August 14, 2020

Amid the coronavirus pandemic, more people are using the mindfulness and meditation app Headspace than ever before—but experts caution that questions remain about the app's effectiveness, Juliet Isselbacher reports for STAT News.

People, companies turn to Headspace amid the pandemic

The Headspace app features guided meditation sessions aimed at helping users "tame" restless minds and focus better, and downloads of the app have increased dramatically since the coronavirus pandemic began, Isselbacher reports.

Headspace also has seen a significant increase in businesses looking to partner—with partnership requests up by 500% since mid-March—and use the app to boost their employees' mental well-being while working from home amid the pandemic, with over 1,100 companies already enrolled in the company's Headspace for Work program.

And, according to Isselbacher, investors also are gravitating toward Headspace. The company received

$140 million in new funding during in the first half of 2020, Isselbacher reports.

How effective is Headspace?

Headspace says research has shown that the app can effectively boost focus and happiness and help people feel less stressed.

Megan Jones Bell, chief strategy and science officer for Headspace, for instance, has pointed to 25 peer-reviewed studies that show Headspace can improve focus and happiness while also reducing stress. In addition, the company says preliminary evidence shows the app can help users manage anxiety and depression.

And experts praise Headspace for collecting data to evaluate the app's efficacy, Isselbacher reports. In fact, Isselbacher reports that a literature review conducted by researchers at the University of Washington School of Medicine and Seattle Children's Research Institute found there were more peer-reviewed studies evaluating Headspace's efficacy than there were on any other mental health and/or stress management apps.

But experts also say that the research doesn't fully support Headspace's efficacy claims, Isselbacher reports.

For example, the researchers from the University of Washington School of Medicine and Seattle Children's Research Institute found the eight studies on Headspace that they reviewed showed inconsistent results. Some of the studies showed that the app was associated with improved users' life satisfaction, positive affect, and resilience, while other studies showed it had no significant effects for users at all, the researchers found.

Further, the researchers noted that six of the eight studies were conducted among fairly small groups of participants, including groups of fewer than 100 people. "When you have these small studies, there's a lot of random effects that can show up," John Torous, director of digital psychiatry at Beth Israel Deaconess Medical Center, said. "I think that the fact that we're seeing contradictory findings just tells us that we need larger, higher-quality studies."

Experts also have noted that some of the studies Headspace touts as evidence of the app's efficacy involved control groups of patients receiving no mental health treatment at all. As a result, those studies may show that Headspace is more helpful than doing nothing, but they don't show that Headspace is actually working rather than simply providing a placebo effect, Isselbacher reports.

For instance, researchers at the National University of Ireland for a 2018 study compared Headspace with a so-called "sham meditation" app—which Isselbacher describes as "the virtual equivalent of a placebo pill"—that looked exactly like the Headspace app but only instructed participants to close their eyes and breathe, rather than provide those instructions along with guidance on how users should focus their attention, as Headspace does. The researchers didn't find any difference between the "sham meditation" app and the Headspace app when it came to effects on critical thinking, executive functioning, emotional experience, or wellbeing, Isselbacher reports.

James Coyne, a psychology researcher and professor emeritus at the University of Pennsylvania, believes Headspace could have a significant placebo effect. "The issue is that people really want it—it's a commercial product. And when they get a chance to be in a study where they get access to it for free, they approach it with a lot of expectations of getting something special," he said.

According Isselbacher, experts ultimately are concerned that, while it's likely Headspace isn't harmful to users, it's possible that someone may use the app in place of more effective and needed care.

"You have to think about the opportunity cost of somebody doing a mindfulness meditation or someone doing a Headspace app," Chris Noone, a psychologist and researcher on the University of Ireland study, said. "Does that mean that they're doing that instead of, say, doing a [cognitive behavioral therapy] program?"

And although Headspace doesn't claim that the app can treat any medical conditions, the company does prominently feature anxiety on its website—which some experts say could be misleading.

"Headspace especially doesn't say it's a mental health app, but it's certainly advertised that way," Jessica D'Arcey, a graduate student at the University of Toronto who studies digital ads for psychosis patients, said. She added, "If you are handing this app to a patient and giving them the expectation that this is the end-all be-all therapy while we're in a pandemic and not able to receive care as usual, it sets expectations that are unrealistic and unethical."

But Jones Bell stressed that Headspace isn't designed as a treatment for medical conditions, nor should it replace professional care. "This is a both-and problem," she said. "We need to ensure swift access to high quality specialized care for those in need—and meet swelling demand with scalable evidence-based approaches like Headspace."

Further, Jones Bell said Headspace hasn't seen mixed results for its primary outcomes—which include stress, happiness, and resilience—nor from the company's "well-done, appropriately powered" studies. She added that the company also has 50 ongoing studies on the app being conducted by a variety of outside partners, including UCSF, Carnegie-Mellon, and the United Kingdom's National Health Service.

"We are committed to advancing the science on digital health and happiness interventions—and this means doing research that may not always show an impact for Headspace," Jones Bell said. "We believe that being fully transparent is essential to consumer trust. If we aren't doing research that shows null effects, we aren't challenging ourselves and advancing the field" (Isselbacher, STAT News, 8/7).

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