Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy, or CBT for short, combines two approaches: cognitive therapy, which focuses on thoughts and evaluations, and behavioral therapy, which addresses specific behaviors. Its basic premise is simple: what a child thinks, how they feel, and how they behave are closely interrelated.

Here’s an example from everyday life: Before giving a presentation, a girl thinks, “I’m going to embarrass myself in front of everyone.” That thought triggers anxiety; the girl calls in sick, and her fear of the next presentation grows. CBT addresses precisely this chain of events. The child and therapist examine such thought patterns, evaluate them, and look for more realistic thoughts. Experts refer to a typical pattern as “catastrophizing”—that is, imagining the worst-case scenario.

CBT typically follows a structured approach focused on the present. The central question is what is standing in the child’s way today and what specifically helps. The therapist and the child also work together to explain how a disorder develops and is maintained. Experts call this process “psychoeducation,” and it helps the child better understand their own reactions.

The process begins with getting to know one another. For children and adolescents, health insurance covers up to six trial sessions during which the child, parents, and therapist assess whether it’s a good fit. Only then is the actual therapy requested.

During the sessions, the problem is first examined in detail: Which situations trigger the anxiety, sadness, or compulsions, and what keeps them going? This leads to specific goals and a treatment plan. Active participation between appointments is a hallmark of CBT. Many children keep a journal of their thoughts and feelings or practice relaxation and coping techniques. In the case of an anxiety disorder, the child gradually approaches the feared situation, accompanied by the therapist, and thus experiences that the anxiety subsides on its own.

For younger children, much of the process involves play, pictures, and age-appropriate exercises rather than lengthy conversations. This “homework” is an integral part of the treatment. Progress and new challenges are discussed regularly during sessions.

Behavioral therapy and its cognitive extensions are among the most widely used and scientifically well-studied forms of psychotherapy. CBT is considered the treatment of choice for several disorders. It is used, among other things, to treat anxiety disorders, depression, obsessive-compulsive disorder, and eating disorders.

For obsessive-compulsive disorder in children and adolescents, the S3 guideline, led by the German Society for Child and Adolescent Psychiatry (2021), recommends offering disorder-specific CBT as the first-line psychotherapy. The core element is exposure and response prevention, a form of exposure therapy. Medications containing serotonin reuptake inhibitors are only considered if therapy alone is insufficient.

For depression in children and adolescents, the IQWiG concludes that CBT and interpersonal psychotherapy can alleviate depressive symptoms and are no less effective than antidepressants. CBT is one of the guideline-recommended treatments. This means its benefits are scientifically recognized, and statutory health insurance plans cover the treatment.

The younger the child, the more involved the parents are. They provide information about daily life, learn the techniques, and practice them at home. Some treatments combine CBT with parent training so that daily family life supports the child’s progress.

For parents, this is often an adjustment. It helps the child more when parents remain calm and guide them through the practiced steps than when they take over anxious behaviors out of concern. The family discusses what makes sense in each individual case with the treating specialist.

CBT is not the only recognized approach. Depending on the child and the disorder, Acceptance and Commitment Therapy (ACT) or psychodynamic therapy may also be appropriate. Which approach is right depends on the diagnosis, the child’s age, and what the child is comfortable with.

The first point of contact is often the pediatrician or family doctor. For psychotherapy, children and adolescents need a specialist with the appropriate training, such as a child and adolescent psychotherapist or a doctor specializing in child and adolescent psychiatry. In many regions, families wait several months for a spot covered by health insurance. During this time, it can be helpful to contact a parenting counseling center or the social psychiatric service.

Whether cognitive-behavioral therapy (CBT) is appropriate depends on a careful diagnosis. Only a child and adolescent psychiatrist (KJP) or a medical or psychotherapeutic specialist can make this assessment and decide on a course of treatment. Rückenwind “Eltern” supports and empowers parents in their daily lives through coaching. Janike is a social worker and parent coach currently training to become a child and adolescent psychotherapist. She does not make diagnoses and does not replace psychotherapy.