| Methods |
RCT, UK |
| Participants |
138 NHS employees who had contact with patients. 30% were nurses, 37% were care assistants, 20% were psychologists, speech therapists, physiotherapists or social workers, and 3% were doctors. The rest (10%) were administrative staff. |
| Interventions |
1) Experimental 1: Cognitive therapy techniques training: participants attended 3 weekly 3½‐hour workshops. Participants in both intervention groups received didactic teaching in the concepts of stress and burnout and the physical and mental signs of stress. The cognitive groups also received teaching and practice in the cognitive model, identification of negative automatic thoughts, thought challenging, beliefs and attitudes, positive self talk, distraction and relaxation using imagery. These were packaged together as all involve the employment of cognitive strategies to influence thinking, emotions and well‐being. N = 57
2) Experimental 2: Behavioural coping skills training: 3 weekly 3½‐hour workshops of teaching and practice in time management, assertion, problem solving, goal planning, healthy lifestyles, Type A and Type B behaviours and progressive muscular relaxation. These were packaged together as all stress the importance of changing behaviour so as to improve one's work environment and relationships, as well as general health and well‐being. N = 44
3) Control: No intervention. N = 37 |
| Outcomes |
The Mental Health Professional Stress Scale, The General Health Questionnaire (GHQ‐12), Ways of Coping Scale, Support Questionnaire |
| Notes |
|
| Risk of bias |
| Bias |
Authors' judgement |
Support for judgement |
| Random sequence generation (selection bias) |
High risk |
"Random assignment of staff to various groups was not always feasible due to organizational constraints, staff availability and some participants requesting early intervention. Some staff were assigned to groups (and hence condition) according to their work location." (p. 141) |
| Allocation concealment (selection bias) |
Unclear risk |
"Randomization was achieved by putting 16 proposed courses into a hat (8 cognitive and 8 coping) and drawing them out one by one. The order in which they came out determined the order in which they were delivered."... "In the event 14 courses ran and it was fortunate that courses 15 and 16 would have been one of each condition, coping and cognitive. Date and venue thus determined the condition, and participants did not know which course they were allocated to until they arrived." (p. 141) |
| Blinding (performance bias and detection bias)
All outcomes |
High risk |
Not possible, self report |
| Incomplete outcome data (attrition bias)
All outcomes |
Low risk |
"To assess for attrition bias, comparisons were made between those participants who dropped out of the study and those who were retained on factors thought to bias the results. Independent t tests and chi‐squared tests showed no significant differences between those who dropped out of the study and those who remained." (p. 145) |
| Selective reporting (reporting bias) |
Unclear risk |
"Table III. Means and standard deviations and significance levels using one‐way ANOVA for all variables where significant differences were found." (p. 146) |
| Other bias |
Unclear risk |
We did not find any indications of other sources of bias. |
