Anxiety in Kids: Therapy Options That Truly Help
Have you noticed a worried look on your child’s face more often lately? Maybe they're refusing to go to school, having “meltdowns” before social events, or developing an impressive collection of mysterious stomachaches. As a parent, watching your child struggle with anxiety can feel like being stuck in an emotional maze without a map.
And if you have anxiety yourself? Well, that's like trying to help someone out of quicksand while standing in it yourself. (No pressure, right?)
The good news: Effective treatments exist, and finding the right therapy can make a world of difference. Let's explore how to identify childhood anxiety and navigate some of the many therapeutic options.
Childhood anxiety symptoms checklist
Anxiety in children aged 5-12 often looks different from adult anxiety. While adults can say the words, "I'm anxious," children's bodies and behaviors typically do the talking.
Physical signs of anxiety in kids:
- Frequent stomachaches or headaches with no medical cause
- Sleep disturbances or nightmares
- Changes in eating patterns
- Restlessness or fidgeting (that goes beyond normal kid energy)
Behavioral signs of anxiety in kids:
- Excessive clinginess or fear of separation
- Constant seeking of reassurance ("But what if...?" becomes their catchphrase)
- Avoidance of specific activities, places, or people
- Meltdowns or tantrums when facing anxiety-provoking situations
- Perfectionism or fear of making mistakes
- Difficulty concentrating (which can often be mistaken for ADHD)
One mom described her 8-year-old's anxiety as "preparing for a disaster that never happens." Her daughter would spend hours mentally rehearsing for everything from a class presentation to a playdate, creating elaborate worst-case scenarios that left her exhausted.
Does my child need therapy for anxiety?
It's the question that keeps parents up at night: Is this normal childhood worry, or something that needs professional support?
Consider starting therapy for your child when anxiety:
- Persists for several weeks or months
- Interferes with daily activities (school, friendships, family life)
- Causes significant distress
- Leads to avoidance behaviors that limit your child's experiences
- Doesn't respond to your supportive parenting strategies
Remember: Seeking therapy isn't admitting defeat as a parent—it's providing your child with additional support tools. Think of it as adding more resources to your parenting toolkit, not replacing it.
You wouldn't hesitate to get your child glasses if they couldn't see clearly. Therapy helps children see their thoughts and feelings more clearly when anxiety has blurred their vision.
Types of therapy that can help with childhood anxiety
Not all therapy approaches are created equal when it comes to treating childhood anxiety. Here's a breakdown of evidence-based options:
Cognitive Behavioral Therapy (CBT)
Cognitive Behavioral Therapy (CBT) is the gold standard for treating anxiety in children. CBT helps kids identify anxious thoughts, challenge them, and develop coping strategies.
What it looks like in practice: Sessions are structured and often include activities, games, and homework.
A therapist might use a "thought detective" approach where your child becomes an investigator looking for evidence that supports or contradicts worried thoughts.
Techniques you might see:
- Worry boxes where kids write down and "contain" their worries
- Creating "worry ladders" to gradually face fears in manageable steps
- Learning to recognize physical anxiety symptoms and using relaxation techniques
Example: Eight-year-old Marco was afraid of dogs. His CBT therapist helped him create a "fear ladder" starting with looking at cartoon dogs, progressing to watching videos of real dogs, then viewing dogs from a distance, and eventually petting a calm therapy dog. At each step, Marco practiced his "brave breathing" and challenged his scary thoughts about dogs.
Play Therapy
Play therapy uses play as the primary communication tool, allowing children to express feelings they may not have words for.
What it looks like in practice: The therapist's office has toys, art supplies, sand trays, puppets, and other materials. Children communicate through play while the therapist observes, participates, and helps process emotions. The most important distinction is a Play Therapist interprets your child's play to help diagnose and treat.
Techniques you might see:
- Sand tray therapy where children create scenes representing their inner world
- Puppet play where children can express feelings through characters
- Art therapy activities that help externalize worries
Example: Six-year-old Jasmine was having separation anxiety at school drop-off. In play therapy, she repeatedly enacted scenes with animal families where baby animals got lost and then found their way back. Her therapist helped her verbalize the feelings of the baby animals and practice coping skills through the characters.
It is important to note that Play Therapy is different from using creative play in session. Play Therapy can only be performed by a licensed play therapist while any licensed mental health provider can incorporate play into the clinical sessions with the child.
Exposure and Response Prevention (ERP)
Exposure and Response Prevention (ERP) is a specialized form of CBT particularly effective for OCD and specific phobias, focusing on gradually facing fears without using unhelpful coping behaviors.
What it looks like in practice: The therapist creates a hierarchy of anxiety-provoking situations and guides the child through facing them, starting with less scary scenarios and working up.
Techniques you might see:
- "Facing the fear" exercises in a safe environment
- Practicing "riding the wave" of anxiety without seeking reassurance
- Reward systems to celebrate brave behavior
Example: Ten-year-old Jayden had contamination fears and washed his hands until they were raw. His ERP therapist helped him touch "slightly germy" objects (like doorknobs) and wait increasingly longer before washing, while learning to tolerate the uncomfortable feelings.
