Web-based CBT for the Treatment of Selective Mutism: Results from a Pilot Randomized Controlled Trial in Singapore

Abstract

Introduction: Cognitive behavioral therapy (CBT) approaches have shown promise for some children with Selective Mutism (SM), but to date there are limited published randomized controlled trials (RCT) of CBT interventions for SM. We present findings from a pilot RCT of the Meeky Mouse program, a 14-week web-based CBT program for children with SM. Method: A total of 21 children (6-12 years old) with a primary diagnosis of SM from a child psychiatric outpatient clinic were included in this study. They were randomly assigned to either 14 weeks of the Meeky Mouse program (n=10) or to a control condition in which they interacted with the therapist while playing computer games (n=11). Results: No significant group differences were found on anxiety symptoms. The control group showed significant improvements from pre- to post-treatment on total frequency of speech. Children in the Meeky Mouse group showed greater improvements in clinician-rated severity of mental illness and had higher clinician-rated improvement scores relative to those in the control group. Conclusions: Findings from our pilot RCT study suggest that the web-based CBT using anxiety management strategies may be no different from an intervention that involves regular monitoring of child’s engagement in socializing activities for improving SM symptoms. Further study is needed to determine optimal strategies for treating children with SM with the use of web-based applications.