|Ahead of print publication
Efficacy of online mental health program “EmoAid” during the COVID-19 pandemic
Shilpa Gupta1, Deepak Gupta2, Eti Goel1, Usama Rehman3
1 Centre For Child and Adolescent Wellbeing, New Delhi, India
2 Centre For Child and Adolescent Wellbeing; Department of Child and Adolescent Psychiatry, Sir Ganga Ram Hospital, New Delhi, India
3 Department of Psychology, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
|Date of Submission||13-Dec-2021|
|Date of Decision||21-Jan-2022|
|Date of Acceptance||04-Feb-2022|
|Date of Web Publication||24-Aug-2022|
Centre for Child and Adolescent Wellbeing, New Delhi
Source of Support: None, Conflict of Interest: None
Background: COVID-19 has triggered public health crises all around the globe. It has caused mental health issues not only in infected cases but also in uninfected cases. The world was put under strict/restricted lockdown to contain the transmission of COVID-19 diseases. All important aspects of life including therapies and counseling went online. “EmoAid” is one such online mental health program started during the COVID-19 to ease psychological distress. Aim: The current study assessed the efficacy of “EmoAid” program. Methods: One hundred and twenty-two participants completed depression, anxiety, and stress scale-21 online at three time periods; before the program (T1), after the program (T2), and 3 weeks after the program to study the maintenance effect (T3). Results: The results suggested that the program was successful in decreasing symptoms of depression, anxiety, and stress among participants. The maintenance effect of the program was also observed. Conclusion: The results highlight the importance of “EmoAid,” an online mental health program in lowering the levels of psychological distress during the pandemic, however, a randomized controlled study is required to validate the results.
Keywords: COVID-19, EmoAid, Mental health, Online counseling, Online Mental Health Program
|How to cite this URL:|
Gupta S, Gupta D, Goel E, Rehman U. Efficacy of online mental health program “EmoAid” during the COVID-19 pandemic. J Mental Health Hum Behav [Epub ahead of print] [cited 2022 Oct 1]. Available from: https://www.jmhhb.org/preprintarticle.asp?id=354426
| Introduction|| |
COVID-19 was first found in Wuhan, China, as unexplained cases with severe pneumonia which spread and affected people across the globe., It has caused significant public health chaos and economic crisis. The World Health Organization declared COVID-19 a pandemic, as the infection continues to soar. Countries were put under lockdown with restricted essential services and people were quarantined to contain the transmission of coronavirus. Further, people were asked to follow COVID-19 appropriate behavior such as social distancing, wearing mask, and frequent hand sanitization. With pharmacological treatments not being effective, vaccine hesitancy,, and availability have further aggravated the disease as the virus continues to mutate. As of November 24, 2021, it has infected more than 25 crore people worldwide from which approximately 51 lakh had already lost their lives. it has become crucial to take care of one's well-being as COVID-19 disease is coming back in different waves.
The COVID-19 pandemic has significantly affected the mental health of both infected as well as uninfected people. In an initial systematic review, Xiong and colleagues reported the prevalence of anxiety (6.33% to 50.9%), depression (14.6% to 48.3%), posttraumatic stress disorder (7% to 53.8%), psychological distress (34.43% to 38%), and stress (8.1% to 81.9%) among the general population from China, Spain, Italy, Iran, U. S., Turkey, Nepal, and Denmark during the COVID-19 pandemic. In another systematic review and meta-analysis, the prevalence of stress was found to be “29.6%,” anxiety “31.9%,” and depression “33.7%.” In an online survey among Indians, 38.2% reported anxiety, 10.5% had depression, 74.1% reported moderate levels of stress, and 71.7% reported poor well-being. Mental health during the pandemic was also influenced by demographics and professions. A study among varied professionals found students and health workers at higher risk as they reported higher levels of anxiety, stress, and depression as compared to others. Females were also found to be at greater risk than their male counterparts., Considering the psychological damage, the use of online therapy/counseling to overcome psychological distress was preferred and advised.,,
Due to lockdown and restricted human movements, many programs including counseling and psychological therapies shifted to online platforms. People have been using online counseling services for a long time, however, it has been utilized and preferred to avoid any possible transmission of coronavirus during the COVID-19 pandemic. Practitioners are hopeful of its efficacy despite its limitations (such as technological issues and rapport building). Although face-to-face psychotherapy cannot be compared with remote psychotherapy, psychotherapists found it useful. In a study during the pandemic, participants who took online counseling reported lower levels of anxiety, stress, and depression than people who did not take the counseling. Online counseling/mental health services were also found to be useful during the coronavirus pandemic. Considering the psychological distress during the COVID-19 pandemic, Weiner and colleagues developed an online cognitive behavioral therapy (CBT) program “my health too,” however, the efficacy of the program is still unknown. Center for Child and Adolescent Wellbeing (CCAW) also started an online program called “EmoAid” to address the psychological issues in the community. Considering the pandemic and scarce literature, it has become important to assess the efficacy of online mental health programs, especially developed in and for the current pandemic. Therefore, to address the need, the current study tested the efficacy of an online mental health program “EmoAid.”
