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Authors: Kunzler, Angela Mareike
Title: Learning to Bounce Back? – Current Evidence From a Systematic Cochrane Review on Resilience Interventions in Healthcare Professionals and a Pilot Study on a Mobile-Based Positivity Bias Training
Online publication date: 17-Nov-2021
Language: english
Abstract: Background. There is an increasing interest in interventions to foster resilience, that is, the maintenance or quick recovery of mental health despite adversities. Healthcare professionals (HCP), exposed to various work-related stressors, are at an elevated risk of mental disorders and might benefit from such programs. Due to methodological weaknesses, previous reviews cannot answer the question of which interventions are really effective in HCP and how they should be implemented. Besides stressor exposure, biases in information processing may also determine mental health, with a focus on the reduction of negativity biases in previous research. Although a positivity bias (PB) is viewed as protective factor that might also facilitate a resilient response to stressors, training approaches to foster a PB have been neglected, especially at the level of action tendencies. Objectives. Overall, this thesis addresses the question of whether interventions to foster resilience are effective in improving resilience and mental health by the following two objectives: 1) To synthesize the evidence on the efficacy of resilience training (i.e., trainings fostering one or several resilience factors) in HCP and to explore the potential moderating role of intervention characteristics (e.g., setting), in order to assess the meaning of these programs. 2) To develop a mobile-based positivity training at the level of action tendencies using various affective stimuli which solely focuses on the resilience factor of PB and whose feasibility and effects are evaluated. Methods. Two complementary approaches were used. First, a systematic Cochrane review and meta-analysis was conducted. CENTRAL, MEDLINE, Embase, 11 other databases, and three trial registries were searched from 1990 to June 2019, with reference lists being checked and researchers in the field contacted. Randomized controlled trials (RCTs) in adults aged ≥ 18 years who are employed as HCP, comparing any form of psychological intervention to foster resilience, hardiness, or posttraumatic growth against a comparator, were eligible. Primary outcomes were resilience and mental health, secondary outcomes were resilience factors. Study selection, data extraction, quality assessment, and the rating of the certainty of evidence were performed in duplicate. Random-effects meta-analyses were conducted along with preplanned subgroup and sensitivity analyses. Second, in the empirical pilot study TRAIN4Positivity (single-group design), N = 41 healthy participants (university students) exposed to many microstressors underwent the three-week mobile-based intervention called “Breezly”. Based on the modified Approach Avoidance Task (AAT) and using pictures from validated databases, “Breezly” included daily sessions of picture training. Using a pre- and postassessment with Ecological Momentary Assessment (EMA) throughout the intervention, perceived stress and the perceived severity of microstressors served as primary outcomes, with the latter being compared to a (matched) historical control group (N = 70). Secondary outcomes included implicit action tendencies, measures of resilience and well-being, psychological EMA outcomes (e.g., mood), cognitive reappraisal, and emotional experience. Data were analyzed using various methods (e.g., multilevel modeling). Results. Overall, both projects provided mixed results concerning the positive effects of interventions to foster resilience. In the systematic review, 44 RCTs were identified, with 39 solely in HCP (N = 6,974) and four in mixed samples (N = 1,000). Most studies investigated high-intensity group interventions, delivered face-to-face, and based on combined theoretical foundations. At postintervention, very-low certainty evidence indicated that, compared to controls, HCP receiving resilience training may report higher levels of resilience and lower levels of depression, and stress. There was little or no evidence for any effect on anxiety and well-being. Effect sizes were small to moderate, with the positive effects maintained within 3 months after training, but mostly not evident at longer follow-ups. Data on undesired events were only available for three studies, with none reporting any adverse effects. Subgroup analyses showed no consistent effect modifiers. Controlled for stressor exposure and the baseline attributional style, the app-based study found no evidence for any training effects on the above-mentioned outcomes, with the changes in action tendencies not moderated by attributional style. Only the ability to distance from negative stimuli partly improved. Conclusions. Both projects contribute to resilience intervention research. The systematic review provides very-low certainty evidence that resilience training may result in higher levels of resilience, lower levels of depression, stress, and higher levels of certain resilience factors at postintervention, with the effects mostly sustained in the short-term. The paucity of medium- and long-term data, restricted geographical distribution, and heterogeneous interventions limit the generalizability of results; thus, conclusions should be drawn carefully. A need for high-quality replications and improved study designs is implied. Second, the findings of the pilot study indicate that the app-based training is feasible, but did not change most of the psychological outcomes, partly attributable to (methodological, intervention) limitations. The results arise the question of the suitability of the AAT as a measure of PB at the action level. Given the tendency for improvements for several outcomes, there is a need for further research to develop the training and examine its efficacy, for example in (stressor-exposed) individuals like HCP.
DDC: 150 Psychologie
150 Psychology
Institution: Johannes Gutenberg-Universität Mainz
Department: FB 02 Sozialwiss., Medien u. Sport
Place: Mainz
URN: urn:nbn:de:hebis:77-openscience-ed2fc76e-8ac0-4bae-9dd4-659aa68dab8e8
Version: Original work
Publication type: Dissertation
License: In Copyright
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Extent: XXIII, 468 Seiten
Appears in collections:JGU-Publikationen

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kunzler_angela_mareike-learning_to_bo-20211015172959035.pdfDissertation11.02 MBAdobe PDFView/Open
kunzler_angela_mareike-learning_to_bo-20211015173429215.zipDigital Appendix D Cochrane-Review11.77 MBZIPView/Open
kunzler_angela_mareike-learning_to_bo-20211015174039577.zipDigital Appendix K TRAIN4Positivity40.35 MBZIPView/Open