Identifying evidence informed psychological interventions during the COVID-19 pandemic: Rapid review of the literature.

•Less than a quarter of psychological interventions are developed based on evidence.•Evaluation of the effectiveness of existing online mental health resources is required.•Front-line healthcare providers experienced severe mental distress during COVID-19.

Introduction

The volume of individuals who have tested positive for COVID-19 has had a detrimental effect on the global health care system, with many countries experiencing rising infection rates and varying levels of strain, particularly among front line health care providers (Lancet, 2020). Many of these front-line health care providers work longer than normal hours, report increase stress, are at heightened risk for infection due to reduced access to personal protective equipment, and experience new psychiatric symptoms resulting in increased levels of distress (Montemurro, 2020). Globally, 20% of healthcare providers have been infected, with at least 22 deaths directly attributed to COVID-19 (Lancet, 2020).

In addition to the detrimental impact of COVID-19 on front line health care providers, a subgroup of these healthcare workers (e.g. registered nurses, physicians, respiratory therapists, physiotherapists) appear to present with increase severity of symptoms. This subgroup being front-line healthcare providers enrolled in university programs (i.e. graduate education, post-diploma, advanced certification programs) to advance their training. Anecdotal evidence suggests this cohort of front-line healthcare providers (FLHCP) experience severe anxiety, depression, physical and mental fatigue, and insomnia, compared to the general population of FLHCP. This may be a result of them practicing on the front line: they treat and care for patients diagnosed with COVID-19, while facing challenges related to working longer than normal hours, being on-call to respond to emergent situations or being redeployed to new units (requiring on-the-spot learning of health conditions and their management) as well as dealing with increased patient acuity. As mature students, many have additional responsibility of caring for dependents.

As well, this cohort of FLHCP face additional stress related to concurrent academic requirements. Educational programs moved to online delivery, with students being forced to contend with modification of lectures, redesign of courses, restructuring of assignments, and the integration of new methods for engagement with online materials and platforms. Challenges related to adapting to a new teaching method, access to digital technology and videoconferencing capabilities, space and privacy for teaching and learning, and ability to engage remotely have had to be sorted out and addressed in real time. All of these issues have and continue to contribute to increased stress among this cohort of healthcare providers. Thus, the combination of on-the-job stress, the risk of acquiring the virus and transmitting it to loved ones, and attendance to academic requirements, is unique to this cohort yielding heightened exhaustion and burnout.

The exorbitant amount of stress, anxiety and fatigue experienced by this specific cohort of FLHCP is alarming. High stress levels can compromise psychological endurance, which increases individual’s risk of acquiring the virus while negatively impacting on the quality of care they provide. Thus, it is important to ensure valid and reliable resources are made available for these individuals. A number of mental health resources are currently available to assist health care providers in managing their stress; however, it is unclear if the listed strategies are evidence-based. The purpose of this rapid review was to review the literature to determine which of the strategies or therapies presented among the resources are evidence-based, thus, having the potential to benefit this cohort. This information is needed to begin to formulate a collection of evidence based psychological resources to support FLHCP concurrently enrolled in university to increase their resilience and mitigate attrition within the workplace during the current and future waves of the COVID-19 pandemic.

Research questions

This rapid review addressed the following research questions: 1) what resources pertaining to stress, anxiety, insomnia, well-being, physical function, resilience, post-traumatic stress disorder, and/or depressive symptoms are available to FLHCP who are also concurrently enrolled in a university program? and 2) are these resources based on empirical and/or theoretical evidence?

Materials and methods

Design

A rapid review was conducted to inform evidence-based decision-making pertaining to the selection of effective strategies or therapies that this cohort could use to promote mental health and resilience both within the clinical practice and academic environment.

Inclusion criteria

Resources were included as part of this review based on their relevance as oppose to methodological rigor. As a result, links to online materials and video recordings; as well as references to empirical papers, non-empirical manuscripts, and workshops/sessions were considered for inclusion in this review. Furthermore, this rapid review only addressed resources that were available via publicly facing internet sites. Unit or employee initiated one on one consultations with mental health professionals that may have been available via internally facing Intranet sites were not reviewed because the researchers did not have institutional access to these materials/resources.

The search was limited to resources that were available from the start of the pandemic; identified as COVID-19 specific interventions; and which have a focus on insomnia, stress, anxiety, depressive symptoms, well-being, physical function, resilience, or post-traumatic stress disorder; to capture the range of mental health symptoms associated with psychological health. The selection of therapies for each symptom was intentionally kept general to ensure a wide-ranging scope of potential interventions are identified. The search was conducted over the period of three months from May to August 2020.

Search strategy, screening, and data extraction

The search strategy began by reviewing all academic, hospital, home, community, and long-term care webpages. In particular, the home page, human resource, and occupational health pages were reviewed. As well, google search engine was used to identify additional resources using the following search terms: COVID-19; coronavirus, frontline healthcare workers, university programs, mental health resources, healthcare providers, academic institutions, university assistance for mental health, counselling resources, healthcare professionals, frontline student nurses, mental health help, registered nurses, physicians, respiratory therapists, physiotherapists, social workers, personal support workers, registered practical nurses, frontline healthcare student, university mental health resources, and COVID-19 healthcare professionals.

All resources retrieved were reviewed independently by both the first author and a trained research assistant. The screening process consisted of the research assistant previewing the information to determine it fits with specific mental health symptoms associated with psychological health. If the resources addressed any of the following psychological symptoms: stress, anxiety, insomnia, well-being, physical function, resilience, post-traumatic stress disorder, or depressive symptoms, it was included in the review. In case of any uncertainty about the relevance of the resources; these were then shared with the study team members to determine relevance and fit with study inclusion criteria. No discrepancies appeared at the final stage of screening. The search yielded 84 COVID-19 psychological online resources within the academic setting and 53 COVID-19 online mental health resources within the clinical settings (Fig. 1).

Fig. 1

Prisma flow diagram.

Data were extracted pertaining to whether or not the resources addressed any or all of the mental health symptoms (i.e. stress, anxiety, insomnia, well-being, physical function, resilience, post-traumatic stress disorder, and/or depressive symptoms), as well as whether or not the resources were evaluated to determine effectiveness. Data collected were presented in a table format based on specific mental health symptoms (Table 1).

Table 1

Psychological resources.

