The effectiveness of an online based stress management intervention.
Creators: name: Uhlig, Juliane
name: Kortsch, Timo
name: Rimpler, Ramon
Publisher: name: Open Science Framework
Year: 2022
Subjects: subject: Health Information Technology
subject: Psychiatry and Psychology
subject: Medicine and Health Sciences
subject: Mental and Social Health
subject: burnout
subject: coping
subject: digital mental health
subject: effectiveness
subject: evaluation
subject: job crafting
subject: stress control mindset
subject: Stress management intervention

description: Theoretical background: Nowadays work is the most significant stress factor (e. g. Techniker Krankenkasse, 2016). Since persistent stress is associated with a variety of risks for physical and mental health and also places a burden on organizations and the public health system (Hassard et al., 2018), the relevance of effective stress prevention is increasing. The current Covid 19 pandemic not only adds to the strain (Wang et al., 2020), but also emphasizes the benefits of online programs as an alternative to interventions that require the physical presence of participants (Lattie et al., 2019). The purpose of this study is to examine the ability of an online stress management course based on the Job-Demands-Resources model (Demerouti, Bakker, Nachreiner &amp; Schaufeli, 2001) to reduce participants' stress levels. Another focus is on testing the improvement of proactive stress coping strategies and a change in stress-related cognitions through the intervention. Furthermore, a scientific explanation of the effect model and an understanding of the underlying mechanisms of functional stress coping pave the way for the optimization of existing and well-founded development of new effective prevention offers. Study goals: This study aims to evaluate the effectiveness of an online stress management intervention on stress, burnout, coping and mindset compared to a wait-list control group. Moreover, it will be tested if effects remain stable at a four-weeks, seven-weeks and six-months follow-up. In addition the mechanism of change will be explored by conducting a path analysis. Hypotheses: 1. Participants of the intervention group show significantly reduced stress from baseline to post-treatment directly after intervention and at a four-weeks, seven-weeks and a six-months follow-up compared to the wait-list control group. 2. Burnout is significantly reduced in participants of the intervention group from baseline to post-treatment at a four-weeks, seven-weeks and a six-months follow-up compared to the wait-list control group. 3. Participants of the intervention group report improved knowledge from baseline to post-treatment directly after intervention and at a four-weeks, seven-weeks and a six-months follow-up compared to the wait-list control group. 4. Participants of the intervention group report more functional coping from baseline to post-treatment directly after intervention and at a four-weeks, seven-weeks and a six-months follow-up compared to the wait-list control group. 5. Participants of the intervention group report less dysfunctional coping from baseline to post-treatment directly after intervention and at a four-weeks, seven-weeks and a six-months follow-up compared to the wait-list control group. 6. Participants of the intervention group report increased job crafting behaviour from baseline to post-treatment directly after intervention and at a four-weeks, seven-weeks and a six-months follow-up compared to the wait-list control group. 7. Participants of the intervention group report an enhanced stress control mindset from baseline to post-treatment directly after intervention and at a four-weeks, seven-weeks and a six-months follow-up compared to the wait-list control group. 8. There is an indirect effect of coping skills on the association of participation in the intervention and reduced stress. Study Plan Study design: The study will use a wait-list control group design with matched pairs and four points of measurement. Groups will be parallelized regarding the baseline stress level. Self-report data will be assessed via online questionnaire at baseline before the intervention (t1), directly after the intervention (t2), as well as four weeks (t3), seven weeks (t4) and six months after the intervention (t5). Manipulated variables: The participants will be assigned to one out of to two groups. The intervention group participates in an online stress management intervention for five weeks. The intervention investigated in this study is the "Einfach weniger Stress - Onlinekurs" based on the “Einfach weniger Stress” stress management course (Kortsch, 2020). Participants of the wait-list control condition will receive no intervention at first but will get free access to the online intervention as soon as the last survey is conducted. The intervention investigated: The “Einfach weniger Stress - Onlinekurs" is a digital stress prevention program that promotes the development of stress management skills in participants and thus aims to lead to more serenity and less stress in the long term. The content is based on the scientifically evaluated "Einfach weniger Stress" course concept (Paulsen &amp; Kortsch, 2020). In total, the "Einfach weniger Stress - Onlinekurs" consists of seven modules. All modules build on one another, but each is self-contained in terms of content and contains learning objectives, knowledge input, exercises and a final quiz. The online course is divided into an introductory module which provides an overview of the online course and an initial introduction to the topic of stress prevention in terms of content, five main modules focussing on "Understanding Stress,", "Recognizing Stressors,", "Activating Resources,", "Planning