Guided internet-based cognitive behavioral therapy for adolescent anxiety: Predictors of treatment response

Abstract

BackgroundGuided internet-based cognitive behavioral therapy (ICBT) has been found efficacious in reducing symptoms of anxiety in adolescents with anxiety disorders, but not all respond equally well. ObjectiveIn this study, we explored candidate predictors of ICBT treatment response within the frame of a randomized controlled trial. MethodsSixty-five adolescents (13–17 years) with anxiety disorders according to DSM-IV received 14 weeks of therapist-guided ICBT. Outcome was evaluated as improvement (continuous change score) from pre-treatment to 12-month follow-up according to self-reported anxiety symptoms and clinician-rated diagnostic severity. Clinical predictors included baseline self- and parent-reported anxiety symptom levels, baseline clinician-rated severity of primary diagnosis, summed baseline clinician-rated severity of all anxiety diagnoses, baseline self-rated depressive symptoms, age of onset, and primary diagnosis of social phobia. Demographic predictors included age, gender and computer comfortability. Therapy process-related predictors included number of completed modules and therapist phone calls, summed duration of therapist phone calls, degree of parent support, and therapeutic alliance. Multi-level models were used to test the prediction effects over time. ResultsHigher levels of self- and clinician-rated baseline anxiety and self-rated depressive symptoms, female gender, and higher levels of computer comfortability were associated with increased treatment response. None of the proposed therapy process-related predictors significantly predicted treatment response. ConclusionThe present findings indicate that ICBT may be an acceptable choice of treatment for youths, even those with relative high levels of anxiety and depressive symptoms.