Cognitive behavioural therapy, commonly known as CBT, is one of the main talking therapies used to support children and young people with depression. It can help your child understand how their thoughts, feelings, behaviours and physical symptoms are connected, while learning healthier ways to manage difficult situations.
Depression in children does not always appear as sadness. You may notice changes such as irritability, withdrawing from others, tiredness, negative thoughts about themselves, losing interest in activities, difficulty concentrating or changes in sleep and appetite. NHS guidance recognises that children and young people can experience depression, and early support can help reduce the impact on school, relationships and daily life.
CBT is not about telling your child to simply “think positive” or ignoring how they feel. Instead, it helps them identify unhelpful patterns, try different ways of responding and gradually build coping skills. The NHS describes CBT as a therapy where your child can explore difficult situations, understand how they affect thoughts, feelings and actions, and work with a therapist to find more helpful approaches.
What Is CBT?
CBT stands for cognitive behavioural therapy and is a type of talking therapy used to support children and young people with depression. It is based on the idea that thoughts, feelings, physical sensations and behaviours are connected and can influence each other.
When your child is depressed, these connections can sometimes create a difficult cycle. For example, they may think “I am useless”, feel hopeless, avoid schoolwork, fall behind and then feel even worse about themselves.
CBT helps your child recognise these patterns and learn different ways to respond to difficult thoughts and feelings. The aim is not to pretend everything is fine, but to help your child manage depression in a safer and more effective way.
How CBT Helps With Depression
Depression can make everyday life feel difficult and overwhelming for your child. They may start avoiding activities, spending less time with friends, struggling at school or feeling as though things will not get better.
CBT can help by breaking these challenges into smaller and more manageable steps. Your child may work on understanding their thoughts, changing unhelpful behaviours, building routines, improving problem-solving skills and slowly reconnecting with activities they enjoy.
The NHS explains that CBT can help children and young people question unhelpful thoughts, understand emotions and physical feelings, and make changes to behaviours they may have been avoiding. These skills may help your child manage symptoms, improve daily functioning and gradually work towards recovery.
Evidence Note
NICE recommends individual CBT as a key treatment for young people aged 12 to 18 with moderate to severe depression. The therapy is normally delivered over at least three months and should be provided by a professional trained in child and adolescent mental health. For younger children, treatment needs to be adapted more carefully to their developmental level and may involve greater family participation.
CBT Is Practical, Not Just Talking
CBT involves talking, but it is also a practical type of therapy that focuses on using skills in everyday life. Your child may be encouraged to try small tasks between sessions, such as keeping a mood diary, practising coping strategies, noticing unhelpful thoughts or planning a manageable activity.
The NHS explains that people having CBT are often asked to practise what they learn between sessions and may use worksheets or diaries to track their progress. These activities help your child apply therapy skills outside the appointment.
Practising these skills in real situations is an important part of CBT. Over time, using these techniques regularly can help your child feel more confident in managing difficult thoughts, feelings and situations.
CBT Does Not Blame the Child
Some parents worry that CBT may make their child feel blamed because it focuses on thoughts and behaviours. It is important to understand that good CBT does not suggest your child is responsible for their depression.
Instead, CBT helps your child understand how depression can affect the way they think, feel and respond to situations. It focuses on building skills and making small changes that may help reduce the impact of the depression cycle.
The therapist should work at a pace that feels comfortable and adapt the approach to suit their age, development and individual needs. NICE recommends choosing psychological therapy based on a full assessment, including your child’s maturity, personal experiences, family circumstances, additional needs, communication style and preferences.
When CBT May Be Recommended
CBT may be recommended for children and young people with depression depending on their age, the severity of symptoms, level of risk and individual circumstances. A healthcare professional will consider what type of support is most suitable for your child.
NICE recommends psychological therapies for children and young people with mild depression that continues after a period of watchful waiting. This may include digital CBT, group CBT or individual CBT, depending on your child’s needs and situation.
For young people aged 12 to 18 whose mild depression continues after a period of watchful waiting, NICE recommends discussing psychological treatment options such as digital CBT, group CBT, group interpersonal therapy or group non-directive supportive therapy. The choice should reflect the young person’s needs, preferences, developmental level and access to appropriate services.
