Evaluating the Impact of an App-Based Homework Program Following One-Session Treatment for Childhood Phobias: A Randomized Controlled Trial

Journal of the American Academy of Child & Adolescent Psychiatry

Abstract

OBJECTIVE: Specific phobias are among the most common, earliest-onset psychiatric disorders in youth. Although one-session treatment (OST) is a well-established intervention, 35% to 40% of children do not reach full remission. This study examined whether supplementing OST with a child-focused, app-supported homework program would enhance outcomes. METHOD: In this parallel-group randomized superiority trial, 172 children (7-14 years old; mean [SD] age = 10.65 [2.09] years; 59% girls) meeting criteria for any specific phobia received standard OST before randomization to therapist-provided homework (OST-only group) or an app-supported program (OST + app group). Assessments occurred before and after a 3-week baseline, post-OST, post-practice, and at 6-month follow-up. Primary outcomes were diagnostic status and clinician-rated severity; secondary outcomes included behavioral avoidance, self-reported fear and avoidance, and functional impairment. Mixed-effects linear models were used. RESULTS: Both groups showed significant improvements on all outcomes, with medium to large effect sizes and gains maintained through post-practice and follow-up. Remission rates were 25.2% post-OST, 46.0% post-practice, and 69.6% at follow-up. Children in both groups practiced frequently. The app-supported homework program did not enhance outcomes or at-home practice. Families in the OST + app group reported higher treatment satisfaction. Children with blood-injection-injury phobias showed lower remission rates than children with other phobias. CONCLUSION: Findings underscore the effectiveness of OST across diverse clinical settings. The app-supported homework program did not enhance outcomes, though families reported higher treatment satisfaction, suggesting potential value warranting investigation. Future research should clarify whether specific child or symptom profiles may benefit from app-based support and strengthen OST implementation. STUDY REGISTRATION INFORMATION: Early Intervention and Treatment Prediction in Childhood Specific Phobias: Combining One-Session-Treatment With App-Based Technology; https://onderzoekmetmensen.nl/en/trial/55077.

Authors 20

1. Annelieke Hagen corresponding Aachen

   Leiden University

   Affiliation as printed

   Leiden University, Leiden, the Netherlands. Electronic address: anneliekehagen@hotmail.com

2. Thomas H. Ollendick

   Virginia Tech

   Affiliation as printed

   Child Study Center, Virginia Tech, Blacksburg, Virginia

3. Robin Zimmermann

   Ruhr University Bochum

   Affiliation as printed

   Mental Health Research and Treatment Center (FBZ), Ruhr University Bochum, Bochum, Germany

4. Tim de Jong
   Affiliation as printed

   Independent Researcher, Bellingwolde, the Netherlands

5. Francisca J. A. van Steensel

   University of Amsterdam

   Affiliation as printed

   UvA minds, Academic Child and Family Mental Health Care Centre, Amsterdam, the Netherlands

6. Karen Krause

   Ruhr University Bochum

   Affiliation as printed

   Mental Health Research and Treatment Center (FBZ), Ruhr University Bochum, Bochum, Germany

7. Jasmin Rahemenia Aachen

   Leiden University

   Affiliation as printed

   Leiden University, Leiden, the Netherlands

8. Esther I. de Bruin

   University of Amsterdam

   Affiliation as printed

   University of Amsterdam, Amsterdam, the Netherlands; UvA minds, Academic Child and Family Mental Health Care Centre, Amsterdam, the Netherlands

9. Sara L. M. Velthuizen Aachen

   Leiden University

   Affiliation as printed

   Leiden University, Leiden, the Netherlands

10. Lana van Rijswijk van der Pluijm

    University of Amsterdam

    Affiliation as printed

    UvA minds, Academic Child and Family Mental Health Care Centre, Amsterdam, the Netherlands

11. H.I. Meckling

    University of Groningen · Accare

    Affiliation as printed

    University of Groningen, Groningen, the Netherlands; Accare Child Study Center, Groningen, the Netherlands

12. Anika Bexkens Aachen

    Leiden University

    Affiliation as printed

    Leiden University, Leiden, the Netherlands; Leiden University Treatment and Expertise Centre (LUBEC), Leiden, the Netherlands

13. Erwin de Gier
    Affiliation as printed

    Trifork Amsterdam B.V., Amsterdam, the Netherlands

14. Jeanine M. D. Baartmans Aachen

    Leiden University

    Affiliation as printed

    Leiden University, Leiden, the Netherlands

15. Lynn Mobach

    Pro Persona · University of Amsterdam

    Affiliation as printed

    University of Amsterdam, Amsterdam, the Netherlands; Pro Persona, Institute for Integrated Mental Health Care, Nijmegen, the Netherlands

16. Maaike H. Nauta

    University of Groningen · Accare

    Affiliation as printed

    University of Groningen, Groningen, the Netherlands; Accare Child Study Center, Groningen, the Netherlands

17. Susan Maria Bögels

    University of Amsterdam

    Affiliation as printed

    University of Amsterdam, Amsterdam, the Netherlands

18. Ronald M. Rapee

    Macquarie University

    Affiliation as printed

    Centre for Lifespan Health and Wellbeing, Macquarie University, Sydney, Australia

19. Silvia Schneider

    Deutsches Zentrum für Psychische Gesundheit · Ruhr University Bochum

    Affiliation as printed

    Mental Health Research and Treatment Center (FBZ), Ruhr University Bochum, Bochum, Germany; German Center for Mental Health (DZPG), Bochum, Germany

20. Anke M. Klein Aachen

    Leiden University

    Affiliation as printed

    Leiden University, Leiden, the Netherlands