Psychological change in a single session (with Jessica Schleider)
Spencer Greenberg speaks with Dr. Jessica Schleider about how brief moments and single-session interventions can create lasting mental health change. They discuss common themes in personal turning points, the science behind short interventions, and practical tools to foster hope and agency.
Deep Dive Analysis
14 Topic Outline
Possibility of Life Change Through Short Interventions
Personal Turning Point in Anorexia Recovery
Common Themes in Mental Health Turning Points
Self-Determination Theory and Behavior Change
Identity Change and Mental Health Interventions
Experimental Design of Single-Session Interventions for Teens
Understanding Effect Sizes and Control Group Boosts
Behavioral Activation Single-Session Intervention
Other Effective Single-Session Interventions and Delivery
The Single Session Consultation Protocol
Importance of Mixed Methods: Qualitative and Quantitative Research
Why Single-Session Interventions are Crucial for Public Health
Adapting Single-Session Interventions for Adolescents vs. Adults
Reflecting on and Noticing Personal Turning Points
8 Key Concepts
Turning Points in Mental Health
These are moments, ranging from a few seconds to a half-hour, that significantly shift a person's mental health trajectory or coping. While seemingly brief, they often build upon a lifetime of prior experiences and struggles.
Self-Determination Theory
This is a framework explaining how people change their behavior, positing that all humans have three basic psychological needs: competence (feeling skilled), autonomy (feeling control over one's future), and relatedness (feeling connected and seen by others). Fulfilling these needs can unlock behavior change.
Project Personality (People-Can-Change Intervention)
A single-session digital intervention designed for teenagers that teaches them depression and anxiety are not fixed traits. Its primary mechanism of change is increasing hope and a sense of agency, leading to sustained symptom reduction.
Behavioral Activation Intervention (ABC Project)
A single-session digital intervention that teaches the principle that actions can shape feelings, and one does not need to feel good before taking values-aligned action. It guides participants to create an action plan for engaging in activities that align with their goals and values.
Single Session Consultation (SSC)
A human-delivered, problem-agnostic single-session support designed to help individuals take a concrete step towards a goal. It's often used for people on waiting lists for longer-term therapy and focuses on setting expectations and identifying a 'miracle day' vision.
Solution-Focused Approach
A therapeutic approach that assumes individuals possess inherent strengths and skills, rather than lacking them. It focuses on helping people identify exceptions to their problems and leverage their existing abilities to make progress, rather than teaching new skills.
Regression to the Mean
A statistical phenomenon where extreme measurements tend to be closer to the average upon re-measurement. In clinical trials, this means participants recruited during a peak of symptoms are likely to show some improvement over time, even without intervention.
Expectancy Effect (Placebo Effect)
The phenomenon where a person experiences a perceived improvement in their condition due to their belief in the treatment, rather than the treatment's specific active ingredients. This can contribute to improvements seen in control groups in clinical trials.
7 Questions Answered
Yes, it's possible for brief moments or experiences, ranging from a few seconds to 20-30 minutes, to have a lasting impact, though they often build on prior experiences and existing contexts.
Common themes include surprising oneself by doing something previously thought impossible, feeling profoundly validated or seen by another person, and reclaiming one's narrative by consciously taking steps towards a desired future.
SSIs like Project Personality and behavioral activation increase hope and a sense of agency right after the intervention, which then predicts sustained reductions in depression, anxiety, and other related symptoms months later.
Compared to a credible control, single-session interventions typically show a small but significant effect size (around Cohen's D of 0.18), which is considered clinically meaningful and better than what's expected from waiting lists.
SSIs are crucial because traditional longer-term therapies are inaccessible to most people due to financial, logistical, and stigma barriers, making SSIs a vital part of a broader mental health ecosystem that provides accessible support.
Many SSIs, including the human-delivered consultation and even some digital programs initially for teens, are found to be effective for adults with minimal adaptation, as core skills and the need for hope are generally ageless.
Reflecting on past moments where one felt seen, was inspired by someone, took control of their future, or surprised themselves can help shift perspectives on what's possible and make one more attuned to future turning points.
11 Actionable Insights
1. Embrace Instant Change
Adopt the mindset that significant personal change can occur at any moment, not just over long periods, as this can be an uplifting thought when struggling.
