Little Treatments, Promising Effects? Meta-Analysis of Single-Session Interventions for Youth Psychiatric Problems

Effects of an incremental theory of the personality intervention on psychophysiological responses to social stress during the transition to college

This randomized controlled trial (NCT04786496) examined the effects of a preventive intervention based on Incremental Theory of the Personality (ITP) on psychophysiological responses to social stress and evaluated whether levels of depression moderate the intervention effects. The participants, 107 first-year university students, were randomly assigned to one of three conditions: ITP intervention, ITP + a self-affirmation intervention (SA), and a control condition (CC). Indicators of the Hypothalamic–Pituitary–Adrenal axis, autonomic nervous system, and subjective mood were assessed with the Trier Social Stress Task. Participants in the ITP condition displayed a lower decline in respiratory sinus arrythmia (RSA) compared to those in the CC during the first phases of the task [Slopes: -0.08 (0.09) vs -0.21 (0.09), z = 2.86, p = .004] and a higher decrease in cortisol at recovery [β = -0.18 (0.08), z = -2.37, p = .018]. Depressive symptoms moderated the effect of ITP [β = -0.10 (0.05), z = -2.15, p =.032] and ITP+SA [β = -0.09 (0.04), z = -2.06, p =.039] in the decline during stress and recovery in RSA. In participants with low/medium levels of depressive symptoms, both interventions predicted a lower decline during stress [Slopes: -0.06 (0.09) for ITP, -0.17 (.09) for ITP+SA, and -0.26 (0.09) for CC] and higher recovery in RSA [Slopes: 0.18 (0.01) for ITP, 0.24 (0.01) for ITP+SA, and 0.30 (0.01) for CC]. The findings suggest that the ITP intervention has the potential to be an effective preventive intervention to reduce the stress response.

Family-based treatments for disruptive behavior problems in children and adolescents: An updated review of rigorous studies (2014-April 2020)

Disruptive behavior problems in youth are common and costly, lead to adverse outcomes, and are often left untreated. This article builds on previous work by providing an updated evaluation of family-based treatments based on results from randomized controlled trials (RCTs) for three populations: (1) children with disruptive behavior, (2) adolescents with disruptive behavior, and (3) adolescents with juvenile justice involvement. Using a comprehensive process, 28 new reports on 27 RCTs were identified for the 2014-April 2020 period, which when combined with the prior evidence base of all rigorous RCTs, resulted in 3 well-established, 11 probably efficacious, and 7 possibly efficacious family-based treatment categories. Many of the RCTs lent further support to existing treatment categories, more countries were represented, and several RCTs incorporated technology. Notable issues that remain include a limited number of family-based treatments for adolescents and for youth with juvenile justice involvement, as well as methodological concerns.

Harnessing the Single-Session Intervention approach to promote scalable implementation of evidence-based practices in healthcare

Effective implementation of evidence-based practices often involves multi-level strategies targeting individual-, organizational-, and system-level determinants of change. Although these multi-level implementation approaches can successfully facilitate EBP uptake, they tend to be complex and resource intensive. Accordingly, there is a need for theory-driven, generalizable approaches that can enhance efficiency, cost-effectiveness, and scalability of existing implementation approaches. We propose the Single-Session Intervention approach as an unexplored path to developing low-cost and scalable implementation strategies, especially those targeting individual-level behavior change. We argue that single-session strategies (S3) for implementation, which can simultaneously target myriad barriers to individual behavior change, may promote clinicians' EBP uptake and sustainment in a manner that is low-resource and scalable. We first overview the evidence-base supporting the Single-Session Intervention approach for patient-level outcomes; situate this approach within the implementation science literature by outlining its intersections with a leading framework, the Theoretical Domains Framework (TDF), as an exemplar; and illustrate how the TDF might directly inform the design and evaluation of single-session strategies for EBP implementation. Overall, single-session strategies (S3) for implementation reflect a promising but yet-to-be-tested means of streamlining and scaling individual-level behavior change efforts in healthcare settings. Future partnered research is needed to gauge the potential of this approach across diverse clinical and community contexts.

Testing the effects of the Shamiri Intervention and its components on anxiety, depression, wellbeing, and academic functioning in Kenyan adolescents: study protocol for a five-arm randomized controlled trial

BACKGROUND

Treatments for youth mental disorders are a public health priority, especially in sub-Saharan Africa (SSA), where treatment options remain limited due to high cost, elevated stigma, and lack of trained mental health professionals. Brief, accessible, and non-stigmatizing community-based interventions delivered by lay providers may help address treatment needs in SSA. One such intervention, the Shamiri Intervention, consisting of three elements (growth mindset, gratitude, and value affirmation) has been tested in randomized controlled trials with school-going Kenyan adolescents. This three-element Shamiri Intervention has been shown to significantly reduce depression and anxiety symptoms and improve social support and academic performance relative to a control group. In this trial, we aim to investigate the effects of each element of the Shamiri Intervention.

METHODS

In this five-arm randomized controlled trial, we will test each of the intervention components (growth mindset, gratitude, and value affirmation) against the full Shamiri Intervention and against a study skills control intervention. Students (Nplanned = 1288) at participating secondary schools who are interested in participating in this universal intervention will be randomized in equal numbers into the five groups. The students will meet in groups of 8-15 students led by local high school graduate lay providers. These lay providers will receive a brief training, plus expert supervision once a week throughout the intervention delivery. Multi-level models will be used to compare trajectories over time of the primary outcomes (depressive symptoms, anxiety symptoms, academic performance, and wellness) and secondary outcomes in each intervention group to the control group. Multi-level models will also be used to compare trajectories over time of the primary outcomes (depressive symptoms, anxiety symptoms, academic performance, and wellness) and secondary outcomes of participants in the single-element interventions compared to the full Shamiri Intervention. Finally, effect sizes (calculated as mean gain scores) will be used to compare all groups on all measures.

DISCUSSION

This trial will shed light on the mechanisms and outcomes targeted by each individual intervention, helping prioritize which mental health interventions are most important to disseminate.

TRIAL REGISTRATION

PACTR Trial ID: PACTR202104716135752 . Approved on 4/19/2021.

The Session Wants and Need Outcome Measure: The Development of a Brief Outcome Measure for Single-Sessions of Web-Based Support

Single-session, brief interventions in therapy for young people make up a large proportion of service provision, including in digital mental health settings. Current nomothetic mental health measures are not specifically designed to capture the benefit or ‘change’ directly related to these brief interventions. As a consequence, we set out to design an outcome measure to concretely demonstrate the value of single-session interventions. The Session Wants and Needs Outcome Measure (SWAN-OM) aims to capture in-session goals and focuses on being user-centric, elements critical to the success of single-session and brief interventions which typically are asset-based and solution-focused. We describe the 4-stage process that was followed to develop this measure: (I) classical item generation and development, (II) content and (III) face validity pilot testing, and (IV) a user-experience approach with young people using framework analysis. This final stage was critical to ensure the integration of this outcome tool into a web-based digital therapy setting, a context which adds another layer of design complexity to item and measure development. This iterative methodology was used to overcome the challenges encountered and to place the needs of the young people and service practitioners at the centre of the design process, thus ensuring measure usability. To end, we highlight the main lessons learnt from engaging in this design process. Specifically, the needs of a measure for single-session interventions are considered, before outlining the learning associated with integrating the measure into a digital mental health platform. Both of these areas are emerging fields and, as such, this study contributes to our understanding of how an idiographic patient outcome theory driven measure can be created for use in a web-based digital mental health therapy service.

