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<article xmlns:xlink="http://www.w3.org/1999/xlink" article-type="letter" dtd-version="2.0">
  <front>
    <journal-meta>
      <journal-id journal-id-type="publisher-id">JMIR</journal-id>
      <journal-id journal-id-type="nlm-ta">J Med Internet Res</journal-id>
      <journal-title>Journal of Medical Internet Research</journal-title>
      <issn pub-type="epub">1438-8871</issn>
      <publisher>
        <publisher-name>JMIR Publications</publisher-name>
        <publisher-loc>Toronto, Canada</publisher-loc>
      </publisher>
    </journal-meta>
    <article-meta>
      <article-id pub-id-type="publisher-id">v25i1e51320</article-id>
      <article-id pub-id-type="pmid">37824179</article-id>
      <article-id pub-id-type="doi">10.2196/51320</article-id>
      <article-categories>
        <subj-group subj-group-type="heading">
          <subject>Research Letter</subject>
        </subj-group>
        <subj-group subj-group-type="article-type">
          <subject>Research Letter</subject>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title>A Digital Music-Based Mindfulness Intervention (“healing attempt”) for Race-Based Anxiety in Black Americans</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="editor">
          <name>
            <surname>Eysenbach</surname>
            <given-names>Gunther</given-names>
          </name>
        </contrib>
        <contrib contrib-type="editor">
          <name>
            <surname>de Azevedo Cardoso</surname>
            <given-names>Taiane</given-names>
          </name>
        </contrib>
      </contrib-group>
      <contrib-group>
        <contrib contrib-type="reviewer">
          <name>
            <surname>Yan</surname>
            <given-names>Xinghui</given-names>
          </name>
        </contrib>
        <contrib contrib-type="reviewer">
          <name>
            <surname>Knoerl</surname>
            <given-names>Robert</given-names>
          </name>
        </contrib>
        <contrib contrib-type="reviewer">
          <name>
            <surname>Khalili</surname>
            <given-names>Robabe</given-names>
          </name>
        </contrib>
      </contrib-group>
      <contrib-group>
        <contrib id="contrib1" contrib-type="author" corresp="yes">
          <name name-style="western">
            <surname>Jones</surname>
            <given-names>Grant</given-names>
          </name>
          <degrees>MA</degrees>
          <xref rid="aff1" ref-type="aff">1</xref>
          <address>
            <institution>Department of Psychology</institution>
            <institution>Harvard University</institution>
            <addr-line>33 Kirkland Street</addr-line>
            <addr-line>Cambridge, MA, 02138</addr-line>
            <country>United States</country>
            <email>gmj005@g.harvard.edu</email>
          </address>
          <ext-link ext-link-type="orcid">https://orcid.org/0000-0002-2426-310X</ext-link>
        </contrib>
        <contrib id="contrib2" contrib-type="author">
          <name name-style="western">
            <surname>Castro-Ramirez</surname>
            <given-names>Franchesca</given-names>
          </name>
          <degrees>MA</degrees>
          <xref rid="aff1" ref-type="aff">1</xref>
          <ext-link ext-link-type="orcid">https://orcid.org/0000-0001-5643-1510</ext-link>
        </contrib>
        <contrib id="contrib3" contrib-type="author">
          <name name-style="western">
            <surname>McGuire</surname>
            <given-names>Taylor</given-names>
          </name>
          <degrees>BS</degrees>
          <xref rid="aff1" ref-type="aff">1</xref>
          <ext-link ext-link-type="orcid">https://orcid.org/0000-0002-2020-5746</ext-link>
        </contrib>
        <contrib id="contrib4" contrib-type="author">
          <name name-style="western">
            <surname>Al-Suwaidi</surname>
            <given-names>Maha</given-names>
          </name>
          <degrees>MA</degrees>
          <xref rid="aff2" ref-type="aff">2</xref>
          <ext-link ext-link-type="orcid">https://orcid.org/0000-0002-2024-127X</ext-link>
        </contrib>
        <contrib id="contrib5" contrib-type="author">
          <name name-style="western">
            <surname>Herrmann</surname>