Mental Health Symptom	Resources	Medium	THEME	Intended audience	Evidence Based reporting or referencing of evaluation (yes, no)
Stress	https://bb31a78a-5cf6-4d5b-950e-8d7723740e07.filesusr.com/ugd/021036_d36f9fbb37e14296a38fe4bfd74939ef.pdf?index=true	Single PDF document	Mindfulness	Physician	No
Stress	https://medschool.ucsd.edu/som/fmph/research/mindfulness/pages/default.aspx	Tools and resources to address stress	Mindfulness exercises	Healthcare providers	No
Stress	https://www.headspace.com/	Headspace - provides access to hundreds of online resources - partially free with limited access	Guided Meditations - tools and resources to look after the mind	Healthcare providers	Yes
Stress	https://www.sanvello.com/	Sanvello - provides access to online resources	Self-care, peer support, coaching, therapy	Healthcare providers	Yes
Stress	https://my.happify.com/	Happify- single destination for effective, evidence-based solutions for better mental health	Meditations and online resources - partially free with limited access	Healthcare providers	Yes
Stress	https://www.wysa.io/	Wysa-keeps track of your mood with friendly chats and helps you fight stress and anxiety with tailored tools and exercises	Friendly chats, tailored tools and exercises	Healthcare providers	Yes
Stress	https://www.calm.com/	App for sleep, meditation, and relaxation - partially free with limited access	Meditate -	Healthcare providers	No
			Learn the life-changing skill of meditation; Sleep -
			Get more restful sleep and wake up feeling refreshed;
			Music - Exclusive music to help you focus, relax, sleep;
			Body -
			Video lessons on mindful movement and gentle stretching; Masterclass -
			Audio programs taught by world-renowned mindfulness experts;
			Scenes
			Nature scenes and sounds to enjoy while relaxing, sleeping, working or studying
Stress	https://boldly.joulecma.ca/home/managing-covid-19-stress-and-anxiety Website - online information Self-care guide Healthcare providers	Ontario Shores - All health care workers dealing with mental health challenges during this pandemic can get rapid access to a new service to support their resiliency and recovery.	- System Navigation	Health care providers	No
			- Crisis Planning
			- Psychoeducation
			- Brief individual therapy
			- Primary care phone consultation guidance
			- referral to prompt care clinic for most at risk
Stress	https://bouncebackontario.ca/	Website	Self-care - skill building activities	Healthcare providers	Yes
Stress	https://pg.postmd.utoronto.ca/wp-content/uploads/2020/04/RESOURCES_Managing-Stress-w-COVID-19-.pdf	PDF document	Written document for Self-Care tips during and after the outbreak	Physicians who are students	No
Stress	https://pg.postmd.utoronto.ca/wp-content/uploads/2020/05/Psychological_FirstAid_HealthCare_COVID-19_Workbook_Final_2.pdf	Workbook	Strategies to enhance wellness focusing on: nutrition, breathing, stretching, relaxation, sensory grounding, hydration, sleep, social connection, self-compassion, anxiety exercises, relationship building	physicians who are students	No
Stress	https://www.ptsd.va.gov/covid/COVID_healthcare_workers.asp	Website	Tips and strategies for managing stress	Healthcare providers	No
Stress	https://www.desouzainstitute.com/wp-content/uploads/Mindfulness-Flyer.pdf	30 ​min virtual mindfulness sessions offered on Mon, Tues, Wed, Thurs	Mindfulness- Drop in and learn short mindfulness practices to help find calm in the midst of challenge. Relax, recharge, and learn howto incorporate moments of mindfulness into your day	Healthcare providers	No
Stress	https://pg.postmd.utoronto.ca/wp-content/uploads/2020/04/TIPS_Keeping-healthy-w-COVID-19_20mar31.pdf	MD-led virtual chats and PDF document providing	Steps to promoting resilience	physicians who are students	No
Stress	https://pg.postmd.utoronto.ca/wp-content/uploads/2020/04/FACT-SHEET_Buddy-system_20mar31.pdf	PDF Fact Sheet	Uses the Buddy System to foster the sharing of responsibilities of well-being, safety, and active support	physicians who are student	No
Stress	https://www.baypsychology.ca/workshops	DBT Workbook	Dialectical Behaviour Therapy (DBT) - managing feelings, skills, and emotions with tolerance	psychotherapists, social workers, physicians, and graduate level students	No
Stress	https://cpa.ca/corona-virus/psychservices/	Free virtual counselling with psychologists	Counselling	Healthcare providers	No
Stress	https://www.albertahealthservices.ca/topics/Page17019.aspx	Text4Hope - free service providing three months of daily CBT–	Cognitive Behavioural Therapy (CBT)–based text messages written by mental health therapists.	Healthcare providers -in Alberta	No
Stress	https://www.virusanxiety.com/	A website and app by Shine - articles, meditations, mindfulness, expert connections, relaxation exercises	Free online toolkit with resources to promote mental wellness and health	Healthcare providers	Yes
Stress	https://www.tenpercent.com/coronavirussanityguide	Website	Guided meditations, blogs, podcasts provided free to healthcare providers	Healthcare providers	No
Stress	https://www.corepoweryogaondemand.com/keep-up-your-practice?fbclid=IwAR3-T4eGvS1B7S2RKGV6tLoglWAobw3n6S4mYxPAq750ppu32BPxlzAZfuA	Collection of online videos	Yoga	Healthcare providers	No
Stress	https://www.youtube.com/user/yogawithadriene/featured	Collection of youtube videos	Yoga	Healthcare providers	No
Stress	https://www.youtube.com/playlist?list=PLPbDo1Dse11ysp2ugMFNgqaHdJJH6Tpzq	Collection of guided meditation videos	Meditation	Healthcare providers	No
Stress	https://www.betterhelp.com/helpme/?utm_source=AdWords&utm_medium=Search_PPC_c&utm_term=free+trial+betterhelp_e&utm_content=25637168530&network=g&placement=&target=&matchtype=e&utm_campaign=177007450&ad_type=text&adposition=&gclid=Cj0KCQjw-r71BRDuARIsAB7i_QPw5hsn-ai4sNg2erPpG_KZruR8rRiOr3e1p8518xn5Co2BYvr7C1MaApb2EALw_wcB&not_found=1&gor=helpme	Virtual counselling - free for a limited time	Therapy counselling	Healthcare providers	No
Stress	https://ephysicianhealth.com/	Virtual podcasts and modules for mental health, weight, nutrition, and fitness	eLearning modules for self-care with mental and physical health	Physicians and medical students	No
Stress	https://www.calm.auckland.ac.nz/index.html	A collection of text-based, audio, and video resources - partially free with limited access	Computer assisted learning self-care strategies - to manage stress, depressive symptoms, anxiety, and promote resilience	Healthcare providers	No
Stress	https://cdn.dal.ca/content/dam/dalhousie/pdf/faculty/medicine/departments/core-units/resident-affairs/The%20Basics%20Strategies%20for%20coping%20with%20stress%20and%20building%20resilience.pdf	PDF document outlining Basics Strategies for coping with stress & building resilience for mental health support	Self-care guide	Physicians	No
Stress	https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html	Virtual information - coping with stress during the pandemic with a number of PDF and external links for help with talking to others	Self-care guide	Everyone	Yes
Stress	https://drive.google.com/file/d/1FopkiPYKRcyi24FPcgPdRZKAM5y850pp/view	A PDF with general information about coping with stress during the pandemic with additional links to websites and people for resources	Self-care with coping and managing strategies	Healthcare providers	Yes
Stress	https://insighttimer.com/	App and online community for meditation - partially free with limited access	Meditation, Music, and talks posted by contributing experts	Healthcare Providers	Yes
Stress	https://www.who.int/docs/default-source/coronaviruse/coping-with-stress.pdf	PDF produced by WHO	Self-care coping strategies for dealing with stress	Healthcare providers	Yes
Stress	https://www.youtube.com/watch?v=hnpQrMqDoqE	Youtube video	Self-care strategies - animated video with tips for keeping stress under control	Healthcare providers	No
Stress	http://apps.library.ryerson.ca/assignment-calculator/	An assignment calculator which creates a schedule to reduce stress	Self-care	Healthcare providers who are students	No
Stress	https://my.life/	Online app - partially free with limited access	Mindfulness - activities that addresses emotions,	Healthcare providers	No
Stress	http://t2health.dcoe.mil/apps/breathe2relax	Free virtual tool	Breathing exercises to address stress, mood, and anxiety	Healthcare providers	No
Stress	http://media.dartmouth.edu/∼healthed/special_place.mp3	Online audio	Guided imagery - address tension and stress	Healthcare providers	No
Stress	https://www.google.ca/search?source=hp&ei=8HHqXvWPEoTI_QaBhq_QAg&q=how+to+practice+buddhist+walking+meditation&oq=ow+to+practice+buddist+walking+med&gs_lcp=CgZwc3ktYWIQARgAMggIIRAWEB0QHjoFCAAQsQM6BQgAEIMBOgIIADoECAAQCjoECAAQDToICAAQFhAKEB46BggAEBYQHjoGCAAQDRAeOgoIABAIEA0QChAeUJYBWIQzYINAaAFwAHgAgAGbAYgBixySAQUxMi4yMpgBAKABAaoBB2d3cy13aXo&sclient=psy-ab#kpvalbx=_-XHqXplxgtu0BqDisogD32	Online video	Meditation - practice Buddist Walking Meditation	Healthcare providers	No
Stress	https://www.youtube.com/watch?v=ipO3AuqbZq8&feature=youtu.be	Youtube video	Strategies to address stress and anxiety	Healthcare providers	No
Stress	https://good2talk.ca/about/	Counselling and referrals	A free, confidential support service to talk to a professional counsellor and also receive referrals	Healthcare providers	Yes
Stress	https://www.youtube.com/watch?v=Rkz7vJOZ2HU&feature=youtu.be	Video for how to cope with COVID-19	Three steps to coping with COVID-19 - Problem, Emotion, Meaning	Healthcare providers	No
Stress	https://pg.postmd.utoronto.ca/wp-content/uploads/2020/04/RESOURCES_CAMH-Mental-Health-and-the-COVID_20Mar31.pdf	FACT sheet	Strategies for addressing mental health and stigma	physicians who are student
Stress	https://www.theawakenetwork.com/free-online-meditation-resources-for-the-time-of-social-distancing/	Awake Network	Meditation - Free Online Meditation Resources for Times of Social Distancing/COVID-19	Healthcare Providers	Yes
Stress	https://mindfulnessexercises.com/free-online-mindfulness-courses/	Free online mindfulness exercises	Mindfulness Exercises	Healthcare providers	No
Stress	https://wellness.mcmaster.ca/app/uploads/2020/04/Online-Resources-for-Mental-Wellness-and-Social-Connection.pdf	Online (Apps and websites) resources for social connection and mental wellness during COVID-19	Apps to help with increasing social connection; promoting mental wellness; online resources for mental health; and tips for managing mental health	Healthcare providers	No
Stress	https://apps.apple.com/ca/app/breathe2relax/id425720246	Free app that provides detailed info on stress	evidence-based exercise to help you breathe to reduce stress levels	Healthcare providers	No