For children aged 5 to 11, treatment should be adapted carefully to their age and development. The clinical team may consider approaches such as family-based work, individual therapy or other age-appropriate psychological support rather than assuming that the same format used with teenagers will be suitable.
Mild Depression and CBT
Mild depression may sometimes improve with careful monitoring, support and time, particularly when symptoms are recent and there are no significant safety concerns. However, it is still important to pay attention to how your child is feeling and how symptoms are affecting their daily life.
NICE recommends watchful waiting for some children and young people with diagnosed mild depression, with a further assessment usually within two weeks. If symptoms continue, psychological therapies such as digital CBT, group CBT or other age-appropriate support may be considered depending on your child’s needs.
It is important not to dismiss mild depression as something that does not matter. If your child’s symptoms continue or begin affecting school, sleep, friendships or family life, getting the right support early can make a positive difference.
Moderate to Severe Depression and CBT
Moderate to severe depression can have a significant effect on your child’s daily life. You may notice changes such as difficulty attending school, losing interest in activities, withdrawing from friends, major changes in sleep or appetite, feeling hopeless or having thoughts of self-harm.
NICE recommends specialist mental health assessment, such as review by CAMHS, for children and young people with moderate to severe depression. For children aged 5 to 11, the clinical team may consider family-based psychological therapy, individual CBT or other developmentally appropriate therapy after discussing the available options with the child and family.
This is why a thorough assessment is important before starting treatment. Your child’s support plan should be based on their symptoms, level of risk and individual needs, rather than only the diagnosis of depression.
CBT and Medication
CBT may be used on its own or alongside medication when this is considered appropriate for your child’s needs. The treatment approach will depend on factors such as the severity of depression, your child’s response to support and the advice of healthcare professionals.
For young people aged 12 to 18 with moderate to severe depression, NICE states that combined treatment with fluoxetine and psychological therapy may be considered in some situations. Medication may also be considered after specialist multidisciplinary review if moderate to severe depression has not improved after 4 to 6 sessions of psychological therapy.
Medication is not suitable for every child, and NICE recommends that antidepressants are generally used alongside psychological therapy rather than on their own. For many families, CBT remains an important part of helping your child understand their feelings and develop skills to manage depression.
CBT Treatment Options at a Glance
| Situation | CBT May Be Used As | Important Point |
| Mild depression after watchful waiting | Digital CBT, group CBT or individual CBT in selected cases | Treatment should match age, development and need |
| Moderate-to-severe depression in ages 5 to 11 | Developmentally appropriate psychological therapy, which may include family-based treatment or adapted individual CBT | Therapy should be adapted to developmental level |
| Moderate to severe depression in ages 12 to 18 | Individual CBT for at least three months | NICE recommends this as a key treatment |
| Depression with family stress | CBT may be combined with family work or another therapy | Family context should be assessed |
| Depression with anxiety | CBT may address both mood and anxiety patterns | Assessment should look at both conditions |
| Depression not improving | Multidisciplinary review may be needed | Diagnosis, risk and treatment fit should be reconsidered |
| Depression with self-harm risk | CBT may form part of specialist care | Safety planning and urgent support are essential |
The table is a general guide. Your child’s care should be personalised after assessment.
What Happens Before CBT Starts?
Before your child starts CBT, they will usually have an assessment to understand what support they need. The therapist may ask about their symptoms, concerns and what they hope to achieve from treatment before recommending the most suitable approach.
For depression, the assessment may include your child’s mood, sleep, appetite, school attendance, friendships, family stress, anxiety, physical symptoms, self-harm thoughts and any previous support they have received. This helps build a clearer picture of what your child is experiencing.
NICE recommends considering other conditions, as well as your child’s social, educational and family circumstances, when assessing depression. Understanding these factors helps the therapist identify what may be affecting your child’s mood and how best to support their recovery.
What Happens in a CBT Session?
A CBT session usually involves talking about situations your child has experienced and exploring how they thought, felt and responded. Your child’s therapist may help them understand patterns such as avoiding activities, expecting things to go wrong, seeing situations negatively or pulling away from support.
During sessions, your child and their therapist may work together to plan small tasks or activities to try between appointments. These are not like school homework; they are practical ways to practise new skills and build confidence in everyday situations.
