Examining mediators of change in wellbeing, stress, and depression in a blended, Internet-based, ACT intervention for university students
Open accessAbstract
A coach-guided Acceptance and Commitment Therapy (ACT) intervention that uses a blended approach of two face-to-face and five online sessions (iACT; N = 33) has been found to be more effective than a waiting-list control condition (WLC; N = 35) at enhancing the wellbeing of university students while also reducing stress and depression. The present study explored possible mediators of change that may account for the outcomes of the study. Mediation analyses revealed that changes in the non-reactivity subscale of mindfulness mediated changes in wellbeing, depression, and stress in the iACT group. In addition, changes in the sense of coherence subscale of meaningfulness mediated changes in all outcomes. Psychological flexibility and cognitive defusion did not mediate changes in outcomes. The results suggest that the use of practices focusing on non-reactivity, meaning the ability to allow thoughts and feelings to come and go without getting carried away by them, is especially important for enhancing the wellbeing of university students. A focus on enhancing meaningfulness also plays a significant role in reducing psychological distress. These findings provide a first step toward understanding the potential mechanisms of change taking place in brief, Internet-supported, blended ACT programs.
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Räsänen et al. (2020) found comparative gains in wellbeing, stress, and depression for the ACT condition compared to wait-list among 68 students in Finland.
“The results showed comparative gains in wellbeing ( p = .008, d = 0.46), stress ( p = .028, d = 0.54), and depression ( p = .003, d = 0.69) for the ACT condition.”
From A randomised controlled trial of brief web-based acceptance and commitment Therapy on the general mental health, depression, anxiety and stress of college Students (2022) · cites this paper as Räsänen et al., 2020
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“R ¨ as ¨ anen et al. (2016, 2020) investigated the use of a 7-week online ACT intervention, which included five modules aimed at each ACT process, with two in-person meetings with an ACT coach before accessing the online modules.”
InfluentialRodríguez‐Rivas, M. E., Valdebenito, S., Benavente, M., Alfaro, J., Villacura, P., Chuecas, M. J., Ditzel, A. L., & Galdames, A. (2025) · Psicothema · doi:10.70478/psicothema.2025.37.17 · Cited by 6 · see citing works
Zhou, Y., Wen, X., Li, Y., Liu, L., & Li, Q. S. (2024) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2024.100868 · Cited by 5 · see citing works
Mechanisms of change in an online acceptance and commitment therapy intervention for insomnia
Hämäläinen, T., Lappalainen, P., Langrial, S. U., Lappalainen, R. I., & Kiuru, N. H. (2025) · Scientific Reports · doi:10.1038/s41598-025-87018-3 · Cited by 5 · see citing works
“Practices on non-reactivity mediated the effect of a blended ACT intervention on university students’ stress, depression, and well-being 34 , and changes in depressive symptoms mediated the effect of online ACT on adolescents’ subsequent school engagement 35 .”
Jeong, N., Kim, E., & Chun, J. (2024) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2024.100842 · Cited by 4 · see citing works
A Mixed-Methods Analysis of Mobile ACT Responses From Two Cohorts
Hoel, S., Victory, A., Sagorac Gruichich, T., Stowe, Z. N., McInnis, M. G., Cochran, A., & Thomas, E. B. K. (2022) · Frontiers in Digital Health · doi:10.3389/fdgth.2022.869143 · Cited by 4 · see citing works
“Further support for the efficacy of ACT when delivered virtually comes from positive outcomes when internet ACT, or iACT, is studied among individuals with depression (29, 30).”
BackgroundMerikko, J., & Räsänen, P. (2026) · Lecture notes in computer science · doi:10.1007/978-3-032-13184-3_14 · Cited by 1 · see citing works
Bruna, B., Rozas, G., Guerra, C., & García, F. E. (2024) · Psychologia · doi:10.21500/19002386.6672 · Cited by 1 · see citing works
“…Binfet et al. , 2017; Carpena et al. , 2019; Dear et al. , 2019, Galante et al. , 2021; Hindman et al. , 2014; Jafar et al. , 2015; López et al. , 2017; Molla et al. , 2015; Räsänen et al. , 2020; Sang, 2019; Saleh et al. , 2018), mientras que un artículo lo hizo entre 21 y 30 (Bíró et al. , 2014).”
BackgroundInfluentialDillenburg, M. S., Ludwig, M. W. B., Garicochêa, P. R., Boff, N., Zancan, R. K., & Oliveira, M. D. S. (2021) · Contextos Clínicos · doi:10.4013/ctc.2021.142.01
Lappalainen, R. I., Keinonen, K., & Lappalainen, P. (2022) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780197550076.013.28
Pierce, B. G., Twohig, M. P., & Levin, M. E. (2025) · Journal of College Student Mental Health · doi:10.1080/28367138.2024.2409244
“…(RCT) with 68 college students found a web-based ACT program led to significant improvements in depression, stress, and well-being relative to a waitlist condition, which were mediated by changes in psychological flexibility processes, particularly mindfulness in this study (Räsänen et al., 2020).”
Kharaghani, R., Ahmadnia, E., Mousavi, S. E., & Norouzi, Z. (2025) · Journal of Medical Education Development · doi:10.61882/edcj.18.3.47
Barrios, P. P., Reales, E. B., Cantillo, L. B., Mendoza, P. S., Conde, W. R. I., & Brochado, E. R. C. (2025) · IEEE Colombian Caribbean Conference (C3) · doi:10.1109/c366505.2025.11340093
“In terms of Comparison , studies using various types of control groups were considered, including treatment as usual and waiting lists [10], [11].”
InfluentialSelinheimo, S., Vuokko, A., Lappalainen, P., Keinonen, K., Tolvanen, A. J., Lappalainen, R. I., Sainio, M., & Paunio, T. (2026) · International Journal of Behavioral Medicine · doi:10.1007/s12529-026-10477-z
- Authors
- Räsänen, P., Muotka, J., & Lappalainen, R.
- Affiliations
- University of Jyväskylä (FI)
- Corresponding author
- Räsänen, Panajiota
- Venue
- Internet Interventions
- Publisher
- Elsevier BV
- Published
- 2020-12
- Volume
- 22
- Pages
- 100343
- ISSN
- 2214-7829 (ISSN-L)
- PMC
- PMC7508697
- OpenAlex
- W3081588170
- Cited by
- 23
- References
- 75
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 4 · 2023: 2 · 2022: 6 · 2021: 4
- FWCI
- 1.20
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Internet Interventions (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Jyväskylä University Digital Archive (University of Jyväskylä) (submittedVersion, cc-by-nc-nd)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- University of Jyvaskyla's (21000841)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Social Psychology › Psychological Well-being and Life Satisfaction
- Keywords
- acceptance and commitment therapy, online intervention, blended intervention, university students, well-being, stress, depression, mindfulness, non-reactivity, sense of coherence, meaningfulness, psychological flexibility, cognitive defusion, mechanisms of change
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