Abstract
BackgroundIncreased awareness of anxiety in adolescents emphasises the need for effective interventions. Internet-based cognitive behavioural therapy (ICBT) could be a resource-effective and evidence-based treatment option, but little is known about how to optimize ICBT or which factors boost outcomes. Recently, the role of knowledge in psychotherapy has received increased focus. Further, chat-sessions are of interest when trying to optimize ICBT for youths. This study aimed to evaluate the role of learning support and chat-sessions during ICBT for adolescent anxiety, using a factorial design.MethodA total of 120 adolescents were randomised to one of four treatment groups, in a 2x2 design with two factors: with or without learning support and/or chat-sessions.ResultsAnxiety and depressive symptoms were reduced (Beck Anxiety Inventory- BAI; Cohen’s d =0.72; Beck Depression Inventory- BDI; d =0.97). There was a main effect of learning support on BAI (d =0.38), and learning support increased knowledge gain (d =0.42). There were no main effects or interactions related to the chat-sessions. Treatment effects were maintained at 6-months, but the added effect of learning support had by then vanished.ConclusionICBT can be an effective alternative when treating adolescents with anxiety. Learning support could be of importance to enhance short-term treatment effects, and should be investigated further.
Highlights
Adolescence has been described as a time of vulnerability to anxiety (1), and in those affected, the risk of relapse and development of psychiatric problems later on in life is high (2– 4)
Meta-analyses show moderate between group effect sizes against no treatment control conditions (6, 9) in trials on Internetbased cognitive behavioral therapy (ICBT) for adolescents, suggesting that treatment is better than no treatment which is in line with the literature on adults (10)
The group that received Standard ICBT with Chat-sessions had received more previous treatments than participants in other groups [c2(3) = 7.92, p =.05], and in the group that received ICBT with Learning support and Chatsessions the prevalence of Attention deficit hyperactivity disorder (ADHD) was higher compared to other groups [c2(6) = 14.03, p =.03]
Summary
Adolescence has been described as a time of vulnerability to anxiety (1), and in those affected, the risk of relapse and development of psychiatric problems later on in life is high (2– 4). Internetbased cognitive behavioral therapy (ICBT) is an evidence-based and often cost-effective form of treatment. Since youth anxiety is associated with youth depression, a transdiagnostic approach with an aim to treat both conditions with the same treatment manual is of interest. Transdiagnostic ICBT shows medium to large effect sizes for both anxiety and depression in adults (11), but has been less studied in adolescents. Understanding which active treatment components positively affect outcome may enhance our understanding of how and why treatment works and potentially support the development of more effective interventions (9, 12). Internet-based cognitive behavioural therapy (ICBT) could be a resource-effective and evidence-based treatment option, but little is known about how to optimize ICBT or which factors boost outcomes. This study aimed to evaluate the role of learning support and chat-sessions during ICBT for adolescent anxiety, using a factorial design
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