A digital positive psychology intervention for college student mental health and health behaviors

Abstract

Purpose

The purpose of this study is to evaluate the impact of a 10-week positive psychology course on college student stress, anxiety, self-compassion, resilience and health behaviors.

Design/methodology/approach

This study implemented a 10-week positive psychology program that included ten one-week modules. Each module consisted of a reading on a given positive psychology topic, a guided learning slideshow, a video to reinforce topical understanding and individual reflection or application exercises. Participants completed pre and postintervention measures, including the perceived stress scale, generalized anxiety disorder-7, self-compassion scale, brief resilience scale and wellness behavior inventory.

Findings

A total of 48 students consented to participate in the study, of which 35 completed the 10-week positive psychology online intervention as well as the pre and postsurveys (27.1% attrition rate). There were no statistically significant differences between pre and postresponses for any of the outcome scales. However, there was a trend toward a decrease in perceived stress and generalized anxiety, as well as a trend toward an increase in self-compassion and health behaviors from pre to posttest.

Research limitations/implications

The main limitation of this study was design and sample size. Although it was a pilot study, future research should consider a randomized control trial, including pre and postevaluation and blind comparison group. Finally, this intervention was only implemented in the online, asynchronous format. Future research might consider comparing face-to-face, asynchronous online and synchronous online modalities.

Practical implications

Future implementation should include a more rigorous design, such as a comparison group with randomization as well as a larger sample size.

Social implications

Given the previous effectiveness of positive psychological interventions on health behaviors, continued research may use direct measures of health behavior engagement throughout the intervention (Biber and Ellis, 2019). This study provides other researchers and practitioners with a model for utilization with middle, high and university students.

Originality/value

This study used open-access content that was free of charge to students to promote positive mental health and health behavior change.

Citation

Biber, D. and Davis, A. (2024), "A digital positive psychology intervention for college student mental health and health behaviors", Mental Health and Digital Technologies, Vol. 1 No. 2, pp. 228-239. https://doi.org/10.1108/MHDT-02-2024-0007

Introduction

The transition from high school to college is developmentally challenging and stressful (Hunt and Eisenberg, 2010). College is associated with high levels of depression, anxiety and stress (Hishan et al., 2018). College students have to cope with academic standards, social expectations and overall life transition, much of which can contribute to psychological issues (Crystal et al., 1994; Uehara et al., 2010). This is important to note because, as students transition from high school into college, they have more autonomy to choose lifestyle behaviors such as smoking, drinking, exercise and eating, to name a few. Health behaviors, whether adaptive or maladaptive, tend to cluster in college students (El Ansari et al., 2018). Throughout the COVID-19 pandemic there has been an increase in college student stress, depression and anxiety, as well as a negative relationship between such anxiety with optimism and academic performance (Biber et al., 2022; Lee, 2020; Wang et al., 2020). Both longitudinal and cross-sectional studies revealed significant pandemic impacts on college-student psychological distress and anxiety (Allen et al., 2023), with a disproportionate impact on students who were women, of lower socioeconomic status, had poorer health and had family members who experienced negative repercussions of COVID-19 (Browning et al., 2021). In addition, first-year college students exhibited an increase in attention problems and externalizing problems throughout COVID-19, along with decrements in mood and daily health behaviors (Copeland et al., 2021). These studies were further supported by a systematic and meta-analytic review that showed a negative psychological impact of the COVID-19 pandemic on this age group (Wang et al., 2021).

To address such mental, social and physical problems in college, positive psychological interventions (PPIs) have been implemented. PPIs aim to enhance the “conditions and processes that contribute to the flourishing or optimal functioning of people” (Gable and Haidt, 2005, p. 104). Seminal research conducted by Peterson and Seligman(2004) outline key PPI virtues, including:

• wisdom and knowledge;

• courage;

• humanity;

• justice;

• temperance; and

• transcendence (2004).

