CBT for Children and Young Patients with Anxiety Disorders

1 CBT for Children and Young Patients with Anxiety Disorders Cognitive-behavioral Therapy (CBT) is a practice that has been in existence since 1980s. This approach involves a specific effort to preserve the positive impacts of behavior therapy that have been proved with involvement of the cognitive activities that are exhibited by the individual receiving the treatment. The main aim of merging the two approaches is to produce therapeutic change in the client (Albano & Kendall, 2002). In its early years, it was highly utilized in Europe and North America for the treatment of various disorders. For instance, it was used for the treatment of panic disorder in United Kingdom and United States. This approach has been effective in the transformation of individual’s thinking and behavior.

An anxiety disorder is a condition that is very common among children and teenagers. The disorder is identified in an individual where a person develops a high level of fear that a bad event will happen. The individual becomes vulnerable since all the coping mechanisms are overlooked making him or her pessimistic.

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The individual adopts a negative cognitive appraisal and becomes very hypercritical and self-focused. This makes him or her view any situation as posing a threat to their lives. There have also been cases of physiological arousal leading to somatic sensations and behavioral avoidance. This is where the child may avoid certain situations like going to school making it hard to ascertain predictions of a negative event (Bailey, 2001).

There have been increased rates in the number of children suffering from anxiety disorders in the past few years. This has forced therapists to develop treatment methods that are evidence-based in order to provide a solution to this crisis. Various approaches have been tried where the focus has been to adopt the method that has proven efficacy.

Cognitive-behavioral Therapy has been used in the treatment of anxiety disorder.

The approach is based on the objective of changing the behavior of an individual that has developed from irrational thoughts (Bailey, 2001). This is through educating the individual and empowering him or her through positive experiences that result to development of coping mechanisms. It involves methods which have been picked from behavioral therapy that have been included by dealing with cognitive components of adjustment. This approach has been used to direct the treatment of children and youths facing anxiety disorders. This is through building effective skills that enables the children to function properly in various situations by avoiding unnecessary anxiety.

The CBT treatment of children and young patients has been adopted from the practice that has been carried out on adults. This is where the therapists working with the young patients adjust the content and speed of the therapy so that it can match with

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the level of a particular child. Due to existence of limitations in young patients in terms of metacognition and ineffectiveness in labeling of their feelings, the therapists working with these individuals adopt a more active approach so that they can utilize higher level of behavioral and cognitive techniques (Vonk & Early, 2002). When applying this approach on the treatment of children with anxiety disorders, therefore, the therapist needs to understand that the individual is facing harmful thoughts of danger where fear for his or her well being dominate making the perception of the future appear disastrous.

The approach of treatment using CBT utilizes three main areas. Using various ways, the identification and understanding of physiologic arousal enable the children facing this problem to have the ability to control the arousal. This is through the instructions that these young patients are given making them empowered to control their bodies and also utilize practices that reduce the arousal. The patients are led through the process of understanding the nature of their thoughts and how events that they encounter can be interpreted without arousing anxiety (Lewis, 2010). Through the provision of ways of challenging the truth of their thoughts, the young patients are able to come up with coping mechanisms through presenting the real nature of the situation at hand. This is an important step in solving the anxiety disorder since the patients are able to deal with dangerous thoughts that lead to avoidance. The patients achieve this through adopting a framework that is rational and realistic. The other step in this approach is supporting the youths to deal with situations that arouse their anxiety (Compton et al., 2009). This is a higher level where the patients are exposed to these situations and are encouraged to use the learnt methods to deal with the arousal. The

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therapist guiding these patients assist the patients to face the situation of fear without running away from the fearful situations until their can do so, on their own.

This approach is very effective for children facing anxiety disorders. Using the cognitive-behavioral approach, the child’s problem is analyzed where feelings of inability to cope with a situation at hand make the child pick an avoidance behavior thus increasing the fears that the child has already built within him or herself. Therapists dealing with such patients have been successful through the adoption of transformational thought diary. This method enables the young patient to rate his or her level of discomfort using a subjective unit of discomfort scale that ranges from 0 to 10.

