In this talk, “Little Treatments, Big Effects? Building Brief Interventions to Reduce Youth Psychopathology at Scale,” Jessica Schleider ’12 explains her research on depression and anxiety in children and adolescents while explaining how youth mental health interventions work. Schleider, whose work is funded by the National Institute of Health, is working on a book, Growth Mindset Workbook for Teens, using brain science to boost behavior change.

“Given this need for briefer, scalable interventions, and the promise of single-session approaches,” she says, “the goal of this project … is to test whether our one-session, computer-based intervention, teaching growth mindset of personalities—so the idea that who you are can change over time—could reduce internalizing problems, improve perceived control, and improve recovery from social stress in elevated-symptom adolescents with anxiety and depression.”

Schleider majored in psychology with a minor in cognitive science at Swarthmore and participated in a clinical psychology Ph.D. program at Harvard University. She later completed an internship in critical and community psychology at Yale University. An assistant professor of clinical psychology at Stony Brook University, Schleider also supervises graduate students on research and runs the Lab for Scalable Mental Health.

 

Audio Transcript:

Jane: I'm Jane Gillham, a lot of you know me. I'm the current Chair of the Psychology Department and it is my great pleasure to welcome Jessica Schleider here. I'm going to do a pretty brief introduction so that we have most of the time hear from Jessica. Jessica is here as part of our department's recent alumni bachelors series which we put together a few years back in honor of Debbie Kemler Nelson, Emeriti Psychologist, who was here for many years and retired in 2011.

Jessica graduated... well, let me back up a little. So first I just want to say that I've been here 21 years, and teaching students at Swarthmore is both exhilarating and incredibly humbling. And they do amazing things. You all do amazing things while you're here and then if we're lucky, we stay in touch and we get to see or hear about, or read about the amazing things that you do after you graduate. And so, I'm really thrilled to be able to bring Jessica back here and I think this is the first time she's been back at Swarthmore since graduating in 2012 and to have her share with you some of the amazing work she's been doing.

I'll give you a little bit of background. Jessica graduated in 2012, she majored in psychology, and on her way over here she told me that her first psychology class was in this room with Allen Schneider. Imagine coming back to teach in a room where you were a student. She worked with me and Beth Krause in the wellbeing lab during her junior and senior years and worked with us on several different projects. Worked development workshops with Swarthmore students based on positive psychology, writing a wellbeing program at the school for adolescent girls. Worked on a peer research looking at the relationship between parenting behaviors and adolescence adjustment. And, wrote a review paper... it got published... looking at anxiety as a predictor for depression in kids.

While she was a student, she was also involved in many other activities outside [inaudible 00:02:36] psychology. One of the activities I just want to highlight because I'm sort of more aware of it maybe than other things is that she co-directed [inaudible 00:02:45]. And, as a co-director of [inaudible 00:02:48], she worked really hard to raise awareness of psychological difficulties and stress, and emotional well-being here on campus. And, she worked to reduce stigma associated with mental health problems. And so that work was really, really important and it's ongoing because [inaudible 00:03:09] as well.

After graduating from Swarthmore, Jessica completed a clinical Psych PhD program at Harvard where she worked with John Weiss. And, after that, she completed an internship in critical and community psychology at Yale. She is now assistant professor of clinical psychology at Stony Brook University where she teaches courses in clinical psychology, she supervises graduate students on research, does probably lots of other things but runs a lab which is called The Lab for Scalable Mental Health.

She has longstanding interests in clinical psychology, child and adolescent clinical psychology, especially developmental psychology, cognitive psychology. She's interested in the context of effectual well-being, including families, including schools. I think that you're going to see a lot of those interests come together in this talk.

Her research focuses... some of it focuses on depression and anxiety in children and adolescents on developing, testing, and scaling brief interventions for each depression and anxiety and on understanding how youth mental health interventions work. So, what are the processes through which interventions are effective. Especially processes within the adolescent and also in their families.

