness-based stress reduction improve mental health and wellbeing? A systematic review and meta-analysis of mediation studies. Clinical Psychology Review, 37, 1–12. https://doi.org/10.1016/j.cpr.2015.01.006.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Havranek, E. P., Mujahid, M. S., Barr, D. A., Blair, I. V., Cohen, M. S., Cruz-Flores, S., Davey-Smith, G., Dennison-Himmelfarb, C. R., Lauer, M. S., Lockwook, D. W., Rosal, M., & Yancy, C. W. (2015). Social determinants of risk and outcomes for cardiovascular disease: a scientific statement from the American Heart Association. Circulation, 132(9), 873–898. https://doi.org/10.1161/CIR.0000000000000228.

    Article  PubMed  Google Scholar 

  14. Hofmann, S. G., Sawyer, A. T., Witt, A. A., & Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review. Journal of Consulting and Clinical Psychology, 78(2), 169–183.

  15. Huberty, J., Vranceanu, A.-M., Carney, C., Breus, M., Gordon, M., & Puzia, M. E. (2019). Characteristics and usage patterns among 12,151 paid subscribers of the Calm meditation app: cross-sectional survey. JMIR mHealth and uHealth, 7(11), e15648. https://doi.org/10.2196/15648.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Huffman, J. C., Celano, C. M., Beach, S. R., Motiwala, S. R., & Januzzi, J. L. (2013). Depression and cardiac disease: epidemiology, mechanisms, and diagnosis. Cardiovascular Psychiatry and Neurology, 695925. https://doi.org/10.1155/2013/695925.

  17. Jousilahti, P., Vartiainen, E., Tuomilehto, J., & Puska, P. (1999). Sex, age, cardiovascular risk factors, and coronary heart disease: a prospective follow-up study of 14,786 middle-aged men and women in Finland. Circulation, 99(9), 1165–1172. https://doi.org/10.1161/01.CIR.99.9.1165.

    Article  PubMed  Google Scholar 

  18. Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: past, present, and future. Clinical Psychology: Science and Practice, 10(2), 144–156. https://doi.org/10.1093/clipsy.bpg016.

    Article  Google Scholar 

  19. Kabat-Zinn, J. (2011). Some reflections on the origins of MBSR, skillful means, and the trouble with maps. Contemporary Buddhism, 12(1), 281–306. https://doi.org/10.1080/14639947.2011.564844.

    Article  Google Scholar 

  20. Levine, G. N., Lange, R. A., Bairey-Merz, C. N., Davidson, R. J., Jamerson, K., Mehta, P. K., Michos, E. D., Norris, K., Ray, I. B., Saban, K. L., Shah, T., Stein, R., Smith, S. C., & American Heart Association Council on Clinical Cardiology, Council on Cardiovascular and Stroke Nursing, and Council on Hypertension. (2017). Meditation and cardiovascular risk reduction: a scientific statement from the American Heart Association. Journal of the American Heart Association, 6(10), e00221. https://doi.org/10.1161/JAHA.117.002218.

    Article  Google Scholar 

  21. Lichtman, J. H., Bigger Jr., J. T., Blumenthal, J. A., Frasure-Smith, N., Kaufmann, P. G., Lespérance, F., Mark, D. B., Sheps, D. S., Taylor, C. B., & Froelicher, E. S. (2008). Depression and coronary heart disease. Circulation, 118(17), 1768–1775. https://doi.org/10.1161/CIRCULATIONAHA.108.190769.

    Article  PubMed  Google Scholar 

  22. Lichtman, J. H., Froelicher, E. S., Blumenthal, J. A., Carney, R. M., Doering, L. V., Frasure-Smith, N., Freedland, K. E., Jaffe, A. S., Leifheit-Limson, E. C., Sheps, D. S., Vaccarino, V., Wulsin, L., & American Heart Association Statistics Committee of the Council on Epidemiology and Prevention and the Council on Cardiovascular and Stroke Nursing. (2014). Depression as a risk factor for poor prognosis among patients with acute coronary syndrome: systematic review and recommendations: A scientific statement from the American Heart Association. Circulation, 129(12), 1350–1369. https://doi.org/10.1161/CIR.0000000000000019.

