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Internet-delivered cognitive behavioural therapy for children with anxiety disorders: A randomised controlled trial
Open accessAbstract
BACKGROUND: Cognitive behaviour therapy (CBT) has been shown to be an effective treatment for anxiety disorders in children, but few affected seek or receive treatment. Internet-delivered CBT (ICBT) could be a way to increase the availability of empirically supported treatments. AIMS: A randomised controlled trial was conducted to evaluate ICBT for children with anxiety disorders. METHOD: Families (N = 93) with a child aged 8-12 years with a principal diagnosis of generalised anxiety disorder, panic disorder, separation anxiety, social phobia or specific phobia were recruited through media advertisement. Participants were randomised to 10 weeks of ICBT with therapist support, or to a waitlist control condition. The primary outcome measure was the Clinician Severity Rating (CSR) and secondary measures included child- and parent-reported anxiety. Assessments were made at pre-treatment, post-treatment and at three-month follow-up. RESULTS: At post-treatment, there were significant reductions on CSR in the treatment group, with a large between-group effect size (Cohen's d = 1.66). Twenty per cent of children in the treatment group no longer met criteria for their principal diagnosis at post-treatment and at follow-up this number had increased to 50%. Parent-reported child anxiety was significantly lower in the treatment group than in the waitlist group at post-treatment, with a small between-group effect size (Cohen's d = 0.45). There were no significant differences between the groups regarding child-ratings of anxiety at post-treatment. Improvements were maintained at three-month follow-up, although this should be interpreted cautiously due to missing data. CONCLUSIONS: Within the limitations of this study, results suggest that ICBT with therapist support for children with anxiety disorders can reduce clinician- and parent-rated anxiety symptoms. TRIAL REGISTRATION: Clinicaltrials.gov: NCT01533402.
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“Similarly, Internet-delivered CBT has shown treatment effects comparable to those of face-to-face CBT for pediatric anxiety disorders [27].”
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 [27]
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“According to a previous study using three kinds of rating scales (doctor-rated, parent-rated and child-rated) to measure anxiety in the same children, the doctor-rated scale produced the least similar results among the three kinds of rating scales, while the parent-rated scale showed smaller differences than the doctor-rated scale, and the self-rated scale showed no differences [34].”
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“Moderate between-group treatment effects for child and adolescent self-rated anxiety symptoms on SCAS-C has previously been shown [84] but from an overall perspective on the literature, these self-ratings tend to fluctuate from small and/or non-significant [46, 48, 83] to large and highly significant [44].”
BackgroundDevelopment of the Spence Children’s Anxiety Scale - Short Version (SCAS-S)
Ahlen, J., Vigerland, S., & Ghaderi, A. (2018) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-017-9637-3 · Cited by 69
Self-citationDyadic Psychosocial eHealth Interventions: Systematic Scoping Review
Shaffer, K. M., Tigershtrom, A., Badr, H., Benvengo, S., Hernandez, M., & Ritterband, L. M. (2019) · Journal of Medical Internet Research · doi:10.2196/15509 · Cited by 63
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“Three scheduled telephone calls plus additional telephone calls if needed (to increase motivation or problem solve) Anxiety; 8- 12 years Vigerland et al (2016) [63] and Vigerland et al (2017) [64] Possibly promising The 3 primary outcomes were: parent-reported time management, parent-reported…”
BackgroundInfluentialAssessing anxiety disorders in children and adolescents
Spence, S. H. (2017) · Child and Adolescent Mental Health · doi:10.1111/camh.12251 · Cited by 67
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“, 2004), and it has been widely used with children of the age range considered here (e.g., Hudson et al., 2014; Vigerland et al., 2016).”
MethodRadomski, A. D., Wozney, L., McGrath, P., Huguet, A., Hartling, L., Dyson, M. P., Bennett, K., & Newton, A. S. (2019) · Journal of Medical Internet Research · doi:10.2196/11128 · Cited by 40
“Through email the therapist provided “written feedback on worksheets” and was available to “answer questions and clarify treatment content, increase motivation and to help solve problems” [83].”
BackgroundWahlund, T., Andersson, E., Jolstedt, M., Perrin, S., Vigerland, S., & Serlachius, E. (2020) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2019.06.002 · Cited by 49
Self-citationWozney, L., McGrath, P. J., Gehring, N. D., Bennett, K., Huguet, A., Hartling, L., Dyson, M. P., Soleimani, A., & Newton, A. S. (2018) · JMIR Mental Health · doi:10.2196/mental.9655 · Cited by 50
“Technology adoption was examined by 10 studies with studies reporting positive (60%) [42-44,47,50,53] and mixed (40%) [45,46,55,79] findings for technology compliance and adherence.”