Her work has been funded by National Institutes of Health and by several foundations as well. She has published more than 35 academic papers and book chapters... seven here... and produced several open access intervention programs. She also has a book that's under contract, "Growth Mindset Workbook for Teens" using brain science to boost behavior change.

And, she's won numerous awards. I'm just going to give you a few recent examples. NIH, National Institutes of Health, Early Independence Award. The President's New Researcher Award from the Association for Behavioral Pattern Therapies. The Dorothy Bishop Journal of Child Psychology and Psychiatry Best Paper Award, which was awarded for her 2018 paper, "Single-session growth mindset intervention for adolescent anxiety and depression: 9-month outcomes of a randomized trial". Her work has been recognized in a popular press as well so she was recently featured in the Atlantic in August. And, just this week, September 17, there was an article in Vox that focused on her work as well.

Jessica is very generous with her time. You're going to hear a lot from her. I [inaudible 00:06:13] students who are working in my lab. They're going to have the great fortune of having her join us tomorrow morning. And then, for anyone who's interested in graduate school for clinical psychology, Jessica is going to hold a lunch meeting. That's at noon to 1:30. If you can't make the whole time, don't worry. Stop in when you can. It's in 116 Colberg. It's about applying for graduate school and graduate school in clinical psych. We, faculty here, will be running a panel in the beginning of October on applying for graduate school. But you'll have the opportunity tomorrow to learn, first hand, about it from somebody who's been through it a lot more recently than I have. And so I think she'll have a lot of good pointers if you're about to make that lunch.

I am thrilled to be able to introduce Jessica to you. I know you are in for a treat and I hope that you'll join me in welcoming her back to Swarthmore.

Jessica: This is crazy. Hi. It's great to be here. Jane, thank you so much for that lovely, generous introduction. And, you're right, this is the last time I was here. That was right after the graduation ceremony and I'm not a hat person so I had taken off their [inaudible 00:07:34] already. I'm equally happy to be here today as I was in that picture and really grateful for the opportunity. I thought it was funny.

Then, in walking through where we're going to go and what we're going to cover today. First, I'm going to give you a broad overview of the work that we do in my lab and why we do it. I'm going to discuss the promise of brief and even single-session interventions to make meaningful change in youth psychopathology. And, I'm going to talk about some specific randomized trials we've conducted, testing SSI, single-session interventions for youth mental health or interest in access to care focusing on modifying factors within individuals like kids and parents.

I'm also going to give you a preview of where we're going next, what we're working on right now, and over the next few years in this domain.

There's been a whole lot of progress in the development and identification of affective youth mental health interventions, but we have an extremely long way to go before meeting the needs of kids and families across the country. So, of the kids in the United States who experience a significant mental health concern, about one in five will ever access mental health services. Of that one in five, about 20% will complete what we consider to be a full course of treatment. About 16 sessions in cognitive behavioral therapy.

So, given that the current model of care being face-to-face, one-to-one psychotherapy doesn't seem to be meeting this large scale need, novel approaches are going to be required to reduce the burden of these mental health problems at scale. Not only that, but our best treatments don't always help.

A really sad paper came out recently by my graduate school mentor. Sad and inspiring, right. These are the effect sizes for the past 50 years for youth mental health treatments from 1970 to today. For the four most common kinds of youth psychopathology, those downward spokes for depression and conduct problems are significant. We've gotten worse at treating depression and conduct problems over the past 50 years. Maybe because we're using great control groups now, but maybe not. Bottom line is, we need to do better both at enhancing the potency of the interventions that we have and their scalability.

So, right, this need exists for accessible and well-targeted approaches both to augment effects of treatments that already exist, which are really benefiting a lot of kids and families out there. But, also to offer something, ideally with scientific support, to the many kids who might otherwise get nothing at all.

