Abstract
Background: Mental health problems in university students are associated with many negative outcomes, yet there is a gap between need and timely access to help. Single-session interventions (SSIs) are designed to be scalable, accessible, delivering core evidence-based intervention components within a one-off encounter.
Objective: The Common Elements Toolbox (COMET) is an online self-help SSI, including behavioral activation, cognitive restructuring, gratitude, and self-compassion. COMET has previously been evaluated in India, Kenya, and the United States with promising results. In the current study, we tested the acceptability, appropriateness, perceived utility, and efficacy of COMET within UK university student’s peri-pandemic.
Methods: We conducted a randomized controlled trial (RCT) evaluating the efficacy of COMET compared to a control group, with 2-week and 4-week follow-ups. Outcome variables included subjective wellbeing, depression severity, anxiety severity, positive affect, negative affect, and perceived stress. We also measured intervention satisfaction immediately after completion of COMET. All UK university students with access to the internet were eligible to participate and were informed of the study online. The data was analyzed using linear mixed models and was reported in accordance with Consolidated Standards of Reporting Trials (CONSORT-EHEALTH).
Results: Of the 831 people screened, 468 participants were randomized to a condition, 407 completed the post intervention survey, 147 returned the 2-week follow-up survey, 118 returned the 4-week follow-up survey, and 89 returned both. Of the 239 randomized 212 completed COMET. Significant between-group differences in favor of the COMET intervention were observed at 2-week follow-ups for the subjective wellbeing (WEMWBS; MD = 1.39, 95% CI 0.19 to 2.61, p=.026), depression severity (PHQ-9; MD = -1.31, 95% CI -2.51 to -0.12, p=.033) and perceived stress (PSS-4; MD = -1.33, 95% CI -2.10 to -0.57, p<.001). Overall, participants were satisfied with COMET, with the majority (>70%) endorsing the intervention and its modules to be acceptable, appropriate, and exhibit high utility. The self-compassion module was most often reported as participants’ favorite module and the behavioral activation module as their least favorite. Qualitative analysis revealed that participants found COMET generally accessible, but too long, and experienced immediate and long-term beneficial effects.
Conclusions: This study demonstrated high engagement with the COMET intervention, along with preliminary short-term efficacy. Almost all participants completed the intervention, but research attrition was high. Participant feedback indicated high level of overall satisfaction with the intervention, with perceived accessibility, immediate benefits, and potential long-term impact being notable findings. These findings support the potential value of COMET as a mental health intervention and highlight important areas for further improvement.
Objective: The Common Elements Toolbox (COMET) is an online self-help SSI, including behavioral activation, cognitive restructuring, gratitude, and self-compassion. COMET has previously been evaluated in India, Kenya, and the United States with promising results. In the current study, we tested the acceptability, appropriateness, perceived utility, and efficacy of COMET within UK university student’s peri-pandemic.
Methods: We conducted a randomized controlled trial (RCT) evaluating the efficacy of COMET compared to a control group, with 2-week and 4-week follow-ups. Outcome variables included subjective wellbeing, depression severity, anxiety severity, positive affect, negative affect, and perceived stress. We also measured intervention satisfaction immediately after completion of COMET. All UK university students with access to the internet were eligible to participate and were informed of the study online. The data was analyzed using linear mixed models and was reported in accordance with Consolidated Standards of Reporting Trials (CONSORT-EHEALTH).
Results: Of the 831 people screened, 468 participants were randomized to a condition, 407 completed the post intervention survey, 147 returned the 2-week follow-up survey, 118 returned the 4-week follow-up survey, and 89 returned both. Of the 239 randomized 212 completed COMET. Significant between-group differences in favor of the COMET intervention were observed at 2-week follow-ups for the subjective wellbeing (WEMWBS; MD = 1.39, 95% CI 0.19 to 2.61, p=.026), depression severity (PHQ-9; MD = -1.31, 95% CI -2.51 to -0.12, p=.033) and perceived stress (PSS-4; MD = -1.33, 95% CI -2.10 to -0.57, p<.001). Overall, participants were satisfied with COMET, with the majority (>70%) endorsing the intervention and its modules to be acceptable, appropriate, and exhibit high utility. The self-compassion module was most often reported as participants’ favorite module and the behavioral activation module as their least favorite. Qualitative analysis revealed that participants found COMET generally accessible, but too long, and experienced immediate and long-term beneficial effects.
Conclusions: This study demonstrated high engagement with the COMET intervention, along with preliminary short-term efficacy. Almost all participants completed the intervention, but research attrition was high. Participant feedback indicated high level of overall satisfaction with the intervention, with perceived accessibility, immediate benefits, and potential long-term impact being notable findings. These findings support the potential value of COMET as a mental health intervention and highlight important areas for further improvement.
| Original language | English |
|---|---|
| Article number | e58164 |
| Number of pages | 18 |
| Journal | Journal of Medical Internet Research |
| Volume | 27 |
| Early online date | 31 Jan 2025 |
| DOIs | |
| Publication status | Published - 31 Jan 2025 |
Data Availability Statement
Data are available on reasonable request. The guarantor (M Loades) is willing to examine all requests for the deidentified dataset.Acknowledgements
We are very grateful to Akash Wasil and Professor Robert DeRubeis, Department of Psychology, University of Pennsylvania, Philadelphia, United States, who created COMET (Common Elements Toolbox) and allowed us to use it for this study. We also thank Tanvi Malhotra and Lucy Robinson for their support during this project.Funding
VP (Advanced Fellowship, NIHR301312) and M Loades (Advanced Fellowship, 302929) are funded by the National Institute for Health Research (NIHR) for this research project. The views expressed in this publication are those of the authors and not necessarily those of the NIHR, National Health Service (NHS), or the UK Department of Health and Social Care. NHS’s work was supported by the Economic and Social Research Council (grant ES/P000630/1). The expenses incurred in providing vouchers for the prize draw were supported by research funds from the Department of Psychology, University of Bath.
| Funders | Funder number |
|---|---|
| National Institute for Health Research | NIHR301312, NIHR302929 |
| Economic and Social Research Council | ES/P000630/1 |
Keywords
- Common Elements Toolbox
- mental well-being
- online interventions
- single-session interventions
- university students
ASJC Scopus subject areas
- Health Informatics
