Web-Based Guided Self-Help Acceptance and Commitment Therapy (ACT) to Increase Self-Compassion and Psychological Flexibility in Psychology Undergraduates Suffering Emotional Distress: A Feasibility Study
[Guided Self-Help Acceptance and Commitment Therapy (ACT) Berbasis-Web untuk Meningkatkan Self-Compassion dan Fleksibilitas Psikologis pada Mahasiswa Sarjana Psikologi dengan Distress Emotional: Studi Fisibilitas]
Abstract
Emotional distress amongst university students is an issue which has emerged as the result of various factors, such as the transition from adolescence to young adulthood, an increase in demands made, and changes in the situation and the system of learning. The phenomenon of distress may be seen from the number of undergraduate students seeking psychological help in university clinics. The queues of undergraduates always exceed the capacity for the provision of services, so that undergraduates are forced to wait for between one and three months. One of the ways to overcome this phenomenon is by conducting web-based psychological intervention. Internet connection may increase accessibility and facilitation of web-based psychological intervention. This study examined the feasibility of eight sessions of web-based guided self-help Acceptance and Commitment Therapy (ACT) organized to reduce the levels of emotional distress and to increase the psychological flexibility and self-compassion of undergraduate students of the Faculty of Psychology of a university in Indonesia. This study was quasi-experimental, with a one group pretest-posttest design involving 38 participants. After the interventions, there was a significant reduction in symptoms of distress detected, as well as an increase in the levels of psychological flexibility and self-compassion of the participants. Feasibility assessment results showed that with the supportive resources of the people conducting the trial, Internet connections, and independence on the part of the participants, the conducting of a web-based program of Acceptance and Commitment Therapy (ACT) is feasible. More in-depth research on a wider scale is required to reach a closer to adequate conclusion regarding the effectiveness of such a program, however, the feasibility of the web-based Acceptance and Commitment Therapy (ACT) intervention, as proven in this study, indicated that the features of online psychological intervention offer an efficient option for the providers of mental health services.
Distress emosional pada mahasiswa adalah isu yang muncul akibat berbagai faktor, seperti transisi dari usia remaja ke dewasa muda, bertambahnya tuntutan, dan perubahan situasi serta sistem belajar. Fenomena distress terlihat dari banyaknya mahasiswa sarjana yang mencari bantuan psikologis di klinik universitas. Antrean mahasiswa selalu melebihi kapasitas pemberi layanan sehingga mahasiswa perlu mengantre selama satu hingga tiga bulan. Salah satu cara untuk mengatasi fenomena ini adalah dengan menjalankan intervensi psikologis berbasis-web. Koneksi Internet dapat meningkatkan keterjangkauan dan kemudahan partisipan mengakses layanan psikologis. Studi ini meneliti fisibilitas delapan sesi guided self-help Acceptance and Commitment Therapy (ACT) berbasis-web yang disusun untuk menurunkan tingkat distress emosional serta meningkatkan fleksibilitas psikologis dan self-compassion mahasiswa sarjana Fakultas Psikologi dari sebuah universitas di Indonesia. Studi ini merupakan quasi-experimental dengan desain one-group pretest-posttest sebanyak 38 partisipan. Setelah intervensi, ditemukan penurunan gejala distress yang signifikan, disertai dengan naiknya fleksibilitas psikologis dan self-compassion partisipan. Hasil asesmen fisibilitas menunjukkan bahwa dengan sumber daya yang menunjang dari pihak pelaksana, koneksi Internet, dan kemandirian dari pihak partisipan, program Acceptance and Commitment Therapy (ACT) berbasis-web fisibel untuk dilakukan. Riset lebih dalam dengan skala lebih luas dibutuhkan untuk mencapai konklusi yang lebih adekuat mengenai efektivitas program, namun fisibilitas intervensi Acceptance and Commitment Therapy (ACT) berbasis-web yang terbukti pada studi ini menunjukkan bahwa intervensi psikologis fitur daring merupakan opsi efisien bagi penyedia layanan kesehatan mental.
