Anxiety Disorders, Depressive Disorder, Mental Health
Conditions
Keywords
Mindfulness, Depression, Emotional Regulation, Cognitive Flexibility, Primary School Students, Middle School Students, Feasibility, Natural Psychotherapy
Brief summary
This randomized controlled trial aims to evaluate the efficacy of a universal intervention based on Natural Psychotherapy in reducing anxiety and depressive symptoms among primary and middle school students. To evaluate both the clinical outcomes and the potential underlying mechanisms of change, data will be collected at four distinct time points: baseline (pre-intervention), post-intervention, 3-month follow-up, and 6-month follow-up.
Detailed description
Objective 1: Evaluate the Efficacy of Natural Psychotherapy on Primary Outcomes (Anxiety Symptoms and Rumination) To evaluate the short-term and sustained efficacy of the Natural Psychotherapy program in reducing anxiety symptoms and maladaptive rumination among primary and middle school students compared to standard schooling. Objective 2: Assess the Impact on Secondary Outcomes (Psychological Well-being, Emotional Regulation, Stress, Sleep, Self-Esteem, Depression, Life Satisfaction, and Social Support) To assess the effects of the Natural Psychotherapy program on secondary psychological outcomes, including mindfulness, perceived stress, resilience, insomnia severity, self-esteem, depressive symptoms, life satisfaction, eudaimonic well-being, and perceived social support, and to examine whether improvements in these domains mediate the primary outcomes. Objective 3: Explore the Mechanisms of Change and Predictors of Treatment Response To explore the underlying psychological mechanisms through which Natural Psychotherapy produces its therapeutic effects on primary outcomes (anxiety and rumination) and to identify baseline predictors and moderators of treatment response.
Interventions
BEHAVIORALMulti-modal Nature-based Meditation
A 4-week universal group meditation practice delivered in classrooms. The intervention aims to reduce anxiety and depressive symptoms through nature-based mindfulness exercises.
BEHAVIORALIntervention diary
Participants are required to maintain a daily log of their meditation practice and life events, with a particular focus on instances of emotional fluctuation and their corresponding behavioral responses.
Sponsors
Beijing HuiLongGuan Hospital
Capital Normal University
Tsinghua University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Intervention model description
Participants will be randomly assigned to either the intervention group (receiving universal intervention program) or the control group (receiving business-as-usual education).
Eligibility
Sex/Gender
ALL
Age
7 Years to 18 Years
Healthy volunteers
Yes
Inclusion criteria
* Ages: 7 to 18 years. * Population: School-aged children and adolescents currently enrolled and attending primary or secondary school. * Capacity: Ability to comprehend the study procedures and provide assent (or consent, if applicable).
Exclusion criteria
* School Attendance: Children not currently attending school or on long-term academic leave. * General Exclusion: Any condition that, in the opinion of the investigator or school physician, would interfere with the participant's ability to attend school or comply with study procedures.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Generalized Anxiety Disorder-7 Scale (GAD-7) | Week 1, Week 5, Week 9, Week 17, Week 29 | A 7-item self-report scale assessing the severity of anxiety symptoms over the past two weeks. Scores range from 0 to 21, with higher scores indicating more severe anxiety. Clinical cut-off scores are: 0-4 (minimal/no clinical anxiety), 5-9 (mild), 10-14 (moderate),and≥ 15 (severe). This is a widely used, valid, and reliable tool for screening and monitoring anxiety in adolescents. Time points of measurements: (1) Assessment at Week 1 (Pre-intervention, Baseline); (2) Week 5( immediately Post-intervention, after the 4-week intervention period); (3) Week 9 (1-month follow-up); (4) Week 17 (3-month follow-up); (5) Week 29: 6-month follow-up. |
