A Local Community Course That Raises Mental Wellbeing and Pro-Sociality

trained facilitator

This is how they describe their facilitators:

The course is manualised and scalable: each course is led by two volunteers – screened by Action for Happiness for motivation and skills, and once approved, provided with structured resources – as facilitators on an unpaid basis in their local communities. Recruitment of course leaders follows a carefully documented, standardised process: each candidate completes a Leader Registration process sharing their motivation and skills and is given clear instructions on what is required. Once potential course leaders have a co-leader, venue, and dates in mind, they complete a Course Application process. The team at Action for Happiness reviews this application and, if all criteria are met, arranges a call to discuss next steps. Once a course is fully approved, course leaders receive on-going guidance and support. There is also a post- course follow-up process.

Not sure if that's what you had understood and meant with 'trained facilitator' (just wanted to make it clear that it doesn't mean licensed behavioral therapist or something).

Thanks for your thoughts!

Yes, regarding persistence they also note:

To look at treatment effect persistence, we exploit data points at follow-up in an extended sample. As all respondents have been treated at follow-up, we cannot estimate causal effects, so that results are exploratory.

I'm also pretty uninformed on the biomarkers aspect. Beyond what they say in the paper:

One reason why we do not find significant effects on biomarkers at conventional levels may be power issues combined with relatively noisy measures. Another, related reason may be the composition of our sample: high levels of pro-inflammatory cytokines have been found for major depression; respondents in our sample, however, report, on average, only mild depressive symptomatology, pre-treatment. In fact, we find that only eight out of 133 respondents (about 6%) report strong depressive symptomatology, as indicated by PHQ-9 scores of fifteen or higher. Moreover, even amongst these, only about a third show associated elevated inflammation (Wium-Andersen and Nielsen, 2013). For cortisol, individual differences and timing of measurement matter; it has been found to be a rather short-term measure for stress (Miller et al., 2007).

I found Table 5 here gives a bit more context on the correlation between these biomarkers and different outcomes.

As far as comparisons, they say:

Impacts on subjective wellbeing, mental health, and pro-sociality are large: the course increases life satisfaction on a zero-to-ten scale by about one point, more than being partnered as opposed to being single (+0.6) or being employed as opposed to being unemployed (+0.7) (Clark et al., 2018). It is more than double the effect of ENHANCE, a 12-week course focusing primarily on positive habits, skills, and attitudes, which is probably the most comparable intervention (Kushlev et al., 2017). 28 However, the authors are able to track outcomes over a longer period of time, up to six months post-treatment. Finally, the effect on life satisfaction is somewhat larger than effects found in trials by the UK Big Lottery Fund, which funded a wide range of wellbeing programmes (fourteen portfolios, each consisting of three to 34 actual trials) from 2008 to 2015 at a volume of £200 million. Trials typically included community-based activities such as horticultural activities, cooking lessons, or sports events. As a conservative estimate, they increased life satisfaction on a zero-to-ten scale by, on average, 0.5 points for six months post-treatment (New Economics Foundation-Centre for Local Economic Strategies, 2013). Different from our intervention, however, these trials all targeted specific groups with mental health needs, including overweight adults, families with young children, or people with substance use disorders.