Mental Health 21Mental Health Magazine for the 21st Century

Treatment and Therapy

Cognitive Behavioral Therapy For Children

cognitive behavioral therapy for children

Cognitive Behavioral Therapy (CBT) is considered a standard therapy for many mental disorders in children.

As a parent, you want your children to grow up being healthy and strong in both body and mind. It can be hard to recognize or admit that your child has a mental health problem, especially given the stigma that still exists around it. It isn’t uncommon, unfortunately – anxiety and depression affect 6.5% and 2.1% of young people respectively, and the numbers only seem to rise every year.

The causes of such conditions are relatively unknown as yet. They’re thought to be a mixture of genetic predisposition (if a child’s parent or another blood relative suffers from mental illness, it’s possible they inherited it, too) and environmental factors (stress in school, traumatic memories, or even seemingly minor events). Rest assured that it’s quite likely your child’s condition is in no way your fault. By helping him or her deal with it, you’re doing the best thing you can do at this time.

There’s a number of ways your child can seek treatment, including cognitive behavioral therapy (with a therapist or at home), activities to help build self-esteem and confidence, and proper diet and nutrition. Through a combination of these treatment methods, your child can control and even beat an anxiety disorder, depression, behavioral problem, eating disorder, or another condition entirely.

1. What is Cognitive Behavior Therapy (CBT), and how does it work?

As soon as you realize your child needs help dealing with anxiety disorders or other mental issues, your first temptation may be to put them in therapy. One such type that has been particularly successful with children suffering from conditions is cognitive behavioral therapy, or CBT.

It’s a particular style of therapy that differs from other types of psychotherapy and psychiatry in several ways. Cognitive behavioral therapy tends to rely on the participation of the client, as the therapist helps you to understand the way your emotions, thoughts, and actions are intricately connected. It’s based on evidence and scientific studies, rather than guesses about how the human psyche is designed.

child tantrums

Child throwing tantrums? CBT is a proven method that eliminates a lot of child's unwanted behavior.

For example, if your child becomes anxious about her grades, the therapist may explain that her anxiety does not mean the situation is dangerous, and that anxiety is a perfectly normal reaction to stressful situations. Instead of letting her thoughts run wild about what could happen if she gets bad grades, the therapist might guide her through the worst possible scenario and what she could do if that happened, and then the most likely scenario that will result from the situation that stresses her out.

This allows your child to gradually replace her fears about doing badly in school with coping strategies like deep breathing, and remembering that she is in control of her own thoughts and that it’s unlikely she will be humiliated in front of her peers.

Another example of cognitive behavioral therapy as an aid for children might have to do with phobias. Some children have specific fears about an animal (like dogs or birds), a place, or a thing. By gradually exposing your child to situations that induce fear, then talking her through how to handle the fear, become aware of negative thoughts, and change them to positive ones, she can overcome the fear. This doesn’t necessarily mean she’ll never be afraid of a situation again (though that does sometimes happen), though… relapses can happen when your child is stressed, tired, or even for no reason at all.

2. Maybe CBT works, but is it right for my child?

CBT is a proven method with about a 70-80% success rate overall, and will help equip your child with the tools and coping strategies he or she needs to manage anxiety, depression, or other disorders. It isn’t a fix-all sort of cure, though.

The effectiveness of CBT has been proven in children over the age of 8, though children as young as 2-3 years old have been treated with age-appropriate methods. It doesn’t carry any overt risks, but it’s often the case that you expect too much too quickly, or vice versa. If your child isn’t ready to progress to the next stage of therapy but the therapist insists on it, a different therapist or treatment method may be necessary. On the other hand, if you want to move too quickly, CBT may not be right, as it takes time to slowly build your child’s coping strategies and tools.

Finally, your child simply may not be a good fit for this type of therapy. It is very much focused on the present moment and what the patient can do right now to monitor, identify, and replace negative thoughts and feelings. If your child has suffered a particular traumatic event, for example, it may be helpful to focus on how they feel right now as opposed to rehashing the past. On the other hand, this might just be what your child needs, too.

It’s important to work with your child to figure out whether or not cognitive behavioral therapy is right for them. It’s entirely possible that they need a different style of therapy, or simply a different therapist. Some children don’t even need a therapist, and can practice CBT techniques at home with your guidance and their own determination to overcome their anxieties or fears.

Defiant Child Behavior problems

3. How can I, as a parent or guardian, help?

Aside from getting your child to a specialist, there are many other ways you can help manage a child’s anxiety issues or other related disorders. Depending on the severity of your child’s condition, you may even be able to teach your child to manage it with your help. Of course, professional help is sometimes required, but not every child feels comfortable with talking to a therapist immediately.

anxious child

CBT is not a set-it-and-forget-it technique. It requires effort – and a lot of love and patience – from everyone.