NHS guidance explains that CBT often involves discussing difficult experiences, understanding how they affect thoughts, feelings and actions, and finding different ways to manage these situations. Over time, this can help your child develop healthier ways of coping.
Clinical Tip
Children often respond better when therapy feels collaborative rather than something being done to them. Helping your child understand why CBT is being recommended and allowing them to ask questions can improve engagement.
CBT for Younger Children
CBT for younger children often needs to be adapted so it matches their age and stage of development. Your child may not always be able to explain thoughts and feelings in words, so therapy may use drawings, stories, games, emotion cards, simple charts, role play or more involvement from you as a parent.
NICE recommends that psychological therapy choices should take into account your child’s maturity, developmental level, communication needs and any learning difficulties. For children aged 5 to 11 with moderate to severe depression, individual CBT may be considered when it is adapted to suit their developmental needs.
When your child is younger, you may have a more active role in supporting therapy at home. This can include helping with routines, practising skills and creating a supportive environment where your child feels understood.
CBT for Teenagers
CBT for teenagers may look similar to CBT for adults, but it should always be adapted to suit their stage of development. Your teenager may work on challenges such as negative thinking, avoiding situations, perfectionism, low confidence, sleep problems, school stress, social withdrawal or being overly self-critical.
Teenagers often benefit from having some private time with their therapist so they can speak openly about their feelings and concerns. At the same time, you can still play an important role by supporting safety planning and helping them apply skills in everyday life.
NICE recommends individual CBT for at least three months for young people aged 12 to 18 with moderate to severe depression. When your teenager feels respected and involved in the process, they are more likely to engage with therapy and feel that support is something done with them, not something imposed on them.
Digital CBT and Group CBT
CBT can be provided in different formats depending on your child’s needs and what feels most suitable for them. It may include one-to-one sessions, guided self-help, group sessions or digital CBT delivered online, in person or by phone.
NICE recognises digital CBT and group CBT as possible options for some children and young people with mild depression after a period of monitoring. These approaches can be helpful for some children, but they may not be the right choice for everyone.
If your child has significant safety concerns, severe symptoms, complex family circumstances, trauma, learning needs or communication difficulties, they may need a more personalised approach. The right type of CBT should be based on your child’s individual situation and support needs.
How Many CBT Sessions Are Needed?
The number of CBT sessions your child needs can vary depending on their age, the severity of their depression, the type of therapy and how they respond to treatment. There is no single number of sessions that works for every child.
General NHS CBT guidance says people often have around 5 to 15 sessions, depending on the reason for therapy, while NICE recommends individual CBT for at least three months for young people aged 12 to 18 with moderate to severe depression. For young people aged 12 to 18 with moderate to severe depression, NICE recommends individual CBT for at least three months.
Some children may need longer support, especially if their depression is severe, keeps returning, is linked with trauma, occurs alongside anxiety or affects different areas of their daily life. Your child’s therapist will help decide the most suitable length of treatment.
Skills Children May Learn in CBT
CBT can teach a range of practical skills. The exact skills depend on your child’s age and symptoms.
| CBT Skill | What It Means | How It May Help |
| Mood tracking | Noticing mood changes over time | Helps identify patterns and triggers |
| Thought spotting | Recognising self-critical or hopeless thoughts | Makes negative thoughts easier to challenge |
| Behavioural activation | Reintroducing manageable activities | Reduces withdrawal and inactivity |
| Problem-solving | Breaking problems into smaller steps | Helps with school, friendships and family stress |
| Coping plans | Creating strategies for difficult moments | Supports emotional regulation |
| Relaxation or grounding | Calming the body during distress | May help your child manage distress or accompanying anxiety |
| Sleep routine work | Improving bedtime and wake patterns | Supports mood and energy |
| Relapse planning | Spotting early warning signs | Helps prevent symptoms worsening again |
| Communication practice | Finding words for feelings and needs | Can improve family and school support |
CBT is most useful when these skills are practised between sessions in a realistic way.
Behavioural Activation
Behavioural activation is often an important part of CBT for children with depression. When your child is feeling low, they may stop doing activities they once enjoyed or found rewarding, which can lead to feeling more isolated and make their mood harder to manage.