Within these six virtues are various strengths of character that can be implemented, strengthened and evaluated. In addition to this model of positive psychology, Fredrickson outlined ten positive emotions that are often included in PPIs, such as love, joy, awe, gratitude, serenity, interest, hope, pride, amusement and inspiration (Fredrickson, 2013). Various meta-analyses have found moderate-to-strong effects of PPIs on depression, anxiety and stress when compared to control groups (Bolier et al., 2013; Carr et al., 2020; Fu et al., 2020). PPIs have also been found to increase overall physical health, mental health, life satisfaction and well-being (Carr et al., 2020; Lyubomirsky et al., 2006; Tejada-Gallardo et al., 2020). That said, other reviews have found mixed results regarding the efficacy of digital PPIs for university students (Riboldi et al., 2023). Digital PPIs have the potential to reach a large audience, with tailored content, through a variety of modalities to improve access to mental health care (Hadler et al., 2021). Since university students are predominantly required to engage in course content through learning management systems (LMS), digitized PPIs may help with student ease of access and overall engagement (Wies et al., 2021). While PPIs have the potential to educate university students on the benefit of positive psychology, improve emotional and behavioral awareness and promote self-help, continued evaluation is needed (Mitchell et al., 2009; Norcross, 2006; Parks, 2015).

One theory to help explain the impact of positive psychology on positive emotions and healthy behaviors is the Broaden and Build theory (Fredrickson, 1998, 2001, 2004, 2013). This theory posits that positive emotions broaden an individual’s thought-action repertoires, empowering a broader and more flexible perspective, cognitions, ideas and potential behaviors in a given situation (Garland et al., 2010). Over time, positive emotional expression and broadening of action repertoires builds a reserve of emotional and behavioral flexibility, resilience, social connectivity and physical health (Fredrickson, 2013). On the contrary, negative emotions tend to narrow cognitions, leading to specific action urges that promote self-preservation such as fight or flight (Frijda, 2017; Schmitz et al., 2009). Positive emotions and resultant broadened thought-action repertoires are complementary to the role of negative emotions and narrowed thought-action repertoires. It is important to continually examine the adaptive role of positive emotions with cognitive, emotional and behavioral outcomes.

Additional constructs that can be positively impacted by the broaden-and-build model are resilience and self-compassion. Research supports the upward spiral mechanism of this model in that positive emotions can enhance psychological resources like resilience, as well as adaptive thinking like self-compassion (Fredrickson, 2004). Resilience, or the ability to bounce back or recover from stress (Smith et al., 2008, p. 194), is positively correlated with and predictor of positive emotions in college (Maggalinggam and Ramlee, 2021; Zhang et al., 2021). Resilience was even found to moderate the relationship between COVID-19 induced stress on mental health in college students and was only second in strength to physical health as a moderator (Wattick et al., 2023). Self-compassion involves approaching daily and chronic difficulties with self-kindness, common humanity and mindful awareness (Neff, 2003). Research with college students in the COVID-19 pandemic indicated lower trajectories of anxiety and depression in college students who were more self-compassionate (Liang et al., 2022).

Given the difficulty of transitioning to college, along with the negative impact of the COVID-19 pandemic, the need for positive psychological interventions that promote such resilience, self-compassion, mindfulness and overall physical health is evident. A recent review indicated mental health screening and intervention to be top priority for universities given the prevalence of mental health problems (Deng et al., 2021). The purpose of this study was to evaluate the impact of a 10-week positive psychology course on college student stress, anxiety, self-compassion, resilience and health behaviors.

Method

Participants

Participants (n = 35) were undergraduate students from a university in the southeast USA. A convenient sampling technique was used and undergraduate students from the public health and health promotion program were recruited through announcements in the various undergraduate classes LMS. Participants were mostly female (71.4%), African American (62.9%) and classified as a junior at the university (57.1%). This is representative of the university in terms of female representation (72%), while only 47.3% are racial or ethnic minorities. Participants were e-mailed the consent form, demographic questionnaire and other questionnaires via university e-mail. Participants did not receive any compensation for participation in the study. There was no harm that participants could incur from participating in this study.

Intervention

This study implemented a 10-week digital positive psychology program that included ten, one-week modules deployed via the university LMS. Each module consisted of a reading on a given positive psychology topic, a guided learning slideshow, a video to reinforce topical understanding and individual reflection or application exercises. Table 1 below highlights the ten different topics along with examples of each of the reflection and application exercises. The 10-week digital PPI was developed by two faculty with expertise in positive psychology and online course design (Biber and Czech, 2020). The PPI was developed using scholarly research and peer-reviewed by various editors and experts in digital learning. All participants completed the modules in the same order and were afforded the same amount of time to complete said modules.

