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Juhász Á, Sebestyén N, Árva D, Barta V, Pártos K, Vokó Z, Rákosy Z. We need better ways to help students avoid the harms of stress: Results of a meta-analysis on the effectiveness of school-based stress management interventions. J Sch Psychol 2024; 106:101352. [PMID: 39251304 DOI: 10.1016/j.jsp.2024.101352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/18/2024] [Accepted: 07/18/2024] [Indexed: 09/11/2024]
Abstract
The level of psychological stress in children and adolescents has increased rapidly over the past decade. The aim of the present meta-analysis was to evaluate the effectiveness of school-based intervention programs targeting stress management and coping/resilience in school-aged children. The present study used more rigorous selection criteria than previous meta-analyses by only including randomized controlled trials to increase the validity of the meta-analysis. Fifty-five studies were selected for the analysis, including 66 comparisons in the case of stress and 47 comparisons in the case of coping/resilience outcomes. A meta-regression with robust variance estimation was used. Effects were calculated as the standardized mean difference (Hedges' g) between the intervention and control conditions at posttest. The results highlighted important methodological issues and the influence of outliers. Without outliers, the results indicated a small significant overall effect on stress (g = -0.15, p < .01) and coping/resilience (g = 0.14, p = .01). When outliers were included, the effect sizes markedly increased in both cases (gstress = -0.26, p = .022; gcoping/resilience = 0.30, p = .009). Stress management interventions were more effective if they were delivered by mental health professionals or researchers than by teachers. Coping/resilience interventions were more effective in older age groups, in selective samples, and if they included cognitive behavioral therapy. An explanation of the results and a detailed discussion of the limitations of the study and its implications for practice are considered.
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Affiliation(s)
- Ágnes Juhász
- Department of Organisational and Leadership Psychology, Eötvös Loránd University, Izabella utca 46, Budapest H-1064, Hungary; MTA-PTE Innovative Health Pedagogy Research Group, Szigeti utca 12, Pécs H-7624, Hungary.
| | - Nóra Sebestyén
- MTA-PTE Innovative Health Pedagogy Research Group, Szigeti utca 12, Pécs H-7624, Hungary; Department of Pedagogy and Psychology, Hungarian Dance University, Columbus utca 87-89, Budapest H-1145, Hungary
| | - Dorottya Árva
- MTA-PTE Innovative Health Pedagogy Research Group, Szigeti utca 12, Pécs H-7624, Hungary; Institute of Preventive Medicine and Public Health, Faculty of Medicine, Semmelweis University, Nagyvárad tér 4, Budapest H-1089, Hungary
| | - Veronika Barta
- MTA-PTE Innovative Health Pedagogy Research Group, Szigeti utca 12, Pécs H-7624, Hungary; National Korányi Institute for Pulmonology, Korányi Frigyes út 1, Budapest H-1122, Hungary
| | - Katalin Pártos
- MTA-PTE Innovative Health Pedagogy Research Group, Szigeti utca 12, Pécs H-7624, Hungary; Institute of Preventive Medicine and Public Health, Faculty of Medicine, Semmelweis University, Nagyvárad tér 4, Budapest H-1089, Hungary
| | - Zoltán Vokó
- Center for Health Technology Assessment, Semmelweis University, Üllői út 25, Budapest H-1091, Hungary; Syreon Research Institute, Mexikói út 65/A, Budapest H-1142, Hungary
| | - Zsuzsa Rákosy
- MTA-PTE Innovative Health Pedagogy Research Group, Szigeti utca 12, Pécs H-7624, Hungary; Department of Public Health Medicine, School of Medicine, University of Pécs, Szigeti utca 12, Pécs H-7624, Hungary; Bethesda Children's Hospital, Bethesda utca 3, Budapest H-1146, Hungary
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Egan SJ, Greene D, Callaghan T, Raghav S, Funk J, Badenbach T, Talam S, Kemp G, McEvoy P, Ehring T, Kopf-Beck J. Worry and rumination as a transdiagnostic target in young people: a co-produced systematic review and meta-analysis. Cogn Behav Ther 2024:1-24. [PMID: 38923912 DOI: 10.1080/16506073.2024.2369936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024]
Abstract
PROTOCOL REGISTRATION PROSPERO (CRD42023408899).
