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.
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.
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).
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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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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Treleaven, D. A. (2018). Trauma-sensitive mindfulness: practices for safe and transformative healing. W. W. Norton & Company.
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.
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.
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.
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.
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.
This study is funded by the National Institutes of Health/National Center for Complementary and Integrative Health, award number K23AT009715, CL.
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.
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
- Cardiovascular disease