A randomized controlled trial of a self-guided, multimedia, stress management and resilience training program

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Abstract

Background

Stress is a common and costly behavioral health issue. Technology-based behavioral health programs (e.g., computer or web-based programs) are effective for treating anxiety or depression. These programs increase availability of evidence-based interventions to individuals who are not able or willing to receive such in-person treatments. Stress management training has empirical support, but little data exists on its efficacy with stressed but healthy individuals, and there are no prior studies employing a self-guided, multimedia intervention. We conducted a randomized controlled trial of a self-guided, multimedia stress management and resilience training program (SMART-OP) with a stressed but healthy sample.

Methods

Participants (N = 66) were randomized to SMART-OP or an attention control (AC) group that received marketed videos and published material on stress management. Participants were evaluated on self-report measures and Trier Social Stress Test (TSST) performance. Analyses were based on study completers (N = 59).

Results

SMART-OP group reported significantly less stress, more perceived control over stress, and rated SMART-OP as significantly more useful than AC. During the TSST, the data suggests the SMART-OP group showed greater within-task α-amylase recovery at post-assessment.

Conclusions

SMART-OP is highly usable and is a more effective and useful stress management training program than an educational comparison.

Highlights

► We developed and evaluated a multimedia stress management training program. ► The program (SMART-OP) was compared to an attention control group. ► SMART-OP decreased perceived stress and increased perceived control over stress. ► SMART-OP was rated as more useful than attention control and very easy to use.

Section snippets

Efficacy of technology-based behavioral healthcare

A growing body of literature supports the efficacy of technology-based (i.e., computer/Internet) interventions for anxiety and depression (e.g., Andrews, Cuijpers, Craske, McEvoy, & Titov, 2010; Proudfoot et al., 2003). To date, studies have not targeted stressed but otherwise healthy populations. Typically, technology-based programs developed for and tested with clinical samples are as efficacious as face-to-face therapy or better than treatment as usual (Proudfoot et al., 2003; Titov,

Stress and resilience

Stress has various definitions that converge upon the notion of “strain” (Webster's Online Dictionary, 2012) or “the nonspecific response of the body to any demand placed upon it” (Selye, 1956). Resilience is “the ability of individuals to adapt successfully in the face of acute stress, trauma, or chronic adversity, maintaining or rapidly regaining psychological well-being and physiological homeostasis” (Charney, 2004).

In the short-term, the body's response to stress can be helpful and adaptive

Methods

All study procedures were approved by the UCLA Office of Human Research Protection Program.

Baseline data

There were no significant baseline group differences on any measure.

Pre- and post-assessment self-report measures

PSS-10: The Condition × Time interaction was significant (F (1, 57) = 8.04, p < .01; η2 = .14). Simple main effects analyses showed significant effects for Time within SMART-OP (F (1, 57) = 46.83, p < .01) and within AC (F (1, 57) = 7.57, p < .01). Also, while the groups did not differ significantly at pre-assessment (F (1, 57) = .45, p = .51), SMART-OP was lower than AC at post-assessment (F (1, 57) = 4.59, p < .04) (see

Discussion

Stress management training is empirically supported in clinical populations (e.g., Meichenbaum, 2007), yet stress is a common and costly behavioral health problem (Madhu, 2002). While there is growing empirical support for computer-based interventions for anxiety and depression (Proudfoot et al., 2003), to our knowledge, there are no studies examining the efficacy of computer-based stress management training in stressed but otherwise healthy populations. We report the results of an RCT of a

Acknowledgments

The authors acknowledge the contributions of Fred Connors, Ryan Green, and Timothy Elliott to the production of SMART-OP. This work was supported by the National Space Biomedical Research Institute through NASA NCC 9-58 in a grant to R. Rose (# NBPFOI 605).

References (44)

  • D.S. Charney

    Psychobiological mechanisms of resilience and vulnerability: implications for successful adaptation to extreme stress

    American Journal of Psychiatry

    (2004)
  • S. Cohen et al.

    A global measure of perceived stress

    Journal of Health and Social Behavior

    (1983)
  • S. Cohen et al.

    Perceived stress in a probability sample of the United States

  • P. Corrigan

    How stigma interferes with mental health care

    American Psychologist

    (2004)
  • G. Eysenbach

    The law of attrition

    Journal of Medical Internet Research

    (2005)
  • R.A. Hussian et al.

    The reduction of test, state, and trait anxiety by test-specific and generalized stress inoculation training

    Cognitive Therapy and Research

    (1978)
  • N. Kapur et al.

    Suicide after leaving the UK armed forces – a cohort study

    PLoS Medicine

    (2008)
  • J.K. Kiecolt-Glaser et al.

    Psychoneuroimmunology: psychological influences on immune function and health

    Journal of Consulting and Clinical Psychology

    (2002)
  • C. Kirschbaum et al.

    The ‘Trier social stress test’ – a tool for investigating psychobiological stress responses in a laboratory setting

    Neuropsychobiology

    (1993)
  • K. Lorentz et al.

    Evaluation of a direct alpha-amylase assay using 2-chloro-4-nitrophenyl-alpha-d-maltotrioside

    Clinical Chemistry and Laboratory Medicine

    (1999)
  • K. Madhu

    Assessing the economic impact of stress – the modern day hidden epidemic

    Metabolism – Clinical and Experimental

    (2002)
  • S. Maguen et al.

    The stressors and demands of peacekeeping in Kosovo: predictors of mental health response

    Military Medicine

    (2004)
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