For Families > Seeking Professional Help

Cognitive Behavior Therapy (CBT)

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.

Cindy, 12 years old, is very concerned about looking perfect. She won't join a study group or go to a party because she's worried about what other people will think of her.

Jason, 7 years old, is afraid of spiders. He won't go to the neighborhood playground because he's afraid he may see one.

Cognitive Behavior Therapy (CBT) would help Sam, Cindy, and Jason feel more comfortable and help them to no longer avoid these situations.

What is Cognitive Behavior Therapy?

Research has shown that CBT is a form of therapy that's effective for a number of childhood mental health disorders. A major aim of CBT is to lessen the child's negative feelings, such as anxiety or sadness, by changing the beliefs or behaviors that help to maintain these emotions. During CBT sessions, the child learns how thoughts, feelings, and behaviors are related and influence each other. In order to change unwanted feelings or problematic behaviors, the therapist teaches the child strategies to modify his or her thoughts and respond differently during certain situations. In other words, CBT has two essential features:

  • The cognitive component helps children change how they think about a situation.
  • The behavioral component helps children change how they react to the situation.

Cognitive Behavior Therapy is known to be a short-term, solution-focused treatment. The goal is to teach children, as well as their caregivers, a variety of coping skills to help them manage difficult situations, both now and in the future.

Who can CBT help?

Many types of anxiety, such as separation anxiety, specific phobias, social anxiety, and obsessive-compulsive disorder, as well as mood-related disorders, such as depression, can be successfully treated with CBT. Exposure therapy, one of the most important components of CBT for anxiety disorders, targets avoidant behaviors and helps children learn to gradually approach scary objects or situations. The procedure allows them to slowly gather evidence that will help them to challenge their false beliefs about a particular thing or situation, for example, the idea that "All dogs bite" or, "If a bee stings me I'll die!" Through such exposures, children learn 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 previously feared was exaggerated and unrealistic.

CBT is also effective in alleviating a child's depression by changing the beliefs or behaviors that encourage the maintainance of sad feelings. 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 that occur the most often. CBT can also help children and teens increase the pleasure and sense of accomplishment they get from daily life, and improve their social and problem-solving skills in order to help them have more successful interactions with their environment, which are excellent life skills for anyone to add to their tool box.

How does CBT treatment typically proceed?

Phase I - Involves psychoeducation; the therapist teaches children and their families about the struggles they are experiencing 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 cope with their unwanted emotions and reclaim areas of their lives that are currently being disrupted.

Phase II - Involves collaborative work between the child and therapist as they generate a plan for decreasing the child's symptoms. The plan generally includes learning a variety of emotion coping skills and ways to respond more adaptively or effectively during different situations, as well as planning exposures to help them face unpleasant or scary situations. During such exposure activities, the child learns to face a feared object or situation while the therapist prevents him from performing the avoidance strategies he used in the past to reduce the anxiety or negative feelings (this strategy is termed Exposure and Response Prevention). Although the exposure deliberately arouses anxiety, it is done in a controlled and gradual way, always making sure the child feels safe and ready to participate.

Phase III - The therapist prepares the child and his or her family for the cessation of active treatment. The likelihood of an eventual reemergence of symptoms is discussed explicitly, both to normalize the experience as well as to encourage the child to take on more independence in using the coping skills and strategies learned during treatment. In the last few sessions, the therapist works carefully with the child to develop a plan for relapse prevention, emphasizing that the same skills the child has mastered in therapy are those that they can use on their own whenever the need arises. Symptoms may reoccur during times of stress, fatigue, or physical illness, or sometimes randomly, for no reason at all. This does not mean that the child will experience a complete relapse. Rather, a reemergence of symptoms can serve as a signal to the child that it is time to revisit the skills he or she learned in therapy and implement them as needed. Booster sessions are scheduled so that the therapist and child can reconnect at regular intervals to address any problems or simply to check in and celebrate continued good health.

It is in this way that CBT teaches adaptable coping skills that children will be able to use for the rest of their lives.

If you are interested in finding out more about CBT or are interested in setting up an initial evaluation, please contact our intake coordinators at (646) 754-5000 or email: services@aboutourkids.org.

Our Clinicians

Our team of seasoned clinicians and cognitive behavioral therapists include:

Aleta Angelosante, PhD

Kirsten Cullen-Sharma, PsyD

Lori Evans, PhD

Richard Gallagher, PhD

Sameena Groves, PhD

Daniela Montalto, PhD

Dana Rhule, PhD

Carrie Spindel, PsyD

Andrea Vazzana, PhD