Heber Elena, Ebert David Daniel, Lehr Dirk, Cuijpers Pim, Berking Matthias, Nobis Stephanie, Riper Heleen
Department of Health Psychology and Applied Biological Psychology, Institute of Psychology, Leuphana University Lueneburg, Lueneburg, Germany.
Division of Online Health Training, Innovation Incubator, Leuphana University Lueneburg, Lueneburg, Germany.
J Med Internet Res. 2017 Feb 17;19(2):e32. doi: 10.2196/jmir.5774.
Stress has been identified as one of the major public health issues in this century. New technologies offer opportunities to provide effective psychological interventions on a large scale.
The aim of this study is to investigate the efficacy of Web- and computer-based stress-management interventions in adults relative to a control group.
A meta-analysis was performed, including 26 comparisons (n=4226). Cohen d was calculated for the primary outcome level of stress to determine the difference between the intervention and control groups at posttest. Analyses of the effect on depression, anxiety, and stress in the following subgroups were also conducted: risk of bias, theoretical basis, guidance, and length of the intervention. Available follow-up data (1-3 months, 4-6 months) were assessed for the primary outcome stress.
The overall mean effect size for stress at posttest was Cohen d=0.43 (95% CI 0.31-0.54). Significant, small effects were found for depression (Cohen d=0.34, 95% CI 0.21-0.48) and anxiety (Cohen d=0.32, 95% CI 0.17-0.47). Subgroup analyses revealed that guided interventions (Cohen d=0.64, 95% CI 0.50-0.79) were more effective than unguided interventions (Cohen d=0.33, 95% CI 0.20-0.46; P=.002). With regard to the length of the intervention, short interventions (≤4 weeks) showed a small effect size (Cohen d=0.33, 95% CI 0.22-0.44) and medium-long interventions (5-8 weeks) were moderately effective (Cohen d=0.59; 95% CI 0.45-0.74), whereas long interventions (≥9 weeks) produced a nonsignificant effect (Cohen d=0.21, 95% CI -0.05 to 0.47; P=.006). In terms of treatment type, interventions based on cognitive behavioral therapy (CBT) and third-wave CBT (TWC) showed small-to-moderate effect sizes (CBT: Cohen d=0.40, 95% CI 0.19-0.61; TWC: Cohen d=0.53, 95% CI 0.35-0.71), and alternative interventions produced a small effect size (Cohen d=0.24, 95% CI 0.12-0.36; P=.03). Early evidence on follow-up data indicates that Web- and computer-based stress-management interventions can sustain their effects in terms of stress reduction in a small-to-moderate range up to 6 months.
These results provide evidence that Web- and computer-based stress-management interventions can be effective and have the potential to reduce stress-related mental health problems on a large scale.
压力已被确认为本世纪主要的公共卫生问题之一。新技术为大规模提供有效的心理干预提供了机会。
本研究旨在调查相对于对照组，基于网络和计算机的压力管理干预措施对成年人的疗效。
进行了一项荟萃分析，包括26项比较（n = 4226）。计算主要压力结果水平的Cohen d值，以确定干预组和对照组在测试后的差异。还对以下亚组中对抑郁、焦虑和压力的影响进行了分析：偏倚风险、理论基础、指导和干预时长。对主要结果压力评估了可用的随访数据（1 - 3个月，4 - 6个月）。
测试后压力的总体平均效应量为Cohen d = 0.43（95%CI 0.31 - 0.54）。在抑郁（Cohen d = 0.34，95%CI 0.21 - 0.48）和焦虑（Cohen d = 0.32，95%CI 0.17 - 0.47）方面发现了显著的小效应。亚组分析显示，有指导的干预（Cohen d = 0.64，95%CI 0.50 - 0.79）比无指导的干预更有效（Cohen d = 0.33，95%CI 0.20 - 0.46；P = 0.002）。关于干预时长，短干预（≤4周）显示出小效应量（Cohen d = 0.33，95%CI 0.22 - 0.44），中长干预（5 - 8周）有中等效果（Cohen d = 0.59；95%CI 0.45 - 0.74），而长干预（≥9周）产生了不显著的效果（Cohen d = 0.21，95%CI -0.05至0.47；P = 0.006）。就治疗类型而言，基于认知行为疗法（CBT）和第三波认知行为疗法（TWC）的干预显示出小到中等的效应量（CBT：Cohen d = 0.40，95%CI 0.19 - 0.61；TWC：Cohen d = 0.53，95%CI 0.35 - 0.71），替代干预产生了小效应量（Cohen d = 0.24，95%CI 0.12 - 0.36；P = 0.03）。随访数据的早期证据表明，基于网络和计算机的压力管理干预在长达6个月的时间内，在小到中等范围内能够维持其减轻压力的效果。
这些结果提供了证据，表明基于网络和计算机的压力管理干预可以有效，并且有可能大规模减少与压力相关的心理健康问题。
