Abstract
Objectives
Internet-based self-help Mindfulness Intervention for Emotional Distress (iMIED) program is a newly developed program targeting essential transdiagnostic factors underlying emotional distress, the effects of which have gained initial support in sub-clinical samples. The current study investigated its effects on the underlying mechanisms by examining mindfulness and experiential avoidance as putative mediators.
Method
Patients with emotional disorders were recruited online. After interviews, 75 patients were randomly allocated to either iMIED (n = 37) including treatment as usual (TAU) or TAU-only control group (n = 38). Mindfulness, experiential avoidance, and emotional distress (i.e., anxiety, depression, and general emotional distress) were measured before (T0) and after the intervention (T8). During the intervention period, mindfulness was measured weekly (T1–T7); experiential avoidance was measured at Week 2 (T2) and Week 5 (T5).
Results
Intention-to-treat 2 × 2 repeated-measures ANOVAs showed that, compared with the TAU-only group, mindfulness, experiential avoidance, and emotional distress significantly improved in the iMIED + TAU group (Cohen’s d = 0.53–0.79). Latent growth curve analyses showed that more than half of the improvement in mindfulness and experiential avoidance occurred at T3 and T5, respectively. Serial mediation analyses found that mindfulness at T3 and experiential avoidance at T5 sequentially mediated the effects of the iMIED program on emotional distress.
Conclusions
The current study, using a randomized controlled trial with multiple time-point measurements, demonstrated that the iMIED program offers a scalable approach for the management of emotional distress by increasing mindfulness and decreasing experiential avoidance.
Preregistration
The current study was preregistered in the Chinese Clinical Trial Registry (http://www.chictr.org.cn/, Registration number: ChiCTR2100044480).
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Data Availability
The data that support the findings of this study are openly available in Open Science Framework at https://osf.io/79njr/ (file name = data_raw_withDataUsedInTheCurrentPaper.sav and data_EMimputation_withDataUsedInTheCurrentPaper.sav). We exclude other data collected in the same experiments (e.g., sleep quality and somatic symptoms) since they are not the outcome variables of interest in the current manuscript.
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Acknowledgements
We thank all the participants who participated in this study. We thank Kaerqika Shalihaer, Wingsze Chiu, Xinfen Li, You Chen, and Zhu Liu for helping conduct the interview and collect the data. We thank Doctor Liu Lijun for helping post the recruitment advertisement. We thank Ivan McNally for helping edit the language.
Funding
This work was supported by the National Natural Science Foundation of China (Project No. 31971016) and the National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital; Project No. NCRC2021M01). The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.
Dr. Hofmann received financial support from the Alexander von Humboldt Foundation and the James S. McDonnell Foundation 21st Century Science Initiative in Understanding Human Cognition – Special Initiative. He receives compensation for his work as editor from SpringerNature and the Association for Psychological Science, and as an advisor from the Palo Alto Health Sciences, Otsuka Pharmaceuticals, and Jazz Pharmaceuticals, and for his work as a Subject Matter Expert from John Wiley & Sons, Inc. and SilverCloud Health, Inc. He also receives royalties and payments for his editorial work from various publishers.
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XL and YL designed the study. YL collected, analyzed, and interpreted the data, and wrote and revised the manuscript. XL designed the intervention program, commented on the manuscript, and supervised the whole study. AJZ delivered the intervention material, reanalyzed the data, checked the results, and edited the manuscript. YM helped conduct the interview and collected the data. SGH and YZ collaborated by editing and revising the manuscript.
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Li, Y., Zhang, A.J., Meng, Y. et al. A Randomized Controlled Trial of an Online Self-Help Mindfulness Intervention for Emotional Distress: Serial Mediating Effects of Mindfulness and Experiential Avoidance. Mindfulness 14, 510–523 (2023). https://doi.org/10.1007/s12671-023-02083-x
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DOI: https://doi.org/10.1007/s12671-023-02083-x