Cognitive Behavioral Therapy is an effective treatment for many mental health disorders. Because of things like age and emotional/intellectual maturity, therapy for children and teens needs to be tailored to meet their needs. Because of this many therapists specialize in working with children and/or teens, seeking further education and training on how to adapt therapy based on the developmental stages of their patients.
What Is CBT?
Cognitive Behavioral Therapy is a practical therapy modality that looks at the way our thoughts, emotions, and behaviors are shaped by both our own preconceived notions and our environment. The goal of CBT is to help the individual learn to recognize irrational thought patterns that lead to negative behavioral outcomes, and construct new, rational thought patterns in their place. Through skills training and behavior modification, the CBT therapist helps empower the individual, giving them lifelong tools to manage their symptoms that can be applied throughout their lives.
Cognitive Behavioral Therapy uses several therapeutic techniques specific to CBT that aid in the individual’s mental and emotional growth. Common practices include cognitive restructuring and refocusing, problem solving, relaxation techniques, and skills training/development.1
How Is CBT Adapted for Children & Teens?
Working with children and teens in therapy presents its own set of unique challenges. Among those challenges are how to adapt therapeutic techniques based on age and maturity, including caregivers in treatment planning and implementation, and incorporating other therapeutic treatment methods such as play therapy that aid in participation of young children.2
Of these adaptations, perhaps the most crucial one is the inclusion of caregivers in the therapeutic process. This can include the parents or legal guardians of the patient, as well as teachers, babysitters or daycare workers, and even grandparents and other family members. For therapeutic techniques to be effective, it is important to secure the help of all those involved in caring for the patient, as consistency in treatment interventions is the key for success.
When working with younger children, most of the therapeutic work is usually done with the parents/caregivers, teaching them the CBT techniques and how to incorporate them into use with the child. With older children and teens, it becomes a combination of work with caregivers and the patient, teaching both how to use techniques to address the issues that brought them to therapy. This process gives more control to the patient, empowering them, while still utilizing the help of caregivers to ensure proper use of therapeutic techniques outside of the therapy office.
What Childhood & Teenage Issues Can CBT Address?
Cognitive Behavioral Therapy is used to treat a vast number of mental health issues. And while there are changes that must be made in how to utilize CBT for adolescents, there is significant research suggesting that CBT is very useful when working with this population.
Common issues affecting adolescents that can be treated using CBT include:
- Anxiety and Panic Attacks
- Social Anxiety
- Depression
- Attention-Deficit/Hyperactivity Disorder
- Obsessive-Compulsive Disorder
- Eating Disorders
- Adjustment Disorders
- Behavioral Disorders
- Self-Esteem and Identity Issues
- Insomnia and Sleep Disorders
Common CBT Techniques & Tools for Kids & Teens
Typical Cognitive Behavioral techniques and tools that are used with adults are also used with kids and teens, though the approach may look different depending upon age. Cognitive challenging/restructuring, goal setting, relaxation techniques, behavioral modification, and skills training are all part of the CBT arsenal and can be successfully used when working with children and teens.
Cognitive Challenging/Restructuring
The process of breaking down one’s negative thinking patterns by identifying irrational thoughts and replacing them with rational ones. Age can play a factor here in what the patient is able to understand, but a skilled CBT therapist will be able to adapt this technique to reflect the needs and intellectual level of their patient.
Goal Setting
SMART goals are great for use with kids as it helps them set goals that are Specific, Measurable, Attainable, Realistic, and Time-specific. Goals should be tailored for age and maturity, and SMART goals cater to this need.
Relaxation Techniques
Includes grounding exercises, breathing techniques, and muscle relaxation. These teach the patient to calm their physical and emotional responses to stress and can be simplified for even the youngest of patients.
Behavioral Modification
Identifying and eliminating any unwanted behaviors and encouraging and developing new, appropriate behaviors. When working with children, caregiver involvement is typically required. The caregivers and therapist work together to develop an action plan for behavior modification, which is then applied at home, school, etc.
