Web-based Stress Management Research Articles

The Role of Mental Health Stigma in University Students' Satisfaction With Web-Based Stress Management Resources: Intervention Study.

University students frequently report elevated levels of stress and mental health difficulties. Thus, the need to build coping capacity on university campuses has been highlighted as critical to mitigating the negative effects of prolonged stress and distress among students. Since the COVID-19 pandemic, web-based stress management resources such as infographics and web-based workshops have been central to supporting university students' mental health and well-being. However, there is a lack of research on students' satisfaction with and uptake of these approaches. Furthermore, mental health stigma has been suggested to have not only fueled the emergence of these web-based approaches to stress management but may also influence students' help-seeking behaviors and their satisfaction with and uptake of these resources. This study explored potential differences in students' satisfaction and strategy use in response to an interactive infographic (an emerging resource delivery modality) presenting stress management strategies and a web-based workshop (a more common modality) presenting identical strategies. This study also examined the relative contribution of students' strategy use and family-based mental health stigma in predicting their sustained satisfaction with the 2 web-based stress management approaches. University students (N=113; mean age 20.93, SD 1.53 years; 100/113, 88.5% women) completed our web-based self-report measure of family-based mental health stigma at baseline and were randomly assigned to either independently review an interactive infographic (n=60) or attend a synchronous web-based workshop (n=53). All participants reported their satisfaction with their assigned modality at postintervention (T1) and follow-up (T2) and their strategy use at T2. Interestingly, a 2-way mixed ANOVA revealed no significant group × time interaction or main effect of group on satisfaction. However, there was a significant decrease in satisfaction from T1 to T2, despite relatively high levels of satisfaction being reported at both time points. In addition, a 1-way ANOVA revealed no significant difference in strategy use between groups. Results from a hierarchical multiple regression revealed that students' strategy use positively predicted T2 satisfaction in both groups. However, only in the web-based workshop group did family-based mental health stigma predict T2 satisfaction over and above strategy use. While both approaches were highly satisfactory over time, findings highlight the potential utility of interactive infographics since they are less resource-intensive than web-based workshops and students' satisfaction with them is not impacted by family-based mental health stigma. Moreover, although numerous intervention studies measure satisfaction at a single time point, this study highlights the need for tracking satisfaction over time following intervention delivery. These findings have implications for student service units in the higher education context, emphasizing the need to consider student perceptions of family-based mental health stigma and preferences regarding delivery format when designing programming aimed at bolstering students' coping capacity.

Determining the Right Levels of Health Coaching and Heart Rate Variability Biofeedback in a Workplace Behavior Change Intervention: Multiphase Optimization Strategy Preparation Study.

Work-related stress is associated with poor job performance and negative health outcomes. Changing health behaviors through corporate wellness programs can improve physical and mental health and help employees manage stress. This project sought to pilot the potential addition of brief coaching and biofeedback to an 8-week web-based self-help program to improve employee stress using the multiphase optimization strategy. This study aims to determine which candidate components will be tested in a later optimization phase and at what dose they will be tested, examine the feasibility and acceptability of delivering the different components, investigate whether the outcomes can be feasibly measured, and review evidence to build a conceptual model before the optimization phase. The study was positioned within the preparation phase of the multiphase optimization strategy. It is a 2×2×2×2 design with 4 components: 2 types of health coaching and 2 types of biofeedback. All components were tested by turning them on or off. A total of 16 adult office workers (mean age 40, SD 14.3 years; n=15 women) completed an 8-week self-paced web-based stress management and health behavior change program and were randomly assigned to 1 of the 16 conditions, created from a combination of the 4 candidate components. Assessments included web analytics, surveys, and interviews regarding program recommendations, likes, and dislikes. Findings from the interviews provided suggestions to improve the intervention (eg, separating wellness from stress content) and trial conduct (eg, streamlining the onboarding process). On average, participants logged into the wellness program 83 times (range 36-291), with 75% (12/16) participant retention and 67% (8/12) survey completion. There were no reported problems with coaching or obtaining data from interviews or apps. The interview findings suggested potential mediators to include and assess in a future conceptual model. The results provided areas to improve the intervention content and trial methods. Instead of progressing to the next scheduled large-scale optimization phase, our plan to iterate through a second preparation phase after making changes to the protocol, apps, and corporate coaching partner.

