Cognitive-Behavioral Therapy for Childhood Anxiety and Depression

For both depression and anxiety disorders in youths, there is increasing evidence of clinical benefit from cognitive-behavioral therapy (CBT).

Anxiety disorders

Both SSRIs and CBT individually have been shown to be effective in the treatment of children with anxiety disorders. A recent large randomized controlled trial examined the combined efficacy of these treatments in 488 children and adolescents (aged 7 to 17 years) who had anxiety disorder (separation anxiety disorder, social phobia, or generalized anxiety disorder).1

Patients were randomized to receive sertraline, CBT, sertraline and CBT, or placebo for 12 weeks. Combination treatment was significantly superior to either sertraline or CBT alone. Response rates were 81% for combination treatment, 60% for CBT, 55% for sertraline, and 24% for placebo. The effect size for combination treatment was 0.86 compared with 0.45 for sertraline and 0.31 for CBT. The investigators concluded that children and adolescents who receive combination treatment for anxiety disorders can consistently expect a significant reduction in anxiety severity.

Is CBT effective for young children with anxiety disorders? Typically, anxiety studies include children older than 8 years. Recently, Freeman and colleagues2 compared the efficacy of family-based CBT with family-based relaxation treatment for children aged 5 to 8 years who have ob-sessive-compulsive disorder (OCD). The 12-session CBT treatment was tailored to younger children to address their developmental stage. CBT had a moderate treatment effect (0.53). Half of the children who received CBT obtained clinical remission compared with 20% in the relaxation treatment group. The authors recommended family-based CBT as an important component when addressing early childhood–onset OCD.

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