Technology-Enhanced Family-Focused Treatment for Adolescents at High Risk for Mood Disorders

项目总结 该提案响应了RFA-MH-17-612《治疗试验有效性试验》， 预防和服务干预(R34)。“我们已经在几个随机试验中表明 针对双相情感障碍高危症状青少年的家庭重点治疗(FFT)--包括 心理教育、家庭沟通和解决问题的技能培训-是一种有效的 作为药物治疗的辅助手段，加速症状恢复。然而，50%-60%的 高危青少年在服药18周后仍有残余情绪症状和功能障碍 快速傅立叶变换。在我们之前的研究中，出现了两个结构作为缺乏反应的预测因素 治疗：儿童情绪不稳定和父母情绪表达(EE)(即频繁 批评性评论或敌意)。父母患有双相情感障碍的青少年(12-18岁)或 严重的抑郁障碍，我们假设通过频繁和有针对性的增加FFT 通过智能手机应用程序(MyCoachConnect或MCC)对家庭环境进行干预将(A) 对情绪定向机制的影响比标准的FFT更大、更快 青少年中的不稳定和父母中的EE，以及(B)因此，加强症状的解决和 在青少年中发挥作用。要获得资格，青少年必须在父母评价的指标上获得高分 情绪不稳定，并且至少有一个父母按照语音样本编码标准是高EE的。 MCC应用程序将记录每周一次来自父母和孩子的开放演讲样本，以及每日和 来自青少年的每周情绪评估。APP评估将反馈给FFT临床医生， 世卫组织将使用这些信息来“推送”情绪调节、沟通、 以及针对家长和青少年的问题解决策略(与快速傅立叶变换模块相关联)。在第一年，我们 将进行公开试验(n=25)，以确定(A)FFT的可行性和可接受性 移动辅导(FFT-MCC)，由临床医生在社区环境中提供，以及(B)协会 在目标的在线/语音特征代理之间(测量的情绪不稳定和EE 每周MCC)和目标的标准衡量标准。在第二年和第三年，我们将进行75- 案例RCT中，家庭被分配到FFT和MCC技能指导，FFT和MCC 仅限评估，不带指导；或仅限FFT，不带MCC。我们假设FFT-MCC 将被家长、青少年和临床医生接受，并且比没有FFT的情况下更有效 MCC指导或FFT--仅限于与情绪不稳定和EE的目标接触，并促进 在超过27周的时间里，青少年的情绪症状和生活质量有所改善。这项研究将 促进将技术增强转化为基于证据的家庭干预， 目标是增加情绪障碍家庭的治疗机会。

PROJECT SUMMARY This proposal responds to RFA-MH-17-612, “Pilot Effectiveness Trials for Treatment, Preventive and Services Interventions (R34).” We have shown in several randomized trials that family-focused therapy (FFT) for symptomatic youth at high-risk for bipolar disorder - consisting of psychoeducation and family communication and problem solving skills training - is an effective adjunct to pharmacotherapy in hastening symptomatic recovery. However, between 50%-60% of high-risk youth still have residual mood symptoms and functional impairment after 18 weeks of FFT. In our prior studies, two constructs have emerged as predictors of lack of response to treatment: mood instability in the child and expressed emotion (EE) in parents (i.e., frequent critical comments or hostility). In adolescents (ages 12-18) with a parent with bipolar disorder or major depressive disorder, we hypothesize that augmenting FFT with frequent and targeted interventions in the home setting through a Smartphone app (MyCoachConnect, or MCC) will (a) have a greater and more rapid impact than standard FFT on the targeted mechanisms of mood instability in adolescents and EE in parents, and (b) as a result, enhance symptom resolution and functioning in adolescents. To be eligible, adolescents must score high on parent-rated measures of mood instability, and have at least one parent who is high-EE by speech sample coding criteria. The MCC app will record weekly open speech samples from parents and children and daily and weekly mood ratings from adolescents. The app assessments will be fed back to the FFT clinician, who will use this information to “push” recommendations for mood regulation, communication, and problem-solving strategies (linked to the FFT modules) for parents and youth. In year 1, we will conduct an open trial (n=25) to determine (a) the feasibility and acceptability of FFT with mobile coaching (FFT-MCC), as given by clinicians in community settings, and (b) associations between online/speech feature proxies of the targets (mood instability and EE as measured weekly by MCC) and standard measures of the targets. In years 2 and 3 we will conduct a 75- case RCT in which families are assigned to FFT with MCC skills coaching, FFT with MCC assessments only, with no coaching; or FFT Only, without MCC. We hypothesize that FFT-MCC will be acceptable to parents, adolescents and clinicians, and more effective than FFT without MCC coaching or FFT-Only in engaging the targets of mood instability and EE and promoting improvements in adolescents' mood symptoms and quality of life over 27 weeks. The study will facilitate the translation of a technological augmentation to an evidence-based family intervention, with the goal of increasing treatment access among families with mood disorders.