'Dove Confident Me Indonesia: Single Session': study protocol for a randomised controlled trial to evaluate a school-based body image intervention among Indonesian adolescents

Background

Due to the prevalence and associated adverse health consequences of negative body image among adolescents globally, there is a need to develop acceptable, effective, and scalable interventions. School-based body image interventions delivered by trained teachers show promise in reducing negative body image in adolescents. However, there is currently a lack of evidenced-based body image interventions for use in low- and middle-income countries (LMICs). This paper outlines a protocol for the development and evaluation of Dove Confident Me Indonesia: Single Session, a single-session, teacher-led body image intervention for Indonesian adolescents.

Method

The effectiveness of the intervention will be evaluated using a cluster randomised controlled trial design. Due to the COVID-19 pandemic, the trial will be conducted online. Trained teachers or school guidance counsellors will deliver the intervention. Self-report questionnaires will be collected at three time points: baseline, post-intervention, and two-month follow-up. The primary outcome is body esteem. Secondary outcomes are internalisation of appearance ideals, mood, engagement in life activities, tendency to engage in appearance comparisons, and skin shade satisfaction. A minimum of 1000 participants will provide 95% power to detect small-to-medium intervention effects. To account for attrition and potential internet issues, the sample will comprise of 2000 Indonesian adolescents in grades 7–9, attending state junior high schools in Surabaya, East Java. Quantitative and qualitative data on acceptability of the intervention will also be collected from teachers and students. Additionally, fidelity of lesson implementation will be assessed. This project received ethical approval from the Universitas Indonesia and the University of the West of England. The intervention will be disseminated in junior high schools throughout Indonesia via UNICEF’s Life Skills Education (LSE) programme, which will be freely available for teachers to download.

Discussion

This paper presents Dove Confident Me Indonesia: Single Session, a culturally adapted school-based intervention designed to improve Indonesian adolescents’ body image. It details the plan for evaluation, highlighting the strengths and limitations of the proposed study design. It will be informative for others aiming to adapt evidence-based school curricula to promote well-being among adolescents in LMICs.

Trial registration

NCT04665557. Registered 11th December 2020.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11770-0.

Rising to the Occasion of This COVID-19-Impacted Nation: Development, Implementation, and Feasibility of the Brief Assessment-Informed Skills Intervention for COVID-19 (BASIC)

The COVID-19 pandemic has had a profound impact on the global economy, physical health, and mental health. This pandemic, like previous viral outbreaks, has resulted in spikes in anxiety, depression, and stress. Even though millions of individuals face the physical health consequences of infection by COVID-19, even more individuals are confronted with the mental health consequences of this pandemic. This significantly increased demand for mental health services cannot be easily met by existing mental health systems, which often rely on courses of therapy to be delivered over months. Single session interventions (SSIs) may be one important approach to meeting this increased demand, as they are treatments designed to be delivered over the course of a single meeting. SSIs have been found to be effective for a range of mental health challenges, with durable effects lasting months to years later. Here, we describe an SSI designed for the COVID-19 pandemic. This Brief Assessment-informed Skills Intervention for COVID-19 (BASIC) program draws upon therapeutic skills from existing empirically supported treatments to target common presenting complaints due to this pandemic. We discuss the process of developing and implementing this intervention, as well as explore feasibility and initial clinical insights. In short, BASIC is an easy-to-adopt intervention that is designed to be effective in a single session, making it well-suited for handling the increased demand for mental health services due to COVID-19.

The Dosage, Context, and Modality of Interventions to Prevent Cyberbullying Perpetration and Victimization: a Systematic Review

Past reviews of cyberbullying preventative interventions have critiqued the field regarding scientific rigor, and a meta-analysis found that randomized controlled trials (RCTs) of such interventions were more effective than non-RCTs. However, no review has examined the risk of bias, dosage, modality, and delivery context of such programs to date. The current study addresses this gap through a systematic review of the literature. Potential articles (N = 4,737) from 4 databases were identified and screened (Academic Search Premier including ERIC, PsychINFO, and the Psychology and Behavioral Collection; PubMed; Web of Science; Compendex); 72 articles were reviewed for eligibility. Final articles included (N = 30) were based on a rigorous search process guided by inclusion and exclusion criteria. The majority of studies were conducted in Europe; two were conducted in the USA, three in Australia, and two in the Middle East. Efforts to reduce risk of bias were evaluated using the Cochrane's Risk of Bias tool. Harvest plots were constructed to qualitatively illustrate the rigor, dosage, modality, and context of the interventions, and meta-analytic random effects models were conducted to examine effect sizes of the interventions on cyberbullying perpetration and victimization. Results suggest that cyberbullying interventions delivered through schools are effective, though expanded follow-up time is suggested, and additional evidence is needed for home settings and digital delivery.

A novel walk-in clinic treatment intervention for youth presenting with anxiety and depression

TOPIC

This article explores a novel, single-session treatment intervention for anxiety and depression through an externalizing process, transforming of metaphoric imagery, and shifting of underlying maladaptive emotional schemas within the Walk-in counseling setting.

PURPOSE

The purpose of this paper is to present a novel, single-session treatment protocol that is delineated through a six-stage process (or mediators of change) for the clinical population of youth presenting with anxiety and/or depression, mild-to-moderate severity. These are two of the most common presenting concerns for this population and the proposed treatment intervention is from a very brief format. A case study is used to illustrate the treatment protocol which is presented in table format and within-session description.

SOURCES USED

A composite literature review was conducted with relevant works specific to single-session consultation including Walk-in clinic models to mental health treatment.

CONCLUSIONS

The interconnected theoretical constructs both map and manualize its key clinical processes, which reflects the mechanism of change in this brief model. This proposed line of clinical research may introduce a paradigm shift towards specific treatments for specific presenting concerns in the Walk-in counseling modality for youth.

An online, single-session intervention for adolescent self-injurious thoughts and behaviors: Results from a randomized trial

BACKGROUND

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.

METHOD

565 adolescents (M_age = 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.

RESULTS

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).

CONCLUSIONS

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. CLINICAL TRIALS.

GOV IDENTIFIER

NCT04498143.

Efficacy of Motivational Interviewing to Improve Utilization of Mental Health Services Among Youths With Chronic Medical Conditions: A Cluster Randomized Clinical Trial

IMPORTANCE

Despite the high prevalence of anxiety and depression in youths with chronic medical conditions (CMCs), physicians encounter substantial barriers in motivating these patients to access mental health care services.

OBJECTIVE

To determine the efficacy of motivational interviewing (MI) training for pediatricians in increasing youths' use of mental health care.

DESIGN, SETTING, AND PARTICIPANTS

The COACH-MI (Chronic Conditions in Adolescents: Implementation and Evaluation of Patient-Centered Collaborative Healthcare-Motivational Interviewing) study was a single-center cluster randomized clinical trial at the University Children's Hospital specialized outpatient clinics in Düsseldorf, Germany. Treating pediatricians were cluster randomized to a 2-day MI workshop or treatment as usual (TAU). Patient recruitment and MI conversations occurred between April 2018 and May 2020 with 6-month follow-up and 1-year rescreening. Participants were youths aged 12 to 20 years with CMCs and comorbid symptoms of anxiety and depression; they were advised by their MI-trained or untrained physicians to access psychological counseling services. Statistical analysis was performed from October 2020 to April 2021.

