Internet-Based Cognitive–Behavioral Therapy Intervention Master Your Worries With Telephone Coaching for Anxious Finnish Children Aged 10-13 Years: A Population-Based Randomized Controlled Trial

Abstract

Objective

No previous studies have evaluated the efficacy of internet-based cognitive–behavioral therapy (ICBT) among children below age 13 years screened at the population level. This study was an open, 2 parallel–group randomized controlled trial (RCT), stratified by sex, that compared ICBT with telephone coaching vs an educational control.

Method

Altogether 465 children (mean age = 11.5 years, SD = 1.0 years, 71.4% girls) were randomly allocated to ICBT or psychoeducation. The 10-week ICBT included weekly digital material and exercises and weekly telephone calls. Assessments comprised child and parent reports on anxiety (Screen for Child Anxiety Related Emotional Disorders questionnaire [SCARED]), impacts of anxiety, quality of life, comorbidity, and parental mental health assessed at baseline and at 6-month follow-up.

Results

The ICBT group yielded significantly higher improvement in primary outcomes (SCARED total scores) when compared with control group in the child reports (p = .04, Cohen d = 0.17) but not in the parent reports (p = .41, d = 0.03). The ICBT group had significantly higher improvement in several secondary measures of outcome, including child-reported SCARED generalized anxiety (p = .047, d = 0.09), separation anxiety (p = .004, d = 0.40), social anxiety (p = .007, d = 0.27), the parent-reported Strengths and Difficulties Questionnaire total score (p = .002, d = 0.22), emotional difficulties (p = .02, d = 0.20), hyperactivity (p = .003, d = 0.19), and quality of life (p = .02, d = 0.16).

Conclusion

When children were screened at the population level for anxiety and enrolled in this RCT study of ICBT combined with telephone guidance, they showed efficacy in improving anxiety and quality of life. These findings are encouraging when developing early population-based intervention strategies for childhood anxiety.

Plain language summary

This randomized controlled trial compared internet-based cognitive–behavioral therapy (ICBT) with telephone coaching to an internet-based educational control (EC) among 10- to 13-year-old children (n = 465) screened for anxiety at a population level in school health care check-ups. Both ICBT and EC groups showed significant improvement in the parent and child reports between baseline and follow-up in most measures related to child anxiety, other psychopathology, daily functioning level, and quality of life, as well as parental emotional well-being. The ICBT group showed significantly better improvement when compared with the EC group in child-reported anxiety as well as on parent-reported and child-reported overall psychopathology, emotional difficulties, hyperactivity, and quality of life. Overall, the effect sizes for these relative improvements at follow-up were small.

Clinical trial registration information

A Randomized Controlled Study of Digitalized Cognitive-behavioral Intervention for Childhood Anxiety; https://clinicaltrials.gov/study/NCT03310489