CBT-based anxiety intervention

• Identity and version: Name the component or programme, its edition or protocol where relevant, and the purpose being evaluated.
• Source role: Separate direct comparative evidence, descriptive implementation findings, guidance, theoretical support and firsthand experience.
• Population and setting: Retain the studied age, communication/access characteristics and setting. State when an intended application lies outside them.
• Intended and actual delivery: Record the planned components and dose separately from what was received, by whom, and with what support or interruptions.
• Comparison and other support: Name the actual comparison and concurrent changes. If there is no comparison group or it is unreported, say so rather than supply an assumed usual-care condition.
• Outcome and reporter: Record the outcome, time point and reporter. Keep the young person’s account separate from proxy judgement, and access or participation separate from task performance.
• Fidelity and adaptation: Record whether the core components were delivered and describe adaptations; distinguish an adapted application from the protocol tested.
• Burden and unwanted effects: Record time, effort, practical access, cost or workload where known, alongside refusal, fatigue, distress, restriction and other unwanted consequences. Unreported burden is not evidence of no burden.

This profile asks what can be said about a specified CBT-based intervention for anxiety in children and young people, while keeping educational support, exposure components and treatment packages distinct. It does not decide an individual indication.

The seven retained works include three full original comparative reports, one full qualitative report, two original abstracts and one full original guideline chapter with limited current-page corroboration. They are not seven independent efficacy replications. Smart's interviews followed participants in Waite's trial; the Cochrane synthesis overlaps the trial literature. Any reuse by A015 also remains the same study. Programme manuals cited within articles have not been independently certified against current commercial versions.

The inherited overall Strong/Established labels are removed as current ratings. The Cochrane identity and its comparison-specific pattern were verified from its original abstract, with the actual primary-remission denominator distinguished from the full review population.⁶ That verification does not rerun the review, validate every underlying study or grant a uniform grade to A026. A 2026 six-decade synthesis was located by title and DOI in search, but substantive publisher access failed; its historical ranking claim remains unresolved and is not used as a current conclusion.

The previous distinction between informal principles and therapy is retained and made operational: identify the therapeutic model, competence, formulation, actual delivery and review. Teachers and families may contribute support without receiving permission to improvise exposure or withdraw accommodations. The former list of benefits is recast as purposes and possible mechanisms to examine, with specific comparative findings kept separate from these aims.

The unnamed technology-assisted qualitative lead now has a directly opened, relevant original study. It supplies adolescent accounts, not a claim that the old hidden citation has been recovered exactly.⁴ Its selected sample and the linked routine-service null trial are retained together so positive experiences do not stand in for comparative effectiveness.⁵

Outcome definitions matter. Child/Adolescent Anxiety Multimodal Study (CAMS) reports clinician-rated improvement, the Cochrane primary outcome is loss of the primary diagnosis, and the autism study uses a clinician interview severity measure with secondary parent ratings.¹³⁶ These cannot be combined into a single success rate. Primary diagnosis remission also differs from remission of every anxiety diagnosis, and a symptom measure does not directly answer whether a particular valued activity became accessible.

Creswell's active-comparison group trial is particularly useful for interpretation: a supported treatment can be credible without outperforming another supported treatment.² Its failure to show superiority does not establish equal effects within a prespecified margin, and improvement within both arms cannot isolate the contribution of either treatment from time or shared support. The reviewed abstract of Waite's smaller trial similarly has an interval compatible with substantially different effects.⁵

Behavioural Interventions for Anxiety in Children with Autism (BIACA) is a package comparison, not an experiment assigning one adaptation at a time.³ Longer sessions, parent involvement and additional content change together. A recommendation to consider accessible delivery therefore does not mean that adding any one feature has a known independent effect. These distinctions are particularly important when an Atlas user encounters a broadly familiar programme label and assumes that a shorter school activity is an equivalent intervention.

The retained samples have consequential boundaries. The trials and interview study exclude or underrepresent some young people whose communication, intellectual, language or clinical needs are central to special educational needs and disabilities (SEND) practice. Study eligibility rules describe who was studied; they are not a blanket rule denying support to people outside a trial. Outside that population, the record should state uncertainty and seek an appropriate formulation and accessible route rather than copy the study's effect estimate.

