Long-term outcomes of internet-delivered cognitive behaviour therapy for paediatric anxiety disorders: towards a stepped care model of health care delivery
Open accessAbstract
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.
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This study presents the first stepped-care CBT protocol for childhood anxiety developed for use in a primary care setting.
“However, to our knowledge, this study presents the first stepped-care CBT protocol for childhood anxiety developed for use in a primary care setting.”
From Developing a primary care-based cognitive behavioral intervention for anxiety in children through a participatory approach: a qualitative study. (2026) · cites this paper as [39]
The Discussion says this was the first study to adopt a stepped-care approach in a clinical setting for paediatric anxiety, using internet-delivered CBT followed by face-to-face CBT for non-remitters. It does not say the protocol was developed for primary care: the Methodology > Interventions section places the face-to-face treatment at a specialised child and adolescent psychiatry research centre. Primary care centres are mentioned in Methodology > Participants as a source of referrals. (LLM, conf=0.87)
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- Authors
- Jolstedt, M., Vigerland, S., Mataix-Cols, D., Ljótsson, B., Wahlund, T., Nord, M., Högström, J., Öst, L.-G., & Serlachius, E.
- Affiliations
- Region Stockholm (SE)
- Karolinska Institutet (SE)
- Stockholm University (SE)
- Corresponding author
- Jolstedt, Maral
- ORCID
- Venue
- European Child & Adolescent Psychiatry
- Published
- 2020-09-22
- Volume
- 30
- Issue
- 11
- Pages
- 1723-1732
- ISSN
- 1018-8827 (ISSN-L)
- 1435-165X
- PMC
- PMC8558186
- OpenAlex
- W3088420987
- Cited by
- 17
- References
- 29
- Citations by year
- 2026: 7 · 2025: 2 · 2024: 3 · 2023: 1 · 2022: 3 · 2021: 1
- FWCI
- 1.13
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- European Child & Adolescent Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Forskningsrådet om Hälsa, Arbetsliv och Välfärd (Forte 2014-4052)
- Stockholms Läns Landsting (HNSV 14099)
- Karolinska Institute
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- internet-based cognitive behavioral therapy, stepped care, long-term treatment outcomes, remission, children and adolescents, child and adolescent mental health services
- MeSH terms
- Internet-Based Intervention, Anxiety Disorders, Child, Delivery of Health Care, Humans, Cognitive Behavioral Therapy, Treatment Outcome, Models, Organizational
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