JMIR Publications

ABSTRACT

Background:

Promoting individual resilience – i.e., maintaining or regaining mental health despite stressful circumstances – is often regarded as important endeavor to prevent mental illness. However, digital resilience interventions designed to enhance mental health outcomes, including stress levels and self-perceived resilience, have yielded mixed results. Such heterogeneous effects reflect a variety of unsolved conceptual challenges in interventional resilience research. These range from grounding interventions in genuine resilience frameworks, using theory or targeting etiologically important resilience factors as intervention content, to a lack of knowledge about the mechanisms underlying effects, and employing techniques specifically developed to foster psychosocial resources. The web- and app-based resilience intervention RESIST was designed to address these challenges, mainly by utilizing both the Positive Appraisal Style Theory of Resilience as its theoretical foundation and interventional techniques from Strengths-based Cognitive Behavioral Therapy.

Objective:

The study’s primary aim was to evaluate the effectiveness of RESIST in a general working population as a means of universal prevention, relative to a waitlist control group. A secondary study aim was to explore the resilience factors of self-efficacy, optimism, perceived social support, and self-compassion the intervention targets as potential mediators of its effect on stress and self-perceived resilience.

Methods:

In total, 352 employees were randomly assigned to either a self-help version of RESIST or waitlist control group. Data were collected at baseline, post-intervention, and at 3- and 6-month (intervention group only) follow-up. The primary outcome was perceived stress, measured with the Perceived Stress Scale-10. Secondary outcomes included self-perceived resilience, the resilience factors targeted, and other mental and work-related health outcomes.

Results:

The intervention group reported significantly less stress than controls post-intervention (Δ=-3.14; d=-0.54, 95%CI -0.75 to -0.34, and P<.001) and at 3-month follow-up (Δ=-2.79; d=-0.47, 95%CI -0.71 to -0.22, and P=.002). These improvements in the intervention group were maintained at 6-month follow-up. Favorable between-group differences also were detected for self-perceived resilience and the resilience factors. Effects on other mental and work-related outcomes were mixed. Parallel mediation analyses revealed significant indirect effects of optimism (a2b2=-0.34, 95% CI -0.63 to -0.06) and self-compassion (a4b4=-0.66, 95% CI -1.15 to -0.17) on perceived stress, whereas indirect effects through self-efficacy and social support were not found. A similar pattern emerged for self-perceived resilience as mediation outcome.

Conclusions:

In a sample of employees experiencing heightened work-burden levels, RESIST was effective in reducing perceived stress, and increasing self-perceived resilience as well as the targeted resilience factors. Mediation analyses suggested that developing a positive future outlook and a self-compassionate attitude toward oneself may be key drivers to enhance resilience. Changing the quality of social relationships and strengthening the belief in one’s abilities may require more time, the involvement of others, or personal support from a mental health professional, such as an e-coach, to ensure sufficient learning opportunities. Clinical Trial: German Clinical Trials Register DRKS00017605; https://drks.de/search/de/trial/DRKS00017605