The National Institute for Health and Care Excellence (NICE) chapter supports competent, monitored delivery and attention to the wider environment for social anxiety.⁷ Its original full chapter was accessible; current NICE recommendations were retrievable in indexed text but repeated page/PDF openings failed. The source register preserves that access difference. No legal claim or assertion of a current local service entitlement is made from it. Broader autism-guidance pages were search leads but not retained as opened evidence.

The evidence record separates four questions: did symptoms change; was the treatment delivered; was it acceptable to this person; and did unwanted effects occur? None is a substitute for the others. Dropout is a limited proxy because people may continue an unwanted treatment or leave for practical reasons. A reassuring attendance figure cannot establish informed agreement or manageable workload.

The direct interview material is useful precisely because it includes variation and friction.⁴ Its accounts support asking about task relevance and format rather than assuming that the availability of online delivery resolves access. The absence of dropouts from that interview sample is an important missing perspective. No participant quotation or identifying name is retained in these working records.

The CAMS report actively elicited events, whereas the Cochrane abstract notes unclear adverse-effect monitoring in much of the literature.¹⁶ Reported events during therapy are not automatically caused by therapy, and an absence of events attributed to treatment is not evidence of zero distress or workload. These are reasons for explicit local monitoring, not estimates of a universal cognitive behavioural therapy (CBT) harm rate.

This was a targeted reconstruction of material inherited claims and pivotal counterexamples, not a systematic search or formal risk-of-bias/availability assessment. It does not establish long-term comparative effectiveness, every diagnosis-specific protocol, equitable access, current programme revisions or the effectiveness of adaptations for intellectual disability and complex communication needs. The abstract-only sources retain missing-data, adherence and detailed dose gaps. No attempt was made to bypass restricted access or contact authors or practitioners.

Current master/source-version selection, human specialist and recipient review, editorial adoption and publication remain pending. Separate AI editorial review is recorded in the batch support records. The source-specific records below identify what was actually checked; unanswered questions must not be filled by the historical overall evidence labels.

A026-S01 — Walkup et al. — Cognitive Behavioral Therapy, Sertraline, or a Combination in Childhood Anxiety

Access: Original journal PDF opened; targeted methods, results, tables and discussion read; public third-party copy. Locator: pp. 2754–2756 Methods; Figure 1; Table 2; Tables 3–4; pp. 2764–2765 Discussion.

• Identity and version: CAMS: Coping Cat-based anxiety CBT, adapted for age and 12-week study.
• Source role: Original four-arm randomised trial; independent evaluators masked; medication/placebo double-blind, CBT/combination unblinded.
• Population and setting: 488 US participants, ages 7–17, separation/generalised anxiety disorder (GAD)/social phobia, intelligence quotient (IQ)≥80. Excluded anxiety-related school refusal, pervasive developmental disorders, current major depression and acute risk.
• Intended and actual delivery: Planned 14×60-minute CBT sessions, parent check-ins/two parent sessions. CBT 139 allocated, 133 completed week 12 assessment; individual session receipt not extracted.
• Comparison and other support: Sertraline, CBT+sertraline, pill placebo with medication management. Stable stimulant treatment allowed; combined arm had additional contact.
• Outcome and reporter: Week 12 Clinical Global Impression–Improvement scale, a clinician rating of change (CGI-I) much/very-much improvement: CBT 59.7%, placebo 23.7%, sertraline 54.9%, combined 80.7%; combination exceeded monotherapies. Improvement is not diagnostic remission.
• Fidelity and adaptation: Certified experienced therapists; regular supervision. No numerical CBT adherence estimate verified in selected report.
• Burden and unwanted effects: Standardised adverse-event inquiry; events recorded in CBT too. More combination visits increased reporting opportunities; no universal harmlessness inference.

Source limits: Short-term primary report; diagnostic and access exclusions matter. CBT-specific adverse-event causation not established by event counts. Trial appears in later syntheses; do not count it twice. ¹

A026-S02 — Creswell et al. — Clinical outcomes and cost-effectiveness of brief guided parent-delivered cognitive behavioural therapy and solution-focused brief therapy for treatment of childhood anxiety disorders

Access: Full original article opened; methods/results/discussion and tables checked. Locator: Methods: Study design and participants, Procedures, Outcomes; Results Tables 2–3; Discussion.

