An e-mental health intervention to support burdened people in times of the COVID-19 pandemic: CoPE It.

The outbreak of the novel SARS CoV-2-virus (COVID-19) is pushing national and international healthcare systems to their limits. The aspect of mental health issues, which has been neglected (so far) in times of social isolation and governmental restrictions, now demands innovative and situation-based approaches to support psychological burdened people. The developed e-mental health intervention 'CoPE It' offers manualized, evidence-based psychotherapeutic/psychological support to overcome psychological distress in times of COVID-19. E-mental health approaches offer great possibilities to support burdened people during the SARS-CoV-2 pandemic effectively.

To the editor

The SARS CoV-2-virus (COVID-19) with over 1.7 million infections worldwide is pushing national and international healthcare structures to their limits. Up to this point, little is known about vaccinations or treatment options to face the novel virus. Governmental priorities lie on necessary actions to slow down the spread of the virus. The closure of public facilities, travel restrictions, quarantine and social distancing are unavoidable to ‘flatten the curve.’ However, the impact of those restrictions is tremendously influencing the economy, public life and every single person. The neglected aspect of mental health issues in times of COVID-19 and weeks of quarantine are an additional burden to the community. Innovative and situation-based approaches to foster the psychological well-being are urgently required. ‘Coping with Corona: Extended Psychosomatic care in Essen’ (CoPE) is a structured approach to support burdened people. An integral part of the ‘CoPE’ concept is the brief e-mental health intervention ‘CoPE It.’ ‘CoPE It’ is a self-guided e-mental health intervention for burdened people in times of COVID-19 to overcome psychological distress and improve mental health. The ‘CoPE It’ intervention is based on the established, evidence-based psychotherapeutic/psychological intervention techniques of mindfulness-based stress reduction and cognitive behavioral therapy and has been adapted to the context of the corona pandemic by experts for psychosomatic medicine and stress prevention from the universities of Duisburg-Essen and Tübingen. The content of the four modules included is evidence-based and manualized., The intervention aims to reduce distress by enhancing coping strategies and self-efficacy and activating personal resources. The four modules (Table 1) of the intervention involve several media, including psychoeducational videos, audio-guided mindfulness exercises, individual skills boxes and interactive skills training. Furthermore, at the end of each module, participants receive an individual summary of the finished module with individual achieved contents, a mindfulness exercise schedule and motivational quotes. During the intervention, participants collect helpful skills and mindfulness exercises in their individual skills box through psychological exercises. ‘Cope It’ is web-based and can be conducted on the private PC, tablet or smartphone anytime and anywhere; only Internet access is required. The intervention consists of four modules, each lasting about 30 minutes and conducted every other day over the course of 2 weeks. The intervention also involves homework assignments and mindfulness exercises that should be integrated into the daily routines. To ensure intervention adherence and fidelity, participants will receive notifications to inform them when a new module is available. In addition, push notifications can be activated to receive mindfulness reminders in order to enhance motivation. The use of ‘CoPE It’ is free and approved by the ethics committee of the medical faculty of the University of Duisburg-Essen (20-9243-BO). In times of COVID-19, it is crucial to support psychological burdened people, directly or indirectly affected by the corona virus, with appropriate interventions. As in China, tele-medical approaches are needed to be implemented in public health strategies in order to support many people simultaneously and effectively. The benefits of e-mental health approaches are great and innovative resources and currently more necessary than ever before.

Table 1

Overview of the COVID-19 adapted topics, contents and exercises of ‘CoPE It’

	Topic/Psychoeducation	Skills Training/Exercises for COVID-19 specific psychological burden	Mindfulness
Module 1	• The rationale of the skills and mindfulness training	• Planning a daily routine in times of COVID-19	Mindful breathing
	• Rituals and routines	• Activating personal contacts
		• Enhancing sleep routine
Module 2	• Coping with distress in times of COVID-19	• Stress management model • Encouraging quotes	Mindful experiencing
	• tress management	• Self-effective skills
Module 3	• Individual resources	• Activating individual resources in times of COVID-19	Mindful compassion
	• Resource management strategies	• Searching for possible enjoyable activity
		• Activity skills
Module 4	• Skills box to handle psychological burdens in times of COVID-19	• Individual skills for emotional emergencies	Mindful body awareness
		• My emergency kit
		• Reminder skills