A Meta-analysis to Guide the Enhancement of CBT for Childhood Anxiety: Exposure Over Anxiety Management
Open accessAbstract
Cognitive behavior therapy (CBT) is the most empirically supported therapy for childhood anxiety disorders (CADs) but has not reliably outperformed other credible interventions. The current study used meta-analysis to examine the frequency with which the most common treatment components are included in outcome studies and the relation of these components to symptom improvement. Seventy-five studies were identified that included youth with an anxiety disorder treated with CBT or a comparison condition. The protocols for the 111 CBT conditions generally consisted of 12, 1-h sessions delivered to the child with minimal parent inclusion. A greater amount of in-session exposure was related to significantly larger effect sizes between CBT and waitlist control across reporters (- 0.12 to - 0.15; P's < .05) and from pre- to post-treatment for child report (- .06; P < .01). Compared to treatments that omitted relaxation, treatments that included relaxation strategies were associated with significantly smaller pre- to post-treatment effect sizes across reporters (0.38 to 0.80; P's < .05). The current study suggests that CBT protocols for CADs that emphasize in-session exposure and do not include relaxation have the potential to improve the efficacy and effectiveness of therapy. Dismantling studies directly testing these hypotheses are needed.
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CBT based on exposure principles demonstrates high to moderate effects across anxiety disorders in meta-analyses, even against placebo conditions.
“and demonstrates high to moderate effects across disorders in meta-analyses, even against placebo conditions (e.g., Carpenter et al., 2018;Whiteside et al., 2020).”
From Effective—and Tolerable: Acceptance and Side Effects of Intensified Exposure for Anxiety Disorders (2023) · cites this paper as Whiteside et al., 2020
The Abstract and Treatment Outcome section report a meta-analysis of CBT for childhood anxiety in which more in-session exposure was associated with larger effects relative to waitlist controls. The paper does not establish high-to-moderate effects across anxiety disorders generally: it studies children, does not characterize the overall effects that way, and its Data Synthesis and Analyses section says it did not examine between-group effects against active controls. It therefore does not support the placebo-comparison portion of the claim. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe inclusion of somatic coping strategies in pediatric CBT for anxiety has been questioned.
“But the inclusion of such somatic coping strategies in pediatric CBT for anxiety has been questioned [26, 50].”
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 [50]
A meta-analysis showed that interventions incorporating somatic management strategies (including relaxation and breathing exercises) had smaller effect sizes than those that omitted such strategies.
“A meta-analysis showed that interventions incorporating somatic management strategies (including relaxation and breathing exercises) had smaller effect sizes than those that omitted such strategies [50].”
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 [50]
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“The balance of these components varies greatly in terms of when and how exposure is initiated, what type of cognitive strategies are included, whether relaxation is included, and whether other modules are added, such as social skills training (Ale, McCarthy, Rothschild, & Whiteside, 2015).”
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Overlapping and non-overlapping practices in usual and evidence-based care for youth anxiety
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The use of exposure therapy for child anxiety disorders in a medical center.
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Self-citationBehavioral treatment of social phobia in youth: Does parent education training improve the outcome?
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Detección temprana y tratamiento de adolescentes con fobia social generalizada
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Exposure therapy practices and mechanism endorsement: A survey of specialty clinicians.
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Self-citationThe Length of Child Anxiety Treatment in a Regional Health System
Whiteside, S. P. H., Ale, C. M., Young, B. J., Olsen, M. W., Biggs, B. K., Gregg, M. S., Geske, J. R., & Homan, K. J. (2016) · Child Psychiatry & Human Development · doi:10.1007/s10578-016-0628-5 · Cited by 25 · see citing works
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Brief Cognitive-Behavioral Therapy for Anxious Youth: The Inner Workings
Beidas, R. S., Mychailyszyn, M. P., Podell, J. L., & Kendall, P. C. (2012) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2012.07.004 · Cited by 23 · see citing works
Atención individualizada y tratamiento en grupo de adolescentes con fobia social generalizada
Rodríguez, J. O., Alcázar, A. I. R., & Olivares-Olivares, P. J. (2006) · DOAJ (DOAJ: Directory of Open Access Journals) · Cited by 18 · see citing works
Tratamiento cognitivo-conductual para niños mexicanos con fobia social
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Does individual attention improve the effect of group treatment of adolescents with social phobia?
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Papel de los efectos inespecíficos en el tratamiento psicológico de adolescentes con fobia social
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Cited by
Sorted by citations
Epidemiology of anxiety disorders: global burden and sociodemographic associations
Javaid, S. F., Hashim, I. J., Hashim, M. J., Stip, É., Samad, A., & Ahbabi, A. A. (2023) · Middle East Current Psychiatry · doi:10.1186/s43045-023-00315-3 · Cited by 502 · see citing works
“Individuals in wealthier nations may face more daily pressures to achieve and portray an image of wealth and beauty to others, which can adversely affect self-image and contribute to anxiety [11].”
