Clinical CBT
A therapeutic treatment delivered by trained therapists that helps children recognise and manage negative thoughts, feelings, and behaviours.
What is it?
Cognitive Behavioural Therapy (CBT) is a type of talking therapy that has been used to address a range of mental health needs. This summary focuses on clinical CBT for children and young people who have diagnosed mental health conditions linked to aggression or behavioural difficulties, and those who are at risk of violence or offending. We have summarised the evidence on CBT skills development programmes that can be provided to all children, here.
Clinical CBT is usually delivered by trained practitioners such as clinical psychologists, CBT therapists, Children and Adolescent Mental Health Services (CAMHS) practitioners, or other trained mental health practitioners. It is most often delivered in outpatient mental health services, hospitals, and youth justice or secure settings.
Interventions are usually structured around a treatment plan or manual but are tailored to the child or young person’s developmental, behavioural, and health needs as well as their level of risk and wider circumstances.
Sessions are typically delivered face-to-face, either one-to-one with the child or young person, jointly with parents or carers, or in small groups. They are often delivered weekly, with many programmes lasting between one to six months, although some continue for longer.
A key feature of clinical CBT is cognitive restructuring. This means helping children and young people to identify and change fixed patterns of thinking, such as assuming the worst of others, which can then escalate to conflict or aggression. Sessions may also include:
- managing anger and other strong emotions
- solving problems and thinking through the consequences of different actions
- building social and communication skills
- using coping strategies, such as self-soothing or breathing exercises
Children practise these skills through activities such as role-play, games, group discussions, worksheets, and practice tasks.
Clinical CBT aims to reduce violence and offending by helping children and young people to respond to conflict and difficult situations more safely. Over time, the approach is intended to improve self-control, reduce impulsive or aggressive reactions, and help children manage conflict without resorting to harmful behaviour.
Is it effective?
The research suggests that, on average, the impact of clinical Cognitive Behavioural Therapy approaches on preventing violence is likely to be high.
The evidence suggests that clinical CBT may reduce violence by 69%.
The research also estimates that, on average, clinical CBT may reduce crime and offending by 88%.
Clinical CBT approaches were also found to have positive effects on improving mental health, regulating and managing emotions, reducing drug and alcohol use, and ability to resolve conflict.
How secure is the evidence?
We have moderate confidence in our estimate of the average impact of clinical CBT on violence.
We gave this rating because our estimate is based on 9 studies. Of these, one study was high quality, 7 were moderate quality and one was low quality. One study was conducted in the UK, 3 studies in the US, 3 in the Netherlands, and one study each in Canada and Iran.
We have low confidence in our estimate of the average impact of clinical CBT on crime and offending. We gave this rating because our estimate is based on 6 studies. Of these, 2 were high quality, 3 were moderate quality and one was low quality.
The studies that produce the impact ratings on violence, crime and offending assessed the effectiveness of these approaches for 1,042 children and young people.
Who does it work for?
There is limited evidence on how the effectiveness of clinical Cognitive Behavioural Therapy may differ for different groups of children.
The children involved in these studies most frequently presented with disruptive behaviour disorders, conduct problems, or aggression, and a smaller number had diagnoses of autism or substance abuse. One study included children with disruptive mood dysregulation disorder, and another included children with fire setting behaviour.
One study from the Netherlands found that CBT was effective across ethnic groups, across age groups, and for children with, and without, mild learning disabilities.
The review did not find reliable evidence that explored the role of gender, neurodiversity, socioeconomic status, disability, or care experience, in effectiveness of clinical CBT.
How can you implement it well?
The review found 10 studies that provided evidence related to implementation, including 7 from the US, 2 from the Netherlands, and 1 from Iran.
Maximise engagement through varied activities
Use engaging activities, such as video games and reward systems, to encourage children to participate in therapy. However, these formats should not draw the intervention too far away from face-to-face working.
Actively involve parents or carers
Involving parents or carers improves transparency about what CBT involves and supports sustained participation. Regular check-ins, shared activities that let children demonstrate learned skills, and clear communication about treatment goals build collaboration and help parents reinforce those skills at home.
Tailor interventions to meet specific needs
Tailor treatment to children’s developmental characteristics, clinical complexity, and environmental contexts. Deliver flexibly using modular or adaptable formats, so therapists can adjust content, pacing, and emphasis to individual need, while preserving core therapeutic mechanisms such as cognitive restructuring, exposure, coping skills, and behavioural practice.
Take account of children’s wider context
Deliver CBT in ways that account for trauma, exclusion, discrimination, and racism, and how these may shape behaviour, engagement, and trust in services. Cognitive restructuring should focus only on inaccurate or unhelpful interpretations that are contributing to harm, not where children are responding to real experiences of racism or discrimination. Use culturally responsive practice, supervision, and ethnicity data to reflect on bias and address inequities.
How much does it cost?
Cognitive Behavioural Therapy delivered by clinically trained and supervised specialists is likely to be high cost.
The number and intensity of sessions will vary based on the needs of the child, but it is likely to cost between £2,000 and £6,000 per child.
Costs will vary depending on the complexity of the child’s needs, the frequency and length of sessions, who delivers the programme, the level of practitioner expertise and supervision required, and the delivery format.
Topic summary
- Clinical Cognitive Behavioural Therapy is a talking therapy that can be provided to children and young people who have diagnosed mental health conditions linked to aggression or behavioural difficulties, and those who are at risk of violence or offending. It is delivered by trained clinicians or specialised practitioners and aims to change harmful patterns of thinking, emotion, and behaviour.
- It is estimated to have a high impact on reducing violence and offending, though our confidence in the estimate for violence is moderate and low for crime and offending.
- Tailoring delivery to children’s needs, supporting practitioners with training, and supervision, and involving the family, are key factors for successful implementation.
- Clinical CBT is likely to be high cost.
Take away messages
- Invest in clinically-led Cognitive Behavioural Therapy provision, and increase access for children who need it, including those at-risk or already involved in violence. As a higher-intensity intervention, it should be offered based on a clinical needs assessment rather than involvement in violence alone.
- Ensure referrals and needs assessments take place quickly.
- Put strategies in place to reach children and families from racially minoritised communities and to keep them engaged throughout the intervention.
- Deliver clinical CBT in ways that take account of discrimination, exclusion, and racism, so that children’s responses are understood in context. Use culturally responsive practice, supervision, and ethnicity data to reflect on bias and address inequities.
External links
NICE guideline: Antisocial behaviour and conduct disorders in children and young people
A clinical guidance for services using psychosocial interventions for recognising and managing antisocial behaviour and conduct disorders in children and young people aged under 19.
Clear explanation about recognised CBT practice standards.
NHS: Cognitive Behavioural Therapy
An overview from the NHS explaining what CBT is, how it works, what sessions involve, and how to access it through NHS services.