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Randomized Controlled Trial of the Resilience and Coping Intervention (RCI) with Undergraduate University Students

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Title: Randomized Controlled Trial of the Resilience and Coping Intervention (RCI) with Undergraduate University Students
Language: English
Authors: Houston, J. Brian, First, Jennifer, Spialek, Matthew L., Sorenson, Mary E., Mills-Sandoval, Toby, Lockett, McKenzie, First, Nathan L., Nitiéma, Pascal, Allen, Sandra F., Pfefferbaum, Betty
Source: Journal of American College Health. 2017 65(1):1-9.
Availability: Routledge. Available from: Taylor & Francis, Ltd. 325 Chestnut Street Suite 800, Philadelphia, PA 19106. Tel: 800-354-1420; Fax: 215-625-2940; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 9
Publication Date: 2017
Sponsoring Agency: Substance Abuse and Mental Health Services Administration (DHHS/PHS)
Document Type: Journal Articles
Reports - Research
Education Level: Higher Education
Postsecondary Education
Descriptors: Resilience (Psychology), Coping, Intervention, Undergraduate Students, Randomized Controlled Trials, Pretests Posttests, Anxiety, Depression (Psychology), Psychological Patterns, Program Effectiveness
Assessment and Survey Identifiers: Center for Epidemiologic Studies Depression Scale
DOI: 10.1080/07448481.2016.1227826
ISSN: 0744-8481
Abstract: Objective: The purpose of this pilot study was to evaluate the Resilience and Coping Intervention (RCI) with college students. Participants: College students (aged 18-23) from a large Midwest US university who volunteered for a randomized controlled trial during the 2015 spring semester. Methods: College students were randomly assigned to an intervention (n = 64) or a control (n = 65) group. Intervention participants received three 45-minute RCI sessions over subsequent weeks. All participants completed pre- and post-intervention assessments at the beginning of Week 1 and end of Week 3. Student resilience, coping, hope, stress, depression, and anxiety were assessed. Results. RCI participants reported significantly more hope and less stress and depression from Week 1 to Week 3 compared with control participants. Results for resilience also approached statistical significance. Effect sizes were small to moderate. Conclusions: This study found preliminary evidence that RCI is an effective resilience intervention for use with college students.
Abstractor: As Provided
Number of References: 32
Entry Date: 2016
Accession Number: EJ1124152
Database: ERIC
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  Value: <anid>AN0120392408;acl01jan.17;2019Feb14.13:13;v2.2.500</anid> <title id="AN0120392408-1">Randomized controlled trial of the Resilience and Coping Intervention (RCI) with undergraduate university students. </title> <p>Objective: The purpose of this pilot study was to evaluate the Resilience and Coping Intervention (RCI) with college students. Participants: College students (aged 18–23) from a large Midwest US university who volunteered for a randomized controlled trial during the 2015 spring semester. Methods: College students were randomly assigned to an intervention (n = 64) or a control (n = 65) group. Intervention participants received three 45-minute RCI sessions over subsequent weeks. All participants completed pre- and post-intervention assessments at the beginning of Week 1 and end of Week 3. Student resilience, coping, hope, stress, depression, and anxiety were assessed. Results. RCI participants reported significantly more hope and less stress and depression from Week 1 to Week 3 compared with control participants. Results for resilience also approached statistical significance. Effect sizes were small to moderate. Conclusions: This study found preliminary evidence that RCI is an effective resilience intervention for use with college students.</p> <p>Keywords: Anxiety; coping; depression; group; hope; intervention; resilience; stress</p> <p>Many college students report concerns about stress, anxiety, and depression,[<reflink idref="bib1" id="ref1">1</reflink>] and rates of mental health problems among college student populations appear to be increasing.[<reflink idref="bib2" id="ref2">2</reflink>] In a survey of 66,887 US college students, 54.70% of students reported feeling overwhelming anxiety sometime during the previous 12 months, 33.20% reported feeling so depressed it was difficult to function sometime during the previous 12 months, and 87.10% felt overwhelmed by all they had to do sometime during the previous 12 months.[<reflink idref="bib3" id="ref3">3</reflink>] In a large survey of college students seeking mental health services (<emph>N</emph> = 25,475), the most frequently reported concerns were anxiety (55.10%), depression (45.26%), and stress (43.18%).[<reflink idref="bib1" id="ref4">1</reflink>]</p> <p>Among college students, experiencing stress, anxiety, or depression has been found to be associated with increased episodic drinking,[<reflink idref="bib4" id="ref5">4</reflink>] unhealthy relationship behaviors,[<reflink idref="bib5" id="ref6">5</reflink>] and poorer academic performance.[[<reflink idref="bib3" id="ref7">3</reflink>], [<reflink idref="bib6" id="ref8">6</reflink>]] College student stress, anxiety, or depression may be caused by the transition from living at home to being at college, academic challenges and pressure, financial concerns, interpersonal (eg, roommate, romantic partner) conflict, and uncertainty about postgraduation plans.[[<reflink idref="bib7" id="ref9">7</reflink>]] The prevalence of college student mental health concerns coupled with an overall growing college population size[<reflink idref="bib8" id="ref10">8</reflink>] has resulted in a "mental-health crisis" on college campuses[<reflink idref="bib10" id="ref11">10</reflink>]<sups>(p</sups>[<reflink idref="bib1" id="ref12">1</reflink>] that has stressed the capacity of college counseling centers.[[<reflink idref="bib7" id="ref13">7</reflink>], [<reflink idref="bib10" id="ref14">10</reflink>]]</p> <p>One approach to preventing and addressing some of the increased need for college mental health services is through the use of interventions that foster resilience and coping skills in college students. Resilience is the ability to positively adapt in the face of adversity, trauma, or stress.[<reflink idref="bib12" id="ref15">12</reflink>] Resilience has been associated with a number of factors that appear to promote protection in challenging situations such as problem-focused coping, social support, physical health, cognitive flexibility, and the ability to create meaning from adversity.