Anxiety disorders are among the most prevalent psychiatric disorders in adolescents, and they can have profound effects on adolescents’ well-being. Cognitive-behavioral therapy (CBT) has been established as the gold-standard treatment for adolescent anxiety disorders due to its effectiveness in reducing adolescents’ anxiety and associated impairments. In recent years, intensive CBT protocols have emerged for treating adolescent anxiety. The content of these treatments typically reflects conventional CBT protocols, but treatment is provided over a shorter period or through fewer sessions, with the goal of providing patients with more immediate relief. As one example of such treatments, the principal investigator of the study developed and piloted an intensive CBT treatment for adolescent anxiety (IT-CBT) that exhibited marked efficacy in treating youth with a range of anxiety disorders. To further expand the accessibility of the treatment, a randomized controlled trial comparing the in-person and virtual delivery of this treatment was initiated. To illustrate IT-CBT’s potential utility as a virtual treatment, this case study describes a 15-year-old girl with a specific phobia of vomiting and subclinical generalized anxiety symptoms who completed IT-CBT virtually. Results from this adolescent case example and others suggest that virtual IT-CBT may be feasible and efficacious for treating adolescent anxiety disorders.
AngelosanteA. G.PincusD. B.WhittonS. W.CheronD.PianJ. (2009). Implementation of an intensive treatment protocol for adolescents with panic disorder and agoraphobia. Cognitive and Behavioral Practice, 16(3), 345–357. https://doi.org/10.1016/j.cbpra.2009.03.002
BlackstockJ.ChaeK. B.MaukG. W.McDonaldA. (2018). Achieving access to mental health care for school-aged children in rural communities. Rural Educator, 39(1), 12. https://doi.org/10.35608/ruraled.v39i1.212
4.
CarpenterA. L.PincusD. B.FurrJ. M.ComerJ. S. (2018). Working from home: An initial pilot examination of videoconferencing-based cognitive behavioral therapy for anxious youth delivered to the home setting. Behavior Therapy, 49(6), 917–930. https://doi.org/10.1016/j.beth.2018.01.007
5.
ComerJ. S.RoyA. K.FurrJ. M.GotimerK.BeidasR. S.DugasM. J.KendallP. C. (2009). The intolerance of uncertainty scale for children: A psychometric evaluation. Psychological Assessment, 21(3), 402–411. https://doi.org/10.1037/a0016719
6.
Cooper-VinceC. E.ChouT.FurrJ. M.PuliaficoA. C.ComerJ. S. (2016). Videoteleconferencing early child anxiety treatment: A case study of the internet- delivered PCIT CALM (I-CALM) program. Evidence-Based Practice in Child and Adolescent Mental Health, 1(1), 24–39. https://doi.org/10.1080/23794925.2016.1191976
7.
CornacchioD.FurrJ.SanchezA.HongN.FeinbergL.TenenbaumR.BustoC.BryL.PoznanskiB.MiguelE.OllendickT.KurtzS.ComerJ. (2019). Intensive group behavioral treatment (IGBT) for children with selective mutism: A preliminary randomized clinical trial. Journal of Consulting and Clinical Psychology, 87(8), 720–733. https://doi.org/10.1037/ccp0000422
8.
CraskeM. G.KircanskiK.ZelikowskyM.MystkowskiJ.ChowdhuryN.BakerA. (2008). Optimizing inhibitory learning during exposure therapy. Behaviour Research and Therapy, 46(1), 5–27. https://doi.org/10.1016/j.brat.2007.10.003
9.
CraskeM. G.LiaoB.BrownL.VervlietB. (2012). Role of inhibition in exposure therapy. Journal of Experimental Psychopathology, 3(3), 322–345. https://doi.org/10.5127/jep.026511
10.
CummingsC.CaporinoN.KendallP. (2014). Comorbidity of anxiety and depression in children and adolescents: 20 years after. Psychological Bulletin, 140(3), 816–845. https://doi.org/10.1037/a0034733
11.
