Therapy

New Support for Cognitive Behavioral Therapy

CBT Helps Half of Kids With Anxiety Disorders Oct. 19, 2005 — Cognitive behavioral therapy helps children and teens suffering from anxiety disorders.

That’s the judgment of a Cochrane review, widely considered the gold-standard rating system for medical treatments. Cochrane reviews evaluate whether clinical studies provide enough first-rate evidence to say a treatment truly works.

Cognitive behavioral therapy — or CBT — is a brief form of psychotherapy. Using specific, step-by-step techniques, it teaches patients skill sets that allow them to change the ways they think and act.

CBT treatments for anxiety, for example, teach patients skills to help them deal with anxiety-provoking situations. Patients are then gradually exposed — either in imagination or in real life — to the things that make them anxious or fearful.

Psychiatrist Anthony James, MD, senior lecturer at the University of Oxford in England, and colleagues analyzed 13 clinical studies of CBT in children and teens with mild-to-moderate anxiety disorders. The results:

* 56% of children and teens got better, vs. 28% of kids in untreated groups.
* Children and teens treated with CBT averaged 58% fewer symptoms of anxiety.
* Three kids must be treated with CBT to cure one case of anxiety disorder.

“Cognitive-behavioral therapy does work for children with anxiety disorders,” James tells WebMD. “It probably compares favorably with the effects of drug treatment. CBT probably should be offered as a first-line treatment where therapists are available to deliver it.”

James says the studies offer “robust” support for CBT as a treatment for pediatric anxiety. He gets no argument from Jennifer Hagman, MD, associate professor of psychiatry with the University of Colorado Health Sciences Center and co-director of the eating disorders treatment program at The Children’s Hospital, Denver.

“Fifty percent improvement in symptoms is really pretty good,” Hagman says. “In clinical practice, patients do very well with goal-oriented therapy that teaches specific skills. And the outcomes are very strong in the studies where a consistent approach is used.”

While CBT clearly benefits patients, James warns that it is not a cure-all.

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“There is no panacea,” he says. “Cognitive behavioral therapy is a collaborative treatment that does appear to work in all of its various formats. But there is still room for improvement. A good percentage of patients do not improve. That may be the group for whom combined CBT and drug therapy is most effective.”

Hagman points to recent clinical trials suggesting that, at least for some patients, CBT can be more effective when combined with medicationCBT can be more effective when combined with medication.

Best When Parents Involved

Does your child suffer from an anxiety disorder? Children with anxiety problems may or may not act like anxious adults.

“Kids are more likely to have physical symptoms from anxiety disorders,” Hagman says. “They have stomachaches or headaches; sometimes with vomiting or diarrhea. But they can look very worried, very stressed, and can have panic syndromes just as adults do.”

Before jumping to the conclusion that your child has an anxiety disorder, Hagman advises parents to consider the child’s developmental stage.

“A 2-year-old who won’t get in the car because of separation anxiety is different from an 8-year-old who can’t get into the car because he panics and has trouble breathing,” she says. “If a child is afraid of a snake, that is normal. If a child is afraid to walk down the block because he or she is afraid of seeing a snake, that is a problem.”

CBT helps. But parents can’t expect simply to drop their child off at the therapist’s office and expect results.

“Parents should be part of every session in some way,” Hagman says. “If the child is under 12, parents need to be present for every appointment. In the teen years, we’ll have some appointments with just the child. But you want the parent to learn to help the child use these new skills. That is real important. The ideal is the kid and the parents learn how to do this on their own, and the therapist is just directing them on how to use these skills properly.”

SOURCES: James, A. “Cognitive Behavioral Therapy for Anxiety Disorders in Children and Adolescents,” The Cochrane Collaboration, 2005. Anthony James, MD, senior lecturer, University of Oxford, England. Jennifer Hagman, MD, associate professor of psychiatry, University of Colorado Health Sciences Center; co-director, eating disorders treatment program, The Children’s Hospital, Denver.

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