A Daily Coping Toolkit for Medical Personnel and First-Responders During COVID-19 Pandemic

During times of persistent high levels of stress, many individuals experience depletion in
psychological resources, suffering intense distress that can make daily occupational and
interpersonal functioning difficult. In order to assist during this exceptionally challenging
crisis, this research team has developed a brief daily intervention based on decades of
stress and trauma research that may help to support psychological health and coping resources
in individuals on the frontlines: medical personnel and first-responders. These are
individuals who are most essential to society in this difficult time. Although hospitals,
fire, and police departments have existing support resources in place, they are either based
on traditional models of treatment or consist of online peer-support or wellness
applications. All facets of existing support/interventions have considerable utility, but it
is not clear that these resources are designed to address the frequent and ongoing coping
demands of this crisis across a broad swath of individuals. In particular, traditional
psychotherapy models are unlikely to be successful due to very real time constraints of this
population at this time. Moreover, several decades of research would argue that traditional
psychotherapy is unlikely to be needed by most individuals, given prototypical patterns of
adjustment across a range of aversive events, including prior pandemics (SARS: Bonanno, et al
2008). However, even resilient individuals will struggle with distress and some symptoms.
Prior research has suggested that specific emotion processing patterns can support resilient
outcomes over the long-term and thus frontline workers may benefit from an intervention that
leverages this existing knowledge to facilitate adaptive emotion regulatory processing and
elevate well-being during this crisis.

The proposed project aims to investigate a novel intervention: A Daily Coping Toolkit,
administered via online application, that consists of 3 activities targeting adaptive
emotional attention and expression, administered one time each day, only 4-10 minutes in
duration daily. The Toolkit is both practically feasible given the demands and current burden
on the target population as well as highly consistent with existing evidence. Moreover, the
Toolkit is not likely to conflict with other online tools or with traditional psychotherapy
and hence, can be practically applied across a broad swath of individuals in need. The
primary project aim is to test the Daily Coping Toolkit on a broader population of medical
personnel and first responders to determine efficacy over time, to test relative dosing, and
to explicate the underlying therapeutic processes. The potential impact of this research will
be evidence to support the further use of this novel tool to assist essential front-line
personnel during this ongoing crisis. This may assist with mitigating the psychological toll
of this crisis and also support the occupational functioning of medical personnel and first
responders, thus, contributing indirectly to improved patient outcomes. Finally, knowledge
gained from this research will support the further development of this tool to support
individuals facing future challenging events and circumstances.

Participants: n=1000 medical personnel and first responders to test the efficacy of the Daily
Coping Toolkit.

Procedure: Interested individuals will go to www.tinyurl.com/dailycopingtoolkit for
additional information, including the informed consent. Once consent is provided, individuals
complete a brief assessment of current symptoms, well-being and psychiatric/treatment history
and then receive instructions to download the research application ExpiWell
(www.expiwell.com) a secure platform that operates on ios/Android devices upon which we
administer the Toolkit. Once downloaded, participants are randomized to a high versus low
treatment condition and will receive daily prompts to complete the intervention. After 7
days, they complete a brief assessment of symptoms, well-being, and acceptability of the
intervention and consent again for continuation in the research. Individuals can continue to
use the application without consenting further if they choose and their data will not be
accessible to researchers. For those that do consent, follow-up assessments occur at 2,6, and
9 months (symptoms and well-being).

Daily Coping Toolkit Intervention: Participants are prompted one time daily (with 1-2
reminders) to complete the intervention which consists of the following three parts.
Randomization to high versus low condition is maintained for the first 7 days only in order
to test for relative dose effects (see #3 below).

1. Emotion Labelling Activity: Participants rate 10 discrete negative and positive
emotional words on a likert scale (0-4). Precise labelling of emotional experience can
serve as a form of implicit emotion regulation and has been associated with healthy
psychophysiological and behavioral adaptation in a range of community and clinical
samples

2. Expressive Writing and Self Distancing Activity: Participants respond to an open-ended
prompt to write about their day in an open text box in response to the prompt: "What was
today like...?" After this is completed, they are prompted that if the experience was
very challenging, to revisit that experience in their mind by taking a "fly on the wall"
perspective (Kross & Ayduk, 2016; see figure for instructions). Persistent evidence has
indicated that expressive writing is an effective coping tool. In addition, research has
identified the ways in which specific word use can facilitate healthy emotional
processing during stress. There is also significant research demonstrating that shifting
perspective about negative emotional experiences can facilitate a healthier distance
from it.

3. Positive Emotion Generation Activity (1 v. 2 prompts) Participants are prompted to take
a deep breath and then respond to 1 (or 2) of 8 possible prompts in which they can
generate positive emotions. In response to each, they are asked to describe their
thoughts or memories in open-ended text box. Note: For the first 7 days, participants
are randomized to either respond to one (low dose) or two (high dose) prompts so as to
test the relative efficacy of the "dose". After 8 days, all participants default to the
higher dose of 2 prompts. Prompts are designed to elicit gratitude, positive social
experiences, amusing memories, kind acts they committed, satisfaction/pride with
accomplishments, positive future focus, and love for close others. Prior research has
demonstrated that positive emotions generated during highly stressful events predict
resilience and improved emotion regulation and coping. Moreover, positive emotion
generation has been shown broadly to predict increased psychological wellbeing.