Experiences of Receiving an Internet Cognitive Behaviour Therapy Stepped-Care Model: Young Person Perspectives

Objective Qualitative research examining young people’s experiences with stepped-care internet cognitive behaviour therapy (ICBT) for anxiety is limited. Guided by Proctor et al.’s implementation framework, this study explored children and adolescents’ experiences of the BRAVE Stepped-Care programme including perceived acceptability and appropriateness of the early, mid-intervention stepped-care model, helpful and challenging aspects of treatment, experiences being stepped-up (or not stepped up) to therapist-support, and, for those stepped-up, perceptions of clinician support and support modality. Methods Semi-structured interviews were conducted with 18 clinically anxious young people (aged 9-16 years) who participated in the BRAVE Stepped-Care ICBT programme. Interview questions were informed by Proctor et al.’s implementation science framework, and data was analysed using deductive reflexive thematic analysis. Results Three themes were identified: (1) self-directed component promoted independence and was perceived as less stressful; (2) programme support, including orientation to the programme, parental support, and clinician support was important; and (3) a strong therapeutic relationship enhanced engagement and treatment experiences. Conclusions Overall, participants viewed the BRAVE Stepped-Care ICBT programme as acceptable and appropriate. Children and adolescents valued completing the self-directed component independently while recognising the importance of parental and clinician support. Younger children suggested that an initial practical session aiding programme navigation would be useful.