CBT for Kids: How It Works, Examples, & Effectiveness

How Does CBT for Kids Work?

When working with younger children, much of the focus in CBT is on teaching the child’s caregivers how to apply the techniques in everyday situations. Caregivers learn strategies to help the child recognize unhelpful thought patterns and guide them through healthier ways of thinking and responding. For older children, the approach shifts to empowering them to take a more active role in identifying their own thought patterns and challenging them independently. Caregivers still play a supportive role, but the focus is on fostering the child’s independence in managing their thoughts and emotions.

CBT Techniques for Kids

CBT sessions with kids often include practical activities, like role-playing, drawing, or storytelling, making it easier for them to engage and understand. These methods are designed to give children tools they can apply in real-life situations—whether it’s calming themselves down when they feel overwhelmed, learning how to handle a problem at school, or dealing with conflicts with friends. Over time, they build skills that they can use independently to manage challenges.

Here are several common CBT techniques for kids:

Cognitive Restructuring

Cognitive restructuring is a key technique in CBT that helps children recognize and challenge negative or unhelpful thoughts. For example, your child might frequently think, “I’m going to fail,” when faced with a difficult task. In cognitive restructuring, the therapist helps your child notice these negative thoughts, understand how they affect their feelings and behavior, and then reframe them into more realistic and balanced thoughts.

Your child will learn to question their unhelpful thoughts by asking themselves things like, “Is this thought 100% true?” or “What evidence do I have for this thought?” From there, they’ll work on replacing the negative thought with something more helpful, such as, “I can try my best, and that’s enough,” or “Even if I don’t do perfectly, I can still learn and improve.”

Parents' Role

The therapist will guide you in reinforcing these techniques at home by helping your child recognize when they’re having negative thoughts and gently encouraging them to use the tools they’ve learned. For example, if your child expresses a thought like, “I’ll never be good at this,” you can remind them to challenge that thought and ask questions like, “What have you learned from past experiences?” or “What would you tell a friend who was feeling the same way?”

Behavioral Modification

Behavioral modification involves identifying behaviors that are problematic—such as frequent tantrums, avoidance of tasks, or acting out—and helping your child learn new, more positive behaviors. The focus is on reducing the negative behaviors while teaching your child better ways to handle situations.

Positive reinforcement, such as praising your child or using a reward system, plays a big role in this process. It works because when your child gets praise, affection, or a reward for doing something well, they associate that behavior with positive feelings. This makes it more likely they will want to do it again in the future.

Parents' Role

You’ll work with the therapist to create a clear plan for behavior changes that can be used at home, school, or other places. The therapist will help you understand the behaviors that are causing problems, and together, you will set clear goals for new behaviors. For example, if your child tends to avoid doing homework, the action plan might include setting a daily homework routine, breaking tasks into smaller steps, and creating a sticker chart where after a certain number of stickers, they get a reward.

Relaxation Techniques

Relaxation strategies are important tools in CBT that help children manage intense feelings, such as anger, frustration, or anxiety, which can lead to acting out or withdrawing. Techniques such as deep breathing, progressive muscle relaxation, and mindfulness exercises can help your child calm down when they feel overwhelmed. These skills work by slowing down the body’s stress response, allowing your child to feel more in control of their emotions in the moment.

For example, if your child often lashes out when things don’t go their way, a therapist might teach them to notice the early signs of frustration—like feeling tense or getting upset—and then use tools like taking deep breaths, counting to ten, or finding a calm space to cool down.

Parents' Role

The therapist will likely show your child how to do these exercises during sessions, but regular practice at home makes them more effective. You can encourage your child to use deep breathing or muscle relaxation when they start to feel stressed, frustrated, or overwhelmed. You might say, “It looks like you’re starting to feel frustrated. Let’s try some deep breathing or take a moment to calm down before we decide what to do.” It’s also helpful to make practicing relaxation techniques a daily habit, even when your child isn’t feeling particularly stressed. This way, they’ll feel more comfortable using these tools when they truly need them.

Exposure Therapy

CBT for children with anxiety or OCD often involves exposure therapy in order to help them face specific fears. It works by slowly introducing your child to the things they fear, starting with less anxiety-provoking situations and working up to more challenging ones. The goal is to help your child become less fearful over time, allowing them to handle these situations with more confidence and ease.