INTERVENTIONS

MI physicians were trained through a 2-day, certified MI training course; they recommended use of mental health care services during routine clinical appointments.

MAIN OUTCOMES AND MEASURES

The primary outcome of uptake of mental health care services within the 6-month follow-up was analyzed using a logistic mixed model, adjusted for the data's cluster structure. Uptake of mental health services was defined as making at least 1 appointment by the 6-month follow-up.

RESULTS

Among 164 youths with CMCs and conspicuous anxiety or depression screening, 97 (59%) were female, 94 (57%) had MI, and 70 (43%) had TAU; the mean (SD) age was 15.2 (1.9) years. Compared with patients receiving TAU, the difference in mental health care use at 6 months among patients whose physicians had undergone MI training was not statistically significant (odds ratio [OR], 1.96; 95% CI, 0.98-3.92; P = .06). The effect was moderated by the subjective burden of disease (F2,158 = 3.42; P = .04). Counseling with an MI-trained physician also led to lower anxiety symptom scores at 1-year rescreening (F1,130 = 4.11; P = .045). MI training was associated with longer conversations between patients and physicians (30.3 [16.7] minutes vs 16.8 [12.5] minutes; P < .001), and conversation length significantly influenced uptake rates across conditions (OR, 1.03; 95% CI, 1.01-1.06; P = .005).

CONCLUSIONS AND RELEVANCE

In this study, use of MI in specialized pediatric consultations did not increase the use of mental health care services among youths with CMCs but did lead to longer patient-physician conversations and lower anxiety scores at 1 year. Additional research is required to determine whether varying scope and duration of MI training for physicians could encourage youths with CMCs to seek counseling and thus improve integrated care models.

TRIAL REGISTRATION

German Trials Registry: DRKS00014043.

Efficacy of a Single-Session "Empowered Relief" Zoom-Delivered Group Intervention for Chronic Pain: Randomized Controlled Trial Conducted During the COVID-19 Pandemic

BACKGROUND

Cognitive behavioral therapy-pain is an evidence-based treatment for chronic pain that can have significant patient burden, including health care cost, travel, multiple sessions, and lack of access in remote areas.

OBJECTIVE

The study aims to pilot test the efficacy of a single-session videoconference-delivered empowered relief (ER) intervention compared to waitlist control (WLC) conditions among individuals with chronic pain. We hypothesized that ER would be superior to WLC in reducing pain catastrophizing, pain intensity, and other pain-related outcomes at 1-3 months posttreatment.

METHODS

We conducted a randomized controlled trial involving a web-based sample of adults (N=104) aged 18-80 years with self-reported chronic pain. Participants were randomized (1:1) to 1 of 2 unblinded study groups: ER (50/104, 48.1%) and WLC (54/104, 51.9%). Participants allocated to ER completed a Zoom-delivered class, and all participants completed follow-up surveys at 2 weeks and 1, 2, and 3 months posttreatment. All the study procedures were performed remotely and electronically. The primary outcome was pain catastrophizing 1-month posttreatment, with pain intensity, pain bothersomeness, and sleep disruption as secondary outcomes. We also report a more rigorous test of the durability of treatment effects at 3 months posttreatment. Data were collected from September 2020 to February 2021 and analyzed using intention-to-treat analysis. The analytic data set included participants (18/101, 17.8% clinic patients; 83/101, 82.1% community) who completed at least one study survey: ER (50/101, 49.5%) and WLC (51/104, 49%).

RESULTS

Participants (N=101) were 69.3% (70/101) female, with a mean age of 49.76 years (SD 13.90; range 24-78); 32.7% (33/101) had an undergraduate degree and self-reported chronic pain for 3 months. Participants reported high engagement (47/50, 94%), high satisfaction with ER (mean 8.26, SD 1.57; range 0-10), and high satisfaction with the Zoom platform (46/50, 92%). For the between-groups factor, ER was superior to WLC for all primary and secondary outcomes at 3 months posttreatment (highest P<.001), and between-groups Cohen d effect sizes ranged from 0.45 to 0.79, indicating that the superiority was of moderate to substantial clinical importance. At 3 months, clinically meaningful pain catastrophizing scale (PCS) reductions were found for ER but not for WLC (ER: PCS -8.72, 42.25% reduction; WLC: PCS -2.25, 11.13% reduction). ER resulted in significant improvements in pain intensity, sleep disturbance, and clinical improvements in pain bothersomeness.

CONCLUSIONS

Zoom-delivered ER had high participant satisfaction and very high engagement. Among adults with chronic pain, this single-session, Zoom-delivered, skills-based pain class resulted in clinically significant improvement across a range of pain-related outcomes that was sustained at 3 months. Web-based delivery of ER could allow greater accessibility of home-based pain treatment and could address the inconveniences and barriers faced by patients when attempting to receive in-person care.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04546685; https://clinicaltrials.gov/ct2/show/NCT04546685.

Can Artificial Intelligence Improve Psychotherapy Research and Practice?

Leonard Bickman's article on the future of artificial intelligence (AI) in psychotherapy research paints an encouraging picture of the progress to be made in this field. We support his perspective, but we also offer some cautionary notes about the boost AI can provide. We suggest that AI is not likely to transform psychotherapy research or practice to the degree seen in pharmacology and medicine because the factors that contribute to treatment response in these realms differ so markedly from one another, and in ways that do not favor advances in psychotherapy. Despite this limitation, it seems likely that AI will have a beneficial impact, improving empirical analysis through data-driven model development, tools for addressing the limitations of traditional regression methods, and novel means of personalizing treatment. In addition, AI has the potential to augment the reach of the researcher and therapist by expanding our ability to gather data and deliver interventions beyond the confines of the lab or clinical office.

Emotion Differentiation and Youth Mental Health: Current Understanding and Open Questions

A growing body of research identifies emotion differentiation-the ability to specifically identify one's emotions-as a key skill for well-being. High emotion differentiation is associated with healthier and more effective regulation of one's emotions, and low emotion differentiation has been documented in several forms of psychopathology. However, the lion's share of this research has focused on adult samples, even though approximately 50% of mental disorders onset before age 18. This review curates what we know about the development of emotion differentiation and its implications for youth mental health. I first review published studies investigating how emotion differentiation develops across childhood and adolescence, as well as studies testing relations between emotion differentiation and mental health in youth samples. Emerging evidence suggests that emotion differentiation actually falls across childhood and adolescence, a counterintuitive pattern that merits further investigation. Additionally, several studies find relations between emotion differentiation and youth mental health, but some instability in results emerged. I then identify open questions that limit our current understanding of emotion differentiation, including (i) lack of clarity as to the valid measurement of emotion differentiation, (ii) potential third variables that could explain relations between emotion differentiation and mental-health (e.g., mean negative affect, IQ, personality, and circularity with outcomes), and (iii) lack of clear mechanistic models regarding the development of emotion differentiation and how it facilitates well-being. I conclude with a discussion of future directions that can address open questions and work toward interventions that treat (or even prevent) psychopathology.