[<reflink idref="bib13" id="ref16">13</reflink>] Interventions designed to enhance resilience often focus on promoting strengths and protective factors rather than on targeting deficits.[<reflink idref="bib14" id="ref17">14</reflink>]</p> <p>Positive coping skills have been shown to decrease symptoms of psychological distress and promote adaptation in individuals experiencing adversity.[<reflink idref="bib15" id="ref18">15</reflink>] Coping includes cognitive and behavioral efforts to control, lessen, or endure internal and/or external strains related to stressful situations.[<reflink idref="bib16" id="ref19">16</reflink>] Coping efforts may be generally positive and adaptive or negative and maladaptive. Interventions designed to promote positive coping may focus on teaching or strengthening a variety of positive coping skills.[<reflink idref="bib15" id="ref20">15</reflink>]</p> <p>Resilience and coping programs have been implemented and evaluated with college students. For example, Steinhardt and Dolbier[<reflink idref="bib9" id="ref21">9</reflink>] tested a 4-session (2 hours per session) resilience intervention that included psychoeducation, cognitive-behavioral therapy, rational-emotive therapy, and internal family systems therapy components. They found that, compared with a control group, college students completing the intervention generally reported more resilience, coping, and protective factors, and fewer symptoms of psychological distress. Other studies have implemented resilience-oriented programs with college students and found them to be effective at reducing student stress.[[<reflink idref="bib17" id="ref22">17</reflink>]] A meta-analysis of resilience building programs found that across a broad array of intervention approaches and populations, these programs generally had a small to moderate effect size in improving resilience and affecting mental health outcomes.[<reflink idref="bib19" id="ref23">19</reflink>] The meta-analysis authors cautioned that there was low confidence in these conclusions, though, due to the low or underreported quality of the studies included in the analysis.[<reflink idref="bib19" id="ref24">19</reflink>]</p> <p>Resilience and coping interventions may have particular utility for college health if they are implemented broadly (universal application) with students who do and do not have current mental health concerns, are delivered in a group setting to maximize reach by allowing providers to serve many students, can be delivered by mental health and non–mental health campus providers, and provide a mechanism for identifying students who may have need for more individualized mental health services.[<reflink idref="bib6" id="ref25">6</reflink>] The current study is a randomized controlled trial of one such model: the Resilience and Coping Intervention (RCI).</p> <hd id="AN0120392408-2">Resilience and Coping Intervention (RCI)</hd> <p>RCI is a manualized group intervention for children and youth designed to help participants identify thoughts, feelings, and coping strategies related to issues following a traumatic event or a problematic experience or related to everyday stressors.[<reflink idref="bib20" id="ref26">20</reflink>] RCI is based on the "Listen to the Children" interview process that was developed and implemented with 6,400 students following the 1995 Oklahoma City bombing.[<reflink idref="bib21" id="ref27">21</reflink>] RCI sessions are led by one or more group facilitators, last approximately 45 minutes to 1 hour, and can be repeated. RCI sessions focus on a specific problem that is shared by the group. The problem to be discussed in an RCI session can be identified by facilitators before a session (eg, a recent community disaster) or by participants as part of the session. Once a shared problem has been identified, a facilitator leads the group through several steps to describe the problem (ie, what happened or what is happening?) and what has changed as a result of the problem, to explore thoughts and feelings related to the problem, to identify new problems that are occurring now, to brainstorm options for change, to consider consequences related to the brainstormed options for change, and to develop an individual and group action plan.[<reflink idref="bib20" id="ref28">20</reflink>] When working through the RCI process in a group setting with peers, participants have opportunities to share and validate their own experiences, recognize that others have similar thoughts and feelings related to a shared problem, express and process their thoughts and feelings related to a problem, correct cognitive distortions, recognize their own existing coping strategies, learn new coping strategies from peers, connect to supports, learn problem solving, and gain satisfaction from helping others.[<reflink idref="bib22" id="ref29">22</reflink>]</p> <p>RCI has been evaluated with children and adolescents in at-risk neighborhoods in the southern United States in a non–control group pre/post study design.[<reflink idref="bib22" id="ref30">22</reflink>] This noncontrolled pilot evaluation found that children and adolescents participating in RCI reported decreased difficulties with behavior and emotions and increased feelings of hope following RCI sessions.[<reflink idref="bib22" id="ref31">22</reflink>] However, RCI has yet to be evaluated using a comparison group in a randomized controlled trial. The current study addresses this gap and also extends the use of RCI to college students at a large Midwest US university. We hypothesize that participants assigned to the RCI condition will report an increase in resilience, coping, and hope and a decrease in stress, depression, and anxiety compared with the control group.</p> <hd id="AN0120392408-3">Methods</hd> <p>RCI was implemented with college undergraduate students aged 18 to 23 during the spring 2015 semester at a large Midwest US university. Participants were recruited with study announcements distributed using mass university e-mails and posted flyers. Recruitment materials explained that participants would be randomly assigned to a control group or an intervention group. Control group participants completed assessments at Weeks 1 and 3. Intervention group participants completed the same assessments at Weeks 1 and 3, and also participated in an approximately 45-minute RCI session at Weeks 1, 2, and 3. Study participants were compensated for their time with a $10 gift card at Week 1, $15 gift card at Week 2, and $20 gift card at Week 3. All study procedures and participant compensation were reviewed and approved by the University of Missouri Institutional Review Board.