Ethics code: IR.IAU.KHUISF.REC.1402.135
Associate Professor, Department of Psychology, Naein Branch, Islamic Azad University, Naein, Iran. , elham_for@yahoo.com
Abstract: (550 Views)
Background : The growth of any society depends on its students in the future; accordingly, countries spend significant amounts of their income on their education systems. However, depression reduces the quality of students’ mental health (1). Existing research, such as Mortier et al. (2) and Pillay et al. (3), show that depression is prevalent among students (4). Some students manage to cope with it, while the subjective well-being has troubled others. Therefore, it is crucial to know the effective strategies for alleviating the depression symptoms of students (5).
Mental well-being denotes individuals’ evaluation of life and comprises both reflective cognitive judgments (such as life satisfaction) and emotional responses to life when experiencing positive and pleasant emotions versus unpleasant and negative emotions (7). It includes emotional (Emotional well-being), social (Social Well-being), and psychological (Mental Well-being) categories. The psychological category can be defined as an individual’s ability to express his satisfaction without allowing others to influence the experience of positive feelings (8). The emotional category refers to the presence of positive emotions, the absence of negative emotions, and satisfaction (9). Social category is the evaluation and recognition of an individual on how he functions in society and the quality of his relationships with individuals and social groups (10).
Mindfulness-based interventions are among the efforts aimed at effectively and efficiently reducing depression symptoms in students (12). It enables clients to understand their experiences non-judgmentally and alter their relationships with others by challenging and accepting their beliefs and feelings (15).
Behavioral activation is one of the effective treatment methods (17), which assumes that the life problems of vulnerable individuals take away their ability to receive positive reinforcement from the environment. This is based on emphasizing the major and real factors causing depression, i.e., the reduction of rewarding activities and the increase of avoidance behaviors and ruminative thoughts (19).
Shahsavari (2022) found that mindfulness improved well-being scores (24). Ghamari (2021) reported that mindfulness increased psychological well-being (25). Bahreini (2021) indicated that mindfulness influenced the well-being level (26). Yosep (2023) concluded that mindfulness could help improve psychological well-being (27). Ghodrati and Vaziri Neku (2018) found that behavioral activation therapy affected psychological well-being (28). Mazzucchelli (2010) realized that the effectiveness of behavioral activation intervention was comparable to the integrated effect of positive psychology interventions on well-being (29). A meta-analysis conducted by Stiles-Shields (2014) showed that behavioral activation positively impacted depression. (30).
The review of the literature revealed that no systematic study has yet been conducted on this topic in Iran. Therefore, the purpose of the current research is to answer the question of whether there was a significant difference between the effectiveness of behavioral activation training and mindfulness training on the mental well-being of students with depressive syndrome.
Methods: The research was semi-experimental with a pre-test, post-test, control group, and 60-day follow-up design. The statistical population included all female students studying for both bachelor’s and master’s degrees who were referred to the counseling center of the University of Isfahan, among whom 45 were selected and randomly assigned to two experimental groups and a control group, each comprising 15 students.
The experimental group participants of behavioral activation received this intervention during nine two-hour sessions; the participants of the mindfulness training group underwent eight two-hour sessions, while the control group received no intervention. The participants were retested after 60 days as a follow-up. Finally, they completed the questionnaires in three stages, and the data were analyzed using the mixed analysis of variance and the Bonferroni post-hoc test by SPSS26.
Beck depression scale: This test was developed by Beck (1961) and has 21 items that measure the severity of depression symptoms using a four-point Likert scale, with scores ranging between 0 and 63. Dobson and Mohammad Khani (2006) reported Cronbach’s alpha of 0.93 for students (34).
The mental well-being questionnaire: it was developed by Keyes and Magyarmo (2003). The items are rated on a 5-point Likert scale, ranging from not at all (1) to all the time (5). The internal consistency coefficient of the questionnaire, estimated by Cronbach’s alpha, was 0.80 (36). The description of mindfulness training sessions was taken from Kabat-Zinn (2013) (36), and the description of behavioral activation sessions was provided by Lejuez et al. (2011) (37).
Results: Demographic characteristics were investigated in the descriptive statistics section, and the variables were described using mean and standard deviation. In both experimental groups, the mean score of total well-being increased compared to the pre-test. Levene’s test was used to perform a mixed analysis of variance, which indicates the confirmation of the assumption of homogeneity of variance (P<0.05). Covariance analysis was used to investigate the between-groups effect (F=0.745, p=0.32). Therefore, there was a significant difference between the mean scores of the between subjects’ group in the post-test and the follow-up of the total well-being (P<0.05). Bonferroni post-hoc test was used to examine the difference between the mean of the experimental and control groups in pairs and to determine the effectiveness. The results indicated a significant difference between the mean of the post-test and follow-up well-being of the control group and the experimental group of behavioral activation (P< 0.01), while a significant difference was observed in the mindfulness intervention group only in the follow-up phase (P<0.05); therefore, both methods effectively and equally increased well-being. It is noteworthy that only the behavioral activation treatment effect remained constant over time.
Conclusion: The results showed that both methods effectively and equally increased the mental well-being of students, but only the behavioral activation treatment effect remained constant over time. Although no similar study was found, the findings of Dominguez Rodrigues et al. (23), Shahsavari et al. (24), Ghamari et al. et al. (27), Ghodrati and Vaziri Neku (28), Mazzuchelli (29) and Shields et al. (30) are consistent with those of the present study.
In explaining the findings, it can be stated that behavioral activation is assumed to help individuals engage in different behaviors to feel pleasure and be useful (28). At the same time, mindfulness helps students become more self-aware and allows them to identify negative thought patterns and feelings associated with depression. Therefore, it can be concluded that these two approaches can improve the mental well-being of students.
