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.
The Hidden Family Challenges When Anxiety Meets Autism
Research reveals how families navigate different struggles when children have anxiety alone versus anxiety combined with autism spectrum disorder.
When Emma's 10-year-old son Jake was diagnosed with both autism spectrum disorder and anxiety, she thought she understood what lay ahead. After all, her older daughter had been successfully treated for anxiety disorders a few years earlier with cognitive behavioural therapy. But as months passed, Emma began to notice that their family dynamics felt different this time around. The strategies that had worked before seemed less effective, communication felt more strained, and the whole family seemed to be operating under more stress than they had experienced with their daughter's anxiety treatment.
Emma's experience reflects findings from new research that reveals differences in how families function when children have anxiety disorders alone compared to when anxiety occurs alongside autism spectrum disorder. The study offers insights for families and healthcare providers regarding the challenges and needs associated with various family situations.
Understanding Family Functioning
Family functioning refers to how well families communicate, handle daily routines, and maintain positive relationships with each other. Researchers typically look at two main dimensions:
Family Relational Functioning: This includes how cohesive, expressive, and supportive a family is. Families with good relational functioning tend to be more connected, communicate openly, and provide emotional support to each other.
System Maintenance: This involves how organized and structured a family is, including things like rules, hierarchy, and control. While some structure is helpful, very high levels can indicate a more rigid, authoritarian family environment.
When family functioning is poor, it often contributes to increased stress for parents, more behavioural problems in children, and greater difficulty managing mental health conditions like anxiety.
The Research Landscape
Previous research has consistently shown that families of children with anxiety disorders often experience challenges in family functioning compared to families with typically developing children. Similarly, studies have found that families of children with autism spectrum disorder face unique stresses that can impact how the family operates as a unit.
However, to date, no research has specifically examined what happens in families where children have both conditions. Given that anxiety disorders are common in children with autism (affecting up to 40-50% of this population), understanding these family dynamics is important for providing effective support and treatment.
A Comprehensive Study
Researchers conducted a comprehensive study involving 264 children aged 7 to 18 and their parents. The participants were divided into three groups:
- 95 children with anxiety disorders but not autism
- 79 children with both autism spectrum disorder and anxiety disorders
- 90 typically developing children without mental health diagnoses
The researchers wanted to answer three key questions:
- How does family functioning differ among these three groups?
- Does family functioning improve after children receive cognitive behavioural therapy for anxiety?
- Can family functioning at the start of treatment predict how well children will respond to anxiety treatment?
Striking Differences in Family Experiences
The results revealed important differences between the groups that have implications for families and treatment providers.
Families with autism plus anxiety faced the greatest challenges: These families reported lower levels of supportive, cohesive relationships compared to families with typically developing children. They also reported higher levels of rigid structure and control compared to both other groups.
Families with anxiety alone functioned more like typical families: Surprisingly, families of children with anxiety disorders alone didn't show significantly different functioning compared to families with typically developing children. This was unexpected, as previous research had suggested these families would show more challenges.
Both parents and children reported similar patterns: The findings were consistent whether researchers asked children, mothers, or fathers about family functioning, suggesting these differences reflect real family experiences rather than just one person's perspective.
What This Means for Daily Life
These research findings translate into real differences in how families experience daily life:
For families dealing with autism plus anxiety:
- Parents may need to maintain more structured routines and clearer rules
- Family communication might be more challenging
- There may be less flexibility in family activities and interactions
- Parents might feel more stressed about managing both conditions simultaneously
For families dealing with anxiety alone:
- Family functioning may remain relatively stable
- The anxiety symptoms might be the primary challenge rather than broader family dynamics
- Treatment focused on the child's anxiety might be sufficient to improve overall family wellbeing
The Therapy Question
One of the most significant findings related to treatment outcomes. The researchers tracked families through cognitive behavioral therapy for anxiety and found that:
Therapy helped reduce anxiety symptoms but didn't change family functioning: While children in both clinical groups showed significant improvement in their anxiety levels after therapy, their family functioning scores remained stable. This was true even two years after treatment ended.
Family functioning didn't predict treatment success: Contrary to expectations, families with better functioning at the start of treatment weren't more likely to see greater improvements in their children's anxiety symptoms.
These findings challenge some assumptions about how family-focused treatment approaches should be designed and implemented.
Understanding the Autism Plus Anxiety Challenge
The research suggests several possible explanations for why families with children who have both autism and anxiety face greater challenges:
Compounding Effects: Having two conditions may create more complex daily management challenges than having either condition alone.
Different Needs: Children with autism may benefit from more structured, predictable family environments, which might appear as "higher system maintenance" in research measures but could actually be adaptive for these families.
Parental Stress: Parents may experience greater stress when managing both conditions, which could impact overall family dynamics.
Limited Treatment Focus: Current anxiety treatments may not address the broader family needs when autism is also present.
Rethinking Family Support
These findings have important implications for how healthcare providers and families approach treatment and support:
One Size Doesn't Fit All: Families dealing with anxiety alone may need different types of support than families dealing with both autism and anxiety.
