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Online CBT in the treatment of child and adolescent anxiety disorders: issues in the development of brave-online and two case illustrations
Open accessAbstract
Abstract This paper describes the rationale for and development of an online cognitive-behavioural treatment for child and adolescent anxiety (BRAVE–ONLINE). It highlights the challenges involved in adapting a clinic-based intervention for delivery using the internet, with separate sessions for parents and their children (or adolescents). We outline strategies to ensure that young people remain engaged in online therapy, and describe techniques designed to optimize the alliance between clients and the online therapist. Two case studies are presented that illustrate the practical and technical aspects of implementing the intervention, and demonstrate the feasibility of achieving successful outcomes using online delivery of CBT for child and adolescent anxiety. However, firm conclusions regarding the efficacy of this approach cannot be drawn until the results of randomized controlled trials are available. The paper identifies directions for future research.
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“When looking specifically at ICBT with adolescents, studies are sparse (Tillfors et al., 2011; Spence et al., 2008; Spence et al., 2011; Lenhard et al., 2014; Lenhard et al., 2017).”
From Internet-based cognitive behavioral therapy for adolescents with anxiety disorders: A feasibility study (2018) · cites this paper as Spence et al., 2008
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“Challenges related to exposure tasks in ICBT seems though to be a general issue in the literature (see for example Spence et al., 2008) more so than a barrier reserved for the present study.”
From Internet-based cognitive behavioral therapy for adolescents with anxiety disorders: A feasibility study (2018) · cites this paper as Spence et al., 2008
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Cited by
Sorted by citations
A randomized controlled trial of online versus clinic-based CBT for adolescent anxiety.
Spence, S. H., Donovan, C. L., March, S., Gamble, A., Anderson, R. E., Prosser, S., & Kenardy, J. (2011) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0024512 · Cited by 381
March, S., Spence, S. H., & Donovan, C. L. (2009) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsn099 · Cited by 315
“For a more detailed description of the development of the program, see Spence et al. (2008).”
BackgroundRichardson, T., Stallard, P., & Velleman, S. (2010) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-010-0069-9 · Cited by 272
“Abeles et al. (2009) recruited children and adolescents with a primary diagnosis of depression, whilst participants in the studies by Cunningham et al. (2009), March et al. (2009) and Spence et al. (2006, 2008) had a primary diagnosis of an anxiety disorder.”
BackgroundMethodInfluentialUsing technology to deliver mental health services to children and youth: a scoping review.
Boydell, K., Hodgins, M., Pignatiello, A., Teshima, J., Edwards, H. E., & Willis, D. (2014) · Europe PMC (PubMed Central) · Cited by 197
Rooksby, M., Elouafkaoui, P., Humphris, G., Clarkson, J., & Freeman, R. (2015) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2014.11.006 · Cited by 143
Telemental health for children and adolescents
Gloff, N. E., LeNoue, S. R., Novins, D. K., & Myers, K. (2015) · International Review of Psychiatry · doi:10.3109/09540261.2015.1086322 · Cited by 128
“One example is BRAVE-Online, developed for the treatment of anxiety and depression in young people (Spence et al., 2008).”
BackgroundA randomized controlled trial of the cool teens CD-ROM computerized program for adolescent anxiety
Wuthrich, V. M., Rapee, R. M., Cunningham, M. J., Lyneham, H. J., Hudson, J. L., & Schniering, C. A. (2012) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2011.12.002 · Cited by 124
“Our results using Cool Teens mirror the findings from the published case studies for the Cool Teens(33) and BRAVE online anxiety program for teenagers.(30,34) They are also commensurate with the findings from large randomized controlled trials examining the efficacy of computerized interventions for adults with anxiet…”
ResultCBT for adolescents with anxiety: mature yet still developing
Kendall, P. C., & Peterman, J. S. (2015) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2015.14081061 · Cited by 115
Sauter, F. M., Heyne, D. A., & Westenberg, P. M. (2009) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-009-0058-z · Cited by 127
“Another recent CBT for anxious young people is the BRAVE-ONLINE program developed by Spence et al. (2008).”
