Improving Mental Health of Chinese University Students in Hong Kong: Adventure-based Cognitive Behavioural Intervention

Study Overview
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Brief Summary
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This study delivered an adventure-based cognitive behavioral intervention program to a group of Hong Kong university students. The program effectiveness was evaluated by a randomized controlled trial in reducing psychological distress and improving mental health of these students. The 3-month maintenance effect was also tested.

Detailed Description
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University students are vulnerable to mental health problems due to the various challenges they have to face in university life. However, few studies have been conducted to evaluate the effectiveness of university counseling programs in Hong Kong. This project aims at developing and systematically evaluating a culturally adapted and adventure-based cognitive behavioral intervention (aCBI) program to decrease psychological distress and improve various mental health outcomes for Chinese university students in Hong Kong. The aCBI program was delivered in a form of general education course in a university setting. Randomized controlled trial (RCT) design was adopted. The program was evaluated its effectiveness in reducing psychological distress, perceived stress, depressive and anxiety symptoms, negative thoughts and negative emotions and increasing positive thoughts and positive emotions.

Official Title
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A Randomized Controlled Trial of Adventure-based Cognitive Behavioural Intervention for University Students in Hong Kong

Conditions
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Adventure-based Cognitive Behavioral Intervention

Intervention / Treatment
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* Other: adventure-based cognitive behavioral intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: be of Chinese nationality be studying in undergraduate programs at Hong Kong Baptist University (HKBU), as the aCBI program will be provided in the form of a general education course at this university have GHQ-12 scores of 2-10 (0-0-1-1) (i.e., mild to moderate levels of psychological distress) be willing to complete the entire process of the project. Exclusion Criteria: have GHQ-12 scores of 0-1 (i.e., a low level of psychological distress) or 11-12 (i.e., a high level of psychological distress) have one or more psychosis have experienced severe depression with suicidal attempts/ideation in the past 3 months, as diagnosed by a psychiatrist or a clinical psychologist.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Randomized controlled trial
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Adventure-based cognitive behavioral intervention<br>An adventure-based cognitive behavioral intervention program A 13-session adventure-based cognitive behavioral intervention program, including 6 lectures, 5 workshops and adventure training (one adventure day camp (2 sessions) and adventure activities in the beginning of each workshop). One session per week, 3 hours for each session. A variety of cognitive behavioral skills were taught in lectures and these skills were practiced in two groups (with appropriately 20 students in each group) in workshop to help students to apply these skills to cope with their own daily life stress. Skill briefing, case demonstration and debriefing, group sharing and discussion, in-class exercise and homework were used in the intervention program. | Other: adventure-based cognitive behavioral intervention<br>* The adventure-based cognitive behavioral intervention is a combination of cognitive behavioral therapy and adventure training. The intervention program is delivered in a 39-hour general education course entailed Improving Mental Health for University Success in a public university in Hong Kong. The program includes 6 lectures, 5 workshops, 5 adventure games and an adventure day camp. Students are divided into two groups in workshop to practise CBT skills to deal with their own issues.<br>|
| No Intervention: Control group<br>No intervention of the adventure-based cognitive behavioral program | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| General Health Questionnaire-12 | 12-item rating scale for psychological distress, scale score ranges from 0-12, with a higher score indicating a higher level of psychological distress | baseline: before the intervention program starts | 
| General Health Questionnaire-12 | 12-item rating scale for psychological distress, scale score ranges from 0-12, with a higher score indicating a higher level of psychological distress | post-test: 1 month upon completion of the intervention program | 
| General Health Questionnaire-12 | 12-item rating scale for psychological distress, scale score ranges from 0-12, with a higher score indicating a higher level of psychological distress | 3-month follow-up test: 3 months after completion of the intervention program | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Perceived Stress Scale | 10-item rating scale for perceived stress, scale score ranges from 0-4, with a higher score indicating a higher level of perceived stress | baseline: before the intervention program starts | 
| Perceived Stress Scale | 10-item rating scale for perceived stress, scale score ranges from 0-4, with a higher score indicating a higher level of perceived stress | post-test: 1 month upon completion of the intervention program | 
