Web-Based Acceptance and Commitment Therapy for Mental Health Problems in College Students: A Randomized Controlled Trial

Probably not a substantial claim: may not pass S3 (load-bearing).

Up to almost 50% of students have a diagnosable psychological disorder each year.

“Epidemiological studies indicate up to almost 50% of students have a diagnosable psychological disorder each year (Blanco et al., 2008).”

• cites Blanco et al., 2008 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

Mental health problems are a significant issue among students at universities.

“Mental health problems are a significant issue among students at universities.”

• cites Blanco et al., 2008 sourceSupported

May combine two claims.

These studies found promising results suggesting web-based ACT may be acceptable and helpful to students for improving academic success, preventing mental health problems, and as an adjunctive treatment along with counseling.

“These studies found promising results suggesting web-based ACT may be acceptable and helpful to students for improving academic success (Chase et al., 2013), preventing mental health problems (Levin et al., 2014) and as an adjunctive treatment along with counseling (Levin et al., 2015).”

• cites Chase et al., 2013 sourceNot checked — no full text of the source
• cites Levin et al., 2014 sourceSupported
• cites Levin et al., 2015 sourceNot checked — no full text of the source

May combine two claims.

The two studies testing ACT as a transdiagnostic treatment found positive effects on depression and anxiety, but did not assess a broader range of problems.

“The two studies testing ACT as a transdiagnostic treatment found positive effects on depression and anxiety, but did not assess a broader range of problems (Levin et al., 2014;2015).”

• cites Levin et al., 2014 sourcePartly supported

  The Results (Between Group Analyses; page unavailable) report greater reductions in depression and anxiety for distressed students receiving ACT than for those on the waitlist, but no significant anxiety difference among nondistressed students. The Methods (Measures; page unavailable) show that the study also assessed stress, so it did not restrict assessment to depression and anxiety; it did not assess a wide range of other mental health problems. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites Levin et al., 2015 sourceNot checked — no full text of the source

May combine two claims.

The MHC-SF has been found to have adequate reliability and validity in past research and to be sensitive to detecting the effects of ACT.

“The MHC-SF has been found to have adequate reliability and validity in past research (Keyes, 2005) and to be sensitive to detecting the effects of ACT (Bohlmeijer, Lamers & Fledderus, 2015).”

• cites Keyes, 2005 sourceCould not verify

  The Keyes (2005) citation is attached to the MHC-SF’s reliability and validity, not to its sensitivity to ACT effects. The Measures section (p. 4) reports internal consistency for other mental-health scales, but the passages found when searching for MHC-SF and reliability do not establish the MHC-SF’s reliability or validity. (LLM, conf=0.76)

  Experimental — accuracy not yet measured
• cites Bohlmeijer, Lamers & Fledderus, 2015 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

The AAQ-II has been found to have adequate reliability and validity in past studies with college students.

“The AAQ-II has been found to have adequate reliability and validity in past studies with college students (Bond et al., 2011).”

• cites Bond et al., 2011 sourceSupported

May combine two claims.

Other concerns included that they did not have the time or privacy to use the program (7%), that there was inadequate coverage for certain, specific mental health problems (7%) and that they did not like the web-based and self-help format for receiving services (3%).

“Other concerns included that they did not have the time or privacy to use the program (7%), that there was inadequate coverage for certain, specific mental health problems (7%) and that they did not like the web-based and self-help format for receiving services (3%).”

May combine two claims.

Participants primarily were recruited through the SONA research platform and participated for extra credit rather than specifically for help with a psychological problem.

“However, the participants primarily were recruited through the SONA research platform and participated for extra credit rather than specifically for help with a psychological problem.”

May combine two claims.

The sample consisted of 79 college students who were 18 years of age or older and currently enrolled at a mid-size university in the Mountain West region of the US.

“The sample consisted of 79 college students who were 18 years of age or older and currently enrolled at a mid-size university in the Mountain West region of the US.”

May combine two claims.

Of 18 comparisons, a statistically significant difference was found on one measure, CCAPS academic concern subscale, such that those in the ACT condition had higher academic concerns at baseline.

“Of 18 comparisons a statistically significant difference was found on one measure, CCAPS academic concern subscale, t(76) = 2.21, p = .03,such that those in the ACT condition had higher academic concerns at baseline (ACT M = 2.01, ACT SD = 1.00,Waitlist M = 1.57,Waitlist SD = .72).”

May combine two claims.

