Efficacy of the my health too online cognitive behavioral therapy program for healthcare workers during the COVID-19 pandemic: A randomized controlled trial

Background

Healthcare workers' mental health has been impacted by the COVID-19 pandemic, emphasizing the need for mental health interventions in this population. Online cognitive behavioral therapy (CBT) is efficient to reduce stress and may reach numerous professionals. We developed "MyHealthToo", an online CBT program to help reduce stress among healthcare workers during the COVID-19 pandemic.

Objective

The aim of our study is to investigate the efficacy of an online CBT program on stress and mental health conditions among healthcare workers during a health crisis.

Methods

We performed a multicentric randomized controlled trial among 155 participants allocated either to the experimental or active control group (bibliotherapy). The primary outcome was the decrease of perceived stress scores (PSS-10) post-treatment. Secondary outcomes included depression, insomnia and PTSD symptoms along with self-reported resilience and ruminations. Assessments were scheduled pretreatment, mid-treatment (4 weeks), post-treatment (8 weeks), and at 1-month and 4-months follow-up.

Results

For both interventions, mean changes on the PSS-10 were significant post-therapy (W8), as at 1-month (W12) and 4-months (W24) follow-ups. The between-group comparison showed no difference at any time point (ps > 0.88). Work-related ruminations significantly decreased in the experimental group with a significant between-group difference at W8 (Δ = -1.83 [-3.57; -0.09], p = 0.04). Posttraumatic stress symptoms significantly decreased in the experimental group with a significant between-group difference at W12 (Δ = -1.41 [-2.68; -0.14], p = 0.03). The decrease in work-related ruminations at W8 mediated the decrease in posttraumatic stress symptoms at W12 (p = 0.048).

Conclusion

The "MyHealthToo" online CBT intervention may help reduce ruminations about work and posttraumatic stress symptoms among healthcare workers during a major health crisis. Work-related ruminations may represent a relevant target of online interventions to improve mental health among healthcare workers.

Posttraumatic stress disorder and depression after the 2018 Strasbourg Christmas Market terrorist attack: a comparison of exposed and non-exposed police personnel

Background: Police personnel are among the first responders exposed to terrorist attacks, raising in number in the late decades. Due to their profession, they are also exposed to repetitive violence, increasing their vulnerability to PTSD and depression.Objective: Our study aims at comparing the prevalence of PTSD and depression, and the risk factors associated with these conditions among directly and indirectly exposed versus non-exposed police personnel during the Strasbourg Christmas Market terrorist attack.Method: Three months after the attack, participants completed a survey assessing their sociodemographic characteristics, occupational data, degree of exposure, sleep debt around the event, event centrality (CES), and three mental health conditions: PTSD (PCL-5), depression (PHQ-9), and suicide risk (yes/no questions).Results: A total of 475 police personnel responded to the questionnaire: 263 were exposed to the attack (182 of them directly) and 212 were non-exposed. Among directly exposed participants, the prevalences of partial and complete PTSD were 12.6 and 6.6%, and the prevalence of moderate-to-severe depression was 11.5%. Multivariate analysis revealed that direct exposure was associated with a higher risk of PTSD (OR = 2.98 [1.10-8.12], p = .03). Direct exposure was not associated with a higher risk of depression (OR = 0.40 [0.10-1.10], p = .08). A significant sleep debt after the event was not associated with a higher risk of later PTSD (OR = 2.18 [0.81-5.91], p = .13) but was associated with depression (OR = 7.92 [2.40-26.5], p < .001). A higher event centrality was associated with both PTSD and depression (p < .001).Conclusions: Police personnel directly exposed to the Strasbourg Christmas Market terrorist attack were at higher risk of PTSD but not depression. Efforts to prevent and treat PTSD should focus on directly exposed police personnel. However, general mental health should be monitored for every personnel member.

Programme de thérapie cognitivo-comportementale (TCC) en ligne pour diminuer les effets du stress chez les professionnels de santé

Contexte

Lorsque l’épidémie de coronavirus a débuté en mars 2020, très rapidement il est apparu au pôle de psychiatrie du CHU la nécessité d’offrir à la communauté hospitalière un outil de prévention pour minimiser les effets sur la santé psychique d’une telle crise sanitaire. La littérature scientifique mettait en effet en évidence des taux de dépression, d’état de stress post-traumatique et d’anxiété important dans les équipes de soignants en Chine ou lors des précédentes épidémies (SARS, MERS). Les thérapies cognitivo-comportementale (TCC) ont démontré leur effet dans la prévention du stress professionnel. Mais deux freins majeurs ont été identifiés pour leur mise en œuvre en présentiel : la disponibilité des soignants et le respect de la distanciation physique.

