PMID- 32022692 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200928 IS - 2368-7959 (Print) IS - 2368-7959 (Electronic) IS - 2368-7959 (Linking) VI - 7 IP - 2 DP - 2020 Feb 7 TI - Examining the Usage, User Experience, and Perceived Impact of an Internet-Based Cognitive Behavioral Therapy Program for Adolescents With Anxiety: Randomized Controlled Trial. PG - e15795 LID - 10.2196/15795 [doi] LID - e15795 AB - 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, Being Real, Easing Anxiety: Tools Helping Electronically (Breathe), with anxiety-based resource webpages, we aimed to (1) describe intervention use among adolescents allocated to Breathe or webpages and those who completed postintervention assessments (Breathe 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 Breathe respondents. METHODS: Enrolled adolescents with self-reported anxiety, aged 13 to 19 years, were randomly allocated to Breathe or webpages. Self-reported demographics and anxiety symptoms (Multidimensional Anxiety Scale for Children-2nd edition [MASC-2]) were collected preintervention. Automatically-captured Breathe or webpage use and self-reported symptoms and experiences (User Experience Questionnaire for Internet-based Interventions) were collected postintervention. Breathe 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 t tests and correlations examined relationships between them. The MCID was calculated using the mean MASC-2 change score among Breathe 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 Breathe (mean 2.2 sessions, SD 2.3; n=258) or webpages (mean 2.1 visits, SD 2.7; n=278), but was higher for Breathe (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 Breathe than webpage respondents (P<.001). Breathe 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 Breathe respondents. Treatment response was not correlated with respondents' experiences or use of Breathe (P=.32 to P=.88). CONCLUSIONS: Respondents reported positive experiences and changes in their anxiety with Breathe; however, their reports were not correlated with program use. Breathe 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. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02970734 https://clinicaltrials.gov/ct2/show/NCT02970734. CI - (c)Ashley D Radomski, Alexa Bagnell, Sarah Curtis, Lisa Hartling, Amanda S Newton. Originally published in JMIR Mental Health (http://mental.jmir.org), 07.02.2020. FAU - Radomski, Ashley D AU - Radomski AD AUID- ORCID: 0000-0003-1491-3516 AD - Department of Pediatrics, University of Alberta, Edmonton, AB, Canada. FAU - Bagnell, Alexa AU - Bagnell A AUID- ORCID: 0000-0002-1484-9676 AD - Department of Psychiatry, Dalhousie University, Halifax, NS, Canada. AD - Department of Psychiatry, Izaak Walton Killam Health Centre, Halifax, NS, Canada. FAU - Curtis, Sarah AU - Curtis S AUID- ORCID: 0000-0003-4996-7784 AD - Department of Pediatrics, University of Alberta, Edmonton, AB, Canada. FAU - Hartling, Lisa AU - Hartling L AUID- ORCID: 0000-0001-8341-3991 AD - Department of Pediatrics, University of Alberta, Edmonton, AB, Canada. FAU - Newton, Amanda S AU - Newton AS AUID- ORCID: 0000-0003-3020-674X AD - Department of Pediatrics, University of Alberta, Edmonton, AB, Canada. LA - eng SI - ClinicalTrials.gov/NCT02970734 PT - Journal Article DEP - 20200207 PL - Canada TA - JMIR Ment Health JT - JMIR mental health JID - 101658926 PMC - PMC7055748 OTO - NOTNLM OT - adolescents OT - anxiety OT - clinical effectiveness OT - cognitive behavioral therapy OT - computer-assisted therapy OT - internet OT - minimal clinically important difference OT - satisfaction OT - treatment adherence COIS- Conflicts of Interest: None declared. EDAT- 2020/02/06 06:00 MHDA- 2020/02/06 06:01 PMCR- 2020/02/05 CRDT- 2020/02/06 06:00 PHST- 2019/08/07 00:00 [received] PHST- 2019/12/16 00:00 [accepted] PHST- 2019/12/02 00:00 [revised] PHST- 2020/02/06 06:00 [entrez] PHST- 2020/02/06 06:00 [pubmed] PHST- 2020/02/06 06:01 [medline] PHST- 2020/02/05 00:00 [pmc-release] AID - v7i2e15795 [pii] AID - 10.2196/15795 [doi] PST - epublish SO - JMIR Ment Health. 2020 Feb 7;7(2):e15795. doi: 10.2196/15795.