CBT can help you support your child in gradually returning to small activities that feel achievable. This could include going for a short walk, messaging a trusted friend, spending time with a pet, attending part of a club or completing one small school task.
The aim is not to overwhelm your child or expect them to return to their usual routine immediately. Instead, you can help them take small steps that gently interrupt the cycle of low mood and build confidence over time.
Thought Challenging
Depression can sometimes lead your child to have harsh or unhelpful thoughts about themselves, other people or the future. They may think things like “Nobody likes me”, “I always fail” or “Nothing will ever get better”, even when these thoughts are not fully accurate.
CBT helps your child notice these thoughts and look at them more carefully. A therapist may help them explore what evidence supports the thought, what evidence challenges it and whether there is a more balanced way to understand the situation.
This does not mean your child is being told to simply think positively. Instead, CBT helps them understand that depressive thoughts can feel very real while learning that they may not always reflect the full picture.
Problem-Solving Skills
Some children feel overwhelmed when they are dealing with several problems at the same time. CBT can help your child break these challenges into smaller, more manageable steps rather than feeling stuck.
A therapist may support your child in identifying what can be changed, what help they need and what first step feels realistic. For example, if your child is falling behind at school, they may focus on one subject, speak to one teacher or complete one small piece of work first.
Taking small steps can help your child feel more in control and reduce feelings of helplessness. Over time, these problem-solving skills can help them manage challenges with greater confidence.
CBT and Physical Symptoms
Children with depression may also experience physical symptoms such as headaches, tummy aches, tiredness or changes in sleep. These symptoms can sometimes happen alongside changes in mood and behaviour.
CBT can help your child understand how their emotions, stress levels, sleep, physical sensations and actions may affect each other. This can help them develop healthier ways to manage difficult feelings and everyday challenges.
However, it is important not to assume that all physical symptoms are caused by emotions. If your child has ongoing, severe or unusual symptoms, you should seek medical advice so they can be properly assessed.
CBT and Anxiety
Depression and anxiety often occur together in children and young people. Your child may feel low or hopeless while also experiencing constant worries, avoiding school, having panic symptoms or finding it difficult to sleep.
CBT can be helpful because it focuses on both unhelpful thought patterns and behaviours that keep anxiety and low mood going. Your child’s treatment plan may include anxiety-management techniques alongside strategies to support depression.
NICE recommends that other concerns, including additional diagnoses and developmental, social or educational difficulties, should be considered as part of care. This means your child should be supported as a whole person, rather than focusing on just one condition.
CBT and School Problems
Depression can affect many areas of your child’s school life, including attendance, concentration, homework, behaviour and confidence. You may notice changes such as your child avoiding school, struggling with motivation or finding it harder to complete everyday tasks.
CBT can help your child understand and manage challenges such as fear of failure, perfectionism, low motivation, avoiding difficult situations or feeling unable to ask for help. It can give them practical tools to cope with thoughts and emotions that affect their learning.
School support may also be an important part of your child’s recovery. NICE recognises that psychological therapies can be provided in different settings, including schools, colleges, primary care and other community services, and in many cases therapy works best alongside support from school.
What Parents Can Do Between Sessions
You do not need to become your child’s therapist, but your support can make a positive difference between CBT sessions. Creating a calm and supportive environment can help your child feel more comfortable while they work through their challenges.
You can help by keeping routines gentle and predictable, encouraging practice tasks without pressure, noticing small improvements, supporting sleep, meals and school attendance, helping them attend appointments and keeping communication about safety open.
Try not to make CBT homework feel like another school task or something your child can fail at. Your child may need encouragement and reassurance, but too much pressure can make therapy feel more difficult.
CBT Homework
CBT homework usually involves practising the skills your child learns during therapy sessions. This may include tracking their mood, challenging an unhelpful thought, planning a small activity, practising breathing exercises or noticing how they respond to difficult situations.
The aim is to help your child apply therapy skills in situations that matter to them. These activities are not about getting everything perfect but about helping your child build confidence over time.
For children, homework should be realistic, suitable for their age and manageable. If your child finds a task too difficult, their therapist can adjust it so it feels more achievable and supportive.
