Feasibility, acceptability, and efficacy of a positive emotion regulation intervention to promote resilience for healthcare workers during the COVID-19 pandemic: A randomized controlled trial

Judith Tedlie Moskowitz; Kathryn L. Jackson; Peter Cummings; Elizabeth L. Addington; Melanie E. Freedman; Jacquelyn Bannon; Cerina Lee; Thanh Huyen Vu; Amisha Wallia; Lisa R. Hirschhorn; John T. Wilkins; Charlesnika Evans

doi:10.1371/journal.pone.0305172

Peer Review History

Original SubmissionOctober 2, 2023
13 Nov 2023 Decision Letter - Mohammed Amir Rais, Editor PONE-D-23-29506Feasibility, acceptability, and efficacy of a positive emotion regulation intervention to promote resilience for healthcare workers during the COVID-19 pandemic: A randomized controlled trialPLOS ONE Dear Dr. Moskowitz, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Dec 28 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Mohammed Amir Rais, DMD Academic Editor PLOS ONE Journal requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. We note that you have indicated that data from this study are available upon request. PLOS only allows data to be available upon request if there are legal or ethical restrictions on sharing data publicly. For information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. In your revised cover letter, please address the following prompts: a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially identifying or sensitive patient information) and who has imposed them (e.g., an ethics committee). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent. b) If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings as either Supporting Information files or to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. Please see http://www.bmj.com/content/340/bmj.c181.long for guidelines on how to de-identify and prepare clinical data for publication. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. We will update your Data Availability statement on your behalf to reflect the information you provide. 3. Please include your full ethics statement in the ‘Methods’ section of your manuscript file. In your statement, please include the full name of the IRB or ethics committee who approved or waived your study, as well as whether or not you obtained informed written or verbal consent. If consent was waived for your study, please include this information in your statement as well. 4. Please include a separate caption for each figure in your manuscript. 5. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. 6. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Additional Editor Comments: Hi! Please read carefully reviewers remarks and correct your paper in 10 days and send it back. Thanks [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: No ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: No Reviewer #2: Yes Reviewer #3: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: This manuscript is written well and has good corelation. But I recommend to add some valid points before acceptance of this paper. Add the characteristis of participants in tabulated form. Add the conclusion, after discussion. Also write the future prospectives of this study. Reviewer #2: In general, this research work is quite strong and could provide robust evidence to this area of research Abstract: In the background section of abstract, authors need to include a “Specific” objective for the trial. In the methods section of the abstract, authors should provide information on the number of participants, setting and few details on the intervention and statistical methods used in analysis. Introduction: This section is very well-written. Methods: In line 193, the authors referred to time using two labels (T1 and T2). It was not added explicitly what does each of the two Ts denote? In line 206, what did authors mean by “Combined sample”? Also, there are some words repeated in those few lines to be rephrased. Results and Discussion sections are very well written However, in the CONSORT diagram, I am a bit confused how did the number of HCWs increased in PARK NOW gp. from 122 at T2 to 184 at T3? Also in Fig. 2a it was clear that the primary outcome has fallen in PARK NOW group between T2 and T3. Authors need to elaborate in that in their discussion and recommendation sections. In Table 3 and 4, authors need to add confidence intervals for changes occurring in different variables in study gps. I recommend Authors would add at least two clear conclusions based on the research findings. Reviewer #3: Add statistics to the abstract in addition to the significance /non-significance. Better name the model as “ linear mixed-effects model” or “linear mixed model”. Be consistent with the model name throughout the text. You can not “independently” add a moderator to the model. T score is not clearly explained. Since LSM is the estimate for primary analysis, better report it in the tables. The flow chart is not clear to me. Omit usage weeks. Add reasons for number changes and add numbers for analysis. See examples in the journal. It is hard to see which groups have more changes in figures 2b and 3b which can be omitted. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes: Kanwal Irshad Reviewer #2: No Reviewer #3: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0305172.r001
Revision 1
22 Dec 2023 Author Response Response to reviewers and editors are included in the response to reviewers document and also pasted here: We appreciate the editor and reviewers’ comments and have revised the manuscript accordingly. We address each comment below. Thank you for your time and attention. Reviewer #1: This manuscript is written well and has good corelation. But I recommend to add some valid points before acceptance of this paper. • Add the characteristis of participants in tabulated form. See Table 2. • Add the conclusion, after discussion. We have added a conclusion section to the Discussion. • Also write the future prospectives of this study. We have added a sentence about future work to the conclusion section. Reviewer #2: In general, this research work is quite strong and could provide robust evidence to this area of research Abstract: • In the background section of abstract, authors need to include a “Specific” objective for the trial. We have added an objective sentence to the abstract. • In the methods section of the abstract, authors should provide information on the number of participants, setting and few details on the intervention and statistical methods used in analysis. Added to the abstract. Introduction: • This section is very well-written. Methods: • In line 193, the authors referred to time using two labels (T1 and T2). It was not added explicitly what does each of the two Ts denote? Earlier in the manuscript we describe what T1, T2, and T3 denote as follows: Baseline/T1 completed between April 1, 2022 and April 30, 2022, July 2022 (T2), and October 2022 (T3). We have reiterated