Abstract
Studies shown that young adults are more prone to develop mental health problems. One of the feature in emerging adulthood – instability, makes them more vulnerable to depression compared to other age groups. Many studies have demonstrated similar effectiveness between cognitive behavior therapy (CBT) and acceptance and commitment therapy (ACT) on depression. However, previous studies have been focusing more on education settings rather than emerging adults in general, and more on western countries compared to eastern cultures where they prioritize collectivism. Presently, generation Z is the one that still going through the emerging adulthood phase. They have different exposures and preferences towards technology and social media compared to the older generations. Thus, it is beneficial to keep researching on what is the therapy that works best for them. Hence, this study examines the effectiveness of CBT and ACT on depression and anxiety symptoms among emerging adults in Malaysia. This is an experimental study with pre-post-test design that involved 102 emerging adults. They were assigned into two treatment groups (CBT and ACT) and one control group through random assignment. The questionnaires involved are Beck Depression Inventory II and Beck Anxiety Inventory. There is a statistically significant difference in depression at post-test between ACT and control, but not between CBT and control, and between CBT and ACT. At follow-up, depression scores differ significantly between CBT and control, as well as between ACT and control. No significant difference among the groups in anxiety symptoms at post-test and follow-up. ACT seems to be more superior compared to CBT and control group in terms of depression post-test and follow-up. For anxiety, CBT and ACT exhibit similar reductions at post-test, with ACT showing more improvement at follow-up. Since eastern cultures seems to be more responsive of acceptance-based therapy compared to the western counterparts, therefore ACT is one of the best option to manage Malaysian emerging adults with depression symptoms. Future study could emphasize more on emerging adults who have limited access to higher education such as those in rural areas.
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The data are available from the authors upon reasonable request and with the permission of Universiti Putra Malaysia.
References
Abdul Kadir, N. B. Y., & Mohd, R. H. (2021). The 5Cs of positive youth development, purpose in life, hope, and well-being among emerging adults in Malaysia. Frontiers in psychology, 12, 641876. https://doi.org/10.3389/fpsyg.2021.641876
Ahmed, N. (2019). Generation Z’s smartphone and social media usage: A survey. Journalism and mass communication, 9(3), 101–122. https://doi.org/10.17265/2160-6579/2019.03.001
Altman, D. G., & Dore, C. J. (1990). Randomisation and baseline comparisons in clinical trials. The Lancet, 335(8682), 149–153. https://doi.org/10.1016/0140-6736(90)90014-V
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).: American Psychiatric Publishing. https://doi.org/10.1176/appi.books.9780890425596
Araki, H., Oshima, Y., Lida, D., & Tanaka, K. (2019). Effects of brief depression prevention program based on Cognitive Behavior Therapy among college students: a randomized controlled trial. Kitasato Medical Journal, 49, 26–34.
Arnett, J. J. (2000). Emerging adulthood: A theory of development from the late teens through the twenties. American psychologist, 55(5), 469. https://doi.org/10.1037/0003-066X.55.5.469
Arnett, J. J. (2014). Emerging adulthood: The winding road from the late teens through the twenties. Oxford University Press. https://doi.org/10.1093/acprof:oso/9780199929382.001.0001
Arnett, J. J., Žukauskienė, R., & Sugimura, K. (2014). The new life stage of emerging adulthood at ages 18–29 years: Implications for mental health. The Lancet Psychiatry, 1(7), 569–576. https://doi.org/10.1016/S2215-0366(14)00080-7
Ashcroft, R.E. (2008) The declaration of Helsinki The Oxford textbook of clinical research ethics. 141-8.
A-Tjak, J. G., Morina, N., Topper, M., & Emmelkamp, P. M. (2018). A randomized controlled trial in routine clinical practice comparing acceptance and commitment therapy with cognitive behavioral therapy for the treatment of major depressive disorder. Psychotherapy and Psychosomatics, 87(3), 154–163. https://doi.org/10.1159/000486807
Beck, J. S., & Beck, A. T. (2011). Cognitive therapy: Basics and beyond. Guildford Publications.
Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988). An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology, 56, 893–897. https://doi.org/10.1037/0022-006X.56.6.893
Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for Beck Depression Inventory-II. Psychological Corporation. https://doi.org/10.1037/t00742-000
Bishop, J. L., Norona, J. C., Roberson, P. N., Welsh, D. P., & McCurry, S. K. (2019). Adult Attachment, Role Balance, and Depressive Symptoms in Emerging Adulthood. Journal of Adult Development, 26(1), 31–40. https://doi.org/10.1007/s10804-018-9295-z
Brown, L. A., Forman, E. M., Herbert, J. D., Hoffman, K. L., Yuen, E. K., & Goetter, E. M. (2011). A randomized controlled trial of acceptance- based behavior therapy and cognitive therapy for test anxiety: A pilot study. Behavior modification, 35(1), 31–53. https://doi.org/10.1177/0145445510390930
Burian, H., Böge, K., Burian, R., Burns, A., Nguyen, M. H., Ohse, L., … Diefenbacher, A. (2021). Acceptance and commitment-based therapy for patients with psychiatric and physical health conditions in routine general hospital care–Development, implementation and outcomes. Journal of Psychosomatic Research, 143, 110374. https://doi.org/10.1016/j.jpsychores.2021.110374
Cheah, C. S., & Nelson, L. J. (2004). The role of acculturation in the emerging adulthood of aboriginal college students. International Journal of Behavioral Development, 28(6), 495–507. https://doi.org/10.1080/01650250444000135
Country Meters. (2023). Malaysia population. https://countrymeters.info/en/Malaysia#population_2023
Creswell, J. W. (2002). Educational research: Planning, conducting, and evaluating quantitative (pp. 146–166). Prentice Hall.
Cuijpers, P., Karyotaki, E., Eckshtain, D., Ng, M. Y., Corteselli, K. A., Noma, H., Quero, S., & Weisz, J. R. (2020). Psychotherapy for depression across different age groups: A systematic review and meta-analysis. JAMA psychiatry, 77(7), 694–702. https://doi.org/10.1001/jamapsychiatry.2020.0164
Dereix-Calonge, I., Ruiz, F. J., Sierra, M. A., Peña-Vargas, A., & Ramírez, E. S. (2019). Acceptance and commitment training focused on repetitive negative thinking for clinical psychology trainees: A randomized controlled trial. Journal of Contextual Behavioral Science, 12, 81–88. https://doi.org/10.1016/j.jcbs.2019.02.005
Ezegbe, B. N., Eseadi, C., Ede, M. O., Igbo, J. N., Anyanwu, J. I., Ede, K. R., … Omeje, G. N. (2019). Impacts of cognitive-behavioral intervention on anxiety and depression among social science education students: A randomized controlled trial. Medicine, 98(15). https://doi.org/10.1097/MD.0000000000014935
Farabaugh, A., Nyer, M. B., Holt, D. J., Fisher, L. B., Cheung, J. C., Anton, J., ... & Baer, L. (2018). CBT Delivered in a Specialized Depression Clinic for College Students with Depressive Symptoms. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 1-10. https://doi.org/10.1007/s10942-018-0300-z
Flynn, H. A., & Warren, R. (2014). Using CBT effectively for treating depression and anxiety. Current Psychiatry, 13(6), 45–53.
Gall, M. D., Borg, W. R., & Gall, J. P. (1996). Educational research: An introduction. Longman Publishing.
Gaidhani, S., Arora, L., & Sharma, B. K. (2019). Understanding the attitude of generation Z towards workplace. International Journal of Management, Technology and Engineering, 9(1), 2804–2812.
Germani, A., Delvecchio, E., Li, J. B., & Mazzeschi, C. (2020). Protective factors for depressive symptoms in emerging adulthood. Scandinavian journal of psychology, 61(2), 237–242. https://doi.org/10.1111/sjop.12616
Gili, M., Castellví, P., Vives, M., de la Torre-Luque, A., Almenara, J., Blasco, M. J., Cebria, A. I., Gabilondo, A., Pérez-Ara, M. A., Lagares, C., Parés-Badell, O., Piqueras, J. A., Rodríguez-Jiménez, T., Rodríguez-Marín, J., Sato-Sanz, V., Alonso, J., & Roca, M. (2019). Mental disorders as risk factors for suicidal behavior in young people: A meta-analysis and systematic review of longitudinal studies. Journal of Affective Disorders, 245, 152–162. https://doi.org/10.1016/j.jad.2018.10.115
Gustavson, K., Knudsen, A. K., Nesvåg, R., Knudsen, G. P., Vollset, S. E., & Reichborn-Kjennerud, T. (2018). Prevalence and stability of mental disorders among young adults: Findings from a longitudinal study. BMC psychiatry, 18(1), 1–15. https://doi.org/10.1186/s12888-018-1647-5
Harris, R. (2019). ACT made simple: An easy-to-read primer on acceptance and commitment therapy. New Harbinger Publications.
