"Everyone will laugh at me." "Something is hiding in the dark." "If my mom goes out, she might not come back."
These are thoughts that, for children with anxiety disorders, can interfere with their quality of life. Child anxiety disorders are common, affecting about one to two out of every 10 school-age children.
Researchers from the University of Pittsburgh Schools of Health Sciences -- Jennifer Silk, an expert in child anxiety, and Bambang Parmanto, an expert in telehealth -- have developed a promising new technology to enhance treatment for child anxiety disorders: a mobile health platform called SmartCAT.
SmartCAT stands for smartphone-enhanced child anxiety treatment. The platform connects a smartphone app for patients with a clinician portal, allowing real-time communication between the two.
SmartCAT is intended to augment cognitive behavioral therapy, an effective treatment for child anxiety disorders. Children undergoing conventional therapy typically meet once a week with a mental health professional to learn coping skills, such as how to identify thoughts that make them anxious and replace them with more appropriate thoughts.
"Our idea was that kids need to be working on this more than once a week," Silk said. "And if they could ... practice the skills in their daily life when they're actually experiencing anxiety, we thought that might be able to improve the treatment." Using a smartphone app to complement treatment was a natural choice, the researchers say, given kids' familiarity with technology.
Conventional therapy typically lasts about four months, or 16 sessions. Research has shown that about 60 percent of children who complete treatment no longer have a diagnosis of anxiety disorder. With SmartCAT, the developers hope to increase that percentage and decrease treatment time.
A pilot study of the SmartCAT program involved nine young people ages 9-14 with an anxiety-related diagnosis. Three were given 16-session cognitive behavior therapy; the remaining six were treated with a shortened eight-week course that combined conventional therapy and SmartCAT. Four of the children in the combination program no longer have an anxiety diagnosis. This is similar to the response rate of children who underwent the longer conventional treatment.
The young patients did actively use the app, so although the study is preliminary, it suggests children may get better faster when they use SmartCAT.
The heart of the SmartCAT app is a skills coach. A therapist develops a skills coach plan for each child. When kids are feeling anxious, they press the icon for the skills coach and answer questions about their feelings. The skills coach suggests coping thoughts and problem-solving strategies for the children to use in the moment.
"That's the key, being able to assess right then and there and ask the kids to practice when the symptom happens," Parmanto explained.
This poses a problem for children who experience anxiety in school, however, because most ban the use of cellphones. "We find that kids will often report on things that happened during school when they get home," Silk said. To account for that, the skills coach asks kids to think about how they handled the situation and whether there was a coping strategy they did not try that might have helped.
SmartCAT also allows messaging between the portal and smartphone; therapists can send the kids encouraging messages, and the children can share successes.
"We have a lot of kids who are nervous about going on sleepovers," Silk explained. "Whenever they successfully accomplish that, they like to send a little note to the therapist saying, 'I did it! I had a great time.' " This frequent interaction helps the children stay motivated to practice their skills.
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