Importance of Online Therapy for Healthcare Workers in Building Resilience

Working through the COVID-19 pandemic has had a significant impact on the mental health outcomes of healthcare professionals, particularly frontline healthcare workers. The exposure to high levels of psychological distress, coupled with the continuous pressure to provide optimal care, has made healthcare worker resilience a crucial factor. Resilience describes a person's capacity to manage, adapt, and cope with external stressors. This is especially important for healthcare workers during the pandemic, as research indicates that higher resilience scores can improve health outcomes in many patients.

The COVID-19 pandemic often resulted in increased stress and burnout for healthcare professionals. One study that involved Massachusetts General Brigham healthcare workers investigated the effects of online interventions to support mental health needs and increase mental resilience. Many healthcare workers (such as nurses, mental health professionals, and frontline workers who completed the online interventions (three short videos) experienced higher levels of emotional resilience. Another type of online intervention to support the mental health needs of healthcare workers and others may be coronavirus online therapy.

Healthcare resilience during COVID-19: An overview

The fear and uncertainty of COVID-19 have been felt in populations worldwide. Still, healthcare workers, typically on the front lines of treatment, may have experienced exceptionally high levels of emotional distress throughout the pandemic and afterward. Approximately 18% of healthcare workers have quit over the past two years, and almost one-third are reported to have considered leaving their current positions.

Several factors may have amplified the mental health effects of COVID-19. Unpredictability has generally become the rule rather than the exception, with changing protocols and unreliable PPE supplies. During the height of the pandemic, many public health employees were temporarily moved from their traditional roles to help treat COVID patients. Even before COVID-19, around 35% to 54% of nurses and physicians may have been experiencing burnout. Working during the pandemic may have been enough to push many of these individuals to leave their careers altogether.

Challenges faced by healthcare workers

More than half reported that they experienced physical symptoms related to their stress, such as changes in appetite, headaches, and stomachaches. Experiencing traumatic scenarios day after day may have also led to many employees developing compassion fatigue, causing irritability, apathy, cynicism, and continuous thoughts about the suffering of others.

Importance of online therapy for healthcare workers

Healthcare workers may already be at risk for burnout, and COVID-19 likely amplified the strain many were feeling. During previous epidemics, such as the H1N1 outbreak in 2009, researchers confirmed that even short interventions (like therapy, support groups, stress management and peer support) could effectively support the mental health needs of healthcare workers. Building on previous research, researchers in Massachusetts created an online course focused on helping healthcare workers cope with stress more efficiently. The goal of this study was generally to determine whether the system increased the resilience and well-being of participants.

Participants

Participants were recruited through system-wide emails that advertised the study to Massachusetts General Brigham healthcare system employees. Employees weren’t required to complete the study but were offered the course as support amid the COVID-19 pandemic.

Inclusion criteria included being an employee of the MGB healthcare system aged 18 or older. Over 500 healthcare workers completed the baseline sample, but 148 were included in the longitudinal model. The mean age of the baseline sample was 44.14 years old. Nurses comprised 26.9% of the piece, physicians 13.9%, and other roles such as therapists, technicians, and administrators made up the remaining 59.2%. Over 80% were working from the hospital, and over 40% had at least some contact with COVID patients.

Methods

Researchers designed a short online course titled “Resilience Training for Healthcare Workers,” consisting of three videos, each less than 20 minutes long. The system used informational content, application exercises, and healthcare worker testimonials to develop mentalization, mindfulness, and self-compassion skills. It was delivered using a familiar online platform and offered as part of a more significant effort to support employee wellness.

The first (19-minute) session focused on resilience and mindfulness skills, the second (16-minute) session on using cognitive-behavioral and mindfulness skills to enhance cognitive flexibility, and the third (12-minute) session on developing self-compassion. Each section included specific strategies for implementing what participants learned in real-life scenarios.

Participants completed a survey three times throughout the study: once before viewing the course to establish a baseline, then one month and two months after finishing the course. The survey included 23 questions that assessed emotional distress, coping skills, COVID-related anxiety, resilience, and loneliness.

Results

A few different types of results were gathered throughout the study. Of those who enrolled in the study, not all completed the course of the three assessments. The course outcomes were analyzed based on individuals with full participation in the sessions and reviews.

Of the 554 participants, 231 (41.7%) watched at least part of the resilience training course, and 20.7% watched all three sessions. Of the 554 people who completed the baseline survey, only 26.7% completed all three surveys. Of the 148 who completed all three surveys, 38 people watched one session of the course, 28 people watched two sessions, and 27 people watched all three.

