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Promoting the Self-Regulation of Stress in Health Care Providers: An Internet-Based Intervention

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The aim of our internet-based intervention study was to find out whether healthcare professionals can autonomously down-regulate the stress they experience at their workplace, using an established self-regulation tool called Mental Contrasting with Implementation Intentions (MCII). Applying MCII to reduce stress implied for our participants to repeatedly engage in a mental exercise that (1) required specifying a wish related to reducing stress, (2) identifying and imagining its most desired positive outcome, (3) detecting and imagining the obstacle that holds them back, and (4) coming up with an if-then plan on how to overcome it. We recruited on-line nurses employed at various health institutions all over Germany, and randomly assigned participants to one of three groups. In the MCII group (n = 33), participants were taught how to use this exercise via email and the participants were asked to engage in the exercise on a daily basis for a period of 3 weeks. As compared to two control groups, one being a no-treatment control group (n = 35) and the other a modified MCII group (n = 32), our experimental MCII group showed a reduced stress level and an enhanced work engagement. We discuss the strengths and weaknesses of the present study as well as ways to intensify MCII effects on stress reduction.
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... The sample size of the included studies varied widely, from 14 participants (Palumbo et al., 2012) to 249 participants (Ghawadra et al., 2020). Participant work settings included hospitals (McElligott et al., 2003;Cohen-Katz et al., 2005;Walker, 2006;Moeini et al., 2011;Kurebayashi et al., 2012;Orly et al., 2012;Palumbo et al., 2012;Villani et al., 2013;Hersch et al., 2016;Bahmanzadeh and Haji Alizadeh, 2017;Calder Calisi, 2017;Singh and Jain, 2017;Wang et al., 2017;Prado et al., 2018;Hwang and Jo, 2019;Lary et al., 2019;Lin et al., 2019;Bernburg et al., 2020;Ghawadra et al., 2020;Niva et al., 2020), settings that focus on mental health (Collier et al., 2018;Yang et al., 2018;Bernburg et al., 2019;Hsieh et al., 2020), intensive care units (Nazari et al., 2015), and health care institutions with different organizational and hierarchical structures (Gollwitzer et al., 2018;Alkhawaldeh et al., 2020). ...
... Fifteen studies used a randomized controlled trial to study the effects of the treatment on nurses' stress level (Kurebayashi et al., 2012;Palumbo et al., 2012;Nazari et al., 2015;Hersch et al., 2016;Calder Calisi, 2017;Collier et al., 2018;Gollwitzer et al., 2018;Prado et al., 2018;Bernburg et al., 2019Bernburg et al., , 2020Hwang and Jo, 2019;Lin et al., 2019;Alkhawaldeh et al., 2020;Ghawadra et al., 2020;Niva et al., 2020). However, only three studies employed blind procedures (Prado et al., 2018;Alkhawaldeh et al., 2020;Bernburg et al., 2020). ...
... As for the modalities, the most common interventions were technology-delivered interventions for stress management and mental health. Particularly, three studies implemented self-help programs guided by a website (Hersch et al., 2016;Gollwitzer et al., 2018;Ghawadra et al., 2020) and three additional interventions investigated the effectiveness of mobile phonedelivered programs for stress management (Villani et al., 2013;Hwang and Jo, 2019;Hsieh et al., 2020). Other commonly used modality types included mindfulness-based programs (Cohen-Katz et al., 2005;Walker, 2006;Wang et al., 2017;Yang et al., 2018;Lin et al., 2019), cognitive-behavioral interventions (Moeini et al., 2011;Orly et al., 2012;Bahmanzadeh and Haji Alizadeh, 2017), self-care interventions (Singh and Jain, 2017;Lary et al., 2019;Alkhawaldeh et al., 2020), auriculotherapy (Kurebayashi et al., 2012;Prado et al., 2018), massage (McElligott et al., 2003Nazari et al., 2015), psychological competence trainings combined with cognitive-behavioral components (Bernburg et al., 2019(Bernburg et al., , 2020, breathing exercises (Calder Calisi, 2017), chanting mantras (Niva et al., 2020), physical activity training (Palumbo et al., 2012) and multisensory environmental therapy (Collier et al., 2018). ...
