Promoting Well-Being and Psychological Thriving in University Students: A Gestalt-Mindfulness-Based Personal Development Counseling Intervention ()
1. Introduction
University education is designed to prepare students for academic life and equip them for successful adulthood. College students often experience stress and anxiety as they adjust to the challenges of their academic and personal lives. They struggle with several academic concerns, family problems, and issues relating to intimate and social relationships, finances, personal appearance, and personal health. Research on the Greek student population has shown that the majority of students have low scores for Life Satisfaction ( Paschali & Tsitsas, 2010 ; Tsitsas et al., 2019 ) and high levels of stress due to the economic crisis ( Mouza, 2015 ). Nowadays, there is an increasing number of students claiming assistance in counseling centers on campus, indicating an increasing need for mental health among students ( Chiodelli et al., 2022 ). Student wellness has always been a major concern for universities ( Xiong et al., 2022 ). To address this concern, college mental health services have implemented mindfulness-based interventions (MBIs).
The practice of mindfulness has its roots in Eastern philosophy and the Buddhist tradition. It represents an inherent capacity of the human organism ( Brown & Ryan, 2003 ; Kabat-Zinn, 2003 ) and is a human ability to be Present and Aware ( Siegel, 2018 ). Mindfulness is defined as “intentional, nonjudgmental attention in the present moment” ( Kabat Zinn, 1994: p. 4 ) carried out with openness, curiosity, kindness, and flexibility. While mindfulness begins as a technique (formal or informal), it eventually transforms into a way of being in the world ( Kabat-Zinn, 1994 ). Mindfulness is the act of keeping one’s consciousness alive to the present reality ( Hanh, 1975 ), and is an integral process of growth that can be fostered through training, practice, or psychotherapy ( Brown et al., 2007 ). The goals of psychotherapy and mindfulness are different. Mindfulness aims to connect the person to Source and free them from unhappiness, while psychotherapy aims to help a person integrate aspects of the self, and take responsibility for their own life and self-realization. Nowadays, mindfulness is being used in clinical practice as “assimilative integration” ( Walsh & Shapiro, 2006: p. 227 ) through various psychotherapeutic approaches; each with its foundations, goals, and strategies ( Hayes & Shenk, 2004 ; Kabat-Zinn, 1990 ; Linehan, 1994 ; Segal et al., 2007 ). MBIs are being used to help students prevent and manage psychological crises and increase well-being, and are now part of college mental health services ( Bamber & Morpeth, 2019 ; Dawson et al., 2020 ; Daya & Hearn, 2018 ; De Vibe et al., 2018 ; Galante et al., 2021 ; Lin & Mai, 2018 ; Miller et al., 2022 ; Reavley, 2018 ; Rosky et al., 2022 ; Xiong et al., 2022 ; Zollars et al., 2019 ).
Gestalt Therapy (GT) as a psychotherapeutic approach was developed in the 1940’s. It is a synthesis of incorporated various elements such as psychoanalysis, phenomenology, existential philosophy, Gestalt psychology, holism, field theory, and Far East philosophy ( Corey, 2017 ; Crocker & Philippson, 2005 ; Fall et al., 2017 ; Gold & Zahm, 2022 ; Mann, 2010 ; Wagner-Moore, 2004 ). GT develops present moment awareness of and direct contact with their internal world and the environment. GT aims to increase awareness in the present moment through bodily sensations, senses, emotions, thoughts, and behaviors. GT focuses on primary experience which is sensory and perceptual—immediate, in the moment, and embodied ( Gold & Zahm, 2022 ). It emphasizes the importance of experiencing full, authentic functioning in the moment ( Brown et al., 2007 ) and the way that individuals relate to their experience, leading to be understood holistically and contextually. GT is future-oriented emphasizing Here and Now, self- awareness, and personal responsibility. It aims to help individuals to be and act in a way that best satisfies their needs in the present situation, developing a more authentic sense of self, and promoting personal growth and well-being through enhanced self-regulation and self-support ( Skottun & Krüger, 2022 ).
We hypothesized that students who take part in the Personal Development counseling group would display improved outcomes in the areas of well-being (decreasing depression, anxiety, and stress) and awareness (including mindfulness and emotional intelligence) compared to the control group at the end of the intervention.