BackgroundInfluentialShahnavaz, S., Hedman-Lagerlöf, E., Hasselblad, T., Reuterskiöld, L., Kaldo, V., & Dahllöf, G. (2018) · Journal of Medical Internet Research · doi:10.2196/jmir.7803 · Cited by 48
“Others have reported similar results for ICBT in children with specific phobias, with approximately 50% of children at a 3-month follow-up free from a specific-phobia diagnosis [18,20].”
BackgroundResultHill, C., Martin, J. L., Thomson, S., Scott-Ram, N., Penfold, H. A., & Creswell, C. (2017) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.115.180372 · Cited by 48
Internet-assisted cognitive behavioral therapy
Andersson, G., & Carlbring, P. (2017) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2017.08.004 · Cited by 45
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“However, the study also indicated that only 30% of anxious youth who enrolled in the program with no therapist support completed three or more sessions, whereas previous studies in which ICBT was supplemented with therapist support have reported much higher levels of program adherence (March et al., 2009; Spence et al…”
Hill, C., Creswell, C., Vigerland, S., Nauta, M. H., March, S., Donovan, C., Wolters, L., Spence, S. H., Martin, J. L., Wozney, L., et al. (2018) · Internet Interventions · doi:10.1016/j.invent.2018.02.002 · Cited by 44
“First, iCBT programs for children often incorporate parents/caregivers into treatment, with many offering separate parent programs or involving the parent as a coach or support person in the treatment (March et al., 2009; Spence, 2011; Vigerland et al., 2016; Wuthrich et al., 2012).”
Self-citationEilert, N., Wogan, R., Leen, A., & Richards, D. (2022) · JMIR Pediatrics and Parenting · doi:10.2196/33551 · Cited by 43
“68 [21,22]) but more in line with equivalent comparisons against active control groups (Hedges g=0.”
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“It has also been proven effective for other disorders in children and adolescents like anxiety disorders [29] and obsessive compulsive disorder (OCD) [30].”
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“The relevance of the influence of time emerged also from the DARE studies [51,52].”
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“Previous iCBT studies have used clinical severity ratings (ratings have ranged from 0=none to 8=extremely severe) as a proximal indicator of treatment response [27,29,79,81].”
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“…supporting childrenwith CVI using such strategies, there is evidence of the effectiveness of these cognitive-based strategies in children with other developmental disorders, such as ASD and anxiety disorders (Conaughton, Donovan, and March 2017; Perry-Parrish et al. 2016; Vigerland et al. 2016).”
MethodLenhard, F., Mitsell, K., Jolstedt, M., Vigerland, S., Wahlund, T., Nord, M., Bjureberg, J., Sahlin, H., Andrén, P., Aspvall, K., et al. (2019) · Journal of Medical Internet Research · doi:10.2196/13602 · Cited by 31
“More detailed descriptions can be found in the original publications [29-33].”
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“…Halle, 2013; Wainer & Ingersoll, 2013), to those with wait-list controls (e.g., Enebrink, Högström, Forster, & Ghaderi, 2012; Lenhard et al., 2017; Vigerland et al., 2016; Wuthrich et al., 2012), to those with fully-powered randomized control trials that compare the standard evidence-based…”
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“10 studies focused on anxiety disorders [34 – 39, 17 , 40 – 43], six on depression [44 – 48 , 32 ] and”
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Self-citationInternet-Delivered Cognitive Behaviour Therapy
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“Neverthe-less, the existing results are slightly contradictory regarding the precise nature of this association (Spence et al., 2017; Vigerland et al., 2016a, 2016b).”
BackgroundResultInfluentialSakellari, Ε., Notara, V., Lagiou, A., Fatkulina, N., Ivanova, S., Korhonen, J., Velikonja, N. K., Lalova, V., Laaksonen, C., Petrova, G. G., et al. (2021) · Children · doi:10.3390/children8050345 · Cited by 27
“Similarly, internet CBT was associated with significant improvements in anxiety postintervention and at follow-up compared to the waitlist [51].”
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“Several successful iCBT platforms have been developed and validated internationally for children and young people (eg, BIP Anxiety [11,12] and SPARX [13]) and adults (eg, MindSpot Clinic [14], This Way Up [15], and Shuti [16,17]).”
