Integrating Stepped-Care Approaches into Internet-Based Cognitive Behavioural Therapy for Young People with Anxiety Disorders

Integrating Stepped-Care Approaches into Internet-Based Cognitive Behavioural Therapy for Young People with Anxiety Disorders

The overarching aim of this program of research was to identify the optimal way stepped-care internet-based cognitive behavioural therapy (ICBT) interventions can be delivered to anxious young people, specifically a mid-treatment approach, while determining suitability and effectiveness of these interventions. A multi-methods approach grounded in principles of implementation science was employed, consisting of one quantitative study (N=275) and three qualitative studies. The quantitative study identified pre-treatment factors associated with those more likely to be stepped-up, treatment response and treatment dropout. The qualitative studies explored the perspectives of clinicians (N=6), young people (N=18), and parents (N=20), that experienced a stepped-care ICBT model, identifying themes related to model implementation, support modality suitability, and recommendations for model refinement. Quantitative findings indicated that young people with generalised anxiety disorder (GAD) and separation anxiety disorder (SEP) were more likely to require stepping-up to additional support, compared to social phobia (SOC). Higher child-reported anxiety interference in the context of the home showed a steeper initial drop, while low parent-reported anxiety interference (at home) showed symptom reduction during treatment, plateauing in follow-up. It was also found that lower overall functioning and treatment expectancy were associated with treatment dropout. The qualitative studies found clinicians rated videoconferencing as the most acceptable modality of support, and most likely to use in their own practice. Young people expressed preference for independently completing the self-directed component of the stepped-care model. Younger children indicated an initial practical session aiding program navigation would be helpful. Both clinician and parental support were valued by young people, and parents indicated that more personalised ongoing support, particularly via email, was expected. Overall, the early stepped-care ICBT model was viewed as an acceptable and appropriate treatment approach by clinicians, young people, and parents. However, challenges and preferences were identified, suggesting the need for further research and refinement. Mild to moderate anxiety and specific anxiety types were deemed more suitable for this model of care, while more severe symptomatology or GAD may pose challenges. Clinicians should consider these factors when determining the suitability of this stepped-care ICBT model.

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