Measures

The following questionnaires were administered using the Qualtrics online survey platform. Participants completed baseline questionnaires (one week prior to the intervention) and at follow-up (one week after the intervention).

Personal history questionnaire. This measure solicited self-reported gender, race and/or ethnicity and education grade classification.

Perceived stress scale (PSS). The PSS evaluated the participants’ perception of stress over the previous month (Cohen and Williamson, 1988). The PSS used ten items to measure perceived stress from a total mean calculation. Responses for each item range from 0 (never) to 4 (very often). Items are then summed to determine a total perceived stress score, ranging from 0 to 40. The PSS had strong internal consistency, test-retest reliability and validity with anxiety and depression (Lee, 2012).

General anxiety disorder-7 (GAD-7). The GAD-7 assessed anxiety over the past two weeks. The GAD-7 was shown to have good internal and test–retest reliability, as well as convergent, construct, criterion, procedural and factorial validity for the diagnosis of generalized anxiety disorder (Spitzer et al., 2006). Scores on the GAD-7 ranged from 0 to 21; scores of 5, 10 and 15 represented mild, moderate and severe anxiety symptoms, respectively (Kroenke et al., 2007). The Cronbach’s alpha for the scale in this study was 0.94.

Wellness behaviors inventory (WBI). This is a 12-item assessment that measured the frequency of health promoting behaviors, such as healthy eating and exercising (Sirois, 2001). Each item was scored on a five-point scale with responses ranging from 1 (less than once a week or never) to five (every day of the week). The WBI was calculated by averaging the scores from ten of the 12 items to determine general health behaviors. This scale was negatively correlated with stress, negative affect and positively correlated with health behavior intentions, physical health and perceived control over health (Dunne et al., 2018; Sirois, 2015a, 2015b, 2015c).

Self-compassion scale (SCS-12). The 12-item scale measured several attitudes (e.g. self-kindness, self-judgment, mindfulness) that combine to represent self-compassion (Raes et al., 2011). The SCS-12 includes 12 items measured on a Likert scale from 1 (almost never) to 5 (almost always). It is scored by reverse scoring negative subscale items, then computing a total mean based on the six subscale means (Raes et al., 2011). With university samples, three-week test–retest reliability was supported (r = 0.93) and internal consistency was α = 0.92. Concurrent validity was demonstrated by large correlations with indicators of depression, anxiety and life satisfaction. The SCS had strong scale reliability (α = 0.77) (Neff, 2003; Neff and Pommier, 2013; Raes et al., 2011).

Brief resilience scale (BRS). A validated resiliency scale survey was used at baseline and follow-up to measure changes in resiliency. The BRS was a validated measure developed to evaluate the ability of the individual to bounce back from stress and adversity (Smith et al., 2008). BRS was a brief, single-factor instrument with three positively worded items and three negatively worded items to minimize response bias. The six items are measured from 1 (strongly disagree) to 5 (strongly agree). The responses to the six items are summed, and a mean score is calculated with six indicating the highest resilience. In a recent review of resilience scales, it was noted to have the most satisfactory psychometric properties and said to be one of the most frequently used resilience scales in a total of 25 scales (Windle et al., 2011).

Page views. Using the Desire2Learn (D2L) LMS, the number of unique page views per module was tracked.

Procedure

Upon institutional review board approval, undergraduate students were recruited from a rural university in the southeast USA. In the spring semester of 2022, instructors of public health and health promotion undergraduate classes were sent an e-mail asking for student participation. If given approval, instructors sent an e-mail to potential participants. The e-mail included a link to electronic informed consent and if they choose to continue, electronic surveys including the personal history questionnaire, resilience, grit, self-compassion, anxiety, depression and health behaviors using the Qualtrics survey software. Participants completed the questionnaires at baseline (i.e. one week prior to the intervention) and at follow-up (i.e. one week after the intervention). Participants then received weekly announcements in the D2L LMS to remind them to engage in the weekly PPI content. Participants were not incentivized to participate in the study and were allowed to discontinue participation at any time without penalty.