Stress	https://www.youtube.com/playlist?list=PL1A11CDC25D710702	Collection of Youtube videos	Yoga	Healthcare providers	No
Stress	https://vimeo.com/400663720	Online video	Stress management strategies	Physicians	No
Stress	http://www.camh.ca/en/health-info/mental-health-and-covid-19/coping-with-stress-and-anxiety	Website	Coping strategies and personal assessment tools to help manage stress and anxiety	Healthcare providers	Yes
Stress	https://medical.mit.edu/sites/default/files/mindful_yoga.mp3	Audio recording of Yoga session	Yoga	Healthcare providers	No
Stress	https://www.youtube.com/watch?v=I6402QJp52M&feature=youtu.be	Youtube video for how to deal with stress	Self-care	Healthcare providers	No
Stress	https://buddhify.com/	App to address sleep and stress	Meditation and Mindfulness exercises	Healthcare providers	Yes
Anxiety	https://bb31a78a-5cf6-4d5b-950e-8d7723740e07.filesusr.com/ugd/021036_d36f9fbb37e14296a38fe4bfd74939ef.pdf?index=true	Single PDF document	Mindfulness	Physician	No
Anxiety	http://t2health.dcoe.mil/apps/breathe2relax	Free virtual tool	Breathing exercises to address stress, mood, and anxiety	Healthcare providers	No
Anxiety	https://www.headspace.com/	Headspace - provides access to hundreds of online resources - partially free with limited access	Guided Meditations - tools and resources to look after the mind	Healthcare providers	Yes
Anxiety	https://www.anxietycanada.com/resources/mindshift-cbt/	Mindshift CBT	Cognitive Behavioural Therapy (CBT) strategies to help students learn to relax and be mindful, develop more effective ways of thinking, and use active steps to take charge of your anxiety.	Healthcare providers	Yes
Anxiety	https://www.sanvello.com/	Sanvello- provides access to online resources	Self-care, peer support, coaching, therapy	Healthcare providers	Yes
Anxiety	https://my.happify.com/	Happify- single destination for effective, evidence-based solutions for better mental health	Meditations and online resources - partially free with limited access	Healthcare providers	Yes
Anxiety	https://www.wysa.io/	Wysa-keeps track of your mood with friendly chats and helps you fight stress and anxiety with tailored tools and exercises	Friendly chats, tailored tools and exercises	Healthcare providers	Yes
Anxiety	https://www.youtube.com/playlist?list=PL1A11CDC25D710702	Collection of Youtube videos	Yoga	Healthcare providers	No
Anxiety	https://www.calm.com/	App for sleep, meditation, and relaxation - partially free with limited access	Meditate -	Healthcare providers	No
			Learn the life-changing skill of meditation; Sleep -
			Get more restful sleep and wake up feeling refreshed;
			Music - Exclusive music to help you focus, relax, sleep;
			Body -
			Video lessons on mindful movement and gentle stretching; Masterclass -
			Audio programs taught by world-renowned mindfulness experts;
			Scenes
			Nature scenes and sounds to enjoy while relaxing, sleeping, working or studying
Anxiety	https://pg.postmd.utoronto.ca/wp-content/uploads/2020/04/RESOURCES_Managing-Stress-w-COVID-19-.pdf	PDF document	Written document for Self-Care tips during and after the outbreak	physicians who are student	No
Anxiety	https://pg.postmd.utoronto.ca/wp-content/uploads/2020/05/Psychological_FirstAid_HealthCare_COVID-19_Workbook_Final_2.pdf	Workbook	Strategies to enhance wellness focusing on: nutrition, breathing, stretching, relaxation, sensory grounding, hydration, sleep, social connection, self-compassion, anxiety exercises, relationship building	physicians who are student	No
Anxiety	https://www.desouzainstitute.com/wp-content/uploads/Mindfulness-Flyer.pdf	30 ​min virtual mindfulness sessions offered on Mon, Tues, Wed, Thurs	Mindfulness- Drop in and learn short mindfulness practices to help find calm in the midst of challenge. Relax, recharge, and learn howto incorporate moments of mindfulness into your day	Healthcare providers	No
Anxiety	https://www.baypsychology.ca/workshops	DBT Workbook	Dialectical Behaviour Therapy (DBT) - managing feelings, skills, and emotions with tolerance	psychotherapists, social workers, physicians, and graduate level students	No
Anxiety	https://www.theawakenetwork.com/free-online-meditation-resources-for-the-time-of-social-distancing/	Awake Network	Meditation - Free Online Meditation Resources for Times of Social Distancing/COVID-19	Healthcare Providers	Yes
Anxiety	https://cpa.ca/corona-virus/psychservices/	Free virtual counselling with psychologists	Counselling	Healthcare providers	No
Anxiety	https://www.albertahealthservices.ca/topics/Page17019.aspx	Text4Hope - free service providing three months of daily CBT–	Cognitive Behavioural Therapy (CBT)–based text messages written by mental health therapists.	Healthcare providers -in Alberta	No
Anxiety	https://www.virusanxiety.com/	A website and app by Shine - articles, meditations, mindfulness, expert connections, relaxation exercises	Free online toolkit with resources to promote mental wellness and health	Healthcare providers	Yes
Anxiety	https://wellness.mcmaster.ca/app/uploads/2020/04/Online-Resources-for-Mental-Wellness-and-Social-Connection.pdf	Online (Apps and websites) resources for social connection and mental wellness during COVID-19	Apps to help with increasing social connection; promoting mental wellness; online resources for mental health; and tips for managing mental health	Healthcare providers	No
Anxiety	https://www.tenpercent.com/coronavirussanityguide	Website	Guided meditations, blogs, podcasts provided free to healthcare providers	Healthcare providers	No
Anxiety	https://www.youtube.com/playlist?list=PLPbDo1Dse11ysp2ugMFNgqaHdJJH6Tpzq	Collection of guided meditation videos	Meditation	Healthcare providers	No
Anxiety	https://insighttimer.com/	App and online community for meditation - partially free with limited access	Meditation, Music, and talks posted by contributing experts	Healthcare Providers	Yes
Anxiety	https://www.betterhelp.com/helpme/?utm_source=AdWords&utm_medium=Search_PPC_c&utm_term=free+trial+betterhelp_e&utm_content=25637168530&network=g&placement=&target=&matchtype=e&utm_campaign=177007450&ad_type=text&adposition=&gclid=Cj0KCQjw-r71BRDuARIsAB7i_QPw5hsn-ai4sNg2erPpG_KZruR8rRiOr3e1p8518xn5Co2BYvr7C1MaApb2EALw_wcB&not_found=1&gor=helpme	Virtual counselling - free for a limited time	Therapy counselling	Healthcare providers	No
Anxiety	https://www.heretohelp.bc.ca/	Virtual library for information about well-being, anxiety, eating and sleep	Self-care modules	Healthcare providers	Yes
Anxiety	https://www.calm.auckland.ac.nz/index.html	A collection of text-based, audio, and video resources - partially free with limited access	Computer assisted learning self-care strategies - to manage stress, depressive symptoms, anxiety, and promote resilience	Healthcare providers	No
Anxiety	https://ecouch.anu.edu.au/welcome	Virtual online interactive modules	Self-help strategies with cognitive, behavioural, and interpersonal therapies, as well as relaxation and physical activity techniques	Healthcare providers	Yes
Anxiety	https://boldly.joulecma.ca/home/managing-covid-19-stress-and-anxiety Website - online information Self-care guide Healthcare providers	Ontario Shores - All health care workers dealing with mental health challenges during this pandemic can get rapid access to a new service to support their resiliency and recovery.	- System Navigation	Health care providers	No
			- Crisis Planning
			- Psychoeducation
			- Brief individual therapy
			- Primary care phone consultation guidance
			- referral to prompt care clinic for most at risk
Anxiety	https://www.bigwhitewall.com/?lang=en-ca	Online community	Online peer support community with online resources and conversation with practitioners	Healthcare providers	Yes
Anxiety	https://www.youtube.com/watch?v=ipO3AuqbZq8&feature=youtu.be	Youtube video	Strategies to address stress and anxiety	Healthcare providers	No
Anxiety	https://anxieties.com/homepage/index#.VkJVx7_igVc	A website with a wide variety of educational videos and self-help guides related to anxiety	Self-help guides and videos with strategies for addressing anxiety	Students	No
Anxiety	https://www.google.ca/search?source=hp&ei=8HHqXvWPEoTI_QaBhq_QAg&q=how+to+practice+buddhist+walking+meditation&oq=ow+to+practice+buddist+walking+med&gs_lcp=CgZwc3ktYWIQARgAMggIIRAWEB0QHjoFCAAQsQM6BQgAEIMBOgIIADoECAAQCjoECAAQDToICAAQFhAKEB46BggAEBYQHjoGCAAQDRAeOgoIABAIEA0QChAeUJYBWIQzYINAaAFwAHgAgAGbAYgBixySAQUxMi4yMpgBAKABAaoBB2d3cy13aXo&sclient=psy-ab#kpvalbx=_-XHqXplxgtu0BqDisogD32	Online video	Meditation - practice Buddist Walking Meditation	Healthcare providers	No
Anxiety	https://good2talk.ca/about/	Counselling and referrals	A free, confidential support service to talk to a professional counsellor and also receive referrals	Healthcare providers	Yes
anxiety	http://www.camh.ca/en/health-info/mental-health-and-covid-19/coping-with-stress-and-anxiety	Website	Coping strategies and personal assessment tools to help manage stress and anxiety	Healthcare providers	Yes
Anxiety	https://moodgym.com.au/	Website -paid subscription based resources	Self-directed, interactive cognitive behavioural therapy program	Healthcare providers	Yes
Anxiety	https://pg.postmd.utoronto.ca/wp-content/uploads/2020/04/RESOURCES_CAMH-Mental-Health-and-the-COVID_20Mar31.pdf	FACT sheet	Strategies for addressing mental health and stigma	physicians who are student	No
Anxiety	https://bouncebackontario.ca/	Website	Self-care - skill building activities	Healthcare providers	Yes
Anxiety	https://mindfulnessexercises.com/free-online-mindfulness-courses/	Free online mindfulness exercises	Mindfulness Exercises	Healthcare providers	No
Anxiety	https://apps.apple.com/ca/app/breathe2relax/id425720246	Free app that provides detailed info on stress	evidence-based exercise to help you breathe to reduce stress levels	Healthcare providers	No
insomnia	https://bb31a78a-5cf6-4d5b-950e-8d7723740e07.filesusr.com/ugd/021036_fb58011e60574cabaecd7b540a5e29a8.pdf?index=true	Single PDF document	Sleep strategies	Physician	No
insomnia	https://www.headspace.com/	Headspace - provides access to hundreds of online resources - partially free with limited access	Guided Meditations - tools and resources to look after the mind	Healthcare providers	Yes
insomnia	https://www.wysa.io/	Wysa-keeps track of your mood with friendly chats and helps you fight stress and anxiety with tailored tools and exercises	Friendly chats, tailored tools and exercises	Healthcare providers	Yes
insomnia	https://www.calm.com/	App for sleep, meditation, and relaxation - partially free with limited access	Meditate -	Healthcare providers	No
			Learn the life-changing skill of meditation; Sleep -
			Get more restful sleep and wake up feeling refreshed;