“EmoAid” is a flagship online experiential learning program of CCAW. “EmoAid,” as the word suggests, is a program targeted at individuals to help them understand and resolve emotional issues by teaching them various techniques which can be used during distress hours. The program serves as aid to emotional distress which was also quite evident during the COVID-19 pandemic. The program adopted techniques from certain renowned empirically proven techniques such as neuro-linguistic programming, eye movement desensitization, reprocessing, acceptance therapy, narrative therapy, Yoga, etc.
| Method|| |
Since the program was designed and started off during national lockdown, the primary aim of the program was to ease the distress around. A call to participate was sent out at different social media platforms such as Facebook, Instagram, LinkedIn, etc. The participants paid a nominal amount to register for the program. The program was a five-session online program conducted over 5 weeks, one session per week, which lasted from 2 to 3 hours. All the sessions were conducted by trained and experienced psychologists. One group consisted of 6–8 participants only. A call was also arranged mid-week from the psychologist asking about whether the techniques were practiced? Did it help and if there were any doubts? In case a participant missed a part of the session due to network issues, the facilitator connected with them separately after the completion of session. A brief description of all the five sessions along with the activities is given in [Table 1]. During registration, the participants were also briefed about the research goal and a prior written consent was obtained. The participants responded to the questionnaire thrice: T1, before the start of the program. T2, after the completion of the program and T3, post 3 weeks of the program. Repeated measure analysis of variance (ANOVA) was used to infer the efficacy of the program. Since a handful of participants were below 18 years of age, the written consent was taken from their parents. Ethical standards in the 2013 Declaration of Helsinki were followed and the study was approved by the Institutional Ethical Committee. The study was conducted from May 2020 to August 2020.
A total of 146 Indian participants enrolled in the program. However, one hundred and twenty-two participants who took part in all three time periods were included in the study and rest 24 were excluded. None of the participants or members of their immediate family was infected with the virus. The age range of the participants was 15–72 with 27.64 being the mean age. There were 29 males and 93 females. Fifty-one identified themselves as students, 15 as housewife, 31 as working professionals, 10 as health professionals, and 15 as mental health professionals. None of the participants reported taking any form of psychotropics drug.
Anyone above the age of 15, able to understand English and Hindi, who had a good Internet facility on smartphones or laptops with a video camera.
Participants who had a problem in comprehending instructions, significant physical or mental illness, and noncooperative subjects.
Questions related to age, sex, and other demographics were asked along with their psychometric details.
Depression Anxiety Stress Scale-21
The Depression Anxiety Stress Scale-21 was used to assess depression, anxiety, and stress. The scale has 21 items, 7 items each for depression, anxiety, and stress. Each item is rated on a 4-point scale ranging from 0 (did not apply to me at all) to 3 (applied to me very much or most of the time), with higher scores indicating higher symptoms of depression, anxiety, and stress. The scale has been commonly used globally and also in India.
| Results|| |
The mean values along with standard deviation, significance test and pairwise comparison are shown in [Table 2] and [Table 3]. For depression, Mauchly's test of sphericity indicated that the assumption had been violated, X2 (2) = 26.129, P < 0.01. Therefore, multivariate tests are reported (ε = 0.84). The results of ANOVA show that there was a significant effect in depression scores across three time periods, V = 0.51, F (2, 120) = 62.61, P < 0.01. The results of pairwise comparison using Bonferroni adjustment showed that the mean differences between T1 and T2 and T3 were statistically significant. The mean score of depression at T1 (M = 8.11, standard deviation [SD] = 5.21) was found to be significantly greater than T2 (M = 4.75, SD = 4.47) and T3 (M = 3.56, SD = 3.54). The mean score of depression at T2 (M = 4.75, SD = 4.47) was also found to be significantly greater than T3 (M = 3.56, SD = 3.54).
