Cognitive-Behavioral Therapy for Children and Teens

What is cognitive-behavioral therapy (CBT)?

Cognitive-behavioral therapy is a treatment that may help with problems such as:

• depression and other mood disorders
• anxiety disorders such as panic attacks and phobias
• eating disorders
• substance abuse and alcohol abuse.

CBT focuses on how a child thinks and what a child does. CBT mainly focuses on the present and future rather than past events or unconscious motives. The therapist decides (along with your child) what behaviors and thinking patterns need to change.

Cognitive-behavioral therapy is different from other kinds of therapy in several ways. It is:

• Goal-oriented. It helps your child set goals, plan ways to achieve those goals, and check progress.
• Problem-focused. The therapist works with your child to identify problems and what exactly needs to change.
• Active. CB therapists ask questions and actively listen to the child.

CBT typically requires the child to complete weekly homework assignments. This helps the child change behaviors between sessions. It also cuts down on the number of sessions needed.

Psychologists, psychiatrists, and social workers provide CBT. CBT can be used in individual, family, and group therapy settings.

What happens during a typical therapy session?

Children and teens are usually brought to therapy by a family member who thinks there is a problem. Children often blame their problems on family members, teachers, or peers. They may not see how talking to a therapist about their problems will help. Therapists who specialize in working with children and teens are skilled in finding out what the child wants. For example, do they want to stop being picked on by their peers? Get along better with family members? Feel better about themselves? This helps the therapist to motivate the child. The therapist also finds out whether the problem involves domestic violence or substance abuse.

Examples of cognitive-behavioral techniques include:

• Bell and Pad: This method is used to treat children who wet the bed. A pad is placed on the child's bed. It sets off an alarm when urine is detected, and awakens the child. This helps the child learn to wake up and get to the bathroom before urinating.
• Exposure Therapy: Exposure therapy or systematic desensitization helps children to face their fears (for example, a fear of dogs). First the child or teen learns how to relax. The child is then exposed to low levels of what is scary, such as pictures of dogs. The therapist helps the child learn to stay relaxed. Over time, the therapist exposes the child to increasing fear levels (such as sitting next to a dog) while staying relaxed. This helps the child learn to replace fear with feelings of relaxation.
• Modeling: In this technique, the child observes someone model the desired behavior. Modeling can be used to increase assertiveness, help resolve family conflicts, or help a child act less aggressive.
• Cognitive Restructuring: This technique helps children identify feelings and thoughts in situations when they are anxious. The therapist helps the child develop a plan to cope with the anxiety. The child practices the skills outside of session and reports on progress at the next therapy session.

To find a CB therapist who specializes in working with children and teens, check with

• your family healthcare provider
• friends or family members who have been in therapy
• local associations of psychologists, social workers, or counselors