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Morey A, Samuel V, Williams M. Universal online self-help ACT interventions for youth: A systematic review. Behav Res Ther 2024; 180:104576. [PMID: 38852229 DOI: 10.1016/j.brat.2024.104576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 05/25/2024] [Accepted: 05/28/2024] [Indexed: 06/11/2024]
Abstract
Previous reviews of online self-help have not exclusively focussed on universally delivered Acceptance and Commitment Therapy (ACT). This systematic review aimed to evaluate the effectiveness of universal online self-help ACT interventions for young people. Relevant databases were searched for studies examining ACT interventions that were delivered universally, online and as self-help (guided and unguided) to young people aged 10 to 25-years-old. Eleven studies met inclusion criteria. These were assessed for quality and findings summarised using a narrative synthesis. Outcomes on mental health, well-being and ACT processes were reviewed, and results across studies were mixed. Most studies found significant improvements in mental health and well-being outcomes following the ACT intervention; however less than half found improvements in ACT process measures. Subgroups, such as those with elevated mental health symptoms, had better outcomes. There were no changes in measures of psychological inflexibility. However, methodological issues limited the interpretation of findings. Heterogeneity between studies and methodological issues made it difficult for this review to draw conclusions regarding the effectiveness of universal online self-help ACT interventions for young people. Future research with consistent approaches is needed across these types of interventions to improve methodological rigour to determine whether these interventions are effective.
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Affiliation(s)
- Alex Morey
- South Wales Doctoral Programme in Clinical Psychology, Cardiff University, Tower Building, 70 Park Place, Cardiff, CF10 3AT, UK.
| | - Victoria Samuel
- South Wales Doctoral Programme in Clinical Psychology, Cardiff University, Tower Building, 70 Park Place, Cardiff, CF10 3AT, UK.
| | - Marc Williams
- South Wales Doctoral Programme in Clinical Psychology, Cardiff University, Tower Building, 70 Park Place, Cardiff, CF10 3AT, UK.
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Wüllner S, Hermenau K, Krutkova M, Petras IK, Hecker T, Siniatchkin M. Mobile applications in adolescent psychotherapy during the COVID-19 pandemic: a systematic review. Front Public Health 2024; 12:1345808. [PMID: 38420028 PMCID: PMC10899334 DOI: 10.3389/fpubh.2024.1345808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/31/2024] [Indexed: 03/02/2024] Open
Abstract
Background To bridge the gap in adolescent psychotherapy created by the increasing need for mental health interventions and the limited possibilities of in-person treatment during the pandemic, many health care providers opted to offer online mental health care programs. As a result, the number of mental health apps available in app stores experienced a sharp increase during the COVID-19 pandemic. Objective The aim of the current review is to provide an overview of feasibility and effectiveness studies testing mobile applications in adolescent psychotherapy during the peak phase of the COVID-19 pandemic. Methods We conducted a literature search in Pubmed, PsychInfo, Google Scholar, OpenSIGLE and OpenGREY for papers published from June 2020 to June 2023. Studies were included if they evaluated app-based interventions intended for psychotherapeutic treatment and targeted adolescents between 12 and 27 years of age with symptoms of psychological disorders. The quality of each study was assessed using the Systematic Assessment of Quality in Observational Research (SAQOR). Effectiveness outcomes were analyzed by vote counting and calculating a binomial probability test. Results The search yielded 31 relevant studies that examined 27 different apps with a total of 1,578 adolescent participants. Nine articles were primary effectiveness studies and 22 focused on feasibility measures as primary outcome. There was evidence that mental health apps influenced adolescents' psychotherapy, with 83% of the studies with effectiveness outcomes favoring the intervention (p = 0.002). Sixty-one percent of the included studies were rated at low or very low quality. Conclusions The pandemic has given apps a firm and important role in healthcare that will probably continue to expand in the future. To ensure that mental health apps are truly effective and beneficial for adolescents' psychotherapy, we need a standardized measurement of quality features of mental health apps and higher quality app evaluation studies. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=406455, PROSPERO International Prospective Register of Systematic Reviews [CRD42023406455].
