Examining the Usage, User Experience, and Perceived Impact of an Internet-Based Cognitive Behavioral Therapy Program for Adolescents With Anxiety: Randomized Controlled Trial (Preprint)
Authors: Radomski Ashley D , Bagnell Alexa , Curtis Sarah , Hartling Lisa , Newton Amanda S 
Published: August 2019

BACKGROUND

Internet-based cognitive behavioral therapy (iCBT) increases treatment access for adolescents with anxiety; however, completion rates of iCBT programs are typically low. Understanding adolescents’ experiences with iCBT, what program features and changes in anxiety (minimal clinically important difference [MCID]) are important to them, may help explain and improve iCBT program use and impact.

OBJECTIVE

Within a randomized controlled trial comparing a six-session iCBT program for adolescent anxiety, <i>Being Real, Easing Anxiety: Tools Helping Electronically</i> (<i>Breathe</i>), with anxiety-based resource webpages, we aimed to (1) describe intervention use among adolescents allocated to <i>Breathe</i> or webpages and those who completed postintervention assessments (<i>Breathe</i> or webpage respondents); (2) describe and compare user experiences between groups; and (3) calculate an MCID for anxiety and explore relationships between iCBT use, experiences, and treatment response among <i>Breathe</i> respondents.

METHODS

Enrolled adolescents with self-reported anxiety, aged 13 to 19 years, were randomly allocated to <i>Breathe</i> or webpages. Self-reported demographics and anxiety symptoms (Multidimensional Anxiety Scale for Children—2nd edition [MASC-2]) were collected preintervention. Automatically-captured <i>Breathe</i> or webpage use and self-reported symptoms and experiences (User Experience Questionnaire for Internet-based Interventions) were collected postintervention. <i>Breathe</i> respondents also reported their perceived change in anxiety (Global Rating of Change Scale [GRCS]) following program use. Descriptive statistics summarized usage and experience outcomes, and independent samples <i>t</i> tests and correlations examined relationships between them. The MCID was calculated using the mean MASC-2 change score among <i>Breathe</i> respondents reporting somewhat better anxiety on the GRCS.

RESULTS

Adolescents were mostly female (382/536, 71.3%), aged 16.6 years (SD 1.7), with very elevated anxiety (mean 92.2, SD 18.1). Intervention use was low for adolescents allocated to <i>Breathe</i> (mean 2.2 sessions, SD 2.3; n=258) or webpages (mean 2.1 visits, SD 2.7; n=278), but was higher for <i>Breathe</i> (median 6.0, range 1-6; 81/258) and webpage respondents (median 2.0, range 1-9; 148/278). Total user experience was significantly more positive for <i>Breathe</i> than webpage respondents (<i>P</i>&lt;.001). <i>Breathe</i> respondents reported program design and delivery factors that may have challenged (eg, time constraints and program support) or facilitated (eg, demonstration videos, self-management activities) program use. The MCID was a mean MASC-2 change score of 13.8 (SD 18.1). Using the MCID, a positive treatment response was generated for 43% (35/81) of <i>Breathe</i> respondents. Treatment response was not correlated with respondents’ experiences or use of <i>Breathe</i> (<i>P</i>=.32 to <i>P</i>=.88).

CONCLUSIONS

Respondents reported positive experiences and changes in their anxiety with <i>Breathe</i>; however, their reports were not correlated with program use. <i>Breathe</i> respondents identified program design and delivery factors that help explain their experiences and use of iCBT and inform program improvements. Future studies can apply our measures to compare user experiences between internet-based interventions, interpret treatment outcomes and improve treatment decision making for adolescents with anxiety.

CLINICALTRIAL

ClinicalTrials.gov NCT02970734; https://clinicaltrials.gov/ct2/show/NCT02970734