Are web-based stress management interventions effective as an indirect treatment for depression? An individual participant data meta-analysis of six randomised trials

QuestionDepression is highly prevalent and associated with numerous adverse consequences for both individuals and society. Due to low uptake of direct treatment, interventions that target related, but less stigmatising problems,...

Variable selection for individualised treatment rules with discrete outcomes.

An individualised treatment rule (ITR) is a decision rule that aims to improve individuals' health outcomes by recommending treatments according to subject-specific information. In observational studies, collected data may contain many variables that are irrelevant to treatment decisions. Including all variables in an ITR could yield low efficiency and a complicated treatment rule that is difficult to implement. Thus, selecting variables to improve the treatment rule is crucial. We propose a doubly robust variable selection method for ITRs, and show that it compares favourably with competing approaches. We illustrate the proposed method on data from an adaptive, web-based stress management tool.

Randomized controlled trials assessing efficacy of brief web-based stress management interventions for college students during the COVID pandemic.

The purpose of this study was to evaluate the efficacy of brief, self-guided web-based interventions for decreasing distress among U.S. college students during the pandemic. Three randomized controlled trials were conducted during the spring (Study 1), summer (Study 2), and fall (Study 3) 2020 terms, and were combined into one sample to increase power (N = 775). We evaluated a web-based intervention that focused on increasing present control that had been shown to be effective in several studies prior to the pandemic (e.g., Nguyen-Feng et al., 2017). This intervention was compared to an active comparison condition (psychoeducation about and reminders to engage in Centers for Disease Control and Prevention (CDC)-recommended stress management techniques) in Study 1, to a waitlist comparison in Study 2, and to both comparison conditions in Study 3. Participants were undergraduate psychology students at two campuses of a midwestern state university system. Outcomes-perceived stress (primary); depression, anxiety, and stress symptoms (secondary); and boredom (tertiary)-were assessed at pretest and posttest (and 3-week follow-up in Study 3). Differences across conditions were significant for perceived stress, stress symptoms, and boredom (but not depression or anxiety). Contrary to hypotheses, the Present Control and CDC stress management interventions were equally effective. Both were more effective than no intervention (between-group ds = -0.27 and -0.42). Both interventions were more effective for students with higher baseline stress levels. Completion and adherence rates were high for both conditions. Results suggest that very brief, self-guided stress management interventions can be effective in reducing stress among college students. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Supplemental Material for Randomized Controlled Trials Assessing Efficacy of Brief Web-Based Stress Management Interventions for College Students During the COVID Pandemic

Supplemental Material for Randomized Controlled Trials Assessing Efficacy of Brief Web-Based Stress Management Interventions for College Students During the COVID Pandemic

A Web-Based Stress Management Intervention for University Students in Indonesia (Rileks): Feasibility Study Using a Pretest-Posttest Design.

BackgroundUniversity students are susceptible to excessive stress. A web-based stress management intervention holds promise to improve stress but is still at a novel stage in Indonesia.ObjectiveThe aim of this paper was to report the feasibility of the intervention we developed—Rileks—among university students in Indonesia in terms of acceptability and usability, and to propose recommendations for future improvements.MethodsA single-group pretest and posttest design was used. Participants with scores of 15 or higher on the stress subscale of the 42-item Depression Anxiety Stress Scales were given access to the intervention (N=68). The main outcome measures were the 8-item Client Satisfaction Questionnaire (CSQ-8) score, the System Usability Scale (SUS) score, and intervention uptake. Participants’ experience in each session was evaluated using closed- and open-ended questions for future improvements. Descriptive statistics were used to examine primary outcome and qualitative session evaluations. Participants’ responses to each topic of the open questions were summarized.ResultsThe intervention was evaluated as being satisfactory (CSQ-8 mean score 21.89, SD 8.72; range 8-32). However, the intervention’s usability was still below expectation (SUS mean score 62.8, SD 14.74; range 0-100). The core modules were completed by 10 out of 68 participants (15%), and the study dropout rate was 63% (43/68) at postassessment. In general, the module content was rated positively, with some notes for improvement covering content and technical aspects.ConclusionsThis study indicates that Rileks is potentially feasible for Indonesian university students. In order to be optimally applied in such a context and before scaling up web-based interventions in Indonesia, in general, further development and refinement are needed.International Registered Report Identifier (IRRID)RR2-10.2196/11493

