Guide to Behavioral Treatments
If your child has an emotional or behavioral problem, you might be told that behavioral therapy would be a good treatment for her. This guide offers an overview of behavioral treatments, how they work and how they can help.
List of Treatments
There are a lot of different kinds of behavioral therapy, each of which has been developed to work effectively with a specific disorder or set of disorders. They have been tested on children with that disorder, and they have been manualized — that is, spelled out step-by-step to insure that the techniques are used in the manner and sequence that have been shown to be most effective. There are also clear measures of a child’s progress, and an estimated duration for the treatment.
Here’s a look at some of the most common behavioral treatments that are effective for kids.
Acceptance and Commitment Therapy (ACT)
Who is it for? Older children and adolescents who suffer from anxiety, depression or self-harming behaviors
What is it? ACT combines techniques from CBT and mindfulness as a way of accepting emotion instead of attempting to get rid of it through unhealthy coping mechanisms.
How does it work? ACT focuses on the idea that difficult things are going to happen to which the child or teen is going to have a negative response. The patient is asked to commit to feeling those things without reacting in a way that is unhealthy or self-harming. The goal is to learn that the patient can feel negative emotions but doesn’t have to react with an unhealthy behavior. Its goal is to help the patient become more at peace with the thoughts and the feelings, rather than feeling desperate to get rid of them.
Applied Behavior Analysis (ABA)
Who is it for? Children with autism spectrum disorder
What is it? ABA is an intensive intervention designed to help children with autism develop behaviors they don’t pick up the way neurotypical children do — including social, verbal and motor skills — and decrease behaviors that are problematic or self-injurious.
How does it work? ABA begins with close observation of a child engaged in an activity and uses positive prompts or reinforcement to increase desired behaviors. Problematic behaviors are addressed by studying what occurs before and after the behavior and altering those triggers or reinforcements rather than focusing on the behavior itself.
Who is it for? Children and adolescents who are struggling with depression
What is it? Behavioral activation targets the avoidance and withdrawal that cause depressed kids to stop participating in rewarding activities.
How does it work? Kids who are depressed are asked to participate in activities they have enjoyed in the past, even though they may have lost interest in them. The therapy uses activities to jumpstart momentum towards reengagement, bolstered by positive reinforcement. The goal is also for the child to learn to see the link between his activities and mood, understand avoidance patterns, and learn to choose more adaptive patterns.
Cognitive Behavior Therapy (CBT)
Who is it for? Cognitive behavioral therapy is used to treat a wide range of disorders and difficulties.
What is it? CBT is based on the premise that thoughts (cognitions), feelings and behaviors all influence one another. CBT is an umbrella term for many specific kinds of therapy tailored to specific psychiatric disorders.
How does it work? A therapist can use CBT to help your child identify how her thoughts influence her behaviors. Changes in behavior, in turn, can help her change the way she manages unwanted feelings and thoughts.
CBTp (CBT adapted for psychosis)
Who is it for? CBTp is a form of cognitive behavioral therapy developed specifically to help people with schizophrenia who are experiencing psychotic symptoms, including delusions (ideas that are not true) and hallucinations (hearing or seeing things that no one else hears or sees).
What is it? The goal of CBTp is to help reduce the distress associated with a patient’s delusions and hallucinations so that he can function better. It is not aimed at removing symptoms or trying to convince someone that their experience is not “real.” CBTp is part of Coordinated Specialty Care, a combination of treatments that has been shown to reduce recurrence of psychotic symptoms by 50%.
How does it work? Once the clinician gains a detailed understanding of the patient’s delusions and hallucinations, she helps the patient change the way he interprets and reacts to them, which can result in a reduction of the need for medication and less impairment.
Cognitive Processing Therapy (CPT)
Who is it for? Trauma therapy for adolescents and young adults
What is it? Cognitive processing therapy helps patients talk about what happened to them, but with a focus on identifying how the trauma altered their beliefs and the way in which those beliefs have kept them from moving forward.
How does it work? In CPT clinicians help a client examine how her beliefs have changed after experiencing trauma. They talk through those thoughts and break down which beliefs are realistic and healthy and which aren’t (such as her own feelings of guilt). The goal in the end is to help her develop a healthier view of what happened so that she can move past it.
Who is it for? Families of non-compliant or defiant teens between the ages of 13 and 18.
What is it? In Defiant Teens a clinician coaches both parents and teens, aiming to help each family member develop more effective problem-solving, negotiation and communication skills and to correct unreasonable beliefs that might be impeding their interactions.
