Improving the Transportability of CBT for Internalizing Disorders in Children
Abstract
Research provides strong support for the efficacy and effectiveness of cognitive behavioral therapy (CBT) for the treatment of childhood internalizing disorders. Given evidence for limited dissemination and implementation of CBT outside of academic settings, efforts are underway to improve its transportability so that more children with mental health needs may benefit from treatment. Creative modifications to existing treatments aim to deliver CBT for anxiety disorders and depression in a more transportable format. Notable progress has been made within the areas of computerized CBT, camp-based CBT, school-based CBT, and CBT delivered through primary care settings. These approaches are discussed within the context of key elements of transportability that are particularly germane to the dissemination and implementation of child treatments.
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Compared to specialist services, primary care mental health services are characterized by offering early and brief interventions to a heterogeneous group of patients, with less symptom severity and functional impairment.
“Compared to specialist services, primary care mental health services are characterized by offering early and brief interventions to a heterogeneous group of patients, with less symptom severity and functional impairment.”
From Developing a primary care-based cognitive behavioral intervention for anxiety in children through a participatory approach: a qualitative study. (2026) · cites this paper as [13]
Differences in clinical practice and patient needs limit the compatibility of established CBT protocols in primary care settings.
“These differences in clinical practice and patient needs limit the compatibility of established CBT protocols in primary care settings [13].”
From Developing a primary care-based cognitive behavioral intervention for anxiety in children through a participatory approach: a qualitative study. (2026) · cites this paper as [13]
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WEB-BASED CBT FOR SELECTIVE MUTISM
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Early intervention and prevention
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School-based prevention of depression
Hautzinger, M., & Poessel, P. (2010) · Journal of Affective Disorders · doi:10.1016/j.jad.2010.02.042 · Cited by 4 · see citing works
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Logging into therapy: Adolescent perceptions of online therapies for mental health problems
Sweeney, G., Donovan, C., March, S., & Forbes, Y. (2016) · Internet Interventions · doi:10.1016/j.invent.2016.12.001 · Cited by 116 · see citing works
CBT for adolescents with anxiety: mature yet still developing
Kendall, P. C., & Peterman, J. S. (2015) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2015.14081061 · Cited by 115 · see citing works
Efficacy of cognitive-behavioral therapy for childhood anxiety and depression
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A Meta-Analysis on the Efficacy of Technology Mediated CBT for Anxious Children and Adolescents
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No need to worry: the promising future of child anxiety research
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“Camp-based programs can offer increased opportunity for peer interaction and the convenience of receiving treatment in an intensive format during the summer months (Elkins et al, 2011 ).”
BackgroundInfluentialComputer-assisted cognitive behavioral therapy for children with epilepsy and anxiety: A pilot study
Blocher, J. B., Fujikawa, M., Sung, C. Y. Y., Jackson, D. C., & Jones, J. E. (2013) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2012.12.014 · Cited by 72 · see citing works
“[41] Additional research is needed to reduce dissemination barriers and to improve the accessibility of CBT to children and adolescents.[42]”
BackgroundDrmic, I., Aljunied, M., & Reaven, J. (2017) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-016-3007-y · Cited by 73 · see citing works
“Thoughtful adaptations that are compatible with an organizations’ values and beliefs and are perceived to be flexible in delivery, are more likely to be adopted than interventions that have not been carefully modified (Beidas et al. 2011; Dingfelder and Mandell 2011; Elkins et al. 2011; Volkmar et al. 2011).”
BackgroundStorch, E. A., Salloum, A., King, M. A., Crawford, E. A., Andel, R., McBride, N. M., & Lewin, A. B. (2015) · Depression and Anxiety · doi:10.1002/da.22399 · Cited by 64 · see citing works
Impaired fear extinction in adolescent rodents: Behavioural and neural analyses
Baker, K., Bisby, M. A., & Richardson, R. (2016) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2016.05.019 · Cited by 54 · see citing works
Assessment and Treatment of Anxiety Among Children and Adolescents
Freidl, E. K., Stroeh, O. M., Elkins, R. M., Steinberg, E. J., Albano, A. M., & Rynn, M. A. (2017) · FOCUS The Journal of Lifelong Learning in Psychiatry · doi:10.1176/appi.focus.20160047 · Cited by 45 · see citing works
Reaven, J., Moody, E. J., Grofer Klinger, L., Keefer, A., Duncan, A., O'Kelley, S., Meyer, A., Hepburn, S., & Blakeley-Smith, A. (2018) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000285 · Cited by 35 · see citing works
The Emerging Role of Technology in Cognitive–Behavioral Therapy for Anxious Youth: A Review
Berry, R. R., & Lai, B. S. (2014) · Journal of Rational-Emotive & Cognitive-Behavior Therapy · doi:10.1007/s10942-014-0184-5 · Cited by 30 · see citing works
“Recently, manualized empirically supported treatments targeting anxiety in school-age children were adapted to computer-or internet-based formats (Elkins et al. 2011).”