1.1. Awareness, Mindfulness, and Emotional Intelligence
Awareness is the cornerstone of GT. GT’s goal is for the clients to gain awareness by being willing to stay present in the “here” and “now” experience, positive or negative ( Spagnuolo Lobb, 2013 ; Yontef & Jacobs, 2005 ) and paying attention to the structure of their experience, what one is experiencing and how is doing it ( Corey, 2017 ). Recent research by Öztürk (2019) has found that implementing a Gestalt-based intervention group for students can lead to increased awareness levels. Mindfulness, as defined by Kabat-Zinn (1994) , involves intentionally focusing on the present experience in a non-judgmental way. This practice cultivates receptive attention and awareness toward both external and internal experiences, which can add clarity to one’s current experience and help in recognizing body sensations, thoughts, and emotions ( Brown et al., 2007 ; Brown & Ryan, 2003 ). Both GT and mindfulness practices, while not specifically targeting emotional intelligence, contribute to the development of emotions as a significant aspect of the overall experience ( Barber, 2012 ). Emotional intelligence reveals the degree to which one embodies emotional performance such as the ability to understand and be able to express his/her emotions naturally; the ability to perceive and understand the emotions of others; the ability to regulate their emotions and to recover from psychological distress; the ability to direct their emotions towards constructive activities and personal performance ( Wong & Law, 2002 ). Many authors intend to investigate the effect of MBI on EI or the correlation between them ( Bao et al., 2015 ; Chu, 2010 ; Kong & Zhao, 2013 ; Ruiz-Aranda et al., 2014 ; Schutte & Malouff, 2011 ; Seppälä et al., 2020 ; Sharma & Gupta, 2021 ; Snowden et al., 2015 ; Wang & Kong, 2014 ).
1.2. Awareness and Depression Anxiety and Stress
Awareness is an experience that links individuals with the present reality ( Joyce & Sills, 2014 ) and it allows them not to slip into the past or the future. GT encourages people to heightened awareness and attending contact, at contact boundaries. Healthy contact from a GT perspective, involves awareness and excitement ( Perls et al., 1951 ) and contact boundaries permeable and flexible to maintain contact/withdrawal from the environment and to sustain growth and development ( Mann, 2010 ). As social and relational beings, we regulate our relationships ( Geller, 2020 ). If the excitement, which should lead to contact, is a power vacuum leads to isolation. On the other hand, anxiety results from neglecting personal needs, punitive self-criticism, constricted breathing, and futurizing. Anxiety is the result of inadequate breathing support ( Perls et al., 1951 ), and is a psychosomatic event. To allay anxiety Perls et al. (1951) suggest breathing exercises and open dialogue between the top dog and the underdog, the controlling and the subjugated part of the self, ( Joyce & Sills, 2014 ) developing self- compassion ( Kirkpatrick, 2005 ). Breathing is the anchor in the here and now ( Hanh, 2010 ), mindful breathing is a way of tackling the futurizing tendency in anxious people by bringing their awareness back to the here and now ( Gold & Zahm, 2018 ; Olendzki, 2013 ; Shapiro et al., 2006 ; Yontef & Jacobs, 2005 ). Mindfulness breathing was practiced to prevent participants from being overwhelmed by their anxious emotions, feelings of uncontrollability and helplessness and to regulate emotional arousal. A goal of gestalt therapists is to help anxious people get back to the present moment and stay with positive or negative experiences during the breathing process reducing their urge to escape from their experience ( Khor, 2019 ; Spagnuolo Lobb, 2013 ). Mindfulness has a stabilizing function ( Germer et al., 2013 ; Hill & Updegraff, 2012 ). MBIs have effective benefits in alleviating stress when implemented in a neutral environment for university students and not in stressful conditions ( Myint et al., 2011 ). A meta-analysis ( González-Valero et al., 2019 ) showed that MBIs produce significant results in the reduction of stress, anxiety, and depression in students. MBIs have been found to protect against changes in depression ( Finkelstein-Fox et al., 2018 ) to reduced psychological distress among college students ( Miller et al., 2022 ) to increased resilience to stress ( Galante et al., 2018 , 2020 , 2021 ) to decreased psychological distress and perceived discrimination among international college students ( Xiong et al., 2022 ). Additionally, Cozzolino et al. (2020) argued that a mind-body intervention for stress reduction was effective and sustainable in a nonclinical group of university students.