Randomized Waitlist-Control Trial of a Web-Based Stress-Management and Resiliency Program for Adolescent and Young Adult Cancer Survivors: Protocol for the Bounce Back Study.

BackgroundThe emotional health of adolescent and young adult (AYA) cancer survivors is compromised both during and after cancer treatment. Targeted programs designed to support AYAs’ ability to cope with stress in the years following treatment completion are lacking. Mind-body programs may ameliorate the negative psychological and emotional effects of stress and assist AYAs with managing the psychosocial challenges of early survivorship.ObjectiveOur randomized waitlist-control trial aims to assess the feasibility, acceptability, and preliminary efficacy of a virtual group program (Bounce Back) to promote stress management and resiliency among posttreatment AYAs.MethodsBounce Back is a stress management and resiliency program delivered via videoconference by a trained mental health clinician. Sessions were adapted from an evidence-based mind-body program (Stress Management and Resiliency Training - Relaxation Response Resiliency Program [SMART-3RP]) grounded in relaxation response elicitation, mindfulness, cognitive behavioral therapy, and positive psychology. Seventy-two AYAs (diagnosed with cancer between ages 14 years and 29 years and had completed cancer treatment within the last 5 years) were randomly assigned to the Bounce Back program or waitlist-control group and completed assessments at baseline, 3 months postbaseline, and 6 months postbaseline. The primary aim of the study is to determine the feasibility and acceptability of the Bounce Back program. Descriptive statistics, including means, frequencies, and ranges supplemented by qualitative exit interview feedback will be used to characterize the sample and to summarize feasibility and acceptability. The exploratory aims are to evaluate the preliminary effects of the program on stress coping and psychosocial outcome measures (ie, anxiety, depression) collected across the 3 time points.ResultsThis study was funded by the National Cancer Institute in July 2017. Study procedures were approved by the Dana-Farber Harvard Cancer Center Institutional Review Board in October 2018 (Protocol 18-428). The randomized trial was conducted from July 2019 to March 2021. Quantitative data collection is complete, and qualitative exit interview data collection is ongoing. Results are expected to be published in peer-reviewed journals and presented at local, national, or international meetings in the coming years.ConclusionsFew evidence-based programs exist that tackle the key transitional issues faced by AYA cancer survivors. Future analyses will help us determine the feasibility and acceptability of the Bounce Back program and its impact on AYA stress coping and psychological well-being.Trial RegistrationClinicalTrials.gov NCT03768336; https://clinicaltrials.gov/ct2/show/NCT03768336International Registered Report Identifier (IRRID)DERR1-10.2196/34033

Evaluation of a Web-Based Stress Management Program for Persons Experiencing Work-Related Stress in Sweden (My Stress Control): Randomized Controlled Trial.

