A scalable, single session intervention for perceived control over anxiety during COVID-19 (Preprint)

BACKGROUND Anxiety is rising across the United States during the COVID-19 pandemic, and social distancing mandates preclude in-person mental healthcare. Anxiety is not necessarily pathological; however, increased worrying about COVID-19 shows links to more severe anxiety pathology. Greater perceived control over anxiety has predicted decreased anxiety pathology, including adaptive responses to uncontrollable stressors. Evidence suggests that no-therapist, single-session interventions can strengthen perceived control over emotions like anxiety; similar programs, if designed for the COVID-19 context, could hold substantial public health value. OBJECTIVE Our registered report tested whether a no-therapist, single-session online intervention adapted for the COVID-19 context could: 1) decrease generalized anxiety and increase perceived control over anxiety, versus a placebo intervention and 2) achieve this without decreasing social-distancing intentions. METHODS We tested these questions using a between-subjects design in a weighted-probability sample of U.S. adults (N=500). RESULTS We found no support for therapeutic or iatrogenic effects; effects on generalized anxiety were d = -0.06 (P = 0.48, CI [-0.27, 0.15]), effects on perceived control were d = 0.04 (P = 0.48, CI [-0.08, 0.16]), and effects on social-distancing intentions were d = -0.02 (P = 0.83, CI [-0.23, 0.19]). CONCLUSIONS Strengths of this study included a large, nationally representative sample and adherence to open science practices. Implications for scalable interventions are discussed. CLINICALTRIAL NCT04459455

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 (ds=0.61; P<.001) and significant increases in their distress tolerance (ds=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

Reducing Teachers’ Unfounded Beliefs Through Critical-Thinking Education: A Non-Randomized Controlled Trial

The prevalence of unfounded beliefs (UB; e.g. supernatural or conspiracy beliefs) remains an important issue due to their negative consequences in various domains. Interventions were shown to reduce supernatural UB only when addressing pseudoscientific beliefs. Based on these findings, we designed a single session intervention aiming to teach participants the epistemological distinction between science and pseudoscience. We then assessed the effectiveness of this intervention. Secondary school teachers (N = 130) were assigned to one of two groups focusing on critical thinking with or without the intervention content related to pseudoscience. UB (supernatural, conspiracy, pattern perception) were measured using computerized surveys pre- and one moth post-intervention. Mixed-model analyses revealed the expected decrease in conspiracy UB, d = .60, supernatural UB, d = 1.01 and illusory pattern perception, d = .34 among teachers in the pseudoscience-focused group. Our intervention constitutes a novel cost-effective tool for critical thinking promotion among education professionals.

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 to those in acute clinical need. Single-session interventions, well-targeted 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 (Mage = 14.95 years) endorsing recent engagement in non-suicidal self-injury (NSSI) were randomized to receive a 30-minute, 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: Relative to control-group participants, SAVE participants reported greater increases in their desire to stop future NSSI (d = .25, p = .003) and greater decreases in self-hatred (d = -.35, p &lt; .001), but no significant difference in perceived likelihood of future NSSI (d = -.16, p = .16), immediately post-intervention. Between-group effects were non-significant for 3-month outcomes (self hatred, frequency of NSSI, frequency of suicidal ideation). 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.

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

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 (<i>d_s</i>=0.61; <i>P</i>&lt;.001) and significant increases in their distress tolerance (<i>d_s</i>=0.43; <i>P</i>&lt;.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. CLINICALTRIAL ClinicalTrials.gov NCT04453865; https://tinyurl.com/4h84j8t9

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; dav = 0.36, dz = 0.50, p &lt; 0.001) and in the perceived negative impact of the COVID-19 crisis on their quality of life (dav = 0.22, dz = 0.25, p &lt; 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 (dav = 0.13, dz = 0.14, p = 0.066). Our results highlight the acceptability and utility of an online intervention for supporting individuals through the COVID-19 crisis.

Empowering Anxious Parents to Manage Child Avoidance Behaviors: Randomized Trial of a Single-Session Intervention for Parent 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. Methods: This trial evaluated the acceptability and proximal effects of Project EMPOWER: a web-based, self-guided SSI designed to reduce parent accommodation, a parenting behavior known to increase anxiety risk in offspring. 301 parents reporting elevated anxiety symptoms (98.01% mothers) with children ages 4-10 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, parents who received Project EMPOWER reported significant reductions in their accommodation of child anxiety (𝑑𝑠=0.61, p&lt;.001), as well as significant increases in their distress tolerance(𝑑𝑠=0.43, p&lt;.001), from baseline to 2-week follow-up. Additionally, parents who completed Project EMPOWER rated it as highly acceptable (e.g., easy to use, helpful, engaging) per pre-registered benchmarks. Conclusions: Project EMPOWER is an acceptable self-guided SSI for parents of children at-risk for anxiety, yielding proximal reductions in clinically-relevant targets.

Economic Evaluation of an Online Single-Session Intervention for Depression in Kenyan Adolescents

Objective: To evaluate the costs and cost-effectiveness of Shamiri-Digital, an online single-session intervention (SSI) for depression among Kenyan adolescents. Method: Data were drawn from a randomized clinical trial with n=103 Kenyan high school students (64% female, Mage=15.5). All students were eligible to participate, regardless of baseline depression symptomatology. We estimated delivery costs in 2020 US dollars from multiple perspectives. To account for uncertainty, we performed sensitivity analyses with different cost assumptions and definitions of effectiveness. Using number needed to treat (NNT) estimates, we also evaluated the cost required to achieve a clinically meaningful reduction in depressive symptoms.Results: In the base-case (the most realistic cost estimate), it cost US $3.57 per student to deliver Shamiri-Digital. Depending on the definition of clinically meaningful improvement, 7.1 to 9.7 students needed to receive the intervention for one student to experience a clinically meaningful improvement, which translated to a cost of US $25.35 to US $34.62 per student. Under a worst-case scenario (i.e., assuming the highest treatment cost and the strictest effectiveness definition), the cost to achieve clinically meaningful improvement was US $92.05 per student.Conclusions: Shamiri-Digital is a low-cost intervention for reducing depression symptomatology, especially relative to traditional psychotherapies. The public health benefit of empirically supported SSIs could be especially important in low-income countries, where funding for mental health care is most limited. Future research can compare the cost-effectiveness of online SSIs to higher-cost treatments and estimate the robustness of Shamiri-Digital’s effects over a longer time horizon.