Effectiveness of Acceptance and Commitment Therapy (ACT) on Alleviating Depression Symptoms: A Longitudinal-Naturalistic Study
DOI:
https://doi.org/10.69569/jip.2024.0285Keywords:
Acceptance and commitment therapy, Depression, Psychological flexibility and inflexibility, Longitudinal-naturalistic study, FilipinoAbstract
Acceptance and commitment therapy (ACT) is recognized as a transdiagnostic and one of the effective therapeutic intervention approaches for depression in young adults and university students with a proven extended significant benefit. ACT’s core goals are to be psychologically flexible and less prone to depression. However, although numerous studies demonstrated ACT’s effectiveness, it is necessary to address the gap in determining whether the efficacy is consistent with previous research that mostly applied randomized controlled trials (RCTs). This study utilized a rare approach in navigating its efficiency among an underrepresented sample of Filipino students in a local university. This research applied a longitudinal-naturalistic single-group design within a two-month interval between baseline and post-intervention data among 124 participants. Relevant data were gathered using the Quick Inventory for Depressive Symptomatology – Self-Rated Version (QIDS-SR) in evaluating depressive levels and symptomatology and the Multidimensional Psychological Flexibility Inventory (MPFI) for identifying psychological flexibility and inflexibility. The results demonstrated significant changes with a p-value of 0.000 and an effect size d of .85. More so, it can be surmised that the value of F (2, 121) = 33.80 with a p-value less than 0.05 significantly impacted depression. Hence, ACT psychoeducation group intervention through a synchronous online platform alleviated the depression symptoms among students in a local university. Also, data proved that psychological flexibility and inflexibility have a significant impact on depression. Thus, the potential utilization and inclusion of psychoeducation based on ACT in the course and counseling program among college students is highly suggested.
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Abalajen, M., Almenario., E., Baloca., S., Cuasay, J., Mosuela, M., &Quiom. S. (2022). Existential Crisis and Personality Traits Among Psychology Students of Taguig City University (Thesis). Taguig City University, Philippines.
Abdul-Aziz, D., Mohd, S., Athirah, Y., and Suhaime, N. (2020). Mindfulness, Self-Compassion, and Psychological Flexibility As Predictors of Depression Among Students. Psychology and Education, 57. 2504 - 2507. https://doi.org/10.17762/pae.v57i9.630.
Ahmadsaraei, N.F., Doost, H.T., Manshaee, G., & Nadi, M.A. (2017). The Effectiveness of Acceptance and Commitment Therapy on Depression among Patients with Type II Diabetes. Iranian Journal of Diabetes and Obesity, 9, 6–13. https://doi.org/10.18869/acadpub.ihepsaj.4.1.31
Arbona, C., Fan, W., & Olvera, N. (2018). College Stress, Minority Status Stress, Depression, Grades, and Persistence Intentions Among Hispanic Female Students: A Mediation Model. Hispanic Journal of Behavioral Sciences, 40(4), 414-430. https://doi.org/10.1177/0739986318799077
Bai, Z., Luo, S., Zhang, L., Wu, S., & Chi, I. (2020). Acceptance and Commitment Therapy (ACT) to reduce depression: A systematic review and meta-analysis. Journal of Affective Disorders, 260, 728–737. https://doi.org/10.1016/j.jad.2019.09.040
Clemente, M., Costales, N., Manzano, J., and Perina, C. (2019). The Prevalence of Depression Among College Students (Thesis). Taguig City University, Philippines.