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Affiliation(s)
- Sarah J Egan
- enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
- Discipline of Psychology, Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Danyelle Greene
- Australian Institute for Business and Economics, University of Queensland, Brisbane, Australia
| | - Thomas Callaghan
- Discipline of Psychology, Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Australia
| | | | - Julia Funk
- Department of Psychology, LMU Munich, Munchen, Germany
| | | | | | - Georgia Kemp
- Independent Lived Experience Expert Consultant, UK
| | - Peter McEvoy
- enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
- Discipline of Psychology, Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Thomas Ehring
- Department of Psychology, LMU Munich, Munchen, Germany
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Binder F, Koenig J, Resch F, Kaess M. Indicated Stress Prevention Addressing Adolescents with High Stress Levels Based on Principles of Acceptance and Commitment Therapy: A Randomized Controlled Trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2024; 93:191-202. [PMID: 38588654 PMCID: PMC11152027 DOI: 10.1159/000537934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 02/19/2024] [Indexed: 04/10/2024]
Abstract
INTRODUCTION Stress affects many adolescents and is associated with physical and mental health symptoms that can have a negative impact on normative development. However, there are very few evidence-based, specific treatment approaches. The aim of the study was to investigate an eight-session group intervention using components of Acceptance and Commitment Therapy (ACT) enriched with elements of CBT (psychoeducation, problem solving) and art therapy, compared to a waitlist control (WLC) group, regarding its efficacy in reducing stress and associated symptoms. METHODS We conducted a randomized controlled trial in eight cohorts. Eligible participants were 13-18 years old with elevated stress levels. Via block-randomization (n = 70), participants were allocated to receive ACT (n = 38) or WLC (n = 32) and subsequent ACT. We used a multimodal assessment (self-reports, interviews, ecological momentary assessment, physiological markers) before treatment (T1), after the training of the ACT group (T2) and after subsequent training in the WLC group (T3). Primary outcome was perceived stress at T2 assessed with the Perceived Stress Scale. The trial was preregistered at the German Clinical Trials Register (ID: DRKS00012778). RESULTS Results showed significantly lower levels of perceived stress in the ACT group at T2, illustrating superiority of ACT compared to WLC with a medium to large effect size (d = 0.77). Furthermore, the training was effective in the reduction of symptoms of school burnout and physical symptoms associated with stress. CONCLUSION Indicated prevention, especially when based on the principles of ACT and CBT, seems efficient in significantly decreasing stress in adolescents with increased stress.
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Affiliation(s)
- Franziska Binder
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Julian Koenig
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Franz Resch
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Kaess
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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Sierra MA, Ortiz E. Feasibility and effect of a self-help online acceptance and commitment therapy program focused on repetitive negative thinking for Colombian young women. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2023. [DOI: 10.1016/j.jcbs.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
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Keulen J, Matthijssen D, Schraven J, Deković M, Bodden D. The effectiveness and cost-effectiveness of Acceptance and Commitment Therapy as a transdiagnostic intervention for transitional-age youth: study protocol of a randomized controlled trial. BMC Psychiatry 2023; 23:51. [PMID: 36658510 PMCID: PMC9850708 DOI: 10.1186/s12888-023-04535-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 01/09/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Although the prevalence of psychological problems in transitional-age youth (i.e., youth aged 15 to 25; TAY) is high, TAY are much less likely to receive age-appropriate treatments for their psychological problems compared to younger adolescents or older adults. Hence, effective interventions for TAY seem warranted. ACT your way is a transdiagnostic treatment, specifically developed for TAY, based on the principles of Acceptance and Commitment Therapy (ACT). ACT your way is not directed primarily at symptom reduction, but mainly aims to change the underlying mechanism of psychopathology, namely increasing TAY's psychological flexibility. Meta-analyses show that ACT is an effective treatment for adults with diverse types of psychopathology. Less is known about the effectiveness of ACT for TAY. Therefore, the goal of this study is to examine the effectiveness and cost-effectiveness of ACT your way. In addition, we will investigate for whom and under what circumstances (i.e., moderators) and how (i.e., mediators) the intervention is (most) effective. METHOD The study is designed as a multi-centre, randomized controlled trial. In total, 140 TAY diagnosed with any psychological disorder will be randomly assigned to either the ACT your way or treatment as usual (TAU) condition. In total, six assessments will be conducted: at baseline, after 3, 6 and 9 sessions, at post-intervention and at 6-month follow-up, using multiple informants (TAY, parents/caregivers, therapists). Assessments will include diagnostic interviews