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Care"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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\u201312 years with mild to moderate anxiety suitable for Swedish primary care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A participatory design approach was used, including workshops and interviews with parents (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20096), therapists (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200912), managers (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20093), and CBT experts (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20093). Following development of a preliminary CBT protocol, children (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20094) and their parents piloted the intervention. Subsequent interviews with children, parents, and therapists explored treatment experiences and informed further refinement.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The developed intervention,\n                      <jats:italic>Step by Step<\/jats:italic>\n                      , 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12875-026-03191-y","type":"journal-article","created":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T02:54:23Z","timestamp":1769568863000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Developing a primary care-based cognitive behavioral intervention for anxiety in children through a participatory approach: a qualitative study"],"prefix":"10.1186","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-8386-6415","authenticated-orcid":false,"given":"Albin","family":"Isaksson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johan","family":"\u00c5hl\u00e9n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henna","family":"Hasson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leif","family":"Eriksson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,28]]},"reference":[{"issue":"3","key":"3191_CR1","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1111\/jcpp.12381","volume":"56","author":"GV Polanczyk","year":"2015","unstructured":"Polanczyk GV, Salum GA, Sugaya LS, Caye A, Rohde LA. 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Newbury Park (CA): Sage; 1985."}],"container-title":["BMC Primary Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12875-026-03191-y","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12875-026-03191-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12875-026-03191-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T17:13:54Z","timestamp":1781630034000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12875-026-03191-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,28]]},"references-count":52,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["3191"],"URL":"https:\/\/doi.org\/10.1186\/s12875-026-03191-y","relation":{},"ISSN":["2731-4553"],"issn-type":[{"value":"2731-4553","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,28]]},"assertion":[{"value":"14 April 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 January 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 January 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was approved by the Swedish Ethical Review Authority (reference number 2021\u201304864; 2022-02336-01) and was conducted in accordance with the Declaration of Helsinki. All participants received both written and verbal information about the study, and informed consent was obtained. For participating children, written assent was obtained from the child and written consent from all legal guardians (i.e., both guardians when applicable, or one if only one legal guardian existed).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"69"}}