JMIR MHEALTH AND UHEALTH Plaza et al

Review

Mindfulness-Based Mobile Applications: Literature Review and

Analysis of Current Features

Inmaculada Plaza1, PhDEng; Marcelo Marcos Piva Demarzo2, MD, PhD; Paola Herrera-Mercadal3, BAppPsych,
MS(Psycho); Javier García-Campayo4, MD, PhD
1
EduQTech R&D&I Group, Department of Electronics and Communications Engineering, Universidad Zaragoza, Teruel, Teruel, Spain
2
Mente Aberta - Brazilian Center for Mindfulness and Health Promotion, Department of Preventive Medicine, Universidade Federal de Sao Paulo -
UNIFESP, Sao Paulo, Brazil
3
Chair of Innovation of Health Technologies, Universidad de Zaragoza, Zaragoza, Spain
4
Instituto Aragonés de Ciencias de la Salud, Department of Psychiatry, Universidad de Zaragoza, Zaragoza, Spain

Corresponding Author:
Javier García-Campayo, MD, PhD
Instituto Aragonés de Ciencias de la Salud
Department of Psychiatry
Universidad de Zaragoza
Avda Isabel La Católica 1
Zaragoza, 50009
Spain
Phone: 34 976253621
Fax: 34 976254006
Email: [email protected]

Abstract
Background: Interest in mindfulness has increased exponentially, particularly in the fields of psychology and medicine. The
trait or state of mindfulness is significantly related to several indicators of psychological health, and mindfulness-based therapies
are effective at preventing and treating many chronic diseases. Interest in mobile applications for health promotion and disease
self-management is also growing. Despite the explosion of interest, research on both the design and potential uses of
mindfulness-based mobile applications (MBMAs) is scarce.
Objective: Our main objective was to study the features and functionalities of current MBMAs and compare them to current
evidence-based literature in the health and clinical setting.
Methods: We searched online vendor markets, scientific journal databases, and grey literature related to MBMAs. We included
mobile applications that featured a mindfulness-based component related to training or daily practice of mindfulness techniques.
We excluded opinion-based articles from the literature.
Results: The literature search resulted in 11 eligible matches, two of which completely met our selection criteria–a pilot study
designed to evaluate the feasibility of a MBMA to train the practice of “walking meditation,” and an exploratory study of an
application consisting of mood reporting scales and mindfulness-based mobile therapies. The online market search eventually
analyzed 50 available MBMAs. Of these, 8% (4/50) did not work, thus we only gathered information about language, downloads,
or prices. The most common operating system was Android. Of the analyzed apps, 30% (15/50) have both a free and paid version.
MBMAs were devoted to daily meditation practice (27/46, 59%), mindfulness training (6/46, 13%), assessments or tests (5/46,
11%), attention focus (4/46, 9%), and mixed objectives (4/46, 9%). We found 108 different resources, of which the most used
were reminders, alarms, or bells (21/108, 19.4%), statistics tools (17/108, 15.7%), audio tracks (15/108, 13.9%), and educational
texts (11/108, 10.2%). Daily, weekly, monthly statistics, or reports were provided by 37% (17/46) of the apps. 28% (13/46) of
them permitted access to a social network. No information about sensors was available. The analyzed applications seemed not
to use any external sensor. English was the only language of 78% (39/50) of the apps, and only 8% (4/50) provided information
in Spanish. 20% (9/46) of the apps have interfaces that are difficult to use. No specific apps exist for professionals or, at least,
for both profiles (users and professionals). We did not find any evaluations of health outcomes resulting from the use of MBMAs.
Conclusions: While a wide selection of MBMAs seem to be available to interested people, this study still shows an almost
complete lack of evidence supporting the usefulness of those applications. We found no randomized clinical trials evaluating the

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impact of these applications on mindfulness training or health indicators, and the potential for mobile mindfulness applications
remains largely unexplored.

(JMIR Mhealth Uhealth 2013;1(2):e24)   doi:10.2196/mhealth.2733

KEYWORDS
mobile health; mHealth; mindfulness; social networks; personalized education; health informatics; evidence-based medicine

appearing, for instance, the “Internet of Things” (IoT).

