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New research from the University of Oxford has revealed that an online programme that empowers parents to apply Cognitive Behavioural Therapy (CBT) principles in their child’s day to day lives is just as effective as traditional talking therapies for child anxiety problems.

An image of an anonymous child being comforted by an adult © Shutterstock

It also found it substantially reduced the amount of therapist time required and making support more accessible for many families. The approach provides parents online tools and some therapist guidance to help children overcome problems with anxiety.

Published today in The Lancet Psychiatry, the findings suggest this parent-led online CBT model could allow health services to treat more families, at lower cost, and reducing potential barriers to access for families. This could have major implications for expanding access to much-needed mental health treatment for children.

Anxiety disorders are among the most common mental health problems faced by children, affecting over a quarter of people at some point in their lives. If left untreated, they can severely impact social development, education attainment, and wellbeing. While cognitive behavioural therapy (CBT) is an effective treatment, few children can access it due to high demands on mental health services.

To address this gap, researchers, with support from a United Kingdom Research and Innovation (UKRI) Research Grant and the National Institute for Health and Care Research (NIHR), developed ‘Online Support and Intervention’ (OSI) – an online program that guides parents through CBT strategies to help their anxious child. It includes educational content, tools like worksheets, quizzes, and brief weekly support from a therapist by phone or video

Professor Cathy Creswell, Professor of Developmental Clinical Psychology in the Departments of Psychiatry and Experimental Psychology, at the University of Oxford explained:


“Anxiety problems often start early in childhood and bring substantial distress. Our study shows that by supporting parents to help their children using online tools with therapist support, we can dramatically increase how many children get timely, effective help.”

The study compared OSI plus therapist support to standard, in-person, care in over 400 children aged 5-12 treated across 34 child mental health services across England and Northern Ireland. The children receiving OSI with therapist support showed similar reductions in anxiety and improvements in daily functioning as those receiving standard CBT.

Importantly, OSI required almost half as much therapist time to deliver – 182 minutes on average compared to 307 minutes for usual care. Based on this, researchers determined that OSI could allow therapists to treat more children within busy mental health systems without compromising outcomes. If implemented widely, this could substantially expand access to effective anxiety treatment.

"The OSI programme shows that we can support children with anxiety problems in a way that fits into family life and potentially reach many more families by reducing demand on services," said Professor Creswell. “This approach could make a real difference to child and adolescent mental health services, offering a practical solution to the current gap between the need for treatment and its availability.”

The researchers also interviewed parents and therapists about their experiences. Parents found the online program flexible, user-friendly, and fitted well into family life. Many felt OSI equipped them with lifelong skills to manage anxiety in their child and other children. Therapists were enthusiastic about OSI’s potential to reach more families in need.

Co-author Dr Vanessa Raymont, Senior Clinical Researcher at the Department of Psychiatry and Director of Research and Development at Oxford Health NHS Foundation Trust, said:


“Children’s mental health services across the country are strained, and waiting lists keep growing. This research shows that empowering parents to help anxious children via technology-supported treatment, is feasible and could bring major time and cost savings without compromising clinical benefits.”

The findings provide hope that innovations like OSI could be taken up by healthcare systems, learning from successful digital rollouts in other areas of healthcare, to transform children’s mental healthcare and allow many more families to access timely, effective treatment.