			Music - Exclusive music to help you focus, relax, sleep;
			Body -
			Video lessons on mindful movement and gentle stretching; Masterclass -
			Audio programs taught by world-renowned mindfulness experts;
			Scenes
			Nature scenes and sounds to enjoy while relaxing, sleeping, working or studying
insomnia	https://www.baypsychology.ca/workshops	DBT Workbook	Dialectical Behaviour Therapy (DBT) - managing feelings, skills, and emotions with tolerance	psychotherapists, social workers, physicians, and graduate level students	No
insomnia	https://www.heretohelp.bc.ca/	Virtual library for information about well-being, anxiety, eating and sleep	Self-care modules	Healthcare providers	Yes
insomnia	https://buddhify.com/	App to address sleep and stress	Meditation and Mindfulness exercises	Healthcare providers	Yes
insomnia	https://mysleepwell.ca/	Virtual information to help sleep better. Provides access to: books, apps, tools, planners, diaries, checklists, quizzes, sleep calculators	Relaxation, thoughts, and hygiene exercises	Healthcare providers	Yes
insomnia	https://insighttimer.com/	App and online community for meditation - partially free with limited access	Meditation, Music, and talks posted by contributing experts	Healthcare Providers	Yes
insomnia	https://justgetflux.com/	Free downloadable computer software to adjust lighting	Modification of light dependent on time of day to assist with sleep	Healthcare providers	No
insomnia	https://medical.mit.edu/sites/default/files/BedtimeMeditation.mp3	Audio recording of meditation to help with sleep	Meditation	Healthcare providers	No
insomnia	https://pg.postmd.utoronto.ca/wp-content/uploads/2020/04/RESOURCES_CAMH-Mental-Health-and-the-COVID_20Mar31.pdf	FACT sheet	Strategies for addressing mental health and stigma	physicians who are student	Yes
insomnia	https://medical.mit.edu/community/sleep/resources	Print and audio downloads for sleep resources	Self-care	Healthcare providers	No
well-being	https://bb31a78a-5cf6-4d5b-950e-8d7723740e07.filesusr.com/ugd/021036_d36f9fbb37e14296a38fe4bfd74939ef.pdf?index=true	Single PDF document	Mindfulness	Physician	No
well-being	https://medical.mit.edu/sites/default/files/mindful_yoga.mp3	Audio recording of Yoga session	Yoga	Healthcare providers	No
well-being	https://bb31a78a-5cf6-4d5b-950e-8d7723740e07.filesusr.com/ugd/021036_2a7949ea84d646bc83d38c5f9372e8f3.pdf?index=true	Single PDF document	Strategies to promote wellness	Physician	No
well-being	https://bb31a78a-5cf6-4d5b-950e-8d7723740e07.filesusr.com/ugd/021036_dae21e39f59147b198c270cfd108c9cb.pdf?index=true	Single PDF document	Strategies to enhance normalcy	Physician	No
well-being	https://www.headspace.com/	Headspace - provides access to hundreds of online resources - partially free with limited access	Guided Meditations - tools and resources to look after the mind	Healthcare providers	Yes
well-being	https://my.happify.com/	Happify- single destination for effective, evidence-based solutions for better mental health	Meditations and online resources - partially free with limited access	Healthcare providers	Yes
well-being	https://www.desouzainstitute.com/2020/03/24/4307/	Weekly virtual psychological support groups and 30-min virtual mindfulness groups l	Support groups	Healthcare providers	No
well-being	https://www.wysa.io/	Wysa-keeps track of your mood with friendly chats and helps you fight stress and anxiety with tailored tools and exercises	Friendly chats, tailored tools and exercises	Healthcare providers	Yes
well-being	https://www.calm.com/	App for sleep, meditation, and relaxation - partially free with limited access	Meditate -	Healthcare providers	No
			Learn the life-changing skill of meditation; Sleep -
			Get more restful sleep and wake up feeling refreshed;
			Music - Exclusive music to help you focus, relax, sleep;
			Body -
			Video lessons on mindful movement and gentle stretching; Masterclass -
			Audio programs taught by world-renowned mindfulness experts;
			Scenes
			Nature scenes and sounds to enjoy while relaxing, sleeping, working or studying
well-being	https://medical.mit.edu/sites/default/files/energize.mp3	Audio-recording	Deep Breathing - revive and energize yourself	Healthcare providers	No
well-being	https://pg.postmd.utoronto.ca/wp-content/uploads/2020/04/RESOURCES_Managing-Stress-w-COVID-19-.pdf	PDF document	Written document for Self-Care tips during and after the outbreak	physicians who are student	No
well-being	https://www.desouzainstitute.com/wp-content/uploads/Mindfulness-Flyer.pdf	30 ​min virtual mindfulness sessions offered on Mon, Tues, Wed, Thurs	Mindfulness- Drop in and	Healthcare providers	No
			learn short mindfulness practices to help find calm in
			the midst of challenge. Relax, recharge, and learn how
			to incorporate moments of mindfulness into your day
well-being	https://pg.postmd.utoronto.ca/wp-content/uploads/2020/04/FACT-SHEET_Buddy-system_20mar31.pdf	PDF Fact Sheet	Uses the Buddy System to foster the sharing of responsibilities of well-being, safety, and active support	physicians who are student	No
well-being	https://mentalhealth-covid.ca/	Free online course	Three-hour training uses case scenarios, activities, tip sheets, and reflective journals to equip frontline workers with tools and approaches to address mental health concerns in the context of a pandemic	Healthcare providers	No
well-being	https://www.dcogt.com/	Virtual telephone support	Trained volunteer responders provide confidential emotional support and crisis intervention through the phone to at-risk and vulnerable individuals from across the GTA, 24-hours a day, seven days a week.	Healthcare providers	No
well-being	https://www.pause4providers.com/	Virtual support	Mindfulness	Healthcare providers	Yes
well-being	https://www.baypsychology.ca/workshops	DBT Workbook	Dialectical Behaviour Therapy (DBT) - managing feelings, skills, and emotions with tolerance	psychotherapists, social workers, physicians, and graduate level students	No
well-being	https://camh.echoontario.ca/echo-coping-with-covid/	virtual education and capacity - building program	provides skills and resources	Healthcare providers	Yes
well-being	https://cpa.ca/corona-virus/psychservices/	Free virtual counselling with psychologists	Counselling	Healthcare providers	No
well-being	https://wellness.mcmaster.ca/app/uploads/2020/04/Online-Resources-for-Mental-Wellness-and-Social-Connection.pdf	Online (Apps and websites) resources for social connection and mental wellness during COVID-19	Apps to help with increasing social connection; promoting mental wellness; online resources for mental health; and tips for managing mental health	Healthcare providers who are students	No
well-being	https://www.heretohelp.bc.ca/	Virtual library for information about well-being, anxiety, eating and sleep	Self-care modules	Healthcare providers	Yes
well-being	https://www.cma.ca/maintaining-wellness-during-pandemic	CMA Website - wellness tips during the pandemic	Maintaining wellness through self-care	Physicians	No
well-being	https://www.ryerson.ca/content/dam/thriveru/resources/Seven%20Tips%20for%20Success%20at%20University.pdf	A PDF which outlines 7 tips for success at university	Self-care guide	Healthcare providers who are students	No
well-being	https://www.ryerson.ca/content/dam/thriveru/resources/ThriveRU-WorkBook-Fillable.pdf	A PDF workbook for weekly exercises to manage challenges and cultivate one’s well-being	Calendar workbook -self-care guide	Healthcare providers who are students	No
well-being	https://www.ryerson.ca/content/dam/thriveru/resources/SAThriveRU-Cards-web.pdf	A PDF with resilience flashcards that deal with skills for a healthy life, specific problems, situations, or areas of development	Self-care guide	Healthcare providers who are students	No
well-being	https://soundcloud.com/user-743147355-683744593/sets/thriveru-medidation-recordings	A collection of recordings for meditations	Meditation	Healthcare providers	Yes
Well-being	Keep.meSAFE	- linguistically and culturally matched licensed clinicians	Student Support Program - promoting early intervention and 24/7 access to mental health support	Healthcare providers who are students	Yes
well-being	https://www.google.ca/search?source=hp&ei=8HHqXvWPEoTI_QaBhq_QAg&q=how+to+practice+buddhist+walking+meditation&oq=ow+to+practice+buddist+walking+med&gs_lcp=CgZwc3ktYWIQARgAMggIIRAWEB0QHjoFCAAQsQM6BQgAEIMBOgIIADoECAAQCjoECAAQDToICAAQFhAKEB46BggAEBYQHjoGCAAQDRAeOgoIABAIEA0QChAeUJYBWIQzYINAaAFwAHgAgAGbAYgBixySAQUxMi4yMpgBAKABAaoBB2d3cy13aXo&sclient=psy-ab#kpvalbx=_-XHqXplxgtu0BqDisogD32	Online video	Meditation - practice Buddist Walking Meditation	Healthcare providers	No
well-being	https://boldly.joulecma.ca/home/managing-covid-19-stress-and-anxiety Website - online information Self-care guide Healthcare providers	Ontario Shores - All health care workers dealing with mental health challenges during this pandemic can get rapid access to a new service to support their resiliency and recovery.	- System Navigation	Health care providers	No
			- Crisis Planning
			- Psychoeducation
			- Brief individual therapy
			- Primary care phone consultation guidance
			- referral to prompt care clinic for most at risk
well-being	https://good2talk.ca/about/	Counselling and referrals	A free, confidential support service to talk to a professional counsellor and also receive referrals	Healthcare providers	Yes
well-being	https://bouncebackontario.ca/	Website	Self-care - skill building activities	Healthcare providers	Yes
well-being	https://www.youtube.com/watch?v=Rkz7vJOZ2HU&feature=youtu.be	Video for how to cope with COVID-19	Three steps to coping with COVID-19 - Problem, Emotion, Meaning	Healthcare providers	No
well-being	http://www.cookspiration.com/	An application for cooking based on mood and time of day	Recipes and meal planner	Healthcare providers	Yes
well-being	https://www.theawakenetwork.com/free-online-meditation-resources-for-the-time-of-social-distancing/	Awake Network	Meditation - Free Online Meditation Resources for Times of Social Distancing/COVID-19	Healthcare Providers	Yes
well-being	https://www.bigwhitewall.com/?lang=en-ca	Online community	Online peer support community with online resources and conversation with practitioners	Healthcare providers	Yes
well-being	https://mindfulnessexercises.com/free-online-mindfulness-courses/	Free online mindfulness exercises	Mindfulness Exercises	Healthcare providers	No
well-being	https://www.youtube.com/playlist?list=PL1A11CDC25D710702	Collection of Youtube videos	Yoga	Healthcare providers	No
