Digital cognitive behavioural therapy intervention in the workplace:study protocol for a feasibility randomised waitlist-controlled trial to improve employee mental well-being, engagement and productivity

INTRODUCTION: One in six workers experience some form of mental health problems at work costing the UK economy an estimated £70 billion/year. Digital interventions provide low cost and easily scalable delivery methods to implement psychological interventions in the workplace. This trial tests the feasibility of implementing a self-guided 8-week digital cognitive behavioural therapy intervention for subthreshold to clinical depression and/or anxiety versus waitlist control (ie, life as usual) in the workplace. METHODS AND ANALYSIS: Feasibility of implementation will be tested using a mixed-methods evaluation of the two-arm randomised waitlist-control trial. Evaluation will include examination of organisational buy-in, and the engagement of employees through the trial indicated by the completion of outcome measures. In addition, we also explore how participants use the platform, the appropriateness of the analysis both with reference to the outcome measures and linear modelling. Finally, we examine the acceptability of the intervention based on participants experiences using qualitative interviews. Assessments take place at baseline (T0), at 8 weeks post-treatment (T1), at short-term follow-up 4 weeks post-treatment (T2) and long-term follow-ups (6 and 12 months after-end of treatment). We will recruit from 1 July 2021 to 31 December 2021 for employees and self-employed workers with depression and anxiety symptoms (subclinical and clinical levels) who are not seeking or engaged in treatment at the time of the trial. ETHICS AND DISSEMINATION: Full approval was given by the University of Warwick Biomedical and Research Ethics Committee (BSREC 45/20–21). The current protocol version is 2.8 (August 2021). Publication of results in peer-reviewed journals will inform the scientific, clinical and business communities. We will disseminate results through webinars, conferences, newsletter as well as a lay summary of results on the study website (mhpp.me). TRIAL REGISTRATION NUMBER: ISRCTN31161020

Supporting employers and their employees with mental hEalth conditions to remain eNgaged and producTive at wORk (MENTOR):A feasibility randomised controlled trial

Employees with mental health conditions often struggle to remain in employment. During the COVID-19 pandemic, these employees faced additional stressors, including worsening mental health and work productivity. In 2020, as part of a larger programme of work called the Mental Health and Productivity Pilot (MHPP), we developed a new early intervention (MENTOR) that jointly involved employees, managers, and a new professional (Mental Health Employment Liaison Worker (MHELW). The intervention involved trained MHELWs delivering ten sessions to employees with existing mental health conditions and managers (three individual sessions and four joint sessions) over twelve weeks. These sessions aimed to improve psychological flexibility, interpersonal relationships, and engagement of employees. This feasibility randomised controlled trial aimed to examine the feasibility and acceptability of the intervention from the perspective of employees and managers using a mixed methods approach. The intervention was largely considered feasible and acceptable. Initial findings suggest there may be benefits for employee's productivity, mental health, and managers mental health knowledge. Logistical challenges acted as a barrier to the participation and retention of participants in the trial. The major strengths of this study were the co-design and inter-disciplinary approach taken. Overall, findings suggest that this novel intervention has potential but needs some adjustments and testing in a larger sample

Emotion dysregulation in attention-deficit/ hyperactivity disorder and borderline personality disorder

Abstract There is ongoing debate on the overlap between Attention-Deficit/Hyperactivity Disorder (ADHD) and Borderline Personality Disorder (BPD), particularly regarding emotion dysregulation (ED). In this paper, we present a narrative review of the available evidence on the association of these two disorders from several standpoints. First, we discuss the unique and shared diagnostic criteria for ADHD and BPD, focusing particularly on ED. We consider the methodology of ecological momentary assessment and discuss why this approach could be an alternative and more accurate way to qualitatively distinguish between ADHD and BPD. We summarise key findings on the genetic and environmental risk factors for ADHD and BPD and the extent to which there are shared or unique aetiological and neurobiological risk factors. Finally, we discuss the clinical relevance of considering both disorders in the assessment of patients presenting with trait-like behavioural syndromes, distinguishing the two conditions and implications for treatment

Rewards to stimulate safety belt use : an overview of research findings.

