Mental health issues affect a large number of children and young people, with high demand for services that often result in long waiting lists. This blog delves into a recent study that explored the effectiveness of a digitally augmented psychological therapy for child anxiety compared to standard treatment.
The study focused on non-inferiority, aiming to determine if the digitally augmented therapy was at least as effective as standard treatment. Results showed that the digitally augmented therapy was as effective as treatment as usual, indicating its potential to improve efficiency without compromising effectiveness.
A significant proportion of children and young people experience difficulties with anxiety, but the wait for treatment can be long. We need to increase the efficiency of delivering treatments, but without losing effectiveness.
Methods
The study focused on treating anxiety in 5–12-year-olds within Child and Adolescent Mental Health Services. Participants were assigned to receive digitally augmented therapy or treatment as usual, with outcomes assessed at multiple time points. The digitally augmented therapy involved parent-led CBT delivered through a digital platform with therapist support.
Primary and secondary outcomes were evaluated, along with economic measures such as quality-adjusted life years. Results showed no significant difference in outcomes between the digitally augmented therapy and standard treatment.
Results
Out of 444 participants, both treatment arms had similar completion rates at different assessment points. Therapists reported higher comfort levels with standard treatment but found the digitally augmented therapy to be equally logical and successful.
Main findings
The study concluded that the digitally augmented therapy was not inferior to standard treatment, indicating its potential for use in clinical practice. Cost effectiveness analyses also suggested savings in therapist time with the digitally augmented therapy.
Cost effectiveness
Health economic analyses revealed no significant difference in quality-adjusted life years between the treatment arms, with lower costs associated with the digitally augmented therapy due to reduced therapist time requirements.
Qualitative outcomes
Qualitative interviews with parents and therapists highlighted positive experiences with the digitally augmented therapy, emphasizing benefits such as flexibility and reduced burden on therapists.
The OSI programme plus therapist support demonstrated similar outcomes to standard parent-led CBT for child anxiety, suggesting that OSI is not less effective.
Conclusions
The study demonstrated that digitally augmented therapy has similar outcomes to standard treatment for child anxiety, with potential cost savings and overall acceptability. The findings support the use of digitally augmented interventions in improving treatment efficiency without sacrificing effectiveness.
This research provides valuable insights into the potential of digitally augmented therapies to enhance mental health services for children and young people, offering a promising approach to address treatment demand and reduce waiting times.
The OSI plus therapist support treatment required an estimated 59% of the therapist time required for treatment as usual, suggesting that it is a more cost-effective option for child anxiety.
Strengths and limitations
One strength of the study is its real-world implementation within CAMHS services, providing practical insights into treatment delivery. The study’s inclusion of various outcome measures and a qualitative evaluation adds depth to the findings.
However, limitations include the lack of ethnic diversity in the sample and the focus on a specific age group and mental health condition. Future research could explore the applicability of digitally augmented therapy across different populations and conditions.
The study provides an example of how digitally augmented mental health treatment can be useful for improving efficiency whilst maintaining effectiveness.
Implications for practice
The study’s findings suggest that digitally augmented therapy could be a valuable addition to clinical services, offering a cost-effective and efficient treatment option for child anxiety. Implementing such interventions could help address the growing need for mental health support among children and young people.
Insights from qualitative data also point to the benefits of digitally augmented therapies for both parents and therapists, highlighting the potential for improved engagement and effectiveness in treatment delivery.
Therapists noted the reduced burden on their time and appreciated being able to monitor engagement with the OSI programme.
Statement of interests
The lead author of the study has a collaboration with another researcher mentioned in the research, but was not directly involved in this study.
Links
Primary paper
Creswell, C., Taylor, L., Giles, S., Howitt, S., Radley, L., Whitaker, E., … & Yu, L. M. (2024). Digitally augmented, parent-led CBT versus treatment as usual for child anxiety problems in child mental health services in England and Northern Ireland: a pragmatic, non-inferiority, clinical effectiveness and cost-effectiveness randomised controlled tri. The Lancet Psychiatry, 11(3), 193-209.
Other references
Newlove-Delgado, T., Marcheselli, F., Williams, T., Mandalia, D., Davis, J., McManus, S., … & Ford, T. (2022). Mental Health of Children and Young People in England, 2022-wave 3 follow up to the 2017 survey. NHS Digital.
