Confucian-informed ACT for psychological flexibility, mental health, and sleep in college students: A randomized controlled trial

College students are susceptible to psychological and sleep problems in the face of interpersonal, academic, financial, and uncertain pressures, which are exacerbated by the limited resources available at universities for psychological or sleep interventions and the negative help-seeking attitudes of college students. Therefore, there is a need to design and apply university-based interventions that are easily accessible to college students. Transdiagnostic Internet-based Acceptance and Commitment Therapy (TACT) has been widely utilized due to its low cost and scalability; however, to date, its effectiveness and cross-cultural adaptation in mainland China remain to be studied. University students were recruited and randomly assigned to either a) the intervention group (n = 48, Student COMPASS Enhanced Course), which received the I-ACT intervention course with crosscultural adaptation modifications, or b) the control group (n = 48, Student COMPASS Course), which received the Student COMPASS Course, in a randomized controlled trial design. The Student COMPASS Enhanced Course is a program that has undergone cultural adaptation improvements. The course utilizes the Theoretical Model of Confucian Self-Development as the ethical guideline, while mapping Zeng Guofan's (1811-1872) experience of self-cultivating to the six sub-processes of psychological flexibility and become the essential part of the course. Participants all received a post-intervention assessment after 7 weeks and a follow-up assessment after 15 weeks. The results indicated time effects across all symptom measures (ISI, GHQ-12, PPFI, ESS, DASS-21, and AAQ-II), suggesting significant improvements in mental health, sleep health, and psychological flexibility over time in both the intervention and control groups. Additionally, between-group main effects were observed for PPFI, ESS, DASS-21, and AAQ-II scores. However, the Generalized Estimating Equations (GEE) analysis revealed no group by time interaction effects for scores on any of the measures. Therefore, the Student COMPASS Enhanced Course is an effective Transdiagnostic Internet-based Acceptance and Commitment Therapy for college students in mainland China, with cross-cultural adaptation modifications to the I-ACT and incorporation of the Social workers and counselors are important for the design of psychological intervention programs and subsequent research on I-ACT in mainland Chinese universities.