Potential mechanisms within the digital stress-management intervention StressProffen for cancer survivors: a qualitative study post randomized controlled trial

Cecilie Varsi; Elin Børøsund; Shawna L Ehlers; Matthew M Clark; Michael A Andrykowski; Lise Solberg Nes

doi:10.3389/fpsyg.2025.1703540

Potential mechanisms within the digital stress-management intervention StressProffen for cancer survivors: a qualitative study post randomized controlled trial

Front Psychol. 2026 Jan 12:16:1703540. doi: 10.3389/fpsyg.2025.1703540. eCollection 2025.

Authors

Cecilie Varsi^{1

2}, Elin Børøsund^{1

3}, Shawna L Ehlers⁴, Matthew M Clark⁴, Michael A Andrykowski⁵, Lise Solberg Nes^{1

4

6}

Affiliations

¹ Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.
² Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.
³ Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.
⁴ Department of Psychiatry and Psychology, College of Medicine and Science, Mayo Clinic, Rochester, MN, United States.
⁵ Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, United States.
⁶ Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.

Abstract

Background: Cancer diagnoses and treatment are characterized by physical and psychological stressors. Evidence-based psychosocial stress-management interventions offer physical and psychological relief, but are not always available. Results from clinical trials show the digital, evidence-based, and user-centered stress-management intervention StressProffen to be associated with reduced stress, anxiety, and depression, as well as improved self-regulatory capacity and quality of life for cancer survivors. While such interventions can be efficacious, the actual mechanisms of these effects remain understudied.

Objective: To qualitatively explore potential mechanisms in terms of psychological and behavioral change for cancer survivors after 12 months of access to StressProffen.

Methods: Using a selection matrix to ensure variation in sex, age, diagnosis, and program progress, the current study invited 39 participants who had access to StressProffen over 12 months through a randomized controlled trial (RCT) to participate in post-RCT semi-structured qualitative interviews related to use and potential benefit. Interview transcripts were analyzed using thematic analysis.

Results: Twenty-six cancer survivors completing the RCT agreed to participate. Qualitative analyses yielded five themes based upon patient-reported changes attributed to StressProffen use: (1) Self-awareness and personal values; who I am and what I want; (2) Comprehension; reflection and understanding of difficult thoughts and emotions; (3) Social relationships; manage my relations, (4) Relaxation and focusing skills; learn new relaxation, distraction, and focusing techniques; and (5) Coping skills and adjustment; coping with, adjusting to, and being prepared for difficult situations in all aspects of life.

Conclusion: Access to digital stress-management interventions, such as StressProffen, has been shown to contribute to improved psychological wellbeing and quality of life for cancer survivors. Qualitative analyses of patient-reported benefits suggest mechanisms of enhanced self-awareness, improved comprehension of the relationship between thoughts and emotions, stronger social relationships, and improved skill self-efficacy in terms of relaxation, focusing, and coping skills. A mixed methods approach, including quantitative as well as qualitative analyses, can facilitate in-depth explorations of the impact of digital psychosocial interventions for cancer survivors.

Keywords: cancer; cognitive behavioral therapy; digital; health; intervention; qualitative; stress-management.