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Behavioral Therapy for Anxiety and Depression in Children

Behavioral therapy targeting anxiety and depression was tested on children with an average age of 11 and compared to the success of referral to an outpatient community health center. Children who received behavioral therapy had significantly higher rates of improvement, reduction of symptoms and better functioning compared to those that were referred out.


Anxiety and depression are both widespread conditions among youth that have measurable effects on function and are unfortunately largely undertreated. It is estimated that only 20% of youth affected by anxiety, and 40% struggling with depression, receive mental health services.

V. Robin Weersing and her team of researchers set out to improve access quality of care for this vulnerable population, by testing the effectiveness of behavioral therapy for anxiety and depression in children delivered in pediatric primary care offices, compared to the outcomes of simply referring these children out for outpatient mental health care.

This novel study, published in JAMA Psychiatry, recruited a total of 185 children between the ages of 8 and 17. Children were randomly divided into two groups, with 95 children receiving behavioral therapy and 90 receiving a referral. The behavioral therapy consisted of 8 to 12 weekly, 45-minutes sessions, completed within a 16-week period, and included behavioral strategies, relaxation techniques, and problem-solving skills to assist in stress management. Those children that were referred out for additional mental health services were contacted by telephone every two weeks over the course of the study.

The differences between the two groups were significant. Children in the behavioral therapy group had twice the rate of clinical improvement the referral group did (56.8% compared to 28.2%). Additionally, the behavioral group had a greater reduction of symptoms and better functioning. A surprising and unexpected finding of this research was the marked difference that behavioral therapy had on Hispanic children. Comparing the overall responses, Hispanic children were 10 times more successful with behavioral therapy than when they were referred out for care (76.5% versus 7.1%).

This study suggests that the common practice of referring children out for mental health services is significantly less effective than providing behavioral therapy in cooperation with the child’s pediatrician, especially as it pertains to the Hispanic population.


Written By: Sean Manning, BA, DC, MWC



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