(PS9-85) Evaluating the Impact of a Mobile-enhanced Group Cognitive Behavioral Therapy on Emotional Regulation and Behavioral Health Indices among Adolescents with Mood and Psychotic Disorders

Mobile applications offer a promising methodology to augment treatment for mental health conditions by increasing access to treatment materials and bridging treatment sessions. Our research team developed a mobile application (app) in an effort to enhance a group cognitive behavioral therapy (CBT) based on the Unified Protocol for Adolescents (i.e., AppUP), for adolescents with mood and psychotic disorders. The app provided psychoeducation, mood tracking, and CBT skills practice. In a randomized trial of AppUP compared to group CBT without a mobile application, primary study results showed greater psychosocial improvements and reductions in depressive symptoms among AppUP participants. This current study is a secondary analysis of the randomized trial for adolescents with mood and psychotic disorders. The current study examined changes in emotional regulation (Difficulties in Emotion Regulation Scale; DERS) and behavioral health indices (sleep, physical activity, self-reported stress). Participants (N = 48; 23 female, 16 male, 9 “other”) aged 13-18 (M = 15.0, SD = 1.3) were followed across the nine-week treatment plus three months post-treatment. A linear mixed model (LMM) was used to analyze (1) overall changes in behavioral indices and emotional regulation over the course of treatment and their relationship over time, (2) differences in these changes between the app-enhanced and no app conditions, and (3) the moderating effects of demographic factors (age, gender, race/ethnicity). Given prior research on health disparities among diverse populations, we examined race and ethnicity as moderating variables, anticipating that group treatment would offer enhanced psychosocial support for adolescents from diverse backgrounds. Sleep and stress improved across the trial (ps < .01 and .05, respectively), though physical activity did not change. There were also significant improvements in emotional regulation (p < .001). Over the 5-month trial, improvements in sleep and stress were associated with greater improvements in emotion regulation scores (ps < .01 and .001, respectively). Across all outcomes, we did not find significant differences between the app and no app groups in treatment effects, though there were changes over time. Sleep, physical activity, and emotional regulation outcomes were moderated by gender and race. Minority races (i.e., Black and “Other” race participants) showed worse sleep than White teens. “Other” gender teens reported less stress than cisgendered participants. Finally, Asian/Asian American teens had a different trajectory of DERS change than White teens. These findings suggest that a group-based CBT can be helpful in improving emotion regulation and behavioral health indices among adolescents with mood and psychotic disorders, although there was no evidence that the app-enhanced treatment augments these effects. The differing outcomes based on gender and racial identity indicate that demographic differences that may influence treatment responsiveness and require further consideration in future research.