Do Immediate Gains Predict Long-Term Symptom Change? Findings from a Randomized Trial of a Single-Session Intervention for Youth Anxiety and Depression

  • Jessica L. SchleiderEmail author
  • Madelaine R. Abel
  • John R. Weisz
Original Article


Single-session interventions (SSIs) can help reduce youth psychopathology, but SSIs may benefit some youths more than others. Identifying predictors of SSIs’ effectiveness may clarify youths’ likelihoods of benefitting from an SSI alone, versus requiring further treatment. We tested whether pre-to-post-SSI shifts in hypothesized symptom change mechanisms predicted subsequent reductions in youth internalizing symptoms. Data were from a trial evaluating whether an SSI teaching growth mindset (the belief that personality is malleable) reduced youth anxiety and depression. Youths (N = 96, ages 12–15) self-reported growth mindsets, perceived primary control, and perceived secondary control pre- and immediately post-intervention. They self-reported depression and anxiety symptoms at pre-intervention and 3, 6, and 9-month follow-ups. Larger immediate increases in primary control predicted steeper depressive symptoms declines across the follow-up; larger immediate increases in secondary control predicted steeper anxiety symptoms declines. Immediate shifts in proximal intervention “targets” may predict longer-term response to an SSI for youth internalizing distress.

Clinical Trials registration: NCT03132298.


Single-session intervention Brief intervention Anxiety Depression Mindset 



This study was funded by the National Institute of Mental Health (F31 MH108280), an Elizabeth Munsterberg Koppitz Fellowship from the American Psychological Foundation; and a Julius B. Richmond Fellowship from the Harvard Center on the Developing Child, all awarded to the first author.

Compliance with Ethical Standards

Conflict of interest

The authors have no potential conflicts of interest to report pertaining to the research described in this manuscript.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

10578_2019_889_MOESM1_ESM.docx (162 kb)
Supplementary material 1 (DOCX 161 kb)
10578_2019_889_MOESM2_ESM.docx (97 kb)
Supplementary material 2 (DOCX 97 kb)


