Can Online Therapy Effectively Treat Pediatric Anxiety and OCD?

What you need to know

• Intensive online therapy can be as effective as in-person treatment for children with anxiety and OCD
• Children who received treatment during the COVID-19 pandemic reported higher anxiety levels at intake
• Expanding access to online therapy options may help address barriers to mental health care for youth

The growing need for accessible youth mental health treatment

Anxiety disorders and obsessive-compulsive disorder (OCD) are among the most common mental health conditions affecting children and teenagers. These disorders often emerge early in life and can have significant negative impacts on a child’s development, academic performance, social relationships, and overall quality of life if left untreated.

Unfortunately, rates of anxiety in youth have been rising over the past decade, with a dramatic acceleration during the COVID-19 pandemic. At the same time, there are significant barriers that prevent many children from accessing quality mental health care, including:

• Limited availability of child mental health specialists
• Geographic distance from treatment providers
• Costs associated with treatment
• Stigma around seeking mental health care
• Family stressors that make it difficult to attend regular appointments

To address these challenges, there is an urgent need to develop effective and accessible treatment options for youth struggling with anxiety and OCD. One promising approach is to deliver evidence-based therapy via telehealth platforms.

Comparing in-person and online intensive treatment

This study examined the effectiveness of an intensive, group-based cognitive behavioral therapy (CBT) program for treating pediatric anxiety and OCD. The researchers compared outcomes for two groups of patients:

1. Children who received the intensive CBT program in-person prior to the COVID-19 pandemic
2. Children who received the same program delivered entirely online via videoconferencing during the pandemic

The treatment program included:

• Four half-day sessions per week for at least 4 weeks
• Group-based exposure therapy sessions
• Psychoeducation on anxiety/OCD and CBT skills
• Family meetings and parent guidance groups
• Medication management (if needed)

A total of 130 children and adolescents aged 8-19 participated in the study. The researchers measured anxiety symptoms and functional impairment (how much symptoms interfered with daily life) at the start and end of treatment using standardized rating scales completed by both children and parents.

Key findings on telehealth effectiveness

The study found several important results:

1. Children who started treatment during the pandemic reported higher anxiety levels at intake compared to the pre-pandemic group. This aligns with other research showing increases in youth mental health concerns during COVID-19.

2. Both the in-person and online treatment groups showed significant improvements in anxiety symptoms and functional impairment from pre- to post-treatment, as reported by children and parents.

3. There were no significant differences in treatment outcomes between the in-person and online groups after controlling for pre-treatment symptom levels.

In other words, the intensive CBT program delivered entirely via telehealth was just as effective at reducing anxiety and improving functioning as the same program delivered in-person.

How online therapy may improve access to care

These findings are encouraging, as they suggest that intensive, evidence-based treatment for pediatric anxiety and OCD can be successfully adapted to an online format without compromising effectiveness. Expanding access to telehealth options has the potential to address many common barriers to mental health care for youth:

• Geographic barriers: Children can access specialized treatment from home, regardless of their location

• Logistical barriers: Families don’t need to manage transportation to frequent in-person appointments

• Provider shortages: Clinicians can serve patients from a wider geographic area

• Stigma: Some families may feel more comfortable engaging in treatment from home

• COVID-19 concerns: Telehealth allows continued access to care while minimizing infection risks

The group-based nature of this program also allows clinicians to serve multiple patients simultaneously, which may help address high demand and long waitlists for youth mental health services.

Considerations for implementing telehealth programs

While these results are promising, several factors should be considered in expanding access to online mental health treatment for youth:

• Technology access: Reliable internet and devices are needed to participate in videoconference-based therapy. Some families may face a “digital divide” in accessing these resources.

• Insurance coverage: Policies around coverage and reimbursement for telehealth services vary. Continued advocacy is needed to ensure parity between in-person and online treatment options.

• Licensing restrictions: Many states restrict practice across state lines, limiting access to specialized telehealth programs.

• Clinical considerations: Some exposure therapy exercises or assessments may need to be adapted for online delivery. Parent involvement may also look different in a telehealth format.

• Privacy concerns: Secure platforms and private spaces for sessions are important considerations for online therapy with youth.

Further research is also needed to determine which patients are best suited for intensive telehealth programs versus other treatment formats.

Conclusions

• Intensive online CBT can be as effective as in-person treatment for children with moderate to severe anxiety and OCD
• Telehealth options may help overcome common barriers to accessing specialized mental health care for youth
• Continued research, policy changes, and clinical innovations are needed to expand equitable access to effective online treatment programs