Cbt Treatment For Anxiety In Children
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Even before the Covid-19 pandemic, growing numbers of young people were experiencing high rates of clinical-level anxiety. About 11.6% of kids had anxiety in 2012, up 20% from 2007. But during the pandemic, those numbers nearly doubled, such that 20.5% of youth worldwide now struggle with anxiety symptoms, according to a meta-analysis of 29 studies reported in JAMA Pediatrics (Vol. 175, No. 11, 2021). Besides Covid-related stressors like social isolation, missed milestones, and increased family tension, background stressors such as school shootings, political unrest, and the war in Ukraine have likely fueled these increases.
These soaring numbers are clashing with a major crisis in mental health provision, and most children and teens with anxiety disorders are not getting the help they need. Factors exacerbating this problem include long waiting lists to see a psychologist, a dearth of trained providers, and a disproportionate lack of access to quality care for low-income individuals and people of color, according to those who study and treat these disorders.
Another positive development is that the medical community is seeing the value of homing in on anxiety disorders: In April, a group of experts making up the independent U.S. Preventive Services Task Force recommended that all young people ages 8 to 18 receive regular screening for anxiety. And thanks to increased public awareness about mental health issues, stigma surrounding anxiety is down, and psychologists say more parents are open to seeking anxiety treatment for their children.
When kids get appropriate treatment for anxiety, it can make an enormous difference in the trajectory of their lives, said Kathryn D. Boger, PhD, ABPP, co-founder of the McLean Anxiety Mastery Program at McLean Hospital and co-founder and chief clinical officer of InStride Health, a new virtual company that broadly disseminates evidence-based anxiety and OCD treatment to young people.
The current iteration of the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition), the DSM-5-TR (text revision), lists 11 anxiety disorders in total. That is a change from the DSM-4, which included obsessive-compulsive disorders and trauma-based symptoms within the anxiety disorders category. Those conditions are now listed separately, though they often overlap with anxiety disorders.
While the underlying mechanisms are the same, however, anxiety disorders look somewhat different in children and adolescents depending on their developmental stage, Flannery-Schroeder added. One big difference is that young children think in concrete terms and hence lack insight into how unreasonable their anxiety may be. Teens and adults, though, can see that their level of anxiety does not necessarily make sense, but cannot stop feeling anxious anyway.
With children and teens, Goldstein begins treatment by showing them a diagram depicting thoughts, feelings, and behaviors connected via bidirectional arrows. He explains that positive thoughts can lead to positive behaviors, and negative behaviors can lead to negative feelings, for example.
Parents take part in treatment in different capacities depending on the situation, Merson added. With very young children, she may see parents and children together for all or most of the sessions, or just work with the parents alone. For older kids and teens, she often sees the child separately for most of a given session and then brings in the parents for the last 10 minutes to do a recap and go over homework. She may also see parents of older children alone for a few sessions to ensure that they can effectively coach their children in using new anxiety-management skills.
While anxiety disorders affect many young people, some are at greater risk than others. These include sexual- and gender-minority youth, who are much more likely than youth in general to meet criteria for anxiety disorders. In the 2022 National Survey on LGBTQ Youth Mental Health, conducted by the Trevor Project, for example, 73% of LGBTQ+ youth reported experiencing current symptoms of anxiety, and 45% said they had seriously considered attempting suicide in the past year.
Another at-risk group is children of color, due to social determinants such as poor access to quality mental health care, psychological factors related to racism, and greater stigma about seeking mental health care, said Kent State University professor Angela Neal-Barnett, PhD.
For more than 30 years, Neal-Barnett has been heading the Program for Research on Anxiety Disorders among African Americans, which develops research-based anxiety interventions for Black Americans. One project within that program is a weekly meeting called Sisters United Now (SUN), aimed at helping middle-school Black girls lower their anxiety, create connections, and build psychological resiliency. SUN uses psychoeducation along with an app to teach the girls about causes of stress and anxiety and employs culturally competent cognitive behavioral interventions to help build their confidence.
Additionally, researchers are finding that certain temperamental styles are closely linked to the development of anxiety disorders. A recent study indicates that anxious children who exhibited a temperamental style called behavioral inhibition at a very early age had a much more difficult time managing their anxiety symptoms during the pandemic than did others. The study, conducted by Selin Zeytinoglu, PhD, of the University of Maryland, and colleagues, analyzed longitudinal data on 291 young adults tracked at ages 2, 3, 7, 15, and 18, looking at measures of behavioral inhibition characterized by fearful responses to novel stimuli.
Teens with high levels of behavioral inhibition starting as toddlers were much more likely to suffer increased anxiety during the pandemic than those who did not show this behavior early on. The findings suggest the importance of pinpointing and treating behavioral inhibition as early as possible, the authors noted (Journal of the American Academy of Child and Adolescent Psychiatry, Vol. 60, No. 10, 2021).
The effectiveness of CBT in treating anxiety disorders in young people has been well established, with recent studies showing that cognitive restructuring and exposure tasks both lead to major improvements in youth anxiety, and that the quantity of exposures is linked to better outcomes. Now, researchers are looking into what can make treatment even more successful.
Others are looking into how to better disseminate proven treatments for pediatric and adolescent anxiety to broader populations. For example, Boger is eager to make evidence-based treatments available to many more kids via her new company.
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Parents play an essential role in helping their child or teen manage anxiety. When coping skills and brave behaviour is rewarded and practiced in the home, children and teens can learn to face their fears, take reasonable risks, and ultimately gain confidence.
For even more information and tools, visit MAP for Children. My Anxiety Plan (MAP) is a free, self-paced, online anxiety management program designed to help with anxiety. MAP includes 6 easy to navigate units with 45 lessons.
As discussed throughout this website, anxiety is useful in certain situations, some of the time. But how do you, the parent or caregiver, know when the signs of anxiety you are seeing in your child might be significant enough to qualify for an anxiety disorder An appointment with your family physician or a trained mental health professional is a good first step. However, in preparation for that visit, or to decide whether a visit is needed, it can help to understand what professionals look for in diagnosing an anxiety disorder.
Next, anxiety specialists have identified that when a child experiences anxiety more often (e.g. most days, and for months at a time), and more intensely than other children of the same age, it is more likely that the child has an anxiety disorder. Finally, those children who experience a specific list of anxious symptoms, more frequently and intensely than peers, are more likely to also experience significant disruption in their lives. This disruption can interrupt or even stop him or her from participating in a variety of typical childhood experiences such as:
It is normal for young children to sometimes feel worried or upset when faced with routine separations from their parents or other important caregivers causing children to cry, cling, or refuse to part.
Children and teens with generalized anxiety disorder (GAD) experience excessive and uncontrollable worry about aspects of day to day life, future events, and minor matters. This can include worry about the health and safety of themself and their fami[...]
Cognitive-behavioral therapists treating separation anxiety disorder will work with the child to help him/her better understand their anxiety. When children learn about their anxiety, they can also begin to control and manage it. Children receiving CBT will learn what anxiety is and how it impacts them, their thoughts, and behaviors. They will learn about the way that they think and how to deal better with their anxious thoughts. Children will learn to change their thinking and think in more rational and productive ways.
Over time, with CBT kids with separation anxiety can also learn to think about separations differently and examine their fears more rationally. They will learn to cope with separations and deal with the fears that arise in a healthy way. This is accomplished, in part, by changing their thinking and using effective self-talk. In addition, they will learn about how changing their behavior and doing things that they may wish to avoid (e.g. going to