A Randomized Controlled Trial of Internet-Based Self-Help for Stress During the COVID-19 Pandemic
Open accessAbstract
Purpose The COVID-19 pandemic has heightened the need for mental healthcare that can be delivered remotely and at scale to college students. This study evaluated the efficacy of online self-help for stress among students during the pandemic.Method College students with moderate or higher stress (N = 585) were recruited between November 2020 and February 2021, when COVID-19 had a major impact on colleges. Participants were randomly assigned to receive either online self-help using cognitive-behavioral therapy and positive psychology principles to support resilience and coping with pandemic-related stressors (n = 301) or referral to usual care (n = 284). Stress (primary outcome), depression, and anxiety (secondary outcomes) were assessed at pretreatment, one-month post-treatment, and three-month follow-up.Results Participants in the online self-help condition experienced significantly larger reductions in stress (d = -0.18, p = .035) and depression (d = -0.20, p = .018) from pretreatment to post-treatment than participants in the referral group. Reductions in stress from pretreatment to follow-up were also larger in the treatment versus referral group (d = -0.23, p = .005). Groups did not differ in change in anxiety. More time using the self-help program predicted greater improvement in depression at post-treatment (d = -0.41, p = .001) and follow-up (d = -0.32, p = .007), although usage was unrelated to change in stress or anxiety.Conclusion Online self-help targeting resilience and coping during the pandemic appears efficacious for long-term alleviation of stress and short-term alleviation of depression symptoms among the college students.Registration ClinicalTrials.gov (NCT04762173).
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The study by Rackoff et al targeted positive affect but also included elements that focused on building healthy relationships and coping skills and finding a greater meaning in life.
“Similarly, the study by Rackoff et al [61] targeted positive affect but also included elements that focused on building healthy relationships and coping skills and finding a greater meaning in life.”
From Psychological Interventions and Those With Elements of Positive Psychology for Child and Youth Mental Health During the COVID-19 Pandemic: Literature Review, Lessons Learned, and Areas for Future Knowledge Dissemination (2024) · cites this paper as [61]
The Method’s Self-help condition table describes modules on fostering connections, active coping and problem-solving, and identifying sources of purpose. It also includes balanced optimism and gratitude, but the Abstract’s Method identifies resilience and coping with pandemic-related stressors—not positive affect—as the intervention’s stated targets. No page numbers are provided in our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThere were several CBT-based studies, as well as mixed hybrid CBD studies involving other techniques such as combined CBT with dialectical behavior therapy (DBT) and combined mindfulness with CBT.
“There were also several CBT based studies [54,55,58,59,61-65], as well as mixed hybrid CBD studies involving other techniques such as combined CBT with dialectical behavior therapy (DBT) [65] and combined mindfulness with CBT [62,64].”
A few studies did not find that the interventions reduced both anxiety and depression together.
“A few studies did not find that the interventions reduced both anxiety and depression together [45,61,64,70,80,81].”
The 4-week CBT RCT (N=585) by Rackoff et al found that the intervention reduced depression, but there were no substantial changes in anxiety.
“while the 4-week CBT RCT (N=585) by Rackoff et al [61] found that the intervention reduced depression, there were no substantial changes in anxiety.”