Coto-Lesmes, R., Fernández-Rodríguez, C., & González-Fernández, S. (2020). Acceptance and Commitment Therapy in group format for anxiety and depression. A systematic review. Journal of Affective Disorders, 263, 107–120. https://doi.org/10.1016/j.jad.2019.11.154
Fletcher, J. (2022, May 25). What are the uses and benefits of ACT therapy? Medical News Today. Retrieved from https://www.medicalnewstoday.com/articles/act-therapy
Grégoire, S., Lachance, L., Bouffard, T., Dionne, F. (2018). The Use of Acceptance and Commitment Therapy to Promote Mental Health and School Engagement in University Students: A Multisite Randomized Controlled Trial. Behavior Therapy, 49(3), 360-372. https://doi.org/10.1016/j.beth.2017.10.003
Hallis, L., Knäuper, B., Cameli, L., & Dionne, F. (2016). Combining Cognitive Therapy With Acceptance and Commitment Therapy for Depression: A Manualized Group Therapy. Journal of Psychotherapy Integration, 29(4), 345–358. https://doi.org/10.1037/int0000028
Hernández-López, M., Cepeda-Benito, A., Díaz-Pavón, P., & Rodríguez-Valverde, M. (2021). Psychological inflexibility and mental health symptoms during the COVID-19 lockdown in Spain: A longitudinal study. Journal of Contextual Behavioral Science, 19, 42–49. https://doi.org/10.1016/j.jcbs. 2020.12.002
Heydari, M., Masafi, S., Jafari, M., Saadat, S.H., Shahyad, S. (2018). “Effectiveness of Acceptance and Commitment Therapy on Anxiety and Depression of Razi Psychiatric Center Staff. Open Access Maced J Med Sci, 6(2), 410-415. https://doi.org/10.3889/oamjms. 2018.06
Jensen, A. (2022). Acceptance and Commitment Therapy (ACT): The Pros and Cons. Retrieved from improvementsavvy.com
Karimi M, & Aghaei A (2018). The effectiveness of group application of acceptance and commitment therapy on anxiety, depression, and stress among high school female students. Int J EducPsychol Res, 4, 71-7. https://doi.org/10.4103/jepr. Jepr _24_16
Kato T. (2016). Impact of psychological inflexibility on depressive symptoms and sleep difficulty in a Japanese sample. SpringerPlus, 5(1), 712. https://doi.org/10.1186/s40064-016-2393-0
Kohtala, A., Lappalainen, R., Savonen, L., Timo, E., & Tolvanen, A. (2015). A four-session acceptance and commitment therapy based intervention for depressive symptoms delivered masters degree level psychology students: a preliminary study. Behavioral and cognitive psychotherapy, 43(3), 360-373. https://doi.org/101017/S1352465813000969
Kroska, E.B., Roche, A.I., Adamowicz, J.L., Stegall, M.S. (2020). Psychological flexibility in COVID-19 adversity: Associations with distress. Journal of contextual behavioral science, 18(0), 28-33. https://doi.org/10.1016/j.jcbs.2020.07.011
Kyllonen, H.M., Muotka, J., Puolakanaho, A., Astikainen, P., Keinonen, K., and Lappalainen, R. (2018). A brief Acceptance and Commitment Therapy intervention for depression: A randomized controlled trial with 3-year follow-up for the intervention group.Journal of Contextual Behavioral Science, 10, 55–63. https://doi.org/10.1016/j.jcbs.2018.08.009
Lappalainen, P., Langrial, S., Oinas-Kukkonen, H., Tolvanen, A., & Lappalainen, R. (2015). Web-Based Acceptance and Commitment Therapy for Depressive Symptoms With Minimal Support: A Randomized Controlled Trial. Behavior Modification, 39(6), 805-834. https://doi.org/10.1177/0145445515598142
Petts, R. A., Duenas, J. A., & Gaynor, S. T. (2017). Acceptance and Commitment Therapy for adolescent depression: Application with a diverse and predominantly socioeconomically disadvantaged sample. Journal of Contextual Behavioral Science, 6(2), 134–144. https://doi.org/10.1016/j.jcbs.2017.02.006
