Meditation app usage is associated with decreases in stress, anxiety, and depression symptoms. Many meditation app subscribers, however, quickly abandon or reduce their app usage. This dissertation presents three manuscripts which 1) determined the behavioral, demographic, and socioeconomic factors associated with the abandonment of a meditation app, Calm, during the COVID-19 pandemic, 2) determined which participant characteristics predicted meditation app usage in the first eight weeks after subscribing, and 3) determined if changes in stress, anxiety, and depressive symptoms from baseline to Week 8 predicted meditation app usage from Weeks 8-16. In Manuscript 1, a survey was distributed to Calm subscribers in March 2020 that assessed meditation app behavior and meditation habit strength, and demographic information. Cox proportional hazards regression models were estimated to assess time to app abandonment. In Manuscript 2, new Calm subscribers completed a baseline survey on participants’ demographic and baseline mental health information and app usage data were collected over 8 weeks. In Manuscript 3, new Calm subscribers completed a baseline and Week 8 survey on demographic and mental health information. App usage data were collected over 16 weeks. Regression models were used to assess app usage for Manuscripts 2 and 3. Findings from Manuscript 1 suggest meditating after an existing routine decreased risk of app abandonment for pre-pandemic subscribers and for pandemic subscribers. Additionally, meditating “whenever I can” decreased risk of abandonment among pandemic subscribers. No behavioral factors were significant predictors of app abandonment among the long-term subscribers. Findings from Manuscript 2 suggest men had more days of meditation than women. Mental health diagnosis increased average daily meditation minutes. Intrinsic motivation for meditation increased the likelihood of completing any meditation session, more days with meditation sessions, and more average daily meditation minutes. Findings from Manuscript 3 suggest improvements in stress increased average daily meditation minutes. Improvements in depressive symptoms decreased daily meditation minutes. Evidence from this three-manuscript dissertation suggests meditation cue, time of day, motivation, symptom changes, and demographic and socioeconomic variables may be used to predict meditation app usage.

Young adult collegiate women, particularly students with adverse childhood experiences (ACEs) and who have experienced intimate partner violence (IPV) victimization, report a myriad of adverse mental health and academic difficulties. Practicing yoga has demonstrated promising findings among adults as a healing modality in the aftermath of interpersonal violence victimization and traumatization. Less known are the associations between collegiate women’s yoga participation and their mental health, body connection, and academic well-being examined through a yoga feminist- trauma conceptual framework. Among young adult collegiate women, this study examined (1) associations amongst socio-demographics, mental health service use, IPV types, and yoga participation (2) the strength and direction of associations on measures of ACEs, mental health, body connection, and academic well-being, (3) whether yoga participation predicted students’ mental health, body connection, and academic well-being after controlling for confounding variables, including ACEs and IPV victimization, and (4) whether socio-demographics, mental health service use, ACEs, and IPV types predicted yoga participation. This study was observational, cross-sectional, and gathered self-report quantitative data. Eligible participants were current collegiate women enrolled at an urban, public university in the southwestern United States who were 18 to 24 years of age. The main sub-sample (n = 93) included students who were ever in an intimate relationship and practiced yoga within the past year. IRB approval was obtained. Findings demonstrated that yoga participation was not a significant predictor of students’ mental health, body connection, or academic well-being. Socio-demographics, mental health service use, ACEs, and IPV did not predict yoga participation. However, women with greater ACEs fared worse on measures of mental health (i.e., depression and post-traumatic stress disorder symptoms), and women with experiences of IPV harassment reported greater post-traumatic stress disorder symptoms. Further, employed women reported fewer depression symptoms and were less likely to experience emotional IPV. Lastly, students with greater body connection (more awareness) fared better academically. This research supports prior literature on the adverse mental health outcomes among young adult collegiate women with histories of interpersonal violence. Further examination is warranted into employment and body connection, particularly related to yoga, as protective factors of students' health, safety, and academic well-being.

