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Article

Exploring the Effects of an Acceptance and Commitment Therapy-Based Intervention Course on University Students’ Well-Being—A Mixed-Method Study

by
Ronja Ruuska
1,*,
Nina Katajavuori
2 and
Henna Asikainen
2
1
Faculty of Educational Sciences, University of Helsinki, Siltavuorenpenger 5, 00014 Helsinki, Finland
2
HYPE Centre for University Teaching and Learning, University of Helsinki, Siltavuorenpenger 3a, 00014 Helsinki, Finland
*
Author to whom correspondence should be addressed.
Soc. Sci. 2025, 14(6), 339; https://doi.org/10.3390/socsci14060339
Submission received: 21 March 2025 / Revised: 14 May 2025 / Accepted: 20 May 2025 / Published: 27 May 2025
Versions Notes

Abstract

:
A decline in university students’ well-being is a serious concern internationally. The present study explores how university students benefit from an eight-week online acceptance and commitment therapy (ACT)-based intervention course. This course aims to improve psychological flexibility and organised studying skills. A total of 189 university students participated in the mixed-method study in the spring of 2021 comprising both quantitative and qualitative data. Students’ pre- and post-intervention burnout risk was measured, and students were divided into four groups based on their burnout-risk scores. In addition, students’ reflective reports were analysed using abductive content analysis to identify students’ experiences of the benefits of the course. These categories were further quantified and compared across different burnout-risk groups. The results showed that the burnout risk decreased during the course. Qualitative content analysis revealed seven main categories of benefits from the course: (1) improved general well-being, (2) improved self-knowledge, (3) increased psychological flexibility, (4) improved study practices and study motivation, (5) increased self-compassion, (6) peer support, and (7) improved organised studying. There were no statistically significant differences in these experiences between the burnout-risk groups. The study highlights the potential of ACT-based intervention courses to improve university students’ well-being and studying skills, suggesting a need for further exploration of burnout prevention through such measures.

1. Introduction

University students’ poor well-being has been in a worrying state in recent years, and promoting and supporting university students’ well-being are crucial, yet challenging. Studies have shown that poor mental health is a big concern among higher education students (Auerbach et al. 2016). In addition, the situation became worse during the beginning of 2020, when most students were suddenly forced to shift to remote studies due to the COVID-19 pandemic. This led to a further decrease in students’ well-being, for example, in the form of increased study-related burnout (Salmela-Aro et al. 2022; Sarasjärvi et al. 2022), anxiety, depression, and stress (Elmer et al. 2020), as well as loneliness and lack of interaction (Baltà-Salvador et al. 2021). This crisis in students’ burnout risk calls for measures and research on the topic (e.g., Salmela-Aro and Read 2017).
Recent research has shown that psychological flexibility is a promising element in fostering students’ well-being (Hayes et al. 2006; Puolakanaho et al. 2020; Räihä et al. 2024a) and improved performance in students’ studies (e.g., Martinie and Shankland 2024). It has also been shown to be an important element in reducing burnout (Lloyd et al. 2013; Szarko et al. 2022). Many interventions based on acceptance and commitment therapy (ACT) promoting psychological flexibility in higher education show various benefits, especially quantitatively measured ones (Howell and Passmore 2019; Hsu et al. 2023), but there is a need to explore qualitatively the mechanisms behind the potential effects of the course. Moreover, information is needed on whether the benefits of web-based ACT interventions are similar for students with different levels of risk of burnout. Previous research suggests that ACT interventions decrease stress more efficiently amongst participants who have higher levels of initial stress (Reeve et al. 2018), but studies have also shown differing results (Räihä et al. 2024b). In addition, students with higher baseline levels in depression showed significantly more improvements in their depression symptoms, as well as improved positive mental health in an online ACT intervention (Zhao et al. 2022).
In this study, our aim is to explore students’ experiences about an ACT-based intervention course aimed to support students’ well-being and study skills with a mixed=-method approach. In addition, we aim to compare the experienced effects of the course among students with varying initial burnout risk.

