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Cognitive behavioral therapy is an effective form of treatment for children and adolescents with anxiety disorders. 

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This is the conclusion of a review article from the renowned Cochrane database (1).

The background to the Cochrane article is that many children and adolescents suffer from anxiety.

Children and young people with anxiety are more likely to have problems with friendships, family life and school. Treatments for children and adolescents with anxiety can help prevent them from developing mental health problems or drug and alcohol abuse later in life.

Treatments such as cognitive behavioral therapy (CBT) can help children and adolescents deal with anxiety by developing new ways of thinking. Many parents and children prefer to try talk therapy instead of medications such as antidepressants.

The review article was intended to summarize and assess what we know about research on cognitive behavioral therapy as a treatment for anxiety in children and adolescents. 


What are the characteristics of cognitive behavioral therapy for children and adolescents?

According to a new guide (2011) from the Norwegian Child and Adolescent Psychiatric Association (2), cognitive behavioral therapy for children and adolescents has the following characteristics:


  1. Collaboration model: With the help of real wonder and open "socratic" questions, one explores with the patient his / her experiences and ways of thinking. The therapist's goal is for the patient to discover connections and opportunities for change helped by the therapist's questions and respectful attitude. One explores together what consequences change of mindset or actions may have. Together, they set up behavioral experiments to try this out in practice. The therapist regularly asks for feedback from the patient about how the treatment is experienced. The therapist collaborates with the patient to set up a priority agenda for each session, where they work to understand the problems based on the cognitive model. One makes active problem solving with the patient in the session and continues this learning between the sessions in the form of practice in the home situation.
  2. Therapeutic alliance: Empathy and work alliance between therapist and patient are fundamental to treatment. Together they try to create a cognitive dissonance / symptom dystonia with the goal that the patient experiences "this is how I do not want it anymore". The therapist shares his observations and reflections respectfully, openly and wonderingly with the patient. The therapist should not teach or argue.
  3. Active therapist role: During the session, a wide range of strategies and techniques are used to help the patient identify, evaluate and respond to key cognitions. This is done to achieve a lasting positive change in the patient's emotions, behavior and physical response. Preventing relapse is another important task. The therapist takes responsibility for the structure and progress of the therapy sessions. He / she prepares the lesson and sets his / her own strategies and goals for the content.
  4. Goal-focused: The parties agree on what they want to achieve with the therapy, and the goals govern the work. Frequent summaries and invitations to the patient to give feedback on what is perceived as useful or not, must ensure that one works towards a common goal. This work is focused, motivating and makes future choices and priorities easier.
  5. Individualized: Within the safe framework of structure, it is important to individually adapt to the problem and the patient's needs. The therapist must vary his interventions in line with the patients' developmental stage and ability level, motivation and commitment to treatment, and their trust in the therapist. Furthermore, one must consider their ability to be focused, their learning style, cultural assumptions and many other factors. 
  6. Here and now perspective: You mainly work with the here and now situation. The past is drawn in to the extent necessary to understand thoughts and reactions in the here and now situation, and to help change established inappropriate patterns of cognitions and behaviors.
  7. Skills training: The patient is given the necessary education and training in understanding and using the cognitive model. The goal is for the patient to be able to help themselves, and not be dependent on the therapist. Cognitive behavioral therapy also includes training in e.g. social skills, relaxation techniques, self-observation, problem solving and skills in grasping and assessing one's own negative automatic thoughts and thought patterns. Training tasks between sessions are used both to provide increased time and intensity of the therapeutic work, make the patient more active and co-responsible in their own treatment, provide the opportunity to test hypotheses in real life and to train new functions.


Cognitive behavioral therapy for anxiety disorders in children and adolescents

The article concludes with the following findings:


  1. Cognitive behavioral therapy (CBT) is significantly more effective than no treatment in terms of reducing the symptoms of anxiety in children and adolescents.
  2. There is no clear evidence to suggest that one particular way of conducting cognitive behavioral therapy is more effective than another (for example, in a group, individually, with parents).
  3. CBT is no more effective than other "active therapies" such as self-help books.
  4. The small number of studies meant that authors could not compare CBT with medication, and it was therefore not possible to conclude which of these forms of treatment thus has the best effect.
  5. Only four studies have looked at long-term results after cognitive behavioral therapy. None of these studies provided clear evidence that improvement in anxiety symptoms was maintained over time in children and adolescents receiving cognitive behavioral therapy.


Only cognitive behavioral therapy was demonstrably effective against anxiety in children and adolescents

Another review article concludes that only cognitive behavioral therapy has a documented effect as anxiety treatment in children and adolescents.

The Health Library (3) writes about this:

A recent meta-analysis, recently published in the Clinical Psychology Review, is the first of its kind to cover all different types of anxiety disorders and psychotherapies. The analysis includes 55 studies, several of which are of low quality, according to the authors. Recent research seems to be of better quality than older studies, but the authors nevertheless emphasize that it is important that future research follows given standards for research reports.



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