Hayes, S. C., Barnes-Holmes, D., & Roche, B. (Eds.). (2001). Relational frame theory: A post-Skinnerian account of human language and cognition. Kluwer Academic/Plenum Publishers. https://doi.org/10.1007/b108413
Institute of Public Health. (2015). National health and morbidity survey 2015. Vol II: Non-communicable disease, risk factors & other health problems. https://www.moh.gov.my/moh/resources/nhmsreport2015vol2.pdf
Institute for Public Health (2020). National health and morbidity survey 2019. Vol. I: Non-communicable diseases, risk factors & other health problems. https://www.iku.moh.gov.my/images/IKU/Document/REPORT/NHMS2019/Report_NHMS2019-NCD_v2.pdf
Ito, M., & Muto, T. (2020). Effectiveness of acceptance and commitment therapy for irritable bowel syndrome non-patients: A pilot randomized waiting list controlled trial. Journal of Contextual Behavioral Science, 15, 85–91. https://doi.org/10.1016/j.jcbs.2019.11.009
Khoramnia, S., Bavafa, A., Jaberghaderi, N., Parvizifard, A., Foroughi, A., Ahmadi, M., & Amiri, S. (2020). The effectiveness of acceptance and commitment therapy for social anxiety disorder: a randomized clinical trial. Trends in psychiatry and psychotherapy, 42, 30–38. https://doi.org/10.1590/2237-6089-2019-0003
Kwan, B. M., Dimidjian, S., & Rizvi, S. L. (2010). Treatment preference, engagement, and clinical improvement in pharmacotherapy versus psychotherapy for depression. Behaviour research and therapy, 48(8), 799–804. https://doi.org/10.1016/j.brat.2010.04.003
Lappalainen, R., Lehtonen, T., Skarp, E., Taubert, E., Ojanen, M., & Hayes, S. C. (2007). The impact of CBT and ACT models using psychology trainee therapists: A preliminary controlled effectiveness trial. Behavior modification, 31(4), 488–511. https://doi.org/10.1177/0145445506298436
Lee, S., & Lee, E. (2020). Effects of Cognitive Behavioral Group Program for Mental Health Promotion of University Students. International Journal of Environmental Research and Public Health, 17(10), 3500. https://doi.org/10.3390/ijerph17103500
Losada, A., Márquez-González, M., Romero-Moreno, R., Mausbach, B. T., López, J., Fernández-Fernández, V., & Nogales-González, C. (2015). Cognitive–behavioral therapy (CBT) versus acceptance and commitment therapy (ACT) for dementia family caregivers with significant depressive symptoms: Results of a randomized clinical trial. Journal of Consulting and Clinical Psychology, 83(4), 760. https://psycnet.apa.org/doi/10.1037/ccp0000028
Maideen, S. F. K., Sidik, S. M., Rampal, L., & Mukhtar, F. (2014). Prevalence, associated factors and predictors of depression among adults in the community of Selangor. Malaysia. PloS one, 9(4), e95395. https://doi.org/10.1371/journal.pone.0095395
Nelson, L., Badger, S., & Wu, B. (2004). The influence of culture in emerging adulthood: Perspectives of Chinese college students. International Journal of Behavioral Development, 28(1), 26–36. https://doi.org/10.1080/01650250344000244
Othman, A. A., & Jaafar, W. M. W. (2022). Features of Emerging Adulthood: What are Their Relationship with Depression Symptoms? The Open Psychology Journal, 15(1). https://doi.org/10.2174/18743501-v15-e2208010
Pleger, M., Treppner, K., Diefenbacher, A., Schade, C., Dambacher, C., & Fydrich, T. (2018). Effectiveness of acceptance and commitment therapy compared to CBT+: Preliminary results. The European Journal of Psychiatry, 32(4), 166–173. https://doi.org/10.1016/j.ejpsy.2018.03.003
Reangsing, C., Lauderman, C., & Schneider, J. K. (2022). Effects of mindfulness meditation intervention on depressive symptoms in emerging adults: A systematic review and meta-analysis. Integrative and Complementary Medicine, 28. https://doi.org/10.1089/jicm.2021.0036
Romero-Moreno, R., Marquez-Gonzalez, M., Barrera-Caballero, S., Vara-Garcia, C., Olazaran, J., Pedroso-Chaparro, M. D. S., Jiménez-Gonzalo, L., & Losada-Baltar, A. (2021). Depressive and Anxious Comorbidity and Treatment Response in Family Caregivers of People with Dementia. Journal of Alzheimer’s Disease, 83(1), 395–405. https://doi.org/10.3233/JAD-210348