In the baseline sample, participants reported experiencing moderate to high levels of emotional distress and feeling lonely several days a week. The longitudinal sample of participants who completed all three surveys revealed that higher levels of emotional resilience were associated with lower levels of emotional distress and loneliness.

Participants who completed all the surveys and watched the resilience training generally experienced positive results:

• Their resilience levels increased significantly from the baseline assessment to the two-month follow-up.
• They experienced a significant decrease in emotional distress after the course.

In summary

Healthcare employees in a Massachusetts hospital were recruited to complete a study regarding the impact of resilience training on their mental health. After watching three short videos about coping strategies and how to apply them, some participants experienced significant increases in their resilience and levels of well-being. In addition, their emotional distress significantly decreased.

Future research

This intervention was specifically designed to meet the mental health needs of healthcare workers. Still, the population of healthcare workers can encompass various roles, each with a diverse set of requirements. In addition, the healthcare environment is often considered to have radically evolved over the past two years. Future research on building resilience in healthcare workers may benefit from being tailored to specific jobs within the field.

How can healthcare institutions support their employees?

Although the number and severity of new COVID-19 cases have decreased, the fallout of the pandemic may have continued to the present day. One in five healthcare workers has already left the field; those who remain often call for specific types of support.

One key component to supporting healthcare employees' mental health may be offering support tailored to their needs. This can be done using therapy aid programs, or aid coalitions specifically for healthcare workers. In another recent study, almost 500 healthcare workers completed an online course that included content about managing stress, trauma, and distress to build resilience in participants. Applying behavior changes taught in the program, such as coping mechanisms and increasing self-care behaviors, generally led to significant increases in strength and well-being.

In addition, leadership may actively support employee mental health in several ways. Routine check-ins to assess staff well-being by gauging their current emotional state can be performed digitally and in person. Research has also shown that expressing gratitude can promote resilience. Leadership can support employees in resilience development by providing the training and tools necessary for gratitude expression.

How can you support your mental health as a healthcare worker?

In a podcast from the American Psychological Association, Dr. Ann Masten, a professor at the University of Minnesota, spoke about the role of resilience amid COVID-19. She pointed out that strength can be renewable, similar to a bank account. We may need to put forth the effort to build up our “supply” of resilience to be available during difficult times.

The Connor Davidson Resilience Scale (CD-RISC) provides a standardized measure of psychological resilience. This new resilience scale can be used to assess the personal resilience of healthcare workers, and may provide insight into different psychological outcomes. The scale consists of 25 questions related to stress management, mood control, and self-care behaviors. Although no one “right” answer exists for each question, the results of the resilience scale may offer guidance on what steps to take next.

Increasing your resilience often requires physical and mental efforts, but successfully managing emotional distress can provide both short- and long-term benefits, such as mitigating the risk of developing conditions such as acute stress disorder and post-traumatic stress disorder. The CDC recommends a few tips for healthcare workers to enhance their resilience and cope with the stress and trauma that COVID-19 can cause.

Take mental health breaks when possible

With the Great Resignation in full swing, finding time to take a break may sound laughable, whether aiming for 10 minutes or ten days. Increased patient numbers and low staffing usually make for long days and endless weeks. You might take advantage of any breaks rather than filling downtime with more duties and extra shifts.

You might also challenge yourself to say no to extra work and focus on mentally recharging so you feel ready when it’s time to jump back in.

Identify things you cannot control

Lacking the ability to control specific circumstances can feel infuriating. However, recognizing what you cannot control often allows you to accept the current situation and focus on what you can control.

Follow a consistent schedule as often as you can

A steady routine can provide a sense of control and allow time for daily tasks that contribute to your overall well-being, such as adequate sleep and meals. Whether it’s a daily routine or how you begin your mornings, you might stick to what’s familiar, especially when you’re feeling overwhelmed.

Periodically disconnect from news sources and the internet

When you’re finally able to snag a break from work, consider taking a break from the news, including social media. Constant updates can be emotionally and mentally draining, especially when everything you read feels negative. You might get your screen time from your favorite TV series or game on your phone.

Seek mental health support

If you’re already working with a mental health provider, it can be helpful to maintain your scheduled sessions and reschedule any that you must miss. Working as a healthcare employee can be taxing. Even if you feel like your current mental and emotional state is strong, working with a therapist can help you build your supply of resilience to fall back on during challenges. You might check to see what options are offered by your employer.

Online therapy for patients

You may also consider connecting with a therapist online for virtual sessions at your convenience. An online therapy platform may enable you to meet remotely with a licensed mental health professional who can help you work through complex feelings related to burnout and stress. You may also have connections to valuable tools and resources that can reinforce essential concepts and allow you to improve your mental health from the comfort of your home. Studies have shown that online therapy can be effective in treating a variety of mental health disorders.