Efficacy of a Confucianism-based ACT for university students in China: A randomized controlled trial against a standard mindfulness-based intervention.

OBJECTIVE

Declining mental health among university students is a global concern. This study aimed to compare the effects of a Confucianism-based Internet-delivered Acceptance and Commitment Therapy (C-ACT) with a standard mindfulness-based I-ACT (M-ACT) and to examine the longitudinal relationship between psychological flexibility (PF) and meaning-centered coping (MCC).

METHOD: In this randomized controlled trial, 300 Chinese university students were assigned to either the C-ACT intervention or the M-ACT active comparison group. Both online interventions were delivered over an 8-week period, with follow-up assessments conducted every 4 weeks for 12 weeks thereafter resulting in a total of five assessment time points. A parallel process latent growth curve model was used to analyze the change trajectories of PF and MCC.

RESULTS

Both groups demonstrated significant increases in PF and MCC over time. At baseline, higher PF was significantly associated with higher MCC. Furthermore, the rate of change in PF was positively correlated with the rate of change in MCC across both groups. Crucially, the C-ACT group showed astatistically significantly greater rate of increase in MCC compared to the M-ACT group. No significant group difference was found for the rate of change in PF.

CONCLUSIONS

While the findings support the general efficacy of I-ACT for improving psychological well-being in university students, the relatively stronger effect of the culturally adapted C-ACT on meaning-centered coping specifically highlights the potential benefits of integrating indigenous cultural values, such as Confucian ethics, into evidence-based psychological interventions to enhance specific therapeutic outcomes.

CLINICAL TRIAL REGISTRATION NUMBER: ChiCTR2400090851.