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Zainal NH, Newman MG. 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. JMIR Ment Health 2024; 11:e54412. [PMID: 38787613 PMCID: PMC11161716 DOI: 10.2196/54412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/26/2023] [Accepted: 01/09/2024] [Indexed: 05/25/2024] Open
Abstract
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 fantasy (the ability to imagine being in others' shoes; between-intervention effect size: Cohen d=0.26, P=.007; within-intervention effect size: Cohen d=0.22, P=.02 for the mindfulness EMI and Cohen d=-0.16, P=.10 for the self-monitoring app). From pre-1MFU time points, the mindfulness EMI, but not the self-monitoring app, improved theory-of-mind (a window into others' thoughts and intentions through abstract, propositional knowledge about their mental states, encompassing the ability to decipher social cues) and the fantasy, personal distress (stress when witnessing others' negative experiences), and perspective-taking (understanding others' perspective) empathy domains. The effect sizes were small to moderate (Cohen d=0.15-0.36; P<.001 to P=.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 d=0.30-0.43; P<.001 to P=.03) than the self-monitoring app (Cohen d=-0.12 to 0.21; P=.001 to P>.99) from pre-1MFU time points. No between-intervention and within-intervention effects on empathic concern (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. TRIAL REGISTRATION ClinicalTrials.gov NCT04846777; https://clinicaltrials.gov/study/NCT04846777.
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Affiliation(s)
- Nur Hani Zainal
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States
- Department of Psychology, National University of Singapore, Singapore, Singapore
| | - Michelle G Newman
- Department of Psychology, The Pennsylvania State University, University Park, PA, United States
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Borghi O, Voracek M, Tran US. Day-to-day associations between mindfulness and perceived stress: insights from random intercept cross-lagged panel modeling. Front Psychol 2024; 15:1272720. [PMID: 38694436 PMCID: PMC11062411 DOI: 10.3389/fpsyg.2024.1272720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 04/04/2024] [Indexed: 05/04/2024] Open
Abstract
Objective Mindfulness is frequently seen as a protective factor of stress, but self-report measures of mindfulness may overlap with other related constructs, such as mental health, and could thus not only be a predictor, but also an outcome of stress. This study thus aimed to examine the longitudinal bidirectional associations between the use and perceived helpfulness of the four mindfulness facets Observe, Describe, Nonjudge, and Nonreact with daily perceived stress. Methods Participants from a large (N = 1,276) mixed student and community group sample filled out a brief daily diary over the time span of 7 days. Bidirectional cross-lagged effects were investigated using the random-intercept cross-lagged panel model, an extension of the traditional cross-lagged panel model that allows to differentiate between stable between-unit differences and time-varying within-unit dynamics. In addition, we controlled for several baseline and sociodemographic confounders. Results At the within-subject level, the use of Actaware was associated with higher perceived stress on the next day (β = 0.03, p = 0.029). The use (β = -0.04, p = 0.025) and perceived helpfulness (β = -0.05, p = 0.014) of Nonreact were associated with lower perceived stress on the next day. In turn, perceived stress was associated with lower perceived helpfulness of Describe (β = -0.04, p = 0.037) and Nonreact (β = -0.03, p = 0.038) on the next day. In addition, there were several residual correlations between mindfulness facets and perceived stress within days. At the between-subject level, there was a positive association between the random intercept of Describe and daily stress (r = 0.15, p = 0.003). In addition, while baseline perceived stress was negatively associated with the random intercepts of the mindfulness facets, two baseline components of mindfulness were not associated with the random intercept of perceived stress. Conclusion On the currently investigated time scale, our results challenge prior results and assumptions regarding mindfulness as a buffering and protective factor against daily stress. With the exception of Nonreact, mindfulness was either positively associated with perceived stress, or in turn perceived stress appeared to interfere with the ability to stay mindful in daily life.