As for anxiety, Mauchly's test indicated that the assumption of sphericity had been violated, X2 (2) = 14.18, P < 0.01, therefore, multivariate tests were reported (ε = 0.920). The results of ANOVA show that there was a significant difference in anxiety scores across three time periods, V = 0.38, F (2, 120) = 36.12, P < 0.01. The results of pairwise comparison using Bonferroni adjustment showed that the mean differences between T1, T2, and T3 were significant. The mean score for anxiety at T1 (M = 7.57, SD = 5.15) was found to be significantly greater than T2 (M = 5.52, SD = 4.37) and T3 (M = 4.50, SD = 3.59). The mean score at T2 was also significantly greater than T3.
For stress, Mauchly's test indicated that the assumption of sphericity had been violated, X2 (2) = 19.93, P < 0.01, therefore, multivariate tests were reported (ε = 0.87). The results of ANOVA show that there was a significant difference in anxiety scores across three time periods, V = 0.57, F (2, 120) = 78.46, P < 0.01. The results of pairwise comparison using Bonferroni adjustment showed that the mean differences between T1, T2, and T3 were significant. The mean score for anxiety at T1 (M = 10.32, SD = 4.46) was found to be significantly greater than T2 (M = 6.53, SD = 4.52) and T3 (M = 5.53, SD = 3.73). The mean score at T2 was also significantly greater than T3. A graphical representation of mean scores across three time periods is shown in [Figure 1].
| Discussion|| |
The current study evaluates an experiential learning program which equips participants with various techniques to overcome psychological distress during distressing times such as the coronavirus pandemic. The study is the first one to assess the efficacy of “EmoAid” which is a flagship program of CCAW, designed and implemented during the COVID-19 pandemic. The results of the study highlight the efficacy of the program “EmoAid” as the mean values of depression, anxiety, and stress symptoms reduced significantly. The program was found to ease the distress for a considerate time as maintenance effect (post 3 weeks of the program) was also observed. The study was done during the COVID-19 lockdown in India when a significant psychological distress was observed among the general people.,, A longitudinal study by Rehman and colleagues reported a significant decrease in symptoms of depression, anxiety, and stress from lockdown to unlock phase, however, the results of our study further validate the efficacy of “EmoAid” as the pre-post difference is incremental, which could be attributed to the program itself. The probable reason could be that the program empowers participants to be self-efficacious and resilient in the face of adversity, thus increasing their well-being. The techniques which were taught and practiced in the program were proven techniques to ease out the distress and have been used in the past.,,,,,,, With one such program, the participants learn to resolve his/her own emotional difficulties by themselves. The study is in line with previous researchers (such as Kumar et al.,) who, in a recent review, found that internet-based CBT is useful in treating mental illness. Online counseling was found to increase resilience and effective to stay strong during the COVID-19 pandemic among students., In another study, a significant reduction in negative affect and state anxiety was observed even after a single counseling session.
Thus, it can be inferred that “EmoAid” is an effective mental health program which empowers participants with important psychological techniques that can be used during distress hours to overcome distress.
| Conclusion and Limitations|| |
The study is the first one to assess the efficacy of an online experiential learning mental health program aimed to ease out distress during public health emergencies such as the COVID-19 pandemic. The study finds that the program has a maintenance effect of 3 weeks; however, assessing the participants again after a long duration could further validate the results. Although the study is important, it does have some limitations. The demographics of participants and socioeconomic status could play an important role in overcoming distress, especially during the pandemic. For example, people who had essential supplies were found to be less affected psychologically than others. The study assesses the efficacy by just one measure. It could be quite possible, as also reported by news articles that people started to enjoy the time with family as the time went by during the pandemic. An in-depth study involving other measures could provide concrete results. The study is a single group design which further hinders the validity of the results. The results are limited to participants who have not reported any case of coronavirus disease in their families.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Rajkumar RP. COVID-19 and mental health: A review of the existing literature. Asian J Psychiatr 2020;52:102066.
