Development and Open Trial of a Technology-Enhanced Family Intervention for Adolescents at Risk for Mood Disorders

Abstract

Aim: Integrating psychosocial interventions with mobile apps may increase treatment engagement among adolescents. We examined the user experience, uptake, and clinical effects of a mobile-enhanced family-focused therapy (FFT) among adolescents at risk for mood disorders.

Method: We created a mobile app containing 12 lesson plans corresponding to content of weekly FFT sessions, with modules concerning mood management, family communication and problem-solving. We pilot tested the app in an open trial of FFT (12 sessions in 18 weeks) for adolescents who had active depressive or hypomanic symptoms, a parent with mood disorder, and at least one parent who expressed high levels of criticism. Teens and parents made daily and weekly ratings of youths' moods, amount of parent/offspring criticism, and practice of FFT psychoeducational, communication or problem-solving skills. Independent evaluators interviewed adolescents at baseline and every 9 weeks over 27 weeks to measure symptom trajectories.

Results: Participants were adolescents (n=22; mean age 15.4 ± 1.8 years; 45.5% female) and their 34 parents. Completion of requested app assessment and skill practices averaged 46%-65% among adolescents and parents over 18 weeks of treatment. Adolescents showed significant improvement in clinician-rated depression scores over 27 weeks (Cohen's d=1.58, 95% CI, 0.83 to 2.32) and reported reductions in the amount of perceived criticism expressed by parents.

Limitations: The uncontrolled design limits inferences about whether the mobile app augmented the effects of FFT on moods or family relationships.

Conclusions: Mobile applications may enhance users' responses to family therapy and provide clinicians with information regarding clinical status. Clinicaltrials.gov NCT03913013.

Keywords: Digital mental health; bipolar disorder; early intervention; expressed emotion; mobile apps.

Copyright © 2020. Published by Elsevier B.V.

Figures

Fig. 1.

App Structure.

Fig. 2.

Family App Home Page.

Fig. 3.

Example of Daily Mood, Stress and Perceived Criticism Ratings. In this example, the adolescent reported more day-to-day mood variability than was observed by the parent. The adolescent rated the days with more extreme moods as those in which he or she perceived the primary parent to be more critical.