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Cites
(1995) · Cited by 6,909 · see citing works
Missing data analysis: making it work in the real world
Graham, J. W. (2009) · Annual Review of Psychology · doi:10.1146/annurev.psych.58.110405.085530 · Cited by 6,163 · see citing works
Antony, M. M., Bieling, P. J., Cox, B. J., Enns, M. W., & Swinson, R. P. (1998) · Psychological Assessment · doi:10.1037/1040-3590.10.2.176 · Cited by 4,874 · see citing works
Sawyer, S. M., Azzopardi, P. S., Wickremarathne, D., & Patton, G. C. (2018) · The Lancet Child & Adolescent Health · doi:10.1016/s2352-4642(18)30022-1 · Cited by 3,666 · see citing works
Meta-Analysis: Recent Developments in Quantitative Methods for Literature Reviews
Rosenthal, R., & DiMatteo, M. R. (2001) · Annual Review of Psychology · doi:10.1146/annurev.psych.52.1.59 · Cited by 1,780 · see citing works
Five Essential Elements of Immediate and Mid–Term Mass Trauma Intervention: Empirical Evidence
Hobfoll, S. E., Watson, P., Bell, C. C., Bryant, R. A., Brymer, M. J., Friedman, M. J., Friedman, M., Gersons, B. P. R., de Jong, J. T. V. M., Layne, C. M., et al. (2007) · Psychiatry · doi:10.1521/psyc.2007.70.4.283 · Cited by 1,654 · see citing works
Bayram, N., & Bilgel, N. (2008) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-008-0345-x · Cited by 1,391 · see citing works
Adolescent psychiatric disorders during the COVID-19 pandemic and lockdown
Guessoum, S. B., Lachal, J., Radjack, R., Carretier, E., Minassian, S., Benoit, L., & Moro, M. R. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.113264 · Cited by 1,025 · see citing works
robustlmm : An R Package for Robust Estimation of Linear Mixed-Effects Models
Koller, M. (2016) · Journal of Statistical Software · doi:10.18637/jss.v075.i06 · Cited by 720 · see citing works
Linardon, J., & Fuller-Tyszkiewicz, M. (2020) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000459 · Cited by 573 · see citing works
Charles, N. E., Strong, S. J., Burns, L. C., Bullerjahn, M. R., & Serafine, K. M. (2021) · Psychiatry Research · doi:10.1016/j.psychres.2021.113706 · Cited by 459 · see citing works
Harrer, M., Adam, S. H., Baumeister, H., Cuijpers, P., Karyotaki, E., Auerbach, R. P., Kessler, R. C., Bruffaerts, R., Berking, M., & Ebert, D. D. (2019) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.1759 · Cited by 445 · see citing works
Heber, E., Ebert, D. D., Lehr, D., Cuijpers, P., Berking, M., Nobis, S., & Riper, H. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.5774 · Cited by 408 · see citing works
Positive psychology in a pandemic: buffering, bolstering, and building mental health
Waters, L., Algoe, S. B., Dutton, J., Emmons, R., Fredrickson, B. L., Heaphy, E., Moskowitz, J. T., Neff, K., Niemiec, R., Pury, C., et al. (2022) · The Journal of Positive Psychology · doi:10.1080/17439760.2021.1871945 · Cited by 377 · cited 2× · see citing works
“[15] Intervention studies have suggested that targeting these constructs can support mental health during times of stress, [16,17] and perceptions of purpose, strengths, and support have been associated with better mental health in studies conducted during the pandemic.”
Pierce, B. S., Perrin, P. B., Tyler, C. M., McKee, G. B., & Watson, J. D. (2021) · American Psychologist · doi:10.1037/amp0000722 · Cited by 374 · see citing works
Casellas-Grau, A., Font, A., & Vives, J. (2014) · Psycho-Oncology · doi:10.1002/pon.3353 · Cited by 299 · cited 1× · see citing works
“[15] Intervention studies have suggested that targeting these constructs can support mental health during times of stress, [16,17] and perceptions of purpose, strengths, and support have been associated with better mental health in studies conducted during the pandemic.”
