Document Type
Article
Journal/Book Title/Conference
Journal of Contextual Behavioral Science
Author ORCID Identifier
Michael E. Levin https://orcid.org/0000-0001-5562-2366
Volume
37
Publisher
Elsevier BV
Publication Date
8-12-2025
Journal Article Version
Accepted Manuscript
First Page
1
Last Page
38
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.
Abstract
Naturalistic research on “real world” usage of digital mental health interventions (DMHIs) is critical for DMHIs to meet their goal of increasing access to mental health services. DMHI adherence is much lower in naturalistic settings versus controlled research, but less is known about dimensions of engagement beyond adherence to module completion or how these patterns extend to DMHIs based on acceptance and commitment therapy (ACT). This study reported the adherence and engagement patterns among 1,896 university students who registered for a free ACT DMHI service deployed at a single university from 2019 to 2023. Adherence was very low with only 57% logging into the program even once, 7% completing half of modules, and 3% completing the entire program. However, engagement was high among students who adhered to a given module as indicated by high rates of module exercise completion, at least partial homework completion, spending at least 10 minutes per module, and program satisfaction. Predictors of higher adherence included higher engagement, being older, and lower depression and anxiety. Overall, results add to research highlighting adherence challenges when deploying DMHIs as services outside of controlled research, which are potentially worsened with successful efforts to increase enrollment and reduce barriers such as cost. At the same time, the findings highlight how a subset of individuals adhere to and engage in DMHIs in a way that is likely to provide benefits.
Recommended Citation
Levin, Michael E., Mercedes G. Woolley, Emily M. Bowers, & Korena S. Klimczak. “Naturalistic Observation of Adherence and Engagement With a University-Wide Deployment of Digital Acceptance and Commitment Therapy.” Journal of Contextual Behavioral Science, 2025, 37, https://doi.org/10.1016/j.jcbs.2025.100929