The Impact of Parental Support on Adherence to Therapist-Assisted Internet-Delivered Acceptance and Commitment Therapy in Primary Care for Adolescents With Anxiety: Naturalistic 12-Month Follow-Up Study
BackgroundMental health problems among adolescents are increasing, and internet-delivered acceptance and commitment therapy (iACT) constitutes a possible way to improve access to care while reducing costs. Nevertheless, few studies have investigated iACT for adolescents in re...
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JMIR Publications
2025-01-01
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| Series: | JMIR Pediatrics and Parenting |
| Online Access: | https://pediatrics.jmir.org/2025/1/e59489 |
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| author | Anna Larsson Sandra Weineland Linnea Nissling Josefine L Lilja |
| author_facet | Anna Larsson Sandra Weineland Linnea Nissling Josefine L Lilja |
| author_sort | Anna Larsson |
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BackgroundMental health problems among adolescents are increasing, and internet-delivered acceptance and commitment therapy (iACT) constitutes a possible way to improve access to care while reducing costs. Nevertheless, few studies have investigated iACT for adolescents in regular primary care nor the role of parental support.
ObjectiveThis is an exploratory evaluation investigating iACT, with or without parental support, for adolescents. The aims were to examine treatment adherence, symptoms of anxiety and depression, psychological flexibility, and overall functioning.
MethodsAdolescents with anxiety were recruited within the regular primary care patient flow during the implementation phase of therapist-assisted iACT for adolescents. Assessment and inclusion were executed face-to-face. Due to organizational reasons, the assignment of treatment methods could not be randomized. Adherence was investigated by measuring the number of completed modules. Outcome measures were collected by self-assessment questionnaires including the Revised Children’s Anxiety and Depression Scale and Avoidance and Fusion Questionnaire for Youth, as well as interviews using the Children’s Global Assessment Scale. The analysis was performed as an exploratory evaluation using descriptive data for treatment adherence and nonparametric within-group analysis with the Wilcoxon signed rank test for related samples and treatment outcomes. This evaluation is naturalistic, and the results are preliminary and of a hypothesis-generating character and should be handled with caution.
ResultsThe iACT group without parental support (n=9) exhibited a gradual dropout throughout the treatment period (n=5), whereas the iACT group with parental support (n=15) exhibited the lowest number of dropouts from treatment before completion (n=2), of which all occurred during the second half of treatment. The within-group, per-protocol analyses for the Revised Children’s Anxiety and Depression Scale indicated reduced symptoms of anxiety and depression at the 12-month follow-up (z score: –2.94; P=.003; r=–0.6). The within-group, per-protocol analyses for the Avoidance and Fusion Questionnaire for Youth indicated increased psychological flexibility at the 12-month follow-up (z score: –2.54; P=.01; r=0.55). Nevertheless, no differences in overall functioning measured by the Children’s Global Assessment Scale were found.
ConclusionsThe results indicate that parental support might play a role in treatment adherence in iACT for adolescents with anxiety. Moreover, the outcome measures suggest that iACT for adolescents in primary care could constitute an effective treatment for both anxiety and depression, as indicated by the symptom reduction and increased psychological flexibility, maintained at the 12-month follow-up. Nevertheless, due to a small and gender-biased sample size with a large proportion of dropouts and missing data, a nonrandomized assignment of intervention, and an analysis limited to within group, this study should be considered an explorative evaluation rather than an outcome study. |
| format | Article |
| id | doaj-art-c5caa0126c8a49989ae4044942d6f841 |
| institution | Kabale University |
| issn | 2561-6722 |
| language | English |
| publishDate | 2025-01-01 |
