Effectiveness of and Mechanisms of Change in a Self-Help Web- and App-Based Resilience Intervention on Perceived Stress in the General Working Population: Randomized Controlled Trial.

Background: Promoting individual resilience-that is, maintaining or regaining mental health despite stressful circumstances-is regarded as an important endeavor to prevent mental illness. However, digital resilience interventions designed to enhance mental health have yielded mixed results. Such heterogeneous effects reflect a variety of unsolved conceptual challenges in interventional resilience research. These range from grounding interventions in resilience frameworks, using theory or targeting etiologically important resilience factors as intervention content, to a lack of knowledge about the mechanisms underlying effects, and using techniques specifically developed to foster psychosocial resources. The web- and app-based resilience intervention RESIST was designed to address these challenges, mainly by using both the Positive Appraisal Style Theory of Resilience as its theoretical foundation and interventional techniques from Strengths-Based Cognitive Behavioral Therapy. Objective: This study's primary aim was to evaluate the effectiveness of RESIST on perceived stress 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, self-compassion, and perceived social support, 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 a waitlist control group. Data were collected via the web at baseline, postintervention, and at 3- and 6-month (intervention group [IG] only) follow-ups. 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 IG reported significantly less stress than controls postintervention (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 IG were maintained at 6-month follow-up. Favorable between-group differences also were detected for self-perceived resilience and the resilience factors. IG participants completed on average 2.2 (SD 2.3) web-based sessions and used the app's core feature a median of 14 times (IQR 4.00-33.75, range 1-220). The positive effects of the intervention on stress and resilience were primarily mediated by changes in optimism and self-compassion. No evidence was found that self-efficacy and social support also acted as mediators. 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 an eCoach to ensure sufficient learning opportunities.