mindfulness (Dunning et al. 2019; Klingbeil et al. 2017), dialectical behaviour therapy (McCauley et al. 2018), and acceptance and commitment therapy (Hancock et al. 2018).
Brief models of CBT, such as single‐session exposure therapy for the treatment of specific phobias, have been found to be highly effective (Öst & Ollendick 2017). Similarly, brief parent‐guided CBT has been found to be effective in the treatment of anxiety disorders (Cartwright‐Hatton et al. 2011; Creswell et al. 2017). Finally, model‐specific interventions, such as cognitive therapy for social anxiety (Leigh & Clark 2018) or single‐session exposure therapy for specific phobias (Davis et al. 2019), have found encouraging results.
This substantial and consistent evidence has resulted in CBT being recommended by expert groups such as the UK National Institute for Health and Clinical Excellence and the American Academy of Child and Adolescent Psychiatry for the treatment of young people with emotional disorders including depression, OCD, PTSD, and anxiety. This growing evidence base has also promoted the development of national training programmes in CBT. In the UK, the successful Improving Access to Psychological Therapies (IAPT) programme has been extended to children and young people (Shafran et al. 2014).
CBT as a preventative intervention
In addition to being an effective treatment, CBT has proven to be effective in the prevention of mental health problems such as anxiety and depression (Calear & Christensen 2010; Neil & Christensen 2009). Preventive programmes offer the potential to reduce the severity of symptomology of those already displaying problems whilst enhancing the resilience of those who are not currently symptomatic. The results of prevention programmes are encouraging and suggest that school‐based anxiety and depression prevention based on CBT is effective (Dray et al. 2017; Hetrick et al. 2015; Stockings et al. 2016; Werner‐Seidler et al. 2017).
Typically, preventative programmes are provided in schools either to whole classes of young people (e.g. universal approach) or to young people identified as at risk of developing or experiencing problems (e.g. targeted approaches). School‐based programmes have good reach, and integrating them into the school curriculum can help to reduce the stigma attached to mental health so that worries and problems can be more openly acknowledged and discussed (Barrett & Pahl 2006). Reviews suggest that classroom‐based approaches designed to improve mental health and well‐being are effective both as universal and as targeted programmes (Šouláková et al. 2019; Stockings et al. 2016).
There are many CBT anxiety and depression prevention programmes, with the most well evaluated being FRIENDS for Life (Barrett 2010), Penn Resilience Programme (Jaycox et al. 1994), Coping with Stress Course (Clarke et al. 1990), Resourceful Adolescent Program (Shochet et al. 1997), and the Aussie Optimism Programme (Roberts 2006). Whilst the results are generally positive, not all evaluations of these programmes have shown positive effects. The intervention leader requires careful consideration. Whilst teachers and school staff are well placed to deliver these programmes, studies have shown that they may not necessarily be as effective as trained mental health leaders (Stallard, Skrybina, et al. 2014; Werner‐Seidler et al. 2017). It is therefore important to consider the knowledge, support, and supervision of those delivering these programmes.
CBT with younger children
Whilst CBT can routinely be used with children from the age of seven years, comparatively few studies have evaluated the effectiveness of CBT with children under the age of 12 (Ewing et al. 2015). Most studies tend to involve young adolescents aged 12–17. Randomised controlled trials evaluating CBT for the treatment of depression rarely include children under the age of 12 (Forti‐Buratti et al. 2016). For example, Yang et al. (2017) undertook a review and meta‐analysis of CBT for the treatment of depression in children (defined as under the age of 13) and identified only nine studies, with six of these being conducted before the turn of the century.
In terms of anxiety, a few specific programmes for young children have been developed. These include Being Brave (Hirshfeld‐Becker et al. 2010), Taming Sneaky Fears (Monga et al. 2015), and the school‐based universal prevention programme Fun Friends (Pahl & Barrett 2010). Results from these studies are limited but nonetheless encouraging.
A few researchers have developed and explored the effectiveness of CBT with young children with PTSD (Dalgleish et al. 2015; Salloum et al. 2016). For example, Scheeringa et al. (2011) reported the feasibility of a trauma‐focused CBT intervention with children aged three to six who had experienced a life‐threatening event and found a large reduction in PTSD symptoms at six months. Research with OCD is similarly limited, although once again the results are promising. In one of the few studies, Freeman et al. (2014) found that 72% of children aged five to eight with OCD were assessed as ‘much improved’ after completing a 14‐session family‐based CBT programme.
It cannot be assumed that because CBT is effective with young adolescents that it will also be effective with young children. Developmental factors need to be considered and the role of parents/carers requires careful attention. Nonetheless, although research is limited, the results are encouraging and are consistent with those obtained with older samples.
CBT with children and young people with learning difficulties
There is evidence that CBT can be effective with young people with learning difficulties, particularly those with high‐functioning autistic spectrum disorder (ASD; Perihan et al. 2019). For example, studies have demonstrated that CBT programmes for young people with ASD do have a beneficial effect on reducing symptoms of anxiety (Storch et al. 2013; Van Steensel & Bogels 2015; Wood et al. 2009) and OCD (Vause et al. 2018).
Researchers have highlighted how CBT needs to be modified to accommodate the young person’s specific learning difficulties (Attwood & Scarpa 2013; Donoghue et al. 2011). This involves attending to factors such as communications/language abilities, interpersonal/social abilities, cognitive and behavioural inflexibility, and sensory sensitivities (Scarpa et al. 2017). In terms of communication, adaptations might include the use of simple, precise, and concrete language and the greater use of more non‐verbal visual techniques such as pictures, worksheets, or visual prompts (e.g. writing the aim/focus of each session on a board). The young person’s special interests can be integrated into the intervention through the development of metaphors or use of rewards. Interpersonal skills with young people with ASD maybe more limited, so greater attention needs to be paid to the assessment and development of core skills such as ‘mind reading’ to aid understanding of how people might think and feel. Once again, the process can be made concrete through the use of role plays. Cognitive flexibility can be promoted using self‐talk where different options are verbalised and modelled or through multiple choice questions which encourage awareness and consideration of alternative strategies. For behavioural inflexibility, interactions during clinical sessions may need to be modified to be more consistent with the expectations of the young person. For example, Donoghue et al. (2011) note that the usual social exchanges at the start of therapy sessions may create anxiety and suggest that the therapist adopts a more task‐focused approach. Similarly, anxiety associated with change can be minimised by using the same room to meet, having a clear session routine/structure, and establishing a clear length for the meeting. In terms of sensory issues, it may be necessary to reduce the length of the session, change the lighting, remove visual material from the room, or use relaxation skills to help reduce sensory overload. Finally, generalisation from clinical sessions to the young person’s everyday environment can be facilitated through the involvement of parents, mobile phones to send prompts and reminders, and digital cameras to capture difficult situations (Donoghue et al. 2011).
Research with young people with other disorders is more limited. For visually impaired young people, tactile prompts can be used to remind the young person of the steps involved in managing anxiety (Visagie et al. 2017). For those with moderate learning difficulties, skills such as problem solving can be broken down into simple