Parents' Role

As a parent, your role is essential in supporting your child through exposure therapy. The therapist will create a plan that outlines the steps of exposure, and you’ll help implement it in real-life situations. For example, if your child is afraid of social situations, the therapist might suggest starting with small social interactions, like saying hello to a familiar person. You can help by encouraging your child to follow through with these steps and providing praise for their efforts.

Problem-Solving Skills

Through CBT, your child will learn a structured, step-by-step process for handling problems. The process typically involves identifying the problem, brainstorming possible solutions, evaluating those options, choosing the best solution, and then trying it out. This approach helps your child develop confidence in facing challenges head-on, knowing they have the tools to work through them.

Parents' Role

As a parent, you can guide them through the process at home when they’re faced with challenges, like figuring out how to manage homework or resolving conflicts with siblings. For instance, when a problem arises, you might say, “Let’s work through this step by step. What’s the problem, and what are some ways we could solve it?”

Play Therapy

Since younger children often have a hard time talking about their emotions, play becomes a natural and safe way for them to understand and manage their thoughts, feelings, and behaviors. For example,  if your child feels anxious about school, the therapist might set up a scene where the child plays as a student going to school, using toy figures or objects to represent teachers, classmates, or the school environment. As your child plays, the therapist will help them make connections between their feelings, thoughts, and behaviors. For instance, the therapist might ask, “What do you think your character is feeling right now?” or “How do you think this character could solve the problem?” This helps your child become more aware of how their emotions influence their behavior, and they learn how to handle difficult situations in healthier ways.

Parents' Role

As a parent, you may be asked to continue using some of the play-based strategies at home. The therapist might share activities or games that help your child practice what they’re learning in therapy.

Modeling

Since children naturally learn by watching and imitating others—much like how they learn to walk or talk when they’re younger—modeling provides a powerful way to teach new skills in a natural, engaging way. For example, if a child struggles with expressing their emotions, the therapist might model how to talk about feelings. The therapist could say, “I’m feeling a little frustrated right now, but I’m going to take a deep breath to calm down,” showing the child how to manage emotions in a healthy way. By observing the therapist, the child sees how to handle similar situations and learns how to apply these behaviors themselves.

Parents' Role

Children learn best when they see consistent examples both in therapy and at home, so you can help by modeling similar behaviors in everyday life. For instance, if your child is working on handling frustration, you might say, “I’m feeling a little upset right now, so I’m going to take a few deep breaths,” just like the therapist would. This reinforces the skill and shows your child that it’s something they can use in different situations.

Conditions in Kids That CBT Can Help

CBT is an effective treatment for the following conditions:

Attention-Deficit Hyperactivity Disorder (ADHD)

Children with ADHD often face challenges in academics and behavior due to symptoms like difficulty with impulse control, time management, maintaining focus, and completing tasks.¹ CBT offers a variety of skills and strategies designed to address these issues. Through CBT, children learn to stop, think, and plan before acting, which helps them develop better self-control. Many CBT therapists working with children also implement behavior tracking and reward systems tailored for both school and home settings. These systems focus on reducing problem behaviors and encouraging positive behavior changes.

Although research on its effectiveness as a standalone treatment is mixed, evidence strongly supports the use of CBT alongside medication for optimal results. Studies suggest that the combination of stimulant medication and CBT provides the most significant benefits, helping children manage their symptoms more effectively.²

Anxiety

CBT is widely recognized as an evidence-based treatment for anxiety disorders in children and is often the first recommended approach.^{3, 4, 5} Children with anxiety often struggle with constant worry and fear about things that are unlikely to happen.¹

CBT helps by teaching kids how to use logic to challenge these fear-based thoughts, which can reduce their anxiety. Some children also develop avoidance behaviors, refusing to do certain activities or visit places that make them nervous. For these kids, CBT may include exposure therapy—a step-by-step approach that helps them face their fears gradually and build confidence.

Depression

CBT is widely recognized as an effective, evidence-based treatment for childhood depression.⁵ CBT can help a child with depression better understand and track their symptoms while developing healthy coping skills and strategies to improve their mood. For example, CBT may involve identifying negative thoughts that worsen depression and learning how to replace them with more positive, balanced thinking. Activity scheduling is another common component, helping children establish routines that promote engagement and improve their mood.

