A web-based training program using cognitive behavioral therapy to alleviate psychological distress among employees : randomized controlled pilot trial
Open accessAbstract
BACKGROUND: A number of psychoeducational programs based on cognitive behavioral therapy (CBT) to alleviate psychological distress have been developed for implementation in clinical settings. However, while these programs are considered critical components of stress management education in a workplace setting, they are required to be brief and simple to implement, which can hinder development. OBJECTIVE: The intent of the study was to examine the effects of a brief training program based on CBT in alleviating psychological distress among employees and facilitating self-evaluation of stress management skills, including improving the ability to recognize dysfunctional thinking patterns, transform dysfunctional thoughts to functional ones, cope with stress, and solve problems. METHODS: Of the 187 employees at an information technology company in Tokyo, Japan, 168 consented to participate in our non-blinded randomized controlled study. The training group received CBT group education by a qualified CBT expert and 1 month of follow-up Web-based CBT homework. The effects of this educational program on the psychological distress and stress management skills of employees were examined immediately after completion of training and then again after 6 months. RESULTS: Although the training group did exhibit lower mean scores on the Kessler-6 (K6) scale for psychological distress after 6 months, the difference from the control group was not significant. However, the ability of training group participants to recognize dysfunctional thinking was significantly improved both immediately after training completion and after 6 months. While the ability of participants to cope with stress was not significantly improved immediately after training, improvement was noted after 6 months in the training group. No notable improvements were observed in the ability of participants to transform thoughts from dysfunctional to functional or in problem-solving skills. A sub-analysis of participants who initially exhibited clinically significant psychological distress (K6 score ≥5) showed that the mean K6 score was significantly improved immediately after training completion for the training group compared to the control group (-2.50 vs -0.07; mean difference 2.43, 95% CI 0.55-4.31; d=0.61), with this effect remaining even after 6 months (-3.49 vs -0.50; mean difference 2.99, 95% CI 0.70-5.29; d=0.60). CONCLUSIONS: Our results suggest that a brief stress management program that combines group CBT education with Web-based CBT homework moderately alleviates the distress of employees with clinically significant psychological distress. In addition, the program might help improve employees' ability to evaluate their own stress management skills.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Mori et al.'s blended web-based CBT program produced a small significant improvement versus controls in the intervention group's ability to transform thoughts postintervention (d = 0.26).
“A small significant improvement versus controls was observed in the intervention group's ability to transform thoughts postintervention (d = 0.26) and their ability to cope with stress at 6-month follow-up (d = 0.37).”
From Web-based interventions for the management of stress in the workplace: Focus, form, and efficacy (2017) · cites this paper as [22]
Among 73 participants with clinically significant levels of emotional distress at baseline, participants with distress in the intervention group reported significantly lower psychological distress scores postintervention compared with similar participants in the control group, with medium effect size (d = 0.61).
“Participants with distress in the intervention group reported significantly lower psychological distress scores postintervention compared with similar participants in the control group with medium effect size (d = 0.61).”
From Web-based interventions for the management of stress in the workplace: Focus, form, and efficacy (2017) · cites this paper as [22]
Mori et al.'s blended web-based CBT program produced a small significant improvement versus controls in the intervention group's ability to cope with stress at 6-month follow-up (d = 0.37).
“A small significant improvement versus controls was observed in the intervention group's ability to transform thoughts postintervention (d = 0.26) and their ability to cope with stress at 6-month follow-up (d = 0.37).”
From Web-based interventions for the management of stress in the workplace: Focus, form, and efficacy (2017) · cites this paper as [22]
The improvement in psychological distress among the 73 distressed participants was maintained at 6-month follow-up (d = 0.60).
“Improvement was maintained at 6-month-follow-up (d = 0.60).”
From Web-based interventions for the management of stress in the workplace: Focus, form, and efficacy (2017) · cites this paper as [22]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Multiple Imputation for Nonresponse in Surveys
Rubin, D. B. (1987) · Wiley Series in Probability and Statistics · doi:10.1002/9780470316696 · Cited by 20,701 · see citing works
KESSLER, R. C., ANDREWS, G., COLPE, L. J., HIRIPI, E., MROCZEK, D. K., NORMAND, S.-L. T., WALTERS, E. E., & ZASLAVSKY, A. M. (2002) · Psychological Medicine · doi:10.1017/s0033291702006074 · Cited by 10,327 · 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
Screening for serious mental illness in the general population
Kessler, R. C., Barker, P. R., Colpe, L. J., Epstein, J. F., Gfroerer, J. C., Hiripi, E., Howes, M. J., Normand, S.-L. T., Manderscheid, R. W., Walters, E. E., et al. (2003) · Archives of General Psychiatry · doi:10.1001/archpsyc.60.2.184 · Cited by 5,692 · see citing works
Review: a gentle introduction to imputation of missing values.
