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ANXIETY IN YOUTH

Youth Suffering with Anxiety:

Treated with Cognitive-Behavioral Therapy

Ashley Hall

Mansfield University

Professor Karen Crisp

April 18, 2021

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Abstract

Anxiety is experienced by all: older, middle, younger people, and also children. Anxiety is often

difficult to diagnose because it frequently presents itself as fear and worry. However, it can be

much more extreme. A child’s fear and worry could eventually progress and develop into an

anxiety disorder such as separation anxiety, generalized anxiety, or social anxiety. A therapy

approach that could be beneficial and, in turn, help lower a child’s anxiety levels is a cognitive-

behavioral therapy approach. Family-based, relaxation, and group-based therapy are all forms of

cognitive-behavior therapy that have advantages to decreasing and learning how to appropriately

respond to anxiety.
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Cognitive-Behavioral Therapy in Children Who Suffer from Anxiety

Anxiety is a disorder that results in the feeling of fear, dread, and uneasiness. Anxiety in

children can be hard to diagnose at times because it often appears as fear and worry. These

feelings can come from the stress of school, home, and even play activities and various anxiety

disorders can arise from such things. Anxiety disorders may come in the form of separation

anxiety, phobias, social anxiety, general anxiety, and panic disorders. Symptoms of anxiety in

children could be finding it hard to concentrate, trouble sleeping, not eating properly, and

complaining of stomach aches (Anxiety and Depression in Children, 2020). Children have such

difficulty managing their emotions, especially negative ones, so when a problematic issue arises,

they naturally experience intensified thinking which adds to their anxiety (Kearny et al., 2014).

According to Seligman and Ollendick (2011), “anxiety disorders are the most frequently

diagnosed class of disorder in children and adolescents”. For children who may have more

severe anxiety or those with other treatments that aren’t being as successful, cognitive-behavioral

therapy is often used as a therapy option. However, “instruction for children needs to be specific

for them to successfully acquire and implement essential cognitive-behavioral therapy coping

skills” (Kearny et al., 2014). Even some of the other subgroups of anxiety disorders that children

may experience such as separation anxiety, generalized anxiety, and social anxiety, have been

treated with the cognitive-behavioral therapy approach.

Cognitive-behavioral therapy, otherwise known as CBT, is a model of psychotherapy that

can help by changing the way that you think and behave. CBT helps treat many disorders besides

anxiety such as bipolar disorder, obsessive-compulsive disorder, post-traumatic stress disorder,

schizophrenia, etc. Cognitive-behavioral therapy is based on the idea that your thoughts, feelings,

and physical sensations are interconnected. Meanwhile, your negative thoughts and feelings trap
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you in a vicious cycle. CBT’s main goal is to help break down overwhelming and negative

thoughts and turn them into more positive thoughts. It also wants to “change maladaptive

learning and thought patterns” (Seligman & Ollendick, 2011). CBT can encourage kids to

generate more realistic versions of their situations and how to properly cope with them (NHS).

Those that choose CBT as the best option of therapy for their situation should experience some

sort of relief from their symptoms within a brief period of time, approximately three to four

months. Cognitive-behavioral therapy doesn’t only occur in outpatient clinics but also in

inpatient clinics, schools, and primary care practices (Seligman & Ollendick, 2011). Along with

the general CBT approach, there are also other forms of CBT that may also be beneficial for

various anxiety disorders. These might include family-based therapy, relaxation therapy, and

group-based therapy. Cognitive-behavioral therapy introduces skills, practice, and problem-

solving skills to help make the initial step towards changing a child’s negative thoughts into

positive.

