Development and evaluation of an app-based unified protocol intervention for treating and preventing emotional disorders in Chinese adults : scale validation and randomized controlled trial

Abstract

This work aimed to validate four transdiagnostic measures and conduct a randomized controlled trial to assess the effectiveness of the app-based Unified Protocol (Mood-UP) in treating and preventing emotional disorders among Chinese adults. In Study 1, clinically-at-risk (n = 221) and community (n = 775) adult samples filled in a questionnaire consisting of four Chinese-translated scales: Difficulties in Emotion Regulation Scale Short Form (DERS-16), Five Facet Mindfulness Questionnaire Short Form (FFMQ-SF), Cognitive Flexibility Inventory (CFI) and Discomfort Intolerance Scale (DIS), alongside with other psychometric scales for reliability and validity analyses. In Study 2, clinically-at-risk (n = 172) and non-clinical (n = 102) samples were recruited and randomly assigned to receive the 10-session Mood-UP or a 3-month waitlist. Disorder-specific primary outcomes and transdiagnostic secondary outcomes were measured at pre-test, post-test, 1-month follow up and 3-month follow up. Mixed effect models were conducted to evaluate the effectiveness of Mood-UP and mediating effects of the transdiagnostic outcomes were examined. Results showed Chinese versions of DERS-16, FFMQ-SF, CFI-16 and DIS to be reliable and valid measures, with good model fits. Mood-UP was found to reduce the symptoms of depression, anxiety and stress while increase the quality of life over time in clinical sample and alleviate depression and anxiety symptoms in non-clinical sample. Mediation analyses showed that changes in emotion regulation and mindfulness partially mediated the relationship between groups and change in depression, anxiety and perceived stress. Implications, limitations, and recommendations for future research were discussed.