</p> <p>Students interested in participating in the advertised study contacted the study coordinator and were provided study details (including the dates and times of different RCI sessions) and were e-mailed a consent form. Based on this information, participants who were interested and available to attend a session registered for a specific RCI session time. For Week 1, participants arrived at a reception room where they were provided a hardcopy consent form for review and signature. Group randomization was conducted immediately prior to the Week 1 sessions using blocked randomization with 4 units in each block.[<reflink idref="bib23" id="ref32">23</reflink>] Following informed consent, participants were sent to a different room depending on whether they had been randomized to the intervention or control group. Intervention group participants completed pre-intervention assessments and then participated in an RCI session. Following the RCI session, intervention group participants were instructed to return for Weeks 2 and 3. For Week 1, control group participants also completed pre-intervention assessments and were then dismissed and reminded to return for the Week 3 (for post-intervention assessment). Ten RCI intervention groups were formed with 3 to 8 participants in a group. RCI participants remained with their same group throughout the 3 weeks of the study.</p> <p>RCI sessions are intended to allow group members to discuss shared problems. These problems can be identified by participants as part of the session or can be identified in advance by facilitators (eg, a recent community disaster). For the current study, RCI group participants identified their own shared problems to discuss during the RCI sessions in Weeks 1 and 2. Group identified problems included stress (general and academic), future (career) concerns, time management challenges, and roommate and relationship problems. For Week 3, we provided participants with a list of possible problems (fitting in on campus, problems with instructors and professors, drinking and substance use, relationship problems, depression and anxiety, and grief and loss) and instructed group participants to select from that list. Most groups (7 out of 10) selected depression and anxiety as the Week 3 topic. Our RCI groups were led by licensed social workers trained in facilitating RCI. Graduate students from non–mental health disciplines assisted with facilitation (eg, wrote group responses on a board as part of the session). To assess fidelity of RCI implementation, facilitators completed a session report after each RCI session. These forms tracked whether intervention exercise components were completed, not completed, or completed with modification. Inspection of the session report forms indicated excellent fidelity across all sessions.</p> <hd id="AN0120392408-4">Participants</hd> <p>A total of 129 participants enrolled in the study; 65 were randomly assigned to the control group and 64 were randomly assigned to the intervention group using blocked randomization. All participants completed Week 1, 53 participants assigned to the intervention group completed Week 2 (11 intervention participants did not participate in Week 2; control participants were not scheduled for Week 2), and 119 participants completed the Week 3 assessments (including 3 intervention participants who did not participate in the Week 3 RCI group but did complete the assessments). See Figure 1. The majority of participants (72.1%, <emph>n</emph> = 93) were female. Participant age ranged from 18 to 23. A majority of participants were White/Caucasian (68.2%, <emph>n</emph> = 88), followed by Black/African American (12.4%, <emph>n</emph> = 16), Other or not reported (9.4%, <emph>n</emph> = 12), Asian/Asian American (7.0%, <emph>n</emph> = 9), and Hispanic/Latino (3.1%, <emph>n</emph> = 4).</p> <p>Graph: Figure 1. Participants flow diagram.</p> <hd id="AN0120392408-5">Measures</hd> <p>All measures were completed at the beginning of Week 1 for pre-intervention assessment and were then repeated at the end of Week 3 for post-intervention assessment.</p> <hd id="AN0120392408-6">Resilience</hd> <p>Resilience was assessed using the Connor-Davidson Resilience Scale[<reflink idref="bib24" id="ref33">24</reflink>] that asks participants how well 25 items describe themselves, with response options ranging from 0 (<emph>Not true at all</emph>) to 5 (<emph>True nearly all of the time</emph>). Examples items include "I am able to adapt to change," "I can deal with whatever comes," "I know where to turn for help," "I have a strong sense of purpose," and "I am not easily discouraged by failure." The measure was reliable at pre- (α =.88) and post- (α =.90) assessment.</p> <hd id="AN0120392408-7">Coping</hd> <p>Coping was measured using the Brief Coping Orientations to Problems Experience scale (Brief COPE).[<reflink idref="bib25" id="ref34">25</reflink>] Brief COPE includes 28 coping strategies and asks participants to indicate how often they have been doing each item, ranging from 1 (<emph>I haven't been doing this at all</emph>) to 4 (<emph>I've been doing this a lot</emph>). The coping strategies included in the Brief COPE cover a range of activities from seeking emotional support to using alcohol and drugs. The Brief COPE can be used to assess coping in general (<emph>dispositional</emph> coping) or coping related to a specific challenge such as a disaster or health problem (<emph>situational</emph> coping). We utilized the dispositional version of the scale by not orienting the measure to a single problem or challenge. As recommended by other researchers,[[<reflink idref="bib9" id="ref35">9</reflink>], [<reflink idref="bib26" id="ref36">26</reflink>]] we analyzed our pre-assessment Brief COPE data to determine how coping strategies grouped together within our sample and context. Using principal component analysis with promax rotation (run with SPSS 23; IBM, Armonk, NY), we retained 15 individual coping items that represented 5 coping components (support, giving up and self-blame, taking action, alcohol, and religion). We used eigenvalue scores of 1.0 or greater to identify the number of coping components, and we only retained individual coping scale items that loaded.60 or higher on a single component while also loading no higher than.40 on any other component. See Table 1 for final item loading on the 5 components. The 5 coping components were used as dependent variables in our analysis.