Jeong Seohyun, Kim Hyeonseong, Lho Silvia Kyungjin, Hwang Inae, Mun Seongjun, Kim Soohyun, Lim Hyejin, Kim Hyeonhee, Shin Min-Sup, Moon Woori
Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea.
40FY Inc, Seoul, Republic of Korea.
J Med Internet Res. 2025 Aug 14;27:e65892. doi: 10.2196/65892.
In South Korea, access to mental health services remains limited due to stigma, cost, and self-reliance. While digital interventions can help reduce these barriers, few are designed to address the underlying cognitive-emotional patterns that perpetuate psychological distress.
This study evaluated the effectiveness of a schema-informed digital intervention (Mindling) aimed at reducing distress and enhancing coping in adults experiencing schema-linked difficulties such as perfectionism (unrelenting standards schema), low self-worth (self-sacrifice schema), social withdrawal (social isolation and alienation schema), and anxiety (negativity and dependence schemas).
A total of 300 adults (aged 18-60 years) with elevated perceived stress and one dominant distress pattern were recruited on the web and randomized to an intervention group (n=201) or waitlist control (n=99). Participants were assigned to one of four 10-week web-based program modules tailored to their dominant distress pattern: perfectionism (Riggy), low self-worth and fear of rejection (Pleaser), social withdrawal (Shelly), or chronic anxiety (Jumpy). Each module included psychoeducation, guided reflection, and behavioral tasks. Outcomes, including perceived stress, perfectionism, self-esteem, loneliness, and anxiety, were measured at baseline, midintervention (week 5), and postintervention (week 10). Analyses were conducted on 218 participants who completed all 3 assessments (n=138 intervention; n=80 waitlist), using repeated-measures ANOVA or analysis of covariance, as appropriate. In addition, a 1-month follow-up assessment was conducted for the intervention group only to examine maintenance of effects.
Compared with the waitlist group, the intervention group showed significantly greater improvement in perceived stress (F=27.52; P<.001; partial η=0.11) and improvements in pattern-linked outcomes: perfectionism (F=6.24; P=.003; partial η=0.10); self-esteem (F=11.83; P<.001; partial η=0.20); loneliness (F=8.26; P<.001; partial η=0.13); and anxiety (F=10.75; P<.001; partial η=0.16). Secondary outcomes (eg, depression, trait anxiety, and self-efficacy) also improved across most programs. These effects were maintained at a 1-month follow-up. As supplementary findings, adherence was high among those who accessed the platform, with 70.1% (131/187) completing all 10 sessions. The intervention group was also more likely than the waitlist to seek external mental health services (t=2.59; P=.01; mean difference=0.45; 95% CI 0.12-0.80).
The schema-informed digital intervention led to significant (P<.05) short-term improvements in distress and associated psychological patterns, with high completion rates and increased help-seeking behavior among participants. These findings suggest the potential utility of structured, accessible digital interventions within stepped-care models for mental health support. However, limitations in study design, sample representativeness, and follow-up duration suggest that further research is needed to assess the long-term effectiveness and broader applicability of such digital programs.
ClinicalTrials.gov NCT06166693; https://clinicaltrials.gov/study/NCT06166693.
在韩国，由于耻辱感、成本和自力更生的观念，获得心理健康服务的机会仍然有限。虽然数字干预有助于减少这些障碍，但很少有干预措施旨在解决导致心理困扰持续存在的潜在认知 - 情感模式。
本研究评估了一种基于图式的数字干预（Mindling）的有效性，该干预旨在减轻经历与图式相关困难（如完美主义（严苛标准图式）、低自我价值感（自我牺牲图式）、社交退缩（社会孤立和疏离图式）以及焦虑（消极和依赖图式））的成年人的困扰并增强应对能力。
通过网络招募了总共300名感知压力较高且有一种主要困扰模式的成年人（年龄在18 - 60岁之间），并将他们随机分为干预组（n = 201）或等待列表对照组（n = 99）。参与者被分配到四个基于网络的10周项目模块中的一个，这些模块根据他们的主要困扰模式量身定制：完美主义（Riggy）、低自我价值感和害怕被拒绝（取悦者）、社交退缩（雪莉）或慢性焦虑（神经质）。每个模块都包括心理教育、引导式反思和行为任务。在基线、干预中期（第5周）和干预后（第10周）测量结果，包括感知压力、完美主义、自尊、孤独感和焦虑。对完成所有三项评估的218名参与者（n = 138干预组；n = 80等待列表组）进行分析，根据情况使用重复测量方差分析或协方差分析。此外，仅对干预组进行了为期1个月的随访评估，以检查效果的维持情况。
与等待列表组相比，干预组在感知压力方面有显著更大的改善（F = 27.52；P <.001；偏η = 0.11），并且在与模式相关的结果方面也有改善：完美主义（F = 6.24；P =.003；偏η = 0.10）；自尊（F = 11.83；P <.001；偏η = 0.20）；孤独感（F = 8.26；P <.001；偏η = 0.13）；以及焦虑（F = 10.75；P <.001；偏η = 0.16）。大多数项目中的次要结果（如抑郁、特质焦虑和自我效能感）也有所改善。这些效果在1个月的随访中得以维持。作为补充发现，访问该平台的人依从性较高，70.1%（131 / 187）完成了所有10个疗程。干预组比等待列表组更有可能寻求外部心理健康服务（t = 2.59；P =.01；平均差异 = 0.45；95% CI 0.12 - 0.80）。
基于图式的数字干预在困扰及相关心理模式方面带来了显著（P <.05）的短期改善，参与者完成率高且寻求帮助的行为增加。这些发现表明，在心理健康支持的阶梯式护理模式中，结构化、可及的数字干预具有潜在效用。然而，研究设计、样本代表性和随访持续时间方面的局限性表明，需要进一步研究来评估此类数字项目的长期有效性和更广泛的适用性。
ClinicalTrials.gov NCT06166693；https://clinicaltrials.gov/study/NCT06166693