1.3. The Current Study
Intervention counseling group aimed to support student’s personal development by enhancing their awareness. This study investigates whether a “Gestalt Personal Development Group” had beneficial effects on depression, anxiety, and stress, mindfulness skills, and emotional intelligence of undergraduate students who participated in the group counseling program prepared by the researchers compared to the control group. Researchers developed a mixed Gestalt-based with mindfulness practices “Personal Development Group” intervention program which was offered as a workshop for university students in a psychology course. Mindfulness practices were included as mediative gestalt experiments, to facilitate participants’ awareness and insight, making it consistent with the growing trend of using mindfulness practices to enhance college students’ personal growth and well-being ( Dvořáková et al., 2017 ). GT utilizes a phenomenological approach, dialogical commitment, field approach, and experimental process. It is an adequate approach to address on healthy population ( Corey, 2017 ; Ginger, 2007 ) and acknowledges the human capacity for growth and healing through interpersonal contact and insight ( Skottun & Krüger, 2022 ; Yontef, 1993 ).
According to the purpose of the study, the following research questions were formulated:
1) Is there a significant difference between the pre-posttest score averages of intervention group participants’ depression, anxiety, and stress compared to those of the control group?
3) Is there a significant difference between the pre-posttest score averages of intervention group participants’ awareness, attention, and mindfulness compared to those of the control group?
4) Is there a significant difference between the pre-posttest score averages of intervention group participants’ emotional intelligence compared to those of the control group?
2. Methodology
The participants were university students at Harokopio University. Their participation was voluntary, and they agreed to answer anonymously, some demographic questions related to their age, gender, and professional status. They also completed a series of self-report measures one week before the intervention began, and one week after it ended. Greek versions were used for all measures and the questionnaires were distributed to the participants in a counterbalance order.
2.1. Participants
The sample consisted of 207 participants. One hundred and forty-seven (147) of them formed the intervention group and 60 formed the group which received no intervention. All participants were undergraduate students. The mean age of the intervention group was M = 19.68 (SD = 2.94) and the no-intervention group was M = 19.75 (SD = 1.78). There was no significant difference in gender between the experimental and control groups particularly, 70.3% (103) in the intervention group and 70% (42) of the control group were females.
2.2. Procedures
There were two groups of participants, intervention, and control, who attended different study courses and had no prior relationship that could affect the spread of information. All potential participants were adequately informed before participation and signed consent forms. Two hundred undergraduate students were invited to participate in each group, making a total of 400 students. Of these, 200 participated in the “Personal Development” group as part of their academic curriculum. These constituted the intervention group. The remaining 200 were undergraduate students who had not participated in any counseling group. Of those invited, 189 intervention and 85 control group participants consented to participate. Out of those, 148 intervention and 60 control group participants completed both baseline and endpoint assessments and were analyzed further.
2.3. Intervention
The Personal Development Group program is designed to help participants enhance their perception awareness through bodily sensations, senses, culture, emotions, imagination, and intuition. This is achieved through existential dialogue, phenomenological approach, and experiments. The program’s structure is based on Barber’s multiple-reality model of facilitating change, a Gestalt-based intervention, which incorporates elements of mindfulness providing a holistic approach ( Barber, 2012 ).
The researcher designed the intervention program considering the results of previous research which suggest that students’ intervention programs have better outcomes in not stressful conditions ( Myint et al., 2011 ) and their duration must be longer than 8 sessions ( Bamber & Morpeth, 2019 ). The intervention program consisted of 10 weekly sessions, 90’ each, that were conducted in groups of 15 (±2) participants. The program was based on the GT counseling group and was called the “Personal Development Group” program, which was developed using GT’s principles and methods. The program aimed to develop awareness, dialogic relationships, working in the present moment, phenomenological practices, embodied awareness, experimental attitudes, and mindfulness practices. To promote intrapersonal awareness, meditation exercises, and mindfulness practices were included. To enhance interpersonal awareness, mindful contact and dialogue were encouraged within the group. Each session lasted for 90 minutes and followed a specific structure: 1) short group “check-in” sharing, 2) introduction to the theme and session plan, 3) Gestalt and mindfulness practices, 4) sharing in dyads or triads, and 5) sharing and exchanges in the whole group. The intervention program included experiential and experimental gestalt techniques and mindfulness practices, with each session focusing on a specific topic.
Hence, the GT intervention program was manualized but not as a stereotyped program protocol, allowing for modifications to meet each group’s current needs ( Brownell & Roubal, 2019 ).
3. Measures
The independent variable was the personal development intervention program with mindfulness practices for 10 weeks. The dependent variables were mindfulness, emotional intelligence, depression, anxiety, and stress. All participants were asked to fill in the following questionnaires before and after the application of the intervention.
3.1. Demographic Data
Participants were asked to answer some demographic questions related to their age, gender, and professional status.