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Background: Nurses are facing unprecedented amounts of pressure because of the ongoing global health challenges. Improving nurses' resilience to job-related stress and enhancing their strategies to cope effectively with stressors are key issues facing many health care institutions during the COVID-19 pandemic. This literature review aimed to: a) provide a thorough overview of individual-level interventions for stress management among nurses, b) identify measurement tools utilized to evaluate nurses' stress level, and c) provide the best evidence-based recommendations for future research and practice adapted to the current restrictions. Design: Systematic review. Data Sources: Studies published between January 2000 and October 2020 were retrieved from the following sources: EBSCOhost, Dortmund University Library, PubMed, Medline, Google Scholar, Applied Nursing Research , and reference lists from relevant articles. Review methods: Individual-level interventions with a control group or a placebo intervention were included in the final sample. Primary outcome was defined as a change in individual stress level or stress symptoms which were measured by objective or subjective instruments with evidence of validity. Articles published in English or German were included in the present review. Results: In total, 27 relevant studies were included into the current review. There are some indications that technology-delivered interventions with relaxation and stress management interventions comprising cognitive-behavioral components might be effective in decreasing stress among nurses and improving their well-being. Furthermore, although there were some attempts to collect objectively measured parameters for assessing the primary outcome of stress, the majority of the interventions utilized self-reported stress scales. Conclusion: A wide range of interventions are available for nurses. However, it is of utmost importance to develop and implement stress management programs that are conveniently accessible in the workplace and above all, meet the current restrictions for minimizing human contacts. To this end, innovative interventions delivered through digital technology, such as virtual reality, seem to be a promising solution for combating the detrimental impact of stress on nurses. Special attention should be also paid to applying standardized objective measurement tools to allow the assessment of sensitive physiological indices and the generalizability of scientific knowledge.
... This tool is highly accessible (i.e., brief, little-to-no cost, delivered online) and customizable to personal needs. MCII has been effective across life domains including the health domain (Stadler et al., 2010;Gollwitzer et al., 2018;Valshtein et al., 2020). This thoughtbased strategy contains two complementary phases-mental contrasting (MC) and implementation intentions (II)-that facilitate binding goal commitments and goal-directed action. ...
... Our results suggest this may be the case but are not conclusive. The condition effect at low-SES, though not statistically significant, is consistent with prior findings that MCII helps individuals facing challenging circumstances (e.g., Gawrilow et al., 2013;Gollwitzer et al., 2018;Wittleder et al., 2019;Mutter et al., 2020) and extends prior research on MCII among individuals of low-SES into the domain of smoking reduction. ...
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... For instance, "If situation Y is encountered, then I will initiate the goal directed behavior X!". This strategy has medium to large effect sizes on behavior observed across various populations, modes of delivery (e.g., internet-or laboratory based interventions) and behaviors and has been confirmed as successful in the context of stress reduction in general (Gollwitzer, 1999;Gollwitzer & Sheeran, 2006;Hagger & Luszczynska, 2014) as well as concerning work-related stress (Gollwitzer et al., 2018). Further, research indicates that one-time performed planning interventions are effective for behavior changes (Hagger & Luszczynska, 2014). ...
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Background: Occupational stress is one of the main sources of stress in apprentices with physical and psychological health consequences. Just-in-time planning interventions (JITPIs) are one opportunity to deliver intervention components at the right times and locations to optimally support apprentices in stressful situations. The aim of this study was to test the proximal effect of a mobile phone-delivered JITPI to reduce occupational stress in 386 apprentices within a planning intervention. Methods: An AB/BA crossover design in which participants were randomly allocated to (A) the planning intervention or (B) the assessment only condition was implemented. Results: The analyses of the study "ready4life", multilevel modeling, revealed no significant effect of the planning intervention on occupational stress reduction. Conclusions: Possible reasons for the missing effect might be the low stress level of participants or the type of the intervention delivery. Since apprenticeships in Switzerland differ considerably, future studies should enable more adapted interventions for the apprentices and consider individual circumstances of stress. Further, the intervention should focus on apprentices with high occupational stress levels or a high-risk of stress. Studies should investigate exactly when and why a person needs support regarding her/his occupational stress. Therefore, objective measurements of stress could be helpful.