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Affiliation(s)
- Sarah Wüllner
- University Clinic of Child and Adolescent Psychiatry and Psychotherapy, Protestant Hospital Bethel, Bielefeld University, Medical School East Westphalia, Bielefeld, Germany
| | - Katharin Hermenau
- University Clinic of Child and Adolescent Psychiatry and Psychotherapy, Protestant Hospital Bethel, Bielefeld University, Medical School East Westphalia, Bielefeld, Germany
| | - Mariya Krutkova
- University Clinic of Child and Adolescent Psychiatry and Psychotherapy, Protestant Hospital Bethel, Bielefeld University, Medical School East Westphalia, Bielefeld, Germany
| | - Ira-Katharina Petras
- University Clinic of Child and Adolescent Psychiatry and Psychotherapy, Protestant Hospital Bethel, Bielefeld University, Medical School East Westphalia, Bielefeld, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics of Children and Adolescents, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Tobias Hecker
- Institute for Interdisciplinary Conflict and Violence Research, Bielefeld University, Bielefeld, Germany
- Department of Psychology, Faculty of Psychology and Sports Science, Bielefeld University, Bielefeld, Germany
| | - Michael Siniatchkin
- University Clinic of Child and Adolescent Psychiatry and Psychotherapy, Protestant Hospital Bethel, Bielefeld University, Medical School East Westphalia, Bielefeld, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics of Children and Adolescents, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
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3
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Alexander ES, Halkett GKB, Lawrence BJ, O’Connor M. A Conceptual Model Depicting How Children Are Affected by Parental Cancer: A Constructivist Grounded Theory Approach. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1507. [PMID: 37761468 PMCID: PMC10530185 DOI: 10.3390/children10091507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/06/2023] [Accepted: 08/08/2023] [Indexed: 09/29/2023]
Abstract
Cancer patients' children are vulnerable to psychosocial and behavioural issues. The mechanisms underlying how children are affected by their parent's diagnosis are unknown, warranting further research. This study investigated how children are affected by their parent's cancer diagnosis and provides a theoretical model conceptualising this experience. Informed by methods of grounded theory, embedded within a social constructivist framework, 38 informants (15 health professionals (HPs); 11 parents; 12 children (5 to 17 years)) were interviewed using a semi-structured format. Three themes were identified: (i) children were worried and distressed because they felt alone, (ii) parents were unable to tend to children's needs because they were overwhelmed by practical factors, and (iii) HPs were not detecting children due to barriers that affected their visibility in clinical settings. The proposed Alexander's Children's Cancer Communication (ACCC) Model and clinical recommendations made can be used to guide the clinical practice and development of future intervention research.
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Affiliation(s)
- Elise S. Alexander
- Discipline of Psychology, School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, WA 6102, Australia; (E.S.A.); (B.J.L.)
| | - Georgia K. B. Halkett
- Curtin School of Nursing/Curtin Health Innovation Research Institute (CHIRI), Faculty of Health Sciences, Curtin University, Bentley, WA 6102, Australia
| | - Blake J. Lawrence
- Discipline of Psychology, School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, WA 6102, Australia; (E.S.A.); (B.J.L.)
| | - Moira O’Connor
- Discipline of Psychology, School of Population Health/Curtin Health Innovation Research Institute (CHIRI), Faculty of Health Sciences, Curtin University, Bentley, WA 6102, Australia;
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Jiménez-Lérida C, Herrera-Espiñeira C, Granados R, Martín-Salvador A. Attending to the Mental Health of People Who Are Homeless by Mobile Telephone Follow-Up: A Systematic Review. Healthcare (Basel) 2023; 11:1666. [PMID: 37372784 DOI: 10.3390/healthcare11121666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND More than 20% of the world's population has no decent or suitable home. People who are homeless have more health problems than the rest of the population, especially mental health-type problems. The main objective of this study was to identify follow-up interventions by using mobile telephones to improve the mental health of people who are homeless and to analyze their efficiency. METHODS To do so, a systematic review was carried out in the Web of Science, PubMed, Scopus, Ebscohost, and PsyInfo databases. RESULTS Studies conclude that mobile phone use is a suitable means to improve adherence to medication and the mental health of the homeless. However, significant attempts to demonstrate health benefits by means of reliable and valid instruments that supplement qualitative satisfaction and feedback instruments appear to be lacking. CONCLUSIONS The literature about mental health benefits through technology for people who are homeless is scarce and shows methodological limitations that can lead to failure when setting up methodologies in clinical practice.
