Despite progress in the development of evidence-based interventions for youth psychiatric problems, up to 75% of youths with mental health needs never receive services, and early dropout is common ...among those who do. If effective, then single-session interventions (SSIs) for youth psychiatric problems could increase the accessibility, scalability, completion rates, and cost-effectiveness of youth mental health services. This study assessed the effects of SSIs for youth psychiatric problems.
Using robust variance estimation to address effect size (ES) dependency, findings from 50 randomized-controlled trials (10,508 youths) were synthesized.
Mean postintervention ES showed a Hedges g value equal to 0.32; the probability that a youth receiving SSI would fare better than a control-group youth was 58%. Effects varied by several moderators, including target problem: ESs were largest for anxiety (0.56) and conduct problems (0.54) and weakest for substance abuse (0.08; targeted in >33% of studies). Other problems yielded numerically promising but nonsignificant ESs (e.g., 0.21 for depression), potentially from low representation across trials. ESs differed across control conditions, with larger ESs for studies with no treatment (0.41) versus active controls (0.14); developmental periods, with greater ESs for children (0.42) than adolescents (0.19); intervention types, with largest ESs for youth-focused cognitive-behavioral approaches (0.74); and follow-up lengths, with smaller ESs for follow-ups exceeding 13 weeks. ESs did not differ for self- versus therapist-administered interventions or for youths with diagnosable versus subclinical problems.
Findings support the promise of SSIs for certain youth psychiatric problems and the need to clarify how, to what degree, and for whom SSIs effect lasting change.
Compared to youths who believe that personal traits are malleable, those who believe that personal traits are fixed experience more academic and self-regulatory distress. Recently, studies have begun ...to explore relations between beliefs about the malleability of personal traits, or implicit theories, and youth mental health problems. We synthesized this emerging body of research in youths (ages 4–19) across 45 effect sizes from 17 research reports. Studies were included if they assessed youth mental health and implicit theories and did not manipulate implicit theory or affective/behavioral states prior to measuring these variables. Our random-effects meta-analysis using clustered data analysis techniques (i.e., effect sizes nested within samples) revealed that youths holding entity theories—the belief that personal traits are fixed—showed more pronounced mental health problems. This association between entity theories and mental health problems was evident across methodological factors and problem types (internalizing versus externalizing; psychopathology versus general distress). Limitations include the small number of eligible studies, insufficient data to test further demographic moderators, and few longitudinal studies on this topic. Overall, findings support the value of parsing the implicit theory–mental health link in youths. Implicit theories may prove to be promising targets for treatment and prevention of youth mental health problems.
•We explored relations between implicit theories and youth mental health problems.•We used a random-effects meta-analysis and clustered data analysis techniques.•Youths holding entity theories showed more pronounced mental health problems.•Findings suggest value of parsing implicit-theory-mental health links in youths.•Implicit theories may be promising targets for treatment of youth psychopathology.
COVID-19 presents significant social, economic, and medical challenges. Because COVID-19 has already begun to precipitate huge increases in mental health problems, clinical psychological science must ...assert a leadership role in guiding a national response to this secondary crisis. In this article, COVID-19 is conceptualized as a unique, compounding, multidimensional stressor that will create a vast need for intervention and necessitate new paradigms for mental health service delivery and training. Urgent challenge areas across developmental periods are discussed, followed by a review of psychological symptoms that likely will increase in prevalence and require innovative solutions in both science and practice. Implications for new research directions, clinical approaches, and policy issues are discussed to highlight the opportunities for clinical psychological science to emerge as an updated, contemporary field capable of addressing the burden of mental illness and distress in the wake of COVID-19 and beyond.
Public Significance Statement
Clinical psychological science must lead a national response to address mental health issues following COVID-19. This article highlights urgent challenges to confront, and timely opportunities to contemporize a field to better address mental health issues now and long after. The article concludes by discussing implications for new research directions, clinical approaches, and policy issues.
Objective
Eating disorders and depression impact youth at alarming rates, yet most adolescents do not access support. Single‐session interventions (SSIs) can reach youth in need. This pilot examines ...the acceptability and utility of a SSI designed to help adolescents improve functionality appreciation (a component of body neutrality) by focusing on valuing one's body based on the functions it performs, regardless of appearance satisfaction.
Method
Pre‐ to post‐intervention data were collected, and within‐group effect sizes and 95% confidence intervals were computed, to evaluate the immediate effects of the SSI on hopelessness, functionality appreciation, and body dissatisfaction. Patterns of use, demographics, program feedback, and responses from within the SSI were collected.