Obsessive Compulsive Disorder (OCD)

Children with OCD often experience frequent intrusive thoughts and worries that cause significant anxiety and distress. To manage these feelings, they may develop rigid, compulsive rituals like handwashing, counting, checking, or repeatedly seeking reassurance from caregivers.¹ A specialized type of CBT called exposure and response prevention (ERP)  is commonly used to treat OCD. ERP is a structured therapy that helps children gradually face their fears while learning to cope without relying on compulsions. This approach reduces the power of intrusive thoughts and builds healthier coping strategies.

Research strongly supports ERP as an effective treatment for OCD in children. A recent meta-analysis found that ERP is as effective as medications like SSRIs in reducing OCD symptoms in children. In fact, the research suggests that ERP may be even more effective than medication as a standalone treatment, though combining the two can also be beneficial.⁶

Trauma & PTSD

PTSD in children can develop after they experience, witness, or learn about a traumatic or extremely stressful event. Trauma-focused cognitive behavioral therapy (TF-CBT) is a specialized approach often used to help children with PTSD. In TF-CBT, therapists guide children in creating a trauma narrative—a detailed account of what happened. This process helps the child make sense of the trauma, gradually desensitize to it, and eventually share the narrative with their parents or caregivers.

TF-CBT is a leading treatment for PTSD in children and teens, with strong research showing its effectiveness. Over the course of 12–24 structured sessions, most children and teens see a significant reduction in the frequency, intensity, and severity of their PTSD symptoms.⁷

Selective Mutism

Selective mutism is a childhood anxiety disorder where children are unable or refuse to speak in most social situations.¹ CBT is a leading treatment for selective mutism and is often combined with certain anti-anxiety medications.⁸ Research shows that CBT can help children manage or even overcome selective mutism, allowing them to gain confidence and improve their ability to speak and interact in social situations. CBT treatment typically starts by helping the child identify triggers for their anxiety and mutism, as well as recognize changes in their thoughts, feelings, and behaviors. Exposure therapy is often a key component, gradually guiding the child to face feared social situations and engage in conversations step by step.

Types of CBT for Kids

CBT is a highly effective treatment for children and can be delivered in several ways, each tailored to the specific needs of the child and family:

• Individual CBT: Sessions involve only the child and the therapist, allowing for personalized, one-on-one support. The therapist helps the child work through specific challenges using techniques like cognitive restructuring and coping skills. This approach is particularly effective for anxiety, depression, and other emotional difficulties.³
• Parent-child CBT: The therapist works with both the child and their parents together. In these sessions, parents learn specific skills to support their child’s progress, such as helping them manage emotions or handle difficult situations. This approach is especially helpful for families dealing with trauma or behavioral issues.⁹
• Family-based CBT: These sessions include the child, parents, and sometimes siblings or other close family members. The therapist teaches everyone CBT strategies, focusing on improving family communication, problem-solving, and emotional support. This method strengthens the family’s ability to help the child manage their emotions and behaviors.¹⁰
• Group CBT: The child participates in sessions with a therapist and other children who are facing similar challenges. Group settings offer peer support, allowing children to learn from each other while practicing important social and emotional skills. It’s a great option for building confidence and improving self-esteem in a supportive group environment.¹¹
• CBT paired with motivational enhancement therapy: This combination is particularly effective for teens struggling with substance use. By integrating CBT with motivational enhancement therapy, this approach helps teens work through their resistance to change and develop healthier coping mechanisms.¹²

Examples of CBT for Children

CBT offers strategies to address a wide range of challenges children may face, from social anxiety to behavioral issues and ADHD. By focusing on specific needs, therapists help children develop skills and confidence, fostering growth in both personal and academic settings. Below are examples illustrating how CBT can support children in different scenarios.

CBT for Social Anxiety

Blake, 5, recently started kindergarten and has been described by his parents as very shy. While his teacher reports that he does well academically, Blake struggles with making friends. During recess, he prefers to play alone, even when other children invite him to join in. When asked why he doesn’t play with the others, Blake becomes upset and starts crying. Concerned, Blake’s teacher suggests his parents seek the help of a therapist to better understand what might be going on.

At their first session with a CBT therapist, Blake’s parents explained that he is an only child, and his mother has stayed home to care for him since birth. As a result, Blake has had limited opportunities to interact with other children and is unsure how to engage with them. The therapist identifies that Blake’s underdeveloped social skills have contributed to social anxiety.

