Self-Help Plus (SH+) for Stress Reduction in Social Service Workers: A Pilot RCT

Feasibility and Preliminary Effectiveness of WHO Self-Help Plus (SH+) for Stress Reduction Among Social Service Workers: A Pilot Randomized Controlled Trial

This is a two-arm, stratified cluster-randomized controlled pilot trial evaluating the feasibility and preliminary effectiveness of the World Health Organization's Self-Help Plus (SH+) intervention for stress reduction among social service workers employed by the Istanbul Provincial Directorate of Family and Social Services (ASHP). Four institutions (clusters) are randomized 1:1, stratified by service type, to receive either SH+ plus Enhanced Care as Usual (ECAU) or ECAU only, with a target of 50 participants (25 per arm). The primary aim is to assess feasibility indicators (recruitment, session attendance, retention, and acceptability) to inform a future full-scale definitive trial. Preliminary effects on perceived stress and related mental health and well-being outcomes are examined as secondary outcomes.

Study Overview

• Status: Not yet recruiting
• Conditions: Burnout, Professional; Stress, Psychological; Psychological Distress; Stress, Psychological, Occupational
• Intervention / Treatment: Behavioral: Self-Help Plus (SH+); Behavioral: Enhanced Care as Usual (ECAU)

Detailed Description

Social service workers are chronically exposed to traumatic content and occupational stress, placing them at elevated risk for psychological distress and secondary traumatic stress. A universal-prevention approach is adopted: no individual stress threshold is required for inclusion, as the occupational context itself serves as a high-risk filter.

Randomization is performed at the institution (cluster) level rather than the individual level to prevent contamination, accommodate the group format of the intervention, and reflect logistical realities of the institutions. Two clusters are allocated to the intervention arm and two to the control arm (1:1), stratified by service type. The allocation list is generated by a researcher independent of the field team, and assignment is revealed only after baseline (T0) assessment is complete. The trial is single-blind: participants and facilitators cannot be blinded, but outcome assessment is self-report via online forms (structural assessor masking) and the data analyst is blinded to group allocation (groups coded A/B until analysis is complete).

The SH+ intervention is a low-intensity, guided self-help program based on Acceptance and Commitment Therapy, delivered by trained non-specialist facilitators in a group format across five weekly sessions of approximately two hours each. It uses a pre-recorded audio course complemented by the illustrated self-help book "Doing What Matters in Times of Stress"; participants receive the book and weekly audio exercises for between-session practice. The ECAU control comprises continued access to existing institutional support and routine services plus a comprehensive psychoeducational information pack (stress-coping strategies, recognition of stress symptoms, and pathways to mental health and psychosocial support services in Istanbul). After the 3-month follow-up (T2), control-arm participants are offered the opportunity to attend SH+ sessions.

Assessments are collected at baseline (T0, pre-randomization), post-intervention (T1), and 3-month follow-up (T2) via self-report online forms. Feasibility progression thresholds are pre-specified: recruitment rate ≥70%, session attendance ≥70% (attending at least 3 of 5 sessions), and follow-up completion ≥75%. Preliminary effectiveness is analyzed using design-effect-adjusted methods or linear mixed models accounting for clustering; effect sizes (Cohen's d) with 95% confidence intervals are reported. The intraclass correlation coefficient (ICC) for the primary clinical outcome (PSS-10) is estimated to inform sample-size planning for a future full-scale cluster RCT.

• Study Type: Interventional
• Enrollment (Estimated): 50
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Yunus Oguz, MD; Phone Number: +90 542 205 65 43; Email: yunusoguz@windowslive.com

Study Locations

• Turkey (Türkiye)
  • Istanbul, Turkey (Türkiye)
    • Istanbul Provincial Directorate of Family and Social Services

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Currently employed (permanent, contracted, or temporary staff) at an institution under the Istanbul Provincial Directorate of Family and Social Services
• Able to read and write in Turkish
• Willing to participate voluntarily
• Provides written informed consent

Exclusion Criteria:

• Imminent suicide risk, screened at baseline (T0) via PHQ-9 item 9; participants scoring 2 or higher are not enrolled and are immediately referred to a mental health professional
• Active psychosis, severe substance use disorder, or severe intellectual disability
• An acute medical condition that would preclude participation
• Planned extended leave (e.g., maternity or unpaid leave) during the study period

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: SH+ plus Enhanced Care as Usual (ECAU); Participants in clusters allocated to this arm receive the Self-Help Plus (SH+) group program (five weekly approximately 2-hour sessions) in addition to Enhanced Care as Usual.	Behavioral: Self-Help Plus (SH+); WHO Self-Help Plus: a low-intensity, ACT-based guided self-help program delivered by trained non-specialist facilitators in a group format over five weekly sessions (approximately 2 hours each), using a pre-recorded audio course and the illustrated self-help book "Doing What Matters in Times of Stress."; Behavioral: Enhanced Care as Usual (ECAU); Continued access to existing institutional support and routine services plus a comprehensive psychoeducational information pack on stress-coping strategies, recognition of stress symptoms, and referral pathways to mental health and psychosocial support services
Active Comparator: Enhanced Care as Usual (ECAU) only; Participants in clusters allocated to this arm receive Enhanced Care as Usual only (psychoeducational information pack plus continued access to existing services). SH+ is offered after the 3-month follow-up (waitlist).	Behavioral: Enhanced Care as Usual (ECAU); Continued access to existing institutional support and routine services plus a comprehensive psychoeducational information pack on stress-coping strategies, recognition of stress symptoms, and referral pathways to mental health and psychosocial support services