</p> <p>Table 1. Principal component analysis of the Brief COPE scale.</p> <p> <ephtml> <table><thead><tr><td /><td>Coping components</td></tr><tr><td>I've been...</td><td>Support</td><td>Giving up, Self-blame</td><td>Taking action</td><td>Alcohol</td><td>Religion</td></tr></thead><tbody><tr><td>Getting emotional support from others</td><td char="."><bold>.824</bold></td><td char=".">.191</td><td char=".">.296</td><td char=".">.055</td><td char=".">.130</td></tr><tr><td>Getting help and advice from other people</td><td char="."><bold>.889</bold></td><td char=".">.091</td><td char=".">.151</td><td char=".">.058</td><td char=".">.075</td></tr><tr><td>Getting comfort and understanding from someone</td><td char="."><bold>.834</bold></td><td char=".">.033</td><td char=".">.368</td><td char=".">.008</td><td char=".">.099</td></tr><tr><td>Trying to get advice or help from other people about what to do</td><td char="."><bold>.799</bold></td><td char=".">.145</td><td char=".">.158</td><td char=".">−.280</td><td char=".">.166</td></tr><tr><td>Giving up trying to deal with it</td><td char=".">.176</td><td char="."><bold>.733</bold></td><td char=".">−.305</td><td char=".">.098</td><td char=".">−.047</td></tr><tr><td>Criticizing myself</td><td char=".">.026</td><td char="."><bold>.753</bold></td><td char=".">.284</td><td char=".">.225</td><td char=".">−.036</td></tr><tr><td>Giving up the attempt to cope</td><td char=".">.146</td><td char="."><bold>.748</bold></td><td char=".">−.124</td><td char=".">.089</td><td char=".">.012</td></tr><tr><td>Blaming myself for things that happened</td><td char=".">−.010</td><td char="."><bold>.632</bold></td><td char=".">.386</td><td char=".">.230</td><td char=".">−.241</td></tr><tr><td>Concentrating my efforts on doing something about the situation I'm in</td><td char=".">.154</td><td char=".">.006</td><td char="."><bold>.777</bold></td><td char=".">.034</td><td char=".">.039</td></tr><tr><td>Taking action to try to make the situation better</td><td char=".">.298</td><td char=".">−.127</td><td char="."><bold>.750</bold></td><td char=".">−.182</td><td char=".">.072</td></tr><tr><td>Thinking hard about what steps to take</td><td char=".">.307</td><td char=".">.165</td><td char="."><bold>.682</bold></td><td char=".">.001</td><td char=".">.062</td></tr><tr><td>Using alcohol or other drugs to make myself feel better</td><td char=".">−.072</td><td char=".">.180</td><td char=".">−.050</td><td char="."><bold>.967</bold></td><td char=".">−.234</td></tr><tr><td>Using alcohol or other drugs to help me get through it</td><td char=".">.000</td><td char=".">.232</td><td char=".">.008</td><td char="."><bold>.961</bold></td><td char=".">−.174</td></tr><tr><td>Trying to find comfort in my religion or spiritual beliefs</td><td char=".">.170</td><td char=".">−.066</td><td char=".">−.001</td><td char=".">−.264</td><td char="."><bold>.942</bold></td></tr><tr><td>Praying or meditating</td><td char=".">.110</td><td char=".">−.071</td><td char=".">.077</td><td char=".">−.140</td><td char="."><bold>.945</bold></td></tr><tr><td>Pre-test alpha reliability</td><td char=".">.87</td><td char=".">.67</td><td char=".">.68</td><td char=".">.89</td><td char=".">.79</td></tr><tr><td>Post-test alpha reliability</td><td char=".">.88</td><td char=".">.70</td><td char=".">.75</td><td char=".">.94</td><td char=".">.84</td></tr></tbody></table> </ephtml> </p> <p>10001 <emph>Note</emph>. Cell entries show component loadings for Brief COPE<sups>25</sups> scale items that loaded >.60 on one component and <.40 on all other component. Bottom 2 rows show alpha reliability measures for each coping component.</p> <hd id="AN0120392408-8">Hope</hd> <p>We assessed hope using the Trait Hope Scale,[<reflink idref="bib27" id="ref37">27</reflink>] which includes 12 items and asks participants to indicate how well each item describes themselves, ranging from 1 (<emph>Definitely false</emph>) to 7 (<emph>Definitely true</emph>). Example items include "there are lots of ways around problems," "I energetically pursue my goals," "my past experiences have prepared me well for my future," and "I usually find myself worrying about something (reverse coded for analysis)." The hope scale proved reliable at pre- (α =.78) and post- (α =.80) assessment.</p> <hd id="AN0120392408-9">Stress</hd> <p>Perceived stress was measured by asking respondents how often in the last month they experienced 14 stressful experiences, with response options ranging from 0 (<emph>Never</emph>) to 4 (<emph>Very often</emph>).[<reflink idref="bib28" id="ref38">28</reflink>] Example items include "you have been upset because of something that happened unexpectedly," "you found that you could not cope with all the things that you had to do," "you have been angered because of things that happened that were outside of your control," and "you have been able to control the way you spend your time (reverse coded)." The scale was reliable at pre- (α =.86) and post- (α =.88) assessment.</p> <hd id="AN0120392408-10">Anxiety</hd> <p>We assessed anxiety using the Generalized Anxiety Disorder 7-item scale.[<reflink idref="bib29" id="ref39">29</reflink>] Respondents were instructed to read the items and report how often they had been bothered by each item over the last 2 weeks, with response options ranging from 0 (<emph>Not at all</emph>) to 3 (<emph>Nearly every day</emph>). Example items included "feeling nervous, anxious, or on edge," "becoming easily annoyed or irritable," and "worrying too much about different things." The scale was reliable at pre- (α =.90) and post- (α =.91) assessment.</p> <hd id="AN0120392408-11">Depression</hd> <p>Depression was measured using the Center for Epidemiological Studies Depression Scale,[<reflink idref="bib30" id="ref40">30</reflink>] which includes 20 items that participants were instructed to read and then report how often they felt that way during the past week, with response options ranging from 0 (<emph>Rarely or none of the time; less than 1 day</emph>) to 3 (<emph>Most or all of the time; 5–7 days</emph>). Example items include "I felt depressed," "People were unfriendly," "I did not feel like eating; my appetite was poor," and "I was happy (reverse coded)." The scale was reliable at pre- (α =.91) and post- (α =.92) assessment.