this in the analysis section as requested by the reviewer. • In line 206, what did authors mean by “Combined sample”? Also, there are some words repeated in those few lines to be rephrased. We revised this section to clarify that the “combined sample” was all participants, whether randomized to PARK-Now or PARK-Later. This full sample of all participants was analyzed together to example change from the assessment just prior to starting the intervention to the assessment following the intervention (T1 to T2 for PARK-Now and T2 to T3 for PARK-Later). Results and Discussion sections are very well written • However, in the CONSORT diagram, I am a bit confused how did the number of HCWs increased in PARK NOW gp. from 122 at T2 to 184 at T3? These numbers reflect the number of participants who completed the survey at each time point. Even if they did not complete the survey at T2, they were still invited to complete the survey at T3. Thus, a number of participants who skipped the T2 survey, completed the T3 survey leading the N to increase from T2 to T3. • Also in Fig. 2a it was clear that the primary outcome has fallen in PARK NOW group between T2 and T3. Authors need to elaborate in that in their discussion and recommendation sections. • While both PARKnow and PARKlater decrease from T2 to T3, the decrease is not statistically different from 0, and the difference in decrease between the two groups is not statistically different, either. We have added this point to the results. • In Table 3 and 4, authors need to add confidence intervals for changes occurring in different variables in study gps. 95% Confidence Intervals have been added to Table 3 and Table 4. • I recommend Authors would add at least two clear conclusions based on the research findings. We have added a conclusion section to the end of the Discussion. Reviewer #3 • Add statistics to the abstract in addition to the significance /non-significance. Better name the model as “ linear mixed-effects model” or “linear mixed model”. Be consistent with the model name throughout the text. Test statistics and p-values have been added to the abstract, and language has been changed such that the term “mixed-effects linear regression” is now used throughout. • You can not “independently” add a moderator to the model This has been updated to “individually”, and specific clarification has been added to indicate that one model per moderator was run for this analysis. • T score is not clearly explained. We have added the following clarification: “Moderators originally scored on a T-score metric (i.e., PROMIS measures) were converted to theta scores (theta=(t-score-50)/10)) to provide a meaningful "zero” for effects.” • Since LSM is the estimate for primary analysis, better report it in the tables. LSM estimates are presented in all tables. Footnotes have been added to each table for additional clarification (e.g., “Note: Means provided are least-squares means estimated from the models”) • The flow chart is not clear to me. Omit usage weeks. Add reasons for number changes and add numbers for analysis. See examples in the journal. We have added to the description of Figure 1 (the flow chart) in the text. Figure 1 is the CONSORT diagram following the guidance published in 2010: Schulz KF, Altman DG, Moher D, for the CONSORT Group (2010) CONSORT 2010 Statement: Updated Guidelines for Reporting Parallel Group Randomised Trials. PLoS Med 7(3): e1000251. The usage weeks are akin to the amount of the intervention “dose” received. The numbers in the diagram correspond to the Ns analyzed at each time point. It is hard to see which groups have more changes in figures 2b and 3b which can be omitted. We have omitted the waterfall plots in the main text (Figures 2b and 3b) as well as the supplementary data section. When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf We have double-checked to make sure the manuscript follows PLOS ONE’s style requirements. 2. We note that you have indicated that data from this study are available upon request. PLOS only allows data to be available upon request if there are legal or ethical restrictions on sharing data publicly. For information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. We have uploaded the de-identified dataset to OSF: https://osf.io/bvdu5/that and it will be made publicly available once the manuscript is accepted for publication. 3. Please include your full ethics statement in the ‘Methods’ section of your manuscript file. In your statement, please include the full name of the IRB or ethics committee who approved or waived your study, as well as whether or not you obtained informed written or verbal consent. If consent was waived for your study, please include this information in your statement as well. We have added information on the name of the IRB, the approval number, and the consent process to the Methods section. 4. Please include a separate caption for each figure in your manuscript. We have added a caption for each figure. 5. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. We have updated the in-text citations and captions for supplemental figures and tables. 6. Please review your reference list to ensure that it is complete and correct We have checked the reference list and no changes are needed. Attachments Attachment Submitted filename: PARK HCW response to reviews 12-20-23.docx https://doi.org/10.1371/journal.pone.0305172.r002
27 May 2024 Decision Letter - Mohammed Amir Rais, Editor Feasibility, acceptability, and efficacy of a positive emotion regulation intervention to promote resilience for healthcare workers during the COVID-19 pandemic: A randomized controlled trial PONE-D-23-29506R1 Dear Dr. Moskowitz We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. We appreciate your hard work and great dedication that you provided during revision to make this paper of high quality. Again, congratulations on your hard work, and looking forward to receiving other projects in future. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Mohammed Amir Rais, DMD Academic Editor PLOS ONE ********** https://doi.org/10.1371/journal.pone.0305172.r003
Formally Accepted
13 Jun 2024 Acceptance Letter - Mohammed Amir Rais, Editor PONE-D-23-29506R1 PLOS ONE Dear Dr. Moskowitz, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Mohammed Amir Rais Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0305172.r004

Open letter on the publication of peer review reports

PLOS recognizes the benefits of transparency in the peer review process. Therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. Reviewers remain anonymous, unless they choose to reveal their names.

We encourage other journals to join us in this initiative. We hope that our action inspires the community, including researchers, research funders, and research institutions, to recognize the benefits of published peer review reports for all parts of the research system.

Learn more at ASAPbio .