A Meta-analysis to Guide the Enhancement of CBT for Childhood Anxiety: Exposure Over Anxiety Management

Stephen P.H. Whiteside, Leslie A. Sim, Allison S. Morrow, Wigdan H. Farah, Daniel R. Hilliker, M. Hassan Murad, Zhen Wang

Research output: Contribution to journalReview articlepeer-review

17 Scopus citations


Cognitive behavior therapy (CBT) is the most empirically supported therapy for childhood anxiety disorders (CADs) but has not reliably outperformed other credible interventions. The current study used meta-analysis to examine the frequency with which the most common treatment components are included in outcome studies and the relation of these components to symptom improvement. Seventy-five studies were identified that included youth with an anxiety disorder treated with CBT or a comparison condition. The protocols for the 111 CBT conditions generally consisted of 12, 1-h sessions delivered to the child with minimal parent inclusion. A greater amount of in-session exposure was related to significantly larger effect sizes between CBT and waitlist control across reporters (− 0.12 to − 0.15; P’s <.05) and from pre- to post-treatment for child report (−.06; P <.01). Compared to treatments that omitted relaxation, treatments that included relaxation strategies were associated with significantly smaller pre- to post-treatment effect sizes across reporters (0.38 to 0.80; P’s <.05). The current study suggests that CBT protocols for CADs that emphasize in-session exposure and do not include relaxation have the potential to improve the efficacy and effectiveness of therapy. Dismantling studies directly testing these hypotheses are needed.

Original languageEnglish (US)
Pages (from-to)102-121
Number of pages20
JournalClinical Child and Family Psychology Review
Issue number1
StatePublished - Mar 1 2020


  • Childhood anxiety disorders
  • Cognitive behavior therapy
  • Exposure therapy
  • Literature review
  • Relaxation

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Education
  • Developmental and Educational Psychology
  • Clinical Psychology
  • Psychiatry and Mental health


Dive into the research topics of 'A Meta-analysis to Guide the Enhancement of CBT for Childhood Anxiety: Exposure Over Anxiety Management'. Together they form a unique fingerprint.

Cite this