Ding K, Yang J, Chin MK, Sullivan L, Demirhan G, Violant-Holz V, et al.
Mental health among adults during the COVID-19 pandemic lockdown: A cross-sectional multi-country comparison. Int J Environ Res Public Health 2021;18:2686.
Hartley DM, Perencevich EN. Public health interventions for COVID-19: Emerging evidence and implications for an evolving public health crisis. JAMA 2020;323:1908-9.
Meo SA, Abukhalaf AA, Alomar AA, AlMutairi FJ, Usmani AM, Klonoff DC. Impact of lockdown on COVID-19 prevalence and mortality during 2020 pandemic: Observational analysis of 27 countries. Eur J Med Res 2020;25:56.
Chiu NC, Chi H, Tai YL, Peng CC, Tseng CY, Chen CC, et al.
Impact of wearing masks, hand hygiene, and social distancing on influenza, enterovirus, and all-cause pneumonia during the coronavirus pandemic: Retrospective National Epidemiological Surveillance Study. J Med Internet Res 2020;22:e21257.
Sanders JM, Monogue ML, Jodlowski TZ, Cutrell JB. Pharmacologic treatments for coronavirus disease 2019 (COVID-19): A review. JAMA 2020;323:1824-36.
Dror AA, Eisenbach N, Taiber S, Morozov NG, Mizrachi M, Zigron A, et al.
Vaccine hesitancy: The next challenge in the fight against COVID-19. Eur J Epidemiol 2020;35:775-9.
Husain F, Shahnawaz MG, Khan NH, Parveen H, Savani K. Intention to get COVID-19 vaccines: Exploring the role of attitudes, subjective norms, perceived behavioral control, belief in COVID-19 misinformation, and vaccine confidence in Northern India. Hum Vaccin Immunother 2021;17:3941-53.
Wouters OJ, Shadlen KC, Salcher-Konrad M, Pollard AJ, Larson HJ, Teerawattananon Y, et al.
Challenges in ensuring global access to COVID-19 vaccines: Production, affordability, allocation, and deployment. Lancet 2021;397:1023-34.
Lauring AS, Hodcroft EB. Genetic variants of SARS-CoV-2 – What do they mean? JAMA 2021;325:529-31.
Singh OP. COVID-19 and access to mental health care – Need of increased investment. Indian J Psychiatry 2020;62:S328-9.
Fisayo T, Tsukagoshi S. Three waves of the COVID-19 pandemic. Postgrad Med J 2021;97:332.
Xiong J, Lipsitz O, Nasri F, Lui LM, Gill H, Phan L, et al.
Impact of COVID-19 pandemic on mental health in the general population: A systematic review. J Affect Disord 2020;277:55-64.
Salari N, Hosseinian-Far A, Jalali R, Vaisi-Raygani A, Rasoulpoor S, Mohammadi M, et al.
Prevalence of stress, anxiety, depression among the general population during the COVID-19 pandemic: A systematic review and meta-analysis. Global Health 2020;16:57.
Grover S, Sahoo S, Mehra A, Avasthi A, Tripathi A, Subramanyan A, et al.
Psychological impact of COVID-19 lockdown: An online survey from India. Indian J Psychiatry 2020;62:354-62. [Full text]
Rehman U, Shahnawaz MG, Khan NH, Kharshiing KD, Khursheed M, Gupta K, et al.
Depression, anxiety and stress among indians in times of COVID-19 lockdown. Community Ment Health J 2021;57:42-8.
Wang C, Pan R, Wan X, Tan Y, Xu L, McIntyre RS, et al.
A longitudinal study on the mental health of general population during the COVID-19 epidemic in China. Brain Behav Immun 2020;87:40-8.
Verma K. The mental health impact of the COVID-19 epidemic on college students in India. Asian J Psychiatr 2020;53:102398.
Grover S, Sahoo S, Mehra A. How to organize mental health services in the era of unlockdown. Indian J Psychol Med 2020;42:473-7.
