Genes Expressed in the Brain Before Birth May Affect Risk of Childhood Mental Illness
Study’s findings provide additional evidence that risk for mental illness in children begins in the womb.
Child Cognitive Behavioral Therapy (CBT) Program
The mission of the Child Cognitive Behavioral Therapy Program at Massachusetts General
Hospital is to provide state-of-the-art cognitive behavioral therapy to children,
adolescents and young adults with a range of emotional and behavioral problems.
Child Cognitive Behavioral Therapy Program
55 Fruit Street, Warren 719
Boston,
MA
02114
Phone: 617-643-9898
Explore This Treatment Program
About the Program
The Child Cognitive Behavioral Therapy (CBT) program at Massachusetts General Hospital provides state-of-the-art treatment options for children, adolescents and young adults (ages 3-24) facing a range of emotional and behavioral problems. In addition to our clinical practice, we work to advance the scientific understanding of CBT approaches and to foster the dissemination of CBT techniques.
CBT aims to reduce emotional distress and psychological symptoms by changing the underlying factors, including negative thoughts or errors in interpretation, unhelpful coping strategies and behaviors that may inadvertently reinforce these feelings and symptoms. CBT works by teaching patients new coping skills and providing opportunities, both in-session and between sessions, to practice these skills.
Skills Taught in CBT
- Gaining a thorough understanding of factors maintaining emotional distress and situational avoidance
- Identifying and modifying negative patterns of thinking
- Developing problem-solving skills
- Mastering relaxation and deep breathing techniques
- Learning to gradually face feared situations rather than avoid them
- Developing organizational skills
- Improving social interactions
- Improving parent-child interactions
Research supports the use of CBT with children, adolescents and young adults. For youth with mild-to-moderate symptoms, CBT alone can result in significant improvement. For youth with more severe symptoms, CBT used together with medication can lead to a significant reduction in symptoms and improvements in day-to-day living. Recent research has shown that CBT can also be effectively administered via modalities such as the internet, increasing its potential for widespread use and administration.
Disorders We Treat
Research over the past 40 years has shown that cognitive behavioral therapy (CBT) can be very effective in treating a range of disorders in children and adolescents. Among young people, anxiety disorders are the most common form of psychological distress, with approximately 10% of youth suffering from an anxiety disorder. CBT can be particularly helpful in treating these anxiety disorders and stress-related problems.
Separation Anxiety
Excessive anxiety caused by being separated from parents or away from home can cause significant distress or interfere in a child’s daily functioning. Children with this condition may be reluctant or unable to go to school or elsewhere because of anxiety about separation, may complain of physical symptoms when separation is imminent, or may express and display high levels of fear, aggression or distress when separated.
Associated symptoms include:
- “Shadowing” parents around the house
- Difficulty sleeping alone
- Anxiety about going to parts of the house alone
Social Phobia
Social phobia is excessive, persistent anxiety caused by being the focus of attention or doing something embarrassing or foolish in front of others. Although mild social concerns are typical of middle-school aged youth or adolescents, social phobia is diagnosed when the child’s distress is severe and interferes with his/her ability to engage in age-appropriate tasks. Some social anxiety may be very specific, for example, fears of eating in public because of embarrassment, Some children may experience significant anxiety in many or most social situations. Anxiety may be most pronounced in unfamiliar situations or with new peers, and the child may be described as very “shy” or withdrawn.
Common signs of social phobia:
- Avoidance of social situations
- Difficulty making friends
- Vulnerability to social exclusion or teasing
Generalized Anxiety Disorder (GAD)
Children with this condition are often described as always worried. Although a certain amount of worry is normal in childhood, children with GAD worry excessively most days and experience any number of physical symptoms. Frequent focuses of worry include schoolwork and grades, performance in other extracurricular activities, family, health, world issues; and smaller events that may have happened in the past (“did I make a mistake or say the wrong thing?”). Many of these children may be perfectionistic and highly driven. Although this worry may interfere in daily life, many of these children may be doing well in school or other areas. However, a diagnosis of GAD is considered when the worry prevents the child from enjoying activities or causes excessive distress.