DavisT. E. I.MunsonM. S.TarczaE. V. (2009). Anxiety disorders and phobias. In MatsonJ. L. (Ed.), Social behavior and skills in children (pp. 219–243). Springer Science + Business Media.
12.
de LijsterJ. M.DielemanG. C.UtensE. M. W. J.DierckxB.WierengaM.VerhulstF. C.LegersteeJ. S. (2018). Social and academic functioning in adolescents with anxiety disorders: A systematic review. Journal of Affective Disorders, 230(1), 108–117. https://doi.org/10.1016/j.jad.2018.01.008
13.
DonovanC. L.CobhamV.WatersA. M.OcchipintiS. (2015). Intensive group-based CBT for child social phobia: A pilot study. Behavior Therapy, 46(3), 350–364. https://doi.org/10.1016/j.beth.2014.12.005
14.
EssauC. A.LewinsohnP. M.OlayaB.SeeleyJ. R. (2014). Anxiety disorders in adolescents and psychosocial outcomes at age 30. Journal of Affective Disorders, 163(2), 125–132. https://doi.org/10.1016/j.jad.2013.12.033
FraccaroR. L.StelnickiA. M.NordstokkeD. W. (2015). Test review: Multidimensional anxiety scale for children by J. S. March. Canadian Journal of School Psychology, 30(1), 70–77. https://doi.org/10.1177/0829573514542924
17.
GalloK. P.ChanP. T.BuzzellaB. A.WhittonS. W.PincusD. B. (2012). The impact of an 8-day intensive treatment for adolescent panic disorder and agoraphobia on comorbid diagnoses. Behavior Therapy, 43(1), 153–159. https://doi.org/10.1016/j.beth.2011.05.002
18.
Hajesmaeel-GohariS.BahaadinbeigyK. (2021). The most used questionnaires for evaluating telemedicine services. BMC Medical Informatics and Decision Making, 21(1), 36. https://doi.org/10.1186/s12911-021-01407-y
19.
Higa-McMillanC. K.FrancisS. E.Rith-NajarianL.ChorpitaB. F. (2016). Evidence base update: 50 years of research on treatment for child and adolescent anxiety. Journal of Clinical Child and Adolescent Psychology, 45(2), 91–113. https://doi.org/10.1080/15374416.2015.1046177
20.
HudsonJ. L.McLellanL. F.EapenV.RapeeR. M.WuthrichV.LynehamH. J. (2023). Combining CBT and sertraline does not enhance outcomes for anxious youth: A double-blind randomised controlled trial. Psychological Medicine, 53(5), 1741–1749. https://doi.org/10.1017/S0033291721003329
21.
KazdinA. E.HollandL.CrowleyM.BretonS. (1997). Barriers to treatment participation scale: Evaluation and validation in the context of child outpatient treatment. The Journal of Child Psychology and Psychiatry and Allied Disciplines, 38(8), 1051–1062. https://doi.org/10.1111/j.1469-7610.1997.tb01621.x
22.
KellerA. E.LangerD. A.PincusD. B.ElkinsR. M.KernsC. E.ComerJ. S. (2019). A psychometric evaluation of the distress intolerance index for youth. Journal of Psychopathology and Behavioral Assessment, 41(3), 447–455.
23.
KellerM. B.LavoriP. W.WunderJ.BeardsleeW. R.SchwartzC. E.RothJ. (1992). Chronic course of anxiety disorders in children and adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 31(4), 595–599. https://doi.org/10.1097/00004583-199207000-00003
24.
KodalA.FjermestadK.BjellandI.GjestadR.ÖstL.-G.BjaastadJ. F.HauglandB. S. M.HavikO. E.HeiervangE.WergelandG. J. (2018). Long-term effectiveness of cognitive behavioral therapy for youth with anxiety disorders. Journal of Anxiety Disorders, 53, 58–67. https://doi.org/10.1016/j.janxdis.2017.11.003
25.
