Cognitive behavioural therapy for anxiety disorders in children and adolescents

  • Review
  • Intervention




Childhood and adolescent anxiety disorders are relatively common, occurring in between 5-18% of all children and adolescents. They are associated with significant morbidity and impairment in social and academic functioning, and when persistent, there is a risk of depression, suicide attempts and substance abuse in adulthood. There is accumulating evidence for the efficacy of cognitive behavioural therapy (CBT), with a number of randomised controlled trials (RCTs) suggesting benefit.


To determine whether CBT is an effective treatment for childhood and adolescent anxiety disorders in comparison to waiting list or attention controls.

Search methods

Search of the Cochrane Register of Controlled Trials and the Cochrane Depression, Anxiety and Neurosis Group Register, which includes relevant randomised controlled trials from the bibliographic databases - The Cochrane Library ( to January 2004), EMBASE, (1970-2004) MEDLINE (1970-2004) and PsycINFO (1970-2004). We also searched the references of all included studies and relevant textbooks, and contacted authors in order to identify further trials.

Selection criteria

Each identified study was assessed for possible inclusion by two reviewers independently.
Inclusion criteria consisted of randomised controlled trials of CBT versus waiting list/attention controls in children (more than six years of age) and adolescents (under the age of 19 years) with a DSM (Diagnostic Statistical Manual) or ICD (International Classification of Diseases) anxiety diagnosis; and excluding simple phobia, obsessive compulsive disorder and post-traumatic stress disorder. Each study was required to conform to the principles of CBT through use of a protocol and comprising at least eight sessions of CBT.

Data collection and analysis

The methodological quality of included trials was assessed by two reviewers independently. The dichotomous outcome of remission of anxiety diagnosis was pooled using relative risk (RR) with 95% confidence intervals. Means and standard deviations of anxiety symptom continuous scores were pooled using the standardised mean difference (SMD). Heterogeneity was assessed and intention-to-treat (ITT) analyses undertaken. The presence of publication bias was assessed using funnel plots.

Main results

Thirteen studies with 498 subjects and 311 controls met the inclusion criteria and were included in the analyses. The studies involved community or outpatient subjects only, with anxiety of only mild to moderate severity. ITT analyses showed a response rate for remission of any anxiety diagnosis of 56% for CBT versus 28.2% for controls (RR 0.58,95%CI 0.50 to 0.67), with no evidence of heterogeneity. The number needed to treat (NNT) was 3.0 (95%CI 2.5 to 4.5). For reduction in anxiety symptoms, the SMD was -0.58 (95% CI -0.76 to -0.40) with no significant heterogeneity indicated. Post hoc analyses suggest that individual, group and family/parental formats of CBT produced fairly similar outcomes.

Authors' conclusions

Cognitive behavioural therapy appears an effective treatment for childhood and adolescent anxiety disorders in comparison to waiting list or attention control. There was no evidence for a difference between an individual, group or parental/family format. CBT can be recommended for the treatment of childhood and anxiety disorders, although with only just over half improving, there is a need for further therapeutic developments.




焦慮症在兒童與青少年的人口中約有5 – 18%,是相當常見的疾病。他們與顯著的發病率及社會學業功能損害有關,當情況持續下去,在成人期可能會演變成憂鬱,企圖自殺及物質濫用。有越來越多累積的證據顯示認知行為治療(CBT)是有效的,而多數的隨機對照試驗(RCTs)也提出了其效益。




搜尋登錄在Cochrane憂鬱、焦慮、精神官能症團體,以及的臨床試驗研究,這些研究是從書目資料庫考科藍圖書館(到2004年1月),EBMASE(1970 – 2004),MEDLINE(1970 – 2004),以及PsycINFO(1970 – 2004)找出相關的臨床試驗研究。我們也搜尋了所有研究的文獻、相關的教科書,並聯繫這些作者以確認進一步的試驗。






有13研究包含了498名個案,及311的控制對象符合納入標準,並列入了分析。這些研究包含了社區或門診的焦慮個案,只有嚴重度只有輕到中度的焦慮。意向性治療分析顯示焦慮診斷的緩解反應比率,CBT有56%,對照組有28.2%(RR = 0.58,95%CI 0.50 to 0.67),沒有異質性。益一需治數(NNT)是3.0 (95%CI 2.5 to 4.5)。對於減少焦慮症狀的離均差(SMD)是−0.58(95%CI = −0.76 to −0.40),沒有顯著的異質性。事後分析顯示,個別、團體和家庭/父母等CBT的形式有相當類似的結果。





此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。



Plain language summary

Cognitive behavioural therapy compared to waiting list or an attention control for child and adolescent anxiety disorders

Cognitive behavioural therapy has been adapted for the treatment of anxiety disorders in adolescents and children over the age of six years. This psychological treatment can be delivered in various formats: individual, group and family /parent. Cognitive behavioural therapy appears effective in just over 50% of cases. There is no difference between formats.