BackgroundHronis, A., Roberts, L., & Kneebone, I. (2017) · British Journal of Clinical Psychology · doi:10.1111/bjc.12133 · Cited by 113
Anderson, R. E. E., Spence, S. H., Donovan, C. L., March, S., Prosser, S., & Kenardy, J. (2012) · Journal of Medical Internet Research · doi:10.2196/jmir.1848 · Cited by 102
“described in detail elsewhere [4,25], and therefore the following contains only a brief overview.”
BackgroundResultSelf-citationOnline CBT for preschool anxiety disorders: A randomised control trial
Donovan, C. L., & March, S. (2014) · Behaviour Research and Therapy · doi:10.1016/j.brat.2014.05.001 · Cited by 105
Tindall, L., Mikocka‐Walus, A. A., McMillan, D., Wright, B., Hewitt, C. E., & Gascoyne, S. (2017) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/papt.12121 · Cited by 114
“Thus far, much research has focused on the delivery of CBT in this form (e.g., Abeles et al., 2009; Spence, Holmes, March, & Lipp, 2006; Spence et al., 2008; Wright et al., 2014), with computerized CBT (CCBT) representing an alternative form of therapy delivery that can be administered at a lower cost than traditional…”
BackgroundTillfors, M., Andersson, G., Ekselius, L., Furmark, T., Lewenhaupt, S., Karlsson, A., & Carlbring, P. (2011) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2011.555486 · Cited by 101
“We are only aware of one case study using online CBT to treat an adolescent female with SAD (Spence et al., 2008).”
BackgroundPierce, D., Liaw, S.-T., Dobell, J., & Anderson, R. (2010) · International Journal of Mental Health Systems · doi:10.1186/1752-4458-4-10 · Cited by 100
“Significant resources are allocated each year to develop educational material, including online material, designed to combat mental ill health [24,25].”
Self-citationMarch, S., Spence, S. H., Donovan, C. L., & Kenardy, J. A. (2018) · Journal of Medical Internet Research · doi:10.2196/jmir.9211 · Cited by 84
“The BRAVE-ONLINE program for youth anxiety when delivered with minimal therapist assistance has been described elsewhere [10-12,16].”
MethodMendenhall, A. N., & Mount, K. B. (2011) · Families in Society The Journal of Contemporary Social Services · doi:10.1606/1044-3894.4097 · Cited by 86
“Technology-based interventions BrAVE-oNLINE (Spence et al., 2008) Weekly separate parent and child sessions over 10 weeks; 1- and 3-month follow-up sessions Children and adolescents with anxiety disorders reduction in anxiety symptoms, parent and child both reported new skills to manage anxiety”
MethodThe practice of tele-mental health: Ethical, legal, and clinical issues for practitioners.
Barnett, J. E., & Kolmes, K. (2016) · Practice Innovations · doi:10.1037/pri0000014 · Cited by 85
“It has been shown to be helpful in treating individuals, couples, families, and groups for issues such as anxiety disorders to include generalized anxiety disorder, posttraumatic stress disorder, and panic disorder (e.g., Germain, Marchand, Bouchard, Drouin, & Guay, 2009; Spence et al., 2008; Wims, Titov, Andrews, & C…”
BackgroundNo need to worry: the promising future of child anxiety research
Kendall, P. C., Settipani, C. A., & Cummings, C. M. (2012) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2012.632352 · Cited by 82
“Some initial support and feasibility has been demonstrated for the BRAVE for Children program (March, Spence, & Donovan, 2009 ; Spence et al, 2008 ), the Cool Teens program (Cunningham et al, 2007 ; Cunningham et al, 2009 ), and Camp-Cope-A-Lot (CCAL; Kendall & Khanna, 2008a ; Khanna & Kendall, 2010 ).”
BackgroundUtilizing technological innovations to enhance psychotherapy supervision, training, and outcomes.
Barnett, J. E. (2011) · Psychotherapy · doi:10.1037/a0023381 · Cited by 83
Conaughton, R. J., Donovan, C. L., & March, S. (2017) · Journal of Affective Disorders · doi:10.1016/j.jad.2017.04.032 · Cited by 77
“Indeed, non-completion of sessions is problematic for internetprograms and has been noted in all studies conducted on BRAVE-ONLINE to date (March et al., 2009; Spence et al., 2008; Spence et al., 2011).”