Introduction According to Atzori [13], the basic idea of IoT is the pervasive
Mindfulness-Based Therapies presence around us of a variety of things or objects—such as
tags, sensors, actuators, and mobile phones—that are able to
Mindfulness techniques have emerged in the Western world in interact with one another and cooperate with their neighbors to
the fields of health and education as the application of ancient achieve common goals. The main strength of the IoT is the large
meditative practices from Buddhist tradition. It is from this impact it will have on several aspects of everyday life including
tradition that they draw inspiration and take their basic technical the behavior of potential users.
features. Since its introduction, interest in mindfulness has
increased exponentially particularly over the last two decades In this context, “smart devices” play an important role. They
in the psychology and medicine fields [1]. Several types of can perform intelligent operations and are capable of
approaches have been tested from secular (mindfulness-based communicating to jointly deliver a service to the user [14].
therapies-MBTs) to Eastern meditative traditions (such as Zen Primary among these devices are “mobile devices.” They are
and Vipassana), and scientific evidence of their effectiveness portable, allow access to information and data anywhere, and
is rapidly accumulating [2,3]. can be carried and used during their transport. Presently, this
concept includes a very large number of devices-smartphones,
The psychological trait or state of mindfulness refers to an PDAs, MP3 players, and laptops. Most current mobile devices
awareness that emerges by way of paying attention intentionally contain wireless communication capabilities. The common
and nonjudgementally, in the present moment, to the unfolding characteristics of mobile devices are their small size, portability,
of the moment-by-moment experience [4,5]. Mindfulness is a processing capability, network connection, and limited memory.
skill that can be obtained using several training techniques, and Specifically, smartphones and small tablets allow access to a
group and individual interventions have been designed for this large number of apps (mobile-based software). Additionally,
purpose [6]. Generally, two main complementary approaches they can be incorporated into daily activities in a nonintrusive
have been used for mindfulness training (1) exercises in focused way.
attention, and (2) open monitoring of experiences in the present
moment. The use of mobile devices is increasing continuously. In 2012,
global smartphone shipments grew 46% to 722 million units,
Mindfulness is significantly related to several indicators of (ie, smartphone shipments have more than tripled since 2009
physical and psychological health such as improved immune when 174 million units were shipped). The tablet market also
and autonomic nervous systems, higher levels of positive affect, did very well in the past year. Total shipments reached 128
life satisfaction, vitality, and adaptive emotional regulation, and million units, which was a 78% increase over 2011. Conversely,
it has been linked to lower levels of negative affect and the personal computer (PC) industry continued to struggle in
psychopathological symptoms [2,3,7]. Furthermore, MBTs have 2012. Shipments of laptop and desktop PCs declined 3% and
demonstrated effectiveness in treating many disorders, including 4%, respectively, as consumers switched to mobile connected
chronic pain conditions [8-10]. devices (Figure 1 shows the growing tablet market for 2011 and
The mechanisms underlying the effects of mindfulness training 2012) [15,16].
on health are diverse and include improvements in attention According to Milosevic et al [17], users of today’s
control, coping and management of life stressors, descriptions ever-increasing number of mobile phones expect to have their
of inner experiences, thoughts and emotional awareness and favorite desktop apps on smartphones. In addition, a number of
regulation, and changes in the concept of the self or body new apps are taking advantage of the specific features and
awareness [11]. One of the main limitations of MBTs is the sensors on smartphones. This tendency also has been observed
need for regular practice. Psycho-technology mobile apps have in healthcare. A study of the Healthx Team concluded that the
demonstrated effectiveness as a complementary tool in many most recent growth in mobile apps usage has not proliferated
psychotherapies [12], and they would be expected to be useful at the expense of browsing the traditional Web; people are
in MBTs as well. simply using mobile apps more [18]. Medical/health care is the
Information and Communication Technology third-fastest-growing app category for both the iPhone and
Google Inc.’s Android phones based on information from Float
Information and communication technology (ICT) concerns the
Mobile Learning [19].
elements and techniques related to manipulating and transmitting
information, specifically, computers, the Internet, and Currently, it is possible to search the App Store and find 21,227
telecommunications. This concept is dynamic and shows rapid apps using the criteria “Healthcare & Fitness”, 17,148 using
growth and evolution. Thus, new related paradigms are the criteria “Medical”, or 65,128 using the criteria “Lifestyle”

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[20]. To design their apps, developers can choose among Healthy patients or professionals interested in MBTs or their
different platforms. The most popular are Google Android, practice may benefit from mindfulness-based mobile apps
Windows Phone, Apple iOS, BlackBerry, and Nokia’s Symbian; (MBMAs). The potential use of these apps could include online
reference [21] gives a complete comparison of the first four. and offline training, practice for daily adherence and
maintenance, mindfulness-based group management (for
The usability and ubiquity of mobile devices have resulted in
professionals), and information exchange through social forums
great interest in the development of features for healthcare apps.
[12].
Research has shown that disease management and health
education are areas with broad potential for apps in which Thus, the objective of this study is to present an in-depth
mobile devices could enhance the quality of life for people in analysis of the functionalities and features of current MBMAs
general and for those living with chronic illnesses in particular in the most-used mobile platforms and to compare them to the
[12,22]. For example, well-designed mobile apps with decision current evidence-based literature regarding health and clinical
support features such as personalized education have settings. Comparing current with potential features and with
demonstrated potential to enhance self-management outcomes scientific-based recommendations from the literature, we discuss
in diabetes patients [22]. a future agenda to improve the usability and utility of MBMAs.

Figure 1. The global tablet market.