</p> <hd id="AN0120392408-12">Data analysis</hd> <p>Descriptive statistics for all dependent variables were calculated using SPSS 23. For hypothesis testing, mixed-effects models with random intercepts were built with the SAS 9.3 (SAS Institute, Cary, NC) MIXED procedure to assess the effect of the intervention on the outcome measures (resilience, coping components, hope, stress, anxiety, and depression). Two variables, intervention group (intervention, control) and time (pre-assessment, post-assessment), as well as their interaction term (intervention group × time) were included as predictors. In each of these models, the covariance matrix was left unstructured and restricted maximum likelihood (REML) method was used to estimate model parameters. The main effect of the time variable indicates a change in that variable from pre- to post-assessment. The interaction term indicates different trajectories in the dependent variables between the intervention groups at pre- and post-assessment. Therefore, it is the interaction effect that constitutes the primary test of our hypothesis. Contrast estimates were calculated for the interaction term. The effect size of the intervention effect on each of the outcomes was determined by computing Cohen's <emph>f</emph><sups>2</sups> statistics. The probability of Type 1 error was set at.05.</p> <hd id="AN0120392408-13">Results</hd> <p>See Table 2 for pre- and post-intervention assessment mean scores and standard deviations for all dependent variables, displayed for intervention groups. Mixed-effects model results are displayed in Tables 3 and 4. Table 3 shows results for resilience, hope, stress, anxiety, and depression, and Table 4 includes results for the 5 coping components (support, giving up and self-blame, taking action, alcohol, and religion).</p> <p>Table 2. Means and standard deviations at pre- and post-assessment for outcome measures.</p> <p> <ephtml> <table><thead><tr><td /><td>Intervention</td><td>Control</td></tr><tr><td /><td>Pre (<italic>n</italic> = 64)</td><td>Post (<italic>n</italic> = 58)</td><td>Pre (<italic>n</italic> = 65)</td><td>Post (<italic>n</italic> = 61)</td></tr><tr><td>Measure</td><td><italic>M</italic></td><td><italic>SD</italic></td><td><italic>M</italic></td><td><italic>SD</italic></td><td><italic>M</italic></td><td><italic>SD</italic></td><td><italic>M</italic></td><td><italic>SD</italic></td></tr></thead><tbody><tr><td>Resilience</td><td char=".">3.71</td><td char=".">0.49</td><td char=".">3.80</td><td char=".">0.53</td><td char=".">3.82</td><td char=".">0.48</td><td char=".">3.83</td><td char=".">0.49</td></tr><tr><td>Coping component</td><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td> Support</td><td char=".">2.48</td><td char=".">0.76</td><td char=".">2.72</td><td char=".">0.70</td><td char=".">2.63</td><td char=".">0.75</td><td char=".">2.77</td><td char=".">0.82</td></tr><tr><td> Giving up/Self-blame</td><td char=".">1.87</td><td char=".">0.60</td><td char=".">1.77</td><td char=".">0.58</td><td char=".">1.94</td><td char=".">0.59</td><td char=".">1.85</td><td char=".">0.61</td></tr><tr><td> Taking action</td><td char=".">2.88</td><td char=".">0.66</td><td char=".">3.06</td><td char=".">0.61</td><td char=".">2.90</td><td char=".">0.64</td><td char=".">3.05</td><td char=".">0.61</td></tr><tr><td> Alcohol</td><td char=".">1.50</td><td char=".">0.81</td><td char=".">1.53</td><td char=".">0.84</td><td char=".">1.50</td><td char=".">0.72</td><td char=".">1.64</td><td char=".">0.85</td></tr><tr><td> Religion</td><td char=".">2.17</td><td char=".">0.99</td><td char=".">2.21</td><td char=".">1.02</td><td char=".">2.14</td><td char=".">1.14</td><td char=".">2.17</td><td char=".">1.17</td></tr><tr><td>Hope</td><td char=".">4.90</td><td char=".">0.60</td><td char=".">5.04</td><td char=".">0.69</td><td char=".">5.00</td><td char=".">0.80</td><td char=".">5.03</td><td char=".">0.74</td></tr><tr><td>Stress</td><td char=".">2.94</td><td char=".">0.49</td><td char=".">2.75</td><td char=".">0.52</td><td char=".">2.91</td><td char=".">0.57</td><td char=".">2.91</td><td char=".">0.55</td></tr><tr><td>Anxiety</td><td char=".">2.18</td><td char=".">0.81</td><td char=".">1.97</td><td char=".">0.64</td><td char=".">2.08</td><td char=".">0.73</td><td char=".">2.13</td><td char=".">0.90</td></tr><tr><td>Depression</td><td char=".">1.85</td><td char=".">0.52</td><td char=".">1.77</td><td char=".">0.48</td><td char=".">1.82</td><td char=".">0.52</td><td char=".">1.87</td><td char=".">0.57</td></tr></tbody></table> </ephtml> </p> <p>20001 <emph>Note</emph>. Intervention condition included 3 sessions of the Resilience and Coping Intervention (RCI).</p> <p>Table 3. Effect of intervention on resilience, hope, stress, anxiety, and depression.</p> <p> <ephtml> <table><thead><tr><td>Variable</td><td>Resilience</td><td>Hope</td><td>Stress</td><td>Anxiety</td><td>Depression</td></tr></thead><tbody><tr><td>Condition (Reference = Control)</td><td><italic>F</italic>(1, 117) = 0.42 <italic>p</italic> =.5162</td><td><italic>F</italic>(1, 117) = 0.01 <italic>p</italic> =.9250</td><td><italic>F</italic>(1, 117) = 0.71 <italic>p</italic> =.4000</td><td><italic>F</italic>(1, 117) = 1.11 <italic>p</italic> =.2939</td><td><italic>F</italic>(1, 117) = 0.21 <italic>p</italic> =.6488</td></tr><tr><td>Time</td><td><italic>F</italic>(1, 117) = 1.58 <italic>p</italic> =.2112</td><td><italic>F</italic>(1, 117) = 1.52 <italic>p</italic> =.2200</td><td><italic>F</italic>(1, 117) = 7.77 <italic>p</italic> =.0062*</td><td><italic>F</italic>(1, 117) = 1.85 <italic>p</italic> =.1760</td><td><italic>F</italic>(1, 117) = 0.07 <italic>p</italic> =.7849</td></tr><tr><td>Interaction: Condition × Time</td><td><italic>F</italic>(1, 117) = 3.79 <italic>p</italic> =.0540</td><td><italic>F</italic>(1, 117) = 4.33 <italic>p</italic> =.0395*</td><td><italic>F</italic>(1, 117) = 18.54 <italic>p</italic> <.0001*</td><td><italic>F</italic>(1, 117) = 0.59 <italic>p</italic> =.4451</td><td><italic>F</italic>(1, 117) = 5.36 <italic>p</italic> =.0223*</td></tr><tr><td>Intervention group post vs pre: Contrast estimate 95% CI</td><td>0.08</td><td>0.13</td><td>−0.18</td><td>−0.10</td><td>−0.08</td></tr><tr><td>0.01; 0.15</td><td>0.02; 0.24</td><td>−0.26; −0.11</td><td>−0.24; 0.03</td><td>−0.17; 0.01</td></tr><tr><td><italic>p</italic> =.0271*</td><td><italic>p</italic> =.0223*</td><td><italic>p</italic> <.0001*</td><td><italic>p</italic> =.1398</td><td><italic>p</italic> =.0730</td></tr><tr><td>Control group post vs pre:Contrast estimate 95% CI</td><td>−0.02</td><td>−0.03</td><td>0.04</td><td>−0.03</td><td>0.06</td></tr><tr><td>−0.09; 