What If Your Child Does Not Want CBT?
Some children may not want to start CBT at first, and this can happen for many reasons. Your child may feel embarrassed, worried, unsure about what will happen or concerned that therapy means something is wrong with them.
You can start by listening to their concerns and answering their questions honestly. They may worry that they will be blamed, judged or that everything they say will automatically be shared with others.
You can explain that CBT is simply a way to understand their thoughts and feelings and find helpful ways to cope. A first appointment can be viewed as a chance to explore what support may help, rather than a commitment to long-term therapy.
Confidentiality in CBT
Confidentiality is an important part of CBT, especially for teenagers who may need a private space to talk openly. Your child may feel more comfortable discussing difficult topics such as mood, self-harm, bullying, family stress, relationships or other personal concerns when they know their privacy is respected.
Children and young people’s mental health services usually keep information confidential unless there is a concern about your child’s safety or someone else’s safety. This helps create trust while ensuring the right support is provided when needed.
You should expect to be involved if there are serious safety concerns. At the same time, respecting your child’s privacy where appropriate can help them feel more confident and build a positive relationship with their therapist.
Choosing the Right Therapist
CBT for children and young people should be provided by a therapist who has the right training and experience. Choosing someone who understands children’s mental health can help your child feel more comfortable and supported during therapy.
NICE recommends that psychological therapies for childhood and adolescent depression are delivered by therapists trained in child and adolescent mental health and skilled in the specific therapy they provide. Children are not simply smaller adults, so therapy needs to consider their development, family life, school experiences, safety and communication needs.
When choosing a therapist, you can ask about their experience working with children, depression and CBT. You can also discuss any additional needs your child has to make sure the approach is suitable for them.
CBT for Neurodivergent Children
Children who are autistic, have ADHD, learning differences or communication needs may still benefit from CBT, but the therapy may need to be adapted to suit your child’s individual needs. A flexible approach can help make sessions easier to understand and more comfortable for them.
Your child’s therapist may use visual tools, shorter activities, clear routines, practical examples, sensory awareness and more involvement from you as a parent. NICE recommends considering neurodevelopmental conditions, communication needs, sensory impairments and learning disabilities when choosing the right support.
If your child has additional needs, it is helpful to share this with the therapist early. This allows them to adjust the approach and provide support that works for your child, rather than expecting them to follow a standard format.
CBT for Children With Trauma or Bullying
Depression in children can sometimes be linked with difficult experiences such as bullying, abuse, bereavement, family conflict or major changes at home. These experiences can have a significant impact on your child’s emotional wellbeing and may increase the risk of depression.
CBT can help some children understand their thoughts and feelings, while developing ways to cope with difficult emotions. However, if trauma or safeguarding concerns are involved, your child may need additional or different types of support.
NICE recommends that professionals assessing depression should ask about experiences such as bullying, abuse, self-harm and suicidal thoughts. When your child is being harmed or feels unsafe, protecting them and addressing the situation must come before focusing only on therapy techniques.
CBT and Bullying Support
If bullying is contributing to your child’s depression, CBT alone may not be enough. Your child can learn coping skills and ways to manage difficult emotions, but the bullying itself also needs to be addressed.
NICE recommends that when bullying is a factor in a child or young person’s depression, CAMHS, healthcare professionals and education teams should work together to reduce bullying and create effective strategies for support. Working together can help your child feel safer and more supported.
You can speak with your child’s school calmly and clearly, while keeping notes of incidents, changes in behaviour and any effects on sleep, attendance or wellbeing. CBT can help your child cope emotionally, but adults also need to take action to address the situation causing harm.
CBT and Lifestyle Support
CBT works best as part of a wider plan that supports your child’s everyday wellbeing. Depression can disrupt sleep, appetite, movement, school attendance, friendships and daily routines, and these areas may need attention alongside therapy.
Your child’s therapist may help them make gradual, realistic changes rather than expecting them to transform everything at once. This could include establishing a more regular sleep routine, eating consistent meals, spending short periods outside, returning gradually to school or reconnecting with a trusted friend or enjoyable activity.
Lifestyle support does not replace CBT or specialist mental health care. However, small and achievable routines can support behavioural activation, improve structure and give your child more opportunities to practise the skills they learn during therapy.