• Identity and version: Manualised brief guided parent CBT versus solution-focused brief therapy (SFBT).
• Source role: Assessor-masked randomised superiority trial: 68 per arm, 136 total.
• Population and setting: Four Oxfordshire NHS services; ages 5–12, impairing anxiety. Diagnosis not mandatory. Excluded psychotropic medication and English/physical/intellectual/autism barriers judged to impede participation.
• Intended and actual delivery: Nominal 5 h therapist contact per arm. CBT book, thought testing, exposure/problem solving and parent homework. Listed 4×45 min+4×15 min sums 4 h: report inconsistency, not corrected by assumption.
• Comparison and other support: Credible manualised SFBT, including child/parent sessions; no untreated arm.
• Outcome and reporter: Assessor CGI-I using parent/child information; no superiority across post/6 months: risk ratio (RR) 1.01[.86–1.19], p=.95. This model estimate is not a crude post-treatment risk ratio.
• Fidelity and adaptation: Two training days per approach, fortnightly supervision; 52 sampled recordings distinguished treatment content. Actual per-family hours not extracted.
• Burden and unwanted effects: Parent reading/practice plus contacts. No treatment/trial-related adverse events reported; no equivalence or comprehensive burden-free claim.

Source limits: Superiority design does not prove equivalence. Relatively advantaged, predominantly White sample; exclusions limit SEND/language transfer. Nominal dose conflicts with listed session arithmetic. Economic finding not adopted as guaranteed savings. ²

A026-S03 — Wood et al. — Cognitive Behavioral Treatments for Anxiety in Children With Autism Spectrum Disorder: A Randomized Clinical Trial

Access: Full publisher article opened; methods/results/tables/discussion checked. Locator: Methods: Participants, Interventions, Therapist Fidelity; Results; Tables 2–3; Limitations.

• Identity and version: BIACA autism-adapted CBT versus Coping Cat and treatment as usual (TAU).
• Source role: Three-arm randomised trial; masked independent evaluators; 167 randomised, 145 completed.
• Population and setting: US university volunteer sample, ages 7–13, autism/interfering anxiety; IQ≥70 (±SEM, where SEM is the standard error of measurement).
• Intended and actual delivery: 16 weekly sessions: BIACA 90 min, Coping Cat 60 min. BIACA added parent time, modular/social-engagement work and individual interests; both included reappraisal/exposure. Individual session receipt not extracted.
• Comparison and other support: Standard CBT active comparison group; small TAU arm continued chosen services/referrals. Psychiatric medication occurred; no isolated adaptation-component comparison.
• Outcome and reporter: Post-treatment evaluator Pediatric Anxiety Rating Scale, a clinician-rated measure of anxiety severity (PARS): BIACA 2.13, Coping Cat 2.43, TAU 2.93; adapted comparisons p=.04 and<.001. Endpoint PARS n=66/59/18 respectively. Parent school-impact difference versus standard CBT not significant (p=.44).
• Fidelity and adaptation: Sampled-topic adherence 97%/96%; supervision. Longer dose and extra parent work confound attribution to particular adaptations.
• Burden and unwanted effects: Session adverse-event forms; two serious events, neither judged study-related. Exposure, homework and family time remain burdens to review.

Source limits: PARS is a clinician interview outcome; secondary impact ratings are parent reports. Short-term findings and selected cognitive/age range do not cover all autistic SEND recipients. No inference of autism normalisation or universal improvement in participation. ³

A026-S04 — Smart et al. — The acceptability of a therapist-assisted internet-delivered cognitive behaviour therapy program for the treatment of anxiety disorders in adolescents: a qualitative study

Access: Full open-access publisher article read. Locator: Methods: Participants, Sampling, Intervention, Procedure; Results themes 1–2; Strengths and limitations.

• Identity and version: BRAVE for Teenagers-ONLINE; qualitative follow-up to Waite 2019 trial.
• Source role: Original direct adolescent interviews; reflexive thematic analysis, not an effectiveness comparison.
• Population and setting: 13 UK Child and Adolescent Mental Health Services (CAMHS) adolescents aged 13–17; predominantly White/advantaged. Autism, interfering learning/language difficulties excluded in parent trial; home internet required.
• Intended and actual delivery: Planned 10 weekly approximately 60 min modules plus 2 boosters; therapist emails/mid-course call. All interviewees completed≥8 modules.
• Comparison and other support: No interview comparison group. Same cohort as S05; selected follow-up cannot provide an independent treatment-effect replication.
• Outcome and reporter: Interviews mean 11 months after treatment: support and some learning valued; format/content fit varied. No comparative symptom effect inferred.
• Fidelity and adaptation: Interviewers independent of treatment; no new treatment-fidelity estimate. Dropouts absent despite recruitment efforts.
• Burden and unwanted effects: Reading load, repetition, timing, technology and difficult/poorly matched practice reported; rewards/relaxation mixed. Preferences are not represented by attendance alone.

