Child Anxiety Tales (CAT; Khanna & Kendall, 2017) is an online parent-mediated intervention for children with anxiety that specifically targets the important role of parents within the treatment process. CAT is a parent-administered online cognitive-behavioral treatment program that utilizes 10-sessions over 10 weeks to improve children's anxiety symptoms. A paucity of research to date has examined CAT treatment outcomes. Using a randomly controlled experimental design, this study investigated the fidelity, effectiveness, and acceptability of the CAT program. Data collected at pre-treatment, post-treatment, and 1-month follow-up was used to evaluate the fidelity, effectiveness, and acceptability of the CAT program. Comprehensive recruitment efforts resulted in 78 parents expressing interest in the study and 44 met study criteria. Of the 34 who consented to treatment, 17 were randomly assigned to each group. Six in each group were unable to complete the study for a range of reasons (many as result of the challenges associated with a global pandemic) and withdrew prior to completion of post-test measures. A total of 22 participants (n = 11 in the intervention group; n = 11 randomly placed in the waitlist control group) completed the study in full. The 11 parents who completed the CAT intervention program reported success in carrying out the CAT intervention as intended, with self-rated treatment fidelity scores averaging 97% completion of all treatment components. Additionally, results from the parents in the intervention group revealed statistically and clinically significant reductions in their own levels of anxiety, stress, overprotective behaviors, and negative beliefs about their child's experience of anxiety. In addition, statistically and clinically significant improvements in their child's anxiety symptoms were also reported when compared to control group parent ratings. No statistically significant improvements were found on a measure of negative parent-child interactions between the two groups, despite clinically meaningful improvements reported by parents in the intervention group. Finally, parents who completed CAT reported very high levels of acceptability pertaining to the intervention approach. Study findings are limited by the small sample size and the characteristics (e.g., highly motivated) of the demographically-homogenous study participants who completed this online intervention and waitlist control conditions in the midst of the challenges associated with a global pandemic. Study findings make a strong contribution to (a) the limited literature on online parent-administered programs to treat children experiencing anxiety and (b) the broader literature highlighting the importance of including parents within the child anxiety treatment process to maximize treatment effects. In addition, this is the first CAT program study to assess parent measures as the primary outcome and only the second CAT program study to assess fidelity, effectiveness, and acceptability. Implications for further research and potential implications for future clinical practices with children presenting with anxiety symptoms and resulting dysfunction are discussed.
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