Mitigating the psychological effects of social isolation during the covid-19 pandemic
Razai, M. S., Oakeshott, P., Kankam, H. K. N., Galea, S., & Stokes-Lampard, H. J. (2020) · BMJ · doi:10.1136/bmj.m1904 · Cited by 201 · see citing works
CLME: An R Package for Linear Mixed Effects Models under Inequality Constraints
Jelsema, C., & Peddada, S. D. (2016) · Journal of Statistical Software · doi:10.18637/jss.v075.i01 · Cited by 174 · see citing works
College Mental Health Before and During the COVID-19 Pandemic: Results From a Nationwide Survey
Kim, H., Rackoff, G. N., Fitzsimmons‐Craft, E. E., Shin, K. E., Zainal, N. H., Schwob, J. T., Eisenberg, D., Wilfley, D. E., Taylor, C. B., & Newman, M. G. (2021) · Cognitive Therapy and Research · doi:10.1007/s10608-021-10241-5 · Cited by 173 · see citing works
Self-citationBennett, S. D., Cuijpers, P., Ebert, D. D., McKenzie Smith, M., Coughtrey, A. E., Heyman, I., Manzotti, G., & Shafran, R. (2019) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13010 · Cited by 162 · see citing works
College Counseling Today: Contemporary Students and How Counseling Centers Meet Their Needs
Brunner, J. L., Wallace, D. L., Reymann, L. S., Sellers, J.-J., & McCabe, A. G. (2014) · Journal of College Student Psychotherapy · doi:10.1080/87568225.2014.948770 · Cited by 152 · see citing works
Wahlund, T., Mataix-Cols, D., Olofsdotter Lauri, K., de Schipper, E., Ljótsson, B., Aspvall, K., & Andersson, E. (2021) · Psychotherapy and Psychosomatics · doi:10.1159/000512843 · Cited by 105 · cited 1× · see citing works
“One large trial (N 1⁄4 670) found that a cognitive-behavioral therapy (CBT)-based online intervention targetingworry caused improvements in pandemicrelated anxiety relative to awaiting list control, [13] whereas one smaller trial (N 1⁄4 120) found that an expressive writing intervention did not improve stress, depress…”
Enrique, A., Palacios, J. E., Ryan, H., & Richards, D. (2019) · Journal of Medical Internet Research · doi:10.2196/12775 · Cited by 81 · cited 1× · see citing works
“[26] Interestingly, there were no such dose-response relationships between usage metrics and improvement in stress or anxiety.”
Marković, M. V., Bjekić, J., & Priebe, S. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.587282 · Cited by 56 · see citing works
A randomized controlled trial of a smartphone-based application for the treatment of anxiety
Newman, M. G., Jacobson, N. C., Rackoff, G. N., Bell, M. J., & Taylor, C. B. (2021) · Psychotherapy Research · doi:10.1080/10503307.2020.1790688 · Cited by 37 · see citing works
Self-citationEnrique, Á., Mooney, O., Salamanca-Sanabria, A., Lee, C. T., Farrell, S., & Richards, D. (2020) · JMIR Formative Research · doi:10.2196/20167 · Cited by 29 · see citing works
Flagged first, then by citations
3 of the 29 references couldn’t be matched to a known paper.
Research works printed but not linked: 1
- [1]WHO WHO coronavirus disease (COVID-19) dashboard. World Health Organization Available at: https://covid19.who.int/ 2021 37184163
Cited by
Sorted by citations
Madrid‐Cagigal, A., Kealy, C., Potts, C., Mulvenna, M. D., Byrne, M., Barry, M. M., & Donohoe, G. (2025) · Early Intervention in Psychiatry · doi:10.1111/eip.70017 · Cited by 78 · see citing works
Wang, Q., Zhang, W., & An, S.-B. (2023) · Internet Interventions · doi:10.1016/j.invent.2023.100690 · Cited by 51 · see citing works
Digital Mental Health Interventions for Young People Aged 16-25 Years: Scoping Review
Potts, C., Kealy, C., McNulty, J. M., Madrid‐Cagigal, A., Wilson, T., Mulvenna, M. D., O’Neill, S. M., Donohoe, G. J., & Barry, M. M. (2025) · Journal of Medical Internet Research · doi:10.2196/72892 · Cited by 57 · see citing works
