SmartCAT: Smartphone-enhanced Child Anxiety Treatment

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SmartCAT is a mHealth platform for improving cognitive-behavioral treatments for child anxiety disorders. Anxiety disorders are one of the most commonly-diagnosed childhood mental health problems, affecting 10-20% of school-aged youth. Cognitive-Behavioral Therapy (CBT), which involves teaching children skills for coping with their anxiety and practicing the skills with a therapist, has been recognized as an efficacious treatment, but many children continue to have symptoms of anxiety even after weekly therapy sessions. SmartCAT is designed to improve the treatment efficacy by delivering an engaging intervention for youth to practice CBT skills in their day-to-day life (in vivo). Moreover, SmartCAT provides skills coaching to patients when and where it is most needed, not only during weekly 1-hour office visits. SmartCAT offers several advantages for improving CBT approaches: (1) providing opportunities for repetition to improve learning of CBT skills, (2) facilitating skills practice by reminding patients to complete home-based practice and to apply CBT skills during real-world emotional situations, (3) providing increased communication between therapists and patients, and (4) helping therapists track progress and personalize treatment by focusing on patient-specific skills deficits and strengths.

SmartCAT consists of a smartphone app, a therapist portal, and a secure two-way communication connecting them. The app cues patients to complete a series of questions (skills coach entry) about recent emotional events and their use of CBT skills. Instead of an isolated local app, the app is able to receive treatment cues or audiovisual materials from the clinician portal and send monitoring data to the therapist portal. The therapist is therefore able to review patients’ real-world CBT skill use, monitor adherence, and send encouraging messages.

To keep the youth engaged, youth earn prizes for using the app. They select from a collection of prizes such as small toys or games, accessories, or stickers, each of which can be earned with a specific number of points. Each time a patient completes an entry, the reward bank opens to show how many points they have earned and how many more are needed to obtain the selected reward. The reward bank is reset each time points are “cashed in” for a prize. Therapists can use the portal to manage reward points for each and every patient. Interactive games to further engage the patients are under development.

The smartCAT can be easily integrated with EHR/PHR. Data from the clinician portal can flow to the EHR/PHR and vice versa, and the two-way communication between the app and the portal provide secure exchange between the EHR/PHR and the app.

Results of a pilot project suggest that SmartCAT is capable of supporting CBT, and received positive feedback from both therapists and youth. Patients rated the app as highly usable (M=1.7 on 1-7 scale, with 1=“easy”), used it almost daily (5.36 times per week) and took an average of 3.14 minutes to complete the entries. The app is currently available in Android platform, with an iPhone version under development. Interactive games to engage youth are also being developed.

The app and description of the app are available at: http://www.hari.pitt.edu/RESEARCH/SmartCAT.aspx