Cognitive Behavioral Therapy Eases
Anxiety in Children and Adolescents
A form of psychotherapy that helps youngsters develop
coping skills while they identify what is bothering them can ease
anxiety for children and adolescents, according to a new review of
Traditional psychotherapy is sometimes dubbed “talk
therapy.” By contrast, cognitive behavior therapy is an active treatment
based on changing thinking patterns that lead to irrational behavior —
it does not involve looking backward at root causes of psychological
“It’s a cooperative therapy between the patient and
therapist, working together to map out the patient’s abnormal thoughts
and reactions,” says psychiatrist Anthony James, lead author on the
The systematic review appears in the current issue of
The Cochrane Library, a publication of The Cochrane Collaboration, an
international organization that evaluates medical research. Systematic
reviews draw evidence-based conclusions about medical practice after
considering both the content and quality of existing medical trials on a
The review analyzes 13 studies of children and
adolescents with mild to moderate anxiety disorders who were treated
with cognitive behavior therapy or CBT.
Anxiety symptoms subsided in 56 percent of the young
people treated with CBT, the review found.
Pediatrician Martin Stein, who was not involved in the
study, said the success of CBT is promising because “many parents would
like to have a non-pharmacologic approach to mild anxiety.”
In most health care settings today, the first line of
treatment for anxiety is medication, James said. But emerging
information on side effects and risks makes some parents wary of the
drugs commonly prescribed for mood disorders.
“For mild or moderate anxiety, starting with cognitive
behavior therapy makes all the sense in the world,” Stein said.
“We shouldn’t decry medicines if you need to use
them,” James said. Psychological treatments can also have downsides, he
said, but “the side effects of cognitive behavior therapy are relatively
Results for the 498 patients treated with cognitive
behavior therapy were compared with 311 children and adolescents who had
similar diagnoses but were not treated immediately.
As a measure of CBT’s benefit, the review found that
for every additional young person to get relief from anxiety, the
therapist needs to treat only three patients.
“Cognitive behavior therapy does work, it shows a
clear benefit over waiting controls,” James said.
The Cochrane review did not investigate the enduring
effects of CBT, but James said there are indications that cognitive
behavior therapy has long-term benefits. At the same time, James said
some physicians are concerned that drug therapy for mood disorders can
be followed by relapse once the medicine wears off.
Cognitive behavior therapy has made inroads into
mental health practice in the last 20 years, Stein said, and is
especially accepted by mental health professionals because research on
the method is reproducible.
“Researchers have developed manuals that clinicians
can follow. It’s harder to do that with (traditional) psychotherapy,” he
Many therapists already offer a combination of CBT and
insight psychotherapy, according to Stein. But James cautions that
systematic cognitive behavior therapy requires special training that can
18 October 2005