title: Restoring depleted resources: Efficacy and mechanisms of change of an internet-based unguided recovery training for better sleep and psychological detachment from work.
abstract: OBJECTIVE
  This randomized controlled trial evaluated the efficacy of an Internet-based intervention, which aimed to improve recovery from work-related strain in teachers with sleeping problems and work-related rumination. In addition, mechanisms of change were also investigated.
  
  
  METHODS
  A sample of 128 teachers with elevated symptoms of insomnia (Insomnia Severity Index [ISI] ≥ 15) and work-related rumination (Cognitive Irritation Scale ≥ 15) was assigned to either an Internet-based recovery training (intervention condition [IC]) or to a waitlist control condition (CC). The IC consisted of 6 Internet-based sessions that aimed to promote healthy restorative behavior. Self-report data were assessed at baseline and again after 8 weeks. Additionally, a sleep diary was used starting 1 week before baseline and ending 1 week after postassessment. The primary outcome was insomnia severity. Secondary outcomes included perseverative cognitions (i.e., work-related rumination and worrying), a range of recovery measures and depression. An extended 6-month follow-up was assessed in the IC only. A serial multiple mediator analysis was carried out to investigate mechanisms of change.
  
  
  RESULTS
  IC participants displayed a significantly greater reduction in insomnia severity (d = 1.37, 95% confidence interval: 0.99-1.77) than did participants of the CC. The IC was also superior with regard to changes in all investigated secondary outcomes. Effects were maintained until a naturalistic 6-month follow-up. Effects on insomnia severity were mediated by both a reduction in perseverative cognitions and sleep effort. Additionally, a greater increase in number of recovery activities per week was found to be associated with lower perseverative cognitions that in turn led to a greater reduction in insomnia severity.
  
  
  CONCLUSIONS
  This study provides evidence for the efficacy of an unguided, Internet-based occupational recovery training and provided first evidence for a number of assumed mechanisms of change.
authors.affiliation: Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University.
authors.forename: David D
authors.identifier: 0000-0001-6820-0146
authors.initials: DD
authors.lastname: Ebert
authors.affiliation: Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University.
authors.forename: Matthias
authors.initials: M
authors.lastname: Berking
authors.affiliation: Division of Online Health Training, Innovation Incubator, Leuphana University.
authors.forename: Hanne
authors.initials: H
authors.lastname: Thiart
authors.affiliation: Division of Online Health Training, Innovation Incubator, Leuphana University.
authors.forename: Heleen
authors.initials: H
authors.lastname: Riper
authors.affiliation: Harvard Medical School, Harvard University.
authors.forename: Johannes A C
authors.identifier: 0000-0001-5044-5540
authors.initials: JAC
authors.lastname: Laferton
authors.affiliation: Division of Online Health Training, Innovation Incubator, Leuphana University.
authors.forename: Pim
authors.initials: P
authors.lastname: Cuijpers
authors.affiliation: Division of Online Health Training, Innovation Incubator, Leuphana University.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Sieland
authors.affiliation: Division of Online Health Training, Innovation Incubator, Leuphana University.
authors.forename: Dirk
authors.initials: D
authors.lastname: Lehr
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods; D003863:Depression / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D005178:Faculty; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020407:Internet / Q000639:trends; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function / Q000502:physiology; D012890:Sleep / Q000502:physiology; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D016896:Treatment Outcome; D016526:Workload / Q000523:psychology*