Effectiveness of an Internet-Based, Self-Guided, Short-Term Mindfulness Training (ISSMT) Program for Relieving Depressive Symptoms in the Adult Population in China: Single-Blind, Randomized Controlled Trial
Open accessPublished version of a preprint
Abstract
Background: Depression is a significant global public health issue, and in China, access to mental health services remains limited despite high demand. Research has shown that mindfulness can effectively alleviate depressive symptoms and that telehealth solutions offer a promising avenue for addressing this service gap. Despite this potential, there are currently few studies in China focusing on short-term online mindfulness training. Most existing online mindfulness studies relied on traditional 8-week programs, which can be challenging for participant adherence due to limited accessibility and high dropout rates. Additionally, limited research exists on short-term online mindfulness interventions, and findings remain inconsistent. Objective: This study aimed to develop and evaluate an internet-based, self-guided, short-term mindfulness training (ISSMT) program based on the Monitor and Acceptance Theory (MAT) to reduce depression symptoms. Methods: The ISSMT program was delivered via an online platform, “Hi Emotion,” and was accessible to the general public. Interested individuals aged 18 years and older were randomized into either the ISSMT group or a wait-list control group. Participants in the ISSMT group received daily reminders to participate in a 15- to 20-minute session over a 14-day training period. Measurements, including mindfulness and depressive symptoms, were collected at baseline and weekly for the subsequent 3 weeks. Results: A total of 205 adults participated in the 14-day online intervention. Linear mixed models were used to analyze both per-protocol (PP) and intention-to-treat (ITT) samples. Compared with the wait-list control group, participants in the ISSMT group showed significant improvements in mindfulness (Cohen d=0.44 for ITT; Cohen d=0.55 for PP) and reductions in depressive symptoms (Cohen d=0.50 for ITT; Cohen d=0.53 for PP). Furthermore, participants expressed high acceptance of this training format with a relatively low dropout rate (<40%). Conclusions: The ISSMT program based on the MAT effectively enhanced mindfulness and alleviated depressive symptoms. This intervention could be considered for integration into psychosocial service systems to improve mental health outcomes and help bridge the gap between limited resources and the high demand for services in China. Future research should focus on personalizing these programs and incorporating advanced technologies to enhance their effectiveness and user engagement. Trial Registration: Open Science Framework; https://doi.org/10.17605/OSF.IO/8P4V6
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Mindfulness meditation improves cognition: evidence of brief mental training
Zeidan, F., Johnson, S. K., Diamond, B. J., David, Z., & Goolkasian, P. (2010) · Consciousness and Cognition · doi:10.1016/j.concog.2010.03.014 · Cited by 1,363 · see citing works
Vago, D. R., & Silbersweig, D. A. (2012) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2012.00296 · Cited by 1,310 · see citing works
Adherence in Internet Interventions for Anxiety and Depression
Christensen, H., Griffiths, K. M., & Farrer, L. (2009) · Journal of Medical Internet Research · doi:10.2196/jmir.1194 · Cited by 1,133 · see citing works
Spijkerman, M. P. J., Pots, W. T. M., & Bohlmeijer, E. T. (2016) · Clinical Psychology Review · doi:10.1016/j.cpr.2016.03.009 · Cited by 975 · cited 2× · see citing works
“The effect size ( d =0.80) of self-help training protocols is only slightly lower than that of standardized treatment protocols ( d =0.82) [10-15].”
InfluentialMechanisms of mindfulness training: Monitor and Acceptance Theory (MAT
Lindsay, E. K., & Creswell, J. D. (2017) · Clinical Psychology Review · doi:10.1016/j.cpr.2016.10.011 · Cited by 919 · see citing works
Prevalence of depressive disorders and treatment in China: a cross-sectional epidemiological study
Lu, J., Xu, X., Huang, Y., Li, T., Ma, C., Xu, G., Yin, H., Xu, X., Ma, Y., Wang, L., et al. (2021) · The Lancet Psychiatry · doi:10.1016/s2215-0366(21)00251-0 · Cited by 844 · cited 1× · see citing works
“A recent study revealed that, in China, fewer than 10% of patients with depression received any form of treatment, with only 0.5% receiving adequate care [6].”