How does it work? The first half of the program focuses on teaching parents more effective tools for handling noncompliance or defiant behavior. But the program also includes training for the adolescent to help him become a participant in changing the family dynamic. In the second half, parents and teenagers are both trained in problem-solving communication.
Dialectical Behavior Therapy (DBT)
Who is it for? Dialectical behavior therapy was originally developed for people with borderline personality disorder, but it has been adapted successfully to treat eating disorders, suicidal and self-injurious behavior, depression and substance abuse.
What is it? DBT focuses on accepting rather than challenging difficult thoughts, while at the same time initiating change in the way you respond to them.
How does it work? DBT helps individuals focus on accepting — rather than becoming overwhelmed by — difficult thoughts by using what’s called “mindful awareness,” while taking steps to improve interpersonal interactions and avoid problematic behavior. It’s called dialectical because it involves balancing both acceptance and change.
Exposure and Response Prevention (ERP)
Who is it for? Children with OCD, social anxiety, specific phobias, panic disorder and generalized anxiety disorder
What is it? ERP involves exposing the child to the things that trigger his anxiety in a safe and controlled setting. By introducing the trigger in tiny increments, the therapist helps the child learn to tolerate the anxiety without performing the compulsive ritual or avoidance behavior.
How does it work? The OCD or anxiety symptoms diminish as the child slowly gets used to dealing with things that trigger his anxiety. As the therapy progresses, he’ll become able to deal with more and more anxiety-provoking stimuli without needing to resort to compulsions or other problem behaviors to escape the stimulus.
Family-Based Treatment (FBT) or Maudsley Method
Who is it for? Adolescents who struggle with eating disorders, including anorexia and bulimia
What is it? This therapy engages the whole family in helping the anorexic or bulimic teen recover from disordered eating and then reclaim their autonomy and identity.
How does it work? FBT is an intensive outpatient training program which starts from the premise that parents can be a very active and positive force in their child’s recovery. The manualized training, delivered by a clinician in their office, has three phases: restoring the teen to an appropriate weight, restoring control over eating to the adolescent, and finally helping the adolescent develop a healthy identity and age-appropriate independence, as well as focusing on any co-morbid issues.
Family-Focused Therapy (FFT)
Who is it for? Patients with bipolar disorder and their families
What is it? FFT is a combination of psychoeducation and family therapy that includes communication enhancement training and problem solving skills. FFT begins with the premise that the patient’s symptoms — especially in the case of children and adolescents — do not exist independently from the family system and its dynamics.
How does it work? FFT engages parents and other family members in keeping track of symptoms and improving communication and problem-solving in the home, to avoid spikes in family stress, which can lead to bipolar episodes.
Habit Reversal Therapy (HRT)
Who is it for? Children who have tics, Tourette’s and other body-focused repetitive behaviors, including trichotillomania and skin-picking.
What is it? HRT is a form of therapy that gives the child some control over tics by teaching him to be aware of what’s called a “premonitory urge” — a fleeting sensation that occurs before the tic — and responding in a different way .
How does it work? By learning to recognize premonitory urges the child can initiate what’s called a competing response — a less disruptive or problematic reaction that’s incompatible with the tic.
Interpersonal Psychotherapy (IPT)
Who is it for? Interpersonal psychotherapy is often used to treat children and adolescents with depression, but can be helpful with a wide-range of issues and disorders.
What is it? IPT is a form of short-term therapy that focuses on helping your child explore how her relationships with peers and family positively (and negatively) affect her mood and behavior.
How does it work? Interpersonal therapy helps the child identify things that might be adversely affecting her mood — including conflicts, transitions, grief and negative patterns in relationships — and make improvements that can positively impact her feelings and behavior.
The Incredible Years
Who is it for? Parents of kids from infants through age 12. Small group training programs are broken into four age groups (baby, toddler, preschool and school age). In addition, the therapy is designed for high-risk socioeconomically disadvantaged families, and for families with children diagnosed with ADHD and oppositional defiance disorder.
What is it? Parent training with a focus on improving parent-child relationships and positive attachment and then moving on to consistent routines, rules and limit-setting. Finally it covers strategies such as ignoring, redirection, logical and natural consequences, time to calm down and problem-solving
How does it work? New skills are taught in each session as earlier ones are mastered. The small group setting allows parents to learn from each other as well as the therapist. The program offers children’s groups for kids from four to eight which focus on helping them acquire emotional regulation strategies and social skills.
