An Online Wellness Intervention for Internalizing Symptoms in College Students: A Multi-site Randomized Controlled Trial Evaluating the Efficacy of The Common Elements Toolbox (COMET)

Untreated internalizing symptoms among young people is a large public health problem. One way to expand access to care involves developing and disseminating evidence-based online interventions. Previous research has shown that online interventions can be effective, even as single-session interventions (SSIs), and that they are well-received by users. The Common Elements Toolbox (COMET) is composed of four modules derived from various psychotherapy packages. Several open trials and a recent randomized controlled trial (RCT) support the efficacy of COMET, while a recent large-scale RCT casts doubt on its efficacy. We evaluated the efficacy of the COMET SSI with accompanying online support to promote skill practice vs. an attention-matched waitlist control (WLC). We evaluated group differences in depression, anxiety, and well-being, as well as positive and negative affect among undergraduates (N = 453). Outcomes were assessed 2-, 4-, and 8-weeks post-intervention. Results suggest that, relative to participants in the WLC, participants randomized to COMET experienced decreases in depression (SMD = -0.24, 95% CI: [-0.42, -0.06]) and anxiety (SMD = -0.30, 95% CI: [-0.50, -0.11]), along with small non-significant increases in positive affect (SMD = 0.18, 95% CI: [-0.10, 0.45]) and well-being (SMD = 0.19, 95% CI: [-0.03, 0.40]). Overall, the results provide support for COMET’s efficacy as a low-intensity mental health intervention for college students.