CBT with Children

Child smiling and looking at camera

Cognitive Therapy

The basis of cognitive therapy is that, as is the case with adults, a young person’s thoughts can influence feelings and that emotional responses to situations come from his/her interpretation of that situation.

For example, imagine that your child is experiencing the sensations of his/her heart racing and shortness of breath. If these physical symptoms occurred while he/she was sitting quietly in class they would likely be attributed to some medical condition, such as a heart or asthma attack, and may cause him or her to become fearful and anxious. In contrast, if these physical symptoms occurred while running around in gym class, they likely would not be attributed to a medical ailment, and may not lead to fear or anxiety. In short, different interpretations of the same sensations could lead to entirely different emotions.

Cognitive therapy suggests that, for individuals of all ages, many of our emotions are due to our thinking (i.e., the ways that we have perceived or interpreted our environments). Sometimes these thoughts may be biased or distorted. For instance, an adolescent might interpret an ambiguous phone message as suggesting interpersonal rejection, or physical symptoms as suggesting a medical problem. Others may set unrealistic expectations for themselves, or harbor pervasive concerns regarding their acceptance among others. These types of thoughts can contribute to distorted, biased, or illogical thinking processes that then affect feelings.

In cognitive therapy, children, adolescents, and their families learn to:

  • Distinguish between thoughts and feelings.

  • Become aware of the ways in which thoughts can influence feelings in ways that sometimes are not helpful.

  • Learn about thoughts that seem to occur automatically, without even realizing how they may affect emotions.

  • Evaluate critically whether these “automatic” thoughts and assumptions are accurate, or perhaps biased.

  • Develop the skills to notice, interrupt, and correct these biased thoughts independently.

Behavior Therapy 

Although behavioral approaches for children and adolescents vary widely, they focuses primarily on how some problematic thoughts or behaviors may accidentally get “rewarded” within a young person’s environment. These rewards or reinforcements often contribute to an increase in the frequency of these thoughts and behaviors. Behavior therapies can be applied to a wide range of psychological symptoms among adults, adolescents, and children. A couple of examples are provided below.

Although behavioral therapies are different from disorder to disorder, a common thread is that behavioral therapists encourage children and adolescents to try new behaviors and not to allow negative “rewards” to dictate the ways in which they act.

Examples of behavior therapy with children:

  • For instance, imagine a teenager who persistently requests permission to use the family car to go out with friends. After repeated requests to parents, and repeated denials for permission, the teenager becomes angry, irritable, and disobedient towards his/her parents. Following a tantrum, the parents decide they can not take the hassle any more and allow their child to borrow the car. By granting permission, the child actually has received a “reward” for throwing a tantrum. Behavior therapists say that by granting permission after a tantrum, the child has “learned” that disobedient behavior is actually an effective strategy for getting permission. Behavior therapists seek to understand such links between behaviors, rewards, and learning, and change negative patterns of thinking and behaving. In other words, in behavior therapy, parents and children can “un-learn” unhealthy behaviors, and instead reinforce positive behaviors.

  • Imagine that a child is afraid to ride in an elevator. To avoid the fear and anxiety, she might eventually refuse to ride in any elevators, and insist upon walking up flights of stairs instead. The extra time and energy that is needed to walk the stairs could cause both mother and child to be constantly late for work, appointments, etc. Behavior therapists suggest that avoiding the elevator has rewarded the child with the absence of anxiety and fear. Behavioral treatments for this child would involve supervised and guided experience with riding elevators until the “rewards” associated with avoidance have been “un-learned,” and the negative associations she has with elevators has been “un-learned.”

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