State-Adaptive Versus Target-First Music Sequencing for Working Adults With Occupational Stress: Affective Dynamics and Symptom Outcomes in a Home-Based, Web-Delivered Randomized Trial
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Background
Web-based music interventions are scalable, but automated delivery requires decisions about how music should be sequenced. The iso principle provides a rationale for beginning with mood-matched music and gradually progressing toward an affective target, but translating this therapist-guided principle into a reproducible digital intervention requires formalizing it as explicit rules for music selection and sequencing.
Methods
We operationalized the iso principle as a session-level state-adaptive sequencing strategy (ISO) and compared it with target-first direct-uplifting delivery (DUL) in a home-based web-delivered intervention, testing two automated routes toward the same affective target. In a two-arm randomized trial, 120 Chinese-speaking working adults reporting occupational stress were allocated 1:1 to ISO or DUL. Following a common five-day pre-intervention observation period, participants completed five consecutive evening sessions of music delivered remotely through a web-based platform in their own home environments, allowing the two sequencing strategies to be evaluated under repeated, everyday-use conditions. Prespecified primary outcomes were baseline-to-immediate-post changes in occupational stress, anxiety, and depressive symptoms, analyzed using intention-to-treat mixed-effects models with Holm correction. Within-session affective dynamics were examined as exploratory outcomes.
Results
Primary between-group estimates were numerically in the ISO-favoring direction for occupational stress (-2.45 points, 95% CI -7.08 to 2.18), anxiety (-2.34, -5.22 to 0.54), and depressive symptoms (-3.60, -7.19 to -0.01), but none met the Holm-adjusted criterion for statistical significance. Exploratory models showed distinct within-session trajectories of valence, arousal, and dominance between the two sequencing strategies, and valence alignment increased across intervention days among ISO completers. Most attrition occurred during the common five-day pre-intervention observation period, before exposure to the assigned music-sequencing strategy. No adverse events were reported. Comparative symptom conclusions were sensitive to missing-outcome assumptions.
Conclusions
The iso principle was operationalized and evaluated as an automated, state-adaptive web-based intervention delivered repeatedly in participants’ own homes. Among five-session completers, state-adaptive and target-first sequencing produced different within-session affective trajectories, but superiority in symptom outcomes was not established. These findings require confirmation in future confirmatory trials.
Trial registration
ClinicalTrials.gov NCT07055061 , retrospectively registered.
