USU research team creates digital therapy tool to expand health care access

LOGAN — As Utahns are experiencing a statewide shortage of mental health professionals, students and professors at Utah State University are developing self-guided therapy programs available from anywhere, at the press of a button.

Acceptance and commitment therapy is a widely adopted, evidence-based therapy typically used in individual or group settings. However, psychology professionals and students at USU are creating digital tools that implement methods from this behavioral therapy technique in a self-help setting.

"Part of living life (means) we experience challenging emotions, challenging thoughts. But where people get really stuck is in this type of inflexible patterns, particularly when we focus on trying to avoid and get away from what we think and feel," said Michael Levin, licensed psychologist and co-director of the USU Acceptance and Commitment Therapy Research Group. "(Acceptance and commitment therapy) seeks to address this with whatever form of suffering people are struggling with by teaching people how to open up to these experiences rather than avoid them, how to be more mindfully aware of what's available in the present moment and how to engage in meaningful activities so that we're able to build out a rich, full, meaningful life."

The USU Acceptance and Commitment Therapy Self-Help Program is a digital suite of self-help resources available through the university's Sorenson Legacy Foundation Center for Clinical Excellence. The program is available for those seeking to improve their emotional well-being or manage mental health issues like anxiety, depression and stress. The original guide includes 12 self-guided modules that teach users to practice mindfulness, better interact with negative feelings, clarify personal values and set goals.

The suite also offers acceptance and commitment therapy guides for specific needs, including programs for adolescents and those who struggle with skin picking, trichotillomania (pulling one's own hair) and hoarding. The newest addition to the catalog is a program for those who struggle with chronic health conditions.

The programs aim to utilize tools taught in therapy in a self-help format, which are becoming increasingly popular as people seek mental health support but face barriers to receiving care. This may include psychological barriers like stigma, lack of motivation or uncertainty of the need for treatment, and practical barriers like cost, time and travel. Levin says he believes the self-guided programs are especially beneficial to those who live in rural communities without reasonable access to mental health services.

"I think the self-help format is really important when we consider the challenges of accessing mental health services," said Levin. "When I started graduate school, I was so excited about how we can use research to help refine and optimize treatments; we can get better resources out to people. But then I was quickly discouraged by just how many barriers also show up. When we think about the number of people who would benefit from psychological services, there's so many more than our available providers, especially when we get out of city centers, and we look at rural settings and think about specialty services."

The self-help format may also be useful for patients seeking care from a therapist or other psychological professional, but experiencing long wait times or other gaps in care.

The first non-research version of the self-guided program became available to the public in 2019, according to Levin, who has been developing research for the program since 2008. The program has undergone more than 40 clinical trials, performing research on various groups of people with diverse mental health needs.

The Acceptance and Commitment Therapy Research Group first studied college students, a population at high risk for developing mental health issues due to their age and lifestyle challenges. Utah State University students were offered free access to the acceptance and commitment therapy guide from December 2019 to April 2022, and the group found that nearly 1,600 students — or about 6% of the student body — accessed the tool during that period.

They found that one-third of the students who used the tool had never sought mental health counseling before, and about half reported they had been struggling with a mental health concern for several years. This led to other student research that found those who may receive medication for a mental illness, but do not receive counseling, were more likely to seek therapy after using the self-help guide.

"Sometimes there is a worry about (self-guided programs) trying to replace and disrupt therapy," said Levin. "Definitely not. I'm a licensed psychologist, I'm a big proponent of therapy, but the idea more is can we increase access to more resources for our community and there's a lot of different ways that I see self health resources fitting in. One of them is that there is a subset of people who, for whatever reason, aren't seeking help but would really benefit from learning things like these ... skills. This can be a step in for them to learn them."

The acceptance and commitment therapy programs are available online here. Most programs cost $25 for six months of access, with the funds supporting program maintenance and development. There is also an Acceptance and Commitment Therapy Guide Lite available for $5 for six months of access to a single session of the online program.

Professionals in the USU Acceptance and Commitment Therapy Research Group are currently working on developing more self-help programs for individuals with dementia and their caregivers, adults with autism and undocumented people.

"We need to continue to increase access to therapy services. Self-help is an additional component that I think is important to have in the portfolio of options that we offer people, that might be offered to people who aren't getting services otherwise," said Levin.

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