Skills Training
Involves teaching age appropriate skills, such as: time management, social skills, organizational skills, and healthy lifestyle adjustments.
Examples of CBT for Children & Teens
The following are examples of how Cognitive Behavioral Therapy can help children and teens.
Blake, Age 5
Blake, 5, just started kindergarten and is described by his parents as very shy. His teacher says he does well in school academically but appears to be having a difficult time making friends. During recess, Blake prefers to play by himself even when engaged by other children. When asked why he doesn’t join the others, Blake becomes very upset and begins crying. Blake’s teacher then encourages his parents to seek a therapist to help understand what is happening with him.
During their first appointment with a CBT therapist they inform the therapist that Blake is an only child, and his mother has stayed home to raise him since he was born. Because of this, Blake hasn’t spent much time around other children and doesn’t know how to interact with them. The therapist determines that Blake’s lack of social skills development has led to social anxiety.
Over the next few months Blake attends a social skills group every week where he learns how to interact with his peers. He also attends individual sessions with his therapist to work on his anxiety and learning simple relaxation techniques to use when he feels nervous. His parents and teacher are also taught these techniques so that they can help Blake use them when needed. Blake begins to feel more confident and less anxious at school. He starts talking more in class and playing with the other children during recess.
Allie, Age 12
Allie is a 12-year-old whose parents are getting a divorce. Allie has been getting into trouble at school and home. She is talking back and not turning in her schoolwork. Her parents are concerned because her behavior is out of character for her, she is usually a good student and respectful. Her parents decide to find a therapist for her to talk to. After a few sessions with the therapist, Allie reveals that she is upset about her parents’ divorce and is mad at them for breaking up her family. The therapist tells Allie’s parents that her behavior issues are a result of an adjustment disorder brought on by the change to their family structure.
The therapist works with Allie using cognitive restructuring to help her see alternative ways of thinking about her situation, her parents are happier now and they both still love her and want her to be happy as well. The therapist also helps the parents develop parenting strategies that redirect unwanted behaviors and encourage positive ones. Allie spends 4 months working with her therapist on identifying negative thoughts and verbalizing her emotions in productive ways. Allie’s grades begin to improve as she starts turning in her schoolwork. Allie learns to accept her changing family and begins to feel happy again as a result.
Cam, Age 16
Cam, 16, is in high school. His dad describes him as lazy and unmotivated. He is worried that he will not be able to get into college after he graduates due to his poor academic performance. Though Cam does well on tests he struggles with homework and lengthy assignments. Cam’s dad has also received multiple calls from his teachers about his behavior in class. His teachers say he doesn’t follow along during lectures and interrupts other students while they are talking.
Cam’s dad takes him to see a psychiatrist who diagnoses him with ADHD. The psychiatrist prescribes Cam medication and refers him to a CBT therapist to work on his behavioral issues. In therapy Cam learns how to set goals for himself and break those goals down into smaller, easy to accomplish steps. He applies this to his homework assignments and begins turning them in on time after he learns how to use a planner to keep track of assignments and due dates.
He also learns social skills that help him have more productive interactions with peers and teachers. Cam spends 6 months in therapy and by the time he begins to apply to colleges he has made significant improvements to his grades. His dad also notes a change in his behavior at home, saying Cam is more helpful around the house and has fewer negative behaviors.
Is CBT Effective for Treating Children & Teens?
While research on how effective Cognitive Behavioral Therapy is when working with adults is extensive, less research has been done on using CBT with children. However, new studies conducted on the issue have found great success when using CBT with kids and teens. While more research is needed to further explore these findings, there appears to be strong evidence supporting CBT as an effective treatment modality for children.