Background: Unmanaged stress is a major contributing factor to the development of disease in both men and women. Middle-aged adults (40-64) have some of the highest stress of all age groups and the use of meditation may provide relief for conditions such as stress. A smartphone application (app) may help limit the magnitude of the perceived challenges of meditation. The purpose of this study is to determine the feasibility of a consumer-based meditation app (i.e., Calm) to reduce stress in middle-aged adults who self-report elevated stress. The preliminary effects of Calm on stress and health outcomes related to stress were explored as well as the preliminary effects of Calm on mindfulness and coping behaviors for stress were explored.

Methods: Adults were recruited to a 4-week app-based health and well-being study. Participants were randomized into either a mindfulness meditation (i.e. Calm) group or a health education (POD) control group. Participants were asked to participate at least 10 minutes per day. Assessments were conducted for stress, anxiety, depression, mindfulness, physical activity, eating habits, and coping behaviors at pre- and post-intervention and voluntary phone interviews were held post-intervention. App usage data were collected subjectively through weekly participation logs and through objective app usage data provided by Calm.

Results: Eighty-three participants were enrolled into the study and 60 completed the intervention and were analyzed. Feasibility and demand benchmarks were met with 96% of participants satisfied with the intervention and 93% found it enjoyable, appropriate, and useful. There was a 70% adherence (minutes/week) to the meditation intervention. Recruitment of men into the intervention group was 38.1% and retention of men was 81.3%. Significant changes were not observed in stress, anxiety, depression, or mindfulness, physical activity, eating habits, and coping behaviors.

Conclusion: The findings of this study support the feasibility of a 4-week, mobile app-based mindfulness meditation intervention (i.e. Calm) in middle-aged adults. These finding do not demonstrate preliminary efficacy of Calm to reduce stress, anxiety, and depression or improvement of mindfulness, physical activity, eating habits, or coping behaviors among middle-aged adults who report elevated stress. These results can be applied for improved design of future studies.

Objectives: To explore the feasibility and effects of using a meditation mobile app 10-minutes a day for 4-weeks to reduce burnout (primary outcome), improve mindfulness, reduce stress, and depression in physician assistant (PA) students compared to a wait-list control.
Methods: This study was a randomized, wait-list, control trial with assessments at baseline and post-intervention (week 4). Participants were asked to meditate using Calm for 10 minutes per day. A p value ≤0.05 was considered statistically significant.
Results: The majority of participants (n=19) stated using Calm helped them cope with the stress of PA school. The intervention group participated in meditation for an average of 76 minutes/week. There were significant differences in all outcomes for the intervention group (all p ≤0.06). There was a significant interaction between group and time factors in emotional exhaustion (p=.016) and depersonalization (p=.025).
Conclusions: Calm is a feasible way to reduce burnout in PA students. Our findings provide information that can be applied to the design of future studies.

The number of cancer survivors in the United States is growing rapidly and it is expected to double by 2040. Arizona is nationally ranked with the 14th highest number of survivors, many of which experience a wide range of persisting medical complications that result from the cancer and associated treatment. Consequently, there is an increased need for services tailored to the health and wellness of survivors. Studies have shown that exercise rehabilitation is effective in improving the physical and mental health of this patient population. This project aimed to investigate the status of medically-based exercise rehabilitation for cancer survivors in Arizona. It focused on services offered by cancer treatment centers and cardiac rehabilitation clinics, with cardiac rehabilitation providing a possible delivery method for future cancer exercise rehabilitation. A directory of resources was compiled based on responses to structured telephone interviews with the cancer treatment centers (n=32) and cardiac rehabilitation clinics (n=34) within the state. The directory will serve as a resource for both patients and clinicians by identifying statewide related services that are available at the medical institutions and within the community. Results showed that 42.9% and 39.4% of the cancer treatment centers and cardiac rehabilitation clinics, respectively, offered exercise related services for cancer survivors. 78.6% of cancer centers stated that they refer cancer survivors to physical therapy, while only 35.7% refer survivors to community-based programs. Only 2 cardiac rehabilitation clinics, or 6%, offered preventative cardiology exercise consultations to cancer survivors. In conclusion, rehabilitative exercise resources for cancer survivors in Arizona were limited. Additional cancer rehabilitation efficacy studies are needed to further clarify evidence-based practice guidelines and provide direction for optimal methods of healthcare delivery. It is recommended that this directory remains current with routine updates in an effort to increase patient accessibility to care.