Downloads
References
Abbott, J. H. (2014). The distinction between Randomized Clinical Trials (RCTs) and preliminary feasibility and pilot studies: What they are and are not. Journal of Orthopedic & Sports Physical Therapy, 44(8), 555-558. https://doi.org/10.2519/jospt.2014.0110
Ahmad, S. F., & Nurwianti, F. (2020). Using Acceptance and Commitment Therapy (ACT) in a group setting to increase quality of life in university students with social media addictions. Joint Proceedings of the 3rd International Conference on Intervention and Applied Psychology (ICIAP 2019) and the 4th Universitas Indonesia Psychology Symposium for Undergraduate Research (UIPSUR 2019): Advances in Social Science, Education and Humanity Research, 494. https://doi.org/10.2991/assehr.k.201125.015
Andersson, G., & Titov, N. (2014). Advantages and limitations of Internet-based interventions for common mental disorders. World Psychiatry, 13(1), 4-11. https://doi.org/10.1002/wps.20083
Andersson, G., & Cuijpers, P. (2009). Internet-based and other computerized psychological treatments for adult depression: A meta-analysis. Cognitive Behaviour Therapy, 38(4), 196-205. https://doi.org/10.1080/16506070903318960
Basha, E., & Kaya, M. (2016). Depression, Anxiety and Stress Scale (DASS): The study of validity and reliability. Universal Journal of Educational Research, 4(12), 2701-2705. https://doi.org/10.13189/ujer.2016.041202
Beiter R., Nash, M., McCrady, D., Rhoades, D., Linscomb, M., Clarahan, M., & Sammut, S. (2015). The prevalence and correlates of depression, anxiety, and stress in a sample of college students. Journal of Affective Disorders, 173, 90-96. https://doi.org/10.1016/j.jad.2014.10.054
Bland, H. W., Melton, B. F., Welle, P., & Bigham, L. (2012). Stress tolerance: New challenges for millennial college students. College Student Journal, 46(2), 362-375. https://psycnet.apa.org/record/2012-19556-013
Bonanno, G. A., & Burton, C. L. (2013). Regulatory flexibility: An individual differences perspective on coping and emotion regulation. Perspectives on Psychological Science, 8(6), 591-612. https://doi.org/10.1177/1745691613504116
Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., Waltz, T., & Zettle, R. D. (2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire-II: A revised measure of psychological inflexibility and experiential avoidance. Behavior Therapy, 42(4), 676-688. https://doi.org/10.1016/j.beth.2011.03.007
Bowen, D. J., Kreuter, M., Spring, B., Cofta-Woerpel, L., Linnan, L., Weiner, D., Bakken, S., Kaplan, C. P., Squiers, L., Fabrizio, C., & Fernandez, M. (2009). How we design feasibility studies. American Journal of Preventive Medicine, 36(5), 452-457. https://doi.org/10.1016/j.amepre.2009.02.002
Budiani, A. M. (2017). Acceptance and Commitment Therapy (ACT) untuk meningkatkan self-compassion pada perempuan pasien teknologi reproduksi berbantu (TRB) yang mengalami distress psikologis [Acceptance and Commitment Therapy (ACT) for enhancing self-compassion among women taking assisted reproductive technology (ART) with psychological distress [Master’s thesis, Universitas Indonesia]. Universitas Indonesia Library. https://library.ui.ac.id/detail?id=20446007&lokasi=lokal
Burns, K. (2010). At issue: Community college student success variables: A review of the literature. The Community College Enterprise, 16(2), 33-61. https://home.schoolcraft.edu/cce/search-archives/316
Chase, J. A., Houmanfar, R., Hayes, S. C., Ward, T. A., Vilardaga, J. P., & Follette, V. (2013). Values are not just goals: Online ACT-based values training adds to goal setting in improving undergraduate college student performance. Journal of Contextual Behavioral Science, 2(3-4), 79-84. https://doi.org/10.1016/j.jcbs.2013.08.002
Cowpertwait, L., & Clarke, D. (2013). Effectiveness of web-based psychological interventions for depression: A meta-analysis. International Journal of Mental Health and Addiction, 11(2), 247-268. https://doi.org/10.1007/s11469-012-9416-z
Creswell, J. W. (2015). 30 essential skills for the qualitative researcher (1st ed.). SAGE Publications, Inc.. https://us.sagepub.com/en-us/nam/30-essential-skills-for-the-qualitative-researcher/book237360
