Graduate Thesis Or Dissertation
 

A Comparison of Online and In-Person Counseling Using Solution-Focused Brief Therapy for College Students With Mild to Moderate Anxiety

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  • Emerging adulthood is a newly-defined developmental phase that occurs during the traditional college years (18-22) (Arnett, 2015). These students at colleges and universities are showing a dramatic increase in emotional distress, with the largest increase occurring in anxiety and stress symptomology (Association of University and College Counseling Center Directors, 2017). As these numbers increase, so do requests for appointments at campus counseling centers. Staff at these centers are struggling to keep up with the demand for anxiety treatment, resulting in long waiting lists and inadequate services. In addition, many of the most at-risk college students do not access mental health treatment (Eisenberg, Golberstein & Gollust, 2007). Therefore, there is a need to offer effective short-term strategies to alleviate anxiety, as well as to create a variety of non-traditional delivery methods to improve access. College counseling centers rely on research to make decisions about effective and efficient options. However, there is a paucity of studies looking at solution-focused brief therapy (SFBT)—a brief counseling model that was developed in the late ‘80s—in the college setting, and none combining that therapeutic model with an online delivery system. The present dissertation was designed to examine two main areas of research related to the use of SFBT in a college counseling setting with emerging adults who reported mild to moderate anxiety levels. Two studies were developed to address these, and both were conducted in a university counseling center in the northeastern United States. Both studies involved the same set of participants (N=49) who were randomly assigned to in-person or online counseling. Students were recruited through e-mailed flyers and posters around campus, as well as during typical screening appointments at the counseling center. Participants qualified for the study based on generalized anxiety and social anxiety subscale scores on the Counseling Center Assessment of Psychological Symptoms-62 (CCAPS-62). The first study examined outcome for anxiety treatment to determine the effectiveness of SFBT in both in-person and videoconference/online treatment delivery. A non-inferiority analysis was conducted to look at equivalency outcomes with the two delivery methods. The research questions guiding this study were: 1. “Is SFBT effective for reducing symptoms of mild to moderate anxiety in emerging adults at college as measured by the Beck Anxiety Inventory (BAI) at three time points (pretest, posttest, and 3-week follow-up)?; 2. Is online counseling using SFBT as effective as in-person counseling using SFBT to reduce the symptoms of mild to moderate anxiety in emerging adults in college as measured by the BAI?; 3. Is online counseling using SFBT as effective as in-person counseling using SFBT to reduce symptoms of mild to moderate anxiety in emerging adults in college as measured by the CCAPS?” The Welch’s t test results for Question 1 show statistically significant improvement in BAI scores over the 3 time periods (pretest, posttest, and follow-up), supporting the hypothesis that SFBT is effective for this treatment. A repeated measures ANOVA was used to evaluate Question 2, and the results showed that there was no statistically significant difference in outcomes for the two delivery methods. For the CCAPS, reliable change indices (RCI) (Jacobson & Truax, 1991) were compared using a chi square test which showed no statistically significant difference in the two delivery methods. The non-inferiority analysis indicated equivalency between the two delivery methods. Again, all of these results supported the original hypotheses. The second study looked at therapeutic working alliance (TWA) as evaluated by the working alliance inventory (WAI) for the two delivery methods (online compared to in-person). The TWA was examined due to the central role it plays in the effectiveness of counseling (Bachelor & Horvath, 1999). The research questions guiding this study were: 1. “Is the TWA (as measured by the client version of the WAI) using online counseling comparable to the TWA with in-person counseling after the initial session when using SFBT to treat emerging adults at college with mild to moderate anxiety?; 2. Is the TWA (as measured by the client version of the WAI) using online counseling comparable to the TWA using in-person counseling after the third session when using SFBT to treat emerging adults at college with mild to moderate anxiety?” Welch’s t tests, designed to have greater power than doing a Levene’s test for equal variances and then a Student’s t test, were conducted at first and third sessions. They indicated that there was no statistically significant difference in the TWA between online and in-person delivery. Again, non-inferiority analysis suggested equivalency to the two delivery methods. This supported the original hypotheses. Both studies randomly assigned participants to delivery method in order to incase the robustness of the results. The findings in these studies indicate support for the equivalency of online to in-person delivery of counseling. They also support the use of SFBT in college settings and the power of this brief, strength-based method to create change quickly. These results can inform counseling centers on proven techniques to reach more at-risk students as well as more efficient interventions for anxiety treatment for emerging adults. Additionally, these findings provide additional strength for the equivalency of delivery methods, even when students are randomly assigned. As counseling centers continue to grapple with the increase in anxiety-related issues, they can move to easier access through online delivery, while seeing symptom improvement in a shorter time period with SFBT.
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