BackgroundStjerneklar, S., Hougaard, E., McLellan, L. F., & Thastum, M. (2019) · PLOS ONE · doi:10.1371/journal.pone.0222485 · Cited by 71
Rickwood, D., & Bradford (2012) · Psychology Research and Behavior Management · doi:10.2147/prbm.s23357 · Cited by 62
Sethi, S. (2013) · Australian Psychologist · doi:10.1111/ap.12006 · Cited by 59
Newton, A. S., Bagnell, A. L., Rosychuk, R. J., Duguay, J., Wozney, L., Huguet, A., Henderson, J. L., & Curran, J. (2020) · JMIR mhealth and uhealth · doi:10.2196/18439 · Cited by 57
“Like our study, in other mHealth studies, technology has been regarded as useful, easy, and relevant to CBT practice, but support during use, other commitments, perceived relevance, and difficulty of use can be factors in whether an adolescent uses and continues to use a technology [32,33].”
Cognitive Behavioral Therapy for Childhood Anxiety Disorders: A Review of Recent Advances
Banneyer, K. N., Bonin, L., Price, K., Goodman, W. K., & Storch, E. A. (2018) · Current Psychiatry Reports · doi:10.1007/s11920-018-0924-9 · Cited by 59
Stallard, P., Velleman, S., & Richardson, T. (2010) · Child and Adolescent Mental Health · doi:10.1111/j.1475-3588.2009.00540.x · Cited by 58
Telemental health and Web-based applications in children and adolescents
Siemer, C. P., Fogel, J., & Van Voorhees, B. W. (2011) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2010.08.012 · Cited by 54
Cardy, J. L., Waite, P., Cocks, F., & Creswell, C. (2020) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-020-00324-2 · Cited by 53
Radomski, 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
“Studies found that both parent and child ratings of therapeutic alliance and program use were high [76,81].”
BackgroundInfluentialAutomatic Detection and Classification of Cognitive Distortions in Mental Health Text
Shickel, B., Siegel, S., Heesacker, M., Benton, S. A., & Rashidi, P. (2020) · IEEE International Conference on Bioinformatics and Bioengineering (BIBE) · doi:10.1109/bibe50027.2020.00052 · Cited by 56
Attwood, M., Meadows, S., Stallard, P. N., & Richardson, T. H. (2011) · Child and Adolescent Mental Health · doi:10.1111/j.1475-3588.2011.00627.x · Cited by 45
“:3) have also found promising results (Cunningham et al., 2009; Spence et al., 2008), as has a case series of a cCBT programme called (cid:2) Stressbusters (cid”
BackgroundAdolescents and the Internet: What Mental Health Clinicians Need to Know
Rafla, M., Carson, N. J., & DeJong, S. M. (2014) · Current Psychiatry Reports · doi:10.1007/s11920-014-0472-x · Cited by 45
“Psychotherapies, particularly cognitive-behavioral treatments, are available online, either as “ iCBT ” [70], or as “ Virtual environments, ” avatar-Curr based interactive treatments in which therapist and patient can act out anxiety-ridden scenarios and interventions in the displaced setting of…”
BackgroundSpence, S. H., March, S., & Donovan, C. L. (2019) · Internet Interventions · doi:10.1016/j.invent.2019.100268 · Cited by 47
“, 2018), as has the therapist-assisted version (March et al., 2009; Spence et al., 2008).”
BackgroundHill, 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
“To date, iCBT programs for CYP anxiety disorders have been evaluated in a variety of ways including case reports (e.g., Spence et al., 2008), uncontrolled trials (Nordh et al., 2017; Silfvernagel et al., 2015; Vigerland et al., 2013) and randomized controlled trials (e.g., Donovan and March, 2014;…”
Lenhard, F., Vigerland, S., Engberg, H., Hallberg, A., Thermaenius, H., & Serlachius, E. (2016) · PLOS ONE · doi:10.1371/journal.pone.0164311 · Cited by 37
“For example, intervention formats range from traditional approaches that translate face-to-face CBT into a web-based format [26] to innovative computer game-like solutions [27].”
