This dismantling trial compared the effects of a full online Acceptance and Commitment Therapy (ACT) intervention to the isolated effects of the Open (i.e., acceptance, cognitive defusion) and Engaged (i.e., values, committed action) components of ACT. A sample of 181 distressed college students were randomized to one of four conditions: a 12-session full ACT website (Full), a version targeting the Open components (Open), a version targeting the Engaged components (Engaged), or waitlist. Participants in active conditions were also randomized to receive phone coaching or just email prompts to increase program adherence. All three ACT conditions significantly improved over time relative to the waitlist condition on the primary outcome of mental health symptoms. The Engaged and Full conditions had greater rates of reliable change on the primary outcome relative to waitlist, but not the Open condition. Similarly, only Engaged and Full conditions improved on positive mental health relative to waitlist. The Full condition had greater improvements on a few ACT process measures relative to Engaged and Open conditions, particularly cognitive fusion. Overall, results indicate targeting only the Open components of ACT was somewhat less effective, and that including both the Open and Engaged components led to greater decreases in cognitive fusion.

Objectives: College counseling centers face significant challenges meeting the mental health needs of their students and waitlists are common. Mobile apps offer a promising solution to increase access to resources while students wait for services. Methods: This pilot randomized controlled trial evaluated the feasibility and acceptability of a publicly available mindfulness app. Students on a counseling center waitlist (n=23) were randomized to use the app or not, with assessments completed over four weeks. Results: Recruitment over three semesters was slow, leading to an underpowered trial. Participants reported high satisfaction and moderate app usage. Very preliminary support was found for potential app efficacy relative to the control condition, particularly for depression, anxiety, and overall distress. Weaker, mixed effects were found for mindfulness and values processes. Conclusions: Overall, these results provide mixed findings suggesting the potential benefits, but also challenges in using a mindfulness app for students waiting to receive counseling services.

Clinical perfectionism is characterized by imposing excessively high standards on oneself and experiencing severe distress when standards are not met. It has been found to contribute to the development and maintenance of various clinical presentations including anxiety, obsessivecompulsive, and eating disorders. The present study tested the efficacy of ten weekly individual sessions of acceptance and commitment therapy (ACT) relative to a waitlist control on clinical perfectionism and global outcomes among 53 individuals with clinical perfectionism. ACT is a process-based therapy that targets maladaptive underlying processes (e.g., rigid adherence to unrealistic high standards) rather than symptom topography (e.g., anxiety, depression). Participants completed assessments at pretreatment, posttreatment, and one-month follow-up. Results indicated compared to the waitlist condition, the ACT condition led to greater improvements in clinical perfectionism as well as outcomes related to wellbeing, functional impairment, distress, and processes of change. Our study suggests targeting core dysfunctional processes (i.e., clinical perfectionism) rather than symptom topography with treatments like ACT is feasible and efficacious, supporting a shift from symptom-focused to process-based care. We also note potential weaknesses in our treatment protocol and study methodology that should be addressed in future research. Study limitations included a small sample size and high dropout rate (35.7%).

Mobile apps may be useful in teaching psychological skills in a high-frequency, low-intensity intervention. The acceptance and commitment therapy (ACT) matrix is a visual tool to help develop psychological flexibility by categorizing moment-to-moment experience and is well suited to a mobile app. This pilot study tested the effects of a simple and complex version of a novel app using the ACT matrix in two distinct samples: help-seeking individuals ( n = 35) and students receiving SONA credit ( n = 63). Findings indicated no differences between app conditions and a waitlist condition in the SONA credit sample. However, in the help-seeking sample, improvements were found on well-being and valued action in participants who used the app, with greater improvements and app adoption for those using a complex version with additional skills. A mobile app based on the ACT matrix has benefits for help-seeking individuals, but supplementary features may be necessary to support consistent use and benefits.

