Category: Treatment - CBT
We developed a novel smartphone application, SmartCAT (Smartphone-Enhanced Child Anxiety Treatment), that provides daily opportunities for practicing CBT skills between sessions. SmartCAT includes a set of interactive modules that target specific skills addressed in CBT. Thought Buster and Thought Swapper, modules in which patients identify negative thoughts and develop coping thoughts, target cognitive reframing. Challenger, a customizable module, facilitates home exposures and targets approach vs. avoidance. A fourth module, Body Map, focuses on improving participants’ emotion identification. A Skills Coach module targets the integration and utilization of all skills.
We collected data on total module usage for 28 youth (ages 9-14; 14 females) with generalized, separation, and/or social anxiety disorder who were enrolled in an open trial testing feasibility, acceptability, and target engagement for brief (8 session) CBT combined with SmartCAT. The Responses to Stress Questionnaire (RSQ; Connor-Smith et al., 2000) was used to measure the utilization of relevant coping skills in response to daily stressors at pre- and post-treatment. Paired t-tests revealed significant reductions from pre- to post-treatment in Involuntary Engagement (rumination, intrusive thoughts, physiological arousal; t(1,27) = 4.72, p < 0.001), Involuntary Disengagement (cognitive interference, involuntary avoidance, emotional numbing; t(1,27) = 4.04, p < 0.001), and Disengagement Coping (denial, avoidance; t(1,27) = 3.41, p = .002).
Next we examined how frequency of use of each module was associated with improvement in these skills, assessed via difference scores (scores at pre-treatment minus post-treatment). We found evidence that use of several modules was related to improvement in skills targeted by those modules. Specifically, we found that total use of Thought Swapper and Skills Coach correlated with greater reductions in Involuntary Engagement (Thought Swapper: r = .431, p = .022; Skills Coach: at trend, r = .371, p = .052). We also found that total use of Thought Buster and Body Map correlated with greater reductions in Involuntary Disengagement (Thought Buster: at trend, r = .361, p = .059; Body Map: r = .447, p = .017). Finally, we found that total use of Challenger correlated with greater reductions in Disengagement Coping (r = .502, p = .006). These findings provide evidence that children and adolescents who used the SmartCAT modules more often improved in relevant CBT skills, suggesting that SmartCAT reasonably supplements CBT alone in this population.