One of the most successful and widely implemented among the rash of cognitive behavior therapy programs has been developed at Temple University in Philadelphia by the Director of the Child and Adolescent Anxiety Disorders Clinic, Philip Kendall.

Kendall is the pioneer and painstaking evaluator of the Coping Cats program – replicated in Canada as Coping Bears and in Australia as Coping Koalas or FRIENDS. Other variations run in the UK and elsewhere in continental Europe.

Based solidly on theory about how people learn behavior, CBT helps those with problems to separate out their thoughts, emotions, physical reactions and behavior and so better understand the situations or events that trigger them.

It involves the therapist asking a child what was in her mind when she avoided school, for example, how she felt at the moment she made the decision, whether she experienced any physical symptoms such as a racing heart, and what happened afterwards. The invitation to reflect and reconsider is intended to lead the child toward new ways of thinking and, further, to more productive behavior.

The literature is full of fancy descriptions of the methods, including cognitive re-structuring, contingent reinforcement and guided imagery. The approach requires the skills of trained professionals and systematic progress but the core principles are relatively easy to understand.

Kendall's Coping Cats program is based on between 15 and 20 sessions with a trained psychologist. It can be group-based or delivered to an individual. Some sessions rely heavily on parents’ involvement, others do not. The therapist builds a rapport with the child, identifies the problem, suggests new coping skills and makes it possible to try them out in increasingly stressful situations, evaluating progress along the way. The coping skills are varied. Children learn to talk themselves through a crisis; they evaluate their own performance and reward themselves when they do well.

Invoking Cats, Bears or Koalas, most CBT programs are based on commonsense. They distill what many parents do for their children, and how people ordinarily cope with difficulty. If there is a weakness, it is that success has led CBT enthusiasts to make rash claims about effectiveness.

More knowledge is needed about why CBT works and for which developmental impairments. And more work is required by policy makers to match to the available programs the children most likely to benefit – and to persevere in the search for services that will address problems and disorders that do not respond so readily to behavior therapy interventions.

[See also Queensland assault against anxiety builds on the FEAR plan and Look at it this way, cognitive therapy really works