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Vally Z, Shah H, Varga SI, Hassan W, Kashakesh M, Albreiki W, Helmy M. An internet-delivered acceptance and commitment therapy program for anxious affect, depression, and wellbeing: A randomized, parallel, two-group, waitlist-controlled trial in a Middle Eastern sample of college students. PLoS One 2024; 19:e0313243. [PMID: 39637057 PMCID: PMC11620599 DOI: 10.1371/journal.pone.0313243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 10/21/2024] [Indexed: 12/07/2024] Open
Abstract
BACKGROUND College students during the young adult years are at elevated risk for the development of anxiety and depressive difficulties. Moreover, a preliminary body of evidence suggests that, for those who reside in Middle Eastern contexts, despite an established need, sociocultural impediments prevent active psychological help-seeking. Internet-delivered, self-directed mental health programs may hold significant promise to alleviate these difficulties in contexts where individuals would otherwise not enlist the support of a mental health practitioner. METHOD The present study developed a bespoke, 4-module, internet-delivered program based upon acceptance and commitment therapy (ACT) principles and tested its feasibility and efficacy within the context a randomized controlled trial. A total of 129 participants were randomized to receive either the ACT program or to a waitlist control condition. Assessments of generalized anxiety, social anxiety, depressive affect, and wellbeing were administered at baseline and at post-intervention. RESULTS Analyses indicated that the intervention was efficacious in mitigating both generalized and social anxiety and in improving wellbeing. CONCLUSION These results provide preliminary evidence of the feasibility and efficacy of internet-delivered ACT in a Middle Eastern context.
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Affiliation(s)
- Zahir Vally
- Department of Clinical Psychology, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Harshil Shah
- Department of Clinical Psychology, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Sabina-Ioana Varga
- Department of Clinical Psychology, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Widad Hassan
- Department of Clinical Psychology, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Mariam Kashakesh
- Department of Clinical Psychology, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Wafa Albreiki
- Department of Clinical Psychology, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Mai Helmy
- Department of Psychology, Sultan Qaboos University, Muscat, Sultanate of Oman
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Hayes-Skelton SA, Roemer L, Orsillo SM. Do treatment responders maintain their gains following a randomized clinical trial comparing an acceptance-based behavior therapy to applied relaxation for generalized anxiety disorder? Cogn Behav Ther 2024:1-16. [PMID: 39440656 PMCID: PMC12014859 DOI: 10.1080/16506073.2024.2417423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 10/08/2024] [Indexed: 10/25/2024]
Abstract
To examine the maintenance effects of acceptance-based behavior therapy (ABBT) and applied relaxation (AR) for generalized anxiety disorder (GAD) 46 adults (69.6% female, 82.6% White) with high end-state functioning following an RCT comparing ABBT to AR were re-assessed at 12- and 24-month follow-up. End-state functioning was based on post-treatment scores within one standard deviation of the mean on three of five outcome measures [Clinician Severity Rating (CSR), Hamilton Anxiety, Penn State Worry Questionnaire (PSWQ), Depression Anxiety Stress Scale stress subscale (DASS-Stress), and State-Trait Anxiety Inventory (STAI)]. At 12 months, 93.8% of high endstate responders in ABBT and 95.5% in AR had maintained gains. At 24 months, 71.4% of responders from ABBT and 83.3% from AR maintained gains. Mixed-effects regression models revealed a significant effect for Time and Condition for DASS-Stress but not for Condition X Time. There was also a significant time effect for PSWQ, indicating PSWQ and DASS-Stress scores increased across follow-up. The rate of increase did not differ across conditions. Non-significant, small effects were found for all other outcomes indicating that symptoms did not significantly change across follow-up regardless of condition. While the results are limited by dropout rates, clients receiving ABBT or AR appear to maintain gains over long-term follow-up.
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Affiliation(s)
| | - Lizabeth Roemer
- Department of Psychology, University of Massachusetts Boston, Boston, MA, USA
| | - Susan M Orsillo
- Department of Psychology, Suffolk University, Boston, MA, USA
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Grégoire S, Beaulieu F, Lachance L, Bouffard T, Vezeau C, Perreault M. An online peer support program to improve mental health among university students: A randomized controlled trial. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024; 72:2001-2013. [PMID: 35943903 DOI: 10.1080/07448481.2022.2099224] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 06/01/2022] [Accepted: 06/27/2022] [Indexed: 06/15/2023]
Abstract
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.
