Cognitive Behavior Therapy for Anxious and Depressed Youth: Improving Homework Adherence Through Mobile Technology

Abstract

BackgroundAnxiety and mood disorders are the most common mental illnesses, peaking during adolescence and affecting approximately 25% of Canadians aged 14-17 years. If not successfully treated at this age, they often persist into adulthood, exerting a great social and economic toll. Given the long-term impact, finding ways to increase the success and cost-effectiveness of mental health care is a pressing need. Cognitive behavior therapy (CBT) is an evidence-based treatment for mood and anxiety disorders throughout the lifespan. Mental health technologies can be used to make such treatments more successful by delivering them in a format that increases utilization. Young people embrace technologies, and many want to actively manage their mental health. Mobile software apps have the potential to improve youth adherence to CBT and, in turn, improve outcomes of treatment.ObjectiveThe purpose of this project is to improve homework adherence in CBT for youth anxiety and/or depression. The objectives are to (1) design and optimize the usability of a mobile app for delivering the homework component of CBT for youth with anxiety and/or depression, (2) assess the app’s impact on homework completion, and (3) implement the app in CBT programs. We hypothesize that homework adherence will be greater in the app group than in the no-app group.MethodsPhase 1: exploratory interviews will be conducted with adolescents and therapists familiar with CBT to obtain views and perspectives on the requirements and features of a usable app and the challenges involved in implementation. The information obtained will guide the design of a prototype. The prototype will be optimized via think-aloud procedures involving an iterative process of evaluation, modification, and re-evaluation, culminating in a fully functional version of the prototype that is ready for optimization in a clinical context. Phase 2: a usability study will be conducted to optimize the prototype in the context of treatment at clinics that provide CBT treatment for youth with anxiety and/or depression. This phase will result in a usable app that is ready to be tested for its effectiveness in increasing homework adherence. Phase 3: a pragmatic clinical trial will be conducted at several clinics to evaluate the impact of the app on homework adherence. Participants in the app group are expected to show greater homework completion than those in the no-app group.ResultsPhase 3 will be completed by September 2019.ConclusionsThe app will be a unique adjunct to treatment for adolescents in CBT, focusing on both anxiety and depression, developed in partnership with end users at every stage from design to implementation, customizable for different cognitive profiles, and designed with depression symptom tracking measures for youth made interoperable with electronic medical records.

Impacts of cognitive-behavioral intervention on anxiety and depression among social science education students

“…In line with our findings, numerous studies [48,63–66] have shown that cognitive-behavioral intervention led to successful treatment of anxiety disorder in students. In addition, young people exposed to cognitive-behavioral approach have high quality of life with regard to health and wellbeing, as well as lower levels of anxiety.…”

Psychologists’ motivations for integrating apps into therapy with secondary school-aged young people

“…The inherent structure of manualised treatments such as CBT translate easily to digital mediums, and as a result apps to address mental health concerns are predominately informed by CBT activities and strategies (Stawarz et al, 2018). Homework tasks and activities are an essential component of CBT, and homework completion is often used as a measure of therapeutic engagement (Wilansky et al, 2016). Unsurprisingly, participants inclined to utilise CBT with clients expressed a motivation to use apps with young people due to the features and functions (such as reminder notifications and EMA) that could encourage the completion of homework tasks, increasing engagement.…”

Combining e‐mental health intervention development with human computer interaction (HCI) design to enhance technology‐facilitated recovery for people with depression and/or anxiety conditions: An integrative literature review

“…The need to be able to access the programme from a mobile device is explicitly mentioned in several of the examined articles (Kok, 2014, Lauritsen et al 2017Miloff et al 2015;Pham et al 2016;Wilansky et al 2016;Zhao et al 2017). As a consequence of the selected framework, this review did not distinguish between mobile and nonmobile technologies and included both types.…”

“…Mobile technology is integrated into the daily life of users differently to that of the computer; for example, it often has touchscreen, smaller screens, and is used frequently throughout the 24-hour period. The need to be able to access the programme from a mobile device is explicitly mentioned in several of the examined articles (Kok, 2014, Lauritsen et al 2017Miloff et al 2015;Pham et al 2016;Wilansky et al 2016;Zhao et al 2017).…”