An email-based program may help decrease stress and increase confidence and feelings of gratitude, according to an unusual study from Finland.
Experts questioned the usefulness of the results, however, because despite the study having recruited more than 40,000 participants through a TV game show, more than half dropped out.
It’s not clear how interesting these findings are, said Dr. Giovanni A. Fava of the University of Bologna and the State University of New York at Buffalo, who was not part of the study. “First of all, subjects were recruited in a very odd way (a TV show), there was no actual control for the intervention and the participation was very low, casting doubts on the entire study validity,” he said by email.
The researchers advertised the internet-based wellbeing study during a reality show called Life at Stake in which Finnish celebrities were trained by coaches to improve their own wellbeing, between 2012 and 2013.
“People were invited to do an electronic health check on program’s internet site, where they were also offered a possibility to participate in the intervention,” said lead author Minna Torniainen-Holm of the National Institute for Health and Welfare and the Institute for Molecular Medicine Finland FIMM at the University of Helsinki.
More than 73,000 people responded to the ads and more than 42,000 actually began the email-based exercises.
The interventions were based on cognitive behavioral therapy and positive psychology, intended to increase wellbeing and improve ability to cope with stress. Participants could choose between programs targeting interpersonal relationships, like conflict resolution, or their own lifestyle, like quitting smoking, weight management or exercise. Both were options on the Electronic Health and Wellbeing Check and Coaching program, which is commercially available through health centers and websites in Finland.
Participants were sent 17 emails including a paragraph giving some background on the health topic chosen, a link to a video on the “assignment” of the email and instructions for the assignment. They received two to three emails per week for two months.
Some assignments were designed to promote forgiveness, to let go of past experiences or to recognize personal coping strategies, among others. Participants tracked their progress with periodic questionnaires answered before the programs began, two months later and again two years later.
People who chose lifestyle interventions only showed improvement at the two-month point, with no longer-term changes, compared to people who filled out the initial questionnaires but did not continue the programs. Those who chose interpersonal interventions showed more gratitude and confidence at the two-month and two-year follow up points, albeit only small increases, according to the results in BMC Psychology.
“The effect on their life also appears to depend on how much effort a person invests on doing the assignments as instructed,” Torniainen-Holm said. But less than 17,000 people took part in at least one follow-up questionnaire, the authors note.
“High dropout rate may reflect the fact that people were not primarily recruited to participate in a study, but they were invited to do an electronic health check and to participate on the trainings,” Torniainen-Holm said.
The new study was not a randomized controlled trial, so it was not perfect, said Dr. Gavin Andrews, professor of psychiatry at UNSW in Sydney, Australia, who also was not part of the new study.
“Our field is using automated web based (cognitive behavioral therapy) courses to help people with anxiety and depressive disorders, with and without complicating physical disorders, to recover,” Andrews said. “We have done 25 randomized controlled trials and it is clear that the benefits are comparable to face to face therapy, that the benefits last, that the costs are small.” If general wellbeing did improve, people may have slept better, eaten better, drank less and been less irritable, he said.
There are similar commercially available programs and phone apps for English speakers, Andrews told Reuters Health by email. Many apps are free, while programs with proven results are available for less than $50 USD, he said.
