{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T03:30:53Z","timestamp":1790825453678,"version":"4.1.0"},"reference-count":62,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2023,9,13]],"date-time":"2023-09-13T00:00:00Z","timestamp":1694563200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Existing studies have unequivocally demonstrated that parents of children with autism spectrum disorder (ASD) experience various stressful daily life events and suffer from psychological distress. Mindfulness level is found to be an effective buffer between parents\u2019 appraisal of stress life events and psychological distress. However, the mechanism behind the function of mindfulness is unclear, and traditional mindfulness-based intervention (MBI) in experimental settings is not tailored to personal real-life needs. This study proposes to conduct a randomized controlled trial (RCT) to examine the effectiveness of MBI delivered by ecological momentary intervention (EMI) and assessed by ecological momentary assessment (EMA) in changing participants\u2019 cognitive appraisal of stressful life events and thus reducing the psychological distress of parents of children with ASD.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Method<\/jats:title>\n<jats:p>The proposed study will recruit 670 parents of children with ASD and randomly assign them to the intervention and control groups (335 in each group). Participants in the intervention group will install the EMI\/A app on their smartphones. In the app, participants can receive practice prompts daily, browse and practice different mindfulness exercises in the intervention library at any time, talk to a virtual counselor (chatbot) when feeling stressed, complete EMA on the cognitive appraisal of life events, and receive the log of change of psychological status daily. Participants in the control group will only receive audio-based standardized mindfulness practice instructions three times per week. The effects of MBI will be assessed based on the EMA data, right after the intervention and at the 2-month follow-up. The primary outcome will be participants\u2019 psychological distress measured by the depression anxiety stress scale. The secondary outcomes will include participants\u2019 subjective well-being, measured by the satisfaction with life scale, and level of resilience, measured by the psychological empowerment scale. Multilevel structural equational modelling will be applied to examine the pathways of the relationship between daily life events, cognitive appraisal, and psychological distress.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Discussion<\/jats:title>\n<jats:p>The potential benefit of the proposed study is to increase the psychological well-being of parents of children with ASD, and the method may extend to participants suffering from other psychological issues in the future.<\/jats:p>\n<jats:p><jats:bold>Trial registration:<\/jats:bold> This trial has been registered on clinicaltrials.gov with the ID of <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT05746468\" xlink:type=\"simple\">NCT05746468<\/jats:ext-link>.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0291168","type":"journal-article","created":{"date-parts":[[2023,9,13]],"date-time":"2023-09-13T17:30:07Z","timestamp":1694626207000},"page":"e0291168","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":11,"title":["The mechanism and effectiveness of mindfulness-based intervention for reducing the psychological distress of parents of children with autism spectrum disorder: A protocol of randomized control trial of ecological momentary intervention and assessment"],"prefix":"10.1371","volume":"18","author":[{"given":"Qi","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siu-man","family":"Ng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4465-3102","authenticated-orcid":true,"given":"Xiaochen","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,9,13]]},"reference":[{"key":"pone.0291168.ref001","doi-asserted-by":"crossref","first-page":"112679","DOI":"10.1016\/j.psychres.2019.112679","article-title":"Prevalence of autism spectrum disorder in Asia: A systematic review and meta-analysis.","volume":"284","author":"S Qiu","year":"2020","journal-title":"Psychiatry Res."},{"key":"pone.0291168.ref002","article-title":"Prevalence of Autism Spectrum Disorder and Co-morbidities in Children and Adolescents: A Systematic Literature Review.","author":"C Bougeard","year":"2021","journal-title":"Front Psychiatry [Internet]."},{"issue":"1","key":"pone.0291168.ref003","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/2040-2392-4-7","article-title":"Prevalence of autism in mainland China, Hong Kong and Taiwan: a systematic review and meta-analysis.","volume":"4","author":"X Sun","year":"2013","journal-title":"Mol Autism."},{"key":"pone.0291168.ref004","journal-title":"Statistics on persons with disabilities and chronic diseases in 2020 [Internet]."},{"key":"pone.0291168.ref005","volume":"15","author":"A Schnabel","journal-title":"Psychopathology in parents of children with autism spectrum disorder: A systematic review and meta-analysis of prevalence."},{"issue":"1","key":"pone.0291168.ref006","first-page":"4","article-title":"Assessing needs and challenges reported by caregivers and teachers of children with autism spectrum disorders in China.","volume":"11","author":"Y Ding","year":"2010","journal-title":"J Int Assoc Spec Educ"},{"key":"pone.0291168.ref007","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.rasd.2015.05.003","article-title":"Self-esteem, social support, and life satisfaction in Chinese parents of children with autism spectrum disorder.","volume":"17","author":"M Lu","year":"2015","journal-title":"Res Autism Spectr Disord"},{"issue":"3","key":"pone.0291168.ref008","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1007\/s10803-012-1604-y","article-title":"The Impact of Parenting Stress: A Meta-analysis of Studies Comparing the Experience of Parenting Stress in Parents of Children With and Without Autism Spectrum Disorder.","volume":"43","author":"SA Hayes","year":"2013","journal-title":"J Autism Dev Disord."},{"issue":"6","key":"pone.0291168.ref009","article-title":"Links between the conduct of carers and clients\u2019 challenging behaviour","volume":"16","author":"A. 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