Examining the Effects of a Brief, Fully Self-Guided Mindfulness Ecological Momentary Intervention on Empathy and Theory-of-Mind for Generalized Anxiety Disorder: Randomized Controlled Trial (Preprint)
Authors: Zainal Nur Hani , Newman Michelle G 
Published: May 2024

BACKGROUND

The utility of brief mindfulness ecological momentary interventions (EMIs) to improve empathy and theory-of-mind has been underinvestigated, particularly in generalized anxiety disorder (GAD).

OBJECTIVE

In this randomized controlled trial, we aimed to examine the efficacy of a 14-day, fully self-guided, mindfulness EMI on the empathy and theory-of-mind domains for GAD.

METHODS

Adults (aged ≥18 y) diagnosed with GAD were randomized to a mindfulness EMI (68/110, 61.8%) or self-monitoring app (42/110, 38.2%) arm. They completed the Interpersonal Reactivity Index self-report empathy measure and theory-of-mind test (Bell-Lysaker Emotion Recognition Task) at prerandomization, postintervention, and 1-month follow-up (1MFU) time points. Hierarchical linear modeling was conducted with the intent-to-treat principle to determine prerandomization to postintervention (pre-post intervention) and prerandomization to 1MFU (pre-1MFU) changes, comparing the mindfulness EMI to self-monitoring.

RESULTS

Observed effects were generally stronger from pre-1MFU than from pre-post intervention time points. From pre-post intervention time points, the mindfulness EMI was more efficacious than the self-monitoring app on <i>fantasy</i> (the ability to imagine being in others’ shoes; between-intervention effect size: Cohen <i>d</i>=0.26, <i>P=</i>.007; within-intervention effect size: Cohen <i>d</i>=0.22, <i>P=</i>.02 for the mindfulness EMI and Cohen <i>d</i>=−0.16, <i>P=</i>.10 for the self-monitoring app). From pre-1MFU time points, the mindfulness EMI, but not the self-monitoring app, improved <i>theory-of-mind</i> (a window into others’ thoughts and intentions through abstract, propositional knowledge about their mental states, encompassing the ability to decipher social cues) and the <i>fantasy</i>, <i>personal distress</i> (stress when witnessing others’ negative experiences), and <i>perspective-taking</i> (understanding others’ perspective) empathy domains. The effect sizes were small to moderate (Cohen <i>d</i>=0.15-0.36; <i>P</i>&lt;.001 to <i>P</i>=.01) for significant between-intervention effects from pre-1MFU time points. Furthermore, the within-intervention effect sizes for these significant outcomes were stronger for the mindfulness EMI (Cohen <i>d</i>=0.30-0.43; <i>P</i>&lt;.001 to <i>P</i>=.03) than the self-monitoring app (Cohen <i>d</i>=−0.12 to 0.21; <i>P=</i>.001 to <i>P</i>&gt;.99) from pre-1MFU time points. No between-intervention and within-intervention effects on <i>empathic concern</i> (feeling affection, compassion, and care when observing others in distress, primarily attending to their emotional well-being) were observed from pre-post intervention and pre-1MFU time points.

CONCLUSIONS

The brief mindfulness EMI improved specific domains of empathy (eg, fantasy, personal distress, and perspective-taking) and theory-of-mind with small to moderate effect sizes in persons with GAD. Higher-intensity, self-guided or coach-facilitated, multicomponent mindfulness EMIs targeting the optimization of social relationships are likely necessary to improve the empathic concern domain in this population.

CLINICALTRIAL

ClinicalTrials.gov NCT04846777; https://clinicaltrials.gov/study/NCT04846777