Open Access Open Badges Study protocol

Efficacy and cost-effectiveness of a web-based and mobile stress-management intervention for employees: design of a randomized controlled trial

Elena Heber1*, David Daniel Ebert12, Dirk Lehr1, Stephanie Nobis1, Matthias Berking12 and Heleen Riper134

Author affiliations

1 Division of Online Health Training, Innovation Incubator, Leuphana University, Lueneburg, Germany

2 Department of Clinical Psychology and Psychotherapy, Philipps-University, Marburg, Germany

3 Department of Clinical Psychology, VU University, Amsterdam, The Netherlands

4 Institute for Health and Care Research (EMGO), VU University Medical Centre, Amsterdam, The Netherlands

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Citation and License

BMC Public Health 2013, 13:655  doi:10.1186/1471-2458-13-655

Published: 15 July 2013



Work-related stress is associated with a variety of mental and emotional problems and can lead to substantial economic costs due to lost productivity, absenteeism or the inability to work. There is a considerable amount of evidence on the effectiveness of traditional face-to-face stress-management interventions for employees; however, they are often costly, time-consuming, and characterized by a high access threshold. Web-based interventions may overcome some of these problems yet the evidence in this field is scarce. This paper describes the protocol for a study that will examine the efficacy and cost-effectiveness of a web-based guided stress-management training which is based on problem solving and emotion regulation and aimed at reducing stress in adult employees.


The study will target stressed employees aged 18 and older. A randomized controlled trial (RCT) design will be applied. Based on a power calculation of d=.35 (1-β of 80%, α = .05), 264 participants will be recruited and randomly assigned to either the intervention group or a six-month waitlist control group. Inclusion criteria include an elevated stress level (Cohen’s Perceived Stress Scale-10 ≥ 22) and current employment. Exclusion criteria include risk of suicide or previously diagnosed psychosis or dissociative symptoms. The primary outcome will be perceived stress, and secondary outcomes include depression and anxiety. Data will be collected at baseline and seven weeks and six months after randomization. An extended follow up at 12 months is planned for the intervention group. Moreover, a cost-effectiveness analysis will be conducted from a societal perspective and will include both direct and indirect health care costs. Data will be analyzed on an intention-to-treat basis and per protocol.


The substantial negative consequences of work-related stress emphasize the necessity for effective stress-management trainings. If the proposed internet intervention proves to be (cost-) effective, a preventative, economical stress-management tool will be conceivable. The strengths and limitations of the present study are discussed.

Trial registration

German Register of Clinical Studies (DRKS): DRKS00004749

Internet intervention; Efficacy; Prevention; Work-related stress; Stress management; Depression; Occupational health; Cost-effectiveness