This pilot randomized active-comparison study examined two formats of emotional awareness and cognitive reappraisal training for adults with co-occurring anxiety and depressive symptoms. Participants were assigned to either a real-time awareness group or a retrospective awareness group. The real-time awareness group used a smartwatch-based heart-rate prompting system to identify emotions in daily life and later complete cognitive reappraisal exercises. The retrospective awareness group completed daily evening reflection and cognitive reappraisal exercises based on emotional events from that day. The study lasted six weeks and included assessments at baseline, mid-intervention, and post-intervention. Outcomes included anxiety symptoms, depressive symptoms, emotional clarity, mood repair, cognitive reappraisal, expressive suppression, and psychological well-being. The purpose of the study was to examine preliminary patterns of change and compare how the two formats may support emotion regulation processes.
The study used a pilot randomized active-comparison design. Participants were adults aged 18 to 45 years with co-occurring anxiety and depressive symptoms. Eligible participants were randomly assigned to one of two intervention conditions: a real-time awareness condition or a retrospective awareness condition. The intervention lasted six weeks and included three assessment points: baseline/pretest, mid-intervention assessment, and post-intervention assessment. The intervention consisted of two sequential phases. The first phase lasted approximately two weeks and focused on heart-rate baseline collection and emotional awareness training. Participants in the real-time awareness condition wore a smartwatch for three consecutive days to establish an individualized heart-rate baseline, followed by eleven days of real-time emotion identification training triggered by physiological prompts. When heart rate exceeded the individualized threshold, participants received a vibration prompt and selected the emotion category that best represented their current state. Participants in the retrospective awareness condition received no active intervention during this initial phase. The second phase consisted of four weeks of cognitive reappraisal training for both groups. The reappraisal training was based on psychological distancing, particularly self-distancing and third-person perspective taking. During this phase, participants in the real-time awareness condition continued to receive physiological prompts and completed cognitive reappraisal exercises immediately after these prompts. Participants in the retrospective awareness condition completed daily evening reappraisal exercises based on emotionally salient events recalled from that day. Both groups attended weekly meetings with the researcher to review strategy use and discuss difficulties encountered during implementation. Self-report outcomes were assessed at baseline, mid-intervention, and post-intervention. The study examined changes in anxiety symptoms, depressive symptoms, emotional clarity, mood repair, cognitive reappraisal, expressive suppression, and psychological well-being. The primary purpose was to characterize feasibility, preliminary effects, and temporal patterns of change associated with the two intervention formats rather than to establish definitive treatment efficacy.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
NONE
Enrollment
42
This behavioral intervention combined wearable-based physiological prompting, real-time emotion identification, and third-person cognitive reappraisal. Participants wore a smartwatch that monitored heart rate continuously. When heart rate exceeded 20% above the individualized baseline, the device delivered a vibration prompt. Participants identified their current emotion from six basic emotion categories. During the reappraisal phase, they recorded the triggering event, emotion category, emotional intensity, and thoughts, and then completed a third-person perspective-taking reappraisal exercise.
This behavioral intervention combined daily end-of-day emotional reflection with third-person cognitive reappraisal. Participants recalled an emotionally salient event from that day, recorded the emotion category, emotional intensity, and thoughts experienced at the time of the event, and then reinterpreted the event from the perspective of a personally significant or neutral third-person figure. They subsequently reported their post-reappraisal emotion category, emotional intensity, and new thoughts.
亞洲大學
Taichung, Taiwan
Change in Anxiety Symptoms
Anxiety symptoms were assessed using the Chinese version of the Beck Anxiety Inventory (BAI). The BAI consists of 21 items rated on a 4-point scale from 0 to 3, with total scores ranging from 0 to 63. Higher scores indicate greater anxiety symptom severity.
Time frame: Baseline, mid-intervention approximately 2 weeks after baseline, and post-intervention approximately 6 weeks after baseline.
Change in Depressive Symptoms
Depressive symptoms were assessed using the Chinese version of the Beck Depression Inventory-II (BDI-II). The BDI-II consists of 21 items rated on a 4-point scale from 0 to 3, with total scores ranging from 0 to 63. Higher scores indicate greater depressive symptom severity.
Time frame: Baseline, mid-intervention approximately 2 weeks after baseline, and post-intervention approximately 6 weeks after baseline.
Change in Emotional Clarity
Emotional clarity was assessed using the emotional clarity subscale of the Chinese version of the Trait Meta-Mood Scale (TMMS). Higher scores indicate greater perceived ability to identify and understand one's emotions.
Time frame: Baseline, mid-intervention approximately 2 weeks after baseline, and post-intervention approximately 6 weeks after baseline.
Change in Mood Repair
Mood repair was assessed using the mood repair subscale of the Chinese version of the Trait Meta-Mood Scale (TMMS). Higher scores indicate stronger perceived ability to regulate, alleviate, or repair negative emotional states.
Time frame: Baseline, mid-intervention approximately 2 weeks after baseline, and post-intervention approximately 6 weeks after baseline.
Change in Cognitive Reappraisal
Cognitive reappraisal was assessed using the cognitive reappraisal subscale of the Chinese version of the Emotion Regulation Questionnaire (ERQ). Higher scores indicate greater habitual use of cognitive reappraisal.
Time frame: Baseline, mid-intervention approximately 2 weeks after baseline, and post-intervention approximately 6 weeks after baseline.
Change in Expressive Suppression
Expressive suppression was assessed using the expressive suppression subscale of the Chinese version of the Emotion Regulation Questionnaire (ERQ). Higher scores indicate greater habitual use of expressive suppression.
Time frame: Baseline, mid-intervention approximately 2 weeks after baseline, and post-intervention approximately 6 weeks after baseline.
Change in Psychological Well-Being
Psychological well-being was assessed using the psychological well-being subscale of the Taiwan Subjective Well-Being Scale Short-Form (TSWBS-SF). The subscale consists of 4 items rated on a 4-point Likert scale, with total scores ranging from 4 to 16. Higher scores indicate greater psychological well-being.
Time frame: Baseline, mid-intervention approximately 2 weeks after baseline, and post-intervention approximately 6 weeks after baseline.
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.