Acceptance and Commitment Therapy (ACT) for kids with anxiety
Acceptance and Commitment Therapy (ACT) teaches kids to accept difficult feelings rather than fighting them, while committing to behaviors that align with their values.
What it looks like in practice: Sessions include mindfulness exercises, metaphors, and activities that help children relate differently to anxious thoughts.
Techniques you might see:
- The "leaves on a stream" visualization where children picture thoughts floating away
- "Naming the worry monster" to externalize anxiety
- Values compass activities to identify what matters most to them
Example: Twelve-year-old Sophia experiences test anxiety. Her ACT therapist taught her to notice anxious thoughts as "just thoughts" (not facts) using the metaphor of being the unchanging sky, while her thoughts and feelings were just weather passing through.
Family Therapy
Family Therapy involves the whole family in treatment, recognizing that family dynamics can sometimes unintentionally maintain anxiety patterns.
What it looks like in practice: Parents and sometimes siblings attend sessions together to improve communication, adjust interaction patterns, and learn how to respond effectively to anxiety.
Techniques you might see:
- Family role-playing of challenging situations
- Communication exercises to express feelings safely
- Parent coaching on responding to anxiety behaviors
Example: The Wilson family attended therapy together when 7-year-old Emma developed school refusal. The therapist helped them recognize how Mom's excessive reassurance and Dad's frustration were unintentionally reinforcing Emma's anxiety, then coached them on a united, supportive approach.
When your child resists therapy
It's not uncommon for children to be reluctant about therapy. After all, it's new, unknown, and involves talking about uncomfortable feelings with a stranger.
If your child is hesitant to try or continue therapy:
- Frame therapy positively—it's help for their worries, not punishment or a sign something's "wrong" with them
- Let them know many kids see therapists—it’s important for them to know they're not alone
- Consider allowing them to bring a comfort item to sessions—ask if their favorite stuffy wants to join them
- Give them appropriate control where possible—like choosing between two therapists or days/times of their appointments. You might find that your child prefers to go before school so they can practice what they are learning throughout the day. Or maybe going to therapy on days where they have their most anxiety-provoking events feels counterproductive.
As for the first-session jitters, most therapists expect this and work to make children comfortable. Generally, give a new therapist 3-4 sessions before deciding if it's a good fit. The first couple of sessions is often just about building rapport, not diving deep into therapeutic work.
One creative mom told her therapy-resistant son they were "interviewing worry doctors" to find someone who could help him feel braver. This framing gave him a sense of control and turned the process into an adventure rather than something scary.
When therapy doesn't seem to be helping your child
If you're several sessions in and seeing little improvement, don't lose hope.
Next steps to consider:
- Communicate with the therapist - Share your observations and ask about their assessment of progress. Remember therapy does take time and a lot of practice.
- Evaluate the therapeutic relationship - Does your child feel comfortable with this therapist?
- Consider the approach - Some children respond better to different therapy types. It’s okay to ask the clinician to try something different.
- Look at frequency and consistency - Are sessions regular enough? Are skills being practiced at home?
- Assess for complicating factors - Could there be another diagnosis or environmental stressor?
Remember: Progress isn't always linear. Some children improve gradually while others show a "sleeper effect" where benefits become apparent weeks after therapy ends.
If you've given it a fair shot (usually 8-12 sessions) without improvement, it's reasonable to:
- Try a different therapist
- Switch to another evidence-based approach
- Get a comprehensive evaluation to ensure the diagnosis is accurate
When to consider treating childhood anxiety with medication
For some children with severe anxiety, the combination of therapy and medication provides the most effective relief.
Consider discussing medication with a child psychiatrist if:
- Anxiety significantly impairs daily functioning (sleeping, eating, social, etc.), despite continued efforts in therapy.
- Your child is unable to participate in therapy effectively due to anxiety severity. Sometimes starting on medication first allows the child’s brain and body to participate better in sessions.
- Physical symptoms are severe (panic attacks, inability to sleep, refusing to eat or to go school).
- There's a family history of anxiety disorders that responded well to medication.
Medication decisions should always be made in consultation with a qualified medical professional who specializes in children's mental health, ideally a child psychiatrist rather than a pediatrician or other primary care provider.
Therapy for childhood anxiety: the bottom line
Parenting an anxious child can feel overwhelming, but effective help is available.
With the right therapeutic approach, most children show significant improvement in their anxiety symptoms and quality of life.
By seeking help early, you're not only addressing current struggles but also equipping your child with lifelong emotional coping tools. You're teaching them that it's brave to ask for help—perhaps one of the most valuable lessons they'll ever learn.
As one dad put it after his daughter completed therapy for social anxiety: "We didn't eliminate anxiety from her life—that's not realistic. But she now has a relationship with her worry that allows her to do the things she loves despite it. That's not just coping; that's thriving."
Jun 20, 2025
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