Back to where we hope our lab comes in. I wrote, "The Lab for Scalable Mental Health" at Stony Brook University, and our goals are kind of three-fold. First, our goal is to develop brief and scalable interventions for youth mental health problems with a focus on depression and related disorders. To identify change mechanisms and ways of matching kids to the treatments they might benefit from most. And then, to test novel ways of disseminating these treatments beyond brick and mortar clinics.

Just quick definition by "scalable" what I mean is expandable under real world conditions to reach a greater portion of the population while retaining effectiveness that's observed in more controlled studies.

I want to point out that the treatments that I'm going to talk about today, they're not going to replace therapy. Absolutely not. But, what I hope that they might be able to do is compliment and extend the system that we already have in place to give more access to a larger portion of the population.

In pursing this kind of work, you probably want to know if brief interventions can actually do anything. I wanted to know that too. A few years ago we decided to conduct a meta-analysis of taking this idea to the maximum. Essentially seeing if single-session interventions can actually do anything for youth mental health problems. To my surprise, there were already 50 randomized controlled trials in 2017 testing single-session mental health interventions, which I had no idea about, and this is what happened. On this access, on the Y-axis, you can see effect sizes. I labeled small, medium, and large. Just trust that those are meaningful designations. These are the different kinds of problems. That very large effect size you see for eating disorders is non-significant and based on very few studies.

But, what you can see, is that we do have significant effects in medium range for anxiety and conduct problems, and a small, albeit non-significant, effect based on six studies for depression. We looked at multiple moderators, or factors that might influence the size of these effects, and we did find that single-session interventions tend to be more helpful for children and early adolescents than for older adolescents. We did not find any evidence that single-session interventions were more effective when delivered by a therapist versus self-administration. We did not find any differences from treatment versus prevention programs and we did not find any significant differences depending on the country in which the RCTs are placed.

What was probably the most surprising thing that I took away from this meta-analysis... so those red bars are the mean effect sizes based on meta-analytic evidence for full-length youth psychotherapies. Yeah. So, either really great or really terrible. I'm going to go with great because this is what I study, but it was very interesting to see that those effect sizes aren't that different. Which one read is that you can actually do something in a short amount of time.

That begs the question of, "Well, okay so we can do something in that short amount of time but what should we do and how should we do it?" We take the approach of looking at intra-person mechanisms that can be modified in a relatively short period of time and that may underlie broader forms of psychopathology. So, things like cognitions have been shown to be modifiable. It would be intervention, so we focus on those.

Much of my work is focused on one type of cognition called mindset. I also call it implicit theories but mindset's shorter so we're going to go with that today. I'm just going to present a few different studies on how we've approached modifying mindsets for youth mental health and what we found to date.

So, backing up a little bit. What are mindsets? Good question. It's based on Carol Dweck's achievement motivation theory. The basic tenant is that people tend to view personal attributes and traits in one of two ways. Understood is two ends of the continuum. On the one hand, you can view a given trait or ability through a fixed mindset lens. Which means you view those traits as static and unchangeable, so effort is bad. It means you're just not good at something. Though through the growth mindset do those same personal traits act malleable through personal effort. So, effort is viewed as the only path to self improvement, and therefore, a good thing.

A large body of literature suggests that kids who view their traits through the fixed mindset lens tend to do worse when faced with setbacks, both socially and academically. They give up prematurely, they engage in more negative self-talk and other negative outcomes.

I've been interested for a while in whether and how mindsets might relate to youth mental health. First of all, to figure out whether they did, we conducted a meta-analysis and we found that, in fact, fixed mindset were linked to higher levels of youth psychopathology from kids ages 4-17. More so for depression and anxiety than for externalizing problems. We did a longitudinal study in Cambridge Public Schools and found that stronger fixed mindsets were bi-directionally linked to greater psychopathology over the course of the school year. A lot of research that we haven't done but that others have done has suggested that mindsets are valuable. The interventions have been able to shift how people view their personal traits and abilities with positive outcomes. It's also the case, drawing from the clinical literature, that mindsets overlap quite a bit conceptually. And, also in terms of the construct itself, with other negative cognitive styles like hopelessness and low agency that have also been shown to be malleable through intervention.

