Large-Scale Dissemination of Internet-Based Cognitive Behavioral Therapy for Youth Anxiety: Feasibility and Acceptability Study

Abstract

BackgroundInternet-based cognitive behavioral therapy (iCBT) for child and adolescent anxiety has demonstrated efficacy in randomized controlled trials, but it has not yet been examined when disseminated as a public health intervention. If effective, iCBT programs could be a promising first-step, low-intensity intervention that can be easily accessed by young people.ObjectiveThe objective of our study was to examine the feasibility and acceptability of a publicly available online, self-help iCBT program (BRAVE Self-Help) through exploration of program adherence, satisfaction, and changes in anxiety.MethodsThis study was an open trial involving the analysis of data collected from 4425 children and adolescents aged 7-17 years who presented with elevated anxiety at registration (baseline) for the iCBT program that was delivered through an open-access portal with no professional support. We assessed the program satisfaction via a satisfaction scale and measured adherence via the number of completed sessions. In addition, anxiety severity was assessed via scores on the Children’s Anxiety Scale, 8-item (CAS-8) at four time points: baseline, Session 4, Session 7, and Session 10.ResultsParticipants reported moderate satisfaction with the program and 30% completed three or more sessions. Statistically significant reductions in anxiety were evident across all time points for both children and adolescents. For users who completed six or more sessions, there was an average 4-point improvement in CAS-8 scores (Cohen d=0.87, children; Cohen d=0.81, adolescents), indicating a moderate to large effect size. Among participants who completed nine sessions, 57.7% (94/163) achieved recovery into nonelevated levels of anxiety and 54.6% (89/163) achieved statistically reliable reductions in anxiety.ConclusionsParticipant feedback was positive, and the program was acceptable to most young people. Furthermore, significant and meaningful reductions in anxiety symptoms were achieved by many children and adolescents participating in this completely open-access and self-directed iCBT program. Our results suggest that online self-help CBT may offer a feasible and acceptable first step for service delivery to children and adolescents with anxiety.

Social support as a predictor of treatment adherence and response in an open-access, self-help, internet-delivered cognitive behavior therapy program for child and adolescent anxiety

“…The BRAVE Self-Help program has been described in detail previously (March et al, 2018), as has the therapist-assisted version (March et al, 2009; Spence et al, 2008). The program consists of 10 interactive, Web-based CBT sessions developed for the treatment of specific phobia, generalized anxiety disorder, separation anxiety disorder and social anxiety disorder.…”

“…In a recent study, March et al (2018) reported on the outcome of 4425 anxious young people who enrolled in an open-access, ICBT intervention. Results showed that young people who completed at least three treatment sessions tended to show significant reductions in anxiety symptoms.…”

“…Results showed that young people who completed at least three treatment sessions tended to show significant reductions in anxiety symptoms. For those participants who completed the majority of the program, 57% achieved recovery into the non-anxious range on the 8-item Children's Anxiety Scale (CAS-8: Spence et al, 2014), and 54% achieved statistically reliable reductions in anxiety symptoms (March et al, 2018). However, the study also indicated that only 30% of anxious youth who enrolled in the program with no therapist support completed three or more sessions, whereas previous studies in which ICBT was supplemented with therapist support have reported much higher levels of program adherence (March et al, 2009; Spence et al, 2011; Vigerland et al, 2016).…”

An Internet-Based Cognitive Behavioral Program for Adolescents With Anxiety: Pilot Randomized Controlled Trial

“…A total of four randomized controlled trials (RCTs) provide evidence of the treatment effects of ICBT for adolescents with anxiety disorders [ 11 - 14 ]; two other studies with adolescent populations have been recently published, but their focus was on establishing feasibility [ 15 , 16 ]. The 9-session program developed by Tillfors et al [ 13 ], which represents the earliest published RCT of ICBT, targeted social fears (namely public speaking) among high school students who met diagnostic criteria for social anxiety disorder.…”

Using stepped-care approaches within internet-based interventions for youth anxiety: Three case studies

“…To date, ICBT or e-Mental Health interventions generally, have not been routinely adopted into healthcare services for children and young people (Wozney et al, 2018), nor are there formalised approaches to such dissemination (Hill et al, 2018). Preliminary support for routine implementation has been reported by Jolstedt et al (2018) and March et al (2018), though very different approaches were utilised. Jolstedt et al (2018) distributed a therapist-supported ICBT program to twenty anxious children and their parents via outpatient clinics in Sweden.…”