| Ruminative Responses Scale (RRS) | Week 1, Week 5, Week 9, Week 17, Week 29 | Symptom Rumination: Assesses repetitive focus on the symptoms of distress (e.g., feelings of sadness, fatigue, and loneliness). Brooding: Assesses a moody, reflective style characterized by passive comparison of one's current situation with unachieved standards. Reflective Pondering: Assesses purposeful and reflective examination of one's mood and its causes to gain insight. Scoring: Each item is rated on a 4-point Likert scale from 1 (almost never) to 4 (almost always). Total scores range from 22 to 88. Higher total scores indicate a greater tendency toward rumination. Time points of measurements: (1) Assessment at Week 1 (Pre-intervention, Baseline); (2) Week 5( immediately Post-intervention, after the 4-week intervention period); (3) Week 9 (1-month follow-up); (4) Week 17 (3-month follow-up); (5) Week 29: 6-month follow-up. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Mindfulness - Mindful Attention Awareness Scale (MAAS) | Week 1, Week 5, Week 9, Week 17, Week 29 | A 15-item self-report scale measuring dispositional mindfulness.Each item is rated on a 6-point Likert scale from 1 (almost always) to 6 (almost never). Scoring is computed as the mean of all 15 items, with scores ranging from 1 to 6.Higher scores indicate greater levels of dispositional mindfulness (Brown \& Ryan, 2003).Time points of measurements: (1) Assessment at Week 1 (Pre-intervention, Baseline); (2) Week 5( immediately Post-intervention, after the 4-week intervention period); (3) Week 9 (1-month follow-up); (4) Week 17 (3-month follow-up); (5) Week 29: 6-month follow-up. |
| Perceived Stress - Perceived Stress Scale (PSS-10) | Week 1, Week 5, Week 9, Week 17, Week 29 | A 10-item self-report questionnaire measuring perceived stress over the past month.Each item is rated on a 5-point Likert scale from 0 (never) to 4 (very often). Four positively worded items are reverse-scored. Total scores range from 0 to 40, with higher scores indicating greater perceived stress. Interpretive guidelines: 0-13 (low), 14-26 (moderate), 27-40 (high stress) (Cohen et al.,1983). Time points of measurements: (1) Assessment at Week 1 (Pre-intervention, Baseline); (2) Week 5( immediately Post-intervention, after the 4-week intervention period); (3) Week 9 (1-month follow-up); (4) Week 17 (3-month follow-up); (5) Week 29: 6-month follow-up. |
| Resilience - Connor - Davidson Resilience Scale (CD-RISC-10) | Week 1, Week 5, Week 9, Week 17, Week 29 | A 10-item self-report scale measuring resilience. Each item is rated on a 5-point Likert scale from 0 (not true at all) to 4 (true nearly all the time). Total scores range from 0 to 40, with higher scores indicating greater resilience (Campbell-Sills \& Stein, 2007). Time points of measurements: (1) Assessment at Week 1 (Pre-intervention, Baseline); (2) Week 5( immediately Post-intervention, after the 4-week intervention period); (3) Week 9 (1-month follow-up); (4) Week 17 (3-month follow-up); (5) Week 29: 6-month follow-up. |
| Insomnia Severity - Insomnia Severity Index (ISI) | Week 1, Week 5, Week 9, Week 17, Week 29 | A 7-item self-report questionnaire assessing insomnia severity over the past two weeks. Each item is rated on a 5-point Likert scale from 0 (no problem) to 4 (very severe problem). Total scores range from 0 to 28,with higher scores indicating more severe insomnia. Cutoffs: 0-7 (no clinically significant insomnia), 8-14 (subthreshold), 15-21 (moderate), 22-28 (severe) (Bastien et al.,2001). Time points of measurements: (1) Assessment at Week 1 (Pre-intervention, Baseline); (2) Week 5( immediately Post-intervention, after the 4-week intervention period); (3) Week 9 (1-month follow-up); (4) Week 17 (3-month follow-up); (5) Week 29: 6-month |
