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Using stepped-care approaches within internet-based interventions for youth anxiety: Three case studies

BACKGROUND: There are a lack of clear guidelines for the dissemination of Internet-based cognitive behaviour therapy (ICBT) for childhood and adolescent anxiety in routine care. While self-guided ICBT has greater reach than therapist-guided ICBT, it is plagued by problems of low program adherence an...

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Autores principales: March, Sonja, Donovan, Caroline L., Baldwin, Sarah, Ford, Martelle, Spence, Susan H.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6926334/
https://www.ncbi.nlm.nih.gov/pubmed/31890629
http://dx.doi.org/10.1016/j.invent.2019.100281
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author March, Sonja
Donovan, Caroline L.
Baldwin, Sarah
Ford, Martelle
Spence, Susan H.
author_facet March, Sonja
Donovan, Caroline L.
Baldwin, Sarah
Ford, Martelle
Spence, Susan H.
author_sort March, Sonja
collection PubMed
description BACKGROUND: There are a lack of clear guidelines for the dissemination of Internet-based cognitive behaviour therapy (ICBT) for childhood and adolescent anxiety in routine care. While self-guided ICBT has greater reach than therapist-guided ICBT, it is plagued by problems of low program adherence and many young people are not successfully treated. It is important that we identify models of ICBT that are accessible, but provide the right support, at the right time to those who need it. Stepped-care models of ICBT offer one potential solution. OBJECTIVE: This case study examined the application of stepped-care within an ICBT intervention for childhood and adolescent anxiety, in which young people were stepped up from self-guided to therapist-guided ICBT. METHODS: Three case studies are presented and include young males (aged 11–12 years) who participated in BRAVE Stepped-Care, a new ICBT program incorporating two treatment steps: Step 1 – five sessions of self-guided ICBT and Step 2 – five sessions of therapist-guided ICBT. Participants completed diagnostic assessments at pre- and post-treatment, along with a battery of self-report questionnaires. Step-up requirements were determined at a mid-treatment assessment. Treatment response was determined by change on diagnostic severity and presence of diagnosis and changes in self-reported anxiety symptoms (through T-scores and Reliable Change Indices). RESULTS: In-depth examination of the three case studies showed that decisions to step-up from Step 1 to Step 2 were complex and required consideration of program engagement and adherence, as well as changes on self-reported anxiety, behavioural indicators of anxiety and parent perspectives. Results showed that non-responders at mid-treatment who were stepped-up to therapist-guided ICBT after Step 1 were able to increase engagement and response to treatment in Step 2, such that they were free of their primary anxiety diagnosis at post-treatment. CONCLUSIONS: The findings highlight the importance of early assessment of engagement and non-response within self-guided ICBT programs for youth anxiety and the positive changes that can subsequently occur when therapist-guidance is introduced mid-treatment for non-responders. The efficacy of stepped-care ICBT models needs to be confirmed in larger randomised controlled trials.
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spelling pubmed-69263342019-12-30 Using stepped-care approaches within internet-based interventions for youth anxiety: Three case studies March, Sonja Donovan, Caroline L. Baldwin, Sarah Ford, Martelle Spence, Susan H. Internet Interv ISRII meeting 2019 special issue: Guest edited by Gerhard Anderson, Sonja March and Mathijs Lucassen BACKGROUND: There are a lack of clear guidelines for the dissemination of Internet-based cognitive behaviour therapy (ICBT) for childhood and adolescent anxiety in routine care. While self-guided ICBT has greater reach than therapist-guided ICBT, it is plagued by problems of low program adherence and many young people are not successfully treated. It is important that we identify models of ICBT that are accessible, but provide the right support, at the right time to those who need it. Stepped-care models of ICBT offer one potential solution. OBJECTIVE: This case study examined the application of stepped-care within an ICBT intervention for childhood and adolescent anxiety, in which young people were stepped up from self-guided to therapist-guided ICBT. METHODS: Three case studies are presented and include young males (aged 11–12 years) who participated in BRAVE Stepped-Care, a new ICBT program incorporating two treatment steps: Step 1 – five sessions of self-guided ICBT and Step 2 – five sessions of therapist-guided ICBT. Participants completed diagnostic assessments at pre- and post-treatment, along with a battery of self-report questionnaires. Step-up requirements were determined at a mid-treatment assessment. Treatment response was determined by change on diagnostic severity and presence of diagnosis and changes in self-reported anxiety symptoms (through T-scores and Reliable Change Indices). RESULTS: In-depth examination of the three case studies showed that decisions to step-up from Step 1 to Step 2 were complex and required consideration of program engagement and adherence, as well as changes on self-reported anxiety, behavioural indicators of anxiety and parent perspectives. Results showed that non-responders at mid-treatment who were stepped-up to therapist-guided ICBT after Step 1 were able to increase engagement and response to treatment in Step 2, such that they were free of their primary anxiety diagnosis at post-treatment. CONCLUSIONS: The findings highlight the importance of early assessment of engagement and non-response within self-guided ICBT programs for youth anxiety and the positive changes that can subsequently occur when therapist-guidance is introduced mid-treatment for non-responders. The efficacy of stepped-care ICBT models needs to be confirmed in larger randomised controlled trials. Elsevier 2019-09-10 /pmc/articles/PMC6926334/ /pubmed/31890629 http://dx.doi.org/10.1016/j.invent.2019.100281 Text en © 2019 The Authors http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle ISRII meeting 2019 special issue: Guest edited by Gerhard Anderson, Sonja March and Mathijs Lucassen
March, Sonja
Donovan, Caroline L.
Baldwin, Sarah
Ford, Martelle
Spence, Susan H.
Using stepped-care approaches within internet-based interventions for youth anxiety: Three case studies
title Using stepped-care approaches within internet-based interventions for youth anxiety: Three case studies
title_full Using stepped-care approaches within internet-based interventions for youth anxiety: Three case studies
title_fullStr Using stepped-care approaches within internet-based interventions for youth anxiety: Three case studies
title_full_unstemmed Using stepped-care approaches within internet-based interventions for youth anxiety: Three case studies
title_short Using stepped-care approaches within internet-based interventions for youth anxiety: Three case studies
title_sort using stepped-care approaches within internet-based interventions for youth anxiety: three case studies
topic ISRII meeting 2019 special issue: Guest edited by Gerhard Anderson, Sonja March and Mathijs Lucassen
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6926334/
https://www.ncbi.nlm.nih.gov/pubmed/31890629
http://dx.doi.org/10.1016/j.invent.2019.100281
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