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Affiliation(s)
- Simon Grégoire
- Département d'éducation et pédagogie, Université du Québec à Montréal, Montréal, Québec, Canada
| | - Frédérique Beaulieu
- Département de psychologie, Université du Québec à Montréal, Montréal, Québec, Canada
| | - Lise Lachance
- Département d'éducation et pédagogie, Université du Québec à Montréal, Montréal, Québec, Canada
| | - Thérèse Bouffard
- Département de psychologie, Université du Québec à Montréal, Montréal, Québec, Canada
| | - Carole Vezeau
- Département de psychologie, Université du Québec à Montréal, Montréal, Québec, Canada
- Département de psychologie, Cégep régional de Lanaudière à Joliette, Joliette, Quebec, Canada
| | - Michel Perreault
- Département de psychiatrie, Université McGill, Montréal, Québec, Canada
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Liu XQ, Guo YX, Xu Y. Risk factors and digital interventions for anxiety disorders in college students: Stakeholder perspectives. World J Clin Cases 2023; 11:1442-1457. [PMID: 36926387 PMCID: PMC10011984 DOI: 10.12998/wjcc.v11.i7.1442] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/06/2023] [Accepted: 02/10/2023] [Indexed: 03/02/2023] Open
Abstract
The worldwide prevalence of anxiety disorders among college students is high, which negatively affects countries, schools, families, and individual students to varying degrees. This paper reviews the relevant literature regarding risk factors and digital interventions for anxiety disorders among college students from the perspectives of different stakeholders. Risk factors at the national and societal levels include class differences and the coronavirus disease 2019 pandemic. College-level risk factors include the indoor environment design of the college environment, peer relationships, student satisfaction with college culture, and school functional levels. Family-level risk factors include parenting style, family relationship, and parental level of education. Individual-level risk factors include biological factors, lifestyle, and personality. Among the intervention options for college students' anxiety disorders, in addition to traditional cognitive behavioral therapy, mindfulness-based interventions, psychological counseling, and group counseling, digital mental health interventions are increasingly popular due to their low cost, positive effect, and convenient diagnostics and treatment. To better apply digital intervention to the prevention and treatment of college students' anxiety, this paper suggests that the different stakeholders form a synergy among themselves. The nation and society should provide necessary policy guarantees, financial support, and moral and ethical supervision for the prevention and treatment of college students' anxiety disorders. Colleges should actively participate in the screening and intervention of college students' anxiety disorders. Families should increase their awareness of college students' anxiety disorders and take the initiative to study and understand various digital intervention methods. College students with anxiety disorders should actively seek psychological assistance and actively accept and participate in digital intervention projects and services. We believe that in the future, the application of methods such as big data and artificial intelligence to improve digital interventions and provide individualized treatment plans will become the primary means of preventing and treating anxiety disorders among college students.
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Affiliation(s)
- Xin-Qiao Liu
- School of Education, Tianjin University, Tianjin 300350, China
| | - Yu-Xin Guo
- School of Education, Tianjin University, Tianjin 300350, China
| | - Yi Xu
- School of Education, Tianjin University, Tianjin 300350, China
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Browning ME, Morena A, Gould ER, Lloyd-Richardson EE. Brief ACT for Undergraduates: A Mixed-Methods Pilot Investigation of Acceptance and Commitment Therapy Delivered over Zoom. JOURNAL OF COLLEGE STUDENT PSYCHOTHERAPY 2022. [DOI: 10.1080/87568225.2022.2029659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Morgan E. Browning
- Department of Psychology, University of Massachusetts Dartmouth, North Dartmouth, MA, USA
| | - Alexandra Morena
- Department of Psychology, University of Massachusetts Dartmouth, North Dartmouth, MA, USA
| | - Evelyn R. Gould
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Martinez JH, Eustis EH, Arbid N, Graham-LoPresti JR, Roemer L. The role of experiential avoidance in the relation between racial discrimination and negative mental health outcomes. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:461-468. [PMID: 32369427 DOI: 10.1080/07448481.2020.1754221] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 02/25/2020] [Accepted: 03/29/2020] [Indexed: 06/11/2023]
Abstract
Objective Racial discrimination has been shown to be associated with negative mental health outcomes among people of color (POC), and students of color (SOC) specifically. The current study examines experiential avoidance (EA) as a potential moderator in the relation between discrimination and mental health outcomes. Sample: Two-hundred students of color at a large, public university in Northeastern United States. Methods: We evaluated the associations between racial discrimination frequency and stress appraisal (GEDS and GEDS-A), EA (AAQ), and the Depression, Anxiety, and Stress Scales (DASS). Results: Discrimination frequency and appraised stress were associated with each DASS subscale. EA moderated the relation between GEDS and depression, and between GEDS-A and the stress subscale. Conclusions: Discrimination frequency and appraised stress were positively associated with DASS subscales, and at low EA scores, frequency and appraised stress of discrimination were no longer associated with depressive or stress symptoms, respectively.
