Talking therapies such as cognitive behavioural therapy (CBT) can help children and young people to deal with anxiety by using new ways of thinking. Many parents and children prefer to try talking therapies rather than medication such as antidepressants.
Who will be interested in this review?
Parents, children and young people; people working in education; professionals working in mental health services for children and young people; and general practitioners.
What questions does this review aim to answer?
This review is an update of a previous Cochrane review from 2005, which showed that CBT is an effective treatment for children and young people with anxiety.
This update aims to answer the following questions:
• Is CBT more effective than no therapy (waiting list)?
• Is CBT more effective than other 'active' therapies such as self-help books aimed at children and young people?
• Is CBT more effective than medication?
• Does CBT help to reduce symptoms of anxiety for children and young people in the longer term?
Which studies were included in the review?
Search databases were used to find all high-quality studies of CBT for anxiety in children and young people published between 1970 and July 2012. To be included in the review, studies had to be randomised controlled trials and had to include children and young people with a clear diagnosis of anxiety.
Forty-one studies with a total of 1806 participants were included in the review. The review authors rated the overall quality of the studies as 'moderate'.
What does the evidence from the review tell us?
CBT is significantly more effective than no therapy in reducing symptoms of anxiety in children and young people.
No clear evidence indicates that one way of providing CBT is more effective than another (e.g. in a group, individually, with parents).
CBT is no more effective than other 'active therapies' such as self-help books.
The small number of studies meant the review authors could not compare CBT with medication.
Only four studies looked at longer-term outcomes after CBT. No clear evidence showed maintained improvement in symptoms of anxiety among children and young people.
What should happen next?
The review authors recommend that future research should look in greater detail at what makes CBT work best for children and young people, how CBT can be provided in the most cost-effective way, and how CBT can be adapted for different age groups.
Authors' conclusions:
Cognitive behavioural therapy is an effective treatment for childhood and adolescent anxiety disorders; however, the evidence suggesting that CBT is more effective than active controls or TAU or medication at follow-up, is limited and inconclusive.