Before you go to a therapist, you can research cognitive behavioral therapy online and offline, then implement certain elements of the therapy on your own. If you would like to explore this option, you can first search for professionally written courses, worksheets, handbooks, and similar materials. There are independent resource sites run by therapists, concerned parents, and advocacy groups, but a professionally-written guide addressing your specific situation is usually best.

Also, remember that there are a number of reasons you might be looking to get your child to see a therapist, and each reason may have underlying causes that a therapist is or isn’t experienced in dealing with. For instance, if you’re concerned because your child suffers from anxiety and panic attacks and you believe this is due to a physical assault they once experienced, but the underlying reason has to do with their fear of perfectionism, the therapist you choose might be very experienced in dealing with assault, but not “everyday” experiences. The average therapist or professional psychologist is capable of handling most situations, but be aware that each has a specialty and varying degrees of knowledge about areas outside that specialty.

This is one more reason you may find it more effective to try at-home anxiety management techniques by using elements of CBT therapy without seeking out a therapist immediately. If your child begins to deal with issues you aren’t prepared to handle, you can and should find a psychologist for professional help immediately. On the other hand, it may be a relatively normal fear haunting your child, such as worry that you won’t love them if they don’t score an A on their next test, and you can help them learn otherwise easily!

Probably the best and most comprehensive behavioral therapy course is The Total Transformation Program by James Lehman. It is primarily designed to address and correct bad behavior, but it works wonders even for children whose behavior is effected by psychological conditions, such as anxiety, depression, ADD, ADHD, obsessive compulsive disorders (OCD), and many others. Mr. Lehman now offers the complete course for free, in exchange for your feedback, so it is a great opportunity to give it a try, risk free. (Concerned that James Lehman’s The Total Transformation Program is a scam? Click the link to read our guest author’s review)

It’s important to work with your child to figure out whether or not cognitive behavioral therapy is right for them. It’s entirely possible that they need a different style of therapy, or simply a different therapist. Some children don’t even need a therapist, and can practice CBT techniques at home with your guidance and their own determination to overcome their anxieties or fears.

Another well-known and popular program is The Anxiety Free Child Program, written by Well known authors in the field, Mr. Rich Presta and Dr. Cheryl Lane. This program, however, goes beyond CBT, as it deals primarily with children suffering from anxieties, and addresses psychological issues behind the behavior.

4. What activities can my child do alongside therapy?

Professional and psychological help can only go so far; it may damage your child more to be in therapy every hour of the day than it would to visit them once every two weeks. In the meantime, this doesn’t mean you have to pretend it isn’t happening or constantly bring it up to your child.

Instead, there are a number of activities they can participate in that don’t directly relate to therapy and will provide benefits to their health, help them have fun, and perhaps help them work through issues they may have on their own, or complement existing therapy sessions.

playing kids

Spending quality time with your kids is essential for CBT to be effective.

You know your child better than almost anyone else, in all likelihood. Is she extroverted or introverted? Is she shy or outgoing? What types of activities does she enjoy doing?

An introverted child shouldn’t be forced to do group activities, but they may help her overcome shyness and anxiety. Be sure to consult her first on what exactly she wants to do, let her know when to expect the first class, game, or meeting, and check back with her regularly on how it went, particularly the socialization aspect. Provide support if she wants it (and many children won’t ask, but find a parent’s presence at their group activity very reassuring), and if she wants to quit immediately, see if there’s an underlying reason behind this anxiety to leave. Sometimes it’s best to let her quit, while other times, she may end up enjoying it if persuaded to stay. It’s a balancing act that only you and those who know her very well can perform.

On the other hand, an extroverted child may benefit not only from group activities they might normally seek out, but also from specifically team-building activities or solitary activities. Team sports, for instance, can help them learn that they aren’t always the center of attention and drive home the importance of cooperation. Individual activities can help them by giving them solitude and the time to learn themselves and grow without a group to “perform” in front of or lead.

Of course, one child is rarely strictly one or the other – they may be introverted at home, but extroverted at school, for instance. They may be quiet and introspective while doing art activities, even in a group, but run wild during sports. Trying to help them reach balance through careful selection of activities can really benefit your child’s life.

All kinds of activities, crafts, arts, hobbies, and sports can help a child deal with anxiety, depression, mood disorders, eating disorders, or nearly any other condition. Tests on many different categories of activities have revealed that they help build self-esteem, confidence, honesty, emotional intelligence, teamwork, and so on.