How Progress Is Monitored
Your child’s progress in CBT can be monitored in different ways, including discussions with the therapist, your feedback, school feedback, diaries or questionnaires. These tools can help you and the healthcare team understand how your child is responding to support.
NICE states that the Mood and Feelings Questionnaire may be considered alongside clinical judgement when monitoring progress in secondary care. However, progress is not always a straight path, and your child may have better days and more challenging days during treatment.
You may notice signs of improvement such as better sleep, attending school more often, communicating more openly, having fewer negative thoughts, taking part in activities again, avoiding fewer situations or coping better during difficult moments.
What If CBT Does Not Help?
CBT does not work immediately for every child, and your child may need a different approach or extra support if symptoms continue. If you do not notice improvement, the healthcare team may review the diagnosis, the severity of symptoms, safety concerns and whether CBT is the right type of therapy for your child.
They may also look at other factors that could be affecting your child’s progress, such as family stress, school difficulties, anxiety, neurodevelopmental needs or whether medication should be considered. NICE recommends further review if mild depression does not improve after psychological therapy, or if moderate to severe depression does not respond after several therapy sessions.
If CBT has not helped your child as expected, it does not mean they have failed or that treatment has not worked. It may simply mean the support plan needs to be changed so your child can receive the most suitable help for their needs.
Signs CBT May Be Helping
CBT may be helping your child even before their mood has fully improved. You may start to notice small changes, such as them talking more openly, using coping strategies or becoming more willing to ask for help.
Your child may also begin trying activities again, attending school more regularly, sleeping slightly better, challenging negative thoughts or recovering more quickly after difficult moments. These changes can be positive signs that they are learning new ways to manage their feelings.
Progress with CBT is often gradual, and your child may still experience some symptoms of depression while they are improving. You can support them by recognising small steps and encouraging their progress without expecting everything to change at once.
When CBT May Not Be Enough
CBT can be helpful for many children with depression, but it may not be enough on its own in more complex situations. You may need additional support if your child’s depression is severe, ongoing, linked with self-harm, suicidal thoughts, trauma, eating difficulties, substance misuse, psychosis or major family stress.
NICE recommends CAMHS assessment for children and young people with moderate to severe depression, active suicidal thoughts or plans, repeated episodes of moderate or severe depression, unexplained self-neglect or depression that has not improved with earlier support.
In these situations, your child’s care plan may include support from CAMHS, psychiatry, family therapy, medication, school support or other specialist services. The right approach depends on your child’s individual needs and level of risk, rather than relying on one type of treatment alone.
Asking About Suicide Does Not Put the Idea in Your Child’s Head
Many parents feel afraid to ask directly about suicidal thoughts because they worry that mentioning suicide could make the situation worse. However, asking calmly and clearly can help your child feel able to tell you what they are experiencing.
You might say, “Sometimes when people feel this low, they have thoughts about not wanting to be alive. Has that happened to you?” You can also ask whether they have thought about harming themselves, whether they have made a plan or whether they feel able to stay safe.
NICE recommends that healthcare professionals ask children and young people with depression, and their parents or carers, directly about self-harm and ideas about suicide.
A calm, direct question can open the door to support. Staying silent does not protect your child if they are already struggling, whereas asking gives you an opportunity to understand the risk and seek appropriate help.
When Urgent Help Is Needed
CBT is not an emergency service. Seek urgent professional help if your child is having suicidal thoughts, has self-harmed, feels unable to remain safe or is experiencing a rapid deterioration in their mental health.
Contact your child’s mental health team, GP, NHS 111 or the local urgent mental health service for immediate advice. Do not wait for the next CBT session when you are concerned about your child’s safety.
Call 999 or go to A&E if your child has taken an overdose, has seriously harmed themselves, is about to act on suicidal thoughts or cannot be kept safe. Where it is safe to do so, stay with your child and reduce access to medicines, weapons or other possible means of harm while emergency support is arranged.
When to Speak to a GP
You should arrange a GP appointment if you think your child may be experiencing depression or if you have concerns about their mental health and wellbeing. Speaking to a GP can be an important first step in understanding what your child is going through.
