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This essay will explain how Cognitive Behavioural Therapy (CBT) is used to treat
children and adolescents with anxiety disorders, and whether it is an effective form of
treatment. I will start by looking at what anxiety is (according to the DSM-V) and the
prevalence of specific types of anxiety disorders in children and adolescents. Following this I
will explain what CBT is and how the treatment was formed based on various cognitive
theories. I will then explain how CBT is administered to children and adolescents, and the
different techniques that are used. Lastly, I will look at whether CBT works as a form of
treatment for anxiety in children and adolescents and whether the therapy is effective in
reducing symptoms for everyone who tries it. To do this I will review previous research;
specifically, research that looks at the remission rate of patients who have received CBT as a
treatment. I will also look at why CBT is not 100% effective and what can be done to make it
more effective as a treatment, and what can be done to make sure more people are effectively
treated.
experiences feelings of anxiety excessively, for a prolonged period of time (i.e. for at least 6
months), and to the extent where it may interrupt a persons ability to perform day to day tasks
such as going to work. Of all the psychiatric disorders, anxiety disorders are some of the most
common in society, not just in adults (Kessler et al., 2005) but also in children and adolescents.
Cartwright-Hatton, McNicol, and Doubleday (2006) reviewed research into the prevalence of
anxiety disorders and found that generalized anxiety disorder can be found in up to 17.5% of
children from various populations. More specifically, around 0.7% of children aged 5-10 in
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Great Britain will present enough symptoms to be diagnosed with generalized anxiety disorder.
This is a lot of people suffering with similar problems, that not only are distressing to live with
but also make day to day activities extremely difficult; hence such a strong relationship
between anxiety disorders and depression and/or suicidal thoughts and behaviours (Brady &
Kendall, 1992; Nepon, Belik, Bolton, & Sareen, 2010). Therefore, treatments have been
developed in order to decrease the intensity of symptoms, making life more bearable for
sufferers.
disorders (Clark, 2011). It stems from the cognitive theory of psychological disorders proposed
by Beck (1967) as cited in Jacobs and Joseph (1997). The main component of the theory is the
cognitive triad that looks at the interactions between a persons view of themselves, view of
the world and how they view the future. Jacobs and Joseph (1997) provided real life evidence
that supported that people with higher scores on measures of anxiety have a more negative
view of themselves, the world and the future. They found that 29% of the variance in anxiety
between 218 adolescent individuals was accounted for by scores on a 36-item cognitive triad
inventory (the self, the world, and the future), suggesting that anxiety can be explained by the
cognitive triad. Therefore, a therapeutic technique that targets the faulty aspects of the
Beck and Clark (1988; 1997) looked at the different aspects of the cognitive theory that
cause anxiety. They suggested that anxiety was not just a result of the faulty aspects of the
cognitive triad, but also a result of a persons faulty schema-based information processing. In
particular, the differences in how people with and without anxiety problems register
threatening stimuli, and whether this activates primal responses such as autonomic arousal (i.e.
fight or flight). They suggested that not only do people with anxiety process stimuli as more
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threatening in general but also that they have maladaptive schemas that often overrise
functional ones resulting in a fight or flight response to stimuli that people without anxiety
would not consider threatening. CBT aims to target these schemas and alter faulty cognitions
The techniques used in CBT are similar for both adults and children (Stanley et al.,
2009). The differences lie in what techniques are appropriate for what age group. For example,
Kendall (1994) stated that the CBT techniques used for 9-13 year olds with anxiety disorders
included recognizing anxious feelings and personal reactions to anxiety, clarification of the
cognitions involved in the onset of anxious feelings, developing a coping plan using techniques
such as positive self-talk and relaxation, evaluating the effectiveness of these techniques, and
providing self-reinforcement. Whereas, Stanley et al. (2009) administered CBT to 134 older
adults and the therapeutic techniques used involved those used by Kendall (1994), as well as
motivational interviewing and problem solving skills training which are both more complex
therapeutic techniques and therefore are more appropriate for older people than children,
because adults have a more developed brain than children and therefore can deal with more
researchers have studied its effectiveness in terms of reducing symptoms and have found
Hatton, Roberts, Chitsabesan, Fothergill, & Harrington, 2004). Reynolds, Wilson, Austin, and
anxiety in children and adolescents. They found that overall psychological therapy was
symptoms of anxiety. More specifically they found that disorder specific CBT (CBT that has
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been altered to target specific aspects of a certain disorder) was more effective that regular
CBT, individual therapy was more effective than group therapy, minimal parental involvement
proved more effective than no parental involvement, and the optimum length of treatment was
between 9 and 16, 1-hour sessions. This not only suggests that CBT is an extremely effective
form of treatment for anxiety, but also provides an insight into what increases the effectiveness
of CBT in reducing symptoms. It suggests that perhaps the involvement of a parent in treatment
increases its effectiveness, possibly due to the increase in familial support and understanding
(Steketee, 1993).
