CBT for Kids: How it Works, Techniques, and FAQs

Often, we think about mental health conditions and visualize adults going through difficulties and hardships. Adults are not the only ones who go through things like anxiety, depression, or even cognitive distortions and negative thoughts. Children are also susceptible to various mental health struggles. This is where cognitive behavioral therapy (CBT) for kids comes in. CBT is an effective treatment approach for numerous mental health conditions. Here, we’ll discuss how it works, its techniques, and answer some commonly asked questions to give you.

What is CBT?

Cognitive behavioral therapy (CBT) is a form of talk therapy that examines how our thoughts, emotions, and behaviors are shaped by the environment and our preconceived notions. CBT aims to help individuals recognize irrational thought patterns that result in negative behavioral outcomes. It also teaches us how to construct new, rational thought patterns.

Therapists who use this approach can help empower children, who they equip with lifelong skills to manage their symptoms. CBT can also be used alone or together with other therapies to improve various mental health conditions. It can also be applied in other situations. For instance, children who need help with stress or those who are dealing with other problems can both take advantage of CBT.

How Does CBT for Kids Work?

CBT works on the idea that our feelings, thoughts, and behaviors are all related and can have an impact on each other. When children feel anxious or low in mood, it can get easy to get stuck in a cycle of negative or unhelpful thoughts. CBT works by providing kids with steps to recognize the negative thoughts, feelings, or behaviors and, together with the therapist, work on replacing maladaptive thinking and acting with more constructive thoughts and behaviors.

Much of the therapeutic work done with children in counseling with CBT involves the parents or caregivers. Therapists work closely with them to teach CBT techniques that can then be incorporated into daily interactions with children. As children get older, the more directly involved the therapist will be along with the parents or guardians. This gives adolescents more control, empowering them while still utilizing the support of their caregivers to receive the right treatment outside of the therapist’s office.

How Effective is CBT for Kids?

CBT has been shown to be an effective treatment for a wide range of psychological problems in children. Studies have shown that CBT is effective for children with conditions such as depression, generalized anxiety disorder, obsessive-compulsive disorder, school phobias, and conduct problems [*]. The Centers for Disease Control and Prevention (CDC) has also reported that CBT is effective at treating depression, anxiety, disruptive behavior disorder, and post-traumatic stress disorder in children [*].

Conditions in Kids That CBT May Help

There are various conditions for children that CBT may help. Here are some of the most common ones:

ADHD

ADHD is characterized by challenges with conduct, specifically inattention, impulsivity, and, at times, hyperactivity. CBT for children is particularly relevant starting at seven years old and up since it provides them with anger regulation and social problem-solving skills [*]. This enables them to behave in more independent and situation-appropriate ways.

Anxiety

Anxiety in children is common, often with symptoms persisting and worsening over time. Research has found that psychosocial interventions such as CBT are effective in targeting anxiety in children, moderated by the level of intervention, approach, and the level of training of the provider or program facilitator [*].

OCD

Cognitive behavioral therapy can also be used to treat symptoms of obsessive-compulsive disorder (OCD). More specifically, CBT with a focus on exposure and response prevention is an effective psychosocial treatment for children with OCD with a high efficacy as evidenced by large effect sizes from meta-analyses [*].

Trauma and PTSD

CBT has also been found to be effective in treating PTSD in children and adolescents, especially those who have suffered sexual abuse or war trauma [*]. Research has shown that CBT is more effective in treating PTSD in children and adolescents aged seven to 18.

Depression

There is some evidence that CBT is effective for children with subclinical levels of depression, especially if it has components of behavioral activation and challenging one’s thoughts [*]. Treatment was also more effective with the involvement of caregivers.

Autism Spectrum Disorders

Studies have found that CBT significantly improved symptoms related to autism spectrum disorders (ASD) based on clinician-rated outcomes and task-based outcomes [*]. It can also help with socio-emotional problems in children or adolescents with ASD.

Selective Mutism

Selective mutism is an anxiety disorder that is “characterized by the persistent failure to speak in select social settings despite possessing the ability to speak and speak comfortably in more familiar settings [*].” CBT can be effective in the long term when treating selective mutism [*].

Types of CBT for Kids

There is more than one type of CBT that can be used for treating children with various symptoms and conditions.

Individual CBT

One-on-one therapy sessions with a psychologist are the most well-studied type of cognitive behavioral therapy for children and are the most effective.

Family-Based CBT

Family-based CBT is all about helping parents and other family members learn CBT skills along with their child. This improves communication and support, especially for the children.

Parent-Child Therapy

Parent-child CBT aims to help families with a history of trauma or abuse. It helps children heal while allowing parents to build positive parenting skills and emotional regulation.

Group CBT

In group CBT, children receive therapy with same-aged peers in a group setting. It allows them to learn important skills together and increase their self-esteem.

CBT Techniques for Kids

Techniques and tools used in cognitive behavioral therapy for adults are also typically used with children and adolescents, though the approach may look different depending on age. Here are several CBT techniques for kids that work to relieve symptoms and treat certain conditions.

Cognitive Restructuring

Cognitive restructuring is a technique that is at the heart of CBT. It involves breaking down a child’s negative thinking patterns and replacing irrational thoughts with more logical ones.

