Technology-Assisted Cognitive Behavioral Therapy for Adolescents and Young Adults with Cancer: A Pilot Randomized Controlled Trial

Background/Purpose. Adolescents and young adults (AYAs) diagnosed with cancer face depression throughout their cancer journey. Depression among AYA cancer survivors often leads to poor treatment adherence, impaired quality of life, risky health behaviors, and self-harm behaviors. While evidence-based depression treatments, like cognitive-behavioral therapy (CBT) are available, many AYA cancer survivors do not receive care due to access barriers. While computer-based CBTs (C-CBT) can potentially reduce access barriers, most existing C-CBTs are academically oriented and text-heavy, resulting in low treatment adherence and engagement. This study evaluates the feasibility and efficacy of a novel C-CBT, Mind-Your-Total-Health (MYTH), which intentionally engages patients through an animated retrospective storyline, including a cliffhanger by the end of each session to strengthen user engagement.

Methods. Seventeen AYAs diagnosed with cancer (15-26 years old) were randomly assigned to treatment (MYTH) or control (BeatingtheBlue, BtB), which is a standard commercialized C-CBT program. Baseline and immediately post-treatment assessments were completed using self-reported clinical scores of PHQ-9 and GAD-7. Feasibility was measured by the number of participants who completed at least 6 out of 8 MYTH sessions. Preliminary efficacy was evaluated using (within-group) paired samples t-test, (between-group) independent samples t-test. In addition, we also calculated small-sample-size corrected Hedges’ g for PHQ-9 and GAD-7 score changes, considering the clinical magnitudes of treatment effects of MYTH versus BtB for AYA cancer survivors’ depression and anxiety.

Results. Eight out of ten participants in the MYTH group completed at least six out of eight sessions, suggesting strong feasibility (80% completion rate) among AYAs with cancer. Efficacy outcomes indicated that participants in the MYTH group reported significant pre- and post-treatment reduction in depression, t(9)=5.25, p<0.001, and anxiety, t(9)=5.07, p<0.001. Notably, participants in the MYTH group reported significantly lower post-treatment depression than participants in the BtB group, t(15)=2.40, p<0.05. The between-group difference reflected a significant between-group treatment effect size, d=1.12, p<0.05.

Conclusions and Implications. The MYTH program, an engaging and coach-assisted C-CBT intervention, is not only feasible and acceptable to AYAs with cancer, but also promising in alleviating depression among AYA cancer survivors. The findings of this study offered promising alternatives for health and medical social workers supporting AYAs with cancer with an evidence-supported program. Given the program can be delivered remotely, it also reduces health disparities for AYAs with cancer. Future research needs to include larger sample size and a more diverse patient population.