Schema-Informed Digital Mental Health Intervention for Maladaptive Cognitive-Emotional Patterns: Randomized Controlled Trial

Abstract

Background: In South Korea, access to mental health services remains limited due to stigma, cost, and self-reliance. While digital interventions can help reduce these barriers, few are designed to address the underlying cognitive-emotional patterns that perpetuate psychological distress.

Objective: This study evaluated the effectiveness of a schema-informed digital intervention (Mindling) aimed at reducing distress and enhancing coping in adults experiencing schema-linked difficulties such as perfectionism (unrelenting standards schema), low self-worth (self-sacrifice schema), social withdrawal (social isolation and alienation schema), and anxiety (negativity and dependence schemas).

Methods: A total of 300 adults (aged 18-60 years) with elevated perceived stress and one dominant distress pattern were recruited on the web and randomized to an intervention group (n=201) or waitlist control (n=99). Participants were assigned to one of four 10-week web-based program modules tailored to their dominant distress pattern: perfectionism (Riggy), low self-worth and fear of rejection (Pleaser), social withdrawal (Shelly), or chronic anxiety (Jumpy). Each module included psychoeducation, guided reflection, and behavioral tasks. Outcomes, including perceived stress, perfectionism, self-esteem, loneliness, and anxiety, were measured at baseline, midintervention (week 5), and postintervention (week 10). Analyses were conducted on 218 participants who completed all 3 assessments (n=138 intervention; n=80 waitlist), using repeated-measures ANOVA or analysis of covariance, as appropriate. In addition, a 1-month follow-up assessment was conducted for the intervention group only to examine maintenance of effects.

Results: Compared with the waitlist group, the intervention group showed significantly greater improvement in perceived stress (F_2,432=27.52; P<.001; partial η²=0.11) and improvements in pattern-linked outcomes: perfectionism (F_2,102=6.24; P=.003; partial η²=0.10); self-esteem (F_2,96=11.83; P<.001; partial η²=0.20); loneliness (F_2,110=8.26; P<.001; partial η²=0.13); and anxiety (F_2,110=10.75; P<.001; partial η²=0.16). Secondary outcomes (eg, depression, trait anxiety, and self-efficacy) also improved across most programs. These effects were maintained at a 1-month follow-up. As supplementary findings, adherence was high among those who accessed the platform, with 70.1% (131/187) completing all 10 sessions. The intervention group was also more likely than the waitlist to seek external mental health services (t₂₁₆=2.59; P=.01; mean difference=0.45; 95% CI 0.12-0.80).

Conclusions: The schema-informed digital intervention led to significant (P<.05) short-term improvements in distress and associated psychological patterns, with high completion rates and increased help-seeking behavior among participants. These findings suggest the potential utility of structured, accessible digital interventions within stepped-care models for mental health support. However, limitations in study design, sample representativeness, and follow-up duration suggest that further research is needed to assess the long-term effectiveness and broader applicability of such digital programs.

Trial registration: ClinicalTrials.gov NCT06166693; https://clinicaltrials.gov/study/NCT06166693.

Keywords: anxiety; digital mental health intervention; low self-esteem; perfectionism; randomized controlled trial; schema-informed intervention; social isolation.