Technology‐delivered cognitive‐behavioral therapy for pediatric anxiety disorders: a meta‐analysis of remission, posttreatment anxiety, and functioning
Open accessAbstract
Background: The efficacy of technology‐delivered cognitive‐behavioral therapy (tCBT) for pediatric anxiety disorders (ADs) is uncertain as no meta‐analysis has examined outcomes in trials that used structured diagnostic assessments at pre‐ and posttreatment. Methods: We carried out a systematic review and meta‐analysis of randomized controlled trials (RCTs) of tCBT for pediatric ADs that included participants <18 years of age with a confirmed primary AD according to a structured diagnostic interview. Nine studies with 711 participants were included. Results: tCBT outperformed control conditions for remission for primary AD (37.9% vs. 10.2%; k = 9; OR = 4.73; p < .0001; I 2 = 0%; moderate certainty), remission for all ADs (19.5% vs. 5.3%; k = 8; OR = 3.32; p < .0001; I 2 = 0%; moderate certainty), clinician‐rated functioning ( k = 7; MD = −4.38; p < .001; I 2 = 56.9%; low certainty), and caregiver‐reported anxiety ( k = 7; SMD = 0.27; p = .02; I 2 = 41.4%; low certainty), but not for youth‐reported anxiety ( k = 9; SMD = 0.13; p = .12; I 2 = 0%; low certainty). More severe pretreatment anxiety, a lower proportion of completed sessions, no face‐to‐face sessions, media recruitment, and a larger proportion of females were associated with lower remission rates for primary AD. Conclusions: tCBT has a moderate effect on remission for pediatric ADs and clinician‐rated functioning, a small effect on caregiver‐reported anxiety, and no statistically significant effect on youth‐reported anxiety. The certainty of these estimates is low to moderate. Remission rates vary substantially across trials and several factors that may influence remission were identified. Future research should examine for whom tCBT is most appropriate and what care to offer the large proportion that does not remit. Future RCTs should consider contrasting tCBT with partial tCBT (e.g., including therapist‐led exposure) and/or face‐to‐face CBT.
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In a meta-analysis of 9 RCTs on iACT for pediatric anxiety disorders, the authors concluded that their confidence in the effect of iACT on functioning is low.
“However, in a meta-analysis of 9 RCTs on iACT for pediatric anxiety disorders, of which 7 included CGAS as a measure of functioning, the authors concluded that their confidence in the effect of iACT on functioning is low [51].”
From The Impact of Parental Support on Adherence to Therapist-Assisted Internet-Delivered Acceptance and Commitment Therapy in Primary Care for Adolescents With Anxiety: Naturalistic 12-Month Follow-Up Study (2025) · cites this paper as [51]
The Abstract reports nine RCTs of technology-delivered cognitive-behavioral therapy (tCBT), and Study selection says seven used CGAS. The Discussion explicitly says confidence in the effect on functioning is low. The paper evaluates tCBT, however, not iACT as the citing sentence states. (LLM, conf=0.90)
Experimental — accuracy not yet measuredCervin & Lundgren (2022) found that ICBT showed a moderate effect on remission of primary anxiety diagnosis and clinician-rated functioning.
“ICBT showed a moderate effect on the remission of primary anxiety diagnosis and functioning as rated by clinicians.”
From Effectiveness of and processes related to internet-delivered acceptance and commitment therapy for adolescents with anxiety disorders: a randomized controlled trial (2023) · cites this paper as Cervin & Lundgren, 2022
The Discussion reports a moderate effect on remission of the primary anxiety disorder and clinician-rated functioning compared with controls. However, that result is for technology-delivered CBT, which the Introduction defines to include computer- and internet-based formats; the paper does not establish the same effect for internet-delivered CBT specifically. Page numbers are unavailable in our copy. (LLM, conf=0.82)
Experimental — accuracy not yet measuredA recent meta-analysis of ICBT for patients under 18 with pediatric anxiety found ICBT effective on remission of primary anxiety diagnosis and clinician-rated overall functioning, but not on self-reported anxiety symptoms.
“Interestingly, this result is in line with a recent metaanalysis of ICBT for patients <18 years with pediatric anxiety, where ICBT showed effectiveness on remission of primary anxiety diagnosis and overall functioning as rated by clinicians, but not for anxiety-symptoms as assessed by self-report measures of participating youths (Cervin & Lundgren, 2022).”
From Effectiveness of and processes related to internet-delivered acceptance and commitment therapy for adolescents with anxiety disorders: a randomized controlled trial (2023) · cites this paper as Cervin & Lundgren, 2022
The Discussion (page unavailable) reports effects on remission of the primary anxiety disorder and clinician-rated functioning, but no statistically significant effect on youth-reported anxiety. The Introduction (page unavailable) defines the intervention more broadly as technology-delivered CBT, including computer- and Internet-based formats; the claim's description of the meta-analysis as specifically about ICBT is therefore too narrow. (LLM, conf=0.85)
Experimental — accuracy not yet measuredCervin & Lundgren (2022) found a small significant effect for parent/caregiver-reported anxiety but no significant effect on youth-rated anxiety.
“Less evidence was found for rated anxiety symptoms, where a small significant effect was found for parent/caregiver-reported anxiety but no significant effect on anxiety was rated by the youths themselves (Cervin & Lundgren, 2022).”
From Effectiveness of and processes related to internet-delivered acceptance and commitment therapy for adolescents with anxiety disorders: a randomized controlled trial (2023) · cites this paper as Cervin & Lundgren, 2022
Some meta-analyses have shown promising results for the efficacy of ICBT for children and adolescents.
“Some meta-analyses have also shown promising results for the ICBT efficacy for children and adolescents (Cervin & Lundgren, 2022; Ebert et al., 2015; Vigerland et al., 2016).”
From Effectiveness of and processes related to internet-delivered acceptance and commitment therapy for adolescents with anxiety disorders: a randomized controlled trial (2023) · cites this paper as Cervin & Lundgren, 2022
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- Authors
- Cervin, M., & Lundgren, T.
- Affiliations
- Lund University (SE)
- Region Stockholm (SE)
- Corresponding author
- Cervin, Matti
- Venue
- Journal of Child Psychology and Psychiatry
- Publisher
- Wiley
- Published
- 2021-07-07
- Volume
- 63
- Issue
- 1
- Pages
- 7-18
- ISSN
- 0021-9630 (ISSN-L)
- 1469-7610
- OpenAlex
- W3178210157
- Cited by
- 34
- References
- 42
- Citations by year
- 2026: 7 · 2025: 11 · 2024: 8 · 2023: 2 · 2022: 6
- FWCI
- 0.64
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Child Psychology and Psychiatry (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Lund University Publications (Lund University) (submittedVersion)
- 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
- childhood anxiety disorders, remission, functioning, treatment moderators
- MeSH terms
- Adolescent, Anxiety, Anxiety Disorders, Child, Female, Humans, Technology, Cognitive Behavioral Therapy
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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