Stasiak, K., Merry, S., Frampton, C. M., & Moor, S. (2016) · Psychotherapy Research · doi:10.1080/10503307.2016.1244617 · Cited by 37
“BRAVE-ONLINE, a cCBT program, has been shown to be an effective treatment for child and adolescent anxiety by the program developers (March, Spence, & Donovan, 2009; Spence et al., 2008, 2011).”
BackgroundMethodStjerneklar, S., Hougaard, E., Nielsen, A. D., Gaardsvig, M. M., & Thastum, M. (2018) · Internet Interventions · doi:10.1016/j.invent.2018.01.001 · Cited by 36
What steps to take? How to approach concerning anxiety in youth.
Kendall, P. C., Makover, H. B., Swan, A. J., Carper, M. M., Mercado, R., Kagan, E. R., & Crawford, E. A. (2016) · Clinical Psychology Science and Practice · doi:10.1111/cpsp.12156 · Cited by 35
Sundram, F., Hawken, S. J., Stasiak, K., Lucassen, M. F. G., Fleming, T. M., Shepherd, M., Greenwood, A., Osborne, R., & Merry, S. (2017) · JMIR Mental Health · doi:10.2196/mental.5878 · Cited by 32
“BRAVE-ONLINE is a clinician supported anxiety program in which young people receive weekly emails from a clinician designed to give them feedback and encourage their program progression [20].”
BackgroundSalloum, A. (2010) · Professional Psychology Research and Practice · doi:10.1037/a0018330 · Cited by 33
Tozzi, F., Nicolaidou, I. A., Galani, A., & Antoniades, A. (2018) · JMIR Pediatrics and Parenting · doi:10.2196/pediatrics.7248 · Cited by 31
Day, J. J., Freiberg, K., Hayes, A. J., & Homel, R. J. (2019) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-019-00282-4 · Cited by 32
Radomski, A. D., Bagnell, A., Curtis, S., Hartling, L., & Newton, A. S. (2020) · JMIR Mental Health · doi:10.2196/15795 · Cited by 30
“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].”
InfluentialThe Emerging Role of Technology in Cognitive–Behavioral Therapy for Anxious Youth: A Review
Berry, R. R., & Lai, B. S. (2014) · Journal of Rational-Emotive & Cognitive-Behavior Therapy · doi:10.1007/s10942-014-0184-5 · Cited by 32
“Each session takes approximately 60 min to complete (Spence et al. 2008).”
BackgroundComputer-based Treatment Programs for Youth Anxiety: A Systematic Review
Donovan, C. L., & March, S. (2014) · Psychopathology Review · doi:10.5127/pr.033613 · Cited by 25
“…Hoek et al., 2012; Khanna & Kendall, 2010; March et al., 2009; Spence et al., 2011; Spence et al., 2006; Sportel et al., 2013; Stallard et al., 2011; Wuthrich et al., 2012), one (Blocher et al., 2013) was an uncontrolled trial and two (Cunningham et al., 2009; Spence et al., 2008) were case series.”
Self-citationMoor, S., Williman, J., Drummond, S., Fulton, C., Mayes, W., Ward, N., Dovenberg, E., Whitaker, C., & Stasiak, K. (2019) · Internet Interventions · doi:10.1016/j.invent.2019.100249 · Cited by 26
Esbjørn, B. H., Normann, N., & Reinholdt‐Dunne, M. L. (2015) · Journal of Contemporary Psychotherapy · doi:10.1007/s10879-015-9294-3 · Cited by 28
“However, downward extensions of adult treatment programs must be adjusted to the specific needs of children (Spence et al. 2008), as they lack the social, linguistic and cognitive sophistication that unmodified treatment techniques require (Reinecke et al. 2002).”
BackgroundOn the Value of Nonremovable Reminders for Behavior Modification
Koritzky, G., & Yechiam, E. (2011) · Behavior Modification · doi:10.1177/0145445511414869 · Cited by 28
Raffagnato, A., Iannattone, S., Tascini, B., Venchiarutti, M., Broggio, A., Zanato, S., Traverso, A., Mascoli, C., Manganiello, A., Miscioscia, M., et al. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18189880 · Cited by 27
“The closure of schools, the strong limitations of social interactions, and the increasing of time spent together, also due to parents’ remote working, brought the family structure to a greater importance [71] for the mental well-being of children, at a time when the fallout in mental health may also afflict the adult…”
BackgroundTreating anxiety disorders in children and adolescents with epilepsy: What do we know?
