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Effectiveness of cognitive behavioral therapy (CBT) for child and adolescent anxiety disorders across different CBT modalities and comparisons: a systematic review and meta-analysis
Open accessAbstract
Aim: Pediatric Anxiety Disorders (AD) are common. Cognitive behavioral therapy (CBT) is one of two first-line treatments of youth AD and it has previously been shown to be superior to wait-list but not placebo therapy. This study consists of a systematic review and meta-analysis of the literature to assess the efficacy of CBT modalities in comparison to control contingencies for pediatric anxiety disorders.Methods: Studies were included if they were randomized controlled trials, and if CBT was manualized or modular, alone or in combination with medication. CBT was required to include behavioral treatment, exposure treatment, or cognitive elements. Eligible studies included participants aged 18 years or younger.Results: Eighty-one studies were included, with 3386 CBT participants and 2527 control participants. The overall results indicated that CBT is an effective treatment for childhood AD. The results showed that individual-based CBT is superior to wait-list and attention control. Group-based CBT is superior to wait-list control and treatment as usual. Remote-based CBT was superior to attention control and wait-list control. Family-based CBT was superior to treatment as usual, wait-list control, and attention control. Selective serotonin reuptake inhibitors were no more effective than individual-based CBT. Combination treatment was, however, more effective than individual-based CBT.Conclusion: To the best of our knowledge, no meta-analysis has thus far disentangled the effects of CBT modalities across various comparisons. This meta-analysis hence provides an important update to the literature on the efficacy of CBT for treating anxiety disorders in young people.
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“In terms of youth, a meta-analysis of 81 RCTs tested various modalities of CBT (individual, group, family-based, and remote) against waitlist, attention, TAU, and medication controls in children and adolescents (Mage = 10.9 [1.6]) with mixed anxiety disorders [118].”
From Psychotherapeutic treatments for generalized anxiety disorder: cognitive and behavioral therapies, enhancement strategies, and emerging efforts (2022) · cites this paper as [118]
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“Overall, CBT in various modalities was superior to waitlist, showed mixed beneficial effects compared to attention controls, and did not outperform TAU.”
From Psychotherapeutic treatments for generalized anxiety disorder: cognitive and behavioral therapies, enhancement strategies, and emerging efforts (2022) · cites this paper as [118]
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“Individual CBT was not significantly different from SSRIs, but the combined treatment was superior to either treatment alone at post-test.”
From Psychotherapeutic treatments for generalized anxiety disorder: cognitive and behavioral therapies, enhancement strategies, and emerging efforts (2022) · cites this paper as [118]
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“Although a growing body of literature supports the use of individual, group, family-based, transdiagnostic, and disorder-specific CBT protocols for AD treatment (Butler et al., 2006; Cuijpers et al., 2016; Ewing et al., 2015; Sigurvinsdóttir et al., 2020), CBT adjustments to different age groups are still debated (Jam…”
Cognitive Behavioral Therapy for Anxiety and Depression in Children and Adolescents
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“Cognitive Behavioural Therapy (CBT) is a common and effective treatment of anxiety in neurotypical youth (Sigurvinsdóttir et al., 2019).”
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“Cognitive behavioural therapy (CBT) has traditionally been favoured as the psychological treatment for most difficul - ties (Blane et al., 2013 ; National Institute for Health and Care Excellence, 2011 ; Sigurvinsdóttir et al., 2019 ).”
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“CBT’s structured, problem-focused approach has been widely researched and applied in various cultural contexts, including Turkey, demonstrating its versatility (Atwood & Friedman, 2020; Başer & Hisar, 2021; Carroll, 2020; McGuire et al., 2021; Sigurvinsdóttir et al., 2020; Yorulmaz & Dirik, 2021).”
Li, L., Li, Q., Wang, J., Fu, Q., & Chi, M. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-07227-y · Cited by 4
“4 Relative effects plot supports the effectiveness of CBT, which, in line with the majority of research, significantly alleviates anxiety disorders in children and adolescents [99–101].”
