The Center for
Cognitive Therapy

Cognitive Behavioral Therapy for Kids

Anxiety disorders are the most frequent disorders of childhood and adulthood as well, with the highest estimate being 30% of people will suffer from an anxiety disorder at some point in their lives (Costello, Egger, & Arnold; Merikangas et al., 2010). And, a study published in 2018 shows that anxiety disorder diagnoses among young people has increased by 17% in the previous five years.

Suffering from anxiety can have serious affects on a child’s family live, physical and mental health, academic achievement, and overall quality of life.

Some anxious kids appear visibly distressed – they perform rituals, ask excessive questions, and cling to their parents, while others are perfectionistic, worry silently and hide their fears. Kids with anxiety can also seem irritable and easily frustrated when things don’t go exactly as planned. To their teachers, and sometimes to their families, anxious kids are often perceived as fine, and are considered competent and model students. Because they internalize their symptoms, they often do not cause problems in their classroom or act disruptively.

However, they may have fewer friends than their peers, spend an inordinate amount of their time trying to fall asleep at night, doing homework, or asking for reassurance about their safety. They may avoid sleep-overs or after school activities, and family life may be stressful.

Despite its bad reputation, anxiety actually prepares us to meet the ordinary and extraordinary challenges of daily life. While uncomfortable, anxiety is a universal response to stress and uncertainty. Rather than avoid it, we need to learn to tolerate it.

In fact, research shows that moderate levels of anxiety increase performance – Athletes get mentally prepared for a game, students study hard for a test. Anxiety is a built-in warning system that alerts us to danger and potential threats. However, when they have too much of it, kids can start to feel uncomfortable and it keeps them from functioning well in their lives.

We offer Cognitive Behavioral Therapy (CBT) for anxiety disorders in children. The aim of CBT is to help kids manage their worries and fears by noticing when their “worry brain” has taken over and skewed their vision of a given situation. Once they identify their anxious thoughts, they learn to pay less attention to them and use distraction and self-talk to find realistic ways of thinking. Kids learn that things get easier when they face them and start to engage in activities they previously avoided, like sports, sleepovers with friends, or participating in class.

CBT techniques include, among others, the development of realistic thinking (examining evidence for thoughts), exposure (facing fears), relaxation (breathing and muscle relaxation), and parenting strategies (working with parents to create a supportive and challenging environment).

Working with kids of all ages, we use humor, creativity, art, books, and games to build CBT skills.

If your child’s worries and fears are getting in the way of their development and enjoyment of life, it’s time to seek help. 

What is the Parent’s Role in treatment ?

It can be overwhelming and painful to see your child in distress. Most parents of anxious children are drawn into performing “accommodating behaviors” to help alleviate their child’s anxious feelings. Examples of this include allowing your child to sleep in your bed because she is scared of the dark, or staying at a class because your child has separation anxiety and cannot tolerate being dropped off. Research shows a high correction between high levels of parent accommodation and severe anxiety symptoms, more severe impairment, and worse treatment outcomes.

Parents will be asked to spend time learning about anxiety and consulting with the therapist to decrease accommodation. When parents understand how anxiety works, they feel empowered and less overwhelmed by their child’s fears and worries. Cognitive Behavioral Therapy also introduces simple strategies that parents can implement into their everyday life, which will facilitate the positive change process at home. Parents will partner with their kids to “boss back” their worries and fears. They will learn to be active coaches and encourage their child to complete therapy homework.

Tamar Chansky, whose book “Freeing Your Child from Anxiety” is featured in our recommendation section, writes, “Remember the goal: It’s not to talk your children out of their fears, it’s to teach them how to talk themselves through their fears. Don’t remove the hurdle, but teach them how to jump over it.”

Please see the SPACE program featured under the services we offer for information about a parenting coaching program for anxious kids.

CBT for Depression in Children & Adolescents

As many as 1 in every 33 children may have depression; in teens, that number may be as high as 1 in 8.

Just because a child seems sad from time to time doesn’t necessarily mean he or she has significant depression. However, if the sadness becomes persistent and interferes with normal social activities, interests, schoolwork, or family life, parents should have their child or teen evaluated for Major Depressive Disorder, or major depression.

A child with major depression feels depressed almost every day. In kids, depression can appear as “bad mood” or irritability that persists for a long time, even if a child doesn’t acknowledge being sad.

Dysthymia may be diagnosed if sadness or irritability is not as severe but continues for a year or longer. Kids with dysthymia often feel “down in the dumps.” They can have low self-esteem, feel hopeless, and even have problems sleeping and eating.

Unlike major depression, dysthymia does not severely interfere with day-to-day functioning but the “down mood” is a pervasive part of the child’s world. However, at least 10% of those with dysthymic disorder go on to develop major depression.

Bipolar disorder, another type of mood disturbance, is characterized by episodes of low-energy depression (sadness and hopelessness) and high-energy mania (irritability and explosive temper). Bipolar disorder may affect as many as 1% to 2% of kids.

A consultation with one of our staff members can always help clarify diagnostic questions.

How Can I Tell if My Child Is Depressed?

The symptoms of depression in children vary. Depression often goes untreated because symptoms are passed off as normal emotional and psychological changes that occur during growth. Early medical studies focused on “masked” depression, where a child’s depressed mood was evidenced by acting out or angry behavior. While this does occur, particularly in younger children, many children display sadness or low mood similar to adults who are depressed. The primary symptoms of depression revolve around sadness or irritability, a feeling of hopelessness, and mood changes.

Signs and symptoms of depression in children include:

• Irritability or anger.
• Continuous feelings of sadness and hopelessness.
• Social withdrawal.
• Increased sensitivity to rejection.
• Changes in appetite – either increased or decreased.
• Changes in sleep – sleeplessness or excessive sleep.
• Vocal outbursts or crying.
• Difficulty concentrating.
• Fatigue and low energy.
• Physical complaints (such as stomachaches, headaches) that don’t respond to treatment.
• Reduced ability to function during events and activities at home or with friends, in school, extracurricular activities, and in other hobbies or interests.
• Feelings of worthlessness or guilt.
• Impaired thinking or concentration.
• Thoughts of death or suicide.

Not all children have all of these symptoms. In fact, most will display different symptoms at different times and in different settings.  Keep in mind that while depression is a serious illness, it is also a treatable one.

Mood Disorders and CBT- Parent Participation

The treatment of depression may involve working with parents to improve the emotional climate at home, helping young people and parents improve their communication patterns, teaching the young person ways to relax or manage their symptoms of depression, and helping him or her learn how to solve interpersonal problems more effectively.

Parents may participate in “coaching” sessions which teach empathic and productive ways of responding to their depressed child.