Cognitive behavioural therapy and anxiety

Strong evidence – there is lots of high-quality evidence that some young people find this treatment option helpful.

Cognitive behavioural therapy (CBT) is a type of therapy where your professional helps you to learn how your feelings, thoughts and behaviours affect each other, and how you can change the way you think, behave and feel.

‘Cognitive’ refers to the things that take place in your mind, such as thoughts, images, memories, or processes like worrying. ‘Behaviour’ is what you do, for example escaping or avoiding something.

A typical CBT intervention for anxiety includes:

  • Psychoeducation, which means learning more about anxiety and understanding how it affects you.
  • Learning practical strategies to manage the physical effects of anxiety.
  • Spotting and challenging your anxious thoughts.
  • Facing situations that you fear (which is also known as ‘exposure’) and learning to manage your anxiety. In the beginning you will tackle things that make you feel a little bit anxious and as you become better at managing your anxiety, you will work up to things that would have made you feel very anxious before you started treatment. This process is called ‘graded exposure’.
  • Developing a plan to stay well.

CBT programmes

CBT treatments for anxiety often have a set programme (called a manual) that the therapist follows. These are called ‘manualised CBT programmes’. The manuals set out the steps to follow in treating your anxiety and also often have tips on ways to solve common problems. This can be helpful as it helps both you and your professional to know what to expect during the therapy. Research on this type of CBT suggests that it is often helpful for children and young people with anxiety.

Some manualised CBT programmes are for specific types of anxiety disorder, while others can be helpful for a range of anxiety disorders. Here, the programme you follow is the same for each type of anxiety disorder, although the detail might be different from person to person.

Less intensive forms of CBT, such as computerised CBT or group CBT, might be more suitable if you have mild to moderate anxiety symptoms, and are well supported and motivated. If you have more severe problems and/or are less well supported or motivated, you might need more intensive one-to-one CBT.

Coping Cat and Cool CAT

Coping CAT is a programme that can be helpful for generalised anxiety disorder, separation anxiety disorder and social anxiety disorder. Your professional could suggest trying it if you have one of these anxiety disorders and are 7-13 years old. If you are 14-18 years old there is a version for your age group called Cool Cat.

These interventions involve either one-to-one meetings with your therapist or meetings with a group of 6-8 other children or young people. The groups include children or young people of a similar age and are led by one or two therapists. There is also a computerised version called Camp-Cope-A-Lot: The Coping Cat.

Coping Cat will usually involve your parents or carers. Your professional might meet with them a couple of times to discuss your treatment plan and how they can support you. There is also a family-focused Coping Cat programme which involves parents or carers in all the sessions.

The programme will help you to identify and understand your anxious feelings and separate them from your other feelings. You will practise keeping track of your anxious feelings and recognising your own anxious self-talk. You’ll learn skills such as coping self-talk and relaxation techniques, and you’ll be gradually exposed to anxiety-producing situations to help you practise these coping skills. Your professional will also encourage you to reward yourself for making progress.

There is strong evidence that the Coping Cat programme can be helpful for anxiety.

CBT approaches for specific anxiety disorders

There are other CBT approaches where the programme is for a specific type of anxiety disorder (e.g. social anxiety disorder). You could have these on a one-to-one basis, in a group, or via a computer.

Research on the different types of CBT suggests that they are all effective. There is less research comparing them with each other, but if you have social anxiety disorder, CBT which specifically targets social anxiety tends to be more helpful than a general CBT programme.

CBT delivered by your parents or carers

There are also CBT approaches where your therapist works with your parents or carers, teaching them how to help you cope with situations that make you anxious.

Other CBT programmes involve your parents or carers through self-help books that they can use to deliver your CBT programme. This might be with or without support from a therapist.

Treatments outlined on these webpages may not be available in every local area. It’s important that you discuss with your GP or mental health professional the treatment options available to you. You can also search for services near you on our Youth Wellbeing Directory and find out more about referral processes here.

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