Single-session interventions embedded within Tumblr: Acceptability, feasibility, and utility study

Abstract

Background: Existing mental health treatments are insufficient for addressing mental health needs at scale, particularly for teenagers; many teens now seek mental health information and support online. Single-session interventions (SSIs) may be particularly well-suited for dissemination as embedded, online support options that are easily-accessible within popular social platforms. Objective: Evaluate the acceptability and effectiveness of three, 5 to 8-minute SSIs (ABC Project, Project SAVE, and REFRAME)—embedded as Koko “minicourses” on Tumblr—to improve three key mental health outcomes: hopelessness, self-hate, and desire to stop self-harm behavior. Methods: Quantitative data (i.e., star ratings, SSI completion rates) evaluated acceptability and short-term utility of all three SSIs. Paired t-tests assessed changes in hopelessness, self-hate, and desire to stop future self-harm, from pre- to post-SSI. Where demographic information was available, analyses were restricted to teenagers (13-19 years). Examples of positive and negative qualitative user feedback (i.e., written text responses) were provided for each program. Results: Between March 2021 and February 2022, the SSIs were completed 6,179 times. All three SSIs generated high star ratings (>4 out of 5 stars), with high completion rates (~25-57%) relative to real-world completion rates among other digital self-help interventions. Paired t-tests detected significant pre-post reductions in hopelessness for those who completed ABC Project (P < .0001, dz = -.81, 95% CI [-.85, -.77]) and REFRAME (P < .0001, dz = -.88, 95% CI [-.96, -.80]). Self-hate significantly decreased (P < .0001, dz = -.67, 95% CI [-.74, -.60]), and desire to stop self-harm significantly increased (P < .0001, dz = .40, 95% CI [.33, .47]), from pre- to post-completion of Project SAVE. Results remained consistent across sensitivity analyses and after correcting for multiple tests. Examples of positive and negative qualitative user feedback point toward future directions for SSI research.Conclusions: Very brief SSIs, when embedded within popular social platforms, are one promising and acceptable method for providing free, scalable, and potentially helpful mental health support online. Considering unique barriers to mental health treatment access that many teenagers face, this approach may be especially useful for teens without access to other mental health supports.

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

“…These design principles reflect insights from participatory action research, which highlights the benefits of empowering individuals to 'expert' positions [21], which is highly consistent with implementation science approaches; self-determination theory, which suggests that boosting feelings of competence, agency, and relatedness can motivate adaptive behavior change [22,23]; and meta-analyses suggesting that personal testimonials increase the persuasiveness of health-related messaging [24,25]. Indeed, self-guided SSIs adhering to this design framework have shown consistent, sustained impacts on myriad proximal outcomes known to motivate adaptive behavior change, including hope [14]; self-efficacy and perceived agency [16,26]; and expectancies that changes in emotions and behaviors are possible [9,27,28]. Moreover, evidence from SSI trials suggests that short-term changes in these outcomes (e.g., perceived control and agency) predicts larger improvements in long-term clinical outcomes (e.g., depression, anxiety), suggesting these targets as likely mechanisms of single-session intervention effects [26].…”

“…In virtually all healthcare settings, clinicians have exceptionally limited time; therefore, new S3s must be optimized for brevity and simplicity to ensure acceptability. Evidence suggests that substantially-reduced versions of the same patient-directed, digital SSIs-from 25 minutes to 5 minutes in length-produce comparable impacts on clinically-important outcomes (e.g., hopelessness, self-hate, motivation to stop self-harm [14]). Therefore, minimizing S3 user burden-and making S3 completion intrinsically or extrinsically rewarding (e.g., offering compensation for S3 completion; integrating S3 completion into existing needs such as continuing medical education;…”

“…A wealth of evidence suggests that SSIs are effective in improving a range of individual-level outcomes spanning many disciplines, including education, medicine, and public health. SSIs have increased motivation to empathize, empathic accuracy, and the number of self-reported friendships in students during their first college semester [9]; decreased alcohol consumption among individuals with alcohol use disorder [10]; mitigated rates of HIV infection among high-risk adolescents [11]; increased distress tolerance and endorsement of positive parenting practices among high-anxiety parents of young children [12]; decreased self-hatred and increased intentions to stop self-harming in youth with histories of non-suicidal self-injury [13,14]; produced clinically significant improvements in pain catastrophizing, pain intensity, and pain interference in adults with chronic lower back pain, with non-inferior effects to 8session cognitive behavioral therapy [15]; and significantly reduced 3-month depression, anxiety, hopelessness, and restrictive eating behaviors in a nationwide sample of adolescents (N = 2,452) during the COVID-19 pandemic, versus a supportive-therapy control [16]. In a meta-analysis of 50 randomized trials, SSIs significantly reduced youth mental health problems, relative to their respective controls, with effect sizes only slightly smaller than those observed for longer-term and more expensive youth mental health treatments [17,18].…”