Psychotherapy for anxiety disorders in children and adolescents
- Evan Alvarez, MA
Evan Alvarez, MA
- Research Project Coordinator
- Columbia University, New York State Psychiatric Institute
- Anthony Puliafico, PhD
Anthony Puliafico, PhD
- Assistant Professor of Medical Psychology (in Psychiatry)
- Columbia University
- Kimberly Glazier, PhD
Kimberly Glazier, PhD
- Rogers Memorial Hospital
- Ann Marie Albano, PhD, ABPP
Ann Marie Albano, PhD, ABPP
- Professor of Medical Psychology (in Psychiatry)
- Columbia University
Anxiety disorders are the most common psychiatric disorders diagnosed in childhood and adolescence [1,2]. Anxiety disorders that may begin in childhood include generalized anxiety disorder, social anxiety disorder, and separation anxiety disorder (collectively known as the “child anxiety triad”), in addition to selective mutism, panic disorder, agoraphobia, and specific phobia.
Pediatric anxiety disorders are associated with functional difficulty in childhood and tend to persist into adulthood, where they are associated with functional impairment and co-occurring psychiatric disorders. The development and testing of psychotherapies for pediatric anxiety disorders has largely been limited to cognitive-behavioral therapy and more recent advances in parent-child therapy in very young children.
This topic describes psychotherapy for anxiety disorders in children and adolescents. The epidemiology, pathogenesis, clinical manifestations, course, assessment and diagnosis of anxiety disorders in children and adolescents are described separately. Pharmacotherapy for anxiety disorders in children and adolescents is also described separately. Psychosocial treatment for obsessive compulsive disorder and posttraumatic stress disorder in children is also discussed separately. (See "Anxiety disorders in children and adolescents: Epidemiology, pathogenesis, clinical manifestations, and course" and "Anxiety disorders in children: Assessment and diagnosis" and "Pharmacotherapy for anxiety disorders in children and adolescents" and "Psychosocial treatment of posttraumatic stress disorder in children and adolescents" and "Treatment of obsessive-compulsive disorder in children and adolescents".)
Cognitive-behavioral therapy (CBT) focuses on the interplay between cognitions, behaviors and emotions, helping patients to recognize and modify maladaptive anxiety-provoking thoughts and to change patterns of avoidance. The content of CBT programs can vary but typically includes psychoeducation and exposure to anxiety producing stimuli and situations, couched within an active and collaborative patient-therapist relationship, and reinforced by the use of patient-centered homework assignments.
Exposure treatment is central to all efficacious CBT for pediatric anxiety disorders; this involves the child gradually but repeatedly experiencing the feared situation with the intent of reducing the associated anxiety, or learning to tolerate and manage normal, expected levels of anxiety.
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- COGNITIVE-BEHAVIORAL THERAPY
- Conceptualization and components
- - Psychoeducation
- - Somatic management skills
- - Cognitive restructuring
- - Exposure
- - Relapse prevention
- - Social anxiety disorder
- - Selective mutism
- - Specific phobia
- - Panic disorder
- - Multiple anxiety disorders
- Moderators of treatment outcome
- Adaptations for young children
- - Separation anxiety disorder
- OTHER PSYCHOTHERAPIES
- COMPARING MEDICATION AND PSYCHOTHERAPY
- COMBINING MEDICATION AND PSYCHOTHERAPY
- TREATMENT SELECTION
- First-line treatment
- SUMMARY AND RECOMMENDATIONS