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Affiliation(s)
| | - Carmen Herrera-Espiñeira
- PhD Department of Nursing, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (Ibs. Granada), 18012 Granada, Spain
| | - Reina Granados
- PhD Department of Nursing, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain
| | - Adelina Martín-Salvador
- PhD Department of Nursing, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain
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Li SH, Achilles MR, Subotic-Kerry M, Werner-Seidler A, Newby JM, Batterham PJ, Christensen H, Mackinnon AJ, O’Dea B. Protocol for a randomised controlled trial evaluating the effectiveness of a CBT-based smartphone application for improving mental health outcomes in adolescents: the MobiliseMe study. BMC Psychiatry 2022; 22:746. [PMID: 36451142 PMCID: PMC9710004 DOI: 10.1186/s12888-022-04383-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 11/09/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Depression is a leading cause of disability in adolescents, however few receive evidence-based treatment. Despite having the potential to overcome barriers to treatment uptake and adherence, there are very few CBT-based smartphone apps for adolescents. To address this gap, we developed ClearlyMe®, a self-guided CBT smartphone app for adolescent depression and anxiety. ClearlyMe® consists of 37 brief lessons containing core CBT elements, accessed either individually or as part of a 'collection'. Here, we describe the protocol for a randomised controlled trial aiming to evaluate the effect of ClearlyMe® on depressive symptoms and secondary outcomes, including engagement, anxiety and wellbeing, when delivered with and without guided support compared to an attention matched control. METHODS We aim to recruit 489 adolescents aged 12-17 years with mild to moderately-severe depressive symptoms. Participants will be screened for inclusion, complete the baseline assessment and are then randomly allocated to receive ClearlyMe® (self-directed use), ClearlyMe® with guided SMS support (guided use) or digital psychoeducation (attention-matched control). Depressive symptoms and secondary outcomes will be assessed at 6-weeks (primary endpoint) and 4-months post-baseline (secondary endpoint). Engagement, conceptualised as uptake, adherence and completion, will also be assessed 6-weeks post-baseline. Mixed-effects linear modelling will be used to conduct intention-to-treat analyses to determine whether reductions in depressive symptoms and secondary outcomes are greater for conditions receiving ClearlyMe® relative to control at 6-weeks and 4-months post-baseline and greater for intervention adherers relative to non-adherers. To minimise risk, participants will be encouraged to use the Get Help section of the app and can also opt to receive a call from the team clinical psychologist at baseline, and at the 6-week and 4-month post-baseline assessments when reporting suicidal ideation. DISCUSSION This is the first clinical trial examining a CBT smartphone app specifically designed for adolescent depression. It will provide empirical evidence on the effects of ClearlyMe® on depressive symptoms when used with and without guided support. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ACTRN12622000131752). UNIVERSAL TRIAL NUMBER U1111-1271-8519.
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Affiliation(s)
- S. H. Li
- grid.1005.40000 0004 4902 0432Black Dog Institute and School of Psychology, University of New South Wales, Sydney, New South Wales Australia
| | - M. R. Achilles
- grid.1005.40000 0004 4902 0432Black Dog Institute, University of New South Wales, Sydney, New South Wales Australia
| | - M. Subotic-Kerry
- grid.1005.40000 0004 4902 0432Black Dog Institute, University of New South Wales, Sydney, New South Wales Australia
| | - A. Werner-Seidler
- grid.1005.40000 0004 4902 0432Black Dog Institute, University of New South Wales, Sydney, New South Wales Australia
| | - J. M. Newby
- grid.1005.40000 0004 4902 0432Black Dog Institute and School of Psychology, University of New South Wales, Sydney, New South Wales Australia
| | - P. J. Batterham
- grid.1001.00000 0001 2180 7477Centre for Mental Health Research, Australian National University, Canberra, Australian Capital Territory Australia
| | - H. Christensen
- grid.1005.40000 0004 4902 0432Black Dog Institute, University of New South Wales, Sydney, New South Wales Australia
| | - A. J. Mackinnon
- grid.1005.40000 0004 4902 0432Black Dog Institute, University of New South Wales, Sydney, New South Wales Australia
| | - B. O’Dea
- grid.1005.40000 0004 4902 0432Black Dog Institute, University of New South Wales, Sydney, New South Wales Australia
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Bear HA, Ayala Nunes L, DeJesus J, Liverpool S, Moltrecht B, Neelakantan L, Harriss E, Watkins E, Fazel M. Determination of Markers of Successful Implementation of Mental Health Apps for Young People: Systematic Review. J Med Internet Res 2022; 24:e40347. [DOI: 10.2196/40347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/12/2022] [Accepted: 09/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background
Smartphone apps have the potential to address some of the current issues facing service provision for young people’s mental health by improving the scalability of evidence-based mental health interventions. However, very few apps have been successfully implemented, and consensus on implementation measurement is lacking.
