Abstract
BackgroundAnxiety disorders are the most common mental health problem among youth, contribute to reduced quality of daily life, and are associated with high rates of comorbidity. However, treatment rates for anxiety are very low, causing a sizeable treatment gap. There is an immediate need to identify treatment interventions that are effective, affordable, and can be delivered easily to the youth population. Cognitive Bias Modification (CBM) is one potentially effective intervention that could reach youth on a large scale, especially when self-administered at home. Thus, we aim to assess the benefit of CBM to treat youth anxiety. Further, we aim to test whether adding an adherence promotion (AP) component to the CBM intervention can improve outcomes, and whether CBM delivered both with and without the AP component is cost effective.MethodsThis is a 12-month randomized controlled trial (RCT) conducted within an existing healthcare system. Potentially eligible youth (ages 12 to 17) will be identified by reviewing the electronic health record (EHR) for clinical anxiety diagnoses, which are then confirmed via research interview. We aim to enroll 498 participants and randomize them 1:1:1 to one of three arms: Arm 1 is a Low-Ratio version of the CBM program (nearly identical to the other CBM versions, but minimally effective); Arm 2 is a High-Ratio “active” CBM program; and Arm 3 is the High-Ratio CBM program with an added AP component. Participants will complete assessments at baseline, 1-, 3-, 6- and 12-months post-baseline. Youth in all three arms will self-administer the CBM program at home and will be asked to complete twelve intervention sessions over a four-week period. Arm 3 participants (High-Ratio CBM + AP) will also receive up to four telephone calls from phone coaches during the intervention period to provide technical assistance, encouragement, and motivational enhancement to increase adherence. The primary clinical outcome will be anxiety remission at 6-month follow-up.DiscussionThis study protocol describes the method and design for an RCT to test whether self-administered CBM both with and without adherence promotion can be an effective at-home treatment for anxious youth.Trial registrationClinicalTrials.gov: NCT02156531, First Posted June 5, 2014.
Highlights
Anxiety disorders are the most common mental health problem among youth, contribute to reduced quality of daily life, and are associated with high rates of comorbidity
What treatments are known to be effective for youth anxiety disorder? While there is a large body of evidence supporting the efficacy of both cognitive behavioral therapy (CBT) and medications such as selective serotonin reuptake inhibitors (SSRIs) for anxiety disorders, there are significant patient, intervention, and organizational barriers to youth receiving these evidence-based treatments (EBTs)
If we find that self-administered computerized Cognitive Bias Modification (CBM) is an effective treatment option in real world settings, it will be important to consider whether broad dissemination and implementation is feasible
Summary
Anxiety disorders are the most common mental health problem among youth, contribute to reduced quality of daily life, and are associated with high rates of comorbidity. 1 in 3 adolescents meet criteria for an anxiety disorder by age 18, making anxiety disorders the most common mental health problem among youth [1] These disorders interfere with daily life, have high rates of medical and psychiatric comorbidity [1, 2], are associated with high health care costs [3, 4], and are comorbid with substance abuse, depression and functional impairment in adulthood [5]. Anxiety has the lowest treatment rate of any mental disorder in childhood and adolescence [6, 7]; less than one-third of youth identified with anxiety received any intervention [8] This disparity between high prevalence and low treatment makes addressing this “care gap” a significant public health priority. There is an immediate, unmet need to identify and disseminate effective treatment interventions that are accessible, affordable, have few or no negative side effects, and can be delivered to the youth population
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