and questionnaires. The primary outcomes are psychological flexibility and number of DSM-5 diagnoses; the secondary outcomes are the presence of the primary DSM-5 diagnosis, psychopathology, personality problems, global, individual and societal functioning, quality of life, stress, treatment satisfaction, treatment drop-out and therapeutic alliance. We will also assess costs and various moderators (i.e., demographic characteristics, type and severity of problems, psychopathology of parents/caregivers, treatment expectancy and previous treatments) and mediators (i.e., psychological flexibility, emotion regulation, self-compassion, autonomy, perfectionism, self-esteem and group cohesion). DISCUSSION To our knowledge, this is the first study investigating the (cost-)effectiveness of ACT compared to TAU in clinically referred TAY with various types of psychopathology, using a rigorous design. TRIAL REGISTRATION The research project is registered in the Dutch Trial Register (Trial NL9642).
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Affiliation(s)
- Janna Keulen
- Department of Clinical Child & Family Studies, Utrecht University, Utrecht, The Netherlands.
| | | | | | - Maja Deković
- Department of Clinical Child & Family Studies, Utrecht University, Utrecht, The Netherlands
| | - Denise Bodden
- Department of Clinical Child & Family Studies, Utrecht University, Utrecht, The Netherlands
- Altrecht Child and Youth Psychiatry, Utrecht, The Netherlands
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Petersen JM, Barney JL, Barrett TS, Lensegrav-Benson T, Quakenbush-Roberts B, Twohig MP. Values engagement as a predictor of eating disorder severity in a residential sample of female adolescents with eating disorders. Eat Disord 2022; 31:388-404. [PMID: 36469583 DOI: 10.1080/10640266.2022.2141710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Values are freely chosen life directions and/or qualities of being that can motivate behavior change. There is nascent support for the utility of values work as a part of the therapeutic process across treatments, particularly in third wave therapy approaches (e.g., acceptance and commitment therapy). However, therapeutic values work is underresearched in clinical samples of youth. The aim of the present study is to examine the role of the two distinct values processes (engagement and obstruction), body image inflexibility, alongside other common comorbid symptoms of eating disorders (anxiety, depression) in a sample of female adolescents with eating disorders attending a residential eating disorder treatment program. Participants (N = 75) were patients at a residential eating disorder treatment facility and completed a battery of measures at time of admission. Correlational analyses and multiple regression were performed. Results found correlations between eating disorder severity, values engagement, values obstruction, body image flexibility, anxiety, and depression in the expected directions. Regression results found body image inflexibility, progression towards values, and anxiety as significant predictors of eating disorder severity (adjusted R2 = .54). This study points to the importance of emphasizing values engagement in youth with eating disorders, highlighting a potential treatment target for future research.
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Affiliation(s)
- Julie M Petersen
- Department of Psychology, Utah State University, Logan, Utah, USA
| | - Jen L Barney
- Department of Psychology, Utah State University, Logan, Utah, USA
| | - Tyson S Barrett
- Department of Psychology, Utah State University, Logan, Utah, USA
| | | | | | - Michael P Twohig
- Department of Psychology, Utah State University, Logan, Utah, USA
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Sierra MA, Ruiz FJ. Content validity and perceived utility of a self-help online acceptance and commitment therapy program focused on repetitive negative thinking. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022; 26:1-10. [PMID: 35990417 PMCID: PMC9381937 DOI: 10.1016/j.jcbs.2022.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 11/23/2022]
Abstract
Telehealth strategies have become essential for responding to the sanitary emergency due to the COVID-19 pandemic. In this context, developing online psychological interventions (OPIs) that can treat and prevent psychological difficulties is gaining more relevance. This article describes an acceptance and commitment therapy (ACT) based OPI focused on repetitive negative thinking (RNT). This OPI is called Disentangled, Aware, and Committed (DAC) and represents an attempt to adapt previous RNT-focused ACT protocols to this format type. Study 1 evaluated content validity through the assessment of four experts in ACT regarding clarity, utility, pertinence, conceptual adjustment, and therapeutic goal fulfillment for each component of the DAC program. In Study 2, forty-one undergraduate clinical psychology trainees rated the components of the DAC program according to its clarity and perceived utility. These participants were enrolled in a randomized controlled trial that analyzed the efficacy of the DAC to prevent the usually observed increase in emotional symptoms and RNT among this population. Expert reviewers in Study 1 rated all DAC components as clear and useful for potential users, following a logical order, theoretically coherent with the ACT model, and successfully fulfilling its stated goals. In Study 2, the participants also rated the DAC components as clear and potentially useful for their lives. In conclusion, the DAC appears to be a feasible transdiagnostic OPI for treating and preventing emotional symptoms, which warrants further studies analyzing its efficacy.
