Funding Source
NIGMS, 1P20GM156710-01-8302
Project Period
8/8/25-5/31/30
Principal Investigator
Elizabeth Murnane, PhD (Thayer School of Engineering, Dartmouth College)
Other Project Staff
Sarah Lord, PhD; Lisa A. Marsch, PhD; Susan Murphy, PhD (Harvard)
Project Summary
It is imperative to improve the inclusive reach of effective anxiety treatments for adolescents. Anxiety disorders are among the most common psychiatric conditions in adolescents (13-17 years old) yet they are largely undertreated, particularly in rural areas. Behavioral interventions are efficacious in reducing anxiety symptoms while providing individuals with a toolkit of knowledge, skills, and techniques that empower self-care. As anxiety disorders involve an interconnected relationship between psychological and physiological processes, behavioral interventions that combine mind-body practices are coming to be seen as a particularly powerful therapeutic approach. Such treatments can include physical exercises, expressive movements, and other activities that emphasize interoception, autonomic reactivity, and the role of the body in processing and regulating emotions. However, research is needed to tailor these somatic approaches to an adolescent population, more rigorously evaluate their efficacy in diverse settings, and enhance their accessibility in traditionally underserved communities. Further, it is key to ensure such interventions are responsive and available in real-time, considering in-the-moment support is a critical aspect of quality anxiety care.
Mobile technology is a promising platform for delivering personalized behavioral interventions at-scale and on- demand, including through emerging designs like just-in-time adaptive intervention (JITAI). This project aims to better understand barriers and enablers to the implementation of efficacious anxiety treatments for rural adolescents, particularly to inform intervention strategies that leverage increasingly accessible and cost- effective digital technology to deliver somatic therapies and JITAI support. It will use a community-engaged research approach that partners with adolescents and other stakeholders, including close collaboration with local schools to facilitate the tool’s adoption. The intervention will be adapted from an existing mobile health platform developed by the research team for mobility promotion in adults, which has shown feasibility in motivating exercise behavior change over time as well as increasing adherence to at-home physical therapy routines. Specific extensions will involve the integration of somatic therapies, JITAI support, and generally adjusting the tool’s content and interfaces to the context of reducing anxiety in rural adolescents. Following qualitative needfinding to understand anxiety experiences and care needs as well as participatory design and usability testing of the adapted intervention, the tool will be pilot tested with a sample of 50 rural adolescents experiencing elevated anxiety levels who will be randomly assigned to the JITAI tool or a waitlist control, for a treatment period of 3 months. Objectives include demonstrating the acceptability, feasibility, and preliminary efficacy of this intervention approach, while systematically devising a strategy in collaboration with community partners to facilitate its sustained uptake.
Public Health Relevance
The proposed project has significant public health importance. Anxiety disorders are becoming increasingly widespread and undertreated, particularly among youth living in rural areas. In addition to the negative effects on emotional well-being and physical health, anxiety significantly interferes with a young person’s academic performance, interpersonal interactions and social skill development, and overall quality of life. If not treated, anxiety in childhood can become chronic and increase the risk of serious mental illness in adulthood including depression and substance misuse. In turn, these challenges place unsustainable burdens on families, the economy, and the healthcare system. The current proposal will fill a critical knowledge gap regarding barriers and enablers to implementing mental health treatments in rural settings and increase understanding about whether technology-based, just-in-time adaptive interventions can be an acceptable, feasible, and effective approach to improving the reach of treatments to reduce anxiety symptoms in rural youth.