Donders, A. R. T., van der Heijden, G. J. M. G., Stijnen, T., & Moons, K. G. M. (2006) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2006.01.014 · Cited by 2,582 · see citing works
Eysenbach, G. (2005) · Journal of Medical Internet Research · doi:10.2196/jmir.7.1.e11 · Cited by 2,524 · see citing works
Psychosocial work environment and mental health—a meta-analytic review
Stansfeld, S., & Candy, B. (2006) · Scandinavian Journal of Work, Environment & Health · doi:10.5271/sjweh.1050 · Cited by 1,875 · see citing works
Eysenbach, G., & CONSORT-EHEALTH Group (2011) · Journal of Medical Internet Research · doi:10.2196/jmir.1923 · Cited by 1,863 · see citing works
FURUKAWA, T. A., KESSLER, R. C., SLADE, T., & ANDREWS, G. (2003) · Psychological Medicine · doi:10.1017/s0033291702006700 · Cited by 1,570 · see citing works
The performance of the Japanese version of the K6 and K10 in the World Mental Health Survey Japan
Furukawa, T. A., Kawakami, N., Saitoh, M., Ono, Y., Nakane, Y., Nakamura, Y., Tachimori, H., Iwata, N., Uda, H., Nakane, H., et al. (2008) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.257 · Cited by 1,478 · see citing works
Mental Illness and Mental Health: The Two Continua Model Across the Lifespan
Westerhof, G. J., & Keyes, C. L. M. (2010) · Journal of Adult Development · doi:10.1007/s10804-009-9082-y · Cited by 1,345 · see citing works
Andrews, G., Cuijpers, P., Craske, M. G., McEvoy, P., & Titov, N. (2010) · PLoS ONE · doi:10.1371/journal.pone.0013196 · Cited by 1,311 · see citing works
Adherence in Internet Interventions for Anxiety and Depression
Christensen, H., Griffiths, K. M., & Farrer, L. (2009) · Journal of Medical Internet Research · doi:10.2196/jmir.1194 · Cited by 1,133 · see citing works
A meta-analysis of psychotherapy dropout
Wierzbicki, M., & Pekarik, G. (1993) · Professional Psychology: Research and Practice · doi:10.1037/0735-7028.24.2.190 · Cited by 1,118 · see citing works
The benefits of interventions for work-related stress
(2001) · American Journal of Public Health · doi:10.2105/ajph.91.2.270 · Cited by 999 · see citing works
Delivering interventions for depression by using the internet: randomised controlled trial
Christensen, H. (2004) · BMJ · doi:10.1136/bmj.37945.566632.ee · Cited by 928 · cited 1× · see citing works
“Participants who were provided information concerning CBT during the Web-based CBT are reportedly more likely to complete their homework [48,49].”
BackgroundBonde, J. P. E. (2008) · Occupational and Environmental Medicine · doi:10.1136/oem.2007.038430 · Cited by 919 · see citing works
Mental illness and well-being: the central importance of positive psychology and recovery approaches
Slade, M. (2010) · BMC Health Services Research · doi:10.1186/1472-6963-10-26 · Cited by 754 · see citing works
Clark, D. M. (2011) · International Review of Psychiatry · doi:10.3109/09540261.2011.606803 · Cited by 699 · see citing works
Dropout from Internet‐based treatment for psychological disorders
Melville, K. M., Casey, L. M., & Kavanagh, D. J. (2010) · British Journal of Clinical Psychology · doi:10.1348/014466509x472138 · Cited by 597 · see citing works
Titov, N., Andrews, G., Davies, M., McIntyre, K., Robinson, E., & Solley, K. (2010) · PLoS ONE · doi:10.1371/journal.pone.0010939 · Cited by 406 · see citing works
Simon, G. E., Ludman, E. J., Tutty, S., Operskalski, B., & Korff, M. V. (2004) · JAMA · doi:10.1001/jama.292.8.935 · Cited by 395 · see citing works
Clarke, G., Eubanks, D., Reid, E., Kelleher, C., O'Connor, E., DeBar, L. L., Lynch, F., Nunley, S., & Gullion, C. (2005) · Journal of Medical Internet Research · doi:10.2196/jmir.7.2.e16 · Cited by 372 · cited 1× · see citing works
“Participants who were provided information concerning CBT during the Web-based CBT are reportedly more likely to complete their homework [48,49].”
