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, PhDCenter 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 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.
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