Effects of an internet-based self-help intervention for psychological distress due to COVID-19: Results of a randomized controlled trial

Background: The COVID-19 pandemic and its far-reaching impact on physical and mental health generate high demand and, accordingly, a great need for treatment opportunities that promote well-being and manage psychological distress. Internet-based interventions are particularly suitable for this purpose. They are easily scalable, readily accessible, and the online format allows for adherence to social distancing. For this reason, we developed an internet-based self-help intervention called ROCO to address psychological distress due to the COVID-19 pandemic. This randomized controlled trial aimed to examine the efficacy of the ROCO intervention. Methods: A total of 107 German-speaking adults with at least mild depressive symptoms were randomized either to the intervention group with direct access to the three-week ROCO intervention plus care as usual or the waiting control group receiving care as usual. Primary outcome (depressive symptoms) and secondary outcomes (stress, anxiety, resilience, emotion regulation, health-related quality of life, embitterment, loneliness, optimism, and self-efficacy) were assessed pre- and post-treatment and at a 6-week follow-up using self-report questionnaires (e.g. Patient Health Questionnaire-9 for depressive symptoms). Results: The average age was 40.36 years (SD = 14.59) and 81.3% of participants were female. The intervention did not significantly reduce primary depressive symptoms (between-group effect size: d = 0.04) and secondary outcomes such as anxiety and stress symptoms (between-group effect size: d = 0.19). However, the intervention led to a significant increase in emotion regulation skills (between-group effect size d = 0.35) and resilience (between-group effect size d = 0.38). Conclusions: The internet-based self-help intervention cannot be recommended for the purpose of reducing depressive symptoms. However, the increase in emotion regulation skills and resilience suggest that the intervention may be suitable for preventive purposes, like improving overall coping with psychological distress or potential stressors. Future research is needed to examine for whom and how the intervention is most effective.