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

How Does Cognitive Behavioral Therapy for Kids & Teens Work?

When working with young children in counseling, most of the therapeutic work is usually done with the parents/caregivers, teaching them the CBT techniques and how to incorporate them to 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 client, empowering them while still utilizing the help of caregivers to ensure proper use of therapeutic techniques outside of the therapy office.

What Child & Teen Issues Can CBT Help With?

Cognitive behavioral therapy is used to treat a vast number of mental health issues, including anxiety, depression, self-esteem and identity issues, and behavioral disorders. 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.

Here are some common applications of CBT for kids and teens:

• CBT for anxiety
• CBT for panic attacks
• CBT for social anxiety
• CBT for depression
• CBT for ADHD
• CBT for OCD
• CBT for eating disorders
• CBT for insomnia

Types of CBT for Children

CBT is an effective intervention for children that can be delivered in a variety of ways, including:

• Individual CBT: One-on-one sessions with a licensed therapist are the most well-studied form of CBT, and have been shown to be most effective, particularly for adolescents with anxiety.¹
• Parent-child therapy: Parent-Child CBT can be delivered individually and in a group setting. It particularly serves to support families with a history of trauma and abuse, helping children to heal and parents to build emotion regulation and positive parenting skills to support their family.²
• Family-based CBT: Incorporating the family therapy in CBT treatment helps parents and other family members learn CBT skills along with their child, improving family communication and support.³
• Group CBT: CBT delivered in a group setting with same-aged peers allows children to learn important skills together, and has been shown to also increase self-esteem.⁴
• Trauma-focused CBT (TF-CBT): For children and teens who have experience trauma, TF-CBT has been shown to be highly effective in helping them, and their caregivers, find healing, particularly when the treatment protocol is modified to fit the child’s developmental level.⁵
• CBT paired with motivational enhancement therapy: Combining CBT and motivational enhancement therapy is particularly effective in treating teens with substance use issues.⁶ Motivational Interviewing is at the core of this treatment approach.

Common CBT Techniques 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 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 Restructuring

Cognitive restructuring involves 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
• Time-specific

Goals should be tailored for age and maturity, and SMART goals cater to this need.

Relaxation Techniques

Relaxation techniques could include grounding exercises, breathwork, and progressive 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

Behavioral modification involves 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

Skills training involves teaching age appropriate skills, such as: time management, social skills, organizational skills, and healthy lifestyle adjustments.

Play Therapy

Play-based CBT incorporates structured, goal-oriented activities and unstructured, child-directed therapeutic play. The therapist helps the child make connections between their thoughts, feelings and behaviors through play. In this approach, the therapist might create scenes from the child’s life, use role-play games and desensitization techniques to provide developmentally-appropriate care.

Modeling

In working with children, the therapist will often employ modeling to demonstrate desired skills and behavior without direct instruction. Children are naturally adept at imitating others – this is how they learn new skills like walking and talking early in life. By showing the child how to express their emotions, restructure thoughts or handle challenging social situations, the therapist helps them to reach their goals organically.

Exposure Therapy

Exposure therapy often accompanies CBT for children and adolescents with anxiety or OCD in order to help them face specific fears. By working with the child to increase coping skills to utilize when exposed to anxiety-producing situations, the therapist helps the child to ultimately decrease anxiety-related symptoms over time. Exposure is often considered to be a vital component of CBT in treating anxiety disorders.

Examples of CBT for Children & Teens

The following are examples of how cognitive behavioral therapy can help children and teens:

CBT for Social Anxiety in a Young Child

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 learn 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.

CBT for Behavioral Problems in a Child Whose Parents Are Getting Divorced

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.

CBT for ADHD in a Teenager

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 for 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 Institute 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.⁷ 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.⁸ More 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.⁹

How to Find a CBT Therapist for Your Child or Teen

There are a large number of online therapist directories devoted to aiding in the search for a therapist for your teen or younger child. 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.

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 they can expect throughout their experience in treatment. Sharing the therapist’s name, where the office is located and what it looks like, and what they can expect to do there will help the child to feel prepared for their first visit. Tailoring your conversation to the child’s age and developmental level is key. For all children, emphasizing that the therapist is there to help them with their feelings, that it is a safe place for them to talk about anything and that you will support them along the way are important messages to relay.

When explaining CBT, it can be helpful to let the child know that the therapist will talk with them about their thoughts, feelings and actions so that they can build skills to work through tough moments and ultimately feel better.

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 anxiety and stress.

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:

1. 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.
2. 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?
3. What do you taste? Are you eating or drinking something? If so, what does it taste like? Is it sweet or savory?
4. 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.
5. 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:

1. Feet: Curl your toes tightly into your feet, hold for 5 seconds, then release.
2. Calves: Point your feet, hold for 5 seconds, then release.
3. Thighs: Squeeze your thighs tightly together, hold for 5 seconds, then release.
4. Torso: Tighten the muscles of your abdomen, hold for 5 seconds, then release.
5. Back: Squeeze your shoulder blades together, hold for 5 seconds, then release.
6. Shoulders: Lift your shoulders up toward your ears and squeeze them together, hold for 5 seconds, then release.
7. 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.
8. Hands: make tight fists by curling your fingers into your palms, hold for 5 seconds, then release.
9. Face: Scrunch your facial features and pull them toward the center of your face, hold for 5 seconds, then release.
10. 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.