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Project ACCEPT

Project Accept logo of a person with a thought bubble above their head

Prior literature holds no clear definition of “intrusive thoughts”. Magee and colleagues stated that they are, “Unwanted, distressing, and difficult-to-control thoughts and images” (Magee et al., 2014). Intrusive thoughts are typically ego-dystonic, unacceptable, and are associated with a loss of control (Julien et al., 2007). These types of thoughts are very common, with estimates that 90% or 93% of people have experienced them (Garcia-Soriano et al., 2022; Julien et al., 2007). Despite how common these thoughts are, many are unfamiliar with the concept. Additionally, some individuals, particularly adolescents, experience distress associated with these thoughts, often because they do not know how common these thoughts are, or because they believe having these thoughts means they are a bad or immoral person (Valentiner & Smith, 2008). For this reason, adolescence has been identified as a good time to provide early intervention and prevention of conversion to clinical obsessive-compulsive states (Fontenelle et al., 2022). Therefore, an acceptable intervention is needed for adolescents experiencing distressing intrusive thoughts that would educate on what the thoughts are, how common they are, and strategies to enact if experiencing a distressing intrusive thought.

Evidence-based, digital support options are needed to increase access to

mental health treatment for at-risk youth. Traditional forms of mental healthcare are often time and resource-intensive, creating insurmountable access barriers. Existing interventions for youth were designed with the intent for delivery in brick-and-mortar clinics by highly trained clinicians. These interventions might span weeks or months and cannot meet the current need for treatment. Brief, digital, and self-guided mental health supports are needed to bridge otherwise unfillable gaps in the mental healthcare ecosystem.

Building online single-session interventions (SSIs) can help address the access and dissemination barriers. SSIs include components from long-standing evidence-based treatments, taking the most effective skills from traditional forms of mental healthcare and designing brief, engaging digital programs for youth. This innovative approach enables potency while maintaining brevity and accessibility. For example, two SSIs—both online, self-guided, 30-minute programs—have specifically reduced adolescent major depression symptoms (Schleider & Weisz, 2017). The first, “Project Personality,” teaches that personal traits and symptoms can change (a “growth mindset”); this SSI reduced adolescent depressive symptoms across 4-9 months compared to adolescents assigned to an active control group (Schleider & Weisz, 2018). The second SSI, “The ABC Project,” targets behavioral activation, teaching youth how engagement in valued activities can improve mood; in randomized clinical trials (RCT), both therapist-delivered and online versions of this SSI improved adolescent depressive symptoms (Schleider et al., 2020). Further, in a recent nationwide, NIH-funded RCT testing both Project Personality and the ABC Project in high symptom adolescents (N=2,452), each 30-minute SSI produced small but significant 3-month improvements in depressive symptoms (ds=0.18), versus a supportive control (Schleider et al., 2022).

The present study adapts key components of Acceptance and Commitment Therapy (ACT) into a single-session, 30-minute, online program. This brief, accessible online intervention will teach adolescents information about intrusive thoughts and will teach strategies for alleviating distress associated with intrusive thoughts.

Aim: We will assess whether this online SSI can alleviate distress associated with intrusive thoughts in adolescents relative to an information-online control condition. Through the development, revision, and testing of this brief intervention we hope to educate youth about unwanted thoughts and how best to cope with them.


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