Малинаускас, Р. К., & Malinauskiene, V. A. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19159199 · Cited by 33 · see citing works
D'Adamo, L., Paraboschi, L., Claire Grammer, A., Fennig, M., Graham, A. K., Yaeger, L. H., Newman, M. G., Wilfley, D. E., Barr Taylor, C., Eisenberg, D., et al. (2023) · Journal of Behavioral and Cognitive Therapy · doi:10.1016/j.jbct.2023.05.002 · Cited by 37 · see citing works
Self-citationYosep, I., Hikmat, R., & Mardhiyah, A. (2023) · Journal of Multidisciplinary Healthcare · doi:10.2147/jmdh.s406688 · Cited by 32 · see citing works
Racial and Ethnic Disparities in Barriers to Mental Health Treatment Among U.S. College Students
Doren, N. V., Zhu, Y., Vázquez, M. M., Shah, J., Grammer, A. C., Fitzsimmons‐Craft, E. E., Eisenberg, D., Wilfley, D. E., Taylor, C. B., & Newman, M. G. (2024) · Psychiatric Services · doi:10.1176/appi.ps.20230185 · Cited by 20 · see citing works
Self-citationYosep, I., Suryani, S., Mediani, . S., Mardhiyah, A., & Maulana, I. (2023) · Journal of Multidisciplinary Healthcare · doi:10.2147/jmdh.s416424 · Cited by 19 · see citing works
Sriati, A., Kurniawan, K., Senjaya, S., Khoirunnisa, K., Muslim, R. N. I., Putri, A. M., Armansyah, N. A., & Fitriani, N. (2023) · Journal of Holistic Nursing · doi:10.1177/08980101231162990 · Cited by 19 · see citing works
Kurniawan, K., Yosep, I., Maulana, S., Mulyana, A. M., Amirah, S., Abdurrahman, M. F., Sugianti, A., Putri, E. G., Khoirunnisa, K., Komariah, M., et al. (2022) · Sustainability · doi:10.3390/su141912866 · Cited by 14 · see citing works
Meyer, M. L., Kaesler, A., Wolffgramm, S., Perić, N. L., Bunjaku, G., Dickmann, L., Serino, S., Lernia, D. D., Tuena, C., Bernardelli, L., et al. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11082080 · Cited by 13 · see citing works
Chi, D., Zhang, Y., Zhou, D., Xu, G., & Bian, G. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.1045400 · Cited by 12 · see citing works
Weiss, E. M., Harder, M., Staggl, S., Holzner, B., Dresen, V., & Canazei, M. (2025) · BMC Public Health · doi:10.1186/s12889-025-23399-4 · Cited by 9 · see citing works
Wang, Q., An, S., & Shao, Z. (2023) · PLoS ONE · doi:10.1371/journal.pone.0283208 · Cited by 7 · see citing works
Lyzwinski, L., Zwicker, J. D., Mcdonald, S., & Tough, S. (2024) · JMIR Pediatrics and Parenting · doi:10.2196/59171 · Cited by 6 · see citing works
“A few studies did not find that the interventions reduced both anxiety and depression together [45,61,64,70,80,81].”
BackgroundResultInfluentialRutkowska, A. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192114040 · Cited by 6 · see citing works
Rackoff, G. N., Monocello, L. T., Fowler, L. A., Vázquez, M. M., Shah, J., Fitzsimmons‐Craft, E. E., Taylor, C. B., Eisenberg, D., Wilfley, D. E., & Newman, M. G. (2023) · Journal of Behavioral and Cognitive Therapy · doi:10.1016/j.jbct.2023.05.001 · Cited by 9 · see citing works
Self-citationPranata, G. K. A. W., Koa, A. J. A. F., & Chang, Y. (2024) · Nursing and Health Sciences · doi:10.1111/nhs.70003 · Cited by 4 · see citing works
Xu, F., Zhu, W., Chen, Q., & Tang, Y. (2023) · Current Psychology · doi:10.1007/s12144-023-05188-7 · Cited by 3 · see citing works
Wang, L., Slaughter, F. A., Nguyen, A., Smith, S., Prabhu, S., Beima‐Sofie, K., Wallace, S. E., Crane, H. M., Simoni, J. M., & Graham, S. M. (2024) · AIDS Care · doi:10.1080/09540121.2024.2341220 · Cited by 3 · see citing works
Digital Interventions to Improve College and University Student Mental Health
Hensel, D. J. (2022) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2022.05.017 · Cited by 3 · see citing works