Objective
This review aims to determine the proportion of evidence-based mental health and well-being apps that have been successfully adopted and sustained in real-world settings. A secondary aim is to establish if key implementation determinants such as coproduction, acceptability, feasibility, appropriateness, and engagement contribute toward successful implementation and longevity.
Methods
Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, an electronic search of 5 databases in 2021 yielded 18,660 results. After full-text screening, 34 articles met the full eligibility criteria, providing data on 29 smartphone apps studied with individuals aged 15 to 25 years.
Results
Of 34 studies, only 10 (29%) studies were identified that were evaluating the effectiveness of 8 existing, commercially available mental health apps, and the remaining 24 (71%) studies reported the development and evaluation of 21 newly developed apps, of which 43% (9/21) were available, commercially or otherwise (eg, in mental health services), at the time of enquiry. Most studies addressed some implementation components including adoption, acceptability, appropriateness, feasibility, and engagement. Factors including high cost, funding constraints, and lengthy research processes impeded implementation.
Conclusions
Without addressing common implementation drivers, there is considerable redundancy in the translation of mobile mental health research findings into practice. Studies should embed implementation strategies from the outset of the planned research, build collaborations with partners already working in the field (academic and commercial) to capitalize on existing interventions and platforms, and modify and evaluate them for local contexts or target problems and populations.
Trial Registration
PROSPERO CRD42021224365; https://tinyurl.com/4umpn85f
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Conley CS, Raposa EB, Bartolotta K, Broner SE, Hareli M, Forbes N, Christensen KM, Assink M. The Impact of Mobile Technology-Delivered Interventions on Youth Well-being: Systematic Review and 3-Level Meta-analysis. JMIR Ment Health 2022; 9:e34254. [PMID: 35904845 PMCID: PMC9377434 DOI: 10.2196/34254] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 03/04/2022] [Accepted: 03/05/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Rates of mental health problems among youth are high and rising, whereas treatment seeking in this population remains low. Technology-delivered interventions (TDIs) appear to be promising avenues for broadening the reach of evidence-based interventions for youth well-being. However, to date, meta-analytic reviews on youth samples have primarily been limited to computer and internet interventions, whereas meta-analytic evidence on mobile TDIs (mTDIs), largely comprising mobile apps for smartphones and tablets, have primarily focused on adult samples. OBJECTIVE This study aimed to evaluate the effectiveness of mTDIs for a broad range of well-being outcomes in unselected, at-risk, and clinical samples of youth. METHODS The systematic review used 5 major search strategies to identify 80 studies evaluating 83 wellness- and mental health-focused mTDIs for 19,748 youth (mean age 2.93-26.25 years). We conducted a 3-level meta-analysis on the full sample and a subsample of the 38 highest-quality studies. RESULTS Analyses demonstrated significant benefits of mTDIs for youth both at posttest (g=0.27) and follow-up (range 1.21-43.14 weeks; g=0.26) for a variety of psychosocial outcomes, including general well-being and distress, symptoms of diverse psychological disorders, psychosocial strategies and skills, and health-related symptoms and behaviors. Effects were significantly moderated by the type of comparison group (strongest for no intervention, followed by inert placebo or information-only, and only marginal for clinical comparison) but only among the higher-quality studies. With respect to youth characteristics, neither gender nor pre-existing mental health risk level (not selected for risk, at-risk, or clinical) moderated effect sizes; however, effects increased with the age of youth in the higher-quality studies. In terms of intervention features, mTDIs in these research studies were effective regardless of whether they included various technological features (eg, tailoring, social elements, or gamification) or support features (eg, orientation, reminders, or coaching), although the use of mTDIs in a research context likely differs in important ways from their use when taken up through self-motivation, parent direction, peer suggestion, or clinician referral. Only mTDIs with a clear prescription for frequent use (ie, at least once per week) showed significant effects, although this effect was evident only in the higher-quality subsample. Moderation analyses did not detect statistically significant differences in effect sizes based on the prescribed duration of mTDI use (weeks or sessions), and reporting issues in primary studies limited the analysis of completed duration, thereby calling for improved methodology, assessment, and reporting to clarify true effects. CONCLUSIONS Overall, this study's findings demonstrate that youth can experience broad and durable benefits of mTDIs, delivered in a variety of ways, and suggest directions for future research and development of mTDIs for youth, particularly in more naturalistic and ecologically valid settings.