BackgroundStress is one of the most common reasons for sick leave. Web-based interventions have the potential to reach an unlimited number of users at a low cost and have been shown to be effective in addressing several health-related problems. Handling stress on an individual level is related to behavior change. To support behavioral changes in stress management, My Stress Control (MSC) was developed. The development of MSC was based on several health psychology theories and models; however, central in the development were Social Cognitive Theory, Theory of Reasoned Action, Theory of Planned Behavior, Transactional Theory of Stress and Coping, and the Transtheoretical Model and Stages of Change. MSC is a fully automated program. The program is tailored to the user’s specific needs for stress management and behavior change.ObjectiveIn this study, we aim to conduct a randomized controlled trial to evaluate the extent to which MSC affects perceived stress in persons experiencing work-related stress.MethodsThis was a randomized controlled trial with 2 arms. Study participants were recruited by visiting the worksites and workplace meetings. Participants were assigned to the intervention or wait-list group. Web-based questionnaires were used before and after the intervention to collect data. Perceived stress measured using the Perceived Stress Scale-14 was the primary outcome measurement. Analyses were conducted for both between-group and within-group changes.ResultsA total of 92 participants were included in this study: 48 (52%) in the intervention group and 44 (48%) in the wait-list group. Overall, 25% (12/48) of participants in the intervention group and 43% (19/44) of participants in the wait-list group completed the postintervention assessment. There were no significant effects on perceived stress between the intervention and wait-list groups or within the groups. A small effect size (Cohen d=0.25) was found when comparing mean change over time on the primary outcome measure between the intervention and wait-list groups. In addition, a small effect size was found between pre- and postintervention assessments within the intervention group (Cohen d=0.38) as well as within the wait-list group (Cohen d=0.25).ConclusionsThe effect of MSC on perceived stress remains uncertain. As adherence was low in the intervention group, elements or features that facilitate adherence and engagement must be further developed before firmer conclusions regarding the effect of MSC can be made.Trial RegistrationClinicalTrials.gov NCT03077568; https://clinicaltrials.gov/ct2/show/NCT03077568

Adaptive web-based stress management programs among adults with a cardiovascular disease: A pilot Sequential Multiple Assignment Randomized Trial (SMART)

ObjectiveTo assess the feasibility and acceptability of using a Sequential Multiple Assignment Randomized Trial (SMART) to optimize the delivery of a web-based, stress management intervention for patients with a cardiovascular disease (CVD). Methods59 patients with a CVD and moderate stress were randomized to a self-directed web-based stress management program (n = 30) or the same intervention plus lay telephone coaching (n = 29). After 6 weeks, non-responders were re-randomized to continue with their initial intervention or switched to motivational interviewing (MI). Feasibility, acceptability, and clinical significance were assessed. ResultsSMART procedures were feasible. Attrition rates were almost twice as high in the web-only group than the lay coach group. This might be because of the low satisfaction (47%) in the web-only group. On average, 1.7/5 modules were completed. Effect sizes for stress and quality of life generally exceeded 0.2 (clinical benchmark), except for the group that initially received lay coaching and then switched to MI. ConclusionsResults suggest that a larger trial would be feasible. Issues pertaining to attrition and satisfaction for non-responders need to be addressed. Practice implicationsFindings contribute to the evidence on how best to develop and deliver e-Health interventions to maximize their efficacy while remaining cost-effective.

A three-armed randomised controlled trial investigating the comparative impact of guidance on the efficacy of a web-based stress management intervention and health impairing and promoting mechanisms of prevention