    Article  PubMed  Google Scholar 

  23. Mani, M., Kavanagh, D. J., Hides, L., & Stoyanov, S. R. (2015). Review and evaluation of mindfulness-based iPhone apps. JMIR mHealth and uHealth, 3(3), e82. https://doi.org/10.2196/mhealth.4328.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Matsuda, R., Kohno, T., Kohsaka, S., Fukuoka, R., Maekawa, Y., Sano, M., Takatsuki, S., & Fukuda, K. (2017). The prevalence of poor sleep quality and its association with depression and anxiety scores in patients admitted for cardiovascular disease: a cross-sectional designed study. International Journal of Cardiology, 228, 977–982. https://doi.org/10.1016/j.ijcard.2016.11.091.

    Article  PubMed  Google Scholar 

  25. McComb, J. J., Tacon, A., Randolph, P., & Caldera, Y. (2004). A pilot study to examine the effects of a mindfulness-based stress-reduction and relaxation program on levels of stress hormones, physical functioning, and submaximal exercise responses. The Journal of Alternative and Complementary Medicine, 10(5), 819–827. https://doi.org/10.1089/acm.2004.10.819.

    Article  Google Scholar 

  26. McPhillips, R., Salmon, P., Wells, A., & Fisher, P. (2019). Qualitative analysis of emotional distress in cardiac patients from the perspectives of cognitive behavioral and metacognitive theories: why might cognitive behavioral therapy have limited benefit, and might metacognitive therapy be more effective? Frontiers in Psychology, 9, 2288. https://doi.org/10.3389/fpsyg.2018.02288.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Mikolasek, M., Berg, J., Witt, C. M., & Barth, J. (2018). Effectiveness of mindfulness- and relaxation-based ehealth interventions for patients with medical conditions: a systematic review and synthesis. International Journal of Behavioral Medicine, 25(1), 1–16. https://doi.org/10.1007/s12529-017-9679-7.

    Article  PubMed  Google Scholar 

  28. Moynihan, J. A., Chapman, B. P., Klorman, R., Krasner, M. S., Duberstein, P. R., Brown, K. W., & Talbot, N. L. (2013). Mindfulness-based stress reduction for older adults: effects on executive function, frontal alpha asymmetry and immune function. Neuropsychobiology, 68(1), 34–43. https://doi.org/10.1159/000350949.

    Article  PubMed  Google Scholar 

  29. Olano, H. A., Kachan, D., Tannenbaum, S. L., Mehta, A., Annane, D., & Lee, D. J. (2015). Engagement in mindfulness practices by U.S. adults: sociodemographic barriers. Journal of Alternative and Complementary Medicine, 21(2), 100–102. https://doi.org/10.1089/acm.2014.0269.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Perneger, T. V. (1998). What’s wrong with Bonferroni adjustments. BMJ [British Medical Journal], 316(7139), 1236–1238. https://doi.org/10.1136/bmj.316.7139.1236.

    Article  Google Scholar 

  31. Ruo, B., Rumsfeld, J. S., Hlatky, M. A., Liu, H., Browner, W. S., & Whooley, M. A. (2003). Depressive symptoms and health-related quality of life: the heart and soul study. JAMA, 290(2), 215–221. https://doi.org/10.1001/jama.290.2.215.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Spijkerman, M. P. J., Pots, W. T. M., & Bohlmeijer, E. T. (2016). Effectiveness of online mindfulness-based interventions in improving mental health: a review and meta-analysis of randomised controlled trials. Clinical Psychology Review, 45, 102–114. https://doi.org/10.1016/j.cpr.2016.03.009.

    Article  Google Scholar 

  33. St-Onge, M.-P., Grandner, M. A., Brown, D., Conroy, M. B., Jean-Louis, G., Coons, M., & Bhatt, D. L. (2016). Sleep duration and quality: impact on lifestyle behaviors and cardiometabolic health: a scientific statement from the American Heart Association. Circulation, 134(18), e367–e386. https://doi.org/10.1161/CIR.0000000000000444.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Strohmaier, S. (2020). The relationship between doses of mindfulness-based programs and depression, anxiety, stress, and mindfulness: a dose-response meta-regression of randomized controlled trials. Mindfulness, 11(6), 1315–1335. https://doi.org/10.1007/s12671-020-01319-4.

