Abstract
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.
Highlights
Chronic stress can lead to serious psychological and physical implications, such as depression [1], sleep problems [2], neck and shoulder disorders [3], and an increased risk of coronary heart disease events [4] and related mortality [5]
Given that stress represents a major threat to public health, effective and scalable solutions to accommodate the demand for stress-management interventions are needed
We found significant small-to-medium effect sizes for short (Cohen d=0.33, 95% CI 0.22-0.44; n=9) and medium interventions (Cohen d=0.59, 95% CI 0.45-0.74; n=13), whereas long interventions led to a nonsignificant effect size of Cohen d=0.21
Summary
Chronic stress can lead to serious psychological and physical implications, such as depression [1], sleep problems [2], neck and shoulder disorders [3], and an increased risk of coronary heart disease events [4] and related mortality [5]. The evidence base on traditional face-to-face stress-management interventions is comprehensive, showing small-to-moderate overall effects in reducing adverse outcomes for mental health [7]. In their meta-analysis on interventions for work-related stress, van der Klink et al [8] reported a combined effect size of Cohen d=0.34 across all studies. Richardson and Rothstein’s more recent meta-analysis [9] on occupational cognitive behavioral, relaxation, organizational, multimodal, or alternative stress-management interventions yielded somewhat larger effects, with an overall effect of Cohen d=0.53, an effect of Cohen d=0.68 for anxiety, and Cohen d=0.73 for stress. New technologies offer opportunities to provide effective psychological interventions on a large scale
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