scholarly journals Design and Delivery Features That May Improve the Use of Internet-Based Cognitive Behavioral Therapy for Children and Adolescents With Anxiety: A Realist Literature Synthesis With a Persuasive Systems Design Perspective

10.2196/11128 ◽  
2019 ◽  
Vol 21 (2) ◽  
pp. e11128 ◽  
Author(s):  
Ashley D Radomski ◽  
Lori Wozney ◽  
Patrick McGrath ◽  
Anna Huguet ◽  
Lisa Hartling ◽  
...  
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Children And Adolescents ◽  
Behavioral Therapy ◽  
Systems Design ◽  
Cognitive Behavioral ◽  
Literature Synthesis ◽  
Persuasive Systems Design ◽  
Design Perspective ◽  
Use Of Internet ◽  
Persuasive Systems

scholarly journals Design and Delivery Features That May Improve the Use of Internet-Based Cognitive Behavioral Therapy for Children and Adolescents With Anxiety: A Realist Literature Synthesis With a Persuasive Systems Design Perspective (Preprint)

2018 ◽  
Author(s):  
Ashley D Radomski ◽  
Lori Wozney ◽  
Patrick McGrath ◽  
Anna Huguet ◽  
Lisa Hartling ◽  
...  
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Children And Adolescents ◽  
Behavioral Therapy ◽  
Systems Design ◽  
Primary Task ◽  
Cognitive Behavioral ◽  
Adolescent Anxiety ◽  
Methodological Rigor ◽  
Persuasive Systems Design ◽  
Persuasive Systems

BACKGROUND Internet-based cognitive behavioral therapy (iCBT) is a persuasive system as its design combines therapeutic content, technological features, and interactions between the user and the program to reduce anxiety for children and adolescents. How iCBT is designed and delivered differs across programs. Although iCBT is considered an effective approach for treating child and adolescent anxiety, rates of program use (eg, module completion) are highly variable for reasons that are not clear. As the extent to which users complete a program can impact anxiety outcomes, understanding what iCBT design and delivery features improve program use is critical for optimizing treatment effects. OBJECTIVE The objectives of this study were to use a realist synthesis approach to explore the design and delivery features of iCBT for children and adolescents with anxiety as described in the literature and to examine their relationship to program use outcomes. METHODS A search of published and gray literature was conducted up to November 2017. Prespecified inclusion criteria identified research studies, study protocols, and program websites on iCBT for child and adolescent anxiety. Literature was critically appraised for relevance and methodological rigor. The persuasive systems design (PSD) model, a comprehensive framework for designing and evaluating persuasive systems, was used to guide data extraction. iCBT program features were grouped under 4 PSD categories—Primary task support, Dialogue support, System credibility support, and Social support. iCBT design (PSD Mechanisms) and delivery features (Context of use) were linked to program use (Outcomes) using meta-ethnographic methods; these relationships were described as Context-Mechanism-Outcome configurations. For our configurations, we identified key PSD features and delivery contexts that generated moderate-to-high program use based on moderate-to-high quality evidence found across multiple iCBT programs. RESULTS A total of 44 documents detailing 10 iCBT programs were included. Seven iCBT programs had at least one document that scored high for relevance; most studies were of moderate-to-high methodological rigor. We developed 5 configurations that highlighted 8 PSD features (Tailoring, Personalization [Primary task supports]; Rewards, Reminders, Social role [Dialogue supports]; and Trustworthiness, Expertise, Authority [System credibility supports]) associated with moderate-to-high program use. Important features of delivery Context were adjunct support (a face-to-face, Web- or email-based communications component) and whether programs targeted the prevention or treatment of anxiety. Incorporating multiple PSD features may have additive or synergistic effects on program use. CONCLUSIONS The Context-Mechanism-Outcome configurations we developed suggest that, when delivered with adjunct support, certain PSD features contribute to moderate-to-high use of iCBT prevention and treatment programs for children and adolescents with anxiety. Standardization of the definition and measurement of program use, formal testing of individual and combined PSD features, and use of real-world design and testing methods are important next steps to improving how we develop and deliver increasingly useful treatments to target users.