            <given-names>Felipe</given-names>
          </name>
          <degrees>BA</degrees>
          <xref rid="aff1" ref-type="aff">1</xref>
          <ext-link ext-link-type="orcid">https://orcid.org/0000-0002-6945-6810</ext-link>
        </contrib>
      </contrib-group>
      <aff id="aff1">
        <label>1</label>
        <institution>Department of Psychology</institution>
        <institution>Harvard University</institution>
        <addr-line>Cambridge, MA</addr-line>
        <country>United States</country>
      </aff>
      <aff id="aff2">
        <label>2</label>
        <institution>Department of Psychology</institution>
        <institution>University of California, Los Angeles</institution>
        <addr-line>Los Angeles, CA</addr-line>
        <country>United States</country>
      </aff>
      <author-notes>
        <corresp>Corresponding Author: Grant Jones <email>gmj005@g.harvard.edu</email></corresp>
      </author-notes>
      <pub-date pub-type="collection">
        <year>2023</year>
      </pub-date>
      <pub-date pub-type="epub">
        <day>12</day>
        <month>10</month>
        <year>2023</year>
      </pub-date>
      <volume>25</volume>
      <elocation-id>e51320</elocation-id>
      <history>
        <date date-type="received">
          <day>27</day>
          <month>7</month>
          <year>2023</year>
        </date>
        <date date-type="rev-request">
          <day>12</day>
          <month>9</month>
          <year>2023</year>
        </date>
        <date date-type="rev-recd">
          <day>26</day>
          <month>9</month>
          <year>2023</year>
        </date>
        <date date-type="accepted">
          <day>29</day>
          <month>9</month>
          <year>2023</year>
        </date>
      </history>
      <copyright-statement>©Grant Jones, Franchesca Castro-Ramirez, Taylor McGuire, Maha Al-Suwaidi, Felipe Herrmann. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 12.10.2023.</copyright-statement>
      <copyright-year>2023</copyright-year>
      <license license-type="open-access" xlink:href="https://creativecommons.org/licenses/by/4.0/">
        <p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.</p>
      </license>
      <self-uri xlink:href="https://www.jmir.org/2023/1/e51320" xlink:type="simple"/>
      <abstract>
        <p>This study replicates and extends findings that “healing attempt”—a brief digital music-based mindfulness intervention—represents a feasible and potentially effective intervention for race-based anxiety in the Black community.</p>
      </abstract>
      <kwd-group>
        <kwd>Black music</kwd>
        <kwd>mindfulness</kwd>
        <kwd>meditation</kwd>
        <kwd>music</kwd>
        <kwd>song</kwd>
        <kwd>songs</kwd>
        <kwd>psychotherapy</kwd>
        <kwd>self-compassion</kwd>
        <kwd>ethnic</kwd>
        <kwd>cultural</kwd>
        <kwd>culturally</kwd>
        <kwd>single-case experiment</kwd>
        <kwd>race</kwd>
        <kwd>racial</kwd>
        <kwd>anxiety</kwd>
        <kwd>digital health intervention</kwd>
        <kwd>Black</kwd>
        <kwd>digital health</kwd>
        <kwd>low income</kwd>
        <kwd>Black community</kwd>
        <kwd>racial disparity</kwd>
        <kwd>mental health</kwd>
      </kwd-group>
    </article-meta>
  </front>
  <body>
    <sec sec-type="introduction">
      <title>Introduction</title>
      <p>Anxiety stemming from racism and discrimination disproportionately impacts Black Americans [<xref ref-type="bibr" rid="ref1">1</xref>]. Decades of research indicate that mindfulness-based interventions can effectively alleviate anxiety [<xref ref-type="bibr" rid="ref2">2</xref>]. However, three limitations often hinder the Black community from accessing these resources: a lack of cultural relevance, high costs, and excessive time commitments [<xref ref-type="bibr" rid="ref3">3</xref>-<xref ref-type="bibr" rid="ref5">5</xref>]. In response to these barriers, Author GJ created “healing attempt,” a brief digital music-based mindfulness intervention for race-based anxiety in the Black community. The intervention consists of originally composed and prerecorded songs, meditations, and poems. All components of the intervention are accompanied by background music rooted in Black music traditions (eg, gospel) to increase the cultural relevance of the intervention. Additionally, the intervention includes contributions from Lama Rod Owens, an acclaimed Buddhist teacher, and Terry Edmonds, former chief speechwriter for President Clinton. In light of the “replication crisis” in psychology [<xref ref-type="bibr" rid="ref6">6</xref>], this study seeks to replicate and extend findings from our initial study in which we demonstrated that “healing attempt” may be a feasible and effective intervention for Black American race-based anxiety.</p>