Levin, M. E., MacLane, C., Daflos, S., Seeley, J., Hayes, S. C., Biglan, A., & Pistorello, J. (2014). Examining psychological inflexibility as a transdiagnostic process across psychological disorders. Journal of Contextual Behavioral Science, 3(3), 155–163. https://doi.org/10.1016/ j.jcbs.2014.06.003
Louma, J., Hayes, S., & Walser, R. (2017). Learning ACT: An Acceptance & Commitment Therapy Skills Training Manual for Therapists. 2nd Ed. Context Press, An imprint of New Harbinger Pub., Inc. California, USA 94609
Ma, J., Ji, L., & Lu, G. (2023). Adolescents’ experiences of acceptance and commitment therapy for depression: An interpretative phenomenological analysis of good-outcome cases. Frontiers in Psychology, 14, 1050227. https://doi.org/10.3389/fpsyg.2023.1050227
Mahnaz,K., Asghar, A., (2018). The effectiveness of group application of acceptance and commitment therapy on anxiety, depression, and stress among high school female students. International Journal of Educational and Psychological Researches, 4(2), 71. https://rb.gy/wsb0k5
Masuda, A., Mandavia, A., Tully, E.C. (2014). The role of psychological inflexibility and mindfulness in somatization, depression, and anxiety among Asian Americans in the United States. Asian Am J Psychol., 5(0), 230–236. . https://doi.org/10.1037/ a0034437
McCracken, L. M. (2013). Committed action: An application of the psychological flexibility model to activity patterns in chronic pain. The Journal of Pain, 14(8), 828–835. https://doi.org/10.1016/j.jpain.2013.02.009
Østergaard, T., Lundgren, T., Zettle, R. D., Landrø, N. I., & Haaland, V. Ø. (2020). Psychological flexibility in depression relapse prevention: Processes of change and positive mental health in group-based act for residual symptoms. Frontiers in Psychology, 11, 528. https://doi.org/10.3389/fpsyg.2020.00528
Padir, M.A., Vangölü, M.S., & Mutlu, Ş. (2024). Could Psychological Flexibility Play a Buffering Role against the Negative Effects of Depression, Stress, and Anxiety in General Population: A Canonical Correlation Analysis. Elektronik Sosyal Bilimler Dergisi. 23(90), 525-538. https://doi.org/10.17755/esosder. 1359777
Pots, W. T. M., Fledderus, M., Meulenbeek, P. A. M., Ten Klooster, P. M., Schreurs, K. M. G., & Bohlmeijer, E. T. (2016). Acceptance and commitment therapy as a web-based intervention for depressive symptoms: Randomised controlled trial. British Journal of Psychiatry, 208(1), 69–77. https://doi.org/10.1192/bjp.bp.114.146068
Puolakanaho, A., Muotka, J. S., Lappalainen, R., Hirvonen, R., Lappalainen, P., & Kiuru, N. (2023). Temperament and symptoms of stress and depression among adolescents: The mediating role of psychological flexibility. Journal of Affective Disorders Reports, 12, 100493. https://doi.org/10.1016/ j.jadr. 2023.100493
Mega Radyani, A., Hanna Indra, G., & Ika Dian Oriza, I. (2022). Psychological Inflexibility Moderates Stress and Loneliness in Depression Among Indonesian College Students During the COVID-19 Pandemic. KnE Social Sciences, 7(1), 168–188. https://doi.org/10.18502/kss.v7i1.10210
Räsänen, P., Lappalainen, P., Muotka, J., Tolvanen, A., & Lappalainen, R. (2016). An online guided ACT intervention for enhancing the psychological wellbeing of university students: A randomized controlled clinical trial. Behaviour Research and Therapy, 78, 30–42. https://doi.org/10.1016/j.brat.2016.01.001
Rolffs, J. L., Rogge, R. D., & Wilson, K. G. (2016). Disentangling Flexibility Components via the Hexaflex Model Development and Validation of the Multidimensional Psychological Flexibility Inventory (MPFI). Assessment, 25(4), 458–482. https://doi.org/10.1177/1073191116645905.