Source limits: No quotations or participant names retained. Recall and participation selection; pre-pandemic experience, not current platform assessment. Direct experience of one supported online version, not all CBT or all adolescents. ⁴

A026-S05 — Waite, Marshall and Creswell — A randomized controlled trial of internet-delivered cognitive behaviour therapy for adolescent anxiety disorders in a routine clinical care setting with and without parent sessions

Access: Original abstract opened; repository full text blocked; linked qualitative report supplies explicitly attributed implementation context. Locator: Abstract Methods/Results/Conclusions; implementation context only from S04 Methods.

• Identity and version: Therapist-supported online anxiety CBT with/without additional parent sessions; BRAVE identity from S04.
• Source role: Original randomised routine-service trial; abstract-level verification.
• Population and setting: 60 adolescents 13–18, referred for anxiety disorder in UK routine care.
• Intended and actual delivery: Immediate treatment or 16-week waitlist; half parents assigned sessions. Dose/receipt not specified in abstract; S04 describes planned programme.
• Comparison and other support: Waitlist and additional-parent-session comparison; detailed concurrent support not verified.
• Outcome and reporter: Primary-disorder remission post-treatment odds ratio (OR) 2.19[.72–6.70], not significant. Parent-session ORs .75[.26–2.15] post and 1.14[.42–3.15] at 6 months; not significant.
• Fidelity and adaptation: Randomisation stated; assessor masking, adherence and actual parent-session receipt not verified from abstract.
• Burden and unwanted effects: No harms/detailed workload information in abstract; direct burden explored in S04. No null-to-equivalence inference.

Source limits: Wide intervals; small trial. Full outcome denominators, missing-data methods and fidelity remain unverified. S04 is a selected follow-up of this cohort, not a second efficacy trial. ⁵

A026-S06 — James et al. — Cognitive behavioural therapy for anxiety disorders in children and adolescents

Access: Original review abstract opened; publisher/PMC full text blocked. Locator: Abstract Search methods, Selection criteria, Main results, Authors conclusions.

• Identity and version: Cochrane CD013162.pub 2, searches to October 2019; specified anxiety CBT with direct child/parent contact.
• Source role: Original systematic review, used as contextual synthesis; this Atlas review is not systematic.
• Population and setting: 87 studies/5964 participants overall, under 19 with anxiety diagnoses; no included intellectual-impairment samples.
• Intended and actual delivery: Variable interventions/formats; no single dose or actual receipt established by abstract.
• Comparison and other support: Waitlist/no treatment, usual care, attention controls, alternatives and medication; constituent trials overlap primary sources here.
• Outcome and reporter: Primary-diagnosis remission versus waitlist: 39 studies/n 2697, 49.4% versus 17.8%, OR 5.45[3.90–7.60]. Much weaker evidence for superiority over usual care/alternatives.
• Fidelity and adaptation: Quality judgements belong to review authors and specific comparisons, not an inherited Phoenix grade; study-level fidelity not audited.
• Burden and unwanted effects: Acceptability defined by lost post-assessments, not satisfaction. No reported adverse effects in synthesis, but monitoring often unclear; not a safety guarantee.

Source limits: Review cutoff is 2019, not a current exhaustive evidence census. Abstract does not verify all subgroup, broader-outcome or long-term findings. Broad synthesis and named trials are not independent sources of participants. ⁶

A026-S07 — NICE/National Collaborating Centre for Mental Health (NCCMH) — Social Anxiety Disorder: Recognition, Assessment and Treatment, chapter7 Interventions for Children and Young People

Access: Original full guideline chapter opened on NCBI; current NICE pages/PDFs blocked; current indexed recommendation wording corroborates selected principles. Locator: Sections 7.8–7.9.3; current CG159 indexed 1.5.1–1.5.6.

