This is a plain English summary of an original research article. The views expressed are those of the author(s) and reviewer(s) at the time of publication.
This study included children with anxiety problems. Researchers compared online therapy led by parents, supported by therapists, with standard care. Standard care was usually CBT (cognitive behavioural therapy) delivered by a therapist. The study found that, compared with standard care, the parent-led intervention:
- led to similar reductions in anxiety
- required less time with therapists.
The online intervention was associated with cost savings and was likely to be good value for money. The researchers say their findings could improve access to treatment for children with anxiety problems.
More information about anxiety problems in children can be found on the NHS website.
The issue: can an online intervention help children with anxiety problems?
Anxiety problems are common in children and CBT is known to be an effective treatment. However, many barriers, including long waiting lists, reduce children’s access to this treatment. For instance, a small study in 2020 showed that fewer than 3% of children diagnosed with anxiety disorders received CBT.
In brief forms of CBT for pre-adolescent children, therapists typically help parents to implement CBT strategies in their children’s day-to-day lives. This approach reduces overall therapy time and does not require children to attend regular sessions at a clinic; it also means families can learn to manage difficulties in the longer term.
Researchers previously developed an online intervention to help parents and carers work with their children to overcome anxiety problems. The intervention includes text, audio and video content, along with practical exercises, worksheets and quizzes. Parents receive remote, brief therapist support. The intervention could potentially increase the availability of treatment but is not yet routinely used in child mental health services.
Researchers explored whether this online intervention with brief therapist support, could reduce anxiety in children as effectively as standard care.
What’s new?
The study included 444 children (and their parents or carers) from 34 child and adolescent mental health services in England and Northern Ireland. It was carried out between 2020 and 2022. Children were aged 5 – 12 years (with an average age of 9). Most (58%) were female, and the majority (90%) were white.
Half received CBT via the online support intervention with weekly, 20-minute therapist support. The rest received standard care, usually CBT in individual or group sessions. Parents or carers completed a questionnaire at 14 and 26 weeks to assess the impact of their child’s anxiety on their home, school, and social life. The researchers also examined the value for money.
At 26 weeks:
- children in both groups had similar meaningful reductions in anxiety (both scored 18 on the anxiety questionnaire; a reduction of 9 points for the intervention group and of 8 points for the standard care group)
- treatment delivery costs for the online intervention (£308) were less than for standard care (£366), mainly because the online intervention took less therapist time (3 hours) than standard care (5 hours).
Parents and carers found the online intervention acceptable, and no serious adverse events were reported.
Why is this important?
The online, therapist-supported intervention was as effective as standard care at reducing anxiety in children, and it cost the NHS less. Parents and carers found it acceptable to use.
Parent-led CBT (with therapist and online support) could increase access to psychological therapies for children with anxiety problems. The tool required less therapists’ time than standard care, freeing them up to see more families more quickly. Therapists achieved good outcomes with minimal training and support to offer the intervention.
The intervention was designed in collaboration with families and therapists, to enable efficient, engaging and accessible treatment for childhood anxiety problems. Some parents and carers found the intervention easy to use: “I just thought it was really easy to navigate. It was very straightforward working through the modules.”
Others said it improved their relationship with their child: “Personally, me and my daughter are now closer. We got to a stage where we were sort of quite estranged…and we can now see a brighter future...”
Limitations of this study include that only people with access to the internet and computers, tablets or mobile phones could use the online intervention. Most participants were white, and it is not clear whether the findings will be the same in other ethnic groups.
What’s next?
NICE is due to review this trial as part of an early value assessment.
Since completing the trial, clinical services have continued to use the intervention; more than 1000 families are using it outside of research trials. The researchers are supporting the ongoing implementation of the intervention in the NHS and associated services.
Ongoing studies are evaluating the implementation of the online intervention through schools. They are also evaluating versions adapted for childhood obsessive compulsive disorder (OCD), selective mutism, and for anxiety problems among autistic children.
The NIHR has supported projects to implement the intervention across the NHS.
Further work is needed to explore how much therapist training leads to the best outcomes.
You may be interested to read
This is a summary of: Creswell C, and others. Digitally augmented, parent-led CBT versus treatment as usual for child anxiety problems in child mental health services in England and Northern Ireland: a pragmatic, non-inferiority, clinical effectiveness and cost-effectiveness randomised controlled trial. Lancet Psychiatry 2024; 11: 193 - 209.
An article about the intervention written by the researchers.
A short video describing the findings.
Funding: This study was funded by the NIHR Policy Research Programme.
Conflicts of Interest: One of the study authors wrote a book for parents that is used by many of the participating clinical teams, and they receive royalties on sales of the book. The other authors have no interests to declare. See paper for full details.
Disclaimer: Summaries on NIHR Evidence are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that the views expressed are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.
NIHR Evidence is covered by the creative commons, CC-BY licence. Written content and infographics may be freely reproduced provided that suitable acknowledgement is made. Note, this licence excludes comments and images made by third parties, audiovisual content, and linked content on other websites.
