Can a brief imagery-and-planning exercise lower nurses' stress?
Nurses taught a short wish-obstacle-plan exercise reported somewhat less stress and more work engagement three weeks later than nurses who only reflected on stress, although the overall group differences were borderline.
Source
Promoting the Self-Regulation of Stress in Health Care Providers: An Internet-Based Intervention
Study at a glance
- Design
- RCT — Randomised 3 (control vs MCII vs MCII plus an if-then plan for when/where to practise it) x 2 (baseline vs 3 weeks) design delivered online; participants did one written session and were asked to rehearse the strategy mentally each day; ANCOVA on follow-up scores adjusting for baseline, plus intention-to-treat analysis
- N
- N=105 · 105 nurses completed both assessments (33 MCII, 34 MCII plus plan, 38 control) out of 129 randomised; intention-to-treat analyses used all 129 with baseline values carried forward
- Population
- Nurses working in German health-care institutions (mostly hospitals), mean age about 40, mostly female
- Outcome
- Overall stress index (perceived stress questionnaire plus physical stress symptoms) and work engagement (UWES-9) after 3 weeks, adjusted for baseline
Structured fields used in claim comparison tables when every cited study has a complete layer.
What they did
Nurses from across Germany were randomly assigned online to one of three conditions. All wrote about what less stress at work would mean to them and named a personal wish. The MCII group then imagined the best outcome of that wish, identified and imagined their main inner obstacle, and formed an if-then plan to overcome it, and were asked to repeat these steps mentally every day for three weeks; a second group did the same but also made an if-then plan for when and where to practise. Stress, physical symptoms and work engagement were measured before and three weeks after.
What they found
The omnibus difference in stress change across the three groups was just short of significance (p = 0.062), but the MCII group reported significantly less stress than the control group in a pairwise comparison (p = 0.019). The MCII group also showed more work engagement than both other groups. Unexpectedly, adding a plan for when and where to practise did not help: that group did not differ from the controls on either outcome, and the same pattern held in intention-to-treat analyses.
The limits
What it doesn't show
The key effects were small and fragile: the overall tests were borderline and the pairwise differences no longer reached conventional significance after correcting for multiple comparisons. All outcomes were self-reported after only three weeks, participants volunteered knowing the study was about stress reduction, and there was no measure of whether or how often they actually practised the exercise. The control group received no active alternative, so the study cannot say whether MCII beats standard stress-management training or simply any attention-matched activity.
Key terms
- Mental contrasting
- A self-regulation strategy of imagining a desired future and then the main obstacle in present reality that stands in the way, which energises effort when the obstacle is surmountable.
- Implementation intention
- An if-then plan linking a specific situation to a specific response: 'If situation X arises, then I will do Y.'
- MCII (WOOP)
- Mental contrasting combined with implementation intentions, popularised as Wish, Outcome, Obstacle, Plan.
- Intention-to-treat analysis
- Analysing all randomised participants in their assigned groups, including dropouts, to avoid bias from who completes the study.
- Work engagement
- A positive work state of vigour, dedication and absorption, measured here with the Utrecht Work Engagement Scale.
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Common questions
What is special about MCII compared with typical stress courses?
It does not teach a set coping technique; each person picks their own wish, obstacle and response, and the intervention is a single short written session followed by self-guided mental rehearsal.
Why might adding a when-and-where plan have backfired?
The authors suggest it may have locked people into one time and place, clashed with the slow, effortful nature of mental contrasting, or required commitment to MCII that people did not yet have; none of these was tested.
Should the results be treated as strong evidence?
Only as preliminary. The overall effects were borderline, the sample was modest, and the follow-up lasted just three weeks.
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