Children's Literature on Anxiety: A Systematic Review and Content Analysis

Children's literature can teach life lessons and effective coping strategies, and can be a way to disseminate practice elements (i.e., building blocks of evidence-based practices) for mental health as a universal prevention strategy. We conducted a content analysis on the presence of practice elements for youth anxiety in children's literature picture books about anxiety. Analytic plan was preregistered on OSF. Books 1,640 children's literature books were screened, and 191 books were coded for eight practice elements for youth anxiety: psychoeducation, labeling body sensations, relaxation, cognitive, problem solving, contingency management (e.g., rewards and praise), exposure, and post-exposure processing. Characters in the books modeled an average of 2.39 practice elements (SD = 1.76). The most frequently modeled practice elements were cognitive (60% of books), exposure (46%), and labeling body sensations (42%). The least commonly modeled practice element was contingency management (7%). Books written by mental health professionals were more likely to demonstrate post-exposure processing. Books with additional self-help information were more likely to model post-exposure processing and relaxation skills. Books written for youth age 9-12 years modeled more practice elements than books written for youth age 8 years and younger. Children's books on youth anxiety model relatively few practice elements. Although exposure was one of the most used practice elements, 54% of books with an anxious character do not model having that character face their fears-a key strategy for youth anxiety. Additionally, few books demonstrate use of rewards and praise by caregivers, who often read stories with their children. Clinicians, caregivers, and librarians are encouraged to purchase books written by therapists or with self-help information, given that these books are more likely to model practice elements.