Skarphéðinsson, G., & Karlsson, G. K. (2023) · Child Psychiatry & Human Development · doi:10.1007/s10578-023-01552-7 · Cited by 7
The Effect of Cognitive Behavioral Therapy on Anxiety in Adolescents
Khan, Z., Zaib, Q., Saeed, K., Khan, B., Pal, H. A., & Zaman, M. (2025) · Indus journal of bioscience research. · doi:10.70749/ijbr.v3i1.475 · Cited by 3
The Long-Term Effects of Emotional Neglect on Family Functioning and Anxiety Symptoms in Adolescents
Calaresi, D., Verrastro, V., Giordano, F., & Saladino, V. (2025) · Journal of Family Violence · doi:10.1007/s10896-025-01011-y · Cited by 3
A homeschool‐based cognitive behavioral program to improve adolescent mental health
Harper, A., & Brewer, T. L. (2021) · Journal of Child and Adolescent Psychiatric Nursing · doi:10.1111/jcap.12364 · Cited by 3
Evaluation of an Intensive Program for Children With Co-occurring Medical and Emotional Disorders
Girardet, R. G., Shellman, A. B., Llorens, A. V., Nguyen, L. K., Ellsworth, M., Rennie, K. M., & Ha, C. (2022) · Clinical Pediatrics · doi:10.1177/00099228221091429 · Cited by 3
Barron-Linnankoski, S. T. A., Raaska, H. K., Bergman, P., Närvänen, E., Elovainio, M. J., & Laasonen, M. R. (2022) · Children · doi:10.3390/children9111602 · Cited by 4
“According to the available systematic reviews/meta-analyses there is little evidence that CBT is superior to treatment as usual (TAU) in the treatment of internalizing symptoms [2,3,30,31].”
BackgroundResultInfluentialTrends, advances and directions in cognitive‐behavioral therapy for adolescent anxiety
Kendall, P. C., Meyer, M., & Ney, J. S. (2024) · World Psychiatry · doi:10.1002/wps.21247 · Cited by 4
Emmelkamp, J., Wisman, M. A., Beuk, N., Stikkelbroek, Y. A. J., Nauta, M. H., Dekker, J., & Christ, C. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-04291-6 · Cited by 6
“For adolescents with depressive and anxiety disorders, Cognitive Behavioral Therapy (CBT) is considered the treatment of choice [35, 36], with medium to large effect sizes in symptoms reduction [37].”
BackgroundCommon Treatment Elements of Manualized Evidence-Based Treatments for Youth Anxiety Disorders
Cepeda, S. L., Grassie, H. L., & Ehrenreich-May, J. (2022) · Advances in Psychiatry and Behavioral Health · doi:10.1016/j.ypsc.2022.06.005 · Cited by 2
Heydari, M., Bakhshipour, A., & Jajarmi, M. (2025) · Journal of Health Reports and Technology · doi:10.5812/jhrt-159745 · Cited by 2
Ong, C. S. Y., Rodgers, J., Cooper, M. N., Dempsey, Z., Eaton, R., Haines, K., Kuzminski, R., Magiati, I., Maybery, M. T., Uljarević, M., et al. (2025) · JCPP Advances · doi:10.1002/jcv2.70027 · Cited by 3
Tourette Syndrome Through the Ages: A Historical and Contemporary Overview
Vippa, T., & Martindale, J. M. (2025) · Journal of Child Neurology · doi:10.1177/08830738251404102 · Cited by 2
“…often recommended as an alternative treatment given its evidence of symptom reduction in commonly co-occurring conditions (depression, 92 anxiety, 93 anxiety with TS, 94 and obsessive-compulsive disorder 95,96 ); however, there is limited evidence for its ef fi cacy in the treatment of TS speci fi…”