Damanik, E. D. (2006). Pengujian reliabilitas, validitas, analisis item dan pembuatan norma Depression Anxiety Stress Scale (DASS): Berdasarkan penelitian pada kelompok sampel Yogyakarta dan Bantul yang mengalami gempa bumi dan kelompok sampel Jakarta dan sekitarnya yang tidak mengalami gempa bumi [Testing of reliability, validity, item analysis, and norm construction of the Depression Anxiety Stress Scale (DASS): Based on research on study groups from Yogyakarta and Bantul which experienced earthquake and from Jakarta and neighboring regions which did not experience earthquake [Master’s thesis, Universitas Indonesia]. Universitas Indonesia Library. http://www.lontar.ui.ac.id/detail?id=94859
Day, V., McGrath, P. J., & Wojtowicz, M. (2013). Internet-based guided self-help for university students with anxiety, depression and stress: A randomized controlled clinical trial. Behaviour Research and Therapy, 51(7), 344-351. https://doi.org/10.1016/j.brat.2013.03.003
Eisenberg, D., Gollust, S. E., Golberstein, E., & Hefner, J. L. (2007). Prevalence and correlates of depression, anxiety, and suicidality among university students. American Journal of Orthopsychiatry, 77(4), 534-542. https://doi.org/10.1037/0002-9432.77.4.534
Eldridge, S. M., Lancaster, G. A., Campbell, M. J., Thabane, L., Hopewell, S., Coleman, C. L., & Bond, C. M. (2016). Defining feasibility and pilot studies in preparation for Randomised Controlled Trials: Development of a conceptual framework. PLoS ONE, 11(3):e0150205. https://doi.org/10.1371/journal.pone.0150205
Elita, Y., Sholilah, A., & Sahiel, S. (2017). Acceptance and Commitment Therapy (ACT) bagi penderita gangguan stress pasca bencana [Acceptance and Commitment Therapy (ACT) for patients with post-traumatic stress disorder]. Jurnal Konseling dan Pendidikan, 5(2), 97-101. https://doi.org/10.29210/117800
Farrand, P., & Woodford, J. (2015). Effectiveness of cognitive behavioural self-help for the treatment of depression and anxiety in people with long-term physical health conditions: A systematic review and meta-analysis of randomised controlled trials. Annals of Behavioral Medicine, 49(4), 579-593. https://doi.org/10.1007/s12160-015-9689-0
Fathiyah, K. N. (2016). Stigma dan keinginan mencari bantuan psikologis di layanan profesional: Meta analisis [Stigma and the desire to seek psychological help in professional service: A meta-analysis]. Proceeding of Seminar ASEAN 2nd Psychology & Humanity, Indonesia, 556-566. https://mpsi.umm.ac.id/files/file/556-%20566%20Kartika%20Nur%20Fathiyah.pdf
Fitasari, I. N. (2011). Faktor yang berhubungan dengan kejadian stress pada mahasiswa Fakultas Kesehatan Masyarakat Universitas Airlangga Surabaya [Factors related to the stress incidence in the undergraduate students of the Faculty of Public Health Universitas Airlangga Surabaya [Undergraduate thesis, Universitas Airlangga]. Universitas Airlangga Repository. http://repository.unair.ac.id/22942/
Gilbert, K. E., Tonge, N. A., & Thompson, R. J. (2019). Association between depression, anxious arousal and manifestations of psychological inflexibility. Journal of Behavior Therapy and Experimental Psychiatry, 62, 88-96. https://doi.org/10.1016/j.jbtep.2018.09.006
Goldberg, D. (2000). Distinguishing mental illness in primary care. British Medical Journal, 321:1412. https://doi.org/10.1136/bmj.321.7273.1412
Gravetter, F. J., & Wallnau, L. B. (2010). Statistics for the behavioral sciences (7th ed.). Cengage Learning. https://www.cengageasia.com/TitleDetails/isbn/9781305504912
Groen, R. N., Ryan, O., Wigman, J. T. W., Riese, H., Penninx, B. W. J. H., Giltay, E. J., Wichers, M., Hartman, C. A. (2020). Commorbidity between depression and anxiety: Assessing the role of bridge mental states in dynamic psychological networks. BMC Medicine, 18:308. https://doi.org/10.1186/s12916-020-01738-z
Gunadha, R., & Rahmayunita, H. (2020, April 16). Kuliah online saat Corona picu ketimpangan akses bagi mahasiswa miskin [Online study during the Coronavirus pandemic triggers inequality of access for the financially challenged undergraduate students]. Suara. https://www.suara.com/news/2020/04/16/130712/kuliah-online-saat-corona-picu-ketimpangan-akses-bagi-mahasiswa-miskin
