Brisbane Cognitive Psychology
Anxiety: Symptoms and Psychological Treatment
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Psychological Therapy for Anxiety

Brisbane Cognitive Therapy offers Cognitive-Behaviour Therapy (CBT), including Rational-Emotive Therapy, as well as relaxation techniques such as autogenic training for the psychological treatment of anxiety.

Core Features of Anxiety Disorders

Anxiety disorders are common in children (and adults), with prevalence estimates ranging from 5% to 25% in different countries (Figueroa, Soutullo, Ono & Saito, 2012; Simon & Boegels, 2009). Anxiety disorders are often comorbid with affective disorders and can result in depression or other mental health problems such as substance use. Early onset anxiety disorders (13 years or younger) may follow a chronic course and the anxiety may prevent individuals from seeking treatment or may delay a diagnosis by weeks or months (Simon & Boegels, 2009, p. 625-6).

Separation Anxiety Disorder (SAD)

Within the broad context of child anxiety, separation anxiety disorder is a very frequent presentation and according to the DSM-IV-TR criteria, should be diagnosed for children and adolescents less than 18 years only. SAD is characterized by a significant behavioural and emotional response to a real or imagined separation from one or more attachment figures. In addition, the impairment must interfere with daily activities. To meet DSM-IV-TR diagnostic criteria, “the anxiety must be beyond what is expected for the child's developmental level, last longer than four weeks, begin before age 18 and cause significant distress or impairment” (American Psychiatric Association, 2000, in Figueroa, et al., 2012).

More specifically, three key features of SAD are:

  • Excessive and persistent fears or worries before and at the time of separation.
  • Behavioural and somatic symptoms before, during and after the separation, and
  • Persistent avoidance or attempts to escape the separation situation (Figueroa, et al., 2012, p. 2).

Behavioural symptoms include crying, clinging and/or school refusal. Somatic symptoms are similar to those in a panic attack (Figueroa, et al., 2012, p. 2). SAD often results in school refusal which then leads to a diagnosis and some form of treatment, not necessarily by a psychologist. SAD is also predictive of adult mental health disorders, especially panic disorder (Figueroa, et al., 2012).

What are the Causes of Anxiety Disorders?

Cognitive-behavioural models of the pathogenesis of anxiety disorders suggest that negative automatic thoughts play a significant role. Hence, Cognitive Behavioural Therapy (CBT) strategies have been developed, which include cognitive restructuring, coping self-talk, in vivo exposure, modelling and relaxation training (Muris, Mayer, den Adel, Roos & van Wamelen, 2009). The effectiveness of CBT can be further enhanced through the addition of family therapy, even this has not been shown in all studies (Muris et al., 2009). The authors report that negative automatic thoughts and anxiety control (the feeling to be in control of symptoms) make unique contributions to treatment outcome. The influence of both automatic thoughts and anxiety control appeared to differ across various types of anxiety disorders (Muris et al., 2009, p.147).

What are the Psychological Treatment Options?

CBT is long established as a method of choice for anxiety and depression in children. Muris et al. (2009, p.147) argue that “negative automatic thoughts play a dominant role in symptoms of separation anxiety disorder”. The individual may make false or immature predictions about what can happen in the absence of care-givers or partners. Alternatively, the individual may rehearse in his or her mind what might happen to attachment figures during periods of absence, which could lead to an indefinite separation. The individual may also “catastrophise”, that is, interpret minor events in the absence of parents or partners as very negative and, as a result, experience intense fear.

Barrett et al. (2001, p.135/6) observed that, when compared with a group without treatment, CBT alone as well as CBT plus family management/treatment showed greater improvement on a variety of measures at a 12-month follow-up. More specifically, “clients that received family training also showed significantly greater improvement than the CBT-only group on a number of measures” (Barrett et al., 2001, p.136).

How does Cognitive Behavioural Therapy work? CBT addresses distorted and unhelpful patterns of thinking that result in anxiety. Based on the assumption that negative thoughts result in negative emotions and that well-adapted positive thoughts result in positive emotions, CBT tries to replace cognitive distortions (unhelpful thinking styles) with well-adjusted thinking patterns. Core elements of CBT are:

  • Cognitive restructuring: Identifying negative thoughts and replacing these by positive thinking styles.
  • Modelling: Practicing successful behaviour for critical situations; plus
  • Relaxation training: This may include calming (breathing) techniques, autogenic training or progressive muscle relaxation. Relaxation methods can be adjusted for children.

Please note that Brisbane Cognitive Psychology is not able to offer crisis services. Therefore, if you or a loved one is thinking or talking about suicide then you will need to seek urgent medical attention or alternatively call a crisis service such as Lifeline on 13 11 14.

For information on fees and a first appointment, please email today.


American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author.

Barrett, P. M., Duffy, A. L., Dadds, M. R., & Rapee, R. M. (2001). Cognitive-behavioral treatment of anxiety disorders in children: long-term (6-year) follow-up. Journal of Consulting and Clinical Psychology, Vol. 69, 135-141.

Figueroa, A., Soutullo, C., Ono, Y., & Saito, K. (2012). Separation Anxiety. In Rey, J.M. (Ed), IACAPAP e-Textbook of Child and Adolescent Mental Health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions.

Muris, P., Mayer, B., den Adel, M., Roos, T., & van Wamelen, J. (2009). Predictors of Change Following Cognitive-Behavioral Treatment of Children with Anxiety Problems: A Preliminary Investigation on Negative Automatic Thoughts and Anxiety Control. Child Psychiatry Human Development, Vol. 40, 139-151.

Simon, E. & Boegels, S.M. (2009). Screening for anxiety disorders in children. European Child Adolescent Psychiatry. Vol. 18, 625–634.