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Affiliation(s)
- Colleen S Conley
- Department of Psychology, Loyola University Chicago, Chicago, IL, United States
| | | | - Kate Bartolotta
- Department of Psychology, Fordham University, Bronx, NY, United States
| | - Sarah E Broner
- Department of Psychology, Loyola University Chicago, Chicago, IL, United States
| | - Maya Hareli
- Department of Psychology, Loyola University Chicago, Chicago, IL, United States
| | - Nicola Forbes
- Department of Psychology, Fordham University, Bronx, NY, United States
| | - Kirsten M Christensen
- Department of Psychology, University of Massachusetts Boston, Boston, MA, United States
| | - Mark Assink
- Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, Netherlands
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8
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Wagner B, Reuter L, van Noort BM. Internet-Based Prevention Program of Victimization for Youth in Care and Care Leavers (EMPOWER YOUTH): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e34706. [PMID: 35700035 PMCID: PMC9240930 DOI: 10.2196/34706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/10/2022] [Accepted: 04/12/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The global estimate of the number of children in institutional care is around 5 million, with around 1 million of these children living in Europe. In Germany, about 75,000 children and adolescents find themselves in the foster care system and about 93,000 additional children and adolescents are living in institutions. Traumatic experiences and neglect in childhood are highly prevalent among these youth in care and are related to severe long-term effects. Childhood maltreatment and abuse can increase the risk of future victimization experiences. Although youth in care are at risk of victimization or revictimization, no specific evidence-based prevention program has been designed to address these specific needs. OBJECTIVE This study aims to evaluate the efficacy of a newly developed 6-module internet-based prevention program of victimization for youth in care, named EMPOWER YOUTH. METHODS In a randomized controlled trial, the intervention group will be compared to a waiting-list control group with an unblinded 1:1 allocation ratio. Assessments will take place before randomization (baseline) and at follow-up 18 weeks after baseline (ie, 12 weeks after finishing the last module of the program). The primary endpoint is the number of victimization, and online and offline bullying experiences (composite score) at the 18-week follow-up. Secondary endpoints are risk-taking behavior, aggressive tendencies, empathy, prosocial behavior, depressiveness, and loneliness at follow-up. The expected outcome requires a sample size of 156 subjects to achieve a power of 80%. Assuming a 30% dropout rate at follow-up, we require 225 participants to be allocated to the trial. Participants are youth in care, that is, adolescents in foster care, adopted adolescents, or young care leavers aged 14 to 21 years. RESULTS Ethical approval was granted by the Ethics Committee of the Medical School Berlin in March 2021 (MSB-2021/55). Recruitment started in September 2021 and is planned until November 2022. The results are expected to be published in January 2023. CONCLUSIONS Given the increased likelihood for future victimization experiences among youth in care, there is a strong need for a low-threshold intervention specifically for this high-risk age group. There are no existing nationwide mental health programs exclusively for youth in care in Germany. TRIAL REGISTRATION German Clinical Trials Register DRKS00024749; https://tinyurl.com/tjaahayw. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/34706.