  1. 1.
    Öst LG, Ollendick TH (2017) Brief, intensive and concentrated cognitive behavioral treatments for anxiety disorders in children: a systematic review and meta-analysis. Behav Res Ther 97:134–145CrossRefGoogle Scholar
  2. 2.
    Schleider JL, Weisz JR (2017) Little treatments, promising effects? Meta-analysis of single session interventions for youth psychiatric problems. J Am Acad Child Adolesc Psychiatry 56:107–115CrossRefGoogle Scholar
  3. 3.
    Schleider JL, Weisz JR (2017) Can less be more? The promise (and perils) of single-session youth mental health interventions. Behav Ther 40:256–261Google Scholar
  4. 4.
    Kataoka SH, Zhang L, Wells KB (2002) Unmet need for mental health care among U.S. children: variation by ethnicity and insurance status. Am J Psychiatry 159:1548–1555CrossRefGoogle Scholar
  5. 5.
    Thomas KC, Ellis AR, Konrad TR, Holzer CE, Morrissey JP (2009) County-level estimates of mental health professional shortage in the United States. Psychiatr Serv 60:1323–1328CrossRefGoogle Scholar
  6. 6.
    NHS Foundation Trust. Stepped care model.
  7. 7.
    Tang TZ, DeRubeis RJ (1999) Sudden gains and critical sessions in cognitive-behavioral therapy for depression. J Consult Clin Psychol 67:894–904CrossRefGoogle Scholar
  8. 8.
    Norton PJ, Klenck SC, Barrera TL (2010) Sudden gains during cognitive-behavioral group therapy for anxiety disorders. J Anxiety Disord 24:887–892CrossRefGoogle Scholar
  9. 9.
    Kelly MA, Cyranowski JM, Frank E (2007) Sudden gains in interpersonal psychotherapy for depression. Behav Res Ther 45:2563–2572CrossRefGoogle Scholar
  10. 10.
    Gaynor ST, Weersing VR, Kolko DJ, Birmaher B, Heo J, Brent DA (2003) The prevalence and impact of large sudden improvements during adolescent therapy for depression: a comparison across cognitive-behavioral, family, and supportive therapy. J Consult Clin Psychol 71:386–393CrossRefGoogle Scholar
  11. 11.
    Hofmann SG, Schulz SM, Meuret AE, Moscovitch DA, Suvak M (2006) Sudden gains during therapy of social phobia. J Consult Clin Psychol 74:687–697CrossRefGoogle Scholar
  12. 12.
    Tang TZ, DeRubeis RJ, Hollon SD, Amsterdam J, Shelton R (2007) Sudden gains in cognitive therapy of depression and depression relapse/recurrence. J Consult Clin Psychol 75:404–408CrossRefGoogle Scholar
  13. 13.
    Aderka IM, Appelbaum-Namdar E, Shafran N, Gilboa-Schechtman E (2011) Sudden gains in prolonged exposure for children and adolescents with posttraumatic stress disorder. J Consult Clin Psychol 79:441–446CrossRefGoogle Scholar
  14. 14.
    Dour HJ, Chorpita BF, Lee S, Weisz JR (2013) Sudden gains as a long-term predictor of treatment improvement among children in community mental health organizations. Behav Res Ther 51:564–572CrossRefGoogle Scholar
  15. 15.
    McLeod BD, Islam NY, Chiu AW, Smith MM, Chu BC, Wood JJ (2014) The relationship between alliance and client involvement in CBT for child anxiety disorders. J Clin Child Adolesc Psychol 43:735–741CrossRefGoogle Scholar
  16. 16.
    Fjermestad KW, Lerner MD, McLeod BD et al (2016) Therapist-youth agreement on alliance change predicts long-term outcome in CBT for anxiety disorders. J Child Psychol Psychiatry 57:625–632CrossRefGoogle Scholar
  17. 17.
    Niles AN, Burklund LJ, Arch JJ, Lieberman MD, Saxbe D, Craske MG (2014) Cognitive mediators of treatment for social anxiety disorder: comparing acceptance and commitment therapy and cognitive-behavioral therapy. Behav Ther 45:664–677CrossRefGoogle Scholar
  18. 18.
    Gordon JA (2017) Director’s blog: an experimental therapeutic approach to psychosocial interventions.
  19. 19.
    Schmidt NB, Eggleston AM, Woolaway-Bickel K, Fitzpatrick KK, Vasey MW, Richey JA (2007) Anxiety sensitivity amelioration training (ASAT): a longitudinal primary prevention program targeting cognitive vulnerability. J Anxiety Disord 21:302–319CrossRefGoogle Scholar
  20. 20.
    Diedrichs PC, Atkinson MJ, Steer RJ, Garbett KM, Rumsey N, Halliwell E (2015) Effectiveness of a brief school-based body image intervention ‘Dove Confident Me: Single Session’ when delivered by teachers and researchers: results from a cluster randomised controlled trial. Behav Res Ther 74:94–104CrossRefGoogle Scholar
  21. 21.
    Schleider JL, Weisz JR (2016) Reducing risk for anxiety and depression in adolescents: effects of a single-session intervention teaching that personality can change. Behav Res Ther 87:170–181CrossRefGoogle Scholar
  22. 22.
    Schleider JL, Weisz JR (2018) A single-session growth mindset intervention for adolescent anxiety and depression: nine-month outcomes of a randomized trial. J Child Psychol Psychiatr 59:160–170CrossRefGoogle Scholar
  23. 23.