Theoretical Background

Well-being contains many elements and dimensions that are interrelated, and it is defined in many ways. The concept of health is defined by the World Health Organization Constitution as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity”. However, well-being is a much more complex concept. It can be viewed through objective measures, such as living standards, mental health, and physical health, but as importantly, through subjective well-being (Diener et al. 2018; Ryan and Deci 2001). Subjective well-being is traditionally divided into hedonistic and eudaimonic traditions. The hedonistic tradition views well-being through individuals’ emotions, where well-being consists of the individual’s subjective happiness and pertains to the “overall experience of pleasure and displeasure, including all evaluations of life’s positive and negative aspects” (Ryan and Deci 2001). In contrast, the eudaimonic tradition views well-being as a state where people’s actions are in line with their deeply held values allowing them to exist as the truest version of themselves and express their true human potential (Ryff and Keyes 1995; Steger et al. 2006). Mental well-being plays a crucial role in both traditions, influencing how individuals perceive their life satisfaction and meaning.
Study-related burnout is one aspect affecting well-being. The concept of study-related burnout means a long-term reaction to ongoing emotional and interpersonal stress in studies and is defined by three dimensions: exhaustion, cynicism, and inefficacy (Maslach and Schaufeli 2001; Schaufeli et al. 2002). Attention to study-related burnout has increased in recent years, since an alarming portion of students experience study-related burnout (Salmela-Aro et al. 2022; Sarasjärvi et al. 2022). This is a severe issue, since study-related burnout may lead to depression later in life (Salmela-Aro 2009; Salmela-Aro and Upadyaya 2014), as well as dropping out of university (Bask and Salmela-Aro 2013). Exhaustion is defined as feelings of strain, stress and chronic fatigue, as well as study loads, and study demands perceived as overtaxing. Cynicism in the study context refers to students’ distant attitudes and loss of interest towards studying and viewing their studying as insignificant. The lack of efficacy related to studying and feelings of inadequacy as a student, in turn, refer to lowered feelings of competence, successful achievement, and accomplishment (Salmela-Aro et al. 2009; Salmela-Aro and Read 2017). Study-related burnout is associated with poor study progress (Asikainen et al. 2020, 2022; Salmela-Aro and Read 2017), diminished performance (May et al. 2015), dropouts (Bask and Salmela-Aro 2013), as well as students’ decreased engagement with and dedication to studies (Salmela-Aro and Upadyaya 2014). It is important to support students’ well-being and prevent burnout, particularly at the beginning of university studies, since burnout symptoms may increase during the studies (Salmela-Aro and Read 2017).
The basis of psychological flexibility lies in acceptance and commitment therapy (ACT). Psychological flexibility is the ability to take meaningful actions despite the negative feelings and thoughts one might have by focusing on the present moment (Hayes et al. 2006). ACT aims to improve psychological flexibility, further promoting well-being in all its aspects: emotional, psychological, and social well-being (Hayes et al. 2006). ACT aims to target psychological inflexibility (attempts to alter the occurrence of one’s thoughts and emotions even when doing so causes harm to the individual) with the general goal of increasing psychological flexibility through its six core processes. The process of acceptance is an alternative to experiential avoidance and involves embracing one’s thoughts, memories, and feelings, rather than attempting to change them (Hayes et al. 2006). Acceptance is not the end goal of ACT; it is rather a tool for supporting the individual’s ability to act according to one’s values. Cognitive defusion represents the process of alternation of those unpleasant thoughts, and the ability to view these thoughts as separate parts of internal behaviour, rather than seeing them as the truth of the world or oneself (Luoma and Hayes 2008). By being present, one is in constant non-judgmental contact with psychological and environmental events and thoughts. Being present includes seeing the self as context. This means seeing oneself as a container of one’s thoughts and experiences, and thus being able to observe them non-judgmentally. Values are the foundation for fostering psychological flexibility as they offer guidance in terms of behaviour, and value-based action and behaviour are necessary for experiences of life satisfaction and meaningful life (LeJeune and Luoma 2019; Luoma and Hayes 2008). The sixth process of psychological flexibility, committed action, leads to a life that is emphasised by values through acting according to one’s values, instead of behaviour guided by the avoidance of negative thoughts (Hayes et al. 2006).
Psychological flexibility has been found to be an important element in supporting well-being and decreasing stress (Räsänen et al. 2016), depression and anxiety (Levin et al. 2017), as well as study-related burnout (Frögeli et al. 2016; Räihä et al. 2024b; Szarko et al. 2022) among university students. In addition, recent research suggests that psychological flexibility is related to performance in studies, in the form of study success and pace (Asikainen et al. 2018; Hailikari et al. 2022), as well as study engagement and self-efficacy (Martinie and Shankland 2024) and integration into studying (Asikainen 2018), and self-regulation (Dionne 2016). Furthermore, psychological flexibility has a strong individual role in explaining procrastination along with time- and effort-management skills (Hailikari et al. 2021).
In addition to psychological flexibility, organised studying is defined as time and effort management (Entwistle and McCune 2004), and it has been found to be an important element regarding students’ well-being and their study performance and progress (e.g., Hailikari and Parpala 2014). Students who have the skills to manage their time and effort are more likely to experience better overall well-being and less stress and burnout (e.g., Asikainen et al. 2020; Heikkilä et al. 2012). Furthermore, they have been shown to have higher grades and study progression than students without organised studying skills (Asikainen et al. 2020; Hailikari and Parpala 2014; Rytkönen et al. 2012). Interventions have been found to help promote skills of organised studying (Häfner et al. 2014; Katajavuori et al. 2023). In the context of ACT-based interventions, there is evidence that psychological flexibility is related to higher levels of organised studying (Asikainen et al. 2019; Hailikari et al. 2022). Thus, students with higher psychological flexibility are more likely to be organised in their studies and to procrastinate less (Hailikari et al. 2022).
The aim of this study is to examine students’ experiences of an ACT-based intervention course aimed to support students’ well-being and study skills using a mixed-method approach. The specific research questions are: How did the students’ burnout risk change during the course? How did the students experience the benefits of the course?