[Outpatient Psychological Therapies in Children and Adolescents in Germany: Status Quo and Time Trends, 2009-2018]

OBJECTIVE

To determine the prevalence of outpatient psychological therapies (PT) in youths with statutory health insurance in Germany.

METHODS

Based on statutory health insurance funds data for 2009-2018, the prevalence of outpatient PT was assessed, stratified by sex, age, and federal state. Psychotherapeutic specialty, coded psychiatric diagnoses, and type of PT were also analysed.

RESULTS

In 2018, 7.3 % received any form of PT (2009: 7.1 %). Of these, 18.4 % (2009: 12.8 %) received therapy according to the directives for psychotherapy (dPT), with CBT (since 2012) being most frequently used. PT prevalence was highest in 15- to 19-year olds, and only marginally differed by sex. Child psychiatrists delivered the majority of PTs. Main diagnoses were anxiety/emotional disorders, ADHD, and adjustment disorders.

CONCLUSION

During the studied period, PT prevalence has not changed markedly. Yet, the share of dPT has increased, with CBT ranking top.

A Waitlist Intervention for Transgender Young People and Psychosocial Outcomes

BACKGROUND

Recent referrals of transgender young people to specialist gender services worldwide have risen exponentially, resulting in wait times of 1-2 years. To manage this demand, we introduced an innovative First Assessment Single-Session Triage (FASST) clinic that provides information and support to young people and their families and triages them onto a secondary waitlist for subsequent multidisciplinary care. Although FASST has been shown to substantially reduce initial wait times, its clinical impact is unknown.

METHODS

FASST was evaluated by analysis of clinical surveys and qualitative interviews. A total of 142 patients were surveyed before and after FASST, and comparison was made to a historical control group of 120 patients who did not receive FASST. In-depth interviews were also held with FASST attendees (n = 14) to explore experiences of FASST, and inductive content analysis was performed.

RESULTS

After FASST, there were improvements in depression (standardized mean difference [SMD] = -0.24; 95% confidence interval [CI]: -0.36 to -0.11; P < .001), anxiety (SMD = -0.14; 95% CI: -0.26 to -0.02; P = .025) and quality of life (SMD = .39; 95% CI: 0.23 to 0.56; P < .001). Compared with historical controls, those attending FASST showed reduced depression (SMD = -0.24; 95% CI: -0.50 to 0.01; P = .065) and anxiety (SMD = -0.31; 95% CI: -0.57 to -0.05; P = .021). FASST attendees qualitatively described an increased sense of agency, which was related to improved outlook, validation, sense of self, and confidence.

CONCLUSIONS

Given burgeoning waitlists of pediatric gender services worldwide, this study suggests FASST may prove a useful model of care elsewhere.

The Use of Psychological First Aid in Children Exposed to Mass Trauma

PURPOSE OF REVIEW

Psychological first aid (PFA) has been widely disseminated and promoted as an intervention to support short-term coping and long-term functioning after disasters. Despite its popularity, earlier reviews cite a startling lack of empirical outcome studies. The current review explores recent studies of PFA, especially pertaining to its use with children.

RECENT FINDINGS

Initial studies of PFA show that it is well received by youth, families, and providers as well as being linked to decreases in depressive and posttraumatic stress symptoms, improved self-efficacy, increased knowledge about disaster preparedness and recovery, and enhanced feelings of safety and connection. The flexibility of the modular style of PFA and cultural adaptations emerged as significant themes. Although the studies reviewed cast a favorable light on PFA, more research is needed regarding its use and outcomes. This review describes the challenges to conducting these studies as well as suggestions for paths forward.

Empowering Anxious Parents to Manage Child Avoidance Behaviors: Randomized Control Trial of a Single-Session Intervention for Parental Accommodation

BACKGROUND

A majority of youth who need anxiety treatment never access support. This disparity reflects a need for more accessible, scalable interventions-particularly those that may prevent anxiety in high-risk children, mitigating future need for higher-intensity care. Self-guided single-session interventions (SSIs) may offer a promising path toward this goal, given their demonstrated clinical utility, potential for disseminability, and low cost. However, existing self-guided SSIs have been designed for completion by adolescents already experiencing symptoms, and their potential for preventing anxiety in children-for instance, by mitigating known anxiety risk factors-remains unexplored.

OBJECTIVE

This trial evaluated the acceptability and proximal effects of project EMPOWER: a web-based, self-guided SSI designed to reduce parental accommodation, a parenting behavior known to increase the risk of anxiety in offspring.

METHODS

In total, 301 parents who reported elevated anxiety symptoms with children aged 4-10 years received either project EMPOWER or an informational control (containing psychoeducational materials and resources); parents self-reported their accommodation of child anxiety and overall distress tolerance at baseline and 2-week follow-up.

RESULTS

Relative to control-group parents, those who received the intervention outlined in project EMPOWER reported significant reductions in their accommodation of child anxiety (d_s=0.61; P<.001) and significant increases in their distress tolerance (d_s=0.43; P<.001) from baseline to 2-week follow-up. Additionally, parents rated project EMPOWER as highly acceptable (ie, easy to use, helpful, and engaging) in accordance with preregistered benchmarks.

CONCLUSIONS

Project EMPOWER is an acceptable self-guided SSI for parents of children at-risk for anxiety, which yields proximal reductions in clinically relevant targets.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04453865; https://tinyurl.com/4h84j8t9.

A cluster randomised controlled trial of a web-based youth mental health service in Australian schools

BACKGROUND

Secondary schools have attempted to address gaps in help-seeking for mental health problems with little success. This trial evaluated the effectiveness of a universal web-based service (Smooth Sailing) for improving help-seeking intentions for mental health problems and other related outcomes among students.

METHODS

A cluster randomised controlled trial was conducted to evaluate the 12-week outcomes of the Smooth Sailing service among 1841 students from 22 secondary schools in New South Wales, Australia. Assignment was conducted at the school level. The control condition received school-as-usual. The primary outcome was help-seeking intentions for general mental health problems at 12-weeks post-baseline. Secondary outcomes included help-seeking behaviour, anxiety and depressive symptoms, psychological distress, psychological barriers to help-seeking, and mental health literacy. Data were analysed using mixed linear models. This trial was registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12618001539224).

FINDINGS

At 12-weeks post-baseline, there was a marginal statistical difference in the relative means of help-seeking intentions (effect size=0•10, 95%CI: -0•02-0•21) that favoured the intervention condition. Help-seeking from adults declined in both conditions. There was a greater reduction in the number of students who "needed support for their mental health but were not seeking help" in the intervention condition (OR: 2•08, 95%CI: 1•72-2.27, P<•0001). No other universal effects were found. Participants found the service easy to use and understand; However, low motivation, time, forgetfulness, and lack of perceived need were barriers to use.

INTERPRETATION

Smooth Sailing led to small improvements in help-seeking intentions. Refinements are needed to improve its effectiveness on other mental health outcomes and to increase student uptake and engagement.

FUNDING

HSBC and Graf Foundation.