Harris, R. (2009). ACT made simple: An easy-to-read primer on Acceptance and Commitment Therapy (1st ed.). New Harbinger Publications. https://www.newharbinger.com/9781684033010/act-made-simple/
Harris, R. (2012). The reality slap: Finding peace and fulfillment when life hurts. New Harbinger Publications. https://www.newharbinger.com/9781608822805/the-reality-slap/
Harris, R. (2017, September 26). The happiness trap: Evolution of the human mind [Video file]. YouTube. https://www.youtube.com/watch?v=kv6HkipQcfA&t=105s
Hayes, S. C. (2004). Acceptance and Commitment Therapy and the new behavior therapies: Mindfulness, acceptance, and relationship. In S. C. Hayes, V. M. Follette, & M. M. Linehan (Eds.), Mindfulness and acceptance: Expanding the cognitive-behavioral tradition (pp. 1-29). Guilford Press. https://psycnet.apa.org/record/2005-02461-001
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and Commitment Therapt: Model, processes and outcomes. Behaviour Research and Therapy, 44(1), 1-25. https://doi.org/10.1016/j.brat.2005.06.006
Hayes, S. C., Pistorello, J., & Levin, M. E. (2012). Acceptance and Commitment Therapy as a unified model of behavior change. The Counseling Psychologist, 40(7), 976-1002. https://doi.org/10.1177/0011000012460836
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2011). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press. https://www.guilford.com/books/Acceptance-and-Commitment-Therapy/Hayes-Strosahl-Wilson/9781462528943
Hebert, E., Ebert, D. D., Lehr, D., Cuijpers, P., Berking, M., Nobis, S., Riper, H. (2017). The benefit of web- and computer-based interventions for stress: A systematic review and meta-analysis. Journal of Medical Internet Research, 19(2):e32. https://doi.org/10.2196/jmir.5774
Horwitz, A. V. (2007). Distinguishing distress from disorder as psychological outcomes of stressful social arrangements. Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine, 11(3), 273-289. https://doi.org/10.1177/1363459307077541
Jacobson, N. S., Martell, C. R., & Dimidjian, S. (2001). Behavioral activation treatment for depression: Returning to contextual roots. Clinical Psychology: Science and Practice, 8(3), 255-270. https://doi.org/10.1093/clipsy.8.3.255
Kalin, N. H. (2020). The critical relationship between anxiety and depression. [Editor’s note]. The American Journal of Psychiatry, 177(5), 365-367. https://doi.org/10.1176/appi.ajp.2020.20030305
Karekla, M., Konstantinou, P., Ioannou, M., Kareklas, I., & Gloster, A. T. (2019). The phenomenon of treatment dropout, reasons and moderators in Acceptance and Commitment Therapy and other active treatments: A meta-analytic review. Clinical Psychology in Europe, 1(3), 1-36. https://doi.org/10.32872/cpe.v1i3.33058
Köhle, N., Drossaert, C. H. C., Jaran, J., Schreurs, K. M. G., Verdonck de-Leuw, I., & Bohlmeijer, E. T. (2017). User-experiences with a web-based self-help intervention for partners of cancer patients based on Acceptance and Commitment Therapy and self-compassion: A qualitative study. BMC Public Health, 17:225), 1-16. https://doi.org/10.1186/s12889-017-4121-2
Kotz, S., Read, C. B., Balakrishnan, N., Vidakovic, B., & Johnson, N. L. (2004). Encyclopedia of statistical sciences. John Wiley & Sons. https://doi.org/10.1002/0471667196
Kypri, K., Vater, T., Bowe, S. J., Saunders, J. B., Cunningham, J. A., Horton, N. J., & McCambridge, J. (2014). Web-based alcohol screening and brief intervention for university students: A randomized trial. JAMA: The Journal of the American Medical Association, 311(12), 1218-1224. https://doi.org/10.1001/jama.2014.2138
Lappalainen, P., Granlund, A., Siltanen, S., Ahonen, S., Vitikainen, M., Tolvanen, A., Lappalainen, R. (2014). ACT Internet-based vs face-to-face? A randomized controlled trial of two ways to deliver Acceptance and Commitment Therapy for depressive symptoms: An 18-month follow-up. Behaviour Research and Therapy, 61, 43-54. https://doi.org/10.1016/j.brat.2014.07.006