One of the limitations of the study was that the results were related to female students, and the generalization of the results to the male ones should be done with caution. It is suggested that this research be conducted on other age groups as well. Therefore, it is possible to enhance the mental well-being and reduce mood disorders of students by holding training courses in university counseling centers.
Mental well-being denotes individuals’ evaluation of life and comprises both reflective cognitive judgments (such as life satisfaction) and emotional responses to life when experiencing positive and pleasant emotions versus unpleasant and negative emotions (7). It includes emotional (Emotional well-being), social (Social Well-being), and psychological (Mental Well-being) categories. The psychological category can be defined as an individual’s ability to express his satisfaction without allowing others to influence the experience of positive feelings (8). The emotional category refers to the presence of positive emotions, the absence of negative emotions, and satisfaction (9). Social category is the evaluation and recognition of an individual on how he functions in society and the quality of his relationships with individuals and social groups (10).
Mindfulness-based interventions are among the efforts aimed at effectively and efficiently reducing depression symptoms in students (12). It enables clients to understand their experiences non-judgmentally and alter their relationships with others by challenging and accepting their beliefs and feelings (15).
Behavioral activation is one of the effective treatment methods (17), which assumes that the life problems of vulnerable individuals take away their ability to receive positive reinforcement from the environment. This is based on emphasizing the major and real factors causing depression, i.e., the reduction of rewarding activities and the increase of avoidance behaviors and ruminative thoughts (19).
Shahsavari (2022) found that mindfulness improved well-being scores (24). Ghamari (2021) reported that mindfulness increased psychological well-being (25). Bahreini (2021) indicated that mindfulness influenced the well-being level (26). Yosep (2023) concluded that mindfulness could help improve psychological well-being (27). Ghodrati and Vaziri Neku (2018) found that behavioral activation therapy affected psychological well-being (28). Mazzucchelli (2010) realized that the effectiveness of behavioral activation intervention was comparable to the integrated effect of positive psychology interventions on well-being (29). A meta-analysis conducted by Stiles-Shields (2014) showed that behavioral activation positively impacted depression. (30).
The review of the literature revealed that no systematic study has yet been conducted on this topic in Iran. Therefore, the purpose of the current research is to answer the question of whether there was a significant difference between the effectiveness of behavioral activation training and mindfulness training on the mental well-being of students with depressive syndrome.
Methods: The research was semi-experimental with a pre-test, post-test, control group, and 60-day follow-up design. The statistical population included all female students studying for both bachelor’s and master’s degrees who were referred to the counseling center of the University of Isfahan, among whom 45 were selected and randomly assigned to two experimental groups and a control group, each comprising 15 students.
The experimental group participants of behavioral activation received this intervention during nine two-hour sessions; the participants of the mindfulness training group underwent eight two-hour sessions, while the control group received no intervention. The participants were retested after 60 days as a follow-up. Finally, they completed the questionnaires in three stages, and the data were analyzed using the mixed analysis of variance and the Bonferroni post-hoc test by SPSS26.
Beck depression scale: This test was developed by Beck (1961) and has 21 items that measure the severity of depression symptoms using a four-point Likert scale, with scores ranging between 0 and 63. Dobson and Mohammad Khani (2006) reported Cronbach’s alpha of 0.93 for students (34).
The mental well-being questionnaire: it was developed by Keyes and Magyarmo (2003). The items are rated on a 5-point Likert scale, ranging from not at all (1) to all the time (5). The internal consistency coefficient of the questionnaire, estimated by Cronbach’s alpha, was 0.80 (36). The description of mindfulness training sessions was taken from Kabat-Zinn (2013) (36), and the description of behavioral activation sessions was provided by Lejuez et al. (2011) (37).
Results: Demographic characteristics were investigated in the descriptive statistics section, and the variables were described using mean and standard deviation. In both experimental groups, the mean score of total well-being increased compared to the pre-test. Levene’s test was used to perform a mixed analysis of variance, which indicates the confirmation of the assumption of homogeneity of variance (P<0.05). Covariance analysis was used to investigate the between-groups effect (F=0.745, p=0.32). Therefore, there was a significant difference between the mean scores of the between subjects’ group in the post-test and the follow-up of the total well-being (P<0.05). Bonferroni post-hoc test was used to examine the difference between the mean of the experimental and control groups in pairs and to determine the effectiveness. The results indicated a significant difference between the mean of the post-test and follow-up well-being of the control group and the experimental group of behavioral activation (P< 0.01), while a significant difference was observed in the mindfulness intervention group only in the follow-up phase (P<0.05); therefore, both methods effectively and equally increased well-being. It is noteworthy that only the behavioral activation treatment effect remained constant over time.
Conclusion: The results showed that both methods effectively and equally increased the mental well-being of students, but only the behavioral activation treatment effect remained constant over time. Although no similar study was found, the findings of Dominguez Rodrigues et al. (23), Shahsavari et al. (24), Ghamari et al. et al. (27), Ghodrati and Vaziri Neku (28), Mazzuchelli (29) and Shields et al. (30) are consistent with those of the present study.
In explaining the findings, it can be stated that behavioral activation is assumed to help individuals engage in different behaviors to feel pleasure and be useful (28). At the same time, mindfulness helps students become more self-aware and allows them to identify negative thought patterns and feelings associated with depression. Therefore, it can be concluded that these two approaches can improve the mental well-being of students.
One of the limitations of the study was that the results were related to female students, and the generalization of the results to the male ones should be done with caution. It is suggested that this research be conducted on other age groups as well. Therefore, it is possible to enhance the mental well-being and reduce mood disorders of students by holding training courses in university counseling centers.
Type of Study: Research |
Subject:
Clinical Psychiatry
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