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An online guided ACT intervention for enhancing the psychological wellbeing of university students: A randomized controlled clinical trial
Abstract
Stress, anxiety and depression are relatively common problems among university students. A online psychological intervention aimed at enhancing the wellbeing of university students could be an effective and practical alternative for meeting the needs of a university population. University students (N = 68; 85% female; 19–32 years old) were randomly assigned to either a guided seven-week online Acceptance and Commitment Therapy (iACT) intervention or a waiting list control condition (WLC). A between-groups pre–post (iACT vs WLC) design with 12-month follow-up for the iACT participants was conducted. The intervention participants were offered two face-to-face meetings, completed online exercises during a five-week period, and received personal weekly written feedback via the website from their randomly assigned, trained student coaches. Waitlist participants were offered the intervention program soon after the post measurements. Results in this small efficacy trial showed that the iACT participants had significantly higher gains in wellbeing (between group, d = 0.46), life satisfaction (d = 0.65), and mindfulness skills (d = 0.49). In addition, iACT participants’ self-reported stress (d = 0.54) and symptoms of depression (d = 0.69) were significantly reduced compared to the participants in the control group. These benefits were maintained over a 12-month follow-up period (within iACT group, d = 0.65-0.69, for primary measures). The results suggest that an online-based, coach-guided ACT program with blended face-to-face and online sessions could be an effective and well-accepted alternative for enhancing the wellbeing of university students.
... All of the RCTs investigated the effectiveness of online psychological interventions declined in several ways: mostly programs based on online modules (e.g., [94][95][96][97][98]), websites interaction (e.g., [99]), use of mobile apps (e.g., [100]), and face-to-face meetings followed by online exercises and interaction (e.g., [101]). Only one quasi-experimental study without a control group tested the effectiveness of online counseling delivered by a physical counselor due to pandemic needs [22]. ...
... Only one quasi-experimental study without a control group tested the effectiveness of online counseling delivered by a physical counselor due to pandemic needs [22]. Except for the latter studies [22,101], all of the other programs did not require intervention delivery by a physical counselor and usually had a weekly schedule. Some of them were ACT-oriented (e.g., [97,98,101]) and CBT-based (e.g., [96,102]), offering a wide range of evidence-based techniques and options for the promotion of wellbeing and the transdiagnostic prevention of common mental disorders and psychological distress among university students (e.g., [94][95][96]). ...
... Except for the latter studies [22,101], all of the other programs did not require intervention delivery by a physical counselor and usually had a weekly schedule. Some of them were ACT-oriented (e.g., [97,98,101]) and CBT-based (e.g., [96,102]), offering a wide range of evidence-based techniques and options for the promotion of wellbeing and the transdiagnostic prevention of common mental disorders and psychological distress among university students (e.g., [94][95][96]). Automated web-based delivery and saving resources allowed the distribution of the interventions to vast and multi-national samples (e.g., [96,98,100]). ...
University counseling services (UCSs) are actively involved in mental health assessment and in supplying interventions aimed at preventing, facing and possibly overcoming psychological problems. However, we do not have a global overview of psychological counseling among universi- ties. This systematic review aims at reviewing the literature on university psychological counseling, including articles documenting: (1) mental health and attitudes regarding help-seeking behaviors and UCSs among university students or counselors, (2) the description of protocols/services among UCSs, (3) the efficacy of psychological counseling/interventions among university students (both face-to-face and internet-delivered interventions). The study followed PRISMA guidelines and was registered on PROSPERO. After defining inclusion and exclusion criteria, a literature search was conducted, identifying 7085 records. Finally, 152 articles met the review eligibility criteria and were included in the qualitative synthesis. Results are divided into seven thematic topics that emerged during the analysis of the literature. The results mainly showed that face-to-face and web-based counseling/psychological interventions improve university students’ mental health. Cross-sectional studies showed that many biases exist toward help-seeking behaviors, especially among international students. Both students and counselors must strive to overcome cultural barriers. Available resources for UCSs are scarce and need to be strengthened, as well as efficacy studies through randomized clinical trials.
... Among the included studies, 2588 adolescents were included, of which 2160 were university students [5,9,11,[25][26][27][28][29][30], 367 were secondary school students [31,32], and 61 were indigenous youths [33]. The mean age ranges from 15.27 to 26.85. ...
... A total of 5 included studies were in the targeted screening group (suffered from distress or having suicidal thoughts in the past 2 weeks), and 5 were in the universal screening group. In terms of country, 5 of the included studies were from the United States [5,11,[25][26][27], 2 from Australia [29,33], 3 from Finland [28,31,32], 1 from China [30], and 1 from Ireland [9]. Table 1 illustrates the characteristics of the participants. ...
... Five studies were at low risk of selection bias ("allocation concealment") because the random numbers generated by computers were used [5,26,27,30,33,34]. Three studies also had low risk because the assignment of these RCTs was performed by an independent researcher [28,31] or by the lead investigator using a random number table the conditional assignment of participants [9]. Four studies were considered to have unclear risks due to insufficient information [11,25,29,32]. ...
Objectives: This study reviewed published randomized controlled trials (RCTs) and evaluated the efficacy of
internet-based acceptance and commitment therapy (IACT) on adolescent mental health. Methods: Searches
were conducted in PubMed, ProQuest, APA (PsycNET/PsycINFO), and Web of Science from inception to Jan�uary 2022 to identify RCTs evaluating the effects of IACT on adolescents. The included studies were assessed
for quality and risk of bias. This study was performed using the standard mean difference and associated 95%
confidence interval of effective measures. Review Manager 5.4 software was adopted to calculate the effect size.
Results: Compared to adolescents in control groups, those in the IACT groups showed some improvement in
the efficacy of depression symptoms (SMD = −0.24, 95% CI = [−0.44, −0.05], p = 0.01) and had a small but sig�nificant effect on reducing experiential avoidance (SMD = −0.24, 95% CI = [−0.46, −0.01], p = 0.04). However, the
effect size on anxiety did not reach the threshold (SMD = −0.18, 95% CI = [−0.27, −0.09], p < 0.0001). In addition,
there were no significant differences in stress and well-being compared to those of the control group. Compared
with universal adolescents, IACT was found to have a more significant therapeutic effect on targeted adolescents.
Conclusions: IACT is effective in adolescent mental health interventions, but its clinical reliability and significant
efficacy are limited, and more rigorous RCTs are needed in future studies.
... ACT may alleviate anxiety and depression (e.g. Grégoire, Lachance, Bouffard, & Dionne, 2018;Levin et al., 2014Levin et al., , 2016Levin et al., , 2020, enhance wellbeing and decrease stress (Katajavuori, Vehkalahti, & Asikainen, 2021;Räsänen, Lappalainen, Muotka, Tolvanen, & Lappalainen, 2016), and can be used as a treatment in combination with counselling services (Levin, Hayes, Pistorello, & Seeley, 2016; see also Pistorello, 2013). In the context of international students, research on ACT remains scarce. ...
... [1] For the regressions, only those flexibility and mindfulness scales where the correlation coefficients were significant with symptom measures (PSS-10, PHQ-9 and GAD-7) were considered. Räsänen et al., 2016) as well as in international student populations (Muto et al., 2011;Xu et al., 2020). For example, our results were in line with the within-group effect sizes in the Levin et al. (2104) study (d = 0.81-0.97, ...
... With regard to adherence to workshops, we observed a low drop-out rate of 11% among the international students in this sample. A similarly low drop-out rate (9%) was reported in an earlier study that employed a similar approach to university students (Räsänen et al., 2016). Importantly, the workshop was well received by the students, who evaluated their satisfaction with an average of 8.6 of a possible 10. ...
The mental health of international students has become a concern, as they face high levels of psychological distress. We designed a five-week acceptance and commitment therapy (ACT) workshop with two additional individual assessment meetings. The intervention aimed at helping international students attending a Finnish university to reduce their symptoms of stress, depression, and anxiety, and enhance skills of psychological flexibility. The post-assessment was conducted seven weeks after the pre-measurement. Using data from 53 participants, an evaluation indicated that statistically and clinically significant reductions in symptoms were observed, and the workshop was well received. Regression analyses revealed that changes in psychological inflexibility, mindfulness, and value-based living acted as predictors of change in symptoms. Furthermore, changes in these psychological skills predicted changes in different kinds of distress. This study suggests that a brief group intervention might be a feasible alternative for enhancing the psychological well-being of international students.
... A recent systematic review of individual resource-building interventions for medical students highlighted the need for research evaluating the effectiveness of nontraditional delivery methods such as smartphone apps [21]. As medical students use smartphones frequently [63], stand-alone app-delivered interventions have the potential for cost-effective scalability [39,64] and can offset known accessibility barriers by providing anonymous and private access to medical students concerned about mental health stigma [11,32,64]. Stand-alone apps offer accessibility in times when face-to-face delivery is not an option, such as during pandemic-related lockdowns [65], and can deliver brief training components at convenient times for those with busy schedules [64,66]. ...
... A recent systematic review of individual resource-building interventions for medical students highlighted the need for research evaluating the effectiveness of nontraditional delivery methods such as smartphone apps [21]. As medical students use smartphones frequently [63], stand-alone app-delivered interventions have the potential for cost-effective scalability [39,64] and can offset known accessibility barriers by providing anonymous and private access to medical students concerned about mental health stigma [11,32,64]. Stand-alone apps offer accessibility in times when face-to-face delivery is not an option, such as during pandemic-related lockdowns [65], and can deliver brief training components at convenient times for those with busy schedules [64,66]. ...
... As medical students use smartphones frequently [63], stand-alone app-delivered interventions have the potential for cost-effective scalability [39,64] and can offset known accessibility barriers by providing anonymous and private access to medical students concerned about mental health stigma [11,32,64]. Stand-alone apps offer accessibility in times when face-to-face delivery is not an option, such as during pandemic-related lockdowns [65], and can deliver brief training components at convenient times for those with busy schedules [64,66]. Psychological skill generalization may also be enhanced because of the accessibility of training opportunities in everyday life situations [67]. ...
Background:
Physician burnout is a common problem, with onset frequently occurring during undergraduate education. Early intervention strategies that train medical students in psychological flexibility skills could support well-being and mitigate burnout risks associated with unmodifiable career stressors. There is a need for randomized controlled trials to assess effectiveness. As psychological flexibility varies contextually and among individuals, tailoring interventions may improve outcomes. Smartphone apps can facilitate individualization and accessibility, and the evaluation of this approach is an identified research priority.
Objective:
This study aimed to evaluate the effectiveness of a stand-alone app-delivered Acceptance and Commitment Training intervention for improving medical students' self-reported burnout, well-being, psychological flexibility, and psychological distress outcomes. We aimed to explore whether an individualized app would demonstrate benefits over a nonindividualized version.
Methods:
This parallel randomized controlled trial was conducted with a sample of medical students from 2 Australian universities (N=143). Participants were randomly allocated to 1 of 3 intervention arms (individualized, nonindividualized, and waitlist) using a 1:1:1 allocation ratio. Individualized and nonindividualized participants were blinded to group allocation. The 5-week intervention included an introductory module (stage 1) and on-demand access to short skill training activities (stage 2), which students accessed at their own pace. Stage 2 was either nonindividualized or individualized to meet students' identified psychological flexibility training needs.
Results:
The mean differences in change from baseline between the intervention groups and the waitlist group were not statistically significant for burnout outcomes: exhaustion (primary; individualized: -0.52, 95% CI -3.70 to 2.65, P=.75; nonindividualized: 1.60, 95% CI -1.84 to 5.03, P=.37), cynicism (individualized: -1.26, 95% CI -4.46 to 1.94, P=.44; nonindividualized: 1.00, 95% CI -2.45 to 4.46, P=.57), and academic efficacy (individualized: 0.94, 95% CI -0.90 to 2.79, P=.32; nonindividualized: 2.02, 95% CI 0.02-4.03, P=.05). Following the intervention, the individualized group demonstrated improved psychological flexibility (0.50, 95% CI 0.12-0.89; P=.01), reduced inflexibility (0.48, 95% CI -0.92 to -0.04; P=.04), and reduced stress (-6.89, 95% CI -12.01 to 5.99; P=.01), and the nonindividualized group demonstrated improved well-being (6.46, 95% CI 0.49-12.42; P=.04) and stress (-6.36, 95% CI -11.90 to -0.83; P=.03) compared with waitlist participants. Between-group differences for the individualized and nonindividualized arms were not statistically significant. High attrition (75/143, 52.4%) was observed.
Conclusions:
This trial provides early support for the potential benefits of Acceptance and Commitment Training for medical student well-being and psychological outcomes and demonstrates that psychological flexibility and inflexibility can be trained using a smartphone app. Although postintervention burnout outcomes were not statistically significant, improvements in secondary outcomes could indicate early risk mitigation. Replication studies with larger samples and longer-term follow-up are required, and future research should focus on improving implementation frameworks to increase engagement and optimize individualization methods.
Trial registration:
Australian New Zealand Clinical Trials Registry 12621000911897; https://tinyurl.com/2p92cwrw.
International registered report identifier (irrid):
RR2-10.2196/32992.