You, D., Kim, Y., & Seo, K. (2025) · CHI Conference Extended Abstracts on Human Factors in Computing Systems (CHI EA) · doi:10.1145/3706599.3719824 · Cited by 2 · see citing works
Artificial Intelligence, Digital Health Research, and the Clinical Nurse Specialist
Siedlecki, S. L. (2023) · Clinical Nurse Specialist · doi:10.1097/nur.0000000000000763 · Cited by 2 · see citing works
Mudin, N. S. S., Ahmad, A. B., Kee, P., Othman, M. N. H., & Wahab, S. A. (2024) · Pertanika journal of social science & humanities · doi:10.47836/pjssh.32.3.10 · Cited by 4 · see citing works
Bastien, L., Cho, S., Petrovic, J., Khoury, B., Bloom, E. L., & Heath, N. L. (2025) · Internet Interventions · doi:10.1016/j.invent.2025.100868 · Cited by 1 · see citing works
Aprilianty, L., Windarwati, H. D., & Supriati, L. (2026) · Indigenous Jurnal Ilmiah Psikologi · doi:10.23917/indigenous.v11i2.15981 · Cited by 1 · see citing works
Rackoff, G. N., & Newman, M. G. (2025) · Stress and Health · doi:10.1002/smi.70032 · Cited by 1 · see citing works
Self-citationYosep, I., Hikmat, R., Mardhiyah, A., Wati, N. L., & Lukman, M. (2023) · KnE Social Sciences · doi:10.18502/kss.v8i14.13811
Jumadi, J., Puspita, K., & Anasanti, M. D. (2024) · Research Square · doi:10.21203/rs.3.rs-4471730/v1 · Cited by 1 · see citing works
Yosep, I., Hikmat, R., & Mardhiyah, A. (2022) · doi:10.2196/preprints.39293
Barriers to Mental Health Treatment in United States College Students of ColorPreprint
Doren, N. V., Zhu, Y., Vázquez, M. M., Shah, J., Grammer, A. C., Fitzsimmons‐Craft, E. E., Eisenberg, D., Wilfley, D. E., Taylor, C. B., & Newman, M. G. (2023) · doi:10.31234/osf.io/dynaw
Self-citationFord, C. A. (2023) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2023.05.005
Рафиковна, Х. З., Plotnikov, A., Kelareva, I., & Gani, S. V. (2025) · Communications in computer and information science · doi:10.1007/978-3-032-04958-2_21
Reangsing, C., Seethikaew, N., Kodyee, S., Maneekungwong, K., Pitchalard, K., & Moonpanane, K. (2026) · Mindfulness · doi:10.1007/s12671-026-02856-0
- Authors
- Rackoff, G. N., Fitzsimmons-Craft, E. E., Taylor, C. B., Eisenberg, D., Wilfley, D. E., & Newman, M. G.
- Affiliations
- Pennsylvania State University (US)
- Palo Alto University (US)
- University of California, Los Angeles (US)
- Washington University in St. Louis (US)
- Corresponding author
- Rackoff, Gavin N.
- Venue
- Journal of Adolescent Health
- Publisher
- Elsevier BV
- Published
- 2022-08
- Volume
- 71
- Issue
- 2
- Pages
- 157-163
- ISSN
- 1054-139X (ISSN-L)
- PMC
- PMC8813578
- OpenAlex
- W4210788867
- Cited by
- 34
- References
- 29
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 6 · 2023: 12 · 2022: 7
- FWCI
- 7.05
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Adolescent Health (acceptedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- ScholarSphere (Penn State Libraries) (submittedVersion, cc-by)
- Funders
- The Pennsylvania State University University Park
- National Institutes of Health
- National Institute of Mental Health (K08MH120341, R01MH115128)
- Pennsylvania State University
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Social Sciences › Psychology › Developmental and Educational Psychology › Student Stress and Coping
- Keywords
- COVID-19 pandemic, university students, stress, online self-help, online intervention, cognitive behavioral therapy, positive psychology, resilience, coping, depression, anxiety
- MeSH terms
- COVID-19, Anxiety, Depression, Humans, Cognitive Behavioral Therapy, Internet, Pandemics
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