Data analysis

Means, standard deviations, frequencies and proportions were calculated for gender, race and school classification. For missing data attributed to nonresponse, data were replaced using the imputation approach in which missing values were filled in with estimations for the missing data. Separate analyses of variance (ANOVAs) were used to compare demographic variables on outcome variables. Scale reliabilities (i.e. Cronbach’s alpha; α) were calculated for the PSS, GAD-7, WBI, SCS-12 and BRS questionnaires. Alphas greater than or equal to 0.70 were classified as acceptable, 0.60–0.69 were considered questionable, 0.50–0.59 were classified as poor and below 0.50 were considered unacceptable (George and Mallery, 2016). Paired t-tests were used to examine differences in pre and postscores for the PSS, GAD-7, WBI, SCS-12 and BRS.

Results

Participants and intervention usage

A total of 48 students consented to participate in the study, of which 35 completed the pre and postsurveys (27.1% attrition rate). This number of participants was deemed adequate for a single–group pilot study based on previous research (Hertzog, 2008; Isaac and Michael, 1995; Johanson and Brooks, 2010). The average number of page views per participants was 771.1 (SD = 185.6; range = 314–1,245) for the ten modules included in the intervention. There were no statistically significant differences on any demographic variable for any of the outcome variables.

Scale reliability

All scale reliabilities were acceptable and above except for the pre-SCS (α = 0.66) and post-BRS (α = 0.67) (see Table 2). However, we continued with analyses without adjustments because lower alphas can be expected when scales have fewer items (Cortina, 1993).

Descriptive statistics for outcome variables

Paired T-tests were used to examine differences in pre and postscores for the PSS, GAD-7, WBI, SCS-12 and BRS. The mean pre and postscores for each of the outcome variables can be found in Table 2. There were no statistically significant differences between pre and postresponses for any of the outcome scales. That said, there was a trend toward a decrease in perceived stress and generalized anxiety, as well as trend toward an increase in self-compassion and health behaviors from pre to posttest.

Discussion

The purpose of this study was to evaluate the impact of a 10-week positive psychology course on college student stress, anxiety, self-compassion, resilience and health behaviors. Following participation in the asynchronous intervention, there was not a statistically significant difference in the outcome variables from pre to postintervention. However, there were small positive improvements in stress and anxiety, as well as in self-compassion and health behaviors. Furthermore, this study had high participation rate and relatively low attrition. The results of this pilot study are discussed relative to previous research and future research implications.

First, it is important to note that mean difference from pre to postintervention revealed improvements across the outcome variables, although not at a statistically significant level. Previous meta-analytic analyses showed that PPIs had significant effects on stress and anxiety in both clinical and nonclinical samples (Hendriks et al., 2018; Hendriks et al., 2020). Online PPIs with college students also resulted in significant increases in self-compassion and resilience (Baños et al., 2017; Kadian et al., 2022; MacDonald and Neville, 2022). Although previous online PPI research can positively impact negative and positive mental states, and the results from this study are trending in that direction, the consensus is that greater rigor regarding study design is needed to determine true long-term effectiveness (Baños et al., 2017). With a larger sample size, it may be possible to see significant effects for all outcome variables given that the 10-week intervention included multiple modalities of engagement and learning (i.e. reading content, watching video and individual reflection/application) and high engagement.

Second, this intervention was implemented in a manner that is feasible given that it was integrated with the university online LMS and allowed for asynchronous participation. One of the main critiques of online PPIs is that they are not tailored to meet the needs of the target population (Baños et al., 2017). However, the PPI used in this study was integrated with the same LMS the students used to access their university courses. Such a model may have allowed for a sense of comfort and familiarity when engaging with the 10-week intervention. The attrition rate of this study was low and comparable to that of PPIs as well, which may be supported by the availability for participants to enroll completely online (Linardon and Fuller-Tyszkiewicz, 2020; Meyer et al., 2012). Participants in this study were also able to engage with the PPI modules on their laptops or smartphone devices, supporting ease of access.

Finally, this study used a 10-module PPI with content that is easily translatable to other universities in different geographic regions, with various grade or age levels (i.e. middle school, high school or graduate school) and with activities that are easy to modify. Previous PPI implementation has found that tailored content can promote engagement, interest and enjoyment by participants (Redzic et al., 2014). Regardless of the target population, future use of this intervention could elicit feedback from potential participants regarding most desired modules or content areas prior to implementation. Allowing participants to engage in the intervention for more than one semester may also allow for user feedback and content modification, followed by further examination of engagement or effectiveness postmodification (Redzic et al., 2014). It is crucial for online PPIs to effectively enhance the core domains included in the intervention (see Table 1 for content domains), and then focus on improvements in emotional and behavioral outcomes (i.e. stress, anxiety, health behaviors) (Mohr et al., 2013).