0.05</td><td>−0.14; 0.08</td><td>−0.03; 0.11</td><td>−0.16; 0.10</td><td>−0.02; 0.15</td></tr><tr><td><italic>p</italic> =.6224</td><td><italic>p</italic> =.5447</td><td><italic>p</italic> =.2790</td><td><italic>p</italic> =.6708</td><td><italic>p</italic> =.1465</td></tr><tr><td>Cohen's <italic>f</italic><sup>2</sup> (for intervention effect)</td><td>0.04</td><td>0.04</td><td>0.16</td><td>0.01</td><td>0.05</td></tr><tr><td>Null model likelihood ratio test</td><td>χ<xref ref-type="bibr" rid="bibr2">2</xref> = 140.81; <italic>df</italic> = 1; <italic>p</italic> <.0001</td><td>χ<xref ref-type="bibr" rid="bibr2">2</xref> = 122.07; <italic>df</italic> = 1; <italic>p</italic> <.0001</td><td>χ<xref ref-type="bibr" rid="bibr2">2</xref> = 153.69; <italic>df</italic> = 1; <italic>p</italic> <.0001</td><td>χ<xref ref-type="bibr" rid="bibr2">2</xref> = 102.24; <italic>df</italic> = 1; <italic>p</italic> <.0001</td><td>χ<xref ref-type="bibr" rid="bibr2">2</xref> = 109.75; <italic>df</italic> = 1; <italic>p</italic> <.0001</td></tr></tbody></table> </ephtml> </p> <p>30001 <emph>Note</emph>. Cohen's <emph>f</emph><sups>2</sups> interpretation: 0.02 (small effect); 0.15 (medium effect); 0.35 (large effect). *<emph>p</emph> <.05.</p> <p>Table 4. Effect of intervention on coping components.</p> <p> <ephtml> <table><thead><tr><td /><td>Coping components</td></tr><tr><td>Variable</td><td>Support</td><td>Giving up, Self-blame</td><td>Taking action</td><td>Alcohol</td><td>Religion</td></tr></thead><tbody><tr><td>Condition (Reference = Control)</td><td><italic>F</italic>(1, 117) = 0.62 <italic>p</italic> =.4336</td><td><italic>F</italic>(1, 117) = 0.93 <italic>p</italic> =.3360</td><td><italic>F</italic>(1, 117) = 0.00 <italic>p</italic> =.9800</td><td><italic>F</italic>(1, 117) = 0.15 <italic>p</italic> =.7039</td><td><italic>F</italic>(1, 117) = 0.00 <italic>p</italic> =.9729</td></tr><tr><td>Time</td><td><italic>F</italic>(1, 117) = 9.41 <italic>p</italic> =.0027*</td><td><italic>F</italic>(1, 117) = 2.71 <italic>p</italic> =.1022</td><td><italic>F</italic>(1, 117) = 8.89 <italic>p</italic> =.0035*</td><td><italic>F</italic>(1, 117) = 2.96 <italic>p</italic> =.0881</td><td><italic>F</italic>(1, 117) = 0.06 <italic>p</italic> =.8137</td></tr><tr><td>Interaction: Condition × Time</td><td><italic>F</italic>(1, 117) = 1.27 <italic>p</italic> =.2626</td><td><italic>F</italic>(1, 117) = 0.14 <italic>p</italic> =.7055</td><td><italic>F</italic>(1, 117) = 0.05 <italic>p</italic> =.8305</td><td><italic>F</italic>(1, 117) = 0.75 <italic>p</italic> =.3876</td><td><italic>F</italic>(1, 117) = 0.22 <italic>p</italic> =.6402</td></tr><tr><td>Intervention group post vs pre: Contrast estimate 95% CI</td><td>0.23</td><td>−0.10</td><td>0.17</td><td>0.05</td><td>−0.01</td></tr><tr><td>0.07; 0.38</td><td>−0.24; 0.04</td><td>0.02; 0.32</td><td>−0.12; 0.21</td><td>−0.14; 0.12</td></tr><tr><td><italic>p</italic> =.0041*</td><td><italic>p</italic> =.1594</td><td><italic>p</italic> =.0274*</td><td><italic>p</italic> =.5524</td><td><italic>p</italic> =.8713</td></tr><tr><td>Control group post vs pre:Contrast estimate 95% CI</td><td>0.11</td><td>−0.06</td><td>0.15</td><td>0.15</td><td>0.03</td></tr><tr><td>−0.05; 0.26</td><td>−0.20; 0.07</td><td>0.00; 0.29</td><td>−0.01; 0.31</td><td>−0.10; 0.16</td></tr><tr><td><italic>p</italic> =.1671</td><td><italic>p</italic> =.3661</td><td><italic>p</italic> =.0501</td><td><italic>p</italic> =.0666</td><td><italic>p</italic> =.6147</td></tr><tr><td>Cohen's <italic>f</italic><sup>2</sup> (for intervention effect)</td><td>0.01</td><td><0.01</td><td><0.01</td><td>0.01</td><td><0.01</td></tr><tr><td>Null model likelihood ratio test</td><td>χ<xref ref-type="bibr" rid="bibr2">2</xref> = 76.19; <italic>df</italic> = 1; <italic>p</italic> <.0001</td><td>χ<xref ref-type="bibr" rid="bibr2">2</xref> = 45.98; <italic>df</italic> = 1; <italic>p</italic> <.0001</td><td>χ<xref ref-type="bibr" rid="bibr2">2</xref> = 46.69; <italic>df</italic> = 1; <italic>p</italic> <.0001</td><td>χ<xref ref-type="bibr" rid="bibr2">2</xref> = 72.56; <italic>df</italic> = 1; <italic>p</italic> <.0001</td><td>χ<xref ref-type="bibr" rid="bibr2">2</xref> = 183.41; <italic>df</italic> = 1; <italic>p</italic> <.0001</td></tr></tbody></table> </ephtml> </p> <p>40001 <emph>Note</emph>. Cohen's <emph>f</emph><sups>2</sups> interpretation: 0.02 (small effect); 0.15 (medium effect); 0.35 (large effect). *<emph>p</emph> <.05.</p> <p>The interaction term (intervention group × time) for resilience approached significance, <emph>F</emph>(<reflink idref="bib1" id="ref41">1</reflink>, 117) = 3.79, <emph>p</emph> =.054, with a small effect size, Cohen's <emph>f</emph><sups>2</sups> = 0.04. Contrast estimates indicated that resilience scores for the intervention group increased significantly from pre- to post-assessment (<emph>p</emph> =.027), whereas there was no significant change in resilience for the control group from pre to post. See Table 2 for the coping components results. There was a significant main effect of time for support, <emph>F</emph>(<reflink idref="bib1" id="ref42">1</reflink>, 117) = 9.41, <emph>p</emph> =.004, and taking action, <emph>F</emph>(<reflink idref="bib1" id="ref43">1</reflink>, 117) = 8.89, <emph>p</emph> =.004; however, the interaction terms were not significant for these or any of the other coping component measures. Contrast estimates did indicate a significant increase in support (<emph>p</emph> =.004) and taking action (<emph>p</emph> =.03) for intervention participants from pre- to post-assessment. But the nonsignificant interaction term indicates that these trajectories of increased coping components did not significantly differ from the control group trajectories.</p> <p>The interaction term for hope was significant, <emph>F</emph>(<reflink idref="bib1" id="ref44">1</reflink>, 117) = 4.33, <emph>p</emph> =.04, and the effect size was small, Cohen's <emph>f</emph><sups>2</sups> = 0.04. Contrast estimates indicated that hope significantly increased (<emph>p</emph> =.02) for intervention participants from pre- to post-assessment. The time main effect for stress was significant, <emph>F</emph>(<reflink idref="bib1" id="ref45">1</reflink>, 117) = 7.77, <emph>p</emph> =.006, as was the interaction term, <emph>F</emph>(<reflink idref="bib1" id="ref46">1</reflink>, 117) = 18.54, <emph>p</emph> <.001. The effect size for the interaction was moderate, Cohen's <emph>f</emph><sups>2</sups> = 0.16. Contrast estimates indicated that stress symptoms declined significantly (<emph>p</emph> <.001) for the intervention group from pre- to post-assessment. Neither the time main effect nor the interaction term was statistically significant for the anxiety measure. The interaction term for depression was significant, <emph>F</emph>(<reflink idref="bib1" id="ref47">1</reflink>, 117) = 5.36, <emph>p</emph> =.02, with a small effect size, Cohen's <emph>f</emph><sups>2</sups> = 0.05. Contrast estimates indicated that depression approached a statistically significant decline (<emph>p</emph> =.07) from pre- to post-assessment.