Harnessing Wise Interventions to Advance the Potency and Reach of Youth Mental Health Services

Despite progress in research on evidence-based treatments (EBTs) for youth psychopathology, many youths with mental health needs do not receive services, and EBTs are not always effective for those who access them. Wise interventions (WIs) may help address needs for more disseminable, potent youth mental health interventions. WIs are single-component, social-psychological interventions designed to foster adaptive meaning-making. They have improved health-related and interpersonal youth outcomes, yet their potential to reduce youth psychopathology has not been systematically explored. Accordingly, we conducted a systematic, descriptive review characterizing WIs' potential to reduce youth mental health problems. Across 25 RCTs (N = 9219 youths, ages 11-19) testing 13 intervention types, 7 WIs qualified as "Well-Established," "Probably Efficacious," or "Possibly Efficacious" for reducing one or more types of youth psychopathology, relative to controls. Among these, 5 WIs significantly reduced youth depressive symptoms; 3, general psychological distress; and 1 each, eating problems, anxiety, and substance use. Three of these 7 WIs were self-administered by youths, and four by trained interventionists; collectively, they were 30-168 min in length and targeted clinic-referred and non-referred samples in clinical, school, and laboratory settings. Overall, certain WIs show promise in reducing mild-to-severe youth psychopathology. Given their brevity and low cost relative to traditional (i.e., therapist-delivered, 12- to 16-week, clinic-based) EBTs, WIs may represent beneficial additions to the youth mental healthcare ecosystem. Priorities for future research are proposed, including testing WIs for parents, younger children, and externalizing problems; as EBT adjuncts; and in schools and primary care clinics to increase access to brief, effective supports.

Online single-session interventions for Kenyan adolescents: study protocol for a comparative effectiveness randomised controlled trial

BACKGROUND

Mental health problems are the leading cause of disability among adolescents worldwide, yet access to treatment is limited. Brief digital interventions have been shown to improve youth mental health, but little is known about which digital interventions are most effective.

AIMS

To evaluate the effectiveness of two digital single-session interventions (Shamiri-Digital and Digital-CBT (cognitive-behavioural therapy)) among Kenyan adolescents.

METHODS

We will perform a school-based comparative effectiveness randomised controlled trial. Approximately 926 Kenyan adolescents will be randomly assigned to one of three conditions: Shamiri-Digital (focused on gratitude, growth mindsets and values), Digital-CBT (focused on behavioural activation, cognitive restructuring and problem solving) or a study-skills control condition (focused on note-taking and essay writing skills). The primary outcomes include depressive symptoms (measured by the Patient Health Questionnaire-8), anxiety symptoms (Generalized Anxiety Disorder Screener-7) and subjective well-being (Short Warwick-Edinburgh Mental Well-being Scale). The secondary outcomes include acceptability, appropriateness, primary control and secondary control. Acceptability and appropriateness will be measured immediately post-intervention; other outcomes will be measured 2 weeks, 4 weeks and 12 weeks post-intervention.

RESULTS

We hypothesise that adolescents assigned to Shamiri-Digital and adolescents assigned to Digital-CBT will experience greater improvements (assessed via hierarchical linear models) than those assigned to the control group. We will also compare Shamiri-Digital with Digital-CBT, although we do not have a preplanned hypothesis.

CONCLUSIONS

Our findings will help us evaluate two digital single-session interventions with different theoretical foundations. If effective, such interventions could be disseminated to reduce the public health burden of common mental health problems.

TRIAL REGISTRATION NUMBER

PACTR202011691886690.

The Parents Are Not Alright: A Call for Caregiver Mental Health Screening During the COVID-19 Pandemic

Nearly a year into the COVID-19 pandemic, conversations about the impact of COVID-19 on children and families have shifted. Initial advice for parents stressed topics such as how to talk about the pandemic with children or cope with illness-related distress. They now focus on youth adjustment to a heavily disrupted school year and on strategies for building long-term resilience. Although these conversations often center on youth adjustment, they have-at last-started to consider the well-being of parents (and other caregivers) as well. This shift in focus is crucial given the enormous challenges that parents face right now and the direct links between their well-being and that of their children. What continues to lag, even well into the pandemic, however, is the provision of workable solutions for addressing parents' mental health. While we applaud the renewed focus on parenting stress and well-being, we remain deeply concerned by the absence of a plan for intervening.

Comparative efficacy of a single-session "Empowered Relief" videoconference-delivered group intervention for chronic pain: study protocol for a randomized controlled trial

BACKGROUND

Chronic pain is naturally aversive and often distressing for patients. Pain coping and self-regulatory skills have been shown to effectively reduce pain-related distress and other symptoms. In this trial, the primary goal is to pilot test the comparative efficacy of a single-session videoconference-delivered group pain education class to a waitlist control among patients with chronic pain.

METHODS

Our study is a randomized clinical trial pilot testing the superiority of our 2-h single-session videoconference-delivered group pain education class against a waitlist control. We will enroll 120 adult patients with mixed etiology chronic pain and randomize 1:1 to one of the two study arms. We hypothesize superiority for the pain education class for bolstering pain and symptom management. Team researchers masked to treatment assignment will assess the outcomes up to 3 months post-treatment.

DISCUSSION

This study aims to test the utility of a single-session videoconference-delivered group pain education class to improve self-regulation of pain and pain-related outcomes. Findings from our project have the potential to significantly reduce barriers to effective psychological treatment for pain, optimizing the delivery of increasingly vital online and remote-delivered intervention options.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04546685 . Registered on 04 September 2020.

Leveraging the developmental science of psychosocial risk to strengthen youth psychotherapy

More than 50 years of randomized clinical trials for youth psychotherapies have resulted in moderate effect sizes for treatments targeting the most common mental health problems in children and adolescents (i.e., anxiety, depression, conduct problems, and attention disorders). Despite having psychotherapies that are effective for many children, there has been a dearth of progress in identifying the contextual factors that likely influence who will respond to a given psychotherapy, and under what conditions. The developmental psychopathology evidence base consistently demonstrates that psychosocial risk exposures (e.g., childhood adversities, interpersonal stressors, family dysfunction) significantly influence the onset and course of youth psychopathology. However, the developmental psychopathology framework remains to be well integrated into treatment development and psychotherapy research. We argue that advances in basic developmental psychopathology research carry promising implications for the design and content of youth psychotherapies. Research probing the effects of psychosocial risks on youth development can enrich efforts to identify contextual factors in psychotherapy effectiveness and to personalize treatment. In this article we review empirically supported and hypothesized influences of individual- and family-level risk factors on youth psychotherapy outcomes, and we propose a framework for leveraging developmental psychopathology to strengthen psychotherapies.

Identifying intervention strategies for preventing the mental health consequences of childhood adversity: A modified Delphi study

Exposure to childhood adversity is a powerful risk factor for psychopathology. Despite extensive efforts, we have not yet identified effective or scalable interventions that prevent the emergence of mental health problems in children who have experienced adversity. In this modified Delphi study, we identified intervention strategies for effectively targeting both the neurodevelopmental mechanisms linking childhood adversity and psychopathology - including heightened emotional reactivity, difficulties with emotion regulation, blunted reward processing, and social information processing biases, as well as a range of psychopathology symptoms. We iteratively synthesized information from experts in the field and relevant meta-analyses through three surveys, first with experts in intervention development, prevention, and childhood adversity (n = 32), and then within our study team (n = 8). The results produced increasing stability and good consensus on intervention strategy recommendations for specific neurodevelopmental mechanisms and symptom presentations and on strength of evidence ratings of intervention strategies targeting youth and parents. More broadly, our findings highlight how intervention decision making can be informed by meta-analyses, enhanced by aggregate group feedback, saturated before consensus, and persistently subjective or even contradictory. Ultimately, the results converged on several promising intervention strategies for prevention programming with adversity-exposed youth, which will be tested in an upcoming clinical trial.