    </sec>
    <sec sec-type="methods">
      <title>Methods</title>
      <sec>
        <title>Overview</title>
        <p>We recruited participants using Prolific—a web-based study platform—in January 2023. Participants were 8 middle-to-low income (&#60;US $50,000/yr annual salary) Black American adults with elevated race-based anxiety. Study visits occurred on Zoom (Zoom Video Communications). We used a multiple-baseline design in which we assessed state anxiety and mindfulness/self-compassion every 2 minutes across two phases. In the initial phase (phase A), participants were randomized to one of four baseline conditions that ranged between 10 and 16 minutes (5-8 assessment periods). Participants were then instructed to go about their business as usual. In the second phase (phase B), we delivered the 25-minute intervention. The only instructions were to find a comfortable body position and attend to the intervention. After the intervention, we assessed the feasibility of the intervention using mixed methods.</p>
        <p>The research team administered the questionnaires during the study. We used the State-Trait Anxiety Inventory–6 to assess state anxiety, and used a 5-item study-specific scale to measure state mindfulness/self-compassion; this scale includes items from the Toronto Mindfulness Scale and the State Self-Compassion Scale.</p>
        <p>We analyzed all results in R (version 4.1.2; R Foundation for Statistical Computing) using the <italic>Scan</italic> package [<xref ref-type="bibr" rid="ref7">7</xref>]. We used tau-U analyses to analyze our data; this analytical approach allows one to control for data trends when assessing intervention effects in multiple baseline studies, meaning that we could control for natural changes in anxiety or mindfulness/self-compassion during the study.</p>
      </sec>
      <sec>
        <title>Ethical Considerations</title>
        <p>All study procedures were approved by the Harvard Institutional Review Board (protocol IRB21-0256). Participant data were deidentified. All participants provided informed consent before the study and were compensated with US $60.</p>
      </sec>
    </sec>
    <sec sec-type="results">
      <title>Results</title>
      <p><xref ref-type="table" rid="table1">Table 1</xref> presents the results of our tau-U models assessing the impact of the intervention on state anxiety. All tau-U values were negative and significant (<italic>P</italic>&#60;.001), including those that corrected for trends in the baseline and intervention phases, indicating that the intervention reduced state anxiety.</p>
      <p><xref ref-type="table" rid="table2">Table 2</xref> presents the results of our tau-U models assessing the impact of the intervention on mindfulness/self-compassion. All tau-U values for these models were positive and significant (<italic>P</italic>&#60;.05), suggesting that the intervention increased mindfulness/self-compassion.</p>
      <p>Lastly, the feasibility scores for the intervention were high (ie, the average scores for all feasibility and acceptability measures were ≥86 out of 100). Further details on our results are provided in <xref ref-type="supplementary-material" rid="app1">Multimedia Appendix 1</xref>.</p>
      <table-wrap position="float" id="table1">
        <label>Table 1</label>
        <caption>
          <p>Overall tau-U models assessing the impact of the intervention on state anxiety.</p>
        </caption>
        <table width="1000" cellpadding="5" cellspacing="0" border="1" rules="groups" frame="hsides">
          <col width="30"/>
          <col width="350"/>
          <col width="120"/>
          <col width="110"/>
          <col width="150"/>
          <col width="120"/>