well-being	https://store.samhsa.gov/product/Taking-Care-of-Your-Behavioral-Health-Tips-for-Social-Distancing-Quarantine-and-Isolation-During-an-Infectious-Disease-Outbreak/PEP20-01-01-007	Virtual resources for taking care of your behavioural health	Tips for Social Distancing, Quarantine, and Isolation During an Infectious Disease Outbreak	Healthcare providers	No
well-being	https://www.youtube.com/playlist?list=PLPbDo1Dse11w1d35YNcO9cm07TfFDie8k	Collection of Youtube videos	Yoga	Healthcare providers	No
well-being	https://www.doyogawithme.com/	Collection of videos	Yoga	Healthcare providers	No
well-being	https://www.alomoves.com/	Videos - learn skills for fitness and wellness goals - $20 charge	Yoga, meditation, and fitness	Healthcare providers	No
well-being	https://www.obefitness.com/how-it-works	Live and recorded videos, along with blogs, to improve fitness - reduced fee	Yoga and exercise	Healthcare providers	No
well-being	https://www.montereybayaquarium.org/animals/live-cams	Virtual tour of Monterey Bay Aquarium	Live sightseeing attractions	Healthcare providers	No
well-being	https://zoo.sandiegozoo.org/	Virtual tour of San Diego Zoo	Live sightseeing attractions	Healthcare providers	No
well-being	https://www.cliffsofmoher.ie/	Virtual tour of the Cliffs of Moher in Ireland	Live sightseeing attractions	Healthcare providers	No
well-being	https://www.virtualvisittours.com/blarney-castle/	Virtual tour of Blarney Castle in Ireland	Live sightseeing attractions	Healthcare providers	No
well-being	https://www.google.com/maps/@28.418732,-81.5813006,3a,75y,214.73h,104.64t/data=!3m9!1e1!3m7!1svlXS5W-lSh3-0p7hbptVCA!2e0!7i13312!8i6656!9m2!1b1!2i50	Virtual tour through Google Street View of Magic Kingdom Park	Live sightseeing attractions	Healthcare providers	No
well-being	https://www.google.com/maps/@28.3691793,-81.5526231,2a,75y,193.61h,94.41t/data=!3m6!1e1!3m4!1sqPrUJV08Zb-JowNGR5tx0w!2e0!7i13312!8i6656	Virtual tour through Google Street View of Epcot	Live sightseeing attractions	Healthcare providers	No
well-being	https://www.google.com/maps/@28.3593933,-81.5605846,2a,75y,271.42h,110.06t/data=!3m6!1e1!3m4!1sUgglNL_jmY4_TpXJrU2O2w!2e0!7i13312!8i6656	Virtual tour through Google Street View of Disney’s Hollywood Studios	Live sightseeing attractions	Healthcare providers	No
well-being	https://artsandculture.withgoogle.com/en-us/national-parks-service/parks	Virtual tour of The Hidden Worlds of The Natural Parks	Live sightseeing attractions	Healthcare providers	No
well-being	https://www.metopera.org/user-information/nightly-met-opera-streams/	Virtual tour of Nightly Opera Streams by the Met opera	Online opera streams	Healthcare providers	No
well-being	https://www.broadwayhd.com/	Virtual tour of Broadway tunes	Online Broadway Streaming Service	Healthcare providers	No
well-being	https://artsandculture.google.com/story/1gJiszMqltReJA	Virtual tour dramatic stages around the world	Sightseeing attractions	Healthcare providers	No
well-being	10 Museums You Can Explore Right Here, Right Now	Virtual tour of 10 Museums from around the world	Sightseeing attractions	Healthcare providers	No
well-being	https://ca.portal.gs/	Wellness Together Canada website	Get connected to mental health and substance use support, resources, and counselling with a mental health professional	Healthcare provider	No
well-being	https://www.virusanxiety.com/	A website and app by Shine - articles, meditations, mindfulness, expert connections, relaxation exercises	Free online toolkit with resources to promote mental wellness and health	Healthcare providers	Yes
Well-being	http://www.camh.ca/-/media/images/all-other-images/covid-19-professionals/tidesinfosheetselfmanagement-pdf.pdf?la=en&hash=12B507DB7D7AAEBA172F2AB9883A94B5853C1CE4	Online PDF	Strategies for well-being and resilience	Healthcare providers	Yes
well-being	https://medical.mit.edu/sites/default/files/progressive_relaxation.mp3	Audio recording of progressive relaxation meditative exercises	Meditation	Healthcare providers	No
well-being	https://ephysicianhealth.com/	Virtual podcasts and modules for mental health, weight, nutrition, and fitness	eLearning modules for self-care with mental and physical health	Physicians and medical students	No
physical function	https://www.headspace.com/	Headspace - provides access to hundreds of online resources - partially free with limited access	Guided Meditations - tools and resources to look after the mind	Healthcare providers	Yes
physical function	https://my.happify.com/	Happify- single destination for effective, evidence-based solutions for better mental health	Meditations and online resources - partially free with limited access	Healthcare providers	Yes
physical function	https://www.calm.com/	App for sleep, meditation, and relaxation - partially free with limited access	Meditate -	Healthcare providers	No
			Learn the life-changing skill of meditation; Sleep -
			Get more restful sleep and wake up feeling refreshed;
			Music - Exclusive music to help you focus, relax, sleep;
			Body -
			Video lessons on mindful movement and gentle stretching; Masterclass -
			Audio programs taught by world-renowned mindfulness experts;
			Scenes
			Nature scenes and sounds to enjoy while relaxing, sleeping, working or studying
physical function	https://www.baypsychology.ca/workshops	DBT Workbook	Dialectical Behaviour Therapy (DBT) - managing feelings, skills, and emotions with tolerance	psychotherapists, social workers, physicians, and graduate level students	No
physical function	https://www.corepoweryogaondemand.com/keep-up-your-practice?fbclid=IwAR3-T4eGvS1B7S2RKGV6tLoglWAobw3n6S4mYxPAq750ppu32BPxlzAZfuA	Collection of free online videos	Yoga	Healthcare providers	No
physical function	https://www.youtube.com/user/yogawithadriene/featured	A collection of youtube videos	Yoga	Healthcare providers	No
physical function	https://apps.apple.com/ca/app/calorie-counter-diet-tracker/id341232718	An APP for fitness and nutrition	Workouts and logs to track meals	Healthcare providers	No
physical function	http://www.cookspiration.com/	An application for cooking based on mood and time of day	Recipes and meal planner	Healthcare providers	Yes
physical function	https://ephysicianhealth.com/	Virtual podcasts and modules for mental health, weight, nutrition, and fitness	eLearning modules for self-care with mental and physical health	Physicians and medical students	No
physical function	https://www.heretohelp.bc.ca/	Virtual library for information about well-being, anxiety, eating and sleep	Self-care modules	Healthcare providers	Yes
physical function	https://www.youtube.com/playlist?list=PL1A11CDC25D710702	Collection of Youtube videos	Yoga	Healthcare providers	No
physical function	https://www.youtube.com/playlist?list=PLPbDo1Dse11w1d35YNcO9cm07TfFDie8k	Collection of Youtube videos	Yoga	Healthcare providers	No
physical function	https://www.doyogawithme.com/	Collection of videos	Yoga	Healthcare providers	No
physical function	https://www.youtube.com/playlist?list=PLPbDo1Dse11xWqcsIav1BEhyI3YinD5ho	Body workout and training video exercises	Exercise training	Healthcare providers	No
physical function	https://www.youtube.com/playlist?list=PLPbDo1Dse11xpxup5BaRspwYHV_Wr4vjk	Running videos	Exercise - Running	Healthcare providers	No
physical function	https://www.alomoves.com/	Videos - learn skills for fitness and wellness goals - $20 charge	Yoga, meditation, and fitness	Healthcare providers	No
physical function	https://www.obefitness.com/how-it-works	Live and recorded videos, along with blogs, to improve fitness - reduced fee	Yoga and exercise	Healthcare providers	No
physical function	https://www.orangetheory.com/en-us/athome/#open-modal	Videos	Exercise	Healthcare providers	No
Physical function	https://watch.lesmillsondemand.com/at-home-workouts	Video - workouts	Exercise	Healthcare providers	No
Physical function	https://www.fitnessblender.com/videos	Video recordings for workouts	Exercise	Healthcare providers	No
Physical function	https://ecouch.anu.edu.au/welcome	Virtual online interactive modules	Self-help strategies with cognitive, behavioural, and interpersonal therapies, as well as relaxation and physical activity techniques	Healthcare providers	Yes
resilience	https://bb31a78a-5cf6-4d5b-950e-8d7723740e07.filesusr.com/ugd/021036_d36f9fbb37e14296a38fe4bfd74939ef.pdf?index=true	PDF document	Mindfulness	Physician	No
resilience	https://www.headspace.com/	Headspace - provides access to hundreds of online resources - partially free with limited access	Guided Meditations - tools and resources to look after the mind	Healthcare providers	Yes
resilience	https://my.happify.com/	Happify- single destination for effective, evidence-based solutions for better mental health	Meditations and online resources- partially free with limited access	Healthcare providers	Yes
resilience	https://www.wysa.io/	Wysa-keeps track of your mood with friendly chats and helps you fight stress and anxiety with tailored tools and exercises	Friendly chats, tailored tools and exercises	Healthcare providers	Yes
resilience	https://camh.echoontario.ca/echo-coping-with-covid/	virtual education and capacity - building program	provides skills and resources	Healthcare providers	Yes
resilience	https://www.desouzainstitute.com/2020/03/24/4307/	Weekly virtual psychological support groups and 30-min virtual mindfulness groups l	Support groups	Healthcare providers	No
resilience	https://www.calm.com/	App for sleep, meditation, and relaxation - partially free with limited access	Meditate -	Healthcare providers	No
			Learn the life-changing skill of meditation; Sleep -
			Get more restful sleep and wake up feeling refreshed;
			Music - Exclusive music to help you focus, relax, sleep;
			Body -
			Video lessons on mindful movement and gentle stretching; Masterclass -
			Audio programs taught by world-renowned mindfulness experts;
			Scenes
			Nature scenes and sounds to enjoy while relaxing, sleeping, working or studying
resilience	https://drive.google.com/file/d/1M7g7h2rV7DY5xJ0b1HbZCyIRiWzRsGfI/view?fbclid=IwAR2S3DUJuoGX34mZ87GzAn4yU2gbQUlM2t-8kMHnjav9Tll3-zzxzBsJ7fs	PDF Document	Strategies for maintaining good mental hygiene	Healthcare providers	No
resilience	https://pg.postmd.utoronto.ca/wp-content/uploads/2020/04/RESOURCES_Managing-Stress-w-COVID-19-.pdf	PDF document	Written document for Self-Care tips during and after the outbreak	physicians who are student	No
resilience	https://boldly.joulecma.ca/home/managing-covid-19-stress-and-anxiety Website - online information Self-care guide Healthcare providers	Ontario Shores - All health care workers dealing with mental health challenges during this pandemic can get rapid access to a new service to support their resiliency and recovery.	- System Navigation	Health care providers	No
			- Crisis Planning
			- Psychoeducation
			- Brief individual therapy
