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Boosting positive mood in medical and emergency personnel during the COVID-19 pandemic: preliminary evidence of efficacy, feasibility and acceptability of a novel online ambulatory intervention
  1. Karin G. Coifman1,
  2. David D Disabato1,
  3. T H Stanley Seah1,
  4. Sarah Ostrowski-Delahanty2,
  5. Patrick A Palmieri3,
  6. Douglas L. Delahanty1,
  7. John Gunstad1
  1. 1 Department of Psychological Sciences, Kent State University, Kent, Ohio, USA
  2. 2 Neuro-Developmental Science Center, Akron Children’s Hospital, Akron, Ohio, USA
  3. 3 Traumatic Stress Center, Summa Health System, Akron, Ohio, USA
  1. Correspondence to Dr Karin G. Coifman, Department of Psychological Sciences, Kent State University, Kent, OH 44242, USA; kcoifman{at}


Objectives The aim of this project was to test the efficacy of a brief and novel online ambulatory intervention aimed at supporting psychological health and well-being for medical personnel and first responders during the COVID-19 pandemic.

Methods Interested participants, n=28, actively employed as medical personnel, support staff and emergency responders, in the Midwestern USA in May–June of 2020, provided informed consent and were randomised to complete either low-dose or high-dose intervention, one time daily for 1 week via smartphone application. Each daily intervention included expressive writing, adaptive emotion regulation activity and (one vs two) positive emotion-generation activities, lasting 3–6 min a day. Ratings of negative and positive emotion were provided before and after each activity daily. Analyses tested compliance, acceptability, as well as efficacy at increasing positive emotion and decreasing negative emotion with each use and across time.

Results The results indicated a 13% increase in positive emotion, t(25)=2.01, p=0.056; and decrease in negative emotion by 44%, t(25)=−4.00, p=0.001 across both doses. However, there was a clear advantage for individuals in the high-dose condition as daily boosts in positive emotion were significantly greater (an additional 9.4%) B=0.47, p=0.018. Overall, compliance was good. Acceptability ratings were good for those who completed the follow-up assessment.

Conclusion Front-line personnel, including medical staff and emergency responders, are experiencing unprecedented psychological stress during the COVID-19 pandemic. This investigation suggests both feasibility and efficacy for a brief, daily, ambulatory intervention which could provide essential psychological support to individuals at risk in the workplace.

  • COVID-19
  • mental health
  • occupational health
  • psychology

Data availability statement

Data are available upon reasonable request. This research consists of preliminary feasibility data for NCT0439827. All data and materials are available upon request to the lead author, KGC, at

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

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Data availability statement

Data are available upon reasonable request. This research consists of preliminary feasibility data for NCT0439827. All data and materials are available upon request to the lead author, KGC, at

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  • Contributors All authors contributed to the research design and manuscript development. KGC, THSS, DDD, SO-D and PAP completed data collection.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.