          <col width="120"/>
          <thead>
            <tr valign="top">
              <td colspan="2">Model</td>
              <td>τ</td>
              <td>SE</td>
              <td>95% CI</td>
              <td>
                <italic>Z</italic>
              </td>
              <td><italic>P</italic> value</td>
            </tr>
          </thead>
          <tbody>
            <tr valign="top">
              <td colspan="7">
                <bold>Overall tau-U (cases 1-4)</bold>
              </td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>A vs B</td>
              <td>–0.91</td>
              <td>0.14</td>
              <td>–1.18 to –0.64</td>
              <td>–6.57</td>
              <td>&#60;.001</td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>A vs B – trend A</td>
              <td>–0.81</td>
              <td>0.17</td>
              <td>–1.14 to –0.49</td>
              <td>–4.89</td>
              <td>&#60;.001</td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>A vs B + trend B</td>
              <td>–0.73</td>
              <td>0.10</td>
              <td>–0.91 to –0.54</td>
              <td>–7.62</td>
              <td>&#60;.001</td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>A vs B + trend B – trend A</td>
              <td>–0.58</td>
              <td>0.08</td>
              <td>–0.74 to –0.42</td>
              <td>–7.04</td>
              <td>&#60;.001</td>
            </tr>
            <tr valign="top">
              <td colspan="7">
                <bold>Overall tau-U (cases 5-8)</bold>
              </td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>A vs B</td>
              <td>–0.90</td>
              <td>0.14</td>
              <td>–1.17 to –0.63</td>
              <td>–6.51</td>
              <td>&#60;.001</td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>A vs B – trend A</td>
              <td>–0.79</td>
              <td>0.17</td>
              <td>–1.12 to –0.47</td>
              <td>–4.79</td>
              <td>&#60;.001</td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>A vs B + trend B</td>
              <td>–0.71</td>
              <td>0.10</td>
              <td>–0.90 to –0.52</td>
              <td>–7.45</td>
              <td>&#60;.001</td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>A vs B + trend B – trend A</td>
              <td>–0.56</td>
              <td>0.08</td>
              <td>–0.72 to –0.40</td>
              <td>–6.77</td>
              <td>&#60;.001</td>
            </tr>
          </tbody>
        </table>
      </table-wrap>
      <table-wrap position="float" id="table2">
        <label>Table 2</label>
        <caption>
          <p>Overall tau-U models assessing the impact of the intervention on mindfulness/self-compassion.</p>
        </caption>
        <table width="1000" cellpadding="5" cellspacing="0" border="1" rules="groups" frame="hsides">
          <col width="30"/>
          <col width="360"/>
          <col width="120"/>
          <col width="110"/>
          <col width="150"/>
          <col width="110"/>
          <col width="120"/>
          <thead>
            <tr valign="top">
              <td colspan="2">Model</td>
              <td>τ</td>
              <td>SE</td>
              <td>95% CI</td>
              <td>
                <italic>Z</italic>
              </td>
              <td><italic>P</italic> value</td>
            </tr>
          </thead>
          <tbody>
            <tr valign="top">
              <td colspan="7">
                <bold>Overall tau-U (cases 1-4)</bold>
              </td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>A vs B</td>
              <td>0.72</td>
              <td>0.14</td>
              <td>0.45-0.99</td>
              <td>5.20</td>
              <td>&#60;.001</td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>A vs B – trend A</td>
              <td>0.79</td>
              <td>0.17</td>
              <td>0.46-1.11</td>
              <td>4.76</td>
              <td>&#60;.001</td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>A vs B + trend B</td>
              <td>0.59</td>
              <td>0.10</td>
              <td>0.40-0.78</td>
              <td>6.18</td>
              <td>&#60;.001</td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>A vs B + trend B – trend A</td>
