Initial findings on RESTORE for healthcare workers: an internet-delivered intervention for COVID-19-related mental health symptoms

Kathryn Trottier, Candice M Monson, Debra Kaysen, Anne C Wagner, Rachel E Liebman, Susan E Abbey, Kathryn Trottier, Candice M Monson, Debra Kaysen, Anne C Wagner, Rachel E Liebman, Susan E Abbey

Abstract

Many healthcare workers on the frontlines of the COVID-19 pandemic are experiencing clinical levels of mental health symptoms. Evidence-based interventions to address these symptoms are urgently needed. RESTORE (Recovering from Extreme Stressors Through Online Resources and E-health) is an online guided transdiagnostic intervention including cognitive-behavioral interventions. It was specifically designed to improve symptoms of anxiety, depression, and posttraumatic stress disorder (PTSD) associated with COVID-19-related traumatic and extreme stressors. The aims of the present study were to assess the feasibility, acceptability, and initial efficacy of RESTORE in healthcare workers on the frontline of the COVID-19 pandemic. We conducted an initial uncontrolled trial of RESTORE in 21 healthcare workers who were exposed to COVID-19-related traumatic or extremely stressful experiences in the context of their work and who screened positive for clinical levels of anxiety, depression, and/or PTSD symptoms. RESTORE was found to be feasible and safe, and led to statistically significant and large effect size improvements in anxiety, depression, and PTSD symptoms over the course of the intervention through follow-up. RESTORE has the potential to become a widely disseminable evidence-based intervention to address mental health symptoms associated with mass traumas.Clinical Trials Registration: This trial was registered with ClinicalTrials.gov ID: NCT04873622.

Conflict of interest statement

CMM receives royalties related to the publishing of a treatment manual from which RESTORE was adapted. DK’s contribution to this publication was part of her work as a paid consultant and was not part of her Stanford University duties or responsibilities. Other authors declare no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Flow diagram of participants through the phases of study recruitment, assessment, and intervention.

