Internet-based Therapy Potentially Useful for Adolescents with Anxiety Disorders

According to preliminary conclusions from a recent study, Internet-based cognitive behavioral therapy (ICBT) could be useful for adolescents with anxiety disorders along with standard treatment delivered in child and adolescent psychiatric clinics.

Anxiety disorders are among the most common psychiatric disorders of children and adolescents, and anxiety that occurs during childhood has a moderate to high impact on functioning and could lead to severe disability that often continues into early adulthood. This likelihood is pronounced for patients who do not receive treatment, which unfortunately accounts for an estimated 80% of cases.

Treatment for adolescents may involve pharmacotherapy, but it will typically consist mainly of cognitive behavioral therapy (CBT). Generally, the goal of treatment is to help the patient identify physical, cognitive and behavioral components of the anxiety and then to gradually apply skills to face fearful situations outside the therapy session.

The study in Internet Interventions looked at internet-based cognitive behavioral therapy (ICBT), which involves a combination of computerized CBT manuals and guided therapy. ICBT is structured to mirror face-to-face care. Some form of personal contact with a CBT therapist—including e-mails, phone conversations, and potentially in-person visits—is included for support. The Internet Interventions study tested the effects of tailored ICBT for adolescents with anxiety and possible comorbid depressive symptoms.

The intervention was tested within a child and adolescent psychiatric clinic in Sweden. Study participants were 11 adolescents age 15—19 who sought treatment at the clinic for mild to moderate anxiety. Patients with obsessive-compulsive disorder, post-traumatic stress disorder, severe depression, risk of suicide, among others, were excluded.

Participants who met the inclusion criteria were asked to complete an online screening via the internet treatment platform and then were given semi-structured interviews. Treatment consisted of individually prescribed CBT text modules adapted for the age group. Therapist guidance was via an online platform along with telephone and face-to-face support. The duration of treatment was 6—18 weeks with a prescription of 6–9 treatment modules for each participant. The participants were advised to spend 1–2 weeks on each prescribed module and the treatment was combined with additional telephone calls or face-to-face sessions if required.

Statistically significant improvements were found on all dependent measures immediately following treatment for the 8 adolescents who completed treatment. The within-group effect size on the Beck Anxiety Inventory, the primary outcome measure, was d=2.51 at post-treatment and 80 percent (4/5) adolescents no longer met criteria for their primary anxiety disorder.

Overall, the results found in this study suggest that tailored ICBT may be a suitable treatment for adolescents with anxiety. “The significant results and large within-group effect sizes reported in this study should be viewed with caution given the most important limitation of this study: the small sample size and the lack of randomization to a control group, limiting internal validity of the study,” the study authors noted. “In addition, there was no follow-up of treatment results after the post-assessment.”

However, the study was “conducted in a clinical setting with a population that is common in child and adolescent psychiatry. Inclusion criteria were inclusive, with few restrictions with regards to comorbidity, strengthening external validity. This means that the results are interesting from the standpoint of generalizability and further studies ought to be conducted with larger samples,” the authors wrote.