The feasibility of improving CBT for childhood anxiety disorders through a dismantling study
Abstract
This preliminary randomized controlled trial (RCT) examines the feasibility of dismantling cognitive behavioral therapy (CBT) for childhood anxiety disorders. Fourteen children (10 girls) ages 7 to 14 (m = 10.2) with social phobia, generalized anxiety disorder, separation anxiety disorder, or panic disorder were randomized to receive 6 sessions of either a) the pre-exposure anxiety management strategies presented in traditional CBT, or b) parent-coached exposure therapy. The sample was selected from a treatment seeking population and is representative of children in clinical settings. Examination of fidelity ratings, dropouts, and satisfaction ratings indicated that the interventions were distinguishable, safe, and tolerable. The overall sample improved significantly with pre-post effect sizes generally in the large range for both conditions. Between-group effect sizes indicating greater improvement with parent-coached exposure therapy were moderate or large for ten of 12 variables (i.e., 0.53 to 1.52). Re-evaluation after three months of open treatment suggested that the intervention emphasizing exposure early maintained its superiority while requiring fewer appointments.
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A dismantling study demonstrated that exposure-focused therapy was associated with better treatment outcomes compared to an intervention focusing on anxiety management strategies such as identification of anxious cognitions, problem solving, and relaxation training.
“Additionally, a dismantling study demonstrated that exposure-focused therapy was associated with better treatment outcomes compared to an intervention focusing on anxiety management strategies such as identification of anxious cognitions, problem solving, and relaxation training [26].”
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 [26]
Few studies have examined CBT for pediatric anxiety at a component level.
“However, few studies have examined CBT for pediatric anxiety at a component level.”
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 [26]
The reported benefits of exposure training align with previous research.
“the reported benefits of exposure training align with previous research [25, 26].”
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 [26]
The 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 [26]
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Cognitive behavioural therapy for anxiety disorders in children and adolescents
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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).”
BackgroundSelf-citationPractitioner Review: Anxiety disorders in children and young people – assessment and treatment
Creswell, C., Waite, P., & Hudson, J. (2020) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13186 · Cited by 140 · see citing works
“Exposure has been shown to be an important part of treatment (Ale et al., 2015; Peris et al., 2015b; Whiteside et al., 2015);”
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“Exposure therapy has been shown to be the key ingredient in CBT for anxiety (Ale, McCarthy, Rothschild, & Whiteside, 2015; Olatunji, Cisler, & Deacon, 2010; Peris et al., 2015, 2017; Voort, Svecova, Jacobson, & Whiteside, 2010; Whiteside et al., 2015), though community providers report using…”
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“, 2007), and an individual parent-coached exposure protocol administered once weekly for CADs (Whiteside et al., 2015) but larger than those found in an effectiveness study of usual care and the traditional model CBT for CADs (Southam-Gerow et al.”
BackgroundMethodResultInfluentialSelf-citationThe use of exposure therapy for child anxiety disorders in a medical center.
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“While no large-scale dismantling studies have been completed, one pilot study compared parent-guided exposure to non-exposure components of CBT for CADs and found differential effect sizes favoring exposure for many variables, including anxiety severity and overall improvement (Whiteside et al., 2015).”
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“Importantly, although expert consensus and dismantling studies indicate that exposure-based elements of CBT are active components that are effective in treating anxiety disorders, exposure-based CBT is infrequently included in interventions for children [19,20].”
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“To begin with, the symptom improvement with the Anxiety Coach application was large and consistent with previous studies supporting the success of exposure therapy without additional components (Whiteside et al., 2015).”
