The use of Internet-based stress management programs (ISM) effectively reduce stress for a sustainable period, according to a Cleveland Clinic study published recently in Annals of Behavioral Medicine.

Online stress management programs aim to increase accessibility for individuals affected by chronic stress at a lesser cost than traditional methods. Data suggests that stress reduction using ISM is comparable to face-to-face stress management.

Three-hundred study participants completed an eight-week ISM program where they received online relaxation practice materials, strategies to help cope with life’s stressors, stress assessments at the beginning and end of the program, and daily topics to inspire participants to continue the meditation and relaxation techniques.

Program participants, who were compared with a control group, showed a significant decrease in perceived stress from high levels to average, as well as greatly improved emotional wellbeing, compared with the pre-program results and to participants of the control group. Results confirmed a positive correlation between the number of meditations completed per week and perceived stress reduction.

“Our recent findings provide individuals and employers with a new option to consider for themselves or their employees’ stress management,” said Michael Roizen, MD, Chief Wellness Officer at Cleveland Clinic. “Unmanaged stress causes some of the highest healthcare costs for employers and has a lasting impact on everyone; this study implies such health effect may be readily reduced.”

Using Perceived Stress Scale (PSS) to measure a person’s perception of stress, individual results were based on a 0 (best) to 40 scale. Study participants’ stress levels prior to ISM averaged 23.05, much higher than the U.S. norm, 13.7 for females and 12.1 for males. Relative to a control group, active participants demonstrated a substantial stress score improvement of 4.04. Individuals who completed five meditations per week were likely to experience a 6.12 decrease in perceived stress scores vs. practicing once per week.

Chronic stress is a major public health issue and is associated with increased health risk and chronic disease. Comparable to smoking, psychological distress is more significant in terms of health risks to blood pressure, obesity, and diabetes. A national survey from the American Psychological Association (Stress in America) showed that 75 percent of American adults continue to report high levels of stress despite an improving economy, with little accessibility to a feasible stress management program. Most Americans cite work as being the most stressful component in their lives.

Face-to-face stress management programs often include massage therapy, exercise, diet modification, acupuncture, and meditation, whereas ISM focuses heavily on achieving a state of mindfulness through relaxation and meditation, and guided imagery. To compare the two types of programs, standard outcome measures including the Perceived Stress Scale (PSS), Mindfulness Attention Awareness Scale, Adult Self-Transcendence Inventory, among others, were observed and recorded throughout the 12-week study.

The feasibility study was a joint effort with GE (NYSE: GE), which offered the ISM program to employees in three of its sites as part of the trial.

“Understanding consumer behavior related to health and healthcare is critical to advancing care delivery,” said Mitch Higashi, chief economist for GE Healthcare. “In this case, demonstrating how workplace stress management programs could be delivered effectively in online formats provides important insights for future innovation.”

The stress management program used for the research, Stress Free Now (SFN), was designed by Cleveland Clinic experts and is sold at Cleveland Clinic’s Wellness site. On-going research continues in order to improve workplace wellbeing and quality of life using ISM programs. SFN has been modified following the results of this study, allowing for increased likelihood of program completion, and simpler implementation within the workplace with the purpose of improving stress in a corporate environment.

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The Wellness Institute at Cleveland Clinic directs research designed to help with the prevention and treatment of lifestyle-related chronic disease. Current areas of focus include helping people eliminate tobacco usage, and to better care for or reverse pre-diabetes, weight gain, psychological stress, and insomnia. Studies aim to understand the effect of behavioral modification programs or web-based interventions on these states.

About Cleveland Clinic

Cleveland Clinic is a nonprofit multispecialty academic medical center that integrates clinical and hospital care with research and education. Located in Cleveland, Ohio, it was founded in 1921 by four renowned physicians with a vision of providing outstanding patient care based upon the principles of cooperation, compassion and innovation. Cleveland Clinic has pioneered many medical breakthroughs, including coronary artery bypass surgery and the first face transplant in the United States. U.S.News & World Report consistently names Cleveland Clinic as one of the nation’s best hospitals in its annual “America’s Best Hospitals” survey. About 2,800 full-time salaried physicians and researchers and 11,000 nurses represent 120 medical specialties and subspecialties. Cleveland Clinic Health System includes a main campus near downtown Cleveland, eight community hospitals and 18 Family Health Centers in Northeast Ohio, Cleveland Clinic Florida, the Lou Ruvo Center for Brain Health in Las Vegas, Cleveland Clinic Canada, and, currently under construction, Cleveland Clinic Abu Dhabi. In 2010, there were 4 million visits throughout the Cleveland Clinic health system and 167,000 hospital admissions.

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Bridget Peterlin
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Cleveland Clinic