Results
The SSI and all questionnaires were completed by 75 adolescents (ages: 13–17 years, 74.70% White/Caucasian, 48.00% woman/girl) who reported elevated body image and mood problems. Analyses detected significant pre–post improvements in hopelessness (dav = 0.60, 95% CI: 0.35–0.84; dz = 0.77, 95% CI: 0.51–1.02), functionality appreciation (dav = 0.72, 95% CI: 0.46–0.97; dz = 0.94, 95% CI: 0.67–1.21), and body dissatisfaction (dav = 0.61, 95% CI: 0.36–0.86; dz = 0.76, 95% CI: 0.50–1.02). The SSI was rated as highly acceptable, with a mean overall score of 4.34/5 (SD = 0.54). Qualitative feedback suggested adolescents' endorsement of body neutrality concepts, including functionality appreciation, as personally‐relevant, helpful targets for intervention.
Discussion
This evaluation supports the acceptability and preliminary effectiveness of the Project Body Neutrality SSI for adolescents with body image and mood concerns.
Public Significance
Results suggest the acceptability and utility of a digital, self‐guided, single‐session intervention—Project Body Neutrality—for adolescents experiencing co‐occurring depressive symptoms and body image disturbances. Given the intervention's low cost and inherent scalability, it may be positioned to provide support to youth with limited access to traditional care.
Extensive evidence links youth mental health to family functioning, highlighting the need to document causal pathways. This will require longitudinal studies, but traditional methods for longitudinal ...clinical research have several limitations, including high cost and resource demands, underrepresentation of fathers, and attrition bias. We tested whether an online alternative might address limitations of—and thus provide a useful complement to—traditional methods. We used the Mechanical Turk (MTurk) survey program to obtain reports from parents (N = 177) on family functioning, the parents’ own symptoms, their children’s behavioral and emotional problems, and parenting stress, with assessments in three consecutive months. Parents provided largely high-quality data (e.g., passed consistency checks); measures showed acceptable psychometrics at each time-point; and correlations among study measures paralleled those observed in prior research. Compared to prior studies using traditional longitudinal methods, the MTurk method was (a) much lower in cost and resource requirements, (b) successful in enrolling fathers, (c) comparable in participant attrition, and (c) similar in attrition bias, participant race/ethnicity, and enrollment of single parents. Overall, findings suggest that MTurk is a viable tool with its own set of strengths and limitations, and a potentially useful complement to traditional longitudinal methods. In particular, MTurk might be a cost-effective first step in generating causal hypotheses about family processes and youth mental health, for later testing via more traditional methods.
Efforts to reduce youth mental health problems have advanced greatly but have not lowered overall rates of youth mental illness. Thus, a need exists for disseminable, mechanism-targeted approaches to ...reducing risk of youth psychopathology. Accordingly, we conducted a randomized-controlled trial testing whether a single-session intervention teaching growth personality mindsets (the belief that personality is malleable) reduced known risk factors for anxiety and depression in adolescents experiencing or at risk for internalizing problems (N = 96, ages 12–15). Compared to a supportive-therapy control, a 30-min computer-guided mindset intervention strengthened adolescents' perceived control; this improvement was associated with increases in growth mindsets. Further, electrodermal activity recovery slopes showed that youths receiving the mindset intervention recovered from a lab-based social stressor over three times as fast as control group youths. Improvements in growth mindsets and perceived control were linked with faster stress recovery. Results suggest a disseminable strategy for reducing internalizing problem risk among adolescents.
•A brief growth mindset program reduced risk factors for anxiety/depression in youth.•The program improved perceived primary and secondary control in youths.•The program improved social stress recovery based on steeper EDA recovery slopes.•Improvements in stress recovery were associated with increased perceived control and growth mindsets.•Results suggest a disseminable strategy for reducing internalizing risk in youth.
Objective
Multilevel treatment barriers prevent up to 80% of individuals experiencing eating disorders (EDs) from accessing care. This treatment gap creates a critical need to identify interventions ...that are accessible, easily completable, and optimized for effectiveness by targeting core mechanisms linked to ED onset and maintenance. We propose single‐session interventions (SSIs) as a promising path toward catalyzing innovation in the development of accessible, effective ED interventions. SSIs are structured programs that intentionally involve one encounter with a program or provider; they may serve as stand‐alone or adjunctive clinical supports. All SSIs are built to acknowledge that any session might be someone's last—and that any single session can nonetheless yield meaningful clinical benefit.
Method
We define SSIs, summarize research supporting their utility for ED symptoms and other mental health problems, and recommend future directions for work in this domain.