</p> <hd id="AN0120392408-14">Comment</hd> <p>To better understand the effectiveness of the Resilience and Coping Intervention (RCI), we conducted the first randomized controlled trial of RCI using the intervention with college students. Our randomly assigned intervention group included 3 RCI sessions, each lasting approximately 45 minutes, delivered over 3 subsequent weeks. We conducted pre-intervention assessments before the first RCI session and post-intervention assessments after the last session. Control participants did not participate in the intervention but completed the same pre- and post-assessments at the same time. We recruited college students from the undergraduate student body at a large midwestern university through e-mails and flyers. We did not incorporate any inclusion criteria (eg, students reporting mental health concerns) or exclusion criteria for study participation; thus, we consider this a universal application of RCI.</p> <p>Overall, our results provide preliminary evidence that RCI is an effective resilience intervention for use with college students. Mixed-effects models indicated that intervention participants reported significantly more hope and significantly less stress and depression from pre- to post-assessment compared with control participants. The strongest intervention effects were the moderate effects of RCI on student stress. The intervention was conducted during the spring semester, which is reported to be the most stressful semester for students.[<reflink idref="bib31" id="ref48">31</reflink>] Depression and stress are 2 of the most frequent mental health concerns reported by college students,[[<reflink idref="bib1" id="ref49">1</reflink>], [<reflink idref="bib3" id="ref50">3</reflink>]] and RCI was able to significantly improve these outcomes for intervention participants compared with students who did not participate in RCI. Our results also indicated that intervention participants approached a significant increase in resilience from pre- to post-assessment compared with control participants. The effect sizes for resilience, hope, and depression were small, but the overall range of small to moderate (for stress) effects situates RCI in the common range of effect sizes documented in a recent meta-analysis of resilience programs.[<reflink idref="bib19" id="ref51">19</reflink>] Also, for resilience, hope, stress, and depression, even when the pre- to post-assessment comparison with control participants was not significantly different, the descriptive outcome means (see Table 1) improved from pre- to post-assessment (eg, hope increased, depression decreased), whereas the reverse was observed for the control groups (eg, hope decreased, depression increased).</p> <p>RCI had no effect on anxiety in this trial. Anxiety is a common mental health concern among college students[[<reflink idref="bib1" id="ref52">1</reflink>], [<reflink idref="bib3" id="ref53">3</reflink>]] and is thus an important outcome for college resilience interventions to target. When intervention participants selected their own problems to discuss during the first 2 weeks of the intervention, none of the groups discussed anxiety as a specific problem. For the final week of the intervention, we provided a group of topics from which participants could choose, and many of the groups selected "depression and anxiety" to discuss. However, given the breadth of this topic, it is unclear to what extent those discussions focused on anxiety specifically. Thus, perhaps more focused discussion about anxiety problems would result in participants reporting significant effects for this outcome. Alternatively, perhaps some small amount of psychoeducational discussion or information (handouts) could boost the effects of the intervention, particularly for outcomes such as anxiety. One of the advantages of the RCI model is that it is not a typical training or educational session like other resilience programs. We posit benefits from the group-led discussion of problems, thoughts, feelings, and coping strategies. However, some short instruction added to the RCI format might result in stronger effects across outcomes. Future trials should examine this possibility.</p> <p>We also hypothesized that RCI would improve participant coping capacity compared with control participants, but these results were not significant. Some of these unexpected results may be related to the use of the Brief COPE to assess student coping. We used principal component analysis to determine how coping actions loaded together in our sample, and through this process we dropped 13 of the coping items. These results call into question the Brief COPE's effectiveness in assessing general (<emph>dispositional</emph>) coping skills, at least in the current context. The Brief COPE was initially validated using a sample of adults living in a community affected by a hurricane[<reflink idref="bib26" id="ref54">26</reflink>] as a measure of <emph>situational</emph> coping relative to specific difficulties, although the Brief COPE has also been used to assess general (<emph>dispositional</emph>) coping as we employed it in the current study.[<reflink idref="bib9" id="ref55">9</reflink>] However, perhaps the implementation of multiple RCI sessions on different, specific problems and the use of the Brief COPE to assess generalized coping was a mismatch. Each RCI session focused on different problems, and so there are several practical constraints to using a situational version of the Brief COPE as part of RCI assessment. Future RCI trials should consider alternative approaches to measuring coping.</p> <p>We implemented RCI in a universal undergraduate student population and did not focus specifically on students with an identified mental health concern. As a result, we likely had reduced opportunity to identify an intervention effect.