Effects of web-based single-session growth mindset interventions for reducing adolescent anxiety : four-armed randomized controlled trial

Abstract

Background: Anxiety disorders are the most common mental health conditions worldwide, yet 65% of those affected do not access services. The high prevalence of anxiety and the low rate of intervention uptake highlight the urgent need to develop timely, scalable, and effective interventions suitable for adolescents. This study adapted existing single-session interventions (SSIs) to further develop an SSI focused on a growth mindset regarding negative emotions for adolescent mental health. Objective: The study aims to compare the effectiveness of 4 SSIs, SSI of a growth mindset for anxiety (SIGMA), SIGMA with boosters (SIGMA-Booster), SSI of a growth mindset of personality (SSIGP), and an active control group (support therapy [ST]), in reducing adolescent anxiety. Methods: Classes from each secondary school were randomized to 1 of 4 intervention conditions: SIGMA, SIGMA-Booster, SSIGP, or ST. Each intervention took approximately 45 minutes online. Participants reported on anxiety symptoms (primary outcome), depressive symptoms, suicidal/self-harming thoughts, perceived control, hopelessness, attitude toward help-seeking, and psychological well-being (secondary outcomes) at preintervention, 2-week follow-up, and 8-week follow-up. Participants also completed a feedback scale postintervention. Generalized estimating equations were used to examine the effectiveness of the SSIs. Results: A total of 731 adolescents from 7 secondary schools were randomized. The intent-to-treat analysis found a significant decrease in anxiety symptoms. The mean and 95% CI at baseline were 6.8 (6.0-7.6) for SIGMA-Booster, 6.5 (5.8-7.3) for SIGMA, 7.0 (6.2-7.7) for SSIGP, and 6.9 (6.1-7.7) for ST. At the 2-week follow-up, the mean and 95% CI were 5.9 (5.1-6.7) for SIGMA-Booster, 5.7 (4.9-6.5) for SIGMA, 5.4 (4.6-6.2) for SSIGP, and 5.7 (4.9-6.4) for ST. At the 8-week follow-up, the mean and 95% CI were 5.9 (5.1-6.7) for SIGMA-Booster, 5.3 (4.5-6.0) for SIGMA, 5.6 (4.8-6.4) for SSIGP, and 5.8 (5.1-6.6) for ST. These reductions were observed across all 4 groups. Moderation analysis found that participants with higher motivation for change, higher baseline anxiety scores, and fixed mindsets showed greater improvements in anxiety symptoms. Most participants (459/731, 62.8%) viewed the feasibility and acceptability of the SSIs positively. Conclusions: The SSI for all 4 groups was effective in reducing anxiety and depression among adolescents over 8 weeks. Our data suggest the potential benefits of brief web-based interventions for adolescents, which could serve as scalable, destigmatized, and cost-effective alternatives to school-based programs. The intervention effects may have been underestimated, as this study did not exclude adolescents with minimal or no anxiety symptoms. Future studies should focus on the specific effects of interventions for adolescents with varying levels of anxiety symptoms. Trial Registration: ClinicalTrials.gov NCT05027880; https://clinicaltrials.gov/ct2/show/NCT05027880