Cognitive Behavioral Therapy (CBT) for Kids and Teens
Practical, proven skills for anxiety, worry, and fear.
Core Method
Practical skills that help kids face worry with confidence
Cognitive Behavioral Therapy (CBT) is the most widely studied treatment for childhood anxiety. It is structured, goal-focused, and hands-on: children learn how thoughts, feelings, and actions connect, and then practice new, braver ways of responding when anxiety shows up.
How it works
Changing the cycle of anxiety
Anxiety grows through avoidance. When a child avoids what scares them, they feel relief right away, but the fear gets stronger over time. CBT breaks that cycle by teaching children to understand their anxiety, question anxious predictions, and gradually approach the situations they have been avoiding.
The most active ingredient in CBT for anxiety is exposure, or "brave practice": planned, step-by-step experiences that let kids learn firsthand that they can cope. Skills are always taught in a warm, playful, developmentally appropriate way.
- Understanding anxiety. Kids learn that anxiety is the body's alarm system, why it sometimes goes off when there's no real danger, and how it shows up in their body, thoughts, and behavior.
- Building coping tools. Calm breathing, mindfulness, muscle relaxation, and problem-solving give children a toolkit they can use in the moment.
- Catching thinking traps. Children become "worry detectives," spotting anxious thoughts and testing them against the evidence to create more balanced self-talk.
- Brave practice (exposure). Together we build a fear ladder and climb it one step at a time, from easier challenges to harder ones, until the fear loses its grip.
- Keeping gains. We review what worked, plan for future challenges, and make sure your child knows how to be their own coach.
Who it helps
- Generalized anxiety and constant "what if" worry
- Social anxiety and shyness that gets in the way
- Separation anxiety and trouble being apart from parents
- Specific phobias (dogs, vomiting, needles, the dark)
- Panic attacks and fear of physical sensations
- School refusal and selective mutism
What sessions look like
Sessions are typically 50 minutes and follow a predictable structure: checking in, reviewing practice from the week, learning or practicing a skill, and planning the next small step.
Parents join part of most sessions so they can support the same skills at home. Short, realistic practice between sessions is what turns skills into lasting change.
We measure progress regularly with brief questionnaires, so you can see how things are changing.
Tailored to your child
How we adapt it by age
Ages 5 to 8
Heavy parent involvement, games, stories, and rewards. Parents often act as coaches, and we keep abstract talk to a minimum.
Ages 9 to 12
Kids take a bigger role in naming worries and planning brave steps, with parents as supportive teammates.
Teens
More independence and privacy, with a focus on the teen's own goals, such as school, friendships, sports, and independence.
The parent's role: Parents are powerful partners. You'll learn how to respond to worry in ways that show empathy and confidence, how to gently reduce the everyday accommodations that keep anxiety going, and how to reward brave behavior. Research shows that parent-focused approaches can be as helpful as working with the child directly[4].
The evidence
What the research says
CBT has been tested in more than 80 randomized controlled trials with children and teens. It is recommended as a first-line treatment for pediatric anxiety by the American Academy of Child and Adolescent Psychiatry[3].
of children improved significantly with CBT alone, compared with pill placebo, in a trial of 488 children ages 7 to 17.
Walkup et al., 2008 [1]improved when CBT was combined with medication, the strongest outcome in the same study.
Walkup et al., 2008 [1]of young people were free of their main anxiety diagnosis after CBT, compared with waitlist, across 87 trials.
James et al., 2020 [2]- A Cochrane review of 87 randomized trials (5,964 young people) concluded that CBT is more effective than no treatment for childhood anxiety, with about one additional child reaching remission for every three treated[2].
- In the landmark CAMS study, CBT alone and sertraline alone each outperformed placebo, and CBT had fewer side effects such as insomnia and sedation than medication[1].
- The AACAP 2020 guideline recommends that CBT be offered to children and teens ages 6 to 18 with social, generalized, or separation anxiety, specific phobia, or panic disorder[3].
- A 2020 randomized trial of 124 children found that a parent-based program focused on reducing family accommodation (SPACE) was as effective as child CBT[4].
Research results describe averages across groups of children. Every child is different, and we track your child's progress with standardized measures throughout treatment.
Common questions
How long does CBT take?
Many children make meaningful progress in about 12 to 20 weekly sessions, though this varies with how long anxiety has been present, how severe it is, and whether other concerns are involved. We review goals together regularly.
Will my child be pushed to do things that are too scary?
No. Brave practice is always collaborative and gradual. Your child helps choose each step, and we start where they feel ready to succeed.
Does my child need medication too?
Many children do well with CBT alone. For moderate to severe anxiety, research shows that combining CBT with medication can work even better. We're happy to coordinate with your pediatrician or a child psychiatrist if that's a good fit.
Can CBT be done over telehealth?
Yes. CBT adapts well to video sessions, and telehealth can make practicing skills in your child's real environment easier.
References
- Walkup, J. T., Albano, A. M., Piacentini, J., et al. (2008). Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. New England Journal of Medicine, 359(26), 2753–2766. View study
- James, A. C., Reardon, T., Soler, A., James, G., & Creswell, C. (2020). Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database of Systematic Reviews, CD013162. View study
- Walter, H. J., Bukstein, O. G., Abright, A. R., et al. (2020). Clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 59(10), 1107–1124. View study
- Lebowitz, E. R., Marin, C., Martino, A., Shimshoni, Y., & Silverman, W. K. (2020). Parent-based treatment as efficacious as cognitive-behavioral therapy for childhood anxiety: A randomized noninferiority study of Supportive Parenting for Anxious Childhood Emotions. Journal of the American Academy of Child & Adolescent Psychiatry, 59(3), 362–372. View study