| Perceived Stress Scale | 10-item rating scale for perceived stress, scale score ranges from 0-4, with a higher score indicating a higher level of perceived stress | 3-month follow-up test: 3 months after completion of the intervention program | 
| Beck Depression Inventory | 21-item rating scale for depressive symptoms, scale score ranges from 0-63, with a higher score indicating a higher level of depressive symptoms | baseline: before the intervention program starts | 
| Beck Depression Inventory | 21-item rating scale for depressive symptoms, scale score ranges from 0-63, with a higher score indicating a higher level of depressive symptoms | post-test: 1 month upon completion of the intervention program | 
| Beck Depression Inventory | 21-item rating scale for depressive symptoms, scale score ranges from 0-63, with a higher score indicating a higher level of depressive symptoms | 3-month follow-up test: 3 months after completion of the intervention program | 
| Beck Anxiety Inventory | 21-item rating scale for anxiety symptoms, scale score ranges from 0-63, with a higher score indicating a higher level of anxiety symptoms | baseline: before the intervention program starts | 
| Beck Anxiety Inventory | 21-item rating scale for anxiety symptoms, scale score ranges from 0-63, with a higher score indicating a higher level of anxiety symptoms | post-test: 1 month upon completion of the intervention program | 
| Beck Anxiety Inventory | 21-item rating scale for anxiety symptoms, scale score ranges from 0-63, with a higher score indicating a higher level of anxiety symptoms | 3-month follow-up test: 3 months after completion of the intervention program | 
| Automatic Thoughts Questionnaire | 14-item rating scale for positive and negative automatic thoughts, score ranges from 1-5 for the positive thought subscale and negative thought subscale, with a higher score indicating a higher level of positive/negative thought. | baseline: before the intervention program starts | 
| Automatic Thoughts Questionnaire | 14-item rating scale for positive and negative automatic thoughts, score ranges from 1-5 for the positive thought subscale and negative thought subscale, with a higher score indicating a higher level of positive/negative thought. | post-test: 1 month upon completion of the intervention program | 
| Automatic Thoughts Questionnaire | 14-item rating scale for positive and negative automatic thoughts, score ranges from 1-5 for the positive thought subscale and negative thought subscale, with a higher score indicating a higher level of positive/negative thought. | 3-month follow-up test: 3 months after completion of the intervention program | 
| Chinese Affect Scale | 20-item rating scale for positive and negative emotions, score ranges from 1-6 for positive emotion subscale and negative emotion subscale, with a higher score indicating a higher level of positive/negative emotion | baseline: before the intervention program starts | 
| Chinese Affect Scale | 20-item rating scale for positive and negative emotions, score ranges from 1-6 for positive emotion subscale and negative emotion subscale, with a higher score indicating a higher level of positive/negative emotion | post-test: 1 month upon completion of the intervention program | 
| Chinese Affect Scale | 20-item rating scale for positive and negative emotions, score ranges from 1-6 for positive emotion subscale and negative emotion subscale, with a higher score indicating a higher level of positive/negative emotion | 3-month follow-up test: 3 months after completion of the intervention program | 
| Chinese Making Sense of Adversity Scale | 12-item rating scale for measuring sense-making coping, score ranges from 1 = totally disagree to 6 = totally agree, with a higher score indicating a higher level of sense-making coping. | baseline: before the intervention program starts | 
| Chinese Making Sense of Adversity Scale | 12-item rating scale for measuring sense-making coping, score ranges from 1 = totally disagree to 6 = totally agree, with a higher score indicating a higher level of sense-making coping. | post-test: 1 month upon completion of the intervention program | 
| Chinese Making Sense of Adversity Scale | 12-item rating scale for measuring sense-making coping, score ranges from 1 = totally disagree to 6 = totally agree, with a higher score indicating a higher level of sense-making coping. | 3-month follow-up test: 3 months after completion of the intervention program | 
| Connor-Davidson Resilience Scale | 25-item rating scale for measuring resilience, score ranges from 1 = not true at all to 5 = true all the time. All the Item scores are summed up as a total score, with a higher score indicating greater resilience. | baseline: before the intervention program starts | 
| Connor-Davidson Resilience Scale | 25-item rating scale for measuring resilience, score ranges from 1 = not true at all to 5 = true all the time. All the Item scores are summed up as a total score, with a higher score indicating greater resilience. | post-test: 1 month upon completion of the intervention program | 
| Connor-Davidson Resilience Scale | 25-item rating scale for measuring resilience, score ranges from 1 = not true at all to 5 = true all the time. All the Item scores are summed up as a total score, with a higher score indicating greater resilience. | 3-month follow-up test: 3 months after completion of the intervention program |