Internet-Based Cognitive Behavioral Therapy Helps Improve Anxiety in Adolescents

by | Oct 28, 2019 | 2019, Alternative Therapies, Brain Health, Infant and Children's Health

Written by Angeline A. De Leon, Staff Writer. This study found the Danish version of Chilled Out Online to be efficacious and feasible in relieving symptoms of anxiety in adolescents with anxiety disorders.

Recent studies estimate that about 10% of adolescents in Western countries suffer from some form of anxiety disorder 1. Studies suggest that cognitive behavioral therapy (CBT) is one of the most effective treatments available for adolescent anxiety 2, however, several barriers to treatment also exist, including reluctance among adolescents to seek help for emotional problems 3, fear of perceived social stigma 4, and concerns about treatment cost and transportation 5. Internet-based CBT was developed as an alternative means of delivering psychotherapy and involves therapeutic support comparable to face-to-face CBT 6. By providing greater anonymity and a greater sense of self-determination, ICBT is capable of overcoming many of the barriers to treatment associated with more traditional forms of therapy 7. Meta-analyses also show that ICBT delivers promising results in children, adolescents, and young adults with anxiety and depression 8,9. For example, a recent randomized trial comparing ICBT with in-person CBT found comparable reductions in self-rated anxiety symptoms after 12 weeks and a similar percentage of patients who reported being anxiety-free at the end of treatment (34% vs. 30%, respectively) 10. In 2019, researchers in Denmark conducted an exploratory study evaluating the efficacy of a newly developed ICBT program (based on manualized group CBT) in the treatment of anxiety disorders among adolescents.

A randomized controlled trial was carried out in a group of 70 adolescents (aged 13-17 years) with a primary anxiety disorder diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders 4th Ed (DSM-IV). Subjects were randomized to a therapist-guided ICBT called The Chilled Out Online Program (involving a structured online CBT protocol teaching goal-setting, realistic thinking, coping skills, etc., along with weekly supportive phone calls for 14 weeks) or a waitlist condition (WL). At baseline, Month 3, and at 12-month follow-up, the Anxiety Disorders Interview Schedule for DSM-IV, Child and Parent Versions (ADIS-IV, measure of clinician-rated diagnostic severity) and the Spence Children’s Anxiety Scale (SCAS, measuring overall symptom severity as rated by adolescent and parents) were administered.

According to server logs, subjects completed an average of 74% of all module components. Analyses of primary outcome measures indicated that 40% of adolescents in the ICBT group were free of their primary anxiety disorder diagnosis, compared to 16% in WL group (p = 0.027), at the end of 12 months. At 12-month follow-up, a significantly greater number of subjects in the ICBT group were also free of all anxiety diagnoses, as compared to the WL group (29% vs. 3%, respectively, p = 0.005). Moderate to large between-group effect sizes were reported for the ICBT group on the ADIS-IV (primary diagnosis: d = 0.65, p = 0.022; all diagnoses: d = 0.83, p = 0.022) and the SCAS (adolescent: d = 0.68, p < 0.001; mother: d = 1.12, p < 0.001; father: d = 0.46, p = 0.011). At 12-month follow-up, adolescents in ICBT showed maintenance of treatment gains based on SCAS (48%, 65%, and 67% based on adolescent, mother, and father reports, respectively) with 40-45% classified as completely recovered by the end of the study.

Based on evidence from the study, therapist-guided ICBT appears to be effective in improving anxiety among adolescents. Ratings across clinicians, adolescents, and parents corroborate CBT’s ability to significantly improve diagnostic severity and anxiety symptoms. Analysis of secondary outcome measures also linked ICBT with better self-efficacy and quality of life, relative to the WL condition. Promisingly, The Chilled Out Online Program was associated with maintenance of treatment effects for all included measures at the end of the 12-month study period. Researchers conclude that the implementation of similar ICBT interventions in youths with anxiety represents a highly practical and efficacious form of treatment deserving further investigation in future trials. Study limitations to consider include the lack of an active control condition and the carrying out of clinical interviews by supervised student trainees (who were relatively inexperienced with psychological assessments) rather than by fully trained psychologists.

Source: Stjerneklar S, Hougaard E, McLellan LF, et al. A randomized controlled trial examining the efficacy of an internet-based cognitive behavioral therapy program for adolescents with anxiety disorders. PLos ONE; 2019; 14(9): e0222485. DOI: 10.1371/journal.pone.022485.

© 2019 Stjerneklar et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Posted October 28, 2019.

Angeline A. De Leon, MA, graduated from the University of Illinois at Urbana-Champaign in 2010, completing a bachelor’s degree in psychology, with a concentration in neuroscience. She received her master’s degree from The Ohio State University in 2013, where she studied clinical neuroscience within an integrative health program. Her specialized area of research involves the complementary use of neuroimaging and neuropsychology-based methodologies to examine how lifestyle factors, such as physical activity and meditation, can influence brain plasticity and enhance overall connectivity. http://www.naturalhealthresearch.org/wp-content/uploads/2017/10/Angeline.jpg

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