1. Web-Based Self-Help for College Students: Evaluating A Transdiagnostic Acceptance and Commitment Therapy Program
Michael Levin, Jack Haeger, Jennifer Krafft, Benjamin Pierce, Jameson Daines, & Michael Twohig, Ph.D

2. Challenges on campuses
Mental health problems are prevalent and costly among college students
Many campuses are struggling to keep up with rapid increases in demand for services
And many students still don’t seek treatment
A transdiagnostic online approach is promising
Increase reach and access with a single referral source while reducing burden on existing systems
ACT is a promising transdiagnostic approach
Psychological inflexibility is related to a range of problems
ACT is effective at treating a range of problems
ACT outcomes are mediated by reducing inflexibility

3. Initial research on online ACT for college students
Developed a prototype ACT program for preventing mental health problems
Positive results relative to waitlist (Levin et al., 2014)
But mixed findings relative to psychoeducation control (Levin et al., 2016)
Developed a second prototype ACT program for college counseling centers
An open trial indicated positive preliminary effects (Levin et al., 2015)
Currently developing a final version for a RCT

4. Challenges with development
Creating custom programs from the ground up is
Expensive and time consuming
Challenging for content development
Likely to delay development (while seeking funding and during development)
Revisions based on findings cost more money and time
Ongoing delivery of programs is limited by hosting and maintenance costs

5. A new approach to tech development
Using existing content management systems (CMS) can
Increase speed and efficiency of development
Reduce costs significantly
Enhance content development with an iterative revision approach
Some CMS also
Provide unique features and widgets
Increase platform stability
Have been refined in terms of usability and design
Eliminate hosting and update costs
But many CMS do not provide database integration
Survey platforms like qualtrics do

6. Our First Finding
Compared a $50,000 ACT prototype to a two session qualtrics-based psychoed condition
The psychoeducation condition had
Higher adherence to the program (86% vs. 55%)
Equal usability ratings (SUS M = vs )
Higher satisfaction ratings on individual items

7. A Second RCT Satisfaction/engagement
79 college students in distress and interested in online self-help
87% in the clinical range on CCAPS subscale
Almost all ended up participating for course credit
RCT compared ACT qualtrics to waitlist
Assessments at baseline and post (6 weeks later)
Satisfaction/engagement
75% completed half (3) of the six session program
55% completed all six sessions
“Good” usability score (M = 71.13, SD = 16.78)
60% said it was too long and/or too repetitive

8. Mental Health Outcomes
Time by condition interactions showed improvements in ACT vs. waitlist for:
CCAPS total distress, F = 6.59, p = .013, d = .66
CCAPS depression, F = 4.20, p = .045, d = .52
CCAPS social anxiety, F = 8.43, p = .005, d = .75
CCAPS academic concern, F = 5.75, p = .020, d = .62
MHC Positive mental health, F = 4.28, p = .043, d = .53
CCAPS general anxiety, F = 3.27, p = .076, d = .46
No effects on CCAPS eating concerns, hostility, or alcohol subscales (p > .10)

9. Processes of Change
Time by condition interactions showed improvements in ACT vs. waitlist for:
PHLMS Acceptance, F = 4.50, p = .04, d = .52
VQ Obstruction, F = 6.38, p = .04, d = .62
No effects on AAQ-II, CFQ, PHLMS awareness, or VQ progress (p > .10)
PHLMS acceptance and VQ Obstruction mediated outcomes for all outcomes but academic distress

10. Lessons learned
Developing self-help programs through a survey CMS can lead to adequate acceptability, usability and efficacy
But results are weaker than hoped for on key usability, usage and process measure variables
Effects might be improved by reducing length of sessions and longer reading segments
A general, transdiagnostic approach reduced a range of problems
But did not impact outcomes largely outside of internalizing disorders
Recruitment challenges with engaging college students in web-based self-help

11. The LifeToolbox
Conduct a dismantling trial to compare the efficacy of ACT components in isolation/combination
Mindfulness only vs. values only vs. all combined
Transdiagnostic intervention for distressed college students
But now with a phone screening for more stringent eligibility
Expanded recruitment to actively engage students seeking self-help
Revised intervention approach
Emphasis on briefer sessions targeting a more specific concept/skill
Homepage with open access to twelve sessions
Testing the impact of coaching

13. v

14. Recruitment Collaborated with USU Student Affairs Methods included
Which provided connections across a wide range of access points
Methods included
Counseling and health center
MyUSU online posting
Meeting with student government, campus committees, clubs (diversity, veterans, etc…)
Regional campuses and distance education
s to faculty, staff, advisors, PR
Social media posting
Campus posting (including residence halls)
USU Connections course
Parent newsletter
Directed to an online pre-screening
Provided a single flyer for ongoing recruitment
Streamlined early screening steps
Contacted by about 200 students in 5 weeks
100 enrolled in studies
65 enrolled in LifeToolbox

15. Participants & Procedures
Sample of 70 college students enrolled
N have completed post
Currently in distress based on CCAPS, but not actively suicidal
Phone screening
Online consent and baseline survey
Randomized to waitlist, ACT-Full, ACT-Mindful, ACT-Values
Also randomized to phone coaching or not
Post assessment 6 weeks later and then follow up assessment at week 10

16. Preliminary results Program satisfaction Engagement rates
Outcome results

17. Discussion
Need to consider more research focused on generalizable knowledge
Rather than validating a custom built technology
We need a way to more rapidly iterate and test theory-driven questions
The custom build approach may not support this as well
Increased emphasis on effectively implementing and engaging students with the technologies available

18. Extra Slides

19. Qualtrics – Interactive Options
Multiple choice, checkboxes, matrix tables, dropdown, etc…
Fill in the blank, forms, essays, etc…
Drag and drop, Rank order
Sliders
Heat maps
File upload
Timers
Video and audio file embedding
File download

20. Qualtrics - Features
Formatting font, images, buttons, header, background, etc…
Left navigation bar with progress indicator
Skip logic, branching, display logic, randomization
Carry forward of data within and across sessions
In text as well as in exercises
Login feature: Carry forward data, start sessions where left off, track progress, etc…
HTML and javascript code (expand/collapse, rollover, button text, etc…)
and panel triggers
Stability and cross platform compatibility
Responsive design for mobile phone