Rush, A. J., Trivedi, M. H., Ibrahim, H. M., Carmody, T. J., Arnow, B., Klein, D. K., & Keller, M. B. (2003). Quick Inventory of Depressive Symptomatology Self-Rating (QIDS SR-16). Retrieved from https://eprovide.mapitrust.org/instruments/self-report-quick-inventory-of-depressive-symptomatology
Rutschmann, R., Romanczuk-Seiferth, N., and Richter, C. (2023). Acceptance and commitment therapy in a psychiatric day hospital—A longitudinal naturalistic effectiveness trial. Front. Psychiatry, 13, 1052874. https://doi.org/10.3389/fpsyt.2022.1052874
Saedy, M., Kooshki, S., Jamali Firouzabadi, M., Emamipour, S., & Rezaei Ardani, A. (2015). Effectiveness of Acceptance-Commitment Therapy on Anxiety and Depression among Patients on Methadone Treatment: A Pilot Study. Iranian Journal of Psychiatry and Behavioral Sciences, 9(1), e222. https://doi.org/10.17795/ijpbs222
Grégoire, S., Lachance, L., Bouffard, T., & Dionne, F. (2018). The Use of Acceptance and Commitment Therapy to Promote Mental Health and School Engagement in University Students: A Multisite Randomized Controlled Trial. Behavior therapy, 49(3), 360–372. https://doi.org/10.1016/j.beth.2017.10.003
Strange, E. (2021). Acceptance and Commitment Therapy- Accredited Certification. Udemy
Stange, J. P., Alloy, L. B., & Fresco, D. M. (2017). Inflexibility as a Vulnerability to Depression: A Systematic Qualitative Review. Clinical psychology : a publication of the Division of Clinical Psychology of the American Psychological Association, 24(3), 245–276. https://doi.org/10.1111/cpsp.12201
Strosahl, K. & Robinson, P. (2017). The Mindful & Acceptance Workbook for Depression. 2nd Ed. New Harbinger Pub., Inc. Oakland, CA 94609
Toghiani, Z., Ghasemi, F., & Samouei, R. (2019). The effectiveness of acceptance and commitment group therapy on social anxiety in female dormitory residents in Isfahan university of medical sciences. Journal of education and health promotion, 8, 41. https://doi.org/10.4103/jehp.jehp_111_18
Towsyfyan, N. & Sabet, F.H. (2017). The Effectiveness of Acceptance and Commitment Therapy on the Improving of Resilience and Optimism in Adolescents with Major Depressive Disorder. International Journal of Humanities and Social Science, 7(3), 239-245. https:///www.ijsshnet.com2221-0989
Twohig, M. P., & Levin, M. E. (2017). Acceptance and Commitment Therapy as a Treatment for Anxiety and Depression: A Review. The Psychiatric Clinics of North America, 40(4), 751–770. https://doi.org/10.1016/j.psc.2017.08.009
Valdez, R. (2022). What is Acceptance and Commitment Therapy? Retrieved from https://www.verywellhealth.com/acceptance-and-commitment-therapy-5215323
Wang, J., Fang, S., Yang, C., Tang, X., Zhu, L., & Nie, Y. (2023). The Relationship Between Psychological Flexibility and Depression, Anxiety and Stress: A Latent Profile Analysis. Psychology Research and Behavior Management, 16, 997–1007. https://doi.org/10.2147/PRBM.S400757
World Health Organization (2022). World mental health report: transforming mental health for all. Retrieved from https://www.who.int/publications/i/item/9789240049338
World Health Organization (2017). Depression and Other Common Mental Disorders. Retrieved from https://www.who.int/publications/i/item/depression-global-health-estimates
Yao, Y., Tang, J., Meng, H., Li, Y., Du, H., Li, Z. (2023). The mediating effect of psychological flexibility on fatigue and depressive symptoms among nursing staff. Int J Occup Med Environ Health., 36(4), 563-574. https://doi.org/10.13075/ijomeh.1896.02073
Zhao, B., Wang, Q., Wang, L., Chen, J., Yin, T., Zhang, J., Cheng, X., & Hou, R. (2023). Effect of acceptance and commitment therapy for depressive disorders: A meta-analysis. Annals of General Psychiatry, 22(1), 34. https://doi.org/10.1186/s12991-023-00462-1
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