RCT of a Transdiagnostic Online REBT Intervention for Youth Anxiety and Depression

Overview

This randomized controlled trial evaluated an internet-delivered, transdiagnostic Rational Emotive Behavioral Therapy (REBT) intervention targeting anxiety and depression in children and adolescents. The intervention demonstrated promise in reducing internalizing symptoms by addressing common cognitive mechanisms across disorders, offering a scalable and accessible treatment option.

Background

Anxiety and depressive disorders are among the most prevalent mental health issues in youth, with early onset and significant long-term consequences including academic and occupational impairments. Despite effective treatments, access to mental health care remains limited, especially in low-resource settings such as Romania. Internet-delivered interventions have emerged as a cost-effective and flexible approach to improve access, with transdiagnostic protocols targeting shared cognitive mechanisms across disorders to address comorbidity efficiently. REBT, a cognitive behavioral therapy focusing on modifying irrational beliefs, is well-suited for such transdiagnostic applications and has shown moderate efficacy in youth anxiety and depression.

Data Highlights

Key epidemiological data include: 38.1% onset rate of anxiety disorders before age 14; 3.1% for depressive disorders. Treatment rates for youth internalizing disorders are low globally, with only 31% for anxiety and 36% for depression receiving care. In Europe, mental health treatment access is 25.6%, dropping to 18.9% in low-resource countries. Romania has 1.2 child psychiatrists and 4.5 psychologists per 100,000 inhabitants, significantly fewer than higher-resource countries. Internet interventions have shown significant anxiety symptom reductions in youth, with mixed results for depression.

Key Findings

• Internalizing disorders in youth are highly prevalent and associated with substantial disease burden and increased healthcare utilization.
• Treatment access for anxiety and depression in children and adolescents is markedly insufficient, especially in low-resource countries like Romania.
• Internet-delivered interventions provide increased accessibility, anonymity, and cost-effectiveness for youth mental health care.
• Transdiagnostic approaches targeting shared cognitive mechanisms, such as irrational beliefs, address comorbidity efficiently and reduce the need for multiple disorder-specific protocols.
• REBT is an effective transdiagnostic therapy focusing on modifying irrational evaluative cognitions, with demonstrated moderate effects on anxiety and depression in youth.
• The REBTonAd intervention consists of a fixed sequence of nine modules designed to target core mechanisms underlying anxiety and depression, facilitating standardized internet delivery and scalability.

Clinical Implications

Clinicians should consider transdiagnostic internet-delivered REBT interventions as a scalable and accessible treatment option for youth with anxiety and depression, particularly in settings with limited mental health resources. Targeting irrational beliefs can effectively reduce internalizing symptoms across disorders, potentially improving treatment reach and outcomes. Incorporating such protocols may alleviate service disparities and reduce healthcare costs associated with untreated internalizing problems.

Conclusion

This study supports the feasibility and promise of a transdiagnostic, internet-delivered REBT intervention to address anxiety and depression in children and adolescents. Such scalable approaches are critical to improving mental health care access and outcomes in youth globally.

References

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