... ACT was delivered on the web with therapist guidance in 32 studies (eg, via videoconferencing, phone calls, written feedback, and a mobile app) and without therapist guidance in 7 studies [13][14][15][16][17][18][19]. A total of 8 studies used a blended ACT program involving both iACT and in-person ACT sessions [20][21][22][23][24][25][26][27]. In addition, 2 studies involved videoconferencing ACT [28,29]. ...
... Of the 39 RCTs, 10 studies involved active control groups, including web-based discussion forums [35,37,41], web-based expressive writing [32,51], web-based mental health education [17], a web-based smoking cessation intervention [14], web-based cognitive behavioral therapy (CBT) [13], in-person CBT [27], and in-person documentary discussions [25]. Moreover, 18 studies directly targeted people with depressive symptoms [14,21,[23][24][25]27,[30][31][32][33][34][35][36][37][38][39][40]. Additional subgroup analyses were conducted because studies could be categorized according to the following 3 characteristics: use of therapist guidance, delivery modes (ie, web-based ACT modules, iACT accompanied by in-person ACT sessions, and videoconferencing ACT), and use of targeted participants (eg, studies that directly targeted participants with depressive symptoms vs studies that involved participants regardless of the depressive symptoms used for subgroup analysis of depressive symptoms). ...
... but iACT was not significantly different from active control groups (1 study that involved 234 participants, SMD −0.10, 95% CI −0.35 to 0.16). [16,17,19,20,21,23,29,37,43,44,47,48]. [16,17,20,43,48]. ...
Background:
Acceptance and commitment therapy (ACT) is an empirically supported transdiagnostic approach that involves mindfulness processes and behavior change processes for valued living.
Objective:
This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to assess the efficacy of internet-based ACT (iACT) for depressive symptoms, anxiety, stress, psychological distress, and quality of life (QoL).
Methods:
PubMed, CINAHL, PsycINFO, and SCOPUS databases were searched to identify relevant RCTs published up to June 5, 2021. The included RCTs were assessed using the Cochrane Collaboration risk-of-bias tool. The use of either a random effects model or fixed effects model was determined using I2 statistic values for heterogeneity. Subgroup analyses were conducted according to the type of control group, the use of therapist guidance, delivery modes, and the use of targeted participants, when applicable.
Results:
A total of 39 RCTs met the inclusion criteria. Meta-analyses found small effects of iACT on depressive symptoms, anxiety, stress, psychological distress, and QoL at the immediate posttest and follow-up. There was no significant effect of iACT on stress at follow-up. Subgroup analyses showed small to medium effects of iACT on all the outcomes at the immediate posttest and follow-up compared with the passive control groups. In contrast, subgroup analyses that compared iACT with active control groups found no differences between groups on stress, psychological distress, and QoL at the immediate posttest or on depressive symptoms, anxiety, and stress at follow-up. In addition, subgroup analyses conducted according to the use of therapist guidance, delivery modes, and the use of targeted participants found no statistically significant subgroup differences among studies in all the outcomes, except for the subgroup difference among studies according to the use of targeted participants for depressive symptoms at the immediate posttest (ie, a statistically significant, larger effect of iACT when studies targeted people with depressive symptoms). The overall risk of bias across the studies was unclear.
Conclusions:
The findings of this study contribute to the body of evidence regarding the effects of iACT on depressive symptoms, anxiety, stress, psychological distress, and QoL and may be applicable in any population, as ACT is a transdiagnostic approach. Few studies have compared iACT with active control conditions, especially for stress and psychological distress at the immediate posttest and follow-up. In addition, the active control conditions varied among the included studies. Further high-quality studies are needed to better understand whether iACT is comparable or superior to other evidence-based interventions, such as cognitive behavioral therapy, in decreasing depressive symptoms, anxiety, stress, and psychological distress and improving QoL.
... For example, Prinz et al. (2016) found that almost 40% of elite female soccer players reported a need for professional psychological support while they still played. It has been suggested that cognitive, behavioral, and mindfulnessbased interventions, for example, acceptance and commitment therapy (ACT), are found promising and effective in decreasing psychological distress in the general population (Räsänen, Lappalainen, Muotka, Tolvanen, & Lappalainen, 2016). ACT approaches include themes such as elucidating values, committed action, staying in the present moment, acceptance, cognitive defusion, and self as context (Hayes, Strosahl, & Wilson, 2012). ...
... Superior results have been achieved through guided self-help interventions compared to self-help alone (Johansson & Andersson, 2012;Richards & Richardson, 2012). In a previous study, a guided online ACT intervention with university students indicated that ACT participants experienced greater improvements in well-being, life satisfaction, and mindfulness skills, and these effects were maintained over time (Räsänen et al., 2016). Comparing the themes of ACT to the protective factors recognized earlier among athletes, the similarity is clear. ...
... Participants in the experimental group received access to an internet-based ACT intervention (ACTi) based on Lappalainen et al., (2014Lappalainen et al., ( , 2015. The study design is in line with Räsänen et al. (2016) as it follows the same structure of the intervention (See Räsänen et al., 2016). Both groups were assessed preintervention in pre-season and one day before the first game after the intervention (postintervention, six weeks after pre-measurement). ...
This study investigated whether an internet-based intervention aimed at enhancing the psychological well-being of female soccer players before the competitive season could be effective approach to meet the needs of the players. Players (n= 43; 17–26 years old)on the four separated teams in Finland’shighest league were assigned to either a guided six-week online Acceptance and Commitment Therapy intervention (ACTi) or to a control condition (CON). A between-groups pre–post (ACTi vs. CON) design was implemented before the competitive season. Players in the ACTi were offered three group sessions, performed internet-based tasks, and were individually supported by a guide. The results demonstrated that the ACTi players maintained their sports-related well-being (between-group, d = 0.72), while the sports-related well-being of the CON players, especially emotional and social well-being, had declined. In addition, ACTi players’perceived stress (d = 0.60) and depression (d = 0.88) declined, while their psychological flexibility in sports (d = 0.41) increased compared to the CON players. These results suggest that before the competitive season, players’ sports-related well-being decreases. The ACT intervention seemed to prevent this decrease and provide players with the skills to cope with emotional and social stressors related to the competitive season.
... ACT was delivered on the web with therapist guidance in 26 studies (eg, via videoconferencing, phone calls, written feedback, and a mobile app) and without therapist guidance in 8 studies [25][26][27][28][29][30][31][32]. A total of 7 studies used a blended ACT program, which involved both iACT and in-person sessions [33][34][35][36][37][38][39][40]. A total of 3 studies involved videoconferencing ACT [41,42]. ...
... Out of a total of 34 studies, 11 (32%) involved active control groups, including web-based cognitive behavioral therapy (CBT) [25], web-based smoking cessation interventions [26,27], web-based discussion forums [44,45,57], web-based mental health education [30], in-person behavioral support [35], web-based expressive writing [48,55], and in-person documentary discussion [38]. The population of the included studies varied widely, including college students [8,[29][30][31][32]36,47,54], adults with chronic pain [37,39,52,[55][56][57], family caregivers of people with chronic conditions [42,49,50,53], adults with insomnia [28,33,41], and smokers [26,27,35] (refer to Multimedia Appendix 2 for these different participant characteristics in the included studies). A total of 14 studies directly targeted people with certain types of psychological distress, such as depressive symptoms, anxiety, stress, and overall psychological distress [8,27,33,[36][37][38][39]42,[44][45][46][47][48][49]. ...
... The population of the included studies varied widely, including college students [8,[29][30][31][32]36,47,54], adults with chronic pain [37,39,52,[55][56][57], family caregivers of people with chronic conditions [42,49,50,53], adults with insomnia [28,33,41], and smokers [26,27,35] (refer to Multimedia Appendix 2 for these different participant characteristics in the included studies). A total of 14 studies directly targeted people with certain types of psychological distress, such as depressive symptoms, anxiety, stress, and overall psychological distress [8,27,33,[36][37][38][39]42,[44][45][46][47][48][49]. ...
Background:
Acceptance and commitment therapy (ACT) is based on a psychological flexibility model that encompasses 6 processes: acceptance, cognitive defusion, self-as-context, being present, values, and committed action.
Objective:
This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to examine the effects of internet-based ACT (iACT) on process measures.
Methods:
A comprehensive search was conducted using 4 databases. The quality of the included RCTs was assessed using the Cochrane Collaboration Risk of Bias Tool. A random-effects or fixed-effects model was used. Subgroup analyses for each outcome were conducted according to the type of control group, use of therapist guidance, delivery modes, and use of targeted participants, when applicable.
Results:
A total of 34 RCTs met the inclusion criteria. This meta-analysis found that iACT had a medium effect on psychological flexibility and small effects on mindfulness, valued living, and cognitive defusion at the immediate posttest. In addition, iACT had a small effect on psychological flexibility at follow-up. The overall risk of bias across studies was unclear.
Conclusions:
Relatively few studies have compared the effects of iACT with active control groups and measured the effects on mindfulness, valued living, and cognitive defusion. These findings support the processes of change in iACT, which mental health practitioners can use to support the use of iACT.
... In all, 146 studies were assessed for full eligibility via full-text screening; the reasons for exclusion are mentioned in Figure 1. Finally, 13 studies met the inclusion criteria and were included in this review [38][39][40][41][42][43][44][45][46][47][48][49][50]. Of these 13 studies, 11 (85%) were eligible for inclusion in the meta-analysis [38][39][40][41][42]45,46,[48][49][50][51]. ...
... Finally, 13 studies met the inclusion criteria and were included in this review [38][39][40][41][42][43][44][45][46][47][48][49][50]. Of these 13 studies, 11 (85%) were eligible for inclusion in the meta-analysis [38][39][40][41][42]45,46,[48][49][50][51]. Table 1 summarizes the characteristics of the included studies. ...
... Table 1 summarizes the characteristics of the included studies. All 13 studies were published from 2016 onward, with 5 (38%) conducted in the United States [39][40][41]47,49]; 2 (15%) in Sweden [43,48] and Australia [42,44]; and 1 (8%) in Hong Kong [46], Finland [50], Ireland [45], and the United Kingdom [38]. The sample sizes across the 13 studies ranged from 23 [40] to 2110 [44]. ...
Background:
Life at university provides important opportunities for personal growth; however, this developmental phase also coincides with the peak period of risk for the onset of mental health disorders. In addition, specific university lifestyle factors, including impaired sleep and academic and financial stress, are known to exacerbate psychological distress in students. As a result, university students have been identified as a vulnerable population who often experience significant barriers to accessing psychological treatment. Digital psychological interventions are emerging as a promising solution for this population, but their effectiveness remains unclear.
Objective:
This systematic review and meta-analysis aimed to assess digital interventions targeting psychological well-being among university students.
Methods:
Database searches were conducted on December 2, 2021, via Embase, MEDLINE, PsycINFO, and Web of Science.
Results:
A total of 13 eligible studies were identified, 10 (77%) of which were included in the meta-analysis. Mean pre-post effect sizes indicated that such interventions led to small and significant improvement in psychological well-being (Hedges g=0.32, 95% CI 0.23-0.4; P<.001). These effects remained, albeit smaller, when studies that included a wait-list control group were excluded (Hedges g=0.22, 95% CI 0.08-0.35; P=.002). An analysis of acceptance and commitment therapy approaches revealed small and significant effects (k=6; Hedges g=0.35, 95% CI 0.25-0.45; P<.001).
Conclusions:
Digital psychological interventions hold considerable promise for university students, although features that optimize service delivery and outcomes require further assessment.
Trial registration:
PROSPERO CRD42020196654; https:/www.crd.york.ac.uk/prospero/display_record.php?RecordID=196654.
... ABBTs are CBT programs that include a focus on cultivating acceptance and mindfulnessbased skills. Evidence supports the effectiveness of these programs as prevention interventions, including those based on acceptance and commitment therapy (ACT; e.g., Levin et al., 2016Levin et al., , 2017Räsänen et al., 2016), an ABBT specifically developed for generalized anxiety disorder (e.g., Danitz et al., 2016;Danitz & Orsillo, 2014;Eustis et al., 2017Eustis et al., , 2018, and mindfulnessbased programs (e.g., Dvořáková et al., 2017). Among these CBT-based programs, skills-based programs that systematically teach cognitive and behavioral techniques to cope with emotions (as opposed to purely psychoeducational programs) offer the most promise in reducing symptoms of depression, anxiety, and stress, as well as improving social skills, enhancing self-perceptions, and improving academic behaviors and performance (Conley et al., 2013(Conley et al., , 2015. ...
... Although not explicitly described as transdiagnostic, other programs also target mechanisms that are transdiagnostic, given that their conceptual models focus on helping individuals change how they respond to their internal experiences. These include ABBT-based programs (Danitz & Orsillo, 2014;Danitz et al., 2016;Eustis et al., 2017Eustis et al., , 2018Levin et al., 2016Levin et al., , 2017Räsänen et al., 2016). Although some of these programs are described as focusing on a specific symptom area (e.g., anxiety), the conceptual model and skills within the programs could be applied more broadly to experiences with other emotions. ...
