Pirbaglou Meysam, El Morr Christo, Ahmad Farah, Ritvo Paul
School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, ON, Canada.
School of Health Policy & Management, Faculty of Health, York University, Toronto, ON, Canada.
JMIR Ment Health. 2025 Aug 18;12:e65853. doi: 10.2196/65853.
Mindfulness-based interventions (MBIs) are widely used in mental health promotion and treatment. Despite widespread evidence of effectiveness with different populations and delivery modes, there are sparse findings concerning the mechanisms of action in MBIs.
The objective of this paper was to understand the mediators of the Mindfulness Virtual Community (MVC) intervention, an 8-week, multicomponent, online mindfulness and cognitive-behavioral therapy (M-CBT) intervention, based on a secondary evaluation of 2 randomized controlled trials (RCTs) with student participants.
Mediation analysis, using structural equation modeling, was used to assess direct and indirect relationships between study group (ie, intervention or wait list control) and outcomes. Consistent with the intervention's theoretical perspective and direct effects paths, a model was specified to evaluate whether mindful nonreactivity, as evaluated by the 5-factor mindfulness questionnaire, mediated the effect of MVC intervention on anxiety and depression (as symptom-driven outcomes), and perceived stress and quality of life (as functional outcomes). The model included additional mediating paths for perceived stress through anxiety and depression, and for quality of life through anxiety, depression, and perceived stress. The model was thereafter extended, adjusting for pre-intervention differences in mindfulness (ie, observing, describing, activity with awareness, nonjudgment, and nonreactivity) facets.
Direct (nonmediated) effects indicated statistically significant differences at 8 weeks between the MVC and waitlist control (WLC) groups on depression (-1.72; P=.002), anxiety (-3.40; P=.001), perceived stress (-2.44; P<.001), quality of life (4.31; P=.005), and the nonreactivity facet of mindfulness (1.63; P<.001), in favor of the MVC intervention. Mediation analysis supported the mediating role of the nonreactivity facet of mindfulness, depression, anxiety, and perceived stress through single and sequential mediation paths. Results indicated good fit characteristics for the main (comparative fit index [CFI]=.99; root-mean-square error of approximation [RMSEA]=.05; standardized root-mean-square residual [SRMR]=.05) and extended (CFI=.99; RMSEA=.04; SRMR=.04) models.
This research underscores the importance of mindful nonreactivity, depression, and anxiety as key mediators of MVC intervention benefits.
基于正念的干预措施（MBIs）广泛应用于心理健康促进和治疗。尽管有大量证据表明其在不同人群和实施方式中有效，但关于MBIs作用机制的研究结果却很少。
本文旨在通过对两项针对学生参与者的随机对照试验（RCTs）进行二次评估，了解正念虚拟社区（MVC）干预措施的中介因素。MVC干预是一项为期8周的多成分在线正念和认知行为疗法（M-CBT）干预。
采用结构方程模型进行中介分析，以评估研究组（即干预组或等待名单对照组）与结果之间的直接和间接关系。根据干预的理论观点和直接效应路径，构建一个模型来评估通过五因素正念问卷评估的正念非反应性是否介导了MVC干预对焦虑和抑郁（作为症状驱动的结果）以及感知压力和生活质量（作为功能结果）的影响。该模型还包括通过焦虑和抑郁对感知压力的额外中介路径，以及通过焦虑、抑郁和感知压力对生活质量的中介路径。此后，对模型进行扩展，调整干预前正念（即观察、描述、有意识活动、非评判和非反应性）各方面的差异。
直接（非中介）效应表明MVC组和等待名单对照组（WLC）在8周时在抑郁（-1.72；P = 0.002）、焦虑（-3.40；P = 0.001）、感知压力（-2.44；P < 0.001）、生活质量（4.31；P = 0.005）以及正念的非反应性方面（1.63；P < 0.001）存在统计学显著差异，支持MVC干预。中介分析通过单一和顺序中介路径支持了正念的非反应性、抑郁、焦虑和感知压力的中介作用。结果表明主要模型（比较拟合指数[CFI]=0.99；近似均方根误差[RMSEA]=0.05；标准化均方根残差[SRMR]=0.05）和扩展模型（CFI = 0.99；RMSEA = 0.04；SRMR = 0.04）具有良好的拟合特征。
本研究强调了正念非反应性、抑郁和焦虑作为MVC干预益处的关键中介因素的重要性。