Beyond Child-Focused Treatment: While cognitive behavioural therapy for anxiety is effective for reducing anxiety symptoms, families dealing with autism plus anxiety may need additional support to address broader family functioning challenges.
Redefining "Problems": Higher structure and control in families with autism plus anxiety might not always be problematic; it could represent adaptive responses to the unique needs of children with autism.
Long-term Perspective: Since family functioning remained stable even after successful anxiety treatment, families may need ongoing support rather than expecting that treating the child's anxiety will resolve all family challenges.
Practical Implications for Families
For families currently navigating these challenges, the research offers several insights:
Normalize Your Experience: If you're dealing with both autism and anxiety in your family, know that experiencing greater family stress and needing more structure is a common and understandable response.
Seek Comprehensive Support: While anxiety treatment is important and effective, you may also benefit from family therapy, parent training, or other supports that address broader family dynamics.
Don't Assume Therapy Will Fix Everything: Successful anxiety treatment is valuable and important, but it may not resolve all family challenges, especially when autism is also present.
Consider Individual Family Needs: What works for other families may not work for yours, and that's okay. Some families thrive with more structure and clear expectations.
Looking Forward
This research opens up important questions for future investigation:
Tailored Interventions: How can treatment approaches be modified to better support families dealing with both autism and anxiety?
Measurement Matters: Current ways of measuring family functioning may not capture what's truly helpful or problematic for families with autism.
Individual Differences: Rather than looking at group averages, researchers might need to examine what works for individual families.
Broader Family Factors: Other elements like socioeconomic status, parental mental health, and social support likely influence family functioning and deserve investigation.
A Message of Hope
While this research identifies real challenges faced by families dealing with autism plus anxiety, it also provides hope. The study confirmed that cognitive behavioral therapy is effective for reducing anxiety symptoms in children with autism, just as it is for children without autism. This means that evidence-based treatments can help children regardless of their autism diagnosis.
The research also suggests that families naturally adapt to meet their children's needs. What might look like "dysfunction" on a research measure might actually represent a family's successful adaptation to supporting a child with complex needs.
Supporting All Families
For healthcare providers, this research emphasizes the importance of:
Assessing Family Needs: Understanding not just the child's symptoms but how the family as a whole is functioning and what support they need.
Providing Comprehensive Care: Offering treatment that addresses both the child's specific symptoms and broader family dynamics when needed.
Avoiding One-Size-Fits-All Approaches: Recognizing that families with different combinations of conditions may need different types of support.
Validating Family Experiences: Acknowledging that families dealing with multiple conditions face unique challenges that require understanding and support.
The research reminds us that children don't exist in isolation; they're part of family systems that both influence and are influenced by their mental health and developmental conditions. By understanding these family dynamics better, we can provide more effective, compassionate support to children and families facing these complex challenges.
For families like Emma's, this research provides validation that their experiences are real and understandable, while also pointing toward more targeted and effective ways to support both children and families in thriving despite the challenges they face.
Hagen, A., Klein, A. M., Bögels, S. M., & van Steensel, B. F. (2025). Family Functioning in Families of Children with an Anxiety Disorder, with and without Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 1-14.
Medical experts discover that brief cognitive behavioral therapy can transform how families manage food allergies and reduce unnecessary anxiety
When Sarah's 8-year-old son was diagnosed with a peanut allergy, she thought she was being a responsible parent by banning all nuts from their home, refusing playdates at houses where peanut butter might be present, and checking with restaurants multiple times about ingredients. But what started as caution gradually became consuming fear. Sarah found herself lying awake at night worrying about invisible peanut dust, avoiding family gatherings where nuts might be served, and even considering homeschooling her son to avoid any potential exposure.
Sarah's experience illustrates a growing recognition in the medical community: while food allergies and other allergic conditions are serious medical issues requiring careful management, the anxiety and fear surrounding them can sometimes become more disabling than the allergies themselves. Now, allergy specialists are discovering that incorporating psychological techniques into routine medical care can dramatically improve both the mental health and practical management of allergic diseases.
The Hidden Mental Health Crisis in Allergy Care
Anxiety and allergic diseases often go hand in hand, creating what medical experts call a "two-fold challenge." The allergic diagnosis frequently becomes the root cause of anxiety, which then interferes with a person's ability to engage in normal educational, social, and recreational activities.
The numbers reveal the scope of this problem. Research shows that 19% of caregivers believe their child has a moderate to high chance of dying from a food-induced allergic reaction, despite the actual risk being less than 1 in 100,000. This dramatic overestimation of risk leads to what experts call "false evidence appearing real" (FEAR), where anxiety becomes based not on actual medical facts but on misperceptions and worst-case scenario thinking.
The consequences extend beyond worry. Families may avoid social situations, limit their children's independence, experience relationship strain, and develop elaborate safety behaviors that don't actually improve safety but do increase stress and reduce quality of life.
