Evaluation of an online self-help cognitive behaviour therapy (CBT) based treatment for anxiety in children

BRAVE is an online cognitive behavioural therapy (CBT) program for children aged 7-12 with anxiety. The program is age-appropriate and is designed to meet the developmental and cognitive level of young children. BRAVE is delivered by internet at home to the child and parent. BRAVE consists of ten child sessions, six parent sessions and two booster sessions (each session is one hour in length). The six parent sessions coincide with the first six child sessions. Parent sessions provide education about anxiety and information on strategies for managing anxious behaviours in children. The two booster sessions are conducted one month and three months following completion of treatment for both parent and child. The sessions focus on consolidation of previously learned skills, in addition to relapse prevention strategies. The booster sessions are designed to supplement treatment, however are not an integral component of the program. Information is presented through interactive exercises, text, colourful graphics, animation, quizzes, and games. To avoid activities being skipped, most exercises require a response before the next screen can be accessed. Homework exercises are set at the end of each session. If a child misses a session, the system sends out automatic reminders. The sessions are designed to be completed sequentially at weekly intervals (the next available session becomes accessible seven days after the previous one is completed). Previous versions of the program have been offered with minimal therapist-assistance. However the current implementation will be offered in a self-help mode, that is with no support from therapists. For children that enter the program, at the start and end of each session they use a thermometer to rate their symptoms of anxiety. These scores are recorded and will be regularly monitored by a therapist. Children whose symptoms remain high with no improvement will be refereed for treatment elsewhere. Participants will be provided with automated computer-generated emails that provide feedback on their progress. Personalised automated reminder emails are sent to advise when the next session is available for completion, or to provide prompts if the session is not completed by the due date.