Mechanisms of change in peer coaching for digital ACT: A serial mediation model on program adherence and psychological flexibility's role in reducing distress

IF 3.4 3区心理学 Q1 PSYCHOLOGY, CLINICAL

Journal of Contextual Behavioral Science Pub Date : 2025-07-01 DOI:10.1016/j.jcbs.2025.100922

Korena S. Klimczak, Michael P. Twohig, Gretchen G. Peacock, Michael E. Levin

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Abstract

Background

Coaching is a well-supported intervention for improving adherence to online mental health programs. It is currently unclear whether peer-support coaching improves mental health outcomes solely through improving program adherence, or if it can also have a direct impact on mental health. We investigated this using a randomized controlled trial and applying serial mediation models.

Method

A total of 230 college students were instructed to use the 12-session ACT Guide program over 10 weeks. They were randomly assigned to additionally receive either peer-support coaching over weekly phone calls, text message conversations, or a no-coaching control group. Coaching followed a standardized protocol.

Results

Phone coaching had a significant total effect, but not a direct effect, on psychological distress. Both the phone coaching → psychological flexibility → distress, and the phone coaching → program adherence → psychological flexibility → distress indirect pathways were significant. Text coaching had a significant total and direct effect on psychological distress. The full serial pathway was the only significant indirect effect (text coaching → program adherence → psychological flexibility → distress).

Conclusions

We found that peer coaching in both formats significantly increased program adherence, which in turn improved psychological flexibility, consequently reducing psychological distress. Coaching through phone calls had a significantly greater indirect effect on distress and direct effect on program adherence in comparison to the text message format. It is possible that the skills review and ACT-based strategies used in phone coaching directly improve psychological flexibility regardless of the number of modules completed, with text coaching being too brief to elicit this same effect.

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数字ACT同伴辅导的变化机制：项目依从性和心理灵活性在减少痛苦中的作用的系列中介模型

辅导是一种得到良好支持的干预措施，可以提高对在线心理健康项目的依从性。目前还不清楚同伴支持指导是否仅仅通过提高项目的依从性来改善心理健康结果，或者它是否也能对心理健康产生直接影响。我们采用随机对照试验和串行中介模型对此进行了研究。方法总共230名大学生在10周的时间里接受了12节ACT指导课程的指导。他们被随机分配到另外一组，要么通过每周的电话、短信交谈接受同伴支持的指导，要么接受没有指导的对照组。训练遵循标准化的规程。结果电话辅导对心理困扰有显著的总影响，但没有直接影响。电话辅导→心理灵活性→痛苦和电话辅导→项目遵守→心理灵活性→痛苦的间接路径均显著。短信辅导对心理困扰有显著的总体和直接影响。完整的序列通路是唯一显著的间接效应（文本指导→程序遵守→心理灵活性→痛苦）。结论我们发现同伴辅导在两种形式下都能显著提高项目依从性，从而提高心理灵活性，从而减少心理困扰。与短信形式相比，通过电话进行的指导对痛苦有更大的间接影响，对坚持计划有更大的直接影响。电话辅导中使用的技能回顾和基于act的策略有可能直接提高心理灵活性，而不管完成了多少个模块，而短信辅导太短，无法产生同样的效果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Contextual Behavioral Science PSYCHOLOGY, CLINICAL-

CiteScore

8.50

自引率

18.00%

发文量

审稿时长

61 days

期刊介绍： The Journal of Contextual Behavioral Science is the official journal of the Association for Contextual Behavioral Science (ACBS). Contextual Behavioral Science is a systematic and pragmatic approach to the understanding of behavior, the solution of human problems, and the promotion of human growth and development. Contextual Behavioral Science uses functional principles and theories to analyze and modify action embedded in its historical and situational context. The goal is to predict and influence behavior, with precision, scope, and depth, across all behavioral domains and all levels of analysis, so as to help create a behavioral science that is more adequate to the challenge of the human condition.