In the shadow of COVID-19: A randomized controlled online ACT trial promoting adolescent psychological flexibility and self-compassion

Psychological flexibility, self-compassion, subjective well-being, and substance misuse in college students: a serial mediation model

Substance misuse is a pressing public health concern, especially among emerging adults, with implications for psychological health and overall well-being. This cross-sectional study investigates the mediating roles of self-compassion and subjective well-being in the relationship between psychological flexibility and substance misuse among Turkish college students. The study included 445 emerging adults enrolled at a state university in Türkiye. University participants were recruited via convenience sampling using snowball methods. Data were collected using self-report scales. The sample was 69% female (n = 307) and 31% male (n = 138) and ranged in age from 18 to 26 years (M = 20.85, SD = 1.35). In the study, Pearson product-moment correlation analysis was conducted to examine the relationships between the variables and then the serial mediation model was tested. The findings have revealed that psychological flexibility significantly predicts substance misuse, subjective well-being, and self-compassion. Additionally, the study identifies self-compassion as a mediator in the relationship between psychological flexibility and subjective well-being. While self-compassion contributes significantly to well-being, it does not explain the impact of psychological flexibility on substance misuse. Furthermore, subjective well-being also appears to be a mediator in the relationship between psychological flexibility and substance misuse, emphasizing its potential significance in reducing the likelihood of resorting substance misuse. Overall, the study contributes to understanding the pivotal role of self-compassion and psychological flexibility in fostering well-being and preventing substance misuse in the college setting.

Outcomes of Best-Practice Guided Digital Mental Health Interventions for Youth and Young Adults with Emerging Symptoms: Part I. A Systematic Review of Socioemotional Outcomes and Recommendations

Youth-specific digital mental health interventions (DMHI) represent an emerging field of study, and aim to increase access, improve socioemotional outcomes, and, where required, support triage to targeted interventions. However, prior reviews have reported inconsistent findings on the clinical effectiveness of such interventions in young adults (12-25 years). Further, shortfalls remain for the impact of guided interventions based on the mode of delivery and the type of human support personnel (e.g., professional or peer) guiding the intervention. In response, this systematic review, co-designed with Australia's leading mental health organization, aims to assess the effectiveness of guided digital programs in improving youth socioemotional outcomes. Included studies involve young people experiencing mental ill-health, receiving brief (i.e., 1-12 sessions), digitally delivered (at least partially) psychological interventions that were guided or partially guided, tested in a type of experimental study, with a socioemotional outcome. Specific socioemotional outcomes examined were depression, anxiety, stress, wellbeing, mindfulness, and quality of life. A systematic search of the contemporary published and grey literature identified 22,482 records with 32 relevant records published between 2018 and 2023. A narrative synthesis guided integration of findings. Results demonstrated strong evidence for the effectiveness of guided interventions on socioemotional outcomes (i.e., depression, anxiety, stress) yet these effects were short-lived. When factoring in the use of different control groups (i.e., active vs. inactive), inconsistent effects were observed for the socioemotional outcomes of depression, anxiety, and stress. The mode of delivery (i.e., asynchronous, synchronous, combined) and the type of human support personnel did not appear to impact socioemotional outcomes. Results indicate efficacious brief digital interventions for depression and anxiety include refresher/follow-up content, goal setting content, and relapse prevention content. In contrast, poor efficacy is associated with interventions that include homework tasks, self-monitoring, and log-keeping content.PROSPERO, ID CRD42023405812.