MethodResultSelf-citationPredictive Relationship Between Parental Beliefs and Accommodation of Pediatric Anxiety
Meyer, J. M., Clapp, J. D., Whiteside, S. P. H., Dammann, J. E., Kriegshauser, K. D., Hale, L. R., Jacobi, D. M., Riemann, B. C., & Deacon, B. J. (2017) · Behavior Therapy · doi:10.1016/j.beth.2017.11.004 · Cited by 30 · see citing works
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“…that the personalized feedback element is the active component of the intervention compared to normative feedback (Ale, McCarthy, Rothschild, & Whiteside, 2015). utilized meta-analyses to examine treatment elements related to outcome across 35 RCTs for childhood anxiety disorders (CADs) and…”
BackgroundResultWu, M. S., Caporino, N. E., Peris, T. S., Pérez, J., Thamrin, H., Albano, A. M., Kendall, P. C., Walkup, J. T., Birmaher, B. B., Compton, S. N., et al. (2019) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-019-00574-x · Cited by 29 · see citing works
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“…for the feasibility of conducting larger dismantling studies, and evidence of greater improvement in overall severity and parent-rated internalizing symptoms in the exposure condition supported the feasibility of introducing exposurebased strategies early in treatment (Whiteside et al., 2015).”
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Self-citationCognitive behavioral therapy for children and adolescents with anxiety disorders
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“CBT with young people typically involves anxiety management strategies (e.g., cognitive restructuring, relaxation) followed by exposure (Whiteside et al., 2015), however, the efficacy of individual elements of CBT for youth has received little scrutiny (Whiteside et al., 2015) limiting efforts to…”
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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].”
ResultParent-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-citationBeliefs about safety behaviours in the prediction of safety behaviour use
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“Accordingly, many exposure-based CBT treatment manuals assert that anxious individuals believe safety behaviours are necessary to tolerate anxiety and mitigate threat (Abramowitz et al., 2012; Brosan et al., 2013; Craske et al., 2006; Schmidt, 2012; Whiteside et al., 2015).”
BackgroundDeveloping a statewide network of coaches to support youth access to evidence-based practices
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“This improvement in behavioral skills is notable, especially given that component analyses have suggested that exposure and behavioral activation may account for most of the variance in symptom improvement (Ritschel et al., 2011; Whiteside et al., 2015).”
BackgroundWhiteside, 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-citationWhen Exposures Go Right: Effective Exposure-Based Treatment for Obsessive–Compulsive Disorder
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“This is alarming considering that research indicates that behavioral exposure is the core component of successful anxiety treatment (e.g., Peris et al. 2015; Whiteside et al. 2015).”
BackgroundPlaisted, H., Waite, P., & Creswell, C. (2021) · Behaviour Research and Therapy · doi:10.1016/j.brat.2021.103997 · Cited by 10 · see citing works
Whiteside, 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
“The clinical appropriateness of such an approach is supported by the growing body of evidence suggesting that exposure without other AMS can be tolerable, effective, and efficient (Ale et al., 2015; Whiteside et al., 2015; Whiteside, et al., 2020).”
BackgroundMethodInfluentialSelf-citationde Jong, R., Lommen, M. J. J., Timmerman, M. E., van Hout, W. J. P. J., Kuijpers, R., de Jong, P. J., & Nauta, M. H. (2021) · Behavior Therapy · doi:10.1016/j.beth.2021.03.010 · Cited by 8 · see citing works
“Moreover, a small RCT assessing 14 children with anxiety disorder(s) showed significantly greater improvement of anxiety symptoms for youth who followed just exposure sessions, compared to youth who followed just AMS sessions (Whiteside et al., 2015).”
BackgroundIntensive Treatments for Youth with Obsessive-Compulsive Disorder and Anxiety Disorders
Maye, C. E., Pinciotti, C., & Storch, E. (2022) · Advances in Psychiatry and Behavioral Health · doi:10.1016/j.ypsc.2022.06.003 · Cited by 4 · see citing works
Radtke, S. R., Whiteside, S. P. H., & Ollendick, T. H. (2022) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-022-10018-4 · Cited by 8 · see citing works
“To address these three aims, data from three child anxiety treatment studies conducted by Whiteside and colleagues (Whiteside, 2012; Whiteside et al., 2015; Whiteside et al., 2019) were re-examined.”