It has also been found that this reduction in anxiety related symptoms due to the use of
CBT is not just a short-term change but a relatively long term one. Research suggests that this
reduction in symptoms can be sustained over the course of a year, and that children aged 9-13,
who were no longer diagnosed with an anxiety disorder following treatment, were still without
a diagnosis 12 months after the completion of CBT (Kendall, 1994). This suggests that it not
only reduces symptoms, but treats the disorder completely in some cases. This may be because
patients were treated at a young age, a time when there is a lot of brain plasticity (Mundkur,
2005), meaning that children may just be easier to treat with CBT and that it will not be as
effective for everyone. However, research does suggest that CBT is an effective treatment for
all ages.
Stanley et al., (2009) found results that were both similar and contrasting to previous
research into the effectiveness of CBT as a treatment. They found that when comparing the use
of CBT for 3 months to regular care and enhanced care in older participants (with a mean age
of 66.9 years), CBT improved both the severity of feelings of worry and depressive symptoms,
suggesting it is still and effective form of treatment. However, unlike when it was used to treat
children, CBT did not reduce the severity of the generalized anxiety disorder (GAD) itself.
This supports the idea that children respond better to CBT due to more brain plasticity, because
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older participants did not respond as well to CBT and research suggests that blain plasticity
However, even though CBT has proven to be more effective in treating anxiety
disorders in children and adolescents than treating anxiety in adults, it has still never proven to
be 100% effective in treating everyone with an anxiety disorder. Therefore, there is still room
for improvement to make it a more effective form of treatment for everyone that needs it.
One of the reasons that CBT may not be effective for everyone with an anxiety disorder
therapeutic sessions. This may be due to certain symptoms that make a person unable to leave
their home and go to a therapy session, such as panic attacks or just anxiety about the therapy
itself. If the intensity of these symptoms could be reduced then people would be able to
participate in therapy sessions. Walkup et al. (2008) did a study that looked at whether CBT
would be more effective if patients were having it in combination with a medication that
reduced the intensity of symptoms. They found that 80.7% of children who had a combination
of CBT and sertraline (Selective Serotonin Reuptake Inhibitor) were rated as very much or
much improved following the course of treatment in comparison to only 59.7% improving with
CBT alone and 54.9% for treatment with just medication. This suggests that the effectiveness
of CBT is enhanced by the use of sertraline and that treatment with sertraline is more effective
when used in combination with CBT. This may be because sertraline reduces certain anxiety
related symptoms that would otherwise hinder the CBT process, meaning the patients can fully
dedicate themselves to the therapy and therefore get more out of it.
It has also been found that there are other factors that influence the ability of CBT to
treat people effectively. For example, CBT has been found to have a high dropout rate. This
can be seen in the study of Bados, Balaguer, & Saldaa (2007) that found that, of the 89 patients
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attending a 13-week course of CBT, most patients dropped out after the first session (28.1%),
with the main reason being a lack of motivation or dissatisfaction with the treatment/therapist;
both of which are individual differences. One person may be satisfied with a therapist and
another may not. Therefore, it can be assumed that the effectiveness of CBT is highly
Another factor that should be considered is that, despite CBT being available on the
NHS in the UK, in other countries people of lower economic groups may not be able to afford
treatment and therefore CBT will not be effective as they cannot access it. Therefore, people
have created forms of CBT that are more accessible and effective for everyone, such as self-
help books and computer based cognitive treatments. Although computer based CBT does not
appear to be as effective as face to face CBT, it is still showing some signs of decreasing certain
symptoms (Gega, Marks, & MataixCols, 2004) and therefore can be developed further to
increase the number of people that can be effectively treated with CBT.
Overall, CBT is a commonly used treatment for anxiety disorders in children and
adolescents, and is somewhat effective in reducing symptoms. However, because it is not 100%
effective and is not an accessible and effective treatment for everyone, researchers are
continuously trying to find ways to increase its effectiveness. It is often used in combination
with medication, which increases its effectiveness by reducing the intensity of symptoms that
hider the ability to participate in therapy. However, due to high drop-out rates for a variety of
reasons, further development also needs to be done to make sure that everyone who needs
treatment, can access it and will participate fully in it, in order for it to treat as many people as
References
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