3.1.1. Depression, Anxiety, Stress Scale ( Lovibond & Lovibond, 1995 )
The Greek version ( Lyrakos et al., 2011 ) of Depression, Anxiety, Stress Scale ( Lovibond & Lovibond, 1995 ) was used. A self-reported scale refers to three dimensions that measure depression, anxiety, and stress and consists of 21 items. Each of the three dimensions contains 7 items. The depression scale assesses dysphoria, hopelessness, lack of interest, and inertia. The anxiety scale assesses autonomic arousal and subjective experience of anxious affect. The stress scale assesses difficulty relaxing, nervous arousal, and being easily agitated, irritable, and impatient. Responses were given on a 4-point scale from 0 (Did not apply to me at all) to 3 (Applied to me very much or most of the time). This scale provides three scores one for each subscale of depression, anxiety, and stress. The Greek scale researchers reported a Cronbach’s alpha for Depression α = 0.96, Anxiety α = 0.90, and Stress α = 0.94. For the present study was α = 0.85 for Depression, 0.81 for Anxiety, and 0.81 for Stress.
3.1.2. Mindfulness, Attention and Awareness Scale ( Brown & Ryan, 2003 )
The Greek scale of the Mindful Attention, and Awareness Scale ( Brown & Ryan, 2003 ) was used. The scale is a 15-item, single-factor instrument that measures one’s tendency to function on automatic pilot without attention to present experience, with a high score indicating increased mindfulness. Responses were given on a 6-point scale from 1 (almost always) to 6 (almost never). The original version of the scale reported a Cronbach’s alpha of α = 0.82 ( Brown & Ryan, 2003 ) and for the Greek scale, researchers reported a Cronbach’s alpha of α = 0.86 ( Mantzios & Wilson, 2013 ), for the present study was α = 0.82.
3.1.3. Emotional Intelligence ( Wong & Law, 2002 )
The Greek version ( Kafetsios & Zampetakis, 2008 ) of the Wong & Law Emotional Intelligence Scale ( Wong & Law, 2002 ) was used. The self-reported scale consists of 16-item, and is a four dimensions instrument that measures the Self-Emotion Appraisal (SEA) dimension assesses an individual’s self-perceived ability to understand their emotions; the Use of Emotion (UOE) dimension concerns the self-perceived tendency to motivate oneself to enhance performance; the Others’ Emotion Appraisal (OEA) dimension assesses a person’s tendency to be able to perceive other peoples’ emotions; and the Regulation of Emotion (ROE) dimension concerns individuals’ perceived ability to regulate their own emotions. Coefficients alphas for the four elements were: SEA: 0.84; OEA: 0.66; ROE: 0.84; UOE: 0.77 and for the total scale WLEIS: 0.90.
3.2. Data Analysis Statistical Analysis
The data collected were analyzed using the SPSS statistical software IBM Statistics 23.0 for Windows. Continuous variables are presented with mean and standard deviation (SD). Categorical variables are presented with absolute and relative frequencies. For the comparison of proportions chi-square and Fisher’s exact tests were used. Student’s t-test was used to compare mean differences between the two groups. Differences in changes in study subscales scores during the follow-up period between the two study groups were evaluated using repeated measurements analysis of variance (ANOVA). All p values reported are two-tailed. Statistical significance was set at 0.05.
4. Results
Regarding the differences between the two groups at baseline, there were no statistically significant differences in the instruments’ scores, at the baseline assessment as indicated by Table 1. Table 1 shows changes in Depression, Anxiety and Stress Scale (DASS 21), Mindfulness Attention, Awareness Scale (MAAS), and Wong &Low Emotional Intelligence Scale (WLEIS) at the end of the intervention period for both the intervention and the control group. Scores on Depression, Anxiety and Stress Scale, Mindfulness Attention, Awareness Scale, and Wong &Low Emotional Intelligence Scale were significantly ameliorated only in the intervention group, resulting in better scores as compared to the control group at post measurements. The differences between the two groups at the end- point assessment were in all cases statistically significant in favor of the intervention group. The overall change in the aforementioned subscales was significantly different between the two groups as indicated by the significant interaction effect of the analyses. Furthermore, all time-group interaction effects indicated significant melioration for the intervention group in contrast with the control group which remained unchanged.
5. Discussion
The present study investigated whether the “Gestalt Personal Development Group Program” was effective in increasing undergraduate students’ aspect of well-being. The study, primarily, explored whether the experimental and control groups were equal concerning aspects of students’ well-being, assessed through the Depression, Anxiety, Stress Scale (DASS 21), Mindful Attention Awareness Scale (MAAS), and Emotion Intelligence (WLEIS). Analysis of the pretest results showed that the groups were similar in terms of all variables.