Background:
The positive impacts of yoga on stress, pain, and chronic disease has recently led to the integration of yoga as part of physical therapy (PT) treatment. Due to the lack of training for PTs related to yoga, there is currently a need to provide knowledge and education about how to safely and easily implement therapeutic yoga (TY) as a complementary treatment approach.
Objective:
The purpose of this study was to assess the readiness of PTs (those who do not currently prescribe TY to patients) to integrate TY into treatment, and secondly, the feasibility (i.e., acceptability, demand, and practicality) of a 5-week online TY training to improve the readiness of PT’s to utilize TY in their practice.
Methods:
Licensed Physical Therapist’s (n=103) were recruited nationally through social media and email. Eligible and consented participants were asked to register in a 5-week online TY training course, Readiness for Integrating Yoga Therapeutics into Rehabilitation for PTs (intervention). PTs perceptions of TY and the role of safety and confidence in prescribing TY to patients were measured at baseline and post-intervention using a customized survey. Feasibility outcomes were measured after completion of the 5-week online training course with a survey. Feasibility was measured with acceptability, demand, and practicality. Our benchmarks included: (1) at least 70% of PTs would find the course acceptable, (2) at least 60% would finish the course (i.e., demand) and (3) there would be significant improvements in PTs perceptions of TY.
Results:
A total of 95 licensed PTs registered in the 5-week online TY training course, with 60 PTs (63%) completing the intervention and surveys. Of the PTs who completed the 5-week online training course, most PTs felt they were not ready (n=19/60, 31.7%) or somewhat ready (n=25/60, 41.7%) to integrate TY prior to taking the online training. Over half of PTs thought the online training was acceptable (n= 50/60, 83.3%) and finished the course (n=60/95, 63%). There were significant improvements in personal readiness to prescribe TY, safety prescribing TY, confidence to prescribe TY, current understanding/knowledge of TY and feeling adequately trained and educated to use some form of TY techniques with patients.
Conclusion:
Findings suggest a 5-week online TY training course is feasible in improving PTs readiness to prescribe TY, safety prescribing TY, confidence to prescribe TY, current understanding/knowledge of TY and feeling adequately trained and educated to use some form of TY techniques with patients. Future studies are proposed to test the effectiveness of TY training and education opportunities with PTs to further advance the adoption of TY into PT practice.

College students experience a considerable amount of stress. Unmanaged stress is associated with poor academic performance, health risk behaviors (i.e., inadequate sleep and physical activity, alcohol consumption, poor dietary behaviors), and poor mental health. Coping with stress has become a priority among universities. The most tested stress-related programs to date have been mindfulness-based and face-to-face. These programs demonstrated significant improvements in stress, mindfulness, and self-compassion among college students. However, they may be burdensome to students as studies report low attendance and low compliance due to class conflicts or not enough time. Few interventions have used more advanced technologies (i.e., mobile apps) as a mode of delivery. The purpose of this study is to report adherence to a consumer-based mindfulness meditation mobile application (i.e., Calm) and test its effects on stress, mindfulness, and self-compassion in college students. We will also explore what the relationship is between mindfulness and health behaviors.

College students were recruited using fliers on college campus and social media. Eligible participants were randomized to one of two groups: (1) Intervention - meditate using Calm, 10 min/day for eight weeks and (2) Control – no participation in mindfulness practices (received the Calm application after 12-weeks). Stress, mindfulness, and self-compassion and health behaviors (i.e., sleep disturbance, alcohol consumption, physical activity, fruit and vegetable consumption) were measured using self-report. Outcomes were measured at baseline and week eight.