			- Primary care phone consultation guidance
			- referral to prompt care clinic for most at risk
resilience	https://pg.postmd.utoronto.ca/wp-content/uploads/2020/05/Psychological_FirstAid_HealthCare_COVID-19_Workbook_Final_2.pdf	Workbook	Strategies to enhance wellness focusing on: nutrition, breathing, stretching, relaxation, sensory grounding, hydration, sleep, social connection, self-compassion, anxiety exercises, relationship building	physicians who are student	No
resilience	https://www.desouzainstitute.com/wp-content/uploads/Mindfulness-Flyer.pdf	30 ​min virtual mindfulness sessions offered on Mon, Tues, Wed, Thurs	Mindfulness- Drop in and	Healthcare providers	No
			learn short mindfulness practices to help find calm in
			the midst of challenge. Relax, recharge, and learn how
			to incorporate moments of mindfulness into your day
resilience	http://www.camh.ca/-/media/images/all-other-images/covid-19-professionals/tidesinfosheetselfmanagement-pdf.pdf?la=en&hash=12B507DB7D7AAEBA172F2AB9883A94B5853C1CE4	Online PDF	Strategies for well-being and resilience	Healthcare providers	No
resilience	https://pg.postmd.utoronto.ca/wp-content/uploads/2020/04/TIPS_Keeping-healthy-w-COVID-19_20mar31.pdf	MD-led virtual chats and PDF document providing	Steps to promoting resilience	physicians who are student	No
resilience	https://pg.postmd.utoronto.ca/wp-content/uploads/2020/04/FACT-SHEET_Buddy-system_20mar31.pdf	PDF Fact Sheet	Uses the Buddy System to foster the sharing of responsibilities of well-being, safety, and active support	Physicians who are students	No
resilience	https://www.baypsychology.ca/workshops	DBT Workbook	Dialectical Behaviour Therapy (DBT) - managing feelings, skills, and emotions with tolerance	psychotherapists, social workers, physicians, and graduate level students	No
resilience	https://www.albertahealthservices.ca/topics/Page17019.aspx	Text4Hope - free service providing three months of daily CBT–	Cognitive Behavioural Therapy (CBT)–based text messages written by mental health therapists.	Healthcare providers -in Alberta	Yes
resilience	https://theworkingmind.ca/sites/default/files/twm_self-care-resilience-guide.pdf	A PDF document with external resources linked	Self-care guide and workbook	Healthcare providers	No
resilience	https://ephysicianhealth.com/	Virtual podcasts and modules for mental health, weight, nutrition, and fitness	eLearning modules for self-care with mental and physical health	Physicians and medical students	No
resilience	https://www.calm.auckland.ac.nz/index.html	A collection of text-based, audio, and video resources - partially free with limited access	Computer assisted learning self-care strategies - to manage stress, depressive symptoms, anxiety, and promote resilience	Healthcare providers	No
resilience	https://cdn.dal.ca/content/dam/dalhousie/pdf/faculty/medicine/departments/core-units/resident-affairs/The%20Basics%20Strategies%20for%20coping%20with%20stress%20and%20building%20resilience.pdf	PDF document outlining Basics Strategies for coping with stress & building resilience for mental health support	Self-care guide	Physicians	No
resilience	https://www.ryerson.ca/content/dam/thriveru/resources/10%20tips%20for%20resilience.pdf	A PDF on 10 tips for resilience	Self-care	Healthcare providers who are students	No
resilience	https://www.ryerson.ca/content/dam/thriveru/resources/SAThriveRU-Cards-web.pdf	A PDF with resilience flashcards that deal with skills for a healthy life, specific problems, situations, or areas of development	Self-care guide	Healthcare providers who are students	No
resilience	https://www.google.ca/search?source=hp&ei=8HHqXvWPEoTI_QaBhq_QAg&q=how+to+practice+buddhist+walking+meditation&oq=ow+to+practice+buddist+walking+med&gs_lcp=CgZwc3ktYWIQARgAMggIIRAWEB0QHjoFCAAQsQM6BQgAEIMBOgIIADoECAAQCjoECAAQDToICAAQFhAKEB46BggAEBYQHjoGCAAQDRAeOgoIABAIEA0QChAeUJYBWIQzYINAaAFwAHgAgAGbAYgBixySAQUxMi4yMpgBAKABAaoBB2d3cy13aXo&sclient=psy-ab#kpvalbx=_-XHqXplxgtu0BqDisogD32	Online video	Meditation - practice Buddist Walking Meditation	Healthcare providers	No
resilience	https://www.youtube.com/watch?v=Rkz7vJOZ2HU&feature=youtu.be	Video for how to cope with COVID-19	Three steps to coping with COVID-19 - Problem, Emotion, Meaning	Healthcare providers	No
resilience	https://www.theawakenetwork.com/free-online-meditation-resources-for-the-time-of-social-distancing/	Awake Network	Meditation - Free Online Meditation Resources for Times of Social Distancing/COVID-19	Healthcare Providers	Yes
resilience	https://wellness.mcmaster.ca/app/uploads/2020/04/Online-Resources-for-Mental-Wellness-and-Social-Connection.pdf	Online (Apps and websites) resources for social connection and mental wellness during COVID-19	Apps to help with increasing social connection; promoting mental wellness; online resources for mental health; and tips for managing mental health	Healthcare providers	No
resilience	https://mindfulnessexercises.com/free-online-mindfulness-courses/	Free online mindfulness exercises	Mindfulness Exercises	Healthcare providers	No
resilience	https://well.blogs.nytimes.com/2013/05/09/the-scientific-7-minute-workout/	New York Times article	Scientific 7 ​min workout	Healthcare providers	No
resilience	https://cpa.ca/corona-virus/psychservices/	Free virtual counselling with psychologists	Counselling	Healthcare providers	No
resilience	https://ca.portal.gs/	Wellness Together Canada website	Get connected to mental health and substance use support, resources, and counselling with a mental health professional	Healthcare provider	No
resilience	https://www.virusanxiety.com/	A website and app by Shine - articles, meditations, mindfulness, expert connections, relaxation exercises	Free online toolkit with resources to promote mental wellness and health	Healthcare providers	Yes
post-traumatic stress disorder	https://www.headspace.com/	Headspace - provides access to hundreds of online resources - partially free with limited access	Guided Meditations - tools and resources to look after the mind	Healthcare providers	Yes
post-traumatic stress disorder	https://pg.postmd.utoronto.ca/wp-content/uploads/2020/04/RESOURCES_Managing-Stress-w-COVID-19-.pdf	PDF document	Written document for Self-Care tips during and after the outbreak	physicians who are students	No
post-traumatic stress disorder	https://apps.apple.com/ca/app/breathe2relax/id425720246	Free app that provides detailed info on stress	evidence-based exercise to help you breathe to reduce stress levels	Healthcare providers	No
Post-traumatic stress disorder	https://www.veterans.gc.ca/eng/resources/stay-connected/mobile-app/ptsd-coach-canada	App	learn about and manage symptoms that can occur after trauma	Healthcare providers	No
depressive symptoms	https://www.headspace.com/	Headspace - provides access to hundreds of online resources - partially free with limited access	Guided Meditations - tools and resources to look after the mind	Healthcare providers	Yes
Depressive symptoms	https://boldly.joulecma.ca/home/managing-covid-19-stress-and-anxiety Website - online information Self-care guide Healthcare providers	Ontario Shores - All health care workers dealing with mental health challenges during this pandemic can get rapid access to a new service to support their resiliency and recovery.	- System Navigation	Health care providers	No
			- Crisis Planning
			- Psychoeducation
			- Brief individual therapy
			- Primary care phone consultation guidance
			- referral to prompt care clinic for most at risk
depressive symptoms	https://www.sanvello.com/	Sanvello- provides access to online resources	Self-care, peer support, coaching, therapy	Healthcare providers	Yes
depressive symptoms	https://www.wysa.io/	Wysa-keeps track of your mood with friendly chats and helps you fight stress and anxiety with tailored tools and exercises	Friendly chats, tailored tools and exercises	Healthcare providers	Yes
depressive symptoms	https://www.calm.com/	App for sleep, meditation, and relaxation - partially free with limited access	Meditate -	Healthcare providers	No
			Learn the life-changing skill of meditation; Sleep -
			Get more restful sleep and wake up feeling refreshed;
			Music - Exclusive music to help you focus, relax, sleep;
			Body -
			Video lessons on mindful movement and gentle stretching; Masterclass -
			Audio programs taught by world-renowned mindfulness experts;
			Scenes
			Nature scenes and sounds to enjoy while relaxing, sleeping, working or studying
depressive symptoms	https://www.albertahealthservices.ca/topics/Page17019.aspx	Text4Hope - free service providing three months of daily CBT–	Cognitive Behavioural Therapy (CBT)–based text messages written by mental health therapists.	Healthcare providers -in Alberta	Yes
depressive symptoms	https://www.youtube.com/playlist?list=PLPbDo1Dse11ysp2ugMFNgqaHdJJH6Tpzq	Collection of guided meditation videos	Meditation	Healthcare providers	No
depressive symptoms	https://www.betterhelp.com/helpme/?utm_source=AdWords&utm_medium=Search_PPC_c&utm_term=free+trial+betterhelp_e&utm_content=25637168530&network=g&placement=&target=&matchtype=e&utm_campaign=177007450&ad_type=text&adposition=&gclid=Cj0KCQjw-r71BRDuARIsAB7i_QPw5hsn-ai4sNg2erPpG_KZruR8rRiOr3e1p8518xn5Co2BYvr7C1MaApb2EALw_wcB&not_found=1&gor=helpme	Virtual counselling - free for a limited time	Therapy counselling	Healthcare providers	No
depressive symptoms	https://www.calm.auckland.ac.nz/index.html	A collection of text-based, audio, and video resources - partially free with limited access	Computer assisted learning self-care strategies - to manage stress, depressive symptoms, anxiety, and promote resilience	Healthcare providers	No
depressive symptoms	https://ecouch.anu.edu.au/welcome	Virtual online interactive modules	Self-help strategies with cognitive, behavioural, and interpersonal therapies, as well as relaxation and physical activity techniques	Healthcare providers	Yes
depressive symptoms	https://www.youtube.com/watch?v=VYs05qPycYQ	Youtube video	Self-help videos and strategies to address depression	Healthcare providers	No
depressive symptoms	https://www.youtube.com/watch?v=XiCrniLQGYc	Youtube video	Self-help videos and strategies to address depression	Healthcare providers	No
depressive symptoms	https://good2talk.ca/about/	Counselling and referrals	A free, confidential support service to talk to a professional counsellor and also receive referrals	Healthcare providers	Yes
depressive symptoms	https://bouncebackontario.ca/	Website	Self-care - skill building activities	Healthcare providers	Yes
depressive symptoms	https://moodgym.com.au/	Website -paid subscription based resources	Self-directed, interactive cognitive behavioural therapy program	Healthcare providers	Yes

