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Teen therapyAnxietyOCDDepressionParents and familiesSelf-harm and suicidal ideationStress managementDifficult life transitionsApproaches
Play therapy and art therapyVideo game therapyCognitive behavioural therapy (CBT)Exposure and response preventionMindfulness-based therapiesFamily and filial therapyCollaborative problem solvingSafety planning and harm reductionBook on Jane“Children are often more flexible thinkers than adults give them credit for. Given the right tools, they surprise themselves.”
Pamela Wallberg, RCC
Understanding the approach
Cognitive behavioural therapy is a structured, skills-based approach. It is built on a simple idea: what we think, how we feel and what we do all affect each other.
When a child’s thoughts become stuck on worry, self-doubt or anger, their feelings and behaviours follow. With children, CBT is active, concrete and often playful. We use games, drawings, stories and experiments to help children spot unhelpful thoughts, test them and try new responses. Parents are involved so skills carry over to home.
CBT was developed by psychiatrist Aaron Beck in the 1960s, building on behaviour therapy. It was adapted for children and teens in later decades, for example by Philip Kendall’s work on child anxiety, using games, drawings and stories.
CBT is among the best-studied psychological treatments for children and teens. A Cochrane review found CBT probably more effective than no treatment for anxiety disorders in young people, and a large trial (Walkup et al., 2008) found that CBT and sertraline each worked better than placebo for child anxiety, with the combination working best. For adolescent depression, the TADS trial found the combination of CBT and fluoxetine worked best, while CBT alone was not clearly better than placebo in that study (TADS Team, 2004).
James, A. C., Reardon, T., Soler, A., James, G., & Creswell, C. (2020). Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database of Systematic Reviews, (11), CD013162. link
Wang, Z., et al. (2017). Comparative effectiveness and safety of cognitive behavioral therapy and pharmacotherapy for childhood anxiety disorders: A systematic review and meta-analysis. JAMA Pediatrics, 171(11), 1049–1056. link
Higa-McMillan, C. K., Francis, S. E., Rith-Najarian, L., & Chorpita, B. F. (2016). Evidence base update: 50 years of research on treatment for child and adolescent anxiety. Journal of Clinical Child & Adolescent Psychology, 45(2), 91–113. link
Walkup, J. T., et al. (2008). Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. New England Journal of Medicine, 359(26), 2753–2766. link
Zhou, X., et al. (2020). Comparative efficacy and acceptability of antidepressants, psychotherapies, and their combination for acute treatment of children and adolescents with depressive disorder: A systematic review and network meta-analysis. The Lancet Psychiatry, 7(7), 581–601. link
TADS Team (2004). Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression. JAMA, 292(7), 807–820. link
Sharma, S., Hucker, A., Matthews, T., Grohmann, D., & Laws, K. R. (2021). Cognitive behavioural therapy for anxiety in children and young people on the autism spectrum: A systematic review and meta-analysis. BMC Psychology, 9, 151. link
Gould, K. L., Porter, M., Lyneham, H. J., & Hudson, J. L. (2018). Cognitive-behavioral therapy for children with anxiety and comorbid attention-deficit/hyperactivity disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 57(7), 481–490. link
Kelty Mental Health Resource Centre (BC Children’s Hospital): Cognitive Behavioural Therapy (CBT). link
Read the researchHow it works
Every child is different, so the pace and order change. This is the general path.
01
We map how a situation leads to a thought, a feeling and an action, using simple tools suited to your child’s age.
02
We practise skills such as calming the body, challenging unhelpful thoughts and problem-solving, first in session, then in real life.
03
Your child tries new behaviours gradually, such as facing something avoided, so confidence grows through experience.
04
We review progress, plan for setbacks and make sure your child and family know how to use the skills on their own.
A tool we use
Naming a feeling is often where CBT begins. This emotion wheel starts with six feelings in the centre: anger, happy, surprise, disgust, sad and fear. Each one then branches into more specific words, ring by ring.
Children and parents can start in the centre and work outward to find the word that fits best. The more precisely a feeling is named, the easier it becomes to understand and to respond to.
Wheel designed by Pamela Wallberg. Outer-ring word groupings draw on Parrott, W. G. (2001), Emotions in Social Psychology, Psychology Press.
Tap the wheel to enlarge it.
CBT is part of care for many concerns. Choose one to see how I work with it.
Related approaches
For neurodivergent children and youth, I will often adapt CBT to work with their specific learning profile.
Short, practical tasks between sessions help skills stick, but they are kept small and made as easy and engaging as possible.
Yes, in a play-based form. Very young children benefit most when parents are closely involved.
CBT is active and goal-focused. We build specific skills and practise them, rather than only talking through what happened.
Trusted resources
Free, evidence-informed information from Kelty Mental Health at BC Children’s Hospital. These links open in a new tab.
Information on this page is provided by Pamela Wallberg, MA, RCC, Registered Clinical Counsellor. Last updated October 2026. This page is general information and is not a substitute for individual care.
Related: Anxiety · Depression · OCD therapy