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Affiliation(s)
- Birgit Wagner
- Department of Psychology, Medical School Berlin, Berlin, Germany
| | - Laurence Reuter
- Department of Psychology, Medical School Berlin, Berlin, Germany
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9
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Schaeffer CM, Dimeff LA, Koerner K, Chung J, Kelley-Brimer A, Kako N, Ilac M, Tuerk E, Carroll D, Beadnell B. A Smartphone App for Parental Management of Adolescent Conduct Problems: Randomized Clinical Trial of iKinnect. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2022:1-15. [PMID: 35640058 DOI: 10.1080/15374416.2022.2070851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE This study evaluates iKinnect, a linked caregiver-teen mobile app system designed to address serious adolescent conduct problems through a focus on key targets of evidence-based treatments for juvenile offending, such as parent expectation setting, monitoring, consistency, and positive reinforcement. Additional gamification and autonomy-supporting features are designed to maximize youth engagement. Digital therapeutics such as mobile apps have great potential to expand access to effective interventions, particularly for youth who engage in serious conduct problems and substance abuse, since most never receive an evidence-based treatment and few apps exist for these concerns. METHODS This randomized clinical trial used a short-term (12 week) longitudinal design with four time points. Recruited was a U.S. national sample of teens (n = 72, age 13-17, 59.7% male, 68.1% White) receiving services for a serious conduct problem and their primary caregiver. The efficacy of iKinnect, used by parent and teen dyads, was measured against an active control condition, Life360, an app that provided mutual GPS-based location tracking to dyads. RESULTS Across 12 weeks of app use, youth who used iKinnect showed significantly greater reductions in alcohol use, marijuana use, school delinquency, status offenses, and general delinquency than did controls. Parents who used iKinnect Reported greater improvements in structure/rule clarity and discipline consistency relative to control parents. Teen and parent iKinnect app use and acceptability ratings were high. CONCLUSIONS Real-world use of iKinnect in future applications can, like other emerging digital health technologies, help to expand the reach of evidence-based interventions to children, youth, and families.Registered at clinicaltrials.gov (NCT03065517).
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Affiliation(s)
| | | | | | | | | | | | | | - Elena Tuerk
- Department of Human Services, University of Virginia School of Education
| | - David Carroll
- Department of Media Design, Parsons School of Design
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10
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Buchanan CB, Stallworth JL, Joy AE, Dixon RE, Scott AE, Beisang AA, Benke TA, Glaze DG, Haas RH, Heydemann PT, Jones MD, Lane JB, Lieberman DN, Marsh ED, Neul JL, Peters SU, Ryther RC, Skinner SA, Standridge SM, Kaufmann WE, Percy AK. Anxiety-like behavior and anxiolytic treatment in the Rett syndrome natural history study. J Neurodev Disord 2022; 14:31. [PMID: 35568815 PMCID: PMC9107202 DOI: 10.1186/s11689-022-09432-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 02/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rett syndrome (RTT) is a neurodevelopmental disorder most often related to a pathogenic variant in the X-linked MECP2 gene. Internalizing behaviors appear to be common, but standard methods of diagnosing anxiety are not readily applied in this population which typically has cognitive impairment and limited expressive language. This study aims to describe the frequency of anxiety-like behavior and anxiolytic treatments along with associated clinical features in individuals with RTT. METHODS Parental reports and medication logs provided data from 1380 females with RTT participating in two iterations of the multicenter U.S. RTT Natural History Study (RNHS) from 2006 to 2019. RESULTS Most participants with RTT (77.5%) had at least occasional anxious or nervous behavior. Anxiety was reported to be the most troublesome concern for 2.6%, and within the top 3 concerns for 10.0%, of participants in the second iteration. Parents directly reported treatment for anxious or nervous behavior in 16.6% of participants in the second iteration with most reporting good control of the behavior (71.6%). In the medication logs of both RNHS iterations, the indication of anxiety was listed for a similar number of participants (15% and 14.5%, respectively). Increased use of anxiolytics and selective serotonin reuptake inhibitors (SSRIs) was related to more frequent anxiety-like behaviors (P < 0.001), older age (P < 0.001), and mild MECP2 variants (P = 0.002). CONCLUSION Anxiety-like behavior is frequent at all ages and is a significant parental concern in RTT. Older individuals and those with mild MECP2 variants are more likely to be treated with medications. Better diagnosis and treatment of anxiety in RTT should be a goal of both future studies and clinical care. TRIAL REGISTRATION NCT00299312 and NCT02738281.
