title: Multilevel growth curve analyses of treatment effects of a Web-based intervention for stress reduction: randomized controlled trial.
abstract: BACKGROUND
  Stress is commonly experienced by many people and it is a contributing factor to many mental and physical health conditions, However, few efforts have been made to develop and test the effects of interventions for stress.
  
  
  OBJECTIVE
  The aim of this study was to examine the effects of a Web-based stress-reduction intervention on stress, investigate mindfulness and procrastination as potential mediators of any treatment effects, and test whether the intervention is equally effective for females as males, all ages, and all levels of education.
  
  
  METHODS
  We employed a randomized controlled trial in this study. Participants were recruited online via Facebook and randomly assigned to either the stress intervention or a control condition. The Web-based stress intervention was fully automated and consisted of 13 sessions over 1 month. The controls were informed that they would get access to the intervention after the final data collection. Data were collected at baseline and at 1, 2, and 6 months after intervention onset by means of online questionnaires. Outcomes were stress, mindfulness, and procrastination, which were all measured at every measurement occasion.
  
  
  RESULTS
  A total of 259 participants were included and were allocated to either the stress intervention (n=126) or the control condition (n=133). Participants in the intervention and control group were comparable at baseline; however, results revealed that participants in the stress intervention followed a statistically different (ie, cubic) developmental trajectory in stress levels over time compared to the controls. A growth curve analysis showed that participants in the stress intervention (unstandardized beta coefficient [B]=-3.45, P=.008) recovered more quickly compared to the control group (B=-0.81, P=.34) from baseline to 1 month. Although participants in the stress intervention did show increases in stress levels during the study period (B=2.23, P=.008), long-term stress levels did decrease again toward study end at 6 months (B=-0.28, P=.009). Stress levels in the control group, however, remained largely unchanged after 1 month (B=0.29, P=.61) and toward 6 months (B=-0.03, P=.67). Mediation analyses showed nonlinear (ie, cubic) specific indirect effects of mindfulness and a linear specific indirect effect of procrastination on stress. In simple terms, the intervention increased mindfulness and decreased procrastination, which was related to lower stress levels. Finally, the effect of the stress intervention was independent of participants' gender, age, or education.
  
  
  CONCLUSIONS
  The results from this randomized controlled trial suggest that a Web-based intervention can reduce levels of stress in a normal population and that both mindfulness and procrastination may be important components included in future eHealth interventions for stress.
  
  
  BACKGROUND
  International Standard Randomized Controlled Trial Number (ISRCTN): 25619675; http://controlled-trials.com/ISRCTN25619675 (Archived by Webcite at http://www.webcitation.org/6FxB1gOKY).
authors.affiliation: Research and Development, Changetech AS, Oslo, Norway. fd@changetech.no
authors.forename: Filip
authors.initials: F
authors.lastname: Drozd
authors.forename: Sabine
authors.initials: S
authors.lastname: Raeder
authors.forename: Pål
authors.initials: P
authors.lastname: Kraft
authors.forename: Cato Alexander
authors.initials: CA
authors.lastname: Bjørkli
mesh_terms: D000328:Adult; D005260:Female; D015438:Health Behavior; D006801:Humans; D020407:Internet; D008297:Male; D055361:Multilevel Analysis; D011613:Psychotherapy / Q000379:methods / Q000706:statistics & numerical data; D061108:Social Media; D013315:Stress, Psychological / Q000517:prevention & control / Q000523:psychology / Q000628:therapy*; D011795:Surveys and Questionnaires; D017216:Telemedicine; D013813:Therapy, Computer-Assisted / Q000379:methods* / Q000706:statistics & numerical data; D055815:Young Adult