BackgroundAnxiety disorders in children and adolescents: A summary and overview of the literature
Rapee, R. M., Creswell, C., Kendall, P. C., Pine, D. S., & Waters, A. M. (2023) · Behaviour Research and Therapy · doi:10.1016/j.brat.2023.104376 · Cited by 202 · see citing works
Sharma, S., Hucker, A., Matthews, T., Grohmann, D., & Laws, K. R. (2021) · BMC Psychology · doi:10.1186/s40359-021-00658-8 · Cited by 109 · see citing works
“Across general populations, the efficacy of CBT for reducing symptoms of anxiety has been demonstrated; and includes the maintenance of treatment gains for up to 12 months amongst youth receiving CBT for anxiety disorders [19, 20].”
BackgroundHalldorsson, B., Hill, C., Waite, P., Partridge, K., Freeman, D., & Creswell, C. (2021) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13400 · Cited by 84 · see citing works
“…Peris et al., 2017) and recent research has high-lighted the limited (and potential detrimental) impact of relaxation exercises (Peris et al., 2015; Whiteside et al., 2020), yet the majority of applied games for anxiety problems focused only on training relaxation, and only one (i.e., MindLight;…”
McGuire, A., Steele, R. G., & Singh, M. N. (2021) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-020-00334-0 · Cited by 60 · see citing works
Pegg, S. L., Hill, K. E., Argiros, A. P., Olatunji, B. O., & Kujawa, A. (2022) · Current Psychiatry Reports · doi:10.1007/s11920-022-01384-7 · Cited by 49 · see citing works
Speers, A. J. H., Bhullar, N., Cosh, S., & Wootton, B. M. (2022) · Clinical Psychology Review · doi:10.1016/j.cpr.2022.102132 · Cited by 48 · see citing works
Weisz, J. R., Venturo‐Conerly, K. E., Fitzpatrick, O. M., Frederick, J., & Ng, M. Y. (2023) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-080921-082920 · Cited by 46 · see citing works
Adapting CBT for youth anxiety: Flexibility, within fidelity, in different settings
Kendall, P. C., Ney, J. S., Maxwell, C. A., Lehrbach, K. R., Jakubovic, R. J., McKnight, D. S., & Friedman, A. L. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1067047 · Cited by 43 · see citing works
“Other research supports this notion of effectiveness, including a 2021 meta-analysis of 58 studies that showed CBT for the treatment of anxious youth in routine clinical care settings had similar outcomes to efficacy studies (38) and a 2020 meta-analysis of 75 studies that underscored the importance of using in-sessio…”
BackgroundResultEducational Accommodations for Students With Disabilities: Two Equity-Related Concerns
Lovett, B. J. (2021) · Frontiers in Education · doi:10.3389/feduc.2021.795266 · Cited by 48 · see citing works
“Such interventions typically contain, as the central active ingredient, exposure to the feared situation (Whiteside et al., 2020).”
BackgroundBilek, E. L., Tomlinson, R. C., Whiteman, A., Johnson, T. D., Benedict, C., Phan, K. L., Monk, C. S., & Fitzgerald, K. D. (2021) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2021.1901230 · Cited by 36 · see citing works
“This report presents interim findings from an ongoing RCT (Premo et al., 2020) in which youth with CADs are randomized to EF-CBT or RMT.”
BackgroundResultInfluentialRacz, J. I., Bialocerkowski, A., Calteaux, I., & Farrell, L. (2024) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-024-00478-3 · Cited by 33 · see citing works
“Empirically supported treatment is effective for anxiety-related presentations, namely cognitive-behavioural therapy (CBT), of which exposure therapy (ET) is arguably the most important therapeutic component (Carpenter et al., 2018; Muris, 2019; Whiteside et al., 2020).”
BackgroundCervin, M., & Lundgren, T. (2022) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13485 · Cited by 34 · see citing works
A review of Parent-Child Interaction Therapy (PCIT): Applications for youth anxiety
Phillips, S., & Mychailyszyn, M. (2021) · Children and Youth Services Review · doi:10.1016/j.childyouth.2021.105986 · Cited by 31 · see citing works
Variability in clinician intentions to implement specific cognitive-behavioral therapy components
Wolk, C. B., Becker‐Haimes, E. M., Fishman, J., Affrunti, N. W., Mandell, D. S., & Creed, T. A. (2019) · BMC Psychiatry · doi:10.1186/s12888-019-2394-y · Cited by 29 · see citing works
“For example, while exposure is considered a key component in CBT for anxiety [16], community clinicians rarely use it, relying instead on other less effective CBT strategies, such as relaxation [17, 18].”