| Self-Esteem -Rosenberg Self-Esteem Scale (SES) | Week 1, Week 5, Week 9, Week 17, Week 29 | A 10-item scale measuring global self-worth and self-acceptance. Each item is rated on a 4-point Likert scale from 1 (strongly agree) to 4 (strongly disagree). Total scores range from 10 to 40, with higher scores reflecting higher self-esteem. Time points of measurements: (1) Assessment at Week 1 (Pre-intervention, Baseline); (2) Week 5( immediately Post-intervention, after the 4-week intervention period); (3) Week 9 (1-month follow-up); (4) Week 17 (3-month follow-up); (5) Week 29: 6-month follow-up. |
| The Patient Health Questionnaire-9 (PHQ-9) | Week 1, Week 5, Week 9, Week 17, Week 29 | The PHQ-9 is a brief and efficient self-assessment tool mainly used for screening depressive disorders (Major Depressive Disorder, MDD) and evaluating the severity of depressive symptoms. It was developed by Kurt Kroenke et al. (2001) and is one of the gold standard tools for screening depression in clinical practice and epidemiological studies. The questionnaire consists of 9 items and uses 4-point Likert scale from 0 (almost never) to 3 (almost always). The total score ranges from 0 to 27, with higher scores indicating greater depression. In this study, only the middle school groups used this questionnaire, while the primary school group did not. Time points of measurements: (1) Assessment at Week 1 (Pre-intervention, Baseline); (2) Week 5( immediately Post-intervention, after the 4-week intervention period); (3) Week 9 (1-month follow-up); (4) Week 17 (3-month follow-up); (5) Week 29: 6-month follow-up. |
| Life Satisfaction | Week 1, Week 5, Week 9, Week 17, Week 29 | The research team used a self-compiled social survey questionnaire based on the actual situation of Chinese primary and secondary school students. The questionnaire consists of 6 items and uses a 5-point Likert scale (1 = very scary, 2 = very dissatisfied, 3 = about the same between satisfied and dissatisfied, 4 = very satisfied, 5 = very happy). The total score ranges from 6 to 30 points, with a higher score indicating a greater satisfaction of the individual with their current life. Time points of measurements: (1) Assessment at Week 1 (Pre-intervention, Baseline); (2) Week 5( immediately Post-intervention, after the 4-week intervention period); (3) Week 9 (1-month follow-up); (4) Week 17 (3-month follow-up); (5) Week 29: 6-month follow-up. |
| Perceived Social Support - Multidimensional Scale of Perceived Social Support (MSPSS) | Week 1, Week 5, Week 9, Week 17, Week 29 | A 12-item self-report scale assessing perceived social support from family (4 items), friends (4 items), and significant others (4 items). Each item is rated on a 7-point Likert scale from 1 (very strongly disagree) to 7 (very strongly agree). Total scores range from 12 to 84, with higher scores indicating greater perceived social support. Time points of measurements: (1) Assessment at Week 1 (Pre-intervention, Baseline); (2) Week 5( immediately Post-intervention, after the 4-week intervention period); (3) Week 9 (1-month follow-up); (4) Week 17 (3-month follow-up); (5) Week 29: 6-month follow-up. |
| Eudaimonic Well-being - Flourishing Scale (FS-8) | Week 1, Week 5, Week 9, Week 17, Week 29 | A 8-item scale measuring psychological functioning, meaning, and social well-being. Each item is rated on a 7-point Likert scale from 1 (strongly disagree) to 7 (strongly agree). Total scores range from 8 to 56,with higher scores indicating greater flourishing. Time points of measurements: (1) Assessment at Week 1 (Pre-intervention, Baseline); (2) Week 5( immediately Post-intervention, after the 4-week intervention period); (3) Week 9 (1-month follow-up); (4) Week 17 (3-month follow-up); (5) Week 29: 6-month follow-up. |
Countries
China
Contacts
CONTACTXiang-Yang Zhang, Ph.D.
CONTACTFangfang Shangguan, Ph.D.
PRINCIPAL_INVESTIGATORXiang-Yang Zhang, Ph.D.
Tsinghua University
Outcome results
None listed