KovacsM.DevlinB. (1998). Internalizing disorders in childhood. The Journal of Child Psychology and Psychiatry and Allied Disciplines, 39(1), 47–63. https://doi.org/10.1017/S0021963097001765
26.
MarchJ. S. (2013). Multidimensional anxiety scale for Children–2nd edition: Technical manual. Multi-Health Systems.
27.
MarchJ. S.ParkerJ. D. A.SullivanK.StallingsP.ConnersC. K. (1997). The multidimensional anxiety scale for children (MASC): Factor structure, reliability, and validity. Journal of the American Academy of Child & Adolescent Psychiatry, 36(4), 554–565. https://doi.org/10.1097/00004583-199704000-00019
28.
MerikangasK. R.HeJ.BursteinM.SwendsenJ.AvenevoliS.CaseB.GeorgiadesK.HeatonL.SwansonS.OlfsonM. (2011). Service utilization for lifetime mental disorders in U.S. adolescents: Results of the National Comorbidity Survey–Adolescent Supplement (NCS-A). Journal of the American Academy of Child & Adolescent Psychiatry, 50(1), 32–45. https://doi.org/10.1016/j.jaac.2010.10.006
29.
MerikangasK. R.NakamuraE. F.KesslerR. C. (2009). Epidemiology of mental disorders in children and adolescents. Dialogues in Clinical Neuroscience, 11(1), 7–20. https://doi.org/10.31887/DCNS.2009.11.1/krmerikangas
30.
OsmanağaoğluN.CreswellC.DoddH. F. (2018). Intolerance of uncertainty, anxiety, and worry in children and adolescents: A meta-analysis. Journal of Affective Disorders, 225(1), 80–90. https://doi.org/10.1016/j.jad.2017.07.035
31.
ÖstL.-G.OllendickT. (2017). Brief, intensive and concentrated cognitive behavioral treatments for anxiety disorders in children: A systematic review and meta-analysis. Behaviour Research and Therapy, 97(1), 134–145. https://doi.org/10.1016/j.brat.2017.07.008
32.
ParmantoB.LewisA. N.Jr.GrahamK. M.BertoletM. H. (2016). Development of the telehealth usability questionnaire (TUQ). International Journal of Telerehabilitation, 8(1), 3–10. https://doi.org/10.5195/ijt.2016.6196
33.
PatrickD. L.EdwardsT. C. (2013). Youth quality of life instrument (Research version). Seattle Quality of Life Group.
34.
PatrickD. L.EdwardsT. C.TopolskiT. D. (2002). Adolescent quality of life, Part II: Initial validation of a new instrument. Journal of Adolescence, 25(3), 287–300. https://doi.org/10.1006/jado.2002.0471
35.
PincusD. B.EhrenreichJ. T.MattisS. G. (2008). Mastery of anxiety and panic for adolescents: Therapist guide: Riding the wave. Oxford University Pres.
36.
RockhillC.KodishI.DiBattistoC.MaciasM.VarleyC.RyanS. (2010). Anxiety disorders in children and adolescents. Current Problems in Pediatric and Adolescent Health Care, 40(4), 66–99. https://doi.org/10.1016/j.cppeds.2010.02.002
37.
SalloumA.JohncoC.LewinA. B.McBrideN. M.StorchE. A. (2016). Barriers to access and participation in community mental health treatment for anxious children. Journal of Affective Disorders, 196(1), 54–61. https://doi.org/10.1016/j.jad.2016.02.026
38.
SchnieringC. A.LynehamH. J. (2007). The children’s automatic thoughts scale in a clinical sample: Psychometric properties and clinical utility. Behaviour Research and Therapy, 45(8), 1931–1940. https://doi.org/10.1016/j.brat.2006.09.009
39.
SchnieringC. A.RapeeR. M. (2002). Development and validation of a measure of children’s automatic thoughts: The Children’s automatic thoughts scale. Behaviour Research and Therapy, 40(9), 1091–1109. https://doi.org/10.1016/S0005-7967(02)00022-0
