A multi-module web-based COVID-19 Anxiety and Stress Resilience Training (COAST): Single cohort feasibility study in first responders

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JMIR Form Res. 2021 Apr 17. doi: 10.2196/28055. Online ahead of print.


BACKGROUND: Since the emergence of COVID-19, health care workers and first responders have been at high risk for mental health symptoms due to their exposure to the virus and higher work stress during the pandemic. Although interventions exist to address mental health issues following exposure to disasters, emergencies, and humanitarian crises, considerably less is known about web-based unguided interventions to help mitigate the negative impacts of such events. Additionally, in contexts in which emergencies reduce access to in-person care, remote forms of support are critical, yet there remains limited research on the use of such interventions. Evidence-based, easy to use and scalable interventions are direly needed for this population.

OBJECTIVE: To develop and feasibility-test an unguided e-mental health program tailored to first responders and health care personnel based on scientific evidence and empirically based techniques.

METHODS: We developed COVID-19- specific training modules focusing on several domains that previous research has indicated as key to resilience and stress recovery: self-efficacy, mindfulness, sleep, and positive thinking. The program was made available to 702 first responders between May and August 2020, during the COVID-19 pandemic. Sociodemographic, work- and COVID-19-related information were collected, and psychometric questionnaires completed. We examined user acceptance and user activity, including module choice and participant feedback.

RESULTS: Seven percent of all first responders we reached out to, n= 52, used the program at least once. COAST use was independent of age, sex, or baseline levels of self-efficacy, mindful awareness, sleep quality and positive thinking, all P >. 39. First-responders who had been tested positive and those who had been quarantined were more likely to engage in the program. A click-count analysis per module showed that participants used the self-efficacy and mindfulness modules most often, 382 and 122 clicks over 15 weeks, respectively. Overall, first responders expressed satisfaction with the program.

CONCLUSIONS: Engagement of first responders in a multi-module web-based COVID-19 Anxiety and Stress Resilience Training program was feasible and the first responder cohort expressed overall satisfaction with the program. Those in more difficult circumstances, i.e., in quarantine and those tested positive, may be more likely to engage in such programs. Further controlled studies could pave the way for efficacy studies and development of additional modules, including just-in time interventions or blended interventions combining individual use of an unguided self-help intervention, such as COAST, with subsequent individual psychotherapy for those who continue to experience stress and psychological symptoms.

PMID:33999835 | DOI:10.2196/28055