Data analysis

Following the data collection, descriptive analysis was conducted to describe the findings based on data type that included: type of resources listed (i.e. behavioural therapy, physical exercise, mindfulness, meditation, yoga, deep breathing, relaxation therapy); type of mental health symptom addressed (stress, anxiety, insomnia, well-being, physical function, resilience, post-traumatic stress disorder, depressive symptoms); format for resources delivery (i.e. website written information, video, audio recordings, online workshop/modules); access to resources, that is was the resources (direct link access; need to go through several links to access resources); cost of resources (free, partially free with limited access, payment required), intended audience (healthcare providers, students inclusive of healthcare providers who are concurrently enrolled as students, specific cohort of healthcare providers) for number and type of components associated with the intervention, and whether or not resources were designed and/or evaluated based on evidence as indicated through reporting or referencing of evaluation (yes, no).

Results

Resources commonly listed for each symptom

In total, 137 mental health resources were identified. Many of the resources addressed more than one symptom: well-being (n ​= ​58), stress (n ​= ​50), anxiety (n ​= ​37), resilience (n ​= ​32), physical function (n ​= ​21), depressive symptoms (n ​= ​15), insomnia (n ​= ​12), and post-traumatic stress disorder (n ​= ​4). The ten most common types of mental health resources included: meditation (15.3%, n ​= ​21), mindfulness (11.7%, n ​= ​16), virtual scenic tours (n ​= ​15; 10.9%), physical exercise (n ​= ​13; 9.5%), yoga (n ​= ​12; 8.8%), relaxation therapy (n ​= ​10; 7.3%), counselling/chats (n ​= ​6; 4.5%), self-care information (n ​= ​5; 3.6%), deep breathing (n ​= ​4; 2.9%), and cognitive behavioural therapy (n ​= ​4; 2.9%) (Table 2).

Table 2

Types of psychological resources.

Type of psychological resources and/or support	Frequency count (n, %)
Meditation	21, 15.3
Mindfulnes	16, 11.7
Virtual Tour	15; 10.9
Physical Exercise	13; 9.5
Yoga	12; 8.8
Relaxation therapy	10; 7.3
Counselling	6; 4.5
Self-care information	5; 3.6
Deep breathing	4; 2.9
Cognitive behavioural therapy	4; 2.9
Stretching	2; 1.5
Sleep hygiene activitie	2; 1.5
Music	2; 1.5
Planner	2; 1.5
Sleep/assignment calculator	2; 1.5
Peer support	2; 1.5
Dialectical behaviour therapy	1; 0.7
Tailored tool	1; 0.7
Crisis planning	1; 0.7
Psychoeducation	1; 0.7
Brief individual therapy	1; 0.7
Phone consultation guidance	1; 0.7
Referral to prompt care clinic for most at risk	1; 0.7
Buddy system	1; 0.7
Online toolkit with multiple resource	1; 0.7

Evidence based resources

Less than a quarter (n ​= ​24; 17.5%) of the resources were identified as having been evaluated and/or designed based on evidence (Table 1). These resources addressed all of the mental health symptoms listed. They also included many popular apps (i.e. happify, headspace, wysa), websites (i.e. virusanxiety, moodgym, here2help, cookspiration, awake network, bigwhitewall), and written documents (i.e. WHO COVID-19 PDF resources).

