When a child shows signs of anxiety, we tend to think it will go away—she’s just nervous or shy, and she’ll grow out of it. But when the anxiety becomes so intense that it’s seriously interfering with a child’s life, and the life of her family, it’s important to get help.

Serious untreated anxiety tends to get worse over time, not better, because the child learns that avoidance works in reducing the anxiety, at least in the short run. But as the child—and, indeed, the whole family—work to avoid triggering those fears, they only grow more powerful.

Medication is often prescribed for children with anxiety, as it is for adults. And medication—antidepressants are usually our first choice—often helps reduce anxiety. But what many people don’t know is that cognitive behavioral therapy (CBT) can be very effective for kids who are anxious. In fact, research over more than 20 years has shown that CBT is the most effective treatment for reducing symptoms of severe anxiety. And unlike taking medication, the therapy gives children the tools to manage the anxiety themselves, now and in the future.

What is cognitive behavioral therapy?

Cognitive behavioral therapy is based on the idea that how we think and act both affect how we feel. By changing thinking that is distorted, and behavior that is dysfunctional, we can change our emotions. With younger children, focusing first on the behavioral part of CBT can be most effective. The goal is, essentially, to unlearn avoidant behavior.