A Randomized Trial of an App-Enhanced Group Cognitive Behavioral Therapy for Adolescents With Mood or Psychotic Spectrum Disorders

Objectives: Evidence-based psychosocial treatments for the early stages of mood or psychotic spectrum disorders are difficult to find in public health settings, and the efficacy of these treatments is limited by inconsistent behavioral skill practice among youth between sessions. Treatments can be made more accessible and efficacious when delivered through a group format that makes use of mobile applications to remind users to practice skills. Method: We conducted a 9-week, randomized controlled trial of the unified protocol (UP) for cognitive behavioral therapy (CBT) delivered via telehealth in a group format, comparing an app-enhanced version of the treatment (AppUP) to standard UP for adolescents with mood and psychotic spectrum conditions. The app was designed to help participants review session content, practice treatment skills, and log their psychiatric symptoms. Study assessors evaluated adolescents for psychiatric symptom severity and psychosocial functioning prior to treatment, at posttreatment, and 3 months posttreatment. Results: Sixty adolescents (M-age = 15.0, SD = 1.3) initiated the trial (30 were randomly assigned to each condition) with 49 retained at posttreatment (9 weeks) and 48 retained at 3 months posttreatment. Adolescents in AppUP showed greater improvements in psychosocial functioning over the 5-month study compared with those in standard UP. AppUP was also associated with greater reductions in depression severity among youth with more self-reported skill practice compared to those in standard UP. Conclusions: This study supports the benefits of transdiagnostic CBT for youth with mood and psychotic symptoms. An adjunctive app appears to improve psychosocial functioning and mood among these youth, especially among those who practice behavioral skills regularly.