Web-based CBT is equal to face-to-face CBT at reducing anxiety in adolescents, accordingly to randomised controlled trial


I’ve blogged about computerised cognitive behavioural therapy (CCBT) a few times over recent months and highlighted research that shows it is effective in treating a range of mental health conditions.

Research shows that most young people do not seek treatment for anxiety problems. There are lots of good quality reviews and trials that support the use of CCBT and face-to-face CBT, but the evidence-base for these treatments for anxiety in adolescents is less well studied. Many of the studies focus on the 7-13 year old age group, so it’s good to see this new trial from researchers in Brisbane Australia, which examines the relative efficacy of online versus clinic delivery of cognitive behavioural therapy in the treatment of anxiety disorders in adolescents.

The trial took 115 adolescents (12-18 years old) with a primary diagnosis of separation anxiety disorder, social phobia, generalised anxiety disorder or specific phobia and at least one of their parents.

Patients were randomised to one of three treatment groups:

  1. Online CBT: The ‘BRAVEfor Teenagers – ONLINE’ programme, which is designed to deliver the equivalent to the clinic-based treatment programme. Ten 60 minute weekly sessions for the adolescents and 5 for their parents. A therapist monitored progress and provided email feedback following each session.
  2. Face-to-face CBT: ‘BRAVE-CLINIC’. Equivalent treatment to the online group.
  3. Waiting list control: No contact with the research team during the first 12 weeks, then offered treatment.

The main outcomes studied were anxiety measured on the Anxiety Disorders Interview Schedule, clinical severity ratings and clinician-rated global functioning.

The trial was generally well conducted (good blinding and allocation concealment), had reasonable follow-up (for 12 months) and used an intention to treat analyses (last observation carried forward) that included all of the participants.

Here’s what they found:

  • At 12 weeks:
    • Online CBT did better than the control at reducing primary anxiety diagnosis (34.1% vs 3.7%, p=0.003, completer analysis)
    • Face-to-face CBT did better than the control at reducing primary anxiety diagnosis (29.5% vs. 3.7%, p=0.008, completer analysis)
    • There was no significant difference between the online CBT and face-to-face CBT groups
  • At 6 months:
    • The reduction in primary anxiety diagnosis had risen to 54.5% for online and 50.0% for face-to-face CBT (p=0.67)
  • At 12 months:
    • The figures had improved again with 68.2% recovering in both groups (p=1.00)
    • There were no significant differences between online and face-to-face CBT in improvement in clinical severity and global functioning.

One interesting aside was that parents reported greater satisfaction with the face-to-face CBT than the Internet-delivered variety.

The researchers concluded:

Online delivery of CBT, with minimal therapist support, is equally efficacious as clinic-based, face-to-face therapy in the treatment of anxiety disorders among adolescents. This approach offers a credible alternative to clinic-based therapy, with benefits of reduced therapist time and greater accessibility for families who have difficulty accessing clinic-based CBT.

Spence SH, Donovan CL, March S, Gamble A, Anderson RE, Prosser S, Kenardy J. A randomized controlled trial of online versus clinic-based CBT for adolescent anxiety. J Consult Clin Psychol. 2011 Oct;79(5):629-42. [PubMed abstract]

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