Anne E. Sauve, Ph.D.

WHAT IS COGNITIVE BEHAVIOR THERAPY (CBT)?Research has shown that CBT is an effective form of therapy for childhood anxiety and other childhood disorders. CBT has two essential components: the cognitive component helps children change how they think about or interpret a situation and the behavioral component helps children change how they react (behave) in response to the situation.

Cognitive Component: How we think has a vast influence on how we feel. CBT focuses on teaching a child in how to ‘catch’ their problem thinking, and how to modify it. This is accomplished via instruction of practical techniques and use of fun games and exercises to illustrate the skills. A key problem with anxiety is an overestimation of the danger of a situation coupled with an underestimation of one’s ability to cope or deal with it.  The goal is to redirect kids from their distressful and inaccurate thoughts/interpretations of events and the associated negative feelings. 

Behavioral Component: Anxious children will actively work to avoid the situations they fear. This avoidance actually worsens anxiety. Therefore, a crucial component of CBT for anxiety is to gradually expose the child to the previously avoided situations. Gradual exposure involves small sequential steps from the least feared situation to the most feared situation. Starting with low anxiety situations allows the child to experience exposure with manageable distress and most importantly, to experience success fairly early, which in turns builds confidence. This early success helps to build confidence and motivation in the child. It also helps the child to receive immediate positive feedback from their efforts.  

WHAT HAPPENS IN THERAPY SESSIONS? Therapy sessions are collaborative in nature (working as a team, versus teacher/child) have a predictable pattern to them. A typical sessions begins with setting an agenda, and then progresses to reviewing homework/practice, rehearsing skills and developing assignments for practice at home. CBT is an active, very experiential form of learning; it is learning by doing. For this reason, practice is an essential element of treatment. It is very important for families to be ready to make an active commitment to practice and rehearse skills at home, in order to gain the benefits from this treatment.

It is common to include parents in the sessions to aid reinforcement of the skills at home. Symptom checklists are administered periodically to measure progress and tailor intervention strategy as necessary. 

HOW CAN I HELP AS A PARENT? It is natural to want to help your child when they experience discomfort or unhappiness. However, if you frequently ‘dive in’ and soothe your child when they are upset, scared, or sad it deprives your child the opportunity to learn how to effectively cope and move on from the experience. In essence, you are allowing your child to ‘escape’ feeling discomfort and preventing them from developing their own strategies for coping with everyday situations that may be difficult or challenging.

An effective way to assist your child is to empathize with your child’s upset using a neutral, matter of fact tone and communicate your confidence in their ability to problem solve and cope. For example, “I see that you are really scared. I know you can do this. What can you do first?”

You can also help your child by becoming an active participant in therapy. I often recommend supplemental readings for parents to complement the work I am doing with the child.

HOW DO WE GET STARTED? When working with a child in therapy, I typically spend the first session (60 minutes) with the parents to evaluate the child’s needs and parental concerns. The subsequent 1-2 sessions will be spent with the child to conduct an informal evaluation of the child’s strengths and weaknesses. Following these sessions, I like to meet with the parents to discuss the results of my preliminary evaluation and discuss a treatment plan. Sometimes, I may suggest additional assessment. During this time, we can both decide if I am the best person to provide the services you need in order to meet your treatment goals.

If psychotherapy is begun, I will usually schedule one 50-minute session (one appointment hour of 50 minutes duration) per week or every other week. Sometimes, sessions may be longer or more frequent. I will periodically meet with the parents to discuss progress and therefore it is important that a parent is bringing the child to each therapy meeting.