Why is this review important?
Many children and young people experience problems with anxiety. Children and young people with anxiety disorders are more likely than their peers to have difficulty with friendships, family life, and school, and to develop mental health problems later in life. Therapies such as cognitive behavioural therapy (CBT) can help children and young people to overcome difficulties with anxiety by using new ways of thinking and facing their fears.
Who will be interested in this review?
Parents, children, and young people; people working in education and mental health services for children and young people; and general practitioners.
What questions does this review aim to answer?
This review updates and replaces previous Cochrane Reviews from 2005 and 2015, which showed that CBT is an effective treatment for children and young people with anxiety disorders.
This review aimed to answer the following questions:
- Is CBT more effective than a waiting list or no treatment?
- Is CBT more effective than other treatments and medication?
- Does CBT help to reduce anxiety for children and young people in the longer term?
- Are some types of CBT more effective than others? (e.g. individual versus group therapy)
- Is CBT effective for specific groups? (e.g. children with autism)
Which studies were included in the review?
We searched the databases to find all studies of CBT for anxiety disorders in children and young people published up to October 2019. In order to be included in the review, studies had to be randomised controlled trials (a type of study in which participants are assigned to one of two or more treatment groups using a random method) and had to include young people under 19 years of age with an anxiety disorder diagnosis. We included 87 studies with a total of 5964 participants in the analysis.
What does the evidence from the review tell us?
We rated the overall quality of the evidence as 'moderate’ or 'low'. There is evidence that CBT is more effective than a waiting list or no treatment in reducing anxiety in children and young people, although the findings did vary across studies. There is no clear evidence that CBT is more effective than other treatments. A small number of studies looked at outcomes six months after CBT was given and showed that reductions in anxiety continued. We found no clear evidence that one way of providing CBT is more effective than another (e.g. in a group, longer treatments, with parents) or that CBT is more or less effective for any specific group of children (e.g. children with autism spectrum disorders).
What should happen next?
Future research should compare CBT to alternative treatments and medication; identify who does and does not benefit from CBT and what those who do not benefit need; establish how to make CBT more accessible; and give far more consideration to neglected populations, including children and young people from low‐ and middle‐income countries.