This helps to identify the patient’s progress and enable the child to move from a situation of helplessness. The child achieves this through developing the ability to identify the initial signs of anxious arousal and the training the child receives making him or her gain the skills of anxiety management like relaxation and positive imagery. The patient overcomes the thoughts of danger by challenging them with evidences that are contrary to their perception. With time the patient uses these evidences to develop positive self-talk.

Kendall et al. (1993) summarizes the child’s development of coping mechanisms to deal with anxiety through a four step process. Firstly, the young patient learns to identify the anxiety and develops a way of relaxing. Secondly, instead of expecting bad things to happen from a situation of anxiety, the individual overcomes this through positive self-talk. The third step is adoption of actions and attitudes that are helpful which the problem-solving strategies become. The final step is the self-evaluation where

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the patient is assisted to appreciate the steps he or she has made in coping with failure and negative self-image.

Various studies have discovered treatments that incorporate various methods that assist in the elimination of symptoms of anxiety in young patients. These approaches have used these procedures where relaxation training has been used together with training to enable the patient deal with the negative thoughts concerning situations that he or she fears. The continued development is observed where the patient is exposed to these situations and instructed on how to utilize coping mechanisms to enable the situation not cause anxiety and distress.

The effectiveness of this approach as a therapeutic intervention on young children was illustrated in a program that was conducted by Kendall (1994). In this study, a total of forty seven young patients aged between 9-13 years were treated using CBT approach. The subjects were analyzed using the criteria that involved grouping the subjects into those who had overanxious disorders, those with avoidant disorder and those who had separation-anxiety disorder. The numbers of these subjects were n=30, n= 9 and n= 8 respectively. The program used the treatment condition that involved sixteen weeks of CBT. At the end of the program, the 65 percent of active treatments had noted decrease in illness. This was particularly after the therapists included family management in their approach. The efficacy of CBT approach for the treatment of anxiety disorders in young patients was determined by a study that was conducted by Silverman and his colleagues (Silverman et al., 1999). This was through a follow up program that was done after initial intervention within a range of three, six and twelve months. The study which involved fifty-six young patients aged between 6 and 16 years

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found that the approach was more effective than use of the control group. This is because individuals who were treated using the CBT approach more than five times the number of all the sample population emerged free from illness. This is in comparison with those who adopted the control group as their model of treatment.

Adoption of CBT in the treatment of children with anxiety disorders requires the therapist to look into other related issues that may influence the results of the therapeutic formulation. Firstly, the family of the child is very significant in the success of the treatment. This therefore means that the therapist dealing with the child need to involve the parent of the child (Cobham, Dadds & Spence, 1998). The therapist does this after familiarizing him or herself with the family structure and system of belief that the family of the patient holds. This information may also be beneficial to the therapist since he or she is able to have a clear understanding on hidden issues like abuse or other disabilities. The program by Kendall indicated that the involvement of the patient’s family is essential in facilitating the success of the treatment (Kendall & Warman, 1996).

This is where the parents are directed on how to help their children gain the courage to face situations that they previously feared. Using the acquired cognitive-behavioral skills, the children are encouraged by their parents through positive reinforcements to deal with these situations until the situations become a common occurrence to them such that it no leads to distress. The role that the patients’ families play in their treatment, therefore, cannot be overlooked.

Previous practices have also indicated that the age of the child is of essence when deciding to include the parents of the patient (Dadds et al, 1999). This is where for very young children; the parents are more involved in the therapy process. This is

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because they need to be directed on how the cognitive-behavioral model functions and how it can be applied to solve the child’s problem. The parents are given specific directions on the management of this model in order to make the treatment process effective. The training of a parent makes it possible to come up with an effective plan to solve problems in children facing anxiety disorders. In addition, therapists are able to advice the parents suffering from anxiety to seek treatment in order to avoid negative influence on the treatment of their children (Gowers, 2009). Basically, the sex and age of the patient do not bring out significant differences in terms of the patient’s self-ratings of anxiety both before the treatment and after the process.

In a study that was conducted to demonstrate the efficacy of cognitive-behavioral therapy for young children facing anxiety disorders, reduction of anxiety in children was achieved using this approach (Wenar & Kerig, 2006). This research indicated that the role of parent involvement in this treatment and the need to start the intervention early leads to positive results. This study illustrated that individual CBT combined with parental involvement led to better results.