2. Methods

2.1. Context and Participants

The participants of the present study were students enrolled in an eight-week web-based ACT intervention course that was developed as part of the curriculum of University of X to promote and develop university students’ well-being and study skills (Asikainen and Katajavuori 2021). The course was an optional online course (3 ECTS) and available for all University of X students in spring 2021. Students were recruited to the course through programme leaders and emails/social media and the students could participate in the course without consenting to research. The course progressed week-by-week, with each week having a different theme related to psychological flexibility, study processes, as well as daily habits influencing well-being and studying, such as sleep, nutrition, and physical exercise. The course included short introductions to themes, individual exercises, and peer-group discussions throughout the course (Asikainen and Katajavuori 2021). During this time, the effects of the pandemic were evident and most of the teaching was still online. In total, 238 students participated in the intervention course, of which 193 students voluntarily participated in the study and answered the questionnaires. Informed consent was obtained from the participants. Of the participants, 163 were female, 13 male, 3 others, and 10 preferred not to answer. Of these students, 189 turned in the final report.

2.2. Measures

The study employed a mixed-method research design, combining both quantitative and qualitative approaches. At the beginning and end of the intervention course, students completed a Study Burnout Inventory (SBI-9) (α1 = 0.866, α2 = 0.884) (Salmela-Aro 2009), which was modified to a higher education context (Salmela-Aro and Read 2017). The survey consisted of 9 items measuring the three factors of study-related burnout: (1) exhaustion (four items), (2) cynicism (three items), and (3) sense of inadequacy (two items). All the items were rated on a 6-point Likert-type scale ranging from 1 (completely disagree) to 6 (completely agree). Furthermore, at the end of the course, the students were instructed to write a 2–3-page reflective report where they reflect on their experiences of the effects of the course regarding their well-being and studying.