The results supported the study’s first research question and showed significant differences in the levels of the three psychological indices in the pretest and posttest. More precisely, the levels of depression, anxiety, and stress were prominently reduced for the participants after the intervention. These findings are consistent with GT intervention, showing a positive impact on depression, anxiety and stress of Yezidi women who lived on campus after having experienced traumatic
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Table 1. Differences in scores of DASS 21, MAAS, and WLEIS between the Control and Intervention groups at two assessments, at the start and the end point of the intervention program.
1P-value for group effect; 2P-value for time effect; 3P-value for interaction—effects reported include differences between the groups in the degree of change (repeated measurements ANOVA).
events ( Ali & Cerkez, 2020 ). The study of Gestalt group meditation therapy for career women in Korea also demonstrated a reduction in occupational stress and anxiety in participants ( Kim, 2009 ). Additionally, in line with the previous studies is the gestalt intervention group for anxious parents in Hong Kong ( Leung & Khor, 2017 ). On the other hand, these findings are in line with the meta- analysis of articles reporting interventions targeting the variables of depression, anxiety, stress in the educational field, and the MBIs results are and significant concerning the reduction of stress, anxiety, and depression in students ( González- Valero et al., 2019 ). Moreover, Bamber & Morpeth (2019) claim it must take at least 10 sessions to see anxiety reduction, which is in line with the present intervention.
The study’s second research question found that the intervention group improved their mindfulness skills, while the control group did not. This aligns with previous studies on MBI that also reported an increase in awareness levels ( Brown & Ryan, 2003 ; Canby et al., 2015 ; Chiodelli et al., 2018 ; Crowley et al., 2022 ). The present study’s findings align with GT-based intervention research, which revealed university students’ personal growth ( Arip et al., 2013 ; Öztürk & Yüksel, 2015 ) and enhancement of levels of awareness ( Öztürk, 2019 ). It should be noted that the effectiveness of MBIs was found to be dependent on the mindfulness of both participants and therapists ( Davis & Hayes, 2011 ; Khoury et al., 2013 ).
The third research question was intended to examine any significant difference between the pre-posttest score averages of Personal Development group participants’ Emotional Intelligence compared to those of the control group. The findings are consistent with previous studies demonstrated that the level of mindfulness associated with Emotional Intelligence ( Bao et al., 2015 ; Kong et al., 2012 , 2014 , 2019 ; Kong & Zhao, 2013 ; Schutte & Malouff, 2011 ; Wang & Kong, 2014 ).
6. Limitation and Further Research
The results of the present study showed that the mindfulness-GT-based “Personal Development” group is an effective intervention for undergraduate students.
However, some limitations of the present study should also be considered. First, the principal investigator served as a counselor to the intervention group which may have influenced the score of the self-reported scores instruments in a way that favored the investigator to please her. Secondly, there was a gender imbalance among the participants. Thirdly, there was the rate of non-participation in the study, mainly for the control group, which may affect the generalization of results. Another limitation of the present study is that the impact of the intervention was measured immediately after it was over. Finally, the intervention program was limited to participants from a single department at a university in Athens.
Given the above limitations, we have some suggestions. To address the issue of the counselor/investigator being the same person and to obtain a more balanced view of the impact of experiential intervention, we propose using mixed methods—quantitative and qualitative ( Dattilio et al., 2010 ). Additionally, we recommend creating an equal representation of gender and implementing the intervention program in various university departments, including follow-up measurements. Furthermore, we suggest conducting future studies to investigate the effects of similar interventions and to compare the effects with other beneficial MBIs.
7. Conclusion
University counseling centers are experiencing a high demand for mental health services to support student well-being throughout their academic journey. The “Personal Development Group” program, which combines MBIs and GT counseling, has been successful in enhancing self-awareness, emotional intelligence, and overall life satisfaction for participants. This study suggests that the program has potential for long-term benefits, including improved academic performance, as students with better psychological well-being and self-awareness tend to excel in their studies. It is recommended that similar programs be implemented in university curriculums to assist students in coping with challenges and preparing for adulthood.
Acknowledgements
We wish to express our gratitude to Katerina Maridaki Kassotaki, who always continues to encourage, inspire, and accompany us, and all the students who boost us to ameliorate the counseling services.
Ethics Approval
All procedures of this study were performed under the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. All persons gave informed consent before inclusion in the study.