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 studies.

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 problems.

“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 review.

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 topic.

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 few.”

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 said.

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 take six

Taunya English
18 October 2005


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