traditional mindfulness practices, such as Zen and Vipassana

Methods meditations. Regarding the MBTs, we considered all possibilities
Review of MBMAs including mindfulness-based stress reduction (MBSR),
mindfulness-based cognitive therapy (MBCT), acceptance and
Similar to the study of Chomutare et al [22], our goal was to commitment therapy (ACT), and dialectal behavioral therapy
review MBMAs both in the scientific literature and in the (DBT).
most-used commercial markets and platforms. We independently
searched two types of sources: (1) online journal databases, and Review of the Literature
(2) online markets. In the literature, we searched for apps that
Selection Criteria
have a basis in research. In the online markets and grey
literature, we searched for mature and emerging apps, new The only literatures included in this study were original research
trends, and novel functionalities and features. papers that addressed any mobile app with an explicit
mindfulness component. We aimed to include all types of study
The main inclusion criterion for mobile apps was that they participants including the general population, patients, and
include an explicit mindfulness component. We considered the professionals. This broad inclusion criterion was settled upon
“mindfulness component” to be either secular mindfulness-based after a preliminary search identified only a limited number of
interventions with their related main techniques such as potential articles for inclusion. We excluded opinion-based
mindfulness of breathing, body scanning, walking meditation,
mindful movements, and compassion-based practices or
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articles and those in languages other than English, Spanish, or Evaluation and Assessment of App Features and
Portuguese. Functionalities
Search Strategy User Evaluation
We searched online journal databases, indexes, and reference We found that the evaluation of the apps is better done by the
lists using the search terms “mindful”, “meditation”, “mobile”, users themselves in the form of a trial or, at least, a survey. We
“PDA”, “cell”, “phone”, and “application” from the study’s contacted several of the most important meditation associations
inception to April 30, 2013. We constructed a general search in Spain (including the Soto Zen Spanish Association, Kagyu
string with logical operators using both the conjunction “AND” and the Gelug Tibetan Buddhist Association, and Mindfulness
and the disjunction “OR” (mindful OR meditation OR and Health Association) and found that no one in these groups
acceptance-based) AND (mobile OR PDA OR cell OR phone made regular use of such apps. For this reason, we ruled out the
OR application). We adapted the search string to each database, possibility of a survey and decided to revise the characteristics
and the search was performed on the available metadata–that of the present apps. On this basis, we are developing a catalogue
is, title, abstract, and keywords. of possible utilities of meditation apps and, in a future research
We targeted both original research papers and review articles that is now in preparation, we will assess the opinion of
indexed by Medline, ScienceDirect, Embase, Psychinfo, the “professional” or long-term meditators on these utilities.
Association for Computing Machinery (ACM) Digital Library, Thus, we aimed to analyze the following potential MBMA
the Institute of Electrical and Electronics Engineers (IEEE) features and functionalities, where available.
Xplore Digital Library, Google Scholar and the Digital
Bibliography and Library Project (DBLP) Computer Science App Technology and Design
Bibliography, and ACM Computer-human interaction (CHI) ICT features included:
proceedings. These databases reflect the multidisciplinary nature 1. Smartphone features and operating system
of the research, which involves the medical, psychological, and 2. Text messaging or short message service (SMS); reminders
computer science fields. We screened the reference lists of all or similar
review articles that we identified to crosscheck for missing 3. Camera and other device for collecting and monitoring data
articles of interest. 4. Communication tools to other mobile phone features and
The duplicate entries from multiple databases were removed. existing apps
Only original research papers were eligible for inclusion after 5. Programming interfaces suitable for users
reviewing the metadata. Any potential MBMAs not clearly 6. Automated sensing through sensing devices
reported in the metadata were explored, with assessment made 7. Web interface for connectivity and data exchanging, and
of the full article. Two authors (MD and PHM) independently 8. Other available technology features.
assessed all potentially eligible reports that were identified by Design and characteristics of functionalities included:
the search strategy. In the case of disagreements, the matter was
resolved through discussion with a third author (JGC). After 1. Type of mindfulness practices or interventions provided
the metadata screening, the eligible reports were more (self- and/or supervised-training; content and characteristics)
thoroughly analyzed by two independent reviewers (MD and 2. Tracking and monitoring personal mindfulness practice and
PHM) who examined their full text in detail before they could health information (through journaling of mindfulness
finally be included. Two authors (MD and PHM) extracted the practicing and health-related behaviors and measures; text
data from an included report using a predefined data extraction messaging; automated sensing and recording; online scale
sheet. They also screened the reference list of all eligible reports and questionnaires; charters and statistics; automated
to crosscheck for missing articles of interest. Any persistent feedback, data export and communication with other devices
disagreement was referred to a third author (JGC) for discussion or apps, synchronization with personal health record
and resolution. systems or patient portals)
3. Online or remote accessing to trainers or health
Data Extraction and Coding professionals for personalized monitoring and coaching
Two authors (MD and PHM) extracted data from each included 4. Leveraging social influence (by facilitating peer-to-peer
report using a predefined data extraction sheet. Any persistent support, influence and/or modelling, integration of social
disagreements were referred to a third author (JGC) for media functions)
discussion and resolution. All studies were coded for country 5. Increasing the accessibility to mindfulness and related health
and year of publication, type of study and participants, information (by informational general and/or tailored
intervention characteristics, MBMA functionalities and features messages, reminders–content and frequency pattern,
(as detailed below), explicit mindfulness component of the glanceable displays)
intervention, outcomes in terms of health and app usability 6. Utilizing any kind of entertainment as an educational tool
evaluation, summary of main results, and future directions (if or approach (messages with fun content, mobile
indicated by the authors). phone-based video games to support mindfulness practice
or related healthy behaviors)
7. Declaring “best practice” principles [23], and
8. Other available functionality.