2.3. Analysis

The reflective reports (n = 189) were used to analyse students’ experiences on the benefits of the course. The data were analysed using an abductive approach, which combines both inductive and deductive content analysis (Elo and Kyngäs 2008). First, all the segments of the reports (ranging from one to several sentences), where students described the benefits of the course, were identified and coded by the first author. Each segment could include one or more codes representing the course benefits. Additionally, segments describing the lack of any benefits from the course were coded.
The codes were developed through an iterative process (Forman and Damschroder 2007), where each code was reviewed after the first round of coding of the entire dataset. The trustworthiness of the analysis was ensured through ongoing discussions among all three authors regarding codes open to multiple interpretations. Throughout the analysis, the authors systematically discussed and compared coded text segments, resolved discrepancies, and refined the coding scheme together. All coding decisions—from preliminary codes to final categories—were made collectively until consensus was reached.
The calculation of inter-rater reliability (ICR) has been described as a somewhat controversial and, in some cases, inappropriate step within the context and aims of qualitative research (O’Connor and Joffe 2020). Therefore, analytical rigour and trustworthiness were prioritised through continuous dialogue, reflexivity, and negotiated agreement, as recommended in the qualitative research literature (O’Connor and Joffe 2020; Nowell et al. 2017). In line with Barbour (2001), the main value of involving multiple coders was seen in the insights and alternative interpretations generated through systematic discussion and critical reflection among the authors. This collective process of discussing divergent views and refining the coding frame can increase the trustworthiness and transparency of the analysis (Barbour 2001; Nowell et al. 2017).
Altogether, 111 preliminary codes were generated in the first phase of the analysis. After the preliminary coding, the codes were categorised according to which sectors of life or situations the portrayed benefits belonged to. In this phase of the analysis, subcategories were identified and named (n = 24). These categories were then grouped further into broader main categories (n = 7). The categorised benefits were also quantified. From the quantification, data were obtained, which represented the benefit categories in the reports as binary variables expressing whether a benefit category was present in the report or not, indicating whether the student had experienced the benefit in question.
Students were divided into four groups based on their scores in the beginning of the course—a higher score denotes a higher risk of burnout (Salmela-Aro 2009) similarly to Hyytinen et al. (2022). The Finnish Student Heath Services have defined cut points to the questionnaire which reflects four different burnout risk levels: no risk, average risk, increased risk, and obviously increased risk of burnout differently to female and male students. Based on those scores, the University of X has used averages of the male and female rates to give feedback to the students, namely, no risk: 9–20 points, average risk: 21–25 points, increased risk: 26–33 points, and obviously increased risk: 34–54 points. These cut points were used in the analyses (see Table 1). To calculate the change in students’ risk of burnout, change variables were created by deducting each student’s score from the pre-intervention burnout-risk survey from the post-intervention test score. Tests of normality (Kolmogorov–Smirnov test) showed that the post-intervention data were not normally distributed (p = 0.003); thus, appropriate alternatives for non-parametric data were used to analyse the data. To test the change in students’ risk of burnout during the intervention course, the Wilcoxon signed-rank test was used. To test whether there was a difference in the change in burnout risk between the burnout-risk groups, Kruskal–Wallis H tests with pairwise comparison using Bonferroni correction were conducted. Furthermore, to analyse whether students with different risks of burnout had experienced the benefits of the intervention course differently, each identified course-benefit category was cross-tabulated with the burnout-risk groups. Differences between the groups were tested with Pearson’s chi-squared test.

3. Results

3.1. Change in Students’ Risk of Burnout at the General Level

A significant decrease in participants’ risk of burnout was found (Z = −5.768, p ≤ 0.001). The median ranks were 30.00 pre-intervention and 28.00 post-intervention. Furthermore, when analysing different risk groups, the results showed that there was a statistically significant difference in change in burnout risk between the risk groups: χ2 = 16.43, d.f. = 3, n = 189, p < 0.001 (Table 2). A pairwise comparison test showed that there was a statistically significant difference between the group “No risk of burnout” and the other burnout-risk groups, indicating that the change in the other groups decreased compared to the no risk group.