BackgroundMohr, D. C., Ho, J., Duffecy, J., Reifler, D., Sokol, L., Burns, M. N., Jin, L., & Siddique, J. (2012) · JAMA · doi:10.1001/jama.2012.5588 · Cited by 330 · see citing works
Implementing Mental Health Promotion
Barry, M., Jenkins, R., & Mittelmark, M. (2007) · doi:10.1007/978-3-030-23455-3 · Cited by 295 · see citing works
Psychological treatments of subthreshold depression: a meta‐analytic review
Cuijpers, P. J., Smit, F., & van Straten, A. (2007) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2007.00998.x · Cited by 233 · see citing works
Mohr, D. C., Vella, L., Hart, S., Heckman, T., & Simon, G. (2008) · Clinical Psychology: Science and Practice · doi:10.1111/j.1468-2850.2008.00134.x · Cited by 227 · see citing works
A Stress Management Workshop Improves Residents' Coping Skills
McCue, J. D. (1991) · Archives of Internal Medicine · doi:10.1001/archinte.1991.00400110117023 · Cited by 188 · see citing works
The Prevalence of Psychological Distress in Employees and Associated Occupational Risk Factors
Hilton, M. F., Whiteford, H. A., Sheridan, J. S., Cleary, C. M., Chant, D. C., Wang, P. S., & Kessler, R. C. (2008) · Journal of Occupational & Environmental Medicine · doi:10.1097/jom.0b013e31817e9171 · Cited by 154 · see citing works
The effectiveness of group cognitive behaviour therapy for unipolar depressive disorders
Oei, T. P. S., & Dingle, G. A. (2007) · Journal of Affective Disorders · doi:10.1016/j.jad.2007.07.018 · Cited by 117 · see citing works
Lee, S., & Crockett, M. S. (1994) · Issues in Mental Health Nursing · doi:10.3109/01612849409006918 · Cited by 113 · see citing works
Geraedts, A. S., Kleiboer, A. M., Twisk, J., Wiezer, N. M., van Mechelen, W., & Cuijpers, P. (2014) · Journal of Medical Internet Research · doi:10.2196/jmir.3539 · Cited by 89 · see citing works
Furukawa, T. A., Horikoshi, M., Kawakami, N., Kadota, M., Sasaki, M., Sekiya, Y., Hosogoshi, H., Kashimura, M., Asano, K., Terashima, H., et al. (2012) · PLoS ONE · doi:10.1371/journal.pone.0035330 · Cited by 83 · see citing works
Gr⊘nningæter, H., Hytten, K., Skauli, G., Christensen, C. C., & Ursin, H. (1992) · Psychology and Health · doi:10.1080/08870449208520016 · Cited by 81 · see citing works
Effects of stress inoculation training and coworker support groups on teachers' stress
Cecil, M. A., & Forman, S. G. (1990) · Journal of School Psychology · doi:10.1016/0022-4405(90)90002-o · Cited by 70 · see citing works
Occupational stress and working women: The effectiveness of two stress reduction programs
Higgins, N. C. (1986) · Journal of Vocational Behavior · doi:10.1016/0001-8791(86)90030-8 · Cited by 68 · see citing works
Schneider, J., Sarrami Foroushani, P., Grime, P., & Thornicroft, G. (2014) · Journal of Medical Internet Research · doi:10.2196/jmir.2871 · Cited by 67 · cited 2× · see citing works
“The positive effects of low-intensity CBT on the mental health of patients have already been reported for group education [41] as well as for therapy via email, phone [24,25], and Internet [26-28].”
BackgroundShimazu, A., Kawakami, N., Irimajiri, H., Sakamoto, M., & Amano, S. (2005) · Journal of Occupational Health · doi:10.1539/joh.47.405 · Cited by 56 · see citing works
Geraedts, A. S., Kleiboer, A. M., Wiezer, N. M., van Mechelen, W., & Cuijpers, P. (2014) · Journal of Medical Internet Research · doi:10.2196/jmir.3185 · Cited by 48 · cited 1× · see citing works
“Using CBT to teach this new stress management skill to participants might improve various health outcomes [50-52].”