Universal online self-help ACT interventions for youth: A systematic review

Previous reviews of online self-help have not exclusively focussed on universally delivered Acceptance and Commitment Therapy (ACT). This systematic review aimed to evaluate the effectiveness of universal online self-help ACT interventions for young people. Relevant databases were searched for studies examining ACT interventions that were delivered universally, online and as self-help (guided and unguided) to young people aged 10 to 25-years-old. Eleven studies met inclusion criteria. These were assessed for quality and findings summarised using a narrative synthesis. Outcomes on mental health, well-being and ACT processes were reviewed, and results across studies were mixed. Most studies found significant improvements in mental health and well-being outcomes following the ACT intervention; however less than half found improvements in ACT process measures. Subgroups, such as those with elevated mental health symptoms, had better outcomes. There were no changes in measures of psychological inflexibility. However, methodological issues limited the interpretation of findings. Heterogeneity between studies and methodological issues made it difficult for this review to draw conclusions regarding the effectiveness of universal online self-help ACT interventions for young people. Future research with consistent approaches is needed across these types of interventions to improve methodological rigour to determine whether these interventions are effective.

Use of automated conversational agents in improving young population mental health: a scoping review

Automated conversational agents (CAs) emerged as a promising solution in mental health interventions among young people. Therefore, the objective of this scoping review is to examine the current state of research into fully automated CAs mediated interventions for the emotional component of mental health among young people. Selected databases were searched in March 2023. Included studies were primary research, reporting on development, feasibility/usability, or evaluation of fully automated CAs as a tool to improve the emotional component of mental health among young population. Twenty-five studies were included (N = 1707). Most automated CAs applications were standalone preventions targeting anxiety and depression. Automated CAs were predominantly AI-based chatbots, using text as the main communication channel. Overall, the results of the current scoping review showed that automated CAs mediated interventions for emotional problems are acceptable, engaging and with high usability. However, the results for clinical efficacy are far less conclusive, since almost half of evaluation studies reported no significant effect on emotional mental health outcomes. Based on these findings, it can be concluded that there is a pressing need to improve the existing automated CAs applications to increase their efficacy as well as conducting more rigorous methodological research in this area.

Exploring the Number of Web-Based Behavioral Health Coaching Sessions Associated With Symptom Improvement in Youth: Observational Retrospective Analysis

BACKGROUND

Rates of anxiety and depression have been increasing among children and adolescents for the past decade; however, many young people do not receive adequate mental health care. Digital mental health interventions (DMHIs) that include web-based behavioral health coaching are widely accessible and can confer significant improvements in youth anxiety and depressive symptoms. However, more research is necessary to determine the number of web-based coaching sessions that confer clinically significant improvements in anxiety and depressive symptoms in youth.

OBJECTIVE

This study uses data from a pediatric DMHI to explore the number of web-based coaching sessions required to confer symptom improvements among children and adolescents with moderate or moderately severe symptoms of anxiety and depression.

METHODS

We used retrospective data from a pediatric DMHI that offered web-based behavioral health coaching in tandem with self-guided access to asynchronous chat with practitioners, digital mental health resources, and web-based mental health symptom assessments. Children and adolescents who engaged in 3 or more sessions of exclusive behavioral health coaching for moderate to moderately severe symptoms of anxiety (n=66) and depression (n=59) were included in the analyses. Analyses explored whether participants showed reliable change (a decrease in symptom scores that exceeds a clinically established threshold) and stable reliable change (at least 2 successive assessments of reliable change). Kaplan-Meier survival analyses were performed to determine the median number of coaching sessions when the first reliable change and stable reliable change occurred for anxiety and depressive symptoms.

RESULTS

Reliable change in anxiety symptoms was observed after a median of 2 (95% CI 2-3) sessions, and stable reliable change in anxiety symptoms was observed after a median of 6 (95% CI 5-8) sessions. A reliable change in depressive symptoms was observed after a median of 2 (95% CI 1-3) sessions, and a stable reliable change in depressive symptoms was observed after a median of 6 (95% CI 5-7) sessions. Children improved 1-2 sessions earlier than adolescents.

CONCLUSIONS

Findings from this study will inform caregivers and youth seeking mental health care by characterizing the typical time frame in which current participants show improvements in symptoms. Moreover, by suggesting that meaningful symptom improvement can occur within a relatively short time frame, these results bolster the growing body of research that indicates web-based behavioral health coaching is an effective form of mental health care for young people.