InfluentialMindfulness-based interventions: an overall review
Zhang, D., Lee, E. K. P., Mak, E. C. W., Ho, C. Y., & Wong, S. Y. S. (2021) · British Medical Bulletin · doi:10.1093/bmb/ldab005 · Cited by 668 · see citing works
Dropout from Internet‐based treatment for psychological disorders
Melville, K. M., Casey, L. M., & Kavanagh, D. J. (2010) · British Journal of Clinical Psychology · doi:10.1348/014466509x472138 · Cited by 597 · see citing works
Goldberg, S. B., Riordan, K. M., Sun, S., & Davidson, R. J. (2022) · Perspectives on Psychological Science · doi:10.1177/1745691620968771 · Cited by 520 · cited 3× · see citing works
“A meta-analysis of 44 meta-analyses encompassing various populations, problems, training, comparisons, and outcomes revealed that mindfulness training demonstrated significant effects and advantages ( d =0.10-0.89), including for depression ( d =0.49), compared with negative controls [20].”
InfluentialNovel Models for Delivering Mental Health Services and Reducing the Burdens of Mental Illness
Kazdin, A. E., & Rabbitt, S. M. (2013) · Clinical Psychological Science · doi:10.1177/2167702612463566 · Cited by 465 · cited 1× · see citing works
“The convenience and accessibility of online training programs make them an important supplement to offline training, helping to bridge the gap between limited medical resources and the vast mental health service needs in China [61].”
Erisman, S. M., & Roemer, L. (2010) · Emotion · doi:10.1037/a0017162 · Cited by 411 · cited 1× · see citing works
“…immediate emotional states (eg, a single 10-minute mindfulness meditation training can reduce the intensity of negative affect in response to emotional stimuli [55]), our findings indicated that certain “doses” of training may be necessary to ensure the effectiveness of internet-delivered training.”
A randomised controlled trial of a brief online mindfulness-based intervention
Cavanagh, K., Strauss, C., Cicconi, F., Griffiths, N., Wyper, A., & Jones, F. (2013) · Behaviour Research and Therapy · doi:10.1016/j.brat.2013.06.003 · Cited by 350 · see citing works
Ryan, M. L., Shochet, I. M., & Stallman, H. M. (2010) · Advances in Mental Health · doi:10.5172/jamh.9.1.73 · Cited by 252 · see citing works
Online randomized controlled trial of brief and full cognitive behaviour therapy for depression
CHRISTENSEN, H., GRIFFITHS, K. M., MACKINNON, A. J., & BRITTLIFFE, K. (2006) · Psychological Medicine · doi:10.1017/s0033291706008695 · Cited by 249 · see citing works
Compen, F., Bisseling, E., Schellekens, M., Donders, R., Carlson, L., van der Lee, M., & Speckens, A. (2018) · Journal of Clinical Oncology · doi:10.1200/jco.2017.76.5669 · Cited by 248 · see citing works
Christensen, H., Griffiths, K. M., Korten, A. E., Brittliffe, K., & Groves, C. (2004) · Journal of Medical Internet Research · doi:10.2196/jmir.6.4.e46 · Cited by 240 · cited 3× · see citing works
“High dropout rates are a well-documented challenge for internet-based psychological training, with reported rates ranging from 73.9% to 99.2% in other studies [42,43,57,58].”
InfluentialReger, M. A., & Gahm, G. A. (2009) · Journal of Clinical Psychology · doi:10.1002/jclp.20536 · Cited by 234 · see citing works
Lindsay, E. K., Young, S., Smyth, J. M., Brown, K. W., & Creswell, J. D. (2018) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2017.09.015 · Cited by 226 · see citing works
Lindsay, E. K., Young, S., Smyth, J. M., Brown, K. W., & Creswell, J. D. (2017) · doi:10.31219/osf.io/4se5m · Cited by 226 · see citing works
Farvolden, P., Denisoff, E., Selby, P., Bagby, R. M., & Rudy, L. (2005) · Journal of Medical Internet Research · doi:10.2196/jmir.7.1.e7 · Cited by 223 · cited 1× · see citing works
“High dropout rates are a well-documented challenge for internet-based psychological training, with reported rates ranging from 73.9% to 99.2% in other studies [42,43,57,58].”
