Internet-based stress recovery intervention FOREST for healthcare staff amid COVID-19 pandemic: study protocol for a randomized controlled trial

Lina Jovarauskaite, Austeja Dumarkaite, Inga Truskauskaite-Kuneviciene, Ieva Jovaisiene, Gerhard Andersson, Evaldas Kazlauskas, Lina Jovarauskaite, Austeja Dumarkaite, Inga Truskauskaite-Kuneviciene, Ieva Jovaisiene, Gerhard Andersson, Evaldas Kazlauskas

Abstract

Background: The demand for care during the COVID-19 pandemic has affected the mental health of healthcare workers (HCWs), thus increasing the need for psychosocial support services. Internet-based interventions have previously been found to reduce occupational stress. The study aims to test the effects of an Internet-based stress recovery intervention-FOREST-among HCWs.

Methods: A randomized controlled trial (RCT) parallel group design with three measurement points will be conducted to assess the efficacy of an Internet-based stress recovery intervention FOREST for nurses. The FOREST intervention is a 6-week Internet-based CBT and mindfulness-based program which comprises of six modules: (1) Introduction, (2) Detachment (relaxation and sleep), (3) Distancing, (4) Mastery (challenge), (5) Control, and (6) Keeping the change alive. We will compare the intervention against a waiting list group at pre-test, post-test, and follow-up. Stress recovery, PTSD, complex PTSD, moral injury, the level of stress, depression, anxiety, and psychological well-being will be measured.

Discussion: The study will contribute to the development of mental healthcare programs for the HCWs. Based on the outcomes of the study, the FOREST intervention can be further developed or offered to healthcare staff as a tool to cope with occupational stress.

Trial registration: ClinicalTrials.gov NCT04817995 . Registered on 30 March 2021.

Keywords: Healthcare staff; Internet-based intervention; Moral injury; PTSD; Stress recovery.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Flowchart of the intervention
Fig. 2
Fig. 2
The interface of the FOREST intervention

