DEVELOPMENT AND EVALUATION OF A GAMIFIED M-HEALTH SYSTEM FOR IMPROVING ECOLOGICAL MOMENTARY INTERVENTION (EMI) IN CHILD ANXIETY TREATMENT

Cognitive-Behavioral Therapy (CBT) is an efficacious, short-term treatment for anxiety in children. Although efficacious, many children (40-50%) do not show a significant reduction in symptoms and/or full recovery from primary anxiety diagnoses. Children may fail to improve because they do not fully understand or apply the skills learned in the clinic to their daily life. Homework is routinely assigned in CBT with the goal of generalizing skills beyond the therapy session. Many children however, are likely to struggle with homework completion due to a variety of reasons, including (1) lack of motivation, (2) forgetfulness, and (3) lack of CBT skills understanding. Mobile health (m-Health) gamification provides a potential solution to improving CBT efficacy by delivering more engaging and interactive strategies to facilitate CBT skills practice in everyday life (in vivo). This dissertation describes both the process of redesigning an existing m-Health system entitled Smartphone-enhanced Child Anxiety Treatment (SmartCAT 1.0) and the utilization of the redesigned SmartCAT (SmartCAT 2.0) in brief (8-session) CBT (BCBT) clinical trial. SmartCAT consists of a smartphone app, and a therapist portal. Results from the clinical implementation indicate that the app was frequently used throughout the treatment. On average, anxious children spent 40.43 minutes on the app (SD=55.51) completing 13.93 activities per session (SD=11.23). At the .10 level, the app usage of SmartCAT 2.0 (Median=82.5) was higher than that of SmartCAT 1.0 (Median=39), U=34.00, p<.01, Cohen’s r=.52. The amount of time spent (in minutes) on SmartCAT 2.0 (Median=184.97) was also higher than that observed in SmartCAT 1.0 (Median=106.03), U=64.00, p=.075, Cohen’s r=.31. Post-treatment analysis revealed that remission of anxiety was not associated with app usage patterns, behaviors, patient demographics, and clinical characteristics. On average, the therapist visited the portal twice per week, spending an average of 5.5 minutes per visit, per patient. In conclusion, SmartCAT 2.0 showed good acceptability, usefulness, and engagement among anxious youth receiving BCBT treatment. The therapists rated the portal as both acceptable, and useful when integrated as a part of treatment. Integrating an m-Health gamification system within BCBT for anxious children increases involvement in treatment and may facilitate dissemination of effective procedures