BackgroundFrank, H. E., Becker‐Haimes, E. M., Rifkin, L. S., Norris, L. A., Ollendick, T. H., Olino, T. M., Kratz, H. E., Beidas, R. S., & Kendall, P. C. (2020) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2020.102308 · Cited by 30 · see citing works
Development of the Child- and Parent-Rated Scales of Food Allergy Anxiety (SOFAA)
Dahlsgaard, K. K., Wilkey, L., Stites, S. D., Lewis, M. O., & Spergel, J. M. (2021) · The Journal of Allergy and Clinical Immunology In Practice · doi:10.1016/j.jaip.2021.06.039 · Cited by 27 · see citing works
Treatment of anxiety in autistic adults: A systematic review
Menezes, M., Harkins, C., Robinson, M. F., Pappagianopoulos, J., Cross, R., Vasa, R. A., & Mazurek, M. O. (2022) · Research in Autism Spectrum Disorders · doi:10.1016/j.rasd.2022.102068 · Cited by 26 · see citing works
Cognitive behavioral therapy for children and adolescents with anxiety disorders
Stiede, J. T., Trent, E. S., Viana, A. G., Guzick, A. G., Storch, E. A., & Hershfield, J. (2023) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2022.12.001 · Cited by 25 · see citing works
Efficacy of a Mobile App-Based Intervention for Young Adults With Anxiety Disorders
Bress, J. N., Falk, A. E., Schier, M. M., Jaywant, A., Moroney, E., Dargis, M. A., Bennett, S. M., Scult, M. A., Volpp, K. G. M., Asch, D. A., et al. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.28372 · Cited by 25 · see citing works
Optimising Exposure for Children and Adolescents with Anxiety, OCD and PTSD: A Systematic Review
Plaisted, H., Waite, P., Gordon, K., & Creswell, C. (2021) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-020-00335-z · Cited by 25 · see citing works
The Importance of Including Psychophysiological Methods in Psychotherapy
Lehrer, P. M. (2024) · Applied Psychophysiology and Biofeedback · doi:10.1007/s10484-024-09667-w · Cited by 24 · see citing works
“Whiteside et al. (2020) found that interventions including relaxation training in the CBT practice are significantly less effective in reducing anxiety than interventions that omitted it and give greater emphasis to cognitive restructuring and exposure.”
Dahlsgaard, K. K., Lewis, M. O., & Spergel, J. M. (2022) · Annals of Allergy Asthma & Immunology · doi:10.1016/j.anai.2022.09.021 · Cited by 24 · see citing works
The Management of Anxiety and Depression in Pediatrics
Pettitt, R., Brown, E. A., Delashmitt, J. C., & Pizzo, M. N. (2022) · Cureus · doi:10.7759/cureus.30231 · Cited by 23 · see citing works
“Treatment with CBT focuses on cultivating mechanisms of modifying these thoughts and beliefs so as to alter maladaptive behaviors in response to distressing conditions [5,7,8].”
BackgroundThe intersection of COVID‐19, school, and headaches: Problems and solutions
Karvounides, D., Marzouk, M. A., Ross, A. C., VanderPluym, J. H., Pettet, C., Ladak, A., Ziplow, J. L., Gentile, C. P., Turner, S. B., Anto, M. M., et al. (2020) · Headache The Journal of Head and Face Pain · doi:10.1111/head.14038 · Cited by 23 · see citing works
Crane, M. E., Phillips, K. E., Maxwell, C. A., Norris, L. A., Rifkin, L. S., Blank, J. M., Sorid, S. D., Read, K. L., Swan, A. J., Kendall, P. C., et al. (2021) · School Mental Health · doi:10.1007/s12310-021-09424-y · Cited by 24 · see citing works
Anxiety and Depression Treatment in Primary Care Pediatrics
Lester, T. R., Herrmann, J. E., Bannett, Y., Gardner, R. M., Feldman, H. M., & Huffman, L. C. (2023) · PEDIATRICS · doi:10.1542/peds.2022-058846 · Cited by 21 · see citing works
Virtual reality exposure therapy for reducing school anxiety in adolescents: Pilot study
Beele, G., Liesong, P., Bojanowski, S., Hildebrand, K., Weingart, M., Asbrand, J., Correll, C. U., Morina, N., & Uhlhaas, P. J. (2024) · JMIR Mental Health · doi:10.2196/56235 · Cited by 20 · see citing works
New issue of food allergy: Phobia of anaphylaxis in pediatric patients
Dahlsgaard, K. K., Lewis, M. O., & Spergel, J. M. (2020) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2020.07.010 · Cited by 20 · see citing works
Guzick, A. G., Schneider, S. C., Kendall, P. C., Wood, J. J., Kerns, C. M., Small, B. J., Park, Y. E., Cepeda, S. L., & Storch, E. A. (2022) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000755 · Cited by 19 · see citing works
Effective—and Tolerable: Acceptance and Side Effects of Intensified Exposure for Anxiety Disorders
Heinig, I., Knappe, S., Hoyer, J., Wittchen, H.-U., Richter, J., Arolt, V., Deckert, J., Domschke, K., Hamm, A., Kircher, T., et al. (2023) · Behavior Therapy · doi:10.1016/j.beth.2022.11.001 · Cited by 17 · see citing works
Guzick, A. G., Leong, A. W., Dickinson, E. M., Schneider, S. C., Zopatti, K., Manis, J., Meinert, A. C., Barth, A. M., Perez, M., Campo, D. M., et al. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.01.034 · Cited by 16 · see citing works
“The primary techniques used in this program were exposure therapy and behavioral activation, two central approaches in CBT for internalizing disorders (Weersing et al., 2017; Whiteside et al., 2020).”
