Improving care with a mobile app for youth
CAMH researchers and their partners are creating and evaluating a mobile app to deliver a better treatment experience for youth with depression or anxiety. The app will work alongside in-person therapy, extending care after a young person leaves the therapist’s office.
By engaging young people in treatment exercises on their phones, the team is aiming to improve treatment outcomes. “As therapists, we see a client for one hour once a week, at best, over 12 to 20 weeks. For the rest of the time, a young person is living with anxiety and depression,” says CAMH Collaborator Scientist and principal investigator Dr. Pamela Wilansky, who is also a Psychologist and Co-Founder of Framework: Therapy and Assessment Centre.
“We believe the app’s biggest impact will come from applying treatment techniques whenever you need them as you go about your day, right from your phone,” says Dr. Wilansky. “We believe this will reduce the duration and intensity of depression and anxiety symptoms.”
“The app will give youth a better experience in therapy and a better way to apply the treatment in their own lives, so they get more out of it,” says Dr. John Strauss, Director of Medical Informatics and Clinician Scientist in the Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, part of the Child, Youth and Emerging Adult Program at CAMH. Dr. Strauss is the CAMH clinical lead on the project.
Youth ages 12 to 18 and therapists are shaping the app’s development throughout the four-year research project, from prototype design to testing the app’s effectiveness in a randomized controlled trial. The project team includes therapists, researchers and engineers from hospitals and universities in Canada and the U.K., and technology and commercialization partner BrainFx. (See below, “A collaborative effort.”)
CBT goes digital
The app is being developed for use as part of a widely practised, effective form of treatment called cognitive behaviour therapy (CBT). CBT helps people with depression and anxiety identify feelings and negative thoughts, as well as modify thinking and behaviours to promote well-being.
An important component of CBT is making note of negative thoughts and behaviours as they come up in everyday life and applying new skills to change them. This “homework” is typically done on printed worksheets or computer programs.
“In the many focus groups I’ve conducted after therapy, youth have said that CBT is helpful; however, they don’t complete their paper-based homework or forget to bring it to their appointment, whereas your phone is always with you,” says Dr. Wilansky.
Young people using the new app will be able to record their negative thoughts and feelings, and how they responded. Therapists will be able to tailor content to a client’s needs, while young people will have the option to share access so their therapist can view and discuss their homework with them. Other features will include a timeline graph showing changes over time, and tools to create a personal safety plan to help a young person cope if they experience a crisis or difficult situation. The app will also link to a desktop version, geared to therapists and youth who prefer to use it on their computers. While other CBT apps are available, most are adult-focused, have not been evaluated through research, and were developed for personal use only, rather than augmenting care from a trained therapist.
Learning from youth and therapists
The four-year project, which includes two young people on the team, is in its initial phase: designing the prototype. This has involved interviews with youth and therapists familiar with CBT, and adapting content from an evidence-based CBT manual for youth developed by Dr. Wilansky and Dr. Katharina Manassis. Youth and therapists are now testing the first prototype for ease of use and design features.
In the second phase, up to 20 youth and their therapists from four hospitals in the Greater Toronto Area will use the app as part of a 12-week CBT treatment in order to provide feedback about satisfaction and ease of use.
In the final phase, the team will evaluate the app’s effectiveness in a randomized controlled trial with up to 100 youth and their therapists. One group will complete a 12-week CBT treatment using the app, and another group will complete the same treatment using paper-based homework exercises. The trial will assess if the app increases completion of CBT homework and affects treatment outcomes. The team expects to complete the evaluation in late 2019.