Access to resources

The search on clinical and academic websites required navigating through a number of screens, online advertisements, as well as the clicking through various links before being able to access the intervention. Many of the interventions were obscure and were not readily available. Several sites required users to read onerous text, followed by an online registration before being provided with access to online mental health resources. This was especially true for academic websites, in which users had to search several sites before being able to find resources.

Characteristics of resources identified

The majority of resources were provided in combined formats (n ​= ​70, 51.0%) that included various combinations of online, audio, video, and telephone chats. Just over 25% (n ​= ​35) of these resources were delivered by video, with ten (7.2%) provided in PDF or online written text format, nine (6.5%) provided through audio recordings, four (2.9%) through e-learning modules and one (0.7%) through online workshops. The vast majority (n ​= ​115; 83.9%) of resources were only accessible by navigating through a number of links. For the most part, the (n ​= ​130; 94.8%) interventions were free. However, a small (n ​= ​7; 5.1%) number of resources provided limited access to resources with payment required to access the full scope of the intervention; and one (0.9%) intervention required full payment to access resources. Healthcare providers, that consisted primarily of nurses (n ​= ​110; 80.2%), students inclusive of healthcare providers who are concurrently enrolled as students (n ​= ​18; 13.1%), and specific cohorts of healthcare providers that included: psychotherapists, social workers, physicians, and graduate level students (n ​= ​7; 5.1%) were the target audience for the design and delivery of the mental health interventions.

Discussion and limitations

It appears, well-being, stress, anxiety and resilience were the most prevalent symptoms that were addressed in the mental health resources that were identified. However, of concern, is the significant number of resources that are online that have not been designed based on evidence or even been evaluated to determine their effectiveness in addressing mental health symptoms. This is worrisome as these resources that are being put forward may not be based on the best evidence and may result in potentially harmful situations for users as well as ineffective. Thus, being able to create and maintain an up-to-date database of evidence informed mental health resources is critical for this cohort of frontline health care providers, who may not have the knowledge or time to determine the validity and reliability of these resources in advance of integrating them into their daily routines.

Furthermore, the difficulty associated with navigating through multiple screens, having information being embedded within various pages, and the need to subscribe prior to being able to readily identify mental health resources are of concern, as students who are experiencing moderate to high levels of stress, anxiety, and depression have been shown to have significantly reduced levels of cognitive functioning, self-esteem, and academic performance (Bayram and Bilgel, 2008; Dyrbye et al., 2006). Thus, if this cohort who is already experiencing high levels of stress, anxiety, and depression; are being required to navigate through arduous, time-consuming webpages in order to seek mental health resources, the act of navigating through various webpages or reading volumes of information may result in increased psychological burden leading to exacerbation of existing mental health condition and the abandonment of seeking resources. As well, in some instances, many sites were no longer active which can result in increased stress and anxiety among users.

Moreover, all academic sites provided general information about COVID-19 and strategies to reduce spread and transmission that included maintaining safe social distance, wearing a face mask, and need to wash hands frequently; however, specific mental health resources designed to address the psychological challenges associated with COVID-19 were not readily available. Instead, users were referred to existing psychological interventions which may or may not be relevant to the COVID-19 experience. Thus, users were required to filter through resources to identify relevant interventions that addressed their specific mental health concerns. This is of continued concern, as health care providers working on the frontlines and who are concurrently enrolled in post-secondary education programs may not have the time or the energy to spend reviewing or even assessing resources.

In spite of the challenges associated with accessing resources, many of the interventions that were identified addressed a number of psychological symptoms and were easy to implement. As well, even though over three quarters of the resources (i.e. webpages, applications [Apps], education material) identified, were not empirically evaluated; it was noted, following a review of the research literature that the majority of the individual mental health strategies (i.e. exercise, relaxation, meditation, etc …) contained within the resources identified, have been evaluated on numerous occasions; and have demonstrated effectiveness in enhancing various aspects of an individual’s mental health. Meditation and mindfulness were the most common types of online psychological interventions. Both of these interventions, in addition to deep breathing, and relaxation therapy have been shown to significantly reduce overall level of psychological stress, anxiety, depression, and post-traumatic stress; while enhancing well-being and sleep (Keng et al., 2011); and thus, appears to be the two most comprehensive, well established strategies for addressing mental health challenges. Furthermore, yoga, stretching, and physical exercise (Auty et al., 2017), counselling, phone consultation, referral to clinics, peer support, dialectical behaviour therapy, cognitive behavioural therapy (Van Zyl et al., 2020), and the use of a buddy system (Hall et al., 2018) have been shown to enhance resilience and psychological well-being. Music therapy (Son et al., 2019) has demonstrated effectiveness in reducing stress, anxiety, and depression; while self-care information, tailored tools, crisis planning, and psychoeducational interventions (Holman, Johnson, O’Connor, 2018) have demonstrated effectiveness in enhancing overall psychological wellbeing. Finally, sleep hygiene strategies have demonstrated effectiveness in enhancing sleep (Espie et al., 2016) while virtual tours have been effective in addressing stress and psychological wellbeing (Smith, 2019). The use of a sleep/assignment calculator and brief individual therapy appear to be the only two psychological interventions that have not been evaluated within the empirical literature.

Lastly, many of the psychological interventions that are offered using App based technology (i.e. calm, headspace, happify, insight times, my.life) were advertised on their homepage as being free of charge, however, after scrolling through the various Apps, it became apparent that a basic version with limited functionality was being provided free of charge. Access to the more in-depth version of the resource required payment on a monthly basis. This expense may add to existing levels of psychological distress.

In terms of limitations, since the reviewers did not have institutional access to all clinical/academic internally facing intranet sites, they were not aware of current intervention studies addressing stress/fatigue/wellbeing and thus, may have excluded potentially relevant sources of information.

Implications

Research implications

Based on the findings from this rapid review it appears under a quarter of the mental health resources listed were rigorously evaluated and found to be effective in obtaining desired results. However, the translation of this evidence into the real world and examination of these interventions under unique/novel circumstances have not been evaluated. That is, the evaluation of these interventions in the context of COVID-19 have not been conducted. Also, determining the comparative effectiveness of these interventions, as implemented in the real world have yet to be examined. Thus, the empirical evidence that was reported in research studies needs to be moved to the bedside to determine whether or not the interventions that were found to be effective are indeed clinically meaningful. That is, the actual extent of psychological change is in fact meaningful to individuals, whether this change makes a real difference in their lives, how long the effects of the change lasts, whether the change is deemed acceptable, the cost effectiveness of the change and the psychological intervention, and ease of implementation of recommended strategy (Sekhon et al., 2017). Furthermore, evaluating the effectiveness of these interventions and the various delivery methods for various categories of health care providers who are students should also be considered.

Clinical implications

Clinically, healthcare organizations should consider actively promoting evidence informed mental health resources, as this will encourage FLHCP to use resources which may ultimately produce a positive effect on their overall mental health, thus, likely increase work performance, reduce sick time, while enhancing patient outcomes. Ensuring these resources are available through local employee assistance programs is one approach employers can use to increase access and promote use of these resources, while maintaining employee confidentiality.

Health care organizations can also consider applying some of the recommended strategies into the clinical setting. For example, creating a meditation or yoga space for FLHCP to use while on break; creating and disseminating posters, flyers, and/or brochures that promote deep breathing and relaxation while at work; or sending emails messages with visual imagery to promote calm, and reduce stress throughout the workday.

Additionally, health care organizations can consider cataloging available resources in easy to find and navigate, dedicated spaces on their intranet sites, and possibly formally partnering or subscribing to certain high quality apps or on-line programs to increase visibility and usage of mental health supports.

Conclusions

There is increase awareness in terms of the need for mental health resources for FLHCP who are concurrently enrolled in a university program. Even though a significant number of mental health resources are available, it is unclear if the listed strategies are evidence-based. The purpose of this rapid review was to determine which of the strategies or therapies presented among the resources were evidence-based, thus, having the potential to benefit this cohort. Over one hundred mental health online resources were identified; however approximately, less than a quarter were developed based on evidence or were empirically evaluated. Continued evaluation of online mental health resources is required, as well as the need to determine the effectiveness of these resources within the context of COVID-19. For those resources that have been evaluated, it is suggested that healthcare organizations work towards increasing the awareness of these resources and consider integrating many of the recommended mental health strategies into the healthcare work environment to mitigate staff shortages, reduce sick time, and enhance patient outcomes.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Declaration of competing interest

The authors attest there are no known conflict of interests or competing interests to declare for the manuscript titled “Identifying evidence informed psychological interventions during the COVID-19 pandemic: Rapid review of the literature” that was transferred to Brain, Behaviour, and Immunity - Health.