References

    1. Amsalem D, Dixon LB, Neria Y. The coronavirus disease 2019 (COVID-19) outbreak and mental health: current risks and recommended actions. JAMA Psychiatry. 2021;78:9–10. doi: 10.1001/jamapsychiatry.2020.1730.
    1. Mohr DC, Azocar F, Bertagnolli A, Choudhury T, Chrisp P, Frank R, et al. Banbury forum consensus statement on the path forward for digital mental health treatment. Psychiatr Serv. 2021;72:677–83. doi: 10.1176/appi.ps.202000561.
    1. Torous J, Jän Myrick K, Rauseo-Ricupero N, Firth J. Digital mental health and COVID-19: Using technology today to accelerate the curve on access and quality tomorrow. JMIR Ment Health. 2020;7:e18848. doi: 10.2196/18848.
    1. d’Ettorre G, Ceccarelli G, Santinelli L, Vassalini P, Innocenti GP, Alessandri F, et al. Post-traumatic stress symptoms in healthcare workers dealing with the COVID-19 pandemic: a systematic review. Int J Environ Res Public Health. 2021;18:601. doi: 10.3390/ijerph18020601.
    1. Greenberg N, Weston D, Hall C, Caulfield T, Williamson V, Fong K. Mental health of staff working in intensive care during Covid-19. Occup Med. 2021;71:62–7. doi: 10.1093/occmed/kqaa220.
    1. Major A, Hlubocky FJ. Mental health of health care workers during the COVID-19 pandemic and evidence-based frameworks for mitigation: A rapid review. Preprint at .
    1. Marques L, Bartuska AD, Cohen JN, Youn SJ. Three steps to flatten the mental health need curve amid the COVID-19 pandemic. Depress Anxiety. 2020;37:405–6. doi: 10.1002/da.23031.
    1. Orrù G, Ciacchini R, Gemignani A, Conversano C. Psychological intervention measures during the COVID-19 pandemic. Clin Neuropsychiatry. 2020;17:76–9.
    1. Trottier K, Monson CM, Kaysen D, Wagner AC, Pun C, Abbey SE. Development of RESTORE: an online intervention to improve mental health symptoms associated with COVID-19-related traumatic and extreme stressors. Eur J Psychotraumatol. 2021;12:1984049. doi: 10.1080/20008198.2021.1984049.
    1. Preti E, Di Mattei V, Perego G, Ferrari F, Mazzetti M, Taranto P, et al. The psychological impact of epidemic and pandemic outbreaks on healthcare workers: rapid review of the evidence. Curr Psychiatry Rep. 2020;22:43. doi: 10.1007/s11920-020-01166-z.
    1. Azoulay E, Cariou A, Bruneel F, Demoule A, Kouatchet A, Reuter D, et al. Symptoms of anxiety, depression, and peritraumatic dissociation in critical care clinicians managing patients with COVID-19. A cross-sectional study. Am J Respir Crit Care Med. 2020;202:1388–98. doi: 10.1164/rccm.202006-2568OC.
    1. Johnson SU, Ebrahimi OV, Hoffart A. PTSD symptoms among health workers and public service providers during the COVID-19 outbreak. PloS One. 2020;15:e0241032. doi: 10.1371/journal.pone.0241032.
    1. Luceño-Moreno L, Talavera-Velasco B, García-Albuerne Y, Martín-García J. Symptoms of posttraumatic stress, anxiety, depression, levels of resilience and burnout in Spanish health personnel during the COVID-19 pandemic. Int J Environ Res Public Health. 2020;17:5514. doi: 10.3390/ijerph17155514.
    1. Prasad A, Civantos AM, Byrnes Y, Chorath K, Poonia S, Chang C, et al. Snapshot impact of COVID-19 on mental wellness in nonphysician otolaryngology health care workers: A national study. OTO Open. 2020;4:2473974X20948835. doi: 10.1177/2473974X20948835.
    1. Shechter A, Diaz F, Moise N, Anstey DE, Ye S, Agarwal S, et al. Psychological distress, coping behaviors, and preferences for support among New York healthcare workers during the COVID-19 pandemic. Gen Hosp Psychiatry. 2020;66:1–8. doi: 10.1016/j.genhosppsych.2020.06.007.
    1. De Kock JH, Latham HA, Leslie SJ, Grindle M, Munoz SA, Ellis L, et al. A rapid review of the impact of COVID-19 on the mental health of healthcare workers: Implications for supporting psychological well-being. BMC Public Health. 2021;21:104. doi: 10.1186/s12889-020-10070-3.
    1. Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors associated with mental health outcomes among health care workers exposed to Coronavirus Disease 2019. JAMA Netw Open. 2020;3:e203976. doi: 10.1001/jamanetworkopen.2020.3976.
