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Cognitive Behavior Therapy (CBT)

— NYU Child Study Center
Updated on Jul 9, 2010

Sam, 8 years old, constantly worries about being contaminated by other people's germs. As a result he won't touch doorknobs in school and insists on wearing gloves. Would it be helpful to make him touch doorknobs?

Cindy, 12 years old, is so concerned about looking perfect that she won't join a study group or go to a party because she's concerned about what people will think of her. Would it be helpful to make her join a study group?

Jason, 7 years old, is afraid of spiders and won't go to the neighborhood playground because he's afraid he may see a spider. Would it be helpful to make him go to the playground?

Sam, Cindy, and Jason would benefit from Cognitive Behavior Therapy.

What is Cognitive Behavior Therapy?

Research has shown that CBT is a form of therapy that's effective for childhood anxiety and other disorders. A major aim of CBT and behavioral therapy is to lessen the child's anxiety by changing the beliefs or behaviors that help to keep the anxiety going. During CBT the child learns that thoughts cause feelings and moods which can influence behavior. If a child is experiencing unwanted feelings or has problematic behaviors, the therapist works to identify the underlying thinking that is causing them. The therapist then helps the child replace this thinking 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.

CBT has two essential features:

  • The cognitive component helps children change how they think about a situation; and
  • The behavioral component helps children change how they react to the situation. An essential element of behavioral therapy is helping children gradually confront the situation or thing that they are afraid of.

What forms of mental health problems respond to CBT?

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 she "thinks" is dangerous, and unfortunately, the avoidance keeps anxiety going. Exposure therapy targets the avoidance and is the most important component of CBT for specific phobia, because it involves helping children approach a scary object or go into a scary situation gradually. The procedure allows them to slowly gather evidence that will help them to challenge their false beliefs about a particular thing or situation, e.g., "all dogs bite" or "If a bee stings me I'll die!"

By gradually 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.

CBT is also effective in alleviating a child's depression by changing the beliefs or behaviors that help to keep the depression going. 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 assertiveness skills to help them succeed in their relationships. These are excellent life skills to add to anyone's tool box.

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