Cognitive-behavior therapy (CBT) was developed in the 1960’s by Dr. Aaron Beck for the treatment of depression. However, since then, CBT has been proven effective in the treatment of a wide variety of psychiatric conditions in which emotion and/or behavior dysregulation is a core symptom (e.g., anxiety, disruptive behavior disorders, eating disorders, personality disorders, substance use/abuse). CBT has proven effective for a wide variety of age groups (i.e., children, teens, adults, and the elderly). In children, it is helpful in treating the disorders mentioned above, as well as non-compliance, aggression, self-harm, social isolation, risk-taking behaviors, and inactivity.
In general, CBT is a goal-oriented, skills-based intervention that focuses on the connection between thoughts (i.e., cognitions), feelings and actions (i.e., behaviors). CBT teaches children how to identify and label thoughts and feelings (especially negative ones). In addition, children learn to change negative thoughts into positive ones, so that they feel better and are better able to react in a healthy manner.
CBT requires that children (and their parents) take an active role in treatment. For example, children (with the help of their parents) identify a set of concrete goals that they will work toward each week. Additionally, children and their parents learn a variety of coping skills targeting emotion regulation (e.g., breathing, stretching, counting, positive self-talk, meditation) and conflict resolution (e.g., negotiating, validation, apologizing, repairing). These skills are then modeled and practiced in the session (i.e., a safe, low-stress environment) using role-play and rehearsal. Homework assignments are often assigned, so that skills learned in the therapy session are practiced at home and at school.
While CBT is traditionally an intervention meant for individuals, CBT with children often involves parents and/or caretakers. The most important role for parents is this: Parents can prompt and reward their child’s use of CBT skills at home. In addition, parents are able to accurately track target behaviors and use of skills over the course of each week. Thus, skills that are learned in the therapy session are translated to the “real world,” and progress is tracked in a concrete manner over the course of treatment.
Regarding CBT and its utility with children on the autism spectrum, CBT is most effective with children who are able to verbalize their thoughts and who are able to process and retain new information. Often children diagnosed with autism spectrum disorder (ASD) have difficulty interpreting their emotional experiences. This can cause a slough of difficulties, including misinterpretation of cues, feeling “out of control,” feeling overwhelming anxiety, and reacting in an extreme manner. Thus, teaching children with ASD to identify and label emotions is an important first step in learning how to control behavior.
In sum, CBT is an intervention that is helpful for treating emotion and/or behavior dysregulation. Children and parents who receive CBT are asked to take an active role in goal setting, learning and practicing coping skills, and translating skills to the home and school environments. By the end of CBT treatment, children know how to identify and interpret their emotional experiences, understand the connection between thoughts, feelings, and actions, have an enhanced coping skills repertoire, and are better able to control their behavior.