College is a critical time when students experience major transitions. For example, students may be moving away from family, friends, and support systems. They also may be juggling increased academic responsibilities with employment outside of school, family responsibilities, or other stressors.
While there may also be positive aspects to this transition, for many students, this time period is associated with significant symptoms of stress, anxiety, and/or depression. In fact, recent research indicates that the number of college students diagnosed with mental health conditions has increased significantly, with anxiety disorders being the most common type of diagnosis (American College Health Association, 2014; Center for Collegiate Mental Health, 2018; Auerbach et al., 2016). Some students are coming to college with previous mental health diagnoses or symptoms, which may increase during this time, while others will experience these symptoms for the first time during this period. Clearly, there is a need for effective and accessible evidence-based mental health treatment for college students.
Unfortunately, estimates of the percentage of college students with mental health disorders who access treatment are quite low. Results from a recent study utilizing the World Health Organization World Mental Health Survey results indicated that only 16.4% of college students with mental health diagnoses received any kind of mental health treatment within the past year (Auerbach et al., 2016). There are a number of factors that may prevent students from accessing evidence-based care. For one, many colleges and universities are not able to provide services to all students in need due to lack of funding, resources, and trained therapists. Despite efforts to increase staff at many counseling centers, research indicates that at least one-third of college counseling centers have a waitlist (Center for Collegiate Mental Health, 2018). In addition, students may not access care due to a number of other barriers including mental health stigma, finances, and their schedules. Given the high rates of anxiety in college students, combined with the limitations of our current mental health system, web-based interventions are one way to increase access to evidence-based care.
The current study (Eustis, Hayes-Skelton, Orsillo, & Roemer, 2018) aimed to develop and test a brief web-based acceptance-based behavioral intervention (“Surviving and Thriving During Stress”), which was developed to target anxiety, compared to a waitlist control condition in a sample of college students. The intervention in the current study is based on an acceptance-based behavioral model of anxiety (Hayes-Skelton, Roemer, & Orsillo, 2013; Roemer & Orsillo, 2009, 2014; Roemer et al., 2008), which was originally developed for generalized anxiety disorder, and subsequently adapted into a brief, in-person workshop for college students to target anxiety (Eustis et al., 2017).
In the current study, 156 students were randomized, 78 to the intervention condition, and 78 to the waitlist condition. Of note, the sample was diverse across a number of demographic variables, including race and ethnicity. The intervention consisted of 3 web-based sessions. The first session focused on psychoeducation and taught students about the cycle of anxiety, including the impact that thoughts, physical sensations, and behaviors have on each other. The second session introduced mindfulness or present-moment non-judgmental awareness as a new way to respond to anxiety. The third session focused on values, or principles that are meaningful to individuals, and how to take actions in line with personally meaningful values. Each session included a mix of experiential exercises, didactic information, and examples tailored to college students. The fourth week was used either for additional skill practice or to catch up if students were behind.
Participants were asked to complete one session each week over the course of 4 weeks. After sessions 1-3, they were asked to practice the skill that was introduced in that session (e.g., monitoring their emotions, practicing mindfulness, writing about their values, or taking actions in line with their values) and to complete a written practice assignment. Participants received written feedback from a study therapist on each practice assignment.
Our results indicated that, in general, students found the program to be helpful and acceptable. In addition, participants in the intervention condition reported significantly greater decreases in symptoms of anxiety and depression, and significantly greater increases in quality of life compared to participants in the waitlist condition.
In addition to outcomes, we looked at hypothesized mechanisms of change in acceptance-based behavior therapy, which are thought to be the active parts of treatment that lead to change in outcomes. Results indicated that participants in the intervention condition reported significantly greater changes in several hypothesized mechanisms of change compared to the waitlist condition (including reductions in experiential avoidance, which refers to attempts to control or avoid distressing thoughts, emotions, memories, or physical sensations, and increases in decentering, which refers to being able to recognize that thoughts are thoughts and not “facts,” and values-based living, which refers to taking actions in line with what is personally meaningful for that person).
Future research is needed to determine what “dose” of support is required to achieve beneficial outcomes in web-based interventions. Additional research is also needed to examine the timing of changes in hypothesized mechanisms of change and outcomes in web-based programs.
Results from the current study add to the existing literature on web-based interventions for college students. Our results indicate that it is feasible to provide web-based interventions to diverse college students and that, in general, students found the program to be helpful. In addition, our results suggest that this brief program was effective in decreasing symptoms of anxiety and depression and increasing quality of life. Therefore, web-based interventions should be considered as one way to increase access to evidence-based mental health treatment for college students.
These findings are described in the article entitled 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, recently published in the journal Behavior Therapy.
- American College Health Association. (2014). American College Health Association- National College Health Assessment II: Reference Group Executive Summary Spring 2014. Hanover, MD: Author.
- Auerbach, R. P., Alonso, J., Axinn, W. G., Cuijpers, P., Ebert, D. D., Green, J. G., … Bruffaerts, R. (2016). Mental disorders among college students in the WHO World Mental Health Surveys. Psychological Medicine, 46(14), 2955-2970. doi: 10.1017/S0033291716001665
- Center for Collegiate Mental Health. (2018). 2017 Annual Report (Publication No. STA 18-166).
- Eustis, E. H., Hayes-Skelton, S. A., Orsillo, S. M., & Roemer L. (2018). 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. Behavior Therapy, 49, 889-903. doi:10.1016/j.beth.2018.05.009
- Eustis, E. H., Krill Williston, S., Morgan, L. P, Graham, J. R., Hayes-Skelton, S. A., & Roemer, L. (2017). Development, acceptability, and effectiveness of an acceptance-based behavioral stress/anxiety management workshop for university students. Cognitive and Behavioral Practice, 24, 174-186. doi:10.1016/j.cbpra.2016.03.011
- Hayes-Skelton, S. A., Roemer, L., & Orsillo, S. M. (2013). A randomized clinical trial comparing an acceptance-based behavior therapy to applied relaxation for generalized anxiety disorder. Journal of Consulting and Clinical Psychology, 81(5), 761-773. doi:10.1037/a0032871
- Roemer, L., Orsillo, S. M., & Salters-Pedneault, K. (2008). Efficacy of an acceptance-based behavior therapy for generalized anxiety disorder: Evaluation in a randomized controlled trial. Journal of Consulting and Clinical Psychology, 76, 1083-1089. doi:10.1037/a0012720
- Roemer, L., & Orsillo, S. M. (2009). Mindfulness- and acceptance-based behavioral therapies in practice. New York, NY: Guilford Press.
- Roemer, L., & Orsillo, S. M. (2014). Acceptance-based behavior therapy for the treatment of generalized anxiety disorder. In D. H. Barlow (Ed.), Clinical Handbook of Psychological Disorders, 5th Edition. New York, NY: Guilford Press.