Professor Sonja March’s digital CBT programs for child and adolescent anxiety

Professor Sonja March’s research focus

Co-designing and disseminating freely available evidence-based digital tools to support child and adolescent mental health. 

Almost 14% of young people experience mental health difficulties that interfere with their lives, and around 50% do not receive help for this.

Even fewer children and adolescents receive specialised, evidence-based care due to issues such as long waiting lists, high costs of therapy, geographical distance and stigma. This research aimed to deliver and test a nationwide, digital, self-guided cognitive behaviour therapy program for children, adolescents and parents, free of charge. 

Professor Sonja March

Director, Centre for Health Research and Professor of Psychology at University of Southern Queensland (USQ) and Chief Investigator, Manna Institute

Researcher profile

How was the research conducted?

The BRAVE Program is a digital CBT program for child and adolescent anxiety that had been validated in several randomised controlled trials. This project involved the conversion of BRAVE into a self-directed program, working with young people to establish a national program that could be completed anytime, anywhere. 

The research was funded by Beyondblue, whose mission was to make evidence-based interventions available to all Australian families. This project also conducted an open effectiveness trial to determine the acceptability and effectiveness of this program. 

The program launched in 2014 and has been publicly available to Australian families since this time. The research has included sub-studies to answer specific questions about trajectories of anxiety symptoms during treatment and the impacts of the program on anxiety-related interference.

Why was the research conducted in this manner?

BRAVE had already developed an evidence base through its randomised controlled trials, and a study was needed to see how the program could support children and adolescents in the real world. No restrictions were placed on who could use the program, as the intention was to provide CBT skills to those who were seeking assistance with anxiety. 

What were the outcomes of the research?

Since 2014, over 83,000 children, adolescents and parents have used the BRAVE Program. Our research has shown that young people come to the program for various reasons and engage in the way that is needed for them. 

For those young people who commence the program and work their way through sessions, over 50% show clinically significant reductions in anxiety symptoms. A similar trajectory of anxiety symptom reduction is noted over the program for those initially moderate in anxiety severity and those high in anxiety severity. 

However, those initially high in anxiety severity may need some additional support to reduce the impacts of their anxiety into non-elevated ranges. The research also found that most of the change in anxiety symptoms occurs in the first six sessions. Importantly, the program was acceptable to young people.

Were there any unexpected findings?

We found that there were about 30% of participants who took part in the BRAVE Program were not currently experiencing elevated levels of anxiety. These participants also showed reductions in anxiety over the program, though their anxiety was in the non-elevated ranges. 

What does this research mean for the people of Queensland? 

Since 2014, the BRAVE Program has provided a free, evidence-based program for Queensland chioldren and adolescents. The program has been helping Queensland children to better manage their anxiety and worries and prevent this from worsening into adolescence and adulthood. 

Does this open the door to any further research topics?

Our work with the BRAVE Program has helped us to identify new strategies that can make digital CBT programs even more effective and engaging for young people. It has led us to develop a new, personalised mental health platform, Momentum Hub. 

In our Momentum program, young people can receive a tailored CBT program that targets anxiety, depression and related difficulties like sleep problems, substance use (teens) and healthy lifestyles. This program is now open to Queensland families, and we are evaluating and refining this program on an ongoing basis to make sure it meets the needs of Queensland’s young people. 

Do you have any advice for aspiring mental health researchers?

Find an area you feel particularly passionate about or that makes you feel proud and dream big. I once thought it would be wonderful if my program could help even 100 people, and look where it is now.  

Is there anything else about this research you feel would be beneficial for people in the mental health sector to know?

Our digital programs wouldn’t be what they are without the contributions of hundreds of children, adolescents and parents. I would like to thank them for sharing their valuable time and experiences with anxiety and helping us co-design programs just for them. 

Are there any other related studies you’d recommend people to read?

If you are interested, you can read:

• Co-designing a digital mental health platform, “Momentum”, with young people aged 7–17: A qualitative study.
• Stepped-care versus therapist-guided, internet-based cognitive behaviour therapy for childhood and adolescent anxiety: A non-inferiority trial.
• Changes in life functioning in a self-help, online program for child and adolescent anxiety.
• Large-Scale Dissemination of Internet-Based Cognitive Behavioral Therapy for Youth Anxiety: Feasibility and Acceptability Study. 
• Trajectories of change in an open-access internet-based cognitive-behaviour program for childhood and adolescent anxiety.