    1. Marvaldi M, Mallet J, Dubertret C, Moro MR, Guessoum SB. Anxiety, depression, trauma-related, and sleep disorders among healthcare workers during the COVID-19 pandemic: a systematic review and meta-analysis. Neurosci Biobehav Rev. 2021;126:252–64. doi: 10.1016/j.neubiorev.2021.03.024.
    1. Erquicia J, Valls L, Barja A, Gil S, Miquel J, Leal-Blanquet J, et al. Emotional impact of the Covid-19 pandemic on healthcare workers in one of the most important infection outbreaks in Europe. Med Clin. 2020;155:434–40. doi: 10.1016/j.medcli.2020.07.006.
    1. Mosheva M, Gross R, Hertz-Palmor N, Hasson-Ohayon I, Kaplan R, Cleper R, et al. The association between witnessing patient death and mental health outcomes in frontline COVID-19 healthcare workers. Depress Anxiety. 2021;38:468–79. doi: 10.1002/da.23140.
    1. Muller AE, Hafstad EV, Himmels JPW, Smedslund G, Flottorp S, Stensland SØ, et al. The mental health impact of the covid-19 pandemic on healthcare workers, and interventions to help them: a rapid systematic review. Psychiatry Res. 2020;293:113441. doi: 10.1016/j.psychres.2020.113441.
    1. Bäuerle A, Graf J, Jansen C, Dörrie N, Junne F, Teufel M, et al. An e-mental health intervention to support burdened people in times of the COVID-19 pandemic: CoPE It. J Public Health. 2020;42:647–8. doi: 10.1093/pubmed/fdaa058.
    1. Brog NA, Hegy JK, Berger T, Znoj H. An internet-based self-help intervention for people with psychological distress due to COVID-19: study protocol for a randomized controlled trial. Trials. 2021;22:171. doi: 10.1186/s13063-021-05089-9.
    1. Drissi N, Ouhbi S, Marques G, de la Torre Díez I, Ghogo M, Janati Idrissi MA. A systematic literature review on e-mental health solutions to assist health care workers during COVID-19. Telemed J E Health. 2021;27:594–602. doi: 10.1089/tmj.2020.0287.
    1. Jaworski BK, Taylor K, Ramsey KM, Heinz A, Steinmetz S, Pagano I, et al. Exploring usage of COVID Coach, a public mental health app designed for the COVID-19 pandemic: evaluation of analytics data. J Med Internet Res. 2021;23:e26559. doi: 10.2196/26559.
    1. Jovarauskaite L, Dumarkaite A, Truskauskaite-Kuneviciene I, Jovaisiene I, Andersson G, Kazlauskas E. Internet-based stress recovery intervention FOREST for healthcare staff amid COVID-19 pandemic: Study protocol for a randomized controlled trial. Trials. 2021;22:559. doi: 10.1186/s13063-021-05512-1.
    1. Lewis M, Palmer VJ, Kotevski A, Densley K, O’Donnell ML, Johnson C, et al. Rapid design and delivery of an experience-based co-designed mobile app to support the mental health needs of health care workers affected by the COVID-19 pandemic: Impact evaluation protocol. JMIR Res Protoc. 2021;10:e26168. doi: 10.2196/26168.
    1. Weiner L, Berna F, Nourry N, Severac F, Vidailhet P, Mengin AC. Efficacy of an online cognitive behavioral therapy program developed for healthcare workers during the COVID-19 pandemic: The REduction of STress (REST) study protocol for a randomized controlled trial. Trials. 2020;21:870. doi: 10.1186/s13063-020-04772-7.
    1. Fiol-DeRoque MA, Serrano-Ripoll MJ, Jiménez R, Zamanillo-Campos R, Yáñez-Juan AM, Bennasar-Veny M, et al. A mobile phone-based intervention to reduce mental health problems in health care workers during the COVID-19 pandemic (PsyCovidApp): Randomized controlled trial. JMIR Mhealth Uhealth. 2021;9:e27039. doi: 10.2196/27039.
    1. Resick PA, Monson CM, Chard KM. Cognitive processing therapy for PTSD: a comprehensive manual. Guilford; 2016.
    1. Kaczkurkin AN, Foa EB. Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence. Dialogues Clin Neurosci. 2015;17:337–46. doi: 10.31887/DCNS.2015.17.3/akaczkurkin.
    1. Cuijpers P, Cristea IA, Karyotaki E, Reijnders M, Hollon SD. Component studies of psychological treatments of adult depression: a systematic review and meta-analysis. Psychother Res. 2017;29:15–29. doi: 10.1080/10503307.2017.1395922.