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| spelling | doaj-art-c5caa0126c8a49989ae4044942d6f8412025-01-03T14:30:28ZengJMIR PublicationsJMIR Pediatrics and Parenting2561-67222025-01-018e5948910.2196/59489The Impact of Parental Support on Adherence to Therapist-Assisted Internet-Delivered Acceptance and Commitment Therapy in Primary Care for Adolescents With Anxiety: Naturalistic 12-Month Follow-Up StudyAnna Larssonhttps://orcid.org/0000-0001-7530-3039Sandra Weinelandhttps://orcid.org/0000-0003-2428-4004Linnea Nisslinghttps://orcid.org/0000-0001-6479-2973Josefine L Liljahttps://orcid.org/0000-0003-3623-5760 BackgroundMental health problems among adolescents are increasing, and internet-delivered acceptance and commitment therapy (iACT) constitutes a possible way to improve access to care while reducing costs. Nevertheless, few studies have investigated iACT for adolescents in regular primary care nor the role of parental support. ObjectiveThis is an exploratory evaluation investigating iACT, with or without parental support, for adolescents. The aims were to examine treatment adherence, symptoms of anxiety and depression, psychological flexibility, and overall functioning. MethodsAdolescents with anxiety were recruited within the regular primary care patient flow during the implementation phase of therapist-assisted iACT for adolescents. Assessment and inclusion were executed face-to-face. Due to organizational reasons, the assignment of treatment methods could not be randomized. Adherence was investigated by measuring the number of completed modules. Outcome measures were collected by self-assessment questionnaires including the Revised Children’s Anxiety and Depression Scale and Avoidance and Fusion Questionnaire for Youth, as well as interviews using the Children’s Global Assessment Scale. The analysis was performed as an exploratory evaluation using descriptive data for treatment adherence and nonparametric within-group analysis with the Wilcoxon signed rank test for related samples and treatment outcomes. This evaluation is naturalistic, and the results are preliminary and of a hypothesis-generating character and should be handled with caution. ResultsThe iACT group without parental support (n=9) exhibited a gradual dropout throughout the treatment period (n=5), whereas the iACT group with parental support (n=15) exhibited the lowest number of dropouts from treatment before completion (n=2), of which all occurred during the second half of treatment. The within-group, per-protocol analyses for the Revised Children’s Anxiety and Depression Scale indicated reduced symptoms of anxiety and depression at the 12-month follow-up (z score: –2.94; P=.003; r=–0.6). The within-group, per-protocol analyses for the Avoidance and Fusion Questionnaire for Youth indicated increased psychological flexibility at the 12-month follow-up (z score: –2.54; P=.01; r=0.55). Nevertheless, no differences in overall functioning measured by the Children’s Global Assessment Scale were found. ConclusionsThe results indicate that parental support might play a role in treatment adherence in iACT for adolescents with anxiety. Moreover, the outcome measures suggest that iACT for adolescents in primary care could constitute an effective treatment for both anxiety and depression, as indicated by the symptom reduction and increased psychological flexibility, maintained at the 12-month follow-up. Nevertheless, due to a small and gender-biased sample size with a large proportion of dropouts and missing data, a nonrandomized assignment of intervention, and an analysis limited to within group, this study should be considered an explorative evaluation rather than an outcome study.https://pediatrics.jmir.org/2025/1/e59489 |
| spellingShingle | Anna Larsson Sandra Weineland Linnea Nissling Josefine L Lilja The Impact of Parental Support on Adherence to Therapist-Assisted Internet-Delivered Acceptance and Commitment Therapy in Primary Care for Adolescents With Anxiety: Naturalistic 12-Month Follow-Up Study JMIR Pediatrics and Parenting |
| title | The Impact of Parental Support on Adherence to Therapist-Assisted Internet-Delivered Acceptance and Commitment Therapy in Primary Care for Adolescents With Anxiety: Naturalistic 12-Month Follow-Up Study |
| title_full | The Impact of Parental Support on Adherence to Therapist-Assisted Internet-Delivered Acceptance and Commitment Therapy in Primary Care for Adolescents With Anxiety: Naturalistic 12-Month Follow-Up Study |
| title_fullStr | The Impact of Parental Support on Adherence to Therapist-Assisted Internet-Delivered Acceptance and Commitment Therapy in Primary Care for Adolescents With Anxiety: Naturalistic 12-Month Follow-Up Study |
| title_full_unstemmed | The Impact of Parental Support on Adherence to Therapist-Assisted Internet-Delivered Acceptance and Commitment Therapy in Primary Care for Adolescents With Anxiety: Naturalistic 12-Month Follow-Up Study |
| title_short | The Impact of Parental Support on Adherence to Therapist-Assisted Internet-Delivered Acceptance and Commitment Therapy in Primary Care for Adolescents With Anxiety: Naturalistic 12-Month Follow-Up Study |
| title_sort | impact of parental support on adherence to therapist assisted internet delivered acceptance and commitment therapy in primary care for adolescents with anxiety naturalistic 12 month follow up study |
| url | https://pediatrics.jmir.org/2025/1/e59489 |
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