Bertelsen, T. B., Himle, J., & Håland, Å. T. (2022) · Child Psychiatry & Human Development · doi:10.1007/s10578-021-01304-5 · Cited by 19 · see citing works
“CBT for youth anxiety is typically delivered individually or in larger groups compared to the present study, and lasts on average 18 h with shorter sessions compared to the present study [22].”
BackgroundResultThe feasibility of verbal and virtual reality exposure for youth with academic performance worry
Whiteside, S. P. H., Brennan, E., Biggs, B. K., Vickers, K. S., Hathaway, J. C., Seifert, S. J., Kramer, K. M., & Hofschulte, D. R. (2020) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2020.102298 · Cited by 16 · see citing works
Self-citationLife skills training: Can it increases self esteem and reduces student anxiety?
Winarsunu, T., Azizah, B. S. I., Fasikhah, S. S., & Anwar, Z. (2023) · Heliyon · doi:10.1016/j.heliyon.2023.e15232 · Cited by 27 · see citing works
Mendez, E. M., Dahlsgaard, K. K., Hjelmgren, J. M., Mills, J. A., Suresh, V., & Strawn, J. R. (2023) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/cap.2023.0018 · Cited by 15 · see citing works
Whiteside, S. P. H., Biggs, B. K., Ollendick, T. H., Dammann, J. E., Tiede, M. S., Hofschulte, D. R., Reneson-Feeder, S. T., Cunningham, M. L., Sawchuk, N. R., Geske, J. R., et al. (2022) · Behavior Therapy · doi:10.1016/j.beth.2022.01.010 · Cited by 14 · see citing works
Self-citationUnderstanding therapists’ perceived determinants of trauma narrative use
Frank, H. E., Last, B. S., AlRabiah, R., Fishman, J., Rudd, B. N., Kratz, H. E., Harker, C. M., Fernandez-Marcote, S., Jackson, K., Comeau, C., et al. (2021) · Implementation Science Communications · doi:10.1186/s43058-021-00231-9 · Cited by 16 · see citing works
“One intervention component that is used the least frequently despite having the strongest evidence for its effectiveness is exposure, which involves approaching feared situations in a gradual and supportive manner [6, 7].”
BackgroundPatterns of Child Mental Health Service Utilization Within a Multiple EBP System of Care
Lui, J. H. L., Brookman-Frazee, L. I., Vázquez, A. L., Cox, J. R., Innes-Gomberg, D., Taguchi, K., Pesanti, K., & Lau, A. S. (2021) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-021-01179-7 · Cited by 14 · see citing works
Teunisse, A. K., Pembroke, L., O’Gradey‐Lee, M., Sy, M., Rapee, R. M., Wuthrich, V. M., Creswell, C., & Hudson, J. L. (2022) · JCPP Advances · doi:10.1002/jcv2.12080 · Cited by 15 · see citing works
“…exposure is graded and delivered both in session and out of session, and usually preceded by the introduction of coping strategies (Kendall & Peterman, 2015) despite recent evidence that these might not enhance outcomes, and may in fact impede positive treatment outcomes (Whiteside et al., 2020).”
BackgroundLuo, A., & McAloon, J. (2020) · Depression and Anxiety · doi:10.1002/da.23116 · Cited by 16 · see citing works
“A recent study examining treatment components noted that CBT programs that included a relaxation component was significantly linked with smaller treatment effect sizes when compared with treatment that did not include relaxation (Whiteside et al., 2020).”
ResultAdolescents’ lived experience of panic disorder: an interpretative phenomenological analysis
Baker, H. J., Hollywood, A., & Waite, P. (2022) · BMC Psychology · doi:10.1186/s40359-022-00849-x · Cited by 14 · see citing works
“Given the prominence of avoidance and safety behaviours exhibited among the adolescents in this study, addressing these factors in treatment through exposure is likely to be vital [52].”
BackgroundCognitive Behavioral Therapy for Anxiety and Depression in Children and Adolescents
Smárason, O., Skarphéðinsson, G., & Storch, E. A. (2024) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2024.02.002 · Cited by 22 · see citing works
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“This is consistent with findings that the presence of relaxation within protocols is associated with less effective treatment [44, 46, 48].”
