The Role of Cognitive Flexibility in Mindfulness Intervention for Emotional Distress

Study Overview
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Brief Summary
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This study hopes to: explore whether offline and online mindfulness interventions can significantly alleviate individual emotional distress and improve cognitive flexibility level. explore whether cognitive flexibility is a mediator in mindfulness intervention to alleviate emotional distress, and to meet the principles of mechanism.

Detailed Description
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Cognitive flexibility is a component of executive function, which refers to the ability to transform cognitive models to adapt to changing environmental needs. Studies have shown that people with less cognitive flexibility are less effective at using cognitive restructuring techniques to alleviate emotional distress than those with better cognitive flexibility, which seems to predict the level of cognitive flexibility. Cognitive flexibility levels at the three-month follow-up period were significantly negatively correlated with depression levels and suicidal ideation, and higher levels of cognitive flexibility at baseline significantly predicted lower levels of depression and suicidal ideation in military personnel at the three-month follow-up period. Task switching task was used to measure emotional cognitive flexibility, and explored whether individual differences in cognitive flexibility predicted higher levels of trait anxiety and worry within seven weeks. The results showed that emotional cognitive flexibility in the baseline period seemed to predict anxiety and worry levels after seven weeks. There is a significant positive correlation between mindfulness and cognitive flexibility. One study compared the changes of cognitive flexibility between the mindfulness based cognitive therapy (MBCT) intervention group and the waiting control group in a randomized controlled study of patients with mild to moderate depression. The results showed that the self-reported cognitive flexibility of the MBCT intervention group was significantly higher than that of the waiting control group, and was significantly correlated with the relief of depressive symptoms. Generally speaking, exploring the mechanism of the effect of mindfulness-based intervention on emotional distress is helpful to strengthen the positive components of the intervention to optimize the therapeutic effect, distinguish the specificity of treatment from the broader non-specific effect, promote the identification of therapeutic regulators and the matching of therapeutic individuals, and provide information for theoretical development and interpretation of results. With the rapid development of online projects and online platforms, online mindfulness courses begin to receive more and more attention, and show a good application prospect. However, there are few studies on online mindfulness courses at present. In order to better understand the effectiveness of online mindfulness courses, more randomized controlled trials need to be done in the future. Therefore, this study will explore the effect of mindfulness intervention on emotional distress and the mechanism of cognitive flexibility based on the basic criterion to judge the mechanism of psychological intervention.

Official Title
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Exploring the Mechanism of Mindfulness Interventions for Emotional Distress: the Role of Cognitive Flexibility

Conditions
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Emotional Distress

