Effectiveness of a transdiagnostic computerized self-applied program targeting children with emotional problems: A randomized controlled trial

A Systematic Review Comparing Four Transdiagnostic Programmes for School-Age Children

Transdiagnostic programmes are useful for helping people with internalizing symptoms and comorbid psychopathology. These programmes have as their basic idea that disorders are not separate entities but share common aetiological and maintenance processes. Their use is important with children, who tend to present less differentiated psychopathological manifestations than adults. This systematic review aimed to examine the effectiveness of four evidence-based transdiagnostic programmes: FRIENDS, Pyramid Club, Unified Protocol for Children (UP-C) and Super Skills for Life (SSL). Studies from 2018 to 2023 including children between 4 and 14 years of age were examined. Following PRISMA guidelines, 48 studies that met the inclusion criteria were considered. Most of the studies referred to treatment, only a few used the selected transdiagnostic programmes for prevention, most notably FRIENDS and SSL. Very few of the studies reviewed have been randomized controlled trials, limiting the possibility to examine incremental benefits of these programmes over alternative approaches. The findings show that all programmes showed evidence of effectiveness, but UP-C and SSL appear to be the most promising transdiagnostic programmes for the prevention and treatment of anxiety and depression in children as supported by more numerous studies in recent years. Moreover, UP-C and SSL specifically appeared effective in reducing externalizing problems and improving social skills and prosocial behaviour. Although the results presented are promising, they should be regarded as provisional and in need of further support in randomized controlled trials to test the effectiveness of these evidence-based programmes to ensure the psychological well-being of children and thus reduce healthcare costs.

Comparative randomized trial addressing childhood emotional problems: Computerized vs. traditional transdiagnostic Super Skills program

BACKGROUND

Super Skills for Life is a structured intervention rooted in cognitive-behavioral therapy and a transdiagnostic approach, aimed at preventing childhood emotional problems. Over the past decade, it has demonstrated positive outcomes in various formats and countries. This study evaluated the comparative effectiveness of two individual modalities: the computerized and the traditional version enriched with multimedia content, through a comparative randomized effectiveness trial.

METHOD

109 children (55.24 % female) aged 8-12 years participated, randomly assigned to either the traditional (n = 54) or computerized (n = 51) groups. Pre- and post-intervention assessments involved emotional problem measures completed by children and parents.

RESULTS

Both groups exhibited significant reductions in all outcomes according to parent reports, including depression, anxiety, and anxiety-related life interference. Children's self-reports indicated improvements across all general measures. Generalized Estimating Equations indicated marginally better improvements in the traditional group.

LIMITATIONS

Limitations included the absence of follow-up assessment, variability in participant regions across Spain, and input from other informants like teachers.

CONCLUSIONS

This study pioneers the examination of short-term effects of the program in both a fully computerized format supervised by a specialized therapist and an enriched traditional individual format, and the promising results suggest their potential for indicated prevention of childhood emotional problems.

Prevention of Emotional Problems in Spanish Schoolchildren: Effectiveness of the Super Skills Multimedia Program to Promote Social-Emotional Skills

Compared to traditional psychosocial interventions, the transdiagnostic approach focuses on common processes or factors that contribute to the development and maintenance of emotional problems. In Spain, the Super Skills Program has proven its effectiveness, but issues with displacement or scheduling for families can hinder access to the intervention. This study aims to examine the program's effectiveness in preventing children's psychosocial problems through learning socio-emotional skills when self-administered via the Internet. Participants were 283 Spanish children between the ages of 8 and 12. The children and their parents completed anxiety and depression scales before and after receiving the intervention and 12 months later. The program consisted of 8 self-applied sessions, at a rate of two per week, which included emotional education, cognitive restructuring, self-regulation techniques, training in social skills, problem-solving, and video feedback with cognitive preparation. Significant differences in anxiety and depression symptoms were found after the intervention. A significant reduction in anxiety scores and a marginally significant decrease in depression scores was observed at the long-term follow-up. The "intention to treat" analysis revealed a tendency for children who improved to drop out of the program, completing the intervention children with more symptomathology. Learning socio-emotional skills through a self-applied intervention via the Internet effectively reduced emotional symptoms in school children and is a valuable resource to improve child well-being and prevent future psychological problems.

Efficacy of a transdiagnostic internet-based program for adolescents with emotional disorders: A randomized controlled trial

OBJECTIVE

The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A) is a well-established transdiagnostic cognitive-behavioral therapy (T-CBT) intervention. The aim of the present study was to examine the efficacy of the program Learn to Manage your Emotions [Aprende a Manejar tus Emociones] (AMtE), a self-applied transdiagnostic internet-delivered program based on the Spanish version of the UP-A. This is the first transdiagnostic internet-based program designed for the treatment of emotional disorders in adolescents.

METHOD

A sample of Spanish adolescents with a primary diagnosis of an anxiety and/or depressive disorder (n = 58; age range = 12-18 years; 78.3% girls; 90% Caucasian) were randomly allocated to receive AMtE (n = 28) or the UP-A via videocall (n = 30). Pre-treatment, post-treatment and 3-month follow-up data were collected using self-reports and clinician-rated measures of anxiety, depression, positive and negative affect, anxiety sensitivity and emotional avoidance.

RESULTS

Based on generalized estimating equations (GEE) models, both intervention programs were effective in significantly reducing self-reported anxiety and depressive disorder symptoms and clinician-rated severity of anxiety and depression, as well as self-reported transdiagnostic outcome variables.

CONCLUSIONS

Data provide empirical support for the efficacy of AMtE as a transdiagnostic online CBT treatment for anxiety and depressive disorders in adolescents. No marked nor consistent differences were observed between the UP-A and AMtE, highlighting the potential usefulness of the online self-administered AMtE program.

Preliminary efficacy of a transdiagnostic parent-led internet-delivered intervention for children with anxiety and depressive symptoms: a pilot randomized controlled trial

BACKGROUND

There is extensive research indicating that transdiagnostic interventions are effective for adults and children with anxiety and depressive disorders; however, limited research has been conducted on the efficacy of such programs targeting parents of children with anxiety and depressive symptoms delivered via the Internet. This study aims to investigate the preliminary efficacy of a transdiagnostic Internet-delivered intervention for Romanian parents of children with elevated anxiety and depressive symptoms.

METHODS

We conducted a single-blinded pilot randomized controlled trial. Forty-two parents of children with anxiety and depressive symptoms (Mage = 39.79, 78.6% women) from Romania were randomly assigned to one of the two groups, to ParentKIT, an Internet-delivered intervention based on Rational Emotive and Behavioral Therapy (n = 21), or to a delayed treatment condition (waitlist group) (n = 21). ParentKIT consisted of a brief transdiagnostic intervention delivered through nine modules with therapist guidance.

RESULTS

A significant Group by Time effect was found for child emotional problems as reported by parents (Cohen's d = - 0.85) and for parental self-efficacy (Cohen's d = 0.71).

CONCLUSION

A transdiagnostic Internet-delivered intervention addressed to parents of children with elevated anxiety and depressive symptoms is a promising approach. Future research should include blind assessments as well as multiple outcome assessors and investigate the long-term efficacy of the intervention.

TRIAL REGISTRATION

NCT05341297.