E‐Mailed Standardized Cognitive Behavioural Treatment of Work‐Related Stress: A Randomized Controlled Trial

Abstract

The aim of this study was to assess the effects of a 7-week standardized cognitive behavioural treatment of work-related stress conducted via e-mail. A total of 342 people applied for treatment in reaction to a newspaper article. Initial screening reduced the sample to a heterogeneous (sub)clinical group of 239 participants. Participants were assigned randomly to a waiting list condition (n = 62), or to immediate treatment (n = 177). A follow-up was conducted 3 years after inception of the treatment. The outcome measures used were the Depression Anxiety Stress Scales (DASS-42) and the Emotional Exhaustion scale of the Maslach Burnout Inventory - General Survey (MBI-GS). Fifty participants (21%) dropped out. Both groups showed statistically significant improvements. Intention-to-treat analysis of covariance (ANCOVAs) revealed that participants in the treatment condition improved significantly more than those in the waiting control condition (0.001<p < or = 0.025). In the treatment group, the effects were large to moderate (0.9 (stress) > or = d > or = 0.5 (anxiety)). The between-group effects ranged from d = 0.6 (stress) to d = 0.1 (anxiety). At follow-up, the effects were more pronounced, but this result requires replication in view of high attrition at follow-up. The results warrant further research on Internet-driven standardized cognitive behavioural therapy for work-related stress. Such research should include the direct comparison of this treatment with face-to-face treatment, and should address the optimal level of therapist contact in Internet-driven treatment.

Efficacy of an internet-based problem-solving training for teachers: results of a randomized controlled trial

“…This result supports findings emphasizing the importance of non-work determinants for the prediction of a worker's mental health (56). The changes in depressive symptoms correspond to results from earlier studies of worker-directed interventions, which had effect sizes of d=0.13 (24), d=0.20 (23), d=0.40 (12), and d=0.82 (22) when targeting employees with heightened levels of occupational stress. Only a few earlier studies have investigated the intermediate-term effects of occupational interventions; for instance, Grime (22) reported d=0.60 after three months and d=0.30 after six months.…”

“…In another study, computerized cognitive behavioral therapy for employees with recent stress-related absenteeism was found to be effective in reducing depression post-treatment compared to conventional care, but it was not found to be effective at the three-month follow-up (22). Ruwaard and colleagues (12) demonstrated that an e-mail-based cognitive behavioral treatment for work-related stress was more effective in reducing stress, depression, and anxiety than a waiting control condition. However, e-mail-based interventions might require a high degree of (health) literacy, and they do not make full use of the advantages of website-driven interventions, such as interactivity and multimedia interfaces, which can improve adherence, efficiency and cost-effectiveness.…”

Efficacy of Cognitive Behavioral Therapy Training Using Brief E-mail Sessions in the Workplace: A Controlled Clinical Trial

“…CBT training based on one-way web learning has been found to have several disadvantages, including difficulty in maintaining participant motivation and difficulty giving timely advice. These issues may be addressed as in the present study, using e-mail-based one-on-one communication between each participant and a staff member 13) . Participants may have been encouraged by the staff's timely response in this manner.…”

“…In many of these previous study reports, analysis was performed only for users who had completed the program, necessitating further efficacy analyses which including dropouts 12) . An e-mail-based program may represent a more effective means of training, as the one-to-one interaction between participant and instructor may allow for greater motivation toward the task at hand and greater individual support 13) . Further, e-mail imposes fewer restrictions on time or place, providing the great advantage of workers being able to address issues at their convenience.…”

Internet- and mobile-based stress management for employees with adherence-focused guidance: efficacy and mechanism of change

“…A recent randomized trial found Ebert et al moderate effect sizes with regard to the reduction of depressive symptoms among stressed teachers (6,14), whereas another trial did not find beneficial effects of a problem-solving training on depression or work-related outcomes (15,16). So far, randomized controlled trials (RCT) on internet-based SMI show mixed results with some studies reporting significant results with moderate effects sizes on perceived stress (17)(18)(19) and others yielding non-significant outcomes (20,21). Our group recently conducted a RCT testing the efficacy of an internet-based stress management intervention (iSMI) among employees with heightened levels of perceived stress (22,23).…”