Virtual cognitive behavioural therapy offers lasting benefits to kids with anxiety

The benefits of internet-delivered cognitive behavioural therapy (ICBT) on children with anxiety can persist for at least up to a year after the end of treatment, according to a recent study.

“The current trial is the largest to evaluate the long-term outcomes of ICBT for paediatric anxiety disorders,” the researchers said. “[T]his study is the first to adopt a stepped-care approach in a clinical setting, whereby nonremitters to ICBT were systematically offered manualized face-to-face (F2F) CBT; thus, providing unique insights into the feasibility of implementing this approach in regular healthcare.”

Three months after the 12-week ICBT intervention programme, 73 of the total 123 enrolled children were in remission (R-ICBT) and did not meet the diagnostic criteria for their principal anxiety disorder. The remaining 37 fell short of this definition and were designated as nonremitters, to whom F2F CBT sessions were offered; 19 declined. [Eur Child Adolesc Psychiatry 2020;doi:10.1007/s00787-020-01645-x]

Remitters showed continuous improvement on the Clinician Severity Rating (CSR) score for their principal diagnosis, demonstrating a large effect size from post-treatment to the 3-month follow-up (d, 0.88, 95 percent confidence interval [CI], 0.62–1.15).

Notably, the researchers also documented a smaller but significant improvement persisting until the 12-month follow-up (d, 0.42, 95 percent CI, 0.17–0.68). Comparing the 1-year outcomes to pretreatment status revealed that ICBT had a large and positive overall effect in terms of anxiety (d, 2.42, 95 percent CI, 1.78–3.07).

However, seven children (10.3 percent) who were initially in remission relapsed, eventually meeting the criterial for their principal anxiety disorder by 12 months. Sixty-one patients (89.7 percent) were in remission at 12 months, and 53 (77.9 percent) were free from all anxiety disorders.

“The results clearly showed that treatment gains from ICBT were not only maintained, but even further improved at 12-months follow-up. This was true for clinician-, parent-, and self-rated anxiety symptoms and functional impairment,” the researchers said.

Eighteen patients who were designated as nonremitters accepted the offer for F2F CBT, and all completed the sessions. The researchers pointed out that despite not qualifying for the remission criteria, these patients nevertheless showed significant improvement from pre- to post-ICBT (p=0.001).

These improvements, however, were even more compounded after F2F CBT with a large effect size (d, 1.53, 95 percent CI, 0.55–2.51). When taking the entirety of the intervention, from pretreatment to ICBT and F2F CBT, the researchers saw a very large effect on the CSR at the 12-month follow-up (d, 2.27, 95 percent CI, 1.03–3.50).

“Nonremitters after ICBT who choose to receive additional F2F CBT improved similarly as remitters of ICBT, the largest improvement occurring after F2F CBT. It may be feasible to implement ICBT in regular healthcare adopting a stepped care approach,” the researchers said.