2. Act Without Readiness
Let go of the assumption that you must feel completely ready before taking action on difficult tasks or goals, as readiness may never come and shouldn’t hold you back.
3. Practice Behavioral Activation
Engage in values-aligned activities daily, even if you don’t feel good, because your actions can directly shape your emotions and move you closer to your goals. Plan five minutes a day for something just for you, connecting with someone positive, and a step towards a goal.
4. Challenge Unhelpful Identities
Actively work to undo identities that label you with permanent conditions (e.g., “permanently depressed”) and instead cultivate helpful identities that support your capacity for change.
5. Recognize Change Is Possible
Understand that mental health challenges like depression and anxiety are not fixed traits but experiences that can be managed and changed through coping and different responses.
6. Seek Validation & Connection
Actively seek out individuals or communities where you feel truly understood and seen, as this can combat feelings of loneliness and defectiveness, unlocking motivation for change.
7. Surprise Yourself With Action
Deliberately engage in actions you previously thought impossible for yourself, as observing your own capability can fundamentally shift your self-perception and open new paths for coping.
8. Reclaim Your Future Narrative
Consciously make decisions and take concrete steps towards a future you define and desire for yourself, which combats hopelessness and fosters a sense of control over your life.
9. Fulfill Basic Psychological Needs
Focus on activities that enhance your sense of competence (having skills), autonomy (control over your future), and relatedness (connection to others), as fulfilling these needs unlocks behavior change.
10. Use The “Miracle Day” Exercise
When facing a problem, imagine a “miracle day” where it’s completely resolved and your top hope achieved; then, identify small, concrete steps to move one point closer to that ideal, leveraging your existing strengths.
11. Reflect On Past Turning Points
Regularly reflect on past moments in your life where you experienced significant shifts, such as feeling seen, being inspired, taking control, or surprising yourself, to appreciate past growth and become more attuned to future turning points.
5 Key Quotes
Have you ever thought that that might be the whole thing? All there is to recovery is just doing it. What if you just woke up every day and decided to do something that felt impossible and then just kept doing that over and over again.
Jessica Schleider (recounting a peer's advice)
I think everyone probably has them, but not everybody notices them.
Anonymous interviewee (recounted by Jessica Schleider)
Doing quantitative research in the isolation of any qualitative information, that seems unscientific to me.
Jessica Schleider
Change really can happen at any moment.
Jessica Schleider
When you think about the school assembly approach to preventing mental health problems, like teach all kids coping skills at once and hope that it helps prevent stuff in the future, that's targeting a whole bunch of people who have no motivation or reason to care about the intervention that you're trying to deliver.
Jessica Schleider
2 Protocols
Single Session Consultation (SSC)
Jessica Schleider- Introduce the session by explicitly framing it as a single-session support, setting the expectation that it's not long-term but focused on making the client leave in a better place.
- Ask the client to identify their top problem that led them to seek support today.
- Ask the client to identify their top hope for the conversation, defining what would make it feel important and helpful.
- Conduct the 'Miracle Day' exercise: Ask the client to imagine waking up to find their top problem totally gone and top hope achieved, then describe what would be different in their morning.
- Ask the client to rate on a scale of 1 to 10 how close they are to their Miracle Day being real at this moment (most typically rate 3-6).
- Help the client create a three-point action plan to get one point higher on their Miracle Day scale, using a solution-focused approach to draw on their existing strengths and skills.
Behavioral Activation Intervention (ABC Project)
Jessica Schleider- Ask the participant to rate their current mood on a scale from zero (awful) to ten (great).
- Instruct the participant to pick and watch one of three pre-selected funny, adorable, or inspiring short YouTube videos or TikToks.
- After watching the video, ask the participant to rate their mood again, noting that it almost inevitably increases by at least one point.
- Message the participant that this demonstrates how quickly emotions can change through small actions, and that their actions can shape how they feel.
- Guide the participant through making a concrete action plan for engaging in values-aligned activities: 5 minutes for themselves, connecting with someone positive, and taking one step closer to a goal that matters to them.
- Instruct the participant to screenshot their action plan so they can take it with them and use it moving forward.