Optimizing indicated cognitive behavioral therapy to prevent child anxiety and depression: A cluster-randomized factorial trial

• Published in: Behaviour research and therapy Vol. 176; p. 104520
• Main Authors: Lisøy, Carina, Neumer, Simon-Peter, Adolfsen, Frode, Ingul, Jo Magne, Potulski Rasmussen, Lene-Mari, Wentzel-Larsen, Tore, Patras, Joshua, Sund, Anne Mari, Ytreland, Kristin, Waaktaar, Trine, Holen, Solveig, Askeland, Anne Liv, Haug, Ida Mari, Bania, Elisabeth Valmyr, Martinsen, Kristin
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.05.2024
• Subjects: Anxiety; Children; Cognitive behavioral therapy; Depression; Factorial design; Indicated prevention; Depression; Anxiety; Children; Factorial design; Indicated prevention; Cognitive behavioral therapy
• ISSN: 0005-7967; 1873-622X; 1873-622X
• DOI: 10.1016/j.brat.2024.104520

Identifying effective components can lead to interventions that are less resource-intensive and better suited for real-world needs. In this 2×2×2 cluster-randomized factorial trial (clinicaltrials.gov NCT04263558), we investigated the effects of three components of an indicated, transdiagnostic CBT intervention for children: 1) Intervention Delivery Format (child group format versus a blended format with group sessions and automated web-based sessions), 2) Parental Involvement in the intervention (group-based versus psychoeducational brochure), and 3) a Measurement Feedback System (MFS; on versus off). The intervention was delivered at schools in a group-based format. The participants (N = 701 children) were school children (age 8–12 years) with elevated symptoms of anxiety or depression, and their parents. The main outcomes were self-reported (N = 633) and parent-reported (N = 725) symptoms of child anxiety and depression post-intervention. The secondary outcome was children's user satisfaction with the intervention. We did not find significant main or interaction effects of Delivery Format, Parental Involvement, or MFS on children's symptom levels. There were no significant effects on children's user satisfaction. Results were compatible with retaining the least resource intensive combination (i.e., blended format, parental brochure, no MFS) in an optimized intervention. •Large factorial 23 trial for an indicated intervention addressing child anxiety and depression.•Examined Intervention Delivery Format, Parental Involvement, and a Measurement Feedback System.•No significant effects of Intervention Delivery Format (blended group/digital vs group format).•No evidence for effects of Parental Involvement (high parental involvement vs a brochure).•Using MFS did not significantly enhance child outcomes compared to not using MFS.