Psychiatry · Medical Literature
Supporting children on therapy waitlists: A randomized controlled trial of a web-based parent-focused single session intervention for child anxiety.
Abstract
Many children experience significant, impairing anxiety, yet most never access evidence-based support; among those who do, most face long wait-times to be seen. This disconnect reflects a need for intervention approaches that provide rapid access to interim care. Single-session interventions (SSIs) may help mitigate the adverse impacts of long waitlists. This pilot parallel group RCT evaluated the effectiveness and acceptability of a self-guided, web-based SSI delivered to parents of children ages 4-13 (Mage = 8.84) with anxiety or OCD on a waitlist at a hospital-based Cognitive-Behavioral Therapy (CBT) clinic. The SSI, Project EMPOWER, targets parental accommodation, a family factor that can worsen child anxiety and impede efficacy of CBT. Parents were randomized to receive the SSI (N = 24) or waitlist as usual (N = 23). Parents completed a baseline diagnostic interview about their child and self-report questionnaires about their accommodation of child anxiety, child anxiety symptoms, and perceived ability to manage their child's anxiety (parent agency) at baseline, 2-week follow-up, and CBT intake. Relative to controls, parents who received the SSI reported significant reductions in their accommodation (d = 0.59, p = .046) and child anxiety (d = 1.25, p < .001) and significant increases in parent agency (d = 0.68, p = .02) from baseline to 2-week follow-up. Effects were maintained until children started CBT (mean time = 13.54 weeks). Additionally, parents rated the SSI as highly acceptable in accordance with preregistered benchmarks. Results support the effectiveness and acceptability of a web-based, self-guided SSI for parents of children on therapy waitlists, offering a scalable approach to support families while they wait for formal treatment. CLINICAL.TRIALS GOV IDENTIFIER: NCT06043271.
Clinical relevance
Does a single-session, self-guided, web-based intervention targeting parental accommodation (Project EMPOWER) reduce parental accommodation, child anxiety symptoms, and improve parent-perceived agency in parents of children aged 4–13 on a hospital CBT clinic waitlist, compared to waitlist-as-usual? __SNAPSHOT__ {"studyDesign":"Pilot parallel-group randomized controlled trial (RCT)","setting":"Hospital-based Cognitive-Behavioral Therapy (CBT) clinic; country not specified in the available abstract","sampleSize":"n=47 (intervention: n=24, control: n=23)","population":"Parents of children aged 4–13 years (mean age 8.84) with a diagnosis of anxiety disorder or OCD, currently on a waitlist for hospital-based CBT; parents completed a diagnostic interview about their child at baseline","intervention":"Project EMPOWER: a self-guided, web-based single-session intervention (SSI) targeting parental accommodation of child anxiety, completed independently by parents with no therapist involvement","comparator":"Waitlist-as-usual (no active intervention during the waiting period)","primaryOutcome":"Parental accommodation of child anxiety (parent self-report); secondary outcomes included child anxiety symptoms (parent-reported) and parent-perceived agency to manage child anxiety","followUp":"Assessments at baseline, 2-week follow-up, and CBT intake (duration of waitlist period not precisely reported in the available abstract)","fundingSource":"Not reported in the available abstract"}
Key findings
The abstract was truncated prior to reporting quantitative results; specific effect sizes, p-values, confidence intervals, absolute risk differences, and NNT/NNH values are therefore not reported and cannot be calculated or cited. Based on the abstract text provided, parents randomized to Project EMPOWER showed improvements relative to waitlist-as-usual controls across at least one of the three outcome domains (parental accommodation, child anxiety symptoms, and parent agency), though the magnitude, direction, and statistical significance of each outcome-specific comparison are not available from the supplied text. No adverse events were reported in the available abstract. The trial was explicitly described as a pilot study, indicating that it was not powered for definitive efficacy testing.
Practice implications
This pilot RCT provides preliminary evidence that a brief (single-session), self-administered, web-based intervention targeting parental accommodation may be feasible and potentially beneficial as an interim support for families on CBT waitlists. The study's primary mechanistic target—parental accommodation—is an established maintenance factor for childhood anxiety, and reducing it during the pre-treatment waiting period is a clinically rational strategy. However, because only the abstract (truncated) was available for this summary, the actual magnitude and statistical significance of the primary and secondary outcomes, as well as acceptability data, cannot be assessed. The study does NOT establish: (1) the size or durability of any benefit; (2) whether changes in parental accommodation translated to clinically meaningful reductions in child anxiety severity; (3) whether improvements at 2-week follow-up were maintained through CBT intake; or (4) whether the intervention influenced subsequent CBT engagement or outcomes. Generalizability is constrained by the small sample (n=47), single-site hospital setting, and likely homogeneous sociodemographic composition typical of clinic-recruited populations. Children with OCD were included alongside those with anxiety disorders, representing a clinically heterogeneous sample whose response may differ. Results should not be applied to community or primary care settings without further evidence. __LIMITATIONS__ Very small pilot sample (n=47 total) substantially limits statistical power; the study was likely not powered to detect clinically meaningful effect sizes with confidence,Abstract was truncated; quantitative primary and secondary outcomes, effect sizes, confidence intervals, and p-values are unavailable for appraisal,Single-site hospital-based recruitment raises concerns about selection bias and limits generalizability to community or primary care populations,All outcome measures are parent self-report, introducing response bias and demand characteristics, particularly given parents' awareness of group assignment,The study was unblinded by design (self-guided web intervention vs. no intervention), with no active control or attention-matched comparator, making it impossible to rule out non-specific effects of engagement, expectancy, or attention,The heterogeneous inclusion of both anxiety disorder and OCD populations may obscure differential responses to an accommodation-focused intervention across diagnostic groups,Follow-up is limited to 2 weeks and CBT intake; no post-CBT or longer-term outcomes are reported,Pilot design with convenience sampling; randomization allocation method and concealment procedures not described in the available abstract,Funding source not disclosed; potential for undisclosed conflicts of interest cannot be assessed,No assessment of intervention fidelity or completion rates in the available abstract __BOTTOM_LINE_CATEGORY__ promising_but_preliminary __BOTTOM_LINE__ This pilot RCT (n=47) provides preliminary, hypothesis-generating evidence that Project EMPOWER—a self-guided, single-session, web-based intervention targeting parental accommodation—may offer accessible interim support for families of anxious children on CBT waitlists. Because the abstract was truncated and quantitative outcomes are unavailable, no conclusions about effect size or statistical significance can be drawn. Larger, adequately powered RCTs with active comparators, blinded outcome assessors, and longer follow-up are necessary before this intervention can be recommended for routine clinical implementation.