Comparison of Stepped Care Delivery Against a Single, Empirically Validated Cognitive-Behavioral Therapy Program for Youth With Anxiety: A Randomized Clinical Trial
Open accessAbstract
Objective Stepped care is embraced as an ideal model of service delivery but is minimally evaluated. The aim of this study was to evaluate the efficacy of cognitive-behavioral therapy (CBT) for child anxiety delivered via a stepped-care framework compared against a single, empirically validated program.Method A total of 281 youth with anxiety disorders (6-17 years of age) were randomly allocated to receive either empirically validated treatment or stepped care involving the following: (1) low intensity; (2) standard CBT; and (3) individually tailored treatment. Therapist qualifications increased at each step.Results Interventions did not differ significantly on any outcome measures. Total therapist time per child was significantly shorter to deliver stepped care (774 minutes) compared with best practice (897 minutes). Within stepped care, the first 2 steps returned the strongest treatment gains.Conclusion Stepped care and a single empirically validated program for youth with anxiety produced similar efficacy, but stepped care required slightly less therapist time. Restricting stepped care to only steps 1 and 2 would have led to considerable time saving with modest loss in efficacy. Clinical trial registration information-A Randomised Controlled Trial of Standard Care Versus Stepped Care for Children and Adolescents With Anxiety Disorders; http://anzctr.org.au/; ACTRN12612000351819.
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Existing stepped care interventions for childhood anxiety involved substantially more sessions compared to Step by Step.
“Existing stepped care interventions for childhood anxiety involved substantially more sessions compared to Step by Step.”
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 [37]
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 [37]
The stepped care approach by Rapee et al. involved up to 22 sessions in addition to phone sessions with parents.
“the stepped care approach by Rapee et al. [37] involved up to 22 sessions in addition to phone sessions with parents”
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 [37]
Stepped-care and brief treatment adaptations of a transdiagnostic treatment like the UP allow for more efficient targeting of symptoms and may reduce financial and pragmatic barriers to care.
“Stepped-care and brief treatment adaptations of a transdiagnostic treatment like the UP allow for more efficient targeting of symptoms and may reduce financial and pragmatic barriers to care (Rapee et al., 2017, Salloum et al., 2016).”
From Brief Transdiagnostic Intervention for Parents With Emotional Disorder Symptoms During the COVID-19 Pandemic: A Case Example (2021) · cites this paper as Rapee et al., 2017
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Self-citationParent-Centered Interventions for Childhood Anxiety
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Transdiagnostic, Stepped-Care Approach to Treating Youth Mental Health Concerns
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Dialectical behavior therapy stepped care for hospitals
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Simply the Best: Honoring the Outgoing Editorial Team
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Populationsbasierte Interventionen im Bereich Public Mental Health
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- Authors
- Rapee, R. M., Lyneham, H. J., Wuthrich, V., Chatterton, M. L., Hudson, J. L., Kangas, M., & Mihalopoulos, C.
- Affiliations
- Macquarie University (AU)
- Deakin University (AU)
- Corresponding author
- Rapee, Ronald M.
- ORCID
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 2017-10
- Volume
- 56
- Issue
- 10
- Pages
- 841-848
- ISSN
- 0890-8567 (ISSN-L)
- OpenAlex
- W2744326447
- Cited by
- 81
- References
- 30
- Citations by year
- 2026: 7 · 2025: 9 · 2024: 10 · 2023: 8 · 2022: 11 · 2021: 11 · 2020: 12 · 2019: 9 · 2018: 4
- FWCI
- 8.91
- Type
- journal article
- Language
- en
- Open access
- green
- figshare.com
- Licence
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Figshare (submittedVersion, cc-by)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- stepped care, cognitive behavioral therapy, childhood anxiety, youth anxiety disorders, treatment efficacy, tailored treatment, low-intensity intervention, service delivery models
- MeSH terms
- Adolescent, Anxiety, Anxiety Disorders, Child, Delivery of Health Care, Female, Humans, Male, Cognitive Behavioral Therapy, Treatment Outcome
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