Elizabeth McCauley

Suicide is a pervasive public health concern with risk increasing during adolescence. Universal suicide screening for youth ages 12 years and older has been deemed an important component of suicide prevention. However, little is known about how adolescents feel about screening. This study aimed to better understand how adolescents perceive current suicide risk screening practices in primary care (PC). Purposive sampling identified adolescents with histories of suicidal thoughts or behaviors (STB) who saw a doctor in urban, suburban, or rural pediatric PC clinics at least yearly. Twenty 12–18-year-old adolescents completed semi-structured interviews exploring their views of suicide screening in PC. Interviews were recorded, transcribed, and analyzed using thematic analysis. Themes were compared by geographic setting and described across clinics as a whole. Results were similar across settings and highlight five main themes: (1) asking about STB in PC is important and shows providers care, (2) some adolescents expressed discomfort with the language used in suicide risk screeners and how questions about STB are asked, (3) provider-patient interactions and relationships can either facilitate or hinder STB disclosure, (4) mental health stigma makes disclosing STB feel uncomfortable, and (5) adolescents fear how parents/caregivers will react and potential consequences of disclosing STB (e.g., losing autonomy). Participants overwhelmingly reported that asking adolescents about STB in PC is important. However, several challenges were identified that make it difficult for adolescents to answer questions about STB honestly. Participants suggested several areas for improvement to enhance screening practices and improve adolescent disclosure.

Background: Adolescent and young adult cancer survivors face a high burden of psychological late effects, with cancer-related anxiety being a prevalent mental health concern. Despite the significant need for care, more than half of adolescent and young adult cancer survivors, who require psychosocial services, remain untreated. Digital health interventions offer a promising solution to bridge this care gap. Attention bias modification (ABM) is an evidence-based digital intervention for anxiety disorders. This intervention targets automatic and unconscious negative attention biases and retrains attention away from threat and toward neutral or positive stimuli. Recent research has successfully adapted ABM interventions for cancer survivors. However, ABM has not yet been adapted or tested for adolescent and young adult cancer survivors. Objective: This protocol describes a pilot randomized controlled trial designed to evaluate a novel digital anxiety intervention, the Attention Bias in Cancer survivors (ABCs) intervention, for adolescent and young adult cancer survivors. Methods: This is a single-site, 2-arm, pilot randomized controlled trial enrolling 60 cancer survivors aged 15 to 29 years. Participants will be randomized 1:1 to the ABCs intervention or a sham control condition. The ABCs intervention combines an ABM mobile intervention with daily gratitude and savoring SMS text messages (positive psychology prompts to savor positive emotions) over a 4-week period. The sham condition consists of sham ABM (showing the same cancer-related word stimuli as the active intervention condition but without attention retraining) and daily mood monitoring SMS text messages (prompts to report on current mood and stress levels). The primary objectives are to evaluate intervention feasibility (defined as ≥50% enrollment and ≥70% retention) and acceptability (defined by cutoff scores on the Client Satisfaction Questionnaire and System Usability Scale). Secondary exploratory outcomes include patient-reported measures of attention bias, anxiety, fear of recurrence, pain, resilience, and other psychosocial outcomes. Results: This study was funded in August 2023, and study recruitment began in November 2024. We have completed data collection as of February 2026. We anticipate that data analyses will be completed by September 2026. Manuscript preparation and submission are anticipated for December 2026. Conclusions: This pilot trial examines the feasibility and acceptability of a digital positive psychological intervention targeting anxiety in adolescent and young adult cancer survivors. Exploratory outcomes will inform sample size calculations for a future-powered multisite clinical trial. The ABCs intervention may provide scalable and accessible evidence-based psychosocial care and improve health outcomes. Trial Registration: ClinicalTrials.gov NCT06682039; https://clinicaltrials.gov/study/NCT06682039 International Registered Report Identifier (IRRID): DERR1-10.2196/82665