Understanding the Psychology of Allergy Anxiety
To understand why allergy-related anxiety can become so overwhelming, it helps to look at how our minds process risk and uncertainty. When faced with a potentially life-threatening condition like food allergy, our natural protective instincts can go into overdrive.
Several psychological factors contribute to excessive allergy anxiety:
Catastrophic Thinking: People tend to focus on worst-case scenarios rather than likely outcomes. A parent might think "What if my child accidentally eats a peanut and dies?" rather than "What's the realistic risk, and how can we manage it sensibly?"
Overestimation of Risk: Without good numerical understanding of actual risks, people often assume dangers are much higher than they actually are.
Avoidance Behaviors: The more we avoid feared situations, the more frightening they become. This creates a cycle where avoidance increases anxiety rather than reducing it.
Information Overload: The internet provides endless horror stories and conflicting advice, often reinforcing fears rather than providing balanced, evidence-based information.
Confirmation Bias: People tend to seek out information that confirms their existing fears while dismissing reassuring evidence.
Enter Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) is a well-established psychological approach that helps people understand and change unhelpful thinking patterns and behaviors. The core idea is that our thoughts, feelings, and behaviors are all interconnected, and changing one can positively impact the others.
In the context of allergy care, CBT helps people:
Identify Unrealistic Thoughts: Recognizing when fear-based thinking isn't supported by medical evidence.
Challenge Catastrophic Assumptions: Learning to question automatic worst-case scenario thinking.
Develop Balanced Perspectives: Understanding real risks while maintaining appropriate caution.
Reduce Avoidance Behaviours: Gradually engaging in normal activities with appropriate safety measures rather than excessive restrictions.
Build Confidence: Developing practical skills for managing allergies without being controlled by them.
Brief CBT: Making Psychology Practical for Busy Clinics
While traditional CBT might involve many sessions with a specialized psychologist, allergy doctors have developed what they call "brief CBT" (bCBT) that can be integrated into regular medical appointments. This approach recognizes that most allergists aren't trained psychologists, but they are uniquely positioned to address allergy-related fears because they have the medical expertise to authoritatively correct false beliefs.
Brief CBT in allergy clinics starts with what experts call "curious questions." Instead of immediately providing medical information, doctors begin by exploring how patients and families are currently thinking about and managing their allergies.
Examples of curious questions might include:
- "What goes through your mind when you think about your child's allergy?"
- "How has this allergy changed what your family does day to day?"
- "What are your biggest worries about this condition?"
- "When you imagine the worst-case scenario, what does that look like?"
- "How confident do you feel in managing this allergy right now?"
These questions help doctors understand not just the medical aspects of the allergy, but the emotional and psychological landscape surrounding it.
Real-World Success Stories
Research is demonstrating that even brief psychological interventions can make a difference. In one study, mothers of children with food allergies received just a single session of brief CBT focused on risk communication. Six weeks later, those who had started with high anxiety levels showed significant reductions in their reported anxiety.
Another program called "Food Allergy Bravery" worked with children aged 8 to 12 who were experiencing problematic food allergy anxiety. All children in the program reported that their anxiety became more manageable, and many showed improvements in their overall functioning and quality of life.
These successes suggest that addressing the psychological aspects of allergy management isn't just helpful; it may be essential for optimal care.
The Three-Step Approach
Allergy specialists are developing a systematic approach that combines three key elements:
1. Motivational Interviewing This involves having empathetic conversations that help patients identify their own motivations for change. Rather than lecturing about what patients should do, doctors help patients explore what they want to achieve and what might be holding them back.
2. Brief Cognitive Behavioural Therapy Using curious questions and guided exploration, doctors help patients identify unrealistic thoughts and develop more balanced perspectives on risk and management.
3. Evidence-Based Education Armed with an understanding of the patient's emotional landscape, doctors can then provide medical information in ways that directly address specific fears and misconceptions.
Practical Applications in the Clinic
Here's how this might work in practice:
The Curious Question Phase: "I'm noticing that you seem really worried about your daughter's peanut allergy. Can you tell me what goes through your mind when you think about sending her to school?"
The Exploration Phase: The parent might respond, "I just keep imagining that someone will bring peanut butter cookies and she'll accidentally eat one and die before anyone can help her."
The Gentle Challenge Phase: "That sounds terrifying to imagine. Let's talk about what we know about how allergic reactions actually happen and what the school's emergency plan looks like."
The Reframe Phase: Together, doctor and parent develop a more realistic understanding of risks and create a management plan that provides safety without unnecessary restrictions.
The Behavioral Change Phase: The parent gradually becomes more comfortable with age-appropriate independence for their child, leading to improved quality of life for the whole family.
Verdi, M., Candido, D., Madan, J., Bernstein, J. A., Bukstein, D., Anagnostou, A., ... & Shaker, M. (2025). Addressing Anxiety and Depression in the Allergy Clinic Through Motivational Interviewing, Brief Cognitive Behavioral Therapy, and Curious Questions. The Journal of Allergy and Clinical Immunology: In Practice.