BackgroundBecker, E. M., Becker, K. D., & Ginsburg, G. S. (2012) · School Mental Health · doi:10.1007/s12310-012-9080-2 · Cited by 28 · see citing works
“However, the school environment presents challenges to the implementation of CBT (Elkins et al., 2011; Mufson, 2010).”
Bekker, M. J., Griffiths, K. M., & Barrett, P. M. (2016) · Clinical Psychologist · doi:10.1111/cp.12099 · Cited by 27 · see citing works
Sweeney, G., Donovan, C., March, S., & Laurenson, S. D. (2015) · Internet Interventions · doi:10.1016/j.invent.2015.11.001 · Cited by 26 · see citing works
“Computer-based therapies are well placed to improve access to evidence-based interventions for mental health problems in youth and circumvent many of the barriers to accessing treatment (Elkins et al., 2011).”
Reaven, J., Meyer, A. T., Pickard, K. E., Boles, R. E., Hayutin, L. G., Middleton, C., Reyes, N., Hepburn, S., Tanda, T., Stahmer, A. C., et al. (2021) · Evidence-Based Practice in Child and Adolescent Mental Health · doi:10.1080/23794925.2021.1941430 · Cited by 21 · see citing works
“…interventions (EBI), including mental health treatment such as CBT. Common barriers include lack of trained providers, financial limitations, lack of insurance coverage, proximity to clinic location, and balancing demands of work with securing time-off to attend appointments (Elkins et al., 2011).”
BackgroundCognitive-Behavioral Therapy for Children and Adolescents
Cornacchio, D., Sanchez, A. L., Chou, T., & Comer, J. S. (2017) · Elsevier eBooks · doi:10.1016/b978-0-12-803457-6.00011-8 · Cited by 20 · see citing works
We’ve Come a Long Way, Baby!: Evolution and Revolution in CBT with Youth
Friedberg, R. D., Hoyman, L. C., Behar, S., Tabbarah, S., Pacholec, N. M., Keller, M., & Thordarson, M. A. (2014) · Journal of Rational-Emotive & Cognitive-Behavior Therapy · doi:10.1007/s10942-014-0178-3 · Cited by 19 · see citing works
A cognitive model of digital transformation and IS decision making
Russell, K., O’Raghallaigh, P., McAvoy, J., & Hayes, J. (2020) · Journal of Decision System · doi:10.1080/12460125.2020.1848388 · Cited by 19 · see citing works
“Enterprises may address these misalignments in their personnel through advancement of evidence-based, targeted interventions, such as those in social-science and psychology (Elkins et al., 2011; Mitchell & Gordon, 2007).”
Reaven, J., Reyes, N., Pickard, K. E., Tanda, T., & Morris, M. A. (2019) · School Mental Health · doi:10.1007/s12310-019-09351-z · Cited by 18 · see citing works
Reaven, J., Pickard, K. E., Meyer, A. T., Hayutin, L. G., Middleton, C., Reyes, N., Tanda, T., Stahmer, A. C., Blakeley‐Smith, A., & Boles, R. E. (2023) · Autism · doi:10.1177/13623613231175951 · Cited by 16 · see citing works
Anxious youth in research and service clinics
Aalberg, M., Cummings, C. M., Gere, M. K., Torgersen, S. O., & Kendall, P. C. (2012) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2012.09.003 · Cited by 16 · see citing works
Ruzek, J. I., Rosen, R. C., Marceau, L. D., Larson, M. J., Garvert, D. W., Smith, L., & Stoddard, A. (2012) · Implementation Science · doi:10.1186/1748-5908-7-43 · Cited by 16 · see citing works
“Other lines of research are attempting to improve the transportability of existing CBT interventions by tailoring or optimizing them for delivery in specific systems or for specific audiences, such as with children [14] or veterans [15], by increasing flexibility in implementation [16], and by better integrating cross…”
Cognitive‐Behavioral Therapy for Anxious Children: From Evidence to Practice
Sawyer, M. C., & Nunez, D. (2014) · Worldviews on Evidence-Based Nursing · doi:10.1111/wvn.12024 · Cited by 16 · see citing works
Stone, D. I. G., Elkins, R. M., Gardner, M. M., Boger, K. D., & Sperling, J. (2023) · Child Psychiatry & Human Development · doi:10.1007/s10578-023-01500-5 · Cited by 16 · see citing works
“Creative modifications to evidence-based treatments that alter the setting and/or format in which interventions are delivered have proliferated in attempts to improve accessibility for youth mental healthcare [98].”