Promoting Graduate Student Mental Health During COVID-19: Acceptability, Feasibility, and Perceived Utility of an Online Single-Session Intervention

The COVID-19 outbreak has simultaneously increased the need for mental health services and decreased their availability. Brief online self-help interventions that can be completed in a single session could be especially helpful in improving access to care during the crisis. However, little is known about the uptake, acceptability, and perceived utility of these interventions outside of clinical trials in which participants are compensated. Here, we describe the development, deployment, acceptability ratings, and pre-post effects of a single-session intervention, the Common Elements Toolbox (COMET), adapted for the COVID-19 crisis to support graduate and professional students. Participants (n = 263), who were not compensated, were randomly assigned to two of three modules: behavioral activation, cognitive restructuring, and gratitude. Over 1 week, 263 individuals began and 189 individuals (72%) completed the intervention. Participants reported that the intervention modules were acceptable (93% endorsing), helpful (88%), engaging (86%), applicable to their lives (87%), and could help them manage COVID-related challenges (88%). Participants reported pre- to post-program improvements in secondary control (i.e., the belief that one can control their reactions to objective events; d av = 0.36, d z = 0.50, p < 0.001) and in the perceived negative impact of the COVID-19 crisis on their quality of life (d av = 0.22, d z = 0.25, p < 0.001). On average, differences in their perceived ability to handle lifestyle changes resulting from the pandemic were positive, but small and at the level of a non-significant trend (d av = 0.13, d z = 0.14, p = 0.066). Our results highlight the acceptability and utility of an online intervention for supporting individuals through the COVID-19 crisis.

Mental health and clinical psychological science in the time of COVID-19: Challenges, opportunities, and a call to action

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. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Mental health and clinical psychological science in the time of COVID-19: Challenges, opportunities, and a call to action

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. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Creating a prepared mental health workforce: comparative illustrations of implementation strategies

BACKGROUND

Psychotherapy implementation must contend with the task of preparing a mental health workforce to provide the highest quality services to as much of a service population as possible, in high-income as well as low-to-middle income countries.

OBJECTIVE

We outline general challenges and solutions and investigate how well various implementation strategies would fit a clinical population.

METHODS

Using a data set from a prior cluster randomised trial with a clinically diverse population and 33 intervention practices, we presented multiple illustrations comparing the ability of different implementation strategies to serve youth and families with procedures in which service providers were trained.

FINDINGS

A series of survival functions demonstrated that many common implementation strategies are unlikely to create a prepared workforce, given the large and diverse number of practices needed to be mastered by providers.

CLINICAL IMPLICATIONS

'Benchmark' solutions that afforded superior coverage of the service population could be supported through paced learning approaches (ie, training interventions a little at a time) using extensible, modular intervention designs.

Evaluation of a mental health drop-in centre offering brief transdiagnostic psychological assessment and treatment for children and adolescents with long-term physical conditions and their families: a single-arm, open, non-randomised trial

BACKGROUND

Children and young people with long-term physical conditions have significantly elevated mental health needs. Transdiagnostic, brief psychological interventions have the potential to increase access to evidence-based psychological treatments for patients who attend health services primarily for physical health needs.

OBJECTIVE

A non-randomised study was conducted to assess the impact of brief, transdiagnostic psychological interventions in children and young people presenting at a drop-in mental health centre in the reception area of a paediatric hospital.

METHODS

186 participants attending a transdiagnostic mental health drop-in centre were allocated to assessment and psychological intervention based on a clinical decision-making algorithm. Interventions included signposting, guided self-help based on a modular psychological treatment and referral to the hospital's paediatric psychology service. The primary transdiagnostic mental health outcome measure was the parent-reported Strengths and Difficulties Questionnaire (SDQ), which was given at baseline and 6 months post-baseline.

FINDINGS

There was a significant positive impact of attending the drop-in mental health centre on the SDQ (Cohen's d=0.22) and on the secondary outcome measure of Paediatric Quality of life (Cohen's d=0.55).

CONCLUSIONS

A mental health drop-in centre offering brief, transdiagnostic assessment and treatment may reduce emotional and behavioural symptoms and improve quality of life in children and young people with mental health needs in the context of long-term physical conditions. A randomised controlled trial to investigate the specificity of any effects is warranted.

CLINICAL IMPLICATIONS

Drop-in centres for mental health needs may increase access and have beneficial effects for children and young people with physical conditions.

An enhanced psychological mindset intervention to promote adolescent wellbeing within educational settings: A feasibility randomized controlled trial

OBJECTIVE

This randomized controlled trial feasibility study aimed to investigate a single-session mindset intervention, incorporating third-wave constructs, within educational settings as a universal tool to promote emotional wellbeing.

METHOD

Eighty adolescents (age M = 16.63) were randomized to the 30-min computer intervention or a usual curriculum waitlist. Outcome measures were administered at baseline, posttreatment, 4-week, and 8-week follow-ups.

RESULTS

Student feedback about the intervention and trial procedure was mainly positive. Participants engaged with the intervention content and data were suggestive of possible small-large intervention effects for targeted mechanisms of personality mindset and psychological flexibility. Between-group differences over time across wellbeing outcomes of self-compassion, self-esteem, low mood, and anxiety also yielded some promising results, though assessments of reliable change were less clear. No harm was reported.

CONCLUSIONS

The intervention and study design were deemed feasible, though areas for improvement were noted. A full-scale trial to determine effectiveness is warranted.

Economic Evaluations of Mental Health Programs for Children and Adolescents in the United States: A Systematic Review

The United States (US) spent 201 billion dollars on mental health-related concerns in 2016, ranking mental illness as the leading cause of disability and the single largest source of economic burden worldwide. With mental health-related treatment costs and economic burden only projected to rise, there is an increasing need for cost-inclusive evaluations of mental health interventions in the US. This systematic review evaluated the intervention characteristics and the quality of 9 economic evaluation studies (e.g., cost-effectiveness, cost-benefit) of youth mental health services conducted in the US from 2003 to 2019. Existing evaluations suggest that certain mental health interventions for youth, among the few that have been formally evaluated, may be cost-effective and cost-beneficial. However, intervention characteristics were generally homogenous, a majority of studies did not adhere to the standard of economic evaluations of the CHEERS checklist, and outcome measures were not consistently clinically useful, limiting the utility of such youth mental health economic evaluations to policymakers. By adhering to standards of economic evaluations and diversifying the characteristics of interventions subject to economic evaluations, intervention researchers can increase confidence in conclusions about which youth mental health interventions are cost-effective or cost-beneficial and more meaningfully inform evidence-based mental health policy.