[<reflink idref="bib32" id="ref56">32</reflink>] RCI is posited to have prevention-like effects, meaning that students with increased resilience and more coping skills (as a result of participating in RCI) would be predicted to cope better with challenges in the future, which could in turn prevent mental health issues. However, such preventative effects are harder to detect and require longer-term follow-up, which we did not include in our study design. Future evaluations of RCI should include a long-term follow-up with study participants.</p> <p>Overall, the results of this randomized controlled trial provide preliminary evidence that RCI is an effective resilience intervention for use with college students. In the current study, RCI was implemented in 3 sessions that were each approximately 45 minutes in length. This is a shorter time requirement compared with many other resilience training programs.[<reflink idref="bib19" id="ref57">19</reflink>] Additionally, RCI is implemented with groups to expand the number of students reached in implementation, and RCI can be facilitated by non–mental health staff (eg, college staff trained in RCI such as residence life staff, student affairs professionals, diversity coordinators, peer educators, or health and wellness professionals), which may provide universities with additional and more cost-effective options for delivering these services on campus. Additional evaluation with long-term follow-up is needed to determine the effects of the intervention over time, particularly since RCI may have preventative utility. Lastly, including a small amount of psychoeducation in the form of discussion or information (handouts) might boost intervention effects.</p> <hd id="AN0120392408-15">Limitations</hd> <p>Our results are subject to several limitations. First, we utilized a convenience sample of undergraduate students and thus our results are not generalizable to other college students. Future research should replicate evaluations of RCI with probability samples of participants. Second, our sample included a larger proportion of females (72.1%) than may be found on many college campuses and this may further limit generalizations of our results to college populations. Third, we provided participants with study incentives and it is unknown how this impacted study retention. Lastly, and as previously discussed, we did not include a long-term follow-up. This prevents us from understanding the ongoing effects of RCI after the intervention sessions are completed. The RCI effects documented here may abate after a few weeks or months, or they may strengthen as students continue the coping processes they have begun. Replications of the current study with an added long-term assessment should examine these possibilities.</p> <hd id="AN0120392408-16">Conclusions</hd> <p>To better understand the effectiveness of the Resilience and Coping Intervention (RCI), we conducted the first randomized controlled trial of RCI using the intervention with college students. We found preliminary evidence that RCI is an effective resilience intervention for use with this population. Results indicated that intervention participants reported significantly more hope and significantly less stress and depression from pre- to post-assessment compared with control participants. Our results also indicated that intervention participants approached a significant increase in resilience from pre- to post-assessment compared with control participants.</p> <hd id="AN0120392408-17">Conflict of interest disclosure</hd> <p>The authors have no conflicts of interest to report. The authors confirm that the research presented in this article met the ethical guidelines, including adherence to the legal requirements, of the United States and received approval from the Institutional Review Board of the University of Missouri.</p> <hd id="AN0120392408-18">Funding</hd> <p>This research was supported by the US Substance Abuse and Mental Health Services Administration (SAMHSA) through the Disaster and Community Crisis Center (DCC; <ulink href="http://dcc.missouri.edu">http://dcc.missouri.edu</ulink>) at the University of Missouri, a partner in the National Child Traumatic Stress Network (NCTSN).</p> <ref id="AN0120392408-19"> <title> References </title> <blist> <bibl id="bib1" idref="ref1" type="bt">1</bibl> <bibtext> Center for Collegiate Mental Health. 2014 Annual Report. <ulink href="http://ccmh.psu.edu/wp-content/uploads/sites/3058/2015/02/2014-CCMH-Annual-Report.pdf">http://ccmh.psu.edu/wp-content/uploads/sites/3058/2015/02/2014-CCMH-Annual-Report.pdf</ulink>. 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  Data: Randomized Controlled Trial of the Resilience and Coping Intervention (RCI) with Undergraduate University Students
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  Data: <searchLink fieldCode="SO" term="%22Journal+of+American+College+Health%22"><i>Journal of American College Health</i></searchLink>. 2017 65(1):1-9.
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  Data: Routledge. Available from: Taylor & Francis, Ltd. 325 Chestnut Street Suite 800, Philadelphia, PA 19106. Tel: 800-354-1420; Fax: 215-625-2940; Web site: http://www.tandf.co.uk/journals
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  Data: 10.1080/07448481.2016.1227826
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  Data: 0744-8481
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  Data: Objective: The purpose of this pilot study was to evaluate the Resilience and Coping Intervention (RCI) with college students. Participants: College students (aged 18-23) from a large Midwest US university who volunteered for a randomized controlled trial during the 2015 spring semester. Methods: College students were randomly assigned to an intervention (n = 64) or a control (n = 65) group. Intervention participants received three 45-minute RCI sessions over subsequent weeks. All participants completed pre- and post-intervention assessments at the beginning of Week 1 and end of Week 3. Student resilience, coping, hope, stress, depression, and anxiety were assessed. Results. RCI participants reported significantly more hope and less stress and depression from Week 1 to Week 3 compared with control participants. Results for resilience also approached statistical significance. Effect sizes were small to moderate. Conclusions: This study found preliminary evidence that RCI is an effective resilience intervention for use with college students.
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  Data: 2016
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  Data: EJ1124152
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