Increasing Access - Alternative Treatments

Question 1

Spence et al (2011)

Answer 1

BRAVE-Online for Teenagers compared to CLIN and waitlist control, with comparable outcomes from both BRAVE-Online and CLIN versus waitlist at posttreatment, 6mo, and 12mo follow-up

Question 2

Waite et al (2019)

Answer 2

Showed BRAVE-Online for Teenagers to not significantly differ from waitlist groups in remission posttreatment, but broadly consistent with Spence et al (2011) outcomes

Question 3

Pennant et al (2015)

Answer 3

Systematic review and meta-analysis of computerised therapies for anxiety and depression in CYP

Showed computerised CBT had positive effects for symptoms of anxiety with moderate-to-large effect size in 12-25, but small positive effects for 5-11 and uncertainty around effectiveness

Post-hoc analyses showed significant subgroup differences between 12-17 and 18-25, with greater effect in 18-25, and in younger people with elevated symptom scores

Computerised CBT may benefit from additional parent input for pre-adolescents

Question 4

Hollis et al (2017)

Answer 4

Systematic and meta-review of digital health interventions (not AD specific) supporting moderate-to-large effects for cCBT targeting anxiety, better outcomes than depression, but heterogeneity

Majority of DHIs used BRAVE-Online (Spence et al., 2006), so likely efficacious

Reviewed 4 RCTs for anxiety, showing that at a range of locations and completion, cCBT associated with significant improvements in anxiety posttreatment and follow-up, compared to waitlist and treatment-as-usual

Role of human support poorly specified, with variations in personnel, degree of support, and purpose, which is important to policy and deployment as may not be more cost-effective if requiring lots of human support

Question 5

Co-CAT (Child Anxiety Treatment in Context of COVID-19) (Creswell et al., 2024)

Answer 5

OSI designed in collaboration with families and NHS therapist, with preliminary support for therapist-supported OSI but no systematic evaluation for clinical and cost-effectiveness and acceptability in routine practice

Designed to digitally augment parent-led CBT for ADs in pre-adolescence, focusing on providing parents with all core treatment content in accessible forms across 7 modules, with weekly 20-min calls with therapist, and review 4w after final session

Compared OSI with treatment-as-usual for 444 families (5-12) in 34 CAMHS services, showing OSI plus therapist-support non-inferior for all measures, with mean difference in QALYs approximated to zero, and associated with lower costs than treatment-as-usual