3.2. Students’ Experienced Benefits from the Intervention Course

A total of seven categories of experienced benefits were identified with 24 subcategories (see Table 3). Next, the categories are described, and the representative quotations are presented in Table 3. Most often, the students reported that their well-being had improved during the course (n = 136). This category consisted of all the mentions where students described that their well-being had improved or that they had gained tools for improving their well-being in some way, for example, they had improved their life habits and stress management during the course, or they felt that their anxiety had decreased during the course and that they had more positive emotions and feelings of meaningfulness during the course. These following quotations show the improved well-being during the course:
I have learnt to prioritise my own well-being and have realised how much a sufficient amount of good-quality sleep, enough exercise, and good-quality nutrition affect well-being.
(021)
Thanks to this course, I’ve noticed a positive change in my well-being and mood.
(122)
The second category consisted of students’ (n = 128) experiences of the course having had improved their self-knowledge in different ways. Students described that they had learned to reflect upon their actions and thoughts, had learned something new about themselves, and had gained a new perspective of themselves during the course. This category also included students’ comments where they described that they had learned to recognise their thinking and behavioural patterns, as well as to recognise their strengths as the following quotations indicate:
I’ve been able to recognize patterns in my behaviour and thinking that I hadn’t noticed before the course. I now understand even better how important this skill is in today’s hectic, performance-driven society we live in.
(041)
Reflecting on my own behaviour and the reasons behind it has been beneficial. I have noticed that I don’t always act in a way that is the best for myself. For example, acknowl-edging procrastination in my studying and neglecting of my health helps me make a change regarding them.
(179)
The third category consisted of students’ (n = 125) comments related to improved skills in psychological flexibility. They had clarified their own values and learned to manage negative thoughts and emotions, and had practised being present in the moment, as these following quotations show:
Thanks to the course, I’ve learned to pause even when I’m feeling something unpleasant and just observe my thoughts and emotions, instead of getting carried away by them like I used to.
(060)
Only through this course have I understood that you can make your values visible in your everyday life and that this is how a happy everyday life is formed. Through this realisation, I have consciously reflected on my values every day and made choices according to them.
(035)
I found it really helpful to realize that my self-talk is often negative and self-critical. During the course, I learned to notice it more clearly and not take it so seriously—it’s just thoughts produced by the brain, and they’re not necessarily true.
(022)
The fourth category consisted of all comments related to improved study practices and motivation (n = 123). The course exercises had increased students’ study efficiency, decreased multitasking and procrastination, and increased their motivation towards studying; they had also learned new study techniques. The following comments demonstrate a decrease in multitasking:
I’ve done a lot of multitasking, but the course materials made me realize how draining it actually is. Now I try to focus on one thing at a time and only do that kind of ‘fragmented work’ and allow interruptions if I’ve consciously decided to.
(142).
Discussing psychological flexibility and procrastination has helped me understand what is causing procrastination, and therefore it has made it easier to recognise the moments where the mind is trying to come up with supplementary activities, even though the unpleasant feeling eases only by starting work. The course has affected my studying this way.
(111)
The goal I set at the beginning of the course—to graduate—now feels more achievable, because I feel better equipped to motivate myself for studying and to cope with setbacks.
(142)
The fifth category was improved self-compassion (n = 101) and included all descriptions of viewing oneself more positively and compassionately, for example, recognising one’s adequacy and capabilities and learning to be more friendly and compassionate towards oneself:
I have learnt to respect myself and truly believe that I can do anything if I just try.
(041)
I’m not perfect, and I can’t complete every task perfectly because there just isn’t enough time—and that’s something I’ve learned to accept during this course.
(006)
The sixth category was peer support. Around half of the students (n = 99) felt that peer support and peer-group discussions were extremely important and beneficial to them:
I felt that the group discussions were important especially in gaining and sharing peer support. Especially now during remote studying, it was valuable to get contact with other students and to read interesting thoughts about well-being and studying.
(025)
The seventh category was improved organised studying (n = 92). Students described that they had learned time-management and planning skills during the course, and many had learned to prioritise and plan their studies according to their values and goals:
During the course, I’ve often planned my studies for the next day–like thinking about how much I want to study and what time of day I’m going to do it.
(130)
During this course, I have learnt a lot of things. The most important thing is time management. By observing how I use my time, I realised why I was always behind and why I felt like I didn’t have enough time… Now I can manage my time better and know how to prioritise.
(006)
I made a list of priorities and reorganized my spring courses to better support my graduation. Before, there was no real planning behind the courses I took. Now that I’m more organized, I feel like life is on a steadier path, and I’m focusing only on the actions that help me reach my long-term goals.
(014)
Altogether, six students (3.2%) reported that they did not gain any benefits from the course, and they did not mention any benefits. Meanwhile, 25 other students said that they did not feel they had gained any significant benefits to their well-being or studying, but they still listed many benefits in their reports.

3.3. Differences in Change in Risk of Burnout

A comparison between the different burnout-risk groups and their experienced benefits showed that the course had benefitted students similarly regardless of their initial risk of burnout. The cross-tabulation chi-squared test showed no statistically significant results (Table 4).

