测试简短、自我引导的正念生态即时干预对社交焦虑障碍情绪调节和自我同情的疗效：随机对照试验。
Testing the Efficacy of a Brief, Self-Guided Mindfulness Ecological Momentary Intervention on Emotion Regulation and Self-Compassion in Social Anxiety Disorder: Randomized Controlled Trial.
机构信息
Department of Psychology, National University of Singapore, Singapore, Singapore.
Department of Health Policy, Harvard Medical School, Boston, MA, United States.
出版信息
JMIR Ment Health. 2024 Apr 19;11:e53712. doi: 10.2196/53712.
BACKGROUND
Theories propose that brief, mobile, self-guided mindfulness ecological momentary interventions (MEMIs) could enhance emotion regulation (ER) and self-compassion. Such changes are posited to be mechanisms of change. However, rigorous tests of these theories have not been conducted.
OBJECTIVE
In this assessor-blinded, parallel-group randomized controlled trial, we aimed to test these theories in social anxiety disorder (SAD).
METHODS
Participants with SAD (defined as having a prerandomization cut-off score ≥20 on the Social Phobia Inventory self-report) were randomized to a 14-day fully self-guided MEMI (96/191, 50.3%) or self-monitoring app (95/191, 49.7%) arm. They completed web-based self-reports of 6 clinical outcome measures at prerandomization, 15-day postintervention (administered the day after the intervention ended), and 1-month follow-up time points. ER and self-compassion were assessed at preintervention and 7-day midintervention time points. Multilevel modeling determined the efficacy of MEMI on ER and self-compassion domains from pretrial to midintervention time points. Bootstrapped parallel multilevel mediation analysis examined the mediating role of pretrial to midintervention ER and self-compassion domains on the efficacy of MEMI on 6 clinical outcomes.
RESULTS
Participants demonstrated strong compliance, with 78% (149/191) engaging in at least 80% of the MEMI and self-monitoring prompts. MEMI was more efficacious than the self-monitoring app in decreasing ER goal-directed behavior difficulties (between-group Cohen d=-0.24) and lack of emotional clarity (Cohen d=0.16) and increasing self-compassion social connectedness (Cohen d=0.19), nonidentification with emotions (Cohen d=0.16), and self-kindness (Cohen d=0.19) from pretrial to midintervention time points. The within-group effect sizes from pretrial to midintervention were larger in the MEMI arm than in the self-monitoring app arm (ER goal-directed behavior difficulties: Cohen d=-0.73 vs -0.29, lack of emotional clarity: Cohen d=-0.39 vs -0.21, self-compassion domains of social connectedness: Cohen d=0.45 vs 0.19, nonidentification with emotions: Cohen d=0.63 vs 0.48, and self-kindness: Cohen d=0.36 vs 0.10). Self-monitoring, but not MEMI, alleviated ER emotional awareness issues (between-group Cohen d=0.11 and within-group: Cohen d=-0.29 vs -0.13) and reduced self-compassion acknowledging shared human struggles (between-group Cohen d=0.26 and within-group: Cohen d=-0.23 vs 0.13). No ER and self-compassion domains were mediators of the effect of MEMI on SAD symptoms (P=.07-<.99), generalized anxiety symptoms (P=.16-.98), depression severity (P=.20-.94), repetitive negative thinking (P=.12-.96), and trait mindfulness (P=.18-.99) from pretrial to postintervention time points. Similar nonsignificant mediation effects emerged for all of these clinical outcomes from pretrial to 1-month follow-up time points (P=.11-.98).
CONCLUSIONS
Brief, fully self-guided, mobile MEMIs efficaciously increased specific self-compassion domains and decreased ER difficulties associated with goal pursuit and clarity of emotions from pretrial to midintervention time points. Higher-intensity MEMIs may be required to pinpoint the specific change mechanisms in ER and self-compassion domains of SAD.
TRIAL REGISTRATION
Open Science Framework (OSF) Registries; osf.io/m3kxz https://osf.io/m3kxz.
背景
理论提出，简短、移动、自我引导的正念生态瞬间干预（MEMI）可以增强情绪调节（ER）和自我同情。这些变化被认为是改变的机制。然而，这些理论并没有经过严格的测试。
目的
在这项评估者盲法、平行组随机对照试验中，我们旨在在社交焦虑障碍（SAD）中测试这些理论。
方法
患有 SAD（定义为在随机分组前的自我报告中社交恐惧症量表的得分≥20）的参与者被随机分配到为期 14 天的完全自我引导的 MEMI（96/191，50.3%）或自我监测应用程序（95/191，49.7%）组。他们在随机分组前、15 天干预后（在干预结束后的第二天进行）和 1 个月随访时间点完成了 6 项临床结果测量的在线自我报告。在干预前和 7 天中期评估 ER 和自我同情。多层次模型确定了 MEMI 对 ER 和自我同情领域的疗效，从 pretrial到中期干预时间点。Bootstrapped 平行多层次中介分析检验了从 Pretrial 到中期干预的 ER 和自我同情领域对 MEMI 对 6 项临床结果的疗效的中介作用。
结果
参与者表现出很强的依从性，78%（191 人中有 149 人）至少完成了 80%的 MEMI 和自我监测提示。与自我监测应用程序相比，MEMI 更有效地降低了 ER 目标导向行为困难（组间 Cohen d=-0.24）和缺乏情绪清晰度（Cohen d=0.16），并增加了自我同情的社会联系（Cohen d=0.19），非情感认同（Cohen d=0.16）和自我善良（Cohen d=0.19），从 Pretrial 到中期干预时间点。在 MEMI 臂中，从 Pretrial 到中期干预的组内效应大小大于自我监测应用程序臂（ER 目标导向行为困难：Cohen d=-0.73 对 -0.29，缺乏情绪清晰度：Cohen d=-0.39 对 -0.21，自我同情的社会联系领域：Cohen d=0.45 对 0.19，非情感认同：Cohen d=0.63 对 0.48，自我善良：Cohen d=0.36 对 0.10）。自我监测，而不是 MEMI，减轻了 ER 情绪意识问题（组间 Cohen d=0.11，组内 Cohen d=-0.29 对 -0.13），并减少了自我同情承认共同的人类挣扎（组间 Cohen d=0.26，组内 Cohen d=-0.23 对 0.13）。没有 ER 和自我同情领域是 MEMI 对 SAD 症状（P=0.07-<0.99）、广泛性焦虑症状（P=0.16-0.98）、抑郁严重程度（P=0.20-0.94）、重复消极思维（P=0.12-0.96）和特质正念（P=0.18-0.99）从 Pretrial 到 postintervention 时间点的中介作用。从 Pretrial 到 1 个月随访时间点，所有这些临床结果都出现了类似的非显著中介效应（P=0.11-0.98）。
结论
简短、完全自我引导的移动 MEMI 有效地增加了特定的自我同情领域，并从 Pretrial 到中期干预时间点降低了与目标追求和情绪清晰度相关的 ER 困难。需要更高强度的 MEMI 来确定 SAD 中 ER 和自我同情领域的特定变化机制。
试验注册
开放科学框架（OSF）注册表；osf.io/m3kxz https://osf.io/m3kxz。
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