{
  "abstract": "BackgroundWeb-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.\n\nMethodsWe 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.\n\nResultsPrimary 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.\n\nConclusionsThe 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.\n\nTrial registrationClinicalTrials.gov NCT07055061, retrospectively registered.",
  "abstract_shown": true,
  "affiliations": [
    "Shanghai Mental Center"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 4,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Y. Ding"
    },
    {
      "name": "W. Fu"
    },
    {
      "name": "Y. Tang"
    },
    {
      "name": "D. Zhang"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/4gfbcjqt0d61w.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.08.05.26359641",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.08.05.26359641v2.full",
  "id": "4gfbcjqt0d61w",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.08.05.26359641v2",
  "language": null,
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "psychiatry and clinical psychology"
    ],
    [
      "openalex",
      "3207|Music Therapy and Health"
    ]
  ],
  "openalex": "W7201862631",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.08.05.26359641v2.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-08-05",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/4gfbcjqt0d61w.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:18:27Z",
      "native_id": "10.64898/2026.08.05.26359641",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.08.05.26359641v2"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:psychiatry and clinical psychology",
      "subfield": "psychiatry"
    }
  ],
  "title": "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",
  "title_text": "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",
  "type": "preprint",
  "updated_at": "2026-10-30T12:18:27Z",
  "url": "https://research.draconitic.com/paper/4gfbcjqt0d61w",
  "venue": "medRxiv",
  "versions": []
}