Wilansky Pamela, Eklund J Mikael, Milner Tracy, Kreindler David, Cheung Amy, Kovacs Tim, Shooshtari Shahin, Astell Arlene, Ohinmaa Arto, Henderson Joanna, Strauss John, Mills Rosemary Sl
Child, Youth and Family Services, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.
Department of Electrical, Computer and Software Engineering, University of Ontario Institute of Technology, Oshawa, ON, Canada.
JMIR Res Protoc. 2016 Nov 10;5(4):e209. doi: 10.2196/resprot.5841.
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.
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.
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.
Phase 3 will be completed by September 2019.
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.
焦虑症和情绪障碍是最常见的精神疾病，在青春期达到高峰，影响约25%的14至17岁加拿大人。如果在这个年龄未能成功治疗，它们往往会持续到成年期，造成巨大的社会和经济损失。鉴于其长期影响，寻找提高心理健康护理成功率和成本效益的方法迫在眉睫。认知行为疗法（CBT）是一种基于证据的、贯穿一生的治疗情绪和焦虑症的方法。心理健康技术可用于使此类治疗更成功，通过以提高利用率的形式提供这些治疗。年轻人接受技术，许多人希望积极管理自己的心理健康。移动软件应用程序有潜力提高青少年对CBT的依从性，进而改善治疗效果。
本项目的目的是提高青少年焦虑症和/或抑郁症患者在CBT中的家庭作业依从性。目标是：（1）设计并优化一款移动应用程序的可用性，该应用程序用于为患有焦虑症和/或抑郁症的青少年提供CBT的家庭作业部分；（2）评估该应用程序对家庭作业完成情况的影响；（3）在CBT项目中实施该应用程序。我们假设应用程序组的家庭作业依从性将高于无应用程序组。
第一阶段：将对熟悉CBT的青少年和治疗师进行探索性访谈，以获取关于可用应用程序的要求和功能以及实施过程中所涉及挑战的观点和看法。所获得的信息将指导原型的设计。该原型将通过出声思考程序进行优化，该程序涉及评估、修改和重新评估的迭代过程，最终形成一个功能齐全的原型版本，准备好在临床环境中进行优化。第二阶段：将进行一项可用性研究，在为患有焦虑症和/或抑郁症的青少年提供CBT治疗的诊所环境中优化该原型。此阶段将产生一个可用的应用程序，准备好对其提高家庭作业依从性的有效性进行测试。第三阶段：将在几家诊所进行一项务实的临床试验，以评估该应用程序对家庭作业依从性的影响。预计应用程序组的参与者比无应用程序组的参与者有更高的家庭作业完成率。
第三阶段将于2019年9月完成。
该应用程序将成为CBT中青少年治疗的独特辅助工具，专注于焦虑症和抑郁症，在从设计到实施的每个阶段都与最终用户合作开发，可针对不同的认知概况进行定制，并设计有针对青少年的抑郁症症状跟踪措施，可与电子病历实现互操作。
