Cognitive Behavioral Therapy (CBT)CBT views anxiety as having three different parts, each of which impacts the other: the physical feelings of anxiety (e.g., fast-beating heart), anxious thoughts (e.g., thinking worst case scenarios), and actions (e.g., choosing to stay away from situations that make one feel anxious). Parts of CBT relate to each of the three parts of anxiety as seen below:
The idea is that each strategy will have a positive ripple effect on the entire cycle. CBT is typically short-term treatment, which means that the treatment typically is provided over the course of 12-20 meetings, so you would be seeing some improvements within 3-4 months. That being said, treatment may vary depending on the type of anxiety the child has and should be tailored to the child’s unique fears and anxieties, so it may take fewer or more sessions than that, depending on your child’s needs and any barriers or complicating factors that may exist.
Here are some questions you can ask if your child needs services for an anxiety disorder, such as generalized anxiety disorder, social phobia, separation anxiety disorder, OCD, or a specific phobia:
MedicationMedication can also be a useful treatment for anxiety in youth. Selective Serotonin Reuptake Inhibitors (SSRIs) are the medication of choice for youth anxiety. A recent study found that the combination of sertraline (an SSRI) and CBT resulted in the most improvement in 7-17 years who had generalized anxiety disorder, separation anxiety disorder, or social phobia (Walkup et al., 2008) . Medication and CBT alone were comparable in their effects. The U.S. Food and Drug Administration (FDA) has approved the use of some SSRIs for the treatment of childhood OCD.
Medication can be a short-term or long-term option for youth anxiety, depending on how one responds to the medication and how severe one’s anxiety is. Medications must be prescribed by a medical doctor, such as a psychiatrist or primary care physician. It’s best to find a provider who has extensive training and experience working with youth with anxiety. Child Psychiatrists are likely to have more expertise than general psychiatrists or general pediatricians.
Communication between the medical doctor and mental health provider is encouraged in order to inform treatment planning and monitor progress over time.
A warning was issued in October 2004 by the FDA, stating that antidepressant medications, including SSRIs, may increase suicidal thoughts and behaviors in a small percentage of youth. Of note, no suicides were reported in the studies that led to the warning, and the FDA has not prohibited use of these medications for youth.
Although SSRIs are generally well tolerated by users, common physical side effects include headache, stomachache, nausea, and difficulty sleeping. If you opt to seek medication for your child’s anxiety, you should talk to your child’s doctor about any questions or concerns you have. Your child’s doctor should conduct a thorough evaluation to determine the presence of physical symptoms related to medical problems or anxiety. Side effects, including suicidal thoughts, should be monitored.
If you’d like to learn more about psychiatric medications for children and teens, you can talk with your child’s pediatrician or meet with a child psychiatrist.
You may also like to read:
Straight Talk about Psychiatric Medications for Kids by Timothy E. Wilens. The Guilford Press, 2008
Is it Time to Seek Treatment?A. Intensity: How intense is the anxiety or stress your child is experiencing? Does it seem more intense than what you might expect for someone that age in the same situation? Or is it in the range of what you might expect, but given that there are stressful things going on lately they’ve just been more anxious than usual?
B. Frequency: Is anxiety too frequent? Is it an issue more often than you’d like – almost every day, more days than not? Does the anxiety come up almost every time the person is faced with the situation or thing that disturbs them more than other kids?
C. Interference: Is it interfering? Think of how it might be getting in the way at school, how well your child is doing academically but also how much he enjoys going to school, how much he’s getting out of the experience, or how he is functioning when in school.
D. Duration: Has it been going on longer than a few months? Does it last or cause problems even over the summer break in different ways than during the school year?
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