A study conducted by the National Institutes of Health (NIH) found that under the right conditions and with a skilled therapist, CBT did effectively treat adolescents with diagnoses of anxiety and depression.2 The Centers for Disease Control and Prevention (CDC) also reports CBT is effective for treating anxiety and depression, as well as disruptive behavior disorder and post-traumatic stress disorder in children.3 Other research studies list various other disorders in children that CBT can be effective in treating, including, eating disorders, self-esteem issues, bedwetting, bullying, and substance use.4
How to Find a CBT Therapist for Your Child or Teen
There are a large number of online directories devoted to aiding in the search for mental health professionals. Many websites even allow you to narrow down your search with specific criteria, like searching specifically for CBT and adolescent experts in your area.
Fortunately, the effectiveness of the cognitive-behavioral approach has led to many mental health professionals choosing to specialize in CBT. When contacting a provider, you should ask if they are familiar with Cognitive Behavioral Therapy and how much clinical experience they have using CBT, as well as how much experience they have working with children and teens.
3 At-Home CBT Exercises for Kids & Teens
When children and teens come into therapy, one of the most common issues they present with is some form of anxiety, sometimes co-occurring with other issues or disorders. Below are a few relaxation techniques to help your child combat stress or anxiety.
1. Deep Breathing Exercise
There are an abundance of simple deep breathing exercises that can be performed at home.
To do a deep breathing exercise at home:
- Breath in through your nose for 5 seconds.
- Hold the breath in your lungs for 5 seconds.
- Breath out through your mouth for 5 seconds.
- Repeat.
You can practice this technique for 5-10 minutes at a time and can be used to calm your breathing and slow your heart rate when you are feeling anxious in social situations without drawing attention to yourself.
2. Grounding Exercise
While a grounding exercise can be done to keep focus on the here and now by seeking out sensory stimuli in your current environment, this imagery guided grounding exercise can also be used as a way to calm anxiety:
To begin, think of a place you find comforting. Somewhere in your house, a favorite spot, a beach, or a memory from your childhood. Now spend 5-10 minutes visualizing this place that you have conjured in your mind.
Use your five sense to ask yourself the following questions:
- What do you see? Look around and take in your surroundings in this space. What can you see in the distance? What do you see close to you? Try to notice small details you might normally miss.
- What do you hear? Listen closely to the noises around you. Are the noises you hear soft or loud? Do they sound close by or far away?
- What do you taste? Are you eating or drinking something? If so, what does it taste like? Is it sweet or savory?
- What can you feel? Is it warm or cool? Is there a breeze? Is the sun shining on you warming your skin? Or are you bundled up in a soft blanket? Concentrate on how everything feels.
- What can you smell? What does the air smell like here? Is the scent strong or faint? Focus on the scents you smell and appreciate them.
Use this exercise to relax your mind when you are feeling anxious or stressed. Spend as long as you need visualizing your comfortable space. Allow yourself to feel calm and safe.
3. Progressive Muscle Relaxation Exercise
An easy muscle relaxation exercise to try at home is the progressive muscle relaxation exercise:
- Feet: Curl your toes tightly into your feet, hold for 5 seconds, then release.
- Calves: Point your feet, hold for 5 seconds, then release.
- Thighs: Squeeze your thighs tightly together, hold for 5 seconds, then release.
- Torso: Tighten the muscles of your abdomen, hold for 5 seconds, then release.
- Back: Squeeze your shoulder blades together, hold for 5 seconds, then release.
- Shoulders: Lift your shoulders up toward your ears and squeeze them together, hold for 5 seconds, then release.
- Arms: Make fists and bend your arms in bringing your forearm toward your biceps squeezing the muscles in the arms, hold for 5 seconds, then release.
- Hands: make tight fists by curling your fingers into your palms, hold for 5 seconds, then release.
- Face: Scrunch your facial features and pull them toward the center of your face, hold for 5 seconds, then release.
- Full body: tighten and squeeze all the muscles in your body together at the same time, hold for 5 seconds, then release.
Practice this muscle relaxation exercise daily to release anxiety induced tension from your body.