    1. Gutner CA, Suvak MK, Sloan DM, Resick PA. Does timing matter? Examining the impact of session timing on outcome. J Consult Clin Psychol. 2016;84:1108–15. doi: 10.1037/ccp0000120.
    1. Kazdin AE, Rabbitt SM. Novel models for delivering mental health services and reducing the burdens of mental illness. Clin Psychol Sci. 2013;1:170–91. doi: 10.1177/2167702612463566.
    1. Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder. Arch Intern Med. 2006;166:1092–7. doi: 10.1001/archinte.166.10.1092.
    1. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606–13. doi: 10.1046/j.1525-1497.2001.016009606.x.
    1. Weathers FW, Litz BT, Keane TM, Palmieri PA, Schnurr PP. The PTSD Checklist for DSM–5 (PCL-5). . 2013.
    1. National Institute of Mental Health. Ask suicide-screening questions (ASQ). . 2020.
    1. Beck AT, Brown GK, Steer RA. Psychometric characteristics of the Scale for Suicide Ideation with psychiatric outpatients. Behav Res Ther. 1997;35:1039–46. doi: 10.1016/S0005-7967(97)00073-9.
    1. Attkisson CC, Zwick R. The client satisfaction questionnaire. Psychometric properties and correlations with service utilization and psychotherapy outcome. Eval Program Plann. 1982;5:233–7. doi: 10.1016/0149-7189(82)90074-X.
    1. IBM Corp. Released 2021. IBM SPSS statistics for windows, Version 28.0. Armonk, NY: IBM Corp; 2021.
    1. McNeish DM, Stapleton LM. The effect of small sample size on two-level model estimates: a review and illustration. Educ Psychol Rev. 2016;28:295–314. doi: 10.1007/s10648-014-9287-x.
    1. Feingold A. Effect sizes for growth-modeling analysis for controlled clinical trials in the same metric as for classical analysis. Psychol Methods. 2009;14:43–53. doi: 10.1037/a0014699.
    1. Hedges LV. Distribution theory for Glass’s estimator of effect size and related estimators. J Educ Stat. 1981;6:107–28. doi: 10.3102/10769986006002107.
    1. Newby JM, McKinnon A, Kuyken W, Gilbody S, Dalgleish T. Systematic review and meta-analysis of transdiagnostic psychological treatments for anxiety and depressive disorders in adulthood. Clin Psychol Rev. 2015;40:91–110. doi: 10.1016/j.cpr.2015.06.002.
    1. Monson CM, Shields N, Suvak MK, Lane JEM, Shnaider P, Landy MSH, et al. A randomized controlled effectiveness trial of training strategies in cognitive processing therapy for posttraumatic stress disorder: Impact on patient outcomes. Behav Res Ther. 2018;110:31–40. doi: 10.1016/j.brat.2018.08.007.
    1. Rutt BT, Oehlert ME, Krieshok TS, Lichtenberg JW. Effectiveness of cognitive processing therapy and prolonged exposure in the Department of Veterans Affairs. Psychol Rep. 2018;121:282–302. doi: 10.1177/0033294117727746.
    1. Ennis N, Sijercic I, Monson CM. Trauma-focused cognitive-behavioral therapies for posttraumatic stress disorder under ongoing threat: a systematic review. Clin Psychol Rev. 2021;88:102049. doi: 10.1016/j.cpr.2021.102049.
    1. Lewis C, Roberts NP, Andrew M, Starling E, Bisson JI. Psychological therapies for post-traumatic stress disorder in adults: Systematic review and meta-analysis. Eur J Psychotraumatol. 2020;11:1729633. doi: 10.1080/20008198.2020.1729633.
    1. Bentley KH, Cohen ZD, Kim T, Bullis JR, Nauphal M, Cassiello-Robbins C, et al. The nature, timing, and symptom trajectories of dropout from transdiagnostic and single-diagnosis cognitive-behavioral therapy for anxiety disorders. Behav Ther. 2021;52:1364–76. doi: 10.1016/j.beth.2021.03.007.
    1. Melville KM, Casey LM, Kavanagh DJ. Dropout from internet-based treatment for psychological disorders. Br J Clin Psychol. 2010;49:455–71. doi: 10.1348/014466509X472138.
    1. Breslau N. Epidemiologic studies of trauma, posttraumatic stress disorder, and other psychiatric disorders. Can J Psychiatry. 2002;47:923–9. doi: 10.1177/070674370204701003.
    1. Santiago PN, Ursano RJ, Gray CL, Pynoos RS, Spiegel D, Lewis-Fernández R, et al. A systematic review of PTSD prevalence and trajectories in DSM-5 defined trauma exposed populations: Intentional and non-intentional traumatic events. PloS One. 2013;8:e59236. doi: 10.1371/journal.pone.0059236.

Source: PubMed

3
Tilaa