Reducing Symptoms of Depression, Stress and Anxiety and Enhancing Positive Mental Health: a Randomized-controlled Study of the Positive Emotions Training

Based on the results of the previously published paper "Positive Emotions Training (PoET) as an online intervention to improve mental health: a feasibility study" (Niemann et al., 2023) the goal of this study was to examine the effects of the "Positive Emotions Training" on mental health in a randomized-controlled study. Furthermore, possible predictors for the efficacy of PoET are to be explored.

Hypotheses:

1. It was hypothesized that participants receiving PoET would show a significant increase in positive mental health factors at the second assessment point (T2) at end of the second training day.
2. Furthermore, participants receiving PoET are to be expected to show a significant decrease in depression, anxiety and stress symptoms at T2.
3. It was hypothesized that the changes in mental health factors remain stable up to the last assessment point (T3) three month after the training.
4. Lastly, it was hypothesized that there would be no significant changes in the positive or negative mental health factors in the control group at T2 and T3.
5. The possible predictors of the training's efficacy were not hypothesized, but examined in exploratory investigations.

Methods:

The final sample was n = 207 with n = 90 in the PoET group and n = 117 in the control. The control group did not receive any intervention in the experimental period, but was offered to participate in a later PoET. The allocation was randomized. Participants in the PoET group completed two online training sessions (3 hours each) via Zoom. Group size was about 25-30 people. The sessions included the following positive psychology constructs: happiness, humour, optimism, loving kindness and gratitude on the first day, and hope, self-efficacy, meaningfulness, forgiveness and resilience on the second day. All participants completed a questionnaire at the beginning of the first training session, at the end of the second one as well as three months after the second session. Participants were given an exercise booklet for all exercises (during the training sessions and at home). The one-week break between the two sessions was advertised as a "7-day-challenge" to improve the motivation in participants to exercise at home.

Data was collected pseudonymised via "qualtrics". Data analyses were conducted with RStudio. For the possible effects of PoET on mental health two-factorial repeated measures ANOVAs were conducted. For the exploration of possible predictors for the efficacy of the training, a hierarchical regression was conducted.

Study Overview

• Status: Completed
• Conditions: Mental Health; Randomized Controlled Study; Positive Emotions; General Population (no Specific Condition or Disease); Intervention (Training) Condition
• Intervention / Treatment: Behavioral: PoET

• Study Type: Interventional
• Enrollment (Actual): 297
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Germany
  • North Rhine-Westphalia
    • Bochum, North Rhine-Westphalia, Germany, 44801
      • Ruhr-University Bochum

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• legal age (18), ability to use Zoom and all associated technology

Exclusion Criteria:

• none

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: PoET group; Participants of this arm received the PoET online training within two sessions. They filled out a whole of three questionnaires.	Behavioral: PoET; Participants in the PoET group completed two online training sessions (3 hours each) via Zoom. Group size was about 25-30 people. The sessions included the following positive psychology constructs: happiness, humour, optimism, loving kindness and gratitude on the first day, and hope, self-efficacy, meaningfulness, forgiveness and resilience on the second day.
No Intervention: Control group; Participants did not receive any treatment initially, but were offered to participate in a later PoET training as compensation. They filled out a whole of three questionnaires.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Positive Mental Health Scale (PMH)	9 items, 4-point-scale from 0 ("I do not agree ") to 3 ("I agree"), assessing emotional and psychological aspects of wellbeing, higher scores reflect better positive mental health	before 1st and after 2nd training session, three months after 2nd training session
Depression Anxiety Stress Scale 21 (DASS-21)	21 items, 4-point-scale from 0 ("did not apply to me at all") to 3 ("applied to me very much or most of the time"), assessing negative emotional states, higher scores reflect more symptoms of depression, anxiety and stress	before 1st and after 2nd training session, three months after 2nd training session

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Life Orientation Test revised (LOT-r)	10 items, 5-point-scale from 0 ("strongly disagree") to 4 ("strongly agree"), assessing dispositional optimism, higher scores reflect higher dispositional optimism	before 1st and after 2nd training session, three months after 2nd training session
Satisfaction with Life Scale (SWLS)	5 items, 7-point-scale from 1 ("strongly disagree") to 7 ("strongly agree"), assessing global subjective happiness, higher scores indicate a happier person	before 1st and after 2nd training session, three months after 2nd training session
Brief Resilience Scale (BRS)	6 items, 5-point-scale from 1 ("strongly disagree") to 5 ("strongly agree"), assessing participants' ability to recover from stress despite significant adversity, higher scores reflect higher resilience	before 1st and after 2nd training session, three months after 2nd training session
Perceived Stress Questionnaire (PSQ)	20 items, 4-point-scale from 1 ("almost never") to 4 ("usually"), assessing the perceived stress in different areas of life, higher scores indicate more stress	before 1st and after 2nd training session, three months after 2nd training session
Satisfaction in different areas of life	self-generated, five items, 4-point-scale from 1 ("not satisfied") to 4 ("satisfied"), assessing participants satisfaction in five different areas of life, higher scores reflecting higher satisfaction	before 1st and after 2nd training session, three months after 2nd training session
Implementation of at-home exercices	self-generated, two questions regarding the frequency and the kind of exercise participants did at home	after 2nd training session and three months after 2nd training session
Socio-demographic data	age, gender, marital status, education, employment	before 1st training session

Collaborators and Investigators

• Sponsor: Ruhr University of Bochum
• Investigators: Study Director: Christina Bartnick (born Totzeck), PhD, Ruhr-University Bochum

Publications and helpful links

General Publications

• Niemann L, von Gruner C, Zhang XC, Margraf J, Totzeck C. Positive Emotions Training (PoET) as an online intervention to improve mental health: a feasibility study. BMC Public Health. 2023 Aug 14;23(1):1543. doi: 10.1186/s12889-023-16424-x.

Study record dates

Study Major Dates

• Study Start (Actual): November 3, 2022
• Primary Completion (Actual): May 4, 2023
• Study Completion (Actual): May 4, 2023

Study Registration Dates

• First Submitted: February 24, 2025
• First Submitted That Met QC Criteria: February 24, 2025
• First Posted (Actual): March 25, 2025

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: February 24, 2025
• Last Verified: February 1, 2025

More Information

Terms related to this study

• Keywords: intervention; positive psychology; online intervention; randomized controlled study; general population; positive emotions
• Additional Relevant MeSH Terms: Pathologic Processes; Disease
• Other Study ID Numbers: PoET102

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No