Grant: Operating Grant: Knowledge to Action

Knowledge to Action in Mental Health Care: Mobile Ecological Momentary Intervention (mobile EMI) to Help Adolescents Adhere to Evidence-Based Treatment for their Anxiety Disorder

<html> <body> <b>Anxiety is the most common mental health problem in adolescence</b>, with approximately 1 in 3 adolescents meeting criteria for an anxiety disorder. The recommended psychological treatment for anxiety disorders is cognitive behavioural therapy (CBT). This evidence-based treatment is delivered face-to-face by a trained clinician who teaches the adolescent how to replace anxious thoughts with more helpful ones, face feared situations, and self-reward to offset discomfort. Adolescents are expected to practice skills between sessions to maintain treatment gains.<br> <br> We have partnered with the Treatment of Anxiety Group (TAG) in Halifax, which provides CBT to 13&ndash;18 year olds with anxiety disorders. Together, we have discussed three barriers faced by adolescents practicing skills outside treatment. <i>1)</i> Practice includes purposely and repeatedly placing oneself in feared situations. This is mentally and physically uncomfortable, thus <i>skills take taxing practice and effort</i>. <i>2)</i> Self-reward is forgotten in times of stress during practice, <i>when it is needed most.</i> <i>3)</i> Skills practiced in a treatment session <i>may be carried out differently in varying real life situations</i>. <b>TAG and</b> <b>our team of clinician scientists, youth engagement leaders, health technology experts and knowledge translation scientists</b> <b>view these barriers as a knowledge-to-action opportunity.</b> <br> <br> This project will produce and assess an ecological momentary intervention (EMI), a real-time treatment adjunct that is accessed via smartphone (mobile EMI). Mobile EMI is not used by TAG, but its use by adolescents between CBT sessions has two key advantages: <i>1)</i> they can access it on their phone when and where it is most needed, and <i>2)</i> it can be linked with a phone&rsquo;s functions (e.g., calendar, social media) to support practice, self-reward and adherence. Thus, mobile EMI is a tool that can help adolescents plan and work through treatment activities in any setting, and coach them in practicing CBT skills accurately.<br> <br> <b>Our overall goals are to</b> <i>1)</i> equip clinicians and their adolescent patients with a mobile EMI to help adolescents practice and adhere to skills learned in CBT, and <i>2)</i> identify barriers and facilitators of patient and clinician use of mobile EMI as an adjunct to CBT. In <b>Phase 1</b> of our project, TAG adolescents, their parents and TAG clinicians will take part in discussions on using technology during treatment, necessary EMI features, and factors that may affect mobile EMI feasibility in CBT. These discussions will inform EMI creation and the development of an EMI implementation strategy. Next, adolescents will evaluate the EMI for usability, and mobile application developers will evaluate EMI heuristics. In <b>Phase 2,</b> we will carry out a study to assess the feasibility of TAG patients and clinicians using the EMI during a 4-month CBT treatment period and identify the barriers and facilitators to real-world implementation.<br> <br>Through this study, we will <b>identify issues</b> that are <b>important to clinicians and adolescents</b> for using mobile EMI during CBT, and can <b>help them make informed decisions</b> on using mobile EMI with CBT for an anxiety disorder. Our results can <b>provide a new tool for anxious adolescents to use during CBT treatment</b>. Following usability and feasibility assessment with TAG participants, we will broadly share this clinical tool with mental health professionals and adolescents across Canada.</body> </html>