BackgroundUegaki, K., de Bruijne, M. C., van der Beek, A. J., van Mechelen, W., & van Tulder, M. W. (2010) · Journal of Occupational Rehabilitation · doi:10.1007/s10926-010-9258-0 · Cited by 44 · see citing works
Effectiveness of Stress Management Training for Nurses Working in a Burn Treatment Unit
von Baeyer, C. L., & Krause, L. (1984) · The International Journal of Psychiatry in Medicine · doi:10.2190/wpv9-0y55-55tx-fmx1 · Cited by 42 · see citing works
Effectiveness of a counseling support program for hospice nurses.
Gray-Toft, P. (1980) · Journal of Counseling Psychology · doi:10.1037/0022-0167.27.4.346 · Cited by 37 · see citing works
Interacting with the public as a risk factor for employee psychological distress
Hilton, M. F., & Whiteford, H. (2010) · BMC Public Health · doi:10.1186/1471-2458-10-435 · Cited by 30 · see citing works
Motivational orientations, views about the purpose of education, and intellectual styles
Kroll, M. D. (1988) · Psychology in the Schools · doi:10.1002/1520-6807(198807)25:3 · Cited by 29 · see citing works
Stress-management training: Evaluation of effects on school psychological services
Forman, S. G. (1981) · Journal of School Psychology · doi:10.1016/0022-4405(81)90042-x · Cited by 27 · see citing works
D, M. F. M., Litrman, A., Halperin, P., Pratr, E., Drews, F. R., Oleshansky, M. A., Knapik, J. J., Thompson, C., & Bielenda, C. (1991) · Psychosomatics · doi:10.1016/s0033-3182(91)72073-2 · Cited by 24 · see citing works
Stress inoculation training for direct contact staff working with mentally retarded persons
Keyes, J. B., & Dean, S. F. (1988) · Behavioral Interventions · doi:10.1002/bin.2360030406 · Cited by 20 · see citing works
Communication style: help or hindrance in facilitating return to work?
Williams, N., & Birkin, R. (2011) · Occupational Medicine · doi:10.1093/occmed/kqq193 · Cited by 2 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- [48]Christensen H Griffiths KM Jorm AF Delivering interventions for depression by using the internet: randomised controlled trial BMJ 2004 1 31 328 7434 265 10.1136/bmj.37945.566632.EE 14742346 14742346 PMC324455 · DOI · Paper page
Cited by
Sorted by citations
Stratton, E., Lampit, A., Choi, I., Calvo, R. A., Harvey, S. B., & Glozier, N. (2017) · PLOS ONE · doi:10.1371/journal.pone.0189904 · Cited by 252 · see citing works
Phillips, E. A., Gordeev, V. S., & Schreyögg, J. (2019) · Scandinavian Journal of Work, Environment & Health · doi:10.5271/sjweh.3839 · Cited by 148 · see citing works
“Boß et al, 2017 (76) + - - + Matano et al, 2007 (34) ? - ? - + Bostock et al, 2016 (60) + - - + Mori et al, 2014 (87) + - + - + Brendryen et al, 2017 (48) + - - + Myers et al, 2017 (88) + ? - ? + Carolan et al, 2017 (27) + - - + Neumeier et al, 2017 (89) ? - - - + Cook et al, 2007 (62) + - + + Persson et al, 2017 (90)…”
Stratton, E., Lampit, A., Choi, I., Gavelin, H. M., Aji, M., Taylor, J., Calvo, R. A., Harvey, S. B., & Glozier, N. (2022) · Journal of Medical Internet Research · doi:10.2196/37776 · Cited by 57 · see citing works
Web-based interventions for the management of stress in the workplace: Focus, form, and efficacy
Ryan, C., Bergin, M., Chalder, T., & Wells, J. S. G. (2017) · Journal of Occupational Health · doi:10.1539/joh.16-0227-ra · Cited by 42 · see citing works
A Robot That Encourages Self-Disclosure to Reduce Anger Mood
Akiyoshi, T., Nakanishi, J., Ishiguro, H., Sumioka, H., & Shiomi, M. (2021) · IEEE Robotics and Automation Letters · doi:10.1109/lra.2021.3102326 · Cited by 34 · see citing works
Computer-based versus in-person interventions for preventing and reducing stress in workers
Kuster, A. T., Dalsbø, T. K., Luong Thanh, B. Y., Agarwal, A., Durand-Moreau, Q. V., & Kirkehei, I. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd011899.pub2 · Cited by 28 · see citing works
Effect of management training in organizational justice: a randomized controlled trial
