Efficacy of an online cognitive behavioral therapy program developed for healthcare workers during the COVID-19 pandemic: The REduction of STress (REST) study protocol for a randomized controlled trial

Abstract

<jats:title>Abstract</jats:title> <jats:p><jats:bold>Background: </jats:bold>The acknowledgement of the mental health toll of the COVID-19 epidemic in healthcare workers has increased considerably as the disease evolved into a pandemic status. Indeed, high prevalence rates of depression, sleep disorders and post-traumatic stress disorder (PTSD) have been reported in Chinese healthcare workers during the epidemic peak. Symptoms of psychological distress are expected to be long-lasting and have a systemic impact on healthcare systems, warranting the need for evidence-based psychological treatments aiming at relieving immediate stress and preventing the onset of psychological disorders in this population. In the current COVID-19 context, internet-based interventions have the potential to circumvent the pitfalls of face-to-face formats, and provide the flexibility required to facilitate accessibility to healthcare workers. Online cognitive behavioral therapy (CBT) in particular has proved to be effective in treating and preventing a number of stress-related disorders in populations other than healthcare workers. The aim of our randomized controlled trial study protocol is to evaluate the efficacy of the ‘<jats:italic>My Health too’</jats:italic> CBT program – a program we have developed for healthcare workers facing the pandemic -- on immediate perceived stress, and on the emergence of psychiatric disorders at 3- and 6-month follow-up compared to an active control group (i.e., bibliotherapy). <jats:bold>Methods:</jats:bold> Powered for non-inferiority testing, this six-site open trial involves the random assignment of 120 healthcare workers with stress levels &gt;16 on the Perceived Stress Scale (PSS-10) to either the 7-session online CBT program or bibliotherapy. The primary outcome is the decrease of PSS-10 scores. Secondary outcomes include depression, insomnia, and PTSD symptoms, self-reported resilience and rumination, as well as credibility and satisfaction. Assessments are scheduled at pretreatment, mid-treatment (at 4 weeks), end of active treatment (at 8 weeks) and at 3-month and 6-month follow-up. <jats:bold>Discussion:</jats:bold> This is the first study assessing the efficacy and the acceptability of a brief online CBT program specifically developed for healthcare workers. Given the potential short- and long-term consequences of the COVID-19 pandemic on healthcare workers’ mental health, but also on healthcare systems, our findings can significantly impact clinical practice and management of the ongoing, and probably long-lasting, health crisis. <jats:bold>Trial registration:</jats:bold> NCT04362358, registered April 24, 2020.</jats:p>

COVID-19: anxiety among hospital staff and associated factors

“…The results of this study showed that a large number of hospital staff might need some targeted interventions and professional help in managing their anxiety. It is known that anxiety and psychological distress can have long-term effects, and mental health care support is important during the current pandemic to attenuate the escalation of psychological complications [14,35,49]. A lack of social support and communication, weak coping strategies and a lack of training can be factors leading to the development of mental health problems [45].…”

“…However, it is necessary to make easily attainable, flexibly delivered and cost-effective treatment interventions for anxiety available to hospital staff. Internet-based support interventions, as well as those implemented via the Moodle learning environment or a smart phone, are more cost-effective than face-toface interventions [35,49,50]. The interventions should, however, be jointly approved by mental health care experts and the employers, in addition to being easily implementable [35,51].…”

“…Studies have shown cognitive behaviour therapy (CBT) and mindfulness-based therapy (MBT) to be effective in managing stress and anxiety, in learning relaxation techniques, and in concentrating on the present [16,22,35,49,50,53]. CBT can also mitigate maladaptive coping, such as avoidance and self-blame [35].…”

“…CBT can also mitigate maladaptive coping, such as avoidance and self-blame [35]. As few as seven online sessions of CBT intervention significantly decrease immediate perceived stress and improve the prevention of severe psychiatric disorders, such as PTSD and depression [49].…”

Can Yogic Breathing Techniques Like Simha Kriya and Isha Kriya Regulate COVID-19-Related Stress?

“…However, lack of specific Yoga modules or kriyas precludes extrapolation of controlled trials and their consequent translation. Several ongoing randomized control trials, including our study, aims to investigate the efficacy of various breathing techniques in COVID-19 (Lai et al, 2020;Weiner et al, 2020;Zhang et al, 2020). Figure 1 summarizes the effects of Yogic breathing techniques.…”