Intervention (Hidden)
The Mind Tutor – development and content
The current study aims to test a digital tool – Mind Tutor- which was developed in conjunction with students and university wellbeing services, in order to provide students with tools to use to manage their wellbeing whist at university. MIND TUTOR integrates academic support with wellbeing support based on feedback from students. MIND TUTOR uses an artificial intelligence (AI) tool, whereby users interact with a chatbot.
Mind Tutor was developed to address five key areas relating to student wellbeing and attainment. Data from student wellbeing services, student support, a focus group study and consultation with students in a lecture (see Appendix B for a summary of the data from these areas) were used to select the five areas, which are outlined below:
1. Anxiety - As one of the most common mental health problems faced by students anxiety is important focus for the MIND TUTOR (Thorley, 2017). Research suggests that both generalised anxiety and social anxiety are concerns in the UK student population (Broglia et al., 2021).
2. Mood -Students commonly present to university counselling service with symptoms of depression (Broglia et al., 2021). Mood related topics also relate to coping with feelings of low mood, anger, sadness and worry and enhancing positive emotions (Thorley, 2017).
3. Managing academic work - Academic distress is another common reason that students attend wellbeing services at universities in the UK (McKenzie et al., 2015). Working to deadlines, setting goals relating to assignments and understanding how to get support are key issues in enabling students to manage their academic work.
4. Transitions/ balance - Becoming independent in work and life, balancing work and social life and feeling a sense of autonomy are further challenges that students face (Thorley, 2017). Our data shows that while this transition is an exciting time for students, there are uncertainties that may lead to a loss of confidence or distress. Balance is a key aspect here as shown within our focus groups and lecture survey.
5. Relationships – creating and maintaining connections with others - Connecting with other people is vital. When students move away from home they must develop new friendships as well as stay connected to others at home and elsewhere. As friends may be the first people they turn to when they are feeling worried about studying or their wellbeing, then maintaining new connections is also important. Some students report feeling under pressure to maintain friendships by socialising more than they want to, which may include increased drinking or use of other substances through perceived or actual peer pressure. This is particularly the case for students who feel they have missed out on social activities because of the pandemic. However a fear of missing out (FOMO) has been prevalent in student populations for a number of years (Crawford et al., 2021)
Other topics for consideration in later version of the Mind Tutor included accessing services and signposting, increasing knowledge about mental health, challenging stigma (including self-stigma), dealing with finances.
Within the MIND TUTOR, participants interact with a chatbot (the ‘Mind Tutor’), which identifies which of the five topics they need help with. Once this is identified, the Mind Tutor directs the participant to receive one of five interventions. Participants may then complete a further intervention, or all possible interventions within that topic. They may also go back to the main menu and start looking at another topic. The interventions consist of the following behaviour change techniques and/or tools.
1. Provision of information
Mental Health Literacy (MHL) refers to “knowledge of how to prevent mental disorders; recognition of when a disorder is developing; knowledge of help-seeking options and treatments available; knowledge of effective self-help strategies for milder problems, and first aid skills to support others who are developing a mental disorder or are in a mental health crisis.” (Jorm, 2012). Some studies have shown that students have low levels of MHL overall, and that those who need help the most are the least likely to seek it (Gorczynski et al., 2017). Thus, the MIND TUTOR includes information about the five topics with the aim of increasing knowledge of the issues as a starting point.
2. Goal setting
Given that students need to succeed in their academic goals whilst maintaining high levels of subjective wellbeing, the introduction of goal-setting techniques is of vital importance as goal setting has been shown to improve goal-performance but also can help students maintaining high levels of subjective well-being. Examples of goal-setting techniques the students are introduced are: learning goals (Grant & Dweck, 2003), implementation intentions (Gollwitzer, 1999) as well as exercises based on the goal-striving reasons framework (Ehrlich & Milston, 2022).
3. Mindfulness
Low dose mindfulness has been shown to be effective in improving psychological resilience and coping, and in reducing exam stress in undergraduate populations (Galante et al., 2021; Loucks et al., 2021). Digital mindfulness programmes similarly apparently have potential to target anxiety in students (Lahtinen & Salmivalli, 2020). Mindfulness has also been shown to have potential to improve inter and intra-personal relationships, sleep, self-care, and self-regulation (Jiang et al., 2021; Leyland et al., 2018; Pratscher et al., 2018; Viskovich & De George-Walker, 2019). The integration of digital mindfulness with practical task-orientated goal setting, which also has potential to improve students' wellbeing, might have a greater culminate impact on psychological wellbeing than the two alone.
4. Skills and actions
Taking a small step towards a larger goal, or developing a new coping strategy to deal with feelings of unease can alleviate feelings of worry in the short term. Thus, the MIND TUTOR includes a number of suggested skills and actions for participants to try out. These include writing down feelings, taking a break and going outside, taking exercise and making a study calendar.
5. Reframing
Reframing is a technique to aid with coping in stressful situations. Students may encounter numerous new and unfamiliar stressors when they enter university. It is normal to feel worried when facing a new situation, and recognising that this is a natural reaction may assist in learning to manage stress (Hughes et al., 2011). Thus, the MIND TUTOR includes micro-articles on each topic to highlight that it is normal to feel certain ways.