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Evidence and Research - The Research behind the Big 5
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Our clinical research program on The Big 5 began with two simple questions:

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  1. What are the things we can do each day to support our mental health?

  2. If so, how often should we do these?

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We asked these questions because:

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  1. Scientific models of mental illness emphasise the role of genetics, biology or environment on mental health, and place less importance on the things that people do each day.

  2. Although research had found that some actions (for example, practicing kindness or gratitude) are linked to mental health, there is little information about which actions are most important.

  3. Most people don’t know that their everyday actions have an impact on their mental health – instead, many rely on psychiatric medications or counselling, without also looking at what they can do to become more resilient.

 

Overall Results

  1. In studies with more than 20,000 people, we have consistently found that The Big 5 have a strong relationship with mental health. That is, the more often people do the Big 5 each week, the lower their symptoms of depression and anxiety and the higher their satisfaction with life.

  2. People experiencing symptoms of depression and anxiety who increase how often they do the Big 5 often experience an improvement in their mental health.

  3. People without symptoms who restrict how often they do the Big 5 often have a deterioration in their mental health.

  4. Doing the Big 5 at least half the days of the week will help your mental health.

  5. Summary: The Big 5 are strongly linked to mental health. The more often you do them, the better your mental health. But, if you stop doing them, your mental health is likely to deteriorate.

 

Scientific Research

Research on the Big 5 has now been conducted in several countries and has included more than 20,000 people. The key questions and the results from this research are summarised as follows (see the list of published scientific research, below).

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  1. Bisby, M., Staples, L., Dear, B., & Titov, N. (2024). Changes in the Frequency of Actions Associated With Mental Health During Online Treatment: Analysis of Demographic and Clinical Factors. JMIR Formative Research, 8.

  2. Bisby, M. A., Jones, M. P., Staples, L., Dear, B., & Titov, N. (2024). Measurement of Daily Actions Associated With Mental Health Using the Things You Do Questionnaire-15-Item: Questionnaire Development and Validation Study. JMIR Formative Research, 8, e57804-e57804.

  3. Bisby, M. A., Barrett, V., Staples, L. G., Nielssen, O., Dear, B. F., & Titov, N. (2024). Things You Do: A randomized controlled trial of an unguided ultra-brief intervention to reduce symptoms of depression and anxiety. Journal of anxiety disorders, 105, 102882.

  4. Bisby, M. A., Dear, B. F., Karin, E., Fogliati, R., Dudeney, J., Ryan, K., ... & Titov, N. (2023). An open trial of the Things You Do Questionnaire: Changes in daily actions during internet-delivered treatment for depressive and anxiety symptoms. Journal of affective disorders, 329, 483-492.

  5. Bisby, M. A., Titov, N., Dear, B. F., Karin, E., Wilhelms, A., Nugent, M., & Hadjistavropoulos, H. D. (2022). Examining Change in the Frequency of Adaptive Actions as a Mediator of Treatment Outcomes in Internet-Delivered Therapy for Depression and Anxiety. J. Clin. Med, 11, 6001.

  6. Fisher et al. (2026). Exploring perceived changes to mental health when restricting and resuming specific adaptive daily actions: A longitudinal qualitative sub study within a randomised controlled trial. JMIR Formative Research.

  7. Hadjistavropoulos, H. D., Dear, B. F., Titov, N., & Sapkota, R. P. (2025). Adaptive actions as a mechanism of change in transdiagnostic internet-delivered cognitive behavioral therapy: Comparison with homework engagement. Internet Interventions, 42, 100894.

  8. Sapkota, R. P., Gretton, A., Wilhelms, A., Bisby, M. A., Dear, B., Titov, N., & Hadjistavropoulos, H. D. (2025). Feasibility trial of an unguided ultra-brief online psychological intervention within an online mental health clinic: The “things you do” intervention. Internet Interventions, 41, 100852.

  9. Titov, N., Dear, B. F., Nielssen, O., Barrett, V., Kayrouz, R., & Staples, L. G. (2024). A pilot study examining whether restricting and resuming specific actions systematically changes symptoms of depression and anxiety. A series of N-of-1 trials. Behaviour Research and Therapy, 177, 104536.

  10. Titov, N., Dear, B. F., Bisby, M. A., Nielssen, O., Staples, L. G., Kayrouz, R., ... & Karin, E. (2022). Measures of daily activities associated with mental health (Things You Do Questionnaire): development of a preliminary psychometric study and replication study. JMIR Formative Research, 6(7), e38837.

 

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