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Affiliation(s)
- Marge A Sierra
- Fundación Universitaria Konrad Lorenz, Carrera 9 Bis, Nº 62-43, Bogotá, Colombia
| | - Francisco J Ruiz
- Fundación Universitaria Konrad Lorenz, Carrera 9 Bis, Nº 62-43, Bogotá, Colombia
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Bricker JB, Levin M, Lappalainen R, Mull K, Sullivan B, Santiago-Torres M. Mechanisms of Smartphone Apps for Cigarette Smoking Cessation: Results of a Serial Mediation Model From the iCanQuit Randomized Trial. JMIR Mhealth Uhealth 2021; 9:e32847. [PMID: 34751662 PMCID: PMC8663588 DOI: 10.2196/32847] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/28/2021] [Accepted: 10/12/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Engagement with digital interventions is a well-known predictor of treatment outcomes, but this knowledge has had limited actionable value. Instead, learning why engagement with digital interventions impact treatment outcomes can lead to targeted improvements in their efficacy. OBJECTIVE This study aimed to test a serial mediation model of an Acceptance and Commitment Therapy (ACT) smartphone intervention for smoking cessation. METHODS In this randomized controlled trial, participants (N=2415) from 50 US states were assigned to the ACT-based smartphone intervention (iCanQuit) or comparison smartphone intervention (QuitGuide). Their engagement with the apps (primary measure: number of logins) was measured during the first 3 months, ACT processes were measured at baseline and 3 months (acceptance of internal cues to smoke, valued living), and smoking cessation was measured at 12 months with 87% follow-up retention. RESULTS There was a significant serial mediation effect of iCanQuit on smoking cessation through multiple indicators of intervention engagement (ie, total number of logins, total number of minutes used, and total number of unique days of use) and in turn through increases in mean acceptance of internal cues to smoke from baseline to 3 months. Analyses of the acceptance subscales showed that the mediation was through acceptance of physical sensations and emotions, but not acceptance of thoughts. There was no evidence that the effect of the iCanQuit intervention was mediated through changes in valued living. CONCLUSIONS In this first study of serial mediators underlying the efficacy of smartphone apps for smoking cessation, our results suggest the effect of the iCanQuit ACT-based smartphone app on smoking cessation was mediated through multiple indicators of engagement and in turn through increases in the acceptance of physical sensations and emotions that cue smoking. TRIAL REGISTRATION Clinical Trials.gov NCT02724462; https://clinicaltrials.gov/ct2/show/NCT02724462.
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Affiliation(s)
- Jonathan B Bricker
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, United States.,Department of Psychology, University of Washington, Seattle, WA, United States
| | - Michael Levin
- Department of Psychology, Utah State University, Logan, UT, United States
| | - Raimo Lappalainen
- Department of Psychology, University of Jyvaskyla, Jyvaskyla, Finland
| | - Kristin Mull
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Brianna Sullivan
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Margarita Santiago-Torres
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
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Effectivenes of Acceptance-Commitment Therapy on the Resillience and Psycological Well-being of Female Patients with Multiple Sclerosis in Hamadan, Iran. AVICENNA JOURNAL OF CLINICAL MEDICINE 2021. [DOI: 10.52547/ajcm.28.2.126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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