An online cognitive behavioral therapy program for anxious Finnish children produced a measurable improvement at a 6-month follow-up, according to the Master Your Worries trial published in the Journal of the American Academy of Child and Adolescent Psychiatry. Children aged 10 to 13 who got a 10-week internet program with weekly telephone coaching improved more on a standard child anxiety questionnaire than children who got digital psychoeducation instead, though the difference was small (Cohen d = 0.17, p = .04).
Key takeaways
- Child-reported anxiety on the SCARED improved more in the online CBT group, but the effect was small (p = .04, Cohen d = 0.17).
- Parent-reported scores showed no significant advantage for the program (p = .41, Cohen d = 0.03).
- The comparison group was not a waitlist. They received real psychoeducation in digital form, which makes even a small difference harder to dismiss.
What the study found
The trial screened Finnish schoolchildren at population level during school health care check-ups and randomly allocated 465 of them to internet CBT or to psychoeducation. Their mean age was 11.5 years (SD 1.0) and 71.4% were girls. One group followed a 10-week internet-based therapy program with weekly digital material and exercises and weekly telephone calls. The control group received psychoeducation in digital form. The primary outcome was change in anxiety on the SCARED, scored separately by the child and by a parent, and assessed at baseline and at a 6-month follow-up.
At the 6-month follow-up, children in the online CBT group reported greater improvement on the SCARED total than the control group, with about a 1 in 25 chance the result is coincidence (p = .04). The effect size was 0.17, which is small: the average child in the program ended up less than a fifth of a standard deviation better than the average child in the control group.
Parent reports told a different story. Scoring the same questionnaire, parents saw no significant difference between the two groups (p = .41, Cohen d = 0.03).
Certain symptom clusters moved more than others. Child-reported social anxiety improved more in the intervention group (p = .007, Cohen d = 0.27), a difference unlikely to be chance but still small. The authors found no statistically significant differences in parental mental health.
Dr. Kumar’s take
The headline is not that an app treats anxiety. It is that a low-intensity program with a human coach on the phone produced a measurable benefit at all, on a questionnaire the children filled out themselves.
Now the limits. The effect sizes are small: 0.17 of a standard deviation on the child-reported primary outcome, and secondary outcomes ranging from 0.09 for generalized anxiety to 0.40 for separation anxiety. That is a group average that moves a little, not a group of children transformed. The parent-reported difference was not significant at all, and when the child and the parent disagree, that gap deserves attention. The trial was also open rather than blinded, so children and families knew which program they had been assigned, which can inflate a self-reported improvement.
These children were also found by population screening at school, not referred to a clinic in crisis. That is exactly the group a low-intensity tool should serve.
What it means for you
If a school screening or a pediatrician flags your 10 to 13 year old for anxiety symptoms, a guided online CBT program is a reasonable first step. The program tested here included weekly telephone calls alongside the digital material, and programs without a live human contact were not what this trial tested.
Treat it as the first tier of a stepped plan. Set a review date, roughly three months out, and if your child is not better, or is getting worse, missing school, not sleeping, or pulling away from friends, escalate to a clinical evaluation. What the trial reported was a group average across 465 children, and that average difference was small.
Structured mind-body programs for adults show the same pattern of real but moderate benefit, as in mindfulness-based cognitive therapy for depression in students and mindfulness meditation for chronic insomnia. Worth doing, and not a replacement for care when someone is deteriorating.