One free online session cut teenagers' depression symptoms three months later, by a small amount
2,452 US teenagers aged 13 to 16 with elevated depression symptoms got one online session of behavioural activation, one growth mindset session, or a supportive control. Both active sessions cut three month depressive symptoms, d = 0.18.
Reasonable evidence with real limitations. how we score evidence
Caveat on this rating: Small effect by the authors' own numbers; self-selected online sample; self-report outcomes; adolescents only; three-month horizon. Included as the lower bound of what a free intervention can do, and it should be read as that, not as an alternative to care for a young person with significant depression.
What is the smallest dose of help that does anything? This trial tested a single online session, with no therapist, during the pandemic.
Significant findings
Schleider, Mullarkey, Fox and colleagues recruited 2,452 adolescents aged 13 to 16 from all fifty US states through social media, all with elevated depression symptoms. Each was randomised to one of three single session interventions completed online: a behavioural activation session, a session teaching that personal traits can change, or a supportive control. Outcomes were measured straight after and three months later. The trial was registered in advance (NCT04634903).
"Compared with the control, both active SSIs reduced three-month depressive symptoms (Cohen's d = 0.18), decreased post-intervention and three-month hopelessness (d = 0.16-0.28), increased post-intervention agency (d = 0.15-0.31) and reduced three-month restrictive eating (d = 0.12-17)."
The authors conclude that the results "confirm the utility of free-of-charge, online SSIs for high-symptom adolescents, even in the high-stress COVID-19 context."
The other direction
The effect is small, and the authors report it as such: d = 0.18 is a fraction of what a course of therapy with a person produces in other rows of this set. A single session is a floor, not a treatment.
What this does not show
The sample was self selected through social media and the outcomes are self report questionnaires. The comparison was a supportive control, not nothing, which makes the small effect more credible but does not make it large. Adolescents only.
Worth asking
If a single free session does a little, what is the smallest next step after it?
Source
A randomized trial of online single-session interventions for adolescent depression during COVID-19 — Schleider JL, Mullarkey MC, Fox KR, Dobias ML, Shroff A, Hart EA, Roulston CA (2022)
Reputable peer-reviewed journal
Read the source: https://doi.org/10.1038/s41562-021-01235-0
DOI: 10.1038/s41562-021-01235-0
How this was scored
- Study design
- Randomised controlled trial
- Funding
- Funding not disclosed
- Published in
- Reputable peer-reviewed journal
- Sample size
- 2,452
- Preregistered
- Yes
- Conflicts disclosed
- not recorded
- Independent of proponent
- not recorded
- Retracted
- No
Read the full scoring rubric, including what it can't tell you.
Published September 24, 2026.
Questions
How strong is the evidence behind this?
veisund rates this source "moderate evidence". Reasonable evidence with real limitations. It scores 69 out of 100 on our published rubric. One caveat travels with that badge: Small effect by the authors' own numbers; self-selected online sample; self-report outcomes; adolescents only; three-month horizon. Included as the lower bound of what a free intervention can do, and it should be read as that, not as an alternative to care for a young person with significant depression. The score is calculated from recorded facts about the source — study design, funding, publication venue, sample size, preregistration — not typed in by an editor.
What is the source for this?
A randomized trial of online single-session interventions for adolescent depression during COVID-19 — Schleider JL, Mullarkey MC, Fox KR, Dobias ML, Shroff A, Hart EA, Roulston CA (2022). Published in: Reputable peer-reviewed journal. DOI: 10.1038/s41562-021-01235-0. The full source is linked on this page so you can read it yourself.
Who paid for this research, and does that matter?
Study design: Randomised controlled trial. Funding: Funding not disclosed. Independence from the proponent is not recorded. Industry sponsorship is one of the most reliably measured biases in medicine, which is why funding carries real weight in the score rather than sitting in a footnote.
Is this medical advice?
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.