A Three-Step, Single Session Therapy Intervention for COVID-Related Anxiety in a Pediatric Emergency Department

The novel Coronavirus disease (COVID-19) pandemic has led to increases in anxiety and depression, and mental health-related emergency department visits remain frequent despite overall changes in ED utilization. Here, we present a case of COVID-related anxiety and demonstrate the utility of a brief, single-session therapy intervention delivered in the ED. The growing mental health burden of COVID-19 suggests that pediatric health care providers will treat patients with COVID-related anxiety during this pandemic. This case demonstrates a common presentation of somatization of anxiety and outlines a three-step, cognitive-behavioral intervention that can be particularly effective in treating COVID-related anxiety in the context of a single ED or medical visit.

Randomized Trial of a Single-Session Growth Mind-Set Intervention for Rural Adolescents' Internalizing and Externalizing Problems

Adolescents living in rural regions of the United States face substantial barriers to accessing mental health services, creating needs for more accessible, nonstigmatizing, briefer interventions. Research suggests that single-session "growth mind-set" interventions (GM-SSIs)-which teach the belief that personal traits are malleable through effort-may reduce internalizing and externalizing problems in adolescents. However, GM-SSIs have not been evaluated among rural youth, and their effects on internalizing and externalizing problems have not been assessed within a single trial, rendering their relative benefits for different problem types unclear. We examined whether a computerized GM-SSI could reduce depressive symptoms, social anxiety symptoms, and conduct problems in female adolescents from rural areas of the United States. Tenth-grade female adolescents (N = 222, M age = 15.2, 38% White, 25% Black, 29% Hispanic) from 4 rural, low-income high schools in the southeastern United States were randomized to receive a 45-min GM-SSI or a computer-based active control program, teaching healthy sexual behaviors. Young women self-reported depression symptoms, social anxiety symptoms, and conduct problem behaviors at baseline and 4-month follow-up. Relative to the female students in the control group, the students receiving the GM-SSI reported modest but significantly greater reductions in depressive symptoms (d= .23) and likelihood of reporting elevated depressive symptoms (d= .29) from baseline to follow-up. GM-SSI effects were nonsignificant for social anxiety symptoms, although a small effect size emerged in the hypothesized direction (d= .21), and nonsignificant for change in conduct problems (d= .01). A free-of-charge 45-min GM-SSI may help reduce internalizing distress, especially depression-but not conduct problems-in rural female adolescents.

Healthy Body, Healthy Mind: A Mindset Intervention for Obese Youth

As growth mindset intervention research continues to develop, more work is needed to understand how to most effectively implement these interventions to encourage healthy cognitions and behaviors. The present study details the initial testing of a single-session, online mindset intervention (Healthy Body, Healthy Mind) for obese children and adolescents enrolled in obesity treatment clinics. Using a pre to post-test design, results indicated that growth mindsets of health and cognitions related to health behavior (nutrition and exercise self-efficacy and perceived control) increased significantly. However, despite efforts to mitigate feelings of culpability, blame also increased from pretest to post-test. Yet, body dissatisfaction decreased significantly. Intrinsic value for health behaviors remained unchanged from pretest to post-test. Analysis of narratives suggests that youth were engaged with the intervention content. Additionally, when youth's narratives incorporated themes related to the changeable nature of the attribute, they also self-reported stronger growth mindsets. In the discussion, we note implications of findings for the development of large-scale health-based growth mindset interventions that are developmentally-appropriate for children and adolescents.

A randomised controlled trial of a relationship-focussed mobile phone application for improving adolescents' mental health

BACKGROUND

This study evaluated the acceptability and effectiveness of a relationship-focussed mobile phone application (WeClick) for improving depressive symptoms and other mental health outcomes in adolescents.

METHODS

A randomised controlled trial involving 193 youth (M age: 14.82, SD: 0.94, 86.5% female) from Australia was conducted. Youth were recruited via the Internet and randomly allocated to the intervention or a 4-week wait list control condition, stratified for age and gender. The primary outcome was change in depressive symptom scores measured using the Patient Health Questionnaire for Adolescents (PHQ-A) at baseline, 4-week post-test and 12-week follow-up. Secondary outcomes included anxiety, psychological distress, wellbeing, help-seeking intentions for mental health, social self-efficacy and social support. Participants in the intervention condition received access to the intervention for four weeks. Thematic analysis was utilised to identify and examine acceptability.

RESULTS

The change in PHQ-A scores from baseline to 4-week post-test did not differ significantly (d = 0.26, p = .138) between the intervention (Mchange = -2.9, SD = 5.3) and wait list control conditions (Mchange = -1.7, SD = 4.3). However, significant between-group improvements were observed in wellbeing (d = 0.37, p = .023), help-seeking intentions (d = 0.36, p = .016) and professional help-seeking intentions for mental health problems (d = 0.36, p = .008). Increases in help-seeking intentions were sustained at follow-up in the intervention condition. No differential effects were found for generalised anxiety, separation anxiety, social self-efficacy or for any social support outcomes. Over 90% of participants indicated the app was enjoyable, interesting and easy to use. The app provided 'advice and direction' (n = 42; 46.15%), an 'opportunity for self-reflection' (n = 33; 36.3%) and 'normalised experiences' (n = 21; 23.1%).

CONCLUSIONS

The WeClick app was found to be effective for improving wellbeing and help-seeking intentions for mental health in adolescents. A larger, adequately powered trial is now required to establish differential effects on depressive symptoms. This trial was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12618001982202.

Group Intervention for Adolescent Anxiety and Depression: Outcomes of a Randomized Trial with Adolescents in Kenya

Youth mental health interventions in low-resource communities may benefit from including empirically supported elements, using stigma-free content, and using trained lay-providers. We developed and evaluated such an intervention, targeting adolescent depression and anxiety in Kenya, where mental health care is limited by social stigma and a paucity of providers. Kenyan adolescents (N = 51, ages 14-17, 60.78% female) from a school in an urban slum in Nairobi with self-reported moderate-to-severe symptoms of depression or anxiety were randomized to the 4-week "Shamiri" ("thrive") group intervention or a study skills control intervention of equal duration. The Shamiri intervention included growth mindset, gratitude, and value affirmation exercises. The content was delivered by recent high school graduates (ages 17-21, 60% male) trained as lay-providers. Participants met in school once-a-week in groups of 9-12 youths (average group size 10). Compared to the study-skills control, Shamiri produced greater reductions in adolescent depression symptoms (p = .038; d = .32) and anxiety symptoms (p = .039; d = .54) from baseline to 4-week follow-up, and greater improvements in academic performance (p = .034; d = .32) from the school-term before versus after the intervention. There were no effects on overall social support or perceived control, but the Shamiri group showed larger increases in perceived social support from friends (p = .028, d = .71). This appears to be the first report that a brief, lay-provider delivered, community-based intervention may reduce internalizing symptoms and improve academic outcomes in high-symptom adolescents in Sub-Saharan Africa. Larger replications with extended follow-ups will help gauge the strength and durability of these effects.