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Affiliation(s)
- Caroline B. Buchanan
- grid.418307.90000 0000 8571 0933Greenwood Genetic Center, 106 Gregor Mendel Circle, Greenwood, SC 29649 USA
| | - Jennifer L. Stallworth
- grid.418307.90000 0000 8571 0933Greenwood Genetic Center, 106 Gregor Mendel Circle, Greenwood, SC 29649 USA
| | - Aubin E. Joy
- grid.418307.90000 0000 8571 0933Greenwood Genetic Center, 106 Gregor Mendel Circle, Greenwood, SC 29649 USA
| | - Rebekah E. Dixon
- grid.418307.90000 0000 8571 0933Greenwood Genetic Center, 106 Gregor Mendel Circle, Greenwood, SC 29649 USA
| | - Alexandra E. Scott
- grid.418307.90000 0000 8571 0933Greenwood Genetic Center, 106 Gregor Mendel Circle, Greenwood, SC 29649 USA
| | - Arthur A. Beisang
- grid.429065.c0000 0000 9002 4129Gillette Children’s Hospital, St. Paul, MN USA
| | - Timothy A. Benke
- grid.241116.10000000107903411Children’s Hospital Colorado, University of Colorado at Denver, Denver, CO USA
| | - Daniel G. Glaze
- grid.39382.330000 0001 2160 926XBaylor College of Medicine, Houston, TX USA
| | - Richard H. Haas
- grid.266100.30000 0001 2107 4242Rady Children’s Hospital-San Diego, University of California, San Diego, CA USA
| | - Peter T. Heydemann
- grid.240684.c0000 0001 0705 3621Rush University Medical Center, Chicago, IL USA
| | - Mary D. Jones
- grid.414016.60000 0004 0433 7727UCSF Benioff Children’s Hospital of Oakland, Oakland, CA USA
| | - Jane B. Lane
- grid.265892.20000000106344187Civitan International Research Center, University of Alabama at Birmingham, Birmingham, AL USA
| | - David N. Lieberman
- grid.38142.3c000000041936754XBoston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Eric D. Marsh
- grid.25879.310000 0004 1936 8972Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA USA
| | - Jeffrey L. Neul
- grid.412807.80000 0004 1936 9916Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN USA
| | - Sarika U. Peters
- grid.412807.80000 0004 1936 9916Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN USA
| | - Robin C. Ryther
- grid.4367.60000 0001 2355 7002Washington University School of Medicine in St. Louis, St. Louis, MO USA
| | - Steve A. Skinner
- grid.418307.90000 0000 8571 0933Greenwood Genetic Center, 106 Gregor Mendel Circle, Greenwood, SC 29649 USA
| | - Shannon M. Standridge
- grid.239573.90000 0000 9025 8099Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA ,grid.24827.3b0000 0001 2179 9593Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Walter E. Kaufmann
- grid.254567.70000 0000 9075 106XUniversity of South Carolina School of Medicine, Columbia, SC USA ,grid.189967.80000 0001 0941 6502Emory University School of Medicine, Atlanta, GA USA
| | - Alan K. Percy
- grid.265892.20000000106344187Civitan International Research Center, University of Alabama at Birmingham, Birmingham, AL USA
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11
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A cognitive behavioural therapy smartphone app for adolescent depression and anxiety: co-design of ClearlyMe. COGNITIVE BEHAVIOUR THERAPIST 2022. [DOI: 10.1017/s1754470x22000095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Abstract
Adolescence is associated with heightened vulnerability to symptoms of depression and anxiety. In-person and computerised cognitive behavioural therapy (CBT) are effective treatment options, yet uptake and engagement remain low. Smartphone delivery of CBT offers an alternative, highly accessible method of delivering CBT. However, there is no freely available CBT smartphone application (app) specifically designed to reduce depression and anxiety symptoms in adolescents. The aim of this study was to design a new CBT smartphone app (ClearlyMe) that targets depressive and anxiety symptoms in adolescents. We engaged in a rigorous co-design process with adolescents (n=36), parents (n=15), and mental health professionals (n=32). Co-design involved: (1) discovery of users’ needs, views and preferences by conducting focus groups, (2) defining app features through ideation workshops and user consultations, (3) designing therapeutic CBT content and visual features, and (4) testing prototypes. Users were involved at every step and the process was iterative, with findings carried forward to ensure continued refinement of concepts and features. We found a preference for vibrant, cheerful colours and illustrations and non-endorsement of gamification and chatbots, which contrasted with findings from other studies. Preferences were largely consistent between the three user groups. However, adolescents preferred an app that could be used autonomously without professional support, whereas mental health professionals desired a product for use as a therapy adjunct to support CBT skill development. The importance of co-design, and particularly the inclusion of all stakeholders throughout the entire co-design process, is discussed in relation to the design of ClearlyMe.