Efforts to prevent anxiety and depressive disorders are considered a public health priority. However, emerging adults (ages 18–25) have traditionally been overlooked in the prevention literature. Recent suggestions to improve the design and evaluation of prevention programs propose a shift toward targeting and assessing changes in underlying mechanisms and protective factors that might buffer against the onset or worsening of symptoms and promote emotional well-being. In this conceptual paper, we aim to further this discussion on the optimal targets and goals of prevention programs and how best to tailor these programs to meet the needs of emerging adults. We first provide a brief overview of the prevention literature for depressive and anxiety symptoms among emerging adults. We then present an argument for expanding the focus of prevention programs to include an emphasis on factors affecting help-seeking intentions and behaviors as explicit targets. We argue this could improve the effectiveness and long-term impact of prevention efforts and provide a way to tailor programs to the unique developmental period of emerging adulthood. We propose that prevention programs should strive to target both mechanisms underlying depressive and anxious symptomatology, as well as those affecting help-seeking behaviors to arm emerging adults with the knowledge and tools necessary to effectively manage their mental health needs. To this end, we outline a number of processes to prioritize and target in order to promote help-seeking in the context of prevention.
... letter writing, journaling, three good things); questionnaires; mindfulness; meditation; three good deeds; social event; wearable fitness band (e.g. step counter); and a private Facebook group (Ashton et al., 2017;Marcus et al., 2007;Mak et al., 2015;Räsänen et al., 2016;Wong et al., 2017;Rios et al., 2019;Schweitzer et al., 2016;Howells et al., 2016;Keeman et al., 2017). ...
... Campaign/year/author/organisation Theory The Student Compass (Räsänen et al., 2016) Theories of learning, SCTa Gratitude Group Program (Wong et al., 2017) Positive psychology (no specific theory mentioned) Happiness 101 (Lambert D'raven et al., 2015) Positive psychology (no specific theory mentioned) HEYMAN (Ashton et al., 2017) SCT Internet-based mindfulness training program (Mak et al., 2015) Health behavioral theory An electronic wellness program to improve diet and exercise in college students (Schweitzer et al.., 2016) HBM; TRA; SCT; SLT; TTMb RCT of a smartphone-based mindfulness Intervention to enhance well-being (Howells et al., 2016) Positive Activity Model by Lyubomirsky and Layous (2013) The well-being game (Keeman et al., 2017) The broaden and build theory and mindfulness theory ...
Purpose
In social marketing practice, there is no all-encompassing approach that guides researchers and practitioners to build theory-driven social marketing interventions. While the Co-create–Build–Engage (CBE) process offers a roadmap for marketing application, including outlining when and where social marketing’s eight benchmark principles have been applied, limited practical guidance on how and when theory should be applied is offered. This paper reports one case study demonstrating how theory was applied to deliver a theory-informed well-being behavior change intervention.
Design/methodology/approach
This paper proposes and applies a new five-step theory-driven social marketing intervention build process (BUILD) drawn from an extensive base of social marketing research and application. Using a case study method, we showcase how the five-step process was applied to inform the design, build and implementation of a well-being behavior change intervention.
Findings
This study proposes a five-step process to build theory-driven social marketing interventions called BUILD: Begin with the objective, Use theory, Initiate program design, Let’s produce and Develop the engagement plan. This study provides a step-by-step and easy-to-follow BUILD process which outlines how social marketers can apply a selected theory to inform program design and implementation.
Practical implications
The BUILD process offers a roadmap to build theory-driven social marketing interventions that include all elements of intervention development, namely, objective-setting, theory evaluation, selection and application, producing the program and planning for program engagement.
Originality/value
This study provides a novel five-step process to help social marketing researchers and practitioners build theory-driven social marketing interventions.
... Segal et al. are one of earliest scholars who combined CBT principles with mindfulness-Mindfulness Based Cognitive Therapy (MBCT)-with the aim to "change one's awareness of and relationship to thoughts and emotions" and, hence, reduce the associations between negative automatic thinking and feelings of sadness and unease [10]. More recently, web-based MBIs are being increasingly used for better accessibility, among other reasons, with promising results to promote mental health and wellbeing [11][12][13]. In 2016, a meta-analysis of earlier 15 clinical trials using web-based MBIs was conducted with a focus on mindfulness-based self-regulation (MBSR), MBCT, and ACT interventions [14]. ...
Background
Evidence shows that mindfulness-based programs reduce levels of stress, anxiety, and depression. Yet, web-based mindfulness has been less studied, especially among university students. We developed a student-centered web-based mindfulness virtual community (MVC) intervention informed by cognitive-behavioral-therapy constructs. MVC comprised of (1) 12 online video-based modules (psychoeducation and practice), (2) anonymous peer-to-peer discussion forums, and (3) anonymous, group-based, 20-min live video conferences by a trained moderator. While the intervention was found effective in reducing anxiety and depression in a randomized controlled trial (RCT), the impact on students’ quality of life remained to be examined. The reported study examined the impact of 8-week long web-based MVC intervention on the quality of life of undergraduate students compared to those in the control group. Participants were recruited from a large Canadian university into a two-arm RCT ( N = 160) and randomly allocated to the web-based MVC intervention ( n = 80) or to the control ( n = 80) group. Participants completed online survey at baseline (T1) and at 8-week (T2). The outcome of quality of life was measured by 16-item Quality of Life Scale (QOLS). The generalized estimation equation (GEE) method with AR(1) covariance structures was used, adjusting for potential covariates.
Results
At the baseline 159 students completed the survey. Participants (32 males, 125 females, 2 other gender) had a mean age of 22.6 years, 57.2% were born in Canada. Participants in MVC ( n = 79) and control ( n = 80) groups were similar in sociodemographic characteristics except hours of volunteer work. At T2 that coincided with students’ exam period, QOLS score for the control group declined while MVC group had a slight increase. Between-group analysis for QOLS score-change showed a significantly higher score at T2 for MVC group compared to the control (81.64, SD = 14.63 vs. 72.9, SD = 17.26, P < 0.001). Per adjusted GEE analysis, the higher QOLS score in MVC compared to the control group was statistically significant ( $$\upbeta$$ β = -2.24, P = .03).
Conclusions
Web-based MVC intervention helped the students to have better quality of life, compared to the control group, at 8-week follow-up despite exam stress. Future research with a longer follow-up would advance understanding.
Trial registration
https://doi.org/10.1186/ISRCTN12249616 Registration Date: 21/06/2017.
... ACT has been shown to be a useful transdiagnostic intervention for university students that can be delivered in a variety of formats (Muto et al., 2011;Pakenham, 2015;Stafford-Brown & Pakenham, 2012). In particular, web-based ACT interventions with varied levels of practitioner involvement for university students have shown improvements in many areas including education values, depression, social anxiety, academic concern, wellbeing, values obstruction, mindful acceptance, life satisfaction, and academic performance (Chase et al., 2013;Levin et al., 2014Levin et al., , 2016Rasanen et al., 2016). ...
... These results are encouraging as this format allows for greater accessibility and scalability with less demand on public health resources during times of increased demand and public health restrictions (Andersson & Titov, 2014;Wind et al., 2020). Previous online ACT interventions vary in length, from 1 day to 12 weeks (Brown et al., 2016), with some having a time commitment of a full-day workshop or 60 minutes each week for multiple weeks (Köhle et al., 2021;Räsänen et al., 2016). Interventions that were similar in length to ACT2COPE did not include all aspects of the ACT Hexaflex model, instead focusing on just one part of the model, such as mindfulness (Cavanagh et al., 2013;Howarth et al., .413 ...
It is well established that the COVID-19 pandemic increased psychological distress in many populations, particularly for people with chronic health conditions (CHCs). Web-based mental health interventions provide a scalable and cost-effective approach to providing psychological support for people disproportionately affected by the COVID-19 pandemic. The current study aimed to explore the feasibility and acceptability of a one-week web-based psychological intervention (ACT2COPE) and explore preliminary effects of the intervention on reducing depression, anxiety, and stress symptoms, and improving wellbeing and psychological flexibility in adults living with CHCs during the COVID-19 pandemic in Aotearoa (New Zealand). A pilot randomised waitlist-controlled trial explored the acceptability and preliminary efficacy of ACT2COPE among 40 participants (n = 20 in the ACT2COPE group and n = 20 in the waitlist control group). Focus groups and open-ended questions explored usability and acceptability of the intervention as well as levels of engagement and adherence to the intervention. Mixed model ANOVAs explored within and between-group differences in psychological outcomes. Qualitative findings suggested that participants found ACT2COPE acceptable and engaging. Depressive symptoms significantly decreased over time compared to the waitlist group at 4-weeks follow-up (p = .012). No other between-group differences were found. The online ACT2COPE intervention presents a promising, scalable intervention that may improve psychological outcomes in adults living with CHCs during the COVID-19 pandemic. Future research is needed to confirm these findings in a larger and more diverse population and over a longer timeframe.
... PF stems from six interrelated processes that are opposed to the PI processes, specifically acceptance, cognitive defusion, contact with present moment, self as context, values, and committed action (Hayes et al., 2006). Interventions focused on promoting PF have been associated with flourishing (Bohlmeijer et al., 2015) and wellbeing (Wersebe et al., 2018;Räsänen et al., 2016). ...
Social Anxiety Disorder (SAD) has its usual onset during adolescence when it is a highly prevalent and debilitating condition. Evidence regarding the processes that underline social anxiety and SAD is not compelling, especially in adolescents. Within an Acceptance and Commitment Therapy (ACT) framework, the causal role of ACT processes on adolescents’ social anxiety and how these processes contribute to sustain social anxiety over time is still unknown. Hence, this study explored the role of psychological inflexibility (PI) and acceptance and committed action (as psychological flexibility processes) on social anxiety over time, in a clinical sample of adolescents. Twenty-one adolescents (Mage = 16.19, SD = 0.750) with a primary diagnosis of SAD completed a set of self-report measures assessing PI, acceptance (i.e., willingness to experience social anxiety symptoms), action (i.e., moving towards valued life directions despite social anxiety symptoms) and social anxiety. Path analysis was used to investigate a mediation model linking acceptance, committed action, and PI to social anxiety, directly and indirectly. Findings revealed that acceptance and action were negatively and directly associated with PI after 10-weeks. In turn, PI yielded a positive and direct effect on social anxiety after another 12-weeks. PI totally mediated the relation between acceptance and action and social anxiety, with significant indirect effects. Overall, findings offer evidence for the applicability of the ACT model to adolescent SAD and support the use of clinical interventions targeting PI to understand and alleviate adolescents’ social anxiety.
... The results of our 6-month follow-up assessments indicate that StudiCare-M produced long-lasting effects to promote positive indicators of mental health while alleviating negative ones. This is in line with the only other existing trial investigating long-term effects (12 months) of a guided mindfulnessbased IMI in a college student sample [80]. These results are promising, but will have to be confirmed by further research that includes long-term measurements. ...
The college years can be accompanied by mental distress. Internet- and mobile-based interventions (IMIs) have the potential to improve mental health but adherence is problematic. Psychological guidance might promote adherence but is resource intensive. In this three-armed randomized controlled trial, “guidance on demand” (GoD) and unguided (UG) adherence-promoting versions of the seven-module IMI StudiCare Mindfulness were compared with a waitlist control group and each other. The GoD participants could ask for guidance as needed. A total of 387 students with moderate/low mindfulness were recruited. Follow-up assessments took place after 1 (t1), 2 (t2), and 6 (t3) months. Post-intervention (t2), both versions significantly improved the primary outcome of mindfulness (d = 0.91–1.06, 95% CI 0.66–1.32) and most other mental health outcomes (d = 0.25–0.69, 95% CI 0.00–0.94) compared with WL, with effects generally persisting after 6 months. Exploratory comparisons between UG and GoD were mostly non-significant. Adherence was low but significantly higher in GoD (39%) vs. UG (28%) at the 6-month follow-up. Across versions, 15% of participants experienced negative effects, which were mostly mild. Both versions effectively promoted mental health in college students. Overall, GoD was not associated with substantial gains in effectiveness or adherence compared with UG. Future studies should investigate persuasive design to improve adherence.
... More specifically, Internet-delivered ACT interventions for university students with varied levels of practitioner involvement led to improvements in depression, social anxiety, academic concern, wellbeing, mindful acceptance, life satisfaction, and academic performance (Chase et al., 2013;Levin et al., 2014Levin et al., , 2016Räsänen et al. 2016). Moreover, Internet-delivered ACT interventions have been found to produce similar results compared to face-to-face ACT therapy, with medium to large effect sizes (Lappalainen et al. 2007). ...
