In response to the COVID-19 public health crisis in 2020, PCORI launched an initiative to enhance existing research projects so that they could offer findings related to COVID-19. The initiative funded this study and others.
For youth with anxiety or obsessive-compulsive disorder (OCD), lack of mental health providers can limit access to cognitive behavioral therapy (CBT). The COVID-19 pandemic led to a shift toward telehealth. Team-based telehealth CBT could expand access to mental health care by increasing the availability of providers and facilitating access to treatment at a time when anxiety and OCD symptoms among youth have increased.
To describe how team-based telehealth CBT affected treatment engagement and mental health outcomes among youth with anxiety or OCD
|Descriptive non-randomized study that complements an ongoing RCT comparing 2 ways to provide CBT
|46 youth ages 5–18 with anxiety or OCD diagnosis and 46 caregivers
Treatment engagement, including treatment attendance and session homework completion
Youth- and caregiver-reported outcomes: therapeutic alliance (bond and collaboration with therapist), treatment satisfaction, anxiety and OCD symptoms, quality of life and disability associated with symptoms
CBT provider-reported outcomes: anxiety and OCD symptoms, functional impairment
|Data Collection Timeframe
|June 2020–July 2021
This study, complementing an ongoing randomized controlled trial (RCT), examined team-based CBT via telehealth for youth with anxiety or OCD.
In the ongoing RCT, researchers are comparing in-person, team-based CBT versus standard care with a psychologist for youth with anxiety or OCD. Due to COVID-19, researchers temporarily halted recruitment to two in-person treatment arms in spring 2020 and opened enrollment to team-based telehealth CBT.
Youth received up to six months of weekly telehealth CBT to manage anxiety or OCD. Youth met with a psychologist monthly and a coach, who had a college degree and additional training, all other weeks.
At baseline, every six weeks during treatment, and one to two weeks after treatment, youth, caregivers, and the psychologists and coaches who provided CBT completed surveys. Youth and caregivers completed surveys about therapeutic alliance, treatment satisfaction, symptoms, quality of life, and disability. CBT providers completed surveys about symptoms and functional impairment.
The study included 46 youth ages 5–18 with anxiety or OCD and their caregivers. All youth received treatment through the Pediatric Anxiety Research Center in Rhode Island. Among youth, 87% were White; 2% were Black; 2% were Asian; 3% were Hawaiian, Pacific Islander, or Alaska Native; and 7% were multi-racial; 9% were Hispanic. The average age was 11, and 50% were female.
Patients, family members, hospital leadership, therapists, patient advocates, and insurers provided input on study design.
On average, youth completed 19 of 24 treatment sessions. Youth reported moderately strong therapeutic alliance (38.4 of 48 points), while caregivers reported strong alliance (45 of 48 points). Youth and caregivers generally reported high treatment satisfaction.
From baseline to posttreatment:
- For anxiety, youth and clinicians reported a decrease in symptoms (both p<0.001).
- For OCD, CBT providers reported a decrease in symptoms (p<0.001). Youth also reported a decrease in symptoms, but the decrease was not clinically meaningful.
- Caregivers reported an improvement in youths’ quality of life (p=0.02), but youth did not.
- Caregivers did not report a decrease in youth disability, but youth did (p=0.006).
The sample size was small, and most participants were White, limiting generalizability of results. Without a comparison, this study cannot establish, with certainty, that changes from before to after the team-based telehealth CBT were due to this intervention.
Conclusions and Relevance
This study suggested effectiveness of team-based telehealth CBT for youth with anxiety and OCD. Having coaches with a college education supervised by a psychologist provide telehealth CBT may help expand access to mental health care.