Evaluation of the online version of ‘Learn to Dare!’, a cognitive-behavioral intervention for child anxiety

Despite the proven efficacy of cognitive-behavioral therapy (CBT) for childhood anxiety, most anxious children do not receive treatment due to implementation barriers. Low-intensity online formats may help address this gap. This study examined the effects of the online CBT-based program Learn to Dare! for children aged 8–13 with maladaptive anxiety, and explored the role of its components: psychoeducation, exposure (based on inhibitory learning), and cognitive restructuring. In a randomized controlled design, 92 children (Mage = 9.77, SD = 1.55) were assigned to the intervention (n = 61) or a waitlist control group (WL, n = 31). Assessments took place pre- and post-intervention, and at 3-month follow-up. Anxiety, avoidance, and negative cognitions decreased over time in both groups, while positive cognitions remained stable. A larger proportion of intervention participants showed clinically significant improvement in anxiety levels compared to WL, though not on other measures. At follow-up, children in the intervention group were less likely than WL to meet diagnostic criteria for social anxiety disorder and generalized anxiety disorder, but not for other anxiety disorders. No consistent effects were found for individual components, except for an unexpected increase in avoidance after cognitive restructuring. Also of relevance, high attrition in this online CBT for child anxiety appeared related to higher baseline anxiety levels among drop-outs and limited user engagement. In sum, the findings provide preliminary support for the potential of the Learn to Dare! intervention for children with mild to moderate maladaptive anxiety who complete the program. The study was registered and was registered as a clinical trial via CCMO, NL 60801.068.17, date: May 16th, 2018.