Physical symptoms of GAD:
- Headache or stomachache
- Difficulty sleeping
- Feeling tense and irritable
- Difficulty sitting still or concentrating
- Inability to relax
Panic Disorder
This disorder involves the experience of recurrent panic attacks. During a panic attack, the child experiences numerous, intense symptoms of anxiety that come on unexpectedly and peak very rapidly. Children may also cry, lash out or cling to parents during these attacks.
Physical symptoms of panic attacks:
- Racing heartbeat or chest pain
- Rapid breathing
- Dizziness
- Nausea
- Cold sweats or hot flashes
- Trembling
- Sense of dread
- Fear of losing control or going crazy
Agoraphobia
This condition often (but not always) accompanies panic disorder. Children with agoraphobia fear going places where they may have a panic attack or become very anxious, but in which it would be difficulty to escape or get help. They feel very anxious when they are in this type of situation and often try to avoid situations where they could feel anxious or panicky.
Commonly feared situations:
- Crowded settings
- Elevators
- Public transportation
- Being alone
- Going to school
Specific Phobias
Fears of specific objects are extremely common in childhood (some studies have found that the average child has approximately three fears at any time). However, phobias can be distinguished from more typical fears by their intensity, persistence and interference. A child with a phobia will become highly distressed when confronted by the feared object. He/she will avoid the anxiety-provoking situation to the point where it interferes with their ability to function, participate in age-appropriate activities or limit their daily routines.
Common phobias include:
- Animals, birds or insects
- Deep water
- Clowns/costumed characters
- Blood/injections
- Heights
Obsessive-compulsive Disorder (OCD)
A form of anxiety in which the child experiences repetitive, unwanted, or distressing thoughts (obsessions) or an urge to perform repeated behaviors (compulsions). These are different from typical rituals of childhood, such as bedtime rituals, because the child feels compelled to engage in these behaviors and experiences significant distress, fear or discomfort if he or she cannot. The obsessions and compulsions are time-consuming and often interfere significantly in the child’s daily functioning. Children may also engage in significant avoidance behaviors because of their concerns and may demand that other family members also engage in rituals or avoid certain things because of the OCD.
Common obsessions:
- Distressing thoughts about harm coming to loved ones or to self
- Concerns about germs
- Inappropriate and unwanted sexual thoughts
- Doubting thoughts (Did I do this or not?)
- Distressing thoughts about religious matters
Common compulsions:
- Washing and grooming rituals
- Counting and having “good” and “bad” numbers
- Praying or saying phrases repeatedly
- Checking behaviors
- Symmetry rituals (e.g., touching something with the left hand if touched with the right hand)
- Repeating rituals (e.g., walking repeatedly through a doorway until it “feels right”)
Our Services
The Child CBT Program offers clinical care for youth ages 3-24 years with a range of emotional and behavioral problems. Our program provides treatment through a number of different services.
Individual/Family Therapy
We provide well-established CBT treatments for young people with anxiety disorders, obsessive-compulsive disorder, tics and habit disorders and mood and disruptive behavior disorders. Treatment is usually short term (on average 12-16 sessions), targeted around specific issues and focused on measurable improvements.
Condition-specific Services
We provide specialized, leading-edge services, including treatment of:
- Preschool and early elementary school-aged children with anxiety disorders
- Children of all ages with severe anxiety disorders such as OCD
- Children of all ages with autism spectrum disorders and comorbid anxiety and mood disorders
- Transition-age youth with autism spectrum disorders
- Adolescents and young adults with bipolar disorder
- Preventative services for children of all ages at risk for mood and anxiety disorders
Diagnostic Consultations
We offer diagnostic and treatment consultations for children already receiving psychosocial treatment. We regularly collaborate with other treatment professionals, including psychiatrists, social workers and teachers.
Intensive CBT Program for Youth with Anxiety Disorders
For youth ages 10-24 years with more severe anxiety disorders, we periodically offer an intensive therapy program. This therapy is typically conducted during school vacations, although alternative times may be arranged on a case-by-case basis.
Learn more about Intensive CBT
School Consultation
Our program offers telephone or in-person visits to schools as part of ongoing care. The purpose of these visits includes observing the child in the school setting, participating in team meetings to develop or revise IEP or 504 plans, or collaborating with school personnel as needed.
