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CBT for Youth

By Saige Portera, BA, Hannah Toyama, BA, Jeremy Joves, BA, Anika Mehta, BA, Courtney Giannini, BA, Samantha Honnert, MA, and Beck Institute Faculty Member Robert Friedberg, PhD
Center for the Study and Treatment of Anxious Youth at Palo Alto University

The following summary collects evidence speaking to the efficacy and effectiveness of CBT for youth. As the established psychosocial intervention for behavioral health issues in childhood through adolescence, studies have shown CBT, and modular CBT for comorbidities, to be constructive across multiple disorders, ethnicities, and delivery formats, as well as in tandem with medication. For youth managing anxiety, depression, obsessive compulsive disorder (OCD), autism spectrum disorder (ASD), posttraumatic stress disorder (PTSD) and/or disruptive behavior disorders (DBD), an adaptable approach to the treatment model will likely result in reduction of symptoms and, in some cases, a boost in new positive feelings and behaviors.

Cognitive behavioral therapy (CBT) has demonstrated efficacy and effectiveness in youth across a variety of disorders, such as anxiety, depression, obsessive compulsive disorder (OCD), autism spectrum disorder (ASD), externalizing disorders, and posttraumatic stress disorder (PTSD) (Friedberg & Thordarson, 2018). The efficacy and effectiveness of CBT has been evaluated across peer-reviewed literature through randomized controlled trials (RCTs), meta-analyses, book chapters, and literature reviews.

CBT for Youth

 CBT is widely considered the gold standard for treating anxiety disorders in youth (Higa-McMillan, Francis, Rith-Najarian, & Chorpita, 2016; Kendall & Peterman, 2015). Kendall and Peterman (2015) conducted a literature review examining the efficacy and effectiveness of CBT with youth. Their findings showed significant clinical improvement in both mixed child and adolescent samples and adolescent-only samples, with the rates increasing when combined with medication. CBT enjoys robust efficacy and effectiveness with different ages, among various ethnicities, as well as across multiple delivery formats (e.g., individual, group, family) (Friedberg & Thordarson, 2018; Kendall & Peterman, 2015; Seligman & Ollendick, 2011). The classic Pediatric OCD Treatment Study (POTS, 2004) compared medication, CBT, their combination, and placebo conditions, finding that CBT and medication singularly and in combination were most effective. Öst, Riise, Wergeland, Hansen, and Kvale’s meta-analysis (2016) examined the effectiveness of CBT versus serotonin reuptake inhibitors (SSRIs) in treating OCD. Öst and his team found patients showed higher response rates in CBT versus SSRIs. Additionally, the combination of CBT and SSRIs was no more effective than CBT alone. Friedberg and Thordarson (2018) concluded that CBT is the best psychosocial intervention for OCD.

CBT for youth with depression has been evaluated by multiple studies. Crowe and McKay (2017) conducted a meta-analysis demonstrating efficacy for reduced long- and short-term depressive symptoms. These results were comparable to symptom reduction in anxious youth enrolled in CBT. CBT for adolescents with depression reached well-established status, while CBT with children earned the possibly efficacious status (Weersing, Jeffreys, Do, Schwartz, & Bolano, 2016). CBT in conjunction with medication improved symptoms more quickly and enhanced functioning (Brent et al., 2008; TADS, 2004). Due to comorbidity with other disorders, a modular approach to CBT is recommended, which is found to provide significantly faster improvement compared to usual care (Weisz, Krumholz, Santucci, Thomassin, & Yi Ng, 2015). In sum, CBT for youth with depression is an effective and efficacious psychosocial intervention for depressed youth (Crowe & McKay, 2017; Friedberg & Thordarson, 2018; Weisz et al., 2015).  

CBT is increasingly being applied with young patients diagnosed with ASD and various externalizing disorders. In their RCT with children, Sofronoff, Attwood, and Hinton (2005) found that CBT boosted parental reports of children’s increased friendships, confidence, and emotion regulation. White and her colleagues (2010) noted that CBT resulted in a 16 percent improvement in social skills. McCart and Sheidow (2016) studied the efficacy of CBT approaches to children with disruptive behavior disorders (DBD). McCart and Sheidow (2016) concluded that youth diagnosed with DBD experienced less aggressive/impulsive behaviors, diminished substance abuse, and fewer behavior problems reported by others. These findings support that CBT is an efficacious treatment for youth with DBD.

CBT is a well-established treatment for youth diagnosed with PTSD. In their literature review, Dorsey et al. (2016) suggested that CBT spectrum approaches reduced behavioral problems, anxiety, depression, and shame associated with PTSD. More specifically, Trauma-Focused CBT (TF-CBT; Cohen, Deblinger, Mannarino & Steer, 2004) enjoys solid effectiveness and efficacy results. Finally, TF-CBT appears generalizable to a variety of pediatric patients regardless of contextual and moderating variables (Dorsey et al., 2016; Friedberg & Thordarson, 2018).