Ruiz, F. J., Peña-Vargas, A., Ramírez, E. S., Suárez-Falcón, J. C., García- Martín, M. B., García-Beltrán, D. M., ... & Sánchez, P. D. (2020). Efficacy of a two-session repetitive negative thinking-focused acceptance and commitment therapy (ACT) protocol for depression and generalized anxiety disorder: A randomized waitlist control trial. Psychotherapy. https://doi.org/10.1037/pst0000273
Samaan, M., Diefenbacher, A., Schade, C., Dambacher, C., Pontow, I. M., Pakenham, K., & Fydrich, T. (2021). A clinical effectiveness trial comparing ACT and CBT for inpatients with depressive and mixed mental disorders. Psychotherapy Research, 31(3), 372–385. https://doi.org/10.1080/10503307.2020.1802080
Talaeizadeh, F. (2020). Comparison of Acceptance Commitment Therapy (ACT) and Cognitive Behavioral Therapy (CBT) in Reducing Depression symptoms and Increasing Happiness of Iranian adolescent Girl Students. Journal of Intellectual Disability-Diagnosis and Treatment, 8(1), 16–24. https://doi.org/10.6000/2292-2598.2020.08.01.3
Tamannaeifar, S., Gharraee, B., Birashk, B., & Habibi, M. (2014). A comparative effectiveness of acceptance and commitment therapy and group cognitive therapy for major depressive disorder. Zahedan Journal of Research in Medical Sciences, 16(10 (suppl)).
Tanhan, A. (2019). Acceptance and commitment therapy with ecological systems theory: Addressing Muslim mental health issues and wellbeing. Journal of Positive Psychology and Wellbeing, 3(2), 197–219. https://doi.org/10.47602/jpsp.v3i2.172
Tanhan, A., & Strack, R. W. (2020). Online photovoice to explore and advocate for Muslim biopsychosocial spiritual wellbeing and issues: Ecological systems theory and ally development. Current Psychology, 39(6), 2010–2025. https://doi.org/10.1007/s12144-020-00692-6
van Aubel, E., Bakker, J. M., Batink, T., Michielse, S., Goossens, L., Lange, I., … Myin-Germeys, I. (2020). Blended care in the treatment of subthreshold symptoms of depression and psychosis in emerging adults: A randomised controlled trial of Acceptance and Commitment Therapy in Daily-Life (ACT-DL). Behaviour Research and Therapy, 128, 103592. https://doi.org/10.1016/j.brat.2020.103592
Wider, W., Suki, N. M., Lott, M. L., Nelson, L. J., Low, S. K., & Cosmas, G. (2021). Examining Criteria for Adulthood Among Young People in Sabah (East Malaysia). Journal of Adult Development, 1-13. https://doi.org/10.1007/s10804-020-09367-9
World Health Organization. (2023). Depressive disorder (depression). https://www.who.int/news-room/fact-sheets/detail/depression
Zettle, R. (2007). ACT for depression: A clinician's guide to using acceptance and commitment therapy in treating depression. New Harbinger Publications
Zettle, R. D., Rains, J. C., & Hayes, S. C. (2011). Processes of change in acceptance and commitment therapy and cognitive therapy for depression: A mediation reanalysis of Zettle and Rains. Behavior modification, 35(3), 265–283. https://doi.org/10.1177/0145445511398344
Acknowledgements
We wish to thank Faculty of Educational Studies, Universiti Putra Malaysia for the financial support through the grant. We also would like to thank all the participants involved in this study for their time, energy, commitment, and cooperation throughout the research.
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This research was supported by the Geran PUTRA Berfokus, Faculty of Educational Studies, Universiti Putra Malaysia.
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Ethics approval was acquired from The Ethics Committee for Research Involving Human Subjects, Universiti Putra Malaysia (JKEUPM). Every process in this research was done in accordance with JKEUPM's ethical standards, which was based on the principles articulated in the Declaration of Helsinki (Ashcroft, 2008). JKEUPM-2020-010 is the reference number for the ethical approval.
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Ahmad Othman, A., Wan Jaafar, W.M., Zainudin, Z.N. et al. Effectiveness of cognitive behavior therapy and acceptance and commitment therapy on depression and anxiety among emerging adults in Malaysia. Curr Psychol 43, 9755–9772 (2024). https://doi.org/10.1007/s12144-023-05064-4
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DOI: https://doi.org/10.1007/s12144-023-05064-4