A GP can assess your child’s symptoms, check their physical health, consider any risks and discuss possible support options. If needed, they can refer your child to local children and young people’s mental health services for further help.
Before the appointment, it can be useful to make notes about your child’s mood, sleep, appetite, school life, friendships, any self-harm concerns and how long the changes have been happening. This information can help the GP understand the situation more clearly.
When to See a Paediatrician
A paediatrician may be helpful if your child’s low mood is happening alongside physical symptoms such as tiredness, headaches, tummy aches, sleep changes, appetite changes or concerns about their growth and development. These symptoms can sometimes provide important clues about your child’s overall health.
A paediatrician can look at whether an underlying physical health issue may be affecting your child’s mood and help coordinate care with other healthcare professionals. This can support a more complete understanding of what your child is experiencing.
A paediatrician does not replace CAMHS when your child has moderate to severe depression or there are safety concerns. However, they can play an important role in supporting your child as part of a wider care plan.
When CAMHS Support May Be Needed
Children and young people’s mental health services (CAMHS) can provide different types of support depending on your child’s needs. This may include self-help, talking therapies such as CBT, counselling, family therapy, medicines when appropriate, hospital support or help from other specialist services.
NICE recommends that children and young people with moderate to severe depression are reviewed by CAMHS. Your child may also need this support if they have thoughts of self-harm, suicidal thoughts, several risk factors, complex family situations, difficulties staying in school or limited improvement with previous support.
The way your child is referred to CAMHS can vary depending on where you live. You may be able to get support through your GP, your child’s school, a school nurse or a social worker who can help you access local services.
What Children May Want to Know
Your child may have their own questions or worries about starting CBT. They may wonder if they need to talk about everything, whether the therapist will tell you what they say, or if CBT means they have done something wrong.
You can reassure them that CBT is not about blaming them or forcing them to change. It is designed to help them understand what they are feeling and learn ways to feel more confident, safe and able to cope with challenges.
You should also explain that their conversations with the therapist are usually private, but there are limits if someone’s safety is at risk. This is not a punishment; it is a way to make sure they get the support they need to stay safe.
Myths About CBT for Depression in Children
| Myth | Fact |
| CBT is just telling children to think positively | CBT helps children understand patterns and practise realistic coping skills |
| CBT works in one or two sessions | CBT usually needs repeated practice over time |
| Only teenagers can do CBT | Younger children may benefit when CBT is adapted to developmental level |
| Parents are not involved at all | Parent involvement varies, but family support is often important |
| CBT replaces all other care | Some children also need school support, family work, medication or specialist care |
| CBT homework is like school homework | It usually means practising therapy skills in everyday life |
| CBT means the depression is the child’s fault | CBT does not blame the child; it helps them manage depression patterns |
| If CBT does not work, nothing will help | The plan can be reviewed and other treatments may be considered |
| Asking about suicide will give a child the idea | Calm, direct questions can help identify risk and allow urgent support to be arranged |
These myths can stop families seeking help. A good therapist should explain CBT clearly and adapt it to your child.
Key Takeaways
- CBT helps children understand links between thoughts, feelings and behaviours.
- Therapy should always be adapted to your child’s age and needs.
- Parents play an important supportive role without becoming the therapist.
- Urgent help is needed if your child cannot stay safe or has suicidal thoughts.
- CBT works best when children practise the skills they learn between sessions.
FAQs:
1. What is CBT for depression in children?
Cognitive behavioural therapy (CBT) is a talking therapy that helps children understand the connection between their thoughts, feelings, behaviours and physical symptoms. It teaches practical skills to manage negative thinking patterns, improve coping strategies and gradually rebuild confidence and daily activities.
2. How does CBT help children with depression?
CBT helps children identify unhelpful thoughts, understand emotional patterns and change behaviours that may keep depression going. It may help reduce avoidance, improve problem-solving skills, support healthier routines and help children develop ways to cope with difficult situations.
3. Is CBT suitable for all children with depression?
CBT may be helpful for many children and young people with depression, but the right treatment depends on age, symptoms, severity, risk factors and individual needs. A healthcare professional will assess whether CBT or another approach is most appropriate.