    Yeager DS, Trzesniewski KH, Dweck CS (2013) An implicit theories of personality intervention reduces adolescent aggression in response to victimization and exclusion. Child Dev 84:970–988CrossRefGoogle Scholar
  24. 24.
    Yeager DS, Lee HY, Jamieson JP (2016) How to improve adolescent stress responses: insights from integrating implicit theories of personality and biopsychosocial models. Psychol Sci 27:1078–1091CrossRefGoogle Scholar
  25. 25.
    Miu AS, Yeager DS (2015) Preventing symptoms of depression by teaching adolescents that people can change: effects of a brief incremental theory of personality intervention at 9-month follow-up. Clin Psychol Sci 3:726–743CrossRefGoogle Scholar
  26. 26.
    Silverman WK, Nelles WB (1988) The anxiety disorders interview schedule for children. J Am Acad Child Adolescn Psychiatry 27:772−778CrossRefGoogle Scholar
  27. 27.
    Brown JD, Siegel JM (1988) Attributions for negative life events and depression: the role of perceived control. J Pers Soc Psychol 54:316–322CrossRefGoogle Scholar
  28. 28.
    Culpin I, Stapinski L, Miles ÖB, Araya R, Joinson C (2015) Exposure to socioeconomic adversity in early life and risk of depression at 18 years: the mediating role of locus of control. J Affect Disord 183:269–278CrossRefGoogle Scholar
  29. 29.
    Muris P, Meesters C, Schouten E, Hoge E (2004) Effects of perceived control on the relationship between perceived parental rearing behaviors and symptoms of anxiety and depression in nonclinical preadolescents. J Youth Adolesc 33:51–58CrossRefGoogle Scholar
  30. 30.
    Schleider JL, Abel MR, Weisz JR (2015) Implicit theories and youth mental health problems: a random-effects meta-analysis. Clin Psychol Rev 35:1–9CrossRefGoogle Scholar
  31. 31.
    Higa-McMillan CK, Francis SE, Rith-Najarian L, Chorpita BF (2016) Evidence base update: 50 years of research on treatment for child and adolescent anxiety. J Clin Child Adolesc Psychol 45:91–113CrossRefGoogle Scholar
  32. 32.
    Ritschel LA, Ramirez CL, Jones M, Craighead WE (2011) Behavioral activation for depressed teens: a pilot study. Cog Behav Pract 18:281–299CrossRefGoogle Scholar
  33. 33.
    Weersing VR, Jeffreys M, Do MCT, Schwartz KT, Bolano C (2017) Evidence base update of psychosocial treatments for child and adolescent depression. J Clin Child Adolesc Psychol 46:11–43CrossRefGoogle Scholar
  34. 34.
    Weisz JR, Kazdin AE (2017) The present and future of evidence-based psychotherapies for children and adolescents. In: Kazdin AE, Weisz JR (eds) Evidence-baed psychotherapies for children and adolescents, 3rd edn. Guildford, New YorkGoogle Scholar
  35. 35.
    Ng MY, Weisz JR (2015) Annual research review: building a science of personalized intervention for youth mental health. J Child Psychol Psychiatr 57:216–236CrossRefGoogle Scholar
  36. 36.
    Ebesutani C, Bernstein A, Nakamura BJ, Chorpita BF, Hia-McMillan CK, Weisz JR (2010) Concurrent validity of the child behavior checklist DSM-oriented scales: correspondence with DSM diagnoses and comparison to syndrome scales. J Psychopathol Behav Assess 32:373–384CrossRefGoogle Scholar
  37. 37.
    Piacentini J, Bennett S, Compton SN, Kendall PC, Birmaher B, Albano AM et al (2014) 24-and 36-week outcomes for the Child/Adolescent Anxiety Multimodal Study (CAMS). J Am Acad Child ADolesc Pschiatry 53:297–310CrossRefGoogle Scholar
  38. 38.
    Kirschbaum C, Pirke KM, Hellhammer DH (1993) The ‘Trier Social Stress Test’—a tool for investigating psychobiological stress responses in a laboratory setting. Neuropsychobiology 28:76–81CrossRefGoogle Scholar
  39. 39.
    Aronson E (1999) The power of self-persuasion. Am Psychol 54:875–884CrossRefGoogle Scholar
  40. 40.
    Stice E, Burton E, Bearman SK, Rohde P (2007) Randomized trial of a brief depression prevention program: an elusive search for a psychosocial placebo control condition. Behav Res Ther 45:863–876CrossRefGoogle Scholar
  41. 41.
    Kovacs M (2001) Children’s depression inventory (CDI) technical manual. Multi-Health Systems Inc, Noth TonawandaGoogle Scholar
  42. 42.
    Birmaher B, Brent DA, Chiappetta L, Bridge J, Monga S, Baugher M (1999) Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED): a replication study. J Am Acad Child Adolesc Pscyhiatry 38:1230–1236CrossRefGoogle Scholar
  43. 43.
    Hale WW, Raaijmakers Q, Muris P, Meeus WIM (2005) Psychometric properties of the screen for child anxiety related emotional disorders (SCARED) in the general adolescent population. J Am Acad Child Adolesc Psychiatry 44:283–290CrossRefGoogle Scholar
  44. 44.
    Myers K, Winters NC (2002) Ten-year review of rating scales. II: scales for internalizing disorders. J Am Acad Child Adolesc Psychiatry 57:216–236Google Scholar
