Academic journal article Scandinavian Journal of Work, Environment & Health

Internet- and Mobile-Based Stress Management for Employees with Adherence-Focused Guidance: Efficacy and Mechanism of Change

Academic journal article Scandinavian Journal of Work, Environment & Health

Internet- and Mobile-Based Stress Management for Employees with Adherence-Focused Guidance: Efficacy and Mechanism of Change

Article excerpt

Work-related stress has shown to be a major risk factor for a range of adverse health outcomes, such as depression (1), coronary disease (2) and related mortality (3). The efficacy of interventions for occupational stress has been demonstrated in a large number of randomized controlled trials (4, 5). In spite of the availability of evidence-based interventions, the majority of stressed employees remain untreated. Using the internet to provide self-help interventions may help to overcome some of the limitations of traditional stress-management interventions (SMI) such as limited availability, high threshold for participation and delivery costs (6, 7). Internetbased interventions have been shown to be effective in clinical settings including the treatment of depression (8, 9, 10), anxiety (11), and risky alcohol use (12).

However, only a few interventions have been developed and evaluated to address the specific needs of the working population (13). A recent randomized trial found 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 (17-19) 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). The intervention proved to be effective in reducing perceived stress and other mental and work-related health outcomes. However, given the conflicting results for iSMI so far, replication is essential before a widespread dissemination can be considered. Furthermore, the aforementioned study evaluated an intervention that provided participants with substantial professional support (<4 hours of guidance from a mental health expert for each participant). Although this requires significantly fewer resources than most individual CBT interventions, there might still be room for reducing this costly component even further. In the face of ample evidence that internet-based interventions (IBI) without guidance are less effective than guided interventions (24), and that unguided stress management interventions fail to show significant effects (25-27), it remains a challenging task to develop and disseminate iSMI that require only a minimum of guidance in order to produce a significant outcome.

One way to enhance the cost-efficacy of these interventions is to use the cost-intensive guidance component exclusively to foster adherence to the self-help intervention and not to provide detailed feedback on the exercises participants complete (28, 29). In such an adherence-focused guidance concept, participants are supported in the regular completion of the intervention sessions (ie, e-mail reminders); however, feedback is only provided upon request of the participant. This format may be promising in maintaining the positive effects of guidance whilst keeping the time spent per participant at a minimum; thus, producing a more economic version of iSMI. However, it has not been evaluated whether an iSMI using adherence-focused guidance can be effective.

Purpose of the present study

This study aims to strengthen the evidence base for internet- and mobile-based SMI by investigating the acceptability, effectiveness and mechanism of change of an adherence-focused guided iSMI among employees with heightened levels of perceived stress. We hypothesized the iSMI to be more effective in reducing perceived stress when compared to a waitlist control group (WLC). In secondary explorative analyses, we examined whether the iSMI and WLC groups would differ with regard to important work-related outcomes [work engagement, psychological detachment from work, emotional exhaustion, number of days with reduced productivity at work (presenteeism), number of days on sick leave (absenteeism)], the improvement of relevant skills (general distress- and specific emotion-regulation skills), mental health (depression, anxiety, insomnia, worrying) or quality of life concerning mental and physical health. …

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