Brief remote psychological treatments for healthcare workers with emotional distress during the SARS-CoV-2 pandemic: a randomized clinical trial

SUMMARY BACKGROUND The SARS-CoV-2 pandemic has catalyzed a widespread mental health crisis, impacting millions of people. This study aimed to compare three brief remote psychological treatments for healthcare workers with emotional distress during the SARS-CoV-2 pandemic. METHODS Nationwide three-arm randomized clinical trial in Brazil. This is a transdiagnostic study that included professionals and students from health services with high levels of anxiety, depression, or irritability symptoms, as defined by Patient-Reported Outcomes Measurement Information System (PROMIS). The exclusion criterion was positive suicide risk. Participants were randomized single session psychoeducation group plus weekly personalized pre-recorded videos for four weeks (SSI-ET), brief cognitive behavioral telepsychotherapy group (B-CBT, four sessions), or brief interpersonal telepsychotherapy (B-IPT, four sessions). This study was registered in clinicaltrials.gov ( NCT04635618 ). The primary outcome was the proportion of participants with a 50% reduction in T-scores in PROMIS rating scales of anxiety, depression, and/or irritability at one-month. FINDINGS Of the 3328 volunteers assessed for eligibility, 999 participants were enrolled, from May 19 th 2020 to December 31 st 2021, and allocated to SSI-ET (n=342), B-CBT (n=323), or B-IPT (n=334). All three groups showed significant symptom reductions in the one-month assessment that were maintained over the three and six-month follow-ups (Cohen’s d range = 0.94-1.36, p<0.001), with no significant difference between groups. The estimated proportion of responders were 46.5%, 43.7% and 44.6% for SSI-ET, B-CBT and B-IPT, respectively. Conclusions Our results refute the hypothesis that therapeutic interventions with higher number of sessions and with more specialized therapeutic components offer advantages in alleviating emotional distress, particularly among healthcare workers facing epidemic emergencies. These results have critical implications for planning interventions for crisis responses, especially in settings with limited resources. FUNDING Ministry of Health of Brazil, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Conselho Nacional de Desenvolvimento Científico e Tecnológico, and Fundo de Incentivo à Pesquisa/Hospital de Clínicas de Porto Alegre.