School consultations are not billable to insurance plans and are self-pay only. The cost of the consultation is based on the time spent at the school and travel time. If this is a service that you are interested in pursuing, please speak to your clinician.
What to Expect from CBT Treatment
When you call the Child CBT Program, we will collect preliminary information about you, your child and your reasons for seeking treatment. If it seems that our program would be a good fit, we will schedule an initial appointment.
During this appointment, we will do a comprehensive evaluation to help identify your child's treatment needs. This evaluation is also an opportunity to meet the clinician and begin to establish a working relationship. Whenever possible, we conduct an evaluation with both the child and the parents to get different perspectives. During the first few sessions, we will ask about:
- Your child's current symptoms
- His or her psychiatric history
- Current treatment goals for your child
Most treatment is provided one-on-one with your child, although in many cases, we involve parents in treatment as well (particularly with younger children, who may need more support from parents to implement CBT skills between sessions). In addition, we may have group treatment options. Sessions are usually scheduled once a week at the beginning of treatment and last 45 minutes. As treatment progresses, the frequency of sessions decreases to enable your child to practice skills more independently. The first eight sessions are typically scheduled during the day, but subsequent sessions may be scheduled during after-school hours depending on the clinician’s availability.
Because of the emphasis in CBT on measurable results, we will regularly evaluate your child’s progress to determine whether additional treatment is needed. At the initial visit and then every eight weeks thereafter, we ask patients (and their parents, when appropriate) to complete questionnaires about their symptoms and their functioning. This information is important to therapy because it allows us to assess progress, ensure that treatment is on track and make adjustments as needed.
Please note: We are not an urgent-care facility. We cannot provide treatment to youth who are at acute risk to themselves or others, exhibit high levels of aggression or self-injury or are unable to actively participate in the CBT sessions because of the severity of their symptoms.
We also do not accept patients directly from inpatient facilities, but we will provide treatment once symptoms have stabilized enough to benefit from once-per-week outpatient treatment.
Program Costs
We accept most major insurances and will obtain insurance preapproval prior to your first visit. Patients and families are responsible for paying the co-pay at the time of the visit. We accept payments by check or credit card. If your insurance does not cover a service, you will be responsible for any costs incurred. Note that some of our clinicians offer only self-pay services.
Prior to your first appointment, we ask that you ensure that your information is properly updated in the Mass General patient registration system. To do this, please call 866-211-6588.
Our Team
In addition to our clinical practice, our staff works to advance the scientific understanding of CBT approaches and to foster the dissemination of CBT techniques.
Clinical Team
- Christine Darsney, PhD
- Julie Edmunds, PhD
- Monica Nanda, PhD
- Michael Schonberg, PhD
Administrative Staff
- Jordan Holmen, Clinical Research Coordinator
- Jazmine Ramirez
- Dorothy Weremito, Patient Service Coordinator
- Flavia L. Vaz De Souza, Clinical Research Coordinator
- Mikayla Ver Pault, Clinical Research Coordinator
Our Research
The Child Cognitive Behavioral Therapy Program at Massachusetts General Hospital is actively involved in a wide variety of research to evaluate the efficacy of novel CBT treatments for youth, improve the efficacy of CBT interventions and develop treatments to help children who do not respond to traditional CBT approaches.
We are also interested in understanding predictors of treatment response, including genetics, neuroimaging, family factors, and identifying the neurobiological underpinnings of treatment response to clarify how CBT exerts its effects on the brain.
Our staff has also been involved in long-term studies of children at risk for psychiatric disorders to understand factors that might increase risk for developing anxiety and mood disorders and identify factors that may enhance resilience in these youth.
Current Research Projects
Connectomes Related to Anxiety and Depression in Adolescents
This study examines acute threat and reward prediction error in adolescents (ages 14-15) with anxiety and depression. Adolescents in the study participate in clinical and behavioral assessments, as well as an MRI scan. They also have a brief follow up 6 months and 12 months after initial assessment. This a collaborative effort between Mass General, MIT, McLean Hospital, Boston University and the Human Connectome Project (HCP).
