Online Therapy Shows Benefits for Children with Anxiety in Large Finnish Study
A comprehensive study in Finland has demonstrated that internet-based cognitive behavioural therapy, combined with telephone coaching, can help reduce anxiety in children aged 10 to 13. The research, involving 465 children identified through population-wide screening, offers new insights into early intervention approaches for childhood anxiety.
A Different Approach to Finding Anxious Children
Unlike previous studies that recruited participants from clinics or through advertisements, this research used a unique population based screening approach. Researchers screened over 11,000 children during routine school health checkups across six regions in Finland. This method identified many children whose parents were not previously aware of their anxiety problems.
Of the children who participated in the study, nearly 80% met the diagnostic criteria for at least one anxiety disorder, yet only 4% were taking any psychotropic medication and only 13% had recently contacted specialized psychiatric services. This finding highlights how many children with anxiety disorders remain untreated in the general population.
The Master Your Worries Program
The intervention, called "Master Your Worries," was a 10 week program that combined digital materials with weekly telephone coaching sessions. The program included separate content for children and parents, covering nine themes that progressed from understanding anxiety to developing coping skills and practicing real world exposure exercises.
Children and parents both participated in weekly phone calls with trained coaches, where they discussed the digital materials and received personalized guidance. The program was designed to be developmentally appropriate for children, using animated characters and engaging content to teach anxiety management skills.
Families in the intervention group spent an average of about 11 hours total on the digital materials, with children spending more time than parents. The weekly coaching calls lasted approximately 32 minutes on average.
Comparing Two Approaches
The study used a randomized controlled trial design, comparing the full intervention program to an educational control group. Children in the control group received psychoeducational materials about anxiety but did not receive the cognitive behavioural therapy components or telephone coaching.
This design allowed researchers to determine whether the additional therapy elements provided benefits beyond basic education about anxiety. Both groups also continued to receive any usual care they were already receiving from healthcare providers.
Encouraging Results for Children's Self Reports
The results showed that children in the intervention group reported significantly greater improvements in their anxiety levels compared to those in the control group. The benefits were particularly notable for generalized anxiety, separation anxiety, and social anxiety.
Interestingly, while both groups showed improvement over the six month study period, children who received the full intervention program reported better outcomes when describing their own anxiety symptoms. The effect sizes were modest but statistically significant, suggesting real benefits for participants.
The study found that children who met the diagnostic criteria for anxiety disorders at the beginning of the study showed the greatest benefits from the intervention. For children who did not meet these criteria, the educational materials alone appeared to be sufficient.
Different Perspectives from Parents and Children
One of the most intriguing findings was the difference between parent and child reports of improvement. While children in the intervention group reported significantly better anxiety outcomes, parents did not report the same level of difference between the two groups when rating their children's anxiety.
However, parents in the intervention group did report improvements in other areas, including their children's emotional difficulties, hyperactivity, and overall quality of life. They also noted better total scores on measures of their children's psychological wellbeing.
This difference between parent and child reports may reflect the fact that many parents in the study were not initially aware of their children's anxiety problems. The population based screening approach identified children based on their own reports of anxiety symptoms, rather than parent concerns or clinical referrals.
The Power of Early Identification
The study's use of population based screening revealed important insights about childhood anxiety. Many children experiencing significant anxiety symptoms had never been identified or treated. The screening process itself, combined with basic education about anxiety, appeared to provide some benefit to families.
Both the intervention and control groups showed improvements in anxiety levels, quality of life, and daily functioning over the six month period. This suggests that simply identifying anxiety problems and providing families with information about them can be helpful.
The researchers noted that the assessment process itself might have therapeutic value, as it helps parents become more aware of their children's emotional experiences and may improve communication between parents and children about feelings and concerns.
Accessibility and Real World Applications
One of the study's strengths was its focus on accessibility. The Internet based format combined with telephone support could potentially reach families who face barriers to traditional face to face therapy, such as long waiting lists, geographic isolation, or stigma associated with mental health treatment.
The program was delivered entirely remotely, with no in person meetings required. This approach could be particularly valuable in areas where specialized mental health services for children are limited or difficult to access.
The researchers found high completion rates and satisfaction with the program, with families who had more severe anxiety symptoms showing greater motivation to complete all components.
Understanding the Broader Context
The study contributes to growing evidence about the effectiveness of Internet based interventions for childhood anxiety. Previous research in this area has primarily focused on clinical samples or used different recruitment methods, making this population based approach particularly valuable.
The modest effect sizes observed in the study reflect the fact that participants were identified through screening rather than seeking treatment, meaning their anxiety levels were generally less severe than those seen in clinical settings. This suggests that early intervention approaches may prevent anxiety from becoming more severe over time.
Implications for Families and Healthcare
The findings have several implications for families and healthcare providers. First, they support the value of systematic screening for anxiety in school aged children, as many cases go unrecognized. Early identification could lead to earlier intervention and potentially prevent more serious problems from developing.
Second, the study suggests that basic psychoeducation about anxiety can be beneficial for many families. Simply helping parents and children understand anxiety and its symptoms may improve family functioning and child wellbeing.
Third, for children who meet criteria for anxiety disorders, structured interventions that combine education with specific therapy techniques appear to provide additional benefits. The combination of digital materials and human coaching may offer an optimal balance of accessibility and personalization.
Looking Forward
The research opens up possibilities for implementing population based approaches to childhood anxiety screening and intervention. Such programs could potentially reach many children who would not otherwise receive help for their anxiety problems.
The study also highlights the importance of considering both parent and child perspectives when evaluating treatment outcomes. Children's own reports of their internal experiences may be for understanding the impact of anxiety interventions.
Future research could explore how to optimize these types of programs, including determining the ideal frequency and duration of coaching calls, identifying which children benefit most from different intervention components, and understanding how to best support families throughout the process.
Sourander, A., Korpilahti-Leino, T., Kaajalaakso, K., Ristkari, T., Hinkka-Yli-Salomäki, S., Ståhlberg, T., & Luntamo, T. (2025). Internet-based cognitive–behavioral therapy intervention master your worries with telephone coaching for anxious Finnish children aged 10-13 years: a population-based randomized controlled trial. Journal of the American Academy of Child & Adolescent Psychiatry.
The Bigger Picture
This Finnish study demonstrates that technology assisted interventions can play a valuable role in addressing childhood anxiety at a population level. By combining systematic screening with accessible treatment options, healthcare systems could potentially reach many more children in need of support.
The finding that both basic education and more intensive intervention showed benefits suggests that a stepped care approach might be most effective, starting with psychoeducation for all families and providing additional support for those who need it.
As anxiety disorders are among the most common mental health problems affecting children, developing effective and accessible early intervention approaches is crucial for promoting long term wellbeing and preventing more serious mental health problems in adolescence and adulthood.
