A randomized controlled trial of online versus clinic-based cognitive behaviour therapy (CBT) for adolescent anxiety

The program comprised ten, one-hour online youth sessions and five, online one-hour parent sessions completed over a 12-week period. Booster sessions were completed at one- and three-months following treatment for both the young person and their parent(s). Standard CBT anxiety management strategies were used including: psychoeducation, relaxation training, recognition of the physiological symptoms of anxiety, cognitive strategies of coping self-talk and cognitive restructuring, graded exposure, problem solving, and self-reinforcement. Parent sessions also taught anxiety management skills, in addition to parenting strategies to empower parents to help their child implement anxiety management skills. The content, length and number of session activities in the Internet program replicate those of the clinic-based version. Sessions are designed to be engaging, interactive, and age-appropriate. Eye-catching graphics, sounds, games and quizzes are used to maintain the youths’ level of interest. Information is presented through interactive exercises and followed by quizzes that check for correct understanding and provide personalized corrective or positive feedback through pop up messages. The content of the intervention is designed to meet the developmental and cognitive level of youths, with age-appropriate scenarios, examples, and activities (example situations include school exams, job interviews, dating, and oral presentations). The program is (minimally) therapist-assisted, rather than self-help. Each family is assigned an online therapist (BRAVE Trainer) who monitors their progress through the program and provides brief email feedback following each session. At no stage did any participants have face-to-face contact with their therapist and all other contact (i.e., email or phone) was minimal. Clinician contact was restricted to brief, weekly emails and a short, 15-minute mid-program telephone call to assist in exposure hierarchy development. Most other contact with the ‘online therapist’ was computer generated. Client responses to all session and homework activities are stored in an administrator section of the program and can be viewed by the therapist to guide the content of the weekly email. In addition, automated computer-generated emails are sent on behalf of the online therapist to congratulate participants for completion of sessions and personalized emails are sent to provide feedback about responses to quiz tasks. Personalized automated reminder emails are sent to advise when the next session is available for completion, or to provide prompts if not completed by the due date. The first session also includes a picture of the therapist, and some brief biographical information about them, to which the client responds by providing information about themselves.