Online Socio-emotional Dyad Training for Healthcare Students' Well-being and Social Skills

The Edu:Social Health Care Project: Investigating the Effects of an Online Socio-emotional Dyad Intervention on Healthcare Students' Mental Health, Resilience, Social Competencies and Behaviors

In this Edu:Social Health Care project, a randomized controlled trial with a socio-emotional intervention and a waitlist control group will be conducted to evaluate the effects of a partner-based empathy-compassion Dyad mental training (EmCo) intervention on healthcare students with regard to the following primary outcome domains: 1) mental health, 2) resilience, 3) social cohesion and support, 4) social skills, 5) coping and emotion regulation, and 6) social behaviors.

One main goal is to examine the effects of such adapted 8-week EmCo Dyad intervention within the health care context, with a particular focus on strengthening students' mental health, resilience, social skills and behaviors, and social cohesion as well as fostering interprofessional attitudes by pairing every week study partners across different healthcare disciplines with each other for practicing their daily Dyads (e.g., nursing students will practice daily via app with medical students).

A further aim is to validate the novel Dyad Voice Assessment (DYVA) task, which explores the use of app-based voice recordings as indicators of students' emotional states during their daily partner-based Dyad practice. By combining students' self-reported practice-related emotions with partner-based evaluations, this approach aims to generate new and innovate, more objective markers of training-induced changes in emotional processing and regulation over time in a real-live applied setting.

The final aim is to investigate the cognitive and affective mechanisms and factors underlying observed changes in students' mental health, resilience, social cohesion, social skills and social behaviors, that may explain observed training-related effects in primary outcome domains. Based on previous research, we expect the socio-emotional EmCo Dyad training to activate evolutionary old care- and affiliation-based motivational systems that foster positive affect and motivation, acceptance, trust social capacities and behavioral tendencies. These processes should go along with reduction in loneliness, stress and other mental vulnerabilities (anxiety, depression, burn-out etc.) and foster social skills such as empathy, compassion as well as social cohesion and resilience.

One-quarter to one-third of university students experience a common mental health disorder each year, with evidence indicating rising distress and declining well-being over time. Healthcare students appear particularly vulnerable, showing increasing levels of burnout associated with poorer academic engagement and impaired professional development. Mindfulness- and compassion-based interventions, as well as socio-emotional learning programs, have shown promise in improving mental health outcomes such as depression, anxiety, stress, and burnout, and in strengthening resilience among healthcare students.

In recent years, classic mindfulness-based interventions focusing on individual mental practices have been expanded to include partner-based social practices, known as Dyads, which particularly target social skills such as empathy, (self-)compassion, and social cohesion. However, despite growing research on student well-being, partner-based Dyadic interventions have not yet been systematically investigated in healthcare student populations. Available evidence suggests that Dyads may be more effective than solitary mindfulness practices in reducing loneliness and social stress, strengthening social connection and cohesion, and enhancing resilience and optimism. Moreover, findings indicate that dyadic social practices engage mechanisms that differ from those underlying traditional mindfulness-based interventions.

Empathy, (self-)compassion, and deep listening are core socio-emotional skills in healthcare, supporting effective communication and emotional understanding. However, empathy can lead to empathic distress when individuals are repeatedly exposed to others' suffering, whereas compassion is considered more protective, as it relies on altruistic and care-based motivational systems associated with positive affect and regulatory processes that buffer emotional overwhelm. Despite this distinction, empathy and compassion have not yet been systematically taught to healthcare students in an evidence-based manner. To address this gap, the Edu:Social Health Care project implements the empathy-compassion Dyad training program (EmCo), which trains students to distinguish between empathy and empathic listening and empathy regulation to avoid moving into empathic distress during the first four weeks, and (self)compassion and compassionate listening during the subsequent four weeks.

The EmCo program builds on the Affect Dyad developed in the ReSource project and the online Dyad coaching format implemented in the CovSocial project, both of which demonstrated the effectiveness of partner-based dyadic mental training in inducing brain plasticity, reducing stress, enhancing psychological resilience, and strengthening social cohesion across multiple indicators of biopsychosocial health. In contrast, to the ReSource and CovSocial projects, the present program, includes a novel empathy versus compassion listening component to it. Further, compared with earlier 10-week online Dyad programs, EmCo reduces the intervention duration to eight weeks, aligning with standard mindfulness-based interventions such as MBSR and MBCT and improving feasibility for implementation in healthcare and educational settings.

Accordingly, the study is implemented as a randomized controlled trial in a sample of healthcare students (target N = 360). A multimethod assessment strategy will be used, including self-report validated trait and state questionnaires, behavioral computer tasks delivered at home through webapp, and ecological momentary assessment (EMA) methods based on push-notifications by the app. These different assessments are capturing changes across mental health, resilience, social cohesion and support, social skills, coping and emotion regulation, and social behaviors (e.g., listening, attachment behaviors).

After providing informed consent, participants will be randomized to one of two groups: (1) an empathy-compassion training group (EmCo), based on the Affect Dyad mental practice, or (2) a waitlist control group (WCG). All participants will first complete the pre-test assessment phase including baseline psychometrics, computer-based tasks, and EMA measures. The intervention group will then be onboarded into the intervention with two Online onboarding I and II sessions lead by professional Dyad teachers and then complete the EmCo training program delivered via a dedicated web and smartphone application with daily partner-based Dyads as well as weekly 1.5 hours online coaching sessions. During this period, participants will complete brief weekly self-report questionnaires, Ecological Momentary Assessments (EMA) and daily pre-post Dyad practice ratings (DPR), to capture changes in key psychological and social processes to be used as mediator variables. At the end of the intervention, all participants will complete a post-test phase similar to the pre-test but with an additional final feedback questionnaire.

Following completion of the initial post-test (T1), participants in the waitlist control group will subsequently receive the same 8-week socio-emotional Dyad intervention (EmCo) and complete an additional post-test assessment (T2).

The study was preregistered on the Open Science Framework (OSF) and is publicly available at https://osf.io/3t8s4.

Inclusion Criteria:

1. Between 18- and 65-years old.

2. actively enrolled student at the PMU.

3. Proficient in German.

4. Informed consent.

5. No symptoms of psychiatric disease within the past two years.

6. Stable internet access and necessary technical equipment (computer or laptop or tablet, and mobile phone with internet access).

7. No regular contemplative practice (≤ 50 hours total within the past six months); healthy population, non-clinical population.

   Exclusion Criteria:

8. Insufficient German proficiency.

9. Lack of stable internet access or required devices (computer or laptop or tablet, and mobile phone with internet access).

10. No informed consent.

11. Not actively enrolled at PMU.

12. Regular contemplative practice (> 50 hours in the past six months (e.g., dyad, mindfulness, compassion-based practices).

13. Current psychiatric diagnosis or therapy, or reaching screening cutoffs on:

    • Patient Health Questionnaire-9 (PHQ-9; Martin et al., 2006; Löwe et al., 2004; Cutoff ≥ 10),
    • Generalized Anxiety Disorder-7 (GAD-7; Löwe et al., 2007; Spitzer et al., 2006; Cutoff ≥ 10),
    • Toronto Alexithymia Scale-20 (TAS-20; Bagby et al., 1994; Ritz & Kannapin, 2000; Cutoff ≥ 61)
    • Standardized Assessment of Personality - Abbreviated Scale (SAPAS; Moran et al., 2003; Söchtig et al., 2012, Cutoff ≥ 4).
    • Moreover, participants endorsing suicidality on the PHQ-9 will be excluded.