Muto, T., Hayes, S. C., & Jeffcoat, T. (2011). The effectiveness of Acceptance and Commitment Therapy bibliotherapy for enhancing the psychological health of Japanese college students living abroad. Behavior Therapy, 42, 323-335. https://doi.org/10.1016/j.beth.2010.08.009
International students often experience significant psychological distress but empirically tested programs are few. Broadly distributed bibliotherapy may provide a cost-effective approach. About half of the Japanese international students in a western University in the United States (N = 70) were randomly assigned to a waitlist or to receive a Japanese-translation of a broadly focused Acceptance and Commitment Therapy (ACT) self-help book. Although recruited without regard to health status, the sample was highly distressed with nearly 80% exceeding clinical cutoffs on one or more measures. After two months for the first treatment group to read the book and a two-month follow up, waitlist participants also received the book. Students receiving the book showed significantly better general mental health at post and follow up. Moderately depressed or stressed, and severely anxious students showed improvement compared to those not receiving the book. These patterns were repeated when the waitlist participants finally received the book. Improvements in primary outcomes were related to how much was learned about an ACT model from the book. Follow up outcomes were mediated by psychological flexibility, but not vice versa. Overall, the data suggest that ACT bibliotherapy improved the mental health and psychological flexibility of Japanese international students.