Jones, J. E. (2014) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2014.06.021 · Cited by 21
“BRAVE-ONLINE [51–53] is designed for children experiencing separation anxiety, social phobia, specific phobia, and generalized anxiety disorders.”
BackgroundHearn, C. S., Donovan, C. L., Spence, S. H., & March, S. (2018) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2017.11.005 · Cited by 21
March, S., Donovan, C. L., Baldwin, S., Ford, M., & Spence, S. H. (2019) · Internet Interventions · doi:10.1016/j.invent.2019.100281 · Cited by 23
“In this study, using a methodology previously utilised by the authors (Spence et al., 2008; Cobham et al., 2012), we present three case studies of young people participating in BRAVE Stepped-Care (see Section 2.”
MethodNewton, A. S., March, S., Gehring, N. D., Rowe, A., & Radomski, A. D. (2021) · Journal of Medical Internet Research · doi:10.2196/25012 · Cited by 19
“For practical and feasibility reasons, we recruited adolescent participants among current users of an evidence-based eHealth intervention, the web-based BRAVE Self-Help program [12,29], who had previously consented to be contacted for future research studies.”
March, S., Batterham, P. J., Rowe, A., Donovan, C. L., Calear, A. L., & Spence, S. H. (2021) · JMIR Mental Health · doi:10.2196/27981 · Cited by 20
“The program, described extensively elsewhere [9,24], is offered as an open-access web-based program targeting young Australians aged 7 to 17 years.”
BackgroundWe’ve Come a Long Way, Baby!: Evolution and Revolution in CBT with Youth
Friedberg, R. D., Hoyman, L. C., Behar, S., Tabbarah, S., Pacholec, N. M., Keller, M., & Thordarson, M. A. (2014) · Journal of Rational-Emotive & Cognitive-Behavior Therapy · doi:10.1007/s10942-014-0178-3 · Cited by 22
The Use of Telepsychology in Clinical Practice: Benefits, Effectiveness, and Issues to Consider
Godine, N., & Barnett, J. E. (2013) · International Journal of Cyber Behavior, Psychology and Learning · doi:10.4018/ijcbpl.2013100105 · Cited by 18
Does an Online CBT Program for Anxiety Impact Upon Sleep Problems in Anxious Youth?
Donovan, C. L., Spence, S. H., & March, S. (2016) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2016.1188700 · Cited by 18
“Similarly, the BRAVE-ONLINE programs have been described in detail elsewhere (see March et al., 2009; Spence et al., 2008; Spence et al., 2011; Spence et al., 2006) and therefore only a short description will be provided below.”
MethodDawes, K., Carlino, A., van den Berg, M., & Killington, M. (2020) · Disability and Rehabilitation · doi:10.1080/09638288.2020.1766582 · Cited by 18
Ooi, Y. P., Raja, M., Sung, S. C., Fung, D. S. S., & Koh, J. B. K. (2012) · PubMed · Cited by 16
Wright, K. D., Raazi, M., & Walker, K. L. (2017) · Journal of Clinical Anesthesia · doi:10.1016/j.jclinane.2017.03.007 · Cited by 17
Treatment of pediatric anxiety disorders
Rapp, A. M., Dodds, A., Walkup, J. T., & Rynn, M. A. (2013) · Annals of the New York Academy of Sciences · doi:10.1111/nyas.12318 · Cited by 16
McLellan, L. F., Andrijic, V., Davies, S. R., Lyneham, H. J., & Rapee, R. M. (2017) · Behaviour Change · doi:10.1017/bec.2017.11 · Cited by 14
“…the skills and successfully pitching therapy concepts at the right developmental level, challenges with designing appropriate exposure hierarchies, time demands, and computer-internet access issues (Rapee, Abbott, & Lyneham, 2006; Richardson, Stallard & Velleman, 2010; Spence et al., 2008).”
BackgroundHill, C., Chessell, C., Percy, R., & Creswell, C. (2022) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465822000157 · Cited by 13
“These are effective compared with waitlist (Khanna et al ., 2017; March et al ., 2008; Vigerland et al ., 2016) and face-to-face treatment (Spence et al ., 2011).”
