Cognitive Behavioral Therapy for Child Anxiety
Cognitive behavioral therapy for anxiety can help children manage stress at school, at home, and with friends.
“You don’t have to control your thoughts. You just have to stop letting them control you. ”
If you’ve reached this page, you’re probably the parent of a child who is struggling with worry. Maybe you’ve heard about cognitive behavioral therapy for before, and how it can help anxious kids. You might see your child in one of the following scenarios:
You’ve reassured your child about her worries over and over, but they still come up again and again. Your child knows that the worry isn’t very realistic, but she keeps having it anyway.
You and your child have both started dreading school mornings, because your child has a wave of anxiety about going to school each day.
Your child is having a really hard time separating from you , more so than other kids his age.
You’ve noticed your child has to repeatedly check things or complete routines in a precise way in order to feel better.
Your child is struggling to sleep through the night alone, or gets very nervous at bedtime.
CBT is a special kind of therapy that teaches children that they don’t have to believe their worries, and gives them skills to face their fears. Kids can sometimes overcome anxiety more quickly with CBT than other forms of talk therapy.
What is Cognitive Behavioral Therapy?
Cognitive Behavioral Therapy is based on the idea that our thoughts and actions impact our behavior. Oftentimes, a child’s anxiety feels like a big wave that comes out of nowhere. Most of the time, the anxiety didn’t really come out of nowhere: the child had a thought or a worry that triggered the anxiety. Kids with anxiety have thoughts that are playing tricks on them. These thoughts are too negative to be true, or they get a child worrying about a worst-case scenario that might happen to one in a million people. CBT helps anxious children learn how to spot these thoughts and talk back to them. It can also teach children how calm themselves to face their fears, rather than avoiding frightening situations.
Kids in cognitive behavioral therapy often learn the following skills:
Relaxation techniques to help soothe anxiety and panic
How to spot and deal with unrealistic worries
How to gradually face their fears
Ways to cope with worries without checking things, rituals, or repeated behaviors
Does CBT work with children?
In a word, yes, it does! Cognitive behavioral therapy is a mouthful to say, but the ideas behind it are pretty simple. I have had good experiences teaching CBT skills to children as young as preschool-age. Elementary school-aged children are a wonderful fit for CBT, because they’re old enough to be more aware of their thoughts and worries. I incorporate CBT into therapy with most children that I see, because learning how to cope with worries at a young age can help a child for the rest of her life.
When I use cognitive behavioral therapy for child anxiety, I do my best to make it fun. Learning how to manage worries doesn’t have to be boring, and lots of CBT skills can be taught through play. I always check in with children and keep a close eye on how they’re doing in session, to make sure that they’re challenging themselves without getting overwhelmed.
How many CBT sessions are needed for child anxiety?
One benefit of cognitive behavioral therapy is that it tends to help the therapy process move more quickly. That being said, every kid is different, and the length of therapy is different for every child. Some children—especially children with a pretty simple, straightforward worry—progress very quickly and may only need a few sessions to start feeling better. Children with lots of really complex worries usually need more time to work through everything. I would estimate that most kids who come into therapy seeking CBT for anxiety feel ready to go by about the 6 month mark. I never try to push a child out of therapy prematurely, but I also don’t want children staying with me any longer than they need to. My goal is to put myself out of a job, and help each child get back to enjoying their lives independently as soon as they’re ready.
CBT for children with obsessive-compulsive disorder
Obsessive-compulsive disorder, or OCD, is a form of anxiety that includes a repeated worry that pops into mind over and over (an obsession) and a repeated behavior that a child does to try to alleviate the worry (a compulsion). Some common compulsive behaviors in kids with OCD are repeated hand washing, checking things around the house like light switches or the oven, and rituals that involve counting or doing things a certain number of times. Common OCD worries include fears of germs, worries about illness or vomiting, worries about whether or not the child has done the right thing, and fears that something bad might happen to the child or a loved one.
The problem is, each time a child performs their compulsion, their worry is helped in the short-term, but will come back again stronger the next time the child worries. Kids with OCD sometimes feel pretty hopeless about ever getting over their worries, but there is a form of cognitive behavioral therapy specifically designed to help kids with OCD. Exposure and Response Prevention, or ERP, helps kids learn how to spot OCD thoughts when they occur and learn to ignore them without performing their compulsion. The more a child learns to ignore the worry, the smaller the worry becomes.
CBT for children with separation anxiety
Separation anxiety is one of the most common forms of anxiety I see in my practice. We may think of separation anxiety as being something only little kids experience, but it can affect older children too, especially if there has been a recent change or stress in the family. Very sudden, severe separation anxiety in older kids can also be linked to PANDAS, a syndrome that is thought to be caused by an autoimmune response to the strep virus.
Cognitive behavioral therapy helps kids with separation anxiety to learn how to soothe themselves without relying on a parent, which can help kids feel more confident about being alone. Kids can also gradually practice separating from the parent using CBT, with support from their therapist. The therapist can help the child learn to cope with their anxious feelings while making sure the child is not being pushed outside his or her comfort zone. After a few sessions, many kids notice a big decrease in their separation anxiety.
CBT for kids who are perfectionists
Perfectionism can be a big source of anxiety for school-aged kids, who are learning to deal with the pressure of standardized testing, competition with classmates, and increasing amounts of homework. Some children are more prone to anxiety than others, and may find themselves very worried about doing well enough on assignments. Other children may feel so defeated or frustrated by assignments that they opt to not complete them at all, rather than risking a bad grade.
Many perfectionistic kids are very bright students who are capable of doing well at school: it’s their thinking that’s holding them back. Cognitive behavioral therapy helps children with this form of anxiety to learn more about the thinking that contributes to perfectionism. Through CBT, kids can learn how to cope with mistakes without melting down, and approach problems with more creativity and flexibility.
Cognitive behavioral therapy for child anxiety in Davidson, North Carolina
I’m certified in CBT for children,and I practice in the Lake Norman area of North Carolina, North of Charlotte. If you’re in the Davidson or larger Lake Norman area and think CBT could be a good fit for your child, send me an email or give me a call.
Because I only work with children with anxiety or trauma symptoms, I’ve seen the ways that CBT can be a big help for kids with many forms of anxiety. CBT gives kids the skills they need to cope with anxiety now, while also changing the way that they handle their worries in the future.
More resources on anxiety and CBT for kids
I blog about how CBT can be used to help kids with many forms of anxiety and trauma. For more in-depth information on how to support a child with anxiety, check out my Help for Anxiety page. You can also read a few of my recent blog posts below:
ERP Therapy for Children
Signs of OCD in Children: What Parents Can Look For