Nakamura, S., Somemura, H., Sasaki, N., Yamamoto, M., Tanaka, M., & Tanaka, K. (2016) · Industrial Health · doi:10.2486/indhealth.2015-0164 · Cited by 19 · see citing works
Self-citationOishi, S., Takizawa, T., Kamata, N., Miyaji, S., Tanaka, K., & Miyaoka, H. (2018) · JMIR Research Protocols · doi:10.2196/resprot.8541 · Cited by 20 · see citing works
Self-citationOptimizing Workplace Digital Mental Health Interventions: Systematic Review and Meta-Analysis
Stratton, E., Morris, R. W., Milton, A. C., Deady, M., Choi, I., & Glozier, N. (2025) · Journal of Medical Internet Research · doi:10.2196/71253 · Cited by 15 · see citing works
Sasaki, N., Somemura, H., Nakamura, S., Yamamoto, M., Isojima, M., Shinmei, I., Horikoshi, M., & Tanaka, K. (2016) · Journal of Occupational and Environmental Medicine · doi:10.1097/jom.0000000000000924 · Cited by 14 · see citing works
Self-citationShirotsuki, K., Nonaka, Y., Takano, J., Abe, K., Adachi, S.-I., Adachi, S., & Nakao, M. (2017) · BioPsychoSocial Medicine · doi:10.1186/s13030-017-0111-y · Cited by 14 · see citing works
Shirotsuki, K., Nonaka, Y., Abe, K., Adachi, S. I., Adachi, S., Kuboki, T., & Nakao, M. (2017) · BioPsychoSocial Medicine · doi:10.1186/s13030-017-0109-5 · Cited by 11 · see citing works
Social Cognitive Theories and Electronic Health Design: Scoping Review
Grace-Farfaglia, P. (2019) · JMIR Human Factors · doi:10.2196/11544 · Cited by 11 · see citing works
Luangphituck, W., Boonyamalik, P., & Klainin‐Yobas, P. (2023) · JMIR Research Protocols · doi:10.2196/38597 · Cited by 8 · see citing works
Takizawa, Y., Matsumoto, Y., & Ishimoto, Y. (2024) · Health Open Research · doi:10.12688/healthopenres.13467.1 · Cited by 6 · see citing works
Effectiveness of a Cognitive Behavioral Therapy-Based Exercise Program for Healthy Employees
Takechi, S., Kikuchi, T., Horisawa, S., Nakagawa, A., Yoshimura, K., & Mimura, M. (2015) · Advances in Physical Education · doi:10.4236/ape.2015.54031 · Cited by 6 · see citing works
Modeling and Implementation of Intra-Hug Gestures During Dialogue for a Huggable Robot
Akiyoshi, T., Sumioka, H., Nakanishi, J., Kato, H., & Shiomi, M. (2024) · IEEE Robotics and Automation Letters · doi:10.1109/lra.2024.3498697 · Cited by 5 · see citing works
Imamura, K., Kawakami, N., & Shimazu, A. (2016) · Springer eBooks · doi:10.1007/978-3-319-44400-0_14
A scoping review of low-intensity cognitive behavioral therapy studies across Asia
Tan, C. S. E., Ong, K. K. X., Arden-Gardner, L. S., Bakar, F. N. H. A., Lim, S. Y., Ariffin, A., & Kuek, J. H. L. (2025) · SSM - Mental Health · doi:10.1016/j.ssmmh.2025.100479
Cerazy, D., & Kraszewski, S. (2026) · doi:10.2196/preprints.115272
- Authors
- Mori, M., Tajima, M., Kimura, R., Sasaki, N., Somemura, H., Ito, Y., Okanoya, J., Yamamoto, M., Nakamura, S., & Tanaka, K.
- Affiliations
- Kitasato University (JP)
- Corresponding author
- Mori, Makiko
- Venue
- JMIR Research Protocols
- Publisher
- JMIR Publications Inc.
- Published
- 2014-12-02
- Volume
- 3
- Issue
- 4
- Pages
- e70
- ISSN
- 1929-0748 (ISSN-L)
- PMC
- PMC4275471
- OpenAlex
- W2073362721
- Cited by
- 21
- References
- 48
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2023: 1 · 2022: 1 · 2021: 1 · 2019: 2 · 2018: 1 · 2017: 6 · 2016: 3 · 2015: 1
- FWCI
- 5.18
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JMIR Research Protocols (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Health Sciences › Health Professions › General Health Professions › Workplace Health and Well-being
- Keywords
- cognitive behavioral therapy, online training, psychological distress, workplace stress management, workers, dysfunctional thinking, stress coping, group psychoeducation, Kessler-6, IT professionals, brief intervention, problem-solving skills, follow-up outcomes, attrition bias, workplace mental health promotion
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
