# A mixed methods evaluation of a pilot open trial of a mentor-guided digital intervention for youth anxiety

## TL;DR

A pilot study tested a digital anxiety intervention for teens with mentor support, showing reduced anxiety and positive feedback, though results are limited by small sample size.

## Contribution

This study explores the feasibility and acceptability of a mentor-guided digital intervention for youth anxiety using a mixed methods approach.

## Key findings

- Large effect sizes were observed for changes in anxiety symptoms among youth.
- Acceptability of the intervention was rated positively by both mentors and youth.
- Feasibility benchmarks were met for mentors but not for youth.

## Abstract

Digital mental health interventions (DMHIs), such as cognitive bias modification for interpretations (CBM-I), offer promise for increasing access to anxiety treatment among underserved adolescents, but data regarding their efficacy are mixed. Paraprofessionals and other caring adults in youth’s lives, such as non-parental adult mentors, may be able to support the use of DMHIs and increase teen engagement. The present mixed methods evaluation of a pilot open trial tested the feasibility, acceptability, and preliminary efficacy of implementing MindTrails Teen (an app-based, youth-adapted version of the web-based MindTrails CBM-I intervention) within mentor/mentee dyads. Thirty participants (composed of 15 dyads) participated in remote data collection for 5 weeks. A subset of participants (n = 7 mentors; n = 7 mentees) also provided qualitative feedback. Intervention outcomes (change in anxiety symptoms, and positive and negative interpretation bias), feasibility, and acceptability were assessed via a mix of qualitative interviews, quantitative change in questionnaire scores, and program completion and fidelity metrics. Outcomes were compared to pre-registered benchmarks. Large effect sizes were observed for changes in anxiety among youth. Small to medium effects were observed for change in positive interpretation bias, and no change was found for negative interpretation bias. Intervention outcomes should be considered with caution given very low internal consistency of the interpretation bias measure and the lack of a control comparison group. Acceptability of the intervention was rated positively by mentors and youth. Feasibility benchmarks were met for mentors but not for youth. Qualitative feedback indicated mentors perceived the app as helpful to their mentees, found that it either improved or did not affect their relationship, but also identified implementation challenges. Youth overall perceived the app as helpful but identified barriers to engagement.

Youth anxiety is a serious public health concern, and digital mental health interventions (DMHIs) may provide low-cost, easy-to-access support. However, it can be challenging to reach youth with these interventions, and even more challenging to keep them engaged. Mentors, such as those in Big Brothers Big Sisters or related organizations, may be able to increase youth’s use of such interventions and provide support and accountability. Following a 5-week pilot study of the cognitive-bias modification app MindTrails Teen, guided by mentors, youth reported being less anxious and feeling closer to their mentors. These outcomes should be considered in light of the small sample size and the absence of a control group. Youth and mentors reported that they overall liked the app and found the delivery style acceptable. Further research should test MindTrails Teen in a large comparative trial and more reliably test its impact on cognitive markers of anxiety.