Effectiveness and working mechanisms of e-health modules focusing on worry and self-esteem for anxiety symptoms in undergraduates

The current research focuses on the effectiveness of e-health interventions to
reduce anxiety among students and increase their well-being. Student life is a
turbulent time, in which young adults are expected to become increasingly
independent, while the challenges increase. Students therefore regularly suffer
from fears, whereby complaints such as worrying and doubts about their own
ability occur regularly. E-health interventions can offer a good opportunity to
combat such complaints. It is known from the literature on generalized anxiety
disorder that fears can be 'treated' through interventions aimed at worrying
and self-image. Both ways seem to be effective. However, most e-health
interventions for healthy subjects are somewhat general, in order to be able to
treat the largest possible target group. This may miss an opportunity to
respond to specific mechanisms that play a role in anxiety symptoms (i.e.,
meta-cognitions and self-esteem).

In addition, even less is known about the effective mechanisms of e-health
interventions, and - more generally - of psychotherapy. Most e-health studies
focus on treatment effectiveness and have too few measurement moments to
determine to what extent different e-health interventions work in different
ways. More knowledge about the effective mechanisms of e-health interventions
can help us to understand how e-health interventions work, so that they can be
improved in the future and more targeted recommendations can be made for
individuals ('personalized medicine').

Primary objective: To map the effectiveness and working mechanisms of e-health
modules on worrying and self-esteem in reducing subclinical anxiety symptoms
among students

Randomized controlled trial (RCT). Tilburg University students with increased
anxiety symptoms are randomly assigned to one of three conditions: a
self-esteem e-health module, a worrying e-health module or a control waiting
list, in which no intervention is offered.

Participants who are assigned to an intervention follow either an online worry
module (https://mirro.nl/module/piekeren/) or an online self-image module
(https://mirro.nl/module/zelfbeeld/). Both modules take 4 weeks to complete.

The modules may have beneficial effects for participants, because participants
can complete an e-health module free of charge that is intended to reduce
complaints and improve well-being, but this is not certain. The modules are
already offered online and are freely accessible to everyone. The modules have
been developed by New Health Collective/Mirro in collaboration with
psychologists. For this reason, we expect that the modules will not have any
adverse effects on the participants. The only possible burden we foresee is
that the modules could be confronting for some participants. However,
participation is voluntary and participants may withdraw from the study at any
time.