You’ve got mail: improving mental health and wellbeing

The effectiveness of email-based exercises in promoting psychological wellbeing and healthy lifestyle has been investigated in research published today in BMC Psychology. So did this intervention work? Read more from co-author Minna Torniainen-Holm.

People generally want to be happy and feel good about their life. However ‘feeling good’ is not the only advantage to chasing psychological wellbeing. Wellbeing is also associated with better mental health as well as physical health, better social relationships and even better income.

The good news is that psychological wellbeing can be increased by simple exercises, such as naming good things that have occurred during the day or doing good deeds. We took the simple exercise of emails, and used this as a platform to increase wellbeing.

Traditional face-to-face psychotherapeutic interventions cannot be used for improving psychological well-being in large crowds of people. Internet, in contrast, provides a possibility to reach larger populations. Internet-based interventions also require little financial and personnel resources, and are easy to access when and where wanted.

Our aims in the study were to explore the feasibility of a new, freely accessible intervention for improving wellbeing in the general population.

Our aims in the study were to explore the feasibility of a new, freely accessible intervention for improving wellbeing in the general population.

What did we do?

Researchers at the National Institute for Health and Welfare, Finland and Duodecim Medical Publications recruited participants by aid of a Finnish reality TV program presented between October 2012 and January 2013. The TV program followed five Finnish celebrities who were being trained to improve their well-being and cope with setbacks in their everyday life.

The program advertised a website, where people could fill in a questionnaire on wellbeing and health related lifestyle and participate on the training. All respondents received a feedback report, which included the impact of a person’s life habits on health and ways to influence them. Participants completed the questionnaire at baseline and two months and two years later.

The goal of the email-based intervention was to combine exercises that increase wellbeing and enhance coping with stress. Additionally, participants were offered a choice of interpersonal (e.g. positive interaction in relationship) or lifestyle interventions (e.g. improving sleep or weight management).

At the baseline, 73,000 completed the questionnaire and almost 43,000 started email-based exercises. Altogether, 16,500 participated in at least one follow up. People who did not choose interventions served as controls.

What did we find?

At the two month follow-up, the intervention improved the level of stress, confidence in the future and gratitude when compared with the controls. At the two year follow-up, the persons who chose additional lifestyle interventions showed improvement in the level of stress, whereas the persons who chose additional interpersonal interventions showed improvement in all three measures.

Participants who had done the exercises as instructed showed the largest improvement, which sustained until the two year follow-up.

A large part of the participants had not done the exercises as instructed. Participants who had done the exercises as instructed showed the largest improvement, which sustained until the two year follow-up.

The limitations of the study include lack of randomization, and therefore it is possible that some confounding factor may influence the results. Compared to the general population, the participants, and especially the participants in the intervention group, were more often women and had higher levels of education and a healthier lifestyle. The persons choosing the intervention had also less confidence in the future, fewer feelings of gratitude and more stress at baseline than persons not choosing the intervention.

The internet-based intervention appears to be a cost-effective method for improving psychological wellbeing. The number of people participating in the study suggests that there is a wide interest for wellbeing and lifestyle interventions over internet.

For participants, the intervention provides a means for improving psychological wellbeing. The intervention may be the most effective when a participant is motivated and does the exercises as instructed. The improvement was on average small but long-lasting.

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