Key learning aims
(1)
To understand the co-design process that underpins the development of a new CBT smartphone app for youth with elevated symptoms of depression and anxiety.
(2)
To understand adolescent, parent and mental health professionals’ key preferences regarding the features and functionality of a CBT smartphone app for adolescents with elevated symptoms of depression and anxiety.
(3)
To understand how ClearlyMe has been designed as both a therapy adjunct and stand-alone program, and how it can be incorporated into day-to-day clinical practice.
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12
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Zhou X, Edirippulige S, Bai X, Bambling M. Are online mental health interventions for youth effective? A systematic review. J Telemed Telecare 2021; 27:638-666. [PMID: 34726992 DOI: 10.1177/1357633x211047285] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This systematic review aims to examine the effectiveness of online mental health interventions for youth. METHODS We searched seven electronic databases (PubMed, PsycINFO, Medline, Embase, CINAHL, Web of Science and SCOPUS) for the past 10 years to identify randomized controlled trials which have evaluated the use of telehealth interventions for young people with mental health problems. The included studies were assessed for quality and risk of bias. RESULTS Forty-five randomized controlled trials (n = 13,291 participants) were eligible for this review. Most studies (35 trials) evaluated the use of web-based self-help platforms to deliver cognitive behavioural therapy (14 trials), mindfulness (four trials), acceptance commitment therapy (five trials) and positive psychology (two trials). Mobile/computer applications were used to deliver cognitive behavioural therapy (four trials) and coping strategies training (two trials). Web-based synchronous chat (one trial) was used to assist communication between counsellors and participants. Three studies used artificial intelligence-based conversational agents to deliver cognitive behavioural therapy (two trials) and problem-solving-strategy training (one trial). Eighty-two percent (n = 37) identified the participants as student population (i.e. university students, high school students). Sixty-four percent (n = 29) of the telehealth interventions were found to be effective in managing depression, anxiety, stress, insomnia and improving quality of life when compared with control conditions. CONCLUSIONS Online mental health interventions were found to be effective in managing diverse mental health conditions among youth. Online self-help platforms were the most frequently used modality and artificial intelligence-based chatbots are merging as potential solutions. Future research is warranted to investigate the solutions to improve the retention rate and satisfaction of telehealth interventions among this population.
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Affiliation(s)
- Xiaoyun Zhou
- Centre for Online Health, 1974The University of Queensland, Australia
- Centre for Health Services Research, 1974The University of Queensland, Australia
| | - Sisira Edirippulige
- Centre for Online Health, 1974The University of Queensland, Australia
- Centre for Health Services Research, 1974The University of Queensland, Australia
| | - Xuejun Bai
- Academy of Psychology and Behavior, 205359Tianjin Normal University, China
| | - Matthew Bambling
- Centre for Online Health, 1974The University of Queensland, Australia
- Navitas ACAP School of Psychology, Australia
- School of Psychology, Queensland University of Technology, Australia
- Brisbane Central Medical School, 1974The University of Queensland, Australia
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13
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Facilitating improvements in young people's social relationships to prevent or treat depression: there's an app for that. Transl Psychiatry 2021; 11:470. [PMID: 34504058 PMCID: PMC8429543 DOI: 10.1038/s41398-021-01597-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/28/2021] [Accepted: 08/27/2021] [Indexed: 11/24/2022] Open
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