Over the next few months, Blake attends a weekly social skills group where he learns how to interact with his peers in a supportive environment. In addition to group sessions, he works with his therapist one-on-one to address his anxiety and practice simple relaxation techniques to use when he feels nervous. His parents and teacher are also taught these techniques to help Blake apply them when needed. As Blake practices these skills, he starts feeling more confident and less anxious at school. Gradually, he begins talking more in class and playing with the other children during recess.

CBT for Behavioral Problems

Allie, 10, has been struggling with behavioral issues at both home and school since her parents announced their divorce. She has been talking back, refusing to complete her schoolwork, and acting out, which is unusual for her since she’s typically a good student and respectful. Concerned by the sudden change in her behavior, Allie’s parents decided to seek the help of a therapist.

During the first few therapy sessions, Allie opens up about her feelings. She reveals that she is upset and angry about the divorce, feeling that her family is being torn apart. The therapist explains to her parents that Allie’s behavior stems from an adjustment disorder triggered by the family changes. To help Allie, the therapist uses cognitive restructuring, guiding her to think about the situation in new ways. Allie learns that even though her parents are no longer together, they are both happier now and still love her. At the same time, the therapist works with her parents to develop strategies to address unwanted behaviors and reinforce positive actions.

Over the course of four months, Allie continues therapy, where she works on recognizing and changing her negative thoughts and learning to express her emotions in healthier ways. As she makes progress, her grades improve, and she starts turning in her schoolwork. With the support of her therapist and family, Allie begins to accept the changes in her family and feels happier and more settled.

CBT for ADHD

Liam, 12, has been struggling in school, and his parents are concerned about his academic performance and behavior. While he does well on tests, Liam frequently has trouble completing homework and long-term assignments. His teachers have also reported that he often disrupts class by not following along during lessons and interrupting other students when they’re speaking. His parents are frustrated, especially because Liam is capable but seems unfocused and unmotivated.

Liam’s parents take him to see a psychiatrist, who diagnoses him with ADHD. Along with prescribing medication, the psychiatrist refers Liam to a CBT therapist to help him manage his behavioral challenges. In therapy, Liam learns how to set realistic goals and break them down into smaller, manageable steps. He applies these skills to his schoolwork, learning how to use a planner to track assignments and due dates. As a result, he starts turning in his homework on time and feels more organized.

Additionally, Liam works on social skills during his sessions, helping him improve his interactions with peers and teachers. Over the course of six months in therapy, Liam makes significant progress—his grades improve, and his parents notice a positive shift in his behavior at home. His dad comments that Liam is more cooperative, takes on more responsibilities around the house, and exhibits fewer negative behaviors.

How to Find a CBT Therapist for Your Child

Finding a CBT therapist for your child can feel overwhelming, but there are a few key steps that can help make the process easier. Start by asking your child’s pediatrician, school counselor, or trusted healthcare provider for recommendations—they often have connections to therapists who specialize in working with children. You can also check out an online therapist directory, where you can filter your search by location, specialty, and insurance coverage.

For more convenience, online therapy services like BetterHelp and Talkspace have therapists who specialize in working with children and adolescents, including offering CBT. Many of these services offer virtual sessions, making it easier for your child to access therapy from the comfort of home.

Here are some key factors to keep in mind when searching for a CBT therapist for your child:

Qualifications

Make sure the therapist holds the appropriate credentials, such as a license in counseling, psychology, social work, or family therapy. A valid license shows that the therapist meets the state’s requirements to practice professionally and is well-trained.

Relevant Experience

Choose a therapist who has specific experience working with children. Therapists who understand how to engage young clients will be better equipped to address your child’s concerns in a way that’s developmentally appropriate.

Clear Communication

Look for a therapist who can clearly explain their approach and provide a plan after meeting with your child. They should outline the goals for therapy and how they’ll track progress so you know what to expect moving forward.

Once you have a few options, reach out to set up consultations. This gives you a chance to ask questions about their approach and make sure it’s a good fit for your child’s needs. Trust your instincts, and remember that finding the right therapist can take time, but it’s worth the effort to get your child the support they need.

How to Explain CBT Therapy to Your Child

Before going to therapy, it is always a good idea to talk to your child about what to expect throughout the treatment experience. Explain to your child that the therapist will talk with them about their thoughts, feelings, and actions so they can better understand what’s going on inside their mind and how it affects their behavior. Emphasize that the therapist is there to help them and that it is a safe place for them to talk about anything. Also, make sure to share the therapist’s name, where the office is located, and what it looks like to help your child feel prepared for their first visit.