Elsevier

Behavior Therapy

Volume 42, Issue 2, June 2011, Pages 323-335
Behavior Therapy

The Effectiveness of Acceptance and Commitment Therapy Bibliotherapy for Enhancing the Psychological Health of Japanese College Students Living Abroad

https://doi.org/10.1016/j.beth.2010.08.009Get rights and content

Abstract

International students often experience significant psychological distress but empirically tested programs are few. Broadly distributed bibliotherapy may provide a cost-effective approach. About half of the Japanese international students in a western university in the United States (N = 70) were randomly assigned to a wait-list or to receive a Japanese translation of a broadly focused acceptance and commitment therapy (ACT) self-help book. Although recruited without regard to health status, the sample was highly distressed with nearly 80% exceeding clinical cutoffs on one or more measures. After a 2-months period for the first treatment group to read the book and a 2-month follow up, wait-list participants also received the book. Students receiving the book showed significantly better general mental health at post and follow up. Moderately depressed or stressed, and severely anxious students showed improvement compared to those not receiving the book. These patterns were repeated when the wait-list participants finally received the book. Improvements in primary outcomes were related to how much was learned about an ACT model from the book. Follow-up outcomes were statistically mediated by changes in psychological flexibility, but not vice versa and were moderated by level of initial flexibility. Overall, the data suggest that ACT bibliotherapy improved the mental health and psychological flexibility of Japanese international students.

Section snippets

Participants and recruitment

The participants were 70 Japanese international students (44 females; average age 23.6, range 20–26) enrolled at the University of Nevada, Reno (UNR), during the 2008–2009 academic year. In accord with the population-based focus of the present study, participants constituted a majority of all 138 Japanese international students at the university at the time. Power analysis, conducted using G⁎Power (Faul, Erdfelder, Lang, & Buchner, 2007), showed that the sample had adequate power (> .9) to

Results

A flow chart of participation is shown in Fig. 1. All totaled, 60 of the 70 participants (86%) had complete data in the main part of the study (pre, post, and the first follow-up). In the wait-list arm, eight participants failed to complete the fourth and final assessment after they too received the book. Including this final assessment, 84% of the participants provided at least one postbook assessment package, and 74% provided complete data.

Across both arms of the study, during the 8 weeks the

Discussion

Although college is often thought of as a carefree time, the evidence suggests otherwise. College students in general experience remarkably high rates of distress. The most recent report of the American College Health Association (2008) found that about 13% of college students reported having symptoms of anxiety and more than 18% reported depression symptoms; 43% said they felt so depressed at some point in the academic year that it was difficult to function; 10% had seriously considered

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  • Cited by (0)

    As part of the editorial process, information about two process measures was removed to shorten the manuscript. Values consistency from the Personal Values Questionnaire (PVQ; Blackledge & Ciarrochi, 2006) and accepting without judgment from the Kentucky Inventory of Mindfulness Skills (KIMS; Baer, Smith, & Allen, 2004). Both were impacted by ACT and values consistency mediated GHQ outcomes. Values consistency was significantly worse at pre for those in the ACT condition. Adjusting for that difference did not impact outcomes. Change scores were used in meditational analysis for all process measures because of this predifference, however. Details are available from the authors.

    The authors would like to thank Matt McKay, Elizabeth Adamska, Mariko Mukaibo, Sayo Uyama, and the entire staff at New Harbinger Publications for their generous and ethical support of research focused on their self-help volumes. Volumes were supplied by the publisher at cost for evaluation. The authors of this study received no financial benefit from this study per se, however, it should be noted that the book evaluated generates royalties for Dr. Hayes.

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