Cited by 191Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesChild and Adolescent Psychosocial and Emotional DevelopmentPsychotherapy Techniques and Applications

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A Meta-analysis to Guide the Enhancement of CBT for Childhood Anxiety: Exposure Over Anxiety Management

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Whiteside, Stephen P. H., Sim, Leslie A., Morrow, Allison S., Farah, Wigdan H., Hilliker, Daniel R., Murad, M. Hassan, Wang, Zhen·2020·Clinical Child and Family Psychology Review

DOI 10.1007/s10567-019-00303-2PMC PMC9005063

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Abstract

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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“Consistent with these findings, qualitative studies with caregivers of anxious youth have highlighted the extreme perseverance required of families to access anxiety treatment for their child and the need to reach out repeatedly to providers to successfully access treatment (Crouch et al., 2019;…”
Exposure Therapy in the Treatment of Childhood Anxiety: A Comprehensive Guide and a Case Study
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Díaz, D. E., Norman, L. J., Block, S. R., Iturra-Mena, A. M., Phan, K. L., Monk, C. S., & Fitzgerald, K. D. (2025) · Biological Psychiatry Cognitive Neuroscience and Neuroimaging · doi:10.1016/j.bpsc.2025.12.005
Additional file 1 of Epidemiology of anxiety disorders: global burden and sociodemographic associations
Javaid, S. F., Hashim, I. J., Hashim, M. J., Stip, É., Samad, M. A., & Ahbabi, A. A. (2024) · Figshare · doi:10.6084/m9.figshare.26579618
Additional file 2 of Cognitive behavioural therapy for anxiety in children and young people on the autism spectrum: a systematic review and meta-analysis
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Additional file 2 of Epidemiology of anxiety disorders: global burden and sociodemographic associations
Javaid, S. F., Hashim, I. J., Hashim, M. J., Stip, É., Samad, M. A., & Ahbabi, A. A. (2024) · Figshare · doi:10.6084/m9.figshare.26579621
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Zhang, F., Liu, W., Yang, H., Sun, Y., Lei, X., Ding, Y., Zhang, X., Hu, Z., Hu, S., Wang, Z., et al. (2025) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/s13034-025-01012-1
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Exposure-Focused Cognitive Behavioral Therapy Increases Connectivity Between the Central Executive and Salience Networks in Pediatric Anxiety
Díaz, D. E., Becker, H. C., Hardi, F. A., Beltz, A. M., Bilek, E. L., Block, S. R., Phan, K. L., Monk, C. S., & Fitzgerald, K. D. (2026) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.64898/2026.01.28.26345061
“However, CBT can be challenging for many patients because its most active component, exposure, requires patients to repeatedly confront the very fears that cause them distress (Bilek et al., 2021; Peris et al., 2015; Whiteside et al., 2020).”
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Influential
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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.
ORCID: Whiteside, Stephen P. H.
Sim, Leslie A.
Farah, Wigdan H.
Murad, M. Hassan
Wang, Zhen
Venue: Clinical Child and Family Psychology Review
Publisher: Springer Science and Business Media LLC
Published: 2019-10-18
Volume: 23
Issue: 1
Pages: 102-121
ISSN: 1096-4037 (ISSN-L)
1573-2827
DOI: 10.1007/s10567-019-00303-2
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
Licence: www.springer.com/tdm (tdm)
www.springer.com/tdm (vor)
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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A Meta-analysis to Guide the Enhancement of CBT for Childhood Anxiety: Exposure Over Anxiety Management

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