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Harnessing Wise Interventions to Advance the Potency and Reach of Youth Mental Health Services

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Abstract

Despite progress in research on evidence-based treatments (EBTs) for youth psychopathology, many youths with mental health needs do not receive services, and EBTs are not always effective for those who access them. Wise interventions (WIs) may help address needs for more disseminable, potent youth mental health interventions. WIs are single-component, social–psychological interventions designed to foster adaptive meaning-making. They have improved health-related and interpersonal youth outcomes, yet their potential to reduce youth psychopathology has not been systematically explored. Accordingly, we conducted a systematic, descriptive review characterizing WIs’ potential to reduce youth mental health problems. Across 25 RCTs (N = 9219 youths, ages 11–19) testing 13 intervention types, 7 WIs qualified as “Well-Established,” “Probably Efficacious,” or “Possibly Efficacious” for reducing one or more types of youth psychopathology, relative to controls. Among these, 5 WIs significantly reduced youth depressive symptoms; 3, general psychological distress; and 1 each, eating problems, anxiety, and substance use. Three of these 7 WIs were self-administered by youths, and four by trained interventionists; collectively, they were 30–168 min in length and targeted clinic-referred and non-referred samples in clinical, school, and laboratory settings. Overall, certain WIs show promise in reducing mild-to-severe youth psychopathology. Given their brevity and low cost relative to traditional (i.e., therapist-delivered, 12- to 16-week, clinic-based) EBTs, WIs may represent beneficial additions to the youth mental healthcare ecosystem. Priorities for future research are proposed, including testing WIs for parents, younger children, and externalizing problems; as EBT adjuncts; and in schools and primary care clinics to increase access to brief, effective supports.

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Notes

  1. In this review, we focus on WIs that have been evaluated as brief, stand-alone interventions for reducing symptoms of psychopathology in youth. Initially, we had also intended to evaluate extant evidence on WIs as adjunctive interventions to foster engagement and retention in traditional EBTs. However, we found no existing RCTs that combined traditional EBTs with adjunctive WIs. We were able to identify one trial evaluating the effects of WIs on parents’ attitudes toward youth mental health treatment (Schleider and Weisz 2018a, b); however, this trial did not evaluate WI effects on youth mental health and was thus excluded from our review. Additionally, some of the RCTs included in this review assessed WI effects on youths’ knowledge of mental health problems and motivation for treatment (Bailey et al. 2004; Klimes-Dougan et al. 2009). We therefore discuss the promise of using WIs as adjunctive interventions in the discussion section of this manuscript, although this possibility has yet to be tested empirically.

  2. WIs may intersect in notable ways with components of EBTs for youth psychopathology. Embry and Biglan (2008) define evidence-based “kernels” as "fundamental units of behavioral influence that underlie effective prevention and treatment." From our perspective, WIs may be understood as a specific type or sub-category of kernels, which share defining features of their own. For instance, unlike many other kernels, WIs are generally designed and evaluated as stand-alone interventions (although we also suggest how WIs might complement multi-component EBTs for youth mental health problems).

  3. Notably, brief and even single-session interventions (SSIs) have shown promise in reducing youth psychopathology of multiple types; see Schleider and Weisz 2017, for a meta-analysis of SSIs for youth psychopathology. However, not all SSIs qualify as WIs, due to the criteria noted in this section.

  4. 13 studies in this review were excluded on the basis of intervention length. However, of these 13 interventions, only 4 would have been excluded based on intervention length alone. More commonly, these studies would have qualified for exclusion based on failure to meet other criteria, regardless of whether the intervention length criteria had been in place. (For instance, interventions containing more than five sessions tended to also teach more than one skill or strategy, violating the ‘single-component’ criterion.).

  5. In this paper, our characterization of WIs as “Well-Established,” “Probably Effective,” “Possibly Effective,” “Experimental,” or “Questionable” references each WI type’s demonstrated capacity to reduce levels of symptoms or a disorder of a specific type.

  6. Cognitive dissonance-based programs are based on the counter-attitudinal advocacy paradigm studied extensively in the field of persuasion (Brehm & Cohen, 1962). In this paradigm, participants are induced to advocate (via writing exercises, typically) for a topic inconsistent with their initial beliefs; because humans are motivated to maintain consistency with their attitudes and behaviors, this paradigm theoretically generates cognitive dissonance, facilitating attenuation of those initial beliefs. In programs targeting clinical problems, such as eating disorders, dissonance activities are used to induce critiques of the “thin ideal” in verbal, written, and behavioral exercises (e.g., write a letter about the costs of pursuing this ideal; Halliwell & Dietrichs, 2014). Critiquing the thin ideal theoretically prompts participants to reduce their belief to this ideal, which is thought to decrease body dissatisfaction, negative affect, and disordered eating behaviors.

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Authors and Affiliations

  1. Department of Psychology, Stony Brook University, Stony Brook, USA

    Jessica L. Schleider

  2. Department of Psychology, University of Texas at Austin, Austin, USA

    Michael C. Mullarkey

  3. Department of Applied Psychology, New York University, New York, USA

    Anil Chacko

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  1. Jessica L. Schleider
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  2. Michael C. Mullarkey
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  3. Anil Chacko
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Correspondence to Jessica L. Schleider.

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Schleider, J.L., Mullarkey, M.C. & Chacko, A. Harnessing Wise Interventions to Advance the Potency and Reach of Youth Mental Health Services. Clin Child Fam Psychol Rev 23, 70–101 (2020). https://doi.org/10.1007/s10567-019-00301-4

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