‘E’ therapy in the community: Examination of the uptake and effectiveness of BRAVE (a self-help computer programme for anxiety in children and adolescents) in primary care

OBJECTIVE: Recognizing and treating anxiety early is an important public mental health objective. There is clinical trial evidence that ‘e’ therapies are appealing, engaging and effective and have the potential to improve access to treatment. However, their implementation and effectiveness in real world settings is still emerging. Following a major natural disaster in NZ, an online therapist assisted CBT programme for children with anxiety, (BRAVE_TA) was made available in primary care. METHODS: Uptake and feasibility of BRAVE_TA delivery was assessed by examining referral patterns, non-engagement rates and programme progression within a geographic region of NZ (Canterbury population of around 500,000). Effectiveness of BRAVE_TA was measured by the extent of change in the primary outcome measure of anxiety, the CAS8, between baseline and last completed session. RESULTS: There were 1361 referrals to BRAVE_TA over 2014–2018, mostly from primary care doctors and nurses in primary schools. After attrition due to triage and family withdrawal, 75% (N = 1026) were enrolled. Around half of children/adolescents completed 4 sessions with moderate effect sizes achieved Children/adolescents who completed more sessions, had lower anxiety after their last session, with most of the improvement occurring within the first three to four sessions. CONCLUSION: BRAVE_TA has shown to be an acceptable and effective ‘e’ therapy tool in a ‘real world’ primary care setting for children/adolescents with anxiety. This study supports the role of ‘e’ therapy as part of a stepped-care model within primary care in improving access to treatment and thus improving public mental health in children. Trial registry: ACTRN12612000063819.