Adapted from BRAVE, a clinic-based cognitive behavioral therapy program for anxiety, BRAVE online offers treatment for anxiety disorders to children and adolescents.
BRAVE Online is a trans-diagnostic program that uses CBT techniques to treat a range of anxiety disorders among children and adolescents. Over 10 weekly sessions, users learn about and apply relaxation strategies, cognitive restructuring, and graded exposure. The program uses cartoon animation, bright graphics, text, quizzes, and interactive exercises to engage users. Two versions of the program are available, based on user age. Users are introduced to a therapist via email before starting treatment. The therapist contacts each user through email after each session to monitor responses and provide feedback. The program also includes 11 sessions specifically for parents that offer education on anxiety disorders in youth, contingency management techniques, and relaxation training.
Link to commercial site here.
Cognitive Behavioral Therapy (CBT)
Anxiety symptom severity
Frequency of symptoms
The efficacy of an internet-based cognitive-behavioral therapy intervention for child anxiety disorders.
Summary: In this randomized controlled trial of BRAVE Online, children (7-12 years) were referred to the study website by parents, teachers, and guidance counselors. Youth and parents completed anxiety screening questionnaires online and were assessed over the phone by a clinician. Children meeting diagnostic criteria for anxiety disorders (N=73) were randomized to BRAVE Online or to a waitlist control group. While all participants completed a baseline assessment and a 10-week follow-up, only participants receiving BRAVE Online completed a 6-month follow-up. At the 10-week follow-up only 33% of children and 60% of parents had completed BRAVE Online. The proportion of children meeting criteria for any anxiety disorders decreased significantly from baseline to 10-weeks, but did not differ significantly between conditions. Changes in clinician-rated anxiety severity were comparable between the BRAVE Online and waitlist control groups at 10 weeks. There was a significantly greater improvement in self-reported anxiety severity in the BRAVE Online condition relative to control. For young people that completed BRAVE Online, anxiety symptoms continued to improve from the 10-week to 6-month follow-up.
Take Away: Study demonstrated preliminary efficacy for BRAVE Online in reducing youth self-reported anxiety symptom severity relative to no treatment. Engagement with the program was low, however, and future research should examine facilitators and barriers to program use.
Summary: Online (BRAVE Online) and the clinic-based (BRAVE Clinic) versions of the BRAVE program were compared in a randomized controlled trial. Adolescents with anxiety disorders were recruited through media advertisements and referrals from mental health professionals. After completing phone and online screening and assessment, those diagnosed with a current anxiety disorder (N=115) were randomly assigned to BRAVE Online, BRAVE Clinic, or a waitlist control. Both BRAVE programs included the same number of sessions and content, but differed in delivery format. The waitlist control group received no treatment. All participants completed baseline and 12-week follow-up assessments. Only the participants assigned to BRAVE Online or BRAVE Clinic completed the 6-month and 12-month assessments. At the 12-week follow-up, significantly fewer participants receiving BRAVE Clinic or BRAVE Online met criteria for anxiety disorders.ÂÂ These participants also had significantly greater improvements in anxiety severity and overall functioning. At 12-month follow-up, participants receiving either the Online and Clinic versions of BRAVE had continued improvement in anxiety symptoms. No differences between BRAVE Online and BRAVE Clinic were detected. Completion rates and program satisfaction were comparable for adolescent participants.
Take Away: For adolescents with anxiety disorders, BRAVE Online is as effective as the clinic-based version of BRAVE for reducing anxiety symptom severity and frequency.
Large-scale dissemination of internet-based cognitive behavioral therapy for youth anxiety: Feasibility and acceptability study.
Summary: Researchers recruited 4,425 young people aged 7-17 years with elevated anxiety who had signed up for BRAVE Online over a 2-year period to evaluate the preliminary feasibility and acceptability of BRAVE Online when made open access and disseminated online and through clinician referral. Participants received a modified version of BRAVE Online without therapist support, simplified navigation, and additional content for relaxation and exposure hierarchies. Participants completed assessments of anxiety and intervention satisfaction at baseline and at the beginning of sessions 4, 7, and 10. Anxiety was measured using the CAS-8, with scores at or above the 84th and 94th percentiles indicating elevated and clinical levels of anxiety, respectively. Researchers extracted participant session completion from the BRAVE Online program. On average, participants rated their intervention satisfaction 17.7/25. Participants completed 2.2 sessions on average; 30.3% of participants completed more than 3 sessions. Greater session completion was significantly related to lower anxiety scores. Participants reported significant reductions in anxiety between baseline and sessions 4, 7, and 10. Most participants reporting “elevated” (n=1095) and “clinical” (n=532) levels of anxiety experienced reductions to non-elevated (53.8%) and non-clinical (61.1%) levels, respectively.
Take Away: BRAVE Online show preliminary evidence for reducing anxiety in young people when made open access and disseminated widely, though session completion was low.