4. Discussion

This study investigated students’ experiences of an ACT-based intervention course related to their risk of study burnout. This study adds to the growing body of evidence supporting the use of ACT-based interventions for enhancing student well-being and reducing study-related burnout. The findings from this study show a multi-faceted impact of the ACT-based intervention on university students’ well-being, as evidenced by both quantitative and qualitative data. Quantitatively, the significant decrease in burnout risk across all groups underscores the effectiveness of the intervention in mitigating study-related stress, aligning with prior research that highlights the benefits of ACT in reducing burnout (Lloyd et al. 2013; Räihä et al. 2024a).
Our results showed that the risk of burnout decreased during the course. This is consistent with previous research, which has shown that ACT-based interventions can decrease burnout and increase well-being (Lloyd et al. 2013; Puolakanaho et al. 2020; Räihä et al. 2024a, 2024b). Furthermore, the results of our study align with research demonstrating the benefits of ACT-based interventions for students’ well-being, stress reduction, and enhanced psychological flexibility among students (Hsu et al. 2023; Levin et al. 2017; Räsänen et al. 2016). For example, the study by Levin et al. (2017) showed that participants receiving ACT improved on overall distress, general anxiety, social anxiety, depression, academic concerns, and positive mental health.
In line with previous studies (e.g., Elmer et al. 2020; Salmela-Aro et al. 2022; Sarasjärvi et al. 2022), this study also showed that a large portion of students were experiencing high levels of burnout risk at the beginning of the intervention. This may also be due to the pandemic which has been shown to decrease students’ well-being (Salmela-Aro et al. 2022; Sarasjärvi et al. 2022). The results further showed that a statistically significant portion of the students experienced a decrease in their risk of burnout, and the number of students in the higher burnout-risk groups decreased. These findings are strengthened by previous research, as it has shown that students who participated in an ACT-based intervention experienced lowered rates of study burnout (e.g., Frögeli et al. 2016; Räihä et al. 2024b), as well as by our qualitative findings that further explore students’ experienced benefits from the course. There was a smaller decrease in the no risk group, but this was most likely due to the low averages in burnout to begin with.
Complementing the qualitative results, qualitative analyses provided a nuanced understanding of how students perceived and experienced the benefits of the course and changes in well-being. These qualitative insights suggest that the intervention facilitated not only a reduction in burnout symptoms, but also fostered a holistic development of skills and attitudes that contribute to sustained well-being. Thus, the results of this study showed wide-ranging benefits to its participants—from self-knowledge to study motivation, improvements were experienced in several domains of overall life management, as well as in social domains. Students felt that the course gave them tools for coping and for organising their day-to-day lives, as well as offering them peer support to process and reflect on difficult and profound topics together. Quantitative research on ACT-based interventions shows how these can promote student well-being (Asikainen et al. 2018; Hailikari et al. 2022), organised studying skills, decreased stress and burnout (e.g., Räihä et al. 2024b), and study performance (Asikainen et al. 2018; Hailikari et al. 2022). Previous research also suggests that peer support plays an important role in online learning (Engel et al. 2023; Geary et al. 2023). It has been found that students experienced more loneliness and lack of interaction during the pandemic and longed for peer interaction (Baltà-Salvador et al. 2021). During this time, most of the teaching was online and students did not see each other in the campus. Consequently, the results of this study reveal how students found peer support to be especially meaningful to them. Research shows that during remote studies, peer support can buffer the negative outcomes of remote studying (Wissing et al. 2022). Thus, ACT-based interventions could be developed even further by emphasising the peer-support aspect throughout the course, since the aspect was found to be meaningful to students, and since it could enhance the adapting tools provided by the course. Our intervention was conducted online and included a peer group component, demonstrating these positive outcomes. Previous research has also shown that digital and online delivery of ACT interventions is both feasible and effective (Räsänen et al. 2016; Levin et al. 2017), which supports the relevance and scalability of our approach.