InfluentialEffects of Brief Mindfulness-Based Interventions on Health-Related Outcomes: a Systematic Review
Howarth, A., Smith, J. G., Perkins-Porras, L., & Ussher, M. (2019) · Mindfulness · doi:10.1007/s12671-019-01163-1 · Cited by 219 · see citing works
Krusche, A., Cyhlarova, E., & Williams, J. M. G. (2013) · BMJ Open · doi:10.1136/bmjopen-2013-003498 · Cited by 192 · see citing works
Chen, Y., Yang, X., Wang, L., & Zhang, X. (2013) · Nurse Education Today · doi:10.1016/j.nedt.2012.11.014 · Cited by 189 · see citing works
Sommers-Spijkerman, M., Austin, J., Bohlmeijer, E., & Pots, W. (2021) · JMIR Mental Health · doi:10.2196/28168 · Cited by 179 · cited 2× · see citing works
“Among the various mindfulness-based interventions, 2 of the most widely implemented are Mindfulness-Based Stress Reduction (MBSR) and mindfulness-based cognitive therapy [22].”
A randomized controlled pilot study of a brief web-based mindfulness training
Glück, T. M., & Maercker, A. (2011) · BMC Psychiatry · doi:10.1186/1471-244x-11-175 · Cited by 168 · see citing works
Berger, T., Boettcher, J., & Caspar, F. (2014) · Psychotherapy · doi:10.1037/a0032527 · Cited by 158 · see citing works
Christ, C., Schouten, M. J., Blankers, M., van Schaik, D. J., Beekman, A. T., Wisman, M. A., Stikkelbroek, Y. A., & Dekker, J. J. (2020) · Journal of Medical Internet Research · doi:10.2196/17831 · Cited by 148 · see citing works
Meta-review of the effectiveness of computerised CBT in treating depression
Foroushani, P. S., Schneider, J., & Assareh, N. (2011) · BMC Psychiatry · doi:10.1186/1471-244x-11-131 · Cited by 132 · see citing works
Campo, R. A., Bluth, K., Santacroce, S. J., Knapik, S., Tan, J., Gold, S., Philips, K., Gaylord, S., & Asher, G. N. (2017) · Supportive Care in Cancer · doi:10.1007/s00520-017-3586-y · Cited by 123 · cited 1× · see citing works
“The Intervention Satisfaction Scale designed by Campo et al [47] was used to measure the feasibility of participants’ participation and evaluated satisfaction with the internet-based training.”
Wahbeh, H., Svalina, M. N., & Oken, B. S. (2014) · Open Medicine Journal · doi:10.2174/1874220301401010066 · Cited by 116 · cited 1× · see citing works
“[7].”
Mak, W. W., Chan, A. T., Cheung, E. Y., Lin, C. L., & Ngai, K. C. (2015) · Journal of Medical Internet Research · doi:10.2196/jmir.3746 · Cited by 110 · see citing works
Brief Online Mindfulness Training: Immediate Impact
Kemper, K. J. (2017) · Journal of Evidence-Based Complementary & Alternative Medicine · doi:10.1177/2156587216639199 · Cited by 60 · see citing works
Osborne, E. L., Ainsworth, B., Hooper, N., & Atkinson, M. J. (2023) · Journal of Medical Internet Research · doi:10.2196/44220 · Cited by 37 · cited 1× · see citing works
“[16-20], with substantial evidence supporting its positive impact on depression [19,20].”
Flagged first, then by citations
- Authors
- Zhu, T., Zhang, L., Weng, W., Gan, R., Sun, L., Wei, Y., Zhu, Y., Yu, H., Xue, J., & Chen, S.
- Affiliations
- Shanghai Jiao Tong University (CN)
- Zhejiang University (CN)
- Guangdong Medical College (CN)
- Corresponding author
- Chen, Shulin
- ORCID
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2025-02-13
- Volume
- 27
- Pages
- e55583
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC11888059
- OpenAlex
- W4405360003
- Cited by
- 5
- References
- 33
- Citations by year
- 2026: 3 · 2025: 2
- FWCI
- 2.50
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Shanghai Jiao Tong University
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- mindfulness training, depressive symptoms, depression, online intervention, self-guided intervention, brief intervention, telemedicine, mental health treatment gap, mindfulness, dropout, China, digital platforms, user engagement, program acceptance, psychosocial services, access to mental health care
- MeSH terms
- Internet-Based Intervention, Adult, China, Depression, Female, Humans, Male, Middle Aged, Single-Blind Method, Telemedicine, Internet, Young Adult, Mindfulness
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