Given this need for briefer scalable interventions and the promise of single-session approaches, the goal of this project I'm going to share with you now is to test whether our one-session computer-based intervention teaching growth mindset of personalities — so the idea that who you are can change over time — could reduce internalizing problems, improve perceived control, and improve recovery from social stress in elevated-symptom adolescents with anxiety and depression. Our aim is to look at both immediate and long-term 9-month outcomes of this program.

This shows the sample that we were working with. We have 96 kids with elevated anxiety and depression ages 12-15. We target that age group in a lot of our studies because it is a period of increased risk for depression and anxiety onset. A lot of transitions going on during those years. Most have received or were currently receiving prior treatment for depression. In the spirit of what I said earlier, these kinds of interventions are not intended to replace therapy, but we are interested in whether they can compliment existing therapies.

A majority met some kind of cut-off for either depression or anxiety. We were fortunate, our many phone calls paid off. We had a 74% retention rate at 9-month follow-up. You can see the ratial and ethnic breakdown in family income distribution on the right. We ended up with a bi-model distribution of very low income and very high income families that were represented.

Okay, so what was the study design? We screened 187 kids, and from that 96 met criteria for having elevated symptoms. From there, they came into the lab and they were randomized to one of two conditions. Either the mindset intervention that I'm going to show you in a minute, or what we call a sharing feelings intervention, which I will also explain momentarily. A post intervention assessment. So, we looked at immediate changes in certain proximal factors we thought might be shifted and the kids also did a Trier Social Stress Test which they loved. We followed up with people over a 9-month period every three months.

I want to give you a sense of what these programs look like because a lot of people don't know what to picture when they think of the one session online program. We're trying out this acronym for describing how we do things called the best elements of SSI [inaudible 00:18:48] mental health. We've constructed a few different interventions now along these lines. We use brain science to help normalize the concepts that we're teaching and make them applicable to whoever is reading about them. E is for empowering kids to helper or the expert role as opposed to the patient role that a lot of them are used to. We use seeing is believing exercises drawn from social psych literature to solidify learning and internalization of the concepts that we teach. And we used a whole lot of testimonials and evidence from valued others. In this case, scientists and peers that are slightly older.

What does the intervention look like? This is how we start which is different from therapy, right? We, the researchers, ask the kids who are taking this program, for their assistance in helping translate these scientific concepts that we study into language that makes sense to other kids their age that might be helpful. We elevate kids to that helper role in that sense. Kids listen to a bunch of stories from other kids discussing times when they were struggling in school or they were struggling with depression or anxiety. And, through some kind of personal effort or trying new things, things got better for them and a part of them changed. So, their anxiety got better or their depression got better, etc.

We explained... we give a very simplified lesson on neuro-plasticity to explain why this can happen. That your behaviors can actually change your brain and the kinds of thoughts and behaviors you have. Noting that everyone's brain is a work in progress, not something that's set in stone. Scientists say it's like the connections in our brains are made with a pencil, not a permanent marker. It's not easy to draw new connections, but it's always possible simply because of how we're built as humans.

We use examples from randomized trials of depression treatments to show that people actually can, by changing their behaviors, change their levels of depression over time. We share survey data from kids showing that how lonely they felt at the start of the school year, for instance, changed by the end of the school year. That seeing is believing activity, that's drawn from a large body of literature in social psychology, but we have kids first talk about how they would respond to a hypothetical peer rejection scenario. We asked them to imagine how they would feel and what they would do if, on their first day of school, they went up to a friend or someone who they thought was their friend and totally got ignored.

