Play Therapy Beats Traditional Talk: New Research Reveals the Most Effective Way to Help Anxious Children

A comprehensive analysis of 29 studies shows that cognitive behavioural play therapy significantly outperforms other approaches in reducing childhood anxiety.

Eight-year-old Sophie used to hide behind her mother's legs whenever they encountered new people, refused to participate in school activities, and had frequent meltdowns when faced with unfamiliar situations. Her parents tried traditional counselling, where Sophie was expected to sit and talk about her feelings, but she often remained silent or became more distressed. Then they discovered cognitive behavioral play therapy, where Sophie could work through her anxieties using toys, games, and creative activities. Within months, she was participating in class, making friends, and approaching new situations with confidence rather than fear.

Sophie's transformation reflects findings from new research that analyzed nearly 30 studies involving over 3,000 children with anxiety disorders. The comprehensive analysis reveals not only that cognitive behavioral therapy works remarkably well for childhood anxiety, but that one particular approach stands out as exceptionally effective: cognitive behavioral play therapy.

The Scope of Childhood Anxiety

Anxiety disorders represent the most common mental health challenge facing children today, affecting an estimated 10% to 20% of all kids. Unlike the normal worries and fears that are part of typical childhood development, anxiety disorders involve persistent, overwhelming feelings that interfere with a child's ability to participate in everyday activities like school, friendships, and family life.

These conditions often emerge earlier than other mental health issues and, when left untreated, can lead to significant problems throughout adolescence and into adulthood. Children with anxiety disorders may avoid age-appropriate activities, struggle with peer relationships, experience academic difficulties, and develop patterns of avoidance that can persist for years.

The good news is that research consistently shows these conditions are treatable, particularly with early intervention. Cognitive behavioural therapy (CBT) has emerged as the gold standard treatment, but until now, questions have remained about which specific approaches work best for children at different ages.

The Research Breakthrough

To answer these questions, researchers conducted what's called a meta-analysis, combining results from 29 high-quality studies published between 2015 and 2024. This approach provides much stronger evidence than any single study could offer, as it combines data from thousands of children across different countries, cultures, and treatment settings.

The studies included 15 randomized controlled trials (the gold standard of research) and 14 quasi-experimental studies, encompassing 3,028 children total. The researchers looked at various forms of cognitive behavioural therapy, including:

• Standard CBT (traditional talk therapy adapted for children)
• Cognitive behavioural play therapy
• School-based CBT programs
• Parent-involved CBT
• Computer-assisted CBT games

The children ranged in age from 4 to 12 years old, representing the crucial developmental period when anxiety disorders often first emerge and when intervention can be most effective.

Remarkable Overall Results

The combined analysis revealed that cognitive behavioral therapy is effective for childhood anxiety. Overall, CBT reduced anxiety levels by 1.51 points on standardized anxiety measures, a reduction that researchers classify as large and clinically meaningful.

Even more encouraging, these benefits lasted over time. When researchers looked at follow-up data:

• At 3 months after treatment: Anxiety levels remained 2.21 points lower than before treatment
• At 6 months: Benefits persisted with anxiety 1.04 points lower
• At 12 months: The effects were even stronger, with anxiety 6.32 points lower than pre-treatment levels

This long-term effectiveness is particularly important because it suggests that children aren't just getting temporary relief; they're developing lasting skills and resilience that continue to benefit them over time.

Play Therapy

While all forms of CBT proved effective, cognitive behavioural play therapy emerged as the clear champion, showing by far the largest effect size at 2.41 points of anxiety reduction. This finding has profound implications for how we treat young children with anxiety disorders.

Cognitive behavioural play therapy works by combining the proven techniques of CBT with children's natural language: play. Instead of asking a 6-year-old to sit still and verbally process their feelings about starting a new school, a play therapist might use dolls, puppets, or games to help the child work through those same anxieties in a way that feels natural and engaging.

The approach recognizes that children often lack the verbal skills and abstract thinking abilities needed for traditional talk therapy. Through play, children can:

• Express feelings they can't put into words: A child might show their anxiety about separation by having a toy animal hide from its mother, then work through reunification scenarios.
• Practice coping skills in a safe environment: They might teach a stuffed animal breathing techniques or help a puppet face its fears in a dollhouse school.
• Gain a sense of control and competence: Play naturally gives children agency and the ability to direct the therapeutic process.
• Process traumatic or difficult experiences: Children can reenact and master frightening situations through play scenarios.

How Other Approaches Performed

While play therapy took the top spot, other CBT approaches also showed significant benefits:

School-Based CBT (1.56 points reduction): These programs, delivered in educational settings, offer the advantage of reaching children where they spend most of their time and can address school-specific anxieties directly.

Standard CBT (1.55 points reduction): Traditional cognitive behavioural therapy adapted for children remained highly effective, particularly for older children who can engage more readily with verbal processing.

Parent-Involved CBT (0.73 points reduction): Programs that trained parents in CBT techniques showed meaningful benefits, though smaller than other approaches. This may reflect the challenges of changing both child and parent behaviours simultaneously.

Computer-Assisted Games (0.35 points reduction): While showing the smallest effect, CBT-based computer games still provided meaningful benefits and may offer advantages in terms of accessibility and cost.