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Affiliation(s)
- Jennifer H Martinez
- Department of Psychology, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Elizabeth H Eustis
- Center for Anxiety & Related Disorders, Boston University, Boston, Massachusetts, USA
| | - Natalie Arbid
- Department of Psychology, University of Massachusetts Boston, Boston, Massachusetts, USA
| | | | - Lizabeth Roemer
- Department of Psychology, University of Massachusetts Boston, Boston, Massachusetts, USA
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Aafjes-van Doorn K, Sweeney K. The effectiveness of initial therapy contact: A systematic review. Clin Psychol Rev 2019; 74:101786. [PMID: 31733564 DOI: 10.1016/j.cpr.2019.101786] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 07/17/2019] [Accepted: 09/25/2019] [Indexed: 10/25/2022]
Abstract
'Initial therapy contacts', defined as (the first) 3 h or less of face-to-face psychological treatment, encompassing both the early phase of a longer therapy and one-off single session therapies, are seen as a critical phase of treatment. However, little is known about the direct effect of initial therapy contacts on change in common symptoms typically presented by patients in psychological therapy services. Our systematic literature search resulted in 35 identified empirical studies on the effect of initial therapy contacts. These studies were analyzed in three stages: 1) A systematic comparison of study characteristics using the preferred reporting items for systematic reviews and meta-analyses; 2) A domain-based evaluation of methodological rigor of the studies, in line with Cochrane's guidelines on assessing risk of bias; 3) A narrative synthesis of reported findings. The considerable variability in therapy format (a stand-alone single session, 2 + 1 format, or initial session of multisession therapy) and study design (post/pre-post measurement, with/without control) limited comparability of studies. The quality assessment indicated that the majority of studies had relatively weak methodologies overall. Qualitative synthesis of the effectiveness results suggests that a significant proportion of patients reported benefits, including symptom change. This positive effect is especially clear when compared to no-treatment controls, and appears to be maintained at follow-up. The findings suggest that a broad range of initial therapy formats, could in itself be beneficial to patients in primary care treatment settings, and that further research is warranted.
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Eustis EH, Hayes-Skelton SA, Orsillo SM, Roemer L. Surviving and Thriving During Stress: A Randomized Clinical Trial Comparing a Brief Web-Based Therapist-Assisted Acceptance-Based Behavioral Intervention Versus Waitlist Control for College Students. Behav Ther 2018; 49:889-903. [PMID: 30316488 DOI: 10.1016/j.beth.2018.05.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 04/23/2018] [Accepted: 05/31/2018] [Indexed: 11/26/2022]
Abstract
The high rates of anxiety in college students and the many barriers to accessing evidence-based care in communities and on campuses indicate a clear need to explore ways to increase access to evidence-based treatments. Web-based interventions and preventions are one way to bridge this gap; they hold the potential to decrease mental health disparities and enhance student functioning. The current RCT examined the acceptability and efficacy of a 3-session web-based therapist-assisted acceptance-based behavioral intervention targeting anxiety (Surviving and Thriving During Stress) for college students versus a waitlist (WL) control condition, in a sample of racially and ethnically diverse college students. Overall, participants rated the program as helpful and acceptable. Mixed-effects regression models (MRMs) were run in SPSS to examine the effects of time, condition, and Condition × Time on outcomes and hypothesized mechanisms. Significant Condition × Time interactions for general anxiety, depression, and quality of life (QOL) emerged, suggesting that SATDS participants reported significantly greater changes on these outcomes from pre- to posttreatment versus WL. However, interaction effects were nonsignificant for anxious arousal and social anxiety. MRMs examining hypothesized mechanisms revealed significant Condition × Time interactions for experiential avoidance, decentering, and values-based living. However, interaction effects were nonsignificant for mindfulness. All significant gains were maintained at 1-month follow-up, with the exception of QOL. Results contribute to the growing literature on the acceptability and efficacy of web-based approaches, and suggest these approaches can be effective for diverse college students, and may provide a unique platform to increase access to evidence-based care.
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Williston SK, Roemer L. Predictors of well-being in the lives of student service members and veterans. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2017; 65:404-412. [PMID: 28617102 DOI: 10.1080/07448481.2017.1341891] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 12/22/2016] [Accepted: 03/12/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The current study examined predictors of well-being, including quality of life and academic engagement, in a sample of student service members and veteran college students. METHODS Eighty-seven student service members/veterans (SSM/V) completed an online survey containing questions about post-deployment social support, emotion regulation skills, psychological distress, academic engagement, quality of life, and demographics. Participants were recruited from September 2012 through May 2014. RESULTS Results provided partial support for the proposed bi-directional mediational relations between post-deployment social support and emotion regulation predicting to quality of life and academic engagement. Path models indicated that both post-deployment social support and emotion regulation skills partially mediated the relation with quality of life while accounting for the effect of psychological distress, and that emotion regulation skills fully mediated the relation between social support and academic engagement. CONCLUSIONS These findings suggest that both social support and emotion regulation skills may be useful targets for health promotion and intervention efforts for this population. Limitations and clinical implications for the development of on-campus SSM/V focused health promotion services are discussed.
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Affiliation(s)
- Sarah Krill Williston
- a Department of Psychology , University of Massachusetts , Boston, Boston , MA , USA
| | - Lizabeth Roemer
- a Department of Psychology , University of Massachusetts , Boston, Boston , MA , USA
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