New solution to help therapy ‘dropouts’

• ‘The most common number of therapy sessions people access is one’

• Common in other countries but not in the U.S., single-session interventions are designed to treat patients in just one meeting
• Lab at Northwestern offers digital single-session interventions for youth in nine languages

CHICAGO --- Seeking mental health help is a significant step, but that first intake session can often feel more like paperwork than progress, and a significant proportion of people “drop out” or never return for a second visit, previous research has shown. 

“The most common number of sessions people access is one,” said Jessica Schleider, associate professor of medical social sciences in the divisions of intervention science and implementation science. “If a therapist is spending their first session with somebody exclusively diagnosing them, they’ve lost the opportunity to take advantage of the first and potentially last encounter to actually do something that helps them.” 

In a new, first-of-its-kind review led by Schleider, Northwestern Medicine investigators confirmed that single-session interventions (SSIs) can significantly improve mental health outcomes in both youth and adults. Common in other countries but not the U.S., an SSI is a structured program intentionally designed to provide meaningful support, guidance or treatment in just one meeting, recognizing that many patients may not return for a follow-up appointment. 

“We’re often taught that therapy is supposed to be a journey, a lifelong process, and that ‘change never happens overnight,’” Schleider said. “While that’s often true, people can also have meaningful moments or turning points within one session.” 

The scientists identified 24 systematic reviews of single-session mental health and behavioral health interventions, which included 415 clinical trials. Of the 24 systematic reviews identified, they found that 83% reported positive effects from SSIs for one or more of the following outcomes: anxiety, depression, externalizing problems, eating problems, substance use, and treatment engagement or uptake. 

The findings were recently published in the Annual Review of Clinical Psychology.

Schleider’s Lab for Scalable Mental Health at Northwestern offers four 15-minute digital SSIs available in nine languages that teach one skill or idea per session. Called Project Yes! these SSIs teach youth about self-compassion, the power to change, how to take action and how to cope with minority stress. 

While Schleider said she doesn’t believe SSIs should replace other kinds of support that already exist in the mental health care ecosystem, she thinks SSIs — especially digital, self-guided ones — are poised to fill untouched gaps in the mental health care system that high-intensity treatments like weekly psychotherapy delivered by professionals were never built to address.

How prior work led to this umbrella review

A previous meta-analysis led by Schleider found that across 50 randomized-controlled trials evaluating 10,000 youth, SSIs significantly reduced mental health problems including depression and anxiety. 

“This was really surprising to me, because I’m trained as a psychotherapist to give treatments that are weeks or months or even years long,” Schleider said. “But ever since that meta-analysis, I’ve been dead set on figuring out how we can optimize and make the most of the first, and often last, clinical encounter that someone might have access to.”

Encouraged by these findings, Schleider and her team aimed to determine if an SSI could not only reduce mental health problems, but also increase engagement in other types of mental health services. 

To do this, they conducted an umbrella review, synthesizing all available research on SSIs for mental health problems and service engagement in both youth and adults. 

Schleider said she hopes the findings will push the field of mental health forward in making SSIs a core part of mental health care and inform the creation and implementation of new public policy measures.

“One example of a policy direction we’re hoping to pursue is creating new reimbursement codes, so that single-session interventions can be sustainability offered by clinics that accept insurance so that they can more flexibly support people outside of this traditional workflow of clinical services,” Schleider said.

Co-authors include Juan Zapata, research assistant professor of medical social sciences in the division of intervention science, and Erica Szkody, research assistant professor of medical social sciences. 

This work was supported by the National Institutes of Health Office of the Director (grant DP5OD02812); the National Institute of Mental Health (grant R43MH128075); the Upswing Fund for Adolescent Mental Health; the National Science Foundation (grant 2141710); the Health Research and Services Administration (grant U3NHP45406-01-00); the Society of Clinical Child and Adolescent Psychology; Hopelab; the Child Mind Institute; Alongside; Kooth and the Klingenstein Third Generation Foundation.