Kazzi, C., Campbell, L., & Porter, M. A. (2023) · Review Journal of Autism and Developmental Disorders · doi:10.1007/s40489-023-00371-9 · Cited by 2
Treatment for Anxiety Disorders in Youth: Current Findings for Best Practice
Angelosante, A. G., Gasperetti, C. E., Halabian, T., & Fernandes, S. (2024) · Psychiatric Annals · doi:10.3928/00485713-20240222-01 · Cited by 3
Daş, H., Kurnaz, M. F., & Koçtürk, N. (2024) · Journal of Behavioral and Cognitive Therapy · doi:10.1016/j.jbct.2024.100509 · Cited by 3
School nurse–delivered anxiety interventions for adolescents: a systematic review and meta-analysis
Osland, I., Håland, Å. T., Himle, J., & Bertelsen, T. B. (2025) · Cogent Psychology · doi:10.1080/23311908.2025.2519529 · Cited by 2
“…al., 2023; Zhang et al., 2023) and findings from non-school settings consistently showing the superiority of CBt approaches over non-CBt options for youth anxiety (James et al., 2020; Piacentini, 2023; sigurvinsdóttir et al., 2020). nonetheless, divergent findings in the literature suggest caution.”
Bertie, L., Mackinnon, A. J., McDermott, E. A., O’Gradey‐Lee, M., Kikas, K., Tomlinson, M., & Hudson, J. L. (2026) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-026-00564-8 · Cited by 1
English, A. C., Brady, M., Sanchez, A. L., & Becker‐Haimes, E. M. (2026) · Children · doi:10.3390/children13030413 · Cited by 1
“CBT is a highly efficacious treatment for pediatric anxiety and related disorders, with multiple decades of controlled trials demonstrating its superiority over waitlist and attention controls, and in some cases, other psychotherapies [7–13].”
Elmer, C. K., & McLeod, T. C. V. (2021) · International Journal of Athletic Therapy & Training · doi:10.1123/ijatt.2020-0096 · Cited by 1
Chinsen, A., Wilson, J., Tollit, M. A., Pang, K. C., Pace, C. C., & Cronin, T. J. (2024) · International Journal of Transgender Health · doi:10.1080/26895269.2024.2431835 · Cited by 1
Redburn, J., & Hayes, B. (2025) · School Psychology International · doi:10.1177/01430343241310445 · Cited by 1
“…there was a medium effect size (odds ratio 2.55, 95% con fi dence intervals [1.32, 4.93]) across six studies comparing CBT with attention control groups who had nontherapeutic contact with psychotherapists, controlling for participants ’ expectations of change (Sigurvinsdóttir et al., 2020).”
InfluentialDoğan, U., Sarıcaoğlu, H., Sinem, A. C. A. R., Türkçapar, M. H., Sağkal, A. S., Büyüköksüz, E., Erözkan, A., Zeybek, S. U., Üzmez, H., Dağılgan, E. B., et al. (2025) · Current Psychology · doi:10.1007/s12144-025-07376-z · Cited by 1
Gabinet terapii psychologicznej, N., Meslin-Kuźniak, A., & Nowicka‐Sauer, K. (2020) · Psychiatria i Psychologia Kliniczna · doi:10.15557/pipk.2020.0034 · Cited by 1
“Najwyższą skuteczność leczenia GAD uzyskuje się, łącząc krótkoterminową psychoterapię CBT z farmakoterapią (Bear et al. , 2020; Kendall et al. , 2006; Sigurvinsdóttir et al. , 2020).”