Of the 109 students that enrolled in the study, 41 intervention and 47 control participants were included in analysis. Weekly meditation participation averaged 38 minutes with 54% of participants completing at least half (i.e., 30 minutes) of meditations. Significant changes between groups were found in stress, mindfulness, and self-compassion (all P<0.001) in favor of the intervention group. A significant negative association (p<.001) was found between total mindfulness and sleep disturbance.

An eight-week consumer-based mindfulness meditation mobile application (i.e., Calm) was effective in reducing stress, improving mindfulness and self-compassion among undergraduate college students. Mobile applications may be a feasible, effective, and less burdensome way to reduce stress in college students.

Pitchers are a vital part of the game of baseball and may account for up to two-thirds of the variance in win percentage. As they rise through the ranks of competition, physical skill set becomes less of a factor when compared to mentality. Pitchers are the “first line of defense” for keeping opponents from having an opportunity to score, as well as for holding onto their own team’s lead. Baseball pitchers not only face pressure to perform, but also experience stress from factors such as low pay, adjusting to higher levels of competition, and internal team competition for a limited number of spots. Athletes are often resistant to seeking aid from sport psychologists and often turn to unfavorable means to cope (i.e. drugs/alcohol, excessive exercise) with stress instead. Meditation has been shown to have beneficial effects on psychological factors associated with performance including emotional regulation, anxiety, confidence, focus, and mindfulness. Mobile applications have become a popular means of delivering mindfulness. The purpose of this study was to determine the feasibility and preliminary effectiveness of delivering a mindful meditation intervention using a mobile meditation application to improve psychological factors associated with performance (i.e. emotional regulation, anxiety (somatic and cognitive), confidence, focus, mindfulness) to minor league baseball pitchers. Pitchers in instructional league (Phase one) and off season (Phase two) were asked to meditate daily for 10-minutes each day for three weeks (Phase one) and eight weeks (Phase two). Pitchers were asked to complete self-report questionnaires and satisfaction surveys at pre- and post-intervention. Pitchers in phase one reported enjoying meditation, had improvements in self-confidence and sport confidence, and reported moderate decreases in cognitive anxiety and concentration disruption. Pitchers in phase two also enjoyed meditating (94.7%) and had improvements in self-confidence and moderate decreases in somatic anxiety. Low adherence due to timing (off-season) of intervention may have been a contributing factor to fewer outcomes. Future research should explore the feasibility and effectiveness of implementing meditation during the baseball season.

Background: The purpose of this study was to determine the feasibility of using Facebook as compared to a discussion board in an online, web-based intervention, Fit Minded College Edition-Podcasts (FMCEP), to improve physical activity and self-worth in female college students.
Methods: Participants (n=55) were randomly assigned to either a private Facebook group (FB) or the Fit Minded discussion board (DB) to participate in discussion of health and wellness related podcasts. FMCEP was a 6-week intervention guided by the self-determination theory (SDT) to target autonomy, relatedness and competence. Each week participants were instructed to complete three tasks: (1) listen to an assigned podcast, (2) complete a workbook assignment, and (3) participate in FB or DB online discussion. Participants completed assessments at baseline and post-intervention (6-weeks).
Results: Self-reported physical activity (p=0.032, η2= 0.193) and physical self-worth (p<0.001, η2=0.747) increased significantly over time, but no difference was seen between the groups for both physical activity (p=0.266, η2= 0.056) and physical self-worth (p=0.485, η2=0.024). Website use (measured by mean number of engagements per day, each week) declined across the 6-week intervention in the DB group but was consistent in the FB group.
Conclusion: These findings suggest web-based interventions, guided by SDT, can improve physical activity and physical self-worth among female college students, and the Facebook group may be more feasible and effective. Future studies are needed to optimize web-based physical activity interventions in college females.