We asked them to write about what they would experience in that moment. Then, we asked them, "Pretend that that thing you just wrote about definitely didn't happen to you. It definitely happened to some kid over there. How would you help that kid over there learn how to cope with the situation more effectively based on what you just learned about neuroscience of the brain and personality and how people can change?" kind of hoping that, through this process, kids internalize the idea themselves.

This is one of the things that we got. One kid wrote, "I would tell him through a member that even though it feels like these things will never end, nothing is forever and maybe by being nice to the kid you can make him realize that he's being mean and his neurons will help him change for the better". People got different brains. Everybody's brain is constantly growing and changing. That friend of yours probably got some struggle going on in there and they may just need time. But even if they don't come back to be your friend, they're not the only person who can care about you. So, they got it pretty well. I could fill the entire rest of my talk with these but I won't. They gave some really wonderful answers that are very fun to read through.

Our control program. We wanted to make sure that we had a credible control program that actually was potentially meaningful. So, this was designed to control for non-specific aspects of doing a computer-based intervention and it was designed to resemble supportive psychotherapy. It aims to normalize and encourage kids to share how they are feeling with others who are close to them. Kind of like the advice they might get if they're having a tough day at school and go through the school counselor. They're told like, "Tell me how you're feeling, what's going on?" It's face valid. More kids in this condition guessed that they were in the new intervention than did kids in the other condition.

There's no mention of malleability of personal traits or emotions. It's just that you should share. There's no self persuasion exercise but we matched both programs on how many writing exercises there were. Everyone was randomized to one of those two things but then, regardless of their condition, they did this.

First, we hooked them up to some psychophysiology equipment. We were specifically interested in electrodermal activity in this study. So, how much sweat is on your hands right now, so how nervous are you. For the first five minutes they just watched a neutral video of fish in an aquarium. We actually edited out all the sharks, manually. We knew that nobody would get freaked out. Then, out of nowhere kids got told, "In a couple of minutes there are going to be two people who are going to evaluate you who come into this room. You're going to have two minutes to prepare and three minutes to deliver a speech on what makes a good friend, and what aspects of being a good friend to you have and do you lack. These people are going to be judging you on these characteristics and, all right, plan it, go". Mind you, these are kids with elevated anxiety and depressive symptoms. This was much less intense and severe than what we initially piloted. They did it and we, then, looked at their recovery period.

What we wanted to see was, did kids who just went through this activity showing them that how you are right now, how you're doing right now, isn't forever. Could they bounce back more quickly from this kind of set-back? By the way, the RAs, the Research Assistants you see here, they were actually trained not to smile, nod or give any indication of normal human contact during the entire speech period. So, no matter how well kids were doing, they just got blank stares and looking at watches in return. After this, everyone watched cute animal videos and it was fine.

Afterwards, we followed up with everyone at 3, 6 and 9-months to look at depressive and anxiety symptoms over time from youth and parent report.

I'm not going to go into super detail about the immediate effects, I'm going to focus on the longer term effects because I think they're more important. But, in the immediate we found that, from right before to right after the intervention, kids who received the mindset program versus the control showed improvements in perceived control over behavior and over emotions relative to the control group. They also, actually, recovered from that stressor more rapidly. Nobody got back to baseline but they got closer relative to the control.

The longer term effects we looked at anxiety and depression symptoms. This graph shows the effect sizes from baseline to 9-month follow-up changes and symptoms for the mindset program versus the control. The ones that are highlighted in green were significant. You think back to that graph that I showed earlier, .2, .3 is like a small effect size, .4, .6 is like a medium effect size. We were really happy, particularly with the depression results, for this study. Importantly, we did not find any evidence that effects varied by any of the socio demographic factors that we could think of, nor by receipt of concurrent treatment. Regardless of whether kids were receiving or had received treatment before or during the course of the study, they responded similarly.

I just want to give you a sense of the symptom change trajectory. On the Y-axis is the children's depression inventory score at each time points. On the X-axis is time. The red bar is going to be the mindset programs trajectory. Kids start off at approximately the same place but you can see that, over time, this effect size grows to the point where at 9-month follow-up there's a substantial difference.

