Session ExtensionAn Everyday Insight tool

The research

Session Extension doesn’t add a new method. It gathers long-established practices from therapy in one place and makes them easier to carry between sessions. Each tool’s own site explains the research behind it. This page covers what’s new here, stated no more strongly than the studies allow.

Practice between sessions

Work between sessions, often called homework, is a standard part of cognitive behavioral therapy. Across many studies, therapies that include it tend to have somewhat better results than those that don’t, and clients who do more of it, and do it with more care, tend to do somewhat better. Kazantzis and colleagues found this in reviews in 2000, 2010, and 2016, and Mausbach and colleagues in 2010.

These are patterns across studies, not proof that any single practice works for any one person. Session Extension itself hasn’t been studied, and it can’t tell whether anything is changing for you.

Each tool’s research

The six tools keep their sources on their own sites: Thought Record, Behavioral Experiment, Activity Record, Values Card Sort, Sleep Toolbox, and Behavioral Activation.

Safety planning

A safety plan is a short written list made ahead of time: warning signs, things a person can do on their own, people and places that help, people to ask for help, professionals and crisis lines, and ways to make the surroundings safer for now. The best-known version is the Safety Planning Intervention described by Stanley and Brown (2012).

In a study in emergency departments, safety planning with follow-up phone calls was linked to fewer suicidal behaviors over the next six months than usual care (Stanley et al., 2018). A meta-analysis of safety planning-type interventions found fewer suicidal behaviors, and no clear effect on suicidal thoughts (Nuij et al., 2021). A plan is for getting through a hard moment. It doesn’t prevent anything on its own, and it isn’t a substitute for crisis care.

Session Extension’s safety plan was written for Everyday Insight, with its own headings, wording, and layout. The hope box under “Why I want to keep going” draws on the Virtual Hope Box, an app made for the U.S. Department of Veterans Affairs and tested with veterans in a randomized trial (Bush et al., 2017). The section on putting things out of reach for now follows the approach taught in Counseling on Access to Lethal Means, or CALM.

Problem solving

The problem solving tool follows the steps of problem-solving therapy as developed by Thomas D’Zurilla and Arthur Nezu, in Session Extension’s own words: how you’re approaching the problem, defining it, brainstorming without judging, weighing the options, choosing and planning, and trying it and looking back (Nezu et al., 2013).

A meta-analysis found that problem-solving therapy helped adults with depression compared with control conditions, with smaller effects in the better-designed studies (Cuijpers et al., 2018).

Gratitude and three good things

Writing down three things that went well each evening for a week comes from a study by Seligman and colleagues (2005). Keeping a gratitude list comes from work by Emmons and McCullough (2003). Meta-analyses by Davis and colleagues (2016) and by Cregg and Cheavens (2021) find small effects on well-being and smaller ones on depression and anxiety, and some comparison activities do about as well.

More isn’t always better. In one study, counting blessings once a week helped more than doing it three times a week (Lyubomirsky et al., 2005). That’s why the gratitude journal suggests once a week, and why neither exercise counts streaks. When mood is low, these exercises can feel forced, and it’s fine to stop and come back later.

Sources

None of these studies tested Session Extension. They’re the background for its tools, not an endorsement of it by their authors.