MethodSelf-citationOlsson, 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
Anxiety Disorders in Children and Adolescents
Bertie, L., Sicouri, G., & Hudson, J. L. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-818697-8.00040-6 · Cited by 6 · see citing works
The compatibility of clinical child mental health treatment and evidence-based treatment protocols.
Whiteside, S. P. H., Leffler, J. M., Hord, M. K., Sim, L. A., Schmidt, M. M., & Geske, J. R. (2018) · Psychological Services · doi:10.1037/ser0000267 · Cited by 6 · see citing works
Self-citationRacz, J. I., Perkes, I., Bialocerkowski, A., Dyason, K. M., Grisham, J., McKenzie, M., & Farrell, L. (2025) · Child Psychiatry and Human Development · doi:10.1007/s10578-024-01805-z · Cited by 5 · see citing works
Uduwa-vidanalage, E. S., Lee, J. D., Hermans, D., Engelhard, I. M., Scheveneels, S., & Meyerbröker, K. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-06756-w · Cited by 5 · see citing works
“Exposure-based interventions are considered one of the crucial and active ingredi-ents of effective CBT for SAD [1, 31, 53, 111].”
Optimising Anxiety Treatment for Autistic Children: a Narrative Review
Pearce, R. T., Kelly, A. B., & Campbell, M. A. (2023) · Review Journal of Autism and Developmental Disorders · doi:10.1007/s40489-023-00397-z · Cited by 5 · see citing works
“Parents are often included and gradually assume responsibility for conducting in-session exposures, culminating in fully leading the exposure in final sessions (Whiteside et al., 2015).”
Pediatric Generalized Anxiety Disorder
Cho, S., Przeworski, A., & Newman, M. G. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-813004-9.00012-8 · Cited by 6 · see citing works
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Self-citationChild and adolescent psychiatry: challenges, solutions, opportunities, and future directions
Cortese, S., Arango, C., Aymerich, C., Catalan, A., Chetouani, M., Cohen, D., Coghill, D., Gabellone, A., Iniesta, R., Kadan, A., et al. (2026) · World Psychiatry · doi:10.1002/wps.70044 · Cited by 4 · see citing works
“These studies are currently limited in youth, but show promise (e.g., parent involvement in CBT improves anxiety outcomes) 164 .”
Development of ‘learn to dare!’: An online assessment and intervention platform for anxious children
Simon, E., de Hullu, E., Bögels, S. M., Verboon, P., Butler, P., van Groeninge, W., Slot, W., Craske, M. G., Whiteside, S. P. H., & van Lankveld, J. J. D. M. (2020) · BMC Psychiatry · doi:10.1186/s12888-020-2462-3 · Cited by 4 · see citing works
Self-citationBrennan, 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
“However, research has indicated that children actually tolerate exposure very well and that exposure-focused treatment can be highly effective in the amelioration of CADs (Whiteside et al., 2015, 2020, 2020).”
BackgroundMethodResultInfluentialSelf-citationLieneman, C. C., Guastello, A. D., Munson, M. S., Barthle-Herrera, M. A., Bailey, B. A., Higham, M., Druskin, L. R., & McNeil, C. B. (2024) · Journal of Indian Association for Child and Adolescent Mental Health · doi:10.1177/09731342241252560 · Cited by 3 · see citing works
Racz, J. I., Perkes, I., Bialocerkowski, A., Dyason, K. M., Grisham, J., McKenzie, M., & Farrell, L. (2025) · Children · doi:10.3390/children12020156 · Cited by 1 · see citing works
Cui, L., & Tang, X. (2026) · Behaviour Research and Therapy · doi:10.1016/j.brat.2026.105008 · Cited by 2 · see citing works
Quantifying Session Content in the Delivery of Parent Coached Exposure Therapy
Whiteside, S. P. H., Brennan, E., Biggs, B. K., Sawchuk, N. R., Hofschulte, D. R., & Tiede, M. S. (2021) · Evidence-Based Practice in Child and Adolescent Mental Health · doi:10.1080/23794925.2021.1931986 · Cited by 2 · see citing works
“In addition, the potential for PCET to improve upon the effectiveness and efficiency of multicomponent CBT is supported by a small feasibility-focused randomized controlled trial (Whiteside et al., 2015).”