The effectiveness of psychotherapy for suicidal youth remains a public health priority. Dialectical behavior therapy (DBT; Linehan, 1993) has been recognized as a well-established treatment for suicidal youth (Witt et al., 2021). Although promising, little work has explored mechanisms of change in DBT for suicidal youth (Asarnow et al., 2021). This study aimed to examine covariation in rates of change between symptoms and theorized mechanistic variables during a randomized controlled trial of DBT for suicidal youth. The present study was a secondary data analysis of a randomized controlled trial of DBT for 173 suicidal youth (ages 12-18; McCauley et al., 2018). Multilevel modeling was used to examine the association between person-level rates of change for self-harm (suicide attempts and nonsuicidal self-injury), suicidal ideation, DBT skills, emotion dysregulation, and reasons for living. Both treatment groups showed statistically significant covariation between reductions in self-harm and suicidal ideation. Rates of change in self-harm and suicidal ideation decreased with improvement in emotion regulation for both treatments. An increase in endorsed reasons for living significantly covaried with reductions in self-harm and suicidal ideation within the DBT condition only. Study results support the potential value of efforts to reduce suicidal ideation and self-harm through improving emotion regulation and demonstrate common and unique mechanisms of change across treatments for youths at elevated suicide/self-harm risk. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

BACKGROUND Adolescent and young adult cancer survivors face a high burden of psychological late effects, with cancer-related anxiety being a prevalent mental health concern. Despite the significant need for care, more than half of adolescent and young adult cancer survivors, who require psychosocial services, remain untreated. Digital health interventions offer a promising solution to bridge this care gap. Attention bias modification (ABM) is an evidence-based digital intervention for anxiety disorders. This intervention targets automatic and unconscious negative attention biases and retrains attention away from threat and toward neutral or positive stimuli. Recent research has successfully adapted ABM interventions for cancer survivors. However, ABM has not yet been adapted or tested for adolescent and young adult cancer survivors. OBJECTIVE This protocol describes a pilot randomized controlled trial designed to evaluate a novel digital anxiety intervention, the Attention Bias in Cancer survivors (ABCs) intervention, for adolescent and young adult cancer survivors. METHODS This is a single-site, 2-arm, pilot randomized controlled trial enrolling 60 cancer survivors aged 15 to 29 years. Participants will be randomized 1:1 to the ABCs intervention or a sham control condition. The ABCs intervention combines an ABM mobile intervention with daily gratitude and savoring SMS text messages (positive psychology prompts to savor positive emotions) over a 4-week period. The sham condition consists of sham ABM (showing the same cancer-related word stimuli as the active intervention condition but without attention retraining) and daily mood monitoring SMS text messages (prompts to report on current mood and stress levels). The primary objectives are to evaluate intervention feasibility (defined as ≥50% enrollment and ≥70% retention) and acceptability (defined by cutoff scores on the Client Satisfaction Questionnaire and System Usability Scale). Secondary exploratory outcomes include patient-reported measures of attention bias, anxiety, fear of recurrence, pain, resilience, and other psychosocial outcomes. RESULTS This study was funded in August 2023, and study recruitment began in November 2024. We have completed data collection as of February 2026. We anticipate that data analyses will be completed by September 2026. Manuscript preparation and submission are anticipated for December 2026. CONCLUSIONS This pilot trial examines the feasibility and acceptability of a digital positive psychological intervention targeting anxiety in adolescent and young adult cancer survivors. Exploratory outcomes will inform sample size calculations for a future-powered multisite clinical trial. The ABCs intervention may provide scalable and accessible evidence-based psychosocial care and improve health outcomes. CLINICALTRIAL ClinicalTrials.gov NCT06682039; https://clinicaltrials.gov/study/NCT06682039 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/82665

