A Culturally Adapted Online Acceptance and Commitment Therapy (ACT) Intervention for Chinese International Students: Protocol for a Feasibility, Acceptability, and Exploratory Effectiveness Randomized Controlled Trial (Preprint)
BACKGROUND Chinese international students studying abroad experience elevated levels of psychological distress due to acculturative, academic, and social challenges, yet they frequently encounter barriers to accessing mental health support. Acceptance and Commitment Therapy (ACT) has demonstrated beneficial effects on psychological flexibility and mental health outcomes across diverse populations. However, evidence regarding the feasibility and acceptability of culturally adapted ACT interventions for Chinese international students remains limited. OBJECTIVE This study aims to evaluate the feasibility and acceptability of a culturally adapted online ACT intervention for Chinese international students in the United Kingdom and to generate preliminary estimates of its effects to inform the design of a future definitive randomized controlled trial (RCT). METHODS This three-arm, parallel-group feasibility RCT aims to recruit 60 Chinese international students from UK universities. Participants will be randomly assigned in a 1:1:1 ratio to 1) a 5-week culturally adapted online ACT group intervention, 2) a time-matched online psychoeducation active control group, or 3) a waitlist control group. Assessments will be conducted at baseline (T0), immediately after the intervention (T1), and at the 1-month follow-up (T2). Primary outcomes include feasibility and acceptability, assessed through recruitment, intervention completion, assessment retention, data completeness, participant satisfaction, and focus group interviews. Exploratory outcomes include psychological flexibility (CompACT), psychological distress (DASS-21), and subjective well-being (PANAS and SWLS). Quantitative feasibility and acceptability outcomes will be analyzed descriptively, while qualitative data will undergo reflexive thematic analysis. Exploratory intervention effects will be examined using mixed-design analyses of variance and effect size estimation. RESULTS Participant recruitment and data collection were completed in November 2025. Statistical analyses had not commenced at the time of manuscript preparation. Results will be reported following completion of the feasibility trial. CONCLUSIONS This feasibility trial will evaluate the feasibility and acceptability of a culturally adapted online ACT intervention for Chinese international students. Its findings will inform the design and conduct of a future definitive RCT. CLINICALTRIAL Chinese Clinical Trial Registry ChiCTR2600124236; https://www.chictr.org.cn/showprojEN.html?proj=307398