For Anxious Children, Give Therapy a Shot
Today, most people in our society expect a quick fix for everything. In a world filled with fast food, one-click online shopping, and a pill for every problem, it can be easy to fall into a pattern of expecting immediate results. The field of mental health is certainly no stranger to this way of thinking; concerned parents often want their children's symptoms to vanish instantly. Accordingly, if your child begins experiencing symptoms of anxiety, your first instinct may be to acquire medication to treat the symptoms. However, studies demonstrate that it may be best to delay getting those prescriptions filled, and instead give cognitive-behavioral therapy a chance first.
Cognitive-behavioral therapy (CBT) has been shown to work effectively in uncomplicated cases of childhood anxiety. Disorders proven to respond well to CBT in childhood and adolescence include Obsessive-Compulsive Disorder (OCD), separation anxiety disorder, generalized anxiety, and social anxiety (social phobia). Children may exhibit signs of anxiety by refusing to attend school or separate from his/her care giver; other symptoms include increased worries in multiple areas, test anxiety, perfectionism, obsessions, or increased anxiety in the presence of those who are not family members. Some children report more vague concerns but exhibit physical signs of anxiety, such as stomachaches, headaches, rapid heartbeat, sweating, dizziness, or shortness of breath.
The Wall Street Journal recently highlighted the importance of treating childhood anxiety disorders early, citing studies that point to increased risk for developing other mental disorders later in life. CBT is discussed as the first line of treatment chosen by many doctors and psychologists.
The American Academy of Child and Adolescent Psychiatry recommends that anxious children and adolescents start with a six- to twelve-week trial of CBT treatment before trying medication. If the child/adolescent does not respond to treatment during the trial period, a selective serotonin reuptake inhibitor (SSRI) or other psychotropic medication may be warranted. Starting a child on medication for anxiety without treating the cause or equipping them with the tools to manage their symptoms will likely result in continued anxiety problems in the future. Children and adolescents need to learn how to identify their symptoms and use effective methods to cope with and reduce their anxiety levels on their own.
CBT therapists employ multiple techniques to help children and adolescents recognize and manage their concerns. One such method is diaphragmatic breathing, which helps children learn how to control their respirations and subsequently decrease heart rate. This is especially beneficial for children who frequently exhibit shortness or rapidness of breath and/or increased heart rate when anxious. Other effective techniques include progressive relaxation training, visualization, systematic desensitization, and thought stopping. All of the CBT components are aimed at teaching the child or adolescent how to manage their own anxiety and thereby feel a sense of control over their disorder.
Multiple studies have demonstrated that CBT is effective in children with anxiety disorders. One such study examined 47 children aged nine to thirteen years who had anxiety disorders (Kendall, 1994). One group of children participated in 16 sessions of CBT, while the other group was placed on a waiting list. The researchers administered pre- and post-tests to each of the children participating in the study to directly measure reported progress. More than 60 percent of the children who underwent CBT treatment were found to be without a diagnosis after the sessions and remained within normal limits on anxiety measures one year after treatment.
Family work is an important component of childhood anxiety treatment
In February 2006, the Journal of the American Academy of Child and Adolescent Psychiatry published the results of a study that examined the effectiveness of family cognitive-behavioral therapy for children and adolescents with clinical anxiety disorders. Based on their findings, the researchers concluded that family therapy is an essential element of the CBT process when treating children. It is well documented that there exists a genetic component to anxiety disorders, and some studies have found an overlap of close to 80 percent between childhood and parental anxiety disorders. Parents who are anxious tend to be critical and controlling, which may further cultivate childhood anxiety. Parents who are affected by heightened anxiety should seek treatment to gain better control over their anxiety and to learn how to develop a parenting style that minimizes harshness and overprotection.
An article published in Clinical Psychiatry News reported the findings of a study that examined the benefits of adding a family component to CBT (Schneider, 2008). The study's results indicated that CBT combined with family management was more effective than CBT alone. One year after completing treatment, 96 percent of children who had undergone CBT combined with family management did not meet the criteria for an anxiety disorder; only 70 percent of children who received CBT alone experienced similar long-term effects.
When faced with the decision to start your child on CBT, medication, or a combination of the two, there are many factors to consider. First, the severity of the anxiety must be assessed. Mild to moderate anxiety would likely respond well to CBT alone. In cases of more severe anxiety, however, a combination approach would be more likely to achieve the desired results. Severe anxiety is defined as anxiety that prohibits the child from functioning well in everyday circumstances. Examples include severe obsessive/compulsive behavior, extreme school refusal/separation issues, and panic attacks. Combination therapy has been shown in multiple studies to be more effective than medication or CBT alone; however, a thorough evaluation is necessary to assess whether a major psychotropic drug is necessary and to understand potential side effects of the drug(s) on the child. It is also important to consider comorbid disorders when deciding whether to include medication in the child's treatment. Comorbidity refers to the simultaneous presence of two different disorders in the same person. Common comorbid disorders with childhood anxiety include attention-deficit/hyperactivity disorder (ADHD) and depression. These disorders can mask or be mistaken for anxiety, but anxiety can also worsen the other conditions. Children who are on medication for ADHD sometimes feel that their medication is not working; often, this is caused by ADHD-related attentional difficulties and distraction resulting in added anxiety. The anxiety issues must be treated first so that the ADHD medication will be maximally effective. The best treatment in a case like this would likely be a combination CBT/medication approach.
Dr. Teresa Scott and the Tarnow Center believe in treating childhood anxiety disorders by developing self-management skills in children and their families. Medication may be warranted for severe cases of anxiety, but even then therapy is strongly recommended to treat the disorders. Cognitive-behavioral therapy has been shown many times to be an effective treatment for childhood anxiety. In order for children and their families to learn how to effectively self-manage, they must acquire the tools and strategies necessary for reducing anxiety and increasing coping skills. CBT is one way to do this and can be an effective alternative to medication treatment for many children and adolescents. The first step is to be evaluated for the severity of anxiety and potential comorbid disorders. From that point, learn all you can and feel empowered by taking control of a disorder that often takes on a life of its own without treatment.