Yet another software within the toolbox: an umbrella assessment of single-session interventions for psychological well being issues

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Are you able to guess what essentially the most generally attended variety of remedy periods is? It’s one session. With this in thoughts, single-session interventions (SSIs) purpose to maximise a one-off interplay with psychological well being assist, with out assuming that the particular person will return or full one other session. They’re described as “structured applications that deliberately contain just one go to or encounter with a clinic, supplier, or program” (Schleider et al. 2020), and have beforehand been blogged about on The Psychological Elf by Dr Maria Loades and Georgia Kemp.

Whereas SSIs have been round for a number of many years, curiosity in them has skyrocketed over the previous 10 years. That is probably as a result of enchantment of a low-cost, scalable means of reaching extra folks in want (significantly if they’re delivered on-line) at a time when many spend months on ready lists, which solely occurs as soon as they’ve met thresholds for accessing formal psychological well being assist within the first place (Loades & Schleider, 2023).

Because of the improve in scientific trials evaluating the advantages of SSIs for psychological well being issues, researchers from the Lab for Scalable Psychological Well being within the US sought to carry all of them collectively and consider their effectiveness in an umbrella assessment (i.e., a scientific assessment of systematic critiques).

Single-session interventions aim to maximise the effectiveness of a one-off therapeutic intervention. But do they actually achieve this?

Single-session interventions purpose to maximise the effectiveness of a one-off therapeutic intervention. However do they really obtain this?

Strategies

Schleider et al. (2025) combed by way of the literature to seek out systematic critiques (SRs) measuring the effectiveness of SSIs (outlined as interventions that deliberately concerned only one go to or encounter with a clinic, supplier, or program) by way of scientific trials for a variety of psychological well being issues, substance use, or engagement with psychological well being companies. They adopted the usual process for umbrella critiques, and systematically searched well-known databases (e.g., MEDLINE, PsycINFO) and thesis platforms, in addition to hand-searching for any ongoing critiques.

The inclusion of meta-analyses (a statistical means of mixing findings from totally different research) was optionally available, however narrative critiques (people who solely described the findings with out combining them in a standardised means) had been excluded. Different exclusion standards included SSIs concentrating on motivation or readiness to hunt remedy, SSIs that used pharmacotherapy, and SRs targeted on Vital Incident Stress Debriefing for posttraumatic stress.

The search resulted in 1,391 papers, of which the authors chosen 63 as appropriate for full-text assessment, and ended up together with 24 systematic critiques that matched all standards they had been in search of.

Lastly, a generally used software (AMSTAR 2) to measure the accuracy and transparency of every included systematic assessment was used, to evaluate the scientific rigour with which every assessment was carried out.

Outcomes

Research traits and total results

24 systematic critiques containing 415 particular person scientific trials had been included within the umbrella assessment. These trials concerned roughly 40,629 individuals with ages starting from 5 to 90 years previous.
62% of the systematic critiques had been printed between 2019 and 2024, exhibiting a pointy improve in newly printed scientific trials evaluating the advantages of SSIs in recent times.
Of the 24 included systematic critiques, 20 discovered total advantages of SSIs on a variety of scientific outcomes. Solely two systematic critiques targeted on SSIs to enhance engagement with psychological well being companies, highlighting an absence of proof on this space.
12 of those critiques included a meta-analysis. Primarily based on these, the authors discovered a small, constructive total impact of SSIs throughout numerous psychological well being issues and age teams, in comparison with management individuals in these research (g = −0.25).
To place this into perspective, current umbrella critiques evaluating multi-session psychotherapies throughout all psychological well being issues discovered an total impact of g = -0.34, which can be thought of small.

Which scientific outcomes profit from SSIs?

Eight of the ten systematic critiques evaluating SSIs for substance use discovered total advantages on problematic alcohol use and smoking cessation, each amongst younger folks and adults. Most SSIs used motivational interviewing as their ‘energetic ingredient’.
Eight of 9 systematic critiques specializing in anxiousness discovered total advantages. SSIs focused particular phobias and generalised anxiousness utilizing cognitive behaviour remedy (CBT) strategies, graded publicity for particular phobias, and even train reminiscent of yoga because the ‘energetic ingredient’.
5 of six systematic critiques specializing in despair discovered total advantages, with SSIs utilizing CBT parts or behavioural activation (serving to folks do extra of what they take pleasure in).
Certainly one of two systematic critiques assessing SSIs for consuming issues, together with weight-reduction plan, physique mass, skinny best internalisation, and physique dissatisfaction, discovered total advantages.

Does mode of supply have an effect?

Every of the 4 systematic critiques on self-guided SSIs for younger folks reported total advantages for a minimum of one of many psychological well being outcomes measured.
Nonetheless, most research targeted on human-delivered SSIs (e.g., with a therapist), with 14 of 16 critiques discovering total advantages of such a SSI in comparison with management teams.

How lengthy do the advantages final?

It’s tough to inform as a result of the follow-up occasions diverse drastically amongst particular person research within the included systematic critiques. They ranged from measuring outcomes instantly after the SSI to 2 years post-SSI.

Which is finest – single-session or multi-session interventions?

4 meta-analyses in contrast SSIs with multi-session interventions, with combined findings. Two meta-analyses discovered no important variations, one discovered a single-session motivational interviewing intervention to be extra useful than a multi-session programme, whereas one discovered a number of periods to be extra useful.
This makes it tough to conclude precisely how SSI carry out in comparison with conventional multi-session remedy.

This umbrella review identified 24 eligible systematic reviews, combining data from 415 individual trials. Overall, 83% of the reviews found beneficial effects of single-session interventions for at least one clinical outcome.