ResultSaavedra, L. M., Morgan‐López, A. A., West, S. G., Alegria, M. M., & Silverman, W. K. (2022) · Prevention Science · doi:10.1007/s11121-022-01422-z · Cited by 13 · see citing works
“Over 40 randomized clinical trials provide strong and consistent evidence for the short-term efficacy of exposure-based cognitive behavioral treatment for reducing anxiety and phobic disorders (e.g., Whiteside et al., 2020).”
BackgroundBertelsen, T. B., Wergeland, G. J., Nordgreen, T., Himle, J. A., & Håland, Å. T. (2022) · Psychiatry Research · doi:10.1016/j.psychres.2022.114632 · Cited by 12 · see citing works
Robberegt, S. J., Kooiman, B., Albers, C. J., Nauta, M. H., Bockting, C., & Stikkelbroek, Y. A. J. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-058560 · Cited by 12 · see citing works
Holliman, R., & Foster, R. D. (2023) · Journal of Child and Adolescent Counseling · doi:10.1080/23727810.2023.2232142 · Cited by 13 · see citing works
“an average effect size across all studies to ascertain how effective an intervention might be when taking into account the variegated effect sizes across all included studies (Hoogsteder et al., 2022; Lipsey & Wilson, 2001; Whiteside et al., 2020; Woo et al., 2020).”
BackgroundPremo, J. E., Liu, Y., Bilek, E. L., Phan, K. L., Monk, C. S., & Fitzgerald, K. D. (2020) · Journal of Psychiatry and Brain Science · doi:10.20900/jpbs.20200005 · Cited by 12 · see citing works
“Some research has indicated that relaxation training may not be as effective as either cognitive restructuring or exposure therapy for anxious youth, and may not be necessary in CBT [67,84].”
BackgroundBrown, F. L., Lee, C., Servili, C., Willhoite, A., van Ommeren, M., Hijazi, Z., Kieselbach, B. S., & Skeen, S. (2024) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2024.57 · Cited by 10 · see citing works
“In-session exposure tasks have been found to improve anxiety levels, while relaxation techniques have shown less impact (Whiteside et al., 2020).”
BackgroundParent-coached exposure therapy versus cognitive behavior therapy for childhood anxiety disorders
Whiteside, S. P. H., Biggs, B. K., Geske, J. R., Gloe, L. M., Reneson-Feeder, S. T., Cunningham, M. L., Dammann, J. E., Brennan, E., Ong, M. L., Olsen, M. W., et al. (2024) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2024.102877 · Cited by 11 · see citing works
Self-citationRienks, K., Salemink, E., Sigurðardóttir, L. B. L., Meléndez‐Torres, G. J., Staaks, J. P. C., & Leijten, P. H. O. (2025) · Behaviour Research and Therapy · doi:10.1016/j.brat.2025.104692 · Cited by 13 · see citing works
Woodard, G. S., Triplett, N. S., Frank, H. E., Harrison, J. P., Robinson, S., & Dorsey, S. (2021) · Implementation Research and Practice · doi:10.1177/26334895211057883 · Cited by 11 · see citing works
“However, exposure is rarely implemented in community mental health (CMH) settings (Becker-Haimes et al., 2017; Borntrager et al., 2013; Higa-McMillan et al., 2017; Whiteside et al., 2016; Whiteside et al., 2020; Wolitzky-Taylor et al., 2015).”
BackgroundByrne, G., Connon, G., Martin, E. K., McHugh, S., & Power, L. (2021) · British Journal of Clinical Psychology · doi:10.1111/bjc.12309 · Cited by 11 · see citing works
Norris, L. A., Rabner, J. C., Crane, M. E., Cervin, M., Ney, J. S., Benito, K., Kendall, P. C., & Frank, H. E. (2023) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2023.102742 · Cited by 10 · see citing works
Cognitive Behavioral Therapy for Anxiety Disorders
Trent, E. S., & Storch, E. A. (2024) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2024.04.011 · Cited by 10 · see citing works
aval, M. H., Mashhadi, A., Suveg, C. M., Bigdeli, I., Yazdi, S. A. A., & Rafi, M. A. (2021) · Behavior Therapy · doi:10.1016/j.beth.2021.09.003 · Cited by 10 · see citing works
Whiteside, S. P. H., Sawchuk, N. R., Brennan, E., Lebow, J. R., Sawchuk, C. N., Biggs, B. K., Dammann, J. E., Tiede, M. S., Hofschulte, D. R., Reneson-Feeder, S. T., et al. (2023) · Journal of Clinical Psychology · doi:10.1002/jclp.23537 · Cited by 10 · see citing works
Self-citationStiede, J. T., Mangen, K. H., & Storch, E. A. (2024) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2024.04.014 · Cited by 10 · see citing works
Grajdan, M. M. V., Etel, E., Farrell, L. J., & Donovan, C. L. (2024) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-024-00505-3 · Cited by 9 · see citing works
“…important CBT component in child anxiety treatment and that adding strategies such as relaxation may reduce treatment effects (Ale et al., 2015; Whiteside et al., 2020), research could examine whether including exposure hierarchies in the first parent module and presenting less important…”
Rith‐Najarian, L., Triplett, N. S., Weisz, J. R., & McLaughlin, K. A. (2021) · Development and Psychopathology · doi:10.1017/s0954579420002059 · Cited by 9 · see citing works
“For example, behavioral exposures have shown stronger effectiveness than relaxation skills in the treatment of youth anxiety (Whiteside et al., 2020).”
