Nontreatment Better than CBT for Childhood Anxiety?


Children who received no treatment for their diagnosed anxiety disorder faired better over the long term than did those who chose to take Cognitive Behavioral Therapy (CBT), according to a study in Brain and Behavior. In addition, regardless of being treated or not, about half of the people in both groups were generally fairing better at the time of the long-term follow-up.

A team of mainly University of Toronto researchers were able to follow up approximately eight years later with 120 people who at ages 8–12 had been diagnosed with anxiety disorders between 1997-2003. Half of the participants had taken a CBT program, and a comparable group of children had not. “Nontreatment” or “treatment as usual” was defined as those who declined CBT. Some participants from both groups were involved with supportive therapy, religious or spiritual guidance, or taking medication.

“A statistically significant decrease in total anxiety was found in the nontreatment group at [Long Term Follow Up],” the reseachers wrote. Conversely, “An insignificant increase in anxiety was found in the treatment group.”

The researchers described it as the first long-term study to compare youth treated for their anxiety with CBT during childhood to those who were not treated. “Our results are surprising,” they wrote. They conceded there were many limitations to this form of study, such as possible self-selection bias among the participants.

The study also identified “an inverse relationship” with self-efficacy and self-esteem. “Anxiety decreased as self-efficacy and esteem increased.” The researchers hypothesized that this finding reflected how “the meaning attributed to [the anxiety] and the belief that one has the power to cope with it [are] the differentiating factor between clinical and nonclinical groups. To the best of our knowledge, this is the first study to provide evidence for this correlation in the context of therapy.”

Eight years later: outcomes of CBT-treated versus untreated anxious children (Adler, Gili W. et al. Brain and Behavior. August 19, 2014. DOI: 10.1002/brb3.274)


  1. This is a terrible study as it did not even compare the differences between types of treatment like medication and if they were allowed to use other treatments during the course of CBT and if those treatments had an impact on the outcome of non CBT and CBT using patients.

    We know drug using patients tend to get worse and worse and non drug using patients fair better than users. Non drug using patients end up healthier and live higher quality lives without having to suffer brain damage aka side effects. If you consider brain damaging effects a positive ever then you got a problem..

    I think psychotherapy is way better or having exposure therapy and leisure therapy than not getting anything at all. We really need to actually fix the root cause of a problem tho, whatever it is like poverty or busted public system, poor childhood social welfare system which leads to being stuck with bad parents, etc/whatever. Thus reducing damaging experiences..

    Focus should be less on pathology and awareness of a problem and more on living by experience and guidance an active normal life and engaging in activity to over come the problem. Actually practicing being less anxious rather than merely talking about it and learning about the problem. Fear of going out? Time to go on a paid for vacation to the Bahamas and have money available to do so.

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    • “I think psychotherapy is way better or having exposure therapy and leisure therapy than not getting anything at all.”
      I’d have a problem with that statement. I think that some forms of therapy can be actually harmful – I still think they’re “lesser evil” compared to drugs but I wouldn’t say that they are necessarily better in terms of helping. I think some kids are perfectly capable of coping on their own.
      On the other hand I totally agree with you that it’s hard to conclude anything from a study that measures a correlation like that without taking into account any confounding factors. It’s like disappearance of pirates causes global warming kind of fallacy.

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  2. Also what if those CBT users get trained to feel or think or report they have more problems due to too much focusing on the problem as an issue such as happens to people in treatment. They might even think they are better reporters because they have learned to take their experience and make it their problem due to all the time spent learning skills and getting treatment for it which never seem to be of any help most of the time, solidifyingthe issue and distracting them from other more healthy activities like just living and learning and reshaping their world through moving forward. (Thereby letting neuroplasticity do it’s thing, learning to live normally comes naturally.)

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    • I’ve seen reference to sociological studies of Millenials showing that because many of them had not been allowed unstructured play with children, or to wander on their own, or to play without supervision or constant reminders of risks, are more anxious than people who grew up in previous generations who were allowed to test their limits more and find their own boundaries, and deal with fear on a small scale in which they could conquer it without adult interference.

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  3. So both therapy and drugs prevent healing? One more reason medicalizing all human emotions is NOT beneficial to humanity.

    I think when the medical community decides to declare being a good, active, loving parent “unemployed,” because they want to make a profit off paternally parenting all people. But they think caring for others is defaming them with fictitious “diseases,” then educating them about their “diseases,” or drugging people. Well, we’ve lost the humanity behind caring for others.

    I’m glad the “mental health professionals” never got their hands on my sexually abused child. They would have destroyed him. As an “unemployed” mom, I gave him lots of love, attention, self esteem – and he ended up as the valedictorian of his high school class.

    Healing from childhood sexual abuse is impossible if the “care” givers are “mental health professionals.” But it’s not, if the caregiver is an “unemployed,” but loving, mother with common sense.

    I didn’t try to ignore my child’s real problem, by diagnosing it as a “life, long, incurable, genetic” anxiety disorder. Ignoring people’s real problems, by claiming they’re DSM disorders is so illogical and stupid it staggers my mind. The medical community has lost their minds with their greed, and appalling disrespect of other human beings. Not to mention, they’re actively colluding to keep child molesters on the streets, which is disgusting. Yeah to the mainstream medical community (sarcasm).

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  4. “…the meaning attributed to [the anxiety] and the belief that one has the power to cope with it [are] the differentiating factor between clinical and nonclinical groups.”

    I think this is the most significant finding from this study. It reinforces what I have always believed – the best approach to any “mental health problem” is to assist the person suffering in coming to the conclusion that their suffering is not abnormal given their situation, and that there are ways they can cope with or overcome the situation they are struggling with. Labeling someone with a “disability” and telling them their brain is broken and can’t be fixed to the exact opposite of this. It doesn’t entirely surprise me that even using CBT approaches, especially with kids, could reinforce the idea that there is something wrong with them and that they can’t handle it without “special help.” CBT, especially when done poorly, can often convey to the person that they are “causing their own distress” by thinking the wrong things, and can easily invalidate the real challenges a person may be facing.

    I also agree with the criticism that we would need to know how many in each group were taking psych drugs, because that would be expected to skew the results in the direction of worse outcomes, per Bob’s well-documented thesis regarding drugs increasing the chronicity of “mental health” symptoms.

    —- Steve

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    • I’d not be surprised if the therapy group was more medicated since that often comes together (the drugs will help you to concentrate/have more energy to deal with your problems blah blah) but I’m just guessing here.
      Anyway, I totally agree with “CBT, especially when done poorly, can often convey to the person that they are “causing their own distress” by thinking the wrong things, and can easily invalidate the real challenges a person may be facing.”. I have experience with this myself but as an adult I have realised pretty quickly that the person is an idiot who’s trying to make me blame everyone who was really supportive of me (my family and my friends) plus of course telling me how defective my thinking was and that I was never getting better without his help and tons of other bullshit. Plus he really wanted to talk to me about my sex life like on the 2nd session which I found super creepy.
      In essence I’d advice anyone to stay the hell away from the whole psych crowd no matter how bad they feel. You have better chances of dealing with it on your own.

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  5. Mr. Wipond;

    IF I had a critique, it would extend no further than your inclusion of the Question mark on your title. Thank you for this post.

    Suicidal Ideations By The Numbers: Counseling Is WORSE Than Zoloft.

    Talk Therapy Can Cause Harm Too by Jill Littrell P.hD.

    And if That doesn’t do it for you, let’s Really go to town with Dialectical Behavioral Therapy.

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