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Using stepped-care approaches within internet-based interventions for youth anxiety: Three case studies
Sonja March1, Caroline L Donovan2, Sarah Baldwin3
1University of Southern Queensland, School of Psychology and Counselling and Centre for Health, Informatics and Economics Research, Springfield, QLD 4300, Australia.
Internet Interventions
|January 1, 2020
Summary
Stepped-care Internet-based cognitive behaviour therapy (ICBT) shows promise for youth anxiety. Introducing therapist guidance for non-responders in self-guided ICBT significantly improved treatment outcomes and reduced anxiety diagnoses.
Area of Science:
- Child and Adolescent Psychiatry
- Clinical Psychology
- Digital Health
Background:
- Lack of clear guidelines for Internet-based cognitive behaviour therapy (ICBT) in routine care for childhood and adolescent anxiety.
- Self-guided ICBT has limitations in adherence and treatment success.
- Stepped-care models offer a potential solution for accessible yet supported ICBT.
Purpose of the Study:
- To examine the application of a stepped-care model in an ICBT intervention for childhood and adolescent anxiety.
- To investigate stepping up from self-guided to therapist-guided ICBT.
Main Methods:
- Case study of three young males (11-12 years) in the BRAVE Stepped-Care program.
- Two steps: 5 sessions self-guided ICBT followed by 5 sessions therapist-guided ICBT.
- Pre- and post-treatment diagnostic assessments and self-report questionnaires; mid-treatment assessment for step-up decisions.
Main Results:
- Step-up decisions were complex, considering engagement, adherence, anxiety symptoms, and parent feedback.
- Non-responders who transitioned to therapist-guided ICBT showed increased engagement and treatment response.
- All stepped-up participants were free of their primary anxiety diagnosis post-treatment.
Conclusions:
- Early assessment of engagement and non-response in self-guided ICBT is crucial for youth anxiety.
- Introducing therapist guidance mid-treatment can lead to positive outcomes for non-responders.
- Further randomized controlled trials are needed to confirm the efficacy of stepped-care ICBT models.
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