Relaxation Techniques

Some relaxation techniques that are used in CBT are grounding exercises, breathwork, and progressive muscle relaxation. These can be simplified for young patients so that they can calm their physical and emotional responses to stress.

Behavioral Modification

When we talk about behavioral modification, we are referring to the identification and elimination of unwanted behaviors while encouraging and developing new and more appropriate behaviors. This aspect of CBT typically requires the help of parents and caregivers. They work together with the therapist to come up with an action plan which can then be implemented at home or school.

Modeling

When working with children, therapists will often model the desired skills and behavior without directly instructing them. Therapists can show children how to restructure their thoughts, handle changing social situations, and express their emotions, thereby helping them reach their goals organically.

Play Therapy

CBT for children also uses play as a technique. This can come in the form of structured, goal-oriented activities as well as unstructured, child-directed therapeutic play. Role-play, recreating scenarios, and desensitization techniques may be used in play therapy for successful treatment of various conditions.

What to Expect During CBT Sessions for Kids?

First and foremost, you can expect the therapist to build rapport with your child. A significant part of therapy with children is spent on establishing a good relationship with them to gain their trust. This allows children to be honest during sessions and more motivated to work hard. Expect the therapist to use toys, worksheets, books, or games to make therapy fun for your child, which is an important part of the process.

You can also expect CBT to involve some education, particularly how thoughts, feelings, and actions are contributing to the child’s struggle. You’ll learn more about the relationship between your thoughts, feelings, and behavior, and so will your child.

Children will also learn how to expand their feelings vocabulary and understand the sensations that go with different emotions. They will learn about body cues and how to be aware of them to understand the emotions they are experiencing. You can expect children in CBT to become more aware of their emotions as well as become better at identifying them. They will also learn what triggers these emotions and how to regulate them. CBT also teaches children coping and stress management skills.

Thought restructuring is another skill you can expect your child to learn in therapy. These are cognitive coping techniques that allow children to differentiate their thoughts from their emotions. They’ll learn about cognitive distortions too. Work is done to give your child an opportunity to question and challenge unhelpful or inaccurate thoughts and reframe them with more positive and helpful thinking. As time passes, we hope to change the child’s default thinking patterns to be less self-defeating and more resilient.

Frequently Asked Questions

How can I explain CBT to my child?

It is most helpful to explain CBT in simple terms. Let your child know that they will speak with another adult about their thoughts, feelings, and actions so that they can ultimately feel better. You can tell them that the therapist is trying to help them build skills that will be useful when they have difficult moments.

At what age is CBT suitable for children?

There is good evidence for CBT being done for children aged 8 and up [*].

Are there potential challenges to CBT for kids?

There are reasons why a child may resist CBT, and this may pose several challenges to parents and caregivers. Children may not understand what CBT is or why it is necessary. They may also be afraid of change, which makes them reluctant to try something new. Additionally, if a child has had negative past experiences with therapy, then they may develop an aversion to CBT as well. Some children may simply not prefer CBT and may respond to other forms of therapy such as DBT instead.

How can parents support CBT principles at home?

Parents can support CBT treatment at home by making it a safe and fun environment to apply therapeutic principles. Children will be more receptive to CBT if it is enjoyable and helpful, so parents can get creative with incorporating different techniques at home.

How does CBT for kids differ from adults?

While the CBT approach requires broader techniques when done for children, much of the therapeutic approach remains the same for kids and adults.

The Bottom Line

In conclusion, Cognitive Behavioral Therapy (CBT) for kids is found to be a transformative tool, fostering emotional resilience and empowering young minds to navigate life's challenges. By nurturing self-awareness and providing practical coping strategies, CBT lays the foundation for a brighter, more emotionally sound future for our children.

References:

1. Scott A. Cognitive behavioural therapy and young people: an introduction. 2009.
2. Centers for Disease Control and Prevention. Therapy to Improve Children’s Mental Health. 8 March 2023.
3. Matthys W and Schutter D. Increasing Effectiveness of Cognitive Behavioral Therapy for Conduct Problems in Children and Adolescents: What Can We Learn from Neuroimaging Studies? 8 March 2021.
4. Fisak B, Penna A, Mian N, et al. The Effectiveness of Anxiety Interventions for Young Children: A Meta-Analytic Review. 24 May 2023.
5. Farrel L, Nabinger de Diaz N, Mathieu S, et al. FAST CBT for pediatric OCD: A multiple-baseline controlled pilot trial of parent training in exposure and response prevention delivered via telehealth. 13 December 2022.
6. Xian-Yu C, Zhang J, Li H, et al. Cognitive behavioral therapy for children and adolescents with post-traumatic stress disorder: meta-analysis. 1 July 2022.
7. Oud M, De Winter L, Vermeulen-Smit E, et al. Effectiveness of CBT for children and adolescents with depression: A systematic review and meta-regression analysis. April 2019.
8. Wang X, Zhao J, Huang S, et al. Cognitive Behavioral Therapy for Autism Spectrum Disorders: A Systematic Review. May 2021.
9. Wong P. Selective Mutism. March 2010.
10. Oerbeck B, Overgaard K, Stein M, et al. Treatment of selective mutism: a 5-year follow-up study. 22 January 2018.
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