Salloum, A., Chiappini, E. A., Lewin, A. B., & Storch, E. A. (2013) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465813000647 · Cited by 13
“In an effort to disseminate evidence-based practices (EBP), such as cognitive behavioral therapy for childhood anxiety, computer-assisted cognitive behavioral therapy (CCBT) programs have recently been developed and have demonstrated promising results (e.g. Khanna, and Kendal, 2010; Spence et al., 2008; Spence, Holmes…”
BackgroundMethodAmer, N. A., Abdelrazek, S., Eladrosy, W., El-bakry, H., & Shohieb, S. M. (2024) · International Journal of Cognitive Therapy · doi:10.1007/s41811-024-00225-0 · Cited by 12
“Other studies on mHealth found that the technology was useful, simple, and relevant to CBT practice (Gerrits et al., 2007; Newton et al., 2020; Spence et al., 2008).”
InfluentialUsing new technologies to deliver cognitive behaviour therapy with children and adolescents
Donovan, C. L., Spence, S. H., & March, S. (2013) · Cambridge University Press eBooks · doi:10.1017/cbo9781139344456.031 · Cited by 12
“The programme has been described in detail elsewhere (Spence et al ., 2008) and so only a brief overview is given here.”
BackgroundMethodRadomski, 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
“For example, in preparation for exposure activities, a supportive telephone call or message from the therapist assisted the user in developing a suitable exposure hierarchy [36,88].”
InfluentialJones, K., & Odell‐Miller, H. (2022) · Nordic Journal of Music Therapy · doi:10.1080/08098131.2022.2028886 · Cited by 10
Strengths and Limitations of Internet-Based Cognitive-Behavioral Treatments for Anxiety Disorders
Woods, A., Stults, C. B., Terry, R. L., & Rego, S. A. (2017) · Pragmatic Case Studies in Psychotherapy · doi:10.14713/pcsp.v13i3.2015 · Cited by 11
“These examples illustrate the resistance patients often feel when starting exposure therapy and call attention to the fact that conducting exposure therapy can be even more challenging without face-to-face interaction between the patient and therapist (Spence et al., 2008).”
BackgroundThe Interactive Child Distress Screener: Development and Preliminary Feasibility Testing
March, S., Day, J. J., Zieschank, K. L., & Ireland, M. J. (2018) · JMIR mhealth and uhealth · doi:10.2196/mhealth.9456 · Cited by 10
“Such findings are not dissimilar to those in the child eHealth literature, which demonstrate the effectiveness of interventions that utilize eye-catching graphics, colors, stories, animations, and interactive activities [35-37].”
Spence, S. H., Prosser, S. J., March, S., & Donovan, C. L. (2020) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13257 · Cited by 10
Innovative Play-Based Strategies for Teletherapy
Bolton, C. A., Thompson, H., Spring, J. A., & Frick, M. H. (2021) · Journal of Creativity in Mental Health · doi:10.1080/15401383.2021.2011814 · Cited by 11
“…such as ADHD (Myers et al., 2015), obsessive– compulsive disorder (Comer et al., 2017), disruptive and oppositional behavior (Comer et al., 2014), depression (Nelson et al., 2017), anxiety (March et al., 2009; Spence et al., 2011, 2008), and post-traumatic stress disorder (Stewart et al., 2017).”
BackgroundReitegger, F., Peras, I., Wright, M., & Gasteiger‐Klicpera, B. (2024) · Adolescent Research Review · doi:10.1007/s40894-024-00237-z · Cited by 13
Schulz, A., Vincent, A., & Berger, T. (2017) · Pragmatic Case Studies in Psychotherapy · doi:10.14713/pcsp.v13i3.2012 · Cited by 8
Digital storymaking: Dramatherapy with young people online
Millbrook, A. (2019) · Dramatherapy · doi:10.1177/0263067218817296 · Cited by 9
Korkmaz, B., & Şen, G. (2018) · Klinik Psikoloji Dergisi · doi:10.31828/kpd2602443829092018m000004 · Cited by 9
Deady, M., Teesson, M., KAY‐LAMBKIN, F. J., & Mills, K. L. (2014) · JMIR Research Protocols · doi:10.2196/resprot.3192 · Cited by 9
“Dropout rates from alcohol and other substance abuse treatment interventions are often high [79], similarly, Internet-based interventions, especially among young people, are also likely to compound these attrition rates [80].”