• Identity and version: CG159 child social-anxiety treatment guidance; original 2013 chapter, not generic anxiety protocol.
• Source role: Authoritative guideline and expert recommendations; not a new trial.
• Population and setting: Children/young people with social anxiety disorder; no new participant sample.
• Intended and actual delivery: Recommends focused individual/group CBT; manuals, maturity and parent involvement considered. Recommended durations are not actual delivery data.
• Comparison and other support: Evidence-informed treatment recommendation; no new comparison group or concurrent-care dataset.
• Outcome and reporter: Calls for routine outcomes and attention to emotional/educational/social needs; no new measured treatment effect.
• Fidelity and adaptation: Competent practitioners, regular supervision, adherence/competence monitoring. Wider home/school context addressed.
• Burden and unwanted effects: Burden/recipient harm rates not measured by recommendations. Environmental attention does not itself demonstrate recipient acceptability.

Source limits: Current full NICE page access failed; distinguish original chapter from current indexed corroboration. Diagnosis-specific guidance cannot be exported to every anxiety presentation or to ordinary educational activities. No present-day service availability or professional consultation established. ⁷

1. 1.

   Walkup et al. — Cognitive Behavioral Therapy, Sertraline, or a Combination in Childhood Anxiety. 2008-10-30 online; 2008-12-25 issue. https://i-cbt.org.ua/wp-content/uploads/2017/11/Walkup-childhood-anxiety-2008.pdf. Accessed 2026-09-12; Original journal PDF opened; targeted methods, results, tables and discussion read; public third-party copy. Locator: pp. 2754–2756 Methods; Figure 1; Table 2; Tables 3–4; pp. 2764–2765 Discussion.

   ↩1 ↩2 ↩3
2. 2.

   Creswell et al. — Clinical outcomes and cost-effectiveness of brief guided parent-delivered cognitive behavioural therapy and solution-focused brief therapy for treatment of childhood anxiety disorders. 2017-05-17 online; 2017-07 issue. https://pmc.ncbi.nlm.nih.gov/articles/PMC5483485/. Accessed 2026-09-12; Full original article opened; methods/results/discussion and tables checked. Locator: Methods: Study design and participants, Procedures, Outcomes; Results Tables 2–3; Discussion.

   ↩1 ↩2
3. 3.

   Wood et al. — Cognitive Behavioral Treatments for Anxiety in Children With Autism Spectrum Disorder: A Randomized Clinical Trial. 2019-11-22 online; 2020 issue. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2755898. Accessed 2026-09-12; Full publisher article opened; methods/results/tables/discussion checked. Locator: Methods: Participants, Interventions, Therapist Fidelity; Results; Tables 2–3; Limitations.

   ↩1 ↩2 ↩3
4. 4.

   Smart et al. — The acceptability of a therapist-assisted internet-delivered cognitive behaviour therapy program for the treatment of anxiety disorders in adolescents: a qualitative study. 2021-11-08 online; 2023 issue. https://link.springer.com/article/10.1007/s00787-021-01903-6. Accessed 2026-09-12; Full open-access publisher article read. Locator: Methods: Participants, Sampling, Intervention, Procedure; Results themes 1–2; Strengths and limitations.

   ↩1 ↩2 ↩3
5. 5.

   Waite, Marshall and Creswell — A randomized controlled trial of internet-delivered cognitive behaviour therapy for adolescent anxiety disorders in a routine clinical care setting with and without parent sessions. 2019-03-06 online; 2019-09 issue. https://pubmed.ncbi.nlm.nih.gov/32677216/. Accessed 2026-09-12; Original abstract opened; repository full text blocked; linked qualitative report supplies explicitly attributed implementation context. Locator: Abstract Methods/Results/Conclusions; implementation context only from S04 Methods.

   ↩1 ↩2 ↩3
6. 6.

   James et al. — Cognitive behavioural therapy for anxiety disorders in children and adolescents. 2020-11-16. https://pubmed.ncbi.nlm.nih.gov/33196111/. Accessed 2026-09-12; Original review abstract opened; publisher/PMC full text blocked. Locator: Abstract Search methods, Selection criteria, Main results, Authors conclusions.

   ↩1 ↩2 ↩3 ↩4
7. 7.

   NICE/NCCMH — Social Anxiety Disorder: Recognition, Assessment and Treatment, chapter7 Interventions for Children and Young People. 2013; current NICE indexed recommendations checked 2026-09-12. https://www.ncbi.nlm.nih.gov/books/NBK327663/. Accessed 2026-09-12; Original full guideline chapter opened on NCBI; current NICE pages/PDFs blocked; current indexed recommendation wording corroborates selected principles. Locator: Sections 7.8–7.9.3; current CG159 indexed 1.5.1–1.5.6.

   ↩1 ↩2