BackgroundWeb-based stress management interventions (SMI) fit increasingly digital lifestyles, reduce barriers of uptake and are easily scalable. SMIs might lower levels of stress in employees and thereby contribute to the prevention of depressive symptomatology. Different guidance formats can impact the efficacy of SMIs, with higher intensity assumed to result in larger effects. However, head-to-head comparisons of guidance formats are rare. This is the first trial to examine the impact of adherence-focused guidance compared to self-help on the efficacy of an occupational SMI compared to a wait list control condition. Additionally, it will be investigated if the SMI enfolds its impact on preventing depressive symptomatology by different pathways through reducing health impairing and increasing promoting factors.MethodsA three-armed randomised controlled trial (RCT) on an occupational SMI was conducted. 404 employees with elevated levels of perceived stress (PSS-10 ≥ 22) were randomly assigned to: adherence-focused guidance (AFG), self-help (SH) or a wait list control group (WLC). The primary outcome was perceived stress (PSS-10). Secondary outcomes included health- and work-related measures. A parallel mediation analysis with stress and resilience as mediators for the effect on depression (CES-D) was carried out. Data collection took place at baseline (T1), after 7 weeks (T2) and 6 months (T3).ResultsThe SMI was effective for all groups on the primary and secondary outcomes. For stress, analyses of covariance (ANCOVA) revealed significant group effects at T2 (F2,400 = 36.08, P < .001) and T3 (F2,400 = 37.04, P < .001) with large effect sizes for AFG (T2: d = 0.83; T3: d = 0.85) and SH (T2: d = 0.88; T3: d = 0.91) compared to WLC. No significant group differences were found for the efficacy between AFG and SH on the outcomes. Adherence in terms of completed modules was significantly higher for AFG compared to SH. The SMI’s impact on depression was mediated by perceived stress: a1b1 = − 0.77, 95% CI [− 1.26, − 0.34] and resilience: a2b2 = − 0.62, 95% CI [− 1.05, − 0.26].ConclusionsThe SMI was effective for reducing stress and improving other health- and work-related outcomes, irrespective of the guidance format. Results did not demonstrate superiority of adherence-focused guidance for the efficacy but for adherence in terms of completed modules. Among other reasons, better communication strategies about offered guidance and awareness-raising measures are discussed. Results from mediation analysis suggest that preventive SMIs should be designed to reach two goals: reducing the risk factor of stress and simultaneously increasing health promoting factors such as resilience.Trial registrationGerman Clinical Trial Registration (DRKS) DRKS00005687, 6/6/2014.

Evaluating the Outcomes of a Web-Based Stress Management Program for Nurses and Nursing Assistants.

The purpose of this quality improvement project was to determine the utilization, satisfaction, and effect of a web-based stress management program for nurses and nursing assistants (NAs). This quality improvement project provided BREATHE, a web-based stress management program that consisted of six modules that describe, identify, and help nurses manage stress for 31 nurses and NAs working on a subacute rehabilitation unit at a mid-Atlantic community hospital. The number of login attempts and time spent on the program were included, as were the nurse stress scale (NSS), a 34-item validated instrument that captures seven dimensions of stress, and a seven-item satisfaction survey given at the end of the modules. Nurses utilized and were satisfied with the evidence-based program BREATHE and reported significant improvement in NSS scores. Findings suggest that BREATHE was effective at reducing the NSS score among nurses and NAs. The web-based nature of the program allowed nurses to engage in it at times most convenient for them, which added to the program's acceptability and overall satisfaction.

Moderators of the efficacy of a web-based stress management intervention for college students.

High levels of stress are common among college students. Web-based interventions may be one way to teach students stress management skills. Although previous research has demonstrated the overall efficacy of web-based stress management interventions, little attention has been paid to who might benefit most from these interventions. In this study, we analyzed data from 3 prior studies (N = 782) to examine moderators of the efficacy of a web-based stress management intervention that focused on increasing perceived present control (i.e., aspects of stressors that are controllable in the present). Specific moderators assessed in regression analyses were baseline scores on outcome measures (perceived stress, stress symptoms, anxiety, depression) and the putative mechanism (perceived present control) of the intervention. Baseline symptom levels moderated the effects of the intervention on all outcomes, such that the intervention was more effective for students with more baseline symptoms. Baseline levels of present control had less consistent moderating effects, but significant interactions indicated that the intervention was more effective for those with lower levels of present control. The novel Johnson-Neyman technique was used to identify specific cutoff scores on these measures, below which the effect of the intervention was not significant, and scores on the measures associated with varying effect sizes. Findings from the Johnson-Neyman analyses can inform the development of screening criteria for future research and clinical application. Because the intervention was more effective for students with higher levels of baseline distress, it may be better suited for an indicated rather than universal prevention approach. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Emotional abuse moderates efficacy of an ecological momentary stress management intervention for college students.

