InStride, a virtual person-to-person treatment program for profound worry, fear and avoidance, may be a game-changer for young people ages 7 to 22 with anxiety disorders that lead to inertia, social isolation, school avoidance, depression and physical symptoms. It delivers real-time coaching remotely, when and where they need it, and is now covered by most New Hampshire health insurers, including Anthem BCBS, Harvard Pilgrim and United Health Care.
“Right now, the options are to wait on a long wait list to get (in-person) treatment that is not evidence based,” said Kat Boger, chief clinical officer of the program she co-founded at McLean Hospital in 2021, now with 350 patients in seven Northeast states.
InStride can replace commuting to the greater Boston area for specialized, intensive care for moderate to severe anxiety and OCD, which accounts for roughly 3% of all anxiety disorders.
“There’s a large amount of individuals 7 to 22 who have these diagnoses and who are not able to get care,” said Alexis Ducharme, a spokesperson for InStride Health.
Approximately 32% of adolescents have an anxiety disorder, according to the National Institute of Mental Health.
Before the pandemic, pediatric anxiety disorders were steadily increasing, and COVID “was like throwing gasoline on the fire,” Boger said. Research indicates that by age 18, nearly one in three children will meet criteria for an anxiety disorder, such as obsessive compulsive disorder, social anxiety, panic disorder, post-traumatic stress disorder, separation anxiety or a type of phobia.
“Anxiety is considered a gateway disorder,” Boger said. “If untreated it leads to depression, suicidality and substance misuse. Our goal is to target OCD and anxiety head on during these crucial years.”
According to early findings, 90% of InStride graduates experienced a reduction of moderate to severe anxiety symptoms, with an average 46% drop reported after two months. After three months, 82% of patients cited improvements in daily functioning and less severe symptoms, according to data from InStride Health.
A 13-year-old girl from Massachusetts, diagnosed with anxiety and OCD, has battled repetitive, engulfing thoughts and worries since she was 3, said her mother, a teacher who lives in Hanson, Mass. With an InStride team consisting of a therapist, coach and psychiatrist who met with her remotely, and a hotline to text or call for strategies, her daughter learned to weather anxiety-spiking moments that otherwise might have been crippling.
“She’s handling them more proficiently. I really feel like she can maintain and sustain the progress she’s seen,” said her mother, who discovered InStride on Facebook. Her daughter graduated InStride in the fall after nine months of treatment, and now sees an outside therapist. “To know that this doesn’t make you weird or strange was affirmative for her, too,” her mother said by phone. While participating in InStride, the girl met remotely with other middle school patients and her parents participated in online parent support.
InStride’s virtual program uses cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) to change destructive thought patterns. Incremental exposure helps desensitize young people to things and situations they greatly fear — including dogs, cats, people, certain foods, being surrounded by peers, being alone in a crowd, or being judged in embarrassing situations. Untreated anxiety can easily get in the way of school and work.
“We’re trying to change ‘I’m scared and need to avoid’ to ‘I’m scared and I can find a way to face this. I can break it into small steps. Over time, I can learn to tolerate it,’” Boger said. The more young people steer clear of the things they fear, “the more their anxiety grows.”
The program, which runs from four to 12 months, four to five times a week at the start, includes virtual group and individual sessions for patients, family members and caregivers.
”Finding a therapist for anyone is hard. Finding a therapist for a child is extra hard. Finding one trained in childhood OCD is a whole other level,” said the mother in Hanson, Mass. “Anxiety and OCD are always going to be a component of who (my daughter)is. It’s important for her as she grows up to have a tool kit she can pull from.”
”While I cannot speak to any particular provider, access to evidence-based treatment remains a significant issue,” said Susan Stearns, executive director of NAMI NH, the state’s chapter of the National Alliance on Mental Illness. “Telehealth can be effective for many people.”