Brief, Non-Pharmacological, Interventions for Pediatric Anxiety: Meta-Analysis and Evidence Base Status

In 1998, Ost published [One-session treatment of specific phobias-a rapid and effective method] [in Swedish] giving rise to the idea that brief, intensive, and concentrated psychosocial interventions could exhibit public health impact. At this juncture, and per criteria of the Society for Clinical Child and Adolescent Psychology, there are data supporting that brief, non-pharmacological intervention [prescriptions] for pediatric anxiety can be considered well-established or probably efficacious. In addition, data from 76 randomized controlled trials (N = 17,203 youth) yield an overall mean effect size of 0.19 on pediatric anxiety outcomes (pre-post). Note, however, that effect sizes vary significantly. These data point to the capacity for clinical change coming from in-vivo exposures for specific phobias (~3 h, one session), CBT with social skills training (~3 h, six sessions for indicated prevention and early intervention), and CBT-based parent training (~6 h, eight digital modules with clinician support). Given such evidence, we recommend efforts be made to establish ways to position such treatment innovations for rapid deployment facilitated by high-quality training, monitoring, technical assistance, and ongoing disclosures.

Acceptability and Utility of an Open-Access, Online Single-Session Intervention Platform for Adolescent Mental Health

BACKGROUND

Many youths with mental health needs are unable to access care. Single-session interventions (SSIs) have helped reduce youth psychopathology across multiple trials, promising to broaden access to effective, low-intensity supports. Online, self-guided SSIs may be uniquely scalable, particularly if they are freely available for as-needed use. However, the acceptability of online SSI and their efficacy have remained unexamined outside of controlled trials, and their practical utility is poorly understood.

OBJECTIVE

We evaluated the perceived acceptability and proximal effects of Project YES (Youth Empowerment & Support), an open-access platform offering three online SSIs for youth internalizing distress.

METHODS

After selecting one of three SSIs to complete, participants (ages 11-17 years) reported pre- and post-SSI levels of clinically relevant outcomes that SSIs may target (eg, hopelessness, self-hate) and perceived SSI acceptability. User-pattern variables, demographics, and depressive symptoms were collected to characterize youths engaging with YES.

RESULTS

From September 2019 through March 2020, 694 youths accessed YES, 539 began, and 187 completed a 30-minute, self-guided SSI. SSI completers reported clinically elevated depressive symptoms, on average, and were diverse on several dimensions (53.75% non-white; 78.10% female; 43.23% sexual minorities). Regardless of SSI selection, completers reported pre- to post-program reductions in hopelessness (dav=0.53; dz=0.71), self-hate (dav=0.32; dz=0.61), perceived control (dav=0.60; dz=0.72) and agency (dav=0.39; dz=0.50). Youths rated all SSIs as acceptable (eg, enjoyable, likely to help peers).

CONCLUSIONS

Results support the perceived acceptability and utility of open-access, free-of-charge SSIs for youth experiencing internalizing distress.

TRIAL REGISTRATION

Open Science Framework; osf.io/e52p3.

Harnessing single-session interventions to improve adolescent mental health and well-being in India: Development, adaptation, and pilot testing of online single-session interventions in Indian secondary schools

BACKGROUND

Many evidence-based prevention and intervention approaches for youth mental health exist, but most are time-consuming and expensive to deliver. Innovative approaches are needed to develop and disseminate scalable mental health interventions, especially for youth in low- and middle-income countries. Computerized single-session interventions (SSIs) may be able to overcome many of these implementation barriers, especially if deployed in school settings.

METHODS

Guided by this logic, we designed three computerized SSIs (based on behavioral activation, gratitude, and growth mindset exercises) for delivery in Indian high schools. Then, we conducted focus groups with Indian adolescents and school officials to inform adaptations of the interventions. Finally, we designed a Hybrid Type 1 effectiveness-implementation study to evaluate the interventions.

RESULTS

In this paper, we present the rationale for selecting the interventions, the results of the focus groups, and the design of a Hybrid Type 1 effectiveness-implementation study. Our initial focus group data showed that the interventions were considered acceptable, feasible, and appropriate by both educators and students. We also describe feedback on the interventions which we incorporated to refine the interventions prior to our randomized controlled trial.

DISCUSSION

Computerized SSIs may offer innovative, scalable ways to disseminate evidence-based interventions. By identifying which interventions are most acceptable and effective in this highly scalable format, we may understand which SSIs are best suited for continued development, testing, and, ultimately, widespread dissemination.

Future Directions in Single-Session Youth Mental Health Interventions

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.

Randomized Trial of Academic Training and Medication Decision-Making for Adolescents with ADHD in Usual Care

Objective: This study tested two family-based interventions designed for delivery in usual care: Changing Academic Support in the Home for Adolescents with ADHD (CASH-AA), containing motivational interventions, homework management and schoolwork organization training, and family-school partnership building; and Medication Integration Protocol (MIP), containing ADHD psychoeducation, medication decision-making, and integrated medication management.Method: This study used a cluster randomized design to test CASH-AA + MIP versus CASH-AA Only for adolescents with ADHD in five sites. Therapists (N = 49) were site clinicians randomized to condition. Clients (N = 145) included 72% males; 42% White Non-Hispanic, 37% Hispanic American, 15% African American, and 6% more than one race; average age was 14.8 years. Fidelity data confirmed protocol adherence and between-condition differentiation.Results: One-year improvements were observed across conditions in several outcomes. Overall, CASH-AA + MIP produced greater declines in adolescent-report inattentive symptoms and delinquent acts. Similarly, among non-substance users, CASH-AA + MIP clients attended more treatment sessions. In contrast, among substance users, CASH-AA Only clients showed greater declines in caregiver-report hyperactive symptoms and externalizing.Conclusions: This study provides initial experimental support for family-based ADHD medication decision-making when coupled with academic training in usual care. The treatment protocols, CASH-AA and MIP, showed positive effects in addressing not only ADHD symptoms but also common co-occurring problems, and youth with substance use problems benefitted along with non-using peers.

Contributions of fixed mindsets and hopelessness to anxiety and depressive symptoms: A commonality analysis approach

BACKGROUND

Fixed mindsets (beliefs that personal traits are unchangeable) show consistent associations with internalizing symptoms. However, the mindset-internalizing symptom link has previously been studied in isolation of other maladaptive cognitions that relate to internalizing symptoms. Thus, the unique contributions of mindsets to internalizing symptoms remains unclear.

METHOD

We used commonality analysis (CA), which yields unique and shared effects of independent variables on an outcome, to assess unique contributions of emotion and anxiety mindsets to anxiety and depression symptoms, relative to the contributions of hopelessness. Participants in two online studies (Ns=200, 430) self-reported depression and anxiety symptoms, hopelessness, and emotion and anxiety mindsets.

RESULTS

In Study 1, neither mindset type contributed unique variance to depression or anxiety beyond the contribution of hopelessness. In Study 2, emotion mindsets again explained no unique symptom variance. Anxiety mindsets uniquely contributed 2.0% and 6.5% of depression and anxiety variance, respectively-but far larger proportions of symptom variance (20.0%-60.9%) were contributed by hopelessness alone, variance shared by hopelessness and anxiety mindsets, and variance shared among hopelessness, anxiety mindsets, and emotion mindsets.

LIMITATIONS

The cross-sectional design precludes causal conclusions, and the non-referred adult samples may limit generalizability.

DISCUSSION

Mindsets contributed little unique variance to internalizing symptoms beyond hopelessness. Interventions teaching growth mindsets have been shown to reduce internalizing problem in past studies. However, these interventions might not necessarily operate by shaping mindsets; rather, they may affect symptom change by shaping closely-linked maladaptive cognitions-like hopelessness-with stronger ties to internalizing distress.