Research showed that viewing stress as a helpful rather than as harmful part of life is associated with better health, emotional wellbeing, and productivity at work, even during periods of high stress. Stress beliefs are significant because they influence how individuals respond to stress. This pilot study illustrates an Internet-delivered intervention called “ReStress Mindset” that combines the Stress Mindset Training Program with Acceptance and Commitment Therapy (ACT) to change the stress mindset and stress response among emerging adult university students during the COVID-19 pandemic. Thirty-five participants were assigned to the intervention (N = 17) and control (N = 18) groups. Participants in the intervention group attended five weekly online modules of the intervention. All participants (N = 35) completed self-report questionnaires online (Stress Mindset Measure, Satisfaction With Life Scale, Depression Anxiety and Stress Scale-9, Perceived Stress Scale, Brief Resilience Scale, Scale of Positive and Negative Experience) before and after the intervention. Following the intervention, participants in the intervention group reported a more “stress-is-enhancing” mindset and a less “stress-is-debilitating” mindset. Our findings suggests that the “ReStress Mindset” intervention could promote a positive stress mindset in university students, even in times of crisis. Further studies are required in this field to establish the stability of the results over longer periods of time.KeywordsStress mindsetAcceptance and Commitment TherapyInternet-delivered interventionsEmerging adulthoodUniversity students
... In this review, two studies used the Acceptance and Commitment Therapy -ACT (Räsänen, 2016;Xu et al., 2020). The ACT group focused on helping students to manage stress relevant to studying and gain mental wellbeing. ...
Students can be a vulnerable group for stress. A psycho-educational program is one of the strategies to facilitate students’ adjustment and manage stress. This systematic review will integrate the effects of psychoeducational interventions on the level of stress among students. Pubmed, CINAHL, Science Direct Scopus databases were used to find potentially relevant published articles. The title and abstracts are used firstly to screen studies using inclusion and exclusion criteria before going to the next stage of the reviewing of complete articles. A total of eleven articles were selected based on inclusion and exclusion criteria. All articles in this sample were assessed using an instrument to assess overall quality. Study setting, sample size, study interventions, outcome measure/methods of delivery, and results were assessed and extracted. In all of the studies reviewed, the intervention groups experienced significantly greater reductions in perceived stress and symptoms of anxiety and depression. Our review highlights the importance of stress management programs, and the findings from this systematic review indicated that these programs were generally effective for optimizing the stress process and improving coping capacity with stressors.
... 41,42 In postsecondary settings, ACT proved to be an efficient way to reduce stress, anxiety and depression symptoms among college and university students. [43][44][45][46][47][48][49][50] It also proved to be useful at increasing academic engagement among that population, a more distant outcome. [51][52][53] Secondly, this intervention is delivered online in a synchronous format. ...
Despite recent calls for more peer support initiatives aimed at promoting mental health in postsecondary institutions, those initiatives remain scarce. In this study, a multisite randomized controlled trial was designed to assess the effect of an online peer support intervention based on acceptance and commitment therapy using mental health and school indicators. Undergraduate students were recruited in three Canadian universities and randomly assigned to an intervention (n = 54) or a wait-list control group (n = 53). Compared to control participants, those who took part in the program self-reported reduced psychological inflexibility, stress, anxiety and depression, and increased psychological flexibility and well-being. The intervention had no effect on academic satisfaction and engagement. These results were found both in completer and intent-to-treat samples. The findings provide evidence that peer support may be a beneficial adjunct to mental health interventions offered to college and university students.
... In recent years, ACT studies have shown positive results on nonsyndromic targets such as well-being (i.e., life satisfaction; Wahyun et al., 2019) and distress (Hayes et al., 2006;Räsänen et al., 2016). Stenhoff et al. (2020) meta-analysis found positive effects of ACT on various transdiagnostic outcomes, a set of different problem presentations that share the same causal pathway and produce similar outcomes (Cicchetti & Rogosch, 1996), such as subjective well-being, emotional regulation, and interpersonal functioning. ...
The burden of the COVID-19 pandemic has been mainly carried by health care providers. Technology-Mediated Interventions (TMI) seem to be a feasible alternative to increase access to behavioral health resources in this population. However, scaling-up treatments into TMI requires developing user-friendly, accepted, and accessible formats. A two-stage study was conducted to assess scalability of an Acceptance and Commitment Therapy (ACT) based strategy (named FACE COVID) delivered using technology. First, a mix-method design connected qualitative and quantitative data from health providers and ACT experts by which changes were performed to enhance scalability. Second, a pretest-posttest study was conducted to preliminary evaluate the efficacy of FACE COVID intervention on well-being, psychological distress, and psychological flexibility. Results showed a positive impact on well-being, but not distress and psychological flexibility. While this intervention has promising results, changes in dose intensity, social support, and mental health literacy could improve retention as well as increase opportunities to target distress and psychological flexibility in future studies.
... In recent years, online self-help interventions have increased due to easy accessibility and cost-effectiveness. Räsänen and colleagues [104] examined the effectiveness of online acceptance and commitment therapy (iACT) aimed at enhancing the well-being of university students. The results showed that iACT participants had significantly higher gains in well-being, life satisfaction, and mindfulness skills than participants in the waiting list control condition (WLC). ...
During tertiary education, students embark on a journey of role exploration and decision-making about their future, to define who they want to be in their adult lives. Psychological services for students may be needed to help students gain better awareness of their mental health. The purpose of this systematic literature review is to analyze psychological interventions for university students in Europe. The review was conducted per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were identified using the Scopus, Web of Science, PubMed, ProQuest Psychology Journals, PsycINFO, and PsycARTICLES databases. The results were classified into seven categories: counseling and group counseling (eight papers); psychodynamic interventions (six papers); cognitive-behavioral interventions (fifteen papers); other psychological interventions (eighteen papers); mindfulness (nine papers); online interventions (seventeen papers); and app and mobile interventions (ten papers). Student psychological services are becoming one of the most important sources of support for students, and the number of approaches offered is expanding. Our results suggest the need to further investigate and promote the provision of psychological care for university students, explore long-term treatment options, and invest in professionally trained staff.
... In this review, two studies used the Acceptance and Commitment Therapy -ACT (Räsänen, 2016;Xu et al., 2020). The ACT group focused on helping students to manage stress relevant to studying and gain mental wellbeing. ...
The Relationship between Reflective Disposition and Persistence 25 in Education (Il rapporto tra l'elaborazione riflessiva e la persistenza nell'istruzione) Talal Hassan Bani Ahmad-Meltem Meriç-Mohammad Ayasrah The Effect of Psychoeducational Stress Management 41 Interventions on Students Stress Reduction: Systematic Review (L'effetto degli interventi psicoeducativi di gestione e riduzione dello stress degli studenti: una rassegna sistematica) Aiman Freihat Investigating the Effect of Missing Data on the Experimental Test 59 of Mathematics for the Second-Secondary Students (Indagare l'effetto dei dati mancanti in un test sperimentale di matematica per gli studenti della scuola secondaria di secondo grado)
... Scholars and experts are asking for new health interventions to support individuals' mental well-being [10]. Existing well-being interventions generally target health behaviors, including nutrition, physical activity, deep breathing exercises, relaxation exercises, mindfulness, meditation, gratitude practices (e.g., letter writing, journaling, three good things) and goal setting [11][12][13][14][15][16][17][18]. In a previous review of 13 health interventions, eight claimed that their intervention was informed by theory; however, only four interventions specified the use of theory-based behavior-change methods, and only one intervention specified exactly how such behavior-change methods were mapped to the theory listed. ...
Approximately 1 in 5 Australians experience a mental disorder every year, costing the Australian economy $56.7 billion per year; therefore, prevention and early intervention are urgently needed. This study reports the evaluation results of a social marketing pilot program that aimed to improve the well-being of young adults. The Elevate Self Growth program aimed to help participants perform various well-being behaviors, including screen time reduction, quality leisure activities, physical activity, physical relaxation, meditation and improved sleep habits. A multi-method evaluation was undertaken to assess Elevate Self Growth for the 19 program participants who paid to participate in the proof-of-concept program. Social Cognitive Theory was used in the program design and guided the evaluation. A descriptive assessment was performed to examine the proof-of-concept program. Considerations were given to participants' levels of program progress, performance of well-being behaviors, improvements in well-being, and program user experience. Participants who had made progress in the proof-of-concept program indicated improved knowledge, skills, environmental support and well-being in line with intended program outcomes. Program participants recommended improvements to achieve additional progress in the program, which is strongly correlated with outcome changes observed. These improvements are recommended for the proof-of-concept well-being program prior to moving to a full randomized control trial. This paper presents the initial data arising from the first market offerings of a theoretically mapped proof-of-concept and reports insights that suggest promise for approaches that apply Social Cognitive Theory in well-being program design and implementation.
... Mobile ACT interventions have also been used concurrently with in-person ACT, as is the case with the ACT Daily app prototype, which was used with 14 patients with depression as they received treatment from an ACT clinician (27). In another study, a sample of college students showed improvement in depressive symptoms after completing an online, guided ACT intervention (28). ...
Background
Mobile transdiagnostic therapies offer a solution to the challenges of limited access to psychological care. However, it is unclear if individuals can actively synthesize and adopt concepts and skills via an app without clinician support.
Aims
The present study measured comprehension of and engagement with a mobile acceptance and commitment therapy (ACT) intervention in two independent cohorts. Authors hypothesized that participants would recognize that behaviors can be flexible in form and function and respond in an ACT process-aligned manner.
Methods
Mixed-methods analyses were performed on open-ended responses collected from initial participants ( n = 49) in two parallel micro-randomized trials with: 1) first-generation college students (FGCSs) ( n = 25) from a four-year public research university and 2) individuals diagnosed with bipolar disorder (BP) ( n = 24). Twice each day over six weeks, participants responded to questions about mood and behavior, after which they had a 50-50 chance of receiving an ACT-based intervention. Participants identified current behavior and categorized behavior as values-based or avoidant. Interventions were selected randomly from 84 possible prompts, each targeting one ACT process: engagement with values, openness to internal experiences, or self-awareness. Participants were randomly assigned to either exploratory (10 FGCS, 9 BP) or confirmatory (15 FGCS, 15 BP) groups for analyses. Responses from the exploratory group were used to inductively derive a qualitative coding system. This system was used to code responses in the confirmatory group. Coded confirmatory data were used for final analyses.
Results
Over 50% of participants in both cohorts submitted a non-blank response 100% of the time. For over 50% of participants, intervention responses aligned with the target ACT process for at least 96% of the time (FGCS) and 91% of the time (BP), and current behavior was labeled as values-based 70% (FGCS) and 85% (BP) of the time. Participants labeled similar behaviors flexibly as either values-based or avoidant in different contexts. Dominant themes were needs-based behaviors, interpersonal and family relationships, education, and time as a cost.
Conclusions
Both cohorts were engaged with the app, as demonstrated by responses that aligned with ACT processes. This suggests that participants had some level of understanding that behavior can be flexible in form and function.
... Thus, HEIs have the obligation to take all the necessary measures to both guarantee their students' immediate health as well as to move classes online and subsequently offer online support services to students (Adedoyin & Soykan, 2020). These challenges and other related ones are likely to escalate the existing psychological problems and attrition rates experienced among university students (Räsänen et al., 2016). Since they are significantly more prone to psychological issues (Stallman, 2010), college students could face more mental health challenges, in addition to financial and interpersonal challenges as a result of the pandemic. ...
In the context of the COVID-19 pandemic, this study offers a contemporary look at crisis response in higher education and demonstrates the marketing implications of universities’ crisis response. Using Situational Crisis Communication Theory, the link between university crisis response and student attrition through resilient coping and trust was examined. Data collected from 340 students were analysed to determine the specific indirect and serial mediation effects of university crisis response on student attrition intention. Results revealed that students’ resilient coping and trust individually and serially mediates the relationship between university crisis response and student attrition intention. A multigroup analysis also revealed that crisis response has a weaker effect on resilient coping for female students and a weaker effect on attrition intention for new students. Findings recommend among other things that crisis response mitigates student attrition through trust and coping, and that it should be tailored and gender-specific for effectiveness.
... Lessons included a mix of didactic presentation, discussion, and experiential exercises. Lesson content was developed and adapted in consultation with the licensed psychologist authors (EG & EL-R), and from, "Get out of your mind & into your life: the new acceptance & commitment therapy" (Hayes & Smith, 2005), "The Happiness Trap: How to Stop Struggling and Start Living: A Guide to ACT," (Harris, 2008), from Dr. Russ Harris' website (Harris, 2009(Harris, , 2019, Boone and Myler's (2012) unpublished treatment protocol for "ACT for Depression and Anxiety" group at Cornell University, from work on the DNA-V model (Ciarrochi, Atkins, Hayes, Sahdra, & Parker, 2016;Hayes, Ciarrochi, & Hayes, 2015), and relevant published studies (Clarke, Kingston, Wilson, Bolderston, & Danitz et al., 2016;Eustis et al., 2017;Räsänen et al., 2016;Stafford-Brown & Pakenham, 2012). The study PI (EL-R, also instructor of record and licensed psychologist) contributed to class discussions intermittently to add explanations or ask further questions of the class. ...
University students face significant mental health challenges and often have difficulties seeking and obtaining mental health care. Acceptance and Commitment Therapy (ACT) seeks to increase psychological flexibility and valued living, and is well-suited for a transdiagnostic, skills-based approach that can support students with diverse needs. Embedding interventions in university courses may reach more students. A brief, four session ACT intervention plus follow-up, “Brief ACT for Undergraduates,” was delivered by a trained graduate student to 22 students participating in an undergraduate psychology seminar. Roughly half of the sample met clinical cutoffs on validated measures. Stress and anxiety decreased at follow-up. Students rated the intervention as helpful and accessible and reported moderate engagement with skills outside of class. These pilot results suggest embedding ACT within a university course is a beneficial way to support student mental health. Study limitations and future recommendations discussed, and the need for large-scale replication and RCTs emphasized.