BackgroundImplementing Cognitive-Behavioral Therapy in Children and Adolescents with Anxiety Disorders
Patriarca, G. C., Pettit, J. W., & Silverman, W. K. (2022) · Clinical Psychology and Special Education · doi:10.17759/cpse.2022110207 · Cited by 9 · see citing works
Emotion‐focused skills training for parents with anxious children. A pilot study
Zahl‐Olsen, R., Severinsen, L., Shahar, B., Stiegler, J. R., & Bertelsen, T. B. (2023) · Journal of Marital and Family Therapy · doi:10.1111/jmft.12643 · Cited by 8 · see citing works
Heinig, I., Weiss, M. H., Hamm, A. O., Hein, G., Hollandt, M., Hoyer, J., Kanske, P., Richter, J., Wïttchen, H., & Pittig, A. (2023) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2023.102792 · Cited by 8 · see citing works
Plaisted, H., Waite, P., & Creswell, C. (2021) · Behaviour Research and Therapy · doi:10.1016/j.brat.2021.103997 · Cited by 10 · see citing works
The Cognitive Behavioral Therapy Competence Scale (CCS): initial development and validation
Rodríguez‐Quintana, N., Choi, S. Y., Bilek, E. L., Koschmann, E., Albrecht, J. R., Prisbe, M., & Smith, S. N. (2021) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x21000362 · Cited by 9 · see citing works
“, 2019), although these components, in addition to cognitive restructuring, are potentially the most effective components for youth experiencing depression or anxiety (e.g. Oud et al., 2019; Whiteside et al., 2020).”
BackgroundWhiteside, S. P. H., Biggs, B. K., Dammann, J. E., Tiede, M. S., Hofschulte, D. R., & Brennan, E. (2020) · Behavior Modification · doi:10.1177/0145445520982966 · Cited by 8 · see citing works
Self-citationBaumel, A. (2025) · Frontiers in Digital Health · doi:10.3389/fdgth.2025.1541676 · Cited by 7 · see citing works
CBT for Youth Anxiety: How Does It Fit Within Community Mental Health?
Kendall, P. C., Maxwell, C. A., Jakubovic, R. J., Ney, J. S., McKnight, D. S., & Baker, S. (2022) · Current Psychiatry Reports · doi:10.1007/s11920-022-01403-7 · Cited by 8 · see citing works
de Jong, R., Lommen, M. J. J., de Jong, P. J., van Hout, W. J. P. J., der Marel, A. C. E. D.-V., & Nauta, M. H. (2024) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2024.101942 · Cited by 7 · see citing works
Becker‐Haimes, E. M., Weiss, M., Schaechter, T., Young, S., & Sanchez, A. L. (2025) · Journal of Mood and Anxiety Disorders · doi:10.1016/j.xjmad.2025.100129 · Cited by 6 · see citing works
“A higher dose of exposure received was also associated with improved treatment response, which aligns with prior trials [2].”
InfluentialOlsson, E., Andrén, P., Claesdotter‐Knutsson, E., Dellgran, K., Castro, O. C., Möttus, A., Mataix‐Cols, D., Gušić, S., Perrin, S. G., Serlachius, E., et al. (2025) · Child Psychiatry & Human Development · doi:10.1007/s10578-025-01908-1 · Cited by 7 · see citing works
Bonnert, M., Nash, S., Andersson, E. M., Bergström, S., Janson, C., & Almqvist, C. (2024) · BMJ Open Respiratory Research · doi:10.1136/bmjresp-2023-002035 · Cited by 6 · see citing works
“15 Although some components may be effective, the training provided for each component may not be sufficient to support cognitive or behavioural changes in participants.”
BackgroundBilek, E. L., Iturra-Mena, A. M., Becker, H. C., Phan, K. L., Monk, C. S., & Fitzgerald, K. D. (2025) · JAACAP Open · doi:10.1016/j.jaacop.2025.04.003 · Cited by 6 · see citing works
“…anxiety disorders, bolstering prior fi ndings that relaxation is not necessary for youth engagement with or even response to CBT for anxiety 5,22,55 and adding important new insights that younger children may especially bene fi t from exposure-based models and that teletherapy is as…”
Dunning, E. E., Khan, A. N., Becker‐Haimes, E. M., & Guzick, A. G. (2025) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-025-01317-x · Cited by 6 · see citing works
“This finding was echoed in a meta-analysis of 75 RCT studies (including 5,412 participants) that found protocols with more exposure produced significantly larger effects (standard mean dif - ference: -0.12 to -0.15; Whiteside et al., 2020).”