  45. 45.
    Weisz JR, Weiss B, Wasserman AA, Rintoul B (1987) Control-related beliefs and depression among clinic-referred children and adolescents. J Abnorm Psychol 96:58–63CrossRefGoogle Scholar
  46. 46.
    Weisz JR, Southam-Gerow MA, McCarty CA (2001) Control-related beliefs and depressive symptoms in clinic-referred children and adolescents: developmental differences and model specificity. J Abnorm Child Psychol 110:97–109CrossRefGoogle Scholar
  47. 47.
    Weisz JR, Francis SE, Bearman SK (2010) Assessing secondary control and its association with youth depression symptoms. J Abnorm Child Psychol 38:883–893CrossRefGoogle Scholar
  48. 48.
    Little RJ, Rubin DB (1989) The analysis of social science data with missing values. Sociol Methods Res 18:863–872CrossRefGoogle Scholar
  49. 49.
    Buhi ER, Goodson P, Neilands TB (2008) Out of sight, not out of mind: strategies for handling missing data. Am J Health Behav 32:83–92CrossRefGoogle Scholar
  50. 50.
    Schlomer GL, Bauman S, Card NA (2010) Best practices for missing data management in counseling psychology. J Couns Psychol 57:1–10CrossRefGoogle Scholar
  51. 51.
    Feeley M, DeRubeis RJ, Gelfand LA (1999) The temporal relation of adherence and alliance to symptom change in cognitive therapy for depression. J Consult Clin Psychol 67:578–582CrossRefGoogle Scholar
  52. 52.
    Hauser-Cram P, Krauss MW (1991) Measuring change in children and families. J Early Interv 15:288–297CrossRefGoogle Scholar
  53. 53.
    Webb CA, DeRubeis RJ, Amsterdam JD, Shelton RC, Hollon SD, Dimidjian S (2011) Two aspects of the therapeutic alliance: differential relations with depressive symptom change. J Consult Clin Psychol 79:279–283CrossRefGoogle Scholar
  54. 54.
    Ginsburg GS, Lambert SF, Drake KL (2004) Attributions of control, anxiety sensitivity, and panic symptoms among adolescents. Cog Ther Res 28:745–763CrossRefGoogle Scholar
  55. 55.
    Suveg C, Hoffman B, Zeman JL, Thomassin K (2009) Common and specific emotion-related predictors of anxious and depressive symptoms in youth. Child Psychiatry Hum Dev 40:223–229CrossRefGoogle Scholar
  56. 56.
    Weems CF, Silverman WK (2006) An integrative model of control: implications for understanding emotion regulation and dysregulation in childhood anxiety. J Affect Disord 91:113–124CrossRefGoogle Scholar
  57. 57.
    Hogendoorn SM, Prins PJ, Boer F, Vervoort L, Wolters LH, Moorlag H et al (2014) Mediators of cognitive behavioral therapy for anxiety-disordered children and adolescents: cognition, perceived control, and coping. J Clin Child Adolesc Psychol 43:486–500CrossRefGoogle Scholar
  58. 58.
    Magaro MM, Weisz JR (2006) Perceived control mediates the relation between parental rejection and youth depression. J Abnorm Child Psychol 34:863–872CrossRefGoogle Scholar
  59. 59.
    Chu BC, Colognori D, Weissman AS, Bannon K (2009) An initial description and pilot of group behavioral activation therapy for anxious and depressed youth. Cogn Behav Pract 16:408–419CrossRefGoogle Scholar
  60. 60.
    Dimidjian S, Hollon SD, Dobson KS, Schmaling KB, Kohlenberg RJ, Addi ME et al (2006) Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. J Consult Clin Psychol 74:658–670CrossRefGoogle Scholar
  61. 61.
    Gawrysiak M, Nicholas C, Hopko DR (2009) Behavioral activation for moderately depressed university students: randomized controlled trial. J Couns Psychol 56:468–475CrossRefGoogle Scholar
  62. 62.
    Chorpita BF, Barlow DH (1998) The development of anxiety: the role of control in the early environment. Psychol Bull 124:3–21CrossRefGoogle Scholar
  63. 63.
    Schleider JL, Schroder HS (2018) Implicit theories of personality across development: impacts on coping, resilience, and mental health. In: Zeigler-Hill V, Shackelford TK (eds) The SAGE handbook of personality and individual differences. Sage Publications, CaliforniaGoogle Scholar
  64. 64.
    Heo M, Leon AC (2010) Sample sizes required to detect two-way and three-way interactions involving slope differences in mixed-effects linear models. J Biopharm Stat 20:787–802CrossRefGoogle Scholar
  65. 65.
    Amrhein V, Greenland S, McShane B (2019) Retire statistical significance. Nature 567:305–307CrossRefGoogle Scholar
  66. 66.
    Ng MY, Weisz JR (2016) Building a science of personalized intervention for youth mental health. J Child Psychol Psychiatry 57:216–236CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Psychology DepartmentStony Brook UniversityStony BrookUSA
  2. 2.Psychology DepartmentUniversity of KansasLawrenceUSA
  3. 3.Psychology DepartmentHarvard UniversityCambridgeUSA

Personalised recommendations