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      The Effectiveness of Internet-Based Cognitive Behavioral Therapy as a Preventive Intervention in the Workplace to Improve Work Engagement and Psychological Outcomes: Protocol for a Systematic Review and Meta-analysis


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          Mental health has become an increasingly significant issue in the workplace. Non–health care workers are experiencing increased levels of psychological symptoms in their workplaces, especially during the COVID-19 pandemic, which limited social interactions and health service access. These conditions have a negative effect on employees’ mental health and may also be associated with work-related outcomes, such as reduced levels of work engagement. Cognitive behavioral therapy (CBT) is one of the most effective methods used for treating workers with mental illness and preventing work-related psychological outcomes. The delivery of internet-based CBT (iCBT) has been established as a result of both technological improvements that have influenced health promotion and prevention components, and limited social contact and health service access.


          The purpose of this systematic review is to synthesize the best available evidence concerning the preventive effect of iCBT on employees.


          A systematic search will be conducted across 12 electronic databases, including a hand search for main journals and reference lists. Randomized controlled trials testing the effects of iCBT on psychological outcomes and work engagement among employees will be eligible. Initial keywords will cover the concepts of employees, workers, non–health care personnel, internet-based, web-based, eHealth cognitive behavioral interventions, stress, depression, anxiety, and work engagement, and then a full search strategy will be developed. Following titles, abstracts and the full text will be screened for assessment against the inclusion criteria for the review. Search results will be fully reported and presented per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two independent reviewers will screen and extract data, appraise methodological quality using the Cochrane risk-of-bias assessment tool, and assess overall quality of evidence with the Grading of Recommendations Assessment, Development, and Evaluation approach. A random effects meta-analysis and standardized mean differences using review manager software will be applied to synthesize the effect of iCBT based on similar outcomes.


          This protocol was registered in the International Prospective Register of Systematic Reviews in March 2022 and is now an ongoing process. The data will be analyzed in August 2022, and the review process should be completed by December 2022. All included studies will be synthesized and presented to demonstrate the effectiveness of iCBT in decreasing psychological distress and optimizing work engagement outcomes among employees.


          According to the findings of this study, iCBT therapies will be used to promote mental health concerns such as depressive symptoms, anxiety, psychological distress, stress, insomnia, and resilience among non–health care professionals. In addition, the results will be used to ensure the policy related to reducing psychological distress and optimizing work engagement in the workplace.

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          Most cited references32

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          PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews

          The methods and results of systematic reviews should be reported in sufficient detail to allow users to assess the trustworthiness and applicability of the review findings. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement was developed to facilitate transparent and complete reporting of systematic reviews and has been updated (to PRISMA 2020) to reflect recent advances in systematic review methodology and terminology. Here, we present the explanation and elaboration paper for PRISMA 2020, where we explain why reporting of each item is recommended, present bullet points that detail the reporting recommendations, and present examples from published reviews. We hope that changes to the content and structure of PRISMA 2020 will facilitate uptake of the guideline and lead to more transparent, complete, and accurate reporting of systematic reviews.
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            PRESS Peer Review of Electronic Search Strategies: 2015 Guideline Statement.

            To develop an evidence-based guideline for Peer Review of Electronic Search Strategies (PRESS) for systematic reviews (SRs), health technology assessments, and other evidence syntheses.
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              Psychological distress: concept analysis.

              The term 'distress' is frequently used in nursing literature to describe patient discomfort related to signs and symptoms of acute or chronic illness, pre- or post-treatment anxiety or compromised status of fetuses or the respiratory system. 'Psychological distress' may more accurately describe the patient condition to which nurses respond than does the term 'distress'. Psychological distress is seldom defined as a distinct concept and is often embedded in the context of strain, stress and distress. This creates confusion for nurses attempting to manage the care of people experiencing psychological distress. This paper is a concept analysis of psychological distress based on Walker and Avant's (1995) criteria that identifies the attributes, antecedents, and consequences of psychological distress based upon the findings of the literature review. In addition, empirical references are identified and constructed cases presented. A literature search was conducted using MEDLINE, CINAHL, Ovid, PsychINFO, and Cancer Lit databases over the last 50 years. The purposes of this concept analysis were: (1) to establish the concept of psychological distress as a clear and distinct concept, separate from strain, stress and distress, and (2) to provide nurses with a base of knowledge from which to plan effective clinical interventions. Content analysis of the literature revealed that, although used frequently in health care literature, the origin of the concept of psychological distress has not been clearly articulated and is ill-defined. Psychological distress is a serious problem faced by many of the people whom nurses encounter on a daily basis. An understanding of the concept of psychological distress will help nurses ameliorate this problem in patients. Nursing research related to the exploration of psychological distress is also needed.

                Author and article information

                JMIR Res Protoc
                JMIR Res Protoc
                JMIR Research Protocols
                JMIR Publications (Toronto, Canada )
                19 January 2023
                : 12
                [1 ] Boromarajonani College of Nursing Suphanburi Praboromarajchanok Institute Suphanburi Thailand
                [2 ] Department of Public Health Nursing Faculty of Public Health Mahidol University Bangkok Thailand
                [3 ] The Alice Lee Centre for Nursing Studies Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore
                Author notes
                Corresponding Author: Plernpit Boonyamalik plernpit.suw@ 123456mahidol.ac.th
                ©Wasana Luangphituck, Plernpit Boonyamalik, Piyanee Klainin-Yobas. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 19.01.2023.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on https://www.researchprotocols.org, as well as this copyright and license information must be included.


                systematic review,internet-based,cognitive behavioral therapy,work engagement,psychological outcomes,employees,workplace,web-based,occupational health,mental health,stress,depression,anxiety,ehealth,digital health


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