scholarly journals Potential Reduction of Symptoms With the Use of Persuasive Systems Design Features in Internet-Based Cognitive Behavioral Therapy Programs for Children and Adolescents With Anxiety: A Realist Synthesis (Preprint)

2019 ◽  
Author(s):  
Ashley D Radomski ◽  
Lori Wozney ◽  
Patrick McGrath ◽  
Anna Huguet ◽  
Lisa Hartling ◽  
...  
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Children And Adolescents ◽  
Behavioral Therapy ◽  
Systems Design ◽  
Anxiety Symptoms ◽  
Primary Task ◽  
Design Features ◽  
Methodological Rigor ◽  
Persuasive Systems Design ◽  
Persuasive Systems

BACKGROUND Internet-based cognitive behavioral therapy (iCBT) for children and adolescents is a persuasive system that combines 3 major components to therapy—therapeutic content, technological features, and interactions between the user and program—intended to reduce users’ anxiety symptoms. Several reviews report the effectiveness of iCBT; however, iCBT design and delivery components differ widely across programs, which raise important questions about how iCBT effects are produced and can be optimized. OBJECTIVE The objective of this study was to review and synthesize the iCBT literature using a realist approach with a persuasive systems perspective to (1) document the design and delivery components of iCBT and (2) generate hypotheses as to how these components may explain changes in anxiety symptoms after completing iCBT. METHODS A multi-strategy search identified published and gray literature on iCBT for child and adolescent anxiety up until June 2019. Documents that met our prespecified inclusion criteria were appraised for relevance and methodological rigor. Data extraction was guided by the persuasive systems design (PSD) model. The model describes 28 technological design features, organized into 4 categories that help users meet their health goals: primary task support, dialogue support, system credibility support, and social support. We generated initial hypotheses for how PSD (mechanisms) and program delivery (context of use) features were linked to symptom changes (outcomes) across iCBT programs using realist and meta-ethnographic techniques. These hypothesized context-mechanism-outcome configurations were refined during analysis using evidence from the literature to improve their explanatory value. RESULTS A total of 63 documents detailing 15 iCBT programs were included. A total of six iCBT programs were rated high for relevance, and most studies were of moderate-to-high methodological rigor. A total of 11 context-mechanism-outcome configurations (final hypotheses) were generated. Configurations primarily comprised PSD features from the primary task and dialogue support categories. Several key PSD features (eg, self-monitoring, simulation, social role, similarity, social learning, and rehearsal) were consistently reported in programs shown to reduce anxiety; many features were employed simultaneously, suggesting synergy when grouped. We also hypothesized the function of PSD features in generating iCBT impacts. Adjunct support was identified as an important aspect of context that may have complemented certain PSD features in reducing users’ anxiety. CONCLUSIONS This synthesis generated context-mechanism-outcome configurations (hypotheses) about the potential function, combination, and impact of iCBT program components thought to support desired program effects. We suggest that, when delivered with adjunct support, PSD features may contribute to reduced anxiety for child and adolescent users. Formal testing of the 11 configurations is required to confirm their impact on anxiety-based outcomes. From this we encourage a systematic and deliberate approach to iCBT design and evaluation to increase the pool of evidence-based interventions available to prevent and treat children and adolescents with anxiety.

scholarly journals Potential Reduction of Symptoms With the Use of Persuasive Systems Design Features in Internet-Based Cognitive Behavioral Therapy Programs for Children and Adolescents With Anxiety: A Realist Synthesis

10.2196/13807 ◽  
2019 ◽  
Vol 6 (10) ◽  
pp. e13807
Author(s):  
Ashley D Radomski ◽  
Lori Wozney ◽  
Patrick McGrath ◽  
Anna Huguet ◽  
Lisa Hartling ◽  
...  
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Children And Adolescents ◽  
Behavioral Therapy ◽  
Systems Design ◽  
Anxiety Symptoms ◽  
Primary Task ◽  
Design Features ◽  
Methodological Rigor ◽  
Persuasive Systems Design ◽  
Persuasive Systems

