Why CBT works for anxious children and teens, and how schools can use it

Cognitive Behavioural Therapy (CBT) is one of the most effective and widely studied treatments for anxiety. It’s used by psychologists around the world to challenge thinking habits that have become ingrained over time. However, with the correct support and training, in recent years, schools have started applying some foundational CBT principles in conversation techniques, and the results are promising.

The shift is subtle but important: instead of waiting for students to be referred to external services, more schools are building modest CBT-informed tools into their daily routines. This allows for earlier, broader intervention, particularly for students showing the early signs of avoidance, fear-based behaviour or social withdrawal.

So how does CBT work, and how can schools be supported to use it to challenge unhelpful thinking?

Understanding the basics of CBT

At its core, CBT focuses on the connection between thoughts, feelings and behaviour. For anxious young people, distorted thinking patterns such as catastrophic thinking or black-and-white thinking, can lead to avoidance, school refusal, and outbursts that mask internal distress.

CBT teaches students to:

• Identify and challenge unhelpful thoughts

• Gradually face situations they fear with support

• Build problem-solving and emotion regulation skills

• Develop tools to question unhelpful thinking patterns, and a stronger sense of control

In a clinical setting, these strategies work across a range of anxiety disorders, including generalised anxiety, social anxiety and separation anxiety. However, as an early-intervention tool, teachers can be trained to hold structured serve and return conversations that can start the process of identifying and challenging unhelpful thinking.

Why schools are well placed to deliver early CBT-based strategies

Clinical services remain essential for students with diagnosed disorders, and for many students requiring additional supports during challenging periods. However, for the many students, early, low-intensity interventions can significantly reduce anxiety symptoms before they escalate and help build resilient thinking skills they can carry into the future.

Evidence supports the use of CBT-informed strategies delivered by teachers and wellbeing staff. In a 2015 randomised controlled trial across UK secondary schools, researchers found that brief CBT sessions delivered by non-specialists led to measurable reductions in student anxiety.1 The delivery model relied on structured scripts, short sessions and repetition — all achievable in a school setting with the appropriate .

A 2020 Australian review of school-based CBT programs found that brief interventions lasting as little as six sessions could significantly reduce symptoms among students aged 10 to 14, especially when combined with consistent teacher support.2 Meta-analytic data shows this trend across school contexts: when CBT strategies are embedded into school routines, student engagement improves, and anxiety levels drop.3

What CBT can look like in the classroom as a whole school startegy

We are by no means suggesting that school staff need to take on the role of a psychologist! What can be achieved is a consistent, scaffolded approach using tools that all staff understand.

Some practical examples include:

• Normalising the symptoms of anxiety

  (e.g. “Your heart racing is your body’s way of getting ready to act, not a sign something is wrong”)

• Using graded exposure plans

  (helping students take small steps toward feared situations instead of avoiding them altogether)

• Reframing unhelpful self-talk

  (from “I’ll fail this presentation” to “I might feel nervous but I can get through it”)

• Reinforcing calm behaviour rather than rescuing

  (e.g. giving neutral encouragement rather than removing the challenge)

These strategies are most effective when they’re used consistently across classrooms and supported by a shared language around feelings, thoughts and reactions.

As Dr Paula Barrett, developer of the FRIENDS program, has shown, CBT can be taught at scale when schools move beyond a referral mindset and instead treat anxiety reduction as a core function of wellbeing education.4

The risk of doing nothing — or the wrong thing

Without early intervention, anxiety tends to become entrenched. Avoidance becomes the default for the student. Students develop a narrow window of tolerance and a reduced sense of agency. When teachers don’t feel equipped to respond, the most common reactions are either to accommodate the student's avoidance, or to withdraw support — both of which can deepen the cycle.

CBT techniques can break this pattern by teaching young people that fear is not dangerous, that feelings can be observed without acted on, and that change is possible through practice.

As highlighted in parent and teacher-focused CBT guides, the earlier these skills are taught, the more natural they become, and the less likely anxiety is to derail a student’s development.5

Giving teachers the tools

You do not need to turn teachers into therapists. But giving them a structured, low-intensity CBT tools and framework they can apply in conversations, responses, and lesson structures can shift the experience of anxious students significantly.

What matters most is consistency. When students hear the same calm language from every adult, when expectations remain stable, and when they’re coached through their reactions instead of being removed from difficulty, they learn resilience — not helplessness.

This is not about one program or one staff member. It’s about changing the climate of the school so that anxiety no longer runs the show.

Join schools over 200 schools across Australia implementing our evidence-based, whole-school community approach to effectively manage student anxiety and build resilient thinking skills in children through The Anxiety Project and Resilience In Our Teens projects.

References

• Stallard, P. et al. (2015).

  School-based intervention to reduce anxiety in children: A randomized controlled trial

  . Journal of the American Academy of Child & Adolescent Psychiatry.

• Neil, A. & Christensen, H. (2020).

  School-based CBT interventions in Australia: Effectiveness of brief formats for adolescent anxiety

  . Australian Psychologist.

• Mychailyszyn, M. P. et al. (2011).

  Implementation of cognitive-behavioral therapy in school settings: A meta-analytic review

  . School Psychology Review.

• Creswell, C. & Willetts, L. (2019).

  Overcoming Your Child's Fears and Worries: A self-help guide based on CBT

  . Robinson.

• Barrett, P. M., et al. (2000).

  Prevention of anxiety disorders in school settings: A review of universal and targeted approaches

  . Journal of Clinical Child Psychology.