BackgroundMyers, K., Cummings, J. R., Zima, B. T., Oberleitner, R., Roth, D. E., Merry, S., Bohr, Y. M., & Stasiak, K. (2018) · Journal of Technology in Behavioral Science · doi:10.1007/s41347-018-0055-5 · Cited by 10
Cunningham, M. J., & Wuthrich, V. (2008) · E-Journal of Applied Psychology · doi:10.7790/ejap.v4i2.115 · Cited by 18
BREATHE-EASE Goals for Reducing Special Education Teacher Burnout
Ruble, L. A., McGrew, J. H., Dueber, D., & Salyers, M. P. (2024) · Teacher Education and Special Education The Journal of the Teacher Education Division of the Council for Exceptional Children · doi:10.1177/08884064241288262 · Cited by 9
“The use of goal attainment scaling for our progress-monitoring approach has been applied in at least two other studies of burnout interventions, but for different groups (Orel-lana-Rios et al., 2018; Spence et al., 2008).”
Tutus, D., Plener, P. L., & Niemitz, M. (2018) · Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie · doi:10.1024/1422-4917/a000640 · Cited by 8
Hashtag Healthcare: From Tweets to Mental Health Journals Using Deep Transfer LearningPreprint
Shickel, B., Heesacker, M., Benton, S. A., & Rashidi, P. (2017) · arXiv (Cornell University) · doi:10.48550/arxiv.1708.01372 · Cited by 8
Miller, L. D., Silva, C., Bouchard, S., Bélanger, C., & Taucer-Samson, T. (2012) · Autism and child psychopathology series · doi:10.1007/978-1-4614-3253-1_12 · Cited by 11
Whitaker, E., Chessell, C., Klapow, M. C., & Creswell, C. (2025) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-025-00521-x · Cited by 8
Ciuca, A., Berger, T., & Miclea, M. (2017) · Pragmatic Case Studies in Psychotherapy · doi:10.14713/pcsp.v13i3.2011 · Cited by 7
“Another group of researchers (Spence et al., 2008) used two case studies to illustrate the practical and technical aspects of implementing the intervention and demonstrated the feasibility of achieving successful outcomes using IBCT for child and adolescent anxiety.”
BackgroundYulianti, K. Y., Wijayanti, Y., & Ramdhani, N. (2020) · Gadjah Mada Journal of Professional Psychology (GamaJPP) · doi:10.22146/gamajpp.54888 · Cited by 5
“…et al., 2017) as well as the minimum health services and professionals (Putri et al., 2019), internet-based CBT internet can become an alternative individual-level intervention for social anxiety which has been proven to work in an adolescent sample (Spence et al., 2008; Tillfors et al., 2011).”
BackgroundInternet Supported Cognitive Behavior Therapy to Help Students with Shy-socially Isolated Problems
Ramdhani, N., Widjaja, J. D., & Rahmawati, N. (2015) · Procedia - Social and Behavioral Sciences · doi:10.1016/j.sbspro.2014.12.620 · Cited by 8
Senyard, E., Rowe, A., Krishnamoorthy, G., & March, S. (2025) · Journal of Clinical Psychology · doi:10.1002/jclp.70007 · Cited by 5
“The program is delivered in ten web ‐ based, interactive weekly sessions of 30 to 60min each, followed by two booster sessions one ‐ and 3 ‐ months post ‐ completion of the 10 ‐ session program (Spence et al. 2008).”
InfluentialInformation Systems and Technology
Bunge, E. L., Jones, M. K., Dickter, B., Perales, R., & Spear, A. (2016) · Springer eBooks · doi:10.1007/978-3-319-24693-2_7 · Cited by 4
MindSpace: A Cognitive Behavioral Therapy Game for Treating Anxiety Disorders in Children
Göbl, B., Hlavacs, H., Hofer, J., Müller, I., Müllner, H., Schubert, C., Spallek, H. H., Rybka, C., & Sprung, M. S. (2015) · Lecture notes in computer science · doi:10.1007/978-3-319-24589-8_41 · Cited by 4
“BRAVE-ONLINE mimicks sessions as they take place in face-to-face therapy and is accompanied by a therapist who is introduced via telephone and keeps up contact via mail.”