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Affiliation(s)
- Olaf Borghi
- Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Martin Voracek
- Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
- University Research Platform “The Stress of Life (SOLE) – Processes and Mechanisms underlying Everyday Life Stress”, University of Vienna, Vienna, Austria
| | - Ulrich S. Tran
- Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
- University Research Platform “The Stress of Life (SOLE) – Processes and Mechanisms underlying Everyday Life Stress”, University of Vienna, Vienna, Austria
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Yu Y, Yan S, Zhang Q, Xu Z, Zhou G, Jin H. The Influence of Affective Empathy on Online News Belief: The Moderated Mediation of State Empathy and News Type. Behav Sci (Basel) 2024; 14:278. [PMID: 38667074 PMCID: PMC11047548 DOI: 10.3390/bs14040278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/10/2024] [Accepted: 03/25/2024] [Indexed: 04/29/2024] Open
Abstract
The belief in online news has become a topical issue. Previous studies demonstrated the role emotion plays in fake news vulnerability. However, few studies have explored the effect of empathy on online news belief. This study investigated the relationship between trait empathy, state empathy, belief in online news, and the potential moderating effect of news type. One hundred and forty undergraduates evaluated 50 online news pieces (25 real, 25 fake) regarding their belief, state empathy, valence, arousal, and familiarity. Trait empathy data were collected using the Chinese version of the Interpersonal Reactivity Index. State empathy was positively correlated with affective empathy in trait empathy and believability, and affective empathy was positively correlated with believability. The influence of affective empathy on news belief was partially mediated by state empathy and regulated by news type (fake, real). We discuss the influence of empathy on online news belief and its internal processes. This study shares some unique insights for researchers, practitioners, social media users, and social media platform providers.
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Affiliation(s)
- Yifan Yu
- Department of Psychology, Tianjin Normal University, Tianjin 300387, China; (Y.Y.)
| | - Shizhen Yan
- School of Health, Fujian Medical University, Fuzhou 350122, China;
| | - Qihan Zhang
- Department of Psychology, Tianjin Normal University, Tianjin 300387, China; (Y.Y.)
| | - Zhenzhen Xu
- Department of Psychology, Tianjin Normal University, Tianjin 300387, China; (Y.Y.)
| | - Guangfang Zhou
- Department of Psychology, Tianjin Normal University, Tianjin 300387, China; (Y.Y.)
| | - Hua Jin
- Department of Psychology, Tianjin Normal University, Tianjin 300387, China; (Y.Y.)
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Lengersdorff LL, Wagner IC, Mittmann G, Sastre-Yagüe D, Lüttig A, Olsson A, Petrovic P, Lamm C. Neuroimaging and behavioral evidence that violent video games exert no negative effect on human empathy for pain and emotional reactivity to violence. eLife 2023; 12:e84951. [PMID: 37975654 PMCID: PMC10791126 DOI: 10.7554/elife.84951] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 11/17/2023] [Indexed: 11/19/2023] Open
Abstract
Influential accounts claim that violent video games (VVGs) decrease players' emotional empathy by desensitizing them to both virtual and real-life violence. However, scientific evidence for this claim is inconclusive and controversially debated. To assess the causal effect of VVGs on the behavioral and neural correlates of empathy and emotional reactivity to violence, we conducted a prospective experimental study using functional magnetic resonance imaging (fMRI). We recruited 89 male participants without prior VVG experience. Over the course of two weeks, participants played either a highly violent video game or a non-violent version of the same game. Before and after this period, participants completed an fMRI experiment with paradigms measuring their empathy for pain and emotional reactivity to violent images. Applying a Bayesian analysis approach throughout enabled us to find substantial evidence for the absence of an effect of VVGs on the behavioral and neural correlates of empathy. Moreover, participants in the VVG group were not desensitized to images of real-world violence. These results imply that short and controlled exposure to VVGs does not numb empathy nor the responses to real-world violence. We discuss the implications of our findings regarding the potential and limitations of experimental research on the causal effects of VVGs. While VVGs might not have a discernible effect on the investigated subpopulation within our carefully controlled experimental setting, our results cannot preclude that effects could be found in settings with higher ecological validity, in vulnerable subpopulations, or after more extensive VVG play.
