|Cognitive Behavior Therapy
Research has shown that Cognitive Behavior Therapy is a form of therapy that's effective for childhood
anxiety and other disorders. The main focus of CBT and behavioral therapy is to minimize the child's anxiety
by altering the ideas or behaviors that help maintain the anxiety present. During CBT the child learns that
thoughts cause feelings and moods which can influence behavior. If a child is experiencing unwanted
feelings or has difficult behaviors, the therapist works to identify the inner thoughts that are causing them.
The therapist then helps the child replace these ideas with thoughts that result in more appropriate feelings
and behaviors. CBT works by using exercises and other active techniques that teach a child to respond
differently to anxiety.
CBT has two essential features:
• The cognitive part helps children change how he/she feels about a situation.
• The behavioral element helps children change how they react to the situation. A necessary feature of
behavioral therapy is helping children slowly confront the situation or thing that they are afraid of.
Benefits of Cognitive Behavioral Therapy
Many types of anxiety, such as specific phobias, social anxiety, as well as depression and obsessive-
compulsive disorders, can be helped with CBT. For example, a child with a specific phobia avoids what they
"think" is dangerous, and unfortunately, the evading keeps anxiety persistent. Exposure therapy targets the
avoidance and is the most important piece of CBT for specific phobia, because it involves helping children
approach an intimidating object or go into a scary situation slowly. The process allows them to cautiously
collect evidence that will help them to challenge their false beliefs about a particular thing or situation.
By casually putting them in these situations they learn that they can manage the situation by using their
coping skills (e.g., deep breathing) and cognitive skills (e.g., problem solving and positive self-talk). Kids
also learn that what they feared was exaggerated and unrealistic.
CBT is also effective in improving a child's depression by changing the beliefs or behaviors that influence
depression. Everyone has thoughts that "automatically" pop into their heads, but depressed children and
teens tend to have more "negative" ones. The first step in controlling "negative" thoughts is to learn to
become aware of them and to identify the ones they have most often. CBT can also help teens develop better
social skills, problem-solving skills, and decisive skills to help them succeed in their relationships.
Cognitive Behavioral Therapy Stages
Phase I - it involves psycho-education; the therapist teaches children and their families about anxiety and the
cognitive behavioral model of treatment. The techniques that will be practiced in therapy are introduced as
"tools" that the child will acquire to "boss back" the anxiety symptom and reclaim areas of their lives that the
anxiety currently disrupts.
Phase II - this involves mutual work between the child and therapist as they "map out" the child's anxiety
symptoms, create an exposure ladder, and begin enhancing EX/RP (exposure/response prevention) during
later sessions. The child is put in activities that expose him/her to the feared object or situation and prevents
them from fulfilling the evasion they use to reduce the anxiety. Although the exposure intentionally produces
anxiety, it does so in a controlled and steady approach.
For example, Sam, described above, would be asked to touch a doorknob. This act is called an exposure,
because it exposes him to his fear of contamination and creates anxiety. The response prevents him from
washing his hands, the act that reduces his anxiety. The anxiety levels get higher temporarily and then
subside. This exposure is repeated several times and then followed by more challenging exposures.
The child and therapist work as partners against a mutual opponent—anxiety which develops the trust a
child may have in the therapist as exposures get started. Typically, therapy sessions are used for exposures
that the child is trying for the first time, and then independent sessions are planned for home so that the child
can further master the skills and continue to "shrink" the symptom.
Phase III - the therapist prepares children and their families for the ending of active treatment. The
likelihood of an eventual recurrence of symptoms is discussed openly, both to normalize the experience as
well as to encourage children to take on more independence in planning and to overcome remaining
exposures. In the last few sessions, therapists work carefully with children to develop a plan for relapse
prevention, emphasizing that the same skills the children have mastered in therapy are those that they can
use on their own whenever the need occurs. Additionally, support sessions are scheduled so that therapists
and children can reconnect at regular intervals to address any problems or simply to check in and celebrate
continued good health.
Intensive exposure and response prevention (EX/RP) leads to 'habituation.' When the child repeats the same
act over and over again and sees that nothing happens, they build up a tolerance and anxiety levels go down.
Treatment sometimes leads to a near- or total reduction of symptoms. Symptoms may reoccur during times
of stress, fatigue, or physical illness—and sometimes just out of the blue. This does not mean that the child
will experience a complete relapse. Rather, a return of symptoms can serve as a signal to children that it is
time to revisit the skills they learned in therapy and use them as needed.
It is in this way that CBT teaches adaptable coping skills that children will be able to use for the rest of their
lives. For instance, the ability to recognize problems that are getting out of hand then develop thoughtful
plans to solve them is a general skill that children will find they can apply to several situations. This in turn
will promote feelings of confidence and self-efficacy that can enhance positive development and good
mental health throughout childhood and beyond.
How Parents Can Help
Most parents want to help their children avoid experiencing distress or unhappiness. Helping your child avoid
an anxiety-provoking situation, however, actually reinforces anxious behavior because you are
unconsciously communicating that there is something to be afraid of. Avoidance keeps anxiety going, and
the next time your child is faced with the same situation, he/she will remember that they were not able to
cope with it the previous time. You are unintentionally teaching your child that the way to reduce anxiety is
to avoid what makes him/her anxious. This prevents the anxious child from developing their own strategies
for coping with everyday situations, particularly those that may be difficult or challenging.
Never dismiss your child's fears as "silly" and never say "it's all in your head." Instead, sympathize with your
child's worries using a neutral, matter-of-fact tone, communicating confidence. For example, "I understand
that you are afraid, but I know that you can handle this, and I am here to help you. Let's solve this problem
together. What can you do first?" The goals for encouraging healthy growth is for your children to develop
as happy individuals, allowing them to explore their environments, and master the resources they will need in
order to become successful adults.