Situmorang DDB. Online/cyber counseling services in the COVID-19 outbreak: Are they really new? J Pastoral Care Counsel 2020;74:166-74.
Feijt M, de Kort Y, Bongers I, Bierbooms J, Westerink J, IJsselsteijn W. Mental health care goes online: Practitioners' experiences of providing mental health care during the COVID-19 pandemic. Cyberpsychol Behav Soc Netw 2020;23:860-4.
Humer E, Stippl P, Pieh C, Pryss R, Probst T. Experiences of psychotherapists with remote psychotherapy during the COVID-19 pandemic: Cross-sectional web-based survey study. J Med Internet Res 2020;22:e20246.
Kumari A, Singh P. Impact of counseling on psychological health during lockdown of COVID-19. J Stat Manag Syst 2021;24:53-65.
Rehman U, Shahnawaz MG, Kashyap D, Gupta K, Kharshiing KD, Khursheed M, et al.
Risk perception, social distancing, and distress during COVID-19 pandemic: Exploring the role of online counseling and perceived social support. Death Stud 2021;1-11.
Weiner L, Berna F, Nourry N, Severac F, Vidailhet P, Mengin AC. Efficacy of an online cognitive behavioral therapy program developed for healthcare workers during the COVID-19 pandemic: The REduction of STress (REST) study protocol for a randomized controlled trial. Trials 2020;21:870.
Lovibond SH, Lovibond PF. Manual for the Depression Anxiety Stress Scales. 2nd
ed. Sydney: Psychology Foundation; 1995.
Li X, Tang H, Guo F, He H. A review of Depression-Anxiety-Stress Scale's reliability and validity. Chin J Clin Psychol 2012;20:350-2.
Rehman U, Yıldırım M, Shahnawaz MG. A longitudinal study of depression, anxiety, and stress among Indians during COVID-19 pandemic. Psychol Health Med 2022;1-9.
Shapiro F. The role of eye movement desensitization and reprocessing (EMDR) therapy in medicine: Addressing the psychological and physical symptoms stemming from adverse life experiences. Perm J Winter 2014;18:71-7.
Gerritsen RJ, Band GP. Breath of life: The respiratory vagal stimulation model of contemplative activity. Front Hum Neurosci 2018;12:397.
McKenna J. Stroking profile: Application to Script Analysis. Trans Anal Bull 1974;4:20-4. [doi: 10.1177/036215377400400408].
Bach D, Groesbeck G, Stapleton P, Sims R, Blickheuser K, Church D. Clinical EFT (Emotional Freedom Techniques) improves multiple physiological markers of health. J Evid Based Integr Med 2019;24:1-12.
Newstrom J, Rubenfeld S. The Johari Window: A Reconceptualization. Developments in Business Simulation & Experiential Exercises. 1983;10:117-20.
Palmer-Hoffman J, Brooks AJ. Psychological Symptom Change after Group Application of Emotional Freedom Techniques (EFT). Energy Psychol J 2011;3:1-6. [doi: 10.9769/epj. 2011.3.1.jph].
Edwards DJ. Cognitive therapy and the restructuring of early memories through guided imagery. J Cogn Psychother An Int Q 1990;4:33-50.
Hyatt KJ. Brain Gym®: Building stronger brains or wishful thinking? Remedial Spec Educ 2007;28:117-24. [doi: 10.1177/07419325070280020201].
Kumar V, Sattar Y, Bseiso A, Khan S, Rutkofsky IH. The effectiveness of internet-based cognitive behavioral therapy in treatment of psychiatric disorders. Cureus 2017;9:e1626.
Savarese G, Curcio L, D'Elia D, Fasano O, Pecoraro N. Online University counselling services and psychological problems among Italian students in lockdown due to COVID-19. Healthcare (Basel) 2020;8:440.
Carbone GA, Zarfati A, Nicoli MS, Paulis A, Tourjansky G, Valenti G, et al.
Online psychological counselling during lockdown reduces anxiety symptoms and negative affect: Insights from Italian framework. Clin Psychol Psychother 2022;29:367-72.
[Figure 1], [Table 3]
[Table 1], [Table 2]