School-Based Clinicians Sustained Use of a Cognitive Behavioral Treatment for Anxiety Disorders
LoCurto, J., Pella, J. E., Chan, G., & Ginsburg, G. S. (2020) · School Mental Health · doi:10.1007/s12310-020-09381-y · Cited by 14 · see citing works
Children and Adolescents with ASD and Co-occurring Psychiatric Conditions
Reaven, J., & Wainer, A. (2015) · International review of research in developmental disabilities · doi:10.1016/bs.irrdd.2015.06.001 · Cited by 12 · see citing works
Outcome Findings and Issues in Psychotherapy With Children and Adolescents: Internalizing Disorders
Viana, A. G., Trent, E. S., Conroy, H. E., & Raines, E. M. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-818697-8.00046-7 · Cited by 7 · see citing works
Myburgh, N., Muris, P., & Loxton, H. (2021) · Child Care in Practice · doi:10.1080/13575279.2021.1902785 · Cited by 6 · see citing works
“However brief, intensive CBT treatment programmes have indicated promise with the maintenance of e ff ects over time (Elkins et al., 2011).”
Angelosante, A. G., Ostrowski, M. A., & Chizkov, R. R. (2013) · Springer eBooks · doi:10.1007/978-1-4614-6599-7_7 · Cited by 6 · see citing works
Perceptions of implementing facing your fears in hospital and community organizations
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Protocolos psicoterapêuticos para tratamento de ansiedade e depressão na infância
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SNAP® For Schools: Impact on Internalizing Symptoms
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McCarty, R. J., Downing, S. T., Guastello, A. D., Lazaroe, L. M., Ordway, A. R., Mirhosseini, T., Barthle-Herrera, M. A., Cooke, D. L., Mathews, C. A., & McNamara, J. P. H. (2023) · Behavior Therapy · doi:10.1016/j.beth.2023.08.006 · Cited by 2 · see citing works
CBT for Adolescents With Anxiety: Mature Yet Still Developing
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Multicultural Findings and Considerations from Brief Interventions
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Evaluation of a Packaged Intervention for Treating Selective Mutism: Application in a School Setting
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“These differences in clinical practice and patient needs limit the compatibility of established CBT protocols in primary care settings [13].”
Depression, Bipolar Disorder, and Suicidal Behavior in Children
Freed, R. D., Chan, P. T., Langer, D. A., & Tompson, M. C. (2013) · Wiley eBooks · doi:10.1002/9781118528563.wbcbt35
Anxiety in the Primary Classroom: A Handbook for Elementary Educators
Ismailos, L. (2013) · Brock University Digital Repository (Brock University)
Neurofeedback for Pediatric Emotional Dysregulation
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How Pinteresting: An Analysis of Social Media Resources for Internalizing Disorders
Jose, A. S., Hall, C. M., Schaefer, B. A., & Breeden, N. C. (2019) · Journal of Educational Technology Systems · doi:10.1177/0047239519828079
“…interventions with fewer implementation barriers such as high cost, limited resources, lengthy time requirements, or additional training needs (Bekker et al., 2016; Elkins et al., 2011; Forman et al., 2008; Heier, 2016; Hicks et al., 2014; Langley et al., 2010; Miller, 2010; Whitney et al., 2011).”
BackgroundMethodInfluentialBekker, M. J. (2019) · ANU Open Research (Australian National University) · doi:10.25911/5d134a3f461fa
“Elkins et al. (2011) provided an important start in reviewing this area, although focussed on delivery settings rather than formats, without any focus intensive and brief formats.”
BackgroundInfluentialPerfect, M. M., Frye, S. S., & Williams, S. B. H. (2019) · American Psychological Association eBooks · doi:10.1037/0000157-023
Hayutin, L. G., Middleton, C., Yankowitz, L. D., Boles, R. E., Blakeley‐Smith, A., Meyer, A. T., Pickard, K. E., Reyes, N., Stahmer, A. C., & Reaven, J. (2024) · School Mental Health · doi:10.1007/s12310-024-09730-1
“…are delivered in outpatient specialty clinics, presenting access limitations for many families, including long wait lists, financial costs paired with lack of insurance coverage, proximity to clinics, and parents’ struggles to take time off from work to attend appointments (Elkins et al., 2011).”
- Authors
- Meredith Elkins, R., Kathryn McHugh, R., Santucci, L. C., & Barlow, D. H.
- Affiliations
- Boston University (US)
- Venue
- Clinical Child and Family Psychology Review
- Published
- 2011-02-20
- Volume
- 14
- Issue
- 2
- Pages
- 161-173
- ISSN
- 1096-4037 (ISSN-L)
- 1573-2827
- OpenAlex
- W2074433998
- Cited by
- 52
- References
- 116
- Citations by year
- 2026: 1 · 2024: 2 · 2023: 4 · 2022: 1 · 2021: 2 · 2020: 4 · 2019: 6 · 2018: 1 · 2017: 7 · 2016: 4 · 2015: 6 · 2014: 5 · 2013: 5 · 2012: 4
- FWCI
- 0.59
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Clinical Child and Family Psychology Review (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- cognitive behavioral therapy, transportability, internalizing disorders, children, dissemination and implementation, primary care delivery, anxiety disorders, depression, treatment adaptation
- MeSH terms
- Anxiety Disorders, Child, Depressive Disorder, Humans, Cognitive Behavioral Therapy, Treatment Outcome
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