86% reported participating for extra credit, with only 6% participating for help with a psychological problem/personal distress, and 8% for both extra credit and help with distress.

“86% reported participating for extra credit, with only 6% participating for help with a psychological problem/personal distress, and 8% for both extra credit and help with distress”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The average time spent in each session that a participant completed was 17.19 minutes (SD = 16.20), with the longest time spent in session 1 and the shortest time spent in session 3.

“The average time spent in each session that a participant completed was 17.19 minutes (SD = 16.20), with the longest time spent in session 1 (M = 24.83,SD = 18.63) and the shortest time spent in session 3 (M = 10.50,SD = 12.10).”

May combine two claims.

86% reported learning of the study through the web-based research participant management platform, SONA Systems, and only one participant learned of the study from the counseling or student health center.

“Consistent with this, 86% reported learning of the study through the web-based research participant management platform, SONA Systems (for extra credit assignments), and only one participant learned of the study from the counseling or student health center (despite active attempts to recruit in these settings).”

May combine two claims.

In the ACT condition, there were significant pre-to-post improvements on CCAPS academic concern, MHC total score, and MHC social wellbeing.

“slope estimate = -.39,t(59.84)= -3.85,p < .001,Cohen's d = .69,CCAPS academic concern, slope estimate = -.29,t(60.30)= -2.54,p = .014,Cohen's d = .45,MHC total score, slope estimate = 5.90, t(61.67)= 3.45, p = .001,Cohen's d = .60,and MHC social wellbeing, slope estimate = 2.97, t(62.23)= 3.66, p = .001,Cohen's d = .64.”

May combine two claims.

There were no significant time by condition interactions for CCAPS eating concerns, CCAPS hostility, CCAPS alcohol, MHC emotional wellbeing subscale, or MHC psychological wellbeing (p > .10).

“There were no significant time by condition interactions for CCAPS eating concerns, CCAPS hostility, CCAPS alcohol, MHC emotional wellbeing subscale, or MHC psychological wellbeing (p > .10).”

• Also stated in: § Discussion · plain

  “The ACT website was found to improve a range of outcomes relative to a waitlist condition, although significant effects were not found on all outcomes (hostility, eating concerns, alcohol problems).”

• Also stated in: § Discussion · plain

  “For example, the current study did find some limiting areas where there were no between group differences: eating concerns, hostility, alcohol, and some aspects of positive mental health.”

May combine two claims.

At baseline, 87% of participants had at least mildly severe scores on at least one CCAPS subscale and 68% had scores in the range indicating a clinically significant problem on at least one subscale.

“Based on this information at baseline, 87% of participants had at least mildly severe scores on at least one CCAPS subscale and 68% had scores in the range indicating a clinically significant problem on at least one subscale.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Participants spent on average 73.58 minutes in the ACT program (SD = 83.28).

“Participants spent on average 73.58 minutes in the ACT program (SD = 83.28).”

May combine two claims.

The majority of participants completed at least one session (83% completed session 1) and at least half of the ACT program (75% completed session 3).

“The majority of participants completed at least one session (83% completed session 1) and at least half of the ACT program (75% completed session 3).”

May combine two claims.

PHLMS acceptance and VQ obstacles improved from pre to posttreatment only in the ACT condition.

“In both cases, post hoc analyses indicated that ACT processes only improved from pre to posttreatment in the ACT condition: PHLMS acceptance, slope estimate = -3.44,t(64.45)= -3.56,p = .001,Cohen's d = .62,and VQ obstacles, slope estimate = -4.34,t(62.45)= -4.68,p < .001,Cohen's d = .82.”

• Also stated in: § Discussion · plain

  “In contrast, the obstruction in valued living and mindful acceptance both improved significantly from ACT.”

May combine two claims.

The sample varied in types of clinically significant problems: 45% were in the clinical range for depression, 40% social anxiety, 30% general anxiety, 30% eating problems, 24% academic concerns, 22% hostility, and 14% alcohol problems.

“The sample varied in terms of types of clinically significant problems: 45% were in the clinical range for depression, 40% social anxiety, 30% general anxiety, 30% eating problems, 24% academic concerns, 22% hostility, and 14% alcohol problems.”

May combine two claims.

VQ obstacles was a significant mediator of CCAPS academic concern, MHC total positive mental health and MHC social wellbeing, but PHLMS acceptance did not mediate these outcomes.

