Digital CBT Improves Childhood Anxiety Over 2 Years

Key Takeaways

• School-screened Finnish children aged 10 to 13 years with anxiety symptoms had greater improvement with Master Your Worries than with digital educational materials alone.
• Functional ability improved more with the intervention than with the control condition during follow-up.
• Between-group differences were reported in both child and parent assessments at 1 year and 2 years.
• The intervention’s advantage increased between 6 and 12 months and was maintained through 24 months. Earlier RCT-phase analyses suggested greater benefit among children meeting diagnostic criteria for an anxiety disorder, but the 2-year analysis did not establish that benefit increased with symptom severity.

Anxiety disorders affect an estimated 6% to 18% of school-age children and adolescents, yet scalable treatment remains difficult to deliver when specialty pediatric mental health services are limited. In Finland, a remote, parent-supported digital cognitive behavioral therapy (CBT) model was followed over 2 years in children whose symptoms were identified through routine school health screening rather than specialty-clinic referral. The question in that setting was whether gains from guided online care could persist well beyond the active treatment period.

Investigators followed 465 Finnish children aged 10 to 13 years with anxiety symptoms identified through annual school health check-ups in Finland in a JAMA Network Open study of internet-based CBT and telephone coaching for anxiety in children. Children were randomized either to the 10-week Master Your Worries program or to digital materials on anxiety, well-being, and healthy lifestyle. In the intervention arm, the child completed online content with parental support, parents had their own online resources, and families received weekly telephone guidance. The trial compared guided digital care with educational materials alone across later follow-up assessments.

Anxiety symptoms declined in both groups, but improved significantly more with Master Your Worries, and functional ability also improved more in the intervention group. The between-group difference was evident in both children's and parents' assessments at 1 year and 2 years. Investigators said the effect was stronger at 2 years than at 6 months and appeared to keep strengthening between 6 and 12 months after active treatment ended.

Between-group effects on anxiety were small but statistically significant at 12 and 24 months. At the 24-month assessment, data were available for 335 of 465 randomized children (72%), with 130 participants unavailable for follow-up. The investigators used mixed-effects models and multiple-imputation sensitivity analyses to address missing data. The article did not report formal adverse-event outcomes, so its safety profile cannot be fully assessed.

Overall, the JAMA Network Open follow-up linked the guided digital program with greater long-term improvement in anxiety symptoms and functioning than educational materials alone, according to the investigators. Benefits were reported as still present through 2 years in this Finnish school-screened cohort.

Clinician Questions

Which children were included in the Master Your Worries follow-up?

The follow-up involved Finnish children aged 10 to 13 years whose anxiety symptoms were identified through annual school health check-ups, so the cohort reflected population-based school screening in Finland rather than referral from specialty mental health clinics.

What did the Master Your Worries program include beyond online CBT content?

The program lasted 10 weeks and paired the child's online CBT work with parental support, separate online resources for parents, and weekly telephone guidance for the family.

Why did investigators describe a delayed treatment effect with Master Your Worries?

Researchers described the continued post-treatment widening of benefit as a delayed treatment effect and suggested that cognitive and behavioral strategies from therapy may have become more integrated into daily family life over time.