Early anxiety prevention through a live, online group-based parenting program: Effectiveness in a randomized controlled trial.

Anxiety problems are one of the most prevalent mental health conditions in children, placing a significant burden on families and mental health services. This creates an urgent need for early and accessible preventive interventions that maintain clinical effectiveness while optimizing time and costs for both families and therapists. The present study examined the effectiveness of an evidenced-based preventive anxiety parenting intervention, delivered in a live, online, group-based format using a randomized controlled trial (N = 148). Parents of behaviorally inhibited children aged three to six years were allocated to either the intervention, a Dutch adaptation of 'Cool Little Kids', or a control condition consisting of a book with general parenting advice. To enhance ecological validity, the study was conducted in a naturalistic setting in collaboration with Dutch public and mental health organizations. Linear mixed models analyses (n = 128) demonstrated that parents in the intervention condition reported lower child anxiety symptoms than those in the control condition at post-intervention (d = -.35), six and twelve month follow-up (d = -.46 and d = -.31). Group differences were no longer statistically significant at the twelve month follow-up, potentially due to gradual improvements within the active control condition and the possibility that the study was underpowered to detect smaller intervention effects. However, effect sizes remained comparable to post-intervention, suggesting sustained long-term clinical relevance. Overall, these findings provide novel evidence for live, online, parent-focused, group-based delivery as an effective approach to reducing anxiety symptoms in young, anxiety-prone children. CLINICAL TRIAL REGISTRY: This trial was prospectively registered in the Netherlands Trial Register (NL9633).