Online self-help interventions, in which individuals learn psychological skills on their own to address mental health concerns, are effective and can have broad reach. However, people also regularly struggle with adhering to these programs when using them on their own. Initial research was fairly clear in suggesting that receiving additional guidance and support from another person, such as through coaching calls or emails, increased program adherence and efficacy. That said, the downside with a guided self-help approach is that it increases the challenges in scaling interventions to reach large numbers of people due to the costs and complexity of delivering personalized support to each user. Over time, possibly as online programs have become more sophisticated, results have been more mixed as to whether and how providing guided elements like phone coaching improve these interventions. Thus, it is worth continuing to evaluate the benefits of providing coaching with online self-help programs.
The current study examined whether phone coaching calls delivered by graduate students enhanced adherence to and outcomes from an online acceptance and commitment therapy (ACT) program to address college student mental health. Although there are a number of online ACT studies that have been published to-date, these have largely emerged over just the past 5 years and there have been only a few studies evaluating whether coaching calls/emails enhance outcomes. This study was also unique in that it evaluated the effects of phone coaching within the context of a dismantling trial that compared the effects of online programs targeting the engaged components of ACT (values/committed action), open components (acceptance/defusion), or a combination of all ACT components. This was a secondary analysis study from the larger dismantling trial published this year (Levin et al., 2020).
A sample of 136 distressed college students assigned to one of three versions of an ACT online intervention were randomized to either receive phone coaching or standardized, simple email prompts over the six-week intervention period. Participants assigned to phone coaching completed weekly calls that emphasized reinforcing adherence to the online intervention and problem solving non-adherence based on an established coaching protocol (Duffecy, Kinsinger, Ludman, & Mohr, 2011).
We found that participants assigned to phone coaching did not adhere better to the ACT online program relative to those who only received email prompts. In both conditions, participants completed on average approximately 8 of 12 sessions (about 75% completed at least half the program). Similarly, there was no effect of phone coaching on mental health symptoms or on most ACT processes of change. However, we did find that participants assigned to phone coaching improved more on psychological inflexibility, the primary target of ACT, at posttreatment relative to those only receiving email prompts. Interestingly, ACT component condition moderated this effect such that there was a stronger impact from phone coaching on psychological inflexibility in the Engaged condition (i.e., a version of the ACT website that targeted values and committed action) and a weaker effect in the Open condition (i.e., a version of the website that targeted acceptance and cognitive defusion).
Overall, this study adds to a growing body of research indicating that more intensive guided support strategies like phone coaching do not always provide substantial benefits that justify their heavy resource costs. In some cases, like with our ACT program, it seems simple email prompts are sufficient for delivering online self-help, which is ideal for scaling up these services to reach a large number of users. For example, the program we tested in this study provided the basis for ACT Guide, which we are now offering to the public through Utah State University as a purely self-help program for mental health concerns (https://scce.usu.edu/services/act-guide/). The efficiency and low cost of this self-help approach has allowed us to deliver ACT Guide to over 1,600 people across the world over the past year, including over 800 students at our university.
Duffecy, J., Kinsinger, S., Ludman, E., & Mohr, D. (2011). Telephone coaching to support adherence to internet interventions (TeleCoach): Coach Manual.
Levin, M.E., Krafft, J., Hicks, E.T., Pierce, B. & Twohig, M.P. (2020). A randomized dismantling trial of the open and engaged components of acceptance and commitment therapy in an online self-help program for distressed college students. Behaviour Research & Therapy, 126, 103557.
Read the full paper: Levin, M. E., Krafft, J., Davis, C. H., & Twohig, M. P. Evaluating the effects of guided coaching calls on engagement and outcomes for online acceptance and commitment therapy. Cognitive Behaviour Therapy. doi:10.1080/16506073.2020.1846609
Photo By: Nenad Stojkovic