Results
Single‐session interventions may hold promise to reduce some ED symptoms and risk factors, including restrictive eating and negative body image. Steps toward realizing this promise include (1) testing whether existing evidence‐based SSIs (e.g., for depression) can also reduce EDs, risk factors, and symptoms; (2) developing novel SSIs that target modifiable ED risk factors and symptoms largely unaddressed by SSIs, such as purging and binge eating; (3) studying diverse implementation pathways; (4) capitalizing on SSIs' transdiagnostic utility to broaden funding opportunities; and (5) educating ED researchers and clinicians about SSIs.
Discussion
Understanding the strengths and limits of mechanism‐targeted SSIs for ED‐related problems could be a low‐risk, high‐reward avenue toward reducing EDs at scale.
Public Significance
Most individuals experiencing EDs never access any form of treatment, creating an urgent need to identify ED interventions built to overcome barriers to engaging with care. This Forum article introduces SSIs as a promising path to rapidly developing and testing accessible, evidence‐based ED supports; supplementing existing ED treatment models; and reducing the individual, familial, and societal burdens of EDs at scale.
The United States spends more money on mental health services than any other country, yet access to effective psychological services remains strikingly low. The need-to-access gap is especially wide ...among children and adolescents, with up to 80% of youths with mental health needs going without services, and the remainder often receiving insufficient or untested care. Single-session interventions (SSIs) may offer a promising path toward improving accessibility, cost-effectiveness, and completion rates for youth mental health services. SSIs are structured programs that intentionally involve only one visit or encounter with a clinic, provider, or program; they may serve as stand-alone or adjunctive clinical services. A growing body of evidence supports the capacity of SSIs to reduce and prevent youth psychopathology of multiple types. Here, we provide a working definition of SSIs for use in future research and practice; summarize the literature to date on SSIs for child and adolescent mental health; and propose recommendations for the future design, evaluation, and implementation of SSIs across a variety of settings and contexts. We hope that this paper will serve as an actionable research agenda for gauging the full potential of SSIs as a force for youth mental health.
Across 50 years of research, existing interventions for self-injurious thoughts and behaviors (SITBs) in adolescents have remained largely ineffective and inaccessible. Single-session interventions, ...interventions designed to last one session, may be a low-cost and timely resource for adolescents engaging in SITBs who may not otherwise receive treatment.
565 adolescents (Mage = 14.95 years) endorsing recent engagement in non-suicidal self-injury (NSSI) were randomized to receive a 30-min, web-based, single-session intervention—“Project SAVE”—or an active, attention-matched control program. Proximal outcomes were measured at baseline and immediately post-intervention. Long-term outcomes were measured at baseline and 3-month follow-up.
Adolescents rated Project SAVE as acceptable; 80% of participants randomized to SAVE completed the intervention. Between-group effects were non-significant for pre-registered outcomes: post-intervention likelihood of future NSSI; 3-month frequencies of NSSI and suicidal ideation at follow-up. Relative to control-group participants, SAVE participants reported short-term improvements in two exploratory outcomes: self-hatred (d = −.35, p<.001) and desire to stop future NSSI (d = .25, p = .003).
Project SAVE is an acceptable resource for adolescents engaging in SITBs—with short-term effects on clinically-relevant outcomes. Future research may evaluate SAVE as an easy-to-access, short-term coping resource for youth engaging in SITBs.
NCT04498143.
•A novel, online intervention targeted non-suicidal self-injury in adolescents.•Compared to an active control, the intervention reduced short-term self-hatred.•Self-hatred did not significantly differ between study groups at follow-up.•Non-suicidal self-injury did not significantly differ between groups at follow-up.•Suicidal ideation did not significantly differ between groups at follow-up.
Psychological therapies are highly effective interventions for a range of mental health conditions and often preferred by many patients over medication. Unfortunately, most people who could benefit ...from these therapies do not receive them. This is true even in the United States, which enjoys relatively high numbers of mental health professionals. The lack of access is further compounded by structural inequities, such as income, geography, and race. The low and inequitable access to one of the most effective interventions for mental health conditions is, arguably, one of the most significant barriers to addressing the growing burden of mental health conditions globally. There are several reasons which might contribute to this inequity, notably the historical reliance on complex treatment protocols designed in settings which serve a nonrepresentative group of persons with mental health problems and, consequently, an emphasis on specialist providers and in-person protocols. These factors lead to long and expensive training, variable quality of delivery, and enhanced costs and challenges to patient engagement. In contrast to medication, the lack of a commercial incentive to promote psychological therapies means that there are no market forces which fuel their scaling up. Given there will never be enough psychologists to serve the large unmet and growing mental health needs in the population, we consider stepped and collaborative models that leverage the range of expertise offered by diverse providers, to offer a pathway to scale up a person-centered approach for psychological treatments. In this article, we highlight three innovations that address some barriers and the potential roles of clinical psychologists to broaden the reach of psychological therapies. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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