A Randomized Controlled Trial of Internet-Based Self-Help for Stress During the COVID-19 Pandemic

Abstract

Purpose: The COVID-19 pandemic has heightened the need for mental healthcare that can be delivered remotely and at scale to college students. This study evaluated the efficacy of online self-help for stress among students during the pandemic.

Method: College students with moderate or higher stress (N = 585) were recruited between November 2020 and February 2021, when COVID-19 had a major impact on colleges. Participants were randomly assigned to receive either online self-help using cognitive-behavioral therapy and positive psychology principles to support resilience and coping with pandemic-related stressors (n = 301) or referral to usual care (n = 284). Stress (primary outcome), depression, and anxiety (secondary outcomes) were assessed at pretreatment, one-month post-treatment, and three-month follow-up.

Results: Participants in the online self-help condition experienced significantly larger reductions in stress (d = -0.18, p = .035) and depression (d = -0.20, p = .018) from pretreatment to post-treatment than participants in the referral group. Reductions in stress from pretreatment to follow-up were also larger in the treatment versus referral group (d = -0.23, p = .005). Groups did not differ in change in anxiety. More time using the self-help program predicted greater improvement in depression at post-treatment (d = -0.41, p = .001) and follow-up (d = -0.32, p = .007), although usage was unrelated to change in stress or anxiety.

Conclusion: Online self-help targeting resilience and coping during the pandemic appears efficacious for long-term alleviation of stress and short-term alleviation of depression symptoms among the college students.

Registration: ClinicalTrials.gov (NCT04762173).

Keywords: COVID-19; Cognitive-behavioral therapy; Positive psychology; Self-help; Stress.