4. How long does CBT usually last for children with depression?
The length of CBT varies depending on the child and the severity of depression. Some children may have a shorter course of therapy, while others may need longer support. Progress may be supported by regular attendance and practising skills between sessions, but response also depends on the severity of depression, the suitability of the therapy, family and school circumstances and any additional mental health needs. For young people aged 12 to 18 with moderate to severe depression, NICE recommends individual CBT for at least three months.
5. Does CBT involve parents?
Parent involvement depends on the child’s age, needs and treatment plan. Parents may support younger children by helping practise skills and maintain routines, while teenagers may need more private time with their therapist alongside appropriate family support.
6. Can CBT be used alongside antidepressants?
Yes, CBT may be used alongside medication when antidepressants are recommended. For moderate to severe depression, NICE generally recommends psychological therapy alongside antidepressant treatment rather than medication alone.
7. What happens during a CBT session for a child?
During CBT sessions, a therapist helps the child talk about difficult situations, identify thoughts and feelings, understand behaviour patterns and practise new coping strategies. Sessions may include activities such as mood tracking, problem-solving exercises, thought challenges or planning manageable goals.
8. Can younger children have CBT?
Yes, younger children can have CBT when it is adapted to their developmental level. Therapy may use drawings, stories, games, visual tools, role play and greater parent involvement to make concepts easier to understand.
9. What if my child does not want to attend CBT?
Some children may feel unsure, embarrassed or worried about therapy at first. Listening to their concerns, explaining that CBT is a way to get support and allowing them to ask questions can help them feel more comfortable with treatment.
10. When should a child with depression receive more urgent mental health support?
Urgent support is needed if a child has thoughts of suicide, has self-harmed, has taken an overdose, feels unable to stay safe or their symptoms are rapidly worsening. In these situations, contact emergency services or urgent mental health support rather than waiting for the next CBT appointment.
Final Thoughts: Helping Children Build Confidence Through CBT
Cognitive behavioural therapy (CBT) can be an effective part of treatment for children and young people experiencing depression. It helps children understand their thoughts, feelings and behaviours while developing practical skills to manage difficult emotions, rebuild routines and cope with challenges. With the right support, CBT may also help improve daily functioning and confidence over time. If you have concerns about your child’s emotional wellbeing or possible depression, you can contact us at London Paediatric Clinic to arrange a consultation and discuss your child’s needs.
References:
- National Institute for Health and Care Excellence (NICE) NICE (2019, reviewed 2024) Depression in children and young people: identification and management (NG134). Available at: https://www.nice.org.uk/guidance/NG134
- NHS (2023) Cognitive behavioural therapy (CBT). Available at: https://www.nhs.uk/tests-and-treatments/cognitive-behavioural-therapy-cbt
- Garrido, S., Baranoff, J., Mendez, D., Sanz, A. and Macdonald, J. (2021) ‘Psychological Treatments for Depression in Adolescents: More Than Three Decades Later’, International Journal of Environmental Research and Public Health, 18(9), Article 4600. Available at: https://www.mdpi.com/1660-4601/18/9/4600
- Yang, L. et al. (2017) ‘Efficacy and Acceptability of Cognitive Behavioral Therapy for Depression in Children: A Systematic Review and Meta-analysis’, Academic Pediatrics, 17(1), pp. 9–16. Available at: https://www.sciencedirect.com/science/article/abs/pii/S1876285916304053
- Wickersham, A., Barack, T., Cross, L. and Downs, J. (2022) ‘Computerized Cognitive Behavioral Therapy for Treatment of Depression and Anxiety in Adolescents: Systematic Review and Meta-analysis’, Journal of Medical Internet Research, 24(4), e29842. Available at: https://www.jmir.org/2022/4/e29842/
- NHS (2023) Depression in children and young people. Available at: https://www.nhs.uk/mental-health/children-and-young-adults/advice-for-parents/children-depressed-signs/
- NHS (2023) Children and young people’s mental health services. Available at: https://www.nhs.uk/mental-health/children-and-young-adults/mental-health-support/mental-health-services/
- NHS (2025) Where to get urgent help for mental health. Available at: https://www.nhs.uk/nhs-services/mental-health-services/where-to-get-urgent-help-for-mental-health/