(PS3-D91) Effectiveness of Technology-enabled Modular CBT on Treating Anxiety Symptoms Among Community Adolescents

While cognitive-behavior therapy (CBT) has been well-established as efficacious in treating adolescent anxiety in controlled treatment trials, less is known about how robust treatment effects can be in real-world applications. Tech-enabled CBT (teletherapy and with mobile-app enhanced skills practice) may be especially well-suited to community samples of self-referred youth. Furthermore, recent research suggests that modular CBT may allow for greater treatment adherence and personalization of care. This study examines treatment outcomes for a modular CBT intervention delivered via teletherapy and enhanced by mobile-app skills practice, among a self-referred community sample of adolescents with clinically significant anxiety symptoms presenting for outpatient treatment at Joon Care.  

Participants were 159 community adolescents ages 13-18 years (M=15.42; 73.0% female-identified, 19.5% male-identified, and 7.6% nonbinary/other-identified) self-referred for outpatient therapy for anxiety. All participants were at or above the “moderate” cutoff of 10 on the Generalized Anxiety Disorder Scale (GAD-7) at intake (M=14.12, SD = 2.92). Participants enrolled in a 16-week treatment program involving weekly teletherapy, customized skills practice on a mobile app, and weekly symptom assessment. Therapists customized a CBT treatment plan for each individual drawing from a modular set of CBT interventions (sessions) including psychoeducation, affect recognition, identifying and modifying anxiety-related cognitions, relaxation and coping skills, and exposure. Sessions completed and session order is chosen by the clinician to reflect the needs of the adolescent. All session content includes paired skills practice which can be assigned to the adolescent’s mobile app.

Results indicated that modular CBT delivered in a tech-enabled manner is acceptable and effective among adolescents in a real-world setting. Treatment adherence was good, with adolescents attending on average 78% of scheduled sessions across the 16 weeks (range = 18.7% to 100%) and completing 61.01% of assigned skills on the mobile app. Adolescents showed significant reduction in anxiety symptoms, with mean GAD-7 score after 16 weeks of treatment declining from 14.11 to 9.22, representing on average 34.66% symptom reduction. Paired-samples t-test was significant (t=8.33, p< .001).  “Recovery” was defined as being below the clinical cutoff of 10 for 50% or more of the last 4 weeks of treatment. Based on this definition, 74.7% of adolescents were no longer in the clinical range on the GAD-7 after treatment.