BackgroundInfluentialSelf-Help Treatment of Childhood Anxiety Disorders
McLellan, L. F., Fitzpatrick, S., Schniering, C. A., & Rapee, R. M. (2019) · Cambridge University Press eBooks · doi:10.1017/9781108235655.004 · Cited by 4
Sannes, A., Rognli, E. W., Hanssen‐Bauer, K., Torp, N. C., Storfossen, S. K., Høstaker, M. N., & Aalberg, M. (2025) · Journal of Medical Internet Research · doi:10.2196/83543 · Cited by 5
“The most repor-ted barrier for implementation in terms of user satisfaction by health care providers and patients was the lack of time and self-management skills among some patients to complete digitally delivered therapy [37-42, 44, 45, 47, 49-51 49-51, 56-58 56-58, 60-67 60-67].”
Wuthrich, V., & McLachlan, N. (2015) · Contemporary Behavioral Health Care · doi:10.15761/cbhc.1000108 · Cited by 2
“The BRAVE ONLINE program for anxious adolescents has also been shown in case studies [8] and in a randomized controlled trial to be efficacious in reducing adolescent anxiety [9] with 34% diagnosis free at postassessment, and with impressive outcomes at 1 year follow-up with 78% being free from their primary anxiety d…”
Methode-THERAPY USING COMPUTER AND MOBILE TECHNOLOGIES IN TREATMENT
Stasiak, K., & Merry, S. (2013) · ResearchSpace (University of Auckland) · Cited by 3
MindSpace: Treating Anxiety Disorders in Children with a CBT Game
Göbl, B., Hlavacs, H., Hofer, J., Müller, I., Müllner, H., Schubert, C., Spallek, H. H., Rybka, C., & Sprung, M. S. (2016) · Lecture notes in computer science · doi:10.1007/978-3-319-40216-1_28 · Cited by 3
Friedberg, R. D. (2021) · Practice Innovations · doi:10.1037/pri0000164 · Cited by 2
Rowe, A., Evans, J. L., Donovan, C. L., Spence, S. H., & March, S. (2023) · Child and Adolescent Mental Health · doi:10.1111/camh.12637 · Cited by 2
Duan, G., Wang, Y., Hou, H., & Li, T. (2024) · Scientific Reports · doi:10.1038/s41598-024-80066-1 · Cited by 2
Evans, I. M., FitzGerald, J., Herbert, A. M. L., & Harvey, S. T. (2010) · The Journal of Mental Health Training Education and Practice · doi:10.5042/jmhtep.2010.0689 · Cited by 2
Metadata
- Authors
- Spence, S. H., Donovan, C. L., March, S., Gamble, A., Anderson, R., Prosser, S., Kercher, A., & Kenardy, J.
- Affiliations
- Griffith University (AU)
- The University of Queensland (AU)
- Macquarie University (AU)
- Corresponding author
- Spence, Susan H.
- Venue
- Behavioural and Cognitive Psychotherapy
- Publisher
- Cambridge University Press (CUP)
- Published
- 2008-07
- Volume
- 36
- Issue
- 4
- Pages
- 411-430
- ISSN
- 1352-4658 (ISSN-L)
- 1469-1833
- OpenAlex
- W2156143452
- Cited by
- 120
- References
- 44
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 4 · 2023: 2 · 2022: 3 · 2021: 5 · 2020: 8 · 2019: 11 · 2018: 11 · 2017: 12 · 2016: 7 · 2015: 8 · 2014: 12 · 2013: 6 · 2012: 7
- FWCI
- 6.93
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Behavioural and Cognitive Psychotherapy (publishedVersion)
- Griffith Research Online (submittedVersion)
- University of Southern Queensland ePrints (University of Southern Queensland) (submittedVersion)
- Funders
- Medical Research Council
- National Health and Medical Research Council
- 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, child and adolescent anxiety, online intervention, parent-child therapy, treatment engagement, therapeutic relationship, intervention adaptation, feasibility
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