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  • Dr Bejoi Mathew

The Role of Cognitive Behavioral Therapy in Childhood Anxiety Disorders

Not branchless as the fear tree, It has naked roots and secret twigs

Not geometric as the parabolas

Of hope, it has loose ends With a knot at the top

That's me.

Not wakeful in its white snake

Glassy ways like the eloping gaiety of waters, it drowses, viscous and fibered as pitch.

Flames have only lungs.

Water is all eyes.

The earth has a bone for muscle.

And the air is a flock of invisible pigeons.

But anxiety

Can find no metaphor to end it.



Anxiety doesn't just haunt adults; it also affects young children to a large extent, with up to 25% of the young population being affected. This may be just the tip of the iceberg, as many cases likely go unreported in households that do not believe in the concept of mental health. Each one of us has probably thrown a tantrum when starting school or been a nervous mess when adapting to new environments and meeting new people. However, for some children, anxiety is incessant and affects their behavior and thoughts to an extent where professional help is required. This is when Cognitive Behavioral Therapy (CBT) comes in and serves as the tool these children need.

Let me now walk you through what falls under the anxiety spectrum.

What symptoms to look out for?

Treatment modalities

■ Cognitive behavioral therapy (CBT)

■ Medications – SSRIs , Alprazolam , Beta-blockers( social phobia ) – usually in adolescents

■ Dialectical Behavioural therapy – usually in those with concomitant mood disorders

In this article, I would like to throw some light on Cognitive Behavioural Therapy (CBT) in particular. Is it the hero our young ones need when they exhibit red-flag symptoms? First, we need to know what CBT is. CBT is a well-established and effective form of psychotherapy for treating childhood anxiety disorders. The primary goal of CBT for childhood anxiety disorders is to help the child develop a more accurate and realistic perspective on their worries and fears. Children are taught to identify and challenge negative and unrealistic thoughts and to develop positive and adaptive coping strategies.

If we break down the word CBT into its two components: the cognitive part helps the child learn how to change how they view a situation, while the behavioral part helps them learn how to react differently to each situation. Exposure therapy is key, and it involves teaching children a variety of coping skills to help them manage difficult situations. Another type, known as exposure and response prevention, is effective in treating children and adolescents with obsessive-compulsive disorder. Exposure and response prevention teaches the child to recognize their obsessive thoughts and avoid the associated rituals.

CBT for childhood anxiety disorders is typically conducted in individual or group therapy sessions and typically lasts 10-20 sessions. The length of treatment can vary depending on the child's specific needs. CBT has been proven to be effective in reducing anxiety symptoms in children and adolescents, with effects that persist over time.

Techniques that have been employed include Trauma-focused CBT, Play therapy, Modelling, Restructuring, and Exposure.

How does CBT help?

Although childhood anxiety may seem benign, it can snowball into a distressing experience for both the child and parents. When an anxious child seeks comfort in avoidance, it can pave the way to deterioration in school and social situations. It's important for the child to fully understand what they are confronting, and how their thoughts, images, or objects can shape their lives. Many pediatric psychologists help children by encouraging them to see their anxiety as a big bully, personifying the problem, and showing them that the bully is not as tough as they think. This approach helps children conquer their fear by going through it systematically and gradually, via well-structured exposure. By doing so, the child learns to overcome their anxiety and gains an improved self-image, new coping mechanisms, improved problem-solving skills, and greater self-control.

As Paulo Coelho, in one of his books, said, ‘And one has to understand that braveness is not the absence of fear but rather the strength to keep on going forward despite the fear

With adequate treatment and constant support, the child can achieve symptomatic reduction although complete remission has been observed in many cases.

Why choose CBT?

Simply because it helps the child challenge the negative thoughts and beliefs that contribute to anxiety. This can help children develop more effective coping strategies that they can use to manage their anxiety both during therapy and after.

It is typically short-term: Unlike some other types of therapy that may last for many years, CBT is often a relatively short-term intervention. This can be particularly beneficial for children and families who may not have the time or resources to commit to long-term therapy. Involving parents to walk them through this arduous journey helps the children lean on their parents whenever. Most importantly, numerous studies have testified to the fact that CBT is an effective treatment for childhood anxiety disorders. This means parents and caregivers can be confident that their child is receiving a treatment that has a strong evidence base and is likely to be helpful.

Okay, Doctor, are there any better modes of treatment besides CBT?

Recent data suggest equivalent or superior benefits from another form of therapy known as SPACE(Supportive Parenting for Anxious Childhood Emotions) also known as Full guided parent delivered CBT (UK-based study)

SPACE principally teaches parents to reduce their accommodation and to respond to a child's anxiety symptoms in a supportive manner that translates acceptance of the child's genuine distress along with confidence in the child's ability to cope with anxiety.

In conclusion, CBT is a highly effective and evidence-based form of psychotherapy for childhood anxiety disorders. By helping children identify and challenge negative and unrealistic thoughts, develop positive and adaptive coping strategies, and safely face their fears, CBT can lead to a significant reduction in anxiety symptoms and improvements in quality of life. CBT is typically conducted in individual or group therapy sessions and is time-limited, making it a convenient and accessible form of treatment for children and their families. If you or someone you know is struggling with childhood anxiety, consider seeking CBT as a form of treatment.

It is important to understand that Cognitive behavioral therapy is tedious, both for kids and their parents. But as anxiety diminishes, kids get back to doing the things they like, and the happy child their parents feared they had lost is back again— and nobody would find anything more rewarding.


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