Evidence Base Update: Six Decades of Research on Treatment for Child and Adolescent Anxiety

Anxiety disorders are among the most prevalent and impairing youth mental health problems, underscoring the need for effective treatments. This review synthesized 290 trials of psychosocial interventions for youth with anxiety or avoidance problems. Published between 1966 and mid-2024, these trials encompassed 697 study groups across 66 treatment families.

Studies were drawn from the PracticeWise Evidence-Based Services database and evaluated using a five-level strength-of-evidence framework. We identified efficacious treatments, examined contexts of effectiveness, and assessed impact and durability on symptoms and functioning. We also analyzed practice element profiles to compare the procedures most often used in CBT, Exposure, and other approaches.

Of the 66 treatment families, 43 reached Level 4 support or better: 8 at Level 1 (Best), 26 at Level 2 (Good), 5 at Level 3 (Moderate), and 4 at Level 4 (Minimal). The remaining 23 families were at Level 5 (No Support). CBT and Exposure continued to have the strongest support. Notably, 30 (69.8%) effective families did not involve CBT, reflecting a theoretical diversity of approaches. Additional findings highlight persistent gaps related to generalizability, limited assessment of functioning, and practice element distinctions across treatment types.

Disseminating CBT- and Exposure-based treatments is indicated, and continued investigation of a diversity of approaches is needed to support innovation, access, and contextual fit. Beyond cataloging treatments, this review raises critical questions about methodologies best suited to the ongoing stewardship of decades of research and its equitable translation into actionable knowledge to guide treatment design, training, practice, and policy.