Development and Preliminary Evaluation of a New Internet-Delivered Cognitive Behavioral Intervention for Youths With Anxiety Disorders

Lund University1 site in 1 country48 target enrollmentDecember 12, 2025

ConditionsANXIETY DISORDERS (or Anxiety and Phobic Neuroses)Specific Phobia Social Anxiety Disorder Separation Anxiety Disorder Generalized Anxiety Disorder Panic Disorder Agoraphobia

InterventionsInternet-Delivered Cognitive Behavioral Therapy

Overview

Phase: Not Applicable
Intervention: Internet-Delivered Cognitive Behavioral Therapy
Conditions: ANXIETY DISORDERS (or Anxiety and Phobic Neuroses)
Sponsor: Lund University
Enrollment: 48
Locations: 1
Primary Endpoint: Pediatric Anxiety Rating Scale (PARS)
Status: Recruiting
Last Updated: 2 months ago

Overview Investigators Eligibility Criteria Arms & Interventions Outcomes Sites Similar Trials

Overview

Brief Summary

The goal of this study is to develop a new internet-delivered cognitive behavioral therapy (ICBT) intervention for youths with anxiety disorders based on the best current knowledge about effective cognitive behavioral therapy for the target group, refine the intervention in collaboration with patient and public representatives, and conduct a preliminary evaluation of the treatment effects in an open clinical trial.

The primary objective of the study is:

1. To evaluate the preliminary efficacy of a newly developed ICBT intervention for children and adolescents with anxiety disorders in reducing anxiety severity, as measured by the Pediatric Anxiety Rating Scale (PARS).

Secondary objectives of the study are:

To examine the preliminary efficacy (PARS) of the ICBT intervention at 3 months post-treatment.
To examine how youths with anxiety disorders, their caregivers, therapists, and healthcare leadership experience the ICBT intervention.
To examine factors (e.g., age, type of anxiety disorder, presence of depressive symptoms, experiences of ICBT) that predict treatment outcome.
To examine how the ICBT intervention can be improved (e.g., treatment content and technical delivery) for future use.

Participants will:

Undergo ICBT treatment for anxiety disorders during 12 weeks
Complete questionnaires at multiple time points throughout the study
Participate in follow-ups post-treatment and 3 months post-treatment
A selection of participants will also be invited to focus group interviews with the aim to generate ideas on how the intervention may be improved for future use

Detailed Description

A detailed description is available in the full study protocol. All full study protocol versions may be accessed at the Open Science Framework (https://osf.io/fdnga/).

Registry

clinicaltrials.gov

Start Date

December 12, 2025

End Date

June 1, 2027

Last Updated

2 months ago

Study Type

Interventional

Study Design

Single Group

Sex

All

Investigators

Sponsor

Lund University

Responsible Party

Sponsor

Eligibility Criteria

Inclusion Criteria

•1\) 8 to \<18 years of age.
•Confirmed by the child/caregiver and subsequently by the medical record system. 2) A principal DSM-5-TR anxiety disorder of specific phobia, separation anxiety disorder, social anxiety disorder, generalized anxiety disorder, panic disorder or agoraphobia.
•Confirmed by the Diagnostic Interview for Anxiety, Mood, and OCD and related Neuropsychiatric Disorders - Child and Adolescent Version (DIAMOND-KID).
•3\) Child and caregiver able to read, write and communicate in Swedish.
•Confirmed by the child/caregiver. 4) An available caregiver who can support the child in treatment.
•Confirmed by the caregiver. 5) Access to a smartphone, tablet, or laptop/desktop device, and the internet.
•Confirmed by the child/caregiver.

Exclusion Criteria

•1\) Principal DSM-5-TR anxiety disorder of specific phobia concerning the domain of blood-injection-injury (due to the ICBT program not including relevant information on applied-tension techniques to avoid fainting during exposure exercises).
•Confirmed by a blood-injection-injury phobia being classified as the principal anxiety disorder as assessed by the DIAMOND-KID.
•2\) Established or suspected intellectual disability.
•Confirmed by the caregiver (through previous diagnosis) and/or by attending a special needs school for learning difficulties.
•3\) Another mental disorder in more immediate need of management than an anxiety disorder (e.g., schizophrenia spectrum and other psychotic disorders, bipolar disorder, anorexia nervosa, substance use disorders).
•According to the DIAMOND-KID and/or other available sources. 4) Social/familial/educational difficulties in more immediate need of management than an anxiety disorder.
•Confirmed by the assessor through information from the child/caregiver and/or other available sources.
•5\) Immediate risk to self or others that require urgent attention, such as acute suicidality.
•Confirmed by the assessor through information from the child/caregiver and other available sources.
•6\) Previous CBT for an anxiety disorder, defined as five or more sessions with a certified CBT therapist within the 12 months prior to assessment.

Arms & Interventions

Internet-Delivered Cognitive-Behavioral Therapy

Includes the intervention Internet-Delivered Cognitive-Behavioral Therapy.

Intervention: Internet-Delivered Cognitive Behavioral Therapy

Outcomes

Primary Outcomes

Pediatric Anxiety Rating Scale (PARS)

Time Frame: Baseline; post-treatment (window of 12 to 18 weeks post-enrollment); 3-months post-treatment (window of 23 to 31 weeks post-enrollment).

