Evaluating the efficacy of a mentor-guided digital intervention for anxious youth: a randomized type I hybrid implementation-effectiveness trial

About This Grant

PROJECT SUMMARY/ABSTRACT There is an urgent need to address the high rates of anxiety among adolescents. While traditional therapeutic interventions have demonstrated reasonably good efficacy, they are often difficult for teens to access due to financial, cultural, and geographic barriers. Given the high rates of smartphone ownership among U.S. teens, digital technology may improve youth access to treatment. Over the past decade, many efficacious digital interventions have been developed, but the positive results do not often generalize beyond laboratory studies due to low rates of engagement in real-world settings. Thus, in addition to developing effective interventions, it is also critical to identify feasible and acceptable implementation strategies. Human support is one option for increasing adherence to digital interventions, but therapist availability is limited. With the right training, paraprofessionals such as teachers or religious leaders, may be able to support the delivery of mental health interventions to youth without requiring specific mental health expertise. One especially promising group of paraprofessionals is formal mentors. The structure and established relationships inherent to formal mentoring programs may overcome commonly reported barriers to youth engagement with other guided DMHIs, such as lack of trust in unknown providers/coaches. The widespread presence of formal mentoring programs across the U.S. also makes this a uniquely scalable framework with the option of flexible, program-specific implementation. A significant strength of this approach is its use of existing resources and systems, rather than attempting to create new and potentially burdensome workflows. The primary aim of the proposed study is to test the efficacy of a mentor-guided digital cognitive bias modification for interpretations (CBM-I) app for anxious youth aged 13-17 when implemented through mentoring programs. To do this, the applicant will work alongside sponsors Teachman and Deutsch to conduct a hybrid type I implementation/effectiveness randomized controlled trial testing a mentor-guided version of a youth-adapted CBM-I app (“MindTrails Teen”) against a mentoring-as-usual active comparison condition. CBM-I is well studied as an anxiety intervention and has been adapted successfully to a digital format. The proposed intervention, MindTrails Teen, performed well in a small open pilot trial in which 9/10 youth experienced reductions in anxiety. Preliminary feasibility and acceptability of the mentorship delivery model were established during the open pilot trial, but challenges with enrollment suggested a need to co-design implementation pathways in close collaboration with mentorship partner programs. In addition to the co-design plans, the secondary aims of this research proposal are to: 1) verify the feasibility and acceptability of a mentorship program delivery model for digital mental health interventions (DMHIs), and 2) examine if participating in the program can improve mentor/mentee relationship quality.