It's important to note that these effects weren't entirely uniform across kids in the study. In a recent post-op examination of the data, we actually found that immediate shifts in proximal targets, like perceived control, could predict future symptom reductions after the single-session intervention. Which was quite interesting. So, this raises the possibility that it might be possible to forecast based on immediate improvements on proximal mechanisms who may be more or less likely to benefit from this kind of single-session versus who might need longer term services or more intensive care. This is something we're looking at in our lab now and I'll talk about more in a minute.

It's one study, right? You want to see replications before kind of believing in effect. Fortunately, we got to conduct one. This was a collaboration with some colleagues in North Carolina and this was a study of 222 high school girls and half received an online growth mindset single-session intervention teaching girls mindset of personality, and half received an active control which was an online healthy relationships course which was also one session and time matched.

We found that girls in the growth mindset group showed decreases in their rates of clinically elevated depressive symptoms four months later. Whereas, girls in the control showed slight increases, non-significant but something, four months later.

Taken together, this suggests to us that compared to different active control programs, a single-session, computer-base personality mindset intervention appears to, potentially, improve physiological stress recovery right after intervention, strengthened perceived control, reduced depressive symptoms across four to 9-months. It's possible, although we're exploring this in other studies, that that effect may be, in part, a result of the interventions immediate effect on perceptions of control over emotions and behavior.

Overall, promising for a one session program. We were happy with it.

Now I want to shift a little bit into talking about some of the work we've done about modifying cognitions in parents, specifically, parents' mindsets, for a somewhat different purpose. First of all, why would we target parents if we're interested in youth mental health? Well, parents decide whether kids get treatment. They are the gatekeepers to youth mental health, they transport kids to and from care, they make the decision to pursue care or not to pursue care. Their attitudes towards therapy may really matter. In fact, parents' beliefs about whether treatment is going to help can shape everything from whether they seek treatment for their kids to whether treatment works for their kids.

There's a real need for strategies that are brief and scalable. It can potentially boost parents expectancies and belief that psychotherapy could benefit their children.

Two possible beliefs that I thought might be relevant here were parents' mindsets, parents belief that whether emotions and anxiety are malleable or whether they're fixed. And their beliefs about failure. Do you believe failure is enhancing or debilitating? Why do these things seem relevant? Well, parents who view mental health problems as unchangeable may automatically reject the prospect that treatment could benefit their kids because these things are just stable traits, right?

Failure beliefs seemed relevant because there are many perceived consequences from parents' viewpoints if treatment doesn't work. Parents who view failure as catastrophic, as shameful, might avoid treatment if they're not sure if it's going to work because what does that mean about them as a parent or their child and their difficulties. That may cause some avoidance of treatment seeking.

So, in this study it was a two part study. First, we were interested in looking at whether parents with stronger fixed mindsets of emotion and anxiety and stronger failure is debilitating beliefs actually view mental health treatments less likely to work. And, whether these parents were more likely to opt out of treatment for their kids or for themselves. In study two we tested brief, five to fifteen minute online interventions teaching growth mindsets and failure is enhancing beliefs to see if we could modify parents expectancies and preferences for youth mental health treatment and treatment for themselves.

We did this video on Mechanical Turk. You can do randomized trials on Mechanical Turk. We ended up... this was actually a really great feature using M Turk for this kind of research. You get a lot of dats. Half of our sample was dats, which was unheard of in youth psychopathology research. Seriously, it was very exciting when we realized this.

We, basically, just had everyone fill out a survey. Parents reported on their mindsets of emotion, their mindsets of anxiety, and hypothetical treatment expectancies, and choices. We also looked at levels of parenting that use psychopathology as covariates because those can effect things like reporting.

