Resilient Stress Reactivity Profiles Predict Mental Health Gains from Online Contemplative Training: A Randomized Clinical Trial

Abstract

Low-dose app-based contemplative interventions for mental health are increasingly popular, but heterogeneity in intervention responses indicates that a personalized approach is needed. We examined whether different longitudinal resilience-vulnerability trajectories, derived over the course of the COVID-19 pandemic, predicted differences in diverse mental health outcomes after mindfulness and socio-emotional dyadic online interventions. The CovSocial project comprised a longitudinal assessment (phase 1) and an open-label efficacy trial (phase 2). A community sample of 253 participants received 12 min daily app-based socio-emotional dyadic or mindfulness-based interventions, with weekly online coaching for 10 weeks. Before and after the intervention, participants completed validated self-report questionnaires assessing mental health. Stress reactivity profiles were derived from seven repeated assessments during the COVID-19 pandemic (January 2020 to March/April 2021) and were categorized into resilient (more plasticity) or vulnerable (less plasticity) stress recovery profiles. After both interventions, only individuals with resilient stress reactivity profiles showed significant improvements in depression symptomatology, trait anxiety, emotion regulation, and stress recovery. Those with vulnerable profiles did not show significant improvements in any outcome. Limitations of this study include the relatively small sample size and potential biases associated with participant dropout. Brief app-based mental interventions may be more beneficial for those with greater levels of stress resiliency and plasticity in response to stressors. More vulnerable individuals might require more intense and personalized intervention formats.

Keywords: dyads; mental health; mental training; mindfulness; personalization; plasticity; socio-affective; stress reactivity.

Figure 2

The CONSORT recruitment flow. PHQ-9 = Patient Health Questionnaire-9 [28], GAD-7 = Generalized Anxiety Disorder-7 [29], SASPD = Standardized Assessment of Severity of Personality Disorder [24], CID-S = Composite International Diagnostic—Screener [25], SE = socio-emotional intervention group, MB = mindfulness-based intervention group, WSE = waitlist socio-emotional intervention group. This figure is adapted from a prior study from the CovSocial project [4].

Figure 1

The design of the CovSocial project. (A) Phase 1 of the project involving repeated assessment of stress reactivity to various phases of the COVID-19 pandemic in Berlin, Germany. Grey panels indicate phases of state-mandated lockdowns in Germany. Dotted lines indicate retrospective assessment and solid lines represent concurrent assessment. (B) The depiction of overall resilience–vulnerability trajectories derived over the seven assessment timepoints in phase 1 of this study. (C) The design of the randomized controlled trial (phase 2) conducted with a sub-sample of individuals from phase 1 of this study. SE = socio-emotional intervention group, MB = mindfulness-based intervention group, WC = waitlist control group, WSE = waitlist socio-emotional intervention group, PRE = pre-intervention assessment, POST1 = post-intervention assessment 1, POST2 = post-intervention assessment 2. (D) Study measures assessing mental health at pre- and post-intervention stages of phase 2.

Figure 3

Pre-intervention levels of depressive symptoms, trait anxiety, state anxiety, emotion regulation (ER) difficulties, and resilience (CovSocial project phase 2) stratified by longitudinal vulnerable and resilient response profiles during the COVID-19 pandemic (phase 1). BDI-II = Beck Depression Inventory—II, STAI-T = State Trait Anxiety Inventory—Trait, STAI-S = State Trait Anxiety Inventory—State, DERS = Difficulties in Emotion Regulation Scale, CD-RISC = Connor Davidson Resilience Scale, BRS = Brief Resilience Scale. A significant difference between vulnerable and resilient profiles is indicated by an asterisk (* indicates p < 0.05 after adjustment for multiple comparisons).

Figure 4

Pre- to post-intervention changes in (A) depressive symptoms, (B) trait anxiety, (C) state anxiety, (D) emotion regulation (ER) difficulties, and (E,F) resilience (CovSocial project phase 2) examined within the context of longitudinal vulnerable and resilient response profiles during the COVID-19 pandemic (phase 1). SE = socio-emotional dyadic intervention, MB = mindfulness-based intervention, CD-RISC = Connor Davidson Resilience Scale, BRS = Brief Resilience Scale. A significant change from pre- to post-intervention is indicated by an asterisk (* indicates p < 0.05 after adjustment for multiple comparisons).