As anticipated based on previous research, the results of this study show that an ACT-based intervention course can improve psychological flexibility (e.g., Hayes et al. 2006; Räsänen et al. 2016). Students described improvements in their psychological flexibility through its core processes, which have been also shown in previous studies (Katajavuori et al. 2023). Similarly, in the present study, students described improvements in coping with, confronting, and accepting negative thoughts and feelings by, for example, seeing them merely as thoughts and not as truths. These descriptions can be interpreted as adapting tools of acceptance, cognitive diffusion, and seeing oneself as a context, which are three of the core processes of psychological flexibility (Hayes et al. 2006). The results suggest that many students adapted tools to be mindfully, non-judgmentally present in the moment. This represents the core process of contact with the present moment (Hayes et al. 2006). The results imply that the course enabled students to clarify and reflect on their values, and thus, act upon those values. These represent the core processes of values and committed actions (Hayes et al. 2006). The present study strengthens the view of the overlapping and interrelated nature of the core processes of psychological flexibility (Hayes et al. 2006), as this can be seen in the students’ reflections on the online ACT-based intervention course. Thus, supporting all the core processes simultaneously is possible and, more importantly, necessary in an ACT-based intervention course.
This study showed that organised studying skills can be developed simultaneously with psychological flexibility by integrating exercises targeting time and effort management skills into the intervention course. In addition to improvements in organised studying, the course improved students’ study motivation and practices. Previous research has shown that time and effort management skills, along with psychological flexibility, have a strong association with, for example, procrastination (e.g., Hailikari et al. 2021), which, in turn, is related to study burnout (e.g., Turhan et al. 2022). Therefore, it could be suggested that improvements in students’ organised studying and study practices and motivation along with psychological flexibility may partially explain how the intervention course is an aid in students’ burnout and stress, as shown by previous research (e.g., Heikkilä et al. 2012; Asikainen et al. 2019). Thus, our results suggest that integrating ACT-based intervention with study skills training may offer an effective approach for supporting students’ well-being and studying.
Previous research suggests that ACT-based interventions may be more effective for participants with higher initial well-being, such as baseline depression and stress (Reeve et al. 2018; Zhao et al. 2022). Similarly, this study reveals that students, who were at a higher risk of burnout before the intervention, experienced the most drastic changes in burnout risk during the intervention, compared to students with lower levels of initial burnout risk. However, this study also shows that ACT-based interventions can be beneficial to students regardless of the initial burnout risk. The difference between the changes could be explained by the initial low burnout scores in the no risk group.
The present study is subject to some limitations. Firstly, the intervention course was held during the pandemic, and thus may have influenced the experiences from the course for some participants. However, it is an encouraging finding that regardless of the exceptional and difficult time, the intervention course had such positive and varying effects on students’ lives. Secondly, the quantitative results are based solely on students’ self-reported experiences on their burnout risk, and a control group was not included. Therefore, the quantitative results are to be interpreted with a degree of caution. However, the quantitative results are strengthened by the qualitative results of the study; these results show how students experienced a large variety of benefits, which most likely explain the quantitative results of the study. This study did not include a control group, which is a limitation; therefore, the results should be interpreted with caution. Furthermore, the participant demographic was predominantly female, with 84% of the sample identifying as such, in the university the percentage of females is approximately 64 percent. This gender imbalance may limit the generalisability of our findings, as the results might not accurately reflect the experiences or outcomes for male participants or other gender identities. Future research should aim to include a more balanced representation of genders to ensure broader applicability and understanding of the course’s effects across different demographic groups. Lastly, the benefits were identified from reflective reports, which left out the possibility of elaborative questions and required a certain level of interpretation by the authors. However, the reflective reports were analysed by breaking the identified benefits down in a very specific manner, and there was no attempt of reading hidden meanings between the lines. In addition, all the authors were involved in the analysis process and a common understanding was achieved regarding the categorisation process. In the future, it would be meaningful to interview the participants of the course to gain even deeper knowledge of the mechanisms behind the course benefits.

