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

Ebert, David Daniel; Lehr, Dirk; Heber, Elena; Riper, Heleen; Cuijpers, Pim; Berking, Matthias

doi:10.5271/sjweh.3573

Cited by 107 publications

(111 citation statements)

References 48 publications

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“…In the present study, all patients had moderate to severe pre-treatment symptoms, as is expected in a clinical sample. Comparing our results to other studies of ICBT where participants had elevated levels of stress or were diagnosed with stress-related disorders [10][11][12], effects on mental health outcomes were generally equivalent. The only exception was the effect on disturbed sleep, which was larger in our study (d = 1.05 as compared to d = 0.34-0.52).…”

Section: Discussionsupporting

confidence: 58%

“…It is possible that the early interventions targeting increased recovery and disturbed sleep in the present study (weeks 2 and 3 of treatment) had positive effects on sleep. Previous studies have included optional interventions for improved sleep, generally later in the treatment course [10][11][12]. Studies are needed to investigate potential mediators of change in ICBT for symptoms of chronic stress, particularly the mediating effect of sleep in improving stress-related outcomes in CBT.…”

Section: Discussionmentioning

confidence: 99%

“…Therapist-guided Internet-based CBT (ICBT) has been shown to be efficacious for a wide range of clinical conditions in over 100 randomized controlled trials [8], with important advantages including independence of geographical distance and high scalability. A recent meta-analysis indicated that ICBT can be efficacious in reducing stress with small to moderate effect sizes [9], and some individual studies have yielded large effects on symptoms of stress and emotional exhaustion [10][11][12]. To date, however, trials have almost exclusively used subclinical or undiagnosed samples, recruited from occupational settings.…”

Section: Introductionmentioning

confidence: 99%

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Internet-Based Cognitive Behavioral Therapy for Chronic Stress: A Randomized Controlled Trial

Lindsäter

Axelsson

Salomonsson

et al. 2018

Psychother Psychosom

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Background: Prolonged exposure to stress can lead to substantial suffering, impairment and societal costs. However, access to psychological treatment is limited. Internet-based cognitive behavioral therapy (ICBT) can be effective in reducing symptoms of stress, but little is known of its effects in clinical samples. The aim of this study was to investigate the efficacy of ICBT for patients suffering from chronic stress, operationalized as adjustment disorder (AD) and exhaustion disorder (ED). Methods: A total of 100 adults diagnosed with AD or ED were randomly assigned to a 12-week ICBT (n = 50) or waitlist control condition (n = 50). Primary outcome was the level of perceived stress (PSS). Secondary outcomes included several mental health symptom domains as well as functional impairment and work ability. All outcomes were assessed at baseline, after treatment and at the 6-month follow-up. The study was preregistered at Clinicaltrials.gov: NCT02540317. Results: Compared to the control condition, patients in the ICBT group made large and significant improvements on the PSS (d = 1.09) and moderate to large improvements in secondary symptom domains. Effects were maintained at the 6-month follow-up. There was no significant between-group effect on functional impairment or work ability. Conclusions: A relatively short ICBT is indicated to be effective in reducing stress-related symptoms in a clinical sample of patients with AD and ED, and has the potential to substantially increase treatment accessibility. Results must be replicated, and further research is needed to understand the relationship between symptom reduction, functional impairment and work ability.

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Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Internet-Based Cognitive Behavioral Therapy for Chronic Stress: A Randomized Controlled Trial

Lindsäter

Axelsson

Salomonsson

et al. 2018

Psychother Psychosom

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“…For nine studies, only posttest assessments were available. The participants received guidance in seven studies [24,26,27,34,35,37,42], one study [32] assessed a less intensive guidance format (adherence-focused guidance: combination of reminders and written feedback only on request of the participants), and 16 studies (18 comparisons) investigated unguided interventions. Nine unguided studies reported the use of automated or telephone and mail reminders for completion of the intervention [23,25,28,29,33,36,42,55,56] (Table 2).…”

Section: Resultsmentioning

confidence: 99%

“…In most cases, the concealment of allocation was insufficiently described, and only 13 of 23 studies reported adequate handling of missing data. In particular, the risk for selective outcome reporting was unclear because the study registration prior to the trials could only be retrieved from three studies [31,32,34]. Although another four studies registered their trial [28,30,33,36], this step occurred retrospectively.…”

Section: Resultsmentioning

confidence: 99%

The Benefit of Web- and Computer-Based Interventions for Stress: A Systematic Review and Meta-Analysis

et al. 2017

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BackgroundStress has been identified as one of the major public health issues in this century. New technologies offer opportunities to provide effective psychological interventions on a large scale.ObjectiveThe aim of this study is to investigate the efficacy of Web- and computer-based stress-management interventions in adults relative to a control group.MethodsA meta-analysis was performed, including 26 comparisons (n=4226). Cohen d was calculated for the primary outcome level of stress to determine the difference between the intervention and control groups at posttest. Analyses of the effect on depression, anxiety, and stress in the following subgroups were also conducted: risk of bias, theoretical basis, guidance, and length of the intervention. Available follow-up data (1-3 months, 4-6 months) were assessed for the primary outcome stress.ResultsThe overall mean effect size for stress at posttest was Cohen d=0.43 (95% CI 0.31-0.54). Significant, small effects were found for depression (Cohen d=0.34, 95% CI 0.21-0.48) and anxiety (Cohen d=0.32, 95% CI 0.17-0.47). Subgroup analyses revealed that guided interventions (Cohen d=0.64, 95% CI 0.50-0.79) were more effective than unguided interventions (Cohen d=0.33, 95% CI 0.20-0.46; P=.002). With regard to the length of the intervention, short interventions (≤4 weeks) showed a small effect size (Cohen d=0.33, 95% CI 0.22-0.44) and medium-long interventions (5-8 weeks) were moderately effective (Cohen d=0.59; 95% CI 0.45-0.74), whereas long interventions (≥9 weeks) produced a nonsignificant effect (Cohen d=0.21, 95% CI –0.05 to 0.47; P=.006). In terms of treatment type, interventions based on cognitive behavioral therapy (CBT) and third-wave CBT (TWC) showed small-to-moderate effect sizes (CBT: Cohen d=0.40, 95% CI 0.19-0.61; TWC: Cohen d=0.53, 95% CI 0.35-0.71), and alternative interventions produced a small effect size (Cohen d=0.24, 95% CI 0.12-0.36; P=.03). Early evidence on follow-up data indicates that Web- and computer-based stress-management interventions can sustain their effects in terms of stress reduction in a small-to-moderate range up to 6 months.ConclusionsThese results provide evidence that Web- and computer-based stress-management interventions can be effective and have the potential to reduce stress-related mental health problems on a large scale.

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Interventions for improving recovery from work

Sinval

Veldhoven

Oksanen

et al. 2021

Cochrane Database of Systematic Reviews

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

Cited by 107 publications

References 48 publications

Internet-Based Cognitive Behavioral Therapy for Chronic Stress: A Randomized Controlled Trial

Internet-Based Cognitive Behavioral Therapy for Chronic Stress: A Randomized Controlled Trial

The Benefit of Web- and Computer-Based Interventions for Stress: A Systematic Review and Meta-Analysis

Interventions for improving recovery from work

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