Evaluation of an online program for youth anxiety.

This study aims to test the effectiveness of an online session delivering imagery-based motivation enhancement to improve youth engagement with an internet-based Cognitive Behavioural Therapy (CBT) intervention for anxiety. The motivation enhancement session is based on Functional Imagery Training (FIT), which is a treatment approach developed to enhance motivation for positive behaviour change. FIT is based on Elaborated Intrusion Theory of desire which posits that desire is driven by a process of cognitive elaboration of which mental imagery is a key component. The more vivid an image about a target is, the stronger the desire will be. FIT combines training in mental imagery with the client-centred counselling style of Motivational Interviewing (MI) to engage people in conversations about the positive benefits of change, building self-efficacy and goal-directed planning. FIT involves supplementing these verbal discussions with guided mental imagery, strengthening desire for the imagined goal. This imagery-based session will deliver a brief, self-guided form of FIT which aims to enhance motivation to engage with the program and to complete homework tasks. This online session will provide imagery psychoeducation, explore benefits of change and of completing the program, build self-efficacy for change, goal setting and planning. Throughout the session, participants are invited to create mental images relating to the different areas of discussion. The imagery session is expected to take participants approximately 30 minutes to complete. This imagery session will precede the 7-session online anxiety program. This is delivered on the Momentum platform (www.momentumhub.org.au). The Momentum Anxiety program is an individual, interactive, self-guided, internet-based CBT program for young people experiencing elevated levels of anxiety. The program is comprised of 7 sessions focusing on psychoeducation, the maintaining role of avoidance in anxiety, and a variety of graded-exposure and cognitive restructuring strategies as well as relapse prevention. Participants can input responses directly into the online platform but will be informed and reminded throughout the program that the content is not monitored or reviewed. At the end of each session participants are assigned homework tasks to complete before their next login. It is expected that homework tasks will take participants an average of 30 minutes to complete each week, though this will vary across participants depending how much time they are able/choose to spend on the practise activities. Homework completion is recorded as a binary yes/no response based on whether they attempted their homework activities. Session completion times will also vary across participants, but on average it is expected that completing each session will take approximately 30-60 minutes. Participants are welcome to log in at times that are convenient to them and to complete the program at a pace that suits them, though it is suggested that they try to log in and complete at least one session per week. Participants can complete the online sessions alone or with support of a parent or caregiver, depending on their age. The platform records the date of completed sessions. A session is considered completed if every page has been clicked through until the final screen. The content is based on other evidence-based CBT interventions and was developed by a group of experienced researchers and clinical psychologists with significant experience in developing innovative solutions for child and adolescent mental health concerns. The intervention arm where participants receive the imagery-based motivation enhancement session followed by the standard 7-session Momentum Anxiety program is called the AnxietyPlus arm.