Why Play Therapy Works So Well

Several factors likely contribute to the  effectiveness of cognitive behavioural play therapy:

Developmental Appropriateness: Young children naturally communicate and process experiences through play. This approach meets them where they are developmentally rather than expecting them to adapt to adult communication styles.

Reduced Anxiety About Therapy: Many children feel nervous about "going to therapy" but are naturally drawn to play activities. This reduces initial resistance and helps children engage more quickly.

Enhanced Learning: Children often learn better through active, hands-on experiences rather than passive listening. Play therapy leverages this natural learning style.

Increased Motivation: Games and play activities are inherently motivating for children, leading to better engagement and completion of therapeutic exercises.

Natural Exposure: Play scenarios can provide gentle exposure to feared situations in a controlled, gradual way that feels less threatening than direct confrontation.

Long-Term Benefits and Sustained Effects

One of the most encouraging findings was that CBT's benefits not only lasted over time but actually seemed to strengthen in some cases. At the 12-month follow-up, children who had received CBT showed even greater anxiety reduction compared to control groups than they had immediately after treatment.

This pattern suggests that CBT doesn't just provide temporary symptom relief; it teaches children fundamental skills for managing anxiety that they continue to develop and refine over time. Children learn to:

• Recognize early warning signs of anxiety
• Challenge anxious thoughts with more realistic ones
• Use coping strategies when facing feared situations
• Approach challenges with confidence rather than avoidance

These skills become part of their toolkit for life, helping them navigate not just current anxieties but future challenges as well.

Practical Implications for Families

For parents of anxious children, this research offers both hope and practical guidance:

Seek Treatment Early: The research confirms that anxiety disorders in children are  treatable, with large, lasting benefits from appropriate intervention.

Consider Play-Based Approaches: Particularly for younger children (ages 4-12), cognitive behavioural play therapy appears to offer the best outcomes.

Don't Wait for Children to "Outgrow" Anxiety: Untreated anxiety disorders rarely resolve on their own and can lead to more serious problems over time.

Look for Qualified Therapists: Seek mental health professionals trained explicitly in childhood anxiety and cognitive behavioural approaches.

Be Patient with Progress: While many children show improvement quickly, the full benefits of CBT continue to develop over months and years.

Addressing Barriers to Treatment

Despite the clear effectiveness of CBT for childhood anxiety, many children who could benefit from treatment don't receive it. Common barriers include:

Limited Access: Many communities lack sufficient numbers of trained child therapists, particularly those specializing in anxiety disorders.

Cost Concerns: Mental health treatment can be expensive, and insurance coverage varies widely.

Stigma: Some families worry about the stigma of mental health treatment or believe children should be able to "tough it out."

Misunderstanding: Parents may not recognize anxiety symptoms or may assume they represent normal childhood fears.

The research supports expanding access to CBT services, particularly play-based approaches, as a highly effective investment in children's mental health.

The Role of Different Settings

The research also highlighted the potential for delivering CBT in various settings:

Clinical Settings: Traditional therapy offices remain necessary for intensive, individualized treatment.

Schools: School-based programs can reach children who might not otherwise access treatment and can address school-specific anxieties directly.

Community Centers: These settings may be less stigmatizing and more accessible for some families.

Technology Platforms: While showing smaller effects, computer-based programs could help address access issues in underserved areas.

This comprehensive analysis provides the strongest evidence to date that cognitive behavioural therapy, particularly play-based approaches, represents an excellent first-line treatment for childhood anxiety disorders. The research suggests several important directions for the future:

Training More Specialists: Given the effectiveness of play therapy, training more therapists in these techniques should be a priority.

School Implementation: The effectiveness of school-based programs suggests expanding these approaches could help more children.

Early Prevention: Since anxiety disorders often emerge early, implementing prevention programs using CBT techniques could help stop problems before they become severe.

Personalized Approaches: Future research should explore how to match specific CBT approaches to individual children's needs, personalities, and circumstances.

For families like Sophie's, this research provides validation that seeking help for childhood anxiety is not only worthwhile but highly likely to succeed. The findings show that with appropriate treatment, children can not only overcome their current anxieties but also develop skills that will serve them throughout their lives.

The support of play-based approaches for young children offers hope that treatment can be both effective and enjoyable. Rather than dreading therapy sessions, children can look forward to engaging, play-based activities that help them build confidence and resilience.

As our understanding of childhood anxiety and its treatment continues to evolve, one thing remains clear: these conditions are  treatable, help is available, and children can and do recover. The research provides a roadmap for families, showing that with the right approach, children with anxiety disorders can learn to face their fears, build confidence, and thrive in all areas of their lives.

For parents watching their children struggle with anxiety, the message is: effective help exists, play-based approaches work exceptionally well, and the benefits last. Children like Sophie don't have to remain trapped by their fears; with appropriate treatment, they can learn to approach life with confidence, curiosity, and joy.

Alemdar, H., & Karaca, A. (2025). The effect of cognitive behavioral interventions applied to children with anxiety disorders on their anxiety level: A meta-analysis study. Journal of pediatric nursing, 80, e246-e254.