A Meta-Analysis on the Efficacy of Technology Mediated CBT for Anxious Children and Adolescents
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Several meta-analyses indicate that cognitive-behavioral therapy (CBT) via electronic/technological devices or applications (i.e., eCBT) is an effective alternative to standard therapist-delivered CBT for anxious adults. However, we know little about the efficacy of eCBT interventions for anxious children and adolescents. The present meta-analysis set out to investigate the efficacy of eCBT in comparison to standard CBT or waitlist control for anxious children and adolescents. Eight randomized controlled studies (N = 404 participants) that targeted anxiety at post-intervention and follow-up were included in the analysis. The results indicated that eCBT was as effective as standard CBT (g = .295) and more effective than waitlist (g = 1.410) in reducing anxiety symptoms. Moderation analyses revealed that anxious children and adolescents benefited the most from eCBT in the minimal therapist involvement condition (g = 2.682) in contrast to the significant therapist involvement group (g = .326). Furthermore, older participants seemed to extract greater clinical benefits from eCBT in contrast to younger participants (slope = .514). Current eCBT interventions for anxious children and adolescents appear to be promising, but require further investigation.
KeywordsAnxiety Children Adolescents Technology CBT Meta-analysis
This work was supported by a Grant of the Romanian National Authority for Scientific Research, CNCS—UEFISCDI, Project number PN-II-PT-PCCA-2011-3.1-1500, contract number 81/2012, coordinated by Dr. Anca Dobrean. Furthermore, Ioana Podina’s contribution to this work was also possible with the financial support of the Sectorial Operational Program for Human Resources Development 2007–2013, co-financed by the European Social Fund, under the project number POSDRU/159/1.5/S/132400 with the title “Young successful researchers—professional development in an international and interdisciplinary environment”. The authors would also like to thank Mirela Mohan proof reading this paper.
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Conflict of interest
The authors declare that they have no conflict of interest.
References marked with an asterisk (*) mark articles included in the meta-analysis.
- Anderson, R. E., Spence, S. H., Donovan, C. L., March, S., Prosser, S., & Kenardy, J. (2012). Working alliance in online cognitive behavior therapy for anxiety disorders in youth: Comparison with clinic delivery and its role in predicting outcome. Journal of Medical Internet Research, 14(3), e88.PubMedCentralCrossRefPubMedGoogle Scholar
- Borenstein, M., Hedges, L. V., Higgins, J. P., & Rothstein, H. R. (2011). Introduction to meta-analysis. London: Wiley.Google Scholar
- Campbell, M. A., & Rapee, R. M. (1996). Current issues in the assessment of anxiety in children and adolescents: A developmental perspective. Behaviour Change, 13(03), 185–193.Google Scholar
- Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, N.J.: Routledge.Google Scholar
- Craske, M. G., & Mystkowski, J. L. (2006). Exposure therapy and extinction: Clinical studies. In M. G. Craske, D. Hermans, & D. Vansteenwegen (Eds.), Fear and learning: From basic processes to clinical implications (pp. 217–233). Washington, DC: American Psychological Association.CrossRefGoogle Scholar
- Cuijpers, P., Donker, T., van Straten, A., Li, J., & Andersson, G. (2010). Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and meta-analysis of comparative outcome studies. Psychological Medicine, 40(12), 1943–1957.CrossRefPubMedGoogle Scholar
- Gren-Landell, M., Björklind, A., Tillfors, M., Furmark, T., Svedin, C. G., & Andersson, G. (2009). Evaluation of the psychometric properties of a modified version of the Social Phobia Screening Questionnaire for use in adolescents. Child and Adolescent Psychiatry and Mental Health, 3, 1–7.CrossRefGoogle Scholar
- Hedges, L. V., & Olkin, I. (2014). Statistical method for meta-analysis. New York: Academic press.Google Scholar
- Hunter, J. E., & Schmidt, F. L. (2004). Methods of meta-analysis: Correcting error and bias in research findings. Beverley Hills: Sage.Google Scholar
- *Maldonado, J. G., Magallón-Neri, E., Rus-Calafell, M., & Peñaloza-Salazar, C. (2009). Virtual reality exposure therapy for school phobia. Anuario de psicología/The UB Journal of Psychology, 40(2), 223–236.Google Scholar
- McGough, J. J., & Faraone, S. V. (2009). Estimating the size of treatment effects: Moving beyond p values. Psychiatry (Edgmont), 6(10), 21.Google Scholar
- Proudfoot, J., Ryden, C., Everitt, B., Shapiro, D. A., Goldberg, D., Mann, A., et al. (2004). Clinical efficacy of computerized cognitive-behavioural therapy for anxiety and depression in primary care: Randomised controlled trial. The British Journal of Psychiatry, 185(1), 46–54.CrossRefPubMedGoogle Scholar
- Reyes-Portillo, J. A., Mufson, L., Greenhill, L. L., Gould, M. S., Fisher, P. W., Tarlow, N., et al. (2014). Web-based interventions for youth internalizing problems: A systematic review. Journal of the American Academy of Child and Adolescent Psychiatry, 53(12), 1254–1270.CrossRefPubMedGoogle Scholar
- Reynolds, C. R., & Richmond, B. O. (1985). What I think and feel (RCMAS). Los Angeles, CA: Western Psychological Services.Google Scholar
- Rosenthal, R. (1991). Meta-analytic procedures for social research. Revised edition. Applied social research methods series.Google Scholar
- Stallard, P., Montgomery, A. A., Araya, R., Anderson, R., Lewis, G., Sayal, K., et al. (2010). Protocol for a randomised controlled trial of a school based cognitive behaviour therapy (CBT) intervention to prevent depression in high risk adolescents (PROMISE). Trials, 11(114), 6215-11.Google Scholar
- Stasiak, K., Hatcher, S., Frampton, C., & Merry, S. N. (2012). A pilot double blind randomized placebo controlled trial of a prototype computer-based cognitive behavioural therapy program for adolescents with symptoms of depression. Behavioural and Cognitive Psychotherpy, 20, 1–17.Google Scholar
- *St-Jacques, J., Bouchard, S., & Bélanger, C. (2010). Is virtual reality effective to motivate and raise interest in phobic children toward therapy? A clinical trial study of in vivo with in virtuo versus in vivo only treatment exposure. The Journal of Clinical Psychiatry, 71(7), 924–931.CrossRefPubMedGoogle Scholar
- *Wuthrich, V. M., Rapee, R. M., Cunningham, M. J., Lyneham, H. J., Hudson, J. L., & Schniering, C. A. (2012). A randomized controlled trial of the Cool Teens CD-ROM computerized program for adolescent anxiety. Journal of the American Academy of Child and Adolescent Psychiatry, 51(3), 261–270.CrossRefPubMedGoogle Scholar