5. Conclusions

This study shows that the benefits of an ACT intervention course aiming to promote students’ psychological flexibility and organised studying can reduce students’ risk of burnout through a wide range of benefits. Whereas the students with the most risk of burnout can benefit the most from an ACT intervention, the mechanisms behind the benefits are mostly the same for all students. In addition to the apparent benefits of promoting psychological flexibility, it is possible to simultaneously promote students’ study skills, which in part contributes to increasing student well-being. Importantly, emphasising peer support in online ACT-based courses is important—it may contribute to decreasing students’ burnout and emphasise the effects of the many other benefits that the course has to offer.

Author Contributions

Conceptualization, N.K., H.A., and R.R.; methodology, N.K., H.A., and R.R.; software, N.K. and H.A.; validation, N.K. and H.A.; formal analysis, R.R.; investigation, N.K., H.A, and R.R.; writing—original draft preparation, R.R.; writing—review and editing N.K., H.A. and R.R.; supervision, N.K. and H.A.; project administration, H.A. and N.K.; All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The study is done based on the Ethical guidelines of Helsinki Declaration. Ethical review and approval were waived for this study due to Finnish legislation.

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

Data is available at request.

Conflicts of Interest

No conflict of interest.

Abbreviations

The following abbreviations are used in this manuscript:
ACTAcceptance and commitment therapy

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Table 1. Burnout-risk group score ranges.
Table 1. Burnout-risk group score ranges.
ScoreBurnout-Risk Groupn1 (%)n2 (%)Change
9–20NO No risk27 (14.3)42 (22.2)0.6923
21–25AV Average risk24 (12.7)37 (19.6)−2.0281
26–33IR Increased risk64 (33.9)61 (32.3)−2.2462
34–54OR Obviously increased risk74 (39.2)49 (25.9)−5.2357
Table 2. Burnout means and changes for burnout-risk groups.
Table 2. Burnout means and changes for burnout-risk groups.
Burnout-Risk GroupM1sd1M2sd1Change
NO No risk17.002.4166117.694.978110.69 **
AV Average risk23.261.3165221.235.78486−2.03
IR Increased risk29.172.2539526.926.52234−2.25
OR Obviously increased risk40.795.0287635.588.73032−5.24
** = NO < AV, IR, OR, p < 0.001.
Table 3. Categories of students’ experiences of the effects of the course.
Table 3. Categories of students’ experiences of the effects of the course.
CategorySubcategories (n)n%
Improved
Well-being		Overall increase in well-being (86)
Decreased stress and burnout (67)
Improved daily habits (44)
Improved coping in daily life (21)
Improved relaxation skills (30)
Improved quality of free time (12)
Increased positive feelings (2)		13671.9
Improved
self-knowledge		Recognition of the need for development (69)
Improved self-reflection skills (75)
Gained perspective (55)		12867.7
Increased
psychological
flexibility		Improved skills to cope with negative thoughts
and feelings (69)
Contact with the present moment (16)
Values and committed actions (80)
Overall experience of increased
psychological flexibility (19)		12566.1
Improved
study
practices and study
motivation		Tools for developing study methods (77)
Increased study efficiency (35)
Decreased multitasking (7)
Decreased procrastination (37)
Increased motivation to study (34)
Balance between free time and studying (20)		12365.1
Increased
self-compassion		A positive way of viewing oneself (65)
Compassionate approach towards setbacks (62)		10153.4
Peer
support		Receiving peer support (97)9751.3
Improved
organised
studying		Improved time management (80)
Improved organisation of studies (28)		9248.7
No significant
experienced benefits		 63.2
Table 4. Cross-tabulation of benefit categories and the group of burnout risk pre-intervention, frequencies, Pearson’s chi-squared values, and p-values. Profiles NR = No risk, AR = Average risk, IR, Increased risk, OR = Obviously increased risk.
Table 4. Cross-tabulation of benefit categories and the group of burnout risk pre-intervention, frequencies, Pearson’s chi-squared values, and p-values. Profiles NR = No risk, AR = Average risk, IR, Increased risk, OR = Obviously increased risk.
Experienced BenefitNO
(n = 27)		AR
(n = 24)		IR
(n = 64)		OR
(n = 74)		χ2(3) (p)Experienced Benefit
Improved general well-being181944541.32 (0.725)Improved general well-being
Improved self-knowledge191749426.47 (0.091)Improved self-knowledge
Increased psychological flexibility211544443.40 (0.335)Increased psychological flexibility
Improved study practices and motivation181643450.75 (0.862)Improved study practices and motivation
Increased self-compassion131436371.07 (0.785)Increased self-compassion
Gained peer support11837436.69 (0.083)Gained peer support
Increased organised studying161432304.11 (0.250)Increased organised studying
No significant benefits11043.40 (0.334)No significant benefits
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Ruuska, R.; Katajavuori, N.; Asikainen, H. Exploring the Effects of an Acceptance and Commitment Therapy-Based Intervention Course on University Students’ Well-Being—A Mixed-Method Study. Soc. Sci. 2025, 14, 339. https://doi.org/10.3390/socsci14060339

AMA Style

Ruuska R, Katajavuori N, Asikainen H. Exploring the Effects of an Acceptance and Commitment Therapy-Based Intervention Course on University Students’ Well-Being—A Mixed-Method Study. Social Sciences. 2025; 14(6):339. https://doi.org/10.3390/socsci14060339

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Ruuska, Ronja, Nina Katajavuori, and Henna Asikainen. 2025. "Exploring the Effects of an Acceptance and Commitment Therapy-Based Intervention Course on University Students’ Well-Being—A Mixed-Method Study" Social Sciences 14, no. 6: 339. https://doi.org/10.3390/socsci14060339

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Ruuska, R., Katajavuori, N., & Asikainen, H. (2025). Exploring the Effects of an Acceptance and Commitment Therapy-Based Intervention Course on University Students’ Well-Being—A Mixed-Method Study. Social Sciences, 14(6), 339. https://doi.org/10.3390/socsci14060339

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