    Article  Google Scholar 

  35. Swartz, J. R., Hariri, A. R., & Williamson, D. E. (2017). An epigenetic mechanism links socioeconomic status to changes in depression-related brain function in high-risk adolescents. Molecular Psychiatry, 22(2), 209–214. https://doi.org/10.1038/mp.2016.82.

    Article  PubMed  Google Scholar 

  36. Treleaven, D. A. (2018). Trauma-sensitive mindfulness: practices for safe and transformative healing. W. W. Norton & Company.

  37. Tzoulaki, I., Elliott, P., Kontis, V., & Ezzati, M. (2016). Worldwide exposures to cardiovascular risk factors and associated health effects: current knowledge and data gaps. Circulation, 133(23), 2314–2333. https://doi.org/10.1161/CIRCULATIONAHA.115.008718.

    Article  PubMed  Google Scholar 

  38. Virani, S. S., Alonso, A., Benjamin, E. J., Bittencourt, M. S., Callaway, C. W., Carson, A. P., Chamberlain, A. M., Chang, A. R., Cheng, S., Delling, F. N., Djousse, L., Elkind, M. S. V., Ferguson, J. F., Fornage, M., Khan, S. S., Kissela, B. M., Knutson, K. L., Kwan, T. W., Lackland, D. T., et al. (2020). Heart disease and stroke statistics—2020 update: a report from the American Heart Association. Circulation, 141(9), e139–e596. https://doi.org/10.1161/CIR.0000000000000757.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Westfall, J. M., Mold, J., & Fagnan, L. (2007). Practice-based research—“Blue highways” on the NIH roadmap. JAMA, 297(4), 403–406. https://doi.org/10.1001/jama.297.4.403.

    Article  PubMed  Google Scholar 

  40. Whalley, B., Thompson, D. R., & Taylor, R. S. (2014). Psychological interventions for coronary heart disease: Cochrane systematic review and meta-analysis. International Journal of Behavioral Medicine, 21(1), 109–121. https://doi.org/10.1007/s12529-012-9282-x.

    Article  PubMed  Google Scholar 

  41. Younge, J. O., Gotink, R. A., Baena, C. P., Roos-Hesselink, J. W., & Hunink, M. M. (2015). Mind–body practices for patients with cardiac disease: a systematic review and meta-analysis. European Journal of Preventive Cardiology, 22(11), 1385–1398. https://doi.org/10.1177/2047487314549927.

    Article  PubMed  Google Scholar 

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Funding

This study is funded by the National Institutes of Health/National Center for Complementary and Integrative Health, award number K23AT009715, CL.

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Authors

Contributions

CML conceptualized the study, analyzed the data, and wrote the manuscript. MP managed data collection and dataset, and provided feedback on the manuscript. JH contributed to the design of the study, oversaw study management, and edited the manuscript. AMV contributed to the study conceptualization and analyses plan and collaborated in the writing and editing of the manuscript.

Corresponding author

Correspondence to Christina M. Luberto.

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Conflict of Interest

The authors declare that they have no conflict of interest. JH is currently the Director of Science at Calm. JH has been conducting research with Calm as a partner almost 5 years before becoming the Director of Science and the Scientific Advisory Board (SAB). AMV is a member of Calm’s SAB and is independent from Calm leadership. Her role is to ensure the quality of Calm’s science. There are no financial incentives from the growth of Calm to any author.

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Ethical approval was obtained by the Institutional Review Board at Arizona State University. All participants provided electronic consent prior to completing the survey.

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Luberto, C.M., Huberty, J., Puzia, M. et al. Usage Patterns of the Calm Meditation App Among People with Cardiovascular Disease. Mindfulness 12, 983–993 (2021). https://doi.org/10.1007/s12671-020-01567-4

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Keywords

  • Cardiovascular disease
  • Mindfulness
  • Anxiety
  • Depression
  • E-health