This umbrella assessment recognized 24 eligible systematic critiques, combining information from 415 particular person trials. Total, 83% of the critiques discovered useful results of single-session interventions for a minimum of one scientific consequence.

Conclusions

Primarily based on the 24 included systematic critiques, this umbrella assessment discovered an total small-to-moderate impact of SSIs on a variety of psychological well being issues, together with substance use, despair, anxiousness, and engagement with psychological well being companies. This impact is barely decrease that the consequences normally discovered for conventional, multi-session psychotherapies.

Regardless of the smaller impact, provided that SSIs are a low-cost choice with the potential to achieve extra folks at a faster fee, Schleider et al. (2025) concluded that SSIs may be useful to folks with numerous psychological well being issues. Importantly, they don’t recommend that SSIs ought to exchange multi-session remedy; slightly, they suggest that SSIs needs to be a complementary supply to conventional or extra high-intensity types of assist.

Single-session interventions should not replace traditional, multi-session support; instead, they can complement what is already on offer.

Single-session interventions shouldn’t exchange conventional, multi-session assist; as a substitute, they will complement what’s already on supply.

Strengths and limitations

That is the primary umbrella assessment bringing collectively systematic critiques evaluating SSIs for psychological well being issues, that means it fills an important hole within the literature and aids scientific suggestions to be made on the implementation of SSIs. The authors totally searched the literature, together with unpublished critiques, to make sure the searches are as updated as attainable. They assessed the standard of particular person critiques and commented on their transparency and strengths and limitations, growing the transparency of the umbrella assessment itself. Nonetheless, the authors do level out that many particular person systematic critiques didn’t report pre-registration, that means it’s attainable that a number of the outcomes had been selectively or not transparently reported.

Whereas the authors mentioned the constraints of the included critiques, they didn’t touch upon any limitations of the umbrella assessment itself. Nonetheless, there are some limitations, together with the truth that not all of the critiques included simply randomised managed trials, that are thought of the ‘gold normal’ for measuring the effectiveness of psychosocial interventions. As some critiques contained non-randomised trials, it’s not clear how the management teams in these research had been arrange and whether or not sure individuals (e.g., volunteers for the intervention situation), had been extra more likely to share some traits, reminiscent of motivation or psychological well being signs. This may make it tough to attract conclusions about the effectiveness of the intervention itself versus different shared elements among the many individuals.

SSI period diverse drastically between research and due to this fact assessing them collectively means we can not inform whether or not session size makes a distinction to the effectiveness. Equally, SSI effectiveness was measured at numerous timepoints after the intervention, so it’s not clear how long-lasting the advantages are.

The main strength of this umbrella review is in its thorough and transparent reporting. However, the inclusion of non-randomised trials could introduce bias to the findings.

The principle power of this umbrella assessment is in its thorough and clear reporting. Nonetheless, the inclusion of non-randomised trials may introduce bias to the findings.

Implications for apply

This umbrella assessment considerably contributes to the literature on SSIs by being the primary to synthesise out there systematic critiques assessing their advantages. As proven on this umbrella assessment, the variety of developed and examined SSIs has been repeatedly rising, and there’s hope that they will complement present psychological well being service provision (Loades & Schleider, 2023). As such, it’s vital for clinicians and researchers to have the ability to assessment and draw on evidence-based suggestions and potential advantages of SSIs, significantly these from meta-analyses as they’re thought of the strongest kind of proof for intervention effectiveness within the analysis world.

I perceive that there may be scepticism round SSIs, e.g.:

How can a one-off intervention probably assist somebody in want?
Will this exchange 12-week programs of remedy and the onerous work of therapists?
What about managing danger?

I believe this umbrella assessment is clear about what it may inform us about SSIs. Whereas the proof right here does present their potential scientific advantages, significantly as a number of the particular person critiques discovered that multi-session therapies didn’t outperform SSIs, the authors additionally spotlight many areas that also should be investigated so as to enhance the implementation and advantages of SSIs. Comply with-up occasions range drastically, making it tough to attract conclusions on how long-lasting the consequences are. Even when the SSIs are helpful, with out understanding how and to what extent they are often carried out in actual life, their advantages can be restricted, so extra analysis is required on this.

Personally, after I consider the promise of SSIs, I consider a teen who’s coping with a selected phobia and who receives a one-off session whereas on a ready checklist for multi-session remedy. The one-off session teaches them some primary abilities and the way graded publicity remedy works, giving them a way of company and motivation whereas they wait. I consider a younger grownup coping with gentle low temper signs, however who isn’t fairly positive what’s taking place but. They arrive throughout a self-guided, on-line SSI educating them behavioural activation abilities. This one-off session helps them perceive their struggles and put it into phrases. This empowers them to hunt additional assist whereas practising behavioural activation workout routines as they discover psychological well being assist of their space.

Regardless of my optimism, I’d echo what the authors mentioned – SSIs are probably to enhance, slightly than exchange multi-session assist provision. There are folks for whom one or a number of one-off interventions could also be sufficient, and for others, they are going to want additional assist. However at a time when individuals are struggling to entry any kind of psychological well being assist or assist, SSIs could also be a further software beneath the belt of psychological well being assist techniques.

For some people, SSIs may be able to provide them with the support that they need; for others, SSIs may provide a stepping stone to further support. Either way, SSIs seem like a beneficial tool in the toolbox.

For some folks, SSIs might be able to present them with the assist that they want; for others, SSIs could present a stepping stone to additional assist. Both means, SSIs look like a useful software within the toolbox.

Assertion of pursuits

NK was not concerned within the research summarised above, however she is a PhD researcher creating a single-session intervention. Her analysis group collaborates with a number of the authors of the research on this weblog on creating and adapting SSIs for younger folks within the UK.