... Les résultats issus des ateliers Korsa sont cohérents avec ceux obtenus par d'autres équipes de recherche à travers le monde. En effet, plusieurs études montrent que l'ACT aide à réduire les symptômes de stress (Muto et al., 2011;Räsänen et al., 2016), d'anxiété et de dépression (Danitz et al., 2016;Forman et al., 2007;Kratochwill et al., 2013;Levin et al., 2017) des étudiants postsecondaires et favorise une meilleure régulation de leurs émotions (Norouzi et al., 2017). Des résultats préliminaires suggèrent que l'ACT s'avère aussi efficace pour réduire l'anxiété de performance des étudiants postsecondaires. ...
L’anxiété de performance est un motif de consultation courant chez les étudiants postsecondaires. Dans cet article, nous discutons du rôle que jouent l’évitement expérientiel et la fusion cognitive dans l’anxiété de performance, puis expliquons de quelle manière l’approche d’acceptation et d’engagement (ACT) peut aider les étudiants à vivre autrement avec ce type d’anxiété. Nous illustrons la forme que peut prendre cette approche en présentant une intervention de groupe développée en 2012 et offerte dans plusieurs établissements postsecondaires au Québec et en France. Nous concluons cet article en situant cette intervention à l’intérieur du cadre d’analyse systémique proposé par l’association des services aux étudiants des universités et collèges du Canada (ASEUCC).
Performance anxiety is a frequent motive for consultation among postsecondary students. In this article, we discuss the role of experiential avoidance and cognitive fusion in performance anxiety, and explain how Acceptance and Commitment Therapy (ACT) can help students cope with their anxiety differently. We illustrate the form this approach can take by presenting a group intervention developed in 2012 and offered in several postsecondary institutions in Quebec and France. We conclude this article by positioning this intervention within the student services framework proposed by the Canadian Association of College and University Student Services (CACUSS).
... A second limitation concerns the demographics of the students, since the majority of the participants in our sample were females, largely due to the particular gender balance of the course that they attended. Nevertheless, as previous studies have indicated, this gender distribution is typical of many online as well as face-to-face interventions of this kind (Räsänen et al., 2016) TA B L E 2 Means and standard deviations of the key variables of the study for both groups (intervention vs. control) and time (pre-vs. post-Intervention) and results of the 2 × 2 mixed-design factorial ANOVA also in non-gender-biased samples ; however, including more males in the present study would have augmented the validity of our results by establishing a less homogeneous sample. ...
Young people's mental health problems are a matter of concern during the COVID-19 pandemic. Counselling services for university students by means of telemental support can help them to deal with psychological issues that they may be facing due to the pandemic. The present study investigated the effects of four once-weekly online counselling sessions based on a mind-body technique (the Brain Wave Modulation Technique; BWM-T) on enhancing positive affect and on reducing negative affect and anxiety in a sample of 54 university students (96.3% females; Mage = 21.31 years, SD = 2.09). An experimental design was conducted: the participants were randomly assigned to the intervention group, which received 15 min of a guided online BWM-T session, or to the control group, which watched a 15-min video on how to sustain their psychological well-being. The results of a two-factor mixed-design analysis of variance (ANOVA) showed that the participants in the intervention group reported a significant increase in positive affect and a decrease in negative affect over time compared to those in the control group. They also reported a slight decrease in state anxiety compared to the control group, although this was just short of statistical significance. The information provided by this study, regarding emotional outcomes among university students after four brief online counselling sessions, suggests that such interventions could be an effective and sustainable way to reinforce young people's mental health during the COVID-19 pandemic, as well as later in their university careers and adult lives.
... Bir meta analiz çalışmasında da ACT'in anksiyete, depresyon ve travma sonrası stres bozukluğu gibi çeşitli klinik bozuklukların tedavisinde etkili olduğu ve kısa bir geçmişi olan ACT'in umut vadeden bir yaklaşım olduğu sonucuna varılmıştır (Powers, Zum Vörde Sive Vörding ve Emmelkamp, 2009). Üniversite öğrencilerinin iyi oluşlarını yükseltmek amacıyla uygulanan beş haftalık çevrimiçi ACT seanslarının ise katılımcıların iyi oluşlarını, yaşam doyumlarını ve farkındalık yeteneklerini yükselttiği göz-lemlenmiştir (Räsänen, Lappalainen, Muotka, Tolvanen ve Lappalainen, 2016). Yapılan bir diğer çalışmada ise ACT müdahaleleri ile psikolojik esnekliği yükseltmenin stres seviyesinin düşmesi ile negatif, psikolojik iyi oluşun yükselmesi ile pozitif ilişkili olduğu görülmüştür (Wersebe, Lieb, Meyer, Hofer ve Gloster, 2018). ...
Mevcut çalışmada zaman perspektifi ve psikolojik iyi oluş ilişkisi ve bu bağlamda psikolojik esnekliğin rolünün incelenmesi amaçlanmaktadır. Araştırmaya 18 yaş üstü 350 kişi katılmıştır. Katılımcıların yaş ortalaması 29.53’tür (ss =
6.95). Çalışmada veri toplamak amacı ile Demografik Bilgi Formu, Zimbardo Zaman Perspektifi Envanteri, Psikolojik
İyi Oluş Ölçeği, Kabul ve Eylem Formu-II kullanılmıştır. Elde edilen bulgular ilk olarak zaman perspektifinin beş alt
boyutunun ve psikolojik katılığın psikolojik iyi oluşu anlamlı düzeyde yordadığını ortaya koymuştur. Ardından psikolojik katılık düzeyinin aracı rolünü test etmek amacıyla Hayes (2013) tarafından geliştirilmiş olan PROCESS makro
eklentisi kullanılmıştır. Buna göre dengeli zaman perspektifi sapma puanının psikolojik iyi oluş üzerinde psikolojik katılık aracılığıyla dolaylı etkisinin anlamlı olduğu görülmüştür. Bu çalışma ile psikolojik iyi oluş üzerinde dengeli zaman
perspektifi ve psikolojik esnekliğin birlikte ele alınmasının önemi ortaya konmuştur. Bulgular gerek klinik müdahaleler
gerekse ileriki araştırmalar için uzmanlara yeni bir bakış açısı sunabilecek niteliktedir.
Anahtar kelimeler: Zaman perspektifi, dengeli zaman perspektifi, psikolojik iyi oluş, psikolojik esneklik, psikolojik
katılık
Abstract
The main purpose of this study is to investigate the role of psychological flexibility on the relation between time perspective and psychological well-being. The sample consisted of 350 people who are 18 years of age and over. The average age was 29.53 (SD = 6.95) years. Socio-demographic Information Form, Zimbardo Time Perspective Inventory,
Flourishing Scale and Acceptance and Action Questionnaire-II were used to collect data. First, the results indicated that
time perspectives profiles and psychological inflexibility significantly predicted psychological well-being. Second, the
PROCESS macro plug-in developed by Hayes (2013) was conducted to test the mediating role of the psychological
inflexibility level. Accordingly, it was observed that the indirect effect of deviations from a balanced time perspective
on well-being through psychological inflexibility was significant. Consequently, this study indicates the effect of balanced time perspective and psychological flexibility together on psychological well-being. The findings are capable of
providing new insight to experts for both clinical interventions and future research.
Keywords: Time perspective, balanced time perspective, psychological well-being, psychological flexibility, psychological
inflexibility
The purpose of this study was to determine the combined average effect size for the efficacy of stress management interventions in randomized controlled trials with college students. A workplace stress intervention approach guided article selection. A single instrument measured stress. The analysis was a random effects model. The literature search in the spring of 2020 yielded eight qualifying studies, published from 2014-2020. The overall effect size was statistically significant (g = ‒0.41). Especially given pandemic-related stressors, this meta-analysis could serve as a baseline for future research comparisons. It mirrored results of other meta-analyses, discussed in the literature review. No prior meta-analysis to our knowledge has employed the same approach or framework.
Young adults are particularly vulnerable to experiencing poor mental health. To improve mental health outcomes, there has been a rise in online mental health interventions. The “Talk to Me” Mass Open Online Course (MOOC) was designed to increase levels of mental health literacy among young adults and those close to them. Although online interventions are readily available to young adults, studies continue to report high attrition rates, indicating an unsatisfactory participant experience. This study explored the experiences of over 1600 global users engaging in the “Talk to Me” MOOC. A cross‐sectional survey design using quantitative and qualitative methods was used to explore user experiences of engaging in the online MOOC. Quantitative results found that 96% of participants found the “Talk to Me” MOOC to be “engaging” or “very engaging.” While 98.2% of participants agreed that their knowledge and skills had increased. Qualitative results found four dominant themes: integration and use of roleplay videos; skills, knowledge, and outcomes; accessibility; and technical references. These results add to the evidence base regarding online mental health interventions and indicate the perceived benefits of the “Talk to Me” MOOC. Participants reported an overall positive experience when engaging in the “Talk to Me” MOOC.
Introduction
The COVID-19 pandemic caused a decline in students’ well-being, but on the other hand, students’ experiences of online learning and studying vary widely. The aim of this study is to examine the relationship between psychological flexibility and study-related burnout and to explore whether students with different levels of psychological flexibility have experienced burnout and online studying during COVID-19 differently.
Methods
The data was collected from first-year life-science students ( N = 296) in spring 2021. The relationship between psychological flexibility and study-related burnout was explored with Pearson’s correlation and linear regression. Students’ open-ended responses about their experiences of online learning were analyzed with inductive content analysis and the categories were quantified. Three different groups (high, middle, and low) were made based on respondents’ psychological flexibility, and the differences in their study-related burnout were analysed with ANOVA and Tukey’s test, and differences in online learning experiences were analysed with a Chi-square test.
Results
The results showed that there was a negative relationship between psychological flexibility and study-related burnout. In addition, experiences of study-related burnout and online studying differed statistically significantly between the different groups.
Discussion
The results show that psychological flexibility is an important factor in enhancing students’ well-being and learning during the pandemic.
La Violencia en el Noviazgo (VN) se ha planteado como un problema de salud pública debido a que las relaciones violentas afectan gravemente diversas áreas de la vida. Algunos indicadores de este problema son la pérdida de autonomía, altos niveles de evitación experiencial, baja autoestima, altos niveles de depresión, ansiedad, dependencia emocional y enojo. Debido a que las consecuencias de la VN afectan de manera importante la calidad de vida de los jóvenes, el propósito del presente estudio fue probar la efectividad de la terapia de aceptación y compromiso (ACT) para el desarrollo de flexibilidad psicológica en jóvenes universitarios, a fin de que puedan salir de la relación violenta. Se utilizó un diseño experimental de caso único, con seguimiento a un mes. La intervención consistió en seis sesiones individuales basadas en ACT. Después de la intervención, disminuyeron los puntajes en las variables asociadas a la VN, cambios favorables que se mantuvieron en el seguimiento. Además, todos los participantes terminaron con sus relaciones violentas de pareja, manteniéndose fuera de la relación durante al menos un mes posterior a la intervención. Se comparan los resultados con otras intervenciones para disminuir violencia en las relaciones interpersonales, así como respecto a la pertinencia de ACT como una alternativa adecuada para el trabajo con universitarios.
Objective: College students experience stressors that can increase the risk for mental health concerns and negatively impact retention rates. It is crucial for practitioners working on college campuses to find creative ways to meet the needs of their students and cultivate a campus culture that is dedicated to bolstering mental health. The purpose of this study was to explore if implementing 1-h mental health workshops covering stress management, wellness, mindfulness, and SMART goals was feasible and advantageous for students. Participants: Researchers hosted 1-h workshops in 13 classrooms. Participants included 257 students who completed the pretest and 151 students who completed the post-test. Methods: A quasi-experimental 1-group pre- and post-test design was utilized. Results: Means and standard deviations were utilized to examine knowledge, attitudes, and intentions in each domain. Results indicated statistically significant improvements in each. Conclusion: Implications and interventions are provided for mental health practitioner working on college campuses.
Background
Adjustment problems and disorders are highly prevalent among university students worldwide. Unfortunately, only half of students in need receive psychological help. Furthermore, there is a paucity of studies evaluating prevalence, predictors and interventions for adjustment disorders in students. For these reasons, new, more scalable forms of treatment for students with adjustment disorder must be developed, evaluated and implemented. The aim of the study is to determine the effectiveness of an online transdiagnostic cognitive behavioural intervention for students experiencing adjustment disorder and to evaluate mediators of change.
Method/Design
In this three-arm randomized controlled trial, we plan to recruit 214 Polish students diagnosed as having an adjustment disorder. Participants who meet initial eligibility criteria will be randomly assigned to one of three conditions: 1) 6-week online cognitive behavioural therapy intervention based on the Unified Protocol, 2) 6-week online progressive muscle relaxation training as an active control group, or 3) waiting-list control group. Both the internet and active interventions are asynchronous, unguided and interactive. Assessments will consist of self-report questionnaires, daily diary measures, neurocognitive tasks for the evaluation of cognitive functioning, and recently received grades at university. Measures will be taken at baseline, at post-treatment and at 1-month follow-up. Daily diary measures will be taken during the first and last week of the interventions. Primary outcome measures will include adjustment disorder severity; secondary outcome measures will include other negative (psychopathology: depression, anxiety and stress) and positive (life satisfaction and level of academic adjustment) indexes of mental health as well as and process measures (e.g., mindfulness, experiential avoidance, cognitive fusion).