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These features and functionalities were chosen based on the Currently, the Windows Phone Store offers 150,000 apps [27]
relevant literature [12,22-24], mainly on the study of Klasnja (Figure 4 shows Google apps, Apple apps, and Windows Phone
and Pratt [24], and from a brainstorming and consensus process Store apps) [27].
among all of the authors with two of them (MD and JGC) being
Another important factor is the price of the smartphones that
experts in and teachers of MBTs. We created this list with
use each operating system. In terms of different models and
multiple features and functionalities that we believe has the
brands, the Apple Store [28] offers the following models to
potential to enhance future MBMAs.
users (as of March 2, 2013)-iPhone5 from €669 (iOS), iPhone4S
Analysis of the Current Apps Available in Online from €569 (iOS), and iPhone4 from €389 (iOS).
Vendor Markets At the website of the company Phone House, several mobile
Selection Criteria phones are compared and sold. Following is a sampling of
several examples from different brands [29] (as of March 2,
Platforms 2013)-Android (LG Optimus L3 Black €99; Samsung Galaxy
In the Introduction five operating systems were Mini €119; Motorola Defy Mini Black €129; Sony Xperia Tipo
mentioned-Google Android, Windows Phone, Apple iOS, Black €149; HTC Desire C 179 €179; Samsung Galaxy S III
BlackBerry, and Nokia Symbian. Surveys using the latest €479), Other operating systems (Nokia C2-02 Black runs on
statistics predict that Apple iOS will remain the second biggest Symbian €75; BlackBerry Curve 9220 Black runs on Blackberry
platform worldwide, after Google Android [25,26] (Figure 2 €179; Nokia Lumia 620 runs on Microsoft Windows Phone 8
shows this data; Figure 3 shows further data), until 2015, when €249), and iOS (Apple iPhone5 16Gb White €660).
Windows Phone will surpass it.
In conclusion, Google Android should be considered the biggest
In January 2013, the number of Google Android apps overtook platform worldwide for the next several years. In addition,
those of Apple iOS-800,000 apps are now available on Google mobile phones that use Android are less expensive than those
Play. In October 2012, Google announced that the total number using iOS, which contributes to that operating system’s
of apps in its store numbered 700,000. According to a recent continuous growth. Thus, this study focused on apps for Google
press release, 775,000 apps are available in Apple’s App Store. Android smartphones. Data were obtained from the Google
Play website [30] and from the selected apps.
Figure 2. Worldwide smartphone market share forecast for 2010-2015 based on data from Gartner.

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Figure 3. Worldwide smartphone market share forecast for 2015 based on data from IDC.

Figure 4. Number of apps in Google Play, Apple’s App Store, and Windows Phone Store.

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Users statistics and reports, (11) language, and (12) usability. Finally,
No restriction was applied regarding the types of users of the (13) global assessment was chosen.
apps, and we aimed to include any populations, including the These features and functionalities were chosen based on relevant
general population, patients, and professionals. literature [22,23], our previous analyses of the possibilities that
Free Apps and Paid Apps apps offer to users, and consensus process among several
members of the research group EduQTech who have experience
Both free and paid apps were considered, (eg, the Mindfulness
in developing mobile phone apps [31].
free Android and Mindfulness paid Android apps).
Possible Interventions or Use Cases Results
All possible intervention or use cases were considered including
when the user is walking, sitting, or running, and at the gym, Review of the Literature
at home, or in the office. We retrieved 413 citations from our database search (42 were
duplicates) and excluded 360 of them based on metadata only,
Search Strategy and Data Extraction which left 11 eligible original papers for further analysis. We
According to the “Selection Criteria,” this study focused on did not identify any relevant systematic review article or
apps for Google Android smartphones. Thus, data were obtained international guidelines related to MBMAs, and neither did we
from the Google Play website. The Google Play Store classifies identify any new eligible reports by screening the reference lists
apps according to two main criteria: (1) “popularity” and (2) of these 11 reports (Figure 5 shows the study selection flow
“relevance.” These criteria are based on algorithms that consider diagram).
items such as the number of download, the number of uninstalled
In the end, we included two original papers [32,33] in our study
apps, and reviews from users. In this study, the “relevance”
after excluding nine of the eligible reports after conducting a
criterion was used to filter the most significant apps in two
detailed analysis of their full text. The main reasons for
categories: (1) free and (2) paid. Finally, the research was
exclusion were as follows:
completed in each category using the “popularity” criterion.
1. The subject was not a true mobile app, but was instead the
Evaluation and Assessment
use of a mobile or smartphone to send and/or receive
As previously explained (subsection “Review of the Literature”), information or to access a remote website [34-37].
we contacted several of the most important meditation 2. There was no explicit mindfulness component delivered
associations in Spain and found that no one made use of such [38-40].
apps on a regular basis. Thus, it was not possible to obtain the 3. The topic was mainly a computer-delivered intervention
evaluation of apps either in the form of a trial or a survey. [41,42].
However, the Google Play Store allows users to value apps from
1 to 5. In this case, it was possible to obtain the evaluation made Multimedia Appendix 1 summarizes the general information
by users themselves based on the public Google Play results. extracted from included papers, which were: (1) a pilot study
designed to evaluate the feasibility of a mobile app containing
Features and Functionalities a multimedia-assisted system to support the practice of walking
We aimed to analyze the following potential MBMA features meditation, a type of mindfulness technique [32], and (2) an
and functionalities for available online apps, where available: exploratory study of an app consisting of mood reporting scales
(1) number of apps, (2) number of downloads and prices, and and mindfulness-based mobile therapies [33]. Multimedia
(3) characteristics. Between characteristics: (4) main function, Appendix 2 presents a detailed description of the features and
(5) possible interventions or use cases, (6) resources, (7) social functionalities of apps, focusing on the technology and design
networks, (8) contents, (9) special features, (10) outcomes: characteristics reported in the included studies.