Implementation" and "Acting Calmly." and a final module, which is intended to serve as a review and support transfer to everyday life. Measured variables: Primary outcome will be perceived stress (Perceived Stress Scale-10, Cohen, Kamarck &amp; Mermelstein, 1983). Secondary outcomes will include knowledge on stressors and resources (Paulsen &amp; Kortsch, 2020), burnout (Bergen Burnout Inventory-9, Salmela-Aro, Rantanen, Hyvo¨nen, Tilleman &amp; Feldt, 2011), coping (Coping Inventar zum Umgang mit Stress-Situationen, Kälin &amp; Semmer, 2020), job crafting (Job Crafting Scale, Tims, Bakker, &amp; Derks, 2012) and stress control mindset (Stress Control Mindset Measure, Keech, Orbell, Hagger, O’Callaghan, &amp; Hamilton, 2018). Moreover, sociodemographic data including age, gender, profession and current life situation will be assessed at t1. Sample size: The sample size was decided upon based on an a priori sample size - calculation given an alpha of .05, a power of .8 and an expected effect size of f=0.215 for a two factor ANOVA with repeated measures on both factors. The study aims to include at least 70 participants. Participant recruitment, selection and compensation: Participants in this study will be recruited via advertisements in social media and mailing lists. Participants will be eligible if they confirm to be at least 18 years old and currently not receiving psychological treatment. Participants who meet criteria will sign an informed consent form. Via e-mail they will be sent the online questionnaires using SoSci Survey. Participants will not get any compensation but free access to the course. Study procedures: After registration participants will be matched into pairs so that they show a similar stress level at baseline. One participant of the match will be randomly assigned to one the intervention group, the other participant of the match will participate in the wait-list control group so that the intervention group and the wait-list control group will be balanced in terms of the baseline stress level. During the following five weeks participants of the intervention group will participate in the online course while participants of the waitlist control group will not receive any intervention so far. Self-report data will be assessed via online questionnaire at baseline before the intervention (t1), directly after the intervention (t2), four weeks (t3), seven weeks (t4) and six months after the intervention (t5). After the last time point of measurement the participants of the wait-list control group will get free access to the course, too. Handling of participant drop-out: There will not be any special treatment for participants who drop out and candidates will not be replaced. However, if one part of the matched pair drops out, the corresponding case will not be included in data analysis later. Analysis Plan: Data analysis will follow intention-to-treat-principles and will be conducted using SPSS and R. Missing data will be handled using multiple imputation. If one part of the matched pair drops out the data of the other part of the matched pair will be excluded from analysis as well. At first, descriptives will be computed for every variable. Based on a 2x5 design with repeated measures on both factors hypotheses will be assessed using analysis of variance and path analysis. Contributors: Juliane Uhlig, University of Hildesheim; Dr. Timo Kortsch, Denkverstärker GbR, Ramon Rimpler, Denkverstärker GbR and University of Göttingen Date of preregistration: 19.03.2021 Registration prior to creation of data. Estimated duration of the project: 6 months. Conflict of interest statement: Dr. Timo Kortsch is the developer of the online intervention and profits from the sales of the online course. However, he acts according to the Ethical Principles of Psychologists and Code of Conduct from the Federation of German Psychologist Associations (DGPs). Refrences Demerouti, E., Nachreiner, F., &amp; Schaufeli, W. (2001). The Job Demands–Resources Model of Burnout. The Journal of applied psychology. 86. 499-512. 10.1037/0021-9010.86.3.499. Cohen S., Kamarck T., &amp; Mermelstein R. (1983). A global measure of perceived stress. Journal of Health and Social Behaviour, 24:385–96. doi: 10.2307/2136404. Hassard, J., Teoh, K.R.H., Visockaite, G., Dewe, P., &amp; Cox, T.J. (2018). The cost of work-related stress to society: A systematic review. Occupational Health Psychology. 23(1):1-17. Kälin, W., &amp; Semmer, N. K. (2020). Coping-Inventar zum Umgang mit Stress-Situationen (CISS). Deutschsprachige Adaptation des Coping Inventory for Stressful Situations (CISSTM) von Norman S. Endler und James D. A. Parker. Bern: Hogrefe. Keech, J.J., Hagger, M.S., O’Callaghan, F.V. &amp; Hamilton, K. (2018). The influence of university students’ stress mindsets on health and performance outcomes. Annals of Behavioral Medicine, 52(12), 1046-1059. doi: 10.1093/abm/kay008 Lattie, E.G., Adkins, E.C., Winquist, N., Stiles-Shields, C, Wafford, Q.E., &amp; Graham, A.K. (2019). Digital Mental Health Interventions for Depression, Anxiety, and Enhancement of Psychological Well-Being Among College Students: Systematic Review. Journal of Medical Internet Research, 21(7):e12869. doi: 10.2196/12869 Paulsen, H., &amp; Kortsch, T. (2020). Stressprävention in modernen Arbeitswelten. Das „Einfach weniger Stress“-Manual. Göttingen: Hogrefe. Salmela-Aro, K., Rantanen, J., Hyvönen, K., Tilleman, K., &amp; Feldt, T. (2010). Bergen Burnout Inventory: Reliability and validity among Finnish and Estonian managers. International archives of occupational and environmental health. 84. 635-45. 10.1007/s00420-010-0594-3. Techniker Krankenkasse. (Hrsg.). (2016). Entspann dich, Deutschland. Zugriff am 23.01.2021. 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