              <td>0.55</td>
              <td>0.08</td>
              <td>0.38-0.71</td>
              <td>6.63</td>
              <td>&#60;.001</td>
            </tr>
            <tr valign="top">
              <td colspan="7">
                <bold>Overall tau-U (cases 5-8)</bold>
              </td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>A vs B</td>
              <td>0.47</td>
              <td>0.14</td>
              <td>0.20-0.74</td>
              <td>3.43</td>
              <td>&#60;.001</td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>A vs B – trend A</td>
              <td>0.39</td>
              <td>0.17</td>
              <td>0.06-0.71</td>
              <td>2.33</td>
              <td>.02</td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>A vs B + trend B</td>
              <td>0.44</td>
              <td>0.10</td>
              <td>0.26-0.63</td>
              <td>4.64</td>
              <td>&#60;.001</td>
            </tr>
            <tr valign="top">
              <td>
                <break/>
              </td>
              <td>A vs B + trend B – trend A</td>
              <td>0.34</td>
              <td>0.08</td>
              <td>0.17-0.50</td>
              <td>4.08</td>
              <td>&#60;.001</td>
            </tr>
          </tbody>
        </table>
      </table-wrap>
    </sec>
    <sec sec-type="discussion">
      <title>Discussion</title>
      <p>We replicated and extended our initial findings and showed that “healing attempt” can improve anxiety and mindfulness/self-compassion with high feasibility/acceptability [<xref ref-type="bibr" rid="ref8">8</xref>]. Congruent with the existing literature, the observed improvements in mindfulness/self-compassion may have driven the reductions in anxiety [<xref ref-type="bibr" rid="ref2">2</xref>,<xref ref-type="bibr" rid="ref9">9</xref>]. Similarly, the culturally adapted nature of the intervention also may have contributed to symptom reduction and the high feasibility scores in this experiment [<xref ref-type="bibr" rid="ref10">10</xref>].</p>
      <p>Some limitations should be acknowledged. First, the small sample size and within-subject design limit the ability to make strong causal claims from the results. Second, our prescreening criteria requiring participants to have familiarity with meditation limits generalizability. Third, the mindfulness/self-compassion measure used in the study was not a fully validated scale. Fourth, in the qualitative feedback, one participant suggested eliminating the frequent pausing of the music that accompanied the study design.</p>
      <p>We can address the aforementioned limitations in a future between-subjects randomized feasibility trial that tests “healing attempt” as a single-session intervention. Additionally, future studies can investigate novel low-cost avenues for disseminating the intervention, such as music-streaming platforms. Overall, this study represents a promising next step in providing a culturally relevant, highly scalable mindfulness resource for the Black community.</p>
    </sec>
  </body>
  <back>
    <app-group>
      <supplementary-material id="app1">
        <label>Multimedia Appendix 1</label>
        <p>Supplementary materials.</p>
        <media xlink:href="jmir_v25i1e51320_app1.docx" xlink:title="DOCX File , 869 KB"/>
      </supplementary-material>
    </app-group>
    <ack>
      <p>This project is funded by a Varela Grant from the Mind &#38; Life Institute and a grant from the Harvard Culture Lab Innovation Fund.</p>
    </ack>
    <notes>
      <sec>
        <title>Data Availability</title>
        <p>A link to the data and code for this project is available in <xref ref-type="supplementary-material" rid="app1">Multimedia Appendix 1</xref>. No works have been published or submitted that stem from this data set.</p>
      </sec>
    </notes>
    <fn-group>
      <fn fn-type="con">
        <p>GJ conceptualized the study, executed all data analysis, and oversaw the writing and drafting of the paper. FC-R, TM, MA-S, and FH helped write the paper; all authors edited the manuscript before submission.</p>
      </fn>
      <fn fn-type="conflict">
        <p>None declared.</p>
      </fn>
    </fn-group>
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