Abstract
Internet-delivered cognitive behaviour therapy (ICBT) is emerging as a powerful tool to fill the gap between demand and availability of evidence-based treatment for paediatric anxiety disorders. However, it is still unclear how to best implement it in routine clinical care. 123 children (8–12 years) with anxiety disorders underwent a 12-week ICBT programme with limited therapist support. Participants were assessed 3- and 12-month post-ICBT (3MFU and 12MFU, respectively). Non-remitters who still fulfilled diagnostic criteria for their principal anxiety disorder at 3MFU were offered additional manualised “face-to-face” (F2F) CBT. The aim of the study was to emulate a stepped-care model of health care delivery, where the long-term treatment gains of ICBT as well as the potential benefit of proving addition treatment to non-remitters of ICBT were evaluated. Remitters of ICBT (n = 73) continued to improve throughout the study period (pre-ICBT to 12MFU; Cohen’s d = 2.42). At 12MFU, 89% (n = 65) were free from their principal anxiety disorder. Of all the participants classed as non-remitters at 3MFU (n = 37), 48.6% (n = 18) accepted the offer to receive additional F2F CBT. These participants also improved with a large effect from pre-ICBT to 12MFU (Cohen’s d = 2.27), with the largest effect occurring during F2F CBT. At 12MFU, 83% (n = 15) were free from their principal anxiety disorders. The majority of non-remitters declining additional F2F CBT (63.2%; n = 12) did so due to already receiving treatment at their local CAMHS, prior to 3MFU. The effects of ICBT for anxiety disorders are durable at least up to 1 year after the end of treatment. Patients who fail to fully benefit from ICBT improved further with additional F2F sessions at our clinic, suggesting that it may be feasible to implement ICBT within a stepped-care model of health care delivery.
Highlights
Paediatric anxiety disorders are common [1] and often accompanied by a range of related problems if left untreated [2]
Only three trials have investigated whether the treatment gains of Internet-delivered cognitive behaviour therapy (ICBT) for paediatric anxiety disorders were maintained at long-term follow-up [8,9,10]
This study reports the naturalistic 1-year follow-up data from participants in a large randomised controlled trial (RCT) of ICBT for paediatric anxiety disorders [6]
Summary
Paediatric anxiety disorders are common [1] and often accompanied by a range of related problems if left untreated [2]. Only three trials have investigated whether the treatment gains of ICBT for paediatric anxiety disorders were maintained at long-term follow-up [8,9,10]. European Child & Adolescent Psychiatry (2021) 30:1723–1732 studies suggested that treatment gains were maintained but there were indications of further improvement at follow-up. These studies had substantial data loss at follow-up and none recorded additional treatments received during the follow-up period, casting some doubt about the long-term effects of ICBT. Emulating a stepped-care mode of healthcare delivery, participants who required additional treatment at 3-months follow-up (3MFU), were systematically offered face-to-face CBT (F2F CBT) at our clinic. Our specific research questions were: (1) For patients who were in remission at 3MFU, were their treatment gains maintained up to 12 months after treatment completion? (2) For patients classed as non-remitters at 3MFU, was additional F2F CBT associated with improvements in symptoms and functioning?
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