Effects of a Multifamily App-Enhanced Cognitive-Behavioral Therapy Delivered via Telehealth for Parents of Adolescents With Mood or Psychotic Spectrum Disorders

Abstract

Parents of youth with mood or psychotic disorders are affected by and also impact the course of their offspring’s psychiatric illness(es). Few studies have examined the effects of family psychotherapy on parents’ mental health in this population. This study involved a multifamily group cognitive-behavioral therapy (CBT) for adolescents with mood or psychotic spectrum disorders and their parents, and tested whether a mobile application (app) could increase therapeutic engagement and skill practice. In a secondary analysis of a randomized controlled trial, we examined whether provision of an adjunctive app was associated with increases in parents' engagement in treatment skill practices and improvements in their emotional and parenting stress. Sixty adolescents and their primary parents were randomized into group cohorts to receive either an app-enhanced group delivery of the CBT unified protocol (AppUP) or the standard delivery of the group UP without an app, both delivered via telehealth. Families were followed over the 9-week treatment and 3 months posttreatment (21 weeks total). Unexpectedly, parents in AppUP reported fewer skill practices than parents in the standard UP. There were no differences between treatment conditions in parents’ psychological distress. In a within-group examination of the full sample (i.e., both treatment conditions), parents with higher psychological distress upon entry to the study showed greater decreases in their distress over the 21-week trial than those with lower distress at entry. These improvements in distress levels were positively associated with parents’ treatment skill practice and improvements in family functioning. Greater parental engagement in skill practice across both treatment conditions was also associated with improvements in adolescents’ psychiatric functioning. Among adolescents with mood or psychotic spectrum disorders, parental engagement in group CBT may contribute to reductions in parents' distress and improvements in the mental health of offspring.