Separation anxiety disorder is a common and normal stage of development for infants

and young children. Children with separation anxiety have extreme anxiety and even panic when

they are separated from their parents or key people in their lives. Those with separation anxiety

disorder (SAD) often complain but they also cry, experience nightmares, have heart palpitations,

and breathe rapidly. For a child, these symptoms can be very scary and the thought of losing

someone close to them is unbearable. If these symptoms don’t gradually go away, other disorders

like generalized anxiety or social anxiety may accompany it. Childhood anxiety disorders affect

5% to 10% of children and it is crucial that an effective therapy approach is found (Thirlwall et

al., 2013). Family-based approaches have been studied to be a successful and low-intensity

treatment that could improve the life of a child with separation anxiety disorder. Parent-delivered
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CBT compared with a general treatment of CBT reduces the anxiety of children with anxiety

disorders. By allowing the parents to lead the session, the child will be more comfortable in their

setting rather than separating them to have a stranger deliver it. Not only does it allow for the

child to be comfortable and the treatment to be effective, but it is also inexpensive. By

introducing an efficacious and family-based treatment that is affordable, it gives others that have

the disorder a chance of getting treated (Thirlwall et al., 2013). Additionally, family-based

treatment informs the parents and caregivers how to respond appropriately to their child. It

teaches them how to coach their children through anxious situations and in the long run, children

can calm themselves down (Rudy et al., 2017). Separation Anxiety Family Therapy (SAFT) is

another approach that is based on the foundation of family and those in the child’s life,

specifically the parents or caregivers. It incorporates materials that are specific to the disorder

and also includes parent training. The parent training focuses on parental dysfunctional

cognition, parenting behavior, and parent-child interaction (Schneider et al., 2013). Children with

separation anxiety disorder experience such panic, anxiety, and negative symptoms that it truly

becomes intolerable for them. Parent-delivered and family-based approaches are extremely

beneficial for children not wanting to be away from their loved ones but still be productive.

Everyone experiences some sort of stress and anxiety; however, those with generalized

anxiety disorder is more severe. Generalized anxiety disorder (GAD) is “characterized by

excessive and uncontrollable worry” (Hossein, 2014). GAD may otherwise be known as free-

floating anxiety as those with this disorder worry about practically everything (Comer & Comer,

2019). When you think that you are in danger or are in an anxious situation, the “fight-or-flight”

defense mechanism kicks in as a response to threat. However, anxiety is the reaction to that

stress. Chronic stress, such as GAD, can be detrimental to a person’s health as it causes
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headaches, high blood pressure, chest pain, heart palpitations, skin rashes, and loss of sleep.

Stress vulnerability may increase due to a variety of factors. These factors can include a person’s

personality, coping strategies, life stages, age, sex, ethnic background, and previous experience.

Cognitive-behavioral therapy and relaxation therapy are known to decrease the stress and anxiety

of those with GAD. Cognitive-behavioral therapy is an effective therapy approach for children

with generalized anxiety disorder as it “helps people to identify cognitive patterns or thoughts

and emotions that are linked with behaviors” (Hossein, 2014). The CBT approach used for GAD

focused on five main points: education, self-monitoring, skills training, cognitive restructuring,

and spiritual development. In addition, it emphasizes stress management, coping with stress,

reducing the experience of daily stress, time urgency, and hostility. Relaxation therapy is a broad

term to describe a number of techniques that can be used to reduce stress, eliminate tension

throughout the body, and ensure a peaceful mind. Self-relaxation is the “oldest and most popular

tool in stress management” (Hossein, 2014). There are many methods, but each person responds

differently so it is important that the appropriate one is chosen. There are two methods that may

be increasingly successful for children including mental imagery and progressive muscle

relaxation. During mental imagery, the child will try to imagine himself in a pleasant and

calming place or memory. By doing this it will put the child in a relaxed state and soon his stress

and physiological symptoms will decrease. By the end, children’s muscle tension, respiration

rate, heart rate, blood pressure, and skin conductance will decrease. The second relaxation

technique is known as progressive muscle relaxation which is beneficial if a child tends to

experience physical tension. This is a common technique that is simple and quick to learn. The

child will start by trying to relax each part of his body. He will start with his hands and fingers

and while doing so he will take a deep breath in and exhale slowly. He will repeat this process
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for each body part. Completing this relaxation method will bring his body to a calming state.

Generalized anxiety disorder can inhibit severe panic and worry which introduces a variety of

both physical and physiological symptoms that can be scary for children to experience. However,

cognitive-behavioral therapy and relaxation therapy are really good options for those with GAD.