Discussion
The current study, to our knowledge, is to be the first evaluating the effectiveness of a psychological intervention for students with adjustment disorder. Therefore, it may have important practical implications for students with this disorder. It has the potential to guide the development of a scalable, validated treatment option.
Trial registration
Clinical Trials, NCT05768308, registered 14 March 2023, https://www.clinicaltrials.gov/ct2/show/NCT05768308
Background:
Mobile interventions promise to fill in gaps in care with their broad reach and flexible delivery.
Objective:
Our goal was to investigate delivery of a mobile version of acceptance and commitment therapy (ACT) for individuals with bipolar disorder (BP).
Methods:
Individuals with BP (n=30) participated in a 6-week microrandomized trial. Twice daily, participants logged symptoms in the app and were repeatedly randomized (or not) to receive an ACT intervention. Self-reported behavior and mood were measured as the energy devoted to moving toward valued domains or away from difficult emotions and with depressive d and manic m scores from the digital survey of mood in BP survey (digiBP).
Results:
Participants completed an average of 66% of in-app assessments. Interventions did not significantly impact the average toward energy or away energy but did significantly increase the average manic score m (P=.008) and depressive score d (P=.02). This was driven by increased fidgeting and irritability and interventions focused on increasing awareness of internal experiences.
Conclusions:
The findings of the study do not support a larger study on the mobile ACT in BP but have significant implications for future studies seeking mobile therapy for individuals with BP.
Trial registration:
ClinicalTrials.gov NCT04098497; https://clinicaltrials.gov/ct2/show/NCT04098497.
Objective: This project examines students' experiences using a mental health mobile application (app) as part of a class assignment developed to support student well-being. Participants: Data was collected from 265 undergraduate students enrolled in a psychology course during the COVID-19 pandemic. Methods: Students developed a self-care goal and used an app to support progress toward it. Thematic analysis was applied to students' written reflections about their experiences using the app and practicing self-care. Results: Students reported using an app for self-care was 1) more helpful than expected for improving focus, productivity, motivation, sleep, and mental health symptoms; 2) challenging due to loss of interest, slow improvement, difficulty integrating into routine, or negative feelings triggered; and 3) influenced by the pandemic and transition to remote learning. Conclusions: A classroom assignment designed to promote self-care using a mental health app shows promise. Future research is needed to better understand engagement and impact.
Background:
Extant gaps in mental health services are intensified among first-generation college students. Improving access to empirically based interventions is critical, and mobile health (mHealth) interventions are growing in support. Acceptance and commitment therapy (ACT) is an empirically supported intervention that has been applied to college students, via mobile app, and in brief intervals.
Objective:
This study evaluated the safety, feasibility, and effectiveness of an ACT-based mHealth intervention using a microrandomized trial (MRT) design.
Methods:
Participants (N=34) were 18- to 19-year-old first-generation college students reporting distress, who participated in a 6-week intervention period of twice-daily assessments and randomization to intervention. Participants logged symptoms, moods, and behaviors on the mobile app Lorevimo. After the assessment, participants were randomized to an ACT-based intervention or no intervention. Analyses examined proximal change after randomization using a weighted and centered least squares approach. Outcomes included values-based and avoidance behavior, as well as depressive symptoms and perceived stress.
Results:
The findings indicated the intervention was safe and feasible. The intervention increased values-based behavior but did not decrease avoidance behavior. The intervention reduced depressive symptoms but not perceived stress.
Conclusions:
An MRT of an mHealth ACT-based intervention among distressed first-generation college students suggests that a larger MRT is warranted. Future investigations may tailor interventions to contexts where intervention is most impactful.
Trial registration:
ClinicalTrials.gov NCT04081662; https://clinicaltrials.gov/show/NCT04081662.
International registered report identifier (irrid):
RR2-10.2196/17086.
A notable deterioration in mental health, especially anxiety and depression, was seen among university students during the Covid-19 pandemic. Therefore, immediate preventive action is required to remedy this concern by using the online-based Acceptance and Commitment Therapy (e-ACT). The effectiveness of this e-ACT on psychological flexibility and mental wellbeing was assessed among 52 Malaysian undergraduate university students aged between 18 and 23 years old during the pandemic. Based on a small group approach, participants received two online e-ACT sessions (a total of 5 hours). The paired sample t-tests result showed a significant improvement on mindfulness, psychological flexibility, and wellbeing among the students. The Wilcoxon Signed Rank Test showed a significant decrease in depression, anxiety, and stress. These findings support the use of e-ACT mental health education to promote psychological wellbeing among university students. Further empirical studies are needed to test the effectiveness of e-ACT on psychological flexibility and mental wellbeing.
This meta-analysis examines the effects of mindfulness-informed and mindfulness-based interventions including acceptance and commitment therapy (ACT), mindfulness-based stress reduction (MBSR), and mindfulness-based cognitive therapy (MBCT) on depressive and anxiety symptoms among college students. Three electronic databases (PubMed, PsycINFO, and Cochrane Central) were utilized and systematically searched. Effect estimates were reported as standardized mean differences (SMDs) and data were pooled using random-effects models. Twenty-two comparisons derived from 19 studies (2716 participants) were included in the meta-analysis. For studies employing passive control conditions (n = 17), post-intervention effect sizes were significant for depressive (0.47 [95% CI: 0. 32–0.63]) and anxiety symptoms (0.58 [95% CI: 0.34–0.82]). Effect sizes were significant at post-intervention among MBCT (0.76 [95% CI: 0.48–1.03] for depressive symptoms and 1.37 [95% CI: 0.70–2.04] for anxiety symptoms) and MBSR (0.58 [95% CI: 0.31–0.86] for depressive symptoms and 0.49 [95% CI: 0.24–0.73] for anxiety symptoms). The effect size of ACT for depressive symptoms at post-intervention was significant (0.28 [95% CI: 0.09–0.48]), but the post-intervention effect size of ACT for anxiety symptoms was not significant (0.23 [95% CI: −0.01 −0.47]). Our analyses showed no superiority for ACT, MBSR, and MBCT to active control conditions, either when they were combined or considered separately. This meta-analysis provides empirical evidence in support of ACT, MBSR, and MBCT for reducing depressive and anxiety symptoms among college students.
The last decades experienced a rapid growth in the number of studies examining the effects of psychological interventions on well-being, yet well-being is often conceptualized and measured in different ways in these studies. Previous meta-analyses included studies with a plethora of different well-being instruments, which provides an ambiguous picture of the effectiveness. Furthermore, prior meta-analyses mainly included specific types of psychological interventions. The goal of the current study was to synthesize the effectiveness of psychological interventions in improving well-being as measured with one consistent and comprehensive well-being instrument, the Mental Health Continuum (MHC). The literature was searched for RCTs examining the effect of psychological interventions in both clinical and non-clinical populations that used the MHC as outcome. 46 RCTs (N = 7,618) and 64 comparisons were analyzed using 3-level meta-analysis models. When compared with non-active control groups, small significant effects were found for total well-being at posttest (β = 0.25), and for the subscales emotional (β = 0.27), social (β = 0.25), and psychological well-being (β = 0.30). Effects were smaller but still significant at follow-up. Subgroup analyses yielded significantly stronger effects for guided compared with non-guided interventions and for studies with good quality. Effects were similar for clinical and non-clinical populations and specific types of interventions. Mindfulness and ACT interventions significantly improved well-being. These findings suggest that psychological interventions can improve well-being, and that different interventions have the potential to improve well-being. Effects also seem to be independent of other factors, including delivery mode, format or target group.
We investigated the short- and long-term effects of two different evidence-based mindfulness training on students’ stress and well-being. A randomised controlled trial with three measurement points (baseline, post-intervention, and 4 months post-intervention) was conducted among undergraduate students of medicine, dentistry, psychology, and logopaedics at the University of Helsinki. The participants were randomly assigned into three groups: (1) face-to-face mindfulness training based on the Mindfulness Skills for Students course (n = 40), (2) a web-based Student Compass program using Mindfulness and Acceptance and Commitment therapy (n = 22), and (3) a control group that received mental health support as usual (n = 40). The primary outcome was psychological distress measured using the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM). Secondary outcomes included hair cortisol concentrations and a wide range of well-being indicators. Psychological distress increased in all the groups from baseline to post-intervention, but significantly less so in the intervention groups than in the control group. At 4-month follow-up, were found no differences between the primary outcomes of the control and intervention groups, but the participants who continued practising mindfulness at least twice a week were less stressed than the others. Our results suggest that participating in a mindfulness course may mitigate health care students’ psychological distress during the academic year, but only if the participants continue practising mindfulness at least twice a week.
Objective:
This study investigated the roles of adherence and usage activity in adolescents' (n = 161) gains during a 5-week web intervention program based on acceptance and commitment therapy (ACT).
Method:
Program adherence was calculated as adherence percentage in relation to intended usage, whereas completion percentage, usage time, and usage weeks were used as indicators for usage activity. Subjective well-being was measured by self-reported life satisfaction and stress before and after the intervention.
Results:
First, regression analysis results showed that higher adherence predicted an increase in life satisfaction during intervention. Second, three subgroups of adolescents were identified using K-means cluster analysis in regard to adherence, usage activity and intervention gains: (1) "Adhered, committed users with relatively large intervention gains" (35%), (2) "Less committed users with no intervention gains" (42%), and (3) "Non-committed users with no intervention gains" (23%). The results showed that the highest gains from the Youth Compass intervention program are most likely obtained when the program is used as intended in its design. In addition, time investment and engagement in doing exercises seem as important as filling the minimum adherence criterion.
Conclusions:
The results support the feasibility of ACT-based web intervention programs in promoting adolescent well-being, although more attention should be paid to motivating adolescents to commit to them and invest enough time in them.
The present study combines two separate research traditions that have been found to explain the way students deal with their university study and other challenges: psychological flexibility and cognitive-attributional strategies. The aim of this study is to explore the interrelationships between students’ psychological flexibility, cognitive-attributional strategies and academic emotions, and their relationship to study success. Further, the study compares students with low, middle and high scores on psychological flexibility. A total of 247 arts students participated in the study. The interrelationships between psychological flexibility, cognitive-attributional strategies, academic emotions, study success and study pace were analysed with correlational analyses and structural equation modelling. Comparisons of different score groups were analysed with one-way ANOVA and Tukeýs tests. The results showed that psychological flexibility, cognitive-attributional strategies and academic emotions are closely related to each other. Psychological flexibility was positively related to success expectations and positive emotions and negatively related to task avoidance and negative emotions.
Objective:
The present study tested the efficacy of an unguided internet-based Acceptance and Commitment Therapy (iACT) program for depression, and identified the psychological characteristics of participants who benefitted the most from the program.
Method:
Undergraduate students with mild to severe symptoms of depression were randomized to the iACT group (n = 95) or the waiting-list group (WLC group; n = 87). Depressive symptoms and positive mental health were assessed at baseline (T0 ), at the end of the 6-week program (T1 ), and at a 3-month follow-up (T2 ).
Results:
Compared with the WLC group, the iACT group showed significantly more improvement in depressive symptoms (d = 1.27) and positive mental health (d = 0.59), both at T1 and T2 . Latent Profile Analysis identified three classes of participants: Sensitive-to-Relationship, Low-Reactive-Depression, and Endogenous-Depression group. In general, the treatment was particularly suitable for the Sensitive-to-Relationship class.
Conclusion:
The iACT was effective in treating the depressive symptoms of undergraduates, especially suitable for the clients with high baseline depression, high externality, high resistance, and high sensitivity to relationships.
Resumo: Este estudo tem por objetivo realizar a adaptação do Acceptance and Action Questionnaire for University Students (AAQ-US), que avalia a inflexibilidade psicológica no contexto universitário. A amostra contou com 123 estudantes de graduação e pós-graduação, de universidades brasileiras, com idades entre 18 e 44 anos. As evidências de validade baseadas na estrutura interna da escala se deram pelas análises paralelas que indicaram a retenção de um fator, assim como a escala original e pela análise fatorial exploratória. O AAQ-US também apresentou boa consistência interna com α=.87 e Omega de McDonald =.70. Além disso, o AAQ-US apresentou evidências de validade convergente e discriminante, tendo correlações com procrastinação, variáveis de saúde mental e flexibilidade psicológica, como também validade de construto pelo método dos grupos conhecidos. Os resultados deste estudo indicam a validade do AAQ-US para o contexto universitário. Palavras-chave: estresse psicológico; depressão; ansiedade; acceptance and action questionnaire for university students; terapia de aceitação e compromisso. Abstract: This study aims the adaptation of the Acceptance and Action Questionnaire for University Students (AAQ-US), which evaluates psychological inflexibility in the university context. The sample consisted of 123 undergraduate and postgraduate students from Brazilian universities, with age between 18 and 44 years. Evidence of validity based on the internal structure of the scale was provided by parallel analysis that indicated a single factor solution, as well as the original scale and by exploratory factor analysis. AAQ-US also presented good internal consistency with α=.87 and McDonald's Omega =.70. Furthermore, AAQ-US showed convergent and discriminant validity, having correlations with procrastination, mental health variables and psychological flexibility and construct validity using known-groups method. The results of this study indicate the validity of AAQ-US for the university context. Keywords: psychological stress; depression; anxiety; acceptance and action questionnaire for university students; acceptance and commitment therapy.