Background Internet-based cognitive behavioral therapy (iCBT) for children and adolescents is a persuasive system that combines 3 major components to therapy—therapeutic content, technological features, and interactions between the user and program—intended to reduce users’ anxiety symptoms. Several reviews report the effectiveness of iCBT; however, iCBT design and delivery components differ widely across programs, which raise important questions about how iCBT effects are produced and can be optimized. Objective The objective of this study was to review and synthesize the iCBT literature using a realist approach with a persuasive systems perspective to (1) document the design and delivery components of iCBT and (2) generate hypotheses as to how these components may explain changes in anxiety symptoms after completing iCBT. Methods A multi-strategy search identified published and gray literature on iCBT for child and adolescent anxiety up until June 2019. Documents that met our prespecified inclusion criteria were appraised for relevance and methodological rigor. Data extraction was guided by the persuasive systems design (PSD) model. The model describes 28 technological design features, organized into 4 categories that help users meet their health goals: primary task support, dialogue support, system credibility support, and social support. We generated initial hypotheses for how PSD (mechanisms) and program delivery (context of use) features were linked to symptom changes (outcomes) across iCBT programs using realist and meta-ethnographic techniques. These hypothesized context-mechanism-outcome configurations were refined during analysis using evidence from the literature to improve their explanatory value. Results A total of 63 documents detailing 15 iCBT programs were included. A total of six iCBT programs were rated high for relevance, and most studies were of moderate-to-high methodological rigor. A total of 11 context-mechanism-outcome configurations (final hypotheses) were generated. Configurations primarily comprised PSD features from the primary task and dialogue support categories. Several key PSD features (eg, self-monitoring, simulation, social role, similarity, social learning, and rehearsal) were consistently reported in programs shown to reduce anxiety; many features were employed simultaneously, suggesting synergy when grouped. We also hypothesized the function of PSD features in generating iCBT impacts. Adjunct support was identified as an important aspect of context that may have complemented certain PSD features in reducing users’ anxiety. Conclusions This synthesis generated context-mechanism-outcome configurations (hypotheses) about the potential function, combination, and impact of iCBT program components thought to support desired program effects. We suggest that, when delivered with adjunct support, PSD features may contribute to reduced anxiety for child and adolescent users. Formal testing of the 11 configurations is required to confirm their impact on anxiety-based outcomes. From this we encourage a systematic and deliberate approach to iCBT design and evaluation to increase the pool of evidence-based interventions available to prevent and treat children and adolescents with anxiety.

Hoarding in children and adolescents with obsessive–compulsive disorder: prevalence, clinical correlates, and cognitive behavioral therapy outcome

2019 ◽  
Vol 28 (8) ◽  
pp. 1097-1106 ◽  
Author(s):  
Davíð R. M. A. Højgaard ◽  
Gudmundur Skarphedinsson ◽  
Tord Ivarsson ◽  
Bernhard Weidle ◽  
Judith Becker Nissen ◽  
...  
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Children And Adolescents ◽  
Obsessive Compulsive Disorder ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Therapy Outcome ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Clinical Correlates

Cognitive-Behavioral Therapy for Children and Adolescents

2017 ◽  
pp. 257-288 ◽  
Author(s):  
Danielle Cornacchio ◽  
Amanda L. Sanchez ◽  
Tommy Chou ◽  
Jonathan S. Comer
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Children And Adolescents ◽  
Behavioral Therapy ◽  
Cognitive Behavioral

Cognitive Behavioral Therapy for Insomnia (CBT-i) in School-Aged Children and Adolescents

2019 ◽  
Vol 14 (2) ◽  
pp. 155-165 ◽  
Author(s):  
Julia Dewald-Kaufmann ◽  
Ed de Bruin ◽  
Gradisar Michael
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Children And Adolescents ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
School Aged Children
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