Leary, M. R., Tate, E. B., Adams, C. E., Batts Allen, A., & Hancock, J. (2007). Self-compassion and reactions to unpleasant self-relevant events: The implications of treating oneself kindly. Journal of Personality and Social Psychology, 92(5), 887-904. https://doi.org/10.1037/0022-3514.92.5.887
Levin, M. E., Haeger, J. A., Pierce, B. G., & Twohig, M. P. (2017). Web-based Acceptance and Commitment Therapy for mental health problems in college students: A randomized controlled trial. Behavior Modification, 41(1), 141-162. https://doi.org/10.1177/0145445516659645
Levin, M. E., Pistorello, J., Seeley, J. R., & Hayes, S. C. (2014). Feasibility of a prototype web-based Acceptance and Commitment Therapy prevention program for college students. Journal of American College Health, 62(1), 20-30. https://doi.org/10.1080/07448481.2013.843533
Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33(3), 335-343. https://doi.org/10.1016/0005-7967(94)00075-U
Luoma, J. B., & Platt, M. G. (2015). Shame, self-criticism, self-stigma, and compassion in Acceptance and Commitment Therapy. Current Opinion in Psychology, 2, 97-101. https://doi.org/10.1016/j.copsyc.2014.12.016
Marshall, E. -J., & Brockman, R. N. (2016). The relationships between psychological flexibility, self-compassion, and emotional well-being. Journal of Cognitive Psychotherapy, 30(1), 60-72. https://doi.org/10.1891/0889-8391.30.1.60
Martin, M. M., Staggers, S. M., & Anderson, C. M. (2011). The relationships between cognitive flexibility with dogmatism, intellectual flexibility, preference for consistency, and self-compassion. Communication Research Reports, 28(3), 275-280. https://doi.org/10.1080/08824096.2011.587555
Mirrowsky, J., & Ross, C. E. (2002). Selecting outcomes for the sociology of mental health: Issues of measurement and dimensionality. Journal of Health and Social Behavior, 43(2), 152-170. https://doi.org/10.2307/3090194
Musabiq, S., & Karimah, I. (2018). Gambaran stress dan dampaknya pada mahasiswa [The description of stress and its impact on undergraduate students]. InSight: Jurnal Ilmiah Psikologi, 20(2), 75-83. https://doi.org/10.26486/psikologi.v20i2.240
Neff, K. D. (2003). Self-compassion: An alternative conceptualization of a healthy attitude toward oneself. Self and Identity, 2(2), 85-102. https://doi.org/10.1080/15298860309032
Neff, K. D., Hsieh, Y. -P., & Dejitterat, K. (2005). Self-compassion, achievement goals, and coping with academic failure. Self and Identity, 4(3), 263-287. https://doi.org/10.1080/13576500444000317
Neff, K. D., Kirkpatrick, K. L., & Rude, S. S. (2007). Self-compassion and adaptive psychological functioning. Journal of Research in Personality, 41(1), 139-154. https://doi.org/10.1016/j.jrp.2006.03.004
Peraturan Pemerintah Republik Indonesia Nomor 21 Tahun 2020 Tentang Pembatasan Sosial Berskala Besar Dalam Rangka Percepatan Penanganan Corona Virus Disease 2019 (COVID-19) [Government Regulation of the Republic of Indonesia Number 21 Year 2020 Regarding Massive Scale Social Distancing in Order to Accelerate the Handling of Corona Virus Disease (COVID-19)]. (2020). Jaringan Dokumentasi dan Informasi Hukum - Sekretariat Kabinet Republik Indonesia. https://jdih.setkab.go.id/PUUdoc/176085/PP_Nomor_21_Tahun_2020.pdf
Philips, M. R. (2009). Is distress a symptom of mental disorders, a marker of impairment, both or neither? World Psychiatry, 8(2), 91-92. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2691169/
Raes, F. (2010). Rumination and worry as mediators of the relationship between self-compassion and depression and anxiety. Personality and Individual Differences, 48(6), 757-761. https://doi.org/10.1016/j.paid.2010.01.023
Saniatuzzulfa, R., & Retnowati, S. (2015). Program “Pasien PANDAI” untuk meningkatkan optimisme pasien kanker [The “Pasien PANDAI” program to increase the optimism of cancer patient]. Gadjah Mada Journal of Professional Psychology (GamaJPP), 1(3), 163-172. https://jurnal.ugm.ac.id/gamajpp/article/view/9392
Saracutu, M., Edwards, D. J., Davies, H., & Rance, J. (2018). Protocol for a feasibility and acceptability study using a brief ACT-based intervention for people from Southwest Wales who live with persistent pain. BMJ Open, 8:e021866. https://doi.org/10.1136/bmjopen-2018-021866
