From the Guidelines
Cognitive behavioral therapy (CBT) is a highly effective treatment for children with anxiety disorders, and it should be considered as the first-line treatment, particularly for mild to moderate presentations, due to its strong empirical support and safety profile, as evidenced by the 2020 clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders 1.
Key Components of CBT for Anxiety Disorders
The treatment involves several key components, including:
- Psychoeducation to help children understand anxiety symptoms
- Cognitive restructuring to identify and challenge anxious thoughts
- Gradual exposure to feared situations through a hierarchy of challenges
- Relaxation techniques like deep breathing and progressive muscle relaxation
- Problem-solving skills development Parents are often included in the therapy process to reinforce skills at home and learn how to respond appropriately to their child's anxiety.
Benefits of CBT
CBT has been shown to improve primary anxiety symptoms, global function, and response to treatment, with moderate strength of evidence (SOE) 1. Additionally, combination treatment (CBT and an SSRI) may be a more effective short-term treatment for anxiety in children and adolescents than either treatment alone, with moderate SOE 1.
Recommendations
CBT should be prioritized over medication for recent onset of milder, less distressing, and less functionally impairing anxiety presentations, and combination treatment (CBT and an SSRI) could be offered preferentially over monotreatment for patients 6 to 18 years old with social anxiety, generalized anxiety, separation anxiety, or panic disorder 1. In terms of treatment duration, CBT sessions typically last 45-60 minutes each, and the treatment involves 12-16 weekly sessions. The therapy empowers children by helping them recognize that their thoughts affect their feelings and behaviors, giving them tools to manage anxiety independently over time.
From the Research
Overview of Cognitive Behavioral Therapy for Childhood Anxiety Disorders
- Cognitive behavioral therapy (CBT) is a widely used treatment for childhood anxiety disorders, with numerous studies demonstrating its effectiveness 2, 3, 4, 5, 6.
- CBT has been shown to be superior to wait-list control, attention control, and treatment as usual in reducing anxiety symptoms and improving remission rates in children and adolescents 2, 4.
Comparison of CBT with Other Treatments
- Studies have compared CBT with pharmacotherapy, such as selective serotonin reuptake inhibitors (SSRIs), and found that CBT is equally effective or even more effective in reducing anxiety symptoms 3, 4, 5.
- The combination of CBT and pharmacotherapy has been shown to be more effective than either treatment alone in some studies 3, 4, 5.
- CBT has been found to have fewer adverse effects and lower dropout rates compared to pharmacotherapy 3, 5.
Different Modalities of CBT
- Individual-based CBT, group-based CBT, remote-based CBT, and family-based CBT have all been shown to be effective in treating childhood anxiety disorders 4.
- Different CBT modalities may be more or less effective depending on the specific population and context, highlighting the need for further research to determine the most effective approach for each individual 4, 6.
Recent Advances and Adaptations
- Recent research has focused on enhancing exposure-based CBT components, adapting CBT to work with specific populations, and developing new technologies to improve treatment outcomes 6.
- Successful adaptations to CBT have been developed for preschoolers, adolescents, and children with comorbid autism spectrum disorder and anxiety, demonstrating the flexibility and potential of CBT as a treatment approach 6.