InfluentialIntroduction and Overview of Day Treatment Programs
Leffler, J. M., & Frazier, E. A. (2022) · Issues in clinical child psychology · doi:10.1007/978-3-031-14567-4_1 · Cited by 6 · see citing works
Meyer, A. E., Choi, S. Y., Tugendrajch, S. K., Rodríguez‐Quintana, N., Smith, S. N., Koschmann, E., Abelson, J. L., & Bilek, E. L. (2024) · Evidence-Based Practice in Child and Adolescent Mental Health · doi:10.1080/23794925.2024.2324770 · Cited by 6 · see citing works
“…true given apparent differences among both the efficacy and frequency of delivery of various CBT components, with behavioral components being the most effective, yet least frequently delivered (Becker-Haimes et al., 2017; Garland et al., 2010; Spates et al., 2006; Whiteside et al., 2020).”
Blossom, J. B., Jungbluth, N. J., Bolden, C. R., Woodruff, M. A., Pringle, W., Read, K. L., Jenness, J. L., Martin, B., & Schoenfelder, E. N. (2024) · Evidence-Based Practice in Child and Adolescent Mental Health · doi:10.1080/23794925.2024.2330397 · Cited by 6 · see citing works
“Treatment components include psychoeducation on anxiety and exposure to feared situations, consistent with growing evidence in support of streamlined expo-sure-based interventions (Whiteside et al., 2020).”
Young, B. N., Mohanty, E., Levine, K., & Klein-Tasman, B. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1098449 · Cited by 6 · see citing works
Soo, C. A., Tate, R. L., Catroppa, C., Benson, S. G., McDonald, S., Rapee, R. M., & Anderson, V. A. (2022) · Neuropsychological Rehabilitation · doi:10.1080/09602011.2022.2154811 · Cited by 5 · see citing works
“For example, in the general population, previous researchers have suggested that greater amounts of in-session exposure is related to larger e ff ect sizes between CBT and waitlist control groups (Whiteside et al., 2020).”
BackgroundChessell, C., Halldorsson, B., Walters, S., Farrington, A., Harvey, K., & Creswell, C. (2023) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465823000450 · Cited by 5 · see citing works
“Thus, the lack of improvement for these participants is unsurprising given that exposure to fears/feared situations is key for treatment change (Peris et al ., 2015; Whiteside et al ., 2020).”
BackgroundRueppel, M., Becker, H. C., Iturra-Mena, A. M., Bilek, E. L., Monk, C. S., Phan, K. L., & Fitzgerald, K. D. (2024) · Child Psychiatry & Human Development · doi:10.1007/s10578-023-01658-y · Cited by 5 · see citing works
de Jong, R., Lommen, M. J. J., van Hout, W. J. P. J., Kuijpers, R., Stone, L. L., de Jong, P. J., & Nauta, M. H. (2023) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2023.102785 · Cited by 5 · see citing works
Supporting Clinicians in Implementing Exposure Therapy for Anxiety and Related Disorders
Frank, H. E., Woodard, G., & Martinez, R. G. (2025) · Current Psychiatry Reports · doi:10.1007/s11920-025-01612-w · Cited by 3 · see citing works
Gloe, L. M., Biggs, B. K., Geske, J. R., Reneson-Feeder, S. T., Dammann, J. E., Hofschulte, D. R., & Whiteside, S. P. H. (2025) · Behavior Therapy · doi:10.1016/j.beth.2025.07.002 · Cited by 4 · see citing works
Self-citationA comparison of virtual reality and verbal imaginal exposure for childhood anxiety disorders
Biggs, B. K., Whiteside, S. P. H., Knutson, M., Seifert, S. J., Hofschulte, D. R., Geske, J. R., Lass, A. N. S., Vickers, K. S., Gloe, L. M., & Reneson-Feeder, S. T. (2025) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2025.102974 · Cited by 4 · see citing works
Self-citationEffectiveness of XR‐Based Exposure Therapy for Phobic Disorders
Lamb, R. L., Perry, J., Sutherland, E. C., Hoston, D., Garris, A., & DeRiggs, A. (2025) · Journal of Counseling & Development · doi:10.1002/jcad.12557 · Cited by 4 · see citing works
Chiappini, E. A., Parrish, C., Reynolds, E. K., & Mcguire, J. F. (2021) · Bulletin of the Menninger Clinic · doi:10.1521/bumc.2021.85.3.231 · Cited by 4 · see citing works
Want to help your patients with food allergy anxiety? Do proximity challenges!