(PI: Gabrieli/Whitfield/Gabrieli)
Addressing Anxiety in Young Children
This study will help us develop a way to systematically assess risk for anxiety in 2- and 3-year-old children. Identifying toddlers who are at increased risk for anxiety would allow us to develop and put in place interventions in this young age group. In turn, addressing anxiety in children before they enter preschool could reduce the impact of potentially debilitating anxiety on these children’s early development and greatly reduce risks for learning difficulties, social isolation, family strain, and child suffering.
Professional Training
The Child CBT Program is committed to training professionals in the use of CBT. Although there is a great deal of research to support the use of CBT with children, there is evidence that these approaches are often not being used in the community. This is likely because it is difficult to obtain CBT training and supervision for this specialized form of treatment and there is apprehension about using CBT techniques because they differ from more traditional psychotherapy. At the same time, CBT is relatively easy to disseminate because it uses well-established treatment manuals and focuses on measurable, observable goals.
To bridge the gap between science and practice in the community, we offer seminars and courses for licensed medical professionals, along with intensive training via didactic seminars and ongoing supervision for those who wish to specialize in CBT. We also offer training and supervision to predoctoral psychology fellows as part of Massachusetts General Hospital's Internship in Clinical Psychology and to child psychiatry fellows as part of the Child and Adolescent Psychiatry Residency at the Mass General/Harvard Medical School.
Continuing Education Courses
We offer online courses via the Mass General Psychiatry Academy including:
- Fundamentals Course in Child CBT - this course provides a basic primer for clinicians about CBT interventions and their use with children and adolescents
- CBT for Children with Obsessive Compulsive Disorder (OCD) - this course provides more in-depth training about implementing well-established CBT interventions for youth with OCD
In both courses, role-playing is used to highlight important concepts. As part of these online courses, we offer a message board and call-in times for more individualized feedback.
Resources
Books
For Parents
- 1-2-3 Magic: Effective Discipline for Children 2-12, Thomas W. Phelan
- Raising a Thinking Child, Myrna Shure
- SOS! Help for Parents, Lynn Clark
- How to Talk So Kids Will Listen and Listen So Kids Will Talk, Adele Fabel and Elaine Mazlish
On Obsessive-Compulsive Disorder
- Freeing Your Child from Obsessive-Compulsive Disorder, Tamar Ellsas Chansky
- Talking Back to OCD: The Program That Helps Kids and Teens Say "No Way" -- and Parents Say "Way to Go", John S. March
- What to Do When Your Child Has Obsessive-compulsive Disorder: Strategies and Solutions, Aureen Pinto Wagner
On Anxiety
- Freeing Your Child From Anxiety, Tamar Chansky
- Help for Worried Kids, Cynthia G. Last
- Mastery of Anxiety and Panic for Adolescents (Riding the Wave), Donna B. Pincus, Jill T. Ehrenreich, Sara G Mattis
- Riding the Wave Workbook, Donna B. Pincus, Jill T. Ehrenreich, David A. Spiegel
Books for Kids
- Up and Down the Worry Hill: A Children's Book about Obsessive-Compulsive Disorder and its Treatment, Aureen Pinto Wagner
- Take Control of OCD: The Ultimate Guide for Kids with OCD, Bonnie Zucker
- Blink, Blink, Clop, Clop: Why Do We Do Things We Can’t Stop? An OCD Storybook, E. Katia Moritz and Jennifer Jablonsky
Our Program in the News
- Panel Discussion: Treatment of Anxiety Disorders in Children and Adolescents
- Blog Post: When To Seek Help For A Child’s Anxiety, The Clay Center for Young Healthy Minds
- ADHD Can Be Diagnosed At Age 4, Pediatricians Group Says, The Huffington Post
- Diagnosing Depression Before it Starts, MIT News
- Gene Variants May Increase Risk Of Anxiety Disorders, Science Daily
General Psychiatry Resources Online
This list is provided to help you find useful resources. This page does not indicate an endorsement by Mass General of any products or services offered by these authors.
Pioneering Psychiatry Research
The integration of patient care and clinical research has been a hallmark of the Department of Psychiatry for more than 30 years. Today, the department has the largest clinical research program in the hospital, with studies at the forefront of neuroscience, molecular biology and genetics.