An app-based intervention for stress management among Chinese adolescents in school settings: A cluster randomized controlled trial

This intervention will be a app-based program for stress management. This web-based program will be based on Stress Inoculation Training (SIT). SIT is a stress and anxiety management intervention developed by Mechanbaum. It comprises of relaxation training skills, cognitive reconstructing skills, problem-solving skills etc. This web-based intervention can be implemented via computer and mobile devices that have access to internet. The web-based program will be accessed via a URL link. The intervention will be administered by the first author: a PhD student with a background of school psychology and mental health (XZ). XZ is a registered counsellor in China, who has experience of doing group counselling and individual counselling with clients who have anxiety symptoms and depression symptoms. XZ also have experience with group and individual counselling with Chinese high school students. The intervention will be conducted in computer rooms, where participants can log in to the program via computers provided by the schools. The intervention will comprise of 11 weekly sessions that will be completed in 3 months. Each session will take 30-35 minutes to complete. The web-based intervention will comprise of three phases: (i) conceptualization phase (session 1-3); (ii) skills acquisition and rehearsal phase (session 4-9); (iii) application and follow-through phase (session 10-11). Details of each session is described below: The first session will focus on introduction and assessment. The following activities will be completed: (1) introduction about the web-based program and relevant ethical considerations; (2) implement of assessments (PSS-10; DASS-21; ORS-4; CISS-SFC); (3) psychoeducation about the transactional nature of stress. In the second phase, the web-based program will work together with participants to analyse current problem (i.e., the nature of the participant's stress and coping strategies). In the third session, the web-based program will work together with the participant to offer a conceptual model of the participant's stress reactions. The fourth session will train relaxation skills with the participant by following four steps: (1) introduce stress-tension cycle; (2) tap the participant's previous experience with, concern with, and expectations concerning relaxation; (3) teach the participant relaxation skills through guided relaxation and deep breathing; (4) encourage the client to apply the relaxation skills into daily life. In the fifth session, the chatbot will focus on coping strategies-cognitive restructuring by completing following activities: (1) help the client become aware of automatic thoughts; (2) introduce common "thought distortions"; (3) work with the client to recognize that their thoughts are not usually the facts, but the hypotheses worthy of testing; (4) encourage clients to do personal experiments about their thoughts. In the sixth and seventh sessions, the web-based program will involve problem-solving training with the participant. Seven activities will be conducted in these two sessions: (1) problem-identification; (2) goal selection; (3) generation of alternatives; (4) change of position; (5) evaluation of pros and cons of each proposed solution; (6) strategy rehearsal; (7) encourage the participant to overcome failures and reward themselves for having tried. In the eighth session, the web-based program will focus on self-instructional training. Two activities will be conducted, (1) review with the participant the various stages of their stress experience; (2) work with the participant to generate adaptive self-statements for their stages of stress experience. In the ninth session, the program will focus on the role of "denial" on stress coping. Two activities will be conducted: (1) The chatbot will acknowledge that "denial" can be an adaptive strategy when there is no possibility to exert control; (2) encourage clients to focus on things important for them and that are consistent with their values. The tenth session will focus on imagery rehearsal. Four activities will be conducted: (1) The chatbot and the participant collaboratively generate a hierarchy of scenes, from least to most stressful. The length lasts in 1-5 minutes; (2) The client is encouraged to use any personally generated self-statements and images that would facilitate coping. (3) If the client experience difficulty in reducing stress for any one scene, the participants will have options to either (i) go back to a less intensely stressful scene from the hierarchy or (ii) identify his/her “catastrophizing” self-statement when the participants become overwhelmed; (4) Throughout the imagery rehearsal procedure, the web-based program will always check with the participants about his/her reactions to the imagery process, discussing the users’ ability to visualize and when they can use coping techniques in vivo. In the eleventh session, the web-based program will focus on behavioral rehearsal, role play and modelling. Two activities will be conducted: (1) The web-based program will role play with the client to practice coping skills (communication skills, mobilizing social support, and anger control); (2) The program will show the participant short videos of others coping with stressful events, and discuss with the users’ about other people’s coping efforts. In the last session, the web-based program will focus on relapse prevention and follow-through. Six activities will be conducted: (1) The web-based program will encourage clients to anticipate failures and setbacks; (2) The program will work with the client to rehearse how they will respond to such lapses; (3) the web-based program will help the user to normalize setbacks, and educate the client that our aim is not to eliminate stress, but use the stress constructively; (4) The web-based program will convey to the users that the “door is always open”, and encourage the client to seek additional help if needed; (5) the web-based program will provide the users with additional help resources the client can seek when needed.