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“Previous studies have shown that digitally delivered parent training, based on cognitive behavioral theory (CBT), has been effective in treating childhood anxiety [11] and disruptive behavior [12-14].”
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“The random-effects model yielded an overall effect size in favor of DMHIs compared to any control condition at the postintervention assessment (Hedges g =0.508, 95% CI 0.308-0.707; Figure 3 [83-86 , 94-111 94-111”
InfluentialSchibbye, R., Hedman‐Lagerlöf, E., Kaldo, V., Dahllöf, G., & Shahnavaz, S. (2023) · Journal of Medical Internet Research · doi:10.2196/42322 · Cited by 16
“ICBT has been found to be effective for children with specific phobias [20,21] and children and adolescents with DP [22].”
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Self-citationDesign of Digital Mental Health Platforms for Family Member Cocompletion: Scoping Review
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“…over the phone or via email) has the potential to be an effective treatment for children in rural areas and could alleviate pressure on trained therapists (Podina, Mogoase, David, Szentagotai, & Dobrean, 2016; Rooksby, Elouafkaoui, Humphris, Clarkson, & Freeman, 2015; Vigerland et al., 2016).”
BackgroundResultCOVID-19, children and anxiety in 2020
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“The present study did not include diagnostic assessments of anxiety and so direct comparisons cannot be made, but the results presented here compare favourably with those reported for other online treatments for child anxiety (Spence et al., 2011; Vigerland et al., 2016), particularly given that the follow-up period i…”
Radomski, A. D., Wozney, L., McGrath, P. J., Huguet, A., Hartling, L., Dyson, M. P., BENNETT, K. J., & Newton, A. S. (2019) · JMIR Mental Health · doi:10.2196/13807 · Cited by 13
“Personalized feedback was used to “reinforce effort and success and provide corrective information if required” [36], to “answer questions and clarify treatment content, increase motivation and to help solve problems” [41], or to “[ensure] adolescents’ understanding of the program elements” [83].”
InfluentialAndrén, P., de la Cruz, L. F., Isomura, K., Lenhard, F., Hall, C. L., Davies, E. B., Murphy, T. L., Hollis, C. P., Sampaio, F., Feldman, I., et al. (2021) · Trials · doi:10.1186/s13063-021-05592-z · Cited by 12
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“Therapists (N = 5) will be Masters Students, psychologists trained in CBT, under supervision.”
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“…et al., 2021; Morgan et al., 2018; Salloum et al., 2018; Vigerland et al., 2017) only reported on follow-up data or predictors of outcomes and were thus each merged with their respective primary study (Jolstedt et al., 2018b; Morgan et al., 2017; Storch et al., 2015; Vigerland et al., 2016b).”
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“…no literature around supporting children with CVI related visual issues using strategies such as mindfulness, there is evidence of the effectiveness of mindfulness in children with other developmental disorders, such as autism and anxiety disorders (Conaughton et al., 2017; Vigerland et al., 2016).”
BackgroundA Meta-Analysis of Common Factors in Child Therapy Interventions
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Metadata
- Authors
- Vigerland, S., Ljótsson, B., Thulin, U., Öst, L.-G., Andersson, G., & Serlachius, E.
- Affiliations
- Karolinska Institutet (SE)
- Stockholm University (SE)
- Linköping University (SE)
- Corresponding author
- Vigerland, Sarah
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 2016-01
- Volume
- 76
- Pages
- 47-56
- ISSN
- 0005-7967 (ISSN-L)
- OpenAlex
- W2175826023
- Cited by
- 136
- References
- 63
- Citations by year
- 2026: 11 · 2025: 17 · 2024: 8 · 2023: 10 · 2022: 11 · 2021: 17 · 2020: 14 · 2019: 16 · 2018: 13 · 2017: 11 · 2016: 8
- FWCI
- 17.26
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Behaviour Research and Therapy (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- KTH Publication Database DiVA (KTH Royal Institute of Technology) (submittedVersion, other-oa)
- Funders
- Stockholm County Council (HNS 9576)
- Stockholm County Council and the Karolinska Institutet (ALF 20110278, 20120070)
- Claes Groschinsky foundation (SF11 147)
- 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, childhood anxiety disorders, generalized anxiety disorder, panic disorder, separation anxiety disorder, social anxiety disorder, specific phobia, therapist support, parent-reported anxiety
- MeSH terms
- Anxiety, Anxiety Disorders, Child, Female, Humans, Male, Psychiatric Status Rating Scales, Therapy, Computer-Assisted, Cognitive Behavioral Therapy, Panic Disorder, Treatment Outcome, Internet
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