In a nutshell, what we found was that parents with stronger fixed mindsets of emotion and parents with stronger failure is debilitating beliefs had lower optimism that psychotherapy could be effective either for themselves or their kids. And they were more likely to decline treatment when given a hypothetical option to pursue or not pursue treatment when their child is experiencing distress. Anxiety mindsets were not predictive because it seemed like emotion mindsets were taking up all the variance that anxiety mindsets took up. They were really, really... they were the same, essentially.

With that, we moved onto study two to look at other teaching parents who adopt growth emotion mindsets that adapted views of failure could improve their optimism towards mental health treatment. We had four conditions in this RCT because we were interested in the component parts, or the specific beliefs that might contribute most to parents treatment expectancies. One group, about 112 parents, got just a group mindset intervention. One got a failure is enhancing intervention only, kind of teaching that idea. One got both. And, other people just got a psycho education control that taught where emotions come from in your brain and in your body. Right after whatever program they completed, parents did a little seeing is believing activity. We asked them to read scientific articles, these were the interventions but we framed them as articles, and then write a brief summary describing its main points. We told them that their summaries would be used as part of a new educational program we were developing for teaching new parents about emotional experiences in themselves and their children. So, they were again put in this teacher role, expert role and we appreciate their help.

Long story short, what we found was that both the growth mindset and the combined interventions, so both conditions, significantly improved parents' optimism that psychotherapy could be effective for themselves and for their children. The effect sizes were larger for the combined intervention than for the growth mindset intervention alone. This was based on a one to ten rating scale of how much do you think psychotherapy would help if your kid had this problem or that problem.

How are we approaching expanding the repertoire of why SSIs exist? Because no intervention works for everyone, right? And, even the growth mindset intervention that I presented before really wasn't all that helpful for kids who showed no immediate improvements in perceived control. We need more options that target a diversity of proximal outcomes in order to optimize the potential of these things to effect positive change.

How are we doing this? Well, we're either targeting those mechanisms. Right now we're focused on things like hope and agency of perceived control, and we're thinking about targeting specific symptoms of depression, like anhedonia or self-hate that made underliers for a long-term change and we're still using those best principles.

I already showed you Project Personality which is that growth mindset program that we think targets perceived agency by teaching that symptoms and traits can change. And, we've also developed other programs. The Team Goals project is a 30-minute web-based self-hate intervention. It teaches self-compassion using the same principles that I reviewed earlier and that was first offered by my PhD student, who is fantastic.

The ABC project is, essentially, a behavior to lack of [inaudible 00:36:13] intervention but 30 minutes long on a computer. This is designed to target anhedonia but, I don't know, it could just target hope, we'll see. This was a collaboration between me and PhD students and other folks in my lab.

What are we doing with these? Well, for the growth mindset intervention, one thing that's going on in our lab right now is called the BEST-TECH Project. This is a collaboration with a virtual reality technology company called Limbix, who approached us out of interest in seeing if we could enhance the effects of this program by altering it for a virtual reality context. I thought that was intriguing because one possible mechanism through which this intervention might affect change is by boosting a sense of perceived control in agency. If that's the case, then putting a kid into the intervention where they actually more actively participate in all the activities and maybe more actively help peers or speak to peers and offer them guidance. Maybe that could boost its effect. So, we're testing it out. Don't know if it'll work, but it would be interesting.

One program I'm really excited for and it's called Project S.A.F.E., Service Access for Families Everywhere. In this study, we're testing whether single-session interventions delivered remotely online for teens and for parents can help bridge the gap between depression screening in pediatric primary care settings and access to services later on. So, this is a collaboration with Stony Brooks Pediatric Primary Care Department and we're going to start recruiting on Monday. There are ten clinics around Long Island that are going to be participating in this and all kids with elevated symptoms will be offered the opportunity to take part in this study.