Clinicians can feel confident that CBT is regarded as the premier psychosocial intervention for behavioral health issues ranging from childhood through adolescence. A variety of singular and comorbid psychiatric conditions are well-treated by a faithful and flexible application of the approach.

References:

Bearman, S. K., & Weisz, J. R. (2015). Comprehensive treatments for youth comorbidity – Evidence-guided approaches to a complicated problem. Journal of Child and Adolescent Mental Health, 20(3), 131-141.

Brent, D., Emslie, G., Clarke, G., Wagner, K. D., Asarnow, J. R., Keller, M., … Zelazny, J. (2008). Switching to another SSRI or to venlafaxine with or without cognitive behavioral therapy for adolescents with SSRI-resistant depression: The TORDIA randomized controlled trial. Journal of the American Medical Association, 299(8), 901-913.

Cohen, J. A., Deblinger, E., Mannarino, A. P., & Steer, R. A. (2004). A multisite, randomized controlled trial for children with sexual abuse-related PTSD symptoms. Journal of the American Academy of Child and Adolescent Psychiatry, 43(4), 393–402.

Crowe, K., & McKay, D. (2017). Efficacy of cognitive-behavioral therapy for childhood anxiety and depression. Journal of Anxiety Disorders, 49, 76-87.

Dorsey, S., McLaughlin, K. A., Kerns, S. E. U., Harrison, J. P., Lambert, H. K., Briggs, E. C., … Amaya-Jackson, L. (2016). Evidence base update for psychosocial treatments for children and adolescents exposed to traumatic events. Journal of Clinical Child and Adolescent Psychology, 46(3), 303–330.

Eyberg, S. M., Nelson, M. M., & Boggs, S. R. (2008). Evidence-based psychosocial treatments for children and adolescents with disruptive behavior. Journal of Clinical Child and Adolescent Psychology, 37(1), 215-237.

Friedberg, R.D., & Thordarson, M.A. (2018). Cognitive behavioral therapy. In J. L. Matson (Ed.), Handbook of childhood psychopathology and developmental disabilities of treatment (pp. 43-55). Cham, Switzerland: Springer International Publishing.

Higa-McMillan, C. K., Francis, S. E., Rith-Najarian, L., & Chorpita, B. F. (2016). Evidence base update: 50 years of research on treatment for child and adolescent anxiety. Journal of  Clinical Child and Adolescent Psychology, 45(2), 91–113.

Kendall, P. C., & Peterman, J. S. (2015). CBT for adolescents with anxiety: Mature yet still developing. American Journal of Psychiatry, 172, 519-530.

McCart, M. R., & Sheidow, A. J. (2016). Evidence-based psychosocial treatments for adolescents with disruptive behavior. Journal of Clinical Child and Adolescent Psychology, 45(5), 529–563.

Ost, L., Riise, E. N., Wergeland, G. J., Hansen, B., & Kvale, G. (2016). Cognitive behavioral and pharmacological treatments of OCD in children: A systematic review and meta analysis. Journal of Anxiety Disorders, 43, 58-69.

Pediatric OCD Treatment Study (POTS) Team. (2004). Cognitive-behavior therapy, sertraline, and their combination for children and adolescents with obsessive-compulsive disorder: The pediatric OCD treatment study (POTS) randomized controlled trial. Journal of the American Medical Association, 292(16), 1969–1976.

Seligman, L. D., & Ollendick, T. H. (2011). Cognitive-behavioral therapy for anxiety disorders in youth. Child and Adolescent Psychiatric Clinics of North America, 20(2), 217-238.

Sofronoff, K., Attwood, T., & Hinton, S. (2005). A randomized controlled trial of a CBT intervention for anxiety in children with Asperger’s syndrome. Journal of Child Psychology and Psychiatry and Allied Disciplines, 46(11), 1152-1160.

TADS Team, March, J., Silva, S., Petrycki, S., Curry, J., Wells, K., ... Severe, J. (2004). Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for adolescents with depression study (TADS) randomized controlled trial. Journal of the American Medical Association, 292(7), 807–820.

Weisz, J. R., Krumholz, L. S., Santucci, L., Thomassin, K., & Yi Ng, M. (2015). Shrinking the gap between research and practice: Tailoring and testing youth psychotherapies in clinical care contexts. The Annual Review of Clinical Psychology, 11, 139-163.

Weersing, V. R., Jeffreys, M., Do, M. T., Schwartz, K. T. G., & Bolano, C. (2016). Evidence base update of psychosocial treatments for child and adolescent depression. Journal of Clinical Child and Adolescent Psychology, 46(1), 11-43.

White, S. W., Albano, A. M., Johnson, C. R., Kasari, C., Ollendick, T., Klin, A., … Scahill, L. (2010). Development of a cognitive-behavioral intervention program to treat anxiety and social deficits in teens with high-functioning autism. Clinical Child and Family Psychology Review, 13(1), 77–90.