JMIR Publications

ABSTRACT

Background:

Mental health problems among youths are increasing and internet delivered cognitive behavioral therapy (iCBT) is one possible way for primary care to improve access to care while reducing the costs. Nevertheless, few studies have investigated iCBT for youths in regular primary care nor the role of the parents.

Objective:

This study is a follow-up of a non-randomized controlled trial investigating treatment adherence and outcomes in youths receiving iCBT, with or without parental support, and treatment as usual (TAU). The aims of this study were to examine treatment adherence, symptoms of anxiety and depression, psychological flexibility as well as social, academic and overall functioning in youths 12 months after treatment.

Methods:

In this study, quantitative data was investigated using a nonparametric analysis. The participants were youths aged 13-18 seeking help for anxiety symptoms and being recruited within the regular primary care patient-flow at 3 different healthcare centers. Treatment adherence was investigated measuring the amount of completed modules or sessions, depending on the treatment format. Outcome measures were collected by self-assessment questionnaires that the participants were asked to fill out pre- and post-treatment as well as 6 and 12 months after terminating treatment. Participants were additionally interviewed using diagnostic assessment instruments before and after treatment and at the 12-months follow-up.

Results:

The participants receiving iCBT with parental support (n=15) exhibited the lowest number of dropouts out of which all occurred during the second half of treatment, whereas the iCBT-group without parental support (n=9) exhibited a gradual dropout throughout the treatment period and the highest dropout rate of all groups. Meanwhile, in the TAU-group (n=11) all of the dropouts occurred before or right after the first session. Regarding outcome measures, the within-group per protocol analyses demonstrated a statistically significant difference in depression and anxiety between pre-treatment to the 12-month follow-up of RCADS for the iCBT-group (X23=22.2; P= <.001; n=11), but not the TAU-group (X23=7.0; P=.07; n=6). Subsequently, a follow-up analysis of the iCBT-group indicated a decrease in symptoms of depression and anxiety between pre-assessment and the 12-month follow-up assessment (Z=-2.94; P=.003; r=-0.6). Moreover, the within-group per protocol analyses demonstrated a statistically significant increase in psychological flexibility between pre-treatment to the 12-month follow-up of AFQ-Y8 for the iCBT-group (X23=11.7; P=<.008; n=10), but not the TAU-group (X23=6.5; P=.09; n=5). Furthermore, the follow-up analysis of the iCBT-group indicated an increase in psychological flexibility between pre-assessment and the 12-month follow-up assessment (Z=-2.54; P=.011; r=0.55). Nevertheless, no differences in functioning were found.

Conclusions:

The participants receiving iCBT with parental support exhibited fewer and later drop-outs compared to iCBT without parental support and TAU, indicating that parental support might play a role in treatment adherence in iCBT for youths with anxiety. Moreover, the outcome measures suggest that transdiagnostic iCBT for youths in primary care could be an effective treatment for both anxiety and depression, as indicated by the significant symptom reduction and increased psychological flexibility, maintained at the 12-month follow-up.