Stigma is known to have major impacts on the physical and psychological health of many groups. Psychological inflexibility is a psychological process that may help explain the impact of stigma on both self and others. Accordingly, acceptance and commitment therapy (ACT), which targets psychological inflexibility, has been researched as a potential treatment for stigma. In order to provide a comprehensive overview of these issues, this paper offers a systematic review and meta-analysis of the association between psychological inflexibility and stigma, as well as a systematic review of ACT interventions for stigma. The results of the meta-analysis showed a positive, medium-to-large association between psychological inflexibility and stigma measures aggregating across 16 studies. The systematic review of interventions identified 15 studies on ACT interventions for stigma. Initial findings indicate consistent reductions in stigma following ACT interventions, as well as improved outcomes relative to active controls. Data on mediation and moderation, as well as long-term outcomes, are also presented. Implications for conceptualizing and treating stigma, and limitations of the research, are discussed.

This study sought to develop and validate a domain-specific measure of psychological inflexibility for university students, the acceptance and action questionnaire for university students (AAQ-US). Generic versions of the AAQ tend to not be as sensitive to changes in campus-specific functioning-a key outcome of interest in this population. An online survey was conducted with 425 undergraduate students. Psychometric analyses led to the refinement of a 12-item, single factor scale with strong internal consistency. Evidence for convergent validity was found with moderate to large correlations between the AAQ-US and measures of academic outcomes, mental health, and psychological inflexibility. The AAQ-US was a stronger predictor of academic outcomes than the AAQ-II (a general measure of psychological inflexibility) whereas the AAQ-II was more strongly related to mental health outcomes than the AAQ-US. Incremental validity for the AAQ-US was found for predicting both academic and mental health outcomes while controlling for the AAQ-II, though effects were stronger for academic outcomes. Overall, results indicate that the AAQ-US is a reliable and valid measure of psychological inflexibility among university students and may be particularly relevant in the context of academic outcomes.

Previous research indicates mixed results for guided support with online interventions.The current secondary analysis evaluated the effects of phone coaching from a dismantling trial of online acceptance and commitment therapy (ACT) in a sample of 136 distressed college students randomized to one of three versions of an ACT website. Participants were randomized to receive email prompts alone (non-coaching condition) or email plus phone coaching (coaching condition). Results indicated no differences between the coaching and non-coaching conditions on program engagement, program satisfaction, mental health outcomes, and almost all psychological flexibility processes. However, participants in the coaching condition reported stronger pre-to posttreatment improvements in psychological inflexibility than the non-coaching condition. This effect was moderated by ACT component condition, with larger pre-to posttreatment effects from coaching on psychological inflexibility in the values/committed action condition and weaker improvements from coaching in the acceptance/defusion condition.Overall, results indicate online self-guided ACT interventions with email prompts are sufficient for addressing college student mental health and that phone coaching provided minimal additional benefit.

Weight self-stigma, in which individuals internalize stigmatizing messages about weight, is a prevalent problem that contributes to poor quality of life and health. This pilot randomized controlled trial evaluated acceptance and commitment therapy (ACT) guided self-help using The Diet Trap for 55 overweight/obese adults high in weight self-stigma. Participants were randomized to the ACT self-help book plus phone coaching (GSH-P; n = 17), self-help book plus email prompts only (GSH-E; n = 20), or a waitlist condition ( n = 18), with online self-report assessments at baseline and posttreatment (8 weeks later). Participants reported high satisfaction ratings and engagement with the ACT self-help book, with no differences between GSH-P and GSH-E. Both GSH-P and GSH-E improved weight self-stigma relative to waitlist with large effect sizes. There were mixed findings for health outcomes. The GSH-P condition improved more on healthy eating behaviors and general physical activity, but neither ACT condition improved more than waitlist on self-reported body mass index, emotional eating, and a second measure of physical activity. Results suggest an ACT self-help book with email prompts can reduce weight self-stigma and potentially improve some health behavior outcomes. Phone coaching may provide additional benefits for generalizing ACT to diet and physical activity.