Web-based stress management interventions are effective for college students, particularly those with interpersonal trauma histories. However, these interventions have not been assessed among those reporting childhood emotional abuse, a group with the most distress. Ecological momentary interventions (EMIs), which use mobile phones to deliver near-real-time psychosocial interventions in daily life, offer the possibility of increasing intervention efficacy. This randomized controlled trial examined the feasibility and efficacy of an EMI for reducing psychological distress among students with and without an emotional abuse history. Undergraduate students (N = 382) were randomly assigned to receive (a) an EMI that taught stress management skills, or (b) an ecological momentary assessment (EMA) with self-monitoring of stressors and mood. Both the EMI and EMA lasted for 14 days. Participants completed outcome measures (e.g., depression, anxiety, stress symptoms) at pretest, posttest, and 3-week follow-up. Overall, the EMI appeared feasible, acceptable, and usable, with 80% to 91% completion rates. Linear mixed models indicated that there were no significant Condition × Time interaction effects in the total sample, with decreases in perceived stress and increases in positive affect over time regardless of condition (EMI vs. EMA). Moderation analyses indicated that the EMI was generally more effective for those with a history of emotional abuse and that the EMA was more effective for those without such a history. Post hoc analyses demonstrated that participants wrote less in the EMI than in a web-based version of the intervention. Future interventions could target at-risk groups based on trauma history or baseline distress. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Web-Based Cognitive Behavioral Stress Management for Latino Sexual Minority Men Living With HIV and Cancer

Web-Based Cognitive Behavioral Stress Management for Latino Sexual Minority Men Living With HIV and Cancer

Web-Based Stress Management Program for University Students in Indonesia: Systematic Cultural Adaptation and Protocol for a Feasibility Study.

BackgroundThe number of university students experiencing stress is increasing, which often leads to adverse effects such as poor grades, academic probation, and emotional problems. Unfortunately, most of these problems remain untreated because of limited professional resources and fear of stigma. Several Web-based stress management interventions are now available for student populations, but these treatments are not yet available in Indonesia. To make treatment for stress more acceptable in Indonesia, a cultural adaptation process is needed, and part of the process is assessing the feasibility of the adapted intervention.ObjectiveThis paper describes the first two stages of a cultural adaptation process and the protocol of a feasibility study that will assess the acceptability of a culturally adapted stress management intervention for university students in Indonesia.MethodsFocus group discussions with Indonesian university students were held, and input from Indonesian psychologists was gathered for developing the adapted intervention. A single-group feasibility study with a pre-post design will be conducted. We will recruit at minimum 50 university students who have an elevated level of stress (Depression, Anxiety, and Stress Scales–42 stress subscale score ≥15), identify themselves as being of Indonesian culture (eg, able to speak Bahasa Indonesia fluently), and are studying at a university in Indonesia. The primary endpoints of this study will be rates of participant satisfaction, system usability, dropout rates, and level of adherence. We will also use qualitative data to assess the adapted intervention more thoroughly. Secondary study endpoints will be quality of life, stress, anxiety, and depression levels. Feasibility parameters (eg, participant satisfaction, system usability, and level of adherence) will be summarized with descriptive statistics. Two-tailed paired within-group t tests will be used to analyze stress, anxiety, depression, and quality of life.ResultsThe enrollment of pilot study is currently ongoing. First results are expected to be ready for analysis in the second half of 2019. The project was funded as part of a PhD trajectory in 2015 by the Indonesian Endowment Fund for Education.ConclusionsThis is one of the first studies to assess the feasibility of a culturally adapted Web-based stress management intervention for university students in Indonesia. Strengths and limitations of the study are discussed.International Registered Report Identifier (IRRID)DERR1-10.2196/11493

Supplemental Material for Moderators of the Efficacy of a Web-Based Stress Management Intervention for College Students

Supplemental Material for Moderators of the Efficacy of a Web-Based Stress Management Intervention for College Students

Health-relevant personality traits in relation to adherence to a web-based occupational health promotion and stress management intervention