Dahlsgaard, K. K., & Lewis, M. O. (2025) · Annals of Allergy Asthma & Immunology · doi:10.1016/j.anai.2025.02.020 · Cited by 4 · see citing works
Brennan, E., Bailey, K. J., Biggs, B. K., Cunningham, M. L., Dammann, J. E., Reneson-Feeder, S. T., Tiede, M. S., & Whiteside, S. P. H. (2022) · Journal of Child and Family Studies · doi:10.1007/s10826-022-02396-w · Cited by 4 · see citing works
“Additionally, the simplified exposureonly approach of PCET lends itself well to more portable technology-enhanced treatment platforms that align well with modern youth’s interests (e.g., Anxiety Coach app; see Whiteside et al., 2019).”
MethodResultSelf-citationExamining Community Clinicians Use of Imaginal Exposure with Childhood Anxiety Disorders
Whiteside, S. P. H. (2023) · Child Psychiatry & Human Development · doi:10.1007/s10578-023-01556-3 · Cited by 4 · see citing works
“While these strategies may be less effective than exposure, they are prominently included in evidenced based treatment protocol and therapists cannot be faulted for using them [6, 7].”
Self-citationAnderson, N. J., Rozenman, M. S., Pennington, B. F., Willcutt, E. G., & McGrath, L. M. (2022) · Journal of Learning Disabilities · doi:10.1177/00222194221098719 · Cited by 4 · see citing works
Sørensen, N. M., Skaarnes, H., Mathiasen, K., Thastum, M., & Lomholt, J. J. (2025) · JMIR Formative Research · doi:10.2196/66966 · Cited by 3 · see citing works
“It was decided to develop a cognitive behavioral therapy (CBT)–based program as this is the most well-researched approach and has shown good results in previous evaluations using the internet-based format [27-31].”
Koriakina, M. M., Agranovich, O. Е., Ntoumanis, I., Ulanov, M., Blank, I. B., Шестакова, А. Н., & Blagovechtchenski, E. (2025) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2025.1499521 · Cited by 3 · see citing works
Gloe, L. M., Biggs, B. K., Lipinski, A. W., Pejic, J., Kor, A. K., Knapp, J., Lin, A. J., & Whiteside, S. P. H. (2025) · Evidence-Based Practice in Child and Adolescent Mental Health · doi:10.1080/23794925.2025.2579294 · Cited by 3 · see citing works
Self-citationAdapting and Implementing Evidence-Based Interventions on Inpatient Psychiatric Units
Gurtovenko, K., Waitz, C., & Tebbett-Mock, A. A. (2024) · Issues in clinical child psychology · doi:10.1007/978-3-031-62749-1_12 · Cited by 3 · see citing works
Pilot Study of Self-Distancing Augmentation to Exposure Therapy for Youth Anxiety
Bilek, E. L., Meyer, A. E., Tomlinson, R. C., & Chen, C. R. (2023) · Child Psychiatry & Human Development · doi:10.1007/s10578-023-01540-x · Cited by 3 · see citing works
“Through this process, exposure therapy has gained support as the most effective treatment component in CBT for youth anxiety [8, 9].”
Nonverbal Synchrony and Alliance in Exposure Therapy for Pediatric Anxiety: a Case Report
Oreshina, G. V., & Zhukova, M. (2024) · Journal of Modern Foreign Psychology · doi:10.17759/jmfp.2024130101 · Cited by 3 · see citing works
Wahlund, T., Wallhem, M., Serlachius, E., & Engberg, H. (2021) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x21000027 · Cited by 3 · see citing works
“Exposure to feared and avoided stimuli, the main treatment component of BIP Worry, is an effective treatment technique for youth with anxiety disorders including GAD and worry (Whiteside et al ., 2019).”
- Authors
- Whiteside, S. P. H., Sim, L. A., Morrow, A. S., Farah, W. H., Hilliker, D. R., Murad, M. H., & Wang, Z.
- Affiliations
- Mayo Clinic (US)
- Corresponding author
- Whiteside, Stephen P. H.
- Venue
- Clinical Child and Family Psychology Review
- Published
- 2019-10-18
- Volume
- 23
- Issue
- 1
- Pages
- 102-121
- ISSN
- 1096-4037 (ISSN-L)
- 1573-2827
- PMC
- PMC9005063
- OpenAlex
- W2980786259
- Cited by
- 190
- References
- 127
- Citations by year
- 2026: 28 · 2025: 32 · 2024: 34 · 2023: 23 · 2022: 33 · 2021: 27 · 2020: 11 · 2019: 1
- FWCI
- 2.69
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Clinical Child and Family Psychology Review (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Agency for Healthcare Research and Quality (HHSA290201500013I)
- 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 › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- cognitive behavioral therapy, childhood anxiety disorders, relaxation techniques, treatment components, treatment efficacy, waitlist control, child-reported outcomes, parental involvement
- MeSH terms
- Anxiety Disorders, Child, Humans, Implosive Therapy, Outcome and Process Assessment, Health Care, Relaxation Therapy, Cognitive Behavioral Therapy
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