A multitude of psychological theories - generally in the field of learning and motivation reserve an important place for the principle of reward. In theories varying from those postulated by Skinner and Banduras modern stimulus response theories to theories with a more cognitive orientation, such as Festingers cognitive dissonance theory, goal-setting and expectancy theory, rewards are explicitly regarded as powerful influences on behaviour, even though the principles and presumed mechanisms of effect of the individual theories can vary greatly (see for an overview Lindzey and Aronson, 1985, for example). No matter how different these theories may be, the effect of reward is generally considered greater than that of punishment. Nevertheless, it has been traditional practice in the (Dutch) traffic system for desirable behaviour to be stimulated by rules and laws, resulting in the punishment of offences. The possible role of reward in influencing safe behaviour in traffic is hardly recognised. In recent years, however, this concept is also beginning to reach this field of application. This paper gives an overview of the research that has been performed to determine the effect of rewards (incentives) on safety belt use. In particular the effect of offering material rewards is considered. The greatest proportion of research was performed in the United States: in the Netherlands, only a few studies have been done in this field

REST 2.0: Protocol for a randomised controlled trial of a preventative psychological skills training intervention for employee wellbeing and productivity

The workplace has been identified as a pertinent and sustainable setting for providing mental wellbeing support at scale, whilst overcoming the many barriers to accessing timely treatment through traditional healthcare pathways. Given the consequences of delayed treatment on exacerbation of symptoms and costs to both the employer and wider economy, there is a demand for preventative approaches to strengthen individuals’ protective characteristics (e.g., resilience, emotion regulation skills) against poor mental health outcomes. Following on from a feasibility phase, this study will evaluate the efficacy of the revised REST 2.0 intervention, an integrative digital psychological skills training intervention, on improving measures relating to wellbeing and organisational outputs. A multi-centre, mixed-method randomised waitlist controlled trial will be conducted with working individuals recruited from across the Midlands (England), who express an interest in learning coping skills to improve their resilience and wellbeing. Participants will be randomised to the intervention group or waitlist control group with no active treatment. REST 2.0 is an 8-week digital intervention based on integrated, evidence-based psychological approaches. Participants will complete outcome measures at pre-intervention, post-intervention and three months follow-up, with self-efficacy as the primary outcome measure. Secondary outcomes will explore changes (if any) in levels of wellbeing and organisational outputs. A mixed-method participant experiences assessment at post-intervention and follow-up will also explore in more depth usage of newly learnt skills and their impact. Ethical approval has been granted by the University of Warwick Biomedical and Research Ethics Committee and this trial is registered with the Open Science Framework

Process evaluation protocol for the SLEEP study: a hybrid digital CBT-I intervention for working people with insomnia

Introduction: The Supporting Employees with Insomnia and Emotional Regulation Problems (SLEEP) pilot uses hybrid digital Cognitive Behavioural Therapy for Insomnia (CBT-I) to help working people address their sleep and emotion regulation problems, using cognitive, behavioural, and psychoeducation techniques. A process evaluation within this trial will improve our understanding of how the intervention brought about change, including identifying barriers and facilitators to engagement and subsequent change, and the extent to which contextual factors played a role. Methods and analysis: This qualitative process evaluation will use semi-structured interviews, conducted via online videoconferencing, to explore participant experiences of the SLEEP intervention. Twenty-five participants who completed the SLEEP intervention (16 %) will be randomly sampled. Interviews will be analysed using a thematic and framework analytic approach. A codebook style thematic analysis will be used, and a framework focusing on the research questions will be applied to the codebook. The final report will present themes generated, alongside the finalised codebook. The report resulting from this research will adhere to CORE-Q quality guidelines. Ethics and dissemination: Full approval for the SLEEP study was given by the University of Warwick Biomedical and Research Ethics Committee (BSREC 45/20-21). All data collection adheres to data collection guidelines. Participants provided written informed consent for the main trial, and all interviewees provided additional written and verbal (audio-recorded) consent. The results of the process evaluation will be published in a peer-reviewed journal and presented at conferences. A lay report will be provided to all participants. Trial registration: ISRCTN13596153; Pre-results