School of Graduate Studies, Lingnan University, Hong Kong SAR, China.
Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China.
PLoS One. 2023 Sep 13;18(9):e0291168. doi: 10.1371/journal.pone.0291168. eCollection 2023.
Existing studies have unequivocally demonstrated that parents of children with autism spectrum disorder (ASD) experience various stressful daily life events and suffer from psychological distress. Mindfulness level is found to be an effective buffer between parents' appraisal of stress life events and psychological distress. However, the mechanism behind the function of mindfulness is unclear, and traditional mindfulness-based intervention (MBI) in experimental settings is not tailored to personal real-life needs. This study proposes to conduct a randomized controlled trial (RCT) to examine the effectiveness of MBI delivered by ecological momentary intervention (EMI) and assessed by ecological momentary assessment (EMA) in changing participants' cognitive appraisal of stressful life events and thus reducing the psychological distress of parents of children with ASD.
The proposed study will recruit 670 parents of children with ASD and randomly assign them to the intervention and control groups (335 in each group). Participants in the intervention group will install the EMI/A app on their smartphones. In the app, participants can receive practice prompts daily, browse and practice different mindfulness exercises in the intervention library at any time, talk to a virtual counselor (chatbot) when feeling stressed, complete EMA on the cognitive appraisal of life events, and receive the log of change of psychological status daily. Participants in the control group will only receive audio-based standardized mindfulness practice instructions three times per week. The effects of MBI will be assessed based on the EMA data, right after the intervention and at the 2-month follow-up. The primary outcome will be participants' psychological distress measured by the depression anxiety stress scale. The secondary outcomes will include participants' subjective well-being, measured by the satisfaction with life scale, and level of resilience, measured by the psychological empowerment scale. Multilevel structural equational modelling will be applied to examine the pathways of the relationship between daily life events, cognitive appraisal, and psychological distress.
The potential benefit of the proposed study is to increase the psychological well-being of parents of children with ASD, and the method may extend to participants suffering from other psychological issues in the future. Trial registration: This trial has been registered on clinicaltrials.gov with the ID of NCT05746468.
已有研究明确表明，自闭症谱系障碍（ASD）儿童的父母会经历各种压力性日常生活事件，并遭受心理困扰。研究发现，正念水平是父母对生活压力事件的评价和心理困扰之间的有效缓冲。然而，正念的作用机制尚不清楚，且实验环境下的传统正念干预（MBI）并不符合个人的实际生活需求。本研究拟开展一项随机对照试验（RCT），通过生态瞬时评估（EMA）评估生态瞬时干预（EMI）介导的 MBI 对改变参与者对生活压力事件的认知评估，从而降低 ASD 儿童父母的心理困扰的有效性。
本研究拟招募 670 名 ASD 儿童的父母，并将其随机分配至干预组和对照组（每组 335 名）。干预组的参与者将在其智能手机上安装 EMI/A 应用程序。在应用程序中，参与者每天可收到练习提示，随时浏览和练习干预库中的不同正念练习，感到压力时可与虚拟顾问（聊天机器人）交谈，完成生活事件认知评估的 EMA，并每天接收心理状态变化日志。对照组的参与者仅每周接受三次基于音频的标准化正念练习指导。干预结束后和 2 个月随访时，将根据 EMA 数据评估 MBI 的效果。主要结局指标为使用抑郁焦虑压力量表评估参与者的心理困扰。次要结局指标包括使用生活满意度量表评估参与者的主观幸福感，以及使用心理赋权量表评估参与者的韧性水平。将采用多层次结构方程模型检验日常生活事件、认知评估与心理困扰之间的关系路径。
本研究的潜在益处在于提高 ASD 儿童父母的心理健康水平，未来可能会扩展到其他患有心理问题的参与者。试验注册：本试验已在 clinicaltrials.gov 上注册，注册号为 NCT05746468。
