No Time to Wait: A Randomized Control Trial of Online Single-Session Intervention for Children and Adolescents on Psychotherapy Waitlists in Hong Kong

Early intervention has been shown to effectively reduce symptoms of mental disorder, and the subsequent risk of substance abuse, suicide, and other mental disorders. However, in Hong Kong, only 26% of individuals with common mental health disorders seek any mental health service. Even when help is sought, those in need often face lengthy waiting time before receiving treatment, which can have detrimental effects on their mental well-being. For individuals categorized as stable, the average 90th percentile waiting time for psychiatry specialist outpatient clinics amounted to 90 weeks. Numerous systemic and internal barriers further impede access to mental health services, particularly for youth. These barriers include high costs, transportation challenges, stigma, and a preference for self-help options. As the result, there is a pressing need for scalable and accessible digital interventions that can address the gap in service delivery.

Single-session intervention (SSI) has emerged as a time-efficient and accessible intervention that may provide immediate support and mitigate the negative impact of mental health issues. Online SSIs, in particular, hold substantial promise for addressing many challenges associated with traditional digital mental health tools. They can be completed in a single sitting, minimizing user engagement burdens, and many of them are cost-free, publicly accessible, and incorporate evidence-based intervention components. Despite these advantages, the acceptability and effectiveness of online SSIs outside of controlled clinical trials, as well as their synergy with public mental health services, remained underexplored. This study seeks to fill this gap by evaluating the effectiveness and acceptability of single-session psychotherapy for children and adolescents on psychotherapy waitlists in Hong Kong.

Research on SSIs highlights its potential benefits in addressing mental health concerns in a time-limited manner. Single-session interventions, such as the "Walk-in Clinic" and online self-help model, have been implemented successfully in various settings, demonstrating positive outcomes for individuals with a range of psychological difficulties. Studies have shown that single-session interventions can lead to significant symptom reduction, improved functioning, and increased patient satisfaction. A meta-analysis has shown that the calculated effect size (ES) at the end of the intervention was found to be 0.32 according to Hedges' g, indicating a moderate positive impact. This suggests that there was a 58% likelihood of an adolescent who received the single-session intervention (SSI) experiencing better outcomes compared to a youth in the control group. Moreover, single-session psychotherapy has been found to be particularly effective for certain conditions, such as specific phobias and acute stress reactions.

However, limited research has specifically examined the application of single-session psychotherapy for children and adolescents on public mental health service waitlist. Understanding the potential benefits and limitations of single-session psychotherapy in this context can inform mental health service providers and policymakers in developing efficient and accessible interventions for children and adolescents. This study will examine the possibility of SSI in enhancing participants' acceptability toward future psychotherapy. Furthermore, it aims to address specify personality constructs - alexithymia and fixed mindset - that impede the recovery process and are particularly prominent within Asian culture context.

Alexithymia, a condition marked by difficulties in processing emotions and distinguishing them from physical sensations, affects approximately 10% of the general population. However, research indicates that 36% of adolescents in Hong Kong exhibit alexithymic traits, with 34.3% of males and 40% of females affected. First described by Sifneos, alexithymia has been linked in neurobiological studies to impairments in identifying emotions in others. This condition can worsen depressive symptoms and diminish overall well-being. Moreover, alexithymia complicates psychological treatments, often leading to poorer therapeutic outcomes in managing other psychiatric disorders and reducing the likelihood of seeking help.