... Especially in organising the work processes with networked route planning and service recording, digitalisation is described as a possible solution to some problems, such as skipping breaks due to a lack of time to complete work tasks [51]. Studies on inpatient care services have demonstrated that digitalisation represents an opportunity for the implementation of workplace health promotion, since programmes for stress prevention as well as for occupational health management with integrated optimisation of work processes have been proven successful in randomised controlled trials [52][53][54]. In addition, the COVID-19 pandemic poses a particular challenge for the implementation of workplace health promotion measures, since, for example, infection protection measures such as distance regulations make it difficult to implement group-based offers such as sports courses. ...
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Working conditions in the care sector, especially under the increased strain during COVID-19, make it difficult for outpatient caregivers to adhere to health-promoting behaviours. Research on workplace health promotion (WHP) and COVID-19 support measures in outpatient care services is limited. The aim of this pilot study was to characterise the current situation of WHP and COVID-19 support measures in outpatient care services and to explore how to offer WHP support measures targeted for a specific group. A web-based cross-sectional survey was conducted with outpatient caregivers (N = 171) in northern Germany. The results showed that 60.2% of the study participants were offered WHP support measures, with significantly higher work engagement when WHP support measures were available (Z = 4279.50, p < 0.01) and that 77.2% received specific support from their employer during the COVID-19 pandemic. Although spending a break in a break room was significantly associated with longer breaks as compared with being in a car (Z = 39.10, padj. = 0.01), a break room was neither available in all outpatient care services, nor did it appear to be feasible. Overall, WHP in outpatient care services is insufficiently covered. In order to be able to offer WHP support measures that are targeted to outpatient caregivers, cooperation among local care services, feasibility, and digital measures should be examined.
... Implementation intentions are helpful in showing a specific desired behavior because they make the situation in which the undesired behavior usually occurs cognitively more accessible (Achtziger et al., 2012;Webb & Sheeran, 2004) and because they create an association between the situation and the desired behavior (Webb & Sheeran, 2007. There is strong empirical evidence that implementation intentions are an effective volitional strategy within a broad range of life domains (Gollwitzer & Sheeran, 2006), such as healthy eating (Adriaanse, Vinkers, et al., 2011), physical exercise (Bélanger-Gravel et al., 2013), and job-stress reduction (Gollwitzer et al., 2018). Although most research has examined the effects of implementation intentions with experimental study designs (Gollwitzer & Sheeran, 2006), people also form implementation intentions in everyday life without being explicitly instructed to do so. ...
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Although habits are a well-researched topic within psychology, habits enacted at the workplace received limited attention in the organizational literature. In this article we examine habits that employees show at the workplace. Because workplace habits are not always functional for performance or affective outcomes, and because employees themselves may regard specific habits as undesirable, it is important to identify ways of how employees can abandon such unwanted habits. We report findings from a daily-survey study (N = 145 persons) in which we examined if self-regulatory processes predict disengagement from undesirable habits and engagement in more desirable alternative behaviors. Multilevel path analysis showed that day-specific implementation intentions and day-specific vigilant monitoring were negatively related to day-specific habitual behavior and positively related to day-specific alternative behaviors, both in the morning and in the afternoon. Analysis of follow-up data (N = 126 persons) showed that change in habit strength was stable over a 2-month period, suggesting that implementation intentions, vigilant monitoring, and the associated enactment of alternative behavior indeed may help to disengage from unwanted habits, particularly with respect to task-related habits and when consistency in vigilant monitoring is high. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
... First, five interventions were delivered through an online format (Ouweneel et al., 2013;Dyrbye et al., 2016;Muuraiskangas et al., 2016;Gollwitzer et al., 2018;Kloos et al., 2019). These were app-or web-based and focused on individual exercises that the participants completed online, tasks that they undertook in their everyday working life, and educational elements. ...
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