A Finnish internet-based therapy programme has produced anxiety reductions in children that continued to grow for two years after treatment ended, according to a randomized controlled trial published in JAMA Network Open. The findings offer rare long-term evidence that guided digital cognitive behavioural therapy can help children not only during an active intervention, but also as they continue to apply newly learned strategies in daily life. Researchers from the University of Turku report that children who completed the ten-week Master Your Worries programme experienced significantly greater improvements in anxiety symptoms and everyday functioning than children who received digital educational materials. The study is being described as internationally important because it is the first population-based randomized trial to demonstrate the sustained efficacy of an internet-based cognitive behavioural therapy programme for childhood anxiety over such an extended follow-up period.
The trial involved 465 Finnish children between 10 and 13 years of age who showed symptoms of anxiety during routine school health check-ups. This screening-based approach is significant because it reflects how anxiety might be identified in ordinary community settings rather than only among families who actively seek specialist mental-health care. Children were assessed for anxiety symptoms and then randomly assigned either to the Master Your Worries intervention or to a control group. The control participants received digital information about anxiety, wellbeing and healthy lifestyles, but did not receive the structured therapeutic programme. Randomization allowed researchers to compare changes between the two groups while reducing the likelihood that differences in age, symptom severity or family circumstances would explain the results.
Master Your Worries is based on cognitive behavioural therapy, or CBT, a psychological treatment that links emotions with patterns of thought and behaviour. Anxiety can be maintained when children repeatedly avoid situations they perceive as threatening, seek excessive reassurance, or interpret ordinary physical sensations as signs of danger. CBT aims to interrupt this cycle by helping children recognize anxious predictions, test them against reality and gradually approach situations they would normally avoid. In the Finnish programme, children worked through online therapeutic material with support from a parent. Parents received their own digital resources, while each family was offered weekly telephone guidance. This combination of self-directed online work and human coaching is known as guided digital therapy, and it may provide more support than an entirely automated application without requiring the resources of traditional weekly clinic appointments.
Both groups showed some reduction in anxiety during the follow-up period, a pattern that researchers say may reflect natural changes over time, the general information provided to families, or the benefits of being monitored and assessed. However, the decline was significantly larger among children who participated in Master Your Worries. Their functional ability also improved more substantially, suggesting that the intervention affected not only how anxious children felt, but also how effectively they managed schoolwork, social relationships and ordinary activities. The benefits were most pronounced among children who began the study with more severe symptoms. This pattern is particularly relevant for clinical services because it suggests that digital treatment may be useful not merely as a low-intensity educational tool, but also for children experiencing clinically meaningful anxiety who might otherwise face long waits for specialist care.
The most striking result appeared after the treatment itself had finished. The intervention lasted ten weeks, yet its effects continued to strengthen between the six-month and twelve-month assessments and remained clearly greater at two years than at six months. Improvements were detected both in the children’s own reports and in assessments completed by their parents. In conventional drug trials, effects are often expected to emerge during treatment and then remain stable or decline after treatment stops. Psychological interventions can work differently. The skills learned through CBT may require time and repeated use before they become automatic, allowing a delayed treatment effect to develop as children encounter new situations and apply the strategies outside the therapy environment.
According to the researchers, the delayed improvement may arise because CBT changes behavioural routines across the entire family. A child who learns to challenge catastrophic thoughts may gradually become more willing to attend school, sleep independently, speak with peers or participate in activities previously avoided. Parents, meanwhile, may learn to respond to anxious behaviour without unintentionally reinforcing avoidance or repeated reassurance-seeking. Each successful experience can provide new evidence that feared outcomes are less likely or more manageable than expected. Over months, these small changes may accumulate, strengthening confidence and reducing the influence of anxiety. The study also found that the programme supported parents’ wellbeing and gave them practical tools for assisting their children in everyday situations, potentially extending the intervention beyond the online sessions.
The findings arrive as anxiety among children and adolescents is becoming a growing public-health concern. Researchers estimate that roughly 6 to 18 percent of school-age children and adolescents experience an anxiety disorder, although the exact proportion varies according to the definition used and the population studied. Anxiety can interfere with concentration, attendance and academic performance, while also producing physical symptoms such as headaches, stomach pain, sleep disruption and fatigue. Childhood anxiety is associated with an increased risk of later depression and, in some cases, self-harming behaviour. Yet mental-health services for children face persistent shortages of trained professionals, meaning that many young people do not receive evidence-based treatment. A guided online programme could help address this gap by reaching families who live far from specialist clinics or who encounter long waiting lists.
The study’s population-based design also points toward a possible role for school health services and primary care in earlier detection. Children with anxiety do not always present with an obvious mental-health complaint. Some may appear withdrawn, perfectionistic or reluctant to attend school, while others may repeatedly visit health services with physical symptoms. Screening during routine school check-ups could identify children before anxiety becomes deeply embedded in their social and educational lives. Once identified, children could potentially be offered stepped care, beginning with accessible digital treatment and progressing to more intensive clinical support when symptoms are severe, persistent or accompanied by other risks. The researchers emphasize that Master Your Worries should complement existing services rather than replace professional assessment or specialist treatment when those are required.
Although the results are encouraging, the intervention still depends on family participation, access to the internet and the availability of guidance from trained staff. Digital treatment may not be equally suitable for every child, particularly those with complex psychiatric conditions, limited parental support or difficulties engaging with online material. The control group also received useful information, and anxiety symptoms decreased among those children, showing that the trial was not comparing therapy with complete absence of care. Even so, the sustained separation between the groups, the randomized design, reports from both children and parents, and the two-year follow-up strengthen the evidence that the structured programme itself produced meaningful benefits. The results suggest that the future of child mental-health care may not lie in choosing between digital and face-to-face treatment, but in combining both approaches so that effective support can reach children earlier and remain available for as long as they need it.
Subject of Research: People
Article Title: Internet-Based Cognitive Behavioral Therapy and Telephone Coaching for Anxiety in Children
News Publication Date: 14-Aug-2026
Web References: https://doi.org/10.1001/jamanetworkopen.2026.29195
References: JAMA Network Open, “Internet-Based Cognitive Behavioral Therapy and Telephone Coaching for Anxiety in Children,” DOI: 10.1001/jamanetworkopen.2026.29195
Keywords: childhood anxiety, cognitive behavioural therapy, internet-based therapy, digital mental health, Master Your Worries, randomized controlled trial, child psychiatry, adolescent mental health, University of Turku, telephone coaching