Limitations

The main limitation of this study was design and sample size. Although it was a pilot study, future research should consider a randomized control trial, including pre and postevaluation and blind comparison group. Only 35 individuals participated in the study. To truly assess significant change a larger sample size is needed. Furthermore, this study did not assess the impact of each individual module week-by-week. It would be helpful to understand whether some modules (i.e. gratitude or mindfulness) were individually effective (Huffman et al., 2014). This intervention was only implemented in the online, asynchronous format. Future research might consider comparing face-to-face, asynchronous online and synchronous online modalities. Furthermore, there were various limitations to external validity of this study. Since a convenient sample of university students from a specific region of the USA was recruited, it is not possible to generalize results to university students or young adults globally. To account for this, future studies could recruit from various universities from different countries and randomize participants to either the PPI group or control group.

Conclusions

This study used a 10-week online, asynchronous positive psychology intervention for university undergraduate students. The findings trended positively from pre to postintervention for stress, anxiety, self-compassion, health behaviors. Given the previous effectiveness of PPIs on health behaviors, continued research may use direct measures of health behavior engagement throughout the intervention (Biber and Ellis, 2019). This study provides other researchers and practitioners with a model for utilization with middle, high and university students.

Table 1.

Positive psychology intervention

Topic	Example reflective activity	Description of activity
1. Introduction to positive emotions	Emotional intelligence check-in	Participants completed a questionnaire regarding self-awareness, self-regulation, self-motivation, social awareness and social skills. They then reflected upon domains of potential improvement
2. Growth mindset	Triggers for growth and fixed mindsets	Participants determined specific areas in they exhibit a growth mindset and a fixed mindset. They then focused on self-talk during times of a fixed mindset, trying to reframe such negative self-talk to exhibit that of a growth mindset
3. Grit	Awareness of avoidance	Participants brainstormed activities they had always wanted to try, but had avoided out of fear. Once they created a list, they chose one to attempt while keeping a journal of success
4. Mindfulness	Mindful 4–7–8 breathing	Participants practiced breathing in for 4 s, holding their breath for 7 s and breathing out for 8 s throughout the week
5. Self-compassion	Promoting self-compassion amidst difficulty	Participants wrote down the areas of life that they were the most critical of. Be as specific as possible. They also determined what they said to themselves during times of criticism. Finally, they reframed such criticism to be more self-compassionate
6. Optimism	Optimistic role-playing	Participants wrote down two or three recent or potential scenarios in a journal. They then wrote down both pessimistic and optimistic reactions to that situation. Finally, they reflected on what it felt like to express optimism and pessimism to the various prompts
7. Gratitude	Gratitude Journal	Participants kept a daily list of what they were grateful for each day for an entire week. They were asked to keep track of what they were grateful for and the reason why they felt so grateful
8. Spirituality	Daily intention	Participants were asked to think about their current needs, worries or stressors. They were then asked to brainstorm what would make them feel empowered. They created a spiritual intention that could serve as a grounding mantra for the week. They were asked to write it down in a place they would see often
9. Joy	Finding joy in everyday life	Participants were asked to reflect on seven domains of life, determining aspects of each domain with which they were unsatisfied. They were then tasked to brainstorm ways to find joy in each domain, creating a plan to engage in one activity per day to promote holistic joy
10. Authentic pride	My list of accomplishments	Participants were asked to write a list of what they had accomplished in the past week that they were proud of. They then brainstormed ways to celebrate each accomplishment to promote authentic, intrinsic pride

Source: Created by authors

Table 2.

Descriptive statistics for emotional/suicide symptoms between gender categories

	Pre			Post			Significance
Outcome variable	M	SD	α	M	SD	α	p-value
Perceived stress	18.46	7.55	0.92	17.97	6.83	0.90	0.77
Generalized anxiety	10.20	5.56	0.90	9.54	6.00	0.87	0.63
Self-compassion	3.00	0.69	0.66	3.24	0.49	0.81	0.09
Brief resilience	3.38	0.71	0.75	3.33	0.58	0.67	0.74
Health behaviors	3.34	0.74	–	3.57	0.67	–	0.18

Source: Created by authors