There have been other methods that have been utilized in the treatment of anxiety disorders. For instance, pharmacologists have focused their treatment on the use of antidepressants (Silva, 2003). This method has led to positive results especially due to its efficacy (Scott, Mughelli & Deas, 2005). However, this method when applied to children has led to negative effects. This has led to therapists turning to the use of cognitive-behavioral therapy since it has been used on adults without any side effects.

The adoption of the approach on young children facing anxiety disorders has produced positive results since it does not cause any side effects like the pharmacologic agents

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do. According to Arnold et al (2003), CBT is the most effective treatment approach when dealing with children and other young patients suffering from anxiety disorders.

The most effective setting for the application of cognitive-behavioral therapy for young patients is in an education setup. This is because within the school setting, the program can be designed to fit both the patients and their families. This is through adopting the appropriate timing for the therapy sessions and the time that the treatment will be delivered. The schedule can be arranged to avoid interfering with the school and family programs. In addition, this setting is appropriate since the adjustment made ensures that the patients maintain regular attendance in the sessions of treatment and increase the chances of completing the program (Gail et al, 2005). When the needs of the young patients are considered, adoption of the treatment in the school setting can be the most effective for the therapy intervention process.

The strengths of CBT approach are seen in its ability to be applicable in various setting without reducing its effectiveness. This is unlike other methods that adopt the clinical-based intervention alone (Steele, Elkin, & Roberts, 2008). CBT on the other hand can be applied in the community setting. The program can be initiated in schools and the follow up done in the patient’s homes. This makes it possible to involve the families of the patients a factor that has made the approach bear more positive results.

The strength of the CBT approach can be pointed in its commitment to empowering the patient thus making him or her take control of the situations that may emerge even in the future (Stallard, 2009). By exposing the individual to situations that have always aroused fear and distress and helping him or her utilize the learnt coping mechanisms,

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the individual feels as part of the solution making him or her develop a positive self image.

Despite its success in treatment of young patients facing anxiety disorders, cognitive-behavioral therapy has several limitations. Firstly, the accessibility of these services has proved hard to many families, thus limiting the benefits that this approach brings to these individuals. This has been caused by the number of individuals who have been trained to undertake the processes are fewer than the number of patients who require their services. This is particularly because the skill is mostly learnt by psychologists and psychiatrists who are not enough when compared with the high rate of the occurrence of this condition among children and young adults (Raul et al., 2006).

Secondly, the application of CBT in the treatment of individuals with anxiety disorders has sometimes been a challenge to most families. This is because most parents find it hard to refer their children for therapy treatment especially when the children are very young with the fear that the society will point a blaming finger on them as the cause of their children situation (Barrett, 1998). In addition, some families lack the understanding of the importance of therapy for their children. This is because these parents may not understand what problem their children may be facing thus; they do not see the need for the therapy intervention. Some families may not afford the cost of the therapy especially when the model is individual as it may overstretch their resources. Another concern that has been proposed especially when involving the parents of the patients is occurrence of overprotective behaviors among the parents towards their children. When the parents are not instructed properly on their role they might prevent their children from dealing

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with their former fears by shielding them from these situations (Barrett, Dadds & Rappe, 1996).

In conclusion, cognitive-behavioral therapy has led to good results in the treatment of children and adolescents with anxiety disorders. This is both when applied on an individual or a group. Cognitive-behavioral therapy aims at helping the individual to identify thoughts that are irrational after which the individual deals with these unproductive thought through methods like reinforcement and role play among others.

This approach is patient-centered since the therapist only act more as a director and instructor while the patient determines how the progress will be achieved. Parental involvement in the treatment process has also been beneficial since it has led to improvement of these results. This is where the individual programme for children with anxiety disorders is improved through “Family Anxiety Management (FAM)” programme (Barrett, Dadds & Rappe, 1996). It is also important to consider the setting of the therapy sessions as the appropriate setting will make the therapy successful. For instance, the education setting is the most effective for young patients as indicated above. Cognitive-behavioral therapy is one of the most validated methods of treatment of anxiety disorder where its greatest success has been proved in various researches that have been launched to come up with solutions to various disorders.

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