Interpersonal and Social Rhythm Therapy (IPSRT)
Who is it for? Adolescents with bipolar disorder
What is it? IPSRT is based on the concept that a healthy person has regular social and circadian rhythms such as sleeping, eating, seeing friends, and going to school or work, and that maintaining those rhythms can prevent the onset of episodes of mania and depression.
How does it work? The therapy focuses on helping patients reduce interpersonal stressors and disruptions to a stable lifestyle in order to forestall new episodes of mania or depression. Patients learn to improve relationship skills and keep regular patterns of eating, socializing and sleeping.
Mindfulness-Based Cognitive Therapy
Who is it for? Adolescents who are struggling with anxiety or depression
What is it? MBCT is a behavioral therapy that combines techniques and skills from cognitive behavioral therapy with those of mindfulness, specifically mindfulness meditation, which teaches people to be fully present in the moment and observe their thoughts and feelings without judgment.
How does it work? Using skills taught in CBT with mindfulness, the patient learns to interrupt undesirable thought patterns that can maintain or lead to a depressive episode or anxiety attack, like being self-critical or fixating on negative things in ways that are not constructive.
Who is it for? Adolescent substance abusers who have been directed to treatment by parents or authorities and are unlikely to succeed in it unless they perceive a benefit for themselves
What is it? Motivational interviewing focuses on exploring and resolving ambivalence to treatment in order to increase motivation to change problematic behavior.
How does it work? In a motivational interview, the therapist is collaborative rather than confrontational. The emphasis is on understanding the child’s point of view, eliciting the child’s ideas about change, and emphasizing the child’s responsibility for his behavior.
Parent-Child Interaction Therapy (PCIT)
Who is it for? Parents and children who are struggling to interact in a positive, productive way
What is it? PCIT is a therapeutic technique that restructures the interaction between you and and your child to reduce conflict and disruptive behavior, and improve the attachment relationship.
How does it work? A therapist will help teach you to give effective positive reinforcement for desired behaviors and consistent consequences for undesirable behaviors. Once you’ve learned these skills, you’ll receive live coaching (via a bug in the ear) from a therapist who watches from behind a one-way mirror as you and your child interact. The goal is to help kids and parents enjoy a more positive relationship by teaching parents to exercise their authority calmly and consistently, and helping children learn to manage their own behavior more effectively.
Parent Management Training (PMT)
Who is it for? Parents of 3-13 year-old children who want to learn effective skills for dealing more effectively with challenging behaviors such as aggression, defiance and temper tantrums
What is it? This parent coaching program puts a premium on offering parents more change more quickly, especially for families where the situation at home is particularly urgent.
How does it work? In each of the first four or five sessions or modules (in which, for the most part, parents are seen without the child) parents are taught a new skill, which is modeled by the therapist and role-played by parents. Parents then practice the skills at home. These skills are refined in another four to five sessions in which the child might also participate.
Positive Parenting Program (Triple P)
Who is it for? Parents of children — toddlers through adolescents — who want to gain confidence and self-sufficiency in managing child behavior.
What is it? Triple P is a parenting support system that offers programs ranging from parenting basics taught over four sessions in doctor’s offices to a 12-session parent-and-child-focused treatment for families facing more severe behavior problems.
How does it work? Triple P is aimed at improving parenting on many levels. In some sessions the clinician works one-on-one with parents to improve skills and strategies for dealing with behavior, while in other sessions kids are included and the therapist does live coaching.
Prolonged Exposure Therapy
Who is it for? Adolescents who suffer from trauma
What is it? This treatment is designed to help people stop avoiding thinking about their traumatic experience or anything that might remind them of it.
How does it work? In prolonged exposure therapy the clinician helps the client talk about his traumatic experience and create a list of the things he has been avoiding, ranking them in order of how distressing they are. Slowly, and with the assistance of the clinician, he begins to gradually habituate to the things he has been avoiding. The therapy is designed to help teens move forward after facing the memory of the traumatic experience.
Trauma-Focused Cognitive Behavior Therapy (TF-CBT)
Who is it for? Children and adolescents who have experienced trauma
What is it? TF-CBT is behavioral therapy specifically geared to helping children and parents learn to process a disturbing experience in a healthy way.
How does it work? TF-CBT helps children understand what trauma is and how it has affected them, talk about their trauma, and construct a narrative that enables them to manage distressing thoughts and feelings and recover their sense of well-being. Parents learn that they don’t have to fix their children’s feelings, just listen and validate them.