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Figure 5. Study selection flow diagram.

download rates among the 25 apps analyzed in each case. Figure

Current Apps Available in Online Vendor Markets 8 shows the most recent update of these apps.
Number of Apps Approximately 30% (15/50) of the analyzed apps have both a
Table 1 shows the number of Android apps found in the Google free and paid version. For example, the developers of “Relax
Play App Store related to meditation, mindfulness, or similar Lite: Stress Relief-Free” and “Relax: Stress & Anxiety Relief”
criteria (as of February 25, 2013) [30]. provided interesting data about the usage of both versions [43],
which are summarized in Table 2.
To develop an in-depth analysis of all 203 available apps related
to mindfulness would surpass the scope of this study. According In this specific case, users of the paid app showed more loyalty
to the “Selection Criteria” and “Search Strategy and Data and the number of downloads was greater than the average app.
Extraction” subsections, the “relevance” criterion was used to This is the only company that has provided this type of
filter the 20 most significant apps in two categories: (1) free information publicly.
and (2) paid. Finally, 5 more were added in each category using
The prices of paid apps varied between €0.75 (in the range of
the “popularity” criterion. Thus, 50 apps in total were analyzed
10-50 downloads) to €5.67 (in the range of 1000-5000
in depth in this study, which is 24.6% (50/203). Multimedia
downloads). However, there is not a high correlation between
Appendices 1 and 2 show the names of and relevant data for
the price and the range of downloads in general (the Pearson
these apps. There were two free and two paid apps that did not
coefficient is only 0.34).
work, thus it was not possible to develop a deep analysis of
them and we only gathered information about external features Conversely, approximately 52% (12/23) of the free apps offer
(ie, language, downloads, or prices). more options after payment, and 9% (2/23) ask for donations
or voluntary economic help. The most common options after
Because data such as number and popularity of these apps are
payment are the following: support, additional audio, music,
continuously increasing and changing, February 15, 2013 was
videos or exercises, longer meditations, subscriptions, ability
chosen as the final date for data collection. Figure 6 shows the
to determine the duration of your session by setting a timer,
evolution in the number of Android apps.
removal of ads, mantras, and breath counts.
Downloads and Prices
To compare the free versus paid apps, the number of downloads
was studied. Figure 7 shows it is possible to compare the

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Table 1. Number of Google Play apps related to meditation, mindfulness, or similar criteria (as February 25, 2013).
Apps Free app Paid apps
Meditation >1000 >1000 >1000
Meditation timer >1000 >1000 >1000
Conscience >1000 >1000 >1000
Quality of life >1000 >1000 >1000
Concentration >1000 >1000 >1000
Health, healthy, health tips, health food >1000 >1000 >1000
Breath, breathe, breathing >1000 >1000 >1000
Health tap >1000 >1000 325
Meditation music >1000 >1000 46
Mindfulness 203 99 104
Meditation helper 27 15 12

Table 2. Information about free and paid apps from the same developer [44].
Relax Lite: stress relief–free Relax: stress and anxiety relief
Has been downloaded over 150,000 times worldwide. Has been downloaded over 500,000 times worldwide.
Over 25% of our users still use our apps regularly after 1 year. Over 50% of our paid app users still use our apps regularly after 1 year.
Most apps are used by less than 5% of users after 20 days. Most apps are used by less than 5% of users after 20 days.

Figure 6. Example of the continuous evolution in the number of Android apps related to “Mindfulness.”.

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Figure 7. Comparison of the number of downloads among free and paid Android Mindfulness apps.

Figure 8. Distribution of time of most recent update.

Possible Interventions or Use Cases

Characteristics
A small number of apps enabled the user to choose from among
Main Function several use cases–moving, sitting, or body scan, travelling,
The term “mindfulness” or meditation was not well clarified in walking, gym, or home.
most of the apps. The analyzed apps had several primary All the apps are devoted to practitioners. They are not specific
functions. apps for professionals or, at least, with functionalities useful
Among the free apps–61% (14/23) are devoted to meditation, for each of the profiles.
13% (3/23) concern training, 9% (2/23) concern Resources
tests/questionnaires to know, for instance, the level of stress or
types of stress users are experiencing, 9% (2/23) try to help Although the design of the apps was very different, most of
focus the user’s attention, and 9% (2/23) have another main them used the same resources-reminders (bells, alarms, or
objective. similar), audio tracks, and text. The item “Statistics” will be
explained in the statistics section. “Quotes” or “everyday tips,”
Among the paid apps–56% (13/23) are devoted to meditation, “pictures or photos,” and “music or relaxing sounds” are used
13% (3/23) concern tests/questionnaires, 13% (3/23) concern in a similar number of apps. Figure 9 shows the percentages of
training, 9% (2/23) are related to eating, and 9% (2/23) have apps that utilized these types of resources. It is important to
another main objective. note that the video resources in several apps are links to
In summary, only 56%-61% (13/23-14/23) of the apps are YouTube [44].
devoted to meditation, the core technique to develop Social Networks
mindfulness. The remaining apps would be best characterized Approximately 28% (13/46) of the apps interact with social
with other words. networks. Facebook [45] and Twitter [46] are the most common
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according to the extracted data (see Tables 3 and 4). In addition, Outcomes: Statistics and Reports
most of the developers provided a website. Approximately 37% (17/46) of the apps present some type of
Contents statistics or reports. Usually, these reports are graphic resources
or text. In Table 5, we list the graphic resources and examples
In addition to the use of previously described resources, Android
of represented measurements.
apps offer additional types of resources, for instance, articles,
book information, events, links, personal journals, tutorials, The temporality is nearly always the same: daily, weekly, and
notices, or evaluations. monthly as well as the special case of fully customizable.
Special Features Language
Several apps contained special features. Examples include breath English is the language for 41 apps. There are 11 apps that allow
detection, holographic theming (ie, the background and visual the use of or are developed in other languages. There are 3 apps
aspect can be changed), dieting, single (headphones) or multiple that use Spanish, and only one app provides several videos in
users, skill lists, and review questions about the user’s feelings this language.
after the audio and “difficulty” levels, (eg, beginner,
Usability
intermediate, or advanced). However, assessments of
psychological and biological variables related to mindfulness Thirteen percent (6/46) of the apps lacked an exit button and
or analyses of body statics and kinetics with social interaction readability of the text was limited in 6% (3/46) because of the
were not included in any app studied. The possibility of teaching background color (4%, 2/46) or letter format (2%, 1/46).
or practicing for large groups via the Internet was also absent.
Figure 9. Percentages of apps that utilized different resources.

