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 (Preprint)
Authors: Zainal Nur Hani , Tan Hui Han , Hong Ryan Yee Shiun , Newman Michelle Gayle 
Published: April 2024

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 <i>d</i>=−0.24) and lack of emotional clarity (Cohen <i>d</i>=0.16) and increasing self-compassion social connectedness (Cohen <i>d</i>=0.19), nonidentification with emotions (Cohen <i>d</i>=0.16), and self-kindness (Cohen <i>d</i>=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 <i>d</i>=−0.73 vs −0.29, lack of emotional clarity: Cohen <i>d</i>=−0.39 vs −0.21, self-compassion domains of social connectedness: Cohen <i>d</i>=0.45 vs 0.19, nonidentification with emotions: Cohen <i>d</i>=0.63 vs 0.48, and self-kindness: Cohen <i>d</i>=0.36 vs 0.10). Self-monitoring, but not MEMI, alleviated ER emotional awareness issues (between-group Cohen <i>d</i>=0.11 and within-group: Cohen <i>d</i>=−0.29 vs −0.13) and reduced self-compassion acknowledging shared human struggles (between-group Cohen <i>d</i>=0.26 and within-group: Cohen <i>d</i>=−0.23 vs 0.13). No ER and self-compassion domains were mediators of the effect of MEMI on SAD symptoms (<i>P</i>=.07-&lt;.99), generalized anxiety symptoms (<i>P</i>=.16-.98), depression severity (<i>P</i>=.20-.94), repetitive negative thinking (<i>P</i>=.12-.96), and trait mindfulness (<i>P</i>=.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 (<i>P</i>=.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.

CLINICALTRIAL

Open Science Framework (OSF) Registries; osf.io/m3kxz https://osf.io/m3kxz