BackgroundResultInfluentialSelf-citationWhiteside, S. P. H., Biggs, B. K., Hofschulte, D. R., Seifert, S. J., & Kramer, K. M. (2018) · Evidence-Based Practice in Child and Adolescent Mental Health · doi:10.1080/23794925.2018.1514547 · Cited by 1 · see citing works
“, anxiety and OCD) group treatment, as well as examined empirically (Whiteside et al., 2015; Whiteside, Dammann, Tiede, Biggs, & Hillson Jensen, 2017).”
MethodSelf-citationMoses, K., Gonsalvez, C. J., Kurt, P., & Meade, T. (2025) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2025.2578746 · Cited by 1 · see citing works
“…of arousal reduction strategies, such as diaphragmatic breathing, have been shown to demonstrate little additional clinical benefit (Deacon et al., 2012; B. Deacon et al., 2013) and may prolong therapy and decrease its effectiveness (Adams et al., 2015; Ale et al., 2015; Whiteside et al., 2015).”
Balan, R., Dobrean, A., Poetar, C.-R., Florean, I. S., Balázsi, R., Coșa, I. M., & Månsson, K. N. T. (2026) · Acta Psychologica · doi:10.1016/j.actpsy.2026.106692 · Cited by 1 · see citing works
Pincus, D. B., & Hardway, C. (2019) · Innovations in CBT for Childhood Anxiety, OCD, and PTSD · doi:10.1017/9781108235655.007 · Cited by 1 · see citing works
Exposure therapy for separation anxiety disorder
West, K. B., Wilbanks, J., & Suveg, C. M. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-815915-6.00007-x · Cited by 1 · see citing works
Isaksson, A., Åhlén, J., Hasson, H., & Eriksson, L. (2026) · BMC Primary Care · doi:10.1186/s12875-026-03191-y
“Additionally, a dismantling study demonstrated that exposure-focused therapy was associated with better treatment outcomes compared to an intervention focusing on anxiety management strategies such as identification of anxious cognitions, problem solving, and relaxation training [26].”
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Cognitive and Behavioral Strategies for the Treatment of Feeding Disorders in Adolescents
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Beliefs about Safety Behaviours: An Examination across Three Relevant Populations
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Self-citationTheoretical Base and Mechanism of Action
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Self-citationTreatment of Anxiety Disorders in Children and Adolescents
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Self-citationExposure for Pediatric Anxiety: Evidence-Based Clinical Practice in Context
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- Authors
- Whiteside, S. P. H., Ale, C. M., Young, B., Dammann, J. E., Tiede, M. S., & Biggs, B. K.
- Affiliations
- Mayo Clinic (US)
- Corresponding author
- Whiteside, Stephen P.H.
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 2015-10
- Volume
- 73
- Pages
- 83-89
- ISSN
- 0005-7967 (ISSN-L)
- OpenAlex
- W1018706410
- Cited by
- 84
- References
- 43
- Citations by year
- 2026: 7 · 2025: 5 · 2024: 3 · 2023: 5 · 2022: 9 · 2021: 7 · 2020: 19 · 2019: 11 · 2018: 4 · 2017: 5 · 2016: 7 · 2015: 1
- FWCI
- 8.53
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Behaviour Research and Therapy (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 › Clinical Psychology › Psychological Treatments and Assessments
- Keywords
- childhood anxiety disorders, cognitive behavioral therapy, social anxiety disorder, generalized anxiety disorder, separation anxiety disorder, panic disorder, intervention fidelity, treatment discontinuation, treatment satisfaction, early exposure
- MeSH terms
- Anxiety Disorders, Child, Child Behavior Disorders, Child, Preschool, Feasibility Studies, Female, Humans, Implosive Therapy, Male, Patient Dropouts, Cognitive Behavioral Therapy
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