Stepped Care Cognitive Behavioural Therapy for Children with Anxiety Disorders: A New Treatment Approach
Abstract
Background: The current nonrandomized clinical trial explored changes over time in children with an anxiety disorder during stepped care, manual-based cognitive behaviour therapy (CBT). Methods: Clinically anxious children (8–12 years, n = 133) and their parents participated in child focused CBT (10 sessions). If assessments indicated additional treatment was necessary, participants could step up to a second and possibly third treatment phase (each 5 sessions) including more parental involvement. Results: After the first treatment phase 45% of the Intention-To-Treat sample was free of any anxiety disorder; after the second and third phase an additional 17% and 11% respectively. In total, 74% of the children no longer met criteria for any anxiety disorder following treatment. Child and parent reported anxiety and depression symptoms of children improved significantly during all treatment phases, as well as child reported anxiety sensitivity and negative affect. Children participating in more treatment showed significant improvements during additional treatment phases, indicating that late change occurred for the subgroup that had not changed during the first phase. Conclusions: Stepped care offers a standardized, assessment based, yet tailored treatment approach for children with anxiety disorders. A more intensive treatment is offered when initial CBT is insufficient, providing children additional opportunities to reach the desired outcome.
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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 [38]
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 [38]
The model by Van de Leden et al. included 20 sessions in total.
“the model by Van de Leden et al. [38] included 20 sessions in total.”
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 [38]
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- Authors
- van der Leeden, A. J. M., van Widenfelt, B. M., van der Leeden, R., Liber, J. M., Utens, E. M. W. J., & Treffers, P. D. A.
- Affiliations
- Leiden University (NL)
- Erasmus MC (NL)
- Venue
- Behavioural and Cognitive Psychotherapy
- Publisher
- Cambridge University Press (CUP)
- Published
- 2010-10-08
- Volume
- 39
- Issue
- 1
- Pages
- 55-75
- ISSN
- 1352-4658 (ISSN-L)
- 1469-1833
- OpenAlex
- W2127072783
- Cited by
- 45
- References
- 43
- Citations by year
- 2026: 5 · 2025: 1 · 2024: 4 · 2023: 4 · 2022: 2 · 2021: 1 · 2020: 6 · 2019: 7 · 2017: 2 · 2016: 3 · 2015: 1 · 2014: 3 · 2013: 5 · 2012: 1
- FWCI
- 2.50
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Behavioural and Cognitive Psychotherapy (publishedVersion)
- PubMed (publishedVersion)
- UvA-DARE (University of Amsterdam) (publishedVersion)
- Pure Amsterdam UMC (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- Leiden Repository (Leiden University) (submittedVersion)
- Funders
- Erasmus Medisch Centrum
- Erasmus+
- Topics
- 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
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Keywords
- stepped care, cognitive behavioral therapy, childhood anxiety disorders, parental involvement, treatment escalation, anxiety sensitivity, negative affect, depressive symptoms, treatment response
- MeSH terms
- Adaptation, Psychological, Anxiety Disorders, Child, Combined Modality Therapy, Communication, Depressive Disorder, Education, Family Therapy, Female, Humans, Implosive Therapy, Male, Netherlands, Personality Assessment, Psychotherapy, Group, Cognitive Behavioral Therapy, Parenting
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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