We're collaborating with the Child Mind Institute in New York City. They have a really wonderful project right now called The Healthy Brain Network, which is an effort to better understand many different correlates of youth mental health problems. But, they were very interested in how they could help their participants rather than just collecting data from them. We were in the fortunate position of being able to partner with them to run an RCT. All Healthy Brain Network youth participants who are teenagers are going to have the chance to participate in a project where they will either receive Project Personality or the Teen Goals Project targeting self-compassion and self-hate or our control program, the sharing feelings intervention in about 400 kids. We're really excited to see what that reveals.

I'm really happy... this week I can actually say that we're doing this. Project TRACK to TREAT is something I'm very excited for. It's funded by an Early Independence Award which is designed for high-risk high-reward research. I want to talk a little bit about that. Because the same single-session intervention program is not going to effect change in every kid, we need to consider ways to personalize brief interventions for individual needs and individual problems. That may be especially critical to consider for depression, which is extraordinarily heterogeneous. There are upwards of a thousand ways to be depressed if you count them all up. That yields many different pictures of what depression can be and what treatment might look like from one kid to the next.

You can imagine, for example, two kids who presented a clinic and they both meet criteria for clinical depression. They have five out of nine symptoms on the check list. They could have gotten there through very different pathways and for very different reasons. Alex, for example, might one day have just found, "You know what I just don't care about things anymore" and nothing seemed fun. He may have withdrawn from activities which may have led to sad mood and fatigue and, in turn, hopelessness that that would ever change and that he would read interesting things again. Casey, on the other hand, might have just sort of experienced an overwhelming sense of hopelessness about her future which, in turn, might lead to other symptoms of depression. You can get to the same endpoint at which you're presenting for treatment through very different avenues.

What I'm really interested in exploring is whether person specific or idiographic symptom network structures can help match kids to interventions that are targeted to the symptoms that are most central for them and to determine whether that central symptom could be a modifiable precise treatment target.

We're testing this in an RCT with an ecological momentary assessment period. Basically, what we're doing is first, we're bringing kids in and we're doing a baseline battery looking at symptoms, hopelessness, all sorts of factors. Then, kids are going to have a three week period where on their smart phone or a smart phone will be given to them if they don't have one, they're going to rate different depressive symptoms several times a day for about three weeks. From those experience sampling data, we can actually construct personalized symptom networks for each kid and we can extract a parameter that suggests that for this kid, this is the degree to which this symptom was central. Or, this is the degree to which that symptom was central. And we can see that predicts response to treatment. So, we're going to be randomizing kids to treatments that target different features of depression. Project Personality targeting more cognitive factors, and the Behavioral Activation Program targeting literal engagement in activities and [inaudible 00:42:08].

We're going to be able to see, actually, over two years whether this is a helpful predictive factor in understanding who benefits to what kind of treatment. If so, that would, I think, bring us a pretty long way in understanding how to personalize treatment for adolescent depression which we're currently not very good at treating.

And finally, one project I'm really excited about that was kind of a spur of the moment idea. I think it was last month The Atlantic wrote about what we do in my lab and that was really exciting. We got a lot of calls from parents asking if they could take our programs. They weren't set up for that so we decided to just do it and now they are. You can go on our website today and take any of these programs. Just mark that you're an adult so we exclude your data and we are going to see what happens. We don't have hypothesis here. We are just looking for kids feedback on these programs. We're looking at whether proximal outcomes change like hope and agency from pre to post. And, as a part of Project Y.E.S. we actually ask kids to give advice that we, my research team, will post on our website so that any kid who visits our website will be able to review kind of a repository of advice from peers for coping with depression and anxiety related difficulties.

I checked right before this. Four hundred people have done it so far in the past six days. That's because Vox wrote about it and then everyone got all interested. I'm excited to see what happens here. I don't really know where it's going to go. If you or anyone want to use the interventions for research, you're more than welcome to do so. We post everything on our open science framework page and that's where these slides will be maybe tomorrow, maybe the next day. I don't know.

Okay, that's what I had. Thank you so much. This is really cool to be able to do and I really appreciate the opportunity.