Table 3. Use of Facebook.

Creation year Followers Social networks used together with Facebook
1996 201,290 Twitter and Pinterest
2008 643 Twitter
2009 12,742 Twitter
2010 9 Twitter (more used-768 followers)
2010 252 Twitter
2010 453 LinkedIn
2010 523 -
2011 1010 Twitter
2013 105 Google+Community and Google+Page

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Table 4. Use of Twitter.

Tweets Followers Social networks used together with Twitter
1874 4137 Facebook
3524 768 Facebook
140 100 Facebook
603 936 Facebook
740 581 Facebook

264 ( a) (a)
7795 625,772 Facebook
41 28 The website does not work

a
Last use: 2011. The access is directly through the app. For mindfulness, 45 Tweets were made in 3 days; for meditation, 14 Tweets were made in 1
hour; for relaxation, 15 Tweets were made in 1 hour; and for mindful, 15 tweets were made in 10 hours.

Table 5. Resources and measurements in statistical reports.

Graphic resources Measurements
Number Number of meditations/sessions completed
Bar chart Time of meditation
Symbols + legend Time versus test date/goal
Chart type and chart data Number of consecutive days with at least one recorded session
Comments Stress level over time or stress score out of 100 points + comments
List of choices Time spent at each level
Use of Google Diet: date/time/meal/snack type
Analytics Record of the ratings: correlation analysis, performance satisfaction by intensity level, performance satisfaction by
focus level, and determination of whether the intensity level has positive or negative impact by comparing with the
focus.

A Case
Global Assessment
The most relevant free app has a score of 4.5 (88 voters). The
Valuing Mobile Apps app allows users to utilize its Facebook Page (created in 2013
To study the global assessment by users of the analyzed apps, and had 105 followers in January 2013), Google+Community
we were able to employ the data that Google Play Store offers and Google+Page. The developers also provide a “Journal”
online. As explained in the Methods Section, users can value where users can score their “Conscious level” (from 1 to 7),
mobile apps from 1 to 5. add comments about the practice (challenge), and know at any
time the number of people using the program.
Multimedia Appendices 3 and 4 show the global score and the
number of votes for each analyzed app. In total 10,984 In Table 6, the number of “conscious people” is shown together
assessments were found, 10,309 corresponding to the free with the number of people that completed a challenge. Sunday
versions and 675 to the paid versions of the apps. data are not shown because of technological problems.
In the free versions the scores ranged from 1.2 (lowest) to 5.0 It is interesting to note that Thursday and Saturday are the days
(highest). There were 10,309 users that had assessed the apps, with lower numbers of users, but higher percentages of
and the average was 4.6. In the paid versions the scores ranged completed challenges. On the rest of the days, the percentage
from 1.7 (lowest) to 5.0 (highest). There were 675 users that of users who completed the challenge was approximately
had assessed the apps and the average was 4.0. 37.22% (590/1585). In other words, only one-third of the
followers completed the challenge.
Users experienced higher satisfaction with the free apps.

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Table 6. Average of the maximum number of users and the percentage who completed the daily challenge.
Average number of simultaneous users % of users who completed the daily challenge journal
Tuesday 434 39
Wednesday 407 38
Friday 390 33
Monday 354 39
Thursday 271 65
Saturday 228 58

versions obtain better scores than paid apps. The current time
Discussion is exciting as the number of apps is increasing quickly, as shown
Usefulness of MBMAs by the data from 2011 versus the data from two months in 2013
(Figure 8). Looking at the same figure, it is also possible to
Mobile apps may be useful at facilitating mindfulness predict a trend towards the development of more paid apps. In
accessibility, training, and daily practice adherence [39], which this category (paid apps) a more expensive app does not lead
could enhance the impact of MBTs on health indicators to a lower number of downloads (see Results section, subsection
worldwide. While a wide selection of MBMAs seems to be Downloads and Prices).
available in the market, this study finds a complete lack of
evidence to support the usefulness of those apps. We did not “Mindfulness” terms and definitions that apps use to self-classify
find any randomized clinical trials that evaluate the impact of as MBMAs were not always well clarified. Thus, nearly half of
mobile apps and its features and functionalities on mindfulness the analyzed apps presented different main functionalities and
training or health indicators. In fact, we found only two features that were not necessarily related to
small-sample pilot studies [32,33]. The study by Yu et al [32] mindfulness/meditation. It will be necessary for developers to
was designed to evaluate the feasibility of an MBMA with a clarify the mindfulness concept and the main objectives of
multimedia-assisted system to train and support the practice of mindfulness apps to better meet the expectations of potential
walking meditation, a type of mindfulness technique. As that users, as satisfaction can be considered one of the most
multimedia-assisted system uses a complex net of sensors, it important parameters for usability [35]. It is interesting to note
will most likely remain useful only for mindfulness research that the term “mindfulness” was absent in the metadata of the
rather than for the general population. Another study, by Morris paper from Morris et al [33]; in fact, it is absent throughout the
et al [33], whose MBMA is probably more suitable to the article. This means that terms and definitions for mindfulness
general population, explored the feasibility of an app consisted are also an issue in the scientific literature, and future systematic
of mood reporting scales using touch screen, and self-guided reviews on this subject should perform an exhaustive search to
and -demanded mindfulness-based mobile therapies. Both prevent this potential bias in selection. In addition, authors
MBMAs were developed for the Android operating system, should also include the term “mindfulness” or similar in the
following the tendency observed in the online vendors market. metadata whenever this is appropriate and relevant.

