Developing a primary care-based cognitive behavioral intervention for anxiety in children through a participatory approach: a qualitative study

TL;DR

This study developed a primary care-friendly CBT intervention for children with anxiety using input from parents, therapists, and experts.

Contribution

A participatory approach was used to create a primary care-adapted CBT protocol for children's anxiety.

Findings

The intervention, Step by Step, uses a stepped-care model with group and individual sessions.

Feedback from children and parents highlighted acceptance, feasibility challenges, and appropriateness of the approach.

The protocol will be refined and tested in larger clinical trials.

Abstract

Cognitive behavioral therapy (CBT) is an effective treatment for childhood anxiety, but CBT protocols suited for primary care are lacking, which limits accessibility. This study aimed to develop a CBT intervention for children aged 7–12 years with mild to moderate anxiety suitable for Swedish primary care.

A participatory design approach was used, including workshops and interviews with parents (n = 6), therapists (n = 12), managers (n = 3), and CBT experts (n = 3). Following development of a preliminary CBT protocol, children (n = 4) and their parents piloted the intervention. Subsequent interviews with children, parents, and therapists explored treatment experiences and informed further refinement.

The developed intervention, Step by Step, followed a stepped-care model comprising two steps: Step 1 (four group sessions and one individual session) and Step 2 (three additional individual sessions if needed). Interviews with children, parents, and therapists piloting the intervention resulted in three themes with corresponding subthemes: (a) acceptance - sense of not being alone; appreciation of interactive session activities; (b) feasibility - suitable in primary care but a therapeutic challenge to shift from group to individual format; more time in group needed (c) appropriateness - flexibility promotes relevance and fit; strategies contribute to learning and behavioral change.

This study illustrates how an intervention can be developed to fit a specific setting. A preliminary version of the stepped-care intervention yielded feedback that will be used to finalize the protocol. Larger-scale clinical trials are planned to evaluate feasibility and effectiveness.

The online version contains supplementary material available at 10.1186/s12875-026-03191-y.

Figures