Expanding access to CBT for childhood anxiety disorders via smart phones

描述（由申请人提供）：与RFA-MH-13-061“利用先进的健康技术推动心理健康改善”的目标一致，本R34提案旨在通过最近开发的智能手机应用程序“梅奥诊所焦虑教练”改善儿童焦虑症的循证认知行为疗法（CBT）的交付。焦虑症是儿童时期最常见的精神疾病，患病率高达15%，但最不可能得到治疗（约30%）。这些疾病会导致各种功能领域的严重损害，与其他疾病高度共病，并经常持续到成年。尽管努力传播有效的干预措施，但大多数患者没有得到最先进的社会心理治疗。满足当前心理健康需求的障碍包括从业人员数量不足和基于证据的治疗方法（如基于暴露的认知行为疗法）的使用有限。为了解决这一实施差距，我们的研究团队最近开发了一款智能手机应用程序，梅奥诊所焦虑教练，它可以作为一种独立的治疗方法，只需与治疗师进行最少的接触，也可以作为一种工具，增加治疗师对循证治疗的使用。为了准备梅奥诊所焦虑症教练用于患有焦虑症的儿童，目前的提案将实现以下目标：(1)开发一个基于网络的门户网站，允许治疗师远程监控和与患者沟通；(2)在一项试点研究中，从服务不足的社区环境中招募代表当前使用循证治疗的治疗师，提供治疗；(3)从试点研究中收集数据，比较梅奥诊所焦虑教练在不同治疗师接触水平的支持下对常规治疗的影响。完成后，该项目的数据将提供一份治疗方案，详细说明如何使用创新的智能手机技术，通过以下方式改善儿童焦虑症的有效治疗：(1)在传统精神卫生机构之外提供干预措施，尽量减少与提供者的接触；(2)向社区从业人员传播基于暴露的CBT。通过增加治疗的范围和质量，梅奥诊所焦虑教练有可能改善大量患有焦虑症的儿童的临床和功能结果。

DESCRIPTION (provided by applicant): Consistent with the goals of RFA-MH-13-061 "Harnessing Advanced Health Technologies to Drive Mental Health Improvement," this R34 proposal seeks to improve the delivery of evidence-based Cognitive Behavioral Therapy (CBT) for childhood anxiety disorders with a recently developed smartphone application, Mayo Clinic Anxiety Coach. Anxiety disorders are the most common psychiatric disorders in childhood with prevalence rates as high as 15%, but are the least likely to be treated (approximately 30%). These disorders cause substantial impairment across a variety of domains of functioning, are highly comorbid with other disorders, and often persist into adulthood. Despite efforts to disseminate effective interventions, most patients do not receive state-of-the-art psychosocial treatment. The barriers to meeting the current mental health demand include an insufficient number of practitioners and the limited use of evidence-based treatments, such as exposure-based CBT. To address this implementation gap, our research team recently developed a smartphone application, Mayo Clinic Anxiety Coach, which can be used as a stand alone treatment requiring minimal contact with a therapist or a tool to increase therapist use of evidence-based treatment. To prepare Mayo Clinic Anxiety Coach for use with children suffering from anxiety disorders, the current proposal will accomplish the following aims: (1) develop a web-based portal that allows therapists to monitor and communicate with patients from a distance; (2) recruit therapists from underserved community settings representing the current use of evidence-based treatment to provide treatment in a pilot study, and (3) gather data from the pilot study comparing the impact of Mayo Clinic Anxiety Coach supported with different levels of therapist contact to treatment as usual. When completed, the data from this project will provide a treatment protocol detailing the use of an innovative smartphone technology to improve access to effective treatment for childhood anxiety disorders through (1) providing interventions outside traditional mental health settings with minimal provider contact; and (2) disseminating exposure-based CBT to community practitioners. By increasing the reach and quality of treatment, Mayo Clinic Anxiety Coach has the potential to improve the clinical and functional outcomes for a large number of children suffering from anxiety disorders.