Guided iCBT Linked to Sustained Child Anxiety Improvement

A 2-year follow-up of the Master Your Worries trial found that telephone-guided internet-based cognitive behavioral therapy (iCBT) was associated with greater reductions in child- and parent-reported anxiety than digital psychoeducation among Finnish children. The cohort analysis, published in JAMA Network Open, included 465 children aged 10 to 13 years.

The original randomized clinical trial was conducted from August 2017 through January 2020 across 6 school-based study sites in Finland. Children with elevated anxiety symptoms were eligible if they scored at least 22 on the 41-item Screen for Child Anxiety Related Disorders–Child version (SCARED-C); 234 were assigned to the intervention and 231 to the control group. The intervention comprised 10 weeks of internet-based therapy with weekly telephone coaching for children and parents, while the control group received digital psychoeducation. The primary outcomes were changes in child- and parent-reported SCARED total scores.

At 24 months, the reduction in SCARED-C total score was 4.4 points greater with iCBT than with psychoeducation (P = .001; Cohen d = 0.29). The reduction in the parent-reported score was 2.3 points greater (P = .04; Cohen d = 0.19). Both groups improved from baseline, although the between-group effect sizes were small.

Anxiety scores decreased significantly only in the intervention group between 6 and 12 months, and the improvements were maintained from 12 to 24 months. At 24 months, 335 (72%) of the participants provided data. The authors noted that follow-up relied on child and parent reports without diagnostic reassessment, some higher-risk families were excluded, and overall effect sizes were small.

The investigators concluded that early identification combined with guided iCBT—or even digital psychoeducation—was associated with sustained improvement in symptoms and daily functioning for up to 24 months. They characterized iCBT’s added effectiveness as modest.

Source: Sourander A, Kaajalaakso K, Korpilahti-Leino T, et al. Internet-based cognitive behavioral therapy and telephone coaching for anxiety in children. JAMA Netw Open. 2026;9(8):e2629195. doi:10.1001/jamanetworkopen.2026.29195