Méthode

Les psychologues spécialisés en TCC ont conçu le programme de psychothérapie en ligne auto-administrable « Ma Santé Aussi ».

L’évaluation de l’efficacité du programme en ligne « Ma Santé Aussi » se fait dans le cadre d’un programme de recherche, avec inclusion de soignants issus de 6 différents CH/CHU de l’interrégion Est. Une évaluation pré- et post-programme comporte des questionnaires portant sur les conditions d’exposition, la dépression (PHQ9), la qualité du sommeil, le PTSD, et la satisfaction de l’outil.

Résultats

Le site internet « Ma Santé Aussi » a été ouvert durant l’été, il comporte 7 modules thématiques (ex., sommeil, stress, auto-compassion) qui permettent d’accompagner progressivement le soignant durant le programme de TCC. Le soignant peut utiliser à discrétion le programme de TCC, à son rythme, lorsqu’il est disponible. De plus, il a la possibilité quand il le souhaite de solliciter une consultation avec un psychologue par téléphone.

Le système permet donc de contourner les deux principaux freins à savoir respecter la distanciation physique et être accessible à toute heure pour s’adapter à la disponibilité du soignant sollicitant de l’aide.

Nos données préliminaires suggèrent que les soignants ayant utilisé le programme sont satisfaits et soulagés dès les premières séances. Les données complètes quant à l’efficacité du programme sont attendues en décembre 2020.

Conclusion

Les premiers résultats ont incité l’équipe à poursuivre le développement du site internet, et surtout à augmenter la diffusion de l’outil. Nous sommes ainsi en train d’étudier une mise à disposition pour l’ensemble des établissements de santé du territoire : CH, EHPAD, EPSM, cliniques, établissements médico-sociaux…

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

Background

The acknowledgment of the mental health toll of the COVID-19 epidemic in healthcare workers has increased considerably as the disease evolved into a pandemic status. Indeed, high prevalence rates of depression, sleep disorders, and post-traumatic stress disorder (PTSD) have been reported in Chinese healthcare workers during the epidemic peak. Symptoms of psychological distress are expected to be long-lasting and have a systemic impact on healthcare systems, warranting the need for evidence-based psychological treatments aiming at relieving immediate stress and preventing the onset of psychological disorders in this population. In the current COVID-19 context, internet-based interventions have the potential to circumvent the pitfalls of face-to-face formats and provide the flexibility required to facilitate accessibility to healthcare workers. Online cognitive behavioral therapy (CBT) in particular has proved to be effective in treating and preventing a number of stress-related disorders in populations other than healthcare workers. The aim of our randomized controlled trial study protocol is to evaluate the efficacy of the ‘My Health too’ CBT program—a program we have developed for healthcare workers facing the pandemic—on immediate perceived stress and on the emergence of psychiatric disorders at 3- and 6-month follow-up compared to an active control group (i.e., bibliotherapy).

Methods

Powered for superiority testing, this six-site open trial involves the random assignment of 120 healthcare workers with stress levels > 16 on the Perceived Stress Scale (PSS-10) to either the 7-session online CBT program or bibliotherapy. The primary outcome is the decrease of PSS-10 scores at 8 weeks. Secondary outcomes include depression, insomnia, and PTSD symptoms; self-reported resilience and rumination; and credibility and satisfaction. Assessments are scheduled at pretreatment, mid-treatment (at 4 weeks), end of active treatment (at 8 weeks), and at 3-month and 6-month follow-up.

Discussion

This is the first study assessing the efficacy and the acceptability of a brief online CBT program specifically developed for healthcare workers. Given the potential short- and long-term consequences of the COVID-19 pandemic on healthcare workers’ mental health, but also on healthcare systems, our findings can significantly impact clinical practice and management of the ongoing, and probably long-lasting, health crisis.

Trial registration

ClinicalTrials.gov NCT04362358, registered on April 24, 2020.