Exploration Of Effects And Mechanisms On Mental Health,Metacognition And Self Functions Of Supportive Music And Imagery

Objective:The psychological distress and low social function of healthy adults have not caused our enough attention.Supportive Music and Imagery（SMI）can improve clinical symptoms and quality of life in patients with mood disorders and improve the mental health of healthy adults.Supportive Music&Imagery developed rapidly in recent years,however,there is none systematic clinical study of SMI therapy in healthy adults in China.The mechanisms of SMI are focused on improving self-awareness,coping skills,and enhancing Self-Esteem.We speculate that the above three mechanisms are related to the metacognitive function and Self-function.Metacognitive function as a basic ability to maintain normal psychological functions can help individuals to identify the cognition,emotions and others’mental states,and adjust their actions for effectively coping.Previous studies have found that SMI can improve metacognitive function,but no more systematic exploration continued and no further studies explored the mechanisms on which SMI is effective for healthy adults.The effect of SMI on mental health will be tested and verified in this clinical randomized controlled trial based on healthy adults’needs for psychotherapy,and the role of metacognition and Self function in improving mental health will be explored by analysis the relationship between the relevant variables.In qualitative research,the clients’relevant experiences of metacognitive functions after SMI are analyzed,and types and connections of psychological experiences are summarized and theoretical models are constructed.Relationship between music,Self function,intrinsic Object and internal working mode are further explored through these related experiences.The therapeutic target and the therapeutic dynamics are explored and analysed,and the mechanism of metacognitive function is deeply discussed.Methods:Total 109 clients of healthy adults was recruited as research object differentiated treatment groups and control groups between January 2018 and December2020.and psychological interventions for the treatment group was conducted once a week for a total of 6 weeks.Supportive Music and Imagery was applied as the method of psychological intervention in this experiment.Clinical psychological scales were used to assess changes in clients’mental health,Self function,and metacognitive function before and after treatment.The clients’mental health status was assessed by the Symptom Checklist-90（SCL-90）and the Global Assessment Scale（GAS）and Self function by the Rosenberg Self-Esteem Scale（RSES）and the General Self-Efficacy Scale（GSES）.Interviews and treatment records were used to assess the metacognitive function by the Metacognition Assessment Scale-2009 Revised（MAS-2009R）as evaluation materials.SPSS 22.0 software was used for data processing and statistical analysis.The effect of SMI on mental health improvement was analysed using a clinically randomized controlled trial.Pathway analysis,regression analysis,and mediation effect models were used to explore the mediating mechanism of Self-Esteem and metacognitive function changes on the improvement of mental health.Face-to-face interviews and qualitative research on the related experiences of healthy clients’metacognitive function was conducted.Methods of Grounded Theory was applied to complete the three-level coding including open coding,axis coding and selection coding in turn,then the relevant topic concepts and their relationships was extracted and summarized.The specific experience types and characteristics of metacognitive functions was explored finally.Results:The 10 factors and total scores of SCL-90 and GAS,3 factors and the total score of MAS-2009R,and the total score of RSES and GSES were tested and the results are significantly different.Independent sample t-test was applied in the comparison between the treatment group and the control group,and paired sample t-test for the treatment group itself before and after the treatment.The results showed significant differences（P<0.01）.At baseline and treatment endpoints,the total score of the SCL-90 was negatively correlated with GAS,a positive correlation between the total score of RSES and GSES,and the total score of MAS-2009R was positively correlated with the 3sub-functions.The total score of RSES and GSES and MAS-2009R were all negatively correlated with SCL-90（baseline:r=-0.866,r=-0.714,r=-0.846;endpoints:r=-0.735,r=-0.888,r=-0.779）,and positively correlated with GAS.And the results were statistically significant（P<0.01）.The correlation coefficients showed a strong correlation between the total score of SCL-90 and MAS-2009R,RSES and GSES.Correlation analysis between the changes before and after treatment also had the above findings,and the correlation coefficients were all moderately correlated.Correlated analysis of the total scores of the five scales before and after treatment showed that there was a positive correlation between mental health（total score of SCL-90 and GAS）,Self function（total score of RSES and GSES）and metacognitive function（total score of MAS-2009R）,and the results were statistically significant（P<0.05）.The correlation coefficients mostly are moderately correlated.Multiple stepwise regression analysis was performed with the total score of SCL-90 as the dependent variable and the total score of MAS-2009R（X₁）and RSES（X₂）as the explanatory variables.The complex correlation coefficient R² at baseline was 0.754,and the multiple linear regression equation was:Y=207.203-0.660X₁-1.149X₂.R² at endpoints was 0.724,and the equation was:Y=202.551-0.755X₁-1.084X₂.The mediation effect analysis model showed that the total score of MAS-2009R was the mediating factor between the total score of RSES and SCL-90.The mediated contribution rates at baseline and endpoint were 42.3%and 33.8%respectively.In the qualitative study 12 clients after SMI was interviewed.And 33sub-topic categories,12 sub-themes,and 4 themes were extracted in the interview materials in turn.The 4 themes were:experience related to self,experience related to empathy,experience related to connection,and experience related to action.The conceptual psychological experience is integrated into a theoretical model which is characterized by the self-centered interconnection of these four themes.Conclusions:In this experiment,we found that SMI therapy can significantly improve the mental health status of healthy adult clients,and improve Self function and metacognitive function.SMI therapy is an effective intervention method which is suitable for healthy adults.The possible mechanisms of SMI were improving Self-Esteem and metacognitive function,and the core mechanism is the improving of Self function,and metacognitive function plays a mediating effect.In the case interviews,most of the clients mentioned experiences related to the improvement of Self functions and interpersonal functions involving the four themes in the Theoretical Model of Experiences Related to Metacognitive Functions.Self-related Experiences describes the Self-sense based on self value and identity,including four sub-themes:self-awareness,self-care,self-identity,and autonomy.Empathy-related experience is the awareness and interactive understanding of the mental states and needs of self and others,that is,the Others-sense based on Self-sense,including three sub-themes:putting oneself in the shoes of others,opening up emotions,and seeking understanding.Connection-related experiences describe the process of internal interactive communication between individuals,named the internal connection between Self&Others,including two sub-themes:trust and acceptance.Action-related experiences are interpersonal functional performance of Self and Self’s internal work patterns,including three sub-themes:new perspectives,coping,and benefit.The conceptualized metacognitive function in SMI is proposed:As a transitional Object,music which own the characteristics of safety and nourishment assumed functions of a good Self&Object.This promotes the identity of self-value and gives more empathy and connection functions to the stable core Self.So the agent’s healthy internal work patterns was formed,and a more mature automated behavior mode in interpersonal interaction was presenting.