Background: Adolescents and young adults (AYAs) with cancer are at risk of poor psychosocial outcomes. AYAs grew up with the internet and digital technology, and mobile Health (mHealth) psychosocial interventions have the potential to overcome care access barriers. Objective: This pilot randomized controlled trial (RCT) aimed to establish the feasibility, acceptability, and preliminary efficacy of a fully automated mobile app version of the Promoting Resilience in Stress Management intervention (mPRISM). Promoting Resilience in Stress Management is an evidence-based intervention developed in collaboration with AYAs, based on stress and coping theory, resilience theory, and evidence-based coping strategies. We hypothesized that mPRISM would be feasible, acceptable, and appropriate. Methods: This is a parallel, 2-arm, single-site pilot RCT with a waitlist control design. The study will recruit 80 AYAs with cancer from a clinic. Eligible AYAs are aged 12 to 25 years, within 12 months of a new cancer diagnosis, receiving chemotherapy or radiation therapy, speak, read, or write in English, and are cognitively able to participate in study procedures. Recruitment by clinical research coordinators will occur remotely by phone, video, or text. Participants will be randomized to psychosocial usual care (UC) alone or UC plus mPRISM for an 8-week intervention period, and will remain unblinded to study condition. Enrolled participants will complete surveys at baseline before randomization, 8 weeks, and 3-month follow-up. Using a waitlist design, the UC arm will receive mPRISM upon completion of 3-month follow-up surveys. Those in the UC arm will complete 2 additional measurement points at immediate posttreatment and 3 months later. The primary outcomes of interest are feasibility, defined as ≥60% enrollment and ≥70% retention (ie, percentage of participants who completed the study), and “feasibility, acceptability, and appropriateness” as defined by cut-off scores ≥4/5 on 3 brief validated implementation outcome measures (feasibility of implementation measure, acceptability of intervention measure [AIM], intervention appropriateness measure [IAM]). We will apply top-box scoring for the implementation measures. Exploratory outcomes of interest include patient-reported health-related quality of life, resilience, distress, anxiety, depression, pain, and sleep. We will conduct an intention-to-treat analysis to compare the outcomes of the mPRISM arm versus the control arm with covariate-adjusted regression models. We will summarize individual digital usage metrics using descriptive statistics. Results: Since September 2023, we have enrolled 20 participants and recruitment is ongoing. Conclusions: Although our previous work suggests AYAs with cancer are interested in mHealth psychosocial interventions, such interventions have not yet been sufficiently evaluated or implemented among AYA oncology patients. mPRISM may serve as a potential mHealth intervention to fill this gap. In this study, we will test the feasibility, acceptability, and preliminary efficacy of mPRISM. This work will inform future larger-scale RCTs powered for efficacy outcomes. Trial Registration: ClinicalTrials.gov NCT05842902; https://clinicaltrials.gov/study/NCT05842902 International Registered Report Identifier (IRRID): DERR1-10.2196/57950

BACKGROUND Adolescents and young adults (AYAs) with cancer are at risk of poor psychosocial outcomes. AYAs grew up with the internet and digital technology, and mobile Health (mHealth) psychosocial interventions have the potential to overcome care access barriers. OBJECTIVE This pilot randomized controlled trial (RCT) aimed to establish the feasibility, acceptability, and preliminary efficacy of a fully automated mobile app version of the Promoting Resilience in Stress Management intervention (mPRISM). Promoting Resilience in Stress Management is an evidence-based intervention developed in collaboration with AYAs, based on stress and coping theory, resilience theory, and evidence-based coping strategies. We hypothesized that mPRISM would be feasible, acceptable, and appropriate. METHODS This is a parallel, 2-arm, single-site pilot RCT with a waitlist control design. The study will recruit 80 AYAs with cancer from a clinic. Eligible AYAs are aged 12 to 25 years, within 12 months of a new cancer diagnosis, receiving chemotherapy or radiation therapy, speak, read, or write in English, and are cognitively able to participate in study procedures. Recruitment by clinical research coordinators will occur remotely by phone, video, or text. Participants will be randomized to psychosocial usual care (UC) alone or UC plus mPRISM for an 8-week intervention period, and will remain unblinded to study condition. Enrolled participants will complete surveys at baseline before randomization, 8 weeks, and 3-month follow-up. Using a waitlist design, the UC arm will receive mPRISM upon completion of 3-month follow-up surveys. Those in the UC arm will complete 2 additional measurement points at immediate posttreatment and 3 months later. The primary outcomes of interest are feasibility, defined as ≥60% enrollment and ≥70% retention (ie, percentage of participants who completed the study), and “feasibility, acceptability, and appropriateness” as defined by cut-off scores ≥4/5 on 3 brief validated implementation outcome measures (feasibility of implementation measure, acceptability of intervention measure [AIM], intervention appropriateness measure [IAM]). We will apply top-box scoring for the implementation measures. Exploratory outcomes of interest include patient-reported health-related quality of life, resilience, distress, anxiety, depression, pain, and sleep. We will conduct an intention-to-treat analysis to compare the outcomes of the mPRISM arm versus the control arm with covariate-adjusted regression models. We will summarize individual digital usage metrics using descriptive statistics. RESULTS Since September 2023, we have enrolled 20 participants and recruitment is ongoing. CONCLUSIONS Although our previous work suggests AYAs with cancer are interested in mHealth psychosocial interventions, such interventions have not yet been sufficiently evaluated or implemented among AYA oncology patients. mPRISM may serve as a potential mHealth intervention to fill this gap. In this study, we will test the feasibility, acceptability, and preliminary efficacy of mPRISM. This work will inform future larger-scale RCTs powered for efficacy outcomes. CLINICALTRIAL ClinicalTrials.gov NCT05842902; https://clinicaltrials.gov/study/NCT05842902 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/57950