Thomas J. Morledge, MD, Didier Allexandre, PhD, Emily Fox, MBA, MSSA, LSW, et al. “Feasibility of an Online Mindfulness Program for Stress Management – A Randomized, Controlled Trial.” JOEM. Volume 58: Number 3, March 2016.
- Purpose: This study aims to determine feasibility of an 8-week Internet-based stress management program (ISM) based on mindfulness principles in reducing stress in a 12-week, parallel, randomized, controlled trial.
- Methods: Participants were randomly allocated to ISM, ISM plus online message board (ISM+), or control groups. Perceived stress, mindfulness, self-transcendence, psychological well-being, vitality, and quality of life were measured at baseline, week 8, and week 12 using standard validated questionnaires.
- Results: ISM and ISM+ groups demonstrated statistically significant improvements compared with control on all measures except vitality and physical health.
- Conclusions: The ISM program effectively and sustainably reduced measures of stress. The magnitude of improvement is comparable to traditional mindfulness programs, although fewer participants were engaged. This feasibility study provides strong support for online stress management programs, which increase access at a fraction of the cost of traditional programs.
Chronic stress affects many Americans – approximately 35% of North Americans are affected by severe psychological stress.1 Stress is a major public health issue, and calls have been made for better access to stress management programs to prevent and manage chronic diseases. Stress can be reduced by “cultivating mindfulness, a state of consciousness that focuses on individual’s attention and awareness on the present moment and developing a nonjudgmental, conscious awareness of the moment-to-moment experience of one’s environment, thoughts, feelings, and actions.”2, 3, 4
However, stress management programs may be expensive or have limited access. The purpose of this study was to determine the feasibility of an 8-week Internet-based stress management program (ISM) based on mindfulness principles in reducing stress in a 12-week, parallel, randomized, controlled trial.
The 12-week, randomized, parallel, controlled trial was administered entirely online at the program Website. Participants provided their name and e-mail address and were automatically randomized (using a computer-generated list with a block size of three) into one of three groups: ISM, ISM plus online message board (ISM+), or control. All participants were asked to complete online questionnaires at 0 (baseline), 8, and 12 weeks and to fill out weekly activity logs for weeks 1-8. ISM+ group was asked to participate in an online message board hosted by iVillage.com.
Since high dropout rates are expected for online studies 5, 6, 7, the study enrolled approximately 700 people to obtain the target sample size.
- 1,204 people received the study description, and 684 (57%) people enrolled in the study between September 2010 and August 2011.
- The study ended in November 2011. Of those enrolled, 133 (19%) were lost prior to providing baseline data.
- Of the remaining (81%) who enrolled and completed the baseline questionnaire (n=551), more than half (57%) also completed one or both follow-up questionnaires (n=312).
- The 8- and 12-week completion rates differed across treatment groups: 41 and 33% for ISM, 44 and 38% for ISM+, and 67 and 65% for the control group at weeks 8 and 12, respectively.
This study demonstrates that Internet-based stress management program (ISM) participants experienced significant reductions in stress. The study found that a person who practices meditation techniques an average of 5 times/week will experience a 6.12 decrease (1.53 times 4) in Perceived Stress Scale (PSS) score versus practicing once per week.
Feedback about the ISM program and message board was provided by 78 ISM and 68 ISM+ participants who practiced the relaxation exercise at least once. Of those respondents, 45% found the overall program to be very or extremely helpful, 35% somewhat helpful and 19% little or not at all helpful.
Approximately one third (35%) of all ISM and ISM+ enrollees showed online program activity for 6–8 weeks, and 42% completed the questionnaires at 8 weeks. Program and study retention may be lower than most small-sample size studies of Web-based programs for psychological disorders, which range from 17 to 98% with an average of about 70%6 ; the rates are comparable to larger effectiveness studies5,7 and may be more reflective of real-world settings.
When asked about how helpful and beneficial specific components were, 53% found the meditation techniques, 43% the weekly audio lesson and 48% the articles to be very or extremely helpful.
This study demonstrated an 8-week ISM program could feasibly and effectively reduce stress. Benefits were sustained through week 12 for a well-educated, mostly female and computer savvy self-selected population. Although the participant completion rate was low, the magnitude of improvement was significant for those who completed the online program. This study provides support for online stress management programs that are publicly accessible and not cost prohibitive.
About USPM and Cleveland Clinic
U.S. Preventive Medicine (USPM) partnered with the Cleveland Clinic Wellness Institute in an innovative strategic partnership to integrate their next generation information technology platform and population health management services with their best-of-class wellness programs and e-Coaching services. Cleveland Clinic Wellness focuses on changing behavior in the “Big 4” causes of chronic diseases (food choices, tobacco, physical inactivity, and stress) through programs such as Healthy Performance with Stress Free Now, Cleveland Clinic Wellness e-Coaching, and interactive online programs Stress Free Now, Go! Foods, and Go! to Sleep. Cleveland Clinic’s Healthy Performance with Stress Free Now and CC e-Coaching have driven remarkable results across a wide variety of industries. Cleveland Clinic has led numerous successful community and institutional campaigns committed to improving the lives of children and adults. Also, in 2005 they were the first hospital to become a smoke-free workplace.
- Yusuf S, Hawken S, Ounpuu S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): Case–control study. Lancet. 2004;364(9438):937-952. doi:10.1016/S01406736(04)17018-9.
- Baer RA.Mindfulness training as a clinical intervention: A conceptual and empirical review. Clin Psychol Sci Pract. 2003;10(2):125-143.
- Shapiro SL, Oman D, Thoresen CE, Plante TG, Flinders T. Cultivating mindfulness: Effects on well-being. J Clin Psychol. 2008;64(7):840-862.
- Chiesa A, Serretti A. Mindfulness-based stress reduction for stress management in healthy people: A review and meta-analysis. J Altern Complement Med. 2009;15(5):593-600.
- Meyer B, Berger T, Caspar F, Beevers CG, Andersson G,Weiss M. Effectiveness of a novel integrative online treatment for depression (Deprexis): Randomized controlled trial. J Med Internet Res. 2009;11(2):e15.
- Melville KM, Casey LM, Kavanagh DJ. Dropout from Internet based treatment for psychological disorders. Br J Clin Psychol. 2010;49(Pt 4):455-471.
- Verheijden MW, Jans MP, Hildebrandt VH, Hopman-Rock M. Rates and determinants of repeated participation in a Web-based behavior change program for healthy body weight and healthy lifestyle. J Med Internet Res. 2007;9(1):e1.