Initial development of a treatment adherence measure for cognitive–behavioral therapy for child anxiety.

BACKGROUND Symptoms of depression and anxiety are common after a myocardial infarction (MI). Internet-based cognitive behavioral therapy (iCBT) has shown good results in other patient groups. OBJECTIVE The aim of this study was to evaluate the effectiveness of an iCBT treatment to reduce self-reported symptoms of depression and anxiety among patients with a recent MI. METHODS In total, 3928 patients were screened for eligibility in 25 Swedish hospitals. Of these, 239 patients (33.5%, 80/239 women, mean age 60 years) with a recent MI and symptoms of depression or anxiety were randomly allocated to a therapist-guided, 14-week iCBT treatment (n=117), or treatment as usual (TAU; n=122). The iCBT treatment was designed for post-MI patients. The primary outcome was the total score of the Hospital Anxiety and Depression Scale (HADS) 14 weeks post baseline, assessed over the internet. Treatment effect was evaluated according to the intention-to-treat principle, with multiple imputations. For the main analysis, a pooled treatment effect was estimated, controlling for age, sex, and baseline HADS. RESULTS There was a reduction in HADS scores over time in the total study sample (mean delta=−5.1, P<.001) but no difference between the study groups at follow-up (beta=−0.47, 95% CI −1.95 to 1.00, P=.53). Treatment adherence was low. A total of 46.2% (54/117) of the iCBT group did not complete the introductory module. CONCLUSIONS iCBT treatment for an MI population did not result in lower levels of symptoms of depression or anxiety compared with TAU. Low treatment adherence might have influenced the result. CLINICALTRIAL ClinicalTrials.gov NCT01504191; https://clinicaltrials.gov/ct2/show/NCT01504191 (Archived at Webcite at http://www.webcitation.org/6xWWSEQ22)

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Program Evaluation of Group-based Cognitive Behavioral Therapy for Insomnia: a Focus on Treatment Adherence and Outcomes in Older Adults with Co-morbidities

Clinical Gerontologist ◽

10.1080/07317115.2017.1399190 ◽

2017 ◽

Vol 41 (5) ◽

pp. 487-497 ◽

Cited By ~ 2

Author(s):

Brian M. Ludwin ◽

Patricia Bamonti ◽

Elizabeth A. Mulligan

Keyword(s):

Older Adults ◽

Program Evaluation ◽

Cognitive Behavioral Therapy ◽

Treatment Adherence ◽

Behavioral Therapy ◽

Cognitive Behavioral

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Computer-Assisted Cognitive Behavioral Therapy for Child Anxiety: Results of a Randomized Clinical Trial

Yearbook of Psychiatry and Applied Mental Health ◽

10.1016/j.ypsy.2011.04.011 ◽

2012 ◽

Vol 2012 ◽

pp. 58-60

Author(s):

J.L. Krupnick

Keyword(s):

Clinical Trial ◽

Cognitive Behavioral Therapy ◽

Randomized Clinical Trial ◽

Behavioral Therapy ◽

Child Anxiety ◽

Cognitive Behavioral ◽

Computer Assisted

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Using a Smartphone App and Clinician Portal to Enhance Brief Cognitive Behavioral Therapy for Childhood Anxiety Disorders

10.31234/osf.io/pyeq4 ◽

2019 ◽

Cited By ~ 1

Author(s):

Jennifer Susan Silk ◽

Gede Pramana ◽

Stefanie Sequeira ◽

Oliver Lindhiem ◽

Philip C. Kendall ◽

...

Keyword(s):

Anxiety Disorder ◽

Cognitive Behavioral Therapy ◽

Anxiety Disorders ◽

Behavioral Therapy ◽

Controlled Trial ◽

Child Anxiety ◽

Childhood Anxiety ◽

Post Treatment ◽

Cognitive Behavioral ◽

Childhood Anxiety Disorders

Cognitive behavioral therapy (CBT) is an efficacious treatment for child anxiety disorders, but 40-50% of youth do not respond fully to treatment, and time commitments for standard CBT can be prohibitive for some families and lead to long waiting lists for trained CBT therapists in the community. SmartCAT 2.0 is an adjunctive mobile health program designed to improve and shorten CBT treatment for anxiety disorders in youth by providing them with the opportunity to practice CBT skills outside of session using an interactive and gamified interface. It consists of an app and an integrated clinician portal connected to the app for secure 2-way communication with the therapist. The goal of the present study was to evaluate SmartCAT 2.0 in an open trial to establish usability, feasibility, acceptability, and preliminary efficacy of brief (8 sessions) CBT combined with SmartCAT. We also explored changes in CBT skills targeted by the app. Participants were 34 youth (ages 9-14) who met DSM-5 criteria for generalized, separation, and/or social anxiety disorder. Results demonstrated strong feasibility and usability of the app/portal and high satisfaction with the intervention. Youth used the app an average of 12 times between each therapy session (M = 5.8 mins per day). At post-treatment, 67% of youth no longer met diagnostic criteria for an anxiety disorder, with this percentage increasing to 86% at two-month follow-up. Youth showed reduced symptom severity over time across raters and also improved from pre- to post-treatment in CBT skills targeted by the app, demonstrating better emotion identification and thought challenging and reductions in avoidance. Findings support the feasibility of combining brief CBT with SmartCAT. Although not a controlled trial, when benchmarked against the literature, the current findings suggest that SmartCAT may enhance the utility of brief CBT for childhood anxiety disorders. This paper is currently in press in Behavior Therapy.

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Predictors of Treatment Outcomes and Adherence in Internet-based Cognitive Behavioral Therapy for Social Anxiety in China (Preprint)

10.2196/preprints.10346 ◽

2018 ◽

Author(s):

Huijing Chen ◽

Marcus A. Rodriguez ◽

Mingyi Qian ◽

Tomoko Kishimoto ◽

Muyu Lin ◽

...

