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

项目摘要 本提案响应RFA-MH-17-612，“治疗的初步有效性试验， 预防和服务干预（R34）。我们已经在几个随机试验中证明， 以家庭为中心的治疗（FFT）的症状青年在高风险的双相情感障碍-包括 的心理教育和家庭沟通和解决问题的技能培训-是一个有效的 辅助药物治疗，加速症状的恢复。然而，50%-60%的 高危青少年在18周后仍有残余情绪症状和功能障碍， FFT。在我们之前的研究中，有两个结构已经成为缺乏反应的预测因子， 治疗：儿童的情绪不稳定和父母的情绪表达（EE）（即，频繁 批评或敌意）。在父母一方患有双相情感障碍的青少年（12-18岁）中， 重度抑郁症，我们假设，增加FFT与频繁和有针对性的， 通过智能手机应用程序（MyCoachConnect或MCC）在家庭环境中进行干预将（a） 比标准FFT对情绪的目标机制产生更大、更快的影响 和（B）作为结果，增强症状消退， 在青少年中发挥作用。要符合条件，青少年必须在父母评价的指标上得分高 情绪不稳定，至少有一个父母是高EE的语音样本编码标准。 MCC应用程序将每周记录来自父母和孩子的公开演讲样本， 青少年的每周情绪评估应用程序评估将反馈给FFT临床医生， 他们将使用这些信息来“推动”情绪调节，沟通， 和解决问题的战略（与FFT模块相关联）。第一年，我们 将进行一项开放试验（n=25），以确定（a）FFT的可行性和可接受性， 移动的指导（FFT-MCC），由社区环境中的临床医生提供，以及（B）协会 在目标的在线/语音特征代理（如测量的情绪不稳定性和EE）之间， 每周由管理协调委员会提供）和目标的标准措施。在第二年和第三年，我们将进行75- 家庭被分配到FFT和MCC技能辅导的RCT病例，FFT和MCC 仅评估，无辅导;或仅FFT，无MCC。我们假设FFT-MCC 将被父母、青少年和临床医生接受，并且比没有 MCC辅导或FFT-仅用于参与情绪不稳定和EE的目标，并促进 青少年的情绪症状和生活质量的改善超过27周。这项研究将 促进将技术强化转化为基于证据的家庭干预， 目的是增加有情绪障碍的家庭获得治疗的机会。

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.