1 - (SYM 32) Is Digital CBT an Affirming and Beneficial Treatment Option for Diverse Adolescents?

Background

Youth from minoritized backgrounds experience high rates of anxiety and depression, but most do not receive evidence-based treatment due to barriers like cost and stigma. Digital mental health (MH) apps are a low-cost alternative; however, most are not used after download and lack outcome data. SilverCloud, a clinician-guided, cognitive behavioral therapy (CBT) app, is associated with reduced internalizing symptoms, but its acceptability and feasibility as an intervention for vulnerable youth has not been evaluated.

Methods

Adolescents from New York City (aged 14-18) with moderate symptoms of depression and/or anxiety were recruited for an open trial of SilverCloud. App usage and symptom data were collected. Participants were interviewed biweekly during their enrollment to collect feedback about the program content, structure, and implementation.

SilverCloud includes seven core modules on key principles of CBT for anxiety and depression, along with six additional modules to address specific concerns (e.g., sleep). Modules take roughly one hour to complete. A clinician oversees each person’s progress and offers feedback and suggestions through weekly asynchronous messages.

Results

Participants (N=20) were mostly female (70%), Black (50%), and 45% Hispanic. Participants showed improvements in symptoms of anxiety and depression; 67% who started with moderate-to-severe depression (PHQ-9 10+) and 60% of those with moderate-to-severe anxiety (GAD-7 10+) improved. With respect to feasibility and acceptability, 65% of participants remained active in the program for the full 8-weeks, and 97% agreed or strongly agreed that the program was interesting, relevant, and helpful. On average, participants  viewed 45 pages of content and spent 104 minutes on the app. Participants identified engagement challenges related to competing priorities and recommended refinements to content clarity, functional design, and interaction with the clinician.

Conclusions

Adolescent from diverse backgrounds with depression and/or anxiety benefitted from SilverCloud and felt the program was relatable and helpful. Exploring patterns of engagement and how app use relates to symptom outcomes is important to enhancing benefits across users.

Implications

SilverCloud, a clinician-guided CBT app, has potential to extend evidence-based MH intervention to more youth; it is scalable and efficacious. To increase equity, work is necessary to develop personalized engagement plans so that all young users get a therapeutic dose.