Keyword(s):

Social Anxiety ◽

Cognitive Behavioral Therapy ◽

Treatment Adherence ◽

Behavioral Therapy ◽

Cognitive Behavioral ◽

Group Differences ◽

Online Interventions ◽

Significant Group ◽

Factors Associated ◽

Clinically Significant

BACKGROUND More research is needed to explore why some patients do not achieve clinically significant improvement in online interventions. OBJECTIVE The aim of this study was to identify factors associated with treatment attrition, adherence and outcomes in Internet-based Cognitive Behavioral Therapy (ICBT) for social anxiety in China. METHODS Participants were assigned to either therapist-guided ICBT (N=183) or self-guided ICBT (N=72) groups. RESULTS No significant group differences were found for treatment adherence or outcomes between the therapist-guided and self-guided conditions. Participants diagnosed with Social Anxiety Disorder (SAD) were significantly less likely to dropout (OR 0.531, P = .03) compared to the subclinical group. Older participants (B = 0.17, SE = 0.04, P = .008) and participants with a diagnosis of SAD (B = 0.16, SE = 0.44, P = .01) tended to complete more modules. Participants who completed more modules (B = 0.24, SE = 0.03, P = .01) and participants who identified as female (B = -0.20, SE = 0.18, P = .04) reported greater reductions in SAD symptoms. CONCLUSIONS A comprehensive theoretical model of treatment adherence in online interventions is needed.

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A Randomized Clinical Trial Comparing Individual Cognitive Behavioral Therapy and Child-Centered Therapy for Child Anxiety Disorders

Journal of Clinical Child & Adolescent Psychology ◽

10.1080/15374416.2016.1138408 ◽

2016 ◽

Vol 47 (4) ◽

pp. 542-554 ◽

Cited By ~ 39

Author(s):

Jennifer S. Silk ◽

Patricia Z. Tan ◽

Cecile D. Ladouceur ◽

Suzanne Meller ◽

Greg J. Siegle ◽

...

Keyword(s):

Clinical Trial ◽

Cognitive Behavioral Therapy ◽

Anxiety Disorders ◽

Randomized Clinical Trial ◽

Behavioral Therapy ◽

Child Anxiety ◽

Cognitive Behavioral ◽

Child Centered ◽

Child Anxiety Disorders

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Using Mobile Health Gamification to Facilitate Cognitive Behavioral Therapy Skills Practice in Child Anxiety Treatment: Open Clinical Trial (Preprint)

10.2196/preprints.8902 ◽

2017 ◽

Author(s):

Gede Pramana ◽

Bambang Parmanto ◽

James Lomas ◽

Oliver Lindhiem ◽

Philip C Kendall ◽

...

Keyword(s):

Clinical Trial ◽

Cognitive Behavioral Therapy ◽

Mobile Health ◽

Behavioral Therapy ◽

Child Anxiety ◽

Cognitive Behavioral ◽

User Engagement ◽

Significance Level ◽

Anxiety Treatment

BACKGROUND Cognitive behavioral therapy is an efficacious treatment for child anxiety disorders. Although efficacious, many children (40%-50%) do not show a significant reduction in symptoms or full recovery from primary anxiety diagnoses. One possibility is that they are unwilling to learn and practice cognitive behavioral therapy skills beyond therapy sessions. This can occur for a variety of reasons, including a lack of motivation, forgetfulness, and a lack of cognitive behavioral therapy skills understanding. Mobile health (mHealth) gamification provides a potential solution to improve cognitive behavioral therapy efficacy by delivering more engaging and interactive strategies to facilitate cognitive behavioral therapy skills practice in everyday lives (in vivo). OBJECTIVE The goal of this project was to redesign an existing mHealth system called SmartCAT (Smartphone-enhanced Child Anxiety Treatment) so as to increase user engagement, retention, and learning facilitation by integrating gamification techniques and interactive features. Furthermore, this project assessed the effectiveness of gamification in improving user engagement and retention throughout posttreatment. METHODS We redesigned and implemented the SmartCAT system consisting of a smartphone app for children and an integrated clinician portal. The gamified app contains (1) a series of interactive games and activities to reinforce skill understanding, (2) an in vivo skills coach that cues the participant to use cognitive behavioral therapy skills during real-world emotional experiences, (3) a home challenge module to encourage home-based exposure tasks, (4) a digital reward system that contains digital points and trophies, and (5) a therapist-patient messaging interface. Therapists used a secure Web-based portal connected to the app to set up required activities for each session, receive or send messages, manage participant rewards and challenges, and view data and figures summarizing the app usage. The system was implemented as an adjunctive component to brief cognitive behavioral therapy in an open clinical trial. To evaluate the effectiveness of gamification, we compared the app usage data at posttreatment with the earlier version of SmartCAT without gamification. RESULTS Gamified SmartCAT was used frequently throughout treatment. On average, patients spent 35.59 min on the app (SD 64.18) completing 13.00 activities between each therapy session (SD 12.61). At the 0.10 significance level, the app usage of the gamified system (median 68.00) was higher than that of the earlier, nongamified SmartCAT version (median 37.00, U=76.00, P<.01). The amount of time spent on the gamified system (median 173.15) was significantly different from that of the earlier version (median 120.73, U=173.00, P=.06). CONCLUSIONS The gamified system showed good acceptability, usefulness, and engagement among anxious children receiving brief cognitive behavioral therapy treatment. Integrating an mHealth gamification platform within treatment for anxious children seems to increase involvement in shorter treatment. Further study is needed to evaluate increase in involvement in full-length treatment.

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