Technology Enhanced Family Treatment

Bipolar Disorder Clinical Trial

Official title:

Technology-Enhanced Family-Focused Treatment for Adolescents at High Risk for Mood Disorders

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03913013
• Other study ID #: IRB#18-000906
• Secondary ID: R34MH117200
• Status: Completed
• Phase: Phase 1/Phase 2
• Start date: November 15, 2018
• Est. completion date: October 20, 2021

Study information

• Verified date: October 2022
• Source: University of California, Los Angeles
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The investigators propose to enhance the scalability of family-focused therapy (FFT), a 12-session evidence-based therapy for youth at high risk for mood disorders, through augmentation with a novel mobile phone application called MyCoachConnect (MCC). In adolescents with mood instability who have a parent with bipolar or major depressive disorder, clinicians in community clinics will conduct FFT sessions (consisting of psychoeducation and family skills training) supplemented by weekly MCC "real time" assessments of moods and family relationships; based on results of these assessments and the family's progress in treatment, clinicians will then push personalized informational and coaching alerts regarding the practice of communication and problem-solving skills. The investigators hypothesize that the augmented version of FFT (FFT-MCC) will be more effective than FFT without coaching/informational alerts in altering treatment targets and in stabilizing youths' mood symptoms and quality of life.

Description:

The investigative group has shown in several randomized trials that family-focused therapy (FFT) for symptomatic youth at high-risk for bipolar disorder - consisting of psychoeducation and family communication and problem solving skills training - is an effective adjunct to pharmacotherapy in hastening symptomatic recovery. However, between 50%-60% of high-risk youth still have residual mood symptoms and functional impairment after 18 weeks of FFT. In prior studies, two constructs have emerged as predictors of lack of response to treatment: mood instability in the child and expressed emotion (EE) in parents (i.e., frequent critical comments or hostility). In adolescents (ages 12-18) with a parent with bipolar disorder or major depressive disorder, the investigators hypothesize that augmenting FFT with frequent and targeted interventions in the home setting through a Smartphone app (MyCoachConnect, or MCC) will (a) have a greater and more rapid impact than standard FFT on the targeted mechanisms of mood instability in adolescents and EE in parents, and (b) as a result, enhance symptom resolution and functioning in adolescents. To be eligible, adolescents must score high on parent-rated measures of mood instability, and have at least one parent who is high-EE by speech sample coding criteria. The MCC app will record weekly open speech samples from parents and children and daily and weekly mood ratings from adolescents. The app assessments will be fed back to the FFT clinician, who will use this information to "push" recommendations for mood regulation, communication, and problem-solving strategies (linked to the FFT modules) for parents and youth. In year 1, the investigators will conduct an open trial (n=25) to determine (a) the feasibility and acceptability of FFT with mobile coaching (FFT-MCC), as given by clinicians in community settings, and (b) associations between online/speech feature proxies of the targets (mood instability and EE as measured weekly by MCC) and standard measures of the targets. In years 2 and 3 the investigators will conduct a 60-case randomized clinical trial in which families are assigned to FFT with MCC skills coaching or FFT with MCC assessments only, with no skills coaching. The primary hypotheses are that FFT-MCC will be acceptable to parents, adolescents and clinicians, and more effective than FFT without MCC coaching in engaging the targets of mood instability and EE and promoting improvements in adolescents' mood symptoms and quality of life over 27 weeks. The study will facilitate the translation of a technological augmentation to an evidence-based family intervention, with the goal of increasing treatment access among families with mood disorders.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 65
• Est. completion date: October 20, 2021
• Est. primary completion date: October 20, 2021
• Accepts healthy volunteers: No
• Gender: All
• Age group: 13 Years to 19 Years

Eligibility

Inclusion Criteria:

• English speaking and has access to smart-phones, a tablet, or computer
• Age 13-19 years old
• One parent with diagnosis of bipolar disorder type I, bipolar disorder type II, or
• major depressive disorder.
• At least one parent is rated high in perceived criticism of the child.
• Child shows evidence of mood instability
• Child is not currently in individual therapy.