References

    1. Norkiene I, et al. ‘Should I stay, or should I go?’ Psychological distress predicts career change ideation among intensive care staff in Lithuania and the UK amid COVID-19 pandemic. Int J Environ Res Public Health. 2021;18(5):2660. doi: 10.3390/ijerph18052660.
    1. Liao C, Guo L, Zhang C, Zhang M, Jiang W, Zhong Y, Lin Q, Liu Y. Emergency stress management among nurses: a lesson from the COVID-19 outbreak in China–a cross-sectional study. J Clin Nurs. 2021;30(3–4):433–442. doi: 10.1111/jocn.15553.
    1. Pappa S, Ntella V, Giannakas T, Giannakoulis VG, Papoutsi E, Katsaounou P. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: a systematic review and meta-analysis. Brain Behav Immun. 2020;88:901–907. doi: 10.1016/j.bbi.2020.05.026.
    1. Chew NWS, Lee GKH, Tan BYQ, Jing M, Goh Y, Ngiam NJH, Yeo LLL, Ahmad A, Ahmed Khan F, Napolean Shanmugam G, Sharma AK, Komalkumar RN, Meenakshi PV, Shah K, Patel B, Chan BPL, Sunny S, Chandra B, Ong JJY, Paliwal PR, Wong LYH, Sagayanathan R, Chen JT, Ying Ng AY, Teoh HL, Tsivgoulis G, Ho CS, Ho RC, Sharma VK. A multinational, multicentre study on the psychological outcomes and associated physical symptoms amongst healthcare workers during COVID-19 outbreak. Brain Behav Immun. 2020;88:559–565. doi: 10.1016/j.bbi.2020.04.049.
    1. Manzano García G, Ayala Calvo JC. The threat of COVID-19 and its influence on nursing staff burnout. J Adv Nurs. 2021;77(2):832–844. doi: 10.1111/jan.14642.
    1. Chen R, Sun C, Chen JJ, Jen HJ, Kang XL, Kao CC, Chou KR. A large-scale survey on trauma, burnout, and posttraumatic growth among nurses during the COVID-19 pandemic. Int J Ment Health Nurs. 2021;30(1):102–116. doi: 10.1111/inm.12796.
    1. Ruiz-Fernández MD, Ramos-Pichardo JD, Ibáñez-Masero O, Cabrera-Troya J, Carmona-Rega MI, Ortega-Galán ÁM. Compassion fatigue, burnout, compassion satisfaction and perceived stress in healthcare professionals during the COVID-19 health crisis in Spain. J Clin Nurs. 2020;29(21–22):4321–4330. doi: 10.1111/jocn.15469.
    1. Allan SM, et al. The prevalence of common and stress-related mental health disorders in healthcare workers based in pandemic-affected hospitals: a rapid systematic review and meta-analysis. Eur J Psychotraumatol. 2020;11(1):1810903. doi: 10.1080/20008198.2020.1810903.
    1. Litz BT, Stein N, Delaney E, Lebowitz L, Nash WP, Silva C, Maguen S. Moral injury and moral repair in war veterans: a preliminary model and intervention strategy. Clin Psychol Rev. 2009;29(8):695–706. doi: 10.1016/j.cpr.2009.07.003.
    1. Williamson V, Murphy D, Greenberg N. COVID-19 and experiences of moral injury in front-line key workers. Occup Med (Chic. Ill). 2020;70(5):317–319. doi: 10.1093/occmed/kqaa052.
    1. Medscape UK doctors’ burnout & lifestyle survey 2020. (accessed 04 Dec 2020).
    1. Niles AN, Axelsson E, Andersson E, Hedman-Lagerlöf E, Carlbring P, Andersson G, Johansson R, Widén S, Driessen J, Santoft F, Ljótsson B. Internet-based cognitive behavior therapy for depression, social anxiety disorder, and panic disorder: effectiveness and predictors of response in a teaching clinic. Behav Res Ther. 2021;136:103767. doi: 10.1016/j.brat.2020.103767.
    1. Skruibis P, Eimontas J, Dovydaitiene M, Mazulyte E, Zelviene P, Kazlauskas E. Internet-based modular program BADI for adjustment disorder: protocol of a randomized controlled trial. BMC Psychiatry. 2016;16(1):264. doi: 10.1186/s12888-016-0980-9.
    1. Smoktunowicz E, Lesnierowska M, Carlbring P, Andersson G, Cieslak R. Resource-based internet intervention (Med-Stress) to improve well-being among medical professionals: randomized controlled trial. J Med Internet Res. 2021;23(1):e21445. doi: 10.2196/21445.
    1. Wind TR, Rijkeboer M, Andersson G, Riper H. The COVID-19 pandemic: the ‘black swan’ for mental health care and a turning point for e-health. Internet Interv. 2020;20:100317. doi: 10.1016/j.invent.2020.100317.
    1. Robert Persson Asplund FC, Christensson H, Videsäter E, Annakarin Häggman BL, Carlbring P, Andersson G. Learning how to recover from stress: results from an internet-based pilot randomized controlled trial. 2021.
    1. Christensen H, Griffiths KM, Farrer L. Adherence in internet interventions for anxiety and depression. J Med Internet Res. 2009;11(2):e13. doi: 10.2196/jmir.1194.
    1. Cohen J. Statistical Power Analysis for the Behavioral Sciences. New York: Lawrence Erlbaum Associates; 1988.
    1. Vlaescu G, Alasjö A, Miloff A, Carlbring P, Andersson G. Features and functionality of the Iterapi platform for internet-based psychological treatment. Internet Interv. 2016;6:107–114. doi: 10.1016/j.invent.2016.09.006.
    1. Chan A-W, et al. SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials. BMJ. 2013;346(15):e7586. doi: 10.1136/bmj.e7586.
    1. Dahlin M, Carlbring P, Håkansson A, Andersson G. Internet-based self-help using automatic messages and support on demand for generalized anxiety disorder: an open pilot study. Digit Psychiatry. 2020;3(1):12–19. doi: 10.1080/2575517X.2020.1822730.
    1. Sonnentag S, Fritz C. The Recovery Experience Questionnaire: development and validation of a measure for assessing recuperation and unwinding from work. J Occup Health Psychol. 2007;12(3):204–221. doi: 10.1037/1076-8998.12.3.204.
    1. Almén N, Lundberg H, Sundin Ö, Jansson B. The reliability and factorial validity of the Swedish version of the Recovery Experience Questionnaire. Nord Psychol. 2018;70(4):324–333. doi: 10.1080/19012276.2018.1443280.
    1. Cloitre M, Shevlin M, Brewin CR, Bisson JI, Roberts NP, Maercker A, Karatzias T, Hyland P. The International Trauma Questionnaire: development of a self-report measure of ICD-11 PTSD and complex PTSD. Acta Psychiatr Scand. 2018;138(6):536–546. doi: 10.1111/acps.12956.
    1. Redican E, Nolan E, Hyland P, Cloitre M, McBride O, Karatzias T, Murphy J, Shevlin M. A systematic literature review of factor analytic and mixture models of ICD-11 PTSD and CPTSD using the International Trauma Questionnaire. J Anxiety Disord. 2021;79:102381. doi: 10.1016/j.janxdis.2021.102381.
    1. Litz C, B.T. Phelps A, Frankfurt S, Murphy D, Nazarov A, Houle S, Levi-Belz Y, Zerach G, Dell L, Hosseiny F, the members of the M. I. O. S . (MIOS) “The Moral Injury Outcome Scale,”. 2020.
    1. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24(4):385. doi: 10.2307/2136404.
    1. Ingram PB, Clarke E, Lichtenberg JW. Confirmatory factor analysis of the Perceived Stress Scale-4 in a community sample. Stress Heal. 2016;32(2):173–176. doi: 10.1002/smi.2592.
    1. Kroenke K, Spitzer RL, Williams JBW, Löwe B. An ultra-brief screening scale for anxiety and depression: the PHQ–4. Psychosomatics. 2009;50(6):613–621. doi: 10.1016/S0033-3182(09)70864-3.
    1. Tam CC, Sun S, Yang X, Li X, Zhou Y, Shen Z. Psychological distress among HIV healthcare providers during the COVID-19 pandemic in China: mediating roles of institutional support and resilience. AIDS Behav. 2021;25(1):9–17. doi: 10.1007/s10461-020-03068-w.
    1. Bech P. Measuring the dimensions of psychological general well-being by the WHO-5. QoL Newsl. 2004;32:15–6.
    1. Morris SB. Estimating effect sizes from pretest-posttest-control group designs. Organ Res Methods. 2008;11(2):364–386. doi: 10.1177/1094428106291059.
    1. McCoy CE. Understanding the intention-to-treat principle in randomized controlled trials. West J Emerg Med. 2017;18(6):1075–1078. doi: 10.5811/westjem.2017.8.35985.
    1. Blankers M, Koeter MWJ, Schippers GM. Missing data approaches in eHealth research: simulation study and a tutorial for nonmathematically inclined researchers. J Med Internet Res. 2010;12(5):e1448. doi: 10.2196/jmir.1448.

Source: PubMed

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