Used to assess anxiety severity. Clinician-rated. The scale yields a score of 0 to 35, with higher scores indicating more severe anxiety.

Secondary Outcomes

Diagnostic Interview for Anxiety, Mood, and OCD and Related Neuropsychiatric Disorders - Child and Adolescent Version (DIAMOND-KID)(Baseline; post-treatment (window of 12 to 18 weeks post-enrollment); 3-months post-treatment (window of 23 to 31 weeks post-enrollment).)
Clinical Global Impression Scale - Severity (CGI-S)(Baseline; post-treatment (window of 12 to 18 weeks post-enrollment); 3-months post-treatment (window of 23 to 31 weeks post-enrollment).)
Clinical Global Impression Scale - Improvement (CGI-I)(Baseline; post-treatment (window of 12 to 18 weeks post-enrollment); 3-months post-treatment (window of 23 to 31 weeks post-enrollment).)
Children's Global Assessment Scale (CGAS)(Baseline; post-treatment (window of 12 to 18 weeks post-enrollment); 3-months post-treatment (window of 23 to 31 weeks post-enrollment).)
Therapist time(Consecutively throughout the 12 week treatment period.)
Module completion(Consecutively throughout the 12 week treatment period.)
Number of participants with concomitant interventions(Post-treatment (window of 12 to 18 weeks post-enrollment); 3-months post-treatment (window of 23 to 31 weeks post-enrollment).)
Revised Child Anxiety and Depression Scale - Child version (RCADS-C)(Baseline; post-treatment (window of 12 to 18 weeks post-enrollment); 3-months post-treatment (window of 23 to 31 weeks post-enrollment).)
Child Anxiety Life Interference Scale - Revised - Child version (CALIS-R-C)(Baseline; post-treatment (window of 12 to 18 weeks post-enrollment); 3-months post-treatment (window of 23 to 31 weeks post-enrollment).)
Patient Health Questionnaire-2 (PHQ-2)(Baseline; 3, 6, and 9 weeks into treatment; post-treatment (window of 12 to 18 weeks post-enrollment); 3-months post-treatment (window of 23 to 31 weeks post-enrollment).)
Generalized Anxiety Disorder-2 (GAD-2)(Baseline; 3, 6, and 9 weeks into treatment; post-treatment (window of 12 to 18 weeks post-enrollment); 3-months post-treatment (window of 23 to 31 weeks post-enrollment).)
Well-being(Baseline; 3, 6, and 9 weeks into treatment; post-treatment (window of 12 to 18 weeks post-enrollment); 3-months post-treatment (window of 23 to 31 weeks post-enrollment).)
Mood and Feelings Questionnaire (MFQ) - Suicidality item(Baseline; 3, 6, and 9 weeks into treatment; post-treatment (window of 12 to 18 weeks post-enrollment); 3-months post-treatment (window of 23 to 31 weeks post-enrollment).)
Experiences of CBT - Child version(Baseline; 3, 6, and 9 weeks into treatment; post-treatment (window of 12 to 18 weeks post-enrollment).)
Working alliance - Child version(3, 6, and 9 weeks into treatment.)
Adverse events questionnaire - Child version (AEQ-C)(3, 6, and 9 weeks into treatment; post-treatment (window of 12 to 18 weeks post-enrollment).)
Client Satisfaction Questionnaire - Child version (CSQ-8-C)(Post-treatment (window of 12 to 18 weeks post-enrollment).)
Need for treatment - Child version(Baseline; post-treatment (window of 12 to 18 weeks post-enrollment); 3-months post-treatment (window of 23 to 31 weeks post-enrollment).)
Revised Child Anxiety and Depression Scale - Parent version (RCADS-P)(Baseline; post-treatment (window of 12 to 18 weeks post-enrollment); 3-months post-treatment (window of 23 to 31 weeks post-enrollment).)
Child Anxiety Life Interference Scale - Revised - Parent version (CALIS-R-P)(Baseline; post-treatment (window of 12 to 18 weeks post-enrollment); 3-months post-treatment (window of 23 to 31 weeks post-enrollment).)
Experiences of CBT - Parent version(Baseline; 3, 6, and 9 weeks into treatment; post-treatment (window of 12 to 18 weeks post-enrollment).)
Working alliance - Parent version(3, 6, and 9 weeks into treatment.)
Adverse events questionnaire - Parent version (AEQ-P)(3, 6, and 9 weeks into treatment; post-treatment (window of 12 to 18 weeks post-enrollment).)
Client Satisfaction Questionnaire - Parent version (CSQ-8-P)(Post-treatment (window of 12 to 18 weeks post-enrollment).)
Need for treatment - Parent version(Baseline; post-treatment (window of 12 to 18 weeks post-enrollment); 3-months post-treatment (window of 23 to 31 weeks post-enrollment).)
Avoidance and Fusion Questionnaire for Youth (AFQ-Y8)(Baseline.)
The Cognitive-attentional Syndrome Questionnaire (CAS-1)(Baseline.)
Swanson, Nolan, and Pelham Rating Scale (SNAP-IV)(Baseline.)
Core autism traits - Child version(Baseline.)
Core autism traits - Parent version(Baseline.)
Focus groups(From week 12 and onwards (no specified end date in the study protocol).)