Since so many activities can help, it may be more helpful to think in terms of what you should avoid. Activities that encourage negative emotions or outbursts, for instance, may defeat the purpose of involving them in new things. Scary computer games, particularly single-player ones, can make it hard for a child to sleep (and not just from the game content – the brightness of a monitor late at night tricks the brain into feeling like it’s noon). Some sports leagues focus on competitiveness and winning above all else, and other sports encourage fighting and outbursts of anger.

Holistic lifestyle changes aren’t just for hippies – the term “holistic” refers to the fact that your life is not single-dimensional. Hobbies and activities provide another outlet for your child, and can even help teach them crucial life skills and ways to cope with the feelings they may be experiencing.

5. What other lifestyle changes can help my child?

Coping with feelings is a lot easier when you feel good physically and mentally. Sleep, diet, and exercise are three of the most important factors in maintaining a healthy lifestyle, particularly when dealing with mental conditions, anxiety disorders, panic, stress, and other negative emotions. They are linked not only to each other, but to positive mental health. By ensuring that each contributing factor to mental health is the best it can be, you can speed up the process of therapy or even eliminate the need for it altogether.

weight and anxiety

Be ready to make changes in your lifestyle. The way your child eats can have a great impact on his or her progress.

A proper sleeping schedule is even more important for a child than an adult. Your child should always get eight or nine hours of sleep a night (each individual needs a slightly different number of hours asleep to rest), and should wake up and go to bed at around the same time each day. Exceptions are okay, but don’t make them the rule rather than the exception!

Diet is another major factor in mental health. The importance of proper timing in a diet is often forgotten, as the right foods eaten at the wrong time can have nearly as bad an effect as the wrong food eaten in the first place.

Children, like adults, should never skip breakfast – it revitalizes your energy, gives your body food other than its own tissues to consume, kick-starts mental performance, and encourages your body to stay a healthy weight. Before school, at least a bowl of cereal and glass of juice, toast and peanut butter, yogurt, or fruits can help.

At school, lunch is often not under your control. If your child can bring her own lunch, it will almost certainly help, though! Cafeteria food is hard for you to monitor, but it should contain plenty of vegetables, grains, fruits, and fresh, preferably local dairy or meat if your child chooses to consume them. The fresher and less preserved or processed a food is, the better it will generally be for you or your child.

Finally, you can help your child get an extra boost of anything she might not have had the chance to eat that day at supper, which is great if you aren’t allowed to send her with a lunch. Make sure to keep the meals varied, fresh, and local when possible. To make it easier on yourself, experiment with slow cooker meals if you work full-time or overtime regularly, and learn to plan meals in advance to save money on food and avoid wasting it. You can even involve your child with cooking on weekends, in the summer, and on days off. The improved self-esteem from your child cooking her own meal is fantastic to watch!

A balanced diet is truly crucial if you want to help your child manage and recover from any condition, or even just maintain everyday health. It’s also a factor you can control much more easily than her emotions or experiences, of course, so set a good example and follow common-sense rules for meals. These include not forcing your child to eat a heavy meal immediately before bed (as it can lead to nightmares), helping her try new foods and cooking her own meals (which can distract her from negative thoughts and give her perspective on a bad situation or feeling), and ensuring she drinks enough water and has enough iron, protein, and vitamin B, for instance.


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Vitamins, minerals, and nutrients like these are crucial in maintaining good health. If you suspect your child isn’t getting enough of some particular nutrient, you can help her regain balance by giving her natural supplements to try. (Pharmaceutical remedies should probably be avoided, particularly if she is working with a therapist or psychologist, or may in the near future.)

For example, vitamin B has a huge effect on your mood, and iron and protein on your energy. When you’re deficient, you don’t even know that you’re missing something – you just feel bad. This may contribute to existing conditions or even cause a new one, so the importance of a balanced diet is obvious. Fish oil can help boost omega-3 fatty acid levels and aid in the treatment or management of depression. 5-HTP and St. John’s Wort are two natural depression and anxiety treatments that can help bring balance to serotonin levels, though supplements should be taken cautiously (don’t have your child take St. John’s Wort or 5-HTP together with antidepressants, as the resulting condition is called serotonin syndrome and can be fatal).

Mental illness is debilitating not just for the individual suffering, but for their entire support network. In the case of a child, this includes her parents, siblings, extended family, friends, and teachers. Even a mild problem with anxiety and stress can easily balloon into a big deal if you let it, so try to remember to stay calm and relaxed as much as possible. Your child is the same as she’s always been – you just have a better understanding of what’s plaguing her, and she’s growing to understand her own emotions and actions better.

It’s a challenging time for anyone. Parenting an anxious child, or a child with ADHD, OCD or other behavioral challenging conditions takes a lot of patience and love. Taking steps at home to help reduce or eliminate anxiety, depression, stress, or other issues can aid greatly in therapy or management of any condition.

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