Intervention / Treatment
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* Behavioral: Mindfulness Intervention for Emotional Distress(MIED)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: • Subjects with scores greater than 21 on the Kessler Psychological Distress Scale. Exclusion Criteria: • Subjects who could not access the Internet; Subjects with insufficient Chinese ability; Subjects who have participated in mindfulness based projects for more than 6 weeks before, and / or the current frequency of meditation practice is more than once a week; Patients with schizophrenia or psychotic affective disorder, current organic mental disorder, substance abuse disorder and generalized developmental disorder; Subjects at risk of suicide.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: MIED group<br>provide standard audio instructions for mindfulness exercises, introduce the nature and law of anxiety, depression and other emotions, the source of anxiety, depression and other emotional distress, and the strategies and methods to alleviate emotional distress. These exercises, knowledge and strategies are based on the latest progress in the field of psychological counseling and treatment, and their application in daily life can help alleviate anxiety, depression and other emotional problems | Behavioral: Mindfulness Intervention for Emotional Distress(MIED)<br>* The MIED program integrates the rationales and practices from the Unified Protocol for Treatment of Emotional Disorders (UP) and Mindfulness based Interventions. Formal mindfulness exercises (e.g., body scan, mindful breathing, and mindful stretching) and informal mindfulness practices (e.g., mindful tooth brushing) were adapted from Mindfulness based intervention (MBIs). The offline received the 8-week (2.5-h per week) sessions.The online MIED program was delivered by a Chat Mini Program and lasted for 49 days. Each day, participants received different materials including (a) an audio recording of mindfulness meditation guidance; (b) learning materials in text or audio; and (c) assignments (for example, informal mindfulness practice, emotion journal, and challenging tasks). In total, it took about 30 min per day to finish all the tasks.<br>|
| No Intervention: Waitlist control group<br>no intervention. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Weekly changes of Five Facet Mindfulness Questionnaire during the intervention | The Five Facet Mindfulness Questionnaire is a self-reported questionnaire measuring mindfulness levels. Scores range from 39 to 195, with higher scores indicating higher levels of mindfulness. | pre-intervention; weekly during the 7-week intervention; after the 7-week intervention | 
| Weekly changes of Chinese Perceived Stress Scale during the intervention | The Chinese Perceived Stress Scale is a self-reported questionnaire measuring stress. Scores range from 0 to 56, with higher scores indicating higher levels of stress. | pre-intervention; weekly during the 7-week intervention; after the 7-week intervention | 
| Weekly changes of 10-item Kessler Psychological Distress Scale during the intervention | The 10-item Kessler Psychological Distress Scale is a self-reported questionnaire measuring distress. Scores range from 10 to 50, with higher scores indicating higher levels of distress. | pre-intervention; weekly during the 7-week intervention; after the 7-week intervention | 
| Weekly changes of Overall Anxiety Severity and Impairment Scale during the intervention | The Overall Anxiety Severity and Impairment Scale is a self-reported questionnaire measuring anxiety. Scores range from 0 to 20, with higher scores indicating higher levels of anxiety. | pre-intervention; weekly during the 7-week intervention; after the 7-week intervention | 
| Weekly changes of Overall Depression Severity and Impairment Scale during the intervention | The Overall Depression Severity and Impairment Scale is a self-reported questionnaire measuring depression. Scores range from 0 to 20, with higher scores indicating higher levels of depression. | pre-intervention; weekly during the 7-week intervention; after the 7-week intervention | 
| Weekly changes of Inner Peace Scale during the intervention | The Inner Peace Scale is a self-reported questionnaire measuring peace. Scores range from 0 to 28, with higher scores indicating higher levels of peace. | pre-intervention; weekly during the 7-week intervention; after the 7-week intervention | 
| Weekly changes of 16items Chinese Version of the Attentional Control Scale during the intervention | 16items Chinese Version of the Attentional Control Scale is a self-reported questionnaire measuring attentional control level.Scores range from 16 to 64, with higher scores indicating higher levels of Attentional Control. | pre-intervention; weekly during the 7-week intervention; after the 7-week intervention | 
| Weekly changes of Cognitive flexibility Inventory during the intervention | Cognitive flexibility Inventory is a self-reported questionnaire measuring Cognitive flexibility level.Scores range from 20 to 100, with higher scores indicating higher levels of Cognitive flexibility. | pre-intervention; weekly during the 7-week intervention; after the 7-week intervention | 
| Weekly changes of Decentralized Questionnaire during the intervention | Decentralized Questionnaire is a self-reported questionnaire measuring decentralization ability. Scores range from 20 to 100, with higher scores indicating higher levels of Decentralized ability. | pre-intervention; weekly during the 7-week intervention; after the 7-week intervention | 
| Weekly changes of Beck Depression Inventory during the intervention | Beck Depression Inventory is a self-reported questionnaire measuring depression level.Scores range from 0 to 63, with higher scores indicating higher levels of depression. | pre-intervention; weekly during the 7-week intervention; after the 7-week intervention | 
| Weekly changes of Beck Anxiety Inventory during the intervention | Beck Anxiety Inventory is a self-reported questionnaire measuring Anxiety level.Scores range from 0 to 63, with higher scores indicating higher levels of Anxiety. | pre-intervention; weekly during the 7-week intervention; after the 7-week intervention | 
| Weekly changes of Ruminative Responses Subscale during the intervention | Ruminative Responses Subscale is a self-reported questionnaire measuring Ruminative Responses level.Scores range from 22 to 88, with higher scores indicating higher levels of Ruminative Responses. | pre-intervention; weekly during the 7-week intervention; after the 7-week intervention | 
| Weekly changes of Emotion Regulation Questionnaire during the intervention | Emotion Regulation Questionnaire is a self-reported questionnaire measuring cognitive reappraisal level.Scores range from 6 to 42, with higher scores indicating higher levels of cognitive reappraisal ability. | pre-intervention; weekly during the 7-week intervention; after the 7-week intervention | 
| Weekly changes of Automatic thoughts questionnaire during the intervention | Automatic thoughts questionnaire is a self-reported questionnaire measuring Automatic thoughts level.Scores range from 30 to 160, with higher scores indicating higher levels of Automatic thoughts. | pre-intervention; weekly during the 7-week intervention; after the 7-week intervention | 
| Weekly changes of Cognitive biases questionnaire during the intervention | Cognitive biases questionnaire is a self-reported questionnaire measuring Cognitive biases level.The score compares the scores of four depression-distortion combinations on a scale of 0 to 23. | pre-intervention; weekly during the 7-week intervention; after the 7-week intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| a. Task Switching Task | The measurement of cognitive flexibility comes from the task switching paradigm, in which participants are required to classify emotional images according to emotional task rules or non-emotional task rules. In emotional task rules, participants are instructed to classify images according to whether the depicted scene is positive or negative. For non-emotional task rules, participants must indicate whether the number of people in the graph is one or none (≤ 1), or two or more (≥ 2). Even if there is only a part of a person's body, it counts. The image is taken from the International emotional Image system (International Affective Picture System,IAPS). There are 40 pictures in each category: ≤ 1 person + positive, ≥ 2 + positive, ≤ 1 person + negative, ≥ 2 + negative, a total of 160 pictures. Positive and negative images differ in titer ratings, but are balanced in evocative ratings. Another 20 pictures are used for the practice module. | pre-intervention; after the 3rd week intervention; after the 5rd week intervention; after the 7-week intervention |