The lack of evidence we have found is probably because both Some aspects of usability deserve some comments–a minor
MBTs and their related mobile apps are in their early percentage (about 20%, 9/46) of the apps would benefit from
technological development phase, and because developers in improvements to the design of the interface, (eg, clear exit
the vendors market are not involved in academic or health buttons, changes to the background color or legibility in order
settings. In our opinion, present apps are not aimed to usual to facilitate reading the text, etc). As these pitfalls are subjective
meditators but to nonmeditators that want to become introduced and rather difficult to evaluate, two authors, to increase
to this technique, because the market is wider. Most of the reliability, assessed them. They are easy to improve and would
features and functionalities expected and required for meditators make these apps friendlier.
were absent from existing MBMAs. There is ample room to The question of the language used bears a relation with usability.
explore in regard to the usability and effectiveness of mobile As 78% (39/50) of the apps studied were only available in
apps [47]. The way to do this is to identify present English, users speaking other languages would have more
functionalities, as we have done in this manuscript, suggest new difficulties with these apps. This is an important feature because
functionalities available with present technology, and ask mindfulness decreases conceptual language [5], and it could be
meditators about their feasibility and usefulness, which is part more difficult to practice mindfulness while thinking in a
of a new project. language different from the user’s native tongue.
We identified 203 eligible MBMAs in the online market As regular practice is a key element in obtaining health benefits
(February 25, 2013). It is interesting to note that the number of from MBTs, it is considered a very important issue among
mindfulness apps is much lower than the number of apps found available MBMAs, as approximately 37% (17/46) of them
using other related criteria. As expected, it is clear that the presented some types of statistics or reports of the user’s
number of free downloads is several orders of magnitude higher mindfulness practice. Another key element appears to be the
than paid downloads. It is also worth pointing out that free

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use of social networks as a tool to promote contact among users, acceptance, psychological flexibility, and resilience. The user’s
to create a sense of community and to permit the exchange of emotional state could even be assessed, for example, with
mindfulness practice experiences between users. Therefore, emotion recognition by voice or photographs obtained with
“tracking and monitoring personal mindfulness practice and mobile microphones and cameras [49].
health information” and “leveraging social influence” seem to
Monitoring of biological variables through internal and external
be important functionalities for the MBMA developers in the
sensors could give useful psychophysiological data. Consumer
market.
electroencephalogram (EEG) headsets and electrocardiogram
Assessments of psychological and biological variables related (ECG) monitors have already been developed [50,51] and could
to mindfulness or analyses of body statics and kinetics with allow monitoring of brain and heart activity during formal and
social interaction are not included in any app studied, except informal mindfulness practices. Changes in EEG and ECG can
the study of Morris et al [33], which evaluated users’ mood be expected as a consequence of mindfulness practice over the
reporting. The lack of these functionalities, which are relevant acute/medium/long term. Experts consider [12] that, in the
for research studies and for feedback from users, might be one future, many people will have a set of wearable wireless
of the reasons for the absence of randomized clinical trials to biosensors that will monitor not only basic vital signs
evaluate the impact of mobile apps on mindfulness training. (temperature, blood pressure, pulse, respiratory rate, pulse ox,
The improvement of health outcomes produced by apps is and ECG), but also other variables relevant to mindfulness
probably linked to empowerment and interactivity with the (hormone levels, immune system activity, and inflammation)
smartphone [47], and psychological and biological feedback [52].
could be one of the most important rewards to encourage users
Monitoring of physical movement and the psychological state
to continue to practice mindfulness.
with MBMAs associated with 3-axis accelerometers (to detect
Finally, no app offers a relevant functionality for instructors of linear acceleration in all directions) could reveal whether people
mindfulness-the possibility of teaching or practicing for large are practicing while standing, moving, or walking and whether
groups via the Internet. It is widely accepted that the future of they feel calm or nervous [53,54].
psychotherapy is linked to smartphones [12], so this
The analysis of body statics and kinetics could be possible in
functionality is expected to be one that generates the most
the near future. Devices for full-body gaming such as the Xbox
demand from trainers and trainees of mindfulness.
360 Kinect will soon be connectable to mobile devices, which
Limitations would make possible studies of nonverbal behavior according
A limitation of this review is that we did not include an to body position, posture, and motor skill learning. It may also
extensive evaluation of websites related to mindfulness training be possible to record limb and torso movements continually to
in our method because that would be beyond the scope of this detect changes in body statics and kinetics due to mindfulness
work. As a result, it is possible that we are missing some practice [12].
MBMAs not currently available in online markets or in scientific The analysis of social interactions could be used by trainers.
databases. Furthermore, some functionalities and features may Devices with Bluetooth routinely scan the identity codes of all
be underreported as we did not thoroughly evaluate all of the other Bluetooth devices nearby. As most people now carry a
MBMAs available in the online vendor markets. Bluetooth-enabled mobile phone, the density of local Bluetooth
devices is a good proxy for the number of people nearby [55].
Existing MBMA Versus Real Needs: Future Agenda
This information and call log data allow the inference of social
for Research
networks associated with mindfulness practice [56] and could
Mobile phones and apps are widely used to enhance the delivery be useful for trainers to control individual presence during group
of mental health prevention and treatment interventions [48], activities related to mindfulness training.
and they will be a key element in future research on health
behavior, according to the experts [12]. These devices are Improving adherence to practices can be done online. Achieving
ubiquitous, well accepted in society, relatively inexpensive, individual improvements through online “situational feedback”
programmable and capable of recording media, are already delivered by trainers, automatic SMS alerts, or a reminder is a
owned by a large number of people, operate almost functionality that already exists and may improve adherence to
continuously, allow the input and output of data, and provide a regular mindfulness practice [24,36].
content that is more user-friendly and condensed than regular Context-specific and customized behavior activation can help
Web pages [39]. With a specific focus on apps that increase the app users. Context-specific alerts, SMS, reminders, tips, and
adherence and efficacy of mindfulness practices, there are educational content probably will make these functionalities
important limitations in the current apps that future research more effective, and customized feedback will improve users’
should address. Some improvements in new apps that would skills to be more mindful during, or to practice mindfulness
facilitate mindfulness training, practice, and research are the exercises just before well-known stressful moments or unhealthy
following. behavior daily triggers (for example, preventing psychological
Monitoring psychological variables related to mindfulness would overreaction to a known stressful social event) [24].
be feasible with present technology and quite useful to
meditators that wish to periodically assess their levels of
mindfulness or other psychological constructs, such as