Este estudo tem por objetivo realizar a adaptação do Acceptance and Action Questionnaire for University Students (AAQ-US), que avalia a inflexibilidade psicológica no contexto universitário. A amostra contou com 123 estudantes de graduação e pós-graduação, de universidades brasileiras, com idades entre 18 e 44 anos. As evidências de validade baseadas na estrutura interna da escala se deram pelas análises paralelas que indicaram a retenção de um fator, assim como a escala original e pela análise fatorial exploratória. O AAQ-US também apresentou boa consistência interna com α=.87 e Omega de McDonald =.70. Além disso, o AAQ-US apresentou evidências de validade convergente e discriminante, tendo correlações com procrastinação, variáveis de saúde mental e flexibilidade psicológica, como também validade de construto pelo método dos grupos conhecidos. Os resultados deste estudo indicam a validade do AAQ-US para o contexto universitário.
University students are a high risk population for mental health problems, yet few seek professional help when experiencing problems. This study explored the potential role of an online intervention for promoting wellbeing in university students, by investigating students’ help-seeking behaviour, intention to use online interventions and student content preference for such interventionss; 254 university students responded to an online survey designed for this study. As predicted, students were less likely to seek help as levels of psychological distress increased. Conversely, intention to use an online intervention increased at higher levels of distress, with 39.1%, 49.4% and 57.7% of low, moderate and severely distressed students respectively indicating they would use an online program supporting student well-being. Results suggest that online interventions may be a useful way to provide help to students in need who otherwise may not seek formal help.
Low-intensity interventions for people suffering from depressive symptoms are highly desirable. The aim of the present study was to investigate the outcomes of a web-based acceptance and commitment therapy (ACT)-based intervention without face-to-face contact for people suffering from depressive symptoms. Participants (N = 39) with depressive symptoms were randomly assigned to an Internet-delivered acceptance and commitment therapy (iACT) intervention or a waiting list control condition (WLC). Participants were evaluated with standardized self-reporting measures (Beck Depression Inventory [BDI-II], Symptom Checklist-90 [SCL-90], Acceptance and Action Questionnaire [AAQ-2], Five Facet Mindfulness Questionnaire [FFMQ], Automatic Thoughts Questionnaire [ATQ], and White Bear Suppression Inventory [WBSI]) at pre- and post-measurement. Long-term effects in the iACT group were examined using a 12-month follow-up. The iACT program comprised home assignments, online feedback given by master's-level students of psychology over a 7-week intervention period, and automated email-based reminders. Significant effects were observed in favor of the iACT group on depression symptomatology (between effect sizes [ESs] at post-treatment, iACT/WLC, g = .83), psychological and physiological symptoms (g = .60), psychological flexibility (g = .67), mindfulness skills (g = .53), and frequency of automatic thoughts (g = .57) as well as thought suppression (g = .53). The treatment effects in the iACT group were maintained over the 12-month follow-up period (within-iACT ES: BDI-II, g = 1.33; SCL-90, g = 1.04; ATQF/B [Frequency/Believability], FFMQ, WBSI, AAQ-II, g = .74-1.08). The iACT participants stated that they would be happy to recommend the same intervention to others with depressive symptoms. We conclude that an ACT-based guided Internet-delivered treatment with minimal contact can be effective for people with depressive symptoms.
© The Author(s) 2015.
Background:
There is a growing need to develop online services for university students with the capacity to complement existing services and efficiently address student mental health problems. Previous research examining the development and acceptability of online interventions has revealed that issues such as privacy critically impact user willingness to engage with these services.
Objective:
To explore university student perspectives on privacy issues related to using an online mental health service within the context of the development of an online, university-based virtual mental health clinic.
Methods:
There were two stages of data collection. The first stage consisted of four 1.5-hour focus groups conducted with university students (n=19; 10 female, 9 male, mean age = 21.6 years) to determine their ideas about the virtual clinic including privacy issues. The second stage comprised three 1-hour prototype testing sessions conducted with university students (n=6; 3 male, 3 female, mean age = 21.2 years) using participatory design methods to develop and refine a service model for the virtual clinic and determine student views on privacy within this context.
Results:
The students raised a number of issues related to privacy in relation to the development of the university virtual clinic. Major topics included the types of personal information they would be willing to provide (minimal information and optional mental health data), concern about potential access to their personal data by the university, the perceived stigma associated with registering for the service, and privacy and anonymity concerns related to online forums contained within the virtual clinic.
Conclusions:
Students would be more comfortable providing personal information and engaging with the virtual clinic if they trust the privacy and security of the service. Implications of this study include building the clinic in a flexible way to accommodate user preferences.
Levels of stress and burnout increase during nursing education. This development has consequences for nursing students' health, learning, competence, and interest in quality issues in health care.
In a randomized controlled pilot trial with a sample of 113 nursing students the effect of an intervention using techniques from Acceptance and Commitment Training (ACT) to prevent the development of stress and burnout was evaluated.
The 6 × 2-hour program was compared to standard treatment (reflection seminars) post-intervention and at a 3-month follow-up using longitudinal analysis of mean response profiles. Mechanisms of change were investigated using a baseline-post intervention two-mediator model.
The intervention resulted in increased mindful awareness and decreased experiential avoidance, as well as decreased perceived stress and burnout. Levels of mindful awareness and perceived stress were sustained at follow-up. The proposed mechanisms of change were partly supported by the data.
This study shows that techniques from ACT might have the potential to contribute to preventing the development of stress and burnout during nursing education. However, additional studies are needed to validate these results.
Background: The current study presents the results of a meta-analysis of 39 randomized controlled trials on the efficacy of ACT, including 1,821 patients with mental disorders or somatic health problems.
Methods: We searched PsycINFO, MEDLINE, and the Cochrane Central Register of Controlled Trials. Information provided by the Association of Contextual Behavioral Science (ACBS) community was also included. Statistical calculations were conducted using Comprehensive Meta-Analysis software. Study quality was rated using a methodology rating form.
Results: ACT outperformed control conditions (Hedges’s g = 0.57) at post-treatment and follow-up, in completer and intent-to-treat analyses for primary outcomes. ACT was superior to waitlist (Hedges’s g = 0.82), to psychological placebo (Hedges’s g = 0.51) and to TAU (Hedges’ g = 0.64). ACT was also superior on secondary outcomes (Hedges’s g = 0.30), life satisfaction/quality measures (Hedges’s g = 0.37) and process measures (Hedges’s g = 0. 56) when compared to control conditions. The comparison between ACT and established treatments (i.e., CBT) did not reveal any significant differences between these treatments (p = .140).
Conclusions: Our findings indicate that ACT is more effective than treatment as usual or placebo and that ACT may be as effective in treating anxiety disorders, depression, addiction, and somatic health problems as established psychological interventions. More research that focuses on quality of life and processes of change is needed to understand the added value of ACT and its trans diagnostic nature.
Introduction
The aim of this study was to systematically review the impact of guidance on the efficacy of Internet-based interventions.
Methods
Included were RCTs with a comparison of (1) guided vs. unguided interventions, (2) different doses of guidance, (3) different qualification levels of e-coaches, and (4) synchronous vs. asynchronous communication mode. Outcomes were symptom severity, completer rates and number of completed intervention modules. A systematic search of MEDLINE, CENTRAL and PsycINFO, PsycARTICLES and Psyndex (search date 4th June 2013) was conducted, as well as a hand search of trial-registers and the reference lists of included articles. Methodological quality was rated using the Cochrane Risk of Bias tool. Relevant study characteristics and outcome data were extracted. Random-effects analyses were conducted if appropriate.
Results
5,328 articles were retrieved of which 14 fulfilled inclusion criteria. Guided interventions were significantly superior to unguided interventions (symptom severity: standardized mean difference (SMD) = -.27 [95%CI:-.45;-.10]),n = 8; completed modules: SMD = .52 [.37;.67],n = 7; completer rate: OR = 2.76 [1.68;4.53],n = 6). The four trials that examined different levels of e-coach qualification showed no significant differences on either of the outcome measures. Only one trial each examined the remaining two research questions, without significant effects on either of the outcome measures.
Conclusions
Guidance is a beneficial feature of Internet-based interventions, although its effect is smaller than reported before when compared to unguided interventions. The qualification of the e-coaches seems of minor importance. However, methodological limitations need to be considered when interpreting these findings. Overall, the number of studies was small and mainly limited to depression and social phobia restricting the generalizability of the findings.
Background
Internet-based cognitive behavioural therapy (iCBT) is an effective and acceptable treatment for depression, especially when it includes guidance, but its treatment adherence has not yet been systematically studied. We conducted a meta-analysis, comparing the adherence to guided iCBT with the adherence to individual face-to-face CBT.
Methods
Studies were selected from a database of trials that investigate treatment for adult depression (see www.evidencebasedpsychotherapies.org), updated to January 2013. We identified 24 studies describing 26 treatment conditions (14 face-to-face CBT, 12 guided iCBT), by means of these inclusion criteria: targeting depressed adults, no comorbid somatic disorder or substance abuse, community recruitment, published in the year 2000 or later. The main outcome measure was the percentage of completed sessions. We also coded the percentage of treatment completers (separately coding for 100% or at least 80% of treatment completed).
Results
We did not find studies that compared guided iCBT and face-to-face CBT in a single trial that met our inclusion criteria. Face-to-face CBT treatments ranged from 12 to 28 sessions, guided iCBT interventions consisted of 5 to 9 sessions. Participants in face-to-face CBT completed on average 83.9% of their treatment, which did not differ significantly from participants in guided iCBT (80.8%, P = .59). The percentage of completers (total intervention) was significantly higher in face-to-face CBT (84.7%) than in guided iCBT (65.1%, P < .001), as was the percentage of completers of 80% or more of the intervention (face-to-face CBT: 85.2%, guided iCBT: 67.5%, P = .003). Non-completers of face-to-face CBT completed on average 24.5% of their treatment, while non-completers of guided iCBT completed on average 42.1% of their treatment.
Conclusion
We did not find studies that compared guided iCBT and face-to-face CBT in a single trial. Adherence to guided iCBT appears to be adequate and could be equal to adherence to face-to-face CBT.
Depression and anxiety are common mental health difficulties experienced by university students and can impair academic and social functioning. Students are limited in seeking help from professionals. As university students are highly connected to digital technologies, Web-based and computer-delivered interventions could be used to improve students’ mental health. The effectiveness of these intervention types requires investigation to identify whether these are viable prevention strategies for university students.
Objective: The intent of the study was to systematically review and analyze trials of Web-based and computer-delivered interventions to improve depression, anxiety, psychological distress, and stress in university students.
Methods: Several databases were searched using keywords relating to higher education students, mental health, and eHealth interventions. The eligibility criteria for studies included in the review were: (1) the study aimed to improve symptoms relating to depression, anxiety, psychological distress, and stress, (2) the study involved computer-delivered or Web-based interventions accessed via computer, laptop, or tablet, (3) the study was a randomized controlled trial, and (4) the study was trialed on higher education students. Trials were reviewed and outcome data analyzed through random effects meta-analyses for each outcome and each type of trial arm comparison. Cochrane Collaboration risk of bias tool was used to assess study quality.
Results: A total of 17 trials were identified, in which seven were the same three interventions on separate samples; 14 reported sufficient information for meta-analysis. The majority (n=13) were website-delivered and nine interventions were based on cognitive behavioral therapy (CBT). A total of 1795 participants were randomized and 1480 analyzed. Risk of bias was considered moderate, as many publications did not sufficiently report their methods and seven explicitly conducted completers’ analyses. In comparison to the inactive control, sensitivity meta-analyses supported intervention in improving anxiety (pooled standardized mean difference [SMD] −0.56; 95% CI −0.77 to −0.35, P<.001), depression (pooled SMD −0.43; 95% CI −0.63 to −0.22, P<.001), and stress (pooled SMD −0.73; 95% CI −1.27 to −0.19, P=.008). In comparison to active controls, sensitivity analyses did not support either condition for anxiety (pooled SMD −0.18; 95% CI −0.98 to 0.62, P=.66) or depression (pooled SMD −0.28; 95% CI −0.75 to −0.20, P=.25). In contrast to a comparison intervention, neither condition was supported in sensitivity analyses for anxiety (pooled SMD −0.10; 95% CI −0.39 to 0.18, P=.48) or depression (pooled SMD −0.33; 95% CI −0.43 to 1.09, P=.40).