Sartes, L. M. A., Santos, C. G. B., & de Andrade, A. A. C. (2022) · Springer eBooks · doi:10.1007/978-3-031-12737-3_23 · Cited by 1
Raftery-Helmer, J., Hart, A. S., Faro, A. L., Baez, D., & Moore, P. (2026) · Children · doi:10.3390/children13060837
“Although cognitive-behavioral therapy (CBT) protocols are a highly effective, front-line treatment for pediatric anxiety disorders [3,4], up to 40% of children who participate in these interventions show minimal clinical improvement [5,6]. actions and the reasons why parents engage in unhelpful…”
The role of self-concept in child anxiety disorders
Bellika, K. (2021) · Duo Research Archive (University of Oslo)
فعالية برنامج إرشادي معرفي سلوکي باستخدام الأوريجامي في خفض القلق لدى الأطفال مرضى السرطان
السعيد, ي. م. ا., الباقي, أ. د. إ. ع. ا. ع., & خطاب, ك. س. م. (2021) · مجلة العلوم التربوية بکلية التربية بالغردقة، جامعة جنوب الوادى · doi:10.21608/mseg.2022.132944.1051
Kunnskapsoppsummering og klassifisering av tiltaket: Mestringskatten (3. utg.)
Haugland, B. S. M., & Bjaastad, J. F. (2022) · Ungsinn Tidsskrift for virksomme tiltak for barn og unge · doi:10.7557/25.6688
Seidi, P. A.-M., & Jaff, D. (2023) · Elsevier eBooks · doi:10.1016/b978-0-323-85757-4.00010-9
Pengaruh Remote Cognitive Behavior Therapy (Rcbt) Pada Proses Recovery Pasien Dengan Gangguan Mental
Rumihin, R. B., & Wisnusakti, K. (2022) · JOURNAL SCIENTIFIC OF MANDALIKA (JSM) · doi:10.36312/10.36312/vol3iss5pp382-385
Anxiety disorders in children and adolescents
Muris, P. (2023) · Elsevier eBooks · doi:10.1016/b978-0-323-99613-6.00012-0
Anxiety Disorders and Obsessive-Compulsive Disorder
Corcoran, J., & Wolk, C. B. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780197653562.003.0009
Souto, A. P. B., Sousa, L. M. D. N., Magalhães, L. G., Almeida, C. R. F., Araujo, A. K. O., & Monteiro, A. R. M. (2024) · Caderno Pedagógico · doi:10.54033/cadpedv21n1-144
Non-pharmacological Interventions for Mental Disorders
(2024) · Frontiers research topics · doi:10.3389/978-2-8325-4708-3
Metadata
- Authors
- Sigurvinsdóttir, A. L., Jensínudóttir, K. B., Baldvinsdóttir, K. D., Smárason, O., & Skarphedinsson, G.
- Affiliations
- Akureyri Hospital (IS)
- University of Iceland (IS)
- National University Hospital of Iceland (IS)
- Faculty of Psychology, University of Iceland, Reykjavik, Iceland;
- Corresponding author
- Sigurvinsdóttir, Anna Lilja
- Venue
- Nordic Journal of Psychiatry
- Publisher
- Informa UK Limited
- Published
- 2019-11-18
- Volume
- 74
- Issue
- 3
- Pages
- 168-180
- ISSN
- 0029-1455 (ISSN-L)
- 0803-9488
- 1502-4725
- OpenAlex
- W2945326664
- Cited by
- 130
- References
- 112
- Citations by year
- 2026: 20 · 2025: 21 · 2024: 27 · 2023: 21 · 2022: 21 · 2021: 15 · 2020: 5
- FWCI
- 1.51
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Locations
- Nordic Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Skemman (submittedVersion)
- Hirsla (Landspítali University Hospital) (submittedVersion)
- 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
- cognitive behavioral therapy, childhood anxiety disorders, child and adolescent anxiety, selective serotonin reuptake inhibitors, combination therapy, treatment efficacy, waitlist control, attentional control
- MeSH terms
- Adolescent, Anxiety Disorders, Child, Child Behavior Disorders, Combined Modality Therapy, Humans, Psychotherapy, Group, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Treatment Outcome, Selective Serotonin Reuptake Inhibitors
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