Expanding access to CBT for childhood anxiety disorders via smart phones

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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.