Exclusion Criteria:

• Over 6 on the Autism Spectrum Disorder screener
• a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition manic episode of bipolar I disorder has occurred in the past 2 weeks
• history of persistent psychotic symptoms that have not remitted when mood states remit.
• intelligence quotient below 70 from school records
• Any significant and persistent substance or alcohol abuse in the prior 3 months
• Previously received a full course (i.e., 10-12 sessions) of FFT
• Current, active sexual abuse, physical abuse, or domestic violence.

Related Conditions & MeSH terms

• Bipolar Disorder
• Disease
• Major Depression
• Mood Disorders

Intervention

Behavioral:
• Family-Focused Treatment with MCC App
12 sessions of family-focused therapy plus use of a mobile app that enhances the skill training taught in the sessions.

Locations

Country	Name	City	State
United States	UCLA Child and Adolescent Mood Disorders Program, UCLA School of Medicine	Los Angeles	California

Sponsors (2)

Lead Sponsor	Collaborator
University of California, Los Angeles	National Institute of Mental Health (NIMH)

Country where clinical trial is conducted

United States, 

References & Publications (1)

Miklowitz DJ, Chung B. Family-Focused Therapy for Bipolar Disorder: Reflections on 30 Years of Research. Fam Process. 2016 Sep;55(3):483-99. doi: 10.1111/famp.12237. Epub 2016 Jul 29. Review. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Average mood symptom scores over 27 weeks on the Adolescent Longitudinal Interval Follow-up Evaluation	Adolescent Longitudinal Interval Followup Evaluation (ALIFE), a measure of mood disorder fluctuation based on an interview with the child and at least one parent. ALIFE Psychiatric Status Ratings range from 1 (asymptomatic) to 6 (extremely symptomatic) and are made weekly for depression, mania, hypomania, delusions, hallucinations, and suicidal ideation. Scores of 5 or higher are considered full syndromal (e.g., for major depressive disorder or manic episode) and scores of 1-2 are considered remitted.	27 weeks, with ratings done by an independent evaluator each week
Secondary	Mood instability, as rated by parents and children using the Children's Affective Lability Scale (CALS) and the Parent-Rated General Behavior Inventory	Changes in mood states from sadness to irritability to elation or other moods. The CALS is a 20-item survey completed by parents. In this study, a score of 20 will be used to indicate high mood instability. Parent ratings on the Parent General Behavior Inventory, 10 item Mania scale will be made at study entry, with a score of 6 or higher indicating mood instability.	Mean Children's Affective Lability scores computed at baseline and every 9 weeks for 27 weeks
Secondary	Expressed emotion in parents from the Five Minute Speech Sample	Parental expressed emotion is a measure of critical comments, hostility, or emotional overinvolvement. The primary instrument in this study is the Five Minute Speech Sample, which is scored by an independent evaluator on number of criticisms, presence/absence of hostility, or overinvolvement. One critical comment or a rating of present for hostility or overinvolvement means the parent is rated high in expressed emotion, and low expressed emotion otherwise. Expressed emotion is also measured by the Perceived Criticism Scale, a 1-10 measure of how often the child thinks each parent criticizes him/her. A rating of '5' is considered high and indicative of a high EE parent/offspring relationship.	Ratings of high vs. low expressed emotion in each parent obtained at baseline and every 9 weeks for 27 weeks.
Secondary	Free speech samples coded using the Linguistic Inquiry Word Count system.	Callers are asked to speak for 3-5 minutes about how they are doing and whether anything has gone well or whether they have had difficulties. The samples will be transcribed and coded via the Linguistic Inquiry Word Count. The goal is to measure whether mood instability and expressed emotion can be captured from weekly free speech call-ins by parents or youth.	weekly call-ins, with linguistic counts of negative or positive words tabulated each week for 27 weeks.

External Links

•   UCLA Child and Adolescent Mood Disorders program