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Affiliation(s)
- Lukas Leopold Lengersdorff
- Social, Cognitive and Affective Neuroscience Unit, Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of ViennaViennaAustria
| | - Isabella C Wagner
- Social, Cognitive and Affective Neuroscience Unit, Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of ViennaViennaAustria
| | - Gloria Mittmann
- Social, Cognitive and Affective Neuroscience Unit, Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of ViennaViennaAustria
| | - David Sastre-Yagüe
- Social, Cognitive and Affective Neuroscience Unit, Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of ViennaViennaAustria
| | - Andre Lüttig
- Social, Cognitive and Affective Neuroscience Unit, Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of ViennaViennaAustria
| | - Andreas Olsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska InstituteStockholmSweden
| | - Pedrag Petrovic
- Department of Clinical Neuroscience, Division of Psychology, Karolinska InstituteStockholmSweden
| | - Claus Lamm
- Social, Cognitive and Affective Neuroscience Unit, Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of ViennaViennaAustria
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Zhu Y, Li S, Zhang R, Bao L, Zhang J, Xiao X, Jiang D, Chen W, Hu C, Zou C, Zhang J, Zhu Y, Wang J, Liang J, Yang Q. Enhancing doctor-patient relationships in community health care institutions: the Patient Oriented Four Habits Model (POFHM) trial-a stepped wedge cluster randomized trial protocol. BMC Psychiatry 2023; 23:476. [PMID: 37380993 DOI: 10.1186/s12888-023-04948-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 06/10/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND The poor relationship between doctors and patients is a long-standing, global problem. However, current interventions tend to focus on the training of physicians, while patient-targeted interventions still need to be improved. Considering that patients play a significant role in outpatient consultations, we developed a protocol to assess the effectiveness of the Patient Oriented Four Habits Model (POFHM) in improving doctor-patient relationships. METHODS A cross-sectional incomplete stepped-wedge cluster randomized trial design will be conducted in 8 primary healthcare institutions (PHCs). Following phase I of "usual care" as control measures for each PHC, either a patient- or doctor-only intervention will be implemented in phase II. In phase III, both patients and doctors will be involved in the intervention. This study will be conducted simultaneously in Nanling County and West Lake District. The primary outcomes will be evaluated after patients complete their visit: (1) patient literacy, (2) sense of control and (3) quality of doctor-patient communication. Finally, a mixed-effects model and subgroup analysis will be used to evaluate the effectiveness of the interventions. DISCUSSION Fostering good consultation habits for the patient is a potentially effective strategy to improve the quality of doctor-patient communication. This study evaluates the implementation process and develops a rigorous quality control manual using a theoretical domain framework under the collective culture of China. The results of this trial will provide substantial evidence of the effectiveness of patient-oriented interventions. The POFHM can benefit the PHCs and provide a reference for countries and regions where medical resources are scarce and collectivist cultures dominate. TRIAL REGISTRATION AsPredicted #107,282 on Sep 18, 2022; https://aspredicted.org/QST_MHW.
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Affiliation(s)
- Yunying Zhu
- School of Public Health, and Department of Geriatrics of the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, 310058, China
| | - Sisi Li
- School of Public Health, and Department of Geriatrics of the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, 310058, China
| | - Ruotong Zhang
- School of Public Health, and Department of Geriatrics of the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, 310058, China
| | - Lei Bao
- School of Public Health, and Department of Geriatrics of the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, 310058, China
| | - Jin Zhang
- School of Public Health, and Department of Geriatrics of the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, 310058, China
| | - Xiaohua Xiao
- School of Public Health, and Department of Geriatrics of the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, 310058, China
| | - Dongdong Jiang
- School of Public Health, and Department of Geriatrics of the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, 310058, China
| | - Wenxiao Chen
- School of Public Health, and Department of Geriatrics of the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, 310058, China
| | - Chenying Hu
- Community Health Service Center in Jiangcun Street, Hangzhou, 310050, Zhejiang Province, China
| | - Changli Zou
- Community Health Service Center in Sandun Town, Hangzhou, 310030, Zhejiang Province, China
| | - Jingna Zhang
- Community Health Service Center in Liuxia Street, Hangzhou, Zhejiang Province, 310050, China
| | - Yong Zhu
- Xu Zhen Town Center Health Center, Wuhu, 241306, Anhui Province, China
| | - Jianqiu Wang
- Community Health Service Center in Jishan Town, Wuhu, 241307, Anhui Province, China
| | - Jinchun Liang
- Nanling County Traditional Chinese Medicine Hospital, Wuhu, 241307, Anhui Province, China
| | - Qian Yang
- School of Public Health, and Department of Geriatrics of the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, 310058, China.
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