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


OBJECTIVE
The 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.


METHODS
Phase 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.


RESULTS
Phase 3 will be completed by September 2019.


CONCLUSIONS
The 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.
Child, Youth and Family Services, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.
Pamela
http://orcid.org/0000-0002-3672-9878
P
Wilansky
Department of Electrical, Computer and Software Engineering, University of Ontario Institute of Technology, Oshawa, ON, Canada.
J Mikael
http://orcid.org/0000-0001-7233-3136
JM
Eklund
BrainFx, Inc., Pickering, ON, Canada.
Tracy
http://orcid.org/0000-0003-1368-1733
T
Milner
Division of Youth Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.|Centre for Mobile Computing in Mental Health, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
David
http://orcid.org/0000-0002-2249-0616
D
Kreindler
Division of Youth Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
Amy
http://orcid.org/0000-0001-8564-2990
A
Cheung
Department of Computer Science, Faculty of Engineering, University of Bristol, Bristol, United Kingdom.
Tim
http://orcid.org/0000-0002-9492-5834
T
Kovacs
Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
Shahin
http://orcid.org/0000-0001-5247-2403
S
Shooshtari
Ontario Shores Centre for Mental Health Sciences, Whitby, ON, Canada.|School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom.
Arlene
http://orcid.org/0000-0002-6822-9472
A
Astell
School of Public Health, University of Alberta, Edmonton, AB, Canada.
Arto
http://orcid.org/0000-0002-7094-1573
A
Ohinmaa
Child, Youth and Family Services, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.
Joanna
http://orcid.org/0000-0002-9387-5193
J
Henderson
Shannon Centennial Informatics Lab, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.
John
http://orcid.org/0000-0003-2314-2864
J
Strauss
Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
Rosemary Sl
http://orcid.org/0000-0003-4693-9016
RS
Mills
anxiety; cognitive behavior therapy; depression; homework; mHealth; mobile app; youth