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Recruitment rate (feasibility)	Proportion of eligible staff who provide consent and enroll, calculated as the number enrolled divided by the number eligible, expressed as a percentage. A priori progression threshold is set at 70% or higher.	Through completion of enrollment and baseline assessment (T0), approximately Month 1
Session attendance rate (feasibility)	Proportion of intervention-arm participants attending at least 3 of the 5 SH+ sessions, expressed as a percentage. A priori threshold is 70% or higher.	Across the 5-week intervention period (Weeks 1 to 5)
Follow-up completion / retention rate (feasibility)	Proportion of enrolled participants completing the 3-month follow-up (T2) assessment, expressed as a percentage. A priori threshold is 75% or higher.	From baseline (T0) to 3-month follow-up (T2)
Acceptability and participant satisfaction (feasibility)	Participant-reported acceptability and satisfaction with the intervention, assessed using the purpose-built SH+ Programme Evaluation Form.	At post-intervention (T1), approximately Week 5-6

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in perceived stress (PSS-10)	Perceived Stress Scale (PSS-10), a 10-item self-report measure with a total score ranging from 0 to 40; higher scores indicate greater perceived stress. Between-group comparison of change from baseline.	Baseline (T0), post-intervention (T1), and 3-month follow-up (T2)
Change in depressive symptoms (PHQ-9)	Patient Health Questionnaire-9 (PHQ-9), a 9-item self-report measure with a total score ranging from 0 to 27; higher scores indicate more severe depressive symptoms.	Baseline (T0), post-intervention (T1), and 3-month follow-up (T2)
Change in anxiety symptoms (GAD-7)	Generalized Anxiety Disorder-7 (GAD-7), a 7-item self-report measure with a total score ranging from 0 to 21; higher scores indicate more severe anxiety symptoms.	Baseline (T0), post-intervention (T1), and 3-month follow-up (T2)
Change in professional quality of life (ProQOL-IV)	Professional Quality of Life Scale (ProQOL-IV), a self-report measure assessing compassion satisfaction, burnout, and secondary traumatic stress (compassion fatigue) subscales.	Baseline (T0), post-intervention (T1), and 3-month follow-up (T2)
Change in well-being (WHO-5)	WHO-5 Well-Being Index, a 5-item self-report measure; the raw score is transformed to a 0 to 100 scale, with higher scores indicating better well-being.	Baseline (T0), post-intervention (T1), and 3-month follow-up (T2)

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Intraclass correlation coefficient (ICC) for PSS-10	Intraclass correlation coefficient for the primary clinical outcome (PSS-10), estimated to inform the design effect and sample-size calculations for a future full-scale cluster randomized controlled trial.	Through 3-month follow-up (T2)
Contamination in the control arm	Self-reported exposure of control-arm participants to SH+ materials, sessions, or content during the study period, reported descriptively to assess the feasibility of cluster randomization.	Post-intervention (T1) and 3-month follow-up (T2)

Collaborators and Investigators

• Sponsor: Istanbul Medeniyet University
• Collaborators: Istanbul Provincial Directorate of Family and Social Services

Study record dates

Study Major Dates

• Study Start (Estimated): July 1, 2026
• Primary Completion (Estimated): October 1, 2026
• Study Completion (Estimated): November 1, 2026

Study Registration Dates

• First Submitted: June 9, 2026
• First Submitted That Met QC Criteria: June 9, 2026
• First Posted (Actual): June 12, 2026

Study Record Updates

• Last Update Posted (Actual): June 12, 2026
• Last Update Submitted That Met QC Criteria: June 9, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: Acceptance and Commitment Therapy; pilot study; Turkey; cluster randomized trial; universal prevention; Self-Help Plus; SH+; social service workers; social care workers
• Additional Relevant MeSH Terms: Occupational Stress; Burnout, Psychological; Behavioral Symptoms; Occupational Diseases; Behavior; Stress, Psychological; Burnout, Professional
• Other Study ID Numbers: SHP-TR-2026-PILOT; 2026/0026 (Other Identifier: Göztepe Prof. Dr. Süleyman Yalçın City Hospital Clinical Research Ethics Committee)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: As this is a pilot feasibility trial, a data-sharing plan has not yet been finalized. Decisions regarding sharing of de-identified individual participant data will be made in line with KVKK (Turkish data protection law) requirements and institutional policy, and updated in this record accordingly.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No