Therapy for Anxious Kids and Teens

Is your child often worried, avoidant, seeking reassurance, checking, or doing things repeatedly?

It’s heartbreaking when fears and worries get in the way of healthy learning, playing, or growing. Core anxiety symptoms usually involve 1) that “butterflies-in-your-stomach,” heart-thumping feeling, and 2) a pattern of avoidance. Some kids talk about worries constantly, while others quietly shut down, refuse to go to school, or complain of stomachaches and headaches. You might be worried that anxiety is just a part of their personality, or maybe you remember being an anxious kid yourself and are worried that you “passed it on.” But anxiety does not have to be a life sentence; most of the time, it is an acute pattern that responds well to treatment. Therapy can help by teaching kids to understand what anxiety is, recognize early warning signs, and practice facing fears in small, manageable steps. The goal isn’t to get rid of all anxiety, because it’s a normal emotion, but to help kids feel braver and more in control when it shows up.

How is anxiety treated in kids and teens?

Cognitive Behavior Therapy (CBT), particularly when used with Exposure Therapy or Exposure and Response Prevention (ERP) is typically the best practice for anxiety, though specific procedures may vary between younger and older children/adolescents. For younger children, therapy may focus more on helping parents to facilitate brave approach of the avoided situations, and play may be incorporated into the treatment. For older kids and teens, the process typically involves more direct work around confronting anxious thoughts and gradually facing fears in a structured, manageable way. While the approach may vary, the goal is always the same: helping kids feel more confident in navigating anxiety and building resilience in the process.

Medication can sometimes be a helpful part of treating anxiety, especially when symptoms are severe or persistent. I typically encourage families to give evidence-based therapy a thorough effort, since it is often a slam-dunk for many types of anxiety (even the ones that seem scary or severe, like OCD). Once you get over a fear, it’s pretty hard to “re-learn” it, kind of like the moment you find out that the spider you just freaked out about is a fake one! If you do choose to move forward with medication, it’s important to work closely with a pediatrician or psychiatrist who specializes in child mental health to find the right approach.

I’d be happy to discuss treatment options with you further; contact me to have a conversation.

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It can be frustrating to watch your child panic or shut down over something that seems harmless (e.g., going to bed alone, getting in an elevator, etc.) Anxiety doesn’t always follow logic. It’s more like a false alarm going off in the brain, telling your child that something is unsafe, even when it’s not. To them, the fear feels real in the moment, even if they know it doesn’t make sense. That’s why reassurance alone usually isn’t enough: They need tools to help their brain and body feel safe again so they can move through the fear instead of avoiding it.
It’s completely natural to want to protect your child from things that upset them. And in the short term, avoiding anxiety triggers can bring relief. But over time, avoidance has a funny way of making anxiety stronger. It’s almost like your brain saying “If avoidance feels this good, the thing I’m avoiding must be really bad.” A better approach is to help kids face fears gradually, with support, so they can build confidence and realize they can handle hard things. That’s something therapy can guide in a structured and supportive way.
It might be surprising to hear this, but coping strategies can actually be counter-productive for certain kinds of anxieties. Think about it: If you always close your eyes during the scariest part of a movie, every time you watch it, will that part of the movie ever become less scary? Coping strategies might accidentally slow down the learning process, and hamper efforts to toughen up the nervous system against perceived threats. When used judiciously during therapy, coping strategies can help, but there is some research that most therapists are over-reliant on teaching “strategies” and under-reliant on teaching “bravery.”
It’s a great question, and the answer isn’t always straightforward. With trauma or certain kinds of anxiety like OCD, the fear doesn’t come from a current danger: It comes from the memory or the thought of something that felt scary, overwhelming, or out of control. Even if the threat is long gone, the body and brain can react like it’s still happening. Facing those fears doesn’t necessarily mean simulating or reliving them; instead, some controlled imagination exercises are used to safely “clean out the wound” without re-traumatizing.