Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jan 19, 2026
Date Accepted: May 1, 2026
Self-Guided Internet-Based Mindfulness-Informed Stress Management for Generalized Anxiety Disorder: A Randomized Controlled Trial with Longitudinal Network Analysis
ABSTRACT
Background:
Generalized anxiety disorder (GAD) is a prevalent condition in which stress and anxiety mutually reinforce each other. Evidence for brief, self-guided, internet-based stress management as an adjunct to pharmacotherapy remains limited.
Objective:
To evaluate the efficacy and adherence of an 8-week self-guided, internet-based stress management program (iSM) incorporating mindfulness techniques as an adjunct to treatment as usual (TAU) in GAD, and to further examine individual predictors of response and symptom dynamics via longitudinal network analysis.
Methods:
In a single-blind RCT, 140 adults with GAD were randomized to iSM+TAU (n=73) or TAU (n=67). iSM comprised weekly self-guided online modules combining mindfulnes-based training and Baduanjin-based stretching. Primary outcomes were improvement in anxiety and depression from baseline to post treatment. Secondary outcomes included sleep quality, somatic symptoms, social functioning, mindfulness, rumination, and perceived stress assessed at baseline, mid-treatment, post-treatment, and 3-month follow-up. Multiple regression analyses examined predictors of treatment response, while cross-lagged panel network (CLPN) analysis and random-intercept cross-lagged panel modeling (RI-CLPM) were used to investigate temporal symptom dynamics.
Results:
The iSM group exhibited significantly greater reductions in anxiety and depressive symptoms compared to TAU (Cohen d=0.28–0.64). Additional improvements were observed in sleep quality, somatic symptoms, perceived stress, mindfulness, rumination, and social functioning (Cohen d=0.33–0.67). The program demonstrated 77% (108/140) retention with median 7/8 session completion. Higher baseline acting with awareness predicted better response (β=.167, P=.02), while trait anxiety predicted poorer outcomes (β=–.15, P=.046). CLPN and RI-CLPM identified two key within-person pathways: a bidirectional association between perceived stress (mean β̄=.22, P <.001) and state anxiety (mean β=.17, P=.02), and a unidirectional effect of mindfulness on subsequent anxiety reduction (mean β=–.29, P <.001).
Conclusions:
The findings support the feasibility and clinical value of a brief, self-guided, internet-based stress management program as an adjunct to usual pharmacological treatment for GAD. Network-based temporal analyses further highlight perceived stress and mindfulness as key processes associated with symptom change. Clinical Trial: Chinese Clinical Trial Registry ChiCTR2300078470; https://www.chictr.org.cn/showproj.html?proj=200673
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