Single-Session Interventions Embedded Within Tumblr: Acceptability, Feasibility, and Utility Study (Preprint)

Abstract

Existing mental health treatments are insufficient for addressing mental health needs at scale, particularly for teenagers, who now seek mental health information and support on the web. Single-session interventions (SSIs) may be particularly well suited for dissemination as embedded web-based support options that are easily accessible on popular social platforms.

We aimed to evaluate the acceptability and effectiveness of three SSIs, each with a duration of 5 to 8 minutes (Project Action Brings Change, Project Stop Adolescent Violence Everywhere, and REFRAME)—embedded as Koko <i>minicourses</i> on Tumblr—to improve three key mental health outcomes: hopelessness, self-hate, and the desire to stop self-harm behavior.

We used quantitative data (ie, star ratings and SSI completion rates) to evaluate acceptability and short-term utility of all 3 SSIs. Paired 2-tailed <i>t</i> tests were used to assess changes in hopelessness, self-hate, and the desire to stop future self-harm from before to after the SSI. Where demographic information was available, the analyses were restricted to teenagers (13-19 years). Examples of positive and negative qualitative user feedback (ie, written text responses) were provided for each program.

The SSIs were completed 6179 times between March 2021 and February 2022. All 3 SSIs generated high star ratings (&gt;4 out of 5 stars), with high completion rates (approximately 25%-57%) relative to real-world completion rates among other digital self-help interventions. Paired 2-tailed <i>t</i> tests detected significant pre-post reductions in hopelessness for those who completed Project Action Brings Change (<i>P</i>&lt;.001, Cohen <i>d_z</i>=−0.81, 95% CI −0.85 to −0.77) and REFRAME (<i>P</i>&lt;.001, Cohen <i>d_z</i>=−0.88, 95% CI −0.96 to −0.80). Self-hate significantly decreased (<i>P</i>&lt;.001, Cohen <i>d_z</i>=−0.67, 95% CI −0.74 to −0.60), and the desire to stop self-harm significantly increased (<i>P</i>&lt;.001, Cohen <i>d_z</i>=0.40, 95% CI 0.33 to 0.47]) from before to after the completion of Project Stop Adolescent Violence Everywhere. The 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.

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 on the web. Considering the unique barriers to mental health treatment access that many teenagers face, this approach may be especially useful for teenagers without access to other mental health supports.