CBT allows for the children to think about the negative thoughts that may be causing their

stressed and anxious behavior. Relaxation therapy teaches children how to reduce their stress,

worry, and physical tension in an easy and quick way (Hossein, 2014).

Many people are uncomfortable when they have to interact, talk, or perform in front of

others but they still are able to manage and function fairly well. Individuals with social anxiety

disorder have “severe, persistent, and irrational anxiety about social or performance situations in

which they may face scrutiny by others and possibly feel embarrassment” (Comer & Comer,

2019). The estimated number of children and youth that have been diagnosed with social anxiety

disorder is around 7% to 9%. This makes it one of the most common mental disorders in

childhood. Children with social anxiety may have fewer friendships, less academic success, and

an increasing likelihood that they will develop a comorbid mental disorder (Asbrand et al.,

2019). Cognitive-Behavioral Group Therapy (CBGT) is a group approach that makes use of

“behavioral, cognitive, rational, and group procedures to enhance coping skills of the participants

and ameliorate relational and intrapersonal problems that patients may be experiencing” (Rose,

2007). Children that participate in CBGT may be introduced with new important information

about stress, body language, and thoughts and feeling. Group-based therapy may also introduce

illustrations, games, theory, and other fun activities that will encourage more positive ways of

acting and thinking. Every child has a different background and has gone through various

experiences and it is important to recognize that. During group-based therapy, many children
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will be participating. Some children with anxiety may find that group-based therapy enabled

them to manage their thoughts and feelings, to grow in confidence, and to make new friends and

connections. Others may say that it allowed them to open up and discuss feelings that they would

not normally share and that it helped them learn the appropriate actions to the feelings that they

are experiencing (O’Callaghan & Cunningham, 2015). Post-event processing (PEP) is another

component of a child’s anxiety where he reflects on his thoughts that are occurring after the

social situation, he has just experienced. Many individuals may experience thinking these

negative thoughts after they have just done something. These thoughts in children may be “I am

not interesting enough”, “I am so stupid”, or “Why am I not good at this?”. Post-event

processing leads to children thinking negatively and they tend to have a more negative view of

themselves in social situations, which also leads to the confirmation of those beliefs. Not only do

they think about these negative thoughts, feelings, and images about the most recent social

situation, but it also makes them think about previous situations. The recent social situation that

caused the child anxiety may have reminded him of a past occurrence that was similar to this

one. If this occurs, they will not only dwell on the current experience causing an increase in the

anxious anticipation of another situation but also maintaining their negative self-perception and

image that they had in the past (Asbrand et al., 2019). CBGT would allow for children that share

similar thoughts and feelings to join and share their experiences. Through sharing, children will

realize that they are not the only ones experiencing anxiety in some of these situations. If other

kids have tips that they found helpful, group-based therapy allows them to share those which can

teach children how to appropriately face and calm their anxieties. An overwhelming number of

children have been diagnosed with social anxiety disorders. Cognitive-behavioral Group Therapy

is a helpful and beneficial approach for children to participate in if they have social anxiety.
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Group-based therapy allows for them to meet new people that share the same worries about

being in a social situation or performance. It is also important to acknowledge that their anxieties

not only occur before and after the event, but also after the events. Post-event processing

thoughts can bring up terrible memories and thoughts from a previous experience.

Children are often timid creatures so it is no surprise that they present as fearful and

uneasy, but this can eventually progress into something more serious. Anxiety disorders are more

common than what one would think in children. Children are frequently diagnosed with

separation anxiety, generalized anxiety, social anxiety and possibly others and it is crucial that

we find an effective treatment that is specified to that child’s needs to help with their anxieties.

Cognitive-behavioral therapy is an effective approach to these anxiety disorders. Cognitive-

behavioral therapy comes in a variety of forms (family-based therapy, relaxation therapy, group-

based therapy, etc.) and each child may react differently, so it is important that the right one is

found for each child that is diagnosed with an anxiety disorder.

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