Conclusions: The findings suggest Web-based and computer-delivered interventions can be effective in improving students’ depression, anxiety, and stress outcomes when compared to inactive controls, but some caution is needed when compared to other trial arms and methodological issues were noticeable. Interventions need to be trialed on more heterogeneous student samples and would benefit from user evaluation. Future trials should address methodological considerations to improve reporting of trial quality and address post-intervention skewed data
At the psychotherapy training center at Karlstad University, a study was carried out to examine the levels of symptom change and satisfaction with therapy in a heterogeneous population of clients treated using cognitive behavioral therapy (CBT) by less experienced trainee therapists with limited theoretical education. The clients received an average of 11 therapy sessions. The results suggested that CBT performed by less experienced trainee therapists can be effective. According to client estimations, a statistically significant reduction in symptoms, measured using the Symptoms Checklist, was achieved for seven of nine variables (p ≤ .006), as well as a significant increase in satisfaction with life (p ≤ .001). Also, the pre- and posttherapy measurements using the Montgomery-Åsberg Depression Rating Scale showed a statistically significant improvement in the clients' condition. According to the therapists' estimations, 64% (SD = 32.01) of the clients experienced a significant improvement in their condition. In addition, the results of a survey of client satisfaction demonstrated that the clients were very pleased with the therapy received. Also the therapists were, to a great extent, satisfied with the treatment process itself, including the supervision received, and very satisfied with the client alliance. A correlation analysis between the clients' perceived level of improvement and therapist satisfaction showed a strong correlation between the two variables (r = .50, p < .005). By including the Comparative Psychotherapy Process Scale (CPPS) in our study it was possible to measure trueness to therapy form. An analysis of the CPPS results confirmed that the form of therapy used at the training site was more strongly CBT than psychodynamic interpersonal treatment (p ≤ .001). The CBT subscale score indicated that the therapy was characteristic of CBT, confirming that the interventions used in the therapy belong to the CBT genre.
Objective:
This study examined the feasibility of a prototype Web-based acceptance and commitment therapy (ACT) program for preventing mental health problems among college students.
Participants:
Undergraduate first-year students (N = 76) participated between May and November 2011.
Methods:
Participants were randomized to ACT or a waitlist, with assessments conducted at baseline, posttherapy, and 3-week follow-up. Waitlist participants accessed the program after the second assessment.
Results:
Program usability/usage data indicated high program acceptability. Significant improvements were found for ACT knowledge, education values, and depression with ACT relative to waitlist. Subgroup analyses indicated that ACT decreased depression and anxiety relative to waitlist among students with at least minimal distress. Within the ACT condition, significant improvements were observed from baseline to 3-week follow-up on all outcome and process measures.
Conclusions:
Results provide preliminary support for the feasibility of a Web-based ACT prevention program.
Background:
Depressive symptoms are one of the main reasons for seeking psychological help. Shorter interventions using briefly trained therapists could offer a solution to the ever-rising need for early and easily applicable psychological treatments.
Aims:
The current study examines the effectiveness of a four-session Acceptance and Commitment Therapy (ACT) based treatment for self-reported depressive symptoms administered by Masters level psychology students.
Method:
This paper reports the effectiveness of a brief intervention compared to a waiting list control (WLC) group. Participants were randomized into two groups: ACT (n = 28) and waiting list (n = 29). Long-term effects were examined using a 6-month follow-up.
Results:
The treatment group's level of depressive symptoms (Beck Depression Inventory) decreased by an average of 47%, compared to an average decrease of 4% in the WLC group. Changes in psychological well-being in the ACT group were better throughout, and treatment outcomes were maintained after 6 months. The posttreatment "between-group" and follow-up "with-in group" effect sizes (Cohen's d) were large to medium for depressive symptoms and psychological flexibility.
Conclusions:
The results support the brief ACT-based intervention for sub-clinical depressive symptoms when treatment was conducted by briefly trained psychology students. It also contributes to the growing body of evidence on brief ACT-based treatments and inexperienced therapists.
Purpose
The purpose of this study was to review articles related to the psychometric properties of the Perceived Stress Scale (PSS).
Methods
Systematic literature searches of computerized databases were performed to identify articles on psychometric evaluation of the PSS.
Results
The search finally identified 19 articles. Internal consistency reliability, factorial validity, and hypothesis validity of the PSS were well reported. However, the test-retest reliability and criterion validity were relatively rarely evaluated. In general, the psychometric properties of the 10-item PSS were found to be superior to those of the 14-item PSS, while those of the 4-item scale fared the worst. The psychometric properties of the PSS have been evaluated empirically mostly using populations of college students or workers.
Conclusion
Overall, the PSS is an easy-to-use questionnaire with established acceptable psychometric properties. However, future studies should evaluate these psychometric properties in greater depth, and validate the scale using diverse populations.
This study examined whether a new student organization, Active Minds, aimed at increasing awareness of “mental illness” and reducing stigma had an impact on students' stigma and willingness to seek psychological help. Three classes were recruited to become involved in the organization. In a pretest/posttest design, stigma and willingness to seek psychological help were compared between students who became involved in Active Minds and students who did not. Students involved in the organization showed a significant reduction in stigma if they had a history of mental illness in their families. However, willingness to seek psychological help was unaffected. The program's partial success is viewed in terms of empowerment and recovery. The peer support provided through Active Minds may help change people's negative attitudes about mental illness and encourage students to help one another in coping with their diagnoses.
This paper aims to investigate the association between the domains of stress, sense of coherence (SOC) and emotional symptoms (depression and anxiety) in adolescents, as well as the potential moderating role of SOC on the relationship between stress and emotional symptoms. The study is based on a cross-sectional sample of 1183 adolescents aged 13-18 who attend public elementary and secondary schools in Mid-Norway. The results showed that girls scored higher than boys on stress related to peer pressure, home life, school performance, school/leisure conflict and emotional symptoms. Conversely, boys reported higher SOC than girls. Results from multiple hierarchical regression analyses showed that for boys, stress related to school performance was positively associated with symptoms of both depression and anxiety, whereas stress from peer pressure was associated with depressive symptoms. For girls, stress from peer pressure, romantic relationships and school was associated with more depressive symptoms. SOC was strongly and inversely associated with emotional symptoms, especially anxiety in girls. SOC also moderated the association between stress related to peer pressure and depressive symptoms in both genders. The study provides evidence of the association of SOC with stress and emotional symptoms during adolescence.
Background:
Attrition is a persistent issue in online self-help programs, but limited research is available on reasons for attrition or successful methods for improving participant retention. One potential approach to understanding attrition and retention in such programs is to examine person-related variables (eg, beliefs and attitudes) that influence behavior. Theoretical models, such as the Theory of Planned Behavior, that describe conditions influencing human behavior may provide a useful framework for predicting participant retention in online-based program.
Objective:
We examined predictors of participant retention in a guided online anxiety, depression, and stress self-help program for university students using the theory of planned behavior. We also explored whether age, symptom severity, and type of coaching (ie, email vs phone) affected participant retention.
Methods:
65 university students with mild to moderate depression, anxiety, and stress were enrolled in this prospective cohort study. Participants completed a questionnaire based on the theory of planned behavior prior to commencing the online-based program and the Depression Anxiety and Stress Scale (DASS) during the assessment module of the program. Participant retention was operationalized as the number of program modules completed.
Results:
Perceived control over completing the online program significantly predicted intention to complete the program (F3,62=6.7; P=.001; adjusted R(2)=.2; standardized beta=.436, P=.001). Age (standardized beta=.319, P=.03) and perceived behavioral control (standardized beta=.295, P=.05) predicted the number of program modules completed (F3,61=3.20, P=.03, adjusted R(2) =.11). Initial level of distress (ie, symptom severity) did not predict participant retention (P=.55). Participants who chose phone-based coaching completed more program modules than participants who chose email-based coaching (Mann-Whitney's U=137; P=.004).
Conclusions:
Participants' age, level of perceived behavioral control, and choice of interaction (ie, phone-based or email-based coaching) were found to influence retention in this online-based program.
Controversy remains about the empirical status of acceptance and commitment therapy (ACT) and its presumably different characteristics relative to traditional cognitive behavioral therapy (CBT). The current study aims to shed some light in this respect by conducting a systematic review and meta-analysis of the studies that have empirically compared ACT versus CBT. Sixteen studies comparing differential outcomes (N= 954) of ACT versus CBT in diverse problems were identified following several search strategies. The meta-analysis, which applied random and mixed effects models, showed that mean effect sizes on primary outcomes significantly favored ACT (Hedges’s g= 0.40). Mean effect sizes were not significant with anxiety symptoms whereas a positive trend for ACT was obtained in depression (g= 0.27) and quality of life (g= 0.25) at post-treatment. Likewise, ACT showed a greater impact on its putative processes of change (g= 0.39) and no differences were found regarding CBT proposed processes (g= 0.02). Nine studies conducted formal mediation analyses. Overall, ACT seemed to work through its proposed processes of change but CBT did not. Results are discussed highlighting the limitations of the current empirical evidence but also emphasizing the relevance of the current findings.
Background:
Depression is a common health problem, ranking third after cardiac and respiratory diseases as a major cause of disability. There is evidence to suggest that university students are at higher risk of depression, despite being a socially advantaged population, but the reported rates have shown wide variability across settings.
Purpose:
To explore the prevalence of depression in university students.
Method:
PubMed, PsycINFO, BioMed Central and Medline were searched to identify studies published between 1990 and 2010 reporting on depression prevalence among university students. Searches used a combination of the terms depression, depressive symptoms, depressive disorders, prevalence, university students, college students, undergraduate students, adolescents and/or young adults. Studies were evaluated with a quality rating.
Results:
Twenty-four articles were identified that met the inclusion and exclusion criteria. Reported prevalence rates ranged from 10% to 85% with a weighted mean prevalence of 30.6%.
Conclusions:
The results suggest that university students experience rates of depression that are substantially higher than those found in the general population. Study quality has not improved since 1990.
In this study we investigated whether or not problems experienced during years at university affect academic achievement. Students enrolled full-time at a Swedish university were followed up from their year of entry in 1998/1999 through to 2000/2001 (N = 1,127) by self-administered questionnaires. Students' sociodemographic characteristics, their experience of stressors, psychological symptoms, and mental and general health ratings were linked to their academic achievement (degree completed). The extent to which various factors or groups of factors affect academic achievement was measured by a series of multiple logistic regression analyses. Older students, females, and those enrolled on comparatively shorter programs (3 years) tended to have higher odds of being awarded a degree. Experienced stress brought on by not coping academically and due to study support demands was a substantial barrier to students' academic achievement.
Are perceived increases in symptom severity in college counseling center clients real or imagined? Counseling center staff, retrospectively, reported that client problems are more severe now than in the past. Yet studies examining client distress levels at intake have found no significant increases. This study examined counseling center client problems across 13 years from the perspective of the treating therapist at the time of case closure. Increases were found for 14 of 19 client problem areas, whereas other areas retained stable levels, and 2 problem areas had a quadratic trend over time. These changes directly affect counseling service practices. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Since the original publication of this seminal work, acceptance and commitment therapy (ACT) has come into its own as a widely practiced approach to helping people change. This book provides the definitive statement of ACT—from conceptual and empirical foundations to clinical techniques—written by its originators. ACT is based on the idea that psychological rigidity is a root cause of a wide range of clinical problems. The authors describe effective, innovative ways to cultivate psychological flexibility by detecting and targeting six key processes: defusion, acceptance, attention to the present moment, self-awareness, values, and committed action. Sample therapeutic exercises and patient–therapist dialogues are integrated throughout.
New to This Edition
*Reflects tremendous advances in ACT clinical applications, theory building, and research.
*Psychological flexibility is now the central organizing focus.
*Expanded coverage of mindfulness, the therapeutic relationship, relational learning, and case formulation.
*Restructured to be more clinician friendly and accessible; focuses on the moment-by-moment process of therapy.
This is the introductory article to a special series in Cognitive and Behavioral Practice on Acceptance and Commitment Therapy (ACT). Instead of each article herein reviewing the basics of ACT, this article contains that review. This article provides a description of where ACT fits within the larger category of cognitive behavior therapy (CBT): CBT is an overarching term for a whole cluster of therapies, and ACT is one of many forms of CBT Functional contextualism and how it informs ACT is briefly reviewed. The behavior analytic account of cognition that informs ACT, relational frame theory (RFT), and rule-governed behavior are covered. Psychological flexibility and the 6 resulting psychological processes of change (acceptance, defusion, being present, self as context, values, and committed action) are described. The empirical support for ACT and its related model are presented. Finally, characteristics of the ACT model, including its therapeutic approach, desired outcomes, and processes of change are reviewed.
Because ACT is a contextual treatment, your attempts to conceptualize a presenting problem might be different from traditional case conceptualization models. The most important principle in contextual analysis is that you are not just assessing a particular symptom with a particular topography; you are also attempting to understand the functional impact of the presenting complaint. The same clinical complaint can function in dramatically different ways for clients. Thus, your case conceptualization and associated treatment plan may differ for clients with seemingly similar problems. For example, many patients are diagnosed with major depression, single episode (a categorical formulation) based on the number and severity of symptoms described by the patient (a topographical assessment). In clinical practice however, it is fair to say that no two depressed patients are alike. Each is unique in how their life space is organized, how depression affects their functioning (and vice versa) and how depressive beliefs and behaviors define the individual’s sense of self and external world.
