Where to Start? Impact of Module Ordering in Acceptance and Commitment Therapy for Young Adults Experiencing Paranoia and Low Mood

Background: Paranoia is common in young adults and often occurs alongside low mood. Brief transdiagnostic interventions may therefore be useful for students who do not meet criteria for specialist psychosis services but experience distressing suspicious thoughts. This single-case experimental study evaluated a six-session Acceptance and Commitment Therapy (ACT) intervention and explored whether the order of ACT modules differentially impacted therapy effects. Method: Ten UK university students aged 18-25 with elevated paranoia and mild to moderate depressive symptoms completed daily visual analogue measures of paranoia, affect and ACT processes during baseline, intervention and two-week follow-up. Participants were randomised to receive either ACT-ENGAGE sessions first (values and committed action) followed by ACT-OPEN sessions (mindfulness, defusion and acceptance), or the reverse order. Standardised measures of paranoia, mood and psychological flexibility were completed at baseline, pre-intervention, post-intervention and follow-up. Results: Daily data showed significant reductions in state paranoia, negative affect and improvements in openness and valued action for the ACT-ENGAGE-first condition only. Standardised paranoia scores improved reliably in both conditions, while depression improved more clearly in the ACT-ENGAGE-first condition. Conclusions: Findings provide preliminary evidence that a brief ACT intervention may benefit students experiencing paranoia and low mood, and suggest that beginning with values and committed action may strengthen clinical impact.