PurposeThe purpose of this paper is to investigate the possible associations between health-relevant personality traits and adherence; and if these traits predict adherence to a web-based occupational health intervention.Design/methodology/approachIn total, 563 participants were analyzed using the Health-relevant Personality Inventory. Adherence measures were: logins, utilization of self-help exercises and time spent logged in.FindingsHigher levels of antagonism (a facet of agreeableness) and impulsivity (a facet of conscientiousness) correlated to fewer logins, and higher levels of negative affectivity (a facet of neuroticism) and impulsivity correlated to a higher utilization of self-help exercises. Alexithymia (a facet of openness) negatively predicted self-help exercise utilization and antagonism was a positive predictor. Negative affectivity was a positive predictor of time spent logged in to the intervention. There were sex-related differences in outcomes.Originality/valueThis is the first study to investigate health-relevant personality traits in relation to adherence to a web-based occupational health intervention. The practical implications are that intervention developers could benefit from taking personality into consideration to better understand and improve adherence.

User experiences from a web-based, self-management programme: struggling with what I need when stress management is about me

Objectives: To explore users’ experiences of a tailored, interactive web application that supports behaviour change in stress management and to identify if and in that case what in the web-based programme that needed further development or adjustment to be feasible in a randomised controlled trial.Method: The design of this study was explorative with a qualitative approach. Nine individuals were recruited among the staff at a university. Semi-structured individual interviews were conducted and analysed using qualitative content analysis, after the participants had completed the web-based stress management programme.Results: One theme was identified, Struggling with what I need when stress management is about me, describing the paradox in having a programme that is perceived as supporting stress management while also being perceived as extensive and time consuming. The theme was divided in two categories: Defining the needs, where the users expressed what they needed from the programme and their everyday environment, to be able to use the programme, and It is about me, where the programme was described as helping the users understand their own stress.Conclusion: The participants expressed acceptance of using a web-based programme for stress related problems. The perceived extensiveness of the programme must be considered in further development.

Web-Based Stress Management for Newly Diagnosed Patients With Cancer (STREAM): A Randomized, Wait-List Controlled Intervention Study.

PurposeBeing diagnosed with cancer causes major psychological distress; however, a majority of patients lack psychological support during this critical period. Internet interventions help patients overcome many barriers to seeking face-to-face support and may thus close this gap. We assessed feasibility and efficacy of Web-based stress management (STREAM [Stress-Aktiv-Mindern]) for newly diagnosed patients with cancer.Patients and MethodsIn a randomized controlled trial, patients with cancer who had started first-line treatment within the previous 12 weeks were randomly assigned to a therapist-guided Web-based intervention or a wait-list (control), stratified according to distress level (≥ 5 v < 5 on scale of 0 to 10). Primary efficacy end point was quality of life after the intervention (Functional Assessment of Chronic Illness Therapy–Fatigue). Secondary end points included distress (Distress Thermometer) and anxiety or depression (Hospital Anxiety and Depression Scale). Treatment effect was assessed with analyses of covariance, adjusted for baseline distress.ResultsA total of 222 of 229 screened patients applied online for participation. Between September 2014 and November 2016, 129 newly diagnosed patients with cancer, including 92 women treated for breast cancer, were randomly assigned to the intervention (n = 65) or control (n = 64) group. Adherence was good, with 80.0% of patients using ≥ six of eight modules. Psychologists spent 13.3 minutes per week (interquartile range, 9.5-17.9 minutes per week) per patient for online guidance. After the intervention, quality of life was significantly higher (Functional Assessment of Chronic Illness Therapy–Fatigue: mean, 8.59 points; 95% CI, 2.45 to 14.73 points; P = .007) and distress significantly lower (Distress Thermometer: mean, −0.85; 95% CI, −1.60 to −0.10; P = .03) in the intervention group as compared with the control. Changes in anxiety or depression were not significant in the intention-to-treat population (Hospital Anxiety and Depression Scale: mean, −1.28; 95% CI, −3.02 to 0.45; P = .15). Quality of life increased in the control group with the delayed intervention.ConclusionThe Web-based stress management program STREAM is feasible and effective in improving quality of life.