March Sonja, Spence Susan H, Donovan Caroline L, Kenardy Justin A
Institute for Resilient Regions, University of Southern Queensland, Springfield, QLD, Australia.
School of Psychology and Counselling, University of Southern Queensland, Ipswich, QLD, Australia.
J Med Internet Res. 2018 Jul 4;20(7):e234. doi: 10.2196/jmir.9211.
Internet-based cognitive behavioral therapy (iCBT) for child and adolescent anxiety has demonstrated efficacy in randomized controlled trials, but it has not yet been examined when disseminated as a public health intervention. If effective, iCBT programs could be a promising first-step, low-intensity intervention that can be easily accessed by young people.
The objective of our study was to examine the feasibility and acceptability of a publicly available online, self-help iCBT program (BRAVE Self-Help) through exploration of program adherence, satisfaction, and changes in anxiety.
This study was an open trial involving the analysis of data collected from 4425 children and adolescents aged 7-17 years who presented with elevated anxiety at registration (baseline) for the iCBT program that was delivered through an open-access portal with no professional support. We assessed the program satisfaction via a satisfaction scale and measured adherence via the number of completed sessions. In addition, anxiety severity was assessed via scores on the Children's Anxiety Scale, 8-item (CAS-8) at four time points: baseline, Session 4, Session 7, and Session 10.
Participants reported moderate satisfaction with the program and 30% completed three or more sessions. Statistically significant reductions in anxiety were evident across all time points for both children and adolescents. For users who completed six or more sessions, there was an average 4-point improvement in CAS-8 scores (Cohen d=0.87, children; Cohen d=0.81, adolescents), indicating a moderate to large effect size. Among participants who completed nine sessions, 57.7% (94/163) achieved recovery into nonelevated levels of anxiety and 54.6% (89/163) achieved statistically reliable reductions in anxiety.
Participant feedback was positive, and the program was acceptable to most young people. Furthermore, significant and meaningful reductions in anxiety symptoms were achieved by many children and adolescents participating in this completely open-access and self-directed iCBT program. Our results suggest that online self-help CBT may offer a feasible and acceptable first step for service delivery to children and adolescents with anxiety.
基于互联网的儿童和青少年焦虑症认知行为疗法（iCBT）在随机对照试验中已证明有效，但作为一种公共卫生干预措施进行推广时，尚未得到检验。如果有效，iCBT项目可能是很有前景的第一步低强度干预措施，年轻人可以轻松获得。
我们研究的目的是通过探索项目依从性、满意度和焦虑变化，来检验一个公开可用的在线自助iCBT项目（BRAVE自助项目）的可行性和可接受性。
本研究是一项开放试验，涉及对4425名7至17岁儿童和青少年的数据进行分析，这些儿童和青少年在注册（基线）时焦虑水平升高，参与了通过开放访问门户提供且无专业支持的iCBT项目。我们通过满意度量表评估项目满意度，并通过完成的课程数量衡量依从性。此外，在四个时间点通过8项儿童焦虑量表（CAS-8）的得分评估焦虑严重程度：基线、第4节、第7节和第10节。
参与者对该项目的满意度中等，30%的人完成了三节或更多课程。儿童和青少年在所有时间点的焦虑水平均有统计学意义的显著降低。对于完成六节或更多课程的用户，CAS-8得分平均提高了4分（科恩d值=0.87，儿童；科恩d值=0.81，青少年），表明效应量为中等至较大。在完成九节课程的参与者中，57.7%（94/163）的焦虑水平恢复到非升高水平，54.6%（89/163）的焦虑水平有统计学上可靠的降低。
参与者反馈积极，该项目为大多数年轻人所接受。此外，许多参与这个完全开放访问和自我指导的iCBT项目的儿童和青少年的焦虑症状得到了显著且有意义的减轻。我们的结果表明，在线自助认知行为疗法可能为向焦虑的儿童和青少年提供服务提供一种可行的方式。
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