“VQ obstacles was also a significant mediator of CCAPS academic concern, MHC total positive mental health and MHC social wellbeing, but PHLMS acceptance did not mediate these outcomes.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Many participants requested that the intervention be shorter and less repetitive.

“In addition, many participants requested that the intervention be shorter and less repetitive, which if revised may lead to greater program retention.”

May combine two claims.

This study found transdiagnostic effects for the ACT website with improvements relative to waitlist on general distress, social anxiety, academic concerns, positive mental health, depression, and general anxiety.

“This study found transdiagnostic effects for the ACT website with improvements relative to waitlist on general distress, social anxiety, academic concerns, positive mental health, depression, and general anxiety.”

May combine two claims.

For social anxiety, VQ obstacles and PHLMS acceptance were both only partial mediators.

“The main exception was for social anxiety for which VQ obstacles and PHLMS acceptance were both only partial mediators.”

Classified as probably not a substantial claim.

The current study has not yet determined whether college students would be willing to participate in a self-help ACT website for purely mental health reasons, without additional incentives.

“This means that the current study has not yet determined whether college students would be willing to participate in a self-help ACT website for purely mental health reasons, without additional incentives.”

Probably not a substantial claim: may not pass S2 (checkable).

The transdiagnostic focus of ACT fits particularly well for the college setting.

“The transdiagnostic focus of ACT fits particularly well for the college setting (Hayes, Pistorello & Levin, 2012).”

• cites Hayes, Pistorello & Levin, 2012 sourceNot checked — no full text of the source

Classified as probably not a substantial claim. May combine two claims.

Demands for counseling center services continue to increase along with growing severity/complexity of cases seen.

“Surveys of counseling center directors indicate that demands for services continue to increase along with growing severity/complexity of cases seen (Gallagher, 2014).”

• cites Gallagher, 2014Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

RCTs have found ACT to be effective in a web-based self-help format for depression, smoking, and chronic pain.

“For example, RCTs have found ACT to be effective in a web-based self-help format for depression (e.g., Lappalainen et al., 2014), smoking (e.g., Bricker et al., 2013) and chronic pain (e.g., Trompetter et al., 2015).”

• cites Lappalainen et al., 2014 sourceNot checked — no full text of the source
• cites Bricker et al., 2013 sourceNot checked — no full text of the source
• cites Trompetter et al., 2015 sourceNot checked — no full text of the source

May combine two claims.

Counseling centers typically treat a broader range of problems and do not necessarily focus on treating specific diagnoses.

“Although students are likely to experience specific psychological disorders, counseling centers typically treat a broader range of problems and do not necessarily focus on treating specific diagnoses (AUCCD, 2014;Gallagher, 2014).”

• cites AUCCD, 2014Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Gallagher, 2014Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Classified as probably not a substantial claim. May combine two claims.

Missing data was modeled using mixed model repeated measures analyses (MMRM) and maximum likelihood estimation (ML).

“Missing data was modeled using mixed model repeated measures analyses (MMRM; for between group effects) and maximum likelihood estimation (ML; for mediational analyses).”

• AssumptionRests on an assumption: Missing data are missing at random or otherwise appropriately handled by the mixed model repeated measures and maximum likelihood estimation procedures.

May combine two claims.

The MHC had adequate internal consistency in the current study: total α = .93, emotional wellbeing α = .89, social wellbeing α = .84, psychological wellbeing α = .85.

“The internal consistency of the MHC was adequate in the current study: MCH total score α = .93,MHC Emotional Wellbeing α = .89,MHC Social Wellbeing α = .84,MHC Psychological Wellbeing α = .85.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The SUS had internal consistency α = .84 in the current study.

“The internal consistency of the SUS in the current study was α = .84.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The CFQ had internal consistency α = .95 in the current study.

“The internal consistency of the CFQ in the current study was α =.95.”

Classified as probably not a substantial claim.

Participants were automatically randomized (in blocks of 10) through Qualtrics to either the waitlist or ACT condition.

“After completing the baseline survey, participants were automatically randomized (in blocks of 10) through Qualtrics to either the waitlist or ACT condition.”

May combine two claims.

The CCAPS had adequate internal consistency in the current study: distress total score α = .92, depression α = .91, eating concerns α = .91, alcohol α = .88, social anxiety α = .83, general anxiety α = .79, hostility α = .79, and academic concern α = .73.

“The CCAPS had adequate internal consistency in the current study: distress total score α = .92,depression α = .91,eating concerns α = .91,alcohol α =.88, social anxiety α = .83,general anxiety α = .79,hostility α = .79,and academic concern, α = .73.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The AAQ-II had internal consistency α = .93 in the current study.

