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

Mallory Dobias · Robert R. Morris · Jessica Lee Schleider

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Digital Mental Health Interventions Impact of Technology on Adolescents Mental Health Treatment and Access

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.