Behavioral therapy for children
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.
Cognitive Behavior Therapy 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
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.
Cognitive Behavior Therapy 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
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
Cognitive Behavior Therapy