“The internal consistency of the AAQ-II in the current study was α = .93.”

May combine two claims.

All of these studies tested more limited ACT programs that were brief (1-3 sessions) and did not target all of the key components of ACT, particularly leaving out some mindfulness-focused components such as cognitive defusion and present moment awareness.

“Furthermore, all of these studies tested more limited ACT programs that were brief (1-3 sessions) and did not target all of the key components of ACT (particularly leaving out some of the mindfulness-focused components such as cognitive defusion and present moment awareness).”

May combine two claims.

The VQ had adequate internal consistency in the current study: VQ Progress α = .89 and VQ Obstruction α = .84.

“The internal consistency for the VQ was adequate in the current study: VQ Progress α =.89 and VQ Obstruction α = .84.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Research summarized across 206 studies indicates that the SUS items load onto a single latent factor, have a high level of internal consistency (Cronbach's alpha = .91), and can distinguish between more and less usable programs.

“Research summarized across 206 studies indicates that the SUS items load onto a single latent factor, have a high level of internal consistency (Cronbach's alpha = .91)and can distinguish between more and less usable programs (Bangor, Kortum & Miller, 2008).”

• cites Bangor, Kortum & Miller, 2008 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Only the CCAPS alcohol subscale had a notable nonnormal distribution, which was addressed using an exponential transformation.

“Only the CCAPS alcohol subscale had a notable nonnormal distribution (baseline skewness = 2.34, kurtosis = 5.26; posttreatment skewness = 2.02, kurtosis = 2.86), which was addressed using an exponential transformation.”

May combine two claims.

A total of 62 participants completed the posttreatment survey (78%), with 32 (80%) completing posttreatment in the ACT condition and 30 (77%) completing posttreatment in the waitlist condition.

“A total of 62 participants completed the posttreatment survey (78%), with 32 (80%) completing posttreatment in the ACT condition and 30 (77%) completing posttreatment in the waitlist condition.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The baseline academic concern measure was included as a covariate for MMRM analyses to control for this baseline difference between conditions.

“The baseline academic concern measure was included as a covariate for MMRM analyses to control for this baseline difference between conditions (of note, results are very similar with or without the inclusion of this covariate).”

Probably not a substantial claim: may not pass S3 (load-bearing).

ML is preferred over traditional imputation techniques for missing data, such as last observation carried forward or multiple imputation under normal assumptions.

“ML is preferred over traditional imputation techniques for missing data, such as last observation carried forward or multiple imputation under normal assumptions (Black, Harel, & McCoach, 2010;Enders, 2012).”

• cites Black, Harel, & McCoach, 2010Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Enders, 2012Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The VQ initial validation results indicate adequate reliability and validity.

“The VQ is also a relatively new measure, but initial validation results indicate adequate reliability and validity (Smout et al., 2014).”

• cites Smout et al., 2014 sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

An intent to treat approach was taken in which all participants were included in analyses.

“An intent to treat approach was taken in which all participants were included in analyses.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The PHLMS has been found to have adequate reliability and validity in past studies.

“The PHLMS has been found to have adequate reliability and validity in past studies (Cardaciotto et al., 2008).”

• cites Cardaciotto et al., 2008 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S2 (checkable).

This study demonstrates a more cost effective and efficient method to start testing and refining web-based self-help prototypes much more quickly.

“This study demonstrates a more cost effective and efficient method to start testing and refining web-based self-help prototypes much more quickly.”

May combine two claims.

The website did have an active impact on at least some aspects of psychological inflexibility which led to improvements on a range of outcomes.

“However, the fact that acceptance and obstructions in living values both improved and mediated outcomes, suggests the website did have an active impact on at least some aspects of psychological inflexibility which led to improvements on a range of outcomes.”

May combine two claims.

The pilot study lacked follow-up assessments and used a waitlist control condition, which are limitations in evaluating efficacy.

“This led to some limitations in evaluating efficacy including the lack of follow up assessments and the use of a waitlist control condition.”

May combine two claims.

Research including guided support from a paraprofessional or professional leads to higher engagement rates and treatment effects.

“It is known that research including guided support from a paraprofessional or professional leads to higher engagement rates and treatment effects (Andersson, 2014;Richards & Richardson, 2012).”

• cites Andersson, 2014Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Richards & Richardson, 2012 sourceNot checked — no full text of the source