Please select the eligibility criteria that correspond to the clinical trial below.
Title: INTERSTRESS - Interreality in the Management and Treatment of Stress-related Disorders
Brief Summary: Psychological stress occurs when an individual perceives that environmental demands tax or exceed his or her adaptive capacity. In this view, stressful experiences are conceptualized as person-environment transactions, whose result is dependent on the impact of the external stimulus. This is mediated by the person's appraisal of the significance of the stimulus, of the personal, social and cultural resources available and of the efficacy of the coping efforts.

Extreme levels of stress can have a negative influence on one's professional life and can disrupt both the social and personal life of an individual. Stress can also cause different physiological and psychological disorders such as anxiety, chronic headaches, depression, withdrawal symptoms, nausea, phobias, blood pressure problems, heart impairments and others.

Stress Management Therapy can help to overcome counter effects of stress. Usually various techniques are used including relaxation, interaction, biofeedback and Cognitive Behavior Therapy methods. According to the Cochrane Database of Systematic Reviews the best validated approach covering both stress management and stress treatment is the Cognitive Behavioral Therapy (CBT) approach.

The trouble with stress is that it is very personal. Thus, stress-related disorders depend a great deal on how the person experiencing a stressor is put together -psychologically and physically. So the focus for assessment, prediction and treatment has to be the person's situated experience.

To overcome the above limitations, the INTERSTRESS project suggests the adoption of a new paradigm for e-health - Interreality - that integrates contextualized assessment and treatment within a hybrid environment, bridging physical and virtual world.

From the clinical point of view the INTERSTRESS solution may offer the following innovations to current traditional protocols for stress management:

* Objective and quantitative assessment of user's stress level using biosensors and behavioral analysis;
* Provision of warnings and motivating feedbacks to improve self awareness, compliance and long term outcome;
* Decision Support System (DSS) for treatment planning through data fusion and detection algorithms.


Options:
A: Inclusion Criteria:

* Individual who suffer from psychological stress;
* Age between 25 and 60 years.

Exclusion Criteria:

* DSM_IV-TR Axis I disorders;
* history of neurological diseases, mental retardation, psychosis, alcohol or drug dependence;
* psychotherapy received for their psychological stress;
* pharmacotherapy received for their psychological stress;
* migraine, headache, or vestibular abnormalities.
B: Inclusion Criteria:

1. Participants will be frontline hospital or long-term care home staff involved in the management of COVID-19 patients in Canada or The United States of America.
2. Participants will be aged 18 to 70.
3. Participants will be willing and able to attend, via WebEx software, the introductory phase of SKY or HEP, as well as at least two of the four weekly follow-up sessions
4. Have sufficient hearing to follow verbal instructions.
5. Have an adequate understanding of English.
6. Able to sit without physical discomfort for 60 minutes.
7. Not pregnant and willing to remain not pregnant for the duration of the study.

Exclusion Criteria:

1. Inability to independently provide informed consent.
2. Current suicidality as assessed by the suicide item of the Patient Health Questionnaire-9 scale.
3. History of bipolar disorder.
4. History of chronic PTSD.
5. History of schizophrenia or schizoaffective disorder.
6. Currently practice any type of formal meditation, mindfulness, or breathing techniques regularly (greater than 3 times per week).
7. History of complex PTSD.
C: Inclusion Criteria:

HCPs including physicians, trainee physicians, nurses, nurse practitioners, Physician Assistants, and respiratory therapists providing patient care during the COVID-19 pandemic.

* A single-item stress scale will be used as a screen for eligibility; a minimum score of 6 on a 10-point response scale will be needed to meet inclusion criteria
* Subjects who have at least a 5% increase from baseline in heart rate after exposure to a personalized stressful script OR at least a 33% increase in skin conductance after exposure to the script
* Willingness to address burnout symptoms by non-pharmacological means
* All subjects must provide Informed Consent prior to enrollment in the study.
* Willingness to wear the provided Apple Watch for the data collection process

Exclusion Criteria:

* Antipsychotic medications or beta-blockers
* Current suicidal or homicidal ideation (suicidal ideation as screened by C-SSRI survey pre-enrollment)
* Previous instruction in TM
D: Inclusion Criteria:

* Staff member (nurse or doctor) of the ED department of St. James' hospital, Dublin
* Preference to participate in the study

Strict inclusion criteria will be applied for admitted ED patients (determined by the Clinical Research Facility data controller and ward staff):

* Conscious patient
* Cognitively functioning to an adequate level
* Not actively abusing any substance
* Preference to participate
* Over the age of 18 years

Exclusion Criteria:

* Alcohol or substance abuse within the past 6 months
* Are currently using (at the time of enrolment) anti-psychotic medication or recently started on anti-depressant medication (less than 3 months at the time of enrolment). Participants on a stable dose of anti-depressant medication (for more than 3 months) will be permitted but advised to consult with their GP or psychiatrist prior to enrolment.
* A diagnosis of schizophrenia
* More than 4 consecutive classes of meditation training or mind-body practices (including yoga and tai-chi) in the past 2 years
* Current pregnancy or lactation
* Not available to attend all programme dates

Answer: A