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Conclusions No specific apps exist for professionals or long-term meditators

While a wide selection of MBMAs is available in the online or, at least, for both profiles (users and professionals) and
market, this study found that there is still a lack of scientific contain functionalities useful for each.
evidence to support the use and effectiveness of those apps. The functionalities of the apps available at present are limited.
Assessments of psychological and biological variables related
Recommendations
to mindfulness or analyses of body statics and kinetics with
According to the results of this study, we provide the following social interaction are not included in any app studied, except
recommendations for future apps. one. Another relevant functionality for instructors of
It is necessary to clarify the concept of mindfulness and the mindfulness, the possibility of teaching or practicing for large
principal aim of any mindfulness app to better meet the groups via the Internet, is also absent.
expectations of potential users. About 41% (19/46) of the apps It is necessary to develop apps in languages other than English
that include mindfulness in the title develop some form of a (only 22%, 11/50 of the apps studied allow any other language)
mind-body approach, but not specifically mindfulness. to make them friendlier to non-English-speaking users.
About 20% (9/46) of the apps have interfaces that are difficult In summary, apps are expected to be an important additional
to use, for instance, there is no clear exit button or the tool to increase adherence in MBTs, but some improvements
background color makes reading the text difficult. To solve to the present models are advisable to improve their efficacy.
these problems, published guidelines for app design could be The potential for mobile mindfulness apps remains largely
developed (see, for instance, Google, Apple, and Windows) unexplored.
[57-59] or [17]. Smartphone apps must be intuitive to increase
everyday use and generate confidence.
 

Acknowledgments
MMPD is grateful to the Brazilian National Council for Research and Technology Development (CNPq) for a postdoctoral
fellowship (“Science without Borders Program”). The authors would like to acknowledge the “Chair in Innovation and Technological
Quality.” Thanks to the “Gobierno de Aragón” and to the “Fondo Social Europeo” for their support to the research groups.

Authors' Contributions
IP and JGC had the initial idea for the review and drafted the first protocol. All authors commented and advised on this draft. All
authors devised the search strategy that was conducted by IP and PHM (online vendors), and PHM and MMPD (scientific
databases). All authors participated in the screening of the results of the searches and agreed on the final list of included articles
and mobile app. IP, MMPD, and PHM carried out the data extraction. IP, JGC, and MMPD wrote the first draft of the final papers
with contributions and edits from all remaining authors. All authors contributed to the final draft.

Conflicts of Interest
None declared.

Multimedia Appendix 1
General characteristics of studies.
[PDF File (Adobe PDF File), 136KB - mhealth_v1i2e24_app1.pdf ]

Multimedia Appendix 2
Apps features and functionalities (technology and design characteristics) from the included studies.
[PDF File (Adobe PDF File), 14KB - mhealth_v1i2e24_app2.pdf ]

Multimedia Appendix 3
Mindfulness free Android apps.
[JPG File, 236KB - mhealth_v1i2e24_app3.jpg ]

Multimedia Appendix 4
Mindfulness paid Android apps.
[JPG File, 199KB - mhealth_v1i2e24_app4.jpg ]

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Abbreviations
ACM: Association for Computing Machinery
ECG: electrocardiogram
EEG: electroencephalogram
ICT: Information and communication technology
IoT: Internet of Things
MBMAs: mindfulness-based mobile apps
MBTs: mindfulness-based therapies
PC: personal computer
SMS: short message service

Edited by G Eysenbach; submitted 27.05.13; peer-reviewed by C Morrison, S Jonnalagadda; comments to author 25.06.13; revised
version received 13.08.13; accepted 15.09.13; published 01.11.13
Please cite as:
Plaza I, Demarzo MMP, Herrera-Mercadal P, García-Campayo J
Mindfulness-Based Mobile Applications: Literature Review and Analysis of Current Features
JMIR Mhealth Uhealth 2013;1(2):e24
URL: http://mhealth.jmir.org/2013/2/e24/ 
doi:10.2196/mhealth.2733
PMID:

©Inmaculada Plaza, Marcelo Marcos Piva Demarzo, Paola Herrera-Mercadal, Javier García-Campayo. Originally published in
JMIR Mhealth & Uhealth (http://mhealth.jmir.org), 01.11.2013. This is an open-access article distributed under the terms of the
Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution,
and reproduction in any medium, provided the original work, first published in JMIR mhealth and uhealth, is properly cited. The

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