Effectiveness of telerehabilitation based positive psychological interventions for metropolitan residents with stress: A randomized controlled trial

Urban populations increasingly face psychological stress due to fast-paced lifestyles, environmental stimulation, long work hours, traffic congestion, and noise pollution. Scalable digital mental health and telehealth stress-management interventions are therefore essential to improve psychological well-being and resilience. This randomized controlled trial evaluated a telerehabilitation-based Positive Psychological Intervention (PPI) designed for young urban adults. The remote program incorporated evidence-based mindfulness training, gratitude exercises, and strength-based positive psychology strategies. A total of 406 participants aged 21-35 years in Chennai with baseline Perceived Stress Scale (PSS-10) scores of 14-40 were equally assigned to experimental (telerehabilitation PPI) and control (telerehabilitation Benson Relaxation Technique) groups. Sessions were delivered for 1.5 hours per day, three days weekly, over 12 weeks. Outcomes assessed using salivary cortisol biomarkers and PSS-10 showed significant stress reduction in both groups. These findings highlight telerehabilitation as an effective e-mental health, remote stress-reduction, and urban mental-wellness strategy supporting accessible telehealth-based psychological care.