Sianturi, R., Keliat, B. A., & Wardani, I. Y. (2018). The effectiveness of Acceptance and Commitment Therapy on anxiety in clients with stroke. Enfermería Clínica, 28(1), 94-97. https://doi.org/10.1016/S1130-8621(18)30045-7
Stange, J. P., Alloy, L. B., & Fresco, D. M. (2017). Inflexibility as a vulnerability to depression: A systematic qualitative review. Clinical Psychology: Science and Practice, 24(3), 245-276. https://doi.org/10.1111/cpsp.12201
Stoddard, J. A., & Afari, N. (2014). The big book of ACT metaphors: A practitioner’s guide to experiential exercises and metaphors in Acceptance and Commitment Therapy. New Harbinger Publications. https://www.newharbinger.com/9781608825295/the-big-book-of-act-metaphors/
Thompson, B. L., & Waltz, J. (2008). Self-compassion and PTSD symptom severity. Journal of Traumatic Stress, 21(6), 556-558. https://doi.org/10.1002/jts.20374
Tickle-Degnen, L. (2013). Nuts and bolts of conducting feasibility studies. The American Journal of Occupational Therapy, 67(2), 171-176. https://doi.org/10.5014/ajot.2013.006270
Utami, S., Rufaidah, A., & Nisa, A. (2020). Kontribusi self-efficacy terhadap stres akademik mahasiswa selama pandemi Covid-19 periode April-Mei 2020 [The contribution of self-efficacy on undergraduate students’ academic stress during the Covid-19 pandemic period of April-May 2020]. Teraputik: Jurnal Bimbingan dan Konseling, 4(1), 20-27. https://journal.unindra.ac.id/index.php/teraputik/article/view/294
Van Dam, N. T., Sheppard, S. C., Forsyth, J. P., & Earleywine, M. (2011). Self-compassion is a better predictor than mindfulness of symptom severity and quality of life in mixed anxiety and depression. Journal of Anxiety Disorders, 25(1), 123-130. https://doi.org/10.1016/j.janxdis.2010.08.011
Wahyuni, E., Nurihsan, J., & Yusuf, S. (2018). Kesejahteraan mahasiswa: Implikasi terhadap program konseling di perguruan tinggi [Undergraduate students’ well-being: Implications on the counseling program in universities]. Insight: Jurnal Bimbingan dan Konseling, 7(1), 96-106. https://doi.org/10.21009/insight.071.08
Watson, D. (2009). Differentiating the mood and anxiety disorders: A quadripartite model. Annual Review of Clinical Psychology, 5, 221-247. https://doi.org/10.1146/annurev.clinpsy.032408.153510
Wheaton, B. (2007). The twain meets: Distress, disorder and the continuing conundrum of categories (comment on Horwitz). Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine, 11(3), 303-319. https://doi.org/10.1177/1363459307077545
World Health Organization. (n.d.). Mental health ATLAS 2017 member state profile. World Health Organization. Retrieved January 16, 2021 from https://www.who.int/mental_health/evidence/atlas/profiles-2017/IDN.pdf
Yadavaia, J. E., Hayes, S. C., & Vilardaga, R. (2014). Using Acceptance and Commitment Therapy to increase self-compassion: A randomized controlled trial. Journal of Contextual Behavioral Science, 3(4), 248-257. https://doi.org/10.1016/j.jcbs.2014.09.002
Zahra, N. A., Anelis, S., & Dian, G. (2019, October 14). Melawan stigmatisasi kesehatan mental [Against the stigmatization of mental health]. Economica. https://www.economica.id/2019/10/04/melawan-stigma-gangguan-kesehatan-mental/
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Articles published in ANIMA are licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International license. You are free to copy, transform, or redistribute articles for any lawful, non-commercial purpose in any medium, provided you give appropriate credit to ANIMA and the original Author(s), link to the license, indicate if changes were made, and redistribute any derivative work under the same license.
Copyright on articles is retained by the respective Author(s), without restrictions. A non-exclusive license is granted to ANIMA to publish the article and identify itself as its original publisher, along with the commercial right to include the article in a hardcopy issue for sale to libraries and individuals.
By publishing in ANIMA, Author(s) grant any third party the right to use their article to the extent provided by the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International license.